관절경을 이용한 전방 십자인대 재건술: : Two Tunnel Method와 One Tunnel Method의 비교 Comparison of Two Tunnel Method with One Tunnel Method

김경순,신규철,김동헌 건국대학교 의과학연구소 1995 건국의과학학술지 Vol.5 No.-

저자들은 1988년 3월부터 1994년 9월까지 진구성 방전십자인대 손상에 대하여 관절경하에서 슬개골-건-골을 이용하여 재건술을 시행한 환자중 1년이상 추시가 가능했던 30례의 환자를 대상으로 결과를 분석하여 다음과 같은 결과를 얻었다. 1) 남자가 많았고 30대가 가장 많았다. 2) 가장 많은 손상 원인은 교통사고였으며 17명의 환자에서 동반손상이 있었다. 3) 수상후 수술까지의 기간은 평균 9개월이었고 3개월부터 18개월까지 고른 분포를 보였다. 4) 가장 많은 동반손상은 내측부 인대 파열이었고 다음은 내측부 반월판 손상이었다. 5) 환자의 임상적 평가는 Lysholm knee scoring scale을 사용하였다. Two tunnel군에서는 최종 평가시 79%에서 양호 이상의 소견을 보였고, One tunnel 군에서는 81%에서 양호 이상의 소견을 보였다. 6) 10명의 환자에서 추시관절경을 시행하였으며 관절경 소견상 이식거늬의 생착과정을 확인할 수 있었다. 저자들은 관절경하에서 슬개골-건-골을 이용한 선방 십자인대 재건술을 시행하여 양호한 결과를 얻었고 향후 장기 추시가 필요할 것으로 사료되며 두 가지 수술 방법에 따른 뚜렷한 차이는 없었다. 또한 추시 관절경 검사는 이식건의 성숙 과정을 관찰하고 환자의 재활치료에 방침을 정하기 위해 필요하리라고 사료된다. Recent Arthroscopic ACL reconstruction methods have been developed as a technical solution to achieve proper positioning of the graft. In this study, ACL tear were treated with BTB autograft using either arthroscopic two tunnel method or one tunnel method. We analyzed the 30 cases who had taken the reconstruction surgery of ACL from March 1988 to September 1994. The results were as follows. In the two tunnel group, 79%(15 patients) were estimated as exellent or good result and 81%(9 patients) in the One tunnel group. Follow-up arthroscopy was perfomed to observe the maturation process of the graft in 10 cases. There was no clinical differences between two groups.

관절 내시경술에 의한 퇴행성 슬관절염의 치료

김동헌,장병춘,신규철,이재성 건국대학교 의과학연구소 1999 건국의과학학술지 Vol.9 No.-

The arthroscopic surgery is an increasingly accepted procedure for the treatment of symptomatic arthritic knee. Authors reviewed the operative results of arthroscopic surgery in 35 knee joints of 27 patients from 1993 to 1997. 1. The average age of patients was 64 years old and the primary diagnosis was degenerative osteoarthritis in all patients. 2. Preoperative symptomes and signs were pain(98%), tenderness(85%), swelling(85%), decreased range of motion(71%) and effusion(55%). 3. The operative procedures were irrigation and synovectomy(20%), abrasion arthroplasty(57%), partial menisectomy and abrasion arthroplasty(23%). 4. The symptoms and signs were improved postoperatively: according to Nine point scale, the good results were recorded at postoperative 6 months and follow-up 2 years in nearly all patients. 5. The complications were minimal. Authors concluded that arthroscopic surgery is considered as a reliable method in the treatment of degenerative osteoarthritis of the knee but not as a curable method, needing a long term observation.

노년의 대퇴골 원위부 골절 시 동시에 시행한 전슬관절 성형술 및 금속판 내고정술 : 8예 보고 Report of Eight Cases

김동헌,장병춘,신규철,양준호 건국대학교 의과학연구소 1999 건국의과학학술지 Vol.9 No.-

Supracondylar fracture of the femur can be treated by a wide variety of methods. Although satisfactory results have been achieved with either open and closed treatment, less certain results are obtained for the elderly who have pre-existing osteoarthritis and osteoporosis. Particularly, elderly patients who have preexisting osteoarthritis are at increased risk of posttraumatic arthritis, stiff knee, persistent pain. Primary total knee arthroplasty(TKA) might obviate many of these potential problems and help to return the high-risk patient to an ambulatory functional status immediately. There are few reports about this study. The purpose of this study is to evaluate the results treated by simultaneous internal fixation and TKA for the supracondylar fracture in the elderly who have osteoarthritis of the knee joint. From 1994 to 1998, eight primary TKAs using posterior cruciate sparing PFC knee(Press Fit Condylar, Johnson & Johnson, Raynham, U.S.A) were performed after internal fixation for the supracondylar fracture of the femur with Judet plate or condylar buttress plate by conventional means. Patella was not resurfaced in all knees. According to the M ller classification of the supracondylar fracture of the femur 5 fractures were type A, 2 in type B, 1 in type C. Five patients were female, 3 patients were male. The ages ranged from 66 to 81, with an average of 74 years. Patients were followed for at least 1 year(average 3 years). The mean interval between the injury and operation was 2 weeks(range, 1 week to 4 weeks). Active knee joint exercise was encouraged in a hinge brace under the postoperative pain control. Partial weight bearing was permitted at the postoperative 4 to 6 weeks using crutches. Full weight bearing was allowed after union of the fracture. Fractures were united in all patients and the average duration of bony union was 16 weeks. The average amount of flexion and average flexion contracture for the all patients at the most recent follow-up were 96 degrees (range, 45 to 120 degrees) and 7 degrees (range, zero to 20 degrees), respectively. Using the knee rating score advocated by the American Knee Society, the average postoperative score was 87 for pain and 80 for function. We concluded that simultaneous internal fixation and TKA for supracondylar fracture of the femur in elderly patients who have advanced knee osteoarthritis may provide satisfactory pain relief and function with acceptable morbidity.

