• Archives of Plastic Surgery
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• 제40권1호
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• pp.36-43
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• 2013

Background Because there are numerous methods for reconstruction of the lower lip, it is not easy to choose the optimal method. In choosing the surgical method for lower lip reconstruction, we obtained acceptable outcomes based on our treatment strategy, which included either a barrel-shaped excision or the Webster modification of the Bernard operation. We report on the surgical outcomes based on our treatment strategy. Methods This study included 26 patients who underwent lower lip reconstructive surgery from September 1996 to September 2010. The operation was done using either a barrel-shaped excision or the Webster modification, considering the location of the defect, the size of the defect, and the amount of residual tissue on the lateral side of the vermilion after excision. Results In our series, 3 patients underwent a single barrel-shaped excision, and nine patients underwent a double barrel-shaped excision. In addition, the unilateral Webster modification was performed on in 6 patients, and there were eight cases of bilateral Webster modification. All of the patients except one were satisfied with the postoperative shape of the lip. In one case both recurrence and dehiscence occurred. One patient had a good postoperative lip shape, but had difficulty wearing a denture, and also underwent commissuroplasty. Furthermore, there were two patients who complained of drooling, and 4 with paresthesia. Conclusions A soft tissue defect resulting from wide excision of a lower lip malignancy can be successfully reconstructed using only one of two surgical methods: the barrel-shaped excision or the Webster modification of the Bernard operation.

• Journal of Trauma and Injury
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• 제22권1호
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• pp.65-70
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• 2009

Purpose: Many studies have addressed a psychiatric analysis of self-injury patients who have self-injurious behavior and who have attempted suicide. Few studies on the injury characteristics of self-injury related trauma patients have been conducted. We analyzed the injury characteristics of self-injury patients. Methods: A retrospective review of the medical records extracted from the injury surveillance system of Wonju Christian Hospital for the period from August 2006 to February 2008 was conducted. Of the 121 cases extracted, 103 were included in this study. We analyzed the sex ratio, age group, place of injury, injury mechanism, location of injury, management results, injury severity, and relation with drinking. Results: One hundred three cases were included (sex ratio: 1.06), and the mean age was $33.9{\pm}14.2$ years old. Fifty-six patients (54.4%) were discharged from the emergency department (ED) on the day of injury after primary care, and 9 patients (8.7%) were discharged, because they refused treatment. Seven patients (6.8%) died. Of these, 4 patients (3.9%) died after attempted cardio-pulmonary resuscitation in the ED, 1 patient (1%) was dead on arrival, and 2 patients (1.9%) died after admission. Sixteen patients (15.5%) were admitted to the hospital, including 2 patients (1.9%) needing emergency surgery. Sixteen patients (15.5%) were transferred to other hospitals. Sixty-one cases (59.2%) involved drinking, and 31 (30.1%) did not; for 11 cases (10.7%), the involvement of drinking was unknown. The mean revised trauma score (RTS) was $11.26{\pm}2.52$, and 88 cases (85.4%) hat a RTS of 12. The mean injury severity score (ISS) was $5.80{\pm}14.56$, and 9 (8.7%) severely injured patients had scores of more than 15. Conclusion: Most self-injuries were mild traumas related to drinking and occurred at a young age. Most cases were not so severe, and the patients were discharged from the ED, but some patients needed hospitalization. Other patients had injuries so severe that they died.

• 대한방사선기술학회지:방사선기술과학
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• 제34권1호
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• pp.59-64
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• 2011

