• Journal of Chest Surgery
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• v.31 no.1
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• pp.59-65
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• 1998

Atrial fibrillation is the most common of all cardiac arrhythmias. It is associated with significant morbidity and mortality and is frequently resistant to medical therapy. On the experimental and clinical study, the presence of macroreentrant circuits and the absence of either microreentrant circuits or evidence of atrial automaticity suggests that atrial fibrillation should be amenable to surgical ablation. The results of the maze III procedure are associated with a higher incidence of postoperative sinus rhythm, improved long-term sinus node function, fewer pacemaker requirements, less arrhythmia recurrence, and improved long-term atrial transport function. We had experienced 4 patients with chronic atrial fibrillation. For the first time, Hioki procedure had been performed in the first patient with ASD and atrial fibrillation, regular sinus rhythm showed on postoperative EKG, but junctional rhythm and bradycardia developed postoperative 3 years. The maze III procedure for the rest with mitral valvular disease and atrial fibrillation had been done, followed by regular sinus rhythm for 2 patients and atrial fibrillation for 1 patient, managed with amiodarone, on immediate postoperative state. Echocardiogram documented good contraction of right atrium and hardly contraction of left atrium for 2 patients with regular sinus rhythm postoperative 3 months.

• Journal of Chest Surgery
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• v.16 no.2
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• pp.170-174
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• 1983

Aortic arch syndrome is an unusual disease entity characterized by the narrowing or obliteration of major branches of the arch of the aorta regardless of etiology. We have experienced 2 cases. One of them was 22 years old office girl with 3 months history of headache, intermittent syncope and weakness and claudication on left arm especially during her physical exercise. On physical examination, pulseless on left antecubital and radial artery and blood pressure on left arm was inable to check and coldness with weakness were noted on the same side. Aortic angiography reealed 34% narrowing of left subclavian artery as that of right. But both common carotid artery and both axillary arterial patency were relatively good. Through right supraclavicular and left axillary incision, bypass graft with Gore-tex prosthesis (I.D. 6mm, Length 25 cm) was implanted from right subclavian artery on 2cm distal to origin of right common carotid arery to left axillary artery distal to axillary fossa. End to side anastomosis with preservation of left subclavian artery was done. Postoperative state was stable with blood pressure of 110/70 mmHg on left arm and palpable antecubital and radial pulsation. Another one was 41 year old male patient with 8 months history of pain and numbness on right upper arm and shoulder. On admission, right arm blood pressure was 110/80 mmHg, left arm was 160/110 mmHg, but other physical findings had no abnormalities. Angiography revealed segmental narrowing of right axillary artery on the beginning with 2 cm in length. Operative treatment with right wupraclavicular and right axillary incision, bypass graft with great saphenous vein (Length; 15 cm) from right subclavian artery between scalenus anticus and medius to axillary artery at distal end of axillary fossa was done. The authors report two cases of Aortic arch syndrome treated with bypass graft using Autograft or Gore-tex with good result.

• Journal of Chest Surgery
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• v.19 no.3
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• pp.443-448
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• 1986

Aortic dissection is a serious disease that mortality does not approach to zero despite of medical and surgical improvement. Recently two cases of aortic dissection were treated with good results by the two other methods. Case 1 [57-Y-0-Male]; Chief complaint was chest pain radiating to the back. Preoperatively he was controlled by Minipress, dichlotride, & sodium nitroprusside. Aortography showed DeBakey Type III aortic dissection extending from just below the Lt. subclavian artery to the proximal portion of the origin of the renal artery. Through the midline long incision Flow reversal & Thrombo-exclusion method was used, and bypass course was proximal anastomosis at the ascending aorta - through the Rt. thoracic cavity - midportion of the diaphragm - posterior to the liver, stomach, & pancreas - distal anastomosis at the abdominal aorta proximal to its bifurcation. Bypass graft was preclotted 20 mm Dacron Woven Graft, and the aortic arch between the Lt. subclavian artery & Lt. common carotid artery was divided and meticulously sutured. Control aortogram which was done at 4th postoperative month revealed obstruction of the false lumen by thrombosis, and complications were not noticed. Case 2 [53-Y-0-Male]; Chief complaint was chest pain radiating to the abdomen. DeBakey Type III aortic dissection which was similar to the case 1 was detected by the aortography, and involvement of the Lt. subclavian & common carotid arteries was suspicious. Through the Lt. posterolateral thoracotomy the Ringed Intraluminal Sutureless Graft, No. 22 mm, was inserted from just below the Lt. common carotid artery to the midportion of the descending thoracic aorta under total circulation arrest using a F-F bypass, and the Lt. subclavian artery was ligated. Postoperatively hospital course was uneventful with antihypertensive drugs, and any specific complications were not noticed.

