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일차성, 이차성 그리고 삼차성 부갑상선 기능 항진증 환자의 수술 후 임상결과: 서울대학교 병원에서의 14년 경험
최윤석 ( Yun Suk Choi ),이규언 ( Kyu Eun Lee ),박귀원 ( Kwi Won Park ),노동영 ( Dong Young Noh ),오은미 ( Eun Mee Oh ),최준영 ( June Young Choi ),윤여규 ( Yeo Kyu Youn ),오승근 ( Seung Keun Oh ),구도훈 ( Do Hoon Koo ) 대한임상종양학회 2011 Korean Journal of Clinical Oncology Vol.7 No.1
목적: 일차성, 이차성, 삼차성 부갑상선 기능 항진증은 각각 원인과 치료방법 그리고 임상 경과가 서로 다르지만 부갑상선 절제술이 표준치료로 알려져 있다. 본 연구에서는 각각의 부갑상선 항진증의 수술 전후의 임상적 변화를 알아보고 부갑상선 절제술의 의미를 재고 해보고자 하였다. 방법: 1996년부터 2009년까지 총 126명이 서울대학교 병원에서 부갑상선 절제술을 시행 받았으며 각각 일차성 96명, 이차성 24명, 삼차성 6명이었다. 환자들의 나이, 성별, 생화학적 검사, 수술방법, 병리학적 검사 결과를 전자 의무기록을 통해 후향적으로 분석하였다. 결과: 모든 세 군의 환자에서 혈청 칼슘, 부갑상선 호르몬, 이온화 칼슘이 수술 전보다 호전을 보였다. 이차성 환자군은 다른 두 군에 비해 수술 전, 후의 부갑상선 호르몬이 높았으며(p<0.001, p=0.036), 수술 후 지속적인 부갑상선 기능 항진증(30.4%) 및 일과성 저칼슘혈증(87.5%)도 다른 두 군에 비해 많이 발생하였다.(p< 0.001) 일과성 저칼슘혈증의 대부분(90.4%) 은 6개월 이내 회복 되었다. 이차성 환자에서 부갑상선 아전 및 전 절제술을 시행 받은 경우 수술 후 일과성 저칼슘혈증이 많이 나타났으나(71.4%), 제한적 절제술을 시행 받은 경우 지속적 부갑상선 기능항진증이 더 많이 나타났다.(50%) 결론: 부갑상선 절제술은 생화학 검사상의 호전을 위한 치료 방법으로 추천될 수 있으며, 이차성에서는 제한적 절제를 하는 경우 지속적 부갑상선 항진증의 빈도가 더 높으므로 부갑상선 아전 및 전 절제술을 시행해야 한다. Purpose: Primary hyperparathyroidism(PHPT), secondary hyperparathyroidism(SHPT) and tertiary hyperparathyroidism(THPT) are different in the cause, treatment and prognosis. However the parathyroidectomy has been an efficient treatment in all hyperparathyroidism groups. A single institution`s 14 year experience of surgical treatment was analyzed to investigate perioperative changes of clinical characteristics and reconsider the value of parathyroidectomy as the treatment option. Materials and Methods: From 1996 to 2009, 126 patients underwent parathyroidectomy at single institute and the number of patients with PHPT, SHPT and THPT were 96, 24 and 6 retrospectively. The electronic medical records of age, sex, biochemical analysis, operative method, and pathologic results were reviewed retrospectively. Results: Postoperative calcium (Ca), parathyroid hormone (PTH), ionized calcium (iCa) levels were improved definitely than preoperative Ca, PTH, iCa level in all three groups. Pre and postoperative PTH level in SHPT was higher than in PHPT and THPT(p<0.001, p=0.036) and postoperative persistent PTH increased status were more common in SHPT.(30.4%, p<0.001) Postoperative temporary hypocalcemia was more common in SHPT(87.5%, p<0.001), almost of them (90.4%) were recovered in 6 month. In SHPT group, temporary hypocalcemia were more common in subtotal or total parathyroidectomy group than in limited resection group (94.1%) but persistent iPTH increase were more common in limited resection group (50%). . Conclusion: Parathyroidectomy is highly recommended to improve biochemical laboratory findings in patients with hyperparathyroidism. And in SHPT, subtotal or total parathyroidectomy is more appropriate surgical method for reducing the high incidence of persistent hyperparathyroidism.
