• Journal of Trauma and Injury
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• 제26권3호
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• pp.190-197
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• 2013

Purpose: Trauma is one of the major cause of death in Korea. This study focused on the survival rate and the neurologic outcome for patients with traumatic cardiac arrest (CA) at one emergency center. Methods: We retrospectively reviewed the medical records of patients with traumatic CA who were seen at a regional emergency medical center from January 2010 to December 2011. From among major trauma patients at that medical center, adults older than 18 years of age who had CA were included in this study. CA included out-of-hospital CA with arrival at the Emergency Department (ED) within three hours and in-hospital CA. We checked the survival rate and the neurologic outcome. Results: A total of 61 patients were analyzed: 32 patients had return of spontaneous circulation (ROSC), 6 patients survived to discharge (survival rate: 9.84%), and 4 were still alive 90 days after discharge. The Cerebral performance category (CPC) scores at 6 months after discharge showed 1 good and 5 poor in neurologic outcomes. Factors such as initial rhythm of CA, part with major injury, Revised Trauma Score (RTS) and pH, were significant for ROSC, survival, and neurologic outcome in patients with traumatic CA. Conclusion: In this study, patients who had traumatic CA showed a 9.84% survival rate and a 1.64% good neurologic outcome. The results are poorer than those for CA caused by disease. Multi-center, prospective studies are needed.

• Advances in pediatric surgery
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• 제16권1호
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• pp.11-17
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• 2010

Pancreatic tumors in children are relatively rare, and their prognosis differs from that in adults. The purpose of this study is to examine the clinical characteristics, treatment, and prognosis for children with pancreatic tumors. We retrospectively reviewed the medical records of children under 15 years of age with pancreatic tumors who were treated surgically at Asan Medical Center between January 1992 and November 2009. There were 16 patients, fourteen of whom were pathologically diagnosed with solid pseudopapillary tumor. The other two patients were diagnosed with pancreatoblastoma and acinar cell carcinoma, respectively. Six patients of the 16 patients (38 %) were male, and there was a male-to-female ratio of 1:1.6. The initial presentations were upper abdominal pain in eight patients (50 %), palpable abdominal mass in three, and vomiting in one. Four patients were diagnosed incidentally. Six patients' tumors were located in the pancreatic head, six in the pancreatic body, and four in the pancreatic tail, respectively. The surgical procedures performed included distal pancreatectomy (n=7, 44 %), median segmentectomy (n=3), enucleation (n=3), pancreaticoduodenectomy (n=2), and pylorus-preserving pancreaticoduodenectomy (n=1). Three patients underwent laparoscopic surgery. The median tumor size was 6.5 cm (1.8~20 cm). Early surgical complications included pancreatic fistula (n=4), bile leakage (n=1), and delayed gastric emptying (n=1). A late complication in one patient was diabetes. The median follow-up period was five years and four months, and all patients survived without recurrence. While pancreatic tumors in adults have a poor prognosis, pancreatic tumors of childhood are usually curative with complete resection and thus have a favorable prognosis.

• Archives of Plastic Surgery
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• 제34권2호
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• pp.209-216
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• 2007

Purpose: The ischial area is by far the most common site of pressure sores found in wheel chair bound paraplegic patients, because greatest pressure is exerted from the body on this area in a sitting position. Even after a series of successful pressure sore treatments, the site is very prone to relapse by the simplest ordinary tasks of everyday life. Therefore, it is crucial to preserve the main pedicle during primary surgery. Various surgical procedures employed to treat pressure sores such as myocutaneous flap and perforator flap have been introduced. After introduction of ischial sore treatment using the inferior gluteal artery perforator (IGAP) has been made, the authors experienced favorable clinical results of patients who have undergone IGAP flap procedure in a three year time period. Methods: A total of 17 patients received IGAP flap surgery in our hospital from January 2003 to May 2006, among which 14 of them being males and 3 females. Surgery was performed on the same site again in 6(35%) patients who had originally relapsed after receiving the conventional method of pressure sore surgery. Patients' average age was 49.4(27-71) years old. Most of the patients were paraplegic(11 cases, 65%) and others were either quadriplegic(4 cases, 23%) or ambulatory(2 cases, 12%). Based on hospital records and clinical photographs, we have attempted to assess the feasibility and practicability of the IGAP flap procedure through comparative analysis of several parameters: size of defective area, treatment modalities, occurrence of relapses, complications, and postoperative treatments. Results: The average follow-up duration of 17 subjects was 25.4 months(5-42 months). All flaps survived without any necrosis. Six cases were relapsed cases from conventional surgical procedures. All of them healed well during our follow-up study. Postoperative complications such as wound dehiscence and fistula developed in some subjects, but all were well healed through secondary treatment. A total of 2 cases relapsed after surgery. Conclusion: The inferior gluteal artery perforator flap is an effective method that can be primarily applied in replacement to the conventional ischial pressure sore reconstructive surgery owing to its many advantages: ability to preserve peripheral muscle tissue, numerous possible flap designs, relatively good durability, and the low donor site morbidity rate.

