Kim, Kyung-Hwan;Won, Tae-hee;Kim, Ki-Bong;Ahn, Hyuk
Journal of Chest Surgery
/
v.33
no.1
/
pp.32-37
/
2000
Background: Reconstruction surgery of mitral valve regurgitation is now considered as an effective operative technique and has shown good long-term results. Although reconstructive surgery of mitral valve has been performed since 1970s, we have started only in early 1990s in full scale because of small number of the mitral regurgitation compared to mitral stenosis and lack of knowledge from the viewpoint of patients and physicians. Material and Method: From January 1992 to December 1996, 100 patients underwent repair of the mitral valve for mitral regurgitation with or without mitral stenosis in Seoul National University Hospital. 45(45%) of the patients were men and 55(55%) were women. The mean age was 39.9$\pm$14.4 years. The causes of the mitral regurgitation were rheumatic in 61, degenerative in 28 and others in 11. According to the Carpentier's pathological classification of mitral regurgitation 5 patients were type I. 55 patients were type II and 40 patients were type III. 7 patients underwent concomitant aortic valvuloplasty and 8 patients underwent aortic valve replacement. 7 patients underwent Maze operation or pulmonary vein isolation. Result: There were no operative death but 3 major operative complications: 2patients were postoperative low cardiac output syndrome(needed intra-aortic ballon pump support) and 1 patient was postoperative bleeding. There was one late death(1.0%) The cause of death was sepsis secondary to acute bacterial endocarditis. 3 patients required reoperation for recurred mitral regurgitation. There were no statistically significant risk factors for reoperation. The other 96 patients showed no or mild degree of mitral regurgitation 99 survivors were in NYHA functional class I or II. There were two throumboembolisms but no anticoagulation-related complications. Conclusion: We concluded that mitral valve repair could be performed successfully in most cases of mitral regurgitation even in the rheumatic and combined lesions with very low operative mortality and morbidity. The early results are very promising.
Objective : The purpose of this study was to figure out the radiologic findings and risk factors related to adjacent segment degeneration (ASD) after anterior cervical discectomy and fusion (ACDF) using 3-year follow-up radiography, computed tomography (CT), and magnetic resonance image (MRI). Methods : A retrospective matched comparative study was performed for 64 patients who underwent single-level ACDF with a cage and plate. Radiologic parameters, including upper segment range of motion (USROM), lower segment range of motion (LSROM), upper segment disc height (UDH), and lower segment disc height (LDH), clinical outcomes assessed with neck and arm visual analogue scale (VAS), and risk factors were analyzed. Results : Patients were categorized into the ASD (32 patients) and non-ASD (32 patients) group. The decrease of UDH was significantly greater in the ASD group at each follow-up visit. At 36 months postoperatively, the difference for USROM value from the preoperative one significantly increased in the ASD group than non-ASD group. Preoperative other segment degeneration was significantly associated with the increased incidence of ASD at 36 months. However, pain intensity for the neck and arm was not significantly different between groups at any post-operative follow-up visit. Conclusion : The main factor affecting ASD is preoperative other segment degeneration out of the adjacent segment. In addition, patients over the age of 50 are at higher risk of developing ASD. Although there was definite radiologic degeneration in the ASD group, no significant difference was observed between the ASD and non-ASD groups in terms of the incidence of symptomatic disease.
Background The free anterolateral thigh (ALT) flap has been widely used for various kinds of reconstructions. However, delayed healing at the donor site occasionally occurs due to wound dehiscence or the partial loss of grafted skin at the donor site. The aim of the present study was to identify reliable predictive factors for delayed healing at the donor site after the harvest of a free ALT flap. Methods This study included 52 patients who underwent reconstructive procedures using free ALT flaps. The delayed healing group included patients with wounds at the donor site that had not healed over 3 weeks after surgery, and the normal healing group included patients who showed wound healing within 3 weeks after surgery. Multivariate logistic regression models were created to identify the risk factors for delayed healing at the ALT flap donor site. Results Among the 52 patients, 24 (46.2%) showed delayed healing at the donor site, and 6 patients required additional operative treatment. A high preoperative body mass index (BMI), smoking, and skin grafting were found to be significantly associated with delayed healing at the ALT donor site. Of the 37 patients who underwent skin grafting, 23 (62%) experienced delayed healing at the donor site. Conclusions A high preoperative BMI, smoking, and skin grafting were risk factors for delayed healing at the free ALT donor site. Skin grafting at the ALT donor site should be avoided in patients with a high BMI or a habit of smoking.
