• Title/Summary/Keyword: 간 절제술

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Posterolateral Thoracotomy versus Muscle-sparing Vertical Thoracotomy (후측개흉술과 근육보존수직개흉술의 임상고찰)

  • Kim, Kwang-Ho;Kim, Hyun-Tae;Kim, Jung-Taek;Sun, Kyung
    • Journal of Chest Surgery
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    • v.31 no.5
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    • pp.509-512
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    • 1998
  • Although posterolateral thoracotomy(PLT) has been a standard thoracic incision in resection surgery of the lung for surgeons to achieve a good surgical field, there remains concern about severing a group of thoracic muscles remains. Muscle-sparing vertical thoracotomy (MVT) is an alternative to PLT, which gives cosmetic result and may preserve motion of the shoulder girdle as well as respiratory function of the patient in the early postoperative period. However, surgeons tend not to perfer it because of limited surgical field from the vertical wound made on the lateral thoracic wall. The purpose of this study is to compare the surgical outcomes of PLT versus MVT. We retrospectively reviewed 29 patients(15 who had PLT and 14 who had MVT, organized into those two groups) who had undergone lung resection surgery in our institute. There were no clinical differences between the two groups in terms of operation time, estimated amount of blood loss during the operation, amount of chest drainage on the first and the second postoperative day, duration of chest tube placement, incidence and amount of transfusion, and postoperative complications. We conclude that, from our limited experience, MVT can be applied to lung resection surgery as safely as PLT and that it may have a beneficial role for the patient with compromised lung function in addition to cosmetic effect.

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Hemorrhargic Effusion Caused by Chronic Torsion of Right Middle Lung Lobe with Concurrent Ovarian Tumor in a Female Miniature Poodle Dog (난소종양이 병발한 암컷 푸들에서 오른쪽 중간엽 폐염전으로 인한 만성적인 출혈성 흉수 증례)

  • Kim, Tae-Hwan;Hong, Subin;Kim, Minkyung;Shin, Jeong-In;Jang, Yun-Sul;Lee, Jae-Hoon
    • Journal of Veterinary Clinics
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    • v.32 no.6
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    • pp.530-535
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    • 2015
  • An 11-year-old intact female miniature poodle presented with a four-month history of hemorrhagic effusion. The patient was alert on physical examination, although muffled heart sounds were noted upon auscultation of the right hemithorax. The radiographic finding was pleural effusion. Ultrasonography revealed cystic changes in both ovaries and several nodules in the liver. A refractory opacity in the right lung field, as visualized with computer tomography (CT), was diagnosed as right middle lung lobe torsion with a collapsed bronchus. Five days after diagnosis, a right fifth intercostal thoracotomy was performed to remove the right middle lung lobe; the right middle lung lobe was grossly shrunken as a result of chronic lung lobe torsion. Ovariohysterectomy was also performed. Histopathologic examination revealed papillary adenocarcinoma in both ovaries and suspected metastasized ovarian adenocarcinoma cells in the lung lobe. The patient recovered favorably and had been doing well up to two months post-surgery. However, after four months, the dog presented with respiratory difficulty. The radiographic findings were pleural effusion and collapse of the right cranial and left caudal lung lobes. Malignant cells of epithelial origin were observed in the pleural effusion. The tumor cells were suspected to be metastasized cells from the previously resected lung lobe. Although cancer treatment was recommended, the suggestion was suspended and the dog was discharged from hospital. This was a case of lung lobe torsion that had occurred because of hemorrhagic effusion due to tumor. Although ovariohysterectomy and lobectomy were performed, there was a relapse of hemorrhagic effusion because of metastasized tumor from the previously resected lung lobe.

A Study For Optimizing Input Waveforms In Radiofrequency Liver Tumor Ablation Using Finite Element Analysis (유한 요소 해석을 이용한 고주파 간 종양 절제술의 입력 파형 최적화를 위한 연구)

