• Journal of Chest Surgery
• /
• v.29 no.3
• /
• pp.271-277
• /
• 1996

In selected cases, early corrective surgery is indicated in the management of infants having large ventricular septal defects. The risk of any surgical procedure in infancy is acknowledged to be great and should be avoided whenever possible. However this greater surgical risk is justified when the patient presents with intractable congestive heart failure, severe pulmonary hypertension, marked growth retardation, and recurrent prolonged lower respiratory infections. We analyzed 31 patients with ventricular septal defect in infancy who underwent surgical correction from January 1991 through December 1994. Age ranged from 6 months to 12 months with mean age of 9.2 months. Of the thirty-one patients, 23 patients were male and 8 patients were female. Mean body weight was 7. 4kg. The most common type of ventricular septal defect was perimembraneo s (64.5%). Associated cardiac anomalies were found in 17 patients (55.8%). Mitral regurgitation was the most commonly associated cardiac anomaly (16.1 %) and followed by patent ductus arteriosus (12.9%). When cardiac catheterization data were analysed, the most common range of Qp/qs, RpiRs, Pp/ps were 2.1∼ 3.0, 1-0.25, above 0.70 respectively. Among the indications of surgical correction, there were pulmonary hypertension in 20 patients, congestive heart failure in 3 patients, intractable respiratory infection in 10 patients and growth retardation in 14 patients. The most common surgical approach and method for closure of ventricular septal defect .were right atriotomy (58%) and Dacron patch closure (94%). Postoperative complications occurred in 10 cases (32%) and overall mortality was 12.9% (4 cases). All operative deaths in this series occurred in infants under the age of 8 months and weight of 8 kilograms.

• Journal of Genetic Medicine
• /
• v.5 no.1
• /
• pp.7-14
• /
• 2008

Twenty years have passed since a prenatal screening for Down syndrome and neural tube defect was applied to obstetric field. The Quad test (AFP, hCG, uE3, Inhibin-A) of the second trimester and the combination test (PAPP-A, hCG, NT) of the first trimester became popular now. The recent trend of prenatal screening is to combine these two screening tests together in order to increase a detection rate of Down syndrome. Three types of screening methods are introduced as follows; integrated test, sequential test and contingent test. In addition to combination of each test, an incorporation of characteristic ultrasound findings of Down syndrome is suggested for its risk calculation. The absence of fetal nasal bone would be a very useful marker especially in the first trimester screening test. According to a change of way calculating risk of Down syndrome, obstetrician's role will be more increased not by passive participation, but by active participation using ultrasound in risk calculation.

• Clinical and Experimental Pediatrics
• /
• v.53 no.12
• /
• pp.994-999
• /
• 2010

Purpose: Mitochondrial dysfunction can present with various symptoms depending on the organ it has affected. This research tried to analyze the ophthalmologic symptoms and ophthalmologic examination (OE) results in patients with mitochondrial disease (MD). Methods: Seventy-four patients diagnosed with mitochondrial respiratory chain complex defect with biochemical enzyme assay were included in the study. They were divided into 2 groups based on the OE results by funduscopy and were analyzed on the basis of their clinical features, biochemical test results, morphological analysis, and neuroimaging findings. Results: Thirty-seven (50%) of the 74 MD patients developed ophthalmologic symptoms. Abnormal findings were observed in 36 (48.6%) patients during an OE, and 16 (21.6%) of them had no ocular symptoms. Significantly higher rates of prematurity, clinical history of epilepsy or frequent apnea events, abnormal light microscopic findings in muscle pathology, diffuse cerebral atrophy in magnetic resonance imaging, and brainstem hyperintensity and lactate peaks in magnetic resonance spectroscopy were noted in the group with abnormal OE results. Conclusion: Although the ophthalmologic symptoms are not very remarkable in MD patients, an OE is required. When the risk factors mentioned above are observed, a more active approach should be taken in the OE because a higher frequency of ocular involvement can be expected.

• Clinics in Shoulder and Elbow
• /
• v.19 no.2
• /
• pp.78-83
• /
• 2016

Background: We investigated the risk factors for the recurrence of anterior shoulder instability after arthroscopic surgery with suture anchors and the clinical outcomes after reoperation. Methods: A total of 281 patients (February 2001 to December 2012) were enrolled into our study, and postoperative subluxation and dislocation were considered as recurrence of the condition. We analyzed radiologic results and functional outcome including the American Shoulder and Elbow Surgeons Evaluation Form, the Korean Shoulder Society Score, and the Rowe scores. Results: Of the 281 patients, instability recurred in 51 patients (18.1%). Sixteen out of 51 patients (31.4%) received a reoperation. In terms of the functional outcome, we found that the intact group, comprising patients without recurrence, had a significantly better functional outcome than those in the recurrent group. The size of glenoid defect at the time of initial surgery significantly differed between intact and recurrent group (p<0.05). We found that the number of dislocations, the time from the initial presentation of symptoms to surgery, and the number of anchor points significantly differed between initial operation and revision group (p<0.05). The functional outcome after revision surgery was comparable to intact group after initial operation. Conclusions: Eighteen percent of recurrence occurred after arthroscopic instability surgery, and 5.6% received reoperation surgery. Risk factors for recurrence was the initial size of glenoid defect. In cases of revision surgery, good clinical outcomes could be achieved using additional suture anchor.

