• Asian Pacific Journal of Cancer Prevention
• /
• 제16권6호
• /
• pp.2543-2546
• /
• 2015

Purpose: Percutaneous transhepatic biliary drainage (PTBD) is a form of palliative care for patients with malignant obstructive jaundice. We here compared the infection incidence between internal-external and external drainage for patients with malignant obstructive jaundice. Methods: Patients with malignant obstructive jaundice without infection before surgery receiving internal-external or external drainage from January 2008 to July 2014 were recruited. According to percutaneous transhepatic cholangiography (PTC), if the guide wire could pass through the occlusion and enter the duodenum, we recommended internal-external drainage, and external drainage biliary drainage was set up if the occlusion was not crossed. All patients with infection after procedure received a cultivation of blood and a bile bacteriological test. Results: Among 110 patients with malignant obstructive jaundice, 22 (52.4%) were diagnosed with infection after the procedure in the internal-external drainage group, whereas 19 (27.9%) patients were so affected in the external drainage group, the difference being significant (p<0.05). In 8 patients (36.3%) in the internal-external group infection was controlled, as compared to 12 (63.1%) in the external group (p< 0.05). The mortality rate for patients with infection not controlled in internal-external group in one month was 42.8%, while this rate in external group was 28.6% (p< 0.05). Conclusion: External drainage is a good choice, which could significantly reduce the chance of biliary infection caused by bacteria, and decrease the mortality rate at one month and improve the long-term prognosis.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권21호
• /
• pp.9391-9394
• /
• 2014

Purpose: To evaluate the effect of internal-external percutaneous transhepatic biliary drainage (IEPTBD) for patients with malignant obstructive jaundice. Methods: During the period of January 2008 and July 2013, internal-external drainage was performed in 42 patients with malignant obstructive jaundice. During the procedure, if the guide wire could pass through the occlusion and into the duodenum, IEPTBD was performed. External drainage biliary catheter was placed if the occlusion was not crossed. Newly onset of infection, degree of bilirubin decrease and the survival time of patients were selected as parameters to evaluate the effect of IEPTBD. Results: Twenty newly onset of infection were recorded after procedure and new infectious rate was 47.6%. Sixteen patients with infection (3 before, 13 after drainage) were uncontrolled after procedure, 12 of them (3 before, 9 after drainage) died within 1 month. The mean TBIL levels declined from 299.53 umol/L before drainage to 257.62 umol/L after drainage, while uninfected group decline from 274.86 umol/L to 132.34 umol/Lp (P < 0.5). The median survival time for uninfected group was 107 days, and for infection group was 43 days (P < 0.05). Conclusions: The IEPTBD drainage may increase the chance of biliary infection, reduce bile drainage efficiency and decrease the long-term prognosis, and the external drainage is a better choice for patients with malignant obstructive jaundice need to biliary drainage.

• Journal of Gastric Cancer
• /
• 제4권3호
• /
• pp.176-179
• /
• 2004

Surgical treatment for afferent loop syndrome (ALS) in patients with recurrent gastric cancer is usually not feasible because of the recurrent tumor mass at the anastomosis site and/or extensive carcinomatosis resulting in bowel loop fixation. Furthermore, ALS usually makes oral intake impossible, resulting in a rapid deterioration in general condition. In this situation, gastroscopic stenting at the anastomotic site and/or percutaneous external drainage may be a more feasible alternative for palliation. We herein report a recurrent gastric cancer whose ALS was successfully treated with internal and external drainage procedures.

• Advances in pediatric surgery
• /
• 제9권1호
• /
• pp.52-56
• /
• 2003

A 10 year old boy was admitted with blunt abdominal trauma by bike handle injury. The patient was operated upon for a generalized peritonitis due to pancreaticoduodenal injury. On opening the peritoneal cavity. complete transection of distal end of common bile duct and. partial separation between pancreas head and second portion of duodenum were found. Ligation of the transected end of the common bile duct. T-tube choledochostomy, and external drainage were performed. A pseudocyst was found around the head portion of the pancreas on the 7th postoperative day with CT. An internal fistula had developed between the pseudocyst and ligated common bile duct. The pseudocyst was subsided after percutaneous drainage. In the case of the undetermined pancreatic injury, percutaneous external drainage can be effective in treating the traumatic pancreatic pseudocyst in a pediatric patient.

