• Journal of Yeungnam Medical Science
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• v.1 no.1
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• pp.89-93
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• 1984

This study included 38 children patients of less than 4 years old and 18kg body weight. 93 After 8 hours of starvation, the children were divided into 2 groups: Group I received Hartmann's solution and Group II received Hartmann's dextrose solution. In both groups, the rates of infusion were 10ml/kg/hr before and during operation and blood samples were collected just before and 1 hr after induction of anesthesia, respectively. The results were as follows; 1) In the Group I, blood glucose concentration just before induction was decreased than control values that was checked at ward, and 1 hr values after induction was significantly increased than control values. 2) In the Group II, blood glucose concentration was increased just before and 1hr after induction than control values significantly respectively. 3) In the blood glucose concentration 1 hr after induction, difference between Group I and Group II was not significant. 4) In children, duration of starvation about 8 hrs did not significant influence on blood glucose concentration although dextrose was not administered.

• Journal of the Korean Orthopaedic Association
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• v.53 no.6
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• pp.459-465
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• 2018

Of the many factors that affect the clinical outcomes of orthopedic surgery, the surgical procedure is the most important. Robotics have been developed to perform the surgical procedures more accurately and consistently. Robotic surgical procedures in the orthopedic field were developed 20 years ago. Some designs of surgical robots have disappeared due to practical problems and complications, and an another design of surgical robots is emerging. To date, the use of robot surgery in arthroplasty is still controversial in terms of the clinical outcomes, practicality, and cost-effectiveness, even though it has been reported to be effective in the alignment and positioning of components in the field of artificial joints. Early robotic surgery was based mainly on active robot surgery according to the scheduled operation without the intervention of the operator. Recently the semi-active system of robotic surgery has been introduced. In a semi-active system, the robot constrains the surgeon to a haptic boundary defined by the computer based on the 3-dimensional imaging preoperative plan, and the operator can change the preoperative plan through real-time feedback during operation.

• Korean Journal of Head & Neck Oncology
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• v.16 no.2
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• pp.177-181
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• 2000

배경 및 목적: Theodor Kocker에 의해 일반화된 전통적인 갑상선 수술방법은 갑상선 질환의 종류 및 정도, 수술범위와 상관없이 광범위한 수술범위로 인한 조직 손상으로 인해 수술후 환자들의 여러가지 불편감은 물론 경부의 넓은 부위의 통증과 경부 피부부종, 장액종, 혈종 등과 같은 후유증을 동반할 수 있다. 최근 본 저자들은 이같은 전통적 갑상선 수술의 부작용을 최소화하기 위해 작은 피부절개($3{\sim}4.5cm$) 후 피하 피판(subplatysmal skin flap) 없이 직접 갑상선으로 접근하는 새로운 수술기법으로서 최소침습 갑상선 수술기법을 개발하였기에 그 술식을 소개하고 전통적인 갑상선 절제술에 대한 우월성을 확인하고자 본 연구를 시행하였다. 대상 및 방법: 1999년 1월 15일 부터 2000년 1월 14일까지 573예의 갑상선 수술 예 중 최소침습 갑상선절제술이 시행되었던 466예와 1998년 1월 15일부터 1999년 1월 14일까지 전통적 갑상선 수술을 시행한 549예 중 거대 종양(양성>6cm, 악성>5cm), 흉골하 선종, 국소진행암, 재발암, 측경부의 다발성 림프절 전이가 있었던 112예를 제외한 437예의 임상병리적 특성과 피부절개 길이, 수술 시간, 수술중 출혈양, 수술후 진통제 요구빈도 및 재윈기간, 수술 후 합병증 발생빈도를 비교 분석하였다. 결 과: 두 군간의 임상병리적 특성상의 유의한 차이는 없었다. 피부절개 길이($3.7{\pm}0.7cm,\;vs\;9.6{\pm}3.3cm$), 수술 시간($57.6{\pm}11.7$분 vs $85.2{\pm}32.3$분) 수술 중 출혈양($18.4{\pm}15.3ml\;vs\;43.1{\pm}21.8ml$), 수술후 재원기간($1.6{\pm}0.5$일 vs $4.3{\pm}1.6$일), 및 수술후 진통제 요구빈도가 전통적 수술군에 비해 최소침습 수술군에서 통계적으로 유의하게 감소되었으나(p<0.05), 수술후 장액종 및 혈종 형성, 일시적인 음색변화, 일시적인 저칼슘혈증과 같은 합병증의 발생빈도는 각각 4.3%(n=20)와 4.8%(n=21)로 두 군간에 유의한 차이가 없었다. 결 론: 최소침습 갑상선 수술법은 새로운 수술기구의 도입 없이도 갑상선 수술의 충분한 시야를 확보할 수 있고 안전하고 간단하게 시행할 수 있으며, 기존 수술법으로 인한 부작용을 최소화할 수 있어 전통적 인 수술법을 대치할 수 있는 새로운 방법으로 사료된다.

