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이봉화 사단법인 한국당뇨협회 1995 당뇨 Vol.66 No.-
가장 흔한 질환이 위염, 위십이장궤양, 위암, 식도 위기능장애 등을 치료받고 있는 당뇨환자들에게서는 당뇨환자 병변인 위장운동장애와 겹쳐서 나타나므로 증상이 모호한 경우가 많다. 특히 음식을 적절히 소화시키지 못하므로 영양이 결핍되어 체중이 감소되고 쇠약해지는 경우에는 반드시 위질환을 당뇨의 입장에서 다시 한번 진단해 보고 적절한 치료를 해야 한다.
직장암에 대한 간괄약근 절제술과 자동봉합기 결장항문 문합술의 비교
이봉화,김종완,장미영,박형철,이해완 대한대장항문학회 2008 Annals of Coloproctolgy Vol.24 No.2
Local control and functional results of an intersphincteric resection are controversial in Asian, low BMI patients, even though it might a provide a chance to avoid a permanent colostomy. We tried to evaluate the potential risk of an intersphincteric resection, compared with a stapled coloanal anastomosis, in patients with low rectal cancer. Methods: Patients with low rectal cancer, who underwent a intersphincteric resection with a hand- sewn anastomosis (ISR) or a coloanal anstomosis with staples (stapled CAA), were analyzed. Results: From 1999 to 2006, 85 patients were enrolled. The distance between the anal verge and the lower margin of the tumor was 3.4±0.8 cm (range: 2∼5 cm) in the ISR group and 4.9±0.8 cm (range: 3∼7 cm) in the stapled CAA. The mean body mass index was 23 (range: 18∼32). The patients complained postoperatively of intolerable anal incontinence (Kirwan’s class > 2) in 35% of the ISR group and in 9% as the stapled CAA group, (P<0.02). The local recurrence rate was greater in the ISR group (15%) than in the stapled CAA group (2%, P<0.04). There was no significant difference in distant metastasis between the two groups. The disease-free survival rates were 80.8% and 91.2% at three years in the ISR group and the stapled CAA group, respectively. Complications, such as urinary incontinence and sexual dysfunction in male patients, were not significantly different between the two groups. Conclusions: An intersphincteric resection with hand-sewn anastomosis could be worse than a stapled coloanal anastomosis in function and local recurrence. This may indicate that careful selection is required for a intersphincteric resection even when a stapled anastomosis cannot be applied due to a narrow margin.
이봉화,강형길 대한외상학회 1996 大韓外傷學會誌 Vol.9 No.2
Background: Treatment of perineal burns is complicated by the local bacterial environment and irregular contour anatomically. Purpose: The aim of this study is to know management and adequate treatment for the reduction of complications of perineal burns. Method: Thirty-three patients were included in this retrospective study who were treated by surgical treatment of perineal burns at the department of surgery, Hangang Sacred Heart Hospital, Hallym University during 3 years from 1993 to 1995. Result: Age distribution showed that highest incidence of age groups was between one and five years old(10 cases : 30.3%). The most frequent cause of perineal burn was scalding burn(20 cases : 60.6%) and most patients(21 cases: 63.6%) were lesser affected than 20% extent of burn. Depth of burn was mostly between superficial second degree and deep second degree in 11 cases(33.3%) and above third degree in 11 cases(33.3%). Most frequent accompanied burn area was genitalia(17 cases : 51.2%) followed by buttock(13 cases : 39.4%), back(8 cases : 24.2%) and only perianal area was 3 cases(9.1%). Treatment was done that only topical chemotherapy was performed in 15 cases(45.4%), split thickness skin graft in 15 cases(45.4%), full thickness skin graft in 1 case(3.0%), local flap in 2 cases(6.1%). Duration from operation to diet was that 4-5 days in 7 cases(38.9%), 1-3 days in 6 cases(33.3%). The most frequent duration of hospital stay was between 36 and 42 days(14 cases: 42.4%), followed by above 43 days(12 cases 36.4%). Diverting sigmoid colostomy in two cases were performed. Associated diseases were senile dementia(3 cases ' 9.1%), paraplegia(2 cases : 6.1%), seizure(1 case : 3.0%), mental retardation(1 case : 3. 0%), and others. Postburn complications were hypertrophic scar(6 cases : 18.2%), joint contracture(4 cases : 12.1%), urinary tract infection(3 cases : 9.1%), testicular loss(2 cases : 6.1%), anal stenosis(2 cases 6.1%), urethral stricture(2 cases : 6.1%), irritation dermatitis(2 cases : 6.1%), pyoderma(2 cases : 6.1%), impertigo(1 case : 3. 0%). Conclusion: Most of perineal burns are occurred in children or physically hadicapped persons. Therefore, patients with perineal burn wound present a complex array of clinical problem. All peirineal burn wounds should be carefully managed and an aggressive surgical approach is mandatory occasionally.