• 제목/요약/키워드: Plastic Surgery

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심미적인 결과를 얻기 위한 치근 피개술 (Esthetic Root Coverage for Gingival Recession)

  • 안명환
    • 대한심미치과학회지
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    • 제26권1호
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    • pp.4-16
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    • 2017
  • 현대의 치과 치료에서는 환자들의 심미적 요구도가 점점 높아지고 있다. 그리고, 이러한 심미 치과 영역에서 치은을 비롯한 연조직이 차지하는 비중은 매우 크다고 할 수 있다. 자연치나 임플란트 주위 조직을 분명히 이해하고 적절한 치료를 해줌으로써 환자들의 요구도를 만족시킬 수 있을 것이다. 연조직 부위의 심미를 pink esthetic이라고도 하는데, 이 pink esthetic에서 가장 중요한 영향을 미치는 것이 치은선이라고 할 수 있다. 이 치은선은 순측 치은의 높이, 치간유두의 높이, 그리고 이 둘을 잇는 자연스러운 곡선으로 구성되어 있다. 자연치에서 치은 퇴축이 발생한 경우, 순측 치은의 높이를 비롯한 자연스러운 치은선이 치근쪽으로 이동하게 되고, 더 많은 치아의 치근 부위가 노출되게 되어 비심미적인 모습을 보이게 된다. Root coverage technique(치근피개술)은 자연치의 치은 퇴축(marginal tissue recession)을 치료하기 위해서 오랜 기간동안 사용되어 왔던 술식으로, 치주 성형수술 영역에서는 대표적인 술식중의 하나라고 할 수 있다. 최근에는 임플란트 술식이 매우 보편화되었는데, 그만큼 임플란트의 부작용 또한 급증하고 있다고 할수 있다. 전치부 영역에서 임플란트의 부작용은 자주 심미적인 문제를 동반하게 된다. 기존의 전통적인 root coverage technique은 이러한 치과 임플란트 영역의 심미적 문제의 해결을 위해 많이 사용되고 응용되고 있다. 현재 우리나라의 대다수의 치과에서 임플란트 치료가 시행되고 있는 현실을 생각한다면 그 심미적 부작용의 극복을 위해, root coverage technique을 비롯한 연조직 처치를 숙지하는 것은 매우 유용하다고 할 수 있을 것이다. 이번 글에서는 대표적인 치근 피개술식들을 간단하게 살펴볼 것이며, 더 좋은 심미적 결과를 위한 단계별 고려사항들에 대해서 다뤄보려고 한다.

c-fos mRNA Expression in the Vestibular System following Hypergravity Stimulation in Rats

  • Jin Guang-Shi;Lee Jae-Hyo;Lee Jae-Hee;Lee Moon-Young;Kim Min-Sun;Jin Yuan Zhe;Song Jeong-Hoon;Park Byung-Rim
    • The Korean Journal of Physiology and Pharmacology
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    • 제11권1호
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    • pp.1-7
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    • 2007
  • Altered environmental gravity, including both hypo- and hypergravity, may result in space adaptation syndrome. To explore the characteristics of this adaptive plasticity, the expression of immediate early gene c-fos mRNA in the vestibular related tissues following an exposure to hypergravity stimulus was determined in rats. The animals were subjected to a force of 2 g (twice earth's gravity) for 1, 3, or 12 h, and were examined poststimulus at 0, 2, 6, 12, and 24 h. RT-PCR (reverse transcription polymerase chain reaction) and real-time quantitative RT-PCR were adopted to analyze temporal changes in the expression of c-fos mRNA. The hypergravity stimulus increased the expression of c-fos mRNA in the vestibular ganglion, medial vestibular nucleus, inferior vestibular nucleus, hippocampus, cerebellum, and cortex. The peak expression occurred at 0 h poststimulation in animals stimulated with hypergravity for 1 h, and at 6 h poststimulus in those stimulated for 3 h. In contrast, those stimulated for 12 h exhibited dual peaks at 0 and 12 h poststimulus. Bilateral labyrinthectomy markedly attenuated the degree of c-fos mRNA expression. Glutamate receptor antagonist also dramatically attenuated the degree of c-fos mRNA expression. These results indicate that expression of c-fos mRNA in response to hypergravity occurs in the vestibular related tissues of the central nervous system, in which peripheral vestibular receptors and glutamate receptors play an important role. The temporal pattern of c-fos mRNA expression depended on the duration of the hypergravity stimulus.

