• Journal of Gastric Cancer
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• v.8 no.2
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• pp.97-103
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• 2008

Purpose: Radical surgery is the standard therapy for patients with resectable cardia cancer. In the case of type II disease with esophageal invasion, a transhiatal extended radical total gastrectomy is needed or a gastroesophagectomy through an abdomino-thoracotomy, depending on the extent of the esophageal invasion. We analyzed the indications and outcome of left colon interposition as an esophageal substitution. Materials and Methods: Between 1 January 1994 and 31 December 2006, 10 patients underwent left colon interposition after gastroesophagectomy through an abdomino-thoracotomy or the tanshiatal approach for type II cardia cancer at the Department of surgery, Yonsei University College of Medicine. The outcomes of these patients were reviewed and compared, with those who underwent a Roux-en-Y, by gender and age matched analysis, retrospectively. Results: There were nine males and one female with a mean age of 52.5 (range, 16~72). The operation time was $449.00{\pm}87.39minutes$. The mean distance between the proximal resection margin and the cancer was $6.56{\pm}3.65cm$; the maximum size of the tumor was $9.90{\pm}3.97cm$. These measures differed significantly from patients who underwent Roux-en-Y. The patients had a double primary cancer in the cardia and esophagus. There were no events of colon necrosis. However, a pneumothorax occurred in one patient (10%) and a proximal anastomotic stricture occurred in one patient. There were no reports of heartburn, regurgitation, thoracic or epigastric fullness, and one patient even gained weight, 16 kg. Conclusion: Colon interposition after esophagogastrectomy was safe and effective and should be considered as an additional surgical option for locally advanced type II cardia cancer patients with esophageal invasion.

• Journal of Chest Surgery
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• v.34 no.11
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• pp.823-830
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• 2001

Background: Paraplegia is a serious complication of thoracic or thoracoabdominal aortic operations, which is related to ischemic injury of the spinal cord induced by low perfusion pressure during cross clamping of the aorta. Ischemic preconditioning of heart or brain with reversible sublethal ischemic injury induces resistance to subsequent lethal ischemia. The aim of this study is to investigate whether ischemic tolerance could be induced by the preconditioning of the spinal cord using swine model. Material and Method: The animals were randomly assigned to three groups: sham group(n=3), control group(n=6) and pre-conditioning group(n=8). In the sham group, we performed the left thoracotomy only without any ischemic injury. In the preconditioning group, the swine received reversible spinal cord ischemic injury by aortic clamping for 20 minutes, whereas control group had no previous aortic cross- clamping. Forty-eight hours later, the aorta was clamped for 30 minutes in both groups. Neurological examination was done 24 hours later, then the animals were euthanized for histopathology and malonedialdehyde(MDA) spectrophotometry assay of the spinal cord. Result: Statistically significant difference in neurological outcome was observed between the control and preconditioning groups at 24 hours after ischemic injury. The incidence of paraplegia and severe paresis was 100% in the control group, and 62.5% in the preconditing group(p=0.028). There was no statistically significant difference in histopathology and MDA assay of the ischemic spinal cord between these two groups with borderline statistical difference in MDA assay(p=0.0745). Conclusion: In the present swine study, ischemic preconditioning could induce tolerance against 30 minute ischemic insult of the spinal cord, although the animals did not completely recover(stand-up or walk). We expect that combining this preconditioning with other currently existing protection methods might lead to a synergistic effect, which warrants further investigation.

• Progress in Medical Physics
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• v.22 no.2
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• pp.72-78
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• 2011

The aim of this study is to evaluate the patient's setup errors in TomoTherapy (Hi-Art II, TomoTherapy, USA) Bodyfix system (Medical Intelligence, Ele-kta, Schwabmuchen, Germany) pressure in the vacuum compression, depending on and were evaluated. Bodyfix immobilization system and vacuum pressure was compression applied to the patients who received Tomotherapy thoracic and abdominal area, 21 patients were selected and TomoTehpay treatment total 477 of MVCT images were obtained. The translational (medial-lateral: ML, anterior-posterior: AP, superior-inferior: SI directions) and rolling were recorded and analyzed statistically. Using Pearson's product-moment coefficient and One-way ANOVA, the degree of correlation depending on the different vacuum pressure levels were statistically analyzed for setup errors from five groups (p<0.05). The largest average and standard deviation of systematic errors were 6.00, 5.95 mm in the AP and SI directions, respectively. The largest average of random errors were 4.72 mm in the SI directions. The correlation coefficients were 0.485, 0.244, and 0.637 for the ML-Roll, AP-Vector, and SI-Vector, respectively. SI-Vector direction showed the best relationship. In the results of the different degree of vacuum pressure in five groups (Pressure range: 30~70 mbar), the setup errors between the ML, SI in both directions and Roll p=0.00 (p<0.05) were shown significant differences. The average errors of SI direction in the vacuum pressure of 40 mbar and 70 mbar group were 4.78 mm and -0.74 mm, respectively. In this study, the correlation between the vacuum pressure and the setup-errors were statistically analyzed. The fact that setup-errors in SI direction is dependent in vacuum pressure considerly setup-errors and movement of interal organs was identified. Finally, setup-errors, and it, based on the movement of internal organs in Bodyfix system we should apply more than 50 mbar vacuum pressure. Based on the results of this study, it is suggested that accuracy of the vacuum pressure and the quantitative analysis of movement of internal organs and the tumor should be studied.

