• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제33권4호
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• pp.340-349
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• 2007

Free flap transplantation with microvascular anastomosis has been successfully performed by development of surgical technique, materials and postoperative monitoring equipments of flap. But success rate of microvascular anastomosis is influenced by various factors, and failure rate is about 5-10%. The most influential factor for success rate is surgical technique and other factors that influence failure of microvascular anastomosis are ischemic time of free flap, thrombus formation of anastomosis region and vascular spasm. In this study, vascular patency and thrombus formation in experimental micro-venous anastomosis, and endothelial repair were observed with histologic analysis, scanning electron microscopy, transmission electron microscopic examination. The results were obtained as follows: 1. In vascular patency test in 30 minute and 7 days after micro-venous anastomosis with heparin irrigation, all of 12 anastomosis site were good vascular patency. 2. In thrombus formation in 2 weeks group(Experimental I), 2 site of 6 cases were observed thrombus, and in 4 weeks group(Experimental II), 1 site of 6 cases were observed thrombus. 3. In histologic examination, normal vein(Control Group) showed continued internal elastic lamina, well formed thick smooth muscle layer and connective tissue. The group of 2 weeks after microvenous anastomosis(Experimental I) showd locally recovered internal lamina, discontinued internal lamina, disorganized smooth muscle cells and granulation tissue around suture silk. In the group of 4 weeks after micro-venous anastomosis(Experimental II), anastomosis site showed almostly continued internal lamina, disorganized smooth muscle cells and cicartrized tissue around suture silk. 4. In scanning electron microscope examination in 2 weeks(Experimental I) after micro-venous anastomosis, mesh fibrin formation showed near to endothelial cells, and in 4 weeks after micro-venous anastomosis(EXperimental II), numerous blood cells and fibrin mesh formation was seen associated with irregular endothelial cell arrangement. 5. In transmission electron microscope examination in 2 weeks after micro-venous anastomosis(Experimental I), irregular arrangement of smooth muscle cells was seen adjacent to collagenized tissue around suture silk. In 4 weeks after micro-venous anastomosis(Experimental II), denuded venous wall composed of relatively well arranged smooth muscle cells was covered by endothelial cells, but fibroblast cells and foreign body giant cells near to suture silk was remained. From the results obtained in this study, results of good vascular patiency and anti-thrombotic effect of heparin were obtained as a local irrigation solution, and repair of venous endothelial cell was observed in 2 weeks after micro-venous anastomosis.

• 한국임상수의학회지
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• 제20권3호
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• pp.294-301
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• 2003

개의 전층피부 창상에서 삼출물의 정도와 창상수축, 상피화, 그리고 치유에 대해 hydrocollodi(Duoderm/$\circledR$, HC)과 hydrogel(Nu-Gel$\circledR$, HG) occlusive dressing materials 의 효과를 비교하였다. 3쌍의 정사각형 전층피부 창상을 2${\times}$2cm 의 크기로 12마리 개의 몸통 등외측 면에(6개의 창상/한 마리) 만들었다. HC와 HG, 생리 식염수(대조창)를 무작위로 배분한 2개의 창상에 각각 적용하였다. 창상의 육안적 소견과 병리조직학적 소견을 4주 동안 평가하였다. 창상유발 7일 후, 비교 그룹 간의 평균 창상수축 정도, 평균 상피화율, 평균 창상 치유율에 유의성있는 변화가 관찰되지 않았다. 창상 유발 14일(P<0.01)과 21일(P<0.05) 후, HG 처치창의 평균 상피화율이 HC 처치창의 평균 상피화율과 대조창의 상피화율보다 유의적으로 더 높게 나타났다. 창상 유발 21일 후(P<0.05), HG 처치창의 창상 수축율이 HC 처치창의 평균 창상 수축율과 대조창의 평균 창상 수축율보다 유의적으로 더 높게 나타났다. 창상 유발 21일 후(P<0.02), HG 처치창의 창상 치유율이 HC 처치창의 평균 창상 치유율과 대조창의 평균 창상 치유율보다 유의적으로 더 높게 나타났다. 창상 유발 1, 4, 7일 후, HC 처치창과 대조창의 피하에 다형핵 백혈구의 심한 침착이 관찰되었고, HG 처치창의 피하에 중등도의 다형핵 백혈구의 침착이 관찰되었으나, HG 처치창, HC 처치창 간의 어떠한 유의적인 변화도 발견되지 않았다. 창상 유발 14일 후, HG 처치창에서 상피성 세포가 유의적으로 표면 위로 자라났고, 부종은 창상 밑 조직까지 감소하였으며, 육아조직은 교원질 섬유로 대체되었다. 창상 유발 21일 후, 다른 창상에 비해, HG 처치창은 유의적으로 창상 표면이 거의 재생성 상피로 덮였으며, 육아조직은 창상 유발 14일 후와 비교해서 유의적으로 교원질 섬유로 대체되었다. 위의 모든 결과에서 보듯이, 개에서 전층피부 창상의 처치 시 HG의 사용은 HC와 생리 식염수에 비해 창상치유 복구기의 치유 속도를 촉진하는 것으로 사료된다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제21권3호
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• pp.257-265
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• 1999

