• Title/Summary/Keyword: 수술 사망률

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A Case of Pulmonary Thromboembolism in Crohn's Disease (크론병 환자에서 발생한 폐동맥 색전증 1예)

  • Chung, Eui-Sung;Kim, Jeong-Ho;Jung, Jin-Hwan;Shin, Ju-Young;Yeom, Ju Ok;Kang, Ji Young;Yoon, Hyoung-Kyu;Song, Jeong Sup
    • Tuberculosis and Respiratory Diseases
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    • v.66 no.5
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    • pp.370-373
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    • 2009
  • Crohn's disease, a major form of inflammatory bowel disease (IBD), is a chronic inflammatory condition that is characterized by microvascular and macrovascular involvement. Some extraintestinal complications can occur due to chronic systemic inflammation in IBD. Among them, a pulmonary thromboembolism is a rare manifestation of IBD but is associated with a high morbidity and mortality. To our best of knowledge, there is only one case report of a pulmonary thromboembolism as a complication of Crohn's disease in Korea. We present another rare case of pulmonary thromboembolism as complication in a 25-year-old man with underlying Crohn's disease.

Mortality Analysis of Surgical Neonates: A 20-year Experience by A Single Surgeon (신생아 외과 환자의 수술 후 사망률 변화에 대한 연구)

  • Lee, Eun-Joung;Choi, Kum-Ja
    • Advances in pediatric surgery
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    • v.12 no.2
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    • pp.137-146
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    • 2006
  • Pediatric surgery could establish a definitive position in the medical field on the basis of a stable patient population. Neonatal surgery, the core of pediatric surgery, requires highly skilled surgeons. However, recent advancement of prenatal diagnosis followed by intervention and decreased birth rate has resulted in a significant decrease in the neonatal surgical population and the number of surgical operations. The purpose of this study is to examine the outcome of neonatal surgeries and to propose a guide for the future surgeries. A total of 359 neonatal surgical patients operated upon at the Department of Surgery, Ewha Medical Center, during past 21 years were studied. The study period hasbeen divided into two time periods: from 1983 to 1993 and from 1994 to 2004. Analysis was based on the Clinical Classification System and mortality pattern, frequency of disorders, occurrence and cause of death, and other changes. Neonatal surgery was 6.4 % of all pediatric surgery during the total 21 year period, 9.9 % in the first period and 4.8 % in the second. Male to female ratio increased from 2.7:1 to 2.1:1. The overall mortality was 6.7 %, and there was significant decrease from 7.4 % in the first period to 6.0 % in the second. The clinical classification system (CCS) for death cases included class II 2, III 4, and IV 7 during the first period and class III 3, and IV 8 during the second, respectively. According to the mortality pattern by Hazebroek, there were 6 preventable death cases during the first period, and only one in the second, and 2 non-preventable death cases during the first period and 8 in second, respectively. Although the patients in the second period had more serious diseases, surgical mortality has been decreased in the second period, which may be the result of improved surgery methods for newborns and advanced patient care.

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Recurrent Brain Abscess In Chronic Sinusitis : A Case Report (만성부비동염을 가진 환자에서 재발된 뇌농양 : 증례보고)

  • Yi, SangHak;Hwang, Yong;Lee, Hak Seung
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.19 no.6
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    • pp.275-279
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    • 2018
  • A brain abscess is caused by an infection in the central nervous system and leads to significant neurological sequelae. Despite advances in neurocritical care, high morbidity and mortality rates are still associated with brain abscess, especially in certain high-risk patients. Thus, a brain abscess is a medical emergency requiring prompt diagnosis and treatment with antibacterial therapy. However, the recurrence of brain abscess is rare. A 59-year-old man presented at our neurology clinic with a headache and was found to have chronic otitis media. Serial brain magnetic resonance imaging (MRI) scans of the patient demonstrated a brain abscess in the right frontal lobe. Following stereotactic aspiration of the brain abscess and proper antimicrobial treatment, the patient recovered completely. Five months after discharge, the patient revisited our clinic with a headache and seizure symptoms, and recurrence of the brain abscess was confirmed by brain MRI. Recurrent brain abscess has been documented in patients with predisposing conditions such as retained foreign bodies, chronic sinusitis, arteriovenous fistula, and right-to-left shunt.

