한국인에서 슬관절 전치환술 시 정맥혈전색전증의 예방적 치료

이진규(Jin-Kyu Lee),정규성(Kyu-Sung Chung),백승욱(Seung-Wook Baek),최충혁(Choong-Hyeok Choi) 대한정형외과학회 2012 대한정형외과학회지 Vol.47 No.2

목적: 한국인에서 슬관절 전치환술 후 정맥혈전색전증 예방을 위해 용량과 투약기간을 조절한 약물치료의 효과와 문제점을 평가하였다. 대상 및 방법: 슬관절 전치환술을 시행받은 135명, 180예를 대상으로 2일간 저분자량 헤파린 투여 후 5일 동안 아스피린을 투여한 dalteparin-aspirin (DA)군, 아스피린만 7일 동안 투여한 aspirin (A)군, 저분자량 헤파린만 7일 동안 투여한 dalteparin (D)군의 정맥혈전색전증의 발생 여부와 안전성을 평가하였다. 결과: 임상 증상이 있는 심부정맥혈전증은 4예 발생하였고, DA군 2예, A군 1예, D군 1예였다. 폐색전증은 각 군에서 1예씩 발생하였으나 사망한 예는 없었다. 주출혈은 발생하지 않았으나 소출혈은 DA군 2예, A군 1예, D군 11예가 발생하였다. 대퇴부 멍의 발생도 D군에서 유의하게 많이 발생하였으나 출혈량, 슬관절내 유출량, 대퇴부 부종, 수술창상 삼출에는 차이가 없었다. 결론: 용량 및 투약기간을 단축시킨 약물요법을 물리적 요법과 병행한 경우 사망을 초래하는 폐색전증은 발생하지 않았으나, 7일간 저분자량 헤파린 주사 시 소출혈의 빈도가 증가하였다. 추후 약물 사용 시 용량과 기간은 효과와 출혈위험을 고려하여 조정할 필요가 있다고 생각한다. Purpose: To evaluate the effects and problems of venous thromboembolism (VTE) prophylaxis with a reduced dosage and administration period in Korean total knee arthroplasty (TKA) patients. Materials and Methods: We analyzed 135 consecutive TKA patients with three different VTE prophylaxis regimens. Group dalteparin-aspirin (DA) injected dalteparin for the fi rst 2 days, followed by taking aspirin for the next 5 days, Group aspirin (A) was on aspirin and Group dalteparin (D) on dalteparin 7 days postoperatively. We evaluated the incidence of VTE and safety among the 3 groups. Results: Symptomatic deep vein thrombosis was detected in 4 cases (Group DA: 2, Group A: 1, Group D: 1). Pulmonary embolism (PE) was found in 1 case in each group with no fatal PE. Although no major bleeding complications were seen, minor bleeding incidents were detected in 14 cases (Group DA: 2, Group A: 1, Group D: 11), which was signifi cant in Group D. No significant differences were observed in perioperative blood loss, effusion in the knee joint, thigh swelling or oozing on the wound area among the groups except thigh bruising, which developed more frequently in group D. Conclusion: The reduced dosage and administration period of VTE prophylactic medicine combined with mechanical prophylaxis for Korean TKA patients showed no fatal PE, but some minor bleeding incidents frequently developed with 7 days of dalteparin injections. We need to adjust the dosage and duration of prophylactic medication deliberately for Korean TKA patients, considering prophylaxis effectiveness and bleeding complication risks.

