06. Clinical Practice - Interpretation of diagnostic test.hwp

Size: px
Start display at page:

Download "06. Clinical Practice - Interpretation of diagnostic test.hwp"

Transcription

1 대한내과학회지 : 제 91 권제 3 호 Interpretation of diagnostic test 손목굴증후군 건국대학교의학전문대학원 1 내과학교실류마티스내과, 2 신경과학교실 김해림 1 오지영 2 Carpal Tunnel Syndrome Hae-Rim Kim 1 and Jeeyoung Oh 2 Division of Rheumatology, Departments of 1 Internal Medicine and 2 Neurology, Konkuk University School of Medicine, Seoul, Korea Carpal tunnel syndrome (CTS) is a common entrapment neuropathy caused by compression of the median nerve at the wrist. Although symptoms and signs of CTS are widely known, it is often difficult to make a correct diagnosis. A clinical examination, electrophysiological studies, and ultrasonographic evaluation have similar sensitivities and specificities, and combining them improves diagnostic yield. However, evidence about the optimal treatment has not been well established. We review the clinical manifestations, diagnostic methods, and treatment options for CTS. (Korean J Med 2016;91: ) Keywords: Carpal tunnel syndrome; Ultrasonography; Nerve conduction 서론손목굴증후군 (carpal tunnel syndrome) 은정중신경이손목에서압박되어나타나는포착신경병 (entrapment neuropathy) 으로보통전생애에걸쳐약 10% 정도인구에서발생할정도로흔하다 [1]. 손목굴은손목주름에서 cm 원위부에위치한좁은굴모양의구조로주상골 (scaphoid), 소능형골 (trapezoid), 갈고리뼈 (hamate) 와가로손목인대 (transverse carpal ligamanet) 에둘러싸여있다 [2]. 이구조물안으로정중신경과손가락굽힘근의인대가주행한다. 임신, 부종, 건염, 당뇨, 갑상선기능저하나반복적인수작업등에의해손목굴안의압력이지속적으로상승하게되면정중신경이압박되고이로인해손목굴증후군이발생한다. 체질량지수가높을때 나손의크기가작은경우, 손목의전후직경이큰경우에도손목굴증후군이더호발한다 [3]. 손목굴증후군은흔한질환임에도불구하고진단이나치료에대한특정한가이드라인이많지않아임상경험에의존하는경우가많고, 다른질환과감별도쉽지않은경우도있다. 본고에서는손목굴증후군의다양한임상증상과이를정확히진단하기위한검사도구, 치료방향에대한실제적인내용을다루고자한다. 임상양상전형적인증상은엄지, 검지, 중지와약지반에걸쳐나타나는손가락통증이며, 주무르거나손을털면저린감이완화되고밤에증상이더심해져깨는경우가많다. 그러나통증 Correspondence to Jeeyoung Oh, M.D., Ph.D. Department of Neurology, Konkuk University School of Medicine, Neuongdong-no, Kwangjin-gu, Seoul 05030, Korea Tel: , Fax: , serein@kuh.ac.kr Copyright c 2016 The Korean Association of Internal Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

2 - The Korean Journal of Medicine: Vol. 91, No. 3, 이전완부로방사되거나심지어어깨부위까지통증을호소하는경우도흔해서경추신경뿌리병과감별이어려울때도있다. 고개를돌릴때악화되는통증이나저린감이있으면척추질환의가능성이더높지만, 경추신경뿌리병과손목굴증후군이동시에나타나는경우 (double crush injury) 도있다. 또단순한건초염 (tenosynovitis) 에서도손목굴증후군과유사한증상이나타날수있는데방아쇠손가락 (trigger finger) 이나윤활낭염 (bursitis) 이동반되는경우가흔하다. 자율신경섬유가함께침범되면혈관운동반사 (vasomotor reflex) 가손상되어레이노증후군과유사한증상이나타나며이는류마티스관절염과같은전신질환이있는경우더흔하다. 손가락감각이둔해지면물건을잡고있다가놓치는경우도흔히발생하며, 증상이심해져엄지두덩근이위축되면손가락운동도둔해지게된다. 진단임상진단전형적인증상만으로도진단이가능한데, 몇가지진찰이보다진단의정확도를높일수있다. 손목을 90도로꺾어양손등을맞대고있으면 (Phalen test) 약 1분내에평소와같은저린감이나통증이유발되고, 이상태에서손을가볍게쥐면통증이소실된다 [4]. Tinel 징후는재생중인신경섬유의탈분극역치가낮아생기는현상으로가볍게신경주행경로를두드릴때신경이지배하는영역으로저린감이나타나는것을말한다. 손목굴증후군에서는손목주위를해머로가볍게두드리거나검사자의손으로누를때손끝으로저린감을호소하게된다. 감각신경검사에서전형적인이상소견을보이는경우는생각보다많지않지만, 정중신경의감각신경분지가지배하는엄지, 검지, 중지와약지의반에서통각이나촉각이둔하고, 특히약지의내측과외측의감각이서로다를때는손목굴증후군의가능성이매우높다. 한편엄지두덩을지배하는감각신경은손목굴 3 cm 상부에서분지하기때문에손목굴증후군에서는엄지두덩의감각은정상이어야한다. Carpal Tunnel Syndrome 6 (CTS-6) 는진단을용이하게하고자여섯개의주요증상을점수화한것으로항목은정중신경영역에국한되거나주로나타나는감각이상, 밤에악화되는증상, 엄지두덩의근위축이나근위약, Phalen 테스트양성, 두점식별감각소실, Tinel 징후양성으로구성된다. 총 36점중 12점이상인경우손목굴증후군으로진단할수있는 데민감도 60%, 특이도 90% 로보고되었다 [5] (Table 1). 초음파검사 초음파검사는손목굴증후군에서진단적가치가매우높다. 신경전도검사에서이상이발견되지않는초기손목굴증후군의진단은물론 [6], 주위조직을함께볼수있으므로구조적이상도함께확인할수있는장점이있다 [7,8]. 정중신경이손목굴의근위부에서는종창이, 중간부와원위부에서는압박이생기므로이러한특징적인병변이초음파로잘관찰된다. 정중신경의정상소견은세로스캔에서두께가일정하고, 주변힘줄에비해서에코가낮으나균질적인실타래모양을보이고주변과의경계가뚜렷하다 (Fig. 1A). 가로스캔에서가로손목인대, 고에코성경계를갖는타원형모양의정중신경, 8개의손목굽힘근들이관찰한다 (Fig. 1B). 손목굴증후군을평가할때먼저세로스캔으로정중신경의전체적인주행을관찰하는데손목굴근위부 (proximal carpal tunnel, tunnel inlet) 에서정중신경의종창에의해두께가오히려증가하고, 원위부 (distal carpal tunnel, tunnel outlet) 에서는압박이되며, 에코가감소하며, 경계의명확성이소실된다 (Fig. 1C). 근위부손목굴의가로스캔에서먼저콩알뼈 (pisiform) 와손배뼈 (scaphoid) 를가로지르는가로손목인대를찾고, 그아래를지나는정중신경의단면적을측정하여, mm 2 이상인지여부가진단에가장중요하다 (Fig. 1D). 그후원위부손목굴을가로스캔하여 ( 갈고리뼈가기준점 ) 정중신경의가로길이가세로길이의비율 (flattening ratio) 이 3배이상이면압박이있는것을의미한다. 또한손목굴의압력이증가되어가로손목인대가손바닥방향으로휘어있는지 (palmar bowing) 를확인한다 (Fig. 1E). 마지막으로정중신경자체의이상이나신경을압박할다른병변의존재여부를확인한다. 신경전도검사 신경전도검사는신경의손상정도를정량화하여평가할 Table 1. Carpal Tunnel Syndrome-6 Finding Numbness predominantly or exclusively in the median nerve area Nocturnal symptoms Thenar atrophy or weakness Positive Phalen test Loss of 2-point discrimination (> 5 mm) Positive tinel sign Points