Perforation of IVC by Chest Draings Tube -Report A Case (흉강삽관술시 하대정맥 천공 치험 1례)

  • Jeong, Won-Seok;Mun, Dong-Seok
    • Journal of Chest Surgery
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    • v.30 no.11
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    • pp.1128-1131
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    • 1997
  • Injuries to versa cave continue to be associated with a high mortality. Essentials to successful treatment are immediate recognition of the injury and prompt control of the hemorrhage. We have experienced one case of inferior versa java perforation by a chest rainage tube in the patient with post-operative chronic empyema thoracic. The patient was 38-year old male who was taken RLL lobectomy after 6 cycle of chemotherapy due to small cell carcinoma in the RLL & suffered from post-operative chronic empyema thoracis at D hospital. He moved to our hospital for further evaluation with accidental removal of chest drainge tube. We inserted closed drainage tube and dark blood gushed out abruptly just after insertion of the drainage tube. CTscan, MRI, and angiogram were performed and showed the perforation of IVC just below RA. The IVC was repaired using simple interrupted 4-0 Prolene suture through right posterolateral thoracotomy. The patient recovered without event and doing well until now.

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식도 천공의 외과적 치료

  • 이재익
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 2003.09a
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    • pp.108-108
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    • 2003
  • 식도 천공의 치료는 최근 치료법의 발전에도 불구하고 여전히 난해한 문제이다. 이 환자들은 천공의 원인이나 위치, 심한 정도가 다양한 이질적인 군이며, 반수 이상이 이미 식도에 기존의 질환을 가지고 있어 문제를 더욱 복잡하게 한다. 따라서 절대적이고 획일적인 치료방법은 아직 확립되어 있지 않으며 많은 다양한 방법들이 제시되고 있다. 2002년 11월부터 2003년 7월까지 총 8명의 환자가 식도 천공으로 동아대학교병원 흥부외과에서 치료를 받았으며, 원인별로는 의인성(iatrogenic) 손상이 6례, 자발성(spontaneous) 손상이 2례였고 부위별로는 경부가 3례, 흥부가 5례였다. 의인성 손상에는 내시경 검사중 정상 경부 식도에 발생한 1례, 부식성 식도협착 환자의 풍선 확장술과 스텐트 삽입시 흉부 식도에 발생한 경우가 각각 1례씩, 외상성 경추손상의 수술시 정상 경부 식도에 발생한 경우가 2례, 선천성 식도폐쇄증(esophageal atresia)의 술후 문합부 누출이 생긴 경우가 1례 있었으며, 자발성 손상에는 하부식도에 발생한 기압성(barogenic) 손상 1례와 상흉부 식도암 천공 1례가 있었다. 경부 식도 천공 3례는 모두 경부 배액(drainage)과 식이용 장루술(feeding jejunostomy)을 시행하였고, 부식성 식도협착이 있던 환자 2례는 식도절제술과 흉부내 식도-위 문합을 시행하였으며, Boerhaave씨 증후군 환자는 1차 봉합술, 술후 문합부 유출이 있었던 환자와 식도암 천공이 있었던 환자는 식도절제 및 경부 식도루(esophagostomy), 배액용 위루(gastrostomy), 식이용 장루술을 시행하였다. 모든 환자는 패혈증 등의 심각한 합병증으로의 진행 없이 회복되었다. 현재 위장관의 연속성이 유지 혹은 복원된 환자는 경구식이 중이며 그 외의 환자들은 장루를 통해 영양을 공급하며 식도재건술을 기다리고 있다. 식도 천공은 최근 항생제의 사용, 과영양요법(hyperalimentation), 술후 환자관리의 개선 등으로 치료에 많은 발전이 있었으나, 치료 방침에 있어서는 여전히 논란이 있으며 높은 사망률을 보이는 난제로 남아있다. 비록 일반적인 지침이 도움이 되겠지만, 치료 방침은 환자 개개인의 상황에 따라 적절하게 선택해야 하며, 임상경과에 따라 언제라도 방침을 변경할 수 있는 유연함이 필요하리라 생각한다.

