• 제목/요약/키워드: APEX

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HeartMate 3 Implantation via Only Left Thoracotomy: A Case Report

  • Mi Young Jang;Jun Ho Lee;Su Ryeun Chung;Kiick Sung;Wook Sung Kim;Yang Hyun Cho
    • Journal of Chest Surgery
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    • 제56권3호
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    • pp.224-227
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    • 2023
  • Median sternotomy is a standard surgical technique used for left ventricular assist device (LVAD) implantation. However, if sternotomy has a prohibitive surgical risk, LVAD implantation can be performed through only left thoracotomy. We managed a patient with end-stage heart failure who had recently undergone coronary artery bypass grafting (CABG) elsewhere. The patient also had a deep sternal wound infection and bacteremia. Because of refractory cardiogenic shock, we performed extracorporeal membrane oxygenation (ECMO). After multiple mediastinal washouts and omental flap placement, ECMO was converted to extracorporeal LVAD (from the left ventricular apex to the descending aorta) through a left thoracotomy. The extracorporeal LVAD was maintained for 18 days and replaced by the HeartMate 3 LVAD. The patient was discharged in good condition 115 days after CABG.

In vitro apical pressure created by 2 irrigation needles and a multisonic system in mandibular molars

  • Ronald Ordinola-Zapata;Joseph T. Crepps;Ana Arias;Fei Lin
    • Restorative Dentistry and Endodontics
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    • 제46권1호
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    • pp.14.1-14.7
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    • 2021
  • Objectives: The aim of this study was to evaluate the apical pressure generated by 2 endodontic irrigation needles and the GentleWave system in mandibular molars. Materials and Methods: The mesial and distal root canals of 12 mandibular molars were irrigated with a 30-gauge close-end needle or with a 30-gauge open-end needle. Procedures were performed in the mesial and distal canals. The GentleWave procedure and irrigation at 1 mm from the apex in the distal roots using an open-end needle were used, respectively, as negative and positive controls. The apical pressure was measured using a data acquisition pressure setup. Apical pressure exerted by the different needles in the 2 different canal types was statistically compared using 2-way analysis of variance. Results: Significant differences were found in the apical pressure for both needles and the canal type. The lowest values were obtained with close-end needles and in mesial canals. Negative apical pressure values were obtained using GentleWave. Conclusions: The needle and the canal type influenced the apical pressure. The GentleWave procedure produced negative apical pressure.

A Study on Kyaikkatha: An Early Urban Settlement in Lower Myanmar

  • Win, Lei Lei
    • 수완나부미
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    • 제7권1호
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    • pp.157-186
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    • 2015
  • Sittaung-Thanlwin region in Lower Myanmar is an ecological niche for human settlement. Evidences of human activities in the region are seen through various archaeological sites or settlements along the coastal area between the rivers Sittaung and Thanlwin (Salween). In Lower Myanmar, scholar, U Aung Myint, discovered one major site Kyaikkatha and other small scale sites, namely, Sittaung, Kawhtin, Kadaikgyi, Kadaikkalay, Katkadit, Kelatha (little Zothoke), Ayetthama, Winka, Zothoke (big Zothoke), Lagonbyi (Sampannago), Wagaru, Laming and Ye in present day Mon State. In 1980, U Aung Myint undertook an exploration program at Kyaikkatha. After the exploration, an excavation team conducted systematic digging at Kyaikkatha in March 1986. Excavation continued occasionally at Kyaikkatha throughout the years between 1995 and 2000. It is known that Kyaikkatha, the old city, reveals a kind of monumental civilization exposing four religious structures (a stupa and three monasteries). This essay looks into the distribution of features within Kyaikkatha and infers on its social, political, and religious organization. This essay is also about a new discovery of an early urban settlement located at the apex of the Gulf of Muttama (Martaban) where a lost city of Suvannahumi flourished in the ancient days. By means of aerial photographic observations, the site had been noticed recently, which was by followed some excavations. More systematic and detail surveying may be needed to know more about the site and its features for comparison to other similar settlements of through-out mainland South East Asia.

