• 대한방사선치료학회지
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• 제26권2호
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• pp.329-336
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• 2014

목 적 : 인공 유방 확대술을 받은 환자가 유방암 방사선치료를 받을 경우 유방의 크기별로 치료 조사야와의 거리에 따른 치료반대 측 유방조직에 피폭되는 선량 및 차폐의 효율성을 평가해 보고자 한다. 대상 및 방법 : 인체팬텀(Rando-phantom)을 이용하여 유방 모형의 크기별 (200 cc ~ 500 cc) CT영상을 획득한 후 크기 별로 일 선량 180 cGy의 왼쪽 유방암 방사선 치료계획을 세웠다. 유방 모형이 커질수록 치료 반대 측 유방모형의 표면과 X선의 진행지점 사이에 발생하는 거리가 가까워지게 설정하였고, 체표에 입사하는 선속중심축을 기준으로 3 cm, 6 cm 떨어진 점에서 반대측 유방 표면에 수직으로 내린 거리를 각 A point, B point로 설정하였다. 그리고 유두지점에서 외측으로 2 cm 되는 점을 C point, 체표중앙에서 외측으로 6 cm 되는 점을 D point로 설정하였다. 유방 모형의 크기별로 각 측정지점에 MOSFET을 부착하여 6 MV, 10 MV, 15 MV의 X선 에너지로 조사하여 측정하였다. 이와 동일한 조건으로 납 2 mm의 두께로 차폐한 후의 선량 값과 납 2 mm 아래에 bolus 3 mm를 부착하여 차폐한 후의 선량 값을 얻었다. 결 과 : 유방 모형이 200 cc에서 500 cc로 커짐에 따라 유방 모형의 표면과 X선의 진행지점과의 거리가 A point에서는 2.14 cm에서 최대 1.23 cm으로 근접하였고 B point에서는 2.55 cm에서 1.31 cm으로 근접하였다. 유방 모형의 크기에 따라 180 cGy 기준으로 200 cc 대비 500 cc의 산란선 측정값이 A point에서 3.22 ~ 4.17%, B point에서 4.06 ~ 6.22%, C point는 0.4~0.5% 증가하였고, D point에서는 크기별로 측정값의 차이가 0.4% 미만이었다. X선 에너지가 커짐에 따라 6 MV 대비 15 MV X선에서 180cGy 기준으로 산란선이 A point에서는 4.06~5%, B point에서는 2.85~4.94%, C point에서는 0.74~1.65% 증가하였고, D point에서는 측정값 차이가 0.4% 미만이었다. 차폐체로 납 2 mm를 사용하였을 경우 A와 B point에서 평균 9.74%, C point에서 2.8%, D point에서 1% 미만의 산란선 감소효과가 있었고, 납과 bolus를 함께 차폐하였을 경우 A와 B point에서 평균 9.76%, C point에서 2.2%, D point에서 1% 미만의 산란선 감소효과가 있었다. 결 론 : 일반적으로 인공 유방 확대술을 받은 환자의 경우 유방의 크기에 따라 치료 반대편 유방 표면과 치료조사야의 거리가 가까울수록 유방 표면이 받는 산란선이 증가하였다. 동일한 크기의 유방 모형에서는 사용 X선 에너지가 커질수록 산란선에 의한 피폭이 증가하는 경향을 보였고, 이는 사용 X선의 에너지 선택에 있어 유방암의 방사선 치료계획에서 허용되는 한도에서는 낮은 X선 에너지의 사용이 반대측 유방의 선량 감소에 유리할 것으로 여겨진다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제34권3호
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• pp.341-349
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• 2008

