• Title/Summary/Keyword: 복부수술

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Treatment Results of Ovarian Dysgerminoma (난소 미분화세포종의 치료 결과)

  • Chung, Eun-Ji;Suh, Chang-Ok;Seong, Jin-Sil;Keum, Ki-Chang;Kim, Gwi-Eon
    • Radiation Oncology Journal
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    • v.14 no.3
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    • pp.221-228
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    • 1996
  • Purpose : We tried to evaluate the clinical characteristics, the treatment methods, the results of treatments, and the Patterns of failure in ovarian dysgerminoma retrospectively According to the results we would like to suggest the proper management guideline of stage la ovarian dysgerminoma patients who want to maintain fertility. Materials and Methods : Between 1975 and 1990, 34 patients with ovarian dysgerminoma were treated at the Yonsei University Hospital. The case records of these patients have been reviewed for presenting symptoms, treatment methods, local control and survival following treatment. Excluded from analysis were five patients with mixed ovarian germ cell tumors and gonadoblastomas (46,XY) Treatment results of the twenty nine patients were analysed by each treatment modality. Twenty one patients were treated with surgery and postoperative adjuvant radiotherapy (group 2). The other eight patients were treated with operation alone (group 2). The median age of twenty-nine patients was 23 years with a range of 8 to 39 years. Presenting symptoms were abdominal mass (20) pelvic discomfort or pain (5) et al. Radiotherapy was performed by 10MV LINAC or Co-60 teletherapy unit. The total radiation dose of the whole abdomen was 20-25 Gy/3weeks, 1-1.5 Gy/fraction with a boost to the whole pelvis 10-15 Gy/l-2weeks 1.8-2.0 Gy/fraction. Advanced stage disease (stage II or stage III) patients received prophylactic mediastinal and supraclavicular irradiation to a dose of 16-26 Gy. Median duration of follow-up of living patients was 80 months (range 13-201 months). Results : All of the twenty one patients of group 1 were alive without disease ($100\%$). Among the eight patients who were not treated with radiotherapy (group 2), six patients developed local recurrence. Four Patients referred with recurrent disease were treated with salvage radiotherapy. Three of four patients were salvaged and one Patient who had recurrent intra-abdominal disease died of progressed carcinomatosis at 11 months after salvage radiotherapy. The other two patients with recurrence were salvaged with chemotherapy (1 patient) or re-operation (1 Patient). Twenty eight patients remained alive without disease at last follow up, so the 5 year local control rate and 5 year overall survival rate for all groups were $96.6\%$ (28/29), respectively. Among thirteen patients with stage la unilateral tumors seven patients were treated with postoperative radiotherapy and the other six patients were treated with unilateral salpingo-oophorectomy alone. Five patients who did not received radiotherapy developed local failure but all of the recurrent ovarian dysgerminomas were salvaged with radiotherapy, chemotherapy or re-operation. So all the 13 patients with stage la ovarian dysgerminoma were free of disease from 20-201 months (median 80 months). Conclusion : The authors consider external irradiation to be an effective treatment as a complement to surgery in ovarian dysgerminoma. For those patients with disease presenting in stage la tumors who wish to maintain fertility, unilateral salpingo-oophorectomy alone may be curative and spare ovarian function considering excellent salvage rate of recurrent ovarian dysgerminoma in present study.

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Video-assisted Thoracoscopic Surgery in Posttraumatic Localized Clotted Hemothorax (외상 후 국소적으로 응고된 혈흉의 비디오흉강경수술)

