Colorectal polyp에 對한 臨床的 考察

鄭泳德(Yung Duk Chung) 대한외과학회 1980 Annals of Surgical Treatment and Research Vol.22 No.7

개에서 移植 前, 臟器供與者血의 輸血과 同時免疫抑制가 腎移植에 미치는 효과에 관한 연구

정영덕(Yung Duk Chung),김상준(Sang Joon Kim),김수태(Soo Tae Kim) 대한외과학회 1985 Annals of Surgical Treatment and Research Vol.28 No.1

경동맥체 종양 1예

박명철(Myong Chui Park),정영덕(Yung Duk Chung),백세민(Se Min Baek) 대한두경부종양학회 1987 대한두경부 종양학회지 Vol.3 No.1

Carotid body tumor is rare tumor in the neck. Among the pathologic ccnditions affecting paraganglionic tissue, the carotid body is most frequently involved. There are controversies in terms of natural history, biological behaviors, technique of excision. risks of the operation. Carotid angiography is the most valuable diagnostic aid and important for the planning of therapy. Defmite treatment of carotid body tumor is surgical exci.i!ion. Considerable degree of caution and vascular surgical armamentation are required because of its anatomical location and profuse vascularity. Surgical removal of this kind of paraganglioma must be predicated upon several factors such as tumor character, location. symptom, vascularity, and surgeon's ability.

진드기(Ixodes nipponensis)에 의한 인체 頭皮 感染 1례

이순형(Soon-Hyung Lee),채종일(Jong-Yil Chai),고원규(Weon-Gyu Kho),홍성종(Sung-Jong Hong),정영덕(Yung-Duk Chung) 대한기생충학열대의학회 1989 The Korean Journal of Parasitology Vol.27 No.1

甲狀腺舌管囊胞에 發生한 乳頭狀腺癌

정영덕,김수신,백세민 大韓成形外科學會 1986 Archives of Plastic Surgery Vol.13 No.3

Benign thyroglossal duct cysts are commonly encountered but malignant lesions originating in the benign thyroglossal duct cysts are exceedingly rare. Most malignant lesions are papillary adenocarcinomas in ectopic thyroid tissue of the benign thyroglossal duct remnants and successfully managed by complete wide excision of the primary lesion described by Sistrunk. The authors herein report a case of papillary adenocarcinoma arising in the thyroglossal duct cyst, which was successfully treated by Sistrunk procedure and subsequent total thyroidectomy and radioactive iodine therapy.

기능성경부곽청술을 시행한 악성흑색종의 치험례 : A Case Report 1例 報告

정영덕,백세민 大韓成形外科學會 1986 Archives of Plastic Surgery Vol.13 No.4

The surgical management of malignant melanoma has long been a highly controversial subject. The basic principle of wide excision of the primary site is generally accepted as the proper management of the primary lesion. The controversy, however, surrounds the appropriate management of the regional lymph nodes. It is generally admitted that, in patients with Clark levels Ⅲ, Ⅳ, Ⅴ and all melanomas that are greater than 1.5mm in thickness, the nodes in neck should be removed, even if they are not clinically suspicious nodes. In the past, it was believed that the nodes in neck should be removed only by the classical redical neck dissection. But now the functional or modified neck dissection markedly increases as an elective operation, since it not only shows no significant difference in the risk of recurrence, compared with classical redical neck dissection, but also is functionally, esthetically, and physiologically acceptable. The ideal candidates of the functional neck dissection are those patients who have clinically No necks but whose primaries have signified chance of having microscopic metastases to the lymph nodes and, as such, are considered for elective neck dissection. The authors herein, experienced a patient with Clark level Ⅳ melanoma in the face and no suspicious lymph nodes in the neck, who was successfully managed wide reexcision and functional neck dissection through the incision of the cervicofacial flap.

안면비대칭 환자 교정 147례에 대한 분석

박정일,정영덕,김동일,백세민 大韓成形外科學會 1990 Archives of Plastic Surgery Vol.17 No.6

Asymmetric face is a big problem in social activity in modern society. One who has facial doformity such as asymmetric face can't have normal social life. We can give him self-confidence and furthermore, a "NEW LIFE"by correcting the deformity. The term of FACIAL ASYMMETRY implies all cases whose right or left half of face can not show the mirror image of the opposite side. Facial asymmetry can be resulted from various conditions and show wide spectrum of phenotype that require many kinds of operation for correction. We experienced 147 cases(351 operations) of facial asymmetry during last four and a half years. Among them 68 were male and 79 were female. The most common cause was hemifacial microsomia(44 of 147). The procedure most commonly performed was operation applied to mandible(86 of 351). In 2 cases, it was difficult to intubate through mouth or nose. In these cases tracheotomy was performed for anesthesia. Now we present the summary of our experiences in correction of facial asymmetry.