골재생유도술에 의한 골재생과정의 생물학적 현상을 보다 구체적으로 이해하고자, 백서의 대퇴골에 인위적인 골결손부를 형성하고 비흡수성 차폐막을 설치한 다음 골재생유도 과정에서의 미세혈관의 구축 양상을 통상적인 광학 현미경적 소견 및 미세혈관주형 표본 관찰법을 중심으로 관찰한바 다음과 같은 결과를 얻었다. 광학 현미경적 소견의 초기 즉 술후 1주 및 2주 소견상 차폐막에 의해 피개된 실험부에서 보다 정연한 골성회복이 이루어졌으며, 이는 차폐막으로 인한 혈관망 형성의 양상에 의해 영향을 받는 것으로 나타났다. 즉, 차폐막에 의한 연조직 침입이 차단됨으로 인해 인접 골조직으로부터 수평적으로 들어온 혈관에 의해 규칙적인 혈관 분포를 나타내나, 대조군의 경우 연조직에서 유입된 혈관망에 의해 불규칙한 혈관망을 나타내었다. 시간이 경과되면서 재생된 결손부의 골은 재구성되면서 대조군과 실험군 사이에 골성회복의 양상은 유사하였으나, 인접 실험군의 골조직으로부터 유입된 혈관에 의해 형성된 규칙적인 혈관망이 연조직으로부터 침입한 혈관에 의해 그 규칙적인 배열이 흐트러진 대조군에 비하여 골성회복의 속도가 빨라진다는 사실을 확인하였다. 이상의 결과는 차폐막에 의한 골재생 유도과정에서 혈관의 유래와 혈관망의 정렬상태가 골성회복의 속도와 밀접한 관련이 있음을 보여주는 것이다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제37권5호
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• pp.406-414
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• 2011

Thermally induced bone necrosis during implant surgery is a rare phenomenon and a potential contributing factor to implant failure. The frictional heat generated at the time of surgery causes a certain degree of necrosis of the surrounding differentiated and undifferentiated cells. The bone necrosis occurred in the mandible in all three cases, leading to a soft tissue lesion and pain. In each case, radiolucent areas appeared in the middle and apical portions of the implant 4 weeks after surgery. Thermally induced bone necrosis did not improve following systemic antibiotic medication, necessitating surgical treatment. The nonintegrated implants were removed, and meticulous debridement of dead bone and granulation tissue was performed. Then, new implants were implanted along with the placement of autogenous and xenogenic bone covered with a collagen membrane. No further complications occurred after re-operation. The radiolucencies around the new implants gradually resolved entirely, and the soft tissue lesions healed successfully. At 4-5 months after reoperation, implant loading was initiated and the implant-supported restorations have been functioning. The aim of this case report is to present the successful clinical treatment of three cases suspected to be caused by thermally induced bone necrosis after implant drilling.

