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Analysis of Complications Associated with the Nuss Procedure: Risk Factors and Preventive Measures (너스수술의 합병증에 대한 고찰: 위험인자 분석과 예방책의 제시)

  • Park, Hyung-Joo;Chang, Won-Ho;Jeon, Cheol-Woo;Park, Han-Gyu;Lee, Seock-Yeol;Lee, Cheol-Sae;Youm, Wook;Lee, Kihl-Roh
    • Journal of Chest Surgery
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    • v.37 no.6
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    • pp.524-529
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    • 2004
  • Background: Since the Nuss procedure for the correction of pectus excavatum is in its early stage, there have been problems that need to be solved. We examined complications in a single-institute experience of the Nuss technique in order to develop possible solutions to prevent them. Material and Method: 335 consecutive patients, who underwent the modified Nuss procedure between August 1999 and October 2002, were studied retrospectively. Median age was 8 years (range 1 to 46). 264 patients (78.8%) were in pediatric group (age$\leq$15) and 71 patients (21.2%) were in adult group (age> 15). 193 patients (57.6%) had symmetric and 142 patients (42.4%) had asymmetric pectus configurations. Risk factors predicting postoperative complications were analyzed using multi-variate logistic regression. Result: Postoperative complication rates were 18.9% (61/335) in total patients. Frequent complications were pneumothorax 24 (7.5%), bar displacement 11 (3.4%), and wound seroma 10 (3.1%) in order. Early complications (within a month, 49 cases, 15.2%) were pneumothorax (n=23, 6.9%), wound seroma (n=12, 3.6%), and bar displacement (n=8, 2.4%). Late complications (after a month, 12 cases, 3.7%) were pericarditis and pericardial effusion (n=5, 1.5%), bar displacement (n=4, 1.2%), and hemothorax (n=3, 0.9%). Techniques were modified to prevent complications especially in bar shaping and fixation, which led to decrease complication rate in later experience (Operation Date 1: 15/51 (29.4%) vs Operation Date 2: 34/284 (12.0%), p=0.004). Grand Canyon type (eccentric long canal type) showed higher complication rate than other types (GC type: 12/30(40%) vs Others: 37/305 (12.1%), p<0.001). Major risk factors are severity of pectus (OR=2.88, p=0.038), Grand Canyon type (OR=2.82, p=0.044), and Op. Date 1 (OR=4.05, p=0.001). Conclusion: Major complications were related to severe eccentric type of pectus configuration (Grand Canyon type) and lack of surgeon's experience (Op. Date 1). Com-plication rate was reduced with accumulation of experience and advancement of surgical techniques. The Nuss procedure can be performed at a low risk of complications with our current technique.

Comparison of the Results of Ultrasound-guided Caudal Epidural Block - Herniated Intervertebral Disc vs Spinal Stenosis - (초음파를 이용한 미추 경막외 차단술의 결과 비교 - 추간판 탈출증과 척추관 협착증 -)

  • Kim, Young-Tae;Cho, Kyu-Jung;Ahn, Chi-Hoon
    • The Journal of Korean Orthopaedic Ultrasound Society
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    • v.7 no.2
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    • pp.105-112
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    • 2014
  • Purpose: Ultrasound-guided epidural caudal block for low back pain and radiating pain is often performed in the treatment of outpatients. However, this procedure has a failure rate of up to 25% even when it performed by an experienced physician. The authors investigate the effectiveness of Ultrasound-guided epidural caudal block in patients related to disc herniation or spinal stenosis. Materials and Methods: Ultrasound-guided caudal epidural block was performed in 55 outpatients with LBP and radiating pain. Patient was placed in the prone position and sonographic image of sacral hiatus was obtained using linear probe. A 22-gauge needle was advanced into the sacrococcygeal membrane under ultrasound guidance and then medication was injected into the caudal epidural space. There were 31 cases of disc herniation, and 24 cases of spinal stenosis. Patients were evaluated by Visual Analog Scale (VAS) pain score at pre-treatment, post-treatment, 2 weeks and 4 weeks by telephone interviews. Results: 53 of the 55 cases (96.4%) of needle insertion into the sacral canal under ultrasound guidance were successful. Gender was not significantly different between disc herniation group and spinal stenosis group. But there was a significant age difference between disc herniation group ($42.3{\pm}10.8$), and spinal stenosis group ($62.8{\pm}15.1$) [p<0.001]. The VAS score at pre-treatment, post-treatment, 2 weeks, 4 weeks in disc group were 6.84, 3.1, 1.8 & 1.77. The VAS score at pre-treatment, post-treatment, 2 weeks, 4 weeks in spinal stenosis group were 6.88, 3.58, 4.33 & 4.88. The VAS score in both groups was significantly improved after the procedure (p<0.001). Over time, the two groups were statistically significant differences in VAS score after adjusting for age (p<0.001). Conclusion: Ultrasound-guided caudal epidural block seems to provide a high success rate and a significantly better response in disc group than spinal stenosis group.

