• 대한핵의학회지
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• 제25권2호
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• pp.192-199
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• 1991

Peripheral arterial disease, because of it's significant and prolonged morbidity and related mortality is a major medical and surgical problem. Contrast angiogram remains the essential standard for the anatomic demonstration of disease. It does not, however, provide data suitable for quantification or any evaluation of the microcirculation. For these reasons, radionuclide studies are playing an increasingly important role by not only confirming the diagnosis and offering objective data on the physiologic significance of anatomic lesions, but by offering prognosis of healing and prediction of therapeutic results. In addition, radionuclide procedures offer means to safely and repeatedly monitor response to therapy and long term follow up. The object of this study was to evaluate the clinical availability of $^{201}T1$ perfusion scan in patients with peripheral arterial diseases. We performed $^{201}T1$ perfusion scans in patients with five Buerger' s disease (10 legs), six DM gangrenes (12 legs) and classified three perfusion pattern groups. Finally we compared treatment modalities among each groups and compaired T1-201 perfusion scan findings with angiographic findings in six patients with Buerger's disease. The results were as follows: 1) Seven legs showed increased perfusion in stress image and normal or increased perfusion in resting image (type 1). Six legs showed decreased perfusion in stress image and improved in resting image (type II). Of total 13 legs, only 1 leg needed to amputation. 2) Three legs showed decreased perfusion in stress and resting image (type III), and subsequently all cases were received surgical amputation. 3) In six Buerger's disease patients, there were disagreements in two patients (2 legs) between $^{201}T1$ scan and angiography, in which angiograms were normal but $^{201}T1$ scans showed 'type II' perfusion patterns.

• Clinics in Shoulder and Elbow
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• 제13권1호
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• pp.99-105
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• 2010

목적: 흉쇄관절에는 드물게 발생하는 화농성 관절염과 결핵성 관절염에서 조기에 흉쇄 관절의 완전한 절제와 철저한 변연 절제술을 시행하여 그 치료 결과를 보고하고자 한다. 대상 및 방법: 2003년 9월에서 2008년 9월까지 본원에서 흉쇄관절에서 발생한 2예의 화농성 관절염과 1예의 결핵성 관절염에 대하여 수술적 치료를 시행한 환자들 세 예를 대상으로 진단 및 그 임상적 결과를 평가하였다. 결과: 1년 이상 추시한 단순 방사선 소견 및 혈액 검사상 염증의 소견은 호전되었으며, MRI소견상 원위 쇄골단과 흉골에 골부종과 함께 흉쇄 관절에 경도의 활액막염이나 액체 저류 소견 등이 관찰되었으나, 임상 증상은 호전되었으며 1년 이상 추시하여 더 이상의 재발 없이 좋은 결과를 얻을 수 있었다. 결론: 흉쇄관절에서 화농성 관절염과 결핵성 관절염은 드물게 발생하는 질환으로, 진단 시 이미 흉쇄관절 주위의 골로 파급되어 골수염의 소견이 관찰되므로 조기에 흉쇄 관절의 골수염에 대한 완전한 변연 절제술과 철저한 소파술을 조기에 시행하여 만족스러운 결과를 얻을 수 있을 것으로 보인다.

• Journal of Chest Surgery
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• 제29권10호
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• pp.1123-1128
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• 1996

