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Clinical Analysis on the Closed Thoracostomy -2341 cases (폐쇄식 흉강 삽관술에 대한 임상적 고찰)

  • Kim, Cheon-Seog;Kim, Yeun-Gue;Park, Jin;Lee, Kyong-Woon
    • Journal of Chest Surgery
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    • v.30 no.10
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    • pp.991-1000
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    • 1997
  • Closed thoracostomy with UWSD* which is the most utilized procedure in chest surgery applies general thoracic disorders, trauma and after-thoracic surgery. The University hospital was involved on operating 2341 cases of closed thoracostomy with UWSD except chest tubing after-thoracic surgery for a full six years from January, 1991 to December, 1996. The rate of men and women out of the total 2341 cases was 3.5 : 1, the distribution by age showed that men were 36.6 $\pm21.0$ years old, women were $47.0\pm20.2$ years old and so that the total were 40.0 $\pm$ 20.5 years old. As for indication, spontaneous, secondary and traumatic pneumothorax were the most common, in addition to hemothorax hemopneumothorax, hydrothorax, hydropneumothorax, empyema, chylothorax. The most indwelling period of chest tubing is between eight and fourteen days for 974 cases and the average is 13.7 $\pm$ 6.3 days, The average drainage amount immediately after thoracostomy was 537 $\pm$ 88m1, and in 694 cases(46.0%), the drain amount was 201 ~ 500 ml. The rate of right and left tubing was 52.4 47.6, in 2071 cases(88.5%), the thoracostomy was the first chance and 2210 cases(94.4%) were treated with a single tube drainage. Almost all the patients complained of tube site pain, besides tube site infection, intercostal neuralgia, loss of tube function by the pleural adhesion, intrathoracic infection, incomplete reexpansion of defective lung, hemorrhage caused by the rupture of a blood vessel, subcutaneous emphysema, lung parenchymal rupture, diaphragmatic and intraabdominal trauma, reexpansionary pulmonary edema of one side lung and cellulitis were relapsed. 84.6% of all patients recovered with only clo ed thoracostomy and the rest of patient needed additional some necessary managements and so on to have successful results. There were two deaths(0.1%), caused by reexpansionary pulmonary edema, the cellulitis were complicated by thoracostomy with UWSD on an empyema patients to come to death(due to sepsis). t UWSD = under water seal drainage

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Outcome of Staged Repair of Tetralogy of Fallot with Pulmonary Atresia and a Ductus-dependent Pulmonary Circulation: Should Primary Repair Be Considered?

  • Kim, Hyung-Tae;Sung, Si-Chan;Chang, Yun-Hee;Jung, Won-Kil;Lee, Hyoung-Doo;Park, Ji-Ae;Huh, Up
    • Journal of Chest Surgery
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    • v.44 no.6
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    • pp.392-398
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    • 2011
  • Background: The tetralogy of Fallot (TOF) with pulmonary atresia (PA) and a ductus-dependent pulmonary circulation (no major aorto-pulmonary collateral arteries (MAPCAs)) has been treated with staged repair or primary repair depending on the preference of surgeons or institutions. We evaluated the 19-year outcome of staged repair for this anomaly to find out whether our surgical strategy should be changed. Materials and Methods: Forty-four patients with TOF/PA with patent ductus arteriosus (PDA) who underwent staged repair from June 1991 to October 2010 were included in this retrospective study. The patients with MAPCAs were excluded. The average age at the first palliative shunt surgery was $40.8{\pm}67.5$ days (range: 0~332 days). Thirty-one patients (31/44, 70%) were neonates. The average weight was $3.5{\pm}1.6$ kg (range: 1.6~8.7 kg). A modified Blalock-Taussig (BT) shunt was performed in 38 patients, classic BT shunt in 4 patients, and central shunt in 2 patients. Six patients required concomitant procedures: pulmonary artery angioplasty was performed in 4 patients, pulmonary artery reconstruction in one patient, and re-implantation of the left pulmonary artery to the main pulmonary artery in one patient. Four patients required a second shunt operation before the definitive repair was performed. Thirty-three patients underwent definitive repair at $24.2{\pm}13.3$ months (range: 7.3~68 months) after the first palliative operation. The average age at the time of definitive repair was $25.4{\pm}13.5$ months (range: 7.6~68.6 months) and their average weight was $11.0{\pm}2.1$ kg. For definitive repair, 3 types of right ventricular outflow procedures were used: extra-cardiac conduit was performed in 30 patients, trans-annular patch in 2 patients, and REV operation in 1 patient. One patient was lost to follow-up after hospital discharge. The mean follow-up duration for the rest of the patients was $72{\pm}37$ months (range: 4~160 months). Results: Ten patients (10/44, 22.7%) died before the definitive repair was performed. Four of them died during hospitalization after the shunt operation. Six deaths were thought to be shunt-related. The average time of shunt-related deaths after shunt procedures was 8.7 months (range: 2 days~25.3 months). There was no operative mortality after the definitive repair, but one patient died from dilated cardiomyopathy caused by myocarditis 8 years and 3 months after the definitive repair. Five-year and 10-year survival rates after the first palliative operation were 76.8% and 69.1%, respectively. Conclusion: There was a high overall mortality rate in staged repair for the patients with TOF/PA with PDA. Majority of deaths occurred before the definitive repair was performed. Therefore, primary repair or early second stage definitive repair should be considered to enhance the survival rate for patients with TOF/PA with PDA.

