• Journal of Chest Surgery
• /
• v.34 no.3
• /
• pp.270-273
• /
• 2001

신동맥 사이 또는 신동맥 상부에 위치하는 대부분의 복부대동맥 축착은 흉복부절개의 접근으로 수술한다. 우리는 경흉막 후복막 접근으로 개복을 하지 않고 단측단측 흉복부대동맥의우회술을 시행한 1례의 수술을 소개하고자 한다. 경흉막 후복막 접근은 흉복부대동맥의 시야가 매우 좋으며 개복을 할 때보다 더 쉽게 흉복부대동맥의 우회술을 할 수 있고 복강내 장기를 노출하지 않는 장점이 있다.

• Journal of Chest Surgery
• /
• v.42 no.1
• /
• pp.34-40
• /
• 2009

Background: The principal surgical technique for treating an abdominal aortic aneurysm since the 1960s has been the transperitoneal approach, yet there have been some recent studies that have reported improved surgical results with using the retroperitoneal approach. However, there are only limited clinical Korean studies that have, compared between the transperitoneal and retroperitoneal approaches. Material and Method: This study included 36 patients who had been diagnosed as having an aneurysm of the abdominal aorta and they were surgically treated between January 2001 and July 2007. The patients were subdivided into the retroperitoneal approach group (n=17) and the transperitoneal approach group (n=19), and they were compared in terms of the preoperative risk factors, the postoperative complications and the operative mortality. The risk factors of operative mortality risk and long-term survival for the 36 patients were assessed by the Kaplan-Meier method. Result: There were no significant differences between the groups in terms of gender, age, the underlying disease, a history of smoking, rupture of aneurysm, the preoperative symptoms, the operation time and the incidence of postoperative complications. However, the duration of postoperative fasting, the number of days of having an indwelling nasogastric tube and the length of the stay in the intensive care unit were significantly short for the retroperitoneal approach group (p<0.05). There was a 16.7% rate of operative mortality (6/36) and five of the deaths were attributed to preoperative ruptured aneurysm. On univariate analysis, a higher preoperative serum creatinine level (SCr ${\geq}$1.8 mg/dL, p=0.016) and ruptured aneurysm (p<0.001) were the significant risk factors of operative mortality. As assessed by the Kaplan-Meier method, the long-term survival was comparable between the groups and the five-year survival rate of all the patients was 57.5%. Conclusion: In the present study, a retroperitoneal approach has several advantages such as a shorter intensive care unit stay, a shorter duration of postoperative fasting and a shorter duration of an indwelling nasogastric tube. Therefore, unless there is any contraindication for a retroperitoneal approach, it could be considered as a primary surgical access for repairing an abdominal aortic aneurysm.

• Journal of Chest Surgery
• /
• v.43 no.5
• /
• pp.525-528
• /
• 2010

Congenital interruption of the inferior vena cava (IVC) can lead to secondary hepatic congestion, portal hypertension, and liver cirrhosis. A 49-year-old woman was admitted to the gynecology department with symptoms of menorrhalgia, known uterine myoma, and anemia. Abdominal computed tomography (CT) and venography performed at our hospital revealed congenital interruption of the IVC. The patient underwent retrohepatic cavoatrial bypass surgery with a polytetrafluoroethylene (PTFE) 16-mm ringed graft via posterolateral thoracotomy, and recovered without major complications. A retroperitoneal approach via posterolateral thoracotomy provides appropriate visualization during dorsal cavoatrial bypass in treating patients with congenital interruption of IVC.

• Journal of Hospice and Palliative Care
• /
• v.9 no.1
• /
• pp.35-39
• /
• 2006

A 77-year-old female presented panperitonitis due to advanced gastric ranter during palliative care. In the case of panperitonitis following obstruction or perforation, surgical treatment is vital to avoid fatal sepsis and dehydration. However, the risk of surgery and the residual life of a patient must be carefully considered because of high mortality and complication rate in those patients with advanced disease due to the poor condition. The therapeutic value of aggressive hydration, nasogastric tube insertion, and the use of antibiotics is also questionable. Palliative surgery was not performed on this case, and she passed away peacefully in the presence of family after 4 days of palliative medical care. Here is the appropriate management for this kind of patients we would like to recommend through review of relevant references and long discussions. Firstly, we need to predict survival time using clinical variables. Secondly, considering patient status and risk of surgery, non surgical palliative care such as pain control, transient nasogastric tube insertion, and parenteral hydration is recommended. Minimal use of fluid is desirable to minimize complications such as edema and dyspnea if massive hydration in the beginning of treatment is not proved to be effective. Even though started earlier in the course of disease, discontinuation of antibiotics could be discussed with patients and their caregiver if patient status is not improved.

