• Advances in pediatric surgery
• /
• v.13 no.2
• /
• pp.105-111
• /
• 2007

We reviewed the records of 25 patients who were re-operated upon after primary repair of esophageal atresia with or without fistula at the Department of Pediatric Surgery, Seoul National University Children's Hospital, from January 1997 to March 2007. Types of the esophageal atresia anomalies were Gross type A in 5 patients, C in 18, and E in 2. The indications for re-operation were anastomosis stricture (n = 14), tracheo-bronchial remnant (n = 4), persistent anastomosis leakage (n = 3), recurrent tracheo-esophageal fistula (n = 2) and esophageal web (n = 2). The interval between primary and secondary surgery was from 48 days to 26 years 5 months (mean: 2 years and 4 months). Four patients required a third operation. The interval between the second and third operation was between 1 year 1 month and 3 year 10 month (mean: 2 years 5 months). Mean follow up period after last operation was 35 months (1 years-8 years 6 months). The secondary surgery was end-to-end esophageal anastomosis in 15, esophagoplasty in 5, gastric tube replacement in 5. After secondary operation, 6 patients had anastomosis stricture (4 patients were relieved of the symptoms by balloon dilatation, 2 patients underwent tertiary operation). Five patients had leakage (sealed on conservative management in all). Two patients had recurrent tracheo-esophagel fistula (1 patient received chemical cauterization and 1 patient underwent tertiary operation). Currently, only one patient has feeding problems. There were no mortalities. Secondary esophageal surgery after primary surgery for esophageal atresia was effective and safe, should be positively considered when complications do not respond to nonoperative therapy.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
• /
• v.32 no.1
• /
• pp.39-42
• /
• 2021

Granuloma is an uncommon benign disease that develops in the process of wound healing. Pharyngeal or laryngeal granuloma can be associated with gastric reflux, mechanical injury or trauma including intubation, voice abuse, or foreign body. 50-year-old female was transferred to our institute with a huge mass occupying the upper aerodigestive tract causing dysphagia. The patient has been suffering from a brain hemorrhage for several months and was kept in bed due to the quadriplegia with stuporous mental status, and was tracheotomized. On examination, the whole oropharynx and hypopharynx was covered by a smooth-surfaced soft big diffuse granular mass, which extended down to the upper trachea through the larynx. The huge granuloma was successfully removed with surgery and was found to have a pedunculating stalk on the oropharyngeal posterior wall with a small mucosal defect, suggestive of the origin of the mass. The defect was closed primarily after the cauterization. The patient is now followed up regularly without any recurrence of the disease.

• Journal of Digestive Cancer Research
• /
• v.2 no.1
• /
• pp.1-4
• /
• 2014

Palliative care for cancer aims to relieve the discomfort and pain from the cancer itself and associated conditions. Gastrointestinal cancers originate from the tube like structure of gastrointestinal tract and cause complications such as obstruction, bleeding, adhesion, invasion, and perforation to adjacent organ. Recent advances in interventional endoscopy enables endoscopy physicians to do safe and effective care for gastrointestinal cancer patients. Endoscopic palliation includes stent, hemostasis, nutritional support and targeted drug delivery. Self expandable metallic stent is one of the most important modalities in gastrointestinal palliation. Through the endoscopy or over the wire pre-placed by endoscopy, stents restore the gastrointestinal luminal patency and relieve the obstructive condition. Endoscopic hemostasis is another important palliation in gastrointestinal cancer patients. Epinephrine injection, argon plasma coagulation and thermal cauterization are usual modalities for hemostasis. Histoacryl glue and fibrin glue are also available. Hemostatic nanopowder spray is newly reported effective in benign disease and is supposed to be effective also in cancer bleeding. Enteral feeding tubes including gastro- or jejunostomy and nosoduodenal tubes are placed by using endoscopic guidance. Enteral feeding tubes role as the route of easily absorbable or semi-digested nutrients and effectively maintain both patients calorie requirements and gut microenvironment. Photodynamic therapy is the one of the outstanding medical employments of photo-physics. Especially for superficial cancers in esophagus, photodynamic therapy is very useful in cancer removal and maintaining organ structure. In biliary neoplasm, photodynamic therapy is well known to be effective in cancer ablation and biliary ductal patency restoration. Targeted drug delivery is the lastest issue in palliative endoscopy. Debates and questions are still on the table. In this article, the role of endoscopic interventions in palliative care for the gastrointestinal tumors will be thoroughly reviewed.

