• Maxillofacial Plastic and Reconstructive Surgery
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• 제11권1호
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• pp.21-31
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• 1989

This is a series of continuing research on facial bone fractures of Koreans worked by Dept. of Oral and Maxillofacial surgery, Dental College of Yonsei University, Seoul, Korea, since 1972. The study was based on a series of 630 patients with facial bone fractures treated as in-patient at Yonsei Medical Center, Yonsei University, during the period of Jan., 1982 through Dec., 1987. The results obtained are as follows: 1. The ratio of Men to Women was 4.3 : 1, and admissions for facial bone fractures have been increased year after 1984. 2. The age frequency was highest in the third decade(38.3%), and fourth, second, fifth decade in orders. 3. The traffic accident was the most frequent cause of facial bone fractures (51.3%). 4. The most common location of facial bone fractures was the Mandible(35.3%), and Zygoma complex(29.8%), Nasal bone(15.0%), Maxilla(11.0%) were next in order of frequency. 5. In 291 patients of Mandible fractures, 226(77.7%) had fractures only in Mandible and 65(22.3%) had another facial bone fractures. The most frequent fracture site of Mandible was the Symphysis(43.0%) and Angle(22.4%), and Simple fracture was the most frequent in type of fracture(66.9%). Intermaxillary fixatin & Open reduction was major method of treatment(36.9%). 6. In 394 patients of Midface fractures 323)82.0%) had fractures only in Midface and 71(18.0%) had another facial bone fractures. The most frequent site of Midface fractures was zygoma complex & zygomatic arch(42.7%), and Simple fracture was the most common type of fractures. Observation(Maxilla :44.2%, Zygoma :51.0%) and Open Reduction(Maxilla :20.0%. Zygoma :23.5%) were the major method of treatment. 7. The frequency of Nasal bone fracture was about 1/5 of Midface fractures, and Closed Reduction(45.2%) was the major method of treatment. 8. The complication was reported in only 16 patients, and Malunion was the major complication. 9. Head(44.4%), Lower extrimities(14.5%) and Eye(12.3%) were injured commonly with facial bone fractures. 10. The elapsed time from injury to hospital was within 24 hours in 73.8% of patients, however 15.5% of patients arrived the hospital 72 hours after injury.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권6호
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• pp.515-519
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• 2010

Introduction: Bone defects in the jaw are frequently observed after odontogenic cyst enucleation. The success of bone healing appears to be related to the size of the bone defect, the anatomical location, the patient's age and other parameters. The use of bone grafting material is dependent on the operator's preference. No evidence-based definite treatment protocol has been established. This study evaluated the effect of a bone graft into the defect after odontogenic cyst enucleation. Materials and Methods: A total of 55 patients, who had been treated for an odontogenic cyst with cyst enucleation from 2000 to 2009 at the department of Oral and Maxillofacial Surgery, Samsung Medical Center, were included in this study. Patients who were followed-up for more than 1 year were included. Two groups were defined according to the bone graft (with or without a bone graft) after cyst enucleation. The differences in the healing periods and patterns of bone healing were compared clinically and radiologically. The postoperative 1 year radiographs were analyzed for bone healing and density. Statistical analysis was performed using a Pearson chi square test and Wilcoxon rank-sum test. Results: More infection signs were observed in the bone graft group than in the other group, but there was no statistically significant difference. Radiographically, there was also no significant difference in the size of the radiolucent lesions between the two groups. Conclusion: There was no significant difference in healing between the groups with a bone graft and without bone graft after cyst enucleation.

• 대한소아치과학회지
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• 제34권3호
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• pp.398-407
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• 2007

본 연구는 소아 환자의 유동성 복합 레진 수복 시 접착제의 사용 및 중합 여부 그리고 접착제 종류에 따른 수복물 변연의 미세누출과 전단결합강도를 비교함으로써 치료 시간의 단축 가능성을 타진해보고자 시행하였다. 미세누출을 평가하기 위해 우식이 없거나 법랑질에 제한된 우식이 있는 상, 하악 소구치 84개, 전단결합강도 평가를 위해 협설면에 우식이나 결손부가 없는 대구치 70개를 각각 준비하여 사용하였다. 접착 시스템의 종류에 따라 총 7군을 설정하여 I군과 II군은 Single $Bond^{TM}$, III군과 IV군은 AQ Bond $Plus^{TM}$, Ⅴ군과 Ⅵ군은 Prompt L-$Pop^{TM}$ 그리고 접착 시스템을 사용하지 않고 레진을 충전하는 VII군을 대조군으로 설정하였다. 미세누출과 전단결합강도를 측정하여 다음과 같은 결과를 얻었다. 1. 미세누출 평가 결과 Single $Bond^{TM}$를 사용한 I군과 II군이 다른 군에 비하여 낮은 염료 침투를 나타냈다. I군과 II군 사이의 염료 침투 양상은 유사하게 나타났다. 2. 전단결합측정결과 I군과 II군이 다른 군에 비하여 높은 수치를 나타냈으며 통계적 유의차를 보였다(p<0.05). I군과 II군 사이에는 유의차가 없었다(p>0.05). 3. I군과 II군, III군과 IV군, V군과 VI군 사이에는 통계적 유의차가 없었다(p>0.05). 4. VII군은 I, II군과 V, VI군에 비하여 통계적 유의차가 있게 낮은 전단 결합 강도를 보였으며(p<0.05) III, IV군과는 보다 낮은 수치를 보였으나 통계학적 유의차는 없었다(p>0.05).