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A Clinical Study on Macrosomia (거대아에 대한 임상적 연구)

  • Lee, Kang-Won;Kim, Jong-Wook;Lee, Tae-Hyung;Park, Wan-Seok;Lee, Sung-Ho;Chung, Wun-Youn
    • Journal of Yeungnam Medical Science
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    • v.3 no.1
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    • pp.293-299
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    • 1986
  • Obstetric problems concerning macrosomia were evaluated by retrospective review of 91 pregancies that resulted in the delivery of an infant weighing 4,000gm or more at the Yeungnam University Hospital during 3 1/2 years from Jun. 1983 to Oct. 1986. The results obtained were as follows. 1. Macrosomic infants weighing 4.000gm or more occured in 2.8% of the deliveries. 2. 65.9% of macrosomic infants and 53.5% of total infants were male. The ratio of male was statistically higher in the macrosomic infants than in the total infants(P<0.05). 3. The incidence of macrosomia was higher with increasing qestational age, and deliveries at 42 weeks or more gestation were more common in the macrosomic infants than in the total infants(P<0.01). 4. The incidence of macrosomia was highter with increasing parity, and stastically higher in the multipara than in the primipara(P<0.01). 5. There was no difference in the incidence of macrosomia between the mothers aged 24 or less and that of 30 or more. 6. The cesarean section rate of macrosomia(30.8%) was stastically higher than that of the total infants(15.7%)(P<0.01) 7. With the pregnacy and delivery of macrosomic infants, 22 antepartum anemia(24.2%), 10 postpartum hemorrhage(11.0%), 9 birth canal injury(10.0%), 7 prolonged second stage of labor (7.7%), 4 breech presentation, and 3 pregancy induced hypertension occured in the mothers, and 10 asphyxia(or Apgar score 6 or less), 2 shoulder dystocia, 1 intrauterine fetal death, and 1 sacrococcygeal teratoma occured in the infants.

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Improvement of Seedling Stand and Lodging Prevention in Direct Seeded Rice (벼 직파재배(直播栽培) 입묘율향상(立苗率向上)과 도복경감(倒伏輕減))

