• Journal of Chest Surgery
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• v.39 no.4 s.261
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• pp.275-280
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• 2006

Background: Aortopulmonary window (APW) is a very rare congenital heart anomaly, often associated with other cardiac anomalies. It causes a significant systemic to pulmonary artery shunt, which requires early surgical correction. Accurate diagnosis and surgical correction will bring good outcomes. The purpose of this study was to describe our 20-year experience of aortopulmonary window. Material and Method: Between March 1985 and January 2005, 16 patients with APW underwent surgical repair. Mean age at operation was $157.8{\pm}245.3$ ($15.0{\sim}994.0$) days and mean weight was $4.8{\pm}2.5$ ($1.7{\sim}10.7$) kg. Patent ductus arteriosus (8), atrial septal defect (7), interruptedaortic arch (5), ventricular septal defect (4), patent foramen ovate (3), tricuspid valve regurgitation (3), mitral valve regurgitation (2), aortic valve regurgitation (1), coarctation of aorta (1), left superior vena cavae (1), and dextrocardia (1) were associated. Repair methods included 1) division of the APW with primary closure or patch closure of aorta and pulmonary artery primary closure or patch closure (11) and 2) intra-arterial patch closure (3). 3) Division of the window and descending aorta to APW anastomosis (2) in the patients with interrupted aortic arch or coarctation. Result: There was one death. The patient had 2.5 cm long severe tracheal stenosis from carina with tracheal bronchus supplying right upper lobe. The patient died at 5th post operative day due to massive tracheal bleeding. Patients with complex aortopulmonary window had longer intensive care unit and hospital stay and showed more morbidities and higher reoperation rates. 5 patients had reoperations due to left pulmonary artery stenosis (4), right pulmonary artery stenosis (2), and main pulmonary artery stenosis (1). The mean follow-up period was $6.8{\pm}5.6$ (57.0 days$\sim$16.7 years)years and all patients belonged to NYHA class 1. Conclusion: With early and prompt correction of APW, excellent surgical outcome can be expected. However, optimal surgical method needs to be established to decrease the rate of stenosis of pulmonary arteries.

• Journal of Chest Surgery
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• v.35 no.6
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• pp.454-459
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• 2002

Clinical analysis of the relation between the clinical data of chest trauma patients and bone scan results was done to investigate the sensitivity and specificity of bone scan for the diagnosis of rib or chondral fracture. Material and Method： 445 patients treated due to chest trauma in Dongguk University Kyungju Hospital from July 1998 to December 2001 were studied. Age and sex distribution, causes of chest trauma, interval from the injury to arrival at hospital, final diagnosis, relationship between the chest pain and bone scan results, relationship between local tenderness and bone scan results, and sensitivity and specificity of bone scan were studied. Result： The male was 61.6% and the female was 38.4%. Age distribution was nearly even from the twenties to the sixties. The traffic accident was the most common cause of chest injury(60.4%). Most patients(76.6%) were arrived to the hospital within 6 hours after chest trauma. Rib fracture was the most common final diagnosis(46.5 %). The relationship between the duration of chest pain and tenderness and the bone scan results were significant, and the same in the relationship between the duration of local tenderness and the bone scan results, but the latter is more significant. The sensitivity of bone scan was 99.4% and the specificity was 90.4%. Conclusion： If the patient complains the chest pain continuously and the local tenderness around the chest is continued over 3 weeks, it is good to perform the bone scan. Further study including the MRI may be helpful for more evaluation in chest trauma patients.