• Proceedings of the Korea Water Resources Association Conference
• /
• 2007.05a
• /
• pp.800-804
• /
• 2007

전 세계에서 홍수로 인한 인명손실과 재산적 피해의 기록을 살펴보면 최근 몇 년 동안 꾸준히 증가하고 있다. 이로 인해서 홍수를 방어하기 위한 노력은 증가하게 되었다. 이로 인해 홍수터에서 인구집중과 개발로 인해 홍수방어를 위해서 막대한 투자가 필요하다. 이와 동시에 지속가능하고 효과적인 수자원 관리는 전체적인 접근방법이 요구되며, 사회와 경제발전과 생태계 보호 및 토지이용과 수자원 이용의 적절한 관리와 연결된 개념이 필요하다. 유역은 육지와 수계 사이의 많은 상호작용이 있는 동적인 시스템이다. 이러한 관점에서 유역을 간단한 고정된 지역적인 문제라고 생각하는 것보다 전체로서의 유역 기능을 개선하는데 노력이 필요하고 시도되어야 할 것이다. 통합홍수관리(IFM : Integrated Flood Management)는 홍수의 긍정적인 측면과 부정적인 측면을 고려한 새로운 접근방법이며, 홍수가 자원적 가치를 지닌 것이라고 생각하는 개념이다. 통합홍수관리의 특징은 홍수조절 대책의 적절한 혼합, 대책의 목적 및 형태(구조적 및 비구조적 대책), 단기간 및 장기간 대책 등의 대책들을 통합하는 것이다. 여기에는 전유역의 수문순환 관리, 통합 토지이용 및 수자원 관리, 최적 혼합대책의 적용 및 통합재해관리 적용 등이 있다. 홍수는 자연적인 수문학적 체계의 중요한 요소이며, 주요 수자원이기도 하다. 그리고 빈번한 홍수로 인해 제방을 넘어 홍수터를 점령한다. 이 결과로 상습 홍수범람지역은 점점 더 인구가 밀집되고 있고 홍수에 더 취약하게 된다. 그러므로 금호강유역에 발생한 홍수의 개요, 원인 및 결과에 대해서 살펴보고, 홍수관리대책과 실효성에 대해서 조사 분석하였다. 그리고 홍수가 발생한 후 홍수관리대책과 관리기술의 변화를 통합홍수관리의 개념에서 분석하였다.Jones matrix, which allows a new interpretation in the conversion efficiency of the thin-film optical waveguides.있다는 장점이 있었다. 따라서 소아에서 복막투석도관 수술 시 복강경적 방법을 이용하는 것이 효율적인 복막 투석을 위해 유용하다고 생각된다.상부 방광천자에 비해 민감도 59.5%(25/42), 특이도 86.6%(13/15)였고 위양성률 13.3%(2/15), 위음성률 40.5%(17/42) 로 정확도가 낮았다. 결론 : 소변을 가리지 못하는 영유아에서 요로 감염을 진단하기 위해서는 도뇨관 채뇨에 비해 초음파 감시하 치골상부 방광천자가 정확하고 안전한 채뇨법으로 권장되어야 한다고 생각한다.應裝置) 및 운용(運用)에 별다른 어려움이 없고, 내열성(耐熱性)이 강(强)하므로 쉬운 조건하(條件下)에서 경제적(經濟的)으로 공업적(工業的) 이용(利用)에 유리(有利)하다고 판단(判斷)되어진다.reatinine은 함량이 적었다. 관능검사결과(官能檢査結果) 자가소화(自家消化)시킨 크릴간장은 효소(酵素)처리한 것이나 재래식 콩간장에 비하여 품질 면에서 손색이 없고 저장성(貯藏性)이 좋은 크릴간장을 제조(製造)할 수 있다는 결론을 얻었다.이 있음을 확인할 수 있었다.에 착안하여 침전시 슬러지층과 상등액의 온도차를 측정하여 대사열량의 발생량을 측정하고 슬러지의 활성을 측정할 수 있는 방법을 개발하였다.enin과 Rhaponticin의 작용(作用)에 의(依)한 것이며, 이는 한의학(韓醫學) 방제(方劑) 원리(原理)인 군신좌사(君臣佐使) 이론(理論)에서 군약(君藥)이 주증(主症)에 주(主)로 작용(作用)하는 약물(藥物)이라는 것을 밝혀주는 것이라고 사료(思料)된다.일전 $

