• 한국임상수의학회지
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• 제39권5호
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• pp.253-257
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• 2022

A 5-year-old castrated male Golden Retriever dog weighing 15 kg presented with evidence of intestinal intussusception. The patient had cachexia and severe dehydration before being referred to our department. Ultrasound imaging revealed a target sign indicative of intestinal intussusception. Emergency surgery was performed shortly after diagnosis. After a successful surgery, the patient was hospitalised for postoperative care. Initial treatment was aimed at the reversion of dehydration and the provision of adequate nutrition. Fluid therapy and central parenteral nutrition were administered via the peripheral and central venous catheters, respectively. Ten days postoperatively, swelling and edema were observed in the head and neck. Ultrasound and computed tomography confirmed complete blockage of the cranial vena cava due to thrombosis, which consequently obstructed both the left and right jugular veins. For treatment, dalteparin and tissue plasminogen activator were administered. However, the patient lost all of its vital function on the daybreak of postoperative day 11. Venous thrombus formation secondary to central parenteral nutrition application via the central line is a rare but possible complication. Veterinarians who are concerned about taking care of patients receiving CPN through the central line should keep the possibility of venous thrombus formation in mind.

• Journal of Chest Surgery
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• 제35권7호
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• pp.530-534
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• 2002

배경: 대동맥 수술에서 왼쪽 팔머리정맥의 분리는 대동맥궁 및 대동맥궁의 가지현관들을 노출시키는 데 도움을 줄 수 있다. 그러나 이것의 분리에 대한 안정성과 대동맥수술후 다시 왼쪽 팔머리정맥을 문합해 주어야 하는가에 대해서는 논쟁의 여지가 있다. 왼쪽 팔머리정맥 분리의 안전성과 왼쪽 팔머리정맥을 분리한 후 정맥환류에 대해 연구하였다. 방법: 1998년 11월부터 2000년 1월까지 10명의 환자에서 흉골 정중 절개 후 국소적인 해부학과 원위부 대동맥문합을 고려하여 왼쪽 팔머리정맥의 분리 및 결찰을 왼쪽 팔머리정맥의 중앙부에서 시행하였다. 상지의 부종과 신경학적증상에 대해 평가하였고, 우심방압력과 왼속목정맥의 압력을 측정하였으며 수술 후 정맥조영술을 시행하였다. 결과: 10명의 환자에서 상행대동맥이나 대동맥궁의 수술시 대동맥의 노출에 향상이 있었으며, 환자들의 연령은 24∼72세로 평균 62세였다. 평균추적기간은 3주에서 13개월이었고, 한명의 환자가 메치실린 저항성 황색포도상구균에 의한 종격동염으로 사망하였다. 모든 환자에서 수술 직후 좌측상지에 부종을 보였으나, 술후 4일째 호전되었다. 추적관찰기간동안 좌측상지에 부종이나 운동장애를 보인 환자는 없었다. 술후 뇌경색에 이환된 환자는 없었다. 우심방과 좌내경정맥 사이의 압력차는 수술직후 최고치를 보였고(평균 최고 압력차=25mmHg), 점점 감소하여 술후 4일째 일정한 압력차를 유지하였다. 모든 환자에서 시행한 정맥조영술을 통하여 왼쇄골밑정맥의 정맥환류는 아래갑상선정맥얼기를 통하여 중앙부를 가로질러 우측 심장계로 유입됨을 볼 수 있었다. 결론: 왼쪽 팔머리정맥의 분리는 안전하며 우측 정맥계의 주된 교량역활을 하는 아래갑상선정맥을 보존한다면 왼쪽 팔머리정맥을 다시 연결할 필요는 없다고 할 수 있겠다.

