• Journal of Chest Surgery
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• v.32 no.3
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• pp.281-286
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• 1999

Background: The purpose of this study is to analyze the types of complications, the incidences of complications, and preoperative and postoperative risk factors affecting the incidence of the complication. Material and Method: Between August 1990 and August 1997 in Asan Medical Center, 42 patients(24 men and 18 women) underwent surgical resection for pulmonary aspergilloma. The mean age was 46.6${\pm}$11.5 years(range 29 to 69 years). Hemoptysis(90%) was the most common presentation. Pulmonary tuberculosis was the most common predisposing cause(81%). The associated diseases were bronchiectasis(n=11), active puolmonary tuberculosis(n=9), diabetes mellitus(n=8), lung carcinoid(n=1), and acute myeloblastic leukemia(n=1). Lobectomy was done in 32 cases(76%), segmentectomy or wedge resection in 4, pneumonectomy in 2, and lobectomy combined with segmentectomy in 4. Result: Operative mortality was 2%. The most common postoperative complication was persistent air leakage(n=6). The variables such as age, sex, pulmonary function test, amount and duration of hemoptysis, associated diseases(diabetes mellitus, active pulmonary tuberculosis), mode of preoperative management(steroid, antifungal agent, bronchial arterial embolization), and modes of operative procedures were statistically insignificant. The radiologic extent of infiltration to normal lung parenchyme was statistically significant(p=0.04). Conclusion: We conclude that the extent of the infiltration to normal lung parenchyme in preoperative radiologic studies should be carefully evaluated to reduce the postoperative complications in surgery for pulmonary aspergilloma.

• Journal of Chest Surgery
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• v.32 no.3
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• pp.249-254
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• 1999

Background: Recovery of the left atrial contractile function after the Cox-Maze procedure is related to the size of the left atrium. We have postulated that if too wide area of the atrium were isolated electrically, then the atrial contractile function would be impaired postoperatively. We have modified the Cox-Maze procedure to dissect each pair of the pulmonary veins separately instead of the conventional pulmonary vein encircling incision, and compared the atrial contractile function after each procedure. Material and Method: From February 1995 to October 1997, 55 cases of the Cox-Maze procedure were performed in mitral valvular heart disease. We excluded the cases that did not covert to sinus rhythm. The patient groups were divided according to the interpulmonary vein distance(IPVD) and the procedure performed. Group I was IPVD under 6.5 cm(n=30), group II was IPVD over 6.5cm and the conventional Cox-Maze III procedure was performed(n=16), and group III was IPVD over 6.5cm and the modified Cox-Maze procedure was performed(n=9). Result: Atrial contractile function was evaluated by the echocardiography follow-up between 6 months to 12 months. The right atrial contractile function recovered gradually, the recovery rate after long-term follow-up was 90% in group I, 81% in group II, and 100% in group III(p>0/05). In the left atrium the recovery rate was 63% in group I, 31% in group II(p=0.03), and 66% in group III(p>0.05). Conclusion: The modified Cox-Maze procedure may have beneficial effects on the recovery of the left atrial contractile function, however, there are no statistically significant values. Therefore, further evaluation of this procedure is necessary.

• Journal of Chest Surgery
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• v.32 no.3
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• pp.255-261
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• 1999

