• 제목/요약/키워드: proximal

검색결과 2,599건 처리시간 0.031초

위암환자에서 위절제술 시 근위부 절제연거리의 임상적 중요성 (Clinical Importance of the Resection Margin Distance in Gastric Cancer Patients)

  • 하태경;권성준
    • Journal of Gastric Cancer
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    • 제6권4호
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    • pp.277-283
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    • 2006
  • 목적: 위암환자에서 위절제술 시행 시 절제연거리가 종양의 특성에 따라 재발률, 재발양상 및 예후에 어떠한 영향을 미치는지 명확히 알려져 있지 않다. 연구자들은 이런 관점에서 분석하여 보다 적극적인 치료가 필요한 대상환자를 선별하여 맞춤치료의 기준을 찾고자 한다. 대상 및 방법: 본원에서 1992년 6월부터 2005년 12월까지 위암으로 위절제술을 시행 받은 환자 중 절제연 암침윤 음성이었던 4,472명을 대상으로 후향적 연구를 시행하였다. 추적기간 중앙값은 37개월($1{\sim}162$개월)이었다. 결과: 조기위암 환자군에서 절제연거리가 2 cm 미만인 군과 이상인 군 사이에 재발률, 재발양상 및 5년 생존율에 차이가 없었다. 진행위암 환자는 절제연거리 3 cm를 기준으로 분류하였을 때 그 이상인 경우와 미만인 환자군의 생존율에 의미있는 차이가 있었다(P=0.02). 진행위암 환자 중 미만형, 위하부 1/3 위암, Borrmann 3, 4형은 절제연거리가 3 cm 이상인 군이 미만인 군에 비해 생존율의 의미 있는 차이를 보였다(P<0.05). 생존율에 영향을 미치는 인자는 다변량 생존분석 결과 연령, 병기, 수술방법, Borrmann형, 근치도가 독립적인 인자였다. 결론: 위암환자에서 위절제술 시행 시 종양의 변연부와 근위부 위절제연까지의 거리는 조기위암의 경우 재발률 및 생존율에 영향을 미치는 의미 있는 인자로 생각되지 않으며, 진행위암은 미만형, 하부 1/3, Borrmann 3, 4형의 경우에는 절제연을 3 cm 이상 확보하는 것이 환자의 생존율 향상에 중요할 것으로 판단된다.

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A Report on "Debates on the Strategy for Treating Gastric Cancer" at the Congress of the KoreanGastric Cancer Association

  • Kim, Sung-Geun;Park, Cho-Hyun;Kim, Kyung-Mi;Kim, Jae-Gue;Kim, Hyung-Ho;Park, Wong-Sang;Park, Jong-Jae;Lee, Mun-Su;Jung, Hyun-Chul;Jung, Hun-Yong;Han, Sang-Wook;Hyung, Woo-Jin;The Academic Committee of The Korean Gastric Cancer Association, The Academic Committee of The Korean Gastric Cancer Association;Ryu, Sung-Yeop;Kim, Wook;Yook, Jung-Hwan;Jeung, Hei-Cheul;Jung, In-Ho;Park, Do-Joong;Oh, Sang-Hun;Ryu, Keun-Won;Chin, Hyung-Min;Lee, Sang-Ho;Kim, Min-Chan
    • Journal of Gastric Cancer
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    • 제10권3호
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    • pp.141-148
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    • 2010
  • We have always attempted to create a standard treatment protocol for patients with gastric cancer. However, many debates still exist regarding gastric cancer treatment. For the past 2 years, at the Annual Congress of the Korean Gastric Cancer Association, we have presented a grand symposium on the "Debates on the strategy for treating gastric cancer". In 2008, four major topics were discussed and voted on after discussion. The four major topics were proximal location treatment for early gastric cancer, management choices for pyloric obstruction with advanced gastric cancer, management of liver metastasis, and reconstruction methods after a distal gastrectomy. The opinions of the audience for six minor topics were expressed by an electronic voting system. In 2009, the four main topics were treatment for submucosal tumor sized around 2 cm, laparoscopic gastrectomy in T2N1 gastric cancer, choices for managing gastric lymphoma, and application of a pylorus preserving procedure for early gastric cancer at the antrum. The opinions of the audience for these six minor topics were expressed by an electronic voting system, as was conducted in 2008. It was good opportunity to identify a point of contact about the debates on managing gastric cancer. The results of these debates and studies will identify the best methods to treat patients with gastric cancer.

