• Journal of Chest Surgery
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• v.32 no.12
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• pp.1087-1092
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• 1999

배경 :경동맥 내막 절제술의 목적은 뇌졸중 예방에 있다. 경동맥 내막 절제술시 경동맥 혈류를 차단하였을 때 뇌허혈 상태를 초래하는지 가 가장 중요한 문제이다. 경동맥 혈류 역류압은 뇌내 측부혈류 상태를 반영하므로 경동맥 혈류 차단시 역류압과 뇌파검사 소견에 딸라 shunt 삽입여부 기준을 알아보려고 하였다 대상 및 방법 : 1996년 2월부터 1999년 3월까지 경동맥 내막 절제술을 시행받은 16명을 대상으로 하였다 남자가 14명있고 여자가 2명이었으며 평균연령은 66.35$\pm$6.53이었다 수술부위 경동맥 협착은 평균 73.8$\pm$12.33%였고 반대측 경동맥 협착은 평균 60.99$\pm$23.03%였다. 수술중 모든 환자에서 뇌파감시를 하였으며 경동맥 혈류압을 측정하여 40 mmHg 이하이거나 수술반대측 경동맥 완전폐색이 있는 경우 shunt를 삽입하였다 결과 : 술후 1례에서 사망이 있었는데 이 환자는 전, 중 뇌내동맥 영역에 큰 뇌경색이 있으며 동측에 심한 경동맥 협착이 있고 의식은 기면 상태여서 바로 응급수술을 하였다 수술시경동맥 혈류 역류압은 35mmHg 여서 shunt를 사용하였다 술후 1일째 의식이 혼수상태로 나빠져 뇌 단층촬영한 결과 뇌경색 부위에 출혈이 발생하여 사망하였다. 수술 직후 모든 환자에서 뇌허혈에 따른 합병증 및 사망은 없었고 1례에서 수술후 1일째 수술부위 반대편에 적은 뇌경색이 발생하였다 평균 21.5$\pm$11.85개우러의 외래 추적 검사에서 뇌졸중 재발이 없었다. 결론 : 뇌졸중이환후 경동맥 내막 절제술은 최소 4-6주 이상 안정화 시킨 다음 수술하는 것이 좋다고 생각된다 경동맥 내막 절제술은 뇌졸중 예방에 효과적인 치료방법이며 경동맥 혈류역류압이 40mmHg 이하일 경우 shunt를 설치하여 수술하는 것이 안전하다고 사료된다.

• Journal of Chest Surgery
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• v.30 no.11
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• pp.1083-1091
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• 1997

This study was purposed to assess the result of coronary artery bypass graft surgery by analyzing and comparing the pre and postoperative myocardial perfusion state quantitatively by using myocardial SPECT. Twenty patients who received coronary artery bypass graft surgery since 1993 underwent both preoperative and postoperative myocardial SPECT and the result were analyzed. The mean age was 56.4$\pm$9.0 years, and the patients were composed of thirteen males and seven females. For quantitative analysis, we used polar maps of SPECT generated by Cedars-Sin i Medical Center program and we calculated perfusion scores, ischemic myocardial area ratios and reperfusion scores from polar maps. Preoperative mean stressfrest perfusion score was 7.3$\pm$ 1.117.7$\pm$ 1.0 and postoperative score was 8.1 $\pm$ 1 118.3$\pm$ 1.1. Preoperative mean stress ischemic myocardial area ratio was 0.32$\pm$0.2 and postoperative ratio was 0.15 $\pm$0.1. Postoperative mean perfusion score was significantly increased but, on the other hand, mean ischemic myocardial area ratio was significantly decreased as compared with preoperative values(p<0.01). Preoperative mean perfusion score of patients with postoperative roper(usion score more than 1.5 was significantly higher(p<0.01) than that of patients with postoperative reperfusion score less than 1.5. Preoperative perfusion scores of coronary artery territories that had fixed perfusion defect at myocardial SPECT were significantly low(4.3 $\pm$0.514.6$\pm$0.6, stresslrest), nevertheless it proved quantitatively that there was improvement in myocardial perfusion after surgery by showing improved perfusion scores postoperatively. In conclusion, myocardial SPECT is useful method for quantitative analysis of the myocardial perfusion state after coronary artery bypass grafting surgery.