3 - Hae-Rim Kim, et al. Carpal tunnel syndrome - 수있고, 손목굴증후군과유사한양상을보이는다른질환을감별하는데도움이된다. 운동신경과감각신경을각각검사하는데, 감각신경의변화가더먼저나타난다. 초기에는손가락- 손목구역에서감각신경전달속도가느려지고축삭변성이진행하게되면감각신경전위의진폭이감소한다. 정상운동신경전도와비교하여 (Fig. 2A) 운동신경전도검사에서는말단잠시 (terminal latency) 가연장되고단무지외전근 (abductor pollicis brevis muscle) 이위축되면복합운동활동전위진폭도감소하게된다 (Fig. 2B). 신경손상이심한경우에는활동전위가유발되지않는경우도있다 (Fig. 2C). 증상 A B C D E 의초기에는일상 (routine) 신경전도검사에서이상을보이지않기도하는데, 이런경우에는손바닥구역에서정중신경과척골신경 (ulnar nerve) 의감각신경전도검사를시행하여잠시 (latency) 를비교하면도움이된다 [8,9]. 침근전도검사는운동신경분지의침범여부를확인하거나신경뿌리병과의감별에도움을주지만모든환자에게추천되지는않는다. 전기진단검사결과에따라중등도를결과지에표기하는데 (Table 2) 검사실에서어떤기준을사용하느냐에따라약간다르나축삭변성이동반되는경우는중증으로볼수있다 [10,11]. 환자의증상과전기진단검사의중등도가반드시일치하지는않아중등도표기에논란이있고실제치료방향을결정하는데도환자의주관적인증상이더중요한인자가되지만수술후예후를예측하는데는도움이된다는보고들이있다 [12]. 전형적인증상이있음에도불구하고신경전도검사에서이상소견이발견되지않는경우도있는데, 충분한신경섬유의변성이일어나지않은질병초기에검사를하거나가는신경섬유만침범되어신경전도검사로는발견이안되는경우로생각할수있다 [13,14]. 또신경종 (neuroma) 이나주위조직염증에의해정중신경이단순히자극되어나타나는경우에도신경전도검사가정상일수있어서의심되는경우에는초음파검사를함께시행하는것이좋다 [6,15]. 반대로손목굴증후군의증상은모호하나신경전도검사에서손목부위의정중신경병 (median motor neuropathy at the Table 2. Carpal tunnel syndrome severity grade according to nerve conduction study results Figure 1. Ultrasonographic findings of a normal carpal tunnel and a carpal tunnel with carpal tunnel syndrome. (A) Longitudinal scan shows normal median nerve with regular fibrillary pattern and unchanging thickness surrounded by a hyperechoic boundary in the carpal tunnel. (B) Transverse scan of the proximal carpal tunnel shows transverse carpal ligament (arrows), the oval-shaped median nerve, which is located in the superficial part of the carpal tunnel, and the flexor digitorum superficialis and profundus tendons in the deeper part of the carpal tunnel. In carpal tunnel syndrome, (C) the median nerve is compressed in the middle and distal carpal tunnel (arrows) on a longitudinal scan; (D) cross-sectional area of median nerve increases > 10 mm 2 in the proximal carpal tunnel and (E) the flattening ratio (longest diameter: shortest diameter of median nerve) is > 3:1 in the distal carpal tunnel. MN, median nerve; P, pisiform; TCL, transverse carpal ligament (arrows); FCR, flexor carpi radialis tendon; SC, scaphoid Grade Description Normal (grade 0) All nerve conduction study results are within normal limits Very mild (grade 1) Only within-hand sensory comparison study results are abnormal Mild (grade 2) Median sensory distal latency prolonged; DML is within normal limits Moderate (grade 3) Median SNAP is recordable; median DML is prolonged but < 6.5 ms Severe (grade 4) Median SNAP is unrecordable; median DML is prolonged but < 6.5 ms Very severe (grade 5) Median CMAP is recordable but DML is > 6.5 ms Extremely severe Median CMAP is essentially unrecordable (grade 6) DML, distal motor latency; SNAP, sensory nerve action potential; CMAP, compound motor action potential

4 - 대한내과학회지 : 제 91 권제 3 호통권제 673 호 A B C Figure 2. Compared with a normal motor nerve conduction study (A), results of carpal tunnel syndrome show delayed terminal latency (B, arrow) with no sensory nerve action potential at the finger-wrist segment (C, arrowhead). wrist) 소견을보이는경우에는주의해야한다. 원인은아직명확하지않지만단순한비만에의해서도발생하고, 만성염증탈수초다발신경뿌리병 (chronic inflammatory demyelinating polyradiculoneuropathy) 이나파라단백질과연관된신경병 (pareproteinemic neuropathy), 드물게는아밀로이드신경병이나파브리병의일환으로나타나는경우에잘못진단되면불필요한수술을받거나적절한치료가늦어질수있으므로전기진단검사결과는반드시임상증상과상관되는지확인해야한다. 치료비수술치료비수술적치료는진행을억제한다기보다는일시적으로증상을경감시키는효과가더크다. 국소스테로이드주사는부종을가라앉히고손목굴에서정중신경의압박을경감하는역할을한다. 초음파로신경을확인하면서주사하는것이더안전하고효과적이며 [16] 손바닥에서손목부위를향해주사하는방법이환자에게통증을덜느끼게하는방법이다. 대개 methylprednisolone 40 mg 혹은 80 mg을주사하며, 두용량모두증상완화효과는비슷하나 80 mg 주사군에서 1년후수술받는환자수가더적었다 [17]. Triamcinolone이나 procaine hydrocholoride를주사하기도한다. 손목굴증후군에서나타나는통증도신경병통증이므로경구약물로대증치료가가능하나실제임상연구는많지않 다. Gabepentin을투약한임상연구에서통증, 저린감, 근위약등의증상이위약대비효과적이지못했다. 그러나실제임상에서국소주사와병행해서혹은국소주사나수술치료를거부하는환자에게는통상의신경병통증약물을단기간투약할수있다. Gabapentin 과 pregabalin 은손목굴증후군상병으로는보험급여가되지않지만, 당뇨신경병과함께발생한경우에는급여가가능하다. 시작용량은 gabapentin 100 mg 하루 3회혹은 pregabalin 75 mg 2회이나고령이나신기능이저하된경우는더적은용량으로시작한다. 두약제는각각하루 3,600 mg과 600 mg이최대용량으로효과와부작용에따라투여용량과횟수를증감한다. 손목의과굴곡을막아부종을줄이기위해손목부목 (splint) 을착용하는방법도있다. 8주간부목을착용한환자군에서그렇지않은경우에비해손의기능이호전되고증상이완화된결과를보였다 [18]. 그러나메타분석에서는충분한효과를입증하기어려웠고증상의호전도일시적이라는연구보고도있다 [1]. 그외침, 물리치료등의일차적효과와수술후보조요법에대해서는충분한연구가부족해아직단정하기어렵다 [19]. 수술치료가로손목인대를절단해서손목굴안의압력을완화하는방법으로가장근본적이고효과적인치료라고할수있다. 손바닥피부를절개해서육안으로인대를확인하고절단하는방법 (open technique) 과내시경을이용하는방법이있다

