• Journal of Chest Surgery
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• v.29 no.2
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• pp.177-184
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• 1996

Between 1987 and 1994, 21 patients were treated surgically for aortic aneurysm involving the thoracoabdominal aorta. There were 11 males and 10 females, and their age ranged from 20 to 67 years old and mean age was 41.5 years. Many complained of back pain, chest pain or discomfort, and flank pain, but three patients were asymptomatic. 15 patients had chronic dissection (71.4%) and 6 had nondissecting fusiform or saccular aneurysm(28.5%), and of those 15 patients with chronic dissection, 6(28.5%) had atherosclerosis assniated with hypertension, 5 (23.8%) were Martian syndrome, and 2 (9.5%) were associated with pregnancy. The diameter of an aneurysm ranged from 6cm to 12cm, and their extent was classified as type I in 7(33.3%), type II in 8(38.1%), type III in 3(14.3%), and type IV in 3(14.3%) patients based on Crawford classification for TAA . Diseased aorta was replaced with artificial vascular graft in all but one patient. In whom the aortic tear site due to pseudoaneurysm was closed by primary suture. For the spinal cord protection during the operation, we used partial cardiopulmonary bypass (FV-FA or PA-FA bypass) in 12 patients (57.1%), Biopump (LA-FA bypass) in 4(19.0%), total circulartory arrest and CPB in 2 (9.5%), Gott's heparinized shunt in 1(4.7%), and simple aortic cross clamping in 2 (9.5%). The most common complication after the operation was hoarseness due to unilateral vocal cord palsy which onured in 5 patients (23.8%), and the next common complication was wound infection in 4 patients(19.0%), paraplegia in 2 patients (9.5%), chylothorax in 1 patient(4.7%). The hospital mortality rate was 9.5% (2deaths), and there was no late death. Our experience shows that the graft replacement of TAAA had reasonable rate of mortality, low rate of serious complication, and provided good post operative state of the pati nts, and since the thoracoabdominal aortic operation is not a high risky procedure anymore, we recommend a radical operation for the indicated patients.

• Journal of the Korean Orthopaedic Association
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• v.54 no.1
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• pp.45-51
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• 2019

Purpose: The clinical and radiological results of patients with type 3 talar neck fractures treated with the anteromedial approach using medial malleolar osteotomy and large distractor were analyzed retrospectively. Materials and Methods: From March 2009 to August 2016, 12 patients with a type 3 talar neck fracture, who underwent the anteromedial approach using a medial malleolar osteotomy and large distractor and who could be followed-up for more than 12 months after the operation, were examined. The patients were examined for the presence of Hawkins signs by anteroposterior and lateral radiographs and osteonecrosis by magnetic resonance imaging (MRI) on the postoperative 3 months. Subsequently, every 3 months, radiographic union was assessed by a simple radiograph and clinical symptoms. Twelve months postoperatively, posttraumatic arthritis was assessed and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was analyzed. Results: In 7 cases, osteonecrosis was found on MRI performed 3 months after surgery. On the other hand, at the 12 months follow-up, all of them obtained AOFAS scores of 83.86±4.53 without surgical treatment. Radiographic union was achieved in all cases. The mean union period was 5.3 months. In 10 cases, traumatic arthritis was found after the radiographical and clinical evaluation. In addition, all of them could carry on everyday life by conservative treatment. The AOFAS ankle-hindfoot score was measured to be 85.17 on average. Other complications included superficial wound infection in 2 cases. Conclusion: An anteromedial approach using a medial malleolar osteotomy and a large distractor in the surgical treatment of patients with type 3 talar neck fractures can achieve anatomical reduction of the displaced fragment without a lateral dissection. This is considered to be another good surgical option.