• Journal of Chest Surgery
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• v.37 no.12
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• pp.987-991
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• 2004

Background: Inadequate drainage of traumatic hemothoraces may result in prolonged hospitalization and complication such as empyema, fibrothorax and pleural calcification. This needs to be the placement of a tube thorascostomy which is efficacious in more than 80% of cases. Other cases require surgical treatment. Material and Method: From March 2002 to February 2003, there were 123 patients who was done closed thorascostomy in traumatic hemothorax. 10 patients (group I) were undergone early retained clot evacuation with video assisted thoracoscopic surgery, but 5 patients (group II) who developed a localized hematoma or empyema were operated. Male were more than female and mean average was similar in both group. The most common cause of injury was traffic accidents and frequently combined lesions were a abdomen. Result: Interval from injury and operation, mean operation time, duration of tube drainage and hospital stay in group I were shorter than group II (p<0.05). Operation-related complication and recurrence of fluid collection within follow up period (17.8$\pm$3.8 months) in group I were none, but in group II (21.5$\pm$5.3 months) were 2 cases. Conclusion: Video assisted thoracoscopic surgery can be utilized as an effective and safe method for the removal of retained clotted hemothorax within 7 days.

• Korean Journal of Poultry Science
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• v.17 no.3
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• pp.141-156
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• 1990

The experiments were conducted to investigate the possibility of improving the effectiveness of the existing method to estimate the edible meat weight in the live broiler chicken. A total of 360 birds, five male and female chicks from each line were sacrificed at Trial 1 (body weight 900-1, 000g), Trial 2 (body weight 1.200-1, 400g), Trial 3(body weight 1, 600-1, 700), and Trial 4(body weight 2, 000g) in order to measure the body weight, edible meat weight of breast, thigh and drumsticks, and various components of body weight. Each line was reared at the Poultry Breeding Farm, Seoul National University from the second of july, 1987 to the thirteenth of September, 1987. The results obtained from this study were summarized as follows ： 1. The average body weights of each line( H. T, M, A) were $2150.5\pm$34.9, $2133.0\pm$26.2, $1960.0\pm$23.1, and $2319.3\pm$27.9, respectively. at 7 weeks of age. The feed to body weight eain ratio for each line chicks was 2.55, 2.13, 2.08, and 2.03, respectively, for 0 to 7 weeks of age. The viability of each line was 99.7. 99.7, 100.0, and 100.0%, respectively, for 0 to 7 weeks of age.01 was noticed that A Line chicks grow significantly heavier than did T, H, M line chic ks from 0 to 7 weeks of age. The regression coefficients of growth curves from each line chicks were bA＝1.015, bH＝0.265, bM＝0.950 and bT＝0.242, respectively. 2. Among the body weight components, the feather. abdominal fat, breast, and thigh and drumsticks increased in their weight percentage as the birds grew older, while neck. head, giblets and inedible viscera decreased. No difference wat apparent in shank, wings and hack. 3. The weight percentages of breast in edible part for each line thicks were 19.2, 19.0, 19.9 and 19.0% at Trial 4, respectively. The weight percentages of thigh and drumsticks in edible part for each line chicks were 23.1, 23.3, 22.8, and 23.0% at Trial 4. respective1y. 4. The values for the percentage meat yield from breast were 77.2. 78.9 73.5 and 74.8% at Trial 4 in H, T, M and A Line chicks. respectively. For thigh and drumstick, the values of 80.3, 78.4. 79.7 and 80.2% were obtained. These data indicate that the percentage meat yield increase as the birds grow older. 5. The correlation coefficients between body weight and blood. head, shanks. breast. thigh-drumstick were high. The degree if correlation between abdominal fat(%) and percentage of edible meat were extremely low at all times, but those between abdominal fat (%) and inedible viscera were significantly high.

