외상성 췌장 손상에서 수술적 치료와 역행성 경유두 췌관 삽입술의 유용성

유상범 ( Sang Bum Yoo ),조민수 ( Min Soo Cho ),배금석 ( Keum Seok Bae ),강성준 ( Sung Joon Kang ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.2

Background: The presence of an injury to the pancreatic duct system is the most important determinant of the morbidity and mortality associated with blunt pancreatic trauma. Endoscopic retrograde pancreatography provides detailed images of the pancreatic duct and clearly defines the nature of pancreatic duct injury. Compared with operative intervention, we evaluate the effectiveness of endoscopic placement of transpapillary stent in pancreatic trauma. Patients and Methods: Thirteen patient with pancreas injury from April, 1992 to December 2002 were included in this study. We classified patients according to the treatment method, such as operative intervention or endoscopic placement of transpapillary stent. And demographic information, mode of injury, imaging studies, initial serum amylase, hospital stay and complication were retrospectively reviewed. Results: Eight patients were treated by operative intervention, and another five by endoscopic placement of transpapillary stent. In operative interventional group, mean hospital days were 50.8 days, pancreas specific complication developed in 5 of the 8 were as follws: pseudocyst, intestinal obstruction and enterocutaneous fistula. In endoscopic interventional group, mean hospital days were 31.2 days, pancreas specific complications were 2 cases of nonsymtomatic pseudocyst. Conclusion: Endoscopic placement of transpapillary stent is an alternative treatment in pancreatic injury.

갑상선 결절 환자에서 초기 내원하는 과에 따른 수술적 치료 결과 분석

최영규(Young Gyoo Choi),배금석(Keum Seok Bae),김성철(Sung Chul Kim),강성준(Seong Joon Kang) 대한외과학회 2003 Annals of Surgical Treatment and Research(ASRT) Vol.65 No.6

미세 갑상선 유두상암에서 양측성과 연관된 임상 병리학적 인자에 대한 분석

김광민,박준범,배금석,강성준,Kwang-Min Kim,Joon-Beom Park,Keum- Seok Bae and Sung-Joon Kang 대한갑상선-내분비외과학회 2011 The Koreran journal of Endocrine Surgery Vol.11 No.1

Purpose: Papillary thyroid carcinoma is the most common malignant tumor originating from the thyroid. The recent increase in frequency of thyroid ultrasonography is increasing the diagnostic rate of thyroid cancer, especially of the small-sized cancer. The appropriate extent of surgery for thyroid micropapillary carcinoma is still under debate, and bilaterality of the tumor may be an important factor determining the extent. Therefore, this study analyzed the clinicopathologic factors related to tumor bilaterality in order to help decide the extent of treatment. Methods: Subjects included 134 patients who received total thyroidectomy and central neck lymph node dissection at Wonju Christian Hospital under the diagnosis of thyroid micropapillary cancer from January 1<SUP>st</SUP>, 1994 to December 31<SUP>st</SUP>, 2009. The frequency of bilateral tumor among the subjects were studied, and the relationship between bilaterality and clinicopathologic factors, including patients' gender, age, tumor size, multiple mass in single lobe, capsule invasion, extrathyroidal extension, lymphovascular space invasion, central neck node invasion and lateral neck node invasion was analyzed. Results: There were 32 cases (23.9%) of bilateral tumor. Statistically significant factors related to bilaterality included two or more mass in a single lobe, perithyroidal soft tissue invasion. Conclusion: When we plan thyroidectomy for thyroid micropapillary cancer, one cannot rule out the possibility of bilateral thyroid micropapillary cancer in patients with clinicopathologic factors related to bilaterality. Closer preoperative examination is thought to be required for such patients. (Korean J Endocrine Surg 2011;11:18-21)

소아 환자에서의 외상성 간 손상

구병한 ( Byung Han Koo ),박준범 ( Joon Beom Park ),배금석 ( Keum Seok Bae ),강성준 ( Sung Joon Kang ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.2

Purpose: Trauma is an important cause of death in children. In particular, the liver is the second most commonly organ injured by blunt abdominal trauma. Treatment of patients with liver injury is has changed, and non-operative treatment is the major treatment method at present. In this study, we reviewed traumatic liver injury in pediatric patients. Methods: Seventy-seven patients younger than 16 years of age with traumatic liver injury were assessed for 10 years from July 1999 to June 2009 at Wonju Christian hospital. Records of the patients were reviewed retrospectively. Demographic and clinical data were analyzed. Results: The median age was 6 years, and the male-to-female ratio was 1.2:1. The most common injury grade was grade I. The majority of injuries were caused by was traffic accidents, and the second most common cause of injuries was falls. Twenty-four patients had liver injuries alone, and the most common accopaning injury was a lung injury. The average hospital stay was 20.7 days, and the average ICU stay was 4.8 days. Four patients died (5.2%). There were 6 patients with under 10 points on the Glasgow coma scale (GCS). Among these patients, three died. All mortality cases had over 16 points on the Injury Severity Score (ISS). Two patients were treated surgically, one of whom died. Of the 75 patients with non-operative management, three died due to associated injuries. Conclusion: Most pediatric patients with liver injury have good results with non-operative management. Associated injuries and hemodynamic instability are predictive of patient outcome, and those with isolated liver injuries can be successfully managed non-operatively. (J Korean Soc Traumatol 2009;22:242-7)

