조선초기 왕릉제사의 정비와 운영

조선시대의 왕릉은 풍수지리학과 미술사 등에서 왕릉연구가 이루어졌을 뿐 그것의 국가의례 측면에서의 접근이 거의 없었다. 본고에서는 이중에서 제례를 대상으로초기 왕릉제사의 제도적 정비와 의식, 종묘와 차별성, 그리고 능행의 정치사적 의미등을 천착함으로써 국가의례에서 왕릉이 차지하는 위치를 짚어보고자 하였다.　 왕릉은 태조 즉위 후 추존된 4 대왕 및 왕비 그리고 신의왕후의 齊陵이 조성되었고 능제의 정비는 친모인 신의왕후 한씨의 제일에 태종의 행행이 거행되면서 이루어졌는데, 특히 태종 8 년 태조의 사망을 계기로 본격화되었다. 厚陵과 獻陵이 조성된 세종대에는 제사와 관련된 여러 세부 사항들과 拜陵儀가 수정. 보완되었다. 그내용은 세종 사후『세종실록』오례의 왕릉과 관련된 흉례조와 길례조에 수록되었으며, 이후 부분적 수정을 통해『국조오례의』에 수록되었다.　왕릉에서 시행된 제사는 四孟月의 시제와 朔望, 俗節 등 다양한데, 이것은 당시종묘 및 원묘인 문소전에서 시행된 것과 동일하였다. 이러한 방식은 고려 이래의 전통으로 보이는데, 중국사의 경우에도 비슷하게 나타나고 있다. 그러나 조선의 능제는 국가 祀典의 大祀에 편입된 고려시대와 달리 大・中・小祀의 편재가 아닌 俗祭라는 별도의 체계에 속함으로써 大祀로 국가의 正禮인 종묘와는 구분되었다. 아울러능제를 흉례의 체계에 附加시킨 중국과 달리 왕릉 관련 의식을 흉례와 길례로 구분하여 각각에 편입시키는 독자성을 보였다.　태조 ~ 성종의 100년간 종묘의 국왕친제가 41회에 불과한 반면 왕릉과 원묘（문소전）에 대해서는 국왕이 매년 2 ~ 5 회에 걸쳐 행행했다. 그 후 문소전은 임진왜란과정에서 파괴되었지만 복구되지 않았고, 왕릉의 사시제는 인조대에 이르러 폐지되기에 이르렀다. 이후 왕릉제사는 속절제（臘日 제외）를 중심으로 운영되었다.　조선시대 제사에 왕의 참여는 예상외로 많지 않다. 대표적인 제사대상인　종묘의경우에도 대략 2 ~ 3 년에 한번씩 왕이 친행이 이루어졌을 뿐이었다. 반면에 왕릉의친제는 매년 수차례에 걸쳐 이루어졌다. 누대의 선왕이 모여 있는 혼전보다는 육신이 안치된 개별 능에 인간적인 친근감을 느꼈고, 능제가 俗祭이기 때문에 제사과정이 간략하다는 측면 등이 결합되어 나타난 것이다. 장엄한 의장을 갖춘 능행은 도성을 벗어나 일반 민에게 우리의 ‘왕’을 알릴 수 있는 중요한 정치행위였다

국내 조기위암의 복강경 수술 현황

Owing to the introduction of national screening program, the detection rate of early gastric cancer (EGC) has been rapidly increased in Korea. Laparoscopic gastrectomy has been widely accepted as one of the standard treatments of EGC regardless of the risk of lymph node metastasis. Benefits of laparoscopic surgery included less pain, earlier recovery, lower complication rate than open surgery. Studies from Korean Laparoscopic Gastrointestinal Surgery Study Group (KLASS) reported short-term outcome including feasibility, safety, and effectiveness as well as satisfactory long-term oncologic outcome. Ongoing prospective randomized controlled trials for early and advanced gastric cancer patients designed by KLASS will provide the evidence of the role of laparoscopic surgery

진행성 위암의 수술적 치료

Although the proportion of early gastric cancer has increased, that of advanced gastric cancer (AGC) is still high. The overall prog-nosis of AGC has gradually improved over the past decades with advances in surgical techniques as well as multimodality treatments. Nevertheless, the outcome of AGC still remains poor and worldwide standard treatment guideline has not been established. Radical gastrectomy is the gold standard of management or gastric cancer worldwide, as the complete surgical removal of tumors (R0 resection) confers the only chance for cure. However, the extent of lymph node dissection has been debated between East and West. Radical gastrectomy with extended D2 lymphadenectomy is the accepted standard in Eastern countries, whereas lim-ited D1 lymphadenectomy with chemoradiotherapy is more frequently used in Western countries. Role of splenectomy and laparo-scopic surgery for AGC is still debatable and should be proved by long-term oncologic outcomes from large-scale randomized con-trolled trials

