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Giant Coronary Artery Aneurysm Presenting as a Calcified Mediastinal Mass a, Coronary Artery Fistula - A case report - (종격동 종양으로 오인된 거대관상동맥류와 관상동맥루 - 치험 1례 -)

  • Yoon, You-Sang;Lee, Cheol-Joo;Choi, Ho;Kang, Jun-Kyu;Choi, Jin-Wook;Kim, Hyung-Tae
    • Journal of Chest Surgery
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    • v.34 no.10
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    • pp.787-791
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    • 2001
  • Coronary artery aneurysm is a rare disorder. It is defined as abnormal dilatation of coronary artery with diameter exceeding 1.5 times the adjacent normal segments. The incidence of coronary aneurysm is 2.6% in Caucasians and 0.25% in Asians. Over half of the former were associated with atherosclerotic coronary artery disease. However, 70 percents of the latter were nonobstructive coronary artery aneurysms. Coronary artery fistula is a rare disorder. It has been identified in only 0.2% of routine cardiac angiographic studies conducted over a 10-year period. The clinical spectrums are various, asymtomatic, asymptomatic murmur, dyspnea on exertion, fatigue, and congestive heart failure. The right coronary artery (56%) and left coronary artery(36%) are mainly involved in the origin site of congenital coronary artery fistula. The draining site of fistula are right ventricle(39%), right atrium(33%), and pulmonary artery(20%) and so on. This 54 years-old woman had intermittent chest tightness and an abnormal mediastinal shadow on chest roentgenogram and chest C-T examination, which was diagnosed as a mediastinal mass such as teratoma. We performed the operation under left anterolateral thoracotomy for mass excision. However, we knew the mass had the pulsating arterial blood flow through a fine needle puncture of the mass and that it was attached to the left ventricle. We believed the excision of mass on beating heart would be very dangerous. Therefore, we closed the wound without excising the mass. After several days, we performed an echocardiography and coronary angiography, We knew it was cardiac tumor. Incidentally, the patient had a tortuous coronary fistula from the right coronary artery to pulmonary trunk. Using cardiopulmonary bypass with moderate systemic hypothermia, the mass was resected and the fistula was clipped with surgical clips. Pathology of the specimen was a giant coronary arterial aneurysm.

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Analysis of Surgical Risk Factors in Pulmonary (폐국균종의 수술위험인자 분석)

  • 김용희;이은상;박승일;김동관;김현조;정종필;손광현
    • Journal of Chest Surgery
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    • v.32 no.3
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    • pp.281-286
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    • 1999
  • Background: The purpose of this study is to analyze the types of complications, the incidences of complications, and preoperative and postoperative risk factors affecting the incidence of the complication. Material and Method: Between August 1990 and August 1997 in Asan Medical Center, 42 patients(24 men and 18 women) underwent surgical resection for pulmonary aspergilloma. The mean age was 46.6${\pm}$11.5 years(range 29 to 69 years). Hemoptysis(90%) was the most common presentation. Pulmonary tuberculosis was the most common predisposing cause(81%). The associated diseases were bronchiectasis(n=11), active puolmonary tuberculosis(n=9), diabetes mellitus(n=8), lung carcinoid(n=1), and acute myeloblastic leukemia(n=1). Lobectomy was done in 32 cases(76%), segmentectomy or wedge resection in 4, pneumonectomy in 2, and lobectomy combined with segmentectomy in 4. Result: Operative mortality was 2%. The most common postoperative complication was persistent air leakage(n=6). The variables such as age, sex, pulmonary function test, amount and duration of hemoptysis, associated diseases(diabetes mellitus, active pulmonary tuberculosis), mode of preoperative management(steroid, antifungal agent, bronchial arterial embolization), and modes of operative procedures were statistically insignificant. The radiologic extent of infiltration to normal lung parenchyme was statistically significant(p=0.04). Conclusion: We conclude that the extent of the infiltration to normal lung parenchyme in preoperative radiologic studies should be carefully evaluated to reduce the postoperative complications in surgery for pulmonary aspergilloma.

