• Journal of Chest Surgery
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• v.40 no.9
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• pp.624-628
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• 2007

Between 2001 and 2006, 3 neonates that had multilevel left ventricular outflow tract obstruction and a ventricular septal defect underwent the Norwood-Rastelli procedure. The body weights ranged from 2.9 to 3.1 kg. The patients had a near normal sized mitral valve and left ventricle. We simultaneously performed a modified Norwood procedure with native tissues-to-tissue anastomosis without circulatory arrest, and a Rastelli type procedure using a non-valved conduit from the right ventricle to the pulmonary artery and intracardiac patch baffling from the left ventricle to the pulmonary valve via the ventricular septal defect. The postoperative courses were uneventful. During follow-up, there was one late mortality caused by a cardiac catheterization related complication at 7 months after surgery, One patient required a Rastelli conduit change. Two patients are doing well during a follow-up period of 1 and 5 years, respectively.

• Journal of Chest Surgery
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• v.32 no.1
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• pp.27-31
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• 1999

Background: In spite of the development of chemotherapy, prognosis of metastatic lung cancer was poor. On the other hand, surgical intervention has proven itself to bring out superior results, therefore more operations are being praticed based on this superiority against chemotherapy and other modalities on metastatic lung cancer. Material and Method : We analyzed the surgical cases performed from 1983 to 1997 on 17 cases and estimated 5 year survival rate using Kaplan-Meier method. Result: Average age was 42.8, ratio between male and female was 10:7. We had 8 single lobe resections,3 pneumonectomies,1 wedge resection,2 bilobectomy and 3 cases of lobar resection with wedge resection. 5 deaths have occured and among the 5, 3 patients were caused by recurrence of ca. The remaining 12 patients are being followed up in OPD basis among these, 3 recurrence were observed and 9 are still free of cancer. The average survival time was 40.5 months and 5 year survival rate obtained through the Kaplan-Meier method was 60.4%. Conclusion: Even though we are a bit short of cases, we recommend that a thoracic surgeon approach this disease through a surgical method as possibly as he could.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.434-440
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• 2009

Background: Surgical closure of a patent ductus arteriosus (PDA) can be considered when conservative medical treatment is ineffective or contraindicated. Low weight and earlier gestational age neonates who are treated with conservative medical therapy generally showed a higher failure rate. The morbidity of surgical PDA closure in such extremely low birth weight (ELBW) neonates is also high. Here we present the early results of a new technique for approaching the PDA through a dorsal minithoracotomy. Material and Method: From March 2006 to November 2008, 24 premature neonates underwent surgical PDA closure. The procedures were performed in the newborn intensive care unit via a 2 cm long dorsal minithoracotomy with the baby in the prone position with the left hemithorax elevated 30$^{\circ}$. Bimanual cotton swab blunt dissection completed the extrapleural accesstothe PDA and then two clips were applied. Tube thoracostomy was avoided if there was no meaningful pleural laceration. Result: The infants mean gestational age was 26.5$\pm$2.1 weeks (range: 23 to 30 weeks) and the average age at operation was 11$\pm$11 days. The mean body weight at operation was 933$\pm$271 grams (range: 570 to 1,700 grams). Eight patients expired, but there was no procedure-related death. Postoperative echocardiography revealed two cases of residual shunt but none of these shunts were detected on the follow up echocardiogram that was performed on the post operative 5 and 59 days. Conclusion: We concluded that the technique described here is an effective procedure in view of the satisfactory operative exposure and the low rate of complications.

• Korean Journal of Psychosomatic Medicine
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• v.26 no.2
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• pp.77-85
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• 2018

Objectives : This study aimed to investigate the level of distress using the distress thermometer (DT) and the factors associated with distress in postoperative breast cancer (BC) patients. Methods : DT and WHOQOL-BREF (World Health Organization Quality of Life Scale Abbreviated Version) along with sociodemographic variables were assessed in patients undergoing surgery for their first treatment of BC within one week postoperatively. The distress group consisted of participants with a DT score ${\geq}4$. The prevalence and associative factors of distress were examined by descriptive, univariable, and logistic regression analysis. Results : Three hundred seven women were recruited, and 264 subjects were finally analyzed. A total of 173 (65.5%) were classified into the distress group. The distress group showed significantly younger age (p=0.045), living without a spouse (p=0.032), and worse quality of life (QOL) as measured by overall QOL (p=0.009), general health (p=0.005), physical health domain (p<0.000), and psychological health domain (p=0.002). The logistic regression analysis showed that patients aged 40-49 years were more likely to experience distress than those aged ${\geq}60years$ (Odds ratios [OR]=2.992, 95% confidence interval [CI] 1.241-7.215). Moreover, the WHOQOL-BREF physical health domain was a predictive factor of distress (OR=0.777, 95% CI 0.692-0.873). Conclusions : A substantial proportion of patients are experiencing significant distress after BC surgery. It would be expected that distress management, especially in the middle-aged patients and in the domain of physical QOL (e.g., pain, insomnia, fatigue), from the early BC treatment stage might reduce chronic distress.

