조선왕릉 현궁（玄宮） 조성방법

조선왕릉의 석실현궁은 조선초기부터 시행되었으며 그동안의 고제연구를 통해 세종대에 정리되어『오례의』가 편찬된다. 그 후 세조의 유명으로 석실현궁이 아닌 회격현궁으로 조성된다.　석실현궁의 석재는 단릉과 쌍릉, 합장릉이 각각 다른 부재를 사용하여 축조되었다. 단릉과 쌍릉의 경우 광중에 방석과 북우석, 개석, 가치개석, 문입석, 문역석, 문비석, 문의석 등이 놓였다.　합장릉에서는 단릉의 부재 외에 칸막이벽 역할을 하는 격석（隔石）이 놓이게 된다. 격석은 중앙에는 창혈（窓穴）이 양쪽으로 뚫려있으며, 석실 중앙에 남북으로 길게 놓인다. 격석 북측에는 북우석이 설치되며 격석과 접하는 곳에 주먹장 맞춤으로결구된다. 북우석과 양방석이 접하는 곳에 반턱맞춤으로 빠지거나 밀리지 않도록결구된다.　이처럼 단릉과 쌍릉의 경우 개석을 중심으로 현궁이 조성된 것이며『, 오례의』가편찬된 시점에서의 합장릉에서는 격석을 중심으로 동·서실이 나누어지는 현궁조성방법을 사용하였다.　현궁이 조성되는 바닥에는 잡석과 흙을 이겨 잡석다짐을 하는 단릉과 쌍릉의 경우인 반면 합장릉에서는 탄말가루와 삼물, 동망 등 더욱 견고히 하여 현궁이 조성되었다. 이러한 것은 그동안의 고제연구를 통해 세종대에 이르러 발전시킨 석실현궁 조성방법이라 하겠다.　이러한 석실 축조방법은『세종실록오례의』와『국조속오례의』등에 기록되어있으며, 이후 세조의 광릉을 시작으로 왕릉에 석실은 없어지고 회격현궁으로 나타난다.회격현궁은 주자가 제시한『가례（家禮）』에 등장하며 조선초기 유교적 이념 확립과아울러 널리 보급되었다.　회격현궁은 먼저 광을 판 다음 숯가루를 광 밑에 피우고 삼물로 바닥을 다진다.이후 방회를 설치하는데 크게 두 가지 방식으로 나누어진다. 이는 석실현궁 외벽을축조하는 방식과는 차이가 있지만 그 개념은 동일한 것이라 생각되며 이는 구희릉의 발굴조사를 통해서도 확인된다

다자이 오사무 “황금풍경”

太宰治『黄金風景』Translations Korea

난치성 양엽형 간내결석에 대한 새로운 술식

Background/Aims: Treatmant for hepatolithiasis is characterized by high failure and recurrence rates. In the past, surgery played a major role in the management of this disease, but the development of percutaneous transhepatic cholangioscopy and lithotripsy has played an important role in the treatment of these patients. Therefore, we undertook this prospective study to assess the role of surgery in the treatment of bilateral intractable hepatolithiasis in new era of the endoscopy. Methods: We evaluated our results of 12 patients with bilateral intrahepatic stones treated by preoperative percutaneous transhepatic cholangioscopic approach and new definitive surgical approach (suprahilar approach and hilar cholangiotomy). Results: The rate of complete stone removal was 100%. There was no incidence of procedure and operative mortality. Conclusions: In this new endoscopic era, we carefully foresee that the major role of surgical treatment may be concentrated in the intractable cases of hepatolithiasis. Therefore, we suggest that more definitive surgery must be tried in the treatment of intractable bilateral hepatolithiasis

소아에서 Rocuronium 회피반응에 대한 Remifentanil과 Lidocaine의 효과 비교

Background : This randomized, double-blind study was designed to compare the efficacy of remifentanil and lidocaine with the venous occlusion technique for preventing the withdrawal response associated with rocuronium injection in children. Methods : Ninety children between 3 and 10 years of age were randomly allocated into 1 of 3 groups that were intravenously administered either 1?g/kg of remifentanil (remifentanil group), 1 mg/kg of lidocaine (lidocaine group) or 5 ml of saline (control group). After general anesthesia was induced with 5 mg/kg of 2.5% thiopental sodium, manual occlusion of venous outflow was performed, and the test drug was then injected over 30 sec. In addition, when manual forearm pressure was released, 0.6 mg/kg of 1% rocuronium was injected over 5 sec and the response was then recorded. Additionally, the mean arterial pressure (MAP) and heart rate (HR) were recorded upon arrival in the operating theatre, as well as 1 minute before and 1 min after tracheal intubation. Results : The incidences of withdrawal movement and generalized movement in the control group were significantly higher than in the remifentanil and lidocaine groups. In addition, the MAP and HR were significantly lower in the remifentanil group than the control and lidocaine groups after tracheal intubation. Conclusion : In children, treatment with either 1?g/kg of remifentanil or 1 mg/kg of lidocaine decreased the incidence of rocuronium-induced withdrawal movements. However, remifentanil was more effective than lidocaine at controlling hemodynamics following tracheal intubation

호르몬민감성 전립선암 환자의 치료에 있어서 간헐적 남성호르몬박탈요법이 지속적 남성호르몬박탈요법에 비해 좋은 치료법인가?

