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Clinical Analysis of Repeated Heart Valve Replacement (심장판막치환술 후 재치환술에 관한 임상연구)

  • Kim, Hyuck;Nam, Seung-Hyuk;Kang, Jeong-Ho;Kim, Young-Hak;Lee, Chul-Burm;Chon, Soon-Ho;Shinn, Sung-Ho;Chung, Won-Sang
    • Journal of Chest Surgery
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    • v.40 no.12
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    • pp.817-824
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    • 2007
  • Background: There are two choices for heart valve replacement-the use of a tissue valve and the use of a mechanical valve. Using a tissue valve, additional surgery will be problematic due to valve degeneration. If the risk of additional surgery could be reduced, the tissue valve could be more widely used. Therefore, we analyzed the risk factors and mortality of patients undergoing repeated heart valve replacement and primary replacement. Material and Method: We analyzed 25 consecutive patients who underwent repeated heart valve replacement and 158 patients who underwent primary heart valve replacement among 239 patients that underwent heart vale replacement in out hospital from January 1995 to December 2004. Result: There were no differences in age, sex, and preoperative ejection fraction between the repeated valve replacement group of patients and the primary valve replacement group of patients. In the repeated valve replacement group, the previously used artificial valves were 3 mechanical valves and 23 tissue valves. One of these cases had simultaneous replacement of the tricuspid and aortic valve with tissue valves. The mean duration after a previous operation was 92 months for the use of a mechanical valve and 160 months for the use of a tissue valve. The mean cardiopulmonary bypass time and aortic cross clamp time were 152 minutes and 108 minutes, respectively, for the repeated valve replacement group of patients and 130 minutes and 89 minutes, respectively, for the primary valve replacement group of patients. These results were statistically significant. The use of an intra aortic balloon pump (IABP) was required for 2 cases (8%) in the repeated valve replacement group of patients and 6 cases (3.8%) in the primary valve replacement group of patients. An operative death occurred in one case (4%) in the repeated valve replacement group of patients and occurred in nine cases (5.1%) in the primary valve replacement group of patients. Among postoperative complications, the need for mechanical ventilation over 48 hours was different between the two groups. The mean follow up period after surgery was $6.5{\pm}3.2$ years. The 5-year survival of patients in the repeated valve replacement group was 74% and the 5-year survival of patients in the primary valve replacement group was 95%. Conclusion: The risk was slightly increased, but there was little difference in mortality between the repeated and primary heart valve replacement group of patients. Therefore, it is necessary to reconsider the issue of avoiding the use of a tissue valve due to the risk of additional surgery, and it is encouraged to use the tissue valve selectively, which has several advantages over the use of a mechanical valve. In the case of a repeated replacement, however, the mortality rate was high for a patient whose preoperative status was not poor. A proper as sessment of cardiac function and patient status is required after the primary valve replacement. Subsequently, a secondary replacement could then be considered.

Analysis of the Environmental Index and Situation Naturalized Plants in the Stream of Downtown Jeonju (전주 도심 하천의 귀화식물 현황과 환경지수 분석)

  • Oh, Hyun-Kyung;Beon, Mu-Sup
    • Korean Journal of Environmental Biology
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    • v.24 no.3
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    • pp.248-257
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    • 2006
  • Total naturalized plant species in the streams of Jeonju were listed as 109 taxa; 24 families, 75 genera, 106 species, 3 varieties. Dividing by stream, Jeonju stream has 75 taxa; 20 families, 55 genera, 73 species, 2 varieties. Samcheon stream has 86 taxa; 19 families, 64 genera, 84 species, 2 varieties. Soyang stream has 80 taxa; 21 families, 60 genera, 77 species, 3 varieties. Urbanization Index (UI) of total streams (109 taxa) was 40.2%. UI was 27.7% in Jeonju stream (75 taxa), 31.7% in Samcheon stream (86 taxa), 29.5% in Soyang stream (80 taxa). Dividing by degree of naturalization classification, 25 taxa (9.2%) were found in class 5, 17 taxa (6.2%) in class 4, 32 taxa (11.8%) in class 3, 27 taxa (9.9%) in class 2 and 8 taxa (2.9%) in class 1. Dividing by introduction period, 48 taxa (44%) aye in period I, 19 taxa (17%) in period II, 42 taxa (39%) in period III. Dividing by growth type, 48 taxa (44%) are annuals, 25 taxa (23%) are biennials, 33 taxa (30%) are perennials. Dividing by the place of origin, 39 taxa (35%) are from Euyope, 33 taxa (30%) from North America, 11 taxa (10%) from Tropic America, 9 taxa (8%) from Europe Asia,5 taxa (5%) from South America, 5 taxa (5%) from China.

