• Title/Summary/Keyword: Cervical approach

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Surgical Management of Trachea Stenosis (기관협착증에 대한 기관 성형술)

  • 김치경
    • Journal of Chest Surgery
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    • v.25 no.12
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    • pp.1508-1515
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    • 1992
  • Between 1975 and 1992, forty five patients with trachea stenosis received tracheoplasty for relief of obstruction. The causes of airway problem are brain contusion[19 cases, 40%], cerebrovascular disease[3 cases, 7%], drug intoxication[8 cases, 18%], psychotic problem[2 cases, 4%], trachea tumor[3 cases, 7%], adult respiratory distress syndrome[9 cases, 20%] and direct trauma[1 case, 2%]. Direct causes of trachea stenosis were complications of tracheostomy[36 cases, 80%], complications of nasotracheal intubation[5 cases, 11%], tumor[3 cases, 6%] and trauma[1 case, 2%]. Thirty one patients underwent the sleeve resection and end-to-end anastomosis. Five patients performed a wedge resection and end-to-end anastomosis. Forteen patients received the Montgomery T-tube for relief of airway obstruction. Four patients have done simple excision of granulation tissue. Two, subglottic stenosis patients were received Rethi procedure[anterior division of cricoid cartilage, wedge partial resection of lower thyroid cartilage and Montgomery T-tube molding] and the other subglottic stenosis patient underwent permanent trachea fenestration. Including cervical flexion in all patients postoperatively, additional surgical techniques for obtain tension-free anastomosis were hyoid bone release technique in two cases, and hilar mobilization, division of inferior pulmonary ligament and mobilization of pulmonary vessel at the pericardium were performed in one case. Cervical approach was used in 39 cases, cervicomediastinal in 12 cases and transthoracic in one case. Complications of tracheoplasty were formation of granulation tissue at the anastomosis site[3 cases], restenosis[9 cases], trachea-innominate artery fistula[2 cases], wound infection[2 cases], separation of anastomosis[2 cases], air leakage[3 cases], injury to a recurrent laryngeal nerve[temporary 8 cases, permanent 2 cases] and hypoxemia[1 case]. Surgical mortality for resection with primary reconstruction was 6.7%, with one death due to postoperative respiratory failure and two deaths due to tracheo-innominate artery fistula.

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Estimation of Joint Risks for Developing Uterine Cervix Cancer in Korea (한국인 자궁경부암의 복합위험도 추정)

  • Yoon, Ha-Chung;Shin, Ae-Sun;Park, Sue-Kyung;Jang, Myung-Jin;Yoo, Keun-Young
    • Journal of Preventive Medicine and Public Health
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    • v.35 no.3
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    • pp.263-268
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    • 2002
  • Objective : This study was aiming at estimating the joint effects of various risk factors associated with uterine cervix cancer in Korea. Methods : Data obtained from a case-control study were analyzed with a multiplicative model. Results : After adjustment for age and husband's educational attainments, the family history of cervical cancer (OR=2.1, 95% CI=1.2-3.9), unstable marital status due to separation, by death or divorce, etc. (OR=2.8, 95% CI=1.7-4.6), and a large number of deliveries ($\geq$3 vs. nulliparous OR=6.5, 55% CI=1.4-29.0) increased the risk of uterine cervix cancer, Conversely, first sexual intercourse at an older age ($\geq$25 years vs. <19 years OR=0.4, 95% CI=0.2-0.6) and husband's circumcision (OR=0.7, 95% CI=0.5-1.0) decreased the risk. In the multiplicative model, the highest joint risk (OR=39.2, 95% CI 5.9-258.9) was observed in women with a family history of uterine cervical cancer, an unstable marital status, where the ex-husband was not circumcised, with 3 or more delivery experiences, and having her first sexual intercourse when younger than 19 years of age. However, women without a family history of uterine cervix cancer, married to a circumcised husband, having had her first sexual intercourse at 25 years or older, and nulliparous, showed the lowest joint effect (OR=0.3, 95% CI=0.1-0.5). Conclusion : As carcinogenesis is a complex action involving various factors, we consider a joint effects approach to be appropriate in an epidemiological study on risk factors for uterine cervix neoplasms cervix neoplasm.

