• Journal of Digestive Cancer Research
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• 제5권1호
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• pp.23-27
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• 2017

Although laparoscopic pancreaticoduodenectomy (LPD) is considered as minimally invasive surgery, an advanced level of laparoscopic skill is still required. LPD comprises various procedures including reconstruction. Therefore, establishment of a safe approach at each step is needed. Prevention of intraoperative bleeding is the most important factor in safe completion of LPD. The establishment of effective retraction methods is also important at each site to prevent vascular injury. I also recommend the "uncinate process first" approach during initial cases of LPD, in which the branches of the inferior pancreaticoduodenal artery are dissected first, at points where they enter the uncinate process. This approach is performed at the left side of the superior mesenteric artery (SMA) before isolating the pancreatic head from the right aspect of the SMA, which allows safe dissection without bleeding. Safe and reliable reconstruction is also important to prevent postoperative complications. Laparoscopic pancreatojejunostomy requires highly skilled suturing technique. Pancreatojejunostomy through a small abdominal incision, as in hybrid-LPD, facilitates reconstruction. In LPD, the surgical view is limited. Therefore, we must carefully verify the position of the pancreaticobiliary limb. A twisted mesentery may cause severe congestion of the pancreaticobiliary limb following reconstruction, resulting in severe complications. We must secure the appropriate position of the pancreaticobiliary limb before starting reconstruction. We describe the incidence of intraoperative and postoperative complications and appropriate technique for safe performance of LPD.

• The Korean Journal of Physiology
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• 제21권2호
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• pp.211-223
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• 1987

Head-down tilt (HDT) at $-6^{\circ}$ has been commonly used as the experimental model in both man and animals to induce the blood shift toward the head or central protion of the body, demonstrating similar physiological effect encountered in the weightlessness in the orbital flight. There are few reports about the physiological response upon the cardiovascular regulatory system or the tolerance to the $(-6^{\circ})$ HDT within a relatively short period less than 1 hour. Therefore, the purpose of this study way to observe the effects of $-6^{\circ}$ HDT on cardiovascular system within 30 minutes and to evaluate early regulatory mechanism for simulated hypogravity. Ten mongrel dogs weighing 8-12 kg were anesthetized with the infusion of 1% ${\alpha}-chloralose$ (100 mg/kg) intravenously, and the postural changes were performed from the supine to the $-6^{\circ}$ head-down Position, then from the head-down to the supine (SUP), and each posture was maintained for 30 minutes. Blood flow $({\dot{Q}})$ through common carotid and femoral arteries were determined by the electromagnetic flowmeter. Mean arterial pressure (MAP), heart rate (HR), respiratory rate , and pH, $P_{O_2}$, $P_{CO_2}$ and hematocrit (Hct) of arterial and venous blood were also measured. The peripheral vascular resistance was calculated by dividing respective MAP values by ${\dot{Q}}$ through both sides of common carotid or femoral arteries. The concentration of plasma epinephrine and norepinephrine was determined by Peuler & Johnson's radioenzymatic method. The results are summarized as follows: In the initial 5 minutes in $-6^{\circ}$ HDT, HR was significantly (p<0.05) increased and MAP slightly decreased. Although ${\dot{Q}}$ and carotid peripheral artery resistance were not significantly changed, ${\dot{Q}}$ through femoral artery was diminished and femoral peripheral artery resistance was elevated. In the SUP, the initial changes of MAP and HR were increased (p<0.05), but those of ${\dot{Q}}$ and peripheral vascular resistance through both common carotid and femoral arteries were not significant. After 10 minutes of each postural change in both HDT and SUP, MAP was maintained almost equal to that of the level of pretilting control. During 60 minutes of both postural changes of HDT and SUP, $P_{O_2}$ and Hct were not changed significantly. However pH tended to increase slowly and $P_{CO_2}$ was gradually decreased. The pH and $P_{CO_2}$ seemed to be related to the increased respiratory rate. Plasma epinephrine concentration was not changed significantly and plasma norepinephrine concentration was slightly decreased in the course of HDT and also at 10 minutes of SUP. However these concentration changes were statistically insignificant. From these results, it may be concluded that the effect of $-6^{\circ}$ HDT for 30 minutes on the cardiovascular system and plasma catecholamine levels of the dog is minimum and it is suggestive that the cardiovascular regulatory mechanism, possibly mediated by so called gravity receptors including baroreceptor and volume receptor, has been properly and adequately operated.

