• Maxillofacial Plastic and Reconstructive Surgery
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• v.27 no.1
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• pp.66-70
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• 2005

Cupid's bow, upper lip, columella, and ala of nose are esthetically important, in which their symmetrical plasties determine success or failure of the surgery in cleft lip and palate patients. Z-palsty and its modifications are simple and effective. The double Z-plasty is economical in surgical time and esthetics in reconstructing the cupid's bow compared with other methods. We report a 29-year-old male patient who represented reversed cupid's bow and whistle deformity after the primary repair of the cleft lip. He was corrected the cupid's bow using a double Z-plasty. The reversed cupid's bow was corrected to a normal shape and the whistle deformity disappeared. The tightness of the upper lip was relieved after the operation. The double Z-plasty was esthetically successful because the procedure was limited in the vermilion and did not produce a new scar on the skin. Furthermore, the lip tubercle became protuberant. The cupid's bow was symmetrically smoothly curved at 4 years after the operation. These results indicate that the double Z-plasty is simple, less traumatic to the surrounding tissues, and suitable for the correction of whistle deformity.

• Journal of the Korean Orthopaedic Association
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• v.54 no.2
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• pp.91-99
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• 2019

Most patients experience pain relief and functional improvement after arthroscopic rotator cuff repair. In some patients, however, symptoms still remain after surgery. Failed rotator cuff repair is a complex outcome of biological, technical, and traumatic factors. Moreover, re-tears might or might not be the main cause for patients with persistent pain after rotator cuff repair. Therefore, a thorough understanding of the patient's history, physical examination, and appropriate imaging studies will be needed to evaluate and manage these patients. The patient's age, functional requirement, quality of the rotator cuff, preoperative range of motion, quality of the deltoid, and glenohumeral arthritis are factors to consider before performing revisional rotator cuff repair. Preoperative patient education is as important as the surgical technique for successful revisional rotator cuff repair.

• Journal of the Korean Society of Radiology
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• v.84 no.5
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• pp.1017-1030
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• 2023

Radiofrequency ablation (RFA) is a non-surgical treatment for symptomatic, benign thyroid nodules. This treatment works by heating and destroying the nodule tissue, which results in reduction of its size and alleviation of the symptoms involved. RFA is indicated for nodules which are confirmed to be benign on two or more cytological or histological examinations, and which result in clinical symptoms requiring medical treatment. It is associated with good short-term outcomes on one-year follow-up; however, 20%-30% of the nodules regrow after more than three years. Therefore, on the basis of long-term follow-up, management of regrowth is key to patient care following RFA. Regrowth is more likely to occur in nodules that are large in size prior to RFA, and in those with high or increased vascularity. Recently, new techniques such as hydrodissection, artery-first ablation, and venous ablation have been introduced to inhibit regrowth. In addition, appropriate criteria for additional RFA should be applied to manage regrowth and prolong its therapeutic effects. RFA is essentially an alternative to surgery; therefore, the ultimate goal of this procedure is to avoid surgery permanently, rather than to achieve temporary effects.

• Journal of Hospice and Palliative Care
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• v.10 no.1
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• pp.35-42
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• 2007

Purpose: Colorectal ranter is the 4th leading cause of cancer death in Korea and the prevalence is increasing continuously. This study was aimed to figure out the problems through the clinical consideration about terminal colorectal ranter patients who had died in hospice unit. Methods: We retrospectively reviewed the medical records in 78 patients with colorectal ranter who had admitted, received palliative care, and died in a hospice unit between April 2003 and November 2006. Results: The median age of patients was 59.6 years with 45 men (58%) and 24 women (42%). The median survival in hospice and palliative care was 36 days. The median hospitalization was 22 days. The most prevalent reason for admission was pain (38 patients, 49%), and the most common symptom was also pain (70 patients, 90%). Forty eight patients (62%) took analgesics before hospice referral. Twenty seven patients (65%) of 45 patients with intestinal obstruction have been performed palliative procedures. Median survival of patients with palliative procedure was higher than that of no palliative procedure group (47 days vs 19 days, P-value=0.005). Conclusion: The duration of hospice and palliative care was not enough to care the terminal colorectal cancer. Therefore, we suggest that proper education and information should be provided to physician, patients and their family members for effective hospice and palliative care.