• Journal of Gastric Cancer
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• v.6 no.1
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• pp.52-56
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• 2006

A 69-year old man presented with severe epigastric pain for 1 day. He had early gastric cancer at the antrum and underwent a distal subtotal gastrectomy and Billorth II gastrojejunostomy one month later without any post-operative complications. Radiologic examination revealed a large amount of retroperitoneal free air formation. Because of unremitting pain and unstable vital sign, exploratory laparotomy was followed. During the operation, a perforated duodenal diverticulum at the posterior wall of the 2nd portion of the duodenum was identified. He underwent diverticulectomy and primary closure. He was discharged on the 18th post operative day and has been followed up without any evidence of comlpication for several months.

• Journal of Chest Surgery
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• v.29 no.2
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• pp.177-184
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• 1996

Between 1987 and 1994, 21 patients were treated surgically for aortic aneurysm involving the thoracoabdominal aorta. There were 11 males and 10 females, and their age ranged from 20 to 67 years old and mean age was 41.5 years. Many complained of back pain, chest pain or discomfort, and flank pain, but three patients were asymptomatic. 15 patients had chronic dissection (71.4%) and 6 had nondissecting fusiform or saccular aneurysm(28.5%), and of those 15 patients with chronic dissection, 6(28.5%) had atherosclerosis assniated with hypertension, 5 (23.8%) were Martian syndrome, and 2 (9.5%) were associated with pregnancy. The diameter of an aneurysm ranged from 6cm to 12cm, and their extent was classified as type I in 7(33.3%), type II in 8(38.1%), type III in 3(14.3%), and type IV in 3(14.3%) patients based on Crawford classification for TAA . Diseased aorta was replaced with artificial vascular graft in all but one patient. In whom the aortic tear site due to pseudoaneurysm was closed by primary suture. For the spinal cord protection during the operation, we used partial cardiopulmonary bypass (FV-FA or PA-FA bypass) in 12 patients (57.1%), Biopump (LA-FA bypass) in 4(19.0%), total circulartory arrest and CPB in 2 (9.5%), Gott's heparinized shunt in 1(4.7%), and simple aortic cross clamping in 2 (9.5%). The most common complication after the operation was hoarseness due to unilateral vocal cord palsy which onured in 5 patients (23.8%), and the next common complication was wound infection in 4 patients(19.0%), paraplegia in 2 patients (9.5%), chylothorax in 1 patient(4.7%). The hospital mortality rate was 9.5% (2deaths), and there was no late death. Our experience shows that the graft replacement of TAAA had reasonable rate of mortality, low rate of serious complication, and provided good post operative state of the pati nts, and since the thoracoabdominal aortic operation is not a high risky procedure anymore, we recommend a radical operation for the indicated patients.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.16 no.5
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• pp.3303-3307
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• 2015

The purpose of this study was attemped to investigate the clinical presentation and pathophysiology of 74-year-old female who developed pneumoperitoneum as complications of chest compression from sudden cardiac arrest. Such chest compression is the same one excercised to by-stander and paramedics. A healthy 74 year female had a sudden mental deterioration while working at a restaurant. She was transfered from 119 emergency medical system to the hospital. After the symptom developed, by-stander called 119 who carry out 6 minutes Cardiopulmonary resuscitation(CPR). Defibrillation and CPR was carried out by health provider after the arrival, and the patients spontaneous circulation returned. After Return of spontaneous circulation(ROSC), patients was transferred to the nearst hopspital, but suspicious of myocardial infarction, she was again transferred to a larger scale hospital. At the hospital she took X-rays and Abdominal CT, and the results of suspicious gastro-intestinal perforation near gastro-esophageal junction, surgical repair was recommended. But in operation room, while operation went on, cardiopulmonary arrest appeared again, and she expired. For this reason, prehospital CPR needs more accurate localization of cardiac massage and serious consideration of positive pressure ventilation. Moreover, treatment of pneumoperitoneum after CPR needs more cautious consideration of patients hemodynamic stability.

