• Journal of Chest Surgery
• /
• 제45권1호
• /
• pp.24-29
• /
• 2012

Background: The conventional method of aortic cross-clamping is very difficult and increases the risk of cerebral infarct due to embolism of the calcified aorta in these patients. Accordingly, we analyzed our experience with 11 cases of ascending aorta and aortic valve replacement with hypothermic circulatory arrest. Materials and Methods: From January 2002 to December 2009, 11 patients had ascending aorta and aortic valve replacement with hypothermic arrest at our hospital. We performed a retrospective study. Results: There were 5 males and 6 females, with a mean age of 68 years (range, 44 to 82 years). Eight patients had aortic stenosis, and 3 patients had aortic regurgitation. An aortic cannula was inserted into the right axillary artery in 3 patients and ascending aorta in 6 patients. Two patients with aortic regurgitation had a remote access perfusion catheter inserted though the right femoral artery. The mean cardiopulmonary bypass time was 180 minutes (range, 110 to 306 minutes) and mean hypothermic circulatory arrest time was 30 minutes (range, 20 to 48 minutes). The mean rectal temperature during hypothermic circulatory arrest was $21^{\circ}C$ (range, $19^{\circ}C$ to $23^{\circ}C$). No patient had any new onset of cerebral infarct or cardiovascular accident after surgery. There was no hospital mortality. Early complications occurred in 1 patient who needed reoperation due to postoperative bleeding. Late complications occurred in 1 patient who underwent a Bentall operation due to prosthetic valve endocarditis. The mean follow-up duration was 32 months (range, 1 month to 8 years) and 1 patient died suddenly due to unknown causes after 5 years. Conclusion: Patients with a calcified aorta can be safely treated with a technique based on aorta and aortic valve replacement under hypothermic circulatory arrest.

• Journal of Chest Surgery
• /
• 제33권1호
• /
• pp.32-37
• /
• 2000

Background: Reconstruction surgery of mitral valve regurgitation is now considered as an effective operative technique and has shown good long-term results. Although reconstructive surgery of mitral valve has been performed since 1970s, we have started only in early 1990s in full scale because of small number of the mitral regurgitation compared to mitral stenosis and lack of knowledge from the viewpoint of patients and physicians. Material and Method: From January 1992 to December 1996, 100 patients underwent repair of the mitral valve for mitral regurgitation with or without mitral stenosis in Seoul National University Hospital. 45(45%) of the patients were men and 55(55%) were women. The mean age was 39.9$\pm$14.4 years. The causes of the mitral regurgitation were rheumatic in 61, degenerative in 28 and others in 11. According to the Carpentier's pathological classification of mitral regurgitation 5 patients were type I. 55 patients were type II and 40 patients were type III. 7 patients underwent concomitant aortic valvuloplasty and 8 patients underwent aortic valve replacement. 7 patients underwent Maze operation or pulmonary vein isolation. Result: There were no operative death but 3 major operative complications: 2patients were postoperative low cardiac output syndrome(needed intra-aortic ballon pump support) and 1 patient was postoperative bleeding. There was one late death(1.0%) The cause of death was sepsis secondary to acute bacterial endocarditis. 3 patients required reoperation for recurred mitral regurgitation. There were no statistically significant risk factors for reoperation. The other 96 patients showed no or mild degree of mitral regurgitation 99 survivors were in NYHA functional class I or II. There were two throumboembolisms but no anticoagulation-related complications. Conclusion: We concluded that mitral valve repair could be performed successfully in most cases of mitral regurgitation even in the rheumatic and combined lesions with very low operative mortality and morbidity. The early results are very promising.