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Video-Assisted Thoracic Surgery Lobectomy: Experience with 36 Cases (비디오 흉강경을 이용한 폐엽절제술: 치험 36예)

  • Lee, Hee-Sung;Lee, Jae-Woong;Kim, Kun-Il;Cho, Sung-Woo;Park, Sang-Jun;Kim, Hyoung-Soo;Shin, Yoon-Cheol;Shin, Ho-Seung
    • Journal of Chest Surgery
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    • v.42 no.6
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    • pp.732-737
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    • 2009
  • Background: Many video-assisted thoracic surgery (VATS) lobectomies are performed as a potential alternative to thoracotomy despite the controversy about the safety and the associated morbidity/mortality rates. Material and Method: Between November 2006 and August 2008, we performed 87 lobectomies (VATS 36, Thoracotomy 51) and we retrospectively reviewed the surgical treatment results. A VATS lobectomy was performed by a 4~5 cm thoracotomy without rib spreading and this included anatomic hilar dissection, individual vessel and bronchus stapling and lymph node dissection. Result: We studied 52 male and 35 female patients whose age ranged from 6 to 79 (average age: $59.8{\pm}15.0$ years). The cases were diagnosed with lung cancer (66) (SQC 24, ADC 38, others 4), pulmonary metastasis (2), carcinoid (2) and benign diseases (17). There was no intraoperative death. Postoperative complications were seen in 5 (15.6%) VATS and 33 (64.7%) thoracotomies, and perioperative death caused by adult respiratory distress syndrome occurred in 1 (2.8%) VATS and 3 (5.9%) thoracotomies. Three patients Underwent conversion to thoracotomy (8.3%). The mean time to chest tube removal was 6 days for VATS and 9.4 days for thoracotomy (p<0.001), and the mean length of the hospital stay was 8 days for VATS and 12.8 days for thoracotomy (p<0.001). Conclusion: VATS lobectomy can be performed safely with low morbidity/mortality rates. Furthermore, all the patients benefited from earlier postoperative rehabilitation and less pain and they were candidates for an earlier return to normal activities.

Radiation Therapy for Superior Vena Cava Syndrome (상대정맥증후군의 방사선치료)

  • Kim, Jin-Hee
    • Radiation Oncology Journal
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    • v.23 no.2
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    • pp.78-84
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    • 2005
  • Purpose: The studied the effect of such variables as the symptom improvement rate, survival and prognostic factors on the treatment results of radiation therapy for Superior Vena Cava Syndrome (SVCS). Materials and Methods: From 1988 to 2003, seventy two patients with SVCS were treated with radiation therapy at the Department of Radiation Oncology, Keimyung University Dongsan Medical Center. The patients' ages ranged from 10 to 83 years old with the median age being 61, and sixty four patients were male. For the causes of the SVCS, 64 patients had lung cancer, four had metastatic lung cancer, two had malignant lymphoma and two had thymoma. The radiotherapy was delivered with 6-MV X-rays and all patients received above 900 cGy up to 6,600 cGy, with the median dose being 4,000 cGy The follow-up periods were from 1 to 180 months with a median of 5.6 months. Results: The main clinical manifestations were dyspnea ($84.7\%$), facial edema ($81.9\%$), arm edema ($22.2\%$), neck vein distension ($25\%$), hoarseness ($12.5\%$) and facial plethora ($5.6\%$). Eighty percent of patients achieved excellent to good symptom improvement and $19.4\%$ experienced minimal improvement. The median survival period was 5.1 months, and overall survival rates were $17.7\%$ at 2 years (2YOS) and $14.8\%$ at five years (5YOS) for all the patients. The median survival period, the two and five year disease free survival rates were 4.3 months, $16.7\%$ and $13.4\%$ for the lung cancer patients, respectively. The total tumor dose was a statistically significant survival factor on the univariate analysis for the patients with lung cancer (2YSR; > 30 Gy, $25.6\%$, $\leq$ 30 Gy $6.7\%$, p<0.01). On the multivariated analysis, a higher total tumor dose (p<0.01) and younger age (p<0.05) were statistically significant factors of survival for the lung cancer patients. Patients with NSCLC showed better survival than did the patients with SCLC, but this was not statistically significant (p > 0.05), Conclusion: Radiation therapy for the patients with SVCS due to malignancy could be an effective treatment. We considered that radiation therapy above 30 Gy of the total tumor dose may improve survival for SVCS due to lung cancer.

