• Journal of Yeungnam Medical Science
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• 제31권1호
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• pp.25-27
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• 2014

Patients treated with peritoneal dialysis have increased intra-abdominal pressure and a high prevalence of abdominal wall complications. Hernias can lead to significant morbidity in patients on peritoneal dialysis. Hernias are clinically important because of the risk of incarceration, strangulation and subsequent bowel obstruction, rupture, and peritonitis. In this paper, a case of incarcerated umbilical hernia with small bowel obstruction in a continuous ambulatory peritoneal dialysis (CAPD) patient is reported. The small bowel obstruction improved after herniorrhaphy, and the peritoneal dialysis was resumed 2 weeks after the herniorrhaphy. The patient had been undergoing CAPD without technical failure until the 2 months follow-up after the herniorrhaphy. This case shows that early detection of incarcerated umbilical hernia and herniorrhaphy can prevent resection of a strangulated small bowel so that it can remain on CAPD without post-operative technical failure. Umbilical hernias should be carefully observed and intestinal obstruction should be considered when a CAPD patient with an umbilical hernia has abdominal pain.

• Journal of Chest Surgery
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• 제19권4호
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• pp.618-626
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• 1986

Univentricular heart is a rare congenital cardiac anomaly in which the atrial chambers are connected to only one ventricular chamber and it consists of a diverse group of cardiac malformation characterized by both AV valves or a common AV valve opening into the same ventricle, or the presence of only a solitary AV valve. In spite of recent development in cardiac surgery, corrective operations for univentricular heart still have high mortality and complication rate. Twenty eight patients underwent corrective operation for univentricular heart at Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital from February 1979 to July 1986. Of the 28 patients, 7 patients were operated on by ventricular septation and 21 patients by modified Fontan operation. Of the 28 patients, 19 patients were male and 9 patients female and ages ranged from 5 months to 18 years old with the average age of 7.3 years. There were 2 mortalities in 7 patients operated on by septation with the mortality rate of 28.6% and 5 complications, 3 complete AV block, 1 low cardiac output and 1 arrhythmia. All survived patients are being followed up without specific problem till now. There were 10 mortalities in 21 patients operated on by modified Fontan operation with the mortality rate of 47.6% and 10 complications, 2 low cardiac output, 2 respiratory failure necessitating tracheostomy, 2 persistent cyanosis, 2 arrhythmia, 1 missing of left AV valve in situs inversus patient due to misdiagnosis and one rupture of closed right AV valve. Incremental risk factors for operative mortality are young age less than 5 years old, anomalous pulmonary and systemic venous drainage and atrial septation procedure. In 11 survived patients, 9 patients show good follow-up results but one patient complains of persistent cyanosis and another one patient is suffered from CHF. In our series, results of corrective operation for univentricular heart shows continuing improvement but still high mortality and complication rate. So there must be continuing improvement in surgical result by selection of patient, by adequate decision making for timing and method of operation and by improving operative methods.

• Advances in pediatric surgery
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• 제6권2호
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• pp.143-148
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• 2000

Pseudoaneurysm of the splenic artery may arise from a vascular erosion by a surrounding inflammatory processes in acute and chronic pancreatitis. Rupture of the pseudoaneurysm may threaten the patient's life. Conservative management for massive hemorrhage may cause 100 percent mortality and even with prompt therapy there is a high mortality. Preoperative detection of bleeding source is desirable because of the difficult identification of the bleeding site at laparotomy. Angiographic identification and embolization of the hemorrhagic vessels in selected cases may obviate the risk of urgent surgery. The authors have recently managed a case of ruptured splenic artery pseudoaneurysm combined with a pancreatic pseudocyst in a 6 years old boy. A bolus enhanced CT scan and angiography confirmed the diagnosis. We managed this child successfully with the urgent transcatheter arterial embolization followed by elective surgery.

• 대한구순구개열학회지
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• 제11권2호
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• pp.49-58
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• 2008

The development of fetal surgery has led to promising options for many congenital malformations, such as congenital diaphragmatic hernia (CDH), obstructive uropathy, twin-to-twin transfusion syndrome (TTTS), and sacrococcygeal teratoma. However, preterm labor (PTL) and premature rupture of membranes continue to be uniquitous risks for both mother and fetus. To reduce maternal morbidity and the risk of prematurity, minimal access techniques were developed and are increasingly employed recently. Lift-threatening diseases as well as severely disabling but not life-threatening conditions are potentially amenable to treatment. Recently, improvement of video-endoscopic technology has boosted the development of operative techniques for feto-endoscopic surgery, which has been demonstrated to be less invasive than the open approach. Fetal surgery for repair of cleft lip and palate, a congenital anomaly which is not life threatening, is inappropriate until such time that the benefits are shown to outweigh the risks of both the procedure itself and preterm delivery. Further animal studies will be needed before intrauterine surgery for humans should be considered. For the better understanding of recent techniques and complications associated with fetal intervention of congenital facial defect patients, we reviewed recent related articles about the current knowledge and new perspectives of experimental fetal fetal surgery in the cleft lip and palate defects.

