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대한외과학회> 대한외과학회지> 3세 이상 소아 장중첩증 - 임상양상 및 원인 분석 -

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3세 이상 소아 장중첩증 - 임상양상 및 원인 분석 -

Intussusception in Children Over 3 year Old

이종훈(Jong Hoon Lee) , 한석주(Seok Joo Han) , 최승훈(Seung Hoon Choi) , 황의호(Eui Ho Hwang)
  • : 대한외과학회
  • : 대한외과학회지 50권1호
  • : 연속간행물
  • : 1996년 01월
  • : 131-136(1pages)
대한외과학회지

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Intussusception is an obstructive disease of the gastrointestinal tract which occurs more frequently in childhood than adulthood. In children over 3 year old, intussusception occurs rarely. This study analyzes the etiology and clinical features of 38 cases of intussusception treated surgically in children 3 years old or older at Yonsei Medical Center from January 1973 to December 1993. The results are as follows; 1) The age incidence between 3-4 years old was the most common(36.8%). In sex distribution, male to female ratio was 2.17: 1(26: 12). 2) The duration from the onset of symptoms to admission, for 39.5% of patients was within 24 hours,18.4% from 24 hours to 48 hours and 15.9% from 48 hours to 72 hours. 3) Frequent signs and symptoms were intermittent abdominal pain(86.8%), vomiting(63.2%), mucoid bloody stools(36.8%), and a palpable abdominal mass(21.1%). 4) The most common type was ileocolic type(42.2%), and the next was ileoileal type(28.9%). 5) Manual reduction was performed in 52.6% of the cases, intestinal resection in 36.8%. and other operative method in 10.4%. 6) The leading point was identified in 8 case9(21.1%). 7) The leading points were malignant lymphoma in 4 cases, Henoch-Scholein purpura in 2 cases, ileal polyp and Meckel's diverticulum in each 1 case. 8) Sixteen children(42.1%) were 6 years old or older and two of them had leading points(12.5%). In these two children, the leading points were malignant lymphoma. 9) In the cases of intussusception over 3 year old, leading points were more frequently found Malignant lymphoma occurred frequently as a leading point, especially in children over 6 years old. These things should be considered preoperatively.

UCI(KEPA)

I410-ECN-0102-2009-510-004843428

간행물정보

  • : 의약학분야  > 외과학
  • : KCI등재
  • :
  • : 격월
  • : 1226-0053
  • : 2093-0488
  • : 학술지
  • : 연속간행물
  • : 1959-2012
  • : 8811


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1Original Articles : Outcome of triple-negative breast cancer in patients with or without markers regulating cell cycle and cell death

저자 : Dong Won Ryu , Chung Han Lee

발행기관 : 대한외과학회 간행물 : 대한외과학회지 83권 4호 발행 연도 : 2012 페이지 : pp. 187-195 (9 pages)

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Purpose: The genes p53 and B-cell lymphoma (bcl)-2 play an important role in regulating the mechanisms of apoptosis. In this paper, we retrospectively applied these factors to our series of triple negative breast cancer (TNBC) patients, in conjunction with an evaluation of the prognostic significance of these factors` influence on TNBC survival rate. Particular focus was placed on the role of bcl-2, p53, Ki-67. Methods: The study subjects, 94 women with TNBC, were a subset of patients operated at Kosin University Gospel Hospital from January 2000 to December 2005. Chi-squared tests were used for statistical analysis. Results: Positive staining for cytokeratin (CK)5/6 in 23 cases (24.5%), epidermal growth factor receptor in 15 cases (16.0%), bcl-2 in 26 cases (27.7%), p53 in 55 cases (58.5%) and Ki-67 in 74 cases (78.7%) was determined. Lymph node status, tumor size and expression of CK5/6 or Ki-67 were independent prognostic factors for patients with TNBC. Conclusion: Markers regulating cell cycle and cell death such as p53 and bcl-2 cannot be used to classify TNBCs into two subtypes with differing disease-free survival. But because our study is small in size, more abundant patient data will be needed to evaluate the factors` predictive role in regulating cell cycle and cell death.

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2Original Articles : Observational study of central metastases following thyroid Lobectomy without a completion thyroidectomy for papillary carcinoma

저자 : Jin Seong Cho , Jung Han Yoon , Min Ho Park , Sun Hyoung Shin , Young Jong Jegal , Ji Shin Lee , Hee Kyung Kim

발행기관 : 대한외과학회 간행물 : 대한외과학회지 83권 4호 발행 연도 : 2012 페이지 : pp. 196-202 (7 pages)

