• Journal of Haehwa Medicine
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• v.21 no.1
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• pp.11-21
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• 2012

New onset diabetes is a major complication after kidney transplantation. However, the natural course of posttransplantation diabetes mellitus (PTDM) remains unclear. The aim of this study was to demonstrate the detailed natural courses of PTDM according to the onset and persistency of hyperglycemia, and to investigate risk factors for development of different courses of PTDM in renal allograft recipients. The purpose of this study is to develop novel immune suppressants for PTDM using of action mechanism of them. The use of immunosuppressive drugs in transplanted patients is associated with the development of diabetes, possibly due to ${\beta}$-cell toxicity. To better understand the mechanisms leading to post-transplant diabetes, we investigated the actions of prolonged exposure of ${\beta}$-cells to therapeutical levels of tacrolimus (FK506) or cyclosporin A(CsA). The immunosuppressive drug cyclosporine(CsA) is a potent agent widely used after organ transplantations and various autoimmune disorders. After using CsA, some patients suffer severe complications including renal and vascular toxicity. The renal or vascular toxicity is influenced by the degree of the endothelial damage. FK506(tacrolimus) is a widely used immunosuppressive agent in the treatment of various medical conditions, including autoimmune disease, bone marrow and organ transplantations. We found some interesting clusters and confirmed the feasibility of cDNA microarray in the study of Immunosuppressant. In this study, we investigated gene expression patterns induced by Immunosuppressant in RIN-m5F of rat insulinoma cell line. Gene expressions evaluated using cDNA microarry in two clusters were increased or decreased. this study provides comprehensive comparison of the patterns of gene expression changes induced by CsA and FK506 in ${\beta}$-cells. This study could establish that the mode of action mechanism by which currently used insulin inhibitors inducing PTDM could be elucidated at least in part, which raises the possibility that novel immune suppressive PTDM can be developed. The molecular biological study on PTDM will also contribute the progress in diabetes research field as well as in that of PTDM.

• Journal of Dental Anesthesia and Pain Medicine
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• v.15 no.1
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• pp.31-34
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• 2015

Vascular injury caused by a central venous catheter (CVC) has been reported to be a rare complication, especially delayed vascular injury due to CVC has a few cases and it can be fatal because of delayed recognition and more serious complications. A 59-year-old woman with no available medical history was admitted for treatment of ovarian cancer. For the surgery, a triple-lumen CVC was placed through the left subclavian vein. Parenteral nutrition through the CVC was used for postoperative nutritional management in the first postoperative day. On the sixth postoperative day (POD), the patient suddenly complained of dyspnea. The CT revealed bilateral pleural effusion and irregular soft tissue density and air bubble in anterior mediastinum suggesting migration of the distal portion of the CVC into the anterior mediastium. In the intensive care unit (ICU) bilateral thoracentesis and percutaneous drainage were performed. She was discharged from the ICU in 3 days later and transferred to the general ward. This case emphasizes the possibility of the delayed vascular injury related to CVC and some strategies for prevention of vascular injury.

• Journal of Korean Dental Science
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• v.2 no.1
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• pp.31-38
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• 2009

With today's social and cultural personal interactions, greater leisure time and participation in sports activities, and growing traffic volume, the risk of physical trauma has increased markedly. This is a clinical and retrospective study of patients exposed to oral and maxillofacial trauma. We clinically observed 72 patients with trauma in the Department of Oral and Maxillofacial Surgery, Kyunghee University Dental Hospital, from June 2006 through November 2007. The following data was obtained: 1. The male:female ratio of patients having experienced physical trauma was 6.2:1, with most patients in their twenties. 2. Traffic accident (37.5%) was the most common cause of trauma. 3. The highest incidence of fracture occurred to the zygomatic arch(22.1%) among mid-facial fractures and angle(37.5%), symphysis(35.4%) in mandible fractures. 4. Open reduction (88.9%) was the most frequently used form of treatment. Closed reduction was performed on the remaining 11.1% of cases. 5. Teeth and alveolar bone damage occurred in 23.6% of all cases. 6. Other injuries that were related to mid-face fracture occurred in 27.8% of all cases. 7. Post-operative complications occurred in 31.9% of cases, and the highest complication was the nerve injury.

• Journal of Chest Surgery
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• v.51 no.5
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• pp.350-355
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• 2018

Background: The complication rate of fungal disease is higher among patients with hematological malignancies. We investigated the clinicobacteriological outcomes of resected pulmonary fungal infections complicating hematological malignancies. Methods: Between 2001 and 2017, 21 patients with pulmonary fungal infections complicating hematological malignancies underwent resection, and their clinical records and survival were retrospectively reviewed. Results: The median age of the patients was 47 years, and 13 were male. The histological diagnoses were pulmonary aspergillosis (19 cases), mucormycosis (1 case), and cryptococcosis (1 case). The indications for surgery were resistance to antifungal therapy and the necessity of surgery before hematopoietic stem cell transplantation in 13 and 8 cases, respectively. The diagnoses of the hematological malignancies were acute myelogenous leukemia (10 cases), acute lymphocytic leukemia (5 cases), myelodysplastic syndrome (3 cases), and chronic myelogenous leukemia, malignant lymphoma, and extramedullary plasmacytoma (1 case each). The surgical procedures were partial resection (11 cases), segmentectomy (5 cases), lobectomy (4 cases), and cavernostomy (1 case). The size of the lesions was 0.9-8.5 cm. Fourteen cases had cavitation. There were no surgical-related deaths or fungal progression. Conclusion: Pulmonary fungal infections are resistant to treatments for hematological malignancies. Since the treatment of the underlying disease is extended and these infections often recur and are exacerbated, surgery should be considered when possible.

