• Journal of Oral Medicine and Pain
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• 제37권3호
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• pp.147-154
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• 2012

조혈줄기세포이식은 면역 결핍 질환, 자가 면역 질환, 악성 조혈 종양의 주된 치료법이다. 이종 조혈줄기세포이식의 주요한 합병증은 이식편대 숙주질환이다. 구강 점막 생검은 이식편대 숙주 질환의 확진과 치료계획 수립을 위해 필요하나 영양 결핍과 화학 요법으로 인해 전신상태가 불량한 환자에게 출혈과 균혈증을 일으킨다. 본 논문에서는 레이저를 이용한 최소 침습적 조직생검의 효능을 평가하였다. 모두 3개의 증례가 소개되었고 모든 환자의 의료 기록, 임상 사진, 조직병리학적 결과가 레이저를 이용한 조직생검의 효능을 평가하기 위해 검토되었다. 모든 환자는 생검 후 불편감이 없었고 심각한 합병증이 발생하지 않았다. 생검 조직의 질이 이식편대 숙주 질환을 확진하는 데에 적당했다. 구강 점막의 레이저를 이용한 최소 침습적 생검은 통상의 조직병리학적 생검에 비해 출혈을 일으키지 않아 감염과 균혈증, 술 후 흉터 생성을 줄이므로 이식편대 숙주 질환의 확진에 이로울 것이다.

• 대한기관식도과학회지
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• 제3권2호
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• pp.277-286
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• 1997

저자들은 1988년부터 1996년까지 중앙대학교 부속병원에서 수술적으로 치료한 47례의 타액선 종양환자를 대상으로 다음과 같은 결론을 얻었다. 1) 호발연령은 50대에서 가장 높았으며 악성종양의 경우 양성종양보다 호발연령이 높았다. 2) 여자에서 남자보다 호발하며 그 비율은 1.5;1 이었다. 3) 발생부위는 이하선이 가장 많아 48.9% 였으며, 악하선, 소타액선의 순이었으며 소타액선 종양은 구개에서 가장 많이 발생하였다. 4) 악성의 빈도는 소타액선에서 발생한 경우가 가장 높았으며, 악하선, 이하선 순이었다. 5) 가장 많은 증상은 무통성의 종물이었다. 6) 세침흡인 세포검사의 진단적 정밀도는 88.9% 였다. 7) 가장 흔한 타액선종양은 혼합종으로 전체의 57.4 %였다. 8) 악성종양 중 경부임파절 전이율은 22.2%였다. 9) 수술적 치료후 합병증의 발생률은 19.1% 였으며 일시적 안면신경마비가 가장 많았다.

• Clinics in Shoulder and Elbow
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• 제12권1호
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• pp.14-20
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• 2009

목적: 본 연구는 Wolter 금속판을 이용한 제 2형 원위부 쇄골 골절 치료의 임상적 결과를 평가하고자 하였다. 대상 및 방법: 2004년부터 2007년까지 Wolter 금속판으로 치료한 제 2형 원위부 쇄골 골절을 가진 16명의 환자를 대상으로 하였다. 평균 나이는 32.6세 이었고, 수술 후 평균 추시 기간은 22.9 개월이었다. 정복 및 골유합의 평가는 수술 직후 및 최종 방사선 소견을 이용하였고, 기능적 평가는 Kona의 기능적 평가 기준 및 Constant 점수를 사용하였다. 결과: Kona의 기능적 평가기준에 의해 우수 12예, 양호 3예, 보통 1예의 결과를 보였으며 Constant 점수는 평균 90점을 보였다. 16예 모두에서 골 유합을 확인하였으며, 합병증으로는 1예에서 금속판의 갈고리 부분이 돌출되어 피부에서 촉지 되었으며, 1예에서 견봉 골절이 발생하였으나 2예 모두 만족할 만한 골유합 소견을 보였으며, 그 외 견봉-쇄골 관절의 관절염, 감염증 등 다른 합병증은 관찰되지 않았다. 결론: 제 2형 원위부 쇄골 골절에서 Wolter 금속판을 이용한 고정법은 쉽게 만족스런 정복과 견고한 고정을 얻을 수 있고, 불유합의 발생이 적으며, 임상적 결과가 우수한 수술 방법이라고 생각된다.