High Dose Rate Interstitial Brachytherapy in Soft Tissue Sarcomas : Technical Aspect (연부조직종양에서 고선량율 조직내 방사선치료: 기술적 측면에서의 고찰)

  • Chun Mison;Kang Seunghee;Kim Byoung-Suck;Oh Young-Taek
    • Radiation Oncology Journal
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    • v.17 no.1
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    • pp.43-51
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    • 1999
  • Purpose : To discuss the technical aspect of interstitial brachytherapy including method of implant, insertion time of radioactive source, total radiation dose, and complication, we reviewed patients who had diagnoses of soft tissue sarcoma and were treated by conservative surgery, interstitial implant and external beam radiation therapy Materials and Methods : Between May 1995 and Dec. 1997, ten patients with primary or recurrent soft tissue sarcoma underwent surgical resection (wide margin excision) and received radiotherapy including interstitial brachytherapy. Catheters were placed with regular intervals of 1 ~l.5 cm immediately after tumor removal and covering the critical structures, such as neurovascular bundle or bone, with gelform, muscle, or tissue expander in the cases where the tumors were close to those structures. Brachytherapy consisted of high dose rate, iridium-192 implant which delivered 12~15 Gy to 1 cm distance from the center of source axis with 2~2.5 Gy/fraction, twice a day, starting on 6th day after the surgery, Within one month after the surgery, total dose of 50~55 Gy was delivered to the tumor bed with wide margin by the external beam radiotherapy. Results : All patients completed planned interstitial brachytherapy without acute side effects directly related with catheter implantation such as infection or bleeding. With median follow up duration of 25 months (range 12~41 months), no local recurrences were observed. And there was no severe form of chronic complication (RTOGIEORTC grade 3 or 4). Conclusion : The high dose rate interstitial brachytherapy is easy and safe way to minimize the radiation dose delivered to the adjacent normal tissue and to decrease radiation induced chronic morbidity such as fibrosis by reducing the total dose of external radiotherapy in the management of soft tissue sarcoma with conservative surgery.

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Clinical Application of Stent-graft in Thoracic Aortic Diseases (흉부 대동맥 질환에서 스텐트-그라프트의 임상적 적용)

  • Kim, Kyung-Hwan;Lee, Cheul;Chang, Ji-Min;Chung, Jin-Wook;Ahn, Hyuk;Park, Jae-Hyung
    • Journal of Chest Surgery
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    • v.34 no.9
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    • pp.698-703
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    • 2001
  • Background: Endovascular stent-graft insertion in aortic diseases is now generally accepted as an attractive alternative treatment modality. We reviewed our clinical experiences of endovascular stent-graft insertion in thoracic aorta. Material and Method: Since 1995, we performed 8 cases of endovasclar stent-graft insertion. Preoperative diagnoses were aortic aneurysms in 4, traumatic aortic ruptures in 3, and ruptured aortic pseudoaneurysm in 1. All procedures were performed in angiography room with the guidance of fluoroscopy. The stent-graft device is a custom-made 0.35mm thickness Z-shaped stainless steel wires, intertwined with each other using polypropylene suture ligation. It is covered with expanded Dacron vascular graft. Result: All procedures were performed successfully. Follow-up studies revealed 2 minimal perigraft leakages. There was no significant leakage or graft migration. 2 patients expired due to multiple organ failure and fungal sepsis. Other survivors(6) are doing well. Conclusion: Endovascular stent-graft insertion is relatively saft and effective treatment modality in the managment of various types of aortic diseases. In may be an effective alternative in aortic diseases of great surgical risk.

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The Role of Postoperative External Irradiation for the Incompletely Resected Meningiomas (불완전절제된 수막종에서 수술 후 방사선치료의 역할)

  • Kim Tae-Hyun;Yang Dae-Sik;Kim Chul-Young;Choi Myung-Sun
    • Radiation Oncology Journal
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    • v.18 no.2
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    • pp.85-91
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    • 2000
  • Purpose : The aim of this study is to look for the possible efficacy of postoperative external irradiation for incompletely resected meningiomas. Methods and Materials : From August 198: to January 1997, forty-four patients with intracranial meningioma were treated by postoperative external irradiation. Of the 44 meningiomas, 18 transitional, 13 meningotheliomatous, 6 hemangiopericytic, 4 atypical, 2 fibroblastic and 1 malignant meningioma were identified. We classified all patients into two groups by the histology. The benign group was consisted of the meningotheliomatous, transitional and fibroblastic types. The malignant group was consisted of the atypical, hemangiopericytic and malignat types. In the means of surgery, 37 patients were resected incompletely and 7 patients were managed by biopsy only. After surgery, all patients were received postoperative external irradiation. Radiotherapy was deliverd using Co-60 or 4 MV photon beam to a total dose of 50 to 65 Gy (mean dose 57.4 Gy) with a 1.8 to 2 Gy per fraction. The median follow-up was 48 months (range : 21 $\~$ 101 months). Multivariate analysis of the Influence by age, sex, location, histology and radiation dose on local control has been done using Cox's proportional hazard model. Results : 5-year local control rate was 93.8$\%$ for the benign histology and 51.8$\%$ for the malignant histology (p=0.0110) and overall local control rate at 5 years was 87.4$\%$. The analysis of the prognostic factors, such as age, sex, location, and radiation dose were not significant except for the histology. Conclusion : Adjuvant postoperative external irradiation appears to be significantly improved local control in the patients with incompletely resected meningiomas.

