• 제목/요약/키워드: Damage control surgery

검색결과 133건 처리시간 0.027초

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

  • 이재일;손화영;정성목;김명철
    • 한국임상수의학회지
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    • 제25권4호
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    • pp.257-262
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    • 2008
  • 신장의 허혈-재관류 손상은 수술하는 동안 부득이하게 발생하는 허혈-재관류 손상에 대한 이식조직의 내성에 따라 이식된 장기의 생존력이 달려있기 때문에 임상적으로 아주 중요하다. 본 연구의 목적은 신장 혈관을 차단하여 유발한 허혈-재관류 모델에서 관류-흡인의 효과를 알아보고자 실시하였다. 신기능과 항산화 효소를 검사하기 위해 혈액 샘플을 채취하였고 신장내 동맥의 혈류저항을 측정하였다. 14일째 신장을 절제하여 조직검사를 실시하였다. 신기능(Cr, BUN)은 처치군에 비해 비처치군에서 유의성 있는 상승을 보였다. 신장내 혈류 저항은 두 그룹 사이에 유의성이 없었다. 항산화 효소 활성은 대조군에 비해 비처치군에서 유의성 있는 감소를 보였으나, 처치군에서는 대조군과 유의성이 없었다. 조직검사 결과에서도 처치군이 비처치군에 비해 적은 조직손상을 보였다. 이러한 결과는 관류-흡인 과정이 신장의 허혈-재관류 손상을 감소시키는데 유용한 단계임을 시사한다.

개심술환자에 있어 혈청 Troponin-T 농도의 변화에 관한 연구 (Changes of Serum Troponin-T Concentrations in Patients with Open Heart Surgery)

  • 박동욱;최석철;김윤규;박종원;조관현
    • Journal of Chest Surgery
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    • 제31권2호
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    • pp.125-133
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    • 1998
  • 이 연구는 심근손상이 예상되는 개심술 환자들을 대상으로 수술에 따른 TnT의 혈중내 농도변화를 추적하여 심근세포 손상의 진단적 지표로서의 유용성을 조사하였고 기존의 효소진단 방법인 CK-MB 백분율 및 LDH1/LDH2비와 유용성을 비교 검토하였다. 본 연구는 1996년 1월부터 1996년 6월까지 인제대학교 부산백병원에서 개심술을 받은 성인 환자 중 술전 혈청 TnT 농도가 정상 범위였던 30명을 선정하여 시간대별 채혈로 시행되었다. 연구의 목적에 따라 환자들을 I 군(대동맥 차단시간 60분 이하, n=15)과 II군(대동맥 차단시간 60분 이상, n=15)으로 나누어 비교 조사하여 다음과 같은 결과를 얻었다. 1. 혈청 TnT의 농도는 양 군 모두 수술 중 상승하여 대동맥 차단의 제거후 유의하게 증가하였다(p<0.001). I 군에서는 술후 1일에 최고치(1.10$\pm$0.19 ng/ml)에 도달하였고 II 군에서는 체외순환 종료시 최고치(1.88$\pm$0.42 ng/ml)에 도달하여 이후 술후 7일까지 양군 모두 대조치에 비해 유의한 증가가 지속되었다(p<0.01). 2. CK-MB/total CK(이하 CK-MB 백분율 이라 함)의 경우 양 군 모두 수술 시작과 함께 유의하게 증가하여(p<0.001) 체외순환 종료시 최고치를 보였고 이후 술후 1일째까지 유의한 상승을 보였으나 술후 3일에는 기준치로 돌아옴으로써 혈청TnT에 비해 민감도가 떨어졌다. 3. LDH1/LDH2비는 수술동안 및 술후시기 전체에 걸쳐 대조치에 비해 유의한 변화가 없었다(p>0.05). 4. 수술동안의 혈청 TnT 농도와 CK-MB 백분율 변화간에는 의미있는 상관관계를 보였다(r=0.64, p<0.05). 5. I 군에 비해 II 군에서 혈청 TnT 농도는 대동맥 차단제거 시작 직전부터 술후 1일까지 유의한 증가를 보여(p<0.05) 대동맥 차단 시간의 지속 정도가 심근세포 손상의 중요한 인자임을 확인할 수 있었다. 결론적으로 혈청 TnT는 심근세포 손상에 있어 유용한 기준지표가 됨으로 향후 급성심근 경색증의 진단 뿐만 아니라 개심술에 따른 심근세포 손상 정도의 예측과 술후 환자의 감시에 표식자로서의 중요성이 기대 되었다.

