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다발성 대장암 간전이 환자의 간절제를 위한 새로운 시도
주종우,김형철,임철완,신응진,조규석,유기원,송옥평,홍대식,박성진,조준희,이혜경,김희경,권계원,고은석 순천향의학연구소;Soonchunhyang Medical Research Institute 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2
Multiple bilobar liver matastases (MBLM) are the main cause of low resectability in the colon cancer liver metastases. The authors experienced one case of initially non-resectable colon cancer liver metastases. He was curatively and safely treated with a two-stage hepatectomy using the new method of future remnant liver volume growing. A 54-year-old man was referred to our department with the sigmoid colon cancer combined with MBLM, which were checked in two small metastatic lesions in the left lobe and five large sized lesions in the right lobe in the computed tomogram (CT). A laparoscopic assisted anterior resection was primarily performed. We performed the 1^(st) stage hepatectomy 3 weeks after the colon resection. Intra-operative Ultrasonogram (US) found 9 small superficial metastatic lesions in the left lobe. All that lesions were completely removed by non-anatomical wedge resection. An occlusion ballon catheter was placed in the right portal vein through a small branch of the inferior mesenteric vein at that time. The future remnant liver volume was sufficiently increased 3 weeks after the 1^(st) hepatectomy. A right hepatectomy was safely performed 22 days after the 1^(st) hepatectomy. The patient received a regional chemotherapy (interleukin2 based immuno-chemotherapy through hepatic artery) for 4 months, then received 9 cycles of systemic chemotherapy (biweekly Oxaliplation, leucovorin, plus 5-fluorouracil) without any recurrence evidence.
Clinical Use of Univent Tube with Movable Blocker for the Patient of Bronchopleural Fistula
Shin Ok Koh,Hung Kun Oh Korean Society of Critical Care Medicine 1987 Acute and Critical Care Vol.2 No.2
The loss of substantial portion of critically ill patient's tidal volume through a bronchopleual pleural fistula may significantly alter the intrapulmonary distribution of ventilation, ventilation-perfusion matching and arterial blood gases. Prompt localization of surgical closure of bronchopleural fistula remains the treatment of choice in most patients. We had a chance to use a Univent tube with movable blocker to the patients of bronchopleural fistula which developed during esophageal bougienation, The endotracheal tube has two compartment, a large lumen for conventional air passage and a small lumen where a movable tube is placed. Intubation a accomplished by ordinary technique, advancement of the bronchial tube to the right lowers bronchus being guided by fiberoptic bronchoscopy.
Clinical Study of Patients with Neonatal Respiratory Distress Syndrome
Shin Ok Koh,Hung Kun Oh,Dong Kwan Han Korean Society of Critical Care Medicine 1986 Acute and Critical Care Vol.1 No.1
Forty neonates with respiratory distress syndrome were transferred from nursery after birth to the 1CU at Severance Hospital, Yonsei Medical Complex between March 198l to July 1983 and ventilatory support was given with the pressure-cycled ventilator, Baby- log I, Bourns BP 200, in ICU. We have analysed the 40 cases according to sex, incidence, symptoms and signs, birth weight and gestation weeks and time to the ventilator support, 1CU days and mortality. The results were as follows 1) The proportion of the patients was 0.7% neonates and the overall mortality was 52 5% 2) Obstetric and delivery backgrown4 were as follows. Ceasarean section, 19 cases; pre-eclampsia, 5 cases; placenta-previa, 5 cases, spontaneous premature rupture of membrane; 4 cases, 3) The percentage and mortality of male patients was 57.5% and 57,1%, higher than famale patients. 4) All the patients showed symptoms and signs within 12 houre after birth. 5) Mortality of those cases born with less than 32 wks gestation was 15%, but above 32 wks the mortality was 35%. 6) The number of babies born with a birth weight below 2000 grams was 27 and the mortality for them was 70%. 7) The number of cases who had ventilator support begun at 10 hra, 1l-20 and 21- 30 hours after symptoms and signs developed, were 30, 5 and 5. The mortality was 53, 20 and 60% respectively for these 3 groups. 8) The number of ventilator days less than 4 days duration was 27 cases with a 70% mortality but those above 5 days was 13 cases with 16% mortality. In 1981, the number of patients with ventilator days less than 2 days was 11 cases and 2 cases used the ventilator for 7-8 days. But in 1983 the number of patients with less than 4 ventilator days was 6 cases., and 7 cases used ventilator for more than 5 days. 9) The number of patients with ICU days 1ess 5 daye was 23 cases and a morta!ity of 78% and those of 6-10 day stay was 6 cases with a mortality of 50%,. The number of patients with ICU days above 15 days was 18 and a11 survived. In 1981, 10 cases stay in the ICU for less than 5 days. Only 2 cases stayed in the ICU for 6-10 days. In 1983, 6 cases stayed in the ICU for less than 5 days, but 4 cases stayed stayed in the ICU for more than 15 days, 10) Complications were neonatal hyperbilirubinemia, pneumothorax, pneumomediastinum, sepsis, disseminated intravascuIar coagulopathy, bronchopulmonary dysplasia, and cerebraI hemorrhage. From the above results the mortality rate decreased year by year and this is attributed to the early application of ventilator support and adequate intensive care.
