• Title/Summary/Keyword: 장기 성적

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Long Term Results of Rastelli Operation with a Mechanical Valve (기계 판막을 이용한 라스텔리 수술의 장기 성적)

  • Choi, Se-Hoon;Kim, Kwan-Chang;Kwak, Jae-Gun;Kim, Chang-Young;Lee, Jeong-Ryul;Kim, Yong-Jin;Rho, Joon-Ryang;Kim, Woong-Han
    • Journal of Chest Surgery
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    • v.39 no.12 s.269
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    • pp.900-905
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    • 2006
  • Background: Homografts and bioprostheses are most commonly used for Rastelli operation in congenital heart disease, but the limited durability is responsible for multiple reoperations associated with increased morbidity This study evaluated long-term results after Rastelli operation with a mechanical valved conduit. Material and Method: A total of 20 patients underwent Rastelli operation with mechanical valved conduit from January 1990 to July 1992. Operative mortality was 1 of 20 patients, and a retrospective review of 19 patients(10 males, 9 females) was done. Initial diagnosis was congenitally corrected transposition of great arteries(cc-TGA, n=4), complete TGA (n=2), ventricular septal defect with pulmonary atresia(VSD with PA, n=9), truncus arteriosus(n=2), double outlet right ventricle with pulmonary stenosis(DORV with PS, n=2). The mean age at Rastelli operation was $4.6{\pm}3.4$ years, and mean follow-up period was $12.8{\pm}2.7$ years. Patients underwent Rastelli opearation using 16 CarboMedics mechanical valve, and 3 Bjork-Shiley mechanical valve($17{\pm}2$ mm). Result: There were 15 reoperations for failed mechanical valved conduit. The freedom from reoperation at 5 and 10 years was 53% and 37%. Most patients were received oral anticoagulation with warfarin, and maintained the international normalized ratio(INR) of 1.5 to 2.0. There was no anticoagulation or thromboembolism related complication. There was a significant difference in the causes of a conduit failure between early(within 3 years) and late(after 3 years) failure groups. The six patients reported early prosthetic valve failure, mainly due to valvular dysfunction by thrombosis or pannus formation. The other nine patients reported late prosthetic valve failure, mainly due to dacron conduit stenosis at anastomosis sites, whereas their valvar motion was normal except 1 patient. Conclusion: To avoid early prosthetic valve failure, strict anticoagulation therapy would be helpful. About the late development of obstructive intimal fibrocalcific peels within the Dacron conduit, an improvement of conduit material is necessary to reduce late prosthetic valve failure. In selected patients, the long term results were satisfactory.

The Long-term Clinical Outcomes after Coronary Artery Bypass Graft Surgery (관상동맥 우회술의 장기 임상성적)

  • Park, Chan Beom;Jo, Min-Seop;Kim, Young-Du;Jin, Ung;Moon, Seok-Whan;Kim, Chi-Kyung;Jo, Keon Hyon
    • Journal of Chest Surgery
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    • v.42 no.1
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    • pp.22-27
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    • 2009
  • Background: Coronary artery bypass grafting (CABG) is the standard surgical treatment for coronary artery disease. Although there are many clinical reviews of the long term results after CABG in the Western countries, not many such studies have been done for Korea. Therefore, we reviewed the long term clinical results for the patients who underwent CABG at our hospital. Material and Method: We retrospectively reviewed the medical records of 342 patients who underwent CABG at our hospital from February 1984 to December 2006, which is when CABG was first performed in our institution. A total of 286 patients (83.6%) were able to be followed-up, and the mean follow-up period was $75.7{\pm}46.1$ months. Result: The early mortality rate was 5.6%, and late mortality rate was 23.1%. The one-year survival rate, the five-year survival rate, the ten-year survival rate and the fifteen-year survival rate were 91.5%, 82.1%, 60.7% and 50.0%, respectively. The survival rate was significantly lower for the patients over the age of 60 (p=0.002) and for those with diabetes mellitus (p=0.000), hypertension (p=0.002), multivessel disease (p=0.006) and left ventricular dysfunction (p=0.015). No significant difference was observed between the genders. Multivariate analysis showed that the statistically significant risk factors were diabetes mellitus (p=0.001), age (p=0.005) and those cases for which the left internal thoracic artery was not used (p=0.037). Conclusion: CABG is the effective method of treatment for coronary artery disease. Therefore, active usage of the internal thoracic artery and appropriate medical treatment after surgery, and especially for diabetes mellitus patients, are mandatory for achieving good long-term survival.

