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간이식 수술 후 재발된 B형 간염 환자 및 de novo 감염 환자에서 Adefovir의 치료 효과에 대한 예비 보고
김건국 ( Keon Kuk Kim ),김기훈 ( Ki Hun Kim ),황신 ( Shin Hwang ),안철수 ( Chul Soo Ahn ),문덕복 ( Deok Bog Moon ),하태용 ( Tae Yong Ha ),이승규 ( Sung Gyu Lee ) 대한소화기학회 2005 대한소화기학회지 Vol.45 No.3
Background/Aims: Anti-viral therapy using hepatitis B immune globulin and lamivudine could not prevent HBV recurrence after liver transplantation (LT) completely. Adefovir dipivoxil is a acyclic nucleotide phosphate analogue and known to have potent anti-
반복적인 투침으로 인해 인조혈관과 자가 정맥 사이에 발생한 의인성 동정맥루 환자들에서의 임상적 특징
최상태(Sang Tae Choi),김건국(Keon Kuk Kim),이운기(Woon Ki Lee),이정남(Jung Nam Lee),강진모(Jin Mo Kang),백정흠(Jeong-Heum Baek),이원석(Won Suk Lee),서우형(Woo Hyung Seo) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.1
Purpose: Failure of hemodialysis access is the main medical problem in chronic renal failure patients. This resulted from complications such as thrombosis, infection, pseudoaneurysm, steal syndrome and so on. This study was undertaken in an attempt to describe the clinical characteristics and significances of dialysis failure due to iatrogenic fistula between prosthetic graft and native vein at puncture site. Methods: During 5 years between Feb. 2005 and Feb. 2009, five Iatrogenic fistulas were identified in a retrospective review of 133 patients performed 220 times fistulography due to dialysis failure in PTFE (polytetrafluoroethylene) graft. Results: Overall incidence is 3.8 % in PTFE graft cases. Mean age is 50 (28~75) years, male to female ratio 2:3. Median 1st patency period is 20 months (6~36). All iatrogenic fistula is usually located in not venous but arterial limb of forearm loop, combined with the stenosis in venous limb and anastomosis site. More than 70% venous anastmotic stenosis in 4 cases (80%) and diffuse stenosis of venous limb in 3 cases (60%), revised concomitantly either by patch angioplasty or ballooning. Medial follow-up period is 8 months (5~12), graft occlusion occurred in one case. Conclusion: All iatrogenic fistula usually occurs in not venous but arterial limb of forearm loop graft. Most iatrogenic fistula is combined with the stenosis in venous limb and anastomosis sites, must be revised concomitantly either by patch angioplasty or ballooning. Close assessment to superficial vein and graft is needed for early detection. Fistulography is the most useful diagnostic tool. Careful cannulation method is required to prevent the occurrence of iatrogenic fistula in chronic renal failure patients.
송슬기(Seul Ki Song),최상태(Sang Tae Choi),김건국(Keon Kuk Kim),이정남(Jung Nam Lee),오재환(Jae Hwan Oh),박연호(Yeon Ho Park),백정흠(Jeong Heum Baek),이운기(Woon Ki Lee),정민(Min Chung) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.73 No.1
Purpose: This study was undertaken to describe the clinicopathologic characteristics and evaluate the appropriate management of appendiceal tumors. Methods: During 5 years between Sep. 2000 and Sep. 2005, 28 appendiceal tumors were identified in a retrospective review of 3,744 cases of appendectomy or right hemicolectomy pathology. Results: Carcinoids were found incidentally as appendicitis. Mucinous cystadenomas were common in women older than 50 aged; half of the cases presented with appendicitis and the other half presented with non??specific abdominal symptoms such as palpable mass, intestinal obstruction and intussusception. Carcinomas were common in the older patients(mean age: 62.8 years) and this presented as periappendiceal abscess. Right hemicolectomy was undertaken when there was evidence of tumor spread beyond the resection margin, and carcinoma and tumors were located in the appendiceal base. Recurrence and metastasis were identified only in the carcinoma cases. Conclusion: Most appendiceal tumors presented with appendicitis and periappendiceal abscess. One stage curative resection was possible in more than 76% of the patients, and the prepoperative diagnosis rate was less than 35%. The preoperative diagnosis did not have much impact on the clinical course, and the postoperative pathology was important in determining the additional treatment. Close follow??up is needed for the early detection of recurrence, and all the carcinomas that were advanced as serosal involvement, peritoneal seeding and liver metastasis.
이남준(Nam-Joon Yi),권준혁(Choon Hyuck David Kwon),김건국(Keon Kuk Kim),김봉완(Bong-Wan Kim),유영경(Young Kyoung You),최진섭(Jin Sub Choi),하태용(Tae-Yong Ha),한영석(Young Seok Han),이광웅(Kwang-Woong Lee) 한국간담췌외과학회 2010 한국간담췌외과학회지 Vol.14 No.4
Purpose: Despite refinements in the surgical techniques for adult-to-adult living donor liver transplantation (ALDLT), biliary complications still remain the Achilles’ heel of ALDLT. Moreover, there is no consensus for the ideal technique of biliary reconstruction to reduce the rate of complications to an acceptable range. We strove to collate the available data of the current surgical techniques for biliary reconstruction in ALDLT in Korea. Methods: A questionnaire concerning the surgical techniques for biliary reconstruction was sent to 9 surgeons who performed biliary anastomosis in the major LDLT centers of Korea (the response rate was 100%). Results: MR cholangiography (n=7) and/or intra-operative cholangiography (n=5) were routinely performed to evaluate the donor biliary anatomy. All the participants (n=9) preferred duct-to-duct anastomosis to hepatico-jejunostomy. Anastomosis was usually made on the whole layer (n=7 epithelium, n=2) of recipient’s common hepatic duct under loupe magnification (n=8); only one center reconstructed the anastomosis on the 2nd order hepatic duct under view of a surgical microscope. There were various techniques for biliary reconstruction as follows: suture material (absorbable: n=5, non-absorbable: n=4), suture method (continuous: n=4, interrupted: n=3, mixed: n=3) and the use of a biliary stent (routine: n=3, sometimes: n=5, rare: n=1). Ductoplasty was performed on the back table (n=7) for the cases with a very close distance (<5 mm) between the bile ducts’ openings, but each duct was separately anastomosed to the recipients’ bile duct (n=8) or a roux-en-Y limb (n=1) was done in cases with a distance more than 10 mm. Conclusion: In 9 LDLT centers of Koreas, duct-to-duct was preferred; however, there was no unique consensus, among the major centers, for the biliary reconstruction techniques that might reduce complications.
