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- 검색키워드
- 저자 : Kyung-Yul Hur (검색결과 53 건)
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비후성 유문 협착증 환아에서 유문부 두께에 미치는 인자에 관한 연구
허경열,문철,최은창 순천향의학연구소 1999 Journal of Soonchunhyang Medical Science Vol.5 No.1
The infantile hypertropic pyloric stenosis is the most common surgical condition during period of one to three months after birth, and is diagnosed without difficulty by symptoms of projectile nonbilious vomiting, visible gastric waves and palpation of olive shaped mass and confirmed by upper G-I series and abdominal ultrasonogram if symptoms were not diagnostic. It's treatment performing Fredet-Ramstedt pyloromyotomy is relatively easy. But, considering some serious complications such as dehydration, electrolyte imbalance, malnutrition, persistence of symptoms, duodenal perforation and hemorrhage developing during or after operation, it is necessary to study the size of the pyloric muscle and relating clinical factors for secure and safe pyloromyotomy. The purpose of this study is to assess the affecting factors associated with thickness and length of pyloric muscle in infantile hypertrophic pyloric stenosis. 60 cases of infantile hypertrophic pyloric stenosis had analysed, who had been treated with pyloromyotomy from November 1993 to December 1997 in Mok-dong Hospital, Ewha Womans Medical College. The results were as follows; (1) By ultrasonographic measurement, the thickness and length of pylorus were 5.7±1.6mm(ranges 3.5 ∼ 10mm)and 18.9±3.4mm(ranges 14 ∼ 30mm). These values were greater than normal control group of acute gastroenteritis. The thickness and length of pylorus in infant with acute gastroenteritis were 3.4±0.5mm and 7±0.4mm respectively. (2) Major symptoms were non-bilous vomiting and olive shaped mass. In those with major symptoms of non-bilious vomitng and olive shaped mass, the thickness and length of pylorus were consistent with the mean value of entire group of patients. In those cases with symptoms of only simple nausea and vomiting, the thickness and length of pyloric muscle were smaller than mean value of entire group. But, in cases with symptoms of jaundice, the thickness and length were greater than the mean value of entire group. (3) In cases with symptom duration for 1 week, the thickness and length of pyloric muscle were less than the mean value of the group of 2 weeks duration. But, there was no significant difference between groups of 2 weeks and 3 weeks of symptom duration. (4) Heavier the body weight at the same age, the larger the thickness and length of pylorus. (5) In cases with breast feeding, the thickness of pyloric muscle was greater than that of milk feeding group or mixed feeding group. But there was no difference in the length of pyloric muscle between types of feeding. (6) Electrolyte imbalance were hypochloremia, hypokalemia and metabolic alkalosis. In patients with hypokalemia less than 3.2mEq/L, there was significant increase in the thickness and length of pyloric muscle. But there was no difference in thickness and length of pyloric muscle according to the level of serum chloride. (7) With the group of positive IgG of H.pylori by ELISA test, the thickness and length of pyloric muscle were significantly larger than that of negative group. From these results, it may be concluded that the thickness and length of pyloric muscle were affected by following factors; pattern of cardinal symptoms of nonbilious vomiting and olive sized mass, symptom duration of more than 2weeks, heavier body weight, breast feeding, hypokalemia and presence of H.pylori infection.
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허경열 순천향의학연구소 2000 Journal of Soonchunhyang Medical Science Vol.6 No.2
49 cases of gallbladder polyp had analysed, who had been treated with laparoscopic cholecystectomy from August 1997 to July 1999 in Department of General Surgery, College of Medicine, Soonchunhyang University. The results were as follows; (1) Sixty-five percent of the benign gallbladder polyps were less than 10mm in diameter, whereas 77.8% of the malignant gallbladder polyps were more than 10mm. (2) Sixty-eight percent of patients with benign gallbladder polyp were under 50 years of age, whereas 77.8% of malignant gallbladder polyp patients were over 50. (3) Sixty-seven percent of patients with malignant gallbladder polyp had biliary symptoms, whereas 36.7% of patients with benign gallbladder polyp had biliary symptoms. (4) The incidence of gallstones in the malignant gallbladder polyps(44.4%) was higher than benign gallbladder polyps(15.0%). (5) Sixty-two percent of the benign gallbladder polyps were pedunculated, whereas 71.4% of the malignant gallbladder polyps were sessile. (6) Only one case of malignant polyp was considered as invasive malignant polyp, which needs further curative operation. (7) In contrast with open conventional surgery, mean hospitalization was reduced only 3.8±1.4 day and mean operative time was 87.1±28.3 minutes. From these results, it may be concluded that gallbladder polyp in patients over 50 years, with gallstones, with symptoms, with a diameter greater than 10mm, or showing broad based shape should be resected since malignancy can not be excluded. And with preoperative careful diagnosis, intraoperative frozen biopsy, postoperative meticulous histologic examination and follow up, the laparoscopic cholecystectomy considered to be sufficient if the patient is selected properly.
