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Clinical Analysis of the Early Result of Coronary Artery bypass Graft (관상동맥 우회로술 154예이 조기 임상 결과)

  • Song Chang Min;Ahn Jae Bum;Kim Woo Shik;Shin Yong Chul;Yoo Hwan Kook;Kim Byung Yul;Kim In-Sub
    • Journal of Chest Surgery
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    • v.38 no.7 s.252
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    • pp.476-482
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    • 2005
  • Recently, coronary artery obstructive disease and coronary artery bypass graft surgery have increased, and the operative result has been improved. We reviewed 154 cases of coronary artery bypass graft surgery from Jan. 1985 to Jun. 2004. Material and Method: We reviewed 148 patients, 154 cases of coronary artery bypass surgery from Jan. 1985 to Jun. 2004. This investigation is designed to illustrate the preoperative diagnosis, severity of disease, operative method, the kind of used bypass graft used, number of distal anasomosis, associated surgery, and postoperative morbidity and mortality. Result: There were 84 males, 64 females and the average age was $58.9\pm8.3$ years old. Preoperative clinical diagnosis were unstable angina in 97 cases $(63.0\%)$, stable angina in 31 cases $(20.1\%)$, acute myocardial infarction in 12 cases $(7.8\%)$ and postinfartion angina in 14 cases $(9.1\%)$. Preoperative angiographic diagnosis were three-vessel disease in 68 $(44.2\%)$, two-vessel disease in 39 $(25.3\%)$, one-vessel disease in 35$(22.7\%)$, and left main disease in 12$(7.8\%)$ cases. There were 78 cases of on-pump coronary artery bypass graft surgery and 76 cases of off-pump coronary artery bypass graft surgery. The total distal anastomoses number was 319, mean number of anastomoses was $2.06\pm0.96$. There were 10 concomitant procedures. Postoperative intra-aortic balloon pump was used in 21$(13.6\%)$ cases, but only 4 cases were used at off-pump coronary artery bypass surgery. Total early mortality was $7.8\%$. The mortality was decreased as $4.5\%$ from Jan. 2001 to Jun. 2004. Post operative complication was perioperative yocardial infarction in 9cases$(5.8\%)$, low cardiac output syndrome in 17 cases$(11\%)$, and arrhythmia in 30 cases$(19.5\%)$ cases. Conclusion: Since 1985, The result of coronary artery bypass graft surgery has been improved because of more refined technique, use of off-pump coronary artery bypass surgery, use of internal thoracic artery and radial artery as bypass graft. We should study the long-term follow up more for better operative results.

Surgical Treatment of MDR Pulmonary Tuberculosis (다제내성 폐결핵의 수술적 치료)

  • Seo, Young-Jun;Park, Hoon;Park, Chang-Kwon;Keum, Dong-Yoon;Yoo, Young-Sun
    • Journal of Chest Surgery
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    • v.36 no.11
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    • pp.839-845
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    • 2003
  • Background: Even today when chemotherapy has been established as a treatment for tuberculosis and the prevalence of tuberculosis is gradually decreasing, multi-drug resistance tuberculosis still results in poor treatment performance and lowered survival periods. This research sought to analyze the surgery of multi-drug resistance tuberculosis, and determine the usefulness and danger of surgery in connection with this disease. Material and Method: Starting from February 1990 to February 2002, retrospective surveys were conducted targeted at 21 cases involving 20 patients who underwent surgery due to multi-drug resistance tuberculosis. The survey included 14 males cases and 6 females cases with the age averaging 42.8$\pm$12.1 years. 10.3$\pm$7.6 years on average passed after patients were initially diagnosed with tuberculosis. 13 patients (65%) tested positive in the pre-operative sputum AFB test, and all showed resistance against an average of 3.5 anti-tuberculosis agents including INH and RFP. Pre-operative radiologic examinations revealed cavitary lesions in 15 patients (75%), and three patients had lesions in the both lung fields, with the major lesions existing in the unilateral area. 13 patients (75%) failed negative conversion with medical treatment, while two patients (10%) with recurrent hemoptysis and five patients (25%) with lesions involving high recurrence-rate received the operation. Operations included nine cases (40%) of pneumonectomy, nine cases (45%) of lobectomy, and three cases of lobectomy with segmentectomy. The average follow-up period of patients stood at 23 months. Result: There was no post-operative death, and found were a total of eleven cases involving complications were found: three cases of long-term air leakage, three cases of bleeding requiring re-operation, two cases of empyemas due to broncho-pleural fistula, and one case of atelectasis, wound infection and chest wall fistula each. Eleven cases (85%) of negative conversion were completed immediately after the operation, and two cases failed negative conversion. Eleven months after the operation, the disease recurred in one case of negative conversion patients, and the patient was cured by completion pneumonectomy. Conclusion: If patients' lung function was sufficient and appropriate resection was possible, multi-drug resistance tuberculosis could achieve high-rate negative conversion and cure using combination of surgical and medical treatment, and also there were not many serious complications.