소아암 환자에 대한 양성자치료 시 정밀한 자세재현 확인 및 종양의 위치파악을 위한 DIPS 촬영으로 인하여 발생하는 방사선 피폭에 관하여 확인하여 보았다. 2007년 3월부터 2009년 10월까지 일산의 K 암전문 병원에서 양성자치료를 받은 50명의 소아암 환자를 대상으로 DIPS의 촬영조건을 비교 분석하였으며, 1회 DIPS 촬영 시 피폭선량은 전후 측면촬영에서 0.09~1.57 mGy로 측정 되었으며, 1일 DIPS 촬영이 가장 많은 소아암 환자는 뇌척수조사 환자로 23.55 mGy로 측정되었다. 전뇌조사 환자에서 1일 DIPS 촬영 시 피폭선량이 1.13 mGy로 1일 처방선량을 가장 많이 초과하였으며, 권고선량의 2%를 초과하지 않았다. 치료기간 중 DIPS 피폭선량이 가장 많은 환자는 전뇌조사 환자로 632.71 mGy로 이는 처방선량의 1.13%로 권고선량의 2%를 초과하지 않는 합당한 선량으로 나타났다. 소아암 환자에 대한 DIPS 촬영 시 피폭선량은 처방선량에 대하여 2%를 초과하지 않는 피폭선량으로 나타났지만, 방사선감수성이 높고 평균 잔여 수명이 긴 소아암 환자에게는 유전적 영향 등의 확률적 영향과 관련된 방사선 장해를 초래할 수 있음을 인식하여 소아암 환자의 DIPS 촬영에 대한 가이드라인 제시로 방사선 피폭을 최소화할 수 있는 방안을 마련해야 할 것으로 사료된다.

• 대한방사선기술학회지:방사선기술과학
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• 제39권4호
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• pp.493-499
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• 2016

C-arm장비의 사용 시 시술자의 산란선에 의한 피폭선량을 확인하여 적절하고 효율적인 피폭선량 저 감화 방법을 알아보기 위해 본 연구를 진행하였다. Over Tube 방식에 비해 피폭선량이 적다는 Under Tube 방식의 C-arm 장비를 활용하여 연구한 결과 차폐도구가 두꺼울수록 시술자의 피폭선량은 감소하였고, 중심선에서 멀어질수록 피폭선량이 감소하였고, 조사시간이 길어질수록 피폭선량이 증가하였고, 세 곳의 선량계 부착위치 중 생식선에서 가장 많은 피폭선량이 측정되었고 흉부, 갑상선 순이었다. 그러나 실제 시술 중 피폭선량을 줄이기 위해 거리를 무한정 늘릴 수 없고, 조사시간을 무한정 단축시킬 수 없기 때문에 인위적으로 조절 가능한 차폐 두께를 달리하는 방법으로 시술자의 피폭선량을 감소시킬 수 있었다. C-arm장비를 사용할 경우 시술 중 불편하다는 이유로 방사선 차폐에 소홀히 하고 근접시술이 이루어지기 때문에 피폭량은 증가할 수밖에 없다. 이에 C-Arm장비의 특성상 조정실을 구비할 수 없으므로 Apron 등의 방사선 차폐도구의 적정두께 사용 등으로 시술 중 발생되는 방사선에 의한 시술자의 피폭선량을 경감시켜야 할 것으로 사료된다.

• Archives of Plastic Surgery
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• 제35권4호
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• pp.439-445
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• 2008

Purpose: Malignant fibrous histiocytoma(MFH) is the most common soft tissue sarcoma in adult. As to this date, tissue development, treatment and prognosis of the tumor has not been definitely clarified, however, it has been reported that wide surgical resection of the tumor along with the radiotheraphy and chemotheraphy is needed for treatment. In MFH with high recurrence rate, the reconstruction method and points to be considered for reconstruction in recurrent case were studied in 10 patients who were treated in our hospital. Methods: From August of 1991 to August 2007, location of tumor, initial mass size, 1st recurred period, lymph node metastasis, recurrence rate, treatment modality, complication, reconstruction in recurrent defect, and follow up period was studied in 10 patients who underwent reconstruction at our Plastic surgery department following wide excision. Results: The average age was 62.8(46 - 73) years old, average follow up period was 7.7(1 - 17) years. Various reconstructions has been performed for recurrent cases and postoperative chemotheraphy and radiotheraphy was done. As for reconstruction in recurrent cases, After wide excision, local flap was performed in 6 cases, and free flap in 2 cases. After radiotherapy, osteoradionecrosis was occurred in 4 cases. Recurrence rate was 1 - 5(2.6) times and reconstruction due to recurrence was 7 out of 10 cases(70%). Conclusion: The treatment modality of MFH is not yet defined. Due to it's high recurrence rate, radiotherapy and chemotherapy is commonly combined with surgery. Even still, additional excision and reconstruction may be required. Therefore, possibility of re-operation must be considered when performing every excision and reconstruction; in case a recurrence or osteoradionecrosis occurs. Free flap coverage should be left as the last resort, according to the principle of reconstruction. Nevertheless, if the defect is large or osteoradionecrosis is present, it will benefit greatly to the patient's quality of life.

