• 한국간담췌외과학회지
• /
• 제26권2호
• /
• pp.199-203
• /
• 2022

Gallstone ileus is an uncommon cause of intestinal obstruction. It may present with typical symptoms of intestinal obstruction with or without biliary sepsis. Its management strategies vary depending on the patient and operative factors. Enterotomy and stone removal alone versus synchronous cholecystectomy and fistula disconnection at the same stage, often pose a debate among surgeons. The decision for operative strategies largely depends on the surgeon's experience, patient's physiology, and operative difficulties. As literature on gall stone ileus remains insufficient at a regional level, we report four cases of gallstone ileus managed with different approaches. Three patients were managed in a staged-manner, whereas one patient received a definitive procedure performed at index surgery. Clinical challenges and associated operative strategies are discussed. Findings of the current study were compared to those of the literature. The need for a definitive fistula disconnection and repair or cholecystectomy following stone removal in these patients was subsequently discussed.

• Journal of Chest Surgery
• /
• 제37권6호
• /
• pp.504-510
• /
• 2004

배경: 심장 수술과 관련된 혈관확장성 쇼크는 주로 체외순환 후 바소프레신의 결핍이나 패혈증으로 발생하며, 흔히 사용하는 심근수축제에 잘 반응하지 않는 경우가 많다. 성인에서는 바소프레신의 투여가 효과적인 것으로 알려져 있으나 선천성 심장병 수술을 받은 환자에서 이에 대한 경험이 제한되어 본원의 경험을 보고하고자 한다. 대상 및 방법: 2003년 2월부터 8월까지 선천성 심장병으로 수술후 일반 심근수축제에 반응하지 않는 혈관확장성 쇼크가 발생한 6명에게 바소프레신을 투여하였다. 수술 당시 연령은 생후 2∼41일(중앙값 25일)이었고, 수술 시 체중은 900∼3,530 gm (중앙값 2,870 gm)이었다. 수술 전 진단명은 좌심형성부전증후군 1예, 대동맥 축착증과 심한 승모판막역류을 동반한 완전방실중격결손 l예, 완전대혈관전위증 2예, 활로씨형 양대혈관우심기시증 1예, 총폐정맥환류이상 1예였다. 완전교정술과 고식적 수술이 각각 3명에서 시행되었다. 결과: 일반 심근수축제에 반응하지 않는 저혈압은 대부분의 환자에서 수술 후 24시간 이내에 발생하여 바소프레신의 투여가 필요하였고, 이후 패혈증 쇼크로 바소프레신의 추가 투여가 필요하였다. 바소프레신 투여양은 0.0002∼0.008 unit/kg/min이었고, 총 투여 시간은 26∼140시간(중앙값 59시간)이었다. 바소프레신 투여 직전, 투여 1시간 ,6시간째 수축기 혈압은 각각 42.7$\pm$7.4 mmHg, 53.7$\pm$11.4 mmHg, 56.3$\pm$13.4 mmHg로 의미 있는 혈압 상승이 관찰되었다(투여 직전과 비교하여 투여 1시간 ,6시간 모두 p=0.042). 바소프레신 투여 전과 투여 6시간, 12시간 후의 inotropic index 는 각각 32.3$\pm$7.2 와 21.0$\pm$8.4, 21.2$\pm$8.9)로 바소프레신 투여 전과 비교하여 투여 후 6시간과 12시간 모두 의미 있게 inotropic index의 감소를 보였다(투여 직전과 비교하여 투여 6시간, 12시간 모두 p=0.027). 바소프레신 투여 후 전신 순환의 감소와 관련된 대사성 산증의 악화나 소변량 감소 등의 소견은 관찰되지 않았다. 결론: 선천성 심장병으로 수술받은 환자, 특히 신생아에서 수술 직후 심한 심실 기능 저하의 소견이 없는데도 불구하고 일반 심근수축제에 반응을 하지 않는 심한 저혈압이 발생한 경우, 이로 인한 말단 장기의 비가역적 손상이 발생하기 전 가능한 한 빨리 바소프레신을 정맥 투여함으로써 혈압 상승뿐만 아니라 기존 심근수축제의 사용량을 줄여 이와 관련된 합병증을 감소시킬 수 있어, 바소프레신의 투여는 수술 직후 불안정한 시기에 사용할 수 있는 중요한 치료법의 하나로 생각된다.

