• Journal of the Korean Arthroscopy Society
• /
• v.17 no.1
• /
• pp.38-43
• /
• 2013

Purpose: To evaluate the efficiency of arthroscopic treatment for infected total knee arthroplasty (TKA), and to investigate the factors affecting the outcomes. Materials and Methods: We analyzed 17 cases which underwent arthroscopic treatment to treat infection after TKA. After confirming infection by hematologic examination and analysis of joint fluid, we performed arthroscopic debridement, synovectomy and irrigation with normal saline mixed with antibiotics. Through routine examination after operation, we checked failure of treatment or recurrence of infection. If there is no recurrence until 2 years after the operation, we considered it as a success of treatment. Results: Of the 17 cases taken arthroscopic treatment, 13 cases were treated successfully with primary arthroscopic treatment only, but 4 cases had to undergo re-operation because of persistence or recurrence of infection. Analyzing the factors affecting the results, we found that symptom duration of the re-operation group is longer than the treated group after arthroscopy (p<0.05). Conclusion: Arthroscopic treatment can be effective when we performed appropriate selection of patients, careful and extensive arthroscopic irrigation and debridement, and suitable use of antibiotics. However, we have to do early arthroscopic surgery as soon as possible when infection after TKA is suspected.

• Korean Journal of Clinical Laboratory Science
• /
• v.48 no.4
• /
• pp.321-326
• /
• 2016

This study aimed to analyze the changes of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) measured in acute infection within four weeks post artificial joint surgery to predict potential infection in early stages, provide rapid treatment, and prevent the abuse of antibiotics. This study included 50 patients with acute infection and 50 patients without any symptoms of infection, among patients who received artificial joint replacement surgery on the lower limbs in a four-week period. CRP was the highest two-to-three days after surgery. with $5.77{\pm}3.69$ and $5.17{\pm}3.48$, respectively, in those with infection and without infection. Thereafter, the value rapidly reduced in those without infection. However, it increased again to $3.16{\pm}2.87$ in the group with infection according to the bimodal curve (p<0.001). ESR was the highest two-to-three days after surgery, with $58.8{\pm}24.63$ and $44.08{\pm}21.48$, respectively. Thereafter, the value slowly reduced in those without infection. However, it was increased again to $47.62{\pm}26.26$ in those with infection according to the bimodal curve p<0.001). As this study shows, if there is an increasing trend for CRP and ESR after artificial joint replacement surgery, it may be possible to question whether patients are acutely infected post surgery. In particular, this result is expected and regarded as a useful factor for diagnosing infection due to the high level of sensitivity and uniqueness for CRP.

• Proceedings of the KOR-BRONCHOESO Conference
• /
• 1987.05a
• /
• pp.19.2-19
• /
• 1987

방사선치료후 재발성 또는 잔존성 두경부암의 수술후에 피부판의 괴사 및 slough, 감염, 누공, 부종과 경동맥 노출 심지어는 경동맥 파열 등의 술후 합병증이 빈발함으로 수술에 큰 어려움을 겪게 된다. Pectoralis major myocutaneous flap은 진행된 두경부암의 광범위한 절제후에 그 결손부를 보충해 주는 데 좋은 방법으로 사용할 수 있을 뿐아니라 방사선치료후에 생긴 합병증에도 이 flap을 이용하여 좋은 치료결과를 얻을 수 있다. 저자들은 수술 전에 방사선치료를 받고 심한 부종으로 후두조직의 괴사 및 기능이 손실된 환자와 방사선 치료후 재발된 상인두암환자의 경우에서 수술 후 생긴 pharyngocutaneous fistula와 피부판감염 및 경동맥노출 등으로 치유가 곤란하여 여기에 pectoralis major myocutaneous flap을 사용하여 pharyngostoma를 재건하고 노출된 경동맥부위를 보호하여 좋은 치료효과를 얻었기에 문헌을 고찰하여 보고하는 바이다.