  • 이정희;김정중;이석기;임진수;최형호
    • Journal of Chest Surgery
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    • v.37 no.12
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    • pp.987-991
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    • 2004
  • Background: Inadequate drainage of traumatic hemothoraces may result in prolonged hospitalization and complication such as empyema, fibrothorax and pleural calcification. This needs to be the placement of a tube thorascostomy which is efficacious in more than 80% of cases. Other cases require surgical treatment. Material and Method: From March 2002 to February 2003, there were 123 patients who was done closed thorascostomy in traumatic hemothorax. 10 patients (group I) were undergone early retained clot evacuation with video assisted thoracoscopic surgery, but 5 patients (group II) who developed a localized hematoma or empyema were operated. Male were more than female and mean average was similar in both group. The most common cause of injury was traffic accidents and frequently combined lesions were a abdomen. Result: Interval from injury and operation, mean operation time, duration of tube drainage and hospital stay in group I were shorter than group II (p<0.05). Operation-related complication and recurrence of fluid collection within follow up period (17.8$\pm$3.8 months) in group I were none, but in group II (21.5$\pm$5.3 months) were 2 cases. Conclusion: Video assisted thoracoscopic surgery can be utilized as an effective and safe method for the removal of retained clotted hemothorax within 7 days.

The Production, Distribution, and Utilization of Rice in Japan (일본의 쌀 생산, 유통 및 이용 현용)

  • Inouchi, Naoyoshi
    • Food preservation and processing industry
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    • v.1 no.1
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    • pp.17-26
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    • 2002
  • 일본은 기후적으로도 쌀의 생산에 적합하며 쌀은 일본의 주곡이다. 1893년 국립농업연구소가 설치된 이래로 쌀은 품질과 단보당 생산량이 꾸준히 개선되어와 116의 노동시간으로 생산량은 2.5배의 증가를 가져왔다. 이러한 진전은 재배방법의 개선, 비료, 농약, 재배기술, 기계화, 관개배수, 농지개량 등의 요인들로 볼 수 있다. 현재 일본에서 생산되고 있는 주요 쌀 품종으로는 코시히카리($35.5\%$), 히토메보레($9.7\%$), 히노히카리($9.0\%$), 아키다코마치($8.5\%$), 키라라($4.8\%$) 등 10여 품종이며 최근에는 형질전환 품종의 연구와 함께 생물공학적 연구 ,생리, 품질, 곤충과 잡초, 토양, 식품가공 등 기본적인 연구에 심혈을 기울이고 있다. 새로운 형태의 쌀 품종으로는 냉동조리쌀밥, 초밥, 레토르트룡 쌀 등 가공용으로 적합하도록 하기 위하여 아밀로오즈의 함량을 $5-15\%$로 낮춘 쌀이나 카레, 필라프, 튀김 쌀 등의 용도에 적합하도록 아밀로오스의 함량을 $30\%$이상으로 높인 쌀뿐만 아니라 곡립의 크기와 길이 등을 변형시킨 쌀, 유색미, 향미, 단백질 함량 조절 쌀, 거대 배아미, lipoxygenase 활성을 없앤 쌀, 단맛나는 쌀 등이 연구, 생산되고 있다. 일본에서의 쌀이용은 먼저 가공용 쌀을 들 수 있다. 밥, 청주, 스낵, 쌀가루, 미소발효 등 다양하게 이용이 되고 있으며 parboiled rice와 이의 색과 향을 개선한 converted rice, 현미를 이용한 가공쌀, 쌀빵, 현미가루, 세척미, 쌀국수, 쌀스낵, 당과, 죽, 쌀은 채소아 함께하는 타키코미고한, 초밥, 냉동쌀밥, 무균포장밥, 건조밥, 즉석밥 등 매우 다양하다.는 일, 쌀 재배구조 조정과 함께 높은 미질을 가지는 품종육종, 기계화를 비롯한 경작기술의 발달, 쌀과 부산물 가공기술의 개발연구, 특정기능을 함유하는 유전공학적 기술의 적용, 토지와 도시화 그리고 식량순환에 시스템의 개혁 등 과학기술을 고양하는 일 등을 들 수 있다.하는데 도움이 되리라 생각된다.=0.002)가 통계적으로 유의한 인자였다. 결론 : 본 기관에서 시행되어진 근침윤성 방광암에 대한 방광보존치료법은 기존의 근치적 방광절제술에 비하여 대등한 치료성적을 내는 동시에 $63\%$에서 장기보존이 가능하였다. 따라서 본 치료법이 방광암의 치료에 적극적으로 적용되어야 할 것으로 생각하며 향후 여러 기관이 참여하는 활발한 연구를 통해 한국인에게 가장 적절한 치료법을 개발해야 될 것으로 생각한다. B2+3, C1, C2+3군에서 수술달독군과 방사선치료 추가군의 골반종양제어율은 각각 $79\%$$75\%$ (p=0.88), $100\%$$100\%,\;44\%$$68\%$ (p=0.01)이었다. 전체 환자를 대상으로 다요인 분석을 시행한 결과 생존율과 무병생존율에 병기만이 유의하였고 두 치료 군에서도 역시 병기가 유의한 인자로 나타났다. 전체환자에서 골반종양제어율에 유의한 예후인자로 다요인분석을 시행한 결과 병기와 수술방법이 유의하였다. 수술단독군에서는 병기만이 유의하였고 방사선치료 추가군에서는 수술방법만이 유의하여 복부회음절제술군의 골반종양재발률이 높았다. 결론 : 본 후향적 연구에서 수술 후 보조적 방사선치료를 시행하여 수술단독군에 비해 병기 C2+3군에서 골반종양제어율이 향상되었음을 알 수 있었다. 그러나 병기 B2이상의 모든 환자에서 골반종양제어율 뿐만 아니라 생존율의 향상을 가져오기

