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Surgical Treatment of Pulmonary Aspergillosis (III) (폐 국균증의 외과적 치료(제 3보))

  • 정성철;김우식;배윤숙;유환국;정승혁;이정호;김병열
    • Journal of Chest Surgery
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    • v.36 no.7
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    • pp.497-503
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    • 2003
  • Pulmonary aspergillosis usually results from the colonization of the existing lung lesions by chronic pulmonary diseases, such as tuberculosis. Most cases of pulmonary aspergilloma have been treated surgically for many years because it is a potentially life-threatening disease causing massive hemoptysis. Here we reviewed our results from the last 10 years. Material and Method: We reviewed 31 cases surgically treated from Aug. 1992 to Jul. 2002. retrospectively. This investigation is designed to illustrate the peak age incidence, sex ratio, chief complaints, preoperative study, anatomic location of operative site, postoperative pathologic finding and postoperative complications. Result: The peak age Incidence laid in the 3rd and 4th decade of 20 cases (64.5%). The most common complaint was hemoptysis in 27 cases (87.1%). The 31 cases had a history of treatment with anti-tuberculous drugs under impression of pulmonary tuberculosis. The 19 cases (61.3%) showed the so-called “Air-meniscus sign” on the preoperative chest X-ray. In the 31 cases (100%) on the chest computed tomography. as a preoperative diagnostic modality, positivity was shown in 37.9%, 83.3% was shown on the fungus culture of sputum for Aspergillus, serum immunodiffusion test for A. fumigatus, respectively. The anatomical location of aspergilloma was mainly in the upper lobe in 19 cases (61.3%) and the majority of cases were managed by lobectomy. The postoperative pathologic findings showed that 31 cases (100%) were combined with tuberculosis. The postoperative complications include empyema, prolonged air leakage, remained dead space, postoperative bleeding and these numbers of cases is 3 cases (9.7%), 2 cases (6.45%), 2 cases (6.45%), 1 case (3.23%), respectively. one case was died postoperatively due to massive beeding, and asphyxia. Conclusion: Compared with the previous study, there is no significant difference in results. Preoperative chest computed tomography and immunodiffusion test were more commonly available and showed high positivity. Operations often became technically difficult because of pleural space obliteration, indurated hilar structures, and poor expansion of the remaining lung, which were more prominent in the patients with complex aspergillosis. In such cases, medical treatments and interventional procedures like bronchial artery embolization are preferred. However, cavernostomy is also recommanded with few additional morbidity because of its relatively less invassiveness. Early surgical intervention is the recommended management for patients with simple aspergilloma considering the Row surgical mortality and morbidity in recent days.

Installation and Vegetation Management for Enhanced Authenticity of Jeju Ohyundan (제주 오현단의 진정성 제고를 위한 시설 및 식생관리)

  • Rho, Jae-Hyun;Oh, Hyun-Kyung
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.31 no.3
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    • pp.25-37
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    • 2013
  • The purpose of this study is to draw reasonable management plans to reinforce essence of Ohyundan(五賢壇: Five sprit tablets), a sacred site and monument of Jeju, by investigating and analyzing current status and problems of cultural landscape elements(e.g. architectural structures, installation, letters carved on the rocks, actual vegetation, etc.) while grasping placeness contained in Ohyundan through consideration of its history and transition process of Ohyundan a future being and shrine of Gyulrim Seowon(橘林書院) in Jeju. Results derived from research are summarized as follows. Ohyundan is noted due to its placeness in that it was a place for Gyulrim Seowon, Jeju's one and only Saaek Seowon(賜額書 院) and it was a symbolic space of exile culture in Jeju. As it is inferred from Gyulrim Seowon, which is dangho(堂號: clan name) of Seowon, orchards surrounding all over places are a signature landscape element that shows placeness of the past Ohyundan. Joduseok(俎豆石: altar stone), representing a core installation of Ohyundan and ancestral tablet of five spirits, created a refined place by putting up common stones around altar and founding blocked stones to wall. This refinement and thrift served basic mind of Neo-Confucianism, and led to of Jeju's Jonyang mind(spend-thrift mind). In conclusion, a practice plan is a prerequisite to restore essence of Ohyundan by actively excluding installations not suitable for placeness or overly designed such as Jeju Hyangrodang(a center for the elderly) and numerous monument houses. On the other hand, together with Joduseok, as letters carved on the rocks such as 'Jeungjoo Byukrip(曾朱壁立)' and 'Gwangpoongdae(光風臺)' and Yoocheonseok serve as a signature landscape that well shows mind of five spirits and teaching of Neo-Confucianism, and also a trace from a confucian viewpoint deeply rooted in Jeju, they are judged as a cultural landscape corresponding to the essence of place in Ohyundan which requires proactive preservation and plans for public relations. Together with this, although many different old big trees such as Pinus densiflora , Pinus thunbergii, Quercus variabilis, Celtis sinenis, Zelkova serrata and Rhus succedanea are a landscape element that increases sacred Ohyundan and commemorative value, now required is thorough entity tree management by assigning serial number on them as many of them were dead or removed resulting from transition process of land use. Further, to reinforce quality of site location belonging to Gyulrim Seowon, a prerequsite is to review plans that create Gyulrim at reinstalled site of building and raw land.