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Management of a Large Hypervascular Apicoposterior Mediastinal Mass Using the Purse-String Suture Technique in Robotic-Assisted Thoracoscopic Surgery: A Case Report

  • Juan Kim;Jonggeun Lee;Hyo Yeong Ahn
    • Journal of Chest Surgery
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    • 제57권1호
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    • pp.92-95
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    • 2024
  • Complete resection of an apicoposterior mediastinal mass is essential due to the mass effect, which exerts pressure on adjacent organs. Recently, the use of minimally invasive surgery has had many advantages. In this report, we describe a case in which a large apicoposterior mediastinal hypervascular mass was managed using a purse-string suture technique during robotic-assisted thoracoscopic surgery (RATS). The patient, a 77-year-old woman, was diagnosed with a 6.2-cm apicoposterior mediastinal hypervascular solid mass originating from the branches of the right subclavian artery. The patient underwent RATS for treatment. To obtain an adequate view of the apex of the thoracic cavity, a needle aspiration was performed, followed by the application of a purse-string suture technique. This was done to reduce the size of the tumor and to prevent catastrophic events such as seeding or spillage of the cystic mass. The mass was histopathologically diagnosed as a schwannoma. The patient was discharged on the first postoperative day without experiencing any complications.

Successful Bridge to Heart Transplantation through Ventricular Assist Device Implantation and Concomitant Fontan Completion in a Patient with Glenn Physiology: A Case Report

  • Ji Hong Kim;Ji Hoon Kim;Ah Young Kim;Yu Rim Shin
    • Journal of Chest Surgery
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    • 제57권3호
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    • pp.312-314
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    • 2024
  • A 3-year-old boy with Glenn physiology exhibited refractory heart failure with reduced ejection fraction. To improve the patient's oxygen saturation, he underwent ventricular assist device (VAD) implantation with concomitant Fontan completion. The extracardiac conduit Fontan operation was performed with a 4-mm fenestration. For VAD implantation, Berlin Heart cannulas were positioned at the left ventricular apex and the neo-aorta. Following weaning from cardiopulmonary bypass, a temporary continuous-flow VAD, equipped with an oxygenator, was utilized for support. After a stabilization period of 1 week, the continuous-flow VAD was replaced with a durable pulsatile-flow device. Following 3 months of support, the patient underwent transplantation without complications. The completion of the Fontan procedure at the time of VAD implantation, along with the use of a temporary continuous-flow device with an oxygenator, may aid in stabilizing postoperative hemodynamics. This approach could contribute to a safe transition to a durable pulsatile VAD in patients with Glenn physiology.

Positional relationship between mandibular third molar and mandibular canal in cone beam computed tomographs

  • Yu, Su-Kyoung;Lee, Ji-Un;Kim, Kyoung-A;Koh, Kwang-Joon
    • Imaging Science in Dentistry
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    • 제37권4호
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    • pp.197-203
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    • 2007
  • Purpose: To provide diagnostic information by evaluation of the positional relationship between the mandibular third molar and the mandibular canal. Materials and Methods: Eighty-nine mandibular third molars were classified as mesioangular, horizontal, vertical, distoangular groups. The distances between the mandibular third molar and the mandibular canal were measured in cone-beam computed tomographs. The height and width ratios of distances from the mandibular third molar and the mandibular canal to the mandibular inferior border and to the lingual cortical plate were calculated. Results: The vertical and buccolingual distances between the mandibular third molar and the mandibular canal were 0.03 mm, 2.96 mm in the mesioangular, 0.37 mm, 3.38 mm in the horizontal, -1.50 mm, 1.38 mm in the vertical, -1.10 mm, 4.20 mm in the distoangular group. There were significant differences in vertical (P < 0.05), but not in buccolingual (P>0.05). The height and width ratios of distances on the mandibular third molar were 47.1 %, 36.1 % in the mesioangular, 47.4%, 34.4% in the horizontal, 37.0%, 46.7% in the vertical, 40.9%, 37.4% in the distoangular group. There were significant differences between the mesioangular and the vertical group, and the horizontal and the vertical group in height ratio (P < 0.05), and also between the mesioangular and the vertical group in width ratio (P < 0.05). The height and width ratios of distances on the mandibular canal showed no significant differences between groups (P > 0.05). Conclusion : The mesioangular group showed the nearest distance between the mandibular third molar and the mandibular canal vertically. The root apex of the mandibular third molar was positioned more buccally in the vertical group than in the mesioangular group.

