매복된 중절치의 재식

최수미,이긍호,최영철,박재홍 大韓小兒齒科學會 2005 大韓小兒齒科學會誌 Vol.32 No.4

매복치는 인접치의 이동 및 치근흡수, 악궁의 공간상실, 치성낭종 형성, 부분맹출에 의한 감염, 전위맹출 등 여러 가지 합병증을 유발할 수 있다. 이를 방지하기 위해 매복치의 발육상태,모양,매복된 위치나 각도에 따라 발치, 외과적 노출 및 교정적 견인, 재위치 및 치아이식 등을 시행할 수 있다. 본 증례는 상악 좌측 중절치의 맹출장애를 주소로 본과에 내원한 환아로, 내원 당시 상악 좌측 중절치는 치조골 내에서 정상적인 맹출 경로를 이탈하여 역위 매복되어 있었다. 역위된 정도를 고려했을 때 외과적 견인 및 노출을 이용한 교정적 처치를 수행하기 보다는 재식시키는 것이 바람직할 것으로 판단하였다. 치아를 발거하여 치근 부위의 치낭이 건점함을 확인하고 정상적인 치조와 내로 재식한 후 resin-wire splint로 1주일간 고정하였다. 치아의 생활력이 건전하고 치근형성이 미약하여 치수에 대한 처치는 하지 않았으며 그 후 일년 동안 주기적인 관찰을 시행하여 치근의 성장이 양호함을 확인하였다. 매복된 영구치의 매복된 위치나 각도가 정사 범주에서 지나치게 벗어나 예후가 불확실하더라도 무조건 발치하기보다는 환자와 보호자의 심리적인 면, 저작기능, 심미성 등을 고려하여 더욱 보존적인 시술을 하는 것이 바람직할 것이다. Delayed eruption of a maxillary incisor results in midline shift, the space occupied by adjacent teeth and different levels of alveolar height. Extraction or surgical/orthodontic therapy is the most common treatment for a impacted maxillary incisor. Surgical repositioning provides another option for treatment of this problem. The advantages of this approach include immediate esthetic improvement, use of a single and simplified surgical procedure, simple and short orthodontic therapy, a normal gingival margin and the possibility of the developing root adapting to the new position. Autotransplantation of an immature tooth provides for possible adaptation of the developing root apex to the new position. A root whith an open apex has good chance of pulp revascularization after transplantation.

노인의 영적 간호요구

최미혜,김경희,김귀옥,김기숙,김수강,김정신,김춘숙,노흥진,박지연,성혜연,오명선,이선희,이원옥,이윤영,이현수,장명재,차혜경,채정선,홍상희 중앙대학교 의과대학 간호학과 간호과학연구소 2001 중앙간호논문집 Vol.5 No.1

This study was designed to exam the aged's needs for spiritual nursing care. The purpose was to serve as a basis for the development of spiritual nursing practice. The major findings are as follows : 1. The degree of needs for spiritual nursing care as area was that needs of love and relationship mean 22.0, needs of meaning and object mean 28.2, needs of forgiving mean 13.5. Total needs for spiritual nursing care mean 63.7, which was on the upper middle level. The needs of meaning and object was rated highest. 2. Among the general characteristics of the subjects, needs of love and relatiohship wasn't significanlty different. 3. Among the general characteristics of the subjects, needs of meaning and object was significantly different according to two factors : age(F=7.260, p=0.001), religion(F=5.275, p=0.001). Higher needs of meaning and object was possessed by the older than the younger, by the one who have religion than the other. 4. Among the general characteristics of the subjects, four factors made a significantly difference to needs of forgiving : sex(t=-2.851, p=0.006), age(F=8.201, p=0.001), religion(F=6.928, p=0.000), disease(t=2.327, p=0.024). Higher needs of forgiving was possessed by man than woman, by the older than the younger, by the one who have religion than the other, by the one who have disease than the other.