• Archives of Plastic Surgery
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• 제35권3호
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• pp.261-266
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• 2008

Purpose: The incidence of skin cancer is increasing throughout the world including Asian countries such as Korea. Still there are only limited reports of the clinical features of skin cancer in Korea, especially in the fields of plastic surgery. This study is to demonstrate the recent clinical trends of skin cancer and the treatment of skin cancer in Korea by analyzing a single institution's experience. Methods: During a 11-year period, 370 patients visited our department for the excision of skin cancer. Data of the patients such as histopathologic diagnosis, primary site of the tumor, age and sex of the patient, operative methods were reviewed retrospectively. Results: We had 370 patients, 215 men and 155 women. The ages ranged from 10 to 95 years with a mean of 58.8 years. A total of 143 patients were diagnosed as basal cell carcinoma, while 100 were malignant melanoma, 80 were squamous cell carcinoma, 17 were dermatofibrosarcoma protuberans, and 30 were other miscellaneous skin cancers. Local flaps were the most frequently used reconstructive method after wide excision of the cancer, which was followed by primary closure, split-thickness skin graft, free flap and full-thickness skin graft. Conclusion: There was a gradual increase in the incidence of skin cancer after the year 2000. Basal cell carcinoma had the highest incidence which frequently involved the sun-exposed regions in the old ages. Malignant melanoma showed a relatively high incidence compared with other previous studies in Korea. The extremities were the most frequent location for malignant melanoma. Clinical features of other various skin cancers were also reported in this study. The reconstructive method highly depends on the primary site of the cancer, while local flaps were the mostly used operative technique.

• 대한간호학회지
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• 제23권1호
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• pp.68-89
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• 1993

This study was conducted to develop a model of a fee schedule for nursing services.'Regardless of the demand for skilled and professional nursing service today, the Korean health insurance system does not furnish a chapter for the nursing service fee schedule. A nation-wide survey of hospital nursing service fee schedules was to provide practical and realistic data about how the variety of nursing services are being charged. From September 1990 to April 1991, data from the fee schedule used by twenty hospitals located in eight large cities which are designated large medical regions in the Korea Health Care and Patient Referral System were collected. Nursing services and the fees charged for them were analyzed. The nursing services were subjected to a secondary analysis with referrence to reports on “nursing services to be charged in Korea”. The total number of nursing services recommended by the literatures was 177 : finally 141 types of nursing services were selected by investigator as chargable nursing services. In addition, data on managerial characteristics of the hospitals were collected to discover influential variables for a nursing fee schedule model. Under the assumption that all the managerial characteristics of the hospitals influenced the fee schedule, the following model was tested : Fee of nursing services (C) = f(A₁, A₂, A₃, A₄, A/sub 5/, A/sub 6/, A/sub 7/, A/sub 8/,) When, A₁ = number of nurses A₂ = the first salary of a nurse educated in a four year A₃ = scale of nursing management division A₄ = location of the hospital A/sub 5/ = the type of hospital management (profit / non-profit) A/sub 6/ = number of hospital beds A/sub 7/ = years of hospital operation A/sub 8/ = number and kinds of clinical divisions The results showed that the model should be built as follows : C = f (A₁, A/sub 4/, A/sub 5/) Each nursing service was applied to the fee schedule with consideration for the professional level and time-taken to provide the services. Detailed fee schedules were presented in the related tables. Of the 141 kinds of nursing services, 24.8% were chargeble to the Korea Health Insurance, 32.6％ of the nursing services were being paid directly by the patienty. The rest of nursing services (42.6％) were not being charged to any source. It was recommened that the Korea Health Insurance Reimbursement system should add a classification system for nursing services that can be used in the national health care program. Further study is needed about how to include 32.6% of the nursing services now being paid for directly by the patients in the health insurance system.

