• Title/Summary/Keyword: 술후 처치

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Effects of Melatonin on Preventing Postoperative Intraperitoneal Adhesion Formation in Rats (Rat에서 술후 복강 유착방지에 대한 melatonin의 효과)

  • Lee, Seung-Chan;Kim, Jung-Eun;Kwon, Young-Sam;Jang, Kwang-Ho
    • Journal of Veterinary Clinics
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    • v.23 no.3
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    • pp.230-235
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    • 2006
  • This study was performed in rats to find the minimum dose of melatonin that can effectively prevent the formation of postoperative intraperitoneal adhesions. Forty-two Sprague Dawley male rats were divided into six groups consisting of 7 rats, respectively. After celiotomy, five abrasions of $0.5{\times}1cm$ area were made on the antimesenteric serosal surface of the colon with a scalpel blade. The abdominal cavity was filled with 1 ml of solution containing 1 mg/kg(Mel 1), 3 mg/kg(Mel 3), 10 mg/kg(Mel 10), 30 mg/kg(Mel 30) and 5% ethanol solution(sham) through the catheter, using a sterile syringe before abdominal closure. Control group was given no adjuvant. The locations and values of adhesion were assessed through the second operation on the 14th day after the first operation. The adhesions were located on serosa to mesentery(54 of 210, 25.7%), serosa to serosa(44 of 210, 21%), serosa to omentum (12 of 210, 5.7%) and serosa to parietal peritoneum(0 of 210, 0%). The incidences of adhesion in Control, Sham, Mel 1, Mel 3, Mel 10 and Mel 30 were 68.6%, 91.4%, 57.1%, 60.1%, 17.1% and 20%, respectively. The values of adhesion separation in Mel 10 and Mel 30 group were lower than those in other groups. However, there was no significant(p<0.05) between Mel 10 and Mel 30 group. This study showed that 10 mg/kg of melatonin were effective in reducing the intraperitoneal adhesion.

FIBRIN SEALANTS IN MAXILLOFACIAL SURGERY : A INTRODUCTORY REPORT (악안면 외과 영역에서의 FIBRIN SEALANTS 의 이용)

  • Kim, Myung-Jin;Park, Hyung-Kook
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.13 no.2
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    • pp.129-136
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    • 1991
  • The fibrin sealant was first designed as an alternative to surgical suture for the purpose of surface-to-surface union especially in parenchymal organs like the liver, spleen and kidney. The clinical application of currently used fibrin sealant was first introduced in 1972. The fibrin sealant consists of principal two components; lyophilized human fibrinogen and bovine thrombin. The fibrinogen component also contains coagulation factor XIII. A solution of aprotinin, an inhibitor of fibrinolysis is used to dissolve the fibrinogen and to provide the first component, and a solution of calcium chloride is also used to provide the second component. From July to December in 1990, during 6 months, we used fibrin sealant in the 28 patients of 33 various cases, in the following ways; supportive application of fibrin sealant after free autogenouse nerve graft for the repair of inferior alveolar nerve, facial nerve or accessory nerve, treament of hemangioma or lymphangioma to thrombosize and lead to the tumor shrinking, skin grafting to stimulate the adhesion and tissue repair, bone grafting in the patients of cleft alveolus, mandibular reconstruction or orthognathic surgery to facilitate the knitting of bone chips, tissue adhesion after tumor resection, radical neck dissection or flap reconstructions, and supportive adhesion of external auditory cannal after TMJ surgery via postauricular approach. No adverse effects were observed, none of the patients developed hepatitis or other blood transmitted disease, and the wound healing were acceptable.

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RETROPHARYNGEAL AND MEDIASTINAL ABSCESS SECONDARY TO ODONTOGENIC INFECTIONS : REPORT OF THREE CASES (치성감염에 의해 발생된 후측인두부 및 종격동 농양)

  • Park, Mun-Seong;Kim, Chang-Lyong;Lee, Seung-Ho;Jung, Joo-Sung;Jeong, Jong-Cheol;Kim, Keon-Jung;Ryu, Sun-Youl
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.18 no.4
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    • pp.626-635
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    • 1996
  • Odontogenic infections are usually locally confined, self-limiting processes. However, under certain circumstances, they may break through the bony, muscular, and mucosal barriers and spread into contiguous fascial spaces or planes far from the initial site of involvement, resulting in severe life-threatening complications, such as retropharyngeal spread, suppurative mediastinal extension, airway obstruction, pleuropulmonary suppuration, and hematogenous dissemination to distant organs. The mortality arte for mediastinitis from odontogenic infection ranges from 40% to 60%. Therefore rapid evalution and treatment is essential with a combination of life support, antibiotic therapy, and surgical intervention. Recently, we experienced three cases of retropharyngeal and mediastinal abscesses secondary to odonogenic infections. In all patients, early diagnosis was possible by CT scanning and physical examination. The prognosis was good in all patients by using urgent aggressive surgical and antibiotic therapy.

