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정순섭 ( Soon Sup Chung ) 한국정맥경장영양학회 2014 한국정맥경장영양학회지 Vol.6 No.1
Nutrition support methods in the elderly is not easy, but similar as young adult. Elderly patients are at increased risk of partial or complete loss of independence due to acute and/or chronic disease and often of concomitant protein caloric malnutrition. The type of artificial nutrition to use will depend on the current illness and the previous health record. Because enteral feeding is less expensive and aggressive, enteral feeding should be used whenever possible, leaving parenteral nutrition for specific situations where enteral feeding should not be used
부인두강에 발생한 제 2새열낭종 1례 - 편도주위농양으로 오인된 증례 -
김보형,류재민,정순섭,김요한,Kim, Bo-Hyung,Ryu, Jae-Min,Chung, Soon-Sup,Kim, Yo-Han 대한기관식도과학회 2002 大韓氣管食道科學會誌 Vol.8 No.2
Branchial cleft cysts are most common neck masses in adults. Most are second branchial cysts, which occur in the neck, anterior to sternocleidomastoid muscle at the mandibular angle. Rarely these cysts may be present in the parapharyngeal space. We report a case of a second branchial cleft cysts in the parapharyngeal space of 32-year-old female, which was misdiagnosed as peritonsillar abscess. It was excised via transoral and transcervical approach.
급성 충수돌기염 진단 시 연령에 따른 Alvarado Score의 진단적 가치
오보영(Bo-Young Oh),김광호(Kwang-Ho Kim),이령아(Ryung-Ah Lee),정순섭(Soon Sup Chung) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.2
Purpose: This study aims to assess the diagnostic efficacy of the Alvarado score and to determine cut-off values of Alvarado score according to age for deciding on the options for patients with suspected appendicitis. Methods: From October 2008 to January 2009, we prospectively reviewed 152 patients with suspected appendicitis. The patients were classified into adults and children groups. We then determined cut-off values of the Alvarado score by analyzing each score’s sensitivity and specificity. Results: Of the 147 patients, 96 patients were adults and 51 were children. The mean Alvarado score for adults and children were 6.08±1.85, and 6.69±1.43 in appendicitis and 4.32±2.02, and 4.60±1.81 in non-appendicitis, respectively. In adults, the sensitivity of the Alvarado scores 7 or higher for appendicitis was 66.2%, and the specificity was 67.7%. And the sensitivity of the Alvarado scores 4 or lower for non-appendicitis was 58.1%, and the specificity was 81.5%. In children, the sensitivity of the Alvarado scores 7 or higher for appendicitis was 80.8%, and the specificity was 68.0%. And the sensitivity of the Alvarado scores 4 or lower for non-appendicitis was 52.0%, and the specificity was 92.3%. Conclusion: The cut-off values for Alvarado score were not different according to age of the patient. If the Alvarado score is 7 or higher, surgical management is recommended, and if the Alvarado score is 4 or lower, observation without CT or US is recommended. In equivocal appendicitis as defined by the Alvarado scores 5 to 6, adjunctive CT or US are recommended to confirm appendicitis.
