상행결장의 거대지방종으로 인한 대장중첩증 1예 : Case Report

백무준,김태윤,김성용,이문수,김창호,조무식 순천향의학연구소;Soonchunhyang Medical Research Institute 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Colonic lipoma is rare and mostly asymptomatic lesions; but as they become larger they may produce abdominal pain, constipation, diarrhea, hemorrhage, and intussusception. We report the case of a 61-year-old male who sufferd from nonspectific recurrent abdominal pain in the right upper and lower quadrants. Abdominal computed tomography (CT) revealed a constipating colonic tumor. The patient underwent an operative resection with primary anastomosis. His postoperative course was unremarkable, and he was discharged to home on postoperative day 11. Surgical pathologic examination comfirmed a large lipoma.

생체분해성 고분자를 이용한 사시수술용 제형개발 및 효용성에 대한 연구

민병무,김용백,김승영,김창식,박근성,길숙종,조항진,이성복,노승무,송규상,강대영,조준식,양준묵,정경수,최선웅,이진호,김학용,인현빈 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

A new device, muscle clamping system was developed to facilitate exact quatifying technique A strabismus surgery, and reduce the risk of complications. The device is composed of a lower fixing body with three jaws and an upper supporting body. They are used to clip an extraocular muscle and fix it to the sclera with a single bite. Superior rectus recession on 16 rabbit eyes were performed with this new device. Conjunctival injection, muscle adhesion strength, and light microscopic findings were examined at 1, 2, 4 and 8 weeks postoperatively. The Conjunctival injection were minimal, adhesion power ranged from 420 to 600 gram gravity, which is sufficient in withstand the normal pull of human extraocular muscle. In microscopic exam, some Inflammatory cells and fibrosis were found. The new device was technically easy, fast, and accurate, so it may be useful in stabismus surgery.

생체분해성 망막압정을 이용한 망막고정에 대한 실험적 연구

김용백,민병무,김창식,박근성,김승영,길숙종,조항진,이성복,노승무,송규상,강대영,조준식,양준묵,정경수,최선웅,이진호,김학용,인현빈 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

Biodegradable retinal fixation devices obtain mechnical fixation of the retina with desirable chorioretinal scarring and with the potential for local, sustained release of antimetabolites and steroids to inhibit proliferative vitreoretinopathy. We manufactured a biodegradable retinal tack with barb that was designed in order to prevent intrusion from implantation of retinal tacks. This study was carried to evaluate the efficacy for retinal fixation and the capability for sustained release of drugs with a newly designed biodegradable retinal tack Biodegradable retinal tacks were made of polymers of glycolic acids and were designed with barbs in a shape to prevent the disinsertion. Biodegradale retinal tacks are divided into 3 parts, a conical portion that is inserted into the sclera, a cylinder portion that remains in the vitreous, and a neck portion between the pin and the cylinder. The tapered conical end was manufactured to allow easy insertion through the retina and choroid into the sclera. A cylinder portion was manufactured with a tapered angle that fixes firmly into the orifice of 19 gauge spinal needle. A neck portion, 0.4 mm in diameter, was designed to prevent disinsertion from following implantation of retinal tack. The applicator was a 19 gauge spinal needle and its orifice was prepared to 15°angle to accept the tapered cylinder portion of the retinal tack. The retinal tacks, secured in the needles, were passed through the formed vitreous and inserted into the retina, choroid, and sclera and were released by pushing the internal needle, usually within 2-3mm of the medullary ray of the posterior rabbit retina A retinal tack was placed in each of 8 pigmented rabbit eyes. Slit-lamp biomicroscopy, indirect ophthalmoscopy and fundus photography were performed periodically from 1 day to 8 weeks after surgery. Eight eyes were enucleated and studied by light microscopy at 8 weeks. Biomicroscopic evaluation of the animals revealed edemas adjacent to the retinal surfaces immediately after insertion of the biodegradable retinal tacks in all the animals. These edemas disappeared after 1 week. The first noticeable change in the size of retinal tacks was shown after 2weeks. The size of the retinal tacks gradually got smaller, decreasing to about one-half at 4 weeks and about one-third at 8 weeks. All retinal tacks remained in inserted places without any movement for an 8 week period. On light microscopy, epiretinal proliferations were seen to extend into the vitreous cavity. Cellular capsules that lined the inner aspect of the scleral defect caused by tack insertion were found. However the adjacent retina had a normal cytologic appearance and architecture in all specimens. We manufactured a biodegradable retinal tack that is designed to prevent intrusion from implantation of retinal tacks. All biodegradable retinal tacks reduce in size with time, but no retinal tacks extruded from the inserted place. The newly designed biodegradable retinal tack can be used for retinal fixation and may be used as a vehicle for the introduction of pharmacologic agents to prevent the cellular events that promote proliferative vitreoretinopathy.