• Journal of Chest Surgery
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• v.31 no.4
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• pp.393-397
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• 1998

A 25-year-old man with viral cardiomyopathy and chronic active hepatitis successfully underwent dynamic cardiomyoplasty for the first time in Korea on July 30, 1996. The patient had been intermittently dyspneic for 5 years and was admitted to our center twice because of heart failure. For the past 2 years, he was NYHA functional class III status with a left ventricular ejection fraction(LVEF) of around 30%. The patient was born with scoliosis and showed a short stature. The liver function showed elevated liver enzymes, and hepatitis B antigen was positive. The liver biopsy revealed chronic active hepatitis. The preoperative echocardiogram showed decreased left ventricular function with grade II mitral and grade II tricuspid regurgitation with dilated left and right atrium. Recently his symptoms worsened and we decided to perform a dynamic cardiomyoplasty. The left latissmus dorsi muscle(LDM) was mobilized and tested with lead placement on his right lateral decubitus position. The patient was positioned into supine and, after median sternotomy, the heart was wrapped with the mobilized muscle. The Russian made cardiomyostimulator(EKS-445) and leads (Myocardial PEMB for heart and PEMP-1 for LDM) were used. The total operation time was 8 hours and there were no perioperative episodes. Postoperatively the LDM had been trained for a 10 week period and currently the stimulation ratio is maintained at 1:4. The postoperative LVEF did not increase with the value of 30-35%. However, the patient feels better postoperatively with slightly increased activity.

• Journal of Yeungnam Medical Science
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• v.8 no.1
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• pp.1-11
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• 1991

족부의 교정을 위해서는 비정상적인 상태 및 원인 그 치료법에 대해서 충분히 이해해야 할 것으로 생각되며, 비 척행족에 대해서는 먼저 정확한 원인 인자의 파악과 수술전 평가, 수술의 선택, 수술의 범위등을 정해야 한다. 이렇게 함으로써 변형에 대한 충분한 교정이 가능하며, 수술후 예후가 좋은 척행족으로 될 것이다. 그리고 위에서 밝힌 치료의 원칙은 변하지 않겠지만, 관절 고정술을 대체하여 다른 남은 관절에 영향을 주지 않으면서 더 많은 유연성을 가질 수 있는 기능있는 족부를 만들 수 있는 새로운 수술방법이(관절 치환술등) 더 개발되어 져야할 것으로 생각된다.

• The Journal of the Korea Contents Association
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• v.22 no.7
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• pp.652-662
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• 2022

Currently, in the field of spinal surgery around the world, various new technologies have been rapidly developed and applied to patients. The author believes that it is necessary to discuss whether these new technologies are being fully reviewed for efficacy and safety before being applied to patients. To consider this issue, the author analyzed the basic research data and clinical application process of the intradiscal electrothermal therapy, which was developed as a new technology for discogenic pain disease in the 2000s and has been widely used worldwide. As a result, it was found that this procedure has been performed on patients in a state where there is insufficient base research on efficacy and safety. The author judges that this case reveals an essential problem related to the clinical operation of new medical technologies in the field of spine surgery. Therefore, the author believes that in order to minimize the side effects that new medical technology in the field of spinal surgery may have on patients, more full-fledged basic research and higher clinical acceptance standards should be established.

• Journal of the Korean Orthopaedic Association
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• v.55 no.3
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• pp.200-209
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• 2020

The first human meniscal allograft transplantations (MATs) were performed 30 years ago. In the early era, candidates were limited to patients who have favorable joint conditions. MAT is currently indicated for patients with post-meniscectomy symptoms, such as compartmental pain or effusion after a subtotal or total meniscectomy. The current indication for MAT is being expanded to other patients who were not indicated previously. The present article reviews how the indications of MAT have changed over the years.

• Journal of Chest Surgery
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• v.31 no.7
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• pp.718-721
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• 1998

The surgical closure of VSD in patient with severe pulmonary hypertension has been considered a difficult problem for surgeons, because sudden hemodynamic change after closure of the defect could bring on high perioperative mortality. Recently, it was reported that UVP(unidirectional valve patch), which allows some blood to flow from right to left in case of acute right heart failure, is effective in improving the postoperative hemodynamics after closing septal defects. This 42-year old woman had suffered from VSD for 20 years and recently complained of worsening exertional dyspnea for three months, and was diagnosed of a large VSD(2.0 cm in diameter) with severe pulmonary hypertension(116/38 mm Hg), equal to systemic arterial pressure. We could successfully close VSD with severe pulmonary hypertension using one UVP and the other UVP for the creative ASD to be prepared against possible acute right heart failure. She was discharged on the fourteenth postoperative day and has been well for twelve months with spontanenous closure of UVP patch at the ninth postopeative month.