5 - 김해림외 1 인. 손목굴증후군 - 내시경수술은상처부위가작기때문에수술후압통과움직임제한이덜해회복기간이짧은반면수술중신경손상의위험이개방술에비해상대적으로높다. 어떤술기를사용하더라도가로손목인대를완전히절개하도록권유하고있으며 [20], 이런경우장기추적에서양수술방법사이에효과는차이가없는것으로나타났다. 수술합병증은집도의의술기에따라다르지만 1-25% 에서보고되며가장심각한것은신경의직접적인손상이나주위조직손상에따른복합부위통증증후군 (complex regional pain syndrome) 으로약 2.1-5% 에서발생한다 [1]. 국소스테로이드주사에비해수술치료가장기적인증상개선에더효과적이고신경전도검사결과에서도더나은반응을보이므로, 비수술치료에도불구하고통증이지속되거나운동신경침범에의해손의기능이떨어진경우에는수술치료를고려할수있다. 결 손목굴증후군은임상에서흔히볼수있고간단한방법으로진단과치료가가능하지만일부환자에서는경추신경뿌리병이나척수병혹은다른말초신경병과감별이어려운경우도있다. 통증이나이상감각의분포는진단에큰도움은되지않으나 Phalen test 양성, Tinel 징후, 손을쥐었을때통증이완화되는진찰소견을보이면손목굴증후군을의심할수있고, 신경전도검사와초음파검사로신경손상의정도와구조적이상을확인할수있다. 환자의증상과상태에따라국소스테로이드주사나수술치료로신경기능을초기에회복시켜주는것이중요하며, 그외치료방법에대해서는아직더많은연구가필요하다. 론 중심단어 : 손목굴증후군 ; 초음파 ; 신경전도 REFERENCES 1. Padua L, Coraci D, Erra C, et al. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol 2016;15: Chammas M, Boretto J, Burmann LM, et al. Carpal tunnel syndrome - Part I (anatomy, physiology, etiology and diagnosis). Rev Bras Ortop 2014;49: Henry BM, Zwinczewska H, Roy J, et al. The prevalence of anatomical variations of the median nerve in the carpal tunnel: a systematic review and meta-analysis. PLoS One 2015;10:e Manente G, Torrieri F, Pineto F, Uncini A. A relief maneuver in carpal tunnel syndrome. Muscle Nerve 1999;22: Fowler JR, Cipolli W, Hanson T. A comparison of three diagnostic tests for carpal tunnel syndrome using latent class analysis. J Bone Joint Surg Am 2015;97: Koyuncuoglu HR, Kutluhan S, Yesildag A, Oyar O, Guler K, Ozden A. The value of ultrasonographic measurement in carpal tunnel syndrome in patients with negative electrodiagnostic tests. Eur J Radiol 2005;56: Azami A, Maleki N, Anari H, Iranparvar Alamdari M, Kalantarhormozi M, Tavosi Z. The diagnostic value of ultrasound compared with nerve conduction velocity in carpal tunnel syndrome. Int J Rheum Dis 2014;17: Goldberg G, Zeckser JM, Mummaneni R, Tucker JD. Electrosonodiagnosis in carpal tunnel syndrome: a proposed diagnostic algorithm based on an analytic literature review. PM R 2016;8: Jablecki CK, Andary MT, Floeter MK, et al. Practice parameter: electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2002;58: Bland JD. A neurophysiological grading scale for carpal tunnel syndrome. Muscle Nerve 2000;23: Werner RA, Andary M. Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve 2011;44: Fowler JR, Munsch M, Huang Y, Hagberg WC, Imbriglia JE. Pre-operative electrodiagnostic testing predicts time to resolution of symptoms after carpal tunnel release. J Hand Surg Eur Vol 2016;41: Al-Hashel JY, Rashad HM, Nouh MR, et al. Sonography in carpal tunnel syndrome with normal nerve conduction studies. Muscle Nerve 2015;51: Żyluk A, Walaszek I, Szlosser Z. No correlation between sonographic and electrophysiological parameters in carpal tunnel syndrome. J Hand Surg Eur Vol 2014;39: Rahmani M, Ghasemi Esfe AR, Vaziri-Bozorg SM, Mazloumi M, Khalilzadeh O, Kahnouji H. The ultrasonographic correlates of carpal tunnel syndrome in patients with normal electrodiagnostic tests. Radiol Med 2011;116: Evers S, Bryan AJ, Sanders TL, Selles RW, Gelfman R, Amadio PC. The effectiveness of ultrasound-guided compared to blind steroid injections in the treatment of carpal tunnel syndrome. Arthritis Care Res (Hoboken) 2016 Oct 1 [Epub] Lyon C, Syfert J, Nashelsky J. Clinical inquiry: do corticosteroid injections improve carpal tunnel syndrome symptoms? J Fam Pract 2016;65:

6 - The Korean Journal of Medicine: Vol. 91, No. 3, Page MJ, Massy-Westropp N, O'Connor D, Pitt V. Splinting for carpal tunnel syndrome. Cochrane Database Syst Rev 2012;(7):CD Peters S, Page MJ, Coppieters MW, Ross M, Johnston V. Rehabilitation following carpal tunnel release. Cochrane Database Syst Rev 2016;2:CD Keith MW, Masear V, Chung KC, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of carpal tunnel syndrome. J Bone Joint Surg Am 2010;92:

PowerPoint 프레젠테이션

PowerPoint 프레젠테이션 Physical Examination of the Wrist & Hand 연부조직촉진 (soft tissue palpation) 연부조직의촉진 (soft tissue palpation) 1) 수근관절제 1구역 ; 요골경상돌기 (radial styloid process) (1) Anatomical snuffbox - 요측연 장모지외전근 (Abd. poll. long

More information

< B9E9BFF8B1E22DC0CCB1D4BFEB D E687770>

< B9E9BFF8B1E22DC0CCB1D4BFEB D E687770> 원저 J Korean Neurol Assoc / Volume 23 / October, 2005 한양대학교의과대학신경과학교실 Won-Ky Paek, M.D., Seong-Ho Koh, M.D., Hyun-Young Kim, M.D., Kyu-Yong Lee, M.D., Young Joo Lee, M.D., Hee-Tae Kim, M.D., Seung-Hyun

More information

<30332EBFF8C0FA2DC0B1C1D8BDC42E687770>

<30332EBFF8C0FA2DC0B1C1D8BDC42E687770> 대한임상신경생리학회지 12(2):55~6, 21 ISSN 1229-6414 Original Article 수근관증후군에서임상양상척도및신경전기진단결과와정중신경초음파소견의상관관계 고려대학교의과대학재활의학교실 The Correlation between Ultrasonographic Findings of Median Nerve and Clinical Scale and

More information

PowerPoint 프레젠테이션

PowerPoint 프레젠테이션 Physical Examination of the Wrist & Hand * 손은일상생활의거의모든동작을완수하는기능을지님. * 손상의빈도가높은곳. * 손자체의병변유무검진. Wrist joint 의기능해부학 (functional anatomy) 1) 손목관절을구성하는뼈 - 요골원위부 - 척골의관절판 - 수근골 (carpal bone) 근위열 (proximal row)

More information

원위부요척골관절질환에서의초음파 유도하스테로이드주사치료의효과 - 후향적 1 년경과관찰연구 - 연세대학교대학원 의학과 남상현

원위부요척골관절질환에서의초음파 유도하스테로이드주사치료의효과 - 후향적 1 년경과관찰연구 - 연세대학교대학원 의학과 남상현 원위부요척골관절질환에서의초음파 유도하스테로이드주사치료의효과 - 후향적 1 년경과관찰연구 - 연세대학교대학원 의학과 남상현 원위부요척골관절질환에서의초음파 유도하스테로이드주사치료의효과 - 후향적 1 년경과관찰연구 - 연세대학교대학원 의학과 남상현 원위부요척골관절질환에서의초음파 유도하스테로이드주사치료의효과 - 후향적 1 년경과관찰연구 - 지도김석원교수 이논문을석사학위논문으로제출함

More information

Kbcs002.hwp

Kbcs002.hwp Does Real-time Compound Imaging Improve Evaluation of reast Cancer Compared to Conventional Sonography? o Kyoung Seo, M.D., Yu Whan Oh, M.D., Kyu Ran Cho, M.D., Young Hen Lee, M.D., Hyung Joon Noh, M.D.,

More information

<34365FB1E8C3B6BDC22DC0FCB3B220B5BFBACEC1F6BFAABFA1BCAD20BCD5B8F1C5CDB3CEC1F5C8C4B1BA2E687770>

<34365FB1E8C3B6BDC22DC0FCB3B220B5BFBACEC1F6BFAABFA1BCAD20BCD5B8F1C5CDB3CEC1F5C8C4B1BA2E687770> Journal of the Korea Academia-Industrial cooperation Society Vol. 13, No. 11 pp. 5305-5310, 2012 http://dx.doi.org/10.5762/kais.2012.13.11.5305 전남동부지역에서손목터널증후군의수술전후신경전도검사결과의평가 서충원 1, 김철승 1* 1 서남대학교임상병리학과

More information

Microsoft PowerPoint - evaluation(창원대)

Microsoft PowerPoint - evaluation(창원대) Evaluation 헤렌휘트니스파크한경진 ATC Contents 1. Shoulder 2. Elbow 3. Knee 4. Ankle 1 Shoulder Neer Hawkin s Empty can Speed O brien Shoulder anatomy 2 Neer Test Hawkin s test 3 Empty can test Speed Test 4 O Brien

More information

슬라이드 1

슬라이드 1 팔꿈치의초음파 손과손목의초음파 가톨릭대학교인천성모병원 재활의학과김재민 Elbow, Wrist and Hand 팔꿈치관절의정상초음파소견 팔꿈치관절전면 팔꿈치를신전시킨상태 Transverse scan Longitudinal scan 주관절부위에서얻은초음파영상이다. 화살표가가리키고있는구조물은? (BA: 상완동맥 ) 가. Ulnar nerve 나. Median nerve