• Tuberculosis and Respiratory Diseases
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• v.54 no.1
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• pp.71-79
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• 2003

Background : A bronchoalveolar lavage(BAL) is useful in diagnosing the etiology of bilateral pulmonary infiltrations, but may worsen the oxygenation and clinical status in severely hypoxemic patients. This study assessed the safety and efficacy of the continuous positive airway pressure(CPAP) using a conventional mechanical ventilator via a face mask as a tool for maintaining the oxygenation level during BAL. Methods : Seven consecutive patients with the bilateral pulmonary infiltrates and severe hypoxemia ($PaO_2/FIO_2$ ratio ${\leq}200$ on oxygen 10 L/min via mask with reservoir bag) were enrolled. The CPAP 5-6 $cmH_2O(F_IO_2\;1.0)$ was delivered through an inflatable face mask using a conventional mechanical ventilator. The CPAP began 10 min before starting the BAL and continued for 30 min after the procedure was completed. A bronchoscope was passed through a T-adapter and advanced through the mouth. BAL was performed using the conventional method. The vital signs, pulse oxymetry values, and arterial blood gases were monitored during the study. Results : (1) Median age was 56 years(male:female=4:3). (2) The baseline $PaO_2$ was $78{\pm}16mmHg$, which increased significantly to $269{\pm}116mmHg$(p=0.018) with CPAP. After the BAL, the $PaO_2$ did not decrease significantly but returned to the baseline level after the CPAP was discontinued. The $SpO_2$ showed a similar trend with the $PaO_2$ and did not decrease to below 90 % during the duration of the study. (3) The $PaCO_2$ increased and the pH decreased significantly after the BAL but returned to the baseline level within 30 min after the BAL. (5) No complications directly related to the BAL procedure were encountered. However, intubation was necessary in 3 patients(43 %) due to the progression of the underlying diseases. Conclusion : In severe hypoxemic patients, CPAP using a face mask and conventional mechanical ventilator during a BAL might allow minimal alterations in oxygenation and prevent subsequent respiratory failure.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1982.05a
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• pp.17.2-19
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• 1982

The sinus tympani is subject to great variability in the size, shape and posterior extent. A heavy compact bony zone, especially in the posterior portion and the narrow space between the facial nerve and posterior semicircular canal are the limitation of surgical approach. The facial recess should be opened, creating a wide connection between the mesotympanum and mastoid in the Intact canal wall tympanoplasty with mastoidectomy. The surgically created limits of the facial recess are the facial nerve medially, the chorda tympani laterally and the bone adjacent to the incus superiorly. Using adult Korean's thirty-five temporal bones, the authors measured the osteologic reslationship in the posterior tympanum, especially sinus tympani and facial recess. The result was as followed. 1. The average distance from the anterior end of the pyramidal eminence. 1) to the edge of the sinus tympani directly posterior was 2.54(1.05-5.40)mm. 2) to the maximum posterior extent was 3.22(1.25-7.45)mm. 3) to the maximum cephaled extent was 0.67 (0.40-1.75)mm. 2. The boundary of the sinus tympani was 82.9% from the lower margin oval window to the upper margin round window niche. 3. The deepest part of the sinus tympani was 62.9% in the mid portion, between the ponticulus and subiculum. 4. The oblique dimension from the fossa incudis above to the hypotympanum below was 8.13(7.90-9.55)mm. 5. The transverse dimensions midway between the oval window above and round window below was 3.00(2.85-3.45)mm. 6. The transverse dimension at the level of the fossa incudis was 1.81(1.40-2.15)mm. 7. The facial nerve dehiscence was 14.3%. 8. Anterior-posterior diameter of the footplate was 2.98(2.85-3.05) mm. 9. The average distance from the footplate. 1) to the cochleariform process was 1.42(1.35-1.55) mm. 2) to the round window niche was 1.85(1.45-2.10) mm.

