• 대한임상독성학회지
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• 제7권2호
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• pp.127-136
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• 2009

Purpose: It is known that aspiration pneumonitis is associated with high mortality and morbidity following overdose. However, until now, few domestic studies on this subject have been conducted. The main aim of this study is to investigate the risk factors associated with aspiration pneumonitis in intubated patients following overdose. Methods: Among 654 adult overdosed patients who visited our institution from Jan. 2006 to June 2008, we enrolled 70 intubated patients within 24 hours after their overdose, and we reviewed the medical records to collect the data. This data was processed by univariate analysis, followed by multiple logistic regression analysis. P values <0.05 were deemed statistically significant. Results: In our study, a high incidence of pneumonitis was seen in the patients with an older age, a lower GCS and a high poisoning severity score or a high comorbidity score (p<0.05). Compared with the non-pneumonitis group, the pneumonitis group had a higher incidence of intubation (6% vs 61.8%, respectively, p<0.05). The main cause of intubation was a decreased mentality (68.6%). Older age, a high comorbidity score, irrigation without airway protection, relative hypoxemia and hyperkalemia were the risk factors of aspiration pneumonitis in the intubated overdosed patients (p<0.05). Among these factors, age, a high potassium level and airway protection might be significant predictors of aspiration penumonitis (p<0.05). Conclusion: Older age, a high potassium level and irrigation without proper airway protection may be the significant factors that can predict aspiration pneumonitis in patients who are intubated within 24 hours after overdose, although the further investigations on this are needed.

• Journal of Gastric Cancer
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• 제5권3호
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• pp.139-145
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• 2005

위암은 한국에서 가장 발생빈도가 높은 암이며 암 사망원인의 2위를 차지하고 있다. 치료법 중에서 수술이 유일하게 완치의 기회를 제공하나, 진행 암에서는 근치적 절제(R0 resection, R0 절제)수술 후에도 약 50%의 환자에서 재발을 보여, 보다 효과적인 치료법의 개발이 필요하다. 선행화학요법은 병소가 급격하게 성장, 팽창하는 것을 막고 내성을 지닌 세포의 출현을 예방하며 그렇게 함으로써 완치의 기회를 늘리고, 암의 국소 조절을 더 잘 함으로서 수술의 범위를 줄여 수술로 인한 부담을 줄이며, 절제 불가능한 암을 절제 가능한 암으로 만드는 것이 목표이다. 따라서 치유절제가 불가능할 것으로 판단되었던 위암의 병기를 낮추어 R0 절제 후 완치율을 높일 것으로 기대되고 있으며 계속되는 연구에서 수술로 인한 이환율과 사망률을 높이지 않는 것으로 나타나고 있다. 선행 화학요법에 사용할 수 있는 항암제는 여러 가지이나 가장 높은 효과를 보이는 항암제가 결정되지 않았고 또 항암제를 투여하는 시기, 선행 화학요법 후에 재발을 방지하기 위한 항암제의 복강 내 투여나 방사선 치료의 병용 등이 복막 전이와 국소재발을 줄이는 데 도움이 되는지 등이 향후 시행될 연구에서 규명되어야 하겠고, 또 적절한 수술방법에 관하여도 합의가 이루어져야 하겠다. 선행 화학요법과 관련된 여러 가지 의문들을 해결하기 위한 노력은 다기관이 참여하는 전향적 무작위 3상 임상연구를 통하여 이루어져야 할 것으로 생각된다.

• Archives of Plastic Surgery
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• 제34권2호
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• pp.191-196
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• 2007

Purpose: Gluteal perforator is easily identified in the gluteal region and gluteal perforator flap is a very versatile flap in sacral sore reconstruction. We obtained satisfying results using the gluteal perforator flap, so we report this clinical experiences with a review of the literature. Methods: Between November of 2003 and April 2006, the authors used 16 gluteal perforator flaps in 16 consecutive patients for coverage of sacral pressure sores. The mean age of the patients was 47.4 years (range, 14 to 78 years), and there were 9 male and 7 female patients. All flaps in the series were supplied by musculocutaneous arteries and its venae comitantes penetrating the gluteus maximus muscle and reaching the intrafascial and suprafascial planes, and the overlying skin forming a rich vascular plexus arising from gluteal muscles. Patients were followed up for a mean period of 11.5 months. Results: All flaps survived except one that had undergone total necrosis by patient's negligence. Wound dehiscence was observed in three patients and treated by secondary closure. There was no recurrence during the follow-up period. Conclusion: Gluteal perforator flaps allow safe and reliable options for coverage of sacral pressure sores with minimal donor site morbidity, and do not sacrifice the gluteus maximus muscle and rarely lead to post-operative complications. Freedom in flap design and easy-to perform make gluteal perforator flap an excellent choice for selected patients.