• 대한의생명과학회지
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• 제2권2호
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• pp.133-151
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• 1996

심장수술후 흔히 발생하는 다양한 술후 합병증들은 체외순환으로 인한 체액성 및 세포성 면역계의 손상이 깊이 연루되어 일어나는 것으로 인식되어져 왔다. 특히, 술후 종종 경험하게되는 폐기능 부전은 보체계 활성화 및 염증반응에 따른 백혈구의 폐내 정체(pulmonary leukostasis)가 이와 같은 합병증의 주된 요인으로 알려져 있다. 일부 연구들은 체외순환 실시전 항 염증 약제인 부신피질 호르몬제를 투여함으로써 보체계 및 백혈구 활성화가 억제되어 술후 폐기능 부전의 발생을 예방시켜 주었다고 보고하고 있다. 이에 본 연구의 저자는 체외순환을 이용한 심장수술 동안과 술후, 백혈구의 숫적 변화 및 폐내 정체를 관찰하였다. 술후 시기에 있어 폐기능 평가의 한 지표로 동맥혈 산소분압을 측정하여 술전치와 비교하였고 흉부 X-선 필름을 통한 폐부종 징후와 발열유무, 그리고 그외 여러 변수들을 분석하였다. 또한 체외순환 실시전 투여한 부신피질 호르몬제(solu-Medrol; 30mg/kg)가 이러한 변수들에 어떤 영향을 미치며 과거의 연구에서 설명된 여러가지 예방적 효과가 과연 있는지를 함께 규명하였다. 연구는 무작위로 선정된 심장수술환자 50명을 대상으로 전향적 맹검법(blind fashion)으로 시행하였다 연구의 목적상 전체 환자를 placebo 군(n=25)과 steroid 군(n=25)으로 분류하였고 연구를 통해 다음과 같은 결과를 얻었다. 1. 체외순환은 말초혈액의 총백혈구수를 유의하게 변화시키는데 초기엔 그 수를 저하시켰고 시간이 경과할수록 점차 상승시켰으며 유의한 상승은 술후 7일까지 지속되었다(P<0.05). 이러한 총 백혈구의 숫적 변화는 호중구수의 절대적 변화에 기인한 것이었다. 2. 부분체외순환 동안 placebo 군은 백혈구의 폐내정체가 일어났으나, steroid 군은 예방되었다. 3. 양 군 모두에 있어 체외순환 동안 임파구수는 의미있게 변화되지 않고 체외순환 종료후부터 3일 동안 유의한 감소를 보였으나(p<0.05) 술후 7일엔 완전히 기준치로 회복되었다. 4. 단구수는 양 군 모두 체외순환 초기엔 큰 변화가 없다가 이후 점차 상승하여 술후 7일까지 유의한 증가가 지속되었다(P<0.05) .5. 술후 동맥혈 paO$_2$는 placebo 군은 술전치에 비해 감소되었으나(P=0.01) steroid 군은 유의한 감소가 없었다(P=0.90). 폐부종 발생환자는 placebo 군에 비해 steroid 군이 보다 의미있게 낮았고(P=0.001)술후 발열환자 역시 steroid 군이 placebo 군 보다 훨씬 낮았다(P=0.01). 그러나 기계호흡 보조시간과중환자실에서 머문 시간은 양 군 간에 유의한 차이가 없었다(P>0.05).이상의 연구결과를 통해 저자는 체외순환을 이용한 심장수술 동안 백혈구의 활성화로 인한 숫적변화와 폐내 정체를 관찰하였고 스테로이드의 사용이 보다 높은 호중구 수의 보존효과를 가져다 주었으며 백혈구의 폐내 정체를 예방해주고 술후의 일부 관류후 증후군을 경감시켜줌을 확인할 수 있었다. 그러나 술후 시기에 있어 양 군 모두 임파구의 숫적 감소가 3일간 지속됨으로 해서 임파구와 연관된 면역계의 손상이 여전히 우려되는바 이므로 향후 이 부분에 대한 예방적 수단과 스테로이드의 술후 면역학적 기능에 미치는 영향에 관한 연구 역시 더 필요할 것으로 사료된다.