• Clinics in Shoulder and Elbow
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• 제17권2호
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• pp.68-76
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• 2014

Background: Recently, reverse total shoulder arthroplasty (RTSA) has been accepted as a main treatment option in irreparable massive rotator cuff tear with cuff arthropathy. The purpose of this study was to evaluate the early complication incidence and the preliminary clinical results of RTSAs performed in single institute. Methods: Fifty-seven RTSAs (56 patients) were performed between April 2011 and March 2013. The indications for RTSA were cuff tear arthropathy and irreparable massive rotator cuff tear with or without pseudoparalysis. Exclusion criteria were revision, preoperative infections and fractures. At final follow-up, 45 shoulders were enrolled. Mean follow-up duration was 12.5 months (range, 6-27 months). The mean age at the time of surgery was 73.6 years (range, 58-87 years). All the patients were functionally accessed via Constant score, American Shoulder and Elbow Surgeons (ASES) score, pain and functional visual analogue scale (VAS) scores and active range of motion. Complications were documented as major and minor. Major complications include fractures, infections, dislocations, nerve palsies, aseptic loosening of humeral or glenoid components, or glenoid screw problems. Minor complications include radiographic scapular notching, hematomas, heterotopic ossification, algodystrophy, intraoperative dislocations, intraoperative cement extravasation, or radiographic lucent lines of the glenoid. Results: The mean Constant score increased from 31.4 to 53.8 (p < 0.001). The pain and functional VAS scores improved (5.2 to 2.7, p < 0.001, 4.0 to 6.7, p < 0.001) and active forward flexion improved from $96.9^{\circ}$ to $125.6^{\circ}$ (p = 0.011). One or more complications occurred in 16 (35.6%) of 45 shoulders, with one failure (2.2%) resulting in the removal of implants by late infection. The single most common complication was scapular notching (9 [20%]). There were 4 (8.9%) axillary nerve palsies postoperatively (n=3: transient n. palsy, n=1: Symptom existed at 11 months postoperatively but improving). Conclusions: In a sort term follow-up, RTSA provided substantial gain in overall function. Most common early complications were scapular notching and postoperative neuropathy. Although overall early complication rate was as high as reported by several authors, most of the complications can be observable without compromise to patients' clinical outcome. Long term follow-up is required to clarify the clinical result and overall complication rate.

• Clinics in Shoulder and Elbow
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• 제10권2호
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• pp.204-211
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• 2007

목적: 본 연구는 잠김 압박 금속판(LCP)을 이용한 상완골 근위부 골절 치료의 결과와 합병증을 평가하고자 하였다. 대상 및 방법: 2004년 부터 2006년 까지 잠김 압박 금속판으로 치료한 상완골 근위부의 이분 골절과 삼분 골절을 가진 21명의 환자를 대상으로 하였다. 평균 나이는 54.9세 였다. 술후 평균 추시 기간은 22.9개월 이었다. 정복과 합병증의 평가는 최종 방사선 소견을 이용하였고, 기능적 평가는 Neer의 기능적 평가기준을 사용하였다. 결과: Neer의 기능적 평가기준에 의해 견관절 기능의 평균 점수는 86.3 이었고, 18예에서 만족스러운 결과를 보였다. 불유합은 1예 발생하였으며, 상완골 두의 감염이나 무혈성 괴사는 없었다. 최종 결과와 골절의 유형, 나이, 성별 또는 정복의 양상과는 임상적 연관을 보이지 않았다. 결론: 본 연구에서는 상완골 근위부 골절의 치료에서 잠김 압박 금속판 고정으로 만족스러운 결과를 얻었다. 상완골 근위부 골절의 치료에서 잠김 압박 금속판을 이용한 고정은 만족스러운 정복, 강한 고정 그리고 조기 관절 운동을 얻는 좋은 방법이라고 생각된다.

