60세 이상 환자의 척추수술

윤석만,이경석,도재원,배학근,윤일규 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

Objective: Advances in surgical technique, anesthesia and perioperative patient management, coupled with the rapid increase in the population of patients reaching their 60s or older, have led to a signiticant rise in spinal precedures. The objective of this study was to evaluate frequency of the disease, surgical results and postoperative complications of the aged patients who underwent spinal surgeries. Methods : We reviewed all spinal procedures for spinal lesions including degenerative diseases, trauma, tumor and others in patients aged 60 years or older between January 1 1994 and October 1 1998(56 men and 26 women), retrospectively. Final outcome was assessed by telephone interview with the patient or the family in 67.1%(55/82). Results : There were 56 male patients and 26 female patients. There were 57 cases of degenerative diseases, 14 cases of trauma, 5 cases of metastaisis, 4 cases of infection and 2 cases of others. According to the level of surgical procedures, there were 20 cases fo cervical spine, 8 cases of thoracic spine, 54 cases of lumbar spine. Postoperaive complications included the following(17/82): 7 dural tears, 2 sepsis, 2 nerve root injury and 6 others. There were no operation-related deaths. During follow up period, ten patients(12.2%) had died, 45 patients(54.9%) were contacted and 27 patients(32.9%) could not be located. Mean follow up period for the 45 patients contacted was 26.1±15.7 months. Of the 45 persons contacted, 34(75.6%) reported improvement, 6(13.3%) no change and 5(11.1%) aggravation of their preoperative symptoms. Conclusion: Spine surgery in patients aged 60 years or older has higher complication rate compare to the younger but it is reasonable to consider the surgical procedures even in the elderly if it is needed. We should give attention not to tear the dura during the surgical procedures, especially in the elderly.

자발성 뇌지주막하 출혈 환자에서 최초 뇌실 크기의 임상적 의의

신일영,윤일규,윤석만,도재원,이경석,배학근,최순관,변박장 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

The purpose of this study is to invesetigate the clinical significance of initial enlargement of ventricle in the patients who had aneurysmal SAH. Of the total 821 patients with aneursmal SAH who were registerd in SAH data bank system between 1989-1999, 307 patients who had been already measured in the size of ventricle at the time of admission, were studied retrospectively. The size of ventricle was calculated by bifrontal index. Normal size of ventricle was defined as 30% or less, mild enlargement was defined as 31 to 39%, and moderate enlargement of vertricle was defined as more than 39% in bifrontal index. The sizes of ventricle using bifrontal index were analysed according to the age, sex, blood pressure, consciousness at admission, medical history of hypertension, location of ruptured aneurysm, Fisher's grade on CT(computerized tomography) scan at the time of admission, cerebral vasospasm, intraventricular hemorrhage (IVH), performance of external ventricular drainage (EVD), and prognosis at discherge. Chi-square test and ANONA were used in the statistical evaluation. The results were as follows : 1) Of the 307 patients, 235(76.5%) had a mild to moderate enlargement of ventricle at the time of admission (more than 30% in bifrontal index). 2) The size of ventricle was enlarged according to the increase of age (p<0.05). 3) In the patients who had ruptured aneurysm on anterior cerebral artery, the size of ventricle significantly increased and showed a higher incidence in mild enlargement compared with moderate enlargement of ventricle (p<0.05). 4) The size of ventricle increased in th patients who had IVH and the EVD was more frequently performed in th patients who had the enlarged ventricle associated with IVH (p<0.05). 5) In the patients who had high Fisher's grade, the size of ventricle had a tendency to increase, but there was no statistical significance. 6) In the patients who had poor prognosis, the size of ventricle had a tendency to increase, but there was no statistical significance. Conclusively, the initial size of ventricle was enlarged in th aged patients, ruptured aneurysm on anterior communicating artery, high FIsher's grade, patients associated with IVH. Considering those factors, prediction for the enlargement of ventricle size may help to treat the patients suffering aneurysmal SAH.