The Mid Term Clinical Result and the Risk Factor Analysis of Isolated Aortic Valve Replacement (단독 대동맥판막 치환술의 중기 성적과 그 위험인자에 대한 분석)

  • Park Jae-Min;Jun Hee-Jae;Yoon Young-Chul;Lee Yang-Hang;Hwang Yoon-Ho;Cho Kwang Hyun;Han Il-Yong
    • Journal of Chest Surgery
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    • v.38 no.2 s.247
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    • pp.110-115
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    • 2005
  • Background: The aims of this paper were to review the mid term clinical results and to analyze the preoperative risk factors of isolated aortic valve replacement (AVR). Material and Method: Between January 1992 and February 2003, 80 patients underwent isolated AVR. 58 were male and 22 were female patients, raging from 12 to 75 years of age (mean :$46.8{\pm}13.0$ years). 74 patients except one early death and 5 follow-up loss were contacted by OPD or by telephone. The mean duration of follow-up was $44.2{\pm}29.7$ months and the total cumulative period was 272.8 patient-year. Result: The complications in hospital occurred in 35 cases : 12 wound problems (11 superficial, 1 deep), 11 arrhythmias (9 temporary, 2 persistent), 3 low cardiac output, and so forth. The late deaths were 4 cases : the heart-related deaths were 2 cases ($0.7\%$ patient-year). Conclusion: The risk factors that influenced the early mortality and morbidity were older age (> 60 years)(p=0.04), poor preoperative NYHA functional class (> 3) (p=0.048), high preoperative serum creatinin level (> 1.2 mg/100 ml)(p=0.031), long operation time (aortic clamping time>90 min)(p=0.042). The same factors influenced the late mortality and morbidity. Freedom from valve-related complication was $86.4{\pm}5.3\%,$ actuarial survival rate were $96.8{\pm}2.3\%$ at 3 years and $90.8{\pm}4.6\%$ at 10 years.

입법예고

  • 한국동물약품협회
    • 동물약계
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    • no.52
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    • pp.2-5
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    • 1998
  • [ $\cdot$ ]동물용의약품등취급규칙개정령(안) 입법예고 $\cdot$사료관리법시행규칙개정령(안) 입법예고

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Efficacy of Ultrasonogram for the Diagnosis of Biceps Tendon Pathology (상완 이두건의 병소에 대한 초음파 검사의 유용성)

  • Seo, Joong-Bae;Lee, Jee-Young;Bahng, Seung-Chul
    • Clinics in Shoulder and Elbow
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    • v.11 no.2
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    • pp.90-95
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    • 2008
  • Purpose: We wanted to assess the accuracy of ultrasound for detecting abnormality of the long head of the biceps tendon in patients with rotator cuff disorders. Materials and Methods: Between January 2006 and March 2007, we reviewed the arthroscopic findings of biceps tendons in 67 patients with rotator cuff disorder and who underwent ultrasonography pre-operatively. The patients' average age was 58 years and there were 41 males and 26 females. The statuses of the biceps tendons were described as 'normal', 'dislocation', 'subluxation', 'partial or complete tears', and 'tendinopathy'. We investigated the correspondence between the arthroscopic and ultrasonographic findings. Results: On ultrasonography, the biceps tendons were 'normal' in 37 patients and 'abnormal' in 30 patients. On arthroscopy, 5 biceps tendons turned out to have partial tears, which were 'normal' on ultrasonography. On the other hand, 8 biceps tendons were 'normal' which were 'abnormal' on ultrasonography. Three dislocations and 4 complete tears of biceps tendons were identified on arthroscopy, and all of them were detected by ultrasonography. Of the 20 cases of 'tendinopathy' seen on ultrasonography, 15 patients had partial tears and the remaining 5 patients were normal on arthroscopy. Conclusion: Ultrasonography is accurate for detecting some biceps pathologies, such as dislocation or complete tear, but it is not accurate for the detection of partial tear.