Minsang Kang;Jae Woong Choi;Suk Ho Sohn;Ho Young Hwang;Kyung Hwan Kim
Journal of Chest Surgery
/
v.56
no.5
/
pp.304-310
/
2023
Background: The late progression of tricuspid regurgitation (TR) after mitral valve surgery is well known. However, few reports have described the progression of TR after aortic valve surgery. We investigated the incidence of and risk factors for the development of significant TR after isolated aortic valve replacement (AVR). Methods: This study analyzed patients with less than moderate TR who underwent isolated AVR at Seoul National University Hospital from January 1990 to December 2018. Significant TR was defined as moderate or higher. Echocardiographic follow-up was performed in all patients. The Fine-Gray model was used to identify clinical risk factors for the development of significant TR. Results: In total, 583 patients (61.7±14.2 years old) were included. Operative mortality occurred in 9 patients (1.5%), and the overall survival rates at 10, 20, and 25 years were 91.1%, 83.2%, and 78.9%, respectively. Sixteen patients (2.7%) developed significant TR during the follow-up period (13 moderate; 3 severe). The cumulative incidence of significant TR at 10, 20, and 25 years was 0.77%, 3.83%, and 6.42%, respectively. No patients underwent reoperation or reintervention of the tricuspid valve. Hemodialysis or peritoneal dialysis for chronic kidney disease (hazard ratio [HR], 5.188; 95% confidence interval [CI], 1.154-23.322) and preoperative mild TR (HR, 5.919; 95% CI, 2.059-17.017) were associated with the development of significant TR in the multivariable analysis. Conclusion: TR progression after isolated AVR in patients with less than moderate TR is rare. Preoperative mild TR and hemodialysis or peritoneal dialysis for chronic kidney disease were significant risk factors for the development of TR.
Kim, Myungjin;Bae, Heekyung;Choi, Yeonki;Kim, Mi Kyoung;Koo, Hyun-Ju;Song, Sang-Hwan;Choi, Kwang-Soo
Journal of Environmental Impact Assessment
/
v.14
no.5
/
pp.347-353
/
2005
The risk assessment is the qualitative or quantitative evaluation of the risk posed to human health and the environment by the actual or potential presence or release of hazardous substances, pollutants or contaminants. The environmental impact assessment (EIA) is assessed by the environmental criteria, and risk assessment is assessed by the risk rate. Risk rate based on dose-response values may not be easy to apply on regulatory basis like EIA for uncertainty. Internationally there is an example of OECD program. Risk assessment of High Production Volume (HPV) Chemicals has started since the OECD Program with the 1990 Council Act on the Co-operative Investigation and Risk Reduction of Existing Chemicals. These HPV chemicals include all chemicals produced or imported at levels greater than 1,000 tonnes per year in at least one Member country or in the European Union region. The SIDS called the Screening Information Data Set is regarded as the minimum information needed to assess an HPV chemical to determine whether any further work should be carried out or not. All the data elements of SIDS including assessment for environment and health are prepared as three formats of the full SIDS Dossier, the SIDS Initial Assessment Report (SIAR), and the SIDS Initial Assessment Profile (SIAP) of an HPV chemical. In 1998 the global chemical industry through the International Council of Chemical Associations (ICCA) has joined to work with OECD. The OECD has assessed approximately 1,000 chemicals from 1991 through 2004 with ICCA. Till the February of 2005, 592 chemicals of those chemicals completed SIDS reports. Member countries have been targeted the goal of 1,000 new chemicals from 2005 to 2010 and Korea shared 36 chemicals from the 1,000 new chemicals. Currently Korea has completed SIDS reports of 7 chemicals among sponsored 24 chemicals. In conclusion SIDS project will be linked to national program for outputs application with more reliable production. Both the OECD and industry will carry out their commitment to complete assessments for more and the remaining chemicals assessment. The major outputs will contribute to cope with international chemical management.
