대퇴동맥과 원위부 동맥간 이식편에 발생된 협착에 있어 Duplex scan parameters와 ABI의 비교 분석

강동백,박동은,채권묵,소병준 대한외과학회 2001 대한외과학회 학술대회 초록집 Vol.2001 No.11

대퇴동맥과 원위부 동맥간 이식편에 발생된 협착에 있어 Duplex Scan Parameters와 ABI의 비교 분석

강동백,권정남,박동은,채권묵,김은아,소병준 대한혈관외과학회 2002 Vascular Specialist International Vol.18 No.2

Purpose: Early traditional methods of surveillance to detect failing graft relied on recurrence of symptoms, change of pedal pulses, or a decrease in the Ankle-Brachial Index (ABI). More recently, graft surveillance with Duplex scan which has become an appropriate first-line alternative has been shown to be effective in identifying the patency of threatened femorodistal graft. The purpose of this study was to determine the relationship and significance among ABI change, run-off resistance score, and Duplex scan parameters in femorodistal graft bypass. Method: Among 52 patients who received femorodistal bypass, thirty-one femorodistal grafts (19: above knee, 12:below knee) which had followed up for more than 2 years were followed up by ABI at regular interval and Duplex scan at 2 year. Those were grouped according to the grade of ABI decrease as follows; Group Ⅰ: <0.1 ABI decrease, Group Ⅱ: 0.1≤ ABI decrease<0.15, Group Ⅲ: 0.15 ≤ABI decrease < 0.2, Group Ⅳ:≥0.2 ABI decrease. Peak systolic flow velocity (PSFV) ratio, luminal diameter at near proximal and distal anastomosis, mean body graft velocity (cm/sec) were evaluated. Runoff resistance score was calculated by the finding of the pre-operative angiogram. Result: In proportion to the severity of ABI decrease, proximal and distal peak systolic flow velocity (PSFV) ratio and stenosis (%) increased, mean body graft velocity decreased. Significant statistical difference between groups were shown as follows; Group Ⅱ and Ⅳ: distal PSFV ratio (2.17 vs 2.95, P=0.02), proximal stenosis (32.8% vs 47.4%, P=0.026), distal stenosis (21.7% vs 62.8%, P=0.007), mean body graft velocity (81 cm/sec vs 46 cm/sec, P=0.02) Group Ⅲ and Ⅳ: distal PSFV ratio (2.29 vs 2.95, P=0.02), distal stenosis (40.5% vs 62.0%; P=0.03), body flow velocity (70 cm/sec vs 46 cm/sec, P=0.02). The higher runoff resistance score was, the more distal PSFV ratio, distal stenosis increased, but proximal stenosis, PSFV ratio, and mean body graft velocity did not change significantly. Conclusion: This study shows that higher decrease in ABI (>0.2) is well correlated with critical Duplex parameters. Longer graft patency and economic benefit may be obtained by active evaluation of failing graft using by Duplex scan when the ABI decrease is more than 0.2 in femorodistal graft bypass at regular examination.

Laparoscopic Management of Appendiceal Intussusception Caused by Fecaliths

강동백,김승호,오정택,김강득,조향정,이정균,박원철 대한대장항문학회 2009 Annals of Coloproctolgy Vol.25 No.5

Appendiceal intussusception is a rare condition of abdominal pain. It develops as a result of various anatomic or pathologic conditions, such as polyps, worms, carcinomas, mucoceles, or fecaliths. Furthermore, an accurate preoperative diagnosis of appendiceal intussusception may be difficult. However, recently developed radiologic modalities, such as multidetector CT and laparoscopy, can considerably aid preoperative diagnosis and provide a means of adopting optimal minimally invasive surgery. Here, the authors describe the case of a 30-year-old woman with the clinical features of acute appendicitis, who was preoperatively diagnosed as having appendiceal intussusception with fecaliths and who was managed by using a laparoscopic partial cecectomy. Appendiceal intussusception is a rare condition of abdominal pain. It develops as a result of various anatomic or pathologic conditions, such as polyps, worms, carcinomas, mucoceles, or fecaliths. Furthermore, an accurate preoperative diagnosis of appendiceal intussusception may be difficult. However, recently developed radiologic modalities, such as multidetector CT and laparoscopy, can considerably aid preoperative diagnosis and provide a means of adopting optimal minimally invasive surgery. Here, the authors describe the case of a 30-year-old woman with the clinical features of acute appendicitis, who was preoperatively diagnosed as having appendiceal intussusception with fecaliths and who was managed by using a laparoscopic partial cecectomy.