병원종사자의 코스메슈티컬화장품에 대한 제품선택이 마케팅커뮤니케이션에 미치는 영향 (The effect of hospital workers cosmeceutical cosmetics product selection on marketing communications)

  • 강유나;이인희
    • 한국산학기술학회논문지
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    • 제18권8호
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    • pp.88-98
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    • 2017
  • 본 연구는 최근 증가하고 있는 메디컬스킨케어에 맞추어 등장한 코스메슈티컬화장품을 사용하는 병원종사자의 제품선택이 마케팅커뮤니케이션에 미치는 영향에 대한 연구로 실시하였다. 코스메슈티컬화장품이 주로 사용, 판매되어지고 있는 병원의 병원종사자를 대상으로 코스메슈티컬화장품을 구매하는 소비자와의 불만에 대응하고 부정적 이슈의 영향을 최소화하여 소비자와의 우호적 관계를 강화할 수 있는 대안 마련에 필요한 자료를 얻는데 목적이 있다. 연구는 서울 경기 인천 지역의 병원(피부과, 성형외과, 여성의원, 기타병원)에서 코스메슈티컬화장품을 사용하는 병원종사자를 520명을 대상으로 설문조사를 실시되었다. 총 502부의 설문지가 최종분석에 사용되었으며, 데이터 분석은 Cronbach's ${\alpha}$, one-way ANOVA, 탐색적요인 분석 및 Duncan 테스트로 구성되었다. 또한 변수간의 상관관계를 조사하기 위해 상관분석을 수행하였고, 가설검정을 위해 회귀분석을 수행하였다. 본 연구의 결과로 코스메슈티컬화장품을 선택할 때 마케팅커뮤니케이션의 영향을 미친다는 것을 알 수 있으며 특히 제품의 가치, 품질, 가격 요인이 마케팅커뮤니케이션에 큰 영향을 미치는 것으로 보이고 있다. 즉, 제품의 가치 및 품질을 가장 중시함과 동시에 합리적인 가격을 원하는 것을 알 수 있다. 이를 고려하여 향후 코스메슈티컬화장품만의 차별화된 제품을 추구하고 트랜드의 변화양상에 맞추어 코스메슈티컬화장품의 잠재고객 확보 및 판매증대에 필요한 기초자료로 제공하고자 한다.

화상 후 두피에 생긴 편평 상피세포 종양에 대한 증례 보고 - 증례보고 - (Surgical Treatment of Squamous cell Carcinomas Arising in Scalp Burn Wounds - Two Case Reports -)

  • 김강산;황형식;권흠대;문승명;오석준;최선길
    • Journal of Trauma and Injury
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    • 제20권1호
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    • pp.52-56
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    • 2007
  • Marjolin's ulcer is a rare and often-aggressive cutaneous malignancy that arises in previously traumatized or chronically inflamed skin, particularly after burns. We experienced two cases after burns. Case I involved a forty eight year-old man who had suffered from a flame burn at the parietal scalp area, where had been initially described three years earlier as a full-thickness wound including the pericranium. The man consulted us for a persistent ulcerative and infected wound on the burned lesion during the last 24 months, which turned out on the contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) to be the squamous cell carcinoma with involving the skull and the dura mater. Although the posterior auricular lymph node was enlarged on the ipsilateral side, recent positron emission tomography (PET) CT did not show any metastatic lesion. It was impossible for us to resect the intracranial involvement of the tumor radically, and the postoperative PET CT still showed a focal fluorodeoxyglucose (FDG) uptake around the wall of the superior sagittal sinus. We think that an aggressive combined approach is essential for treatment in early stages for a high success rate, before the intracranial structures are involved because there is no consensus on the treatment for advanced disease, and the results are generally poor. Case 1 also did not involve a radical resection because of the intracranial invasion to the wall of superior sagittal sinus and the possibility of damage to the major cortical veins. He received adjuvant radiotherapy and must be followed periodically. Case 2 involved an eighty six year-old women who suffered from a painful scalp ulcer lesion after flame burns three years earlier. Unlike case 1, neither tumor infiltration into the dura nor lymph node enlargement was observed on the contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET) CT. We did a radical resection of the tumor, including the involved bone, and a cranioplasty with bone cement.