• Journal of Chest Surgery
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• v.24 no.4
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• pp.323-330
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• 1991

Residual significant tricuspid regurgitation after mitral valve operation may significantly increase postoperative morbidity and mortality. However, routine techniques to detect tricuspid regurgitation preoperatively and postoperatively are not accurate. Doppler echocardiography was performed preoperatively and postoperatively to assess its ability to evaluate and quantify the severity of tricuspid regurgitation. In 34 patients with tricuspid regurgitation secondary to mitral valvular disease the tricuspid regurgitations were semiquantified on a scale of 1 to 3+. The 34 patients were divided into two groups on the basis of severity of tricuspid regurgitation as assessed by preoperative Doppler echocardiography. Group I [8 patients] had mild[1+] regurgitation, and group II [26 patients] had moderate to severe[2 ~ 3%] tricuspid regurgitation. In all studied patients, preoperative Doppler echocardiographic studies for the degree of tricuspid regurgitation were correlated with clinical symptoms[including NYHA class] and hemodynamics[JVP and right ventricular systolic pressure], and used as the indicator to determine whether tricuspid annuloplasty should be performed or not. Patients with significant tricuspid regurgitation[group II ] had greater preoperative right ventricular systolic pressures and NYHA classes, although there was no correlation between them. The 8 patients with mild[1+] tricuspid regurgitation[group I ] didn`t undergo any procedure for the tricuspid regurgitation and their postoperative Doppler echocardiographic studies showed the less than mild[0 ~ 1+] tricuspid regurgitation, and the 26 patients with significant[>2+] tricuspid regurgitation, and the 26 patients with significant[>2+] tricuspid regurgitation[group II ] underwent tricuspid annuloplasty for the tricuspid regurgitation and the postoperative Doppler echocardiographic studies showed the findings similar to group I except 1 patient who underwent Carpentier`s ring annuloplasty and had severe right ventricular failure. Therefore, preoperative Doppler echocardiography can accurately assess the relative severity of tricuspid regurgitation. Importantly, postoperative Doppler echocardiography could conveniently determine the effect of tricuspid annuloplasty for the patients with significant tricuspid regurgitation. Doppler echocardiography may be an important diagnostic method both for evaluating the degree of residual tricuspid regurgitation after left heart operation as well as for determining which patients should undergo tricuspid valve repair.

• Journal of Chest Surgery
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• v.32 no.1
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• pp.27-31
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• 1999

Background: In spite of the development of chemotherapy, prognosis of metastatic lung cancer was poor. On the other hand, surgical intervention has proven itself to bring out superior results, therefore more operations are being praticed based on this superiority against chemotherapy and other modalities on metastatic lung cancer. Material and Method : We analyzed the surgical cases performed from 1983 to 1997 on 17 cases and estimated 5 year survival rate using Kaplan-Meier method. Result: Average age was 42.8, ratio between male and female was 10:7. We had 8 single lobe resections,3 pneumonectomies,1 wedge resection,2 bilobectomy and 3 cases of lobar resection with wedge resection. 5 deaths have occured and among the 5, 3 patients were caused by recurrence of ca. The remaining 12 patients are being followed up in OPD basis among these, 3 recurrence were observed and 9 are still free of cancer. The average survival time was 40.5 months and 5 year survival rate obtained through the Kaplan-Meier method was 60.4%. Conclusion: Even though we are a bit short of cases, we recommend that a thoracic surgeon approach this disease through a surgical method as possibly as he could.