• Yonsei Medical Journal
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• 제59권9호
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• pp.1088-1095
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• 2018

Purpose: Post-operative pulmonary function is an important prognostic factor for lung transplantation. The purpose of this study was to identify factors affecting recovery of forced expiratory volume in 1 second (FEV1) at the first year after lung transplantation. Materials and Methods: We retrospectively reviewed the medical records of lung transplantation patients between October 2012 and June 2016. Patients who survived for longer than one year and who underwent pulmonary function test at the first year of lung transplantation were enrolled. Patients were divided into two groups according to whether they recovered to a normal range of FEV1 (FEV1 ${\geq}80%$ of predicted value vs. <80%). We compared the two groups and analyzed factors associated with lung function recovery. Results: Fifty-eight patients were enrolled in this study: 28 patients (48%) recovered to a FEV1 ${\geq}80%$ of the predicted value, whereas 30 patients (52%) did not. Younger recipients [odds ratio (OR), 0.92; 95% confidence interval (CI), 0.87-0.98; p=0.010], longer duration of mechanical ventilator use after surgery (OR, 1.14; 95% CI, 1.03-1.26; p=0.015), and high-grade primary graft dysfunction (OR, 8.08; 95% CI, 1.67-39.18; p=0.009) were identified as independent risk factors associated with a lack of full recovery of lung function at 1 year after lung transplantation. Conclusion: Immediate postoperative status may be associated with recovery of lung function after lung transplantation.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제25권5호
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• pp.353-375
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• 2022

No systematic review to date has examined histopathological parameters in relation to native liver survival in children who undergo the Kasai operation for biliary atresia (BA). A systematic review and meta-analysis is presented, comparing the frequency of native liver survival in peri-operative severe vs. non-severe liver fibrosis cases, in addition to other reported histopathology parameters. Records were sourced from MEDLINE, Embase, and CENTRAL databases. Studies followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and compared native liver survival frequencies in pediatric patients with evidence of severe vs. non-severe liver fibrosis, bile duct proliferation, cholestasis, lobular inflammation, portal inflammation, and giant cell transformation on peri-operative biopsies. The primary outcome was the frequency of native liver survival. A random effects meta-analysis was used. Twenty-eight observational studies were included, 1,171 pediatric patients with BA of whom 631 survived with their native liver. Lower odds of native liver survival in the severe liver fibrosis vs. non-severe liver fibrosis groups were reported (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.08-0.33; I²=46%). No difference in the odds of native liver survival in the severe bile duct destruction vs. non-severe bile duct destruction groups were reported (OR, 0.17; 95% CI, 0.00-63.63; I²=96%). Lower odds of native liver survival were documented in the severe cholestasis vs. non-severe cholestasis (OR, 0.10; 95% CI, 0.01-0.73; I²=80%) and severe lobular inflammation vs. non-severe lobular inflammation groups (OR, 0.02; 95% CI, 0.00-0.62; I²=69%). There was no difference in the odds of native liver survival in the severe portal inflammation vs. non-severe portal inflammation groups (OR, 0.03; 95% CI, 0.00-3.22; I²=86%) or between the severe giant cell transformation vs. non-severe giant cell transformation groups (OR, 0.15; 95% CI, 0.00-175.21; I²=94%). The meta-analysis loosely suggests that the presence of severe liver fibrosis, cholestasis, and lobular inflammation are associated with lower odds of native liver survival in pediatric patients after Kasai.

• Journal of Chest Surgery
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• 제56권4호
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• pp.274-281
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• 2023

Background: Patients who require initial venoarterial extracorporeal membrane oxygenation (VA ECMO) support may need to undergo veno-arteriovenous ECMO (VAV ECMO) conversion. However, there are no definitive criteria for conversion to VAV ECMO. We report 9 cases of VAV ECMO at Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine. Methods: Of 158 patients who received ECMO support between January 2017 and June 2019, 82 were supported by initial VA ECMO. We retrospectively reviewed the medical records of 9 patients (7 men and 2 women; age, 53.1±19.4 years) who had differential hypoxia and required VAV ECMO support. Percutaneous transaortic catheter venting was used to detect the differential hypoxia. Results: Among the 82 patients who received VA ECMO support, 9 (10.9%) had differential hypoxia and required conversion to VAV ECMO support. The mean time from VA ECMO support to VAV ECMO support and the mean duration of the VAV support were 2.1±2.2 days and 1.9±1.5 days, respectively. The average peak inspiratory pressure before and after VAV ECMO application was 23.89±3.95 cmH₂O and 20.67±5.72 cmH₂O, respectively, decreasing by an average of 3.2±3.5 cmH₂O (p=0.040). The PaO₂/FiO₂ ratio was kept below 100 mm Hg in survivors and non-survivors for 116±65.4 and 250±124.9 minutes, respectively (p=0.016). Six patients underwent extracorporeal cardiopulmonary resuscitation, of whom 4 survived (67%). The overall survival rate of patients who underwent conversion from VA ECMO to VAV ECMO was approximately 56%. Conclusion: Rapid detection of differential hypoxia is required when VA ECMO is applied, and efficient conversion to VAV ECMO may be critical for patient survival.

