Delayed formation of sterile abscess after zygomaticomaxillary complex fracture treatment with bioabsorbable plates

도경현,박수진,홍기용,임수아,한강민,어수락 대한두개안면성형외과학회 2018 Archives of Craniofacial Surgery Vol.19 No.2

We present a patient who showed a sterile abscess after facial bone fixation with bioabsorbable plates and screws. He had zygomaticomaxillary complex and periorbital fracture due to falling down. The displaced bones were treated by open reduction and internal fixation successfully using bioabsorbable plate system. However, at postoperative 11 months, abrupt painless swelling was noted on the previous operation sites, left lateral eyebrow and lower eyelid. By surgical exploration, pus-like discharge and degraded materials were observed and debrided. The pathologic analysis revealed foreign body reaction with sterile abscess. This complication followed by bioabsorbable device implantation on maxillofacial bone surgery has been rarely reported in which we call attention to the maxillofacial plastic surgeons.

전산화 단층 촬영에서 소프트웨어를 이용한 소폐결절 모형 부피 측정의 정확성 평가

도경현,구진모,이경원,임정기,Do, Gyeong-Hyeon,Gu, Jin-Mo,Lee, Gyeong-Won,Im, Jeong-Gi 대한영상의학회 2004 대한영상의학회지 Vol.50 No.2

목적: 소폐결절 부피를 자동으로 계산할 수 있는 소프트웨어의 임상 적용 가능성을 알아보기 위하여 여러 가지의 소폐결절 모형을 제작하고 측정된 부피의 정확성을 평가하고자 하였다. 대상과 방법: 여러 가지의 실제 부피를 알고 있는 결절 모형을 제작한 후 다중검출기 전산화 단층 촬영으로 결절의 영상을 얻었다. 이 영상을 3차원적으로 재구성한 후 부피 측정 소프트웨어(Rapidiaⓡ, 3D-Med, Seoul, Korea)를 이용하여 측정한 부피와 실제 부피를 비교하여 정확도를 평가하였다. 결과: 지름 1 cm 미만의 소폐결절의 부피는 -200, -400, -600 HU에서 각각 17.3, 2.9, 11.5(%)로 -400 HU에서 가장 오차가 적었으며 유의한 상관 관계를 보였다(r=0.96, p < 0.001). 석회화를 포함한 결절의 경우 각각의 비교 오차는 10.9, 5.3, 16.5 %로 -400 HU에서 오차가 가장 적었으며 유의한 상관 관계를 보였다(r=1.03, p < 0.001). 결절의 주위에 혈관이 인접한 경우에는 비교 오차가 각각 4.6, 16.3, 31.2 %였고 -200 HU에서 오차가 가장 적었으며 유의한 상관 관계를 보였다(r=1.1, p < 0.001). 단순 폐결절의 경우 정확한 부피 측정이 가능하였으며 석회화가 동반되거나 혈관과 인접한 경우라도 역치를 조정하면 정확도가 증가하였다. 결론: 여러 가지 폐결절 모형으로 자동적인 알고리듬에 의한 부피 측정의 정확도의 평가가 가능하였다. Window setting에 관계없이 항상 같은 역치 하에서는 결절의 부피는 일정하게 측정되었다. Purpose: To determine the accuracy of automated computer aided volumetry for simulated small pulmonary nodules at computed tomography using various types of phantoms Materials and Methods: Three sets of synthetic nodules (small, calcified and those adjacent to vessels) were studied. The volume of the nodules in each set was already known, and using multi-slice CT, volumetric data for each nodule was acquired from the three-dimensional reconstructed image. The volume was calculated by applying three different threshold values using Rapidiaⓡ software (3D-Med, Seoul, Korea). Results: Relative errors in the measured volume of synthetic pulmonary nodules were 17.3, 2.9, and 11.5% at -200, -400, and -600 HU, respectively, and there was good correlation between true volume and measured volume at -400 HU (r=0.96, p<0.001). For calcified nodules, relative errors in measured volume were 10.9, 5.3, and 16.5% at -200, -400, and -600 HU, respectively, and there was good correlation between true volume and measured volume at -400 HU (r=1.03, p<0.001). In cases involving synthetic nodules adjacent to vessels, relative errors were 4.6, 16.3, and 31.2 % at -200, -400, and -600 HU, respectively. There was good correlation between true volume and measured volume at -200 HU (r=1.1, p<0.001). Conclusion: Using computer-aided volumetry, the measured volumes of synthetic nodules correlated closely with their true volume. Measured volumes were the same at each threshold level, regardless of window setting.

