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Clinical Study of the Treatment of Chronic Empyema with Open Window Thoracostomy: 10 Years Experience (개방식 배농술을 이용한 만성 농흉 치료의 임상적 고찰 - 10년 경험 -)

  • Kim, Young-Kyu;Kim, Yeong-Dae
    • Journal of Chest Surgery
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    • v.40 no.11
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    • pp.765-769
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    • 2007
  • Background: The curative treatment of choice for empyema is decortication of the pleura. The risks of this treatment however are increased for the patient with reduced pulmonary function, complicated calcification or septic shock. In the past, open window thoracostomy was a final stage treatment for chronic empyema. Relatively safe treatment of empyema could be achieved in difficult cases with a closure of the open window after open drainage and use of a myocutaneous flap (one stage or staged). Material and Method: A retrospective study of the cause, progression and final outcome of empyema patients who received open window thoracostomy was performed. 21 patients were followed from 1995 to 2004 in the department of Thoracic and Cardiovascular Surgery in the College of Medicine, Pusan National University. Result: The average age of the patients was $57.5{\pm}15.5$ years (range $25{\sim}78$ years), of whom 16 (76.2%) were men and five (23.8%) were women. Pulmonary function test results showed an average FEV1 of $1.58{\pm}0.49 L$. The type of empyema was tuberculous empyema in 13 cases (61.9%), aspergillosis in three cases (14.3%), parapneumonic empyema in three cases (14.3%) and post-resectional empyema in two cases (10%). Bronchopulmonary fistula was seen in 14 cases. Eight cases were complicated by severe calcification of the pleura. For the four cases of bronchopulmonary fistula, the patients' serratus anterior muscle was covered in their first operation. The average number of ribs resected was $4{\pm}1$. Closure of the open window thoracostomy was performed in 12 cases. The average time to closure after open drainage was $10.22{\pm}3.11$ months and the average defect of the empyemal cavity before the final operation was $330{\pm}110 cc$. Among the 12 cases, there were two cases of spontaneous closure. In two cases closure was only achieved by using the reserved skin fold during the first surgery. Of the remaining eight cases, in seven we used the myocutaneous flap (four cases of lattisimus dorsi muscle and three cases of pectoralis major muscle), and in one case we used soft tissue. As regards complications of the closure, tissue necrosis occurred in one case, which led to failed closure, and there was one case of abdominal hernia in the rectus abdominis muscle flap. One patient died within 30 days of the surgery and one patient died of metastatic cancer. Conclusion: A staged operation with a final closure using open window thoracostomy, which consists of open drainage, transposition of the muscle and a myocutaneous flap, can be a safe and effective option for the chronic empyema patient who is difficult to cure with traditional surgical methods.

Clinical Results alter Pulmonary Endarterectomy as a Curative Surgical Method in Chronic Thromboembolic Pulmonary Hypertension: an Approach to Operative Classification of Thromboembolic Disease (만성 폐동맥 색전증의 치료로서 내막제거술의 임상적 결과: 색전증 분류에 따른 접근)

