• Journal of Gastric Cancer
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• 제15권3호
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• pp.191-200
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• 2015

Purpose: This study evaluated the functional and oncological outcomes of proximal gastrectomy (PG) in comparison with total gastrectomy (TG) for upper-third early gastric cancer (EGC). Materials and Methods: The medical records of upper-third EGC patients who had undergone PG (n=192) or TG (n=157) were reviewed. The PG group was further subdivided into patients who had undergone conventional open PG (cPG; n=157) or modified laparoscopy-assisted PG (mLAPG; n=35). Patients who had undergone mLAPG had a longer portion of their intra-abdominal esophagus preserved than patients who had undergone cPG. Surgical morbidity, recurrence, long-term nutritional status, and the incidence of reflux esophagitis were compared between the groups. Results: The rate of postoperative complications was significantly lower for PG than TG (16.7% vs. 31.2%), but the five-year overall survival rate was comparable between the two groups (99.3% vs. 96.3%). Postoperative levels of hemoglobin and albumin were significantly higher for patients who had undergone PG. However, the incidence of reflux esophagitis was higher for PG than for TG (37.4% vs. 3.7%; P<0.001). mLAPG was related to a lower incidence of reflux esophagitis after PG (P<0.001). Conclusions: Compared to TG, PG showed an advantage in terms of postoperative morbidity and nutrition, and there was a comparable prognosis between the two procedures. Preserving the intra-abdominal esophagus may lower the incidence of reflux esophagitis associated with PG.

• 한국동물위생학회지
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• 제31권4호
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• pp.521-532
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• 2008

The prevalence of major calf disease was investigated in 117 Holstein dairy calves in Chonnam area. All of them were moved in the College experimental farm which is operated in intensive units. clinical signs were daily examined throughout two months after the introduction of the College farm. Among calves, 92 cases(78.6%) died in the two months after the introduction in it. Outbreaks of respiratory and alimentary diseases were their main causes of their fatality. The incidence of respiratory disorders during the full period of the experiment was up to 42.8%, and the alimentary diseases were occurred 35.9% of the herd. Most of the mortality was related with respiratory(59.9%) and alimentary(52.1%) pathogens. Also calf mortality by combined infection claimed 6.6% among 100 morbidity cases. Principle pathogens to cause mortality were Pasteurella spp(44.4%), E coli(29.9%), bovine viral diarrhea virus(16.2%), IBRV(12.0%), respectively. Viruses also played as an important role in increasing calf morbidity to secondary respiratory bacterial pathogens. Pasteurella infection combined with infectious bovine rhinotracheitis virus(11 cases), parainfluenza virus type-3(9 cases), or bovine respiratory syncytial virus(7 cases) was appeared as major pattern to mortality. colibacillosis in causing enteritis was concurrently infected with BVD(19 cases), bovine coronavirus infection(14 cases), salmonellosis(5 cases), coccidiosis(5 cases) and clostridial infection(4 cases). Ninty-two cases to death were appeared to have 100% neutralizing antibodies to BCV; Among them, 73.8% had the neutralizing antibody level higher than 64. Calves with neutralizing antibodies higher than 16 to BVDV were 50%. The cases with neutralizing antibody level lower than 8 to BEFV were 89.4% that means the necessity of appropriate vaccination.

• Journal of Korean Neurosurgical Society
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• 제30권8호
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• pp.992-997
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• 2001

Objectives : Essential hyperhidrosis is a common condition characterized by excessive body sweating. Excessive sweating beyond what is necessary to maintain normal body temperature need not be considered pathological unless it interferes with one's occupation and/or life-style. The existing non-operative therapeutic options seldom give sufficient relief or show a transient effect. In this regard, the thoracic sympathectomy may provide a definitive cure. In the past, surgical procedures were highly invasive and caused significant morbidity, but the minimally invasive thoracoscopic procedure provided detailed visualization of sympathetic ganglia and is associated with minimally postoperative morbidity. Nowadays, thoracoscopic transthoracic sympathectomy is accepted as the treatment of choice for essential hyperhidrosis. In palmar hyperhidrosis, however, the level of sympathetic chain to be blocked has been somewhat obscure. It is assumed that the incidence of compensatory hyperhidrosis may closely related to the extent of thoracic sympathectomy. Material & Methods : To compare the results of posterior midline approach with endoscopic sympathectomy, and the results of T2 with T2, 3 sympathectomy or sympathicotomy, we retrospectively studied 62 patients treated for palmar hyperhidrosis between September 1993 and May 2000. We reviewed medical records and recently interviewed the patients by telephone calls. Results : The treatment effect of T2 sympathectomy is no different from T2, 3 sympathectomy. But, the incidence of compensatory hyperhidrosis is less in the T2 sympathectomy group than the T2, 3 sympathectomy group. Conclusion : Thoracoscopic sympathectomy is considered a simple, safe, and effective method for treating palmar hyperhidrosis, with a shorter operation time, fewer hospital days, and a better cosmetic result, as compared with the open approaches. However, sympathicotomy seems to provide the advantages of a limited extent of denervation and the resultant decrease of compensatory hyperhidrosis compared to sympathectomy.

