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김수홍,조용훈,유제호,Kim, Soo-Hong,Cho, Yong-Hoon,Ryu, Je-Ho 대한소아외과학회 2010 소아외과 Vol.16 No.2
Congenital diaphragmatic disease is one of the common major congenital anomalies, and its mortality remained still high despite recent medical advances. The aim of this study is to examine the clinical characteristics of congenital diaphragmatic diseases. A total of 39 patients with congenital diaphragmatic disease that underwent surgery from January, 1997 to December, 2009 at Pusan National University Hospital were included in this study. Medical records were retrospectively reviewed. The male to female ratio was 30:9. Six out of 39 cases died (NS) before surgery, 17 patients had Bochdalek's hernia (BH), 11 patients hiatus hernia (HH), 4 diaphragmatic eventration (DE), and 1 Morgagni hernia (MH). There were no differences in mean birth weight and mean gestational age. NS (83.3 %). BH (35.3 %) was diagnosed more frequently than other diseases in the prenatal period. Three patients (17.6 %) of BH expired due to pulmonary hypoplasia and 1 patient had co-existing congenital heart disease. BH was diagnosed more frequently in the prenatal stage and had a higher motality rate than other conditions. Therefore, BH needs to be concentrated more than other anomalies.
상간하대정맥부터 총장골정맥분지까지 연장된 하대정맥 평활근 육종의 체외절제 후 인공 하대정맥 재건 및 자가 간이식
문덕복(Deok-Bog Moon),이승규(Sung-Kyu Lee),김기훈(Ki-Hum Kim),안철수(Chul-Soo Ahn),하태용(Tae-Yong Ha),송기원(Gi-Won Song),정동환(Dong-Hwan Jung),유제호(Je-Ho Ryu),김관우(Kwan-Woo Kim),고경훈(Kyoung-Hoon Ko),최남규(Nam-Kyu Choi) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.3
Ex situ resection and hepatic auto-transplantation as devised by Pichlmayr may be an answer for a lesion that has close proximity to or has invade the major hepatic veins. We report here on a 31-year-old female patient with a leiomyosarcoma extending from the suprahepatic vena cava to the bifurcation of the common iliac vein, and this tumor was deemed not accessible by the conventional in situ surgical techniques. The liver and retrohepatic inferior vena cava was removed en bloc and taken to the back-table where the neoplasm invading the cava wall was removed together with the inferior vena cava. The inferior vena cava was then replaced by a 26- mm Dacron graft proximally and a 20-mm ringed polytetrafluoroethylene (PTFE) graft distally, and the outflows of the liver was reconstructed to a single opening with using longitudinallyopened autogenous great saphenous vein fencing. The liver was then autotransplanted by the Piggyback technique. Both renal veins were not reconstructed because both gonadal veins were preserved during the operation. The postoperative course was uneventful and the patient is in good health until now.
응급 간이식이 요구되는 전격성 간부전 환자들에게서 Bispectral Index Monitoring을 이용한 이식 전후 의식상태의 지속적인 평가의 유용성
박정익(Jeong-Ik Park),황신(Shin Hwang),이승규(Sung-Gyu Lee),황규삼(Gyu-Sam Hwang),김기훈(Ki-Hun Kim),안철수(Chul-Soo Ahn),문덕복(Deok-bok Moon),하태용(Tae-Yong Ha),송기원(Gi-Won Song),정동환(Dong-Hwan Jung),유제호(Je-Ho Ryu),이효준(Hyo 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.1
Purpose: Deterioration of consciousness is the most critical problem in patients with fulminant hepatic failure (FHF). Electroencephalography (EEG) is a standard procedure to determine the brain activity in unconscious patients. The bispectral (BIS) index derived from EEG was primarily developed to monitor the depth of unconsciousness. Methods: A prospective study was performed to assess the clinical utility of peritransplant BIS monitoring in 11 fulminant hepatic failure (FHF) patients who were undergoing emergency living donor liver transplantation (LT) with using a right liver graft. All the patients recovered their consciousness after LT. Results: There was a significant correlation between the BIS index values and the derived GCS score (r2=0.634, p <0.001). Timing of eye opening to voice command matched the BIS index value of 64±9.5, which was after 14±9.4 hours passing BIS index of 50. All the patients with endotracheal intubation during the early posttransplant period showed progressive increase of their BIS index, which appeared slightly earlier and more evident than the rise of derived GCS scores. Conclusion: BIS monitoring is a noninvasive, simple and easy-to-interpret method and it also appears to be a useful to assess and predict the recovery of a patient’s consciousness level after LT. Therefore, we concluded that BIS monitoring can be an indispensable component of the peritransplant intensive care for patients with FHF and who require emergency LT.