• Journal of Trauma and Injury
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• v.26 no.3
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• pp.248-251
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• 2013

Introduction: A post-traumatic mesenteric arteriovenous fistula (AVF) is extremely rare. Case Report: A previously healthy 26-year-old male was injured with an abdominal stab wound. Computed tomography (CT) showed liver injury, pancreas injury and a retropancreatic hematoma. We performed the hemostasis of the bleeding due to the liver injury, a distal pancreatectomy with splenectomy and evacuation of the retropancreatic hematoma. On the 5th postoperative day, an abdominal bruit and thrill was detected. CT and angiography showed an AVF between the superior mesenteric artery (SMA) and the inferior mesenteric vein with early enhancement of the portal vein (PV). The point of the AVF was about 4 cm from the SMA's orifice. After an emergent laparotomy and inframesocolic approach, the isolation of the SMA was performed by dissection and ligation of adjacent mesenteric tissues which was about 6 cm length from the nearby SMA orifice, preserving the major side branches of the SMA, because the exact point of the AVF could not be identified despite the shunt flow in the PV being audible during an intraoperative hand-held Doppler-shift measurement. After that, the shunt flow could not be detected by using an intraoperative hand-held Doppler-shift measuring device. CT two and a half months later showed no AVF. There were no major complications during a 19-month follow-up period. Conclusion: Early management of a post-traumatic mesenteric AVF is essential to avoid complications such as hemorrhage, congestive heart failure and portal hypertension.

• Journal of Chest Surgery
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• v.5 no.1
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• pp.13-18
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• 1972

In 1835,Schlesinger first described a case of subisthmlc lower thoracic aortic coarctation. Since Olim`s unsuccessful reconstructive surgery in 1949 and Beattie`s first successful resection with homograft replacement on such a lesion in 1951 were reported,about 20 cases of atypical aortic coarctation had been treated by definitive surgery until 1964. In Korea, only 2 cases of atypical aortic coarctation treated by bypass graft were reported until now. This is the third case-report treated by reconstructive surgery. The patient,11 year old girl who had 2 year history of headache, visual weakness, intermittent claudlcation, and general weakness, was first diagnosed of having the hypertension due to atypical coarctation by the findings of high blood pressure[170/110mmHg] at the upper extremity and weak pulsation on both femoral artery,murmur on the epigastrium, absence of aortic knob, and aorto graphy. Aortography demonstrated the isolated segmental narrowing[length 5cm, diameter 0.4cm] at the level of aortic hiatus 2cm above celiac arterial origin, the dilated right 9th, 10th, 11th intercostal arteries with multiple dimunitive collaterals and no associated abnormalities in the other arteries. Preoperatlve positive findings were strong positive mantoux test, high AST[720 units]. transient mild cardiomegaly with right lung infiltration on chest X-ray and suggestive left ventricular hypertrophy on ECG. On December 1970, through separate left thoracotomy and abdominal approach, bypass graft between descending thoracic aorta and abdominal aorta below renal artery was performed. The operation was first successful with satisfactory reduction of hypertension on the upper trunk[postoperatlve 130/80mmHg] and strong pulsation on the lower extremities[postop. O, postop. 140/100mmHg]. However,6 weeks after surgery, she expired of sudden hemoptysis and shock due to anastomotic leak within the thorax. Operative finding disclosed that the affected aorta was firm, with rich periaortic fibrosis and the outer diameter of stenotic site was not attenuated. Histopathology of the resected specimen was also compatible with primary arteritis.

• The Transactions of The Korean Institute of Electrical Engineers
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• v.58 no.10
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• pp.2071-2078
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• 2009

In this paper, we proposed a non-contact respiration measurement system with ultrasonic proximity sensor. Ultrasonic proximity sensor approach of respiration measurement which respiration signatures and rates can be derived in real-time for long-term monitoring is presented. 240 kHz ultrasonic sensor has been applied for the proposed measurement system. The time of flight of sound wave between the transmitted signal and received signal have been used for a respiration measurement from abdominal area. Respiration rates measured with the ultrasonic proximity sensor were compared with those measured with standard techniques on 5 human subjects. Accurate measurement of respiration rate is shown from the 50 cm measurement distance. The data from the method comparison study is used to confirm the performance of the proposed measurement system. The current version of respiratory rate detection system using ultrasonic can successfully measure respiration rate. The proposed measurement method could be used for monitoring unconscious persons from a relatively close range, avoiding the need to apply electrodes or other sensors in the correct position and to wire the subject to the monitor. Monitoring respiration using ultrasonic sensor offers a promising possibility of non-contact measurement of respiration rates. Especially, this technology offers a potentially inexpensive implementation that could extend applications to consumer home-healthcare and mobile-healthcare products. Further advances in the sensor design, system design and signal processing can increase the range of the measurement and quality of the rate-finding for broadening the potential application areas of this technology.