  • Oh, Yun-Jin;Kim, Chung-Kon
    • Korean Journal of Weed Science
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    • v.12 no.3
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    • pp.200-222
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    • 1992
  • The results of recent researches for improvement of seedling stand in direct seeded rice on the dry paddy in Korea were summarized as the following ; a variety to be cultivated should be chosen the characteristics of high percentage germination under low temperature, shorter period of shoot emergence, and better growth of the mesocotyl and shoots. Meanwhile, there was 40% increase in seedling stand at the treatment of removal of the seed awn under using the drill seeder. After seeding the rice seed covered with soil of 3cm depth was better seedling emergence and also there was the hightest seedling emergence at the 70% of moisture content of the soil. In addition, the application of the Release containing GA 10% enabled to increase the seedling stand and furthermore it was effective under deep seeding depth. The optimum seeding date should be seeded around May 10 when mean air temperature is above 12-13$^{\circ}C$ so that may establish more less 70% in seedling stand. Based on an appropriate seedling stand of 150/$m^2$, the optimum seeding rate was 5kg/10a. It was the best in seeding method using drill seeder and the most desirable recommended seeding method was the drill seeder in terms of seedling stand. In order to improve seedling stand water management was more effective in canal irrigation and in drainage at 6hr after irrigation following by the seeding process. On the other hand, for the increase of seedling stand under flooded condition a variety might have characters being better germination at low concentration of dissolved oxygen and vertically deeper growing of the crown root. Also, seedling stand was able to increase with the seed coating of $CaO_2$in the flooded soil. It was possible to be seeded on the early part of May being mean air temperature of avove 10$^{\circ}C$ and the optimum seeding rate was 5kg/10a. For an effective water management water would be flooded up to 3cm depth for 2-3 weeks after seeding. The rice plant grown under the direct seeded cultivation might be not so much strong in lodging resistance compared to that grown under the transplanting and moreover direct seeded rice cultivation under flooded condition would be more weak growth of the rice plant than that on dry paddy. Meanwhile, the lodging would be affected by the seeding rate, the soil depth after seeding. and seeding method even in the same variety. In particular, roots in the lodging pattern of direct seeded rice cultivation under flooded condition were largely distributed on the soil surface so that resulted easily in the lodging. In general, the lodging resistance would be greater as seeding rate and amount of N fertilizer application are lower and soil depth after seeding is higher. Among the introduction of different seeding method the high ridged drill seeding method on dry paddy soil resulted in the lowest in the lodging index and also it was lower in the drill seeding method than in the scattering seeding method under flooded condition. In case of more than 150 seedlings per $m^2$ there was a severe lodging due to high lodging index at the 3rd and 4th internodes. The effective lodging prevention was able to at the treatment of the Inabenfide at 45 days before heading and the Uniconazol at 15 days before heading which caused the shortage by 10-15cm in culm length. Also, fertilizer management using split application of nitrogen would be contributed the reduction of lodging at the rate of 20-30-20-20-10%(basal-5th leaf stage-7th leaf stage-panicle initiation stage-heading stage) on the dry paddy soil.

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The Study on Correlation between the Degree of Herniated Intervertebral Lumbar Disc at L4~5 Level and Improvement of Low Back Pain Treated by Korean Medicine Therapy (제 4~5번 요추 추간판 탈출 정도와 요통의 한의학적 치료 효과의 상관성 연구)

  • Yoo, Hyung-jin;Lee, Hyun-ho;Jeong, Seong-hyun;Jo, Kyeong-sang;Lee, Gie-on;Lee, Dong-hyun;Kim, Sang-min
    • Journal of Korean Medicine Rehabilitation
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    • v.26 no.2
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    • pp.105-121
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    • 2016
  • Objectives The purpose of this study was to compare the effects between the degree of herniated intervertebral lumbar disc (HIVD) at L4-5 level and improvement of low back pain treated by Korean Medicine therapy. Methods 567 patients who received inpatient treatment from May 2014 to December 2015 in the Daejeon-Jaseng of Korean Medicine Hospital were divided into 6 groups by the degree of HIVD at L4-5 level confirmed with a Lumbar spine magnetic resonance imaging. All patients received a combination of treatment including acupunture, chuna manual therapy, pharmacopunture, herbal medication. They were compared and analyzed on the basis of improvement between measuring Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), EuroQol-5 Dimension Index (EQ5D Index) as they were hospitalized and as they were discharged. The statistically significance was evaluated by SPSS 23.0 for windows. Results After treatment, Normal stage on Intervertebral Lumbar Disc at L4-5 level group's Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), EuroQol-5 Dimension Index (EQ5D Index) improvement was $1.30{\pm}1.62$, $4.52{\pm}11.82$ and $0.04{\pm}0.11$ respectively. Bulging group's improvement was $3.25{\pm}2.81$, $8.28{\pm}13.02$ and $0.09{\pm}0.17$ respectively. Spinal canal occupying ratio (SOR) less than 20 group's improvement was $2.15{\pm}1.92$, $11.79{\pm}17.81$ and $0.13{\pm}0.23$ respectively. SOR 20 to less than 40 stage group's improvement was $2.13{\pm}1.92$. $10.79{\pm}15.93$ and $0.10{\pm}0.26$ respectively. SOR 40 to less than 60 group's improvement was $2.16{\pm}2.24$, $9.80{\pm}16.62$ and $0.15{\pm}0.25$ respectively. Surgery group's improvement was $2.47{\pm}2.21$, $11.64{\pm}18.53$ and $0.15{\pm}0.27$ respectively (p<0.03). But there was no statistically significance between 6 group's improvement after treatment (p>0.05). Conclusions After inpatient treatment by Korean Medicine therapy, Most patient's pain, disability and Health Related Quality of Life was improved significantly. But there was no statistically correlation between the degree of HIVD at L4-5 level and improvement of low back pain. So We think that future research of higher quality and correct statistics shall be necessary.