• Pediatric Infection and Vaccine
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• v.8 no.2
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• pp.213-221
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• 2001

Propose : Tsutsugamushi fever is a acute febrile disease, which is caused by O. tsutsugamushi. Recently, this disease is increasingly reported in children. This study was undertaken to investigate clinical features of tsutsugamushi fever in children. Methods : This study involved 17 children with tsutsugamushi fever who were admitted to Masan Samsung hospital between September 1997 and December 2000. We investigated the age, sex ratio, clinical manifestations, laboratory findings, response of therapy and prognosis. Results : The age of patients was $6.9{\pm}3.6$ years, ranging from 6 months to 12 years and male predilection(58.8%) was noted and all cases of patients occured in October or November. The most common symptoms were fever in all cases and headache in 8(47.1%). The most common signs were skin rash in all cases, eschar in 14(82.4%) and lymphadenopathy 8(47.1%). Locations of the eschars were back and inguinal area in each 3 cases, neck and chest in each 2, popliteal area in 2, scalp and thigh in each 1. Laboratory findings included anemia in 1 case, leukopenia and thrombocytopenia in each 5, hematuria and proteinuria in each 1, ESR elevation in 2 and positive CRP in 12, AST elevation in 9 and ALT elevation in 7. Serologic diagnosis was made by passive hemagglutination assay(PHA) in 8 cases(47%) on admission, 4 cases in initial negative group were performed follow-up test at 2nd or 3rd weeks of illness and then all cases of 4 were converted to positive reaction. Clinical improvement was noticed in all cases after treatment to chloramhenicol or doxycycline. Mean duration for defervescence after treatment was $1.4{\pm}0.8$ days. Complications were interstitial pneumonia in 1 case and aseptic meningitis in 3, but all cases of patients were recovered without sequelae or recurrence. Conclusions : Tsutsugamushi fever in children was similiar to adult in the clinical features except male predilection. Early diagnosis and empirical treatment based on clinical manifestations such as fever, skin rash, eschar, lymphadenopathy is important and serologic diagnosis need to perform follow-up test at 2nd or 3rd weeks of illness.

• Childhood Kidney Diseases
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• v.2 no.1
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• pp.41-49
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• 1998

Treatment of $Henoch-Sch\"{o}nlein$ purpura nephritis(HSPN) accomanied by nephrotic syndrome is still controversal, even though both corticosteroids and immunosuppressants have been used for therapy. Azathioprine(AZA) is a chemical analog of the physiologic purines-adenine, guanine, and hyoxanthine and an antagonist to purine metabolism which may inhibit RNA and DNA synthesis and is mainly used for immunosuppressive agent. We studied the effects of AZA in HSPN accompanied by nephrotic syndrome and evaluating the clinical status and histopathologic changes by sequential biopsies following the treatment. Fifteen patients with nehprotic syndrome either initially or during the course of HSPN confirmed by renal biopsies were treated with AZA(2 mg/kg/day) and prednisolone (0.5-1 mg/kg/day qod) for 8months. Folow up renal biopsy was done after treatment in 11 patients. The clinical status of the patients on admission were C(12 cases) and B(3 cases). Improvement of clinical status were showed in 12 cases, but 3 cases were not improved and 1 case was aggrevated after AZA treatment. Complete remission of proteinuria were in 8 cases(53.3%), partial remission were in 4 cases(26.7%) and persistence of proteinuria and hematuria were in 3 cases(20.0%). The loss of hematuria were in 10 cases(66.7%). Histopathologically and immunopathologically, 4 cases were improved. This study suggests that, although control studies are needed, AZA could be used in the treatment of HSPN accompanied by nephrotic syndrome.