• Journal of Chest Surgery
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• 제31권5호
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• pp.494-501
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• 1998

저자들은 1993년 5월부터 1995년 5월까지 인공심폐기를 사용한 개심술을 받은 211명을 대상으로 후향적 조사를 하였다. 우리는 술후 새로이 발생한 급성 신부전에 초점을 두었기에 술전 creatinine 수치가 1.5 mg/dL이하였던 환자를 다변수 통계를 이용하여 조사하였다. 술전 신기능이 정상이었던 환자는 198명(74%)이었는데 이중 27명(14%)이 술후 신장 합병증을 보였다. 20명(10%)은 신기능 이상상태(1.5$\leq$serum creatinine level < 2.5 mg/dL)였고, 7명(4%)은 급성 신부전(serum creatinine level$\geq$2.5mg/dL) 상태였다. 수술 사망률은 정상에서는 5.8%, 신기능 이상 환자에서는 5%, 급성 신부전 환자에서는 43%였다(p=0.036). 술후 급성 신부전은 심혈관 합병증, 호흡기 합병증과 함께 수술 사망의 독립적인 위험인자로 밝혀졌고, 다변수 분석에서 술후 급성 신부전 발생 위험인자는 고령, 응급수술, 저심박출증 등이었다. 술전 신부전을 보였던 13명에서 정상이었던 환자보다 술후 유병률과 사망률이 높았다. 결론적으로 술전 신기능 이상을 보이지 않았던 환자에서 술후 급성 신부전의 발생률은 낮았으나, 신부전과 동반된 사망률은 여전히 높았다. 그러므로 술전, 술중, 술후 신부전 발생에 영향을 주는 혈류역학 인자들의 세심한 관찰이 요구된다.

• Journal of Chest Surgery
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• 제47권3호
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• pp.255-261
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• 2014

Background: To determine the predictors of clinical outcomes following surgical descending thoracic aortic (DTA) repair. Methods: We identified 103 patients (23 females; mean age, $64.1{\pm}12.3$ years) who underwent DTA replacement from 1999 to 2011 using either deep hypothermic circulatory arrest (44%) or partial cardiopulmonary bypass (CPB, 56%). Results: The early mortality rate was 4.9% (n=5). Early major complications occurred in 21 patients (20.3%), which included newly required hemodialysis (9.7%), low cardiac output syndrome (6.8%), pneumonia (7.8%), stroke (6.8%), and multi-organ failure (3.9%). None experienced paraplegia. During a median follow-up of 56.3 months (inter-quartile range, 23.1 to 85.1 months), there were 17 late deaths and one aortic reoperation. Overall survival at 5 and 10 years was $80.9%{\pm}4.3%$ and $71.7%{\pm}5.9%$, respectively. Reoperation-free survival at 5 and 10 years was $77.3%{\pm}4.8%$ and $70.2%{\pm}5.8%$. Multivariable analysis revealed that age (hazard ratio [HR], 1.10; 95% confidence interval [CI], 1.05 to 1.15; p<0.001) and left ventricle (LV) function (HR, 0.88; 95% CI, 0.82 to 0.96; p<0.003) were significant and independent predictors of long-term mortality. CPB strategy, however, was not significantly related to mortality (p=0.49). Conclusion: Surgical DTA repair was practicable in terms of acceptable perioperative mortality/morbidity as well as favorable long-term survival. Age and LV function were risk factors for long-term mortality, irrespective of the CPB strategy.

