• Journal of Trauma and Injury
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• v.22 no.1
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• pp.77-86
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• 2009

Purpose: The appropriate management of traumatic truncal arterial injury is often difficult to determine, particularly if the injury is associated with severe additional truncal lesions. The timing of repair is controversial when patients arrive alive at the hospital. Also, there is an argument about surgery versus stent-graft repair. This study's objective was to evaluate the appropriate method and the timing for treatment in cases of truncal abdominal injury associated with other abdominal lesions. Methods: The medical records at Ajou University Medical Center were reviewed for an 8-year period from January 1, 2001, to December 31, 2008. Twelve consecutive patients, who were diagnosed as having had a traumatic truncal arterial injury, were enrolled in our study. Patients who were dead before arriving at the hospital or were not associated with abdominal organ injury, were excluded. All patients involved were managed by using the ATLS (Advanced Trauma Life Support) guideline. Data on injury site, the timing and treatment method of repair, the overall complications, and the survival rate were collected and analyzed. Results: Every case showed a severe injury of more than 15 point on the ISS (injury severity score) scale. The male-to-female ratio was 9:3, and patients were 41 years old on the average. Sites of associated organ injury were the lung, spleen, bowel, liver, pelvic bone, kidney, heart, vertebra, pancreas, and diaphragm ordered from high frequency to lower frequency. There were 11 cases of surgery, and one case of conservative treatment. Two of the patients died after surgery for truncal organ injury: one from excessive bleeding after surgery and the other from multiple organ failure. Arterial injuries were diagnosed by using computed tomography in every case and 9 patients were treated by using an angiographic stent-graft repair. There were 3 patients whose vessels were normal on admission. Several weeks later, they were diagnosed as having a truncal arterial injury. Conclusion: In stable rupture of the truncal artery, initial conservative management is safe and allows management of the major associated lesions. Stent grafting of the truncal artery is a valuable therapeutic alternative to surgical repair, especially in patients considered to be a high risk for a conventional thoracotomy.

• Childhood Kidney Diseases
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• v.12 no.1
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• pp.88-92
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• 2008

Infection of Epstein-Barr virus(EBV) gives rise to a broad spectrum of clinical manifestations in children. Although renal involvement is rare, diverse renal manifestations are known from hematuria to acute renal failure. Secondary membranous nephropathy(MN) associated with systemic EBV infection is an uncommon renal pathology and only two cases have been reported. We are adding another case of MN associated with EBV infection in a child. An 8-year-old girl was admitted for renal biopsy. She had been followed up for microscopic hematuria and intermittent proteinuria for 5 months. There had been no specific findings in serology and radiology. Tonsil biopsy had been done due to exudative tonsillar hypertrophy and enlarged multiple cervical lymph nodes. And it showed EBV-associated lymphoproliferative findings. Serologic tests for EBV showed positive evidence of recent infection; viral capsid antigen(VCA) IgM was borderline positive, VCA IgG and early antigen IgG were positive, and EB nuclear antigen IgG was negative. In Situ Hybridization of tonsil for EBV mRNA was positive. Because her proteinuria and hematuria were aggravated at that time(protein 3 +, RBC >60/HPF), renal biopsy was done. Renal biopsy showed the findings of MN, characterized by thickened capillary walls with epimembranous spikes on light microscopy and subepithelial, mesangial and subendothelial electron dense deposits on electron microscopy. On immunofluorescence microscopy, IgG, C1q, kappa and lambda chains were positive. After steroid administration, proteinuria and hematuria resolved gradually within 6 months.