• 지역과문화
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• 제6권3호
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• pp.29-53
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• 2019

한국사회에서 여성예술인은 성불평등한 구조와 문화뿐만 아니라 역사적으로 부과된 여성예술가에 대한 왜곡된 대중적 인식이라는 이중고를 겪고 있다. 평상시에는 드러나지 않았던 이러한 인식은 문화예술계의 미투(metoo) 운동에서 성폭력의 피해자를 대하는 이차 가해의 행위를 통해 확인된 바 있다. 특별히 전통예술분야에서의 여성예술인에 대한 인식은 식민지 시대와 해방 이후 근대화 시기를 기점으로 수립된 음악정책의 특성으로 인하여 그 지위가 더 저급화되는 결과를 낳았기 때문이기도 하다. 여악, 여기, 기생 등의 다양한 명칭으로 불렸던 조선시대의 여성 예술인들은 그 시대의 권력이 생산하는 지식의 장에서 그 정체성 및 역할과 기능이 만들어졌는데 다차원적인 담론의 층위 중 섹슈얼리티에 관련되는 부분만이 지속적으로 현재까지 영향을 미치고 있다. 본 논문은 젠더적 분석 없는 전통예술지원정책이 조래할 수 있는 위험(성폭력이 용이한 구조의 지속 등)을 인식하는 가운데 여성예술인이 관련된 정책 담론의 계보를 확인하여 보다 적실성 있는 정책대안을 도출할 수 있는 지식생산을 목적으로 한다. 그 첫 단계로서 여성국악인을 둘러싼 조선시대의 담론을 분석한다. 분석의 결과 여악을 둘러싼 담론은 정치철학적 차원, 음악이론적 차원, 그리고 사회문화적 차원으로 나눌 수 있었다. 이들 중 어떤 차원이 지속성을 유지하게 되는가는 다음 단계의 연구과제로 남겨둔다.

• 대한영상의학회지
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• 제82권3호
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• pp.600-612
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• 2021

목적 간 기능 검사와 영상 소견을 기반으로 하여 췌십이지장절제술 후 발생한 후기 출혈에서 스텐트-그라프트를 이용한 치료의 장기적 영상의학적, 임상적 경과를 보고자 한다. 대상과 방법 2012년 6월부터 2017년 5월까지 췌십이지장절제술 후 발생한 후기 출혈로 스텐트-그라프트 삽입술을 받은 9명의 환자를 후향적으로 분석하였다. 저자들은 시술 직후 술기적, 임상적 결과와 간 기능 검사를 검토하였다. 스텐트-그라프트의 개통성은 CT angiography를 이용하여 평가하였다. 결과 모든 스텐트-그라프트는 즉각적인 동맥 출혈을 멈추면서 간동맥 혈류를 유지할 수 있도록 의도했던 위치에 배치되었다. 기술적 성공은 모든 9명의 환자에게서 이루어졌다. 8명의 환자는 시술 후 생존하여 퇴원하였으며 한 명의 환자는 시술 28일 후 사망하였다. 평균 추적 관찰 기간은 781일이었다(범위: 28~1766일). 추적관찰 CT angiography에서 모든 환자의 스텐트-그라프트는 폐쇄되었다. 그러나 모든 환자들에서 간 경색을 시사할 만한 혈중 아스파르테이트아미노전달효소나 알라닌아미노전달효소 수치의 증가를 보이지 않았다. 결론 스텐트-그라프트 삽입술은 췌십이지장절제술 후 발생한 생명을 위협하는 후기 출혈의 안전하고 효과적인 치료이다. 간 기능과 간 말단부 동맥혈 공급은 추적관찰 CT상 스텐트-그라프트가 높은 확률로 막힘에도 불구하고 유지된다.