Ku, Min Jung;Kim, Su Wan;Lee, Seogjae;Chang, Jee Won;Lee, Jonggeun
Journal of Chest Surgery
/
v.53
no.5
/
pp.258-262
/
2020
Background: The aim of this study was to evaluate risk factors associated with difficult heparin reversal by protamine after cardiopulmonary bypass. Methods: Data from 120 consecutive patients who underwent open heart surgery from 2009 to 2017 were retrospectively reviewed. Patients were divided into 2 groups: (1) those in whom complete heparin reversal was achieved after a single infusion of protamine (group A, n=89); and (2) those who required more protamine for heparin reversal (group B, n=31). Results: Female sex, prolonged bypass time (>200 min), long aortic cross-clamping time (>120 min), and a lowest rectal temperature <26℃ were significant predictors of difficult heparin reversal. Larger amounts of fresh frozen plasma and platelet concentrate were transfused in group B than in group A. Conclusion: Surgeons' efforts to reduce operative time and avoid deep hypothermia may be helpful for increasing the likelihood of easy heparin reversal, especially in female patients.
Though implant treatment is considered as a common treatment option for edentulous patients, there have been few studies on the temporomandibular disorder (TMD) related with implant treatment. The purposes of this study were to evaluate the relevance of TMD to the implant patients and to evaluate the risk factors of TMD in relation with implant treatment. For the evaluation of various risk factors of TMD in relation with implant therapy, clinical evaluation focused on patient factors and implant factors. From a group of 694 patients, 25 patients (3.6 %) were included in this study. The majority of the patients were included in the asymptomatic 'adaptive' group. Parafunction was detected in 11 patients, 8 patients were male. Four patients having parafunction showed complications such as implant failure or fracture of the suprastructure. From the results, it is possible that TMJ related symptoms are developed or aggravated after implant therapy, which requires relatively more chair time; so TMJ examination should be included in the pre-operative evaluation for dental implant patients. Also, it is important to treat patients after they sign an informed consent that includes a detailed explanation on the possibility of TMD during treatment.
A vascular necrosis of the talus has frequently been reported following trauma because talus has no muscle insertions, sixty percent of the surface of the talus is covered by hyaline cartilage, takes only a small area for entrance of a blood supply. Osteonecrosis is also associated with a variety of nontraumatic disorders. There are many indications for steroid usage, patient with rheumatoid arthritis, systemic lupus erythematosus, chronic obstructive pulmonary disease, and status- post renal or cardiac transplantation may be on long- term steroid usage, osteonecrosis may develop. A vascular necrosis of the talus secondary to chronic steroid usage is an unusual case. Delay in detection of osteonecrosis may lead to fragmentation and collapse of the talar body. When pain on range of motion is present and conservative treatment have been exhausted, surgical treatment is indicated, that is, fusion of the ankle joint. However it is important that conservative treatment may prevent its various sequelae with early diagnosis because steroid - treated patients have a more operative risk and increased risk for postoperative infection. We report a rare case of corticosteroid induced avascular necrosis of talus after cardiac transplantation.