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A CLINICAL EVALUATION OF 61 CASES VOCAL CORD PARALYSIS (성대마비 61례에 대한 임상적 분석)

  • 김상현;이원상;김동환;정덕희;김춘길
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1991.06a
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    • pp.30-30
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    • 1991
  • 성대마비 이비인후과 영역에서는 비교적 빈번하게 관찰되는 질환으로 대부분은 미주신경과 그 분지인 반회신경이 경정맥공에서 후두까지의 주행중에 생긴 질환에 의하여 이차적으로 발생하거나, 드물게는 윤상갑상연골 관절의 고정에 의사여 발생하게 된다. 임상적인 진단은 간접후두경이나 화이버옵틱후두경 검사법에 의하여 간단하게 내려질 수 있으나, 그 발생원인은 다양하며, 임상적인 양상 및 그에 따른 치료 원칙도 다르게 나타난다. 이에 연자들은 1986년 1월 1일부터 1990년 12월 31일까지 5년간 국립의료원 이비인후과에 내원한 환자중 성대마비로 진단된 환자 61례에 대한 후향적 기록 분석에 의해 성별, 원인별, 측별, 성대의 위치, 및 그에 따른 치료방향에 대하여 비교 검토하여 다음과 같은 결과를 보였다. 1)성별은 남녀비가 3:2로 남자가 많았으며, 연령별 분포는 20대에서 70대까지 비교적 균등하였으나 50대(23.0%)에서 가장 많은 분포를 보였다. 2)원인으로는 원인불명이 16례(26.2%), 갑상선수술 8례(13.1%), 폐결핵과 기관내삽관후 각각 6례(9.8%), 폐암 5례(8.2%) 순이었다. 3)마비된 성대의 측별 분포는 편측성이 51례(83.6%), 양측성이 10례(16.4%)이며, 편측성중 좌측이 37례(60.6%)로 가장 많았다. 마비된 성대의 위치는 부정주위가 33례(54%)로 가장 많았다. 4)즉 증상은 단지 애성만 있었던 례가 31례(50.8%), 호흡곤란 혹은 기도흡인등을 동반한 애성이나, 애성을 동반하지 않은 례도 있었다(3례). 증상 발현후 병원 내원까지 기간은 2개월이내가 가장 많았다. 5)16례에서 수술적 처치가 시행되었거나(9례), 혹은 자연치유가 관찰되었는데(7례) 편측성마비때 갑상연골성형술 2례, 양측 마비때 후두외접근법에 의한 피열연골절제술 4례, 레이저를 이용한 피열연골절제술 2례, 승모판 협착증에 의한 편측성 성대마비에서 개심술후 성대마비 회복 1례, 자연 치유는 7례에서 관찰되었으며 6례에서는 증상발현후 6개월이내에 회복되었다.

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Seven Cases of Severe Esophageal Stricture (고도의 식도 협착증 7 예)

