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Screening Colonoscopy from a Large Single Center of Thailand - Something Needs to be Changed?

  • Aswakul, Pitulak;Prachayakul, Varayu;Lohsiriwat, Varut;Bunyaarunnate, Thirapol;Kachintorn, Udom
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.4
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    • pp.1361-1364
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    • 2012
  • Background: Results of screening colonoscopy from Western countries reported adenoma detection rates (ADRs) of 30-40% while those from Asia had ADR as low as 10%. There have been limited data regarding screening colonoscopy in Thailand. The objectives of this study were therefore to determine polyp and adenoma detection rates in Thai people, to evaluate the incidence of colorectal cancer detected during screening colonoscopy and to determine the endoscopic findings of the polyps which might have some impact on endoscopists to perform polypectomy. Materials & Methods: This study was a retrospective electronic chart review of asymptomatic Thai adults who underwent screening colonoscopy in our endoscopic center from June 2007 to October 2010.Results: A total of 1,594 cases were reviewed. The patients had an average age of $58.3{\pm}10.5$ years (range 27-82) and 55.5% were female. Most of the cases (83.8%) were handled by staff who were endoscopists. A total of 488 patients (30.6%) were reported to have colonic polyps. Left-sided colon was the most common site (45.1%), followed by right-sided colon (36.5%) and the rectum (18%). Those polyps were removed in 97.5% of cases and 88.5 % of the polyps were sent for histopathology (data lost 11.5%). Two hundred and sixty three cases had adenomatous polyps, accounting for 16.5 % ADR. Advanced adenomas were detected in 43 cases (2.6%). Hyperplastic polyps were mainly located distal to the splenic flexure of the colon whereas adenomas were found throughout the large intestine. Ten cases (0.6%) were found to have colorectal cancer. Four advanced adenomas and two malignant polyps were reported in lesions ${\leq}$ 5 mm. Conclusion: The polyp detection rate, adenoma detection rate, advanced adenoma detection rate and colorectal cancer detection rate in the screening colonoscopy of Thai adults were 30.9%, 16.5%, 2.6% and 0.6% respectively. Malignant transformation was detected regardless of the size and location of the polyps. Therefore, new technology would play an important role indistinguishing polyps.

Management of Traumatic Diaphragmatic Rupture (외상성 횡격막 손상의 치료)

  • Kim, Seon Hee;Cho, Jeong Su;Kim, Yeong Dae;I, Ho Seok;Song, Seunghwan;Huh, Up;Kim, Jae Hun;Park, Sung Jin
    • Journal of Trauma and Injury
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    • v.25 no.4
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    • pp.217-222
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    • 2012
  • Purpose: Diaphragmatic rupture following trauma is often an associated and missed injury. This report is about our experience with treating traumatic diaphragmatic rupture (TDR). Methods: From January 2007 to September 2012, 18 patients who had a diaphragmatic rupture due to blunt trauma or penetrating injury underwent an operation for diaphragmatic rupture at our hospital. We retrospectively reviewed their medical records, including demographic factors, initial vital signs, associated injuries, interval between trauma and diagnosis, injured side of the diaphragm, diagnostic tools, surgical method or approaches, operative time, herniated organs, complications, and mortality. Results: The average age of the patients was 43 years, and 16 patients were male. Causes of trauma included motor vehicle crashes (n=7), falls (n=7), and stab wounds (n=5). The TDR was right-sided in 6 patients and left-sided in 12. The diagnosis was made by using a chest X-ray (n=3), and thorax or upper abdominal computed tomography (n=15). Ten(10) patients were diagnosed within 12 hours. A thoracotomy was performed in 8 patients, a video-assisted thoracoscopic surgery in 4 patients, a laparotomy in 3 patients, and a sternotomy in one patient. Herniated organs were the omentum (n=11), stomach (n=8), spleen and colon (n=6), and liver (n=6). Eighteen diaphragmatic injuries were repaired primarily. Seven patients underwent ventilator care, and two of them had pneumonia and acute respiratory distress syndrome. There were no operative mortalities. Conclusion: Early diagnosis and surgical treatment determine the successful management of TDR with or without the herniation of abdominal organs. The surgical approach to TDR is chosen based on accompanying organ injuries and the injured side.

