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Change of the Left Atrial Dimension and Transport Function after the Cox-Maze Procedure for Treating Atrial Fibrillation Associated with Mitral Valve Disease: the Short-term and Mid-Term Results (승모판막 질환과 동반된 심방세동에 대한 Cox-Maze 술식 후 좌심방 크기 및 기계적 수축력 변화: 중.단기 경과 관찰 분석)

  • Kim, Hwan-Wook;Lee, Jae-Won;Cho, Won-Chul;Jung, Sung-Ho;Choo, Suk-Jung;Song, Hyun;Chung, Cheol-Hyun
    • Journal of Chest Surgery
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    • v.42 no.3
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    • pp.317-323
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    • 2009
  • Background: Although high efficiency of conversion into sinus rhythm has been demonstrated after performing the Cox-Maze procedure in patients with atrial fibrillation associated with mitral valve disease, the changes in the mechanical function and size of the left atrium have not been determined. The aim of the study was to evaluate the effect of the Maze procedure on the left atrial size and contractile transport function. Material and Method: From July 1997 to July 2008, 647 consecutive patients were operated on for chronic atrial fibrillation associated with mitral valve disease. Among these, 211 patients that (1) were able to be followed up for 2 years after surgery, (2) had sustained normal sinus rhythm, regardless of whether they were taking anti-arrhythmic medications and (3) did not have valvular regurgitation greater than grade III or they did not have moderate grade valvular stenosis were selected for evaluation. The left atrial size and contractile transport function were assessed by transthoracic echocardiography at the postoperative base line (1 year) and at regular follow-up periods (2 years, 3 years, 4 years and 6 year). Result: The left atrial dimension was increased and the contractile transport function was decreased during the follow-up period. The longer the follow-up period, the greater was the statistical significance of the left atrial size increase and contractile transport function decrease. Conclusion: In patients who sustain normal sinus rhythm conversion after a Maze III procedure with a mitral valve operation, there is a gradual increase of the left atrial dimensions and a decrease of contractile transport function during the follow-up period. Therefore, scrupulous follow-up is needed for these patients.

A study on the clinical courses, sigmoidoscopic and histologic findings of allergic proctocolitis (알레르기성 직결장염의 임상상과 내시경 및 조직소견)

  • Lee, Joo Hee;Kim, Sung Shin;Park, Jae Ock
    • Clinical and Experimental Pediatrics
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    • v.51 no.3
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    • pp.276-285
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    • 2008
  • Purpose : Allergic proctocolitis is a major cause of bloody stool in early infancy. This study was aimed at ascertaining the clinical courses, sigmoidoscopic and histologic findings of allergic proctocolitis. We also analyzed the relationship between peripheral eosinophilia, the age at symptom onset, and sigmoidoscopic and histologic findings. Methods : We reviewed 25 infants retrospectively who had sigmoidoscopy and biopsy performed with a clinical diagnosis of allergic proctocolitis from April 2003 to April 2007. Results : The mean age at symptom onset was $15.2{\pm}13.2$ weeks. Fourteen infants (56.0%) were breast fed, one (4.0%) was formula fed, six (24.0%) were on combined formula, and four (16.0%) were on a weaning diet. Peripheral eosinophilia (${\geq}250/mm^3$) was seen in eighteen infants (75.0%), but total serum IgE was increased only in six (24.0%). Sigmoidoscopic findings were variable from normal (8.0%), erythema or edema (20.0%), lymphoid hyperplasia (8.0%), erosion (12.0%), hemorrhage and ulcer (4.0%) to lymphoid hyperplasia with erosion, hemorrhage, or ulcer (48.0%). Histologic findings showed focal infiltration of eosinophils in lamina propria (96.0%) and crypt epithelium (96.0%). In twenty four infants (96.0%), the number of eosinophils in mucosa was increased by a more than 60/10 high power field. There was a negative correlation between peripheral eosinophilia and the age at symptom onset. Among the twelve breast fed infants, bloody stool disappeared in ten (83.0%) with a maternal elimination diet of major food groups, but two improved spontaneously. Conclusion : Allergic proctocolitis should be considered as one of the major causes of bloody stool in healthy appearing infants. To confirm the diagnosis it is necessary to perform sigmoidoscopy and biopsy but histologic findings are more informative than sigmoidoscopic findings. Peripheral eosinophilia was prominent in the infants with an early onset of symptoms. Most infants experienced benign courses and recovered with the elimination of causative foods but did not need exclusive food restrictions.

