• 농촌의학ㆍ지역보건
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• 제20권1호
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• pp.31-38
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• 1995

This study was designed to investigate the effectiveness of BCG vaccination. Examination of BCG scar was done among 2,065 first year pupils and tuberculin test with 5 T.U. PPD was performed among 2,730 sixth year pupils in a primary school in Kyongju City, from March to May 1994. The results were; 1. The positive rate of BCG scar was 88.6%, and the BCG vaccination rate was 98.3% among first year pupils. 2. On tuberculin test, 56.3% was negative, 20.4% was intermediate, and 23.3% was positive among sixth year pupils. 3. The BCG vaccination rate among negative and intermediate tuberculin test pupils was 99.6%. 4. The side effects of tuberculin test were reported on 0.4%, consist of blebs and local necrosis.

• Archives of Plastic Surgery
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• 제42권5호
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• pp.626-629
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• 2015

Peripheral nerve injuries remain a challenge for reconstructive surgeons with many patients obtaining suboptimal results. Understanding the level of injury is imperative for successful repair. Current methods for distinguishing healthy from damaged nerve are time consuming and possess limited efficacy. Confocal laser endomicroscopy (CLE) is an emerging optical biopsy technology that enables dynamic, high resolution, sub-surface imaging of live tissue. Porcine sciatic nerve was either left undamaged or briefly clamped to simulate injury. Diluted fluorescein was applied topically to the nerve. CLE imaging was performed by direct contact of the probe with nerve tissue. Images representative of both damaged and undamaged nerve fibers were collected and compared to routine H&E histology. Optical biopsy of undamaged nerve revealed bands of longitudinal nerve fibers, distinct from surrounding adipose and connective tissue. When damaged, these bands appear truncated and terminate in blebs of opacity. H&E staining revealed similar features in damaged nerve fibers. These results prompt development of a protocol for imaging peripheral nerves intraoperatively. To this end, improving surgeons' ability to understand the level of injury through real-time imaging will allow for faster and more informed operative decisions than the current standard permits.

• Journal of Chest Surgery
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• 제27권3호
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• pp.221-225
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• 1994

Video-assisted thoracic surgery[VATS] has recently evolved as an alternative to thoracotomy for several thoracic disorders. Between March 1993 and September 1993, 42 patients underwent VATS at Gil General Hospital. They were diagnosed as spontaneous pneumothorax in 34[81.0%], mediastinal mass in 5, congenital lobar emphysema in 1, traumatic hemothorax in 1, and sarcoidosis in 1. For pneumothorax, wedge resection of bullae or blebs was done in 18 patients, wedge resection and limited parietal pleulectomy in 13, and only pleulectomy in 2. And excision for mediastinal mass in 5, hematoma evacuation for chronic hemothorax in 1, biopsies of mediastinal lymph node and lung for confirming sarcoidosis in 1, and lobectomy of left upper lobe for congenital lobar emphysema in the child of 12 years. The period of chest tube drainage and postoperative hospitalization averaged 3.8 days [range, 1 to 11 days] and 5.9 days [range, 2 to 18 days]. Three complications occurred in 3 patients with pneumothorax [7.1%, 2 recurrent pneumothorax and 1 postoperative bleeding], and the conversion to open thoracotomy was done in 1 due to massive air leak. The causes of postoperative air leak were speculated and the techniques for saving expensive Endo-GIA staplers are described in this paper. VATS is safe and offers the benefits of reduced postoperative pain and rapid recovery. Our experience indicates a markedly expanded role for VATS in the diagnosis and treatment of various thoracic diseases.

• Journal of Chest Surgery
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• 제33권4호
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• pp.306-309
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• 2000

Background: The purpose of this study was to evalute the diagnostic value of 2mm video thoracoscopy for primary spontaneous penumothorax. Material and Method: During the period of March to June 1999, we prospectively analyzed 33 consecutive patients suffering from primary spontaneous pneumothorax. 2mm video-assisted thoracoscopy was compared with the operative finding. We observed recurrence during the mean follow-up of 3months. Result: Blebs were present in 24 patient(73%: 24/33). These were treated by 10mm video-assised thoracoscopic stapling. Nine pateints with no bleb were treated with pleural drainage. There were no significant differences in the bleb finding. No recurrence occurred during the follow-up period. Conclusion: A 2mm video thoracoscopic examination for primary spontaneous pnumothorax is a useful alternative in deciding the operative indication.