임플란트를 이용한 국소의치 수복 (Implants in conjunction with removable partial denture)

  • 김성균;유수연;박인필;이주희
    • 대한치과의사협회지
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    • 제49권2호
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    • pp.77-84
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    • 2011
  • The benefits of implant supported overdenture are readily apparent for the fully edentulous patients and have been well documented, however, there is deficiency of the studies regarding the combination of implants with removable partial dentures for partially edentulous patients. The purpose of this article is to review the literature concerning implants with removable partial dentures and evaluate the evidence for this clinical approach. Through many clinical case reports and studies we have searched from a broad variety of journals, we present the six considerations needed to contemplate respecting implants with removable partial denture in partially edentulous patients. First, the connection between abutment tooth and removable partial denture has to be rigid and the link between implant and removable partial denture should be hinged. Second, a mesial rest acts better in the point of force distribution for distal extension removable partial denture and splinting between implants is also a favorable choice. Third, T bar has an advantage for implants which are used as abutments in distal extension removable partial denture. Forth, as we all known functional impression is better way to reproduce movement for distal extension removable partial denture. Fifth, indirect retainer and guiding plane on the proximal surfaces of terminal abutment teeth are important in preventing denture base lifting. Sixth, implants in conjunction with removable partial denture is superior in the esthetic and phonetic as well as cost-effective point of view. We also suggest that which place we should install implants for force distribution and which diameter and length of implants should be used. in this review article, we recommend to locate the implant near of the abutment tooth for esthetics or near of first molar position for good stress distribution. The diameter and length of implant also influence to stress distribution. When we compare to conservative partial denture, patients go for removable partial denture using implants due to convenience, better support and retention according to several studies. But it is true that we need to study more on this subject and collect long term follow up cases before we discuss on it. So it is enough to bring this subject into the surface of prosthetic treatment by this article.

어린이 성장판 영상화를 위한 초음파와 X-선 방식의 비교 평가 (Comparison Between Ultrasonic and X-ray Methods for Imaging the Children′s Growth Plate)

  • 김상후;김형준;한은옥;한승무
    • 대한의용생체공학회:의공학회지
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    • 제25권6호
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    • pp.551-556
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    • 2004
  • 본 연구에서는 진단 방법의 정확성이 아직까지 구체적으로 규명되지 않고 있는 어린이의 성장 발육을 체계적이고 과학적으로 측정할 수 있는 방법을 제시하고자 시도하였다. 현재 많이 이용되고 있는 성장 진단 방법은 X-ray 영상을 이용한 각 관절 부위의 성장판의 개폐 분석이다. 그러나 X-ray 방식은 성장 진단에서 요구되는 주기적이고 반복적인 측정을 하지 못함과 동시에 방사선 노출이라는 단점을 가지고 있다. 따라서 인체에 무해한 초음파 영상을 이용한 성장판 개폐 분석 대체 가능성을 평가하기 위해 종골의 초음파 광역 감쇄 영상을 이용한 프로파일 분석 및 성장판 영상 분석 알고리즘을 제시하였다. 본 연구에서는 7세~16세의 어린이 269명에 대해서 X-ray를 이용하여 무릎, 손가락, 종골에서의 성장판 영상을 얻었다. 또한 초음파 방식을 이용하여 종골의 성장판 영상을 얻었다. 각 관절에서의 성장판 개폐 유무 시기는 각 개인별로 측정 방법에 따라 조금의 차이는 있으나 전반적으로 일치하였다. 또한. X-ray방식과 초음파 방식에 의한 성장판 영상을 비교한 결과 상호 높은 연관성을 나타내었다. 이와 같이 성장판을 정확하게 측정하기 위해 도입된 초음파 프로파일 분석 알고리즘은 기존의 X-ray 영상 방식에 의한 성장판의 측정을 대체할 수 있을 것으로 사료된다.