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근골격계 질환에서 통증 조절을 위한 부자류 약물의 활용 (Use of Aconitum Herbal Medicine for Pain Control in Musculoskeletal Disease)

  • 박혜진;김현태;이상현;허인;황만석
    • 척추신경추나의학회지
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    • 제16권2호
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    • pp.47-54
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    • 2021
  • Objectives This review was conducted to study use of Aconitum herbal medicine for pain control in musculoskeletal disease. Methods Musculoskeletal disease is a major factor of social cost increase and physical disability. Various drugs, surgery and imaging are being overused regardlessly. Aconitum herbal plants are one of the most toxic Korean traditional herbs. However, they could be utilized effectively on patients with appropriate processing and decocting time. We searched Korean medicine literature to see various features of aconitum herbal plants and tried to find the utilization of the plants in effective way for pain control in musculoskeletal disease. Results Aconitum herbal plants needs to be used carefully because of intoxication which could lead to severe damage to human body. Processing of these toxic plants could minimize the harm and raise the benefits, such as relieving various types of pain and positive inotropic action. Further studies with clearer evidence and discovering aftereffects of processing in more details are needed. Conclusions Aconitum herbal plants could dedicate to controlling pain in musculoskeletal disease with various forms and appropriate processing.

타액선 종양에서 p53과 Ki-67의 발현 (Expression of p53 and Ki-67 in Salivary Gland Tumors)

  • 민현정;김경래;박철원;이형석;백승삼;오영하;태경
    • 대한두경부종양학회지
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    • 제22권1호
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    • pp.8-14
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    • 2006
  • Objectives: The p53 tumor suppressor gene has a key role in cellular control mechanisms involving apoptosis and DNA repair, leading to the G1 arrest following DNA damage. Its mutation is one of the most frequent alterations in human cancers. Ki-67 is identified in replicating cells of both benign and malignant lesions, so it can be the predictor of proliferative activity. The aim of this study is to evaluate the expression of p53 and Ki-67 in salivary gland tumors. Materials and Methods: Immunohistochemical analysis was used to detect expression of p53 and Ki-67 in paraffin-embedded samples from 31 benign and 27 malignant salivary gland tumors. Results were analyzed between benign and malignant tumors and compared with the clinical parameters such as stage and recurrence in malignant tumors. Results: p53 overexpression was detected in 19.6% of benign tumors and 40.7% of malignant tumors, but there was no statistical significance. p53 was significantly expressed in Warthin's tumor(45.5%) compared with pleomorphic adenoma(5.9%). Only 5.9% of pleomorphic adenoma were positive for p53, while 60% of carcinoma ex pleomorphic adenoma were positive for p53. Ki-67 was expressed in 3.2% of benign tumors and 51.9% of malignant tumors, which showed significant higher expression in malignant tumors. In malignant tumors, p53 and Ki-67 expressions bore no correlation to stage and recurrence. Conclusion: p53 overexpression is not associated with the progression of malignant tumors, and Ki-67 overexpression can be used as biologic indicator of malignant salivary gland tumors.