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부분방실관의 교정수술 치험 1예 (Surgical Correction of Partial Atrioventricular Canal: One Case Report)

  • 이철범
    • Journal of Chest Surgery
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    • 제14권1호
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    • pp.49-59
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    • 1981
  • This is one case report of surgically treated partial atrioventricular canal. The 22 year-old male patient had no definitive history of frequent respiratory infection and cyanosis in his early childhood. Since his age of 7 years, dyspnea was manifested on exertion. First appearance of congestive heart failure was at his age of 16 years old. The physical examination revealed that the neck veins were distended and heaving of precordium. A thrill was palpable on the left 3rd-4th intercostal space extending from the sternal border toward the apex and Grade IV/VI systolic ejection murmur was audible on it. Neither cyanosis nor clubbing was noted. Liver was palpable about 5 finger breadths. Chest X-ray revealed increased pulmonary vascularity and severe cardiomegaly (C-T ratio = 74%). EKG revealed LAD, clockwise rotation, LVH and trifascicular block. Echocardiogram showed paradoxical ventricular septal movement, narrowed left ventricular outflow tract and abnormal diastolic movement of the anterior leaflet of mitral valve. Right heart catheterization resulted in large left to right shunt (Qp : Qs = 5.7: 1), ASD and moderate pulfllonary hypertension. Finally, left ventriculogram revealed typical goose neck appearance of left ventrlcalar outflow tract. On Oct. 10, 1980, open heart surgery was performed. Operative findings were: 1. Large primum defect ($6{\times}5$ Cm in diameter) 2. Cleft on the anterior leaflet of mitral valve. 3. The upper portion of ventricular septum was descent but no interventricular communication. 4. Downward attachment of the atrioventricular valves on the ventricular muscular septum. 5. Medium sized secumdum defect ($2{\times}1$ Cm in diameter). The cleft was repaired with 4 interrupted sutures. The primum defect was closed with Teflon patch and the secundum defect was closed with direct suture closure. Postoperatively atrial flutter-fibrillation in EKG and Grade U/VI apical systolic murmur were found. The postoperative course was uneventful and discharged on 29th postoperative day in good general conditions.

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상악중절치부위에 발생된 정중과잉치의 X선학적 연구 (A RADIOGRAPHIC STUDY OF MESIODENSES OCCURRED IN THE MAXILLARY CENTRAL INCISOR REGION)

  • 김영일;황의환;이상래
    • 치과방사선
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    • 제21권2호
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    • pp.367-375
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    • 1991
  • The clinical and radiographic features of 1,171 mesiodenses were studied with periapical radiograms and/or pantomograms in 942 persons visited the Department of Oral Radiology, School of Dentistry, Kyung Hee University during January 1980 to December 1989. The obrained results were as follows; 1. The incidence of mesiodens was higher in males (75.4%) than in females (24.6%). 2. In number of mesiodenses per individual, a single mesiodens was found to be 75.9%, 2-mesiodenses to be 23.8%, and 3-mesiodenses to be 0.2%. 3. In mesiodenses according to erupted and impacted status, the erupted mesiodens was found to be 16.5%, the impacted mesiodens in the interdental alveolar bone to be 66.6%, and in the region below root apex to be 16.9%. 4. In impacted mesiodenses according to direction of tooth crown, the inverted impaction was found to be 68.8%, the vertical impaction to be 15.1%, and the angulated impaction to be 16.1%. Among the impacted mesiodenses, a palatally located impaction was 87.5%, a middle 4.9%, and a labially 7.6%. 5. In mesiodenses according to shape of the tooth crown, a incisor-like type was found to be 1.6%, a canine-like type to be 6.8%, a conical type to be 79.2%, and a tuberculated type to e 12.4%. 6. In effect of mesiodens on adjacent tooth, non-specific influences were found to be 73.4%, crowding to be 0.3%, diastema to be 11.8%, rotation to be 5.7%, delayed eruption to be 3.8%, root resorption to be 2.6%, and dentigerous cyst to be 2.4%.

