• Journal of Chest Surgery
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• v.37 no.4
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• pp.356-363
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• 2004

Esophageal cancer is an aggressive disease with a poor prognosis. Recently, every effort has been made to improve the long term survival, but the general prognosis for patients with this disease remains poor. In this study, we reviewed 8 years of experiences with esophageal cancer patients managed in our department at Dong-A University Hospital and evaluated the effectiveness of cervical lymph node dissection performed selectively. Material and Method: From January 1995 to August 2003, 70 patients underwent esophagectomy for esophageal cancer in our department. Among them, 51 patients who underwent curative resection, had no double primary tumors and no neoadjuvant therapy were analyzed retrospectively. In most patients, intrathoracic esophagectomy and cervical esophago-gastrostomy was performed. Since 1997, 3-field lymph node dissection was performed selectively. Result: There were 46 men and 15 women. The median age was 60 years. The tumor was located in the upper third part in 10 patients (19%), middle third in 21 (41%), and lower third in 20 (40%). Majority of the patients (90%) had squamous cell carcinoma. Cervical anastomosis was made in 41 patients, and intrathoracic anastomosis in 10. 2-field lymph node dissection was done in 40 patients, and 3-field lymph node dissection in 11. The pathologic staging were as follows: stage I in 9 patients (17.6%), IIA in 20 (39.2%), IIIB in 7 (13.7%), III in 11 (21.6%), IVA in 2 (3.9%), and IVB in 2 (3.9%). The in-hospital mortality was 3.9% (2 patients) and complications occurred in 24 patients (47%). Overall actuarial 1, 3, and 5-year survival rates were 74.4%, 48.4%, and 48.4% including operative mortality. The 4-year survival rate did not differ significantly between 3-field lymph node dissection group (50.5%) and 2-field lymph node dissection group (48.9%). In 3-field lymph node dissection group, the respiratory complications were more frequent and operative time was significantly longer. Conclusion: We think that curative resection for esophageal cancer can be performed with acceptable mortality, and aggressive surgical approach may improve the long term survival. even for advanced stages. Effectiveness of 3-field lymph node dissection needs further investigations.

• Journal of Gastric Cancer
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• v.5 no.4 s.20
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• pp.217-221
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• 2005

Purpose: The incidence of gastric neoplasms is increasing in the elderly population, and a rational method of treatment for gastric cancer in the elderly is needed to improve survival. The purpose of the present study was to clarify whether the patient's age is an independent prognostic factor and to determine clinicopathological characteristics in the elderly. Material and Methods: Curative or palliative surgery for gastric cancer was carried out on 706 patients in Chosun University Hospital from March 1995 to February 2002. They were divided into the following two groups: elderly group (75 years or older) and control group (under 74 years old). The clinicopathologic features of these patients were reviewed retrospectively, and a multivariate analysis was performed. Results: There was no difference in clinicopathological appearances between the two groups, and the postoperative morbidity and mortality rates were similar in the two groups. The two groups showed similar survival rates. Conclusion: In this study, age was not a prognostic factor in surgery for gastric cancer. In the elderly, an oncologically correct surgical procedure can safely be prosecuted with satisfactory early and late results.

• Journal of Chest Surgery
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• v.56 no.1
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• pp.25-32
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• 2023