We reviewed our entire experience of 44 consecutive patients undergoing the arterial switch operation [ASO] for transposition of the great arteries [TGA] since March 1985.There were 28 patients with simple TGA[group I] and 16 with associated ventricular septal defect[VSD] [Group II] There were five hospital deaths[11.4%, 5/44], two related to single right coronary artery anatomy. There have been no late deaths. For group I hospital mortality was 14.3%[4/28], and for group II this was 6.25%[1/16]. Mean follow-up was 3.3 years[range 1 month to 8 years] and was completed for all patients. Actuarial survival at 7 years for hospital survivors was 85 $\pm$ 3.2 % in group I and 94 $\pm$ 3.5% in groupII. One patient has mild asymptomatic left ventricular outflow tract obstruction, and five patients [12.8 %,5/ 39] have right ventricular outflow tract gradients[RVOTO] exceeding 25 mmHg; only one patient has required reoperation for RVOTO. Mild neoaortic regurgitation is present in one patient. All survivors are currently in NYHA class I without medicalion, and all are in sinus rhythm. The ASO is associated with low operative risk and excellent medium-term outcome in most subsets of patients undergoing this operation. With more experience, improved results can be expected also in those patients currently at higher risk.
We reviewed our experiences on 33 patients who underwent a bidirectional cavopulmonary shunt[BCPS from February 1992 to July 1994. There were 19 male an 14 female patients, and their weight ranged from 4.4 to 13.3 Kg[mean weight 8.4 $\pm$2.9 Kg . The age ranged from 2 to 55 months [mean age 16.7 $\pm$15.5 months . Their diagnosis included single ventricle group in 16, unbalanced ventricles in 8 whose associated anomalies were double outlet right ventricle, transposition of great arteries and total anomalous pulmonary venous return, tricuspid atresia in 7, hypoplastic left heart syndrome in 1 who underwent a Norwood procedure and double outlet right ventricle with pulmonic stenosis and tricuspid stenosis in 1 who underwent biventricular repair. Among them 10 patients had received other palliative operation before [Norwood procedure 1, pulmonary artery banding 3, modified Blalock-Taussig shunt 6 . The BCPS operations were performed under the cardiopulmonary bypass. 16 patients underwent unilateral BCPS and 17 patients who had bilateral SVC underwent bilateral BCPS. Three patients whose associated anomalies were interruption of IVC underwent total cavopulmonary shunt. There were 5 operative deaths [mortality rate 15.1 % and 2 late deaths. The risk factor for the operation was high mean pulmonary artery pressure [p value<0.05 . The survivors showed good postoperative course and their postoperative oxygen saturation was increased significantly compared to that of preoperative status[p value<0.05 .Conclusively, BCPS operation is effective and safe palliative procedure for the many cyanotic complex congenital anomalies with decreased pulmonary blood flow especialy for the patients who have the high risk factors for Fontan operations.
본 웹사이트에 게시된 이메일 주소가 전자우편 수집 프로그램이나
그 밖의 기술적 장치를 이용하여 무단으로 수집되는 것을 거부하며,
이를 위반시 정보통신망법에 의해 형사 처벌됨을 유념하시기 바랍니다.
[게시일 2004년 10월 1일]
이용약관
제 1 장 총칙
제 1 조 (목적)
이 이용약관은 KoreaScience 홈페이지(이하 “당 사이트”)에서 제공하는 인터넷 서비스(이하 '서비스')의 가입조건 및 이용에 관한 제반 사항과 기타 필요한 사항을 구체적으로 규정함을 목적으로 합니다.
제 2 조 (용어의 정의)
① "이용자"라 함은 당 사이트에 접속하여 이 약관에 따라 당 사이트가 제공하는 서비스를 받는 회원 및 비회원을
말합니다.
② "회원"이라 함은 서비스를 이용하기 위하여 당 사이트에 개인정보를 제공하여 아이디(ID)와 비밀번호를 부여
받은 자를 말합니다.
③ "회원 아이디(ID)"라 함은 회원의 식별 및 서비스 이용을 위하여 자신이 선정한 문자 및 숫자의 조합을
말합니다.
④ "비밀번호(패스워드)"라 함은 회원이 자신의 비밀보호를 위하여 선정한 문자 및 숫자의 조합을 말합니다.
제 3 조 (이용약관의 효력 및 변경)
① 이 약관은 당 사이트에 게시하거나 기타의 방법으로 회원에게 공지함으로써 효력이 발생합니다.
