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Tc-99m DTPA and Tc-99m DMSA Renal Scan findings in Patients with Congenital Megacalyces and Megaureter without Urinary Tract Obstruction (선천성 거대신배증과 거대뇨관증을 가지나 요로폐쇄가 없는 환아의 Tc-99m DPTA 및 Tc-99m DMSA 신장스캔 소견)

  • Ahn, Byeong-Cheol;Bae, Jin-Ho;Jeong, Sin-Young;Lee, Jae-Tae;Lee, Kyu-Bo
    • The Korean Journal of Nuclear Medicine
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    • v.37 no.3
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    • pp.202-205
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    • 2003
  • A 10 days old male infant with congenital megacalyces and megaureter, diagnosed by prenatal ultrasonographic screening, underwent Tc-99m DTPA renal scan for evaluation of urinary tract patency, Tc-99m DMSA scan for evaluation of renal cortical damage. He also underwent intravenous urography(IVU) and renal ultrasonography. Tc-99m DTPA renal scan demonstrates intense tracer accumulation in enlarged both renal pelvocalyses and ureters, which rapidly washout without diuretics administration. Tc-99m DMSA renal cortical scan shows no remarkable photon defect in both renal cortices and visible tracer uptake in both megaureter areas. Ultasonographic and IVU studios show enlarged both renal calyses and bullously dilated ureters, but no dilatation in renal pelvis. Follow up Tc-99m DTPA renal scan, peformed at one year later, also reveals intense tracer accumulation in enlarged both urinary tracts which rapidly washout without diuretics, and shows no significant change compare to the previous Tc-99m DTPA renal scan. Urinary tract obstruction and renal cortical damage can be easily evaluated with Tc-99m DTPA and Tc-99m DMSA scans in patiens with megacalyces and megaureter.

Clinical Outcomes of Arteriovenous Graft in End-Stage Renal Disease Patients with an Unsuitable Cephalic Vein for Hemodialysis Access

  • Son, Joung Woo;Ryu, Jae-Wook;Seo, Pil Won;Ryu, Kyoung Min;Chang, Sung Wook
    • Journal of Chest Surgery
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    • v.53 no.2
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    • pp.73-78
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    • 2020
  • Background: As the population of patients with end-stage renal disease has grown older, the proportion of patients with poorly preserved vasculature has concomitantly increased. Thus, arteriovenous grafts (AVG) have been used more frequently to access blood vessels for hemodialysis. Despite this increasing demand, studies of AVG are limited. In this study, we examined the surgical outcomes of upper-limb AVG creation. Methods: Among the arteriovenous fistula formation procedures performed between January 2014 and March 2019 at Dankook University Hospital, 42 cases involved AVG creation. We compared patients in whom the axillary vein was used (group A; brachioaxillary AVG [B-Ax AVG]; n=20) with those in whom upper limb veins were used (group B; brachiobasilic AVG or brachioantecubital AVG; n=22). Results: The 1-year primary patency rate was higher in group A than in group B (57.9% vs. 41.7%; p=0.262). The incidence of postoperative complications was not significantly different between groups. Conclusion: AVG using the axillary vein showed no major differences in safety or functionality compared to AVG using other veins. Therefore, accounting for age, underlying disease, and expected patient lifespan, B-Ax AVG can be considered an acceptable surgical method.

Endoscopic and Laparoscopic Full-Thickness Resection of Endophytic Gastric Submucosal Tumors Very Close to the Esophagogastric Junction