• Journal of Trauma and Injury
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• 제26권4호
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• pp.273-279
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• 2013

Purpose: In patients with splenic trauma, Computed Tomography (CT) scan is helpful in selecting treatment options and evaluating resolution after NOM (Non-Operative Management). The purpose of this study was to suggest a CT based hemoperitoneum (HP) scoring system that can easily be used by clinicians to evaluate the severity of injury and recovery. Methods: A retrospective review of patients with splenic trauma admitted to our hospital between May 2003 and January 2013 was conducted. Patients diagnosed with isolated spleen injury who had a CT scan on admission were included. 1 or 2 points were given according to location and amount of hematoma in the CT image. Using the existing ultrasonography (US) based HP scoring system, the same method was applied to obtain our CT based HP scoring (CBHS) system, which ranges from 0 to 8 points. The CBHS system can be easily used by clinicians for a quick assessment of splenic injury. Results: Of the 39 patients meeting the inclusion criteria, 6 patients were managed operatively and 33 nonoperatively. There was a significant difference in CBHS between the OM (operative management) group and the NOM group.(p=0.03) CBHS showed correlation with Hb (hemoglobin), Hct (hematocrit), spleen injury grade(AAST), and Hounsfield unit of ROI (Region of interest). (p=0.17, p=0.18, p<0.000, p=0.02, respectively) After successful NOM with stabilized Hb level, the amount of hemoperitoneum was scored in the follow-up CT. CBHS demonstrated correlation with decreased spleen injury grade, decreased Hounsfield unit of ROI (Region of interest) (p=0.039, p=0.049, respectively), and also objectively reflected patient recovery. Conclusion: CBHS can be used as an objective and intuitive tool for clinicians in grading the severity of splenic injury by scoring the amount of hemoperitoneum, and in assessing recovery.

• 대한두경부종양학회지
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• 제25권1호
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• pp.12-17
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• 2009

Background and Objectives : Branchial anomaly is a common neck pathology seen by otolaryngologist. Although there is still controversy regarding the origin, almost all surgeon agree that branchial anomalies result from incomplete involution of the branchial apparatus. Depending on its anatomic location, branchial anomalies can be classified into first, second, third and fourth anomaly. The purpose of this study is to evaluate the incidence of different categories of branchial anomalies and to determine proper method of diagnosis and treatment. Subjects and Method : A retrospective chart review was conducted for 72 patients with branchial anomalies operated on at the Korea University Anam Hospital from 1996 to 2007. The patient's sex, age, presenting symptoms, classification, site of lesion, diagnostic studies, surgical therapy and post-operative surgical complication were reviewed. Results : Patients were commonly seen in the 3rd decades. Eleven patients(15.3%) were first branchial anomalies, 52(72.2%) were second, 1(1.4%) was third, and 8(11.1%) were fourth. Of the types of anomalies, cyst were most commonly seen. In cases of 3rd and 4th branchial anomalies, barium contrast study can delineate the course of sinus or fistula. All cases was operated on for branchial anomalies, there were no major post-operative complication. Conclusion : Cervical mass and recurrent cervical infection or abscess are suspect for branchial anomalies. Especially, clinical history of dysphagia, and recurrent painful swelling in the thyroid region in young patients should raise the suspicion of 3rd and 4th branchial anomalies. Careful history, clinical examination and radiographic study were essential parts in diagnosis of branchial anomalies. Although surgical management of branchial anomalies depend on its type, nature and extent, complete excision is the major surgical procedure.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권2호
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• pp.101-106
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• 2006

