• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.232-235
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• 2009

Purpose: We report here on a solution for the case of a 71 year old lady with cartilage destruction in the left shoulder and the loss of the rotator cuff secondary to post-septic arthritic sequelae. Materials and methods: After thorough laboratory, clinical and radiological investigation of the patient to rule out any foci of active infection, we contemplated performing reverse total shoulder arthroplasty as a primary procedure. Results: At 22 months follow up, the patient had an excellent result according to the UCLA and ASES scales. Conclusion: Reverse total shoulder arthroplasty seems to be an efficient procedure to improve pain and function in the post-septic shoulder accompanying severe rotator cuff injury.

• Journal of Chest Surgery
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• v.31 no.12
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• pp.1159-1164
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• 1998

Background: Although operative outcome is progressing due to the development of operative techniques and myocardial protection, some patients face an increased morbidity and mortality. Therefore, it has become increasingly important to predict the operative morbidity and mortality. Material and Method: This retrospective study reports the results of risk factor analysis of morbidity and mortality of 137 consecutive patients who were underwent coronary artery bypass graft surgery(CABG). Preoperative variables were age, sex, preoperative myocardial infarction, operative priority, left ventricular ejection fraction, obesity and triple vessel disease. Postoperative morbidities were arrhythmia, wound infection, cerebral infarction, prolonged postoperative hospitalization, pneumonia, acute renal failure, prolonged use of ventilator and operative death. Result: The mean age of total patients was 56.7 years, from 27 to 74. The overall mortality was 6.6%(9 of 137) with the mortality of 3.9%(5 of 128) for elective operation, and 44.4%(4 of 9) for emergent or urgent cases. The morbidity of patients over 65 years was stastistically higher than that of under 65 years. Sex distribution showed no difference in morbidity, however operative mortality rate was slightly higher in women (5/41, 12.19%) than in men(4/96, 4.17%). Morbidity of emergent or urgent operation was 100%, much higher than that of the elective operation. Mortality of the patients whose left ventricular ejection fraction was under 50% was higher than that of those over 50%. Conclusion: We concluded that the risk factors of morbidity after CABG were old age above 65 years and emergent or urgent operation, and that risk factors of mortality were low left venticular ejection fraction under 50% and emergent or urgent operation.

• Journal of Chest Surgery
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• v.37 no.1
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• pp.27-34
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• 2004

