• Title/Summary/Keyword: 광범위절제

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Descending Necrotizing Mediastinitis Caused by Yeast -A case report- (이스트에 의한 하행 괴사성 종격동염 -치험 1예-)

  • 윤영철;김성룡;전희재;최강주;이양행;황윤호;조광현
    • Journal of Chest Surgery
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    • v.37 no.4
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    • pp.386-389
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    • 2004
  • Descending nectorizing mediastinitis (DNM). represents a virulent form of mediastinal infection requiring prompt diagnosis and treatment to reduce the high morbidity mortality associated with this disease. Intr. avenous broad-spectrum antibiotic therapy alone is not efficient without adequate surgical drainage of the cervical and mediastinal collections, extensive debridement and excision of necrotic tissue, and wide mediastino-pleural irrigation. A 38-year-old man admitted via emergency room with painful left neck swelling and uncontrolled high fever. Chest computed tomogram showed left paratracheal abscess descending into the superior and anterior mediastinum. Transcervical mediastinal drainage was performed with 26 Fr. chest tube and left paratracheal drainage was performed with Penrose drain in urgency. Culture and sensitivity test grew Yeast. The drains removed via gradually shortening on day 39 after surgery.

Synchronous Multiple Primary Cancers of the Esophagus, Stomach, Lung and Oral Cavity (식도, 위, 폐 그리고 구강에 동시 발생한 다발성 원발암)

  • Shin, Su-Min;Shim, Young-Mog
    • Journal of Chest Surgery
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    • v.42 no.5
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    • pp.662-665
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    • 2009
  • A 65-year-old-male had a mass in the oral cavity, and this was ultimately determined to be squamous cell carcinoma and he underwent wide excision for it. Postoperatively, he underwent the staging work up; this showed that he had other cancers in the esophagus, stomach and lung. We performed a curative resection of all the lesions simultaneously. We report here on a case of synchronous multiple cancers of the esophagus, stomach, lung and oral cavity.

Synovial Sarcoma of the Rib Report of a Case (늑골에 발생한 원발성 활막육종 1 례 보고)

  • Choe, Yong-Su;Kim, Gwan-Min;Kim, Jin-Guk;Sim, Yeong-Mok
    • Journal of Chest Surgery
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    • v.30 no.11
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    • pp.1154-1158
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    • 1997
  • Synovial sarcoma is an uncommon malignant mesenchymal tumor that occurs in the vicinity of the joints, bursae, and tendon sheaths. Typically the lesions are located in the extremities, especially in the lower extremities. They also occur in the abdominal and thoracic walls, but rarely in the head and neck. We experienced a case of synovial sarcoma of the rib in 17-year -old woman. We performed on bloc chest wall resection including the right second rib tumor, fi st and third ribs. The postoperative course was uneventful. She received chemotherapy because of a relapse of the tumor in sternum and both lung during follow-up.

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Resection and End-to-End Anastomosis in Pediatric Tracheal Stenosis (소아 환자에서의 단단문합술에 의한 기관협착 치험 9 례)

  • 김광현;성명훈;이재서;신진성;최승호
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1993.05a
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    • pp.81-81
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    • 1993
  • Tracheal stenosis in children are often the result of prolonged intubation and its treatment depends on the severity and extent of the involved segment. Repeated surgical endoscopic procedures may be indicated in those with mild stenoses mainly consisting of granulation tissues, However, surgical reconstruction of the airway should be performed in patients with severe, extensive stenoses composed of mature scar tissue. The senior author has successfully managed such patients with cartilage graft augmentation and tracheal resection anastomosis. This is a presentation of 9 pediatric patients with tracheal stenosis who have been successfully treated by resection anastomosis. The details of the cases and indications for this type of surgery are discussed.