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Purpose: There are no guidelines for the optimal timing of the decision of when to perform completion thyroidectomy, and controversy exists regarding how the timing of completion thyroidectomy impacts survival patterns. We investigated the legitimacy of an observational strategy in central node metastasis after thyroid lobectomy for papillary thyroid cancer (PTC). Methods: We retrospectively evaluated 522 consecutive patients who underwent thyroid lobectomy. Of the 69 patients with central metastasis, 61 patients (88.4%) were included in an observational study under cautious evaluation with informed consent by the patients, and compared with an observation arm of 180 postlobectomy N0 (node negative proven) patients. Results: Of the 522 patients, six (1.1%) thyroid, five (0.9%) central, and two (0.4%) lateral recurrences were observed. Lateral recurrences occurred in the immediate completion N0 and Nx groups but not in the N1a observation arms. There were two (3.3%) central recurrences without thyroid or lateral recurrence on the observation arm of N1a observation patients. But two (1.1%) thyroid and three (1.7%) central recurrences were on the observation arm of N0 patients. In Kaplan-Meier survival curves for central or lateral recurrences between observation arms for the N1a and N0 groups, no significant difference was found between the N1a and N0 observation arms (P = 0.365). Conclusion: The timing of when to perform completion thyroidectomy in central metastases-proven patients after lobectomy for PTC should be based on the patient`s risk category.

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3Original Articles : The Effects of Helicobacter pylori on the prognosis of patients with curatively resected gastric cancers in a population with high infection rate

저자 : Hoon Hur , Sang Rim Lee , Yi Xuan , Young Bae Kim , Young Ae Lim , Yong Kwan Cho , Sang Uk Han

발행기관 : 대한외과학회 간행물 : 대한외과학회지 83권 4호 발행 연도 : 2012 페이지 : pp. 203-211 (9 pages)

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Purpose: The goal of this study was to assess the correlation between the Helicobacter pylori status of patients who underwent curative resection for gastric adenocarcinoma and their prognosis in Eastern societies where H. pylori infection is prevalent. Methods: Between 2006 and 2007, 192 patients who had a curative resection for the treatment of gastric adenocarcinoma were enrolled in the study. Of these patients, 18 were excluded due to an inexact evaluation of the H. pylori status, thereby leaving 174 patients in the final analysis. Serologic testing for H. pylori was assessed using an enzyme-linked immunosorbent assay kit for immunoglobulin G, and the histological presence of H. pylori was identified using the Giemsa stain. Results: Of the 174 patients, 111 patients (63.8%) were confirmed for H. pylori infection. H. pylori status did not correlate with the overall or disease- free survival. For patients with stage III or IV gastric cancer, a positive H. pylori status was a significant predictive factor for recurrence over that of a negative H. pylori status (P = 0.019). Negative H. pylori status was a predictive factor for recurrence in multivariable analysis (relative risk, 2.724; 95 confidence interval, 1.192 to 6.228). Conclusion: Helicobacter pylori status did not correlate with the clinicopathologic factors of gastric adenocarcinoma. However, a negative Helicobacter pylori status may be a predictive factor for recurrence in patients diagnosed with advanced gastric adenocarcinoma.

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4Original Articles : Transumbilical single port Laparoscopic appendectomy using basic equipment: a comparison with the three ports method

저자 : Jun Suh Lee , Young Il Choi , Sung Ho Lim , Tae Ho Hong

발행기관 : 대한외과학회 간행물 : 대한외과학회지 83권 4호 발행 연도 : 2012 페이지 : pp. 212-217 (6 pages)

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Purpose: Single port laparoscopic surgery is a rapidly evolving laparoscopic surgical approach. We report a comparison of transumbilical single port laparoscopic appendectomy (TUSPLA) and conventional laparoscopic appendectomy (CLA) in a Korean military hospital. Methods: This single-center retrospective study of 63 patients who received laparoscopic appendectomy was conducted between May 2011 and October 2011. Nineteen patients received TUSPLA and 44 patients received CLA. Clinical outcomes such as operation time, hospital stay, postoperative pain, diet, and postoperative complication were reviewed. Results: There were no statistically significant differences between TUSPLA and CLA patients, respectively, in operation time (58.9 minutes vs. 52.3 minutes, P = 0.262), duration of hospitalization (10.2 days vs. 10.6 days, P = 0.782), mean visual analogue scale score (2.6 vs. 2.5, P = 0.894), and return to diet (1.6 days vs. 1.7 days, P = 0.776). There were two cases (10.5%) of short-term complications in the TUSPLA group and four cases (9.1%) of short-term complications in the CLA group. All patients were fully recovered at discharge. Conclusion: TUSPLA is a feasible alternative for CLA. When a glove port is used, no special instruments are needed. Thus, it can be performed in a hospital equipped with basic laparoscopic surgical instruments.

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5Original Articles : Proposal of an endoscopic retrograde cholangiopancreatography-elated perforation management guideline based on perforation type

저자 : Woo Il Kwon , Jin Young Jang , Ji Kon Ryu , Yong Tae Kim , Yong Bum Yoon , Mee Joo Kang , Sun Whe Kim

발행기관 : 대한외과학회 간행물 : 대한외과학회지 83권 4호 발행 연도 : 2012 페이지 : pp. 218-226 (9 pages)

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Purpose: Consensus for endoscopic retrograde cholangiopancreatography (ERCP) related perforation management is lacking. We aimed to identify candidate patients for conservative management by examining treatment results and to introduce a simple, algorithm-based management guideline. Methods: A retrospective review of 53 patients with ERCP-related perforation between 2000 and 2010 was conducted. Data on perforation site (duodenum lateral wall or jejunum, type I; para-Vaterian, type II), management method, complication, mortality, hospital stay, and hospital cost were reviewed. Comparative analysis was done according to the injury types and management methods. Results: The outcome was greater in the conservative group than the operative group with shorter hospital stay (20.6 days vs. 29.8 days, P = 0.092), less cost (10.6 thousand United States Dollars [USD] vs. 19.9 thousand USD, P = 0.095), and lower morbidity rate (22.9% vs. 55.6%, P = 0.017). Eighty-one percent (17/21) of type I injuries were operatively managed and 96.9% (31/32) of type II injuries were conservatively managed. Between the types, type II showed better results over type I with shorter hospital stay (19.3 days vs. 30.6 days, P = 0.010), less cost (9.5 thousand USD vs. 20.1 thousand USD, P = 0.028), and lower complication rate (18.8% vs. 57.1%, P = 0.004). There was no difference in mortality. Conclusion: Type II injuries were conservatively manageable and demonstrated better outcomes than type I injuries. The management algorithm suggests conservative management in type II injuries without severe peritonitis or unsolved problem requires immediate surgical correction, including operative management in type I injuries unless endoscopic intervention is possible. Conservative management offers socio-medical benefits. Conservative management is recommended in well-selected patients.

KCI등재

6Original Articles : Prognostic factors for gallbladder cancer in the Laparoscopy era

저자 : Hak Youn Lee , Young Hoon Kim , Ghap Joong Jung , Young Hoon Roh , Si Young Park , Nam Uk Kang , Soon Hwa Yoon , Jin Han Cho , Myung Hwan Roh , Sang Young Han , Sung Wook Lee , Yang Hyun Baek , Jin Sook Je

발행기관 : 대한외과학회 간행물 : 대한외과학회지 83권 4호 발행 연도 : 2012 페이지 : pp. 227-236 (10 pages)

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Purpose: Hepatobiliary surgery has changed dramatically in recent decades with the advent of laparoscopic techniques. The aim of this retrospective study was to compare survival rates according to stages, adjusting for important prognostic factors. Methods: A retrospective study of a 17-year period from January 1994 to April 2011 was carried out. The cases studied were divided into two time period cohorts, those treated in the first 9-years (n = 109) and those treated in the last 7-years (n = 109). Results: An operation with curative intent was performed on 218 patients. The 5-year survival rates according to the depth of invasion were 86% (T1), 56% (T2), 45% (T3), and 5% (T4). The number of cases of incidental gallbladder cancer found during 3,919 laparoscopic cholecystectomies was 96 (2.4%). Incidental gallbladder cancer revealed a better survival rate (P = 0.003). Iatrogenic bile spillage was found in 20 perforations of the gallbladder during laparoscopic cholecystectomies, 16 preoperative percutaneous transhepatic gallbladder drainages and 16 percutaneous transhepatic biliary drainages; only percutaneous transhepatic biliary drainage patients showed a significantly lower survival rate than patients without iatrogenic bile spillage (P < 0.034). Chemoradiation appeared to improve overall survival (P < 0.001). Multivariate analysis also revealed that time period, type of surgery, surgical margin, lymphovascular invasion, lymph node involvement, and chemoradiation therapy had significant effects. Conclusion: This study found that the prognosis of gallbladder cancer is still determined by the stage at presentation due to the aggressive biology of this tumor. Early diagnosis, radical resection and appropriate adjuvant therapy can increase overall survival.

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7Original Articles : The diagnostic values of preoperative Laboratory markers in children with complicated appendicitis

저자 : Hany Noh , Sei Jin Chang , Airi Han

발행기관 : 대한외과학회 간행물 : 대한외과학회지 83권 4호 발행 연도 : 2012 페이지 : pp. 237-241 (5 pages)

