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Treament of Sternal Dehiscence or Infection Using Muscle Flaps (근육편을 이용한 흉골열개 및 감염의 치료)

  • 최종범;이삼윤;박권재
    • Journal of Chest Surgery
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    • v.34 no.11
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    • pp.848-853
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    • 2001
  • Background: Sternal infection or dehiscence after cardiac surgery through median sternotomy is rare. If suitable treatment is not performed for the complication, however, the mortality is high. For 12 patients with sternal dehiscence or infection, we performed wide excision of the infected and necrotic tissue and covered with muscle flap(s) to obliterate the mediastinal dead space. Material and method: Sternal infection or dehiscence occurred in 13 of patients who underwent cardiac surgery One patient, who died of cerebral infarction before the sternal complication was treated, was excluded in this study. The sternal wound complication occurred in 6 of patients with valve replacement and 6 of patients with coronary bypass surgery, respectively. Since 1991, 9 patients underwent definite surgical debridement and muscle transposition as soon as fever was controlled with closed irrigation and drainage. The necrotic tissue and bone was widely excised and the sternal dead space was eradicated with the single flap or the combined flaps of right pectoralis flap(turnover flap), left pectoralis flap(turnover flap or rotation-advancement flap), and right rectus muscle flap. Result : There was no mortality in 12 patients with coverage of muscle flap(s) for sternal infection or dehiscence The mean interval between the diagnosis of sternal complication and the myoplasty was 6.6$\pm$3.9 days. In 4 patients, one pectoralis muscle flap was used, and in 8 patients both pectoralis muscle flaps were used. For each 1 patient and 2 patients in each group, right rectus muscle flap was added. For the last 3 patients, a single pectoralis flap was used to eradicate the mediastinal dead space and the longer placement of the mediastinal drain catheter was needed. One patient, who had suffered from necrosis of left pectoralis flap(rotation-advancement flap) with subsequent chest wall abscess after coverage of both pectoralis flaps, was managed with reoperation using right rectum flap. Conclusion : Sternal dehiscence or infection after cardiac operation can be readily managed with wide excision of necrotic infected tissue(including bone) and muscle flap coverage after short-term irrigation of sternal wound. The sternal(mediastinal) dead space may be completely eradicated with right pectoralis major muscle flap alone.

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Effect of endothelin receptor blockade on monocrotaline-induced pulmonary hypertension in rats (Monocrotaline으로 유발한 백서 폐동맥 고혈압에서 Endothelin 수용체 차단제 투여의 효과)

  • Lim, Kyoung Ah;Shim, Jung Yun;Cho, Sang Ho;Kim, Kwan Chang;Han, Jae Jin;Hong, Young Mi
    • Clinical and Experimental Pediatrics
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    • v.52 no.6
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    • pp.689-695
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    • 2009
  • Purpose : To examine the effect of bosentan, a dual endothelin receptor (ER) antagonist, on the development of monocrotaline (MCT)-induced pulmonary hypertension in rats by especially focusing on the pulmonary vascular morphology changes. Methods : Sprague-Dawley rats were treated as follows: controls received a subcutaneous saline injection, MCT-treated rats received a subcutaneous MCT injection, and bosentan-treated rats received a MCT injection followed by treatment with bosentan (20 mg/kg/day). To assess the effects of ER blockade on the time course, the animals were exsanguinated, and their hearts and lungs were dissected after 7, 14, or 28 days. Results : The mean body weights of the MCT- and bosentan-treated rats were significantly lower than that of the control rats on days 7, 14, and 28. Bosentan administration significantly inhibited the progression of right ventricular hypertrophy on day 28 (right ventricle/[left ventricle+septum]: $0.71{\pm}0.10$ in MCT-treated rats vs. $0.49{\pm}0.09$ in bosentan-treated rats; P<0.05). Quantitative analysis of peripheral pulmonary arteries revealed that the increase in medial wall thickness after MCT injection was significantly attenuated in the bosentan-treated rats on day 28 ($49.96{\pm}10.06%$ in MCT-treated rats vs. $47.09{\pm}10.48%$ in bosentan-treated rats; P<0.05). In addition, the increase in the number of intra-acinar muscular arteries after MCT injection was reduced by bosentan on days 14 and 28. Conclusion : Bosentan administration in intermediate doses exerts inhibitory effects on lung vascular hypertrophy and right ventricular hypertrophy during the development of MCT-induced pulmonary hypertension in rats.

