수직 불안정 골반환 손상에서 S1, S2 나사못을이용한 후방 고정술의 수술 결과

여광희,문남훈,안재민,정재윤,장재훈 대한골절학회 2018 대한골절학회지 Vol.31 No.1

Purpose: Iliosacral screw fixation is an effective and less invasive method that is used widely for the definitive treatment of unstable pelvic ring injuries. On the other hand, fixation failures after iliosacral screw fixation have been reported in vertically unstable pelvic ring injuries. This study examined the surgical outcomes of posterior pelvic fixation using S1 and S2 screws in vertically unstable pelvic ring injuries. Materials and Methods: Between January 2011 and April 2016, 17 patients with vertically unstable pelvic ring injuries who met the minimum 1 year follow-up criteria were treated with internal fixation using posterior pelvic S1 and S2 screws. Their mean age was 43.9 years. According to the AO/OTA classification, 10 patients had C1, 6 had C2, and 1 had C3 injuries. Surgical treatments of single or multiple steps, where necessary, were performed by two surgeons. The clinical and radiologic outcomes were assessed retrospectively using radiographs and medical records. Results: Overall, 16 patients had bone healing without screw loosening; however, one patient could not maintain anterior pelvic fixation because of an open fracture and deep infection in the anterior pelvic ring. Of five patients who complained of neurological symptoms after injury, three had partially recovered from their neurological deficit. At the last follow-up, the clinical outcomes according to the Majeed score were excellent in 5, good in 6, fair in 4, and poor in 2 patients. The postoperative radiologic outcomes by Matta and Tornetta’s method were excellent in 5, good in 8, and fair in 4 patients. Malposition of the S2 screw was identified in one case. The mean time to union was 14.6 weeks after surgery. Conclusion: S1 and S2 screw fixation can be an effective treatment option for posterior pelvic stabilization in vertically unstable pelvic ring injuries when considering the surgical outcomes, such as screw loosening and loss of reduction.

A Distribution Weighted Prognostic Scoring Model for Node Status in Advanced Rectal Cancer

여광희,김호현,김동이,김영진,주재균 대한암학회 2014 Cancer Research and Treatment Vol.46 No.1

PurposeThere are various lymph node-based staging systems. Nevertheless, there is debateover the use of parameters such as the number of involved lymph nodes and thelymph node ratio. As a possible option, the distribution of metastatic lymph nodesmay have a prognostic significance in rectal cancer. This study is designed to evaluatethe impact of distribution-weighted nodal staging on oncologic outcome in rectalcancer. Materials and MethodsFrom a prospectively maintained colorectal cancer database of our institution, a totalof 435 patients who underwent a curative low anterior resection for mid and upperrectal cancer between 1995 and 2004 were enrolled. Patients were divided into 3groups according to the location of apical metastatic nodes. A location-weighted prognosticscore was calculated by a scoring model using a logistic regression test forlocation based-statistical weight to number of lymph nodes. All cases were categorizedin quartiles from lymph node I to lymph node IV using this protocol. ResultsThe location of lymph node metastasis was an independent factor that wasassociated with a poor prognostic outcome (p<0.001). Based on this result, thelocation-weighted-nodal prognostic scoring model did not show lesser significantresults (p<0.0001) in both overall survival and cancer-free survival analyses. ConclusionThe location of apical nodes among the metastatic nodes does not have a lessersignificant impact on oncologic result in patients with advanced rectal cancer. Alocation-weighted prognostic scoring model, which considered the numbers ofinvolved lymph nodes as the rate of significance according to the location, may moreprecisely predict the survival outcome in patients with lymph node metastasis.

경운기 사고에 의해 발생한 복부 및 회음부 장기 손상

여광희 ( Kwang Hee Yeo ),박찬용 ( Chan Yong Park ),김호현 ( Ho Hyun Kim ),박순창 ( Soon Chang Park ),염석란 ( Seok Ran Yeom ) 대한외상학회 2015 대한외상학회지 Vol.28 No.2

