• Journal of Gastric Cancer
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• 제17권3호
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• pp.246-254
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• 2017

Purpose: The significance of hospital volume remains inconsistent and controversial. In particular, few studies have examined whether hospital volume is associated with the outcome of gastrectomy for gastric cancer in East Asia. This study examined the effect of hospital volume on the short-term surgical and long-term oncological outcomes of patients undergoing curative gastrectomy for gastric cancer. Materials and Methods: Between 2009 and 2011, 1,561 patients underwent curative gastrectomy for gastric cancer at Seoul St. Mary's Hospital (n=1,322) and Bucheon St. Mary's Hospital (n=239). We defined Seoul St. Mary's Hospital as a high-volume center and Bucheon St. Mary's Hospital as a low-volume center. Results: The extent of resection, rate of combined resection, tumor stage, operating time, and hospital stay did not differ significantly between the 2 hospitals. In addition, the hospital volume was not significantly associated with the 30-day morbidity and mortality. When the overall and disease-free survival rates of the patients were stratified according to stage, hospital volume was not significantly associated with prognosis at any stage. Conclusions: Hospital volume might not be a decisive factor with respect to the surgical and oncological outcomes of patients if well-trained surgeons perform gastrectomy for gastric cancer.

• Journal of Trauma and Injury
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• 제27권3호
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• pp.89-93
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• 2014

Bile leaks are complications that are much more frequent after a high-grade liver injury than after a low-grade liver injury. In this report, we describe the management of bile leaks that were encountered after angiographic embolization in a 27-year-old man with a high-grade blunt liver injury. He had undergone an abdominal irrigation and drainage with a laparotomy on post-injury day (PID) 16 due to bile peritonitis and continuous bile leaks from percutaneous abdominal drainage. He required three percutaneous drainage procedures for a biloma and liver abscesses in hepatic segments 4, 5 and 8, as well as endoscopic retrograde cholangiopancreatography with biliary stent placement into the intrahepatic biloma via the common bile duct. We detected communication between the biloma and the bilateral intrahepatic duct by using a tubogram. Follow-up abdominal computed tomography on PID 47 showed partial thrombosis of the inferior vena cava at the suprahepatic level, and the patient received anticoagulation therapy with low molecular weight heparin and rivaroxaban. As symptomatic improvement was achieved by using conservative management, the percutaneous drains were removed and the patient was discharged on PID 82.

• Journal of Korean Neurosurgical Society
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• 제30권5호
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• pp.611-621
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• 2001

Objective : We analyzed the clinical and endocrinological results of the transsphenoidal microsurgery for ACTH secreting pituitary adenomas. Marerials and Methods : From October 1995 to August 2000, 18 patients underwent transsphenoidal microsurgery for Cushing's disease. We analyzed the surgical results of 17 patients, one patient who was previously operated from other hospital was excluded. Age of the patients were 18 to 61 years old(mean 37.7), male to female ratio was 1 : 3.3, and follow-up period was 3 to 50 months(mean 20.3). The selection of candidates for transsphenoidal exploration was based on endocrinologic criteria. Magnetic resonance imaging was the preferred radiologic test. Selective inferior petrosal sinus sampling of adrenocorticotropic hormone futher refined the diagnosis when endocrinologic and radiologic procedures were not definitive. Results : Results of the preoperative endocrinological test were : level of serum ACTH 29.4 to $225{\mu}g/dL$(mean $93.88{\mu}g/dL$) ; serum cortisol 11.9 to $47.5{\mu}g/dL$(mean $27.49{\mu}g/dL$) ; 24-hour urine free cortisol 235 to $1019{\mu}g/day$(mean $571.0{\mu}g/day$). Inferior petrosal sinus sampling for ACTH was performed in 11 patients and all were confirmed by Cushing's disease and we could predict the laterality of the tumor in 9 of 11 patients. We performed transsphenoidal selective adenomectomy in 5 patients, adenomectomy and subtotal hypophysectomy in 2 patients, adenomectomy and partial hypophysectomy in 9 patients, and in the remaining one patient, hemihypophysectomy followed by total hypophysectomy due to remission failure. Fifteen of 17 patients(88.2%) showed endocrinological remission. Glucocorticoid replacement therapy was performed in all the patients who showed remission for 1 to 24 months(mean 5.9 months), and 6 patients received steroid over 6 months. Conclusion : We conclude that the direct demonstration of a tumor in the pituitary gland by MRI is the most important and definitive diagnostic tool and the location of a mass should be confirmed with increased level of ACTH by the inferior petrosal sinus sampling. Transsphenoidal microsurgery is effective treatment modality for Cushing's disease and the immediate postoperative evaluation of the surgical resection of the tumor is very important. The patients should show hypocortisolism, decreased, subnormal serum ACTH and cortisol levels and 24-hours urine free cortisol. We performed 18 transsphenoidal microsurgery for Cushing's disease in 17 patients and 15 patients(88.2%) showed endocrinological remission.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제33권6호
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• pp.643-647
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• 2007