Advantage of Selective Release of Lateral Patellar Retinaculum (선택적 외측 슬개 지지대 이완술의 장점)

  • Son, Jung-Hwan;SaGong, Eun-Seong;Kwon, Young-Ho;Jang, Jae-Ho;Kim, Jae-Do
    • Journal of the Korean Arthroscopy Society
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    • v.10 no.1
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    • pp.61-69
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    • 2006
  • Purpose: Open lateral release and complete lateral release have been conducted as a surgical method in patients with patellofemoral malalignment. But authors sought to find out the best method by conducting selective release, with minimal excision of the involved lesion, and comparative analyzing the result, as postoperative satisfaction and complication. Materials and Methods: Over the 68 patients of 90 cases who underwent arthroscopic release, among 94 patients of 129 cases who underwent lateral retinacular release, from January 1993 to June 1998 were followed up prospectively. A radiological evaluation of patellar inclination, patellar tilt, congruence angle, and Q-angle and a clinical evaluation of HSS-Knee score and modified patellar score were used for analysis data before operation and data at 1 year and 5 year after operation. Results: According to the radiologic evaluation, the patellar tilt and translation revealed improvement of the results, from $13.4^{\circ}$ and 12.1mm to $3.6^{\circ}$ and 3.8mm with arthroscopic lateral complete release, and from $12.3^{\circ}$ and 11.2mm to $4.8^{\circ}$ and 5.2mm with selective release, and from $13.6^{\circ}$ and 12.3mm to $3.3^{\circ}$ and 3mm with open release. But they were not significantly related to the clinical results. HSS-Knee score was 84.2%(48/57), 81.8%(27/33), 82.1%(32/39) and modified patellar score was 82.5%(47/57), 81.8%(27/33), 82.1%(32/39) respectively, which revealed satisfactory results. And no significant difference among the operative methods were shown. Conclusion: Arthroscopic lateral retinacular release which is one of the surgical method for patellofemoral malalignment enhances rehabilitation and satisfaction of the patient, by releasing the involved retinaculum within lesser surgical extent, compared to open and complete lateral release without complications such as adhesion.

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Independent Verification Program for High-Dose-Rate Brachytherapy Treatment Plans (고선량률 근접치료계획의 정도보증 프로그램)

