• Title/Summary/Keyword: Fragment removal

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Penetrating and Nonpenetrating Cardiac Injuries Combined with Cardiac Tamponade. - Report of seven cases and Clinical analysis - (심낭압진이 동반된 관통성 및 비관통성 심장외상 - 7례 보고 및 임상분-)

  • 이만복
    • Journal of Chest Surgery
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    • v.22 no.4
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    • pp.698-704
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    • 1989
  • We experienced the seven cases of penetrating and non-penetrating cardiac injuries combined with cardiac tamponade from June 1986 to June 1989 at Seoul and Chun-An Hospital of SOONCHUNHYANG medical college. The results were as follows. l. In sex distribution, 7 cases were male. In age distribution, The fourth decades occupied about 58 % of all cases. 2. In mode of injury, 4 cases were stab wounds, 1 case penetration by metallic fragment, 2 cases blunt chest trauma. 3. We routinely checked the CVP with subclavian vein catheterization in case of suspicious cardiac tamponade. Significant increments were showed in 4 cases. 4. Becks triad [low blood pressure, raised central venous pressure, distant heart sound] were recorded in 43 % of the cases with proven tamponades. 5. The sites of injury included RV in 4 cases, LV in 1 case, RA in 1 case and branch of RCA in 1 case. The RV injuries were the most common. 6. Coronary artery damage occurred in 2 cases. LADA was severed in 1 case combined with RV rupture and branch of RCA was torn 1 case. 7. Pericardiocentesis was performed 1 case at another hospital before referring to our hospital. We have never used the procedure because we think that it is potentially dangerous with no clear benefit. 8. Subxyphoid pericardial window was performed in 2 cases of severe cardiac tamponade. We have employed this method to stabilize the patients who had systolic hypotension. 9. Surgical approaches were performed with median sternotomy in 3 cases, thoracotomy in 4 cases. 10. We undertook the simple closure in 6 penetrating cardiac wounds. The removal of impacted metallic fragment was performed under the cardiopulmonary bypass. Simple ligation was performed in 2 cases of coronary artery severance 11. One patient with no sign of life was urgently intubated and undertaken an emergency room thoracotomy on the stretch car without antiseptic preparation. The cardiorrhaphy in 6 cases were performed in the operating theater 12. One patient undertaken emergency room thoracotomy did not survive due to refractory hypovolemic shock. But the remaining 6 patients recovered.

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Analysis of Microbial Communities Using Culture-dependent and Culture-independent Approaches in an Anaerobic/Aerobic SBR Reactor

  • Lu Shipeng;Park Min-Jeong;Ro Hyeon-Su;Lee Dae-Sung;Park Woo-Jun;Jeon Che-Ok
    • Journal of Microbiology
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    • v.44 no.2
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    • pp.155-161
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    • 2006
  • Comparative analysis of microbial communities in a sequencing batch reactor which performed enhanced biological phosphorus removal (EBPR) was carried out using a cultivation-based technique and 16S rRNA gene clone libraries. A standard PCR protocol and a modified PCR protocol with low PCR cycle was applied to the two clone libraries of the 16S rRNA gene sequences obtained from EBPR sludge, respectively, and the resulting 424 clones were analyzed using restriction fragment length polymorphisms (RFLPs) on 16S rRNA gene inserts. Comparison of two clone libraries showed that the modified PCR protocol decreased the incidence of distinct fragment patterns from about 63 % (137 of 217) in the standard PCR method to about 34 % (70 of 207) under the modified protocol, suggesting that just a low level of PCR cycling (5 cycles after 15 cycles) can significantly reduce the formation of chimeric DNA in the final PCR products. Phylogenetic analysis of 81 groups with distinct RFLP patterns that were obtained using the modified PCR method revealed that the clones were affiliated with at least 11 phyla or classes of the domain Bacteria. However, the analyses of 327 colonies, which were grouped into just 41 distinct types by RFLP analysis, showed that they could be classified into five major bacterial lineages: ${\alpha},\;{\beta},\;{\gamma}-$ Proteobacteria, Actinobacteria, and the phylum Bacteroidetes, which indicated that the microbial community yielded from the cultivation-based method was still much simpler than that yielded from the PCR-based molecular method. In this study, the discrepancy observed between the communities obtained from PCR-based and cultivation-based methods seems to result from low culturabilities of bacteria or PCR bias even though modified culture and PCR methods were used. Therefore, continuous development of PCR protocol and cultivation techniques is needed to reduce this discrepancy.

