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저자들은 식욕부진 및 복부동통을 주소로 내원한 51세 여자 환자에서 복부컴퓨터단층촬영에서 불균질한 조영증강을 보이며 광범위하게 전체 췌장에 전이된 파터 유두부종양 1예를 경험하였기에 문헌고차로가 함께 보고하는 바이다. Carcinoma of ampulla of Vater is a papillary neoplasm arising in the last centi meter of the common bile duct (CBD) where it passes through the wall of the duodenum and ampulla of Vater. We report the case of an ampulla of Vater cancer with the characteristic extensive invasion to the whole pancreas. A 53-year old female ws admitted to our hospital with chief complaint of epigastric pain, steatorrhea, and weight loss for 2 months. On physical examination, epigastric tenderness was detected. Gastroduodenoscopic biopsy from the mass revealed well differentiated adenocarcinoma. Abdominal CT demonstrated intraduodenal protruding mass with diffuse invasion to the whole pancreas. Arterial phase helical CT scan revealed intense heterogenous enhancement of entire pancreas. She underwent the Whipple procedure with total pancreatectomy. Final pathologic diagnosis was adenocarcinoma of ampulla of Vater with invasion of the whole with invasion of the whole pancreas and metastasis to the large number of regional lymph nodes.
Emergency endoscopy was performed in 117 cases with upper gastrointestinal tract bleeding from Jan. 1985 to Apr. 1988 at Korea Veterans Hospital. The results were as follows: 1) The sources of upper gastrointestinal bleeding in these 117cases were as follows; gastric ulcer in 35 cases (30.0% ), duodenal ulcer in 22 cases (18.8%), erosive gastritis in 18 cases (15.4%), esophageal varices in 17 cases (14.5%), Mallory-Weiss syndrome in 12 cases (10.3%), gastric cancer in 5 cases (4. 3%), Dieulafoy's disease in 2 cases (1.6%), marginal ulcer in 1 case (0.8%) and undetermined in 5 cases (4 3%). 2) Of the 28 cases with esophageal varices, 11 cases (39.3%) had bleeding from nonesophageal varices. The most frequent cause of the nonesophageal variceal bleeding was the erosive gastritis. 3) In gastric ulcer group, the incidence of massive bleeding on admission was lower (8.5%) than that of in duodenal ulcer (27.3%) and in erosive gastritis group (27.8%), but the rate of emergency operation due to persistent or recurrent bleeding was higher in gastric ulcer group (17.1%) than that of in duodenal ulcer (4.5%) and in erosive.gastritis group(0%). And all of the 2 cases of Dieulafoy's disease received emergency operation. 4) Of the 117 patients with upper gastrointestinal bleeding, 6 were expired (mortality rate:6.1%); 5 from ruptured esophageal varices, 1 from gastric ulcer bleeding. In concusion, emergency endoscopy should be done in patients with upper gastrointestinal bleeding to determine the correct diagnosis and adequate management of the bleeding lesions. Thereby the morbidity and mortality rates from upper gastrointestinal bleeding would be decreased by early and proper management.
15세 씨름선수에서 발생한 주두의 횡상 골절 1례에서 골이식 및 내고정 치료를 시행 후, 술 후 6주에 골유합 소견을 확인하고 능동적 근력강화 운동을 통하여 술 후 6개월에 기존 강도의 운동으로 복귀하였다. 18세 야구선수에서 발생한 주두의 사선상골절 1례에 대해서는 안정 및 근력강화운동을 통한 보존적 치료를 시행하였으며, 3개월 후 통증이 완화되어 투구 운동을 재개하였고, 6개월 후 기존 강도의 운동으로 복귀하였다. Operative treatment including a bone graft and an internal fixation was done in a fifteen-year old wrestler with transverse olecranon stress fracture. At 6 weeks after the operation, he could start active muscle strengthening exercise and returned to the previous level of exercise at 6 monthes after surgery. Conservative treatment including resting and muscle strengthening exercise was performed in an eighteen-year old baseball player with oblique olecranon stress fracture. At the follow-up of three months, he could start staged throwing exercise without pain or tenderness. He returned the previous level of throwing following strengthening exercise for 6 months.