• Advances in pediatric surgery
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• 제9권1호
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• pp.19-23
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• 2003

Necrotizing Enterocolitis (NEC) is usually a disease of premature infants, but occasionally it affects the term neonate. Twenty-five infants with NEC were treated at Asan Medical Center between January 2000 and December 2002, and 13 of them were term infants. In each case, the diagnosis of NEC was established by a clinical illness fulfilling the Bell's stage II or III NEC as modified by Walsh or by surgical findings. There were six males and seven females. The birth weight was from 1,960 to 3,700 g. The age at diagnosis was from 1 to 40 days. Four patients had congenital heart disease: one of who had hypothyroidism and cleft palate. Abdominal distension was present in all, and bloody stools in four. One patient had history of hypoglycemia, three had Rota viral infection. Eight patients had leucopoenia (<$5.0{\times}10^9/L$), seven had thrombocytopenia (<$100{\times}10^9/L$), and three severe thrombocytopenia (<$50{\times}10^9/L$). Laparotomy was required in 10 of the 13 patients. Indications for operation in the acute phase were failure to respond to aggressive medical therapy in five, and perforation in three patients. There were two late phase operations for intestinal stricture and fistula. There were no operative complications. Ten of thirteen patients survived (76.9%). Two patients died of septic complication. There was a delayed death due to heart failure. There was a significant difference in survival according to platelet count ($50{\times}10^9/L$) (p<0.05). Congenital heart disease and Rota viral infection are associated with NEC in term infants and thrombocytopenia and leucopoenia may be surgical indications.

• Advances in pediatric surgery
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• 제16권1호
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• pp.11-17
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• 2010

Pancreatic tumors in children are relatively rare, and their prognosis differs from that in adults. The purpose of this study is to examine the clinical characteristics, treatment, and prognosis for children with pancreatic tumors. We retrospectively reviewed the medical records of children under 15 years of age with pancreatic tumors who were treated surgically at Asan Medical Center between January 1992 and November 2009. There were 16 patients, fourteen of whom were pathologically diagnosed with solid pseudopapillary tumor. The other two patients were diagnosed with pancreatoblastoma and acinar cell carcinoma, respectively. Six patients of the 16 patients (38 %) were male, and there was a male-to-female ratio of 1:1.6. The initial presentations were upper abdominal pain in eight patients (50 %), palpable abdominal mass in three, and vomiting in one. Four patients were diagnosed incidentally. Six patients' tumors were located in the pancreatic head, six in the pancreatic body, and four in the pancreatic tail, respectively. The surgical procedures performed included distal pancreatectomy (n=7, 44 %), median segmentectomy (n=3), enucleation (n=3), pancreaticoduodenectomy (n=2), and pylorus-preserving pancreaticoduodenectomy (n=1). Three patients underwent laparoscopic surgery. The median tumor size was 6.5 cm (1.8~20 cm). Early surgical complications included pancreatic fistula (n=4), bile leakage (n=1), and delayed gastric emptying (n=1). A late complication in one patient was diabetes. The median follow-up period was five years and four months, and all patients survived without recurrence. While pancreatic tumors in adults have a poor prognosis, pancreatic tumors of childhood are usually curative with complete resection and thus have a favorable prognosis.

• Tuberculosis and Respiratory Diseases
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• 제61권5호
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• pp.484-489
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• 2006

원발성 기관지내 평활근육종은 폐에 원발하는 매우 드문 악성 종양으로 통상적인 생검방법으로는 육종의 진단이 쉽지 않고 수술적 폐생검이 필요한 경우가 많으며 치료는 근치적 절제술로 완치를 기대할 수 있다. 저자들은 대량객혈을 주소로 내원한 21세 남자에서 좌폐하엽 기관지에서 발생한 원발성 기관지내 평활근육종을 진단하고 좌하엽 수상절제술을 시행하였으나 3개월 후에 국소 재발하였다. 1차 수술 후 4개월 째 좌측 전폐절제술을 시행하였으나 2차 수술 후 11개월 째 다시 국소재발과 기관지흉막루가 발생하였고 이와 관련된 농흉과 패혈증으로 사망하였던 환자를 경험하여 이를 보고하는 바이다.

