수술후 조기 운동이 부종 감소에 미치는 영향에 대한 실험적 연구

김양우 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.2

Edema is an inevitable outcome in any kinds of operative procedure and such edema is an important factor in determining postoperative prognosis or complication. Presently, there are numerous efforts in trying to reduce these postoperative edema. Early postoperative exercise has been proposed to reduce edema, however is exact role or clinical significance has yet to be verified. Here, the author induced edema in the extremity of rabbit by severing all the tissue except bone & neurovascular bundle and repairing them. Such rabbits were divided into exercise group and joint immobilization group and consequently they were compared for their increases in circumference and volume due to edema. Also tissue samples were obtained on postoperative day 7 and observed for their histological difference under microscope. Results were as follows. 1) From postoperative day 1 to 3 there was no significant difference of edema in two groups, however joint immobilizaton group showed slightly lesser edema. 2) In exercise group edema continuously increased until a peak was reached on postoperative day 3 which from this point on edema decreased slowly, however in immobilization group the peak was reached on postoperative day 5 and from then on it failed to decrease and continued up to postoperative day 7. 3) From postoperative day 4 immobilization group showed significant edema as compared to exercise group and with the passing time this significance continued to increase. 4) In the histological examination on postoperative day 7, more inflammatory cells were infiltrated and more degenerative findings were observed in joint immobilization group than exercise group. In conclusion, early postoperative exercise decreases edema beginning from postoperative day 4, but without exercise edema increases up to postoperative day 5 and continues to maintain edema until postoperative day 7.

Captopril의 특발성 부종 조절 효과에 대한 연구

김철환,서홍관,양윤준 인제대학교 1994 仁濟醫學 Vol.15 No.4

연구배경;가정의학과 외래 진료에서 흔하게 접하게 되는 부종 환자의 가장 흔한 원인은 특발성 부종(idiopathic edema)이다. 이뇨제가 아니고 엔지오텐신 전환효소 억제약물(Angiotensin converting enzyme inhibitor, ACE inhibitor)인 Captopril의 부종 조절 효과를 알아보기 위하여 연구를 시행하였다. 방법;1992년 11월 부터 1993년 8월까지 부종을 주소로 서울백병원 가정의학과 외래를 방문한 환자 77명을 대상으로 혈압 및 신체계측, 이학적 검사, 전혈검사(CBC), 혈중 BUN/Cr, Na/K, GOT/GPT, Albumin, HBsAg, TSH 등을 측정하고 뇨단백을 비롯한 요검사와 요현미경검경, 흉부엑스선검사를 실시하였다. 이러한 검사에서 부종을 일으킬만한 특별한 원인이 없고, 또한 하루 2회 체중을 측정하여 0.5 Kg 이상의 체중변화가 있다는 것이 확인된 21명 중 연구에 동의하고 끝까지 참여한 19명의 특발성 부종 환자를 연구대상으로 하였다. 이들을 진찰권 번호에 따라 무작위로 2개 그룹으로 나누어 한 그룹에는 Captopril 25mg을 아침 식전 투여하도록 하였고, 다른 한 그룹에는 Captopril의 모양과 색이 같은 위약(placebo)을 투여하였다. 부종조절효과는 하루 2회 2주간 체중을 측정하여 아침과 저녁 체중 차이가 줄어드는 정도를 지표로 판정하였다. 결과;특발성 부종으로 확진된 환자에서 Captopril과 위약(placebo) 모두 체중변화를 줄이는 경향은 있었으나 통계적으로 유의하지는 않았다. 결론;특발성 부종 환자를 대상으로 하루 25mg Captopril과 위약 투여 후 부종조절효과를 판정한 결과한 통계적으로 유의한 효과는 없었다. Background:Primary care physicians frequently meet the patients who complain of edema. We carried out this study to evaluate the captopril's effect on edema control. Methods:There were 77 patients who had suffered from various types of edema among the patients who had visited the Family Medicine Clinic Of Seoul Paik Hospital from November 1992 to August 1993. We took their medical history, perfomed physical examination, and requested chest X-ray and laboratory tests such as CBC, serum BUN /Cr, Na/K, GOT/GPT, Albumin, HBsAg, TSH, Urinalysis with microscopic examination. Thereafter we could select idiopathic edema. And we prescibed captopril(25mg once a day at morning) for case group, and placebo for control group. We evaluated the captopril's effect on edema through comparing the diurnal change of body weight between case group and control group by paired t -test. Results:Among 77 patients, women were 67 persons(87.0%). There were 13 patients(16.9%) who had organic problems such as chronic renal failure, liver disease, hypothyroidism, and so on. There were 20 healthy people(31.3%) complaining of edema whose range of diurnal body weight change was over 0.5 kg, 9 healthy ones (14.0%) complaining of edema whose range of diurnal body weight change was below 0.5 kg, and 35(54.7%) healthy people complaining of edema whose body weight was not checked. We evaluated the captopril's effect on edema through comparing the diurnal change of body weight between case group and control group but there was no statistically significant difference between case group and placebo group. Conclusions:There were 16.9% organic causes among the patients who had complained of edema. We prescribed captopril to control of enema in case of idiopathic edema, but it was not effective.