• Archives of Craniofacial Surgery
• /
• v.16 no.3
• /
• pp.105-113
• /
• 2015

The main challenge in pharyngoesophageal reconstruction is the restoration of swallow and speech functions. The aim of this paper is to review the reconstructive options and associated complications for patients with head and neck cancer. A literature review was performed for pharynoesophagus reconstruction after ablative surgery of head and neck cancer for studies published between January 1980 to July 2015 and listed in the PubMed database. Search queries were made using a combination of 'esophagus' and 'free flap', 'microsurgical', or 'free tissue transfer'. The search query resulted in 123 studies, of which 33 studies were full text publications that met inclusion criteria. Further review into the reference of these 33 studies resulted in 15 additional studies to be included. The pharyngoesophagus reconstruction should be individualized for each patient and clinical context. Fasciocutaneous free flap and pedicled flap are effective for partial phayngoesophageal defect. Fasciocutaneous free flap and jejunal free flap are effective for circumferential defect. Pedicled flaps remain a safe option in the context of high surgical risk patients, presence of fistula. Among free flaps, anterolateral thigh free flap and jejunal free flap were associated with superior outcomes, when compared with radial forearm free flap. Speech function is reported to be better for the fasciocutaneous free flap than for the jejunal free flap.

• Journal of Chest Surgery
• /
• v.24 no.5
• /
• pp.445-450
• /
• 1991

Forty eight patients diagnosed as atrial septal defect, had been operated from April 1986 to December 1990 at the Department of Thoracic and Cardiovascular Surgery, Inha University Hospital, were analysed retrospectively. Of the 48 patients, 12 patients, were male and 36 patients were female, Their ranged from 8 months to 51 years old, and the mean was 18.0 years old. The proceeding two symptoms were exertional dyspnea and frequent upper respiratory infection. But 10 patients [20.8%] were asymptomatic. Electrocardiographic findings were regular sinus rhythm in 100.0%, RVH in 29.2%, incomplete RBBB in 27.1%, and first degree AV block in 2.1%. Hemodynamic studies were performed in 38 of 48 patients. Significant pulmonary hypertension[over 50mmHg in systolic pulmonary arterial pressure], which is the most serious risk factor, was developed in 4 patients[8.3%]. There was statistical significance between size of defect[cm2/BSA-M2] and systolic pulmonary arterial pressure[sPAP] retrospectively[p=0.036]. We could not find the correlationship between age and Qs % size. Anatomically, secundum type constituted 97.9%, in which 43 patients were PFO type[91.6%] and 3 patients were IVC type[6.3%]. 38 of 48 ASD patients were repaired with patch closure[72.9%] and remains were repaired with direct closure[27.1%]. The operative result was excellent except two cases of transient postoperative arrhythmia. There was no operative mortality.

• Archives of Plastic Surgery
• /
• v.43 no.5
• /
• pp.461-465
• /
• 2016

Extramammary Paget's disease (EMPD) is a rare, slow-growing intraepithelial malignancy that mainly involves the genital region, including the vulva, penis, scrotum, perianal, and periurethral areas. Although several treatment options exist, wide local excision with a safe margin is considered the treatment of choice. After resection of the lesion, it is often challenging to reconstruct the defect because defects in the perineal region require adequate volume for protection and are susceptible to infections, which is a particularly significant risk for large defects. We report a case of perivulvar EMPD that was reconstructed with three-directional local flaps after wide excision of the tumor. We covered the defect sequentially using the following 3 flaps: a gracilis myocutaneous flap from the left thigh, a bipedicled V-Y advancement flap from the lower abdomen, and an internal pudendal artery perforator-based island flap from the right buttock. To the best of our knowledge, this report is the first to describe a three-directional approach to extensive perivulvar reconstruction.

• Journal of the Korean Society of Propulsion Engineers
• /
• v.10 no.2
• /
• pp.102-109
• /
• 2006

In this Paper, Support Vector Machine(SVM) and Artificial Neural Network(ANN) are used for developing the defect diagnostic algorithm of the aircraft turbo-shaft engine. The system that uses the ANN falls in a local minima when it learns many nonlinear data, and its classification accuracy ratio becomes low. To make up for this risk, the Separate Learning Algorithm(SLA) of ANN has been proposed by using SVM. This is the method that ANN learns selectively after discriminating the defect position by SVM, then more improved performance estimation can be obtained than using ANN only. The proposed SLA can make the higher classification accuracy by decreasing the nonlinearity of the massive data during the training procedure.

• Journal of Neurocritical Care
• /
• v.11 no.2
• /
• pp.124-128
• /
• 2018

Background: Secundum atrial septal defect (ASD) is a common congenital heart defect in adults. Patients with ASDs at high risk of cardiovascular complications undergo either surgical repair or percutaneous device closure. Case Report: We report the case of an 85-year-old male with unusual recurrent cerebral infarctions. The patient has undergone repair of secundum ASD 12 years ago. Evaluation by transesophageal echocardiography revealed a mobile mass at the patch repair site in the left atrium. The mass was surgically removed due to recurrent stroke during the anticoagulation. Conclusion: This case emphasizes the importance of regular cardiac checkup and the need to consider cardioembolic source as being part of the etiology of stroke recurrence, even if the event occurs many years after intracardiac shunt closures.

• Archives of Reconstructive Microsurgery
• /
• v.21 no.1
• /
• pp.76-80
• /
• 2012

Various soft tissue defects can be occurred in the hand. In determining the most suitable means of reconstruction a defect, the benefit of the reconstruction has to outweigh the risk of donor morbidity. Flap selection will be based on the size of the defect, the requirements for sensibility, the surgeon's comfort level, and the patient profile such as gender, age, or systemic disease. The hand is the most important tactile sensory organ, hence sensory restoration is critical. Neurosensory free flaps can provide sensibility, vascularity, and soft tissue coverage to an injured hand. This paper will discuss free flaps which can be used for soft tissue reconstruction of the hand.