외상후 발작의 위험인자에 대한 조사

이재학,배학근,윤석만,도재원,이경석,윤일규,최순관,변박장 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

Risk Factors for Posttraumatic Seizure The authors evaluate the risk factors for posttraumatic seizures. this prospective study was performed in a series of 470 head injured patient from January 1996 to Decomber 1998. The patients who were dead within 1 week of injury or children from 3 years old and under were excluded. There were 358 male and 112 female with a mean age of 35.2±22.8 years (range, 4-88 years). The results were as follows : 1). Of the 470 patients, pasttraumatic seizure occurred in 48 patients(10.2%): early seizure in 28(6%) and late seizure in 20 patients(4.2%). 2). The clinical risk factors for posttraumatic seizure were poor consciousness at admission, presence of brainstem herniation signs, poor GCS score, and posttraumatic amnesia more than 24 hours after trauma(p<0.001). 3). The radiological risk factors for posttraumatic seizure were subdural hematoma(p<0.001), intracerebral hematoma (p<0.02), mutiple intracranial CT lesions(p<0.001), or delayed lesions on follow-up CT scans(p<0.001). the incidence of seizure increased according to the severity of diffuse brain lesion(p<0.001), and the seizure rate in mass lesion was higher than that in diffuse lesion(p<0.001). 5). Hypoxia and coagulopathy had a statistically significant influence on posttraumatic seizure(p<0.05). Hypoxia had a infuence on occurrence of late seizure(p<0.05). 6). The incidence of posttraumatic seizure signiticantly increased in surgical group compared with coservative group(p<0.001) and significantly increased in patient who underwent decompressive craniectomy compared with those who underwent craniotomy(p<0.001) 7). Preventive administration of antiepileptic drugs decreased the incidence of early seizure, but did not affect on the reduction of late seizure. 8). Multivariate logistic regression analysis showed the subdural hematoma, GCS score, delayed lesion, and intracerebral hematoma in order of importance for seizure risk. in conclusion, the risk factors affecting on the occurrence of seizure were clinical status at admission, CT lesions, and severity of diffuse brain inJury. Considering that hypoxia affected on the late seizure, it is necessary to detect and treat it immediately after trauma. In addition, the patients who underwent decompressive craniectomy should be carefully followed to evaluate the risk of late seizure. Even though preventive administration of antiepileptic drugs had a tendency to decrease the incidence of early seizure, it is unclear whether administration of antiepileptic drugs can reduce the incidence of posttraumatic seizures. Prospective study will be needed in the selected patients.

Profile^(Ⓡ), ProTaper™ 및 K^(3TM) Ni-Ti파일의 과기구 조작이 치근단공 변위에 미치는 영향

양현,양인석,황윤찬,황인남,윤숙자,김원재,오원만 대한치과보존학회 2007 Restorative Dentistry & Endodontics Vol.32 No.2

본 연구는 ProFile, ProTaper 및 K^(3)를 이용하여 과잉 기구 조작에 의해 근관 성형 시 근관의 만곡형태와 Ni-Ti 파일의 종류에 따라 치근단공이 어떻게 변위 되는지를 비교 분석하고자 시행되었다. 본 실험에서는 레진모형근관으로 J자와 S자의 근관 형태가 재현된 ENDO-TRAINING BLOC을 사용하였다. 근관 성형 기구로는 ProFile^(®), ProTaper™, K^(3TM)를 사용하였다. 총 60개의 레진모형근관을 사용하였으며, 사용된 레진모형근관 및 Ni-Ti 파일의 종류에 따라 10개씩 6개의 군으로 나누어 근관성형을 시행하였다. 근관 성형 전·후 이미지를 Image-analyzing microscope 100X를 이용하여 얻고 Photoshop 7.0 프로그램을 이용하여 중첩하였다. 이미지 분석 프로그램을 이용하여 근관 성형 전·후 치근단공의 중심으로부터의 직경 변화량과 면적을 측정한 결과 만곡된 근관의 성형시 치근단공이 주로 만곡의 외측으로 변위됨을 나타내며 ProFile이 ProTaper나 K^(3) 보다 통계적으로 유의성이 있게 작은 변화량을 나타내어 근관성형시 바람직한 기구임을 시사한다. This study was done to evaluate transportation of the apical foramen after 0.5 mm overinstrumentation by ProFile, ProTaper and K^(3) in simulated resin root canal. Sixty simulated resin root canal with a curvature of J and S-shape were divided into two groups. Each group consisted of three subgroups with 10 blocks according to the instruments used: ProFile^(®), ProTaper™, and K^(3TM). Simulated resin root canal was prepared by ProFile, ProTaper and K^(3) with 300 rpm by the crown-down preparation technique. Pre- and post-instrumentation apical foramen images were overlapped and recorded with Image-analyzing microscope 100X (Camcope, Sometech Inc, Korea). The amounts of difference in width and dimension on overlapped images were measured after reference points were determined by Image Analysis program (Image-Pro^(®) Express, Media Cybernetic, USA). Data were analyzed using Kruskal-Wallis and Mann-Whitney U-test. The results suggest that ProFile showed significantly less canal transportation and maintained original apical foramen shape better than K^(3) and ProTaper.