• Journal of Chest Surgery
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• 제25권5호
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• pp.533-540
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• 1992

To evaluate the risk factors involving the recurrence of the spontaneous pneumothorax, 125 patients were reviewed. These patients were consecutively diagnosed and treated for the spontaneous pneumothorax at the Department of Thoracic and Cadiovascular Surgery, Yeungnam University Hospital, from Jun. 1986 to Apr. 1991. The patients were divided into two groups, control and recurrent. The control group, consisting of the 125 patients, did not have recurrences of the pneumothorax for a period of 2 years following the first attack. The recurrent group were the remaining 57 patients, who experienced at least one recurrence during the same period. The number of patients over the age of 50 was significantly higher in the recurrent group than the control group. Abnormal findings on chest X-ray[e.g., old tuberculous scar, emphysematous change, visible bullae of blebs] were observed more frepuently in the recurrent group. also, when the pneumothorax size was larger than 50%, and the air-leakage from the chest tube was longer than 3 days during the first attack the incidence of recurrence was significantly increased in the recurrent group. The recurrence occured more frequently in the afternoon, and in the same thoracic cavity. Exertion and smoking were not related to the risk factors in this clinical setting.

• Journal of Chest Surgery
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• 제22권5호
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• pp.788-793
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• 1989

We have observed 501 cases of spontaneous pneumothorax from January 1981 to June 1989 at the Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Hospital. Of these, 57 patients have undergone thoracotomy to treat the pneumothorax after closed thoracostomy. These 57 patients were based on this retrospective clinical analysis, and the results were as follows: The ratio of male to female was 4.2:1 in male predominance and the old aged patients, over 50 years old, occupied 47.3% of all patients. Primary spontaneous pneumothorax was 19 cases and secondary spontaneous pneumothorax was 38 cases. The underlying pathology in secondary spontaneous pneumothorax was tuberculosis emphysema and chronic obstructive pulmonary disease in 35 cases. The indications of thoracotomy were persistent air leakage in 23 cases recurrent pneumothorax in 21 cases, inadequate expansion in 13 cases. Rupture of bullae or blebs were most frequent operative and pathologic findings in persistent air leakage group and recurrent pneumothorax group. In inadequate expansion group, predominant finding was destructive lung lesion. Bullectomy and/or bullae ligation was most effective procedures in 36 cases [63%] for operative management of spontaneous pneumothorax. Duration of preoperative and postoperative chest tube indwelling day was 13.35 days and 8.05 days in persistent pneumothorax group, 8.92 days and 7.77 days in recurrent pneumothorax group, 13.23 days and 10.21 days in inadequate expansion group.

• Journal of Chest Surgery
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• 제32권5호
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• pp.448-455
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• 1999