• The Journal of the Korean bone and joint tumor society
• /
• v.1 no.2
• /
• pp.145-153
• /
• 1995

Giant cell tumor is most frequently found in juxtaarticular region, and difficult to treat because of local recurrence. Although primary resections reduce recurrence, the joint function will be markedly impaired. Techniques involving physical adjuncts(high speed burr and electric cauterization), acrylic cement or en bloc resection with VFG(vascularized fibular graft) have been employed to reduce local recurrence. From October 1984 to April 1994, twenty-nine patients diagnosed as giant cell tumor were treated at department of Orthopaedic Surgery, School of Medicine, Kyung Hee University. There were eleven men and 18 women, ranging in age from 17 to 52 years(mean: 34 years). The average follow-up period was four years and five months. The location of the lesion was around the knee in 15, distal radius in three, femoral head in three, and others in eight patients. Fifteen patients around the knee joint were treated with several modalities; curettage with bone graft in five, curettage with cement filling in three, curettage with bone graft and physical adjuncts in five, en bloc resection with VFG in one and en bloc resection with arthroplasty in one patient. The functional results, according to the Marshall's knee score, were excellent in one, good in two, and fair in two after the curettage with bone graft, good in three after the curettage with bone cement filling, excellent in one, good in four after the curettage with bone graft and physical adjuncts, and good in two after the en bloc resection with VFG or arthroplasty. Three patients had local recurrence among 15 patients with giant cell tumor around knee. Vascularized fibular graft around wrist joint provided good functional restoration without local recurrence in all three patients who had giant cell tumor in distal radius. Although there is no statistical significance, it seems that curettage with bone graft using physical adjuncts or acrylic cement reveals better results than simple curettage with bone graft. Excellent functional result were obtained without local recurrence by using vascularized fibular graft after en bloc resection.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.10 no.1
• /
• pp.20-27
• /
• 2007

Purpose: This study was performed to review the recent experiences of pediatric gastrointestinal (GI) endoscopy done in one university hospital. Methods: A retrospective review of medical records was conducted of 1,040 pediatric cases who underwent GI endoscopy at the Pusan National University Hospital between January 2001 to June 2005. Results: A total of 1,040 endoscopies (upper 840 and lower 200) were performed. The male/female ratio was 1.25:1. Neonates and infants accounted for 6.0% and 16.5% respectively. Half of the children were below 5 years (mean age $8.5{\pm}2.1$ years). Upper and lower GI diagnostic endoscopies were performed in 634 and 163 children respectively. Abdominal pain (38.8%), vomiting (19.4%), foreign body (17.7%), and hematemesis (10.3%) were the main reasons for esophagogastroduodenoscopy. Hematochezia (56.0%), abdominal pain (27.5%) and diarrhea (3.0%) were the main reasons for colonoscopy. Upper GI therapeutic procedures included retrieval of foreign bodies, balloon dilatations of esophageal stricture, PEG, and variceal ligation in 148, 27, 15, and 3 children, respectively. Therapeutic lower GI endoscopies were performed in 37 children (polypectomy in 92%, argon lazer cauterization for angiodysplasia in 4%). Conclusion: GI endoscopy played an important role in the diagnosis and treatment of GI diseases in children. Procedures in younger aged children, cases evaluated by colonoscopy and therapeutic endoscopies are increasing in pediatric practice.

• Journal of Oral Medicine and Pain
• /
• v.19 no.1
• /
• pp.73-91
• /
• 1994

The author used rabbits in order to examine the effect of Ga-As low power generating semiconductor laser on artificially produced injuries of experimental animals. Artificially produced injuries include surgical wound of 3mm length, 2mm depth in size on ventral skin surface of rabbit and buccal mucosa, and electrical injury formed on opposite side of skin and buccal mucosa by electrical cauterization of same length and depth, and chemical injury formed by FC(Formocresol) solution applied on the anterior dorsal part of tongue. And then, on the experimental group, Ga-As laser was irradiated beginning on the day after the wound formation and continued to irradiate every each other day for five minutes. After1, 3, 6, 9, 13th day, certain number of animals of control and experimental group were sacrified, and wound site tissue was excised to make samples and was observed under light microscope. The following is the conclusions after comparing the healing procedure of experimental and control group. The following results were obtained : 1. Inflammation was decreased more rapidly in the experimental group than the control group. 2. In the surgical, the electrical and the chemical injuries in the oral mucosa, re-epithelialization was completed more rapidly in the experimental group than the control group. In the electrical injury on the skin, re-epithelialization was completed about 6 days after wound formation on both groups. 3. In the electrical and the surgical injuries on the oral mucosa, granulation tissue formation started at 3 days after injury on both groups, but in the chemical injury, it was completed about 3 days faster in the control group than the experimental group. In the surgical wound on the skin, it was completed about 9 days after injury, but faster in the experimental group. In the electrical injury on the skin, it was faster in the control group than the experimental group. 4. In the electrical and the surgical injuries on the oral mucosa, fibrosis was started at 6~9 days after injury on both groups, but regeneration of connective tissue in the experimental group was observed much more than the control group. 5. When comparing the effect of wound healing on skin and oral mucosa of control and experimental group, granulation tissue formation and re-epithelialization in the oral mucosa was more vigorous. In conclusion, the difference of timing and the sequence of wound healing process(inflammation, re-epithelialization, granulation tissue formation, fibrosis) following Laser irradiation between control and experimental group was not observed, but the healing tissue was observed much more in the Laser irradiated group.

