• Journal of Chest Surgery
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• 제9권2호
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• pp.298-310
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• 1976

A clinical analysis was performed on 118 cases of the benign esophageal diseases experienced at Department of Thoracic Surgery, Seoul National University Hospital during 20 year period from 1957 to 1976. Of 118 cases of the benign esophageal diseases, there were 84 patients of esophagenal stenosis, 14 of esophageal perforation, 8 of esophageal atresia, 7 of achalasia, 2 of hiatal hernia, 2 of esophageal foreign body and one of esophageal diverticulum. Fifty-one patients were male and sixty-seven were female, and ages ranged from one day to sixty-four years with peak incidence in the age group of 20 to 29 years. All but one of the esophageal stenosis were caused by corrosive esophagitis and ages ranged from three to sixty-four years with peak incidence in third decade. Main symptoms of the esophageal stenosis were dysphagia, weight loss and chest pain in order and mostly began between one month and one year after ingestion of corrosive agents. Corrosive esophageal stenosis developed most frequently in middle one-third of the esophagus and about one-forth of them were diffuse. Operations were performed on 72 patients of esophageal stenosis of whom 26 patients had esophagocologastrostomy, 21 gastrostomy, 20 esophagogastrostomy, 4 esophagojejunogastrostomy and 2 pharyngogastrostomy. There were 5 deaths in the postoperative period, an operative mortality of 6.9 percent, and 20 patients had one or two complications; eight were anastomotic leaks, 6 gangrenes of replaced loop, 4 wound abscesses and others. The causes of the esophageal perforation were traumatic in 7 cases, caustics in 4 and spontaneous in 3, and the most frequent site of the perforation was lower one-third of the esophagus. Frequent symptoms of the esophageal perforation were pain, fever, dysphagia and dyspnea, and preoperatively there were mediastinitis in 8 cases, empyema in 7, lung abscess in 3 and others. All 14 patients of the esophageal perforation underwent operation: primary closure in 7 cases, drainage in 4, esophagogastrostomy in 2 and 'esophageal diversion in one. There were 4 postoperative deaths and 11 postoperative complications occurred in 7 patients. The duration of symptoms in achalasia was between 3 months and 25 years, with an average duration of 6. 2 years. Frequent symptoms of the achlasia esophagi were dysphagia, regurgitation, pain and weight loss in order. All 7 patients of achlasia underwent modified Heller's operation where 2 patients had complications, restenosis in one and esophageal perforation in another. All 8 patients of congenital esophageal atresia had distal tracheoesophageal fistula and were admitted within 5 days of life, but there were pneumonic consolidation on chest X-ray in patients. Five patients underwent one staged operation with the result of 2 deaths and one anastomotic leak.

• Journal of Chest Surgery
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• 제30권2호
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• pp.195-199
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• 1997

복부대동맥과 그 이하 주요분지들의 동맥폐쇄에 의한 하지 만성허혈은 동맥경화증이 주원인이며 이 질환의 임상적 중요성은 혈관이 진행적으로 폐쇄됨에 따라 혈류장애가 발생하여 간헐적 파행, 휴식시 동통이 일어나며 더 진행되면 조직의 괴사가 발생,결국괴사된 조직의 절단을 초래하게된다. 본한국보 훈병원 흉부외과에서는 1992년 12월부터 1995년 12월까지 폐쇄성 하지동맥 경화증으로 입원한 20명의 환자를 대상으로 동맥간 우회술을 시 행하였다. 임상증상은 괴사및 괴저 9례(45B4), 파행 7례(35%), 안정 시 동통 4례(20%)순이었다. 사용한 혈관은 복부대동맥및 총대퇴동맥의 경우 Y-형및 I-형 인조혈관을 사 용하였고 대퇴동맥이하의 혈관에서는 주로 자가 대복재정 맥을 사용하였다. 술후 합병증은 4례로 20% 를 보였고 이식된 혈관내 혈전증 2례, 창상감염 2례 였다. 술후 혈관개존율은 복부대동맥과 양측 대퇴동 맥간 우회술의 경우 100%였고 대퇴동맥 이하에서는 6개월이 92.6%, 1년 84.2%, 2년 75.4%, 3년 69.4% 였다.