비침습적인 전기자극이 임프란트의 골융합에 미치는 영향;토끼경골에서의 조직계측학적 평가 (Effects of noninvasive electrical stimulation on osseointegration of endosseous implants;A histomorphometric evaluation in the rabbit tibia)

  • 손성배;박진우;서조영
    • Journal of Periodontal and Implant Science
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    • 제35권3호
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    • pp.635-648
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    • 2005
  • The procedure that enhances osteogenesis and shortens the healing period is required for successful implant therapy. It has been introduced that osteogenesis is enhanced by the generation of electric field. Many researchers have demonstrated that application of electric and electromagnetic field promote bone formation. It also has been shown that electrical stimulation enhances peri-implant bone formation. Recently, several investigators have reported that noninvasive electrical stimulation using negatively charged electret such as polytetrafluoroethylene(PTFE) promotes osteogenesis. Therefore, we were interested in the effect of noninvasive electrical stimulation using negatively charged electret on the periimplant bone healing. After titanium implant were installed in the proximal tibial metaphysis of New Zealand white rabbit, negatively charged PTFE membrane fabricated by corana dischage was inserted into the inner hole of the experimental implant and noncharged membrane was applied into control implant. After 4 weeks of healing, histomorphometric analysis was performed to evaluate peri-implant bone response. The histomorphometric evaluations demonstrated experimental implant tended to have higher values in the total bone-to-implant contact ratio(experimental ; $49.9{\pm}13.52%$ vs control ; $37.5{\pm}19.44%$) , the marrow bone contact ratio(experimental ; $34.94{\pm}13.32%$ vs control ; $24.15{\pm}13.69%$), amount of newly formed bone in the endosteal region(experimental ; $1.00{\pm}0.30mm$ vs control ; $0.61{\pm}0.24mm$) and bone area in the medullary canal(experimental ; $13.55{\pm}4.98%$ vs control ; $9.03{\pm}3.05%$). The mean values of the amount of newly formed bone(endosteal region) and bone area(medullary canal) of the experimental implant demonstrated a statistically significant difference as compared to the control implant(p<0.05). In conclusion, noninvasive electrical stimulation using negatively charged electret effectively promoted peri-implant new bone formation in this study. This method is expected to be used as one of the useful electrical stimulation for enhancing bone healing response in the implant therapy

원위 쇄골 불유합의 수술적 치료 (Operative Treatment of Distal Clavicle Fracture Nonunion)

  • 강호정;윤항섭;한수봉;김성재
    • Clinics in Shoulder and Elbow
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    • 제10권2호
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    • pp.220-226
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    • 2007
  • 목적: 원위 쇄골 골절은 근위부나 중간부 쇄골 골절과는 다른 생역학적 구조를 가져서 지연유합과 불유합이 많이 발생한다. 원위 쇄골 불유합 치료에 대한 연구보고는 거의 없는 상태이다. 저자들은 원위 쇄골 골절 불유합에 대한 관혈적 정복 및 골이식의 수술적 치료 후 좋은 결과를 얻었기에 문헌 고찰과 함께 보고하는 바이다. 대상 및 방법: 2003년 8월부터 2006년 5월까지 원위 쇄골 불유합으로 수술 치료받은 8예를 대상으로 하였으며, 평균 연령은 38.9($21{\sim}62$세)세였고, 지배 수지 6예였다. 수상 초기 수술적 치료 후 발생한 불유합이 4예, 보존적 치료 후 발생한 불유합이 4예였고, 불유합 기간은 수상 후 평균 1년 5개월이었다. 전 예에서 자가장골 이식술 및 내고정술을 시행하였고, 내고정물은 금속판이 7예, 긴장대 강선 고정술이 1예였다. 결과: 평균 추시 기간은 14개월이었고, 방사선학적 골유합은 전 예에서 평균 8주에 관찰할 수 있었다. 최종 추시상 견관절의 운동범위는 모두 정상 소견이었고, Kona 등의 평가표에 의한 기능적 평가에서 7예에서 우수한 결과를, 1예에서 양호한 결과를 얻었다. 결론: 원위 쇄골 골절 불유합에 대한 수술적 치료는 조기 재활이 가능하고 견고한 골유합을 얻을 수 있어 추천할 만한 치료 방법으로 사료된다.