  • Lim, Do-Hyung;NamGung, Bum-Seok;Lee, Tae-Woo;Choi, Jin-Seung;Tack, Gye-Rae;Kim, Han-Sung
    • Journal of Biomedical Engineering Research
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    • v.28 no.2
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    • pp.235-243
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    • 2007
  • Hepatocellular carcinoma is significant worldwide public health problem with an estimated annually mortality of 1,000,000 people. Radiofrequency (RF) ablation is an interventional technique that in recent years has come to be used for treatment of the hepatocellualr carcinoma, by destructing tumor tissues in high temperatures. Numerous studies have been attempted to prove excellence of RF ablation and to improve its efficiency by various methods. However, the attempts are sometimes paradox to advantages of a minimum invasive characteristic and an operative simplicity in RF ablation. The aim of the current study is, therefore, to suggest an improved RF ablation technique by identifying an optimum RF pattern, which is one of important factors capable of controlling the extent of high temperature region in lossless of the advantages of RF ablation. Three-dimensional finite element (FE) model was developed and validated comparing with the results reported by literature. Four representative Rf patterns (sine, square, exponential, and simulated RF waves), which were corresponding to currents fed during simulated RF ablation, were investigated. Following parameters for each RF pattern were analyzed to identify which is the most optimum in eliminating effectively tumor tissues. 1) maximum temperature, 2) a degree of alteration of maximum temperature in a constant time range (30-40 second), 3) a domain of temperature over $47^{\circ}C$ isothermal temperature (IT), and 4) a domain inducing over 63% cell damage. Here, heat transfer characteristics within the tissues were determined by Bioheat Governing Equation. Developed FE model showed 90-95% accuracy approximately in prediction of maximum temperature and domain of interests achieved during RF ablation. Maximum temperatures for sine, square, exponential, and simulated RF waves were $69.0^{\circ}C,\;66.9^{\circ}C,\;65.4^{\circ}C,\;and\;51.8^{\circ}C$, respectively. While the maximum temperatures were decreased in the constant time range, average time intervals for sine, square, exponential, and simulated RE waves were $0.49{\pm}0.14,\;1.00{\pm}0.00,\;1.65{\pm}0.02,\;and\;1.66{\pm}0.02$ seconds, respectively. Average magnitudes of the decreased maximum temperatures in the time range were $0.45{\pm}0.15^{\circ}C$ for sine wave, $1.93{\pm}0.02^{\circ}C$ for square wave, $2.94{\pm}0.05^{\circ}C$ for exponential wave, and $1.53{\pm}0.06^{\circ}C$ for simulated RF wave. Volumes of temperature domain over $47^{\circ}C$ IT for sine, square, exponential, and simulated RF waves were 1480mm3, 1440mm3, 1380mm3, and 395mm3, respectively. Volumes inducing over 63% cell damage for sine, square, exponential, and simulated RF waves were 114mm3, 62mm3, 17mm3, and 0mm3, respectively. These results support that applying sine wave during RF ablation may be generally the most optimum in destructing effectively tumor tissues, compared with other RF patterns.

Correlations between dental and skeletal maturity (치아성숙도와 골성숙도의 상호연관성에 관한 연구)

  • Lee, Young-Mi;Kim, Kwang-Won;Yoon, Young-Jooh
    • The korean journal of orthodontics
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    • v.30 no.2 s.79
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    • pp.143-157
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    • 2000
  • To investigate the developmental stages of dental and skeletal maturation by ages and the correlations among dental maturity, skeletal maturity of cervical vertebrae, and that of hand-and-wrist, the author used the cephalograms, orthopantomograms, and hand-and-wrist radiograms of 1055 patients (male 458, female 597) aged 7 to 20 years old. In the cephalograms, the skeletal maturity stages of each bone were mainly assessed by Hassel and Farman's cervical vertebrae maturation indicators (CVMI) method. In the orthopantomograms, the dental maturity stages of each tooth were mainly assessed by Nolla's tooth calcification stages method. In the hand-and-wrist radiograms, the skeletal maturity stages of each bone were mainly assessed by Fishman's skeletal maturity indicators (SMI) method. The results were as follows. 1. There was a high correlation among dental maturity, skeletal maturity of cervical vertebrae, and that of hand-and-wrist in the both sexes (P<0.001). 2. There was a high correlation (r=0.91-0.93) between skeletal maturity of cervical vertebrae and that of hand-and-wrist. 3. There was a high correlation (r>0.8) between skeletal maturity of hand-and-wrist and maturity of upper and lower canine, first premolar, and second premolar. 4. There was high a correlation(r=0.8) between skeletal maturity of cervical vertebrae and maturity of upper canine. 5. By the ages, dental maturity, skeletal maturity of cervical vertebrae, and that of hand-and-wrist were obtained in the both sexes. In summary, dental maturity, skeletal maturity of cervical vertebrae, and that of hand-and-wrist we of sufficient diagnostic worth as an index to predict adolescent growth.

