Open Repair of Ruptured Huge Aorto-Iliac Aneurysm: Warning of Colon Ischemia

조자윤,허승,정희경,김형기 대한혈관외과학회 2014 Vascular Specialist International Vol.30 No.2

A giant abdominal aortic aneurysm (AAA) renders surgical treatment much more difficult by deforming the proximal infrarenal aortic neck (shortened length and disturbed angulation), by altering the iliac arteries (marked tortuosity and aneurysmal dilatation), and by displacing abdominal organs. Because the retroperitoneal rupture of giant AAA makes the mesentery more elongated and deformed, compromising its blood flow and thus increasing the risk of mesenteric ischemia such as colon ischemia. We describe here the surgical repair of a large infrarenal AAA with a ruptured huge left common iliac artery aneurysm of 13.5 cm in diameter, accompanied by colostomy due to colon ischemia which occurred during the operation. We discuss the pathophysiology and preventive strategy of colon ischemia during ruptured giant AAA repair.

80세 이상 고령 환자에서의 복강경담낭절제술

조자윤(Ja Yun Cho),김종열(Jong Yeol Kim),장수근(Su Kurn Chang),김상걸(Sang Geol Kim),황윤진(Yoon Jin Hwang),윤영국(Young Kook Yun) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.76 No.4

Purpose: Biliary tract disease is one of the most common causes of acute abdominal pain in elderly patients, but there is still some debate over treatment. The aim of this study is to determine the safety and surgical outcomes of laparoscopic cholecystectomy (LC) for benign gallbladder disease in octogenarian patients. Methods: We selected 42 patients of 80 years or older who underwent LC or open-converted cholecystectomy(OC) from February 1992 to November 2006. We evaluated clinicopathological features, treatment modalities, and surgical outcomes retrospectively. Results: The patients included 17 males and 25 females. The mean age of the patients was 83.3 and 83.7, respectively. Right upper quadrant pain was the most common symptom, present in 85.7% of the patients. Gallstones were present in 85.7%. ASA class Ⅱ and Ⅲ comprised 92.9% of the patients. Comorbidities included hypertension, cardiac disease, pulmonary disease, and diabetes mellitus. Preoperatively biliary drainage was performed in 12 cases (endoscopic drainage in 8, percutaneous drainage in 4 cases). Preoperative cholecystostomy was performed in 5 cases. Emergency operations were more frequent than elective surgery (25 vs. 17). Mean hospital stay of LC patients was 5 days, whereas that of OC patients was 13 days. Open conversion rate was 16.7%. No surgical mortality was present and postoperative morbidity included acute myocardial infarction in one patient and wound infection in one patient. Conclusion: LC in octogenarian patients was safe. However, since the incidence of comorbidities is high in these patients, great care should be taken to evaluate and manage the comorbidities before surgery.

외상 후 지연성으로 발생한 장간막 동정맥루: 증례보고

조자윤 ( Jayun Cho ),정희경 ( Hee Kyung Jung ),김형기 ( Hyung Kee Kim ),임경훈 ( Kyoung Hoon Lim ),천재민 ( Jae Min Chun ),허승 ( Seung Huh ),박진영 ( Jin Young Park ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.3

Introduction: A post-traumatic mesenteric arteriovenous fistula (AVF) is extremely rare. Case Report: A previously healthy 26-year-old male was injured with an abdominal stab wound. Computed tomography (CT) showed liver injury, pancreas injury and a retropancreatic hematoma. We performed the hemostasis of the bleeding due to the liver injury, a distal pancreatectomy with splenectomy and evacuation of the retropancreatic hematoma. On the 5th postoperative day, an abdominal bruit and thrill was detected. CT and angiography showed an AVF between the superior mesenteric artery (SMA) and the inferior mesenteric vein with early enhancement of the portal vein (PV). The point of the AVF was about 4 cm from the SMA`s orifice. After an emergent laparotomy and inframesocolic approach, the isolation of the SMA was performed by dissection and ligation of adjacent mesenteric tissues which was about 6 cm length from the nearby SMA orifice, preserving the major side branches of the SMA, because the exact point of the AVF could not be identified despite the shunt flow in the PV being audible during an intraoperative hand-held Doppler-shift measurement. After that, the shunt flow could not be detected by using an intraoperative hand-held Doppler-shift measuring device. CT two and a half months later showed no AVF. There were no major complications during a 19-month followup period. Conclusion: Early management of a post-traumatic mesenteric AVF is essential to avoid complications such as hemorrhage, congestive heart failure and portal hypertension.