Successful Management of Post-Traumatic Hydrocephalus and Pseudomeningocele Following Traumatic Brain Injury in a Cat

  • Hyoung-Won Seo;Jeong-Min Lee;Hae-Boem Lee;Yoon-Ho Roh;Tae-Sung Hwang;Kun-Ho Song;Joong-Hyun Song
    • Journal of Veterinary Clinics
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    • v.40 no.1
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    • pp.56-61
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    • 2023
  • A 5-month-old female domestic short-haired cat presented with a history of seizure episodes for two months following an animal bite injury to the head. There were no remarkable findings on physical and neurological examination or blood analysis. Computed tomography revealed a fracture of the left parietal bone with an inward displacement of the bone fragment while magnetic resonance imaging revealed an enlarged temporal horn of the left lateral ventricle and a pseudomeningocele compressing the adjacent cerebral parenchyma. Subsequently, cerebrospinal fluid analysis results were normal. The patient was diagnosed with traumatic brain injury (TBI), with subsequent post-traumatic hydrocephalus (PTH) and pseudomeningocele. Despite treatment with phenobarbital and levetiracetam, seizures were not sufficiently controlled. Craniectomy for bone fragment removal and duraplasty were performed after a week. The patient then returned to normal condition with no further seizure activity. On repeated MRI two months after discharge, the hydrocephalus of the lateral ventricle and pseudomeningocele were enlarged; however, the patient maintained a good clinical status without any neurological signs. To the best of our knowledge, PTH and intracranial pseudomeningoceles have not yet been reported in cats. PTH and pseudomeningocele are among the complications of TBI and may not have any significant relevance with the clinical signs in this case. Thus, to broaden our knowledge about PTH and pseudomeningocele in cats, we describe serial changes in the clinical findings of this cat over the treatment period.

Arthroscopic Removal of Large Cartilage Fragment in a Dog with Osteochondritis Dissecans of Shoulder Joint

  • Park, Se-Jin;Lee, Seung-Yong;Kim, Jung-Hoon;Seok, Seong-Hoon;Park, Tae-Yeong;Kim, Hyun-Jin;Kim, Jun-Min;Lee, Hee-Chun;Yeon, Seong-Chan
    • Journal of Veterinary Clinics
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    • v.33 no.3
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    • pp.172-175
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    • 2016
  • An 11-month-old, 19.5 kg, intact male Border collie was referred with intermittent left forelimb lameness to the Gyeongsang Animal Medical Center. The symptom was first discovered about 6 months ago, and it has gotten worse for the last 10 days with non-weight bearing on the left forelimb. During the physical examination, the patient showed painful reaction when the left shoulder was abducted. On radiographic assessment, a radiolucent line and some osteophytes were found in both humeral heads. Based on patient's clinical signs and radiographic findings, osteochondritis dissecans (OCD) was very suspicious. So, we decided to perform an arthroscopic surgery on left shoulder for definitive diagnosis and treatment because the right forelimb revealed no clinical signs. During arthroscopic technique, we found a large OCD flap on the caudo-central area of humeral head, and observed severe synovitis over a wide range on posterior area of the articular capsule. The large OCD flap was removed by a grasping forceps, and many joint mice were removed either. Curettage was performed using a curette on the articular surface until hemorrhage occurred, and articular capsule flushed with a lactated-ringer's solution. The patient was discharged on the same day without any specific abnormal status. Antibiotic, anti-inflammatory and analgesic drugs were administered. Mild lameness on left forelimb was observed in 2 weeks after surgery, but after 4 weeks, the patient showed complete normal gait without any lameness. Although surgical removal of OCD flap with arthroscopic was previously reported, We would like note that a large OCD flap can also be removed by arthroscopic surgery in this report.

The Surgical Treatment of Chronic Avulsion Fracture of the Anterior Cruciate Ligament (진구성 전방 십자 인대 견열 골절의 수술적 치료)