• Journal of Korean Neurosurgical Society
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• 제44권4호
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• pp.228-233
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• 2008

Objective : The standard treatment strategy of intracranial aneurysms includes either endovascular coiling or microsurgical clipping. In certain situations such as in giant or dissecting aneurysms, bypass surgery followed by proximal occlusion or trapping of parent artery is required. Methods : The authors assessed the result of extracranial-intracranial (EC-IC) bypass surgery in the treatment of complex intracranial aneurysms in one institute between 2003 and 2007 retrospectively to propose its role as treatment modality. The outcomes of 15 patients with complex aneurysms treated during the last 5 years were reviewed. Six male and 9 female patients, aged 14 to 76 years, presented with symptoms related to hemorrhage in 6 cases, transient ischemic attack (TIA) in 2 un ruptured cases, and permanent infarction in one, and compressive symptoms in 3 cases. Aneurysms were mainly in the internal carotid artery (ICA) in 11 cases, middle cerebral artery (MCA) in 2, posterior cerebral artery (PCA) in one and posterior inferior cerebellar artery (PICA) in one case. Results : The types of aneurysms were 8 cases of large to giant size aneurysms, 5 cases of ICA blood blister-like aneurysms, one dissecting aneurysm, and one pseudoaneurysm related to trauma. High-flow bypass surgery was done in 6 cases with radial artery graft (RAG) in five and saphenous vein graft (SVG) in one. Low-flow bypass was done in nine cases using superficial temporal artery (STA) in eight and occipital artery (OA) in one case. Parent artery occlusion was performed with clipping in 9 patients, with coiling in 4, and with balloon plus coil in 1. Direct aneurysm clip was done in one case. The follow up period ranged from 2 to 48 months (mean 15.0 months). There was no mortality case. The long-term clinical outcome measured by Glasgow outcome scale (GOS) showed good or excellent outcome in 13/15. The overall surgery related morbidity was 20% (3/15) including 2 emergency bypass surgeries due to unexpected parent artery occlusion during direct clipping procedure. The short-term postoperative bypass graft patency rates were 100% but the long-term bypass patency rates were 86.7% (13/15). Nonetheless, there was no bypass surgery related morbidity due to occlusion of the graft. Conclusion : Revascularization technique is a pivotal armament in managing complex aneurysms and scrupulous prior planning is essential to successful outcomes.

• Journal of Chest Surgery
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• 제34권9호
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• pp.680-685
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• 2001

배경: 삼첨판막친환술은 매우 드물게 시행되는 수술이며 그 장기 성적은 만족치 못한 수준이다. 또한 어떤 종류의 인공판막을 사용하느냐에 대하여도 논란이 많은 상황이다. 서울대학교병원 흉부외과에서는 1989년 1월부터 1998년 12월까지 10년동안 71명의 환자에서 72례의 삼첨판막 치환술을 시행하였으며 이 결과를 토대로 장단기 성적과 위험요인들을 분석하였다. 대상 및 방법: 평균나이는 42$\pm$13세(16~65세)였으며 남여비는 32/39였다. 술전진단은 50례의 후천성판막질환과 18례의 선천성심장질환이 있었고 삼첨판폐쇄부전만 단독으로 있었던 경우도 4례 있었다. 사용된 인공판막은 기계판막이 69개, 조직판막이 3개였다. 승모판막치환술 또는 대동맥판막치환술과 같이 시행된 경우는 50례였고 1례에서는 폐동맥판막 치환술이 같이 시행되었다. 결과: 조기사망은 7례(9.7%), 만기사망은 7례(13.0%)였고 10년 생존율은 59.2$\pm$7.2%였다. 삼천판막혈전증은 5례에서 11번에 결쳐 발생하였으며 그중 1례는 재수술을 시행받았다. 생존자들의 대부분은 심장기능분류 I-II의 상태로 현재까지 외래 추적관찰중이다. 결론: 삼첨판막치환술은 비록 혈전증등의 위험이 상존하기는 하지만 비교적 낮은 사망률과 이환율을 보이고 있으며 기계판막의 경우에도 조직판막과 비교하여 큰 차이 없이 좋은 장기성적을 얻을 수 있었다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권2호
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• pp.707-712
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• 2014