• Journal of Chest Surgery
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• v.43 no.4
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• pp.375-380
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• 2010

Background: Primary cardiac tumors are extremely rare. The most common type are benign myxomas, and these are almost completely curable with early surgery. Malignant tumors, however, such as sarcomas, are difficult to remove surgically, and their prognosis is known to be poor. In this study, data on patients who had undergone surgical treatment of cardiac tumor in the authors' hospital were collected and analyzed. Material and Method: The subjects included 28 patients who had undergone surgical treatment of cardiac tumor from August 1993 to December 2008. Their medical records were reviewed and retrospectively analyzed. Result: The patients were aged from 20 to 76 years (mean age: $54.2{\pm}15.6$), and 11 were male (39%) and 17 female (61%). Fifteen of them (54%) underwent emergency surgery to improve heart failure symptoms. The most common preoperative symptom was dyspnea (15 cases, 54%). Preoperative echocardiography was performed on all the patients. The average size of the tumor as measured during the operation was $7.0{\pm}6.9cm$ (the average length of the long axis was 2∼40 cm), and the sites of tumor attachment were the interatrial septum (18 cases, 64%), the left atrium (9 cases, 32%), the mitral valve annulus (2 cases, 7%), and the left ventricle (2 cases, 7%). The operation was performed with an incision through both atria in all the patients, and a complete excision was made in 25 cases (89%). According to the biopsy results, there were 4 cases of sarcoma (14%), 1 case of lipoma (4%), and 23 cases of myxoma (82%). The three cases in which the tumors were not completely excised were sarcomas. No operative deaths occurred after the operations. Outpatient follow-up was possible for 24 cases (86%), with a mean follow-up period of $46.8{\pm}42.7$ months. Late death occurred in 3 of the 24 patients; each of these patients had sarcomas. Of these patients, the first had undergone two repeat surgeries, the second had metastatic sites removed, and the last had only chemotherapy. The average recurrence time was $12.7{\pm}10.8$ months, and the average metastasis time was $20.5{\pm}16.8$ months. Conclusion: Most cardiac tumors are benign myxomas. In principle, they should be surgically treated because they can create risks such as embolism, and can be radically treated when surgically removed. In most cases, however, malignant sarcomas are already considerably advanced with severe infiltration into the neighboring tissues at the time of diagnosis. The surgical removal of malignant sarcomas is known to be difficult because of the advanced stage and degree of infiltration. We suggest that excision of the removable portion of the tumor sites to alleviate symptoms such as heart failure can improve quality of life.

• The Journal of the Korean bone and joint tumor society
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• v.16 no.2
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• pp.80-86
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• 2010

Purpose: The skeleton is commonly affected by metastatic cancer. The purpose of this study was to evaluate the results of treating metastatic pathologic fractures in lower extremities using locking plates. Materials and Methods: Between 2004 and 2010, we evaluated 12 patients (13 cases) of metastatic pathologic fractures in lower extremities, treated with the locking plate. Mean patient age was 62.2 years (range, 50-81 years), the locations of the fractures were; proximal femur in 2 cases, femoral mid-shaft in 3, distal femur in 3, proximal tibia in 4, and distal tibia in 1 case. The interval to wheelchair ambulation, pain relief and complications were evaluated. Additionally, we assessed operation time and postoperative blood loss. Results: Mean time from operation to wheelchair ambulation was 3.2 days (range, 1-6 days). Mean VAS scores improved from a preoperative score of 8.1 points (range, 7-9 points) to a score of 2.7 points (range, 2-4 points) at 1 week postoperatively. No early complications associated with surgery were encountered. Mean operation time was 88.4 minutes (range, 70-105 minutes), and mean postoperative blood loss was 246.5 ml (range, 130-320 ml). Conclusion: Internal fixation of metastatic pathologic fractures using a locking plate in the lower extremity can be an effective treatment option in the meta- or diaphyseal area of long bones with massive bony destruction or poor bone stock by offering early ambulation, pain relief and low postoperative complications.

• Journal of Chest Surgery
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• v.40 no.11
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• pp.752-758
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• 2007