• Journal of Korean Medical classics
• /
• v.21 no.1
• /
• pp.1-11
• /
• 2008

Jangjahwa(張子和) was influenced by "Hwangjenaegyeong(黃帝內經)" and Yuhagan(劉河間)'s theory, and other classics. Also, his clinical experience was helpful to theorize his thought. Thus, he improved medical theory by combining previous medical theory and his own experience. The essence of his thought is the importance of pathogenic Gi[邪氣] as the cause of disease and is Sambeop(三法) of Hantoha(汗吐下) as the methodology for removing pathogenic Gi[邪氣] away. He regarded pathogenic Gi as the cause of disease, and eliminated pathogenic Gi for the remedy. Namely, Sambeop(三法) of Hantoha(汗吐下) was selected as the best efficient method for driving pathogenic Gi away. Sambeop of Jangjahwa(張子和) have different meaning from previous one. Traditionally, Diaphoretic Therapy[汗法] was regarded as therapy for exogenous disease[外感病], and its effect was regarded as Balhanhaepyo(發汗解表). Emetic therapy[吐法] was throwing up Dameumsuksik(痰飮宿食) of stomach and above diaphragm. Purgation therapy[下法] means Tongbyeon(通便), Hajeok(下積), Sasil(瀉實), Chuksu(逐水) were regarded as therapy for Yangmyeongsiljeung(陽明實證) of Sanghan(傷寒). He submitted a new extensive concept of Sambeop adding traditional one, and expanded the application range of Sambeop. All methods, can cause circulation of Gihyeol(氣血) by opening the 'Hyeonbu(玄府)', like Moxibution therapy[灸薰], Steaming[蒸], Washing[洗],Heat therapy[慰], Cauterization[烙], Acupuncture therapy[鍼刺], Stone needling, Physical and breathing exercise[導引], Massage[按摩] were regarded as Diaphoretic Therapy[汗法]. Especially, he thought that Diaphoretic Therapy and venesection[瀉血] have same medical implication. If we examine the process of pushing out pathogenic Gi[邪氣] by means of Sambeop(三法), we can find the intermediation, that is circulation of Gihyeol(氣血). Its meaning is implied in the word of 'opening Hyeonbu(玄府)'. He thought that the circulation of Gihyeol(氣血) is the key to control health. Gihyeol(氣血) was circulated well under the physiological balance, but it was not circulated well under the invasion of pathogenic Gi[邪氣]. In other words, pathogenic Gi is the immediate cause of bad circulation of Gihyeol(氣血) and disease. Naturally, the doctor must remove pathogenic Gi that cause bad circulation for healing by means of Sambeop(三法). In my opinion, because the ultimate goal of Jangjahwa(張子和) was circulation of Gihyeol(氣血) by removing pathogenic Gi[邪氣], the concept of Sarnbeop(三法) could be expanded.

• Journal of Rhinology
• /
• v.25 no.2
• /
• pp.75-79
• /
• 2018

Background and Objectives: To investigate the common site of recurrent epistaxis after initial intervention such as packing and cauterization had failed and to evaluate the efficacy of surgical endoscopic electrocautery. Subjects and Method: Retrospective review of 47 patients with recurrent and uncontrolled idiopathic epistaxis between October 1995 and March 2016. All patients underwent endoscopic examination in the operating room after hospitalization. We performed electrocautery when a bleeding site was found. Results: The most common sites of bleeding were the inferior meatus (28%), sphenoethmoid recess (23%), superior septum around the olfactory cleft (13%), and the posterior end of the middle turbinate (15%). There was no serious complication during the one week after surgery. In 46 (98%) patients, refractory epistaxis was successfully controlled. One patient had recurrent epistaxis after electrocautery and underwent endoscopic sphenopalatine artery ligation. Conclusion: In patients with refractory idiopathic epistaxis after failure of first-line treatment, endoscopic examination through a surgical approach and electrocautery for suspected bleeding are effective.

