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The Mid Term Clinical Result and the Risk Factor Analysis of Isolated Aortic Valve Replacement (단독 대동맥판막 치환술의 중기 성적과 그 위험인자에 대한 분석)

  • Park Jae-Min;Jun Hee-Jae;Yoon Young-Chul;Lee Yang-Hang;Hwang Yoon-Ho;Cho Kwang Hyun;Han Il-Yong
    • Journal of Chest Surgery
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    • v.38 no.2 s.247
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    • pp.110-115
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    • 2005
  • Background: The aims of this paper were to review the mid term clinical results and to analyze the preoperative risk factors of isolated aortic valve replacement (AVR). Material and Method: Between January 1992 and February 2003, 80 patients underwent isolated AVR. 58 were male and 22 were female patients, raging from 12 to 75 years of age (mean :$46.8{\pm}13.0$ years). 74 patients except one early death and 5 follow-up loss were contacted by OPD or by telephone. The mean duration of follow-up was $44.2{\pm}29.7$ months and the total cumulative period was 272.8 patient-year. Result: The complications in hospital occurred in 35 cases : 12 wound problems (11 superficial, 1 deep), 11 arrhythmias (9 temporary, 2 persistent), 3 low cardiac output, and so forth. The late deaths were 4 cases : the heart-related deaths were 2 cases ($0.7\%$ patient-year). Conclusion: The risk factors that influenced the early mortality and morbidity were older age (> 60 years)(p=0.04), poor preoperative NYHA functional class (> 3) (p=0.048), high preoperative serum creatinin level (> 1.2 mg/100 ml)(p=0.031), long operation time (aortic clamping time>90 min)(p=0.042). The same factors influenced the late mortality and morbidity. Freedom from valve-related complication was $86.4{\pm}5.3\%,$ actuarial survival rate were $96.8{\pm}2.3\%$ at 3 years and $90.8{\pm}4.6\%$ at 10 years.

Efficacy of Ultrasonogram for the Diagnosis of Biceps Tendon Pathology (상완 이두건의 병소에 대한 초음파 검사의 유용성)

  • Seo, Joong-Bae;Lee, Jee-Young;Bahng, Seung-Chul
    • Clinics in Shoulder and Elbow
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    • v.11 no.2
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    • pp.90-95
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    • 2008
  • Purpose: We wanted to assess the accuracy of ultrasound for detecting abnormality of the long head of the biceps tendon in patients with rotator cuff disorders. Materials and Methods: Between January 2006 and March 2007, we reviewed the arthroscopic findings of biceps tendons in 67 patients with rotator cuff disorder and who underwent ultrasonography pre-operatively. The patients' average age was 58 years and there were 41 males and 26 females. The statuses of the biceps tendons were described as 'normal', 'dislocation', 'subluxation', 'partial or complete tears', and 'tendinopathy'. We investigated the correspondence between the arthroscopic and ultrasonographic findings. Results: On ultrasonography, the biceps tendons were 'normal' in 37 patients and 'abnormal' in 30 patients. On arthroscopy, 5 biceps tendons turned out to have partial tears, which were 'normal' on ultrasonography. On the other hand, 8 biceps tendons were 'normal' which were 'abnormal' on ultrasonography. Three dislocations and 4 complete tears of biceps tendons were identified on arthroscopy, and all of them were detected by ultrasonography. Of the 20 cases of 'tendinopathy' seen on ultrasonography, 15 patients had partial tears and the remaining 5 patients were normal on arthroscopy. Conclusion: Ultrasonography is accurate for detecting some biceps pathologies, such as dislocation or complete tear, but it is not accurate for the detection of partial tear.

The Clinical Evaluation of Anomalous Bronchi Arising From The Trachea and Main Bronchi (기관 및 주기관지에서 발생한 기관지기형의 임상적 고찰)

  • Kim, Jun Chul;Kim, Yeon Jae;Kang, Byung Jun;Youn, Young Deuk;Lee, Se Young;Kwon, Young Lan;Lee, Soo Ok;Jeong, Chi Yeong;Lee, Byung Ki
    • Tuberculosis and Respiratory Diseases
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    • v.59 no.6
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    • pp.664-669
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    • 2005
  • Objectives : To evaluate the clinical significance of abnormal bronchi originating from the trachea or main bronchi. Methods : 21 patients (male:female ratio, 13:8; mean age, 58.2 years, range 34-77), who were diagnosed with major tracheobronchial anomalies by bronchoscopy from January 2001 to March 2005, were enrolled in this study. The anomalous bronchi consisted of 13 tracheal bronchi and 8 cardiac accessory bronchus. The clinical features, bronchoscopic findings, and outcomes were analyzed retrospectively. Results : Common symptoms, including hemoptysis, cough and dyspnea, resulted from the underlying lung disease regardless of the bronchial anomalies. In this series of 13 tracheal bronchi, 7 cases originated from the trachea within 1cm of the carina (carinal type) and 6 cases originated at a higher level(tracheal type). Most patients had favorable outcome with conservative treatment for the underlying lung disease. Conclusion : Most tracheobronchial anomalies are found incidentally in the process of diagnosing lung disease. The clinical outcome of patients with a bronchial anomaly depends on the underlying lung disease.