Comparison of Rotational Strength in Shoulders with Anterior Instability and Normal Shoulders Using Isokinetic Testing (등속성 검사를 통한 견관절 전방 불안정 환자와 정상인의 회전력 비교)

  • Lee, Dong-Ki;Kim, Tae-Kwon;Lee, Jin-Hyuck;Lee, Dae-Hee;Jung, Woong-Kyo
    • Clinics in Shoulder and Elbow
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    • v.15 no.2
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    • pp.79-85
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    • 2012
  • Objective: It has been expected that patient with posttraumatic recurrent anterior shoulder dislocation might have limited daily life activity because of pain and apprehension of dislocation. But there have been only a small number of investigations regarding the rotator strength in this patient. The aim of this study is to find the characteristics about rotator strength of patient with posttraumatic recurrent anterior shoulder dislocation using an isokinetic testing. Method: We enrolled thirteen patients with posttraumatic recurrent anterior shoulder dislocation and fifteen sex, age-matched healthy nonathletic subjects in this controlled study. All participants were male and there were no significant differences between the two groups in age, height, weight, BMI. Isokinetic internal rotator and external rotator strength was evaluated with a Biodex Isokinetic Testing machine (Biodex Medical Systems, Shirley, NY, USA), tests were performed at 60 deg/sec and 180 deg/sec for both sides. Peak torque normalized to body weight, external rotator to internal rotator ratio, total work and fatigue were calculated for each angular velocity. The association between internal rotator and external rotator strength and shoulder instability was analyzed by comparisons with a control group. Results: Any notable differences could not be found between the two groups given all data from no symptomatic left shoulder. There were no significant differences between the two groups statistically in internal rotation strength of right shoulder. However, there has been a tendency that at all angular velocities, external rotator peak torque to body weight, total work and external rotator to internal rotator ratio were significantly lower in the anterior instability group than the control group at all angular velocities. There was no substantial difference between those groups with respect to the fatigue of external rotator and internal rotator in our study. Conclusion: The prominent characteristics of posttraumatic recurrent anterior shoulder dislocation are external rotator weakness and loss of balance with external rotator and internal rotator. Therefore selective training using this information rotator might be helpful in conservative treatment and rehabilitation.

CARIES PREVALENCE AND OCCLUSAL VARIATION OF CHILDREN WITH DECIDUOUS DENTITION IN CHONNAM SEASHORE AREA (전남 해안지역 유치열기 아동의 치아우식 및 교합양상에 관한 연구)

  • Jung, Sung-Ho;Yang, Kyu-Ho;Choi, Nam-Ki;Kim, Seon-Mi;Lim, Hoi-Jeong
    • Journal of the korean academy of Pediatric Dentistry
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    • v.35 no.1
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    • pp.92-101
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    • 2008
  • The purpose of this study was to investigate the dental caries prevalence and occlusion pattern of children with deciduous dentition in Chonnam seashore area. Two thousand two hundred seventy two kindergarten children ranged 3 to 5 years of age were examined. The obtained results were as follows : 1. The rate of children with caries experience(dmf rate) in deciduous teeth was 66.8% at 3 years of age, 77.7% at 4 years of age, and 83.5% at 5 years of age and showed no significant gender differences(p>0.05). 2. The mean number of decayed, missing, filled deciduous teeth(dmft index) was 3.62 at 3 years of age, 4.73 at 4 years of age, and 5.96 at 5 years of age and showed no significant gender differences(p>0.05). 3. Most of the caries-prevailed tooth was mandibular 2nd primary molar and showed 39.48% at 3 years of age, 49.73% at 4 years of age, and 63.85% at 5 years of age. 4. The caries-experienced teeth in order were as follows : mandibular 2nd primary molar with 52.34%, mandibular 1st primary molar with 45.61%, maxillary 2nd primary molar with 38.81%, and maxillary primary central incisor with 38.86%, respectively. 5. In sagittal primary molar relationship, Class 1 occlusion pattern was 53.26%, Class 2 pattern was 1.41% and Class 3 pattern was 30.02%, respectively. Right Class 2 and Left Class 3 pattern was not observed.

