• Title/Summary/Keyword: 치료 부위

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Clinical Characteristics of Patients with Traumatic Diaphragm Injury and Comparison of Scoring Systems as Predictors (외상성 횡격막 손상환자의 임상적 고찰과 예후 예측 인자의 유용성 비교)

  • Lee Sang Jin;Jung Jin Hee;Sohn Dong Suep;Cho Dai Yun
    • Journal of Chest Surgery
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    • v.38 no.1 s.246
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    • pp.56-62
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    • 2005
  • Because of high morbidity and mortality, traumatic diaphragm injury remains a diagnostic challenge. In this study, we evaluate that some factors and scores can be used as predictors. Material and Method: From May 1995 to June 2003, 23 patients with traumatic diaphragm injury were enrolled. We examined the clinical features of patients. RTS, TRISS, ISS and APACHE II scores for each patient are calculated for analyzing the relationship of mortality and ICU duration. Result: The study identified 15 men $(65.2{\%})$ and 8women $(34.8{\%})$. There are right sided diaphragmatic injury in 11 patients $(47.8{\%})$, left sided in 11 $(47.8{\%})$, and both sided in 1 ($0.4{\%}$). Plain X-ray, CT, upper GI contrast study and esophagogastroscopy were used as diagnostic tools. Age, hemodynamic status, early diagnosis are not associated with outcome. As prognostic factor, RTS and ISS are associated with mortality and there was negative relationship between RTS and ICU duration (r=0.737, p=0.026). Conclusion: An early diagnosis of traumatic diaphragm injury can frequently be missed in the acute trauma setting. So high index of suspicion and a careful examination are important in multiple trauma patients. An RTS can probably be used effectively as a predictor for the severity and prognosis in patients with traumatic diaphragm injury.

Effect of Reperfusion after 20 min Ligation of the Left Coronary Artery in Open-chest Bovine Heart: An Ultrastructural Study (재관류가 허혈 심근세포의 미세구조에 미치는 영향 : 재관류 손상에 관한 연구)

  • 이종욱;조대윤;손동섭;양기민;라봉진;김호덕
    • Journal of Chest Surgery
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    • v.31 no.8
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    • pp.739-748
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    • 1998
  • Background: It has been well documented that transient occlusion of the coronary artery causes myocardial ischemia and finally cell death when ischemia is sustained for more than 20 minutes. Extensive studies have revealed that ischemic myocardium cannot recover without reperfusion by adequate restoration of blood flow, however, reperfusion can cause long-lasting cardiac dysfunction and aggravation of structural damage. The author therefore attempted to examine the effect of postischemic reperfusion on myocardial ultrastructure and to determine the rationales for recanalization therapy to salvage ischemic myocardium. Materials and methods: Young Holstein-Friesian cows(130∼140 Kg body weight; n=40) of both sexes, maintained with nutritionally balanced diet and under constant conditions, were used. The left anterior descending coronary artery(LAD) was occluded by ligation with 4-0 silk snare for 20 minutes and recanalized by release of the ligation under continuous intravenous drip anesthesia with sodium pentobarbital(0.15 mg/Kg/min). Drill biopsies of the risk area (antero-lateral wall) were performed at just on reperfusion(5 minutes), 1-, 2-, 3-, 6-, 12-hours after recanalization, and at 1-hour assist(only with mechanical respiration and fluid replacement) after 12-hour recanalization. The materials were subdivided into subepicardial and subendocardial tissues. Tissue samples were examined with a transmission electron microscope (Philips EM 300) at the accelerating voltage of 60 KeV. Results: After a 20-minute ligation of the LAD, myocytes showed slight to moderate degree of ultrastructural changes including subsarcolemmal bleb formation, loss of nuclear matrix, clumping of chromatin and margination, mitochondrial destruction, and contracture of sarcomeres. However, microvascular structures were relatively well preserved. After 1-hour reperfusion, nuclear and mitochondrial matrices reappeared and intravascular plugging by polymorphonuclear leukocytes or platelets was observed. However, nucleoli and intramitochondrial granules reappeared within 3 hours of reperfusion and a large number of myocytes were recovered progressively within 6 hours of reperfusion. Recovery was apparent in the subepicardial myocytes and there were no distinct changes in the ultrastructure except narrowed lumen of the microvessels in the later period of reperfusion. Conclusions: It is likely that the ischemic myocardium could not be salvaged without adequate restoration of coronary flow and that the microvasculature is more resistant to reversible period of ischemia than subendocardium and subepicardium. Therefore, thrombolysis and/or angioplasty may be a rational method of therapy for coronarogenic myocardial ischemia. However, it may take a relatively longer period of time to recover from ischemic insult and reperfusion injury should be considered.