• 대한치과교정학회지
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• 제22권3호
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• pp.531-556
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• 1992

The majority of the commonly used protraction headgears for the protraction of small and/or retropositioned maxilla not allow a change in the point of force application or direction of the force delivery to attain predictable results because of the position of the upper and lower lips to avoid discomfort to the patient. The purpose of this study was to investigate the initial reaction of maxillofacial complex according to the change of force variables such as direction and point of force application with designing an antenna type-modified protraction head gear. A macerated human skull with well aligned upper teeth was used to experimental model and the investigation was done by double exposure holographic interferometry. Fringe patterns of each protraction conditions were compared and analized. The results were as follows. (Frontal view) 1. The Counterclockwise rotation of the maxilla was showed by parallel protraction to occlusal plane and the fringe was decreased in number as higher point of force application. 2. Generally, the number of fringe was increased in 500gm of protraction force than in 300gm. 3. When apply the protraction force to the maxilla with rapid palatal expansion, the direction of fringe patterns was differed from the protraction without expansion. 4. In most of cases, the counterclockwise rotation was decreased in case of the direction of the force is $20^{\circ}$ downward to occlusal plane compared to the parallel direction. 5. At the point of force application is 15mm above and the direction of force is 20 downward to occlusal plane , the translation of the maxillary complex was showed. (Lateral view) 6. The direction of fringe patterns of the facial bones were differed each other by the sutures, and showed almost parallel when apply the 300gm and 500gm of protraction force. 7. In case of rapid palatal expansion with protraction of the maxilla, the fringe patterns between the maxillary area and the area from the posterior of the maxillary first molar to the pterygomaxillary fissure were differed. In case without rapid palatal expansion, the changes of direction and point of the force application did not affect to the direction and the number of the fringe patterns.

• 한국가스학회지
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• 제13권4호
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• pp.27-32
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• 2009

본 본문에서는 헬멧의 정상부에 별도로 보강뼈대를 설치하지 않은 경우에 헬멧의 두께를 변수로 헬멧 구조물에 걸리는 응력과 변형거동 특성을 유한요소법으로 해석하였다. 헬멧은 현장 작업자의 안전성과 충격에너지 흡수력을 높일 수 있도록 제작해야 하고, 헬멧을 오랫동안 착용해도 불편함이 없어야 하며, 또한 머리와 목을 보호할 수 있어야 한다. FEM 해석결과에 의하면, 외부의 충격력이 헬멧의 꼭대기에 가해졌을 때 헬멧에 작용하는 최대응력과 최대변형은 하중이 작용하는 지점에서 발생하고, 최대응력은 헬멧모체 구조물의 초기파손을 일으키는 원인으로 작용하는 것으로 나타났다. 헬멧의 두께를 4mm에서 2mm로 줄이면, 충격에너지 흡수율은 급격하게 증가하지만 헬멧에 작용하는 최대응력은 열가소성 소재의 인장강도 54.3MPa을 많이 초과하므로 파손되었다할 수 있다. 따라서 헬멧의 강도안전을 확보하기 위해서는 헬멧의 정상부에 보강뼈대를 설치하는 것이 바람직하고, 헬멧모체 구조물의 두께를 보다 두껍게 설계할 필요가 있다.

