• Tuberculosis and Respiratory Diseases
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• 제57권4호
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• pp.381-385
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• 2004

저자들은 클렙시엘라균종에 의한 폐렴에 동반된 폐 괴저를 수술적 치료없이 약물로만 호전시킨 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• 대한정형외과학회지
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• 제54권1호
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• pp.37-44
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• 2019

목적: 슬관절 주위 악성 골연부 종양 치료 시 종양의 도약전이나 슬관절 내 침범, 종양인공관절 치환술 후 반복적 감염 치료를 위한 인접골 절제, 국소재발 및 기계적 파괴가 발생한 경우 슬관절 상하부 전치환술은 하지와 슬관절 기능을 보존하는 한 방법이다. 이 중 반복된 감염 치료를 위해 슬관절면 반대측 골까지 절제 후 한시적 슬관절 고정술을 한 환자에서 가동관절로 재치환술 시 적응증, 합병증, 치환물의 생존율에 대하여 알아보고자 하였다. 대상 및 방법: 본 연구는 슬관절 상하부 전치환술 환자 34예 중 슬관절 주위 종양인공관절 치환술 후 반복적인 감염으로 슬관절면 반대측 골까지 절제한 후 한시적 슬관절 고정술이 불가피했던 13예를 대상으로 하였다. 진단, 원발병소의 위치, 슬관절 상하부 전치 환술을 받기 전까지 수술 횟수 및 기간, 재 재건술 후 치환물의 생존율, 합병증, 기능적 결과를 분석하였다. 결과: 슬관절 상하부 종양인공관절 치환물의 Kaplan-Meier 법에 의한 5, 10년 생존율은 각각 69.0%±12.8%, 46.0%±20.7%였다. 총 13예 중 6예(46.2%)에서 주 합병증이 발생하여 3예는 내고정물을 제거 후 슬관절 고정술을, 2예는 내고정물의 부분교체를, 나머지 1예는 감염된 육아조직만 제거하였다. 최종 추시상 가동관절을 유지한 10예의 Musculoskeletal Tumor Society 기능평가 점수는 평균 24.6점(21-27점)이었다. 슬관절 상하부 종양인공관절 치환술이 실패하여 슬관절 고정술로 재치환 한 3예의 기능평가 평균 점수는 12.3점(12-13점)이었다. 가동관절을 유지한 10예의 슬관절 가동 범위는 평균 67°였다(0°-100°). 슬관절 능동적 신전제한은 평균 48° (20°-80°)였다. 결론: 슬관절 주위 종양인공 치환술 후 반복적인 감염으로 슬관절면 반대측 골까지 절제 후 한시적 슬관절 고정술이 불가피했던 환자에서 슬관절 상하부 종양인공관절 치환술은 합병증의 위험성은 높으나 슬관절 고정술에 비해 기능적 결과가 월등하므로 시도할 가치가 있는 술식이다. 고정된 슬관절을 가동관절로 치환 시 반흔 조직을 철저히 제거하고 연부조직을 확보하여 종양인공관절을 삽입 후 굴곡 및 신전이 가능할 정도의 공간을 확보하는 것이 술식의 성공에 중요하다고 생각된다.

• Journal of Chest Surgery
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• 제24권10호
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• pp.1011-1018
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• 1991

From September, 1985 to March, 1991, 33 patients under went thoracotomy for treatment of pulmonary aspergilloma with Pulmonary tuberculosis on the department of Thoracic and Cardiovascular Surgery, National Kongju Hospital. 1. There were 25 male and 8 female patients ranging from 19 to 57 years old [mean age, 36.2 years]. 2. Hemoptysis was the most common symptom [recurrent minor hemoptysis: 24cases, severe hemoptysis [200cc /day]: 4 cases, massive hemoptysis [600/day]: 4 cases]. 3. In the chest X-ray films, intracavitary fungus balls [air meniscus sign] were noted in 20 cases [61%] and upper lobe involvements were 29 cases [88%]. 4. All cases had a history of treatment with antituberculosis drugs under diagnosis of pulmonary tuberculosis for an average of 10 years and 2 months. 5. The most common indication for operation was hemoptysis [32 cases] - hemoptysis with total destroyed lung or lobe: 12cases, hemoptysis with open AFB [t-] cavity: 6cases, recurrent or massive hemoptysis: 14 cases. 6. The operative procedures was as follows - - - lobectomy . 16 cases, pneumonectomy: 8 cases, bilobectomy, segmentectomy, cavernoplasty and lobectomy with segmentectomy: each 2 cases, lobectomy with cavernoplasty: 1 case. 7. 6 complications appeared postoperatively which included empyema with BPF [2 cases], empyema [2 cases] and wound infection [2 cases]. In conclusion, surgical resection is the treatment of choice in the management of pulmonary aspergilloma associated pulmonary tuberculosis.

