• 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.

• Radiation Oncology Journal
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• v.24 no.1
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• pp.11-20
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• 2006

Puroose: In order to find out whether stereotactic radiation therapy (RT) using CyberKnife (CK) could improve survival rate and lower acute toxicity compared to conventional RT. Materials and Methods: From April 2003 through April 2004, 19 patients with Eastern Cooperative Oncology Group (ECOG) performance status ${\leq}3$ and locally advanced pancreas cancer without distant metastasis, evaluated by CT or PET/CT, were included. We administered stereotactic RT consisting of either 33 Gy, 36 Gy or 39 Gy in 3 fractions to 6, 4 and 9 patients, respectively, in an effort to increase the radiation dose step by step, and analyzed the survival rate and gastrointestinal toxicities by the acute radiation morbidity criteria of Radiation Therapeutic Oncology Group (RTOG). Prognostic factors of age, sex, ECOG performance score, chemotherapy, bypass surgery, radiation dose, CA 19-9, planning target volume (PTV), and adjacent organ and vessel invasion on CT scan were evaluated by Log Rank test. Results: The median survival time was 11 months with 1-year survival rate of 36.8%. During follow-up period (range $3{\sim}20$ months, median 10 months), no significant gastrointestinal acute toxicity (RTOG grade 3) was observed. In univariate analysis, age, sex, ECOG performance score, chemotherapy, bypass surgery, radiation dose, CA 19-9 level, and adjacent organ and vessel invasion did not show any significant changes of survival rate, however, patients with PTV (80 cc showed more favorable survival rate than those with PTV>80 cc (p-value<0.05). In multivariate analysis, age younger than 65 years and PTV>80 cc showed better survival rate. Conclusion: In terms of survival, the efficacy of stereotactic radiation therapy using CK was found to be superior or similar to other recent studies achieved with conventional RT with intensive chemotherapy, high dose conformal RT, intraoperative RT (IORT), or intensity modulated RT (IMRT). Furthermore, severe toxicity was not observed. Short treatment time in relation to the short life expectancy gave patients more convenience and, finally, quality of life would be increased. Consequently, this could be regarded as an effective novel treatment modality for locally advanced, unresectable pancreas cancer. PTV would be a helpful prognostic factor for CK.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.627-634
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• 2010

Background: The durability of the tissue valve is important in choice between a mechanical valve and a tissue valve in cardiac surgery. We studied the mid-term results of tissue valve in the aortic position. Material and Method: The subjects were 380 patients who had undergone aortic prosthesis replacement between May 1990 and March 2009. We retrospectively analyzed hospital and outpatient records: the mean age was $69{\pm}9$ years; the male to female ratio was 227 : 162; and the mean follow-up duration was $46.7{\pm}40.8$ months (range 0~196 months). Result: 389 surgical cases in total had been taken with 380 patients. Early death occurred in 15 patients (3.9%). Overall survival rate at 1, 5 and 10 years were 92.3%, 78.1% and 54.2% respectively. Freedom from reoperation at 1, 5 and 10 years were 98.4%, 97.1% and 91.7% respectively. Freedom from structural valvular deterioration at 1, 5 and 10 years were 96.1%, 92.3% and 88.0% respectively. In the multivariate analysis of preoperative risk factors, young age (p<0.001) was significant risk factor for reoperation. High peak velocity in the postoperative period (p=0.034) and young age (p=0.029) were significant risk factors for structural valvular deterioration. Old age (p=0.001), long bypass time (p=0.035), concomitant coronary artery bypass graft surgery (p=0.003) and preoperative low left ventricular ejection fraction (p=0.003) were significant factors for early mortality. Preoperative estimated glomerular filtration rate (< 60 mL/min) (p=0.025) and persistent left ventricular hypertrophy (p=0.032) were the risk factors for late mortality. Conclusion: This study showed that the freedom from reoperation and the freedom from structural valvular deterioration in aortic tissue valve replacement were acceptable. It will be necessary to conduct further studies with long-term follow-up and more patients.