• Journal of Chest Surgery
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• 제28권11호
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• pp.1014-1018
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• 1995

To confirm diagnosis and to set proper therapeutic strategy, open lung biopsies were done in 57 patients who were suspected for diffuse interstitial lung disease from January 1985 to December 1994. Among them, 35 were male and 22 were female[M:F=l.6: 1 and mean age of the patients is 53.5$\pm$ 2.3[24-81 years. Tissue for histologic studies were obtained from left lung in 33, from right lung in 24according to the distributions of the pathology. Preoperative diagnostic work-up`s were chest X-ray, CT[HRCT scan, sputum study, bronchoscopy[BAL, TBLB and PTNA and all of them were unsuccessful to confirm diagnosis. In comparison of pulmonary function tests between preoperative and postoperative values, there were no significant differences in FVC, FEV1, FEV1/FVC[p 0.05 but in AaDO2[p[0.05 . Postoperative complications including atelectasis, wound infection, pulmonary edema and respiratory insnfficiency, were shown in 5 cases[8.8% , and two of them were died of respiratory failure and sepsis[mortality rate 3.5% . Pathologic diagnosis was confirmed in 53 cases postoperatively but it was undetermined in 4[diagnostic yield rate 93.0% . In comparison between preoperative clinical diagnosis and postoperative pathologic diagnosis, new diagnosis were made in 17 cases[29.8% and preoperative tentative diagnosis were confirmed histologically in 36 cases[63.2% . In 4 cases[7.0% , however, diagnoses were not confirmed after biopsies. Therapeutic plans were reset in 46 cases[80.7% in accordance with the final diagnosis.In conclusion, open lung biopsy is recommended for a specific diagnosis and proper therapeutic plan in diffuse interstitial lung diseases because of its high diagnostic yield Irate and it`s relatively low morbidity and mortality rate in these tompromised patents.

• 대한후두음성언어의학회지
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• 제11권1호
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• pp.12-19
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• 2000

Background and Objectives : Dysphonia may be secondary to many different type of benign vocal cord lesions such as vocal polyp, vocal nodule, Reinke's edema, and intracordal cyst. Diagnosis and treatment of intracordal cysts are more difficult than other benign vocal cord lesions. But postoperative voice analysis of intracordal cyst have rarely been reported in the literature. The purpose of this study is to analyze aerodynamic and acoustic results and videostroboscopic findings before and after laryngomicrosurgery. Materials and Methods : We reviewed the pre and post-operative voice analysis results and videostroboscopic findings of 15 surgically treated patients of intracordal cysts at Severance hospital from Jun. 1997 to Nov. 1999 retrospectively. They were diagnosed with videostroboscopic findings, surgical findings, and pathologic reports. Their pre and post-operative speech were analyzed with MDVP(Multi Dimension Voice Analysis Program) of CSL(Computerized Speech Lab) and Aerophone II. Their pre and post-operative mucosal wave of true vocal cord was analyzed with videostroboscopy. In order to compare this results with normal group, 10 of normal persons were evaluated with same methods. Results : After the operation, mucosal wave of true vocal cord was improved in all patients. Postoperative acoustic and aerodynamic results were improved in almost parameters, but they did not reach the normal value. Conclusions : Videostroboscopy was essential in diagnosing intracordal cysts. By comparing the acoustic and aerodynamic results and video-stroboscopic findings before and after the laryngomicrosurgery, postoperative vocal function was defined more accurately and objectively. Almost parameters may be useful in assessing the quantitative changes in vocal quality before and after the laryngomicrosurgery.

• Archives of Plastic Surgery
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• 제36권2호
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• pp.153-160
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• 2009

Purpose: The heterodigital or homodigital artery island flap is a popular method of reconstruction for finger defects. Sometimes, digital artery island flap has some disadvantages such as postoperative flap edema, congestion, and partial necrosis of the flap margin. However, we could decrease these disadvantages by means of venous superdrainage. The aim of this study is to report usefulness and postoperative results of venous supercharging digital artery island flaps for finger reconstruction. Methods: From March of 2005 to March of 2008, a total of eight patients with soft tissue defects of the finger underwent venous supercharging digital island flap transfer. Briefly, the flap is harvested along with dorsal vein that is then anastomosed to a recipient vein in an end - to - end fashion, after flap transfer and insetting. Using this technique, eight patients were operated on, ranging in age 23 to 52 years. Results: All the flaps survived with a success rate of 100 percent, thus fully satisfying the reconstructive requirements. No postoperative flap congestion was recognized, obviating the need to take any measures for venous engorgement, such as suture removal. Among 8 cases, it was possible to make an long - term and follow - up observation more than 6 months. In these cases, the fact that light touches and temperature sensations can be detected in all the flaps. Cold intolerance and hyperesthesia were not seen in our series. Conclusion: Providing good harmony with conventional methods and microsurgery, inclusion of a vein with the heterodigital and homodigital artery island flap allows a more reliable and safer reconstructive choice for finger defects. The venous supercharged island flap is a reliable flap with a consistent arterial structure, and with its augmented venous drainage, it is more reliable, providing single - stage reconstruction of adjacent finger defects, including the fingertip.