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Significance of the Failure Patterns in Cervical Lymph Nodes Achieving a Complete Response to Radical Radiotherapy (근치적 방사선치료에 완전반응을 보인 경부 림프절에서의 재발 양상 및 그 의의)

  • Nam, Ji-Ho;Kim, Won-Taek;Ki, Yong-Kan;Kim, Dong-Hyun;Choi, Young-Jin;Cho, Kyu-Sup;Lee, Jin-Choon;Lee, Byung-Joo;Kim, Dong-Won
    • Radiation Oncology Journal
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    • v.28 no.1
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    • pp.9-15
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    • 2010
  • Purpose: This study was performed to examine the neck failure patterns after a complete response (CR) to definitive radiotherapy for advanced head and neck cancer patients, as well as evaluate the clinical significance of the results of this study. Materials and Methods: Between 1987 and 2008, the clinical data of patients who had been treated with radical radiotherapy for primary squamous cell carcinomas and enlarged cervical lymph nodes was analyzed retrospectively. Ultimately, the cases that showed CR of the cervical lymph node lesions to full-dose radiotherapy were included in this study. The recurrent rate and sites in the cervical lymphatic area were evaluated periodically by radiologic imaging studies, along with some factors which might have affected the rate of recurrence. Results: A total of 73 patients who achieved CR in neck area after radiotherapy were included in this study. The rate of subsequent neck failure among those patients was 19.2%. There was only a 5.5% failure rate in the 55 patients who underwent radiotherapy in their primary site. Eighty percent of the recurrent cases were found within 3 years (median follow-up, 68 months). The majority of neck recurrent cases (47%) were accompanied with the failure of the primary lesions. The initial response of the primary site and the method of radiotherapy simulation were significant prognostic factors associated with the nodal recurrence rate. Conclusion: The recurrence rate of cervical nodes in patients with CR to radiotherapy in the primary site and neck area was about 5%. These patients could be followed up with close observation without a planned neck dissection.

Comparison of Thallium-201, Tc-99m MIBI and I-131 Scan in the Follow-up Assessment after I-131 Ablative Therapy in Differentiated Thyroid Cancer (방사성 옥소 치료 후 분화된 갑상선암 추적관찰에서 Thallium-201 스캔, Tc-99m MIBI 스캔과 I-131 스캔 검사 결과의 비교)

  • Kwon, Jae-Sung;Lee, Sung-Keun;Kim, Doe-Min;Park, Sae-Jong;Jang, Kyong-Sun;Kim, Eun-Sil;Kim, Chong-Soon
    • The Korean Journal of Nuclear Medicine
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    • v.33 no.6
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    • pp.493-501
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    • 1999
  • Purpose: We conducted a comparative study to evaluate the diagnostic values of T1-201, Tc-99m MIBI and I-131 scans in the follow-up assessment after ablative I-131 therapy in differentiated thyroid cancer. Materials and Methods: The study population consisted of 20 patients who underwent surgical removal of thyroid cancer and ablative radioactive iodine therapy, and followed by one or mote times of I-131 retreatments (33 cases). In all patients, T1-201, Tc-99m MIBI, diagnostic and therapeutic I-131 scans were performed and the results were analyzed retrospectively. Also serum thyroglobulin levels were measured in all patients. The final diagnosis of recurrent or metastatic thyroid cancer was determined by clinical, biochemical, radiologic and/or biopsy findings. Results: Positive rates (PR) of Tc-99m MIBI, T1-201, diagnostic and therapeutic I-131 scans in detecting malignant thyroid tissue lesions were 70% (19/27), 54% (15/28), 35% (17/48) and 63% (30/48), respectively. The PR in the group of 20 cases (28 lesions) who underwent concomitant T1-201 and I-131 scans were in the order of therapeutic 131 scan 71%, T1-201 scan 54% and diagnostic I-131 scan 36%. There was no statistically significant difference between T1-201 and diagnostic I-131 scans (p>0.05). In the group of 20 cases (27 lesions) who underwent concomitant Tc-99m MIBI and I-131 scans, the PR were in the order of Tc-99m MIBI scan 70%, I-131 therapeutic scan 52% and I-131 diagnostic scan 33%. The PR of Tc-99m MIBI was significantly higher than that of diagnostic I-131 scan (p<0.05). Conclusion: Tc-99m MIBI scan is superior to diagnostic I-131 scan in detecting recurrent or metastatic thyroid cancer following ablation therapy in patients with differentiated thyroid cancer. T1-201 scan did not showed significantly higher positive rate than diagnostic I-131 scan. Instead of diagnostic I-131 scan before the I-131 retreatment, Tc-99m MIBI scan without discontinuing thyroid hormone replacement would be a prudent and effective approach in the management of these patients.

