• Journal of Trauma and Injury
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• 제23권2호
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• pp.57-62
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• 2010

Purpose: This study analyzed the characteristics of stable pelvic bone fractures with intra-abdominal solid organ injury. Methods: Medical records were retrospectively reviewed from January 2000 to December 2009 of patients with stable pelvic bone fractures. A stable pelvic bone fracture according to Young's classification is defined as a lateral compression type I and antero-posterior compression type I. Subjects were divided into two groups, one with (injured group) and one without (non-injured group) intra-abdominal solid organ injury, to evaluate the dependences of the characteristics on the presence of an intra-abdominal solid organ injury. Data including demographics, mechanism of injury, initial hemodynamic status, laboratory results, Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), amount of transfusion, admission to intensive care unit (ICU), and mortality were analyzed. Results: The subjects were 128 patients with a mean age of 42 years old, of whom were 67 male patients (52.3%). The injured group had 21 patients(16.4%), and the most frequent injured solid organ was the liver. Traffic accident was the most common mechanism of injury and lateral compression was the most common type of fracture in all groups. Initial systolic blood pressure was lower in the injured group, and the ISS was greater in the injured group. Arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. Transfused packed red blood cells within 24 hours were 8 patients(38.1%) in the injured group and 11 patients(10.3%) in the non-injured group. Conservative treatment was the most common therapeutic modality in all groups. Stay in the ICU was longer in the injured group, and three mortalities occurred. Conclusion: There is a need to decide on a diagnostic and therapeutic plan regarding the possibility of intra-abdominal solid organ injury for hemodynamically unstable patients with stable pelvic bone fractures and for patients with stable pelvic bone fractures along with multiple associated injuries.

• Journal of Chest Surgery
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• 제20권1호
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• pp.199-201
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• 1987

We have recently experienced a rare case of abdominal aortic injury caused by deceleration force during fall in upright position. The patient was 43-year-old brick-layer fell from 12 meter height and sustained compression fracture of the spine and both legs. The aortic injury was unnoticed at that time. About 2 years later, marked stenosis of the distal abdominal aorta was found together with clinical manifestations of ischemia of both legs. Aorto-femoral bypass on both sides has completely relieved the symptoms, Similar type of abdominal aortic injuries could not be found in the literatures.

• Journal of Chest Surgery
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• 제25권10호
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• pp.1141-1145
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• 1992

A rare syphilitic abdominal aortic aneurysm associated with pulmonary embolism and deep vein throbosis is reported. We have experienced a huge infrarenal syphilitic abdominal aortic aneurysm which caused venous compression at left common iliac vein. A 29 year-old female was admitted via emergency room due to several episodes of hemoptysis. Clinical evaluation for this patient revealed a couple of small ill-defined masss densities on the both lung field and abominal aortic anuerysm. Emergency wedge resections of left upper and lower lobes were performed because of a massive hemoptysis. Pathologic diagnosis showed pulmonary infarction. 20 days after thoracotomy an elective operation on abdominal aortic anuerysm was successfully carried out and post operative pathology finding showed syphilitic aortitis.

• Journal of Trauma and Injury
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• 제34권3호
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• pp.187-190
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• 2021

A 91-year-old female presented to Chonnam National University Hospital Regional Trauma Center with a lateral compression type III fracture of the pelvis. She was managed non-operatively for a week in the intensive care unit under close observation and had an emergency operation due to delayed onset of an acute obstructed direct inguinal hernia. Traumatic abdominal wall hernias are rare. However, trauma surgeons should always be aware of the possibility of such injuries because of their critical consequences.

• Journal of Trauma and Injury
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• 제25권1호
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• pp.1-6
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• 2012

Purpose: This study analyzed the characteristics of unstable pelvic bone fractures associated with intra-abdominal solid organ injury. Methods: Medical records were retrospectively collected from January 2000 to December 2010 for patients with unstable pelvic bone fractures. Unstable pelvic bone fracture was defined as lateral compression types II and III, antero-posterior compression types II and III, vertical shear and combined type by young classification. Subjects were divided into two groups, with (injured group) and without (non-injured group) intra-abdominal solid organ injury, to evaluate whether the characteristics of the fractured depended on the presence of associated solid organ injury. Data included demographics, mechanism of injury, initial hemodynamic status, laboratory results, revised trauma score (RTS), abbreviated injury scale (AIS), injury severity score (ISS), amount of transfusion, admission to the intensive care unit (ICU), and mortality. Results: The subjects were 217 patients with a mean age of 44 years and included 134 male patients(61.8%). The injured group included 38 patients(16.9%). Traffic accidents were the most common mechanism of injury, and lateral compression was the most common type of fracture in all groups. The initial blood pressure was lower in the injured group, and the ISS was greater. The arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. The amount of the transfused packed red blood cells within 24 hours was higher in the injured group than the non-injured group. Invasive treatment, including surgery and angiographic embolization, was more common in the injured group, and the stay in the ICU was longer in the injured group. Conclusion: A need exists to decide on a diagnostic and therapeutic plan regarding the possibility of intra-abdominal solid organ injury for hemodynamically unstable patients with unstable pelvic bone fractures and multiple associated injuries.

