• Journal of Chest Surgery
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• 제22권5호
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• pp.839-844
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• 1989

There appears to be significant problems remained in the treatment of tuberculous empyema with BPF in spite of several surgical methods: decortication, thoracoplasty, and pleuropneumonectomy. We presented one case of tuberculous empyema with BPF. The patient was 42-year-old male and his chief complaint was hemoptysis. In past history, he was treated with left closed thoracostomy and antituberculous medication for two months, 16 years ago. Chest X-ray, tomogram and C. T, revealed a huge mass with central necrosis in the lower 2/3 of left thoracic cavity and shifting of the mediastinal structure to the right. Needle aspiration cytology was undifferentiated large cell carcinoma. Left thoracotomy was made under the impression of lung cancer and pleuropneumonectomy was done. Operative findings; thick walled empyema sac filled with hematoma and BPF, the mediastinum was fixated due to fibrosis and calcification of the pleura and the mediastinum. Postoperative biopsy was consistent with tuberculosis. In the postoperative course, there was massive hemorrhage and so reoperation was done. But there was no active bleeding focuses in the thoracic cavity at the time of reoperation. Massive transfusion, coagulant therapy and intermittent clamping and declamping of the chest tube were carried out. Especially, serum calcium level was chronically decreased and so large amount of calcium gluconate was infused for the calcium level to be normal. Total transfused blood; whole blood was 33 pints, packed cell was 63 pints and fresh frozen plasma was 70 pints. At the postoperative[reop] 45th day, intrathoracic hemorrhage was stopped and the chest tube was removed. In conclusion, this suggest that uncontrollable bleeding after pleuropneumonectomy of the tuberculous empyema with BPF could be treated without reoperation in case of the mediastinal fixation due to fibrosis and calcification of the pleura and the mediastinum.

• Journal of Korean Neurosurgical Society
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• 제30권sup2호
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• pp.247-253
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• 2001

Objective : In general, to perform posterior lumbar interbody fusion(PLIF), it has been used more invasive procedure than simple discectomy. However we try to perform PLIF with TFC with smaller invasion almost same as in simple discectomy. This study is about its procedure and clinical results. Materials and Methods : The authors retrospectively analyzed 43 cases of minimally invasive PLIF with TFC from July 1998 to May 2000. Operative procedure, operative complication, change of disc height, blood loss, ambulation time, hospitalization period, clinical success rate, and bony fusion rate were analyzed. Results : 40 patients were capable to walk on the 2nd day of the post-operation. The average hospitalization period is 5.6 days. The average blood loss was 0.19L/level with no transfusion or wound drainage. The height of disc changed from 8.84mm to 13.54mm. Clinical success rate is 95% when evaluated by the Prolo's scale. The complication was delayed wound infection(2) and transient paresthesis(1). The bony fusion was shown in 17 patients (94.4%) out of 18 patients who passed one year. Conclusion : As a result of minimally invasive PLIF, pain was decreased and early ambulation and short hospitalization was possible. Complication was similar or lower than other studies, and the bony fusion rate and clinical success rate were also similar during follow-up.

• 한국동물위생학회지
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• 제45권2호
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• pp.139-143
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• 2022

A 10-year-old, spayed female miniature schnauzer was referred to the Veterinary Medical Teaching Hospital of Chungnam National University due to evaluation of sudden polyuria (PU) and, polydipsia (PD) (540 mL/kg/day) with severe anemia and weight loss. Blood examination results were normal except for severe anemia (hematocrit, [HCT]: 11.8%). Urinalysis revealed a urine specific gravity (USG) of 1.003, whereas urine sediment was not specific. Urine osmolality was 90 mOsm (reference range: 800~2500 mOsm), and plasma osmolality was 303 mOsm. No specific lesions were found using diagnostic imaging including radiography, ultrasonography and magnetic resonance imaging (MRI). The serum cortisol level was normal in cosyntropin stimulation test. Plasma arginine vasopressin (AVP) concentration was <0.4 pg/mL (reference range: 3.49~5.45 pg/mL). Blood transfusion was initiated in addition to an oral prescription of desmopressin acetate (DDAVP, 0.1 mg/head) thrice a day for one week. The patient was rechecked for clinical signs, urine osmolality, and USG; the clinical signs of PU/PD were resolved, urine osmolality increased to 1106 mOsm, and, USG increased to 1.021. Considering the improved clinical signs, and increased urine osmolality, and USG after DDAVP treatment, the dog was diagnosed with central diabetes insipidus. USG and urine osmolality increased to >1.030 and 2200 mOsm, respectively. Anemia also gradually improved and HCT increased to >37%. DDAVP was tapered to 0.1 mg/head twice a day and all clinical signs in the patient have completely resolved.