고려대학교 흉부외과학 교실에서는 최근 5년간(1989년 1월∼1994년 7월) 외과적 치료를 시행했던 152례의 식도환자를 대상으로 악성 종양, 양성 종양, 운동성 장애 질환(식도 게실 및 무이완증), 협착, 천공 및 선천성 질환으로 분류 임상분석을 시도하였다. 가장 많았던 질환은 악성종양이며 총 73례로, 전체환자의 48%를 차지하였다. 이중 71%인 52례의 경우에서 식도의 절제 및 재건술을 시도하였고, 나머지 경우에 있어서 위루 성형술, 공장루 성형술 및 식 도관 삽입을 시행하였다. 남녀 비는 남:여 65.8이 었으며, 평균나이는 58.7세였다 이중 합병증으로 인한 병원내 사망례는 5례로 7.8%이며, 합병증으로는 문합부 누출이 가장 많았다. 양성종양은 모두 평활근종으로 6례 (3.9%)였으며, 이중 1례의 경우 흉강경을 이용한 적출술을 시행하였다. 운동성 질환중 식도무이완증(Achalasia)이로(4.6%), 변형된 Hello이 근절개술을 시행하였고, 3례는 Belsey Mark IV 수술을 동반하였다. 게실은 11례 (7.2%)였다 식도협착은 20례 (14.1%)로 대부분이 부식제 섭취에 의한 협착이었으며, 이중 17례에서 위나 대장을 이용한 재 건술을 시행하였다. 식도천공은 20례 (14.1%)였으며 이중 내시경등에 의한 외부손상례가 가장 많았고(15례), 수술방법으로는 천공부위의 일차봉합이 가장 많았고(8례), 6례의 경우 격리 우회술을 시행하였으며, 이중 사망례는 없었다 선천성질환이 6례 (3.9%)였고,나머지 기관-식도루등의 기타질환이 9례(5.9%)였다.

• Journal of Gastric Cancer
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• 제12권1호
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• pp.26-35
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• 2012

Purpose: Emergency operations for perforated peptic ulcer are associated with a high incidence of postoperative complications. While several studies have investigated the impact of perioperative risk factors and underlying diseases on the postoperative morbidity after abdominal surgery, only a few have analyzed their role in perforated peptic ulcer disease. The purpose of this study was to determine any possible associations between postoperative morbidity and comorbid disease or perioperative risk factors in perforated peptic ulcer. Materials and Methods: In total, 142 consecutive patients, who underwent surgery for perforated peptic ulcer, at a single institution, between January 2005 and October 2010 were included in this study. The clinical data concerning the patient characteristics, operative methods, and complications were collected retrospectively. Results: The postoperative morbidity rate associated with perforated peptic ulcer operations was 36.6% (52/142). Univariate analysis revealed that a long operating time, the open surgical method, age (${\geq}60$), sex (female), high American Society of Anesthesiologists (ASA) score and presence of preoperative shock were significant perioperative risk factors for postoperative morbidity. Significant comorbid risk factors included hypertension, diabetes mellitus and pulmonary disease. Multivariate analysis revealed a long operating time, the open surgical method, high ASA score and the presence of preoperative shock were all independent risk factors for the postoperative morbidity in perforated peptic ulcer. Conclusions: A high ASA score, preoperative shock, open surgery and long operating time of more than 150 minutes are high risk factors for morbidity. However, there is no association between postoperative morbidity and comorbid disease in patients with a perforated peptic ulcer.

• 대한소아치과학회지
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• 제35권1호
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• pp.136-143
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• 2008

소아의 구강 악안면 부위의 감염은 부비동, 근막간극, 타액선, 악골, 치아 등의 다양한 해부학적 구조물과 연관되어 발생하며 적절히 치료되지 않는다면 짧은 시간 내에 치명적인 상태로 진행될 수 있어 조기 진단 및 치료가 요구된다. 원인은 다양하지만 대부분이 치성 원인으로서, 괴사된 치수로 인한 치근단 병소, 화농성 치주질환, 치관주위 감염 등으로부터 유래된다. 소아의 치성 감염은 치아우식증이 원인인 경우가 대부분이며 병원성 균이 치수를 통해 인접 조직으로 확산되어 치근단 감염 및 농양, 봉와직염, 골수염, Ludwig's angina, toxic shock syndrome 등의 질환을 유발한다고 알려져 있다. 근막간극이란 느슨한 결체조직으로 채워진 근층 사이에 존재하는 잠재적인 공간으로 일반적인 근막간극 농양의 진행과정은 괴사 치수 염증이 치조 농양 형태로 치근 주위로 퍼지고 점차 근막을 침투해 피질골을 통해 잠재적 간극을 이환시킨다. 구강 악안면 부위의 감염이 연조직으로 침투할 경우, 결체조직을 통하여 그리고 근막간극을 따라 가장 조직 저항이 적은 방향으로 확산된다. 이러한 감염은 치아발치, 근관치료, 배농을 포함한 외과적 치료, 항생제 투여 등에 의해 적절히 치료될 수 있다. 본 증례에서는 치성 원인의 견치 간극 농양 및 협부 간극 농양에 이환된 환자들에 대하여 항생제 투여 및 근관치료, 외과적 배농 등을 시행하여 양호한 치료 결과를 얻었기에 보고하는 바이다.