• Journal of Gastric Cancer
• /
• 제8권2호
• /
• pp.104-109
• /
• 2008

목적: 국내 위 점막하 종양의 임상병리학적 양상과 치료방법에 대해 파악하고자 전국조사를 실시하였다. 대상 및 방법: 국내 47개 병원에서 2005년부터 2006년까지 위 점막하 종양으로 수술 받은 환자 878명의 자료를 수집하여, 진단명, 증상, 위치, 수술법, 사망률, 종양의 크기, 악성도 등을 조사하였다. 결과: 위 점막하 종양의 수술 후 진단으로는 위장관 간질 종양(Gastrointestinal stromal tumor, GIST)이 586명(66.8%)으로 가장 많았고, 평활근종(Leiomyoma) 97명(11.1%), 신경초종(schwannoma) 70명(8.0%), 이소성 췌장(Ectopic pancreas) 68명(7.8%), 유암종(carcinoid) 16명(1.8%) 순이었다. 환자의 평균 나이는 56.0세, 남녀 비는 1:1.18이었으며, 50.9%의 환자가 증상 없이 발견되었다. 위 상부 1/3에 위치한 위 점막하 종양이 가장 흔했으며(n=449, 52.0%), GIST의 55.4% (n=319), 평활근종의 84.5% (n=82)가 위 상부 1/3에 위치하였다. 복강경적 접근이 전체 환자의 44.2% (n=388)에서 시행되었으며, 수술방법으로는 쐐기 절제술(n=726, 82.8%)이 가장 빈번히 시행되었다. 전체 환자 중 1명(0.1%)만이 수술 후 30일 이내에 사망하였다. GIST 환자 중 115명(21.1%, 115/544)이 고위험도의 악성도를 가졌고, 41명(8.3%, 45/495)에서 수술 후 imatinib mesylate 항암 치료를 하였다. 결론: 조사된 국내 점막하 종양의 약 2/3가 GIST였으며, 약 1/2에서 복강경하 절제술이 이루어졌다. 향후 이 보고가 위점막하 종양의 진료 및 연구의 참고자료로 활용되기를 기대한다.

• Journal of Periodontal and Implant Science
• /
• 제33권2호
• /
• pp.159-166
• /
• 2003

The purpose of this study was to investigate and compare the frequence of 4 periodontal pathogens in the supra- and subgingival plaque in periodontally healthy subjects. Twenty adult individuals aged 22 to 28 years (mean age 23.65 years) participated in this study. All subjects had no pocket sites more than 3 mm deep, and the sites selected for sampling were all negative for bleeding. After drying and isolation of the sites with cotton rolls, supragingival plaque was sampled using sterile periodontal curette. Each plaque sample was placed in individual tubes containing 500 ml of 1X PBS. After removal of the supragingival sample and any remaining supragingival plaque, subgingival plaque samples were taken from the same sites using sterile curette and placed in similar individual tubes. Identification of 4 putative periodontal pathogens from the samples was performed by polymerase chain reaction based on 16S rDNA. Chi-square test was employed to identify significant explanatory variables for the presence of the 4 periodontal pathogens. The data show that Actinobacillus actinmycetemcomitans, Porphyromonanas gingivalis, Bacteroides forsythus, and Fusobacterium nucleatum occurred in 16.9%, 14.4%, 52.5%, and 80.6%, respectively. No significant differences were noted in the periodontal pathogens between supra- and subgingival plaques according to the kind of teeth. However, the incisors were at higher risk for harboring F. nucleatum (p <0.05). Conclusion: These results reveal that anaerobic periodontal pathogens can be detected in supragingival plaques. Supragingival plaque may function as a reservoir of peri-odotopathogens.

• Tuberculosis and Respiratory Diseases
• /
• 제49권1호
• /
• pp.93-98
• /
• 2000

Acute respiratory distress syndrome (ARDS) has been reported to be associated with a variety of medical and surgical conditions, including All-trans-retinoic acid (ATTA). ATRA is very efficaceous drug to acute promyelocytic leukemia (APL). This drug can induce complete remission at APL without fatal risk of disseminated intravascular coagulation. But ATRA treatment, sometimes, produces the symptoms of fever, weight gain and acute respiratory distress, renal function impairment. The causes of these symptoms are not fully proved, but supposed as the result of leukostasis and capillary leak syndrome from excessive leukocyte differentiation and cytokines release. Recently, we experienced a 24-year-old woman who complained gum bleeding for 6 days. At bone marrow biopsy, she was diagnosed as APL. 2 days after ATRA treatment, she was suffered from the symptoms of dyspnea and general ache. At laboratory examination, total leukocyte count was 50,400/$mm^3$, $PaO_2$ was 42.5 mm Hg and chest PA revealed the findings compatible with ARDS. Treatment with low dose ara-C, corticosteroid and general supportive cares were tried. Within 3 days after treatment, the patient recovered from ARDS by evidence of arterial blood gas study and chest radiographs. She has acquired complete remission of APL with maintenance of A TRA. And so, we present this case with a review of related literatures.