• Journal of the Korean Society of Radiology
• /
• v.85 no.3
• /
• pp.661-667
• /
• 2024

Afferent loop syndrome (ALS) is a rare complication of gastrectomies and gastrointestinal reconstruction. This can predispose patients to fatal conditions, such as cholangitis, pancreatitis, and duodenal perforation with peritonitis. Therefore, emergency decompression is necessary to prevent these complications. Herein, we report two cases in which transcholecystic duodenal drainage, an alternative decompression treatment, was performed in ALS patients without bile duct dilatation. Two patients who underwent distal gastrectomy with Billroth II anastomosis sought consultation in an emergency department for epigastric pain and vomiting. On CT, ALS with acute pancreatitis was diagnosed. However, biliary access could not be achieved because of the absence of bile duct dilatation. To overcome this problem, a duodenal drainage catheter was placed to decompress the afferent loop after traversing the cystic duct via a transcholecystic approach. The patients were discharged without additional surgical treatment 2 weeks and 1 month after drainage.

• Journal of Gastric Cancer
• /
• v.6 no.1
• /
• pp.52-56
• /
• 2006

A 69-year old man presented with severe epigastric pain for 1 day. He had early gastric cancer at the antrum and underwent a distal subtotal gastrectomy and Billorth II gastrojejunostomy one month later without any post-operative complications. Radiologic examination revealed a large amount of retroperitoneal free air formation. Because of unremitting pain and unstable vital sign, exploratory laparotomy was followed. During the operation, a perforated duodenal diverticulum at the posterior wall of the 2nd portion of the duodenum was identified. He underwent diverticulectomy and primary closure. He was discharged on the 18th post operative day and has been followed up without any evidence of comlpication for several months.

• Journal of Chest Surgery
• /
• v.39 no.7 s.264
• /
• pp.511-519
• /
• 2006

Background: Loss of cardiomyocytes in the myocardial infarction leads to regional contractile dysfunction, and necrotized cardiomyocytes in infracted ventricular tissues are progressively replaced by fibroblasts forming scar tissue. Although cardiomyoplasty, or implantation of ventricular assist device or artificial heart was tried in refractory heart failure, the cardiac transplantation was the only therapeutic modality because these other therapeutic strategies were not permanent. Cell transplantation is tried instead of cardiac transplantation, especially bone marrow is the most popular donated organ. But because bone marrow aspiration procedure is invasive and painful, and it had the fewer amounts of cellular population, the adipose tissue is recommended for harvesting of mesenchymal stem cells. Material and Method: After adipose tissues were extracted from abdominal subcutaneous adipose tissue and intra-abdominal adipose tissue individually, the cellular components were obtained by same method. These cellular components were tried to transformation with the various titers of 5-azacytidine to descript the appropriate concentration of 5-azacytidine and possibility of transformation ability of adipose tissue. Group 1 is abdominal subcutaneous adipose tissue and Group 2 is intra-abdominal adipose tissue-retroperitoneal adipose tissue and omentum. Cellular components were extracted by collagenase and $NH_4Cl$ et al, and these components were cultured by non-induction media - DMEM media containing 10% FBS and inducted by none, $3{\mu}mol/L,\;6{\mu}mol/L,\;and\;9{\mu}mol/L$ 5-azacytidine after the 1st and 2nd subculture. After 4 weeks incubation, tile cell blocks were made, immunostaining was done with the antibodies of CD34, heavy myosin chain, troponin T, and SMA. Result: Immunostaining of the transformed cells for troponin T was positive in the $6{\mu}mol/L\;&\;9{\mu}mol/L$ 5-azacytidine of Group 1 & 2, but CD34 and heavy myosin chain antibodies were negative and SMA antibody was positive in the $3{\mu}mol/L\;&\;6{\mu}mol/L$ 5-azacytidne of Group 2. Conclusion: These observations confirm that adult mesenchymal stem cells isolated from the abdominal subcutaneous adipose tissues and intra-abdominal adipose tissues can be chemically transformed into cardiomyocytes. This can potentially be a source of autologous cells for myocardial repair.