• 대한소아치과학회지
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• 제33권1호
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• pp.139-145
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• 2006

하마종은 구강저에 발생하는 점액 낭종으로 주로 설하선과 관련된다. 즉, 하마종은 설하선 분비도관의 파열로 인하여 타액이 분비도관에서 빠져나와 주위의 연조직 내에 저류됨으로써 발생하는 가성 낭으로 정의되며, 원인은 설하선 도관의 파열이나 폐색이다. 하마종의 임상소견은 청색의 투명한 종창이 구강저의 소대를 중심으로 편측으로 발생하며, 무통성이며, 촉진시 파동성을 나타낸다. 조직소견은 결합 조직 내 와동이 형성되지만, 낭 벽은 상피세포가 아닌 육아조직으로 구성되는 가성 낭을 관찰할 수 있다. 하마종의 첫 번째 치료법으로는 하마종의 내벽이 구강점막의 일부가 되도록 만들어 주는 조대술을 고려할 수 있다. 본 증례는 특징적인 하마종의 임상소견을 보이는 환아에게 gauze-packing등을 동반한 조대술을 이용하여 치료한 증례로써 양호한 치료결과를 보여 보고하고자 한다.

• 대한기관식도과학회지
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• 제10권2호
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• pp.17-21
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• 2004

Background Insertion of tracheal stent in the treatment of benign tracheal & bronchial disease has increased since the introduction of expandable metallic stent. Material & Methods : Between Jan, 1995 and Feb. 2004, eight patients who had benign tracheo-bronchial disease underwent insertion of expandable metallic tracheal stent. We retrospectively analyzed stent insertion indications, complications, and following the result. Results : Surgical indications were post-intubation tracheal stenosis (1 case), tracheal stenosis following tracheal surgery (2 cases), tracheo-esophageal fistula (2 cases), broncho-pleural fistula(1 case), left main bronchus stenosis following bronchoplasty (1 case), and left main bronchus stenosis due to mediastinal repositioning (1 case). Expandable metallic tracheal stent was inserted in five patients to resolve dyspnea caused by airway obstruction, and to prevent recurrent pneumonia in three patients. The complication developed in 6 patients $75\%$; 3 cases of distal stenosis due to growth of granulation tissue, and one case each of tearing of posterior membrane, aggravation of tracheo-esophageal fistula, and airway partial obstruction due to stent migration. The stent was removed in 5 patients and tracheal surgery (tracheal resection and end to end anastomosis with primary repair of esophagus, pericardial patch tracheo-bronchoplasty, tracheal repair and omental wrapping) was performed in 3 patients. Conclusion Insertion of self expandable metallic stent in benign tracheo-bronchial disease is an effective means of relieving dyspnea for only a short period, and it did not increase the long term survival. Better means of treatment of benign tracheo-bronchial stenosis in necessary.

• 대한기관식도과학회지
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• 제13권2호
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• pp.77-81
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• 2007

Foreign body aspiration is a cause of the accidental death at home. Therefore, early intervention and proper management is important. A bronchoscopy is indicated whenever there is a suggestive history and medical opinion. Occasionally, foreign body removal with bronchoscopy may be fail. But, on the situation, there is no definite recommended standard management. We experienced two cases of bronchial foreign body could not be removed with bronchoscopy at first intervention. The one was diagnosed too late. Endobronchial granulation tissue and edema made it impossible to find the foreign body at first bronchoscopy. After steroid and antibiotic therapy, foreign body could be removed with secondary bronchoscopy. Another was bronchial foreign body jammed tightly bronchus intermedius. Even after medical therapy, patient got aggravated. So foreign body was removed with bronchotomy.