Comparison of Phylogenetic Characteristics of Viable but Non-Culturable (VBNC) Bacterial Populations in the Pine and Quercus Forest Soil by 16S rDNA-ARDRA (16S rDNA-ARDRA법을 이용한 소나무림과 상수리나무림 토양 내 VBNC 세균군집의 계통학적 특성 비교)

  • Han Song-Ih;Kim Youn-Ji;Whang Kyung-Sook
    • Korean Journal of Microbiology
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    • v.42 no.2
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    • pp.116-124
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    • 2006
  • In this study was performed to analyze quantitatively the number of viable but non-culturable bacteria in the Pine and Quercus forest soil by improved direct viable count (DVC) and plate count (PC) methods. The number of living bacteria of Pine and Quercus forest soil by PC method were less then 1% of DVC method. This result showed that viable but non-culturable (VBNC) bacteria existed in the forest soil with high percentage. Diversity and structure of VBNC bacterial populations in forest soil were analyzed by direct extracting of DNA and 16S rDNA-ARDRA from Pine and Quercus forest soil. Each of them obtained 111 clones and 108 clones from Pine and Quercus forest soil. Thirty different RFLP types were detected from Pine forest soil and twenty-six different RFLP types were detected from Quercus forest soil by HeaIII. From ARDRA groups, dominant clones were selected for determining their phylogenetic characteristics based on 16S rDNA sequence. Based on the 16S rDNA sequences, dominant clones from ARDRA groups of Pine forest soil were classified into 7 major phylogenetic groups ${\alpha}$-proteobacteria (12 clones), ${\gamma}$-proteobacteria (3 clones), ${\delta}$-proteobacteria (1 clone), Flexibacter/Cytophaga (1 clone), Actinobacteria (4 clones), Acidobacteria (4 clones), Planctomycetes (5 clones). Also, dominant clones from ARDRA groups of Quercus forest soil were classified into 6 major phylogenetic groups : ${\alpha}$-proteobacte,ia (4clones), ${\gamma}$-proteobacteria (2 clones), Actinobacteria (10 clones), Acidobacteria (8 clones), Planctomycetes (1 clone), and Verrucomicobia (1 clone). Result of phylogeneric analysis of microbial community from Pine and Quercus forest soils were mostly confirmed at uncultured or unidentified bacteria, VBNC bacteria of over 99% existent in forest soil were confirmed variable composition of unknown micro-organism.

The Study of Effectiveness of MERS on the Law and Remaining Task (국내 메르스(MERS) 사태가 남긴 과제와 법률에 미친 영향에 대한 소고(小考))

  • Yoon, Jong Tae
    • The Korean Society of Law and Medicine
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    • v.16 no.2
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    • pp.263-291
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    • 2015
  • In May, 2015, a 68 years old man, who has been Middle East Saudi Arabia and the United Arab Emirates, had high fever, muscle aches, cough and shortness of breath. he went two local hospital near his house and the S Medical Center emergency center. He was diagnosed MERS(Middle East respiratory syndrome) and the diseases had put South Korea the fear of epidemics for three months. Especially, this disease has firstly reported in Middle East Asia in September 2012 and spreaded to twenty-six countries. In 21, July, 2015, European Center for disease prevention and control reported 533 people were died and in South Korea, 186 people were infected, 36 people were died and 16,693 people were isolated from MERS. South Korea government were faced into epidemic control and blamed from public. Especially, hospital acquired infection, disease control chain, opening of information, ventilation, lack of isolation bed, the problem of function of local health center, the issue of reparation for hospital and insurance cover rate, the classification of disease, the role of Korea Centers for disease control and prevention, the culture of visiting hospital to see sick people, the issue of hospital multiple room and other related social support policy. it is time to study and discuss to solve these problems. South Korea citizens felt fear and fright from MERS. What is wore, they thought the dieses were out of their government control. It was unusual case for word except Middle East Asia. numerous tourists canceled visiting korea. South korea economic were severly damaged especially, tourism industry. South korea government should admit that they had failed initial action against MERS and take full reasonability from any damages. The government have to open information to public in terms of epidemic diseases and try to prevent any other epidemic diseases and try to work with local governments.

