• Title/Summary/Keyword: 술 전 상태

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Autologous Bone Marrow Cell Transplantation Combined with Off-pump Coronary Artery Bypass Grafting in Ischemic Myocardium (허혈성 심근에 관상동맥우회술과 병행한 자가 골수줄기세포 이식)

  • 김현옥;곽영란;강석민;장양수;임상현;안지영;이창영;강면식;유경종
    • Journal of Chest Surgery
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    • v.37 no.7
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    • pp.547-552
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    • 2004
  • Recently, autologous bone marrow cell transplantation (CTx) for angiogenesis and myogenesis in ischemic myocardium has been extensively investigated to improve heart functions. This study was designed to evaluate the effects of CTx with off-pump coronary artery bypass grafting (OPCAB) in patients who were not feasible for complete revascularization. Material and Method: Four male patients underwent CTx and OPCAB simultaneously. Bone marrow was aspirated from iliac bone. Mean 1.5 ${\times}$ 10$^{9}$ mononuclear cells including mean 6.7 ${\times}$ 10$^{6}$ CD34 + cells and 3.7 ${\times}$ 10$^{6}$ AC133 + cells were obtained and concentrated with 10 cc. These cells were transplanted into non-graftable ischemic myocardium after OPCAB. The heart function of all patients were evaluated using the MIBI scan, echocardiogram and MRI preoperatively. The effects of CTx was evaluated using MIBI scan and echocardiogram at 1 month postoperatively. Result: An average of 2 grafts were bypassed to left anterior descending artery territory. Other territories were transplanted with isolated mononuclear cell. All patients had uncomplicated postoperative course. After 1 month follow up, there were improvement in symptom, ejection fraction (from 49% to 55%) on echocardiogram and myocardial perfusion on MIBI scan in all patients. Conclusion: These preliminary data showed improvement of heart function and myocardial perfusion and also showed the feasibility and safety of combined therapy with OPCAB and CTx in ischemic myocardium. However, the effectiveness of CTx alone cannot be readily assessed. Further randomized, controlled studies are required to evaluate the effectiveness of CTx alone.

A Retrospective Study on the Treatment of Dens Evaginatus for the Last 5 Years (최근 5년간 시행된 치외치 치료에 대한 후향적 연구)

  • Jonghwa, Lim;Gimin, Kim;Jaesik, Lee;Soonhyeun, Nam;Hyunjung, Kim
    • Journal of the korean academy of Pediatric Dentistry
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    • v.49 no.2
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    • pp.158-169
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    • 2022
  • The purpose of this study was to analyze treatment methods, results, timings and clinical signs and symptoms in failed cases of each treatment method of dens evaginatus on the premolar areas. In this study, 151 patients and 417 teeth were included. Resin restoration and direct pulp capping as preventive treatment and pulp revascularization, apexification and conventional endodontic treatment as endodontic treatment were included for treatment methods. In the preventive resin restoration, successful results were shown in the intact tubercles and also effective when the tubercles were fractured. In the direct pulp capping, resolved clinical symptoms and growth of the roots were shown when there was only pain during chewing without apical lesion. Apical lesion was the most common pretreatment signs and symptoms of the pulp revascularization, apexification and conventional endodontic treatment. In the pulp revascularization, successful results was obtained in most cases. But in some cases, root length or root wall thickness was not increased. Effective results were shown both of the apexification and conventional endodontic treatment. In order to increase success rate of preventive treatment of dens evaginatus, resin restoration was required to be done when tubercle did not occluded or in the presence of intact tubercles. When tubercle was fractured, root development stage and pulp condition should be considered for successful treatment.