The Effects of Melatonin on Cisplatin-Induced Renal Cortical Cell Injury in Rabbits

  • Kim, Chung-Hui;Han, Jin;Kim, Na-Ri;Park, Ju-Hee;Yang, Young-Churl;Kim, Eui-Yong
    • The Korean Journal of Physiology and Pharmacology
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    • 제5권3호
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    • pp.223-230
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    • 2001
  • Melatonin, a pineal gland hormone, is believed to act as an antioxidant via the stimulation of radical detoxifying enzymes and scavenging of free radicals. In this study, effects of in vitro and in vivo treatments of melatonin on the cisplatin-induced lipid peroxidation, LDH release and plasma creatinine were determined in rabbit renal cortical cells. The level of malondialdehyde (MDA) was assayed as an index of lipid peroxidation and the level of LDH release as an indicator of cellular damage. In in vitro studies, cisplatin increased the levels of MDA and LDH release in a concentration-and time-dependent manner. Melatonin inhibited the cisplatin-induced lipid peroxidation and LDH release in a concentration-dependent manner. The minimal effective concentration of melatonin that significantly reduced the $300\;{\mu}M$ cisplatin-induced lipid peroxidation and LDH release was 1 mM. In in vivo studies, the levels of lipid peroxidation and LDH release in renal cortical cells increased significantly 24 or 48 hours after a single injection of cisplatin (6 mg/kg). When the cisplatin-injected rabbits were pretreated with 10 mg/kg of melatonin, a significant reduction in both lipid peroxidation and LDH release was observed. The plasma creatinine level increased from $0.87{\pm}0.07$ mg/dl in control to $6.33{\pm}0.54$ mg/dl in cisplatin-injected rabbits (P<0.05). Melatonin partially prevented the increase in serum creatinine level $(1.98{\pm}0.11\;mg/dl)$ by cisplatin (P<0.05). In the proximal tubules from cisplatin-treated group, tubular cells had microvilli of variable heights. Necrotic debris was seen in tubular lumens. In most of cells, the mitochondria and lysosomes were increased in frequency. The endocytic vacuoles were not prominent and distribution of the brush border was irregular and shortened. These cisplatin-induced morphological changes were moderate in the melatonin-pretreated group. These results suggest that the toxicity of cisplatin is associated with the generation of reactive oxygen free radicals and that melatonin is a powerful antioxidant, which prevents some of the adverse effects of cisplatin.

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인간 골 간섭 나사못의 초기 고정력 (Initial Fixation Power of Human Bone Interference Screw)

  • 김정만;정양국;김양수;오인수;고인준
    • 대한정형외과스포츠의학회지
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    • 제1권1호
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    • pp.26-30
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    • 2002
  • 목적: 동종골-슬개건-골을이용한전방십자인대재건술시인간골간섭나사못의초기및조기고정력을알아보려고하였다. 대상및방법 : 동종골-슬개건-골을이용한전방십자인대재건술을28 슬관절에대해수술후6주, 12주, 6개월, 1년에추적조사하였다. Lachman test, flexion rotation drawer test, jerk test등의이학적검사를시행하였고KT-1000 측정을동시에시행하여경골의전방전위정도를측정하였다. Lachman test는 0$\~$2mm 전방전위까지를정상으로하였고KT-1000 측정은정상측과비교하여 2mm 이내는정상으로하였다. 마지막검사시M RI를시행하였다. 결과: 단일예를제외하고는모두이학적검사와KT-1000 측정상정상범위에속하였다. 실패한일례는수술소견상이식물이경골터널에서의근위전위되었으며이는넓어진터널을감안하지않고단하나의간섭나사못을사용한기술적실수로평가되었다. 결론: 인간골골피간섭나사못은전방십자인대의재건술을시행하는데충분한초기및조기고정력을보여주었다.

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한국 여성에서 좌골 신경 분지 위치에 대한 초음파 영상 (Ultrasound Imaging for Position of the Sciatic Nerve Division in Korean Female)