• Journal of Chest Surgery
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• 제23권2호
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• pp.299-308
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• 1990

A review of 50 patients with primary mediastinal tumors or cysts has been done to evaluate clinical and pathological behavior of this heterogeneous group of tumors proved by either excision or biopsy from January 1980 to August 1989 at the cardiovascular department of surgery in Kyungpook National University Hospital. There were 30 males and 20 females in this series. The ages of patients ranged from 4 months to 64 years. The mean age of subjects was 30.4 years. Neurogenic tumors [14 cases, 28%] and teratoma [14 cases, 28%] were most frequently encountered and followed by thymoma [10 cases, 20%] and benign cysts [4 cases, 8%]. The anatomic location of the primary mediastinal tumors or cysts was classified as anterior mediastinum and middle or visceral mediastinum and paravertebral or costovertebral mediastinum on the basis of the Shields’ proposition. In 32 patients[64%], the tumors or cysts were located in anterior mediastinum and in 13 patients[26%], the tumors or cysts were located in paravertebral or costovertebral mediastinum. And the rest 5 patients[10%] had middle or visceral mediastinal tumors or cysts. One of the characteristic features of primary mediastinal tumors or cysts is that some mediastinal tumors or cysts have their own preferred location in the mediastinum. In our series, all of the 14 patients with teratoma and 10 patients with thymoma had the anterior mediastinal location, while 13 of the 14 patients with neurogenic tumors had the paravertebral mediastinal location. 14 patients[28%] were asymptomatic and they all were discovered via so-called “Routine” chest x-ray examination. 39 of 50 patients[78%] were benign. 11 patients[22%] were malignant and they were all symptomatic. 40 patients[80%] were treated with complete resection. 5 patients[10%] were treated with partial resection : 2 of malignant thymoma, 3 of lipoma, neuroblastoma, primary squamous cell carcinoma. The rest 5 patients[10%] were only biopsied: 2 of undetermined malignancy and 3 of hemangioma, lymphoma, primary squamous cell carcinoma. 4 of the 10 patients were treated with combination of irradiation and chemotherapy. Postoperative complications were as followings: Horner’s syndrome [4cases, ado], respiratory failure [3 cases, 6%], pleural effusion[3 cases, 6%], Wound infection[2 cases, 4%] and bleeding, pneumothorax, empyema. There were 5 postoperative deaths [10%]. One patient with neuroblastoma died from intraoperative massive bleeding, 3 patients died early postoperatively from respiratory failure with undetermined malignancy died late postoperatively from congestive heart failure due to direct invasion of the tumor to the heart.

• Journal of Chest Surgery
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• 제30권5호
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• pp.512-516
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• 1997

자연성 기흉은 흉부외과 영역에서 흔히 접하게되는 질환으로 대부분의 경우 폐쇄식 흉강삽관술로 잘 치료 되지만 높은 재발율과 지속적인 공기누출로 인한 폐의 팽창부전등의 이유로 개흉술을 시행해야 하는 경우가 많다. 이러한 경우 개흉술로 인한 수술후 통증, 창상감염, 큰 절개흉터등의 문제가 남게되는데 이러한 문제를 해결하는데 효과적인 비디오 흉강경 수술이 현재 각광을 받고 있다. 본 인제대학교 부산백병원 흉부외과학 교실에서는 최근 3년간 자연성 기흉 환자 66명에 대해 비디오 흉강 경을 이용한 수술을 시행하여 다음과 같은 결과를 얻었다. 남녀 비는 63:3으로 남자가 절대적으로 많았으며 연령별로는 10대후반이 36명으로 전체의 55%를 차지하였다. 발생부위는 우측이 30례, 좌측이 36례 였으며 내원시 임상증상은 흉통, 호흡곤란, 흉부 불쾌감 순이였다. 수술적응증으로는 재발성이 36례로 대부분을 차지하였고 기흉 발생후 흉부 X-선상에서 기포가 보인 경우가 15례 였으며 흉관 삽관후 지속적인 공기 누출로 폐 팽창이 않된 경우가 10례였으며, 환자 본인이 수술을 원 하였던 경우가 5례였다. 기포를 포함한 폐부분 절제술을 시행한 경우\ulcorner 2례였고 폐부분 절제술과 더불어 늑막유착술을 동시에 시 행한 경우가 59례로 대부분을 차지하였다. 명백하게 폐기포를 발견할 수 없었던 5례에서는 늑막유착술만을 시행하였다 슬후 합병증은 4례에서 재발성 기흉이 발생하였고 무기폐와 폐렴 Ifl, 투관침 삽관부위 출혈이 1례 발생하였으나 모두 적절한 치료로 해결되었다. 흉강경을 이용한 자연성 기흉 수술은 여러 가지 장점이 많은 효과적인 수술방법으로 사료되어지며 기타 다른 흉부질환에 있어서도 그 적응증이 더욱 늘어나고 앞으로 더욱 발전될 전망이다.

