194 research outputs found

    ์ฒดํ™”๋œ ์ธ์ง€๋ฅผ ํ†ตํ•œ ์ง€์†๊ฐ€๋Šฅํ•œ ๊ฑด์กฐ ํ™˜๊ฒฝ์˜ ๋ฏธ์  ๊ฒฝํ—˜

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    ํ•™์œ„๋…ผ๋ฌธ (๋ฐ•์‚ฌ)-- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› : ๊ณต๊ณผ๋Œ€ํ•™ ๊ฑด์ถ•ํ•™๊ณผ, 2018. 2. ์ตœ์žฌํ•„.๋ณธ ๋…ผ๋ฌธ์€ ๋™์‹œ๋Œ€์˜ ์†Œ์œ„ ์ง€์†๊ฐ€๋Šฅํ•œ ๊ฑด์กฐ ํ™˜๊ฒฝ์ด ์–‘์‚ฐํ•˜๋Š” ์ง€์† ๋ถˆ๊ฐ€๋Šฅํ•œ ๊ฒฐ๊ณผ์— ๋Œ€ํ•œ ๊ทผ๋ณธ์ ์ธ ์›์ธ์œผ๋กœ ๊ฑด์กฐ ํ™˜๊ฒฝ์˜ ๋ฏธํ•™์  ์ธก๋ฉด์˜ ๊ฒฐ์—ฌ๋ฌธ์ œ๋ฅผ ์ง€์ ํ•œ๋‹ค. ์ด๋Š” ๋ฏธํ•™์„ ์ธ๊ฐ„๊ณผ ํ™˜๊ฒฝ์„ ์—ฐ๊ฒฐํ•˜๊ณ  ์ง€์†๊ฐ€๋Šฅ์„ฑ์„ ๊ตฌํ˜„ํ•˜๋Š” ๋ณ€ํ™”๋œ ์‚ฌ๊ณ ์™€ ์‹ค์ฒœ ํ–‰๋™์œผ๋กœ ์ด๋„๋Š” ๋งค๊ฐœ์ฒด๋กœ์„œ ๊ณ ๋ คํ•˜๋Š” ๊ฒƒ์ด๋‹ค. ๋ฟ๋งŒ์•„๋‹ˆ๋ผ, ๋™์‹œ๋Œ€์˜ ๊ฑด์กฐ ํ™˜๊ฒฝ์— ์˜ํ–ฅ์„ ๋ฏธ์น˜๊ณ  ์žˆ๋Š” ๊ทผ๋Œ€ ๋ฏธํ•™๊ณผ ๊ทธ๊ฒƒ์ด ๊ทผ๊ฐ„์œผ๋กœ ํ•˜๋Š” ์„œ์–‘์˜ ์ „ํ†ต์ ์ธ ๊ฐ๊ด€์ฃผ์˜ ์‚ฌ๊ณ ์™€๋Š” ๋‹ค๋ฅธ ์ƒˆ๋กœ์šด ์‹œ๊ฐ์ด๊ธฐ๋„ ํ•˜๋‹ค.์ œ 1 ์žฅ ์„œ ๋ก  1 1.1. ์—ฐ๊ตฌ์˜ ๋ฐฐ๊ฒฝ ๋ฐ ๋ชฉ์  2 1.1.1. ์—ฐ๊ตฌ์˜ ๋ฐฐ๊ฒฝ ๋ฐ ๋ชฉ์  9 1.2. ์—ฐ๊ตฌ์˜ ๋ฒ”์œ„ ๋ฐ ๋ฐฉ๋ฒ• 11 1.2.1. ์—ฐ๊ตฌ์˜ ๋ฒ”์œ„ 11 1.2.2. ์—ฐ๊ตฌ์˜ ๋ฐฉ๋ฒ• ๋ฐ ์ ˆ์ฐจ 14 1.3. ๊ด€๋ จ ์ฃผ์š” ์„ ํ–‰์—ฐ๊ตฌ 18 1.3.1. ์ง€์†๊ฐ€๋Šฅํ•œ ๊ฑด์กฐ ํ™˜๊ฒฝ๊ณผ ๋ฏธํ•™ 18 1.3.2. ์ง€์†๊ฐ€๋Šฅํ•œ ๊ฑด์กฐ ํ™˜๊ฒฝ์˜ ๋ฏธ์  ๊ฒฝํ—˜๊ณผ ์ฒดํ™”๋œ ์ธ์ง€ 24 ์ œ 2 ์žฅ ์ง€์†๊ฐ€๋Šฅํ•œ ๊ฑด์กฐ ํ™˜๊ฒฝ๊ณผ ๋ฏธ์  ๊ฒฝํ—˜ ๋ฌธ์ œ 30 2.1. ํ˜„๋Œ€์˜ ์ง€์†๊ฐ€๋Šฅํ•œ ๊ฑด์กฐ ํ™˜๊ฒฝ์˜ ๋ฌธ์ œ 32 2.1.1. ์ง€์†๊ฐ€๋Šฅํ•œ ๊ฑด์กฐ ํ™˜๊ฒฝ์˜ ๋ฌธ์ œ 32 2.1.2. ์ง€์†๊ฐ€๋Šฅํ•œ ๊ฑด์กฐ ํ™˜๊ฒฝ์˜ ๋ฏธํ•™์  ์ธก๋ฉด ๊ฒฐ์—ฌ ๋ฌธ์ œ 36 2.2. ์ง€์†๊ฐ€๋Šฅํ•œ ๊ฑด์กฐ ํ™˜๊ฒฝ์˜ ํ•จ์˜ 45 2.2.1. ์ง€์†๊ฐ€๋Šฅํ•œ ๊ฑด์กฐ ํ™˜๊ฒฝ์˜ ๊ฐœ๋… 45 2.2.2. ์ง€์†๊ฐ€๋Šฅํ•œ ๊ฑด์กฐ ํ™˜๊ฒฝ์˜ ๊ฐœ๋…์˜ ํ•œ๊ณ„ 49 2.3. ์ง€์†๊ฐ€๋Šฅ์„ฑ์˜ ๋ฌธํ™”์  ์ฐจ์›์˜ ๋…ผ์˜ ๊ณผ์ • 60 2.4. ๋ฌธํ™”์  ์ง€์†๊ฐ€๋Šฅ์„ฑ์˜ ๋ฏธํ•™์  ์ฃผ์ œ๋กœ์˜ ์ˆ˜๋ ด 63 ์ œ 3 ์žฅ ์ง€์†๊ฐ€๋Šฅํ•œ ๊ฑด์กฐ ํ™˜๊ฒฝ์˜ ๋ฏธ์  ๊ฒฝํ—˜์— ๋Œ€ํ•œ ์ฒดํ™”๋œ ์ธ์ง€์  ์ ‘๊ทผ 66 3.1. ์ง€์†๊ฐ€๋Šฅํ•œ ๊ฑด์กฐ ํ™˜๊ฒฝ์˜ ๋ฏธ์  ๊ฒฝํ—˜ ์—ฐ๊ตฌ์˜ ํ•œ๊ณ„ 69 3.1.1. ๊ฑด์ถ• ๋ฏธํ•™ 69 3.1.2. ์ง€์†๊ฐ€๋Šฅํ•œ ๊ฑด์กฐ ํ™˜๊ฒฝ์˜ ๋ฏธ์  ๊ฒฝํ—˜ ๋…ผ์˜ 78 3.1.3. ๊ฑด์กฐ ํ™˜๊ฒฝ์˜ ๋ฏธ์  ๊ฒฝํ—˜์— ๋Œ€ํ•œ ์ฒดํ™”๋œ ์ธ์ง€์  ๋…ผ์˜ 81 3.2. ์ฒดํ™”๋œ ์ธ์ง€ ์ด๋ก ์˜ ๋„์ž… 88 3.2.1. ์ฒดํ™”๋œ ์ธ์ง€์˜ ์ถœํ˜„๊ณผ ๊ฐœ๋… 88 3.2.2. ๊ฐœ๋…์  ์€์œ  ์ด๋ก ์˜ ๋ชธ์˜ ์€์œ  ๊ตฌ์กฐ 104 3.3. ์ง€์†๊ฐ€๋Šฅํ•œ ๊ฑด์กฐ ํ™˜๊ฒฝ์˜ ๋ฏธ์  ๊ฒฝํ—˜์— ๋Œ€ํ•œ ์ฒดํ™”๋œ ์ธ์ง€์  ์ ‘๊ทผ 121 3.3.1. ์ฒดํ™”๋œ ์ธ์ง€๋ฅผ ํ†ตํ•œ ๋ถ„์„ํ‹€ 121 3.3.2. ๋ชธ์˜ ์€์œ  ๊ฐœ๋… 123 3.3.3. ๊ฑด์กฐ ํ™˜๊ฒฝ์— ๋Œ€ํ•œ ๋ชธ์˜ ์€์œ  ๊ตฌ์กฐ ํˆฌ์‚ฌ 139 ์ œ 4 ์žฅ ์ฒดํ™”๋œ ์ธ์ง€๋ฅผ ํ†ตํ•œ ์ง€์†๊ฐ€๋Šฅํ•œ ๊ฑด์กฐ ํ™˜๊ฒฝ์˜ ๋ฏธ์  ๊ฒฝํ—˜ 163 4.1. ์ง€์†๊ฐ€๋Šฅํ•œ ๊ฑด์กฐ ํ™˜๊ฒฝ์˜ ํ•จ์˜ 166 4.1.1. ์ง€์†๊ฐ€๋Šฅํ•œ ๊ฑด์กฐ ํ™˜๊ฒฝ์œผ๋กœ์„œ ์„ ์œ ๋„๊ณต์› 166 4.1.2. ์„ ์œ ๋„๊ณต์›์— ๋Œ€ํ•œ ์ฒดํ™”๋œ ์ธ์ง€๋ฅผ ํ†ตํ•œ ๋ฏธ์  ๊ฒฝํ—˜ ์—ฐ๊ตฌ์™€ ์ง€์†๊ฐ€๋Šฅ์„ฑ 168 4.2. ์ฒดํ™”๋œ ์ธ์ง€๋ฅผ ํ†ตํ•œ ์ง€์†๊ฐ€๋Šฅํ•œ ๊ฑด์กฐ ํ™˜๊ฒฝ์˜ ๋ฏธ์  ๊ฒฝํ—˜ ์ดํ•ด์˜ ํ‹€ 171 4.2.1. ํ˜„์žฅ ์—ฐ๊ตฌ์˜ ๋ชฉ์  171 4.2.2. ์ดํ•ด์˜ ํ‹€ 172 4.2.3. ๊ด€์ฐฐ ๋ฐ ์‹ฌ์ธต ์ธํ„ฐ๋ทฐ 174 4.3. ์ฒดํ™”๋œ ์ธ์ง€๋ฅผ ํ†ตํ•œ ์ง€์†๊ฐ€๋Šฅํ•œ ๊ฑด์กฐ ํ™˜๊ฒฝ์˜ ๋ฏธ์  ๊ฒฝํ—˜ 197 4.3.1. ํ™˜๊ฒฝ-๋ชธ-๋‡Œ-๋ฏธ์  ๊ฒฝํ—˜ 197 4.3.2. ์ง€์†๊ฐ€๋Šฅํ•œ ๊ฑด์กฐ ํ™˜๊ฒฝ์˜ ๋ฏธํ•™์  ์ธก๋ฉด ์œ ํ˜• ๋ฐ ๊ตฌ์„ฑ์š”์†Œ 202 4.4. ์ง€์†๊ฐ€๋Šฅํ•œ ๊ฑด์กฐ ํ™˜๊ฒฝ์— ๋Œ€ํ•œ ํ•จ์˜ 210 4.4.1. ์ง€์†๊ฐ€๋Šฅํ•œ ๊ฑด์กฐ ํ™˜๊ฒฝ์˜ ๋ฏธํ•™์  ์ธก๋ฉด 210 4.4.2. ์ฒดํ™”๋œ ์ธ์ง€๋ฅผ ํ†ตํ•œ ๋ฏธ์  ๊ฒฝํ—˜์˜ ์€์œ  ๊ฐœ๋… ๊ตฌ์กฐ์™€ ์ง€์†๊ฐ€๋Šฅ์„ฑ 211 ์ œ 5 ์žฅ ๊ฒฐ๋ก  213Docto

