• Childhood Kidney Diseases
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• 제17권2호
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• pp.73-78
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• 2013

목적: 마제신은 신장융합(renal fusion)을 가진 가장 흔한 신기형이다. 저자들은 단일병원에서 관찰된 마제신 환자들의 동반 질환을 포함한 임상적 특징을 조사하고자 하였다. 방법: 2000년 1월부터 2012년 12월까지 부산백병원에서 영상의학적 방법에 의해 마제신으로 진단된 환자 43명을 대상 (소아군 14례, 성인군 29례)으로 후향적으로 의무기록을 분석하였다. 또한 소아군과 성인군의 자료를 비교 분석하였다. 결과: 전체 환자의 진단당시의 평균 연령의 중간값은 34세이었고, 성별은 남자 17명 여자 26명 이었다. 소아군(<18세, 14명)의 평균연령은 $6.7{\pm}6.2$세, 남자가 5명이 있었다. 진단 시 혈뇨를 보인 1명을 제외한 대부분 동반 질환의 평가 도중 우연히 발견되었다. 동반된 질환으로는 터너증후군이 5례(36%)로 가장 많았고, 동반된 비뇨기계 기형으로는 2명(14.2%)에서 신우요관협착을 동반하였다. 신기능은 마지막 추적검사까지 모두 정상이었다. 성인군에서 진단된 29명의 진단 당시 연령 중간값은 48세이었고, 남자가 12명 여자 17명이 있었다. 진단 시 다른 질환의 평가 중 18명이 우연히 발견되었으며, 11명은 혈뇨 또는 결석으로 인한 복통 등이 있었다. 동반질환으로는 터너증후군이 5례로 가장 많았으며, 5명에서 신우요관협착이 동반되었고, 그 외 수신증, 과민성 방광 등을 동반하였다. 마지막 추적검사에서 6명(21%)에서 신기능감소(혈청Cr>1.5)가 관찰되었다. 결론: 마제신은 우연히 발견되는 경우가 대부분으로, 동반된 단일 질환으로는 터너증후군이 가장 많았다. 성인기로 이행 후 다양한 비뇨기과적 합병증의 위험이 높으므로 지속적인 추적 관찰이 필요하다.

• 한국의학물리학회지:의학물리
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• 제25권2호
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• pp.89-94
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• 2014

국소 진행성 직장암 환자에서 수술 전 항암방사선동시요법으로 치료시 추가적인 고주파 온열치료 유무가 수술 후 부작용에 미치는 영향을 분석하였다. 1996년부터 2007년 사이, 본원에서 수술 전 항암방사선동시요법과 근치적 수술을 시행한 환자 205명을 대상으로 급, 만성부작용을 분석하였다. 총 방사선치료선량은 39.6 Gy에서 45 Gy였고 1회 내지 2회의 항암약물치료(5-fluorouracil, leucovorin)를 동시에 시행하였다. 88명의 환자가 주 2회, 8-MHz 고주파 온열치료기를 이용한 국소 온열치료를 시행하였다. 외과적 수술은 수술 전 치료 완결 후 4~6주 경과하여 시행하였다. 환자군의 나이 중앙값은 59세(18세~83세)이고 추적관찰기간 중앙값은 61개월(2개월~191개월)이었다. 전체 환자에서 5년 전체생존율과 무합병증 생존율은 77.4%와 73.7%였다. 각각의 조기 누출, 지연 누출, 연결부 협착, 누공, 소장폐쇄의 발생빈도는 1.0%, 2.9%, 1.5%, 5.9%, 그리고 17.1%였다. 온열치료는 모든 종류의 부작용을 증가시키지 않았다. 온열치료를 실시하지 않은 군과 온열치료군 간의 5년 무합병증 생존율은 71.8%와 76.3%였다(p=0.293). 온열치료는 수술전 항암방사선동시요법 후 근치적 수술을 시행하는 국소 진행 직장암 환자의 수술후 부작용을 증가시키지 않는다.