  • Lim, Ju-Yong;Lee, Jae-Won;Kim, Jeong-Won;Jung, Sung-Ho;Je, Hyoung-Gon;Song, Hyun;Chung, Cheol-Hyun;Choo, Suk-Jung
    • Journal of Chest Surgery
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    • v.41 no.5
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    • pp.591-597
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    • 2008
  • Background: Pulmonary endarterectomy is widely accepted as a treatment for chronic thromboembolic pulmonary hypertension. Based on our experiences, we sought to find ways to reduce perioperative complications and to improve surgical outcomes in patients undergoing pulmonary endarterectomy. Material and Method: This study was designed as a retrospective analysis of 20 patients with pulmonary hypertension who underwent pulmonary endarterectomy between January 1998 and March 2008. All patients presented with chronic dyspnea. Deep vein thrombosis (DVT) was the major cause of chronic pulmonary thromboembolism (55%). Seventeen patients (85%) underwent inferior vena cava (IVC) filter placement. Thirteen patients underwent surgery under total circulatory arrest, while the others underwent surgery while on low flow cardiopulmonary bypass. Concomitant tricuspid annuloplasty was done in 6 patients (66%) whose tricuspid regurgitation was as severe as grade IV/IV. The mean follow-up duration was $45{\pm}32$ months. Result: Using of University of California, San Diego (UCSD), thromboembolism classification, 4 patients (20%) were type 1, 8 patients (40%) were type II, and 8 patients (40%) were type III. Right ventricular systolic pressure was reduced significantly from $77{\pm}29$ mmHg to $37{\pm}19$ mmHg after pulmonary endarterectomy (p<0.001). The degree of tricuspid regurgitation and the NYHA functional class were all improved postoperatively. Reperfusion edema occurred in 7 cases (35%). The incidence of reperfusion edema was higher in the UCSD type III group than in the other group (25% vs 50%, p=0.25) and the length of postoperative intensive care unit stay was longer in type III group ($5{\pm}2$ days vs $9{\pm}7$ days, p=0.07). The early mortality rate was 10%, and the late mortality rate was 15% (n=3); one death was due to progression of underlying non-Hodgkin's lymphoma, and the other deaths were related to recurrent thromboembolism and persistent pulmonary hypertension, respectively. Conclusion: Pulmonary endarterectomy, as a curative surgical method for treating chronic thromboernbolic pulmonary hypertension, should be performed aggressively in patients diagnosed with chronic thromboembolic pulmonary hypertension, and an effort should be made to reduce the frequency of perioperative complications and to improve surgical outcomes.

Survival of Stage IIIA NSCLC Patients with Changes in N Stage after Neoadjuvant Chemoradiotherapy (IIIA기 비소세포 폐암환자에서 신보조 항암방사선치료 후 N병기의 변화에 따른 생존률 비교)

  • Bae, Chi-Hoon;Park, Seung-Il;Kim, Yong-Hee;Kim, Dong-Kwan
    • Journal of Chest Surgery
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    • v.41 no.5
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    • pp.586-590
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    • 2008
  • Background: Non-small cell lung cancer (NSCLC) patients histologically proven to have stage N2 disease by media-stinoscope or thoracoscope underwent subsequent neoadjuvant chemoradiotherapy. This study was designed to find out if there were any differences in survival or recurrence rates between N2 positive and N2 negative patients. Material and Method: Between January 1998 and December 2005, we retrospectively analyzed 69 patients who were divided into three groups. Group A consisted of patients whose N stage was downstaged, group B of patients whose N stage was the same, and Group C of patients who could not undergo surgery because of disease progression during neoadjuvant chemoradiotherapy. We analyzed and compared the mean survival, three-year survival, mean disease-free survival, and three-year disease-free survival rates for the three groups. Result: There were no demographic differences among the groups. The mean survival was 58, 47, and 21 months for groups A, B, and C, respectively. The mean survival was longest in group A, but no statistically significant difference was found on A-B or B-C group comparison (p>0.05). However, a significant difference was noted between group A and group C (p : 0.01). Three-year survival rates were 67%, 41%, and 21.6% for groups A, B, and C, respectively, with a statistical difference similar to that seen in mean survival. The mean disease-free survival was 44 months in group A and 45 months in group B, with no statistically significant difference noted. No significant differences were noted in the three-year disease-free survival rates (55.1%, 46.8%). Conclusion: There were no significant differences in survival or recurrence rates with changes in N stage after neoadjuvant chemoradiotherapy. However, mean survival, three-year survival, and three-year disease-free survival rates tended to be higher in downstaged patients. Nevertheless, the difference was statistically insignificant, and therefore further studies with more patients and longer follow-up are necessary to clarify the positive effects on the survival and prognosis of downstaged patients.