보존적 치료로 회복된 망경색에 의한 급성복증 1예

김정념,이숭환,김정식,김진호,배윤오,박성규,윤상정,한현영,이헌영 충남대학교 의과대학 의학연구소 2003 충남의대잡지 Vol.30 No.1

Omental infarction, the end result of impaired perfusion to the greater omentum, is a rare benign self-limiting clinical entity. The main clinical symptom is non-specific localized abdominal pain with a moderately raised white blood cell and erythrocyte sedimentation rate. These findings often mimic an abdominal surgical emergency. This condition is often misdiagnosed as acute appendicitis or cholecystitis. The characteristic feature of CT scan and ultrasonography provide non-invasive diagnosis in most patients with omental infarction. We report a case of patient whose CT scan showed the characteristic finding of omental infarction. The patient was improved spontaneously only with conservative care.

연성 골수정을 이용한 장관골 개방성 골절의 치료

김동헌,신규철,김경순 건국대학교 의과학연구소 1995 건국의과학학술지 Vol.5 No.-

Multiple fractures of the long bone shaft are not uncommon. There has been much controversies concerning over the method of its treatments due to their frequent complication rate. A randomized, prospective study of Ender nailing for multiple fracture of the long bone shaft of thirty-five cases in twenty-five patients was undertaken at the department of orthopaedic surgery, from January 1989 to Febrary 1995. The results are follows: The average age of the patients was 36-year-old and 20 patients were male and the most common cause was traffic accident. Among 35 cases, comminuted fractures were 10 cases and segmental fractures were 4 and others are transverse, short oblique fractures. Average interval from injury to operation was 2 days. Average bone union time. 1) Humerus : 11 week. 2) Femur : 20 week. 3) Tibia : 18 week. The most common complications were nail migration and superficial infection. The non-union developted in one case. From the result, Ender nailing is one of good treatment modality in open long bone fracture of grade Ⅰ, Ⅱ and selected grade Ⅲa, which provides low risk of complication and allows early weight bearing and ambulation without periosteal stripping in the long bone shaft fracture.

간세포암과 감별이 어려웠던 악성중피종 치험 1예

김선문,허원석,채경훈,강윤세,정재훈,김연수,박기오,문희석,이엄석,김석현,성재규,이병석,이헌영,신경숙,조준식,송인상,강대영 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Malignant peritoneal mesothelioma is a rare neoplasm that arises from the mesothelium of a serosal cavity and is a rapidly fatal disease with a median survival of 4 to 12 months for untreated cases. Recently, we experienced a case with malignant peritoneal mesothelioma who was suspected hepatocelluar carcioma by abdominal CT scan and was confirmed by biopsy including immunohistochemical stain(calretinin) after surgery. We performed tumor excisions and wedge resection of the liver(segment Ⅷ)and inserted Tencoff catheter in abdominal cavity at 25th day of post-operation. We treated with intraperitoneal paclitaxel(25mg/m^(2)/day for 5 days) six courses monthly. She was well tolerable and is still living without any evidence of recurrence for 14th month of post-operation.