• 한국의료질향상학회지
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• 제3권2호
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• pp.36-51
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• 1997

Background : Clinical practice guidelines define "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" and help to improve patient care. The purpose of this study is to develop a clinical practice guideline for the most effective diagnoses and treatments of benign prostatic hyperplasia based on patient preference and clinical need. Methods : For this research project, extensive literature searches (208 articles) were conducted. As well, critical reviews and syntheses (meta-analysis) were used to evaluate empirical evidence and significant outcomes of the BPH literature. Questionnaires about clinical practice for BPH patients were distributed and consensus meetings were undertaken to grasp variations in clinical practice and to reach agreement on the guideline's development. The guideline was promoted under the sponsorship of the Korean Medical Association and the Korean urological Cancer. Society. For the task, the Benign Prostatic Hyperplasia Guideline Panel was composed of multidisciplinary experts in the field. Results : BPH is a disease that affects a patient's quality of life. This Clinical Practice Guideline was developed for the typical man over age 50 with symptoms of prostatism, but with no significant medical morbidities such as diabetes or other known causes of voiding dysfunction, such as urethral stricture or neurogenic bladder. The guidelines detail the relative benefits and obstacles associated with all diagnostic and treatment approaches, including watchful waiting. Conclusion : This guideline provides a cornerstone for our medical association. It represents the most current scientific knowledge regarding the development, diagnosis, and treatment of BPH. It will be revised and updated as needed.

• 대한수의학회지
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• 제21권2호
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• pp.151-159
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• 1981

An investigation on various causes of milking disturbances resulting from injuries and abnormalities of mammary system were made in 2,179 Holstein cows. To perform this investigation, 69 dairy farms of the suburban area of Seoul city, Gyeonggi-do and Chungnam provinces were andomly selected and subjected. Diagnosis was made by means of inspection and palpation of teat, insertion of teat canula, checking milk machines, anamneses and farm records. This investigation was, actively done from March 1977 to February 1979, The results obtained were summerized as follows; 1. It was found that 446 cows, accounting for 20.48% of 2,179 cows inspected, had supernumerary teats. Among them 53.59% had one, 43.72% had two, 2.47% had three, and 0.22% had four supernumerary teats, respectively. 2. Dry off quarters were found in 158 quarters which turned out to be 1.8% of 8,716 quarters inspected. Among dry off quarters, 62.02% seemed to be caused by mastitis, 30.37% by acquired teat obstructions, and 7.59% by congenital blind teats and glands respectively. 3. Teat sphincter stenosis was found in 154 teats of 50 cows, which represents 1.76% of 8,716 teats and 2.29% of 2,179 cows inspected, respectively. Among 154 teats with teat sphincter stenosis, 138 teats (85.7%) of 33 cows were found to be congenital and revealed highest incidence. 4. Loose sphincter was found in 78 teats of 36 cows, which figure 0.89% of 8,7l6 teats and 1.69% of 2,179 cows inspected, respectively. Among 78 teats with loose sphincter, 52 teats (66.66%) of 13 cows were found to be congenital and revealed highest incidence. 5. Injured teat tip caused by over milking of milk machine, was found in 229 teats of 156 cows, which figure 2.63% of 8,716 teats and 7.15% of 2,179 cows observed, respectively. 6. Other miscellaneous injuries and congenital abnormalities of teats and udders were diagnosed as follows: The teat laceration was found in 34 teats (0.39% of 8,716 teats), fissure of teat skin in 24 teats (0.28% of 8,716 teats), stricture of teat cistern in 21 teats (0.24% of 8,716 teats), teat fistula in 12 teats (0.14% of 8,716 teats), papillomas on testes in 8 teats (0.09% of 8,716 teats). Knothole orifice in 7 teats (0.08% of 8,716 teats), subcutaneous abscess of udder in 5 quarters (0.05% of 8,716 teats), membraneous obstruction of teat cistern in 4 teats (0.05% of 8,716 teats), and congenital short teat in 8 teats (0.09% of 8,716 teats), respectively.