• Journal of Chest Surgery
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• 제42권3호
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• pp.311-316
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• 2009

배경: 광범위한 clopidogrel의 사용으로 인해 관상동맥우회로술 전 많은 경우에서 clopidogrel 복용 환자들을 경험하게 된다. 그러나 clopidogrel은 그 고유한 약리 작용으로 인하여 술 후 출혈과 관련한 합병증을 일으킬 수 있다. 저자들은 술 전 clopidogre니 사용이 무심폐기하 관상동맥우회로술(off-pump coronary bypass grafting, OPCAB)후의 수혈 요구량, 지혈을 위한 재수술율 및 출혈과 관련한 재입원율 등에 미치는 영향을 알아보고자 하였다. 대상 및 방법: 이 연구는 2005년 1월부터 2007년 11월까지 단일 수술자에 의해 시행된 무심폐기하 관상동맥우회로술을 받은 환자 중, 수술 전 clopidogrel을 복용하고 있던 103명의 환자를 대상으로 하였다. 이 중 clopidogrel을 수술 5일 전에 복용을 중단한 군을 그룹 1 (n=45)으로 하고, 수술 5일 이내에도 계속 복용한 군을 그룹 2 (n=58)로 나누어 출혈과 관련한 재수술율 및 재입원율, 혈액 투여량, 술 후 출혈양 등을 비교 검토하였다. 결과: 두 군 간의 인구학적 특성, 심초음파, 혈액학적인 특성은 비슷하였다. 술 후 출혈양은 통계적으로 유의하게 차이가 나지는 않았지만, 술 후 수혈양은 그룹 2에서 더 많았다(p=0.018). 지혈을 목적으로 한 재수술율과 출혈과 연관된 재입원율은 그룹 1에서는 각각 0%, 0%였고, 그룹 2에서는 6.9%, 5.2%였다. 그러나 두군 간의 통계적인 차이는 없었다. 결론: 무심폐기하 관상동맥우회로술 시행 전 clopidogrel의 계속적인 사용은 술 후 주요한 출혈을 일으키지는 않지만 어느 정도는 출혈에 영향을 주고, 술 후 수혈양은 증가시켰다. 응급인 경우가 아니라면 술 전 clopidogrel을 일정 기간 끊는 것이 술 후 회복에 좋으리라 생각된다.

• 대한수혈학회지
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• 제23권2호
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• pp.115-126
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• 2012

