• Clinical and Experimental Pediatrics
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• 제50권7호
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• pp.665-671
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• 2007

목 적 : 최근 신생아기에 심장 수술을 받은 환아들의 임상적 특징 및 수술 성적에 대해 알아보고자 하였다. 방 법 : 2000년 3월부터 2006년 2월까지 6년간 경북대학교 병원에서 신생아기에 수술을 받은 82명에 대해 이들의 수술 당시 나이 및 체중, 심기형의 종류, 수술 전 상태, 수술 내용 및 결과, 합병증 등을 검토하였다. 결 과 : 대상 환아 82명 중 남아는 41명이었으며 수술 당시 평균 나이는 12일, 평균 몸무게는 3,200 g이었다. 주된 심기형은 완전대혈관전위, 활로씨사징, 심실중격이 온전한 폐동맥판폐쇄, 기능적 단심실이 다수를 차지하였다. 수술 방법으로 인공심폐기를 사용한 경우가 57례였고, 54례에서 완전 교정수술이 시행되었다. 수술 종류로 완전 교정수술로는 동맥전환수술이, 고식 수술로는 변형 B-T 단락술이 가장 많이 시행되었다. 총 사망은 9례(10.9%)였으며 이 중 조기 사망은 6례, 만기 사망은 3례였다. 수술 후 합병증은 급성 신기능 부전, 지연 흉골 봉합, 상처감염, 수술 후 부정맥, 뇌실내 또는 뇌내출혈 등이 발생하여 내과적 치료를 필요로 하였다. 결 론 : 최근 6년간 본원에서 신생아기의 선천성 심장병에 대한 수술적 치료는 수술 전 처치, 수술 방법, 체외 순환법 그리고 수술 후 집중 치료의 발달을 통해서 많은 향상을 보였다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제32권4호
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• pp.306-312
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• 2010

Purpose: The purpose of this experiment was to evaluate the clinical effect of cultured autoglogous osteoblasts as a way to treat the defect of mandible in rabbits. Materials and Methods: Twelve rabbits were used to determine the rate of osteogenesis. The osteoblasts were obtained from the iliac crest of rabbits using aspiration. They were then cultured in Dulbecco's Modified Eagles's Medium (DMEM) with beta-glycerophosophatate, L-ascorbicacid, and dexamethasone to proliferate and differentiate osteoprogenitor cells. The expression of osteogenic markers were detected by reverse transcription-polymerase chain reaction (RT-PCR) and silver nitrate staining techniques. Five, 10-mm holes were placed in each rabbit mandible to simulate defective regions with the use of a low speed trephine bur. In the experimental group, the previously cited defects were grafted with both activated osteoblastic and autogenous bone. The control group, however, was only grafted with autogenous bone. Both groups were then analyzed at 2, 4, and 8-week intervals using bone histomorphometric analysis. Results: According to histomorphologic analysis, the rates of new bone formation at the 2, 4, and 8-week intervals were 36%, 51%, and 23% for the control group, respectively; 52%, 39%, and 28%, for the experimental group, respectively. The experimental group showed higher rates of new bone formation compared to the control group at both the 2-week and 8-week interval. Conclusion: Bone marrow-derived osteoblasts seems to be a promising bone graft material.

• Journal of Chest Surgery
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• 제33권2호
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• pp.139-145
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• 2000

Background: The purpose of this study is to review the clinical course after the correction of noncomplicated ventricular septal defect and to analyze the morbidity and risk factors of postoperative complications and evaluate residual defect during the follow-up period. Material and Method: From September 1994 to June 1998 24 patients(median age 10 months) underwent surgery under the diagnosis of ventricular septal defect. We made a retrospective review of the clinical records including the operation notes critical care unit records echocardiography results and the follow-up records. Result: There was no early mortality nd late mortality. There was no postoperative complete conduction block. Respiratory complication was the most common complication. The body weight age type of ventricular septal defect associated anomalies and operative procedure were not related to the incidence of complications. residual ventricular septal defects aortic valve regurgitation and tricuspid valve regurgitation were insignificant in postoperative hemodynamics, Conclusions: Correction of the noncomplicated ventricular septal defect was done without mortality and complete heart block. Aggressive preoperative medical treatment and early surgical treatment may decrease postoperative complications. Postoperative residual shunt and tricuspid regurgitation were not problematic during the follow-up

• Archives of Plastic Surgery
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• 제39권6호
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• pp.643-648
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• 2012

