Application of Three-Dimensional Printed Models in Congenital Heart Surgery: Surgeon's Perspective

To treat congenital heart disease, it is important to understand the anatomical structure correctly. Three-dimensional (3D) printed models of the heart effectively demonstrate the structural features of congenital heart disease. Occasionally, the exact characteristics of complex cardiac malformations are difficult to identify on conventional computed tomography, magnetic resonance imaging, and echocardiography, and the use of 3D printed models can help overcome their limitations. Recently, 3D printed models have been used for congenital heart disease education, preoperative simulation, and decision-making processes. In addition, we will pave the way for the development of this technology in the future and discuss various aspects of its use, such as the development of surgical techniques and training of cardiac surgeons.

Application of Three-Dimensional Printed Models in Congenital Heart Surgery: Surgeon's Perspective

To treat congenital heart disease, it is important to understand the anatomical structure correctly. Three-dimensional (3D) printed models of the heart effectively demonstrate the structural features of congenital heart disease. Occasionally, the exact characteristics of complex cardiac malformations are difficult to identify on conventional computed tomography, magnetic resonance imaging, and echocardiography, and the use of 3D printed models can help overcome their limitations. Recently, 3D printed models have been used for congenital heart disease education, preoperative simulation, and decision-making processes. In addition, we will pave the way for the development of this technology in the future and discuss various aspects of its use, such as the development of surgical techniques and training of cardiac surgeons.

Staged Repair of Truncus Arteriosus Associated with Complete Atrioventricular Septal Defect

We report a case of successful repair of truncus arteriosus (TA) associated with complete atrioventricular septal defect (c-AVSD) using a staged approach. TA associated with c-AVSD is a very rare congenital cardiac anomaly. No report of successful staged repair in South Korea has yet been published. We performed bilateral pulmonary artery banding when the patient was 33 days old, and total correction using an extracardiac conduit was performed at the age of 18 months. The patient recovered uneventfully and is doing well.

Treatment of Melasma and Post-Inflammatory Hyperpigmentation by a Picosecond 755-nm Alexandrite Laser in Asian Patients

The picosecond lasers have shown to effectively treat tattoo pigments that are intractable to previous multiple Q-switched (QS) laser treatments. Therefore we hypothesized that a picosecond laser would show better efficacy with minimal adverse events in the treatment of melasma and post-inflammatory hyperpigmentation (PIH) that are difficult to treat with conventional QS lasers. Two patients with melasma and one patient with PIH were treated with a Picosecond 755-nm Alexandrite Laser (Cyanosure, USA). All patients were Korean with skin type IV and no longer responding to QS laser treatments. Laser treatment was well tolerated in all the patients. Adverse events such as PIH were not reported during 8 weeks of follow up period. After the multiple treatment sessions, one patient reported fair improvement and two patients reported good improvement. Consistent with the clinical results, ex vivo skin model irradiated with a Picosecond 755-nm Alexandrite Laser also showed decreased epidermal keratinocyte necrosis compared with the 532-nm QS Neodymium-Doped Yttrium Aluminium Garnet Laser (Lutronic, Korea) yet decreased melanin content. In conclusion, the Picosecond 755-nm Alexandrite Laser may be useful for effective treatment of intractable melasma and PIH with fewer adverse events in dark Asian skin.

Successful Treatment of Tattoos with a Picosecond 755-nm Alexandrite Laser in Asian Skin

No abstract available.

Successful Treatment of Tattoos with a Picosecond 755-nm Alexandrite Laser in Asian Skin

No abstract available.

Successful Surgical Treatment of Cardiac Complication of Graves Disease

Cardiac complications such as arrhythmia and heart failure are common in Graves disease. Early detection and proper treatment of hyperthyroidism are important because cardiac complications are reported to be reversible if the thyroid function is normalized by medical treatment. We report here a case of cardiac complication of Graves disease that was too late to reverse with medical treatment and required surgical treatment.

Anti-obesity and anti-diabetic effects of Yerba Mate (Ilex paraguariensis) in C57BL/6J mice fed a high-fat diet / 한국실험동물학회지

Yerba Mate, derived from the leaves of the tree, Ilex paraguariensis, is widely-used as a tea or as an ingredient in formulated foods. The aim of the present study was to evaluate the effects of Yerba Mate extract on weight loss, obesity-related biochemical parameters, and diabetes in high-fat diet-fed mice. To this end, by using in vivo animal models of dietary-induced obesity, we have made the interesting observations that Yerba Mate has the ability to decrease the differentiation of pre-adipocytes and to reduce the accumulation of lipids in adipocytes, both of which contribute to a lower growth rate of adipose tissue, lower body weight gain, and obesity. Our data from in vivo studies revealed that Yerba Mate treatment affects food intake, resulting in higher energy expenditure, likely as a result of higher basal metabolism in Yerba Mate-treated mice. Furthermore, in vivo effects of Yerba Mate on lipid metabolism included reductions in serum cholesterol, serum triglycerides, and glucose concentrations in mice that were fed a high fat diet. In conclusion, Yerba Mate can potentially be used to treat obesity and diabetes.

