• Clinical and Experimental Pediatrics
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• 제52권2호
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• pp.256-260
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• 2009

특발성 폐 혈철 침착증은 반복되는 객혈, 흉부 X-선상 양측성 폐침윤, 철분 결핍성 빈혈을 특징으로 하는 질환으로 주로 소아에서 발생한다. 매우 드문 질환으로 국내에서는 현재까지 6편의 증례가 보고되었다. 유전, 자가면역, 알레르기, 환경, 대사 등과 관련된 병인에 제시되었으나 아직까지 확실히 밝혀지지 않았다. 본 환자는 9세 여아로 2년간 매 봄, 가을에 객혈, 호흡곤란을 주소로 4차례 입원하였다. 청진 시 양폐야에서 나음이 들렸고 흉부 X-선 검사 및 CT에서 양측성 폐포성 침윤이 확인되었으며 혈액 검사에서 철분 결핍성 빈혈이 관찰되었다. Anti-GBM Ab, ANCA, FANA, RF, cow's milk protein에 대한 IgE 등의 항체 검사는 모두 음성이었고 응고 검사, 면역글로불린, 보체는 모두 정상이었다. 세균에 대한 객담과 혈액 배양 및 결핵에 대한 피부반응검사, 객담 도말 및 배양 검사는 모두 음성이었다. 폐생검에서 폐포내 출혈과 혈철소 함유 대식 세포(hemosiderin-laden macrophage) 및 간질의 섬유화 소견을 보여 폐 혈철 침착증을 확진 하였다. 매 악화 시마다 경구용 스테로이드 투여 후 임상 양상이 호전되어 퇴원하였다. 현재 외래에서 유지요법으로 스테로이드 복용 중이며 17개월간 재발 없는 상태이다. 저자들은 이전에 국내에서 보고되었던 환자들과는 달리 학동기에 처음 발병하여 매년 봄과 가을에 뚜렷한 원인 없이 재발하는 양상을 보인 특발성 폐 혈철 침착증 1예를 보고하는 바이다.

• 한국임상수의학회지
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• 제31권4호
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• pp.303-306
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• 2014

본 증례는 호흡곤란, 기침과 식욕결핍으로 내원한 세 마리의 요크셔테리어 개 (12년령, 13년령, 15년령)를 대상으로 하였다. 실험실적 검사 상 특이소견은 없었다. 그러나 흉부 방사선 검사상 세 마리에서 모두 심저부위의 종괴를 확인할 수 있었고, 기관지의 상승과 대동맥 융기를 확인할 수 있었다. 복부 방사선 검사 시 특이 소견은 관찰할 수 없었다. 초음파 검사상 균질한 고 에코의 종괴가 대동맥 주위에서 확인되었고 이첨판 역류를 확인할 수 있었다. 복부초음파 검사 상 특이소견은 관찰할 수 없었다. 컴퓨터 단층 촬영 결과 경계가 명확한 종괴를 좌측 앞대정맥에서 확인할 수 있었다. 종괴의 크기는 대략 $3{\times}4cm$였고 조영 증강을 확인할 수 있었다. 이상의 검사를 바탕으로 심저부 종양으로 진단하였다. 치료를 위해 심부전과 기관 허탈에 대한 대증 처치를 실시하였다. 진단 후 증례 1 (12년령)은 3 개월, 증례 2 (13년령)는 5개월, 증례 3 (15년령)은 32개월동안 생존하였다. 본 증례는 심저부 종양으로 의심되는 개에서의 임상증상, 흉부 방사선 검사, 컴퓨터 단층 촬영과 대증 처치에 대한 보고이다.

• Journal of Chest Surgery
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• 제29권3호
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• pp.285-291
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• 1996

1973년 3월부터 1994년 12월까지 수술을 시행한 영아 및 소아 연령의 대동맥 교약증 157례를분석하 였다. 남아가 93명 여아가 64명 이 었고 연령은 1개 월부터 15세까지로 평균 23.8 $\pm$ 41.6개월이 었다. 영아 기의 주증상은 심부전이 었고(781113) 그 이상의 연령 에서 무증상이 빈번하였다(15/44). 단독 대동맥 교약증은 31례의 환아에서 있었고, 9례의 환아에서 심방중격결손이 있었으며(I군), 73명 의 환아에서 심실중격결손이 동반됐고(ll군), 44명의 환아에서 복잡 심기형이 있었다(III군).대동맥궁 의 형 성 부전은 17례의 환아에서 발견되었다. 수술은 71례의 환아에서 쇄골하동맥 편 성형술이 시행됐고, 단순 단단문합술이 32례, 조직편 대동맥 성형술이 26례, 확장 단단문합술이 27례, 기타 1례가 있었다, 전체 수술사망률은 17.2% (27/157)이었고, 재 협착률은 18.0% (28/157)이 었다. 수술합병증은 영아기에 서는 호흡기질환이, 그 이상의 연령 에서는 고혈압이 가장 많았다.

