Puborectalis Muscle Involvement on Magnetic Resonance Imaging in Complex Fistula: A New Perspective on Diagnosis and Treatment

정홍윤,송석규,남우정,이종균 대한대장항문학회 2021 Annals of Coloproctolgy Vol.37 No.1

Purpose: According to recent studies, magnetic resonance imaging (MRI) assessment of complex fistulas provides a significant benefit compared to fistulography, computed tomography, and ultrasonography. The aim of this study was to describe the accuracy of MRI and the importance of identifying puborectalis muscle involvement on MRI in patients with complex fistula. Methods: All patients who were clinically diagnosed with ‘complex’ or showed multiple fistula tracts underwent fistula MRI. Eligible patients were consecutive patients who underwent fistula MRI between September 2018 and September 2019 at our hospital. Results: A total of 83 patients (74 males, 9 females; 116 tracts) were included in this study. The sensitivity and specificity of MRI in diagnosing fistula tracts were 94.8% and 98.2%, respectively. The sensitivity and specificity in identifying internal opening were 93.9% and 97.3%, respectively. Of the 35 patients with puborectalis muscle involvement in the MRI, 31 images of suprasphincteric-type patients on the Park’s classification were classified. The patients of puborectalis involvement were divided into 2 groups according to the surgical procedure that was performed. There were 12 sphincter-saving procedures and 19 sphincter division procedures performed. Recurrence was seen in 2 patients in the sphincter-saving procedure group, while no case was seen in the sphincter division procedure group. Five complications were found in the sphincter division procedure group, of which 2 reported incontinence. Conclusion: Fistula MRI is a highly accurate examination for evaluating complex fistulas, and the puborectalis muscle involvement findings are very important for diagnosis and treatment.

Assessing Rectocele Depth and Its Association with Symptoms of Pelvic Floor Disorders Using 2D Transperineal Ultraound

정홍윤,이종균 대한외과초음파학회 2022 대한외과초음파학회지 Vol.9 No.2

We investigated the clinical features of symptomatic rectoceles, as measured by transperineal ultrasound (TPUS), and evaluated the association between rectocele size and the clinical symptoms of pelvic floor disorders. This was a retrospective study using data obtained at a pelvic floor center between August 2020 and January 2021. A total of 125 patients with defecation disorders, such as constipation and fecal incontinence, were included. The preoperative questionnaire included the Cleveland Clinic Constipation Scoring System (CCCS, Wexner constipation score), Cleveland Clinic Incontinence Score (CCIS, Wexner incontinence score), fecal incontinence severity index (FISI), and fecal incontinence quality of life (FIQOL) scale. The size of the rectocele was measured on 2D-TPUSimages. Patients were assigned to three groups based on rectocele size: no rectocele (<10 mm), ≥10 mm rectocele, and ≥15 mm rectocele. In the study population, 43 participants (34.4%) had no rectocele, 50 (40.0%) had ≥10 mm rectocele, and 32 (25.6%) had ≥15 mm rectocele. With the increase in the size of the rectocele from the no rectocele to ≥15 mm rectocelegroup, the scores for the symptoms of incontinence and constipation increased, and the quality of life worsened. The increase in the scores for the three groups was as follows: CCIS (6.00 ± 4.95 vs. 8.62 ± 5.77 vs. 11.08 ± 5.63, P = 0.004), FIQOL (13.72 ± 4.19 vs. 13.42 ± 4.35 vs. 10.38 ± 3.88, P = 0.006), FISI (18.83 ± 17.67 vs. 25.15 ± 17.34 vs. 33.42 ± 15.49, P = 0.010), and CCCS (7.50 ± 6.26 vs. 8.65 ± 5.31 vs. 13.11 ± 5.90, P = 0.006), respectively. TPUS is a valuable method for the anatomical evaluation of symptomatic rectocele. The larger the size of the symptomatic rectocele measured using TPUS, the more severe were the clinical symptoms.