A RESEARCH ON THE EVALUATION OF THE NEW PATIENTS FOR THE LAST 8 YEARS IN DEPT. OF PEDIATRIC DENTISTRY OF CHONBUK UNIVERSITY (최근 8년간 전북대학교치과병원 소아치과에 내원한 초진환자에 관한 실태조사)

  • Ko, Young-Han;Kim, Jae-Gon;Yang, Yeon-Mi;Baik, Byeoug-Ju
    • Journal of the korean academy of Pediatric Dentistry
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    • v.34 no.2
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    • pp.292-298
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    • 2007
  • In order to thoroughly understand change patterns and to set up an appropriate approach the direction of future treatment towards children in Chonbuk area, we carried out this research. we could draw below conclusions from the studies based on researches of distribution of new patients visited Dept. of Pediatric Dentistry, Chonbuk Nat' university from 1998 to 2005 and current changes in dental treatment. 1. There was an increase in the number of patients until 2004 but it decreased in 2005. Boys took higher portion. 2. Number of patients increased during school holidays. 3. 97.7% of patients were urbanites. 4. An age group from 31 months to 6 years showing 48.2% was the highest, each percentage of $7{\sim}13$ years, $13{\sim}30$ months showed 31.3%, 17.2%. 5. 33.8% of patients were referred from local dental clinics and among them, an age group from 31 months to 6 years showing 49.5% was the highest, each percentage of $7{\sim}13$ years, $13{\sim}30$ months showed 35.2%, 12.9%. 6, 5.5% of patients who had systemic diseases, among them, each percentage of cardiovascular disease, mental retardation, respiratory disease showed 21.8%, 13.6%, and 11.0%. 7. According to the distribution of chief complaints, dental caries showing 42.9% was the highest. 8. Root canal treatment, restoration, prosthesis showing 42.6% were the highest of all treatments.

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A Case of Pharmacokinetics of Cisplatin in Concurrent Chemoradiation for Hemodialysis Patient with Advanced Head and Neck Cancer (혈액 투석을 받는 두경부암 환자의 동시화학방사선요법에서 Cisplatin의 약력학 조사 1예)

  • Jeon, Youn-Joo;Shim, Byoung-Yong;Kim, Hyung-Wook;Lee, Sang-Hun;Lee, Ho-Sang;Park, Cheol-Whee;Kim, Su-Zy;Kuh, Hyo-Jeong;Kim, Hoon-Kyo
    • Korean Journal of Head & Neck Oncology
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    • v.23 no.2
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    • pp.153-156
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    • 2007
  • Objectives : We study the feasibility and pharmacokinetics of cisplatin concurrent chemoradiation for advanced head and neck cancer patient undergoing hemodialysis. Materials and Methods : A 57-year old male with end stage renal disease developed stage III external auditory canal cancer. Complete resection surgery was done. Postoperative 6 months, local recurrence was occurred. Despite excision and adjuvant radiotherapy, local tumor was recurred. We decided to treat a cisplatin concurrent chemoradiotherapy. Cisplatin was administered at a dose of $20mg/m^2$ for 30 min. Hemodialysis was started 30 min after completion of the cisplatin infusion and performed for 4 hours. Hemodialysis was performed on day 3 and 5 of chemotherapy. Plasma samples were collected at specified times after administration of cisplatin. Result : At the end of the third cycle of cisplatin concurrent chemoradiotherapy, the tumor size was markedly decreased. The maximum plasma concentrations of plasma platinum and free platinum were 0.74 and $0.37{\mu}g/ml$ respectively. The area under the curve of plasma platinum and free platinum were 94.7 and $11.3{\mu}g{\cdot}h/ml$ respectively. Conclusion : We report a case of Cisplatin concurrent chemoradiation for hemodialysis patient with advanced head and neck cancer and suggest full dose cisplatin concurrent chemoradiotherpay is tolerable for these patients.