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Pulse wave velocity and ankle brachial index in adolescents with essential hypertension (본태성 고혈압 청소년에서 pulse wave velocity와 ankle brachial index에 대한 연구)

  • Joo, Sun Young;Cho, Ki Young;Cho, Su Jin;Hong, Young Mi
    • Clinical and Experimental Pediatrics
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    • v.49 no.7
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    • pp.769-776
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    • 2006
  • Purpose : Pulse wave velocity(PWV) and ankle brachial index(ABI) are not only noninvasive methods used to assess arterial stiffness in adults, but also useful, simple ways to estimate the severity of hypertension, end stage renal disease and atherosclerosis in adults. But there are few studies on PWV and ABI in adolescents and children. In this study, hypertensive adolescents were compared to normal individuals to find out the usefulness of PWV as the index of progress in the disease. Methods : 413 teenagers were divided into three groups. The first group consisted of adolescents that only had hypertension(Group 1 : 23 teenagers). The second group consisted of the adolescents who had hypertension with obesity(Group 2 : 17 teenagers), and the last group was the normal subjects(Group 3 : 328 teenagers). Weight, height and body mass index were measured. Simultaneous measurements of systolic, diastolic and average blood pressure were obtained from the four extremities. PWV, ABI, ejection time and preejection period were also measured. Results : Right brachial-ankle PWV was significantly higher in both group 1 and group 2 compared with group 3, and significantly higher in group 2 compared with group 1. Likewise, left brachial-ankle PWV also showed significantly higher values in both group 1 and group 2 compared with group 3, and also higher values in group 2 compared with group 1. Positive correlations were found between the systolic, diastolic, average blood pressure and PWV. There were also positive correlations between the blood pressure and weight, body mass index. Conclusion : Higher PWV was demonstrated in adolescents with essential hypertension compared to normal subjects. Follow-up study is needed to evaluate the progress.

A Survey Study of the Juvenile Idiopathic Scoliosis Using Radiation Indirect Examination (방사선 간접검사를 이용한 청소년의 척추 측만증에 관한 연구)

  • Kim, Kee-Bog;Jung, Hong-Ryang
    • Journal of radiological science and technology
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    • v.28 no.4
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    • pp.327-332
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    • 2005
  • The purpose of this Study was to investigate the prevalence rate of idiopathic scoliosis to the students from the elementary to the university in S city of Chung-Nam using 100 mm Mirror Camera radiation indirect examination units, with on age range of between eight and thirteen (1.526 subjects), fourteen and sixteen (462 subjects), seventeen and eighteen (291 subjects), nineteen and twenty four(508 subjects) and total of 2,787 participants with the 590 male subjects and 2,197 female subjects. The results of this study can be summarized and compared the primary examination with the secondary test of greater than $10^{\circ}$of Cobb's Angle were obtained as follows; 1. Indirect Examination were conducted to find idiopathic scoliosis amomg total 2.787 subjects, 257 subjects (9.2%) who showed positive sign greater than $10^{\circ}$in the Cobb's Angle ; below age of thirteen (132 subjects), between fourteen and sixteen (52 subjects), seventeen and eighteen (35 subjects), nineteen and twenty four (38 subjects). The $x^2-test$ analysis of Indirect Examination showed no statistical significant difference association between the age range and $10^{\circ}$Cobb's Angle of spinal curve(P>0.059). 2. The numbers of idiopathic scoliosis of greater than $10^{\circ}$Cobb's Angle of spinal curve in the primary examination were observed in 147 subjects (57.2%) at the Thoracolumbar region, 81subjects (31.5%) at the Thoracic region, 20 subjects (7.8%) at the Cervicothoracic region, 7 subjects (2.7%) at the Lumbar region, 2 subjects (0.8%) at the Cervical region. So, the large numbers were Thoracolumbar region, 183 participants (71.2%) showed the right side curve of scoliosis and 74 participant (28.8%) showed the left side curve of scoliosis. 3. The main region of the pain in one's own self more than $10^{\circ}$ Cobb's angle of spinal curve were no pain 219 subjects (85.2%), 18 subjects (7.0%) at the Lumbar region, 9 subjects (3.5%) at the Cervical region, 7 subjects (2.7%) at the Thoracic region, 2 subjects (0.7%) at the shoulder girdle region, 1 subjects (0.39%) at the pelvis and whole body region. There was statistical significant difference association between the Cobb's Angle of spinal curve and the main pain region of one's (P<0.006). This study may be significant to an early stage investigate of the prevalence rate of idiopathic scoliosis in the juveniles using 100 mm Mirror Camera radiation indirect examination units. The results of this study help that the students in a stage on growth the basis of data early discovery and therapy of idiopathic scoliosis.

