• Title/Summary/Keyword: 수술시기

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Risk Factor Analysis and Surgical Indications for Pulmonary Artery Banding (폐동맥 밴딩의 위험인자 분석과 수술적응중)

  • Lee Jeong Ryul;Choi Chang Hyu;Min Sun Kyung;Kim Woong Han;Kim Yong Jin;Rho Joon Ryang;Bae Eun Jung;Noh Chung I1;Yun Yong Soo
    • Journal of Chest Surgery
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    • v.38 no.8 s.253
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    • pp.538-544
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    • 2005
  • Background: Pulmonary artery banding (PAB) is an initial palliative procedure for a diverse group of patients with congenital cardiac anomalies and unrestricted pulmonary blood flow. We proved the usefulness of PAB through retrospective investigation of the surgical indication and risk analysis retrospectively. Material and Method: One hundred and fifty four consecutive patients (99 males and 55 females) who underwent PAB between January 1986 and December 2003 were included. We analysed the risk factors for early mortality and actuarial survival rate. Mean age was $2.5\pm12.8\;(0.2\sim92.7)$ months and mean weight was $4.5\pm2.7\;(0.9\sim18.0)\;kg$. Preoperative diagnosis included functional single ventricle $(88,\;57.1\%)$, double outlet right ventricle $(22,\;14.2\%)$, transposition of the great arteries $(26,\;16.8\%)$, and atrioventricular septal defect $(11,\;7.1\%)$. Coarctation of the aorta or interrupted aortic arch $(32,\;20.7\%)$, subaortic stenosis $(13,\;8.4\%)$ and total anomalous pulmonary venous connection $(13,\;8.4\%)$ were associated. Result: The overall early mortality was $22.1\%\;(34\;of\;154)$, The recent series from 1996 include patients with lower age $(3.8\pm15.9\;vs.\;1.5\pm12.7,\;p=0.04)$ and lower body weight $(4.8\pm3.1\;vs.\;4.0\pm2.7,\;p=0.02)$. The early mortality was lower in the recent group $(17.5\%;\;16/75)$ than the earlier group $(28.5\%;\;18/45)$. Aortic arch anomaly (p=0.004), subaortic stenosis (p=0.004), operation for subaortic stenosis (p=0.007), and cardiopulmonary bypass (p=0.007) were proven to be risk factors for early death in univariate analysis, while time of surgery (<1996) (p=0.026) was the only significant risk factor in multivariate analysis. The mean time interval from PAB to the second-stage operation was $12.8\pm10.9$ months. Among 96 patients who survived PAB, 40 patients completed Fontan operation, 21 patients underwent bidirectional cavopulmonary shunt, and 35 patients underwent biventricular repair including 25 arterial switch operations. Median follow-up was $40.1\pm48.9$ months. Overall survival rates at 1 year, 5 years and 10 years were $81.2\%\;65.0\%,\;and\;63.5\%$ respectively. Conclusion: Although it improved in recent series, early mortality was still high despite the advances in perioperative management. As for conventional indications, early primary repair may be more beneficial. However, PA banding still has a role in the initial palliative step in selective groups.

The Role of Initial Relative Renal Function in Unilateral Hydronephrosis (일측 폐색성 및 역류성 수신증에서 술전 상대적 신기능의 의미)

  • Han Sang-Won;Kang Seon-Jung;Kwon Min-Jung;Kim Dae-Joong;Choi Seung-Kang;Lee Tack
    • Childhood Kidney Diseases
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    • v.3 no.2
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    • pp.203-208
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    • 1999
  • Purpose: The information on the change of the relative renal function after operation is essential to set the initial treatment plan in unilateral hydronephrosis. So we analyzed the preoperative and postoperative relative renal function, and observed the functional changes by operation and reliability of the various factors in those changes. Materials and Methods: A retrospective trial was done of 81 patients, 35 ureteropelvic junction(UPJ) obstruction and 46 vesicoureteral reflux(VUR), among 393 patients undergoing operations at our institution from March. 1992 to February. 1997. The patients who had infravesical abnormalities, abnormal contralateral kidney and insufficient research data were excluded. We determined the relative renal functions using DTPA and MAG3 scan in UPJ obstruction and DMSA scan in VUR. The mean observation period after operation was 2.01(0.25-4) years. Results: A. UPJ Obstruction 1. The relative renal function was improved significantly after operation(P=0.0007). 2. The kidneys which have preoperative functions between 20% and 40% improved significantly in relative renal function comparing to the kidneys of the other functions(P=0.0046). B. VUR 1. The renal functions didn't improve significantly after operation(P>0.05). 2. There was no significant factor affecting the prognosis in renal functions. Conclusions: 1. The kidneys with UPJ Obstruction show the difference in functional improvement after operation according to the degree of the preoperative renal function, but more investigations about the exact value are needed. 2. In VUR there was no difference between preoperative and postoperative functions, the theoretical basis on objectives of the operation could be the symptoms or factors except the operation.