• Radiation Oncology Journal
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• 제33권1호
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• pp.12-20
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• 2015

Purpose: To evaluate treatment outcomes and determine prognostic factors in patients with esophageal cancer treated with esophagectomy after neoadjuvant chemoradiotherapy (NCRT) Materials and Methods: We retrospectively evaluated 39 patients with esophageal cancer who underwent concurrent chemoradiotherapy followed by esophagectomy between 2002 and 2012. Initial clinical stages of patients were stage IB in 1 patient (2.6%), stage II in 5 patients (12.9%), and stage III in 33 patients (84.6%). Results: The median age of all the patients was 62 years, and the median follow-up period was 17 months. The 3-year overall survival (OS) rate was 33.6% in all the patients. The 3-year locoregional recurrence-free survival (LRFS) rate was 33.7%. In multivariate analysis with covariates of age, the Eastern Cooperative Oncology Group performance status, hypertension, diabetes mellitus, tumor length, clinical response, clinical stage, pathological response, pathological stage, lymphovascular invasion, surgical type, and radiotherapy to surgery interval, only pathological stage was an independent significant prognostic factor affecting both OS and LRFS. The complications in postoperative day 90 were pneumonia in 9 patients, anastomotic site leakage in 3 patients, and anastomotic site stricture in 2 patients. Postoperative 30-day mortality rate was 10.3% (4/39); the cause of death among these 4 patients was respiratory failure in 3 patients and myocardial infarction in one patient. Conclusion: Only pathological stage was an independent prognostic factor for both OS and LRFS in patients with esophageal cancer treated with esophagectomy after NCRT. We could confirm the significant role of NCRT in downstaging the initial tumor bulk and thus resulting in better survival of patients who gained earlier pathological stage after NCRT.

• Archives of Reconstructive Microsurgery
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• 제9권1호
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• pp.1-5
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• 2000

The microsurgical reconstruction is necessary for elderly patients to treat severe trauma and head and neck tumor. The aim of this study is to analyze the risks of microvascular surgery and whether or not happening of more complication in elderly patients who are older than 60 years old and to suggest the solution of the complication. The retrospective study included 41 elderly patients who underwent treatment of 44 microsurgical reconstructions among total 271 cases of microsurgical reconstruction from July, 1988 to December, 1998. Their ages ranged from 61 years to 79 years. There were 26 males and 15 females. The involved sites were 23 head and necks, 13 upper gastrointestinal tracts, 3 lower extremities, 1 chest and 1 sacral region. The causes of microsurgical reconstruction were 36 head and neck tumors, 2 radionecrosis, 2 traumas and 1 melanoma in lower limb. The used flaps were 14 radial forearm flaps, 13 jejunal flaps, 10 latissimus dorsi muscle flaps, 3 rectus abdominis muscle flaps, 2 lateral arm flaps, 1 scapular flap, and 1 iliac osteocutaneous flap. They had medical problems which were 29 tobacco abuse, 14 hypertensions, 13 alcohol abuse, 10 chronic obstructive pulmonary diseases, 7 diabetes mellituses, 3 ischemic heart diseases. All patients have had successful results without specific complications except 3 cases of free flap failure and 3 perioperative death. The causes of 3 flap failures were 2 flap necrosis due to arterial insufficiency and 1 flap loss due to secondary infection. All of these cases were treated with secondary free flap surgery. However 3 patients died perioperatively due to 2 respiratory arrests and 1 sepsis. It was not related to operate microsurgical reconstruction itself, but was correlated with the complication of postoperative care after head and neck surgery. We conclude that plastic surgeons consider the importance of prevention of expected complication as thorough analysis of operative risk factor and appropriate treatment. We had to select the donor and recipient vessel appropriately to perform successful microsurgery in elderly patients and consider vein graft and end-to-side anastomosis to reduce complication if necessary. In addition, we emphasize the importance of pre, peri and postoperative care in head and neck cancer patients to reduce postoperative complication and morbidity.