• 대한골관절종양학회지
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• 제1권2호
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• pp.189-193
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• 1995

저자들은 1980년 5월부터 1994년 5월까지 양성골 종양으로 서울대학교 병원 정형외과에서 수술적 치료를 시행한 49례를 분석하여 다음과 같은 결론을 얻었다. 1. 양성 골종양을, 소파술과 화학적 처리한 이종골 및 이종골과 자가 해면질골을 혼합 이식하여 만족한 결과를 얻었다. 2. 화학적 처리한 이종골 이식은 자가골 이식시보다 수술 시간, 수술중 출혈 및 수혈양을 줄여 수술 및 수혈 합병증을 감소시킨 것으로 사료된다. 3. 이종골 이식은 자가골 이식시 발생할 수 있는 문제를 염두에 둘 때 고려할 만한 골 이식 대치물로 사료된다.

• Journal of Korean Neurosurgical Society
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• 제59권6호
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• pp.564-569
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• 2016

Objective : This study used the intradural procedural time to assess the overall technical difficulty involved in surgically clipping an unruptured middle cerebral artery (MCA) aneurysm via a pterional or superciliary approach. The clinical and radiological variables affecting the intradural procedural time were investigated, and the intradural procedural time compared between a superciliary keyhole approach and a pterional approach. Methods : During a 5.5-year period, patients with a single MCA aneurysm were enrolled in this retrospective study. The selection criteria for a superciliary keyhole approach included : 1) maximum diameter of the unruptured MCA aneurysm <15 mm, 2) neck diameter of the MCA aneurysm <10 mm, and 3) aneurysm location involving the sphenoidal or horizontal segment of MCA (M1) segment and MCA bifurcation, excluding aneurysms distal to the MCA genu. Meanwhile, the control comparison group included patients with the same selection criteria as for a superciliary approach, yet who preferred a pterional approach to avoid a postoperative facial wound or due to preoperative skin trouble in the supraorbital area. To determine the variables affecting the intradural procedural time, a multiple regression analysis was performed using such data as the patient age and gender, maximum aneurysm diameter, aneurysm neck diameter, and length of the pre-aneurysm M1 segment. In addition, the intradural procedural times were compared between the superciliary and pterional patient groups, along with the other variables. Results : A total of 160 patients underwent a superciliary (n=124) or pterional (n=36) approach for an unruptured MCA aneurysm. In the multiple regression analysis, an increase in the diameter of the aneurysm neck (p<0.001) was identified as a statistically significant factor increasing the intradural procedural time. A Pearson correlation analysis also showed a positive correlation (r=0.340) between the neck diameter and the intradural procedural time. When comparing the superciliary and pterional groups, no statistically significant between-group difference was found in terms of the intradural procedural time reflecting the technical difficulty (mean${\pm}$standard deviation : $29.8{\pm}13.0min$ versus $27.7{\pm}9.6min$). Conclusion : A superciliary keyhole approach can be a useful alternative to a pterional approach for an unruptured MCA aneurysm with a maximum diameter <15 mm and neck diameter <10 mm, representing no more of a technical challenge. For both surgical approaches, the technical difficulty increases along with the neck diameter of the MCA aneurysm.