Acupuncture Treatment in Feline Horner's Syndrome: Case Report (고양이 Horner's syndrome에 대한 침치료(針治療) 증예보고(症例報告))

  • Hsu, Chin-Yuan;Hsu, Chin-ling;Hsu, Chin-Hwang;Liao, Jim-Cai;Chueh, Hao-Jen;Cheng, Han-Wen;Jun, Hyeong-Kyou;Kim, Duck-Hwan
    • Journal of Veterinary Clinics
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    • v.24 no.2
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    • pp.214-217
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    • 2007
  • A about 2-month- old, mixed female cat was referred to Yeon Chang Veterinaly Clinic in Taiwan. Because this patient was wandering cat, precise history was not blown. At first admission, miosis, ptosis and protrusion of the nictitating membrane was observed in the right sided eye, and also slight miosis was found in the left sided eye. The patient was diagnosed into feline HS. Oculo-AP and injection-AP with dexamethasone were applied to this patient. Oculo-AP at Shang Jiao regions of both eyes was done for 10 minutes. In addition, injection-AP with dexamethasone (0.2 ml/acupoint) at BL01-Jing Ming, BL02-Zan Zhu and ST01-Cheng Qi. After AP treatment, prolapse of the nictitating membrane was amazingly disappeared and pupil was dilatated at session 1. Ocular findings at session 2 (one day after session 1) were maintained with nearly normal state. Accordingly, the present patient was a case with feline HS that showed favorable therapeutic effect by AP treatment.

Double-Chambered Right Ventricle in an Old Standard Poodle Dog

  • Yunho Jeong;Yoonhwan Kim;Eunchan Lee;Ju-Hyun An;Sooyoung Choi;Jin-Young Chung;Jin-Ok Ahn
    • Journal of Veterinary Clinics
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    • v.40 no.2
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    • pp.130-134
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    • 2023
  • A 12-year-old Standard Poodle presented with intermittent weakness and occasional dyspnea at the Veterinary Medicine Teaching Hospital of Kangwon National University. A grade of 4 out of 6 systolic murmur with an irregular tachycardic rhythm was auscultated on both sides of the chest. Systolic blood pressure was 140 mmHg. Panting was noticed in the hospital, but there was no crackle sound. Blood analysis revealed mild increases in liver panel levels (alanine aminotransferase 149 [reference interval, 19-70] U/L; and alkaline phosphatase, 185 [reference interval, 15-127] U/L) and severe increases in cardiac biomarker levels (n-terminal pro-brain natriuretic peptide, 4169 [reference interval, 50-900] pmol/L; and cardiac troponin I, 0.22 [reference interval, 0.03-0.12] ng/mL). On electrocardiography, irregularly irregular supraventricular tachycardic rhythm with an f-wave and no distinct p-wave was observed. Generalized cardiomegaly with an enlarged right atrium and left ventricle was confirmed on thoracic radiography. Moreover, hepatomegaly and an enlarged caudal vena cava were observed. Echocardiographic evaluation revealed a fibromuscular diaphragm in the right ventricle. Because of the obstructive lesion in the right ventricle, the right atrium and ventricle were enlarged (right atrial area index, 38.82 cm2/m2 [reference interval, 4.2-10.2 cm2/m2]; right ventricle end-diastolic area index, 14.152 cm2/m2 [reference interval, 4.9-10.92 cm2/m2]). Accordingly, the patient was diagnosed with double-chambered right ventricle (DCRV). Pimobendan, furosemide, enalapril, diltiazem, and S-adenosylmethionine (SAMe) were prescribed, and all symptoms were relieved. DCRV is a right-sided congenital heart defect resembling pulmonic valve stenosis. If symptoms are not severe, medical therapy can be facilitated without surgery or the balloon dilation.