김진복(Jin Pok Kim),윤여규(Yeo Kyu Youn),김동윤(Dong Yun Kim) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.1
N/A Retrospective analysis of all mortality cases was performed in the department of general surgery admitted to either SICU or RICU during 8 year period between January 1st, 1979 and December 31st, 1986. A total of 18,967 admissions to general surgery were identified during this period. Of these 18, 967 patients of general surgery 140 patients died while in either SICU or RICU. Of 140 morality cases 93 cases were available for patient-chart review. 1) The average age of MSOF patients was 48.1 years with a range of 18 to 94 years. The sex ratio was 1.5: 1 (51 men/34 women). 2) MSOF patients from admission or operation-day to death spent an average of 12.2 days in the SICU or RICU with a range of 1 to 104 days. 3) 93 deaths were analyzed retrospectively, and 85 patients were identified as having died with multisystem and organ failure (MSOF) (91.4%). This patient group provided the bases for this retrospective study using Manships criteria. 4) 48 patients of 85 MSOF deaths were with sepsis (56.5%). 5) Non-traumatic patients of MSOF deaths were over 90%. Of these deaths 55.1 percent was with sepsis. Of 8 traumatic deaths 7 patients were with MSOF. Of 7 late traumatic MSOF deaths 5 patients were with sepsis (71.4 per cent). 6) Cardiovascular system was most frequently involved among six systems and was thought to be consequently responsible for eventual MSOF deaths in almost all cases. 7) Malignancy was most frequent reasons for initial hospitalization, next GI catastrophe, GI bleeding. 8) Only malignancy was most frequently associated with MSOF deaths. Others are a period of shock, GI acute event, massive blood replacement. 9) A clinical misadventure in MSOF deaths was 17.2 per cent during 1979-1986 period. 10) Sepsis was the main contributor to the primary cause of MSOF-death (56.5%). 11) The GI tract was the most frequent site of origin of sepsis. 12) Nearly half of our patients dying of sepsis had more than one positive culture site. 13) Nearly half of MSOF sepsis patients had three or more organisms isolated from the multiple culture sites. 14) The most frequent positive culture site was GI-tract, wounds, and drains. 15) Gram negative rods were most frequent organisms isolated from sepsis MSOF deaths. 16) Risk factors were compared in septic and non-septic MSOF deaths. (1) Poor nutrition was more prevalent in patients with fatal sepsis than in non-septic patients (p< 0.005). (2) Another risk factor of MSOF was oligemic shock in non-septic patients (p<0.05). (3) Cancer had equal chance both in septic and non-septic-MSOF death. 17) Sepsis was more associated with pulmonary failure, Intra abdominal septic focus, albumin<3.0, five or six organ systems failure than non-sepsis case was. MSOF is thought as a final common pathway to the fatal result in severely infected patients. Pulmonary failure occurred almost synchrononsly with clinical sepsis and hepatic failure, stress bleeding, and finally renal failure complete the sequence by the report of Dr. Fry. (Domino effect) Obviously, every ease does not follow a precise prototype, and the sequence of failure may be quite different in different patients. MSOF patients who have anything of sepsis, poor nutrition, oligemic shock was thought to be very risky and easily fatal. Many mediators and effectors in MSOF-sepsis patients was thought to have a certain important role toward death. Following therapeutic principles are suggested for the (1) Every organ function should be supported. (2) Surgical removal of infection focus and adjunctive (3) Primary treatment of mediators and effectors as a (4) Good nutrition and immunoenhancement of MSOF effective treatment of MSOF patients.
윤여규,윤효영,정연권 대한외상학회 1994 大韓外傷學會誌 Vol.7 No.1
To solve the problem of tertiary medical center emergency room, overcrowding and long hospital stay, it is very important to analyze the emergency patients who visited tertiary medical center and to accumulate data bases of various hospitals. For this purpose, we have reviewed 14,521 cases of pateints who visited the emergency room of Seoul National University Hospital, tertiary medical center, from,January 1 to December 31, 1992. The results were as follow: 1. Male to female ratio was l.4:1 and the most common age group was 6th decade. 2. The peak time of patient's enterance in emergency room was between 12:00 PM and 4:00 PM (26.7%), and second peak was between 08:00 AM and midday. 3. In a week, Monday was the most crowding day (mean 44 patients). 4. The most predominant monthly distribution of visit was March and September. 5. Of the patients, 71.7% were known to live in Seoul, 6. About half of the patients who visited emergency room needed internal medical care and 42% of them had gastrointestinal disease. 7. The admission rate was 29.5% and transfer rate was 3.9%. The number of the patients who could admit the ward was largest in Monday (mean 15.2 patients) and smallest in Sunday (mean 6.8 patient,s). The average duration from visit to admission was 51 hours. 8. About 1% (144 patients) of patients expired during the treatment in the emergency room and most of them(81.3%) were internal medical patients.