Background: Atrial fibrillation is one of the most prevalent of all arrhythmias and in up to 79% of the patients with mitral valve disease. This study examined whether the atrial fibrillation that occur in patients with mitral valve operation could be eliminated by a concommitant maze operation without cryoablation. Material and Method: From May 1997 to April 1998, 14 patients with atrial fibrillation associated with mitral valve disease underwent Maze III operation without cryoablation. Preoperatively there were 6 men and 8 women with an average age of 46.2${\pm}$10.7 years. Eleven patients had mitral stenosis, and three had mitral insufficiency. The associated heart diseases were aortic valve disease in 4, tricuspid valve regurgitation in 1 and ASD in 2. Using transthoracic echocardiography, the mean left atrial diameters was 54.7${\pm}$5.3 mm and thrombi were found in the left atrium of 2 patients. Postoperatively the ratio between the peak speed of the early filling wave and that of the atrial contraction wave (A/E ratio) was determined from transmitral flow measurement. Operations were mitral valve replacement in 13 including 4 aortic valve replacements, 1 DeVega annuloplasty and 2 ASD closures. Maze III operation was performed in 1 patient. Result: Five patients (38%) had recurred atrial fibrillation, which was reversed with flecainide or amiodarone at the average time of postoperative 38.8${\pm}$23.5 days. Postoperative complications were postoperative transient junctional rhythm in 6, transient atrial fibrillation in 5, reoperation for bleeding in 3, postpericardiotomy syndrome(1), unilateral vocal cord palsy(1), postoperative psychosis(1), and myocardial infarction(1). Postoperatively A/E ratio was 0.43${\pm}$0.22 and A wave found in 9(64%) patients. 3 to 14 months postoperatively (average follow- up, 8.1 months), all of patients had normal sinus rhythm and 9(64%) patients had left atrial contraction and 11(79%) patients were not on a regimen of antiarrhythmic medication. Conclusion: We conclude that Maze III operation without cryoablation is an effective surgical treatment in atrial fibrillation associated with the mitral valve disease.

• Journal of Chest Surgery
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• v.29 no.12
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• pp.1316-1322
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• 1996

From May 1977 to December 1994, 1.060 cases of open heart surge y for congenital heart disease were performed under cardiopulmonary bypass in Chonnam University Hospital They were divided into two groups; group A(677 cases, from May 1977 lo December 1989), group B(38B cases, from January 1990 to December 1994), to be compared and analized. Of the 1, 060 cases, there were 889 acyanotic (83.9%) and 171 cyanotic(16.1%). The operative mortality was 7.8% in group A and 5.7% in group B (total : 6.6%). The operative mortality for group A was 25% in cyanotic disease and 3.7% in acyanotic disease, respectively in group B, it was 23.8%, 3.2%. There were 19 patients (3.8%) and 78 patients(20.4%) with body weight under 10kg in group A and group B respectively. The operative mortality for these patients were 31.6% in A group and 16.1% in B group. In result, increasing trend in congenital heart disease in patients under 10 kg of body weight has been noted, whereas mortality has decreased. The operative mortality of tetralogy of Fallot has decreased in group B t an group A. These results suggest that the operative result have improved in recent years.

• Journal of Chest Surgery
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• v.29 no.12
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• pp.1360-1365
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• 1996

From September 1992 to May 1996, 38 patients ranging in age from 23 to 78, were operated for aortic dissection at Asan medical center There were 21 men and 17 women. The underlying aortic pathology were acute aortic dissection in 23, chronic aortic dissection in 15. Eight patients had Martian syndrome. In 34 cases of DeBakey type I, II patients, femoral artery and vein and/or right atrial auricle were used as cannulation site. With deep hypothermic c rculatory arrest (esophageal temperature 12 $\pm$ 2.5$^{\circ}C$) and retrograde cerebral perfusion of cold oxygenated blood through SVC, we replaced the ascending aorta and the part of arch if necessary. The mean duration of the total circulatory arrest time was 25 $\pm$ 1.7 mintstuts. In 4 cases of DeBakey type III patients, we replaced descending thoracic aorta or thoracoabdomlnal aorta without shunt or bypass under normothermia with an average 30: 1.5 minutesaortic cross clamp time. One death(2.6%) occurred on the twenty-second postoperative day owing to asphyxia related to ulcer bleeding. Postoperative complications were myocardial infarction with transient left peroneal palsy in 1 case, transient lower extremity weakness in 1 case and prolonged ventilatory support in 1 case. Two patients required reoperation due to retrograde extended dissection and aortic insufuciency. There was no late death with an average 25 months follow-up period.