• Clinical and Experimental Pediatrics
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• 제58권3호
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• pp.112-115
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• 2015

Hand, foot, and mouth disease (HFMD) is an acute, mostly self-limiting infection. Patients usually recover without any sequelae. However, a few cases are life threatening, especially those caused by enterovirus 71 (EV71). A 12-month-old boy was admitted to a primary hospital with high fever and vesicular lesions of the mouth, hands, and feet. After 3 days, he experienced 3 seizure episodes and was referred to our hospital. On admission, he was conscious and his chest radiograph was normal. However, 6 hours later, he suddenly lost consciousness and had developed a massive pulmonary hemorrhage that continued until his death. He experienced several more intermittent seizures, and diffuse infiltration of both lung fields was observed on chest radiography. Intravenous immunoglobulin, dexamethasone, cefotaxime, leukocyte-depleted red blood cells, fresh frozen plasma, inotropics, vitamin K, and endotracheal epinephrine were administered. The patient died 9 hours after intubation, within 3 days from fever onset. EV71 subgenotype C4a was isolated retrospectively from serum and nasopharyngeal swab by real-time reverse transcription-polymerase chain reaction. Here, we report a fatal case of EV71-associated HFMD with sudden-onset massive pulmonary hemorrhage and suspected encephalitis.

• Clinics in Shoulder and Elbow
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• 제17권4호
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• pp.152-158
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• 2014

Background: To investigate the effectiveness of reverse total shoulder arthroplasty (RTSA) in treating irreparable massive rotator cuff tears (RCTs). Methods: Twenty-nine patients who underwent RTSA for the treatment of irreparable massive RCTs and completed follow-up for at least 1 year were selected. Their mean age was 69.7 years (range, 59-80 years). The mean follow-up was 17.7 months (range, 12-42 months). The shoulder range of motion was measured preoperatively and at final follow-up. The functional result was evaluated using visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeon (ASES) score, and Korean Shoulder Society (KSS) score. Additionally, the shoulders were categorized into two groups depending on prior history of surgery and the clinical outcomes were analyzed between two groups. Results: Mean pain VAS improved, from $6.6{\pm}1.2$ to $2.7{\pm}0.9$ (p=0.001), and the mean functional VAS from $35.7{\pm}4.2$ to $73.3{\pm}5.4$ (p=0.006). The mean ASES score improved from $37.2{\pm}2.8$ to $75.0{\pm}3.8$ (p=0.012). The mean KSS improved from $36.5{\pm}7.2$ to $75.6{\pm}5.4$ (p=0.009), the mean forward elevation from $66.3{\pm}4.7$ to $135.6{\pm}8.4$ (p=0.0001), and the mean abduction from $45.2{\pm}4.2$ to $119.0{\pm}6.5o$ (p=0.0001). Internal rotation differed significantly from the first sacral to the third lumbar vertebrae (p=0.036). External rotation did not change significantly (p=0.076). There was also no statistically significant difference between groups (no previous operation versus none). Four complications occurred: one superficial infection, one with anterior dislocation, one acromial fracture, and one clavicle fracture. Conclusions: RTSA provides reliable pain relief and recovery of shoulder function in patients with massive irreparable RCTs in short-term follow-up.

• Archives of Plastic Surgery
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• 제34권6호
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• pp.799-802
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• 2007

Purpose: The masserteric space is an important tissue compartment of the face, but a disease in it is difficult to diagnose and treat. The submasseteric abscess is located between the masseter muscle and mandibular ramus with different appearances such as sepsis, infection, or tumor. Especially the common misdiagnosis of submasseteric abscess is acute or chronic parotitis. The purpose of this report is to pay special attention to the possible diagnosis of submasseteric abscess for the symptoms of unilateral cheek swelling and tenderness that accompany marked trismus. Methods: A 11-year-old boy came to our hospital because of facial swelling, tenderness, and trismus in a history of left cheek swelling and toothache. We diagnosed his case as submasseteric abscess by CT scan and surgical intervention was performed. Under general anesthesia, the abscess was opened by the intraoral incision and considerably massive pus was drained. Results: Swelling, tenderness, and trismus became to subside during postoperative 10 days and general condition and vital signs became stable. After 6 months, CT scan showed that both masseteric muscles were symmetric and there was no periosteal reaction of the mandible. Conclusion: In conclusion, submasseteric abscess is a rare infection with the symptoms of cheek tenderness and marked trismus. A detailed medical history and clinical examination of a patient as well as computed tomography(CT) are important tools in the accurate diagnosis and efficient treatment of the submasseteric abscess. Adequate drainage, removal of cause, and antibiotic infusion are the management of choice.