Early & Midterm Results after Redo Coronary Artery Bypass Grafting (관상동맥우회술 후 재수술의 단기 및 증기 성적)

  • 김준성;김홍관;장우익;김기봉
    • Journal of Chest Surgery
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    • v.37 no.2
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    • pp.146-153
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    • 2004
  • As the experience of coronary artery bypass grafting (CABG) has been accumulated, the number of reoperation after CABG is increasing. We analyzed our clinical experience of redo-CABG. Material and Method: Fourteen patients who underwent redo-CABG between Jan. 1994 and Dec. 2002 were included in this study. The mean period from the first operation to reoperation was 66$\pm$56 (3∼157) months, and the average ages were 62.8$\pm$8.7 (51∼78) years. The survivors were followed up 39$\pm$29 (4∼101) months postoperatively. Indications of reoperation were stenosis or occlusion of previous grafts in 11 patients, progression of native coronary artery disease in one patient, and both etiologies in two patients. Result: There were two in-hospital mortalities (14.3%) resulting from low cardiac output syndrome, Postoperative morbidities were perioperative myocardiac infarction in 2 patients (14.3%), mediastinitis in one patient (7.2%), duodenal perforation in one patient, ischemic necrosis of the lower extremity in one patient, gastric perforation after mesenteric infarct in one patient, delayed brain infarct in one patient, and intraoperative splenic rupture in one patient. There was one late mortality at six months postoperatively during the follow up. There was no angina recurrence during the follow up. Conclusion: Although redo CABG demonstrated relatively high operative mortalities and morbidities, postoperative status and clinical outcome of the survivors were favorable.

Comparison of Immunohistochemical Expression of CBP(cAMP-responsive Element Binding Protein) Transcriptional Co-activator between Premalignant Lesions and Squamous Cell Carcinomas in the Lungs (전암성 폐병변 및 편평상피세포폐암 조직에서 CBP(cAMP-responsive Ele-ment Binding Protein) 전사 공동 활성인자의 면역조직화학적 발현양상의 비교)

  • Shin, Jong Wook;Kim, Jin Soo;Kim, Mi Kyung
    • Tuberculosis and Respiratory Diseases
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    • v.63 no.2
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    • pp.165-172
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    • 2007
  • Background: The pathogenesis of lung cancer includes the accumulation of multiple genetic abnormalities. The CREB-binding protein(CBP) is one of several transcriptional co-activators among various sequence-specific DNA-binding transcription factors. CBP is involved in a wide range of cellular activities, such as DNA repair, cell growth, differentiation, and apoptosis that are suspected of contributing to tumorigenesis. The goal of this study was to evaluate CBP expression in a series of human lung tissues containing normal epithelium, premalignant lesions(hyperplasia and dysplasia) and squamous cell carcinomas. Materials and Methods: Immunohistochemical staining was performed on formalin-fixed paraffin-embedded sections by use of a monoclonal anti-CBP antibody. CBP expression was compared in samples from 120 patients with premalignant and malignant histological types including 20 metaplastic specimens, 40 dysplastic specimens, and 60 squamous cell carcinomas in the lung. Results: CBP expression was seen in 35% (7/20) of the metaplastic specimens. 65% (26/40) of the dysplastic specimens, and 70% (42/60) of the squamous cell carcinomas (p<0.05). According to celluar atypism, CBP expression was 50% (10/20) of the low-grade dysplastic specimens and 80% (16/20) of the high-grade dysplastic specimens(p <0.01). By cellular differentiation, CBP expression was seen in 95% (19/20) of the well differentiated squamous cell carcinomas, 85% (17/20) of the moderately differentiated carcinomas and 30% (6/20) of the poorly differentiated lesions (p <0.05). Conclusion: These results suggest that CBP may have an important role in malignant transformation of precancerous lung lesions and may be a marker for malignancy.