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Analysis of the Inter- and Intra-treatment Isocenter Deviations in Pelvic Radiotherapy With Small Bowel Displacement System (Small Bowel Displacement System을 이용한 골반부 방사선조사에서 치료간 및 치료중 중심점 위치변동에 관한 분석)

  • Kim Moon Kyung;Kim Dae Yong;Ahn Yong Chan;Huh Seung Jae;Lim Do Hun;Shin Kyung Hwan;Lee Kyu Chan
    • Radiation Oncology Journal
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    • v.18 no.2
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    • pp.114-119
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    • 2000
  • Purpose : To evaluate the e지ent and frequency of the inter- and intra-treatment isocenter deviations of the whole pelvis radiation field in using small bowel displacement system (SBDS). Methods and Materials : Using electronic portal imaging device (EPID), 302 postero-anterior 232 lateral portal images were prospectively collected from 11 patients who received pelvic radiation therapy (7 with cervix cancer and 4 with rectal cancer). All patients were treated in prone position with SBDS under the lower abdomen. Five metallic fiducial markers were placed on the image detection unit for the recognition of the isocenter and magnification. After aligning the bony landmarks of the EPID images on those of the reference image, the deviations of the isocenter were measured in right-left (RL), cranio-caudal (CC), and PA directions. Results : The mean inter-treatment deviation of the isocenter in each RL, CC, and PA direction was 1.2 mm ($\pm$ 1.6 mm), 1.0 mm ($\pm$3.0 mm), and 0.9 mm ($\pm$4.4 mm), respectively. Inter-treatment isocenter deviations over 5 mm and 10 mm in RL, CC, and PA direction were 2, 12, 24$\%$, and 0, 0, 5$\%$, respectively. Maximal deviation was detected in PA direction, and was 11.5 mm. The mean intratreatment deviation of the isocenter in RL, CC, and PA direction was 0 mm ($\pm$0.9 mm), 0.1 mm ($\pm$ 1.9mm), and 0 mm ($\pm$1.6 mm), respectively. All intra-treatment isocenter deviations over 5 mm in each direction were 0, 1, 1$\pm$, respectively. Conclusions : As the greatest and the most frequent inter-treatment deviation of the isocenter was along the PA direction, it is recommended to put more generous safety margin toward the PA direction on the lateral fields if clinically acceptable in pelvic radiotherapy with SBDD.

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Radiation dose Assesment according to the Adaptive Statistical Iterative Reconstruction Technique of Cardiac Computed Tomography(CT) (심장 CT 검사시 ASIR 적용에 따른 선량 평가)

  • Jang, Hyun-Cheol;Kim, Hyun-Ju;Cho, Jae-Hwan
    • The Journal of the Korea Contents Association
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    • v.11 no.5
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    • pp.252-259
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    • 2011
  • To identify the effects of the application of the adaptive statistical iterative reconstruction (ASIR) technique in combination with the other two factors of body mass Index (BMI) and tube potential on radiation dose in cardiac CT. The patient receiving operation the cardiac CT examination was divided four groups into according to kVp.[A group(n=20), Non-ASIR, BMI < 25, 100 kVp; B group(n=20), Non-ASIR, BMI > 25, 120 kVp; C group(n=20), 40% ASIR BMI < 25, 100 kVp; D group(n=20), 40% ASIR, BMI > 25, 120 kVp] After setting up the region of interest in the main artery central part and right coronary artery and left anterior descending artery, the CT number was measured and an average and standard deviation were analyzed. There were A group and the difference which the image noise notes statistically between C. And A group was high so that the noise could note than C group (group A, 494 ${\pm}$ 32 HU; group C, 482 ${\pm}$ 48 HU: P<0.05) In addition, there were B group and the difference noted statistically between D. And B group was high so that the noise could note than D group (group B, 510 ${\pm}$ 45 HU; group D, 480 ${\pm}$ 82 HU: P<0.05). In the qualitative analysis of an image, there was no difference (p>0.05) which a group, B group, C group, and D as to average, A group 4.13${\pm}$0.2, B group 4.18${\pm}$0.1, and C group 4.1${\pm}$0.2 and D group note statistically altogether with 4.15${\pm}$0.1 as a result of making the clinical evaluation according to the coronary artery segments. And the inappropriate image was shown to the diagnosis in all groups. As to the radiation dose, a group 8.6${\pm}$0.9 and B group 14.9${\pm}$0.4 and C group 5.8${\pm}$0.5 and D group are 10.1${\pm}$0.6 mSv.

