• Advances in pediatric surgery
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• 제20권2호
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• pp.53-57
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• 2014

Purpose: Neonatal neuroblastoma (NBL) is the most common malignant tumor in neonates, but there have been few studies about it. The purpose of this study was to investigate the clinical features of NBL and to compare prenatal and postnatal diagnosed groups. Methods: Nineteen patients who were diagnosed with NBL prenatally or within 28 days after birth from February 1986 to February 2013 in Seoul National University Hospital were enrolled in the study. The patients were categorized according to the International Neuroblastoma Staging System (INSS) and Children's Oncology Group (COG). Retrospective medical-record reviews were performed on these patients. The operative date, complication, pathological stage, and overall survival of the prenatally diagnosed group and the postpartum diagnosed group were compared. Results: Tumor was detected via prenatal ultrasonography in 8 patients (42.1%), and 11 patients (57.9%) were diagnosed within 28 days after birth. Based on INSS, the patients were divided into the stage I (n=8), stage II (n=1), stage III (n=3), stage IV (n=4), and stage IVs (n=3) groups, respectively. Based on COG, on the other hand, the patients were divided into the low-risk (n=8), intermediate-risk (n=8), and high-risk (n=3) groups. The postoperative complication rate was 29%. One patient died from complications from chemotherapy. The other 18 patients' mean follow-up period was 77.7 months. The differences between the postoperative complication rate, proportion of early-stage tumor, and overall survival of the prenatal and postnatal groups were not statistically significant (p=0.446, p=0.607, p=0.414). Conclusion: NBL showed favorable outcomes but relatively higher postoperative complications. There seem to be no significant statistical differences in the postoperative complications, proportion of early-stage tumor, and overall survival between the prenatally diagnosed group and the postpartum diagnosed group.

• 한국임상수의학회지
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• 제29권5호
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• pp.368-371
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• 2012

본 연구는 개흉술을 실시한 11 마리 개에서 수술 후 흉강 내 음압 형성을 위한 흉강 튜브 삽입방법으로 넓은 등근 아래 흉강 튜브 삽입 방법의 효과를 평가하기 위해 실시 하였다. 흉강 튜브 삽입을 위해 수술 창 뒤쪽으로 다섯 번째 늑간 늑골 위 피부와 넓은 등근에 작은 절개창을 형성하였다. 지혈겸자를 장착한 흉강 튜브를 근육 아래 터널을 통과하여 흉강 내로 삽입하였으며 튜브 장착 후 절개창 주위에 매트리스 봉합법을 이용하여 봉합사를 설치하였다. 수술 후 흉강 내 음압을 형성한 다음 흉강 튜브를 제거하였다. 튜브 관련 부작용을 확인 하기 위해 튜브 삽입 시 튜브 꺽임 현상과 수술 후 신체 검사 및 방사선 검사를 통한 기흉, 피하 기종, 호흡곤란 여부를 확인 하였다. 튜브 삽입 시 튜브 꺽임 현상과 수술 후 기흉 및 호흡 곤란 증상이 11 마리 개 모두에서 확인 되지 않았다. 신체 검사에서 튜브 삽입 주위 피하 기종이 한 마리에서 관찰 되었으나 별다른 치료 없이 3일 후에 사라졌음을 확인 할 수 있었다. 음압 형성 후 평균 (${\pm}SD$) 추적 기간은 $19{\pm}10$ 개월 이었다. 결론적으로 넓은 등근 아래 흉강 튜브 삽입 방법은 튜브가 흉강 내 유지 될 때와 튜브 제거 후 남게 되는 터널을 통한 흉강 내 공기 유입 차단에 효과적이며 흉강 튜브 장착 시 우선적으로 고려 되야 할 방법으로 사료 된다.

• 한국의료질향상학회지
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• 제5권1호
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• pp.106-118
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• 1998