• Journal of Chest Surgery
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• v.36 no.10
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• pp.711-720
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• 2003

Bakground : Complete resection by the surgery has been selected as the treatment of choice in lung cancer patients, but in cases of recurrence after excision or inoperable cases, the importance of anticancer chemotherapy has been emphasized. If one can select a set of the sensitive chemotherapeutic agents before anticancer chemotherapy, it will give more favourable results. Subrenal capsular assay has been recognized as a useful in-vivo chemosensitivity test of thoracic and abdominal tumors and it can be done in a short time for a rapid interpretation of tumor responsiveness to anticancer chemotherapeutic drugs. It has been reported that various kinds of cancer cells can be implantable to the kidney, but so far there is no comparative study of xenogeneic cell implantation on liver, spleen and kidney. The author implanted the human lung cancer cells under the capsule of S.D rat's liver, spleen and kidney respectively and compared the pattern of growth and histology. Material and Method: After incubation of human lung cancer cell line (SW-900 G IV) in RPMI 1640 (Leibovitz L-15 medium) culture media, 3${\times}$3${\times}$3 mm size fibrin clots which contain 108 cancer cells were made. Thereafter the fibrin clots were implanted at subcapsule area of liver, spleen and kidney of S.D. female rat. For immune suppression, cyclosporin-A (80 mg/Kg) was injected subcutaneously daily from post-implantation first day to sixth day. The body weight was measured at pre and post implantation periods. The growth pattern and the size of tumor mass were observed and the pathologic examination and serum tumor marker tests were performed. Result: Body weight increased in both of control and experimental groups. Serum Cyfra 21-1 was not detected. Serum levels of CEA and NSE revealed no significant change. The SCC-Ag increased significantly in implanted group. The growth rate of human lung cancer cells which was implanted on spleen was higher than on liver or kidney. The surface area, thickness, and volume of tumor mass were predominant at spleen. The success rates of implantation were 80% on kidney, 76.7% on spleen and 43.3% on liver. Pathologic examination of implanted tumors showed characteristic findings according to different organs. Tumors that were implanted on kidney grew in a round shape, small and regular pattern. In the spleen, tumors grew well and microscopic neovascularization and tumor thrombi were also found, but the growth pattern was irregular representing frequent daughter mass. Human lung cancer cells that were implanted in the liver, invaded to the liver parenchyme, and had low success rate of implantation. Microscopically, coagulation necrosis and myxoid fibrous lesion were observed. Conclusion: The success rate of implantation was highest in the kidney. And the mass revealed regular growth that could be measured easily. The SCC-Ag was presented earlier than CEA or Cyfra21-1. The Cyfra21-1 was not detected at early time after implantation. The best model for tumor implantation experiment for chemosensitivity test was subrenal capsular analysis than liver and spleen and the useful serum tumor marker in early period of implantation was the SCC-Ag.

• Progress in Medical Physics
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• v.24 no.2
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• pp.127-132
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• 2013

The position of the internal organs can change continually and periodically inside the body due to the respiration. To reduce the respiration induced uncertainty of dose localization, one can use a respiratory gated radiotherapy where a radiation beam is exposed during the specific time of period. The main disadvantage of this method is that it usually requests a long treatment time, the massive effort during the treatment and the limitation of the patient selection. In this sense, the combination of the real-time position management (RPM) system and the volumetric intensity modulated radiotherapy (RapidArc) is promising since it provides a short treatment time compared with the conventional respiratory gated treatments. In this study, we evaluated the accuracy of the respiratory gated RapidArc treatment. Total sic patient cases were used for this study and each case was planned by RapidArc technique using varian ECLIPSE v8.6 planning machine. For the Quality Assurance (QA), a MatriXX detector and I'mRT software were used. The results show that more than 97% of area gives the gamma value less than one with 3% dose and 3 mm distance to agreement condition, which indicates the measured dose is well matched with the treatment plan's dose distribution for the gated RapidArc treatment cases.

• Journal of Chest Surgery
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• v.35 no.5
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• pp.356-364
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• 2002

Background: This study was undertaken to investigate the outcome of composite graft aortic root replacement using coronary button reimplantation technique for the treatment of aneurysms of the ascending aorta involving the aortic root. Material and Method: Between April 1995 and September 2001, 54 patients having aortic root replacement with a composite valve graft using direct coronary button reimplantation were reviewed retrospectively. Left ventricular dysfunction was present in 14 patients(25.9%), aortic regurgitation in 48(89%), and Marfan's syndrome in 17(31.5%). The indications for operation were annuloaortic ectasia in 29 patients(53.7%), aortic dissection in 11(20.4%), aneurysms of the ascending aorta involving aortic root in 12(22.2%), and aortitis in 2(3.7%). Six patients(11.1%) had previous cardiac or ascending aortic operations. Concomitant procedures were arch replacement in 21 patients(38.9%), coronary artery bypass graft in 7(13%), mitral valve repair or replacement in 4(7.4%), and others in 6. The mean time of circulatory arrest, total bypass, and aortic crossclamp were 18 $\pm$ 9 minutes, 177 $\pm$ 42 minutes, and 127 $\pm$ 31 minutes, respectively. Result: There was 1 early death(1.9%). Mean follow-up was 24.6$\pm$ 19.5 months. There were two late deaths(3.8%) including one death due to the traumatic cerebral hemorrhage. The Kaplan-Meier survival rate was 98.0 $\pm$ 2.0% and 93.1 $\pm$ 5.1% at 1 and 6 years, respectively. Two patients required reoperation owing to a false aneurysm at the root anastomosis site and a malfunction of prosthetic aortic valve(3.8%). Staged operation for dissection of the remaining thoracoabdominal aorta was performed in 1 patient. The freedom rate from reoperation was 97.8 $\pm$ 2.0% and 65.3 $\pm$ 26.7% at 1 and 6 years, respectively.

