4.Antiretroviral Therapy during Long-term Surgical Care: ‘Exploring Difficult Cases in HIV Clinics’ of the Korean Society for AIDS Conference in 2023
Jung Ho KIM ; Jae Eun SEONG ; Sangmin AHN ; Yongseop LEE ; Jung Ah LEE ; Jin Young AHN ; Su Jin JEONG ; Nam Su KU ; Joon-Sup YEOM ; Jun Yong CHOI
Infection and Chemotherapy 2024;56(3):287-299
With advancements in antiretroviral therapy (ART), the average lifespan of people with human immunodeficiency virus (HIV) is increasing, as is the number of older adults with HIV. Accordingly, the number of patients with HIV who undergo surgery or require critical care for various reasons is increasing. Since the prognosis of people with HIV depends on the continuous and effective maintenance of ART, there is a need to consider effectively maintaining ART in people with HIV in these conditions. This case involved a 55-year-old patient with well-controlled HIV who received ART and presented to the emergency room with acute abdominal pain. He was diagnosed with extensive bowel infarction and panperitonitis and received critical care in the intensive care unit, including mechanical ventilation and continuous renal replacement therapy. The patient was administered enteral nutrition via a nasogastric tube. The patient subsequently underwent extensive small bowel resection and developed short bowel syndrome. The patient maintained ART during that period. A literature review related to the use of ART under these conditions is included in this study. This case was discussed at the [Exploring Difficult Cases in HIV Clinics] of the Korean Society for AIDS Conference held in 2023.
5.Surgical extraction of a sublingually-displaced retained root with the aid of a magnetic field-based dynamic navigation system: a case study
Yoo-Sung NAM ; Seung-Eun LEE ; Sung-Ah CHE ; Sang-Yoon PARK ; Soo-Hwan BYUN ; Byoung-Eun YANG ; Sangmin YI
Journal of the Korean Association of Oral and Maxillofacial Surgeons 2024;50(6):367-372
The submandibular displacement of a mandibular third molar residual root presents major challenges to oral and maxillofacial surgeons due to the proximity to critical anatomical structures such as the lingual nerve and sublingual artery. Preoperative imaging can approximate the location of the residual tooth root; however, accurately determining its exact position is difficult because of the dynamic nature of the mandible and the difficulty of realtime synchronization of imaging. This study presents the successful extraction of a residual mandibular third molar root in a 67-year-old female patient achieved using a magnetic field-based navigation system. The sublingually-displaced residual root was localized using the navigation system, marked using a virtual implant placement, and positioned by a hand piece using synchronized real-time sensor data. The root was successfully removed with a minimally-invasive approach. No complications occurred postoperatively, and follow-up showed no major issues. Due to the small size of the marker, ease of calibration, and independence from visual obstacles, magnetic field-based navigation systems are a promising tool for the removal of residual roots displaced into adjacent soft tissue.
6.Successful extracorporeal membrane oxygenation treatment of catecholamine-induced cardiomyopathy-associated pheochromocytoma: a case report
Sangshin PARK ; Min KIM ; Dae In LEE ; Ju-Hee LEE ; Sangmin KIM ; Sang Yeub LEE ; Jang-Whan BAE ; Kyung-Kuk HWANG ; Dong-Woon KIM ; Myeong-Chan CHO ; Dae-Hwan BAE
Acute and Critical Care 2024;39(1):194-198
The main mechanism of Takotsubo cardiomyopathy (TCM) is catecholamine-induced acute myocardial stunning. Pheochromocytoma, a catecholamine-secreting tumor, can cause several cardiovascular complications, including hypertensive crisis, myocardial infarction, toxic myocarditis, and TCM. A 29-year-old woman presented to our hospital with general weakness, vomiting, dyspnea, and chest pain. The patient was nullipara, 28 weeks’ gestation, and had a cachexic morphology. Her cardiac enzyme levels were elevated and bedside echocardiography showed apical akinesia, suggesting TCM. The next day, she could not feel the fetal movement, and an emergency cesarean section was performed. After delivery, the patient experienced cardiac arrest and was transferred to the intensive care unit for cardiopulmonary resuscitation (CPR). Spontaneous circulation returned after 28 minutes of CPR, but cardiogenic shock continued, and extracorporeal membrane oxygenation (ECMO) was initiated. On the third day of ECMO maintenance, left ventricular ejection fraction improved and blood pressure stabilized. On the eighth day after ECMO insertion, it was removed. However, complications of the left leg vessels occurred, and several surgeries and interventions were performed. A left adrenal gland mass was found on computed tomography and was removed while repairing the leg vessels. Pheochromocytoma was diagnosed and left adrenalectomy was performed.
