• Journal of Korean Academy of Nursing
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• v.42 no.3
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• pp.424-433
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• 2012

Purpose: To investigate the accuracy, precision and validity of fever detection of tympanic membrane (TM), temporal artery (TA) and axillary temperature (AT) compared with pulmonary artery temperature (PA). Methods: Repeated-measures design was conducted for one year on 83 adult cardiac care unit patients with pulmonary artery catheters after open heart surgery. Sequential temperature measurements were taken three times at 20-minute intervals. Accuracy, precision, repeatability, and validity of fever detection were analyzed. Results: Mean pulmonary artery temperature was $37.04^{\circ}C$ (SD $0.70^{\circ}C$). The mean (SD) offsets from PA, with the mean reflecting accuracy and SD reflecting precision, were $-1.31^{\circ}C$ ($0.75^{\circ}C$) for TA, $-0.20^{\circ}C$ ($0.24^{\circ}C$) for TM, and $-0.97^{\circ}C$ ($0.64^{\circ}C$) for AT. Percentage of pairs with differences within ${\pm}0.5^{\circ}C$ was 9.6% for TA, 19.7% for AT, and 91.6% for TM. Repeated measurements with all three methods had mean SD values within $0.04^{\circ}C$. Sensitivity, specificity, and positive and negative predictive values of tympanic measurements were 0.76, 1.0, and 1.0, and 0.90, respectively. Conclusion: Results show that TM best reflects PA, and is most consistent, accurate, and precise. AT tends to underestimate PA, and TA is least accurate and precise. Therefore tympanic membrane measurement is a reliable alternative to other non-invasive methods of measuring temperatures.

• Archives of Reconstructive Microsurgery
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• v.10 no.1
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• pp.28-33
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• 2001

The numbers of breast cancer are increasing in Korea and the needs for breast reconstruction are also parallel with cancer frequency. The purpose of the study is to define the different state and condition between the delayed reconstruction and the immediate reconstruction of breasts and to suggest how to get more satisfactory outcome. The study included 22 patients who underwent delayed breast reconstruction using transverse rectus abdominis myocutaneous(TRAM) free flap from December, 1990 to January, 2001. Their ages ranged from 28 years to 58 years. We have used internal mammary artery and vein as a recipient vessel in 13 patients because of fibrosis and severe scarring in the axillary region and thoracodorsal artery and vein in 9 patients. When we used internal mammary artery with recipient vessel, we would use contralateral deep inferior epigastric artery with donor vessel. We obtained satisfactory result without any flap loss, and most patients satisfied with shape and volume of reconstructed breast. We found that delayed breast reconstruction have some differences compared with immediate breast reconstruction. First, we remove fibrotic and scar tissue as much as possible to achieve satisfactory shape of breast. Second, we plan preoperative design in standing position to obtain symmetrical recreation of inframammary fold. Third, we use internal mammary vessel in many cases with recipient vessel for microvascular anastomosis. Fourth, patients with delayed breast reconstruction feel more satisfaction than patients with immediate breast reconstruction do. Finally, economic burden is much higher in the delayed case than in the immediate case because of no coverage with insurance.

• Journal of Chest Surgery
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• v.9 no.2
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• pp.245-250
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• 1976

A 33 year-old man was admitted with chief complaints of severe sharp pain on left upper interscapular region and motor weakness of left arm for 9 days. He had a history of blunt trauma over left shoulder about 3 years ago. Physical examination showed a ping pong ball sized mass which was located at the left supraclavicular area and was firm, fixed, and nonpulsatile. No bruit or murmur was obtained over the mass. Ipsilaterally, radial, ulnar, and brachial pulse were very weak and ptosis and anhidrosis were noticed. Neurologic examination revealed moderate or severe weakness of flexion and extension of left elbow, wrist and fingers, and anesthesia of the skin in left C8-T1 dermatome and hypalgesia in left C6-C7 dermatome. Retrograde aortography demonstrated complete obstruction of left subclavian artery. An exploratory operation was performed through the left 4th intercostal space. It was found that the mass was a left subclavian aneurysm of traumatic false type. Proximal and distal ligation of the aneurysm were applied and the sac was partially removed. The continuity of the subclavain artery was established by the use of a 6mm. Dacron graft from the root of the subclavian to the axillary artery. Postoperatively the patient was improved from the circulatory and neurologic disturbances.