• Advances in pediatric surgery
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• 제1권2호
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• pp.140-148
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• 1995

저자들은 96예의 선천성 식도 폐쇄를 분석하여 다음의 결과를 얻었다. 1) 남녀비는 1.1:1로 비슷하였다. 2) 출생시 평균 체중은 2.8kg 였고 2.5kg 미만의 저출생 체중아가 32.3%를 차지했다. 3) 주증상은 타액 분비 과다, 수유시 호흡 곤란, 청색증 등이었다. 4) Gross 분류법에 의한 해부학적 유형은 Type C가 가장 많은 빈도로 관찰되었다(82.3%). 5) 동반 선천성 기형이 35%에서 관찰되었고 이 중 심장 기형이 가장 많은 빈도로 관찰되었다(60%). 6) 수술은 Type A, C의 경우 일차적 문합을 시행하였고 일차적 문합이 불가능한 원간격 결손 환아에서 역위관 삽입술이 시행되었다. Type E(H-type)의 경우 식도기관루 절제술이, Type F의 경우 식도협착부위 절제 및 단단 문합술이 시행되었다. 7) 수술후 주요 합병증은 문합부 누출, 문합부 협착, 기관 식도루 재발 등이었다. 8) 생존율은 86%였고 Waterston Criteria에 따른 생존율은 Class A, 93%, Class B, 86%, Class, 58%였다. 9) 추적 조사 결과 93%의 환아가 건강했고 7%의 환아가 잦은 호흡기 감염으로 입원한 병력이 있었다.

• Journal of Chest Surgery
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• 제8권2호
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• pp.149-152
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• 1975

In spite of great advances in surgical treatment during past several decades, surgery of the trachea failed to develop correspondingly, partly because of relative rarity of the tracheal lesions and partly because of difficulties in surgical technique and anesthesia. Surgical diseases of the trachea are largely obstructions due to neoplasm or cicatrical stenosis and tracheal malacia. The present treatment of respiratory failure, using cuffed endotracheal and tracheostomy tubes, has produced, apparently with increasing frequency, tracheal stenosis, tracheomalized tracheal erosion. Surgery is presently the only reasonable way to treat stenotic lesions of the tracheobronchial tree. In the case of tumors, the current trend has been that of radical excision. Primary end-to--end reconstruction of the trachea has been generally recognized as the ideal method of repair following resection. However, for decades it was believed that a maximum of four tracheal rings only might be excised and primary healing achieved with safety. A great variety of procedures, developed by numerous investigations and directed at tracheal substitution, have almost invariably met with discouraging results. A meticulous study done by Grillo and associates on autopsy specimens has shown that an average 6.4cm of mediastinal trachea can be safely resected by full mobilization of the right lung and transplantation of the left main bronchus into the bronchus intermedius. Recently, we experienced a case of successful resection of a tumor of the tracheal carina and primary tracheo-left main bronchial anastomosis at the Department of Thoracic & Cardiovascular Surgery, the National Medical Center in Seoul. The patient, a 29-year-old man, was admitted to the hospital with complaints of dyspnea and cough. On admission, chest film showed hydropneumothorax on the right. After closed thoracostomy, hydropneumothorax disappeared, but hazy densities, developed in the right middle and lower lung fields, resisted to treatment. Bronchoscopy uncovered irregular tumor covering the carina and the right main bronchus, and biopsy indicated well differentiated squamous Cell carcinoma. Operation was performed on July 2, 1975. A right postero-lateral thoracotomy was used. Excision involved the lower trachea, the carina, the left main bronchus and the right lung. This was followed by direct anastomosis between the trachea and the left main bronchus. Bronchography was done on 17th postoperative day revealed good result of operation without stricture at the site ofanastomosis. About one month after the operation symptoms and signs of bronchial irritation with dyspnea developed, and these responded to respiratory care. On 82nd postoperative day, sudden dyspnea developed at night and the patient expired several hours later. Autopsy was not done and the cause of death was uncertain.