• Journal of Chest Surgery
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• v.35 no.7
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• pp.542-547
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• 2002

Background: Postpneumonectomy empyema(PPE) is an infrequent but potentially life-threatening complication. To date, various surgical efforts have been made to manage this complication. We reviewed our 20-year surgical experience of PPE and long-term follow-up data. Material and Method: Total of 37 patients who were treated for PPE between fan, 1980 and Jun, 2000 were included. Various clinical factors such as micro-organism, operative method and timing, presence of bronchopleural fistula(BPF), underlying disease and fate of empyema cavity were retrospectively reviewed and analyzed. Result: Majority of patients(34) underwent Eloesser operation for effective drainage. There was only one operative mortality. The causative organisms were Staphylococcus species and Pseudomonas species in 46% BPF was found in 20 cases, among which spontaneous closures took place in 4 cases. The chest wall was closed in 40%(8/20) of patients with BPF, compared to 59%(10/17) without BPF. The closure rate was statistically better in patients without BPF(p=0.006). Even though the patients with benign disease showed higher closure rate(50%) than those with lung cancer (31%), the difference was not significant(p=0.25). Conclusion: Eloesser procedure was an effective method for initial drainage of PPE cavity with low operative mortality. Given the findings of low spontaneous closure rate of BPF, aggressive approach to close the BPF is mandatory to achieve the final goal of chest wall closure. It was found that majority of patients still left their chest cavity opened, even after controlling the active inflammation of the empyema cavity. More aggnessive approach for chest wall closure is recommended in all patents with benign disease and in selective patients with lung cancer if there is no evidence of recurrence at several years after the initial operation.

• Journal of Chest Surgery
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• v.31 no.2
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• pp.134-141
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• 1998

Primary lung cancer has recently increased progressively in its incidence in Korea. It is clearly evident that surgical resection offers the best offortunity for cure of non-small cell carcinoma. This study was designed to analyse the clinical data of 100 primary non-small cell carcinoma patients who underwent lung resection surgery from January 1992 to July 1995 at the department of Thoracic and Cardiovascular Sugery, Kyungpook National University Hospital. There were 86 males and 14 females(6:1). In the age distribution, the peak incidence was recorded in the seventh decade(43%). The methods of tissue diagnosis were bronchoscopic biopsy in 53 patients(50.5%), percutaneous needle aspiration in 17 patients(16.2%), transbronchial lung biopsy in 11 patients(10.5%), mediastinoscopic biopsy in 2 patients (1.9%), sputum cytology in 2 patients(1.9%), and thoracotomy in 20 patients(19.0%). Fifty-five lobectomies, 22 pneumonectomies, 15 bilobectomies, 2 segmentectomies, 4 sleeve lobectomies, a sleeve pneumonectomy, and a wedge pneumonectomy were performed. Operative mortality occured in 4 cases(sepsis in 2 cases, respiratory failure in 1 case, and acute myocardiac infarction in 1 case). The histologic types of tumor were 67 squamous cell carcinomas, 26 adenocarcinomas, 6 large cell carcinomas, and an adenosquamous cell carcinoma. Eighteen patients with N2 mediastinal lymph node metastases had 8 squamous cell carcinomas(11.9%), 9 adenocarcinomas(34.6%), and a large cell carcinoma(16.7%). The primary tumors in these patients were in the right upper lobe in 4 patients, the right middle and lower lobe in 9 patients, the left upper lobe in 3 patients, and the left lower lobe in 2 patients. With regard to pathologic stages, 45 patients had stage I disease; 13 patients, stage II; 36 patients, stage IIIa; 5 patients, stage IIIb; and 1 patient, stage IV. The overall actuarial survival rate was 77.5% at 12 months, 56.1% at 24 months and 43.7% at 43 months. The actuarial survival rates at 43 months were 81.3% in Stage I, 20.8% in Stage II, 27.9% in Stage IIIa, 25.0% in Stage IIIb and 33.3% in Stage IV. These facts suggest that early detection and surgical resection are recommended for favorable postoperative survival in non-small cell lung cancer.