Background Aggressive treatment of sternoclavicular joint (SCJ) infection involves systemic antibiotics, surgical drainage and resection if indicated. The purpose of this paper is to describe a classification of post resectional SCJ defects and highlight our reconstructive algorithm. Defects were classified into A, where closure was possible often with the aid of topical negative pressure dressing; B, where parts of the manubrium, calvicular head, and first rib were excised; and C, where both clavicular, first ribs and most of the manubrium were resected. Methods Twelve patients (age range, 42 to 72 years) over the last 8 years underwent reconstruction after SCJ infection. There was 1 case of a type A defect, 10 type B defects, and 1 type C defect. Reconstruction was performed using the pectoralis major flap in 6 cases (50%), the latissimus dorsi flap in 4 cases (33%), secondary closure in 1 case and; the latissimus and the rectus flap in 1 case. Results All wounds healed uneventfully with no flap failure. Nine patients had good shoulder motion. Three patients with extensive clavicular resection had restricted shoulder abduction and were unable to abduct their arm past $90^{\circ}$. Internal and external rotation were not affected. Conclusions We highlight our reconstructive algorithm which is summarised as follows: for an isolated type B SCJ defect we recommend the ipsilateral pectoralis major muscle for closure. For a type C bilateral defect, we suggest the latissimum dorsi flap. In cases of extensive infection where the thoracoacromial and internal mammary vessels are thrombosed, the pectoralis major and rectus abdominus cannot be used; and the latissimus dorsi flap is chosen.

• Journal of Chest Surgery
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• 제11권3호
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• pp.326-332
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• 1978

There appears some conduction defects frequently after total correction of Tetralogy of Fallot. Common defect is right bundle branch block due to surgical intervention. We experienced complete A-V block which occured 3 months later after total correction of Tetralogy of Fallot in a 8 year old boy. The patient was completely free of any A-V block after the operation for 3 months, and sudden onset of A-V block with coupled premature ventricular contractions resulted him in shock state during the attack of severe bronchopneumonia for 4 days prior to the second visit. Emergency implantation of Cordis demand type temporary pacemaker was necessary to control the complete heart block with bradyarrhythmia and frequent ventricular fibrillation. Permanent cardiac pacemaker was implanted two weeks later as indicated with Cordis Stanicor lambda demand pacemaker, and the patient was discharged uneventfully on the 8th post implantation day with the heart rate of 72/min. Another 3 months after the implantation, the patient was transported to this hospital as dead on arrival after an accidental fall from a 2 meter height, and all possible cardiopulmonary resuscitation was performed for 60 minutes at the emergency room in vain. Autopsy was done to find out the cause of sudden death and the etiology of complete heart block. Microscopic focal infarctions with scar formation were noted along the course of conduction system in the interventricular septum, which might be the main cause of complete heart block during the attack of severe bronchopneumonia complicated with acute bacterial endocarditis. The tip of the pacemaker wire was slipped from the granulation scar at the apex of the right ventricular cavity, and this might be the direct cause of pacing failure and death.

• Journal of Chest Surgery
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• 제17권3호
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• pp.371-380
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• 1984

Corrected transposition of the great arteries [C-TGA] is one of the rare congenital heart disease in which there is both a discordant atrioventricular relationship and transposition of the great vessels. With this arrangement, systemic venous blood passes through the right atrium into the morphologic left ventricle and out the pulmonary artery. Pulmonary venous blood returns to the left atrium, flows into the morphologic right ventricle and out the aorta. Thus, in the rare case when no additional cardiac anomaly is present, a hemodynamically normal heart exists. But more often they are symptomatic as a result of one or several of the commonly associated defects. This paper describes 13 patients who underwent repair of one or more cardiac anomalies associated with corrected transposition at SN UH, from June 1976 through June 1984. 1.8 were males and 5 females, with ages ranging from 3 years to 27 years. 2. Segmental anatomy was {S,L,L} in 12, or {I,D,D} in 1. 3.Associated anomalies were ventricular septal defect in 10, pulmonary outflow tract obstruction in 6, tricuspid insufficiency in. 4, atrial septal defect in 3, subaortic stenosis in 1, mitral insufficiency in 1, and patent ductus arteriosus in 1. 4.None had complete heart block preoperatively, and 3 developed complete heart block intraoperatively. But one of them recovered sinus rhythm on the postoperative 7th day spontaneously. 5.There were 3 cases of hospital morality. But there was no morality since Dec. 1980. 6.Patients with single ventricle, hypoplastic ventricle or those who had palliative surgery alone are not included in this review.

• Journal of Chest Surgery
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• 제33권8호
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• pp.630-637
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• 2000

Backgroud: There are well-known problems in the management of low weight neonates or infants with congenital heart defects. In the past, because of a perceived high risk of operations using cardiopulmonary bypass(CPB) in these patients, there was a tendency for staged palliation without the use of CPB. However, the recent trend has been toward early reparative surgery using CPB, with acceptable mortality and good long-term survival. Therefore we reviewed our results of the operations in infants weighing less than 3kg and considered the technical aspect of conducting the CPB including myocardial protection. Material and Method: Between Jan. 1995 and Jul. 1998, 28 infants weighing less than 3kg underwent open heart surgery for many cardiac anomalies with a mean body weight of 2.7kg(range; 1.9-3.0kg) and a mean age of 41days(range; 4-110days). Preoperative management in the intensive care unit was needed in 20 infants and preoperative ventilator support therapy in 11. Total correction was performed in 23 infants and the palliative procedure in 5. Total circulatory arrest was needed in 11 infants(39%). Result: There were seven hospital deaths(25%) caused by myocardial failure(n=3), surgical failure(n=2), multiorgan failure(n=1), and sudden death(n=1). The median duration of hospital stay and intensive care unit stay were 13days(range; 6-93days) and 6days(range; 2-77days) respectively. The follow-up was achieved in 21 patients and showed three cases of late mortality(15%) and a one-year survival rate of 62%. No neurologic complications such as clinical seizure and intracranial bleeding were noticed immediately after surgery and during follow-up. Conclusion: The early and late mortality rate of open heart surgery in our infants weighing less than 3 kg stood relatively high, but the improved outcomes are expected by means of the delicate conduct of cardiopulmonary bypass including myocardial protection as well as the adequate perioperative management. Also, the longer follow-up for the neurologic development and complications are needed in infants undergoing circulatory arrest and continuous low flow CPB.