• Archives of Plastic Surgery
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• 제33권3호
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• pp.289-293
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• 2006

By means of microsurgical free-tissue transfer providing a large amount of required tissue, the surgeon can resect tumoral tissue more safely, which allows tumor-free margins and enhances the reliability of the ablative surgery that otherwise could not be performed radically. The morbidity of elective free-tissue transfer seems to be quite low, carrying acceptable risks for most patients. But the elderly patients are at risk for cardiac and respiratory problems, deep vein thrombosis, pulmonary emboli and infection merely as a function of age. This study was undertaken to define further risks of the elderly population with regards to free-tissue transfer. We retrospectively reviewed our experience with 110 microsurgical free-tissue transfers for head and neck reconstruction in patients greater than 60 years of age. Microsurgical procedures in all cases were preformed by the plastic and reconstructive department at Yonsei medical center. The investigated parameters were patient demographics, past medical history, American Society of Anesthesiologists(ASA) status, site and cause of defect, the free tissue transferred and postoperative complication including free-flap success or failure. There were 46 patients in the age group from 60 to 64 years, 34 patients from 65 to 70 years, and 30 patients 70 years or older. There happened 3 flap losses, resulting in a flap viability rate of 97%. Patients with a higher ASA designation experienced more medical complication(p=0.05, 0.01, 0.03 in each age group I, II, III) but not surgical complication p=0.17, 0.11, 0.54 in each age group I, II, III). And the relationship between postoperative complication and age groups was not significant. These observations suggest that major determinant for postoperative medical complication be the patient's American Society of Anesthesiologists score, and chronologic age alone should not be an exclusion criterion when selecting patients for free-tissue transfer

• Journal of Chest Surgery
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• 제31권7호
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• pp.692-696
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• 1998

원인 질환이 동반된 속발성 자연기흉에 대한 개흉술은 수술 전후로 높은 위험율을 동반하나, 비디오 흉강경은 최소의 침습적 수술방법으로 치료 효과를 기대할 수 있다. 저자들은 비디오 흉강경술을 이용한 속발성 자연기흉에 대한 36 예(남 33 예, 여 3 예)의 환자에서 임상적 결과로서 유용성을 알고자 하였다. 대상의 평균 나이는 56.3세(범위, 31∼80세)였으며, 21 예에서 폐기종, 20 예에서 폐결핵을 동반하였다. 술전 폐기능 검사상 FEV1은 예상치의 59.3%, FVC는 예상치의 64.0%를 보였다. 19 예의 환자에서 술전 3일 이상의 지속적 공기유출을 보였고, 15 예의 환자에서는 한 번 이상의 재발 기왕력을 보였다. 36 예의 전 환자에서 기계적 흉막유착술을 시행하였으며 33예의 환자에서는 폐기포절제술(bullectomy) 및 폐기포배제술(bullous exclusion technique)을 시행하였다. 평균 수술시간은 97분이었다. 7 예에서 심한 유착을 보였으며, 10 예의 환자에서 폐상엽에 경미한 흉막유착을 보였다. 술후 지속적인 공기유출로 개흉술이 필요한 경우는 없었으나 1 예에서 술후 지속된 공기유출과 호흡부전으로 인하여 사망하였다. 술후 평균 입원기간은 7일(범위, 2∼17일)이었다. 술후 평균 15.8개월(범위, 5∼45개월)의 추적기간동안 기흉의 재발은 없었다. 저자들이 시행한 112 예의 원발성 자연기흉에 대한 비디오 흉강경술에 비하여 수술시간 및 치료 실패율에 있어서 통계적 유의한 차이를 보이지 않았으나 술후 흉강삽관기간 및 입원기간은 더 길었다. 개흉술을 시행하기에 위험한 비교적 고령의 속발성 자연기흉의 환자에서 비디오 흉강경술은 효과적이고 비교적 안전한 수술방법이라 사료된다.

• Journal of Chest Surgery
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• 제48권4호
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• pp.258-264
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• 2015