Clinical Analysis of Arteriovenous Fistula Using Perforating Vein on Antecubital Fossa / 대한흉부외과학회지

BACKGROUND: It is very important to obtain vascular access that resists repeated punctures and maintains an adequate blood flow for performing hemodialysis in patients with ESRD. This study was designed to identify the risk factors that may influence the patency rate of arteriovenous fistula (AVF) using perforating vein on antecubital fossa. MATERIAL AND METHOD: We analyzed 205 cases of AVF in 195 patients who underwent hemodialysis access surgery on antecubital fossa in our hospital from May 2006 to December 2009. RESULT: The patency rate of AVF from 6 months after surgery using perforating vein was 75.91%. The risk factors that influence the patency rate was age. There was no statistic difference between used vessels. CONCLUSION: The patency of the AVF using perforating vein on antecubital fossa was comparable. The condition of sex and location and presence or absence of diabetes and hypertension and other cardio-neurovascular disease did not make statistically significant effect on the AVF patency rate. The age was an independent risk factor for patency rate.

CSF Leakage through a Subarachnoid-pleural Fistula after Resection of a Malignant Solitary Fibrous Tumor / 대한흉부외과학회지

Solitary fibrous tumor is an uncommon submesothelial mesenchymal neoplasm that primarily arises from the pleura. Most solitary fibrous tumors have a benign course, and the single most important predictor of the clinical outcome is the ability to excise the entire lesion. We experienced a case of CSF leakage through a subarachnoid-pleural fistula after resection of a malignant solitary fibrous tumor and the involved rib. We detected CSF leakage via performing CT myelography and we treated this case with hemilaminectomy and dura repair.

Pulmonary Metastasectomy for Colorectal Carcinoma

PURPOSE: Surgical resection is an important curative treatment for pulmonary metastases from colorectal adenocarcinoma. We analyzed the outcomes and the prognostic factors related to the post operative mortality after surgical resection for pulmonary metastases from colorectal adenocarcinoma. MATERIALS AND METHODS: Between January 1994 and December 2009, 28 patients underwent complete pulmonary resection of metastatic colorectal carcinoma. We performed a retrospective review of the patient's characteristics and the factors affecting survival. Survival was analyzed by the Kaplan-Meier method and comparison between groups was performed by a log-rank analysis. RESULTS: The median survival was 53.07 months (Kaplan-Meier method). The number of pulmonary metastases (p=0.0151) and a prethoracotomy carcinoembryonic antigen (CEA) level over 5 ng/mL (p=0.0217) were significantly related with survival. CONCLUSION: The prethoracotomy CEA level and the number of metastases were significantly related with the survival rate. Resection of pulmonary metastatic lung lesion from colorectal cancer may improve the survival rate in a selected group of patients.

Removal of an Infected Permanent Pacemaker through a Right Atriotomy without Cardiopulmonary Bypass Via a Right Thoracotomy / 대한흉부외과학회지

A 52-year-old female presented with pain and swelling owing to recurrent inflammation on a generator pocket. She had undergone a permanent pacemaker implantation (DDD type) 7 years previously. We planned to insert a new pacemaker after removal of the previous generator and wires through a surgical approach. However, she had a history of the left modified radical mastectomy (MRM) with radiation therapy for breast cancer. For this patient, it would be difficult to care for the postoperative wound if we approached via the median sternotomy. Therefore, we decided to use a right atrial approach via a right thoracotomy. We removed the previous pacing wires through an atriotomy and inserted a new pacemaker using epicardial pacing leads without cardiopulmonary bypass.

Retroperitoneal Pulmonary Sequestration in a Neonate : A case report / 대한흉부외과학회지

Retroperitoneal pulmonary sequestration is an extremely rare congenital malformation. It is more frequently diagnosed in the antenatal period due to routine ultrasonic examinations that are conducted for a fetus or during the first 6 months of life, although retroperitoneal pulmonary sequestration is incidentally discovered in adults on rare occasions. Because the location and radiological findings of retroperitoneal pulmonary sequestration are very similar to those of another retroperitoneal masses, retroperitoneal pulmonary sequestration, although they are very rare, should be included in the differential diagnosis of a retroperitoneal suprarenal mass. Although fine needle aspiration may be considered as an aid for making the preoperative diagnosis, surgery remains the treatment of choice for symptomatic lesions and this surgery is associated with excellent results and a good prognosis.