Growth Pattern of Red-tongued Viper Snake (Gloydius ussuriensis) Inhabiting Gapado, Jeju Island (가파도에 서식하는 쇠살모사의 성장 패턴)

  • Kim, Byoung Soo;Chang, Min-Ho;Oh, Hong Shik
    • Journal of Environmental Impact Assessment
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    • v.25 no.6
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    • pp.477-486
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    • 2016
  • We investigated the growth pattern of Red-tongued viper snakes (Gloydius ussuriensis), which were captured from the islet of the Jeju Island, Gapado between April, 2006 and November, 2009. The results indicated that there were some snakes that grew relatively fast, but most snakes either almost did not grow or grew around 10mm in snout-vent length during one year period. High growth rates was April and June. Since the growth rate of snakes is highly correlated with their foods, these results implied that the feeding activity of Red-tongued viper snakes is high during this period compared to other months. In female, difference in body condition between good-conditioned and bad-conditioned snakes became large as time elapsed from April to June. The body condition of the male Red-tongued viper snakes improved with the progression of time from April till June. Many of the Red-tongued viper snakes were captured between April and June, while they were rarely captured between July and September. Some of the Red-tongued viper snakes were captured during the autumn season. This tendency was because snakes were rarely active during hibernation and peak summer seasons. Thus, Red-tongued viper snakes are active between April and June and between September and November. They then go into hibernation as the temperature dropped in November. Furthermore, the limitation of the movement period of the Red-tongued viper snakes restricted their feeding activities while foods became scarce, which ultimately restricted their overall growth rate. The growth rate of the snakes decreased with age. The snout-vent length of the Red-tongued viper snakes and growth rate showed a negative correlation (r = -0.591), however, it was not statistically significant due to small sample size. The findings from this study could provide meaningful information in the further study of the life cycle of Red-tongued viper snakes.

The Developmental Outcome of Fetal Mild Isolated Ventriculomegaly (단독 태아 경뇌실확장증의 임상적 예후)

  • Jeong, Myung Sook;Chun, Jung Mi;Kim, Kyung Ah;Ko, Sun Young;Lee, Yeon Kyung;Shin, Son Moon;Lee, Eu-Ree
    • Clinical and Experimental Pediatrics
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    • v.48 no.8
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    • pp.826-831
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    • 2005
  • Purpose : This study is directed to evaluate standardized developmental test performances of infants and children who, as fetuses, had mild isolated cerebral ventriculomegaly diagnosed by ultrasound. Methods : All prenatal sonographic findings from 2001 to 2002 were evaluated. Live isolated mild ventriculomegaly(IMVM) of 10-15 mm were observed in 95 cases(1.1 percent). Standardized developmental testing of 40 cases of IMVM and 36 cases in a comparison group were offered to parents Both groups of children were adjusted to normal antepatum subjects with respect to sex, race, indication for ultrasound and gestational age at the time of ultrasound. Test of cognitive and motor development(Bayley Scales of Infant Development, Second Edition; BSID-II) were administered by developmental examiners. Results : Forty cases and 34 comparison sujects completed the testing. The IMVM and comparison groups were similar with respect to parental age, gestational age, birth weight, familial socioeconomic status. The IMVM subjects scored lower than the comparison group on both the BSID-II, but there was not statistically significant. differences; metal development index(MDI)($92.7{\pm}12.9$ vs $94.7{\pm}14.1$, P=0.47) and psychomotor development index(PDI)($100.3{\pm}14.1$ vs $101.3{\pm}10.7$, P=0.75). Eleven cases(27.5 percent) of IMVM group and five cases(14.7 percent) of the comparison group were developmentally delayed, but most cases in both groups showed mild delays. Resolution or lack of progression, lateral ventricle diameter ${\leq}12mm$ and females were associated with better scores, but there were not statistically significant. Polarity, and head circumference were not related to later development. Conclusion : This study show children with MIVM did not delay performance in the developmental test, but we might suggest a tendency to increase the risk of mild developmental delay.