• 대한족부족관절학회지
• /
• 제22권1호
• /
• pp.21-25
• /
• 2018

Purpose: To analyze the correlation between a rupture of the hypovascular zone and early single heel raising after Achilles tendon repair. Materials and Methods: From January 2012 to August 2015, 68 patients, who underwent surgical treatment for a Achilles tendon rupture using Krackow method, were analyzed retrospectively. The patients were divided into two groups according to possibility of single heel raises within 3 months postoperatively. During the periodic outpatient observations, the visual analogue scale, Achilles tendon total rupture score (ATRS), and timing capable single heel raises were evaluated. In addition, the preoperative defect size and distance between the calcaneal osteotendinous junction and the rupture site were measured by ultrasound in all cases. Results: Twenty-three patients could perform a single heel raise within 3 months after surgery (early single heel raise group), and fortyfive patients could perform a single heel raise after 3 month postoperatively. The age, gender, body mass index, smoking, and operation delay were similar in the two groups. In addition, the defect size and distance between the calcaneal osteotendinous junction and rupture site as measured by preoperative ultrasound were similar (p=0.379 and p=0.631, respectively). On the other hand, when the rupture site was divided into the hypovascular zone (4~7 cm from calcaneal osteotendinous junction) and non-hypovascular zone, the hypovascular zone rupture rate was significantly lower in the early single heel raise group (60.9%, 14/23; 91.1%, 41/45; p=0.003). In logistic regression analysis, the odds of the hypovascular zone rupture group being capable of early single heel raise were 0.189 (p=0.017). The ATRS score at 3 months and 1 year after surgery were significantly higher in the early single heel raise group (p<0.001). Conclusion: Achilles tendon rupture at the hypovascular zone is a poor prognostic factor for early single heel raise and might affect the prognosis significantly after an Achilles tendon rupture operation.

• Journal of Chest Surgery
• /
• 제34권6호
• /
• pp.472-476
• /
• 2001

배경: Nuss에 의한 누두흉의 최소 침습적 수술법은 연골 절제나 흉골절개가 없이 누두흉을 교정하는 새로운 수술법이다. 보고자는 Nuss술식의 조기 경험을 보고하는 바이다. 대상 및 방법: 1999년 12월에서 2001년 1월까지 20명의 누두흉 환자에서 Nuss술식을 시행하였다. 수술 대상은 남자 14 명, 여자 6 명으로, 1 세에서 33세까지 평균 10.1$\pm$7.7 세이며 대부분의 환자는(19명) 20세 이하였고, 33세된 성인 여자도 1명이 있었다. 결과: 가슴 함몰의 정도는 CT로 조사하였는데 CT지수는 평균 4.9$\pm$5.7 이었다. 평균 수술시간은 85.8$\pm$23.7 분이었다. 사용된 금속막대의 길이는 8 인치 에서 16인치 가지 평균 11.8$\pm$14.4 인치였다. 술후 조기 합병증은 3례의 환자에서 기흉이 있었고, 1례에서는 장마비, 전례에서 술후 통증조절을 위해 정맥진통제를 사용하였다. 1례의 성인 환자에서 술후 통증 조절을 목적으로 경막외 통증조절을 위한 도관을 삽입하였다. 그러나 전례에서 중대한 합병증은 발생치 않았다. 결론: 보고자가 누두흉 치료에 적용한 Nuss술식의 조기결과는 만족할만 하였지만 널리 이용되기에는 장기적인 관찰이 필요할 것으로 사료된다.

• 대한족부족관절학회지
• /
• 제26권1호
• /
• pp.40-47
• /
• 2022

Purpose: The modified Broström repair (BR) technique has yielded good outcomes in patients with chronic ankle instability. This study compared clinical and radiological outcomes between two groups of patients who underwent modified BR or lateral ligament augmentation using suture tapes (ST). Materials and Methods: Seventy-seven patients (ST group [n=47], BR group [n=30]; body mass index <26.61 kg/m²; mean age, 30.7±11.0 years [range, 17~39 years]; mean follow-up, 34.0±12.0 months [range, 24~59 months]) were retrospectively reviewed between January 2014 and July 2017. The Foot and Ankle Outcome Score (FAOS), American Orthopedic Foot and Ankle Score (AOFAS), Foot and Ankle Ability Measure (FAAM), visual analogue scale (VAS) score, and Sefton grading system were used for clinical assessment. The talar tilt angle and anterior talar translation were measured using the Telos stress device (Telos GmbH, Marburg, Germany) at 150 N for radiological evaluation. Results: FAOS, AOFAS, FAAM, and VAS scores improved in both groups at final follow-up (ST, 91.1±5.2, 93±2, 88.1±4.5, 1.5±0.7 vs. BR, 91.3±5.4, 93±3, 83.3±4.8, 1.2±0.7, respectively; p=0.854, 0.971, <0.001, 0.04, respectively). According to the FAOS, mean sports activity scores for the ST and BR groups at the final follow-up were 90.3±3.2 and 76.6±4.2, respectively, reflecting superior outcomes in the ST group (p<0.001). Sefton grading revealed satisfactory functional outcomes (ST, 91.5% vs. BR, 90.0%). There was significant improvement in the talar tilt angle and anterior talar translation in both the ST and BR groups (7.6°±1.2°, 10.5±1.8 mm vs. 4.9°±1.1°, 7.9±1.5 mm, respectively; p<0.001). Conclusion: The ST group demonstrated comparable clinical but better improvement in mechanical stability and FAOS sports scores than the BR group.