수술실 CCTV 설치의 쟁점과 입법방향에 관한 소고(小考) (A Study on the Major Issues and Legislative Considerations of CCTV Installation in an Operating Room)

  • 김성은;최아름;백경희
    • 의료법학
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    • 제22권2호
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    • pp.111-138
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    • 2021
  • 대리수술 및 유령수술 등으로 대변되는 '비의료인의 의한 무면허의료행위'는 생명·신체에 돌이킬 수 없는 피해를 야기한다는 측면에서 매우 엄격하고 진지한 관리가 필요한 영역에 속한다. 무면허 대리수술 근절 등을 위한 '수술실 내 영상정보처리기기(CCTV) 설치법안'은 오래 전부터 논의되어 온 영역이나 많은 쟁점과 찬·반 대립이 극심하여 오랜 기간 관계법안이 국회에 계류되어 왔다. 그러나 그간 미용성형수술 분야에서 문제되어 온 대리수술 및 공장식 성형수술은 물론, 최근에는 치료적 수술 영역에서도 무면허 대리수술 사건이 발생하는 등 관계법안이 국회에서 본격 논의될 것으로 보인다. 수술실은 기본적으로 밀실성과 폐쇄성, 내부자 간 침묵의 공모 등과 같은 특성으로 인하여 이들 간에 불법행위를 공모·은폐하는 경우는 물론, 정당한 수술행위라 하더라도 영리목적의 많은 수술실적을 위하여 집도의가 신속한 성형수술 후 의료기관을 이탈하여 수술종결 및 회복에 심각한 결과를 야기할 수 있는 측면에서 CCTV는 불법행위의 규명과 과실 판단에 큰 도움이 될 수 있다. 반면, 성형수술 외 치료목적 수술의 근본 목적이 환자의 생명·신체 회복이라는 구명(救命)에 있다는 점에 착안하여 볼 때는 수술과정 촬영이 의사와 환자의 관계를 감시와 불신에서 출발하게 하여 환자 측이 최상의 수술결과 달성미흡 등을 이유로 한 촬영기록 열람과 분쟁의 증가, 주치의에게 부담을 증가시켜 과감한 수술의 단행보다는 양심에 반하는 비침습적 치료로 전환하게 하거나 수술시기의 판단에 어려움을 유발하는 등 외과계 의료제공에 제한이 초래되어 개별 의사와 환자 간의 관점은 물론, 장기적 관점에서도 국민과 환자에게 불이익이 발생할 우려 또한 존재한다. 본고에서는 수술실 CCTV 설치에 대한 국내·외 현황과 쟁점 등을 살펴보고 제도 도입에 따른 법리적 문제점과 부작용을 최소화하는 방향으로 입법될 수 있도록 다양한 관점과 대안을 제시하여 국민과 환자, 피수술자의 생명과 건강 보호에 도움이 되고자 한다.

3차원 전산화단층영상을 이용한 턱나옴증 환자의 하악공의 방사선학적 연구 (Radiologic study of mandibular foramen of mandibular prognathism by three-dimensional computed tomography)

  • 이승훈;문철현;임정수;서화정
    • Imaging Science in Dentistry
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    • 제40권2호
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    • pp.75-81
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    • 2010
  • Purpose : This study is aimed to evaluate the position of mandibular foramen of mandibula prognathism patients using 3-dimensional CT images in order to reduce the chance of an anesthetic failure of the mandibular nerve and to prevent the damage to the inferior alveolar nerve during the orthognathic surgery. Materials and Methods : The control group consist of 30 patients with class I occlusion. The experimental group consist of 44 patients with class III malocclusion. Three-dimensional computed tomography was used to evaluate the position of the mandibular foramina. Results : The distance between mandibular plane and mandibular foramen, class I was 25.385 mm, class III was 23.628 mm. About the distance between occlusal plane and mandibular foramen, class I was 1.478 mm, class III was 5.144 mm. The distance between posterior border plan of mandibular ramus and mandibular foramen had not statistically significant. About the distance between sagittal plane of mandible and mandibular foramen did not also showed statistically significant. Conclusion : The result of this study could help the clinicians to apprehend more accurate anatomical locations of the foramina on the mandible with various facial skeletal types. thereby to perform more accurate block anesthesia of the mandibular nerve and osteotomy with minimal nerve damage. In addition, this study could provide fundamental data for any related researches about the location of the mandibular foramina for other purposes.