More information

Microsoft Word - 0492008001.doc

Microsoft Word - 0492008001.doc online ML Comm 0REVIEW ARTICLE0 J Kor Neurotraumatol Soc 2008;4:1-7 ISSN 1738-8708 수근관 증후군: 개방적 수술의 최신지견 충북대학교 의과대학 신경외과학교실 김 동 호 Carpal Tunnel Syndrome: Open Carpal Tunnel Release Dong-Ho Kim, MD Department

More information

<30332DC0E5C8A3BFAD2DBFF8C0FA2D2E687770>

<30332DC0E5C8A3BFAD2DBFF8C0FA2D2E687770> 원저대한체열학회지제 9 권제 2 호 2009 수근관증후군 : 온도차와근전도검사상의중증정도와의비교 장호열 국민건강보험공단일산병원, 연세대학교의과대학신경외과학교실 Carpal Tunnel Syndrome: Correlation between Thermal Differences and Severity in EMG Study Ho-Yeol Zhang, MD Department

More information

김성혁.hwp

김성혁.hwp 대한임상신경생리학회지 13(1):31~37, 2011 ISSN 1229-6414 Original Article 가천의과학대학교가천의대길병원신경과 Electrophysiologic Characteristics of Combined Idiopathic Carpal Tunnel Syndrome and Tarsal Tunnel Syndrome Sung-Hyouk Kim,

More information

<30312DC1A4BAB8C5EBBDC5C7E0C1A4B9D7C1A4C3A52DC1A4BFB5C3B62E687770>

<30312DC1A4BAB8C5EBBDC5C7E0C1A4B9D7C1A4C3A52DC1A4BFB5C3B62E687770> Journal of the Korea Institute of Information and Communication Engineering 한국정보통신학회논문지(J. Korea Inst. Inf. Commun. Eng.) Vol. 19, No. 2 : 258~264 Feb. 2015 ID3 알고리즘 기반의 귀납적 추론을 활용한 모바일 OS의 성공과 실패에 대한

More information

Lumbar spine

Lumbar spine Lumbar spine CT 32 111 DOI : 10.3831/KPI.2010.13.2.111 Lumbar Spine CT 32 Received : 10. 05. 23 Revised : 10. 06. 04 Accepted : 10. 06. 11 Key Words: Disc herniation, CT scan, Clinical analysis The Clinical

More information

< B1E8C7FDC1A42DBCD5B8F1C5CDB3CEC1F5C8C4B1BA20C1F8B4DC20BDC32E687770>

< B1E8C7FDC1A42DBCD5B8F1C5CDB3CEC1F5C8C4B1BA20C1F8B4DC20BDC32E687770> Journal of the Korea Academia-Industrial cooperation Society Vol. 18, No. 10 pp. 290-298, 2017 https://doi.org/10.5762/kais.2017.18.10.290 ISSN 1975-4701 / eissn 2288-4688 박종권 1, 강지혁 2, 김혜정 1* 1 경운대학교임상병리학과,

More information

( ) Jkra076.hwp

( ) Jkra076.hwp Vol. 11, No. 4, December, 2004 Objective: Ultrasonography (USG) of joints has a unique position for the diagnosis of joint diseases. Bone surface, cartilage, periarticular soft tissue and their pathologic

More information

975_983 특집-한규철, 정원호

975_983 특집-한규철, 정원호 Focused Issue of This Month Gyu Cheol an, MD Department of Otolaryngology ead & Neck Surgery, Gachon University of College Medicine E - mail : han@gilhospital.com Won-o Jung, MD Department of Otolaryngology

More information

A 617

A 617 Special Issue Diabetic Retinopathy Won Ki Lee, M.D. Department of Ophthalmology The Catholic University of Korea College of Medicine Kangnam St. Mary s Hospital E mail : wklee@catholic.ac.kr Abstract R

More information

ECG & EP CASES Young-Keun On, MD, PhD Division of Cardiology, Department of Medicine Cardiac & Vascular Center, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Korea A case of

More information

<30352EC1F5B7CA2DB1E8BCB1BFB52E687770>

<30352EC1F5B7CA2DB1E8BCB1BFB52E687770> 대한임상신경생리학회지 11(1):28~32, 2009 ISSN 1229-6414 경북대학교의과대학신경과학교실 1, 울산대학교의과대학울산대학교병원신경과 2 이다인 1 김선영 2 서정규 1 A Case of True Neurogenic Thoracic Outlet Syndrome by Cervical Rib. Dain Lee, M.D. 1, Sun-Young Kim,

More information

Microsoft PowerPoint - 발표자료(KSSiS 2016)

Microsoft PowerPoint - 발표자료(KSSiS 2016) Sang Jun Kim, MD, PhD Application of 3D Printing in the Orthotic Fields Hallux Valgus, Charcot Marie Tooth, ADL Kit, Foot Insole, Wrist Pain, Foot Drop Development of Automated Program for Ankle Foot Orthosis

More information

제5회 가톨릭대학교 의과대학 마취통증의학교실 심포지엄 Program 1 ANESTHESIA (Room 2층 대강당) >> Session 4 Updates on PNB Techniques PNB Techniques for shoulder surgery: continuou

제5회 가톨릭대학교 의과대학 마취통증의학교실 심포지엄 Program 1 ANESTHESIA (Room 2층 대강당) >> Session 4 Updates on PNB Techniques PNB Techniques for shoulder surgery: continuou 제5회 가톨릭대학교 의과대학 마취통증의학교실 심포지엄 (Room 2층 대강당) >> Session 4 Updates on PNB Techniques PNB Techniques for shoulder surgery: continuous vs single injection, interscalene vs supraclavicular approach 의정부성모병원

More information

(

( 317 318 319 320 1 3 5 5 5 5 2 321 : 1.,,,,, 06 2. X-ray beam penetration (density) (contrast) 03 3. patch coating, precipitation, flaking 03 4. centering 03 5. Esophagus, cardia, fundus, body, angle, antrum,

More information

서론 34 2

서론 34 2 34 2 Journal of the Korean Society of Health Information and Health Statistics Volume 34, Number 2, 2009, pp. 165 176 165 진은희 A Study on Health related Action Rates of Dietary Guidelines and Pattern of

More information

한국성인에서초기황반변성질환과 연관된위험요인연구

한국성인에서초기황반변성질환과 연관된위험요인연구 한국성인에서초기황반변성질환과 연관된위험요인연구 한국성인에서초기황반변성질환과 연관된위험요인연구 - - i - - i - - ii - - iii - - iv - χ - v - - vi - - 1 - - 2 - - 3 - - 4 - 그림 1. 연구대상자선정도표 - 5 - - 6 - - 7 - - 8 - 그림 2. 연구의틀 χ - 9 - - 10 - - 11 -

More information

388 The Korean Journal of Hepatology : Vol. 6. No COMMENT 1. (dysplastic nodule) (adenomatous hyperplasia, AH), (macroregenerative nodule, MR

388 The Korean Journal of Hepatology : Vol. 6. No COMMENT 1. (dysplastic nodule) (adenomatous hyperplasia, AH), (macroregenerative nodule, MR 6 3 2000 ; 387-392 (3) Dysplastic Nodule Young Nyun Park, M.D., Chanil Park, M.D. Department of Pathology, Yonsei University College of Medicine BRIEF HISTORY 56. AST/ALT 72/73 IU/L, total bilirubin 0.7

More information

CASE STUDY

CASE STUDY Biomechanics GACHON UNVERSITY Dept, of Physical Therapy Choi Won Ho Chapter8 HAND Intrinsic muscles of the hand The hand contains 20 intrinsic muscles. 1.Muscles of the Thenar Eminence Abductor pollicis

More information

<30372EBFF8C0FA5FB1E8B4EBBCBA2E687770>

<30372EBFF8C0FA5FB1E8B4EBBCBA2E687770> 대한임상신경생리학회지 10(1):43~47,08 ISSN 1229-6414 급성상완신경총염의임상소견과전기생리학적소견 부산대학교의과대학신경과학교실 조희영 김대성 Clinical Features and Electrophysiological Findings of Acute Brachial Plexitis Hee Young Jo, M.D., Dae-Seong Kim,

More information

8월공통

8월공통 김만수 (의왕 아름다운신문 발행인) 한사람 사랑하는 여러분, 하나님은 한 사람 을 찾으 십니다. 오늘 많은 사람이 지구촌에서 살고 있 지만 하나님이 찾으시는 한 사람이 나인가? 하 나님이 찾으시는 한 사람이 여러분이 되기를 축 복합니다. 제작 문의 02-442-0591 www.아름다운신문.net/com/kr 의왕 위대한지역신문 2008년 8. 1 / 제16호