A study on the soil conditioning behaviour according to mixing method in EPB shield TBM chamber (EPB 쉴드 TBM 챔버 내 혼합방법에 따른 배토상태거동에 대한 연구)

  • Kim, Yeon-Deok;Hwang, Beoung-Hyeon;Cho, Sung-Woo;Kim, Sang-Hwan
    • Journal of Korean Tunnelling and Underground Space Association
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    • v.23 no.4
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    • pp.233-252
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    • 2021
  • This paper is a study to improve the efficiency of mixing technology in the shield TBM chamber. Currently, the number of construction cases using the TBM method is increasing in Korea. According to the increasing use of TBM method, research on TBM method such as Disc Cutter, Cutter bit, and Segment also shows an increasing trend. However, there is little research on the mixing efficiency in chamber and chamber. In order to improve the smooth soil treatment and the behavior of the excavated soil, a study was conducted on the change of the mixing efficiency according to the effective mixing bar arrangement in the chamber. In the scale model experiment, the ground was composed using plastic materials of different colors for ease of identification. In addition, the mixing bar arrangement was different and classified into 4 cases, and the particle size distribution was classified into single particle size and multiple particle size, and the experiment was conducted with a total of 8 cases. The rotation speed of the cutter head of all cases was the same as 5 RPM, and the experiment time was also carried out in the same condition, 1 minute and 30 seconds. In order to check the mixing efficiency, samples at the upper, middle (left or right), and lower positions of each case were collected and analyzed. As a result of the scaled-down model experiment, the mixing efficiency of Case 4 and Case 4-1 increased compared to Case 1 and Case 1-1, which are actually used. Accordingly, it is expected that the mixing efficiency can be increased by changing the arrangement of the mixing bar in the chamber, and it is considered to be effective in saving air as the mixing efficiency increases. Therefore, this study is considered to be an important indicator for the use of shield TBM in Korea.

A Study of Improvement of Skin Condition and Sensory Efficacy by Periodic Application of L-α-Amino Acid (L-α-아미노산의 주기적 도포에 의한 피부개선 효능과 소비자 체감 효능 연구)

  • Kwon, Koo Chul;Lee, Sung Woo;Ahn, Byungjun;Kang, Nae-Gyu;Park, Sun Gyoo;Park, Sang Wook
    • Journal of the Society of Cosmetic Scientists of Korea
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    • v.45 no.1
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    • pp.9-17
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    • 2019
  • In this study, $L-{\alpha}-amino$ acid, which is a constituent of natural moisturizing factor, was applied to skin in periodic cycle to improve skin tone and texture roughness. Based on the polarity of the alkyl group (R) of the $L-{\alpha}-amino$ acid, the acid was categorized into two groups and their efficacy was studied. As a result, it was found that the improvement rate of $L-{\alpha}-amino$ acid complex with polar alkyl group ($L-{\alpha}-AAC-1$) is 21% higher than that of $L-{\alpha}-amino$ acid complex with non-polar alkyl group ($L-{\alpha}-AAC-2$). For clinical trials, emulsions containing $L-{\alpha}-amino$ acid complex ($L-{\alpha}-AAC-1$) were applied to the randomly selected 20 to 40 year old female participants, as an experimental group, on the right facial cheek once per day for 8 weeks, and emulsions without $L-{\alpha}-amino$ acid complex, as a control group, were applied to the left facial cheek in the same way. Improvements in skin tone were measured using $JANUS^{(R)}$ equipment and analyzed using image analysis software. Skin texture improvement was measured and analyzed mechanically using the phaseshift rapid in-vivo measurement of the skin (PRIMOS) equipment. As a result, improvements of skin tone and skin texture were 11.7% and 6.7%, respectively. In addition, a questionnaire survey was conducted to the participants on the aesthetic improvement and the degree of the feeling of skin improvement. The results suggest that $L-{\alpha}-amino$ acid can be used as a cosmetic substance that can provide aesthetic satisfaction through physiological skin tone and texture roughness.