배경: 비디오흉강경수술은 최근 기기의 급속한 발달로 인해 많은 흉부 질환에 적용되고 있으며, 자연기흉에 대한 적절한 치료법으로 제시되고 있지만 개흉술에 비해 높은 재발율이 문제점으로 거론되고 있으며, 수술후 재발에 대한 장기 추적관찰이 미흡한 실정이다. 대상 및 방법: 고대 안암병원 흉부외과에서는 비디오흉강경이 도입된 1992년 3월부터 1997년 3월까지 288명의 자연기흉 환자에 대해서 292례의 비디오흉강경수술을 시행하였다. 수술후 추적 관찰한 결과와 재발에 관여하는 인자를 전향적으로 분석하였다. 개흉술로의 전환례 8례는 제외하였다. 결과: 남자 249명(88.9%), 여자 31명(11.1%)이었으며, 나이는 평균 28.1 12.2세(15~69세)였다. 원발성 자연기흉이 237명(83.5%), 이차성 자연기흉이 47명(16.5%)였으며 이차성 자연기흉 중에서는 결핵성이 27명(57.5%)으로 가장 많았다. 수술 적응증으로는 동측 재발성 기흉이 123명(43.9%)과 지속적 공기누출 53명(18.9%)으로 대부분을 차지하였으며, 그외 흉부촬영상 폐기포가 존재한 경우 40명(14.3%), 긴장성 기흉 30명(10.7%), 반대측 기흉 21명(7.5%), 양측성 기흉 3명(1.1%), 합병증이 동반된 경우 2명(0.7%), 그리고 환자나 보호자가 원한 경우가 8명(2.9%)이였다. 흉강경수술시 폐기포가 관찰된 경우 247례(87%)였다. 244례(85.9%)에서 폐기포절제술이 시행되었다. 평균 수술시간은 52.8 23.1분(20~165분)이었다. 술후 합병증으로 5일 이상 공기누출이 16례이었으며, 이중 4례에서 재수술이 필요하였으며 전례에서 폐기포가 다시 발견되었다(100%, 4/4). 출혈이 5례 있었으며 이중 3례에서 재수술이 필요하였다. 그외 무기폐 2례, 농흉 5례, 창상감염 1례가 병발되었으며 술후 사망례는 없었다. 평균 흉관거치기간은 5.0 4.5일(2~37일), 평균 입원일은 8.2 5.5\ulcorner(3~43일)이었다. 평균 22.3 18.4개월(1~65개월)의 추적 관찰기간 동안 12례가 누락됐으며(4.2%), 24례(8.5%,)가 재발하였다. 이중 7명의 경우 재수술이 필요하였으며 6례에서 폐기포가 재발견되었다(85.7%, 6/7). 12개의 요인(나이, 성별, 기흉의 위치, 기흉의 정도, 원인질환 유무, 수술 적응증, 폐기포의 수, 폐기포의 크기, 폐기포의 위치, 폐기포절제 유무, 흉막유착술 방법, 술후 지속성 공기누출 유무)가 재발에 관여하는 지에 대해 분석하였다. 원인질환 유무, 흉막유착술 방법과 술후 지속성 공기누출 유무가 재발에 관여하는 위험요인으로 나타났다. 이차성인 경우가 원발성인 경우보다 재발율이 높았고[17.0%(8/47) : 6.8% (16/237), p=0.038], 술후 지속적 공기누출이 있었던 경우 재발율이 높았으며[37.5%(6/16) : 6.7%(18/268), p=0.001], 기계적 흉막유착술이 흉막절제술보다 재발율이 높았다[11.4%(19/167) : 4.3%(5/117), p=0.034]. 폐기포절제술을 시행한 경우가 하지않은 경우보다 재발율이 낮았으나 통계학적 의의는 없었다[10.0%(4/40) : 8.2%(20/244), p>0.05]. 결론: 비디오흉강경술에서 재발을 낮추기 위해 수술시 폐야 전체를 관찰하여 존재하는 폐기포를 놓치지 않는 것이 중요하며, 폐기포를 확인하지 못한 경우와 이차성 자연기흉에 대해서는 흉막유착술에 더 세심한 주의가 필요하다는 것을 확인하였다. 비디오흉강경수술은 통증이 적고, 입원기간이 짧고, 사회로의 복귀가 빠르며, 고위험군에 적용할 수 있고, 무엇보다도 미용상의 이점이 크다는 면에서 자연기흉에 대해 유용한 치료방법임에는 틀림이 없으나 개흉술에 비해 재발율이 높고 비용이 비싸다는 문제가 제기되고 있는 만큼 더 세심한 주의와 장기 추적관찰이 필요하리라 사료된다.