• Journal of Chest Surgery
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• v.12 no.3
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• pp.281-288
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• 1979

For years, physicians and anatomists have been interested in the heart that has one functioning ventricle. Various terms have been suggested for this entity including single ventricle, common ventricle, double-inlet left ventricle, cor biatriatum triloculare, and primitive ventricle. In this report, the term "single ventricle" is utilized as suggested by Van Praagh, and is defined as that congenital cardiac anomaly in which a common or separate atrioventricular valves open into a ventricular chamber from which both great arterial trunks emerge. An outlet chamber, or infundibulum, may or may not be present and give rise to the origin of either of the great arteries. This definition excludes the entity of mitral and tricuspid atresia. An 11 year old cyanotic boy was admitted chief complaints of exertional dyspnea and frequent upper respiratory infection since 2 weeks after birth. He was diagnosed as inoperable cyanotic congenital heart disease, and remained without any corrective treatment up to his age of 11 year when he suffered from aggravation of symptoms and signs of congestive heart failure for 2 months before this admission. On 22nd of May 1979, he was admitted for total corrective operation under the impression of tricuspid atresia suggested by a pediatrician. Physical check revealed deep cyanosis with finger and toe clubbing, and grade V systolic ejection murmur with single second heart sound was audible at the left 3rd intercostal space. Development was moderate in height [135 cm] and weight[28Kg]. Routine lab findings were normal except increased hemoglobin [21.1gm%], hematocrit [64 %], and left axis deviation with left ventricular hypertrophy on EKG. Cardiac catheterization and angiography revealed 1-transposition of aorta, pulmonic valvular stenosis, double inlet of a single ventricle with d-loop, and normal atriovisceral relationship [Type III C solitus according to the classification of Van Praagh]. At operation, longitudinal incision at the outflow tract of right ventricle in between the right coronary artery and its branch [LAD from RCA] revealed high far anterior aortic valve which had fibrous continuity with mitral annulus, and pulmonic valve was stenotic up to 4 mm in diameter positioned posterolaterally to the aorta. Ventricular septum was totally defective, and one markedly hypertrophied moderator band originated from crista supraventricularis was connected down to the imaginary septum of the ventricular cavity as a pseudoseptum of the ventricle. Size of the defect was 3X3 cm2 in total. Patch closure of the defect with a Teflon felt of 3.5 x 4 cm2 was done with interrupted multiple sutures after cut off of the moderator band, which was resutured to the artificial septum after reconstruction of the ventricular septum. Pulmonic valvotomy was done from 4 mm to 11 mm in diameter thru another pulmonary arteriotomy incision, and right ventriculotomy wound was closed reconstructing the right ventricular outflow tract with pericardial autograft of 3 x 4 cm2. Atrial septal defect of 2 cm in diameter was closed with 3-0 Erdeck suture, and atrial wall was sutured also when rectal temperature reached from 24`C to 35.5`C. Complete A-V block was managed with temporary external pacemaker with a pacing rate of 110/min. thru myocardial wire, and arterial blood pressure of 80/50 mmHg was maintained with Isuprel or Dopamine dripping under the CVP of 25-cm saline. Consciousness was recovered one hour after the operation when his blood pressure reached 100 /70 mmHg, but vital signs were not stable, and bleeding from the pericardial drainage and complete anuria were persisted until his heart could not capture the pacemaker impulse, and patient died of low output syndrome 320 min after the operation.

• Journal of Chest Surgery
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• v.12 no.3
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• pp.289-296
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• 1979