② 당 사이트는 이 약관을 개정할 경우에 적용일자 및 개정사유를 명시하여 현행 약관과 함께 당 사이트의
초기화면에 그 적용일자 7일 이전부터 적용일자 전일까지 공지합니다. 다만, 회원에게 불리하게 약관내용을
변경하는 경우에는 최소한 30일 이상의 사전 유예기간을 두고 공지합니다. 이 경우 당 사이트는 개정 전
내용과 개정 후 내용을 명확하게 비교하여 이용자가 알기 쉽도록 표시합니다.
제 4 조(약관 외 준칙)
① 이 약관은 당 사이트가 제공하는 서비스에 관한 이용안내와 함께 적용됩니다.
② 이 약관에 명시되지 아니한 사항은 관계법령의 규정이 적용됩니다.
제 2 장 이용계약의 체결
제 5 조 (이용계약의 성립 등)
① 이용계약은 이용고객이 당 사이트가 정한 약관에 「동의합니다」를 선택하고, 당 사이트가 정한
온라인신청양식을 작성하여 서비스 이용을 신청한 후, 당 사이트가 이를 승낙함으로써 성립합니다.
② 제1항의 승낙은 당 사이트가 제공하는 과학기술정보검색, 맞춤정보, 서지정보 등 다른 서비스의 이용승낙을
포함합니다.
제 6 조 (회원가입)
서비스를 이용하고자 하는 고객은 당 사이트에서 정한 회원가입양식에 개인정보를 기재하여 가입을 하여야 합니다.
제 7 조 (개인정보의 보호 및 사용)
당 사이트는 관계법령이 정하는 바에 따라 회원 등록정보를 포함한 회원의 개인정보를 보호하기 위해 노력합니다. 회원 개인정보의 보호 및 사용에 대해서는 관련법령 및 당 사이트의 개인정보 보호정책이 적용됩니다.
제 8 조 (이용 신청의 승낙과 제한)
① 당 사이트는 제6조의 규정에 의한 이용신청고객에 대하여 서비스 이용을 승낙합니다.
② 당 사이트는 아래사항에 해당하는 경우에 대해서 승낙하지 아니 합니다.
- 이용계약 신청서의 내용을 허위로 기재한 경우
- 기타 규정한 제반사항을 위반하며 신청하는 경우
제 9 조 (회원 ID 부여 및 변경 등)
① 당 사이트는 이용고객에 대하여 약관에 정하는 바에 따라 자신이 선정한 회원 ID를 부여합니다.
② 회원 ID는 원칙적으로 변경이 불가하며 부득이한 사유로 인하여 변경 하고자 하는 경우에는 해당 ID를
해지하고 재가입해야 합니다.
③ 기타 회원 개인정보 관리 및 변경 등에 관한 사항은 서비스별 안내에 정하는 바에 의합니다.
제 3 장 계약 당사자의 의무
제 10 조 (KISTI의 의무)
① 당 사이트는 이용고객이 희망한 서비스 제공 개시일에 특별한 사정이 없는 한 서비스를 이용할 수 있도록
하여야 합니다.
② 당 사이트는 개인정보 보호를 위해 보안시스템을 구축하며 개인정보 보호정책을 공시하고 준수합니다.
③ 당 사이트는 회원으로부터 제기되는 의견이나 불만이 정당하다고 객관적으로 인정될 경우에는 적절한 절차를
거쳐 즉시 처리하여야 합니다. 다만, 즉시 처리가 곤란한 경우는 회원에게 그 사유와 처리일정을 통보하여야
합니다.
제 11 조 (회원의 의무)
① 이용자는 회원가입 신청 또는 회원정보 변경 시 실명으로 모든 사항을 사실에 근거하여 작성하여야 하며,
허위 또는 타인의 정보를 등록할 경우 일체의 권리를 주장할 수 없습니다.
② 당 사이트가 관계법령 및 개인정보 보호정책에 의거하여 그 책임을 지는 경우를 제외하고 회원에게 부여된
ID의 비밀번호 관리소홀, 부정사용에 의하여 발생하는 모든 결과에 대한 책임은 회원에게 있습니다.