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Purpose: Accurate diagnosis and optimal management of acute appendicitis, despite being the most common surgical emergency encountered in emergency departments, is often delayed in pediatric patients due to nonspecific symptoms and communication barriers, often leading to more complicated cases. The aim of this study is to investigate the diagnostic significance of common laboratory markers. Methods: A total of 421 patients aged 15 and younger underwent surgical treatment for acute appendicitis. We conducted a retrospective analysis for white blood cell (WBC), C-reactive protein (CRP) and bilirubin. All patients were classified into simple or complicated appendicitis groups based on postoperative histology. Results: The mean age of the patients in the complicated appendicitis group was younger than that in the simple group (P = 0.005). WBC, CRP and bilirubin levels were significantly higher in the complicated appendicitis group (P < 0.001, <0.001, 0.002). The relative risk for complicated appendicitis was calculated using age, WBC, CRP and bilirubin. Elevated CRP levels were associated with the highest risk for complicated appendicitis (hazard ratio [HR], 2.53; 95% confidence interval [CI], 1.38 to 4.65) followed by WBC (HR, 2.42; 95% CI, 1.07 to 5.46) and bilirubin (HR, 2.04; 95% CI, 1.09 to 3.82). The most sensitive markers for diagnosing complicated appendicitis were WBC (95.2%) and CRP (86.3%). Bilirubin levels showed the highest specificity at 74.8%. Conclusion: The risk of complicated appendicitis was significantly higher in patients younger than 10 years old. Preoperative WBC, CRP and bilirubin have clinical value in diagnosing complicated appendicitis with a HR of 2.0 to 2.5. Our results suggest that the utilization of WBC, CRP, and bilirubin can assist in the diagnosis of complicated appendicitis in pediatric patients, allowing prompt diagnosis and optimal management.

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8Case Rerorts : A rare reason of abdominal compartment syndrome: non-Hodgkin Lymphoma

저자 : Mehmet Abdussamet Bozkurt , Kaplan Baha Temizgonul , Osman Kones , Halil Alis

발행기관 : 대한외과학회 간행물 : 대한외과학회지 83권 4호 발행 연도 : 2012 페이지 : pp. 242-245 (4 pages)

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Abdominal compartment syndrome (ACS) is characterized by intra-abdominal hypertension (IAH) which affects all body systems. In healthy individuals, normal intra-abdominal pressure (IAP) is <5 to 7 mmHg. The upper limit of IAP is generally accepted to be 12 mmHg. ACS has been classified into primary, secondary, and tertiary subtypes. Non-Hodgkin lymphoma (NHL) is a rare reason for ACS. We report here one case of NHL as a primary retroperitoneal mass in an 80-year-old male patient who presented with IAH.

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9Case Rerorts : Liver abscess developed after cadaveric Liver transplantation due to Ligation of an accessory right hepatic artery of the donor graft

저자 : Young Dong Yu , Dong Sik Kim , Geon Young Byun , Sung Ock Suh

발행기관 : 대한외과학회 간행물 : 대한외과학회지 83권 4호 발행 연도 : 2012 페이지 : pp. 246-249 (4 pages)

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It is important that extrahepatic arteries are identified precisely at the time of graft procurement. We present a case where the accessory right hepatic artery of the liver was ligated leading to postoperative liver abscess formation in the liver graft. A forty- seven-year-old female patient diagnosed with liver cirrhosis underwent orthotopic cadaveric liver transplantation due to altered mentality. The donor graft showed a variant of the hepatic artery anatomy where an accessory right hepatic artery arose from the superior mesenteric artery. This artery was accidentally transected during procurement. Since the back bleeding test using perfusion fluid was good, the artery was ligated. Postoperative abdominal computed tomography scan revealed a 6 cm low attenuating lesion in the liver. The patient underwent conservative treatment. We believe that even small accessory arteries (1 to 2 mm) should be reconstructed whenever possible to avoid postoperative complications such as liver abscess.

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10Case Rerorts : Endovascular treatment of ruptured infected aortic aneurysm with sepsis

저자 : Jeong Goo Kim , Jong Beom Kwon , Kuhn Park , Jong Ho Lee

발행기관 : 대한외과학회 간행물 : 대한외과학회지 83권 4호 발행 연도 : 2012 페이지 : pp. 250-253 (4 pages)

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The generally accepted treatment for infected aortic aneurysms involves open surgical resection and debridement, with in situ or extra-anatomical bypass. Occasionally, endovascular management can be substituted for the standard operation dependent on the patient`s condition. We report the case of an 81-year-old female with a ruptured infected aortic aneurysm and sepsis, successfully treated endovascularly. She had been on oral antibiotics for one year and is doing well 2 years after discharge.

