• Journal of Chest Surgery
• /
• 제29권5호
• /
• pp.495-503
• /
• 1996

Fonlan수술의 고위험군 환자에게 시행되는 양방향성 상대정맥-폐동맥 단락술은 비교적 낮은 수술 위험과 동맥혈내 산소포화도의 증가,그리고 체심실에 대한 용적 부담을 줄임으로서 Fontan수술전에 시행하는 효과적인 중간 단계의 고식적 수술로서 알려져있다 그러나 낮은 체정맥압에 의해 유지되는 페혈류인 양방향성 상대정 맥-폐동맥 단락술후 폐동맥의 크기 변화에 대 해서는 아직까지 논란이 되고 있 다. 본 연구에서는 양방향성 상대정맥-폐동맥 단락술이 폐동맥의 크기에 미치는 영향을 밝혀내고자 1992 년 2월부터 1994년 7월까지 서울대학교 의과대학 흉부외과학교실에서 양방향성 상대정맥-폐동맥 단락 술을 받은 19명의 환자를 대상으로 수술전 3.8 $\pm$4.8개월 및 수술후 19.6$\pm$6.2개월에 시행한 심도자 및 혈 관조영술의 결과를 검토하고 이를 통계 처리하였다. 폐동맥의 크기는 폐동맥 지수와 McGoon비를 이 용하였고 환자의 나이,체표면적,혈관 성형술 여부,수술전 폐동맥의 크기,수술후심도자 및 혈관조엮 술까지의 기간 등을 변수로 폐동맥의 성장여부를 연구하였다. 수술전 심도자 및 혈관조영술 당시 환자의 평균 나이는 1).7$\pm$15.6개월, 평균 체 Ⅸ湧岵\ulcorner0.40$\pm$0.12 m2, 동맥혈 산소포화도는 71.4$\pm$12.4% 이었다. 우폐동맥의 지름은 7.1$\pm$1.7mm, 좌폐동맥의 지름은 6.2$\pm$ 1.7 mm, 폐동맥 지수는 191.8$\pm$82.7mm21m2, McGoon 비는 1.73$\pm$0.49 였다. 폐동맥 압력은 6명에 서 측정하였는데 평균 폐동맥 압은 21 mmHg 이 었다. 한편 수술후 심도자 및 혈관조영술 당시 환자의 평균 나이는 39.9$\pm$ 16.2개월, 평균 체표면적은 0.58$\pm$ 0.07m', 동맥 혈 산소포화도는 83.0$\pm$3.8 % 이었다. 우폐동맥의 지름은 9.0$\pm$ 1.5 mm, 좌폐동맥의 지름은 7.7 $\pm$2.Omm, 폐동맥 지수는 197.3$\pm$57.1 mm2/m2, McGoon 비는 1.76$\pm$0.32 였다 수술후 전 환자에서 폐동맥 압력을 측정하였으며 평균 폐동맥 압은 12.8 $\pm$3.6mmHg이 었다. 환자의 성장에 따라 폐동맥의 지름도 증가하였으나 폐동맥 지수나 McGoon비는 증가하지 않았다. 또한 환자의 나이, 술후 동맥혈내 산소포화도의 증가 정도, 혈관 성형술 여부, 수술후 심도자 및 혈큰조 영술까지의 기간 등은 수술후의 폐동맥 지수의 증가에 영향을미치지 못하였으며 단지 수술전의 폐동맥 의 크기가 매우 작을 경우(McGoon 비 1.2 미만)에는 폐동맥 지수가 유의한 증가를 보였는데 이는 수술 \ulcorner 동반된 폐동맥 성형술등의 영향이 있었음을 감안하여야 할 것으로 생각되었다. 한편 수술전 폐동맥 크기에 대한 지표로서 폐동맥 지수(PAI)와 McGoon 비(MGR)와는 다음과 같은 유의한 상관관계가 있 음을 알 수 있었다 상관식 : PAI : MGRxl18.0-12.4. 결론적으로 양방향성 상대정맥-폐동맥 단락술이 동맥혈내 산소포화도는 증가시키나 폐동맥 지수는 단기간의 본 연구에서는 증가하지 않는 것으로 나타났다. 향후 박동성 양방향성 상대정맥-폐동맥 단락 술이나 또는 Blalock-Taussig 단락술등이 폐동맥의 성 장에 미치는 영 향에 대한 연구가 필요할 것으로 생각된다.