• Archives of Plastic Surgery
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• 제34권2호
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• pp.209-216
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• 2007

Purpose: The ischial area is by far the most common site of pressure sores found in wheel chair bound paraplegic patients, because greatest pressure is exerted from the body on this area in a sitting position. Even after a series of successful pressure sore treatments, the site is very prone to relapse by the simplest ordinary tasks of everyday life. Therefore, it is crucial to preserve the main pedicle during primary surgery. Various surgical procedures employed to treat pressure sores such as myocutaneous flap and perforator flap have been introduced. After introduction of ischial sore treatment using the inferior gluteal artery perforator (IGAP) has been made, the authors experienced favorable clinical results of patients who have undergone IGAP flap procedure in a three year time period. Methods: A total of 17 patients received IGAP flap surgery in our hospital from January 2003 to May 2006, among which 14 of them being males and 3 females. Surgery was performed on the same site again in 6(35%) patients who had originally relapsed after receiving the conventional method of pressure sore surgery. Patients' average age was 49.4(27-71) years old. Most of the patients were paraplegic(11 cases, 65%) and others were either quadriplegic(4 cases, 23%) or ambulatory(2 cases, 12%). Based on hospital records and clinical photographs, we have attempted to assess the feasibility and practicability of the IGAP flap procedure through comparative analysis of several parameters: size of defective area, treatment modalities, occurrence of relapses, complications, and postoperative treatments. Results: The average follow-up duration of 17 subjects was 25.4 months(5-42 months). All flaps survived without any necrosis. Six cases were relapsed cases from conventional surgical procedures. All of them healed well during our follow-up study. Postoperative complications such as wound dehiscence and fistula developed in some subjects, but all were well healed through secondary treatment. A total of 2 cases relapsed after surgery. Conclusion: The inferior gluteal artery perforator flap is an effective method that can be primarily applied in replacement to the conventional ischial pressure sore reconstructive surgery owing to its many advantages: ability to preserve peripheral muscle tissue, numerous possible flap designs, relatively good durability, and the low donor site morbidity rate.

• Archives of Plastic Surgery
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• 제37권4호
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• pp.481-484
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• 2010

Purpose: Congenital dermoid cysts develop during the fusion of the embryo when the ectodermal tissue gets trapped in the line of fusion. Dermoid cysts of the head are rare lesions comprised of epidermal and mesodermal elements. Furthermore, dermoid cysts in the occipital area are extremely rare. Only a few cases of dermoid cysts in the posterior scalp have been reported. Especially, A bilateral, synchronous presentation in this location has not been reported previously in the literature. Methods: All 5 cases had a gradually enlarging mass of the posterior aspect of the scalp. The cysts were mobile, noncompressible, and non-tender, without evidence of an associated sinus tract, skin dimpling, discoloration, or communication with adjacent structures. The CT scan displayed a hypodense cystic lesions about -87 to +24 HU (Housefield units, average +3.2 HU) with hypodense capsule and no postcontrast enhancement. All tumors were found just under the skin, and were well encapsulated, so they were completely removed the mass with adjacent periosteum. Results: On gross findings, all tumors were oval-or round-shaped, and when the cystic tumor was cut open it presented a greasy and caseous substance. Histologically, all specimens contain desquamated squamous epithelium and keratin in the lumen and are encapsulated and lined by keratinized stratified squamous epithelium. And, all cases of posterior mass are the presence of adnexal structures. Conclusion: Appropriate diagnosis requires not only an index of suspicion for this rare tumor a very careful history and search for skin changes. Especially, CT can reveal the exact location of the cyst, its relationship with the adjacent structures. We think that occipital dermoids divide into superficial and deep type. In our cases, because they did not have intra-cranial involvement or fistula formation, they are superficial type. This report describes the clinical and operative aspects of the superficial dermoid cysts and provides a review of the literatures.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.565-570
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• 2009