만성 C형 간염 환자에서 페그인터페론 알파2a와 리바비린 병합 치료중 발생한 벨마비 1예

김일환,장제혁,유충헌,최규남,고정해,김윤정,서광원,김지현,박성재,박은택,이연재,이상혁,설상영 인제대학교 2008 仁濟醫學 Vol.29 No.-

페그인터페론과 리바비린 병합요법은 만성 C형 간염의 일차 치료법이다. 저자들은 만성 C형 간염 환자에서 페그인터페론 과 리바비린 병합 요법 중에 발생한 벨마비 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. 환자는 5년 전부터 만성 C형 간염을 앓아온 48세 남자이며, PEG-IFN α-2a 135μgm 피하주사 주1회와 하루 1200㎎의 리바비린을 투여하였다. 치료시작 후 9개월째 환자는 오른쪽 안면의 근력약화를 호소하였으며 벨마비로 진단되었다. 페그인터페론과 리바비린 병합요법을 지속하면서 관찰하였다. 환자의 벨마비는 페그인터페론 치료를 중단하지 않았음에도 3개월후 증상이 회복되고 이후 벨마비 재발 없이 현재 경과관찰 중이다. 만성 C형 간염에서 페그인터페론과 리바비린 병합 요법시 벨마비의 발생 가능성을 염두에 두어야 하겠다. A Case of Bell's Palsy Associated with Combination Therapy of Pegylated Interferon Alfa-2a (PEG-IFN) and Ribavirin for Chronic Hepatitis C Virus Infection Pegylated interferon alfa(PEG-IFN α) and ribavirin therapy is the first line treatment for chronic hepatitis C. Mild complications of the therapy are common, but more serious complications are rare. We report here a case of Bell's palsy that occurred in a patient with chronic hepatitis C virus infection during combination therapy of PEG-IFN α-2a and ribavirin. The patient was 49-year-old man with chronic hepatitis C (genotype 1b) for 8 years. He had compensated liver cirrhosis with splenomegaly. Therapy with PEG-IFN α- 2a 135mcg/week and ribavirin 1200mg/day was initiated. After 9 months of the therapy, the patient showed a loss of muscular tone on the right side of his face. A diagnosis of Bell's palsy was made. The Bell's palsy resolved over 3 months despite continuation of the combination therapy.

AR기법을 이용한 SLAM 영상 개선

김현,송대건,황기환,연규헌,전계석 慶熙大學校 大學院 1998 高凰論集 Vol.22 No.-

In this paper, we have been studied the enhancement of SLAM image using average response methos. AR methos has been used to reduce the random noise in signal processing. In this the experiment, we have constructed the SLAM system of 10㎒ operating frequency and experienced for holed Al sample. In this experimental result, we have been found that SLAM using AR method was able to get the high-speed and enhanced image compared with SAM.

복 공진형 고주파 인버터의 특성해석 및 설계

김종해,이동헌,이철우,김중기,김동희,조규판 嶺南大學校 工業技術硏究所 1998 工業技術硏究所論文集 Vol.26 No.2

This paper proposes a double resonant high frequency inverter which reduces the distribution of the switching current. The analysis of the proposed circuit is generally described by using the normalized parameters. Also, the principle of the basic operation and the characteristics of driving were estimated by the switching frequency and the load parameters. And the data for the design were got by the characteristic values obtained from the characteristic estimation. At the same time the example of the design method was proposed. In addition, Comparing the theoretical waveforms to the experimental waveforms certified the operating characteristics of the proposed Inverter. It is certain that the proposed circuit will be used and expanded in the high frequency power supplies like induction heating systems.

초음파현미경의 진폭과 위상 영상처리

연규헌,김현 경복대학 1998 京福論叢 Vol.2 No.-

본 연구에서는 시료에서 반사된 신호의 진폭과 위상을 동시에 검출할 수 있는 쿼드러춰 검출기를 사용한 초음파 현미경을 구성하고 표면결함이 존재하는 시료에 적용하여 결함에 대한 진폭과 위상영상을 획득하였으며 비선형 임계치 포스터라이징(Nonlinear Threshold Posterizing) 영상처리방법을 이용하여 산란과 회절에 의한 결함 영상의 질을 개선하였다. 실험을 위하여 시료로서 알루미늄을 사용하여 직경이 2mm인 원형결함이 존재하는 시편을 제작하였으며 영상범위는 50×50 픽셀이 되도록 하고 화소 간격은 200㎛가 되도록 하였다. 비선형 임계치 포스터라이징 처리를 위하여 획득한 영상데이터의 분석으로부터 3개의 임계치를 결정한 후 4개의 그룹으로 명도값 범위를 조정하여 영상처리 하였다. 영상처리결과, 비선형 임계치 포스터라이징 방법은 결함의 경계면에서 콘트라스트를 선형적인 맵핑방법에 비하여 상당히 개선하였으며 특히 위상 영상은 결함 경계면에서 산란과 회절에 의한 블러링 효과를 줄여 진폭영상보다 우수한 영상 화질을 나타내었다. In this study, the acoustic microscope has been constructed using the quadrature detedtor which can simultaneously detect the amplitude and phase of the reflected signal from the sample. The amplitude and phase images of the sample with surface defects have been acquired by the microscope. The scattering and diffration effects have degraded the quality of the images but it has been enhanced by using the nonlinear threshold poterizing processing. In this experiment, the sample has been created by making four circular defects with 2mm diameter on the aluminum surface. The image field of sample is 50×50 pixels and the distance between pixels is 200㎛. To the nonlinear threshold poterizing processing, the threshold values have been decided through the analysis of image data and the range of intensity images has been adjusted in four groups. It has been shown in the results of image processing that the contrast around the boundaries of defects are much more enhanced by the nonlinear threshold poterizing processing method than the linear mapping method, and especially the quality of phase image is better than the amplitude image by reducing the blurring effect around the boundaris.