Surgical Treatment of Acid Induced Corrosive Esophageal Stricture in Children (소아의 산성 부식성 식도협착의 외과적 치료)

  • Park, Kwi-Won;Yang, Seok-Jin;Chun, Yong-Soon;Jung, Sung-Eun;Lee, Seong-Cheol;Kim, Woo-Ki
    • Advances in pediatric surgery
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    • v.3 no.1
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    • pp.47-53
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    • 1997
  • Accidental ingestion of caustic substance is one of the common problems among children around the world. Acid intake accounts for a mere 5% of all reported cases of corrosive ingestion in the West. Because of the esophageal sparing effect of acid, clinically significant esophageal involvement after acid ingestion occurs in only 6 to 20 percent of the instances. Despite effort of prevention, 7% to 15% of children sustaining caustic esophageal burns develop esophageal strictures. If balloon dilatation or bougie dilatation fails to resolve the esophageal strictures, successful outcome following replacement by colon or stomach has been reported in children. But the complications and morbidity following these operations are still relatively high. Seven patients with corrosive-acid induced esophageal strictures who were operated upon at the Department of Pediatric Surgery, Seoul National University Children's Hospital from 1991 to 1995 were reviewed. Primary resection and anastomosis was performed in all of 7 patients. The stricture involved short segments of the esophagus at the level of the lower cervical and the upper thoracic vertebra. The operations were approached through a left cervical incision or a left thoracotomy. In one patient, operative repair of anastomotic leakage was done, and three patients required re-resection of anastomotic strictures postoperatively, and one patient required a third operation(reversed gastric tube) due to an anastomotic stricture. The other anastomotic leaks, strictures or pulmonary complications were resolved with conservative treatment. In conclusion, primary resection and anastomosis of the esophagus was performed successfully on the 6 of 7 children with acid induced corrosive esophageal strictures. This approach is physiologic, especially in children who should have a long life expectancy, and recommended for the treatment of short-segment acid induced corrosive esophageal strictures.

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Surgical Treatment of the Giant Cell Tumors in the Spine (척추에 발생한 거대세포종의 수술적 치료)

  • Kang, Yong-Koo;Lee, In-Ju;Chang, Han;Kwon, Soon-Yong;Rhyu, Kee-Won;Yi, Sang-Hoon
    • The Journal of the Korean bone and joint tumor society
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    • v.4 no.1
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    • pp.37-43
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    • 1998
  • Between 1992 and 1996, 5 patients with the giant-cell tumor of the spine were treated. Four were female and one was male. The mean age was 34 years old, and the mean follow-up time was 36 months. The locations of the lesions were the cervical spine in 1, the thoracic spine in 3, and the lumbar spine in 1. Pain was the predominant presenting symptom in all cases and four had a neurological deficit. A combined anterior and posterior surgical approach wds as performed in all cases, which were also treated with AIF(anterior interbody fusion) and anterior and/or posterior instrumentation. Adjuvant radiation therapy was performed in 1 case of cervical spine. At the final follow-up, the pain and neurologic symptoms were improved. Radiologic examination showed no evidence of local recurrence and no failure of instrumentation of the spine.

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The clinical study on one case of cervical sprain patient due to traffic accident in pregnancy (임신 중 교통사고로 인한 경추 염좌 환자 1례 증례보고)

  • Baek, Seung-hun;Na, Hyo-seok;Park, Hyun-jae;Jung, Eun-a;Choi, Soon
    • The Journal of Korean Obstetrics and Gynecology
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    • v.18 no.1
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    • pp.207-217
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    • 2005
  • Purpose : With the development of society, traffic accident(TA) rate is increasing accordingly. And the number of women in pregnancy who are damaged by TA is increasing as more women are involved in economical and social activities. TA victim in pregnancy cannot get proper treatment(Tx) in western medicine. Oriental medicine Tx is noted as alternative in treating TA victims recently. The main purpose of this clinical study is to make a survey of effective way of the oriental gynecological Tx about TA victim in pregnancy. Methods : The patient in this case, 28-year-old, was admitted for 14days(27th/May/2004 - 9th/June/2004) to cure severe neck pain and limitaion of cervical ROM(range of motion) occured from TA on the 4th week of pregnancy. This patient was treated with the acupunture, herbal medicine and physical treatment. Result and Conclusion : The symptoms of patient in this case are remarkable alleviated. And we think that the TA victims in pregnancy can be managed effectively by oriental gynecological Tx due to consider preservation of fetus and pregnant woman. After this, further study, approach and case will be needed about oriental gynecological Tx of TA victims in pregnancy.

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Association Between Vertebrobasilar Insufficiency and Cervicogenic Headache: Hypothetical Approach Towards Etiopathogenesis of Headache