최소 침습적 잠김 압박 금속판 고정술을 이용한 대퇴 원위 골절의 치료

박기철 ( Ki Chul Park ),정규성 ( Kyu Sung Chung ),문준기 ( Joon Ki Moon ) 대한골절학회 2012 대한골절학회지 Vol.25 No.1

목적: 대퇴골 원위부 골절에서 잠김 압박 금속판 (locking compression plate, LCP)을 이용한 최소 침습적 금속판 고정술의 유용성을 알아보고자 하였다. 대상 및 방법: 2004년 12월부터 2010년 4월까지 대퇴골 원위부 골절에 대한 최소 침습적 잠김 압박 금속판 고정술을 시행한 환자 33명을 대상으로 하였다. 방사선학적으로 골절의 정복 상태 및 골유합 기간을 확인하였으며, 임상적으로 Schatzker와 Lambert의 평가 방법을 이용하였다. 결 과: 평균 골유합 기간은 16.3주 (10∼22주)이었다. 합병증으로 3예에서 불유합, 2예에서 불유합에 의한 금속판 파손이 발생하였고, 표재성 감염이 1예, 7도 외반 변형 1예, 1.5 cm 하지 단축이 1예 발생하였다. 불유합으로 인하여 재수술을 시행한 3예를 제외한 Schatzker와 Lambert의 평가 방법상 우수 11예, 양호 14예, 보통 5예로 나타났다. 결론: 대퇴골 원위부 골절에 대하여 잠김 압박 금속판을 이용한 최소 침습적 금속판 고정술은 임상적 및 방사선학적으로 만족할만한 결과를 보였으나 금속판 파손, 불유합 등 합병증 발생의 가능성이 여전히 존재함으로 보다 좋은 결과를 얻기 위해서는 세심한 수술 술기 및 골절 형태에 따른 적절한 치료가 필요하리라 사료된다. Purpose: To analyze the result of distal femur fracture treatment with minimally invasive plate osteosynthesis (MIPO) using a locking compression plate (LCP). Materials and Methods: From December 2004 to April 2010, 33 patients with distal femur fractures were treated by MIPO with a locking compression plate. The reduction state and bone union time was checked radiologically. The clinical outcome was evaluated by the Schatzker and Lambert criteria. Results: The mean bone union time was 16.3 weeks (10~22 weeks). There were 3 nonunions, 2 broken plates, 1 superficial infection, 7o of valgus angulation in 1 case, and 1.5 cm limb shortening in 1 case. Except for the 3 nonunion cases, according to the Schatzker and Lambert criteria, results were graded as excellent in 11 cases, good in 14 cases, and moderate in 5 cases. Conclusion: The treatment of distal femoral fracture by MIPO with a locking compression plate resulted in good functional and radiological outcomes, but it has problems, such as broken plates and nonunion. Accurate surgical technique and appropriate treatment will be needed according to fracture type.

문맥압항진증에서 Propranolol 및 Isorsorbide-5-Mononitrate의 효과

박찬국(Chan Guk Park),정규성(Kyu Sung Chung),김만우(Man Woo Kim) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.2

N/A Background/Aims: Esophageal variceal bleeding is one of the major causes of death in patients with portal hypertension, mostly due to liver cirrhosis. Surgical portal-systemic shunvs, sclero- therapy and/or pharmacological treatment are used in the primary and secondary prevention of hernorrhages in high-risk patients, but the effect of tbis therapy has not improved. A major innovation in the treatment of portal hypertension was the use of phannacologic agent.; to prevent bleeding and death from ruptured esophageal varices. Porta] pressure can be reduced by decreasing blood flow and/or vascular resistance within the portal venous system. Up to now, the medical treatment of portal hypertension has been based on the use of drugs that reduce the splanchnic blood tlow, such as vasopressin, somatostatin, and 0-adrenergic blockers. Especially, the oral administration of Isosorbide-5-rnononitrate, a preterentia] venous dilator with prolonged biological activity and no hepatic metabo]ism, caused a significant reduction in portal pressure in patients with cirrhosis. This was due in part to a decrease in hepatic vascular resistance. Hcwever, the indications for and against such therapies are not standardized and the problems caused by both hemodynamic evaluation of the response to treatment and selection of responders are still unresolved. Methods: Doppler ultrasonography(real time B-scan imaging and pulsed Doppler ultrasonographic study) represents a valuable and non-invasive method for the study nf portal hemodynamics in patients with liver cirrhosis. Twenty patients(16 males, aged 51+6) had hemo- dynamic measurements in the baseline condition Liefore and 1 day, l week, 3 weeks, aind 5 weeks after oral administration of propranolol and Isosorbide-S-Mononitrate, respectively by Doppler ultrasonography. Results: Diameter, maximal ve]ocity, cross sectional area, mean velcicity, blood flow vo]ume of porta] system were significantly reduced after drug administration(p--0,001). But the congestion index was not decreased statistically. Blood flov, volume difference between the portal vein and the sum of splenic vein and superior mesenteric vein(P-SS) was significantly reduced after drug administration(p<0.001). Conslusions: The oral adrainistration of propranolo] and Isosorbide- 5-Mononitrate achieved an effective reduction in portal hypertension with cirrhosis. When pharmacologic treatment of portal hypertension is contemplated, Doppler u]trasonography would appear to be of considerable interest because of its availability, noninvasivity and repeatability.(Korean J Gastroenterol 1996; 28:241-250)