Background: We reviewed the clinical outcomes of patients with oligometastatic (OM) non-small cell lung cancer (NSCLC) who received multimodal therapy including lung surgery. Methods: We retrospectively analyzed 117 patients with OM NSCLC who underwent complete resection of the primary tumor from 2014 to 2017. Results: The median follow-up duration was 2.91 years (95% confidence interval, 1.48-5.84 years). The patients included 73 men (62.4%), and 76 patients (64.9%) were under the age of 65 years. Based on histology, 97 adenocarcinomas and 14 squamous cell carcinomas were included. Biomarker analysis revealed that 53 patients tested positive for epidermal growth factor receptor, anaplastic lymphoma kinase, or ROS1 mutations, while 36 patients tested negative. Metastases were detected in the brain in 74 patients, the adrenal glands in 12 patients, bone in 5 patients, vertebrae in 4 patients, and other locations in 12 patients. Radiation therapy for organ metastasis was performed in 81 patients and surgical resection in 27 patients. The 1-year overall survival (OS) rate in these patients was 82.8%, and the 3- and 5-year OS rates were 52.6% and 37.2%, respectively. Patients with positive biomarker test results had 1-, 3-, and 5-year OS rates of 98%, 64%, and 42.7%, respectively. These patients had better OS than those with negative biomarker test results (p=0.031). Patients aged ≤65 years and those with pT1-2 cancers also showed better survival (both p=0.008). Conclusion: Surgical resection of primary lung cancer is a viable treatment option for selected patients with OM NSCLC in the context of multimodal therapy.

• Journal of Korean Neurosurgical Society
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• v.29 no.11
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• pp.1437-1444
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• 2000

Objectives : Traditionally intracranial meningiomas are regarded as benign and curable tumors. About half of all intracranial meningiomas locate in the skull base region. However, surgical removal of these tumors may be challenging and require special considerations. Here general aspects of skull base meningiomas including clinical presentation, surgical approaches, complications and their recurrence rate are discussed based on our experiences. Methods : A retrospective analysis of 61 consecutive patients with skull base meningioma among 210 patients of meningioma between 1989 and 1998 were done. Results : There were 41 women and 20 men ranging from 13 to 74 years(mean 52 years). These tumors were divided into seven categories according to location : olfactory groove(n＝9), sphenoid ridge(n＝16), cavernous sinus(n ＝2), tuberculum sellae(n＝8), tentorium(n＝13), cerebellopontine angle(n＝12), and foramen magnum meningiomas (n＝1). Surgical approaches were selected on the basis of the tumor attachment, size and extension on preoperative radiologic findings. Total removal(Simpson grade I and II) was achieved in 50 cases(82%), and subtotal removal (Simpson grade III) in 11 patients(18%). According to WHO classification, there were 52 of cases of benign meningioma( 86%), 6 atypical cases(10%), and 3 malignant cases(5%). The most common postoperative complications were CSF leakage(23.0%) and cranial nerve injury(8.2%). Three patient died related with tumor(one was due to surgical complication and the other two due to recurrence) but three patients died from other systemic causes. Mean follow-up period was 51.7 months after surgery. Recurrence occurred in six patients(10.9%) ; three with tentorial meningioma, two with sphenoid ridge, and one in cerebellopontine angle. Conclusion : With advances in neuroradiology and microsurgical techniques, the surgical outcome of miningiomas has been markedly improved with acceptable morbidity and mortality rates. Overall, our surgical results of skull base meningiomas is comparable to other reports. Therefore, with the appropriate operative strategy and techniques, these tumors can be completely removed and good surgical results can be expected.

• Journal of Chest Surgery
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• v.39 no.6 s.263
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• pp.434-439
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• 2006

Background: Deep hypothermic circulatory arrest during repair of aortic arch anomalies may induce neurological complications or myocardial injury. So we surveyed if the regional cerebral and myocardial perfusion might eliminate those potential side effects. Material and Method: From March 2000 to December 2004, 62 neonates or infants with aortic arch anomaly underwent one stage biventricular repair using the regional perfusion technique by single surgeon. Preoperative diagnosis of the arch anomaly consisted of coarctation (n=46), interruption of the aorta (n=12), hypoplastic left heart syndrome (n=2) and truncus areteriosus (n=2). Combined anomalies were ventricular septal defect (n=51), TAPVR (n=1), PAPVR (n=1) and atrioventricular septal defect (n=2). Arterial cannula was inserted at the innominate artery. Result: The mean regional perfusion time of brain was $28{\pm}10min$. Operative mortality rates was 0 (0/62). Late death was 1 (1/62) during $11{\pm}7$ months of follow-up. Neurologic complications consisted of transient chorea in 1 case. There was no reoperation associated with arch anolamy. Pulmonary complication associated with arch repair occurred in f case which was managed by aortopexy. Conclusion: One-tage rch repair using the regional profusion is safe and effective in minimizing the neurologic and myocardial complications.

