• Journal of Chest Surgery
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• v.41 no.2
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• pp.285-288
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• 2008

Recurrent pneumothorax was associated with the menstrual cycle in two women 20 to 30 years age; this is referred to as catamenial pneumothorax. This form of pneumothorax occurs within 72 hours before or after the onset of menstruation. The pathophysiology underlying this condition is unknown. We report here on two cases of catamenial pneumothorax that were successfully treated by partial resection of the diaphragm.

• Journal of Chest Surgery
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• v.39 no.4 s.261
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• pp.298-303
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• 2006

Background: This study was performed to investigate the outcomes of vascular operations that were done in patients with atheroscerosis obliterans (ASO) of lower limb. Material and Method: Forty patients underwent vascular operations from December 1996 to June 2004. The patient's records were analyzed retrospectively. Mean age was $66{\pm}8$ years (range, $47{\sim}81$ years). Gender ratio was 37:3 (male:female). Result: The operations were done on 50 lower limbs of 40 patients. The names of operations were femoropopliteal bypass in 12 patients (30%), femorofemoral bypass in 12 (30%), femorofemoral bypass and femoropopliteal bypass in five (12.5%), aorta-lower limb artery bypass in five (12.5%), axillofemoral bypass in two (5%), iliopopliteal bypass in two (5%), and endarterectomy in two (5%). All bypass surgeries were done with prosthetic conduits. Mean follow up period was $33.2{\pm}23.2$ months (range, $3.8{\sim}90.2$ months). The cumulative patency rates of 1 and 5 years were 75.5 and 58.7% respectively. In six patients, amputation of the lower limb was done. In eight patients, 12 complications occurred. After the first operation, 10 patients underwent reoperations. Conclusion: Our lower limb arterial bypass surgery revealed acceptable patency rate, but not a few patients required reoperations. An epochal treatment modality that can inhibit the progress of ASO and improve long term patency should be established.

• Journal of Chest Surgery
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• v.33 no.11
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• pp.869-875
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• 2000

배경: 뇌혈관계 합병증은 관상동백우회술 후 발생하는 사망률 중 10% 이상을 차지하는 치명적인 질환이다. 최근들어 고령 환자, 고혈압, 당뇨병 등이 병발하고 고 위험군에 대한 수술이 증가하면서 뇌혈관계 합병증은 오히려 증가하고 있다. 본 연구는 관상동맥우회술을 받은 환자의 의무기록을 조사하여 관상동맥우회술 후 발생되는 뇌혈관계 질환의 위험 인자를 밝히고자 한다. 대상 및 방법: 1991년 3월부터 1999년 7월 사이에 관상동맥우회술을 받은 185명을 조사하여, 뇌혈관계 합병증의 위험 인자들을 통계적으로 검증하였다. 결과: 뇌혈관계 합병증의 유병율은 7.57%(14명)였으며 이중 5예는 사망하였다. 동 기간 중 전체 사망은 11예이므로 사망자의 45.5%가 뇌혈관계 합병증으로 사망한 것이다. 통계적의의가 있는 뇌혈관계 합병증 위험 인자로는 수술 후 부정맥(p=0.0064), 기왕의 뇌혈관계 병력(p=0.0090), 체외순환시간(p=0.0181), 대동맥의 동맥경화(p=0.03575) 및 당뇨병(p=0.0452) 등이었다. 경동맥협착이 동반되어 경동맥 혈관내막 절제술(carotid endarterectomy)을 동시에 시술한 경우는 2예였으나, 뇌혈관계 합병증은 발생하지 않았다. 75세 이상의 고령환자는 3명이었으며 모두 뇌혈관계 합병증은 발생하지 않았다. 결론: 관상동맥우회술 후 발생하는 뇌혈관계 질환과 통계적으로 유의한 위험요인은 수술 후 부정맥, 뇌혈관이상의 기왕력, 체외순환시간, 대동맥궁의 동맥경화, 당뇨 등이었다.

