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수상 후 발생한 골반강내 출혈에 대한 혈관조영 동맥색전술 치료효과
강성준,김영주,배금석,주만기 대한외상학회 2001 大韓外傷學會誌 Vol.14 No.2
Purpose: For pelvic bone fractures accompanying pelvic cavity hemorrhages in multiple trauma patients, surgical therapy and adjuvant therapy do not have sufficient effect on hemostasis. We studied the therapeutic effects of arterial embolization in patients with pelvic cavity hemorrhages. Method: The study was performed on eight male patients who had traffic accidents and who were treated with arterial embolization from March to July in 1999 at Wonju Christian Hospital based on abdominal-pelvic CT by using the Seldinger method and angiographies. After that, as a first choice internal iliac arterial embolization was performed on the vessels suggesting hemorrhage then the area was embolized with Gelfoam (1×1mm), Vasopressin infusion or stainless coils. For judging the therapeutic effects of arterial embolization, we use the shock index (S.I: heart rate/day) and the injected concentrated RBC amount. Result: Five of the eight patients had organ injuries in the abdominal cavity and received operations immediately; they had no evidence of hemorrhage outside the pelvic cavity. Three had no accompanying injuries. Gelfoam was used a five of the eight, A stainless coil was used with two patients for embolization infusion with one the patients' shock index and injected concentrated RBC amount after the procedure were 0.68±0.30 and 0.63±0.74, respectively statistically showing a significant reduction compared with the data before the procedure of 1.11±0.15 and 4.5±1.3 (p$lt;0.005), respectively. Conclusion: Pelvic bone injuries accompanying pelvic cavity hemorrhages can be treated effectively by arterial embolization through angiography or arterial Vasopressin infusion.
김성환,이강현,황성오,김선만,배금석,강성준,조준휘 대한외상학회 2000 大韓外傷學會誌 Vol.13 No.2
Background: After what Dramatic changes have occurred in the management modality for hepatic injury, including the strategy of operative management. However, selection criteria for choosing the treatment modality remain to be determined. The purpose of this study was to determine the factors affecting the decision for the treatment modality of blunt liver injury. Methods: A retrospective review of 46 patients who had blunt hepatic trauma and who were treated at Wonju Christian Hospital from 1997 to 1999 was performed. The patients were divided in two groups (non-operation group vs. operation group) based on the treatment modality. The two groups were compared for injury severity score (ISS), blood pressure, pulse rate, base deficit, liver injury grade, liver enzymes, transfusion amount during initial 12 hours, number of fluid collection sites, age, sex, and mechanism of injury. Results : Although similar in terms of age and sex distribution, as well as the mechanism of injury, the 17 (37%) patients treated operatively had a higher liver-injury grade, higher number of fluid collection sites, a larger initial blood transfusion requirement, and more associated abdominal injuries when compared with the 29 (63%) patients in the non-operative group. There were no differences in initial vital signs and liver enzyme concentration between groups. The transfusion amount during the first 12 hours, the number of fluid collection sites, and the degree of liver injury grade were greater in the operation group than in the non-operation group. Conclusion: The factors affecting the treatment modality of blunt liver injury were the transfusion amount during the first 12 hours, the number of fluid collection sites, and the liver injury grade.
Hungry bone syndrome after parathyroidectomy of a minimally invasive parathyroid carcinoma
Kwang-Min Kim,Joon-Beom Park,Keum-Seok Bae,Seong-Joon Kang 대한외과학회 2011 Annals of Surgical Treatment and Research(ASRT) Vol.81 No.5
The prognosis of parathyroid carcinoma varies significantly between numerous studies. Therefore, many attempts have been made to grade the degree of parathyroid carcinoma, and recently, classifying parathyroid carcinomas into either minimally invasive or widely invasive carcinoma- similar to follicular carcinoma of the thyroid- has led to a more reliable prediction of the prognosis. Hungry bone syndrome can occur if parathyroidectomy is performed due to primary hyperparathyroidism regardless of the cause of the disease. Hungry bone syndrome is characterized by postoperative a hypocalcemic state due to remineralization of various minerals, including calcium, of the bone; this syndrome requires a long-term supplementation of calcium. The authors aim to report, along with a review of related literatures, 1 case of a 29-year-old female patient diagnosed with minimally invasive parathyroid carcinoma who fell into hungry bone syndrome after parathyroidectomy.
Ultrasonographic guideline for thyroid nodules cytology
Kwang Min Kim,Joon Beom Park,Seong Joon Kang,Keum Seok Bae 대한외과학회 2013 Annals of Surgical Treatment and Research(ASRT) Vol.84 No.2
Purpose: The main issue with the current ultrasonography (US) guidelines is the overestimation of malignant and indeterminate nodules as they do not aid in making decisions to treat patients. To overcome this, new US guidelines for thyroid nodules that have been shown to be better correlated with cytologic results have been proposed. We also suggested specific indications for US-guided fine needle aspiration (FNA) using the new US guidelines. Methods: Clinical and pathologic data from 925 patients and 1,419 thyroid nodules were retrospectively collected. All subjects underwent US- and US-guided FNA at Department of Surgery, Wonju Christian Hospital, between March 2010 and July 2011. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both the current guidelines and the new guidelines. Results: The accuracy, sensitivity, specificity, PPV, and NPV for the current guidelines in predicting malignancy were 24.1%, 99.3%, 62.2%, 25.0%, and 99.8%, respectively. The accuracy, sensitivity, specificity, PPV, and NPV for the new guidelines in predicting malignancy were 66.0%, 96.0%, 86.7%, 47.7%, and 99.4%, respectively. Conclusion: The use of the new US guidelines allow for a more accurate and specific diagnosis and a better treatment plan than the current guidelines. Additionally, the use of the new FNA guidelines may help prevent unnecessary FNAs and promote cost-effective follow-up for patients.