Background: This study aimed to evaluate the therapeutic results and safety of pectoralis major muscle turnover flaps in the treatment of mediastinitis after coronary artery bypass grafting (CABG) procedures. Methods: Data regarding 33 patients with post-CABG deep sternal wound infections (DSWIs) who underwent pectoralis major muscle turnover flap procedures in the Emam Reza and Ghaem Hospitals of Mashhad, Iran were reviewed in this study. For each patient, age, sex, hospital stay duration, remission, recurrence, and associated morbidity and mortality were evaluated. Results: Of the 2,447 CABG procedures that were carried out during the time period encompassed by our study, DSWIs occurred in 61 patients (2.5%). Of these 61 patients, 33 patients (nine females [27.3%] and 24 males [72.7%]) with an average age of $63{\pm}4.54$ years underwent pectoralis major muscle turnover flap placement. Symptoms of infection mainly occurred within the first 10 days after surgery (mean, $10.24{\pm}13.62days$). The most common risk factor for DSWIs was obesity (n=16, 48.4%) followed by diabetes mellitus (n=13, 39.4%). Bilateral and unilateral pectoralis major muscle turnover flaps were performed in 20 patients (60.6%) and 13 patients (39.4%), respectively. Complete remission was achieved in 25 patients (75.7%), with no recurrence in the follow-up period. Four patients (12.1%) needed reoperation. The mean hospitalization time was $11.69{\pm}6.516days$. Four patients (12.1%) died during the course of the study: three due to the postoperative complication of respiratory failure and one due to pulmonary thromboembolism. Conclusion: Pectoralis major muscle turnover flaps are an optimal technique in the treatment of post-CABG mediastinitis. In addition to leading to favorable therapeutic results, this flap is associated with minimal morbidity and mortality, as well as a short hospitalization time.

• Clinical and Experimental Pediatrics
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• 제59권sup1호
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• pp.25-28
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• 2016

Phelan-McDermid syndrome is a rare genetic disorder caused by the terminal or interstitial deletion of the chromosome 22q13.3. Patients with this syndrome usually have global developmental delay, hypotonia, and speech delays. Several putative genes such as the SHANK3, RAB, RABL2B, and IB2 are responsible for the neurological features. This study describes the clinical features and outcomes of Korean patients with Phelan-McDermid syndrome. Two patients showing global developmental delay, hypotonia, and speech delay were diagnosed with Phelan-McDermid syndrome via chromosome analysis, fluorescent in situ hybridization, and multiplex ligation-dependent probe amplification analysis. Brain magnetic resonance imaging of Patients 1 and 2 showed delayed myelination and severe communicating hydrocephalus, respectively. Electroencephalography in patient 2 showed high amplitude spike discharges from the left frontotemporoparietal area, but neither patient developed seizures. Kidney ultrasonography of both the patients revealed multicystic kidney disease and pelviectasis, respectively. Patient 2 experienced recurrent respiratory infections, and chest computed tomography findings demonstrated laryngotracheomalacia and bronchial narrowing. He subsequently died because of heart failure after a ventriculoperitoneal shunt operation at 5 months of age. Patient 1, who is currently 20 months old, has been undergoing rehabilitation therapy. However, global developmental delay was noted, as determines using the Korean Infant and Child Development test, the Denver developmental test, and the Bayley developmental test. This report describes the clinical features, outcomes, and molecular genetic characteristics of two Korean patients with Phelan-McDermid syndrome.

• Journal of Trauma and Injury
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• 제22권2호
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• pp.218-226
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• 2009

Purpose: In multiple blunt trauma patients, transfusion may be a significant therapeutic adjunct to non-operative management. The blood products must be expedited and efficiently to patients in impending shock caused by hemorrhage or traumatic coagulopathy, but the decision to perform blood transfusion has been made empirically, based on the clinician' and has not been guided by objective parameters, but own opinion, that may result in an underestimate of or a failure to detect bleeding, in delayed transfusion, and in a reduced outcome. This article presents quickly assessable predictive factors for determining if a blood transfusion is required to improve outcomes in multiple blunt trauma patients admitted to the emergency room. Methods: In a retrospective review of 282 multiple blunt trauma patients who visited our emergency center by emergency rescuer during a 1-year period, possible factors predictive of the need for a blood transfusion were subjected to univariate and multivariate logistic regression analysis. Results: Of blunt trauma patients, 9.2% (26/282), received red blood cells in the first 24 hours of care. Univariate analysis revealed significant associations between blood transfused and heart rate (HR) > 100 beats/min, respiratory rate (RR) > 20 breaths/min, Glasgow Coma Scale (GCS) < 14, Revised Trauma Score (RTS) < 11, white blood cell count (WBC) < 4000 or > 10000, and initial abnormal portable trauma series (Cspine lateral, chest AP, pelvis AP). A multiple regression analysis, with a correction for diagnosis, identified HR > 100 beats/min (EXP 3.2), GCS < 14 (EXP 4.1), and abnormal trauma series (EXP 2.9), as independent predictors. Conclusion: In our study, systolic blood pressure (SBP) < 90 mmHg, old age > 65 years, hemoglobin < 13g/dL, mechanism of injury were poor predictors of early blood transfusion. Initial abnormal portable trauma series, HR > 100 beats/min, and GCS < 14 were quickly assessable useful factors for predicting a need for early blood transfusion in blunt trauma patients visiting the emergency room.