• Journal of Korean Neurosurgical Society
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• v.30 no.3
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• pp.284-294
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• 2001

Objective : Stroke is leading cause of death and more importantly it is cause of serious disability. The effective treatment of acute ischemic stroke still remains a challenge to modern medicine. Recent clinical trials have shown that carotid endareterctomy(CEA) provide overwhelming benefits compared with medical therapy in preventing subsequent stroke for symptomatic carotid stenosis. For the asymptomatic ones, the data are less compelling, but highly suggestive that CEA do have benefits in properly selected patients. Materials and Methods : To investigate the clinical manifestations of carotid stenosis and results of CEAs, authors analyzed retrospectively 19 CEAs in 16 patients from June 1986 to June 1999. Age of patients ranged from 55 to 76 years(median, 66) and male to female ratio was 14 to 2. The duration of follow-up was 1 to 144 months (median, 26). All of CEAs were done on the side of stenosis more than 80% and bilateral CEAs were done in three. Six CEAs were performed in asymptomatic patients. Results : Seventeen of 19 CEAs showed excellent results and complication rate was low although ipsilateral ischemic stroke occurred in two. Conclusion : CEA may be a valuable surgical treatment for ischemic stroke caused by carotid stenosis and also for prevention of stroke of asymptomatic patients with carotid stenosis.

• Journal of Chest Surgery
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• v.42 no.5
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• pp.653-656
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• 2009

The entrapment of the popliteal artery is a rare cause of ischemia of the lower extremities among young males. The development of local occlusive or aneurysmal changes of the popliteal artery is caused by abnormal anatomic relationships between vascular and musculo-tendinous structures in the popliteal fossa. An 18-year-old male visited our outpatient clinic with the chief complaint of claudication in his right calf. Three dimensional CT angiography showed an occlusion of the popliteal artery and less opacified arteries of the right leg. Intraoperatively, the popliteal artery was compressed by an accessory muscle band arising from the medial head of the gastrocnemius. After release of the muscle band, thrombectomy with endarterectomy was done. Three years after surgery, he is doing well without any problems.

• Investigative Magnetic Resonance Imaging
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• v.17 no.1
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• pp.55-58
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• 2013

Persistent proatlantal artery (PPA) is a rare embryologically remnant carotico-vertebrobasilar anastomoses. There are two types of PPA according to embryological considerations, origin and anatomic course. Type I PPA usually originate from internal carotid artery and not traversing transverse foramen. Type II PPA traverses from external carotid artery to C1 transverse foramen. The PPA is usually found incidentally without clinical symptoms, but can be related to several clinically significant vascular lesions, such as hypoplastic vertebral artery, intracranial arteriovenous malformation and in a case of carotid endarterectomy or external carotid artery embolization. So, thorough understanding of this anomaly is needed and we report a case of type II PPA diagnosed by MR angiography.

• Radiation Oncology Journal
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• v.25 no.2
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• pp.93-100
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• 2007

[ $\underline{Purpose}$ ]: To evaluate the outcome and prognostic factors of postoperative radiotherapy in endometrial carcinoma. $\underline{Materials\;and\;Methods}$: From September 1991 to August 2003, 76 patients with endometrial carcinoma received postoperative adjuvant radiotherapy after hysterectomy at Asan Medical Center. Stage was classified as FIGO I in 41 (53.9%), II in 12 (53.9%), and III in 23 (30.3%). Histologic grade 1, 2 and 3 were in 29 (38.2%), 20 (26.3%), and 27 (35.5%) respectively. Forty two patients received both external beam radiation therapy (EBRT) and intracavitary radiation (ICR), 34 patients were treated with EBRT or ICR alone. EBRT dose was 50.4 Gy, ICR was performed in $4{\sim}6$ fractions with $4{\sim}5\;Gy$ per fraction. Median follow-up period was 51 (range $5{\sim}121$) months. $\underline{Results}$: Five-year overall survival was 89.6%. In univariate analysis, statistically significant factors to overall survival were FIGO stage, lymph node metastasis and histologic grade. In disease free survival, FIGO stage, lymph node metastasis and lymphovascular invasion were significant prognostic factors. Recurrence was seen in 11 patients. Of these, systemic failure was in 10 patients. There were no moderate to severe complications after radiation therapy. $\underline{Conclusion}$: The outcome of postoperative adjuvant radiotherapy in endometrial carcinoma was good. Main pattern of failure after postoperative radiotherapy was distant metastasis. So, adjuvant chemotherapy may help in improving outcome. Further study on chemotherapy in combined with postoperative radiotherapy will be needed, especially for patients with high risk factors such as high FIGO stage, lymphovascular invasion, and high histologic grade.