• 동국한의학연구소논문집
• /
• 제8권2호
• /
• pp.155-173
• /
• 2000

한의학의 진단(診斷)에는 망(望) 문(聞) 문(問) 절(切)의 사진법(四診法)과 여러 가지의 변증체계(辨證體系), 즉 기혈진액변증(氣血津液辨證) 장부변증(臟腑辨證), 육경변증(六經辨證), 위기영혈변증(衛氣營血辨證), 삼초변증(三焦辨證), 사상체질변증(四象體質辨證) 등이 응용되어 지고 있으며, 또한 그와 더불어 병상(症狀) 증후감병진단법(證候鑑別診斷法)등이 선택적으로 활용되어 지고 있다. 이러한 광범위(廣範位)한 진단방법(診斷方法)가운데 절진(切診)은 손가락 및 손바닥의 감각(感覺)을 운용(運用)해서 일정부위(一定部位)를 촉지(觸指), 접압(接壓)하는 검사방법(檢査方法)으로써 절맥진(切脈診)과 접진(接診)으로 크게 나눌 수 있다. 이중 안진(按診)이란 손을 사용하여 직접 환부에 촉모(觸摸) 안압(按壓)하여 이상변화를 알아내고 나아가서는 질병(疾病)의 부위(部位)와 성질(性質)과 병정(病情)의 경중(輕重) 등의 내부(內部)의 변화(變化)와 체표(體表)의 반응(反應)을 관찰(觀察)하여 중요(重要)한 변증자료(辨證資料)를 얻는 진단방법(診斷方法)의 한 종류(種類)를 말한다. 또한 접진(接診)에는 안기표(按肌表), 접수족(接手足), 안흉복(按胸腹), 접유혈진법(接兪穴診法)등을 들 수 있다. 배유혈(背兪穴)의 진단법(診斷法)은 경기(經綺)이라는 반응로(反應路)를 통(通)하여 체표(體表)에 발현(發現)되는 압통(壓痛), 자발통(自發痛), 긴장(緊張), 이완(弛緩), 경결(硬結) 및 조색상물(條索狀物) 등의 현상(現象)으로 부터 내부장기(內部臟器)의 병변(病變)을 진단(診斷)하는 방법(方法)이다. 이에 저자(著者)는 접진(接診)의 내용(內容)과 방법(方法)을 연구하면서 십이경맥(十二經脈)의 시동병(始動病) 소생병(所生病)을 알아보고 혈위진단(穴位診斷)의 방법(方法) 및 주의점(注意點)등을 아울러 정리하므로써 다음과 같은 결론(結論)을 얻었다. 1. 유혈(兪穴)은 각(各) 장부(臟腑)의 사기(邪氣)가 주입(注入)하는 곳으로 장병(臟病) 한증(寒症) 허증(虛症)의 의미를 내포한 음성병증(陰性病症) 치료(治療)에 중요(重要)한 곳이다. 2. 유차(兪次)의 촉진(觸診) 즉(卽) 모지(母指)로서 척추극돌기(脊椎棘突起) 좌우측(左右側)을 접압(接壓)하여서 상향(上向)이나 하향(下向)으로 추압지(推壓指)하면 극돌기(棘突起)의 돌(突), 함요(陷凹), 긴장(緊張), 이완(弛緩) 및 압통(壓痛)의 출현부위(出現部位)에 따라 계통별(系統別) 질환(疾患)을 판단(判斷)할 수 있다. 3. 실제(實際) 임상(臨床)에서 환자(患者)의 진단(診斷) 치료(治療)에 있어서 배부접진(背部接診)은 중요(重要)한 진단(診斷)의 한 영역(領域)으로 빠뜨리지 말고 꼭 참고(參考)하여야 할 것으로 사료(思料)된다. 4. 장부질환(臟腑疾患)에 대한 진단방법(診斷方法)의 다양화(多樣化)와 치료영역(治療領域)의 확대(擴大) 및 치료율(治療率)의 상승(上昇)을 위해 배부유혈(背部兪穴)의 정확(正確)한 인식(認識)과 유혈접진(兪穴接診)을 통하여 정확(正確)한 진단(診斷)이 되었으면 한다.

