• 대한방사선치료학회지
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• 제20권2호
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• pp.103-107
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• 2008

목적: 전자선 조사야에서 자기장의 유무, 세기와 형태에 따른 표면 선량의 변화를 알아보고 임상에서의 적용 가능성에 대하여 알아보고자 한다. 대상 및 방법: 6 MeV 전자선과 $10{\times}10\;cm^2$의 조사야를 이용하여 9개의 hole이 있는 차폐블록을 제작하여 필름 농도를 측정하고 전자선 조사야 내에 자장이 위치 할 때와 조사야의 외부에 위치 할 때의 선량변화를 필름과 표면선량 측정기를 이용하여 측정하였다. 결 과: 전자선의 입사각은 조사야의 중심에서 측면으로 4 cm 지점에서 3도 정도의 입사각을 나타내었으며, ring type의 자기장을 사용할 경우 0.9%의 표면선량 증가가 나타나고, lens block에 자기장을 위치시키면 1.58%의 표면선량이 증가하고, half 조사야의 중심 측면에 자기장을 위치시키면 조사야의 중심에 3.6%의 표면 선량 증가를 보였다. 결 론: 전자선은 선속의 중심에서 측면으로 일정 각도를 이루고 조사되어지며 자기장이 위치한 조사야내 표면선량의 변화는 자기장으로 인하여 전자선의 진행 방향이 변화되었음을 의미하고 안구와 같은 부위에 환자의 불편함이 없이 표면선량을 증가 시켜야 할 경우 유용한 방법으로 사용되어질 것이다.

• 대한정형외과스포츠의학회지
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• 제4권2호
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• pp.116-121
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• 2005

목적: 상완골 소두 골절은 매우 희귀한 골절의 형태인데 관절면의 침범으로 인해 적극적인 수술적 치료가 요한다. 이러한 상완골 소두 골절의 관혈적 정복 후 내고정 후의 결과를 보고하는 바이다. 대상 및 방법: 1998년부터 2004년 까지 상완골 소두 골절로 수술 시행받은 4명의 환자를 대상으로 하였다. Morrey의 분류법 상 제 1형이 3례, 제 3형이 1례였다. 전 례에서 주관절의 외측 도달법을 사용하였으며, 관혈적 정복후 유관 나사못 고정을 실시하였다. 수술후 주관절의 부목등의 고정은 4일에서 28일 까지 소요되었다. 최종 추시 판정 시 Mayor의 주관절 기능 평가 방법을 이용하여 주관절 운동 범위, 주관절의 안정성, 동통 유무 등을 평가하였다. 결과: 평균 추시기간은 12개월에서 36개월이었으며 평균 15개월(12개월-36개월) 이었다. 3례의 경우 견고한 골고정을 얻었으며 우수한 관절 운동범위를 얻을 수 있었다. 그러나 만성 소두골 골절 및 부정유합으로 내원하였던 1 례의 경우 추시 관찰동안 재활에 순응하지 않아서 40도-100도의 운동범위만을 보여주었다. 전 례에서 무혈성 괴사나 주관절 관절염의 소견은 보이지 않았다. 결론: 상완골 소두 골절은 희귀하지만 적극적으로 관혈적 정복 및 내고정시 우수한 결과를 보여 줄 수 있었다.

• Journal of Chest Surgery
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• 제12권3호
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• pp.281-288
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• 1979