  • Kwon, Oh Kyoung;Yu, Wansik
    • Journal of Gastric Cancer
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    • v.15 no.4
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    • pp.278-285
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    • 2015
  • Purpose: Gastric submucosal tumors (SMTs) located very close to the esophagogastric junction (EGJ) are a challenge for gastric surgeons. Therefore, this study reports on the experience of using endoscopic and laparoscopic full-thickness resection (ELFR) with laparoscopic two-layer suturing in such tumors. Materials and Methods: Six patients with gastric SMTs very close to the EGJ underwent ELFR with laparoscopic two-layer suturing at Kyungpook National University Medical Center. With the patient under general anesthesia, the lesser curvature and posterior aspect adjacent to the EGJ were meticulously dissected and visualized using a laparoscopic approach. A partially circumferential full-thickness incision at the distal margin of the tumor was then made using an endoscopic approach under laparoscopic guidance. The SMT was resected using laparoscopic ultrasonic shears, and the gastric wall was closed using two-layer suturing. Thereafter, the patency and any leakage were checked through endoscopy. Results: All the ELFR procedures with laparoscopic two-layer suturing were performed successfully without an open conversion. The mean operation time was $139.2{\pm}30.9$ minutes and the blood loss was too minimal to be measured. The tumors from four patients were leiomyomas, while the tumors from the other two patients were gastrointestinal stromal tumors with clear resection margins. All the patients started oral intake on the third postoperative day. There was no morbidity or mortality. The mean hospital stay was $7.7{\pm}0.8$ days. Conclusions: ELFR with laparoscopic two-layer suturing is a safe treatment option for patients with an SMT close to the EGJ, as major resection of the stomach is avoided.

Inguinal Hernia and Ventriculoperitoneal Shunt (뇌실복강간 단락술(Ventriculoperitoneal Shunt)을 시행한 환자에서의 서혜부 탈장의 빈도와 특성)

  • Lee, Seong-Cheol;Lee, Hyuk-Joon;Kim, Ki-Hong;Chung, Sung-Eun;Park, Kwi-Won;Kim, Woo-Ki
    • Advances in pediatric surgery
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    • v.6 no.2
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    • pp.89-94
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    • 2000
  • Ventriculoperitoneal shunt(VP shunt) for hydrocephalus is thought to inhibit the closure of processus vaginalis and promote inguinal hernia by increasing intraabdominal pressure. To estimate the patency rate of processus vaginalis and the incidence and characteristics of the inguinal hernia, 262 cases of VP shunt in early childhood between January 1980 and May 1998 at Seoul National University Children Hospital were reviewed retrospectively. Inguinal hernia developed in 28 cases(10.7 %), but six patients had an inguinal hernia before the VP shunt was placed. Patients who had a VP shunt before 6 months of age developed inguinal hernia in 16.2 %(12/74) of cases, patients shunted between 6 months and 2 years had an incidence of 12.4 %(11/89) and only 5.1 %(5/99) of patients operated upon after 2 years of age developed hernias. Twenty-two patients out of 256 cases (8.6 %) developed inguinal hernia after VP shunt, with male predominance(M : F=4.5:1). Eight patients developed inguinal hernia bilaterally(36.4 %). It is suggested that at least 14% of processus vaginalis is patent until 2 years old.

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Fabrication of Endothelial Cell-Specific Polyurethane Surfaces co-Immobilized with GRGDS and YIGSR Peptides

  • Choi, Won-Sup;Bae, Jin-Woo;Joung, Yoon-Ki;Park, Ki-Dong;Lee, Mi-Hee;Park, Jong-Chul;Kwon, Il-Keun
    • Macromolecular Research
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    • v.17 no.7
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    • pp.458-463
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    • 2009
  • Polyurethane (PU) is widely used as a cardiovascular biomaterial due to its good mechanical properties and hemocompatibility, but it is not adhesive to endothelial cells (ECs). Cell adhesive peptides, GRGDS and YIGSR, were found to promote adhesion and spreading of ECs and showed a synergistic effect when both of them were used. In this study, a surface modification was designed to fabricate an EC-active PU surface capable of promoting endothelialization using the peptides and poly(ethylene glycol) (PEG) spacer, The modified PU surfaces were characterized in vitro. The density of the grafted PEG on the PU surface was measured by acid-base back titration to the terminal-free isocyanate groups. The successful immobilization of pep tides was confirmed by amino acid analysis, following hydrolysis, and contact angle measurement. The uniform distribution of peptides on the surface was observed by scanning electron microscopy (SEM) and atomic force microscopy (AFM). To evaluate the EC adhesive property, cell viability test using human umbilical vein EC (HUVEC) was investigated in vitro and enhanced endothelialization was characterized by the introduction of cell adhesive peptides, GRGDS and YIGSR, and PEG spacer. Therefore, GRGDS and YIGSR co-immobilized PU surfaces can be applied to an EC-specific vascular graft with long-term patency by endothelialization.