수막종에서 뇌부종 발생 정도와 관련된 임상 및 생물학적 인자에 대한 분석

남도현,이상구,황수현,신형진,이정일,김종수,홍승철,박관,어환 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.4

Original Article : Transient Corneal Edema is a Predictive Factor for Pseudophakic Cystoid Macular Edema after Uncomplicated Cataract Surgery

( Jae Rock Do ),( Jong Hyun Oh ),( Roy S Chuck ),( Choul Yong Park ) 대한안과학회 2015 Korean Journal of Ophthalmology Vol.29 No.1

Purpose: To report transient corneal edema after phacoemulsification as a predictive factor for the development of pseudophakic cystoid macular edema (PCME). Methods: A total of 150 eyes from 150 patients (59 men and 91 women; mean age, 68.0 ± 10.15 years) were analyzed using spectral domain optical coherence tomography 1 week and 5 weeks after routine phacoemulsification cataract surgery. Transient corneal edema detected 1 week after surgery was analyzed to reveal any significant relationship with the development of PCME 5 weeks after surgery. Results: Transient corneal edema developed in 17 (11.3%) of 150 eyes 1 week after surgery. A history of diabetes mellitus was significantly associated with development of transient corneal edema (odds ratio [OR], 4.04; 95% confidence interval [CI], 1.41 to 11.54; p = 0.011). Both diabetes mellitus and transient corneal edema were significantly associated with PCME development 5 weeks after surgery (OR, 4.58; 95% CI, 1.56 to 13.43; p = 0.007; and OR, 6.71; CI, 2.05 to 21.95; p = 0.003, respectively). In the 8 eyes with both diabetes mellitus and transient corneal edema, 4 (50%) developed PCME 5 weeks after surgery. Conclusions: Transient corneal edema detected 1 week after routine cataract surgery is a predictive factor for development of PCME. Close postoperative observation and intervention is recommended in patients with transient corneal edema.

말기 암 환자에서의 하지 부종

심병용,홍석인,박지찬,홍숙희,최강현,조홍주,김선영,한선애,이옥경,김훈교,Shim, Byoung-Yong,Hong, Seok-In,Park, Ji-Chan,Hong, Sug-Hui,Choi, Gang-Heun,Cho, Hong-Joo,Kim, Seon-Young,Han, Sun-Ae,Lee, Ok-Kyung,Kim, Hoon-Kyo 한국호스피스완화의료학회 2005 한국호스피스.완화의료학회지 Vol.8 No.2