  • Han Youngyih;Chu Sung Sil;Huh Seung Jae;Suh Chang-Ok
    • Radiation Oncology Journal
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    • v.21 no.3
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    • pp.238-244
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    • 2003
  • Purpose: The Planning of High-Dose-Rate (HDR) brachytherapy treatments are becoming individualized and more dependent on the treatment planning system. Therefore, computer software has been developed to perform independent point dose calculations with the integration of an isodose distribution curve display into the patient anatomy images. Meterials and Methods: As primary input data, the program takes patients'planning data including the source dwell positions, dwell times and the doses at reference points, computed by an HDR treatment planning system (TPS). Dosimetric calculations were peformed in a $10\times12\times10\;Cm^3$ grid space using the Interstitial Collaborative Working Group (ICWG) formalism and an anisotropy table for the HDR Iridium-192 source. The computed doses at the reference points were automatically compared with the relevant results of the TPS. The MR and simulation film images were then imported and the isodose distributions on the axial, sagittal and coronal planes intersecting the point selected by a user were superimposed on the imported images and then displayed. The accuracy of the software was tested in three benchmark plans peformed by Gamma-Med 12i TPS (MDS Nordion, Germany). Nine patients'plans generated by Plato (Nucletron Corporation, The Netherlands) were verified by the developed software. Results: The absolute doses computed by the developed software agreed with the commercial TPS results within an accuracy of $2.8\%$ in the benchmark plans. The isodose distribution plots showed excellent agreements with the exception of the tip legion of the source's longitudinal axis where a slight deviation was observed. In clinical plans, the secondary dose calculations had, on average, about a $3.4\%$ deviation from the TPS plans. Conclusion: The accurate validation of complicate treatment plans is possible with the developed software and the qualify of the HDR treatment plan can be improved with the isodose display integrated into the patient anatomy information.

Studies on the Physiological Root Activity and Its Related Characteristics of Rice Varieties for Application to Rice Breeding (수도근의 생리적 활력 및 그 관련형질의 품종차이와 육종상의 이용에 관한 연구)

  • Rae-Kyung Park
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.18
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    • pp.28-53
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    • 1975
  • Experiments on the physiological root activity and its related characteristics of rice varieties were carried out in order to obtain some basic informations for the application of the results obtained to a rice breeding program. A significant positive correlation was found not only among the various characteristics related to conducting and ventilating systems which connects top and root of rice plant, but also between these characteristics and root activity. On the other hand, a significant difference in physiological root activity was recognized among different varieties and also between different groups of recognized 7 rice varieties differing in the their origin. It was also found that varieties with higher root activity (root activity indices) after ear formation stage tended to have more number of lower green leaves and consequently resulted in higher grain yield. Therefore, it may be possible to diagnose indirectly the root activity by examining the number of green leaves of the rice plant at later growth stage when breeders make selections of parent material for crossing or of hybrid lines in pedigree nurseries.

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Lateral Bud Suppression and Runner Plants Growth of 'Maehyang' Strawberry as Affected by Application Method and Concentration of IBA (IBA 처리방법과 농도에 따른 딸기 '매향'의 측아 발생 억제와 자묘 생육)

  • Hwang, Hee Sung;Jeong, Hyeon Woo;Lee, Hye Ri;Hwang, Seung Jae
    • Journal of Bio-Environment Control
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    • v.29 no.1
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    • pp.80-88
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    • 2020
  • This study was conducted to examine the effect by application method and concentration of the indole-3-butyric acid (IBA), which is auxin-based plant growth regulator, on the growth and runner plants production of strawberry in the greenhouse. The seedlings of strawberry were transplanted in the pot (150 ×135 × 90 mm) filled with coir medium on April 12, 2019. The IBA was applied with a foliar spray or drench as 50, 100, 150, and 200 mg·L-1 (50 mL per plant), respectively. The treatment was started on April 29, 2019. The foliar spray and drench treatment of IBA were repeated at 2-week intervals for 9 weeks from the start date of treatment. At 9 weeks after treatment, the petiole length of mother plants was the shortest in the control. The number of runner plants showed a tendency to decreased in the foliar spray. The number of lateral buds showed a tendency to decreased in the IBA treatment, and the least in the foliar with 100 mg·L-1. There was not significantly difference in the fresh and dry weights of the first and second runner plants. However, in the third runner plants, the fresh and dry weights were the greatest in the drench with 100 mg·L-1. Therefore, when considering the growth of third runner plants and lateral bud suppression, the drench with the 100 mg·L-1 could be better application method and concentration of IBA treatment for growth of the third runner plants and runner plants production of strawberry, and the results can be used as a basic research of plant growth regulator application to save the labor force and enhance the seedling quality in strawberry seedling stage.