    Novel anatomic description of the course of the perioral artery for minimally invasive treatments

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    ์น˜๊ณผ๋Œ€ํ•™/๋ฐ•์‚ฌThe facial artery (FA) arises from the external carotid artery, and passes onto the face as it crosses the mandible. And FA mainly supplies the perioral region, which is bounded by the nasolabial fold, the labiomental crease and the nasal base. Thus, in this study, the perioral artery (PA) was determined as distributing to the perioral region including the trunk of FA (from the mandible margin to the ala of nose, PA trunk), the superior labial artery (SLA), the horizontal labiomental artery (HLA) and the inferior labial artery (ILA). Dermal filler injection is a rapid way of eliminating wrinkles, smoothing acne scars, and enhancing volume. However, careless manipulation leading to PA damage during dermal filler injection could result in vascular complications such as lip and alar rim necrosis. The facial reconstruction helps a normal life for patients who have defects from cleft lip, oral cancer, and trauma. For facial reconstruction, various perioral flaps, such as the nasolabial flap, FAmusculomucosal (FAMM) flap and Abbรฉ flaps have been performed. The success of these flap surgeries depends mainly upon the presence of an appropriate blood supply so the PA should be well grafted in the pedicle. However, most reported data about the PA does not provide delicate topographic information for minimal invasive procedure. Thus author performed the study with the following as its objects. The first aims of this study was to elucidate the distribution pattern of PA trunk and reproduce the whole course of PA trunk as a polynomial curve analysed by image processing, and suggest accurate references for various minimally invasive clinical procedures and facial reconstruction. The second aim of this study was to describe the various distribution patterns of the vascularization on the upper and lower lip area. The final aim of the study was to clarify the definition of the ILA and HLA, and to elucidate the significance of the HLA in the vascularization of the lower lip. For the study of reproducing the whole course of PA trunk, 59 adult hemifaces (21 bilateral and 17 unilateral; 26 males, 13 females; 46-95 years; mean age, 73 years) from 19 Korean and 20 Thai cadavers were used. For the study of the vascularization on the upper lip area, 60 hemifaces (24 bilateral and 12 unilateral; 24 males, 12 females; 46-95 years; mean age, 73 years) from 18 Korean and 18 Thai cadavers were used. For the study of the vascularization on the lower lip area, 63 hemifaces (26 bilateral and 11 unilateral; 24 males, 13 females; 46-95 years; mean age, 73 years) from 18 Korean and 19 Thai cadavers were used. The running course of the PA trunk along the PO line (a line connecting the mandible margin to the ala of nose) exhibited two patterns: oblique (78.0%, 46/59) or vertical (22.0%, 13/59). In the oblique pattern, the PA trunk proceeded along the PO line with two or three inflections, while in the vertical pattern it ran along the PO line but then turned medially near the mouth corner, giving off an alar branch parallel to the facial sagittal midline. The course of the PA trunk on the face can be predicted based on the following references: the PO line, the Rh point (the ramification point of the HLA, 5๏ฝž10 mm medial to the PO line at the level of the middle of the lower lip portion), the Ra point (the ramification point of the alar branch (Ra point), 5๏ฝž10 mm medial to the PO line at the level of lower one-third of the upper lip portion). While the PA trunk generally ran along the PO line, the PA trunk reflected medially at the Ra and Rh points. The branching point of SLA from FA, the S point, was located within a 1.5 cm sided square superolateral to the mouth corner. The S point may be estimated by placing a thumbnail beside the mouth corner. After the SLA branched from FA, it ran superior to the vermilion border under the orbicularis oris muscle, with a minimum depth of 3 mm. At the sagittal midline, the nasal septal branch ramified from the SLA and ran upward to the nasal septum along the sagittal midline. The HLA can be presented in the middle of the lower lip area inferior to the mouth corner, and be inclined gradually to the lower lip border near the facial midline (46.0%). ILA diverged from the FA or SLA at the level of the mouth corner. The HLA rather than ILA could be considered as the main artery supplying the lower lip mucosa.ope

    ์—…๋ฌด์ƒ ์ฐฝ์ž‘์— ๋Œ€ํ•œ ์ง€์ ์žฌ์‚ฐ๊ถŒ์˜ ๊ท€์†์— ๊ด€ํ•œ ์—ฐ๊ตฌ : ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ๊ณผ ์ง๋ฌด๋ฐœ๋ช… ์ œ๋„ ๊ฐ„ ๋น„๊ต๋ฅผ ์ค‘์‹ฌ์œผ๋กœ