Background: Infective endocarditis shows higher operative morbidity and mortality rates than other cardiac diseases. The vast majority of studies on infective endocarditis have been made on aortic endocarditis, with little attention having been paid to infective endocarditis on the mitral valve. This study attempts to investigate the clinical aspects and operative results of infective endocarditis on the mitral valve. Meterial and Method: The subjects of this study consist of 23 patients who underwent operations for infective endocariditis on the mitral valve from June 1995 to May 2003. Among them, 2 patients suffered from prosthetic valvular endocarditis and the other 21 from native valvular endocarditis. The subjects were evenly distributed age-wise with an average age of 44.8$\pm$15.7 (11∼66) years. Emergency operations were performed on seventeen patients (73.9%) due to large vegetation or instable hemodynamic status. In preoperative examinations, twelve patients exhibited congestive heart failure, four patients renal failure, two patients spleen and renal infarction, and two patients temporary neurological defects, while one patient had a brain abscess. Based on the NYHA functional classification, seven patients were determined to be at Grade II, 9 patients at Grade III, and 6 patients at Grade IV. Vegetations were detected in 20 patients while mitral regurgitation was dominant in 19 patients with 4 patients showing up as mitral stenosis dominant on the preoperative echocardiogram. Blood cultures for causative organisms were performed on all patients, and positive results were obtained from ten patients, with five cases of Streptococcus viridance, two cases of methicillin-sensitive Staphylococcus aureus, and one case each of Corynebacteriurn, Haemophillis, and Gernella. Operations were decided according to the AA/AHA guidelines (1988). The mean follow-up period was 27.6 $\pm$23.3 (1 ∼ 97) months. Result: Mitral valve replacements were performed on 43 patients, with mechanical valves being used on 9 patients and tissue valves on the other 4. Several kinds of mitral valve repair or mitral valvuloplasty were carried out on the remaining 10 patients. Associated procedures included six aortic valve replacements, two tricuspid annuloplasty, one modified Maze operation, and one direct closure of a ventricular septal defect. Postoperative complications included two cases of bleeding and one case each of mediastinitis, low cardiac output syndrome, and pneumonia. There were no cases of early deaths, or death within 30 days following the operation. No patient died in the hospital or experienced valve related complications. One patient, however, underwent mitral valvuloplasty 3 months after the operation. Another patient died from intra-cranial hemorrhage in the 31st month after the operation. Therefore, the valve-related death rate was 4.3%, and the valve-related complication rate 8.6% on mid-term follow-up. 1, 3-, and 5-year valve- related event free rates were 90.8%, 79.5%, and 79.5%, respectively, while 1, follow-up. 1, 3-, and 5-year valve- related event free rates were 90.8%, 79.5%, and 79.5%, respectively, while 1, 3-, and 5-year survival rates were 100%, 88.8%, and 88.8%, respectively. Conclusion: The findings suggest that a complete removal of infected tissues is essential in the operative treatment of infectious endocarditis of the mitral valve. It is also suggested that when infected tissues are completely removed, neither type of material nor method of operation has a significant effect on the operation result. The postoperative results also suggest the need for a close follow-up observation of the patients suspected of having brain damage, which is caused by preoperative blood contamination or emboli from vegetation, for a possible cerebral vascular injury such as mycotic aneurysm.

• Journal of Gastric Cancer
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• v.9 no.1
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• pp.18-25
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• 2009

Purpose: The postoperative hospital stay after gastric cancer surgery is usually 8 to 14 days. The main reason for a prolonged hospital stay may be the 3 to 4 day period of postoperative starvation. The aim of this study is to investigate the feasibility of a critical pathway for early recovery after gastric cancer surgery, and this pathway included early postoperative feeding. Materials and Methods: One hundred three consecutive patients who underwent gastric resection and reconstruction for gastric cancer from October 2007 to June 2008 at St. Mary's Hospital were prospectively enrolled in a fast-track critical pathway. The pathway included minimal preoperative procedures, optimal pain relief, proper fluid administration, early mobilization and early enteral nutrition at postoperative 1 day. The exclusion criteria were determined preoperatively, intraoperatively and postoperatively. Results: Of the 103 patients, 19 patients were excluded for preoperative (5), intraoperative (7) and postoperative (7) reasons. Eighty-four patients (81.6%) were included in the fast-track critical pathway. Sixty-eight (88.6%) of 84 patients were discharged at the planned 8 day after surgery during the initial period of the study, and the postoperative hospital stay was shortened up to 6 days during the more recent period. Postoperative complications occurred in 22 patients (26.2%), and these were gastrointestinal track-related complications in 6 cases (3 cases of ileus, 1 case of stasis and 2 cases of leakage) and infection-related complications in 8 cases. There was no statistical difference in the incidence of morbidity according to the clinic-operative features that included age, gender, stomach resection and lymphadenectomy. Conclusion: The fast-track critical pathway with using the available exclusion criteria was a valid option for patients who underwent gastric cancer surgery.

