• Journal of Chest Surgery
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• v.31 no.5
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• pp.472-480
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• 1998

We reviewed the surgical results of intracardiac lateral tunnel Fontan procedure for the repair of functional single ventricles. Between 1990 and 1996, 104 patients underwent total cavopulmonary anastomosis. Patients' age and body weight averaged 35.9(range 10 to 173) months and 12.8(range 6.5 to 37.8) kg. Preoperative diagnoses included 18 tricuspid atresias and 53 double inlet ventricles with univentricular atrioventricular connection and 33 other complex lesions. Previous palliative operations were performed in 50 of these patients, including 37 systemic to pulmonary artery shunts, 13 pulmonary artery bandings, 15 surgical atrial septectomies, 2 arterial switch procedures, 2 resections of subaortic conus, 2 repairs of total anomalous pulmonary venous connection and 1 Damus-Stansel-Kaye procedure. In 19 patients bidirectional cavopulmonary shunt operation was performed before the Fontan procedure and in 1 patient a Kawashima procedure was required. Preoperative hemodynamics revealed a mean pulmonary artery pressure of 14.6(range 5 to 28) mmHg, a mean pulmonary vascular resistance of 2.2(range 0.4 to 6.9) wood-unit, a mean pulmonary to systemic flow ratio of 0.9(range 0.3 to 3.0), a mean ventricular end-diastolic pressure of 9.0 (range 3.0 to 21.0) mmHg, and a mean arterial oxygen saturation of 76.0(range 45.6 to 88.0)%. The operative procedure consisted of a longitudinal right atriotomy 2cm lateral to the terminal crest up to the right atrial auricle, followed by the creation of a lateral tunnel connecting the orifices of either the superior caval vein or the right atrial auricle to the inferior caval vein, using a Gore-Tex vascular graft with or without a fenestration. Concomitant procedures at the time of Fontan procedure included 22 pulmonary artery angioplasties, 21 atrial septectomies, 4 atrioventricular valve replacements or repairs, 4 corrections of anomalous pulmonary venous connection, and 3 permanent pacemaker implantations. In 31, a fenestration was created, and in 1 an adjustable communication was made in the lateral tunnel pathway. One lateral tunnel conversion was performed in a patient with recurrent intractable tachyarrhythmia 4 years after the initial atriopulmonary connection. Post-extubation hemodynamic data revealed a mean pulmonary artery pressure of 12.7(range 8 to 21) mmHg, a mean ventricular end-diastolic pressure of 7.6(range 4 to 12) mmHg, and a mean room-air arterial oxygen saturation of 89.9(range 68 to 100) %. The follow-up duration was, on average, 27(range 1 to 85) months. Post-Fontan complications included 11 prolonged pleural effusions, 8 arrhythmias, 9 chylothoraces, 5 of damage to the central nervous system, 5 infectious complications, and 4 of acute renal failure. Seven early(6.7%) and 5 late(4.8%) deaths occured. These results proved that the lateral tunnel Fontan procedure provided excellent hemodynamic improvements with acceptable mortality and morbidity for hearts with various types of functional single ventricle.

• Journal of Life Science
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• v.9 no.2
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• pp.136-145
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• 1999