• 한국콘텐츠학회논문지
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• 제11권7호
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• pp.234-238
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• 2011

온보드영상장치(OBI)를 사용하고 있는 콘빔CT(CBCT)를 이용하여 인체 팬텀 자세 및 위치와 모의치료시 인체 팬텀 자세 및 위치를 비교하여 CBCT의 3D 타깃 위치의 유용성을 평가하고자 한다. 실제방사선 치료와 동일한 과정으로 모의 치료계획을 하기 위해서 인체 팬텀(The Rando Phantom) 을 set up 한다. 기준점에 놓인 인체팬텀에서 CBCT를 이용하여 평행이동 및 회전이동 하였다. 이때 얻어진 영상들의 위치 차이에 대한 평균 및 편차를 인체 팬텀의 실제 이동 값과 비교하였다. 실험은 10회씩 반복하여 오차의 표준 편차를 구하였다. CBCT로 획득한 영상과 모의치료 시 획득한 CT영상을 비교하는 3D/3D 매칭에서 평균 setup의 residual error의 평균 및 표준편차는 lateral $0.2{\pm}-0.2$ mm, longitudinal $0.4{\pm}0.3$ mm, vertical $-0.4{\pm}0.1$ mm 로 각각 0~4 mm의 범위 이내로 나타났다. 모의실험 된 회전 내용은 $0.4{\pm}0.2$ mm, $0.3{\pm}0.3$ mm, 그리고 $0.3{\pm}0.4$ mm이다. 회전에 의한 error는 $0{\sim}0.6^{\circ}$ 범위이다. 인체 팬텀을 이용한 CBCT 3D/3D 매칭은 모의 치료 시와 환자 치료 시 정확한 정합을 함으로써 error를 최소화 하였다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권5호
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• pp.464-473
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• 2006

Purpose: This study was performed to evaluate relationship between the inferior alveolar nerve injury and the findings of panoramic and tomographic images for preventing inferior alveolar nerve injury after the 3rd molar extraction. Material and Method: From April, 2005 to June, 2005, The 190 patients who visited in the Department of Oral and Maxillofacia Surgery, Chonnam National University Hospital and the panoramic radiographies were taken for extraction of the mandibular third molar, was selected. Among 215 mandibular third molars, Scanora tomographic imagings were taken in the 90 teeth which were overlaped to the mandibular canal in the panoramic imagies. In panoramic radiographies, the angulation, the level, the root morphology, and the superimposition sign of the mandibular third molars with the mandibular canal were evaluated. In the tomographic radiographies, the location and distance of the mandibular third molar from the canal were also evaluated. The relationships between these findings and the inferior alveolar nerve injury were examined. Results: In the panoramic findings, the inferior alveolar nerve injuries were occurred in the darkened roots (5 molars, 7%), the uncontinuous radiopaque image (3 molars, 7%), and the depositioned mandibular canal (2 molars, 10%). In the tomographic findings of 90 molars, 20 molars also had the superimposition imagies. Five molars in those molars (25%) had the inferior alveolar nerve injury after extraction. There were 10 patients who had the inferior alveolar nerve injury. The sensory was began to be recovered in 9 patients, except 1 patient, within 2 weeks, then fully recovered within 3 months. Conclusion: These results indicate that the depth mandibular third molar and the superimposition sign may be related with the risk of the inferior alveolar nerve injury after extraction.

• 대한골관절종양학회지
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• 제1권2호
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• pp.145-153
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• 1995

Giant cell tumor is most frequently found in juxtaarticular region, and difficult to treat because of local recurrence. Although primary resections reduce recurrence, the joint function will be markedly impaired. Techniques involving physical adjuncts(high speed burr and electric cauterization), acrylic cement or en bloc resection with VFG(vascularized fibular graft) have been employed to reduce local recurrence. From October 1984 to April 1994, twenty-nine patients diagnosed as giant cell tumor were treated at department of Orthopaedic Surgery, School of Medicine, Kyung Hee University. There were eleven men and 18 women, ranging in age from 17 to 52 years(mean: 34 years). The average follow-up period was four years and five months. The location of the lesion was around the knee in 15, distal radius in three, femoral head in three, and others in eight patients. Fifteen patients around the knee joint were treated with several modalities; curettage with bone graft in five, curettage with cement filling in three, curettage with bone graft and physical adjuncts in five, en bloc resection with VFG in one and en bloc resection with arthroplasty in one patient. The functional results, according to the Marshall's knee score, were excellent in one, good in two, and fair in two after the curettage with bone graft, good in three after the curettage with bone cement filling, excellent in one, good in four after the curettage with bone graft and physical adjuncts, and good in two after the en bloc resection with VFG or arthroplasty. Three patients had local recurrence among 15 patients with giant cell tumor around knee. Vascularized fibular graft around wrist joint provided good functional restoration without local recurrence in all three patients who had giant cell tumor in distal radius. Although there is no statistical significance, it seems that curettage with bone graft using physical adjuncts or acrylic cement reveals better results than simple curettage with bone graft. Excellent functional result were obtained without local recurrence by using vascularized fibular graft after en bloc resection.