• 치위생과학회지
• /
• 제15권4호
• /
• pp.413-418
• /
• 2015

본 연구는 K대학교에서 비만 또는 과체중 학생을 대상으로 4주간 운영하는 체중조절 프로그램에 개입하여 프로그램 전후의 비만지표 변화와 치주지표 변화를 조사하고 분석하였다. 그 결과, 체중, 허리둘레, 체질량지수, 체지방률, 복부지방률은 모두 유의하게 감소하였고 치면세균막지수는 유의하게 증가하였으며 치은지수, 탐침시 출혈부위수, 천치주낭부위수는 유의한 변화가 없었다. 성별, 흡연, 음주의 특성이 비만지표 변화와 치주지표 변화에 영향을 미치지 않았다. 그러나 프로그램 전후 차이 지표 변화의 상관분석에 체지방율 변화와 탐침시 출혈부위수 변화가 강한 양의 상관관계를 나타내었고 복부지방률 변화와 천치주낭 부위수 변화가 중정도의 양의 상관관계를 나타내었다. 탐침시 출혈 부위수 변화에 대한 체지방률의 설명력은 58.9%로 나타났다. 따라서 체지방률과 복부지방률이 치주 임상지표와 연관성이 있으며, 비만 감소는 치주 건강에 영향을 끼칠 수 있다고 제안한다.

• 대한한의학회지
• /
• 제15권2호
• /
• pp.46-91
• /
• 1994

l. Backgrounds of Studies Cerebrovascular accident. one of the three major causes of death among audults with cardiopathy and malignancy, has been on the increase in korea while it is on the decrease in European countries and Japan. Types of stroke undergo changes caused by prolongment of life expectancy. and social and economic variety. More patients of ischemic stroke show a tendency to increase now than those of hemorrhagic stroke in the past. Many clinical studies on medical cerebrovascular and oriental stroke of paralysis have been published. but few clinical studies on therapeutics of integrated oriental and western medicine are to be found. So I have made an attempt to study clinical observations and therapeutic responses of ischemic stroke under integrated oriental and western medicine. 2.Methods. Among the patients admitted into the clinic of Joong-Poong, Woo-Suk University Hospital from May 1. 1993 until April 30. 1994 those 56 patients who were diagnosed as ischemic stroke on Computed Tomography(CT) and showed no dubious symptom after examination of coagulation and bleeding time were classified into the following six steps and treated: l)diagnosis 2)emergency treatment 3)basic treatment 4)treatment of risk and provoking factors. and preceeding disease 5)complications and conservative therapy 6)rehabilitation. For a period of basic treatment both herb medication and urokinase therapy were applied at the same time. Intravenous injection has been given at a unit of 300.000 dosage a day as urokinase therapy during basic treatment. If they showed any dubious symptom in glucose tolerance test. fructose 500ml and urokinase 300.000 dosage were mixed and injected. In case of no symptom 5% DW 500ml was mixed with urokinase 300.000 unit. and injected at a speed of 15gtt per minute. 3. Results and Conclusions 1) The level of ambulation has been improved from 42.9% when admitted to 73.2% when discharged in the degree of recovery. The level of severe function disorder has been remarkably decreased from 55.4% when admitted to 19.6% when discharged. 2) The treatment effect on the basis of therapeutic response of clinical and subjective symptom shows as follows: 7.1% Excellent. 35.7% Good. 37.5% Effective. 10.7% Stationary. and 8.9% Aggravated. The total recovery above effective shows 80.3%. Judging from the above results I think it proper to develop the model of better preventing and treating ischemic stroke through effective therapeutic and clinical studies of integrated oriental and western medicine.