Accumulated experience indicates that intermittent androgen deprivation (IADT) is an acceptable treatment option for patients with prostate cancer that need ADT. Compared to continuous ADT (CADT), IADT has the advantages of being more economic and less detrimental to the quality of life, and shows similar efficacy in terms of overall survival and disease progression. For this reason, European Association of Urology Guideline and National Comprehensive Cancer Network Guideline recommend its use for the treatment of prostate cancer. Recently, several randomized phase 3 trials comparing IADT with CADT have been published (SEUG9401, TAP22, FinnProstate VII, NCT3653, SEUG9901 and SWOG9346). These heterogeneous studies have shown that IADT is at least non-inferior to CADT in terms of overall survival and disease progression, except for the SWOG9346 trial which was unable to rule out that IADT may decrease overall survival by 20% compared to CADT. The effect of IADT on quality of life was positive with many studies demonstrating significantly better quality of life score compared to CADT. However, these studies should be criticized for not being able to show any prolongation of time to progression as has been shown in the experimental settings. New studies with different designs should elicit undiscovered effectiveness of IADT in the future. For the time being, IADT should be considered in every patient who could potentially benefit from recovery of testosterone, but the method of IADT should be individualized rather than strictly abide by the arbitrarily set criteria in the randomized trial settings

신세포암과 동반된 신주위 가성낭종

Pararenal Pseudocyst Accompanied by Renal Cell Carcinoma Sung Hoon Park, Il Han Kim, Yeun Goo Chung, Se Joong Kim, Sun Il Kim Department of Urology, Ajou University School of Medicine, Suwon, Korea ABSTRACT Pararenal pseudocyst is a collection of fluid within the Gerota's fascia outside of the renal capsule. It is usually caused by trauma, either accidental or operative. Histologically, absence of the cell lining is a typical finding and the wall is composed of dense collagenous fibrous connective tissue. An unusual case of pararenal pseudocyst with the radiological diagnosis of complicated renal cyst and associated with a solid renal tumor was surgically treated. The patient had no history of renal trauma or surgery

후복막강에 발생한 퇴행성 신경초종

An ancient schwannoma is a rare variant of schwannoma characterized by degenerative changes and diffuse hypocellularity. Because a retroperitoneal schwannoma is usually asymptomatic, the diagnosis is often casual and difficult to determine preoperatively. Magnetic resonance imaging is the most valuable radiologic technique for its evaluation. The treatment of choice is complete surgical excision. Herein, we report a case of retroperitoneal ancient schwannoma in a 52-year-old woman presenting with an incidentally found retroperitoneal tumor. The patient has no evidence of disease 6 months after the surgery

두경부암에 의한 안면부와 경부 피부의 침습과 전이

BACKGROUND AND OBJECTIVES: This study was designed to review the incidence of skin involvement in the head and neck cancer. We also reviewed its pattern, treatment results, and prognostic significance of skin invasion and metastases. MATERIALS AND METHODS: We carried out an retrospective evaluation of 41 patients who required resection of the facial or neck skin during surgery for their head and neck cancer in the last ten years. Patients with head and neck skin cancer were excluded from this study. Patients who developed skin involvement were evaluated with regard to the primary origin of tumor, the tumor stage, and the pattern of skin involvement, treatment and outcome. The cases were classified into four groups: firstly, a group with the presence of skin scar made by previous biopsy; secondly, a group with tumor fixed to skin; thirdly, a group with skin resected with a sufficient resection marginal, and lastly a group with gross involvement of skin by tumor. RESULTS: Among 41 patients who required resection of the skin, patients with skin invasion were noted in 24 cases. Only one out of four cases of the biopsy group had skin involvement whereas a half of the fixed group had skin invasion. For the marginal group, only two cases had invasion of skin. The treatment result of patients with skin involvement had poor prognosis compared to patients without skin involvement. In particular, patients with skin metastasis had extremely poor survival. CONCLUSIONS: Skin involvement in the head and neck cancer indicates a poor prognosis, and should not be considered for surgery

성인의 낭성 신종

Cystic nephroma(CN) is a rare benign cystic renal tumor, which only recently has been recognized as an exclusively adult lesion. CN presents after age 30 and affects primarily reproductive age to early menopausal women. Although an aggressive behavior has been reported in very few cases, CN is considered as a benign lesion and surgical excision is curative. We report on a case of CN in a 31-year-old woman who presented with an incidentally detected renal tumor. The patient has had no evidence of disease 5 years after radical nephrectomy

소아 진주종 환자의 측두골 함기도에 대한 연구

BACKGROUND AND OBJECTIVES: Cholesteatoma occuring in childhood is often said to be more aggresive than that in adulthood, since cholesteatoma in children has a larger mastoid and earlier and more frequent recurrence as well as shorter disease history. In this sense, the pathogenesis of child cholesteatoma can be suspected to be different from that of adult cholesteatoma. The aim of this study is to show that cholesteatoma in children has more pneumatized mastoids than cholesteatoma in adults, and to find out the pathogenesis of child cholesteatoma which is deemed different from that of the adult. MATERIALS AND METHODS: In the present study, 20 child cholesteatomas and 20 adults cholesteatomas were used as subjects. We measured the size of mastoid air cells both in children and adult cholesteatoma by using a new analytical program for the temporal bone CT films. The size of the mastoid air cells was determined by the area of the plane showing a lateral semicircular canal on the temporal bone CT. The percent suppression in the area of the diseased side relative to that of the healthy side was calculated. RESULTS: The percent suppression was 10.5% in child cholesteatoma and 29.3% in adult cholesteatoma (P<0.05). CONCLUSION: We found that pneumatization of the mastoid air cells in children cholesteatoma was less suppressed than that in adult cholesteatoma