Arthroscopic Transosseous Suture Repair for Bankart Lesion with a Flexible Drill Device - An Experimental and Preliminary Clinical Report - (유연성 천공기를 이용한 Bankart 병변의 골관통식 봉합 - 동물 실험 및 예비 임상 결과 보고 -)

  • Park, Jin-Su;Won, Ye-Yeon;Yoo, Jung-Han;Park, Yong-Wook;Noh, Kyu-Chul;Chung, Kuk-Jin;Kim, Hong-Kyun;Hwang, Ji-Hyo;Lee, Young-Bum;Suh, Il-Woo
    • Clinics in Shoulder and Elbow
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    • v.13 no.1
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    • pp.72-78
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    • 2010
  • Purpose: Too develop a flexible drill device that can be inserted into the shoulder joint so that arthroscopic transosseous suture repair for Bankart lesion is possible. Materials and Methods: We created a device composed of a flexible drill unit and a guide pipe unit. The flexible drill unit was made of flexible multifilament wires (1.2 mm in diameter) that was twisted into one cord so that it can flex in any direction and a drill bit (1.2 mm in diameter) that is attached onto one end of the flexible wire. The guide pipe unit was a 150 mm long metal pipe (2.0 mm in inner diameter and 3.0 mm in outer diameter), with one end bent to 30 degrees. The flexible drill set was inserted into the shoulder joint through the posterior portal of the joint. The guide pipe component was placed onto the medial wall of the glenoid so that the pipe was placed 5 mm posterior to the margin of the anterior glenoid rim. The flexible drill was driven through the glenoid by the power drill so that holes were made in the glenoid. A non- absorbable suture was passed through the hole. Tying of a sliding knot tying was accomplished over the capsule and labrum after making a stitch through the capsule and labrum with a suture hook loaded with suture passer. The same procedures were done at the 2 and 4 O'Clock positions of the glenoid. Results: Five cases with Bankart lesion received arthroscopic transosseous repair with our flexible drill device. There were no intraoperative problems. Neither redislocation nor subluxation was reported at final follow-up. Conclusion: Arthroscopic transosseous suture repair without suture anchors and easy tying of a sliding knot are possible with a flexible drill set.

Serum homocysteine and tumor necrosis factor-alpha levels after intravenous gammaglobulin treatment in patients with Kawasaki disease (가와사키병 환자에서 면역글로불린 투여 전 후 호모시스테인, tumor necrosis factor-alpha 혈중 농도에 대한 연구 - 가와사키병 환아에서 호모시스테인, TNF-α 혈중 농도 비교 분석 -)

  • Cha, Jung Hwa;Hong, Young Mi
    • Clinical and Experimental Pediatrics
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    • v.49 no.10
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    • pp.1093-1099
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    • 2006
  • Purpose : Homocysteine is a strong and independent risk factor for cardiovascular disease. The deleterious effects of homocysteine included endothelial dysfunction, arterial intimal-medial thickening, wall stiffness and procoagulant activity. However, the precise mechanism responsible for homocysteine release in children with coronary artery disease is still unknown. The purpose of this study was to investigate serum homocysteine and tumor necrosis $factor(TNF)-{\alpha}$ levels and identify whether these levels had any association with the development of coronary artery lesions in Kawasaki disease(KD). Methods : Serum homocysteine and $TNF-{\alpha}$ levels were measured in 24 KD patients(group 1, eight patients with normal coronary artery; group 2, 16 patients with coronary artery lesions) and 21 controls(group 3, 10 afebrile controls; group 4, 11 febrile controls). Blood samples were drawn from each study group before and after intravenous immunoglobulin(IVIG) therapy and in the convalescent stage. Results : The homocysteine levels before IVIG therapy were significantly higher in group 1 than in group 3, and in group 2 than in group 3 and 4. The $TNF-{\alpha}$ levels before IVIG therapy were significantly higher in group 2 than group 3 and 4. Serum homocysteine and $TNF-{\alpha}$ levels were highest in group 2 before IVIG therapy. In the acute KD patients, serum homocysteine levels correlated significantly with $TNF-{\alpha}$ levels. Conclusion : The increased serum homocysteine levels in the acute stage increase the susceptibility to coronary arterial lesions in KD. $TNF-{\alpha}$ may also play an important role in the formation of coronary arterial lesions in KD.