ICM-Trophectoderm Cell Numbers of Bovine IVM/IVF/IVC Blastocysts (체외성숙, 수정 및 체외배양에서 생산된 소 배반포기배의 ICM과 Trophectoderm세포수에 관한 연구)

  • 김은영;엄상준;김선의;윤산현;박세필;정길생;임진호
    • Korean Journal of Animal Reproduction
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    • v.20 no.1
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    • pp.27-34
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    • 1996
  • The objective of this study was to examine the cell number of Total, ICM and TE cells of bovine blastocysts according to development progression cultured in CR1 medium, which was reported as successfully supporting medium for preimplantaion bovine embryo development to the blastocyst stage, by differential labelling of the nuclei with immunosurgery and polynucleot-ide-specific fluorochromes. Blastocysts were obtained at day 8 after in vitro fertilization and classified to early, middle, expanded stage according to the developmental morphology; blastocoel expansion and zona thickness. Also, bias tocysts in the same category were divided into two parts to check the Total cell number by using bisbenzimide only and ICM, TE and Total cell number by using immunosurgery and two polynucleotide-specific fluorochromes. 1) The development rate of blastocysts at day 8 after in vitro fertilization was 29.3% and classified bIas tocysts to early, middle, expanded and hatching stage were 8.7, 9.9, 7.6 and 3.1%, respectively. 2) The numbers of total blastomere using bisbenzimide in the classified blastocysts to early, middie and expanded were 46.9${\pm}$8.6, 66.2${\pm}$12.5 and 122.8 ${\pm}$ 14.4, respectively. This indicated that CR1 is a appropriate culture medium for bovine embryo development. 3) The count of ICM and TE cell number by using differential labelling with immunosurgery and polynucleotide-specific fluorochromes in the classified blastocysts to early, middle and expanded; ICM cell numbers of were 12.8${\pm}$5.9, 26.3${\pm}$8.4 and 35.5${\pm}$15.0, respectively and TE cell numbers were 30.5${\pm}$5.0, 4 41.3${\pm}$8.2 and 81.1${\pm}$13.4, respectively. These results presented that the increase of ICM and TE cell numbers averaged two and three doublings between early and expanded blastocyst stage and also total cell number counted from ICM nuclei and TE nuclei by using differential label-ling showed the increase pattern with development advance level and the results were similar to total cell number obtained from bisbenzimide treatment only. Therefore, the differential labelling of ICM and TE nuclei in situ is a very useful technique to evaluate embryo qualities and can be used as an indicator on study of preim-plantation embryo development.

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Studies on the Fracture Healing in the Alloxan treated Rabbits (Alloxan 투여 가토(家兎)에 대한 골절치유 실험)