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Aortic Valvuloplasty in Pediatric Age (소아연령군에서의 대동맥판막성형술)

  • 임홍국;박천수;황호영;김웅한;이정렬;노준량;김용진
    • Journal of Chest Surgery
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    • v.37 no.8
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    • pp.652-659
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    • 2004
  • Background: In this study, we retrospectively analyzed the outcomes of aortic valvuloplasty in pediatric age. Material and Method: Between January 1993 and March 2004, 35 patients underwent aortic valvuloplasty for aortic stenosis (AS) or aortic regurgitation (AR). The mean age was 81.1$\pm$61.5 (1∼223) months. The mean follow up was 50.8$\pm$30.2 (3∼121) months. Nine patients had AS, 21 had AR, and 6 had AS and AR. Valve morphology was tricuspid in 24 patients, bicuspid in 9, quadricuspid in 1, and unicuspid in 1. The mean peak pressure gradients of AS were 72.0$\pm$33.0 mmHg, and the mean grades of AR were 3.1$\pm$0.9. Result: There was one late mortality without early mortality. After operation, AS improved with mean peak pressure gradients of 23.5$\pm$21.0 mmHg (p < 0.05), and AR improved with mean grades of 1.9$\pm$0.8 (p < 0.05). At mean follow up of 35.0$\pm$23.0 months, AS maintained with mean peak pressure gradients of 31.5$\pm$24.0 mmHg, but AR progressed with mean grades of 2.8$\pm$1.3 (p < 0.05). Reoperation was required in 6 patients 38.3$\pm$21.8 months after the original operation. The actuarial figures for freedom from reoperation at 2, 5 and 8 years were 96.9$\pm$3.1%, 79.5$\pm$5.5%, and 56.8$\pm$11.4%, respectively. Age at operation, presence of AS, preoperative severity of AS or AR, and morphology of aortic valve were not significant risk factors for reoperation, and improvement of AS or AR. Conclusion: Aortic valvuloplasty showed good immediate postoperative valve function. Aortic valvuloplasty offers children many years with tolerable valve function and allows to postpone aortic valve replacement or Ross procedure in pediatric patients.

Radiation Therapy in Recurrence of Carcinoma of the Uterine Cervix after Primary Surgery (자궁경부암으로 수술 후 재발암의 방사선치료)

  • Kim, Jin-Hee;Kim, Ok-Bae
    • Radiation Oncology Journal
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    • v.21 no.2
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    • pp.143-148
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    • 2003
  • Purpose: The purpose of this study was to evaluate treatment results in terms of the survival and failure patterns subsequent to radiation therapy in recurrent cervical cancer, fellowing primary surgery. Material and Methods: Between January 1990 and December 1999, 27 patients, with recurrent cervical cancer following primary surgery, were subsequently treated with radiation in the Department of Radiation Oncology, at the Keimyung University Dongsan Medical Center. Their median age was 48, ranging from 31 to 70 years old. With regard to the Initial FIGO stage on presentation, 20 and 7 patients were stages I and II, respectively. Twenty three patients had squamous cell carcinomas and 4 had adenocarcinomas. The time interval from the primary surgery to the recurrence ranged from 2 to 90 months with a median of 29 months. The recurrent sites were the vaginal cuff alone, the pelvic cavity and combined recurrence in 14, 9 and 4 patients, respectively. Radiation was peformed, with external and vaginal intracavitary radiation in 13 patients, external radiation alone in 13 and vaginal intracavitary radiation alone in another one. The median follow-up period was 55 months, ranging from 6 to 128 months. Results: The five year disease free survival (5y DFS) and five year overall survival (5y OS) rates were 68.2 and 71.9$\%$, respectively. There was a marginal statistically significant difference in the 5y DFS in relation to the recurrent site (5y DFS, 85.7$\%$ in vaginal cuff recurrence alone, 53.3$\%$ in pelvic cavity recurrence, p=0.09). There was no difference in the survival according to the time interval between the primary surgery and a recurrence. There was only a 7$\%$ local failure rate in the patients with a vaginal cuff recurrence. The major failure patterns were local failure in the patients with pelvic cavity recurrence, and distant failure in the patients with a combined recurrence. There were no complications above grade 3 after the radiation therapy. Conclusion: Radiation therapy was safe and effective treatment for a recurrent carcinoma of the uterine cervix following primary surgery, especially the external beam radiation and vaginal intracavitary irradiation achieved the best results in the patients with a vaginal cuff recurrence following primary surgery.