The purpose of this study was to evaluate the effect of organic slovents and noise on hearing loss. We selected organic solvents exposed group of 32 cases, noise exposed group of 31 cases, both noise and solvent exposed group of 31 cases, and control group of 53 cases and studied the relation between exposure level of noise and organic solvents and degree of hearing loss. The results were as follows. The subjects under investigation were exposed to noise and organic solvents under threshold limit values and the amount of urinary hippuric acid excretion were also under biological exposure indices. In case of noise, both noise and organic solvents exposed group and noise exposed group were more exposed than organic solvents exposed group(p<0.05). When urinary hippuric acid excretion were concerned, both noise iud organic solvents exposed group and organic solvents exposed group showed higher values than noise exposed group(p<0.05). In comparison of mean auditory threshold values by frequency, on the air conduction test, both noise and organic solvents exposed group showed significantly higher hearing loss than noise exposed group in 500Hz of right ear, 500 and 2000Hz of left ear(p<0.05). Forty-three cases among 147 subjects were regarded as hearing loss group and average age(42.6years) of hearing loss group was higher than normal groups average age of 38.0 years. Urinary hippuric acid excretions of hearing loss group were significantly higher than normal group(p<0.05). Thirty-eight percent(12cases) of noise exposed group, 40.6 $\%$(13cases) of organic solvents exposed group, 51.6 $\%$(16cases) of both noise and organic solvents exposed group, and 3.8 $\%$(2cases) of unexposed group were regarded as hearing losers. Exposed groups showed higher incidence of hearing loss than unexposed group but there were no significant differences among the exposed groups. The variables showing significant correlation with hearing loss were age and the amount of hippuric acid in urinary excretion. When age were adjusted for the purpose of seeing the effects of hearing losses due to organic solvent, urinary excretion of hippuric acids was the only variable with significant correlation with hearing loss (p<0.05). When odds ratio to hearing loss between control and exposed groups was considered, noise exposed group showed 6.1 times (95 $\%$ CI: 3.3-8.7), organic solvents exposed group showed 7.4 times (95 $\%$ CI: 3.5-14.6) and both noise and organic solvents exposed group showed 17.2 times(95% CI: 5.6-31.8) higher values than unexposed group(p<0.01). Above results suggest that health screening test of hearing loss is also needed in organic solvents exposed workers.

• Clinical and Experimental Pediatrics
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• v.45 no.3
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• pp.339-345
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• 2002

Purpose : The purpose of this study was to evaluate the clinical usefulness of chest high-resolution computed tomography(HRCT) in patients with chronic coughs or persistent wheezing with normal chest X-ray finding. Methods : We reviewed the charts, chest X-rays, and HRCT findings of patients with chronic coughs or persistent wheezing of less than 2 years of age. The records were sourced from the Department of Pediatrics, Inha University Hospital covering the period from July, 1999 to June, 2000. Chronic cough was defined as a cough which was prolonged for more than 3 weeks. Results : The sample consisted of 24 patients(male 15 and female 9, mean age $4.7{\pm}3.8$ months old). Among them, 16 patients showed normal findings(66.7%) and 8 patients showed abnormal (33.3%) in simple chest X-rays. Among 16 patients who had the normal chest X-rays, 13 patients showed abnormal chest HRCT findings(81.3%) such as air space consolidation of the dependent portion(62.5%), bronchiolitis obliterans(12.5%), and bronchopulmonary dysplasia(6.3%). Conclusion : We suggest that the chest HRCT is a useful diagnostic tool in the evaluation of patients with chronic cough or persistent wheezing with normal chest X-ray, especially below 2 years of age.

• Journal of Chest Surgery
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• v.37 no.12
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• pp.983-986
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• 2004

Background: The indications of closed thoracostomy drainage in management of primary spontaneous pneumothorax is well known, but there is no special specification for the size to be inserted. Recently, various minimally invasive operational techniques have been introduced and researched. According to the trend, we tried to ascertain the efficacy of 12 Fr. chest tubes instead of the existing 24 Fr. chest tubes. Material and Method: Patients who were younger than 30 years old and diagnosed as primary spontaneous pneumothorax and treated with closed thoracostomy drainage were enrolled in this study. We retrospectively compared group A who were drained with 24 Fr. chest tubes from January to May 2003 with group B with 12 Fr. chest tubes from November 2003 to April 2004 on procedure time for closed thoracostomy drainage, duration of chest tube drain, duration of hospital stay, complication, and recurrence. Result: The male to female ratio was 16 : 3 in group A and 18 : 2 in group B. The mean age of patients of group A was 21.7$\pm$4.0 and group B was 20.0$\pm$3.7. The mean procedure time for closed thoracostomy drainage in group A (21.6$\pm$2.9 minutes) was significantly longer than group B (10.8$\pm$1.9 minutes)(p < 0.05). The mean duration of chest tube drain was 3.8$\pm$ 1.7 days in group A and 4.3$\pm$2.2 in group B, and the mean duration of hospital stay was 5.6$\pm$1.9 days in group A and 5.2$\pm$1.5 days in group B. There was no complication in both groups and 6 cases in group A (35%) and 5 cases in group B (25%) were operated because of recurrence and persistent air leakage. In conclusion, there was no statistical difference except for the procedure time for closed thoracostomy drainage between two groups. Conclusion: We concluded that there were no significant differences in efficacy between 12 Fr. chest tube and 24 Fr. chest tube in closed thoracostomy drainage for primary spontaneous pneumothorax and we found advantages of 12 Fr. chest tube in shortening procedure time because of easy and simple techniques.