More information

<283732372D3733312920B4D9C3CAC1A120BCD2C7C1C6AEC4DCC5C3C6AEB7BBC1EEC0C720B3EBBEC8C0C720BDC3B7C2BAB8C1A4BFA120B4EBC7D120C0AFBFEBBCBA20C6F2B0A1283035292E687770>

<283732372D3733312920B4D9C3CAC1A120BCD2C7C1C6AEC4DCC5C3C6AEB7BBC1EEC0C720B3EBBEC8C0C720BDC3B7C2BAB8C1A4BFA120B4EBC7D120C0AFBFEBBCBA20C6F2B0A1283035292E687770> 대한안과학회지 제 49 권 제 5 호 2008 J Korean Ophthalmol Soc 49(5):727-731, 2008 DOI : 10.3341/jkos.2008.49.5.727 다초점 소프트콘택트렌즈의 노안의 시력보정에 대한 유용성 평가 김현경 1 김효명 2 정성근 1 가톨릭대학교 의과대학 성모병원 안과학교실 1, 고려대학교 의과대학 안암병원 안과학교실

More information

(Exposure) Exposure (Exposure Assesment) EMF Unknown to mechanism Health Effect (Effect) Unknown to mechanism Behavior pattern (Micro- Environment) Re

(Exposure) Exposure (Exposure Assesment) EMF Unknown to mechanism Health Effect (Effect) Unknown to mechanism Behavior pattern (Micro- Environment) Re EMF Health Effect 2003 10 20 21-29 2-10 - - ( ) area spot measurement - - 1 (Exposure) Exposure (Exposure Assesment) EMF Unknown to mechanism Health Effect (Effect) Unknown to mechanism Behavior pattern

More information

075~090 ¼ö±Ù°üÁõÈıº

075~090 ¼ö±Ù°üÁõÈıº Sweet 75 DOI : 10.3831/KPI.2010.13.4.075 Sweet Received : 10. 11. 12 Revised : 10. 11. 28 Accepted : 10. 12. 02 Key Words: Carpal tunnel sydrome, Sweet Bee Venom Pharmacopuncture, Scolopendrid Pharmacopuncture,

More information

012임수진

012임수진 Received : 2012. 11. 27 Reviewed : 2012. 12. 10 Accepted : 2012. 12. 12 A Clinical Study on Effect of Electro-acupuncture Treatment for Low Back Pain and Radicular Pain in Patients Diagnosed with Lumbar

More information

44-3대지.08류주현c

44-3대지.08류주현c A Comparative Study on the Commuting Regional Type According to the Features of Foreigner Commuting Ju-Hyun Ryu* Abstract The purposes of this study are to identify many implications of commuting regional

More information

Jksvs019(8-15).hwp

Jksvs019(8-15).hwp Grade I Grade II Grade III 12 대한혈관외과학회지 : 제 20 권 제 1 호 2004 Control Group A Group B Fig. 4. Microscopic findings of vein wall in control, group A and group B on the day of 7 after venous occlusion. The

More information

Jkafm093.hwp

Jkafm093.hwp 가정의학회지 2004;25:721-739 비만은 심혈관 질환, 고혈압 및 당뇨병에 각각 위험요인이고 다양한 내과적, 심리적 장애와 연관이 있는 질병이다. 체중감소는 비만한 사람들에 있어 이런 위험을 감소시키고 이들 병발 질환을 호전시킨다고 알려져 있고 일반적으로 많은 사람들에게 건강을 호전시킬 것이라는 믿음이 있어 왔다. 그러나 이런 믿음을 지지하는 연구들은

More information

( )Kjhps043.hwp

( )Kjhps043.hwp Difference of Fistula Maturation Degree and Physical Property by the Types of Tube Material: An Experimental Study Sang Koo Kang, M.D. 1, Hee Chul Yu, M.D. 1,4, Woo Sung Moon, M.D. 2,4, Ju Hyoung Lee,

More information

<30345F283439372D353034295F313135375FC0CCB5BFC8F15FB5B5B7CEC5CDB3CEC0C720B0BBB1B8BACE20B0E6B0FCBCB3B0E8B0A120C5CDB3CE20B3BBBACEC1B6B8ED2E687770>

<30345F283439372D353034295F313135375FC0CCB5BFC8F15FB5B5B7CEC5CDB3CEC0C720B0BBB1B8BACE20B0E6B0FCBCB3B0E8B0A120C5CDB3CE20B3BBBACEC1B6B8ED2E687770> J of Korean Tunn Undergr Sp Assoc 15(5)497-504(2013) eissn: 2287-4747 http://dx.doi.org/10.9711/ktaj.2013.15.5.497 pissn: 2233-8292 도로터널의 갱구부 경관설계가 터널 내부조명에 미치는 영향에 관한 연구 이미애 1 ㆍ이동희 2 * 1 아이라이트 대표이사 2

More information

878 Yu Kim, Dongjae Kim 지막 용량수준까지도 멈춤 규칙이 만족되지 않아 시행이 종료되지 않는 경우에는 MTD의 추정이 불가 능하다는 단점이 있다. 최근 이 SM방법의 단점을 보완하기 위해 O Quigley 등 (1990)이 제안한 CRM(Continu

878 Yu Kim, Dongjae Kim 지막 용량수준까지도 멈춤 규칙이 만족되지 않아 시행이 종료되지 않는 경우에는 MTD의 추정이 불가 능하다는 단점이 있다. 최근 이 SM방법의 단점을 보완하기 위해 O Quigley 등 (1990)이 제안한 CRM(Continu 한 국 통 계 학 회 논 문 집 2012, 19권, 6호, 877 884 DOI: http://dx.doi.org/10.5351/ckss.2012.19.6.877 Maximum Tolerated Dose Estimation Applied Biased Coin Design in a Phase Ⅰ Clinical Trial Yu Kim a, Dongjae Kim

More information

04조남훈

04조남훈 Received : 2011. 11. 16 Reviewed : 2011. 11. 25 Accpeted : 2011. 12. 5 A Case Report of Prescribing Yanghyeolgeopung-tang(yangxuequfeng-tang) to Two Patients with Cervical Disc Herniation and Headache

More information

( )Kju225.hwp

( )Kju225.hwp 비임균성비뇨생식기감염에서 의진단적효용성 Usefulness of the Mycofast Test (MYCOFAST Evolution 2) for the Diagnosis of Nongonococcal Genitourinary Infections Hang Ro Park, Yang Hyun Kim, Ho Jae Lee, Jea Sang Oh, Hyoung Jin

More information

임상신경생리학회지 도비라.indd

임상신경생리학회지 도비라.indd 대한임상신경생리학회지 15(1):7~12, 2013 eissn 2288-1026 pissn 1229-6414 Original Article 수근관증후군에서국소스테로이드주사후임상적, 전기생리학적변화 건양대학교병원신경과 1, 건양대학교병원산부인과 2 김지훈 1 이기욱 1 윤보라 1 김용덕 1 정언석 2 나상준 1 Clinical and Electrophysiological

More information

331 Review J Korean Orthop Assoc 2014; 49: Update on Management of Compressive Neuro

331 Review J Korean Orthop Assoc 2014; 49: Update on Management of Compressive Neuro 331 Review J Korean Orthop Assoc 2014; 49: 331-339 http://dx.doi.org/10.4055/jkoa.2014.49.5.331 www.jkoa.org Update on Management of Compressive Neuropathy 이석하 이승준 건국대학교의학전문대학원정형외과학교실 pissn : 1226-2102,

More information

09구자용(489~500)

09구자용(489~500) The Study on the Grid Size Regarding Spatial Interpolation for Local Climate Maps* Cha Yong Ku** Young Ho Shin*** Jae-Won Lee**** Hee-Soo Kim*****.,...,,,, Abstract : Recent global warming and abnormal

More information

72 순천향의과학 : 제14권 2호 2008 Fig.1. Key components of the rehabilitation evaluation of patients with the rheumatic diseases. The ICF provides a good frame

72 순천향의과학 : 제14권 2호 2008 Fig.1. Key components of the rehabilitation evaluation of patients with the rheumatic diseases. The ICF provides a good frame Journal of Soonchunhyang Medical Science 14(2) p.71~82 December 2008 71 류마티스 관절염의 재활치료 오 기 영 순천향 대학교 의과대학 재활의학교실 Rehabilitation Interventions for the Patient with Rheumatoid Arthritis Ki-Young Oh Department