두피 봉합기로 봉합하기 어려운 두피 열상에 시행한 잠금 수평 매트리스 봉합법의 유용성 관찰 연구 (Locking horizontal mattress suture as the alternative closure method for scalp lacerations difficult to suture with staple)

  • 사승우;설승환;이운정;우선희;김대희;이준영;인상국;김봉겸
    • 대한응급의학회지
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    • 제29권6호
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    • pp.649-655
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    • 2018
  • Objective: This paper reports the possibility of using of a locking horizontal mattress suture technique in repairing lacerations that are difficult to suture with staples. Methods: Data were collected retrospectively over a 6-month period regarding the routine repair of scalp lacerations: those in areas injured by a high energy blunt mechanism, continued to bleed after pressure, nonlinear or damaged skin repaired with a locking horizontal mattress technique, and simple interrupted technique. The effects of the two techniques used to repair scalp lacerations on wound healing, complication rate, and patient satisfaction were examined. The categorical variables are expressed as the number and percent. A Mann-Whitney-Wilcoxon test was used for statistical analysis. A P-value less than 0.05 was considered significant. Results: Thirty-seven consecutive patients with scalp lacerations presented for care. Wound closure was accomplished with the locking horizontal mattress sutures in 40.5% (n=15) (median length, 5.0 cm; interquartile range [IQR], 4.0-7.0 cm). Simple interrupted sutures (median length, 4 cm; IQR, 3.0-5.0 cm) were used in 59.5% (n=22) (P=0.015). The frequency of additional bandage compression (P=0.008), frequency of exudative hemorrhage (P=0.018), and suture mark frequency at suture removal (P=0.047) were significantly lower in the locking horizontal mattress group. Conclusion: The locking horizontal mattress suture, which has the advantage of a horizontal mattress suture, may be one of the ways that can be used alternatively to treat scalp lacerations that difficult to suture with staples.

코로나 바이러스 대유행에 따른 치과 의료 관리 가이드라인 (Guidelines for dental clinic infection prevention during COVID-19 pandemic)

  • 김진
    • 대한치과의료관리학회지
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    • 제8권1호
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    • pp.1-7
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    • 2020
  • Dental settings have unique characteristics that warrant specific infection control considerations, including (1) prioritizing the most critical dental services and provide care in a way that minimizes harm to patients due to delayed care, or harm to personnel from potential exposure to persons infected with the COVID-19 disease, and (2) proactively communicate to both personnel and patients the need for them to stay at home if sick. For health care, an interim infection prevention and control recommendation (COVID-19) is recommended for patients suspected of having coronavirus or those whose status has been confirmed. SARS-CoV-2, which is the virus that causes COVID-19, is thought to be spread primarily between people who are in close contact with one another (within 6 feet) through respiratory droplets that are produced when an infected person coughs, sneezes, or talks. Airborne transmission from person-to-person over long distances is unlikely. However, COVID-19 is a new disease, and there remain uncertainties about its mode of spreads and the severity of illness it causes. The virus has been shown to persist in aerosols for several hours, and on some surfaces for days under laboratory conditions. COVID-19 may also be spread by people who are asymptomatic. The practice of dentistry involves the use of rotary dental and surgical instruments, such as handpieces or ultrasonic scalers, and air-water syringes. These instruments create a visible spray that can contain particle droplets of water, saliva, blood, microorganisms, and other debris. While KF 94 masks protect the mucous membranes of the mouth and nose from droplet spatter, they do not provide complete protection against the inhalation of airborne infectious agents. If the patient is afebrile (temperature <100.4°F)* and otherwise without symptoms consistent with COVID-19, then dental care may be provided using appropriate engineering and administrative controls, work practices, and infection control considerations. It is necessary to provide supplies for respiratory hygiene and cough etiquette, including alcohol-based hand rub (ABHR) with 60%~95% alcohol, tissues, and no-touch receptacles for disposal, at healthcare facility entrances, waiting rooms, and patient check-ins. There is also the need to install physical barriers (e.g., glass or plastic windows) in reception areas to limit close contact between triage personnel and potentially infectious patients. Ideally, dental treatment should be provided in individual rooms whenever possible, with a spacing of at least 6 feet between the patient chairs. Further, the use of easy-to-clean floor-to-ceiling barriers will enhance the effectiveness of portable HEPA air filtration systems. Before and after all patient contact, contact with potentially infectious material, and before putting on and after removing personal protective equipment, including gloves, hand hygiene after removal is particularly important to remove any pathogens that may have been transferred to the bare hands during the removal process. ABHR with 60~95% alcohol is to be used, or hands should be washed with soap and water for at least 20 s.