( Kwang Min Kim ),( Joon Beom Park ),( Keum Seok Bae ),( Seong Joon Kang ) 대한내과학회 2011 대한내과학회지 Vol.81 No.5
The prognosis of parathyroid carcinoma varies significantly between numerous studies. Therefore, many attempts have been made to grade the degree of parathyroid carcinoma, and recently, classifying parathyroid carcinomas into either minimally invasive or widely invasive carcinoma- similar to follicular carcinoma of the thyroid- has led to a more reliable prediction of the prognosis. Hungry bone syndrome can occur if parathyroidectomy is performed due to primary hyperparathyroidism regardless of the cause of the disease. Hungry bone syndrome is characterized by postoperative a hypocalcemic state due to remineralization of various minerals, including calcium, of the bone; this syndrome requires a long-term supplementation of calcium. The authors aim to report, along with a review of related literatures, 1 case of a 29-year-old female patient diagnosed with minimally invasive parathyroid carcinoma who fell into hungry bone syndrome after parathyroidectomy.
Mi Young Lee,Jae Hyun Park,Keum Seok Bae,Yong Gwan Jee,An Na Ko,Yong Jea Han,Jang Yel Shin,Jung Soo Lim,Choon Hee Chung,Seong Joon Kang 대한외과학회 2014 Annals of Surgical Treatment and Research(ASRT) Vol.86 No.2
Purpose: Current management for patients with differentiated thyroid cancer includes near total thyroidectomy and radioactive iodine therapy followed by administration of supraphysiological doses of levothyroxine (L-T4). Although hyperthyroidism is a well known risk factor for osteoporosis, the effects of L-T4 treatment on bone mineral density (BMD) in patients with thyroid cancer do not appear to be as significant as with endogenous hyperthyroidism. In this study, we evaluated the impact of long-term suppressive therapy with L-T4 on BMD and bone turn over markers in Korean female patients receiving L-T4 suppressive therapy. Methods: We enrolled 94 female subjects (mean age, 50.84 ± 11.43 years) receiving L-T4 after total or near total thyroidectomy and radioactive iodine therapy for thyroid cancer (mean follow-up period, 12.17 ± 4.27 years). The subjects were divided into three groups by thyroid stimulating hormone (TSH) level (group 1 with TSH level ≤0.001 μIU/mL, group 2 with TSH level between 0.001 and 0.17 μIU/mL, group 3 with TSH level >0.17 μIU/mL) and four groups by quartile of free T4 level. L-T4 dosage, BMD (examined by dual-energy x-ray absorptiometry), and bone turnover markers were evaluated according to TSH and free T4 levels. Results: No significant decrease was detected in BMD or bone turnover markers according to TSH level or free T4 level. Also, the prevalence of osteoporosis and osteopenia was not different among groups. Conclusion: Long-term L-T4 suppressive therapy after thyroid cancer management did not affect bone density or increase the prevalence of osteoporosis even though TSH levels were supraphysiologically suppressed.
갑상선암 환자에서 전절제술 후 I-131 치료에서 미만성 간침착 정도의 분석
정진형(Jin Hyung Jung),배금석(Keum Seok Bae),강성준(Seong Joon Kang) 대한두경부종양학회 2000 대한두경부 종양학회지 Vol.16 No.2
Objectives: Any uptake of I-131 after total thyroidectomy means the remant thyroid tissue or distant metastasis of the thyroid cancer. However diffuse hepatic uptake of I-131 without abnormal uptake was showen in many cases on I-131 whole body scan. The aim of this study was to classify the liver uptake after I-131 scan and to evaluate the analysis of this finding. Materials and Methods: Between 1982 and 1998, 104 patients(l4 males, 90 females) with normal liver function underwent I-131 scan after total thyroidectomy. Prospectively we reviewed the films of the whole body scan and analysed the correlations between results of radioiodine uptake, pathologic diagnosis, prognostic factors, lymphatic metastasis, and thyroid function test. Result: Diffuse hepatic uptake was found in 44 of 104(42%) patients. 10 of 39(26%) patients on I-131 100mCi, and 34 of 63(54%) on I-131 150mCi showed hepatic uptake. 52 of 104(50%) patients was locally invasive thyroid cancer. The rate of the hepatic uptake was no significant differences with the thyroid hormone levels(T3, Free T4) and thyroglobulin between uptake group and non-uptake group. Conclusion: The rate of I-131 uptake was high in high-dose radioiodine treatment group. However, we can not find any correlation among the thyroid functions, the extent of metastasis or the extent of local invasion. We need further study to find out the causes of the hepatic uptake of I-131 after total thyroidectomy, besides liver metabolism of I-131 attached thyroid hormones.