Background : This study was done to assess the relationship among multiple patient outcomes of cataract surgery perioperatively, 3-4 months and 12 months after surgery. The patient outcomes include changes in visual acuity(operated eye, better eye), visual function(VF-14), patient satisfaction, subjective satisfaction with vision, and subjective overall health status. Methods : For the assessment of relationship, prospective study was performed with 92 patients who had undergone either one or both eye cataract surgery by 3 ophthalmologists practicing at a university hospital. Patients were interviewed. and clinical data were obtained. Doctors were questioned with self-entered questionnaire forms. Medical record was examined to understand surgery process. The survey was conducted at 4 stages : preoperatively, perioperatively, postoperative 3-4 months, and postoperative 12 months. Results : The correlations within patient outcomes at 4 stages - the visual acuity of operated eye and that of better eye, patient satisfaction and VF-14, subjective overall health status and relative health status as against others - were found to be positively correlated. The change in the visual acuity of operated eye and better eye was correlated with VF-14 as well as with patient satisfaction. The change was also correlated with overall health status. However, the correlations between variables were decreased as the postoperative period got longer. Conclusion : As for the postoperative clinical patient outcomes, VF-14 is acted to linker between visual acuity - clinical outcomes and overall health status - endpoint outcomes. Therefore. VF-14 is the index of patient-sided and disease-specific outcome for cataract surgery.

• Journal of Minimally Invasive Surgery
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• 제21권4호
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• pp.168-176
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• 2018

Purpose: Robotic-associated minimally invasive surgery is a novel method for overcoming some limitations of laparoscopic surgery. This study aimed to evaluate the outcomes (postoperative pain, cosmesis, surgeon's workload) of single-incision robotic cholecystectomy (SIRC) vs. single-incision laparoscopic cholecystectomy (SILC) vs. conventional three-port laparoscopic cholecystectomy (3PLC). Methods: 134 patients who underwent laparoscopic or robotic cholecystectomy at a single center during 2016~2017 were enrolled. Prospectively collected data included demographics, operative outcomes, questionnaire regarding pain and cosmesis, and NASA-Task Load Index (NASA-TLX) scores for surgeon's workload. Results: 55 patients underwent SIRC, 29 SILC, and 50 3PLC during the same period. 3PLC patient group was older than the others (SIRC vs. SILC vs. 3PLC: 48.1 vs. 42.2 vs. 54.1 years, p<0.001). Operative time was shortest with 3PLC (44.1 vs. 38.8 vs. 25.4 min, p<0.001). Estimated blood loss, postoperative complications, and postoperative stay were similar among the groups. Pain control was lowest in the 3PLC group (98.2% vs. 100% vs. 84.0%, p=0.004), however, at 2 weeks postoperatively there were no differences among the groups (p=0.374). Cosmesis scores were also worst after 3PLC (17.5 vs. 18.4 vs. 13.3, p<0.001). NASA-TLX score was highest in the SILC group (21.9 vs. 44.3 vs. 25.2, p<0.001). Conclusion: Although SIRC and SILC take longer than 3PLC, they produce superior cosmetic outcomes. Compared with SILC, SIRC is more ergonomic, lowering the surgeon's workload. Despite of higher cost, SIRC could be an alternative for treating gallbladder disease in selected patients.

• 대한정형외과학회지
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• 제54권2호
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• pp.120-126
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• 2019

목적: 내측 개방 근위 경골 절골술 후 통증 조절에서 관절 주위 다중 약물 국소 주사와 내전근관 차단술의 효과를 비교하고자 하였다. 대상 및 방법: 2016년 11월부터 2017년 3월까지 개방형 내측 근위 경골 절골술을 시행한 환자 60명을 대상으로 하여 후향적으로 분석하였다. 전 예에서 척추 마취를 시행하였으며, 수술 직전 선제 약물 투여 후 정맥내 자가 통증 조절 장치를 시행하였다. 30명의 환자(I군)는 관절 주위 다중 약물 국소 주사를 맞았고, 다른 30명의 환자(II군)는 내전근관 차단술을 시행 받았다. 두 그룹에 대해 수술 후 통증 수준, 추가적인 tramadol hydrochloride 주사의 빈도, 자가 통증 조절 장치 사용 총량 및 버튼을 누른 횟수 등을 비교하였다. 결과: 수술 후 2주째까지 시각통증점수(visual analogue scale)는 두 군 간에 유의한 차이를 보이지 않았다. 추가 tramadol hydrochloride 주사의 빈도는 두 군 간에 유의한 차이가 없었다. 자가 통증 조절 장치 버튼을 누르는 횟수와 평균 총 fentanyl 소비량에서도 그룹 간에 유의한 차이가 없었다. 결론: 내측 개방적 근위 경골 절골술을 시행한 환자의 급성기 통증 조절에 있어서 관절 주위 다중 약물 주입 및 내전근관 신경 차단술은 비슷한 효과를 가지는 것으로 생각된다.

