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부식제에 인한 인두-식도 협착의 수술적 치료

  • 김재원;김영모;김태연
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 2003.09a
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    • pp.111-111
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    • 2003
  • 부식제 섭취로 인한 가장 흔한 합병증은 인두-식도 협착이며, 이로 인한 구강섭취 장애는 심각한 문제를 초래한다 이의 치료에 있어 기존의 수술적 치료가 소개되었으나 만족스럽지 못한 결과를 가져왔다. 부식제 섭취로 인한 인두-식도 협착에 있어 본원에서 시행한 수술적 치료 결과에 대해 알아봄으로써 향후 인두-식도 협착 치료에 도움을 주고자 하였다. 2001년 12월부터 2003년 8월까지 본원 이비인후과와 일반외과에서 부식제 섭취로 인한 인후두 및 식도의 완전협착으로 진단 받고 치료를 시행 받은 4예를 대상으로 의무기록을 통하여 술전 이학적 소견, 수술적 치료방법, 술후 합병증, 구강 섭취 시기를 후향적으로 분석하였다. 모든 환자에서 술전 내시경 검사로 인두-식도 접합부에 협착소견을 확인하였으며, 이중 경구 식이가 전혀 가능하지 못하였던 3명의 환자는 전후두인두식도 절제술 및 대장대체술 시행 하였으며, Levine- tube로 관급식이가 가능하였던 1명의 환자는 내시경적 확장술만 시행 받았다. 전 후두인두식도 절제술 및 대장대체술을 시행받은 3명의 환자 모두에서 문합부 유루, 출혈은 없었으나, 그 중 1명에서 술후 재협착으로 내시경적 확장술을 시행 받았고 이 환자를 제외한 2명의 환자에서 술후 10일과 13일에 경구섭취가 가능하였고 재협착이 있었던 환자는 술후 43일에 경구섭취가 가능하였다. 대장대체술을 시행 받았던 환자에서는 연식 이상의 식사가 가능하였으나, 내시경적 확장술을 시행 받은 환자는 관급식이만 가능하였다. 부식제 섭취에 인한 인후두 및 식도 협착에 있어 대장을 이용한 대장 대체술식을 이용하여 인두-식도 협착 치료에 좋은 결과를 얻었으며, 대장대체술은 합병증 및 구강 섭취에 있어 좋은 결과를 가져다 주는 술식으로 판단되었다.결과를 이용하여 향후 전개될 홈 네트워크 서비스 및 관련시장의 발전 방향을 전망해 보고 이에 따른 기업이나 정부차원의 대응전략을 파악하고자 한다.육구에서는 큰 변화를 나타내고 있지 않았다(p<0.05). 운동과 비운동시킨 참돔의 지질 함량의 변화는 운동시킨 참돔은 운동으로 인한 에너지 소비로 인하여 함량이 유의적으로 감소했으며(r=-0.35), 비운동사육구에서는 절식으로 인하여 지질함량이 감소하였다(r=-0.38). 파괴강도와 가장 밀접한 영향을 가지는 콜라겐은 운동과 비운동 모두 사육기간동안 큰 변화는 보이지 않았다. 초기의 파괴강도값은 1.45±0.02kg(운동사육구), 1.36±0.18kg(비운동사육구)이였으며 사육기간동안 운동사육구는 파괴강도값이 증가한 반면, 비운동수조에서는 참돔의 파괴강도는 사육기간동안 큰 유의차가 없었다. 각 성분간의 상관도를 살펴보면, 수분함량과 파괴강도는 상관성을 가졌으며, 지질함량과 파괴강도도 같은 경향은 나타내었다. 운동기간동안의 파괴강도와 콜라겐 사이에는 상관성의 거의 없었다. 이는 운동기간에 따른 파괴강도의 증가가 콜라겐의 함량의 증가보다는 지질함량의 감소와 수분함량의 증가와 같은 성분과의 상관성이 크다고 판단된다. 다음으로는, 운동횟수에 의한 영향으로써 운동시간을 1일 6시간으로 설정하여, 운동횟수를 결정하기 위하여 오전, 오후에 각 3시간씩 운동시키는 방법과 오전부터 6시간동안 운동시키는 두 방법을 이용하여 품질을 비교하였다. 각 조건에 따라 운동시킨 참돔의 수분함량을 나타낸 것으로, 2회(오전 3시간, 오후 3시간)에 나누어서 운동시키기 위한 육의 수분함량은 73.37±2.02%를 나타냈으며, 1회(6시간 운동)운동시키기 위한 육은 71.74±1.66%을 나타내었다. 각각의 운동조건에서 양식된 참돔은