Purpose: Anastomotic leakage (AL) is associated with high morbidity and mortality, high reoperation rates, and increased hospital length of stay. Here we investigated the risk factors for AL after anterior resection for rectal cancer with a double stapling technique. Patients and Methods: Data for 460 patients who underwent primary anterior resection with a double stapling technique for rectal carcinoma at a single institution from 2003 to 2007 were prospectively collected. All patients experienced a total mesorectal excision (TME) operation. Clinical AL was defined as the presence of leakage signs and confirmed by diagnostic work-up according to ICD-9 codes 997.4, 567.22 (abdominopelvic abscess), and 569.81 (fistula of the intestine). Univariate and logistic regression analyses of 20 variables were undertaken to determine risk factors for AL. Survival was analysed using the Cox regression method. Results: AL was noted in 35 (7.6%) of 460 patients with rectal cancer. :Median age of the patients was 65 (50-74) and 161 (35%) were male. The diagnosis of AL was made between the 6th and 12th postoperative day (POD; mean 8th POD). After univariate and multivariate analysis, age (p=0.004), gender (p=0.007), tumor site (p<0.001), preoperative body mass index (EMI) (p<0.001), the reduction of TSGF on 5th POD less than 10U/ml (p=0.044) and the pH value of pelvic dranage less than or equal to 6.978 on 3rd POD (p<0.001) were selected as 6 independent risk factors for AL. It was shown that significant differences in survival of the patients were AL-related (p<0.001), high ASA score related (p=0.036), high-level EMI related (p=0.007) and advanced TNM stage related

• Clinical and Experimental Pediatrics
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• 제54권6호
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• pp.246-252
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• 2011

Purpose: The outcomes of small for gestational age (SGA) infants especially in extremely low birth weight infants (ELBWIs) are controversial. This study evaluated the mortality and morbidity of ELBWIs, focusing on whether or not they were also SGA. Methods: The medical records of 415 ELBWIs (birth weight<1,000 g), who were inborn and admitted to the Samsung Medical Center neonatal intensive care unit from January 2000 to December 2008, were reviewed retrospectively. Mortality and morbidities were compared by body size groups: very SGA (VSGA), birth weight ${\leq}$3rd percentile; SGA, 3rd to 10th percentile; and appropriate for gestational age (AGA) infants, >10th percentile for gestational age. For gestational subgroup analysis, groups were divided into infants with gestational age ${\leq}24^{+6}$ weeks (subgroup I), $25^{+0}$ to $26^{+6}$ weeks (subgroup II), and ${\geq}27^{+0}$ weeks (subgroup III) Results: Gestational age was $29^{+2}{\pm}2^{+6}$ weeks in the VSGA infants (n=49), $27^{+5}{\pm}2^{+2}$weeks in the SGA infants (n=45), and $25^{+4}{\pm}1^{+4}$ weeks in AGA infants (n=321). Birth weight was $692{\pm}186.6$ g, $768{\pm}132.9$ g, and $780{\pm}142.5$ g in the VSGA, SGA, and AGA groups, respectively. Cesarean section rate and maternal pregnancy-induced hypertension were more common in the VSGA and SGA than in AGA pregnancies. However, chorioamnionitis was more common in the AGA group. The mortalities of the lowest gestational group (subgroup I), and also of the lower gestational group (subgroup I+II) were significantly higher in the VSGA group than the SGA or AGA groups (P=0.020 and P=0.012, respectively). VSGA and SGA infants showed lower incidence in respiratory distress syndrome, ductal ligation, bronchopulmonary dysplasia, intraventricular hemorrhage than AGA group did. However, by multiple logistic regression analysis of each gestational subgroup, the differences were not significant. Conclusion: Of ELBWIs, extremely SGA in the lower gestational subgroups, had an impact on mortality, which may provide information useful for prenatal counseling.

• Journal of Trauma and Injury
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• 제25권4호
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• pp.115-121
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• 2012