급성 충수염으로 진단된 예측 불가 염증성 맹장 종물에 대한 외과적 고찰

민경진,백무준,채만규,김성용,이문수,김창호,김재준,송옥평 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

Purpose: An unexpected inflammatory cecal mass of uncertain etiology was encountered during surgery for presumed appendicitis. In this case, the surgeon couldn't exclude differential diagnosis which were severe appendicitis involving the cecal region, diverticular disease, other inflammatory bowel diseases, and neoplasm. Therefore, this finding leads to a therapeutic dilemma for the surgeon, when making surgical decisions during the operation. The aim of this study was to resolve this dilemma, a retrospective review was undertaken in this study. Methods: A retrospective study was performed to review the management of this problem at Soonchunhyang University Chunan Hospital for eight and half years from July 1991 to December 1999. A review of the emergency operation records identified 50 patients who had undergone ileocecal resection or right hemicolectomy for an inflammatory ileocecal mass of uncertain etiology when operated on for probable appendicitis. Results: Altogether, 39 patients underwent ileocecal resection, and 11 patients underwent right hemicolectomy. The final pathologic diagnosis was appendiceal abscess in 32 patients (63%), cecal diverticulitis in 7 patients (14%), neoplasm in 6 patients (12%), appendiceal phlegmon in 3 patients (6%), ileal tuberculosis in 1 patient (2%) and Anisakiasis in another patient (2%). The neoplasm of the 6 neoplasm patients was ascending colon cancer for 4 patients and cecal cancer for 2 patients. There was no mortality in this group. Conclusion: Although most inflammatory cecal masses are caused by benign disease, all cases in which the intraoperative diagnosis is unclear, any pathologic diagnosis including neoplasm cannot be ruled out. So this suggest ileocecal resection or right hemicolectomy to remove a possible underlying malignancy, and to decrease morbidity and mortality.

간세포암에서 중앙 2구역 절제술의 유용성

김태윤,김성용,백무준,이문수,조무식,김창호 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.1

Liver resection for hepatocellular carcinoma(HCC) is now popular. For treatment of centrally located hepatocellular carcinoma, central bisegmentectomy is recommended as a radical surgical procedure and may have an important advantage. Five patients with HCC underwent central bisegmentectomy with an operating time of 380-420 minutes. One patient who had undergone preoperative live artery embolization died by car accident. Four patients survived without relapse 13-35 months postoperatively. Central bisegmentectomy is a safe and effective operative procedure for the treatment of centrally located HCC.

간절제술 후 발생한 기관지 담도 누공 2예

김태윤,김성용,백무준,이문수,조무식,김창호 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

A bronchobiliary fistula (BBF), which is defined by an abnormal communication between the biliary system and the bronchial tree, is an uncommon complication after hepatic resection, trauma, hydatid disease, choledocholithiasis and other causes of biliary obstruction. Bronchobiliary fistulae are rare complications of hepatic resection that can present from days to years after operation. Endoscopic retrograde cholangiopancreatography and PTC are the diagnostic studies of choice and offer the possibility of therapeutic intervention. We report the cases of a 56-year-old woman with cholangiocarcinoma, who developed a BBF 7 months after right hepatic lobectomy and 64-year-old man with intrahepatic duct stones who underwent hepatic resection.

췌십이지장절제술 후 발생한 담즙누출의 치료

김태윤,김성용,백무준,이문수,조무식,김창호 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.1

Operative morbidity and mortality of pancreaticoduodenectomy has been decreasing but remains high. Unintended postoperative cutaneous biliary fistula involving the major bile ducts is an uncommon complication of pancreaticoduodenectomy. Prolonged biliary drainage may lead to severe metabolic disturbances, renal failure and cardiovascular collapse, and usually requires operative reintervention. Among 90 patients who underwent pancreaticoduodenectomy from Feb. 1992 to Dec, 2000, 70 patients whose hospital records could be reviewed were included in this study. Cutaneous biliary fistula were observed in 19 cases(27.1%). In the 14 cases, a biliary drain was inserted around the injured duct via the biliocutaneous fistula. In these cases, biliary drainage alone resulted in resolution of the bile leak, because the injury was partial without a stricture. In the 5 cases, biliary stents were placed percutaneously across the injured portion of the bile duct. Pancreaticoduodenectomy is still associated with high mortality and morbidity even though there has been significant progress in the field of pancreatic surgery and postoperative follow-up. In the absence of organic stenosis, percutaneous drainage approach may be useful in patients with postoperative biliocutaneous fistula.