Reconstruction of a Large Cricotracheal Defect Using a Sternocleidomastoid Myoperiosteal Flap : A Case of Locally Aggressive Papillary Thyroid Carcinoma with Tracheal Invasion (갑상선 수술 후 흉쇄유돌근 근골막피판을 이용한 큰 기도 결손부 재건 1예)

  • Kim, Sang Min;Kim, Mi Ra;Kim, Yong-Wan;Baek, Moo Jin;Park, Jun-Ook
    • Korean Journal of Head & Neck Oncology
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    • v.31 no.1
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    • pp.18-21
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    • 2015
  • 기관을 침범한 갑상선 악성종양을 제거한 후에 성문하부에 비교적 큰 기관 결손이 발생할 수 있다. 단단문합술은 넓은 부위의 결손부를 재건하는 방법으로 널리 받아들여지고 있지만, 문합부 파열, 반회후두신경마비, 재협착 등의 합병증이 발생할 수 있다. 본 증례는 기도를 침범한 갑상선 유두암종을 제거한 후 윤상연골과 기관연골의 비교적 큰 결손부를 흉쇄유돌근 근골막피판을 사용하여 안전하게 재건한 사례이다. 55세 남자 환자가 기도를 침범한 갑상선 유두상암으로 내원하였으며 기도침범은 윤상연골(둘레의 약 30%)과 4개의 기관연골(둘레의 약 50%)을 해당하는 넓은 부위였다. 수술 전 기관절개술을 시행하여 주위 기관연골의 상태가 좋지 않아 단단문합술 시행 후 문합부 파열 가능성이 있다고 판단하여 흉쇄유돌근 근골막피판을 이용하여 재건하기로 계획하였다. 갑상선 절제술, 경부림프절 절제술, 흉쇄유돌근 근골막피판을 이용한 재건술을 시행하였으며 수술 후 12일째 별다른 문제없이 퇴원하였다. 환자는 수술 후 현재 22개월 간 기도 협착 등의 별다른 합병증 없이 지내고 있다. 흉쇄유돌근 근골막피판은 성문하부나 기관지 전외측벽의 비교적 큰 결손부를 재건하는 데 유용하게 사용될 수 있다.

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Clinical Significance of Repeated Delayed Air Reduction in Unsuccessful Initial Reduction of Intussusception (초기 정복에 실패한 장중첩증 환자에서 반복 지연 정복술의 임상적 의의)

  • Shin, Song-Heui;Rho, Young-Il;Park, Young-Bong;Moon, Kyung-Rye
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.4 no.2
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    • pp.175-180
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    • 2001
  • Purpose: The advantages of air reduction are the ease of performing the procedure, reduced radiation time and lower morbidity rate if perforation occurs. But, patients who fail air reduction undergo a laparotomy at which 10% have spontaneously reduced. The first enema decreases the edema and venous congestion of bowel wall, thus repeated reduction may succeed. The aim of this study is to evaluate the efficacy of delayed repeated pneumatic reduction of intussusception in patients with failure of an initial attempt. Methods: Between January 1998 and December 1999, 21 patients with proven intussusception received repeated delayed reduction 1 to 3 hours following the first failed attempt. These patients were in stable condition and did not have peritonitis, shock or toxic sign. Results: Before reduction, the patients had symptoms and signs for 6 to 48 hours (median 24 hr). The interval from the first reduction to the repeated was 1 to 3 hours (median 2.2 hr). The success rate of repeated reductions was 76.2% (16 of 21 patients), and 23.8% (5 of 21 patients) required surgery. Four of 5 patients requiring surgery were manually reduced and 1 spontaneously reduced in the operating room. Conclusion: We recommended a repeated reduction in patients with intussusception who are in stable clinical condition after an unsuccessful initial reduction attempt.

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AN EFFECT OF SLEEPING HOURS PRIOR TO PROCEDURE ON CHLORAL HYDRATE SEDATION FOR PEDIATRIC DENTAL PATIENT (소아환자에서 치료 전 수면 시간이 chloral hydrate 진정 효과에 미치는 영향)

  • Maeng, Yu-Jin;Oh, So-Hee
    • Journal of the korean academy of Pediatric Dentistry
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    • v.38 no.4
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    • pp.355-361
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    • 2011
  • Sedative method and its effect are affected by diverse variables: dosage and intake method of drug, weight, gender, patient compliance, sleeping hours prior to procedure, treatment hours, health status, type of used drugs are the factors. This study is conducted with empirical observation that shorter the sleeping hours before the day of chloral hydrate sedation, the effectiveness is larger; and therefore to actually recognize the correlation between chloral hydrate/hydroxyzine sedation and sleeping hours of child patient prior to sedation. The subjects were those children whose sleeping hours were similar to each other at the ages ranging from 2 to 5 years old totaling 37 children. Total 11 of them received pulp treatment. Sedative effect was evaluated by the same assessor with Houpt's rating scale. Sedative effect in relation with prior day's sleeping hours evaluated with simple regression analysis. Sedative effect in relation with pulp treatment was analyzed with independent t-test. Sleeping hours prior to sedation and sedation effect have negative correlation. No significant correlation is found between pulp treatment and sedation effect(p>0.05).