Purpose: The purpose of this study was to evaluate the $Osstem^{(R)}$ implants (US II/SS II implants) through the retrospective study for the clinical success rate during the installation of the $Osstem^{(R)}$ implants (US II/SS II implants) by using of the procedures of maxillary sinus floor elevation. Materials and methods: The current study was researched in the 6 medical institutions: Chonnam National University, Chosun University, Pusan DaeDong Hospital, Bundang Seoul National University Hospital, Ap-Seon Clinic, and All Clinic. Based on the total number of 116 patients whose treatment was the installation of the US II/SS II implants with the procedures of the maxillary sinus floor elevation, they were conferred on the dental records of the patients under the joint consultation of the 6 medical institutions. On the dental recording charts, there were included in as the following; the name of the institutions, gender, age, with or without smoking or drinking, with or without the generalized diseases, the height of the alveolar bone on the operational sites, elapsed edentulous state period, the state of the opposed or adjacent teeth, the methods of the maxillary sinus floor elevation, secondary time period for surgery, the lengths, types, and diameters of implants, with or without bone transplantation or the types of bone, postoperative current bone height, current adjacent soft tissue state of the implants, with or without the success of the installations of the implants. We have done our survey with the clinical and radiolographical examinations and dental questionaries. The success and survival rate of the implants was evaluated. Results 1. Total number of the patients with the installation of the US II implants were 62. The 252 numbers of US II implants were installed on the 89 maxillary sinuses. The patient's mean age was 54.1 years old and there were 36 men and 27 women. 2. Total number of patients with the installation of SS II implant were 57. The 165 numbers of SS II implants were planted on the 80 maxillary sinuses. Their mean age was 48.7 years old and there were 37 men and 20 women. 3. The follow-up period was 30.7 months(21-49 mon) on average. The vertical bone loss of installed implants after the procedures of the maxillary sinus elevation was 1.1 mm on average in SS II and 1.3 mm on average in US II. There existed no statistical significance on each group. The mean enlarged bone height after the maxillary sinus floor elevation was 8.2 mm. 4. For the procedures of the maxillary sinus elevation, the Lateral approach technique occupied 87.1%, which was the most used one. In addition, the most frequently used transplanted bone was autogenous bone only which was 72.7% during the maxillary sinus floor elevation. 5. The complication of maxillary sinus floor elevation were perforation of sinus membrane, disesthesia on doner site, exposure of cover screw and exposure of maxillar bone. 6. The survival rate of US II and SS II after maxillary sinus floor elevation was 99.2% and 95.8%, respectively. And the success rate of US II and SS II after maxillary sinus floor elevation was 97.6% and 89.7%, respectively. Conclusion : On the evaluation of the analysis of our study, both US II and SS II implants showed the excellent clinical results by use of the procedures of maxillary sinus floor elevation.

• 대한정형외과학회지
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• 제54권5호
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• pp.427-434
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• 2019

목적: 본 연구의 목적은 단일 술자가 시행한 슬관절 부분 치환술의 장기 임상적, 방사선적 결과 및 생존율을 분석하는 것이다. 또한 치환물의 생존에 영향을 미치는 인자를 분석하고 그에 따른 생존 곡선을 비교하는 것이다. 대상 및 방법: 1982년 12월부터 1996년 1월까지 시행된 슬관절 부분 치환술 99예를 대상으로 하였다. Modular II 10예, Microloc 44예, Allegretto 45예였다. 평균 추시기간은 16.5년이었다. 임상적 평가로 술 전, 술 후 1년, 최종 추시 hospital for special surgery(HSS) 점수와 관절운동범위를 조사하였다. 방사선적 평가로 술 전, 술 후 2주, 최종 추시 대퇴 경골각을 조사하였다. Kaplan-Meier 생존 분석을 이용하여 생존율을 분석하였다. Cox 비례위험모형을 이용하여 나이, 성별, 체질량 지수, 술 전 진단, 치환물의 종류 중 생존에 영향을 미치는 요인을 조사하였다. 생존에 영향을 미치는 인자에 따라 군을 나누어 생존 곡선을 비교하였다. 결과: 전체 HSS 점수는 평균 술 전 57.7점, 술 후 1년 92.7점, 최종 추시 79.1점이었다(p<0.001). 관절운동범위는 평균 술 전 134.3도, 술 후 1년 138.4도, 최종 추시 129.3도였다(p<0.001). 전체 대퇴 경골각은 평균 술 전 내반 0.8도, 술 후 2주 외반 4.1도, 최종 추시 외반 3.0도였다(p=0.003). 전체 생존율은 5년 91.8%, 10년 82.9%, 15년 71.0%, 20년 67.0%였다. 부분 치환술의 생존에 영향을 미치는 요인은 환자의 나이와 치환물의 종류였다. 나이가 높을수록 실패 위험이 낮았으며(hazard ratio=0.933), Microloc 사용 시 Modular II와 Allegretto에 비해 위험률이 높았다(hazard ratio=0.202, 0.430, respectively) 60세 미만군의 생존 곡선이 60세 이상 군에 비해 의미 있게 낮았다(p=0.003). Microloc 사용군의 생존 곡선이 Modular II와 Allegretto 사용군에 비해 낮았다(p=0.025). 결론: 고정형 치환물을 사용한 슬관절 부분 치환술의 장기 임상적, 방사선적 결과 및 생존율은 만족스러웠다. 부분 치환물의 장기 생존을 위해 적절한 환자와 치환물의 선택이 중요할 것이다.