Relation of Ethanol and Calcium to Contractile and Electrical Activity of Cat Stomach (고양이 위(胃)의 수축 및 전기활동에 대한 에탄올과 칼슘의 관계)

  • Kim, Myung-Suk;Sim, Sang-Soo;Yoon, Shin-Hee;Han, Sang-Jun;Kim, Chung-Chin;Choi, Hyun
    • The Korean Journal of Physiology
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    • v.21 no.2
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    • pp.259-272
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    • 1987
  • This was study carried out to investigate the effect of calcium on spontaneous contraction and electrical activity induced by ethanol in gastric smooth muscle. After peeling off the mucous membrane from the isolated whole stomach of 102 cats, two kinds of small muscle preparations $(2.0{\times}0.2\;cm)$, one longitudinal and the other circular, were excised from the fundus, the corpus and the antrum portion of each whole stomach specimen. The isometric contraction of the small muscle preparation was measured in a cylinder-shaped chamber filled with Krebs-Ringer-dextrose solution (pH 7.4, temperature $36{\pm}0.5^{\circ}C$) bubbling with 5% $CO_2$ in $O_2$. A large muscle preparation $(5.0{\times}1.2\;cm)$ was excised from the anterior wall of the corpus-antrum portion of the same specimen in 72 of 102 cats. The gastric electrical activity (slow wave and spike potential) was monopolarly recorded by four capillary electrodes (Ag-AgCl), of which two were placed on the corpus and two on the antrum, in a muscle chamber filled with the same solution as described above. Changes in the amplitude of the contraction, frequency of the gastric slow wave and the production of the spike potential were observed after adding ethanol and/or under the treatments with verapamil, $CaCl_2$ and Ca-free Krebs-Ringer-dextrose solution. The results were as follows: 1) After adding ethanol, the spontaneous phasic contraction of the corpus was reduced dose-dependently (0.125-2.0%), which was totally abolished by higher concentrations (2.0-8.0%) of ethanol. 2) The corporal phasic contraction was also completely abolished by verapamil $(3{\times}10^{-5}\;M)$ or Ca-free Krebs-Ringer-dextrose solution. The contraction was increased by $CaCl_2\;(1.8{\times}10^{-3}\;M)$, but the inhibitory effect of ethanol on the contraction persisted even under the treatment with $CaCl_2$. 3) At higher concentrations, ethanol caused tonic contraction of both preparations from the fundus, the corpus and the antrum in a dose-dependent manner. The tonic contraction of the fundus produced by ethanol was not influenced by $CaCl_2$ or verapamil, whereas the tonic contraction was not produced by ethanol in tile Ca-free solution. 4) Frequency of gastric slow wave was decreased dose-dependently by the addition of ethanol (0.25-1.0%), and tile slow wave was not produced by higher concentration of ethanol (2.0%). 5) The frequency of slow wave was significantly reduced by verapamil only and the inhibitory influence of ethanol on the slow wave frequency was reinforced by verapamil. 6) The treatment of $CaCl_2$ increased significantly the slow wave frequency, and attenuated the inhibitory effect of ethanol on the frequency. It is therefore suggested that ethanol regulates the phasic contraction and the production of slow wave by interfering with the transport of calcium in the stomach muscle of the cat.

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Characteristic Findings of Exercise ECG Test, Perfusion SPECT and Coronary Angiography in Patients with Exercise Induced Myocardial Stunning (게이트 심근관류 SPECT상 운동 유발성 기절심근을 보이는 환자의 운동부하 심전도, 관류 SPECT 및 심혈관 조영술 소견)

  • Ahn, Byeong-Cheol;Seo, Ji-Hyoung;Bae, Jin-Ho;Jeong, Shin-Young;Park, Hun-Sik;Lee, Jae-Tae;Chae, Shung-Chul;Lee, Kyu-Bo
    • The Korean Journal of Nuclear Medicine
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    • v.38 no.3
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    • pp.225-232
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    • 2004
  • Purpose : Transient wall motion abnormality and contractile dysfunction of the left ventricle (LV) can be observed in patients with coronary artery disease due to post-stress myocardial stunning. To understand clinical characteristics of stress induced LV dysfunction, we have compared the findings of exercise stress test, myocardial perfusion SPECT and coronary angiography between subjects with and without post-stress LV dysfunction. Materials and Methods : Among subjects who underwent exercise stress test, myocardial perfusion SPECT and coronary angiography within a month of interval, we enrolled 36 patients with post-stress LV election fraction (LVEF) was $\geq5%$ lower than rest (stunning group) and 16 patients with difference of post-stress and rest LVEF was lesser than 1 %(non-stunning group) for this study. Treadmill exercise stress gated myocardial perfusion SPECT was performed with dual head SPECT camera using 740 MBq Tc-99m MIBI and coronary angiography was also performed by conventional Judkins method. Results : Stunning group had a significantly higher incidence of hypercholesterolemia than non-stunning group(45.5 vs. 7.1%, p=0.01). Stunning group also had higher incidence of diabetes mellitus and lower incidence of hypertension, but these were not statistically significant. Stunning group had larger and more severe perfusion defect in stress perfusion myocardial SPECT than non-stunning group(extent 18.2 vs. 9.2%, p=0.029; severity 13.5 vs. 6.9, p=0.040). Stunning group also had higher degree of reversibility of perfusion defect, higher incidence of positive exercise stress test and higher incidence of having severe stenosis ($80{\sim}99%$) in coronary angiography than non-stunning group, but these were not statistically significant. In stunning group, all of 4 patients without perfusion defect had significant coronary artery stenosis and had received revascularization treatment. Conclusion : Patients with post-stress LV dysfunction had larger and more severe perfusion defect and severe coronary artery stenosis than patients without post-stress LV dysfunction. All of the patients without perfusion defect in stunning group had significant coronary artery stenosis and needed revascularization. Therefore, we suggest that invasive diagnostic procedures and therapeutic interventions might be needed in patients with post-stress LV dysfunction.