Long Term Results of Carbomedics Mechanical Valve (Carbomedics 기계판막 치환환자의 장기성적)

  • 김병열;임용택;정승혁;강경훈;이정호
    • Journal of Chest Surgery
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    • v.33 no.7
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    • pp.552-559
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    • 2000
  • Background; The aim of this study is to evaluate our clinical experience with the Carbomedics heart valve prosthesis. Material and Method; Between Aug. 1988 and Dec. 1998, 294 Carbomidics valves were implanted in 235 patients(mitral; 143, mitral and aortic; 59, aortic; 33) The mean age at operation is 40.0$\pm$12.3 years(range 7 to 68 years); 63.8% (150patients) were woman. Follow up was 97.4% complete and mean follow up time was 5.7years with a total of 1209.2 patient-years. Result; The hospital mortality was 8.9%(mitral; was 95.2$\pm$1.6%(mitral ; 94.9$\pm$2.1%, mitral and aortic 95.0$\pm$3.7%, aortic 96.2$\pm$3.8%). Actual freedom rates from complications(linearized rates in parentheses) were fllowings; thromboembolism 96.2$\pm$1.5%(0.59%pt-yr), valve thrombosis 96.7$\pm$1.4%(0.5%/pt/yr), anticoagulant related hemorrhage 98.3$\pm$1.0%(0.25%/pt-yr), perivalvular leak 99.0$\pm$1.4%(0.5%/pt-yr), endocarditis 98.7$\pm$1.0%(0.25%/pt-yr), perivalvular leak 99.0$\pm$0.7%(0.17%pt-yr), endocarditis 98.7$\pm$1.0%(0.17%$\pm$pt-yr) and overall valve-related complications 88.9$\pm$2.5%(1.68%/pt-yr). Conclusion; The clinical performance of the Carbomedics valve was quite satisfactory with a low incidence of valve related mortality and morbidity.

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Pulmonary Resection for Multidrug-Resistant Tuberculosis (다제내성 폐결핵의 폐절제술에 관한 연구)

  • 박승규;윤후식;이창민;허진필;권은수
    • Journal of Chest Surgery
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    • v.34 no.1
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    • pp.72-79
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    • 2001
  • 배경: 일반적으로 다제내성 폐결핵의 경우 화학요법만으로는 치료성적이 만족스럽지 못하였다. 이에 수술적 치료와 항결핵 화학요법의 병합사용이 높은 균음전율과 장기 생존율을 보여주고 있으므로 이러한 치료전략이 다제내성 폐결핵환자의 일반적인 치료방법으로 정립되리라는 전망을 갖게 하고 있다. 대상 및 방법: 1995년 1월부터 1999년 12월까지 국립마산결핵병원에서 폐결핵에 대한 수술을 시행받은 130례 중 다제내성 폐결핵으로 폐절제수술을 받은 49례를 대상으로 의무기록 및 검사기록 등을 근거로 후향적 조사를 실시하였다. 결과: 대상환자들의 평균연령은 35세였고, 내성약제의 수는 평균 4.5였다. 43례(87.8%)의 환자에서 공동성 병소를 보였으며 31례(63.3%)의 환자에서 술전 객담내 균양성 소견을 보였다. 수술술식은 12례에서 전폐적출술을, 28례에서 폐엽절제술을, 7례에서는 폐엽절제술과 구역절제술 혹은 설상절제술 등을, 그리고 설상절제술과 공동성형술을 각각 1례에서 시행하였다. 술후 지속적인 내과적 약물치료를 병합하여 장기적인 균음전율은 93.5%였고 술후 사망환자는 없었다. 술후 합병증으로는 1주일 이상 지속되는 공기유출 6례와 술후 출혈, 창상분열이 각각 1례씩 있었다. 결론: 다제내성 폐결핵환자에서 폐절제 수술에 대해서는 적절한 적응증, 수술후 처방, 그리고 술후 치료기간 등에 대한 이견이 있지만 적극적으로 고려되어야 하며 술후 내과적 치료와 병행함으로 좋은 치료효과를 얻을 수 있었다.

