• Journal of Korean Neurosurgical Society
• /
• v.65 no.4
• /
• pp.531-538
• /
• 2022

Objective : Anterior communicating artery (Acom) aneurysm is one of the most common intracranial aneurysms, constituting approximately 30-35% of all aneurysm formation in the brain. Anatomically, the H-complex (the anatomic morphology of both A1 to A2 segments) is thought to affects the nature of the Acom aneurysm due to its close relationship with the hemodynamics of the vessel. Therefore, we investigated the relative risk factors of aneurysmal rupture, especially focusing on H-complex morphology of the Acom. Methods : From January 2016 to December 2020, a total of 209 patients who underwent surgery, including clipping and coiling for Acom aneurysm in our institution were reviewed. There were 102 cases of ruptured aneurysm and 107 cases of unruptured aneurysm. The baseline morphology of aneurysms was investigated and the relationship between the H-complex and the clinical characteristics of patients with Acom aneurysms was assessed. Results : Of the 209 patients, 109 patients (52.1%) had symmetrical A1, 79 patients (37.8%) had unilateral hypoplastic A1, and 21 patients (10.0%) had aplastic A1. The hypoplastic A1 group and the aplastic A1 group were grouped together as unilateral dominancy of A1, and were compared with the symmetrical A1 group. There was no significant difference in demographic characteristics and radiological findings of Acom aneurysms between two groups. However, when dichotomizing the patients into ruptured cases and unruptured cases, unilateral dominance of the A1 segment was associated with aneurysmal rupture with statistical significance (p=0.011). Conclusion : These results suggest that the unilateral dominance of the A1 segment does not have a significant effect on the morphology of Acom aneurysms, but contributes to aneurysmal rupture. Thus, we can better understand the effects of hemodynamics on Acom aneurysm.

• Journal of Chest Surgery
• /
• v.47 no.1
• /
• pp.71-74
• /
• 2014

For high-risk patients, endovascular aortic aneurysm repair (EVAR) is a good option but may lead to serious complications, which should be addressed immediately. A 75-year-old man with a history of abdominal surgery underwent EVAR for an aneurysm of the abdominal aorta and iliac arteries. During EVAR, iliac artery rupture and graft limb occlusion occurred, and they were successfully managed by the additional deployment of an iliac stent graft and balloon thrombectomy, respectively. We, herein, report a rare case of the simultaneous development of the two fatal complications treated by the endovascular technique.

• Journal of Chest Surgery
• /
• v.44 no.1
• /
• pp.76-79
• /
• 2011

Right-sided diaphragmatic rupture is less common and more difficult to diagnose than left-sided lesion. It is rarely combined with the herniation of the abdominal organs into the thorax. High level of suspicion is the key to early diagnosis, and a delay in diagnosis is implicated with a considerable risk of mortality and morbidity. We experienced a case of right-sided diaphragmatic rupture combined with complete avulsion of the right kidney and herniation of the liver into the thoracic cavity.

• Nuclear Engineering and Technology
• /
• v.51 no.8
• /
• pp.1939-1950
• /
• 2019

The MELCOR code useful for a plant-specific hydrogen risk analysis has inevitable limitations in prediction of a turbulent flow of a hydrogen mixture. To investigate the accuracy of the hydrogen risk analysis by the MELCOR code, results for the turbulent gas behavior at pipe rupture accident were compared with CFX results which were verified by the American National Standard Institute (ANSI) model. The postulated accident scenario was selected to be surge line failure induced by station blackout of an Optimized Power Reactor 1000 MWe (OPR1000). When the surge line failure occurred, the flow out of the surgeline was strongly turbulent, from which the MELCOR code predicted that a substantial amount of hydrogen could be released. Nevertheless, the results indicated nonflammable mixtures owing to the high steam concentration released before the failure. On the other hand, the CFX code solving the three-dimensional fluid dynamics by incorporating the turbulence closure model predicted that the flammable area continuously existed at the jet interface even in the rising hydrogen mixtures. In conclusion, this study confirmed that the MELCOR code, which has limitations in turbulence analysis, could underestimate the existence of local combustible gas at pipe rupture accident. This clear comparison between two codes can contribute to establishing a guideline for computational hydrogen risk analysis.

• Nuclear Engineering and Technology
• /
• v.51 no.5
• /
• pp.1307-1313
• /
• 2019

Recent analysis results with realistic assumptions provide the variability of operator allowable time for the initiation of aggressive cooldown under small break loss of coolant accident or steam generator tube rupture with total failure of high pressure safety injection. We investigated how plant risk may vary depending on the variability of operators' failure probability of timely initiation of aggressive cooldown. Using a probabilistic safety assessment model of a nuclear power plant, we showed that plant risks had a linear relation with the failure probability of aggressive cooldown and could be reduced by up to 10% as aggressive cooldown is more reliably performed. For individual accident management, we found that core damage potential could be gradually reduced by up to 40.49% and 63.84% after a small break loss of coolant accident or a steam generator tube rupture, respectively. Based on the importance of timely initiation of aggressive cooldown by main control room operators within the success criteria, implications for improvement of emergency operating procedures are discussed. We recommend conducting further detailed analyses of aggressive cooldown, commensurate with its importance in reducing risks in nuclear power plants.