The Use of Medical Devices for Medical Skin Care and the Legal Issues / 대한피부과학회지

BACKGROUND: Medical skin care is essential for the treatment of skin diseases all over the world. Medical skin care is also part of medical practice and this must be differentiated from the simple skin care that is given for normal healthy skin. OBJECTIVE: We wanted to discuss medical skin care and the related medical devices and legal issues. METHODS: We reviewed the related laws and regulations, we consulted experts and associations and we analyzed the result of the survey. RESULTS: Legally, medical skin care and simple skin care are well classified. However, many illegal procedures are still performed by non-medical personnel and many adverse effects have been reported as a result. Furthermore, there are no legal restrictions for the performer based on the grade of each medical skin care procedure. CONCLUSION: For the best results and safe procedures, medical skin care must be performed by approved medical equipment under the supervision of a physician or medical personnel. Continuous control and guidance by the government is strongly needed.

Surgical Treatment for a Primary Arterioenteric Fistula between a Common Iliac Artery Aneurysm and the Terminal Ileum with Massive Bleeding / 대한흉부외과학회지

A 72-year-old man with progressive, unexplained lower gastrointestinal bleeding presented to the emergency department with abdominal pain and shock. Computed tomography of the abdomen showed a fistula between a right common iliac artery aneurysm and the small intestine. Laparotomy demonstrated a saccular aneurysm of the common iliac artery with a fistulous communication to the terminal ileum. Aneurysmectomy, aortoiliac graft replacement and segmental ileocecal resection with end-to-side anastomosis were all successfully performed. For a patient having an arterioenteric fistula along with lower gastrointestinal bleeding, making an early diagnosis using computed tomography and then performing immediate surgery can be expected to save the patient's life.

Clinical Analysis of Inhalation Burn

PURPOSE: The mortality rate of burn patients dying from burn shock or sepsis is declining owing to improved treatment methods such as advances in fluid therapy and antibiotic application. Over the past 10 years, however, damage to the trachea and the lungs caused by inhalation of poisonous gases in closed spaces and the resulting complications have become the primary causes of death for burn patients. The purpose of this study is to appraise the clinical significance of inhalation burn by focusing the analysis on the mass- produced burn patients from a recent short period. METHODS: This study involved 23 patients who were admitted to the Department of General Surgery from the Emergency Room at the Inha University Hospital after suffering burns in a fire that broke out at a pub in Inchon, Korea, on 30 October 1999. RESULTS: The average age was 16.6 and most of the patients were adolescents. The average of the total burn surface was 7%, with 17 patients (73.9%) having less than 5%. A bronchoscopy was applied to all the patients. A total of 13 patients (56.5%) had intubation. Of these, 4 had a tracheostomy three days after hospitalization. Of the 23 patients who were the subjects of this clinical study, 12 patients, accounting for 52.2% of the total, developed pneumonia. Two people also developed tracheal stenosis and both of them underwent a tracheal resection and anastomosis. Four patients had to receive psychiatric treatment due to post traumatic stresss disorder. None of the 23 patients died. CONCLUSION: In the case of burns suffered in confined areas, an inhalation burn, rather than the mere size of the burn, will have a greater bearing on fatality and the occurrence of pulmonary complications. For this reason, one cannot overemphasize the importance of preventing fire by taking appropriate safety precautions and keeping the surroundings clear of inflammable materials. However, once burn injury occurs, every effort should be made to ensure that there will be minimum after effects and scars through earliest possible intervention.

Clinical, Mammographic, and Ultrasonographic Assessment of Breast Cancer Size

PURPOSE: Tumor size is a prognostic factor, as well as an important factor, in staging. Also, tumor size is a major factor in determining if a woman is a suitable candidate for various treatments, including a mastectomy or breast-conserving surgery. Thus, an accurate assessment of breast tumor size is important in making a prognosis and in planning treatment. METHODS: One hundred fifty-two patients presenting with palpable primary breast cancer were studied to evaluate the accuracies of clinical assessment, mammography, and ultrasonography in measuring tumor size. The clinical, mammographic, and ultrasonographic diameters of the tumors were compared to histological diameters. RESULTS: The average histological diameter of the tumors was 27.0+/-12.9 mm. The average diameter of the tumors on clinical assessment was 33.8+/-13.1 mm, and its correlation coefficient to the histological size was 0.73. The average size on mammography was 21.4+/-9.0 mm and its correlation coefficient to the histological size was 0.71. The tumor size on ultrasonography in 22 patients was 22.3+/-10.4 mm. The sonographic measurement demonstrated the highest correlation coefficient (0.83). The clinical assessment overestimated the histological tumor size, but the mammographic and sonographic measurement underestimated it. A combined measurement using both the clinical and the ultrasonographic methods slightly improved the correlation with the histological size (0.86). CONCLUSION: Ultrasonography could be a useful method for estimating tumor size preoperatively, and when it is combined with clinical assessment, it is the most reliable and accurate technique.