• Journal of Trauma and Injury
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• 제21권2호
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• pp.115-119
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• 2008

Purpose: Abrupt abstinence from alcohol in cause of chronic alcohol addiction can trigger alcohol withdrawal syndrome. The authors studied the effect of post-operative alcohol withdrawal syndrome in patients who require intensive care due to trauma. Methods: For the study group, we selected 70 patients who had undergone emergency surgery from May 2003 to March 2007 due to trauma and who had been treated with prophylactic thiamine. Data was collected retrospectively. We excluded those who extended their hospital stay for other than traumatic causes, those who died within 3 days of surgery after trauma, those who transferred to other institutions, and those who received a psychiatric diagnosis. Patient groups were determined by the existence or the non-existence of withdrawal syndrome. Age, sex, injury mechanism, mortality, complications, durations of hospital stay and intensive care, use of mechanical ventilator, and sedative use were investigated. A Chi-square test and The Mann-Whitney method were used for statistical analysis in this study. Results: Twenty-four (24) patients from the 58 who had an ISS of 16 or more showed alcohol withdrawal syndrome, and men were shown to be affected with the syndrome significantly more than women. Although ISS was higher in the group with alcohol withdrawal syndrome, statistically, the difference was not significant (P<0.08). The total hospital stay in the patient group with alcohol withdrawal syndrome was on average 10 days longer. However, the difference was not significant (P<0.054). The duration of intensive care in the patient group with alcohol withdrawal syndrome was significantly longer (P<0.029). The patients with alcohol withdrawal syndrome showed no significant difference in the duration of mechanical ventilator use (P<0.783), or in the duration of sedative use (P<0.284). Respiratory distress, pneumonia, upper airway infection, sepsis, acute renal failure, and mortality in the alcohol withdrawal syndrome group were investigated, but no statistically significant difference were noted. Conclusion: We found that the duration of intensive care in chronic alcohol abusers was longer due to the development of alcohol withdrawal syndrome. We also discovered that, when the patients overcame the symptoms of alcohol withdrawal syndrome after intensive care, no difference was found in the frequency of developing complications, the morbidity, and the mortality. Therefore, we conclude that intensive care in trauma patients who are chronic alcohol abusers decreases the incidence of complications found in patients with post-operative alcohol withdrawal syndrome and does not adversely impact the prognoses for those patients.

• 한국임상수의학회지
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• 제12권1호
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• pp.917-924
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• 1995

I suis cocciosis in piglets seems to occur in the majority of Korean sow herds. Cocci야osis is characterized by a pasty diarrhea in piglets appearing at 5 to 11 days old. Morbidity is variable, Mortality is usually low but piglets growth is always retarded. And, the principal source of infection is the environment because of the high resistance of oocysts. Control of coccidiosis is usually frustrated since the majority of treatment have not constant results. Mundt et al(1990) developed a new strategy by administrating toltrazuril as an oral suspension. This new anticoccidial drug reduced clinical signs and mortality. Therefore, we will try to medicate piglets with Baycox(Bay Vi 9142) suspension in a sow herd, having a problem of I suis coccidiosis. The incidences of coccidiosis in suckling piglets in C and D bleeding stock farm were from 28.6 to 42.3 and 21.1~57.9 % during 3 to 21 day-old. The body weights of suckling piglets in treated groups were higher than those of control groups at 11 and 18 day-old. Also, those of C breeding stock firm were higher than those of D farm. The body weight gains of suckling piglet of treated groups were higher than those of control groups. Also, those of C breeding stock firm were higher than those of D farm. There was no dead piglet in all experimental groups. Some atrophic piglets were done away with. In C breeding stock farm, the incidences of diarrhea in treatment groups were significantly lower an those of control groups. Also, the degrees of diarrhea in treated groups were significantly lower than those in control groups. In D breeding stock farm, the incidences of diarrhea in treated groups were a little lower than those in control groups. Also the degrees of diarrhea in treated groups were a little lower than those in control groups. In the treated groups, the incidences and degrees of diarrhea were reduced at the 4th day and increased at the 13th day after treatment. The number of litters excreted oocysts in treated groups wert lower than those in control groups after treatment. Also, the OPG in treated groups were lower than those in control groups. According to above results, the effect of Baycox suspension against swine coccidiosis was very good. If we will treat with Barcox suspension swine coccidiosis in swine stock farms, we can get good effects of the improvement of body weight gains and diarrhea and e reduce of excreted costs in faeces.