• Journal of Chest Surgery
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• v.41 no.2
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• pp.239-246
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• 2008

Background: Aortic surgery for high risk patients has high mortality and morbidity rates, and the necessity of performing aortic surgery in cancer patients is questionable because of their short life expectancy. Endovascular repair of aneurysm repair can be considered for high risk patients and cancer patients because it has relatively lower invasiveness and shorter recovery times than aortic surgery does. Especially, percutaneous endovascular stent graft treatment is more useful for high risk patients because it does not require general anesthesia. Material and Method: From July 2003 to September 2007, twelve patients who had inoperable malignancy or who had a high risk of complication because of their combined diseases during aortic surgery underwent endovascular aortic aneurysm repair. he indications for endovascular repair were abdominal aortic aneurysm in 5 patients, descending thoracic aortic aneurysm in 6 patients and acute type B aortic dissection in one patient. The underlying combined disease of these patients were malignancy in 3 patients, respiratory disease in 6 patients, old age with neurologic disease in 6 patients, Behcet's iseae in one patient and chronic renal failure in one patient. Result: Stent grafts were inserted percutaneously in all cases. There were 4 hospital deaths and there were 3 delayed deaths during the follow-up periods. There were no deaths from aortic disease, except one hospital death. There were several complications: a mild cerebrovascular accident occurred in one patient, acute renal failure occurred in 2 patients and ischemic bowel necrosis occurred in one patient. Mild type I endoleak was observed in 2 patients and type II endoleak was observed in a patient after stent graft implantation. Newly developed type I endoleak was observed in a patient during the follow-up period. Conclusion: Percutaneous endovascular stent graft insertion is relatively safe procedure for high risk patients and cancer patients. Yet it seems that its indications and its long term results need to be further researched.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.16 no.12
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• pp.8728-8737
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• 2015

The purpose of this study compared the clinical features of suicidal attempters who visit in the past and present of an emergency medical center, used as a basic data for clinical severity and suicide prevention research of future patients. The author conducted a retrospective analysis of the changed characteristics of suicidal attempters who visit an emergency medical center of Wonkwang University Hospital between from January $1^{st}$, 1998 to December $31^{th}$, 1998 and from August $1^{st}$, 2013 to July $31^{th}$, 2015. Factors related to increased occurrence was changed from male(1.1:1) in 1998 to female(1.3:1) in 2013-2015, from age of $2^{nd}$, $3^{rd}$, and above $6^{th}$ decade in 1998 to $3^{rd}-5^{th}$ decade in 2013-2015. Poisoning was the most common method of suicidal attempt(90.8%;1998, 72.7%;2013-2015), Mortality rate was changed from 16.9%(male 23.1%, female 10.0%) in 1998 to 13.8%(male 18.1%, female 10.5%) in 2013-2015. Among the suicidal attempters(total=516), 37 patients has recurred. But consultant of neuropsychiatric department was 48.3%, All suicidal attempters in future were necessarily neuropsychiatric consultant and continuously follow-up because all patients had recurrent suicide attempt, psychologic disorder, suicide rates are higher than in the general population.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.2
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• pp.235-239
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• 2019

High-grade liver injury is associated with high morbidity and mortality rates. We report successful emergency angioembolization and early interventional radiology support to manage a high-grade liver injury in a 29-year-old man who presented following a fall during parachute training. Upon arrival, his blood pressure was 80/40 mmHg, and emergency ultrasonography showed a liver injury with perihepatic fluid collection. The patient's blood pressure reduced to 60/40 mmHg, and emergency angiography was performed without computed tomography (CT) (door to puncture time 36 min). After angioembolization, his blood pressure returned to 120/77 mmHg. Subsequent CT revealed no additional bleeding or hollow viscus injury. He was admitted to the Intensive Care Unit and discharged without complications 30 days after admission. In this case, emergency angioembolization (without performing CT) could successfully and safely treat a hemodynamically unstable patient with a high-grade liver injury.

