• Journal of Trauma and Injury
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• v.29 no.3
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• pp.93-97
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• 2016

Hepatic duct confluence injury, which is developed by blunt abdominal trauma, is rare. Conventionally, bile duct injury was treated by surgical intervention. In recent decades, however, there had been an increase in radiologic or endoscopic intervention to treat bile duct injury. In a hemodynamically stable patient, endoscopic intervention is considered as the first-line treatment for bile duct injury. A 40 year-old man was transferred to the emergency department of ${\bigcirc}{\bigcirc}$ trauma center after multiple blunt injuries. Contrast-enhanced abdominal computed tomography performed in another hospital showed a liver laceration with active arterial bleeding, fracture of the sacrum and left inferior pubic ramus, and intraperitoneal bladder rupture. The patient presented with hemorrhagic shock because of intra-peritoneal hemorrhage. After resuscitation, angiographic intervention was performed. After angiographic embolization of the liver laceration, emergency laparotomy was performed to repair the bladder injury. However, there was no evidence of bile duct injury on initial laparotomy. On post-trauma day (PTD) 4, the color of intra-abdominal drainage of the patient changed to a greenish hue; bile leakage was revealed on magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP). Bile leakage was detected near the hepatic duct confluence; therefore, a biliary stent was placed into the left hepatic duct. On PTD 37, contrast leakage was still detected but both hepatic ducts were delineated on the second ERCP. Stents were placed into the right and left hepatic ducts. On PTD 71, a third ERCP revealed no contrast leakage; therefore, all stents were removed after 2 weeks (PTD 85). ERCP and biliary stenting could be effective treatment options for hemodynamically stable patients after blunt trauma.

• The Korean Journal of Pharmacology
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• v.10 no.1 s.15
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• pp.55-59
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• 1974

Further elucidation of the mechanism of halothane's negative inotropic action has resulted from a study of the effect of various substrates on halothane-depressed rat atria. Approximately 6 mg% halothane was required to maintain a 50% depression of the contractility of rat atria suspended in a modified Krebs-Ringer bicarbonate glucose medium, pH 7.4, $30^{\circ}C$ for 2hr. Both lactate and acetate were found to restore partially the contractility of halothane-depressed atria. The maximally effective concentration of lactate was 5 mM; for acetate it was 2.5mM. Neither 5 nor 20 mM of additional glucose was effective in restoring the force of contraction of halothane-depressed atria. The results are consistent with the hypothesis that halothane exerts at least a part of its negative inotropic effect on rat atria by inhibiting either the uptake or utilization of glucose by the myocardium. The site of blockade must be prior to the conversion of pyruvate to acetyl CoA. In our previous report dealing with the mechanism of cardiac depressant action of inhalation anesthetic halothane, it has been demonstrated that: 1) approximately 6 mg/100 ml halothane is required to maintain 50% depression of the force of contraction of isolated rat atria in Krebs-Ringer bicarbonate glucose medium; 2) pyruvate partially restores the contractility of halothane-depressed atria, but has no effect on normal atria; the partial recovery of depressed atria by the addition of sodium pyruvate is due to the effect of the pyruvate ion itself, not to the sodium ion; 4) addition of pyruvate, to atria depressed with hypertonic medium, produced only further depression. From these findings we concluded that the cardiac depressant action of halothane on rat atria is a manifestation of inhibition of glucose uptake or utilization. The present studies were undertaken to observe the effect of other substrates on halothane-depressed atria in order to substantiate our conclusion. As with the case of pyruvate, lactate and acetate also partially restored the force of contraction of halothane-depressed atria. These data are consistent with the hypothesis that halothane inhibits glucose uptake or utilization in the glycolytic cycle of the myocardium.