• Clinical and Experimental Pediatrics
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• v.54 no.4
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• pp.169-175
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• 2011

Purpose: Acute internal hemorrhage is an occasionally life-threatening complication in pediatric cancer patients. Many therapeutic approaches have been used to control bleeding with various degrees of success. In this study, we evaluated the efficacy of selective internal iliac artery embolization for controlling acute intractable bleeding in children with malignancies. Methods: We retrospectively evaluated the cases of 6 children with various malignancies (acute lymphoblastic leukemia, acute myelogenous leukemia, chronic myelogenous leukemia, T-cell prolymphocytic leukemia, Langerhans cell histiocytosis, and rhabdomyosarcoma), who had undergone selective arterial embolization (SAE) of the internal iliac artery at the Chonnam National University Hwasun Hospital between January 2004 and December 2009. SAE was performed by an interventional radiologist using Gelfoam$^{(R)}$ and/or Tornado$^{(R)}$ coils. Results: The patients were 5 boys and 1 girl with median age of 6.9 years (range, 0.7-14.8 years) at the time of SAE. SAE was performed once in 4 patients and twice in 2, and the procedure was unilateral in 2 and bilateral in 4. The causes of hemorrhage were as follows: hemorrhagic cystitis (HC) in 3 patients, procedure-related internal iliac artery injuries in 2 patients, and tumor rupture in 1 patient. Initial attempt at conservative management was unsuccessful. Of the 6 patients, 5 (83.3%) showed improvement after SAE without complications. Conclusion: SAE may be a safe and effective procedure for controlling acute intractable hemorrhage in pediatric malignancy patients. This procedure may obviate the need for surgery, which carries an attendant risk of morbidity and mortality in cancer patients with critical conditions.

• The Korean Journal of Physiology and Pharmacology
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• v.20 no.6
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• pp.613-619
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• 2016

Diabetic cardiomyopathy (DCM), a serious complication of diabetes mellitus, is associated with changes in myocardial structure and function. This study sought to explore the ability of insulin-like growth factor-1 (IGF-1) to modulate DCM and its related mechanisms. Twenty-four male Wistar rats were injected with streptozotocin (STZ, 60 mg/kg) to mimic diabetes mellitus. Myocardial fibrosis and apoptosis were evaluated by histopathologic analyses, and relevant proteins were analyzed by Western blotting. Inflammatory factors were assessed by ELISA. Markers of oxidative stress were tested by colorimetric analysis. Rats with DCM displayed decreased body weight, metabolic abnormalities, elevated apoptosis (as assessed by the bcl-2/bax ratio and TUNEL assays), increased fibrosis, increased markers of oxidative stress (MDA and SOD) and inflammatory factors (TNF-${\alpha}$ and IL-$1{\beta}$), and decreased phosphorylation of Akt and glycogen synthase kinase (GSK-$3{\beta}$). IGF-1 treatment, however, attenuated the metabolic abnormalities and myocardial apoptosis, interstitial fibrosis, oxidative stress and inflammation seen in diabetic rats, while also increasing the phosphorylation levels of Akt and GSK-$3{\beta}$. These findings suggest that IGF-1 ameliorates the pathophysiological progress of DCM along with an activation of the Akt/GSK-$3{\beta}$ signaling pathway. Our findings suggest that IGF-1 could be a potential therapeutic choice for controlling DCM.

• Journal of Korean Neurosurgical Society
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• v.48 no.3
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• pp.199-206
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• 2010

Objective : Paraclinoid segment internal carotid artery (ICA) aneurysms have historically been a technical challenge for neurovascular surgeons. The development of microsurgical approach, advances in surgical techniques, and endovascular procedures have improved the outcome for paraclinoid aneurysms. However, many authors have reported high complication rates from microsurgical treatments. Therefore, the present study reviews the microsurgical complications of the extradural anterior clinoidectomy for treating paraclinoid aneurysms and investigates the prevention and management of observed complications. Methods : Between January 2004 and April 2008, 22 patients with 24 paraclinoid aneurysms underwent microsurgical direct clipping by a cerebrovascular team at a regional neurosurgical center. Microsurgery was performed via an ipsilateral pterional approach with extradural anterior clinoidectomy. We retrospectively reviewed patients' medical charts, office records, radiographic studies, and operative records. Results : In our series, the clinical outcomes after an ipsilateral pterional approach with extradural anterior clinoidectomy for paraclinoid aneurysms were excellent or good (Glasgows Outcome Scale : GOS 5 or 4) in 87.5% of cases. The microsurgical complications related directly to the extradural anterior clinoidectomy included transient cranial nerve palsy (6), cerebrospinal fluid leak (1), worsened change in vision (1), unplanned ICA occlusion (1), and epidural hematoma (1). Only one of the complications resulted in permanent morbidity (4.2%), and none resulted in death. Conclusion : Although surgical complications are still reported to occur more frequently for the treatment of paraclinoid aneurysms, the permanent morbidity and mortality resulting from a extradural anterior clinoidectomy in our series were lower than previously reported. Precise anatomical knowledge combined with several microsurgical tactics can help to achieve good outcomes with minimal complications.