조혈모세포이식 환자에서 침습성 진균 감염에 대한 이트라코나졸 액과 플루코나졸 시럽의 예방 효과 : 전향적, 무작위, 비교 임상시험

최수미,이동건,최정현,박선희,엄기성,김유진,김희제,민창기,유진홍,김동욱,이종욱,민우성,신완식,김춘추 대한감염학회 2005 감염과 화학요법 Vol.37 No.2

목적 : 조혈모세포이식 환자에서 호중구 감소 기간 동안 이트라코나졸 액(ITZS)과 플루코나졸 시럽(FCZS)의 진균 감염에 대한 예방 효과를 전향적으로 비교해 보고자 하였다. 재료 및 방법 : 2001년 8월부터 2002년 6월까지 가톨릭 조혈모세포이식센터에 입원하여 동종 조혈모세포이식을 받은 만 18세 이상의 환자들을 각각 ITZS와 FCZS군으로 무작위 배정하여 침습성 진균 감염 발생과 약제 관련 부작용을 전향적으로 조사하였다. 결과 : ITZS군에 40명, FCZS군에 38명이 배정되었고, FCZS군 환자의 평균 나이가 더 많았다. 시험 약제 평균투여기간은 ITZS군 16.4일, FCZS군 21.9일로 ITZS군이 더 짧았다. 이는 ITZS군에서 소화기 부작용으로 인한 약제 중단이 더 많았기 때문으로 보인다. 시험 약제 투여 후 총 빌리루빈 수치의 유의한 증가가 관찰되었으나, 약제 관련 부작용은 모든 환자에서 가역적이었다. 호중구감소 기간동안 표재성 진균 감염은 두 군에서 모두 발생하지 않았고, 침습성 진균 감염은 ITZS군 5명(12.5%), FCZS군 8명(21.1%)으로 FCZS군에서 많았으나, 통계학적으로 유의하지 않았고, 사망률에도 유의한 차이는 없었다. 결론 : 침습성 진균 감염에 대한 이트라코나졸 액과플루코라졸 시럽의 예방 효과에 유의한 차이는 없었으나, 앞으로 더 많은 환자를 대상으로 잘 짝지어진 대조군 연구가 필요할 것으로 보인다. 부작용 중 간독성과 관련하여 이식시 투여되는 여러 약제들과의 상호작용에 대한 연구도 필요할 것이다. Background : Though fluconazole is widely used for antifungal prophylaxis, it is ineffective against mould infections including Aspergillus species. Itraconazole has a broader spectrum than fluconazole but the capsule form shows erratic bioavailability in neutropenic patients. In this study, we compared itraconazole oral solution (ITZS) with fluconazole syrup (FCZS) for the prevention of invasive fungal infection (IFI) in allogeneic hematopoietic stem cell transplant recipients. Materials and Methods : Adults receiving allogeneic hematopoietic stem cell transplantation (HSCT) from september 2001 to June 2002, were randomly allocated to either the ITZS group or the FCZS group. We prospectively evaluated the safety and efficacy of each drug. Results : Out of 78 patients (40 patients in the ITZS group and 38 patients in the FCZS group) who were eligible for this study, 37 patients completed the course of prophylaxis without any evidence of IFI. The mean duration of prophylaxis was 16.4 days for the ITZS group and 21.9 days for the FCZS group (P<0.006). Drug-related adverse events occurred in 28 patients (70.0%) and 19 patients (50.0%) in the ITZS group and the FCZS group, respectively. Common adverse events of ITZS were nausea, vomiting, and diarrhea. Drug-related reversible hepatotoxicity occurred in 4 patients in the ITZS group. There was a significant elevation of total bilirubin level in the ITZS group. The incidence of suspected IFI occurred in 5 patients (12.5%) who received ITZS, compared with 8 (21.1%) who received FCZS (P=0.372). There were no proven IFIs or superficial (oral/vaginal) fungal infections in both groups. Overall mortality was not different between the two groups (2.5% in the ITZS group versus 5.3% in the FCZS group, P=0.610). Conclusion : ITZS and FCZS showed similar protection against IFI during pre-engraftment period. Poor tolerability due to gastrointestinal troubles of ITZS might limit its success as prophylactic therapy. Well matched controlled study with large number of patients will be required in the future.

조혈모세포이식 환자에서 발생한 Cytomegalovirus 질환의 특징 : 일개 대학변원에서 최근 10년간의 경험

최수미,이동건,박선희,김시현,김유진,민창기,김희제,이석,최정현,유진홍,김동욱,이종욱,민우성,신완식,김춘추 대한감염학회 2009 감염과 화학요법 Vol.41 No.1

