• Title/Summary/Keyword: 임상에서의 문제점

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Circular Stapled Billroth I Anastomosis after Distal Subtotal Gastrectomy - Anastomotic Complications and Prevention - (원위부 위아전절제술 후 원형문합기를 이용한 위십이지장 문합술 - 문합부 합병증과 예방책 -)

  • Lee, Moon-Soo;Kang, Gil-Ho;Cho, Gyu-Seok;Kim, Yong-Jin;Kim, Hyung-Soo;Lee, Hwa-Soo;Kim, Sung-Yong;Baek, Moo-Jun;Kim, Chang-Ho;Cho, Moo-Sik
    • Journal of Gastric Cancer
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    • v.6 no.2
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    • pp.103-108
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    • 2006
  • Purpose: The circular stapled Billroth I gastrectomy has been gradually popularized because of several advantages. Thus, this study aims to identify what to be supplemented for the safety of this technique by examining the potential complication after the circular stapled Billroth I gastrectomy. Materials and Methods: This study selected 594 patients who underwent the circular stapled Billroth I gastrectomy because of the gastric cancer in our department of surgery from Jan. 1998 to Dec. 2004 as the subjects. As of Jan. 2001 when the bleeding on the anastomosis site was visually checked through the small incision at the opposite curvature to the lesion of the stomach to be resected and so the operation was completed, the patients were divided into the Group I (n=219) and Group II (n=375), which were the patients before and after Jan. 2001, respectively. Then, the clinical characteristics and postoperative anastomotic complications of both groups were compared. Results: For the comparison of complications between two groups, the anastomotic leakage was found in four cases in Group I and three cases in Group II (p=0.196). The stenosis on the anastomosis region was not observed in both groups. The bleeding on the anastomosis region illustrates the statistically significant difference between Group I and Group II, with 43 cases and 2 cases, respectively (P=0.0019). Conclusion: The circular stapled Billroth I gastrectomy is recommended because of several advantages of this technique. However, the bleeding on the anastomosis site may be indicated as the critical issue. Accordingly, the visual check on the bleeding on the anastomosis site during the operation will improve the safety of circular stapler.

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The Usefulness of Serologic Diagnosis for Tuberculosis with Two Rapid Immunochromatographic Assay Devices (혈청학적 방법을 이용한 결핵 진단 방법의 효용성)

  • Kim, Deog-Kyeom;Kwon, Sung-Youn;Lee, Suk-Young;Park, Gye-Young;Jung, Kyung-Hae;Lee, Chun-Taek;Yoo, Churl-Gyoo;Kim, Young-Whan;Han, Sung-Koo;Shim, Yong-Soo
    • Tuberculosis and Respiratory Diseases
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    • v.47 no.5
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    • pp.586-597
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    • 1999
  • Background: Many diagnostic tests have developed to diagnose tuberculosis and other mycobacterial diseases but the diagnosis of tuberculosis relies largely on radiological findings and acid-fast staining of sputum and/or culture. Recently, new serologic diagnostic methods, which are safe and easy to use have been introduced into Korea. In this study, the usefulness of serologic diagnosis for tuberculosis and the disease pattern induced variation of the test were evaluated. Methods: Serological assay was performed upon 108 patients with two test kits, the ICT tuberculosis and the BioSign$^{TM}$TB, which are based upon a rapid immunochromatographic assay technique, capable of being interpreted within 15 minutes. The case groups consisted of 61 patients with active pulmonary tuberculosis(36 patients), extrapulmonary tuberculosis(3 patients), or both(22 patients). Control groups consisted of 47 patients with inactive old pulmonary tuberculosis(17 patients), nontuberculous pulmonary disease(16 patients) and nonpulmonary cardiac disease(14 patients). Results : The diagnostic sensitivity, specificity, positive predictive value(PPV) and negative predictive value(NPV) of the ICT tuberculosis were 64.3%, 91.5%, 90.0% and 68.3% respectively. The diagnostic sensitivity, specificity, PPV and NPV of the BioSign$^{TM}$TB were 76.5%, 95.3%, 94.1 % and 78.8% respectively. Differences in sensitivity were not significant between patients with previous history of tuberculosis or patients without prior history of tuberculosis. The ICT tuberculosis test showed higher sensitivity in pulmonary tuberculosis patients(76.5%) than extrapulmonary tuberculosis patients(33.3%). There was no difference in sensitivity between patients with or without cavitary lesion by chest X-ray. Conclusion: Considering high specificity and PPV, serologic diagnosis using a rapid immunochromatographic assay device is another helpful diagnostic method in the diagnosis of tuberculosis, when combined with previous diagnostic methods such as chest X-ray, microbiologic study but it has limitation in terms of confirming the diagnosis for tuberculosis as the only diagnostic method because of relatively low sensitivity and NPV.