Purpose: The purpose of this study is to evaluate the value of proliferation factors, Ki67 and PCNA, as prognostic markers predicting the survival and neck metastasis in patients with oral cancer. Methods: 101 patients with HNSCCs, were followed retrospectively for a median period of 60 months(from 16 to 82 months). All tumors were resected surgically and examined by conventional light microscopy, immunohistochemistry. The age, sex, tumor location, clinical stage(size), metastasis, proliferative activity index(assessed by proliferating cell nuclear antigen(PCNA) and Ki67 immunoreactivity) were considered as potential prognostic factors and were correlated with patient survival. Results: Ki67 staining results ranged from 5% to 80% of tumor cell nuclei, with a median of 25%. PCNA staining results ranged from 1% to 90% with a median of 50%. With a cut-off point of 25%, patients with lower Ki67 scores showed survival advantages over those with higher Ki67 scores (p=0.0089). With cut-off point of 50%, patients with lower PCNA scores showed survival advantages over those with higher PCNA scores (p=0.0104). Pathologically neck node positive patients(n=27) showed higher PCNA expression(p=0.02) than pathologically negative neck node patients(n=39). Conclusions: The lower expressions of Ki67 and PCNA were associated with favorable prognosis such as higher survival rate and lower neck node metastasis.

• 대한소아치과학회지
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• 제32권2호
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• pp.200-206
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• 2005

백악질 골화성 섬유종은 가장 흔히 발생하는 섬유 골성 병소(fibro-osseous lesion)로서, 경계가 분명하고, 느리게 성장하는 팽창성의 양성종양이다. 임상적으로 하악골의 소구치와 대구치 부위에서 발생하고, 여성에게서 2배 정도 호발하며, 주로 20대에서 30대 사이에서 발견된다. 백악질 골화성 섬유종은 섬유성 이형성증을 포함한 다른 섬유 골성 병소와 감별되어야 한다. 백악질 골화성 섬유종의 또 다른 형태인 유년형 골화성 섬유종은 15세 이하에서 발생하며, 빠르게 성장하고, 좀 더 골파괴적인 양상을 보인다. 치료는 병소의 크기 에 따른 절제술이고, 재발은 드물다고 알려져 있다. 본 증례는 우측 하악 견치의 미맹출을 주소로 내원한 12세 남자 어린이로, 백악질 골화성 섬유종으로 진단 후, 외과적 적출술을 시행하여 양호한 치유과정을 보이기에 보고하는 바이다.

• 대한소아치과학회지
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• 제38권1호
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• pp.17-24
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• 2011

미성숙 영구 전치에서 MTA를 이용한 치근단 형성술의 예후를 평가하기 위해, 영구 전치의 외상으로 MTA를 이용한 치근단 형성술을 받은 환자 중 최소 3개월 이상의 경과 관찰이 시행된 환자 49명, 치아 64개의 의무기록과 방사선 사진을 검토하였다. 환자 정보, 치아 및 치주조직 외상 위치와 유형, 치료 전 치근단 병소 유무, 임상 증상 유무, MTA 충전 상태, 치근단 형성술 이후 치근단 병소 치유 및 치근단 경조직 장벽 형성 여부를 조사하고, 임상적, 방사선학적 성공을 평가하여 다음과 같은 결과를 얻었다. 1. 64개의 미성숙 영구전치에 시행된 MTA를 이용한 1-visit 치근단 형성술은 89.1%의 임상적 성공률과 73.4%의 방사선학적 성공률을 보였다. 2. 상악 치아와 하악 치아에 행해진 MTA를 이용한 1-visit 치근단 형성술 비교시 상악에서 유의하게 더 높은 성공률을 보였다. 3. 치아 외상 및 치주조직 외상 유형에 따른 성공률은 유의한 차이를 보이지 않았다. 4. MTA의 적절한 충전 여부는 성공률에 영향을 미치지 않았다.