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Altered Functions of Adrenoceptors in Splanchnic Vascular Beds in Portal Hypertensive Rat Model: Effect of Propranolol (문맥 고혈압 흰쥐에 있어서 내장혈관의 아드레나린성 수용체의 기능변동과 이에 대한 Propranolol의 효과)

  • Kim, Chi-Dae;Hong, Ki-Whan
    • The Korean Journal of Pharmacology
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    • v.24 no.1
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    • pp.63-70
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    • 1988
  • Alterations in splanchnic circulatory hemodynamics along with reactivities to the alpha adrenoceptor agonists were assessed in association with the preventive effects of propranolol 10 days after portal ligation. Decreases in precapillary resistance (Ra) and postcapillary resistance (Rv) along with increases in mesenteric blood flow (MBF) and capillary pressure (CP) were observed in conjunction with an increment of splenic pulp pressure (SPP). Dose-dependent increase in Rv in response to noradrenaline, increases in Ra and RV to adrenaline, and increases in superior mesenteric arterial pressure (SMAP), Ra and Rv to phenylephrine observed in sham group were significantly attenuated by portal vein stenosis. In PPL-3 group (propranolol 3 mg/kg, i.p. three times daily for 10 days), MBF was significantly decreased in association with decrease in mesenteric venous pressure (MVP) when compared with those of protal ligated (PL) group, and decreased Ra and Rv in PL group were recovered toward the values of sham group. Likewise, in PPL-1 group (propranolol 5 mg/kg, i.p. once daily for 10 days), the pressor response of Rv to adrenaline was recovered up to the level of sham group. Thus, it is suggested that decreases in Ra and Rv in association with increases in MBF and CP may have a close relevance to the increased SPP, and the changes in circulatory hemodynamics and vascular reactivities were effectively reversed by longterm propranolol treatment. Based on these results, it is concluded that these changes observed in portal hypertension are closely related with the altered functions of the adrenoceptors in the splanchnic vascular beds.

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Long-term Results after 1,144 CarboMedics Mechanical Valve Implantation (CarboMedics 기계판막을 이용한 1,144예 판막치환술의 장기 성적)

  • Kang, Chang-Hyun;Kim, Kyung-Hwan;Kim, Ki-Boong;Ahn, Hyuk
    • Journal of Chest Surgery
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    • v.37 no.7
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    • pp.559-569
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    • 2004
  • The CarboMedics mechanical valve has been reported to show acceptable valve-related complication rates. The aim of this study is to evaluate our clinical experience with the CarboMedics valve. Material and Method: Between August 1988 and September 1999, we implanted 1,144 CarboMedics valves in 850 patients (aortic 179; mitral 385; double-valve 234; tricuspid 52). The mean age was 44.5 $\pm$ 12.5 years. Follow-up was completed in 95.2% and median follow-up period was 7.9 years (6753 patient-years). Result: The overall hospital mortality rate was 3.4% and the mortality rate for each group was 1.7% for aortic group, 2.6% for mitral group, 4.7% for double-valve group, and 9.6% for tricuspid group, Tricuspid group showed significantly higher mortality rate than aortic and mitral group (p〈0.05). The actuarial survival at 10 years was 87.1 $\pm$ 2.6%, 88.9 $\pm$ 1.7%, 82.4 $\pm$ 2.9%, and 77.5 $\pm$ 7.0% for aortic, mitral, double, and tricuspid valve group, respectively. Age and tricuspid valve replacement were significant risk factors for long-term survival in multivariate analysis (p 〈 0.05). Freedom from valve thrombosis at 10 years was 99.4 $\pm$ 0.6%, 98.2 $\pm$ 0.8%, 99.2 $\pm$ 0.8%, and 87.6 $\pm$ 0.5% for aortic, mitral, double and tricuspid valve group. Tricuspid valve group showed significantly higher rate of valve thrombosis (p 〈 0.05). Conclusion: Long-term results of our experience demonstrated that CarboMedics valve showed acceptable incidence of valve-related complications. However, tricuspid valve replacement showed higher rate of early mortality and valve thrombosis than other valve replacement groups.