Repair of Complete Atrioventricular Septal Defect with Surgical Modification (변형술식에 의한 완전방실중격결손의 교정)

  • 김웅한;김수철;이택연;한미영;정철현;박영관;김종환
    • Journal of Chest Surgery
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    • v.32 no.7
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    • pp.628-636
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    • 1999
  • Background: Recent advances in understanding the anatomy of the complete atrioventricular septal defect(including right-dominant unbalanced atrioventricular septal defect) have led to alternative methods of repairing these defects. Material and Method: From May 1997 to July 1998, 8 consecutive infants(age range, 2 to 28 months, mean body weight 6.0$\pm$2.2 kg) received a single-stage intracardiac repair of the complete atrioventricular septal defect with modified surgical methods. Depending on the specific anatomic structure, the procedure was simplified in 3 patients by a direct closure of the ventricular element of the defect(Group I). Two patients judged unsuitable for direct closure due to a potential left ventricular outflow tract obstruction had received a standard two-patch repair(Group II). The remaining 3 patients with right-dominant unbalanced complete atrioventricular septal defect underwent biventricular repair; to enlarge the orifice of the left atrioventricular valve, the ventricular septal patch was placed slightly more to the right of the ventricular crest, a left sided bridging leaflet was augmented with an autologous pericardial patch, and the leaflet was repaired with a double- orifice(Group III . Result: In all 8 patients, the postoperative echocardiography demonstrated good hemodynamics. Seven patients were weaned from the ventilators after a mean 3$\pm$1 days, and 1 patient was weaned after 24 days due to a reoperation and emphysematous lung problem. A reoperation was performed in 1 patient for progressive left atrioventricular valve regurgitation due to leaflet tearing. There were no early and late mortalities. At the time of the latest review, judging from the echocardiographic criteria, left atrioventricular valve stenosis was mild in 1 patient(mean pressure gradient 6.5 mmHg, 13.5%), left atrioventricular valve regurgitation was absent or grade I in 7 patients(87.5%). The right atrioventricular valve regurgitation was absent or grade I in all 8 patients(100%). Conclusion: Infants with complete atrioventricular septal defect were treated with either a simplified approach with direct closure of the ventricular element of the defect or a modified surgical technique for a right-dominant unbalanced atrioventricular septal defect, depending on the anatomic structure. The results were no operative mortalities and low morbidity.

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Effects of Water Restriction on the Growth Performance, Carcass Characteristics and Organ Weights of Naked Neck and Ovambo Chickens of Southern Africa

  • Chikumba, N.;Chimonyo, M.
    • Asian-Australasian Journal of Animal Sciences
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    • v.27 no.7
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    • pp.974-980
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    • 2014
  • In semi-arid areas of Southern Africa, dehydration can compromise the performance and welfare of local chickens, particularly during the growing period when confinement is curtailed and birds are left to scavenge for feed and water. The effect of water restriction on the growth performance was compared in Naked Neck (NNK) and Ovambo (OVB) chickens that are predominant in Southern Africa. A total of 54 eight-wk-old pullets each of NNK and OVB chickens with an initial average weight of $641{\pm}10g/bird$ were randomly assigned to three water intake treatments, each having six birds for 8 wk. The water restriction treatments were ad libitum, 70% of ad libitum and 40% of ad libitum intake. Nine experimental pens with a floor space of $3.3m^2$ per strain were used. The pens were housed in an open-sided house with cement floor deep littered with a 20 cm layer of untreated wood shavings. Feed was provided ad libitum. Average daily water intake (ADWI), BW at 16 weeks of age (FBW), ADG, ADFI, feed conversion ratio (FCR) and water to feed ratios (WFR) were determined. Ovambo chickens had superior (p<0.05) FBW, ADG and ADWI than NNK chickens. Body weight of birds at 16 weeks of age, ADG, ADFI, ADWI, and WFR declined progressively (p<0.05) with increasing severity of water restriction while FCR values increased (p<0.05) as the severity of water restriction increased. Naked Neck chickens had better FCR at the 40% of ad libitum water intake level than Ovambo chickens. The dressing percentage per bird was higher in water restricted birds than those on ad libitum water consumption, irrespective of strain. Heart weight was significantly lower in birds on 40% of ad libitum water intake than those on ad libitum and 70% of ad libitum water intake, respectively. In conclusion, NNK chickens performed better than OVB chickens under conditions of water restriction and would be ideal to raise for meat and egg production in locations where water shortages are a major challenge.