Background : Studies on cytomegalovirus (CMV) diseases in Korean hematopoietic stem cell transplant (HSCT) recipients are lacking and do not reflect the recent trends of advances and changes. Therefore, we tried to analyze the clinical features of CMV diseases in HSCT recipients over the past 10 years at a tertiary university hospital in Korea. Methods : Retrospective review of medical records was done for all adult HSCT patients who received transplant at the Catholic HSCT Center from January 1998 to January 2008. Results : Forty-four cases (2.2%) of CMV diseases were identified. CMV pneumonia was diagnosed in 17 patients, retinitis in 16 patients, enterocolitis in 7 patients, esophagitis 1 patient, gastritis in 1 patient, duodenitis in 1 patient, and hepatitis in 1 patient. The median onset of symptom was 90 days after transplantation. Late CMV diseases accounted for 47.7%. CMV related death varied from 0 to 58.8% according to the involved organ. CMV retinitis was diagnosed relatively later in the course of transplantation mostly in patients who had chronic graft versus host disease (GVHD). On the contrary, CMV enterocolitis mainly occurred in patients who suffered from acute GVHD. The overall concurrent CMV reactivation was documented to be 63.6%: the concurrent CMV reactivation was observed only in 37.5% of patients with retinitis. Conclusions : We observed some differences in the pattern of CMV disease manifestation according to the involved organ and reconfirmed the fact that CMV pneumonia is the most common and fatal disease in HSCT recipients. Additionally, CMV retinitis was not uncommon in HSCT recipients. Since specific marker does not exist in predicting retinitis, regular ocular examination should be done thoroughly, especially in patients with chronic GVHD.

복합레진 적층계면에서 oxygen inhibition의 영향에 관한 연구

최수미,박재홍,최성철,김광철,최영철 大韓小兒齒科學會 2010 大韓小兒齒科學會誌 Vol.37 No.3

The purpose of this study was to assess the effect on oxygen inhibition layer(OIL) for the interfacial bonding between resin composite layers, including shear bond strength, fracture modes and degree of conversion. The first layer of specimen was filled with Z-250(shade A3) and was cured for 40s. The second layer of specimen was filled with same composite(shade A1) and was cured for 40s. The first layer of specimens for each group were prepared by methods as followings. Control(curing in atmospheric air), Group1(curing against Mylar strip), Group2(scrubbed with a acetonesoaked cotton), Group3(using Tescera light cup), Group4(using Tescera heat cup), Group5(stored in disti1led water for 30days at 37℃), Group6 (using bonding agent). The results were as follows: 1. There was no statistically significant different shear bond strength between control and group 1(p>0.05). 2. Group 2 showed significantly lower shear bond strength than control and group 1(p<0.05). 3. The observation of the fracture surface leads to the evidence that a major difference occurs in the case of control, group1 and group 3 samples which break mainly cohesively while the other groups break in majority adhesively. 4. The results of FTIR showed that the degree of conversion was the highest in group 2 and the lowest in control group(p<0.05). It can be concluded that an OIL is not necessary for bonding with composite resin. But if a reduced critical amount of the unreacted monomer is present, it was detrimental to bonding additional layers of composite. Further study, such as the quantitative analysis of the unreacted monomer are required. 복합레진의 적층계면에서 산소억제층(oxygen inhibition layer:이하 OIL)의 영향을 연구하기 위해, 아크릴릭 몰드(하층)에 복합레진의 shade A3를 충전한 후 표면의 조건을 달리하여 중합하였으며 상층은 shade A1으로 충전하고 중합하였다. 대조군(OIL 존재), 1군(OIL 형성억제), 2군(OIL 형성억제+레진표면의 미반응 모노머 제거), 3군(가압하에 중합), 4군(열중합), 5군(시효처리), 6군(시효처리+본딩제 도포)로 하층의 계면조건을 다르게 하였다. 전단결합강도와 파절양상, 전환률을 분석하여 다음의 결과를 얻었다. 1. 전단결합강도 측정 결과 대조군과 제 1군 사이에 통계학적으로 유의한 차이가 없었다(p>0.05). 2. 제 2군은 대조군과 1군에 비해 낮은 결합강도를 보였다(p<0.05). 3. 제 3군은 가장 높은 결합강도를 보인 반면, 4군은 가장 낮은 결합강도를 보였다. 4. 6군은 5군보다 두 배 정도 높은 결합강도를 보였다. 5. 대조군과 1군 및 3군에서는 주로 응집성 복합레진파절이 일어난 반면 2군, 4군, 5군과 6군에서는 주로 접착성 계면파절이 일어났다. 6. FTIR로 전환률을 측정한 결과 2군에서는 50.55%로 가장 높았고, 대조군에서는 가장 낮았다(p<0.05). 전단결합강도와 전환률의 결과로 보아, OIL은 복합레진 계면의 결합에 필수적인 요인은 아니며, 표층의 미반응 모노머가 결합강도에 영향을 미치는 것으로 보인다. 향후 계면 결합강도에 영향을 미칠 수 있는 미반응 모노머의 정량적인 분석을 통한 추가적인 연구가 필요할 것으로 생각된다.