Purpose: The lower extremity edema (LEE) is a common distressful symptom in advanced cancer patients and is hard to manage. We analyze the characteristics of LEE in patients with advanced cancer to provide the basic information of causes and adequate management. Methods: Physical examination, assessment of the location and severity of edema, blood chemistry (albumin, creatinine), Doppler Sono for patients with suspecting deep vein thrombosis (DVT), and abdomen CT scan for patient with suspecting lymph edema were performed. Severity of edema was classified according to NCI lymph edema scaling and improvement was defined as lowering at least 1 grade of edema after management. Results: Among 154 patient who had been admitted to Hospice Ward from Mar 2003 to Jan 2004, 33 had LEE, and 6 had both upper extremity edema and LEE except generalized edema. Their underlying cancers were stomach (7), lung (6), biliary tract (5), liver (5), colorectal (5), pancreas (2), and others (9). There were 12 patient with grade I, 20 patients with grade II, and 7 patients with grade III edema. The causes were hypoalbuminemia (11), lymph edema (10), DVT (7), obstruction of inferior vena cava (IVC) or portal vein (6), and dependent edema (5). The common managements were including leg elevation and diuretics. Elastic stocking was applied for patients with DVT and leg massage and pneumatic compression was used for lymph edema. The 2/3 patients were improved after management. Conclusion: The incidence of LEE in terminal cancer pts was high (25.3%) and their causes were variable including lymph edema, DVT, hypoalbuminemia and dependent edema. Active noninvasive management according to causes could result in good palliation. 목적: 하지 부종은 진행된 말기 암 환자에서 흔하게 발생하는 증상이며 치료하기 어렵다고 생각되고 있다. 우리는 말기 암 환자에서 하지 부종의 특성을 분석하고 원인과 치료에 관한 기본 정보를 얻기 위해 연구를 하였다. 방법: 하지 부종이 있는 환자에서 이학적 검사를 시행하고 부종의 범위, 정도, 혈액 검사(creatinine, albumin)을 시행하였다. 심부정맥 혈전증이 의심되는 환자는 Doppler 초음파를 시행하고 림프부종이 의심되는 환자는 복부 컴퓨터 단층 촬영을 시행하였다. 부종 정도는 NCI의 림프부종 평가를 이용하여 시행하였으며 증상의 호전은 부종의 정도가 1 이상 감소한 경우 호전이라 하였다. 결과: 2003년 3월부터 2004년 1월까지 총 154명의 호스피스 입원 환자 중 하지부종 환자는 39명이었으며 이 중 6명은 상지부종과 하지부종이 모두 있었다. 이 들의 원인 질환은 위암(7명), 폐암(6명), 간담도암(5명), 간암(5명), 대장암(5명), 췌장암(2명), 기타(9명)이었다. 원인으로써는 저알부민혈증(11명), 림프부종(10명), 심부정맥혈전증(7명), 하대정맥 또는 문정맥 폐쇄(6명), 의존성 부종(5명)이었다. 치료로는 하지 거상과 이뇨제를 사용하였으며 심부정맥 혈전증이 있는 경우는 탄력 스타킹을, 림프부종이 있는 경우에는 맛사지와 공기 압축을 이용한 재활 치료를 하였다. 전체 2/3환자에서 증상 호전이 관찰되었다. 결론: 말기 암 환자에서 하지 부종의 빈도는 25.3%로 높으며 원인 질환으로는 저알부민 혈증, 림프부종, 심부정맥혈전증, 의존성 부종 등 다양하다. 적극적인 비침습적 치료로 충분한 증상호전을 가져 올 수 있다.

수종의 병인병기 및 침구치료에 대한 문헌적 고찰

오창록,나건호,최봉균,윤정선,류충열,조명래 대한침구의학회 2005 대한침구의학회지 Vol.22 No.3

Objective : The purpose of this study is to establish a category for acupuncture therapy by appropriate etiological analysis and differenciation of edema. Methods : We arrange Huang Di Nei Jing and thirty four kinds of literature about edema. Results : 1. The cause of Edema is functional disorder of lung, spleen, kidney, bladder and tri-energizer by six kinds of natural factors, internal injury and loss of nutritions. 2. Edema compartmentalize into the water of five zang organs, several kinds of edema(e,g. 5, 10, 12, 24) and yang & yin edema. 3. An ultimate cause of edema pathogenesis is the disturbance of Qi function in kidney. 4. In view of the results so far achived, ‘GV26(水溝)’ is a vitally important acupoint in acupuncture treatment of edema. ‘GV26(水溝)’ and ‘CV9(水分)’ are very useful acupoints in moxibustion. 5. In the acupuncture and moxibustion treatment of yang edema, we can use acupoints as like ‘GV26(水溝)’,‘S36(足三里)’,‘B20(脾兪)’ and ‘SP9(陰陵泉)’ by purgation and reduction for expelling wind, reducing fever and eliminating dampness. In an instance of yin edema, we can use acupoints as like ‘CV9(水分)’,‘S36(足三里)’,‘CV6(氣海)’,‘B20(脾兪)’,‘B23(腎兪)’ and ‘K3(太谿)’ by reinforcement for tonifying spleen yang-middle energizer-, qi-transmission and water promoting.

노인 환자에서 하지부종의 원인 및 기저질환 분석

한승규,기연경,문성우,윤창연,이은영,주영수,한인미,이은영,김창오 대한노인병학회 2014 Annals of geriatric medicine and research Vol.18 No.2