Implant surgery and prosthodontic treatment of Temporomandibular disorder patient combined SERAFIN clear aligner system : Clinical case report (세라핀 투명교정 시스템을 활용한 교합 장애 및 치아 결손 증례의 치료)

  • Won-Gun, Chang
    • Journal of the Korean Academy of Esthetic Dentistry
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    • v.31 no.1
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    • pp.11-18
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    • 2022
  • Adult patients who need implant and prosthodontic treatment often need treatment to improve the existing occlusion through orthodontic treatment for long-term stable treatment results. However, due to non-aesthetic and uncomfortable orthodontic treatment with orthodontic brackets and wires, many adult patients give up treatment even though they know the need for it. Recently, as digital dentistry has affected all areas of dentistry, clear aligner orthodontic systems have begun to be widely used, and their use is increasing in adults and old-aged people due to the esthetic advantage and convenient oral care. SERAFIN clear aligner system developed in Korea has been developed with the aim of implementing a functional occlusion harmony and is used not only for partial orthodontic treatment but also comprehensive orthodontic treatment. This patient presentation is shown the treatment using SERAFIN clear aligner system for the treatment of patient with TMD, severe extrusion of maxillary second molars, and extracted teeth.

Arthroscopic Treatment of Pigmented Villonodular Synovitis of the Shoulder - A Case Report - (견관절 색소 융모 결절성 활막염의 관절경적 치료 - 증례 보고 -)

  • Lee, Seoung-Joon;Yoo, Jae-Chul;Lim, Kyung-Sub
    • Clinics in Shoulder and Elbow
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    • v.10 no.1
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    • pp.140-145
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    • 2007
  • Pigmented villonodular synovitis(PVNS) is a benign proliferative lesion, involving synovial tissue in joints, tendon sheaths, and bursae. Pigmented villonodular synovitis is a rare and usually monoarticular condition and primarily affects the knee joint and hand. Polyarticular PVNS appears in less than 1% of all case and its occurrence in the shoulder is rare(<2%). We present a 64-year-old male who had pigmented villonodular synovitis of both shoulder joints, which was treated by arthroscopic total synovectomy.

Transhiatal versus Transthoracic Esophagectomy for Esophageal Cancer (식도암의 식도열공을 통한 식도절제술과 개흉을 통한 식도절제술의 비교)

  • 박기성;박창원;최세영;이광숙;유영선;이재훈;금동윤
    • Journal of Chest Surgery
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    • v.35 no.4
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    • pp.296-302
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    • 2002
  • The classic approach for esophagectomy is via the combined thoracic and abdominal approach. Controversy exists whether patients with esophageal carcinoma are best managed with Ivor-Lewis esophagectomy(ILO) as combined thoracic and abdominal approach or transhiatal esophagectomy(THO). The THO approach is known to be superior with respect to operative time, severity of leak, morbidity/mortality, and length of stay, but may represent an inferior cancer operation as a result of survival disadvantage due to inadequate mediastinal clearance compared with ILO. Accordingly, we reviewed the results of our esophageal resections to compare these outcome parameters for each operative approach. Material and Method: From January 1993 to July 2001, We performed a retrospective review of all esophagectomies performed at Keimyung University Dongsan ·Medical Center; 27 underwent THO, and 45 underwent ILO Result: The two groups were comparable in terms of age, sex, and stage of the disease. Mean tumor length and mean operative time were 3.81cm and 354 minutes for THO versus 5.31cm and 453 minutes for ILO, respectively (p<0.01 and p<0.001). Respiratory complications were 11.1% for THO versus 35.6% for ILO(p<0.05). Hospital mortality was 11.1% for THO versus 22.2% for ILO. There were no significant differences between THO and ILO with respect to other types of complications, amount of blood transfusion, leak and stricture rates, and hospital stay. Overall long-term survival at 5 years was 37%, respectively. Conclustion: There was no significant difference in long-term survival of patients of both operative approach. ILO had significant difference in respiratory complications associated with hospital mortality. Hence, THO is a valid alternative to ILO for well selected patients. And either approach appears to be acceptable depending on the surgeons, preferences and experiences.