• Journal of Korean Orthopaedic Sports Medicine
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• v.4 no.1
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• pp.36-42
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• 2005

Purpose: To investigate the arthroscopic findings, and to evaluate the clinical outcomes of the treatment of posterior internal impingement of the shoulder in baseball players. Materials and Methods: We followed up 5 cases who were diagnosed as posterior internal impingement for the mean 15 months. All of the cases complained of the pain in the posterior shoulder at late cocking, and were positive in the relocation test added by hyper-horizontal abduction at $120^{\circ}$ abduction of the arm. We sutured posterior labral tear and SLAP lesion arthroscopically, and conducted debridement for rotator cuff. Three cases were performed of anterior capsular plication and the other two were performed of thermal capsular shrinkage. Pain, range of motion, and level of return to sports activity were assessed for the results. Results: As to the arthroscopic findings, all the five cases showed the fraying in posterosuperior labrum, and two of them was accompanied with the flap tear in posterosuperior labrum and the other one was accompanied with type 2 SLAP lesion. All the cases showed the fraying in supraspinatus, and one case showed partial tear. Meanwhile, in all the cases, the rotator cuff was impinged to the labrum at $90^{\circ}{\sim}120^{\circ}$ of abduction and external rotation. As to the postoperative results, all the cases did not complain of pain or instability while pitching, and the competition was recovered to be the mean 88%($80{\sim}100%$) of that before the injury. Conclusion: Definite diagnosis for the posterior internal impingement would be possible through arthroscopic examination. Favorable outcomes could be obtained with capsular plication or shrinkage for anterior microinstability and stretching exercise for posterior capsule tightness inducing the internal impingement.

• Journal of Chest Surgery
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• v.36 no.10
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• pp.754-758
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• 2003

Backgroun: Thymectomy was known as an effective treatment modality of myasthenia gravis. In this paper, we analyzed the result of thymectomy and the factors affecting the postoperative system improvement. Material and Method: We analyzed the medical records of 50 patients who received the thymectomy for myasthenia gravis from January 1997 to December 2001. Result: 39 patients showed sympton improvement. The effect of thymectomy as a treatment is 78%. There was no statistically significant correlation between postoperative improvement and Sex, Age, the Weight of thymic tissue, preoperative symptom duration, and preoperative mestinon dosage. However, the thymic pathology and low grade preoperative symptoms were affecting the postoperative prognosis. Conclusion: Thymic hyperplasia showed good prognosis compared to thymoma. Low grade preoperative symptoms (Group I or IIA) also showed good prognosis. So, early thymectomy is recommendable for the good treatment results of myasthenia gravis.

• Journal of Chest Surgery
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• v.39 no.2 s.259
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• pp.111-116
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• 2006

Background: Perforation of the esophagus is a deadly injury that requires expert management for survival. The mediastinal contamination with microorganisms, gastric acid, and digestive enzymes results in a mediastinitis that is often fatal if untreated. Material and Method: Between January 1990 and June 2004, 38 patients with esophageal perforation were treated in our hospital. Retrospective review of these cases has been performed. Result: There were 28 males and 10 females. The mean age was 43.84$\pm$18.89 years (range $1{\~}73$ years). Spontaneous rupture was found in $34\%$ of perforations, iatrogenic perforation in $32\%$ and traumatic perforation in $34\%$. Perforation occurred in the cervical esophagus in 8 cases, thoracic esophagus in 29 and abdominal esophagus in 1. In the cervical esophageal perforation, managements were primary closure in 8 and drainage in 2. In the thoracic esophageal perforation, managements were primary closure in 14, resection in 3 and conservative management in 12. The mortality rate was $25\%$ in cervical esophageal perforation and $34.5\%$ in thoracic esophageal perforation. We revealed risk factor of esophageal perforation to be peropertaive septic condition (p=0.005). Conclusion: Most important risk factor of esophageal perforation was preoperative septic condition. Preoperative prompt and aggressive preoperative treatment may improve the survival rate of esophageal perforation.