• 대한임상독성학회지
• /
• 제6권1호
• /
• pp.32-36
• /
• 2008

Purpose: The major complication of acute organophosphate (OP) poisoning is respiratory failure as a result of cholinergic toxicity. Many clinicians find it difficult to predict the optimal time to initiate mechanical ventilation (MV) weaning, and as a result have tended to provide a prolonged ventilator support period. The purpose of this study is to determine any clinical predictors based on patients characteristics and laboratory findings to assist in the optimal timing of mechanical ventilator weaning. Methods: We reviewed medical and intensive care records of 44 patients with acute OP poisoning who required mechanical ventilation admitted to medical intensive care unit between July 1998 and June 2007. Patient information regarding the poisoning, clinical data and demographic features, APACHE II score, laboratory data, and serial cholinesterase (chE) levels were collected. Base on the time period of MV, the patients were divided into two groups: early group (wean time < 7 days, n = 28) and delayed group (${\geq}$ 7 days, n = 16). Patients were assessed for any clinical characteristics and predictors associated with the MV weaning period. Results: During the study period, 44 patients were enrolled in this study. We obtained the sensitivity and specificity values of predictors in the late weaning group. APACHE II score and a reciprocal convert of hypoxic index but specificity (83.8%) is only APACHE II score. Also, the chE concentration (rho = -0.517, p = 0.026) and APACHE II score (rho = 0.827, p < 0.001) correlated with a longer mechanical ventilation duration. Conclusion: In patients with acute OP poisoning who required mechanical ventilation, the APACHE II scoring system on a point scale of less than 17 and decrements in cholinesterase levels on 1-3 days were good predictors of delayed MV weaning.

• 대한족부족관절학회지
• /
• 제4권2호
• /
• pp.93-99
• /
• 2000

Eleven patients with calcaneal fracture had 2 acute compartment syndrome of the feet and 9 late complication of the compartment syndrome of the feet. An interstitial pressure of more than 30 mmHg in either the central or interosseous compartment was considered pathologic and was treated by fasciotomy performed medially. Rigid claw toe deformity was treated by excision of the head and neck of the proximal phalanx, dorsal capsular release of the metatarsophalangeal joint, and lengthening of the extensor tendon. Patients were evaluated at a mean of 35 months(range, 21 - 44 months) after operation, and the examination was directed specifically toward symptoms and signs of myoneural ischemia, and walking pain. At follow-up, 2 patients with acute compartment syndrome of the foot had no evidence of myoneural ischemia, 9 patients with claw toe deformity had no pain with walking. Based on our clinical observations, we concluded that compartment syndrome of the foot may occur after the calcaneal fracture and fasciotomy is effective treatment for the prevention of the long term sequelae of this debilitating condition.

• Archives of Reconstructive Microsurgery
• /
• 제10권2호
• /
• pp.169-174
• /
• 2001

Purpose : The problems of late deterioration of sensation and a double sensibility phenomenon are a known deficiency of the original neurovascular island flap. To eliminate this problems, the authors was performed to assess the results of Thumb-pulp loss reconstruction with a heterodigital neurovascular island Flap Using a Nerve Disconnecting-Reconnecting Technique Material and Methods : Between July. 1987 and November. 2000, we have used a disconnecting-reconnecting technique for heterodigital island flaps in which divided nerve of the transferred island flap is sutured to original nerve of the thumb in 9 patients. 9 patients with a mean follow-up period of 3.6 years were examined, while 7 patients were follow-up for 2years or more. Evaluation of results was based on flap quality, donor site quality, classic two-point sensory discrimination(2PD), and location of sensation(double sensibility), donor site cold intolerance, neuroma formation, scar contractures, total active movement(TAM) of the thumb and donor digit and subjective results and objective results. Results : The two-point discrimination was average 6.7 mm. Donor site paresthesia was observed more frequently in a short postoperative period. Sensation was referred to the thumb in all cases and the recovery occurred over a period of a two months. There were no flap complication or failures and the length of the thumb tip was preserved in all cases. Conclusion : This technique was found to provide well-vascularized pulp of the thumb with proper cortical representation in one operative stage.