• Journal of Chest Surgery
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• v.29 no.11
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• pp.1276-1280
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• 1996

Because of paucity of primary cardiac tumors, primary cardiac tumors are of much interest to the pathologist, cardiologist and cardiac surgeon. A cardiac chondrosarcoma, which very rare, is presented as follows: This 37 year-old female patient was admitted under the diagnosis of a left atrial tumor(myxoma) on July 3, 1993. Using the CPB, she underwent complete removal of tumor including the atrial septum. And final pathology report was chondrosarcoma. The adjuvant irradiation with total dose of 5040 cGy(28 fractiations for 2 months) and chemotherapy(VP-16 and ifosfamide) was completed. She had no evidence of recurrence until May 2, 1995. when she was admitted due to brain metastasis, which was detected by MRI scan with a tumor free interval for 2 years. A tumor, located around the frontoparital cortex was removed neurosurgern on Sep. 13, 1995 and the final pathology report was also a chondrosarcoma on pathologic exam. The postoperative course was uneventful.

• The Korean Society of Law and Medicine
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• v.17 no.1
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• pp.299-346
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• 2016

There were also various decisions made in medical area in 2015. In the case that an inmate in a sanatorium was injured due to the reason which can be attributable to the sanatorium and the social welfare foundation that operates the sanatorium request treatment of the patient, the court set the standard of fixation of a party in medical contract. In the case that the family of the patient who was declared brain dead required withdrawal of meaningless life sustaining treatment but the hospital rejected and continued the treatment, the court made a decision regarding chargeable fee for such treatment. When it comes to the eye brightening operation which received measure of suspension from the Ministry of Health and Welfare for the first time in February, 2011, because of uncertainty of its safety, the court did not accept the illegality of such operation itself, however, ordered compensation of the whole damage based on the violation of liability for explanation, which is the omission of explanation about the fact that the cost-effectiveness is not sure as it is still in clinical test stage. There were numerous cases that courts actively acknowledged malpractices; in the cases of paresis syndrome after back surgery, quite a few malpractices during the surgery were acknowledged by the court and in the case of nosocomial infection, hospital's negligence to cause such nosocomial infection was acknowledged by the court. There was a decision which acknowledged malpractice by distinguishing the duty of installation of emergency equipment according to the Emergency Medical Service Act and duty of emergency measure in emergency situations, and a decision which acknowledged negligence of a hospital if the hospital did not take appropriate measures, although it was a very rare disease. In connection with the scope of compensation for damage, there were decisions which comply with substantive truth such as; a court applied different labor ability loss rate as the labor ability loss rate decreased after result of reappraisal of physical ability in appeal compared to the one in the first trial, and a court acknowledged lower labor ability loss rate than the result of appraisal of physical ability considering the condition of a patient, etc. In the event of any damage caused by malpractice, in regard to whether there is a limitation on liability in fee charge after such medical malpractice, the court rejected the hospital's claim for setoff saying that if the hospital only continued treatments to cure the patient or prevent aggravation of disease, the hospital cannot charge Medical bills to the patient. In regard to the provision of the Medical Law that prohibit medical advertisement which was not reviewed preliminarily and punish the violation of such, a decision of unconstitutionality was made as it is a precensorship by an administrative agency as the deliberative bodies such as Korean Medical Association, etc. cannot be denied to be considered as administrative bodies. When it comes to the issue whether PRP treatment, which is commonly performed clinically, should be considered as legally determined uninsured treatment, the court made it clear that legally determined uninsured treatment should not be decided by theoretical possibility or actual implementation but should be acknowledged its medical safety and effectiveness and included in medical care or legally determined uninsured treatment. Moreover, court acknowledged the illegality of investigation method or process in the administrative litigation regarding evaluation of suitability of sanatorium, however, denied the compensation liability or restitution of unjust enrichment of the Health Insurance Review & Assessment Service and the National Health Insurance Corporation as the evaluation agents did not cause such violation intentionally or negligently. We hope there will be more decisions which are closer to substantive truth through clear legal principles in respect of variously arisen issues in the future.

• Journal of Chest Surgery
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• v.38 no.12 s.257
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• pp.852-855
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• 2005

A 85-day-old infant was successfully operated on for truncus arteriosus (type I) with interrupted aortic arch (type A) using one-stage anterior approach without circulatory arrest. Aortic arch was reconstructed by direct anastomosis of ascending aorta and descending aorta with regional perfusion and continuity of right ventricle to pulmonary artery was established with $Shelhigh^{circledR}$ pulmonic conduit. The patient experienced left bronchus compression by descending aorta immediately postoperatively, which was improved with positional change and physiotherapy. The patient had reoperation due to stenosis of valved conduit at 13 months later. The patient is currently well under follow-up of 14 months from initial repair.