• Journal of Chest Surgery
• /
• v.36 no.4
• /
• pp.273-276
• /
• 2003

We report a surgical case of 39-year-old male with a pseudoaneurysm of the left ventricle. Four years ago, the patient underwent aortic and mitral valve replacements with mechanical valves and abscess removal for infective endocarditis with annular abscess. Recent echocardiography demonstrated a communication between left ventricle and abscess pocket, and the size of pocket increased further at the follow-up echocardiography. The patient underwent patch closure of the defect between left ventricle and pseudoaneurysm located at the aortomitral fibrous continuity, under the cardiopulmonary bypass and cardioplegia. The postoperative course was uneventful and the patient was discharged on the 9th postoperative day.

• Journal of the Korean Arthroscopy Society
• /
• v.11 no.1
• /
• pp.20-23
• /
• 2007

Purpose: The purpose of this study is to evaluate characteristics of a deep infection after arthroscopic knee surgery. Materials and Methods: We selected 894 patients who underwent arthroscopic knee surgery between February 1994 and August 2006. We analyzed the results of the patients with definite infection. Results: Seven cases out of the 894 knee arthroscopic surgery which was performed by one surgeon during 12 years were diagnosed as postoperative deep infection (0.9%). Infection developed in one repair case among the meniscal surgeries (1419=0.2%). There were six infection cases in intraarticular ligament reconstruction (6/343=2%); 3 in ACL surgeries (3/152), 2 in PCL surgeries (2/70) and 1 in combined cruciate ligament surgery and extra-articular reconstruction (l/26). Conclusion: Postoperative infection rate of arthroscopic knee surgery was relatively low. However an attention for the prevention of postoperative deep infection should be paid in intraarticular ligament reconstruction because of its relatively high risk of infection.

• Journal of Chest Surgery
• /
• v.43 no.6
• /
• pp.619-626
• /
• 2010

Background: The indications and the optimal time of surgery of infective endocarditis are controversial. We report the surgical results of our hospital during the last 10 years with literature review. Material and Method: Between January 2000 and December 2009, we enrolled 23 infective endocarditis patients who underwent surgery, and analyzed retrospectively. In the preoperative blood culture, 8 cases (34.8%) were positive. The average preoperative antibiotics treatment period was $20.78{\pm}16.00$ days. There were 12 (52.2%) urgent operations. The average follow up period was $49.26{\pm}33.21$ months. Result: 20 mechanical valve replacements were performed, 9 in aortic position, 8 in mitral position and 3 in the both positions. The other procedures were one mitral valvuloplasty, one infected myxoma extirpation, and one infected pacemaker lead removal with debridement. The average period of postoperative intravenous antibiotic treatment was $24.39{\pm}15.98$ days. There were 5 complications, including 2 cases of postoperative bleeding, one postcardiotomy syndrome, one cerebral ischemia, and a low cardiac output syndrome. There were statistically significant postoperative improvement in NYHA class, left ventricle end diastolic/end systolic volume, and left atrium size (p-value < 0.05). Conclusion: We could obtain the satisfactory results without any moftalities by using sufficient preoperative antibiotics in hemodynamically stable patients, and by prompt surgery in unstable patients.

• Journal of Chest Surgery
• /
• v.36 no.8
• /
• pp.583-589
• /
• 2003

With the purpose of identifying significant risk factors in poststernotomy sternal wound infection and mediastinitis, we underwent a retrospective analysis of the whole patients operated on at the our department of cardiovascular surgery for the two years. Material and Method: From March 200f to March 2003 at the depart-ment of cardiovascular surgery, medical school of Soonchunhyang University, major sternal wound infections had been developed in 12 (9.76%) of 123 consecutive patients. These patients underwent open-heart procedure through a midline sternotomy and survived long enough for infection to appear. For this group of patients, we evaluated possible risk factors such as age, sex, diabetes mellitus, chronic obstructive pulmonary disease, obesity, interval between hospital admission and operation, type of surgical procedure, elective or emergency surgical procedure, reoperation, duration of surgical procedures, duration of cardiopulmonary bypass, amount of blood transfused, post-operative blood loss, chest reexploration, rewiring of a sterile sternal dehiscence, duration of mechanical ventilation, and days of stay in the intensive care unit and analyzed these factors. Result: Analysis represented that age, sex, diabetes mellitus, type and mode of surgical procedure, reoperation, duration of operation, duration of cardio-pulmonary bypass, and interval between hospital admission and operation were not significantly associated with wound infection. For all other predisposing factors, p-values of less than .05 were demonstrated. Eight emerged as significant: early chest reexploration (p=0.001), sternal rewiring (p< 0.0001), chronic obstructive pulmonary disease (p<0.0001), blood transfusions (p<0.05), postoperative bleeding (p=0.008), days of stay in the intensive care unit (p< 0.0001), duration of mechanical ventilation (p=0.001), and obesity (p=.003). Conclusion: Contamination of pa-tients may occur before, during, and after the operation, and any kind of reintervention may predispose the patient to wound infection.

