• 대한영상의학회지
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• 제84권5호
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• pp.1163-1168
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• 2023

Candida albicans 감염에 의한 농양 형성은 매우 드물며, 흔하지 않은 위치에 비 전형적인 형태로 관찰되는 경우, 영상의학적 진단을 내리기가 쉽지 않다. 저자들은 산후출혈로 집중치료실에 입원하여 칸디다혈증 진단 후 치료를 받고 퇴원했던 젊은 여성에서, 잠행성으로 발생한 다발성의 Candida albicans 흉벽 및 척추 농양 증례에 대해 보고하고자 한다.

• Journal of Chest Surgery
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• 제35권4호
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• pp.290-295
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• 2002

배경: 전폐절제술은 수술 그 자체가 환자의 심폐기능에 큰 영향을 줄 수 있으며 또한 합병증이 치명적 결과를 초래하는 경우가 많아, 합병증과 그 연관 인자 간의 많은 연구가 있어 왔다. 수술적 수기로 대부분 흉관을 삽입 후 수술을 종료하는 방법을 많이 사용하고 있으나 합병증 중 농흉의 높은 비율로 인해 그 위험 인자 중 융관 삽입술 없이 전폐절제술을 시행하여 발생한 술후 합병증에 대해 비교 분석하여 보고하고자 한다. 대상 및 방법: 1996년 1월부터 2000년 12월 까지 약 5년간 한양대학병원 흉부외과에서 수술 치험한 100례를 대상으로 환자기록지를 참조하여 나이와 성, 수술적응, 관련질환, 수술 환측으로 분류하고 술후 발생한 합병증과 사망률 등을 $\chi$$^2$-test 사용하여 통계학적으로 처리하였다. 수술은 전폐절제술 후 흉막강 내 압력을 유치도뇨관(nelaton catheter)을 사용하여 -15~-20 cm$H_2O$로 한 후 개흉창을 닫고 4~5일 이상 단순 흥부 촬영으로 액체 저류 및 출혈, 종격동의 위치를 감시 하였다. 결과: 총 100례 중 폐결핵 16례(16%), 폐종양 81례(81%), 기관지 확장증 2례(2%), 폐국균종을 동반한 기관지 확장증 1례(1%)였다. 수술 후 사망은 총 100례 중 8례로 8%열으며 합병증은 34명(34%)에서 44례로 조사되었다. 합병증은 나이, 성별, 수술 측과는 통계적 상관 관계가 없었으며, 결핵환자 16명 중 7명(44%), 폐종양 81명 중 27명(33%)로 결핵 환자에서 폐종양에 비해 3.86배로 합병률이 높았으나 통계적인 유의성은 확인할 수 없었다. 또한 술후 발생한 출혈 6례에서 결핵 16례 중 3례, 폐종양 및 기타 84례 중 3례로 결핵에서 술후 출혈률이 통계적으로 의미있게 높았다(p=0.019) 사망률은 총 100례 중 8례(8%)로 폐종양 81례 중 5례(6.1%), 폐결핵 16례 중 3례(18.7%)로 결핵 환자에서 폐종양에 비해 3.93배로 사망률이 높았으나 통계학적으로 유의성은 확인 할 수 없었다.

• 대한소아치과학회지
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• 제24권1호
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• pp.27-40
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• 1997

This study investigated the effects of laser irradiation on the exposed pulp and the possibility of direct pulp capping with the $CO_2$ laser. Results were obtained from the observation of the residual pulpal healing process. Class V cavities on 48 anterior teeth from 8 adult dogs were prepared and pulp chambers were intentionally opened with dental explorer. The control group consisted of 16 teeth. $Dycal^{(R)}$(Caulk Co., U.S.A.) was applied to exposed site once bleeding was stopped. Cavities were sealed with $I.R.M^{(R)}$. In the experimental group 1 (16 teeth), laser(LASERSAT $CO_2^{(R)}$, Satelec Co.) was irradiated on the exposed pulp. The laser procedure followed the manufacturers recommendations for the treatment of human pulp(1.5 Watts, 0.2 seconds, unfocused), and cavities were sealed with $I.R.M^{(R)}$. In the experimental group 2 (16 teeth), laser was irradiated on the exposed pulp in a more powerful dosage(5.0 Watts, 0.2 seconds, unfocused), and cavities were sealed with $I.R.M^{(R)}$. Two dogs were sacrificed immediately after experiment and the others were sacrificed at intervals of one, three, and eight weeks respectively. All teeth were routinely processed and the pulpal tissues and odontoblastic layers were observed by the light microscope. The results were as follows; 1. In the control group, the initial mild inflammation had improved to normal by week eight. An active formation of reparative dentin was observed at week three, and at week eight, a firm dentin bridge was present beneath the $Dycal^{(R)}$ with no inflammatory responses in the remaining pulp. 2. In the experimental group 1, immediately following irradiation, the superficial shape of the exposed pulp was crater-like. And it was lined with the coagulated layer, $60{\sim}70{\mu}m$ in width. Moderate inflammatory pulpal conditions existing at week one were improved to mild at week eight. And from the week three specimens, a reparative dentin formation was observed in the adjacent odontoblastic layer of the exposed site. A dentin bridge at the exposed site, however, did not form during the experimental period. 3. In the experimental group 2, the width of the coagulation layer lining the crater was $70{\sim}130{\mu}m$. Beneath the coagulated layer, severe inflammatory pulpal responses were observed at week one, and conditions did not improve during the experimental period.