Purpose: Numerous techniques have been introduced to reconstruct the perineal area in order to preserve function of both the recipient and the donor site while satisfying aesthetic results. There are several advantages of using the pudendal aretery perforator based flap in that it provides thin coverage of defect area and a relatively excellent circulation through perforators. The perineal region can be divided into two areas : the urogenital triangle and the anal triangle. Since each area differs in structure and function so does its reconstructive plan. The authors of this article report clinical results obtained from pudendal artery perforator based reconstructed cases according to each differrent triangles. Methods: A total of 15 patients who underwent perineal reconstruction were enrolled in our study between the year 2002 and 2006. There were 4 cases of vaginal cancer, 4 cases of extramammary Paget's disease, 1 case of rectovaginal fistula in females and 2 cases of Paget's disease and 4 cases of Fournier's gangrene in male cases. The follow up period was on average 6 month. In female, superfical pudendal artery perforator based local flap were used to reconstruct the urogenital triangle defects, while internal pudendal artery perfoator based local flaps were used to reconstruct the anal traingle defects. In males the gracilis myocutaneous flap and internal pudendal artery perforator based local flaps were used in reconstruction of the scrotum and perineal defect. Result: In females, there was 1 case of partial flap necorsis that employed the superficial pudendal artery perforator but secondary repair through the internal pudendal artery perforator based local flap was done. In addition, there were 4 wound dehiscence cases in females and 2 cases in males. Conclusion: We believe that a better aesthetic and functional outcome can be achieved in perineal reconstruction if discrete surgical planning is carried out systematically categorizing the choice of flap employed acccording to distinct anatomical regions : the urogenital and the anal triangle.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.531-537
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• 2009

Purpose: Alveolar bone grafting has become an essential process in the treatmemt of alveolar cleft patient for stabilization of the maxillary arch, elimination of oronasal fistula, the reconstruction of the soft tissue nasal base support, and creation of bony support for tooth eruption for implant. The use of Autologous iliac cancellous bone is preferable because of the adequate quantity and high osteoinductive potential. However, even with iliac bone, insufficient osteoregeneration and absorption occur due to several factors such as the patient's age, cleft width, functional stress, and others. In order to increase osteoregeneration where the iliac bone is placed, the present study is associated with bone marrow aspirate (BMA). The experimental study evaluated the efficacy of osteoregeneration in normal cleft rabbits when alveolar bone grafting was performed with autologous iliac corticocancellous bone. Methods: Twenty - four New Zealand White rabbits were divided randomly into 2 groups (BMA, control). All animals underwent harvesting of corticocancellous bone graft from the right posterior iliac crest via standard surgical technique. $1m{\ell}$ of BMA were obtained by scraping the needle and aspirate with $10m{\ell}$ syringe from the contralateral iliac bone wall. The muco - periosteal flap on the palate was elevated. A mixture of Equal bone's volumes with BMA and saline as its control was inserted into the cleft. Animals were sacrificed at 2, 4, and 8 weeks and maxilla was harvested for dental peri - apical X-ray, bone matrix density (BMD),and histologic analysis. Result: BMD of regenerated bone to the cleft in the rabbits was higher than that of the control rabbits. X-ray, histologic analysis showed that increased osteoregeneration and low absorption rate were observed in the BMA group. Conclusion: Our experimental study showed BMA enhanced the osteoregeneration and survival rate of alveolar bone grafting. BMA is easy to extract & cost - time effective. So it can be an effective enhancers for bone grafting mixtures.

• Journal of Chest Surgery
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• 제34권10호
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• pp.769-774
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• 2001

배경: 하행 괴사성 종격동염은 문헌에 따라 25%에서 40%의 사망률을 보이는 중증 질환이다. 대개의 원인은 치원성 및 구인두의 감염의 합병증으로 발병된다. 이에 된 교실에서는 지난 4년간 하행 괴사성 종격동염으로 외과적 치료를 받은 환자를 대상으로 후향적 조사를 하여 결과를 보고하고자 한다. 대상 및 방법: 1977년부터 2000년가지 하행 괴사성 종격동염으로 진단된 7례를 대상으로 하였다. 초기 구인두 감염이 종격동염으로 진행된 경우가 47례(57%), 치원성 감염이 3례(43%)이었다. 모든 경우에 괴사조직 제거 및 배농술을 위해 응급경부절개술, 개흉술 및 흉골절개술을 시행하였다. 결과: 평균 재원일은 42일이었고, 2례가 사망하여 사망률은 28.6%이었다. 재발된 농흉 2례와 심낭 압전증 1례는 재수술을 시행하였다. 사망 원인은 재수술후 12일째 대혈관 침식, 신부전 및 호흡부전으로 사망하였다. 재수술을 받지 않은 1례에서 수술후 10일째 기관지-식도루에 의한 질식으로 사망하였다. 결론: 하행 괴사성 종격동염의 사망률을 줄이기 위해서는 조기 진단과 신속한 경흉부 컴퓨터단층촬영 및 적극적인 외자적 치료가 필요하며, 세심한 수술 후 관리가 요구된다 하겠다.