• 한국임상수의학회지
• /
• 제30권6호
• /
• pp.403-408
• /
• 2013

본 연구의 목적은 in vitro 실험에서 human dermal fibroblast cell을 이용한 섬유아세포 증식과 콜라겐 생성을 통한 전층피부창상치유에 대한 효과를 알아보는 것이다. In vitro 실험에서, 베타글루칸 및 양성대조물질 oncostatin M을 사용하여 처치 후 24 또는 48시간 이후 MTT assay와 세포수 관찰을 통해 섬유모세포 증식효과에 대해 평가하였다. Procollagen 생산에 대한 효과를 평가하기 위해 베타글루칸 및 양성대조물질 oncostatin M 처치 48시간 후 hydroxyproline을 HPLC를 이용하여 정량하여 평가하였다. 창상재구축에 대한 효과를 평가하기 위해 베타글루칸 및 양성대조물질 fucoidan fraction 7을 FPCL 모델을 이용하여 평가하였다. 베타글루칸 처치군은 음성대조군 대비 0.1 mg/ml 이상의 농도에서 용량의존적이고 유의적인 OD 또는 섬유아세포수의 증가가 관찰되었다. 게다가 베타글루칸 처치군은 창상면으로 유주된 세포수가 음성대조군 대비 1 mg/ml 이상의 농도에서 용량의존적이고 유의적인 증가가 관찰되었다. 그러나 베타글루칸 처치군은 음성대조군 대비 모든 용량에서 procollagen 생산에 대한 유의적인 변화가 관찰되지 않았다.

• 대한약리학회지
• /
• 제30권2호
• /
• pp.167-179
• /
• 1994

Recent evidence indicates that glial cells have a wide range of funtions which are critical for maintaining a balanced homeostatic environment in the central nervous system(CNS) peripheral nervous system(PNS). Morever, astrocytes are known to participate in the tissue repair and neuroimmunologic events within the CNS through many kinds of growth factors and cytokines. We investigated the effect of $TGF\;{\beta}_1$, on the growth and biochemical changes of rat glial cells in culture. The proliferative effect was determined by $^3H-thymidine$ uptake and the double immunostain with anti-cell-specific marker and anti-Bromodeoxyuridine(BrdU) antibody. To check the effect of biochemical changes we compared the amounts of glial fibrillar acidic protein(GFAP) and the activity of glutamine synthetase(GS) in astrocyte. And the amounts of myelin basic protein and the activity of 2',3'-cyclic nucleotide phosphohydrolase(CNPase) were measured in oligodendrocyte and the amounts of peripheral myelin in Schwann cell. When $TGF\;{\beta}_1$, was treated for 2 days with cultured glial cell, $TGF\;{\beta}_1$, decreased the $^3H-thymidine$ uptake and proliferation index of double immunostain of astrocytes, which indicates the inhibition of astroglial DNA synthesis, but stimulated the growth of Schwann cell. Also, $TGF\;{\beta}_1$, decrease the GS activity and increased the amounts of GFAP in astrocyte. In the case of Schwann cells the amounts of peripheral myelin was increased when treated with $TGF\;{\beta}_1$. However, $TGF\;{\beta}_1$, didn't show any effect on the proliferation and biochemical changes in oligodendrocyte. These results suggest that $TGF\;{\beta}_1$, might have a critical action in the regulation of proliferation and biochemical changes in glial cells, especially astrocyte.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제38권
• /
• pp.22.1-22.6
• /
• 2016

