• Journal of Chest Surgery
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• 제57권2호
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• pp.225-229
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• 2024

Venovenous (VV) extracorporeal membrane oxygenation (ECMO) is a lifesaving technique for patients experiencing respiratory failure. When VV ECMO fails to provide adequate support despite optimal settings, alternative strategies may be employed. One option is to add another venous cannula to increase venous drainage, while another is to insert an additional arterial return cannula to assist cardiac function. Alternatively, a separate ECMO circuit can be implemented to function in parallel with the existing circuit. We present a case in which the parallel ECMO method was used in a 63-year-old man with respiratory failure due to coronavirus disease 2019, combined with cardiac dysfunction. We installed an additional venoarterial ECMO circuit alongside the existing VV ECMO circuit and successfully weaned the patient from both types of ECMO. In this report, we share our experience and discuss this method.

• 한국간담췌외과학회지
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• 제27권1호
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• pp.56-62
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• 2023

Backgrounds/Aims: Endoscopic retrograde cholangiopancreatography-guided gallbladder drainage (ERGD) is an alternative to percutaneous cholecystostomy (PTC) for hospitalized acute cholecystitis (AC) patients. Methods: We retrospectively analyzed propensity score matched (PSM) AC hospitalizations using the National Inpatient Sample database between 2016 and 2019 to compare the outcomes of ERGD and PTC. Results: After PSM, there were 3,360 AC hospitalizations, with 48.8% undergoing PTC and 51.2% undergoing ERGD. There was no difference in median length of stay between the PTC and ERGD cohorts (p = 0.110). There was a higher median hospitalization cost in the ERGD cohort, $62,562 (interquartile range [IQR] $40,707-97,978) compared to PTC, $40,413 (IQR $25,244-65,608; p < 0.001). The 30-day inpatient mortality was significantly lower in hospitalizations with ERGD compared to PTC (adjusted hazard ratio 0.16, 95% confidence interval [CI]: 0.1-0.41; p < 0.001). There was no difference in association with blood transfusions, acute renal failure, ileus, small bowel obstruction, and open cholecystectomy conversion (p > 0.05) between hospitalizations with ERGD and PTC. There was lower association of acute hypoxic respiratory failure (adjusted ratio [AOR] 0.46, 95% CI: 0.29-0.72; p = 0.001), hypovolemia (AOR 0.66, 95% CI: 0.49-0.82; p = 0.009) and higher association of lower gastrointestinal bleed (AOR 1.94, 95% CI: 1.48-2.54; p < 0.001) with ERGD compared to PTC. Conclusions: ERGD is a safer alternative to PTC in patients with AC. The risk complications are lower in ERGD compared to PTC but no difference exists based on mortality or conversion to open cholecystectomy.

• 한국지반공학회:학술대회논문집
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• 한국지반공학회 1999년도 가을 학술발표회 논문집
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• pp.449-456
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• 1999

The concrete wall is the most useful of retaining structure which can obtain the engineering stability, but has problems that is not friendly with nature environment in a fine view, such as poor rear drainage, and shrinkage crack by temperature difference, etc. Because of this problems, the research for a segmental crib retaining wall has been performed. A segmental crib retaining wall is quickly and easily erected because is possible to be erected as the individual members, and is not sensitive to differential settlement and earthquakes. Also, it shows effective drainage and has a friendly advantage with nature environment because of being able to be planted with vines and shrubs in retaining walls The design of crib retaining walls has traditionally been based on classical soil mechanics theories. These theories, originally derived by Rankine(1857) and Coulomb(1776), assume that the wall acts as a rigid body. This assumption results in failure being predicted by either monolithic overturning or base sliding mechanisms. However, the wall consists of individual members which have been created a three dimensional grid. This grid confines an fill mass which becomes part of the wall. The filled wall resists the earth pressure with the same mechanism of classical gravity walls. Because of the flexibility of the individual segment, it allows relative movement between the individual members within the wall. The three dimensional flexible grid leads to stress redistribution when the wall is subjected to external or fill loads. Due to the flexibility and the stress redistribution, the failure of segmental crib wall consists of not only overturing and base sliding but the local deformation and the failure between the segmental members. It has been researched in the field that due to this flexibility and load redistribution, serviceability failure of segmental crib walls is unlikely to be due to overturning or base sliding. Therefore, in this study, the relative displacement appearance of retaining wall due to variation of inclination is measured to examine this behavior characteristics. Also, the behavior characteristics of retaining walls by surcharge load, and location of acting point of retaining wall rear, and the displacement characteristics and deflections are estimated about the existence and nonexistence of Rear Stretcher performing an role in transmitting earth pressure of Header and Stretcher organizing retaining walls. This research focuses on the characteristics due to the behavior of retaining walls. This research focuses on the characteristics due to the behavior of retaining walls.

