메조테라피에 의해 발생한 다발성 이물육아종

김대우,김주익,황수란,우수한,박진,윤석권,김한욱 대한피부과학회 2014 大韓皮膚科學會誌 Vol.52 No.11

메조테라피는 한 가지 이상의 약물을 혼합하여 피내 또는 피하조직에 직접 주사하는 침습적 시술이다. 통증이 적고 시술이 간단하며 전신부작용이 적어 최근 주름, 비만, 탈모 등 다양한 피부미용 분야에 널리 활용되고 있지만 그로 인한 부작용의 발생 또한 증가하고 있다1. 28세 여자가 18개월 전 복부에 발생한 다발성 피하결절을 주소로 내원하였다. 환자는 복부의 지방제거 목적으로aminophylline 500 mg, caffeine sodium benzoate 880 mg, pentoxifylline 300 mg, procaine HCL 2%, normal saline를 혼합한 주사액을 5회 주입하였으며, 이외 다른 시술 및 외상의 기왕력은 없었다. 피부소견 상 시술부위를 따라 단단하게 만져지는 11개의 홍색 혹은 피부색 피하결절이 관찰 되었고, 개개 병변의 표면은 약간 함몰되어 있었다(Fig. 1A). 통증 등의 자각증상은 없었으나 경미한 압통을 호소하였다. 초음파 검사상 약 1.5 cm×1.0 cm 크기의 경계가 비교적 명확하고 균일한 저음영의 에코를 가지는 원형의 피하결절 소견을 보였다(Fig. 1B). 일부 병변의 절제생검에서 육안상 결절이 잘 분리되지 않고 진피층에 단단히 얽혀있었으며, 현미경 소견상 진피 내 다핵 거대세포 및 림프구로 구성된 육아종성 침윤소견 및 스위스 치즈 형태의 원형 또는 난원형의 공동이 관찰되었다(Fig. 2). 일반혈액검사와 세균, 미코박테륨 및 진균배양에서 특이 소견은 없었다. 메조테라피에 의한 다발성 이물육아종으로 진단 후 스테로이드 병변 내 주사요법을 4주 간격으로 4회 시행 후일부 결절의 크기가 약간 감소되었다. 비만을 포함한 다양한 피부미용 분야에서 메조테라피의 시행이 보편화 되었지만 여전히 그 효능, 안전성은 명확히 확립되어 있지 않으며 사용되는 약제의 종류, 용량, 주입위치 등 시술방법 역시 표준화되어 있지 않다. 표준화된 지침 없이 시술자의 경험에 의존하여 다양한 약제들이 혼합되어 사용될 뿐 아니라 시술이 간단하다는 인식으로 숙련되지 않은 비전문가들에 의한 시술이 많이 행해지면서 부작용의 발생은 꾸준히 늘고 있다. 메조테라피 후 발생할수 있는 흔한 부작용으로는 국소감염, 지방위축, 출혈과 혈종, 괴사와 색소침착 등이 있으며, 때로 알레르기 반응, 부교감 증후군 등 전신부작용을 일으키는 경우도 있다2. 이 물육아종은 메조테라피 후 발생하는 드문 부작용으로 체형교정 목적으로 시술 후 발생한 증례는 아직 국내 문헌에 보고된 바 없다3. 이물육아종의 발생기전은 명확하지 않으나 적절하지 않은 약제의 주입 위치, 깊이, 양 혹은 시술중의 오염 등으로 인해 약제가 제대로 흡수되지 못하고 만성적인 자극을 일으켜 발생하는 것으로 추측된다4. 치료로는 스테로이드 병변 내 주사 혹은 경구투여, 미노사이클린, 외과 절제술 등이 사용되나 병변의 완전한 회복을 기대하기 어렵다5. 미용적 개선을 기대하는 젊은 여성에서 오히려 시술로 인해 심각한 미용적 부작용이 발생할 수 있음을 감안할 때, 메조테라피의 효능, 안전성 및 시술방법에 대한 더 많은 검증과 주의가 필요할 것으로 생각되며 시술 전환자에게 이물육아종을 비롯한 부작용의 발생 위험에 대한 충분한 설명과 동의가 선행되어야 할 것이다.

Ethmoidal Mucocele Presenting as Oculomotor Nerve Paralysis

김대우,손희영,전시영,김진평,안성기,박정제,우승훈,허동구 대한이비인후과학회 2013 Clinical and Experimental Otorhinolaryngology Vol.6 No.2

A 56-year-old male was admitted with an acute headache and sudden ptosis on the right side. No ophthalmological or neurological etiologies were apparent. A mucocele of the right posterior ethmoid sinus was observed with radiology. After the marsupialization of the mucocele via a transnasal endoscopic approach, the patient’s symptoms (oculomotor nerve paralysis and headache) resolved in 4 weeks. Oculomotor paralysis is a rare symptom of an ethmoidal mucocele. In this article, we report this rare case along with a literature review.