백금계 촉매상에서 이산화질소(NO₂)의 저감 특성에 관한 실험적 연구 실험적 연구

조자윤(Ja-Yun Cho),김영득(Young-Deuk Kim),김우승(Woo-Seung Kim) 한국자동차공학회 2010 한국자동차공학회 부문종합 학술대회 Vol.2010 No.5

The reduction characteristics of NO₂ to NO are studied experimentally over a platinum-based catalyst, especially at lower temperatures below about 200℃. In the exhaust gas after-treatment system for heavy-duty diesel engines, a diesel oxidation catalyst (DOC) is used as an integral component to effectively reduce engine raw emissions in combination with selective catalytic reduction (SCR) and diesel particulate filter (DPF). In detail, to improve the NOx conversion over a SCR catalyst, the DOC is usually placed upstream of the SCR catalyst to enhance the fast-SCR reaction using equimolar amounts of NO and NO₂. The DOC is also used in conjunction with a DPF, called a continuously regenerating trap (CRT), to oxidize NO for passive particulate combustion by NO₂. Thus, the characteristics of NO₂ conversion over DOC are essentially analyzed to accurately predict the performance of an aftertreatment system. In the present work, two types of steady-state experiments, engine bench and synthetic gas bench tests, are carried out in sequence. Steady-state engine bench tests with the DOC mounted on a light duty 4-cylinder 2.0 liter turbocharged diesel engine are performed and prove that CO plays a major role in NO₂ abatement at temperatures below the light-off temperature of CO oxidation, about 200 . Then, synthetic gas bench tests are performed using synthetic gas mixtures with CO, C₃H?, NO, NO₂, O₂, H₂O, and N₂ in the 140-450 T-range and show that both CO and C₃H? are capable of reducing NO₂. It is noted that the reaction rate of NO₂ with C₃H? is much higher than that with CO. At temperatures below about 200 , the reduction of NO₂ to NO is promoted with increasing CO concentration and NO₂/NOx ratio and with decreasing O₂ concentration, as well as with the presence of H₂O.

소형 산업용 디젤엔진의 Valve Profile 최적화를 통한 성능 개선 연구

조자윤(Jayun Cho),박광문(Kwangmoon Pa),이대호(Daeho Lee),정욱(Wook Jung) 한국자동차공학회 2018 한국자동차공학회 학술대회 및 전시회 Vol.2018 No.11

다발성 외상환자에서 혈관계 접근을 통해 치료한 쇄골하동맥 손상 2례

조자윤 ( Ja Yun Cho ),정희경 ( Hee Kyung Jung ),김형기 ( Hyung Kee Kim ),임경훈 ( Kyoung Hoon Lim ),박진영 ( Jin Young Park ),허승 ( Seung Huh ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.3