The Clinical Characteristics for Emergency Endotracheal Intubation in Acute Drug Intoxication (급성 약물중독 환자의 응급 기관내 삽관에서 임상적 특성)

  • Han, Eol;Chung, Hyun Soo;Park, Yoo Seok;You, Je Sung;Joo, Youngseon;Kong, Taeyoung;Park, Incheol;Chung, Sung phil
    • Journal of The Korean Society of Clinical Toxicology
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    • v.13 no.1
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    • pp.11-18
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    • 2015
  • Purpose: The aim of this study was to compare the clinical characteristics in emergency endotracheal intubation between patients with acute drug intoxication and medical disease. Methods: Data for airway registry collected in two emergency departments (ED) between April 2006 and March 2010 were reviewed retrospectively. The airway registry data included patient's demographic information and variables such as Cormack-Lehane grade, 3-3-2 finger analysis, success rate, the number of attempts at intubation, complications of intubation, and clinical outcomes after intubation. Results: A total of 1480 patients were enrolled; 62 patients were classified as belonging to the intubation group after the drug intoxication group. No significant differences in Cormack-Lehane grade, 3-3-2 finger analysis, success rate, the number of attempts at intubation, and complications after intubation were observed between patients with acute drug intoxication and medical disease. However, significant difference was observed for indication of emergency endotracheal intubation. While emergency endotracheal intubations were usually performed in medical patients because of failure of airway patency, they were performed in intoxicated patients with the goal of preventing serious complications. Conclusion: Anatomical structures related to endotracheal intubation, the process and clinical outcome of intoxicated patients are not significantly different from those for medical patients.

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The Effects of Flow Wave form on the Flow Characteristics in Tapered Vascular Grafts (유량 파형이 데이퍼형 인조혈관 유동에 미치는 영향)

  • Lee, H. C.;Seok, K. W.;Jon, C. W.;Lee, J.;Lee, Y. S.;Kim, S. H.
    • Journal of Biomedical Engineering Research
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    • v.17 no.3
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    • pp.337-346
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    • 1996
  • The patency of small size vascular grafts is poor, and the blood flow characteristics in the artery graft anastomosis are suspected as one of the important factors influencing intimal hyperplasia. Disturbed flow patterns caused by sixte and compliance mismatch generate unfavorable flow environment which promotes intimal thickening. Tapered vascular yuts are suggested in order to reduce sudden expansion near the anastomosis. The photochromic flow visualization method is used to measure the flout fields in the end-to-end anastomosis model under the carotid and femoral artery flow wave form. The results show that flow disturbance near the anastomosis is diminished in the tapered grafts comparing to the tubular graft. As the divergent ang1e decreases, we can reduce the low and oscillatory wall shear stress zone which is prone to intimal hyperplasia. The flow wave form effects the wall shear rate dis- tribution significantly. The steep deceleration and back flow in the femoral flow wAve form cause low mean wall shear rate and high oscillatory shear index.

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Indirect Inguinal Hernia in Pediatric Patients (소아의 간접 서혜부 탈장)

  • Chung, Sang-Young
    • Advances in pediatric surgery
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    • v.16 no.2
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    • pp.101-107
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    • 2010
  • Herniorrhaphy of Indirect inguinal hernia (IIH) is one of the most frequently performed surgical procedures in children. The overall incidence of inguinal hernias in childhood ranges from 0.8 to 4.4 %. The incidence is up to 10 times higher in boys than girls, especially much higher in premature infants. IIHs in children are basically an arrest of embryologic development rather than an acquired weakness, which explains the increased incidence in premature infants. In normal development, the processus vaginalis closes, obliterating the peritoneal opening of the internal ring between 36th and 40th week of gestation. This process is often incomplete, leaving a small patent processus in many newborns. However, closure continues postnatally, and the rate of patency is inversely proportional to age of the child. The presence of a patent processus vaginalis is a necessary but not sufficient variable in developing a congenital IIH. In other words, all congenital IIHs are preceded by a patent processus vaginalis, but not all patent processus vaginalis go on to become IIHs. The overall incidence of IIH in population is approximately 1 to 2 % and the incidence of a processus vaginalis is approximately 12 to 14%, clinically appreciable IIH should develop in approximately 8 to 12 % of patients with a patent processus vaginalis. Although the classic open inguinal hernia repair remains the gold standard for most pediatric surgeons, laparoscopic repair is being performed in many centers. Like open technique, laparoscopic technique is fundamentally a high ligation of the indirect hernia sac with or without internal ring ligation. The advantages of laparoscopic approach include the ease of examining the contralateral internal ring, the avoidance of access damage to vas and vessels during mobilization of cord, decreased operative time, and an ability to identify unsuspected direct or femoral hernias. Almost all groin hernias in children are IIHs and occur as a result of incomplete closure of processus vaginalis. The treatment is repair by high ligation of hernia sac, which can be done by an open or laparoscopic technique. The contralateral side can be explored by laparoscopy or left alone, open exploration is no longer indicated due to potential risk of infertility.