ProFile^®, ProTaper^TM 및 K^3TM Ni-Ti 파일의 과기구 조작이 치근단공 변위에 미치는 영향

양현,양인석,황윤찬,황인남,윤숙자,김원재,오원만,Yang, Hyun,Yang, In-Seok,Hwang, Yun-Chann,Hwang, In-Man,Yoon, Suk-Ja,Kim, Won-Jae,Oh, Won-Mann 대한치과보존학회 2007 Restorative Dentistry & Endodontics Vol.32 No.2

This study was done to evaluate transportation of the apical foramen after 0.5 mm overinstrumentation by ProFile, ProTaper and $K^3$ in simulated resin root canal. Sixty simulated resin root canal with a curvature of J and S-shape were divided into two groups. Each group consisted of three subgroups with 10 blocks according to the instruments used: $ProFile^{(R)},\;ProTaper^{TM},\;and\;K^{3TM}$. Simulated resin root canal was prepared by ProFile, ProTaper and $K^3$ with 300 rpm by the crown-down preparation technique. Pre- and post-instrumentation apical foramen images were overlapped and recorded with Image-analyzing microscope 100X (Camcope, Sometech Inc, Korea). The amounts of difference in width and dimension on overlapped images were measured after reference points were determined by Image Analysis program ($Image-Pro^{(R)}$ Express, Media Cybernetic, USA). Data were analyzed using Kruskal-Wallis and Mann-Whitney U-test. The results suggest that ProFile showed significantly less canal transportation and maintained original apical foramen shape better than $K^3$ and ProTaper. 본 연구는 ProFile, ProTaper 및 $K^3$를 이용하여 과잉 기구 조작에 의해 근관 성형 시 근관의 만곡형태와 Ni-Ti 파일의 종류에 따라 치근단공이 어떻게 변위 되는지를 비교 분석하고자 시행되었다. 본 실험에서는 레진모형근관으로 J자와 S자의 근관 형태가 재현된 ENDO-TRAINING BLOC을 사용하였다 근관성형 기구로는 $ProFile^{(R)},\;ProTaper^{TM},\;K^{3TM}$를 사용하였다. 총 60개의 레진모형근관을 사용하였으며, 사용된 레진모형근관 및 Ni-Ti 파일의 종류에 따라 10개씩 6개의 군으로 나누어 근관성형을 시행하였다. 근관 성형 전 후 이미지를 Image-analyzing microscope 100X를 이용하여 얻고 Photoshop 7.0 프로그램을 이용하여 중첩하였다. 이미지 분석 프로그램을 이용하여 근관 성형 전 후 치근단공의 중심으로부터의 직경 변화량과 면적을 측정한 결과 만곡된 근관의 성형시 치근단공이 주로 만곡의 외측으로 변위됨을 나타내며 ProFile이 ProTaper나 $K^3$보다 통계적으로 유의성이 있게 작은 변화량을 나타내어 근관성형시 바람직한 기구임을 시사한다.

Flow and Heat Transfer Characteristics of Drag Reduction Additives in District Heating and Cooling System

Yoon, Seok-Mann,Kim, Nam-Jin,Kim, Chong-Bo,Hur, Byung-Ki 한국공업화학회 2002 Journal of Industrial and Engineering Chemistry Vol.8 No.6

In the present investigation, the effects of polymer additives in district heating and cooling system to produce significant reductions in drag and heat transfer reduction are having observed. It is found that comparing with well-known polyacrylamide, copolymer additives are more effective and reliable in obtaining maximum drag reduction, and there also exist optimal conditions for mixing ratio of polymers, and with surfactants. It is found that the ice slurry system gives less pressure drops compared with chilled water system with ice fractions. Since the ice slurry system has an advantage due to its heat capacity, it can be a very effective method for district cooling system. Consequently, great energy savings in the system and the competitiveness of the district heating and cooling system will be greatly increased consequently.