배경: 제대 조직은 간엽줄기세포(mesenchymal stromal cells, MSCs)의 유망한 공급원 중 하나이다. 본 연구에서는 동결 보관한 제대 조직에서 유래한 간엽줄기세포의 특성을 신선 제대 조직에서 유래한 간엽줄기세포와 비교함으로써, 제대 조직을 동결한 보관 후 해동하여 간엽줄기세포를 획득하기 위해 제대 조직의 동결 보관 가능성을 제시하고자 하였다. 방법: 각각의 제대 조직을 두 가지 크기($1{\sim}2mm^3$과 0.5 cm)로 처리하여, 두 가지 동결 보존제(자가제대혈장과 RPMI 1640)를 사용하여 액체질소에 동결 보관하였다. $1{\sim}2mm^3$로 잘게 자른 신선 제대 조직을 대조군으로 하였다. 1주일 후 해동하여 세포 배양하였으며, 0.5cm 크기로 동결 보관한 제대 조직은 해동 후 $1{\sim}2mm^3$로 잘게 세포 배양하였다. 각각의 경우에 수확한 세포의 수와 생존율, 세포 증식능, 세포표면항원을 분석하였으며, 배양액에 존재하는 다양한 성장인자(EGF, IGF-1, PDGF, TGF-${\beta}$, bFGF, VEGF)를 측정하였다. 결과: 11개의 제대를 대상으로 하였다. 자가제대혈장을 동결 보존제로 사용한 경우보다 RPMI 1640을 동결 보존제로 사용한 경우에 세포 획득율이 높았으며, 동결 전에 $1{\sim}2mm^3$로 잘게 잘라 동결 보존한 제대 조직보다는 0.5 cm 크기로 동결하였다가 해동 시 잘게 자른 제대 조직에서 세포 획득율이 높았다. 신선 제대 조직과 동결 제대 조직에서 유래한 세포들 간에 증식능의 차이는 없었다. 신선 제대 조직의 배양액보다 RPMI 1640을 이용하여 동결 보관한 제대 조직의 배양액에 성장인자가 더 많이 존재하였다. 결론: 본 연구 결과, 동결 보관한 제대 조직에서 간엽줄기세포뿐만 아니라 배양액의 성장인자도 얻을 수 있었으며, 제대혈을 동결 보관하는 것처럼 향후에는 간엽줄기세포와 성장인자를 필요한 시점에 얻기 위해 제대 조직을 동결 보관하는 것도 가능해질 것으로 기대된다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제37권4호
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• pp.272-277
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• 2011

Purpose: The aim of this study was to compare the estimated blood loss and determine the change in hemoglobin depending on the combination of each orthognathic surgery. Subjects and Methods: The subjects of this study were patients who underwent orthognathic surgery among those diagnosed with a dentofaical deformity in Mok-Dong hospital, Ewha Womans University from 2002 to 2009. One hundred patients (men - 36, women - 64, mean age of $24.5{\pm}4.6$) participated in the study and were divided into four groups (group 1 - bilateral sagittal ramus osteotomy [BSSRO], group 2 - BSSRO+Genioplasty, group 3 - Lefort 1+BSSRO+genioplasty, group 4 - anterior segmental osteotomy on maxilla and mandible). A comparative study on the estimated blood loss (EBL), operation time, peri-operative changes in hemoglobin was performed using anesthesia records. The results were analyzed statistically using a Mann-Whitney U-test and Spearman's Rho test - SPSS 12.0 (SPSS Inc. Chicago, IL, USA). Results: In group 1 (BSSRO), the mean EBL, operation time and change in hemoglobin was $394.43{\pm}52.69$ ml, $184{\pm}42.33$ minutes, and 1.43, respectively, In group 2 (BSSRO+genioplasty), it was $556.32{\pm}63.42$ ml, $231{\pm}37.45$ minutes, and 1.80, respectively. In group 3 (Lefort 1+BSSRO+Genioplasty), it was $820.55{\pm}105.54$ ml, $320{\pm}15.41$ minutes, and 2.73, respectively. In group 4 (segmental osteotomy), it was $1025.39{\pm}160.21$ ml, $355{\pm}20.10$ minutes, and 3.33, respectively. In particular, in group 3, significant differences were observed depending on the method of the orthognathic surgery. The mean EBL in a Lefort 1 osteotomy with advancement was only 687 ml, whereas Lefort 1 osteotomy with canting correction (992 ml), even impaction (764 ml), and posterior nasal spine impaction (100 ml) showed a much higher EBL. Conclusion: From these results, the EBL and peri-operation hemoglobin increased as treatment plans became more complicated and increasing operation time. Safe orthognathic surgery should be performed by applying proper autologous transfusion plans based on the average EBL of each orthognathic surgery type.

