• Journal of Chest Surgery
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• v.43 no.6
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• pp.655-662
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• 2010

Background: Despite the rapid expansion of percutaneous endovascular repair, open surgical repair is still recognized as an option to achieve a cure. We retrospectively analyzed over a 6 year period the surgical outcomes, the complications and the mortality-related factors for patients with abdominal aortic aneurysms. Material and Method: We analyzed 36 patients who underwent surgery for abdominal aortic aneurysms between May 2001 and June 2005, and between April 2007 and November 2009. The indications for surgery were rupture, a maximal aortic diameter > 50 mm, and medically intractable hypertension or pain. Result: The mean patient age was $69.67{\pm}6.97$ years (range: 57 to 84 years). Thirty two patients (88.9%) were males and 4 patients (11.1%) were females. Extension to the iliac artery existed in 28 patients (77.8%). Thirteen patients (36.1%) had ruptured aortic aneurysms. The mean maximal diameter of the aorta was $73.7{\pm}13.3$ mm (60 to 100 mm). Surgery was performed by a midline laparotomy and 10 patients (27.8%) underwent emergency surgery. The mortality rate was 8.3%; the mortality rate for the patients with ruptured aneurysms was 23.1 % and the mortality rate for patients with unruptured aneurysms was 0%. The postoperative complications included wound infection (3 cases), sepsis (2 cases), renal failure (2 cases) and pneumonia (1 case). Unstable vital signs, pre-operative transfusion, ruptured aneurysm, emergency surgery, comorbidity (DM and syncope) and complications (sepsis and renal failure) were the statistically significant mortality-related factors (p < 0.05). Conclusion: Emergency surgery for ruptured aortic aneurysms continues to have high mortality, but the unruptured cases are repaired with relative safety. Even though endovascular aortic repair is the trend for abdominal aortic aneurysms, an elective operation of the unruptured aneurysms could decrease the procedure's morbidity and the inconvenient for repeat evaluation with good surgical results.

• Journal of Chest Surgery
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• v.41 no.6
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• pp.695-702
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• 2008

Background: The choice between a bioprosthetic and a mechanical valve is an important decision in cardiac valve surgery, and the durability of the tissue valve is a major decision factor. We retrospectively evaluated the midterm results of bioprosthetic valve replacement in the mitral position. Material and Method: The subjects were all patients who had undergone mitral bioprosthesis replacement between July 1989 and August 200.7. Among the 216 patients, there were 236 surgical cases. The mean age was $63{\pm}15$ years, and the male to female ratio was 1 : 3. We retrospectively analyzed hospital and outpatient records such that the total follow-up duration amounted to 760.2 patient-years, and the mean follow-up duration was $41.9{\pm}40.7$ months (range $0{\sim}212$ months). Result: Early death occurred in 18 patients (8.3%), and 13 of these underwent concomitant cardiac procedures. The survival rate after 5 years was $79.9{\pm}3.5%$, and the survival rate after 8 years was $65.5{\pm}5.5%$, while freedom from structural valve deterioration (SVD) was $96.2{\pm}2.2%$ at 5 years and $85.9{\pm}5.3%$ at 8 years. Freedom from reoperation was $90.6{\pm}1.7%$ at 5 years and $90.4{\pm}4.2%$ at 8 years, while freedom from reoperation for SVD was $98.1{\pm}1.2%$ at 5 years and $92.3{\pm}4.1%$ at 8 years. On multivariate analysis of preoperative risk factors, small valve size (between 25mm and 27mm) was a significant risk factor for reoperation, and low LV ejection fraction (<40%) was a significant risk factor for SVD and mortality. Conclusion: Survival and freedom from reoperation for SVD in mitral bioprosthesis replacement had acceptable midterm results, but freedom from SVD Was relatively low. In particular, since SVD increased sharply at the eighth postoperative year, frequent follow-up and echocardiograms around that time will be helpful for the early detection of SVD. It will be necessary to conduct further studies involving long-term follow-up and more patients.