• Journal of Chest Surgery
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• v.26 no.12
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• pp.920-925
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• 1993

Extra-anatomic bypass was proposed by Freeman in 1952 and has been used for patient with lower extremity arterial occlusion who had very high operative risk, especially elderly or severly illed patient.We had performed 14 cases of extra-anatomic bypasses from Jan. 1991 till July 1993 and having been following up them. Their results were summarized as follow. Among total 14 patients, 13 was male. Their mean age was 64.8 years old, ranged from 48 to 80. The most common complaint was pain on lower limb and they visited hospital 6.1 months in average after onset of symptom. Frequently, they were associated with systemic diseases such as generalized atherosclersis, hypertension, diabetes mellius, etc. Axillary artery was used as donor artery in 8 cases and crossover femoro-femoral or femoro-popliteal bypass was performed in 6 cases. Postoperative complications were notedd in 8 cases so their morbidity rate was 42.8%. Except for two contraindicated cases, one or more anticoagulants were used routinely . Among them, combined use of aspirin and persantine was most commonly applied.After bypass graft, nine cases were occluded beteween 10 and 53 months. So their average duration of freedom from reocclusion was 35.7 months and 3-year patency rate was 63%.

• Journal of Korean Clinical Nursing Research
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• v.24 no.2
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• pp.227-234
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• 2018

Purpose: This study compared the temporal artery temperature (TAT) measured by infrared temporal artery thermometers to the axillary temperature (AT) measured by standard mercury-in-glass thermometers, and evaluated accuracy of the TAT measurement for clinical practice. Methods: A total of 247 adult inpatients in general wards in a tertiary medical center located in Seoul participated in the study. The TAT was measured within one minute after the AT measurement. Data were analyzed using descriptive statistics, paired t-test, Pearson correlation coefficient, linear regression, and the Bland-Altman plot. Results: There was a significant difference in mean temperature between AT and TAT, $36.89^{\circ}C$ (SD=0.70) versus $37.35^{\circ}C$ (SD=0.72). The Bland-Altman plots demonstrated the difference between the AT and TAT as -1.29 to +0.33. The specificity and sensitivity of the TAT in detecting fever were high. The positive predictive values were 57.5% and 71.0% when the AT were higher than $38.0^{\circ}C$ and the TAT fever cutoff levels were $38.0^{\circ}C$ and $38.3^{\circ}C$ respectively. Conclusion: TAT and AT were highly correlated and agreeable, indicating that TAT is as accurate as AT. The findings suggested that TAT measurement can be used in clinical practice. For accurate communication between medical personnel, medical institutions need to provide guidelines for temperature measurement, especially for the use of thermometer and measurement sites.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.16 no.7
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• pp.4651-4655
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• 2015

The subclavian artery pseudoaneurysm in blunt trauma is uncommon and rarely occurs secondary to penetrating injury. Subclavian artery injuries represent an uncommon complication of blunt chest trauma, this structure being protected by subclavius muscle, the clavicle, the first rib, and the deep cervical fascia as well as the costo-coracoid ligament, a clavi-coraco-axillary fascia portion. Subclavian artery injury appears early after trauma, and arterial rupture may cause life-threatening hemorrhages, pseudoaneurysm formation and compression of brachial plexus. Most injuries were related to clavicle fracture, gunshot, other penetrating trauma, and complication of central line insertion. The presence of large hematomas and pulsatile palpable mass in supraclavicular region should raise the suspicion of serious vascular injury and these clinical evidences must be carefully worked out by physical examination of the upper limb. Since the first reports of endovascular treatment for traumatic vascular injuries in the 1993, an increasing number of vascular lesions have been treated this way. We report a case of subclavian artery pseudoaneurysm 10 days after blunt chest trauma due to traffic accident, treated by endovascular stent grafting.

• Journal of Chest Surgery
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• v.46 no.5
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• pp.340-345
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• 2013