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A Case of Locally Recurrent Gastric Cancer at Kim's Tie Site of the Jejunum after a Total Gastrectomy (위전절제술 후 Kim 's Tie 부근 공장에 국소 재발한 위암환자 1예)

  • Bae Byung-Gu;Suh Byoung-Jo;Yu Hang-Jong;Kang Yun-Kyung;Kim Jin-Pok
    • Journal of Gastric Cancer
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    • v.5 no.1
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    • pp.52-56
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    • 2005
  • Despite improvements in the surgical treatment of gastric adenocarcinomas, the recurrence rates remain high in patients with advanced-stage disease. Most of the recurrence occurs within 3 years of the surgical resection, and nearly $90\%$ of the patients with recurrence die within 2 years of the diagnosis of recurrence. A recent study analyzed recurrence patterns for patients who had undergone a potentially curative gastrectomy. For those patients, $33\%$ of the recurrences involved locoregional sites, $44\%$ the peritoneum, and $38\%$ distant sites. A 51-year-old female patient was diagnosed with stomach cancer and underwent a total gastrectomy with D2 lymph node dissection during Oct. 1999. The pathologic report indicated a T3N1M0 tumor. We performed immunochemotherapy for 2 years with regular follow up. A gastrofiberscopic examination done during sep. 2004, cancer recurrence was found at the Kim's tie site of the jejunual loop. We did an abdominal exploration and a segmental resection of cancer site with pathologically negative resection margins. After the operation, we started secondary chemotherapy with TS-1.

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Evaluation on Effectiveness for Preventing Post Surgical Adhesion of Sodium Hyaluronate/Sodium Carboxymethyl Cellulose (HA/CMC) Membrane in Rat Cecum/Peritonium Model (쥐 맹장/복벽 찰과상 모델에서 Sodium Hyaluronate/sodium Carboxymethyl Cellulose 멤브레인의 수술 후 유착방지에 대한 유효성 평가)