• Journal of Yeungnam Medical Science
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• v.2 no.1
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• pp.203-210
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• 1985

Febrile morbidity after cesarean section is one of the major problems in obstetric practice. This morbidity is most often due to endometritis. Although parenteral prophylactic antibiotics or antibiotic irrigation has been reported to reduce the incidence of endometritis after cesarean section, its incidence remains high. Among the patients who were undergoing cesarean section at Yeungnam University Hospital from the beginning of March, 1985, three group were evaluated in the orders. 1) 30 cases as intrauterine irrigation group with cephradine solution, 2) 35 cases as intravenous injection group with cephradine, 3) 35 cases as control group are neither irrigated nor injected. Febrile morbidity was also evaluated by means of a fever index. The incidence of clinically diagnosed endometritis in the three group were 6.7%, 2.9%, and 22.9%. As these results, two study groups were markedly reduced the incidence of endometritis than control group. There was no significant difference between the intrauterine irrigation with cephradine and control, but significant difference between the intravenous cephradine injection and control (P<0.05). With the results of fever index analysis, both prophylactic intrauterine irrigation and intravenous injection markedly reduce the incidence of endometritis after cesarean section with stastical significance (P<0.05), and also markedly reduce the febrile degree.

• Journal of Chest Surgery
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• v.30 no.4
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• pp.363-372
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• 1997

One hundred forty-four patients underwent operation for coarctation of the aorta at Seoul National University Children's Hospital between June 1986 and Decembsr 1995. Age ranged 0.1 to 191 months. Of these 78.5%(113) were infants. We classified the patients in terms of the anatomic location of coarctatiln and the associatCd anomalies(I[401= primary coarctation, 11(741=isthmic hypoplasia, lIIf30)=tubular hypoplasia involving transverse arch, Ar63 =with ventricular septal defect, B(28)=with other major cardiac defects). Subcalvian flap coarctoplasty(60), resection & anastomosis(44), extended aortoplasty(26), and onlay patch(14) were used as surgical methods. Overall operative mortality was 16.0(23/144)%. The hospital mortality was signific'antly higher in patheints with type 111, subtype B, younger age(under 3 months), extended aortoplasty(p(0.01). However, one-stage total repair in patients with subtype A or B were not found to be a predictor of hospital death. Restenosis had occured in 18 patients among 121 survivals(14. 9%). The mean follow-up period was 29.1 $\pm$28.8(0~129.2) months. Preoperative, immediate postoperative(within 3 months after operation) and postoperative(later than 6 months after operation) echocardiographic data on the dimensions of ascending aorta(AA), transverse arch(TA), an4 aortic isthmus(Al) were available in 77 patients(I=20, ll=42, 111= 15). Preoperative and postoperative aortic isthmus(All) and tra sverse arch indices(TAI), defined as TAIAA & AIIAA respectively, were compared. Immediate postoperative All in type 1, II and TAI in type 111 were significantly smaller in stenotic than non-stenotic group suggesting incomplete relieves of stenotic segment Younger age, subclavian coarctoplasty in patient under 3 months of age were round to be the risk factors for restenosis in this series. In conclusion, We found that aortic arch index and transverse arch index can be a useful tool to figure out the anatomic and clinical characteristics of the patients with aortic coarctation, and that anatomy, associated anomalies, age, and surgical methods may influence the surgical outcome of the coarctation repair.

• Proceedings of the KSCN Conference
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• 2003.11a
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• pp.1089-1090
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• 2003