여성 가성 반음양 치험례

구상환,정전은,정영덕 大韓成形外科學會 1989 Archives of Plastic Surgery Vol.16 No.6

Normal sexual differentiation is the result of a series of individual steps that occur in an orderly fashion. Initially, chromosomal factors direct the defferentiation of the indifferent gonad into either an ovary or a testis. Then, under the influence of hormones secreted by the fetal testes, differentiation of the internal ducts and external genitalia is completed. Consequently, normal sexual differentiation can be subdivided into three separate events: differentiation of the gonads, development of the internal ducts and differentiation of the external genitalia. However, during embryogenesis any disturbance of the various steps in normal sexual differentiation may be reflected clinically as a disorder of intersexuality e.g. chromosomal anomalies, female pseudohermaphroditism, and male pseudohermaphroditism, etc. Genetic females with female pseudohermaphroditism have virilization of the external genitalia produced by intrauterine exposure to excessive androgen. But, because they normally developed ovaries and Mullerian derivatives, they are all potentially fertile. The degree of masculinization varies depending on the stage of differentiation at the time of exposure, from clitoral hypertrophy to true phallic-urethral formation with labioscrotal fusion. The most common cause is congenital adrenal hyperplasia in which cortisol synthesis is impaired due to deficiency of 21-hydroxylase. In attempting to compensate for lower cortisol levels, ACTH stimulates the adrenal gland to secrete excessive quantities of androgen. We experienced a 2 year-old girl, who expressed genital anomalies such as greatly enlarged clitoris-like male phallus associated with posterior labial fusion and a single perineal urogenital orifice which were first noticed by her parents since birth. The general assessment was normal and the karyotype was 46XX as normal genetic female. Plasma testosterone, ACTH, DHEAS, progesterone, and urinary 17-KS values were higher than normal, but cortisol was within normal value. Her blood pressure and serum eleotrolytes were normal. IVP, abdominal sonogram, retrograde cystogram and vaginogram were found to be normal. Explorative laparotomy and constructive operation of female external genitalia including vaginoplasty using inverted Y-shaped skin flap and clitoridectomy were performed under general anesthesia. Both adrenal glands revealed hyperplastic only, and both ovary was excised in wedge shape for shitologic examination. She was finally diagnosed as female pseudohermaphroditism due to congenital adrenal hyperplasia accompanied by incomplete deficiency of 21-hydroxlase, and hormonal therapy was started with hydrocortisone 15㎎/day in three divided dose for 1 month. The value of 17-KS in 24 hour urine study during follow-up period was within normal limit as 1.3㎎/day at POD ￠1 month, 0.7㎎/day at POD ￠2 month, 1.0mg/day at POD ￠6 month, 0.8mg/day at POD ￠16 month. Results of vaginoplasty, clitoridectomy, and hormonal therapy was satisfactory, and there was no recurrence or prematurity.