• 구강회복응용과학지
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• 제39권4호
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• pp.204-213
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• 2023

구강 악안면 영역에서 외상으로 인해 발생한 골절에 대한 치료로 관혈적 혹은 비관혈적인 골절의 정복을 시행할 수 있다. 그러나, 최적의 정복이 이루어지지 않았거나 부정 유합이 발생할 경우, 하악골과 중안모 간의 구조적 관계가 상실되어 부정교합이 일어날 수 있다. 이러한 부정교합은 외상 후 부정교합이라 정의되며 안정적인 턱관절 위치의 확보 후 악교정 수술, 교정치료, 교합 재형성 및 보철적 재건 등이 외상 후 부정교합의 치료방법으로 제시되고 있다. 안정적인 턱관절은 교합 회복 전 부정교합의 재발 및 교합 변화를 방지하기 위해 필수적이며, 중심위 및 적응된 중심위는 가장 안정적인 턱관절의 위치로 교합 회복의 시작점이다. 본 증례는 다발성 안면 골절의 정복 후, 외상 후 부정교합이 발생하여 전악 교합의 회복을 위해 중심위에서 선택적 교합 조정 및 임플란트 지지 고정성 보철물로 보철적 재건을 시행한 증례로 교합 기능적으로 양호한 결과를 얻었기에 이를 보고하고자 한다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제22권4호
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• pp.430-435
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• 2000

Cleft lip and palate is one of the congenital anomalies which need comprehensive and multidisciplinary treatment plan because 1) oral cavity is an important organ with masticatory function as a start of digestive tract, 2) anatomic symmetry and balance is esthetically important in midfacial area, and 3) it is also important to prevent psycho-social problems by adequate restoration of normal facial appearance. There are many different protocols in the treatment of cleft lip and palate, but our department has adopted and modified the $Z{\"{u}}rich$ protocol, as published in the Journal of Korean Cleft Lip and Palate Association in 1998. The first challenge is feeding. Type of feeding aid ranges from simple obturators to active orthopedic appliances. In our department we use passive-type plate made up of soft and hard acrylic resin which permits normal maxillary growth. We use Millard's method to restore normal appearance and function of unilateral complete cleft lip. In consideration of both maxillary growth and phonetic problems, we first close soft palate at 18 months of age and delay the hard palate palatoplasty until 4 to 5 years of age. When soft palate is closed, posterior third of the hard palate is intentionally not denuded to allow normal maxillary growth. In hard palate palatoplasty the mucoperiosteum of affected site is not mobilized to permit residual growth of the maxilla. We have treated a patient with unilateral complete cleft lip and palate by Ajou protocol, which is a kind of modified $Z{\"{u}}rich$ protocol. It is as follows: Infantile orthopedics with passive-type plate such as Hotz plate, cheiloplasty with Millard's rotation-advancement flap, and two stage palatoplasty. It is followed by orthodontic treatment and secondary osteoplasty to augment cleft alveolus, orthognathic surgery, and finally rehabilitation with conventional prosthodontic treatment or implant installation. The result was good up to now, but we are later to investigate the final result with longitudinal follow-up study according to master plan by Ajou protocol.

• Journal of Trauma and Injury
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• 제29권4호
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• pp.129-138
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• 2016