The detection of circulating breast cancer cells in peripheral blood by reverse transcriptase-polymerase chain reaction

Some circulating cancer cells in the blood play a central role in the metastatic process and may have a major influence on patient progress. Their numbers can be very small and techniques for their detection need to be both sensitive and specific. Polymerase chain reaction (PCR) has been successfully used to detect small numbers of tumor cells in cancer. We used a reverse transcriptase-polymerase chain reaction (RT-PCR) to detect circulating breast cancer cells in venous blood samples before operations and assessed cytokeratin-19 (CK-19) and cytokeratin-20 (CK-20) as target mRNA markers in the blood of healthy donors (n=6) and breast cancer patients (n=30) with American Joint Committee on Cancer stages 0 to IIIa. CK-19 mRNA was expressed in all blood samples of healthy donors and patients. But CK-20 was the only mRNA marker not detected in the blood from healthy donors. Seven of 30 (23%) venous blood isolates of breast cancer patients yielded a CK-20 mRNA with positive results. There was no correlating CK-20 mRNA expression with stage and axillary lymph node status. In conclusion, CK-19 showed no diagnostic value as a mRNA marker in the detection of circulating cancer cells by RT-PCR assay because this was expressed in the blood of healthy donors. CK-20 mRNA was an useful marker to detect circulating cancer cells in breast cancers.

Significance of K-ras mutation, K-ras expression and p53 expression in pancreatic cancer / 한국간담췌외과학회지

BACKGROUND: Though K-ras mutation and aberrant p53 have been considered the event of the oncogenesis of pancreatic adenocarcinoma, it is controversial that these have been attributed to difference of survival in pancreatic adenocarcinoma. We investigated for presence of a K-ras mutation, K-ras expression and p53 expression in carcinogenesis of pancreatic adenocarcinoma. Also their correlation with tumor grade, stage and survival was investigated. METHODS: We examined 48 patients surgically resected, formalin-fixed and paraffin-embedded pancreatic adenocarcinoma. By using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), we detected K-ras mutation at codon 12. An aberrant K-ras and p53 expression was stained using an immunohistochemical staining (IHC) method. RESULTS: Thirty-one of 48 cases (64.6%) showed K-ras mutation. K-ras expression was showed in 68.8% (33/48). p53 expression was showed in 47.9% (23/48). There was no correlation between a presence of K-ras mutation or K-ras expression and tumor grade, lymph node metastasis, clinical stage or survival rate. A positive correlation between p53 expression and clinical stage was found (p0.05). CONCLUSION: Mutation of the K-ras gene and aberrant p53 might play an important role in pancreatic carcinogenesis. But mutation of K-ras gene and K-ras expression is not considered to relate to progression of pancreatic carcinoma. It is suggested that p53 expression seems to be associated with a progression of pancreatic carcinoma.

Significance of K-ras Mutation and p53 Protein Expression in Pancreatic Adenocarcinoma

BACKGROUND: Activation of the K-ras oncogene by specific point mutations at codon 12 occurs at a remarkably high frequency in pancreatic adenocarcinomas. Also, inactivation of the p53 suppressor gene function in pancreatic adenocarcinomas leads to the loss of cellular proliferation regulation and to the induction of cell death. Though K-ras mutation and inactivation of the p53 suppresser gene have been considered to be events in the oncogenesis of a pancreatic adenocarcinoma, whether their association with differences or survival in pancreatic adenocarcinoma is controversial. We investigated the presence of K-ras mutation and overexpression of p53 protein in the carcinogenesis of a pancreatic adenocarcinoma. Also, their correlations with tumor grade, stage, and survival were investigated. METHODS: We examined surgically resected, formalin-fixed, paraffin-embedded pancreatic adenocarci nomas from 48 patients. By using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), we detected a K-ras oncogene mutation at codon 12. An overexpression of p53 protein was detected by using an immunohistochemical staining (IHC) method with anti-p53 monoclonal antibody. RESULTS: K-ras oncogene mutation at codon 12 was detected in 64.6% of the cases and p53 protein was overexpressed in 47.9%. Both K-ras oncogene mutation and p53 protein overexpression were detected in 29.2% of the cases. There was no correlation between the rate of K-ras mutation and tumor grade, T category (tumor size or depth of invasion), N category (lymph-node metastasis) and clinical stage. Also, K-ras mutation was not correlated with the survival rate. A positive correlation between p53 protein overexpression and clinical stage was found (p0.05). CONCLUSION: The mutation of the K-ras oncogene and p53 suppresser gene might play an important role in pancreatic carcinogenesis. However, the mutation of the K-ras oncogene is not thought to be related to the progression of a pancreatic adenocarcinoma and the corresponding survival rate. It is suggested that overexpression of the p53 protein seems to be associated with the progression of pancreatic adenocarcinoma.