• Journal of Chest Surgery
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• v.30 no.3
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• pp.275-281
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• 1997

The radial artery as a graft for myocardial revascularization was introduced by Carpentier in the early 1970s. Mid-term results were unfortunately discoura ing, and the clinical experience with this graft was interrupted. At the end of the 1980s, these authors reproposed the same arterial conduit with more satisfying results, because of improved technique and pharmacological management of the graft. Between October 1994 and July 1995, 36 patients underwent myocardial revascularization with a radial artery graft in Seiong General Hospital. Left internal mammary artery was concomitantly used as a pedicled Vift in 34 patients. Fifteen patients (42%) had a complete arterial waft revascularization. A total of 12) distal anastomoses were performed (average 3.4 per patient), including 36 left internal mammary artery wafts (two sequential in 2 patients), and 23 saphenous vein grafts. The remaining 64 distal anastomoses were perFormed with radial artery grafts (mean 1.8 per patient). The radial arteries were anastomosed to the circumflex (n=38), diagonal (n= 18), right coronary(n=G), and left anterior descending coronary artery(n=2). The percent ge of radial artery graft anastomoses (64) to the total anastomoses(123) was 52%. The radial artery was used as a single graft in 10 patients, as a sequential graft in 25 patients, and two grafts in 1 patient. Twenty patients underwent associated procedures coronary endarterectomy (14), coronary artery patch angioplasty (4), mitral valve repair (1), and repair of ventricular septal rupture (1). One patient died of low cardiac output syndrome and the others had no perioperative myocardial infarction. There are no ischemic and functional complications in the arm or hand aftcr removal of the radial artery. Only 1 patient required reexploration of the am, for the hematoma evacuation, and 2 patients complained transient thumb dysesthesia of the side of the havested arm. This dysesthesia improved within one month. Postoperative angiovaphic controls were obtained in 11 patients(31%) postoperative 79 to 210 days (mean 126 days). The patency rate were as follows : left internal mammary artery (100%), saphcnous vein (100%), and radial artery(95%). We concluded that the radial artery is useful alternative graft, but long term clinical and angiographic studies are required to derterminc whether wider application is warranted.

• Radiation Oncology Journal
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• v.26 no.3
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• pp.149-159
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• 2008

Purpose: To evaluate the results and prognostic factors for postoperative adjuvant radiation therapy in patients at stages I and II of endometrial cancer. Materials and Methods: Between January 1991 and December 2006, 35 patients with FIGO stages I and II disease, who received adjuvant radiation therapy following surgery for endometrial cancer at Ewha Womans University Hospital, were enrolled in this study. A total of 17 patients received postoperative pelvic external beam radiation therapy; whereas, 12 patients received vaginal brachytherapy alone, and 6 patients received both pelvic radiation therapy and vaginal brachytherapy. Results: The median follow-up period for all patients was 54 months. The 5-yr overall survival and disease-free survival rates for all patients were 91.4% and 81.7%, respectively. The 5-yr overall survival rates for low-risk, intermediate-risk, and high-risk groups were 100%, 100% and 55.6%, respectively. In addition, the 5-yr disease-free survival rates were 100%, 70.0%, and 45.7%, respectively. Although no locoregional relapses were identified, distant metastases were observed in 5 patients (14%). The most common site of distant metastases was the lung, followed by bone, liver, adrenal gland, and peritoneum. A univariate analysis revealed a significant correlation between distant metastases and risk-group (p=0.018), pathology type (p=0.001), and grade (p=0.019). A multivariate analysis also revealed that distant metastases were correlated with pathology type (p=0.009). Papillary, serous and clear cell carcinoma cases demonstrated a poor patient survival rate compared to cases of endometrioid adenocarcinoma or adenosquamous carcinoma. The most common complication of pelvic external beam radiation therapy was enteritis (30%), followed by proctitis, leucopenia, and lymphedema. All these complications were of RTOG grades 1 and 2; no grades 3 and 4 were observed. Conclusion: For the low-risk and intermediate-risk groups (stages 1 and 2) endometrial cancer, pelvic control, and overall survival rate was free of severe toxicity when pelvic radiation therapy or vaginal brachytherapy was performed. In the high-risk group, pelvic control rate was excellent, but the survival rate was poor due to distant metastases, in spite of the pelvic radiation therapy. The combined modality of chemotherapy and radiation therapy is recommended for high-risk groups. For the intermediate-risk group, a prospective randomized study is required to compare the efficacy between whole pelvic radiation therapy and vaginal brachytherapy.

