• 한국간담췌외과학회지
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• 제26권2호
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• pp.144-148
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• 2022

Backgrounds/Aims: Splenectomy in patients with non-Hodgkin lymphoma (NHL) is performed to relieve abdominal symptoms, treat hypersplenism or confirm diagnosis. Excision of a very large spleen is technically challenging and data on outcomes of surgery in patients with NHL are scanty. The aim of study was to evaluate the impact of spleen size on the surgical outcome of splenectomy in patients with NHL. Methods: Patients with NHL who underwent splenectomy, between 2006 and 2017, were included and divided into two groups: group 1, spleen ≤ 20 cm; group 2, spleen > 20 cm. Surgical approach, operative time, postoperative morbidity, mortality, hospital stay and re-admission rates were retrospectively compared between groups. Non-parametric data were evaluated with the Mann-Whitney U test. Differences in frequencies were analyzed with Fisher's exact test. Results: Sixteen patients were included (group 1, 6; group 2, 10). Laparoscopy was successful in three patients of group 1, none of group 2 (p = 0.035), the intraoperative time did not differ significantly between groups. One patient in each group developed postoperative complications. The patient in group 1 died of pneumonia. Median length of stay was 8 days (range, 3-16 days) for group 1, 5.5 days (range, 3-10 days) for group 2, showing no significant difference between the two groups. No patient was readmitted to hospital. Conclusions: Spleen size does not affect the outcome of splenectomy in patients with NHL. If a mini-invasive approach is to be chosen, laparoscopy may not be feasible when the spleen size is > 20 cm.

• Clinical and Experimental Pediatrics
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• 제52권2호
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• pp.194-198
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• 2009

목 적 : 총폐정맥 환류이상은 드문 선천성 심장질환이나, 진단 즉시 완전 교정 수술이 필요한 질환이며 폐정맥 협착 동반 유무에 따라 수술 사망률과 예후가 다르게 보고되고 있다. 이번 연구는 총폐정맥 환류이상 환아를 조사하여 이들의 임상적 특성과 수술 후 경과를 살펴보고자 시행하였다. 방 법 : 1994년 1월부터 2008년 2월까지 14년간 경북대학교병원에서 총폐정맥 환류이상으로 진단된 환아 27명의 의무 기록 정보를 후향적으로 분석 하였다. 결 과 : 총폐정맥 환류이상 환아 27명은 남아 17명, 여아 10명이었고, 진단 시 나이는 평균 $28.1{\pm}33.4$일(1-126일), 평균 체중은 $3.6{\pm}0.9$ kg (1.9-6.3 kg)였다. 병원을 방문한 주 증상으로 빈호흡, 저산소증 등의 호흡기 증상이 7명, 수유 시 청색증이나 전신 청색증이 13명, 심잡음이 7명이었다. 13명(48.1%)에서 심부전 소견을 보였다. 심초음파 검사로 진단된 해부학적 형태로 심상부형이 15명(55.6%), 심형이 6명(22.2%), 심하부형이 5명(18.5%)이고 혼합형은 1명(3.7%)있었다. 수술 전 폐정맥 협착이 동반된 경우는 7명으로 심상부형에서 5명, 심형과 심하부형에서 각각 1명이었다. 본원에서 수술 받은 환아는 총 24명으로 수술 중 경식도 초음파 검사는 14명(58.3%)에서 시행하였다. 수술 중 경식도 초음파 검사를 사용한 경우의 사망률은 0%이고 사용하지 않은 경우의 사망률 40%로 유의한 차이(P<0.05)를 보였다. 수술 사망은 4명(16.7%)으로, 수술하지 않고 사망한 환아 2명을 포함하여 전체 사망률은 22.2%였다. 그러나 수술 시기를 2000년을 기준으로 구분하여 살펴보면, 사망한 4명 모두 2000년 이전이었으며(사망률 50%, 4/8명), 2000년 이후에는 수술 후 사망이 한 명도 없었다(사망률 0%, 0/18명). 수술 후 폐정맥의 협착은 심초음파 검사로 진단하여 5명에서 발생하였다. 5명중 3명은 수술 부위의 협착이고 나머지 2명은 폐정맥 자체의 협착이었다. 수술 부위의 협착을 보인 3명은 재수술을 시행하였고(평균 기간 : 24일) 재수술 후 사망률은 0%이며, 현재 모두 약물치료는 시행하지 않으며 특별한 증상도 보이지 않으나 3명 모두 정기적으로 시행한 심초음파에서 후기 재 협착 소견을 보였다. 이들이 수술 부위의 후기 재 협착이 진단되기까지의 평균 기간은 31.3개월(17-54개월)이었다. 폐정맥 자체의 협착을 보인 환아는 2명으로, 교정 수술 후 심초음파 검사로 진단되기까지의 기간은 각각 3개월과 84개월이었다. 추적 관찰되었던 환아 20명에서 평균 관찰 기간은 $24.2{\pm}24.9$개월(2-80개월)이었다. 결 론 : 수술 후 폐정맥 협착 및 수술 부위의 재 협착이 발생할 수 있으므로 수술 중 경식도 초음파 검사의 적극적 이용과 수술 후 정기적이고 지속적인 관리가 필요할 것으로 생각된다.

