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Extended Pyelotilhotomy에 對한 臨床的 考察
張世國,朴允圭,徐石柱,安武植,鄭洙光 慶北大學校 醫科大學 1977 慶北醫大誌 Vol.18 No.1
最近 3年間 慶北大學校 醫科大學 泌尿器科學敎室에 來院한 腎結石患者 12例에서 extended pyelolithotomy을시행하였고 그 方法, 經過 및 結果를 臨床觀察하였다. 1例를 除外한 11例에서 이 手術法으로 腎損傷의 정도를 적게하고 腎盂 및 腎杯노출을 쉽게하여 완전하게 結石을 除去할 수 있었으나 輕度의 合倂症發生은 있었으나 完全治療되었기에 文獻的 考察과 아울러 報告하는 바이다. An ideal operation for removal of renal calculi should allow for minimal destruction of renal parenchyma and complete remove of calculus. In 1965 Gil Vernet revived the extended pyelolithotomy in the surgical approach. This technique provides accesibility to infundibular and caliceal calculi and is especially helpful in the removal of an intrarenal pelvic calculus. The authors appled this extended pyelolithotomy to twelve patients with renal calculi in this department of urology during last 3 years. There was no morbidity related to this procedure in all cases except on who needed nephrectomy because of tearing of the posterior renal artery during the operation.
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長世國,徐城鐸,全燾基 慶北大學校 醫科大學 1974 慶北醫大誌 Vol.15 No.2
腎盂 또는 膀胱에 大腸菌을 接種하였을 때의 尿中 菌出現相과 抗體産生을 보고자 家兎를 使用하여 實驗 해서 다음과 같은 成績을 얻었다. 尿管을 完全結紮하고 腎盂에 菌을 接種하면 尿中에 菌이 少數 나타나나 約 10日後에 消失되고 家兎는 外 見上 健康狀態를 維持하였다. 尿管을 不完全 結紮하거나 結紮하지 않은 家兎의 腎盂에 菌을 注入하면 尿中에 多數의 菌이 나타나는데 E.coli 06을 注入한 家兎는 斃死하였으나 No.16을 注入한 家兎에서는 次次 尿中菌이 消失되고 ML 1410을 注入하면 短時日內에 菌이 消失된다. 이들 家兎에 抗生物質을 投與하면 尿中菌이 減少되거나 또는 消失 되는데 菌은 耐性을 獲得하였다. 膀胱에 E.coli No.16을 注入하면 尿中 菌이 一時 增加하나 時日의 經過에 따라 消失되였다. 腎盂에 菌을 注入하면 約 5日後부터 血中에 抗體가 證明되며 10~15日에 最高에 達하나 時日의 經過에 따 라 抗體價가 下降하였으나 膀胱에 菌을 住入하였을 時의 抗體産生은 明確하지 않았다. In order to know the appearance of bacteria in urine and the antibody response of rabbits inoculated with Escherichia coli and Pseudomonas aeruginosa in renal pelvis and bladder, some experiments were carried out. Also included was the effect of antibiotic administration on bacteuriuia and the following results were obtained. When E.coli was inoculated in renal pelvis after complete ligation of ureter of the same side, small numbers of inoculated organisms appeared in urine within one to two days after inocula-tion. The inoculated rabbits survived with appar-ently healthy condition, and bacteria in urine disappeared after 10 to 13 days. Organisms inoculated into renal pelvis passed non-ligated and partially ligated ureter, and were cultured in large numbers in urine, suggesting that the organisms can propagate in urinary system. The fate of rabbits differed by the organisms inoculated. When E.coli 06 was inoculated in renal pelvis, rabbits succumbed with multiple abscesses in the parenchyma of kidney. However, E. coli No. 16 and ML1410 were inje- cted into renal pelvis, rabbits survived with initial multiplication of organisms in urine and followed by the gradual decrease of bacterial counts. The administration of antibiotics in inoculated rabbits rendered the diminution of bacterial counts in urine, but insufficient amount antibiotics led to the rapid increase of organisms resistant to antibiotics in urine. Organisms inoculated into bladder propagated in urine, but finally disappeared after gradual decrease in bacterial counts. Pseudomonas aruginosa inoculated in renal pelvis was found in urine in large numbers for one to two weeks and then decreased gradually. O Antibody to E.coli was produced in sera of rabbits inoculated in renal pelvis from 5th day of inoculation with the highest titers from 10 to 15 days, and then decreased gradually after one to two weeks of peak level. The anti- body response of rabbits inoculated in bladder was very poor.
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Bacteremic Shock의 副腎皮質 Hormone 療法의 臨床的 觀察
張世國,徐城鐸 慶北大學校 醫科大學 1974 慶北醫大誌 Vol.15 No.2
1969年 10月부터 1974年 9月末까지 5年間 本敎室 泌尿器科 入院患者中 그 治療중에서 發生한 Bacteremic Shock 10例를 經驗하였으며, 그 治療에서 副腎皮質 Hormone을 投與한 患者와 投與하지 않은 患者에서 Shock 期間中의 臨床症狀과 所見 및 그 經過를 觀察하였던 바 다음과 같은 結果를 얻었다. 1. 全例 Cold Shock의 症狀 및 所見을 나타냈고 各症例마다 個人의 特性을 보였다. Shock 發生직후부터 모든 適切한 處置를 하였으며 5例는 副腎皮質 Hormone 投與郡이고 5例는 副腎皮質 Hormone 非投與郡이었 다. 2. 副腎皮質 Hormone 非投與郡 5例中 2例는 死亡했고 回復된 3例에 있어서도 Shock로 부터 完全回復되는 데 3~4日이 所要되었으며 모든 臨床所見의 好轉이 一定하지 않았다. 3. 副腎皮質 Hormone을 投與한 5例에서 全例 回復되었으며 投與 4~6時間에 臨床經過에 好轉이 오기 시작 했으며 48時間以內 完全回復되었다. 2例는 Hydrocortisone 1.5gm을 投與했고 3例는 Dexamethasone 1.0mg/kg의 量을 投與했으며 Hydrocortisone 使用患者와 Dexamethasone 使用者에서 그 臨床經過에 差異 가 없는것 같고 副腎皮質 Hormone에 對한 合倂症도 볼 수 없었다. Bacteremic Shock 患者는 各症例마다 各各의 特性을 나타냈으며 血行力學的 反應에 對한 分析없이 臨床 所見만의 觀察과 또한 Effortil 및 다른 療法의 倂用으로 副腎皮質 Hormone 單獨의 效果에 對해서 正確 한 結論을 내리기는 어려우나 副腎皮質 Hormone을 使用한 患者에서 좋은 臨床經過와 回復을 가져 왔기에 報告하며 향후 더욱 많은 考察과 血行力學的 反應에 對한 詳細한 검토가 요망된다. The use of steroids in bacteremic shock state in man remains a controversial issue. The use of steroids has been advocated by some authors for therapy of shock. They believe that steroids stabilize lysosomal membranes, improve cardiac output by an inotropic effect, and decrease peripheral resistence. We have analysised clinically 10 bacteremic shock patients treated between 1969 and 1974. 5 cases were treated without steroids and another 5 cases with steroids. 5 cases treated with steroids reveal good clinical improvement during shock state and are recovered completely from shock within 16-48 hours after initiation of steroids therapy. Although the effect of steroid alone is difficult to documented since other modes of therapy have either preceded its use or have been used concurrently, all patients treated with steroids reveal good clinical improvement and complete recovery from shock.
ScienceON
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