대장 내시경으로 진단하여 복강경 절제로 치료한충수돌기 출혈 1예

강동백,이정균,양빛나,김승호,오정택,박원철,김기훈,조은영 대한소화기내시경학회 2008 Clinical Endoscopy Vol.37 No.4

하부 위장관 출혈부위를 찾기 위해 대장 내시경 등의 여러 진단 방법들이 시행 되고 했으나 정확한 출혈 부위를 찾아내지 못하는 경우가 있어 종종 진단 및 치료에 어려움이 있다. 하부위장관 출혈이 충수돌기에서 발생되는 경우는 드물게 보고 되고 있으며, 원인으로는 충수돌기염, 게실, 중첩증, 혈관이형성증, 크론씨병 등에 의해 다양한 급, 만성 염증 반응으로 충수돌기 점막하층의 혈관이 노출되면 출혈이 일어날 수 있다. 저자들은 하부위장관 출혈로 내원한 48세 여자에서 대장내시경으로 진단된 충수돌기 출혈에 대하여 복강경 충수돌기절제술로 치료한 1예를 문헌고찰과 함께 보고한다.

A Case of Appendiceal Perforation Caused by Fishbone

강동백,오정택,이정균,조향정,박원철 대한응급의학회 2014 大韓應急醫學會誌 Vol.25 No.1

On rare occasions, ingested foreign bodies make their wayinto the appendix, which can cause an inflammatory reactionwith or without perforation. In addition, perforation of theappendix by a foreign body is relatively rare, however, itshould be considered in atypical cases of peritonitis, intraabdominalabscess, or mass, and intestinal obstruction. Weexperienced a case of appendiceal perforation caused by afishbone, which presented as chronic abdominal pain andintra-abdominal abscess. A 57-year-old man presented withambiguous lower right-side abdominal pain with fever forapproximately one week. Abdominal computed tomographyshowed a foreign body in the appendix with abscess formation. Subsequently, a laparoscopic appendectomy was performedand histopathological examination confirmed perforatedappendicitis with severe inflammation secondary to aforeign body.

Association of Abdominal Obesity with Gastric Cancer

강동백,김용,이석윤,이영환,박원철,이정균 한국정맥경장영양학회 2010 한국정맥경장영양학회 학술대회집 Vol.2010 No.-

Background: The anatomical and physiological differences between visceral fat and subcutaneous fat help to explain the increased metabolic and cardiovascular risks associated with abdominal obesity, and the distribution as well as the volume of adipose tissue may have a specific association with human cancer. In order to examine the possible relationship between abdominal obesity and gastric cancer (GC), we quantified visceral and subcutaneous fat areas of CT images of patients with gastric cancer. Methods: We investigated total fat area (TFA), visceral fat area (VFA), and subcutaneous fat area (SFA) with Fat Scan software using a CT slice at the umbilical level in the 86 patients who underwent radical gastrectomy and was pathologically diagnosed as GC. The relationships of these findings with clinical and pathological data were analyzed. Results: Female patients with undifferentiated-type GC were significantly smaller SFA than those with differentiated-type GC (SFA: 122.0 ± 52.8 Vs. 204.1 ± 48.7). Female patients in the younger group with undifferentiated type GC were significantly smaller VFA and SFA than those with old group (VFA: 54.3 ± 14.3 Vs. 116.2 ± 33.7, SFA : 86.7 ± 27.5 Vs. 241.8± 58.3). EGC patients with undifferentiated-type GC had significantly smaller VFAs and SFAs than those with differentiated-type GC (VFA: 99.0 ± 39.0 Vs. 132.5 ± 35.2, SFA: 110.6 ± 33.2 Vs. 165.9 ± 45.4). Conclusion: Adipose tissue volume was different in the female GC patients and EGC patients according to histological types.