컴퓨터단층촬영 검사의 방사선 피폭 저감화 방안

도경현,성동욱 대한의사협회 2015 대한의사협회지 Vol.58 No.6

Medical imaging is an indispensible diagnostic tool in modern medicine enabling fast and accurate diagnosis. Recent technological advances in medical equipment and increased utilization of the imaging modality have resulted in a significant increase in the exposure to ionizing radiation. After the rapid adoption of multi-detector computed tomography, computed tomography (CT) is now the single largest source of diagnostic radiation exposure to patients. The risks and benefits from radiation must be carefully considered in all examinations using ionizing radiation, and the principles of justification and optimization should be considered in the proper use of CT examination. Justification means that the examination must be medically indicated and useful. Optimization means that the imaging should be performed using doses that are ALARA (as low as reasonably achievable), consistent with the diagnostic task. This includes understanding and changing CT protocols to perform the same diagnostic task with the minimal amount of radiation exposure while maintaining diagnostic accuracy. Protocols and guidelines are important tools for radiation dose reduction. Understanding the parameters and dose information for CT examination is essential for optimization. If the exam is justified, then the parameters must be optimized to the imaging indication, scan area, body size, age, and weight of the patients. The physician should always assess the radiation risk-benefit ratio for each patient before ordering an examination that uses radiation. Continuing education is essential for the implementation of the principles of patient radiation dose reduction. Physicians and radiologists must be aware of the radiation risks associated with CT exams.

사구체종양으로 오인된 조갑하 결절종

도경현,김범식,신혜경,안경찬,홍기용,한예식,어수락 대한수부외과학회 2020 대한수부외과학회지 Vol.25 No.2

Subungual masses accompanying nail deformity are of common occurrence and uniquely confirmed by histopathologic examination postoperatively. Although glomus tumor is most frequently diagnosed with its specific clinical triad, other rarer diagnoses have also been reported. Though ganglion cysts are predominantly found around the distal phalangeal joint as a mucous cyst and myxoid cyst, they might also appear as a subungual mass accompanied by nail deformity thereby mimicking the glomus tumor. A 54-year-old woman visited our outpatient clinic with nail deformity and pain on the tip of the right thumb. She had a history of nail root injury on her right thumb which occurred 3 months back at a nail shop. Physical examination revealed a convex point with tenderness on the right thumbnail. Doppler ultrasonography revealed the presence of 0.43×0.26×0.53 cm3 sized non-specific cystic lesion with hypoechogenicity and no abnormal vascularity. Complete excision of the cyst was performed and histopathology revealed a ganglion cyst. Subungual ganglion cyst is rarely occurred and known to be usually asymptomatic. Herein, we report a case of ganglion cyst of subungual area which was mistakenly diagnosed as a glomus tumor preoperatively. 손발톱 변형을 동반한 조갑하 덩어리는 흔히 발생하며 수술 후 병리조직학적 검사에 의해 유일하게 확인된다. 사구체종양(glomus tumor)은 특정 임상적 세징후로 가장 빈번하게 진단되지만 다른 드문 종양으로의 진단도 보고된다. 결절종(ganglion cyst)은 주로 원위지 골간관절 주위에서 점액 낭종 및 점액성 낭종으로 발견되지만, 손톱 기형을 동반한 조갑하 덩어리로도 나타날 수 있어 사구체종양으로 오인될 수 있다. 저자들은 54세 여성의 우측 엄지손가락 윈위지부에서 손톱 기형과 통증으로 수술 전 사구체종양으로 진단 결정되었던 조갑하 결절종 1예를 경험하고 보고 한다.

저선량 방사선이 인체에 미치는 영향

도경현 대한의사협회 2011 대한의사협회지 Vol.54 No.12

Low dose radiation has been defined as doses in the range under 100 mSv of low linear energy transfer (low-LET) radiation. There are two sources of ionizing radiation: natural and artificial radiation. Medical radiation exposure is the most common artificial radiation exposure. The frequency and volume of medical radiation exposure has markedly increased because of recent developments in medical technology. Radiation protection is now a concern due to the increasing use of computed tomography (CT) scans and diagnostic X-rays. This article introduced several models and hypotheses regarding the possible carcinogenic risks associated with low-LET radiation. Although opinions vary on the health effects of low level radiation exposure, current studies of medical radiation rely on exposure information collected prospectively, including cohort studies such as atomic bomb survivor studies. Although there are differences in perspective, the majority of studies have supported ‘linear-no-threshold model without threshold’ between low-LET radiation and the incidence of cancer risk. There is a need for further studies on medical radiation exposure including CT and positron emission tomography in order to understand the health effects of low-LET radiation, including the cancer incidence.

제1발표 : 진단용 의료 방사선 안전관리 현황과 발전방향

도경현 대한방사선방어학회 2019 대한방사선방어학회 학술발표회 논문요약집 Vol.2019 No.11

욕창의 발병기전과 예방

도경현,허찬영 대한의사협회 2021 대한의사협회지 Vol.64 No.1

The number of pressure ulcer patients is increasing owing to the aging population and increased incidence of elderly illness. This review article aims to introduce the current knowledge on the pathogenesis and prevention of pressure ulcers. The development of a pressure ulcer is associated with external factors such as pressure, shear stress, and friction and internal factors such as age, general condition, skin condition, and nutritional status. Pressure ulcers typically develop over bone protrusions, which are most pressured by weight, but may also be caused by external pressure by medical devices or other objects applied to the patient. This tissue damage is caused by continuous deformation of the tissue due to the pressure acting perpendicular to the tissue surface and shear stress acting parallel to the tissue, either alone or in combination. Limitation of activity and mobility, skin condition, blood circulation and oxygen saturation, nutrition, humidity, body temperature, age, low pain sensitivity, blood count, and general and mental conditions are the primary risk factors for pressure ulcers. A mattress and cushion that reduce pressure and an appropriate posture are necessary to prevent pressure ulcers. In patients with urinary incontinence, contaminated skin should be washed with a mild detergent and absorbent pads and topical protective agents should be used to protect the skin from moisture. Sufficient nutrition may help prevent wounds in patients who are susceptible to pressure ulcers. Furthermore, early screening, individualized management of posture, and regular skin and nutrition monitoring are essential to prevent pressure ulcers.