• 한국의학물리학회지:의학물리
• /
• 제10권2호
• /
• pp.63-71
• /
• 1999

입체조형 치료와 전신 방사선 수술에의 이용을 목적으로 3차원 전신 정위 방사선 치료 장치를 개발하였다. Couch 위에 놓을 수 있는 전신 정위 치료판을 제작하여 방사선 비투과성 카테타 선을 이용하여 치료판 위에 좌표계를 설치하고, MeV-Green(전성 물산, 한국)으로 고정틀을 만들어 환자 자세를 고정시키고, 플라스틱 봉과 봉 지지판을 이용하여 고정틀을 고정하였다. 이러한 설계, 제작으로 입체 조형 치료 등에서 갠트리 회전에 의한 기하학적 제약을 최소화하고 방사선 조사 투과율 이 특정한 방향에서 영향을 받는 문제점을 해소하였다. CT 영상을 통해 치료 표적의 위치를 파악하고 치료판 기준점에 대하여 좌표화하여 모의 치료시와 방사선 치료시의 환자 자세 변화 오차를 줄였다. 3대의 CCTV 카메라를 사용하여 환자 자세 변화를 감지, 수정함으로써 체표변의 외곽선으로 부터 setup 오차를 최소화 할 수 있었다. 치료 효용성을 높이기 위해 이러한 과정을 모니터를 보면서 실시간으로 처리 할 수 있도록 하였고, IDL(Interactive Data Language, RSI, U.S.A.)을 사용하여 image subtraction 방식으로 환자 자세 변화를 가시화하여 오차를 줄이도록 하였다. 내부 장기 움직임에 따른 표적의 움직임을 추적할 목적으로 rotating X-ray 장치를 제작하였다. Landmark 나사를 표적주위 뼈나 표적중심에 삽입하여 이 rotating X-ray 장치를 이용해서 anterior, lateral 두 방향에서 얻은 영상 정보로부터 marker 에 대한 표적의 위치 변화를 가시화 하여 내부 표적의 움직임에 따른 setup 오차를 줄였다. CT 모의치료를 할 수 있도록 IDL 을 이용하여 PC용 모의치료 프로그램을 GUI 환경에서 구현하였고 이 프로그램을 통해서 치료 계획을 위해 CT 에서 수집된 영상정 보를 이용하여 표적을 포함한 장기들의 그래픽 처리, 편집, 전송 등의 작업을 수행하도록 하였다.

• Journal of Acupuncture Research
• /
• 제29권2호
• /
• pp.1-8
• /
• 2012

Objectives : This study was performed to compare the effects between Mountain-burning fire method and Heaven-penetrating cooling method on thermographic change. Materials and Methods : The experiment was conducted to 20 students of College of Oriental Medicine, Woosuk University from July 12, 2011 to July 26, 2011. Acupuncture stimulation was applied at left $Zusanli$($ST_{36}$) with Mountain-burning fire method in A group(n=10) and Heaven-penetrating cooling method in B group (n=10). To estimate thermographic change, temperature of left $Zusanli$($ST_{36}$), $Shuigou$($GV_{26}$), $Zhongwan$($CV_{12}$) were measured by DITI(digital infrared thermographic image) before acupuncture stimulation and 30sec, 10min after needle removal. Results : In A group, the temperature of left $Zusanli$($ST_{36}$), $Shuigou$($GV_{26}$), $Zhongwan$($CV_{12}$) were decreased at 30sec after needle removal, statistically. And the temperature of $Zusanli$($ST_{36}$), $Zhongwan$($CV_{12}$) were decreased at 10min after needle removal, statistically. In B group, the temperature of $Zusanli$($ST_{36}$), $Zhongwan$($CV_{12}$) were decreased at 10min after needle removal, statistically. But, there was no significant difference between two groups on thermographic change, statistically Conclusions : Acupuncture stimulation applied at left $Zusanli$($ST_{36}$) with Mountain-burning fire method has more widespread effects than Heaven-penetrating cooling method. But further studies will be needed such as thermographic change with no stimulation and with more subjects.