  • Song Eun-Kyoo;Seol Jong-Yoon;Choi Jin
    • Journal of the Korean Arthroscopy Society
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    • v.6 no.1
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    • pp.31-36
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    • 2002
  • Objective : The purpose of this study was to evaluate the clinical and radiological results after treatment of old ACL(anterior cruciate ligament) avulsion fracture of tibia. Materials and Method : 11 cases who were followed up at least 2 years after treatment in chronic ACL avulsion fracture of tibia were included in this study. The average age of patients was 26(9-66) years and the mean period of follow up was 53(24-131) months. After evaluation of the lesion and treatment of associated lesion under arthroscope, open reduction and internal fixation or fragment removal was performed. Pull-out suture was performed in 8 cases, screw fixation in 2 cases. Results : The Lysholm knee score was 64.3 in average preoperatively and improved to 96.2 average at follow up. On the Lachman test, there were mild(+) instabilities in 7 cases, moderate(++) in 4 cases. On the postoperative Lachman test, there were no instabilities in 9 cases, mild(+) instabilities in only 2 cases. According to Meyers and Mckeever's evaluation protocol, 9 cases $(81.8\%)$ were excellent, 2 case $(18.2\%)$, good. On preoperative instrumented anterior laxity test with $Telos^{\circledR}$, side to side difference in 201b was 7.8(10-4) min in average and 2.1(6-0) mm in average at follow-up. Conclusion : In chronic ACL avulsion fracture, it is thought that combination of arthroscopic evaluation of associated injury and open reduction and fixation and fragment removal can bring about satisfactory results.

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Reccurent Foreign body Granuloma after Gore-tex Removal in Rhinoplasty (융비술에서 고어텍스 제거 후 발생한 재발성 이물성 육아종의 치험례)

  • Kwon, Soon Geun;You, Young Cheun;Yang, Won Yong;Park, Jun;Kang, Sang Yun
    • Archives of Plastic Surgery
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    • v.35 no.5
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    • pp.611-614
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    • 2008
  • Purpose: Infection, foreign body reaction and decreased volume of implant are common complications after augmentation rhinoplasty with $Gore-tex^{(R)}$ implant. The author experienced two cases of recurrent foreign body granuloma in the patients who underwent $Gore-tex^{(R)}$ removal because of infection after augmentation rhinoplasty. and treated them with complete removal of$Gore-tex^{(R)}$. Methods: Case 1: A 49 year-old female visited our clinic for recurrent foreign body reaction on nasal dorsum and tip area. The patient underwent augmentation rhinoplasty with $Gore-tex^{(R)}$ 3 years ago and implant was removed due to infection 9 months ago. Excision of the granuloma was performed and a piece of foreign body suspicious to be a $Gore-tex^{(R)}$ implant debris was detected under the subcutaneous pocket. The implant fragments were removed and nasalis muscle rotation flap was performed to cover the lesion. The specimen was proved to be $Gore-tex^{(R)}$ in histological study. Case 2: A 31 year-old-male with recurrent foreign body granuloma on the nasal tip area visited our clinic. 10 years ago, the patient had augmentation rhinoplasty with silicone implant and then, he underwent revisional rhinoplasty five times including nasal implant removal, which was performed 9 months ago. The authors excised the granuloma and found a small sized foreign body suspicious to be a $Gore-tex^{(R)}$ implant debris under the granuloma. The foreign body was excised and identified to be $Gore-tex^{(R)}$ in histological study. Results: In both cases, the lesions were healed without any complications and there were no evidences of recurrence up to 6 months of follow-up. Conclusion: The $Gore-tex^{(R)}$ is known to be weak against mechanical force. These properties of $Gore-tex^{(R)}$ make it difficult to remove the implant completely. In the patient who have infection after augmentation rhinoplasty with $Gore-tex^{(R)}$, the operator should take care to perform the complete removal without remaining fragment of the implant.

Epidermal Cyst of the Nasal Tip Presenting as Foreign Body Reaction (이물 반응으로 오인된 비첨부 표피 낭종)

  • Choi, Chang Yong;Choi, Hwan Jun
    • Archives of Plastic Surgery
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    • v.36 no.1
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    • pp.105-108
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    • 2009
  • Purpose: Epidermoid cyst may be congenital or acquired. Acquired cysts are most commonly of traumatic origin and result from an implantation or downward displacement of an epidermal fragment. Traumatic epidermoid cysts are rare tumors occurring on the nasal tip, especially resulting aesthetic procedure. So, we report a rare case of an iatrogenic epidermoid cyst in the nasal tip following rhinoplasty. Methods: A 44 - years old man had undergone rhinoplasty for several times. First time, the previous augmentation rhinoplasty and wedge osteotomy were performed nineteen months ago, lastly implant removal and unknown filler injection were performed one year ago at another local clinic. He had induration and tenderness on nasal tip and dorsum continued for 3 months. We thought that it caused by foreign body reaction with residual alloderm in nose. For removal of residual alloplastic material, open approach using transcolumellar incision was done. But, incidentally we found cystic mass on the nasal tip. Results: The findings were of an $0.8{\times}0.5{\times}0.5cm$ sized round cystic mass containing cream coloured material with a thick cheese - like consistency. The mass was completely excised and submitted for histology. This confirmed the diagnosis of an epidermoid cyst lined by keratinizing squamous epithelium. There was no induration, tenderness and sign of recurrence after excision of the mass. Conclusion: Epidermal cyst of the nasal tip region represents an unusual clinical lesion and it presents as foreign body reaction. And then, our case demonstrates that meticulous surgical approach and suture technique are the keys to prevention against iatrogenic nasal epidermoid cyst, especially in secondary rhinoplasty.