More information

<4D F736F F F696E74202D2030C1A635B0AD20BCD5B0A1B6F420B0FCC0FD20BAB8C1B6B1E2205BC8A3C8AF20B8F0B5E55D>

<4D F736F F F696E74202D2030C1A635B0AD20BCD5B0A1B6F420B0FCC0FD20BAB8C1B6B1E2205BC8A3C8AF20B8F0B5E55D> 제 5 강. 손관절보조기 중수지절관절에대한보조기 MP flexor orthosis Common Name: Knuckle bender 목적및구성 : dorsal hand band(d), dorsal finger band(d), palmar rod(p) 두개의밴드의양쪽에돌출된후크에고무줄을연결시켜서 MP를굴곡시키는작용을함. MP flexor orthosis MP

More information

< D30362D BCB1BFECC0CFB3B22DB0ADBBE7C0B1292E687770>

< D30362D BCB1BFECC0CFB3B22DB0ADBBE7C0B1292E687770> 원저 제주대학교의과대학신경과, 연세대학교의과대학신경과 a 강사윤김승민 a 선우일남 a Clinical and Electrophysiological Characteristics of Leprous Neuropathy Sa-Yoon Kang, M.D., Seung Min Kim, M.D. a, Il-Nam Sunwoo, M.D. a Department of Neurology,

More information

09권오설_ok.hwp

09권오설_ok.hwp (JBE Vol. 19, No. 5, September 2014) (Regular Paper) 19 5, 2014 9 (JBE Vol. 19, No. 5, September 2014) http://dx.doi.org/10.5909/jbe.2014.19.5.656 ISSN 2287-9137 (Online) ISSN 1226-7953 (Print) a) Reduction

More information

???? 1

???? 1 The Korean Journal of Applied Statistics (2014) 27(1), 13 20 DOI: http://dx.doi.org/10.5351/kjas.2014.27.1.013 Maximum Tolerated Dose Estimation by Stopping Rule and SM3 Design in a Phase I Clinical Trial

More information

A Study on Married Female Immigrants Life Style and Marriage Satisfaction in Terms of Preparing Their Old Age in Chungcheongnam-do Department of Gerontology, Hoseo University Doctoral Student : Hi Ran

More information

untitled

untitled 통증 : 제 19 권 2009 종설 수근관증후군의수술적치료 연세대학교의과대학성형외과학교실 탁관철 = Abstract = Surgical Treatment of Carpal Tunnel Syndrome Kwan-Chul Tark, MD, PhD, FACS Department of Plastic & Reconstructive Surgery, Yonsei University

More information

<B0E6C8F1B4EBB3BBB0FAC0D3BBF3B0ADC1C E687770>

<B0E6C8F1B4EBB3BBB0FAC0D3BBF3B0ADC1C E687770> 개원의와함께하는임상강좌 2011 역류성식도질환제대로이해하기 Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea Jae-Young Jang, M.D., PhD. 개원의와함께하는임상강좌 2011 109 최신치료

More information

untitled

untitled 대한마취과학회지 2008; 55: 190~6 Korean J Anesthesiol Vol. 55, No. 2, August, 2008 임상연구 대한민국의 마취통증의학 임상실습 현황 연세대학교 의과대학 마취통증의학교실 및 마취통증의학연구소 장동진ㆍ안소운ㆍ안지원ㆍ김종훈 The current status of anesthesiology clerkship in Korea

More information

( )Kju269.hwp

( )Kju269.hwp 만성세균성전립선염모델흰쥐에서 의항염효과 Anti-inflammatory Effect of Lycopene on Chronic Bacterial Prostatitis Rat Model Cho Hwan Yang, Dong Wan Sohn, Yong-Hyun Cho From the Department of Urology, The Catholic University

More information

16(1)-3(국문)(p.40-45).fm

16(1)-3(국문)(p.40-45).fm w wz 16«1y Kor. J. Clin. Pharm., Vol. 16, No. 1. 2006 x w$btf3fqpsu'psn û w m w Department of Statistics, Chonnam National University Eunsik Park College of Natural Sciences, Chonnam National University

More information

(김선영).hwp

(김선영).hwp 원저 당뇨병환자에게동반된손목굴증후군의임상적특징 울산대학교의과대학신경과학교실, 경북대학교의과대학신경과학교실 a 김선영고민수권지현서정규 a Clinical Characteristics of Carpal Tunnel Syndrome in Patients With Diabetes Sun-Young Kim, MD, Min-Soo Ko, MD, Jee-Hyun Kwon,

More information

Pharmacotherapeutics Application of New Pathogenesis on the Drug Treatment of Diabetes Young Seol Kim, M.D. Department of Endocrinology Kyung Hee Univ

Pharmacotherapeutics Application of New Pathogenesis on the Drug Treatment of Diabetes Young Seol Kim, M.D. Department of Endocrinology Kyung Hee Univ Application of New Pathogenesis on the Drug Treatment of Diabetes Young Seol Kim, M.D. Department of Endocrinology Kyung Hee University College of Medicine & Hospital E mail : ycell2@yahoo.co.kr Abstract

More information

< D30392D C0CCB5BFB1B92DC0CCC8BFB9CE292D E687770>

< D30392D C0CCB5BFB1B92DC0CCC8BFB9CE292D E687770> 원저접수번호 :09-029(2 차 -0710) 수근관증후군환자에서감각역치검사의진단적유용성 대구가톨릭의대신경과 이효민윤창효석정임이동국 Diagnostic Usefullness of Current Perception Threshold Test in Carpal Tunnel Syndrome Hyo Min Lee, MD, Chang Hyo Yoon, MD, Jung

More information

ÀÇÇа�ÁÂc00Ì»óÀÏ˘

ÀÇÇа�ÁÂc00Ì»óÀÏ˘ Common Allergic Diseases in Children Sang - Il Lee, M.D. Department of pediatrics Sungkyunkwan University School of Medicine, Samsung Medical Center E - mail : silee@smc.samsung.co.kr Abstract Allergy

More information

12이문규

12이문규 Review on Conservative Treatment of Spinal Scoliosis Moon-kyu Lee, O.M.D., Gil-jae Lee, O.M.D., Yun-kyung Song, O.M.D., Hyung-ho Lim, O.M.D. Dept. of Oriental Rehabilitation Medicine College of Oriental

More information

005송영일

005송영일 Received : 2015. 12. 09 Reviewed : 2015. 12. 16 Accepted : 2015. 12. 16 Sternal Fracture occurred after Thai Massage : A Case Report Young-Il Song, K.M.D. 1, Dong-Eun Kim, K.M.D. 1 1 Department of Rehabilitation

More information

139~144 ¿À°ø¾àħ

139~144 ¿À°ø¾àħ 2 139 DOI : 10.3831/KPI.2010.13.2.139 2 Received : 10. 04. 08 Revised : 10. 04. 26 Two Case Report on Wrist Ganglion Treated with Scolopendrid Pharmacopuncture Accepted : 10. 05. 04 Key Words: Wrist Ganglion,

More information

<30382EC0C7C7D0B0ADC1C22E687770>

<30382EC0C7C7D0B0ADC1C22E687770> 대한내과학회지: 제 76 권 제 2 호 2009 의학강좌-개원의를 위한 모범처방(Current Clinical Practice) 간기능검사의 이해와 적용 인제대학교 의과대학 일산백병원 내과학교실 김 경 아 Understanding and application of liver function tests Kyung-Ah Kim, M.D. Department of

More information

ºÎÁ¤¸ÆV10N³»Áö

ºÎÁ¤¸ÆV10N³»Áö case of brugada syndrome presented as chest pain STRCT rugada syndrome was described in 1992 as a new clinical entity characterized by electrocardiographic STsegment elevation in the right precordial leads

More information

Sheu HM, et al., British J Dermatol 1997; 136: Kao JS, et al., J Invest Dermatol 2003; 120:

Sheu HM, et al., British J Dermatol 1997; 136: Kao JS, et al., J Invest Dermatol 2003; 120: Sheu HM, et al., British J Dermatol 1997; 136:884-890 Kao JS, et al., J Invest Dermatol 03; 1:446-464 1 10 0 3 Day Normal MLE Lotion Lotion MLE Cream Cream 80 7 70 6 3 Day Normal MLE Lotion Lotion MLE

More information

- i - - ii - - iii - - iv - - v - - vi - - 1 - - 2 - - 3 - 1) 통계청고시제 2010-150 호 (2010.7.6 개정, 2011.1.1 시행 ) - 4 - 요양급여의적용기준및방법에관한세부사항에따른골밀도검사기준 (2007 년 11 월 1 일시행 ) - 5 - - 6 - - 7 - - 8 - - 9 - - 10 -

More information

Fluoroscopic anatomy for supraventricular tachycardia ablation Hui-Nam Pak, MD, PhD Division of Cardiology, Yonsei Cariovascular Center and Cardiovascular Research Institute, Yonsei University College

More information

Thieme: Color Atlas of Acupuncture

Thieme: Color Atlas of Acupuncture IX Contents Part 1: Body Acupuncture Points Part 2: Ear Acupuncture Points The Lung Channel... 2 The Large Intestine Channel... 7 The Stomach Channel... 15 The Spleen Channel... 23 The Heart Channel...