국내 조혈모세포이식 환자에서 Human Cytomegalovirus gB 유전형의 분포와 질환과의 연관성 : 예비 보고

최수미,김진희,이동건,박선희,최정현,유진홍,박철민,이종욱,민우성,황응수,신완식,김춘추 대한감염학회 2007 감염과 화학요법 Vol.39 No.2

목적 : 사람 거대세포바이러스(Human cytomegalovirus, 이하 HCMV) glycoprotein B (gB)는 UL55 유전자에 의해 부호화되는 당단백으로, UL55 유전자의 염기서열변화에 따라 4가지 유전형으로 나뉜다. 본 연구에서는 국내 조혈모세포이식 환자들에서 HCMV gB 유전형의 분포와 그 특성을 알아보고, gB 유전형에 따라 특정 HCMV 질환 발생과 연관이 있는지 그 임상적 의미를 분석해 보고자 하였다. 재료 및 방법 : 동종 조혈모세포이식 환자 52명의 혈액검체 94개에 대해, Chou 등이 제시한 방법에 따라, 먼저 UL55 유전자 부위를 nested PCR로 증폭한 후, RsaI과HinfI으로 Restriction fragment length polymorphism(RFLP) 분석을 시행하였다. 결과 : gB type 1은 73.1% (38/52), gB type 2는 13.5%(7/52), gB type 3는 1.9% (1/52), gB type 1과 type 2에 의한 혼합감염은 9.6% (5/52)로 나타났다. gB type 4는 관찰되지 않았다. 1명(1.9%)에서 gB 유전형을 결정할 수 없었는데, RFLP 패턴으로 보아 Trincado 등이 제시한 gB type 7에 해당하는 것으로 생각되었고, 이 새로운 아형에 대해서는 현재 염기서열 분석 중이다. 52명 중 5명(9.6%)에서 HCMV 질환이 발생하였고, 3명에서 HCMV 폐렴, 1명에서 망막염과 위장관염, 나머지 1명에서 망막염이 발생하였다. 5명 중 HCMV 질환과 관련하여 사망한 예는 없었고, 감염된 HCMV는 모두 gB type 1이었다. HCMV gB유전형과 HCMV 질환 발생 사이에 유의한 연관성은 없었고, 단일 주에 의한 감염과 혼합감염에 따른 HCMV 질환발생 사이에도 유의한 연관성은 관찰되지 않았다. 자료 분석 중 gB type 2에 감염되어 있던 환자에서 gB type 1에 재감염 되면서 발열, 간효소 수치 상승 및 pp65 HCMV 항원혈증이 나타난 예가 있었다. 결론 : 연구결과 gB type 1이 아주 우세하고, gB type 4는 검출되지 않았으며, 혼합감염의 빈도가 비교적 낮은 분포를 보였다. 이는 외국의 보고와는 다른 국내 조혈모세포이식 환자에서의 독톡한 감염 양상으로 추정된다. 본 연구에서 HCMV gB 유전형과 질환 발생과의 연관성을 밝힐 수는 없었으나, HCMV 유전형에 대한 연구는 바이러스 감염의 발병기전이나 전파 경로 및 양식과 같은 역학적 연구에 중요한 자료가 될 것이다. 현재 더 많은 수의 조혈모세포이식 환자를 대상으로 연구가 진행 중에 있으며, 앞으로 다른 질환군의 환자나 건강한 잠복 감염자에서의 추가 연구가 필요할 것으로 생각된다. Background : Human cytomegalovirus (HCMV) glycoprotein B (gB) is the major envelope glycoprotein, encoded by the UL55 gene. Based on sequence variation in the UL55 gene, HCMV can be classified into four gB genotypes. Previous studies have suggested an association between HCMV gB genotypes and clinical outcome in the immunocompromised hosts. The goal of this study was to determine the distribution of HCMV gB genotypes and the effect of gB genotype in the developement of HCMV diseases in hematopoietic stem cell transplant (HSCT) recipients in Korea. Materials and Methods : DNA was extracted from 94 blood specimen of 52 allogeneic HSCT recipients with HCMV infection. HCMV gB genotype was determined using polymerase chain reaction to amplify a region of UL55, followed by restriction fragment length polymorphism (RFLP) analysis based on RsaI and HinfI digestion. Results : The distribution of gB types were as follows: gB1, 73.1% (38/52) of patients; gB2, 13.5% (7/52); gB3, 1.9% (1/52) and mixed infection (gB1 and gB2), 9.6% (5/52). While gB4 was not detected, a new genotype (described as gB7 by Trincado et al, 2000) was identified on the basis of their RFLP pattern. During average 708 days’ follow up period, HCMV diseases developed in 5 patients. All of them had gB1 genotype. There was no statistically significant association between the incidence of HCMV diseases and the gB genotypes. Re-infection with gB1 strain was detected in one patient who had been previously infected with gB2. This episode was associated with fever, elevated liver enzyme and positive antigenemia. Conclusion : HCMV gB1 was the dominant genotype and no gB4 was detected in allogeneic HSCT recipients in Korea, which is an unique pattern compared with the previous reports. Although we can not find significant association between the HCMV diseases and the gB genotypes, genotyping of HCMV will serve in the study of pathogenesis and transmission of this virus in transplant patients. Further study is underway with large study population.