  • 남일현;여의동;유지수;이준호;이영구
    • 대한정형외과 초음파학회지
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    • 제7권1호
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    • pp.28-32
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    • 2014
  • 목적: 슬관절 이하 부위의 정형외과적 수술을 위해 좌골 신경 차단 술기가 흔히 시행되고 있다. 좌골 신경 분지는 해부학적 차이가 있어 통상적인 신경 차단은 불완전한 신경 차단을 유발한다. 본 연구는 마취의 성공율을 개선하기 위하여 한국 여성에서 좌골 신경 분지 위치를 초음파를 이용해 확인하였다. 대상 및 방법: 한국 여성 33명을 대상으로 하였으며 체중, 키를 측정하였다. 초음파 측정을 위해 M-Turbo ultrasound system (SonoSite,Bothell, WA,USA) 13-6 MHz, 38 mm high frequency linear array transducer를 사용하였다. 복와위 자세에서 슬와 주름부터 분지부까지의 거리, 분지부에서 피부부터 신경까지의 깊이를 cm 단위로 측정하여 체중과 키와의 상관관계를 확인하였다. 측정은 한 명의 전문의에 의해 측정되었다. 통계는 SAS version 9.3를 사용하여 multiple linear regression 방법으로 분석하였다. 결과: 33명 여성의 평균 나이는 53세(34~71세), 평균 체중 59.7(50~77.1 kg), 평균 키 157.4(145~173.9 cm), 평균 BMI 24.1(18.4-28.9)였다. 슬와 주름에서 좌골 신경 분지부까지의 평균 거리는 5.7(4.5~7.5 cm)이였으며, 분지부에서 피부부터 신경까지의 평균 깊이는 2.4(1.8~3.2 cm)였으며, 통계적 분석 결과에서 거리와 키 조사 p-value 0.55, 거리와 몸무게 조사 p-value 0.34, 깊이와 키 조사 p-value 0.5, 깊이와 몸무게 조사 p-value 0.036 이였다. 결론: 한국 여성의 좌골 신경 분지 위치는 차이가 있었으며, 특히 몸무게에 따른 깊이 변화는 의미가 있었다. 한국 여성에서 좌골 신경 차단 술기를 시행할 때 평균 거리, 깊이를 생각하고 몸무게를 고려한다면 성공율이 증가할 것으로 생각되며, 슬와 주름 7.5 cm 상방에서 시행할 것을 추천하다.

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Eugenol, Capsaicin과 Demethoxy - NE가 치수동통 반응에 미치는 영향 (EFFECTS OF EUGENOL, CAPSAICIN AND DEMETHOXY-NE ON THE PAIN RESPONSE OF DENTAL PULP)

  • 이은구;이정식
    • Restorative Dentistry and Endodontics
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    • 제17권1호
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    • pp.10-21
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    • 1992
  • The purpose of this study was to investigate the analgesic effect of eugenol, capsaicin and demethoxy-NE. Young adult cats, weighing 2.0 to 3.0kg, were used. Each animal was anesthetized (${\alpha}$-chloralose 60mg per kg body weight) and divided into four groups; control, eugenol, capsaicin and demethoxy-NE group. The anterior digastric muscles were exposed and a pair of electrodes was inserted to record the electromyograms. To expose the pulp, each canine teeth was prepared with a low speed bur under cooling and used for recording anterior digastric muscular EMGs evoked by noxious stimulation of dental pulp. To observe effects on jaw opening reflex, inferior alveolar nerve of both sides were exposed for drug application and wire electrodes were inserted in anterior digstric muscle for recording the EMGs. To observe effects on action potential, saphenous nerves of both sides were exposed and three tissue pools were made from surrounding tissue. The most distal pool was used for applying stimulation, the most proximal one for recording of action potential, and the other one for drug application. One side of inferior alveolar nerve and saphenous nerve were used for eugenol, capsaicin, or demethoxy-NE application, the other side of nerve for control experiments(only vehicle application). Anterior digastric muscular EMGs evoked by noxious stimulation of dental pulp were recorded before drug application, immediate after drug application, at 60 and 120 minutes, and 5 days after drug application. Action potentials were recorded before drug application, immediate after 30 minutes drug application, at 30, 60 and 120 minutes after drug had been washed out. The results were as follows; 1. Eugenol had a continuous blocking effect on the anterior digastric muscular EMGs evoked by noxious pulp stimulation and after 5 days, showed completely blocking effect. 2. After 5 days, demethoxy-NE applied to dental pulp had a considerable blocking effect on the jaw opening retlex evoked by noxious stimulation but capsaicin had no significant effect. 3. After 5 days, eugenol group showed the strongest blocking effect among the all experimental groups on the jaw opening reflex evoked by noxious stimulation of dental pulp and capsaicin group showed the weakest blocking effect. 4. Eugenol had a completely blocking effect on the action potential conductivity of peripheral nerve. Capsaicin and demethoxy-NE had the blocking effect on the action potential conductivity of ${\alpha}$-and C-nerve fibers. 5. Capsaicin, demethoxy-NE and eugenol applied to inferior alveolar nerve surppressed the jaw opening reflex evoked by noxious stimulation of dental pulp.

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