• Journal of Chest Surgery
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• v.40 no.6 s.275
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• pp.399-406
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• 2007

Background: Ischemia-reperfusion injury related to unsuccessful myocardial protection affects postoperative ventricular function and mortality during open-heart surgery. We prospectively compared the effects of administration of histidine-tryptophan-ketoglutarate (HTK) solution and cold blood cardioplegia (CBC) on myocardial protection and clinical outcome in patients undergoing mitral valve surgery. Material and Method: Seventy patients with mitral regurgitation (MR) undergoing mitral valve surgery were randomly divided into the HTK group (n=31) and the CBC group (n=31 ): eight patients were excluded. Perioperative hemodynamics, cardiac medications, pacing, postoperative outcomes and complications were recorded during the hospital stay. All patients received follow-up for at least 6 months postoperatively for morbidity and mortality. Resuか: There were no significant differences in the hemodynamics between the groups during the study period, except for the mean pulmonary artery pressure (MPAP), PCWP and CVP that were lower in the HTK group at 15 min after weaning of CBP. There were no differences for inotropic support and pacing during the 12 hrs postoperatively between the groups. CK-MB values on day 1 and day 2 were $77{\pm}54$ and $41{\pm}23$ for the HTK group and $70{\pm}69$ and $44{\pm}34$ for the CBC group, respectively (p=NS). Postoperative clinical outcomes were similar in both groups for at least 6 months during the follow-up period. Conclusion: These results suggest that the use of HTK solution is as safe as cold blood cardioplegia in terms of myocardial protection.

• Journal of Chest Surgery
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• v.42 no.6
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• pp.757-762
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• 2009

Background: Compression of the left common iliac vein by the overriding common iliac artery is frequently combined with acute deep vein thrombosis in patients with May-Thurner Syndrome. We evaluate the results of treatment with thrombolysis and thrombectomy followed by stenting in 34 patients with May-Thurner Syndrome combined with lower extremity deep venous thrombosis. Material and Method: The authors retrospectively reviewed the records of 34 patients (mean age: $65{\pm}14$ year old) who had undergone stent insertion for acute deep vein thrombosis that was caused by May-Thurner syndrome. After thrombectomy and thrombolysis, insertion of a wall stent and balloon angioplasty were performed to relieve the compression of the left common iliac vein. Urokinase at a rate of 80,000 to 120,000 U/hour was infused into the thrombosed vein via a multi-side hole thrombolysis catheter. A retrieval inferior vena cava (IVC) filter was placed to protect against pulmonary embolism in 30 patients (88%). Oral anticoagulation with warfarin was maintained for 3 months, and follow-up Multi Detector Computerized Tomography (MDCT) angiography was done at the date of the patients' hospital discharge and at the 6 months follow-up. Result: The symptoms of deep venous thrombosis disappeared in two patients (4%), and there was clinical improvement within 48 hours in twenty eight patients (82%), but there was no improvement in four patients (8%). The MDCT angiography at discharge showed no thrombus in 9 patients (26%) and partial thrombus in 21 (62%), whereas the follow-up MDCT at $6.4{\pm}5.5$ months (32 patients) revealed no thrombus in 23 patients (72%), and partial thrombus in 9 patients (26%). Two patients (6%) had recurrence of DVT, so they underwent retreatment. Conclusion: Stent insertion with catheter-directed thrombolysis and thrombectomy is an effective treatment for May-Thurner syndrome combined with acute deep vein thrombosis in the lower extremity.

• Pediatric Infection and Vaccine
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• v.18 no.2
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• pp.193-200
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• 2011

Purpose : The effect of corticosteroid on severe pneumonia caused by 2009 pandemic influenza (H1N1) A virus is controversial. This study was aimed to present the effects of early, short-term corticosteroid treatment for severe pneumonia with this virus infection. Methods : A retrospective analysis was performed on severe pneumonia patients (37 patients) who had severe respiratory distress at presentation requiring oxygen therapy and received intravenous methylprednisolone (MP, 8-10 mg/kg, divided in 4 doses/day for 2-3 days) with oseltamivir. The clinical and laboratory characteristics of the patients were evaluated through the medical records and chest radiographic findings. Results : The mean age and male-to-female ratio of the patients were 6.5${\pm}$2.9 years of age, and 3.4:1 (male 29 patients), respectively. The 5-9 aged group was predominant among the age groups (25 patients, 67.6%). Duration of fever prior to admission was 1.4${\pm}$0.6 days and dyspnea developed within 24 h after beginning of respiratory symptoms in all patients. All patients were previously healthy and received oseltamivir within 48 h. Thirteen patients (35.1%) developed dyspnea during oseltamivir treatment. Following MP infusion, all 37 patients including 13 progressive pneumonia patients during oseltamivir treatment showed an immediate halt in the progression of pneumonic infiltration with rapid clinical improvement. There were no side-effects following steroid use. Conclusion : For severe pneumonia patients, early corticosteroid treatment halted clinical exacerbation, and possibly prevented progression to acute respiratory distress syndrome. Further controlled clinical studies are needed for the role of corticosteroids and antivirals on severely affected patients with influenza virus infections.