• Journal of Chest Surgery
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• 제34권11호
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• pp.843-847
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• 2001

배경: 식도질환의 수술 후 식도재건술은 아직도 식도수술에 관여하는 외과의사에게 해결해야 될 부분이 많이 있다. 1996년 1월부터 1999년 12월가지 흉부식도암환자 27명에서 흉부식도절제술 후 15예의 식도-위 문합술과 12예의 유리총장 이식술을 시행하였다. 저자들은 식도암 수술 후 문합부 누출, 문합부위의 협착, 역류성식도염, 수술시간, 호흡기 합병증 등을 양 군을 나누어 비교하였다. 대상 및 방법: 고식적 우회술 또는 식도인공삽입술, 인두식도와 식도 위 결합부위의 암은 본 연구에서 제외하였다. 우측 개흉술로 식도를 절제하였고, 자동봉합기를 사용하여 식도-위 문합을 시행하였다. 유리공장이식술의 경우 근위부의 식도는 6예에서 자동봉합기를 사용하였으며, 6예의 근위부와 12예의 원위부는 수기통합하였다. 모든 식도 재건술은 후종격동을 경유하였다. 결과: 3예의 수술사망을 포함하여 3예의 문합부 누출, 2예의 이식공장괴사 등 중한 합병증과 11예의 역류성 식도염, 5예의 문합부 협착이 발생되었다. 식도-위 문합술의 평균 수술시간은 300$\pm$160분, 유리공장이식술은 550$\pm$280분이었다. 결론: 역류성 식도염은 식도-위 문합군에서 더 많았고, 수술시간은 유리공장이식군에서 더 길었다(p<0.05). 적절한 환자의 선택과 장시간의 수술에 따르는 술 후 합병증을 줄일 수 있다면, 식도재건수술후의 역류식도염을 감소시키는 수술로 유리공장이식술이 우수하다고 판단된다.

• Advances in pediatric surgery
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• 제10권1호
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• pp.1-8
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• 2004

A re-pull-through operation for Hirschsprung's disease is performed when the primary operation has failed because of the remnant or acquired aganglionosis, anastomotic stricture and/or fistula. The purpose of this study is to review our experience of the re-pull-through procedure for Hirschsprung's disease. From May 1978 to July 2003, 26 patients who underwent re-pull-through operations at the Department of Pediatric Surgery, Seoul National University Children's Hospital, were studied retrospectively by means of chart review as well as telephone interview. The mean age at primary operation and re-operation were llmonths (2 months - 10 years) and 43 months (1 year - 23 years 3 months), respectively. Initial operation for Hirschsprung's disease was Duhamel's procedure in 17, Swenson's in 6 and Soave's 3. Causes of failure of primary operation were remains of secondary aganglionic segment (n=23), vascular arcade injury (n= 1), rectoperineal fistula (n=2, due to mesenteric torsion and poor blood supply), Mean interval between the primary operation and the re-operation was 34 months (6 months-22 years). Reoperation methods were Soave's in 12, Duhamel's in 8, APSP (abdomino-posterosagittal pull-through procedure) in 5, and Swenson's in 1 case. In 2 cases of repeated rectoperineal fistula or rectourethral fistula, re-APSP were performed 3 times, respectively. A total of 29 re-pull-through operations were performed. Postoperative complications were wound infection (n=1), adhesive ileus (n=1), rectoperineal fistula (n=3), rectourethral fistula (n=2), and death due to pulmonary embolism (n=1). Mean follow up period of reoperation was 78 months (1 month-23years). In current state, 2 patients have an ileostomy because of repeated rectoperineal fistula and rectourethral fistula. Of the remaining 23 patients, 21(91 %) are totally continent with or without minimal soiling. Reoperation for Hirschsprung's disease was effective and safe for the patients complicated to the initial pull-through operation.