• Tuberculosis and Respiratory Diseases
• /
• 제81권2호
• /
• pp.106-115
• /
• 2018

Chest tube insertion is a common procedure usually done for the purpose of draining accumulated air or fluid in the pleural cavity. Small-bore chest tubes (${\leq}14F$) are generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general, with the possible exception of hemothoraces and malignant effusions (for which an immediate pleurodesis is planned). Large-bore chest drains may be useful for very large air leaks, as well as post-ineffective trial with small-bore drains. Chest tube insertion should be guided by imaging, either bedside ultrasonography or, less commonly, computed tomography. The so-called trocar technique must be avoided. Instead, blunt dissection (for tubes >24F) or the Seldinger technique should be used. All chest tubes are connected to a drainage system device: flutter valve, underwater seal, electronic systems or, for indwelling pleural catheters (IPC), vacuum bottles. The classic, three-bottle drainage system requires either (external) wall suction or gravity ("water seal") drainage (the former not being routinely recommended unless the latter is not effective). The optimal timing for tube removal is still a matter of controversy; however, the use of digital drainage systems facilitates informed and prudent decision-making in that area. A drain-clamping test before tube withdrawal is generally not advocated. Pain, drain blockage and accidental dislodgment are common complications of small-bore drains; the most dreaded complications include organ injury, hemothorax, infections, and re-expansion pulmonary edema. IPC represent a first-line palliative therapy of malignant pleural effusions in many centers. The optimal frequency of drainage, for IPC, has not been formally agreed upon or otherwise officially established.

• Archives of Plastic Surgery
• /
• 제43권1호
• /
• pp.88-92
• /
• 2016

There are two general categories of lateral osteotomy techniques-the external perforating method and the internal continuous method. Regardless of which technique is used, procedural effectiveness is hampered by limited visualization in the surgical field. Considering this point, we devised a new technique that involves using a wide subperiosteal dissection and internal perforation under direct visualization. Using an intranasal approach, whereby the visibility of the intended fracture line was maintained, enabled a greater degree of control, and in turn, results that were more precise, and thus predictable and reproducible. Traditionally, it has been taken as dogma that the periosteum must be preserved, considering the potential for dead space and bony instability; however, under sufficient visualization of the surgical field with an internal perforating method, complete osteotomy with fully preserved intranasal mucosa could be conducted exactly as intended. This intact mucosal lining compensates for the elevated periosteum. Compressive dressing and drainage through a Silastic angio-needle catheter enabled the elimination of dead space. Therefore, precise, reproducible, and predictable osteotomy minimizing the potential for associated complications such as ecchymosis, that is, bruising owing to hemorrhage, could be performed. In this article, we introduce a novel technique for lateral osteotomy with improved visualization.

• 대한영상의학회지
• /
• 제84권6호
• /
• pp.1403-1407
• /
• 2023

방광암의 림프절 전이는 방광의 림프순환에서 처음과 두 번째로 거쳐 가는 외/내 장골, 폐쇄림프절과 총장골림프절에서 주로 일어난다. 방광암에서 횡격막을 넘어서 일어나는 전이는 드물고, 두경부로의 전이는 예후가 좋지 않으며 생존율도 낮다. 방광요로상피암 환자에서 뼈나 그 외에 고형장기로의 전이 없이 목 피부의 염증성 변화와 함께 림프절전이를 동반하는 것은 드문 증례이므로 이에 보고하고자 한다.