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A Case of Childhood Malignant Hyperthermia Complicated by Rhabdomyolysis (소아 악성 고열증과 동반되어 발생한 횡문근융해증 1례)

  • Lee Bum-Hee;Lee Jin-Sook;Cho Hee-Yeon;Kang Ju-Hyung;Kang Hee-Gyung;Cheong Hae-Il;Choi Yong;Ha Il-Soo
    • Childhood Kidney Diseases
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    • v.7 no.2
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    • pp.229-233
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    • 2003
  • Mortality and morbidity of malignant hyperthermia has decreased markedly by the avoidance of succinylcholine, and the earlier detection and introduction of dantrolene. We report a fourteen-year-old boy who developed malignant hyperthermia during general anesthesia. He showed the earlier clinical signs, such as elevation of end-tidal $CO_2$, tachycardia, and hypertension. After prompt administration of dantrolene, operation was continued with profopol and midazolam. Rhabdomyolysis and myoglobinuria followed, and were managed by hydration and alkalinization of urine. Azotemia did not occur, and he was discharged without any sequelae on the $10^{th}$ postoperative day.

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Survival Rate of the Korean Cyprinidae Subject to Passive Integrated Transponder (PIT) Tagging (국내에 서식하는 잉어과 어류의 Passive integrated transponder (PIT) tag 적용에 따른 생존율 평가)

  • Yoon, Ju-Duk;Jang, Min-Ho
    • Korean Journal of Ecology and Environment
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    • v.42 no.1
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    • pp.134-138
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    • 2009
  • The survival rate of PIT tagged fish was investigated for five Korean Cyprindae fish species, Acheilognathus lanceolatus (n=18, total length : $92.5{\pm}13.1mm$; body weight : $9.6{\pm}4.3g$), Hemibarbus labeo (n=28, TL : $220{\pm}74.4mm$; BW : $91.8{\pm}76.2g$), Zacco koreanus (n=13, TL : $116.5{\pm}23.8mm$; BW : $13.6{\pm}10.6g$), Zacco platypus (n=108, TL : $100.6{\pm}17.8mm$; BW: $8.7{\pm}4.8g$), Opsariichthys uncirostris amurensis (n=6, TL : $161.8{\pm}26.3mm$; BW : $27.5{\pm}18.3g$) with respect to applicability and effectiveness of PIT tagging. The survival rate were daily checked for 30 days. The survival rate was the highest and lowest for Z. koreanus and Z. platypus, respectively. The survival days were greater as fish total length increased. Based on these results, PIT tagging is not effective for Z. platypus, while PIT tagging for fish>150 mm was effect for field research.

Endovascular Treatment for Arterioureteral Fistula of the Abdominal Aorta: A Case Report and Literature Review (복부 대동맥에 발생한 동맥-요관 누공의 혈관 내 치료: 증례 보고와 문헌고찰)

  • Hyoung Nam Lee;Woong Hee Lee
    • Journal of the Korean Society of Radiology
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    • v.81 no.4
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    • pp.953-957
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    • 2020
  • We present a rare case demonstrating successful endovascular management of an arterioureteral fistula involving the abdominal aorta. Arterioureteral fistulas are rare but life-threatening, with mortality rates ranging from 7% to 23%. Early recognition and prompt management are essential for preventing catastrophic consequences, including hypovolemic shock. However, recognition of an arterioureteral fistula requires a high index of clinical suspicion due to its rarity and the lack of a sensitive diagnostic method. Arterioureteral fistulas could be induced by traumatic events in patients who have a history of pelvic surgery, radiation, and prolonged placement of a ureteral stent. Endovascular stent graft placement could be a valid treatment option for arterioureteral fistulas involving the abdominal aorta.