• Journal of Chest Surgery
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• v.35 no.12
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• pp.871-875
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• 2002

Despite early aggressive treatment, post myocardial infarction(MI) ventricular septal defect(VSD) revealed high surgical mortality. We reviewed the 10-year experiences of surgically treated post-MI VSD in Yonsei University. Material and Method: From Jan. 1991 to May 2001, 17 patients underwent surgical repair of post-MI VSD. Ages ranged between 47 and 77 years(mean age＝63.2$\pm$9.1). There were 10 males and 7 females. VSD was located at anterior in 16 patients and at posterior in one. IABP was inserted preoperatively in 12 patients due to cardiogenic shock. Mean interval from MI to occurrence of VSD was 5.6 days. Among patients undergoing early surgical correction(n＝13), mean interval from occurrence of VSD to operation was 2.5 days. In 11 patients, concomitant CABG was performed during repair of VSD. Result: Four patients died within 30 days after the operation(30 day mortality＝23.5%). Among 12 patients with preoperative cardiogenic shock, 4 patients died within 30 days(30-day mortality＝33.3%). During mean follow up period of 52 months, one patient died of unknown cause and 10-year survival of discharged patients was 66.7%. All follow-up patients were in NYHA functional class I or II when their last OPD visit. Conclusion: In the treatment of post-MI VSD, aggressive medical treatment with early surgical correction seems to be very important in terms early and long-term survival of patients.

• Proceedings of the Korea Water Resources Association Conference
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• 2009.05a
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• pp.302-307
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• 2009

물리적인 조류제어 기술에 해당하는 수류 차단막(이후 차단막)은 유입하천의 수류를 차단 또는 우회시켜 영양염류가 저수지의 유광층으로 공급되는 것을 차단하고 본류 수역으로의 조류 확산을 방지하는 기능이 있어 일본에서는 저수지 녹조제어 대책으로 자주 활용된 바 있다. 그러나 이러한 차단막은 국내 저수지와 같이 홍수시 유입 유속이 크고 수위변동이 심한 환경에서는 설치효과가 검증되지 않아 현장적용에 앞서 수치모의를 통한 효과 검증이 선행되어야 하며, 최적 규모와 위치 선정도 필요하다. 본 연구에서는 수위변동이 심한 국내 저수지 특성을 고려하여 차단막이 수위변화에 따라 상하로 이동할 수 있도록 기존 CE-QUAL-W2(이후W2) 모델의 알고리즘을 수정하고, 대청호에서 다양한 수리 수문조건에서 차단막의 기작과 효과를 예측하기 위해 가뭄년(2001년)과 평수년(2004, 2006년)을 대상으로 각각 모델을 적용하였다. 차단막 설치 예정지점은 소옥천 하류(7 m 깊이)와 댐으로부터 각각 14.9 km, 27.4 km 상류에 위치한 회남대교 아래 지점(10 m 깊이)과 대정리(10 m 깊이)로 가정하고, 모의 시나리오는 차단막을 설치하지 않은 경우(S-1), 소옥천 하류에 단독으로 설치한 경우(S-2), 소옥천과 대정리에 설치한 경우(S-3), 모든 지점에 설치한 경우(S-4)를 비교하였다. 차단막 설치에 따른 수문년 및 계절별 수질개선 효과(S-1에 대한 S-4 농도 저감 비)를 비교한 결과, 대청호에서 녹조문제가 가장 심각했던 2001년 6월$^{\sim}$8월 기간 동안 차단막은 봄-여름에 걸쳐 모든 비교 지점(회남, 댐, 추동, 문의수역)에서 Chl-a 농도를 최저(문의수역) 30%에서 최고(회남수역) 70% 정도 저감하는 효과를나타냈다. 평수년인 2004년과 2006년에는 강우사상에 따라 차단막 설치에 따른 Chl-a의 농도 저감 효과가 지점별로 다르게 나타났으며, 큰 강우사상이 6월, 7월, 8월에 걸쳐 골고루 발생한 2004년에 비해 7월 한 달 동안 집중된 2006년에 설치효과가 크게 나타났다. 수역별로 차단막의 설치효과를 비교해 보면, 유입수의 영향을 직접 받는 회남수역과 추동수역이 댐 앞과 문의수역에 비해 차단막 설치에 따른 Chl-a 농도의 저감 효과가 큰 것으로 나타났다. 그러나, 큰 홍수가 유입할 때 차단막 상류부에 집적된 조류의 일부가 수류의 포획(Entrainment) 기작에 의해 저수지 내부로 유입되는 것으로 확인되어 차단막 효과를 극대화하기 위해서는 홍수 전 차단막 상류부에 집적된 조류의 처리대책이 필요할 것으로 판단된다.