  • Kaur, Aninditya;Rakesh, N.;Reddy, Sujatha S.;Thomas, Nithin;Nagi, Ravleen;Patil, Deepa Jatti
    • Journal of Oral Medicine and Pain
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    • v.45 no.4
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    • pp.97-109
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    • 2020
  • Purpose: Cervicogenic headache (CGH) is pain referred to the head/ face from the structures in vicinity of upper cervical spinal nerves via trigeminocervical pathway. Ponticulus Posticus (PP) and Elongated Styloid Process (ESP) are anatomical structures that cause compression of vasculature present around upper cervical nerve plexus. Recently, computational fluid dynamics (CFD) has shown to play an essential role in identification of these high-pressure zones in the brain. The aim of this research is to study the association of ESP and PP in patients with CGH and to develop a hypothesis by CFD to analyse vertebrobasilar insufficiency as a contributing factor in occurrence of CGH. Methods: Retrospective analysis of 4500 full skull CBCT scans was done for the presence of partial or complete PP and length of Styloid Process (SP). Research was divided into two phases; In first Preliminary Phase, 150 scans that showed the presence of PP and ESP were analysed, and only 134 patients gave consent to fill the questionnaire containing 96 question items pertaining to symptoms associated with CGH. In the second phase, simulation of Vertebral and Carotid Artery was done using Fluent 14.5 Software and by CFD, pressure distribution on arteries was obtained that helped to identify high pressure regions. Results: Both PP and ESP showed a statistically significant association with CGH (p<0.001). By CFD analysis, both steady and transient phases of simulation showed drop in pressure due to constriction of internal carotid and vertebral artery by ESP and PP respectively and were found to decrease the volume of blood reaching the brain, 0.12 /0.13 mL and 0.06 mL respectively. Conclusions: Our analysis proves ESP and PP as contributing factors towards CGH. Hence for proper diagnosis and management of headache disorders, clinicians should have adequate knowledge about these anatomical structures and their resulting clinical symptoms.

Reconstruction and Exploratory Analysis of mTORC1 Signaling Pathway and Its Applications to Various Diseases Using Network-Based Approach

  • Buddham, Richa;Chauhan, Sweety;Narad, Priyanka;Mathur, Puniti
    • Journal of Microbiology and Biotechnology
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    • v.32 no.3
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    • pp.365-377
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    • 2022
  • Mammalian target of rapamycin (mTOR) is a serine-threonine kinase member of the cellular phosphatidylinositol 3-kinase (PI3K) pathway, which is involved in multiple biological functions by transcriptional and translational control. mTOR is a downstream mediator in the PI3K/Akt signaling pathway and plays a critical role in cell survival. In cancer, this pathway can be activated by membrane receptors, including the HER (or ErbB) family of growth factor receptors, the insulin-like growth factor receptor, and the estrogen receptor. In the present work, we congregated an electronic network of mTORC1 built on an assembly of data using natural language processing, consisting of 470 edges (activations/interactions and/or inhibitions) and 206 nodes representing genes/proteins, using the Cytoscape 3.6.0 editor and its plugins for analysis. The experimental design included the extraction of gene expression data related to five distinct types of cancers, namely, pancreatic ductal adenocarcinoma, hepatic cirrhosis, cervical cancer, glioblastoma, and anaplastic thyroid cancer from Gene Expression Omnibus (NCBI GEO) followed by pre-processing and normalization of the data using R & Bioconductor. ExprEssence plugin was used for network condensation to identify differentially expressed genes across the gene expression samples. Gene Ontology (GO) analysis was performed to find out the over-represented GO terms in the network. In addition, pathway enrichment and functional module analysis of the protein-protein interaction (PPI) network were also conducted. Our results indicated NOTCH1, NOTCH3, FLCN, SOD1, SOD2, NF1, and TLR4 as upregulated proteins in different cancer types highlighting their role in cancer progression. The MCODE analysis identified gene clusters for each cancer type with MYC, PCNA, PARP1, IDH1, FGF10, PTEN, and CCND1 as hub genes with high connectivity. MYC for cervical cancer, IDH1 for hepatic cirrhosis, MGMT for glioblastoma and CCND1 for anaplastic thyroid cancer were identified as genes with prognostic importance using survival analysis.

EAGLE'S SYNDROMES (CALCIFIED STYLOID LIGAMENT PROCESS) ACCOMPANIED WITH THROAT PAIN ON SWALLOWING;REPORT OF 2 CASES (연하시 경부동통을 동반한 Eagle씨 증후 2례와 조직소견)

  • Kim, Dae-Sung;Kim, Myung-Rae;Choi, Jang-Woo;Kim, Choong
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.21 no.4
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    • pp.395-400
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    • 1999
  • Elongation of the styloid process (styloid syndrome, Eagle's Syndrome) is named after Eagle who insisted the styloid process as a cause of pain but distinguishable from the glossopharyngeal neuralgia. Eagle's syndrome is characterized by a dull nagging pharyngeal pain, a palpable hardness in the tonsillar fossa, radiopaque elongation and enlargement of the syloid process. This is to report two cases of Eagle's Syndrome. The clinical and radiological features, development and pathogenesis of the Eagle's Syndrome and pathologic findings of the calcified styloid ligaments were described with review of literatures. The external cervical approach to resect the enlarged calcified processes can be an option due to better visualization and accessbility, less infection at risk than intra-oral approach. The findings and results were as follows ; 1. The calcified styloid ligaments accompanied with throat pain were reseded in size of $5.5{\times}48mm(#1,\;Rt)$, $3.6{\times}5mm(#1,\;Lt)$, $5.2{\times}51mm(#2,\;Rt)$ and $3.1{\times}38mm(#2,\;Lt)$. 2. The submandibular approach to resect the calcified styloid process is of help to get better visibility and accessiblilty avoiding the injury to the deep cervial vital structures. 3. The resected styloid processes were examined histopathologically as the matured cortical bones with marrow structures or cartilagenous cells without any findings of neoplasmic changes. 4. The remained process did not show any noticeable regrowth in 3 years after surgical amputation.