7.Successful extracorporeal membrane oxygenation treatment of catecholamine-induced cardiomyopathy-associated pheochromocytoma: a case report
Sangshin PARK ; Min KIM ; Dae In LEE ; Ju-Hee LEE ; Sangmin KIM ; Sang Yeub LEE ; Jang-Whan BAE ; Kyung-Kuk HWANG ; Dong-Woon KIM ; Myeong-Chan CHO ; Dae-Hwan BAE
Acute and Critical Care 2024;39(1):194-198
The main mechanism of Takotsubo cardiomyopathy (TCM) is catecholamine-induced acute myocardial stunning. Pheochromocytoma, a catecholamine-secreting tumor, can cause several cardiovascular complications, including hypertensive crisis, myocardial infarction, toxic myocarditis, and TCM. A 29-year-old woman presented to our hospital with general weakness, vomiting, dyspnea, and chest pain. The patient was nullipara, 28 weeks’ gestation, and had a cachexic morphology. Her cardiac enzyme levels were elevated and bedside echocardiography showed apical akinesia, suggesting TCM. The next day, she could not feel the fetal movement, and an emergency cesarean section was performed. After delivery, the patient experienced cardiac arrest and was transferred to the intensive care unit for cardiopulmonary resuscitation (CPR). Spontaneous circulation returned after 28 minutes of CPR, but cardiogenic shock continued, and extracorporeal membrane oxygenation (ECMO) was initiated. On the third day of ECMO maintenance, left ventricular ejection fraction improved and blood pressure stabilized. On the eighth day after ECMO insertion, it was removed. However, complications of the left leg vessels occurred, and several surgeries and interventions were performed. A left adrenal gland mass was found on computed tomography and was removed while repairing the leg vessels. Pheochromocytoma was diagnosed and left adrenalectomy was performed.
8.Successful extracorporeal membrane oxygenation treatment of catecholamine-induced cardiomyopathy-associated pheochromocytoma: a case report
Sangshin PARK ; Min KIM ; Dae In LEE ; Ju-Hee LEE ; Sangmin KIM ; Sang Yeub LEE ; Jang-Whan BAE ; Kyung-Kuk HWANG ; Dong-Woon KIM ; Myeong-Chan CHO ; Dae-Hwan BAE
Acute and Critical Care 2024;39(1):194-198
The main mechanism of Takotsubo cardiomyopathy (TCM) is catecholamine-induced acute myocardial stunning. Pheochromocytoma, a catecholamine-secreting tumor, can cause several cardiovascular complications, including hypertensive crisis, myocardial infarction, toxic myocarditis, and TCM. A 29-year-old woman presented to our hospital with general weakness, vomiting, dyspnea, and chest pain. The patient was nullipara, 28 weeks’ gestation, and had a cachexic morphology. Her cardiac enzyme levels were elevated and bedside echocardiography showed apical akinesia, suggesting TCM. The next day, she could not feel the fetal movement, and an emergency cesarean section was performed. After delivery, the patient experienced cardiac arrest and was transferred to the intensive care unit for cardiopulmonary resuscitation (CPR). Spontaneous circulation returned after 28 minutes of CPR, but cardiogenic shock continued, and extracorporeal membrane oxygenation (ECMO) was initiated. On the third day of ECMO maintenance, left ventricular ejection fraction improved and blood pressure stabilized. On the eighth day after ECMO insertion, it was removed. However, complications of the left leg vessels occurred, and several surgeries and interventions were performed. A left adrenal gland mass was found on computed tomography and was removed while repairing the leg vessels. Pheochromocytoma was diagnosed and left adrenalectomy was performed.