연구배경: 하지부종은 여러 가지 다양한 기저질환을 가지고 있는 노인 환자들에게 나타나는 흔한 증상이다. 본 연구는노인 환자에서 하지부종의 원인 및 기저질환에 따른 차이를알아보기 위해 시행되었다. 방법: 2010년 1월부터 2012년 12월까지 서울의 3차 병원응급의료센터에 하지부종을 주소로 내원한 65세 이상의 환자247명의 의무기록을 후향적으로 분석하였다. 환자의 나이, 성별, 주증상, 퇴원 시의 진단명 등을 조사하였다. 결과: 임상 조사항목이 불충분한 21명을 제외한 226명의환자를 대상으로 하였다. 노인 환자에서 하지부종의 원인으로가장 많은 단일 질환은 신부전이었으며(42명, 18.6%), 다음으로는 심부전(37명, 16.4%)과 심부정맥혈전증(32명, 14.2%)의순이었다. 그러나 66명(29.2%)의 환자에서는 원인을 찾지 못하였다. 신부전과 심부전이 원인인 경우 기저질환으로 각각신장질환(40명, 95.2%)과 심혈관계질환(29명, 78.4%)을 동반한 경우가 많았으며, 그 외 당뇨와 외상을 동반한 경우도 적지않았다. 심부정맥혈전증의 경우 기저질환으로 고형암(13명, 40.6%)을 동반한 경우가 가장 많았으며, 외상과 1년 이내의수술 병력 및 당뇨도 높은 빈도를 보였다. 전체적으로는 만성양측성 하지부종(120명, 53.1%)이 가장 많았다. 심부정맥혈전증과 봉와직염 및 림프부종의 경우 일측성으로 발생한 경우가 많았으며, 신부전이나 심부전, 간경화와 같은 전신질환이원인인 경우에는 주로 양측성으로 하지부종이 발생하였다. 결론: 노인 환자에서 하지부종은 기저질환과 밀접한 관련이 있는 신부전과 심부전 등의 전신적 질환에 의해 발생하는경우가 많았다. 따라서 노인 환자에서는 다양한 기저질환을고려한 부종의 원인에 대한 접근 및 이에 따른 치료가 중요할것이다. Background: Leg edema is a common symptom among elderly patients with multiple underlying diseases. This study was aimed to investigate the etiologies and underlying diseases of leg edema in elderly patients. Methods: We retrospectively reviewed medical records of 247 patients aged over 65, who visited an Emergency Department of a tertiary hospital due to leg edema from January 2010 to December 2012. Results: A total of 226 patients with complete medical records were included. The most common cause of leg edema in elderly patients was renal failure (42 cases, 18.6%), followed by heart failure (37 cases, 16.4%), and deep vein thrombosis(32 cases, 14.2%). However, the etiologies were not established in 66 cases (29.2%). Patients with leg edema caused by renal and heart failure had renal (40 cases, 95.2%) and cardiovascular diseases (29 cases, 78.4%), respectively, while others had diabetes mellitus and trauma. Patients with leg edema caused by deep vein thrombosis had underlying conditions such as cancer (13 cases, 40.6%), trauma, surgery within 1 year, and diabetes mellitus. Overall, chronic bilateral edema (120 cases, 53.1%) was most commonly observed form of leg edema in elderly patients. Deep vein thrombosis, cellulitis, and lymphedema usually caused unilateral edema, whereas systemic diseases such as renal failure, heart failure, and liver cirrhosis caused bilateral edema. Conclusion: Leg edema in elderly patients is usually caused by systemic diseases such as renal and heart failure closely related to underlying diseases. Therefore, it is important to consider the variety of underlying diseases, when approaching the cause and treatment of leg edema in elderly patients.

Assessment for Macular Thickness after Uncomplicated Phacoemulsification Using Optical Coherence Tomography

Byung-Jin Kim,Ye Jin Ahn,Hye-Young Oh,Soon Il Choi,Young-Sik Yoo,Woong-Joo Whang,Yong-Soo Byun,Mee-Yon Lee,Choun-Ki Joo 대한안과학회 2022 Korean Journal of Ophthalmology Vol.36 No.4