• 한국가스학회지
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• 제12권3호
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• pp.31-37
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• 2008

본 본문에서는 유한요소법을 사용하여 여러 가지 헬멧 모델의 강도안전에 관한 응력과 변형률을 해석하였다. 차세대 헬멧은 작업자의 안전성과 작업성을 높일 수 있도록 제작되어야 하고, 오랫동안 착용해도 불편함이 없으면서 머리를 보호할 수 있어야 한다. 결국 헬멧은 안전하고, 착용성이 좋아야 하며, 헬멧의 모체 구조물을 가볍게 제작해야 한다. 따라서 헬멧은 화재나 가스폭발과 같은 가혹한 작업조건에 잘 견딜 수 있어야 한다. FEM 해석결과에 의하면, 외부의 충격력이 헬멧모체 구조물의 정상부 지역에 가해졌을 경우 최대응력과 변형률은 하중이 작용되는 지점부위에서 발생하였다. 따라서 헬멧의 모체 구조물에는 보강뼈대를 설치하고 두께를 늘려서 강도안전성을 확보하는 것이 중요하다. 반면에 헬멧의 일반적인 균일한 두게는 줄여서 헬멧의 경량화를 추구하는 것도 중요하다.

• 인지과학
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• 제20권4호
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• pp.507-533
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• 2009

관계절의 공백과 채움어의 의존관계(gap-filler dependencies)가 어떻게 해결되는지에 대한 가설은 '채움어촉발 처리전략(filler-driven parsing strategy)'과 '공백촉발 처리전략(gap-driven parsing strategy)'으로 요약할 수 있다. 두 가설의 언어보편적 타당성을 알아보기 위해, 본 연구는 안구이동추적법(eyetracking)을 이용하여, 한국어 화자들이 후핵언어(head-final language)인 한국어의 주격관계절과 여격관계절을 실시간으로 처리하는 과정을 살펴보았다. 그 결과, 피험자들이 관계절 내 공백의 위치에서 채움어에 상응하는 그림을 거의 응시하지 않았으나, 관계사와 결합한 관계절동사를 들은 시점부터는 채움어 그림을 응시하는 비율이 큰 폭으로 증가하기 시작하여 머리어를 들은 시점에서 가장 많이, 가장 오래 채움어 그림을 응시하였다. 이 결과는 공백이 관계절의 처리를 촉발하는 것이 아니라, 관계사와 결합한 관계절 동사에서 관계절의 통사처리가 시작되어 채움어가 인지된 시점에서 완성됨을 보여주는 것이다. 또한 주격관계절과 여격관계절 간의 상이한 안구이동 양상은 관계절 내의 논항과 결합한 격조사의 통사정보에 기인하는 것으로 보여서, 한국어의 관계절은 채움어촉발 처리전략을 따르기는 하지만 영어와 같은 선핵언어와는 다른 처리전략이 사용됨을 알 수 있다.

• 한국운동역학회지
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• 제20권2호
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• pp.155-165
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• 2010

The purpose of this study was to analyze kinematic quantitative factors required of a forehand counter drive in table tennis through 3-D analysis. Four national table tennis players participated in this study. The mean of elapsed time for total drive motion was $1.009{\pm}0.23\;s$. At the phase of impact B1 was the fastest as 0.075 s. This may affect efficiency in the initial velocity and spin of the ball by making a powerful counter drive. The pattern of center of mass showed that it moved back and returned to where it was then moved forward. At the back swing, lower stance made wide base of support and a stronger and safer stance. It may help increasing the ball spin. Angle of the elbow was extended up to $110.75{\pm}1.25^{\circ}$ at the back swing and the angle decreased by $93.75{\pm}3.51^{\circ}$ at impact. Decreased rotation range of swinging arm increased linear velocity of racket-head and impulse on the ball. Eventually it led more spin to the ball and maximized the ball speed. Angle of knee joint decreased from ready position to back swing, then increased from the moment of the impact and decreased at the follow thorough. The velocity of racket-head was the fastest at impact of phase 2. Horizontal velocity was $7796.5{\pm}362\;mm/s$ and vertical velocity was $4589.4{\pm}298.4\;mm/s$ at the moment. It may help increase the speed and spin of the ball in a moment. The means of each ground reaction force result showed maximum at the back swing(E2) except A2. Vertical ground reaction force means suggest that all males and females showed maximum vertical power(E2), The maximum power of means was $499.7{\pm}38.8\;N$ for male players and $519.5{\pm}136.7\;N$ for female players.