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1화상 마우스에서의 세균 감염에 대한 저항성 변화

저자 : 조석주(Suck Ju Cho) , 최수진나(Soo Jin Na Choi) , 정상영(Sang Young Chung) , 이현철(Hyun Chul Lee) , 김신곤(Shin Kon Kim)

발행기관 : 대한외과학회 간행물 : 대한외과학회지 50권 1호 발행 연도 : 1996 페이지 : pp. 1-14 (14 pages)

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Thermal injury is known to be a potent modulator of many host immune function. Exposure of experimental animals to thermal injury induces a reduction in their ability to initate and effectuate various types of cellular immune responses. In this study. the effects of artificial thermal injury on resistance to Listeria monocytogenes(LM) or Pseudomonas aeruginosa(Ps) were examined at the cellular level. The number of cultivable LM recovered from the spleens of burnt mice were decreased at 2 and 3 days postinfection compared with those of the untreated control mice. However, the acquired immunity, which developed in either burnt, LPS or IL-1 pretreated mice 7 days after immunization with streptomycin(SM) sensitive LM, was weaker than that developed in the untreated, control mice. To elucidate the possible mechanisms underlying the observation that thermal injury did increases innate immunity but decreased acquired immunity of mice to infection with LM, we assessed the effects of thermal injury of mice on the production of lL-2 and IFN-ygamma activated  
splenocytes and TNF-gamma by peritoneal macrophages. Activated splenocytes from burnt mice exhibited a reduced capacity to produce IFN-γ and IL-2. However, the peritoneal macrophasges from burnt mice produced more TNF-? in the presence of LPS. Pretreatmemt of mice with LPS or IL-1? showed similar results to burnt mice in the production of lL-2 or IFN-γ by activated splenocytes and resistance to LM. When burnt mice were treated with dehydroepiandrosterone(DHEA), a native adrenal steroid hormone, the acquired immunity to LM was restored with increased production of IL-2 and IFN-r by activated splenocytes. These findings suggest that the dual effects of thermal injury on the innate and acquired immunity of mice to the LM infection may be associated with altered capacities of splenocytes and peritoneal macrophages of the mice to produce cytokines including lL-1 and DHEA seemed to restore the acquired immunity to LM. DHEA deserves intensive study for used in the therapeutic modulation of infection caused by immunodeficiencies.

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2백서에서 문정맥 - 하대정맥 션트를 이용한 연구에서 비문정맥조영술의 유용성에 관한 연구

저자 : 유창현(Chang Hyun Yoo) , 신정국(Jung Kook Shin) , 김준현(Jun Hyun Kim) , 김병호(Beong Ho Kim)

발행기관 : 대한외과학회 간행물 : 대한외과학회지 50권 1호 발행 연도 : 1996 페이지 : pp. 15-19 (5 pages)

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The portocaval shunt(PCS) procedure is frequently employed for studying the effects of portal-systemic shunting of splanchnic blood. In many species, a PCS eventually leads to hepatic   
failure and death, but the rat has been known to survive and regain weight. Some investigators  
explained the mechanism of weight-sparing effect as due to portal hypertension from stenosis of PCS which induces hepatopedal collaterals which in turn prevent atrophy. This also may explain the different results obtained between investigators. Some recent studies using the shunt in the rat closed their eye to the necessity to confirm that the shunt was opened by splenoportography. We studied two groups of Sprague-Dawley rats. In Group L the shunt stomal size was maximal(m=10); in group II, the stoma was constricted to a guarter by a ligature at the first week of shunt operation(n=10). The serum enzyme activities of AST, alkaline phosphatase and r-GTP(Glutamyl transpeptidase) and bilirubin were normalized within 2 weeks in both groups. Body weight decreased for 10 days after surgery and then increased at significantly different rates between the two groups. Weight-gain of group 11 was significantly faster than group K because the collaterals prevented the liver of group H form the severe atrophy noted in group I(p<0.05). Splenoportographies were taken at the 4th and 6th week postsurgery. All rats of group 1 showed an open-shunt without stomal stenosis. All rats of group II at the 6th week showed the collaterals with visualization of liver. In this study. we stress the importance of perfect microsurgical technique and the need for splenoportography to confirm the shunt open.

KCI등재

3갑상선 절제술 후의 국소 합병증

저자 : 노우철(Woo Chul Noh) , 김옥영(Ok Young Kim)

발행기관 : 대한외과학회 간행물 : 대한외과학회지 50권 1호 발행 연도 : 1996 페이지 : pp. 20-25 (6 pages)

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One of the many controversies surrounding the treatment of thyroid cancer is the extent of surgical resection for well-differentiated thyroid carcinoma. The benefits of total thyroidectomy as the initial therapy of well-differentiated thyroid cancer have been well documented by many authors. But the opponents of total thyroidectomy cite the high local complication rate of the procedure. Postoperative complications of thyroidectomy seem to be underestimated frequently because the majority of them are temporary and do not result in permanent or serious damage. So, to determine the morbidity rate according to the extent of surgery, we reviewed 145 patients who had undergone thyroidectomy at Ewha Womans University Hospital from Oct.1988 to Mar. 1995. The results were as follows. 1) The most common complication after thyroidectomy was transient hypocalcemia (18.6% in total thyroidectomy, 12.5% in subtotal or near-total thyroidectomy, 5.4% in lobectomy) The relationship between transient hypocalcemia and the extent of surgery was statistically significant.(P<0.050) 2) The second most common complication was transient hoarseness.(8.6% in total thyroidectomy, 4.1% in subtotal or near-total thyroidectomy, 2.7% in lobectomy) 3) There were no postoperative airway complications and no patients had wound hemorrhage requiring reoperation. There were two case of permanent recurrent laryngeal nerve damage in lobectomy and subtotal thyroidectomy. and one permanent hypoparathyroidism following total thyroidectomy. 4) The overall morbidity was 13.5% in lobectomy, 18.8% in subtotal or near-total thyroidectomy and 39.5% in total thyroidectomy. The relationship between the morbidity and the extent of surgery was statistically significant(P<0.05). 5) For prognostically favorable thyroid carcinoma, the possible benefit of total thyroidectomy must be balanced against the prospect of increased morbidity.