• 대한약침학회지
• /
• 제4권3호
• /
• pp.7-14
• /
• 2001

Objective: This study was done to observe the effects on the thermal changes and side effects of Bee Venom acupuncture. The objectives are as follows; If there are remarkable local thermal changes between pre and post Bee Venom acupuncture therapy on D.I.T.I. or not. If there are those, we examine how long it' s changes are maintained, what is the adequate interval on Bee Venom acupuncture therapy, and what the reactions in a local or whole body are on that therapy. Methods: To study the local thermal changes in Bee Venom acupuncture therapy, D.I.T.I. was used. Determination of this analysis periods are pre and post-therapy(5 minutes, 1 hour, 1day,2days, 3days, 5days and 7days later). The study group was divided into two groups. One was BV group(N=19), another was NS(Normal Saline) group. The Bee Venom acupuncture was injected by 0.2ml divided into 0.05ml at the Fengmen(風門:12), Feishu(肺兪:B13), Fufen(附分:B41), Pohu(魄戶: B42) 4 points. Then, in order to analyze the clinical form, we have observed responses of 23 students whenever we checked the thermal changes of their after performing. Results: The following results were obtained. 1. In BV group, there was a significant dermatothermal difference between pre and post therapy. That difference was most remarkable in post-therapy 1 hour to lday, and was not remarkable in post-therapy 5-7days later. 2. There was no significant dermatothermal changes at NS group, but BV group had remarkable changes between operated and non operated area in post-therapy 1hour, 1day, 2days. But there was none 7 days later. 3. Among the physical reactions after Bee Venom acupuncture therapy, operated-area pain, itching, pain on moving and fatigue sign most appeared until post-therapy 3days. Itching and fatigue sign appeared until post-therapy 7days. 4. In comparison the dermatothermal changes with the physical reactions, the decrease of { CT = (Rt Temperature -Lt. Temperature) / Rt. $Temperature{\times}100$} and the disappearance of physical reactions were about the same.

• 대한임상전기생리학회지
• /
• 제5권2호
• /
• pp.61-72
• /
• 2007

INTRODUCTION: Local heat and cold application has been frequently used as means of muscle relaxation and blood circulation or reinforcing muscle strength, relaxing muscle tension in clinical situation. In particular, it has been known that long-term heat and cold application for relaxing muscle tension inhibits muscle spasticity or tension. But, it has been rarely reported that what influences of heat and cold application on activation of muscle action potential. Therefore, this study aims to analyze surface temperature and electromyography activities according to the heat and cold application. METHODE: Subjects of this research were 10 normal men and women (5 men, 5 women). Hot pack and cold pack was applied to vastus medialis muscle of thigh and rectus femoris muscle for 20 min. Surface temperature of vastus medialis muscle and rectus femoris muscle was measured, knee joint of subjects was in $45^{\circ}$ flexion, sitting on a chair, maximal isometric contraction was induced, surface electromyography (sEMG) signals were collected and root mean square (RMS) and median frequency (MOF) were analyzed. All measurements were conducted before and immediately after experiment, 10 min., 20 min. and 30 min. after experiment. Data were analyzed with SPSS 12.0 program, comparison of changes in superficial temperature and sEMG signals through repeated measurement was conducted with repeated measures ANOVA and significance level $\alpha$ was 0.05. RESULTS: Changes of surface temperature of vastus medialis muscle according to cold application were radically decreased immediately after application, but it was recovered after 30 min. of application and it showed significant difference (F4. 36=72.216, P<0.001). Surface temperature of rectus femoris also showed radical decrease immediately after application, but it was recovered after 30 min. of application and showed significant difference (F4. 36=88.930, P<0.001). Changes of surface temperature of vastus medialis muscle according to heat application were radically increased immediately after application, but it was recovered after 30 min. of application and it showed significant difference (F4. 36=27.267, P<0.001). Surface temperature of rectus femoris also showed radical decrease immediately after application, but it was recovered after 30 min. of application and showed significant difference (F4. 36=19.774, P<0.001). Changes of sEMG by heat and cold application were no statistical difference. Surface temperature of skeletal muscle after heat and cold application showed significant change for 30 min., but it was found that increase or decrease of surface temperature had not great influence on sEMG activities.