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Treatment of Tumor Involving Thoracic Inlet by Using Transmanubrial Osteomuscular Sparing Approach - One case report- (흉강입구를 침범한 종양의 근골보존 경흉골병 접근술을 이용한 치유 -1예 보고-)

  • Choi Chan Young;Kim Wook Sung;Ryoo Ji Yoon;Chang Woo Ik;Kim Min-Kyung;Cho Seong Joon;Kim Yeon Soo
    • Journal of Chest Surgery
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    • v.38 no.2 s.247
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    • pp.175-179
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    • 2005
  • The operative case of transmanubrial osteomuscular sparing approach for the tumor involving thoracic inlet is reported. A 69-year-old man visited the hospital due to right upper extremity weakness. Chest roentgenogram showed bronchiectasis, chronic pulmonary tuberculosis, and fungal ball in right upper lobe. On computed tomogram, tumor was located in epidural space of the 6th, the 7th cervical, and the 1st thoracic spine and extended to the apex of the right thorax. A neurosurgeon performed laminectomy and removed the tumor located in the spinal canal. A thoracic surgeon performed a transmanubrial osteomuscular sparing approach and removed the tumor involving thoracic inlet. The tumor was diagnosed as hemangiopericytoma. The patient recovered without complication.

SHADE ANALYSIS OF ANTERIOR TEETH USING DIGITAL SHADE ANALYSIS SYSTEM (Digital Shade Analysis System을 이용한 전치부의 색조 특성에 관한 연구)

  • Kim Hee-Eun;Cho In-Ho;Lim Ju-Hwan;Lim Hun-Song
    • The Journal of Korean Academy of Prosthodontics
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    • v.41 no.5
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    • pp.565-581
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    • 2003
  • Statement of problem : A scientific examination and understanding of overall aspects of the natural dentition is the first step involved in making a satisfactory selection in the shade of an aesthetic prosthesis. Proper natural shade selection of the prosthetic restoration that is in harmony with the remaining dentition is as important aesthetically, as harmony of form and function in the anterior dentition. Clinically, the most commonly applied method of shade selection has been visual, but because of the subjective nature inherent to this method, shade selection results are variable and can be influenced by such factors as the technician, the type of shade guide used, and the type and intensity of the lighting. Purpose : The purpose of this study was to develop a more objective and scientific approach to examining and understanding the shade of teeth, which has in turn lead to the development of a number of shade analysis devices that present a more objective method of shade analysis. Material and Method : In this study, the shades of healthy anterior teeth were examined and analyzed using the recently developed digital shade analysis of the $ShadeScan^{TM}$ System. The study examined 80 individuals in their twenties, 40 males and 40 females, presenting 6 healthy, unrestored maxillary anterior teeth. Tooth brushing and oral prophylaxis were performed prior to evaluation. The ShadeScan handpiece was used to acquire images of the 6 maxillary anterior teeth. These images were analyzed using the Vita/Classical mode of the $ShadeScan^{TM}$ Software, and shade maps of each tooth were acquired and divided into cervical, middle, and incisal thirds. The shade distribution of each third, left and right symmetry, and gender differences were investigated and analyzed. Results : The results of the study are as follows : 1. An overwhelming majority of the examined teeth were found to possess shades belong to Group A, with the greatest variations occurring at the middle and cervical thirds of the maxillary central and lateral incisors, in both male and female subjects. 2. Canines of both male and female subjects showed left and right symmetry with uniform shade distribution of A4 and C4, while the lateral and central incisors showed left-right symmetry of the incisal 1/3 with a uniform shade distribution of A2 and A3 shades 3. No significant differences in shade distribution were seen between genders in maxillary canines, whereas maxillary central and lateral incisors showed differences at the middle and cervical thirds between male and female subjects The results of this study show that with the exception of maxillary canines, maxillary anterior teeth display a diverse shade distribution as well as gender differences. Conclusion : Clinically, when making a shade selection using the existing shade guide, one must consider the fact that even a single tooth consists of a variety of shades. The results of this study show that when selecting a shade from a number of groups is difficult, shades from A group are the most consistent with the natural shade or maxillary anterior teeth.