• Korean Journal of Bronchoesophagology
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• v.5 no.2
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• pp.191-197
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• 1999

Background and Objective : Soft palate plays a great role in function of speech and swallowing. Ablation of tonsil cancer results in multi-demensional defect including soft palate in most cases and restoration of the postoperative oral cavity function is a continuing surgical challenge. Although a variety of techniques are available, radial forearm free flap has been known as an effective method for these defect, which offers a thin, pliable, and relatively hairless skin, and a long vascular pedicle. The aim of the present study is to report the speech and swallowing function test results of our 5 consecutive radial forearm free flaps used for tonsil cancers. Materials and Methods : We reviewed the medical records of 5 patients who were offered intraoral reconstruction with a radial forearm free flap after ablative surgery for tonsil cancers, from Dec. 1997 to Oct. 1998, and analyzed the surgical methods, complications, and speech and swallowing function test results. We have examined with modified barium swallow to evaluate postoperative wallowing function and articulation and resonance test for speech. Results : The tumor sizes by TNM stage(AJCC, 1997) were T1(1), T2(2), and T4(3). The paddles of flaps were tailored in multilobed designs from oval shape to pentalobed design and in variable size from 24$cm^2$ to 108$cm^2$(average size = 78.4$cm^2$), according to the defect after ablation. This procedures resulted in satisfactory flap success and functional results all but 1 case of flap contracture in 2 postoperative week, achieved early oral diet until 16-57 postoperative day(average, 28 days) and social speech. The oropharyngeal defect including soft palate reconstruction with radial forearm free flap might be an excellent method for the maximal functional results, after ablative surgery of tonsil cancer that results in multidimensional defect.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.532-536
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• 2009

Bypass surgery is performed for insuring continuity of a blood supply that is restricted due to obstruction of the native blood supply. Two types of surgery are commonly carried out: one is anatomic bypass and the other is extraanatomic bypass. Especially, extraanatomic bypass surgery is performed in patients who are a high risk for performing anatomical bypass surgery. The risk factors for anatomical bypass surgery are old age, infection, previous surgery and trauma. A 96-year-old patient underwent extraanatomic bypass surgery from the right femoral artery to the left femoral artery due to total occlusion of the left iliac artery, and 7 years after that operation, a pseudoaneurysm abruptly and spontaneously appeared from the bypass suture site without any predisposing factor. The lesion was revealed to be an organizing thrombus.

• Journal of Chest Surgery
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• v.41 no.6
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• pp.777-781
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• 2008

Benign metastasizing leiomyoma is a rare disease that histologically shows features of a benign tumor; however it can metastasize to the lung or other organs. We report here on a case of a 53-year-old Woman with benign metastasizing leiomyoma, and she was admitted to the hospital with symptoms of coughing for 2 months; she showed multiple diffuse nodular opacities of both lungs on a chest radiograph. She had undergone hysterectomy for leiomyoma of the uterus 13 years previously. Thoracoscopic lung biopsy was performed to rule out metastatic lung cancer. The pulmonary nodules appeared benign with a very low mitotic rate and they consisted of smooth muscle cells. The pathologic findings of the pulmonary nodules were consistent with benign metastasizing leiomyoma. The patient has been followed up closely without any specific therapy.

• Tuberculosis and Respiratory Diseases
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• v.47 no.2
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• pp.247-254
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• 1999

Respiratory failure is the most serious manifestation and usual cause of death in acute organophosphate poisoning, and is common in acute cholinergic crisis. But the respiratory failure may appear suddenly in a patient who is recovering from the cholinergic crisis, even while receiving conventional therapy. These are case report of 37 years old male and 24 years old female with intermediate syndrome in organophosphate poisoning. The two patients ingested organophosphate(fenthion and mixture of DDVP with chlorpyrifos respectively) incidentally and in a sucide attempt respectively. After apparent recovery from the cholinergic crisis with a conventional therapy but before the expected onset of delayed polyneuropathy, the respiratory failure appeared suddenly with a muscular weakness, affecting predominantly the proximal limb muscles, neck flexors, territories of several motor cranial nerves. The two patients needed mechanical ventilatory support and recovery from the intermediate syndrome was complete in both patients, although one subsequently developed hypoxic encephalopathy. The clinical manifestation and electrophysiologic study support the clinical diagnosis of intermediate syndrome. The syndrome carries a risk of death. because of respiratory paralysis, if not recognized early and treated adequatedly. Prompt endotrachial intubation and mechanical ventilatory support is the cornerstone of treatment of the intermediate syndrome. Therefore, all patient should be observed in a hospital for up to 5 days after poisoning.