For years, physicians and anatomists have been interested in the heart that has one functioning ventricle. Various terms have been suggested for this entity including single ventricle, common ventricle, double-inlet left ventricle, cor biatriatum triloculare, and primitive ventricle. In this report, the term "single ventricle" is utilized as suggested by Van Praagh, and is defined as that congenital cardiac anomaly in which a common or separate atrioventricular valves open into a ventricular chamber from which both great arterial trunks emerge. An outlet chamber, or infundibulum, may or may not be present and give rise to the origin of either of the great arteries. This definition excludes the entity of mitral and tricuspid atresia. An 11 year old cyanotic boy was admitted chief complaints of exertional dyspnea and frequent upper respiratory infection since 2 weeks after birth. He was diagnosed as inoperable cyanotic congenital heart disease, and remained without any corrective treatment up to his age of 11 year when he suffered from aggravation of symptoms and signs of congestive heart failure for 2 months before this admission. On 22nd of May 1979, he was admitted for total corrective operation under the impression of tricuspid atresia suggested by a pediatrician. Physical check revealed deep cyanosis with finger and toe clubbing, and grade V systolic ejection murmur with single second heart sound was audible at the left 3rd intercostal space. Development was moderate in height [135 cm] and weight[28Kg]. Routine lab findings were normal except increased hemoglobin [21.1gm%], hematocrit [64 %], and left axis deviation with left ventricular hypertrophy on EKG. Cardiac catheterization and angiography revealed 1-transposition of aorta, pulmonic valvular stenosis, double inlet of a single ventricle with d-loop, and normal atriovisceral relationship [Type III C solitus according to the classification of Van Praagh]. At operation, longitudinal incision at the outflow tract of right ventricle in between the right coronary artery and its branch [LAD from RCA] revealed high far anterior aortic valve which had fibrous continuity with mitral annulus, and pulmonic valve was stenotic up to 4 mm in diameter positioned posterolaterally to the aorta. Ventricular septum was totally defective, and one markedly hypertrophied moderator band originated from crista supraventricularis was connected down to the imaginary septum of the ventricular cavity as a pseudoseptum of the ventricle. Size of the defect was 3X3 cm2 in total. Patch closure of the defect with a Teflon felt of 3.5 x 4 cm2 was done with interrupted multiple sutures after cut off of the moderator band, which was resutured to the artificial septum after reconstruction of the ventricular septum. Pulmonic valvotomy was done from 4 mm to 11 mm in diameter thru another pulmonary arteriotomy incision, and right ventriculotomy wound was closed reconstructing the right ventricular outflow tract with pericardial autograft of 3 x 4 cm2. Atrial septal defect of 2 cm in diameter was closed with 3-0 Erdeck suture, and atrial wall was sutured also when rectal temperature reached from 24`C to 35.5`C. Complete A-V block was managed with temporary external pacemaker with a pacing rate of 110/min. thru myocardial wire, and arterial blood pressure of 80/50 mmHg was maintained with Isuprel or Dopamine dripping under the CVP of 25-cm saline. Consciousness was recovered one hour after the operation when his blood pressure reached 100 /70 mmHg, but vital signs were not stable, and bleeding from the pericardial drainage and complete anuria were persisted until his heart could not capture the pacemaker impulse, and patient died of low output syndrome 320 min after the operation.

• Journal of Chest Surgery
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• 제33권4호
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• pp.290-300
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• 2000

Background: To evaluate the diagnostic accuracy of EBT(Electron Beam Tomography) in the diagnosis of conotruncal anomaly and to determine whether it can be used as a substitute for cardiac angiography. Material and Method: 20 patients(11M & 9F) with TOF(n=7, pulmonary atresia 2), DORV(n=7), complete TGV(n=4), & corrected TGV(n=2) were included. The age ranged from 7 days to 26 years(median 60 days). We analyzed the sequential chamber localization, the main surgical concenrn in each disease category (PA size, LVED volume and coronary artery pattern for TOF & pulmonary atresia, the LV mass, LVOT obstruction, coronary artery pattern for complete TGV, and type of VSD and TV-PV distance for DORV, etc) and other associated anomalies(e.g., VSD, arch anomalies, tracheal stenosis, etc). Those were compared with the results of echocardiography(n=19), angiography (n=9), and surgery(n=11). The interval between EBT and echocardiography/angiography was within 20/11 days, respectively except for an angiography in a patient with corrected TGV (48 days). Result: EBT correctly diagnosed the basic components of conotruncal anomalies in all subjects, compared to echocardiography, angiography or surgery. These included the presence, type and size of VSD(n=20), pulmonic/LV outflow tract stenosis(n=15/2), relation of great arteries and the pattern of the proximal epicardial coronary arteries(16 out of 20). EBT proved to be accurate in quantitation of the intrapericardial and hilar pulmonary arterial dimension and showed high correlation and no difference compared with echocardiography, angiography, or surgery(p>0.05) except for left pulmonary arterial & ascending arterial dimension by echocardiography. LVED volume in seven TOF(no difference: p>0.05 & high correlation: r=0.996 with echocardiography), and LV mass in 4 complete TGV were obtained. Additionally, EBT enabled the cdiagnosis of subjlottic tracheal stenosis and tracheal bronchus in 1 respectively. Some peripheral PA stenosis were not detected by echocardiography, while echocardiography appeared to be slightly more accurate than EBT in detecing ASD or PDA. Conclusion: EBT can be a non-invasive and accurate modality of for the evaluation of most anatomical alteration including peripheral PS or interruption in patients with conotruncal anomalies. Combined with echocardiography, EBT study provides sufficient information for the palliative or total repair of anomalies.