• Radiation Oncology Journal
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• 제6권2호
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• pp.211-226
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• 1988

방사선 단독 치료나 수술후 방사선 치료를 받았던 165명의 식도암 환자 중에서 평균 생존율은 6.6개원이였으며 3,5년 생존율은 $10\%,\;8\%$였다. 생존율을 semilogarithmical하게 나타낸 biphasic plotting에서 보면 non-responder group은 치료에도 불구하고 1년내 모두 사망하였고 responder group중에서는 수술후 방사선 치료를 받았던 환자 20명 $(54\%)$은 1, 2, 3년 생존율이 각각$80\%,\;70\%,\; 60%$였으며, 방사션 치료만 받은 환자 61명$(48\%)$의 생존율은 각각 $62\%,\;38\%,\;23\%$였다. 즉, 3년간의 생존율의 비교는 수술후 방사선 치료가 방사선 단독치료 보다는 좋았다 (P<0.01). 가장 많은 사망의 원인으로는 연하곤란$(55\%)$이였으며 환자의 대다수는 국소적인 치료실패에 의해 사망하였으며 $(62\%)$ 협착의 $88\%$는 지속적인 암의 존재와 관련이 있었다. 환자의 $50\%$는 국소적인 임파절 전이가 발견되었다. 수술전의 진단 실패율은 $54\%$가 국소임파절 전이 때문에, $29.7\%$가 육안적인 임파절 전이 때문에, $13.5\%$가 혈행성 전이 때문에 그리고 $14\%$가 국소적인 직접 침범 때문이였다. Conventional radiation (6000 cGy/30 fraction in 6 weeks)이나 hyperfractionation radiation (upto 6900cGy, l15cGy/fraction)이거나 관계없이 gross disease는 충분히 즉일수 없었다. 그러나 hyperfractionation 테크닉에 의해서 급성 방사선 염증이 감소되어서 환자의 고통을 덜어줄 수 있었으며 그 후의 만성 부작용으로서의 방사선 합병증이 현저히 감소되었다.

• Journal of Chest Surgery
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• 제25권9호
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• pp.948-954
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• 1992

In spite of recent progress in anticancer chemotherapy, the survival of patients with metastases to the lung treated nonsurgically has been extremely poor. So we adopted more aggressive surgical approaches for the treatment of patients with pulmonary metastases since 1985. We experienced 22 operations of metastatic lung cancer in 19 patients in the department of Thoracic & Cardiovascular Surgery in Kosin Medical College since 1985, so we reviewed the results of treatment retrospectively. The results were as follows: 1. The primary organs of metastatic lung cancer were 4 cases in each of the breast, uterus, and extremities, 3 cases in the rectum, 2 cases in the kidney, 1 case in each of the pelvis and liver, and the pathological findings were 13 cases in carcinoma and 6 cases in sarcoma. 2. The treatments for primary lesions were 15 cases of the operations with anticancer chemotherapy or radiation therapy, 2 cases of choriocarcinoma with anticancer chemotherapy only, 1 cases of uterine cervical carcinoma with chemo-radiation therapy, and 1 case of pelvic synovia sarcoma with intra-arterial anticancer chemotherapy. 3. Disease free intrerval were as follows: 7 cases were in 2 years to 4 years, 4 cases were in 1 year to 2 years, and 5 cases were beyond one year, of them one case was discovered primary lesion and metastatic lung tumor concomittently. 3 cases were above 4 years, of them one case of breast cancer were above 13 years especially. 4. The sites of metastatic lung cancer was 15 lesions in the right lung, and 9 lesions in the left lung, And the lobar sites were 10 lesions in the upper lobe, 2 lesions in the middle lobe, and 12 lesions in the lower lobe. 5. The operative methods of metastatic lung cancer were 7 case of partial resection of lung, 12 cases of pulmonary lobectomy, 1 case of pneumonectomy and 1 case of dissection of mediastinal lymph node. 6. The postoperative complications were 1 case of mild respiratory insufficency, 1 cases of pyothorax, and 1 case of urethral stricture. 7. Postoperative adjuvant therapy were as follows: No adjuvant therapy were 4 cases, anti-cancer chemotherapy were 8 cases, radiation therapy was 1 case, and combined with chemo k radiation therapy were 8 cases. 8. The results of long term follow-up were as follows: The 5 patients were died at 2 months, 22 months, 24 months, 32 months, and 49 months postoperatively, so mean survival period was 32 months postoperatively excluding one patient who was died at 2 months postoperatively. And 14 patients are aliving, of them 3 patients are living in recurred state, and the other 11 patients are living without any evidence of recurrence.