• Journal of Preventive Medicine and Public Health
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• 제25권4호
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• pp.413-428
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• 1992

The aim of this study was to evaluate the appropriateness of some kinds of surgery and admission, such as cesarean section (C/S), cholecystectomy, and pediatric pneumonia. For appropriateness evaluation, we ourselves developed some criteria, which were included in the category of explicit and linear criteria, with the assistance of specialists of relevant clinical field. The evaluation of appropriateness was performed by two family physicians. The major findings were as follows: 1. For cesarean section, 77.6% of deliveries were determined to be 'appropriate', but the level of appropriateness was not significantly different among hospitals and between hospital groups by size. The most freqeunt indication of C/S was repeated operation, followed by cephalopelvic disproportion (CPD). The labor trials for vaginal delivery among repeated C/S and CPD cases were performed in 24.5% of pertinent deliveries. 2. About 73.8% of cholecystectomy cases was appropriate to one of the surgical indications, without significant differences among hospitals. Of surgical indications, 'sufficiently frequent and intense symptom recurrence' was the most frequent, and 'confirmed acute cholecystitis' was the second. 3. Of children admitted due to pneumonia, only 57.4% of cases satisfied admission criteria, and the level of appropriateness of admission was different among hospitals. The common reasons fur admission were 'failure to initial treatment', 'suspected bacterial pneumonia', 'young infant', etc. We could find that there were differences of quality among hospitals in some procedures, especially in the pediatric pneumonia and labor trial before C/S, which suggested that the implementation of quality assurance activiteis would be necessary in this country. In this study, we used some simple and primitive research tools and the numbers of subjects and tracer procedures were limited. So advanced studios with plentiful subjects and more representative diseases or procedures should be tried.

• Asian Pacific Journal of Cancer Prevention
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• 제15권7호
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• pp.3207-3210
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• 2014

Background: Inflammatory breast cancer (IBC) is an aggressive form of locally advanced breast cancer characterized by rapidly progressive breast erythema, pain and tenderness, oedema and paeu d'orange appearance. It accounts for 1-3% of all newly diagnosed cases of breast cancer in the west. Data on IBC from India are lacking. The aim of our study was to assess the clinical-pathological parameters and outcome of IBC at, All India Institute of Medical Sciences, a large tertiary care centre. Materials and Methods: We screened 3,650 breast cancer cases registered from January 2004 to December 2012 and found 41 cases of IBC. Data included demographics as well as clinical, radiological and histopathological characteristics, and were collected from clinical case records using the International Classification of Diseases code (C-50). Patients who presented with IBC as a recurrence, or who had a neglected and advanced breast cancer that simulated an IBC were excluded from this study. Results: The median age was 45 years (range 23-66). The median duration of symptoms was 5 months. The American Joint Committee on Cancer stage (AJCC) distribution was Stage III - 26 and IV - 15 patients. Estrogen receptor (ER), progesterone receptor (PR) positivity and human epidermal growth factor receptor 2 (HER2/neu) positivity were 50%, 46% and 60%, respectively. Triple negativity was found in 15% of the cases. All the non metastatic IBC patients received anthracycline and/ or taxane based chemotherapy followed by modified radical mastectomy, radiotherapy and hormonal therapy as indicated. Pathological complete remission rate was 15%. At a median follow-up of 30 months, the 3 year relapse free survival and overall survival were 30% and 40%respectively. Conclusion: IBC constituted 1.1% of all breast cancer patients at our centre. One third of these had metastatic disease at presentation. Hormone positivity and Her2 neu positivity were found in 50% and 60% of the cases, respectively.

