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Giant Coronary Artery Aneurysm Presenting as a Calcified Mediastinal Mass a, Coronary Artery Fistula - A case report - (종격동 종양으로 오인된 거대관상동맥류와 관상동맥루 - 치험 1례 -)

  • Yoon, You-Sang;Lee, Cheol-Joo;Choi, Ho;Kang, Jun-Kyu;Choi, Jin-Wook;Kim, Hyung-Tae
    • Journal of Chest Surgery
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    • v.34 no.10
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    • pp.787-791
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    • 2001
  • Coronary artery aneurysm is a rare disorder. It is defined as abnormal dilatation of coronary artery with diameter exceeding 1.5 times the adjacent normal segments. The incidence of coronary aneurysm is 2.6% in Caucasians and 0.25% in Asians. Over half of the former were associated with atherosclerotic coronary artery disease. However, 70 percents of the latter were nonobstructive coronary artery aneurysms. Coronary artery fistula is a rare disorder. It has been identified in only 0.2% of routine cardiac angiographic studies conducted over a 10-year period. The clinical spectrums are various, asymtomatic, asymptomatic murmur, dyspnea on exertion, fatigue, and congestive heart failure. The right coronary artery (56%) and left coronary artery(36%) are mainly involved in the origin site of congenital coronary artery fistula. The draining site of fistula are right ventricle(39%), right atrium(33%), and pulmonary artery(20%) and so on. This 54 years-old woman had intermittent chest tightness and an abnormal mediastinal shadow on chest roentgenogram and chest C-T examination, which was diagnosed as a mediastinal mass such as teratoma. We performed the operation under left anterolateral thoracotomy for mass excision. However, we knew the mass had the pulsating arterial blood flow through a fine needle puncture of the mass and that it was attached to the left ventricle. We believed the excision of mass on beating heart would be very dangerous. Therefore, we closed the wound without excising the mass. After several days, we performed an echocardiography and coronary angiography, We knew it was cardiac tumor. Incidentally, the patient had a tortuous coronary fistula from the right coronary artery to pulmonary trunk. Using cardiopulmonary bypass with moderate systemic hypothermia, the mass was resected and the fistula was clipped with surgical clips. Pathology of the specimen was a giant coronary arterial aneurysm.

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Analysis of Gwonbeop(拳法) in traditional martial arts literature (전통무예서의 권법 분석)

  • Kwak, Nak-hyun;Lim, Tae-hee
    • (The)Study of the Eastern Classic
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    • no.54
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    • pp.289-318
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    • 2014
  • The purpose of this study was to compare Gwonbeop motions among "Gihyosinseo", "Mubiji", "Muyejaebobunyuksokjib" and to analysis catalogue of books on Gwonbeop for comprehensive interpretation in "Muyedobotongji". the conclusion through literature review was as follows. First, There were total 16 references which were composed of 14 references of China and 2 references of Korea. In particular there was no reference of Japan for Gwonbeop. In detail, unrepresentative references of China were "Hanseo", "Gihyosinseo", "Mubiji" and unrepresentative reference of Korea was Muyejaebobunyuksokjib". Second, We compared motions of Gwonbeop between China and Korea. There were located 5 motions such as Gyungakguheese(False Prey Posture), Gigose(Flag Beating Posture), Ahnshichukshinse(Goose Wing Posture), Jumjoose(Picking Elbow Posture), Pogase(Throwing Shelf Postere). In other three references unmentioned "Mubiji" there were located 8 motions such as Jungranse(Spring Railing Posture), Gichukgakse(Ghost Kicking and Leg Striking Postere), Jidangse(Open Finger Attacking Posture), Soodoose(Beast Head Shield Posture) Shingwon(Heavenly Fist Posture), Il-jopyunse(Whipping Lunging Posture), Jakjiryongse(Dragon Prey Snatching Posture), Joyangsoose(Slanting Hero Hand Posture), In two references of Korea there were located 2 unique motions such as Nachaluichoolmun Gakabyunhase(Low Encountering Posture), Gumgyedongnipse(Single Leg Throwing Postere). Third, Most of all we found two kinds of unique motions such as Chukcheonse and Eungswaeik on "Muyejaebobunyuksokjib" and such as Nachaluichoolmun Gakabyunhase(Low Encountering Posture), Gumgyedongnipse (Single Leg Throwing Postere) on "Muyedobotongji". Based on chronological table although "Gihyosinseo" is the longest literature, there was begun changing techniques in details on literatures of Korea. Transformed into techniques of Gwonbeop on Korea could be supposed that those skills were reflected in society and culture of the Joseon Dynasty. To sum it up, Gwonbeop of "Muyedobotongji" was written by "Gihyosinseo", "Mubiji", "Muyejaebobunyuksokjib" but most motions of Gwonbeop were begun to change gradually except 5 motions of "Gihyosinseo". Especially, there were 8 unique motions which could not be found in references of China. Those unique motions of Korea literatures were living proof of attempting transfiguration from motions of China. The significance of this study was to be able to put stepping-stone to interpretate history of Taekwondo which takes center stage on bare hands martial arts and analyzed the meaning of historical martial arts on Gwonbeop in Joseon Dynasty.