김창종(Chang Jong Kim),오보영(Bo-Young Oh),홍경숙(Kyoung Sook Hong),이령아(Ryung-Ah Lee),정순섭(Soon Sup Chung),김광호(Kwang Ho Kim) 대한종양외과학회 2012 Korean Journal of Clinical Oncology Vol.8 No.1
목적 : 복강경 수술은대장암 환자에서 보편화된 수술 방법의 하나로 자리잡았다. 하지만 접촉감의 부재와 긴 수술 시간, 기술적인 복잡성, 제한된수술시야등과같은점이제한점으로제시되었고, 이에 대한 대안으로 수부 보조 복강경 수술(HALS)이 제시되었다. 이에 본 연구에서는 직장암 환자에서 HALS와 개복 수술(OS)의 결과에 대해 비교하고자 하였다. 방법 : 본 연구는 2009년 1월부터 2011년 10월까지 직장암으로 수술을 받은 36명의 환자를 대상으로 하였다. 환자들 중 내장 복막에 침습이 있거나 종양의 크기가 5 ㎝보다 큰 경우, 직장 외에 다른 장기로의 전이가 동반된 경우, 수술 시 직장 외에 다른 장기의 동반 절제가 시행된 경우, 그리고 HALS 도중 OS로 전환된 경우는 본 연구 대상에서 제외하였다. 대상 환자들을 HALS 군과 OS군으로 분류하여 수술 전후의 결과에 대해 비교하였다. 결과 : 36명의 환자 중 14명이 HALS를 시행 받았고 22명이 OS를 시행 받았다. 두 군간에 연령 및 성별, 체질량 지수, 동반 질환에 있어 유의한 차이는 보이지 않았다. HALS는 OS에 비해 수술시간이 길었으며(243.9 분 vs 201.1 분, p=0.014), 창상의 길이는 작았고(7.5 ㎝ vs 19.5 ㎝, p=0.000), 추정 실혈량은 적게 측정되었다(112.0 mL vs 342.3 mL, p=0.001). 조직병리학적결과에 있어서 HALS 군이 OS 군에 비해 더 낮은 병기를 보였으나(1.5 vs 2.3, p=0.009), 수술 중 절제된 림프절 수와 절제연에 있어서는 유의한 차이는 보이지않았다. 수술 후 경과를 비교하였을 때 gas-out이 된 시기와 식이 시작 시기, 진통제 투여 기간, 수혈량은 유의한 차이를 보이지 않았으나, HALS 군에서 더 짧은 재원 일수를 보였다(10.4일 vs 13.3일, p=0.011). 또한 두 군의 수술 후 합병증 및 사망률은 유의한 차이를 보이지 않았다. 결론 : HALS는 최소 침습적인 동시에 종양학적 안전성 갖는 수술방법으로 직장암 환자에서 시행할 수 있는 유용한 수술 방법의 하나가 될 수 있을 것으로 생각된다. Purpose : Laparoscopic surgery has been shown to be useful modality to be compared with conventional open surgery. However, it has been raised several limitations such as absence of tactile sense, long operative time, technically complexity, and limited operative field. Hand-assisted laparoscopic surgery (HALS) has been proposed as an alternative to these limitations of laparoscopic surgery. The aim of this study is to compare HALS with conventional open surgery(OS) in rectal cancer patients. Methods : We reviewed 36 rectal cancer patients who underwent operation between Jan 2009 and Oct 2011, retrospectively. Patients were diagnosed with rectal cancer and underwent HALS AR/LAR or open AR/LAR by the same surgical team. Patients were excluded from this study when visceral peritoneum was invaded (T4), the largest lesion was bigger than 5 ㎝, there were synchronous metastasis of other organs other than the rectum, resection of other organs in addition to rectum were accompanied during operation, and HALS was converted to OS. Patients were classified into two groups with either HALS or OS. We compared perioperative outcomes of each group. Results : Out of 36 patients, 14 underwent HALS AR/LAR and 22 underwent open AR/LAR. There was no significant difference between these two groups in age, sex, BMI, and comorbidities. HALS group had significantly longer operative time than OS group (243.9 min vs. 201.1 min, p= 0.014). HALS group had significantly shorter skin incision (7.5 ㎝ vs. 19.5 ㎝, p=0.000) and less estimated blood loss (112.0 ㎖ vs. 342.3 ㎖, p=0.001) than OS group. In histopathologic reports, HALS group had significantly earlier stage (1.5 vs. 2.3, p=0.009) than OS group, but there was no significant difference in number of harvested lymph nodes and length of resection margin. In postoperative course, there was no significant difference in date of first gas out, date of starting diet, number of parenteral opioid analgesics administered, and amount of RBC transfused, but HALS group was shown shorter length of hospital stay (10.4 days vs. 13.3 days, p=0.011) than OS group. Also post-operative morbidity or mortality did not shown significant differences between the two groups. Conclusion : This study showed that HALS AR/LAR seems to be minimally invasive and oncologically feasible. Therefore, it is also useful alternative modality as laparoscopic surgery or open surgery in rectal cancer patients.
김정은,정순섭 건국대학교 의과학연구소 2002 건국의과학학술지 Vol.12 No.-
Neonatal gastric perforation is an uncommon disease that occurs only in neonatal period. It requires the early diagnosis and emergency operation. Especially neonatal gastric perforation with diaphragmatic eventuration is extremely rare. Four days old male infant who revealed sudden onset vomiting and dyspnea was diagnosed as neonatal gastric perforation with diaphragmatic eventuration and successfully treated by primary closure of stomach with two layer suture after debridement and correction of eventrated diaphragm with nonabsorbable material.