• 한국건축시공학회지
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• 제21권3호
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• pp.181-188
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• 2021

본 연구는 바닥 난방을 위한 바닥용 건조 시멘트 모르타르의 현장 혼합수량비(W/DM) 변화에 따른 각종 품질특성을 검토한 것이다. 연구결과, 바닥용 건조 시멘트 모르타르의 현장 시공은 현장에서 혼합하는 혼합수량의 증가에 따라 플로가 증가하고, 단위용적질량이 감소하는 일반적인 경향이며, 압축강도 및 건조수축 길이변화율은 혼합수량의 변동에 따라 바닥용 DM의 품질에 크게 영향을 미치기 때문에 적정 W/DM의 관리가 바닥용 DM의 시공 품질 확보에 있어서 매우 중요하다. 따라서, 바닥용 DM의 현장 시공시 작업자의 작업성만을 고려한 과도한 현장 W/DM 증가는 과도한 블리딩 및 재료분리 등으로 인해 바닥용 DM의 경화 후 품질저하를 초래할 수 있으므로 주의가 필요하다. 이상으로, 본 연구 범위의 실험결과를 종합하면, 현장 시공 시 바닥용 DM의 품질확보를 위한 현장 품질관리 기준으로는 W/DM 약 20%가 바람직한 것으로 판단되고, 이를 바탕으로 현장 여건에 따라 적정 혼합수량이 관리될 수 있다면 바닥용 DM의 양호한 품질확보가 가능할 것으로 판단된다.

• 한국건설안전학회 논문집
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• 제6권1호
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• pp.12-18
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• 2024

건축물의 초고층화, 대형화, 다양화가 가능하고 콘크리트 단면의 축소로 구조물 자중이 경감되어 보와 슬래브 두께를 얇게 함으로 층고를 증감하거나 같은 높이에서 많은 층수를 축조할 수 있고 넓은 유효공간이 확보되며, 기초 저면 지정에 사용된 자재 및 철근과 콘크리트 양을 절감하는 효과를 기할 수 있다. 현장시공 및 품질측면에서는 낮은 물결합재비 배합으로 건조수축 발생 저감 효과와 콘크리트 표면의 블리딩 최소화 효과를 얻을 수 있으며, 고성능감수제 사용에 의한 유동성 증진으로 자체 충전성이 확보되어 현장시공이 용이해지며, 콘크리트의 조기 강도 발현으로 거푸집 탈형 기간을 단축시킬 수 있는 장점이 있다. 특히 근래에 들어 콘크리트와 관련한 건축기술의 비약적인 발전에 따라 초고층 건축물에서는 설계기준강도 100MPa급 이상의 초고강도콘크리트의 적용이 확대되고 있다. 그러나 최근 국내에서도 120층 이상의 초고층 건축물들이 발주 또는 발주 예정되어 있으나, 현장 적용성이 고려된 130MPa급 이상의 초고강도 콘크리트를 개발하여 현장에서 실제 적용 가능성 여부를 실험, 평가한 연구실적은 미흡하다. 본 연구에서는 초고강도콘크리트의 현장적용 가능성을 확인하기 위하여 여러 가지 방법의 실내기초 실험으로 연구되어진 최적의 배합비를 찾아서 축소모의부재 예비실험을 실시하였다. 그 후 실물크기와 유사한 모의부재에 130MPa급 초고강도콘크리트를 레미콘 공장에서 생산하여 현장 펌프압송 타설을 통해 콘크리트의 유동특성, 강도특성, 수화열에 관하여 실험 연구하였다.