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The Short Term and Intermediate Term Results of using a T-tube in Patients with Tracheal Stenosis (기관 협착 환자에서의 T-튜브의 중단기 결과)

  • Sa, Young Jo;Moon, Seok-Whan;Kim, Young-Du;Jin, Ung;Park, Jae-Kil;Kim, Jae Jun;Kim, Chi-Kyung;Jo, Keon Hyon;Park, Chan Beom;Yim, Hyeon Woo
    • Journal of Chest Surgery
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    • v.42 no.1
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    • pp.63-71
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    • 2009
  • Background: The treatment of tracheal stenosis includes less invasive bronchoscopic intervention and more invasive segmental resection & anastomosis. Depending on the patient's clinical features, sometimes all these methods are inappropriate. Silicone T-tube stenting has recently been used as an alternative, safe management of tracheal stenosis. We studied the short term and Intermediate term results of using T-tubes in patients with tracheal stenosis, and this tracheal stenosis was caused by various underlying diseases. Material and Method: We retrospectively reviewed 57 patients with tracheal stenosis and who were treated with T-tubes between Jan 1997 and Apr 2007. Based on the patient's medical records and the imaging studies, we evaluated the clinical findings and status of T-tube removal. Result: There was no T-tube related morbidity or mortality in this series. On follow-up, one patient underwent sleeve resection and end-to-end anastomosis. The T-tube could be successfully removed from 13 patients (13/57, 22.8%) without additional interventions. For another four patients, a T-tube was again inserted after removal of the first T-tube due to tracheomalacia or recurrent stenosis. Four patients died of underlying disease and cancer. The patients' gender and previous tracheostomy significantly affected T-tube removal. By contrast, multiple logistic regression analysis identified gender as a predictor of successfully removing a T-tube. Gender (p=0.033) and previous tracheostomy (p=0.036) were the two factors for success or failure of T-tube removal. Conclusion: A T-tube provided reliable patency of a stenotic airway that was caused by any etiology. We have proven that using a T-tube is safe and effective therapy for patients with tracheal stenosis for the short term or the intermediate term.

Effect of Operative Wound Protection on Surgical Wound Complications (수술 증 절개창 보호 방법이 수술 후 절개창 합병증에 미치는 영향)

  • Lim, Jin-Hong;Kim, Sung-Soo;Choi, Won-Hyuk;Oh, Sung-Jin;Hyung, Woo-Jin;Choi, Seung-Ho;Noh, Sung-Hoon
    • Journal of Gastric Cancer
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    • v.7 no.4
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    • pp.248-253
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    • 2007
  • Purpose: Surgical wound complications remain a cause of morbidity and mortality among postoperative patients, and the cost of caring for patients with a surgical wound complication is substantial. The purpose of this study was to evaluate the ability of a vinyl wound protector to reduce the rate of wound complications when used in clean-contaminated surgery. Materials and Methods: Between May 2006 and September 2006, 295 patients with a gastric cancer that underwent gastric surgery were studied prospectively, and the patients were randomized into one of two groups: the no wound protector group (n=137) or the polyethylene protector group (n=132). Results: The demographics and operation type and operation time were similar for patients in both groups. The rate of wound complication was different between patients in the no protector group (n=42) and the polyethylene protector group (n=12) (P=0.001) and the rates of seroma (P=0.001), infection (P=0.030) and dehiscence (P=0.282) were different for the two groups. The postoperative hospital stay was significantly shorter in the polyethylene protector group of patients (P=0.040). Conclusion: The use of a polyethylene protector resulted in a reduction of the surgical wound complication rate, and the cost of caring for patients, and morbidity and mortality among postoperative patients could be reduced.