• 대한방사선치료학회지
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• 제33권
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• pp.71-78
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• 2021

목 적: 폐암과 간암 환자에 대해 압력 기반 복부압박장치를 적용하여 입체적 세기변조 회전 방사선치료(VMAT)를 시행하였을 때의 치료 간(interfraction) 위치 재현성과 호흡 재현성을 평가함으로써 그 유용성을 평가하고자 한다. 대상 및 방법: 압력 기반 복부압박장치를 사용해 입체적 세기변조 회전 방사선치료를 받은 6명의 폐암 환자와 3명의 간암 환자를 대상으로 하였다. 치료 간 위치 재현성 평가를 위해 모의치료 CT 영상과 매일 획득한 CBCT 영상 174건을 비교하여 이미지 정합의 이동 값을 비교, 분석하였다. 치료 간 호흡 재현성 평가를 위해 모의치료 4DCT 영상과 매주 획득한 4D CBCT 영상 54건을 비교하여 호흡량 오차를 구하였다. 결 과: 수평수직 세 방향의 3D 벡터값인 전체 위치변화(Overall position variation, Overall VP)값은 폐와 간에서 각각 평균 1.1 ± 1.4 mm, 4.5 ± 2.8 mm로 나타났다. 호흡 변화(respiratory variation, Vr)값은 폐에서 평균 0.7 mm ± 3.4 mm (p=0.195), 간에서 평균 3.6 mm ± 2.6 mm (p<0.05)로 나타났다. 결 론: 흉복부 방사선 치료 시 압력 기반 복부압박장치의 적용은 복부 압박 재현을 통해 치료 간 종양의 호흡 변이뿐만 아니라 위치 변이를 안정적으로 조절하는 데에 유용한 것으로 사료된다. 보다 안정적인 재현성을 위해 치료 계획 시 적절한 PTV 여유가 고려되어야 하고, 매 치료 전 영상 유도에 따른 표적의 위치와 호흡 검증이 필요하다.

• Journal of Korean Neurosurgical Society
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• 제52권3호
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• pp.257-260
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• 2012

Spinal extradural arachnoid cysts usually cause symptoms related to spinal cord or nerve root compression. Here, we report an atypical presentation of a spinal extradural arachnoid cyst combined with congenital hemivertebra which was presented as a retroperitoneal mass that exerted mass effects to the abdominal organs. On image studies, the communication between the cystic pedicle and the spinal arachnoid space was indistinct. Based on our experience and the literature of the pathogenesis, we planned anterior approach for removal of the arachnoid cyst in order to focus on mass removal rather than ligation of the fistulous channel. In our estimation this was feasible considering radiologic findings and also essential for the symptom relief. The cyst was totally removed with the clogged 'thecal sac-side' end of the cystic pedicle. The patient was free of abdominal discomfort by one month after the surgery.

• Journal of Trauma and Injury
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• 제33권1호
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• pp.18-22
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• 2020

Purpose: Damage control laparotomy has contributed to improved survival rates for severe abdominal injuries. A large part of severe abdominal injury occurs with a concomitant pelvic bone fracture. The safety and effectiveness of internal fixation of pelvic bone fracture(s) has not been established. The aim of the present study was to evaluate infection risk in the pelvic surgical site in patients who underwent emergent abdominal surgery. Methods: This single-center retrospective observational study was based on data collected from a prospectively maintained registry between January 2015 and June 2019. Patients who underwent laparotomy and pelvic internal fixation were included. Individuals <18 and ≥80 years of age, those with no microbiological investigations, and those who underwent one-stage abdominal surgery were excluded. Comprehensive statistical comparative analysis was not performed due to the small number of enrolled patients. Results: A total of six patients met the inclusion criteria, and the most common injury mechanism was anterior-posterior compression (67%). The average duration of open abdomen was 98 hours (range, 44-98), and the time interval between abdominal closure and pelvic surgery was 98 hours. One patient (16.7%) died due to multi-organ dysfunction syndrome. Micro-organisms were identified in the abdominal surgical site in five patients (83%), with no micro-organisms in pelvic surgical sites. There was no unplanned implant removal. Conclusions: Internal fixation of pelvic bone fracture(s) could be performed in the state of open abdomen, and the advantages of early fixation may countervail the risks for cross contamination.

