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외상성 비장 손상의 외과적 고찰 및 치료 방법에 대한 비교
배희열 ( Hee Yeol Bae ),정봉화 ( Bong Wha Chung ),이기주 ( Ki Chu Lee ),배수동 ( Soo Tong Pai ) 대한외상학회 1990 大韓外傷學會誌 Vol.3 No.2
Injuries to the speen are commonly encountered by surgeons treating the patients with abdominal trauma. With documentation that overwhelming postsplenectomy infection can occur after splenectomy for trauma, splenic salvage procedure rather than splenectomy have been considered the preferred treatment for traumatic splenic injuries. Splenic salvage has been most often accomplished by splenorrhaphy and more recently by a controversial non-operative approach. This report delineated results with splencetomy, splenorrhaphy and non-operative approach based on 7 years (1984-1990) inwhich 150 consecutive patients with splenic injuries were treated. Results were as follow: 1) The ratio of male to female patients was 2.75: 1 and peak incidence of age was the 3rd decade. 2) The most common cause of splenic injury(52%)was the traffic accident. 3) The most common site of associated trauma is liver(45%)in intraperitoneum and is rib fractures(98%)in extraperitoneum. 4) Of these, 95 patients were treated by splenectomy, 42 patients by splenorrhaphy and 13 patients by non-operative management. 5) Comparative studies of main complication were evaluated by analyzing the values of two groups dividing on each preoperative status concerning to the multiplicity of associated injury, grade of splenic injury and arrival time with X2-test to find higher significance in group of multiple injuries than the opposite group(p< 0.0005). 6) Comparative studies of operative methods were evaluated by analyzing value of two group dividing on duration of operation, amount of transfusion and complica-tion rate with t-test. On result, it was not found any evidence that splenectomy was superior to splenorrhaphy. 7) The overall motality rate was 9.3%.
양익,정수영,박해정,이열,정봉화,심정원,Yang, Ik,Chung, Soo-Young,Park, Hai-Jung,Lee, Yul,Chung, Bong-Wha,Shim, Jeong-Won 대한영상의학회 1997 대한영상의학회지 Vol.37 No.4
Purpose : To assess the usefulness of 3D-gradient echo dynamic contrast enhanced MRI (3D-DMRI) in the diagnosis of breast cancer and to determine the most useful parameter for this diagnosisMaterials and Methods : Using a 1.0T MR unit, (Magnetom, Sienens, Erlaugen, Germany), 3D-DMRI (TR/TE=30/12) with Gd-DTPA was performed in 38 cases of breast cancer, 22 of fibroadenoma, and in three normal volunteers. We retrospectively evaluated the findings according to the speed on dynamic study and maximal amount of contrast enhancement during the delayed phase;we calculated the three diagnostic parameters.Results : On conventional spin-echo T1- and T2-weighted imaes, there was no significant difference of signal intensity brtween benign fibroadenoma and breast carcinoma. Rapid contrast enhancement (within one minute) was benign in 35 breast cancer lesions (92.1%), but relatively low and slow contrast enhancement (after five minutes) was noted in three such lesions (7.9%). Gradual contrast enhancement was noted in 21 lesions of fibroadenoma (95.5%), but a moderate degree of rapid contrast enhancement (from three to five minutes) was noted in the other case (7.9%). of On the delayed enhanced phase of 3D-DMRI, the maximal amount of contrast enhancement showed no significant difference between fibroadenoma and cancer. On 3D-DMRI, an irregular, spiculated border, with high contrast enhancement was noted in all cases of breast cancer, in particular, irregular thick peripheral contrast enhancement with central necrosis was noted 11 cases (28.9%).Conclusion : For the diagnosis of breast cancer, 3D-DMRI is a useful technique. Among the diagnostic criteria of speed, maximal amount of contrast enhancement and morphology, morphologic change after contrast enhancement study was the most useful diagnostic parameter.