Postoperative Olfactory Results in Chronic Rhinosinusitis with Nasal Polyposis According to Wound Healing Status

김대우,김진용,김상욱,전시영 대한이비인후과학회 2013 Clinical and Experimental Otorhinolaryngology Vol.6 No.3

Objectives. Postoperative wound healing status has not been considered in earlier studies on olfactory changes after surgery. This may be a factor accounting for the equivocal postoperative olfactory results. The aim of this study was to investigate postoperative olfactory results according to wound healing status. Methods. Fifty patients who underwent endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps with smelling disturbance were examined preoperatively, and at 6 months after surgery. Patients were divided into two groups according to postoperative Lund-Kennedy score: favorable and unfavorable wound healing. Preoperative ostiomeatal unit computed tomography (CT), such as Lund-Mackay score and olfactory cleft opacification score, clinical characteristics and olfactory function tests such as the butanol threshold test and cross-cultural smell identification test, and questionnaire responses were compared between the two groups. Results. There were no differences in preoperative clinical characteristics between the favorable and unfavorable wound healing groups. The favorable wound healing group displayed greater improvement of olfactory results after surgery than the unfavorable wound healing group. Postoperative olfactory improvement patterns showed a hierarchy from subjective to objective improvement and from threshold to identification improvement. Patients who had postoperative favorable wound healing but showed no success of olfaction were characterized by more severe preoperative subjective symptoms and higher olfactory cleft opacification, especially in the upper part of olfactory cleft on preoperative CT scan. Conclusion. Wound healing status is an apparent risk factor for postoperative olfactory improvement. Moreover, preoperative opacification in the olfactory cleft may predict bad olfactory results after surgery, even in patients with favorable wound healing.

남북한 통일 대비 화폐ㆍ환율 모형에 관한 연구

金大羽 龍仁大學校 1996 용인대학교 논문집 Vol.12 No.-

The economic integration between South and North Koreas will be a historical inevitability. Also The Monetary integration between South and North Koreas will be important in economic integration. In this study, I survey the exchange rate between South and North Koreas in monetary integration. The exchange rate of monetary integration will calculate in four method. It is CPI method, unit cost method, XPI method, capacity oriented monetary approach. We can summarize like this table Finally, we must be concerned with minimization of impact in a economic monetary integration This exchange rate will be North : South = 1 : 267.430~1 : 665.865