③ 회원은 당 사이트 및 제 3자의 지적 재산권을 침해해서는 안 됩니다.
제 4 장 서비스의 이용
제 12 조 (서비스 이용 시간)
① 서비스 이용은 당 사이트의 업무상 또는 기술상 특별한 지장이 없는 한 연중무휴, 1일 24시간 운영을
원칙으로 합니다. 단, 당 사이트는 시스템 정기점검, 증설 및 교체를 위해 당 사이트가 정한 날이나 시간에
서비스를 일시 중단할 수 있으며, 예정되어 있는 작업으로 인한 서비스 일시중단은 당 사이트 홈페이지를
통해 사전에 공지합니다.
② 당 사이트는 서비스를 특정범위로 분할하여 각 범위별로 이용가능시간을 별도로 지정할 수 있습니다. 다만
이 경우 그 내용을 공지합니다.
제 13 조 (홈페이지 저작권)
① NDSL에서 제공하는 모든 저작물의 저작권은 원저작자에게 있으며, KISTI는 복제/배포/전송권을 확보하고
있습니다.
② NDSL에서 제공하는 콘텐츠를 상업적 및 기타 영리목적으로 복제/배포/전송할 경우 사전에 KISTI의 허락을
받아야 합니다.
③ NDSL에서 제공하는 콘텐츠를 보도, 비평, 교육, 연구 등을 위하여 정당한 범위 안에서 공정한 관행에
합치되게 인용할 수 있습니다.
④ NDSL에서 제공하는 콘텐츠를 무단 복제, 전송, 배포 기타 저작권법에 위반되는 방법으로 이용할 경우
저작권법 제136조에 따라 5년 이하의 징역 또는 5천만 원 이하의 벌금에 처해질 수 있습니다.
제 14 조 (유료서비스)
① 당 사이트 및 협력기관이 정한 유료서비스(원문복사 등)는 별도로 정해진 바에 따르며, 변경사항은 시행 전에
당 사이트 홈페이지를 통하여 회원에게 공지합니다.
② 유료서비스를 이용하려는 회원은 정해진 요금체계에 따라 요금을 납부해야 합니다.
제 5 장 계약 해지 및 이용 제한
제 15 조 (계약 해지)
회원이 이용계약을 해지하고자 하는 때에는 [가입해지] 메뉴를 이용해 직접 해지해야 합니다.
제 16 조 (서비스 이용제한)
① 당 사이트는 회원이 서비스 이용내용에 있어서 본 약관 제 11조 내용을 위반하거나, 다음 각 호에 해당하는
경우 서비스 이용을 제한할 수 있습니다.
- 2년 이상 서비스를 이용한 적이 없는 경우
- 기타 정상적인 서비스 운영에 방해가 될 경우
② 상기 이용제한 규정에 따라 서비스를 이용하는 회원에게 서비스 이용에 대하여 별도 공지 없이 서비스 이용의
일시정지, 이용계약 해지 할 수 있습니다.
제 17 조 (전자우편주소 수집 금지)
회원은 전자우편주소 추출기 등을 이용하여 전자우편주소를 수집 또는 제3자에게 제공할 수 없습니다.
제 6 장 손해배상 및 기타사항
제 18 조 (손해배상)
당 사이트는 무료로 제공되는 서비스와 관련하여 회원에게 어떠한 손해가 발생하더라도 당 사이트가 고의 또는 과실로 인한 손해발생을 제외하고는 이에 대하여 책임을 부담하지 아니합니다.
제 19 조 (관할 법원)
서비스 이용으로 발생한 분쟁에 대해 소송이 제기되는 경우 민사 소송법상의 관할 법원에 제기합니다.
[부 칙]
1. (시행일) 이 약관은 2016년 9월 5일부터 적용되며, 종전 약관은 본 약관으로 대체되며, 개정된 약관의 적용일 이전 가입자도 개정된 약관의 적용을 받습니다.