  • Lee, Young-Moo;Lee, Young-Woo
    • Membrane Journal
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    • v.15 no.3
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    • pp.213-223
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    • 2005
  • We prepared an anti-adhesion membrane made of sodium hyaluronate/sodium carboxymethylcellulose (HA/CMC) and evaluated its effectiveness for adhesion prevention in a rat model. The anti-adhesion membrane was prepared by lyophilizing HA/CMC solution and cross-linking properly with 1-Ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDAC). In a cecum/abdominal wall abrasion model of Sprague-Dawley rat, cecal serosa and abdominal wall were abraded in $1\times2\;(cm^2)$ with a bone burr after peritoneal midline incision and sutured at 3 points around the injured surface. The denuded cecum was covered with HA/CMC membrane (experimental group), or nothing (control group) and apposed to the abdominal wall. Most of the control group represented 3 or more of adhesion grade at POD 7, 14, 21, and 28, whereas $60\~70\%$ of the experimental group was 2 or less of adhesion grade at 14, 21, and 28. It was similar in the adhesion strength. In a general manner, the adhesion grade and strength showed gradual increasing until POD 14, almost same or a little increasing POD 21, but decreasing POD 28. Also the control group was much higher in adhesion grade, strength, and area than the experimental group. It is expected that the anti-adhesion membrane will have a good clinical result in postoperative adhesion prevention.

First Successful Dynamic Cardiomyoplasty in Korea (심근 성형술 1례 보고)

  • ;;;;;;;;Igor Dubrovski, Ph.D.
    • Journal of Chest Surgery
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    • v.31 no.4
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    • pp.393-397
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    • 1998
  • A 25-year-old man with viral cardiomyopathy and chronic active hepatitis successfully underwent dynamic cardiomyoplasty for the first time in Korea on July 30, 1996. The patient had been intermittently dyspneic for 5 years and was admitted to our center twice because of heart failure. For the past 2 years, he was NYHA functional class III status with a left ventricular ejection fraction(LVEF) of around 30%. The patient was born with scoliosis and showed a short stature. The liver function showed elevated liver enzymes, and hepatitis B antigen was positive. The liver biopsy revealed chronic active hepatitis. The preoperative echocardiogram showed decreased left ventricular function with grade II mitral and grade II tricuspid regurgitation with dilated left and right atrium. Recently his symptoms worsened and we decided to perform a dynamic cardiomyoplasty. The left latissmus dorsi muscle(LDM) was mobilized and tested with lead placement on his right lateral decubitus position. The patient was positioned into supine and, after median sternotomy, the heart was wrapped with the mobilized muscle. The Russian made cardiomyostimulator(EKS-445) and leads (Myocardial PEMB for heart and PEMP-1 for LDM) were used. The total operation time was 8 hours and there were no perioperative episodes. Postoperatively the LDM had been trained for a 10 week period and currently the stimulation ratio is maintained at 1:4. The postoperative LVEF did not increase with the value of 30-35%. However, the patient feels better postoperatively with slightly increased activity.

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Small Bowel Intussusception in Children: Spontaneous Resolution vs. Surgical Intervention (소아에서 소장형 장중첩증; 자연 정복과 수술적 치료의 비교)

  • Park, Mi-Ran;Lim, Mi-Sun;Seo, Jeong-Kee;Ko, Jae-Sung;Chang, Ju-Young;Yang, Hye-Ran;Lim, Yoon-Joung;Kim, Woo-Sun
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.13 no.2
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    • pp.128-133
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    • 2010
  • Purpose: Intussusception is one of the most common causes of an acute abdomen in infancy. The majority of pediatric cases of intussusception are of the ileocolic type and usually idiopathic. Small bowel intussusception is rarely diagnosed in children, and few cases have been reported. The purpose of this study was to determine the clinical features and causes of small bowel intussusception in children. Methods: We retrospectively reviewed the clinical and radiologic findings of 21 children with small bowel intussusception who were admitted to Seoul National University Children's Hospital between March 2005 and January 2010. Results: The clinical presentation of small bowel intussusception included abdominal pain or irritability (85%), vomiting (23%), fever (14%), bloody stools (14%), and abdominal masses (4%). Six patients required surgical management. Ultrasonography showed that the mean diameter of the lesions and mean thickness of the outer rims were 1.6${\pm}$0.7 and 1.7${\pm}$1.8 mm, respectively. Eleven lesions were located in the left abdominal or paraumbilical regions. Children who underwent surgical management were older than children with transient small bowel intussusception (mean age, 51 vs. 109 months). The mean diameter of the lesions and mean thickness of the outer rims were greater in the surgically-managed group. The location of intussusception was not significantly different between the two groups. Conclusion: Small bowel intussusception was spontaneously reduced in a large number of pediatric patients. However, sonographic demonstration of larger size, older age, and pathologic lead point warrant surgical intervention.