Growth Inhibitory Effect of Extracts of Propolis on Epithelial Ovarian Cancer Cells (상피성 난소암 세포에서 프로폴리스 추출물의 세포 증식 저해 효과)

  • Yang, Ga Ram;Yoon, Kyung Mi;Oh, Hyun Ho;Kim, Min Sung;Hwang, Tae Ho;An, Won Gun
    • Journal of Life Science
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    • v.27 no.7
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    • pp.834-839
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    • 2017
  • Propolis is a natural product collected from plants by honey bees product used extensively in traditional medicine for its antioxidant, anti-inflammatory, immunomodulatory and anti-cancer effects. Propolis exhibits a broad spectrum of biological activities because it is a complex mixture of natural substances. Ovarian cancer is the second most common newly diagnosed cancer from all cancers among women in Korea and the leading cause of death from gynecological malignancies. While most ovarian cancer patients initially respond to surgical debulking and chemotherapy, patients later succumb to the disease. Thus, there is an urgent need to test novel therapeutic agents to counteract the high mortality rate associated with ovarian cancer. In this study, we investigated the anti-cancer properties and the active mechanism of Australian propolis in human epithelial ovarian cancer A2780 cells. Our data revealed that propolis showed a cytotoxic activity in a dose-dependent manner. Flow cytometric analysis for cell cycle arrest and apoptosis using propidium iodide staning and annexin V-FITC indicated that propolis could induce cycle arrest in the G0/G1 phase and apoptosis in a dose-dependent manner on human epithelial ovarian cancer cells. These results suggest that the Australian propolis is potential alternative agent on ovarian cancer prevention and treatment.

Total Gastrectomy with Distal Pancreatico-splenectomy for Treating Locally Advanced Gastric Cancer (진행 위암에서의 위 전절제술에 동반된 원위부 췌-비장 절제)

  • Lee, Sung-Ho;Kim, Wook;Song, Kyo-Young;Kim, Jin-Jo;Chin, Hyung-Min;Park, Jo-Hyun;Jeon, Hae-Myung;Park, Seung-Man;Ahn, Chang-Jun;Lee, Jun-Hyun
    • Journal of Gastric Cancer
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    • v.7 no.2
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    • pp.74-81
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    • 2007
  • Purpose: Routine pancreatico-splenectomy with total gastrectomy should no longer be considered as the standard surgical procedure for gastric cancer because of the lack of proven surgical benefit for survival. The aim of this study is to evaluate the clinicopathologic factors and the survival of patients with locally advanced gastric cancer and they had undergone combined pancreatico-splenectomy with a curative intent. Material and Methods: We retrospectively reviewed a total of 118 patients who had undergone total gastrectomy with distal pancreatico-splenectomy from 1990 to 2001. The patients were divided into 2 groups: 90 patients who were free from cancer invasion (group I), and 28 patients with histologically proven cancer invasion into the pancreas (group II). The various clinicopathologic factors that were presumed to influence survival and the survival rates were analyzed. Results: The rate of pathological pancreatic invasion was 23.7%. The tumor stage, depth of invasion, pancreas invasion, lymph node metastasis, lymph node ratio, curability and the hepatic and peritoneal metastasis were statistically significance on univariate analysis. Among these factors, the tumor stage, lymph node ratio and curability were found to be independent prognostic factor on multivariate analysis. The 5-years survival rates were 36.2% for group I and 13.9% for group II. The morbidity rate was 22.1%, and this included pancreatic fistula (5.1%), intra-abdominal abscess (4.2%) and bleeding (4.2%). The overall mortality rate was 0.8%. Conclusion: Combined distal pancreatico-splenectomy with total gastrectomy with a curative intent was selectively indicated for those patients with visible tumor invasion to the pancreas, a difficult complete lymph node dissection around the distal pancreas and spleen, and no evidence of liver metastasis or peritoneal dissemination.

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