Ultrasonographic Features of Intra-abdominal Abscess (복부내 농양의 초음파 소견)

  • Cho, Kil-Ho;Jung, Kyung-Hee;Hwang, Mi-Soo;Chang, Jae-Chun;Kwun, Koing-Bo;Min, Hyun-Sik
    • Journal of Yeungnam Medical Science
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    • v.2 no.1
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    • pp.87-93
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    • 1985
  • Intraabdommal abscess usually causes distress with fever, leukocytosis, pain and toxicity. Diagnosis of intraabdominal abscess is occasionally difficult and It has high morbidity. However radiologic method, such as ultrasonography, CT scan, or RI scan are helpful to early detection of intraabdominal abscess. Among these methods, ultrasonography is a non-invasive technique and performed without discomfort to patient. And also differential diagnosis between cystic and solid lesion is very easy and sequential ultrasonography in same patient is valuable for the evaluation of treatment effect. We analyzed the ultrasonic features of 48 cases with intra-abdominal abscesses and the results are as follows; 1. In total 48 cases, the intra-abdominal abscesses were 30 cases, the retroperitoneal abscesses, 5 cases, and the visceral abscesses, 13 cases. 2. The causes of the intra-abdominal abscesses were perforating appendicitis (25 cases), postoperative complications (5 cases), pyogenic and amebic hepatic abscesses (13 cases), and the others (5 cases). 3. Round or oval shaped lesions were 26 cases (54%), irregular shape, 18 cases (38%), and multiple abscess formation in 4 cases (8 %). 4. The size of the lesions were between 5 and 10cm in diameter in 54% of total 48 cases, and the most frequent feature of the echo-pattern of the lesions was cystic with or without internal echogenicity (69%).

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Compression Plate Fixation with Autogenous Bone Graft for Humerus Shaft Nonunion (상완골 간부 불유합에 대한 금속판 고정 및 자가골 이식술)

  • Cho, Chul-Hyun;Song, Kwang-Soon;Bae, Ki-Cheor;Kim, In-Kyoo;Kwon, Doo-Hyun
    • Clinics in Shoulder and Elbow
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    • v.12 no.1
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    • pp.33-37
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    • 2009
  • Purpose: To evaluate the results of the compression plate fixation and autogenous bone graft in the management of humerus shaft nonunion. Materials and Methods: Eighteen cases were treated for humerus shaft nonunion using compression plate fixation and an autogenous iliac bone graft. The mean follow-up period was 28 months. Bony union was confirmed from the serial radiographs and the clinical outcomes were assessed according to ASES scoring system. Results: In 12 cases of initial plate fixation, the causes of nonunion were 6 cases of inadequate plate length, 2 with a broken plate, 2 with screw loosening, 1 infection and 1 noncompliance of a psychiatric patient. In 3 cases of initial intramedullary fixation, the cause of nonunion was a distraction of the fracture site. In 3 cases of external fixation, the cause of nonunion was inadequate fixation. All cases showed bony union after an average of 24 weeks. The clinical outcomes were 11 excellent, 6 good and 1 fair. Conclusion: In the treatment for nonunion, compression plate fixation with autogeneous bone graft after complete removal of the fibrous and necrotic tissue is believed to give satisfactory results.

Cartilage Shaving Procedure for Thyroid Carcinoma Invading the Tracheal Cartilage: Is it an Appropriate Treatment? (기관연골 침윤 갑상선암의 면도식 절제술식의 평가)

  • Park Cheong-Soo;Suh Kwang-Wook;Min Jin-Sik
    • Korean Journal of Head & Neck Oncology
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    • v.8 no.1
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    • pp.1-5
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    • 1992
  • 기관연골까지만 침윤된 갑상선암에서 침윤된 기관연골을 면도식으로 깍아 내는 술식을 선택했을때 효과적인 치료방법이 되는가를 알아보기 위하여 본 연구를 실시하였다. 1979년 부터 1988년까지 10년간수술이 시행된 갑상선암환자 432예중 기관연골까지만 침윤된 환자는 16예 이였다. 남자가 3예, 여자가 13예 이었으며, 이들의 평균 연령은 55.8세 이었고, 조직학적으로는 유두상암이 14예, 여포상암이 2예 였다. 전예에서 침윤된 기관연골을 면도식으로 깍아내였으며, 수술후 보조치료로 방사성 동위원소 치료나 외부 방사선 조사를 추가하였고, 또한 갑상선 홀몬 투여로 TSH 억제 치료를 하였다. 평균 추척 기간은 67.7개월이었다. 16예중 무병생존은 4예에 불과하였고, 12예가 치료에 실패했는데 이중 7예는 갑상선암의 재발로 사망하였다. 이상의 결과로 면도식 절제술은 갑상선암이 기관연골에 침윤되었을 때의 술식으로는 부적당하며 무병 생존율을 향상시키기 위해서는 비록 표재성인 기관연골 침윤이라도 기관제술과 같은 적극적인 술식 선택이 바람직하다고 사료되었다.