Improved Specificity of $^{18}F-FDG$ PET/CT for Lymph Node Staging of Non-Small Cell Lung Cancer Considering Calcified Lymph Node as Benign (비소세포 폐암에서 석회화 림프절을 양성으로 보았을 때 $^{18}F-FDG$ PET/CT의 특이도 향상)

  • Kwon, Seong-Young;Seo, Young-Soon;Min, Jung-Joon;Song, Ho-Chun;Na, Kook-Joo;Choi, Chan;Kim, Young-Chul;Kim, Yun-Hyun;Bom, Hee-Seung
    • Nuclear Medicine and Molecular Imaging
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    • v.41 no.1
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    • pp.16-21
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    • 2007
  • Purpose: We evaluated the diagnostic value of $^{18}F-FDG$ PET/CT (PET/CT) in lymph node staging of non-small cell lung cancer (NSCLC) considering calcification and histologic types as well as FDG uptake. Materials and Methods: Fifty-three patients (38 men, 15 women; mean age, 62 years) with NSCLC underwent surgical resection (tumor resection and lymph node dissection) after PET/CT. After surgery, we compared PET/CT results with the biopsy results, and analyzed lymph node metastases, based on histologic types. PET diagnosis of lymph node metastasis was determined by maximum SUV (maxSUV) > 3.0, and PET/CT diagnosis was determined by maxSUV > 3.0 without lymph node calcification. Results: By PET diagnosis, the sensitivity, specificity, and accuracy of overall lymph node staging were 45% (13 of 29), 91% (228 of 252), and 86% (241 of 281). Specificity was 91% in both squamous cell carcinoma and adenocarcinoma, while sensitivity was 71% in squamous cell carcinoma and 36% in adenocarcinoma. When we excluded calcified lymph node with maxSUV > 3.0 from metastasis by PET/CT diagnosis, specificity improved to 98% in squamous cell carcinoma and 97% in adenocarcinoma. The degree of improvement was not dependent on histologic types. Conclusion: PET/CT improved specificity of lymph node staging by reducing false positive lymph node regardless of histologic types of NSCLC.

Mid-term Results of Mitral Valve Repair in Mitral Regurgitation (승모판 폐쇄부전중에서 승모판막 재건술 및 중기성적)

  • Yun, Yang-Gu;Jang, Byeong-Cheol;Yu, Gyeong-Jong;Kim, Si-Ho
    • Journal of Chest Surgery
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    • v.29 no.1
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    • pp.24-31
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    • 1996
  • Between January 1992 and February 1995, 36 patients with mitral regurgitation were treated by a mitral repair There wert nineteen men and seventeen women whose mean age was 41.8 years, ranged from 10 to 71. Seventeenth patients had dystrophic change of mitral valve, twelve patients had rheumatic change of mitral valve, second patients had infective change of mitral valve and another fifth patients had functional change of mitral valve. Operation proced res were suture annuloplasty (35 cases), resection of leaflet (25 cases), chordal shortening(9 cases) and commisurotomy(1 cases). These procedures were combined in most patients. Two third of the patients were in New York Heart Association class III or IV and four fifth of the patients were in mitral regurgitation grade III or IV by doppler echocardiogram. After mitral valve repair, the patients were improved hemodynamic, echocardiographic data and functional class. Intraoperative TEE had been used in all most patients after weaning of bypass. If there remained MR more than grade 2, the valve was re-repaired or replacement. There were no operative death. The late mortality was 5.5% and cause of death was congestive heart failure. Patients have been followed up from 3 to 40 months, mean 15. Second patients underwant reoperation due to recurred mitral regurgitation, 4 and 19 days after the operation. During reoperation, we found that the repair suture was disrupted in both patients. Th s expierence demonstrated that intraoperative TEE is accurate and predictable and excellent immediate and mid-term results have been achieved by mitral valve repair.