Purpose: The purpose of study was to investigate the correlationship between lip canting change and occlusal canting change after bimaxillary orthognathic surgery, and the ratio of lip canting change and occlusal canting change after the surgery. Patients and methods: The subjects for this study was obtained from a group of 25 patients who took bimaxillary orthognathic surgery for occlusal canting correction at the Department of the Oral and Maxillofacial Surgery, Samsung Medical Center in Seoul, Korea between January 2000 and December 2005 and a patient's chart had to contain a resting frontal facial photograph in natural head position and a corresponding PA cephalogram in occlusion on the same day before the surgery and post-op 6 months later. The lip canting change was assessed with the angle each labial commissure and the bipupilary reference line. And, the occlusal caning change in the frontal plane was assessed with the angle between the each maxillary first molar occulasal surface and the bi-frontozygomatic suture reference line. Results: In angular measurement, average occlusal canting change was $3.09^{\circ}$ and standard deviation was $1.05^{\circ}$, average lip canting change was $1.56^{\circ}$ and standard deviation was $1.05^{\circ}$. In linear measurement, average occlusal canting change was 2.41mm and standard deviation was 2.75mm, average lip canting change was 1.18mm and standard deviation was 0.43mm. Lip canting correction ration to occlusal canting correction was 51.5(${\pm}8.4$)% in angular measurement and 48.8(${\pm}9.1$)% in linear measurement. Under Pearson's correlation analysis, Pearson's correlation coefficient was 0.869 in angular measurement and 0.887 in linear measurement(p-value < 0.01). High correlationship was shown between occlusal canting change and lip canting change. Conclusion: First, Bimaxillary orthognathic surgery can correct lip canting as well as occlusal canting. Second, The average amount of lip canting correction is $51.5{\pm}8.4%,\;48.8{\pm}9.1%$ of occlusal canting correction in the study.

• Journal of Gastric Cancer
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• 제9권3호
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• pp.117-127
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• 2009

목적: 의료진은 암 환자들에게 적절한 건강 관련 정보를 제공함으로써 암 환자들이 자신의 질병과 치료에 대한 불확실한 상황을 극복하여 스스로 건강을 관리하는 것을 도울 수 있다. 효과적으로 정보를 제공하기 위해서는 환자가 실제 알고자 하는 정보 내용을 파악하는 것이 필요하다. 본 연구에서는 위암 수술 후 환자의 정보 요구 경향을 확인하고자 하였다. 대상 및 방법: 위암 수술 후 환자로, 2008년 11월 18일 삼성서울병원 위암센터에서 주관한 '위암 환자의 날' 행사에 참여한 대상자에게 설문지를 배부하여 직접 작성하도록 하였고, 수집된 190명의 설문지를 분석하였다. 설문 도구는 검사, 치료, 예후, 추후 관리, 성 생활, 위암 관련 정보 영역과 7개의 단일 문항의 총 37개 문항으로 구성되었다. 결과: 정보 요구는 예후, 치료 기간 동안 스스로 할 수 있는 건강 관리 방법, 추후 관리, 위암 관련 정보, 치료, 검사 등의 순으로 높게 나타났다. 문항별로 살펴보면, 예후, 식이, 치료 중의 건강 관리와 관련한 문항에서 높은 정보 요구를 보였다. 대상자의 연령이 젊을수록 검사, 치료, 성 생활, 위암 관련 정보 영역의 정보 요구가 높았다. 결론: 기존에 축적된 병원의 치료 결과 및 예후 자료에 근거한 객관적인 예후 관련 정보를 교육 프로그램에 반영하고 암 환자 및 보호자가 이해하기 쉽도록, 그리고 치료 과정에 적극적으로 참여할 수 있도록 적절한 정보를 전달하여야 할 것이다.