장구균의 동정에 대한 PCR 방법의 유용성

최연화,이영선,김홍빈,김치경,김봉수 대한감염학회 2001 감염 Vol.33 No.2

Background : Enterococci are important cause of nosocomial infections. Recently, vancomycin-resistant enterococci (VRE) has been increasingly reported as significant nosocomial pathogens. Therefore, accurate identification of enterococcal species is a prerequisite step for the appropriate antibiotic treatment and epidemiologic surveillance. We wanted to know the usefulness of PCR method compared with Vitek automatic identification system. Methods : Totally 105 isolates were identified on the species level by Vitek (GPI card and software version R06.1), methyl-α -D-glucopyranoside test, and PCR methods. Results : Among 105 enterococcal isolates, 59 were identified as E. faecium, 11 E. faecalis, 6 E. gallinarum by Vitek. But 29 isolates (28%) were unidentified. Subsequently all of these isolates were analyzed by PCR, the results of which were as follows : 17 E. faecium, 5 E. casseliflavus, 7 E. gallinarum. Two isolates identified as E. gallinarum by Vitek were reidentified as E. casseliflavus by PCR and other methods far phenotypic characterization. Conclusoin : PCR method was more accurate and sensitive than Vitek for the identification of enterococci species. (Korean J Infect Dis 33:123∼127, 2001)