• Journal of the Korean Orthopaedic Association
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• v.55 no.5
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• pp.374-382
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• 2020

Recurrence is the most common complication after shoulder instability surgery, and the main causes of the postoperative recurrence of instability are trauma, misdiagnosis, and technical errors. The risk factors of recurrence may be classified as patient related, anatomical or technical. Causes of failure should be thoroughly evaluated by meticulous history taking, physical examination, and imaging studies, and followed by proper treatment of pathologic lesions. Nonoperative treatment should be considered initially in cases of recurred instability after shoulder instability surgery, but if this fails, repeated recurrence is prevented by performing appropriate anatomical reconstruction of ruptured Bankart lesions, capsular laxities, glenoid deficiencies and humeral head bone defects.

• Journal of Chest Surgery
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• v.30 no.5
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• pp.537-539
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• 1997

An orthotopic cardiac transplantation was successfully performed in a 40 year-old Jehovah's witness without use of any blood product. Preoperatively, the patient had been on coumadin to prevent left atrial thrombi and the INR(Internation Normalized Ratio)of prothrombin titre was 2.4. During the operation, cell saver was used for shed blood and aprotinin was admini tered intravenously for platelet function. Total postoperative drainage was 860cc and the lowest hemoglobin was 12.2 gmldl. Postoperative course was complicated by central nervous system infection by wisteria monocytogenes and two episodes of rejection, both of which were effectively treated. The patient is on his 5th postoperative month and doing well.

• Korean Journal of Psychosomatic Medicine
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• v.7 no.1
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• pp.3-9
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• 1999

Abnormal external appearance may cause psychiatric trauma or problem in social adaption. The plastic surgeons should consider the patient's quality of life, and their roles are correcting psychiatric and emotional trauma as well as external appearance which help the patient adapting social life. Because the patients in plastic surgery have higher level of expectation for the result of their operation, it is necessary for the surgeons to explain precisely the procedure and possible complications precisely at preoperative meeting and to maintain the good doctor-patient relationship at postoperative follow-up period. In case if the patient dissatisfy the postoperative result, it is recommended to listen the second opinion from another plastic surgeon. If the patient still dissatisfy, then the patient should be consulted to psychiatrist.

• Clinical and Experimental Pediatrics
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• v.46 no.7
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• pp.661-667
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• 2003

Purpose : This study was performed to find the chief clinical problems associated with the ages of adult patients of tetralogy of Fallot(TOF) who had undergone total correction. Methods : Of the 30 patients who were registered at the Grown-Up Congenital Heart Disease (GUCH) Clinic of Samsung Medical Center for TOF, a retrospective investigation was carried out on 28 patients who underwent total correction. Results : Mean age at retrospective study was 30.8(range : 16-53) years old. Age at total correction was 15.8(range : 2-49) years old. Problems after corrective surgery were assessed. They were arrhythmia, pulmonary valve regurgitation, left pulmonary artery stenosis, residual ventricular septal defect, mitral valve regurgitation, tricuspid valve regurgitation, right ventricle outflow tract obstruction, aortic valve regurgitation, infective endocarditis and protein losing enteropathy. After repair of TOF, such arrhythmias as atrial arrhythmia and AV conduction disturbances were observed in some patients. Cardiomegaly was found significantly in the subjects with arrhythmia(P<0.05), and arrhythmia was less observed in patients who underwent surgery at a young age. Eight patients required a reoperation; the main indications were residual ventricular septal defect, right ventricle outflow tract obstruction and peripheral pulmonary artery stenosis. Conclusion : The majority of the patients seemed to live normal lives after Tetralogy of Fallot repair. However, as residual anatomic and functional abnormalities exist postoperatively, continued careful follow-up is needed to detect and correct structural and functional abnormalities.