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Surgical Management of Comminuted Midshaft Clavicle Fractures Using Reconstruction Plate and Circumferential Wiring: Does the Circumferential Wiring Interfere with the Bone Union? (쇄골 간부 복합 골절에서 재건 금속판 및 환 강선을 이용한 수술적 치료: 환 강선이 골 유합을 방해하는가?)

  • Kim, Kyung-Tae;Shin, Chung-Shik;Park, Young-Chul;Kim, Dong-hyun;Kim, Min-Woo
    • Journal of the Korean Orthopaedic Association
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    • v.56 no.3
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    • pp.245-252
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    • 2021
  • Purpose: This study examined the radiological and clinical outcomes of internal fixation using a reconstruction plate and 21G circumferential wire in comminuted midshaft clavicular fractures. Materials and Methods: A retrospective cohort study was performed on 51 patients between 2005 and 2019. Thirty-two patients underwent internal fixation with a reconstruction plate and a 21G circumferential wire with minimal soft tissue detachment, and 19 patients underwent surgery without a wire. The patients were assessed with the radiographic parameters, the University of California at Los Angeles (UCLA) score, and the visual analogue scale (VAS) pain score. Based on this, patients who operated without a circumferential wire were set as the control group, and the differences in bone union between the two groups were compared. Results: Thirty-two patients were followed-up for an average of 65 weeks, and 19 patients in the control group were followed-up for an average of 56 weeks. The radiological evaluation confirmed the anatomical reduction and bone union in all 32 patients. No case of nonunion was present. The UCLA score was 32.38 on average and 33.11 in the control group (p=0.395). The VAS score was 1.00 on average and 0.84 in the control group (p=0.668). A significant difference in the bony union time was observed between the group who underwent internal fixation with a reconstruction plate and a 21G circumferential wire with minimal soft tissue detachment, and the control group (p=0.015). On the other hand, there was no statistical significance when other variables were controlled (p=0.107). Conclusion: For displaced midshaft clavicular fractures, internal fixation using a reconstruction plate and 21G circumferential wire maintained accurate anatomical reduction. The satisfactory clinical and radiological results mean that internal fixation using a reconstruction plate and 21G circumferential wire may be a good option for surgical treatment.

The Change of Functional Fitness and Bone Mineral Density on a Long-Term Combined Exercise Intervention in Breast Cancer Survivors. (유방암 생존자의 장기간 복합 운동중재에 따른 기능적 체력과 골밀도의 변화)

  • Kim, Yang-Sook;Kim, Mi-Sook
    • Journal of Life Science
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    • v.18 no.7
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    • pp.968-973
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    • 2008
  • The study was to provide basic data and to examine the effect of combined exercise for 12 months on functional fitness and bone mineral density (BMD) in breast cancer survivors. The subjects of this study were 40 to 60-year-old married women (N=24) who finished their treatments chemotherapy and radiation therapy. They were divided into two groups that exercise group and exercise with alendronate group. Eighteen (T-score=$-2.2{\pm}0.8$) of the 24 women who were diagnosed osteopenia (N=15) and osteoporosis (N=3), participated in combined exercise (EG). The other six (T-score=$-4.6{\pm}0.9$) women who were diagnosed as osteoporosis (EDG), participated in the combined exercise program with osteoporosis drug (Alendronate 70 mg/w). The result of the analysis was as follows: Twelve months after, the participants (N=24) had a significant increase of the items such as sit and reach ups, grip strength (R and L) and sit ups test of functional fitness in the periods. In body composition, FM (fat mass) had significant decrease in periods. In the comparison of BMD, EG (N=18) had no change, while EDG (N=6) had significant improvement in L1, T12 and T-score after 12months. Consequently, complex exercise program (Hatha yoga, elastic band, gym ball) had positive effect on functional fitness and bone mineral density. We suggest that complex exercise program can be applied as recovery program after breast cancer surgery. Further research needs various and repetitive studies from more different targets or methods in the exercise program for its improvement.