Purpose: Severe pancreaticoduodenal injuries are relatively uncommon, but may result in high morbidity and mortality, especially when management is not optimal, and determining the appropriate treatment is often difficult. The objective of this study was to review our experience and to evaluate the role of a pancreaticoduodenectomy (PD) in treatment of pancreaticoduodenal injuries. Methods: We performed a retrospective review of 16 patients who underwent an emergency PD at our hospital for severe pancreaticoduodenal injury from 1990 to 2011. Demographic data, clinical manifestations, mechanism and severity of the injury, associated injuries, postoperative complications and outcomes were reviewed. Results: The mean age of the 16 patients was $45{\pm}12years$ ($mean{\pm}standard$ deviation), and 15(93.8%) patients were male. All patients underwent an explorative laparotomy after a diagnosis using abdominal computed tomography. Almost all patients were classified as AAST grade higher than III. Thirteen(83.3%) of the 16 patients presented with blunt injuries; none presented with a penetrating injury. Only one(6.3%) patients had a combined major vascular injury. Fifteen patients underwent a standard Whipple's operation, and 1 patient underwent a pylorus-preserving pancreaticoduodenectomy. Two of the 16 patients required an initial damage-control procedure; then, a PD was performed. The most common associated injured organs were the small bowel mesentery(12, 75%) and the liver(7, 43.8%). Complications were intraabdominal abscess(50%), delayed gastric emptying(37.5%), postoperative pancreatic fistula(31.5%), and postoperative hemorrhage (12.5%). No mortalities occurred after the PD. Conclusion: Although the postoperative morbidity rate is relatively higher, an emergency PD can be perform safely without mortality for severe pancreaticoduodenal injuries. Therefore, an emergency PD should be considered as a life-saving procedure applicable to patients with unreconstructable pancreaticoduodenal injuries, provided that is performed by an experienced hepatobiliary surgeon and the patient is hemodynamically stable.

• Journal of Trauma and Injury
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• 제26권3호
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• pp.157-162
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• 2013

Purpose: Abdominal trauma rarely causes injuries involving duodenum. But, it is associated with higher rate of the complication and mortality than other abdominal injuries. There are many options for the management of duodenal injuries. Herein we are to review our experiences and find out the risk factors related to the morbidity and the mortality in traumatic duodenal injuries. Methods: The medical records of total 25 patients who managed by surgical managements and survive more than 48 hours were conducted from January 2006 to December 2012. The clinical characteristics, treatments, and outcomes are reviewed. Results: Among 25 patients, most of them (n=17, 68.0%) were managed by the pyloric exclusion and the gastrojejunostomy. The $3^{rd}$ portion is the most injured site (n=15, 60.0%), and the majority exhibited grade 2 severity (n=14, 56.0%). Most of patients had blunt abdominal traumas (n=23, 92.0%) so that many of them (n=14, 56.0%) had other combined abdominal injuries. The mean ISS is $11.5{\pm}6.2$. The surgery related mortality rate was 28.0%. There was no statistical significance between each factors and the mortality except leakage (p=0.012). But, we could find some trends about traumatic duodenal injuries in this study. The mortality rates of them who older than 55 years were higher than others. And, all 3 patients who delayed the operation more than 24 hours after the trauma had some complications or died. Also, the patients who had the $2^{nd}$ portion injury, grade 3 injury, or combined abdominal injury were less survived. Conclusion: Duodenal injury is related to high rate of morbidity(47.8%) and mortality(28.0%). Age, portion of injury, OIS grade, ISS>15, combined intra-abdominal operation, and trauma to operation time over 24 hrs have some trend with attribution to mortality. Especially leakage of duodenal injury is related to mortality.

• Journal of Chest Surgery
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• 제35권2호
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• pp.113-117
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• 2002

기계판막이나 조직판막을 이용한 인공판막 치환술의 한계가 인식되면서부터 대동맥판막 성형술은 판막치환술의 대안으로 관심을 끌어왔다. 대상 및 방법: 1999년 7월부터 2000년 7월까지 대동맥판막 폐쇄부전으로 설상절제술(triangular resection)을 시행 받은 8명의 환자를 대상으로 수술합병증 및 수술 전후의 심초음파 소견을 비교하였다. 8례 중 남자와 여자는 각자 4명이었으며, 평균 연령은 18.4$\pm$12.6세였다. 술전 시행한 심초음파검사에서 대동맥판막 폐쇄부전의 정도는 평균 3.570.5였다. 6례에서는 심실중격결손증을 동반한 삼첨판인 대동맥판막이었고, 2례에서는 이첨판이었다. 수술방법은 탈출된 판엽을 nodule of Arantius를 중심으로 다른 엽보다 길어진 만큼 설상절제하고 교련술을 시행하였다. 이첨판인 경우는 raphe를 제거하였다. 결과: 기사망이나 합병증은 발생하지 않았다. 평균 추적기간은 11.9$\pm$3.6개월이었으며, 술후 항응고제는 사용되지 않았다. 수술전, 퇴원전 그리고 마지막 추적 검사시 시행한 심초음파검사에 의한 대동맥판막 폐쇄부전의 정도는 각각 grade 3.5$\pm$0.6, grade 0.6$\pm$0.5 그리고 grade 0.8$\pm$0.6으로 통계적으로 유의하게 감소하였다(p value=0.01). 마지막 추적검사에서의 대동맥판막 폐쇄부전의 정도는 grade 2가 1명이였고, 나머지 환자들에서는 grade 1이거나 경도 미만한 정도였다. 결론: 설상절제술은 만족할만한 조기결과를 보여주지만,오랜 기간의 추적검사가 필요하리라 본다.