• Journal of Trauma and Injury
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• 제21권1호
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• pp.46-52
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• 2008

Purpose: This study was to evaluate the effect of arterial embolization on survival in patients with pelvic bone fractures and arterial bleeding. Methods: From January 2001 to December 2007, in all, 18 patients with pelvic bone fractures that had been treated with interventional arterial embolization were included in this retrospective study. The Injury Severity Score (ISS), the Revised Trauma Score (RTS), the initial hemodynamic status, the blood gas analysis, blood transfusion data, and mortality were the main outcome measurements. Results: Pelvic bone fractures were classified into lateral compression (LC), antero-posterior compression (APC), vertical shear (VS), and combined (CM) type according to the Young-Burgess classification. The Survivor group included 11 patients (61.1%), and the non-survivor group included 7 patients (38.9%). The mean ages for the survivor and the non-survivor groups were 40.0 and 45.6 years (p=0.517). The types of pelvic bone fractures were LC 11 (61.1%), APC 6 (33.3%), and VS 1 (5.6%): LC 7 (63.6%), and APC 4 (36.4%) in the survivor group and LC 4 (57.1%), APC 2 (28.6%), and VS 1 (14.3%) in the non-survivor group. The internal iliac artery was the predominant injured vessel among both the survivors (n = 5, 45.5%) and the non-survivors (n = 4, 57.1%). No differences in initial blood pressures, ISS, and RTS existed between the two groups, but the arterial pH was lower in the non-survivor group (pH 7.09 (${\pm}0.20$) vs 7.30 (${\pm}0.08$), p=0.018). The number of transfused 24-hour units of packed RBC was greater in the non-survivor group ($24.1{\pm}12.5$ vs $14.4{\pm}6.8$, p=0.046). Conclusion: No differences in initial blood pressure and trauma scores existed between survivors and non-survivors with pelvic bone fractures, who had been treated with arterial embolization, but arterial pH was lower the in non-survivors.

• Journal of Korean Neurosurgical Society
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• 제56권3호
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• pp.218-223
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• 2014

Objective : C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are often utilized to evaluate for postoperative infection. Abnormal values may be detected after surgery even in case of non-infection because of muscle injury, transfusion, which disturbed prompt perioperative management. The purpose of this study was to evaluate and compare the perioperative CRP, ESR, and white blood cell (WBC) counts after spine surgery, which was proved to be non-infection. Methods : Twenty patients of lumbar open discectomy (LOD) and 20 patients of posterior lumbar interbody fusion (PLIF) were enrolled in this study. Preoperative and postoperative prophylactic antibiotics were administered routinely for 7 days. Blood samples were obtained one day before surgery and postoperative day (POD) 1, POD3, and POD7. Using repeated measures ANOVA, changes in effect measures over time and between groups over time were assessed. All data analysis was conducted using SAS v.9.1. Results : Changes in CRP, within treatment groups over time and between treatment groups over time were both statistically significant F(3,120)=5.05, p=0.003 and F(1,39)=7.46, p=0.01, respectively. Most dramatic changes were decreases in the LOD group on POD3 and POD7. Changes in ESR, within treatment groups over time and between treatment groups over time were also found to be statistically significant, F(3,120)=6.67, p=0.0003 and F(1,39)=3.99, p=0.01, respectively. Changes in WBC values also were be statistically significant within groups over time, F(3,120)=40.52, p<0.001, however, no significant difference was found in between groups WBC levels over time, F(1,39)=0.02, p=0.89. Conclusion : We found that, dramatic decrease of CRP was detected on POD3 and POD7 in LOD group of non-infection and dramatic increase of ESR on POD3 and POD7 in PLIF group of non-infection. We also assumed that CRP would be more effective and sensitive parameter especially in LOD than PLIF for early detection of infectious complications. Awareness of the typical pattern of CRP, ESR, and WBC may help to evaluate the early postoperative course.