• Journal of Chest Surgery
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• 제13권1호
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• pp.60-65
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• 1980

We have experienced 2 cases of the hunshot wound sof the chest involving cardiac injuries at department of the thoracic surgery, Capital Armed Forces General Hospital during I year from April I 1979 to Jan. 1980. In one case of two patients , he was a 22 years old man who was transported to this emergency room 4 hour 10 minutes after having gunshot wound of the left chest by helicopter. Physical examination showed small inlet in left 3rd ICS and left parasternal border, large outlet in left 8th ICS and left scapular line, no breath sound on left side and distant heart sound. chest roentgenography demonstrated marked pleural effusion in left side and mediastinum shifted to right. As soon as chest X-ray was taken, the bleeding through penetrating wound became profuse and cardiac arrest ensued. Closed chest cardiac massage was started and vigorous transfusion continued, but no effective cardiac activity could not be obtained. The patient was pronounced dead due to exsanguinating hemorrhage from wuwpected cardiac wounds. In this critically injured patient with evidence of intrathoracic hemorrhage and suspected cardiac penetration, only emergency thoracic exploration and immediate surgical control of bleeding points might offer the maximum possibility of survival. The other case was a 23 years old man who was transferred to the emergency room 4 hours 50 minutes after having kmultiple communicated fractures of sternum and linear fracture of right mandible by a missile. Examination revealed about 30% skin loss of the anterior chest wall, weak pulse of 96 beats/min., distant heart sound and decreased breath sounds bilaterally. finding on the chest X-ray films showed multiple sternal fractures, marked pericardial effusion indicating hemopericardium. So, the patient was moved immediately to the operation room where, after endotracheal tube inserted, a median sternotomy was performced. A hemorrhagic congestion of the right upper lobe and marked bulging pericardium were disclosed. The pericardium was opened anterior to right phrenic nerve and exsanguinating hemorrhage ensued from the 0.5cm lacerated wound in the auricle of right atrium. The rupture site of right atrium was occluded with non-crushing vascular clamps and then was over sewn with interrupted sutures. It was thought to be highly possible that he was alive long enough to have cardiorrhaphy because of cardiac tamponade, which prevented exsanguinating hemorrhage. He was taken closed reduction for linear fracture of right mandible 2 weeks after repair of ruptured right auricle in dental clinic. This patient's post-operative course was not eventful.

• Journal of Chest Surgery
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• 제18권4호
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• pp.753-758
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• 1985

Hemorrhage is an important complication after operation with cardiopulmonary bypass and sometimes necessitates a further emergency operation. Between July, 1962 and June, 1985, reoperation for hemorrhage was carried out on 81 patients [3.1%] out of a total 2634 patients who had previously undergone cardiopulmonary bypass surgery at the Department of Thoracic and Cardiovascular Surgery, Yonsei University Medical Center. There were 38 males and 43 females, with an average age of 25 years [ranging 6 months to 60 years] and an average body weight of 38 kg [ranging 5 to 77 kg].There were 43 patients of cyanotic heart disease, 32 patients of acquired valvular heart disease, 4 patients of coronary artery occlusive disease, 2 patients of ascending aorta aneurysm and annuloaortic ectasia. The average amount of blood loss in the case of cyanotic heart disease was 71.7140ml/kg, in acyanotic heart disease 45.16.3ml/kg, in acquired heart disease, 56.514.4ml/kg and in coronary artery occlusive disease, 50.618.7ml/kg during first post operative day. But there was no statistical difference [p>0.05]. The mean blood loss below 10 years old was 70.412.1 ml/kg. Those below 10 years old were believed to bleed more than any other group. But there was also no statistical difference [p>0.05]. Indications for reoperation were continued excessive blood loss [74%], cardiac tamponade or hypotension [23%] and radiological evidence of a large hematoma in the thorax and pericardium [2%]. Average bypass time was 2.10.1 hours [ranging 30 minutes to 5 hours]. The interval between operation and reoperation was as follows; less than 12 hours in 49 patients [60%], 12 to 24 hours in 20 patients [25%], 24 to 48 hours in 8 patients [10%], more than 48 hours in 4 patients [5%]. The commonest sites for bleeding were chest wall [36%], heart [34%], aorta [12%], pericardium [6%], thymus [5%] and others [6%]. But no definite source was found in ll patients [31%]. Twenty seven out of 81 patients [31%] had wound problems and 5 patients [6%] were expired. [Mean SEM]. In conclusion, in order to decrease the amount of blood loss after open heart surgery with cardiopulmonary bypass, shortening of bypass time and bleeding control at the wire suture site during chest wall closure were important. If the amount of blood loss was over 45 ml/kg or 8 m/kg/hour, reoperation should be considered as soon as possible. After operating, careful wound dressings were applied to prevent wound problems.