Purpose: Macular edema including cystoid macular edema is one of the main causes of unfavorable visual outcomes after cataract surgery. The macular thickness and the occurrence of macular edema after uncomplicated cataract surgery was evaluated using optical coherence tomography (OCT) in this study. Methods: Macular map images were taken by OCT before surgery and at 1 week, 1 month, and 2 months postsurgery. The subjects were classified into two groups (group 1, patients with no macular edema; group 2, patients with macular edema). Group 2 was defined as increase in central macular thickness (CMT) by 30% compared with that before surgery. The risk factors for macular edema were evaluated. Group 2 was divided into two subgroups: subclinical macular edema (group 2A) and cystoid macular edema (group 2B) and they were assessed in terms of the clinical course of best-corrected visual acuity and CMT. Results: A total of 376 patients were enrolled in this study, of which 36 (9.57%, group 2) showed macular edema measured by OCT after the surgery. Univariate analysis for group 1 and 2 revealed that intracameral injection of epinephrine during phacoemulsification was associated with the development of macular edema. In group 2, five patients (1.33%) developed cystoid macular edema. Statistically significant differences in the clinical course of CMT were observed at 2 months (201.2 ± 23.1, 250.0 ± 29.8, and 371.0 ± 160.3 in group 1, group 2A, and group 2B, respectively; p < 0.001) and 1 month postoperatively (198.5 ± 23.6, 237.8 ± 40.9, and 314.0 ± 104.5 in group 1, group 2A, and group 2B, respectively; p < 0.001). Group 2B required additional treatment and eventually achieved best-corrected visual acuity of >0.2 with CMT in the normal range. Conclusions: The intracameral injection of epinephrine may cause macular edema after uncomplicated cataract surgery. Examination of CMT using OCT is recommended for the early detection of macular edema.

Prognostic Implication of Focal Breast Edema on Preoperative Breast Magnetic Resonance Imaging in Breast Cancer Patients

Pamela Sung,이종윤,천종호,최인실,박진현,박정환,김병혁,오소희,추아정,황기태 한국유방암학회 2023 Journal of breast cancer Vol.26 No.5

Purpose: In this study, we investigated the prognostic implications of focal breast edema on preoperative breast magnetic resonance imaging (MRI) in patients with breast cancer. Methods: Data of 899 patients with breast cancer at a single institution were retrospectively analyzed. The patients were divided into an edema-positive group (EPG) and an edema-negative group (ENG) based on the presence of peritumoral, prepectoral, or subcutaneous edema. Two radiologists evaluated the presence or absence of focal edema and its subtypes on preoperative breast MRI. Clinicopathologic characteristics and survival outcomes were compared between the two groups and among the three subtypes using Pearson’s χ2 test, Kaplan–Meier estimator, and Cox proportional hazards model. Results: There were 399 (44.4%) and 500 (55.6%) patients in the EPG and ENG, respectively. The EPG showed significantly higher rates of axillary lymph node metastasis (55.6% vs. 19.2%, p < 0.001) and lymphovascular invasion (LVI) (57.9% vs. 12.6%, p < 0.001) than the ENG. Patients in the EPG showed significantly worse overall survival (OS) rate (log-rank p < 0.001; hazard ratio [HR], 4.83; 95% confidence interval [CI], 2.56–9.11) and recurrence-free survival rate (log-rank p < 0.001; HR, 3.00; 95% CI, 1.94–4.63) than those in the ENG. After adjusting for other variables, focal breast edema remained a significant factor affecting the OS rate, regardless of the edema type. Specifically, the presence of subcutaneous edema emerged as the strongest predictor for OS with the highest HR (p < 0.001; HR, 9.10; 95% CI, 3.05–27.15). Conclusion: Focal breast edema on preoperative breast MRI implies a higher possibility of LVI and axillary lymph node metastasis, which can lead to a poor prognosis. A detailed description of focal breast edema, especially subcutaneous edema, on preoperative breast MRI may provide prognostic predictions. More intensive surveillance is required for patients with breast cancer and focal preoperative breast edema.

광간섭단층촬영으로 분류된 미만성 당뇨황반부종의 위험인자

김도형,김상훈,김현웅,윤일한,Do Hyung Kim,M,D,Sang Hoon Kim,M,D,Hyun Woong Kim,M,D,Ill Han Yoon M,D 대한안과학회 2006 대한안과학회지 Vol.47 No.4

Purpose: Recently diffuse diabetic macular edema has been morphologically classified by optical coherence tomography. This study was conducted to examine the difference of risk factors of the classified types of diffuse macular edema. Methods: The subjects included 93 people who were diagnosed with non-insulin dependent diabetes. We diagnosed the presence of diabetic macular edema with slit lamp fundus examination and used OCT for the classification of diffuse macular edema. We examined the differences in epidemiological risk factors in non-diabetic macular edema patients after diabetic macular edema patients were examined with fluorescein angiography to confirm diffuse macular edema. Results: Diabetic macular edema was classified into 4 types using OCT. Compared with patients without macular edema, sponge-like macular edema - related epidemiological risk factors included diabetic nephropathy, cystoid macular edema was related to HbA1c, serous macular detachment was related to treatment of diabetes by insulin, and posterior hyaloid raction was related to diastolic blood hypertension. Conclusions: In the present study, differences in epidemiological risk factors were related to the occurrence of a type of diffuse macular edema.