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Detection of Multidrug Resistance Using Molecular Nuclear Technique (분자핵의학 기법을 이용한 다약제내성 진단)

  • Lee, Jae-Tae;Ahn, Byeong-Cheol
    • The Korean Journal of Nuclear Medicine
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    • v.38 no.2
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    • pp.180-189
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    • 2004
  • Although the outcome of cancer patients after cytotoxic chemotherapy is related diverse mechanisms, multidrug resistance (MDR) for chemotherapeutic drugs due to cellular P-glycoprotein (Pgp) or multidrug-resistance associated protein (MRP) is most important factor in the chemotherapy failure to cancer. A large number of pharmacologic compounds, including verapamil, quinidine, tamoxifen, cyclosporin A and quinolone derivatives have been reported to overcome MDR. Single photon emission computed tomography (SPECT) and positron emission tomography (PET) are available for the detection of Pgp and MRP-mediated transporter. $^{99m}Tc$-MIBI and other $^{99m}Tc$-radiopharmaceuticals are substrates for Pgp and MRP, and have been used in clinical studies for tumor imaging, and to visualize blockade of PgP-mediated transport after modulation of Pgp pump. Colchicine, verapamil and daunorubicin labeled with $^{11}C$ have been evaluated for the quantification of Pgp-mediated transport with PET in vivo and reported to be feasible substrates with which to image Pgp function in tumors. Leukotrienes are specific substrates for MRP and $N-[^{11}C]acetyl-leukotriene$ E4 provides an opportunity to study MRP function non-invasively in vivo. SPECT and PET pharmaceuticals have successfully used to evaluate pharmacologic effects of MDR modulators. Imaging of MDR and reversal of MDR with bioluminescence in a living animal is also evaluated for future clinical trial. We have described recent advances in molecular imaging of MDR and reviewed recent publications regarding feasibility of SPECT and PET imaging to study the functionality of MDR transporters in vivo.

Comparative Analysis of Double Bundle and Single Bundle ACL Reconstruction with Tibialis Anterior Allograft (동종건을 이용한 단일다발 및 이중다발 전방십자인대 재건술의 비교 분석)

  • Kim, Deok-Weon;Lee, Kang;Kim, Young-Woo;Yang, Sang-Jin;Seo, Jeong-Gook;Kim, Jin-Goo
    • Journal of the Korean Arthroscopy Society
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    • v.12 no.3
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    • pp.198-204
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    • 2008
  • Purpose: The purpose of this study is to analyze the merits and demerits of double bundle reconstruction and achieve improvements hereafter, by comparing the results of double bundle and single bundle reconstruction using tibialis anterior allograft. Materials and Methods: Twenty seven patients were divided to undergo either double bundle(n=14) or single bundle(n=13) reconstruction with tibialis anterior allograft tendon. The evaluation methods were AP laxity with KT-2000 arthrometer, isokinetic knee strength measurements, pivot-shift test, IKDC subjective score, Lysholm knee score, Tegner activity score, radiographic evaluations with postoperative MRI, and second look arthroscopy. Results: Lysholm knee score and Tegner activity score were significantly better in double bundle reconstruction. In pivot-shift test, single bundle reconstruction was evaluated as grade 0 in 10 of the knees, grade 1 in 1, and grade 2 in 2. Double bundle reconstruction was evaluated as grade 0 in 13, and grade 2 in 1. In second look arthroscopy, single bundle was evaluated as excellent in 6 of the knees, fair in 7, anteromedial bundle of double bundle reconstruction was excellent in 13 and fair in 1, and posterolateral bundle was excellent in 4, fair in 9, and poor in 1. There were no significant differences in other evaluations. Conclusion: Favorable outcome may be expected with double bundle reconstruction of ACL. However there are still need for improvement in terms of reconstruction technique and rehabilitation protocol to reduce PL bundle injury.