• The Korean Society of Law and Medicine
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• v.22 no.2
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• pp.111-138
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• 2021

'Unlicensed medical practice by a non-medical practitioner' often represented by surrogate surgery or so-called 'ghost surgery,' causes irreparable damage to life or body, and therefore calls for very strict and effective controls. The 'bill on installment of CCTVs in an operating room' to prevent unlicensed surrogate surgery has been discussed for a long time, but due to numerous issues and heated confrontations, it has been pending in the National Assembly. Nevertheless, it is expected that the bill will be discussed again in earnest in the National Assembly because surrogate surgery and factory-type cosmetic surgery, which has been performed mainly in the field of cosmetic surgery, has also been occurring in the field of therapeutic surgery. In general, an operating room is considered as being locked or closed, as well as disallowing implicit complicity among insiders. Hence, if the insiders conspire to commit or cover up an illegal act, or if a surgeon performs rapid cosmetic surgery and then leaves the recipient (or medical institution) so as to perform more operations for profit - even if it is legitimate practice - it may result in serious consequences in terms of the recovery of a patient. In this case, installation of CCTVs can be of great help in identifying an illegal act and assessing any occurrence of negligence. On the other hand, while the fundamental purpose of therapeutic surgery is to restore a patient's life or body - that is, lifesaving - installation of CCTVs may base the relationship between a surgeon and a patient on distrust and surveillance, so it may increase the number of requests for CCTV footage or lead to more disputes, as well as placing a burden on the surgeon when best results are not achieved for a patient. As a result, the surgeon may choose non-invasive treatment contrary to conscience instead of risky but necessary surgery, or he/she may have significant difficulty in determining the timing of surgery, which may limit the provision of effective surgical medical care. Then, in terms of the relationship between a surgeon and patient, and in the long run, there could be significant disadvantages for the public and patients if CCTV footage is allowed. In this paper, we review domestic and overseas cases and issues regarding installation of CCTVs in an operating room, and present various viewpoints and suggestions to promote legislation with minimized legal problems and side effects, thereby contributing to protection of the lives and health of the public, patients, and recipients of surgery.

• Journal of Chest Surgery
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• v.34 no.5
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• pp.393-398
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• 2001