• Clinical and Experimental Pediatrics
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• 제48권1호
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• pp.68-74
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• 2005

목 적 : 혈역동 상태가 불안정한 신부전 환자에서 CRRT 시행이 증가하고 있으나 국내에서는 소아 환자에서의 보고는 드물다. 그러므로 저자들은 소아 환자들에서 CRRT의 치료 경험을 보고하고자 한다. 방 법 : 2001년 5월부터 2004년 5월까지 서울아산병원에서 CRRT를 시행한 소아 환아 23례를 대상으로 하여 원인 질환 및 신대체요법 시작 시 임상 양상과 경과, CRRT의 방법과 결과를 검토하였고 생존군과 사망군 사이의 차이를 비교 분석하였다. 결 과 : 23명의 환아 중 남아가 12명, 여아가 11명이었고 연령은 3일에서 16세(중간값 5세)였다. 체중은 2.4 kg에서 63.9 kg(중간값 23.0 kg)였고 20 kg 이하가 5명이었다. 대상 환아의 기저 질환은 종양성 질환이 9명, 다장기 부전 증후군 5명, 선천성 대사이상 질환에 의한 고암모니아 혈증 4명, 간기능 부전과 동반된 급성 신부전 3명, 확장성 심근증 1명, 선천성 신증후군 1명 이었다. PRISM III 점수는 $17.6{\pm}7.6$이었고 평균 부전 장기의 수는 $3.0{\pm}1.7$개였다. CRRT를 시행한 기간은 1일에서 27일(평균 9일)이었다. 23명의 환아 중 11명(47.8%)이 생존하였다. 이중 4명에서 후유증이 남았는데 1명은 뇌출혈이 발견되었고 2명은 만성 신부전으로 진행하였으며 또 다른 1명에서는 내경정맥에 2중 도관 삽입과 관련된 상대정맥 혈전으로 인해 유미흉이 발생하였다. 생존군과 사망군을 비교하였을 때 생존군에서 CRRT 시작 당시의 PRISM III 점수와 투여되는 승압제의 수가 유의하게 낮았다(P<0.05). 결 론 : 혈역동상태가 불안정하고 다장기 부전이 동반된 급성 신부전 환아에서 CRRT를 효과적으로 시행할 수 있었고 생존율에는 CRRT 시작 전 PRISM III 점수, 승압제 투여 정도가 중요한 요인이었다.

• Neonatal Medicine
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• 제18권1호
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• pp.89-95
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• 2011

목적: 고나트륨혈증은 미숙아에서 자주 볼 수 있으며 심한 경우 뇌출혈을 일으킬 수 있다. 이에 미숙아 중 극소 저체중 출생아(<1,250 g)에서 과나트륨혈증의 발생빈도, 출현시기, 발생의 위험요인을 알아보며, 뇌출혈 발생과의 관계도 알아보고자 본 연구를 시행하였다. 방법: 2006년 1월부터 2009년 12월까지 원광대학교 병원NICU에서 7일 이상 생존하였던 1,250 g 미만의 극소 저체중 출생아 55예를 대상으로 하였다. 환아들의 의무기록을 이용하여 출생 후 6일 동안 고나트륨혈증의 발생빈도, 출현시기, 고나트륨혈증 유발의 위험 요인으로 알려진 Na 투여량, 수액 공급량, 소변배출양, 체중 감소, 그리고 뇌출혈 발생 유무를 후향적으로 조사하고, 이들을 혈청 나트륨이 단 1회라도 150 mEq/L 이상으로 검사된 경우의 고나트륨혈증군과 비고나트륨혈증군으로 구분하여 비교 하였다. 결과: 1,250 g 미만의 극소 저체중 출생아에서, 1) 고나트륨혈증의 빈도는 52.7%이고, 처음 출현한 시기는 출생 후 2.8${\pm}$1.3일이었다. 2) 고나트륨혈증을 보인 군의 Na 투여량이 보이지 않은군에 비해 더 많아 보였으나 의의는 없었다. 3) 고나트륨혈증을 보인 군과 보이지 않은 군의 수액투여량은 차이가 없었다. 4) 고나트륨혈증을 보인 군과 보이지 않은 군의 소변배출량은 차이가 없었다. 5) 고나트륨혈증을 보인 군(3.52${\pm}$2.19%)의 체중 감소가 보이지 않은 군(2.00${\pm}$3.24%)에 비해 생후 3일째 의의 있는 감소를 보였으며(P<0.05) 이후에도 체중감소의 정도가 더 심하였으나 의의는 없었다. 6) 뇌출혈의 빈도는 38.2% (21/55명)이었으며, 고나트륨혈증을 보인 군(14/29명, 41.4%)과 보이지 않은 군(9/26명, 34.6%)의 뇌출혈 발생 빈도의 차이는 의의가 없었다. 결론: 극소 저체중 출생아에서 출생초기의 고나트륨혈증은 자주 유발되며 출생 초기의 심한 체중감소가 발생의 중요 요인으로 보이나, 약간 높은 혈청내 Na 농도는 뇌출혈 발생에 영향이 적은 것으로 보인다.