• Journal of Chest Surgery
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• v.35 no.2
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• pp.102-112
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• 2002

This study was undertaken to analyze the outcome of composite valve graftreplacement(CVGR) for the treatment of aneurysms of the ascending aorta involving the aortic root. Material and Method: Between April 1995 and June 2001, 56 patients had replacement of the ascending aorta and aortic root with a composite graft valve and were reviewed retrospectively. Aortic regurgitation was present in 50 patients(89%), Marfan's syndrome in 18 patients(32%), and bicuspid aortic valve in 7(12.5%). The indications for operation were annuloaortic ectasia(AAE) in 30 patients(53.6%), aortic dissection in 13(23.2%), aneurysms of the ascending aorta involving aortic root in 11(19.6%), and aortitis in 2(3.6%). Cardiogenic shock due to the aortic rupture was present in 2 patients. Nine patients(16%) had previous operations on the ascending aorta or open heart surgery. The operative techniques used for CVGR were the aortic button technique in 51 patients(91%), the modified Cabrol technique in 4, and the classic Bentall technique in 1. The concomitant procedures were aortic arch replacement in 24 patients(43%), coronary artery bypass graft in 8(14.3%), mitral valve repair in 2, redo mitral valve replacement in 1, and the others in 7 The mean time of circulatory arrest, total bypass, and aortic crossclamp were 21$\pm$14 minutes, 186$\pm$68 minutes, and 132$\pm$42 minutes, respectively. Result: Early mortality was 1.8%(1/56). The postoperative complications were left ventricular dysfunction in 16 patients(28.6%), reoperation for bleeding in 7(12.5%), pericardial effusion in 2, and the others in 7. Fifty-three patients out of 55 hospital survivors were followed up for a mean of 23.2 $\pm$ 18.7 months(1-75 months). There were two late deaths(3.8%) including one death due to the traumatic cerebral hemorrhage, and CVGR-related late mortality was 1.9%. The 1- and 6-year actuarial survival was 98.1$\pm$1.9% and 93.2$\pm$5.1%, respectively. Two patients required reoperation for complication of CYGR(3.8%) and two other patients required subsequent operations for dissection of the remaining thoracoabdominal aorta. The 1- and 6-year actuarial freedom from reoperation was 97.8$\pm$2.0% and 65.3$\pm$26.7%, respectively.

• Journal of Chest Surgery
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• v.40 no.6 s.275
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• pp.414-419
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• 2007

Background: Replacing the ascending aorta is a standard surgical option for treating acute type A aortic dissection. But replacing the aortic arch has recently been reported as an acceptable procedure for this disease. We compared the effects of aortic arch replacement for treating acute type A aortic dissection with the effects of ascending aortic replacement. Material and Method: From 2002 to 2006, 25 patients undewent surgical treatment for acute type A aortic dissection, 12 patients undewent ascending aortic replacement and 13 patients underwent aortic arch replacement. Among the aortic arch group, an additional distal stent-graft was inserted during the operation in 5 patients. 19 patients (11 arch replaced patients and 8 ascending aortic replaced patients) were followed up at the out patient clinic for an average of $756{\pm}373$ days. All the patients undewent CT scanning and we analyzed their distal aortic segments. Result: 4 patients who underwent ascending aortic replacement died, so the overall mortality rate was 16%. Among the 11 long term followed-up arch replacement patients, 2 patients (18.1 %) developed distal aortic dilatation and one of them underwent thoracoabdominal aortic replacement later on. However, among the 8 the ascending aortic replaced patients, 5 patients (62.5%) developed distal aortic dilatation. Conclusion: Aortic arch replacement is one of the safe options for treating acute type A aortic dissection. Aortic arch replacement for treating acute type A aortic dissection could contribute to a reduced distal aortic dilatation rate and fewer secondary aortic procedures.