한국인의 피부 기저세포암종과 편평세포암종의 XRCC1 유전자 다형 (Polymorphism in the DNA Repair Gene XRCC1 Associated with Squamous Cell Carcinoma and Basal Cell Carcinoma of the Skin in Koreans)

  • 강상윤;이광길;심정연;정윤규;김남근;민완기
    • Archives of Plastic Surgery
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    • 제33권4호
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    • pp.433-439
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    • 2006
  • Purpose: DNA in most cell is regularly damaged by endogenous and exogenous mutagens. Unrepaired damage resulted in apoptosis or may lead to unregulated cell growth and cancer. Inheritance of genetic variants at one or more loci results in an reduced DNA repair capacity. These polymorphisms are highly prevalent in the population, and therefore the attributable risks for cancer could be high. Several studies have documented that polymorphisms of XRCC1, XPD and XRCC3 are associated with skin cancer, especially, XRCC1 among of them has been reported frequently. So, this study involves the relationship between mutation of XRCC1 of squamous cell and basal cell cancer of the skin and risk of cancer development in Korean population. Methods: In case control study, study population (n=100, each cancer) is patients who were pathologically diagnosed as skin cancer(squamous cell carcinoma and basal cell carcinoma) in Yonsei Wonju Christian Hospital and Bundang CHA General Hospital between 1998 and 2004. The samples of DNA from whom no history of premalignant skin lesion and other malignant diseases were reported belonged to the control group(n=210). Blood and tissue samples were analyzed for presence of XRCC1 Arg399Glu, Arg280His, Arg194Trp using PCR/ RFLP method. Results: For Korean, there was a significant correlation between XRCC1 Arg399Gln gene mutation and risk of basal cell carcinoma development(Arg 399Gln(GA), p=0.012, OR=2.016, 95% CI; 1.230-3.305) /Arg399Gln (AA), p=0.011, OR=1.864, 95% CI; 1.149-3.026)). And, there was also significant correlation between XRCC1 Arg194Trp and risk of skin squamous cell carcinoma development (Arg194Trp (CT+TT), p=0.041, OR=0.537, 95% CI; 0.301-0.960)). In contrast, there was no significant correlation between XRCC1 Arg280His and risk of either basal cell carcinoma or squamous cell carcinoma development. Conclusions: Our result present that XRCC1 Arg399 Gln in basal cell carcinoma and XRCC1 Arg194Trp in squamous cell carcinoma have possibility of cancer risk and biomarker in Korean population. But XRCC1 Arg280 His known having cancer risk on other studies is not associated with cancer risk to squamous cell carcinoma and basal cell carcinoma in Korean population.

미세 투석기를 이용한 실험적 급성 허혈 심근에 관한 영구 (Investigation of Experimental Acute Ischemic Myocardium with a Microdialysis Appratus)

  • 박성달;김송명
    • Journal of Chest Surgery
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    • 제26권6호
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    • pp.441-451
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    • 1993
  • Protective effect of superoxide dismutase[SOD] and substrates on acute ischemic and reperfused myocardium was assessed by cardiac microdialysis. 30 Rabbits were divided into 4 groups; normal control group [group I, n=5], ischemic group [group II, n=5], SOD treated group [group III, n=10], and substrates treated group [group IV, n=10]. After a microdialysis apparatus was implanted in rabbit myocardium, coronary artery was occuluded for 5 minutes and reperfusion was performed for 30 minutes. Hemodynamic changes, CK-MB isoenzyme level and adenine ring compound level in effluent dialysates [equilibrated with interstitial fluid], and ultrastructural changes of myocardial cell were analysed. Systolic blood pressure at 10 and 30 minutes after reperfusion was higher in group III and IV than in group II [p<.05]. Also percent recovery of systolic blood pressure in group III [p<.01] and IV [p<.02] was higher than in group II. CK-MB isoenzyme level in effluent dialysates was peaked at 10 minutes after reperfusion, thereafter decreased in group II, III and IV. At 30 minutes after reperfusion, its level was lower in group III and IV than in group II[p<.05]. Adenine ring compound level in effluent dialysates increased till 10 minutes after reperfusion and progressively decreased. At 10 and 30 minutes after reperfusion, its level was lower in group III and IV than in group II without significance. Degree of myocardial damage was estimated by scoring of mitochondrial injury. Group I was within normal range and most severe injury was seen in group II. And the score of mitochondrial injury in group III and IV was lower than in group II. In conclusion, SOD and substrates[KMP solution] had protective effect on stunned myocardium. The microdialysis appratus was a good device for studying stunned myocardium, and cardiac microdialysis might be a unique technique for analysis of regional intramyocardial interstitial fluid.