• Journal of Chest Surgery
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• 제39권2호
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• pp.154-156
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• 2006

난원와 하부에 위치하는 하정 맥동형 심방중격결손증(inferior sinus venclsus defect)은 매우 드문 선천성심질환으로 수술 전 이차공형 심방중격결손증과 감별이 어렵고 수술 중에도 발견하기가 쉽지 않다. 저자들은 10세 때에 심방중격결손증으로 단순 봉합술 시행 후 별 문제없이 지내다가 이비인후과 수술 위한 사전 검사로 시행한 심장초음파 검사상 잔여 심방중격결손증이 발견된 24세 여자 환자에서 심방중격결손증 재수술을 시행하였다. 환자는 이차공형 심방중격결손증과 하정맥동형 심방중격결손증을 동시에 가지고 있었으나 일차수술에서 하정맥동형 심방중격결손증을 발견하지 못하여 이차공형 심방중격결손증만 교정된 상태였고, 금번 재수술에서 하정맥동형 심방중격결손증을 확인하고 패취 봉합을 시행하였다.

• 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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• 제35권1호
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• pp.52-55
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• 2002

저자들은 심한 청색증을 주소로 내원한 체중 3.4kg의 생후 18일된 여아를 보고한다. 환자는 경흉부 심장초음파로만 진단되었으며 직경이 2mm 정도의 매우 작은 구멍을 가진 삼심방증과 횡격막하형의 폐쇄성 총폐정맥환류 이상, 매우 작은 심방중격결손, 그리고 승모판과 대동맥판의 전향성 혈류가 거의 없는 상태였다. 환자는 술전 검사에서 삼심방증의 매우 작은 구멍을 통한 전향성 혈류가 거의 없고 원위부 좌심방 및 좌심실의 심한 허탈로 인해 수술 전 양심실성 교정 가능성에 대한 판단이 매우 어려웠다. 심한 청색증으로 응급수술을 시행하였으며 수술중에 관찰한 승모판 및 좌심실 구조물들의 발육부전이 있었지만 체순환을 감당할수 있다고 판단되어 양심실성 교정을 시행하였다. 수술 후 매우 양호한 경과를 보였다. 환아는 퇴원 후 4개월째 외래추적중으로 심장초음파 검사에서 폐정맥 협착이나 승모판 기능에 이상은 없었다

• Journal of Korean Neurosurgical Society
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• 제42권2호
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• pp.77-82
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• 2007

Objective : The authors tried to reveal some unique features of lipomeningomyelocele (LMMC), including clinical presentation, factors precipitating onset of symptoms, pathologic entities of LMMC associated with tethered cord syndrome, and surgical outcome in LMMC patients. Methods : Seventy-five patients with LMMC were enrolled in this study. Neuro-imaging and intraoperative findings allowed classification of LMMC into three Types. The patients were divided into two groups by age : A (51 patients), from birth to 3 years, and B (24 patients), from 3 to 24 years. For prevention of retethering of the cord, a mega-dural sac rebuilding procedure was performed in 15 patients. Results : During a mean postoperative follow-up period of 4 years, the surgical outcome was satisfactory in terms of improved pain and motor weakness, but disappointing with reference to the resolution of bowel and bladder dysfunction. Among these 75 patients with LMMC, preoperative deficits were improved after surgery in 29 (39%), remained stable in 28 (37%), changed slightly in 13 (17%), and worsened in 5 (7%). Patients in group A achieved better outcomes than those in group B. Depending on the type of lesion, patients with types I and II LMMC have better outcomes than those with type III LMMC. Finally, retethering of the cord with neurological deterioration occurred in 4 (5.3%) of the 75 patients, but no retethering was found in the 15 patients who were recently treated with a mega-dural sac rebuilding procedure. Conclusion : Our data continue to support the opinion that early diagnosis and optimal surgery are still essential for the treatment of patients with LMMC, since there is a high likelihood of residual neurological functions that can be preserved. Based on our surgical experience of untethering and decompression of lipomas, a mega-dural sac repair is useful to prevent retethering of the cord.