• Tuberculosis and Respiratory Diseases
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• v.61 no.1
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• pp.46-53
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• 2006

Background: Intra-abdominal hypertension (IAH) is defined as the presence of either an intra-abdominal pressure (IAP) ${\geq}12mmHg$ or an abdominal perfusion pressure (APP = mean arterial pressure - IAP) ${\leq}60mmHg$. Abdominal compartment syndrome (ACS) is defined as the presence of an IAP ${\geq}20mmHg$ together with organ failure. The purpose of this study was to investigate the prevalence of IAH and ACS on the day of admission and the effects of these maladies on the prognosis of critically ill patients in the ICU. Methods: At the day of admission to the ICU, the IAP was recorded by measuring the intravesicular pressure via a Foley catheter. The APACHE II and III scores were checked and SAPS II was also scored during the days the patients were in the ICU. The primary end point was the prevalence of IAH and ACS at the day of admission and the correlation between them with the 28-days mortality rate. The measurement of IAP continued until the 7th day or the day when the patient was transferred to the general ward before 7th day, unless the patient died or a Foley catheter was removed before 7th day. Patients were observed until death or the 28th day. Results: A total of 111 patients were enrolled. At the day of admission, the prevalence of IAH and ACS were 47.7% and 15.3%, respectively and the mean IAP was $15.1{\pm}8.5mmHg$. The rates of IAH for the survivor and the non-survivor groups were 56.5% and 71.4%, respectively, and these were not significantly different (p=0.593). Yet the rates of ACS between these two groups were significantly different (4/62, 6.5% vs. 13/49, 26.5%; Odds Ratio = 5.24, 95% CI = 1.58-17.30, p=0.004). Conclusion: In the present study, the prevalence of IAH was 47.7% and the prevalence of ACS was 15.3% on the day of admission. ACS was associated with a poor outcome for the critically ill patients in the ICU.

• Journal of Chest Surgery
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• v.42 no.6
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• pp.732-737
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• 2009

Background: Many video-assisted thoracic surgery (VATS) lobectomies are performed as a potential alternative to thoracotomy despite the controversy about the safety and the associated morbidity/mortality rates. Material and Method: Between November 2006 and August 2008, we performed 87 lobectomies (VATS 36, Thoracotomy 51) and we retrospectively reviewed the surgical treatment results. A VATS lobectomy was performed by a 4~5 cm thoracotomy without rib spreading and this included anatomic hilar dissection, individual vessel and bronchus stapling and lymph node dissection. Result: We studied 52 male and 35 female patients whose age ranged from 6 to 79 (average age: $59.8{\pm}15.0$ years). The cases were diagnosed with lung cancer (66) (SQC 24, ADC 38, others 4), pulmonary metastasis (2), carcinoid (2) and benign diseases (17). There was no intraoperative death. Postoperative complications were seen in 5 (15.6%) VATS and 33 (64.7%) thoracotomies, and perioperative death caused by adult respiratory distress syndrome occurred in 1 (2.8%) VATS and 3 (5.9%) thoracotomies. Three patients Underwent conversion to thoracotomy (8.3%). The mean time to chest tube removal was 6 days for VATS and 9.4 days for thoracotomy (p<0.001), and the mean length of the hospital stay was 8 days for VATS and 12.8 days for thoracotomy (p<0.001). Conclusion: VATS lobectomy can be performed safely with low morbidity/mortality rates. Furthermore, all the patients benefited from earlier postoperative rehabilitation and less pain and they were candidates for an earlier return to normal activities.