The Comparison of Clinical Outcomes of Off-Pump versus On-Pump Coronary Artery Bypass Grafting in High Risk Patients (고위험군 환자에서 시행한 On-Pump CABG와 Off-Pump CABG의 비교연구)

  • 윤영남;이교준;김치영;안지영;오영준;유경종
    • Journal of Chest Surgery
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    • v.37 no.9
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    • pp.749-754
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    • 2004
  • Off-pump coronary artery bypass grafting (Off-Pump CABG) has been proven to have less morbidity and to facilitate early recovery. High-risk surgical patients may have benefitted by avoiding the adverse effects of the cardiopulmonary bypass. We compared the effectiveness of Off-Pump CABG with that of coronary artery bypass using cardiopulmonary bypass (On-Pump CABG) in high-risk patients. Material and Method: 682 patients (424 Off-Pump CABG and 258 On-Pump CABG) underwent isolated coronary artery bypass grafting between January 2001 and June 2003. Patients who were considered high risk were selected High risk is defined as the presence of one or more of nine adverse prognostic factors. Data were collected from 492 patients in Off-Pump CABG and 100 in On-Pump CABG for risk factors, extent of coronary disease, and in-hospital outcomes. Result: Off-Pump CABG group and On-Pump CABG group did not show differences in their preoperative risk factors. We used more arterial grafts in Off-Pump CABG group (p < 0.05). Postoperative results showed that operative mortality (0.5% in Off-Pump CABG versus 2.0% in On-Pump CABG), renal failure (2.6% in Off-Pump CABG versus 7.0% in On-Pump CABG), and perioperative myocardial infarction (1.5% in Off-Pump CABG versus 1.0% in On-Pump CABG) did not differ significantly. However, Off-Pump CABG had shorter mean operation time (p<0.05), lower mean CK-MB level (p <0.05), lower rate of usage of inotropics (p < 0.05), shorter mean ventilation time (p <0.05), lower perioperative stroke (0% versus 2.0%), and shorter length of stay (p < 0.05) than On-Pump CABG. On-Pump CABG had more distal grafts (p<0.05) than Off-Pump CABG. Although Off-Pump CABG and On-Pump CABG did not show statistical differences in mortality and morbidity was more frequent in CABG. Conclusion: Off-Pump CABG reduces morbidity and favors hospital outcomes. Therefore, Off-Pump CABG is safe, reasonable and may be a preferable operative strategy for high-risk patients.

Tibial Tuberosity Advancement for Partial Rupture of Cranial Cruciate Ligament in Two Dogs (경골조면 전이동술을 이용한 개에서의 부분 전십자인대 단열치료 2례)

  • Heo, Su-Young;Lee, Hae-Beom
    • Journal of Veterinary Clinics
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    • v.31 no.2
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    • pp.141-144
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    • 2014
  • Two dogs (Case 1 weighing 27 kg, Case 2 weighing 42 kg) were referred with hindlimb lameness. On physical examination, there was moderate pain on stifle joint testing and mild cranial translation on cranial drawer testing in Case 1. This translation was obvious when the patient was under general anesthesia. Case 2 showed discomfort during hyperextension of the stifle joint, but no significant cranial translation under general anesthesia. Joint effusion was detected on radiography in both cases. Based on physiologic and radiographic examinations, cranial cruciate deficiency was suspected, so exploratory arthroscopy was performed. Arthroscopy revealed partial rupture of the cranial cruciate ligament (CrCL) in both cases. Case 1 showed unstable partial CrCL rupture, while Case 2 had stable CrCL rupture. Tibial tuberosity advancement (TTA) was carried out as planned. Seroma occurred one week postoperatively in Case 2, and was removed surgically. The patients returned to satisfactory weight-bearing ambulation 5 months after initial surgery. Based on the results of these cases, TTA appears to be a useful procedure in the treatment of CrCL partial rupture.