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상악동의 형태에 관한 방사선학적 연구 (A RADIOGRAPHIC STUDY ON THE MORPHOLOGY OF THE MAXILLARY SINUS)

  • 김봉영;김재덕
    • 치과방사선
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    • 제21권2호
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    • pp.297-306
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    • 1991
  • The purpose of this study is to improve the availabilities of radiographic technics as diagnostic methods to evaluate maxillary sinus in dental clinic. For the morphologic study of maxillary sinus, 20 dry maxillas were used and intraoral standard views, orthopantomograms, and skull P-A views were taken. For measuring the vertical image magnification rates, 5 sites in maxillary molar regions of 5 dry mandibles were selected radndomly and 25 wires of the determined sizes for selected portions were attached to the sites, after then, intraoral radiograms with bisecting technic and orthopantomograms were taken. The acquired results were as follows: 1. The anterior extension of the maxillary sinus on orthopantomogram was the distal side of the canine in 45.45% of subjects, the mesial side of the canine in 27.27%, the lateral incisor in 9.09%, the mesial side of the 1st premolar in 9.09%, and the mesial side of the 2nd pre-molar in 9.09%. 2. The positional relationship between the floor of maxillary sinus and the apex of alveolar socket revealed superimposed type in 58.3% of subjects, approached type in 33.3%, and separated type in 8.4%. 3. The morphology of inferior border of maxillary sinus was simple V or U shape in edentulous stage and V or wide U shape in alveolar socket stage. 4. The vertical image length on intraoral film taken by bisecting technic was magnified by 27.23% on the average and the length on orthopantomogram by 12.35%. 5. The inferior borders of maxillary sinus coinciding with each of the areas bearing the anterior and the posterior teeth on skull P-A view were determined.

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A Scanning Electron Microscopic Study on the Glochidial Encystment of a Freshwater Clam, Anodonta arcaeformis on the Host Fish, Carassius auratus

  • Lee, Yong-Seok;Min, Byung-Jun;Kang, Se-Won;Jo, Yong-Hun;Kim, Tae-Yun;Kho, Weon-Gyu;Han, Yeon-Soo;Park, Hong-Seog;Jeong, Kye-Heon
    • 한국패류학회지
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    • 제23권2호
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    • pp.181-187
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    • 2007
  • A scanning electron microscopic study on the glochidium and glochidial encystment of Anodonta arcaeformis on the host fish Carassius auratus was conducted. The shape of the glochidium was apparently subtriangular and its average size was $270\;{\mu}m\;\times\;260\;{\mu}m\;\times\;145\;{\mu}m$. The glochidial shell valves were of the same size, kept together by a ligament that is 50.4 ${\mu}m$ in length and 5.5 ${\mu}m$ in width. Each of the glochidial shell valve had a long hook studded with many spines on the superior face. A large area of at the apex of the valve surrounding the base of the hook was provided with numerous small spines which became progressively smaller toward the periphery of the area. The glochidial shell valve consisted of two layers. The mantle cells line the glochidial shell valves and some of hair cells were observed. A larval thread was 2.3 ${\mu}m$ in diameter. In the artificial infection of the glochidia to one of the natural hosts, Carassius auratus, it took about three to four hours to encyst the glochidia with epithelial cells of the fish fins. The encystment method was the cell migration from the neighboring epithelial cells.

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