• Journal of Chest Surgery
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• 제32권3호
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• pp.287-293
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• 1999

Isoniazid와 rifampin을 포함한 여러 항결핵약제에 내성을 보이는 다제내성 폐결핵의 경우 기존의 화학요법으로는 치료성공률이 낮고 장기생존율도 낮은 것으로 보고되고 있다. 최근 들어 다제내성 페결핵환자에 대한 약물치료의 보조적인 요법으로 적극적인 수술적 치료에 대한 보고가 이루어지고 있으며 좋은 치료성적을 보고하고 있다. 서울대학교병원 과에서는 1994년 1월부터 1998년 3월까지 다제내성 폐결핵으로 폐절제술을 시행 받은 27례의 임상기록에 대한 분석을 시행하였다. 환자들의 평균나이는 40세였고 술전 병력기간은 평균 3.1년이었다. 모든 환자들은 술전 2차 약제를 투여 받고 있었으며 약물 감수성 검사상 평균 4.4개의 약물에 내성을 보였다. 방사선 검사상 대부분의 환자(96%)에서 주된 병변으로 공동을 발견할 수 있었고 양측성 병변은 19례 (70%)에서 발견되었다. 술전 객담검사상 11례 (41%)에서 객담균 음전화가 이루어졌다. 수술은 전폐적출술이 9례, 폐엽절제술을 16례, 구역절제술을 2례에서 시행하였다. 술후 사망은 없었으며 술후 합병증으로는 1주이상의 지속적인 공기누출이 3례, 출혈로 인한 재수술이 2례, 술후 4개월 후에 발생한 기관지늑막루로 인한 재수술이 1례, 일시적인 신경학적 이상소견이 1례에서 관찰되었다. 수술 직후 22례 (82%)의 환자에서 객담균음전이 이루어졌고, 술후 지속적인 약물치료로 나머지 4례 (14%)에서 균음전이 이루어졌다. 양측성 공동병변을 갖고 있던 1례(4%)에서 객담균음전이 이루어지지 않았다. 다제내성 폐결핵 환자에서 그 병변이 국한되어 있고 수술적 치료를 견딜 수 있는 경우 적극적인 수술적 치료와 내과적 치료를 병합한 경우 높은 치료성공률을 보임을 확인할 수 있었다.

• Journal of Chest Surgery
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• 제40권9호
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• pp.617-623
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• 2007

배경: 침습성 폐아스페르길루스증은 면역체계가 낮은 환자들에게 흔한 진균감염으로, 특히 백혈병으로 항암제 치료를 받고 있는 환자들에서는 항진균제 치료에 반응이 적은 것으로 알려져 있다. 저자들은 백혈병의 치료 중 합병된 폐아스페르길루스증에 대하여 모두 폐절제술을 시행하였으며, 그의 효과 등을 알아보고자 하였다. 대상 및 방법: 1998년 2월부터 2007년 4월까지 혈액암 질환의 진단과 함께 침습성 폐아스페르길루스증 진단을 받은 환자 14명을 대상으로 후향적인 검토를 하였다. 환자의 의무기록을 통해 혈액암(기저질환)의 종류와 그에 따른 치료, 침습성 폐아스페르길루스증의 진단방법, 수술 전 혈액학적 상태와 처치, 수술방법, 수술 후 합병증과 사망여부, 수술 후 폐아스페르길루스증의 재발현율 및 골수이식 여부 등을 조사하였다. 결과: 침습성 폐아스페르길루스증이 합병된 혈액암 환자 14명에서 모두 폐엽절제술이 시행되었다. 수술 후 1명의 환자에서 기관지흉막루가 발생되었으나, 기타 창상감염, 출혈 등의 위중한 합병증이나 수술 후 사망한 환자는 없었으며, 모두 백혈병치료를 지속할 수 있었다. 결론: 침습성 폐아스페르길루스증은 혈액암에 대한 치료 도중 종종 발생되는 위중한 질환이나, 폐엽절제술은 안전하며 효과적으로 혈액암의 치료를 유지시켜 줄 수 있는 치료법으로 생각한다.