• Journal of Chest Surgery
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• v.29 no.1
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• pp.32-37
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• 1996

Between May 1991 and September 1995, 7 patients underwent surgical repair of ventricular septal defect (VSD) complicated with myocardial infarction in Asan Medical Center. The patients included two male and five female. The ages of patients were ranged from 54 years to 76 years with a mean of 65 years. The sites of postinfarction ventricular septal defect were consist of anterior septal defect in 6 patients and anteroposterior septal defect in 1 patient. Preoperative 2D-echocardiography & angiography were performed in all patients in order to measure ventricular function and evaluate the extent of coronary artery disease. The operations were delayed till mean 24 $\pm$ 12days after myocardial infarction. All patients underwent infarctectomy and Teflon patch closures through the area of the left ventricle infarction or aneurysm in the anterior or apical aspect of postinfarction ventricular septal defect. The ventricular septal defect repaired simultaneously with coronary artery b pass graft in 3 patients, with ventricular aneurysmectomy in 5 patients, and with left ventricular thrombectomy in 1 patient. Patch fixation in the left side of interventricular septum by tracts-septal interrupted pledget suture reduced the recurrence rate of VSD. There were 2 postoperative complications : One with pneumonia, 1 patient with the skin necrosis of left thigh. There was ilo early death. The 6 patients except for one emigrant were followed up postoperatively between 3 and 63 months(mean .28 months), without any sequelae and late death. They are in New York Heart Association functional class I-II.

• Journal of Yeungnam Medical Science
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• v.14 no.2
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• pp.350-358
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• 1997

We studied the effects of adding a single bolus(500 mg) of sodium thiopental to a continuous infusion of low-dose fentanyl on plasma beta-endorphin immunoreactivity(iBE) responses to cardiopulmonary bypass(CPB) in 28 patients undergoing elective coronary artery bypass grafting or valve procedures. Thiopental was injected just prior to the initiation of CPB. The iBE levels and the hemodynamic indices such, as mean arterial pressure, cardiac output and systemic vascular resistance were measured before CPB, at 30 min and again at 60 min after the initiation of the bypass. The results were as follows. After the initiation of CPB, iBE levels increased at 30 min and 60 min(P=0.006, P=0.004 respectively) in the control group, but not in the thiopental group. There were significant differences in the changes of iBE levels between the groups(F=8.7, G-G=0.002, P=0.001). The hemodynamic indices were similar in both groups. In conclusion, pretreatment with thiopental just before the initiation of CPB prevents the stress-induced beta-endorphin response to CPB.

• Clinical and Experimental Pediatrics
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• v.45 no.2
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• pp.208-213
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• 2002

Purpose : The major cause of cardiac dysfunction, after open heart surgery for congenital heart disease, is perioperative myocardial injury. Cardiac troponin I is found only within the myocardial cell, so it can be used as a biochemical marker of the myocardial injury. We performed this study to evaluate the worth of cardiac troponin I as a biochemical marker reflecting the extent of perioperative myocardial injury and recovery. Methods : Thirty-four patients who had undergone elective open heart surgery of congenital heart disease(CHD) from April to July 2001 were enrolled in this study. We measured types of CHD, serial cardiac troponin I(baseline 1 day before operation, postoperative day 1, 2, 3, 7), duration of cardiopulmonary bypass(CPB), aortic cross clamping(ACC), intubation and postoperative hospital stay. Results : Compared with the baseline before operation, there was a significant, increase of cardiac troponin I on the postoperative day 1 and a significant gradual decrease on the day 2, 3, 7. The levels of cardiac troponin I were the highest in the transposition of great artery(TGA) repair on the postoperative day 1 and high in the tetralogy of Fallot(TOF), atioventricular septal defect (AVSD), ventricular septal defect(VSD) and atrial septal defect(ASD) repair with decreasing sequence. The longer duration of CPB, ACC and intubation, the higher of cardiac troponin I, but there were no significant correlations between cardiac troponin I levels and duration of hospital stay. Conclusion : Because there was significant increases or decreases of cardiac troponin I according to the perioperative time and types of the congenital heart disease, it is a worthy biochemical marker which reflects the extent of perioperative myocardial injury and recovery after open heart surgery.