• Journal of Life Science
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• v.17 no.12
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• pp.1701-1708
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• 2007

Seed pelleting is generally conducted in order to save the labor for sowing and thinning by enabling the precision mechanical planting. In the present study, the influence of physical and chemical properties of pelleting solid materials was investigated on carrot seed germination. Among the pelleting solid materials evaluated, dialite, kaolin, and talc showed low bulk density and high porosity. Bentonite and dialite carried high water holding capacities of 184% and 173%, respectively, while calcium carbonate, calcium oxide, and fly ash showed relatively low water holding capacity. The pH of kaolin (6.8) and dialite (7.4) were close to neutral, while limestone (12.8), calcium oxide (13.0), and bentonite (10.0) were highly basic. High electro-conductivity was shown in limestone and calcium oxide. EDS analysis revealed that the main elemental compositions of talc were Si (71.0%) and Mg (29.0%), and those of calcium carbonate were Ca (66.6%), Si (22.9%), and Mg (10.5%). High granulation capacity was observed from talc and the mixture of talc and calcium carbonate. Seeds pelleted with bentonite showed the highest hardness. The dissolving type of the pellet layer after imbibition was split type in talc, limestone, zeolite, and fly ash, melt type in calcium carbonate and calcium oxide, and swell type in bentonite and vermiculite. The shortest dissolving time of pellet layer was observed from calcium carbonate and kaolin. The germination speed $(T_{50})$ was delayed as the size of pelleted seeds increased. The optimum size of pelleting was 19 ratio in carrot.

• Journal of Genetic Medicine
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• v.7 no.2
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• pp.160-164
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• 2010

Structural abnormalities of the Y chromosome affect normal testicular differentiation and spermatogenesis. The present case showed a rare monocentric derivative Y chromosome with partial duplication of Yp including the SRY gene and deletion of Yq12 heterochromatin. The karyotype was 46,X,der(Y)(pter${\rightarrow}$q11.23::p11.2${\rightarrow}$pter).ish der(Y)(DYZ3+,DYZ1-,SRY++), confirmed through a FISH study. Even though the patient possessed an abnormal Y chromosome, testicular biopsy showed normal testicular volumes in the proband, with gonadal hormonal levels in the normal range but bilateral varicocele and hypospermatogenesis. We speculate that the abnormal Y chromosome arose from sister chromatids during Y chromosome recombination or intra chromosomal NAHR (non-allelic homologous recombination) during meiosis in the patient's father or in the very early stages of embryogenesis. The derivative Y chromosome might interfere in the meiotic stage of spermatogenesis, leading to the developmental arrest of germ cells. The present case illustrates that the infertility phenotype can have various causes. Also, it emphasizes the importance of accurate and various genetic analyses and could aid in male infertility treatment.

• The Korean Journal of Nuclear Medicine
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• v.36 no.6
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• pp.357-367
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• 2002