A HISTOPATHOLOGIC STUDY ON THE PULPAL RESPONSE TO DEMINERALIZED FREEZE-DRIED BONE IN DOGS (탈회냉동건조골에 대한 성견의 치수조직반응에 관한 연구)

  • Jung, Moon-Yong;Lee, Chang-Seop;Park, Joo-Chul;Lee, Sang-Ho
    • Journal of the korean academy of Pediatric Dentistry
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    • v.27 no.2
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    • pp.318-332
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    • 2000
  • The purpose of this study was to investigate the effects of demineralized freeze-dried bone (DFDB) on mechanically exposed pulp of dog by evaluating the pulpal inflammation and healing process, formation of dental hard tissue, and structural changes of fibroblasts of the remaining pulp tissue. Teeth of 4 dogs, weighing 10kg, were used in this study. Class V cavities were prepared followed by exposed the pulp tissue mechanically by sterilized round bur. In control group, exposed pulps were capped with calcium hydroxide paste followed by sealed with IRM. In experimental groups, the exposed pulps of one group were capped with the collagen and those of the other group were capped with DFDB. All cavities were sealed with same manor as control group. The animals were sacrificed at the intervals of 3, 7, 14, and 28 days for histopathlogic evaluation. The specimens were observed by the light microscope and trans-electron microscope. The results were as follows: 1. Pulp necrosis was not observed in all groups. Inflammatory response was disappeared from 1 week in control group and group 2. But it was not disappeared until 2 weeks and also irregular arrangement of odontoblasts was showed at the lateral walls of root canal just beneath the amputated site of the pulp in group 1. 2. Dentinal bridge was formed incompletely at 2 weeks but it was formed completely at 4 weeks in control group. Odontoid tissue was also found in control group at 4 weeks from treatment. Amputated site of pulp was encapsulated with fibrous tissue and odontoblast and dentinal bridge was not found in group 1. Preodontoid tissue and reparative dentin which were formed by odontoblast differentiated around DFDB were found, but dentinal bridge was not found in group 2. 3. Cell with large basophillic-stained nuclei infiltrated to amputated site and DFDB at 1 week from treatment in control group and group 2. They were found more in group 2 than in control group. Odontoblasts arranged more regularly and reparative dentin was found more as time elapsed. 4. Dentin-formative odontoblasts which showed ultramicrostructure of cytoplasm with polarized nucleus, rEM, Golgi complex, secretory granules, secretion of organic matrix in control of group and group 2. In regards to above results, the demineralized freeze-dried bone(DFDB) induce odontoblastic differentiation and further come up to the dentin formation in amputated pulp.

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Studies on the Morphological Characteristics and Life History of the Chili Fish, Cultriculus eigenmanni (Jordan et Metz) (1) On the Egg Development and the Fry in the Larval Stage (치리(Cultriculus eigenmanni)의 형태 및 생활사에 관한 연구 I. 난발생과 부화자어에 대하여)