• Journal of Trauma and Injury
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• 제24권1호
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• pp.1-6
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• 2011

Purpose: Even though traumatic pancreatic injuries occur in only 0.2% to 4% of all abdominal injuries, the morbidity and the mortality rates associated with pancreatic injuries remain high. The aim of this study was to evaluate the clinical outcomes of traumatic pancreatic injuries and to identify predictors of mortality and morbidity. Methods: We retrospectively reviewed the medical records of 26 consecutive patients with a pancreatic injury who underwent a laparotomy from January 2000 to December 2010. The data collected included demographic data, the mechanism of injury, the initial vital signs, the grade of pancreatic injury, the injury severity score (ISS), the revised trauma score (RTS), the Glasgow Coma Scale (GCS), the number of abbreviated injury scales (AIS), the number of associated injuries, the initial laboratory findings, the amount of blood transfusion, the type of operation, the mortality, the morbidity, and others. Results: The overall mortality rate in our series was 23.0%, and the morbidity rate was 76.9%. Twenty patients (76.9%) had associated injuries to either intra-abdominal organs or extra-abdominal organs. Two patients (7.7%) underwent external drainage, and 18 patients (69.3%) underwent a distal pancreatectomy. Pancreaticoduodenectomies were performed in 6 patients (23.0%). Three patients underwent a re-laparotomy due to anastomosis leakage or postoperative bleeding, and all patients died. The univariate analysis revealed 11 factors (amount of transfusion, AAST grade, re-laparotomy, associated duodenal injury, base excess, APACHE 11 score, type of operation, operation time, RTS, associated colon injury, GCS) to be significantly associated with mortality (p<0.05). Conclusion: Whenever a surgeon manages a patient with traumatic pancreatic injury, the surgeon needs to consider the predictive risk factors. And, if possible, the patient should undergo a proper and meticulous, less invasive surgical procedure.

• The Korean Journal of Physiology
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• 제6권2호
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• pp.39-48
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• 1972

Two polyethylene tubes were inserted into the esophagus of anesthetized rabbit in order to record the fluctuation of the intraluminal pressure through the orifices located near the tips of the tubes. The orifice of the first tube was 10 cm apart from the incisor of the rabbit and the orifice of the second tube was 5 cm below that of the first one. The tubes were filled with saline solution running at various rates ranging from 1.5 ml/min. to 4.2 ml/min. The tubes were connected to the pressure transducers and the electrical signals were recorded by the physiograph. When the peristaltic wave approached to the orifice a rise in the pressure was recorded, returning to the base line when the portion of the orifice was quiescent. The frequency of the peristaltic motion and the velocity of the wave were studied in connection with the flow rate of saline solution through the tubes and in the case of massive acute hemorrhage. The results obtained were as follows: 1. There was reflux of fluid induced during the procedure of the experiment. This outwrad flow through the pharynx seemed to elicite swallowing reflexes. Accordingly, the frequency of peristalsis of the esophagus was largely dependent on the flow rate of the fluid through the inserted tubes. By the flow rate of 1.5 ml/min., 2.5 ml/min., or 4.2 ml/min., the frequencies of the peristalsis were revealed to be $8.6{\pm}3.6/10min.,\;14.5{\pm}4.8/10min.\;or\;21.1{\pm}6.3/10min.,$ respectively. The velocity of peristalsis also coincided with the enhanced motility of the esophagus, showing $6.6{\pm}1.5\;cm/sec.,\;8.9{\pm}3.9\;cm/sec.,\;or\;12.4{\pm}4.6\;cm/sec.,$ respectively. 2. By acute hemorrhage, amounting to 2% of the body weight, the frequency of the peristalsis increased to twofold of the control and the propagation velocity also increased by 52 percent. 3. Retransfusion of the shed blood resulted in divergent responses. In some cases there were noticable ameliorations of the effects brought by acute hemorrhage, and in the others there were still increasing tendenies of the motility after the transfusion. 4. Some speculation was made about the possibility of a kind of relationship between the irreversibility of the hemorrhagic shock and the absence of responses by transfusion. 5. The peristalsis persisted even after complete disconnection at the midportion of the esophagus, reaffirming the view of a central regulation of the spatiotemporally coordinated motility, peristalsis.