Bacterial Community Composition of Activated Sludge Relative to Type and Efficiency of Municipal Wastewater Treatment Plants

  • Ahn, In-Sook;Kim, Myeong-Woon;La, Hyun-Joon;Choi, Kyung-Min;Kwon, Joong-Cheon
    • Journal of Microbiology and Biotechnology
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    • v.13 no.1
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    • pp.15-21
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    • 2003
  • Two microbial communities of activated sludge in the same municipal wastewater, but treated with different systems, were studied and compared using molecular microbiological approaches. The bacterial 16S rDNA sequences from 124 clones were analyzed, however, the majority of them were not closely related to any known species, and found to belong to 8 different phylogenetic groups and 3 different unidentified groups. The relative frequencies of each group were similar between the two microbial communities. Fingerprinting using terminal restriction fragment length polymorphism (T-RFLP) showed that the putative Nitrospira-related populations were more diverse and quantitatively higher in the KNR process system than in the other system using a conventional activated sludge process. The relationship between the bacterial community composition and the higher removal efficiency of nitrogen and phosphorus in the KNR process is discussed.

Fracture of a Dental Needle during Inferior Alveolar Nerve Block in a Young Child: A Case Report (어린 아동의 하치조신경 전달마취 시 발생한 주사바늘 파절 : 증례보고)

  • Lee, Hanbyeol;Kim, Minkeun;Park, Howon;Seo, Hyunwoo;Lee, Juhyun
    • Journal of the korean academy of Pediatric Dentistry
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    • v.43 no.3
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    • pp.320-326
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    • 2016
  • The fracture of a needle during local anesthesia in dental treatment is rare; however, when it occurs, the needle should be removed without damage to surrounding structures as soon as possible. A fractured needle fragment that is buried in soft tissue would be difficult to remove, and a careful surgical procedure under general anesthesia is recommended in such cases. Children who require dental treatment are often not capable of cooperative behavior, thus unexpected movements can increase the risk of needle fracture. Clinicians can reduce the incidence of needle fracture accidents with a few precautions. In the present case report, we report a case of needle fracture due to abrupt movement during inferior alveolar nerve block anesthesia in a young child, with the purpose of drawing attention to needle fracture incidents. This report describes the possible causes and prevention methods of local anesthetic needle fracture, and the localization methods and surgical procedure for needle fragment removal.

Percutaneous Endoscopic Interlaminar Discectomy for L5-S1 Disc Herniation: Axillary Approach and Preliminary Results

  • Lee, Seung-Cheol;Lee, Sang-Ho;Choi, Won-Chul;Choi, Gun;Shin, Song-Woo;Kaul, Richard
    • Journal of Korean Neurosurgical Society
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    • v.40 no.2
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    • pp.79-83
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    • 2006
  • Objective : The purpose of this study was to describe a surgical technique of axillary approach of percutaneous endoscopic interlaminar discectomy for L5-S1 disc herniation and its preliminary results. Methods : From July 2002 to September 2003, 101 patients with lumbar radiculopathy due to L5-S1 disc herniation, who were treated by percutaneous interlaminar endoscopic discectomy, were retrospectively reviewed. There were 57 males and 44 females with a mean age of 44.8 years [range, 18 to 62 years]. The surgery consisted of needle insertion into the epidural space via the interlaminar space, sequential dilatation, and endoscopic discectomy through the axillary area of the S1 root. Results : The mean follow-up period was 14.5 months and the average surgical time was 41 min. According to the modified Macnab criteria, 44 patients [43.6%] had excellent outcomes, 49 [48.5%] had good results and only 8 [78%] had fair or poor outcomes. Four patients had a revision microdiscectomy due to incomplete removal of disc fragment. There were no major complications related to this surgical approach. Conclusion : Axillary approach of percutaneous endoscopic interlaminar discectomy is safe and effective procedure for the treatment of L5-Sl disc herniation. It combines the advantages of MED and conventional percutaneous endoscopic discectomy.