국내 혈액질환 환자에서 침습성 진균 감염의 구제치료로서 Caspofungin의 효과와 안전성

최수미,박선희,이동건,최정현,유진홍,민우성,신완식,김춘추 대한감염학회 2005 감염과 화학요법 Vol.37 No.5

목적 : 본 연구에서는 국내 혈액질환 환자들에서 일차 항진균제를 부작용으로 인해 투여할 수 없거나, 일차 항진균제에 반응이 없는 침습성 진균 감염증의 구제치료로서 caspofungin의 효과와 이상반응에 대한 임상 경험을 소개하고, 예후인자를 분석해 보았다. 재료 및 방법 : Caspofungin은 첫날 70 mg, 이틀째 부터 50 mg을 하루 일회 투여하였고, caspofungin 종료시 그리고 종료 4주 후 반응을 평가하였다. 결과 : 총 55명의 환자가 분석에 포함되었고, 남자 32명, 여자 23명, 평균 나이는 38.2세(16-65세)였다. 기저 질환은 급성 백혈병 33명, 골수이형성 증후군 12명, 만성 백혈병 3명, 기타 7명이었다. 진균 감염은 확진 1명, 가능 5명, 추정 47명, 불확실 2명이었고, 감염 장소는 폐를 침범한 경우가 49명, 파종감염 6명이었다. 전체적으로 41.8% 환자에서 양호한 반응을 보였으며, 치료군, 치료후 기저질환의 상태, 침습성 진균 감염 진단시 호중구 감소증 여부, 스테로이드 등 면역억제제 사용 여부가 유의한 예후인자였다. 약제관련 이상반응은 14.5%에서 관찰되었고, 발열, 피부 발진, 간기능 저하 등으로 나타났다. 이중 4명에서 이상반응과 관련하여 투약을 중지하였고, 약제 중단 후 증상은 모두 호전되었다. Caspofungin 관련 신독성은 관찰되지 않았다. 결론 : Caspofungin은 국내 혈액질환 환자에서 침습성 진균 감염증의 구제치료에 효과적으로 안전하게 사용될 수 있겠다. 최근 여러 항진균제들이 개발되어 임상에 도입되고 있는 바, 항진균 작용 범위, 독성, 약역동학적 특성, 비용-효과면 등을 고려하여 환자별로 직절한 항진균제를 선택하도록 해야 할 것이다. Background : Invasive fungal infection (IFI) is an important cause of morbidity and mortality in patients with hematologic malignancy. Patients with IFI who fail to standard therapy have poor prognoses. We investigated the efficacy and safety of caspofungin (CAS) in Korean adults with hematologic diseases and IFI who did not respond to the conventional antifungal therapy. Materials and Methods : Patients with IFI refractory or intolerant to standard antifungal therapy received CAS 50 mg IV daily after 70 mg loading dose on day 1. Efficacy and safety of CAS were assessed in patients who received more than one dose. Favorable response [complete (CR) or partial (PR)] was defined as significant improvement of all clinical symptoms, signs, and radiologic abnormalities. Results : From Feb. 2004 to Feb. 2005, 55 patients who met the inclusion criteria were enrolled. There were 32 male and 23 female patients with mean age of 38.2 years (range, 16-65). Underlying diseases were acute leukemia (33 cases), myelodysplastic syndrome (12 cases), chronic myelogenous leukemia (3 cases), and other hematologic diseases (7 cases). Thirty-six patients were receiving chemotherapy and 13 patients were under hematopoietic stem cell transplantation (HSCT). The number of proven, probable, possible, and indeterminate IFI cases was 1, 5, 47, and 2, respectively. Conventional amphotericin B, intravenous itraconazole, and liposomal amphotericin B were administered for average of 14.9 days prior to administering CAS. Mean duration of CAS therapy was 12.8 days (range, 1-45). Twenty-three patients (41.8%) showed favorable responses (CR : PR=8 : 15) at the end of CAS therapy. Chemotherapy group, neutropenic state, remitted state of underlying disease, and no steroid therapy were significant prognostic factors for favorable response. Eight (14.5%) patients developed drug-related adverse events such as fever, skin eruption, and hepatic dysfunction which were reversible after discontinuation of CAS. Drug-related nephrotoxicity was not observed. Conclusion : On the basis of our investigation, CAS was effective and safe as a salvage therapy of refractory IFI or as an alternative for patients intolerant to standard antifungal agents.

두부외상환자에서의 예후인자

최성혁,문준동,김수진,문철규,이성우,홍윤식 대한응급의학회 2001 대한응급의학회지 Vol.12 No.2

Background: Predicting outcome after head trauma is of great interest for clinicians, especially in the early stage. It may provide a basis for therapeutic strategies and may be helpful to select different approaches. But, reliable outcome prediction from head trauma is still unresolved. The purpose of this study is to determine which clinical parameters can be used effectively after an event of head trauma. Methods: In our study we studied head trauma patients who came to the Emergency department of Korea University Medical School Anam Hospital from the 1st of June 1998 to 31th of January 2000, looked into medical records, and studied the records in a retrospective manner. The head trauma patients were divied into two group, a) favourable outcome-related and b) unfavourable outcome-related. The two groups were then subdivided according to their sex, age, the mechanism of their injury, the time they came in, alcohol drinking, loss of consciousness, vomiting, pupil change, previous medical illness, associated injuries and were seperately compared and analyzed. And the factors affecting Glasgow Outcome Scale(GOS) were analyzed in the parameters of Injury Severity Score(ISS), Revised Trauma Score(RTS), Glasgow Coma Scale(GCS), motor score of GCS(mGCS), Marshall Computed Tomographic Classification(MCTC). Statistically, t-test and Mann-Whistney rank sum test using Jandel-sigma were used in the study and then were assessed in Chi-square analysis methods. The statistical significance was determined at a level of p less than 0.05. Results: The total of the head trauma patients, added up to 129 people, 99:males and 30:females. Among this sum, 99 patients showed a favourable outcome and 30 patients showed an unfavourable outcome at discharge. The causes of injury included: automobile accident in 42 cases; fallss in 26; assaults in 6; and accidental-slipping injury etc in 55 cases. 12 patients had bilateral unreactive pupils on admission, 2 had unilateral reactive pupils, and 113 had bilateral reactive pupils. Compared to the favourable outcome-related head trauma group, the unfavourable outcome-relared head trauma group had more history of loss of consciousness, unreactive pupils and tended to have previous medical illness. There were no difference in alcohol related, vomiting and associated injuries between two groups(favourable outcome-related head trauma group: unfavourable outcome-related head trauma group). Substantial difference were observed in GCS, mGCS, ISS, RTS, MCTC between two groups. Patients with unfavourable outcome had a significantly higher ISS, lower RTS, lower mGCS. After MCTC, patients with mass lesion had unfavourable outcome than patients with diffuse injury. Conclusion: Age, history of loss of consciousness, previous medical illness and unreactive pupil change are predictives of outcomes of head trauma patients with respect to Glasgow outcome scale. The lower GCS, lower RTS, lower mGCS, higher ISS, mass lesion based on CT scan provide poorer prognostic outcome in patients with head trauma. Use of prognostic factors thorough complete history taking and physical examination would provide useful prognostic information and facilitate improved therapeutic decision-malting in head-injuried patients.