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Development of New Device to Improve Sucess Rate of Maze Procedure with Radiofrequency Energy (고주파에너지를 이용한 미로술식의 성적향상을 위한 새로운 기구의 개발)

  • 박남희;유양기;이재원
    • Journal of Chest Surgery
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    • v.37 no.6
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    • pp.467-473
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    • 2004
  • Background: The sinus conversion rate after the maze procedure in chronic atrial fibrillation using radiofrequency energy is lower than with either conventional 'cut and saw' technique or cryothermia. The creation of incomplete transmural lesions due to poor tissue-catheter contact is thought to be the main cause. To address this problem, the current study was aimed to evaluate the effectiveness of a specially constructed compression device designed to enhance tissue catheter contact during unipolar radiofrequency catheter ablation. Material and Method: Circum-ferential right auricular epicardial lesions were created with a linear radiofrequency catheter in 10 anesthetized pigs. A device specially designed to increase contact by compression of the catheter to the atrial wall was used in 5 pigs (study group). This device was not used in the control group (5 pigs). Conduction block across the right auricular lesion was assessed by pacing, and the transmurality of the lesions were confirmed by microscopic examination. Result: Conduction block was observed in a total of 8 pigs; 5 in study group and 3 in control group. Transmural injury was confirmed microscopically by the accumulation of acute inflammatory cells and loss of elastic fibers in the endocardium. In two pigs with failed conduction block, microscopic examination of the endocardium appeared normal. Conclusion: Failed radiofrequency ablation is strongly related to non-transmural energy delivery. The specially constructed compression device in the current study was successful in creating firm tissue-catheter contact and thereby generating transmural lesions during unipolar radiofrequency ablation.

Vegetation Distribution Near Abandoned Metalliferous Mines and Seed Germination Properties of Woody Plants by the Contaminated Soils (폐광산 주변의 목본 식생 현황 및 오염 토양에 대한 목본 종자의 발아 특성)

  • Seo, Kyung-Won;Kim, Rae-Hyun;Koo, Jin-Woo;Noh, Nam-Jin;Kyung, Ji-Hyun;Kim, Jeong-Gyu;Son, Yo-Whan
    • Korean Journal of Environmental Agriculture
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    • v.25 no.1
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    • pp.47-57
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    • 2006
  • This study was carried out to select the Eco-tree for successful phytoremediation of abandoned metalliferous mines. We examined vegetation and heavy metal concentrations of woody plants in abandoned mining areas, and also conducted seed germination and seedling growth experiment on contaminated soils from Gahak and Geumjeong mines. Pinus densiflora, Robinia pseudoacacia, Lespedeza bicolor and Alnus japonica showed high frequency in the survey areas and had high heavy metal concentrations compared to other species. Heavy metal concentrations were higher in roots than in leaves and stems. The seed germination rate was in the order of P. densiflora, L. bicolor, R. pseudoacacia, and Alnus japonica from the incubactor and greenhouse experiment. In the incubator experiment germination rate was highest in the control soil for P. densiflora and A. japonica. Germination rate of P. densiflora was highest on the 100% contaminated soil for Gahak mine while germination rate decreased with increased percentage of contaminated soil for Geumjeong mine. In the greenhouse experiment germination rate was lowest on the 40% contaminated soil for Gahak mine while germination rate was lowest on the 20% contaminated soil for Geumjeong mine and increased with increased percentage of contaminated soil. Shoot growth was highest for L. bicolor while root growth was highest for R. pseudoacacia except for 20% contaminated soil in Geumjeong mine.

