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( Sung Woo Moon ),( Ji Ye Jung ),( Young Ae Kang ),( Moo Suk Park ),( Young Sam Kim ),( Se Kyu Kim ),( Joon Chang ),( Hyo Chae Park ),( Chang Young Lee ),( Song Yee Kim ) 대한결핵 및 호흡기학회 2014 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.118 No.-
Background: Primary graft dysfunction (PGD) is a severe type of acute lung injury after lung transplantation and is reported to be associated with early morbidity and mortality. We were to investigate donor, recipient, and perioperative risk factors and outcome of PGD. Methods: We performed a retrospective study using data collected in one tertiary care hospital in South Korea. The patients who underwent lung transplantation between January 2010 and March 2014 were enrolled. The primary outcome was grade 3 PGD (PaO2/FiO2 < 200 and presence of diffuse infiltrates on chest radiograph of allograft at 48 or 72 hours after transplant) and PGD grade was defined according to International Society for Heart and Lung Transplantation criteria. Results: A total of 61 patients were enrolled and 16 subjects (26.2%) developed grade 3 PGD. In univariate study, higher body mass index (BMI) in recipients, any history of recipient smoking, extracorporeal membrane oxygenation usage before transplantation in recipients, and ischemic time during operation were associated with PGD. Primary recipient diagnosis, transplant type, mean pulmonary artery pressure, donor-smoking history were not related with PGD. In multivariate model, independent risk factors for PGD were BMI in recipients (Odds ratio [OR], 1.290; P=0.048) and total ischemic time during operation (OR, 1.013; P=0.009). PGD was significantly associated with higher re-operation rate (OR, 3.500; P=0.042), longer days of ventilator apply (median 6 days vs.14.5 days; P=0.044), longer intensive care unit stay (median 9 days vs. 17 days; P=0.041) and higher rate of renal replacement therapy (OR, 7.708; P=0.002) after transplantation. Conclusions: We identified risk factors and outcome of grade 3 PGD after lung transplantation. Our findings can be used to develop predictive models for PGD that may allow for modification of risk factors.
( Hyo-joon Yang ),( Chang Woo Cho ),( Jongha Jang ),( Sang Soo Kim ),( Kwang-sung Ahn ),( Soo-kyung Park ),( Dong Il Park ) 대한내과학회 2021 The Korean Journal of Internal Medicine Vol.36 No.4
Background/Aims: We aimed to develop a deep learning model for the prediction of the risk of advanced colorectal neoplasia (ACRN) in asymptomatic adults, based on which colorectal cancer screening could be customized. Methods: We collected data on 26 clinical and laboratory parameters, including age, sex, smoking status, body mass index, complete blood count, blood chemistry, and tumor marker, from 70,336 first-time colonoscopy screening recipients. For reference, we used a logistic regression (LR) model with nine variables manually selected from the 26 variables. A deep neural network (DNN) model was developed using all 26 variables. The area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of the models were compared in a randomly split validation group. Results: In comparison with the LR model (AUC, 0.724; 95% confidence interval [CI], 0.684 to 0.765), the DNN model (AUC, 0.760; 95% CI, 0.724 to 0.795) demonstrated significantly improved performance with respect to the prediction of ACRN (p < 0.001). At a sensitivity of 90%, the specificity significantly increased with the application of the DNN model (41.0%) in comparison with the LR model (26.5%) (p < 0.001), indicating that the colonoscopy workload required to detect the same number of ACRNs could be reduced by 20%. Conclusions: The application of DNN to big clinical data could significantly improve the prediction of ACRNs in comparison with the LR model, potentially realizing further customization by utilizing large quantities and various types of biomedical information.
Obturator schwannoma: Two cases of report and literature review
( Hyo-eun Kim ),( Jin-young Choi ),( Hyun-jin Rho ),( Soo-jeong Lee ),( Jun-woo Ahn ),( Sang-hun Lee ) 대한산부인과학회 2018 대한산부인과학회 학술대회 Vol.104 No.-
Schwannomas are nerve sheath tumors that usually affect the head, neck and the flexor surfaces of the extremities. These are usually slow growing tumors and are often detected incidentally. These tumors are usually solid but may undergo necrosis and cystic degeneration. It is rare to find a schwannoma in the retroperitoneal cavity. We present our clinical experience with benign retroperitoneal schwannomas in two patients who underwent surgical excision. Surgical treatment of schwannomas are challenging to achieve complete resection of them without an unexpected injury to urinary, digestive, reproductive and neurogenic system. In the first case, we report laparoscopic management of an obturator nerve schwannoma in a 40-year-old woman with right lower abdominal pain. CT and MRI revealed a mass 40mm in diameter in the right obturator fossa, suggesting a retroperitoneal tumor. Because CT and MRI revealed clear continuity with the right obturator nerve, this case was preoperatively diagnosed as an obturator nerve schwannoma. Tumor enucleation was performed by laparoscopy. In the second case, total transabdominal hysterectomy and retroperitoneal mass excision was performed due to large symptomatic uterine myoma and concurrent left retroperitoneal mass. On intraoperative exploration, the mass was noted to be contiguous with the obturator nerve, either invading into the nerve or arising from the nerve itself. The final pathology of the two cases resulted in benign schwannoma. The patients had no complications and neurologic deficits. There were no evidences of recurrence for one-year follow-up. Preoperative diagnosis of obturator nerve schwannomas is quite difficult, but careful inspection of CT and MRI is important to identify the original nerve of schwannoma preoperatively. Laparoscopic resection is a good treatment option in suspicious isolated schwannoma in retroperitoneal space.
( Sung-woo Ahn ),( Nam-joon Yi ),( Kyung Chul Yoon ),( Suk Kyun Hong ),( Hyo-sin Kim ),( Hyeyoung Kim ),( Youngrok Choi ),( Kwang-woong Lee ),( Kyung-suk Suh ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Purpose: Pediatric liver transplantation (PLT) has been the key therapy for end stage liver disease and the outcome has been excellent. However, still surgical complication associated with small recipient is the main cause of graft loss. In the present study, we assessed recent advances in outcome of PLTs through our experience. Methods: A total of 235 PLTs performed between Mar 1988 and July 2015 were analyzed. Three chronological periods were investigated: the initial period (1988-2007, n=117), the mid-term period in which our PLT management protocol was settled down (2008-2011, n=62), and the period in which surgical procedures were refined for small children (2012-2015, n=56). Results: The grafts’ (84% vs. 82% vs. 98%) and patients’ (84% vs. 87% vs. 98%) survival have been improved (p<0.05), whereas the number of biliary atresia (31% vs. 45% vs. 50%) deceased and the proportion of deceased donor (24% vs. 36% vs. 52%) and split PLT (7%vs. 16% vs. 46%) increased (p<0.05). The number of re-LT (3% vs. 9% vs. 2%) has been changed. ABO incompatible PLT has introduced on the last period (9%). Conclusion: The quality of the PLT has recently been standardized through a large volume of experience, and the operation has been proven to improve the survival outcome. However, a constant evaluation of our experience is critical for further progress.