• Journal of Korean Neurosurgical Society
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• 제61권3호
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• pp.363-375
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• 2018

Intraoperative monitoring (IOM) utilizes electrophysiological techniques as a surrogate test and evaluation of nervous function while a patient is under general anesthesia. They are increasingly used for procedures, both surgical and endovascular, to avoid injury during an operation, examine neurological tissue to guide the surgery, or to test electrophysiological function to allow for more complete resection or corrections. The application of IOM during pediatric brain tumor resections encompasses a unique set of technical issues. First, obtaining stable and reliable responses in children of different ages requires detailed understanding of normal age-adjusted brain-spine development. Neurophysiology, anatomy, and anthropometry of children are different from those of adults. Second, monitoring of the brain may include risk to eloquent functions and cranial nerve functions that are difficult with the usual neurophysiological techniques. Third, interpretation of signal change requires unique sets of normative values specific for children of that age. Fourth, tumor resection involves multiple considerations including defining tumor type, size, location, pathophysiology that might require maximal removal of lesion or minimal intervention. IOM techniques can be divided into monitoring and mapping. Mapping involves identification of specific neural structures to avoid or minimize injury. Monitoring is continuous acquisition of neural signals to determine the integrity of the full longitudinal path of the neural system of interest. Motor evoked potentials and somatosensory evoked potentials are representative methodologies for monitoring. Free-running electromyography is also used to monitor irritation or damage to the motor nerves in the lower motor neuron level : cranial nerves, roots, and peripheral nerves. For the surgery of infratentorial tumors, in addition to free-running electromyography of the bulbar muscles, brainstem auditory evoked potentials or corticobulbar motor evoked potentials could be combined to prevent injury of the cranial nerves or nucleus. IOM for cerebral tumors can adopt direct cortical stimulation or direct subcortical stimulation to map the corticospinal pathways in the vicinity of lesion. IOM is a diagnostic as well as interventional tool for neurosurgery. To prove clinical evidence of it is not simple. Randomized controlled prospective studies may not be possible due to ethical reasons. However, prospective longitudinal studies confirming prognostic value of IOM are available. Furthermore, oncological outcome has also been shown to be superior in some brain tumors, with IOM. New methodologies of IOM are being developed and clinically applied. This review establishes a composite view of techniques used today, noting differences between adult and pediatric monitoring.

• 대한정형외과스포츠의학회지
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• 제9권1호
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• pp.58-64
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• 2010

목적: 최근 교통 수단 및 레저 수단으로써 자전거 이용이 증가함에 따라 자전거 관련 수상 환자도 증가하는 추세이다. 본 저자들은 자전거 사고로 인해 입원 치료를 시행한 환자들의 사고 유형에 대해 분석하였다. 대상 및 방법: 본 연구는 2008년 01월 01일부터 2009년 05월 31일까지 자전거 주행중 사고로 인해 본원에 입원한 75명의 환자 중 추시 가능하였던 71명을 대상으로 하였다. 남자 54명 및 여자 17명이었고 평균 나이는 36.7세였다. 수상 정도, 수상 부위, 수상 기전, 수상 장소, 자전거 종류, 자전거 이용 목적, 동반 탑승 혹은 화물 적재 여부, 계절 그리고 보호구 착용 여부 등을 Injury Severity Score( ISS)를 이용하여 분석하였다. 결과: Injury Severity Score 는 1점이 11례, 4점이 41례, 5점이 2례, 9점이 13례, 13점이 1례,16점이 2례 및 29점이 1례였다. 상지 및 하지의 골절 46례중 수술적 치료를 필요로 하였던 환자는 36례였고, 이는 전체 환자의 50.7 %였으며, 척추체 골절, 안면부 손상 및 복부장기 손상으로 인해 수술적 치료를 시행한 환자는 각각 2례,8례 및 1례였다. 두부 손상은 전체 10례였는데, 이중 중환자실 치료를 필요로 할 정도로 심각한 손상은 3례로 전체 환자의 4.2%였다. 결론: 자전거 사고를 방지하기 위해서는 자전거 전용 도로 확충, 안전 교육 및 헬멧을 포함한 상지 및 하지 보호대 착용 등의 사고 예방 노력이 필요할 것으로 사료된다.