• 대한족부족관절학회지
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• 제23권1호
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• pp.24-30
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• 2019

Purpose: To evaluate the efficiency of the electronic foot function index (eFFI) through a prospective, random based, multi-institutional study. Materials and Methods: The study included 227 patients ranging in age from 20 to 79 years, visited for surgery in different 15 institutes, and agreed to volunteer. The patients were assigned randomly into a paper-based evaluated group (n=113) and tablet-based evaluated group (n=114). The evaluation was done on the day of hospital admission and the method was changed on the second day of surgery and re-evaluated. PADAS 2.0 (https://www.proscore.kr) was used as an electronic evaluation program. Results: There were no differences in age and sex in both groups. The intraclass correlation coefficient (ICC) evaluation revealed an eFFI ICC of 0.924, showing that both results were similar. The evaluation time was shorter in the tablet-based group than the paper-based group (paper vs tablet, $3.7{\pm}3.8$ vs $2.3{\pm}1.3minutes$). Thirty-nine patients (17.2%) preferred to use paper and 131 patients (57.7%) preferred the tablet. Fifty-seven patients (25.1%) found both ways to be acceptable. Conclusion: eFFI through tablet devices appears to be more constant than the paper-based program. In addition, it required a shorter amount of time and the patients tended to prefer the tablet-based program. Overall, tablet and cloud system can be beneficial to a clinical study.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.519-525
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• 2010

Purpose: Of various effects of relaxin, we assumed that anti-fibrotic effects, neovascularization effects and vasodilatation effects of relaxin might enhance the survival rate of skin flap. In the current study, we used adenovirus expressing relaxin genes to examine whether these genes could enhance the survival rate of a skin flap. Methods: A total of 30 Sprangue-Dawley rats were divided into three groups: RLX group (10; relaxin virus injected group), CTR group (10; no gene coded virus injection group), and PBS group (10; PBS injected group). Each group was intradermally injected with the virus ($10^7$ PFU) and PBS 48 hours before and immediately before the flap elevation. A distally based flap $3{\times}9\;cm$ in size was elevated on the dorsal aspect of each rat. Following this, a flap was placed in the original location and then sutured using a #4-0 Nylon. A surviving area of the flap was measured and then compared on postoperative days 3, 7 and 10. Using a laser Doppler, the amount of blood flow was measured. On postoperative day 10, tissues were harvested for histologic examination and the number of blood vessels was counted. Results: There was a significant increase in the area of the flap survival in the RLX group on postoperative days 3 and 7. The Doppler measurement also showed significantly increased blood flow immediately after the operation and on postoperative days 7 and 10. The number of blood vessels was significantly greater in the RLX group in the tissue harvested on postoperative day 10. The VEGF concentration was significantly higher in the RLX group than others in the tissues harvested on postoperative day 10. Conclusion: Following an analysis of the effects of relaxin-secreting adenovirus on the survival of a flap, the surviving area of the flap and the blood flow also increased. A histopathology also showed an increase in the number of blood vessels and the concentration of VEGF.

• Journal of Chest Surgery
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• 제42권2호
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• pp.135-140
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• 2009

배경: 동종이형의 심장이식 후에 나타나는 만성 거부반응은 수술 후 약 6개월이 지나 나타나며, 이로 인해 이식된 심장의 관상동맥의 동맥 경화 소견과 심장의 손상을 일으키는 혈관병증이 나타나는 바, 대혈관인 대동맥에서도 이러한 소견을 보이는 지를 확인하고자 하였다. 대상 및 방법: $200{\sim}300gm$의 백서(Spraque-Dawley Rat)에서 이소성의 동종이형의 심장이식(heterotopic heart alto-transplantation)을 Ono-Lindsey method로 시행한 후 사이클로스포린(cyclosporin A 10mg/kg/day, 종근당 제공)을 투여하여 3개월 이상 생존한 군에서 동물을 희생시킨 후 자가 상행 대동맥과 이식된 심장의 대동맥에서 각각 조직 절편을 얻어 조직 검사를 시행하여 비교하였다. 자가 상행 대동맥의 조직 검사(N=9, native ascending aorta)와 동종 이형의 이식된 심장의 대동맥(N=13, alto-transplanted aorta)의 조직 검사를 동종이형의 심장이식 후의 만성 거부 반응의 특징적인 조직 검사 소견인 1) 내막 비후(intimal thickening), 2) 중층 비후(medial hyperplasia), 3) 중층 석회화(medial calcification), 4) 중층 염증(medial inflammation), 5) 연골 화생(chondroid metaplasia)에 대하여 한 명의 병리의에 의해 대조군과 이식군에서 각각 심한 정도를 통계처리(Mann-Whitney Test, SPSS version 12.0 Windows)하여 비교하였다. 결과: 중층 비후 외(p=0.36)에 내막 비후(p<0.0001), 중층 석회화(p=0.045), 중층 염증(p<0.0001), 연골 화생(p=0.045)에 있어 이식된 심장의 대동맥에서 의미 있는 변화를 보였다. 결론: 동종 이형의 심장 이식 후에 만성 거부 반응에 의한 혈관병증(cardiac allograft vasculopathy)은 관상 동맥을 침범하여 심근의 손상을 가져오며, 이와 같은 만성 거부 반응에 의한 혈관 병증의 변화는 대혈관인 이식된 대동맥에서도 상기의 결과와 같이 나타나 대동맥에서도 만성적인 거부 반응이 진행되고 있음을 확인할 수 있었다.