Prognostic Value of Serum S100 Protein by Elecsys S100 Immunoassay in Patients with Spontaneous Subarachnoid and Intracerebral Hemorrhages

Yoon, Seok-Mann,Choi, Young-Jin,Kim, Hwi-Jun,Shim, Jai-Joon,Bae, Hack-Gun,Yun, Il-Gyu The Korean Neurosurgical Society 2008 Journal of Korean neurosurgical society Vol.44 No.5

Objective: The serum S100 protein has been known to reflect the severity of neuronal damage. The purpose of this study was to assess the prognostic value of the serum S100 protein by Elecsys S100 immunoassay in patients with subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH) and to establish reference value for this new method. Methods: Serum S100 protein value was measured at admission, day 3 and 7 after bleeding in 42 consecutive patients (SAH : 20, ICH : 22) and 74 healthy controls, prospectively. Admission Glasgow coma scale (GCS) score, Hunt & Hess grade and Fisher grade for SAH, presence of intraventricular hemorrhage, ICH volume, and outcome at discharge were evaluated. Degrees of serum S100 elevation and their effect on outcomes were compared between two groups. Results: Median S100 levels in SAH and ICH groups were elevated at admission (0.092 versus $0.283{\mu}g/L$) and at day 3 (0.110 versus $0.099{\mu}g/L$) compared to healthy controls ($0.05{\mu}g/L;$ p<0001). At day 7, however, these levels were normalized in both groups. Time course of S100 level in SAH patient was relatively steady at least during the first 3 days, whereas in ICH patient it showed abrupt S100 surge on admission and then decreased rapidly during the next 7 days, suggesting severe brain damage at the time of bleeding. In ICH patient, S100 level on admission correlated well with GCS score (r=-0.859; p=0.0001) and ICH volume (r=0.663; p=0.001). A baseline S100 level more than $0.199{\mu}g/L$ predicted poor outcome with 92% sensitivity and 90% specificity. Logistic regression analyses showed Ln (S100) on admission as the only independent predictor of poor outcome (odd ratio 36.1; 95% CI, 1.98 to 656.3) Conclusion: Brain damage in ICH patient seems to develop immediately after bleeding, whereas in SAH patients it seems to be sustained for few days. Degree of brain damage is more severe in ICH compared to SAH group based on the S100 level. S100 level is considered an independent predictor of poor outcome in patient with spontaneous ICH, but not in SAH. Further study with large population is required to confirm this result.

Delayed Carotid Wallstent Shortening Resulting in Restenosis Following Successful Carotid Artery Angioplasty and Stenting

Yoon, Seok-Mann,Jo, Kwang-Wook,Baik, Min-Woo,Kim, Young-Woo The Korean Neurosurgical Society 2009 Journal of Korean neurosurgical society Vol.46 No.5

Carotid angioplasty and stenting (CAS) for carotid stenosis has been increasingly used as an alternative treatment in patients not eligible for surgery. Even though CAS can be performed relatively simply in many cases, various complications can occur. We report four cases of CAS using the Carotid Wallstent, which were complicated by delayed shortening of the stent, resulting in restenosis after successful CAS.

Bilateral Vertebral Artery Dissecting Aneurysms Presenting with Subarachnoid Hemorrhage Treated by Staged Coil Trapping and Covered Stents Graft

Yoon, Seok-Mann,Shim, Jai-Joon,Kim, Sung-Ho,Chang, Jae-Chil The Korean Neurosurgical Society 2012 Journal of Korean neurosurgical society Vol.51 No.3

The treatment of bilateral vertebral artery dissecting aneurysms (VADAs) presenting with subarachnoid hemorrhage (SAH) is still challenging. The authors report a rare case of bilateral VADA treated with coil trapping of ruptured VADA and covered stents implantation after multiple unsuccessful stent assisted coiling of the contralateral unruptured VADA. A 44-year-old woman was admitted to our hospital because of severe headache and sudden stuporous consciousness. Brain CT showed thick SAH and intraventricular hemorrhage. Cerebral angiography demonstrated bilateral VADA. Based on the SAH pattern and aneurysm configurations, the right VADA was considered ruptured. This was trapped with endovascular coils without difficulty. One month later, the contralateral unruptured VADA was protected using a stent-within-a-stent technique, but marked enlargement of the left VADA was detected by 8-months follow-up angiography. Subsequently two times coil packing for pseudosacs resulted in near complete occlusion of left VADA. However, it continued to grow. Covered stents graft below the posterior inferior cerebellar artery (PICA) origin and a coronary stent implantation across the origin of the PICA resulted in near complete obliteration of the VADA. Covered stent graft can be used as a last therapeutic option for the management of VADA, which requires absolute preservation of VA flow.

지역난방을 이용한 근교농업 테스트베드 구축 및 운영

윤석만(Seok Mann Yoon),안덕용(Deog Yong Ahn),이창수(Chang Soo Lee),백재승(Jae Sung Paek),신찬영(Chan Young Shin),이병로(Byong Ro Lee) 대한설비공학회 2017 대한설비공학회 학술발표대회논문집 Vol.2017 No.6