• Tuberculosis and Respiratory Diseases
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• 제51권4호
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• pp.390-394
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• 2001

Lymphocytic interstitial pneumonia(LIP) is characterized by a massive infiltration of the interstitium of the lung by mature lymphocytes, plasma cells and reticuloendothelial cells. LIP may be associated with autoimmune diseases including Sj$\check{o}$grens syndrome, SLE, myasthenia gravis, pernicious anemia, autoimmune hemolytic anemia, and HIV or an EB virus infection. There is a possibility of LIP progressing to a pulmonary or systemic lymphoma. The therapeutic response to corticosteroids and/or immunosuppressive drugs varies. Here we report a case of LIP that was diagnosed by an open lung biopsy and clonality study. The patient was a 36 year-old man without autoimmune disease or HIV infection. He was admitted as a result of severe hypoxemia showing $PaO_2$ of 48.3mmHg. The patient was treated with corticosteroids after the diagnosis and had fully recovered without a sequalae or relapse.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제22권1호
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• pp.110-116
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• 2000

A 61-years old man with diabetes mellitus(DM) was admitted to our hospital, complaining of progressive right periorbital swelling, headache and toothache on the right lower second molar. On the first visit, moderate swelling was noticed from the right periorbital region with exophthalmos and subconjunctival effusion. Intraorally, right lower second molar had a severe periodontal disease and fistular formation on its distal area. From 3 days after hospitalization, the visual acuity of his right eye was gradually worsen and we performed CT scan. CT scan demonstrated an inflammatory change at the right orbit with subperiosteal abscess at the inferior orbital wall, which was extended from the right infratemporal, parapharyngeal and internal pterygoid space. Patient was treated by mean of intraoral(right upper vestibular and retromolar) and extraoral(infraorbital) incision and drainage, massive anti-therapy and DM control. The patient improved gradually and finally was discharged from the hospital, but his visual loss of right side was not recovered.

• Archives of Plastic Surgery
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• 제38권4호
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• pp.527-530
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• 2011

Purpose: Liver transplantation is a groundbreaking section in the field of surgery. Nowadays over 90% of success rate is accomplished and life expectancy of the patients has been elongated. Patients are now seeking for surgical procedures including cosmetic plastic surgery. But these patients take immunosuppressive medication and steroids, which can increase the risk of wound infection, and delay wound healing. By reviewing the case of a 21-year-old liver transplant recipient who underwent mastopexy due to breast ptosis, we discussed about the matters we should consider when performing surgery in liver transplantation recipients. Methods: The patient was a 21-year-old female who received liver transplantation from her father. She was exposed to massive amount of steroids and immunosuppressants, which led to breast ptosis. The vertical and short horizontal incision mastopexy using a medial-based pedicle was done, 29 months after the liver transplantation. Results: On postoperative day 1, she was discharged. On day 10, sutures were removed and taping was applied. There was no sign of wound infection, wound dehiscence, hematoma or bleeding. The patient was followed up at 3, 6 and 9 months after the operation. Mild recurrence of the glandular ptosis was observed but revision was not required. Conclusion: We were able to successfully operate without any complications in the liver transplant recipient. With special attention and consideration, cosmetic plastic surgery can be safely performed in organ transplantation recipients.

• 한국수의병리학회지
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• 제6권1호
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• pp.41-48
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• 2002

Oval cell is considered as facultative precursor cells for both hepatocytes and biliary cells, as well as origin of hepatocellar and cholangiocellular carcinoma (CCC) during carcinogenesis or toxic liver injury. To clarify the cellular origin or differentiation of cholagiocarcinogensis, the fate of carcinogen-induced oval cells was pathologically and phenotypically chased in Syrian golden hamster liver after Clonorchis sinensis (CS) infection which would give rise to a promoting effect. Two week treatment of hamsters with 0.005% diethylnitrosamine (DEN) followed by 2 week treatment of 1% 2-acetylaminofluorene (AAF) under choline deficient diet resulted in massive proliferation of BrdU labeleed and PCNA positive oval cells showing various distinct morphology, histochemical and immunohistochemical phenotypes for GGT, cytokeratin 19 and OV-6. Oval cells also frequently form ductular-like structures or phenotypically show hepatocyte-like characteristics. After CS infection, the oval cells showed sequential morphological changes to atypicl proliferating bile ductules and all hamsters thereafter developed well differentiated and anaplastic CCC at 16 week after CS infection. In electron microscopy, some bile ductules were constructed by intermediate oval cells and bile ductular cells surrounded by basement membrane. The results of this study strongly suggest that CCC developed in the present study were originated from hepatic stem-like oval cells, supporting the theory of stem cell origin of cancers. In addition, this hamster model would be valuable for the molecular mechanistic study during chemical-triggered cholangiocarcinogenesis.