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    ํ•™์œ„๋…ผ๋ฌธ (๋ฐ•์‚ฌ)-- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› ๋ฒ•๊ณผ๋Œ€ํ•™ ๋ฒ•ํ•™๊ณผ, 2017. 8. ๋ฐ•์ค€์„.์ด ๊ธ€์—์„œ์˜ ์—…๋ฌด์ƒ ์ฐฝ์ž‘์ด๋ผ ํ•จ์€ ์ €์ž‘๊ถŒ๋ฒ•์ƒ ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ ๋˜๋Š” ํŠนํ—ˆ๋ฒ•๊ณผ ๋ฐœ๋ช…์ง„ํฅ๋ฒ•์˜ ์ง๋ฌด๋ฐœ๋ช…๊ณผ ๊ฐ™์ด, ๊ณ ์šฉ๊ด€๊ณ„ ๋“ฑ์— ์˜ํ•˜์—ฌ ์‚ฌ์šฉ์ž์˜ ์—…๋ฌด์— ์ข…์‚ฌํ•˜๋Š” ์ข…์—…์›์ด ๊ทธ ์ง๋ฌด์ƒ ์‹ค์งˆ์ ์ธ ์ฐฝ์ž‘ ํ–‰์œ„๋ฅผ ํ•˜๊ณ , ์‚ฌ์šฉ์ž๋Š” ์ด๋Ÿฌํ•œ ์ฐฝ์ž‘ ๊ณผ์ •์— ํ•„์š”ํ•œ ์„ค๋น„์™€ ์›์žฌ๋ฃŒ ๋˜๋Š” ์ฐฝ์ž‘ ํ™œ๋™์— ํ˜‘๋ ฅํ•  ์ „๋ฌธ ์ธ๋ ฅ์ด๋‚˜ ๊ธฐ์ˆ  ๋“ฑ์„ ์ง€์›ํ•˜๋Š” ๊ฒƒ๊ณผ ๊ฐ™์€ ๋ฌผ์งˆ์ ,์ธ์ ,๊ธฐ์ˆ ์  ์ž์› ๋“ฑ์„ ํˆฌ์ž…ํ•˜๋Š” ๋น„์ฐฝ์ž‘์  ๊ธฐ์—ฌ๋ฅผ ํ•œ ๊ฒฝ์šฐ๋ฅผ ๋งํ•œ๋‹ค. ์ด์ฒ˜๋Ÿผ ๊ณผํ•™๊ธฐ์ˆ ์˜ ๋ฐœ์ „๊ณผ ๋ฌธํ™” ์‚ฐ์—…์˜ ํ™œ์„ฑํ™”๋กœ, ๋ฐœ๋ช…๊ณผ ์ €์ž‘๋ฌผ ์ค‘์—์„œ ์ง๋ฌด๋ฐœ๋ช…๊ณผ ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ์ด ์ฐจ์ง€ํ•˜๋Š” ๋น„์ค‘์ด ์ƒ๋‹นํžˆ ๋†’์œผ๋ฉฐ ์•ž์œผ๋กœ๋„ ๊ณ„์† ์ฆ๊ฐ€ํ•˜๊ฒŒ ๋  ์ƒํ™ฉ์—์„œ, ์—…๋ฌด์ƒ ์ฐฝ์ž‘์— ๋Œ€ํ•œ ๊ทœ์œจ์„ ์–ด๋–ป๊ฒŒ ํ•  ๊ฒƒ์ธ๊ฐ€๋ผ๋Š” ๋…ผ์˜์˜ ์ค‘์š”์„ฑ์ด ์ ์  ์ปค์ง€๊ณ  ์žˆ๋‹ค. ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ์— ๊ด€ํ•œ ํ˜„ํ–‰ ์ €์ž‘๊ถŒ๋ฒ•์— ๋”ฐ๋ฅด๋ฉด, ์‚ฌ์šฉ์ž์˜ ์—…๋ฌด์— ์ข…์‚ฌํ•˜๋Š” ์ž๊ฐ€ ์—…๋ฌด์ƒ ์ฐฝ์ž‘ํ•œ ์ €์ž‘๋ฌผ ์ค‘ ์‚ฌ์šฉ์ž์˜ ๊ธฐํš๊ณผ ์‚ฌ์šฉ์ž ๋ช…์˜์˜ ๊ณตํ‘œ๊ฐ€ ์žˆ๋Š” ๊ฒฝ์šฐ, ๋‹น์‚ฌ์ž ๊ฐ„์— ๋ณ„๋„์˜ ๊ณ„์•ฝ์ด ์—†๋Š” ํ•œ ์‚ฌ์šฉ์ž๋ฅผ ์ €์ž‘์ž๋กœ ๋ณด์•„ ์‚ฌ์šฉ์ž์—๊ฒŒ ์ €์ž‘์žฌ์‚ฐ๊ถŒ๊ณผ ์ €์ž‘์ธ๊ฒฉ๊ถŒ์ด ๋ชจ๋‘ ์›์‹œ์ ์œผ๋กœ ๊ท€์†๋œ๋‹ค. ๋ฐ˜๋ฉด ์ข…์—…์›์€ ์ €์ž‘์žฌ์‚ฐ๊ถŒ, ์ €์ž‘์ธ๊ฒฉ๊ถŒ, ๋ณด์ƒ์ฒญ๊ตฌ๊ถŒ ๋“ฑ ์•„๋ฌด๋Ÿฐ ๊ถŒ๋ฆฌ๋„ ๊ฐ€์ง€์ง€ ๋ชปํ•œ๋‹ค. ๊ทธ์— ๋ฐ˜ํ•ด ์ง๋ฌด๋ฐœ๋ช…์— ๋Œ€ํ•ด ๊ทœ์œจํ•˜๊ณ  ์žˆ๋Š” ํŠนํ—ˆ๋ฒ• ๋ฐ ๋ฐœ๋ช…์ง„ํฅ๋ฒ•์— ๋”ฐ๋ฅด๋ฉด, ์ข…์—…์›์ด ๊ทธ ์ง๋ฌด์ƒ ์ฐฝ์ž‘ํ•œ ๋ฐœ๋ช…์— ๋Œ€ํ•œ ํŠนํ—ˆ๋ฐ›์„๊ถŒ๋ฆฌ๋Š” ์ข…์—…์›์—๊ฒŒ ์›์‹œ์ ์œผ๋กœ ๊ท€์†๋˜๋„๋ก ํ•˜๊ณ , ์‚ฌ์šฉ์ž์—์˜ ์Šน๊ณ„๊ฐ€ ํ™•์ •๋œ ๊ฒฝ์šฐ ์ข…์—…์›์€ ๋ณด์ƒ์ฒญ๊ตฌ๊ถŒ์„ ๊ฐ€์ง„๋‹ค. ์ด๋ ‡๋“ฏ ์—…๋ฌด์ƒ ์ฐฝ์ž‘์— ๋Œ€ํ•œ ์ง€์ ์žฌ์‚ฐ๊ถŒ์˜ ์›์‹œ์  ๊ท€์†์— ๋Œ€ํ•ด, ์ข…์—…์›์ฃผ์˜๋ฅผ ์ทจํ•˜๋Š” ์ง๋ฌด๋ฐœ๋ช…๊ณผ๋Š” ์ƒ๋ฐ˜๋˜๊ฒŒ ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ์— ๋Œ€ํ•ด์„œ๋Š” ์‚ฌ์šฉ์ž์ฃผ์˜๋ฅผ ์ทจํ•˜๊ณ  ์žˆ๊ณ , ๊ทธ ๋ฐ–์— ๋ณด์ƒ์ฒญ๊ตฌ๊ถŒ์ด๋‚˜ ํ†ต์ƒ์‹ค์‹œ๊ถŒ ์ธ์ • ์—ฌ๋ถ€ ๋“ฑ ์ดํ•ด๊ด€๊ณ„ ์กฐ์ • ์žฅ์น˜ ๋“ฑ์—์„œ๋„ ์ƒ์ดํ•˜๊ฒŒ ๊ทœ์ •ํ•˜๊ณ  ์žˆ๋‹ค. ์ด๋กœ ์ธํ•ด ๋™์ผํ•œ ๋Œ€์ƒ์— ๋Œ€ํ•œ ๋ฒ•์  ๊ทœ์œจ์ด ๋‹ฌ๋ผ์ ธ ์ง€์ ์žฌ์‚ฐ๊ถŒ๊ฐ„ ์ถฉ๋Œ์„ ๋ฐœ์ƒ์‹œํ‚ค๊ณ  ํ˜•ํ‰์— ๋ฐ˜ํ•˜๋Š” ๊ฒฐ๊ณผ๊ฐ€ ์ผ์–ด๋‚  ์ˆ˜ ์žˆ๋‹ค๋Š” ๋ฌธ์ œ์ ์ด ์ œ๊ธฐ๋œ๋‹ค. ์˜ˆ๋ฅผ ๋“ค์–ด ๋ฐœ๋ช…๊ณผ ์ €์ž‘๋ฌผ๋กœ์„œ์˜ ์„ฑ์งˆ์„ ๋™์‹œ์— ๊ฐ€์ง€๋Š” ์ปดํ“จํ„ฐํ”„๋กœ๊ทธ๋žจ์„, ๋ฐœ๋ช…์ง„ํฅ๋ฒ•์˜ ์ ์šฉ์„ ๋ฐ›๋Š” ์ง๋ฌด๋ฐœ๋ช…์œผ๋กœ ๋ณด๋Š” ๊ฒฝ์šฐ ์ข…์—…์›์ด ๊ทธ ํŠนํ—ˆ๋ฐ›์„๊ถŒ๋ฆฌ๋ฅผ ์›์‹œ์ ์œผ๋กœ ์ทจ๋“ํ•˜๊ฒŒ ๋˜๋ฉฐ, ์ด๋ฅผ ์‚ฌ์šฉ์ž์— ์Šน๊ณ„ํ•˜๋Š” ๊ฒฝ์šฐ ์ข…์—…์›์€ ์ •๋‹นํ•œ ๋ณด์ƒ์„ ๋ฐ›์„ ์ˆ˜ ์žˆ๋‹ค. ๋ฐ˜๋ฉด ์ €์ž‘๊ถŒ๋ฒ•์˜ ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ๋กœ ๋ณด๋Š” ๊ฒฝ์šฐ์—๋Š” ์‚ฌ์šฉ์ž๊ฐ€ ์ €์ž‘์žฌ์‚ฐ๊ถŒ ๋ฐ ์ €์ž‘์ธ๊ฒฉ๊ถŒ ์ผ์ฒด๋ฅผ ์›์‹œ์ ์œผ๋กœ ์ทจ๋“ํ•˜๋ฉด์„œ ์ข…์—…์›์—๊ฒŒ๋Š” ๋ณด์ƒ์„ ํ•  ์˜๋ฌด๋„ ์—†์–ด, ์ข…์—…์›์€ ์•„๋ฌด๋Ÿฐ ๊ถŒ๋ฆฌ๋„ ๊ฐ€์ง€์ง€ ๋ชปํ•œ๋‹ค. ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ ๊ทœ์ •์€ 1946๋…„ ์ œ์ • ํŠนํ—ˆ๋ฒ•์— ์ง๋ฌด๋ฐœ๋ช…์— ๊ด€ํ•œ ๊ทœ์ •์ด ์ž…๋ฒ•๋˜๊ณ  ๋‚œ ํ›„์ธ 1986๋…„ ์ €์ž‘๊ถŒ๋ฒ• ๊ฐœ์ •์œผ๋กœ ๋ช…๋ฌธํ™”๋˜์—ˆ์Œ์—๋„, ์˜๋„์ ์œผ๋กœ ๋ฒ•์˜ ํ˜•ํ‰์„ ์ทจํ•˜์ง€ ์•Š์•˜๋˜ ์ด์œ ๋ฅผ ์œ ์ถ”ํ•ด ๋ณด์•˜๋‹ค. ๊ทธ ๊ฒฐ๊ณผ ์ €์ž‘๊ถŒ์€ ๋“ฑ๋ก์„ ์š”ํ•˜์ง€ ์•Š๊ณ  ์ฐฝ์ž‘๊ณผ ๋™์‹œ์— ๊ถŒ๋ฆฌ๊ฐ€ ๋ฐœ์ƒํ•˜๊ธฐ์—, ์™ธ๋ถ€์˜ ์ด์šฉ์ž๊ฐ€ ๋ณผ ๋•Œ ๋ˆ„๊ฐ€ ์ฐฝ์ž‘์ž์ธ์ง€๋ฅผ ํŒ๋‹จํ•˜๊ธฐ ์šฉ์ดํ•œ ์ œ๋„๊ฐ€ ๋ฐ”๋žŒ์งํ•˜๋‹ค๋Š” ์ , ๋˜ํ•œ ์ €์ž‘๊ถŒ๋ฒ•์—๋Š” ํŠนํ—ˆ๋ฒ•์— ๋น„ํ•ด ํ›จ์”ฌ ๊ฐ•๋ ฅํ•œ ์ €์ž‘์ธ๊ฒฉ๊ถŒ์ด ์กด์žฌํ•œ๋‹ค๋Š” ์  ๋“ฑ์„ ์ง์ž‘ํ•ด๋ณผ ์ˆ˜ ์žˆ์—ˆ๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ์ด๋Ÿฌํ•œ ์ฐจ์ด์ ๋“ค๋งŒ์œผ๋กœ๋Š” ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ๊ณผ ์ง๋ฌด๋ฐœ๋ช…์— ๋Œ€ํ•œ ๊ทœ์œจ์— ์žˆ์–ด, ๊ถŒ๋ฆฌ์˜ ์›์‹œ์  ๊ท€์† ์ฃผ์ฒด ๋“ฑ ์‚ฌ์šฉ์ž์™€ ์ข…์—…์› ๊ฐ„ ๊ตฌ์ฒด์ ์ธ ์ดํ•ด๊ด€๊ณ„ ์กฐ์ • ์ˆ˜๋‹จ์— ๊ด€ํ•˜์—ฌ, ํ˜„ํ–‰๊ณผ ๊ฐ™์€ ์ •๋„์˜ ์ƒ๋‹นํ•œ ์ฐจ์ด๋ฅผ ๋‘˜ ๋ฌธ์ œ๋Š” ์•„๋‹ˆ๋ผ๊ณ  ๋ณธ๋‹ค. ์˜คํžˆ๋ ค ๋‹ค๋ฅด๊ฒŒ ๊ทœ์ •ํ•จ์œผ๋กœ ์ธํ•˜์—ฌ ๋˜ ๋‹ค๋ฅธ ๋ฌธ์ œ์ ์„ ์•ผ๊ธฐํ•˜๊ณ  ํ˜ผ๋ž€๋งŒ ๊ฐ€์ค‘์‹œํ‚ฌ ๋ฟ์ด๋‹ค. ์ด์— ๊ถŒ๋ฆฌ์˜ ์›์‹œ์  ๊ท€์† ์ฃผ์ฒด ๋“ฑ ์—…๋ฌด์ƒ ์ฐฝ์ž‘ ์ œ๋„์˜ ์ „์ฒด์ ์ธ ํฐ ํ‹€์— ๋Œ€ํ•ด์„œ๋Š” ์ผ์›์ ์œผ๋กœ ๊ตฌ์„ฑํ•˜๋˜, ๊ฐ ์ง€์ ์žฌ์‚ฐ๊ถŒ์˜ ํŠน์ง•์„ ๋ฐ˜์˜ํ•  ํ•„์š”๊ฐ€ ์žˆ๋Š” ๋ถ€๋ถ„์— ๋Œ€ํ•ด์„œ๋Š” ๊ด€๋ จ ๊ทœ์ •์„ ๋ณด์™„ํ•˜๊ฑฐ๋‚˜ ์ผ๋ถ€ ์ˆ˜์ •ํ•˜๋Š” ๋ฐฉํ–ฅ์œผ๋กœ ์ œ๋„๋ฅผ ๊ตฌ์„ฑํ•˜๋Š” ๊ฒƒ์ด ํ•„์š”ํ•˜๋‹ค. ๊ทธ ๋ฐ–์—๋„ ํ˜„ํ–‰ ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ ์ œ๋„์— ๋Œ€ํ•ด์„œ๋Š” ์‚ฌ์šฉ์ž์˜ ๊ธฐํš ๋ฐ ์‚ฌ์šฉ์ž ๋ช…์˜์˜ ๊ณตํ‘œ ์š”๊ฑด์˜ ๋ถˆํ•ฉ๋ฆฌ์„ฑ ๋ฌธ์ œ, ์ €์ž‘์ธ๊ฒฉ๊ถŒ๊นŒ์ง€ ์‚ฌ์šฉ์ž์—๊ฒŒ ๊ท€์†๋˜๋Š” ๋ฌธ์ œ, ์ฐฝ์ž‘์ž์˜ ๋ณด์ƒ์ฒญ๊ตฌ๊ถŒ์ด ์ธ์ •๋˜์ง€ ์•Š๋Š” ๋ฌธ์ œ ๋“ฑ์ด ์žˆ๊ณ , ์ง๋ฌด๋ฐœ๋ช… ์ œ๋„์— ๋Œ€ํ•ด์„œ๋Š” ํŠนํ—ˆ๋ฐ›์„๊ถŒ๋ฆฌ์˜ ์ด์ค‘์–‘๋„๋กœ ์ธํ•œ ์‚ฌ์šฉ์ž์—์˜ ์Šน๊ณ„ ๊ท€์†์ด ๋ถˆ์•ˆ์ •ํ•˜๋‹ค๋Š” ๋ฌธ์ œ ๋“ฑ์ด ๋Œ€ํ‘œ์ ์œผ๋กœ ์ œ๊ธฐ๋œ๋‹ค. ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ๊ณผ ์ง๋ฌด๋ฐœ๋ช…์— ๋Œ€ํ•ด ์ œ๊ธฐ๋˜๋Š” ๊ฐ๊ฐ์˜ ๋ฌธ์ œ์ ์„ ๋ณด์™„ํ•˜๊ณ  ์žฅ์ ์€ ์‚ด๋ฆด ์ˆ˜ ์žˆ๋Š” ์—…๋ฌด์ƒ ์ฐฝ์ž‘ ์ œ๋„์— ๋Œ€ํ•œ ๊ธฐ๋ณธ์ ์ธ ๊ตฌ์กฐ๋ฅผ ์ผ์›์ ์œผ๋กœ ์‚ดํŽด๋ณด์ž๋ฉด, ์šฐ์„  ์—…๋ฌด์ƒ ์ฐฝ์ž‘์˜ ์ •์˜์™€ ์„ฑ๋ฆฝ ์š”๊ฑด์„ ์‚ฌ์šฉ์ž์˜ ์—…๋ฌด์— ์ข…์‚ฌํ•˜๋Š” ์ž๊ฐ€ ๊ทธ ์—…๋ฌด์ƒ ์ฐฝ์ž‘ํ•˜๋Š” ์ง€์  ์‚ฐ๋ฌผ๋กœ ๋‹จ์ˆœํ™”ํ•˜๊ณ , ์ข…์—…์›์—๊ฒŒ ์ฐฝ์ž‘๋ฌผ์— ๋Œ€ํ•œ ์ฐฝ์ž‘์ž ์ง€์œ„๋ฅผ ์ธ์ •ํ•˜๋ฉด์„œ ์ง€์ ์žฌ์‚ฐ๊ถŒ์„ ์ข…์—…์›์—๊ฒŒ ์›์‹œ์ ์œผ๋กœ ๊ท€์†์‹œํ‚ค๋„๋ก ํ•ด์•ผ ํ•œ๋‹ค. ์ด์™€ ํ•จ๊ป˜ ์‚ฌ์ „์–‘๋„๊ณ„์•ฝ์˜ ์œ ํšจ์„ฑ์„ ๋ช…๋ฌธํ™”ํ•จ๊ณผ ๋™์‹œ์—, ์‚ฌ์šฉ์ž๊ฐ€ ์ง€์ ์žฌ์‚ฐ๊ถŒ์„ ๋ณด๋‹ค ๊ฐ„ํŽธํ•˜๊ณ  ์•ˆ์ •์ ์œผ๋กœ ์Šน๊ณ„ ๋ฐ›์„ ์ˆ˜ ์žˆ๋„๋ก ์‚ฌ์šฉ์ž์˜ ์Šน๊ณ„ ํ†ต์ง€ ๋“ฑ ๋ณ„๋„์˜ ์Šน๊ณ„ ์ ˆ์ฐจ๋ฅผ ์š”๊ตฌํ•˜์ง€ ์•Š๊ณ , ์—…๋ฌด์ƒ ์ฐฝ์ž‘์— ๋Œ€ํ•œ ์ง€์ ์žฌ์‚ฐ๊ถŒ์ด ๋ฐœ์ƒํ•  ๋•Œ ์ž๋™์ ์œผ๋กœ ๊ทธ ๊ถŒ๋ฆฌ๊ฐ€ ์‚ฌ์šฉ์ž์—๊ฒŒ ์Šน๊ณ„ ๊ท€์†๋˜๋„๋ก ํ•ด์•ผ ํ•œ๋‹ค. ํ•œํŽธ ์ผ์ • ๊ธฐ๊ฐ„ ๋‚ด์— ์‚ฌ์šฉ์ž๊ฐ€ ์ง€์ ์žฌ์‚ฐ๊ถŒ์˜ ํฌ๊ธฐ์˜์‚ฌ๋ฅผ ์•Œ๋ฆฐ ๋•Œ์—๋Š” ๊ทธ ์Šน๊ณ„๋Š” ๋ฌดํšจ๋กœ ํ•œ๋‹ค. ๊ทธ๋Ÿฐ๋ฐ ์Šน๊ณ„์‹œ์ ์„ ์•ž๋‹น๊ธฐ๋Š” ๊ฒƒ๋งŒ์œผ๋กœ๋Š” ์—…๋ฌด์ƒ ์ฐฝ์ž‘์— ๋Œ€ํ•œ ์ง€์ ์žฌ์‚ฐ๊ถŒ์˜ ์ด์ค‘์–‘๋„ ๋ฌธ์ œ๋ฅผ ์™„์ „ํžˆ ํ•ด์†Œํ•˜์—ฌ ์‚ฌ์šฉ์ž์—์˜ ๊ถŒ๋ฆฌ์˜ ์Šน๊ณ„ ๊ท€์†์˜ ์•ˆ์ •์„ฑ์„ ๊ธฐํ•˜๊ธฐ๋Š” ์–ด๋ ต๋‹ค. ์ด์— ๋…์ผ์˜ ์ข…์—…์›๋ฐœ๋ช…๋ฒ• ์ œ7์กฐ ์ œ2ํ•ญ์˜ ์ƒ๋Œ€์  ์ฒ˜๋ถ„๊ธˆ์ง€ ์กฐํ•ญ์„ ์ฐธ๊ณ ํ•˜์—ฌ, ์‚ฌ์ „์–‘๋„๊ณ„์•ฝ์˜ ๊ตฌ์†์„ ๋ฐ›๋Š” ์ข…์—…์›์ด, ์‚ฌ์šฉ์ž๊ฐ€ ์ง€์ ์žฌ์‚ฐ๊ถŒ์˜ ํฌ๊ธฐ์˜์‚ฌ๋ฅผ ์•Œ๋ฆฌ๊ธฐ ์ „์—, ๋‹นํ•ด ์—…๋ฌด์ƒ ์ฐฝ์ž‘์— ๋Œ€ํ•œ ์ง€์ ์žฌ์‚ฐ๊ถŒ์„ ์ž„์˜๋กœ ์ฒ˜๋ถ„ํ•˜๋Š” ๊ฒฝ์šฐ, ์‚ฌ์šฉ์ž์— ๋Œ€ํ•ด์„œ๋Š” ๊ทธ ์ฒ˜๋ถ„์„ ๋ฌดํšจ๋กœ ํ•˜๋Š” ๊ทœ์ •์„ ์‹ ์„คํ•˜๋Š” ๊ฒƒ์ด ํ•„์š”ํ•˜๋‹ค. ์˜ˆ๋ฅผ ๋“ค์–ด ์ง๋ฌด๋ฐœ๋ช…์˜ ๊ฒฝ์šฐ ์„ค์‚ฌ ์„ ์˜์˜ ์ œ3์ž๊ฐ€ ์‚ฌ์šฉ์ž๋ณด๋‹ค ๋จผ์ € ์ถœ์›ํ–ˆ๋‹ค๊ณ  ํ•˜๋”๋ผ๋„, ์‚ฌ์šฉ์ž๊ฐ€ ์˜จ๋‹นํžˆ ๊ทธ ํŠนํ—ˆ๊ถŒ์„ ๋˜์ฐพ์„ ์ˆ˜ ์žˆ๋„๋ก ํ•˜๊ณ ์ž ํ•จ์ด๋‹ค. ๋˜ํ•œ ์‚ฌ์šฉ์ž๊ฐ€ ์—…๋ฌด์ƒ ์ฐฝ์ž‘์— ๋Œ€ํ•œ ์ง€์ ์žฌ์‚ฐ๊ถŒ์„ ์Šน๊ณ„ํ•˜์ง€ ์•Š๊ฒ ๋‹ค๋Š” ํฌ๊ธฐ์˜์‚ฌ๋ฅผ ํ†ต์ง€ํ•˜๋Š” ๋“ฑ์˜ ์ด์œ ๋กœ ์ข…์—…์› ๋˜๋Š” ์ œ3์ž๊ฐ€ ์—…๋ฌด์ƒ ์ฐฝ์ž‘์— ๋Œ€ํ•œ ์ง€์ ์žฌ์‚ฐ๊ถŒ์„ ์ทจ๋“ํ•˜๊ธฐ๋กœ ํ™•์ •๋œ ๊ฒฝ์šฐ, ์‚ฌ์ „์–‘๋„๊ณ„์•ฝ์˜ ์ฒด๊ฒฐ ์—ฌ๋ถ€๋ฅผ ๋ถˆ๋ฌธํ•˜๊ณ , ์‚ฌ์šฉ์ž์—๊ฒŒ ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ์˜ ๊ฒฝ์šฐ์—๋Š” ๋น„๋ฐฐํƒ€์ ์ด์šฉ๊ถŒ์„, ์ง๋ฌด๋ฐœ๋ช…์˜ ๊ฒฝ์šฐ์—๋Š” ํ†ต์ƒ์‹ค์‹œ๊ถŒ์„ ๋ฌด์ƒ์œผ๋กœ ์ธ์ •ํ•  ํ•„์š”๊ฐ€ ์žˆ๋‹ค. ๊ทธ๋ฆฌ๊ณ  ์‚ฌ์šฉ์ž์—์˜ ์ง€์ ์žฌ์‚ฐ๊ถŒ ์Šน๊ณ„ ๊ท€์†์ด ํ™•์ •๋˜๊ณ , ๊ทธ ์ฐฝ์ž‘๋ฌผ์„ ํ™œ์šฉํ•œ ์ˆ˜์ต ์‚ฌ์—…์„ ํ†ตํ•˜์—ฌ ํˆฌ์ž๋น„์šฉ๊ณผ ์ž„๊ธˆ ๋“ฑ์„ ์ƒํšŒํ•˜๋Š” ํ˜„์ €ํ•œ ์ด์ต์ด ๋ฐœ์ƒํ•˜๋Š” ๊ฒฝ์šฐ, ์ข…์—…์›์˜ ๋ณด์ƒ์ฒญ๊ตฌ๊ถŒ์„ ์ธ์ •ํ•˜๋Š” ๊ฒƒ์ด ํƒ€๋‹นํ•˜๋‹ค. ํ•œํŽธ ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ์˜ ๊ฒฝ์šฐ์—๋Š” ์ข…์—…์›์˜ ์ €์ž‘์ธ๊ฒฉ๊ถŒ ํ–‰์‚ฌ๋ฅผ ์ผ๋ถ€ ์ œํ•œํ•  ์ˆ˜ ์žˆ์Œ์„ ๋ช…๋ฌธํ™”ํ•˜๊ฑฐ๋‚˜ ๊ทธ์— ๋Œ€ํ•œ ํŠน์•ฝ์˜ ์œ ํšจ์„ฑ์„ ์ธ์ •ํ•˜์—ฌ, ์‚ฌ์šฉ์ž๊ฐ€ ์ €์ž‘๋ฌผ์„ ์ด์šฉํ•œ ์‚ฌ์—…์„ ์•ˆ์ •์ ์œผ๋กœ ์˜์œ„ํ•  ์ˆ˜ ์žˆ๋„๋ก ํ•˜์—ฌ์•ผ ํ•œ๋‹ค. ์ด๋ ‡๊ฒŒ ์—…๋ฌด์ƒ ์ฐฝ์ž‘์— ๊ณตํ†ต๋˜๋Š” ๊ธฐ๋ณธ์ ์ธ ๊ตฌ์กฐ๋ฅผ ํ† ๋Œ€๋กœ ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ๊ณผ ์ง๋ฌด๋ฐœ๋ช…์— ๋Œ€ํ•ด ๊ฐ๊ฐ์— ์ œ์‹œ๋œ ๊ตฌ์ฒด์ ์ธ ๊ฐœ์ •์•ˆ๋“ค์€ ํ˜„ํ–‰ ์ œ๋„์˜ ๋ฌธ์ œ์ ์„ ํ•ด๊ฒฐํ•˜๋Š” ํ•œํŽธ, ํ˜„ํ–‰ ์ œ๋„์— ๋น„ํ•˜์—ฌ ์ข…์—…์›๊ณผ ์‚ฌ์šฉ์ž๋Š” ๋ฌผ๋ก  ์ด์šฉ์ž ๊ทธ๋ฆฌ๊ณ  ๋ฒ•๋ฆฌ์ ์ธ ์ธก๋ฉด๊นŒ์ง€ ๋ชจ๋‘์— ์ด์ต์ด ๋  ์ˆ˜ ์žˆ์„ ๊ฒƒ์ด๋‹ค. ์ด๋Ÿฌํ•œ ๊ฐœ์„ ๋ฐฉ์•ˆ์„ ํ†ตํ•˜์—ฌ ์ข…์—…์›์˜ ์ฐฝ์ž‘ ๋™๊ธฐ๋ฅผ ์ €ํ•ดํ•˜์ง€ ์•Š์Œ๊ณผ ๋™์‹œ์—, ์ง€์  ์ฐฝ์ž‘๋ฌผ์˜ ํŠน์„ฑ์ƒ ์ข…์—…์›์ด ์ฐฝ์ž‘์„ ์™„์„ฑํ–ˆ๋Š”์ง€ ์—ฌ๋ถ€์— ๋Œ€ํ•œ ์ •๋ณด๋ฅผ ์–ป๊ธฐ ํž˜๋“  ์‚ฌ์šฉ์ž๋„ ๋ณดํ˜ธํ•˜์—ฌ, ์—…๋ฌด์ƒ ์ฐฝ์ž‘์— ๋Œ€ํ•œ ์‚ฌ์šฉ์ž์˜ ์ ๊ทน์ ์ธ ํˆฌ์ž๋ฅผ ์œ ๋„ํ•  ์ˆ˜ ์žˆ์„ ๊ฒƒ์ด๋ฉฐ, ์•„์šธ๋Ÿฌ ๊ตญ๊ฐ€์˜ ์‚ฐ์—…๋ฐœ์ „๊ณผ ๊ฒฝ์Ÿ๋ ฅ ์ œ๊ณ ๋ผ๋Š” ์ง€์ ์žฌ์‚ฐ๊ถŒ๋ฒ•์˜ ๊ถ๊ทน์ ์ธ ๋ชฉ์  ๋‹ฌ์„ฑ์—๋„ ๊ธฐ์—ฌํ•  ๊ฒƒ์œผ๋กœ ๊ธฐ๋Œ€ํ•œ๋‹ค.โ… . ์„œ 1 โ…ก. ์—…๋ฌด์ƒ ๋ฐœ์ƒํ•˜๋Š” ์ง€์ ์žฌ์‚ฐ๊ถŒ์— ๋Œ€ํ•œ ๊ทœ์œจ ํ˜„ํ™ฉ 6 1. ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ์— ๋Œ€ํ•œ ์ €์ž‘๊ถŒ 6 ๊ฐ€. ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ์˜ ์˜์˜ 6 ๋‚˜. ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ์˜ ์„ฑ๋ฆฝ ์š”๊ฑด 11 1) ์‚ฌ์šฉ์ž์˜ ๊ธฐํš 11 2) ์‚ฌ์šฉ์ž์˜ ์—…๋ฌด์— ์ข…์‚ฌํ•˜๋Š” ์ž๊ฐ€ ์ž‘์„ฑํ•œ ๊ฒƒ 14 3) ์—…๋ฌด์ƒ ์ž‘์„ฑ๋˜๋Š” ์ €์ž‘๋ฌผ์ผ ๊ฒƒ 18 4) ์‚ฌ์šฉ์ž ๋ช…์˜๋กœ ๊ณตํ‘œ๋˜๋Š” ์ €์ž‘๋ฌผ์ผ ๊ฒƒ 19 ๋‹ค. ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ์˜ ํšจ๊ณผ 22 2. ์ง๋ฌด๋ฐœ๋ช…์— ๋Œ€ํ•œ ํŠนํ—ˆ๋ฐ›์„๊ถŒ๋ฆฌ 25 ๊ฐ€. ์ง๋ฌด๋ฐœ๋ช…์˜ ์˜์˜ 25 ๋‚˜. ์ง๋ฌด๋ฐœ๋ช…์˜ ์„ฑ๋ฆฝ ์š”๊ฑด 26 1) ๋ฐœ๋ช…์ด ์‚ฌ์šฉ์ž์˜ ์—…๋ฌด๋ฒ”์œ„์— ์†ํ•  ๊ฒƒ 26 2) ์ข…์—…์›์ด ๊ณผ๊ฑฐ๋‚˜ ํ˜„์žฌ ์ง๋ฌด์— ๊ด€ํ•˜์—ฌ ํ•œ ๋ฐœ๋ช…์ผ ๊ฒƒ 27 ๋‹ค. ์ง๋ฌด๋ฐœ๋ช…์˜ ํšจ๊ณผ 30 1) ์ข…์—…์›์— ๋ฐœ๋ช…์ž ์ง€์œ„ ์ธ์ • 30 2) ์ข…์—…์›์— ํŠนํ—ˆ๋ฐ›์„๊ถŒ๋ฆฌ์˜ ์›์‹œ์  ๊ท€์† 33 3) ์‚ฌ์šฉ์ž์˜ ํ†ต์ƒ์‹ค์‹œ๊ถŒ 34 4) ์ง๋ฌด๋ฐœ๋ช…์— ๋Œ€ํ•œ ์‚ฌ์ „์–‘๋„๊ณ„์•ฝ ์œ ํšจ์„ฑ 38 5) ์‚ฌ์šฉ์ž์—์˜ ๊ถŒ๋ฆฌ ์Šน๊ณ„ ์ ˆ์ฐจ 41 6) ์ข…์—…์›์˜ ๋ณด์ƒ์ฒญ๊ตฌ๊ถŒ 46 7) ๊ณต๋ฌด์› ๋ฐ ๊ตญ๊ณต๋ฆฝ๋Œ€ํ•™ ๊ต์ง์›์— ๋Œ€ํ•œ ํŠน๋ก€ 49 ๋ผ. ์ง๋ฌด๋ฐœ๋ช… ๊ทœ์ • ๊ด€๋ จ ๋ฐœ๋ช…์ง„ํฅ๋ฒ• ๊ฐœ์ •์•ˆ 52 3. ์ง๋ฌด๊ณ ์•ˆ์— ๋Œ€ํ•œ ์‹ค์šฉ์‹ ์•ˆ๋“ฑ๋ก์„ ๋ฐ›์„ ์ˆ˜ ์žˆ๋Š” ๊ถŒ๋ฆฌ ๋ฐ ์ง๋ฌด๋””์ž์ธ์— ๋Œ€ํ•œ ๋””์ž์ธ๋“ฑ๋ก์„ ๋ฐ›์„ ์ˆ˜ ์žˆ๋Š” ๊ถŒ๋ฆฌ 55 4. ์ƒํ‘œ๊ถŒ 57 5. ์ง๋ฌด์ƒ ์œก์„ฑ์— ๋Œ€ํ•œ ํ’ˆ์ข…๋ณดํ˜ธ๋ฅผ ๋ฐ›์„ ์ˆ˜ ์žˆ๋Š” ๊ถŒ๋ฆฌ 63 6. ์—…๋ฌด์ƒ ๋ฐ˜๋„์ฒด์ง‘์ ํšŒ๋กœ์˜ ๋ฐฐ์น˜์„ค๊ณ„์— ๋Œ€ํ•œ ๋ฐฐ์น˜์„ค๊ณ„๊ถŒ์˜ ์„ค์ •๋“ฑ๋ก์„ ์‹ ์ฒญํ•  ์ˆ˜ ์žˆ๋Š” ๊ถŒ๋ฆฌ 70 7. ๋ถ€์ •๊ฒฝ์Ÿ๋ฐฉ์ง€ ๋ฐ ์˜์—…๋น„๋ฐ€๋ณดํ˜ธ์— ๊ด€ํ•œ ๋ฒ•๋ฅ ์ƒ ์˜์—…๋น„๋ฐ€ 72 โ…ข. ์—…๋ฌด์ƒ ๋ฐœ์ƒํ•˜๋Š” ์ง€์ ์žฌ์‚ฐ๊ถŒ์— ๋Œ€ํ•œ ์™ธ๊ตญ์—์„œ์˜ ๊ทœ์œจ ํ˜„ํ™ฉ 78 1. ๋ฏธ๊ตญ 78 ๊ฐ€. ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ์˜ ๊ทœ์œจ์ฒด์ œ 78 1) ์ข…์—…์›์ด ๊ทธ ์—…๋ฌด์ƒ ์ž‘์„ฑํ•œ ์ €์ž‘๋ฌผ 80 2) ํŠน๋ณ„ํžˆ ์ฃผ๋ฌธ ๋˜๋Š” ์œ„ํƒ๋œ ์ €์ž‘๋ฌผ 82 3) ํ•œ๊ตญ๊ณผ์˜ ์ œ๋„ ๋น„๊ต 84 ๋‚˜. ์ง๋ฌด๋ฐœ๋ช…์˜ ๊ทœ์œจ์ฒด์ œ 86 1) ์‚ฌ์ „์–‘๋„๊ณ„์•ฝ์ด ์กด์žฌํ•˜๋Š” ๊ฒฝ์šฐ 86 2) ์‚ฌ์ „์–‘๋„๊ณ„์•ฝ์ด ์กด์žฌํ•˜์ง€ ์•Š๋Š” ๊ฒฝ์šฐ 87 3) ํ•œ๊ตญ๊ณผ์˜ ์ œ๋„ ๋น„๊ต ๋ฐ ํ•œ๊ตญ์—์˜ ์‹œ์‚ฌ์  89 2. ์˜๊ตญ 94 ๊ฐ€. ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ์˜ ๊ทœ์œจ์ฒด์ œ 94 1) ์ผ๋ฐ˜๋ก  94 2) ํ•œ๊ตญ๊ณผ์˜ ์ œ๋„ ๋น„๊ต ๋ฐ ํ•œ๊ตญ์—์˜ ์‹œ์‚ฌ์  97 ๋‚˜. ์ง๋ฌด๋ฐœ๋ช…์˜ ๊ทœ์œจ์ฒด์ œ 98 1) ์ผ๋ฐ˜๋ก  98 2) ํ•œ๊ตญ๊ณผ์˜ ์ œ๋„ ๋น„๊ต 101 3. ๋…์ผ 102 ๊ฐ€. ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ์˜ ๊ทœ์œจ์ฒด์ œ 102 1) ์ผ๋ฐ˜๋ก  102 2) ํ•œ๊ตญ๊ณผ์˜ ์ œ๋„ ๋น„๊ต ๋ฐ ํ•œ๊ตญ์—์˜ ์‹œ์‚ฌ์  104 ๋‚˜. ์ง๋ฌด๋ฐœ๋ช…์˜ ๊ทœ์œจ์ฒด์ œ 106 1) ์ผ๋ฐ˜๋ก  106 2) ํ•œ๊ตญ๊ณผ์˜ ์ œ๋„ ๋น„๊ต ๋ฐ ํ•œ๊ตญ์—์˜ ์‹œ์‚ฌ์  109 ๋‹ค. ๋…์ผ ์ง€์ ์žฌ์‚ฐํ†ตํ•ฉ๋ชจ๋ธ๋ฒ• ๋‚ด ์—…๋ฌด์ƒ์ฐฝ์ž‘๋ฌผ๋ฒ• 110 4. ํ”„๋ž‘์Šค 112 ๊ฐ€. ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ์˜ ๊ทœ์œจ์ฒด์ œ 112 ๋‚˜. ์ง๋ฌด๋ฐœ๋ช…์˜ ๊ทœ์œจ์ฒด์ œ 114 5. ์ผ๋ณธ 116 ๊ฐ€. ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ์˜ ๊ทœ์œจ์ฒด์ œ 116 ๋‚˜. ์ง๋ฌด๋ฐœ๋ช…์˜ ๊ทœ์œจ์ฒด์ œ 117 1) ์ผ๋ฐ˜๋ก  117 2) ํ•œ๊ตญ๊ณผ์˜ ์ œ๋„ ๋น„๊ต ๋ฐ ํ•œ๊ตญ์—์˜ ์‹œ์‚ฌ์  120 โ…ฃ. ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ๊ณผ ์ง๋ฌด๋ฐœ๋ช…์˜ ๊ทœ์œจ์ฒด์ œ๊ฐ€ ๋‹ค๋ฅด๊ฒŒ ๊ทœ์ •๋œ ์ด์œ ์— ๋Œ€ํ•œ ๊ฒ€ํ†  122 1. ์ž…๋ฒ•ํ˜•์„ฑ๊ณผ์ •์ƒ ์ด์œ ๊ฐ€ ์žˆ์—ˆ๋Š”์ง€ ์—ฌ๋ถ€ 123 ๊ฐ€. ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ ์ œ๋„์˜ ์ž…๋ฒ• ์—ฐํ˜ 124 1) ์ž…๋ฒ• ์—ฐํ˜ 124 2) ์ผ๋ณธ ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ ๊ทœ์ •์˜ ์ž…๋ฒ• ๊ฒฝ์œ„ 130 3) ํ”„๋ž‘์Šค ์ง‘ํ•ฉ์ €์ž‘๋ฌผ ์ œ๋„์˜ ์ž…๋ฒ• ์ด์œ  134 4) ๋ฏธ๊ตญ Works Made For Hire ๋ฒ•๋ฆฌ์˜ ์ž…๋ฒ•ํ˜•์„ฑ๊ณผ์ • โ€“์ข…์—…์› ๊ท€์† ์›์น™์—์„œ ์‚ฌ์šฉ์ž ๊ท€์† ์›์น™์œผ๋กœ์˜ ์ „ํ™˜ ๊ณผ์ • 135 ๋‚˜. ์ง๋ฌด๋ฐœ๋ช… ์ œ๋„์˜ ์ž…๋ฒ• ์—ฐํ˜ 148 ๋‹ค. ๊ฒ€ํ†  151 2. ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ๊ณผ ์ง๋ฌด๋ฐœ๋ช… ์ œ๋„์˜ ์ทจ์ง€ ๊ฐ„ ์ฐจ์ด์—์„œ ๋น„๋กฏ๋œ ๊ฒƒ์ธ์ง€ ์—ฌ๋ถ€ 155 3. ์ €์ž‘๊ถŒ๋ฒ•๊ณผ ํŠนํ—ˆ๋ฒ• ๊ฐ„ ์ผ๋ฐ˜์  ์ฐจ์ด์—์„œ ๋น„๋กฏ๋œ ๊ฒƒ์ธ์ง€ ์—ฌ๋ถ€ 161 ๊ฐ€. ์–‘๋ฒ•์˜ ์ผ๋ฐ˜์  ์ฐจ์ด 161 ๋‚˜. ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ๊ณผ ์ง๋ฌด๋ฐœ๋ช… ๊ฐ„ ๊ทœ์œจ ์ฐจ์ด๋ฅผ ๊ฐ€์ ธ์˜ฌ ๋งŒํ•œ ์–‘๋ฒ•์˜ ์ฐจ์ด์  ๋ถ„์„ 168 4. ์ข…ํ•ฉ์  ๊ฒ€ํ†  171 โ…ค. ์—…๋ฌด์ƒ ์ฐฝ์ž‘์— ๋Œ€ํ•œ ์ง€์ ์žฌ์‚ฐ๊ถŒ ๊ท€์†์— ๊ด€ํ•œ ๋น„ํŒ์  ๊ฒ€ํ†  176 1. ํ˜„ํ–‰ ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ ๊ด€๋ จ ๋ฌธ์ œ์  176 ๊ฐ€. ์‚ฌ์šฉ์ž์˜ ๊ธฐํš ๋ฐ ์‚ฌ์šฉ์ž ๋ช…์˜์˜ ๊ณตํ‘œ ์š”๊ฑด์˜ ๋ถˆํ•ฉ๋ฆฌ์„ฑ 176 ๋‚˜. ์ €์ž‘์ธ๊ฒฉ๊ถŒ๊นŒ์ง€ ์‚ฌ์šฉ์ž์—๊ฒŒ ๊ท€์† 180 ๋‹ค. ์ฐฝ์ž‘์ž์— ๋Œ€ํ•œ ๋ณด์ƒ์ฒญ๊ตฌ๊ถŒ ๊ทœ์ •์˜ ๋ถˆ๋น„ 184 1) ์ง๋ฌด๋ฐœ๋ช… ๊ทœ์ •์˜ ์œ ์ถ”์ ์šฉ ๊ฐ€๋Šฅ ์—ฌ๋ถ€ 185 2) ๊ฒ€ํ†  186 ๋ผ. ์ €์ž‘๊ณผ ์‹ค์—ฐ ๊ฐ„ ํ˜•ํ‰์„ฑ 187 ๋งˆ. ๊ณ„์•ฝ์— ์˜ํ•œ ์ข…์—…์›์—์˜ ๊ถŒ๋ฆฌ ๊ท€์†์ด ์‚ฌ์‹ค์ƒ ๋ถˆ๊ฐ€๋Šฅ 187 ๋ฐ”. ๊ณ„์•ฝ์— ์˜ํ•œ ์ €์ž‘์ž ์ž์ฒด์˜ ๋ณ€๊ฒฝ 188 ์‚ฌ. 2016ํ—Œ๊ฐ€12 ์ €์ž‘๊ถŒ๋ฒ• ์ œ9์กฐ ์œ„ํ—Œ์ œ์ฒญ์‚ฌ๊ฑด ์‹ฌ๋ฆฌ ์ค‘ 189 1) ์ €์ž‘์žใ†๋ฐœ๋ช…์žใ†๊ณผํ•™๊ธฐ์ˆ ์ž์˜ ํ—Œ๋ฒ•์ƒ ๊ธฐ๋ณธ๊ถŒ ์นจํ•ด 191 2) ์ง์—…์„ ํƒ์˜ ์ž์œ  ์นจํ•ด 192 3) ์ž์œ ์‹œ์žฅ์ฃผ์˜ ๊ฒฝ์ œ์›์น™ ํ›ผ์† 193 4) ๊ฒ€ํ†  194 2. ํ˜„ํ–‰ ์ง๋ฌด๋ฐœ๋ช… ๊ด€๋ จ ๋ฌธ์ œ์  195 ๊ฐ€. ํŠนํ—ˆ๋ฐ›์„๊ถŒ๋ฆฌ์˜ ์ œ3์ž์—์˜ ์ด์ค‘์–‘๋„ 195 1) ํŠนํ—ˆ๋ฐ›์„๊ถŒ๋ฆฌ ์–‘๋„์˜ ํšจ๋ ฅ 196 2) ํŠนํ—ˆ๋ฐ›์„๊ถŒ๋ฆฌ ์ด์ค‘์–‘๋„์— ๋Œ€ํ•œ ๋ฒ•์  ์ทจ๊ธ‰ 197 3) ๊ฒ€ํ†  201 ๋‚˜. ๋ฌต์‹œ์  ๊ณ„์•ฝ ์—ฌ๋ถ€์™€ ๊ด€๋ จ๋œ ๋ถ„์Ÿ ๋ฐœ์ƒ ๊ฐ€๋Šฅ์„ฑ 203 ๋‹ค. ๋ณด์ƒ์ฒญ๊ตฌ๊ถŒ ๊ธˆ์•ก์˜ ๊ณผ์ž‰ ๊ฐ€๋Šฅ์„ฑ 205 ๋ผ. ์‚ฌ์ „์–‘๋„๊ณ„์•ฝ์ด ์—†๊ฑฐ๋‚˜ ์Šน๊ณ„ ์—ฌ๋ถ€๋ฅผ ํ†ต์ง€ํ•˜์ง€ ์•Š์€ ๊ฒฝ์šฐ ์‚ฌ์šฉ์ž์— ๋Œ€ํ•œ ๋ถˆ์ด์ต 206 3. ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ๊ณผ ์ง๋ฌด๋ฐœ๋ช…์— ๋Œ€ํ•œ ๊ทœ์œจ ์ฐจ์ด๋กœ ์ธํ•œ ๋ฌธ์ œ์  207 โ…ฅ. ์—…๋ฌด์ƒ ์ฐฝ์ž‘ ์ œ๋„ ๊ฐœ์„ ์— ๋Œ€ํ•œ ๊ธฐ๋ณธ๋ฐฉํ–ฅ 214 1. ์—…๋ฌด์ƒ ์ฐฝ์ž‘์— ๊ด€ํ•œ ์ง€์ ์žฌ์‚ฐ๊ถŒ ์ œ๋„ ๊ฐ„ ํ†ตํ•ฉ์  ๋…ผ์˜์˜ ํ•„์š”์„ฑ 214 2. ์—…๋ฌด์ƒ ์ฐฝ์ž‘์˜ ์ •์˜ ๋ฐ ์„ฑ๋ฆฝ ์š”๊ฑด์˜ ๋‹จ์ˆœํ™” 220 3. ์ข…์—…์›์— ์ฐฝ์ž‘์ž ์ง€์œ„ ์ธ์ • ๋ฐ ์ง€์ ์žฌ์‚ฐ๊ถŒ ์›์‹œ์  ๊ท€์† 224 ๊ฐ€. ๋ฏผ๋ฒ•์ƒ ์†Œ์œ ๊ถŒ ๊ท€์†๊ณผ์˜ ๊ตฌ๋ณ„ 225 ๋‚˜. ์›์‹œ์  ๊ท€์†์— ๊ด€ํ•œ ๋…ผ์˜์˜ ํ•„์š”์„ฑ 228 ๋‹ค. ์›์‹œ์  ๊ท€์† ๊ด€๋ จ ์ž…๋ฒ• ์œ ํ˜• 231 1) ์ข…์—…์›์ฃผ์˜(์ฐฝ์ž‘์ž์ฃผ์˜) 232 2) ์‚ฌ์šฉ์ž์ฃผ์˜ 234 3) ๊ณต์œ ์ฃผ์˜ 235 4) ๊ธฐ์—ฌ์ž์ฃผ์˜ 237 ๋ผ. ์ข…์—…์›์ฃผ์˜์˜ ํƒ€๋‹น์„ฑ 239 ๋งˆ. ๋‹น์‚ฌ์ž ๊ฐ„ ๊ณ„์•ฝ์œผ๋กœ ์›์‹œ์  ๊ท€์† ์ฃผ์ฒด ๋ณ€๊ฒฝ ๋ถˆ๊ฐ€ 247 4. ์—…๋ฌด์ƒ ์ฐฝ์ž‘์— ๋Œ€ํ•œ ์‚ฌ์ „์–‘๋„๊ณ„์•ฝ ์ฒด๊ฒฐ ๊ฐ€๋Šฅ 249 ๊ฐ€. ์‚ฌ์šฉ์ž์˜ ์ดํ•ด๊ด€๊ณ„๋ฅผ ๊ณ ๋ คํ•ด์•ผ ํ•˜๋Š” ์ด์œ  250 ๋‚˜. ์‚ฌ์ „์–‘๋„๊ณ„์•ฝ ์œ ํšจ์„ฑ์„ ์ธ์ •ํ•ด์•ผ ํ•˜๋Š” ์ด์œ  250 1) ๋ฏธ๊ตญ์—์„œ์˜ ๊ฒฝ์ œํ•™์  ๋ถ„์„ 251 2) ๊ฒ€ํ†  254 5. ์—…๋ฌด์ƒ ์ฐฝ์ž‘์— ๋Œ€ํ•œ ์ง€์ ์žฌ์‚ฐ๊ถŒ ๋ฐœ์ƒ์‹œ ์ž๋™์œผ๋กœ ์‚ฌ์šฉ์ž์— ์Šน๊ณ„ ๊ท€์† ๊ฐ„์ฃผ 255 6. ์‚ฌ์šฉ์ž์˜ ํฌ๊ธฐ์˜์‚ฌ ํ†ต์ง€ ์ „ ์ข…์—…์›์˜ ์ฒ˜๋ถ„์€ ์‚ฌ์šฉ์ž์— ๋Œ€ํ•ด์„œ๋Š” ๋ฌดํšจ๋กœ ๊ทœ์ • 257 7. ์‚ฌ์šฉ์ž์— ๋น„๋ฐฐํƒ€์ ์ด์šฉ๊ถŒ ๋˜๋Š” ํ†ต์ƒ์‹ค์‹œ๊ถŒ ์ธ์ • 259 8. ํ˜„์ €ํ•œ ์ˆ˜์ต ๋ฐœ์ƒ์‹œ ์‚ฌ์šฉ์ž์˜ ๋ณด์ƒ ์˜๋ฌด ๋ถ€๊ณผ 260 9. ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ ๊ฒฝ์šฐ์˜ ํŠน์น™ โ€“์ข…์—…์›์˜ ์ €์ž‘์ธ๊ฒฉ๊ถŒ ํ–‰์‚ฌ ์ œํ•œ ํŠน์•ฝ์˜ ์œ ํšจ์„ฑ ์ธ์ • 262 โ…ฆ. ๊ฐ ์ œ๋„๋ณ„ ๊ตฌ์ฒด์ ์ธ ๊ฐœ์ •๋ฐฉ์•ˆ 269 1. ์—…๋ฌด์ƒ์ €์ž‘๋ฌผ ์ œ๋„ 269 ๊ฐ€. ํ˜„ํ–‰ ์ œ๋„ ๋ฐ ๋ฌธ์ œ์  269 ๋‚˜. ๊ตฌ์ฒด์  ๊ฐœ์ •๋ฐฉ์•ˆ 270 ๋‹ค. ๊ฐœ์ •์— ๋”ฐ๋ฅธ ๊ธฐ๋Œ€ํšจ๊ณผ 271 2. ์ง๋ฌด๋ฐœ๋ช… ์ œ๋„ 274 ๊ฐ€. ํ˜„ํ–‰ ์ œ๋„ ๋ฐ ๋ฌธ์ œ์  274 ๋‚˜. ๊ตฌ์ฒด์  ๊ฐœ์ •๋ฐฉ์•ˆ 278 ๋‹ค. ๊ฐœ์ •์— ๋”ฐ๋ฅธ ๊ธฐ๋Œ€ํšจ๊ณผ 279 โ…ง. ๊ฒฐ 280 ์ฐธ๊ณ ๋ฌธํ—Œ 293 Abstract 306Docto