• Journal of Chest Surgery
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• 제36권1호
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• pp.30-34
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• 2003

급성 대동맥 박리증과 대동맥 침투성 궤양은 근내혈종과 함께 급성 대동맥 증후군을 구성하는 치명적 질환이나 그 병태생리와 자연경과가 다르고 치료전략이 다를 수 있어 정확한 감별진단을 요한다. 그러나 서로 임상양상이 비슷하고 초음파나 CT, MRI등의 진단방법으로도 명확히 구분이 안되는 경우가 많다. 환자는 약 10년간의 고혈압 병력이 있는 71세 여자로 내원 3일전에 갑자기 시작된 전흉부 통증 및 오심, 구토를 주소로 입원하였다. 전산화 단층촬영상에서 내막박리편은 보이지 않았으며, 상행대동맥 및 무명동맥간, 대동맥궁, 하행 흉부대동맥에 걸친 근내혈종(intramural hematoma)과 양측성 혈흉 및 혈성 심낭삼출 소견이 보였고, 무명 동맥간의 하방 약 1 cm 거리에 상행대동맥의 앞쪽으로 국소적인 궤양소견이 보여 상행대동맥에 생긴 침투성 궤양 및 이로인한 대동맥 파열로 진단하고 응급수술을 시행하였다. 그러나, 수술장 소견에서는 무명동맥 기시부 하방 1cm 정도에 약 0.5cm크기로 내막이 찢어져 있었고 외막을 열고 오래된 혈종을 제거하니 거의 폐쇄되어있던 가성내강이 관찰되었으며 이는 내막 파열 부위와 교통하였다. 이처럼 대동맥 박리증이 침투성 궤양과 흡사한 임상양상 및 진단 소견을 보일 수 있음을 경험하였기에 증례로 보고하는 바이다.

• Journal of Chest Surgery
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• 제45권2호
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• pp.85-90
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• 2012

Background: At present, many surgeons prefer axillary artery cannulation because it facilitates antegrade cerebral perfusion and may diminish the risk of cerebral embolization. However, axillary artery cannulation has not been established as a routine procedure because there is controversy about its clinical advantage. Materials and Methods: We examined 111 patients diagnosed with acute type A aortic dissection between January 2000 and December 2009. The right axillary artery was cannulated in 58 patients (group A) and the femoral artery was cannulated in 53 (group F). The postoperative outcomes were retrospectively reviewed and compared between the two groups. Results: There were 46 male and 65 female patients with a mean age of $58.9{\pm}13.1$ years (range, 26 to 84 years). The extent of aortic replacement in both groups did not differ. There were 8 early deaths (7.2%) and 2 late deaths (1.8%). The mean follow-up duration was $46.0{\pm}32.6$ months (range, 1 month to 10 years). Transient neurologic dysfunction was observed in 11 patients (19.0%) in group A and 14 patients (26.4%) in group F. A total of 11 patients (9.9%) suffered from a permanent neurologic dysfunction. Early and delayed stroke were observed in 6 patients (10.3%) and 2 patients (3.4%), respectively, in group A as well as 2 patients (3.8%) and 1 patient (1.9%), respectively, in group F. There were no statistical differences in the cannulation-related complications between both groups (3 in group A vs. 0 in group F). Conclusion: There were no differences in postoperative neurologic outcomes and cannulation-related complications according to the cannulation sites. The cannulation site in an aortic dissection should be carefully chosen on a case-by-case basis. It is important to also pay attention to the possibility of intraoperative malperfusion syndrome occurring and the subsequent need to change the cannulation site.

• 대한두경부종양학회지
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• 제13권2호
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• pp.187-199
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• 1997

Thyroid carcinoma ranks low in incidence and as a cause of death when compared to carcinomas arising in the other site. With adequate surgical treatment, the prognosis of operable thyroid carcinoma is good. However, the extent of surgical resection in treatment of thyroid cancer remains still controversy. The aim of this study was to assess the results of thyroid cancer patients treated surgically and to analyze the prognostic factors affecting survival and to improve the survival rate. We retrospectively analyzed the outcome of a total of 278 thyroid cancer patients treated surgically at Inje University Paik Hospital from 1980 to 1995 and followed for 1 to 16 years. There were man in 47 and woman in 231 patients with age range of 14 to 79 years(mean 42 years). Histopathologic findings were papillary carcinoma in 233, follicular carcinoma in 33, mixed carcinoma in 7, medullary carcinoma in 2, and undifferentiated carcinoma in 3 patients, respectively. Operative procedures were unilateral lobectomy in 111, subtotal thyroidectomy in 100, and total thyroidectomy in 67 patients. Central node dissection was performed in 92, modified neck disseciton in 62, radical neck dissection in 28, and no node dissection in 96 patients. Thyroid hormone was administered for the period of 3 to 5 years to suppress endogenous TSH production. Overall 5-year survival rate according to Kaplan-Meier method was 91.1%. Independently, significant factors affecting the prognosis were age at diagnosis, tumor size, pathologic type, tumor stage, lymph node metastasis, angioinvasion, extrathyroidal extension, and 'risk' group category. but, the prognosis were not influenced by sex and capsular invasion. Patients at low risk or with small size carcinomas had long survival over 5 years with only lobectomy. Lymph node dissection was carried out with a limited type in no jugular metastasis, radical neck dissection was performed only therapeutically in proved jugular node metastasis. Fifteen patients were dead of tumor recurrence after surviving for three months to two and half years, and the cause of death was local recurrence in nine, bone metastasis in four and lung metastasis in two patients. In conclusion, more extensive surgery including total thyroidecotmy and systematic compartment-oriented dissection of the lymph node metastases in patient at high-risk group will results in better survival and lower recurrence rate.