The Clinical Evaluation of Anomalous Bronchi Arising From The Trachea and Main Bronchi (기관 및 주기관지에서 발생한 기관지기형의 임상적 고찰)

  • Kim, Jun Chul;Kim, Yeon Jae;Kang, Byung Jun;Youn, Young Deuk;Lee, Se Young;Kwon, Young Lan;Lee, Soo Ok;Jeong, Chi Yeong;Lee, Byung Ki
    • Tuberculosis and Respiratory Diseases
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    • v.59 no.6
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    • pp.664-669
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    • 2005
  • Objectives : To evaluate the clinical significance of abnormal bronchi originating from the trachea or main bronchi. Methods : 21 patients (male:female ratio, 13:8; mean age, 58.2 years, range 34-77), who were diagnosed with major tracheobronchial anomalies by bronchoscopy from January 2001 to March 2005, were enrolled in this study. The anomalous bronchi consisted of 13 tracheal bronchi and 8 cardiac accessory bronchus. The clinical features, bronchoscopic findings, and outcomes were analyzed retrospectively. Results : Common symptoms, including hemoptysis, cough and dyspnea, resulted from the underlying lung disease regardless of the bronchial anomalies. In this series of 13 tracheal bronchi, 7 cases originated from the trachea within 1cm of the carina (carinal type) and 6 cases originated at a higher level(tracheal type). Most patients had favorable outcome with conservative treatment for the underlying lung disease. Conclusion : Most tracheobronchial anomalies are found incidentally in the process of diagnosing lung disease. The clinical outcome of patients with a bronchial anomaly depends on the underlying lung disease.

Early & Midterm Results after Redo Coronary Artery Bypass Grafting (관상동맥우회술 후 재수술의 단기 및 증기 성적)

  • 김준성;김홍관;장우익;김기봉
    • Journal of Chest Surgery
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    • v.37 no.2
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    • pp.146-153
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    • 2004
  • As the experience of coronary artery bypass grafting (CABG) has been accumulated, the number of reoperation after CABG is increasing. We analyzed our clinical experience of redo-CABG. Material and Method: Fourteen patients who underwent redo-CABG between Jan. 1994 and Dec. 2002 were included in this study. The mean period from the first operation to reoperation was 66$\pm$56 (3∼157) months, and the average ages were 62.8$\pm$8.7 (51∼78) years. The survivors were followed up 39$\pm$29 (4∼101) months postoperatively. Indications of reoperation were stenosis or occlusion of previous grafts in 11 patients, progression of native coronary artery disease in one patient, and both etiologies in two patients. Result: There were two in-hospital mortalities (14.3%) resulting from low cardiac output syndrome, Postoperative morbidities were perioperative myocardiac infarction in 2 patients (14.3%), mediastinitis in one patient (7.2%), duodenal perforation in one patient, ischemic necrosis of the lower extremity in one patient, gastric perforation after mesenteric infarct in one patient, delayed brain infarct in one patient, and intraoperative splenic rupture in one patient. There was one late mortality at six months postoperatively during the follow up. There was no angina recurrence during the follow up. Conclusion: Although redo CABG demonstrated relatively high operative mortalities and morbidities, postoperative status and clinical outcome of the survivors were favorable.

Comparison of Immunohistochemical Expression of CBP(cAMP-responsive Element Binding Protein) Transcriptional Co-activator between Premalignant Lesions and Squamous Cell Carcinomas in the Lungs (전암성 폐병변 및 편평상피세포폐암 조직에서 CBP(cAMP-responsive Ele-ment Binding Protein) 전사 공동 활성인자의 면역조직화학적 발현양상의 비교)