• The Journal of the Korean bone and joint tumor society
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• v.10 no.2
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• pp.96-106
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• 2004

Purpose: To determine the usefulness of limb salvage operation with recycled autogenous bone graft in musculoskeletal malignant tumors. Materials and Methods: Twenty nine cases, who underwent limb salvage operation with recycled autogenous bone graft for the treatment of musculoskeletal malignant tumor between February 1990 and January 2003, were included. There were 18 males and 11 females and the mean age was 33 years (range, 10 to 65 years). The mean follow-up period was 51.8 months (range, 18 to 117 months). The Enneking stage was IIA in 10 cases and IIB in 19 cases. The recycling method of autogenous bone was deep freezing in 6 cases, autoclaving in 11 cases, pasteurization in 7 cases and the composite of autoclaving and vascularized fibular graft in 5 cases. The union of junctional site was evaluated radiologically and the functional results was analyzed by the grading systems of the International Symposium On Limb Salvages (ISOLS). Results: The mean union time was 7.2 months (range, 3 to 15 months). The union took 5.8 months (range, 4 to 8 months) in deep freezing, 9.7 months (range, 6 to 15 months) in autoclaving, 5.9 months (range, 4 to 8 months) in pasteurization, and 5 months (range, 4 to 8 months) in the composite of autoclaving and vascularized fibular graft. The mean functional evaluation percentage was 76.8% (range, 40 to 90%). It was 65.8% (range, 40 to 85%) in deep freezing, 76.6% (range, 40 to 90%) in autoclaving, 81.6% (range, 70 to 90%) in pasteurization, and 83.4% (range, 75 to 90%) in the composite of autoclaving and vascularized fibular graft. There were 6 cases of complications including 1 case of local recurrence, lung metastasis, infection, fracture, respectively and 2 cases of nonunion. Conclusion: The limb salvage operation with recycled autogenous bone graft is a useful treatment method for the musculoskeletal malignant tumors. Particularly, autoclaving is the most reliable sterilization method. The vascularized fibular graft can compensate decreased osteoinductivity and mechanical strength of recycled bone. So, the composite of autoclaving and vascularized bone graft seems to be a favorable treatment method for high grade malignant musculoskeletal tumors.

• Tuberculosis and Respiratory Diseases
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• v.47 no.1
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• pp.57-65
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• 1999

Backround : Pneumoconiosis is the parenchymal lung disease that results from the inhalation and deposition of dust, usually mineral dust of occupational or environmental origin. Most of the pneumoconiosis can be categorized to coal workers' pneumoconiosis (CWP) in Korea. No effective treatement is currently available, and the therapy for symptomatic CWP is limited to treatment of complication. Therefore authors analyzed and reviewed clinical features and radiological findings of 95 patients with pneumoconiosis for assessing the prognostic factors in disease progression. Method: We reviewed medical records of 95 cases with pneumoconiosis including history, chest X-ray, pulmonary function test, electrocardiography, AFB stain and culture of sputum, and routine blood examination between June 1995 and June 1997 in Seonam University Namkwang Hospital. Results: All of cases are male(mean age, 57.4 years), 91 cases out of them are miners. The mean duration of exposure to dust is 18.8 years. Major clinical symptoms are dyspnea (100%), sputum (71.6%), chest pain (55.8%), cough (23.2%), and hemoptysis (6.3%). 82 % of cases are over Morgan-Seaton Grade 2 in the degree of dyspnea. Small opacity on chest x-ray is 82.1 % and large opacity is 17.9%. Small opacity has tit type (37.2%), q/q type (25.6%) and r/r type (11.5%). B type is 42.2% in large opacity. For the pulmonary function test, restrictive type is 40.3%, mixed type 19.5% and obstructive type 8.3%. The more increasing chest Xray density, the more decreasing $FEV_1$ (p<0.01). 38% of patients show tuberculosis in chest X-ray, 15.8% positive smear of acid fast bacilli in sputum. The prevalence of pulmonary tuberculosis is high in patients with poor clinical condition. The cases with the active pulmonary tuberculosis have severe dyspnea. Expired cases show 100% and 75% of positive pulmonary tuberculosis in chest X-ray and sputum examination, respectively. 75% of expired cases show the chronic cor pulmonale, who died of acute respiratory failure. Conclusion: These findings indicate that tuberculoois infection has a decisive influence on the progress and prognoois of pneumoconioois.