Comparison of the Reconstruction Routes after Esophagectomy for Esophageal Cancer (식도암 절제후 식도 재건경로의 비교)

  • Lee, Seung-Yeoll;Kim, Kwang-Taik;Choi, Young-Ho;Kim, Il-Hyun;Baik, Man-Jong;Sun, Kyung;Lee, In-Sung;Kim, Hyoung-Mook
    • Journal of Chest Surgery
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    • v.32 no.9
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    • pp.806-812
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    • 1999
  • Background: Selection of reconstruction route in esophageal cancer surgery is based on the patient's status, characteristics of tumor, surgeon's preference and experience. Of the various routes, it has been documented that subcutaneous or substernal route may prolong operation time and may be vulnerable to postoperative respiratory complications. This study was designed to evaluate whether the selection of reconstruction route affects the surgical outcomes. Material and Method: Of 131 patients who have undergone resection and reconstruction for esophageal cancer, posterior mediastinal route(Group I, n=34), substernal route (Group II, n=31), and subcutaneous route(Group III, n=21) were retrospectively reviewed in 86 patients. Results of early operations and morbidities were compared between the groups. Result: There was a male prevalence(79 of males vs. 7 of females). There were 81 squamous cell cancers and 5 adenocarcinomas. There were no differences between groups in weight, height, age, cancer staging and location, and in the preoperative anesthetic risk evaluation and pulmonary function test(p=NS). Postoperative mechanical ventilation time was longer in Group I(20.6 hours) than in Group II(7.8 hours) or III(3.4 hours)(p=0.005). Duration of stay in the intensive care unit was prolonged in Group III(6.4 days) compared to Group I (3.9 days) or II(3.1 days)(p=0.043). No differences were noted in the duration of hospital stay between the groups(p=NS). Blood transfusion was needed in 30 out of 34 patients in Group I compared to 14/31 in Group II or 15/21 in Group III(p=0.001). The mean amount of transfusion for each patient was also higher in Group I(3,833 mL) than in Group II(1535 mL) or Group III(1419 mL)(p=0.04), but there was no difference in the inreoperation due to bleeding. Ea ly mortality rate was substantially higher in Group I(17.6%) but the differences between the groups were insignificant(p=NS). Although sepsis was a more prevalent cause of death in Group I, it was not related to anastomotic leak. Other morbidities did not differ between the groups(p=NS). Conclusion: In above results show that the reconstruction route does not affect the outcome of esophageal cancer surgery. We believe that the selection of reconstruction route can be based on the surgeon's preference and experience.

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Mid-term Results of the Congenital Bicuspid Aortic Valve Repair (선천성 이엽성 대동맥판막질환에 대한 판막성형술의 중기 성적)

  • 조광리;곽재건;안혁
    • Journal of Chest Surgery
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    • v.37 no.10
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    • pp.833-838
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    • 2004
  • Background: Despite the excellent early results after the repair of congenital bicuspid aortic valve (BAV) disease, the mid-term durability of the repaired valve has still controversies. Material and Method: To evaluate the mid-term results of BAV repair, retrospective review of medical records and echocardiographic data were done. Between 1994 and 2003, twenty-two patients underwent reparative procedure for either regurgitant or stenotic congenital bicuspid aortic valve (BAV). Result: Mean age was $41\pm14$ years with male predominance (Male=17, Female=5). The pathophysiologies of the BAV were regurgitation-dominant in 20 (91%) and stenosis-dominant in 2 (9%) cases. Various repair techniques were used for raphe, prolapsed leaflet, thickened leaflet, and commissures; 1) release of raphe in 19 (86%), 2) wedge resection and primary repair in 11 (50%), pericardial patch reinforcement after plication of the leaflet in 6 (27%), and plication of the leaflet in 3 (14%), 3) slicing of thickened leaflet was used in 12 (55%) cases, 4) commissuroplasty in 8 (36%), and commissurotomy in 6 (27%) cases. There was no in-hospital mortality. During the mean follow-up of $38\pm17$ months, one patient underwent aortic valve replacement after developing acute severe regurgitation from dehiscence of the suture on postoperative 2 months. New York Heart Association functional class was improved from $1.9\pm0.6$ to $1.2\pm0.5$ (p<0.01). Left ventricular end-systolic and diastolic dimension (LVESD/LVEDD) were also improved from $45\pm9$ and $67\pm10$ to $37\pm10$ and $56\pm10,$ respectively (p<0.01). The grade of aortic regurgitation (AR) was improved from preoperative $(3.1\pm1.2)$ to post-bypass $(0.9\pm0.7).$ However, the grade at last follow-up $(1.7\pm1.1)$ was deteriorated during the follow-up period (p<0.01). Freedom from grade III and more AR at one, three, and four year were 89.7%, 89.7%, and 39.9% respectively. Conclusion: Midterm clinical result of the BAV repair was favorable. But, the durability of the repaired valve was not satisfactory.