Current Status of Medical Radiation Exposure

도경현 대한췌담도학회 2013 대한췌담도학회지 Vol.18 No.1 Suppl

특발성폐섬유증 환자에서 폐기종 동반 여부가 노력성폐활량(FVC)감소 및 생존에 미치는 영향 - 임상연구와 관련된 관점에서의 분석

오동규,도경현,이상민,한승봉,김동순 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.0

목적: 폐기종을 동반한 특발성폐섬유증(CPFE)환자는 노력성폐활량(FVC)의 감소는 적지만 폐확산능(DLco)의 감소가 심하고 폐고혈압의 유병률이 높아 FVC 변화를 주지표로 하는 임상연구에서 이들을 제외해야 한다는 주장이 있다. 하지만 아직까지 이에 대한 근거가 없어 본 연구를 시행하였다. 방법: 서울아산병원에서 IPF로 진단된 환자 중 고해상도흉부전산화단층촬영(HRCT)의 분석이 가능하고 진단 후 12개월의 폐기능검사 결과가 있는 212명을 대상으로 진단시 HRCT 상 폐섬유증및 폐기종의 정도, 진단 후 12개월의 FVC 감소와 생존율의 관계를 조사하였다. 결과: CPFE군은 77명(36.3%)으로 순수 IPF군에 비해 남성과 흡연자가 많았고, 진단 시 두군 사이에 폐섬유화 지수는 차이가 없었으나(7.8 vs. 8.4,p=0.168), FVC 86.3% vs. 74.5% (p<0.001), DLco 65.0% vs. 69.3% (p=0.136)였고, 폐고혈압의 빈도는 23.4% vs 6.1% (p=0.004)였다. 두 군간에 생존률의 차이는 없었고 폐섬유화지수는 중요한 생존예측인자였다. 양군에서 진단 후 12개월의 FVC 감소 정도는 사망의 유의한 예측인자였으나(CPFE군: HR 1.038, p=0.030; 순수IPF군: HR 1.061, p<0.001), FVC 감소 정도는 CPFE군에서 순수 IPF군보다 작았다(120 ml: 4.65% vs 20ml: 0.27%, p=0.008). 결론: CPFE군에서는 진단 후 12개월의 FVC 감소가 적고 사망예측에 미치는 영향도 감소하므로 임상연구에서는 이들을 제외하는 것이 타당할 것으로 사료된다.

Association of Chest CT-Based Quantitative Measures of Muscle and Fat with Post-Lung Transplant Survival and Morbidity: A Single Institutional Retrospective Cohort Study in Korean Population

조영훈,도경현,Eun Jin Chae,최세훈,조경욱,Sang-Oh Lee,홍상범 대한영상의학회 2019 Korean Journal of Radiology Vol.20 No.3

Objective: Abnormal body composition is an important modifiable risk factor in lung transplantation. Therefore, precise quantification of different body components, including muscle and fat, may play an important role in optimizing outcomes in lung transplant patients. The purpose of the study was to investigate the prognostic significance of muscle and subcutaneous fat mass measured on chest CT with regard to lung transplantation survival and other post-transplant outcomes. Materials and Methods: The study population included 45 consecutive adult lung transplant recipients (mean age of 47.9 ± 12.1 years; 31 males and 14 females) between 2011 and 2017. Preoperative cross-sectional areas of muscle and subcutaneous fat were semi-automatically measured on axial CT images at the level of the 12th thoracic vertebra (T12). Additional normalized indexed parameters, adjusted for either height or weight, were obtained. Associations of quantitative parameters with survival and various other post-transplant outcomes were evaluated. Results: Of the 45 patients included in the present study, 10 mortalities were observed during the follow-up period. Patients with relative sarcopenia (RS) classified based on height-adjusted muscle area with a cut-off value of 28.07 cm2/m2 demonstrated worse postoperative survival (log-rank test, p = 0.007; hazard ratio [HR], 6.39:1) despite being adjusted for age, sex, and body mass index (HR, 8.58:1; p = 0.022). Weight-adjusted parameters of muscle area were negatively correlated with duration of ventilator support (R = -0.54, p < 0.001) and intensive care unit (ICU) stay (R = -0.33, p = 0.021). Conclusion: Patients with RS demonstrate worse survival after lung transplantation that those without RS. Additionally, quantitative parameters of muscles measured at the T12 level on chest CT were associated with the duration of post-lung transplant ventilator support and duration of stay in the ICU.