Introduction: Surgical treatment of subclavian artery (SA) injury is challenging because approaching the lesion directly and clamping the proximal artery is difficult. This can be overcome by using an endovascular technique. Case 1: A 37-year-old male was drawn into the concrete mixer truck. He had a right SA injury with multiple traumatic injuries: an open fracture of the right leg with posterior tibial artery (PTA) injury, a right hemothorax, and fractures of the clavicle, scapula, ribs, cervical spine and nasal bone. The injury severity score (ISS) was 27. Computed tomography (CT) showed a 30-mm-length thrombotic occlusion in the right SA, which was 15 mm distal to the vertebral artery (VA). A self-expandable stent(8 mm×40 mm in size) was deployed through the right femoral artery while preserving VA flow, and the radial pulse was palpable after deployment. Other operations were performed sequentially. He had a viable right arm during a 13-month follow-up period. Case 2: A 25-year-old male was admitted to our hospital due to a motorcycle accident. The ISS was 34 because of a hemothorax and open fractures of the mandible and the left hand. Intraoperative angiography was done through a right femoral artery puncture. Contrast extravasation of the SA was detected just outside the left rib cage. After balloon catheter had been inflated just proximal to the bleeding site, direct surgical exploration was performed through infraclavicular skin incision. The transected SA was identified, and an interposition graft was performed using a saphenous vein graft. Other operations were performed sequentially. He had a viable left arm during a 15-month follow-up period. Conclusion: The challenge of repairing an SA injury can be overcome by using an endovascular approach.

Open Repair of Ruptured Abdominal Aortic Aneurysm: The Suitability of Endovascular Aneurysm Repair Does Not Influence Operative Mortality

윤혜영,조자윤,송인철,김형기,허승 대한혈관외과학회 2015 Vascular Specialist International Vol.31 No.3

Purpose: We analyze the outcomes of open repair (OR) in patients with ruptured abdominal aortic aneurysm (RAAA) according to the anatomic suitability for endovascular aneurysm repair (EVAR). Materials and Methods: We reviewed retrospectively all consecutive RAAA patients who underwent OR from January 2005 to March 2014. All suspected patients underwent preoperative computed tomography (CT). Outcomes were major morbidities and mortality. Multivariate analysis was performed by using logistic regression adjusted by controlled variables; gender, Hardman index, maximal aneurysmal diameter, rupture type, perioperative transfusion requirement, and perioperative urinary output. Results: Among 54 consecutive patients with RAAA who underwent OR, 45 patients were included after exclusion of 9 patients (7, suprarenal; 1, infected; 1, inflammatory). Preoperative CT showed 27% (12/45) EVAR-suitable patients. Hostile neck anatomy was found in 88% (29/33) among unsuitable anatomy (UA) (n=33). The maximal aneurysmal diameter was statistically larger (83.1±21.0 mm vs. 68.8±12.3 mm, P=0.032) in the UA group. The 30-day mortality was 28.9% (13/45; 33% vs. 17% in UA group vs. suitable anatomy [SA] group, P=0.460; adjusted P=0.445). UA group had more patients with cardiac morbidity (55% vs. 25%, P=0.079; adjusted P=0.032; odds ratio, 12.914; 95% confidence interval, 1.238-134.675). There was no statistical difference in survival rate between SA and UA groups (74.1%, 74.1%, and 74.1% vs. 60.6%, 55.6%, and 32.4% at 1-, 3- and 5-year, respectively; P=0.145). Conclusion: In this study, relatively unfavorable outcomes were found in the EVAR-unsuitable group after OR in RAAA patients. However, unsuitable anatomy did not influence patient survival after OR by multivariate analysis.