• Journal of Chest Surgery
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• v.39 no.4 s.261
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• pp.275-280
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• 2006

Background: Aortopulmonary window (APW) is a very rare congenital heart anomaly, often associated with other cardiac anomalies. It causes a significant systemic to pulmonary artery shunt, which requires early surgical correction. Accurate diagnosis and surgical correction will bring good outcomes. The purpose of this study was to describe our 20-year experience of aortopulmonary window. Material and Method: Between March 1985 and January 2005, 16 patients with APW underwent surgical repair. Mean age at operation was $157.8{\pm}245.3$ ($15.0{\sim}994.0$) days and mean weight was $4.8{\pm}2.5$ ($1.7{\sim}10.7$) kg. Patent ductus arteriosus (8), atrial septal defect (7), interruptedaortic arch (5), ventricular septal defect (4), patent foramen ovate (3), tricuspid valve regurgitation (3), mitral valve regurgitation (2), aortic valve regurgitation (1), coarctation of aorta (1), left superior vena cavae (1), and dextrocardia (1) were associated. Repair methods included 1) division of the APW with primary closure or patch closure of aorta and pulmonary artery primary closure or patch closure (11) and 2) intra-arterial patch closure (3). 3) Division of the window and descending aorta to APW anastomosis (2) in the patients with interrupted aortic arch or coarctation. Result: There was one death. The patient had 2.5 cm long severe tracheal stenosis from carina with tracheal bronchus supplying right upper lobe. The patient died at 5th post operative day due to massive tracheal bleeding. Patients with complex aortopulmonary window had longer intensive care unit and hospital stay and showed more morbidities and higher reoperation rates. 5 patients had reoperations due to left pulmonary artery stenosis (4), right pulmonary artery stenosis (2), and main pulmonary artery stenosis (1). The mean follow-up period was $6.8{\pm}5.6$ (57.0 days$\sim$16.7 years)years and all patients belonged to NYHA class 1. Conclusion: With early and prompt correction of APW, excellent surgical outcome can be expected. However, optimal surgical method needs to be established to decrease the rate of stenosis of pulmonary arteries.

• Journal of Chest Surgery
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• v.40 no.6 s.275
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• pp.420-427
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• 2007

Background: Postpneumonectomy empyema (PPE) due to bronchopleural fistula (BPF) can be a surgical challenge for surgeons. We analyzed the follow-up outcomes after performing omentopexy and thoracoplasty for the treatment of PPE with BPF after pneumonectomy. Material and Mehod: Between December 1991 and January 2006, 9 patients underwent BPF closure using an omental pedicled flap for the treatment of PPE with BPF after pneumonectomy. There were 7 males and 2 females (mean age: $45.9{\pm}9$ years). The patients were followed up for a mean of 58 months (median: 28 months, range: $6{\sim}169$). When we performed omentopexy, the surgical procedures for empyema were thoracoplasy for 8 patients and the Clagett procedure for 1 patient. Thoracoplasty was performed for the latter patient due to recurrence of empyema, Result: For the 8 patients who were treated by omentopexy and thoracoplasty, there was 1 operation-related death due to sepsis. During follow up, 1 patient, who was treated by omentopexy and a Clagett procedure, died of acute hepatitis 40 months postoperatively. The early mortality was 11.1% (8/9). Of the 8 patients, including the 1 late death patient, successful closure of the BPF were achieved in all patients (8/9) and the empyema was cured in 7 patients (7/8). Conclusion: The BPF closure using an omental pedicled flap was an effective method for treating PPE with BPF due to 75-destroyed lung, and thoracoplasty with simultaneous omentopexy was effective and safe for removing dead space if the patient was young and in a good general condition.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.18 no.3
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• pp.78-86
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• 2018