• 대한방사선치료학회지
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• 제33권
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• pp.35-46
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• 2021

목 적 : 폐암의 정위 절제 방사선 치료(Stereotactic Ablative Radiation Therapy, SABR)시 복부압박을 이용한 치료계획과 양압지속유지기(The Continuous Positive Air Pressure, CPAP)를 이용한 치료계획을 비교, 분석하여 방사선 치료 효과 향상에 기여하고자 한다. 대상 및 방법 : 본원의 폐의 SABR 환자 중 2명을 대상으로 복부 압박 고정 장치(the Body Pro-Lok, BPL)와 CPAP를 이용한 치료 계획을 수립하여, RTOG 0813에서 제안한 parameter들과 균질도(Homogeneity Index, HI), 일치도(Conformity Index, CI)를 통해 치료계획을 분석하였다. 또한 모든 4D CT에서 각 Phase별 계획용 표적 체적(Planning Target Volume, PTV) 중심의 X, Y, Z축 움직임을 분석하고, PTV와 손상위험장기(Organ At Risk, OAR)의 체적과 평균 선량을 구하여 비교하였다. 그리고 4개의 원뿔형빔 전산화단층촬영(Cone Beam Computed Tomography, CBCT)을 이용하여, PTV 중심점과 0°, 90°, 180°, 270° 중 세 방향에서의 흉강내 접점까지의 직선거리를 측정하고, 각 방향에서 평균거리 값과의 차이를 비교하였다. 결 과 : BPL과 CPAP를 사용하여 얻은 치료계획은 모두 RTOG의 권고값을 따랐으며, 균질도와 일치도에서도 큰 차이가 없었다. PTV 중심의 X축, Y축, Z축 움직임은 A 환자의 경우 BPL 사용시 0.49 cm, 0.37 cm, 1.66 cm, CPAP 사용시 0.16 cm, 0.12 cm, 0.19 cm을 보였고, B 환자의 경우 BPL 사용시 0.22 cm, 0.18 cm, 1.03 cm, CPAP 사용시 0.14 cm, 0.11 cm, 0.4 cm을 보였다. CPAP 사용시 BPL 사용시보다 A 환자의 경우 ITV가 46.27% 감소하였고 좌측 폐의 체적이 41.94% 증가하였으며, 평균선량은 심장에서 52.81% 감소하였다. B 환자의 경우 좌측 폐 106.89%, 우측 폐 87.32% 체적이 증가하였고, 평균선량은 위에서 44.30% 감소하였다. 각 방향의 직선거리 값과 평균거리 값과의 최대 차이는 A 환자의 경우 a방향에서 0.05 cm, b방향에서 0.05 cm, c방향에서 0.41 cm 났고, B 환자의 경우 d방향에서 0.19 cm, e방향에서 0.49 cm, f방향에서 0.06 cm 차이가 났다. 결 론 : CPAP 사용시 폐용적의 증가를 통해 표적 근처 OAR의 선량을 BPL 사용시보다 더 효과적으로 감소시킬 수 있으며, 호흡에 따른 종양의 움직임 제한에도 더 효과적으로 기여할 수 있다는 것을 확인하였다. 추후 CPAP의 다양한 부위 적용과 다른 치료기와의 결합을 통해 방사선 치료 효과를 개선시킬 수 있을 것으로 사료된다.

• 대한방사선치료학회지
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• 제26권1호
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• pp.69-76
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• 2014

목 적 : 외부 압박을 통해 전립선암 환자의 복강 내 압력을 안정화시켜 움직임을 감소하여 치료 간(interfraction)과 치료 중(intrafraction)에 변화를 측정하여 평가하고자 시행하였다. 대상 및 방법 : 10명의 전립선환자들은 전체 치료과정동안 MVCT 스캔을 통해 치료 전과 후에 걸쳐 환자 당 60개의 영상을 획득하였고 획득한 좌우방향(X), 상하방향(Y), 전후방향(Z), 회전방향(Roll)에 대한 Shift 값들을 이용하여 복부 압박 시 치료 간 치료준비 변화와 치료 중 표적 움직임의 상호 연관성을 분석하였다. 결 과 : 치료 간의 움직임 변화는 평균 좌우방향(X)에서 $0.65{\pm}2.32mm$, 상하방향(Y)에서 $1.41{\pm}4.83mm$, 전후방향(Z)에서 $0.73{\pm}0.52mm$, 회전방향(Roll)에서 $0.96{\pm}0.21^{\circ}$로 나타났다. 치료 중 움직임 변화는 평균 좌우방향(X)에서 $0.15{\pm}0.44mm$, 상하방향(Y)에서 $0.13{\pm}0.44mm$, 전후방향(Z)에서 $0.24{\pm}0.64mm$, 회전방향(Roll)에서 $0.1{\pm}0.9^{\circ}$로 나타났다. 결 론 : 전처치과정과 외부에서 복부압박을 통한 전복부의 움직임을 제한한다면 치료동안에 내부 장기와 환자의 움직임을 감소시켜 보다 적은 여유(margin)로 계획용 표적체적(PTV)을 생성할 수 있어서 정상조직의 부작용 증가 없이 더욱 이상적인 선량 체적을 얻을 수 있을 것으로 사료된다.