소아에서 발생한 장중첩증에서 수술적 치료의 필요와 관련된 위험인자

하헌탁,조자윤,박진영,Ha, Heontak,Cho, Jayun,Park, Jinyoung 대한소아외과학회 2014 소아외과 Vol.20 No.1

The aim of this study was to identify the risk factor related to the need for operative treatment and avoid unnecessary non-operative management for intussusception in children. We retrospectively reviewed medical records of patient treated for intussusception at our institution between January 2006 and January 2013. Clinical features such as gender, age, seasonal variation, symptoms and signs, treatment results were analyzed. Univariate and multivariate analyses including a chi-square test for categorical variables and logistic regression analysis were performed. During the study period, 356 patients were treated for intussusception. 328 (92.1%) was treated successfully by the non-operative pneumoreduction, and 28 (7.9%) required operative management. On univariate analysis, risk factors which were related to the need for operative treatment were age, vomiting, bloody stool, lethargy, and symptoms duration. A logistic regression analysis in order to assess for independent predictors of operative treatment was performed. Age (<6 vs ${\geq}12$ months) (OR 4.713, 95% CI 1.198~18.539, p=0.027) and symptoms duration longer than 48 hours (OR 4.534, 95% CI 1.846~11.137, p=0.001) were significantly associated with a requirement for operative treatment. We conclude that younger age and a longer duration of symptoms (${\geq}48$ hours) are the independent risk factor related to the need for operative treatment for intussusception. Early surgical intervention or transfer to a hospital with pediatric surgical capabilities should be considered for patients with these findings.

상지절단 환자에서 시행된 재접합술의 추적관찰 결과

김형기,조자윤,허승,오창욱,정호윤,노영남,김영욱 대한혈관외과학회 2013 Vascular Specialist International Vol.29 No.1

Purpose: To report follow-up data on upper extremity (UE) macroreplantation in patients with traumatic amputation injuries. Methods: Between 1996 and 2003, 11 patients underwent UE macroreplantation at a single institution. All patients had an open fracture (n=9; upper arm, 5; forearm, 4) or an open dislocation of the elbow (n=2), combined with neurovascular and soft tissue transection injuries. The replantation procedures were performed on an emergency basis by a multi-departmental team. The mean warm ischemic time was 328 minutes (range, 165 to 480 minutes). Functional recovery of the replanted UE was evaluated with Chen's classification system, and patient satisfaction was determined using Russell's questionnaire; periodic examinations were conducted over a minimum follow-up period of 2 years. Results: Early complications consisted of 2 arterial thromboses, 1 soft tissue infection resulting in sepsis, and 1 episode of acute renal failure; UE reamputation was required in 2 patients. As a result, limb salvage was achieved in 82% of patients (9/11). A functional extremity, defined as grades I and II using Chen's criteria, was preserved in 33.3% of patients with successfully replanted limbs. Despite the objectively poor rate of function preservation, 89% of patients who had successful replantation procedures were satisfied with the results. Conclusion: Even though the functional recovery rate was low, UE macroreplantation resulted in acceptable limb salvage rates and good patient satisfaction.

Efficacy of Uncross-Matched Type O Packed Red Blood Cell Transfusion to Traumatic Shock Patients: a Propensity Score Match Study

강병희,최동환,조자윤,권준식,Yo Huh,문종환,김영환,정경원,John Cook-Jong Lee 대한의학회 2017 Journal of Korean medical science Vol.32 No.12

A new blood bank system was established in our trauma bay, which allowed immediate utilization of uncross-matched type O packed red blood cells (UORBCs). We investigated the efficacy of UORBC compared to that of the ABO type-specific packed red blood cells (ABO RBCs) from before the bank was installed. From March 2016 to February 2017, data from trauma patients who received UORBCs in the trauma bay were compared with those of trauma patients who received ABO RBCs from January 2013 to December 2015. Propensity matching was used to overcome retrospective bias. The primary outcome was 24-hour mortality, while the secondary outcomes were in-hospital mortality and intensive care unit (ICU) length of stay (LOS). Data from 252 patients were reviewed and UORBCs were administered to 64 patients. The time to transfusion from emergency room admission was shorter in the UORBC group (11 [7–16] minutes vs. 44 [29–72] minutes, P < 0.001). After propensity matching, 47 patients were included in each group. The 24-hour mortality (4 [8.5%] vs. 9 [13.8%], P = 0.135), in-hospital mortality (14 [29.8%] vs. 18 [38.3%], P = 0.384), and ICU LOS (9 [4–19] days vs. 5 [0–19] days, P = 0.155) did not differ significantly between groups. The utilization of UORBCs resulted in a faster transfusion but did not significantly improve the clinical outcomes in traumatic shock patients in this study. However, the tendency for lower mortality in the UORBC group suggested the need for a large study.