다발성 외상환자에서 혈관계 접근을 통해 치료한 쇄골하동맥 손상 2례

조자윤 ( Ja Yun Cho ),정희경 ( Hee Kyung Jung ),김형기 ( Hyung Kee Kim ),임경훈 ( Kyoung Hoon Lim ),박진영 ( Jin Young Park ),허승 ( Seung Huh ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.3

Introduction: Surgical treatment of subclavian artery (SA) injury is challenging because approaching the lesion directly and clamping the proximal artery is difficult. This can be overcome by using an endovascular technique. Case 1: A 37-year-old male was drawn into the concrete mixer truck. He had a right SA injury with multiple traumatic injuries: an open fracture of the right leg with posterior tibial artery (PTA) injury, a right hemothorax, and fractures of the clavicle, scapula, ribs, cervical spine and nasal bone. The injury severity score (ISS) was 27. Computed tomography (CT) showed a 30-mm-length thrombotic occlusion in the right SA, which was 15 mm distal to the vertebral artery (VA). A self-expandable stent(8 mm×40 mm in size) was deployed through the right femoral artery while preserving VA flow, and the radial pulse was palpable after deployment. Other operations were performed sequentially. He had a viable right arm during a 13-month follow-up period. Case 2: A 25-year-old male was admitted to our hospital due to a motorcycle accident. The ISS was 34 because of a hemothorax and open fractures of the mandible and the left hand. Intraoperative angiography was done through a right femoral artery puncture. Contrast extravasation of the SA was detected just outside the left rib cage. After balloon catheter had been inflated just proximal to the bleeding site, direct surgical exploration was performed through infraclavicular skin incision. The transected SA was identified, and an interposition graft was performed using a saphenous vein graft. Other operations were performed sequentially. He had a viable left arm during a 15-month follow-up period. Conclusion: The challenge of repairing an SA injury can be overcome by using an endovascular approach.

백금계 촉매상에서 이산화질소(NO₂)의 저감 특성에 관한 실험적 연구 실험적 연구

조자윤(Ja-Yun Cho),김영득(Young-Deuk Kim),김우승(Woo-Seung Kim) 한국자동차공학회 2010 한국자동차공학회 부문종합 학술대회 Vol.2010 No.5

The reduction characteristics of NO₂ to NO are studied experimentally over a platinum-based catalyst, especially at lower temperatures below about 200℃. In the exhaust gas after-treatment system for heavy-duty diesel engines, a diesel oxidation catalyst (DOC) is used as an integral component to effectively reduce engine raw emissions in combination with selective catalytic reduction (SCR) and diesel particulate filter (DPF). In detail, to improve the NOx conversion over a SCR catalyst, the DOC is usually placed upstream of the SCR catalyst to enhance the fast-SCR reaction using equimolar amounts of NO and NO₂. The DOC is also used in conjunction with a DPF, called a continuously regenerating trap (CRT), to oxidize NO for passive particulate combustion by NO₂. Thus, the characteristics of NO₂ conversion over DOC are essentially analyzed to accurately predict the performance of an aftertreatment system. In the present work, two types of steady-state experiments, engine bench and synthetic gas bench tests, are carried out in sequence. Steady-state engine bench tests with the DOC mounted on a light duty 4-cylinder 2.0 liter turbocharged diesel engine are performed and prove that CO plays a major role in NO₂ abatement at temperatures below the light-off temperature of CO oxidation, about 200 . Then, synthetic gas bench tests are performed using synthetic gas mixtures with CO, C₃H?, NO, NO₂, O₂, H₂O, and N₂ in the 140-450 T-range and show that both CO and C₃H? are capable of reducing NO₂. It is noted that the reaction rate of NO₂ with C₃H? is much higher than that with CO. At temperatures below about 200 , the reduction of NO₂ to NO is promoted with increasing CO concentration and NO₂/NOx ratio and with decreasing O₂ concentration, as well as with the presence of H₂O.

80세 이상 고령 환자에서의 복강경담낭절제술

조자윤(Ja Yun Cho),김종열(Jong Yeol Kim),장수근(Su Kurn Chang),김상걸(Sang Geol Kim),황윤진(Yoon Jin Hwang),윤영국(Young Kook Yun) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.76 No.4