Fish Passage Evaluations in the Fishway Constructed on Seungchon Weir (승촌보에 설치된 어도에서 어류의 이동성 평가)

  • Choi, Ji-Woong;Park, Chan-Seo;Lim, Byung Jin;Park, Jong-Hwan;An, Kwang-Guk
    • Journal of Environmental Science International
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    • v.22 no.2
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    • pp.215-223
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    • 2013
  • The objective of this study was to evaluate fish passage efficiency, based on fish-trap monitoring methodology, in the fishway of Seungchon Weir, which was constructed on the lower region of Yeongsan River in 2011. Seasonal patterns and diel variations of fish movements, fish fauna, and compositions in the fishway were analyzed in relation to the current velocity and location of the trap-setting in the fishway. For the analysis, we conducted seven times surveys in 2012 on the fishway and also conducted intensive monitoring of the fishway as 3 hrs interval for the diel variations of fish fauna and compositions in the fishway. According to the fish-trap monitoring methodology, the total number of fish species was 13 species, which was a 43.3% of the total. Most dominant fish used the fishway was Squalidus chankaensis tsuchigae and the relative abundance of the species used the fishway was 33.5% of the total. The season and time zone (in diel variation) observed most frequently in the fishway were July and 18:00-21:00 PM, respectively. The fish movements and use-rates of fishway varied depending on the locations of trap-setting; Fish biomass and the number of species were statistically (p < 0.05) greater in the most right or left-sided traps than in the mid-traps. Also, fish movements and use-rates of fishway were influenced by current velocity on the fishway; fish in the fishway preferred the low current velocity (mean 0.71 m/sec) than the high current velocity (mean 1.13 m/sec). Further long-term studies should be monitored for the efficiency evaluations of the fishway.

Prognostic Factors of Idiopathic Facial Palsy: A Retrospective Study

  • Park, Gi Nam;Jeong, Jeong Kyo;Kim, Eun Seok;Kim, Jung Ho;Kim, Young Il
    • Journal of Acupuncture Research
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    • v.34 no.3
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    • pp.23-38
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    • 2017
  • Objectives : The purpose of this study was to evaluate the clinical prognostic factors affecting facial palsy in 98 idiopathic facial palsy patients who were hospitalized and treated in 2015, using retrospective statistical analysis. Methods : We investigated patients with idiopathic facial nerve palsy, admitted to a Korean medical hospital in 2015, and examined patients' variables and therapeutic variables. For analysis of clinical data, an independent sample t-test, analysis of variance (ANOVA), and simple regression analysis were performed using IBM SPSS version 24.0. Results : 1. The initial degree of facial palsy showed statistical significance with age. The older the age, the more severe the initial palsy. 2. Following treatment degree of facial palsy was statistically significant with age, hypertension, and fasting blood sugar (FBS). The higher the value, the slower the recovery from facial palsy. There was a statistical significance with the number of treatments in a Korean medical hospital. The more frequent the treatment, the faster the facial palsy recovery. 3. Degree of facial palsy after 12 months was statistically significant with age, hypertension, diabetes, FBS, and the initial severity of facial palsy. The higher the value, the slower the facial palsy recovery. 4. Sex, left or right sided palsy, alcohol consumption, smoking, history of facial palsy, season of onset, total number of treatments and bio chemistry (BC), complete blood cell count (CBC), urinalysis (UA) factors had no statistical significance with prognosis of facial palsy. Conclusion : Age, season of onset, hypertension, diabetes, FBS, initial severity of facial palsy, and the number of treatments at a Korean medical hospital showed statistical significance. The number of treatments at the Korean medical hospital positively correlated with facial palsy prognosis, and the others variables showed a negative correlation with facial palsy prognosis.