• Journal of Acupuncture Research
• /
• 제18권1호
• /
• pp.40-49
• /
• 2001

Background and Purpose : There have been many studys about the relationship between the meridians and the acupoints of the twelve meridians, but no study about the extra points. To verify Dong-Shi acupoints, a kind of extra points, we studied the effects on the thermal changes of the ankle region following acupuncture on the Wu-Hu. Object and Methods : This study was researched into clinical statistics for 45 healthy normal students. The object was divided into two groups. One was the control group and the other was the acupuncture group. The acupuncture group was divided into two groups ; ACU-up : The class of ascent thermal change among acupuncture group. ACU-dn : The class of descent thermal change among acupuncture group. First, in the control group, we took a picture at the ankle region(BL60, BL62, GB40, ST41) without any stimulation with the Digital Infrared Thermal Imaging System and did after 10 minutes respectively. Second, in the acupuncture group, we took a picture without any stimulation and then acupuncture on Wu-Hu and took a picture after 10 minutes in the same way respectively. Results : 1. In the control group, average thermal change of BL60, BL62, GB40 and ST41 was decreased(about $0.2^{\circ}C$) after 10 minutes. 2. The skin temperature of all measured parts was significantly lower in the ACU-dn group after 10 minutes. 3. There were no significant differences of thermal change between the control and the acupuncture group, between the control and ACU-up group after 10 minutes. Conclusion : This result indicated that the acupuncture on the Wu-Hu was effective at the ankle region. And so the more study is needed continuously.

• 한국가정과학회지
• /
• 제7권3호
• /
• pp.35-48
• /
• 2004

In this study, by determining lower limb movements which cause significant changes in body surface lines, body parts with the greatest maximum expansion and contraction rate respectively were illustrated in descending order. Using unmarried female university students aged 18 - 24 as subjects, a total of 32 body surface categories (15 body surface lines and 17 body surface segment lines) were measured in one static and 9 movement poses. In particular, expansion and contraction levels and rates were measured and used in the analysis. The analysis first involved the calculation of the average measurement per body part in body surface line in static pose as well as of the average expansion and contraction levels and rates in 9 lower limb movements. Two-way MANOVA and multiple comparison analysis (Tukey) were conducted on movements and individual somatotypes regarding measurement per body part and expansion and contraction rates. Movements which cause measurements of body surface lines differed significantly in body surface line in static pose versus in movement were then identified. Among average expansion and contraction rates in such movements, maximum average expansion and contraction levels, maximum average expansion and contraction rate, and classes of expansion and contraction rate were determined per body part. The results of this study are as follows. First, 5 lower limb movements; F2, F5, F6, F7, F8, which caused significant changes in body surface lines were determined and illustrated in table 4. Second, the levels, rates, and classes of expansion and contraction rate per body part are illustrated in Tables 5 and 6. Body parts with the greatest maximum expansion rate were, in descending order: upper segment of center back leg line, upper segment of inner leg line, middle segment of center front leg line, posterior crotch length, anterior knee girth, anterior thigh girth, center back leg line, girth at crotch height, anterior midway thigh girth, hip girth, anterior crotch length, knee girth, waist girth, inner leg line, thigh girth, and crotch length. Those with the greatest maximum contraction rate were, in descending order: anterior crotch length, upper segment of center front leg line, lower segment of center back leg line, center front leg line, and posterior thigh girth. The maximum expansion rates and maximum contraction rates, which ranged from 2.05 to $35.95\%$ and from -0.20 to $-30.16\%$ respectively, were classified per body part into 4 ABCD classes. The body part with maximum expansion was the upper segment of the center back leg line at vertical body surface line, expanding by $35.95\%$ or 16.03cm in F5 flexion movement. In contrast, the body part with maximum contraction was the anterior crotch length at vertical body surface line, contracting by $-30.16\%$ or -10.54cm in F5 flexion movement. Both, however, were the body parts to expand or contract the most among all horizontal and vertical body surface lines.