Utilization of pollen grains for the expression of epidermal growth factor (Epidermal growth factor 발현을 위한 화분립의 이용)

  • Choi, Byung-Jin;Park, Hee-Sung
    • KSBB Journal
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    • v.23 no.5
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    • pp.460-462
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    • 2008
  • Pollens grains collected from fully dehisced lily (Lilium longiflorum) anthers were given wounds by means of shaking in the presence of aluminum oxide particles. They were transformed by infiltration with Agrobacterium cells harboring a synthetic DNA encoding signal peptide-fused epidermal growth factor (EGF). After incubation for 24 hr in vitro, the pollen culture showed that EGF mRNAs and proteins were successfully expressed in the analysis of cDNA blot hybridization and immuno-blotting.

일측성선조체의 6-OHDA손상 후 도파민효능약물 투여로 발현된 회전운동의 특성

  • 이순철;문민선;이수정
    • Proceedings of the Korean Society of Applied Pharmacology
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    • 1997.04a
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    • pp.104-104
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    • 1997
  • 본 실험은 신경독성물질을 이용하여 선조체도파민신경찰성을 충분하게 손상시키고 도파민효능약물투여 후 유발되는 특정행동이 basal ganglia에서 발생되는 진행성이며 퇴행성신경질환인 파킨슨씨 질환(Parkinson's disease : PD)의 연구에 기여할 수 있는지의 타당성을 검토하고자 하였다. 흰쥐의 왼쪽선조체에 6-OHDA 8,16 and 24$\mu\textrm{g}$/2${\mu}\ell$(in 0.1% ascorbic acid)를 각각 투여하여 효율적으로 상동행동을 발현하는 신경독성물질의 투여 용량을 검토하고 도파민신경에 작용하는 약물의 투여방법(반복투여), 관찰기간(수술후 1주부터 4주간) 및 투여시기(7,21 및 35주령)에 따른 행동발현의 특성을 비교검토하고 아울러 성별의 영향도 검토하였다.

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축주교육을 통한 예방진료의 실천과 병원의 성장

  • 유형규
    • Journal of the korean veterinary medical association
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    • v.28 no.8
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    • pp.470-475
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    • 1992
  • 개업수의사로서 실천할 수 있는 예방의학 1. 효과적인 예방주사접종과 정확한 주사간격(예방주사접종일이 되면 축주에게 전화나 엽서로 시기가 되었음을 알려준다.) 2. 영양교육과 grooming 상담을 통한 건강상태 개선과 관계되는 처방약품 또는 양질의 용품판매 3. 비상/상비약품 필요성 인식과 판매, 건강유지를 위한 영양제의 계속적인 필요성 강조로 축주의 영양관리에 대한 인식개선 4. 1년에 2회, 분변검사를 통한 정기적인 기생충 r제와 일단 감염시 2회 치료와 효과확인 5. 구강검사를 통한 제질병의 발견과 치아검사의 필요성강조 및 치아건강 관련제품 사용권장 6. 각 품종별 특이한 질병의 설명과 예방을 한 검사(X-ray, 병리검사)의 추천과 결과에 따라 진행방지 방법이나 수술/치료 권유 7. 적극적인 진료자세-예)종양의 보다 세밀한 검사와 치료로 전이예방

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Bronchial Atresia with Collapse of the Right Upper Lobe -A Case Report (우상엽의 허탈을 동반한 기관지 폐쇄증 -1례 보고)

  • 김성호;장인석
    • Journal of Chest Surgery
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    • v.30 no.8
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    • pp.843-846
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    • 1997
  • Congenital bronchial atresia is one of the rare bronchopulmonary anomalies which is thought to be caused by a vascular insult of uncertain timing during fefal development. It is defined as an anomaly which does not have communication between a segmental or lobar bronchus a'nd the main airway. Because of the collateral ventilation, almost all of these cases show hyperlucency of the involved segment or lobe in chest roentgenogram. We report an extremely rare case of congenita bronchial atresia with collapse of the right upper lobe which was treated by surgical resection.