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Amelioration Effects of Irrigation-Aspiration on Renal Ischemia-Reperfusion Injury in Canine Model (개에서 신장의 허혈-재관류 손상에 대한관류-흡인의 감소효과)

  • Lee, Jae-Il;Son, Hwa-Young;Jeong, Seong-Mok;Kim, Myung-Cheol
    • Journal of Veterinary Clinics
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    • v.25 no.4
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    • pp.257-262
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    • 2008
  • Renal ischemia-reperfusion injury is great clinical important because viability of the transplanted organ depends on the tolerance of the graft to ischemia-reperfusion injury, an inevitable processing during surgery. The purpose of this study was to investigate the effects of irrigation-aspiration in ischemia-reperfusion injury model induced by cross-clamping of renal vessels. Blood samples were collected from these dogs for measurement of kidney function and antioxidant enzyme activity, and RI at the intrarenal artery was measured at different time intervals. And the kidneys were taken for histopathologic evaluation at day 14. Kidney function (Cr and BUN) showed a significant increasing in untreated group compared to treated group. Resistive index of intrarenal artery was no significant difference among the groups. Activity of antioxidant enzymes in plasma was significant decrease in untreated group compare to control group while in treated group was no significant difference compared to control group. In histopathologic finding, treated group was showed less damage than that of untreated group. This result suggests that the processing of irrigation-aspiration is useful to reducing ischemia-reperfusion injury.

The Gastric-Bile Juice Reflux in Patients from Hepatobiliary Scan with Subtotal Gastrectomy (위 부분절제술 환자의 간담도 스캔에서 위-담즙역류)

  • Kwak, Dong-Woo;Kim, Ji-Hyeon;Kim, Kyung-Hun;Lee, Kyung-Jae;Park, Young-Jae;Lee, In-Won
    • The Korean Journal of Nuclear Medicine Technology
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    • v.14 no.2
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    • pp.17-20
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    • 2010
  • Purpose: The hepatobiliary scan is the examination which is the possibility of knowing the function of liver, gall bladder and closing of the biliary tract. Also, after subtotal gastrectomy, the increased gastric-bile reflux is known as the primary reason of reflux gastritis. In this study, according to changing the acquisition method, we tried to prove the reflux time and reflux index in patients who underwent subtotal gastrectomy. Materials and Methods: From Oct 2008 to Jan 2009, 72 patients with subtotal gastrectomy who took the hepatobiliary scan (man: 52, woman: 20, age range: 31-77, mean age: $60.5{\pm}7$) in our department. We used the radiopharmaceutical $^{99m}Tc$-mebrofenin 185 MBq/0.5 cc. After 5 minutes, we acquired 300,000 counts anterior image on supine, and then we acquired right lateral and $45^{\circ}$ LAO position by using the time setting method. We acquired 30 min, 60 min, 90 min, 120 min and fatty meal by the same method. We painted the ROI of liver, GB and CBD on 30 min anterior image and LAO image in patients had occurred the bile juice reflux. And then we painted the ROI of stomach on others image. We calculated the reflux index from those values. Results: According to this study, we found out 40 patients (55.6%) who had occurred the gastric-bile juice reflux (1 person from 30 min, 7 persons from 60 min, 4 persons from 90 min, 28 persons from after fatty meal). Hourly, the bile reflux highest level is 6 persons from 60 min, 2 persons from 90 min, 32 persons from fatty meal among those people. The reflux index of anterior is 0.85-23.36% (mean 6.53%). The reflux index of LAO is 1-29.13% (mean 8.89%). By visual assessment, we can distinguish that there were 26 of the 40 patients (65%) had occurred the reflux on LAO image more than anterior image. Conclusion: We find out that the patients with subtotal gastrectomy had occurred gastric-bile juice reflux more than 50% from hepatobiliary scan. And after eating fatty meal, we can know that it's the most possible to occur the gastric-bile juice reflux. When it happened, we have to change the acquisition method to reduce the overlap between colon and stomach. This study will be more valuable in diagnosis.

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The Significance of Prophylactic Gastrojejunostomy for Patients with Unresectable Stage IV Gastric Cancer (절제 불가능한 4기 위암에서 예방적 위 공장 우회술의 의의)