Whole Body Bone Scan for Detecting Missed Bone Injuries in Multiple Trauma Patients

정홍윤,김임경,최서희,이창로,주만기 대한외상중환자외과학회 2017 Journal of Acute Care Surgery Vol.7 No.2

Purpose: Patients with multiple traumas often experience multiple fractures that are missed or overlooked, despite the use of imaging, careful history taking, and physical examinations. This study aimed to evaluate the usefulness of whole body bone scan (WBBS) for detecting missed bone injuries in patients with multiple traumas. Methods: We evaluated 30 patients with multiple traumas who underwent WBBS at single tertiary referral center between March 2008 and February 2016. We assessed the association of patient demographics with WBBS uptake as a binomial outcome variable. Results: There were no significant differences in patient demographics by WBBS. The mean injury severity score did not differ by WBBS (18.1 in the WBBS-negative group vs. 18.4 in the WBBS-positive group), and duration from admission to the evaluation of the WBBS was similar (5.4 days in both groups). The most common uptake site in the WBBS was the ribs (n=7), followed by the tibia (n=3), skull (n=2), ankle (n=1), and sternum (n=1). None of the missed injuries required further treatment, such as manual reduction or surgery. Conclusion: WBBS was useful for detecting missed bone injuries in patients with multiple trauma. (J Acute Care Surg 2017;7:56-60)

Comparison of 3-Dimensional Pelvic Floor Ultrasonography and Defecography for Assessment of Posterior Pelvic Floor Disorders

정홍윤,양시준,조동호,박덕훈,이종균 대한대장항문학회 2020 Annals of Coloproctolgy Vol.36 No.4

Purpose: The aim of this study was to determine the accuracy of 3-dimensional (3D) pelvic floor ultrasonography and compare it with defecography in assessment of posterior pelvic disorders. Methods: Eligible patients were consecutive women undergoing 3D pelvic floor ultrasonography at one hospital between August 2017 and February 2019. All 3D pelvic floor ultrasonography was performed by one examiner. A total of 167 patients with suspected posterior pelvic disorder was retrospectively enrolled in the study. The patients were divided into 3 groups according to the main symptoms. Results: There were 82 rectoceles on defecography (55 barium trapping) and 84 on 3D pelvic floor ultrasonography. Each modality identified 6 enteroceles. There were 43 patients with pelvic floor dyssynergia on defecography and 41 on ultrasonography. There were 84 patients with intussusception on defecography and 41 on 3D pelvic floor ultrasonography. Agreement of the 2 diagnostic tests was confirmed using Cohen’s kappa value. Rectocele (kappa, 0.784) and enterocele (kappa, 0.654) both indicated good agreement between defecography and 3D pelvic floor ultrasonography. In addition, pelvic floor dyssynergia (kappa, 0.406) showed moderate agreement, while internal intussusception (kappa, 0.296) had fair agreement. Conclusion: This study showed good agreement for detection of posterior pelvic disorders between defecography and 3D pelvic floor ultrasonography.

장심도 굴착시 암질특성이 공휨 현상에 미치는 영향

정홍윤,김병우,고용권,박경우,류지훈 한국방사성폐기물학회 2016 한국방사성폐기물학회 학술논문요약집 Vol.2016 No.05

폐광산 광미 · 토양으로부터 식물로의 중금속 전이에 관한 연구

정홍윤(Hong Yun Jeong),정건희(Geon Hee Jeong),황지애(Ji Ae Hwang),변현숙(Hyun Suk Byun),김영훈(Young Hun Kim),김정진(Jeong Jin Kim) 대한지질학회 2013 대한지질학회 학술대회 Vol.2013 No.10

광미 내 중금속의 식물정화기법 실증 연구

정홍윤(Hong Yun Jeong),김정진(Jeong-Jin Kim),고용권(Yong-Kwon Koh) 대한지질학회 2015 대한지질학회 학술대회 Vol.2015 No.10

장군광산 광미 토양으로부터 아카시아의 중금속 전이에 관한 연구

정홍윤 ( Hongyun Jeong ),김영훈 ( Younghun Kim ),김정진 ( Jeongjin Kim ) 한국광물학회 2015 광물과 암석 (J.Miner.Soc.Korea) Vol.28 No.2