Perioperative stress prolong post-surgical pain via miR-339-5p targeting oprm1 in the amygdala

  • Zhu, Yi;Sun, Mei;Liu, Peng;Shao, Weidong;Xiong, Ming;Xu, Bo
    • The Korean Journal of Pain
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    • 제35권4호
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    • pp.423-432
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    • 2022
  • Background: The decreased expression of mu-opioid receptors (MOR) in the amygdala may be a key molecular in chronic post-surgical pain (CPSP). It is known that miR-339-5p expression in the amygdala of a stressed rat model was increased. Analyzed by RNAhybrid, miR-339-5p could target opioid receptor mu 1 (oprm1) which codes MOR directly. So, the authors hypothesized that miR-339-5p could regulate the expression of MOR via targeting oprm1 and cause the effects to CPSP. Methods: To simulate perioperative short-term stress, a perioperative stress prolongs incision-induced pain hypersensitivity without changing basal pain perception rat model was built. A pmiR-RB-REPORTTM dual luciferase assay was taken to verify whether miR-339-5p could act on oprm1 as a target. The serum glucocorticoid level of rats was test. Differential expressions of MOR, GFAP, and pERK1/2 in each group of the rats' amygdala were tested, and the expressions of miR-339-5p in each group of rats' amygdalas were also measured. Results: Perioperative stress prolonged the recovery time of incision pain. The expression of MOR was down-regulated in the amygdala of rats in stress + incision (S + IN) group significantly compared with other groups (P < 0.050). miR-339-5p was up-regulated in the amygdala of rats in group S + IN significantly compared with other groups (P < 0.050). miR-339-5p acts on oprm1 3'UTR and take MOR mRNA as a target. Conclusions: Perioperative stress could increase the expression of miR-339-5p, and miR-339-5p could cause the expression of MOR to decrease via targeting oprm1. This regulatory pathway maybe an important molecular mechanism of CPSP.

Agent "M" -'혐오'의 장치와 리빙 데드의 (비)인간 (Agent "M" -The Apparatus of "Hate" and Human or Non-Human Beings as Living Dead)

  • 권두현
    • 대중서사연구
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    • 제27권1호
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    • pp.133-185
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    • 2021
  • 이 글은 낙태 문제를 다룬 텔레비전 드라마 을 물질성, 관계성, 행위주체성 등의 이론적 초점과 연결시켜 행위적 현실(agential reality)의 축도로서 회절적으로 독해하려는 시도다. 캐런 바라드의 행위적 실재론(agential realism)에 따르면, 텔레비전 드라마 은 당대의 의료기술, 괴담과 전설, 그리고 남성중심적 정동 등의 물질적이고 담론적인 장치들의 행위적 내부작용을 통해 산출된 사회문화적 현상이라 할 수 있다. 1990년대는 기술, 담론, 정동 등의 장치들을 통해 '혐오'를 반복적으로 드러내는데, 이는 여성의 젠더화된 신체를 향한다. 성형과 낙태라는 물질적-담론적 실천은 몸을 둘러싼 행위적 현실이 의료 기술은 물론, 젠더화된 혐오의 정동과 긴밀하게 엮여 있다는 사실을 예증한다. 이와 관계된 또 다른 물질적-담론적 현상으로서 괴담의 유행과 전설의 재발견 역시 탈자연화된 몸에 대한 혐오의 정동으로부터 생산되고, 이 정동을 다시 한 번 확대재생산하고 있음을 방증한다. 이러한 정동 환경 속에서 등장한 은 회절(diffraction)을 상연하는데, 이는 테크노-신체의 물질화에 대한 포스트휴먼적 함축을 결여한 채 백래시의 역행적 힘에 따라 이루어진다. 은 역사적으로 틀 지워지고, 맥락 속에서 정의된 '인간(Man)'에 대한 휴머니즘적 가정들을 보편적인 정의(justice)로서 앞세운다. 이것은 어디까지나 휴머니즘의 젠더화된 정의(definition)일 뿐이다. '낙태죄' 폐지 이후, COVID-19 감염증 유행과 함께, 의료 기술 및 담론, 신체적 물질을 둘러싼 정동이 격렬히 내부작용하는 현재는 이 애써 거부한 인간의 대안적 정의에 대해 신중하게 사유하고 응답해야 할 때다.

일 의료원의 통합 고충처리센터 접수 내용과 이에 대한 해결방안 분석 (Analysis of the Issues received by Quality Improvement Department and their Management in a Medical Center)

