• Journal of Chest Surgery
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• v.39 no.1 s.258
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• pp.35-41
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• 2006

Background: The radial arteries are being used more often for coronary artery bypass grafting, We tried to the endoscopic radial artery harvest to reduce the cosmetic problems and neurologic complications of the conventional open harvesting and report the techniques and early results. Material and Method: The 86 patients underwent coronary artery bypass grafting between May 2003 and April 2005 had their nondominant radial artery endoscopically removed through a 2 cm incision at the wrist. The radial pedicle was dissected and was divided at antecubial area through a 5 mm counterincision. Result: The 23 patients complained of neuralgias on territory of superficial raidal none but no one complained of neuralgias on territory of lateral antebrachial cutaneous none. There was no functional impairment of the hand. There was no wound complication except a localized hematoma. All patients were contacted by telephone after postoperative 7.9$\pm$3.6 months. The 4 patients still complained of neuralgia. All the patients were satisfied with the aesthetics of the wounds. The multidetectional tomography was done on the 66 patients for the estimation of early patency of radial artery. There were 2 cases of stenosis and a case of occlusion. Conclusion: Endoscopic radial artery harvest had no functional impairment of the hand, lesser rate of neurologic complications and outstanding aesthetics. The results of early patency of the radial artery was similar to conventional methods. Therefore, we think that endoscopic radial artery harvest is the optimal procedure.

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

• Childhood Kidney Diseases
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• v.1 no.2
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• pp.101-108
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• 1997

Purpose : The clinical characteristics of renovascular hypertension (RVHT) in children were analyzed. Methods : Medical records of 16 children diagnosed as RVHT on the basis of angiography during Jan. '86 to Jun. 94 in our hospital were reviewed retrospectively. Results : The mean age at the onset was 8.5 yrs and the sex ratio(M:F) was 7:9. The causes of RVHT were Takayasu arteritis in 6, Moyamoya disease in 5, and fibromuscular dysplasia in 3 patients. Abdominal bruit was noted in 6 patients (38%). Peripheral renin activity was raised in all tested patients. Bilateral renal arterial involvemnent was found in 9 patients (56%). Captopril renal scans showed good correlation with angiographic findings. Five patients were treated with antihypertensives only, and blood pressure was controlled completely in 2 and incompletely in 3. Percutaneous transluminal angioplasty was performed in 10 patients with 50% of success rate. However, hypertension was recurred due to restenosis or accompaning aortic stenosis in 3 patients. Surgical treatment was performed in 4 patients, and the blood pressure was controlled partially in 1 and poorly in the remaining 3. Conclusions : Takayasu arteritis, Moyamoya disease and fibromuscular dysplasia are the major causes of childhood RVHT in our country. The diagnosis of RVHT in children should be based on a set of tests individually selected for case by case. For the low curability of the current treatment modalities available, RVHT in children should not be regarded as 'curable' so far. We expect, however, that the outcome will be improved by more extensive application of the newly developed surgical technique.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.19 no.2
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• pp.167-180
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• 1997

79 surgically managed mandibular condylar fracture patients included the 25 patients treated with Dr, Nam's method were analysed the postoperative resluts in Oral and Maxillofcial Surgery, School of Dentistry, Wonkwang University since 1993 to 1995. Mean patient's age is 32.5 years (range, 8 to 65 years), and follow-up periods were a minimum of 3 months to 28 months. 19% condylar fractures were associated with mostly symphysis portion. According to the patient's age, severity of condylar fractures, clinical signs and symptoms, radiographic findings, treatmenet plans had been performed. Rigid fixation have performed greatly, and then fragment removal of fractured mesial pole of proximal segment of the condylar and little cases of reshaping and eminoplasty and lag screw have been applied. Two cases of the both condylar resorption and deviated condyle posteriorly in Dr. Nam's method. None of infection or necrosis signs of treated condyle surgically. In my opinion, whenever possible, displaced condylar fracture can be managed surgically with rigid fixation, but not Dr. Nam's method. Usually if perform the surgical management of condylar fractures you should maintain maxillomandibular fixation for 2 weeks, or more and has to follow-up functional mandibular exercise should be kept continuously.

• Journal of Chest Surgery
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• v.42 no.3
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• pp.404-407
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• 2009

A 43-yr-old patient visited our department with intermittent chest pain he had suffered with for the past 2 months. Chest CT showed an egg shaped mass in the left chest wall. Local resection was performed for distinguishing the mass from a neurogenic tumor. The diagnosis was periosteal Ewing sarcoma of the rib. Since there was no evidence of metastasis based on the PET-CT, a 2nd operation was done with wide resection and thoracoplasty. The patient was then treated with combined chemotherapy. There has been no local recurrence for the fast 1 year. The patient's age and tumor origin were distinct from the usual characteristics of Ewing's sarcoma. Periosteal Ewing's sarcoma of the rib has rarely been reported. We report here on a case of periosteal Ewing's sarcoma of the rib along with a review of the relevant medical literature.