긴 자가정맥 By-pass graft를 이용한 하지 버-거씨질환의 치험례 : 11例 報告

김우경,김수신,정영덕,백세민 大韓成形外科學會 1989 Archives of Plastic Surgery Vol.16 No.2

Thromboangitis obliterans (Buerger's disease) is the most common peripheral vascular disease in Korea, whereas arteriosclerosis is in the western countries. It is an obstructive vascular disease caused by segmental inflammatory and proliferative lesions of the medium and small arteries and veins of the limbs. Arteriography is essential in diagnosis, which disclosing segmental multiple occlusions of the medium size and small arteries, associated with collateral and distal run-off vessels visualization. With recent development of arteriography, more segmental Buerger's disease with distal run-off vessels are found. Treatment of Buerger's disease consists of conservative measures, sympathectomy, various vascular surgery such as endarterectomy, patch graft and bypass vein graft, and eventually amputation. Bypass vein graft is most effective, but technically difficult, treatment modality among them. We developed new technique of microvascular surgery which enabled us to revascularize those small arteries such as ant. & post. tibial or peroneal arteries. Now it is our recent policy to explore all the distal legs whenever we confirm visualization of distal run-off vessels of tibial trification and/or arterial pulse waves around the ankle joint with Doppler ultrasonography, no matter how diseased those appears. A long length of autogenous saphenous vein was harvested from the ipsilateral leg or from the contralateral leg when the iplilateral vein is deseased and hence unsuitable for grafting. Breakdown of 11 cases is as follows: 1. Most prevalent incidence is at age group of 31-40, and all patients were male. 2. 9 of 11 patients were smokers. 3. Arteriographies revealed occlusion of lumens, most commonly in superficial femoral arteries, followed by popliteal arteries and ant.tibial arteries. 4. The main type of surgery in all cases was autogenous bypass graft; bypass grafts only in 6 cases (1 case was in-situ bypass), bypass with microendarterectomies in 4, and bypass with subsequent B-K amputation in 1 case. 5. Most common bypass graft was superficial femoral to P.T.A.(6 cases), followed by common femoral to P.T.A.(2 cases), common femoral to bifurcation of P.T.A. & peroneal artery (1 case), common femoral to A.T.A.(1 case; in-situ bypass), superficial femoral to A.T.A.(1 case). 6. Rate of graft failure within 6 months was 30%.

족부를 공여부로 한 수지재건술에 대한 임상적 고찰(16例 報告)

김수신,김우경,백세민,정영덕 大韓成形外科學會 1989 Archives of Plastic Surgery Vol.16 No.2

The hand is an important functioning organ requiring rest and performing the greatest activities, including locomotion. Moreover, the thumb is used in nearly every hand maneuver and plays a key role in hand function. There are many of the favored conventional methods in the hand reconstruction, which continue to be useful and valuable in specific patients. But the introduction of microsurgery of the hand has added a new dimension to reconstructive surgery of the hand, eapecially when the thumb is involved. Prevision of adequate soft tissue coverage and restoration of sensibility & near normal length to the hand present major challenges to the reconstructive hand surgery. The development of microsurgical technique has made possible the transfer of sensory free flaps, which must provide the hand with sensibility, for protection and precise prehension. Because the receptor site is on the hand, the flap must have specific characteristics-thinness, a small size occasionally complex shapes, and good sensory discrimination. By reason of its anatomic similarity, the foot is the donor site of choice, supplying according to needs, its dorsal skin, its first commissure and the pulp of toe. With the development of another microsurgical technique, the era of the thumb reconstruction by free microvascular one stage transfer was also introduced in the form of toe-to-thumb, partial toe flap ("wraparound") and vascularized joint transfer. This one stage reconstruction not only allows for excellent return of sensibility, restoration of near normal hength and usually freedom from pain, but also leads to prompt return of hand function and better cosmetic appearance than do most other reconstructive procedures. This is the report of 16 micrevascular reconstructive surgeries of the hand, using the foot as a donor site. Breakdown of 16 cases is a follows: 1. 6 of a total of 16 cases were innervated free flaps from the dorsum & first commissure of the foot, 1 were microsurgical joint transfer after progressive thumb lengthening of Matev procedure, 3 were toe-to-thumb transfers, (the donor sites of 2 cases were great toes and that of 1 case was 2nd.toe)and 6 were partial toe transfers. (3 cases were "wraparound" flap & the others were toe pulp flaps). 2. We experienced all types of anatomic variations of 1st. dorsal metatarsal artery except Gilbert's typeⅢ. 3. As the skin on the hand was insuffient, in 2 cases, groin flap coverage of the redial side of the hand with additional skin restoration was done before performing great toe-to-thumb transfer. 4. Toe-to-thumb transfer was esthetically & functionally excellent method of the thumb reconstruction. As donor site, great toe was more excellent than 2nd. toe and no significant gait disturbance was seen after toe-to-thumb transfer. 5. The procedure of a "wraparound" flap was more esthetically excellent than any other reconstructive procedures of the thumb, even than toe-to-thumb transfer. 6. We experienced 3 cases of extensive soft tissue loss in the thumb (2 cases) & index finger (1 case). We performed free pulp flaps from the lateral hemipulp of great toes, which is the best method for the restoration of sensation and skin quality of the hand pulp, because local sensory flap was not feasible.