Purpose: We aimed to delineate clinical spectrum and short-term effects after enzyme replacement therapy (ERT) for 5 mucopolysaccharidosis type II (MPS II). Methods: Five patients were diagnosed with MPS II by clinical findings, enzyme activity, and genetic testing. Idursulfase was administered by intravenous infusion at a dose of 0.5 mg/kg every week. Observational chart analysis of patients, who underwent systematic investigations more than 12 months after initiation of ERT was done retrospectively. Results: Three patients were classified as having the attenuated type, and 2 patients were classified as having the severe type. The median age at the diagnosis was 9.6 years (range 3.4-26 years). Four different mutations in 5 Korean patients (4 families) with MPS II were identified, among which two were novel mutations (1 small insertion mutation: p.Thr409Hisfs*22, and 1 missense mutation: p.Gly134Glu). Two severe type sibling patients with the same mutation had different clinical manifestation. Urinary glycosaminoglycan excretion decreased within the twelve months of ERT (P=0.043). Liver and spleen volumes showed reductions that were maintained in all patients (P=0.043 and P=0.043, respectively). Improvements were also noted in left ventricular mass index (P=0.042), shoulder flexion (P=0.043), shoulder abduction (P=0.039), knee flexion (P=0.043), elbow flexion (P=0.042), and respiratory distress index (P=0.041). Conclusion: This study demonstrates that Korean patients with MPS II are clinically heterogeneous and indicates that idursulfase is relatively effective in several clinical parameters including heart size and respiratory distress index without infusion-related reactions in patients with MPS II.

• The Korean Journal of Nuclear Medicine Technology
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• v.23 no.2
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• pp.20-24
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• 2019

Purpose Molecular Breast Imaging (MBI) scan is used in nuclear medicine, for which $^{99m}Tc-sestaMIBI$ is administered by intravenous injection. However, the breast uptake rate of $^{99m}Tc-sestaMIBI$ is less than 1% of the total dose administered, relying on blood flow conditions of organs. The purpose of this study is to evaluate the impact of changes to body temperature on the uptake of $^{99m}Tc-sestaMIBI$ in breast tissue. Materials and Methods We investigated 30 breast cancer patients who performed more than one follow-up MBI scan. All scans were acquired by Discovery 750B (Genral Electric Healthcare, USA). $^{99m}Tc-sestaMIBI$ injected with 740 MBq (20 mCi), after 60 minutes, gained bilateral breast CC (CranioCaudal), MLO (Medio Lateral Oblique) View. The follow-up examination was then classified into 15 body temperature control group and 15 body temperature non-control group, and gained breast image in the same way as before. The breast uptake rate was analyzed in the MLO View of the opposite side of the lesion, and blind images were evaluated. Results The breast uptake rate increased by 30.31% in the body temperature control group and it was statistically significant(P<0.05), and 0.96% in the body temperature non-control group, and it was not statistically significant(P=0.955). There was a significant difference in the uptake rate between the body temperature control and the non-control group of P value of 0.01. Evaluation of blind images showed significant results in terms of the quality of the images. Conclusion Increased breast tissue uptake was observed when the subject was kept warm. When the body temperature was raised after injection, dilation of the peripheral blood vessels can be achieved. As a result, the blood flow became smooth and the breast uptake rate increased. In addition, an increase in breast tissue uptake will improve the quality of images.

• Journal of the Korean Society of Radiology
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• v.85 no.1
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• pp.138-146
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• 2024

Purpose To evaluate whether the image quality of chest radiographs obtained using a camera-type portable X-ray device is appropriate for clinical practice by comparing them with traditional mobile digital X-ray devices. Materials and Methods Eighty-six patients who visited our emergency department and underwent endotracheal intubation, central venous catheterization, or nasogastric tube insertion were included in the study. Two radiologists scored images captured with traditional mobile devices before insertion and those captured with camera-type devices after insertion. Identification of the inserted instruments was evaluated on a 5-point scale, and the overall image quality was evaluated on a total of 20 points scale. Results The identification score of the instruments was 4.67 ± 0.71. The overall image quality score was 19.70 ± 0.72 and 15.02 ± 3.31 (p < 0.001) for the mobile and camera-type devices, respectively. The scores of the camera-type device were significantly lower than those of the mobile device in terms of the detailed items of respiratory motion artifacts, trachea and bronchus, pulmonary vessels, posterior cardiac blood vessels, thoracic intervertebral disc space, subdiaphragmatic vessels, and diaphragm (p = 0.013 for the item of diaphragm, p < 0.001 for the other detailed items). Conclusion Although caution is required for general diagnostic purposes as image quality degrades, a camera-type device can be used to evaluate the inserted instruments in chest radiographs.