For years, physicians and anatomists have been interested in the heart that has one functioning ventricle. Various terms have been suggested for this entity including single ventricle, common ventricle, double-inlet left ventricle, cor biatriatum triloculare, and primitive ventricle. In this report, the term "single ventricle" is utilized as suggested by Van Praagh, and is defined as that congenital cardiac anomaly in which a common or separate atrioventricular valves open into a ventricular chamber from which both great arterial trunks emerge. An outlet chamber, or infundibulum, may or may not be present and give rise to the origin of either of the great arteries. This definition excludes the entity of mitral and tricuspid atresia. An 11 year old cyanotic boy was admitted chief complaints of exertional dyspnea and frequent upper respiratory infection since 2 weeks after birth. He was diagnosed as inoperable cyanotic congenital heart disease, and remained without any corrective treatment up to his age of 11 year when he suffered from aggravation of symptoms and signs of congestive heart failure for 2 months before this admission. On 22nd of May 1979, he was admitted for total corrective operation under the impression of tricuspid atresia suggested by a pediatrician. Physical check revealed deep cyanosis with finger and toe clubbing, and grade V systolic ejection murmur with single second heart sound was audible at the left 3rd intercostal space. Development was moderate in height [135 cm] and weight[28Kg]. Routine lab findings were normal except increased hemoglobin [21.1gm%], hematocrit [64 %], and left axis deviation with left ventricular hypertrophy on EKG. Cardiac catheterization and angiography revealed 1-transposition of aorta, pulmonic valvular stenosis, double inlet of a single ventricle with d-loop, and normal atriovisceral relationship [Type III C solitus according to the classification of Van Praagh]. At operation, longitudinal incision at the outflow tract of right ventricle in between the right coronary artery and its branch [LAD from RCA] revealed high far anterior aortic valve which had fibrous continuity with mitral annulus, and pulmonic valve was stenotic up to 4 mm in diameter positioned posterolaterally to the aorta. Ventricular septum was totally defective, and one markedly hypertrophied moderator band originated from crista supraventricularis was connected down to the imaginary septum of the ventricular cavity as a pseudoseptum of the ventricle. Size of the defect was 3X3 cm2 in total. Patch closure of the defect with a Teflon felt of 3.5 x 4 cm2 was done with interrupted multiple sutures after cut off of the moderator band, which was resutured to the artificial septum after reconstruction of the ventricular septum. Pulmonic valvotomy was done from 4 mm to 11 mm in diameter thru another pulmonary arteriotomy incision, and right ventriculotomy wound was closed reconstructing the right ventricular outflow tract with pericardial autograft of 3 x 4 cm2. Atrial septal defect of 2 cm in diameter was closed with 3-0 Erdeck suture, and atrial wall was sutured also when rectal temperature reached from 24`C to 35.5`C. Complete A-V block was managed with temporary external pacemaker with a pacing rate of 110/min. thru myocardial wire, and arterial blood pressure of 80/50 mmHg was maintained with Isuprel or Dopamine dripping under the CVP of 25-cm saline. Consciousness was recovered one hour after the operation when his blood pressure reached 100 /70 mmHg, but vital signs were not stable, and bleeding from the pericardial drainage and complete anuria were persisted until his heart could not capture the pacemaker impulse, and patient died of low output syndrome 320 min after the operation.

• Journal of Chest Surgery
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• v.45 no.2
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• pp.110-115
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• 2012

Background: Pneumonectomy remains the ultimate curative treatment modality for destroyed lung caused by tuberculosis despite multiple risks involved in the procedure. We retrospectively evaluated patients who underwent pneumonectomy for treatment of sequelae of pulmonary tuberculosis to determine the risk factors of early and long-term outcomes. Materials and Methods: Between January 1980 and December 2008, pneumonectomy or pleuropneumonectomy was performed in 73 consecutive patients with destroyed lung caused by tuberculosis. There were 48 patients with empyema (12 with bronchopleural fistula [BPF]), 11 with aspergilloma and 7 with multidrug resistant tuberculosis. Results: There were 5 operative mortalities (6.8%). One patient had intraoperative uncontrolled arrhythmia, one had a postoperative cardiac arrest, and three had postoperative respiratory failure. A total of 29 patients (39.7%) suffered from postoperative complications. Twelve patients (16.7%) were found to have postpneumonectomy empyema (PPE), 4 patients had wound infections (5.6%), and 7 patients required re-exploration due to postoperative bleeding (9.7%). The prevalence of PPE increased in patients with preoperative empyema (p=0.019). There were five patients with postoperative BPF, four of which occurred in right-side operation. The only risk factor for BPF was the right-side operation (p=0.023). The 5- and 10-year survival rates were 88.9% and 76.2%, respectively. The risk factors for late deaths were old age (${\geq}50$ years, p=0.02) and low predicted postoperative forced expiratory volume in one second (FEV1) (< 1.2 L, p=0.02). Conclusion: Although PPE increases in patients with preoperative empyema and postoperative BPF increases in right-side operation, the mortality rates and long-term survival rates were found to be satisfactory. However, the follow-up care for patients with low predicted postoperative FEV1 should continue for prevention and early detection of pulmonary complication related to impaired pulmonary function.