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Diagnostic Role of F-18 FDG PET/CT in the Follow-up of Patients with Colorectal Cancer: Comparison with Serum CEA, CA 19-9 Levels and Computed Tomography (대장암 치료 후 추적 검사로서 F-18 FDG PET/CT의 역할: 혈청 CEA, CA 19-9 및 Computed Tomography와의 진단 성능 비교)

  • Kang, Sung-Min;Song, Bong-Il;Lee, Hong-Je;Seo, Ji-Hyoung;Lee, Sang-Woo;Yoo, Jeong-Soo;Ahn, Byeong-Cheol;Lee, Jae-Tae;Choi, Kyu-Suk;Jun, Soo-Han
    • Nuclear Medicine and Molecular Imaging
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    • v.43 no.2
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    • pp.120-128
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    • 2009
  • Purpose: Early detection of recurrence is an important factor for long term survival of patients with colorectal cancer. Measurement of serum levels of CEA, CA 19-9, CT and PET/CT has been commonly used in the postoperative surveillance of colorectal cancer. The purpose of this study was to compare the diagnostic ability of PET/CT, tumor marker and CT for recurrence in colorectal cancer patients after treatment. Materials and Methods: F-18 FDG PET/CT imaging was performed in 189 colorectal cancer patients who underwent curative surgical resection and/or chemotherapy. Measurement of serum levels of CEA, CA 19-9 and CT imaging were performed within 2 months of PET/CT examination. Final diagnosis of recurrence was made by biopsy, radiologic studies or clinical follow-up for 6 months after each study. Results: Overall sensitivity, specificity of PET/CT was 94.7%, 91.1%, while those of serum CEA were 44.7% and 97.3%, respectively. Sensitivity and specificity were 94.2%, 90.4% for PET/CT and better than those of combined CEA and CA 19-9 measurement(52.1%, 88.5%) in 174 patients measured available both CEA and CA 19-9 data. In 115 patients with both tumor markers and CT images available, PET/CT showed similar sensitivity but higher specificity(92.9%, 91.3%) compared to combination of tumor markers and CT images(92.9%, 74.1%). Conclusion: PET/CT was superior for detection of recurred colorectal cancer patients compared with both CEA, CA 19-9, and even with combination of both tumor markers and CT. Therefore PET/CT could be used as a routine surveillance examination to detect recurrence or metastasis of colorectal cancer.

The Outcome of Postoperative Radiation Therapy for Patients with Stage II Pancreatic Cancer (T3 or N1 Disease) (2기(T3 또는 N1) 췌장암 환자들의 수술 후 방사선치료의 성적 및 고찰)

  • Kim, Sang-Won;Kim, Myung-Wook;Kim, Wook-Hwan;Kang, Seok-Yun;Kang, Seung-Hee;Oh, Young-Taek;Lee, Sun-Young;Yang, Ju-No;Chun, Mi-Sun
    • Radiation Oncology Journal
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    • v.25 no.4
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    • pp.213-218
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    • 2007
  • Purpose: To analyze retrospectively the outcome of postoperative radiation therapy with or without concurrent chemotherapy for curatively resected stage II pancreatic cancer with T3 or N1 disease. Materials and Methods: Between January 1996 and December 2005, twenty-eight patients completed adjuvant radiation therapy at Ajou University Hospital. The patients had either pathologic T3 stage or N1 stage. The radiation target volume encompassed the initial tumor bed identified preoperatively, resection margin area and celiac nodal area. In the case of N1 patients, the radiation field extended to the lower margin of the L3 vertebra for covering both para-aortic lymph nodes bearing area. The median total radiation dose was 50 Gy. Ten patients received concurrent chemotherapy. Results: Thirteen patients (46%) showed loco-regional recurrences. The celiac axis nodal area was the most frequent site (4 patients). Five patients showed both loco-regional recurrence and a distant metastasis. Patients with positive lymph nodes had a relatively high probability of a distant metastasis (57.1%). Patients that had a positive resection margin showed a relatively high local failure rate (57.1%). The median disease-free survival period of all patients was 6 months and the 1-and 2-year disease free survival rates were 27.4% and 8.2%, respectively. The median overall survival period was 9 months. The 2-and 3-year overall survival rates were 31.6% and 15.8%, respectively. Conclusion: The pancreatic cancer patients with stage II had a high risk of local failure and a high risk of a distant metastasis. We suggest the concurrent use of an effective radiation-sensitizing chemotherapeutic drug and adjuvant chemotherapy after postoperative radiation therapy for the treatment of patients with stage II pancreatic cancer.