• Journal of Chest Surgery
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• 제35권3호
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• pp.239-243
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• 2002

본 증례의 39세 남자는 전신부종과 간부전증을 일으키는 Budd-Chiari syndrome과 상대정맥 폐색증을 가지고 입원하였다. 보존적 내과 치료 후 방사선과의 침습적 방법에 의한 확장술에 실패하여 하공정맥-우심방 단락술을 시행하였다. 수술은 정중흉골 절제술 및 직사행 복부 절제술을 통하여 직경 24 mm의 Dacron graft를 사용하여 좌신정맥 하에서 하공정맥-우심방 단락술을 체외순환을 하지 않고 시행하였다 수술후 출혈이나 합병증없이 양호한 결과를 보였으며 수술당일부터 항응고제 치료를 병행하였다. 술후 26일째 시행한 복부 도플러 초음파 상에서 graft의 유통성이 양호함을 확인하였다. 퇴원시 상대정맥 폐색 증상은 남아 있었으나 외래 추적 검사시 상대정맥 폐색 증상도 호전되었음을 확인할 수 있었다

• Tuberculosis and Respiratory Diseases
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• 제64권3호
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• pp.219-223
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• 2008

저자들은 대량 객혈로 내원한 환자에서 폐 출혈과 함께 반복적인 심인성 폐부종, 카테콜라민 유도성 심부전이 합병된 드문 형태의 갈색세포종을 경험하여 이러한 임상 증상시 폐나 심장 질환 외에 갈색세포종에 대한 고려가 필요할 것으로 생각되어 문헌고찰과 함께 보고하는 바이다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제11권1호
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• pp.261-266
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• 1989

This study was undertaken to compare those 4 most commonly used incisions for exposure of fractures of the infraorbital rim and the orbital floor. The patient's age ranged from 19 to 67 years, the majority being in the 2nd decade. There were 17males and 1 female. Three orbital rim, 5 lower eyelid, 7 subciliary and 3 combined conjunctival-lateral canthotomy incisions were reviewed. Following points were the summury of author's experience. 1. The average scar following any of four incisions is barely noticeable. 2. Adequate fracture exposure was achieved with lower eyelid, orbital rim, subciliary and combined conjunctival-lateral canthotomy incisions. 3. One transient ectropion following subciliary incision occurred in 29-years old man with prolonged postoperative eyelid edema.

• Journal of Chest Surgery
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• 제25권4호
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• pp.356-363
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• 1992

We have performed left lung transplantations in 15 dogs for one year and six months from June, 1990 to December, 1991 at the Repartment of Thoracic and Cardiovascular Surgery Yonsei University College of medicine, Seoul, Korea. These dogs were sacrificed at from operative day to post-operative 15 days when their general conditions were deteriorated. The gross findings of the transplanted lungs were thrombi in left atrium in three cases, partial occlusion of pulmonary artery or pulmonary veins in three cases, hemorrhage at pulmonary arterial anastomotic site in one case and bronchial anastomotic stenosis in two cases, bronchial anastomotic rupture in one case % no abnormal gross findings in four cases. The microscopic findings of the transplanted lungs were hemorrhagic infarction in one case, perivascular hemorrhage or pulmonary edema in two cases, peribronchial inflammatory cell infiltration & pneumonia in three cases, and alveolar type rejection with infiltration of type II pneumocytes and septal thickening in 3 cases. And also there were no abnormal findings including rejection or inflammatory evidences in six cases. The one among these six dogs survived to 15 days without evidence of rejection or inflammatory reaction & died due to postoperative care accident.