• The Korean Journal of Physiology
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• v.17 no.2
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• pp.93-101
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• 1983

A possibility whether the appearance of adaptation to cold climate during winter could occur or not in Taegu area was evaluated by comparing the data obtained in winter with that obtained by the same method in summer. Circulatory response was induced by the immersion of one hand in the cold water. The systemic and local responses in the blood circulation from the immersed hand and the unimmersed opposite hand were observed simultaneously. In addition Galvanic skin resistance(GSR) that is influenced by the activity of autonomic nervous system and the vascular tonicity was recorded. The experiment was performed by examining sixty healthy college students in winter and fifty in summer, whose mean age was 21.0, mean weight $60.6{\pm}0.90\;kg(male)$ and $48.3{\pm}0.98\;kg(female)$. The cold stimulus was applied by immersing the left hand into the cold water of $5^{\circ}C$ for 3 minutes, and the response was observed on immersed left hand and unimmersed right hand simultaneously. The observation was made through determining mean blood pressure, heart rate, amplitude of photoelectric capillary pulse (APCP) and GSR. The results obtained are as follows: The mean blood pressure was elevated during the cold stimulation. The increase of blood pressure in summer was more remarkable than in winter. At the recovery period the blood pressure was decreased to the control level in winter but the decrease below the control level was observed in summer. The increase of heart rate in summer was more remarkable than in winter during the cold stimulation. At the recovery period heart rate in both winter and summer was decreased below the control level. During the cold stimulation the APCP was decreased on both hands in winter. However it was more prominent on left hand indicating additional direct cold effect on immersed hand. In summer, the decrease of APCP during immersion was less remarkable than that in winter, but the regain of APCP was faster than that in winter at the recovery period. And the prompt increase of APCP over the control level has been obtained at the 3 minutes of the recovery period. The GSR was remarkably increased on immersed hand but slightly decreased on unimmersed opposite hand during the cold stimulation. Thus the finding on immersed hand indicates that the local direct effect of cold water is more prominent than the systemic effect, where as the finding on unimmersed hand indicates that the circulatory response to painful stress elicited by the cold stimulation is more prominent than cold temperature itself. In summary, it seems that the systemic circulatory response to the local cold stimulation of the one hand is arised more from the secondary elicited pain sensation and less from the low water temperature. On the contrary to the report of Kim et $al^{39)}$, the adaptation phenomena in blood pressure to the relatively mild cold climate in winter was not observed in this study. The difference of circulatory response observed in this study between winter and summer may be due to the difference of the magnitude of subjective sensation of the cold water stimulation by the seasonal changes in air temperature.

• Journal of Chest Surgery
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• v.32 no.6
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• pp.556-560
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• 1999