• 대한한의학회지
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• 제40권3호
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• pp.198-223
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• 2019

Objectives: The purpose of this study was to investigate the effect of Korean medicine treatment on facial asymmetric treatment in 5 cases of facial asymmetry correction by non - surgical treatment such as acupucture, chuna treatment, FCST (Functional cerebrospinal technique) and cranial osteopathy. Methods: We analyzed the initial charts of 5 patients who had undergone facial asymmetry in a Korean medicine clinic and measured the position and distance using the photograph, lateral cephalograms, and whole body radiograms. The results were as follows. Results: To quantify both soft and hard tissues to confirm the results of Korean medicine treatment of facial asymmetry, soft tissues quantitatively measure the displacement of the face, the slope of the left and right eyes, and the slope of the lip in order to grasp the positional displacement of the mandible. As a result, on the average, the correction effect as measured by the angle difference between A and C is $1.8{\pm}0.57$, the correction effect as measured by the angle difference between B and C is $1.4{\pm}0.89$, and the angle difference between D and the horizontal plane is $1.9{\pm}0.89$, and the angle difference between E and the horizontal plane is $1.9{\pm}0.89$. The result of reduced angle difference between A and C means that the head position shifted from the center of the body to the unilateral side was shifted to the center. The decrease in the angle difference between B and C means the restoration of the maxillary distortion relative to the mandible. In hard tissues, numerical values were measured based on the skull standard. The average distortion of the skull was $1.9{\pm}0.67$, and the distortion of the lower eye was $1.4{\pm}0.41$. Conclusion: General studies on facial asymmetric treatment are limited to treatments such as surgery and orthodontics. However, this study confirmed the possibility that facial asymmetry could be corrected by Korean medical treatment consisting of reversible non-surgical treatment rather than irreversible treatment such as surgery or orthodontic treatment. In particular, Korean medicine treatment is effective for muscular asymmetry, soft asymmetry, functional asymmetry, etc. The facial asymmetric treatment of Korean medicine is not limited to the face-centered correction, but the asymmetry of the whole body may be corrected as well.

• 대한방사선치료학회지
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• 제30권1_2호
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• pp.97-105
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• 2018