Post-natal Outcome of Fetal Hydronephrosis Detected with Prenatal Ultrasonography (산전 초음파로 진단된 태아 수신증의 생후 경과 관찰)

  • Park, Youn Jin;Mun, Soon Jung;Bae, Chong Woo;Lee, Bum Ha;Kim, Jin Il
    • Clinical and Experimental Pediatrics
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    • v.45 no.10
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    • pp.1213-1218
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    • 2002
  • Purpose : Hydronephrosis constitutes a great portion of fetal anomalies screened by prenatal sonogram. The present authors made an attempt to access its natural courses through follow up neonatal hydronephrosis diagnosed by prenatal sonogram. Methods : The study was composed of 23 neonates(36 renal units) who were diagnosed with hydronephrosis through prenatal sonogram screening and confirmed 3-7 days after birth with sonographic evaluation at Kyung Hee University Hospital. The neonates were closely monitored for 12-24 months with renal sonogram, diuretic renogram, intravenous pyelography(IVP) and voiding cystoureterography(VCUG). Results : The underlying diseases were composed of 16 cases(44%) of functional abnormalities, 14 cases(39%) of ureteropelvic junction(UPJ) obstruction, three cases(8%) of vesicoureteral reflux (VUR) and on case each of multicystic dysplastic kidney, UPJ obstruction with ureteral stenosis and ureterovesical junction(UVJ) obstruction with VUR. The degree of hydronephrosis was divided into three classes according to its severity. In 30 renal units with UPJ obstruction and functional abnormalities, 26(87%) showed mild hydronephrosis, while four(13%) were moderate. During the follow up period, six cases(20%) showed natural resolution of hydronephrosis, 15 cases(50%) showed improvement while two cases(7%) were aggravated with improvement only after surgery of the underlying disease. The cases which showed natural resolution were all mild hydronephrosis at diagnosis and the cases which underwent surgery due to continuous aggravation were mild one case and moderate one case. Conclusion : Those with cases of mild hydronephrosis show rapid natural improvement. On the other hand, in some cases, follow up monitoring reveal aggravation of the situation, emphasizing the necessity for thorough follow up for a long period of time.

Endoscopic Bio-Imaging Using Optical Coherence Tomography (마이크로 내시경 및 첨단 광 단층촬영기법을 이용한 생체 이미징)

  • Ahn, Yeh-Chan;Brenner, Matthew;Chen, Zhongping
    • Journal of the Korean Society for Nondestructive Testing
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    • v.31 no.5
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    • pp.466-471
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    • 2011
  • Optical coherence tomography(OCT) is an emerging medical diagnostic tool that draws great attention in medical and biological fields. It has a 10-100 times higher spatial resolution than that of the clinical ultrasound but lower imaging depth such as 1-2 mm. In order to image internal organs, OCT needs an endoscopic probe. In this paper, the principle of Fourier-domain optical coherence tomography with high-speed imaging capability was introduced. An OCT endoscope based on MEMS technology was developed. It was attached to the Fourier-domain OCT system to acquire three-dimensional tomographic images of gastrointestinal tract of New Zealand white rabbit. The endoscope had a two-axis scanning mirror that was driven by electrostatic force. The mirror stirred an incident light to sweep two-dimensional plane by scanning. The outer diameter of the endoscope was 6 mm and the mirror diameter was 1.2 mm. A three-dimensional image rendered by 200 two-dimensional tomographs with $200{\times}500$ pixels was displayed within 3.5 seconds. The spatial resolution of the OCT system was 8 ${\mu}m$ in air.

Arthroscopy for the Diagnosis and Treatment of Failed Trochleoplasty in a Dog (활차구 성형술이 실패한 개에서 관절경을 이용한 진단과 치료)

  • Hwang, Junho;Heo, Suyoung;Kim, Bumseok;Lee, Sanghoon;Jeong, Seongmok;Lee, Haebeom
    • Journal of Veterinary Clinics
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    • v.32 no.3
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    • pp.251-254
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    • 2015
  • A 3-year-old castrated male Spitz dog (8.4 kg) was referred for hindlimb lameness. The dog had undergone corrective surgery for bilateral medial patellar luxation 6 weeks prior to presentation. Intermittent lameness of both hind limbs was evident on general inspection. Physical examination revealed moderate pain and crepitus upon flexion and extension of the stifle joints. Radiography revealed features consistent with distal deviation of the cartilage flaps and effusion in both stifle joints. Detachment and deviation of both osteochondral blocks were suspected based on the physical and radiographic findings. Arthroscopy confirmed failed osteochondral blocks (right $1.5cm{\times}0.9cm{\times}0.2cm$, left $1.3cm{\times}0.9cm{\times}0.1cm$), which were removed. After removal of the osteochondral blocks, the stepped trochlear grooves were located and debrided using an arthroscopic burr, to prevent patellar tracking disorder. The dog resumed normal ambulation without medial patellar luxation 2 weeks postoperatively, and there were no complications. Arthroscopy is an effective surgical modality for the diagnosis and treatment of canine joint disorders. It offers a magnified view of the joint, which allows accurate evaluation of intra-articular structures. In addition, arthroscopic surgery can reduce the postoperative complications associated with surgical wound.