9.Successful extracorporeal membrane oxygenation treatment of catecholamine-induced cardiomyopathy-associated pheochromocytoma: a case report
Sangshin PARK ; Min KIM ; Dae In LEE ; Ju-Hee LEE ; Sangmin KIM ; Sang Yeub LEE ; Jang-Whan BAE ; Kyung-Kuk HWANG ; Dong-Woon KIM ; Myeong-Chan CHO ; Dae-Hwan BAE
Acute and Critical Care 2024;39(1):194-198
The main mechanism of Takotsubo cardiomyopathy (TCM) is catecholamine-induced acute myocardial stunning. Pheochromocytoma, a catecholamine-secreting tumor, can cause several cardiovascular complications, including hypertensive crisis, myocardial infarction, toxic myocarditis, and TCM. A 29-year-old woman presented to our hospital with general weakness, vomiting, dyspnea, and chest pain. The patient was nullipara, 28 weeks’ gestation, and had a cachexic morphology. Her cardiac enzyme levels were elevated and bedside echocardiography showed apical akinesia, suggesting TCM. The next day, she could not feel the fetal movement, and an emergency cesarean section was performed. After delivery, the patient experienced cardiac arrest and was transferred to the intensive care unit for cardiopulmonary resuscitation (CPR). Spontaneous circulation returned after 28 minutes of CPR, but cardiogenic shock continued, and extracorporeal membrane oxygenation (ECMO) was initiated. On the third day of ECMO maintenance, left ventricular ejection fraction improved and blood pressure stabilized. On the eighth day after ECMO insertion, it was removed. However, complications of the left leg vessels occurred, and several surgeries and interventions were performed. A left adrenal gland mass was found on computed tomography and was removed while repairing the leg vessels. Pheochromocytoma was diagnosed and left adrenalectomy was performed.
10.Oval Tunnel Shows Better Rotational Stability Than Round Tunnel in Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction:Biomechanical Study in a Porcine Model
Seong Hwan KIM ; Kyu-Tae KANG ; Han-Jun LEE ; Deokjae HEO ; Kyunghwan CHA ; Sangmin LEE ; Yong-Beom PARK
Clinics in Orthopedic Surgery 2024;16(6):925-931
Background:
To compare knee laxity between the conventional round tunnel and oval tunnel techniques in primary anterior cruciate ligament (ACL) reconstruction in a porcine knee model.
Methods:
Twenty porcine knees were used for evaluating laxity in terms of anterior translation and anterolateral rotation. The study determined porcine knee kinematics on the Instron instruments under simulated Lachman (89 N anterior tibial load) at 15°, 30°, and 60° of flexion and a simulated pivot shift test (89 N anterior tibial load, 10 Nm valgus, and 4 Nm internal tibial torque) at 30° of flexion. Kinematics were recorded for intact (n = 10), ACL-deficient (n = 10), and conventional round (n = 10) or oval tunnel (n = 10) techniques. All measurements were repeated twice, and the average was used for comparison.
Results:
Under the Lachman test, the conventional round tunnel and oval tunnel both showed significantly larger anterior tibial translation (ATT) at 30° and 60° compared to the intact knee (p < 0.05), but smaller ATT compared to the ACL-deficient knees (p < 0.05). However, there were no differences in ATT between the conventional round tunnel and oval tunnel techniques (p > 0.05). Under simulated pivot shift at 30° flexion, there was a significant difference between the conventional round tunnel and oval tunnel techniques (round vs. oval: 4.27 ± 0.87 mm vs. 3.52 ± 0.49 mm, p = 0.028).
Conclusions
Both conventional round tunnel and oval tunnel techniques reduced ATT compared to ACL-deficient knees but failed to restore normal knee stability. However, the oval tunnel technique showed better rotational stability at 30° than the round tunnel technique. These findings suggest that the oval tunnel technique would be a reasonable option in anatomical single-bundle ACL reconstruction.

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