• 대한두경부종양학회지
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• 제25권2호
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• pp.138-142
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• 2009

Introduction : Although bilateral exploration has been thought to be the standard therapeutic modality for primary hyperparathyroidism(pHPT) due to the admirable cure rate, questions have remained as to whether bilateral neck exploration for all patients with pHPT is needed because 80-85% of patients with pHPT have a single parathyroid adenoma. If the diseased parathyroid can be determined preoperatively, a directed and minimal operation is appropriate using the recent innovations of preoperative diagnosis and operation techniques for parathyroid diseases, the radio-guided parathyroid surgery(RGPS) is one of the standards. In especial, RGPS has been reported beneficial in special circumstances, such as in recurrent disease, ectopic parathyroid, and in mediastinal parathyroid. It can be also useful for the parathyroid disease in previously explored or irradiated neck. Material and Methods : We experienced 2 cases of pHPT successfully treated by RGPS in who previously underwent extensive neck dissection and concomitant external or internal radiotherapy. We adopted and modified the technique described by Dr. James Norman at the University of South Florida-the minimally invasive parathyroidectomy using intraoperative nuclear mapping with 99mTc-sestamibi scanning and radioactivity detection probe. Results : We acquired the successful results for these patients. Conclusion : RGPS is thought to be the alternative technique for the patients with prior central neck exploration and irradiation.

• Journal of Chest Surgery
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• 제24권4호
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• pp.404-420
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• 1991

Surgical treatment of congenital and acquired heart disease preceded the development of accurate techniques for diagnosis, heart lung machine and cardiopulmonary bypass, intraoperative myocardial protection, operative techniques and cardiac anesthesia. For 5 years from Sep. 1985 to Sep. 1990, six hundred cases of open heart surgeries [OHS] were performed in the department of Thoracic & Cardiovascular Surgery, Pusan Paik Hospital, College of Medicine, Inje University. The results were summarized as follows. 1. The annual number of OHS[cases per year] was above 100 since 1987, and the increasing rate of cases was 23.5% per year since 1986. 2. Among the total 600 cases, there were 470 cases of congenital heart diseases and 130 cases of acquired. Age range of the congenital patients was 8 months to 44 years with the mean age of 10 years, and acquired patients was 16 to 56 years with the mean age of 36 years. 3. Among the 470 congenital anomalies, there were 429 cases of acyanotic and 41 cyanotic patients. Totally, VSD was 286 cases[60.6%], ASD 103 cases[21.9%], TOF 35 cases [7.4%], PS 20 cases [4.1%], ECD 12 cases [2.0%], Ebstein`s anomaly 3 cases [0.6%], Valsalva sinus rupture 3 cases [0.6%] and others. The appropriate one stage radical operations were applied to the all congenital cases with the result of 2.6% immediate postoperative hospital mortality rate. 4. Among the 130 acquired cases, there were 122 cases of valvular heart diseases, 6 of heart tumors [5 myxoma, one malignant histiocytoma], one of LA thrombus and one of annuloaortic ectasia. Cardiac tumors and LA thrombus were removed through the atrial septal approach. Bentall procedure was adopted to the annuloaortic ectasia case. AVR, MVR and TVA [DeVega procedure] were applied to 120 valve diseases, and there were also one of OMC and one of MVA[Jerome-Kay procedure]. 5. Among the 120 valve replacement cases, there were 87 of single valve replacement cases [AVR: 8, MVR: 79], 11 of double valve replacement [AVR+MVR: 11], 12 of MVR+TVR and 10 of MVR+AVR+TVA. The total number of implanted prosthetic valves were 141. In MVR, 45 of St. Jude Medical valves, 63 of Carpentier-Edward valves and 4 of Ionescu-Shiley valves were used. In AVR, 18 of St. Jude Medical valves and 11 of Carpentier-Edward valves were used. in MVR, 29mm and 31mm sized valves were used mostly and In AVR, 23mm sized valves were used mostly. 6. Postoperatively many kinds of complications were occurred. Among them, wound problems [30 cases], low output syndrome [29 cases], arrhythmia [20 cases], pleural effusion and pneumothorax [13 cases] were occurred frequently. The postoperative immediate hospital mortality was 3.0% in total [congenital 2.6%, acquired 4.6%].