• 한국안전학회지
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• 제34권6호
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• pp.7-12
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• 2019

Flux Cored Arc Welding (FCAW), which has been widely used in many industries, was developed in the 1950s to supplement shortcomings of the Shielded Metal Arc Welding (SMAW). FCAW has an advantage in that it can weld regardless of postures and give good quality results in the filed with many different working conditions. In this study, SM490A (rolled steel for welding structural purpose) with different thicknesses (L:25T+R:30T) were welded using FCAW. Then the mechanical properties (tension test, bending test, hardness test, impact test and macro test) were analyzed and the following conclusions were drawn. In the tensile test, it exceeds the KS standard tensile strength range (400~510) in all welding positions, which means there is a problem in the tensile force transmission performance. In the bending test, it was found that most of the specimens did not exhibit surface rupture or other defects during bending test and they exhibit sufficient toughness even after plastic deformation. In the hardness test, all the results were lower than the standard value of 350 Hv of KS B 0893, which means they have good hardness. In the impact test, all results were larger than the KS reference value of 27J. In the macro test, they showed uniform structure state by the shape of the weld, and there was risk of lamination because no internal defects, bubbles, or impurities were found on the surface of the weld.

• Journal of Korean Neurosurgical Society
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• 제43권2호
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• pp.90-96
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• 2008

Objective: Delayed ischemic deficit or cerebral infarction is the leading cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study is to reassess the prognostic impact of intraoperative elements, including factors related to surgery and anesthesia, on the development of cerebral infarction in patients with ruptured cerebral aneurysms. Methods: Variables related to surgery and anesthesia as well as predetermined factors were all evaluated via a retrospective study on 398 consecutive patients who underwent early microsurgery for ruptured cerebral aneurysms in the last 7 years. Patients were dichotomized as following; good clinical grade (Hunt-Hess grade I to III) and poor clinical grade (IV and V). The end-point events were cerebral infarctions and the clinical outcomes were measured at postoperative 6 months. Results: The occurrence of cerebral infarction was eminent when there was an intraoperative rupture, prolonged temporary clipping and retraction time, intraoperative hypotension, or decreased $O_2$ saturation, but there was no statistical significance between the two different clinical groups. Besides the Fisher Grade, multiple logistic regression analyses showed that temporary clipping time, hypotension, and low $O_2$ saturation had odds ratios of 1.574, 3.016, and 1.528, respectively. Cerebral infarction and outcome had a meaningful correlation (${\gamma}$=0.147, p=0.038). Conclusion: This study results indicate that early surgery for poor grade SAH patients carries a significant risk of ongoing ischemic complication due to the brain's vulnerability or accompanying cardio-pulmonary dysfunction. Thus, these patients should be approached very cautiously to overcome any anticipated intraoperative threat by concerted efforts with neuro-anesthesiologist in point to point manner.

• Journal of Yeungnam Medical Science
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• 제31권2호
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• pp.139-143
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• 2014

Spontaneous intramuscular hematoma of the abdominal wall is a rare condition characterized by acute abdominal pain. It is often misdiagnosed as a surgical condition. It used to be associated with risk factors such as coughing, pregnancy, and anticoagulant therapy. Most cases of abdominal wall hematomas were rectus sheath hematomas caused by the rupture of either the superior or inferior epigastric artery, but spontaneous internal oblique hematoma was extremely rare. In this report, we present a case of spontaneous internal oblique hematoma in a 69-year-old man with non-dialysis chronic kidney disease who was taking cilostazol. The patient complained of abrupt abdominal pain with a painful palpable lateral abdominal mass while sleeping. The abdominal computed tomography showed an 8 cm-sized mass in the patient's left internal oblique muscle. The administration of cilostazol was immediately stopped, and the intramuscular hematoma of the lateral oblique muscle disappeared with conservative management.