• Journal of Chest Surgery
• /
• v.40 no.5 s.274
• /
• pp.341-350
• /
• 2007

Background: We present here the early and midterm surgical results for infective endocarditis and we especially focus on the effect of aggressive reconstruction or root implantation after wide debridement. Material and Method: Between January 1995 and Jun 2006, we enrolled 79 adult infective endocarditis patients who underwent surgical treatment. There were 63 and 16 native and prosthetic valve endocarditis cases, respectively. They included 27 cases of culture negative endocarditis. With performing valve replacement or repair, 28 of the patient underwent a more aggressive surgical option, for example, aortic root replacement or reconstruction, or heart base reconstruction etc. Result: There were statistical relationships between the in-hospital mortality and staphylococcal infection, urgent-based operation and operation during the active phase of endocarditis. Wide debridement and aggressive reconstruction were not related to either the post operative mortality or the early morbidity. Culture negative endocarditis was not related to the postoperative mortality and morbidity. Conclusion: Physicians must pay attention to patients' medical treatment during the preoperative period of the infective endocarditis. If surgery is considered for treating infective endocarditis, it should be performed before the downhill course of the disease so that the surgical outcome is improved. Wide debridement and more aggressive reconstruction are also warranted.

• Journal of Chest Surgery
• /
• v.35 no.7
• /
• pp.517-522
• /
• 2002

Background: Congenital heart surgery may lead to myocardial swelling and hemodynamic instability. Delayed sternal closure may be beneficial in this setting. The purpose of this study was to assess mortality and mediastinal infection rate associated with delayed sternal closure after congenital heart surgery and to evaluate the risk factors which affect mortality and mediastinal infection rate. Material and Method: We retrospectively reviewed 40 patients who underwent delayed sternal closure after repair of congenital heart disease at Yonsei Cardiovascular Hospital, from January 1994 to May 2001. In these patients, we assessed the mortality and mediastinal infection rate, and evaluated their risk factors including operation time, bypass time, aortic cross clamp time, duration to sternal closure and postoperative artificial ventilation time. Mediastinal infection was defined to have positive culture in mediastinum. Result: Hemodynamic instability was the most common indication for delayed sternal closure(n=36) and other indications included postoperative bleeding(n=2) and conduit compression(n=2). The median age at operation was $14.4{\pm}33.4$months old(range, 2days-12years). The patients with postoperative bleeding and conduit compression were much older than the others. The sternum was left open for $4.5{\pm}3.4$ days(range, 1-20days). Overall mortality was 25%(10/40) and mediastinal infection occured in 24.3%(9/37) (3 patients were excluded in mediastinal infection for early death). In risk factor analyses, only aortic cross clamp time had statistical significance for mortality in univariate analyses. However, multivariate analyses revealed that there were no significant predictors for risk of mortality and mediastinal infection. Conclusion: Delayed sternal closure after repair of congenital cardiac disease had relatively high mortality and mediastinal infection rate. But, in patients with hemodynamic instability, postoperative bleeding and conduit compression after repair of congenital cardiac disease, delayed sternal closure may be an effective life saving method.

• The Journal of the Korean bone and joint tumor society
• /
• v.12 no.2
• /
• pp.141-147
• /
• 2006

In 1996, a nine-year-old girl was treated with recycling autograft after wide resection of the distal femoral osteosarcoma. The leg lengthening and revision with growing tumor prosthesis were performed due to limb leg discrepancy and epiphyseal problem. However, deep infection developed after operation, and a temporary spacer with cement and Ender nail was inserted. After infection was controlled completely, the final leg lengthening was performed with mono-external fixator for limb length discrepancy (10 cm). Lastly, Tumor prosthesis was reinserted to preserve the joint function.