• 지질공학
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• 제21권4호
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• pp.313-322
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• 2011

2007년 9월 태풍 "나리"의 영향으로 전라남도 지역에서 많은 붕괴비탈면이 발생되었으며, ${\bigcirc}{\bigcirc}$우회도로에 위치한 도로비탈면에서 붕괴가 발생되어 도로시설물을 파손시켰다. 본 연구의 목적은 붕괴비탈면의 현장특성과 구성 토사의 공학적 특성 및 점토광물의 분포, 정량분석 결과 등을 바탕으로 붕괴발생원인을 고찰하는 것이다. 대상비탈면은 화산암 기원의 풍화토사로 이루어져 있으며 붕괴부에서는 소규모 단층과 염기성암맥이 발견된다. 상부자연비탈면 내 진입로는 포장이 되지 않았고, 배수로의 설치 미흡으로 인하여 많은 유수가 붕괴부 쪽으로 집중되는 환경이었다. 붕괴부 토사는 저소성실트와 고소성점토로 분류되며, X선회절분석에서는 스멕타이트와 버미큘라이트와 같은 팽윤성 점토광물이 다량 함유되어 있음이 확인되었다. 대상비탈면은 배수시설의 설치 불량, 지질학적 약대 존재, 활성도가 큰 점토광물의 함유 등으로 붕괴가 발생되었던 것으로 판단된다.

• Journal of Chest Surgery
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• 제9권2호
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• pp.125-132
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• 1976

The author made clinical study of 100 cases of empyema in infancy and childhood that were treated at the Department of Chest Surgery, Busan University Hospital and Busan Children's Charity Hospital, from Jan 1962 to Nov. 1975. 1. In infancy and childhood, 62 cases out of my 100 cases of empyema were caused by .staphylococci and most of recent reports showed a gradual increase in number of staphylococcal empyema. 2. Most frequent lesion predisposing to empyema in infancy and childhood was pneumonia (72%), being remarkable in staphylococcal empyema (85.5%) to that of others. 3. Antibiotics sensitivity test for staphylococci revealed that the erythromycin was most susceptible (85. 5%). 4. The mortality rate was 6% in over all and the author believes that from the point of view of surgical treatment, failure of early continuous drainage on account of multiple thoracentesis for the early stage of empyema, and also early open thoracotomy procedure such as decortication were all the contributing factors to higher mortality in the empyema of infancy and childhood. 5. It may be concluded that the treatment of choice for empyema in infancy and childhood were early and prolonged continuous drainage of pus by closed thoracotomy with caution and administration of more susceptible antibiotics with nutritional support.

• Journal of Korean Neurosurgical Society
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• 제57권5호
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• pp.379-385
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• 2015

Chronic subdural hematomas mainly occur amongst elderly people and usually develop after minor head injuries. In younger patients, subdural collections may be related to hypertension, coagulopathies, vascular abnormalities, and substance abuse. Different techniques can be used for the surgical treatment of symptomatic chronic subdural hematomas : single or double burr-hole evacuation, with or without subdural drainage, twist-drill craniostomies and classical craniotomies. Failure of the brain to re-expand, pneumocephalus, incomplete evacuation, and recurrence of the fluid collection are common complications following these procedures. Acute subdural hematomas may also occur. Rarely reported hemorrhagic complications include subarachnoid, intracerebral, intraventricular, and remote cerebellar hemorrhages. The causes of such uncommon complications are difficult to explain and remain poorly understood. Overdrainage and intracranial hypotension, rapid brain decompression and shift of the intracranial contents, cerebrospinal fluid loss, vascular dysregulation and impairment of venous outflow are the main mechanisms discussed in the literature. In this article we report three cases of different post-operative intracranial bleeding and review the related literature.