Airway size in malocclusions with hyperdivergent skeletal pattern (개방교합성 골격헝태를 갖는 부정교합자의 기도크기)

  • Kwak, So-Yeong;Kim, Hyo-Young;Jeon, Young-MI;Kim, Jong-Ghee
    • The korean journal of orthodontics
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    • v.33 no.4 s.99
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    • pp.293-305
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    • 2003
  • The pharynx have significant locations and functions because it forms a part of the unit in which respiration and deglutition are carried out. Because of the closed relationship between the pharynx and the dentofacial and craniofacial structure, many studies are carried out on this subjects. The purpose of this study were to compare the airway size including pharynx, soft palate, tongue and hyoid bone between normal and hyperdivergent skeletal pattern and to evaluate the change of those size in different age. The sample of this study were consisted of 51 subjects in normal group, 52 subjects in hyperdivergent group. Each was divided into two subgroups by age , child group(9-l2yr old) and adult group(18yr old over). The lateral cephalometric radiographs were taken and the distance, angle and ratio of the facial skeleton, pharynx, soft palate, tongue and hyoid bone were measured and evaluated statistically. The result obtained were summarized as follows : 1 SN-Mn angle, FMA, and Pal-Mn angle were significantly larger in child group than adult group, but the lower anterior facial height(LAFH) and facial height ratio(FHR) were significantly smaller in child group than adult group. Occlu-Mn angle was significantly steep in hyperdivergent group than normal, but not significantly different between child group and adult group. 2. Hyperdivergent group and child group had the stronger correlation between SN-Mn angle, FMA, Pal-Mn angle, LAFH and FHR and airway size than normal group and adult group. Hyperdivevgent child group had significant negative correlation between SN-Mn angle, FMA, Pal-Mn angle and sagittal skeletal dimension of nasopharynx and sagittal depth of nasopharyngeal lumen. Significant positive correlation were seen between LAFH and vertical measurement of airway. 3. There was no difference of the linear measurement of airway size between hyperdivergent group and normal group. 4. Adult group had smaller posterior pharyngeal wall, target nasopharyngeal depth longer nasopharyngeal height and longer pharyngeal length than child group. 5. The sagittal measurement of hyoid bone had no difference between child group and adult group. But adult group had larger vertical measurement of hyoid bone than child group.

Exact Solutions of Plasma Diffusion in a Fine Tube Positive Column Discharge (세관 양광주 방전에서 플라즈마 확산의 완전 해)

  • Jin, D.J.;Jeong, J.M.;Kim, J.H.;Hwang, H.C.;Chung, J.Y.;Cho, Y.H.;Lim, H.K.;Koo, J.H.;Choi, E.H.;Cho, G.S.
    • Journal of the Korean Vacuum Society
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    • v.19 no.1
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    • pp.36-44
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    • 2010
  • The ambipolar diffusion equation has been solved in a fine-tube lamp of a few mm in diameter. In the diffusion of radial direction, the plasma diffuses and vanishes away at the glass wall by recombination with the characteristic time of plasma loss is given by $\tau_r\;=\;(r_0/2.4)^2/D_a$. With the radius $r_0{\sim}1\;mm$ and the ambipolar diffusion coefficient $D_a{\sim}0.01\;m^2/s$, the vanishing time is calculated $\tau_r{\sim}10\;{\mu}s$ which corresponds to the least value of frequency 30 kHz for the sustaining the plasma in the operation of high voltage AC-power. In the diffusion of longitudinal z-direction, a high density plasma generated at the area of a high voltage electrode, diffuses into the positive column with the characteristic time $\tau_z{\sim}0.1\;s$. The plasma diffusion velocity at the boundary of high density plasma is $u_D{\sim}10^2\;m/s$ at the time $t{\sim}10^{-6}$ s and the diffusion velocity becomes slow as $u_D{\sim}1\;m/s$ at $t{\sim}10^{-3}\;s$. Therefore, for the long lamp of 1 m, it takes about several seconds for the high density plasma at the area of electrode to diffuse through the whole positive column space.