• Korean Journal of Radiology
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• 제20권6호
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• pp.956-966
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• 2019

Objective: To characterize the changes in right ventricular (RV) volume, volume load, and function measured with cardiac computed tomography (CT) over the entire time course of tetralogy of Fallot (TOF). Materials and Methods: In 374 patients with TOF, the ventricular volume, ventricular function, and RV volume load were measured with cardiac CT preoperatively (stage 1), after palliative operation (stage 2), after total surgical repair (stage 3), or after pulmonary valve replacement (PVR) (stage 4). The CT-measured variables were compared among the four stages. After total surgical repair, the postoperative duration (POD) and the CT-measured variables were correlated with each other. In addition, the demographic and CT-measured variables in the early postoperative groups were compared with those in the late postoperative and the preoperative group. Results: Significantly different CT-based measures were found between stages 1 and 3 (indexed RV end-diastolic volume [EDV], 63.6 ± 15.2 mL/m² vs. 147.0 ± 38.5 mL/m² and indexed stroke volume (SV) difference, 7.7 ± 10.3 mL/m² vs. 32.2 ± 16.4 mL/m²; p < 0.001), and between stages 2 and 3 (indexed RV EDV, 72.4 ± 19.7 mL/m² vs. 147.0 ± 38.5 mL/m² and indexed SV difference, 5.7 ± 13.1 mL/m² vs. 32.2 ± 16.4 mL/m²; p < 0.001). After PVR, the effect of RV volume load (i.e., indexed SV difference) was reduced from 32.2 mL/m² to 1.7 mL/m². Positive (0.2 to 0.8) or negative (-0.2 to -0.4) correlations were found among the CT-based measures except between the RV ejection fraction (EF) and the RV volume load parameters. With increasing POD, an early rapid increase was followed by a slow increase and a plateau in the indexed ventricular volumes and the RV volume load parameters. Compared with the preoperative data, larger ventricular volumes and lower EFs were observed in the early postoperative period. Conclusion: Cardiac CT can be used to characterize RV volume, volume load, and function over the entire time course of TOF.

• Clinics in Shoulder and Elbow
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• 제26권4호
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• pp.357-365
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• 2023

Background: The purpose of this study was to evaluate the effect of concomitant open distal clavicle excision (DCE) on postoperative clinical outcomes and incidence of acromial and scapular stress fractures (ASFs) in patients with symptomatic acromioclavicular joint osteoarthritis (ACJ OA) undergoing reverse total shoulder arthroplasty (RTSA). Methods: A single-surgeon retrospective cohort study was conducted including patients who underwent primary elective RTSA with or without DCE from 2015 to 2019 with a minimum 6-month follow-up period. Shoulder active range of motion (AROM) and visual analog scale (VAS) pain were recorded preoperatively and postoperatively. ASFs and other adverse events were identified using postoperative notes and/or radiographs. Characteristics and outcomes were compared between the RTSA and RTSA-DCE groups. Results: Forty-six RTSA patients (mean age, 67.9±8.7 years; 60.9% male; mean follow-up, 24.9±16.6 months) and 70 RTSA-DCE patients (mean age, 70.2±8.9 years; 20.0% male; mean follow-up, 22.7±12.9 months) were included. There were no significant intergroup differences in rates of ASF (RTSA, 0.0% vs. RTSA-DCE, 1.4%; P=1.00), stress reactions (RTSA, 8.7% vs. RTSA-DCE, 11.4%; P=0.76), reoperation, revision, or infection (all P>0.05), or in pre-to-postoperative reduction in VAS pain (P=0.17) at latest follow-up. However, the RTSA-DCE group had greater pre-to-postoperative improvement in flexion AROM (RTSA, 43.7°±38.5° vs. RTSA-DCE, 59.5°±33.4°; P=0.03) and internal rotation (IR) AROM (P=0.02) at latest follow-up. Conclusions: Concomitant DCE in RTSA improves shoulder flexion and IR AROM, alleviates shoulder pain, and does not increase the risk of ASFs. Level of evidence: III.