• Radiation Oncology Journal
• /
• v.6 no.1
• /
• pp.63-73
• /
• 1988

One hundred fifty-four patients with the carcinoma of the uterine cervix were studied retrospectively to assess the result and impact of treatment at Department of Radiation Oncology, Korea University, Hae-Wha Hospital from Feb 1981 through Dec. 1986. Prior to radiotherapy, the patients were evaluated and staged by recommendation of FIGO including physical examination, pelvic examination, cystoscopy, rectosigmoidoscopy, chest X-ray, IVP. Ba enema. Also, an additional pelvic CT scan was obtained for some of the patients. The patients were treated by radiotherapy alone or adjuvant postoperative irradiation; in case of radiation therapy only, whole pelvic irradiation was given with Co-60 teletherapy unit via AP and PA parallel opposing fields or 4-oblique fields, 180 cGy per day, 5 days per week and intracavitary insertion was performed. In satges Ia, Ib, and IIa with small primary lesion, external irradiation was initially given to pelvis up to $2,000\~3,000\;cGy/2frac{1}{2}\;-3frac{1}{2}$ weeks and then intracavitary insertion was performed using Fletcher-Mini-Declos Applicator with cesium-137 cources and followed by external irradiation of $1,000\~2,000\;cGy/1frac{1}{2}\;-2frac{1}{2}$weeks via AP and PA parallel opposing fields with midline shield to spare of bladder and rectum. However, if the primary lesion is large, external irradiation was given without midline shield. More than stages IIb, the patients were treated by external beam irradiation up to 5,400cGy/30f for 6 weeks via 4-oblique portals and at the dose of 5,040cGy/28f the field was cut 5cm from the top margin for spare of small bowel, and followed by intracavitary irradiation, If there was residual tumor an additional dose of $900\~l,200cGy/5\~7f$ was given to parametrium and/or residual tumor area. Total dose of radiation to A and B-point were as follows; A-point; In early stages, Ia, Ib, IIa; $8,000\~9,000$ B-point $5,000\~6,000 cGy$ A-point; In advanced stages IIb, IIIa, IIIb; $9,000\~10,000$ B-point $60,000\~7,000cGy$ The results were obtained and as fellows; 1 The patients distribution according to FIGO staging system were stage Ia 6, Ib 27, IIa 28, IIb 54, IIIa 12, IIIb 18, and stage IVa 9. 2. Value of CT scan were demonstration of cervix tumor mass, parametrial and pelvic side wall tumor spread, pelvic and inguinal lymph nodes metastases, and hydronephrosis. Three dimensional quantitative demonstration of tumor volume is also important in planning radiation therapy. Another advantage of CT scan was detection of recurrent tumor after radiation or surgery. 3. Local control rate of tumor according to the size was $91.3\%$ for less than 5cm in size and $44.6\%$ in tumor over 5cm (p<0.0068). 4. Thirty out of 50 recurrent sites has locoregional failures and 17 cases has distant metastases. And the para-aortic lymph nodes were the most common site for distant metastases. 5. The most common complication was temporal rectal bleeding which was controlled most by conservative management. However, 4 patients required for endoscopic cauterization. 6. The 5-year survival rates showed; stage la and Ib $95\%,\;stage\;IIa\;81\%\;stage\;lIb\;67\%,\;stage\;IIIa\;37.7\%,\;stage\;IIIb\;23\%$ and 3-year survival rate of stage IVa showed $11.6%$, retrospectively.

• Tuberculosis and Respiratory Diseases
• /
• v.65 no.5
• /
• pp.390-395
• /
• 2008

Background: Since the early 1980s, interferon-alpha ($IFN-{\alpha}$) has been used as adjuvant therapy in pediatric patients with recurrent respiratory papillomatosis (RRP). However, its efficacy in adults needs to be validated. Since 2002, Samsung Medical Center's guidelines have mandated regular injection of $IFN-{\alpha}$ in patients with RRP to prevent recurrence. To evaluate these guidelines, patient data were investigated. Methods: Five patients diagnosed as having RRP by bronchoscopy and histopathology were included. After initial bronchoscopic intervention, including laser cauterization, all patients received subcutaneous injection of 6 million units of $IFN-{\alpha}$ every 2 months. Further bronchoscopic intervention was carried out as needed. Patients were regularly evaluated using bronchoscopy or computed tomography. Results: The median age of the patients was 44 years (range 13~68), and the median duration of papillomatosis was 31 years (range 1~45). Three and two patients had juvenile-onset and adult-onset disease, respectively. Two patients had a history of tracheostomy at the time of diagnosis. The median duration of $IFN-{\alpha}$ therapy was 56 months (range 12~66). Two patients showed complete remission at 12 and 36 months after $IFN-{\alpha}$ injection, respectively. The other three patients showed partial remission, and the number of laser therapy sessions was significantly reduced.Conclusion: Intermittent $IFN-{\alpha}$ injection is effective in patients with long-standing RRP and can reduce the number of laser therapy sessions required in their treatment.