• Tuberculosis and Respiratory Diseases
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• v.57 no.2
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• pp.183-187
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• 2004

Bronchiolitis obliterans (BO) is a nonspecific inflammatory injury affecting primarily the small airways. Its inflammatory process is characterized by fibrotic obliteration of the lumen of bronchioles. BO can be idiopathic or associated with connective tissue disease, inhaled toxins, infections, drugs, and chronic graft-versus-host-disease (GVHD). Pulmonary complications occur in 40~60% of patients who undergo allogeneic bone marrow transplantation (BMT), causing 10~40% of transplant-related deaths. BO is a characteristic pulmonary complication which occurs usually within a few years after BMT. Documented complications of BO include air-leak syndromes such as pneumomediastinum, subcutaneous emphysema and pneumothorax. We report a case of a 30-year-old male patient with BO due to chronic GVHD after allogenic BMT who presented with recurrent bilateral pneumothoraces.

• Tuberculosis and Respiratory Diseases
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• v.65 no.2
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• pp.142-146
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• 2008

Small cell lung cancer is characterized by an aggressive clinical course and a high tendency for early dissemination in spite of a good chemotherapy response. Topotecan is a topoisomerase I inhibitor, and it is used as second-line treatment for small cell lung cancer. The reported dose-limiting adverse reactions to topotecan are mainly hematologic. Yet pulmonary toxicity associated with topotecan is known to be rare. We report here on a case that showed the development of acute respiratory distress syndrome during the 3rd cycle of topotecan chemotherapy in a patient with small cell lung cancer. He developed dyspnea and respiratory failure, and the chest CT scan revealed diffuse ground-glass opacity that was probably due to chemotherapy-related pulmonary toxicity. He finally died of acute respiratory distress syndrome.

• The Journal of Korean Academy of Prosthodontics
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• v.56 no.2
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• pp.141-153
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• 2018

A non-physiological occlusal plane caused by continuous tooth loss, occlusal wear, and failure of a prosthesis may result in an unattractive appearance and functional problems, such as reduced masticatory efficiency and occlusal interference. Therefore, when undertaking prosthetic treatment for edentulous patients or patients with a collapsed occlusal plane, it is important to establish an occlusal plane that is compatible with masticatory function. The patient in this case report had undergone restoration of a completely edentulous maxilla using an implant-supported fixed prosthesis. On follow-up examination in the following 6 years, mechanical complications were observed in the existing implant prosthesis, including porcelain chipping, occlusal wear, and screw loosening. Moreover, due to occlusal wear and supraeruption of the opposing anterior teeth, as well as loss of some posterior teeth, the occlusal plane had collapsed. Following diagnosis, the patient underwent full mouth rehabilitation, involving additional implant installation in edentulous sites, recreation of the existing prosthesis, and prosthetic restoration of all remaining teeth.

• Parasites, Hosts and Diseases
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• v.55 no.3
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• pp.319-325
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• 2017

We described 4 human infection cases of zoonotic fish-tapeworm, Diphyllobothrium nihonkaiense, identified with morphological and molecular characters and briefly reviewed Chinese cases in consideration of it as an emerging parasitic disease in China. The scolex and mature and gravid proglottids of some cases were seen, a rosette-shaped uterus was observed in the middle of the mature and gravid proglottids, and the diphyllobothriid eggs were yellowish-brown in color and displayed a small knob or abopercular protuberance on the opposite end of a lid-like opening. The average size of the eggs was recorded as $62-67{\times}42-45{\mu}m$. The parasitic materials gathered from 4 human cases were morphologically identified as belonging to the genera Diphyllobothrium and Adenocephalus. The phylogenetic analysis based on the nucleotide sequences of cytochrome c oxidase subunit 1 gene of the etiologic agents confirmed that the 4 cases were D. nihonkaiense infection. The finding of 4 additional D. nihonkaiense cases suggests that D. nihonkaiense might be a major causative species of human diphyllobothriasis in China. A combined morphological and molecular analysis is the main method to confirm D. nihonkaiense infection.