통일비용조달방안

김대우 龍仁大學校 1998 용인대학교 논문집 Vol.15 No.-

Many studies that examine the cost of reunification are available. The estimated costs can differ according to the assumptions and the methods of each particular study. The costs have been estimated to range between 200 million won to 400 million won. While many studies have been done on the cost of the reunification. very little researhes have been done on the willingness to pay, even though it is just as crucial to secure the determination of the participants as well as the policy makers. Reunification of the Korean peninsula would surely entail high costs to the South Korean economy. On the other side of the coin, one can also think about the benefits that can be accrued from reunification. This artricle indirectly measures the benefit by asking what amount the South Korean people would be willing to pay for reunification. If reunification is a commodity and a market price exists. the price can be a measure of perceived satisfaction gained through purchase of the good. However, such price does not exist and one has to rely on other methods to evaluate the perceived benefit of reunification. One such way is to apply the Contingent Valuation Method (CVM). This method evaluates the price of public moods or services through surveys that ask people their willingness to pay for a supply of specific public goods or services. By carefully explaining the benefits of a specific public good and then asking questions about the value of each benefit, CVM derives the price that the public is willing to pay for that good. I calculated that each person was willing to pay about 19,102 ∼ 23,932 won a month. This amonut is less than the estimated cost by major studies. This gap foretells possibility of a hardship that the goverment will face in covering the cost of reunification. Having to raise more money than the people are willing to pay, the government can face tax resistance. Therfore, we must think other methods. Their methods are an increase in government debt through bond issues (resulting in an increase in government fiscal deficit), participating private captal, enforcing fiscal foundation though government reform, reducing military force, inducing foreign capital, and using project financing. To minimize the future difficulty in bridging the gap between the cost and funds for reunification, the South Korean government should undertake preventive measures. It can take the following preemptive measures. 1.Follow plans to minimize cost of reunification and minimize negative sentiments arising from the cost. Of course the cost of reunification will depend on the speed of the progress and the type of reunification. If the South absorbs the North, then the burden will lay entirely with the South, but if the two countries decide to unite and maintain sovereignty for a flexed length of time, then the cost can be shared Reunification could occur abruptly, outside of the two countries' control and will, but nonetheless the government can look for reunification methods that can minimize the cost. 2.Help the North help itself by increasing South's economic aid to the North. By reviving the North's economy so that it will be able to share the cost and not be a completely unmanagble burden, the South can make for a smoother and less expensive reunification. 3.Instill positive attitude in South Korean tax payers about the benefits of reunification. Without proper understanding of its benefits, abrupt merge of the two societie can lead to a problematic division among the South Koreans and the North Koreans, as seen in the case of Germany. The government should work to create an atmosphere of painless assimilation of the two societies. The sense of unity will then foster a sense of responsibility for the well being of others and diminish the threat of having to compete for resources. Particularly because young adults, who feel little obligation or desire to pay for reunification, are less likely to have to bear the burden, it is crucial to educate the public and create a pro-reunification atmosphere. 4.Instill confidence in realization of reunification. In my study, those who are more optimistic about reunification were more likely to give more for the cause than those who believe that reunification is not likely to occur. 5.Prepare politics to secure funds through voluntary cooperation. Through increasing the public's understanding about the benefit of reunification. the government may be able to minimize resistance to additional taxation. No one likes making long term investments if they think that the benefit will be lower than their investment. Also, since the public perception of tax in itself is negative, the government should also seek alternative sources of income. 6.Strengthen domestic economy. The health of economy governs the level of public satisfaction. In a survey conducted in September 1994 by the Germans, when people were asked if" condition has worsened compared to the time before reunification" only 18% of the East Germans said yes. But when the same question was asked by the Economist magazine in November 1996, 89% of the same respondents said yes. Dissatisfaction about reunification arises from economic difficulties that people experience, Fortifying the domestic economy now to maintain healthy economic growth after reunification will increase the willingness of South Korean to pay for the cost. 7.Maximize return on investments made in the North. In Germany, the West Germans are becoming more uneasy about the prospect of continuing fiscal outlay into the East without having seen any improvements. The South Korean government should make sure that the investments that they make with public's money are clear and desirable, so that people may be satisfied with seeing the results of investments made with their money.

Epitaxy behavior of various inorganics on the surface of graphene and its application for recyclable epitaxy substrate of CVD

김대우,김선준,최형욱,정희태 한국고분자학회 2014 한국고분자학회 학술대회 연구논문 초록집 Vol.2014 No.4

학습곡선 상승기 중 비내시경하 경비강 경접형동 뇌하수체 종양 절제술의 임상적 결과

김대우,박경범,조상재,고준석,주연희,정진명,전시영 대한이비인후과학회 2011 대한이비인후과학회지 두경부외과학 Vol.54 No.2

Background and Objectives The aim of this study was to compare endoscopic endonasal transsphenoidal hypophysectomy (EETSA) with microscopic transseptal transsphenoidal hypophysectomy (MTTSA) in terms of clinical results during an acceleration of learning curve. Subjects and Method A retrospective chart review was performed of the first 14 cases of EETSA and previous 14 cases of MTTSA. Resection results, endocrinologic outcomes, complication rates, operating time, and duration of hospital stay were investigated. A non-parametric analysis was performed to determine the significance of differences between groups. Results EETSA was performed, achieving gross total removal, based on postoperative MRI, for 12 of the 14 patients (86%) and hormonal remission for 4 of the 5 patients (80%); on the other hand, MTTSA was performed, achieving gross total removal for 9 of the 14 patients (64%) and hormonal remission for 1 of the 5 patients (20%). We found better resection results in patients who underwent EETSA than in those who did MTTSA with respect to tumors extending into suprasellar area (p<0.05). Visual improvement was achieved in all the cases with visual defect (n=5) after EETSA, whereas 4 of 6 cases (66%) were improved after MTTSA. Significant differences in complication rates, operating time and hospital stay could not be determined. All cases with CSF leakage in EETSA were successfully managed by using the nasoseptal flap. Conclusion EETSA provided better resection results than MTTSA did, especially in cases extending into the suprasellar area, showing good hormonal cure and visual improvement rates. Two approaches were comparable with respect to complications during the learning curve.

여성 긴장성 요실금 환자에서 Stress Leak-Point Pressure와 Maximal Urethral Closure Pressure의 비교

김대우,박석산 大韓泌尿器科學會 1997 Korean Journal of Urology Vol.38 No.10

통일에 대비한 남북한 경제통합 방안

김대우 용인대학교 1997 용인대학교 논문집 Vol.13 No.-

韓國의 債券 收益率 豫測 理論과 模型

金大羽 단국대학교 산업연구소 1992 산업연구 Vol.15 No.-