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Perinatal outcomes according To chorionicity in Twin Gestations (쌍생아 임신의 융모막과 주산기 결과)

  • Choi, Eun-Jin;Yun, Hyun-Jin;Hyh, Jae-Won;Hong, Yong-Hong
    • Neonatal Medicine
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    • v.15 no.1
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    • pp.67-74
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    • 2008
  • Purpose : The purpose of this study was to assess the natural history and perinatal outcomes of twin gestations according to chorionicity. Methods : We retrospectively reviewed the medical records of 99 monochorionic (MC) and 206 dichorionic (DC) twin gestations delivered at Il Sin Christian Hospital in Busan between January 2002 and December 2007. The incidences of twin-to-twin transfusion syndrome (TTS) and selective intrauterine growth restriction (sIUGR), as well as perinatal morbidity and mortality, were evaluated. Results : MC twins had a lower gestational age (35.7 vs. 36.6 weeks, P=0.03) at birth and a higher incidence of intrauterine fetal loss (10% vs. 1.5%, P<0.001) than DC twins. The incidence of intrauterine fetal loss was higher in MC sIUGR than in DC sIUGR (19% vs. 2.5%, P=0.025) twins. The number of admissions to the neonatal intensive care unit (NICU; 31% vs. 16%, P=0.042), and the incidence of periventricular leukomalacia (7% vs. 0%, P=0.031), and respiratory distress syndrome with surfactant treatment (27% vs. 11%, P=0.049) were higher in MC than DC twins. The incidences of sIUGR and TTS were 21 and 9% among the MC twins. The incidences of intrauterine fetal loss were higher in MC twins with TTS [6 of 9 (67%)] or sIUGR [4 of 21 (19%)] than uncomplicated MC twins (P<0.001). The frequency of admission to the NICU (P=0.001), the length of hospital stay (P=0.033), the prevalence of periventricular leukomalacia (P=0.011), and intraventricular hemorrhage (P=0.007) were also higher in MC with TTS or sIUGR than in uncomplicated MC twins. Conclusion : The incidence of neonatal complications was higher in MC twins, especially those gestations complicated by TTS or sIUGR.

A New Forage Oat Cultivar 'Taehan' for Early-heading and High-yielding of Double Cropping Cultivation in Paddy Field (이모작 재배에 적합한 조숙성 추파용 귀리 신품종 '태한')

  • Han, Ouk-Kyu;Park, Tae-Il;Park, Hyung-Ho;Song, Tae-Hwa;Oh, Young-Jin;Hwang, Jong-Jin;Kwon, Young-Up
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.33 no.4
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    • pp.227-233
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    • 2013
  • 'Taehan' (Avena sativa L.), a winter oat for forage use, was developed by the breeding team at the Department of Rice and Winter Cereal Crops, NICS, RDA in 2012. It was derived from a cross between 'Malgwiri' and 'CI8015'. Subsequent generations were handled in bulk and pedigree selection programs at Suwon and Yeoncheon, respectively. After 2 years of preliminary and advanced yield tests, 'SO00020B-YB-15-5-9-4-3', designated as 'Gwiri78', were subsequently evaluated for earliness and forage yield during 3 years in four regions such as Yesan, Iksan-1 (Paddy), Iksan-2 (upland), and Jeju from 2010 to 2012, and finally named 'Taehan'. Over 3 years, the heading date of 'Taehan' was about 6 days earlier than that of the check cultivar 'Samhan' (May 8 and May 14, respectively), and their average forage dry matter yield harvested at the milk-ripe stage was 14.5 tone $ha^{-1}$, compared with 14.1 tone $ha^{-1}$ for the check cultivar. The cultivar 'Taehan' was lower than that of the check cultivar 'Samhan' in terms of protein content (6.3% and 7.7%, respectively) and total digestible nutrients (60.7%, and 62.1%, respectively). The TDN yield was more than that of the check cultivar (9.1 tone $ha^{-1}$ and 8.0 tone $ha^{-1}$, respectively). Fall cropping of 'Taehan' is recommended only in areas where average daily minimum mean temperatures in January are > $-6^{\circ}C$, and it should not be cultivated in mountainous areas, where frost damage is likely to occur.