배경: 일차성 자연기흉의 재발방지를 위해서 폐기포절부위에 흡수성 셀룰로스망사와 Fibrin gluefm 도포하여 수술후 재발율을 줄일 수 있는 지 알아보았다. 대상 및 방법: 1996.4우러부터 2000.6월까지 2명의 술자가 222례의 일차성 자연기흉을 수술하였으며, 수술시기와 치료방법에 따라 4군으로 나누어 비교하였다. 제1군은 1996년부터 1997년가지 비디오흉강경수술 및 기계적 늑막유착술로 시술받은 군(25례), 제 2군은 같은 기간동안 액와개흉술 및 늑막유착술로 시술받은 군(53례), 제 3군은 1998년부터 2000.4월까지 흉강경수술 및 늑만유착술로시술받은 군(110례), 제 4군은 1999.7월부터 2000.6월까지 흉강경수술 및 봉합부위를 셀룰로스망사와 Fibrin glue로 보강한 군(34례)이었다. 각 군간, 엑스선상 기흉의 크기 및 폐기포의 수나 크기에 따라 재발율, 공기누출시간 및 흉관지속지간등을 일반선형모델을 사용하여 비교 분석하였다. 결과: 대상환자는 남자 203례, 여자 19례 이었고, 나이는 14게에서 68세이었고, 평균연령은 23.2$\pm$9.6세였다. 재발한 경우는제 1군이 5례(25%), 제 2군이 2례(3.8%), 제 3군이 5례(4.5%)이었고, 제 4군은 재발례가 없었다. 재발례는 모두 수술자의 수술경험이 2년이내일 때 발생하였다. 흉관지속기간은 제 4군이 제 3군(p<0.0006) 및 제1, 제2군(p<0.0001)에 비해서 더 짧았고, 술후 공기누출이 제 4군에서는 없었다. 술전흉부엑스선상 기흉의 크기에 따른 수술후 기흉의 재발울은 경도의 기흉에서 14.3%(2/14)이었고, 중등도 기흉에서 7.4%(10/134)이었으며, 심한 기흉에서는 재발례가 없었다. 재수술한 12례중 봉합부위근처에서 기포가 발행된 경우가 9례(75%)로 많았다. 결론: 재발방지를 위한 시술로 늑막유착술을 시행하지 않고 폐기포절제부위를 흡수성 셀룰로스망사와 Fibrin glue로 덮어주는 시술은 비교적 용이하며, 수술 후 공기 누출이 없었고, 수술 후 흉관지속기간이 더 짧았고, 단기간 추적에서 재발이 없었다. 재발에 영향을 미치는 것으로 흉부엑스선상 기흉의 크기가 작은 경우에는 재발율이 더 높았고, 수술자의 경험이 중요하였다.

• Journal of Chest Surgery
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• v.36 no.8
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• pp.566-575
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• 2003

We reviewed our 18-year surgical experience of biventricular repair for double-outlet right ventricle. Material and Method: One hundred twelve consecutive patients (80 males and 32 females) who underwent biventricular repair for double-outlet right ventricle between May 1986 and September 2002 were included. We assessed risk factors for early mortality and reoperation. Reoperation-free survival rate and actual survival rate were analysed. Result: Most common type of ventricular septal defect was subaortic (n=58, 52%) and non-committed type was second most common (n=32, 29%). Four different surgical methods were used: intraventricular baffle repair (n=71 , 63%): right ventricle to pulmonary ariery conduit interposition or REV with left ventricle to aorta baffle repair (n=24, 21 .4%): arierial switch operation with left ventricle to pulmonary artery baffle (n=14, 12.5%): Senning atrial switch operation with left ventricle to pulmonary artery baffle (n=3, 2.7%). Thirty four patients(30%) underwent palliative procedures before definite repair. Twenty three patients (21%) required reoperations. There were 12 (10.7%) early deaths and 4 late deaths. Age younger than 3 months at repair (p=0.003), cardiopulmonary bypass and aortic cross clamp time (p=0.015, p=0.067), type of operation (arterial switch operation) (p <0.001) and type of ventricular septal defect (subpulmonic type) (p=0.002) were revealed as risk factors for early death in univariate analysis, while age under 3 months was the only significant risk factor in multivariate analysis. Patients younger than 1 year of age (p=0.02), pulmonary artery angioplasty at definitive repair (p=0.024), type of ventricular septal defect (non-committed) (p=0.001), type of operation (right ventricle to pulmonary artery conduit interposition and REV operation) (p=0.028, p=0.017) were risk factors for reoperation in univariate analysis but there was no significant risk factor in multivariate analysis. Follow-up was available on 91 survivals with a mean duration of 110.8$\pm$56.4 (2~201) months. 5, 10 and 15 year survival rates were 86.5%, 85% and 85% and reoperation free survival were 85%, 71.5%, 70%. Conclusion: Age under 3 months at repair, subpulmonic ventricular septal defect and arterial switch operation were significant risk factors for early mortality. Patients with non-committed ventricular septal defect and who underwent conduit interposition or REV operation were risk factors for reoperation. With careful attention to chose best timing and surgical approach depending on morphologic characteristics, biventricular repair for double outlet right ventricle can be achieved with good long-term outcome.