Background: The cause of spontaneous pneumothorax is not yet but it is certain that intrathoracic air comes from ruptured bulla. Video-assisted thoracoscopic surgery(VATS) or open thoracotomy is recommended for thoracic incision in recurrent pneumothorax. However, recurrent rate after bullectomy with the VATS is very high compared to mini-thoracotomy, 3% to 20% and below 2%, respectively. Material and Method: This retrospective analysis was performed on 16 re-operated cases among 446 surgically treated pneumothorax of the 737 cases of spontaneous pneumothorax diagnosed at Yongdong Severance Hospital from Nov. 1992 to June 1997. Result: Among the 446 surgically-treated patients in 737 case of spontaneous pneumothorax, 16 patients underwent re-operation, showing a 3.5% re-operation rate. Male-to-female ratio was 15 to 1 and mean age at initial attack was 20.2 years(ranging from 15 to 50). Mean hospital stay was 6.34 days(ranging from 2 to 20 days) and mean chest tube indwelling period was 4.2 days(ranging from 1-10 days). Median follow-up was 46 months(range 10-66 months). Three different surgical methods were applied : video-assisted thoracoscopic surgery(VAST) in 281 cases, of whom 2 underwent local anesthesia; subaxillary mini-thoracotomy in 159 cases and limited lateral thoracotomy in the remaining 6 cases. Three different re-operative surgical methods were applied ; video-assisted thoracoscopic surgery (VAST) in 6 cases, subaxillary mini-thoracotomy in 9 cases, and limited lateral thoracotomy in the remaining 1 case. The underlying etiological factors of the recurrent pneumothorax after bullectomy were o erlooking type(9) and new growing type(7). Mean recurrent period from previous operation was 1 month for overlooking type and 18 months for new growing type. Conclusion: The underlying etiological factors of recurrent pneumothorax lead to re-operation were new-growing and over-looking type. We need additional treatments besides resecting blebs of prevent the recurrence rate and more gentle handling with forceps due to less damage to the pleura.

• Journal of Chest Surgery
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• v.43 no.5
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• pp.513-517
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• 2010

Background: Diaphragmatic plication through a thoracoscopic approach has been an effective modality to treat diaphragmatic enventration. However, the conventional technique for thoracoscopic plication has some disadvantages. We have developed an improved and simplified technique with utilizing the head up position, $CO_2$ insufflation and figure-of-eight sutures. Material and Method: Between October 2005 and September 2009, 9 patients with diaphragmatic paralysis underwent repair using our modified technique. The mean patient age was $38.5{\pm}53.0$ years (range: 2~76 years). Result: The mean operation time was $46.7{\pm}15.9$ min (range: 30~85 min). None of the patients died due to this procedure, but there was one case of prolonged air leakage, and a case of re-expansion pulmonary edema, which required 3 days of ventilator support after the procedure. The mean hospital stay was $6.22{\pm}2.04$ days (range: 4~11 days). The mean follow-up duration was $27.2{\pm}11.6$ months (range: 2~43 months). All the patients had their symptoms relieved and there was no recurrence of eventration except for one patient who developed more than 2 cm elevation of the diaphragm compared to the immediate post-operation status. Conclusion: With our technique, thoracoscopic diaphragmatic plication was feasible via using only three 5 mm ports and without a working window and the midterm results were favorable. Therefore, we advocate thoracoscopic diaphragmatic plication as a preferred technique to the conventional open plication technique.

• Journal of Chest Surgery
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• v.37 no.5
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• pp.438-443
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• 2004

Background : The treatment strategy for urinary spontaneous pneumothorax has progressively changed with the introduction of video-assisted thoracic surgery (VATS). Recently, we modified the strategy of primary spontaneous pneumothorax. If the patient had mild dyspnea and the lung was minimally collapsed, 2 mm thoracoscopic examination was performed. If no blob or bullae was inspected, the intrathoracic air was evacuated through the 2 mm thoracoscopic troca without closed thoracostomy, and if the blob and bullae was noted, the 10 mm thoracoscopic bullecotomy was carried out immediately and also application of fibrin glue was substituted for pleural abrasion. We compared the clinical outcomes of modified treatment strategy with conventional strategy in primary spontaneous pneumothorax. Material and Method: Patients were divided into four groups. Group I (n=21) underwent 2 mm thoracoscopic examination. Group II (n=68) underwent closed thoracostomy. Group III (n=56) underwent VATS and application of fibrin glue. Group IV (n=87) underwent VATS and pleural abrasion. The duration of chest tube drainage, the duration of hospitalization and the recurrence rate were compared between group I and group II and between group III and group IV. Result: Mean age, sex, location of pneumothorax were not different in all groups. In group I, the blob or bullae were existed in 12 patients, In remaining 9 patients, the bleb or bullae was not inspected. The mean duration of hospitalization in 9 patients were 2.4 $\pm$1.0 day and in group II were 3.9$\pm$2.1 day (p=0.014). There was 1 case of recurrence among the 9 patients in group I and 26 recurrences in group II (p=0.149). The mean duration of chest tube drainage were not difference in group III and IV (group III: 2.8$\pm$1.8 day, group IV: 3.0$\pm$2.5 day). The mean duration of hospitalization was shorter in group III than group IV (group III: 5,6$\pm$2.7 day, group IV: 1.3$\pm$3.3 day)(p=0.002). There was no recurrence in group III and 7 recurrences in group IV (p=0.043). Conclusion: Our modified treatment strategy of primary spontaneous peumothorax was effective in short hospital course and low recurrence rate.