• Journal of Trauma and Injury
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• v.23 no.2
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• pp.170-174
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• 2010

Purpose: As techniques and instruments for video-assisted thoracic surgery (VATS) have been evolving, attempts to perform VATS for chest trauma have been increasing. Several studies have demonstrated the feasibility and safety of VATS for thoracic trauma. We reviewed our experience to evaluate the clinical feasibility and safety of VATS for thoracic trauma. Methods: Fifty-two patients underwent thoracic surgery for chest trauma in Asan Medical Center from January 1990 to December 2009. VATS was performed in 21 patients who showed stable vital signs. We reviewed retrospectively the medical records of those patients to investigate the results of VATS for thoracic trauma. Results: Thoracic exploration for chest trauma was performed in 52 patients. There were 46 males (88.5%) and 6 females (11.5%). The median age was 46.0 years (range: 11~81 years). There were 39 blunt and 13 penetrating traumas. A standard posterolateral thoracotomy was performed in 31 patients, and VATS was tried in 21 patients. We performed successful VATS in 13 patients; 11 males (84.5%) and 2 females (15.5%) with a median age of 46.0 years (range: 24~75 years). The indication of VATS was persistent intrathoracic hemorrhage in 10 patients and clotted hemothorax in 3 patients. There were no complications, but there were two mortalities due to multiple organ failure after massive transfusion. In 8 patients, VATS was converted to a standard posterolateral thoracotomy for several reasons. The reason was inadequate visualization for bleeding control or evacuation of the hematoma in 5 patients. In 3 patients, VATS was performed to evaluate diaphragmatic injury. After the diaphragmatic injury had been confirmed, a standard posterolateral thoracotomy was performed to repair the diaphragm. Conclusion: VATS should be safe and efficient method for diagnostic evaluation and surgical management of stable patients with thoracic trauma.

• Journal of the Korean Wood Science and Technology
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• v.35 no.6
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• pp.13-22
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• 2007

This study was carried out to scrutinize possibility of manufacturing pitch pine (Pinus rigida) glued laminated timber in order to add values of pitch pine trees. Also, it was investigated to improve bending performance of pitch pine glulam. Pitch pine was imported as one of major plantation species in Korean peninsula. Machine stress rated grades of pitch pine lumber mostly ranged between E7 and E9. which grades were more or less inferior to producing high quality glulam. However, the adhesive properties between pitch pine and pitch pine, and between pitch pine and Japanese larch (Larix kaempferi Carr.), such as shear bond strength, wood failure rate and de-lamination rate of bonded layer submerged in cold and boiling water, were higher than Korean Standard criteria. These properties are essential for manufacturing glulam with single species or multiple species. The modulus of rupture (MOR) of pitch pine glulam exceeded the criterion of Korean Standard for glulam strength grade but modulus of elasticity (MOE) was lower than the criterion. On the other hand, the bending performances (MOR and MOE) were improved 20 percent by mixing with Japanese larch laminar. It is effective to arrange higher quality Japanese larch laminar at the outer layer of glulam for improving bending performances. In conclusion, it is possible to use low quality pitch pine as laminar of structural glulam for adding values of pitch pine.

• Proceedings of the KACD Conference
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• 2008.05a
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• pp.213-223
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• 2008

The objective of this study was to compare dentin shear bond strength (DSBS) of dentin bonding agents (DBAs) cured with a plasma arc (PAC) light curing unit (LCU) and those cured with a light emitting diode (LED) LCU. Optical properties were also analyzed for Elipar freelight 2 (3M ESPE); LED LCU, Apollo 95E (DMT Systems); PAC LCU and VIP Junior (Bisco); Halogen LCU. The DBAs used for DSBS test were Scotchbond Multipurpose (3M ESPE), Singlebond 2 (3M ESPE) and Clearfil SE Bond (Kuraray). After DSBS testing, fractured specimens were analyzed for failure modes with SEM. The total irradiance and irradiance between 450 nm and 490 nm of the LCUs were different. LED LCU showed narrow spectral distribution around its peak at 462 nm whereas PAC and Halogen LCU showed a broad spectrum. There were no significant differences in mean shear bond strength among different LCUs (P > 0.05) but were significant differences among different DBAs (P < 0.001).