  • Kim, Hwan-Soo;Kim, Chong-Suk;Kim, Jong-Han;Mok, Young-Jae;Park, Sung-Soo;Park, Seong-Heum;Jang, You-Jin;Kim, Seung-Joo
    • Journal of Gastric Cancer
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    • v.9 no.4
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    • pp.231-237
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    • 2009
  • Purpose: The aim of this study was to evaluate the significance of palliative gastrojejunostomy for treating patients with unresectable stage IV gastric cancer, and as compared with laparotomy for treating patients with incurable gastric cancer. Materials and Methods: We retrospectively studied 167 patients who could not undergo resection without obstruction at Korea University Hospital from 1984 to 2007. They were classified into two groups, one that underwent palliative gastrojejnostomy (the bypass group, n=62) and one that underwent explo-laparotomy (the O&C group, n=105), and the clinical data and operative outcomes were compared according to the groups. Results: For the clinical characteristics, there were no differences of age, gender and liver metastasis between the bypass group and the explo-laparotomy group, but there was a significant different for the presence of peritoneal metastasis (P=0.001). There was no difference between two groups for the postoperative mortality and morbidity. For the postoperative outcomes, the duration of the hospital stay (29.25 vs 16.67) and the frequency of re-admission were not different, but the median overall survival (4.3 months vs. 3.4 months, respectively) was significantly different. By multivariate analysis, the presence of peritoneal metastasis was identified as the independent prognostic factor for incurable gastric cancer. Conclusion: A prophylactic bypass procedure is not effective for improving the quality of life and prolonging the life expectancy of unresectable stage IV gastric cancer patients without obstruction.

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Massive Rotator Cuff Tear Repair (광범위 회전근 개 파열의 봉합술)

  • Shin, Sang-Jin
    • Clinics in Shoulder and Elbow
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    • v.13 no.1
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    • pp.167-174
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    • 2010
  • Purpose: Anatomical repair of massive rotator cuff tear has been technically challenging because of medial retraction, muscle atrophy and fatty degeneration. Among several treatment options for massive rotator cuff tear, we reviewed rotator cuff repairs and investigated modalities for improvement of clinical outcomes, decreasing the re-tear rate, and increasing healing. Materials and Methods: Patient-related factors and rotator cuff-related factors were the two major groups of factors we considered when choosing a treatment plan. Results: Mobilization of a massive rotator cuff tear was increased by soft tissue release and by the interval slide technique. After meticulous soft tissue release, anatomical repair could be achieved. If the injury was not amenable to anatomical repair, alternative treatment options such as partial repair, the margin convergence technique and augmentation with a tenotomized biceps tendon were considered. Many reports of massive rotator cuff repair demonstrated satisfactory clinical outcomes, decreased pain, recovery of shoulder functions, and increases in muscle strength. However, the re-tear rate had been reported to be relatively high in long-term follow-up. Conclusion: Despite a high re-tear rate after massive rotator cuff repair, a better understanding of the pathogenesis, progression and clinical symptoms of massive rotator cuff tear and improved surgical materials and techniques will lead to satisfactory clinical outcomes.

Attenuation of Renal Ischemia-Reperfusion Injury by Antioxidant Vitamins in Pigs (돼지의 신장에서 Antioxidant Vitamins에 의한 허혈 및 재관류 손상의 감소에 관한 연구)

  • Kim, Myung-Jin;Lee, Soo-Jin;Park, Chang-Sik;Son, Hwa-Young;Jun, Moo-Hyung;Jeong, Seong-Mok;Kim, Myung-Cheol
    • Journal of Veterinary Clinics
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    • v.24 no.2
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    • pp.94-98
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    • 2007
  • This study was to investigate the effects of ascorbic acid and alpha-tocopherol on the attenuation of renal ischemia-reperfusion (IR) injury in pigs. Ten pigs were subjected to 60 minutes of warm unilateral renal ischemia followed by removal of contralateral kidney and then divided into two groups. Treatment group was performed ascorbic acid and alpha-tocopherol pretreatment 2 days before operation and ascorbic acid with heparin-saline solution irrigation-aspiration. Otherwise, control group used only irrigation-aspiration of heparin-saline solution. Blood samples were collected from these pigs for measurement of serum blood urea nitrogen (BUN) and creatinine values, antioxidant superoxide dismutase (SOD) at pre, day 1, day 3, day 7 and day 14. The kidneys were taken for histopathologic evaluation after euthanasia on postoperative day 14. The levels of BUN were significantly increased in the control group on day 1, day 3 and day 7 (P<0.05). And the level of creatinine was significantly increased in the control group on day 3 (p<0.05). Activity of antioxidant enzymes in plasma revealed significant difference (p<0.05) between control and treatment group at day 14. In histopathologic findings, treatment group was showed less damage than that of control group on the basis of renal tubular damage. It was concluded that ascorbic acid and alpha-tocopherol attenuated renal I/R injury in the pigs.

REIMPLANTATION OF FREEZE-TREATED AUTOGENOUS BONE AFTER MANDIBULECTOMY;REPORT OF THREE CASES (하악골 절제술후 재이식된 동결자가골 재이식;치험 3례)

  • Kim, Sik;Kim, Su-Gwan;Kim, Woon-Kyu;Kim, Soo-Min;Ryu, Chong-Hoy;Lee, Jun-Gil;Cho, Gyeong-An;Kim, Soo-Heung;Chung, Tae-Young;Yeo, Hwan-Ho
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.23 no.2
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    • pp.185-190
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    • 2001
  • We described three cases of immediate reimplantation of a frozen-thawed autogenous mandible composed of a mixture of iliac bone, marrow, and particulate hydroxyapatite in tumors of the mandible. Acceptable outcomes were obtained in three patients who underwent immediate autogenous mandibular graft reconstruction. The conditions leading to successful outcome of the procedure are also discussed. Reimplantation of frozen autogenous lesioned mandible was performed in three patients with mandibular tumors. Two reimplanted grafts survived without complications following surgery. One case had postoperative infection that resolved with appropriate antibiotic treatment. There were no recurrences of the primary lesions. Satisfactory facial contour after surgery was achieved. These results are most promising, and we believe that, with further refinement, this technique will offer a new and acceptable modality for facial reconstruction in patients with cancer.

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Plant Regeneration from Leaf Tissue Culture and Some Effective Substances in Scutellaria baicalensis G. (황금(黃芩)의 엽조직(葉組織) 배양(培養)에 의한 식물체(植物體) 재분화(再分化)와 주요(主要) 성분(成分))

  • Lee, Man-Sang;Kim, Kui-Ho;O, Ki-Hong
    • Korean Journal of Medicinal Crop Science
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    • v.1 no.1
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    • pp.43-48
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    • 1993
  • Present experiments were carried out to examine the effect of plant growthregulators for callus induction and plantlet regeneration through leaf tissue culture of Scutellaria baicalensis GEORGI. The results indicated that Callus was induced well on MS medium supplemented with 0.5mg/L NAA or 0.5mg/L NAA Plus 0.5mg/L zeatin. MS medium supplemented with 1.0mg/L BAP plus 0. 5mg /L NAA or 1. 0mg /L zeatin Plus 0.5mg /L NAA and 1.0mg /L NAA were the most effective for plant regeneration. Thin layer chromatogram of baicalin component (Rf 0.39) was observed from callus cultured on MS medium containing 0.5mg /L NAA plus 0.5mg /L zeatin.

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A Case of Anterior Glottic Web (Video) (후두 격막증의 치험 1례)

  • 김기령;박인용;김광문;이원상;이경재;정태영;이명호
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1983.05a
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    • pp.8.1-8
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    • 1983
  • An anterior glottic web can be congenital or develop as a result of trauma. The congenital webs indicate failure of normal separation of the two vocal cord primordia and the cicatrical membrane caused by accidental and operative trauma. When the web is small it rarely produces significant sympto-matology but larger webs may produce stridor as well as hoaresness in various degrees. Achievement of epithelialization of the anterior commisure after excision of a web, thus preventing adhesions from forming between the denuded vocal cords, is the principle underlying the surgical treatment of anterior glottic webs. Recently the authors experienced a case of anterior glottic web which occured in a 23 year old man after repeat removal of a papilloma several times in child-hood. The patient received treatment of a web excision followed by placement of a gold keel between the cords in the anterior glottis.

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A Case Study of Prosthetic Ambulation Training for Rotation-Plasty Client (하지 분절절제 및 회전재접합술자의 의지 보행훈련 증례연구)

  • Lee, Jeong-Weon;Chung, Nack-Su
    • Physical Therapy Korea
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    • v.3 no.1
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    • pp.65-72
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    • 1996
  • The purpose of this study was to introduce rotation-plasty procedure and prosthetic ambulation training. The recent development of chemotherapy and diagnostic facility have permitted the orthopaedic surgeons to try limb saving procedures rather than amputations for the treatment of the malignant bone tumors. If the tumors around the knee joint were treated by mid-thigh amputation or hip disarticulation, it would impose the client with a great handicap for rehabilitation. Rotation-plasty procedure was first done by Borggreve, in 1930 for the congenital short femur. Recently this procedure was used a malignant bone tumor at the distal femur by Kotz and Salzer in 1982. In spite of its cosmetic problem of the distal stump, this procedure has the great functional advantage of converting the above-knee amputation to the below-knee amputation. The inverted foot was also good to control the prosthesis as a below-knee stump and heel functioned as a patella to support the body weight. This 15 years old girl case was had rotation-plasty due to osteosarcoma of the distal femur with 3rd postoperative chemotherapy, and admitted to Yonsei rehabilitation hospital for prosthetic ambulation training. Then, the case had excellent functional results of prosthetic ambulation training with rotaion-plasty after 3 months.

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