• Journal of Chest Surgery
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• 제29권7호
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• pp.728-733
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• 1996

1922년 Jacobaeus가 흥강경을 처음으로 기술한 이래, 비디오흥강경수술은 많은 흉부 질환에 적용되어 왔다. 본원에서는 1994년 6월부터 1995년 7월까지 원발성 자연기흥을 가진 35명의 환자를 실험군으로 하여 비디오 흥강경수술을 시행하였고, 같은 수의 자연기흥 환자를 대조군으로 하여 정중액와 개흥술로 폐기포 절제술을 시행하였다. 저자들은 양군으로 부터 얻은 임상결과를 다음과 같이 비교하였다. 1. 성별분포는 실험군에서 남자 28명, 여자 7명이고, 대조군에서는 남자 30명, 여자 5명으로 양군에서 남 자가 대부분이었다. 연령분포는 실험군에서 최소 17세, 최고 69세, 평균 28.5$\pm$ 12.6세이고, 대조군에 서는 최소 15세, 최고 39세, 평균 23.9$\pm$6.3세를 보였다. 2. 수술시간은 실험군에서 평균 98.8 $\pm$39.3분이고 대조군에서 103.6$\pm$32.6분 이 었다. 3. 술후 흥관 삽관기간은 실험군이 평균 2.60$\pm$0.98일, 대조군이 평균 4.80$\pm$2.08일(P<0.01)이고, 술후 재원기간은 실험군이 최단 2일 최장 6일 평균 4.17$\pm$1.22일, 대조군이 최단 )일 최장 15일 평균 6.69 $\pm$ 2.52일(P<0.01)로 술후 흥관 상관기간 및 재원기간이 실험군에서 유의하게 짧았다. 4. 술 \ulcorner진통제 투여는 수술일 실험군이 1.57$\pm$0.74회1명, 대조군이 2.23 $\pm$0.60회1명이고(P<0.01), 술후 1 일째에는 실험군이 1.97 $\pm$0.70회1명, 대조군이 2.60$\pm$0.67회1명(P<0.01), 술후 2일째에는 실험군이 1 00$\pm$0.68회1명, 대조군이 2.17$\pm$0.76회1명(P<0.01)으로 실험군에서 현저한 감소를 보였고, 술후 재원 기간 중 평균 투여기간과 투여량에서도 실험군에서 각각 2.48$\pm$1.01일1명, 4.88 $\pm$ 3.70회1명이고 대조 군에서는 각각 3.70$\pm$ 1.40일1명, 8.94$\pm$4.21회1명으로 실험군에서 유의한 감소를 보였다(P<0.01, p< 0.01). 저자들은 위의 결과로, 비디오 흥강경수술을 받은 군이 정중액와 개흥으로 폐기포 절제술을 시행받은 군보다 수술후 회복이 빠르다는 것을 알 수 있었다.

• Journal of Chest Surgery
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• 제31권5호
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• pp.502-508
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• 1998

인공 심폐기를 이용한 체외순환은 우리 몸에 전신적인 염증반응을 일으키므로 수술후에 여러장기의 기능부전을 초래할수 있다. 이러한 염증반응은 체외순환후 체액성, 세포성 및 보체계등의 면역계가 활성화 되어 전체적인 염증반응을 일으키는 것으로 일부연구에서 보고하고 있으며, 이러한 염증반응에는 Tumor Necrosis Factor-$\alpha$(TNF-$\alpha$)를 비롯한, Interleukin-1, Interleukin-6, Interleukin-8 등의 cytokine등 이 전구물질로써 중요한역할을 하는 것으로 알려져 있다. 본 교실에서는 이러한 cytokine의 유리를 억제함으로 체외순환후 염증반응을 줄일수 있다는 가정하에 항염증작용이 있는 부신피질 호르몬을 체외순환전에 투여함으로서 염증반응이 현저히 감소하는지를 혈청내 TNF-$\alpha$를 측정하여 비교 연구하였다. 1996년 6월부터 1996년 8월까지 심장수술환자 20명에서 전향적 연구를 했다. 10명의 비교군은 수술 하루전, 마취전, 체외순환 시작 5분후, 대동맥 차단시작 5분후, 대동맥 차단 끝나기 5분전, 체외순환 끝나기 5분전, 재관류후 2시간, 4시간, 6시간, 12시간, 24시간 별로 10cc씩 채혈하여 TNF-$\alpha$의 수치를 ELISA 방법으로 측정하였고 10명의 스테로이드군은 마취 1시간전에 부신피질 호르몬(Dexamethasone 1mg/Kg)을 정맥주사하고 채혈은 비교군과 같게 했다. 그리고 양군에서 수술전 심전도 및 혈청내 LDH, CPK 효소치와 백혈구 수치를 측정하고 수술후 1일째, 3일째 재측정하였으며, 수술후 3일째내에 환자의 혈압동태 ,폐기능 상태 및 회복상태를 관찰하여 비교하였다. 환자군 간에 LDH 및 백혈구 수치간에 의미있는 차이는 없었으나 CPK 수치가 수술후 첫째날/세째날 비교군이 1122$\pm$456/864 $\pm$42 이고 스테로이드군은 567$\pm$471/325$\pm$87로 큰 차이를 보였고(P=0.002), CPK-MB 효소는 술후 1일째 비교군이 106.4, 스테로이드군이 29.5로 이의있는 차이를 보여주었으나(P=0.02) 수술후 3일째에는 두 군간의 차이가 없었다. 수술후 72시간 관찰기간중 비교군에서 4명의 환자가 3번 이상의 저혈압으로 처치가 필요했고 38$^{\circ}C$ 이상의 발열은 3명의 환자에서 있었다. 환자군 간에 대동맥 차단시간과 체외순환 시간간에 의미있는 차이는 없었고, 인공호흡기 부착시간과 중환자실 체류기간, 입원기간 비교에 있어 스테로이드군이 적은 수치를 보였으나 통계학적 의미는 없었다. TNF-$\alpha$는 대동맥 차단 5분후부터 체외순환 끝나기 5분전까지 양군에서 현저히 증가하였는데 비교군은 체외순환 끝나기 5분 전에 측정한 수치의 평균은 22.3$\pm$6.8 pg/ml였고, 스테로이드군은 대동맥 차단 끝나기 5분 전에 측정한 수치의 평균은 11.9$\pm$4.7 pg/ml였다. 이상의 연구결과에서 수술전 부신피질 호르몬을 정주함으로 체외순환시 Cytokine의 분비를 억제하여, cytokine으로 인한 심장수술후 발생할수있는 전신적 염증반응을 감소시킬것으로 기대되므로 수술후 환자의 중환자실 체류기간, 입원기간 및 합병증률을 줄일 수 있으리라 생각된다.

