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Jun Gyo Gwon,Yong-Pil Cho,Youngjin Han,Jungyo Suh,Seung-Kee Min 대한혈관외과학회 2023 Vascular Specialist International Vol.39 No.3
Radical nephrectomy with tumor thrombectomy for advanced renal cell carcinoma is an oncologically relevant approach that can achieve long-term survival even in the presence of distant metastases. However, the surgical techniques pose significant challenges. The objective of this clinical review was to present technical recommendations for tumor thrombectomy in the vena cava to facilitate surgical treatment. Transesophageal echocardiography is required to prepare for this procedure. Cardiopulmonary bypass should be considered when the tumor thrombus has invaded the cardiac chamber and clamping is not feasible because of the inability to milk the intracardiac chamber thrombus in the caudal direction. Prior to performing a cavotomy, it is crucial to clamp the contralateral renal vein and infrarenal and suprahepatic inferior vena cava (IVC). If the suprahepatic IVC is separated from the surrounding tissue, it can be gently pulled down toward the patient’s leg until the lower margin of the atrium becomes visible. Subsequently, the tumor thrombus should be carefully pulled downward to a position where it can be clamped. Implementing the Pringle maneuver to reduce blood flow from the hepatic veins to the IVC during IVC cavotomy is simpler than clamping the hepatic veins. Sequential clamping is a two-stage method of dividing thrombectomy by clamping the IVC twice, first suprahepatically and then midretrohepatically. This sequential clamping technique helps minimize hypotension status and the Pringle maneuver time compared to single clamping. Additionally, a spiral cavotomy can decrease the degree of primary closure narrowing. The oncological prognoses of patients can be improved by incorporating these technical recommendations.
Jun Gyo Gwon,Tae-Won Kwon,Yong-Pil Cho,Young Jin Han,Min Su Noh 대한외과학회 2016 Annals of Surgical Treatment and Research(ASRT) Vol.91 No.6
Purpose: The aim of this study was to confirm the factors that affect the mortality associated with the open surgical repair of ruptured abdominal aortic aneurysm (rAAA) and to analyze the long-term survival rates. Methods: A retrospective review was performed on a prospectively collected database that included 455 consecutive patients who underwent open surgical repair for AAA between January 2001 and December 2012. We divided our analysis into in-hospital and postdischarge periods and analyzed the risk factors that affected the long-term survival of rAAA patients. Results: Of the 455 patients who were initially screened, 103 were rAAA patients, and 352 were non-rAAA (nAAA) patients. In the rAAA group, 25 patients (24.2%) died in the hospital and 78 were discharged. Long-term survival was significantly better in the nAAA group (P = 0.001). The 2-, 5-, and 10-year survival rates of the rAAA patients were 87%, 73.4%, and 54.1%, respectively. Age (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.02–1.08; P < 0.001) and aneurysm rupture (HR, 1.96; 95% CI, 1.12–3.44; P = 0.01) significantly affected long-term survival. Conclusion: Preoperative circulatory failure is the most common cause of death for in-hospital mortality of rAAA patients. After excluding patients who have died during the perioperative period, age is the only factor that affects the survival of rAAA patients.
Jun Gyo Gwon,Sun-Young Ko,Hyokee Kim 대한외과학회 2022 Annals of Surgical Treatment and Research(ASRT) Vol.103 No.4
Purpose: The platelet function analyzer (PFA)-100/200 is widely used to assess platelet function. However, its role in predicting the perioperative risk of bleeding in patients undergoing liver resection remains controversial. Therefore, we aimed to ascertain whether the platelet function test could be useful in predicting bleeding risk in patients undergoing hepatic surgery. Methods: The study participants were patients who underwent hepatectomy for hepatocellular carcinoma at our hospital over a period of 10 years from January 1, 2010 to May 31, 2020. PFA-200 values of these patients were divided into 2 groups; normal (n = 333) and prolonged (n = 39). Results: There were no significant differences regarding the volumes of calculated blood loss during surgery between the normal and prolonged PFA groups (879.55 ± 1,046.50 mL vs. 819.74 ± 912.64 mL, respectively; P = 0.733); intraoperative RBC transfusion (0.52 ± 2.02 units vs. 0.26 ± 1.02 units, P = 0.419) and postoperative RBC transfusion (0.24 ± 1.17 units vs. 0.46 ± 1.97 units, P = 0.306) were similar between the 2 groups, respectively. Multivariate analysis revealed no association between PFA closure time and calculated blood loss (hazard ratio, 1.06; P = 0.881). Moreover, there was no association between PFA closure time and preoperative laboratory results or assessment of tool-related liver function in multivariate analysis. Conclusion: There was no correlation between the amount of blood loss and platelet function in patients who underwent liver resection. In patients undergoing liver resection who are not managed on antiplatelet agents or do not have chronic kidney disease, the use of routine PFA is not recommended.
Enteral nutrition associated non-occlusive bowel ischemia
Jun-Gyo Gwon,Young-Ju Lee,Kyu-Hyouck Kyoung,Young-Hwan Kim,Suk-Kyung Hong 대한외과학회 2012 Annals of Surgical Treatment and Research(ASRT) Vol.83 No.3
We describe two patients, with no previous history of vascular problems but poor lung function, who experienced septic shock due to bowel ischemia. Both were fed an enteral formula rich in fiber using a feeding tube and experienced septic shock with regular enteral feeding. Surgical finding showed hemorrhagic ischemia in the bowel. The pathologic finding suggests these changes may have been due to inspissations of bowel contents, which may put direct pressure on the mucosa of the bowel wall, leading to local impairment of mucosal and submucosal blood flow with subsequent bowel necrosis. Bowel ischemia may have been precipitated by an increased mesenteric blood flow requirement in combination with a metabolically stressed bowel. Patients in the intensive care unit fed a fiber-rich enteral formula may have inspissated bowel contents, leading to bowel ischemia, suggesting that the use of fiber-rich formula should be limited in patients at high-risk of bowel ischemia.