• Journal of Chest Surgery
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• v.32 no.1
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• pp.38-42
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• 1999

Background: In neonatal respiratory distress syndrome patients, various types of pulmonary air leak contributes to elevate morbity and mortality. Although early surgical interventions can provide better results in several cases, whole clinical outcomes are poor. This study was designed to investigate the clinical aspects of pulmonary air leak in the neonatal respiratory distress syndrome patients and major contributing factors to mortality. Material and Method : We retrospectively evaluated 48 cases of pulmonary air leak in the neonatal respiratory distress syndrome patients from September 1994 to May 1997. Result: There were 15 cases of primary and 33 cases of secondary pulmonary air leakages. The prominent manifestations were pure interstitial emphysema in 19 cases(39.9%) and combined pneumothorax in 19 cases(39.9%). In clinical aspects, normal birth weight was dominant(83.4%), the onset occurred within 24 hours was in 28 cases(58.8%). The pulmonary diseases were meconium aspiration syndrome(25.2%) and hyaline membrane disease(33.2%). The overall hospital mortality was 25.2%, and the majority were hyaline membrane diseases. Conclusion: Although the overral mortality rate of these diseases were high, more detailed studies about immediate treatement, perinatal prevention, intensive care to geriatric problems were needed individually to improve outcomes.

• Journal of Chest Surgery
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• v.32 no.10
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• pp.916-923
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• 1999

Background: Many institutes are interested in lung metastatectomy than before because of the improved long term survival, low mortality, and low morbidity after lung metastatectomy. However, prognostic factors affecting long term survival are controversial. We attempt to analyze the prognostic factors affecting retrospectively by comparing the results of lung metastasectomy. Material and Method: Between Jan. 1990 and Dec. 1997, 74 operations were taken in 63 patients with pulmonary metastases in various primary sites. We analyzed the postoperative long term survival according to sex, cell type, laterality, disease free interval(DFI), operation, the number of metastases, and the size of the largest metastasis. Result: There were 27 male and 36 female patients. Sex did not appeared to affect survival time(p=0.849). The primary tumor was carcinoma in 32, sarcoma in 28, and others in 3. Cell type, considering carcinoma and sarcoma, did not relate to survival time(p=0.071). DFI had no influence on the outcome(p=0.902). The type of operative procedure had no influence on the outcome(p=0.556). The laterality of metastases, 47 unilateral(74.6%) and 16 bilateral(25.4%), had no influence on the outcome(p=0.843). The number of metastases excised(one, two or three, four or more) did not appear to affect survival(p=0.263). The size of largest metastasis(<=10mm, 11mm-30mm, and >30mm) did not appear to affect survival(p=0.751). Previous factors were evaluated in both the carcinoma and sarcoma patients respectively. DFI was the only significant prognostic factor in metastatic lung sarcoma(p=0.0026). Conclusion: Survival was not related to sex, cell type, laterality, DFI, operative procedure, number of metastases, nor the size of the largest metastasis. DFI was related to the survival time in sarcoma group but further study is needed.

• Journal of Community Nutrition
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• v.6 no.1
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• pp.35-41
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• 2004

Cardiovascular disease has the highest mortality rate in South Korea. Previous studies have reported that serum cholesterol level relates to intake of dietary fat and cholesterol. Therefore, in this study we developed a semiquantitative food frequency questionnaire (FFQ) for Koreans with a high-risk of hypercholesterolemia and to validate the FFQ. Semiquantitative FFQ, which includes 160 food items, reflects intakes of energy, fat, saturated fatty acid (SFA), monounsaturated fatty acid (MUPA), polyunsaturated fatty acid (PUPA) and cholesterol. We chose food items from the previous study of our research group (Suh 1999) which reported a nutritional status of Korean adults with normocholesterolemia, borderline and hypercholesterolemia. To validate the FFQ, we compared the results of the FFQ with those of a 3-day food record using a paired t-test. In addition, we calculated Pearson's and Spearmen's correlation coefficients. Intakes assessed by the FFQ and a 3-day food record were classified into quartile and the degree of agreement was obtained. Fifty-five participants responded for the validation study by completing both the FFQ and a 3-day food record. Pearson's correlation coefficients between estimated intakes by respective methods for energy, fat, SF A, MUPA, PUPA and cholesterol were 0.32,0.41,0.37,0.41,0.37 and 0.21, respectively. Spearman's correlation coefficients of energy, fat, SF A, MUPA, PUPA, cholesterol were 0.31, 0.44, 0.39, 0.46, 0.46, and 0.37, respectively. Nutrient densities in 1000kcal were compared. Pearson's correlation coefficient of cholesterol density increased and other values were similar with original values. The average degree of agreement was 67％ that intakes of energy, fat, SF A, MUPA, PUPA and cholesterol assessed by the FFQ and 3-day food records were classified within the same and the adjacent quartile. On the average, 8％ were misclassified into the extreme opposite quartile. The average of weighted kappa was 0.46. In conclusion, the FFQ developed in this study is considered to be a reliable tool to assess nutrient intakes for Koreans with a risk of hypercholesterolemia because the FFQ reflects the intakes of energy, fat, SFA, MUFA, PUPA, and cholesterol.