• Journal of Korean Neurosurgical Society
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• v.30 no.2
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• pp.173-179
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• 2001

Purpose : To assess therapeutic effects of percutaneous polymethylmethacrylate(PMMA) vertebroplasty on the pain caused by osteoporotic thoracic and lumbar vertebral body compression fractures in a large scale of a prospective clinical design, and to determine clinical factors influencing its therapeutic effects. Methods : A prospective clinical study was carried out in 349 vertebral levels of 159 patients between April 1998 and July 1999. The compression fractures were confirmed with bone scan and spine CT, and bone marrow density was measured. Visual analogue scale(VAS) score was used for pre- and post-operative assessments of the pain. All 159 patients were assessed immediately after surgery, and 140 patients of them were followed-up for about 6 months in average. Results : Partial and complete pain relief was sustained immediately after operation in 73%, through follow-up period in 88% of the patients. Pain relief was not proportional to the amount of PMMA or the rate of increase in the height of the compressed vertebral body. It appears that 3 to 6cc of PMMA was proper enough to sustain pain relief. Better clinical improvement was achieved in the patients treated within 6 months after occurrence of vertebral body fracture. The most frequent surgical complication was epidural leakage of PMMA, and the most serious complication was extravertebral leakage into the paravertebral muscles, which appeared to exert the worst influence on the outcome. However, surgery was not required in these patients. Conclusion : Therapeutic effects of PMMA percutaneous vertebroplasty on osteoporotic vertebral body compression fractures were confirmed in a relatively large scale of prospective clinical study. It appears that good outcome can be achieved in patients treated within 6 months after fracture, treated each level with 3 to 6cc of PMMA in amount. without serious complications.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.216-220
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• 2001

Objective : Cranioplasty is required to protect underlying brain, to correct major aesthetic deformities, or both. The ideal material for this purpose is autogenous bone. When this is not available, alloplastic or artificial materials may be used. In this study authors compared the infection rate according to the cranioplasty materials(the frozen autologous bone vs. bone cement), and duration of the skull defect. Materials : Between May 1994 and December 1999, 111 patients with skull defect treated with cranioplasty(82 cases of frozen autologous bone and 29 cases of artificial bone material) were included in this study. There were 77 males and 34 females with a mean age of 41.4 years(range 1-85 years). 57 patients had head trauma and 54 had non-traumatic insults. According to the duration of skull defect, there were 28 cases under 1 month, 33 cases of 1-2 months, 15 cases of 2-3 months, 20 cases of 3-6 months and 15 cases over 6 months of duration. Results : Overall infection rate was 9.9%. In cases with frozen autologous bone and artificial bone material, the infection rate was 8.5% and 13.7%, respectively. The infection rate according to the duration of skull defect was 3.6%(among 28 cases) under 1 month of age, while those were 12%(4 among 33 cases) at 1-2 months, 20%(3 among 15 cases) at 2-3 months, 5%(1 among 20 cases) at 3-6 months and 13%(2 among 15 cases) over 6 months. Accoring to the underlying disease, the infection rate in traumatic cases was 12%(7 among 57 cases) and that in non-traumatic one was 3.7%(2 among 54 cases). Conclusion : From this study, it appears that skull defect should be repaired as soon as possible, because early cranioplasty can lower the infection rate. And surgeons could save the patients' cranial bone as possible as they can because autologous bone is not only cost effective in cosmatic purpose but lower the infection rate.

• Journal of Chest Surgery
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• v.38 no.2 s.247
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• pp.152-156
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• 2005