목 적 : Proton Therapy는 Bragg-peak를 이용해 종양에는 최대의 선량, 정상조직에는 최소의 선량을 줄 수 있는 특징을 가지고 있기 때문에 환자의 위치변화나 치료부위의 위치 변화를 정량화 할 수 있는 의료영상 분석 시스템은 양성자 치료에 있어서 무엇보다도 중요하다. 본 연구 목적은 Matlab 기반의 In-house Registration code를 제작하여 기존 DIPS program을 통한 Set-up과 In-house code를 통한 영상정합을 비교하여 Algorithm의 유용성을 평가하고 DIPS와 DRR간의 오차 값을 확인하여 기존 치료의 정확성을 평가하고자 한다. 대상 및 방법 : 본원에서 양성자 치료를 받은 13명의 뇌종양, 두경부암 환자를 대상으로 하였으며 영상비교에 필요한 DIPS Program System(Version 2.4.3, IBA, Belgium)와 환자의 치료계획을 위해 Eclipse Proton Planning System(Version 13.7, Varian, USA)을 사용하였다. Registration 방법에 대한 Validation을 위해 Test image를 인위적으로 회전 및 이동하여 기존 Image와 영상정합 하였고, 기존 Set up 방식의 DIPS program의 환자 일별 초기 Set up image를 plan DRR과 영상정합 하여 각각 오차 값을 얻어 Algorithm의 유용성을 평가하였다. 그리고 기존 Set up 방식의 정확성을 평가하기 위해 환자 일별 최종 Set up image와 DRR image를 영상정합하여 오차 값을 확인하였다. 결 과 : Test image를 left와 right 방향으로 각각 0.5, 1, 10 cm를 이동시켰을 때 평균 0.018 cm의 오차 값을 보였으며 시계와 반시계방향으로 각각 1, $10^{\circ}$씩 회전시켰을 경우에는 평균 $0.0011^{\circ}$의 오차를 나타냈다. 4명의 환자 일별 초기 image를 영상정합 하였을 때는 x, y, z 방향 순으로 평균 0.056, 0.044, 0.053 cm의 오차 값을 나타냈으며 Rotation, Pitch 순으로 0.190, $0.206^{\circ}$의 차이를 나타냈다. 13명의 환자 일별 최종 image를 영상 정합 하였을 때는 x, y, z 방향 순으로 평균 차이는 0.062, 0.085, 0.074 cm이였고 Vector 값으로는 평균 0.120 cm의 차이를 보였다. Rotation, Pitch 순으로는 평균 0.171, $0.174^{\circ}$의 차이 값을 나타냈다. 결 론 : 본 연구를 통해 제작된 Matlab 기반의 In-house Registration code는 단순한 Image 뿐만 아니라 해부학적 구조에서도 Intensity 기반의 정확한 영상정합을 나타냈다. 또한 기존 치료방식의 DIPS program을 통한 Set-up 오차는 매우 미미한 차이를 보임으로써 이는 양성자치료의 정확성을 확인할 수 있었다. 앞으로 임상적용을 위해 추가적인 프로그램 개발과 향후 Intensity 기반의 Matlab In-house code 연구가 필요하다고 사료된다.

• 한국의학물리학회지:의학물리
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• 제24권4호
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• pp.271-277
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• 2013

전립선에 대한 IMRT 치료계획을 작성 시 CTV를 확장해서 PTV를 얻을 때 가끔 직장 내의 공기가 포함되는 경우가 있는데, 공기의 처리 여부에 따라 선량 처방에 문제가 발생한다. 이 경우 IMRT 플랜의 최적화 과정에서 다음과 같은 세 가지 가능성을 생각해 볼 수 있다: PTV에 포함된 공기를 원래의 공기밀도로 두는 경우('airOpt'), 포함된 공기의 밀도를 조직과 비슷하게 밀도 1로 하는 경우('density1Opt'), 공기 부분을 제외한 PTV를 고려하는 경우('noAirOpt'). 본 연구에서는 이 세가지 경우에 대해 7개 방향에서 10 MV 광자선으로 동일한 인자의 IMRT 플랜을 하였다. 평가를 위해서는 CTV를 복사한 후, PTV 내에서 직장 쪽으로 이동시켜 최악의 표적 위치 설정이 되도록 원래의 공기가 있는 부분에 위치하도록 해서 가상의 CTV를 만들었다. PTV의 선량커버(dose coverage)와 최대 선량값을 비교했을 때, density1Opt 플랜만이 임상적으로 적절하였다. airOpt 경우, PTV에 과도한 선량이 전달되었고 선량전달체적 또한 과도하였다. noAirOpt 경우에는 이동된 가상 CTV 위치에서 저선량을 보였다. 이 결과에 의하면, 전립선 IMRT 플랜의 작성에서 공기가 포함된 PTV의 경우 플랜의 최적화와 선량 처방을 하기 전에, PTV에 포함된 공기의 밀도를 밀도값 1로 변경하는 것이 적절하였다. 이 아이디어는 두경부 IMRT 플랜을 비롯하여, 표적체적 내에 공기가 포함된 기타 경우에도 그대로 적용가능한 것으로 판단되며, 추가연구를 진행 중이다.