• 한국임상수의학회지
• /
• 제37권3호
• /
• pp.157-162
• /
• 2020

A 6-year-old Thoroughbred mare presented to the Korea Racing Authority Equine Hospital with dropping of the left front fetlock due to an injury sustained while racing. Radiographic examination revealed a comminuted fracture of both proximal sesamoid bones of the affected fetlock. Arthrodesis of the fetlock joint using a broad dynamic compression plate with a tension band wire was performed as a salvage procedure for the future use as a broodmare. After surgery, however, a delayed union of the bones and surgical site infection was present for a prolonged period. Staphylococcus aureus was persistently identified from the surgical site, and antimicrobial therapies were based on antibiotic sensitivity tests, including regional perfusions. The removal and replacement of surgical implants associated with seropurulent discharge was based on coordinating the development of fetlock ankylosis and infection control over 13 months. Firstly, seven screws associated with surgical drainage were replaced and bone morphogenetic protein-2 (BMP-2) and local antibiotics were placed into the surgical site to accelerate bone fusion at postoperative month 7. Further six screws, along with drainage, were removed at postoperative month 10. The plate and screws were removed from the limb due to the progression of bone fusion at postoperative month 13; BMP-2 and local antibiotics were also used. Delayed healing of arthrodesis due to surgical site infection and implant instability were treated by implant removals and antibiotic therapies, and the horse eventually showed improved weight-bearing ability of the affected limb.

• 대한골관절종양학회지
• /
• 제2권1호
• /
• pp.38-46
• /
• 1996

The traditional methodology in Ewing's sarcoma was chemotherapy and radiotherapy. Recently surgery is reemerging as an important therapeutic tool and some paper report increased survival with it. The purpose of this nonrandomized study is to evaluate our result of Ewing's sarcoma with surgery, retrospectively. We experienced 30 cases for seven years and among them 6 were extraskeletal. In location, axial was 10 cases and peripheral was 20. By Enneking's classification, state IIB was 26 cases and IIIB was 4. Eighteen patients took operation, chemotherapy and/or radiotherapy, and remaining twelve took chemotherapy and/or radiotherapy only. Type of operation was limb salvage in 16 cases and amputation 2. Average dosage of radiation was 45.1Gy. Six kinds of chemotherapeutic regimen were used, but among them main protocols were Ifosfamide-Adriamycin(17 cases) and IESS(Cytoxan, Adriamycin, Methotrexate, Vincristine:8 cases). Complications were as follows. In operation group, there were 3 local recurrence and one case of nonunion. In nonoperated group, one local recurrence and one pancytopenia resulting in death. Average follow up was 29.7 months. Kaplan-Meier's ten year actuarial survival rate for the whole 30 cases was 26.8%. Significant difference in survival exists between central and peripheral lesions(p=0.05, by log rank test). Types of chemotherapy and surgery itself showed no significance. But surgery is important in function and local control. More intensive chemotherapeutic regimen to prevent distant metastasis and combined surgery and radiotherapy may be needed in Ewing's sarcoma.

• 대한골관절종양학회지
• /
• 제14권1호
• /
• pp.10-16
• /
• 2008

효과적인 항암 약물요법의 발달과 사지의 절단술에 따르는 기능적인 경제적인 비효율성은 뼈의 원발성 암 환자에서 사지 구제술의 발달을 가져 왔다. 소아에서의 사지 구제술은 종양의 광범위 절제 시 성장판이 같이 절제되어 건측과의 사지 길이 차이가 발생하게 될 수 있고 소아 환자들의 왕성한 활동성 때문에 견고하고 내구성 있는 재건술이 필요하다. 소아 환자에서 악성 골종양의 절제 후 성장한 만큼 대치물의 길이도 같이 늘일 수 있는 확장형 종양 대치물(expandable tumor prosthesis)을 이용한 재건술이 시행되어 왔으나 모든 환자에서 만족스러운 결과를 가져오진 못하였다. 최근 들어 확장형 종양 대치물의 발달로 합병증의 발생을 줄이면서 비침습적인 방법으로 사지 길이를 맞추고 종양 대치물의 수명을 길게 하는 시도들이 늘고 있다. 본 논문에서는 확장형 종양 대치물의 적응증, 특성 및 합병증 등에 대해서 짚어 보고자 한다.