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Glottic and subglottic airway obtruction

  • 김영모
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 2003.09a
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    • pp.113-113
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    • 2003
  • 성문과 성문하부의 기도 폐쇄는 위치 정도 원인 기간 등은 환자에 따라 다르고 그 치료방법 역시 다양하다. 주 원인으로는 기관내 삽관, 각종 외상 및 화상 등 을 들 수 있다. 이러한 질환의 치료 목적은, 기관내 튜브나 기관 캐뉼러 를 통하지 않고 비강을 통하여 자연스럽게 호흡할 수 있도록 기도를 유지 하면서 발성이 가능하고 기고 흡인 없이 연하가 가능하도록 하며 기침 반사가 원활하게 되도록 하는데 있다. 치료목적의 달성을 위하여 협착의 경우, 단계 즉 초기 단계 또는 성숙단계 여부, 위치, 정도, 범위 환자의 연령 전신상태 등을 술전에 잘 평가하고 수술도중의 소견과 술자의 경험이나 기호에 따라 적절한 치료법을 선택하여 치료해야 한다. 후두 외상에 의한 기도 문제는 다른 외상에 비해 흔하지 않은데 이는 연골의 유연성과 후두의 가동성 그리고 후두가 하악과 흉골사이에 위치하여 외상시 보호받게 되는 해부학적 특성에 기인한다. 여러 요인으로 인하여 진단이 늦어질 수도 있는데 이러한 경우 심각한 증상이 초래 되거나 치료가 의 시기가 지나 후두 또는 기관 협착, 발성장애등의 후유증이 유발 될 수 있다.

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A Study on the Tree Surgery Problem and Protection Measures in Monumental Old Trees (천연기념물 노거수 외과수술 문제점 및 보존 관리방안에 관한 연구)

  • Jung, Jong Soo
    • Korean Journal of Heritage: History & Science
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    • v.42 no.1
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    • pp.122-142
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    • 2009
  • This study explored all domestic and international theories for maintenance and health enhancement of an old and big tree, and carried out the anatomical survey of the operation part of the tree toward he current status of domestic surgery and the perception survey of an expert group, and drew out following conclusion through the process of suggesting its reform plan. First, as a result of analyzing the correlation of the 67 subject trees with their ages, growth status. surroundings, it revealed that they were closely related to positional characteristic, damage size, whereas were little related to materials by fillers. Second, the size of the affected part was the most frequent at the bough sheared part under $0.09m^2$, and the hollow size by position(part) was the biggest at 'root + stem' starting from the behind of the main root and stem As a result of analyzing the correlation, the same result was elicited at the group with low correlation. Third, the problem was serious in charging the fillers (especially urethane) in the big hollow or exposed root produced at the behind of the root and stem part, or surface-processing it. The benefit by charging the hollow part was analyzed as not so much. Fourth, the surface-processing of fillers currently used (artificial bark) is mainly 'epoxy+woven fabric+cork', but it is not flexible, so it has brought forth problems of frequent cracks and cracked surface at the joint part with the treetextured part. Fifth, the correlation with the external status of the operated part was very high with the closeness, surface condition, formation of adhesive tissue and internal survey result. Sixth, the most influential thing on flushing by the wrong management of an old and big tree was banking, and a wrong pruning was the source of the ground part damage. In pruning a small bough can easily recover itself from its damage as its formation of adhesive tissue when it is cut by a standard method. Seventh, the parameters affecting the times of related business handling of an old and big tree are 'the need of the conscious reform of the manager and related business'. Eighth, a reform plan in an institutional aspect can include the arrangement of the law and organization of the old and big tree management and preservation at an institutional aspect. This study for preparing a reform plan through the status survey of the designated old and big tree, has a limit inducing a reform plan based on the status survey through individual research, and a weak point suggesting grounds by any statistical data. This can be complemented by subsequent studies.