• Journal of Community Nutrition
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• v.2 no.1
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• pp.5-11
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• 2000

Populations both in the US and worldwide are aging. It is projected that by the year 2030 the population of Americans over 65 will increase to 70 million, more than twice their number in 1998. About one-third of elderly over the age of 65 have debilitating chronic health conditions that greatly impede their activities. Age-associated chronic diseases are believed to be associated with free radicals and the imbalance in antioxidant and oxidative stress contributes to development of several chronic health conditions. Diet and nutrients can have great impact in the health status of elderly. Several factors may contributor to the inadequate consumption of nutrients in elderly, including an inability to chew food adequately, polypharmacy, living along and limited income. Low intake of energy and several micronutrients are common among the elderly. Although overt deficiency of nutrients among the elderly is not common. a recent study showed that while elderly consume more fat, the total energy intake is low among the elderly. Inadequate intake of antioxidant nutrients such as vitamin E in elderly may contribute to the development of chronic health problems. Intake of higher than normal RDA levels of vitamin E for long periods of time has been shown to reduce the risk of many degenerative diseases, such as cardiovascular diseases(CVD) and cancer, and improve immune response in elderly. High intake of other antioxidants is also associated with reduced risk chronic diseases. Dietary antioxidants are abundant in fruits and vegetables. However, due to variety of factors, the elderly may not be able to receive these and other micronutrients through diet. Therefore, supplemental intake of micronutrients in the form of multi vitamins/minerals and/or specific micronutrients is a more practical approach to the maintenance of health status in the elderly.

• Korean Journal of Community Nutrition
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• v.2 no.4
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• pp.578-592
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• 1997

The use of semiquantitative food frequency questionnaires to estimate dietary intake has become widespread in nutritional epidemiologic studies. It had been suggested that knowledge about a person's usual portion size of each meal in addition to consumption frequency will improve the accuracy of this method. This study was performed to investigate the dietary intake status(nutrient, food, and dish intake) and one portion size of commonly consumed food and dishes to develop a semiquantitative food frequency questionnaire that will be used to expore the relationship between the incidence of cardiovascular disease and diet in Korean women after menopause. Intake of food or dish in 123 elderly women were measured by 3-day food records in March to May, 1996. The results obtained in this study were summarized as follow : 1) Calcium, vitamin A, and vitamin E intakes were less adequate than Recommended dietary allowances(RDA). 2) The subjects who consumed more than 20% of the energy from fat were 35% and the subjects consumed dietary cholesterol more than 300mg were 18$\%$. 3) The most frequently consumed foods or dishes by the subjects were Korean cabbage kimchi〉cooked rice, well-milled〉laver〉apple〉strawberry〉mixed rice〉soybean soup. 4) The major dish groups which contributed to most daily nutrient intakes were cooked rice, Korean cabbage kimchi, soybean soup because of large amount and high frequency of intake although they do not contain large amount of most nutrients. 5) One portion size of commomly consumed foods and dishes in elderly women was different from one portion size suggested in the Korean nutrition society. This study provides information for the design of data-based semiquantitative food frequency questionnaire. for Korean elderly women. In addition, they may be useful to health care planners or nutrition educators. (Korean J Community Nutrition 2(4) : 578-592, 1997)