Background: Occlusive complications after arterial revascularization are difficult to treat and have high recurrence rate. This study was performed to establish an effective treatment modality and to evaluate the factors affecting the occlusive complications by analysis of clinical data. Material and Method: During the period of 5 years. 33 patients (55 reoperations) were studied at the Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital following 173 arterial revascularization surgeries. The clinical characteristics, operating methods, the time intervals of reoperation, used graft, and the results of treatment were evaluated retrospectively. Result: All the patients were men except one and the mean age was 63.5 years old. The mean time internal from first operation to reoperation was 11.9 months. The cause of arterial occlusive diseases were 28 atherosclerosis and 5 Burger's diseases, Associated diseases were Hypertension $(57.6\%)$, Diabetes mellitus $(33.3\%)$, heart failure $(18.2\%)$, and so on. The mean rate of reoperation was 1.67 times and the most common type of first operation was femoro-popliteal bypass grafting $(57.6\%)$. The graft that used revascularization surgery were 25 cases of PTFE and 6 case were Dacron. There was no statistical difference between two groups. The kinds of reoperations were thrombectomy in 20 cases, angioplasty 18 cases, re-bypass surgery in 13 cases, and lumbar sympathectomy in 4 cases. The results of reoperation were 15 cases of functional recovery, 7 cases of limb salvage, 5 cases of above-knee amputation. 3 cases of below-knee amputation and 3 deaths. Conclusion: The main cause of occlusive complications are occlusion of inflow or outflow artery. Treatments were different according to the first operation methods and graft used. The most frequent time of reoperation was within one year after the first operation. We believe that graft surveillance especially during the first year is very important factor in observing the patient. We can look forward to improving limb salvage rate to perform additional treatment such as radiological interventions and lumbar sympathectomy.

• Journal of Chest Surgery
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• v.42 no.1
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• pp.46-52
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• 2009

Background: Vascular injuries to the extremities are potentially devastating and they can lead to limb loss and mortality if they are not appropriately managed. The vascular trauma caused by traffic and industrial accidents has recently increased according to the developing industry and transport system in Korea. Early recognition and treatment of these injuries are mandatory to achieve satisfactory outcomes. Material and Method: We retrospective reviewed 43 patients with vascular injuries that were due to blunt and penetrating trauma and they underwent emergency operations from January of 1998 to December of 2006. Result: There were 38 men and 5 women patients with a mean age of $42.0{\pm}16.8$ years (range: 17~77). The cause of vascular injuries were 28 traffic accidents (65%), 6 industrial accidents (14%), 6 glass injuries (14%) and 3 knife injuries (7%). The average time from admission to the operating room was $319.0{\pm}482.2$ minutes (range: 27~2,400 minutes). The average time from admission to discharge was $53.1{\pm}56.0$ days (range: 2~265 days). The anatomic injuries included the femoral artery in 16 cases (37%), the popliteal artery in 8 cases (19%), the brachial artery in 8 cases (19%), and the subclavian and axillary arteries in 7 cases (16%). The associated injuries were 23 bone fractures (53%), 18 muscle injuries (42%) 5 nerve injuries (12%) and 11 vein injuries (26%). The operation methods were 20 end to end anastomoses (46%), 16 interposition grafts (36%), 2 repairs with using patches (5%) and 5 others (12%). The number of amputations and cases of mortality were 3 cases (7%) and 4 cases (9%), respectively. Conclusion: Minimizing ischemia is an important factor for maximizing salvage of extremities. Prompt diagnosis and treatment can reduce the amputation and mortality rates.

• Childhood Kidney Diseases
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• v.11 no.2
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• pp.280-287
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• 2007

Purpose : Urinary lithiasis is uncommon in children, however, it may lead to chronic renal insufficiency and even end stage renal disease. The etiology of stone formation in children is largely unknown; although the most common causes are known to be associated with congenital anomalies of the genito-urinary(G-U) tract, urinary tract infections(UTI), and metabolic diseases. Methods : A total of 73 children(male:female=42:31, mean age $6.6{\pm}5.3$ years) presented with urinary lithiasis between Sep. 1998 and Jul. 2007 at Seoul National University Children's Hospital. The medical records were reviewed retrospectively. Results : The most common presenting symptoms were gross hematuria(28/73, 38%) and flank or abdominal pain(23/73, 32%). The stones were located in the upper urinary tract in 48 patients(66%), in the bladder in 18(24%), and in both the bladder and upper urinary tract in 2 (3%). Congenital anomalies of the G-U tract with/without UTI were detected in 30 children (41%), hypercalciuria with/without hypercalcemia in 15(20%), and other metabolic diseases in 8(11%). In 17 patients(23%), no underlying cause of stone formation was detected. The majority of stones were infected stones(24/36, 67%), which were followed by calcium stones(8/36, 22%), uric acid stones(3/36, 8%). and cystine stones(1/36, 3%). Thirty-four patients(46%) underwent surgical procedures and/or extracorporeal shockwave lithotripsy for stone removal, and 13(18%) passed stones spontaneously with/without medical management. Stones recurred in 6 patients(8%): 4 with neurogenic bladder augmented by ileocystoplasty, 1 with cystinuria, and 1 with unknown etiology. Conclusion : The common causes of urinary lithiasis in children were congenital anomalies of the G-U tract with/without UTI and metabolic disorders including hypercalciuria/hypercalcemia. For the management of stones, minimally invasive procedures should be chosen on the basis of accompanying symptoms and the composition, locations and etiology of stones.