More information

09È«¼®¿µ 5~152s

09È«¼®¿µ5~152s Korean Journal of Remote Sensing, Vol.23, No.2, 2007, pp.45~52 Measurement of Backscattering Coefficients of Rice Canopy Using a Ground Polarimetric Scatterometer System Suk-Young Hong*, Jin-Young Hong**,

More information

14.531~539(08-037).fm

14.531~539(08-037).fm G Journal of the Korea Concrete Institute Vol. 20, No. 4, pp. 531~539, August, 2008 š x y w m š gj p { sƒ z 1) * 1) w w Evaluation of Flexural Strength for Normal and High Strength Concrete with Hooked

More information

290 pissn : , eissn : Original Article J Korean Orthop Assoc 2013; 48:

290 pissn : , eissn : Original Article J Korean Orthop Assoc 2013; 48: 290 pissn : 1226-2102, eissn : 2005-8918 Original Article J Korean Orthop Assoc 2013; 48: 290-296 http://dx.doi.org/10.4055/jkoa.2013.48.4.290 www.jkoa.org 수근관감압술후초음파상정중신경단면적의변화와예후와의상관관계 이승주 김지섭 최윤락 김성준

More information

歯5-2-13(전미희외).PDF

歯5-2-13(전미희외).PDF The Korean Journal of Counseling 2004, Vol. 5, No. 2, 423-434,. 4 5 18 9, 9.,,,,,.,,, t-.. :,,, (,, 1996),.,,. (, 2001),... 88 98 2000, 88 12.5%(250 )98 35.6%(712 )2.8 (,,, 2001) (Corresponding Author)

More information

김범수

김범수 Analysis of Outcomes after Resection of Sarcomatous Hepatocellular Carcinoma Purpose: Sarcomatous hepatocellular carcinoma (HCC) is rare. Therefore, the clinicopathologic characteristics and prognosis

More information

스포츠과학 143호 내지.indd

스포츠과학 143호 내지.indd https simtk.org,, sanghyuk0620@kspo.or.kr.... 48 SPORT SCIENCE . 33 55% 1 2 Iwamoto and Takeda 2003 3 1 3.......?... 4 SPORT SCIENCE 1. 2 3 12 16 3 6.. 5 strain gauge. 1970. 6 1) Brukner, P., Bradshaw,

More information

2 제1935호 CMC 오늘 인물동정 신장내과 김석영 교수 대전성모 제8대 의무원장 취임 지난 1일 가톨릭대학 교 대전성모병원 신장 내과 김석영 교수가 제8 대 대전성모병원 의무 원장으로 취임했다. 김석영 교수는 신장 김석영 교수 이식과 만성신부전 등 신장질환 치료 분

2 제1935호 CMC 오늘 인물동정 신장내과 김석영 교수 대전성모 제8대 의무원장 취임 지난 1일 가톨릭대학 교 대전성모병원 신장 내과 김석영 교수가 제8 대 대전성모병원 의무 원장으로 취임했다. 김석영 교수는 신장 김석영 교수 이식과 만성신부전 등 신장질환 치료 분 가톨릭대학교 서울성모병원 2009. 3. 23 개원 D-7 제1935호 2009. 3. 16 이제는 서울성모병원입니다! 가톨릭대학교 서울성모병원 발대식 환우 중심의 친절, 상호 존중의 문화 다짐 가톨릭대학교 서울성모병원을 향한 교 직원들의 의지가 한곳에 모였다. 가톨릭대학교 강남성모병원은 지난 10 일 오후 5시 30분, 성의회관 마리아홀에서 가톨릭대학교 서울성모병원

More information

03-ÀÌÁ¦Çö

03-ÀÌÁ¦Çö 25 3 (2004 9 ) J Korean Oriental Med 2004;25(3):20-31 1), 2), 3) 1) 2) 3) Grope for a Summary Program about Intellectual Property Protection of Traditional Knowledge (TK)etc. Discussed in WIPO Hwan-Soo

More information

<31312D31352D B9E9C7F6BCAE2DB9DAB9CEBCF E687770>

<31312D31352D B9E9C7F6BCAE2DB9DAB9CEBCF E687770> 증례 http://dx.doi.org/10.17340/jkna.2015.3.11 영남대학교의과대학신경과학교실 Acute-Onset Chronic Inflammatory Demyelinating Polyradiculoneuropathy Mimicking Miller-Fisher Syndrome Hyun-Seok Baek, MD, Chang Hun Bin, MD,

More information

ePapyrus PDF Document

ePapyrus PDF Document Introduction 373 374 Definition of Child Abuse 375 376 Current Status of Child Abuse 377 378 Causes of Child Abuse 379 Signs and Sequelae of Child Abuse 380 A B C 381 382 383 384 385 Clinical Evaluation

More information

03-서연옥.hwp

03-서연옥.hwp 농업생명과학연구 49(4) pp.31-37 Journal of Agriculture & Life Science 49(4) pp.31-37 Print ISSN 1598-5504 Online ISSN 2383-8272 http://dx.doi.org/10.14397/jals.2015.49.4.31 국가산림자원조사 자료를 적용한 충남지역 사유림경영율 추정 서연옥

More information

001-학회지소개(영)

001-학회지소개(영) Review Article Randomization, What is the Proper Method? Jin Ho Hong, M.D., Jae Chul Yoo, M.D. Shoulder & Sports medicine, Department of Orthopedic Surgery, Samsung Medical Center Purpose: Among the numerous

More information

ORIGINAL ARTICLE pissn eissn J Korean Soc Surg Hand 2017;22(1): JOURNAL OF THE KO

ORIGINAL ARTICLE pissn eissn J Korean Soc Surg Hand 2017;22(1): JOURNAL OF THE KO ORIGINAL ARTICLE pissn 1598-3889 eissn 2234-998 J Korean Soc Surg Hand 217;22(1):49-56. http://doi.org/1.1279/jkssh.217.22.1.49 JOURNAL OF THE KOREAN SOCIETY FOR SURGERY OF THE HAND The Fate of Anterior

More information

- iii - - i - - ii - - iii - 국문요약 종합병원남자간호사가지각하는조직공정성 사회정체성과 조직시민행동과의관계 - iv - - v - - 1 - - 2 - - 3 - - 4 - - 5 - - 6 - - 7 - - 8 - - 9 - - 10 - - 11 - - 12 - - 13 - - 14 - α α α α - 15 - α α α α α α

More information

자기공명영상장치(MRI) 자장세기에 따른 MRI 품질관리 영상검사의 개별항목점수 실태조사 A B Fig. 1. High-contrast spatial resolution in phantom test. A. Slice 1 with three sets of hole arr

자기공명영상장치(MRI) 자장세기에 따른 MRI 품질관리 영상검사의 개별항목점수 실태조사 A B Fig. 1. High-contrast spatial resolution in phantom test. A. Slice 1 with three sets of hole arr Original Article pissn 1738-2637 J Korean Soc Radiol 2012;67(2):129-134 The Survey of Magnetic Resonance Imaging Quality according to in Korea 1 자기공명영상장치(MRI) 자장세기에 따른 MRI 품질관리 영상검사의 개별항목점수 실태조사 1 Hyun-Hae

More information

±èÇ¥³â

±èÇ¥³â 533 Fig. 1. Dead zone. Nine echoes are positioned 2-10 mm below the scan surface with 1 mm distance. All nine echoes are clearly visualized. 534 Fig. 2. Vertical and horizontal measurement. 10 cm distance

More information

<C7A5C1F620BEE7BDC4>

<C7A5C1F620BEE7BDC4> 연세대학교 상경대학 경제연구소 Economic Research Institute Yonsei Universit 서울시 서대문구 연세로 50 50 Yonsei-ro, Seodaemun-gS gu, Seoul, Korea TEL: (+82-2) 2123-4065 FAX: (+82- -2) 364-9149 E-mail: yeri4065@yonsei.ac. kr http://yeri.yonsei.ac.kr/new