전용석,정수영,양익,이경원,김홍대,신상준,정봉화,Cheon, Yong Seok,Chung, Soo Young,Yang, Ik,Lee, Kyung Won,Kim, Hong Dae,Shin, Sang Joon,Chung, Bong Wha 대한영상의학회 2001 대한영상의학회지 Vol.45 No.3
Purpose: To compare 3D ultrasound (3D-US) with 2D ultrasound (2D-US) in terms of their usefulness and limitations in the diagnosis of breast masses. Materials and Methods: We obtained 2D and 3D US images of 37 breast lesions present in 20 cases of fibroadenoma, nine of cancer, and eight of fibrocystic disease proven in a total of 26 cases [fibroadenoma (n= 13), breast cancer (n= 9), fibrocystic disease (n=4)] by histologic examination, and by clinical evaluation and clinical evaluation with sonographic imaging in eleven. When comparing 3D and 2D-US images we had no prior information regarding detection rate according to the size of lesions, whether or not internal and boundary echo patterns could be interpreted, accurate differentiation between tumorous and non-tumorous lesions, or the accuracy with which benign and malignant tumors could be differentiated. Results: For lesions of 1 cm or less in diameter the detection rate of 3D-US was lower than that of 2D-US, but for lesions over 1 cm there was no difference between the two modalities. In fibroadenoma and breast cancer, 3D-US was more useful than 2D-US for the evaluation of both internal and boundary echo, but with fibrocystic disease and in the diagnosis of tumor/non-tumor, there was no significant difference. In breast cancer, however, 3D-US more accurately determined malignancy, and in fibroadenoma, because of the pseudospicule revealed by 3D-US, this modality was less exact in determining benignancy. Conclusion: In the evaluation of internal and boundary echo in breast mass diagnosis, 3D-US was more useful than its 2D counterpart. For lesions of 1 cm or less in diameter, however, the detection rate of 3D-US was low, and since in some benign cases a pseudospicule was apparent, the possibiliy of confusion with malignancy arose. For these reasons, the usefulness of 3D-US was limited. 목적: 유방 종괴의 진단에 있어서 2차원 초음파 진단과 비교하여 3타원 초음파진단의 유용성과 제한점을 알아보고자 하였다. 대상과 방법 : 37예의 유방종괴에 대하여 각각 2타원 초음파(HDI-3000, ATL, U.S.A.)와 3차원 초음파(Voluson 530D, Medison, Korea)를 이용하여 영상을 얻었다. 유방종괴는 섬유선종 20예, 유방암 9예. 및 섬유낭성질환 8예 등이었으며 섬유선종 13예, 유방암 9예, 및 섬유낭 성질환 4예는 병리조직학적으로 화친되었으며 나머지 11 예는 영상소견과 임상적 소견 및 초음파 결과를 토대로 진단하였다 전향적으로 사전 정보 교환 없이 각각 2타원 및 3타원 초음파 검사를 시행하여 병변의 크기에 따른 발견을, 내부에코 판별능, 경계에코 판별능. 종양과 비종양의 감별 진단에 있어서의 정확도, 및 종양에 있어서 양성과 악성진단의 감별의 정확도를 비교 분석하였다 결과: 크기가 1 cm 미만인 병변의 발견율은 2차원 초음파검사가 3차원 초음파검사보다 높았으나 1 cm이상의 병변은 2차원과 3차원 초음파검사간에 차이가 없었다 내부에코 판별능과 경계에코 판별능에서는 3차원 초음파검사가 2차원 초음파검사보다 섬유선종과 유방암에서는 더 유용하였으나 섬유낭성질환에서는 2차원 초음파검사와 큰 타이가 없었다 종양과 비종양의 감별진단의 정확도에서도 3차원 초음파검사와 2차원 초음파검사가 큰 타이를 보이지 않았으나 3차원 초음파는 유방암인 경우 악성도 예측에 있어서는 우수하였고 섬유선종의 경우에는. 3차원 초음파검사가 영상재건도중 발생하는 가성돌기로 인해서 2차원 초음파검사에 비해 양성도 예측률이 낮았다. 결론: 유방 종괴의 진단에 있어서 3타원 초음파진단은 2차원 초음파진단에 비하여 내부에코 판별능 및 경계에코 판별능에 있어서 유용한 소견을 보였다. 그러나 1 cm 미만의 작은 병변의 발견율이 낮고. 양성 종양의 일부에서 가성돌기 소견이 보여서 악성 종양과 혼돈을 일으킬 수는 있는 제한점이 있는 것으로 사료된다