• Journal of Chest Surgery
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• 제25권3호
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• pp.258-270
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• 1992

Benign lung tumors have been considered as relatively rare disease, which comprise approximately 8 to 15% of all solitary pulmonary lesions that are detected radiographically. We clinically analized 30 cases of benign lung tumors underwent the operation from Jan. 1970 to Aug.1991 in the department of thoracic and cardiovascular surgery, Catholic University Medical College. We adopted the classification presented by the World Health Organization[WHO], modified from Liebow, and added benign mesothelioma. There were 11 males & 19 females ranging in age from 2 years to 68 years old % the mean age was 38 years old. Of all 30 benign lung tumors, hamartomas [14 cases, 49%] were the most common & followed by hemangiomas [9 cases, 30%], 3 cases of benign mesotheliomas % a case of teratoma, papilloma, arteriovenous malformation and inflammatory pseudotumor. 14 cases of tumors were asymptomatic & were incidentally detected by plane chest x-ray In other cases, chief complaints at admission were coughing, chest discomfort, dyspnea, hemoptysis, and fever. Diagnosis were made by pathological examination; exploratory thoracotomy in 23 patients[76.7%], bronchoscopy in 4 patients and percutaneous needle aspiration biopsy in 3 patients. Precisely, preoperative diagnosis for confirmation of benign lung tumor was made only in 7 cases[23.6%]. Tumors were located on Rt.side[24 cases], especially Rt. middle lobe, and Lt.side[6 cases]. Operation methods were as follows: 21 cases [70%] of lobectomy, 2 cases of segmentectomy, 2 cases of wedge resection, 1 case of pneumonectomy, 1 case of bronchotomy, 2 cases of wedge resection, 1 case of pneumonectomy, 1 case of bronchotomy removal of the endobronchial hamartoma which located at the rt. main stem bronchus and 3 cases of complete resection in benign mesotheliomas. There were no operative death. The post operative complications were developed in 3 cases; post pneumonectomy empyema, wound infection and atelectasis. In conclusion, benign lung tumors must be histologically diagnosed to confirm of benignity and to provide limited resection for preservation of the lung tissue, whenever possible.

• Journal of Chest Surgery
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• 제17권4호
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• pp.762-774
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• 1984

A clinical analysis was performed on 49 cases of the benign esophageal diseases experienced at Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital during 7 year period from 1977 to 1983. Of 49 cases Of the benign esophageal diseases, there were 19 patients of esophageal stricture, 11 of achalasia, 6 of perforation, 3 of bronchoesophageal fistula, 3 of esophageal perforation, 3 of esophageal leiomyoma and one of esophageal foreign body. Twenty three patients were male and 26 were female. Ages ranged from 4 years to 74 years with the average age of 34.7 years. Of 19 patients of esophageal strictures, 7 patients were male and 12 were female and ages ranged from 6 years to 74 years with the average being 33.8 years. Causes of esophageal strictures were corrosive of esophageal strictures were dysphagia, vomiting, general weakness, weight loss and pain that order and developed on several different parts of esophagus. Operations were performed in 18 cases, of whom 7 patients were performed by esophagocologastrostomy, 4 gastrostomy, 4 esophagogastrostomy, 1 esophageal resection and esophagoesophagostomy, 1 esophagotomy and dilatation and 1 scar revision. Five patients had one or two complications; 2 anastomotic leakage, 1 wound infection, 1 localized empyema, 1 bilateral pneumothorax and 1 respiratory failure. One patient expired due to respiratory failure arising from aspiration pneumonia. The average age of achalasia patients was 33.1 years and symptom durations were from 2 months to 10 years with the average of 3.3 years. Main symptoms were dysphagia, vomiting, weight loss, pain and cough in that order. Modified Hellers myotomy was performed in 11 patients with one complication of restenosis. One patient was operated on by using longitudinal incision and transverse sutures with good result. Of 6 patient of esophageal diverticulum, 2 patients were traction diverticulum on the midesophagus, 2 were pulsion diverticulum on the midesophagus and 2 were pulsion diverticulum on the lower esophagus. Diverticulectomy was performed on 2 cases of traction diverticulum and esophagocardiomyotomy with or without diverticulectomy was erformed on 4 cases of pulsion diverticulum with good results. Of 5 patients of congenital bronchoesophageal fistula, the chief complaints were productive cough in 4 patients and hematemesis without respiratory symptoms in one patient. Two patients were operated on by using fistulectomy only and 3 by fistulectomy with pulmonary lobectomy. Of 3 patients of esophageal perforation, causes were foreign body ingestion, esophageal stricture after ECG and corrosive esophagitis. Two patient were operated on by using drainage and gastrostomy with symptomatic improvement but one patient died due to septic shock after thoracotomy. Three patients of esophageal leiomyoma were all male and 2 patients were operated on by using enucleation and one by distal esophagectomy with esophagogastrostomy. In one patient of esophageal foreign body, it was removed by esophagotomy through the right thoracotomy.