• 대한두경부종양학회지
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• 제17권1호
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• pp.26-31
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• 2001

Background: Primary malignant lymphoma of the parotid gland is a rare disease and defined as any malignant lymphoma that first manifests in the parotid gland, regardless of the subsequent stage of the diseases, whether it arises in the parenchyma or intraglandular lymph nodes. This study was performed to review the clinicopathological characteristics of primary parotid lymphoma and identify its optimal treatment modality. Materials and Methods: Six cases with parotid mass as first presentation of malignant lymphoma between 1988 and 2000, were studied on the basis of clinical features, diagnostic tools, treatment modality, treatment outcomes, and clinical stage by Ann Arbor Criteria. All were microscopically reevaluated and classified by NCI working formulation. Results: All patients were males and mean age was 36.7 years (2-66 years). Rapid growing non-tender mass was presented in all the cases and cervical lymphnodes were palpated in 4 cases. However, there was not any evidence of concurrent autoimmune disease such as Sjogren's syndrom or Rheumatoid arthritis. One case was confirmed by surgical specimen after superficial parotidectomy, 2 by excisional biopsy, and 3 by incisional biopsy. The stage of disease by NCI working formulation was IE in 1 patient, IIE in 4 and IV in 1. All were classified into non-Hodgkin' lymphoma, of which there were 5 cases of B-cell type and 1 case of T-cell type. There were 3 diffuse large cell lymphomas, 1 Burkitt lymphoma, 1 MALT lymphoma and 1 T-lymphoblastic lymphoma. Three cases were treated by chemotherapy only, 2 by radiotherapy only and 1 by chemo-radiotherapy. One case with Burkitt lymphoma was died from the disease and one case was lost to follow-up. The others are alive with no evidence of recurrence. Conclusions: Although primary parotid lymphoma is rare and difficult to diagnose preoperatively, most were detected in early stage and showed a relatively good response to the chemotherapy or radiotherapy like other types of extranodal malignant lymphoma.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권3호
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• pp.203-210
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• 2004

The purpose of this study was comparing the effectiveness in the topical applications of cyclosporine with that of steroid, the conventional and standard drug in the treatment of oral lichen planus. 21 patients with oral lichen planus were treated with cyclosporine (n=11) or steroid (n=10) by random allocations. They were recalled 2 weeks, 4 weeks, and 8 weeks after initial treatments. In each recall, the lesion size, clinical symptoms like pain or burning sensation, and side effects were evaluated. The differences of these measurements were compared and the effects of each drug were checked. In reticulation types, steroid showed higher effectivity than cyclosporine and this difference was significant statistically. But in erythema type lesions, either drug showed no significant recovery, statistically. However, the effect of cyclosporine was thought to be more effective. The pain of the lesions was significantly decreased by cyclosporine but not by steroid. The decrease of burning sensation was more dependant upon steroid than cyclosporine, but no statistical relationship could be found. There were no clinical side effects. There was limitation to draw in conclusion due to small pool of this study group. But with the results, this suggestion could be proposed that either drug might be superior to another in effectivity in a specific lesion type or patient symptom, so selection and usage of one drug in a specific case could be better than universal application of one drug in all cases.

• Tuberculosis and Respiratory Diseases
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• 제59권5호
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• pp.566-570
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• 2005

폐에 발생하는 원발성 비호지킨 림프종은 아주 드문 질환으로 대개 폐문이나 중격동의 림프절 비대로 나타난다. 조직학적으로 대개 low grade B-cell 형태로 주로 발생하고 말초 T세포 형태로 폐에 원발성으로 발생하는 림프종은 드문 것으로 알려져 있다. 저자들은 발열과 전신 홍반이 있으면서, 흉부 X-선 사진상 급속히 진행하는 미만성 폐침윤 및 흉수 소견을 보여 초기에는 감염성 질환을 의심하였으나 피부병변과 림프절 및 골수 검사상 말초 T세포 림프종으로 진단된 예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.