장군광산은 과거 갱도채굴한 폐금속광산으로 위치는 N36° 51``31.59", E129° 03``38.91"에 위치하고 있다. 산사면에 적치해 놓은 광미 적치장은 상부에 오염되지 않은 토양으로 약 20 cm 정도 복토한 후 아카시아를 식재해 놓은 상태이다. 광미 적치장에 식재해 놓은 아카시아는 대략 15년생 정도이다.광미 적치장에서 채취한 토양시료의 중금속 농도는 As (66.43-9325.34 ㎎/㎏), Cd (0.96-1.09 ㎎/㎏), Cu (16.90-57.60 ㎎/㎏), Pb (57.33-945.67 ㎎/㎏), Zn (154.48-278.61 ㎎/㎏)으로 비오염 토양인 대조군의 As (38.98 ㎎/㎏), Cd (0.42 ㎎/㎏), Cu (10.26 ㎎/㎏), Pb (8.21 ㎎/㎏), Zn (46.74 ㎎/㎏) 보다 훨씬높다. 가장 오염도가 높은 토양에 식재된 아카시아의 잎에서의 As, Cd, Cu, Pb, Zn의 농도는 각각 165.95, 0.04, 10.68, 3.18, 48.11 ㎎/㎏이다. 비오염 토양에 식재되어 있는 아카시아의 잎에서의 중금속농도는 As 1.31㎎/㎏, Cu 3.90 ㎎/㎏, Pb 0.22 ㎎/㎏, Zn 11.01 ㎎/㎏이다. 아카시아에서의 중금속의 농집도는 껍질과 잎에서 높으며 심재와 변재에서 낮은 경향을 나타낸다. Janggun mine (longitude 129° 03′38.91″ Latitude 36° 51′31.59″) had been operated as an underground mine for last few decades. As the part of the remediation process, the surface of tailing dump was covered with uncontaminated soil about 20 cm in depth and acacia trees were planted. Heavy metal uptake of acacia from tailing soil has continued for the past 15 years. Heavy metal concentration ranges of tailing soil that contaminated with As (66.43-9325.34 ㎎/㎏), Cd (0.96-1.09 ㎎/㎏), Cu (16.90-57.60 ㎎/㎏), Pb (57.33-945.67 ㎎/㎏), and Zn (154.48-278.61 ㎎/㎏) have higher than those of control soil As (38.98 ㎎/㎏), Cd (0.42 ㎎/㎏), Cu (10.26 ㎎/㎏), Pb (8.21 ㎎/㎏), Zn (46.74㎎/㎏). The As, Cd, Cu, Pb and Zn concentrations of leaf of acacia in highly contaminated tailing dump were 165.95, 0.04, 10.68, 3.18, 48.11 ㎎/㎏, respectively. The metal contents of leaf of acacia tree that obtained from uncontaminated control soil are 1.31 of As, 3.90 of Cu, 0.22 of Pb and 11.01 ㎎/㎏ of Zn. It was investigated that in the acacia tree, heavy metals such as As, Cu, Pb and Zn tend to be more highly concentrated in bark and leaf, compared with sapwood and heartwood.

소설 『태백산맥』의 공간적 배경 고찰 - 벌교 지역을 중심으로

임성운,정홍윤 순천대학교 남도문화연구소 2006 南道文化硏究 Vol.12 No.-

Three-Dimensional Pelvic Floor Ultrasound Assessment of Pelvic Organ Prolapse: Minimal Levator Hiatus and Levator Ani Deficiency Score

윤용우,정홍윤,박덕훈,이종균 대한대장항문학회 2021 Annals of Coloproctolgy Vol.37 No.5

Purpose: The purpose of this study was to determine whether levator ani deficiency (LAD) scores and minimal levator hiatus (MLH) areas affect Pelvic Organ Prolapse Quantification (POP-Q) stage.Methods: This study was a retrospective chart review of patients with pelvic organ prolapse (POP) at Seoul Songdo Hospital between August 2019 and August 2020. Three-dimensional (3D) pelvic floor ultrasound, preoperative anal manometry, and other physiological tests were performed in 78 patients with POP symptoms. We divided the patients into mild prolapse and severe prolapse groups based on the POP-Q. We examined the LAD and MLH areas. LAD scores were categorized as mild, moderate, or severe.Results: There were 32 patients (41.0%) in the mild prolapse group (POP-Q stage I and II) and 46 (59.0%) in the severe prolapse group (POP-Q stage III and IV). The mean LAD score was significantly higher in severe prolapse group (13.33±2.49 vs. 8.19±2.92, P<0.001), and the rate of severe deficiency was also significantly higher in the severe prolapse group (29 [63.0%] vs. 2 [6.3%], P<0.001). The mean MLH was also significantly larger in the severe prolapse group (17.91±2.74 cm2 vs. 14.95±2.60 cm2, P<0.001). In addition, both MLH and LAD scores tended to increase at each stage.Conclusion: There is a strong positive correlation between the POP-Q stage and the MLH and LAD scores that can be seen on 3D pelvic floor ultrasound. The findings of this study, by objectively demonstrating LAD and MLH in women with POP, are an important contribution to POP.