• Journal of Animal Science and Technology
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• 제48권6호
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• pp.943-948
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• 2006

본 연구는 육경절단이 사슴뿔 성장에 있어서 낙각시기, 녹용생산량, 녹용길이에 미치는 영향을 구명하기 위하여 실시하였으며, 그 결과를 요약하면 다음과 같다. 육경의 외과적 자극과 녹용의 길이성장은 유의성은 없었으나, 2차 년도에는 한쪽 절단구가 가장 길었고 양쪽 절단구가 가장 짧았다, 가지의 발생은 1차 년도에서 외과적 상처가 많을수록 증가하였다(P<0.05). 낙각 시기는 한쪽 절단구가 2주일정도 빨랐다(P<0.05). 육경의 절단두께별 녹용생산량은 육경을 절단하지 않은 구가 148±23g 이였으며, 절단 두께가 0.3, 0.4, 0.5 및 0.6cm로 절단하였을 때 절단된 육경 쪽의 녹용생산량은 126±61.4 179±63.3 170.0±0.0 및 48±25.4g으로 절단두께는 0.4～0.5cm 범위가 가장 양호하였고, 절단두께가 0.6cm 이상인 경우 유의하게 줄어들었다(P<0.05). 녹용생산량은 1년차에서 외과적 상처가 많을수록 증가하였으며, 2차 년도에서는 대조구, 육경 한쪽 절단구 및 양쪽 절단구가 각각 588, 790 및 657g으로 한쪽 절단구가 유의적으로 녹용생산량이 많았다(P<0.05).이상의 결과에서 육경을 절단하면 가지의 발생이 많아지고 녹용의 생산량이 증가하는 것으로 사료된다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제13권2호
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• pp.129-136
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• 1991

Fibrin Sealants 는 과거 간, 비장, 신장등의 일반외과 수술에서 단순한 외과적 봉합으로는 해결하지 못하는 넓은 면적의 조직의 유착을 위하여 1940 년경 부터 개발되기 시작한 것으로 악안면 영역에서는 1970 년대 중반부터 미세신경접합술과 피부이식을 위하여 사용되기 시작한 후, 현재, 골이식후의 골세편의 고정, 혈관봉합술, 연조직에서 조직들의 유착과 지혈, 그리고 혈관종의 치유등을 목적으로도 광범위하게 연구되고 사용되고 있다. 이것은 인체에서 채취한 혈액응고인자 XIII 을 포함하는 Fibrinogen 성분과, 소에서 추출한 Thrombin 의 두가지 주요 성분으로 구성되며, Fibrinogen 용해제인 Aprotinin 액과 Thrombin 용해제인 염화칼슘액과 함께 네부분으로 구성된다. 각제품에 따라 그리고 사용된 농도에 따라 차이는 있으나, 대개 수분후에 조직이 응고되어 달라붙기 시작하고, 수시간후에 최대접착효과에 도달하며, 응고된 접착효과는 12 일에서 15 일간 유지되고 그후 정상적인 섬유소분해작용과 식세포활동에 의하여 분해된다. 저자는최근 6 개월간 서울대학교병원 구강악안면외과에서 28 명의 각종 질환 및 기형 환자에서 미세신경봉합술, 피부이식, 악교정성형술과 구개파열 또는 하악골 재건을 요하는 환자의 골이식후의 골세편의 고정, 경부곽청술이나 종양제거술후 각종 피부판 또는 근피판을 이용한 연조직의 적합, 혈관종의 처치, 후이개접근 법에 의한 악관절수술후의 외이도의 접합등 다양한 목적을 위하여 적용된 Fibrin Sealants 를 사용하여 양호한 결과를 얻었기에 보고하는 바이다.