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The oriental-western literatural study of Amnesia (건망증(健忘症)에 대(對)한 동서의학적(東西醫學的) 고찰(考察))

  • Yoon, Sang-hak;Lee, Sang-ryong
    • Journal of Haehwa Medicine
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    • v.9 no.2
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    • pp.293-313
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    • 2001
  • The oriental-western Literatural study of Amnesia, the results were as follows. 1. esia is caused by qi-depression resulted from excessive thought and deficiency of the kidney resulted from congenital deficiency and deficiency of the heart, the disharmony between the heart and the kidney, phlegm, stagnant blood, loss of the blood etc. resulted from deficiency of the heart blood. 2. The treatment method of Amnesia is as follows, the highest frequence was growing blood-tranquilization-regulating spleen, in descending order removing phlegm-stagnant blood-relaxing the mind and invigorate the heart-spleen-kidney and much tonification qi-blood and growing nutrient qi-manifesting source qi and regulating the harmony between the heart and the kidney and maintaining patency for the flow of gi were the most treatment method. 3. The treatment medicine of Amnesia is as follows, the highest frequence was Kuei Bi Tang(歸脾湯) in decending order Jeng Ji Whan(定志丸), Su Seng Whan(壽星丸), Chun Whang Boo Sim Dan(天王補心丹), Ju Jak Whan(朱雀丸), Doo Dam Tang(導痰湯), Yin Sin Kuei Sa Dan(引神歸舍丹), Ga Gam Go Bon Dan(加減固本丸), Ryung Ji Go(寧志膏), Jang Won Dan(壯元丹), Tong Ol Tang(通鬱湯). 4. In oriental medicine functional physiology and pathology was significant in differential diagnosis and treatment and in western medicine it was explained organically and psychologically. 5. In western medicine As one of memory disorder Amnesia is divided into psychogenic amnesia and organic amnesia, and organic amnesia is divided into anterograde amnesia and retrograde amnesia and psychogenic amnesia is divided into localized amnesia, generalized amnesia selective amnesia.

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Radionuclide Tubal Function Test (방사핵을 이용한 난관기능검사)

  • Roh, T.S.;Kim, J.G.;Yoon, B.H.;Moon, S.Y.;Lee, J.Y.;Chang, Y.S.;Chung, J.K.
    • Clinical and Experimental Reproductive Medicine
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    • v.14 no.1
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    • pp.1-6
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    • 1987
  • The Radionuclide test (RN test) using radioactively labelled human albumin microspheres was developed recently to evaluate the patency and functional capacity of the fallopian tubes. 57 infertile women underwent this procedure as a part of their infertility work up. The results of the radionuclide evaluation were compared with those of the hysterosalpingography (HSG) and further the surgical findings of the laparoscopy and laparotomy. In 64.9%(37/57) of the cases, there was complete agreement between radionuclide test (RN test), hysterosalpingography(HSG) and surgical findings. In comparison with surgical findings, RN test showed a complete agreement rate of 89.4%(51/57), a partial agreement rate of 5.3%(3/57) and no agreement rate of 5.3%(3/57), respectively. Likewise, HSG revealed a complete agreement rate of 80.7%(46/57), a partial agreement rate of 10.5%(6/57) and no agreement 8.8%(5/57), respectively. It would appear that as opposed to the traditional HSG, RN test may give a better understanding of the functional capacity of the tube and may prove a useful method before and after tubal surgery.

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