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4한국인 유방암의 발병 위함 요인에 관한 환자 - 대조군 연구

저자 : 안세현(Sei Hyun Ahn) , 박건춘(Kun Choon Park) , 윤용이(Yong Yee Youn) , 이무송(Moo Song Lee) , 김영식(Young Sik Kim) , 김미경(Mi Kyung Kim) , 이양자(Yang Ja Lee)

발행기관 : 대한외과학회 간행물 : 대한외과학회지 50권 1호 발행 연도 : 1996 페이지 : pp. 26-35 (10 pages)

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The authors conducted a case-control study to elucidate the risk factors of breast cancer among Korean women. The breast cancer cases(n=212) were recruited from surgically proven cases in the Department of Surgery. Asan Medical Center from June 1986 to July l993. Controls(n=226) were also recruited from the Asan Medical Center. The authors collected information on demographic, reproductive and dietary factors by direct interviews.The distribution of risk factors was compared between the cases and controls to yield odds ratios with 95 percent confidence intervals. Parity was significantly associated with breast cancer risks: parous women showed significantly reduced risk of breast cancer (49 percent) compared to nulliparous women. The number of parity and the age of the first full-term pregnancy also showed negative and positive correlations, respectively. History of lactation and oral contraceptive usage, however, was not associated with breast cancer risks. Obese women showed a significantly increased risk, especially among premenopausal women. Intake frequencies of several food items influenced the risks: intake of ribs and meaty soups increased the risks, but intake of green vegetables decreased the incidence of breast cancer. Concerning dietary nutrients, caloric intake as well as protein and fat intake were significantly related to an increased risk of breast cancer. These effects were accentuated among postmenopausal women. Multivariate analysis controlling for age, reproductive factors, and body mass index, however, showed no significant effects regarding dietary nutrients. These results, being the first report on the risk factors of breast cancer among Korean,

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5원발 및 재발유방암 환자에서 CA 15-3 의 의의

저자 : 김희석(Hee Seok Kim) , 이영하(Young Ha Lee)

발행기관 : 대한외과학회 간행물 : 대한외과학회지 50권 1호 발행 연도 : 1996 페이지 : pp. 36-41 (6 pages)

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The early detection of recurrence is still a major challenging problem after primary surgical treatment of breast cancer. The purpose of this study was to investigate the diagnostic value of CA 15-3 test on the recurrence of breast cancer after primary treatment. During the period from July 1990 to December 1993, 45 patients with recurrent breast cancer were diagnosed using bone X-ray, bone scan, US, CT and MRI at Kyungpook National University Hospital. Serum CA 15-3 levels were measured by immunoradiometric assay in 45 patients with recurrent breast cancer (Group B: 9 patients with local recurrence only, Group C: 6 patients with local and distant metastasis, Group D: 30 patients with distant metastasis only.), and also in the patients with primary breast cancer used as a control group during the same period (Group A: 34 patients who revealed no evidence of local recurrence or distant metastasis after primary treatment). The mean values of CA 15-3 were 8.84U/ml in Group A, 17.82 U/ml in Group B, 136.43U/ml in Group and 138.87 U/ml Group D respectively. At the base of normal upper limit (2h U/ml), the sensitivity of CA 15-13 test for distant metastasis was 61.1%, and specificity was 94.1%. In 8 patients with distant metastasis, their CA 15-3 level doubled when compared with the levels at the time of no metastasis. Using student T-test, there was no significant difference in CA 15-3 values between Group A and B, and the mean value of CA 15-3 in Group D was elevated significantly compared with the mean value of CA 15-3 in Group B (P<0.005) These results suggest that CA 15-3 test is a simple and relatively accurate technique reflecting distant metastasis rather than local recurrence in the breast cancer.