본 연구는 대구ㆍ경북지역 대장직장암 환자의 일반 생활 상황과 식행동 특성을 분석 평가하여 지역민의 대장직장암 예방을 위한 영양교육에 활용할 수 있는 식생활 관련 기초 자료를 얻고자 수행되었다. 최근 경북대학교 병원에서 대장직장암 진단을 받고 입원한 수술 전후 환자 123명 (남 79명, 여 44명)을 환자군 대상으로 하였고 대장질환이 없는 정형외과 환자 등 182명(남 117명, 여 65명)을 비교군 대상으로 하였다. 대상자의 일반 특성, 식습관, 식행동 특성, 식품섭취 빈도 등의 내용을 포함한 설문지를 이용하여 개인 면담을 통하여 조사하였다. 현재 BMI와 과거 가장 높았던 체중의 BMI는 남녀 모두 환자군에서 유의하게 높게 나타났다. 환자군의 교육 수준은 비교군에 비해 낮았고 주 거주지역 분포는 농촌이 가장 많았으며 가계 소득은 환자군에서 비교군에 비하여 높은 것으로 나타났다. 주요 일상활동 강도는 비교군에 비해 환자군에서 유의적으로 가벼운 것으로 나타났다. 발병 전 일상생활에서 느끼는 스트레스의 정도가 환자군에서 비교군에 비해 유의적으로 높았던 것으로 나타났다. 자신의 성격 유형을 비관적인 것으로 생각하는 비율과 가족의 암 병력이 환자군에서 유의적으로 높게 나타났다 식사의 규칙성에서도 환자군에서 끼니를 거르는 비율이 유의적으로 높았다. 환자군은 비교군에 비해 육식을 유의적으로 높게 선호하였으며 외식시 고기류를 선호하는 비율이 높았다. 평소 물 섭취량은 환자군에서 비교군에 비해 적었다. 환자군이 비교군에 비해 짠맛에 대한 선호도가 유의적으로 높았고 단 맛과 매운 맛은 비교군에 비해 싫어하는 경향을 보였으며 기름진 맛을 선호하는 경향이 환자군에서 유의하게 높았다. 환자군에서 굽기, 튀기기를 좋아하는 경향이 유의적으로 높았다. 환자군에서 음주 빈도, 음주량 그리고 커피 섭취량이 높게 나타났으며, 1일 흡연량이 많았고, 흡연 시작 연령은 빨랐으며, 금연 연령은 늦어 흡연 기간이 유의적으로 긴 것으로 나타났다. 환자군의 영양지식 정도와 영양태도는 비교군에 비해 유의적으로 낮았고 환자군의 영양지식 수준이 높을수록 좋은 영양태도를 가지는 것으로 나타났다. 과거 10년간 식품 섭취 빈도 조사 결과 환자군은 등푸른 생선류와 콩류 및 된장, 두부를 비교군에 비해 유의적으로 더 많이 섭취하였고 해조류, 생 녹황색채소류, 익힌 녹황색 및 담색채소류와 녹차를 더 적게 섭취한 것으로 나타났다. 본 연구의 결과는 일상생활의 스트레스와 가족의 암 병력 및 비관적 성격 유형이 대장직장암 발병의 위험인자가 될 수 있음을 제시하며 육식 선호, 적은 양의 물 섭취, 짜고 기름진 맛에 대한 높은 기호도, 음주, 흡연, 커피의 섭취 그리고 나쁜 식습관이 대장직장암 발생과 관련된 식생활 위험인자가 될 수 있음을 제시한다. 해조류, 녹황색채소, 담색채소, 녹차가 대장직장암 발생의 보호인자의 가능성도 제시되었다. 따라서 향후 지역적 식문화 특성을 고려한 보다 광범위하고 체계적인 조사 연구를 통해 이 지역의 대장직장암 발생의 위험인자와 보호인자를 재확인할 필요가 있다고 보며 본 연구의 결과는 지역민의 대장직장암 예방을 위한 영양교육 자료로서 활용될 수 있다고 본다.

• Journal of Gastric Cancer
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• v.7 no.3
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• pp.152-159
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• 2007