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2 Cases of Malignant Changed Laryngeal Papilloma (악성변화를 일으킨 후두유두종 3례)

  • 이종담;고한진;고의경
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1982.05a
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    • pp.6.1-6
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    • 1982
  • Papilloma is the common benign tumor of the larynx and the incidence of its malignant change was variable. The authors recently experienced 2 cases of squamous cell carcinoma of the larynx which were considered to be transformed from laryngeal papilloma. Case 1. A 58 year old male patient visited O.P.D. of Department of Otolaryngology of Busan National University Hospital, because of hoarseness for 3 years on May 13th, 1980. At that time, local finding of indirect laryngoscopy revealed whitish hypertrophic papillomatous mass on both vocal cords and anterior commissure, and dirty gray white pseudomembrane on left aryepiglottic fold, and the result of biopsy was squamous cell papilloma. So the laryngeal papilloma was removed under suspension laryngoscopy and then he had no specific treatment in spite of being recommended 5-FU topical spray. On March 5th, 1981, he visited O.P.D. again because of progressive exacerbation of hoarseness with mild dyspnea and histopathological finding was revealed squamous cell carcinoma of the larynx. Seven days later from that day, he visited emergency room due to severe dyspnea, and emergency tracheostomy was performed on sitting position. On April 7th 1981, total laryngectomy was performed successfully and postoperative irradiation therapy was recommended. Case 2. A 47 year old male patient visited our O.P.D. because of hoarseness for 5 years on Sep. 27, 1978. At that time, local finding of indirect laryngoscopy revealed papillomatous mass on left vocal cord and left ventricle and result of biopsy was squamous cell papilloma. So he had been treated with 11 times removal of papilloma, topical spray of 5-Fu and estrogen for 3 years, but the papilloma had been recurred. On Sep. 9th, 1981, he visited O.P.D. because of severe dyspnea and emergency tracheostomy and biopsy was performed. The result of biopsy was squamous cell carcinoma of larynx and total laryngectomy was performed successfully.

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Evaluation of Attenuation Rate Error on Skin Dosimeter using Monte Carlo Simulation in Photon and Electron Beam Therapy (광자선 및 전자선 치료에서 피부선량계의 측정과 시뮬레이션을 이용한 감약률 오차 평가)

  • Han, Moo-Jae;Yang, Seung-Woo;Heo, Seung-Uk;Bae, Sang-Il;Moon, Young-Min;Park, Sung-Kwang;Kim, Jin-Young
    • Journal of the Korean Society of Radiology
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    • v.14 no.6
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    • pp.841-848
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    • 2020
  • In the field of radiation therapy using photon beams and electron beams, since each patient has a different sensitivity to radiation, skin side effects may occur even at the same dose. Therefore, if there is a risk of excessive dose to the skin, a dosimeter is attached to verify whether the correct dose is being investigated. However, since the skin dosimeter checks the attachment site visually by measuring a point dose, it is difficult to confirm an accurate dose distribution. As a result, the measurement and simulation errors of the material HgI2 in the 6 MV photon beam were 3.73% and 5.24%, respectively, at the minimum thickness of 25 ㎛, and the material PbI2 was 4.73% and 5.65%, respectively. On the other hand, as a result of the 6 MeV electron beam, the measurement and simulation errors of the material HgI2 were 1.35% and 1.12%, respectively, at a minimum thickness of 25 ㎛, and the material PbI2 showed relatively low attenuation error, 1.67% and 1.20%, respectively. Therefore, it was evaluated that the thickness of the photon beam within 25 ㎛ and the electron beam within 100 ㎛ is suitable to have a reduction rate error within 5%. This study presents a new research direction for a flexible dosimeter attached to the human body that is required in clinical practice and the construction conditions of a future skin dosimeter.