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A MODIFICATION OF THE MICHELET TECHNIQUE FOR SLIDING HORIZONTAL OSTEOTOMY;A CASE REPORT (MICHELET 테크닉의 변형을 이용한 이부성형술의 치험례)

  • Lee, Jin-Gew;Davis, Isaac E.;Swift, James Q.
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.16 no.2
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    • pp.145-151
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    • 1994
  • 앞 턱 부위가 짧고 후방으로 위치해 있을 때 턱의 높이를 증가시키고 전방으로 돌출시키는 축조 이부성형술의 방법으로는, 매식체 삽입술, 골 절단술, 골 절제술 또는 이들을 동시에 시행하는 혼합술등이 행해져 왔다. 그러나 매식체 삽입술에서는 감염 또는 매식체의 유동성 등의 합병증의 발병이 빈발하고 매식체의 밑 부위에 골이 흡수된다든지 연조직의 변화를 예측하기 어렵다든지 하는 복잡한 문제점들이 종종 보고되고 있다. 따라서 매식체를 이용하지 않는 골 절단술이나 골 절제술만을 이용한 다양한 방법의 이부성형술이 많이 시행되고 있다. 하악골이 전후방 관계로 발육부전인 환자에게 양측 하악지 시상분할술을 시행하여 전방 이동시킨 후 앞 턱의 위치를 좀더 개선하기 위하여 $Michel{\'{e}}t$ 테크닉의 변형법을 이용한 이부성형술을 추가로 시행하였다. 이 방법의 이부성형술은 턱의 수직적, 수평적 길이를 증가시키기 위하여 하악결합면 부위에 장부와 장붓구멍 모양을 한 골 절단술을 시행하고 광범위한 연조직경을 보존하여 골편으로의 혈류 차단을 최소화하였으며 나사를 이용한 견고한 고정을 용이하게 하였다. 이 술식은 턱을 수직적으로 증가시킬 때 두 골편 사이의 공간에 골 이식을 시행할 필요가 없으며, 금속판을 이용하지 않아도 정확한 위치에 골편을 고정하기가 용이하고, 또한 고정용 나사가 향후 골형성 부위에 위치하게 된다는 장점을 경험하게 되어 이에 한 증례를 보고하는 바이다.

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Clinical application of implant assisted removable partial denture to patient who underwent mandibular resection with oral cancer: A case report (구강암으로 변연골 절제술 시행한 환자를 임플란트 보조 국소의치로 수복한 증례)

  • Yoon, Young-Suk;Han, Dong-Hoo;Kim, Hyung-Joon;Kim, Jee Hwan
    • The Journal of Korean Academy of Prosthodontics
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    • v.54 no.3
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    • pp.280-285
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    • 2016
  • Mandible defects could be caused by congenital malformations, trauma, osteomyelitis, tumor resection. If large areas are included for reconstruction, those are primarily due to tumor resection defects. The large jaw defect results in a problem about mastication, swallowing, occlusion and phonetics, and poor esthetics causes a lot of inconvenience in daily life. It is almost impossible to be a part underwent mandibular resection completely reproduced, should be rebuilt artificially. This case is of a patient who was diagnosed with squamous cell carcinoma pT1N0M0, stage I in February 2004 and received surgery (combined mandibulectomy and neck dissection operation (COMMANDO) in oromaxillofacial surgery) in March 2004, by implant assisted removable partial denture. We could obtain good retention and stability through sufficient coverage and implant holding. Follow up period was about four years. Mandibular left third molar regions have been observed to have resorption of surrounding bone, and periodic check-ups are necessary conditions.

Debridement Arthroplasty using Posteromedial Approach in Elbow Joint with Pain and Bony Limitation of Motion (동통과 골성 운동 제한이 있는 주관절에서 후내측 도달법을 이용한 변연 절제 관절 성형술)

  • Cheon, Sang-Jin;Lee, Dong-Ho;Cha, Seung-Han;Kim, Hui-Taek;Suh, Jeung-Tak
    • Clinics in Shoulder and Elbow
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    • v.12 no.1
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    • pp.67-75
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    • 2009
  • Purpose: This study evaluated the clinical outcomes of debridement arthroplasty using the posteromedial approach in elbow joints with pain and bony limitation of motion. Materials and Methods: This study involved 16 elbows in 16 patients with pain and bony limitation of motion, which were treated by debridement arthroplasty using the posteromedial approach from March 2005 to March 2008. The mean follow up period was 27.6 (13~52) months. The clinical outcomes were analyzed using the Visual Analogue Scale(VAS) for pain scale, the preoperative and postoperative range of motion and the Mayo Elbow Performance Scores(MEPS). Results: The VAS was decreased significantly from a preoperative mean of 4.5 to a postoperative mean 1.1 (p<0.001). The average arc of motion improved significantly from $61.6 (0~90)^{\circ}$ preoperatively to $109.4 (80-120)^{\circ}$ postoperatively (p<0.001). The MEPS also improved significantly from 59.4 to 85.6 postoperatively (p<0.001). There were no complications, such as hematoma and elbow instability. Conclusion: Debridement arthroplasty using the posteromedial approach is a useful surgical procedure in the elbow joint with pain and bony limitation of motion, where all compartments can be debrided, the ulnar nerve can be manipulated easily and damage to the medial collateral ligament can be minimized.