• 펄프종이기술
• /
• 제31권1호
• /
• pp.39-45
• /
• 1999

Refining in papermaking plays an important role in changing fiber properties as well as paper properties. The major effects of refining on pulp fibers are internal and external fibrillation, fiber shortening, and fines formation. Many workers showed that internal fibrillation of the primary refining effects was most influential in improving paper properties. In particular, refining produces separation of fiber walls into several lamellae, thus causing fiber wall swelling with water penetration. This leads to the increase of fiber flexibility and of fiber-to-fiber contact during drying. If the fibers are very flexible, they will be drawn into close contact with each other by the force of surface tension as the water is removed during the drainage process and drying stages. In order to study the effect of fiber wall delamination on paper properties, cross-sectional image of fibers in a natural condition had to be generated without distortion. Finally, it was well recognized that confocal laser scanning microscope (CLSM) could be one of the most efficient tool for creating and quantifying fiber wall delamination in combination with image analysis technique. In this study, the CLSM could be used not only to observe morphological features of transverse views of swollen fibers refined under low and high intensity, but also to investigate the sequence of fiber wall delamination and fiber wall breakage. From the CLSM images, increasing the specific energy or refining decreased the degree of fiber collapse, fiber cross-sectional area, fiber wall thickness and lumen area. High intensity refining produced more external fibrillation.

• 보존과학회지
• /
• 제34권1호
• /
• pp.11-21
• /
• 2018

등록문화재 제233호 '공주 중학동 구 선교사 가옥'의 유래와 보존현황에 관한 연구결과 건축연대는 1921년 10월 23일이 합당하며 일제 강점기 말기 최후 거주자는 그동안 Amendt 선교사로 알려져 왔으나, 1939년 작성된 Williams 선교사의 편지 및 새로운 증언에 의해 Alice Sharp 선교사가 1939년 은퇴시까지 사용하였던 건물로서 독신여선교사들의 주거는 물론 여학교역할도 하였던 건물로 밝혀졌다. 따라서 이 문화재의 명칭도 '공주 여선교사 기념관'으로 변경하는 것이 바람직하다. 본 문화재의 내 외부 보존현황 조사 결과 건물 벽체의 기울기에는 이상이 없으나 내부 목재상태가 상당부분 열화되어 있어 안전진단 후 전체적인 보수가 필요한 상황으로 판단된다. 특히, 창호시설의 경우 본래의 상하 미닫이 창호로 복원할 필요가 있으며, 건물의 남서측 계단과 데크 및 우물의 원형복원이 필요한 것으로 판단된다. 아울러 문화재의 하부지반의 안전성에 관한 지반 비파괴진단결과 이 선교유적이 2~5 m 두께의 불균등한 표토층 위에 건축되었으며 표토층과 그 하부의 풍화암과의 경계면이 지형경사 방향으로 기울어져 있는 현상이 발견되고 있다. 이러한 현상은 우기에 지반의 함수비가 증가하면 지반의 지지력이 저하되는 바 부등침하발생 가능성이 있으며, 특히 집중호우가 발생한다면 산사태를 초래할 가능성이 있다. 따라서 본 건물 부지의 남서단 경계부에 석축시설을 설치하는 것이 바람직하며 신속한 배수가 되도록 배수시설 설치가 필요하다.

• Archives of Plastic Surgery
• /
• 제39권6호
• /
• pp.643-648
• /
• 2012

Background Aggressive treatment of sternoclavicular joint (SCJ) infection involves systemic antibiotics, surgical drainage and resection if indicated. The purpose of this paper is to describe a classification of post resectional SCJ defects and highlight our reconstructive algorithm. Defects were classified into A, where closure was possible often with the aid of topical negative pressure dressing; B, where parts of the manubrium, calvicular head, and first rib were excised; and C, where both clavicular, first ribs and most of the manubrium were resected. Methods Twelve patients (age range, 42 to 72 years) over the last 8 years underwent reconstruction after SCJ infection. There was 1 case of a type A defect, 10 type B defects, and 1 type C defect. Reconstruction was performed using the pectoralis major flap in 6 cases (50%), the latissimus dorsi flap in 4 cases (33%), secondary closure in 1 case and; the latissimus and the rectus flap in 1 case. Results All wounds healed uneventfully with no flap failure. Nine patients had good shoulder motion. Three patients with extensive clavicular resection had restricted shoulder abduction and were unable to abduct their arm past $90^{\circ}$. Internal and external rotation were not affected. Conclusions We highlight our reconstructive algorithm which is summarised as follows: for an isolated type B SCJ defect we recommend the ipsilateral pectoralis major muscle for closure. For a type C bilateral defect, we suggest the latissimum dorsi flap. In cases of extensive infection where the thoracoacromial and internal mammary vessels are thrombosed, the pectoralis major and rectus abdominus cannot be used; and the latissimus dorsi flap is chosen.