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가토 두개골 결손부에 이식된 저골(猪骨)과 혈소판 풍부 섬유소의 골형성 효과
박정익,전성배,송영일,도형식,이진용,장현석,권종진,임재석,이의석,Park, Jeong Ik,Jeon, Seong Bae,Song, Young Il,Do, Hyung Sik,Lee, Jin Yong,Jang, Hyun Seok,Kwon, Jong Jin,Rim, Jae Suk,Lee, Eui Seok 대한악안면성형재건외과학회 2012 Maxillofacial Plastic Reconstructive Surgery Vol.34 No.6
Purpose: The purpose of this study was to evaluate the effectiveness of the platelet-rich fibrin (PRF) used in combination with the porcine cancellous bone as a scaffold, in promoting bone regeneration in the bone defects ofthe rabbit calvaria. Methods: Ten rabbits were used in the study. Three round-shaped defects (diameter 8.0 mm) were created in the rabbit calvaria and were filled with nothing (control group), porcine cancellousbone (Experimental Group 1, porcine bone) and PRF-mixed porcine cancellous bone (Experimental Group 2). TS-GBB is a xenogenic bone-substitute product comprised of a high heat-treated mineralized porcine cancellous bone. Animals were sacrificed at 6 weeks and 12 weeks for the histological and radiographic evaluations. Results: In the micro computed tomography and histological results, the experimental groups 1 and 2 showed more bone formation, remodeling, and calcification than the control group. The new bone formation ratio showed theGroup 2 to be larger than Group 1 at6 and 12 weeks. However, there was no significant difference between the experimental groups 1 and 2 in the new bone formation area, at the 6 and 12 weeks (P>0.05). Conclusion: The PRF-mixed group showed more bone formation than the porcine cancellousbonegroup (TS-GBB), butthere was a no significant difference. The PRF may not lead to enhanced bone healing when grafted with the porcine cancellous bone.
담낭암의 생존율에 영향을 미치는 예후 인자에 대한 분석
박정익(Jeong-Ik Park),김진수(Jin-Soo Kim),김기훈(Ki-Hun Kim),김관우(Kwan-Woo Kim),김광희(Kwang-Hee Kim),최창수(Chang-Soo Choi),최영길(Young-Kil Choi) 한국간담췌외과학회 2010 한국간담췌외과학회지 Vol.14 No.3
Purpose: Recent findings indicate that after cholecystectomy for early gallbladder cancer (GBC), outcomes are generally satisfactory. But outcomes for advanced GBC are dismal, even with recent advances in diagnostic and therapeutic modalities. The purpose of this study was to evaluate surgical outcomes and prognostic factors affecting survival after surgical resection in patients with GBC. Methods: We retrospectively reviewed clinical data from 133 patients with GBC who underwent surgical resection between January 2000 and December 2008. Their clinical condition, surgical treatment, and pathologic factors were analyzed. Results: Among the 133 patients with GBC, curative resection was achieved in 95 (71.4%). The 5-year survival rate in patients who underwent curative resection (52.6%) was much better than in those who underwent palliative resection (0.0%, p<0.000). Univariate analysis revealed that the following factors were associated with patient survival: preoperative jaundice, pain at presentation, incidental GBC, serum total bilirubin, alkaline phosphatase (ALP), carbohydrate antigen 19-9 levels, curability, lymph node (LN) dissection, size, site, macroscopic type of tumor, histologic differentiation, the depth of tumor invasion (T stage), LN metastasis, TNM stage and microscopic perineural invasion. Multivariate analysis revealed that the following were independent, favorable prognostic factors: curative resection, no LN metastasis, low TNM stage, non-papillary macroscopic type, and low ALP levels. Conclusion: Complete tumor resection and no LN metastasis are important prognostic factors for GBC. Favorable survival outcomes can be achieved when curative resection is done in early stage GBC and when operative procedures are planned with the consideration of the survival benefit of surgery in advanced GBC.
박정익(Jeong-Ik Park),허찬영(Chan-Young Hur),김진수(Jin-Soo Kim),김기훈(Ki-Hun Kim),김광희(Kwang-Hee Kim),박오환(Oh-Hwan Park),최창수(Chang-Soo Choi),최영길(Young-Kil Choi) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.1
Gallbladder perforation during laparoscopic cholecystectomy (LC) with spillage of bile and gallstones occurs frequently, but clinical sequelae caused by dropped gallstones are uncommon. We present a case of subhepatic and right-back abscess formation due to spilled gallstones occurring two years after LC, which were successfully removed using a percutaneous method as a minimally invasive technique. The patient firstly visited a primary care physician with right-back mass that was increasing in size and becoming symptomatic, then underwent incision and drainage. He was referred to our hospital and the subhepatic and right-back inflammatory mass containing spilled gallstones was revealed by computed tomography. Under fluoroscopic control, a percutaneous drainage catheter was placed within the abscess and pus was aspirated. The spilled gallstones were successfully retrieved with basket forceps, thereafter. The patient was discharged without significant complications on the 9th day after the percutaneous stone removal.