  • 탁관철;박현주;천자혜;강은숙;문주영;최미영;김현주;강진경
    • 한국의료질향상학회지
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    • 제7권1호
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    • pp.118-131
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    • 2000
  • Background : A continuous healthcare quality improvement is needed to provide high quality healthcare service as well as to maintain trust in terms of satisfying the needs of the patients. Recently it also became an essential issue. in hospital management, recognized for it's competitive potentiality among healthcare organization groups. This study was conducted to analyze patient complaints and issues received by the Quality Improvement Department. Its purpose is to improve healthcare qualities within the hospital, as well as establish policies and appropriate strategies in hospital management. Method : From July 1st to September 30th of the year 1999, we analyzed all complaints and issues made by various patients and their families, which were received through 24 hour phone consultation, numerous suggestion boxes, letters and E-mails, The issues were classified into 16 different categories based on a Patient Satisfaction Assessment Tool. All data were segregated according to the departmental frequencies and their contents. To come up with for environmental and patient satisfaction improvement, all complaints or issues were communicated with hospital administrators, medical and nursing staff and employees. Comprehensive customer satisfaction activities including improving phone etiquette were discussed in Customer Satisfaction Team, CQI Team and each Department. All opportunities for improvement were implemented. Feedback actions were discussed. Results : A total of 317 cases were collected. Issues regarding parking and other accommodation facilities were most common complaints that were 14.5% of total. Issues regarding admission rooms (10.7%), admission procedures (10.7%), waiting room environment (8.8%), nurses and nurse assistants (7.6%), physicians (6.6%) and others (23%) followed. Thirteen of 45 departments received more than 8 complaints. The Nursing Department had the most complaint, receiving 9.8% of total complaints. Complaints regarding the Nursing Department were predominantly related to the environment of patient rooms. The Department of Psychiatry for phone etiquette (4.7%), Department of Otolaryngology for the nursing staff's attitude and phone etiquette (4.4%), and the Admission Department followed. As a part of efforts to improve patient satisfaction, a new parking structure was built and reallocation of the parking space was done. Renovation of other accommodation facilities were carried out by hospital administration, Monthly phone call and answering attitude survey was done by QI Department. Based on this survey we made a phone etiquette manual and distributed throughout the hospital. Compare to the last year, Patient Satisfaction Index measured by Korea Productivity Center using National Customer Satisfaction Index was improved 7 points. According to our organization's own study, we confirmed the phone etiquette was improved 11% than last year. Conclusions : Issues related to parking and other accommodation facilities ranked first followed by complaints made regarding the patient care area, the admission and cashier process, and nurses' and doctors' attitude. The Nursing and Psychiatry Departments need improvement regarding phone etiquette. Results were shared and played a vital role in policymaking and strategic planning of the hospital. It is imperative that we keep our database updated by listening to and solving the needs of each patient. The CQI activities can be achieved only by full commitment of the hospital top management supported by related personal.

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양측성 순구개열 신생아 환자의 수술전 비치조 정형장치 치료에 의한 치조골 조형(molding) 효과의 분석 (Analysis of alveolar molding effects in infants with bilateral cleft lip and palate when treated with pre-surgical naso-alveolar molding appliance)

  • 남동석;양원식;백승학;김석화
    • 대한치과교정학회지
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    • 제29권6호
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    • pp.649-661
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    • 1999
  • 본 연구의 목적은 1) 양측성 순구개열 신생아에 대한 수술전 비치조정형 장치 (Pre-surgical nasoalveolar molding appliance, PNAM) 치료를 소개하고, 2) 이 장치의 치조골 조형 (molding) 효과를 평가하는 것이다. 서울대학교병원 교정과에 내원하여 PNAM 장치를 사용하여 치료받은 8명의 양측성 순구개열 환자 (남자 7명, 여자 1명, 평균 초진 연령:61.6일)를 연구대상으로 하였으며, 치조골에서 전상악골의 치조능 좌우측 말단부와 양측 분절 치조능 최전방점까지의 파열부간 평균거리는 $8.09{\pm}5.03mm$였고 치조골 정형치료의 평균 기간은 $8.8{\pm}3.1$주였다. 초진시 (T0)와 성공적인 치조골 정형술이 완료된 시기(T1)에 인상을 채득하여 모형을 제작한 후, 사진 촬영과 digital caliper를 사용하여 20개의 길이항목과 14개의 각도항목을 계측하였다. Microsoft사의 Excel 97 program을 사용하여 각 항목의 계측치들을 통계 처리하였고, 치조골 정형술에 의한 치료전후의 차이를 비교하기 위하여 paired t-test를 사용하였다. PNAM 장치에 의한 치조골 조형 효과에 대한 결론은 다음과 같다. 1. 양측성 순구개열 파열부의 폐쇄가 성공적으로 이루어졌다. 2. 양측 분절의 측방 성장이 억제되어 내측 굴곡이 발생하였다. 3. 전상악골 후방부에 위치한 서골(vomer) 전방부의 굴곡에 의하여 전상악골의 후방이동과 회전이 발생하였다. 구순성형술을 시행하기 전에 PNAM장치를 사용하여 양측성 순구개열 신생아 환자의 파열부 폐쇄에 대한 좋은 결과를 얻을 수 있었다.

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