  • Kim, Sung-Joon
    • The Korean Journal of Pharmacology
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    • v.7 no.1
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    • pp.53-65
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    • 1971
  • It is well known that diabetes mellitus is associated with metabolic derangements, such as hyper-glycemia, ketosis, glycosuria, and also widespread alterations in the blood vessels, kidneys, eyes, peripheral nerves and heart. It is also recognized that healing of skin wound is delayed in diabetics. In bone, according to Aegerter, osteopenia develops in diabetes mellitus and it is chiefly ascribed to overutilization of protein. Shim claims that total blood flow to the entire skeletal system is approximately 4 to 8 percent of resting cardiac output and blood supply to the skeletal system would be decreased on account of secondary arteriosclerotic changes in the diabetics. An adequate blood supply is an essential factor in the healing process of fracture, and disturbed blood flow, either local or systemic, will invariably delay union of the fragments or the fragments from being fused. As the author has encountered several cases of diabetics in whom healing of fracture was delayed or incomplete, this experimental study was undertaken to elucidate the effects of hyperglycemia and diabetes mellitus on the healing process of fracture. In this experiment adult albino rabbits, weighing about 2 kg. were used and divided into 6 groups. The femur of each animal was fractured surgically, and then the healing process of fracture was periodically checked by radiography at an interval of one week for a period of 6 weeks. Thereafter, all the rabbits were killed to obtain tissue preparation of the femur. The experimental groups were as follows; 1) Control group: Six rabbits sustained a surgical fracture to the femur, without being given any other treatment or drug. 2) Alloxan-treated group: For inducing diabetes, alloxan was given intravenously to 17 rabbits in various dose as follows; to 7 of them 40 mg/kg, to 6 rabbits 80 mg/kg and to 4 rabbits 120 mg/kg of body weight, respectively. 3) Insulin-treated group: Protamine-zinc insulin was injected subcutaneously to each of 6 rabbits in a daily dose of 1 unit per kilogram of body weight. 4) Group treated with insulin after alloxan: Four rabbits were given 80 mg of alloxan once and than 1 unit of insulin per kilogram of body weight daily. Another 5 rabbits were injected 1 unit of insulin per kg of body weight daily following administration of alloxan in a dose of 120 mg/kg. 5) Homotransplantation group: Following intravenous injection of alloxan in a dose of 120 mg/kg, 10 rabbits underwent homotransplantation of a short bone segment to the femur. Five of them were subsequently given 1 unit/kg of insulin daily. 6) Sugar-treated group: six rabbits were fed $15{\sim}20$ gm of sugar daily throughout the period of experiment. The results obtained are summarized as follows; 1. Blood sugar level and damage to the pancreatic islet increased proportionately when alloxan was given to the rabbits in various doses. No appreciable change could be observed in the islets when the blood sugar level was altered by either oral administration of sugar or subcutaneous injection of insulin. 2. Comparing with the control group, healing of fracture was delayed in the alloxan-treated group, while callus formation and periosteal reaction were shown to be more prominent in this group and subsequently, the ultimate osseous tissue formed at the fracture site was significantly smaller in amount and less compact. These findings were more marked as the amount of alloxan increased. 3. Administration of insulin prevented the delay in healing process of fracture in the rabbits with alloxan-induced hyperglycemia. In this case, the course and progression of fracture healing were almost similar to those of control group. 4. Union between the host bone and the fragment transplanted from other rabbit of the same species was more delayed in the group treated with alloxan alone than in the group to which insulin was administered after development of alloxan-induced diabetes. In both groups periosteal new bone developed from the ends of the host bone, above and below the transplanted fragment, and directly fused with failure of periosteal callus to bridge the adjacent ends of the host bone and the transplanted fragment. 5. The healing process of fracture was not inhibited by alteration in blood sugar level when the blood sugar was abnormally increased by excessive sugar intake or lowered by administration of insulin alone. The healing of fracture in these groups progressed similarly as in the control group. In brief summary, it appears that the healing process of fracture would be definitely disturbed in diabetic state brought about by damage to the pancreatic islet. As such an inhibition could be overcome with insulin, it seems that insulin plays an important role in healing of fracture, but alteration in blood sugar level alone does not modify healing process of fracture to significant degree.

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The Efficacy and Effect of Reverse Geometry Contact Lens on Cornea (역기하학 렌즈의 유효성과 각막에 미치는영향)

  • Kim, Kwang-Bae;Kim, Young-Hoon;Bark, Sang-Bai;Sun, Kyung-Ho;Jeong, Youn-Hong
    • Journal of Korean Ophthalmic Optics Society
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    • v.12 no.2
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    • pp.1-12
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    • 2007
  • Object of this research is to estimate the effect of myopia correction and safety on reverse geometry contact lens fitting in school children. This research include 53(106eyes) schoolchildren among 7 to 18 years who has low to moderate myopia(-1.00D~-5.00D) and prescribed reverse geometry contact lens for purpose on orthokeratology between January to July 2004 and had 3months full follow up examination. They were tested for slit lamp examinations, BUT(Break up time), direct ophthalmoscopy, retinoscopy, uncorrected visual acuity, best corrected visual acuity, autorefraction, autokeratometry and corneal topography in each examination(1day, 1week, 2weeks, 1, 2, and 3months) of before-and-after lens wearing to find out the effect of myopic correction and side effect. The results came out as follow. The average of uncorrected visual acuity was $0.0938{\pm}0.378$ before lens wear and $0.3136{\pm}0.283$ after 1day lens wear, and there was fast improvement after 1week($0.7925{\pm}0.301$) and little improvement after 2weeks period but still they shows better uncorrected visual acuity(p<0.01). The result of this study, the reverse geometry lens is very useful to correct refractive error and control the progression of myopia temporally among low to moderate myopic patient. The side effects were relatively rare but further study should be necessary with long term lens wear effect on eye health. For the lens prescription, the clinical fitting process had higher rate of success with consideration of eccentricity and corneal topography.