Small bowel obstruction caused by acute invasive enteric anisakiasis

강동백,김승호,오정택,박원철,윤기중,이정균 대한외과학회 2009 대한외과학회 학술대회 초록집 Vol.2009 No.11

Primary adenosquamous carcinoma of the colon

강동백,오정택,Hyang Jeong Jo,박원철 대한외과학회 2011 Annals of Surgical Treatment and Research(ASRT) Vol.80 No.6

Adenosquamous cell carcinoma (Ad-SCC) of the colon is rare. The pathogenesis of Ad-SCC is unclear, however, several hypotheses have been suggested. The clinical presentation and gross findings of Ad-SCC of the colon are similar to those of adenocarcinoma of the colon, but Ad-SCC has a more aggressive clinical course and a poorer prognosis. We report on two cases of Ad-SCC of the colon with obstruction; a collision-type Ad-SCC that has not only obstruction but also numerous hepatic metastases, and a composite-type Ad-SCC treated with left hemicolectomy followed by an adjuvant chemotherapy.

P-9 : Effective Support Management of TPN in Patient with of Recto-Seminal Vesicle Fistula After LAR

강동백,김근영,박원철,이정균 한국정맥경장영양학회 2014 한국정맥경장영양학회 학술대회집 Vol.2014 No.-

Despite their anatomic proximity, communication between the colorectum and seminal vesicle is an uncommon event, likely because of positioning of the seminal vesicle in the pelvic basin and anatomic protection beneath the bladder. Symptoms of a recto-seminal vesicle fistula may vary but generally mimic those of a colovesicle fistula, namely pneumaturia and dysuria. A number of different imaging modalities have been successful in establishing the diagnosis. Although the optimal method of control of the recto-seminal vesicle fistula is unknown, we believe that TPN is adequate and effective management as long as the involved rectal segment is healed or removed. We describe a case of a fistula between the rectum and seminal vesicle as a complication of LAR, which was effectively control by TPN support.

폐쇄 및 천공을 동반한 대장암 응급 수술 후 합병증과 사망률 발생 위험인자 분석

강동백,신창열,이정균,박원철 대한대장항문학회 2009 Annals of Coloproctolgy Vol.25 No.3

Purpose: Despite increased effort for the detection of early colorectal cancer, advanced disease presenting as obstruction or perforation still accounts for 8 to 29% and 3-8% of all colorectal cancers, respectively. The aim of this retrospective study was to evaluate the clinical characteristics, the surgical methods, the complications, and the risk factors of obstructive or perforated colorectal cancer that may influence the outcome. Methods: A retrospective study was carried out in 60 patients with colorectal cancer, who underwent surgery due to obstruction or perforation from March 2000 to December 2005. The colorectal cancers were considered to be complicated when clinical signs of peritonitis were observed, the radiologic characteristics of the tumor did not permit preoperative mechanical bowel preparation, or perforation existed, when these observations were confirmed by operative findings. The following data were analyzed: clinical characteristics, surgical methods, complications, and risk factors. Results: Thirty-three patients (55%) had obstruction, and 27 patients (45%) had perforation. Overall, major complications occurred in 33.3% and 48.5%, respectively. The mortality rates were 6.1% and 14.8%, respectively. Risk factors for major complication were age, perforation, and transfusion whereas those for mortality were perforation and American Society of Anesthesiologists (ASA) class. Conclusion: The risk factors of complication were old age, transfusion, and perforation and those for mortality was perforation and ASA class. Earlier diagnosis and prompt, intensive, careful management should be attempted in these high-risk patients. Purpose: Despite increased effort for the detection of early colorectal cancer, advanced disease presenting as obstruction or perforation still accounts for 8 to 29% and 3-8% of all colorectal cancers, respectively. The aim of this retrospective study was to evaluate the clinical characteristics, the surgical methods, the complications, and the risk factors of obstructive or perforated colorectal cancer that may influence the outcome. Methods: A retrospective study was carried out in 60 patients with colorectal cancer, who underwent surgery due to obstruction or perforation from March 2000 to December 2005. The colorectal cancers were considered to be complicated when clinical signs of peritonitis were observed, the radiologic characteristics of the tumor did not permit preoperative mechanical bowel preparation, or perforation existed, when these observations were confirmed by operative findings. The following data were analyzed: clinical characteristics, surgical methods, complications, and risk factors. Results: Thirty-three patients (55%) had obstruction, and 27 patients (45%) had perforation. Overall, major complications occurred in 33.3% and 48.5%, respectively. The mortality rates were 6.1% and 14.8%, respectively. Risk factors for major complication were age, perforation, and transfusion whereas those for mortality were perforation and American Society of Anesthesiologists (ASA) class. Conclusion: The risk factors of complication were old age, transfusion, and perforation and those for mortality was perforation and ASA class. Earlier diagnosis and prompt, intensive, careful management should be attempted in these high-risk patients.