• Restorative Dentistry and Endodontics
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• v.33 no.3
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• pp.213-223
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• 2008

The objective of this study was to compare dentin shear bond strength (DSBS) of dentin bonding agents (DBAs) cured with a plasma arc (PAC) light curing unit (LCU) and those cured with a light emitting diode (LED) LCU. Optical properties were also analyzed for Elipar freelight 2 (3M ESPE); LED LCU, Apollo 95E (DMT Systems); PAC LCU and VIP Junior (Bisco); Halogen LCU. The DBAs used for DSBS test were Scotchbond Multipurpose (3M ESPE), Singlebond 2 (3M ESPE) and Clearfil SE Bond (Kuraray). After DSBS testing, fractured specimens were analyzed for failure modes with SEM. The total irradiance and irradiance between 450 nm and 490 nm of the LCUs were different. LED LCU showed narrow spectral distribution around its peak at 462 nm whereas PAC and Halogen LCU showed a broad spectrum. There were no significant differences in mean shear bond strength among different LCUs (P > 0.05) but were significant differences among different DBAs (P < 0.001)

• The Journal of Korean Academy of Prosthodontics
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• v.40 no.6
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• pp.545-559
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• 2002

There has been increasing use of IPS Empress $2^{(R)}$ owing to easy fabrication method, high esthetics similar to natural teeth, good marginal accuracy, and sufficient fracture strength. However, in clinical application, although a luting agent and the tooth cementation bonding procedure influence the marginal accuracy and fracture strength restoration, there has been a controversy in the selection of proper luting agent. This study was to measure the marginal fidelites and fracture strength of IPS Empress crowns according to three cement types, Protec $cem^{(R)}$, Variolink $II^{(R)}$ and Panavia $21^{(R)}$. After construction of 12 experimental dies for each group, IPS Empress $2^{(R)}$ crowns were fabricated and luted the metal master die prepartion of the maxillary right premolar. Marginal gaps before cementation and after cementation were measured. Buccal incline on the functional cusp of specimens were loaded until the catastrophic failure and fracture strength was measured. The results of this study were as follows: 1. The range of gap was $34.04{\pm}4.84{\mu}m$ before cementation and $37.88{\pm}5.00{\mu}m$ after cementation, which showed significant difference by paired t-test (p<0.05). The difference in the results from marginal accuracy according to measuring point proved to be not statistically significant by two-way ANOVA test (p>0.05). 2. The difference in the results from marginal accuracy according to three cement types Proved that The Variolink $II^{(R)}$ cement group had the least gap, $35.43{\pm}5.03{\mu}m$, and showed superior marginal accuracy while there existed statistic significance in Protec $cem^{(R)}$ cement group, $39.06{\pm}4.41{\mu}m$ or Panavia $21^{(R)}$ cement group, $39.16{\pm}4.39{\mu}m$ by two-way ANOVA test & multiple range test (p<0.05). 3. The difference in the results from fractures strength testing according to three cement type groups proved to be statistically significant (p<0.05). The Variolink $II^{(R)}$ cement group shows highest fracture strength of $1257.33{\pm}226.77N$, Panavia $21^{(R)}$ cement group has $1098.08{\pm}138.45N$, and Protec $cem^{(R)}$ cement group represents the lowest fracture strength of $926.75{\pm}115.75N$. 4. Three different cement groups of different components showed acceptable marginal fidelity and fracture strength. It is concluded that IPS Empress $2^{(R)}$ crowns luted using Variolink $II^{(R)}$ cement group had stronger fracture strength and smaller marginal gap than the other cement groups. Although Variolink $II^{(R)}$ resin cement seemed acceptable to clinical applications in IPS Empress $2^{(R)}$ system, the IPS Empress $2^{(R)}$ system still requires long-term research due to the lack of data in clinical applications.