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Serum Phospholipid Fatty Acids in Benign Breast Tumor and Breast Cancer (양성 유방 종양과 유방암 환자의 혈청 인지질 지방산 조성)

  • Shim, Eu-Gene;Ahn, Sei-Hyun;Hwang, You-Jeong;Leekim, Yang-Cha
    • Journal of Nutrition and Health
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    • v.42 no.3
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    • pp.213-220
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    • 2009
  • Studies on the relationship between blood fatty acids and the risk of breast cancer have not yielded definite conclusions. The role of fatty acids in the development and progression of breast cancer is unclear. We conducted a case-control study to determine serum phospholipid fatty acid composition in benign breast tumor and breast cancer. Subjects consisted of 27 benign breast tumor and 68 breast cancer patients, and 28 matched controls. The levels of fatty acids were measured by gas chromatography. Higher arachidonic and palmitic acids were observed in breast cancer patients as compared with control and benign breast tumor patients. The percentage of total saturated fatty acids in breast cancer was higher than in control and benign breast tumor patients. The level of stearic acid was lower in benign breast tumor and breast cancer patients. Saturation index, the ratio of stearic to oleic acid, was lower in benign breast tumor and breast cancer patients compared to the control. Moreover, stearic acid was negatively and arachidonic acid was positively correlated with the cancer stage. In conclusion, our results support that serum phospholipid compositions of specific fatty acids are associated with the risk of benign breast tumor as well as breast cancer. Further studies are necessary to investigate mechanisms linked to the breast cancer etiology.

A Study on effective directive technique of 3D animation in Virtual Reality -Focus on Interactive short using 3D Animation making of Unreal Engine- (가상현실에서 효과적인 3차원 영상 연출을 위한 연구 -언리얼 엔진의 영상 제작을 이용한 인터렉티브 쇼트 중심으로-)

  • Lee, Jun-soo
    • Cartoon and Animation Studies
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    • s.47
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    • pp.1-29
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    • 2017
  • 360-degree virtual reality has been a technology that has been available for a long time and has been actively promoted worldwide in recent years due to development of devices such as HMD (Head Mounted Display) and development of hardware for controlling and executing images of virtual reality. The production of the 360 degree VR requires a different mode of production than the traditional video production, and the matters to be considered for the user have begun to appear. Since the virtual reality image is aimed at a platform that requires enthusiasm, presence and interaction, it is necessary to have a suitable cinematography. In VR, users can freely enjoy the world created by the director and have the advantage of being able to concentrate on his interests during playing the image. However, the director had to develope and install the device what the observer could concentrate on the narrative progression and images to be delivered. Among the various methods of transmitting images, the director can use the composition of the short. In this paper, we will study how to effectively apply the technique of directing through the composition of this shot to 360 degrees virtual reality. Currently, there are no killer contents that are still dominant in the world, including inside and outside the country. In this situation, the potential of virtual reality is recognized and various images are produced. So the way of production follows the traditional image production method, and the shot composition is the same. However, in the 360 degree virtual reality, the use of the long take or blocking technique of the conventional third person view point is used as the main production configuration, and the limit of the short configuration is felt. In addition, while the viewer can interactively view the 360-degree screen using the HMD tracking, the configuration of the shot and the connection of the shot are absolutely dependent on the director like the existing cinematography. In this study, I tried to study whether the viewer can freely change the cinematography such as the composition of the shot at a user's desired time using the feature of interaction of the VR image. To do this, 3D animation was created using a game tool called Unreal Engine to construct an interactive image. Using visual scripting of Unreal Engine called blueprint, we create a device that distinguishes the true and false condition of a condition with a trigger node, which makes a variety of shorts. Through this, various direction techniques are developed and related research is expected, and it is expected to help the development of 360 degree VR image.