• Journal of Trauma and Injury
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• v.33 no.2
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• pp.128-133
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• 2020

Traumatic abdominal wall hernias (TAWHs) are uncommon and the incidence of this, which is rarely encountered in clinical practice, has been estimated at 1%. Furthermore, blunt transection of the entire abdominal wall musculature caused by seatbelt is a very rare complication. We report a case of adult with a complete disruption of the entire anterolateral abdominal wall muscle following the seatbelt injury. A 32-year-old male was wearing a seat belt in a high speed motor vehicle collision. Abdominal computed tomography (CT) scan revealed the complete disruption of bilateral abdominal wall musculatures including TAWH without visceral injury. However, injuries of small bowel and sigmoid colon were observed in the intra-operative field. The patient underwent the repair by primary closure of the defect with absorbable monofilament sutures. This case suggests that especially in TAWH patients, even if a CT scan is normal, clinicians should keep the possibility of bowel injury in mind, and choose a treatment based on the clinical findings.

• Korean Journal of Health Education and Promotion
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• v.3 no.1
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• pp.63-73
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• 1985

Ratio of physically and mentally handicapped people among the total population is about 3∼4%. Regardless of the extent of seriousness of handicaps, they have to sustain various difficulties in their life time and pose challenging problems to their homes, community and nation. In the spectrum of their problems, measures such as treatment, rehabilitation and welfare work all occupied important part but most significant measure is the prevention. Such handicaps items from health care of maternal and child, mostly causes throughout the process of pregnancy, delivery and upbringing. And then this study is focused on the pregnant history of the mothers with handicapped children. The objective of this study is to identify the basic factors which can create a handicapped child during pregnancy and is to prevent the birth of such a child. For this study, 301 mothers who have handicapped children were selected, now receiving various training at 5 rehabilitation and educational facilities. And questionnaires distributed to them during the period of Oct, 1983 to Dec, 14. The collected responses have been analized in terms of significant numbers, percentage and metic average. Their related results are as follows: 1. The sexual ratio between the male and female was 58.5% compare 41.5%. The average age of the handicapped children was 10.1 years old and that of mothers at the time of the children's birth was 28.9 old years. They were born as 2.14th in their family, the ratio of antenatal care for pregnant mothers was 36.2% and 22.9% were abnormally delivered. 37.9% out of the total were born from mothers with ages above 35 years and as their first baby. 2. The time of confirming the handicapped nature of children was during babyhood by 97.1% and discovery of these misfortunes were made by chance. As for causes of those-handicapped status 20.9% disease from complication, 15.3% from difficulties experience at the time of delivery, 11.3% from heredity and 10% were results of drug abuse during pregnancy, and 49.8% of the handicapped children were mentally retarded.

• Archives of Plastic Surgery
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• v.33 no.2
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• pp.193-197
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• 2006

Pulmonary thromboembolism is often clinically silent and difficult to diagnose, and can be fatal to patients with belated treatment. This complication is seen in patients who underwent TRAM breast reconstruction. Multiple factors are involved in this disease such as the presence of malignancy itself, major surgery and therapy-related interventions. TRAM surgery is a lengthy procedure involving mastectomy, flap surgery and abdominoplasty. The purpose of this study is to evaluate the incidence and the correlation between presurgical risk factors(BMI and age) of symptomatic pulmonary thromboembolism after TRAM surgery and the incidence. From July 2001 to March 2005 a total of 384 pedicled TRAM reconstruction of breast was performed in 382 patients at Asan Medical Center. The average of Body mass index was $21.9kg/m^2$ and mean age of the patients was 37.9 years old. We diagnosed symptomatic pulmonary thromboembolism using ventilation/perfusion lung scan and pulmonary embolism computed tomography. Incidence of in-hospital symptomatic pulmonary thromboembolism was 1.3%. BMI and age showed no significant statistical relationship to pulmonary thromboembolism. But the incidence of symptomatic pulmonary thromboembolism in obese patients (BMI > 25) was 3.75%. According to the guideline of the 7th American College of Chest Physicians Consensus Conference on Antithrombotic and Thrombolytic Therapy, the incidence of 3.75% was classified as high risk group. The prevention of pulmonary thromboembolism should be considered in cases of obese patients with low molecular weight heparin(BMI > 25).