Location of Ruptured Bullae in Secondary Spontaneous Pneumothorax

  • Choi, Jinseok;Ahn, Hyo Yeong;Kim, Yeong Dae;I, Hoseok;Cho, Jeong Su;Lee, Jonggeun
    • Journal of Chest Surgery
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    • v.50 no.6
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    • pp.424-429
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    • 2017
  • Background: The surgical treatment of secondary spontaneous pneumothorax (SSP) can be complicated by fragile lung parenchyma. The preoperative prediction of air leakage could help prevent intraoperative lung injury during manipulation of the lung. Common sites of bulla development and ruptured bullae were investigated based on computed tomography (CT) and intraoperative findings. Methods: The study enrolled 208 patients with SSP who underwent air leak control through video-assisted thoracoscopic surgery (VATS). We retrospectively reviewed the sites of bulla development on preoperative CT and the rupture sites during VATS. Results: Of the 135 cases of right-sided SSP, the most common rupture site was the apical segment (31.9%), followed by the azygoesophageal recess (27.4%). Of the 75 cases on the left side, the most common rupture site was the apical segment (24.0%), followed by the anterior basal segment (17.3%). Conclusion: The azygoesophageal recess and parenchyma along the cardiac border were common sites of bulla development and rupture. Studies of respiratory lung motion to measure the pleural pressure at the lung surface could help to determine the relationship between cardiogenic and diaphragmatic movement and bulla formation or rupture.

Traumatic Diaphragmatic Hernia (외상성 횡경막 허니아)

  • Jang, Bong-Hyeon;Han, Seung-Se;Kim, Gyu-Tae
    • Journal of Chest Surgery
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    • v.20 no.4
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    • pp.839-846
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    • 1987
  • The records of 10 patients with traumatic diaphragmatic hernia seen from November 1977 through July 1987 were reviewed. All the patients had a transdiaphragmatic evisceration of abdominal contents into the thorax. We treated 7 male and 3 female patients ranging in age from 3 to 62 years. In 8 patients, diaphragmatic hernia followed blunt trauma and in 2 patients, stab wounds to the chest. The herniation occurred on the right side in 3 patients and on the left side in 7. All the patients sustained additional injuries: rib fractures [7 patients], additional limb, pelvic and vertebral fractures [6], closed head injury [2], lung laceration [1], liver laceration [1], renal contusion [1], ureteral rupture [1], and splenic rupture [1]. Organs herniated through the diaphragmatic rent included the omentum [6 patients], stomach [4], liver [4], colon [3], small intestine [1], and spleen [1]. For right-sided injuries, the liver was herniated in all 3 patients and the colon, in 1. in the initial or latent phase, dyspnea, diminished breath sounds, bowel sounds in the chest were noted in 4 patients, and in the obstructive phase, nausea, vomiting, and abdominal pain were found in all 3 patients. Two patients had a diagnostic chest radiograph with findings of bowel gas patterns, and an additional 8 had abnormal but nondiagnostic studies. Hemothorax, pleural effusion or abnormal diaphragmatic contour were common abnormal findings. Three patients were operated on during the initial or acute phase [immediately after injury], 4 patients were operated on during the latent or intermediate phase [3 to 210 days], and 3 patients were operated on during the obstructive phase [10 to 290 days]. Six patients underwent thoracotomy, 2 required thoracoabdominal incision, and 2 had combined thoracotomy and laparotomy. Primary suture was used to repair the diaphragmatic hernia in 9 cases. One patient required plastic repair by a Teflon felt. Empyema was the main complication in 2 patients. In 1 patient, the empyema was treated by closed thoracostomy and in 1, by decortication and open drainage. There were no deaths.

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