Purpose: Due to recent advances in internal fixation techniques, instrumentation and orthopedic implants there is an increasing number of humeral shaft fracture treated operatively. As a consequence, an increased number nonunion after operative fixation are being referred to our center. The aim of this study is to report the common error during osteosynthesis that may have led to nonunion and present a systematic analytical approach for the management of aseptic humeral shaft nonunion. Methods: In between January 2007 to December 2013, 20 patients with humeral shaft nonunion after operative procedure were treated according to our treatment algorithm. We could analysis x-rays of 12 patients from initial treatment to nonunion. In a subgroup of 12 patients the initial operative procedure were analyzed to determine the error that may have caused nonunion. The following questions were used to examine the cases: 1) Was the fracture biology preserved during the procedure? 2) Does the implant construct have enough stability to allow fracture healing? Results: In 19 out of 20 patients have showed radiographic evidence of union on follow up. One patient has to undergo reoperation because of the technical error with bone graft placement but eventually healed. There were 2 cases wherein the treatment algorithm was not followed. All patients had problems with mechanical stability, and in 13 patients had biologic problems. In the analysis of the initial operative fixation, only one of 12 patients had biologic problems. Conclusion: In our analysis, the common preventable error made during operative fixation of humeral shaft fracture is failure to provide adequate stability for bony union to occur. And with these cases we have demonstrated a systematic analytic management approach that may be used to prevent surgeons from reproducing the same fault and reduce the need for bone grafting.

• Journal of Periodontal and Implant Science
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• 제48권4호
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• pp.213-223
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• 2018

Purpose: Oral lichen planus (OLP) is a chronic oral mucosal disease that has been recognized as an immune condition. The purpose of this study was to evaluate factors affecting the clinical outcomes of topical corticosteroid application on OLP lesions using dexamethasone gargle and ointment. Methods: The charts of patients who were clinically diagnosed with OLP and treated with dexamethasone from July 2003 to August 2017 at the Section of Dentistry of Seoul National University Bundang Hospital were thoroughly evaluated to identify subjects who were suitable for this retrospective study. For each patient, age at the index date, gender, medical history, and dental records related to OLP lesions and dexamethasone treatment were reviewed. Results: In total, 113 of the 225 patients were included in the present study. Among them, 79 patients were female (69.9%) and 34 were male (30.1%), with a mean age of 57.6 years. The average duration of dexamethasone treatment was 4.7 months and the mean follow-up period was 2.24 years. Improvements were observed within 1 year after dexamethasone treatment in most cases, and 17.7% of patients had a new OLP lesion after treatment. New OLP lesions were more frequently gingival than mucosal, although mucosal OLP lesions were more common than gingival OLP lesions in all age groups. In age- and gender-adjusted multivariate logistic regression, a history of malignant disease was found to be a significant factor affecting the formation of new lesions. Gingival OLP lesions and intermittent use of dexamethasone showed near-significant associations. In Kaplan-Meier failure analysis, history of malignancy, menopausal status, age, and the site of the OLP lesion were significant factors affecting clinical outcomes. Conclusions: The treatment outcomes of OLP were significantly influenced by age, history of malignancy, menopausal status, and the site of the OLP lesion, but not by factors related to dexamethasone treatment.

• Journal of Periodontal and Implant Science
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• 제39권3호
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• pp.303-310
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• 2009

Purpose: The aerosol generated by ultrasonic scaler can contain bacteria or virus which can penetrate into body through respiratory systems of dentists, dental hygienist or patients. The aim of this study is to evaluate the effect of chlorhexidine digluconate as preoperative mouthrinse or lavage for ultrasonic scaler on the reduction of viable organisms in aerosol produced during periodontal treatment using ultrasonic scaler. Methods: 30 patients with moderate chronic periodontitis were included and divided into 3 groups: Control (no preoperative mouthrinse and tap water as lavage), CHG (preoperative mouthrinse with 0.1% chlorhexidine digluconate and tap water as lavage), CHL (no preoperative mouthrinse and 0.1% chlorhexidine digluconate as lavage). Each patient received scaling or subgingival curettage for 30 min. In CHG group, mouthrinse with chlorhexidine digluconate was performed for 1 min. before treatment. Before, during and after scaling or subgingival curettage, air sampling was performed for 7 min. each (1000 L/7 min.) with trypticase-soy agar plate. Agar plates were incubated in $37^{\circ}C$ aerobically. The numbers of colony-forming units (CFU) were counted and compared. Results: The numbers of CFUs of the samples obtained during treatment were $97{\pm}14.0$ in control, $73.1{\pm}14.9$ in CHG group and $44.5{\pm}9.0$ in CHL group. The difference among the 3 groups was determined to be statistically significant (one-way ANOVA with Bonferroni's correction, p-value: 0.0003). In contrast, the numbers of CFU of samples obtained before and after treatment were not significantly different among the groups. Conclusions: Chlorhexidine digluconate used as preoperative mouthrinse or lavage for ultrasonic scaler can reduce the microorganisms in aerosol produced during periodontal treatment using ultrasonic scaler. Less number of microorganisms were detected when chlorhexidine was used as lavage for ultrasonic scaler.