    Basal Cell Carcinoma of the Scalp with Lung, Bone and Lymph Node Metastasis in a Korean Woman

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    Metastatic basal cell carcinoma (MBCC) is very rare with incidences estimated to range from 0.0028% to 0.5% in the Caucasian population. The incidence of basal cell carcinoma is known to be much lower in Asian populations including Koreans. We present a rare case of metastatic BCC in a Korean woman who showed lymph node, lung and bone metastasis, with a review of the MBCC cases reported in the Korean literature.ope

    Transabdominal embryofetoscopy in 6 cases of first trimester prenatal diagnosis for congenital anomalies

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    Objective: To demonstrate the efficacy of first trimester embryofetoscopy for prenatal diagnosis of congenital anomalies in continuing pregnancies. Methods: Under ultrasound guidance, six patients at 12+6-14+6 weeks of gestation underwent endoscopic procedures. Indications included history of 2 recurrent major genetic syndromes, history of cleft lip/palate in 2 cases, each one of the patient itself and the previous fetus and each family history of syndactyly and polydactyly. A 1 mm semirigid fiberoptic endoscope with a 18 gauge examination sheath and a single-chip digital camera were used for transabdominal embryofetoscopy. Results: Excellent visualization of the external fetal anatomy was obtained in 83% of cases (5/6) with the duration of procedures ranging 15 to 40 minutes. A diagnosis of Meckel-Gruber syndrome was made at 13+1 weeks of gestation by visualizing postaxial polydactyly and an occipital encephalocele. Subsequently the pregnancy was terminated. Three full-term infants were delivered with no gross limb or facial abnormalities. Amniotic fluid leakage after the procedure occurred in 2 cases resulting in termination of pregnancy. Conclusion: Our experiences confirm the efficacy of embryofetoscopy for early diagnosis in the first trimester of pregnancy. Procedure-related risks are to be established by multicenter studies.ope