• Archives of Reconstructive Microsurgery
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• 제11권1호
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• pp.47-52
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• 2002

One of the most common problems in cord injury is pressure sores. In the early stage of pressure sores, the wound can be covered by advancing or transpositioning a local myocutaneous flap. However, it can be a great challenge to treat end-stage paraplegic patient who underwent multiple prior flaps, where continuous treatment is needed to prevent recurrent pressure sore due to infection and metabolic drain. In these patients, a local myocutaneous flap may be very difficult for coverage of the wounds. Therefore, hemipelvectomy may be considered. The authors performed a hemipelvectomy on a 33 year-old male paraplegic patient who presented with multiple, large wounds seen in end-stage pressure sores. He had a compression fracture of the lumber spine 9 years ago during a motor vehicle accident. After a wide exicision of the wound, the anterior flap was used as a fillet-flap for reconstruction. On the sixth day postoperatively, secondary repair was done due to wound dehiscence and the postoperative results have been satisfactory thus far.

• Journal of Chest Surgery
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• 제39권4호
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• pp.310-316
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• 2006

배경: 식도암 환자에서 환자의 관점에서 본 수술 후의 삶의 질과 기능상의 호전을 연구해서 회복과정의 지침이 되게 하고자 하였다. 대상 및 방법: 1996년 12월부터 2002년 8월까지 서울아산병원에서 식도암으로 수술 받은 환자 250명 중 상담이 가능하며 1년 이상 재발 없이 살아있는 환자 57명을 대상으로 하였다. 질문은 환자와 직접 또는 전화 면담을 통하여 이루어졌으며 질문의 내용은 식사습관, 체중변화, 위식도 역류증, 급성 이동증, 일상생활의 변화 등으로 이루어졌다. 결과: 남자가 53명(93%) 여자가 4명(7%)로 평균 연령은 $62{\pm}05{\pm}8.7$ (범위 : $37{\sim}94$)이었다. 수술은 43예(75.4%)에서 Ivor Lewis 술식으로 행해졌고 4예(7.1%)에서 위결장공장 문합술 10예(17.5%)에서 Mckeown Operation이 시행되었다. 식사습관은 55명(96.5%)의 환자가 하루 세 차례 이상 식사하였으며 평균 빈도수는 3.5회/일이었으며 51명(89.5%)의 환자가 고형식, 정상식이 가능했고 5명(8.8%)는 유동식만이 가능했다. 술 전과 비교해 32명(56.9%)의 환자가 80% 이상의 식사속도로 먹을 수 있었고 28명(39.1%)의 환자는 술 전 양의 80% 이상을 먹을 수 있었다. 32명(56.9%)의 환자에서 체중이 10% 이내의 적은 변화가 있었으며 25명(43%)의 환자에서는 체중이 술 전보다 증가하였다. 4명(7%)의 환자에서 매 식사마다 위식도역류증이 있었고, 27명(47.4%)의 환자에선 식사 후 적은 역류증이 있었다. 7명(12.3%)의 환자에서 급속 이동증에 의한 식후 설사를 경험했다. 38명(66.6%)의 환자는 정상적인 활동을 하였고 19명(33.3%)의 환자에서 활동의 감소가 있었다. 면담 시점에서 53명(93%) 대부분의 환자가 때때로의 불편함에도 불구하고 수술 결과에 만족해 하였다. 정동상태에서 보면 50명(88.4%)의 환자가 수면장애 없이 잘 수 있었고 65%의 환자가 정신적으로 안락한 상태였다. 39%의 환자가 성욕을 느낀다고 대답했는데 환자군의 평균 연령이 63세인 것을 감안하면 정상범위에 있다고 할 수 있었다. 결론: 식도암으로 식도절제술 및 재건술을 받은 환자들의 삶의 질은 거의 술 전 상태로 회복할 수 있음을 알 수 있었다.