• Journal of the Korean Society of Radiology
• /
• v.84 no.3
• /
• pp.750-756
• /
• 2023

Spontaneous arterial bleeding is uncommon, and a mediastinal hematoma caused by spontaneous rupture of the internal thoracic artery has not been reported previously. Patients with liver cirrhosis or heavy alcohol consumption have a higher risk of hemorrhage than those without cirrhosis or excessive alcohol consumption. We present the case of a 39-year-old female with a history of alcoholic liver cirrhosis, who presented with a large mediastinal hematoma attributable to spontaneous rupture of the internal thoracic artery.

• Journal of Korean Neurosurgical Society
• /
• v.45 no.2
• /
• pp.85-89
• /
• 2009

Objective : The International Study of Unruptured Intracranial Aneurysms (ISUIA) reported that the 5-year cumulative rupture rate of small unruptured aneurysms less than 7 mm in diameter is very low depending on the aneurysm's location. However, we have seen a large number of ruptured aneurysms less than 7 mm in clinical practice. The purpose of this study was to review our experience and to measure the size and location at which aneurysms ruptured in our patient population. Methods : We reviewed the characteristics of aneurysms, such as size and location, from the original angiograms of patients who were admitted to our hospital between January 2004 and December 2007. All aneurysms were treated surgically or through endovascular procedures. Results : Interventional or surgical treatment was given to a total of 889 patients, including 568 females and 321 males. At the time of our study, 627 cases were ruptured aneurysms and 262 cases were unruptured aneurysms. Of the ruptured cases, the mean diameter of the aneurysm was 6.28 mm. We found that 71.8% of ruptured aneurysms were smaller than 7 mm in diameter, and 87.9%, were smaller than 10 mm. Based on location, the data show that anterior communicating artery aneurysms most often presented with rupture sizes less than 7 mm (76.8%) and 10 mm (92.1%) in diameter. Most ruptured aneurysms were less than 7 mm in size, although recent studies have noted that small aneurysms are less likely to rupture. Conclusion : Although the natural history of unruptured intracranial aneurysms remains controversial, the aneurysm size and location play a signigicant role in determining the risk of rupture. Larger sample sizes and a long term study are needed to reveal the natural history and the rupture risk of unruptured intracranial aneurysms because the size of most ruptured aneurysms was less than 7 mm in diameter in our series.

• Journal of Chest Surgery
• /
• v.37 no.9
• /
• pp.774-780
• /
• 2004

Although traumatic thoracic aortic rupture is potentially a fatal condition requiring surgical attention, the presence of concomitant injury involving other parts of the body may greatly increase the risk of cardio-pulmonary bypass. We report our experience of treating associated injuries prior to the thoracic aortic rupture in these patients. Material and Method: From 1997 to 2003, the medical records of 24 traumatic aortic rupture patients were retrospectively reviewed and checked for the presence of associated injury, surgical method, postoperative course, and complications. Surgical technique comprised thoracotomy with proximal anastomosis under deep hypothermic circulatory arrest followed by side arm perfusion to reestablish cerebral circulation. CSF drainage was performed to prevent lower extremity paraplegia. Result： Major concomitant injuries (n=83) were noted in all of the reviewed patients, Of these, there were 49 thoracic injuries, 18 musculoskeletal injuries, and 13 abdominal injuries, Operations for associated injuries (n=16) were performed in 12 patients on mean 7.6$\pm$12.6 days following the injury. The diagnosis of aortic rupture at the time of injury was detected in only 18 patients. Delayed surgery of the thoracic aorta was performed on average 695$\pm$1350 days after injury and there were no deaths or progression of rupture in any of these patients during the observation period. There were no operative deaths and no major postoperative complications. Conclusion: Treating concomitant major injuries prior to the aortic injury in traumatic aortic rupture may reduce surgical mortality and morbidity.

• Nuclear Engineering and Technology
• /
• v.49 no.2
• /
• pp.313-326
• /
• 2017

The systematic management of plant risk is crucial for enhancing the safety of nuclear power plants and for designing new nuclear power plants. Accident sequence precursor (ASP) analysis may be able to provide risk significance of operational experience by using probabilistic risk assessment to evaluate an operational event quantitatively in terms of its impact on core damage. In this study, an ASP methodology for two operation mode, full power and low power/shutdown operation, has been developed and applied to significant accident precursors that may occur during the operation of nuclear power plants. Two operational events, loss of feedwater and steam generator tube rupture, are identified as ASPs. Therefore, the ASP methodology developed in this study may contribute to identifying plant risk significance as well as to enhancing the safety of nuclear power plants by applying this methodology systematically.

• Clinics in Shoulder and Elbow
• /
• v.5 no.2
• /
• pp.73-80
• /
• 2002

Purpose: Weight lifting is a good training to control body weight, to correct body shape and to relieve stress. How-ever if the training is continued by inadequate training method and technique, the risks of the shoulder injuries are relatively high. Main Subject: The rotator cuff injury is the most common disorder to wright lifters and often results from the train- ing program of upright row, military press and pectoral deck. The chances of subacromial impingement in these postures are high because the shoulder rotates under the acromion at 90 abduction state. Shoulder instability in weight lifters can develop due to various causes. aepeated microtrauma and excessive abduction and external rotation may result in laxity of the anterior capsular structure, ligament and muscles. Behind the neck and bench press are high risk training postures. Other than those injuries, idiopathic osteolysis of distal clavicle, acromioclavicular separation, pectoralis major muscle rupture, and triceps muscle rupture nay develop. Conclusion: The best treatment option of the shoulder injury to weight lifters is to eliminate the possible risk elements for the weight lifters in training program and to provide proper and prompt treatment as soon as possible.