박지연 ( Ji Yeon Park ),정민 ( Min Chung ),이영돈 ( Yeong Don Lee ),이정남 ( Jung Nam Lee ),이운기 ( Woon Ki Lee ),박연호 ( Yeon Ho Park ),백정흠 ( Jung Heum Baek ),박흥규 ( Heung Gyu Park ),김건국 ( Keon Kuk Kim ),강진모 ( Jin M 대한외상학회 2010 大韓外傷學會誌 Vol.23 No.2
Purpose: A classic approach to abdominal stab wounds has been a routine laparotomy for the purpose of diagnosis or treatment. However, management protocols for abdominal stab wounds are still contentious in most trauma centers. We examined the relationship between the character of the stab wound and the injured intraabdominal organs by retrospectively analyzing the medical records of patients with abdominal stab wounds admitted to Gil hospital, and the findings for our patients are then confronted with a review of the literature. We aimed to propose proper management protocols to approach abdominal stab wounds. Methods: The medical records of all 80 patients sustaining abdominal stab wounds, admitted at the Department of Surgery, Gil Hospital, Gachon Medical School, from January 2004 to December 2008 were retrospectively reviewed. All the abdominal stab wounds were collated based on the site and the character of the injury, investigations performed on admission, results of investigations, operations performed and findings at the time of the operation. Results: The most prevalent age group was patients in their forties and the average age of the patients was 41 years for both genders. The stab wounds were most commonly located at the periumbilical area (16.9%), followed by the epigastric area (15.6%), and 18.2% of the patients had multiple wounds. The most commonly eviscerated organ was the omentum (9 out of 16 cases); 61.7% of non-eviscerated patients underwent a therapeutic laparotomy while 81.3% of eviscerated patients underwent a therapeutic laparotomy. The small bowel was the most commonly injured organ (22.7%, 17 out of 75 injuries). The review revealed a relatively common diaphragmatic injury in abdominal stab wound patients (8 cases, 10.5%). The average hospital stay was 11 days. Conclusion: This review revealed commonly eviscerated and injured intraabdominal organs in abdominal stab wound patients and their relationship with a therapeutic laparotomy. Although the management is still controversial, the authors suggest indications for an immediate laparotomy and a protocol for managing abdominal stab wounds. Hemodynamic instability and peritoneal irritation signs are definite indicators for an immediate laparotomy, but the review revealed intraabdominal organ evisceration alone not to be a statistically significant factor. In addition, the authors suggest that abnormal CT findings can be valuable for making a decision on management of hemodynamically stable stab wound patients. Further study may clarify a role for a more selective approach to operative intervention and for a more extensive use of selective observation. (J Korean Soc Traumatol 2010;23:134-141)
성인 충수염 환자에서 수술까지의 시간 지연이 충수염 진행에 미치는 영향
이민아(Min A Lee),정민(Min Chung),이영돈(Young Don Lee),이정남(Jung Nam Lee),이운기(Woon Ki Lee),박연호(Yeon Ho Park),박흥규(Heung Gyu Park),김건국(Keon Kuk Kim),최상태(Sang Tae Choi),강진모(Jin Mo Kang),이원석(Won Suk Lee),김현영(Hyun 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.76 No.6
Purpose: There are many reports that delayed operation of appendicitis in children is safe, but it is controversial whether the same principle can be applicable in adult patients. The aim of this study was to evaluate the relationship between the interval from onset of symptoms to operation and the pathologic degree of appendicitis. Methods: In this retrospective study, 783 adult patients (16 years old or more) diagnosed with appendicitis pathologically between 2004 and 2007 were included. The time from onset of symptoms to hospital arrival (patient interval) and time from hospital arrival to operation (hospital interval) were investigated. Pathologic and gross state of the appendicitis was graded as G1 (suppurative), G2 (gangrenous), G3 (ruptured), G4 (periappendiceal abscess). Results: The median time from symptom onset to operation (total interval) was 35 hours. The percentage of G1, G2, G3, and G4 was 86.3%, 11.4%, 2.4%, and 0% when total interval was <24 hours, 61.3%, 21.3%, 15.8%, and 1.6% when between 24 and 72 hours, and 23.8%, 13.9%, 36.9%, and 25.4% when the interval was over 72 hours. The advanced grade of appendicitis correlated with increased hospital stay (P<0.0001). Conclusion: This study suggests that delayed appendectomy in acute appendicitis in adults is a risk factor for advanced grades, and that the sooner the operation is undertaken, the better the outcome is.