• 한국임상수의학회지
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• 제24권2호
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• pp.269-275
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• 2007

Two dogs referred to Veterinary Medical Center, Chungbuk National University diagnosed as multiple extrahepatic portosystemic shunt were reported. The first dog was a 20-month-old, 8 kg, male Cocker spaniel with history of peritoneal effusion, diarrhea, anorexia and stunted growth. The second dog was a 3-year-old, 13.4 kg, male Jindo with a history of severe depression. Hematologic examination of first dog revealed mild microcytosis and nonregenerative anemia. All of 2 cases, serum chemical values showed increase of serum ammonia, ALP, r-GTP and glucose. In survey radiography, microhepatia was apparent. In the color Doppler ultrasonographic examination, the first dog revealed a dilated tortuous vein communicating with caudal vena cava was observed near the left kidney and the second dog revealed numerous shunting vessels ventral to L5 and L6. Transcolonic portal scintigraphy of the first dog confirmed the presence of portosystemic shunt. In intraoperative jejunoportography, the first dog showed single congenital extrahepatic portosystemic shunt and multiple acquired extrahepatic portosystemic shunts. The second dog showed multiple acquired extrahepatic portosystemic shunts. In these dogs, the presence of congenital and acquried portosystemic shunts and histopathologic findings were considered to represent a combination of multiple extrahepatic portosystemic shunts and noncirrhotic portal hypertension or portal vein hypoplasia.

• Asian Spine Journal
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• 제12권6호
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• pp.1043-1052
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• 2018

Study Design: Level III retrospective cross-sectional study. Purpose: To define and characterize the presentation, symptom duration, and patient/surgical risk factors associated with 'post-decompressive neuropathy (PDN).' Overview of Literature: PDN is characterized by lower extremity radicular pain that is 'different' from pre-surgical radiculopathy or claudication pain. Although it is a common constellation of postoperative symptoms, PDN is incompletely characterized and poorly understood. We hypothesize that PDN is caused by an intraoperative neuropraxic event and may develop early (within 30 days following the procedure) or late (after 30 days following the procedure) within the postoperative period. Methods: Patients who consented to undergo lumbar laminectomy with or without an instrumented fusion for degenerative lumbar spine disease were followed up prospectively from July 2013 to December 2014. Relevant data were extracted from the charts of the eligible patients. Patient demographics and surgical factors were identified. Patients completed postoperative questionnaires 3 weeks, 3 months, 6 months, and 1 year postoperatively. Questions were designed to characterize the postoperative pain that differed from preoperative pain. A diagnosis of PDN was established if the patient exhibited the following characteristics: pain different from preoperative pain, leg pain worse than back pain, a non-dermatomal pain pattern, and nocturnal pain that often disrupted sleep. A Visual Analog Scale was used to monitor the pain, and patients documented the effectiveness of the prescribed pain management modalities. Patients for whom more than one follow-up survey was missed were excluded from analysis. Results: Of the 164 eligible patients, 118 (72.0%) completed at least one follow-up survey at each time interval. Of these eligible patients, 91 (77.1%) described symptoms consistent with PDN. Additionally, 75 patients (82.4%) described early-onset symptoms, whereas 16 reported symptoms consistent with late-onset PDN. Significantly more female patients reported PDN symptoms (87% vs. 69%, p=0.03). Patients with both early and late development of PDN described their leg pain as an intermittent, constant, burning, sharp/stabbing, or dull ache. Early PDN was categorized more commonly as a dull ache than late-onset PDN (60% vs. 31%, p=0.052); however, the difference did not reach statistical significance. Opioids were significantly more effective for patients with early-onset PDN than for those with late-onset PDN (85% vs. 44%, p=0.001). Gabapentin was most commonly prescribed to patients who cited no resolution of symptoms (70% vs. 31%, p=0.003). Time to symptom resolution ranged from within 1 month to 1 year. Patients' symptoms were considered unresolved if symptoms persisted for more than 1 year postoperatively. In total, 81% of the patients with early-onset PDN reported complete symptom resolution 1 year postoperatively compared with 63% of patients with late-onset PDN (p=0.11). Conclusions: PDN is a discrete postoperative pain phenomenon that occurred in 77% of the patients who underwent lumbar laminectomy with or without instrumented fusion. Attention must be paid to the constellation and natural history of symptoms unique to PDN to effectively manage a self-limiting postoperative issue.