응급 간이식이 요구되는 전격성 간부전 환자들에게서 Bispectral Index Monitoring을 이용한 이식 전후 의식상태의 지속적인 평가의 유용성
박정익(Jeong-Ik Park),황신(Shin Hwang),이승규(Sung-Gyu Lee),황규삼(Gyu-Sam Hwang),김기훈(Ki-Hun Kim),안철수(Chul-Soo Ahn),문덕복(Deok-bok Moon),하태용(Tae-Yong Ha),송기원(Gi-Won Song),정동환(Dong-Hwan Jung),유제호(Je-Ho Ryu),이효준(Hyo 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.1
Purpose: Deterioration of consciousness is the most critical problem in patients with fulminant hepatic failure (FHF). Electroencephalography (EEG) is a standard procedure to determine the brain activity in unconscious patients. The bispectral (BIS) index derived from EEG was primarily developed to monitor the depth of unconsciousness. Methods: A prospective study was performed to assess the clinical utility of peritransplant BIS monitoring in 11 fulminant hepatic failure (FHF) patients who were undergoing emergency living donor liver transplantation (LT) with using a right liver graft. All the patients recovered their consciousness after LT. Results: There was a significant correlation between the BIS index values and the derived GCS score (r2=0.634, p <0.001). Timing of eye opening to voice command matched the BIS index value of 64±9.5, which was after 14±9.4 hours passing BIS index of 50. All the patients with endotracheal intubation during the early posttransplant period showed progressive increase of their BIS index, which appeared slightly earlier and more evident than the rise of derived GCS scores. Conclusion: BIS monitoring is a noninvasive, simple and easy-to-interpret method and it also appears to be a useful to assess and predict the recovery of a patient’s consciousness level after LT. Therefore, we concluded that BIS monitoring can be an indispensable component of the peritransplant intensive care for patients with FHF and who require emergency LT.
하지 근육형동맥과 복부 탄력형동맥의 동맥경화위험요소의 비교
박종권(Jong Kwon Park),김관우(Kwan Woo Kim),박정익(Jeong-Ik Park),오성진(Sung Jin Oh),서병조(Byoung Jo Suh),오상훈(Sang Hoon Oh),전시열(Si-Youl Jun) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.6
Purpose: Muscular artery differs from elastic artery in physical properties and constituents of the arterial wall. To investigate the difference between muscular and elastic arteries, we measured the pulse wave velocities (PWVs) in lower extremity muscular arteries (femoral ankle PWV, faPWV) and abdominal elastic arteries (brachial femoral PWV, bfPWV), and searched for the relationships between the PWVs of muscular, elastic arteries and the risk factors of arteriosclerosis. Methods: 184 normal volunteers were enrolled in the study. Among them, the ratios of male/female, smoker/non-smoker, and hypertension/normal were 81/103, 66/118, and 63/121, respectively. Using volume plethysmography, faPWV and bfPWV were measured. The risk factors of arteriosclerosis in this study were age, gender, smoking, hypertension, body mass index, low density lipoprotein, high density lipoprotein, triglyceride, hemoglobin A1C, and white blood cell. Results: The PWVs of lower extremity muscular arteries (faPWVs) were significantly faster than those of abdominal elastic arteries (bfPWVs) (right, P<0.001; left, P<0.001) Multiple regression analysis revealed that the independent risk factors of the PWV were age (right, P<0.001; left, P<0.001) and gender (right, P=0.008; left, p=0.014) in abdominal elastic arteries. However, in lower extremity muscular arteries, hypertension (right, P<0.001; left, P<0.001) as well as age (right, P<0.001; left, P<0.001) and gender (right, P=0.009; left, P=0.001) were other significant independent risk factors. Conclusion: The PWVs of lower extremity muscular arteries were significantly faster than those of abdominal elastic arteries. The significance of hypertension in faPWV suggests that hypertension is an important risk factor in inducing arterial stiffness, especially in lower extremity muscular arteries.