Purpose: Cultivator accidents are frequent and often lead to abdomino-perineal organ injury and, if severe, to death. This study presents the clinical characteristics, outcomes, and factors associated with mortality in patients who sustained an abdomino-perineal organ injury in cultivator accidents. Methods: We retrospectively analyzed the records of 53 patients who visited the emergency department of a tertiary hospital with abdomino-perineal organ injuries caused in cultivator accidents from April 2005 to March 2010. Results: All 53 patients had visited other medical institutions before visiting our hospital. Their mean age was 64.0± 11.1 (range, 20-80) years and 32 (60.4%) patients were 65 or older. The male-to-female ratio was 46:7. The chief complaint was abdominal pain (38 cases, 71.7%). The 53 patients included 41 cultivator operators (77.4%), 11 passengers (20.8%), and 1 passerby (1.9%). The causes of the injuries included a direct impact of the handlebar in 20 cases (37.7%), a rollover in 21 cases (39.6%), a fall in 10 cases (18.9%), and a wheel in two cases (3.8%). Several of the 53 patients had injuries to multiple abdomino-perineal organs, and the injured organs included the liver (23 cases, 26.4%), spleen (16 cases, 18.4%), pancreas (7 cases, 8.0%), small bowel (7 cases, 8.0%), mesentery (6 cases, 6.9%), adrenal gland (5 cases, 5.8%), and other organs. According to the abbreviated injury scale (AIS) dictionary, a thoracic injury was the most frequent co-injury (33 of 53 cases, 62.3%). Abdomino-perineal surgery was performed in 31 cases (58.8%) and angio-embolization was performed for six liver and two kidney injuries. Thirteen patients died (24.5%); all were males. The Injury Severity Scale (ISS) was lower in the survivors (17.8±8.5 vs. 27.0±16.0; p=0.010). Conclusion: With the aging of agricultural workers, safety education programs should be implemented. Furthermore, the patient transfer system in agricultural areas must be improved. [ J Trauma Inj 2015; 28: 60-66 ]

외상성 후종격동 혈종의 내시경적 치료 -증례보고-

김선희; 최선우; 박성진; 여광희; 박찬익; 이상봉; 김호현; 박찬용; 김재훈; 황정주; 조현민 부산대학교 병원 암연구소 2007 부산대병원학술지 Vol.- No.37

Successful Endovascular Management of Post-Traumatic Phlegmasia Cerulea Dolens from Rupture of the External Iliac Vein

박찬용,조현민,여광희,석준필,이찬규 대한외상중환자외과학회 2017 Journal of Acute Care Surgery Vol.7 No.2

We report a rare case of a 47-year-old male with posttraumatic phlegmasia cerulea dolens caused by a ruptured right external iliac vein and treated with an endovascular venous stent graft. The patient was the victim of motor vehicle accident, and suffered direct injuries to the head and abdomen. The patient had a cyanotic and swollen right lower leg. Abdominal and lower extremity computed tomography angiography revealed a large retroperitoneal hematoma caused by a ruptured right external iliac vein, and grade I liver injury. The right external iliac vein rupture was successfully treated with a venous stent graft, followed by inferior vena cava filtering, because a venous thrombus was identified below the stent graft. He initially was hemodynamically unstable but recovered following treatment. The patient was comatose when presenting at the emergency department. He was discharged, fully recovered, on hospital day 18. (J Acute Care Surg 2017;7:87-89)

Delayed Pneumatosis Intestinalis Induced by Blunt Trauma in a Strangulated Small Intestine

노동섭,조현민,이찬규,김선희,여광희 대한외상중환자외과학회 2017 Journal of Acute Care Surgery Vol.7 No.2

An ischemia-reperfusion injury of the intestine due to blunt trauma is very rare. Low blood flow can result in an incarceration and an ischemia-reperfusion injury of the small intestine. A 63-year-old woman fell, producing a splenic rupture. Despite the successful angio-embolization of the splenic rupture, the patient continued to suffer from hypotension. During laparotomy to identify the bowel injury, no intestinal perforation was found. However, we found a hemorrhagic infarction of the small intestine with congestion of the submucosal blood vessels. The part of bowel with the hemorrhagic infarction was resected and reconstructed with a jejuno-colic anastomosis. After surgery, she recovered from the trauma and was discharged without complications. We present this ischemia-reperfusion injury of the intestine due to blunt trauma. Meticulous examination and computed tomography scan is mandatory for diagnosis and assessment of treatment outcome. (J Acute Care Surg 2017;7:83-86)