• Clinical and Experimental Pediatrics
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• 제49권7호
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• pp.800-804
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• 2006

괴사성 장염은 미숙아에서 외과적 응급 수술을 요하는 가장 흔한 질환이며 여전히 높은 이환율과 사망률을 차지하고 있다. 괴사성 장염의 치료로는 전통적으로 천공성 괴사성 장염인 경우 개복술이 시행되어 왔으나 미숙아에서 일차적 복강 배액술이 시도된 이후 초극소 저출생 체중아에서도 양호한 결과를 보인 사례들이 보고되고 있다. 저출생 체중아에서 천공성 괴사성 장염치료시 일차적 복강 배액술과 개복술 중 어느 시술이 더 우수한 결과를 보이는지에 대한 연구는 아직 진행 중에 있으나 일차적 복강 배액술은 전신 마취나 수술을 시행하기에는 불안정한 환자상태인 경우에 시행을 고려할 수 있다. 저자들은 초극소 저출생 체중아에서 천공성 괴사성 장염으로 인한 세균성 복막염 치료로 환아 상태상 전신 마취 및 수술을 바로 시행하기에는 어려워 일차적 복강 배액술을 시행 후 호전된 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• 대한두경부종양학회지
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• 제19권1호
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• pp.9-15
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• 2003

Purpose: To introduce our early experience with intensity-modulated radiotherapy (IMRT) in the treatment of nasopharyngeal carcinoma. Methods and Materials: Eight patients who underwent IMRT for no disseminated nasopharyngeal carcinoma at the Asan Medical Center between September 2001 and November 2002 were evaluate by prospective analysis. According to the 1997 American Joint Committee on Cancer staging classification, 5 had Stage III, and 3 had Stage IVB disease. The IMRT plans were designed to be delivered as a 'Simultaneous Modulated Accelerated Radiation Therapy' (SMART) using the 'step and shoot' technique with a MLC (multileaf collimator). Daily fractions of 2.2-2.5Gy and 1.9-2Gy were prescribed and delivered to the GTV and CTV and clinically negative neck node, respectively. The prescribed dose was 70A-79.0Gy to the gross tumor volume (GTV), 60Gy to the clinical target volume (CTV) and metastatic nodal station, and 46Gy to the clinically negative neck. All patients also received weekly cisplatin during radiotherapy. Acute and late normal tissue effects were graded according to the Radiation Therapy Oncology Group (RTOG) radiation morbidity scoring criteria. Results: Follow-up period was ranging from 5 to 18 months. All patients showed complete response and loco-regional control rate was 100% but one patient died of malnutrition due to treatment related toxicity. There were no Grade 3 or 4 xerostomia and all patients had experienced improvement of salivary gland function. Conclusion: 'Simultaneous Modulated Accelerated Radiation Therapy' (SMART) boost intensity-modulated radiotherapy technique allows parotid sparing as evidenced both clinically and by dosimetry. Initial tumor response and loco-regional control was promising. It is clinically feasible. A larger population of patients and a long-term follow-up are needed to evaluate ultimate tumor control and late toxicity.

• Journal of Korean Neurosurgical Society
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• 제30권2호
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• pp.207-210
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• 2001

Objective : The prognosis of spontaneous intracerebral hemorrhage often depends on initial neurologic condition, size and location of hemorrhage and associated intraventricular hemorrhage. However, age of patient, coagulation state and other associated vascular diseases may also play a role when present. In recent years, the geriatric population has been increasing. The age distribution of the patients with intracerebral hemorrhages also has been increased, accordingly. However, such patients, especially when associated with poor initial conditions often tend to be managed rather conservatively. The authors analyzed retrospectively on forty-five patients with spontaneous intracerebral hemorrhage over the seventies with poor initial condition to find out whether there exists a difference of outcome between surgery and non-surgery group. Material and Method : A total of 45 patients over seventies with spontaneous intracerebral hemorrhage with Glasgow Coma Scale(GCS) 4-8 treated over last six years were included. The validity of surgical management for these patients as well as clinical variables which might have been operated on the outcome of these patients were evaluated. The Glasgow Outcome Scale(GOS) after three months was used for comparison of outcome. Results : In surgical group(19 cases), mean age was 74.5 years old, mean hematoma volume 67.2ml and mean GCS score 5.7 points. In nonsurgical group(26 cases), mean age was 79.3 years old, mean hematoma volume 32.1ml, and mean GCS score 6.8 points. Mortality rate in surgical group was 47.4%(9 patients), including 2 cases of post-operative rebleeding, while that in nonsurgical group was 46.2%. However, when patients with initial GCS 4-6 points and over 30ml in hematoma volume were regrouped, mortality rate in surgical group was 46.2%, whereas mortality rate in nonsurgical group was 66.7%. Conclusion : It is concluded that the mortality rate is much low in surgery group with initial GCS less than 6 points and hematoma volume over 30cc. There was no significant difference of outcome in patients with basal ganglia and thalamic hemorrhage. However, surgical treatment lowered the mortality and morbidity rate in patients with subcortical and cerebellar hemorrhage.