• Journal of Chest Surgery
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• v.38 no.10 s.255
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• pp.669-674
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• 2005

Background: There are several studies that report the relationship between leukocytosis and cardiovascular disease mortality. Most of these studies stand on the basis that atherosclerosis is mediated by inflammatory process. By the same token, preoperative white blood cell count is suggested as an independent predictable factor of postoperative mortality and morbidity in coronary artery bypass grafting. The purpose of this study is to define the influence of preoperative white blood cell count on postoperative morbidity and mortality after coronary artery bypass grafting. Material and Method: The medical records of the 133 patients who had undergone isolated coronary artery bypass grafting at Inha University Hospital from 1996 to 2003 were reviewed. Patients were evenly divided into four groups, and named as group A, B, C, and D respectively based on their preoperative white blood cell count in ascending order. The number of patients in each group were 33 with exception of 34 in group A. The range of white blood cell count were from $1.3\times10^3/{\mu}L\;to\;5.9\times10^3/{\mu}L\;in\;group\;A,\; from\;6.0\times10^3/{\mu}L\;to\;7.0\times10^3/{\mu}L\;in\;group\;B,\;from\;7.1\times10^3/{\mu}L\;to\;8.9\times10^3/{\mu}L$ in group C, and from $8.9\times10^3/{\mu}L\;to\;16.9\times10^3/{\mu}L$ in group D. Result: The number of patients with recent myocardial infarction was 0 in group A, $2(6.1\%)$ in group B, $4(12.1\%)$ in group C, and $8(24.3\%)$ in D group, showing proportional increase to the white blood cell count (p<0.01). There were six postoperative deaths; $1(2.9\%)$ in group A, $1(3.0\%)$ in group B, $2(2.6\%)$ in group C, and $2(6.1\%)$ in group D (p=0.44), showing no significant difference between the groups. Postoperative wound infection occurred in 3 patients; all 3 patients were in group D, showing that postoperative wound infection is closely related to the preoperative white blood cell count. Conclusion: The association between preoperative white blood cell count and postoperative mortality could not be defined. The incidence of postoperative wound infection was found to be proportional to the preoperative white blood cell counts.

• Journal of Biomedical Engineering Research
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• v.25 no.1
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• pp.71-76
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• 2004

In order to investigate the Post-operative changes in scoliotic spine according to selection of fusion level a mathematical finite element model of King-Moe type II scoliotics spine system was developed. By utilizing this finite element scoliosis model surgical correction simulation procedures of pedicle fixation and derotation were simulated. In consequence of the calculation by changing the fusion Levels, postoperative changes like Cobb angle, apical vertebrae axial rotation (AVAR), thoracic kyphosis, and rib hump were Qualitatively analyzed. In the analysis of operative kinematics, the decrease or Cobb angle was most prominent in distraction than in deroation. Applying the rod derotation only was not effective in decrease of Cobb angle but just caused increase of At AR and rib hump. From the operative simulation, co-action or distraction and translation during rod insertion has major impact on Cobb angle decrease and maintenance of kyphosis. With rod rotation, Cobb angle decrease was obtained, but combined increase of AVAR and rib hump was simulation observed as well. The case of most extended instrumentation range with 60o rod rotation produced double decrease of Cobb angle, but the increase of rib hump and AYAR occurred corresponding1y. The optimum selection of fusion level was proved as one level less than inflection position of the thoracic spine curvature.

• Journal of the Korean Society of Radiology
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• v.85 no.1
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• pp.36-53
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• 2024

As the number of spinal surgeries being performed expands, the number of medical imaging procedures such as radiography, CT, and MRI is also increasing, and the importance of their interpretation is becoming more significant. Herein, we present the radiological findings of a variety of complications that can occur after spinal surgery and discuss how effectively and accurately they can be diagnosed through imaging. In particular, this study details the characteristic imaging findings specific to the early and long-term postoperative periods. Early complications of spinal surgery include improper placement of surgical instruments (instrument malpositioning), seromas, hematomas, pseudomeningoceles, and infections in the region surrounding the surgical site. Conversely, long-term complications may include osteolysis around surgical instruments, failure of fusion, adjacent segment disease, and the formation of epidural fibrosis or scar tissue. A precise understanding of the imaging assessments related to complications arising after spinal surgery is crucial to ensure timely and accurate diagnosis, which is necessary to achieve effective treatment.