One Anchor Double Fixation (OADF) Technique for Arthroscopic Bony Bankart Repair (두가닥의 봉합사를 가진 봉합나사못을 이용한 새로운 관절경적 골성 방카르트 병변 봉합술)

  • Choi, Eui-Sung;Park, Kyoung-Jin;Kim, Yong-Min;Kim, Dong-Soo;Shon, Hyun-Chul;Cho, Byung-Ki;Bae, Seung-Hwan
    • Clinics in Shoulder and Elbow
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    • v.13 no.1
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    • pp.40-46
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    • 2010
  • Purpose: The aim of this study was to evaluate the usefulness of arthroscopic Bony Bankart repair using a One Anchor Double Fixation Technique. Materials and Method: Seventeen patients with a Bony Bankart lesion were treated using the One Anchor Double Fixation Technique (OADF Technique). There were 13 males and 4 females. The average age was 24 years (range 17-42). The average follow-up period was 22.3 months. One 3.0 mm suture anchor with doubly loaded sutures was inserted into the glenoid rim. One suture strand was passed the around the small bony fragment and tied first. Another suture strand was passed through the capsule and tied over the bony fragment. The result was measured using Rowe's evaluation index & KSS score. The glenoid defect & bony fragment were measured by 3D-CT scan. Results: Rowe's evaluation index on the final follow-up showed an overall improvement from an average of 54 (range, 23-71) to 83.4 (range 71-90). Of the 17 cases, 13 were excellent, 3 were good, and 1 was fair. KSS scores showed improvement from an average of 71 (range 49-82) to 92.5 (range 82-94). There were no cases where pain continued to the final follow-up, and no cases being re-dislocated during the follow-up period. For six cases, we confirmed the bony healing of the bony Bankart lesion by CT. Conclusion: Bony Bankart lesion repair using this new method achieves excellent clinical results with low recurrence rates and is considered another choice for bony Bankart lesions.

Characterization of Mutations in Bruton's Tyrosine Kinase(Btk) Gene from Unrelated 3 X-linked Agammaglobulinemia(XLA) Families in Korea (국내 X-관련성 범저감마글로불린혈증 세가족에 대한 Bruton's Tyrosine Kinase 단백질 발현 및 유전자 변이 분석)

  • Song, Chang-Hwa;Jo, Eun-Kyeong;Park, Jeong-Kyu;Kim, Jung-Soo;Hong, Soo-Jong;Lee, Jae-Ho
    • Clinical and Experimental Pediatrics
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    • v.45 no.3
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    • pp.302-310
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    • 2002
  • Purpose : X-linked agammaglobulinemia(XLA) is an immunodeficiency caused by abnormalities in Bruton's tyrosine kinase(Btk), and is characterized by a deficiency of peripheral blood B cells. We studied cytoplasmic expression of Btk protein and analyzed the Btk gene in peripheral blood mononuclear cells(PBMC) from three XLA families in Korea. Methods : Heparinized venous blood samples were collected from four XLA patients and additional family members in three unrelated XLA families. Mononuclear cells were separated from their blood and the intracellular Btk protein was characterized by a flow cytometry. The mutation analysis was performed using direct sequencing. Results : Cytoplasmic expression of Btk protein in monocytes was not detected in the patients with XLA. We observed a novel deletion and two point mutations within introns(intron 1 and intron 18) resulting in alternative splicings. In XLA family 2, a 980 bp deletion(from intron 9+191 T to intron 10-215 C) including exon 10 was found in patient P2. He was the only sporadic case in this study, because his mother and brother showed a normal Btk expression by flow cytometry. Conclusion : These identified genetic alterations support the molecular heterogeneity of Btk gene in XLA disease. Additionally, by means of flow cytometric analysis, we diagnosed three hypogammaglobulinemia patients as XLA. Advancements in diagnostic methods has facilitated a prompt and definite diagnosis of this disease.