• Journal of Chest Surgery
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• v.54 no.6
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• pp.466-472
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• 2021

Background: Major intraoperative hemorrhage reportedly predicts unfavorable survival outcomes following surgical resection for esophageal carcinoma (EC). However, the factors predicting the amount of blood lost during thoracoscopic esophagectomy have yet to be sufficiently studied. We sought to identify risk factors for excessive blood loss during video-assisted thoracoscopic surgery (VATS) for EC. Methods: Using simple and multiple linear regression models, we performed retrospective analyses of the associations between clinicopathological/surgical factors and estimated hemorrhagic volume in 168 consecutive patients who underwent VATS-type esophagectomy for EC. Results: The median blood loss amount was 225 mL (interquartile range, 126-380 mL). Abdominal laparotomy (p<0.001), thoracic duct resection (p=0.014), and division of the azygos arch (p<0.001) were significantly related to high volumes of blood loss. Body mass index and operative duration, as continuous variables, were also correlated positively with blood loss volume in simple linear regression. The multiple linear regression analysis identified prolonged operative duration (p<0.001), open laparotomy approach (p=0.003), azygos arch division (p=0.005), and high body mass index (p=0.014) as independent predictors of higher hemorrhage amounts during VATS esophagectomy. Conclusion: As well as body mass index, operation-related factors such as operative duration, open laparotomy, and division of the azygos arch were independently predictive of estimated blood loss during VATS esophagectomy for EC. Laparoscopic abdominal procedures and azygos arch preservation might be minimally invasive options that would potentially reduce intraoperative hemorrhage, although oncological radicality remains an important consideration.

• Journal of Physiology & Pathology in Korean Medicine
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• v.35 no.6
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• pp.255-260
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• 2021

Crohn's disease (CD) is an idiopathic inflammatory bowel disease (IBD) with unknown etiopathogenesis. Currently there are no definitive treatment modalities for CD. This case report presents clinical remission and its maintenance of CD induced by Korean herbal medicine treatment. A 56-year-old male patient diagnosed as CD by capsule endoscopy presented to a Korean Medicine clinic with severe abdominal pain as a chief complaint. Despite taking 5-aminosalicylic acid and immunosuppressant for 2 years, his abdominal pain was worsening at the time of visit. Treatment was initiated with Jinmoo-tang based on pattern identification and continued for approximately a year with some modifications according to patient's symptom changes. He was mainly given Jinmoo-Tang for a year and clinical remission was achieved; he could stop taking western medications. For 6 years since then, he took Korean medicine from time to time when he felt his condition went down and he is still maintaining remission. There were no adverse events reported. This case report suggests that individualized Korean herbal medicine treatment may have the potential for induction and maintenance of clinical remission of CD. Further research is warranted to establish an evidence-base for such approach.

• Journal of Trauma and Injury
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• v.35 no.4
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• pp.291-296
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• 2022

The therapeutic approach for colon injury has changed continuously with the evolution of management strategies for trauma patients. In general, immediate laparotomy can be considered in hemodynamically unstable patients with positive findings on extended focused assessment with sonography for trauma. However, in the case of hemodynamically stable patients, an additional evaluation like computed tomography (CT) is required. Surgical treatment is often required if prominent mesenteric extravasation, free fluid, bowel infarction, and/or colon wall perforation are observed. However, immediate intervention in hemodynamically stable patients without indications for surgical treatment remains questionable. Three patients with colon and mesocolon injuries caused by blunt trauma were treated by nonoperative management. At the time of admission, they were alert and their vital signs were stable. Colon and mesocolon injuries, large hematoma, colon wall edema, and/or ischemia were revealed on CT. However, no prominent mesenteric extravasation, free fluid, bowel infarction, and/or colon wall perforation were observed. In two cases, conservative treatment was performed without worsening abdominal pain or laboratory tests. Follow-up CT showed improvement without additional treatment. In the third case, follow-up CT and percutaneous drainage were performed in considering the persistent left abdominal discomfort, fever, and elevated inflammatory markers of the patient. After that, outpatient CT showed improvement of the hematoma. In conclusion, nonoperative management can be considered as a therapeutic option for mesocolon and colon injuries caused by blunt trauma of selected cases, despite the presence of large hematoma and ischemia, if there are no clear indications for immediate intervention.