  • Shin, Jong Wook;Kim, Jin Soo;Kim, Mi Kyung
    • Tuberculosis and Respiratory Diseases
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    • v.63 no.2
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    • pp.165-172
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    • 2007
  • Background: The pathogenesis of lung cancer includes the accumulation of multiple genetic abnormalities. The CREB-binding protein(CBP) is one of several transcriptional co-activators among various sequence-specific DNA-binding transcription factors. CBP is involved in a wide range of cellular activities, such as DNA repair, cell growth, differentiation, and apoptosis that are suspected of contributing to tumorigenesis. The goal of this study was to evaluate CBP expression in a series of human lung tissues containing normal epithelium, premalignant lesions(hyperplasia and dysplasia) and squamous cell carcinomas. Materials and Methods: Immunohistochemical staining was performed on formalin-fixed paraffin-embedded sections by use of a monoclonal anti-CBP antibody. CBP expression was compared in samples from 120 patients with premalignant and malignant histological types including 20 metaplastic specimens, 40 dysplastic specimens, and 60 squamous cell carcinomas in the lung. Results: CBP expression was seen in 35% (7/20) of the metaplastic specimens. 65% (26/40) of the dysplastic specimens, and 70% (42/60) of the squamous cell carcinomas (p<0.05). According to celluar atypism, CBP expression was 50% (10/20) of the low-grade dysplastic specimens and 80% (16/20) of the high-grade dysplastic specimens(p <0.01). By cellular differentiation, CBP expression was seen in 95% (19/20) of the well differentiated squamous cell carcinomas, 85% (17/20) of the moderately differentiated carcinomas and 30% (6/20) of the poorly differentiated lesions (p <0.05). Conclusion: These results suggest that CBP may have an important role in malignant transformation of precancerous lung lesions and may be a marker for malignancy.

Ultrasonographic Features of Intra-abdominal Abscess (복부내 농양의 초음파 소견)

  • Cho, Kil-Ho;Jung, Kyung-Hee;Hwang, Mi-Soo;Chang, Jae-Chun;Kwun, Koing-Bo;Min, Hyun-Sik
    • Journal of Yeungnam Medical Science
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    • v.2 no.1
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    • pp.87-93
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    • 1985
  • Intraabdommal abscess usually causes distress with fever, leukocytosis, pain and toxicity. Diagnosis of intraabdominal abscess is occasionally difficult and It has high morbidity. However radiologic method, such as ultrasonography, CT scan, or RI scan are helpful to early detection of intraabdominal abscess. Among these methods, ultrasonography is a non-invasive technique and performed without discomfort to patient. And also differential diagnosis between cystic and solid lesion is very easy and sequential ultrasonography in same patient is valuable for the evaluation of treatment effect. We analyzed the ultrasonic features of 48 cases with intra-abdominal abscesses and the results are as follows; 1. In total 48 cases, the intra-abdominal abscesses were 30 cases, the retroperitoneal abscesses, 5 cases, and the visceral abscesses, 13 cases. 2. The causes of the intra-abdominal abscesses were perforating appendicitis (25 cases), postoperative complications (5 cases), pyogenic and amebic hepatic abscesses (13 cases), and the others (5 cases). 3. Round or oval shaped lesions were 26 cases (54%), irregular shape, 18 cases (38%), and multiple abscess formation in 4 cases (8 %). 4. The size of the lesions were between 5 and 10cm in diameter in 54% of total 48 cases, and the most frequent feature of the echo-pattern of the lesions was cystic with or without internal echogenicity (69%).

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Compression Plate Fixation with Autogenous Bone Graft for Humerus Shaft Nonunion (상완골 간부 불유합에 대한 금속판 고정 및 자가골 이식술)

  • Cho, Chul-Hyun;Song, Kwang-Soon;Bae, Ki-Cheor;Kim, In-Kyoo;Kwon, Doo-Hyun
    • Clinics in Shoulder and Elbow
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    • v.12 no.1
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    • pp.33-37
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    • 2009
  • Purpose: To evaluate the results of the compression plate fixation and autogenous bone graft in the management of humerus shaft nonunion. Materials and Methods: Eighteen cases were treated for humerus shaft nonunion using compression plate fixation and an autogenous iliac bone graft. The mean follow-up period was 28 months. Bony union was confirmed from the serial radiographs and the clinical outcomes were assessed according to ASES scoring system. Results: In 12 cases of initial plate fixation, the causes of nonunion were 6 cases of inadequate plate length, 2 with a broken plate, 2 with screw loosening, 1 infection and 1 noncompliance of a psychiatric patient. In 3 cases of initial intramedullary fixation, the cause of nonunion was a distraction of the fracture site. In 3 cases of external fixation, the cause of nonunion was inadequate fixation. All cases showed bony union after an average of 24 weeks. The clinical outcomes were 11 excellent, 6 good and 1 fair. Conclusion: In the treatment for nonunion, compression plate fixation with autogeneous bone graft after complete removal of the fibrous and necrotic tissue is believed to give satisfactory results.