    PTEN Methylation Dependent Sinonasal Mucosal Melanoma

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    Sinonasal mucosal melanoma (SMM) is an aggressive and rare type of melanoma. Although the classic RAS-RAF-MEK pathway is thought to be the main pathway involved in melanoma pathogenesis, genetic alterations in the phosphatidylinositol 3-kinase-AKT pathway, including PTEN-regulated signaling, are also thought to contribute. So far, data regarding altered PTEN expression and epigenetic mechanism of PTEN silencing in development of SMM is extremely limited. Herein we report on a case of SMM with liver and bone metastases with an epigenetic alteration of PTEN. Results of mutation analysis for BRAF, NRAS, HRAS, KRAS, PIK3CA, c-Kit, and PTEN were negative; however, methylation of PTEN CpG islands was observed. Our case not only supports PTEN as a major tumor suppressor involved in melanoma tumorigenesis, but also a potential epigenetic mechanism of PTEN silencing in development of SMM.ope

    Ultrasound-Guided Injection of the Adductor Longus and Pectineus in a Cadaver Model

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    BACKGROUND: The close anatomic and functional relationship between the proximal parts of the adductor longus and pectineus muscles produce considerable overlap in symptoms and signs in the inguinal region. To our knowledge, there have been no publications of ultrasound (US)-guided injection techniques into the 2 muscles. OBJECTIVE: This study sought to describe US-guided injection techniques in the proximal part of the adductor longus and pectineus muscles and to validate whether these techniques deliver injections appropriately to their target muscles in unembalmed cadavers. STUDY DESIGN: Cadaveric study. METHODS: A preliminary trial with 2 unembalmed cadavers provided information on the target sonographic structures of proximal adductor longus and pectineus muscles. Bilateral US-guided intramuscular injections in the proximal adductor longus and pectineus were performed using the remaining 5 unembalmed male cadavers. To avoid confusion of dye location, we did not inject into both the adductor longus and pectineus muscle in the same side. After injections, each specimen was dissected to evaluate the accuracy of injection. RESULTS: Ten injections (5 for the adductor longus muscle and 5 for the pectineus muscle) were performed targeting the proximal parts of muscles in 5 cadaveric specimens. All injections were successful and blue dye was injected accurately at the target area within the adductor longus and the pectineus muscles. No other muscles were injected unintentionally. There were no accidental penetrations and/or injuries at adjacent neurovascular structures as well. LIMITATION: Despite successful injection of the proximal parts of adductor longus and pectineus, this study did not verify the usefulness of this technique in clinical practice. CONCLUSIONS: The results of this study may play a role in the diagnosis and management of patients presenting with chronic pelvic pain syndrome and sports hernia.ope

    Motion estimation from one conic and two lines using projective invariants

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