Lung Injury Score in Predicting the Outcome of the Patients in the Intensive Care Unit
Shin Ok Koh,Se Sil Lee,Eun Chi Bang,Sung Won Na Korean Society of Critical Care Medicine 1998 Acute and Critical Care Vol.13 No.1
Introduction: Lung Injury Score (LIS) provides a quantitative method for scoring acute lung injury that usually occurs after sepsis. The aim of this study is to evaluate the LIS in prediction the patients outcome and determine the relationship between the LIS and mortality rate, acute physiology and chronic health evaluation II (APACHE II) score and multiple organ failure (MOF) score. METHODS: Patients admitted to Intensive Care Unit (ICU), Severance Hospital Yonsei University College of Medicine from November 1995 to March 1996 were included. LIS at admission and discharge, APACHE II score with MOF score and duration of ICU stay between survivors and nonsurvivors were compared. Relationship of LIS between mortality rate and APACHE II score and MOF score were evaluated. RESULTS: LIS is higher in nonsurvivors than survivors at admission and discharge with statistical significance. LIS of survivors and nonsurvivors at discharge was lower and higher than those at admission (p
Clinical Survey of Paitents on Ventilar Support in the Intensive Care Unit
Shin Ok Koh,Hung Kun Oh Korean Society of Critical Care Medicine 1987 Acute and Critical Care Vol.2 No.1
The Intensive Care Unit(ICU) of Severance Hospital was opened on October 18, 1968 with 7 beds and expanded to 19 beds on February 2, 1981. Statistical analysis of ICU patients was already been reported twice: 1. from 1970 to 1977 with 3,072 cases and 2. from 1975 to 1981 with 4.348 cases The following is a report of clinical analysis of 1,458 ventilator eases which comprised 33. 5% of ICU patients from march 1975 to February 1982. Until 1979 pressure and volume cycled ventilators were used in even ratio; however, since 1980, volume-cycled ventilators such as the Bennett MAI and the Bourns LS 104-150 were mainly used. The ratio of ventilator eases from the Department of Internal Medicine and Cardiac Surgery remained almost constant at 30: 30 from 1975 to 1977 However since 1978, the Cardiac Surgery ventilator cases increased to over 50% of the total. The number of ventilator cases be low the ten year age group was 396 cases, about 27 of the total. They have increased year by year. Among 537 ventilator cases in 1981, the Bennett MAI and II were used in 225, 203 cases respectively. In the under 1 year old age group, 36 cases(43.9%) and 30 cases(36.6%) were put on with the Bourns LS 104-150 and Drager babylog I respectively. 487(90.7%) of cases were supported with controlled mechanical ventilation(CMV) mode and 135(25%) with the positive end expiratory pressure (PEEP). Of 537 cases, 441(85%) were disconnected from the ventilator within 3 days. Death according to duration of ventilator support were 47(18.8%), 38(23.8%) and 14(36.9%,) in 1., 2 and 10 days respecitively. But, for the period of 10~19 days, the number of deaths was 4(36.4%) and for 20 or more days 1 cases(25%) 3. Incidence of causative disease for ventilator support was postcardiac operation cases(301 case, 56%) followed by CNS(central nervous system), 1RDS(idiopathic respiratory distress syndrome), and laparotomy cases in that order. All ventilator cases with neuromuscular disease survived, but none with DIC(Disseminated Intravascular Coagulopathy) did. From above results it can be conciuded that ventilator support cases are increasing and the attendant mortality rate is decreasing year by year.