Henoch-$Sch{\ddot{o}}nlein$ Nephritis in Children (소아 Henoch-$Sch{\ddot{o}}nlein$ 신염의 추적 관찰)

  • Jang, Hee-Suk;Hong, In-Hee;Go, Cheol-Woo;Koo, Ja-Hun;Kwak, Jung-Sik
    • Childhood Kidney Diseases
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    • v.4 no.2
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    • pp.120-126
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    • 2000
  • Purpose : This retrospective study has been undertaken to find out the clinical outcome of children with HS nephntis and its relationship with initial clinical presentation and/or renal pathologic finding. Patients and methods : Study population consisted of 59 children with HS nephritis who have been admitted to the Pediatric department of Kyungpook University Hospital from 1987 to 1999, and biopsy was done with indications of heavy proteinuria (> 1 g/m2/day) lasting over 1 month, nephrotic syndrome, and persistent hematuria and/or proteinuria over 1 year. Patients were divided clinically into 3 groups ; isolated hematuria, hematuria with proteinuria and heavy proteinuria (including nephrotic syndrome). Biopsy findings ore graded from I-V according to International Study of Kidney Disease in Children (ISKDC). Results : Mean age of presentation was $8.1{\pm}3.0$ years and slight male preponderance m noted (33 boys md 26 girls). Histopathologic grading showed Grade I ; 2, Grade II ; 44, and Grade III ; 13 cases. Clinical outcome at the follow-up period of 1-2 year (49 cases) and 3-4 years (30 cases) shooed normal urinalysis in 75 (30.6$\%$) and 18 cases (60.0$\%$), persistent isolated hematuria in 20 (40.8$\%$) and 2 cases (6.7$\%$), hematuria with proteinuria in 11 (22.5$\%$) and 8 cases (26.6$\%$), and persistent heavy proteinuria in 3 (6.1$\%$) and 2 cases (6.7$\%$) respectively. Clinical outcome according to histopathologic grading showed the frequency of normalization of urinalysis being lower in Grade III compared to grade I or II. Clinical outcome according to initial clinical presentation showed no relationship to the normalization or urinalysis at follow-up periods. However, 15-20$\%$ of children with initial heavy proteinuria showed persistent heavy proteinuria (3 out of 20 cases at 1-2 years, and 2 out of 10 case at 3-4 years of follow-up periods). Conclusion : The majority of children with HS nephritis (histopathologic grade I, II, III) improved within 3-4 years and persistent heavy proteinuria was seen only in a kw of children with initial clinical presentation of heavy proteinuria.

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Lower Lung Field Tuberculosis (폐 하야 결핵)

  • Moon, Doo-Seop;Lim, Byung-Sung;Kim, Yeon-Soo;Kim, Seong-Min;Lee, Jae-Young;Lee, Dong-Suck;Sohn, Jang-Won;Lee, Kyung-Sang;Yang, Suck-Chul;Yoon, Ho-Joo;Shin, Dong-Ho;Park, Sung-Soo;Lee, Jung-Hee
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.2
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    • pp.232-240
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    • 1997
  • Background : Postprimary pulmonary tuberculosis is located mainly in upper lobes. The tuberculous lesion involving the lower lobes usually arises from the upper lobe cavity through endobronchial spread. When tuberculosis is confined to the lower lung field, it often masquerades as pneumonia, lung cancer, bronchiectasis, or lung abscess. Thus the correct diagnosis may be sometimes delayed for a long time. Methods : We carried out, retrospectively, a clinical study on 50 patients confirmed with lower lung field tuberculosis who visited the Department of Pulmonary Medicine at Hanyang University Hospital from January 1992 to December 1994. The following results were obtained. Results : Lower lung field tuberculosis without concomitant upper lobe disease occurred in fifty patients representing 6.9% of the total admission with active pulmonary tuberculosis over a period of 3 years. It occurred most frequently in the third decade but age distribution was relatively even. The mean age was 43 years old. Female was more frequently affected than male (male to female ratio 1 : 1.9). The most common symptom was cough(68%), followed by sputum(52%), fever(38%), and chest discomfort(30%). On chest X-ray of the 50patients, consolidation was the most common finding in 52%, followed by solitary nodule(22%) collapse(16%), cavitary lesion(10%), in decreasing order. The disease confined to the right side in 25 cases, left side 20 cases, and both sides 5 cases. Endobronchial tuberculosis (1) Endobronchial involvement was proved by bronchoscopic examination in 20 of 50patients. (2) Mean age was 44years old and female was more affected than man (male to female ratio 1 : 3). Sputum AFB stain and Mycobacterium tuberculosis culture were positive only in 50% of cases unlikely upper lobe tuberculosis, additional diagnostic methods were needed. In our study, bronchoscopic examination and percutaneous fine needle aspiration biopsy increased diagnostic yield by 18% and 32%, respectively. The most common associated condition was diabetes mellitus(18%) and others were anemia, anorexia nervosa, stomach cancer, and systemic steroid usage. Conclusion : When we find a lower lung field lesion, we should suspect tuberculosis if the patient has diabetes mellitus, anemia, systemic steroid usage, malignancy or other immune suppressed states. Because diagnostic yield of sputum AFB smear & Mycobacterium tuberculosis culture was low, additional diagnostic methods such as bronchoscopy and fine needle aspiration biopsy were needed.