Reevaluation of the Effect of Phenobarbital on the Response to Pain in Rat (백서에서 동통에 미치는 Phenobarbital 효과의 재평가)

  • So, Byoung-Gyoum;Kim, Kee-Won;Ko, Myoung-Kyu;Yang, Won-Mo;Cho, Kyu-Park
    • The Korean Journal of Pharmacology
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    • v.22 no.2
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    • pp.88-95
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    • 1986
  • Clinically, subhypnotic doses of barbiturates have been known to elicit hyperalgesia. In this experiment, effect of acute or chronic phenobarital treatment on the response to pain in rat was reevaluated by hot-plate method. To elucidate its mechanism, changes of ${\beta}-endorphin$ contents and [3H]-morphine binding of the rat midbrain as well as functional opiate receptor in vas deferens were also measured. Intraperitoneal injection of sub anesthetic dose phenobarbital induced initial hyperalgesia followed by successive analgesia, while chronic phenobarbital-treatment decreased reactivity to pain. Naloxone (10mg/kg, i.p.) markedly shortened hot plate latency period, and significantly inhibited the analgesic action of phenobarbital. Single dose of phenobarbital did not affect ${\beta}-endorphin$ contents and [3H]-morphine binding in rat mid brain, but in the chronic phenobarbital-treated groups, ${\beta}-endorphin$ contents was increased, while Bmax of opiate receptor binding was decreased. Moreover, very significant correlations among responses to pain, changes of ${\beta}-endorphin$ contents and opiate receptor binding were observed. However, Kd values of opiate receptor bindings were not changed in all preparations. In the chronic phenobarbital-treated vas deferens preparations, ID50 of morphine was increased witb concomittant decrease of maximum effect. But $pA_2 $, value for naloxone was not changed. From these results, it is suggested that phenobarbital can produce analgesia due to changes of ${\beta}-endorphin$ contents as well as functional opiate receptors by receptor regulation.

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Conservative Surgery and Definitive Radiotherapy in Early Breast Cancer (보존적 유방 절제술과 근치적 방사선치료가 초기 유방암의 치료 성적에 미치는 효과)

  • Shin, Sei-One;Hong, Jung-Sook;Kim, Myung-Se;Lee, Young-Do;Kim, Sung-Kyu;Lee, Soo-Jung
    • Journal of Yeungnam Medical Science
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    • v.10 no.2
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    • pp.380-387
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    • 1993
  • Local excision and axillary dissection followed by radiation therapy to the breast has been shown to achieve equivalent local control and survival as mastectomy in an prospective randomized trials. We analyzed 28 cases of early breast cancer in order to evaluate the therapeutic effects of conservative surgery and definitive radiotherapy in the management of early breast cancer as possible alternative of simple mastectomy, retrospectively. Obtained results were as follows : 1. Treatment related acute side reactions are more prominant in the case of chemoradiotherapy group than radiotherapy alone group. 2. There were no cases of primary, regional or systemic failures on the last follow up examination. 3. Cosmetic results after treatment were satisfactory in 26 cases out of 28 cases on the last follow up examination. 4. There were no demonstrable differences of tumor control and cosmetic results between the treatment groups. Although, these results suggested that definitive radiotherapy after local excision would be a possible and desirable alternative instead of total mastectomy in the management of early breast cancers, analyzed cases were too small and follow up period was too short to evaluate the therapeutic effect of primary radiotherapy after local excision, exactly.

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