CT Findings of Perforation of the Stomach after Ingestion of Glacial Acetic Acid

김호현,염석란,조현민,여광희,김재훈 대한임상독성학회 2018 대한임상독성학회지 Vol.16 No.2

The ingestion of corrosive substances often leads to severe morbidity and mortality. Acids produce coagulation necrosis with a lesser degree of penetration, whereas alkalis produce liquefactive necrosis with penetration. Acetic acid is a clear, colorless organic acid with a pungent, vinegar-like odor. The ingestion of highly concentrated acetic acid (glacial acetic acid) may cause a range of complications. On the other hand, perforation of the stomach is extremely rare but it has a high mortality rate. This paper reports a case of perforation of the stomach after the ingestion of glacial acetic acid with suicidal intent in an otherwise healthy 76-year-old woman.

Percutaneous Transhepatic Embolization for Isolated Pancreaticoduodenal Vein Rupture in Blunt Abdominal Trauma: A Case Report

권훈,김창원,전창호,여광희,노동섭,이찬규 대한영상의학회 2017 대한영상의학회지 Vol.77 No.5

In blunt abdominal trauma, the prevalence of superior mesenteric vein injury or portal vein injury is low and surgical treatment is often difficult. We report a case of percutaneous transhepatic embolization in a patient who experienced isolated rupture of the pancreaticoduodenal vein (PDV). The patient sustained abdominal trauma in a motorcycle accident. A pseudoaneurysm was suspected in the anterior pancreatic head based on the portal venous phase of computed tomography. However, the lesion was not observed on celiac arteriography and superior mesenteric arteriography. PDV rupture was detected by additional percutaneous transhepatic superior mesenteric venography, and embolization was performed by trapping the PDV. This procedure is a safe, minimally invasive method that can be performed in patients with injuries of the portal venous system accompanying abdominal trauma; this procedure effectively reduces the need for invasive surgery.

환자의 보험급종에 따른 일개 권역응급의료센터의 내원양상

주성용,조석주,이성화,김형회,여광희,황성연,김형빈,조영모 대한응급의학회 2016 대한응급의학회지 Vol.27 No.4

Purpose: In Korea, emergency department overcrowding in large hospitals have caused social concern. Moreover, patients with low socioeconomic status visit the emergency department more frequently. This kind of visitation also causes a burden on the national budget, but emergent patient should be treated in emergency department regardless of economic state. So, on establishment of policy about the patient with low socioeconomic status, the frequency of emergency visitation alone is difficult to obtain a sufficient basis for policy-making. Methods: We retrospectively analyzed adult patients with a disease who visited the Pusan Wide-regional Emergency Center in 2015. Korean Triage and Acuity Scale level I, II or III were defined as emergency, and level IV or V was defined as non-emergency. The ratio of emergency and non-emergency was compared in the National Health Insurance and Medicaid database. Results: The number of patients with National Health Insurance was 16,208 (90.3%) and with Medicaid was 1,737 (9.7%). Among those with National Health Insurance, there were 12,720 (78.5%) emergency cases and 3,488 (21.5%) non-emergency cases. Among those with Medicaid, 1,379 (79.4%) emergency cases and 358 (20.6%) non-emergency cases. Between National Health Insurance and Medicaid, there was no statistically significant difference in the ratio of emergency and non-emergency (p=0.380) Conclusion: Accessibility of emergency and non-emergency patients with National Health Insurance and Medicaid to Pusan Wide-regional Emergency Center was not different.

척수 손상을 일으킨 경부 가위 관통상

김선희 ( Seon Hee Kim ),최선우 ( Sun Woo Choi ),박성진 ( Sung Jin Park ),여광희 ( Kwang Hee Yeo ),김창완 ( Chang Wan Kim ),이상봉 ( Sang Bong Lee ),김호현 ( Ho Hyun Kim ),박찬용 ( Chan Yong Park ),김재훈 ( Jae Hun Kim ),황정주 ( J 대한외상학회 2015 대한외상학회지 Vol.28 No.2

Penetrating neck trauma involving spinal cord injury is relatively uncommon, but can be life-threatening. We report a case of 59-year-old female who presented with hypotension after stab injury self-inflicted with a scissor to her neck. Although Open removal of the scissor and control of bleeding were successfully done, penetration of spinal cord resulted in a neurologic impairment. [ J Trauma Inj 2015; 28: 71-74 ]