Purpose: Biliary tract disease is one of the most common causes of acute abdominal pain in elderly patients, but there is still some debate over treatment. The aim of this study is to determine the safety and surgical outcomes of laparoscopic cholecystectomy (LC) for benign gallbladder disease in octogenarian patients. Methods: We selected 42 patients of 80 years or older who underwent LC or open-converted cholecystectomy(OC) from February 1992 to November 2006. We evaluated clinicopathological features, treatment modalities, and surgical outcomes retrospectively. Results: The patients included 17 males and 25 females. The mean age of the patients was 83.3 and 83.7, respectively. Right upper quadrant pain was the most common symptom, present in 85.7% of the patients. Gallstones were present in 85.7%. ASA class Ⅱ and Ⅲ comprised 92.9% of the patients. Comorbidities included hypertension, cardiac disease, pulmonary disease, and diabetes mellitus. Preoperatively biliary drainage was performed in 12 cases (endoscopic drainage in 8, percutaneous drainage in 4 cases). Preoperative cholecystostomy was performed in 5 cases. Emergency operations were more frequent than elective surgery (25 vs. 17). Mean hospital stay of LC patients was 5 days, whereas that of OC patients was 13 days. Open conversion rate was 16.7%. No surgical mortality was present and postoperative morbidity included acute myocardial infarction in one patient and wound infection in one patient. Conclusion: LC in octogenarian patients was safe. However, since the incidence of comorbidities is high in these patients, great care should be taken to evaluate and manage the comorbidities before surgery.

외상성 십이지장 손상의 치료 성적

유병혁 ( Byung Hyuk Yu ),조자윤 ( Ja Yun Cho ),임경훈 ( Kyoung Hoon Lim ),박진영 ( Jin Young Park ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.3

Purpose: The purpose of this study is to evaluate the surgical outcome of duodenal injuries and to analyze the risk factors related to the leakage after surgical treatment. Methods: A retrospective review of 31 patients with duodenal injuries who managed by surgical treatment was conducted from December 2000 to May 2014. The demographic characteristics, injury mechanism, site of duodenal injury, association of intraabdominal organ injuries, injury severity score (ISS), abdominal abbreviated injury scale (AIS), injury-operation time lag, surgical treatment methods, complications, and mortality were reviewed. Results: Duodenal injury was more common in male. Twenty four (77.4%) patients were injured by blunt trauma. The most common injury site was in the second portion of the duodenum (n=19, 58.6%). Fourteen patients (45.2%) had other associated intraabdominal organ injuries. The mean ISS is 13.6±9.6. The mean AIS is 8.9±6.5. Eighteen patients (58.1%) were treated by primary closure. The remaining 13 patients underwent various operations, including exploratory laparotomy (n=4), pancreaticoduodenectomy (n=3), pyloric exclusion (n=3), Resection with end-to-end anastomosis (n=2), and duodenojejunostomy (n=1). Most common postoperative complications were intraabdominal abscess (n=9) and renal failure (n=9). Mortality rate was 9.7%. Conclusion: ISS, AIS>10, operative time, pancreaticoduodenectomy, sepsis, and renal failure are significant predictors of a postoperative leak after duodenal injury. Careful management is needed to prevent a potential leak in patient with these findings. [ J Trauma Inj 2015; 28: 129-133 ]

백금산화촉매를 통한 이산화질소(NO₂)의 저감 특성에 관한 실험적 연구

김영득(Young-Deuk Kim),조자윤(Ja-Yun Cho),이정길(Jung-Gil Lee),김우승(Woo-Seung Kim) 한국자동차공학회 2012 한국 자동차공학회논문집 Vol.20 No.4

외상성 출혈성 쇼크 환자에서 발생한 비 폐쇄성 장간막 허혈

임경훈 ( Kyoung Hoon Lim ),정희경 ( Hee Kyung Jung ),조자윤 ( Ja Yun Cho ),이상철 ( Sang Cjeol Lee ),박진영 ( Jin Young Park ) 대한외상학회 2014 大韓外傷學會誌 Vol.27 No.4

Non-occlusive mesenteric ischemia (NOMI) encompasses all forms of mesenteric ischemia with patent mesenteric arteries. NOMI is commonly caused by decreased cardiac output resulting in hypoperfusion of peripheral mesenteric arteries. We report a case of NOMI secondary to hemorrhagic shock and rhabdomyolysis due to trauma. A 42-year-old man presented to our trauma center following a pedestrian trauma. On arrival, he was drowsy and in a state of hemorrhagic shock. He was found to have multiple fractures, both lung contusion and urethral rupture. An initial physical examination and abdominal computed tomography (CT) scan revealed no evidence of intra-abdominal injury. High doses of catecholamine were administered for initial 3 days due to unstable vital sign. On day 25 of hospitalization, follow- up abdominal CT scan demonstrated that short segment of small bowel loop was dilated and bowel wall was not enhanced. During exploratory laparotomy, necrosis of the terminal ileum with intact mesentery was detected and ileocecectomy was performed. His postoperative course was uneventful and is under rehabilitation. [ J Trauma Inj 2014; 27: 204-7 ]