자궁경부 상피종양에서 human papillomavirus 감염과 survivin 발현

윤재호,정동준,이정은,박동명,배동한,선우재근,백무준,김창진 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.1

Human papillomavirus (HPV) has been considered a causative agent of uterine cervical carcinoma. HPV is a DNA oncogenic virus, which is well known as a causative virus in uterine cervical carcinoma. The virus is classified into two groups genotypically, low risk and high risk, according to the carcinogenic potentiality, and the determination of the viral genotype is important in clinical practice. Recently, numerous genotypes can be determined by high throughput method using DNA chip. Survivin is a recently characterized inhibitor of anti-apoptosis (IAP) protein, which is abundantly expressed in most solid and hematological malignancies, but undetectable in normal adult tissues. In this study, HPV genotypes are determined by DNA chip and the expression of survivin was examined by immunohistochemistry in 80 cases of uterine cervical intraepithelial neoplasia (CIN) and invasive carcinoma to see the roles of HPV and survivin in the carciogenesis of uterine cervical epithelial neoplasia. The results were as follows: 1. HPV positive rate was 72.5%, while negative rate was 27.5% in 80 cases of CIN and invasive carcinoma. The CIN and invasive carcinoma showed higher HPV positive rate (p <0.05). 2. HPV positive rate according to the histologic grade were 60%, 65%, 77% and 90% in CINI, CINII, CINII and invasive carcinoma, respectively. HPV positive rate showed increasing tendency according to the histologic grade, though there was no statistical significance. 3. The most frequent genotype was type 16 and the next were 58, 52, 18 and 33 in order of frequency. 4. Survivin was expressed in 96.3% of CIN and invasive carcinoma. The expression rate of survivin showed no significant difference between the histologic grade of CIN and invasive carcinoma, but showed tendency of increased expression rate in invasive carcinoma. 5. Survivin was expressed in HPV positive and in HPV negative each as in 95.5% and 96.6% respectively. There was no significant difference of survivin expression between HPV positive and negative cases. The above results suggest that HPV has no effect on the regulation of survivin expresson level in the uterine cervical intraepithelial neoplasia and invasive carcinomas.

섬유층판 간세포암 1례

김태윤,김성용,백무준,이문수,조무식,김창호 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Fibrolamellar hepatocellular carcinoma is a distinct variant of ordinary hepatocellular carcinoma and is very rare in the Orient. Contrary to ordinary hepatocellular carcinoma, Fibrolamellar hepatocellular carcinoma has very good prognosis and usually occurs in adolescents and young adults without sexual preference. We report a case of fibrolamellar hepatocellular carcinoma, which occurred in a 79-year-old woman with normal liver function. Preoperative ultrasonography, computed tomography and magnetic resonance imaging depicted a large tumor in the right anterior and left madial segment, which was compatible with the typical radiological features of fibrolamellar hepatocellular carcinoma. she underwent central bisegmentectomy. Macroscopic findings of the resected liver demonstrated a well-defined whitish-yellow tumor with a central scar. Microscopic findings of the tumor showed cords of tumor cells, which were surrounded by abundant collagenous fibrous tissue arranged in a lamellar distribution. Two years later, she is asymptomatic and evidences no recurrence of the disease. The clinical, pathological, radiological features, treatment options and prognoses of fibrolamellar carcinoma were discussed.

수술 전 고빌리루빈혈증 환자에서 췌십이지장 절제술의 안정성

김태윤,김성용,백무준,이문수,조무식,김창호 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.1

Backgrounds: Pancreaticoduodenectomy is accompanied by a considerable risk of postoperative complication and potential death. Pancreaticoduodenectomy in patient with obstructive jaundice carry on increased risk of postoperative complication. Preoperative biliary drainage has been developed to reduce this morbidity and mortality but the benefit of preoperative biliary drainage is still questioned for several reasons. This study evaluated postoperative outcomes following pancreaticoduodenectomy in relation to patients with hyperbilirubinemia. Methods: Ninety two patients who underwent pancreaticoduodenectomy between 1992 and 2001 were divided into two groups. Group A included 11 cases in patient with preoperative hyperbilirubinemia (serum bilirubin > 10 mg/dl), and the other 81 cases (serum bilirubin < 10 mg/dl) were Group B. In group A, 6 patients underwent preoperative biliary drainage. In group B, 31 patients underwent preoperative biliary drainage. Postoperative morbidity and mortality were anlaysed comparing with two groups by chi-squared test retrospectively. Results: In group A, whose average value of serum bilirubin was 15.2 mg/dl (range 10.2-20.3 mg/dl), wound complications were seen in 9.0%, hemorrhage in 18.1%, delayed gastric empting in 18.1%, anastomosis leakage in 18.1%, abscess in absent, and mortality in 9%. In group B, whose average value of serum bilirubin was 2.3 mg/dl (range 0.8-7.3 mg/dl), wound complications were seen in 14.8%, hemorrhage in 8.6%, delayed gastric empting in 9.8%, anastomosis leakage in 22.1%, abscess in 4.9%, and mortality in 4.9%. There was no significant difference in morbidity and mortality between two groups. Conclusion: Preoperative hyperbilirubinemia did not influence the incidence of postoperative outcomes following pancreaticoduodenectomy. It can be performed safely in patient with hyperbilirubinemia.