• Journal of the Korean Society of Radiology
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• v.81 no.2
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• pp.442-447
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• 2020

Iatrogenic foreign bodies are a challenging complication to both the interventional radiologist and patient, resulting in impaired quality of life and substantial financial cost. The case report describes a successful percutaneous transhepatic removal of an intra-abdominal foreign body. A 72-year-old man underwent surgery for placement of a retrievable covered stent for refractory bile leakage after left hemihepatectomy. Three days after placement, stent folding and migration into a chronic biloma cavity occurred via the bile leakage site. By using a balloon catheter technique, the folded stent could be straightened and repositioned into the bile duct to minimize stent-strut injury during retrieval. The interventional approach could be a valid treatment option for intra-abdominal foreign bodies, as well as intravascular foreign bodies. A thorough understanding of devices and techniques can provide the interventional radiologist with valuable information regarding procedural planning and the management of iatrogenic foreign bodies.

• Korean Journal of Bronchoesophagology
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• v.15 no.2
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• pp.36-41
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• 2009

Background : Controversy exists whether patients with esophageal carcinoma are best managed with classical Ivor Lewis esophagectomy(ILO) as combined thoracic and abdominal approach or transhiatal esophagectomy(THO). The THO approach is known to be superior with respect to operative time, morbidity and mortality, and length of stay, especially at poor pulmonary function patient, but may represent an inferior cancer operation due to inadequate mediastinal clearance compared with ILO. Accordingly, we estimated the THO role at esophageal cancer to compare each operative approach. Material and Method : From January 2002 to December 2007, we performed a retrospective review of all esophagectomies performed at Keimyung University Dongsan Medical Center; 36 underwent THO, and 11 underwent ILO. Result : There were all men and squamous cell carcinoma but 1 woman at ILO group, 2 women at THO group. There were no significant differences between THO and ILO with age, sex, location of tumor, mean tumor length. There were significant differences at preoperative pulmonary function test(In ILO group, average FEV1 is $2.65{\pm}0.6\;L/min$ and iIn THO group, average FEV1 is $2.07{\pm}0.7\;L/min$). The amount of blood transfusion, hospital stay, leak rates and respiratory complication, hospital mortality rate were not significantly different. Conclusion : There was no significant difference in the post-operative complication, hospital mortality rate, long-term survival of patients of both operative method. THO method had lower mobidity and mortality at poor pulmonary function patient than ILO method. Hence, THO is a valid alternative to ILO for patients with poor general condition or expected post-operative respiratory complication.

• Journal of Chest Surgery
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• v.30 no.4
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• pp.402-407
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• 1997

The records of 28 patients with traumatic diaphragmatic injuries seen at Masan Samsung Hospital from march 1986 o March 1995 were reviewed. We treated 21 male and 7 female patients ranging in ages from 5 to 68 years. Thc diaphragimatic injuries were due to blunt trauma in'20 cases(Trawc accident 18, compression injury 1, Human trauma 1) and penetrating injuries 8 cases (all stab wound). Most common symptoms were dyspnea 27 (96%), chest pain 26 (93%), abdomianl pain 8 (29%), comatose mentality 36 (11 %). Chest X-ray were elevated diaphragm in 20 cases(71%) find hemothorax in 18 cases (64%) and 25 cascs (89%) were diagnosed or suspected as diaphragmatic inju,rims prcopcrativcly. The repair of 28 cases were performed with thoracic approach in 20 cases, abdominal approach 7, thoracoabdominal approach in 1 cases. There were 5 death (18%) and all death related to the severity of associated injury. (hypovolcmic shock 3, combined head injury 1, renal failure 1).

• Journal of Gastric Cancer
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• v.24 no.2
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• pp.210-219
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• 2024

Purpose: The study aimed to investigate real-world surgical outcomes of minimally invasive surgery (MIS) for advanced gastric cancer using Korean Gastric Cancer Association (KGCA)-led nationwide data. Materials and Methods: A nationwide survey of patients who underwent surgical treatment for gastric cancer in 2019 was conducted by the KGCA. A total of 14,076 patients from 68 institutions underwent surgery, and 4,953 patients diagnosed with pathological stages IB-III gastric cancer were included. Among them, 1,689 patients who underwent MIS (MIS group) and 1,689 who underwent the open approach (open group) were matched using propensity score in a 1:1 ratio. Surgical outcomes were compared, and multivariate analysis was performed to identify the independent factors for overall morbidity. Results: The MIS group had a lower proportion of D2 lymphadenectomy, total omentectomy, and combined resection. However, the number of harvested lymph nodes was higher in the MIS group. Better surgical outcomes, including less blood loss and shorter hospital stay, were observed in the MIS group, and the overall morbidity rate was significantly lower in the MIS group (17.5% vs. 21.9%, P=0.001). The mortality rates did not differ significantly between the 2 groups. In the multivariate analysis, the minimally invasive approach was a significant protective factor against overall morbidity (odds ratio, 0.799; P=0.006). Conclusions: Based on the Korean nationwide data, MIS for stage IB-III gastric cancer had better short-term outcomes than the open approach, including lower rates of wound complications, intra-abdominal abscesses, and cardiac problems.