Steroid Effect on the Brain Protection During OPen Heart Surgery Using Hypothermic Circulatory Arrest in the Rabbit Cardiopulmonary bypass Model (저체온순환정지법을 이용한 개심술시 스테로이드의 뇌보호 효과 - 토끼를 이용한 심폐바이패스 실험모델에서 -)

  • Kim, Won-Gon;Lim, Cheong;Moon, Hyun-Jong;Chun, Eui-Kyung;Chi, Je-Geun;Won, Tae-Hee;Lee, Young-Tak;Chee, Hyun-Keun;Kim, Jun-Woo
    • Journal of Chest Surgery
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    • v.30 no.5
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    • pp.471-478
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    • 1997
  • Introduction: The use of rabbits as a cardiopulmonary bypass(CPB) animal model is extremely dif%cult mainly due to technical problems. On the other hand, deep hypothermic circulatory arrest(CA) is used to facilitate surgical repair in a variety of cardiac diseases. Although steroids are generally known to be effective in the treatment of cerebral edema, the protective effects of steroids on the brain during CA are not conclusively established. Objectives of this study are twofold: the establishment of CPB technique in rabbits and the evaluation of preventive effect of steroid on the development of brain edema during CA. Material '||'&'||' Methods: Fifteen New Zealan white rabbits(average body weight 3.5kg) were divided into three experimental groups; control CA group(n=5), CA with Trendelenberg position group(n=5), and CA with Trendelenberg position + steroid(methylprednisolone 30 mglkg) administration group(n=5). After anesthetic induction and tracheostomy, a median sternotomy was performed. An aortic cannula(3.3mm) and a venous ncannula(14 Fr) were inserted, respectively in the ascending aorta and the right atrium. The CPB circuit consisted of a roller pump and a bubble oxygenator. Priming volume of the circuit was approximately 450m1 with 120" 150ml of blood. CPB was initiated at a flow rate of 80~85ml/kg/min, Ten min after the start of CPB, CA was established with duration of 40min at $20^{\circ}C$ of rectal temperature. After CA, CPB was restarted with 20min period of rewarming. Ten min after weaning, the animal was sacrif;cod. One-to-2g portions of the following tissues were rapidly d:ssected and water contents were examined and compared among gr ups: brain, cervical spinal cord, kidney, duodenum, lung, heart, liver, spleen, pancreas. stomach. Statistical significances were analyzed by Kruskal-Wallis nonparametric test. Results: CPB with CA was successfully performed in all cases. Flow rate of 60-100 mlfkgfmin was able to be maintained throughout CPB. During CPB, no significant metabolic acidosis was detected and aortic pressure ranged between 35-55 mmHg. After weaning from CPB, all hearts resumed normal beating spontaneously. There were no statistically significant differences in the water contents of tissues including brain among the three experimental groups. Conclusion: These results indicate (1) CPB can be reliably administered in rabbits if proper technique is used, (2) the effect of steroid on the protection of brain edema related to Trendelenburg position during CA is not established within the scope of this experiment.

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The Comparative Study of on Pump CABG during Pulsatile $(T-PLS^{TM})$ and Nonpulsatile $(Bio-pump^{TM})$ Perfusion (관상동맥우회술 시 사용된 박동성펌프$(T-PLS^{TM})$와 비박동성펌프$(Bio-pump^{TM})$의 비교연구)