  • 김기주;김호성;조중환
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1982.05a
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    • pp.5.2-5
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    • 1982
  • With the improvement of living standard and socioenvironmental change, esophageal stricture due to acetic acid, Hcl, insecticides and lye has led to decrease remarkably. Esophageal stricture has decreased because of immediate treatment and adequate management. However there are still sporadic incidents of esophageal stricture due to inadequate treatment and uncooperation of patients. The authors recently have experienced seven severe cases of esophageal stricture. All six patients were treated with 18-51 French Sippy esophageal dilating bougie. One patient was transfered to thoracic surgery department due to complete esophageal obstruction. Case 1. A 23 year old housewife who ingested Hcl for suicide. After Witzel's operation, she visited to dilate esophageal first constriction stircture due to swallowing difficulty postoperation 2 months later. We were treated successfully. Case 2. A case of esophageal stricuture in the second and third physiologic constriction part. The patient was 51 years old man who ingested lye accidently, and was dilated by bougination. Case 3. The patient was 43 year-old man who ingested acetic acid as a mistake and was treated inadequately at hopsital. Inspite of treatment, esophageal stricture developed at the third physiologic part. We are trying to dilate the esophagues now. Case 4. The patient was 55 year-old woman who had ingested Hcl for the purpose of suicidal attempt. 2 months later gastroduodenal anastomoisis due to pyloric region stenosis, the first physiologic constriction stricture was dilated successfully. Case 5. The patient was 41 year-old woman who ingested Hcl for suicide 4 months ago. There was indwelled orogastric tube for 1 month but esophageal stricture developed at the first and 3rd constriction part. She was treated by using a bougination. Case 6. An athlete 21 year old man, ingested acetic acid 2 spoonful per 3 days by purpose in order to soften the bone for last 14 months. There was complete esophageal obsturction in esophagogram and transferred to the thoracic surgery department. Case 7. A 3 year-old girl was ingested lye at a accident. She had a bougination for 16 months under the general anesthesia for dilation due to whole irregular esophageal stricture. She developed lower esophageal perforation, but healed eventually.

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Arthroscopic treatment of septic arthritis of the knee in adults (성인의 화농성 슬관절염의 관절경적 치료)

  • Kyung Hee-Soo;Ihn Joo-Chul;Oh Chang-Wug;Kim Sung-Jung;Kim Joon-Woo
    • Journal of the Korean Arthroscopy Society
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    • v.6 no.1
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    • pp.21-24
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    • 2002
  • Purpose : The purpose was to assess the result of arthroscopic management of the septic arthritis on the knee in compromised patients. Materials and Methods : Fourteen patients with septic knee were analyzed. The mean age was 55 years and the mean follow-up period was 14.6 months. Underlying diseases included 4 cases of diabetes, and history of direct acupuncture in 4 cases. Clinical stage of septic arthritis was judged by $G\ddot{a}chter's$ classification, which was determined by arthroscopic findings. After arthroscopic irrigation and debridement, we observed the results of laboratory data and improvement of clinical findings. Results : Causative organism was identified in 7 cases and no organism was detected in the remaining 7 cases. Stage I was 1, stage II 8, stage III 4, and stage IV 1, respectively. Eleven of 14 cases were improved by one stage operation. Two cases of stage III were recurred and additional arthroscopic management was done. In 1 case of stage IV, symptom was not improved and needed arthrotomy. The result was unsatisfactory in patients with stage III and IV. Serum erythrocyte sedimentation rate and C-reactive protein were normalized after 29.3 and 20.8 days following the operation, respectively. Clinical symptoms disappeared average 2 days following the operation. Conclusion : Arthroscopic management of acute septic arthritis of the knee would be an effective and satisfactory treatment modality in that its postoperative pain and complications are minimal, and it can be done with ease repeatedly.

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SURGICAL CORRECTION OF TORTICOLLIS USING BIPOLAR RELEASE AND Z-PLASTY (Bipolar release와 Z-Plasty를 이용한 선천적 사경증의 치험례)

  • Jeong, Jong-Cheol;Kim, Keon-Jung;Lee, Jeong-Sam;Min, Heung-Ki;Choi, Jae-Sun
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.18 no.3
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    • pp.388-395
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    • 1996
  • Congenital muscular torticollis(CMT) is a disorder characterized by shortening of at least one of the cervical muscles and tilting of the head to opposite side. The most commonly affected muscle is the sternocleidomastoid muscle. Pathogenesis and etiology of congenital muscular torticollis were not clearly identified, but considered as fetal malposition, birth trauma, vascular accident, heredity, infection and CNS pathology. Untreated congenital muscular torticollis often causes facial asymmetry and This is the rasult of tensional rotation of the face toward affected side. So early treatment may prevent facial and neck asymmetry and limitation of neck movement. There are many treatment methods in CMT, including conservative and operative method, but presently Bipolar release and Z-Plasty of SCM muscle has been introduced when the conservative treatment had failed. The benefits of this method are to preservation of the normal Neck V-contour and improvement of the neck motion. We treated CMT using Bipolar release and Z-plasty in two patients. After that the patients improved on the range of neck motion and maintained the normal V-conture of the neck, so we report two cases of CMT with literatures.