• Geomechanics and Engineering
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• 제19권5호
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• pp.435-445
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• 2019

A series of element tests with different drainage conditions and strain rates were performed on compacted unsaturated non-plastic silt in unconfined conditions. Soil samples were compacted at water contents from dry to wet of optimum with the degree of saturation varying from 24 to 59.5% while maintaining the degree of compaction at 80%. The tests performed were shear infiltration tests in which specimens had constant net confining pressure, pore air pressure was kept drained and constant, just before the shear process pore water pressure was increased (and kept constant afterwards) to decrease matric suction and to start water infiltration. In constant water content tests, specimens had constant net confining pressure, pore air pressure was kept drained and constant whereas pore water pressure was kept undrained. As a result, the matric suction varied with increase in axial strain throughout the shearing process. In both cases, maximum shear strength was obtained for specimens prepared on dry side of optimum moisture content. Moreover, the gradient of stress path was not affected under different strain rates whereas the intercept of failure was changed due to the drainage conditions implied in this study.

• Journal of Chest Surgery
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• 제24권4호
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• pp.397-403
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• 1991

From June 1987 to January 1991, 24 patients with moderate or massive pericardial effusion underwent subxiphoid pericardial window procedures for diagnosis and therapy. The patients` ages were ranged from 28 years to 71 years. The underlying diseases were chronic renal failure with long term hemodialysis in 3 cases, malignant lung cancer in 7 cases, stomach cancer in 2 cases, tuberculous pericarditis in 5 cases, pyogenic pericarditis in 2 cases, myxedema in one case, one metastatic squamous cell carcinoma from unknown origin and three of undefined etiology. Preoperative diagnoses of pericardial effusions were confirmed by echocardiogram in all cases. Subxiphoid pericardial drainages were performed under general[n=19] or local anesthesia[n=5]. Histological diagnoses were made from the inferior pericardial tissue in all cases except one. In this one case[tuberculous pericarditis], the subxiphoid pericardial approach was failed from intraoperative bleeding. There were two postoperative death, one[in malignant lung cancer] had postoperative ventricular tachycardia which result in cardiac arrest, and the other[unknown origin metastatic malignant effusion] had persistent tachyarrhythmia postoperatively and died on postoperative 5th days. Twenty three patients were followed up from 3 days to 9 months; mean follow-up day was 43 days. The preoperative and postoperative mean cardiothoracic ratio in chest x-ray were 0.69 and 0.52 respectively. Subxiphoid pericardial drainage may provide definitive diagnosis and treatment for pericardial effusions. The approach through subxiphoid pericardium under general or local anesthesia avoids the complications of pericardiocentesis and is effective for malignant pericardial effusion.

• 대한기관식도과학회지
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• 제5권1호
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• pp.14-21
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• 1999

Perforating injury of the thoracic esophagus leads to an almost Immediate exposure of the mediastinum to both oral secretions and refluxed gastric contents. And necrotizing inflammatory response developed inevitably. So, without proper managements, mediastinitis results in severe dehydration or septic conditions, and consequently the life of the patient can be threaten. We experienced recently 4 cases of esophageal perforation. Three cases were Boerhaave's syndromes and the other one was instrumental perforation in patient with corrosive esophageal stricture. Curative surgical procedures were done in 3 cases and the drainage procedure was only possible in the other one due to hepatic failure. And the patient with the drainage management was dead.

• Journal of Korean Neurosurgical Society
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• 제43권1호
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• pp.11-15
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• 2008

Objective : Burr hole drainage has been widely used to treat chronic subdural hematoma (CSDH). However, the incidence of recurrent CSDH varies from 3.7 to 30% after surgery. The authors attempted to elucidate the risk factors associated with the recurrence of CSDH in one burr hole drainage technique. Methods : A total of 255 consecutive cases who underwent one burr hole drainage for CSDH were included in this study. Twenty-four patients (9.4%) underwent a repeated operation because of the recurrence of CSDH. We analyzed retrospectively the demographic, clinical and radiologic factors associated with the recurrence of CSDH. Results : In this study, two risk factors were found to be independently associated with the recurrence of CSDH. The incidence of CSDH recurrence in the high- and mixed-density groups was significantly higher than those in the low- and iso-density groups (p<0.001). Bleeding tendency such as in leukemia, liver disease and chronic renal failure was also significantly associated with recurrence of CSDH (p=0.037). Conclusion : These results suggest that high- and mixed- density shown on computed tomographic scan was closely relates with a high incidence of recurrence. Therefore, the operation could be delayed in those cases unless severe symptoms or signs are present. Reoperation using the previous burr hole site is a preferred modality to treat the recurrent CSDH.