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6유방증상이 없는 여성에서 선별유방조영술의 임상적 의의

저자 : 김광호(Kwang Ho Kim) , 김옥영(Ok Young Kim)

발행기관 : 대한외과학회 간행물 : 대한외과학회지 50권 1호 발행 연도 : 1996 페이지 : pp. 42-46 (5 pages)

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Early detection of breast cancer with screening mammography has been gaining acceptance in the United States. To evaluate the effectiveness of screening mammography in women who had no symptoms, we analysed medical records of 1078 cases who visited the Health Care Management Center of Ewha Womans University Hospital, between January 1992 to December 1992. Abnormal findings were noted in a total of 86 cases(7.9%). Benign calcifications were noted in 38 of those cases(3.4%), fibroadenoma were noted in 15 cases(1.4%), axillary lymphadenopathy was noted in 16 casesO.5%), atypical dense breast were noted in 7 eases(0.6%), cystic disease was noted in 4 cases(0.4%), ectopic breast were noted in 4 cases(0.4%), fat necrosis was noted in 1 case(0.09%) and carcinoma was found in 1 cases(0.09%). 21 cases(l9.6%) revealed no abnormal findings among 107 cases which were abnormal on mammography. In conclusion, abnormal findings of breast were noted on 7.9% of asymptomatic patients and they were not associated with age. The screening mammography of asymptomatic patients may be needed.

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7원발성 및 전이성 간암에 대한 외과적 항암 Lipiodol 색전술

저자 : 선병호(Byung Ho Sun) , 안병권(Byung Kwon Ahn) , 김병수(Byung Soo Kim) , 김만기(Man Ki Kim) , 김지헌(Ji Hun Kim)

발행기관 : 대한외과학회 간행물 : 대한외과학회지 50권 1호 발행 연도 : 1996 페이지 : pp. 47-62 (16 pages)

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Transcatheter Arterial Enbolization (TAE) has been widely used to manage the patients with primary hepatocellular carcinoma (HCC) or metastatic tumors of the liver. It has been performed only at well equipped large hospitals, therefore most of those patients could not have chances to be managed.  Without the aid of angiography. authors performed transarterial Chemo-lipiodolizations through surgically implanted ports in 6 patients who had HCC or metastatic tumors of the liver. Adjunctive transportal Lipiodol chemoembolizations were also performed in 2 advanced rectal cancer patients who showed no evidence of liver metastases. According to the purposes, 4 palliative lipiodolization for unresectable liver lesions and 4 adjunctive lipiodolization along the principles of multimodality therapy were performed. Postoperatively, there were not only catheter related complications, such as misperfusion to the spleen and partial perfusion of the liver; but also chemoembolization related complications, such as gastroduodenal erosion, liver failure, liver necrosis, and spleen infarction. On serial post-lipiodolization CT scans, at least 50 percent reduction of tumor size was noted in the 4cases with unresectable tumors in the liver. The authors consider that correct surgical catherization and port implantation in the time of operation, that is required for primary malignant lesions or other intra-abdominal problems than unredectable liver tumor itself, 1) could alleviate the risk of repeated catheterization, 2) could afford another effective way of management as TAE does, 3) could afford more chances to treat much more numbers of patients and to overcome the limitations of TAE, and 4) the time intervals longer than 2 months of repeated Lipiodol chemo-embolization would be better to avoid complications such as liver necrosis and liver failure.

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8간내 담석에서 시행한 외측 간절제술

저자 : 최우진 ( Woo Jin Choi ) , 서준석 ( Jun Suk Suh ) , 홍인규 ( In Kyu Hong ) , 정중기 ( Jung Ki Chung ) , 박용현 ( Yong Hyun Park ) , 권오중 ( Oh Joong Kwon ) , 김선회 ( Sun Whe Kim ) , 이건욱 ( Kun Uk Lee )

발행기관 : 대한외과학회 간행물 : 대한외과학회지 50권 1호 발행 연도 : 1996 페이지 : pp. 63-77 (15 pages)

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Intrahepatic stones are difficult to manage, especially they are associated with bile duct stricture, cholangitis and destruction of liver parenchyma. There are several suggested methods of treatment which include surgical bile duct exploration with or without biliary drainage, endoscopic procedures, transhepatic cholangiolithotomy and liver resection. Surgeons must consider the extent of atropy of liver parenchyma. existence of extrahepatic gallstone and nature of intra and extrahepatic biliary tree to choose the type of operation in primary hepatolithiasis. We underwent 20 cases of left lateral segmentectomy for primary hepatolithiasis from Jan.h992 to April.1995 in Seoul City Boramae Hospital. The indication of resection was atropy of lateral segment(n=14) and stricture of bile duct(n=6). Most of the patients were female(n=16) and the mean age was 46.6(31~64). Concomitant CBD exploration was performed in 18 cases and among them 13 cases had choledocholithiasis. Cholecystectomy was performed in 15 cases and among them 3 cases had gallstones.4 cases had previous operation history related to biliary stones, cholecystecomy(CS) and T-tube choledocholithotomy(TTCL)(n=3), CS+TTCL+ choledochoenterostomy(n=1). Residual stone was confirmed with T-tube cholangiography (TTC) and USG and 5 cases had residual stones. Residual stones located at both duct were managed with stone basket successfully in 1 cases and incomplete removal in 1 case(left duct only). The 'other 3 cases(Rt.=2, Lt.=1) were left without treatment and during the follow-up period, left duct stones were disappeared and 1 case of right duct stones caused intermittent cholangitis symptom and 1 case was asymptomatic. The majority of the stone was calcium bilirubinate stone(n =180) and cholesterol stone was absent.6 cases had abnormal LFT preoperatively and all of them returned to normal ㅔostoperative? except one who had right duct residual stones. There was no mortality and no reoperation, but morbidity was 42%(n=8)  (ARF=1, bleeding= 1, bile leakage= 1, right subphrenic abscess=1, atelectasis=1, wound problem=3).