• Journal of Chest Surgery
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• v.43 no.4
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• pp.404-408
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• 2010

Background: Pleural symphysis is regarded as an important treatment option in reducing recurrence rates after surgical treatment of spontaneous pneumothorax. However, there is much debate over the best method for achieving pleural symphysis. We retrospectively compared apical pleurectomy (AP) with mechanical pleural abrasion (MPA). Material and Method: Between January 2000 and December 2007, 83 patients underwent video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax. In addition to wedge resection of bullae, MPA was performed in 21 patients (group A) and AP in 62 patients (group B). Result: There were no significant differences in age, gender and site of pneumothorax between the two groups. Operative time was $97{\pm}44$ minutes in group A and $77{\pm}18$ minutes in group B (p>0.05). The mean amount of pleural drainage through the chest tube on the first postoperative day was $156{\pm}87 cc$ in group A and $147{\pm}87 cc$ in group B (p>0.05). There was no mortality or significant morbidity in all patients with the exception of reoperation for bleeding in two patients in group B. In the postoperative course, there were no statistical differences between the two groups in the rate of residual air space, air leak and indwelling time of chest tube, and hospital stay. Mean follow up time was $31.7{\pm}25.3$ months, and the recurrence rate of pneumothorax was 9.5% (2/21) in group A and 6.5% (4/62) in group B, without statistical significance. Conclusion: AP was no more advantageous than MPA in terms of operative time, postoperative course and prevention of recurrent pneumothorax. Therefore, complete resection of bullae and existence of residual bullae are more important factors in reducing the incidence of recurrent pneumothorax than pleural symphysis.

• Journal of radiological science and technology
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• v.28 no.4
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• pp.293-299
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• 2005

In the present investigation, we analyzed the data of 1,318 patients (2,636 images) who underwent mammographic examinations and obtained the distribution of the patient age and compressed breast thickness. We measured also average glandular doses (AGD) as function of compressed breast thickness. In order to obtain the values of AGD, we measured half value layer (HVL) and tube output (mR/mAs) for each kVp and target/filter combination. Entrance surface air kerma (ESAK) was calculated from the tube output as measured for each voltage used under clinical conditions and from the tube loading (mAs). AGD per exposure were calculated by multiplying the ESAK values by the conversion factors tabulated by Dance. We obtained in this study the following conclusions. The mean value of compressed breast thickness for cranio-caudal (CC) view was 35.8mm and that for medio-lateral oblique (MLO) view was 43.3 mm. The mean value of AGD for CC view was 1.55 mGy and that for MLO view was 1.70 mGy. The AGD for MLO view was 0.15 mGy (10%) higher than that for CC view because the thickness for MLO view was on average 4.8 mm higher than that for CC view. The values of AGD increased with increasing compressed brest thickness. The increased AGD value was on average 0.34 mGy per 10 mm in the thickness ranges $10{\sim}80\;mm$, therefore differences between the AGD values of each thickness were relative large. Thus, it is considered to need limited doses for mammography with the upper end of exposure range at several different compressed brest thickness.