Eruptive Phases and Volcanic Processes of the Guamsan Caldera, Southeastern Cheongsong, Korea (구암산 칼데라의 분출상과 화산과정)

  • ;;;A.J. Reedman
    • The Journal of the Petrological Society of Korea
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    • v.11 no.2
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    • pp.74-89
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    • 2002
  • Rock units, relating with the Guamsan caldera, are composed of Guamsan Tuff and rhyolitic intrusions. The Guamsan Tuff consists almost entirely of ash-flow tuffs with some volcanic breccias and fallout tuffs. The volcanic breccia comprises block and ash-flow breccias of near-vent facies and caldera-collapse breccia near the ring fracture. The lower ash-flow tuffs are of an expanded pyroclastic flow phase from the pyroclastic flow-forming eruption with an ash-cloud fall phase of the fallout tuffs on the flow units, but the upper ones are of a non-expanded ash-flow phase from the boiling-over eruption. The rhyolitic intrusions are divided into intracaldera intrusions and ring dikes that are subdivided into inner, intermediate and outer dikes. We compile the volcanic processes along a single cycle of cadela development from the eruptive phases in the Guamsan area. The explosive eruptions began with block and ash-flow phases from collapse of glowing lava dome caused by Pelean eruption, progressed through expanded pyroclastic flow phases and ash-cloud fallout phases during high column collapse of pyroclastic flow-forming eruption from a single central vent. This was followed by non-expanded ash-flow phases due to boiling-over eruption from multiple ring fissure vents. The caldera collapse induced the translation into ring-fissure vents from a single central vent in the earlier eruption. After the boiling-over eruption, there followed an effusive phase in which rhyolitic magma was injected and erupted to be progressively emplaced as small plugs/dikes and ring dikes with many lava domes on the surface. Finally rhyodacitic magma was on emplaced as a series of dikes along the junction of both outer and intermediate dikes on the southwestern side of the caldela.

A Comparative study of roughness of enamel surface to various interdental enamel stripping methods in vitro (치간 법랑질 삭제방법에 따른 치아표면 거칠기에 관한 비교연구)

  • Row, Joon;Chun, Youn-Sic
    • The korean journal of orthodontics
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    • v.29 no.4 s.75
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    • pp.483-490
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    • 1999
  • Interdental enamel stripping is an usual method for correction of abnormal tooth shape and tooth size discrepancy which is one of the etiologic factors of malocclusion. Clinically it Is useful to correct the minor crowding in anterior teeth and posterior occlusion during finishing stage of orthodontic treatment. But this procedure has risks such as irreversible tooth reduction and remaining roughness of enamel surface can accumulate plaque which can evoke periodontal problem. Even if various methods were introduced to minimize the enamel surface roughness, their evaluation was limited in morphologic differences by scanning electronic microscope(SEM). The purpose of this study was to compare the various interdental enamel stripping method by SEM and to quantify the difference of surface roughness by use of Surfcorder SEF-30D(Kosaka Lab. Ltd.) which can measure the roughness of surface. The stripping methods were divided into mechanical and mechanical-chemical method. Air-rotor stripping and separating strip were used for mechanical stripping and $37\%$ phosphoric acid was used for chemical stripping. The enamel surface roughness after mechanical or mechanical-chemical stripping of interproximal surfaces of premolars which were extracted for orthodontic purpose were measured and compared by means of SEM and $Surfcorder^{\circledR}$, the results were as follows. 1. Enamel surface of primary treated by coarse diamond bur and separating strip groups showed highest value of roughness. 2. To compare the primary treated groups between mechanical and mechanical-chemical method, the latter group showed lower value of roughness remarkably. 3. Mechanical stripping groups which were treated both coarse and fine instrument showed lower value of roughness as much as non treated group. 4. The use of Pumice for final polishing did not show significantly smoothening the stripped enamel surface any more.