• Journal of Periodontal and Implant Science
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• 제29권2호
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• pp.371-387
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• 1999

The present study was performed to assess and compare the clinical and microbiological effects following local application of 2% minocycline gel or 0.1% chlorhexidine subgingival irrigation to augment scaling and root planing in patients with moderate to advanced chronic adult periodontitis. 32 healthy patients with moderate to advanced chronic adult periodontitis were enrolled in the study. In each patient, the quadrants that had 2 or more teeth with $5{\sim}8mm$ probing pocket depth and radiographic evidence of alveolar bone loss were selected and divided into test side and control side according to the split-mouth design. All patients received standardized oral hygiene instructions at the beginning of the study and all remaining teeth received scaling and root planing until 0 week. The 2% minocycline gel was applied to periodontal pocket at 0, 1, 2, 3 week in the test side. The 0.1% chlorhexidine solution and the normal saline were irrigated subgingivally for about 30 seconds in the positive control side and negative control side respectively. The clinical and microbiological analysis carried out at 0, 4, 8, and 12 weeks . The results of this study were as follows; 1. In saline irrigation group, there was no adjunctive effects in probing pocket depth reduction, sulcular bleeding index and no significant changes in relative proportions of subgingival bacteria. 2. The chlorhexidine irrigation as an adjunct to scaling and root planing results in reduction in the plaque index and sulcular bleeding index, but there was not statistically significant. The relative proportion of spirochetes was significantly reduced, but the proportion of motile rods was no significant reduction. 3. The minocycline gel delivered subgingivally as an adjunct to scaling and root planing provide significant benefit in reducing probing depths and sulcular bleeding index compared to saline and chlorhexidine irrigation groups. 4. The relative proportions of spirochetes and motile rods were significantly reduced and the proportions of cocci and non-motile bacteria were correspondingly increased in the minocycline gel group. In conclusion, minocycline gel delivered subgingivally as an adjunct to scaling and root planing induces clinical and microbial responses more favorable for periodontal health than saline and chlorhexidine subgingival irrigation.

• Journal of Periodontal and Implant Science
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• 제38권4호
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• pp.629-638
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• 2008

Purpose: The purposes of this study were to compare and quantify the expression of Stromelysin-1 and MT-MMP-1 in the gingival tissues of patients with type 2 diabetes mellitus(DM) and healthy adults with chronic periodontitis. Materials and Methods: Gingival tissue samples were obtained during periodontal surgery or tooth extraction. According to the patient's systemic condition & clinical criteria of gingiva, each gingival sample was devided into three groups. Group 1 (n=8) is clinically healthy gingiva without bleeding and no evidence of bone resorption or periodontal pockets, obtained from systemically healthy 8 patients. Group 2 (n=8) is inflammed gingiva from patients with chronic periodontitis. Group 3 (n=8) is inflammed gingiva from patients with chronic periodontitis associated with type 2 DM. Tissue samples were prepared and analyzed by Western blotting. The quantification of Stromelysin-1 and MT-MMP-1 were performed using a densitometer and statistically analyzed by one-way ANOVA followed by Tukey test. Results: In the analysis of expression levels, Stromelysin-1 and MT-MMP-1 expressions were similar in group 1 and 2. Stromelysin-1 and MT-MMP-1 expressions was more increased in group 3 than group 1, 2. The difference between group 3 and group 1, 2 was statistically significant. Also, in the interrelationship of Stromelysin-1 and MT-MMP-1 expressions, expressions of Stromelysin-1 and MT-MMP-1 showed increasing tendency in chronic periodontitis associated with type 2 DM and it seems that the MT-MMP-1 expressions were increasing in proportion to Stromelysin-1 expressions. Conclusion: It is suggested that Stromelysin-1 and MT-MMP-1 may be partly involved in the progression of periodontal inflammation associated with type 2 DM, as related to a metabolism of other factors, such as AGE, plasmin and other inflammatory mediators. Therefore, the expression levels of Stromelysin-1 and MT-MMP-1 can be inflammatory markers of periodontal inflammed tissue with type 2 DM.