산부식 시간에 따른 유전치 법랑질의 부식 유형에 관한 연구

최수미,최영철,박재홍,최성철 大韓小兒齒科學會 2008 大韓小兒齒科學會誌 Vol.35 No.3

이 연구의 목적은 유전치 법랑질에서 무소주 법랑질 층이 있는 치경부에서의 적절한 산부식 시간을 알아보고자 함이다. 경희대학교 치과대학병원 소아치과에 내원한 환아에게서 발거한 치아 순면에 우식이 없는 건전한 치아 32개를 대상으로 실험 하였다. 발거된 유전치의 치경부 법랑질을 35% 인산으로 실험 1군은 15초,실험 2군은 30초,실험 3군은 45초,실험 4군은 60초간 산부식한 후 부식시간에 따른 법랑질 표면의 양상을 SEM으로 관찰하여 평가하였다. 1. 실험 1군에서는 Type 3가 75% 나타났으며 실험 2군과 3군 모두에서 Type 1이 38%, Type 2가 50%로 나타났다. 2. 실험 2군보다 실험 3군에서 산부식된 양상이 좀더 뚜렷하게 나타났다. 3. 실험 4군에서 Type 1이 25%. Type 2가 75%를 보였고 Type 3는 나타나지 않았다. 4. 실험 4군에서는 다른 실험군에서 보다 좀더 전형적인 산부식 양상을 보였다. 5. 설험군 간의 산부식 시간에 따른 부식 양상의 차이는 통계학적으로 유의한 차이를 보였다(p<0.05). 6. 산부식 시간이 길수록 부착에 유리한 Type 1과 Type 2가 주로 관찰되었으며 Type 3는 드물게 관찰되었다(p<0.05). 유전치에서 무소주 법랑질 층이 주로 존재하는 치경부 측에,와동의 변연부가 형성될 때에는 산부식 시간을 다소 길게 45∼60초 정도 하는 것이 수복물 유지를 향상시킬 것으로 여겨진다. The presence of a"prismless" layer on the enamel surface particularly on deciduous teeth has been reported by a number of workers. This structure, which appears to lack the normal prism delineations, could interfere with tag formation and hence, reduce bonding to such surfaces. The purpose of this study was to investigate the relationship of etching times on the effect of acid etching on primary enamel with respect to the quality of etching patterns. Labial surfaces of 32 extracted or exfoliated caries-free primary anterior teeth were used. 35% phosphoric acid gel was used only cervical regions of labial surfaces for each etching time group, 15, 30, 45 and 60 seconds. The surfaces were then washed with water for 20 seconds and dried with air spray for 20 seconds. 1. The Type 3 is 75% when the 15 seconds acid etching time was used. 2. The Type 1 is 38% and Type 2 is 75% when the 30 and 45 seconds acid etching time was used. 3. The Type 1 is 25% and Type 2 is 75% when the 60 seconds acid etching time was used. 4. An etching time of 60 seconds produced a constant and regular etching pattern. 5. There is a significant difference between the groups with respect to the patterns of etch achieved(p<0.05). 6. We confirmed that the acid induced patterns(type 1, 2) became more pronounced when the application time increased(p<0.05). 45∼60 seconds was the optimal time for etching on the primary enamel.