• Archives of Plastic Surgery
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• 제38권5호
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• pp.559-566
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• 2011

Purpose: The use of tissue expander/implant in breast reconstruction using tissue expander-implant is one of the most common surgical procedures. The use of AlloDerm as a sling to reestablish the lower pole of the pectoralis major muscle results a decrease in morbidity compared with more invasive procedures. However the use of AlloDerm is more expensive than other options. We decided to compare AlloDerm with Permacol, which has been safely used in human body reconstruction and is less costly than AlloDerm. Methods: After mastectomy, the inferolateral origin of the pectoralis major muscle was elevated. Either AlloDerm or Permacol was sutured to the chest wall at the level of the previously marked inframammary fold. The lower border of the pectoralis major muscle and the upper portion of the crescent-shaped piece of either AlloDerm or Permacol was sutured together using a tension free technique, and a tissue expander was subsequently inserted into the subpectoral-subAlloDerm (or Permacol) dual pocket. Results: AlloDerm was used in twenty-one patients (28 breasts) and Permacol was used in six patients (11 breasts) for tissue expander-implant breast reconstruction. During the mean follow-up period of 17 months (8~25 months). Two infections (7%) occurred in AlloDerm cases and four infections (36%) occurred in Permacol cases. Conclusion: This study is the first comparison of tissue expander/implant breast reconstruction using AlloDerm and Permacol. The use of Permacol resulted in more postoperative infection compared with the use of AlloDerm. This report is still limited with the small number of cases studied.

• Archives of Plastic Surgery
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• 제37권4호
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• pp.469-472
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• 2010

Purpose: Aplasia Cutis Congenita (ACC) is a rare disease characterized by the focal defect of the skin at birth, frequently involving scalp, but it may affect any region of the body. There are no etiology known but some conditions such as intrauterine vascular ischemia, amniotic adherences and viral infections are associated. The ideal treatment for the ACC is not known. Superficial and relatively small sized defects (< $3{\times}5\;cm$) may heal spontaneously and large defects related with risks of infection and bleeding may require aggressive surgical treatment. Hyalomatrix$^{(R)}$ is a bilayer of an esterified hyaluronan scaffold beneath a silicone membrane. It has been used as a temporary dermal substitute to cover deep thickness skin defect and has physiological functions derive from the structural role in extracellular matrix and interaction with cell surface receptor. This material has been used for the wound bed pre-treatment for skin graft to follow and especially in uncooperative patient, like a newborn, this could be a efficient and aseptic way of promoting granulation without daily irritative wound care. For this reason, using Hyalomatrix$^{(R)}$ for the treatment of ACC was preferred in this paper. Methods: We report a case of a newborn with ACC of the vertex scalp and non-ossified partial skull defect. The large sized skin and skull defect ($6{\times}6\;cm$) was found with intact dura mater. No other complications such as bleeding or abnormal neurologic sign were accompanied. Escharectomy was performed and Hyalomatrix$^{(R)}$ was applied for the protection and the induction of acute wound healing for 3 months before the split-thickness skin graft. During the 3 months period, the dressing was renewed in aseptic technique for every 3 weeks. The skin graft was achieved on the healthy granulation bed. Results: The operative procedure was uneventful without necessity of blood transfusion. Postoperative physical examination revealed no additional abnormalities. Regular wound management was performed in out-patient clinic and the grafted skin was taken completely. No other problems developed during follow-up. Conclusion: Hyalomatrix$^{(R)}$ provides protective and favorable environment for wound healing. The combination of the use of Hyalomatrix$^{(R)}$ and the skin graft will be a good alternative for the ACC patients with relatively large defect on vertex.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.559-564
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• 2009

Purpose: Surgical reconstruction of an ischial soft tissue defect presents a challenging problem owing to a high rate of recurrence, especially paraplegic patients. Although various muscle, musculocutaneous and fasciocuta - neous flaps have been used in the reconstruction of ischial soft tissue defect, it is still debated which type of flaps are the best. We had performed a relatively durable adductor magnus perforator island flap based on the perforators originated from the first medial branch of the profunda femoris artery for coverage of ischial soft tissue defect where was not a region universally reconstructed by perforator flap. Methods: From August 2005 until January 2008, the adductor magnus perforator island flap had been used for resurfacing of the ischial soft tissue defects in a series of 6 patients (4 male and 2 female). Ages ranged from 26 to 67 years (mean, 47.5 years), and follow - up period from 13 to 26 months (mean, 16.7 months). Causes were 4 pressure ulcers, 1 cellulitis and 1 suppurative keratinous cyst. Results: The sizes of these flaps ranged from 12 to 18 cm in length and 7 to 9 cm in width. The flaps survived in all patients. Marginal loss over the distal area of the flap by infection was noted in one patient, which was treated successfully with a subsequent split - thickness skin graft. Average thickness of the flap was 0.94 cm, which was more thicker than other perforator flaps. Long term follow - up showed a good flap durability. Conclusion: In planning a reconstructive option of ischial soft tissue defect, the adductor magnus perforator island flap is a relatively large cutaneous flap with a durable thickness. With proper patient selection, careful vascular dissection and postoperative management, we recommend this flap is a good and suitable option for coverage of the ischial soft tissue defect.