• 한국산학기술학회논문지
• /
• 제19권9호
• /
• pp.146-155
• /
• 2018

본 연구는 허혈성심장질환으로 관상동맥우회술을 받은 환자에서 심폐바이패스 여부에 따른 임상성과를 확인하고자 시행하였다. 연구대상은 2008년 7월부터 2012년 6월까지 4년 동안 허혈성심장질환으로 관상동맥우회술을 받은 환자 전수이며, 총 10,981명이었다. 분석 자료는 건강보험심사평가원 청구명세서를 이용하여 후향적으로 수집하였다. 연구결과, 무심폐기 관상동맥우회술(Off Pump CABG, OPCAB) 환자 그룹이 고식적 관상동맥우회술(On Pump CABG, ONCAB) 환자 그룹에서보다 평균 수술소요시간(280분 vs 357분, p<.0001) 및 기관 내 삽관 후 발관까지 평균 소요시간이 짧았고(약 24시간 vs 40시간, p<.0001), 수술 후 출혈 및 혈종 등으로 인한 재수술률이 낮았다(2.7% vs 8.3%, p<.0001). 위험요인 통제 하에 심폐기 사용 여부에 따른 30일내 사망률과 재원일수를 분석한 결과, 고식적 관상동맥우회술(ONCAB) 대비 무심폐기 관상동맥우회술(OPCAB)의 사망 위험비는 0.339(0.266-0.434)이고, 재원일수는 -0.29229로 감소하였다(p<.0001). 이상의 결과 심폐기를 사용하지 않은 경우에서 30일내 사망률과 재수술률이 낮았고, 평균 수술소요시간, 기관 내 삽관 후 발관까지 소요시간, 재원일수가 짧았음을 확인하였다.

• Journal of Trauma and Injury
• /
• 제22권1호
• /
• pp.77-86
• /
• 2009

Purpose: The appropriate management of traumatic truncal arterial injury is often difficult to determine, particularly if the injury is associated with severe additional truncal lesions. The timing of repair is controversial when patients arrive alive at the hospital. Also, there is an argument about surgery versus stent-graft repair. This study's objective was to evaluate the appropriate method and the timing for treatment in cases of truncal abdominal injury associated with other abdominal lesions. Methods: The medical records at Ajou University Medical Center were reviewed for an 8-year period from January 1, 2001, to December 31, 2008. Twelve consecutive patients, who were diagnosed as having had a traumatic truncal arterial injury, were enrolled in our study. Patients who were dead before arriving at the hospital or were not associated with abdominal organ injury, were excluded. All patients involved were managed by using the ATLS (Advanced Trauma Life Support) guideline. Data on injury site, the timing and treatment method of repair, the overall complications, and the survival rate were collected and analyzed. Results: Every case showed a severe injury of more than 15 point on the ISS (injury severity score) scale. The male-to-female ratio was 9:3, and patients were 41 years old on the average. Sites of associated organ injury were the lung, spleen, bowel, liver, pelvic bone, kidney, heart, vertebra, pancreas, and diaphragm ordered from high frequency to lower frequency. There were 11 cases of surgery, and one case of conservative treatment. Two of the patients died after surgery for truncal organ injury: one from excessive bleeding after surgery and the other from multiple organ failure. Arterial injuries were diagnosed by using computed tomography in every case and 9 patients were treated by using an angiographic stent-graft repair. There were 3 patients whose vessels were normal on admission. Several weeks later, they were diagnosed as having a truncal arterial injury. Conclusion: In stable rupture of the truncal artery, initial conservative management is safe and allows management of the major associated lesions. Stent grafting of the truncal artery is a valuable therapeutic alternative to surgical repair, especially in patients considered to be a high risk for a conventional thoracotomy.

• 대한소아치과학회지
• /
• 제31권4호
• /
• pp.680-684
• /
• 2004

혈관종은 혈관의 증식에 의해 발생하는 양성 종양으로 유아와 어린이에서 호발한다. 대부분 진성종양으로 보다는 과오종(hamartoma)으로 보며 구강내 호발부위는 입술 혀, 협점막, 구개부 등이다. 임상소견은 편평하거나 융기된 적청색 병소로 보통 단발성이다. 조직학적 소견을 통해 모세혈관성(capillary), 해면상(cavernous), 혼합성(mixed), 경화성(sclerosing) 등으로 분류되며 확진된다. 본 증례는 6세 남자 환아가 치은에 뭐가 났다는 것을 주소로 전남대학교 병원 소아치과에 내원하였다. 임상검사 결과 #62, 63 부위의 부착치은에 딸기모양 종물(mass)이 관찰되었다. 조직검사 시행 결과 모세혈관종으로 확진되었으며 외과적 절제로 양호한 결과를 얻었기에 보고하는 바이다. 혈관종은 재발이 드물며 악성전환이 없지만 출혈 경향이 높으므로 임상적 시술시 주의가 요구된다.