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9복강경 담낭절제술과 개복에 의한 담낭절제술의 호흡 , 신경내분비 , 대사 및 염증 반응의 비교

저자 : 장정환(Jeong Hwan Chang) , 김성환(Seong Hwan Kim) , 김권천(Kwoen Cheon Kim)

발행기관 : 대한외과학회 간행물 : 대한외과학회지 50권 1호 발행 연도 : 1996 페이지 : pp. 78-87 (10 pages)

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This study was designed to demonstrate advantages of lascpoic cholecystectomy (LC) in comparison to open cholecystectomy (OC) on the endocrine, inflammatory, and respiratory responses to surgical trauma. 21 patients with gall stone were assigned randomly to the laparoscopic cholecystectomy      
 (N=11) or the open cholecytectomy (N=10) groups. Blood samples were obtained before the operation,24 hours and 72 hours after the operation. Plasma concentrations of ACTH, Cortisol,  
Epinephrine and Norepinephrine were measured as indices of the endocrine response. Plasma    
concentrations of lntetheukin-6(IL-6), Interleukin-lα(IL-α), tumor necrotic factor (TNF), ESR and CRP were measured as the indices of the inflammatory response. Vital capacity (VC), Forced expiratory volum in is (FEV1), Functional residual capacity (FRC), pH, PaO2, PaCO2, SaO₂ were measured as the indices of pulmonary function. Plasma concentrations of ACTH and cortisol in the OC group after the operation were increased much more than in LC group. Plasma concentration of lL.6 in the OC group was significantly increased postoperatively. but the respiratory response show no the significant difference between the both groups. On the bases of these results the benefit of LC was proved by the reduced endocrine and inflammatory responses to surgical trauma.

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10수술로 확진된 원발성 담낭암의 임상적 고찰

저자 : 김명원(Myung Won Kim) , 조철균(Chol Kyoon Cho) , 김현종(Hyun Jong Kim)

발행기관 : 대한외과학회 간행물 : 대한외과학회지 50권 1호 발행 연도 : 1996 페이지 : pp. 88-97 (10 pages)

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From January 1984 to December 1993, 35 patients, who received surgical treatment for a primary carcinoma of the gallbladder at the department of surgery in Chonnam University Hospital, were evaluated.The results were as follows: 1) Radiographic diagnostic methods for gallbladder carcinoma were chiefly ultrasonography (91.4%) and computed tomography(85.7%) and the preoperative diagnostic accuracy was 81.3% and 86.7%, respectively. 2) Curative resections were carried out in 16 patients(45.5%). Seven(20.0%) of these patients were treated by simple cholecystectomy. six(17.0%) by cholecystectomy, regional LN dissection and wedge resection of liver, and three(8.5%) by cholecystectomy, regional LN dissection and right hepatic lobectomy. Palliative resections were carried out in 19 patients(54.5%). 3) For treatment of TNM stage III patients(20.0%) with primary gallbladder carcinoma, an extended cholecystecomy was performed in 4 patients. Mean survival time was 9  months. Chlecystectomy, right hepatic lobectomy and regional LN dissection was carried out in 3 patients who had a mean survival time of 16 months. The latter showed a longer mean survival time than the former with statistical significance in patients with TNM stage III primary carcinoma of gallbladder(P value=0.0285). 4) The most common histologic type of primary gallbladder carcinoma was adenocarcinoma (88.6% ) and the most common metastatic site was the liver(40.0%). 5) The five-year survival rate of patients with TNM stage 1 was 20%. Three-year survival rate in TNM stage 11 was 25%. One-year survival rates in TNM stage 111 was 57%, and the survival time of all cases of TNM stage IV was below one year. In terms of pathologic stage the prognosis and survival rate were better in the early stage groups than in the late stage groups (P value<0.01). The overall five-year survival rate was 2.9%. 6) Postoperative complications included hypoalbuminemia(3e3%) and malnutrition(31.4%). The overall mortality rate was 2.9%. 7) Postoperative mean recurrence rate was 19.0% within one year and 60.2% within two years. In conclusion, early detection of primary gallbladder carcinoma is very important for the improvement of its prognosis. For this purpose regular health examinations and improvement of radiographic and labora

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