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Occluding Effect of the Application of Fluoride Compounds and Desensitizers on Dentinal Tubules (불소도포 및 지각과민처치제 적용 후 상아세관 폐쇄효과와 지속력 평가)

  • Lee, Ye-Jin;Jeong, Moon-Jin;Ahn, Yong-Soon;Cheun, Su-Kyung;Jeong, Soon-Jeong;Lim, Do-Seon
    • Journal of dental hygiene science
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    • v.16 no.4
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    • pp.272-283
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    • 2016
  • This study compared and analyzed the occluding effects of fluoride compounds and desensitizers, which are commonly used in dental clinics, on dentinal tubules. This study also evaluated the persistence of the active ingredients over time by performing toothbrushing with an electric toothbrush. Thirty-five molar teeth, which had been extracted within the past 3 months from healthy people without tooth decays, amalgam fillings, or dental crowns, were divided into 4 pieces each. Of these, 135 teeth pieces were used as study specimens. These specimens were divided into a control group, an untreated group, and 5 experimental groups (acidulated fluoride gel, fluoride varnish, Gluma, Super Seal, and SE-Bond). The specimens were then subjected to toothbrushing equivalent to 1 week (140 times), 2 weeks (280 times), and 4 weeks (560 times), and the occluding effects on dentinal tubules in 3 regions of each specimen were examined under a scanning electron microscope. The fluoride varnish treated group showed the highest degree of dentinal tubule occlusion effects during the first, second, and fourth weeks of toothbrushing, with the SE-Bond treated group showing the second highest degree and the Gluma treated group showing the lowest degree. After 4 weeks of toothbrushing, the Gluma treated group and the Super Seal treated group showed the lowest degrees of dentinal tubule occlusion effects. In summary, the fluoride varnish treated group and the SE-Bond treated group displayed higher occlusion effects even after 4 weeks of treatment than did the other experimental groups. Therefore, it is the authors' belief that fluoride varnish and SE-Bond are effective for treating dentinal hyperesthesia.

Underlying Etiologic Factor of Recurrent Pneumothorax after Bullectomy (원발성 기흉환자에서 재수술의 원인)

  • 윤용한;이두연;김해균;홍윤주
    • Journal of Chest Surgery
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    • v.32 no.6
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    • pp.556-560
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    • 1999
  • Background: The cause of spontaneous pneumothorax is not yet but it is certain that intrathoracic air comes from ruptured bulla. Video-assisted thoracoscopic surgery(VATS) or open thoracotomy is recommended for thoracic incision in recurrent pneumothorax. However, recurrent rate after bullectomy with the VATS is very high compared to mini-thoracotomy, 3% to 20% and below 2%, respectively. Material and Method: This retrospective analysis was performed on 16 re-operated cases among 446 surgically treated pneumothorax of the 737 cases of spontaneous pneumothorax diagnosed at Yongdong Severance Hospital from Nov. 1992 to June 1997. Result: Among the 446 surgically-treated patients in 737 case of spontaneous pneumothorax, 16 patients underwent re-operation, showing a 3.5% re-operation rate. Male-to-female ratio was 15 to 1 and mean age at initial attack was 20.2 years(ranging from 15 to 50). Mean hospital stay was 6.34 days(ranging from 2 to 20 days) and mean chest tube indwelling period was 4.2 days(ranging from 1-10 days). Median follow-up was 46 months(range 10-66 months). Three different surgical methods were applied : video-assisted thoracoscopic surgery(VAST) in 281 cases, of whom 2 underwent local anesthesia; subaxillary mini-thoracotomy in 159 cases and limited lateral thoracotomy in the remaining 6 cases. Three different re-operative surgical methods were applied ; video-assisted thoracoscopic surgery (VAST) in 6 cases, subaxillary mini-thoracotomy in 9 cases, and limited lateral thoracotomy in the remaining 1 case. The underlying etiological factors of the recurrent pneumothorax after bullectomy were o erlooking type(9) and new growing type(7). Mean recurrent period from previous operation was 1 month for overlooking type and 18 months for new growing type. Conclusion: The underlying etiological factors of recurrent pneumothorax lead to re-operation were new-growing and over-looking type. We need additional treatments besides resecting blebs of prevent the recurrence rate and more gentle handling with forceps due to less damage to the pleura.

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