남소현(So-Hyun Nam),박정익(Jeong-Ik Park),김대연(Dae-Yeon Kim),김성철(Seong-Chul Kim),김인구(In-Koo Kim) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.5
Purpose: Hepatic hemangioendothelioma (HET) is a rare benign vascular tumor in infants. The clinical manifestations are variable from asymptomatic to life-threatening heart failure or Kasabach-Merritt syndrome (KMSD). We report our non-surgical treatment experience for infantile HET. Methods: We analyzed 15 infants (5 males, 10 females) of HET retrospectively, from January 1989 to December 2007. Results: All except 2 were full-term babies and median birth weight was 3,140 g. The median age at diagnosis was 15 days of life (0∼157 days). Three of 5 patients diagnosed prenatally presented heart failure symptoms and the remaining 2 showed KM SD. Among 6 neonates, 3 showed cyanosis due to congestive heart failure. Nine patients showed multiple nodules at both liver lobes. Three asymptomatic patients were followed with radiologic examinations, thus HETs regressed spontaneously in two and decreased in one. Four cases that showed hepatomegaly or increase in size of subcutaneous hemangioma, were treated with prednisolone. All patients improved from tumor related symptoms and tumor size decreased. Four patients (2 patients of heart failure, 1 with rapid progressive hepatomegaly and 1 with congenital heart disease) received interferon-α. Among them, 3 showed regression of tumor and the remaining 1 showed decrease of tumor size. Two patients who suffered from severe heart failure received prednisolone and interferon-α, and then recovered. In the 2 patients with KM SD, we tried hepatic artery embolization with medical treatment. One survived but the other is not followed after failure of embolization. Conclusion: We experienced that many patients who had clinical symptoms associated with HET very early in their life treated with an aggressive nonsurgical treatment in symptomatic patients showed favorable outcome.
Glissonean Pedicle Transection Method와 Hanging Maneuver를 이용한 간절제의 임상적 적용
김관우(Kwan Woo Kim),박정익(Jeong-ik Park),박광민(Kwang-Min Park),이영주(Young-Joo Lee) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.2
Purpose: The liver hanging maneuver (LHM) is a useful technique enabling a safe anterior approach, which is one of the most important innovations in the field of major hepatic resections. This study was conducted to review tumors’ profiles after applying this procedure and to evaluate the usefulness of LHM and Glissonean pedicle transaction method (GPTM). Methods: Medical records of 64 patients who underwent hepatic resection using LHM and GPTM at the Asan Medical Center were reviewed. The classic LHM was conducted according to the Belghiti method. Results: Among 64 patients, 46 patients had hepatocellular carcinoma; 7, intrahpatic cholangiocarcinoma; 4, hilar cholangiocarcinoma; 4, metastatic liver cancer; 3, benign liver tumor. Mean tumor size was 10.6 cm (3∼22). Mean liver parenchymal transection time was 20 min (15∼30). Right side hepatectomy was performed in 44 patients; left side hepatectomy with or without caudate lobe was performed in 19 patients. Twenty patients (31.3%) required blood transfusion during surgery. There was no in-hospital mortality or major complications. Minor complications developed in 6 patients (9.37%). Conclusion: GPTM and LHM are a safe and useful surgical application of various anatomical resections for huge liver tumor and an effective procedure during left hepatectomy with or without caudate lobe.
서상혁(Sang-Hyuk Seo),박정익(Jeong-Ik Park),김진수(Jin-Soo Kim),김광희(Kwang-Hee Kim),최창수(Chang-Soo Choi),최영길(Young-Kil Choi) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.76 No.6
Purpose: Xanthogranulomatous cholecystitis (XGC) is an uncommon, benign destructive and chronic inflammatory disease which is characterized by a marked proliferative fibrosis within the gallbladder wall. XGC occasionally involves adjacent organs and mimicking an advanced gallbladder carcinoma (GBC). The purpose of this study was to review the clinical manifestations, radiologic and pathologic findings of XGC and to investigate an appropriate treatment plan for patients with XGC. Methods: We retrospectively analyzed the clinical data of 36 patients with a pathologic diagnosis of XGC operated between January 2003 and June 2008. Results: The most frequent clinical symptom was biliary colic (88.8%). Radiologic studies revealed cholelithiasis in 30 patients (83.3%), thickening of gallbladder wall in 24 patients (66.6%), suspicious cancer in 11 patients (30.5%) and Mirizzi syndrome in 3 patients (8.3%). Laparoscopic cholecystectomy was planned in 18 patients but converted to open surgery in 9 patients. Open cholecystectomy was planned and performed in 13 patients including 8 cases of T-tube choledocholithotomy and 1 case of excision of a cholecystoduodenal fistula. Extended cholecystectomy was performed on 3 patients. GBC was suspected before operation in 11 patients. Of these, frozen-section biopsy was performed in 6 and found to be malignant in 1 patient. One patient who had no operative suspicion of malignancy turned out to have GBC at final histology. Conclusion: XGC is difficult to diagnose either preoperatively or intraoperatively and definite diagnosis can be obtained by pathologic examination only. If there is an intraoperative suspicion of GBC, frozen-section biopsy will help to decide the appropriate mode of operation.