  • Park Young-Woo;Her Keun;Lim Jae-Ung;Shin Hwa-Kyun;Won Yong-Soon
    • Journal of Chest Surgery
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    • v.39 no.5 s.262
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    • pp.354-358
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    • 2006
  • Background: Pulsatile pumps for extracorporeal circulation have been known to be better for tissue perfusion than non-pulsatile pumps but be detrimental to blood corpuscles. This study is intended to examine the risks and benefits of $T-PLS^{TM}$ through the comparison of clinical effects of $T-PLS^{TM}$ (pulsatile pump) and $Bio-pump^{TM}$ (non-pulsatile pump) used for coronary bypass surgery. Material and Method: The comparison was made on 40 patients who had coronary bypass using $T-PLS^{TM}\;and\;Bio-pump^{TM}$ (20 patients for each) from April 2003 to June 2005. All of the surgeries were operated on pump beating coronary artery bypass graft using cardiopulmonary extra-corporeal circulation. Risk factors before surgery and the condition during surgery and the results were compared. Result: There was no significant difference in age, gender ratio, and risk factors before surgery such as history of diabetes, hypertension, smoking, obstructive pulmonary disease, coronary infarction, and renal failure between the two groups. Surgery duration, hours of heart-lung machine operation, used shunt and grafted coronary branch were little different between the two groups. The two groups had a similar level of systolic arterial pressure, diastolic arterial pressure and mean arterial pressure, but pulse pressure was measured higher in the group with $T-PLS^{TM}\;(46{\pm}15\;mmHg\;in\;T-PLS^{TM}\;vs\;35{\pm}13\;mmHg\;in\;Bio-pump^{TM},\;p<0.05)$. The $T-PLS^{TM}$-operated patients tended to produce more urine volume during surgery, but the difference was not statistically significant $(9.7{\pm}3.9\;cc/min\;in\;T-PLS^{TM}\;vs\;8.9{\pm}3.6\;cc/min\;in\;Bio-pump^{TM},\;p=0.20)$. There was no significant difference in mean duration of respirator usage and 24-hour blood loss after surgery between the two groups. Plasma free Hb was measured lower in the group with $T-PLS^{TM}\;(24.5{\pm}21.7\;mg/dL\;in\;T-PLS^{TM}\;versus\;46.8{\pm}23.0mg/dL\;in\;Bio-pump^{TM},\;p<0.05)$. There was no significant difference in coronary infarction, arrhythmia, renal failure and morbidity rate of cerebrovascular disease. There was a case of death after surgery (death rate of 5%) in the group tested with $T-PLS^{TM}$, but the death rate was not statistically significant. Conclusion: Coronary bypass was operated with $T-PLS^{TM}$ (Pulsatile flow pump) using a heart-lung machine. There was no unexpected event caused by mechanical error during surgery, and the clinical process of the surgery was the same as the surgery for which $Bio-pump^{TM}$ was used. In addition, $T-PLS^{TM}$ used surgery was found to be less detrimental to blood corpuscles than the pulsatile flow has been known to be. Authors of this study could confirm the safety of $T-PLS^{TM}$.

Healing Effect of 'Creative Writing' on Individual and on Our Age - Focused on the 'Man of Darkness (Vampire)' Symbol - ('창조적 글쓰기'가 개인 및 시대에 미치는 치유적 작용 - '어둠의 남자(Vampire)' 상징을 중심으로 - )

  • Kye-Hee Kim;Ki-Won Kim;Eun-Seun Han
    • Sim-seong Yeon-gu
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    • v.28 no.1
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    • pp.1-49
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    • 2013
  • This article started with 'encounter'. Both authors met around the middle of February and discussed the subject for the inhospital conference presentation scheduled at the break of June. Having conversation like "Movies similar to fairytales heard from childhood are standing out conspicuously among commercial films which are attracting audiences and receiving fervent response these days. This phenomenon is marvelous and mysterious." together, and sharing this and that, the conversation turned naturally to 'Bram Stoker's Dracula', 'Series of Twilight', and 'Warm Bodies', both authors found out the fact that we saw these movies in common with propound impression. Feeling our hearts beating high, bit of fear and hesitation followed simultaneously at the moment when both of us encountered the idea to choose subject of conference presentation related to this and expressed one in words. While preparing for the conference, presenting to others, and having discussion with the audience, our hearts have been filled with Presentation was finished after active discussion beyond fixed hour and it also brought audience (among those present) to show strong emotional response both positively and negatively. At first, we just had a thought to put aside the content of presentation, but we felt lack of something else, lingering in our minds. We finally decided to accomplish our work into an article leading to submission, based on the advice and recommendation from one of the audience. This article is a small 'creative writing' born by sharing both authors' passion and enthusiasm. In the first part of this article, we have introduced the dream of 31-year-old woman's which led to the 'creative writing' and spotlighted her personal life, before and after the dream. In the second part, we have examined the consequence (way of realization) and meaning of creative impulse shown from or experienced from personal unconsciousness (dream, fantasy) together. Creative impulse shown from the individual appeared to bring creative transformation of individual personality through the process of 'introversion'. Otherwise it also appeared to be delivered as a masterpiece through 'creative writing' or from the process of 'extroversion'. Sometimes both consequences happened at once. We tried to examine and interpret the dream of 31-year-old woman's, which was introduced in the first part of this article, that is to say, the dream of 'Stephenie Meyer's, the author of the 'love between vampire boy and ordinary human girl' themed novel 'Twilight Series', in a psychoanalytic perspective. In the third part, highlighting individual dreams and three different movies 'Bram Stoker's Dracula', 'Twilight Series', and 'Warm Bodies', we found the transformation of symbol 'Man of Darkness, vampire' seen in each individual dreams and in some specific popular arts, such as novels and movies, receiving fervent response from people. We also found love between this symbol and humane woman, bearing fruit together with very impressive change shown in the attitude of 'Man of Darkness' (vampire)'s conscious ego and mutual relationship pattern. We contemplated this phenomenon, the reason why these events happen, and what kind of association presents among these events, individual, and this era and discussed the effects on individuals and this era, at present. 'Creative impulse', originated in the deep structure of human mind is realized as a 'transformation of individual personality' or masterpiece through artistic creation. If it has a chance to make a match with this era, shared by a lot of contemporary people, it also appears to bring positive effect as healing and salvation to each individual or to each era. From this article, we mainly highlighted positive and healing aspects of individual 'creative impulse'. We hope to deal with the negative consequences and their reason coming from 'creative impulse', if the occasion arises, in the future with a new article.