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허경열 순천향의학연구소 1996 Journal of Soonchunhyang Medical Science Vol.2 No.1
Sine Ludlow performed gallstone operation in 1930 at the Severance Union Medical College in Seoul, it's incidence has been steadly increasing at Korea, and it is about 1.05% to total admission at Soonchunhyang University hospity hospital in 1992. Gallstone disease which prevailed in 1960s, were characterized by high incidence of extra-cholecystic stone and pigment stones. These clinical features,however, has been changed since 1970s. Incidence of gallbladder stone in a series of gallstone study(Kim et.al) was 33% in 1960s, and it was 42.9% in 1970s, and finally it was 72.6% in 1980s. To sse a relationships in their periodical change and compositional difference according to their location, each 50 gallstones from 1960s' sample and 1980s'sample were taken and they are subjected to qualitative analysis using Magna-IR-spectrometer model 500 (Nicolet) and microanalysis of calcium contents using plasmascan model 221 (Lattam). The following results were observed: 1) In gallbladder stones, cholesterol stones were most frequent (42.5%). And the next frequent stones were calcium bilirubinate stones (35%). 2) In common bile duct stones, calcium bilirubinate stones were most frequent (60.9%). And the others were cholesterol stones, calcium carbonate stones and mixed stones. 3) There is a wide range of calcium contents according to the composition of gallstones. The largest amount of calcium were found in calcium carbonate stones and small amount of calcium were also found in cholesterol stones. 4) There is no significant difference of calcium contents between stones which were located in gallbladder and common bile duct. 5) There is little difference of calcium contents between gallstones of 1960's and 1980s' according to its location. From these analytical observation, it may be concluded that the calcium contents of gallstones shows wide range according to their composition rather than their location. And it would be stated that a least amount of calcium was present in every cholesterol stones suggesting that a role of calcium in nucleation and or growth of the stone may be important.
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유기원,허경열,문철 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1
Background : Because of the shortage of living-related donor and social acceptance of brain death, cadaveric renal transplantation is performed in recent days more frequently than in the past. However, clinical situation of cadaveric transplantation in Korea is somewhat different from that in western countries and the outcome is different also. Materials and methods : We analyzed 22 cadaveric renal transplants performed at SoonChunHyang University Hospital from November, 1994 to June, 1998. Results : The mean age of recipients was 35.9 year(22-52). Male to female ratio was 13:9. Mean HLA mismatching number was 2.09. The immunosuppressive regimen was triple therapy based on cyclosporine. The incidence of delayed graft function was 18.2%(4 cases). The overall incidence of biopasy-proven rejection was 36.4%(8 cases). The factors affecting graft survival in cadaveric renal transplantation were the delayed graft funtion (p=0.002), rejection (p=0.014) and hypertension (p=0.025). The graft survival rate at 1, 2, 3 year was 86.4%, 86.4%, 81.8% respectively. Total 4 renal transplants were lost due to rejection. Conclusion : Our resuls was comparable to that the western countries. Careful manipulation of the donors and recipients and prevention of acute rejection are necessary to increase the survival of the cadaveric renal transplants.
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허경열(Kyung Yul Hur),송태건(Tae Geon Song),박경규(Kyung Kyu Park),송영식(Young Sik Song),김익수(Ik Soo Kim) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.6
N/A Background/Ainis: We planed the study to evaluate the ideal procedure in surgical aspect of peptic ulcer through comparision of results in each procedure. Methnds: we reviewed l47 patients treated during l987 to 1993 at department of surgery, Socmchunhyang University Hospital. Results: The indications of operation were perforation(63.3%), obstruction(17.7%), bleeding(15.0%), intractabi- lity(2.0%) and others(2.0%) in order of frequency. Truncal vagotomy and pyloroplasty was perfor- med in 70 patients(47.6%), truncal vagotomy and antrectomy in 27 patients(18.4%), subtotal gastrectomy in 19 patients(I2.9%), truncal vagotomy and gastrojejunostomy in 15 patients(l0.2%.), primary closure in 10 patients(6.8%) and other procedures in 6 patients(4.1 fo). Perioperative morta- lity rate was l.4%(2 patients1 tha( these patients have severe and uncontrolled medical illness. Among 147 cases, follow-up evaluation was possible in 83 cases. The 66 cases(79.6%) was classified excellent and very good group according to Golighers modified Visick classification. In this study, ulcer recurrence rate was as follows: tnmcai vagotomy and antrectomy 0 il,, truncal vagotnmy and pyloroplasty 7.9%, subtotal gastrectomy 9.1Fo, truncal vagotomy and gastrojejunos- tomy 22.2%, and primary closure 60.0%. Reoperation was necessary in 4 cases after antrectomy and truncal vagotomy(14.8'7c), l patient after truncal vagotomy and pyloroplasty(1.5Fo) and 2 cases after truncal vagotomy and gastrojejunostomy(l3.3%). Conclusions: Considering postoperative complication and reoperation rate, we conclude that truncal vagotomy and pyloroplasty was more acceptable and safe procedure than truncal vagotomy and antrectomy in perforated peptic ulcer, even though its re]atively higher recurrence rate. (Korean J Gastroenterol 1995;27: 626-634)
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