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Characteristic CT Images in Diffuse Lung Disease (미만성 폐질환(肺疾患)에 있어서 특징적(特徵的)인 CT상(像)에 관하여)

  • Ichikawa, Hidel;Kanamori, Isao
    • Journal of radiological science and technology
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    • v.18 no.2
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    • pp.37-48
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    • 1995
  • 1) 천식 기관지 확장증에서는 기종상 음영이나 기관지가 확장된 상이 있고, 또한 미만성 범세기관지염 5예에서는 미세 반점상 음영이 전체 예에서 인정이 되었다. 2) 폐염에서는 기관지의 확장이나 점액이 고여 침윤음영이 전체 예에 나타나고 있었다. 한편, 간질성 폐염 29예에서는 반점상 음영(불균일 CT치의 상승과 내부에 작은 기관지 확장으로 작은 air상)이 보였다. 폐섬유증 19례에서는 기종상 농포상 음영이나 혈관 기관의 부정 확장, 반점상 음영이 15예로 79 %를 차지하고 있다. 만성 폐기종에서는 기종상, 다발성 농포상 음영, 고목상 혈관이 특징적인 소견이었다. 3) 속립성결핵에서는 작은 입상 음영, 폐결핵 15예에서는 공동 음영 7예, 원형의 융합음영 8예, 침윤음영, 다수의 석회화상, 혈관 기관의 부정 확장 등이 특징적이었다. Aspergillus증에서는 공동 음영 내부에 fungus ball이 보였다. 이상은 미만성 폐질환의 특징적인 CT의 이상 소견에 대해서 검토하였으나, 꼭 일치되는 것은 아니며, 기타 기초적 검사나 임상적인 경과관찰이 필요하였다. 끝으로, 대한방사선기술학회의 발전과 학회원 여러분의 건승을 기원합니다. 그리고 한국과 일본의 우호적인 학술교류가 지속되기를 희망합니다.

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Application Plan of Flooding Forecasting and Warning System by Site Type of Excavation Work (굴착공사현장 수재해 예방을 위한 침수 예·경보 시스템 적용방안에 관한 연구)

  • Wang, Jeong Ah;Park, Jong Pyo;Lee, Woo Jin;Jun, Hwan Don
    • Proceedings of the Korea Water Resources Association Conference
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    • 2022.05a
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    • pp.379-379
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    • 2022
  • 기후변화로 인해 집중호우, 돌발 홍수 및 태풍의 규모가 대형화되고 있고, 이에 따른 수재해 피해 사례도 증가하는 추세이다. 특히 건설 현장 중 굴착공사 현장에서의 침수로 인한 사고는 인명피해로 이어질 가능성이 더 크기 때문에 더욱 주의가 필요하다. 하지만 현재 국내에서 실질적으로 굴착현장에 적용하기 위한 침수 대응 예측 시스템 및 구체적인 침수 예경보 체계, 기준, 매뉴얼은 존재하지 않는 실정이다. 따라서 본 연구에서는 굴착공사현장의 수재해 예방을 위한 침수 예·경보 시스템의 적용방안을 제시하였다. 또한 경제적이고 효과적인 측면을 고려하여, 공사현장 규모에 따라 적용하는 침수 예·경보 시스템을 이분화하여 소규모 공사현장에는 Track A, 대규모 공사현장에는 Track B 침수 예·경보 시스템을 적용하도록 제안하였다. 이러한 이유는 소규모 공사현장의 특성상 전체 공사비가 작고 운영되는 장비와 인력이 제한적이므로 침수 예·경보에 필요한 비용과 인력 투입이 어려울 수 있기 때문이며, 또한 대피가 필요한 전체 인원이 대규모 현장에 비해서는 적기 때문에 비교적 신속하고 원활한 대피가 가능할 것이라고 판단하였기 때문이다. 본 연구에서는 각 시스템별 적절하다고 판단되는 예·경보 기준을 제시하였다. Track A에서는 강우법에 의한 최소한의 경보시스템으로 필요한 안전목표를 달성할 수 있도록 고려하였고, Track B에서는 현장인원 대부분이 성인 남성임을 고려하여, 성인 남성의 부상을 유발할 수 있는 수심(H)과 유속(V)의 곱을 척도로 하는 한계 H·V곡선을 기준으로 운영되는 경보시스템을 제안하였다.

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