• Archives of Plastic Surgery
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• 제42권6호
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• pp.709-715
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• 2015

Background The incidence of vascular anomalies in the head and neck is higher than in the extremities. It is especially common for vascular anomalies to involve the lip. The lips are a functionally and aesthetically important component of the head and neck area. A retrospective analysis of data from our vascular anomaly center was performed in order to understand the characteristics and treatment requirements of vascular anomalies of the lip and to establish which treatments are likely to lead to the best outcomes. Methods A retrospective review was performed of the medical records of patients diagnosed with vascular anomalies of the upper or lower lip from January 2001 to September 2013. Using clinical photographs, radiologic findings, and patient records, the diagnosis of each case and the location of the vascular anomaly were recorded, along with information about treatment and follow-up. Results A total of 1,606 patients were diagnosed with vascular anomalies over this time period, of whom 127 (7.9%) were found to have vascular anomalies in the lip only. Surgical treatment with or without embolization, sclerotherapy, laser therapy, medication only, and observation were the treatment strategies adopted in these cases. Conclusions Vascular anomalies of the lip should be diagnosed accurately. Radiologic diagnosis played a crucial role in treatment planning, and several techniques were used to treat vascular anomalies of the lip. When surgical excision is indicated for the correction of vascular anomalies of the lip, the aesthetic and functional characteristics of the lip should be considered.

• Journal of Yeungnam Medical Science
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• 제19권2호
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• pp.99-106
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• 2002

단순 심실중격결손증은 선천성 심질환중 흔한 질환이지만 어린 나이 혹은 저체중환아에서 시행하는 경우 경험에 따라 만족스럽지 못한 경우도 있어 영아기에 수술을 시행한 단순 심실중격결손증 환자들의 수술 결과를 조사하였다. 1996년부터 2000년까지 첩포봉합술을 시행한 45명을 대상으로 체중 5 kg을 기준으로 수술의 결과를 분석하였다. 수술사망은 없었으며 두 군간의 합병증 발생에 있어 유의한 차이는 없었다. 수술 수기로 사용된 단순 연속봉합법은 전례에서 적용할 수 있었으며 증상이 있는 심실 중격결손증은 체중이 5kg이하의 환아에서도 시기에 관계 없이 안전하게 시행할 수 있었다.

• Journal of Chest Surgery
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• 제45권5호
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• pp.295-300
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• 2012

Background: With growing attention to the aortopathy associated with aortic valve diseases, the number of candidates for accompanying ascending aorta and/or root replacement is increasing among the patients who require aortic valve replacement (AVR). However, such procedures have been considered more risky than AVR alone. This study aimed to compare the surgical outcome of isolated AVR and AVR combined with aortic procedures. Materials and Methods: A total of 86 patients who underwent elective AVR between 2004 and June 2010 were divided into two groups: complex AVR (n=50, AVR with ascending aorta replacement in 24 and the Bentall procedure in 26) and simple AVR (n=36). Preoperative characteristics, surgical data, intra- and postoperative allogenic blood transfusion requirement, the postoperative clinical course, and major complications were retrospectively reviewed and compared. Results: The preoperative mean logistic European System for Cardiac Operative Risk Evaluation (%) did not differ between the groups: $11.0{\pm}7.8%$ in the complex AVR group and $12.3{\pm}8.0%$ in the simple AVR group. Although complex AVR required longer cardiopulmonary bypass ($152.4{\pm}52.6$ minutes vs. $109.7{\pm}22.7$ minutes, p=0.001), the quantity of allogenic blood products did not differ ($13.4{\pm}14.7$ units vs. $13.9{\pm}11.2$ units). There was no mortality, mechanical circulatory support, stroke, or renal failure requiring hemodialysis/filtration. No difference was found in the incidence of bleeding (40% vs. 33.3%) which was defined as red blood cell transfusion ${\geq}5$ units, reoperation, or intentional delayed closure. The incidence of mediastinitis (2.0% vs. 0%), ventilator ${\geq}24$ hours (4.0% vs. 2.8%), atrial fibrillation (18.0% vs. 25.0%), mean intensive care unit stay (34.5 hours vs. 38.8 hours), and median hospital stay (8 days vs. 7 days) did not differ, either. Conclusion: AVR combined with additional aortic or root replacement showed an excellent outcome and recovery course equivalent to that after isolated AVR.