( Jun Gyo Gwon ),( Ju Wang Jang ),( Se Kwang Park ),( Se Uk Oh ),( Ho Song Kang ),( Joung Soo Kim ),( Hyun-min Seo ) 대한피부과학회 2020 大韓皮膚科學會誌 Vol.58 No.9
Background: Few studies have investigated the association between Behçet disease (BD) and cardiovascular disease (CVD). The aim of this study was to investigate the risk of various CVDs in patients with BD. Objective: The aim of this study was to investigate the risk of various CVD in patients with BD. Methods: Between 2003 and 2015, we performed a retrospective cohort study involving patients with BD selected from Korea’s National Health Insurance Service-National Sample Cohort database and age- and sex-matched controls. Age- and sex-matched controls were selected randomly from the NHIS-NSC database at a frequency of 1:5. Results: Among the 998 patients with BD and the 4,990 controls studied, patients with BD showed significantly higher risk for angina pectoris (adjusted Hazard Ratio [HR] 1.522, 95% confidence interval [CI] 1.020∼2.273; p=0.04) and peripheral arterial disease (adjusted HR 2.939, 95% CI 1.296∼6.664; p=0.01) than the controls. The cumulative incidence rates of these diseases in patients with BD were also significantly higher than those in the controls. Conclusion: Patients with BD showed independent risk for angina pectoris and peripheral arterial disease. (Korean J Dermatol 2020;58(9):608∼613)
Jun Gyo Gwon,Seonjeong Jeong,Hana Jin,Gi-Young Ko,Yong-Pil Cho,Tae-Won Kwon 대한외과학회 2022 Annals of Surgical Treatment and Research(ASRT) Vol.103 No.6
Purpose: Endovascular aneurysm repair (EVAR) has lower perioperative mortality and morbidity rates and shorter hospital stays when compared to open surgical repair (OSR) in octogenarian patients. However, its long-term results remain unclear. Hence, we aimed to analyze and compare the long-term outcomes of OSR and EVAR in this aging population. Methods: This single-center, retrospective, observational study analyzed the data of patients older than 80 years who underwent primary repair of an abdominal aortic aneurysm (AAA) between 2011 and 2016 in our hospital. The primary outcomes were in-hospital complications and 30-day mortality, while the secondary outcomes included all-cause mortality and reintervention rate. Results: Among the 48 patients with elective AAA repair, 13 underwent OSR and 35 underwent EVAR. In-hospital complications occurred in 10 patients (20.8%), 5 for OSR (38.5%) and 5 for EVAR (14.3%) with no significant difference between the groups (P = 0.067). In the OSR group, pulmonary complications were the most common events; in the EVAR group, 2 patients had ischemic colitis diagnosed with sigmoidoscopy and recovered by conservative treatment. The 1- and 5-year survival rates were 77.8% and 55.6% in the OSR group, and 66.0% and 54.9% in the EVAR group, respectively. The reintervention rate was 8.6% for the EVAR group; none of the OSR group were readmitted. Conclusion: The difference in procedures did not affect patient survival. Therefore, OSR does not necessarily have a worse prognosis than EVAR. Individual risk stratification must be preceded before the selection of an appropriate treatment method.
로드뷰 영상에서 번호판 숫자의 에지 특징을 이용한 자동차 번호판 영역 검출
권교현(Gyo-Hyeon Gwon),박종천(Jong-Cheon Park),전병민(Byoung-Min Jun) 한국산학기술학회 2014 한국산학기술학회 학술대회 Vol.- No.-
본 논문은 로드뷰 영상에서 개인정보 보호를 위해 자동차 번호판을 보이지 않도록 처리하기 위해서 번호판 영역을 검출하는 방법을 제안한다. 영상의 에지를 검출하고 번호판 숫자 영역의 에지 특징을 분석하여 번호판 후보 영역을 검출한 후, 번호판 영역의 구조적인 특징을 이용하여 최종적으로 번호판 영역을 검출하였다. 실험결과, 다양한 환경에서 촬영된 영상에서 정확률 87%, 재현률 83%의 검출결 과를 얻었다.
자연 영상에서 Double Edge 특징을 이용한 자동차 번호판 숫자 영역 검출
권교현(Gyo-Hyeon Gwon),박종천(Jong-Cheon Park),전병민(Byoung-Min Jun) 한국엔터테인먼트산업학회 2014 한국엔터테인먼트산업학회 학술대회 논문집 Vol.2014 No.11
본 논문은 모바일 기기로 획득한 자연 영상에서 개인 정보의 보호를 위해 자동차 번호판을 보이지 않도록 처리하기 위해서 번호판 영역을 검출하는 방법을 제안한다. 자연 영상에서 획득한 컬러 영상을 gray 영상으로 변환 후 영상의 Edge를 검출하고 번호판 숫자 영역의 double Edge 특징을 분석하여 번호판 후보 영역을 검출한 후, 번호판 영역의 구조적인 특징을 이용하여 최종적으로 번호판 영역을 검출하였다. 실험결과, 다양한 환경에서 촬영된 영상에서 번호판 숫자 영역은 정확률 82%, 재현률 86%의 검출결과를 얻었다.