• 한국임상수의학회지
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• 제31권3호
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• pp.246-249
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• 2014

9살의 중성화하지 않은 암컷 시츄가 복통과 복부 팽만을 주증으로 내원했다. 보호자는 개가 태어난 이후로 발정과 관련한 출혈을 단 한번도 관찰하지 못 했다. 초음파 검사 상에서 분절된 생식기계의 확장이 관찰되었다. 생식기계의 종괴를 확인하고, 난소 자궁 질 적출술을 실시하였다. 육안적으로 관찰했을 때, 질은 확장되어 있었고 고형의 짙은 초록색의 물질로 차있었다. 수술 결과와 질조영술을 바탕으로하여 처녀막 잔존증으로 진단하였다. 수술 한달 후, 봉합한 부위와 질의 막혀있는 부분 사이에 잔존성 질축농증이 발생하였다. 잔존된 처녀막은 내시경으로 제거하고, 세척하였으나, 복막염과 패혈증이 발생으로 폐사하였다.

• Journal of Gastric Cancer
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• 제14권2호
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• pp.105-110
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• 2014

Purpose: The advantages of totally laparoscopic surgery in early gastric cancer (EGC) are unproven, and some concerns remain regarding the oncologic safety and technical difficulty. This study aimed to evaluate the technical feasibility and clinical benefits of totally laparoscopic distal gastrectomy (TLDG) for the treatment of gastric cancer compared with laparoscopy-assisted distal gastrectomy (LADG). Materials and Methods: A retrospective review of 211 patients who underwent either TLDG (n=134; 63.5%) or LADG (n=77; 36.5%) for EGC between April 2005 and October 2013 was performed. Clinicopathologic features and surgical outcomes were analyzed and compared between the groups. Results: The operative time in the TLDG group was significantly shorter than that in the LADG group (193 [range, 160~230] vs. 215 minutes [range, 170~255]) (P=0.021). The amount of blood loss during TLDG was estimated at 200 ml (range, 100~350 ml), which was significantly less than that during LADG, which was estimated at 400 ml (range, 400~700 ml) (P<0.001). The hospital stay in the TLDG group was shorter than that in the LADG group (7 vs. 8 days, P<0.001). One patient from each group underwent laparotomic conversion. Two patients in the TLDG group required reoperation: one for hemostasis after intraabdominal bleeding and 1 for repair of wound dehiscence at the umbilical port site. Conclusions: TLDG for distal EGC is a technically feasible and safe procedure when performed by a surgeon with sufficient experience in laparoscopic gastrectomy and might provide the benefits of reduced operating time and intraoperative blood lossand shorter convalescence compared with LADG.

• 대한두개안면성형외과학회지
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• 제16권3호
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• pp.131-135
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• 2015

Background: Variable methods have been introduced for reduction of the zygomatic fractures. The Dingman elevator is used widely to reduce these fractures but is inappropriate in certain types of fractures which require atypical traction vectors. We introduce and examine an alternate method of reducing zygomatic fractures using wire and hook traction. Methods: A retrospective study was performed for all zygomatic fracture patients admitted between 2008 and 2014. Medially rotated fractures were reduced by using a wire looped through an intermaxillary screw secured on the medial side of the zygoma. Laterally rotated fractures were reduced using a hook introduced through an infrazygomatic skin incision. Results: No accidental bleeding or incomplete reduction was observed in any of the cases. Postoperative imaging demonstrated proper reduction immediately after the operation. Follow-up computed tomography study at 1 month after operation also demonstrated proper reduction and healthy union across the previous site of fracture. Conclusion: The hook and wire method allowed precise application of traction forces across zygomatic fractures. The fractured bone fragment could be pulled in the direction precisely opposite to the vector of impact at the time of trauma. Soft tissue damage due to dissection was minimized. In particular, this method was effective in reducing rotated bone fragments and can be an alternative option to using the zygoma elevator.