간담도내 Calcium - bilirubinate 결석을 갖는 환자에서 간흡충증의 유병율에 관한 연구

양태영(Tae Young Yang),서정철(Jeong Cheol Seo),김미자(Mi Ja Kim),정규성(Kyu Sung Chung),주기산(Gi San Ju),김태원(Tae Weon Kim),박찬국(Chan Gook Park),김만우(Man Woo Kim),김석일(Suk Il Kim) 대한내과학회 1996 대한내과학회지 Vol.50 No.1

N/A Objectives: Clonorchiasis is very common in the Far East and nation-wide in our country. Hepatobiliary stones is not rare in the group of hepatobiliary disease. Some debates has been made in the point of the relationship between clonorchiasis and calcium-bilirubiante stone. The object of the study is to evaluate the prevalence of clonorchiasis in the hepatobiliary stone patients. Methods: Ultrasonographic survey were made of 72 patients in Chosun University in Kwang-ju from August 1993 to July 1994. The ultrasonogram was Aloka model SSD 680(Tokyo, Japan). The hepatobiliary stones were classified based on their sonographic characteristics by modified Tsuchiya method. The stoo1 examination was carried out using the cellulous thick smear and the anti-C. sinensis IgG was measured by enzyme-linked immunosorbent assay. Results: The ultrasonographic analysis of stones showed that type 1 mainly composed of cholesterol stone was 45 cases(62.5%) and type 3 mainly composed of calcium-bilirubiante stone was 23 cases (31.9%). The prevalence of clonorchiasis in 72 cases of hepatobiliary stone patients, in 23 cases of calcium-bilirubinate stones, and in 49 cases of non calcium-bilirubinate stones were 18 cases(25%), 10 cases (43.5%), and 8 cases(16.3%) respectively. Conclusion: The relationship between Clonorchiasis and calcium-bilirubinate stone was statistically significant(p<0.01)

척추 사지 골간단 형성 이상에 동반된 내반고

김태승(Tai-Seung Kim),김석환(Suk-hwan Kim),정규성(Kyu-Sung Chung) 대한정형외과학회 2011 대한정형외과학회지 Vol.46 No.3