• 한국잠사곤충학회지
• /
• 제9권
• /
• pp.43-47
• /
• 1969

잠종의 최청란에 2000r 4000r 8000r 16000r을 조사하여 만추잠기실험에서 다음과 같은 결과를 얻었다. 1. 잠아의 전령경과는 표준고와 별차없고 잠아발육은 ${\gamma}$선조사 4000r까지는 제일나 8000과 16,000을 부제하고 척소잠이나 기형잠은 발생치 않었다. 2. 감잠비율은 8000r이상은 현저히 높고 병잠을 분류하였든바 87.6%가 농병잠 5.9%의 연화병잠과 6.5%의 농연화병이 발생하였다. 3. 5령성장극도와 열잠의 조사선 전생체량을 측정하였드니 ${\gamma}$선조사량이 많을수록 저하되고 16000r은 극히 불량하였다. 4. 견의 조제도는 2000r 조사가 가장 제일하고 16000r은 부제하였으며 소형잠이 많었다. 5. 최청란에 ${\gamma}$선조사가 실용형질에 미치는 영향은 2000${\gamma}$조사가 유충이 강하고 견형이 재일한 것으로 보아 2000r 조사전후가 육성과정에 있어서 이용도가 높은 것으로 사료되었다.

• Childhood Kidney Diseases
• /
• 제8권2호
• /
• pp.250-255
• /
• 2004

월슨병은 구리 대사 이상으로 간, 뇌, 각막, 신 및 건혈구에 구리가 침착되어 생기는 상염색체 열성 유전성 질환이다. D-penicillamine이 주된 치료로서 10% 정도의 환자에서 가역적인 부작용이 발생 할 수 있다 저자는 3세된 여아에서 D-penicillamine치료 3주만에 미세변화형 신증후군이 발생하였고 투약 중단만으로 완전 관해된 증례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Radiation Oncology Journal
• /
• 제30권2호
• /
• pp.62-69
• /
• 2012

Purpose: To evaluate the treatment outcome and prognostic factor of postoperative radiotherapy for extremity soft tissue sarcoma (STS). Materials and Methods: Forty three patients with extremity STS were treated with conservative surgery and postoperative radiotherapy from January 1981 to December 2010 at Korea University Medical Center. Median total 60 Gy (range, 50 to 74.4 Gy) of radiation was delivered and 7 patients were treated with chemotherapy. Results: The median follow-up period was 70 months (range, 5 to 302 months). Twelve patients (27.9%) sustained relapse of their disease. Local recurrence occurred in 3 patients (7.0%) and distant metastases developed in 10 patients (23.3%). The 5-year overall survival (OS) was 69.2% and disease free survival was 67.9%. The 5-year local relapse-free survival was 90.7% and distant relapse-free survival was 73.3%. On univariate analysis, no significant prognostic factors were associated with development of local recurrence. Histologic grade (p = 0.005) and stage (p = 0.02) influenced the development of distant metastases. Histologic grade was unique significant prognostic factor for the OS on univariate and multivariate analysis. Severe acute treatment-related complications, Common Terminology Criteria for Adverse Events (CTCAE) grade 3 or 4, developed in 6 patients (14.0%) and severe late complications in 2 patients (4.7%). Conclusion: Conservative surgery with postoperative radiotherapy achieved a satisfactory rate of local control with acceptable complication rate in extremity STS. Most failures were distant metastases that correlate with tumor grade and stage. The majority of local recurrences developed within the field. Selective dose escalation of radiotherapy or development of effective systemic treatment might be considered.

• Journal of Chest Surgery
• /
• 제24권2호
• /
• pp.161-170
• /
• 1991

Clinical results with the Mechanical cardiac valves were reviewed for 261 patients who underwent cardiac valve replacement from September, 1985 to July, 1990. of the Mechanical valves used, 156 were Carbomedics, 109 Duromedics, 52 St. Jude and 11 Bjork-Shiley. Overall hospital mortality was 14 out of 261[5,36%]: 9 out of 159[5.66%] for MVR, 1 out of 35[2.86%] for AVR and 4 out of 67[5.96%] for DVR[AVR+MVR]. Two hundred and forty seven operative survivors were followed up for a total 466.8 patient-years, ranged from 1 month to 4.9 years [a mean 1.8 years] and the follow up was 96.0%. There were 12 valve-related complications: three from thromboembolism, three from valve thrombosis, three from prosthetic valve endocarditis, two from paravalvular leak and the other one from hemorrhage. Actuarial rate free from all valve-related complication at 4.9 years was 96$\pm$1.3%. There were 11 late deaths: two from thromboembolism, one from valve thrombosis, one from prosthetic valve endocarditis, one from hemorrhage and the others 6 from non-valve-related complications. Actuarial survival rate at 4.9 years was 94$\pm$2.0%. 96$\pm$3.0% for MVR, 94$\pm$4.2% for AVR and 91$\pm$3.7% for DVR[AVR+MVR]. And there are 7 reoperations: three from paraprosthetic leak, two from prosthetic valve endocarditis and two from valve thrombosis. Actuarial rate free from reoperation at 9 years was 96$\pm$2.9%. On the basis of this 4.9 years of experience, the pyrolytic carbon mechanical valves appears to be an excellent mechanical prosthesis for cardiac valve replacement, in terms of hemodynamic performance, low mortality and low thrombogenecity.