More information

Journal of Educational Innovation Research 2017, Vol. 27, No. 2, pp DOI: : Researc

Journal of Educational Innovation Research 2017, Vol. 27, No. 2, pp DOI:   : Researc Journal of Educational Innovation Research 2017, Vol. 27, No. 2, pp.251-273 DOI: http://dx.doi.org/10.21024/pnuedi.27.2.201706.251 : 1997 2005 Research Trend Analysis on the Korean Alternative Education

More information

2012년_임상연구논문(교정2).hwp

2012년_임상연구논문(교정2).hwp 2012 년도 국립소록도병원논문집 제 37 권 국립소록도병원 Sorokdo National Hospital 한센병 노인병의학연구소 Research Institute of Leprosy and Geriatrics 2012 임상연구논문집 목차 (CONTENTS) 1. 5 Prevalence Study of Anemia Patients affected by Leprosy

More information

슬라이드 1

슬라이드 1 Proposed Korean guideline for the diagnosis of BPH Hyun Woo Kim The Catholic University of Korea BPH Guideline AHCPR guideline on BPH (1994) AUA guideline on BPH (2003) EAU guideline on BPH (2004) International

More information

DBPIA-NURIMEDIA

DBPIA-NURIMEDIA 27(2), 2007, 96-121 S ij k i POP j a i SEXR j i AGER j i BEDDAT j ij i j S ij S ij POP j SEXR j AGER j BEDDAT j k i a i i i L ij = S ij - S ij ---------- S ij S ij = k i POP j a i SEXR j i AGER j i BEDDAT

More information

methods.hwp

methods.hwp 1. 교과목 개요 심리학 연구에 기저하는 기본 원리들을 이해하고, 다양한 심리학 연구설계(실험 및 비실험 설계)를 학습하여, 독립된 연구자로서의 기본적인 연구 설계 및 통계 분석능력을 함양한다. 2. 강의 목표 심리학 연구자로서 갖추어야 할 기본적인 지식들을 익힘을 목적으로 한다. 3. 강의 방법 강의, 토론, 조별 발표 4. 평가방법 중간고사 35%, 기말고사

More information

308 하중원 최승진 김성훈 나일시적호전후증상의재발이반복되어경피적 A1 활차절개술을계획하였다. 환자는앙와위자세에서 A1 활차부위를촉지하고, 수지를굴곡 신전하며걸림증상을확인한뒤중수지관절수장선부위에 2% Lidocaine/Epinephrine (1:100,000) 1.8

308 하중원 최승진 김성훈 나일시적호전후증상의재발이반복되어경피적 A1 활차절개술을계획하였다. 환자는앙와위자세에서 A1 활차부위를촉지하고, 수지를굴곡 신전하며걸림증상을확인한뒤중수지관절수장선부위에 2% Lidocaine/Epinephrine (1:100,000) 1.8 307 pissn : 1226-2102, eissn : 2005-8918 Case Report J Korean Orthop Assoc 2014; 49: 307-311 http://dx.doi.org/10.4055/jkoa.2014.49.4.307 www.jkoa.org 경피적방아쇠무지절개술후에발생한복합부위통증증후군 하중원 최승진 김성훈 국민건강보험일산병원정형외과

More information

<31335FB1C7B0E6C7CABFDC2E687770>

<31335FB1C7B0E6C7CABFDC2E687770> 에너지기후변화교육 4(2):203~211(2014) 203 초등학교 교과서 에너지 단원의 탐구활동과 시각자료 기능 분석 사례 연구 신명경 권경필 * 경인교육대학교 Abstract : This study aimed to analyze energy related inquiry activity and visual materials in elementary textbook.

More information

충북의대학술지 Chungbuk Med. J. Vol. 27. No. 1. 1~ Charcot-Marie-Tooth Disease 환자의마취 : 증례보고 신일동 1, 이진희 1, 박상희 1,2 * 책임저자 : 박상희, 충북청주시서원구충대로 1 번지, 충북대학교

충북의대학술지 Chungbuk Med. J. Vol. 27. No. 1. 1~ Charcot-Marie-Tooth Disease 환자의마취 : 증례보고 신일동 1, 이진희 1, 박상희 1,2 * 책임저자 : 박상희, 충북청주시서원구충대로 1 번지, 충북대학교 충북의대학술지 Chungbuk Med. J. Vol. 27. No. 1. 1~5 2017 Charcot-Marie-Tooth Disease 환자의마취 : 증례보고 신일동 1, 이진희 1, 박상희 1,2 * 책임저자 : 박상희, 충북청주시서원구충대로 1 번지, 충북대학교의과대학마취통증의학교실, 의학연구소 (28644), happycat19@hanmail.net

More information

07_Àü¼ºÅÂ_0922

07_Àü¼ºÅÂ_0922 176 177 1) 178 2) 3) 179 4) 180 5) 6) 7) 8) 9) 10) 181 11) 12) 182 13) 14) 15) 183 16) 184 185 186 17) 18) 19) 20) 21) 187 22) 23) 24) 25) 188 26) 27) 189 28) 29) 30)31) 32) 190 33) 34) 35) 36) 191 37)

More information

The Window of Multiple Sclerosis

The Window of Multiple Sclerosis THE WINDOW OF MULTIPLE SCLEROSIS Vol.2 No.1 MAR 2009 Topic Review Article Review 01. 02. 03. 04. Case Review The Window of Multiple Sclerosis THE WINDOW OF MULTIPLE SCLEROSIS The Window of Multiple Sclerosis

More information

약수터2호최종2-웹용

약수터2호최종2-웹용 Contents 06 08 11 14 17 17 18 19 23 28 28 33 37 41 45 45 51 56 59 64 66 72 80 26 29 31 34 35 35 38 39 40 42 43 43 46 46 47 49 50 51 52 53 54 56 57 59 60 61 62 69 73 74 77 78 79 14 15 25 36 48 06 07 08

More information

체성 감각신경계 진찰

체성 감각신경계 진찰 말초신경및근육의전기생리학적검사 Electrophysiological Testing in Neuromuscular Disease 김병준교수 ( 신경과학교실, 강북삼성병원 ) 학습목표 - 근전도검사의적응증을설명한다. - 축삭병변과탈수초성병변의구분에있어서근전도검사의유용성을설명한다. - 근전도검사에서의사의역할을설명한다. 1. 근전도검사의개념 근전도검사 (Electromyography,

More information

21-강호정/

21-강호정/ 대한견 주관절학회지제 12 권제 2 호 J. of Korean Shoulder and Elbow Society Volume 12, Number 2, December, 2009 수술적으로치료한주관절삼두근탄발증후군과척골신경탈구 - 2 예보고 - 연세대학교의과대학정형외과교실 강호정 이희영 이정길 한수봉 김성재 Operative Treatement of Snapping

More information

Journal of Educational Innovation Research 2017, Vol. 27, No. 3, pp DOI: (NCS) Method of Con

Journal of Educational Innovation Research 2017, Vol. 27, No. 3, pp DOI:   (NCS) Method of Con Journal of Educational Innovation Research 2017, Vol. 27, No. 3, pp.181-212 DOI: http://dx.doi.org/10.21024/pnuedi.27.3.201709.181 (NCS) Method of Constructing and Using the Differentiated National Competency

More information

232 도시행정학보 제25집 제4호 I. 서 론 1. 연구의 배경 및 목적 사회가 다원화될수록 다양성과 복합성의 요소는 증가하게 된다. 도시의 발달은 사회의 다원 화와 밀접하게 관련되어 있기 때문에 현대화된 도시는 경제, 사회, 정치 등이 복합적으로 연 계되어 있어 특

232 도시행정학보 제25집 제4호 I. 서 론 1. 연구의 배경 및 목적 사회가 다원화될수록 다양성과 복합성의 요소는 증가하게 된다. 도시의 발달은 사회의 다원 화와 밀접하게 관련되어 있기 때문에 현대화된 도시는 경제, 사회, 정치 등이 복합적으로 연 계되어 있어 특 한국도시행정학회 도시행정학보 제25집 제4호 2012. 12 : pp.231~251 생활지향형 요소의 근린주거공간 분포특성 연구: 경기도 시 군을 중심으로* Spatial Distribution of Daily Life-Oriented Features in the Neighborhood: Focused on Municipalities of Gyeonggi Province

More information