Purpose: Recently, the use of laparoscopic assisted gastrectomy for early gastric cancer has been on the increase and the procedure has been quickly adopted by clincians. However, there are few reports regarding the safety and risk of this type of surgery. The aim of this study is to evaluate the morbidity and to verify the safety of laparoscopic assisted gastrectomy for early gastric cancer. Materials and Methods: A total of 376 patients that had undergone laparoscopic assisted gastrectomy for early gastric cancer between April 2004 and December 2006 were reviewed retrospectively. The clinicopathological characteristics, operative complications, and factors related to complications were evaluated. Results: The overall operative morbidity and mortality rates were 10.6% and 0%, intraoperative morbidity was 1.1% (4 of 376 patients) and post operative morbidity was 9.6% (36 of 376 patients). Most complications required no surgery except for an intestinal obstruction in two cases. Multivariate analysis of risk factors related to operative morbidity determined that age was an independent factor associated with morbidity (P=0.021). Conclusion: The complication rate of laparoscopic assisted gastrectomy is low and most complications can be managed by conservative methods rather than with surgery. There were no specific predicting factors for complications except old age. Laparoscopy is a technically feasible and acceptable surgical modality for early gastric cancer.

• Radiation Oncology Journal
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• v.19 no.4
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• pp.312-318
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• 2001

Purpose : To assess the locoregional recurrence rate, survival rate and prognostic factors after modified radical mastectomy and postoperative adjuvant radiation therapy with or with chemotherapy in high-risk breast cancer patients. Methods : Between $1984\~1995$, 48 patients underwent postoperative irradiation to the regional lymphatics and chest wall due to large tumor size $(\geq5\;cm)$ or small tumor size (<5 cm) with axillary lymph node involvement after modified radical mastectomy. The median age of the patients was 47 years (range, $31\~79\;years$). The clinical tumor size was <2 cm in 1 patient, $2\~5\;cm$ in 15 patients, and >5 cm in 32 patients. Thirty two patients had positive axillary lymph nodes. Forty two patients were irradiated to the chest wall and regional lymph node and 6 patients were irradiated in the chest wall only. Radiation dose to the chest wall and regional lymph node was 5040 cGy/28 fraction. The median follow-up time was 61 months. Results : Locoregional recurrence rate was $8\%$ and distant metastatic rate was $14\%$. The actuarial overall survival rate and disease-free survival rate was $53\%\;and\;62\%$ at 5 years, respectively. The median survival time was 57 months. Five-year overall survival rate by the stage is $70\%$ in IIB and $58\%$ in IIA. The significant prognostic factor for survival on multivariate analysis was the stage. Conclusion : Postoperative adjuvant radiation therapy in high-risk breast cancer can reduce the locoregional recurrence rate and increase the survival time by combined chemotherapy. The significant prognostic factor for survival rate was the stage.

• Korean Journal of Head & Neck Oncology
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• v.30 no.2
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• pp.109-114
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• 2014

갑상선절제술은 내분비 외과의사가 하는 수술 중 가장 안전한 수술이지만 수술 중 기도나 식도가 손상 받을 수 있으므로 각별한 주의를 기울여야 한다. 특히 기도 괴사와 같이 생명에 위협을 주는 합병증이 있음을 유념해야 한다. 본 논문은 갑상선 전 절제술과 승모판 치환술을 함께 받은 72세 여성환자가 수술 후 3일만에 기도 괴사가 발생한 케이스이다. 3개의 기관륜에 걸쳐 괴사가 발생되어 있었다. 괴사된 조직을 제거하고, 이후 지속적인 괴사조직에 대한 제거와 치료와 적으로 기관개창술을 시행하고, 자연폐쇄를 유도하여 성공적으로 치료되었다. 비슷한 여러 논문들을 살펴본 결과 기도 괴사를 유발하는 요인으로는 조절되지 않는 기침, 여성, 갑상샘중독 결절, 기도 삽관 시 발생되는 손상, 삽관튜브 커프의 과팽창으로 기도가 장시간 높은 압력으로 압박되었을 때, 적절하기 않은 커프 크기, 삽관튜브 커프의 공기를 빼지 않고 무리하게 움직였을 때, 출혈이 많을 때, 과도한 전기소작으로 인한 손상, 기도로 가는 혈관손상으로 인한 혈액공급의 차단, 감염 등으로 보고 있다. 치료는 기도의 괴사와 감염의 정도에 따라 달라질 수 있다. 일차 봉합술, 일시적 스토마 형성, 일시적 기관조루술, 단단연결술, 기도 스텐트 설치술, 근육피판 재건술, 보존적 치료 등을 시행할 수 있다. 기도 괴사에 대한 위험인자와 치료에 대해서는 아직 확실히 적립되지 않은 상태이다. 드문 합병증이지만 생명을 위협할 수 있는 이러한 합병증에 대해 항상 염두 해 두고 수술 시 신중을 기하고 문제 발생시 신속한 대응을 해야겠다.