Background: The aim of this study is to quantitatively evaluate the effect of rhBMP-2 for repair of bone defects after cyst enucleation using the osteogenesis index (OI). Methods: Under general anesthesia, 10 patients (12 lesions) underwent oral or maxillofacial surgery for cyst enucleation. Postoperatively, 12 lesions were divided into two groups: group A (six lesions) was treated with absorbable collagen sponge (ACS) in combination with rhBMP-2, and group B (six lesions) was treated with ACS alone. After 3 months, cone-beam computed tomographic scans were obtained to measure changes in the volume of the lesions. We then calculated the OI of each group at two different Hounsfield units to determine any statistically significant difference between these two groups (Mann-Whitney U test). Results: As tested at the level of new bone, the mean OI was 72.37 % in group A and 55.08 % in group B -a statistically significant difference (p = 0.041). As tested at the level of mature bone, the mean OI was 27.47 % in group A and 18.88 % in group B, but the difference was not statistically significant (p = 0.394). Conclusions: The application of rhBMP-2 after maxillofacial cyst enucleation accelerated new bone formation in the bone defects. Thus, the use of rhBMP-2 in combination with ACS may be considered an alternative to conventional bone grafting in some patients with postoperative bone defects.

• 한국응용약물학회:학술대회논문집
• /
• 한국응용약물학회 1996년도 춘계학술대회
• /
• pp.183-183
• /
• 1996

Bacteriophage T4 endonuclease V initiates the repair of ultraviolet (UV)-induced pyrimidine dimer photoproducts in duplex DNA. The mechanism of DNA strand cleavage involves four sequential stens: linear diffusion along dsDNA, pyrimidine dimer-specific binding,l pyrimidine dimer-DNA glycosylase activity, and Af lyase activity. Although crystal structure is known for this enzyme, solution structure has not been yet known. In order to elucidate the solution structure of this enzyme NMR spectroscopy was used. As a basis for the NMR peak assignment of the protein, HSQC spectrum was obtained on the uniformly $\^$15/N-labeled T4 endonuclease V. Each amide peak of the spectrum were classified according to amino acid spin systems by interpreting the spectrum of $\^$15/N amino acid-specific labeled T4 endonuclease V. The assignment was mainly obtained from three-dimensional NMR spectra such as 3D NOESY-HMQC, 3D TOCSY-HMQC. These experiments were carried out will uniformly $\^$15/N-labeled sample. In order to assign tile resonance of backbon atom, triple-resonance theree-dimensional NMR experiments were also performed using double labeled($\^$15/N$\^$13/C) sample. 3D HNCA, HN(CO)CA, HNCO, HN(CA)HA spectra were recorded for this purpose. The results of assignments were used to interpret the interaction of this enzyme with DNA. HSQC spectrum was obtained for T4 endonuclease V with specific $\^$15/N-labeled amino acids that have been known for important residue in catalysis. By comparing the spectrum of enzyme*DNA complex with that of the enzyme, we could confirm the important role of some residues of Thr, Arg, Tyr in activity. The results of assignments were also used to predict the secondary structure by chemical shift index (CSI).

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권21호
• /
• pp.9423-9426
• /
• 2014

Objective: Hapatitis B visus (CHB)-induced fibrosis is a precancerous condition of liver. To explore the influence of Chongcao Preparation (Chongcao Yigan Capsule) on the function of intestinal flora and chemoprevention for patients with CHB-induced liver fibrosis. Methods: A total of 136 patients with CHB-induced liver fibrosis were randomly divided into control group treated with lamivudine (LAM) and research group added with Chongcao Yigan Capsule for totally 48 weeks. The changes of intestinal flora, secretory immunoglobin A (SIgA), serum albumin (ALB), prealbumin (PALB), IgA and IgG at different time points in both groups were observed. Results: Before treatment, there was no significant difference between two groups in each index (P>0.05). After treatment, the intestinal flora were evidently optimized in research group than treatment before (P<0.05 or P<0.01), and were apparently better than those in control group (P<0.05 or P<0.01); SIgA was obviously increased and ALB, PALB, IgA and IgG were markedly improved in research group than treatment before (P<0.05 or P<0.01), and were significantly better than those in control group (P<0.05 or P<0.01). Conclusions: Chongcao Yigan Capsule could regulate the intestinal flora, increase SIgA, serum ALB and PALB concentrations and significantly improve serum IgA and IgG as well as strengthen the immunological function and autologous repair capacity of patients with CHB-induced liver fibrosis.