• Journal of Korean Neurosurgical Society
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• 제30권11호
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• pp.1320-1323
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• 2001

SAPHO syndrome is an acronym for an increasingly recognized syndrome of synovitis, acne, pustulosis, hyperostosis, and osteitis. Most of the previously reported case are from Japan and Europe. The authors report a case of SAPHO syndrome in Korean female who presented with extrasternal neurologic symptoms. A 60-year-old female with thoracic and right chest wall pain presented with the sternocostoclavicular hyperostosis, and recurrent aseptic osteitis. Previously, she had hystrectomy and thyroidectomy due to uterine malignancy 25 years ago. Also, she started to take medications for palm and sole pustulosis 7 days prior to admission. Through evaluation of clinical, radiological, serological studies, studies was done along with bone needle biopsy for the biological reassessment. The hyperostosis was found in the pedicles of thoracic 8, 9, 10 vertebrae and sternoclavicular joint. Radio-isotope bone scan showed an accumulation of tracer in thoracic vertebra. The bone biopsy from these site showed increased osseous turnover, thickening of trabeculae accompanied by mild acculuation of granulation tissue and round cell infiltration, compatible with mild chronic inflammation with marrow fibrosis. The patient showed good response to conservative management. The authors report a case of SAPHO syndrome with thoracic radiculopathy. It is considered that SAPHO syndrome is related to spondyloarthropathy, and appears to have benign disease process with good prognosis.

• 대한두개안면성형외과학회지
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• 제14권2호
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• pp.119-123
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• 2013

Except for special situations, it is generally agreed that best results in the treatment of facial fractures is expected if reduction is done within the first 2 or 3 weeks after injury. We reduced facial bone fractures at 4 to 7 weeks after trauma. A 44-year-old female patient underwent open reduction for her right zygomaticomaxillary complex fracture at 7 weeks after injury. A 59-year-old female patient underwent surgery for the right mandible body and left parasymphysis fractures at 4 weeks after injury. Using traditional approaches, granulation tissue and callus were removed from the fracture sites, and malunited fracture lines were separated by a small osteotome. We reduced the displaced fractured zygoma and mandible to their normal anatomical positions and fixed them using titanium plates. No complications such as asymmetry, malunion, malocclusion, or trismus were seen. Unfavorable asymmetric facial contours were corrected, and we obtained good occlusion with favorable bony alignment. The functional and aesthetic outcomes were satisfactory. Through removal the callus and limited osteotomy, a successful approach to the previously fractured line was possible, and an exact correction with symmetry was obtained. This method can be a good option for obtaining good mobility and clinical results in treating delayed facial bone fractures.

• 대한족부족관절학회지
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• 제18권2호
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• pp.68-71
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• 2014

Purpose: The purpose of this study is to report the results of culture test at the time of removal of metal devices used for management of ankle fractures and for analysis of contributing factors. Materials and Methods: We reviewed medical records of 132 patients with lower tibia and ankle fracture who had their metal devices removed during the period from January 2010 to February 2014. Patients with clinical signs of infection were excluded. Culture test was performed by taking the granulation tissue around the metal device at the time of removal. We divided the subjects into two groups, culture positive and negative. We then performed a retrospective review of each medical record of multiple factors that might contribute to the culture results, including laboratory results, medical history, material and size of metal device, indwelling period, and whether or not it was open injury. Results: Among 132 cases, six were culture positive. Enterococcus was detected in two cases and the others were Staphylococcus. No significant difference in medical history of patients and laboratory results, including C-reactive protein level, was observed between the culture positive and negative group. Culture positive rate was 5.4% in titanium and 3.9% in stainless steel. In terms of metal size, culture positive rate was 5.1% in small plates, 6.7% in large plates, and culture negative in intramedullary nails. The average indwelling period of metal device was 61.5 weeks in the culture positive group, and 68.6 weeks in the negative group. Nine cases were open fractures and all were in the culture negative group. Conclusion: Whether or not the culture result was positive, there were no meaningful contributing factors. Presence of bacterium on the metal device could not be screened by any laboratory results or other factors.