Detorque force and surface change of coated abutment screw after repeated closing and opening (코팅된 지대주 나사의 반복 착탈 후 풀림력과 표면변화에 대한 연구)

  • Jang, Jong-Suk;Kim, Hee-Jung;Chung, Chae-Heon
    • The Journal of Korean Academy of Prosthodontics
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    • v.46 no.5
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    • pp.500-510
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    • 2008
  • Statement of problem: Recently researches about WC/C (Tungsten Carbide/Carbon) or TiN (Titanium Nitride) coating on abutment screws are going on. It decreases friction coefficient, resistance against corrosion and withdrawal of physical fragility when the coating is applied to the metal surfaces. It is reported that coated abutment screws improved abrasion, adaptability and detorque force. Purpose: This study is about the effects of coated abutment screws on loosening of screw and for the purpose of solving the loosening phenomenon of abutment screws which is clinical problem. Material and methods: Detorque force and surface changes are compared when 10 times of repeated closing and opening are applied to both uncoated titanium abutment screws (Group A) and coated abutment screws with WC/C (Group B) and TiN (Group C). Each group was made up of 10 abutment screws. Results: 1. Before repeated closing and opening, Somewhat rough surface with regular direction was observed in Group A. Coated granules were observed in group B and group C and overall coated layer appeared in regular and smooth form. 2. Before repeated closing and opening, The coated surface showed bigger and thicker size of coated granules in Group C than Group B. 3. After repeated closing and opening, abrasion and deformation of abutment screw surface was observed in Group A and Group B. Exfoliation phenomenon was observed in Group B. 4. Group A showed biggest range of decrease when the weight changes of abutment screws were measured before and after repeated closing and opening. Group C showed less weight changes than Group B but there was no statistical difference between two groups. 5. Group B and Group C showed higher average detorque force than Group A and there was statistical difference. 6. Group A showed more prominent decrease tendency of average detorque force than Group B and Group C. Conclusion: Coated abutment screws with WC/C or TiN did not show prominent surface changes than uncoated titanium abutment screws even though they were repeatedly used. And they showed excellent resistance against friction and high detorque force. Thus it is considered that adaptation of WC/C or TiN coating on abutment screws will improve the screw loosening problem.

A Study on the Standardization of QSCC II (Questionnaire for the Sasang Constitution Classification II) (사상체질분류검사지(四象體質分類檢査紙)(QSCC)II의 표준화(標準化) 연구(硏究) - 각 체질집단의 군집별(群集別) Profile 분석을 중심으로 -)

  • Kim, Sun-Ho;Ko, Byung-Hee;Song, Il-Byung
    • The Journal of Korean Medicine
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    • v.17 no.2 s.32
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    • pp.337-393
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    • 1996
  • The purpose of this study is to evaluate and standardize the four scales of Questionnaire for the Sasang Constitution Classification  II (QSCCII). QSCCII is newly prepared by statistical item analysis and is designed to examine its diagnostic discriminability. QSCCII is administered to 1366 random informants. From the survey, we could get the data for the standardization. The criteria of standardization are based on the data from 265 informants who are examined by professionals. Collectted data are analyzed by internal consistency, variation analysis(ANOVA), Duncan test and discrimination analysis of SPSS PC+ V4.0 program. The results are as follows reliability of four scales for QSCCII is relatively valid. The internal consistency of Tae-yang(太陽) (太陽) scale is Cronbach's a=0.5708. That of So-yang(少陽) scale is a=0.5708. That of Tae-eum(太陰) scale is a =0.5922. That of So-eum(少陰) scale is a=0.6319. 2. There is a significant difference between each group through variation analysis of four scales. 3. The process of standardization is based on the average value and standard deviation with respect to age and sex difference of each criteria 4. This study suggests a source of standardization of Sasang Constitution Classification by providing norms in which the differences of age, sex, and number of items are taken into deep consideration. QSCC Ⅱ, therefore, can be applied to every age(the 10's to the 60's) and sex groups. 5. The recalculation of the raw-score to standard value (T-score) shows that the diagnostic discriminability (Hit-ratio: 70.08%) of QSCC Ⅱ brings about 37% improvement than proportional chance criteria (33.33%). Especially, Hit-ratios of Tae-eum In(74.5%) and So-eum In(70.8%) are higher than that of So-yang In(60.0%). 6. QSCC has discriminability only to male informants. Compared with QSCC, however, QSCC II has relatively efficient discriminability both to male and female informants. 7. These results would be a demonstration of the fact that the QSCC II could be used as a tool for sasang constitution classification.