• Archives of Plastic Surgery
• /
• 제39권5호
• /
• pp.546-550
• /
• 2012

Background This study was designed to introduce the feasibility of toe tissue transfer without venous outflow for fingertip reconstruction. Methods Five cases of fingertip defects were treated successfully with this method. Four cases were traumatic fingertip defects, and one case was a hook-nail deformity. The lateral pulp of a great toe or medioinferior portion of a second toe was used as the donor site. An arterial pedicle was dissected only within the digit and anastomosis was performed within 2 cm around the defect margin. The digital nerve was repaired simultaneously. No additional dissection of the dorsal or volar pulp vein was performed in either the donor or recipient sites. Other surgical procedures were performed following conventional techniques. Postoperative venous congestion was monitored with pulp temperature, color, and degree of tissue oxygen saturation. Venous congestion was decompressed with a needle-puncture method intermittently, but did not require continuous external bleeding for salvage. Results Venous congestion was observed in all the flaps, but improved within 3 or 4 days postoperatively. The flap size was from $1.5{\times}1.5cm^2$ to $2.0{\times}3.0cm^2$. The mean surgical time was 2 hours and 20 minutes. A needle puncture was carried out every 2 hours during the first postoperative day, and then every 4 hours thereafter. The amount of blood loss during each puncture procedure was less than 0.2 mL. In the long-term follow-up, no flap atrophy was observed. Conclusions When used properly, the free toe tissue transfer without venous anastomosis method can be a treatment option for small defects on the fingertip area.

• 한국임상수의학회지
• /
• 제32권1호
• /
• pp.108-111
• /
• 2015

7개월령 수컷 말티즈견이 1.5개월 동안 오른쪽 눈의 녹내장으로 치료를 받던 중에 내원하였다. 안검사에서 우안, 각막 천공, 홍채 탈출, 각막부종 및 혈관화가 관찰되었다. 안압은 오른쪽 눈이 33 mmHg, 왼쪽 눈이 19 mmHg이었다. 오른쪽 눈은 만성 녹내장, 각막 천공 및 홍채 탈출로 진단되었다. 그 눈은 실명하였으며 안구를 보존하기 위해 안내 보철물 삽입과 결막 플랩을 함께 적용하기로 하였다. 수술 후에 결막 플랩은 각막 천공 부위를 막고 안내 보철물을 적절하게 유지하였다. 수술 15개월 후에도 아무런 합병증 없었으며 보호자는 매우 만족하였다. 그러므로 안내 보철물과 결막 플랩의 병용 적용은 각막 천공으로 인한 녹내장의 치료에 이용될 수 있을 것이다.

• 대한골관절종양학회지
• /
• 제3권1호
• /
• pp.1-8
• /
• 1997

Osteosarcoma is the most common primary bony malignancy and its survivorship has been progressed markedly through refined chemotherapy and surgery. But still there are many non-responders and analysis of prognostic factors may be helpful for them. Two hundred and sixty-six patients were enlisted between Mar, 1985 and Sep. 1994. Among them our inclusion criteria were: 1)primary, nonmetastatic classical osteosarcoma 2)extremity in location 3)no prior treatment at other institute and completed neoadjuvant chemotherapy and surgery according to our protocol. One hundred and eleven cases were eligible. Analyzed factors were:age, sex, location, tumor size, and pathologic response. Statistical methods were log-rank test for univariate and Cox's test for multivariate analysis. Male to female ratio was 69:42 with an average age of 17.2 years. Locations of tumor were distal femur 59, proximal tibia 29, and proximal humerus 8. Tumor size were measured by its maximal diameter and 48 cases were above 10cm and 47 cases were below 10cm. For pathologic response, 57 cases showed more than 90% and 54 cases were less than that. Limb salvage procedure was 101 cases and amputation was 10 cases and their local recurrence rate were 3.6%. Average follow-up period was 24(9-78.2) months and their final status was CDF 86, AWD 8, NED 5, and DOD 12 cases. In univariate study: type of operation(p=0.005), tumor size(p=0.005), and pathologic response(p=0.02) were significant variables. Pathologic response(p=0.03) and type of operation(p=0.01) were meaningful prognostic factors on multivariate analysis. But the latter result was interpreted as a bias, so pathologic response remained as a sole meaningful prognostic factor. More aggressive chemotherapy will be needed to improve the survival.