Background: Thoracic sympathetic block surgery is a safe and effective procedure for palmar hyperhydrosis, and this maintains sufficient moisture and prevents compensatory hyperhidrosis. To avoid compensatory hyperhidrosis, the authors performed sympathetic block surgery just above the R4 level to maintain sympathetic tone affecting the caudal area. Material and Method: A total of 71 subjects (45 males and 26 females) were categorized into two groups. Group 1 (31 patients, mean age: 25.5 years) had clips placed both on the upper and lower part of R4 sympathetic ganglion, and group 2 (40 patients, mean age: 25.9 years) underwent clipping of the upper part of R4. Telephone surveys were done to collect data on 8 categories, and the average follow up interval was 24.9 months (group 1) and 18.9 months (group 2). Result: For group 1, 41.9% experienced no sweating and 48.4% re-plied they experienced some sweating depending on the surrounding conditions. Group 2 showed that 60% experienced no sweating and 35% replied they experienced some sweating depending on the surrounding conditions, 58.1% in group 1 experienced sweating right after the surgery, and 40.0% in group 2 experienced the same. Group 1 (38.1%) and group 2 (37.5%) replied they experienced no hand dryness and more patients in group 2 than in group 1 had hand dryness, but without uncomfortable symptoms. 71.0% (group 1) and 62.5% (group 2) replied they had no compensatory hyperhidrosis or related symptoms. One patient in group 1 and two in group 2 reported they regretted undergoing the procedure. The regions of compensatory hyperhidrosis were the back, thigh and chest in group 1 and the group 2 reported the back, chest, and abdomen in the order of frequency. Fewer incidences of the gustatory hyperhidrosis were noted in group 2. Most of the patients were satisfied with their treatment. Conclusion: Clipping the upper part of the R4 ganglion or R4 sympathetic block are both effective for treating palmar hyperhidrosis and these treatments decrease the occurrence or symptoms of compensatory hyperhidrosis. The upper R4 sympathetic block procedure is easier and safer with fewer incidences of gustatory hyperhidrosis and a higher percentage of patient satisfaction.

• Journal of Chest Surgery
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• v.36 no.2
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• pp.73-78
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• 2003

The Fontan operation has undergone a number of major modifications and clinical results have been improving over time. Nevertheless, during the follow-up period, life-threatening complications develop and affect the long-term outcomes. Surgical interventions for these complications are needed and are increasing. Material and Method: From April 1988 to January 2000, 16 patients underwent reoperations for complications after Fontan operation. The mean age at reoperation was 8.8 :-5.5 years. Initial Fontan operations were atriopulmonary connections in 8 and total cavopulmonary connections in 8. Total cavopulmonary connections were accomplished with intracardiac lateral tunnel in 5 and extracardiac epicardial lateral tunnel in 3. Five patients had variable sized fenestrations. The reasons for reoperations included residual shunt in 6, pulmonary venous obstruction in 3, atrial flutter in 3, atrioventricular valve regurgitation in 2, Fontan pathway stenosis in 1, and protein-losing enteropathy in 1 Result: There were 3 early and late deaths respectively Patients who had residual shunts underwent primary closure of shunt site (n=2), atrial reseptation for separation between systemic and pulmonary vein (n=2), conversion to lateral tunnel (n=1), and conversion to one and a half ventricular repair (n=1). Four patients who had stenotic lesion of pulmonary vein or Fontan pathway underwent widening of the lesion (n=3) and left pneumonectomy (n=1) In cases of atrial flutter, conversion to lateral tunnel after revision of atriopulmonary connections was performed (n=3). For the atrioventricular valve regurgitation (n=2), we performed a replacement with mechanical valve. In one patient who had developed protein-losing enteropathy, aorto-pulmonary collateral arteries were obliterated via thoracotomy. Cryoablation was performed concomitantly in 4 patients as an additional treatment modality of atrial arrhythmia. Conclusion: Complications after Fontan operation are difficult to manage and have a considerable morbidity and mortality. However, more accurate understanding of Fontan physiology and technical advancement increased the possibility of treatment for such complications as well as Fontan operation itself. Appropriate surgical treatment for these patients relieved the symptoms and improved the functional class, Although the results were not satisfactory enough in all patients.

• Journal of Chest Surgery
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• v.39 no.9 s.266
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• pp.702-705
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• 2006

Severe left ventricular dysfunction after relief of massive pericardial effusion has been rarely reported. Interventricular volume mismatch, acute distention of the cardiac chambers and interplay of autonomic none system are believed to be the possible causes for ventricular dysfunction. Presenting two patients who had marked decrease in global ventricular systolic function after relief of pericardial tamponade by subxyphoid pericardial window, we recommend gradual removal of pericardial fluid under hemodynamic monitoring, especially in patient with postcardiotomy tamponade.

• Journal of Chest Surgery
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• v.35 no.11
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• pp.839-841
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• 2002

Generally, patients who have airway compression with severe kyphoscoliosis can be improved through surgery for the thoracolumbar deformity. However, abnormal thoracic configuration due to severe kyphoscoliosis can cause respiratory distress secondary to severe compression of central airway in uncorrectable case. We tried to elevate the chest wall and obtained relatively good result in case of airway compression with abnormal thoracic configuration which was difficult to correct.