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Effect of the Combination of Electroacupuncture and Surgical Decompression on Experimental Spinal Cord Injury in Dogs (개에서 실험적으로 유발한 척수손상에 대한 전침과 감압술의 병용 효과)

  • Kim Sun Young;Kim Min-Su;Seo Kang-Moon;Nam Tchi-Chou
    • Journal of Veterinary Clinics
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    • v.22 no.4
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    • pp.297-301
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    • 2005
  • This study was performed to evaluate the effects of the combination of electroacupuncture (EA) and surgical decompression on paraplegia due to spinal compression in dogs. Ten clinically healthy dogs were assigned into two groups (group A and group B). The one is for the combination of EA and surgical decompression, and the other is for surgical decompression alone. After decompression, neurological function was evaluated daily with modified Tarlov grading system. SEPs were measured as objective evaluation of normal spinal cord function before spinal compression and after neurological recovery. The period of rehabilitation in group A was significantly shorter than that in group B (p<0.05). Conduction velocity of SEPs showed a tendency to return to normal when the dogs got full recovery. According to these results, it was considered that the EA with surgical decompression was more effective than surgical decompression alone for paraplegia resulting from spinal cord injury in dog.

Clinical Use of Thromboelastography as Monitor of Coagulopathy at the Pre and Post-Cardiopulmonary Bypass (개심술 환자의 체외순환 전후 혈전 탄성 묘사도의 임상적 이용)

  • 강경훈;김경훈
    • Journal of Chest Surgery
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    • v.30 no.11
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    • pp.1092-1096
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    • 1997
  • Thromboelastography(TEG) enables a global assessment of hemostatic function to be made from a single blood sample, documenting the interaction of platelets with protein coagulation cascade from the time of the initial platelet-fibrin interaction, through platelet aggregation, clot strengthening and fibrin cross linking to eventual clot Iysis. Thirty-five patients(mean age 34$\pm$ 12) undergoing open heart surgery from April 1st, 1996 to August 31th, 1996 were investigated at preoperatively and immediate, one hour, and 24 hours after cessation of cardiopulmonary bypass using TEG. Comparisons were made between classic hematological indices and TEG data. There were statistically significant correlation between maximal amplitude(MA) and platelet count before CPB, activating clotting time(ACT) and TEG date(R time, K time and a angle) at 24-hour after CPB. The data on the predictive accuracy for postoperative bleeding at 24-hour after CPB, the TEG was significantly better than ACT(57%) or the coagulation profiles(43%) as a predictor of postoperative bleeding, with an accuracy rate of 100% (P=0.0043). In conclusion, TEG seems to be easy to use, clinically accurate, cost effective and provides data which can effectively manage a patient's hemostasis.

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Clinical Evaluation of Surgical Treatment for Hemoptysis Patients (객혈환자의 외과적 처치에 대한 임상적평가)

  • 이성주;문승철
    • Journal of Chest Surgery
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    • v.30 no.11
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    • pp.1097-1104
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    • 1997
  • The expectoration of blood is always a fearful experience for the patient and a matter of grave concern to the attending physician, because it may be the warning sign of serious diseases. When such bleeding occurs, the possibility of its being due to pulmonary tuberculosis, bronchiectasis or carcinoma of the lung is promptly suggested. Nowadays, with the advance of modern diagnostic studies, differential diagnosis has become possible for the hemoptysis patients to have appropriate treatment. This evaluation is based on the review of 75 cases of patients whom we performed emergency open thoracotomies for 6 years from March 1992 to February 1997 in the Department of Thoracic and Cardiovascular Surgery, Seoul Adventist Hospital. The mean age of the patients was 36.6 years old with a range from 19 to 68, and most prevalent age group was thirties. The most common underlying lung disease causin hemoptysis was tuberculosis(44%). Most accurate diagnostic study was bronchoscopy during hemoptysis(95 Vo) and right middle & lower lobe(17.3%) was the most common site of lesion. Lobectomy(50%) was the most frequent operative method and recurrent hemoptysis(31.6%) was the most common postoperative complication. But most of the patients(82.6%) were completely recovered by surgical treatment. Now we concluded that the proper management of hemoptysis was completed by surgical approach with definite diagnosis and supportive medication.

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