외상 환자에서 알코올 금단 증후군의 발생이 예후에 미치는 영향

오동길 ( Dong Gil Oh ),조민수 ( Min Soo Cho ),배금석 ( Keum Seok Bae ),강성준 ( Sung Joon Kang ) 대한외상학회 2008 大韓外傷學會誌 Vol.21 No.2

Purpose: Abrupt abstinence from alcohol in cause of chronic alcohol addiction can trigger alcohol withdrawal syndrome. The authors studied the effect of post-operative alcohol withdrawal syndrome in patients who require intensive care due to trauma. Methods: For the study group, we selected 70 patients who had undergone emergency surgery from May 2003 to March 2007 due to trauma and who had been treated with prophylactic thiamine. Data was collected retrospectively. We excluded those who extended their hospital stay for other than traumatic causes, those who died within 3 days of surgery after trauma, those who transferred to other institutions, and those who received a psychiatric diagnosis. Patient groups were determined by the existence or the non-existence of withdrawal syndrome. Age, sex, injury mechanism, mortality, complications, durations of hospital stay and intensive care, use of mechanical ventilator, and sedative use were investigated. A Chi-square test and The Mann-Whitney method were used for statistical analysis in this study. Results: Twenty-four (24) patients from the 58 who had an ISS of 16 or more showed alcohol withdrawal syndrome, and men were shown to be affected with the syndrome significantly more than women. Although ISS was higher in the group with alcohol withdrawal syndrome, statistically, the difference was not significant (P<0.08). The total hospital stay in the patient group with alcohol withdrawal syndrome was on average 10 days longer. However, the difference was not significant (P<0.054). The duration of intensive care in the patient group with alcohol withdrawal syndrome was significantly longer (P<0.029). The patients with alcohol withdrawal syndrome showed no significant difference in the duration of mechanical ventilator use (P<0.783), or in the duration of sedative use (P<0.284). Respiratory distress, pneumonia, upper airway infection, sepsis, acute renal failure, and mortality in the alcohol withdrawal syndrome group were investigated, but no statistically significant difference were noted. Conclusion: We found that the duration of intensive care in chronic alcohol abusers was longer due to the development of alcohol withdrawal syndrome. We also discovered that, when the patients overcame the symptoms of alcohol withdrawal syndrome after intensive care, no difference was found in the frequency of developing complications, the morbidity, and the mortality. Therefore, we conclude that intensive care in trauma patients who are chronic alcohol abusers decreases the incidence of complications found in patients with postoperative alcohol withdrawal syndrome and does not adversely impact the prognoses for those patients. (J Korean Soc Traumatol 2008;21:115-119)

갑상선 수술 환자에서 세침흡인 세포검사와 조직검사와의 연관성

백종범,김성철,배금석,강성준,Jong Beom Baek,M.D.,Sung Chul Kim,M.D.,Keum Seok Bae,M.D. and Seong Joon Kang,M.D. 대한갑상선-내분비외과학회 2009 The Koreran journal of Endocrine Surgery Vol.9 No.4

Purpose: Fine needle aspiration cytology (FNAC) has become a standard diagnostic tool for thyroid nodules. The purpose of this study is to analyze the correlation between FNAC and the final histology to improve the diagnostic value. Methods: We collected 792 patients who had undergone thyroidectomy, and we selected 549 patients who had undergone preoperative FNAC. The FNAC results were classified as non-diagnostic, malignancy, indeterminate and benign. The final pathologic reports were classified into two categories: malignant or benign. The individual histology was also identified. We retrospectively analyzed the pathologic result, the sensitivity, the specificity and the predictive value of the FNAC. Results: Among 549 patients, their FNACs showed 47 non diagnostic results, 189 malignancies,136 indeterminate results and 177 benign results. The false positive rate was 1.1% and the false negative rate was 12.9%. The final pathology reports were 262 malignancies and 287 benign lesions. There were 42 (30.9%) malignancies among the 136 indeterminate cases. Adenomatous hyperplasia was the most common benign lesion and papillary carcinoma (containing micropapillary carcinoma) was the most common benign lesion. Conclusion: FNAC is an easy and safe diagnostic tool, but it still has many limitations. It is necessary to reduce the number of non diagnostic results. Technical advances, classification of the advanced categories of cytology and other staining methods can provide more specific results, and this can reduce the rate of performing unnecessary surgery. (Korean J Endocrine Surg 2009;9:223-227)

Bethesda Classification에 의거한 갑상선 세침흡인 검사 결과 분석 및 Atypical Cells of Undetermined Significance의 임상적 의의에 대한 고찰

장정택,김광민,박준범,배금석,조미연<SUP>1<.SUP>,강성준,Joung-teak Jang,Kwang-Min Kim,Joon- Beom Park,Keum-Seok Bae,Mee-Yon Cho,<SUP>1<.SUP> and Sung-Joon Kang 대한갑상선-내분비외과학회 2010 The Koreran journal of Endocrine Surgery Vol.10 No.4

복부 둔상 후 간 손상 환자에서 치료방법의 결정요소

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.