  • KIM Eul-Bae;KIM Young-Gill
    • Korean Journal of Fisheries and Aquatic Sciences
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    • v.17 no.2
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    • pp.151-156
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    • 1984
  • The Chili fish, one of the most common species of the freshwater fishes, is distributed in the river basins of the western coast of Korea. However, any studies on this fish, especially its development or life history, have not been made so far. The authors, therefore, carried out an experiment to reveal some characteristics of egg develoment and fry in this fish. For accomplshing this study, we caught some adult Chili fish by means of a casting net at raceway in the vicinity of Kunsan in June and July, 1983; then, we injected 0. 1 cc Gonadotrophic hormone 1,000 unit solution (Puberogen) in order to induce the spawning on the abdominal cavity of male and female respectively, Approximately 12 hours after injection, the artificially fertilized eggs by using of the dry method and the naturally fertilized eggs were observed simultaneously in the aquarium ($30{\times}50{\times}70cm$). The fertilized eggs, in spherical shape, were sperative, demersel, adhesive nature and $1.38{\sim}1.59\;mm$ in diameter. The light yellow yolk was opaque and $1.17{\sim}l.27\;mm$ in diameter. The hatching of eggs took place at 29.5 hours after fertilization under the condition of $23.5{\sim}25.0^{\circ}C$ water temperature. Basically there were not found so many different aspects in comparison with the common species of Cyprinidae in the development process of eggs : however, there were a few noticable characteristics, that is, pigment cells, eye balls and blood circulation are invisible, or the velocity of egg development is rapid, seemed similar to the Loach's egg. Newly hatched larvae with the yolk sac (2.39 mm in size) were $3.87{\sim}3.99\;mm$ in total length and their myotome number was expressed as 28+15=43. About 20 hours after hatching, a caudal and a pectoral fin as well as an anus began to orgin. In addition, a few malanophore showed on the upper regin of the yolk sac of the larvae whose size was 4.73 mm in total length. The larvae developed about 5.02 mm in total length, and the median fin fold in the abdomen extended forward to two thirds or beyond of the yolk sac at 50 hours after hatching. Simultaneously, the eye balls and mouth also appeared. After 3 days, the yolk sac nearly disappeared, and the larvae (5.4 mm in total length) with perfect eye balls began to swim for themselves for the first time. Also, the specialization between the gill arches and the ailmentary canal, the development of each fins except dorsal fin as well as the blood circulation obviously distinguished in this stage. The larvae whose total length was 5.68 mm was very brisk: also, the development of the dorsal fin rudiment, nearly perfect formation of each organs and the function of the upper and lower jaws were noticeably observed 5 days after hatching.

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Studies on the Principal Characteristics of Superior Hybrid Pine (침엽수(針葉樹) 우량교잡종(優良交雜種)의 특성(特性)에 관(關)한 연구(硏究))

  • Ahn, Kun Yong
    • Journal of Korean Society of Forest Science
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    • v.29 no.1
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    • pp.102-114
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    • 1976
  • This experiment was conducted to investigate the percentage of fertile seed in terms of crossabilities and relationships of taxonomic affinities for the ${\times}$ P. rigitaeda of interspecific hybrid, ${\times}$ P. rigida rigitaeda and ${\times}$ P. rigitaeda rigida of backcross hybrids, $F_2$ of ${\times}$ P. rigitaeda and natural hybrid of ${\times}$ P. rigitaeda within Sub-genus Diploxylon of the Genus Pinus. The possibility of establishment of hybrid seed orchard and differentia of hybrids for the purpose of extensive program of reforestation in the future have also been investigated. And, the experimental results obtained are summarized as follows: 1. On the basis of crossabilities as well as on the taxonomic affinities according to the systems of Shaw, Pilger and Duffield, it has been proven that the parental species of those hybrids are of close affinities and range of the fertile hybrid seed production rate was as high as 67-87% in the best hybrid combination (Table 6). 2. Those hybrids seemed to be most promising in the growth perfermance exhibiting 28-80% more volume growth compared to the P. rigida with the statistic significance of 1-5% level (Table 7, 8, 9). And all hybrids exhibit cold hardiness as much as P. rigida except $F_1$ hybrid of ${\times}$ P. rigitaeda and it seems to suggest that the characteristics of cold hardiness were transmitted from the P. rigida. 3. With regard to the anatomical characteristics of needle, the hypoderm is biform in most of the hybrid pines and the characteristics of resin canals are medial in all hybrid. And, the fibrovascular bundles are intermediate of both parent in all hybrid. Therefore it was found to be possible to distinguish the hybrids pines from their parents by the needle characteristics (Table 10). 4. It has been demonstrated that the hybrids pines have a phenolic substance (No. 7) of pale yellow at Rf-0.66, same as P. rigida, but no trace of phenolic substance was observed in the P. taeda. This fact will serve as an important criteria for early identification of hybridity in progeny testing (Table 11). 5. It was found to be possible to distinguish by the starch gel electrophoretic variations banding patterns and staining densities of isoperoxidase in the needles of the hybrids pines from their parents (Fig. 1).

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