Foreign Body in the Gastrointestinal Tract in Children (소아의 위장관 이물질에 대한 임상적 고찰)

  • Lee, Bo-Hyeong;Lee, Hyun-Kyung;Kim, Mi-Jung;Choi, Kwang-Hae
    • Journal of Yeungnam Medical Science
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    • v.18 no.1
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    • pp.75-84
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    • 2001
  • Background: The accidental swallowing of foreign body is a common problem in the children. Ingested foreign bodies may be managed by endoscopy, observation, or surgery. So we analyzed the methods of removal, type, location and complications of foreign bodies. Materials and Methods: This report reviewed 37 cases of ingested foreign body in the gastrointestinal tract at the Department of Pediatrics, Yeungnam University Hospital between January 1997 and April 2001. Results: The age ranged from 8 months to 8 years. The most prevalent age group was between 1 year and 2 years of age(19%). The male to female ratio was 2.1:1 with 25 male and 12 female patients. The type of foreign bodies were coins in 20 cases(54%), nail in 4 cases(11%), key in 4 cases(11%), pin in 2 cases(5.5%), necklace in 2 cases(5.5%) and others. The locations of foreign bodies were upper esophagus in 12 cases(32.5%), lower esophagus in 4 cases(10.8%), stomach in 16 cases(43.2%), small bowel in 5 cases(13.5%). 4. Presenting symptoms were variable with asymptomatic(59.4%), vomiting(19.0%), epigastric pain(8.1%), dysphagia(5.4%) and others. The methods for removal of foreign bodies included 20 cases of endoscopic removal(54.0%). 3 cases of spontaneous removal(8.1%) and there was no surgical removal. 14 cases(37.9%) did not confirmed removal of foreign body because of no revisit of our hospital. Endoscopic finding of patients were normal(15 cases), ulceration(2 cases), erosion(1 case), inflammation(1 case), mucosal scratch(1 case). Conclusion: It appears that the endoscopic approach is the preferable method for the removal of upper gastrointestinal foreign bodies in the children.

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Effect of soil-ameliorator mixtures on nutrient leaching in sandy paddy soil (사질답토양(砂質畓土壤)에 수종(數種) 개량제(改良劑) 시용(施用)이 양분용탈(養分溶脫)에 미치는 영향(影響))

  • Ahn, Sang-Bae;Park, Jun-Kyu;Yeon, Beong-Yeal;Yuk, Chang-Soo
    • Korean Journal of Soil Science and Fertilizer
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    • v.20 no.2
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    • pp.131-138
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    • 1987
  • Experimental informations on the possible alternative resources of soil addition in sandy paddy soils were obtained by applying fertilizer N, P, and K to the top of 26 cm long columns containing the soil-ameliorator mixture and by determining the concentration and leaching loss of nutrients in percolated water and permeability. 1. Addition of red earth and compost to soils decreased pronouncedly the permeability. Relative magnitude of permeability was compost+slag+red earth > compost+red earth > compost > red earth > compost+slag > slag > non-added soil. 2. Concentration and leaching loss of $NH_4-N$ and $SiO_2$ were high by addition of compost-slag or red earth mixture to soils. The present of these nutrients in soils after experiment was, also, higher than that in non-added soil and in red earth to soils. 3. Those of K, Ca, and Mg were similar to $NH_4-N$ and $SiO_2$. Especially, leaching loss and present of K in soils by addition of compost to soils were higher dramatically than those of non-added soil and of red earth to soils. 4. Those of $Fe^{{+}{+}}$ in non-added soil were much higher than those by addition of compost and slag to soils. These values were the highest in 12 days after submergence, while these of $Mn^{{+}{+}}$ the lowest. 5. Concentration of $NH_4-N$ was high by addition of compost to soils, while the present of it in soils after experiment was tended to be contrary.

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