• BMB Reports
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• 제55권8호
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• pp.370-379
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• 2022

Human pregnancy is a delicate and complex process where multiorgan interactions between two independent systems, the mother, and her fetus, maintain pregnancy. Intercellular interactions that can define homeostasis at the various cellular level between the two systems allow uninterrupted fetal growth and development until delivery. Interactions are needed for tissue remodeling during pregnancy at both fetal and maternal tissue layers. One of the mechanisms that help tissue remodeling is via cellular transitions where epithelial cells undergo a cyclic transition from epithelial to mesenchymal (EMT) and back from mesenchymal to epithelial (MET). Two major pregnancy-associated tissue systems that use EMT, and MET are the fetal membrane (amniochorion) amnion epithelial layer and cervical epithelial cells and will be reviewed here. EMT is often associated with localized inflammation, and it is a well-balanced process to facilitate tissue remodeling. Cyclic transition processes are important because a terminal state or the static state of EMT can cause accumulation of proinflammatory mesenchymal cells in the matrix regions of these tissues and increase localized inflammation that can cause tissue damage. Interactions that determine homeostasis are often controlled by both endocrine and paracrine mediators. Pregnancy maintenance hormone progesterone and its receptors are critical for maintaining the balance between EMT and MET. Increased intrauterine oxidative stress at term can force a static (terminal) EMT and increase inflammation that are physiologic processes that destabilize homeostasis that maintain pregnancy to promote labor and delivery of the fetus. However, conditions that can produce an untimely increase in EMT and inflammation can be pathologic. These tissue damages are often associated with adverse pregnancy complications such as preterm prelabor rupture of the membranes (pPROM) and spontaneous preterm birth (PTB). Therefore, an understanding of the biomolecular processes that maintain cyclic EMT-MET is critical to reducing the risk of pPROM and PTB. Extracellular vesicles (exosomes of 40-160 nm) that can carry various cargo are involved in cellular transitions as paracrine mediators. Exosomes can carry a variety of biomolecules as cargo. Studies specifically using exosomes from cells undergone EMT can carry a pro-inflammatory cargo and in a paracrine fashion can modify the neighboring tissue environment to cause enhancement of uterine inflammation.

• Journal of Korean Neurosurgical Society
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• 제65권2호
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• pp.215-223
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• 2022

Objective : This retrospective study investigated the clinical and angiographic characteristics of ruptured true posterior communicating artery (PCoA) aneurysms in comparison with junctional PCoA aneurysms presenting with a subarachnoid hemorrhage. Methods : The medical records and radiological data of 93 consecutive patients who underwent three-dimensional rotational angiography and surgical or endovascular treatment for a ruptured junctional or true PCoA aneurysm over an 8-year period were examined. Results : The maximum diameter of the ruptured true PCoA aneurysm (n=13, 14.0%) was significantly smaller than that of the ruptured junctional PCoA aneurysms (n=80, 4.45±1.44 vs. 7.68±3.36 mm, p=0.001). In particular, the incidence of very small aneurysms <4 mm was 46.2% (six of 13 patients) in the ruptured true PCoA aneurysm group, yet only 2.5% (two of 80 patients) in the ruptured junctional PCoA aneurysm group. Meanwhile, the diameter of the PCoA was significantly larger in the true PCoA aneurysm group than that in the junctional PCoA aneurysm group (1.90±0.57 vs. 1.15±0.49 mm, p<0.001). In addition, the ipsilateral PCoA/P1 ratio was significantly larger in the true PCoA aneurysm group than that in the group of a junctional PCoA aneurysm (mean PCoA/P1 ratio±standard deviation, 2.67±1.22 vs. 1.14±0.88; p<0.001). No between-group difference was identified for the modified Fisher grade, clinical grade at admission, and 3-month modified Rankin Scale score. Conclusion : A true PCoA aneurysm was found to be associated with a larger PCoA and ruptured at a smaller diameter than a junctional PCoA aneurysm. In particular, the incidence of a ruptured aneurysm with a very small diameter <4 mm was significantly higher among the patients with a true PCoA aneurysm.

• The Journal of Korean Physical Therapy
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• 제35권3호
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• pp.57-63
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• 2023

Purpose: The aim of this study was to conduct a systematic review of randomized controlled studies from 2012 to present that explore the diagnostic accuracy of clinical tests used for diagnosing anterior cruciate ligament (ACL) injury. Methods: Study design: Systematic review. Literature search of the PubMed and Scholar databases was conducted using keywords related to diagnostic accuracy of clinical tests for ACL injury. The PRISMA Guidelines were followed to conduct this study. The Cochrane Risk of Bias Tool was utilized to assess the quality of each included study. Results: As a result, 8 studies were included, and 6 clinical tests used in ACL tears were evaluated for diagnostic accuracy. The pivot shift test was reported as having the highest +LR (29.5) value with a sensitivity of 59% and a specificity of 98%. However, the test with the lowest -LR value was the lever test, and the values were as follows: -LR (0.08), +LR (4.7), specificity (80%), sensitivity (94%). Conclusion: In this study, it was concluded that a single clinical test is not sufficient to determine the presence of ACL injury. Test combinations have a higher diagnostic accuracy than a single test. In this study, the accuracy of the clinical tests was examined without considering the amount of ACL rupture and acute-chronic condition. Further research is required to examine the impact of these two factors on diagnostic accuracy of clinical test.