Purpose: While cerebral blood flow and cerebrovascular reserve could be evaluated with basal/acetazolamide Tc-99m-HMPAO SPECT in cerebrovascular disease, objective quantification is necessary to assess the efficacy of the revascularization. In this study we adopted the SPM method to quantify basal cerebral blood flow and cerebrovascular reserve on basal/acetazolamide SPECT in assessment of the patients who underwent bypass surgery for linternal carotid artery (ICA) stenosis. Materials and Methods: Twelve patients ($51{\pm}15$ years) with ICA stenosis were enrolled. Tc-99m-HMPAO basal/acetazolamide perfusion SPECT was peformed before and after bypass surgery. After spatia1 and count normalization to cerebellum, basal cerebral blood flow and cerebrovascular reserve were compared with 21 age-matched normal controls and postoperative changes of regional blood flow and reserve were assessed by Statistical Parametric Mapping method. Mean pixel values of each brain region were calculated using probabilistic anatomical map of lobes. Perfusion reserve was defined as the % changes after acetazolamide over basal counts. Results: Preoperative cerebral blood flow and cerebrovascular reserve were significantly decreased in involved ICA territory, comparing with normal control (p<0.05). Postoperative improvement of cerebral blood flow and cerebrovascular reserve was observed in grafted ICA territories, but cerebrovasculr reserve remained with significant difference with normal control. Improvement of the cerebrovascular reserve was most prominent in the superior temporal and the angular gyrus, nearest to the anastomosis sites. Conclusion: Using SPM quantification method on hasal/acetazolamide Tc-99m-HMPAO SPECT, the cerebral blood flow and cerebrovascular reserve could be assessed before revascularization and so could the efficacy of the bypass surgery.

• The Korean Journal of Nuclear Medicine
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• v.34 no.4
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• pp.276-284
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• 2000

Purpose: We investigated the operative outcome after bypass surgery in patients selected using viability criteria on F-18 FDG PET. Materials and Methods: Rest-24hr delay redistribution imaging of Tl-201 SPECT and F-18 FDG PET were performed in 11 patients. Seven of these 11 patients (6 men, 1 woman) were evaluated to have viable myocardium by F-18 FDG PET. Changes in symptoms and left ventricular ejection fraction (LVEF) after operation were evaluated. Results: In seven of 11 patients, a significant amount of viable myocardium was found on F-18 FDG PET and Tl-201 SPECT. Severity of both chest pain and dyspnea improved markedly in all patients. Mean LVEF improved from 22% to 32%. Conclusion: F-18 FDG PET could be used to select the patients who will benefit from coronary artery bypass surgery.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.4
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• pp.267-274
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• 2008

Purpose: Transient neurological deterioration (TND) is one of the complications after extracranial-intracranial bypass surgery, and it has been assumed to be caused by postoperative transient hyperperfusion. This study was performed to evaluate the relationship between TND and preoperative and postoperative cerebral perfusion status on brain perfusion SPECT following superficial temporal artery - middle cerebral artery (STA-MCA) anastomosis surgery. Materials and Methods: A total of 60 STA-MCA anastomosis surgeries of 56 patients (mean age: $50{\pm}16$ yrs; M:F=29:27; atherosclerotic disease: 33, moyamoya disease: 27) which were done between September 2003 and July 2006 were enrolled. The resting cerebral perfusion and cerebral vascular reserve (CVR) after acetazolamide challenge were measured before and 10 days after surgery using 99mTc-ethylcysteinate dimer (ECD) SPECT. Moreover, the cerebral perfusion was measured on the third postoperative day. With the use of the statistical parametric mapping and probabilistic brain atlas, the counts for the middle cerebral artery (MCA) territory were calculated for each image, and statistical analyses were performed. Results: In 6 of 60 cases (10%), TND occurred after surgery. In all patients, the preoperative cerebral perfusion of affected MCA territory was significantly lower than that of contralateral side (p=0.002). The cerebral perfusion on the third and tenth day after surgery was significantly higher than preoperative cerebral perfusion (p=0.001, p=0.02). In TND patients, basal cerebral perfusion and CVR on preoperative SPECT were significantly lower than those of non-TND patients (p=0.01, p=0.05). Further, the increases in cerebral perfusion on the third day after surgery were significant higher than those in other patients (p=0.008). In patients with TND, the cerebral perfusion ratio of affected side to contralateral side on third postoperative day was significantly higher than that of other patients (p=0.002). However, there was no significant difference of the cerebral perfusion ratio on preoperative and tenth postoperative day between patients with TND and other patients. Conclusion: In patients with TND, relative and moderate hyperperfusion was observed in affected side after bypass surgery. These finding may help to understand the pathophysiology of TND.