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Effects of Electrolytes and Drugs on the Inhibitory Junction Potentials Recorded from the Antrum of Guinea-pig Stomach (기니피그 유문동에서 기록되는 억제성 접합부 전압에 미치는 전해질과 약물의 효과)

  • Goo, Yong-Sook;Suh, Suk-Hyo;Lee, Suk-Ho;Hwang, Sang-Ik;Kim, Ki-Whan
    • The Korean Journal of Physiology
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    • v.24 no.1
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    • pp.1-13
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    • 1990
  • The effects of electrolytes, adenosine, ATP, 5-hydroxytryptamine (5-HT, serotonin) and ketanserin on the inhibitory junction potentials (IJPs) were investigated to clarify the interactions of these drugs with the neurotransmitters released from non-adrenergic, non-cholinergic nerves in the antrum of guinea-pig stomach. Electrical responses of antral circular muscle cells were recorded intracellularly using glass capillary microelectrode filled with 3 M KCI. All experiments were performed in Tris-buffered Tyrode soluition which was aerated with 100% $O_{2}$ and kept at $35^{\circ}C$. The results obtained were as follows: 1) Inhibitory junction potential (IJP) was recorded in antral strip, while excitatory junction potential (EJP) was recorded in fundic strip. 2) IJP recorded in antral strip was not influenced by atropine $(10^{-6}\;M)$ and guanethidine $(5{\times}10^{-6})$. 3) The amplitude of IJP increased in high $Ca^{2+}$ solution, while that of IJP decreased in high $Mg^{2+}$ solution or by $Ca^{2+}$ antagonist (verapamil). Apamin, $Ca^{2+}$-activated $K^{+}$ channel blocker blocked IJP completely. 4) ATP and adenosine decreased the amplitude of IJP. 5) 5-HT decreased the amplitude of IJP with no change of the amplitude of slow waves, while ketanserin (5-HT type 2 blocker) decreased the amplitude of slow waves markedly with no change in that of IJP. From the above results, the following conclusions could be made. 1) IJP recorded in antral strip is resulted from neurotransmitters released from non-adrenergic, non-cholinergic nerves. 2) An increase in the concentration of external $Ca^{2+}$ enhances the release of neurotransmitters from non-adrenergic, non-cholinergic nerves which activate the $Ca^{2+}$-dependent $K^{+}$ channel.

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The Surgical Diagnosis for Detecting Early Gastric Cancer and Lymph Node Metastasis: Its Role for Making the Decision of the Limited Surgery (조기위암 및 림프절 전이에 대한 수술 중 외과적 병기판정의 정확도 및 유용성)

  • Park, Eun-Kyu;Jeong, Oh;Ryu, Seong-Yeop;Ju, Jae-Kyun;Kim, Dong-Yi;Jeong, Mi-Ran;Kim, Ho-Goon;Kim, Hoe-Won;Park, Young-Kyu
    • Journal of Gastric Cancer
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    • v.9 no.3
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    • pp.104-109
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    • 2009
  • Purpose: The aim of this study is to evaluate the accuracy of surgically diagnosing early gastric cancer (EGC) and lymph node metastasis, and to determine its role for performing limited surgery for EGC. Materials and Methods: We reviewed 369 patients who underwent gastrectomy for primary gastric carcinoma. The surgical diagnosis was evaluated by determining its sensitivity, specificity and accuracy, and this was compared with the preoperative examinations. Results: The sensitivity, specificity, and accuracy of the intraoperative diagnosis for EGC were 74.5%, 95.7% and 83.7%, respectively. The predictive value for EGC according to the intraoperative diagnosis was 95.7%. The surgical diagnosis of EGC showed higher specificity and a higher predictive value than preoperative examinations, which significantly reduced the risk of underestimating advanced gastric cancer (AGC) to EGC. The sensitivity, specificity, and accuracy for lymph node metastasis according to the surgical diagnosis were 73.2%, 78.1% and 76.4%, respectively. For 70 patients with a discrepancy in the diagnosis of EGC between the pre- and intra-operative diagnosis, the surgical diagnosis was correct in 63 (90%) patients, but the preoperative examinations were correct in only 7 (10%) patients. Conclusion: The surgical diagnosis showed better accuracy than the preoperative examinations for detecting EGC and lymph node metastasis. Our results suggest that the decision for conducting limited surgery based on the surgical diagnosis might reduce the risk of under-treatment of AGC to EGC better than the preoperative examinations.

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