• 대한핵의학회지
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• 제6권2호
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• pp.21-39
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• 1972

The employment of gamma-ray scintillation camera with the use of short-lived radioisotopic pharmaceuticals, sucu as $^{99m}Tc$ sodium pertechnetate, have enabled us to perform RI (radioisotopic) angiocardiography. Although conventional cardiac catheterization or angiocardiography using contrast media have been an important diagnostic tool, they may carry some risks or serious complications. The author investigated on RI angiocardiography in twelve normal and twenty five patients with cardiovascular diseases in an effort to evaluate its diagnostic value. The results obtained with this study are as follows; 1. In normal subjects, the scintillation camera transit time of arm-to-right heart was found to be $2.1{\pm}0.67$ seconds, right heart-to-lung $1.5{\pm}0.40$ seconds and lung-to-left heart $3.5{\pm}0.86$ seconds. 2. Transformation or displacement of the heart and the great vessel are easily discriminated by RI angiocardiography. Both in the cases with tricuspid atresia and tetralogy of Fallot, ventricular septal defects are well recongnized by sequential RI angiocardiography. 3. It is also helpful in determinining the site and extent of obstruction, and estimatiing the postoperative course both in the cases with superior vena cava syndrome and pulmonary stenosis. 4. Pericarditis with effusion is readilly diagnosed by RI angiocardiogram showing characteristic "dead space" between intracardiac and intrapulmonary radioactivity. 5. It was found that the diagnostic accuracy of this study was 78.4%. It is concluded that above results obtained are useful and accurate enough for the diagnostic screening methode for clinical practice.

• Archives of Plastic Surgery
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• 제34권1호
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• pp.64-69
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• 2007

Purpose: The key of treatment in syndactyly is to separate the fused digits safely, and to create a normal web space with enough cutaneous coverage. Despite many techniques have described the correction of syndactyly, skin graft still remains the annoying one. We designed the pentagonal flap from hand dorsum to reconstruct the web space reliably and try to minimize the need for skin graft. Methods: Between July 2003 and August 2005, six cases of syndactyly were corrected at UCLA Medical Center and Hallym University Sacred Heart Hospital using dorsal pentagonal flap for web space reconstruction and straight incisions for the sides of digits to minimize the need for skin graft. The proximal edge of the pentagonal flap was designed in V shape to allow for easy closure of the donor site after advancement. The pentagonal flap was advanced volarly with the underlying dermofat tissues to form a digital web. In some cases, skin defects were unavoidable and covered with full thickness skin graft from the inguinal area. Results: Syndactyly were seen in 4 cases of Apert syndrome, 1 postburn scar webbing with PIP joint contracture and 1 recurrence after the incomplete reconstruction. In all Apert syndrome, straight line incision was used along the sides of the fingers and skin graft was needed. But, in 2 cases of incomplete type, we could save the need for skin graft only for the correction of syndactyly. We could get a good looking web space without any complications such as flap or graft loss. Conclusion: As a modification of Sherif's V-Y dorsal metacarpal flap, we believe pentagonal flap could be one of the easiest and safest way to reconstruct the web space of syndactyly in functional and cosmetic standpoint.

• 대한족부족관절학회지
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• 제25권4호
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• pp.185-189
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• 2021

An aneurysmal bone cyst (ABC) can occur in many parts of the human body, but a primary ABC of the talus is extremely rare. ABCs are benign, but aggressively growing tumors that usually occur in the first two decades of life. Patients mainly complain of pain, limited movement of the involved joint or a palpable mass. Pain may worsen suddenly because of pathological fractures. If not treated properly, ABC has a risk of local recurrence, followed by the destruction of the joint and a significant functional deficit. While the complete removal of the bone tumor is essential, it is also important to treat the resultant bone defect after removal. The talus has an important part to play in weight-bearing. Therefore, an appropriate bone graft is required for large bone defects that occur after an ABC removal from the talus. We report a primary ABC of the talus in a 28-year-old male that was treated by curettage and a bone pillar pattern graft of autologous tricortical iliac crest bone. The patient had an excellent functional outcome with early weight-bearing, and there was no recurrence at 16 months of follow-up.