Construction of Linkage Database on Nursing Diagnoses, Interventions, Outcomes in Abdominal Surgery Patients (복부수술환자의 간호진단, 간호중재, 간호결과 연계 데이터베이스 구축)

  • Yoo, Hyung-Sook;Chi, Sung-Ai
    • Journal of Korean Academy of Nursing Administration
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    • v.7 no.3
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    • pp.425-437
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    • 2001
  • This reserch was to develop database software in order to handle a lot of clinical nursing data with nursing diagnoses, related factors, defining characteristics, nursing interventions, nursing activities and nursing outcomes. MS Access2000 and SQL was selected to use a general purpose database logic with an efficiency. MS Visual Basic 6.0 was used to construct the circumstance of Graphic User Interface. The Linkage Database of abdominal surgery patients was constructed from the clinical data and questionnaire. This database system could add related factors, defining characteristics, nursing activities in the database and analyze the statistical results through Access query. In the final stage, end-users satisfaction analysis using 5 points Likert scale was dong with the response of using the database system. The accuracy/trustworthiness of the database system was verified with the highest average scores as 4.42 and also, the efficiency as 4.21, user friendly function as 4.1.

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Gastric Teratoma in a Newborn Infant; A Case Report (신생아 위 기형종 1례)

  • Cho, Jin-Han
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.6 no.2
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    • pp.197-201
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    • 2003
  • Gastric teratoma is an extremely rare neoplasm in children which account for less than one percent of all teratomas. Unlike other teratomas, most reported gastric teratomas was benign except one case and occurred predominantly in boys. Additionally, gastric teratomas present in the first year of life as a palpable mass, abdominal distension, vomiting, hematemesis or respiratory distress. Patients with gastric teratomas have an excellent prognosis after complete excision of the tumor. We report a case of immature gastric teratoma in an one-day-old boy, which was diagnosed by abdominal sonography and CT scan, and confirmed by surgery.

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인체의 신비와 건강VIII-허리

  • KOREA ASSOCIATION OF HEALTH PROMOTION
    • 건강소식
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    • v.31 no.8 s.345
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    • pp.6-13
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    • 2007
  • 허리는 요추(허리척추뼈), 척추골사이의 디스크(추간판), 척추와 디스크 주위의인대, 척수와 신경, 요추의 근육, 골반과 복부내의 기관들로 구성되어 있다. 우리 몸에서 고장이 잘 나는 곳은 움직임이 많은 곳이다. 사지도 움직임이 많은 관절에 고장이 잘 생긴다. 척추의 움직임이 많은 곳은 허리이다. 허리는 매우 불안정하여 전 인구의 약80%가 한번은 통증을 경험한다고 한다. 이러한 허리통증은 일반적으로 일상생활에서의 잘못된 자세와 생활습관에 기인하는 경우가 많다. 수술이나 치료 후에도 자세와 생활습관을 교정하지 못하면 재발의 경우가 있는 등 환자 자신이 허리통증에 대한 이해와 노력이 없으면 궁극적인 치료를 기대하기 어려우므로 환자 자신의 관심과 노력이 무엇보다 중요하다.이번 호에서는 인체의 신비 허리에 대해 척추전문에스병원 이승철원장과 경희대학교 동서신의학병원 척추센터 김기택 교수의 도움말로 알아본다.

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