Diagnostic Accuracy of Imaging Study and the Impact of Clinical Risk Factors on the Presence of Residual Tumor Following Unplanned Excision of Soft Tissue Sarcomas (악성 연부조직 종양에 대한 무계획적 절제술 후 잔여 종양의 영상학적 진단의 정확성과 임상적 위험인자)

  • Oh, Eunsun;Seo, Sung Wook;Jeong, Jeonghwan
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.2
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    • pp.150-156
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    • 2019
  • Purpose: This study examined the diagnostic accuracy of an imaging study to find the factors that affect the presence of residual tumors after an unplanned excision of sarcomas. Materials and Methods: Ninety-eight patients, who underwent a re-excision after unplanned surgery between January 2008 and December 2014, were enrolled in this study. Magnetic resonance imaging (MRI) was performed before reoperation in all patients. Positron emission tomography (PET)-computed tomography was performed on 54 patients. A wide re-excision and histology diagnosis were performed in all cases. The clinical variables were evaluated using univariate logistic regression and multivariate logistic regression. Results: The presence of a deep-seated tumor increases the risk of remnant tumors (odds ratio: 3.21, p=0.02, 95% confidence interval: 1.25-8.30). The sensitivity for detecting residual tumors is high in MRI (sensitivity 0.79). Conclusion: Deep-seated tumors have a significantly higher risk of remnant tumors. Because the negative predictive value of MRI and PET scans is very low, reoperation should be performed regardless of a negative result.

Low Grade Osteosarcoma in Proximal Phalanx of the Second Toe - A Case Report- (제 2족지 근위 지골에 발생한 저악성도 골육종 - 증례 보고 -)

  • Han, Chung-Soo;Chung, Duck-Hwan;Shin, Dong-Jun;Lim, Yang-Sun;Jung, Chan-Jong
    • The Journal of the Korean bone and joint tumor society
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    • v.7 no.4
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    • pp.151-156
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    • 2001
  • The reported incidence of osteosarcoma of the foot varies between 0.2-2% of all osteosarcoma. Low grade osteosarcoma of the long bone represents only 1.9% of all osteosarcoma. A 38-year-old female had suffered painful mass in the proximal phalanx of the second toe for 1 year. Radiographic finding showed enlarged osteloytic mass which had penetrated thin cortex of the second toe and apparent increased uptake in bone scan was seen. Mass resection with autogenous bone graft using rib was performed. Histologically, the tumor was compatible with "low grade osteosarcoma". Second stage wide resection was performed. Because low grade osteosarcoma located in the proximal phalanx of the second toe is very rare, we report this unusual case with review of literature.

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Surgical Treatment of Acute Necrotizing Klebsiella Pneumonia -Two cases report- (급성 괴사성 클렙시엘라 폐렴의 외과적 치료 -2례 보고-)

  • 류경민;김삼현;박성식;류재욱;최창휴;박재석;서필원
    • Journal of Chest Surgery
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    • v.32 no.5
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    • pp.484-488
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    • 1999
  • Massive lung gangrene is a rare but very rapidly progressing fatal complication of lobar pneumonia. Etiologic agents are Klebsiella pneumoniae, Pneumococcus and Aspergillus, etc. Chest X-ray shows firm consolidation of the involved pulmonary lobe and bulging fissure due to the volume expansion of involved lung. CT-scan shows extensive lung parenchymal destructions with multiple small cavitary lesions. Recommended treatment is the early surgical intervention combined with antibiotics. Without surgical intervention, lung gangrene is known to progress toward sepsis, multiorgan failure, and high mortality. We report two cases of rapidly progressing massive lung gangrene by Klebsiella pneumonia treated by the resectional surgery.

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