• Journal of Chest Surgery
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• 제18권2호
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• pp.182-192
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• 1985

[here are so many reports that pulsatile blood flow provides physiologic organ perfusions during cardiopulmonary bypass. So, we compared the recent 30 cases undergoing cardiac surgery by Cobe-Stckert pulsatile roller pump with another 30 cases by Polystan nonpulsatile roller pump. Pulsatile flow was applied during aortic-cross clamping period when synchronized to internal EKG simulator, and perfusion mode was changed to continuous nonpulsatile flow after declamping of aorta. Age, sex, weight, and disease entities were comparable and operative techniques were similar between two groups. 1. There were no differences in average ACC time, ECC time, and Operation time. 2. Postoperative artificial respiration time was 6hrs 30mins in nonpulsatile group and 4hrs 48mins in pulsatile group, and detubation time after ventilator weaning was 2hrs 44mins in nonpulsatile group and 1hrs 43mins in pulsatile group. 3. Average pulse pressure was 8mmHg in nonpulsatile group and 55mmHg in pulsatile group, and a mean arterial pressure was 66.0mmHg in nonpulsatile group and 60.7mmHg in pulsatile group. 4. Mean urine-output during ACC;ECC period was 9.717.3;9.913.2ml/kg/hr in nonpulsatile group and 14.215.0;15.817.5 in pulsatile group [p<0, 05], and thereafter progressive decrease of differences in urine output between two groups until POD 2, and lesser amounts of diuretics was needed in pulsatile group during same postoperative period. Serum BUN/Cr level showed no specific difference and urine concentration power was well preserved in both groups. 5. Plasma proteins and other Enzymes showed no differences between two groups, but serum GOT/GPT level was higher in nonpulsatile group till POD 2. 6. Serum Electrolytes showed no differences between two groups. 7. WBC, RBC, Platelet counts, Hgb and Hct were not different and Coagulogram was well preserved in both groups. 8. Plasma free Hgb level was 7.09mg% in pulsatile group compared with 3.48mg% in pulsatile group on POD 1 but was normalized on POD 2. Gross hemoglobinuria after ECC was noted in 6 cases [20%] of pulsatile group and 4 cases [13%] of nonpulsatile group. 9. In both groups, most patients were included in NYHA class III to IV [28 cases;93% in nonpulsatile group, 22 cases;73% in pulsatile group] preoperatively, and well improved to class I to 11[22 cases; 73% in nonpulsatile group, 30 cases; 100% in pulsatile group] postoperatively. There were 7 operative mortalities in nonpulsatile group only, which were 5 cases of TOF with hepatic failure, 1 case of multiple VSDs with low out-put syndrome, and 1 case of mitral valvular heart disease with cardiomyopathy. We concluded that the new, commercially available Cobe-Stckert pulsatile roller pump device was safe, simple, and reliable.