• Journal of Chest Surgery
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• 제42권6호
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• pp.719-724
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• 2009

배경: 심장이식이 최근 증가하면서 거부반응과 감염외의 외과적합병증도 증가하고 있다. 이 논문에서는 한 외과의에 실시된 심장이식후에 발생한 외과적합병증을 보고하고자 한다. 대상 및 방법: 1994년 4월부터 2003년 9월까지 실시된 37명의 심장이식환자를 대상으로 하였으며 심장이식의 적응은 확장성 심근증, 허혈성심근증, 판막심근증, 가족력심근증 등이었다. 결과: 총 15명의 이식환자에서 20예의 합병증이 발생하였으며 실시된 외과적 수술의 종류는 출혈로 인한 재개흉(5), 심낭액저류배액술(4), 인공박동기거치술(1), 아스페르질루스증에 의한 우하엽절제술(1), 요석제거술(1), 담낭제거술(1), 직장주위절개술(1), 부비동배액술(1), 고관절치환술(1), 치주비대에 의한 치주절개술(1), 뇨도절개술(1), 추간판 탈출증수술(1), 자궁근종으로 인한 자궁적출술(1)이 있었다. 합병증의 위치는 흉곽내가 10예, 흉곽외가 10예였다. 결론: 심장이식 수술후에는 흉곽 뿐만 아니라 다른 부위장기에 많은 합병증을 가져올 수 있기 때문에 장기생존율을 높이기 위해서는 다학제간의 적극적인 치료가 매우 중요하다.

• Journal of Trauma and Injury
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• 제20권1호
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• pp.12-18
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• 2007

Purpose: Recently, trauma is more frequent due to the increases in the population, the number of traffic accident, and the incidence of violence. Especially, abdominal trauma is a leading cause of morbidity and mortality. We analyzed the clinical features and the factors associated with morbidity and mortality. Methods: We analyzed 136 patients of abdominal trauma who were admitted at the Department of Surgery, Chonnam National University Hospital, from January 2003 to June 2005. We analyzed the cause of trauma, the injured organ, combined injuries, mental status, blood pressure, laboratory findings, morbidity, and mortality. The relationships between by variable were assesed by using the independent samples test and the Kruskal?Wallis test. Results: The causes of trauma were traffic accidents (98 cases, 72%), falling accidents (9 cases, 6.6%), violence (6 cases, 4.4%), and stab injuries (6 cases, 4.4%). The injured organs were the small intestines (47 cases, 34.6%), the liver (35 cases, 25.7%), the spleen (26 cases, 19.1%), the mesentery (17 cases, 12.5%), the large intestines (15 cases, 11.0%), the pancreas (14 cases, 10.3%), etc. The most common combined injury was chest injury (53 cases, 39%). Comatose or semicomatose mental status and shock on admission (<60 mmHg in systolic) were related to high mortality (85.7%). In laboratory findings, decreased hemoglobin (<8 g/dL), and platelet count (<$50,000/mm^3$), and increased creatinine level (>1.6 mg/dL) were significant prognostic factors. The incidence of postoperative complications was 40.4%, and frequent complications were wound infection (8.1%) and re-bleeding (8.1%). The overall mortality rate was 18.4%, and most common cause was hypovolemic shock (18 cases, 13.2%), however, there was no statistical difference according to injurd organ. Conclusion: In the multivariate analysis, mental status, hemoglobin, and serum creatinine level were the most significant prognostic factors. When an abdominal trauma patient arrives at the emergency room, a rapid and accurate evaluation of the patient's status and risk factors, and resuscitation, if necessary, have to be performed to lower the morbidity and mortality.