• Clinical and Experimental Pediatrics
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• v.50 no.7
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• pp.665-671
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• 2007

Purpose : The purpose of this study was to investigate the clinical features and outcome in newborns undergoing cardiac surgery. Methods : Eighty two neonates underwent heart surgery for congenital heart defect at Kyungpook National University Hospital between March 2000 and February 2006. Patient characteristics (sex, age, diagnosis), pre-operative conditions, operation type, postoperative complications and mortality were reviewed retrospectively. Results : In 82 patients, 41 (50%) were male. The mean age and weight at operation were 12 days and 3.2 kg, respectively. The common cardiac anomalies were complete transposition of the great arteries (TGA), Tetralogy of Fallot (TOF), pulmonary atresia with intact ventricular septum, and single ventricle variants. Fifty seven operations were performed with cardiopulmonary bypass and corrective surgery was done on 54 patients. Arterial switch operation and modified Blalock-Taussig shunt were most frequently performed as corrective and palliative operations, respectively. The early hospital mortality rate was 7%; the late mortality was 3.9%. Complications were acute renal insufficiency, delayed sternal closure, wound infection, arrhythmia, and brain hemorrhage. Conclusion : During the last 6 years, the outcomes of cardiac surgery for congenital heart defects in neonates improved by progress in perioperative, anaesthetic, surgical, and postoperative care.

• Pediatric Infection and Vaccine
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• v.29 no.3
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• pp.173-178
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• 2022

Streptococcus intermedius is a small, non-motile, Gram-positive, non-sporeforming, and aerotolerant anaerobic coccus. It is a part of the normal microflora in the oral cavity and upper respiratory, gastrointestinal and female urogenital tracts. It is an opportunistic pathogen that causes serious infections in patients with immunocompromised states or cardiac diseases as a result of trauma or invasive procedures. We describe a case of septic arthritis of the hip caused by S. intermedius in an immunocompetent healthy 7-year-old boy without a history of periodontal disease or invasive procedures. He had hip joint pain three weeks ago, and the fever began on the day of the visit. He had been healthy and had not undergone any invasive procedures recently. Septic arthritis of the hip was indicated in the magnetic resonance imaging of the hip. S. intermedius was identified in the hip joint fluid aspiration and blood culture. He was successfully treated with surgical intervention and antibiotic therapy with ceftriaxone followed by amoxicillin for five weeks.

• Journal of Dental Rehabilitation and Applied Science
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• v.36 no.1
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• pp.21-28
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• 2020

Purpose: After periodontal surgery, studies have found that the use of periodontal wound dressing reduces the risk of wound infection and increases healing. The purpose of this study is to evaluate the effect of attachable periodontal wound dressing on the healing and patient satisfaction after periodontal flap surgery. Materials and Methods: Twenty-eight patients requiring periodontal surgery underwent periodontal flap surgery on both quadrants of maxilla or mandible. Postoperative pain, bleeding, dietary discomfort and hypersensitivity in relation to attachable periodontal wound dressing was assessed using Visual Analogue Scale (VAS). Additional survey on frequency of burning sensation and overall satisfaction rates were assessed. Results: VAS mean values for pain, bleeding, and dietary discomfort depending on the presence and absence of attachable wound dressing were; pain: 2.82, 3.96 (P = 0.002), bleeding: 1.61, 2.54 (P = 0.008), dietary discomfort: 2.82, 4.18 (P < 0.001), respectively. Test groups with attachable wound dressing reported significantly lower rates of discomfort. No significant difference was observed in burning sensation and hypersensitivity related with wound dressing. Satisfaction was higher in 75% of patients who received wound dressing. Conclusion: According to the results of this study, patients who received attachable periodontal wound dressing reported less postoperative pain, bleeding, and dietary discomfort. There was no statistical significance related to the use of wound dressing with burning sensation and hypersensitivity.