• Journal of Chest Surgery
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• 제9권1호
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• pp.98-101
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• 1976

Clinical observations were made on a total 104 cases of spontaneous pneumothorax during the period of 5 years from MAR. 1971 to MAR. 1976 at the Dept. of Chest Surgery, Korea University Medical College. The ratio of male to female cases was 7.4 : 1 in male predominance, and age distribution was 73% of the total cases within the 15-40 age range. There were 56 patients (53.8%) of right sided pneumothorax and 44 patients (42.3%) of left sided pneumothorax, 8 patients presented bilateral spontaneous pneumothorax. The etiologic factors were tuberculous origin in 42.3%, rupture of bullae or blebs in 15.4%, acute pulmonary infection in 3.8%, pulmonary paragonimiasis in 2.9%, cysticercosis 1%, Marfan's syndrome in 1.9%, unknown causes in 32.7%. In all 104 cases, closed chest tube thoracostomy were performed for reexpansion of collapsed lung. In 50 cases of 104 cases, intrapleural instillation of Quinacrine HCl (Atabrine, Winthrop Laboratories, New York, N.Y.) thru the chest tube was used to control of recurrent pneumothorax, and compared observation with 54 cases control group of closed chest tube thoracostomy only. In both groups, 1) cure rates were 63% in control group and 88% in Atabrine group. 2) average duration of inserted chest tube were 5.6 days in control group and 5.7 days in Atabrine group.

• Parasites, Hosts and Diseases
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• 제23권1호
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• pp.47-58
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• 1985

프라지관텐 투여가 흰쥐체내에서 Fibricola seoulensis에 미치는 영향을 광학 및 주사전자현미경을 이용하여 관찰하였다. 피낭유충은 뱀의 내장에서 분리한 것을 사용하였고 5마리의 비투약대조군 및 10마리의 투약군 횐쥐에 각각 1,000개씩을 경구감염시켰다. 감염 7일후 투약군 횐쥐에 10mg/kg의 프라지관텔을 투여하고 1∼24시간후 횐쥐를 회생시킨 다음 소장으로부터 충체를 수집하여 대조군으로부터 얻은 충체와 비교관찰하였다. 투약군에서 얻은 F. seoulensis충체는 광학현미경적 관찰에서 충체특히 전반부의 수축 및 잇달은 이완, 표피 및 표피하 실질조직의 공포화(vacuolization) 및 장관의 내공폐쇄 등이 특징적으로 관찰되었다. 주사전자현미경적인 충체 표피의 변화는 많은 수포형성(blob formation) 및 파열과 이에 따른 충체 전표피의 파괴로 특징지을 수 있었다. 이런 결과는 프라지관텔에 의한 충체의 손상이 표피에 심하게 나타나지만 표피에 한정되지 않고 표피하층까지도 파급되며 또 장관에도 뚜렷한 손상이 오는 것을 나타내고 있었다. 이런 점으로 보아 충체에 의한 프라지관텔의 흡수는 표피 뿐만 아니고 소화관을 통해서도 일어남을 의미하였다.

• Archives of Plastic Surgery
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• 제32권4호
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• pp.408-415
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• 2005

Following a transverse rectus abdominis musculocutaneous(TRAM) flap breast reconstruction, denervated state of the flap causes the flap skin prone to thermal injury, calling for special attention. During the last 5 years, 69 breast reconstruction with 72 free TRAM flaps, were performed. Four out of thesse 69 patients sustained burn injury. Heat sources were a warm bag(n=2), heating pad(n=1) and warming light (n=1). The thermal injuries occured from 2 days to 3 months following the reconstruction. Three patients healed with conservative treatment, but one patient required debridement and skin graft. Initially 3 out of 4 patients with the burn had shown superficial 2nd degree burn with small blebs or bullae. However all 4 patients healed with scars. Mechanism of burn injuries of the denervated flap are known to be resulting from; 1) loss of behavioral protection due to denervation of flap with flap elevation and transfer, 2) loss of autonomic thermoregulatory control with heat dissipation on skin flap vasculature contributing to susceptibility of burn injury. 3) changes of immunologic and normal inflammatory response increasing thromboxane, and a fall in substance P & NGF (nerve growth factor). Including the abdominal flap donor site, sensory recovery of the reconstructed breast varies individually from 6 month even to 5 years postoperatively. During this period, wound healing is delayed, resulting in easier scarring compared to that observed in the sensate skin. Patients should be carefully informed and warned of possible burn injuries and taught to avoid exposure to heat source at least until 3 years postoperatively.