• 한국가정과학회지
• /
• 제7권3호
• /
• pp.15-33
• /
• 2004

A precise understanding of the human form in static pose serves as the basis of designing clothing. When the human body is in motion, however, even an article of clothing designed to fit the human form in static pose can pull and change, thus restricting the body. In order to increase the fit of the clothing, which may be termed the second skin, its form and measurements therefore must be determined in correlation not only with the formal characteristics of the human body, in static pose but also with its functional characteristics in motion, as caused by the movements of the human body. In this study, the motion factor was selected as the primary basis for designing slacks with good fit in both static and moving states. By indentifying the areas in which lower limb movement cause significant changes in body surface lines, we suggest several application methods for designing slacks. Using unmarried female university students aged 18 - 24 as subjects, a total of 32 body surface categories (15 body surface lines and 17 body surface segment lines) were measured in one static and 9 movement poses. In particular, expansion and contraction levels and rates were measured and used in the analysis. The analysis first involved the calculation of the average measurement per body part in body surface line in static pose as well as of the average expansion and contraction levels and rates in 9 lower limb movements. Two-way MANOVA and multiple comparison analysis (Tukey) were conducted on movements and individual somatotypes regarding measurement per body part and expansion and contraction rates. Body parts whose measurements of body surface lines differed significantly in body surface line in static pose versus in movement were then identified. The results of this study are as follows. First, changes in body surface lines caused by lower limb movements were significant in all body surface lines of the lower trunk, both horizontal and vertical, with the exception of abdomen girth, midway thigh girth, ankle girth, hip length, and posterior knee girth. Second, significantly expanded 10 body surface lines in moving pose were detected and illustrated in table 4. These body parts should be studied in designing or pattern designing, especially for close-fitting pants, in using stretch fabric, and in sensory evaluation of good fit during movement.

• Journal of Chest Surgery
• /
• 제33권7호
• /
• pp.560-564
• /
• 2000

배경; 아프로티닌(Aprotinin)은 nonspecific serine protease inhibitor로 개심술에서 항염효과와 혈액 응고효과를 갖고 있다. 또한 아프로티닌은 심폐기 작동 중에는 항트롬빈(antithrombin) 효과가 있다. 본 연구는 아프로티닌이 헤파린(heparin)사용 양 및 ACT(activated clotting time) 에 어떠한 영향을 미치는 가를 알아보기 위하여 시행하였다. 대상 및 방법; 1998년 12월 1일부터 1999년 11월 30일 까지 본원에서 개심술을 받은 환자 중 연령이 18세 이상인 82명을 대상으로 연구하였다. 환자들은 아프로티닌을 사용한 군(Group A)과 사용하지 안흥ㄴ 군(Group C)으로 나누어 연구하였다. 모든 환자에서 수술 전 체중, 신장, 체표면적, pump time, ACC time 등을 조사하였다. ACT의 측정 시기는 헤파린 공급 전, 공급 후 20분, 40분, 60qs과 프로타민 공급 후 20분 등이었다. 또한 ACT 변화 정도를 알아보기 위하여 헤파린 공급 전과 공급 후 20분, 공급 후 40분과 20분 사이의 차이를 조사하였다. 결과; 연구 대상 환자들이 굴변 특징에서는 연령, 펌프시간 및 대동맥차단 사간에서 모두 A군에서 증가된 소견을 보였다. (p<0.05). 헤파린 공급 전과 프로타민 공급 후의 ACT는 두 군에서 차이가 없으며 헤파린 공급 후 20분(607$\pm$22.3, 525$\pm$169초), 40분(889$\pm$315, 546$\pm$103초), 60분 (748$\pm$310, 472$\pm$115 초)에 측정한 ACT는 모두 A군에서 증가된 소견을 보였다. (p<0.05), 헤파린 공급 전과 궁급 후 20분 사이의 ACT 차이는 A한 군에서 증가된 소견을 보였고(p<0.05), 헤파린 공급 후 40분과 20분 사이의 ACT의 차이 또한 A군에서 증가된 소견을 보였다. (p<0.05). 두 군간의 총 헤파린 및 프로타민 사용 양에는 차이가 없었다. (p>0.05). 결론; 결론적으로 아프로티닌은 본 연구에서 CPB time을 고려해 볼 때 헤파린사용 양을 의미있게 줄여 줄 수 있을 것으로 생각되며 또한 ACT를 증가시켜 주기 때문에 추가적인 헤파린 감량이 가능할 것으로 생각된다.