Studies on the Bare Rock-slope Conservation Measures (I) -Conservation and Revegetation by Parthenocissus spp.- (암벽면녹화공법개발(岩壁面綠化工法開發)에 관(關)한 연구(硏究)(I) - 담쟁이덩굴류(類)의 이용성개발(利用性開發) -)

  • Woo, Bo-Myeong
    • Journal of Korean Society of Forest Science
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    • v.37 no.1
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    • pp.1-16
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    • 1978
  • The study describes on the identification and morphological characteristics of each species, ecological characteristics and propagation techniques, and developing utilization measures of the Parthenocissus plants for environment conservation and revegetation of the babe rock-slopes. The following species and varieties are disscussed in this study; Parthenocissus tricuspidata (S. et Z.) Planch. var. veitchii Rehd. var. lowii Rehd. var. pupurea Hort. Parthenocissus quiquefolia (L.) Planch. var. engelmanni Rehd. var. saint-pauli Rehd. var. hirsuta Planch. Parthenocissus henryana Diels et Gilg. Parthenocissus thomsoni Planch. Parthenocissus heptaphylla Small. Parthenocissus inserta (Kern.) K. Fritsch. Parthenocissus laetevirens Rehd. Parthenocissus himalayana Planch. These are, in general, all vigorous self-clinging climbers that will quickly cover a wall and bare rock surfaces with a dense network of branch growths and beautiful green leaves which change to shades of scarlet and crimson before they fall in Autumn. Parthenocissus tricuspidata out of 8 species in the genus Parthenocissus is the most useful plant for the environment conservation including the bare rock-slope revegetation and for the production of food and shelter for wildlifes. This native of Korea clings by means of small rootlike holdfasts (adhesive discs) and holds (tendrils) to stone work or any other solid support, tenaciously.

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Effect of PE Film Mulching and Irrigation Method on the Growth, Yield and Antioxidant Activity for Potatoes Grown in Winter Season at Saemangeum Reclaimed Land (새만금 간척지에서 감자 겨울재배시 비닐멀칭 및 관수방법이 생육, 수량 및 괴경의 항산화 활성에 미치는 영향)

  • Choi, Weon-Young;Cho, Kwang-Min;Kim, Sun;Jeong, Jae-Hyeok;Lee, Su-Hwan;Lee, Kyeong-Bo;Lee, Geon-Hwi;Park, Ki-Hun
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.60 no.1
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    • pp.63-69
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    • 2015
  • This study was conducted to measure the effect of PE film mulching and irrigation methods on the growth, yield and antioxidant activity of potatoes tubers, in order to examine the possibility of cultivating potatoes in winter season in vinyl greenhouse on the reclaimed tidal land with weak ground inside the sea wall currently completed. The test was conducted on the sandy loam soil (Munpo series), and its salt concentration was 0.42% at the time of planting. The emergence speed per kind of PE film mulching was in the order of black > coloration > transparent > green color, with the black color showing the fastest speed. The temperature change during a day per kind of PE film mulching was in the order of transparent > coloration > green > black color. As for the salt concentration in the soil for each different way of water management, the salt concentration in the treatment of drip irrigation with 1 week interval was lower than that drip irrigation with 2 weeks interval. As for the growth of above-aerial part, plant length was higher, number of tiller and leaves were more and dry weight of above-aerial part was larger in the treatment of drip irrigaton with 1 week interval than drip irrigation with 2 weeks interval. As for the yield of potatoes depending on each way of water management, the yield in the treatment of drip irrigation with 1 week interval was more than drip irrigation with 2 weeks interval. The yield for each different kind of PE film mulching in the weekly drip-irrigation management section was in the order of transparent ${\geq}$ black ${\geq}$ coloration ${\geq}$ green color. In both of total phenol content and DPPH free radical activity experiments, the content and activity were higher with pear color vinyl treatment.