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Transcriptomic Analysis of Rat Brain Tissue Following Gamma Knife Surgery: Early and Distinct Bilateral Effects in the Un-Irradiated Striatum

  • Hirano, Misato;Shibato, Junko;Rakwal, Randeep;Kouyama, Nobuo;Katayama, Yoko;Hayashi, Motohiro;Masuo, Yoshinori
    • Molecules and Cells
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    • 제27권2호
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    • pp.263-268
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    • 2009
  • Gamma knife surgery (GKS) is used for the treatment of various human brain disorders. However, the biological effects of gamma ray irradiation on both the target area, and the surrounding tissues are not well studied. The effects of gamma ray exposure to both targeted and untargeted regions were therefore evaluated by monitoring gene expression changes in the unilateral irradiated (60 Gy) and contralateral un-irradiated striata in the rat. Striata of irradiated and control brains were dissected 16 hours post-irradiation for analysis using a whole genome 44K DNA oligo microarray approach. The results revealed 230 induced and 144 repressed genes in the irradiated striatum and 432 induced and 239 repressed genes in the unirradiated striatum. Out of these altered genes 39 of the induced and 16 of the reduced genes were common to both irradiated and un-irradiated tissue. Results of semiquantitative, confirmatory RT-PCR and western blot analyses suggested that ${\gamma}$-irradiation caused cellular damage, including oxidative stress, in the striata of both hemispheres of the brains of treated animals.

Polygonum cuspidatum stem extract (PSE) ameliorates dry eye disease by inhibiting inflammation and apoptosis

  • Park, Bongkyun;Jo, Kyuhyung;Lee, Tae Gu;Lee, Ik Soo;Kim, Jin Sook;Kim, Chan-Sik
    • 운동영양학회지
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    • 제23권4호
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    • pp.14-22
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    • 2019
  • [Purpose] Here, we aimed to determine the effect of Polygonum cuspidatum stem extract (PSE) on exorbital lacrimal gland-excised rat models and hyperosmotic stress-stimulated human conjunctival cells (HCCs). [Methods] Seven week old male Wistar rats were divided into six groups. Only the rats in the control group (NOR, n=5) did not undergo surgery. Three days after the surgery, the exorbital lacrimal gland-excised rats were randomly allocated to five groups: (1) vehicle-treated dry-eyed rats (DED, n=5); (2) PSE (10 mg/kg) treated DED rats (PSE-10, n=5); (3) PSE (100 mg/kg) treated DED rats (PSE-100, n=5); and (4) PSE (250 mg/kg) treated DED rats (PSE-250, n=5). In addition, the HCC line was co-treated with hyperosmolar media (528 mOsm) and PSE (1-100 μg/ml). [Results] PSE treatment restored the tear volume and goblet cell density by inhibiting severe corneal irregularities and damage. The treatment with PSE significantly attenuated the hyperosmolar stress-induced inflammation and cell death through the suppression of mRNA expression levels of Tumor necrosis factor-α (TNF-α), Interleukin-6 (IL-6), Interleukin-1β (IL-1β), and Interferon-γ (IFN-γ), and the expression of Bcl-2-associated X protein (Bax) as well as the activation of caspase-3 in vitro. [Conclusion] The inhibitory effects of PSE treatment on dry eye disease indicate the potential of nutritional intervention by PES against inflammatory diseases without adverse effects.