• 대한두개안면성형외과학회지
• /
• 제21권5호
• /
• pp.309-314
• /
• 2020

Reconstructions of extensive composite scalp and cranial defects are challenging due to high incidence of postoperative infection and reconstruction failure. In such cases, cranial reconstruction and vascularized soft tissue coverage are required. However, optimal reconstruction timing and material for cranioplasty are not yet determined. Herein, we present a large skull defect with a chronically infected wound that was not improved by repeated debridement and antibiotic treatment for 3 months. It was successfully treated with anterolateral thigh (ALT) free flap transfer for wound salvage and delayed cranioplasty with a patient-specific polyetheretherketone implant. To reduce infection risk, we performed the cranioplasty 1 year after the infection had resolved. In the meantime, depression of ALT flap at the skull defect site was observed, and the midline shift to the contralateral side was reported in a brain computed tomography (CT) scan, but no evidence of neurologic deterioration was found. After the surgery, sufficient cerebral expansion without noticeable dead-space was confirmed in a follow-up CT scan, and there was no complication over the 1-year follow-up period.

• Journal of Korean Neurosurgical Society
• /
• 제50권1호
• /
• pp.1-5
• /
• 2011

Objective : There is no proven regimen to reduce the severity of stroke in patients with acute cerebral infarction presenting beyond the thrombolytic time window. Ozagrel sodium, a selective thromboxane A2 synthetase inhibitor, has been known to suppress the development of infarction. The antiplatelet effect is improved when aspirin is used together with a thromboxane synthetase inhibitor. Methods : Patients with non-cardiogenic acute ischemic stroke who were not eligible for thrombolysis were randomly assigned to two groups; one group received ozagrel sodium plus 100 mg of aspirin (group 1, n=43) and the other 100 mg of aspirin alone (group 2, n=43). Demographic data, cardiovascular risk factors, initial stroke severity [National Institute of Health Stroke Scale (NIHSS) and motor strength scale] and stroke subtypes were analyzed in each group. Clinical outcomes were analyzed by NIHSS and motor strength scale at 14 days after the onset of stroke. Results : There were no significant differences in the mean age, gender proportion, the prevalence of cardiovascular risk factors, stroke subtypes, and baseline neurological severity between the two groups. However, the clinical outcome for group 1 was much better at 14 days after the onset of stroke compared to group 2 (NIHSS score, p=0.007, Motor strength scale score, p<0.001). There was one case of hemorrhagic transformation in group 1, but there was no statistically significant difference in bleeding tendency between two groups. Conclusion : In this preliminary study, thromboxane A2 synthetase inhibitor plus a low dose of aspirin seems to be safe and has a favorable outcome compared to aspirin alone in patients with acute ischemic stroke who presented beyond the thrombolytic time window.

• Archives of Plastic Surgery
• /
• 제40권3호
• /
• pp.251-255
• /
• 2013

We present a case of a 57-year-old male patient who presented with squamous cell carcinoma on his mouth floor with cervical and mandibular metastases. Wide glossectomy with intergonial mandibular ostectomy, and sequential reconstruction using fibular osteomyocutaneous free flap were planned. When the anastomosis between the peroneal artery of the fibular free flap and the right lingual artery was performed, no venous flow was observed at the vena comitans. Then re-anastomosis followed by topical application of papaverine and lidocaine was attempted. However, the blood supply was not recovered. Warm saline irrigation over 30 minutes was also useless. Microvascular thromboses of donor vessels were clinically suspected, so a solution of 100,000 units of urokinase was infused once through a 26-gauge angiocatheter inserted into the recipient artery just at the arterial anastomotic site, until the solution gushed out through the flap vena comitans. Immediately after the application of urokinase, arterial flow and venous return were restored. There were no complications during the follow-up period of 11 months. We believe that vibrating injuries from the reciprocating saw during osteotomies and flap insetting might be the cause of microvascular thromboses. The use of urokinase may provide a viable option for the treatment of suspicious intraoperative arterial thrombosis.

• Tuberculosis and Respiratory Diseases
• /
• 제63권6호
• /
• pp.526-530
• /
• 2007

중증급성호흡곤란증후군으로 전원 된 41세 여자환자를 기존의 기계환기 방법으로 치료했으나 저산소증이 호전되지 않아 내원 후 3시간 내에 신속한 체외생명보조를 시행하여 성공적으로 치료한 예를 경험하여 문헌고찰과 함께 보고하는 바이다.