Background: This study aims to evaluate whether or not the method of right vertical axillary minithoracotomy (RVAM) is preferable to and as reliable as conventional sternotomy surgery, and also assesses its cosmetic results. Methods: Thirty-three patients (7 males, 26 females) with atrial septal defect were admitted to the Cardiovascular Surgery Clinic of Cukurova University from December 2005 until January 2010. The patients' ages ranged from 3 to 22. Patients who underwent vertical axillary minithracotomy were assigned to group I, and those undergoing conventional sternotomy, to group II. Group I and group II were compared with regard to the preoperative, perioperative and postoperative variables. Group I included 12 females and 4 males with an average age of $16.5{\pm}9.7$. Group II comprised 14 female and 3 male patients with an average age of $18.5{\pm}9.8$ showing similar features and pathologies. The cases were in Class I-II according to the New York Heart Association (NYHA) Classification, and patients with other cardiac and systemic problems were not included in the study. The ratio of the systemic blood flow to the pulmonary blood flow (Qp/Qs) was $1.8{\pm}0.2$. The average pulmonary artery pressure was $35{\pm}10$ mmHg. Following the diagnosis, performing elective surgery was planned. Results: No significant difference was detected in the average time of the patients' extraportal circulation, cross-clamp and surgery (p>0.05). In the early postoperative period of the cases, the duration of mechanical ventilator support, the drainage volume in the first 24 hours, and the hospitalization time in the intensive care unit were similar (p>0.05). Postoperative pains were evaluated together with narcotic analgesics taken intravenously or orally. While 7 cases (43.7%) in group I needed postoperative analgesics, 12 cases (70.6%) in group II needed them. No mortality or major morbidity has occurred in the patients. The incision style and sizes in all of the patients undergoing RVAM were preserved as they were at the beginning. Furthermore, the patients of group I were mobilized more quickly than the patients of group II. The patients of group I were quite pleased with the psychological and cosmetic results. No residual defects have been found in the early postoperative period and after the end of the follow-up periods. All of the patients achieved functional capacity per NYHA. No deformation of breast growth has been detected during 18 months of follow-up for the group I patients, who underwent RVAM. Conclusion: To conclude, the repair of atrial septal defect by RVAM, apart from the limited working zone for the surgeon in these pathologies as compared to sternotomymay be considered in terms of the outcomes, and early and late complications. And this has accounted for less need of analgesics and better cosmetic results in recent years.

• Journal of Chest Surgery
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• v.57 no.4
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• pp.380-386
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• 2024

Background: Type A aortic dissection (AD) and intramural hematoma (IMH) are critical medical conditions. Emergency surgery is typically performed under cardiopulmonary bypass immediately after diagnosis, which involves lowering the body temperature to induce total circulatory arrest. Selection of the arterial cannulation site is a critical consideration in cardiac surgery and becomes more challenging in patients with AD. This study explored the strengths and weaknesses of different cannulation methods by comparing each cannulation strategy and analyzing the reasons for patients' outcomes, especially mortality and cerebrovascular accidents (CVAs). Methods: This retrospective study reviewed the medical records of patients who underwent surgery for type A AD or IMH between 2008 and 2023, using the moderate hypothermic circulatory arrest approach at a single center. Results: Among the 146 patients reviewed, 32 underwent antegrade cannulation via axillary, innominate artery, aortic, or transapical cannulation, while 114 underwent retrograde cannulation via the femoral artery. The analysis of surgical outcomes revealed a significant difference in the total surgical time, with 356 minutes for antegrade and 443 minutes for retrograde cannulation (p<0.001). The mean length of stay in the intensive care unit was significantly longer in the retrograde group (5±16 days) than in the antegrade group (3±5 days, p=0.013). Nevertheless, no significant difference was found between the groups in the 30-day mortality or postoperative CVA rates (p=0.2 and p=0.7, respectively). Conclusion: Surgeons should consider an appropriate cannulation strategy for each patient instead of adhering strictly to a specific approach in AD surgery.

• Journal of Chest Surgery
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• v.26 no.2
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• pp.154-157
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• 1993

Aortic dissection of the young woman without Marfan disease is related, in most instances, to pregnancy. We experienced a case of acute type A aortic dissection. The patient was 25 years old woman in 35 weeks of gestational age without evidence of Marfan's syndrome. The challenge of management was successfully met by delivery of the fetus first, followed by aorta surgery. 42 minutes of total circulatory arrest and 104 minutes of total aortic cross clamp time were needed. 34 minutes of selective cerebral perfusion via right axillary artery was used. The patient had uneventful hospital course and was discharged with her healthy baby on 15 th postoperative day.

• Journal of Chest Surgery
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• v.37 no.2
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• pp.176-179
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• 2004

A 30 year-old female patient was admitted for dizziness and palpitation. Pulsation of the both upper extremities and both common carotid arteries were absent. Innominate artery and both common carotid arteries were severely narrowed and both subclavian arteries were completely obstructed on aortogram. The patient was diagnosed as tvue Ⅰ Takayasu's arteritis, and operation was peformed to increase blood flow to the brain and both upper extremities. Ascending aorta, both carotid arteries, both subclavian arteries, and both axillary arteries were exposed by four separate incision, and we performed an aorto-bicarotid-biaxillary bypass with Hemashield graft. Previous dizziness and palpation were disappeared after the operation.