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Integrated Medicine Therapy for an End-stage Lung Cancer Patient with Brain Metastasis (양한방 협진을 통한 뇌전이 동반 말기 폐암환자 치험 1례)

  • Park, Seung-Chan;Kim, Do-Hyung;Han, Chang-Woo;Park, Seong-Ha;Lee, In;Choi, Jun-Yong
    • Journal of Korean Traditional Oncology
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    • v.16 no.2
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    • pp.43-51
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    • 2011
  • Objectives : This study reports one case of a patient diagnosed with non-small cell lung cancer with brain metastasis. Methods : A 79 year-old male patient diagnosed with non-small cell lung cancer with brain metastasis was treated chemotherapy for 3 months and quitted it due to poor general condition. He transferred to Korean medicine hospital and was treated herbal medicine(Saengmaek-san plus Baekhapgogeum-tang gagam), acupuncture, moxibustion, interferential current therapy. To evaluate the patient, we measured of Visual Analogue Scale (VAS), Functional Assessment of Cancer Therapy-Lung (FACT-L), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue). Results : Patient's outcomes were improved during the 1st week regarding VAS (41${\rightarrow}$25), FACT-L (81.2${\rightarrow}$90), FACIT-fatigue (25${\rightarrow}$10). However, dyspnea and cough were was aggravated in the 2nd week. Conclusions : Treatment with Korean medicine therapy may have substantial benefit for patients with end-stage lung cancer. But, Integrated medicine therapy is necessary for proper management of end-stage cancer patients.

Oral rehabilitation of a patient with severely worn dentition using monolithic zirconia (단일구조 지르코니아 보철물을 이용한 심한 마모 환자의 전악 수복 증례)

  • Park, Jun-Seo;Ryu, Jae-Jun
    • The Journal of Korean Academy of Prosthodontics
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    • v.54 no.3
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    • pp.273-279
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    • 2016
  • Severe tooth wear may lead to pathological changes of pulp, imbalance in occlusion as well as functional and esthetic problems. In this case, 34-year-old male came to the hospital because of generally worn dentition due to attrition and erosion. After evaluation, a full mouth restoration with elevation of the vertical dimension of occlusion was planned. After occlusion was stabilized by an occlusal stabilization appliance, centric relation position was recorded and subsequent provisional restorations were fabricated. After evaluation, a CAD-CAM (computer aided design-computer aided manufacturing) prosthetic restoration was carried out using monolithic zirconia. After 12 months of follow up observation, the patient was satisfied with function and esthetic appearance.

Mumps meningoencephalitis without parotitis, after secondary vaccination of Measles-Mumps-Rubella (MMR) : A Case Report (MMR 2차 예방접종을 받은 후 이하선염 없이 발생한 볼거리 뇌염 1례)

  • Choi, Pahn Kyu;Kang, Hyun Goo
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.18 no.9
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    • pp.123-126
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    • 2017
  • Mumps, which are also known as epidemic parotitis,lead to viral infectious diseases that can cause complication such as pancreatitis, orchitis, hearing impairments, oophoritis, parotitis and meningitis. Central nervous system involvement has been reported in up to 65% of mumps patients, with most of these including meningitis. Meningoencephalitis is a rare central nervous system (CNS) complication of the mumps. Measles-Mumps-Rubella (MMR) vaccination has been reported protective effect against clinical complications and hospitalization. Here, we describe acute mumps meningoencephalitis in a 24-year-old female without parotitis who had received the MMR vaccination by age related schedule. She initially visited our hospital with aggravated cognition and confusion. After conservative viral treatment, she recovered cognitive function rapidly and complication was not remained. We report here a case of a patient with good recovery of mumps meningoencephalitis without parotitis after secondary vaccination for MMR.