Operative Treatment with Locking Compression Plate (LCP) in Proximal Humerus Fracture (잠김 압박 금속판을 이용한 상완골 근위부 골절의 치료)

  • Ha, Sung-Sik;Kim, Jae-Young;Hong, Ki-Do;Sim, Jae-Chun;Kang, Jung-Ho;Park, Kwang-Hee
    • Clinics in Shoulder and Elbow
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    • v.11 no.2
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    • pp.137-142
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    • 2008
  • Purpose: To evaluate the clinical and radiographic results of the treatment of a proximal humerus fracture with a locking compression plate(LCP). Materials and Methods: This study reviewed the results of 24 cases of a proximal humerus fracture treated with a LCP from January 2005 to April 2007, after a follow up of more than 12 months. There were 8 males and 16 females with a mean age of 68.9(33-90) years. The clinical results were evaluated using the Neer's evaluation criteria, and the radiographic results were evaluated using the bone union time and Paavoleinen method. Results: The mean time for bone union was 11.9 weeks. Using the Neer's functional evaluation, 21 cases of the 24 patients (87%) showed excellent or satisfactory results. Twenty two cases (91%) showed good results according to the Paavoleinen method. The complications encountered were metal failure (1 patient), AVN of the humeral head (1 patient) and joint stiffness (1 patient). Conclusion: The LCP demonstrated good results in the treatment of a proximal humerus fracture and has relatively fewer complications than other internal fixators.

Treatment for Urinary Tract Infection of Children in Korea (우리나라 어린이 요로 감염의 치료 행태)

  • Kang, Hee-Gyung;Kim, Kwang-Myung;Cheong, Hae-Il;Choi, Hwang;Choi, Yong
    • Childhood Kidney Diseases
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    • v.5 no.1
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    • pp.15-21
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    • 2001
  • Purpose : Urinary tract infections (UTIs) of children require prompt and correct diagnosis and treatment to reduce the risk of renal damage. As a first step to improve the outcome of UTI in Korea, we investigated the practical variations in the methods of diagnosis, treatment, and evaluation of children with UTI and UTI prevention. Method :A questionnaire related to the individual policy on UTI diagnosis. treatment, imaging test, and prevention was submitted to 26 experts. Result Majority of the experts used bag-collected urine specimen for infants and mid-stream urine specimen for children for urinary culture. With a negative result of culture study, they diagnosed UTI when there was pyuria, positive results of the nitrite test, or bacteriuria. 80 $\%$ of experts prescribed prophylactic antibiotics after upper tract UTI. Operative treatment of vesicoureteral reflux (VUR) was indicated for children older than one or two years old with high-grade VUR, refractory breakthrough infections, or recurrent UTIs. Most of them performed kidney ultrasonography on the diagnosis of UTI and more than half of them evaluated children treated of UTI with vesicocystourethrogram and/or DMSA scintigraphy. Majority did not recommend circumcision. Half of the experts were screening siblings of VUR patients. Conclusion : Considering the variations exposed through this study systematic guidelines for management of children with UTI in Korean would be necessary. (J. Korean Soc Pediatr Nephrol 5 : 15-21, 2001)

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Flowering, Fruiting, Seed Fall and Seed Viability of Acer ukurunduense in Mt. Jungwang, Gangwondo (강원도 중왕산 지역에서 부게꽃나무의 개화, 결실, 종자낙하량 및 종자활력)

  • Kim, Gab Tae;Kim, Hoi Jin
    • Journal of Korean Society of Forest Science
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    • v.103 no.2
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    • pp.153-158
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    • 2014
  • To examine the natural regeneration in the natural mixed-broadlived forest, flowering, fruiting, seed-fall, and seed viabilities of Acer ukurunduense Trautv. & C.A. Mey. (AU) were investigated in Mt. Jungwang, Gangwon-do, from 2009 to 2013. The flower of AU consisited many male and bisexual flowers on the raceme (unusual panicle) and the arrangement of two sex morphs are differed for each inflorescence. Flowering dates are differed between sex morph in the same inflorescence. Stamens are stop growing and disappeared after pollinated pistil begin to grow in bisexual flowers, and male flowers have vestial pistil. The flowers of AU might be pollinated by Apis mellifera, Thyris fenestrella seoulensis, Cerambycidae sp., Andrenidae sp. and Ctenophora sp., and had some mechanism to prevent feom self pollination. The number of flower buds per inflorescence is 189 on June 8, and that of young samaras per inflorescence is 41.2 on June 21. At last ripened samaras per inflorescence is reduced 33.4 on September 5. Mean annual seedfall of AU was 6,720 ea/ha (ranged 670~17,930). Rates of sound seeds are highest 43.2%, and those of damaged or decayed seeds are 41.8%,. Those of undeveloped and empty seeds are 10.2% and 4.8%, respectively. Successful regeneration of AU might be in masting year and on the gap sites with proper conditions to germinate and grow. To understand the natural regeneration of the species, Genus Acer, further study on the fruiting habit, pre- and post-dispersal seed viability, and annual variation on these factor should be needed.