• Clinical and Experimental Pediatrics
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• v.51 no.6
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• pp.610-615
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• 2008

Purpose : Idiopathic thrombocytopenic purpura (ITP) is a relatively common hematological disease in children. It generally occurs after exposure to a common viral infection episode; however, it may occasionally follow immunization with measles, measles-mumps-rubella (MMR), hepatitis B (HBV), influenza, diphtheria-tetanus-pertussis (DTP), or chickenpox vaccines. In this study, the incidence, clinical characteristics, and treatment outcome of vaccination-associated ITP were investigated and compared with non-vaccination-associated ITP. Methods : The admission records of 105 pediatric ITP patients between 0-14 years of age admitted to Department of Pediatrics, Wonkwang University Hospital from January 1994 to July 2007 were retrospecitively reviewed. Patients were grouped into a vaccination-associated group and a non-vaccination-associated group according to vaccination history within the previous 1 month, and various clinical features between the two groups were statistically analyzed. Results : Thirteen patients (12%) had a preceding vaccination. Eight had received DTP vaccination, 2 had received hepatitis B, and 1 each had received influenza, MMR, and Japanese B encephalitis vaccination. However, none of the patients had a recurrent thrombocytopenia after subsequent vaccinations. In the vaccination-associated group, the age was significantly lower, anemia was more common, and the risk period with blood platelet count $<20{\times}10^9/L$ was significantly shorter than for the in non-vaccination-associated group. Also, wet purpura was less prominent and the remission within 1month was more frequently achieved in the vaccination-associated ITP group. Conclusion : Vaccination-associated ITP patients showed mild symptoms with a more benign and shorter lasting course than non-vaccination-associated ITP patients. Moreover, platelet count assessment at the time of the next immunization may not be necessary.

• Journal of Chest Surgery
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• v.32 no.8
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• pp.715-721
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• 1999

Background:The number of old patients receiving coronary artery bypass grafting(CABG) is increasing. With the more recent advances in operative techniques, the age at which CABG is indicated has also increased. This study evaluated the risk factors associated with the hospital mortality and the morbidity following CABG in elderly patients. Material and Method: Between March 1991 and June 1998, we retrospectively reviewed 45 consecutive patients aged 65 years or older who underwent CABG. We compared the data with the results of 179 patients under the age 65 years operated during the same period. Result: Mean age was 68${\pm}$1.41 years(range 65 to 74 years). Emergency surgery was required in 4, and elective surgery in 41 patients. The mean number of distal anastomosis per patient was 3.62 ${\pm}$0.81 and mean aortic cross-cramp time was 69.84${\pm}$18.5 minutes. Thirty patients had Canadian class III or IV preoperatively, but 43 patients had class I or II postoperatively. The left ventricular ejection fraction increased significantly from 54.23${\pm}$10.62% preoperatively to 58.14${\pm}$9.88% postoperatively(p<0.05). Postoperative complication was pneumonia in 2 patients, acute renal failure in 2 patients, sternal wound infection in 1 patient, and postoperative myocardial infarction in 1 patient. There were two postoperative deaths. The causes of deaths were low output syndrome in one patient, and sepsis due to pneumonia in the other patient. The hospital mortality was higher in the elderly group(4.4 versus 2.86%) but was not statistically significant(p>0.05). Incremental risk factors for hospital deaths in the elderly were emergent operation, preoperative PTCA, postoperative use of IABP and postoperative ARF(p<0.05). The duration of hospital stay after operation was significantly longer for the elderly group than the younger group(19.27${\pm}$12.51 vs 15.55${\pm}$6.99 days; p＜ 0.05). Follow-up was complete for 34 of the hospital survivors and ranged from 1 to 73 months(mean: 23.58${\pm}$19.56 months). There was no late mortality of cardiac origin. Conclusion: Age is an important factor in selecting optimal management for elderly patients with coronary compromise, but age alone should not dictate the choice of therapy. Coronary artery bypass surgery in the elderly is associated with acceptable early mortality and excellent long-term results.