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Surgical Clues of Distal Anterior Cerebral Artery(DACA) Aneurysms (원위부 전대뇌 동맥류 수술의 실마리)

  • Kim, Sung Bum;Yi, Hyeong Joong;Kim, Jae Min;Bak, Koang Hum;Kim, Choong Hyun;Oh, Suck Jun
    • Journal of Korean Neurosurgical Society
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    • v.29 no.12
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    • pp.1555-1562
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    • 2000
  • Objects : Surgical management of the distal anterior cerebral artery(DACA) aneurysms presents several unique problems to surgeons, such as difficulty in early identification of parent arteries, high incidence of rebleeding and premature rupture, and requirement of unfamiliar approach other than conventional frontotemporal craniotomy. Therefore, preoperative anatomical knowledge of anterior interhemispheric fissure and entry point of dissection is prerequisite. Authors utilized a frontobasal approach for DACA aneurysms by using consistent external landmark for guidance to the deep structure. Materials and Methods : From Nov. 1995 to Jun. 1999, a surgical clipping of DACA aneurysms was carried out in 9 patients among a total 131 patients with intracranial aneurysms. In each case, the clinical and aneurysmal features were carefully reviewed through the angiograms, medical records, and intraoperative findings. Results : The incidence of DACA aneurysms was 6.9% from our series. All cases were arisen from juxtacallosal por-tion ; 6 cases from pericallosal-callosomarginal(PC-CM) junction and 3 from pericallosal-frontopolar(PC-FP) junction. Associated vascular anomalies were noted in 3 cases and multiple aneurysms in 3 cases, respectively. The preoperative clinical grades were generally poor. An early surgery was performed in 7 cases and frontobasal interhemispheric approaches in 7 cases. Postoperatively, two patients died of complications ; one delayed ischemic vasospasm and one aspiration pneumonia but remaining patients recovered well. Conclusion : The frontobasal interhemispheric approach was useful for DACA aneurysms in early surgery. Division of superior sagittal sinus(SSS) enabled a minimal retraction of brain on both sides, and prevention of intraoperative rupture was possible. Authors suggest the frontopolar(first frontal bridging) vein as a constant external landmark for approaching the genu of the corpus callosum and juxtacallosal DACA aneurysms.

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On the Study of Forest Sampling Methods in Natural Deciduous Forest (활엽수림(闊葉樹林)에 대(對)한 자원조사법(資源調査法)의 연구(硏究))

  • Kim, Kap Duk
    • Journal of Korean Society of Forest Science
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    • v.17 no.1
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    • pp.35-42
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    • 1973
  • Deciduous trees grown naturally in the forest of Korea usually have an irregular Lee-form and their utility has been decreased. In Korea, most of the deciduous stands are distributed in the hinterland. A shortage of the total growing stock made utilization of them necessary in this country even though some difficulties to be cutted and transported are accompanied. Therefore, this study was conducted to select the suitable sampling method for surveying them. The results investigated are as follows. 1. Three locations being 10 hectares in each location for the plots were chosen and surveyed with six $20m{\times}50m$ rectangular sample plots by four types of sampling method below. And the result is shown in Table 1. A. Random sampling by grids B. Random sampling by co-ordinates C. Systematic line plot. D. Sub-sampling 2. One hundred and fifty hectares from all plots were sectioned through the application of aerial photography scaled of 1 : 15,000. The author divided forest types according to diameter class and crown density with mirror stereoscope. The forest types were divided into three classes. Seven sample plots from the area of 150 hectars are systematically arranged and the results investigated on the circular sample point of 0.1 hectare are shown in Table 4. 3. There were no significant differences between results by sampling method and by diameter measurement method (population mean) as shown in Table 3. 4. Random sampling by grid and systematic line plot are better than others. 5. There are more over-estimated values when the circular sample point is used than where the rectangular sample point. 6. As forest stands are irregular, smaller number of sample points will make many errors.

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