자가치아 뼈 이식재의 유용성에 관한 임상적 연구

Purpose: This study is to evaluate the efficacy of the autogenous tooth bone graft material, clinically and radiologically, as related to implant installation. Methods: In oral and maxillofacial surgery department of Ajou University Hospital, guided bone regeneration (GBR), implant placement combined with GBR, sinus graft, implant placement combined with sinus graft, and defect filling were performed in 46 patients, using autogenous tooth bone. Among these, 66 implants were inserted with autogenous tooth bone. Implant stability quotient (ISQ) was measured by Osstell Mentor (Integration Diagnostics, Goteborg, Sweden) on 39 implants on the operation date and 4 months later, and on 21 implants 9months on the average at the final setting of restoration. Twenty-eight implants with GBR and sinus graft (GBR group: n=14, sinus graft group: n=14) were evaluated radiologically to measure the resorption of grafted autogenous tooth bone after loading. Results: The average initial stabilization of the installed implants was 67 ISQ, and the average secondary stabilization at 4 months later was 76. The average bone loss of GBR group as measured 8.0 months after application of prosthesis loading was 0.29 mm and the average bone loss of the sinus graft group as measured 7.6 months after application of prosthesis loading was 0.66 mm, respectively. In the histological assessment, formation of the new bone and continuous trabecular bone pattern was identified around autogenous tooth bone. Conclusion: Based on these results, we concluded that autogenous tooth bone is an excellent bone graft material that can substitute the autogenous bone

당뇨병성 족부 감염 환자의 초기 선택 항생제 효율성

Purpose: Foot infections are common complications in patients with diabetes. The patients are usually immune-compromised; therefore the pathogens could be resistant to narrow spectrum antibiotics. Those drugs, however, are categorized as specially managed antibiotics, and access are difficult without confirming of the pathogens. Our aim was to analyze the common pathogens in diabetic foot infection and figure out the proper antibiotics. Materials and Methods: We studied 68 patients treated with diabetic foot infection. The pathogens which caused the infection and their sensitivity to initial antibiotics were analyzed. We also investigated the change of the antibiotics after the confirming of the culture result and average time to get the result. Results: Among the 68 patients, 56 (82%) received cephalosporin and beta-lactam antibiotics. Only 12 (18%) who were confirmed the drug resistant pathogens from previous culture, were treated with broad spectrum antibiotics such as vancomycin and tazoperan. Average culture study time was 6 days. Methicillin-resistant staphylococcus aureus (MRSA) was cultured in 19 patients (28%), Methicillin-resistant coagulase negative staphylococcus (MRCNS) in 11 patietns (17%), pseudomonas in 11 patients (17%). Total 44 (65%) including 3 of other antibiotics resistant pathogen needed broad spectrum antibiotics. Thirty two patients (47%) were resistant to initial antibiotics.irt follow up culture, 2 MRSA and 2 MRCNS were found. The antibiotics resistant pathogens were confirmed in 48 (71%) patients at last. Conslusion: Diabetic patients with foot infection need proper antibiotics from initial treatment. The proper broad spectrum antibiotics should assigned to the patients from the first time without the confirming of the culture results

단순 방사선 사진을 이용한 월상골 형태 분류: 제 1형 및 제 2형

Purpose: Lunate is classified morphologically into 2 types; type 1 which doesn't form joint with hamate and type 2 which articulates with hamate. The purpose of this study is to investigate the type of lunate of Korean by anteroposterior view of plain radiography of the wrists. Materials and Methods: The anteroposterior plain radiographs of 212 cases (106 males and 106 females) were reviewed and classified into type 1 and type 2. The age of the people was 15 to 74 (mean 40.7 years). Results: The number of type 1 lunate was 121 (57.1%) consisting of 58 males and 63 females. The number of type 2 were 91 (42.9%) consisting of 48 males and 43 females. There was no significant difference between genders (p=0.310). Conclusion: In one group of Korean population, 57.1% had type 1 lunate and 42.9% had type 2 lunate

동안신경마비가 동반된 거대세포 동맥염 환자의 치료 경험-증례보고-

Giant cell arteritis, which is also referred to as temporal arteritis, is defined as a systemic vasculitis in individuals over 50 years of age. Here, we report a case of giant cell arteritis combined with oculomotor nerve palsy. An 81-year old female patient experienced a headache for 10 days in her left temporoparietal area, that was characterized by a continuous dull ache and heaviness with intermittent shooting and lancinating pain. Her symptoms persisted in spite of receiving strong analgesics in another hospital. Upon physical examination, she was found to have marked tenderness over the left temporal area, especially along the path of the temporal artery as well as limitation of adduction, supraduction and infraduction of the left eyeball. At the time of admission, her erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were 52 mm/hr and 3.94 mg/dl. In addition her brain MRI revealed no specific findings. Giant cell arteritis was suspected based on the clinical symptoms and signs as well as the elevated ESR and CRP. Oral steroid therapy started was started with an initial dose of 40 mg of prednisolone per day that was gradually tapered to 5 mg a day for 2 weeks. Her headache subsided one day after the steroid therapy and oculomotor nerve palsy was markedly improved after 2 weeks of the therapy. After 2 months she had recovered completely from her symptoms