발달성 내반고(developmental coxa vara)는 드물게 나타나는 질환으로 태생시 이상 소견을 보이지 않다가, 점차 성장하며 걷기 시작함에 따라 증상이 나타나게 된다. 임상적으로 오리걸음(waddling gait), 팔다리 길이 불일치(limb length discrepancy), 잦은 피로 증상을 주로 호소한다. 발달성 내반고는 드물게 골격 형성 이상(skeletal dysplasia)을 동반하기도 한다. 특히 척추 사지 골간단 형성 이상(Spondylometaphyseal dysplasia)은 척추 및 장골 간단의 방사선학적 변화와 동반되어 나타나는 경우가 있으며, 또한 방사선학적으로 장골 간단의 골편 형성 소견인 구석 골절(corner fracture)을 보일 수 있다. 저자들은 국내외 보고 사실이 극히 적은 척추 사지 골간단 형성 이상과 동반한 내반고 1예를 경험하였고, 진단 및 치료 과정에서 만족할만한 결과를 얻었기에 문헌 고찰과 함께 보고하는 바이다. Developmental coxa vara is a rare disease and the symptoms do not appear at birth, but rather, they appear at the age of walking. Clinically, the symptoms include a waddling gait, limb length discrepancy and frequent weariness. Developmental coxa vara is sometimes associated with skeletal dysplasia. Especially, it is associated with spondylometaphyseal dysplsia and the vertebral bodies and long bones are affected. The authors report here on diagnosing and treating this rare disease and we review the relevant literatures.

간담도내 Calcium - bilirubinate 결석을 갖는 한자에서 간흡축증의 유병율에 관한 연구

양태영(Tae Young Yang),서정철(Jeong Cheol Seo),김미자(Mi Ja Kim),정규성(Kyu Sung Chung),주기산(Gi San Ju),박찬국(Chan Gook Park),김만우(Man Woo Kim),김석일(Suk Il Kim) 대한내과학회 1995 대한내과학회지 Vol.49 No.5

N/A graphic characteristics by modified Tsuchiya method. The stool examination was carried out using the cellulous thick smear and the anti-C, sinensis IgG was measured by enzyme-linked immunosorbent assay. Results: The ultrasonographic analysis of stones showed that type 1mainly composed of cholesterol stone was 45cases(62.5%) and type 3 mainly composed of calcium-bilirubinate stone was 23cases (31.9%). The prevalence of clonorchiasis in 72cases of hepatobiliary stone patients, in 23cases of calciumbilirubinate stones, and in 49cases of non calciumbilirubinate stones were 18cases(25%), 10cases (43.5%), and 8cases(16.3%) respectively. Conclusion: The relationship between Clonorchiasis and calcium-bilirubinate stone was statistically significant(p<0.01).

간 낭종을 동반한 성인 다낭신 환자에서 간 낭종의 감염 1예

정규성,서정철,주기산,김원식,임영국,정종훈,문철웅 朝鮮大學校 附設 醫學硏究所 1993 The Medical Journal of Chosun University Vol.18 No.1

Adult polycystic kidney disease(APKD) usually accompanies with renal and extrarenal manifestations and liver cysts are present in aproximately 30% of patients with APKD. Kidney cysts often accompany with hemorrhage, rupture, infection, however, liver cysts are usually asymptomatic and do not impair liver function. Rare complication of liver cysts in patient with APKD include portal hypertension with bleeding esophageal varices and hepatic failure with encephalopathy. But, in APKD patient, infection of liver cysts without infection of renal cysts is extremely rare. We report a case of infected liver cyst in a patient with APKD who has complained generalized abdominal pain and high fever which was confirmed by ultrasound and aspiration. The patient was treated successfully with repeated aspiration and systemic antibiotics.

후천성 이중 유문 1예

정규성,조기섭,정재용,조영호,민영돈,박찬국,김만우 조선대학교 1994 The Medical Journal of Chosun University Vol.19 No.1

Double pyrolus, one of the relatively rare anomalies of the gastrointestinal tract, is a fistulous communication between the gastric antrum and the duodenal bulb. The first case of a double Pylorus was reported in 1969 by Smith, since then several cases have been reported. Recently, as the frequency of examining upper gastrointestinal series and endoscopy increases, it occurs more frequently and a few cases have been described in our country. According to the reports previously published, it resulted only from cysts, diverticla, atresia, band, membrane malformation of the pylorus, however, it might be also caused by penetration, complication of peptic ulcer. We report a case of double pylorus in a 67-year old man with prolonged administration of corticostetoids due to lumbago who has complained epigastric pain which was confirmed by endoscopy and biopsy.