• Clinical and Experimental Pediatrics
• /
• 제61권8호
• /
• pp.245-252
• /
• 2018

Purpose: This study investigated patterns of ischemic injury observed in brain images from patients with neonatal group B Streptococcal (GBS) meningitis. Methods: Clinical findings and brain images from eight term or near-term newborn infants with GBS meningitis were reviewed. Results: GBS meningitis was confirmed in all 8 infants via cerebrospinal fluid (CSF) analysis, and patients tested positive for GBS in both blood and CSF cultures. Six infants (75.0%) showed early onset manifestation of the disease (<7 days); the remaining 2 (25.0%) showed late onset manifestation. In 6 infants (75%), cranial ultrasonography showed focal or diffuse echogenicity, suggesting hypoxic-ischemic injury in the basal ganglia, cerebral hemispheres, and periventricular or subcortical white matter; these findings are compatible with meningitis. Findings from magnetic resonance imaging (MRI) were compatible with bacterial meningitis, showing prominent leptomeningeal enhancement, a widening echogenic interhemisphere, and ventricular wall thickening in all infants. Restrictive ischemic lesions observed through diffusion-weighted imaging were evident in all eight infants. Patterns of ischemic injury as detected through MRI were subdivided into 3 groups: 3 infants (37.5%) predominantly showed multiple punctuate lesions in the basal ganglia, 2 infants (25.0%) showed focal or diffuse cerebral infarcts, and 3 infants (37.5%) predominantly showed focal subcortical or periventricular white matter lesions. Four infants (50%) showed significant developmental delay or cerebral palsy. Conclusion: Certain patterns of ischemic injury are commonly recognized in brain images from patients with neonatal GBS meningitis, and this ischemic complication may modify disease processes and contribute to poor neurologic outcomes.

• Journal of Yeungnam Medical Science
• /
• 제5권1호
• /
• pp.17-22
• /
• 1988

1984년 6월 부터 1987년 8월까지 영남대학교 의과대학 부속병원 정형외과에서 체험한 9예의 대퇴골 결부골절에 대한 분석결과는 아래와 같다. 골절의 원인은 교통사고가 대부분(5예)이었으며, 성별로는 여자 6예, 남자 3예였다. 골절의 유형은 제 2형(transcervical)이 6예로 가장 많았다. 치료는 4예에서 도수정복후 내고정하였으며 3예에서는 관혈적정복 및 내고정했고, 2예에서 견인과 석고붕대 고정하였다. 치료결과는 6예에서 우수하였으나, 3예에서 불량하였다. 불량한 예는 모두 고관절, 대퇴경부 및 대퇴골두에 합병증이 생긴 경우였다. 교통사고 등 사고예방에 관심을 높여야 하고, 빠른 진단과 적절한 내고정방법들이 중요한 것으로 생각되었다.

• Journal of Korean Neurosurgical Society
• /
• 제58권6호
• /
• pp.539-546
• /
• 2015

Objective : To report the learning curve of percutaneous endoscopic lumbar discectomy (PELD) for a surgeon who had not been previously exposed to this procedure based on the period and detailed technique with a retrospective matched comparative design. Methods : Of 213 patients with lumbar disc herniation encountered during the reference period, 35 patients who were followed up for 1 year after PELD were enrolled in this study. The patients were categorized by the period and technique of operation : group A, the first 15 cases, who underwent by the 'in-and-out' technique; group B, the next 20 cases, who underwent by the 'in-and-out-and-in' technique. The operation time, failure rate, blood loss, complication rate, re-herniation rate, the Visual Analogue Scale (VAS) for back and leg were checked. The alteration of dural sac cross-sectional area (DSCSA) between the preoperative and the postoperative MRI was checked. Results : Operative time was rapidly reduced in the early phase, and then tapered to a steady state for the 35 cases receiving the PELD. After surgery, VAS scores for the back and leg were decreased significantly in both groups. Complications occurred in 2 patients in group A and 2 patients in group B. Between the two groups, there were significant differences in operative time, improvement of leg VAS, and expansion of DSCSA. Conclusion : PELD learning curve seems to be acceptable with sufficient preparation. However, because of their high tendency to delayed operation time, operation failure, and re-herniation, caution should be exercised at the early phase of the procedure.