요추 경추간공 경막외강 약물주입 시 조영상의 분석

Background: Lumbar transforaminal epidural injections (LTEIs) have been utilized in the treatment of radicular pain, and LTEIs have the advantage of target-specificity. However, there have not been enough studies on the contrast patterns in LTEIs with using fluoroscopy. The purpose of this study was to evaluate the spreading epidural contrast patterns that are seen during real-time fluoroscopic guided LTEIs. Methods: A total of 131 patients who underwent fluoroscopic guided LTEIs were studied. The inclusion criteria were those patients with low back pain and/or lower extremity pain that was caused by a herniated nucleus pulposus, lumbar spinal stenosis, failed back surgery syndrome, and herpes zoster-associated pain. We classified the contrast patterns in regard to the contrast flow spreading to the nerve root and/or the unilateral, bilateral or cylinderic type of epidural spreading on the AP view of the fluoroscopy and the ventral or dorsal epidural filling on the lateral view. In addition to the pattern analysis, we evaluated the range of contrast spreading from the cranial to the caudal epidural filling and the incidence of an intravascular flow pattern. Results: Epidural spreading was seen in 126 cases (96.2%) of the total patients through the nerve root. Ventral spreading occurred in 120 cases (95.2%). On the AP view, a nerve root with unilateral, bilateral and cylinderic epidural filling was noted for 108 (85.7%), 9 (7.1%) and 9 (7.1%) cases, respectively. The contrast spreading to vertebral segments was smaller for the patients with lumbar spinal stenosis and failed back surgery syndrome than for the other groups (P < 0.0083). The incidence of intravascular injection was 11.1% (14/126). Conclusions: LTEIs using fluoroscopic visualization provided excellent assessment of the ventral epidural filling as well as nerve root filling. However, unilateral epidural spreading was prominent for the LTEIs

자발성 두개강내 저혈압성 두통 환자에서 치료 도중 발생한 경막하혈종 -증례보고-

Spontaneous intracranial hypotension (SIH) is believed to be a benign disease. However, numerous studies have reported serious complications related to SIH, including subdural hematoma. In this case report, a 54- year-old male patient visited the emergency room with orthostatic headache. A brain magnetic resonance imaging (MRI) study showed diffuse mild thickening and enhancement of pachymeninges, with a suspicious minimal amount of subdural fluid collected in the left posterior parietal area. His orthostatic headache showed no improvement with conservative treatment; but his pain was almost completely relieved after two trials of cervical epidural blood patch. On the 74th day after the onset of his pain, the patient showed a drowsy mental status and slurred speech when he visited the pain clinic. Brain computerized tomography indicated a left subdural hemorrhage, and he underwent emergency operation to drain the SDH. In conclusion, pain clinicians should pay attention to abrupt changes in mental status as well as continuous headache, for the early diagnosis of SDH in SIH patients

신경통증클리닉 환자의 1년간 통계고찰

Background: The first pain clinic opened in korea in 1973 at Yonsei University Hospital, however, since then the number of pain clinics has gradually increased, as has the number of patients visiting them.This increase in patient has caused concerns about the way in which pain is managed, therefore, we conducted a retrospective review of data according to the sex, age and disease in an attept to aid us in planning for the future of our pain clinic. Methods: We analyzed 1,282 new patients who had visited our pain clinic and 828 inpatients who were admitted to our pain clinic between March 2006 and February 2007. Results: The most frequent age group was in the sixties in outpatient and in the seventies in inpatient.In addition, the incidence of disease in new patients and inpatients was as follows: in new patients, lumbar herniated intervertebral disc 16.5%, hyperhidrosis 12.3%, cervical disc disorder 10.5%, acute herpes zoster 8.2%, postherpetic neuralgia 7.9%, and trigeminal neuralgia 7.0%; in admitted patients, acute herpes zoster 17.6%, trigeminal neuralgia 15.6%, lumbar herniated intervertebral disc 13.0%, postherpetic neuralgia 11.2%, hyperhidrosis 9.8%, and complex regional pain syndrome 7.0%. Conclusion: The patients visiting our pain clinic have presented with a wide variety of diseases. This improved care reflects an effort to expand our fields not only to the management of outpatients but also inpatients, as well as to the treatment of new fields of disease. In the future, We need to manage various pain patients not only in outpatients but also in inpatients to expand our field even through pain clinic is rapidly growing in Korea