• Clinical and Experimental Reproductive Medicine
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• v.31 no.2
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• pp.119-131
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• 2004

연구 목적: 난소에서 분비되는 스테로이드 호르몬인 에스트로젠과 프로게스테론은 포유동물의 생식기관 발달과 정상적인 생식 기능, 수정과 배아의 착상에 중요한 역할을 한다. 특히 에스트로젠은 자궁내액을 내강으로 분비하여 자궁부종 기작에 중요한 역할을 한다. 자궁내액은 정자의 수정능력 획득과 착상전 배아의 발달에 매우 중요하다. Aquaporin (AQP)은 막관통 물수송 단백질로서 여러 조직에 넓게 분포되어 있으며, 세포간 또는 상피세포간 물의 이동에 중요한 역할을 한다. 본 연구에서는 생쥐 자궁에서 스테로이드 호르몬에 의해 조절되는 자궁내액의 이동에 AQP 유전자가 관여하는지를 알아보았다. 연구 재료 및 방법: 난소 절제술을 시행한 생쥐에 스테로이드 호르몬을 피하주사하고 6, 12, 24시간 간격으로 자궁조직을 적출하였다. 대조군은 sesame oil만을 주사한 후 6시간째에 수획한 자궁조직을 사용하였으며, 실험군은 시간대별과 스테로이드 처리별로 채취한 자궁조직에서 역전사중합효소반응을 수행하였다. 역전사중합효소반응을 통해 막관통 단백질인 AQP-4, -5, -8 mRNA의 발현양상을 살펴보았다. 또한 mRNA의 위치를 살펴보기 위해 laser microdissection을 이용하여 RT-PCR을 수행하였다. 마지막으로 자궁조직내에서의 단백질 발현 부위를 관찰하기 위해 면역조직화학염색을 실시하였다. 결 과: AQP-4, -5, -8 mRNA은 프로게스테론을 처리한 군보다 에스트로젠을 처리한 군에서 많이 발현되었으며, 에스트로젠을 주사한 지 6시간째 발현정도를 대조군과 비교할 때 AQP-4, -5, -8 mRNA가 각각 7.9배, 2.8배, 3.8배로 나타났다. AQP-4, -5, -8 mRNA는 간충조직보다 자궁내 상피조직에서 스테로이드 호르몬의 영향을 받아 발현양상의 차이가 나타났으며, 주로 에스트로젠의 영향을 받아 발현이 증가하였다. AQP-4 단백질은 에스트로젠을 24시간 처리한 후 프로게스테론을 처리한 군의 자궁내 상피조직에서 많이 발현되었으며, AQP-5와 -8 단백질은 에스트로젠을 처리한 군의 자궁내 상피조직에서 발현이 증가하였다. 결 론: 이상의 결과를 통해 AQP-4, -5, -8은 주로 에스트로젠에 의해 자궁내 상피세포에서 발현이 증가되는 것으로 보아 에스트로젠의 영향하에 일어나는 자궁내액의 이동으로 인한 자궁부종기작에 이동통로로서 관여하는 것으로 사료된다.