• Journal of Chest Surgery
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• v.34 no.4
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• pp.338-344
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• 2001

배경: 말기 신부전 환자에서 심장병, 특히 관상 동맥 질환의 이환이 늘어나면서 관상동맥 우회수술의 대상 환자가 지속적으로 증가하고 있다. 이들 환자군은 수술후 유병률과 사망률이 매우 높고 고위험군으로 알려져 있다. 대상 및 방법: 1996년 3월부터 2000년 5우러까지 서울 중앙 병원 흉부외과에서 술전 말기 신부전증으로 진단 받은 후 관상 동맥 우회수술을 시행받은 환자 25명을 대상으로 의무 기록을 중심의 후향적 분석을 하였다. 술전 위험 인자 및 술전 신기능, 수술 결과, 술후 경과, 수술후 합병증, 사망률 및 생존률 등을 분석하였다. 결과: 술전 평균 크레아티닌 청소율은 12.7$\pm$5ml/mim였고 술전 평균 혈중 크레아티닌 치는 6.2$\pm$3mg/dl(1.7-14.4)였다. 술전 투석을 시행중인 환자는 11례(44%)였고 술전 투석을 시행하지 않았던 14례(56%)중 8례(8/14, 57.1%)는 수술전후로 새로이 투석이 필요하였다. 술전 혈액 투석 중이었던 9례중 2례에서 수술후 복막 투석으로 전환하였다. 수술 사망률은 2례(8%)로 흡인성 폐렴과 종격동염으로 1례, 그리고 수술후 출형과 종격도염으로 1례가 사망하였다. 수술후 합병증은 14명(56%)의 환자에서 발생하여 매우 높은 발생율을 보였다. 만기사항은 2례(8%)에서 발생하였으며 사망원인은 카테터에 의한 복막염이었다. 생존 환자의 4년 생존률은 82$\pm$13% 였다. 결론: 말기 신부전 환자에서의 관상동맥 우회수술을 비교적 만족스러운 범위의 수술 사망률(8%)을 보였으나 합병증 발생률이 매우 높고 합병증 발생 시 사망률이 매우 높아 수술주위 감염 예방과 세심한 환자 관리가 필요하다.

• Journal of Chest Surgery
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• v.38 no.2 s.247
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• pp.139-145
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• 2005

Background: There were very few reports on long-term survival after coronary artery bypass graft (CABG) in this country. The aim of this study is to investigate the long-term result in patients undergoing CABG in the early period in this hospital. Material and Method: One-hundred and fourteen patients (male/female, 79/35) who had undergone CABG from December 1990 to December 1995 were identified. Most of the patients had undergone CABG using left internal thoracic artery and vein grafts under cardiopulmonary bypass and cardiopulmonary arrest, and the proximal and distal anastomoses of the grafts were performed during the single aortic cross clamping period. Result: During the mean follow-up period of $135.5\pm17.9$ months, 37 patients $(32.5\%)$ were dead and only 10 patients $(27\%)$ of them died of cardiac cause. Risk-unadjusted survival after CABG was $95.6\%,\;85.1\%,\;71.8\%,$ and $57.9\%$ at 1, 5, 10, and 13 years, respectively, and cardiac death-free survival was $97.4\%,\;94.5\%,\;92.1\%$, and $81.3\%$ at 1, 5, 10, and 13 years, respectively. Predictable factors of long-term survival were sex and age. Predictable factors of postoperative coronary angiography and intervention were hypertension, diabetes, and dyslipidemia. Conclusion: Long-term survival after CABG in the early operative period was comparable to the previous outcomes, and females showed the better long-term survival. Postoperative coronary intervention was more common in patients with preoperative dyslipidemia.