• Journal of Chest Surgery
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• v.33 no.1
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• pp.38-44
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• 2000

Background: We analyzed the result of the "Off-Pump" Coronary Artery Bypass grafting (OPCAB) performed to minimize inflammatory responses to cardiopulmonary bypass and myocardial ischemia during the aortic cross-clamp period. Material and Method : The preoperative diagnosis operative procedure mortality complication and postoperative course of the 50 patients who underwent OPCAB between January 1998 and September 1998 were analyzed. There were 34 males and 16 females with mean age of 60$\pm$9 years. Preoperative clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and postinfarction angina in 3(6%) patients. Preoperative angiographic diagnoses were three-vessel disease in 25(50%) two-vessel disease in 5(10%) one-vessel disease in 7(14%) and left main disease in 13(26%) patients. There were elective operation in 37 cases and urgent operation in 13 cases. Result: The mean number of grafts was 3.2$\pm$1.2 per patient. Grafts used were unilateral internal thoracic artery in 43 greater saphenous vein in 37 radial artery in 7 bilateral internal thoracic arteries in 4 and right gastroepiploic artery in 2 cases Forty sequential anastomoses were performed in 18 cases. Vessels accessed were left anterior descending artery in 48 diagonal branch in 41 obtuse marginal branch in 30 right coronary artery in 24 posterior descending artery in 9 ramus intermedius in 5 and posterolateral branch in 5 anastomoses. Predischarge coronary angiography performed in 44 patients demonstrated the patency rate of 89.5%(128/143) Operative mortality was 2%(1/150) Postoperative complications were arrhythmia in 5 graft occlusion that needed reoperation in 4. perioperative myocardial infarction in 2 femoral artery thromboembolism developed after the application of IABP in 1 postoperative transient delirium in 1 peripheral compression neuropathy in 1 case. Sixteen patients(32%) were extubated at the operating room and the other patients were extubated at the mean 13$\pm$20 hours after the operation. Mean duration of stay in intensive care unit was 49$\pm$46 hours. Thirteen patients(26%) required blood transfusions perioperatively and the amount of perioperative blood transfusion was mean 0.70$\pm$1.36 pack/patient. Conclusion: OPCAB is suggested to be the ideal technique with less postoperative complication less hospitalization time and less cost.less cost.

• Journal of the korean academy of Pediatric Dentistry
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• v.45 no.2
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• pp.179-184
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• 2018

Resin infiltration has been used as a treatment option for the management of early caries lesions recently. However, the etching procedure with hydrochloric acid might be somewhat stressful for the clinicians due to safety problem especially for young children, leading to less utility. This study aims at searching for some alternative surface pretreatment methods of resin infiltration for the early caries lesions in primary anterior teeth by comparing penetration depth of various methods. No significant difference was found in penetration ratio between etched surface with 15% hydrochloric acid and 35% phosphoric acid. However, the penetration ratio was significantly higher in groups pretreated either with dental pumice or abrasive metal strip (p < .05). By the result of this study, etching with phosphoric acid as an alternative of hydrochloric acid was thought clinically acceptable as a pretreatment method for resin infiltration in early caries lesions for primary anterior teeth. It was notable that surface conditioning with dental pumice or metal strip before etching was effective in increasing the penetration. This procedural modification might be much more correspondent with minimally invasive concept and hopefully contribute to increased safety and utility in pediatric dentistry.

• Journal of Biomedical Engineering Research
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• v.23 no.6
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• pp.451-458
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• 2002

Osteoporosis is a systemic skeletal disease caused by low bone mass and the decrease of bone density in the microstructure of trabecular bone. Drug therapy(PTH Parathyroid hormone) may increase the trabecular thickness and thus bone strength. Vertebroplasty is a minimally invasive surgery foy the treatment of osteoporotic vertebral compression fracture. This Procedure includes Puncturing vertebrae and filling with Polymethylmethacrylate(PMMA). Although altering recommended monomer-to-Powder ratio affects material properties of bone cement, clinicians commonly alter the mixture ratio to decrease viscosity and increase the working time. The Purposes of this study were to analyze the effect of 4he monomer-to-powder ratio on the mechanical characteristics of trabecular. In this paper, the finite element model of human vertebral trabecualr bone was developed by modified Voronoi diagram, to analyze the relative effect of hormone therapy and vertebroplasty at the treatment of osteoporotic vertebrae. Trabeuclar bone models for vertebroplasty with varied monomer-to-Powder ratio(0.40∼1.07 ㎖/g) were analyzed. Effective modulus and strength of bone cement-treated models were approximately 60% of those of intact models and these are almost twice the values of hormone-treated models. The bone cement models with the ratio of 0.53㎖/g have the maximum modulus and strength. For the ratio of 1.07㎖/g, the modulus and strength were minimum(42% and 49% respectively) but these were greater than those for drug therapy. This study shows that bone cement treatment is more effective than drug therapy. It is found that in vertebroplasty, using a monomer-to-powder ratio different from that recommended by manufacturer nay significantly not only reduce the cement's material Properties but also deteriorate the mechanical characteristics of osteoporotic vertebrae.

• Journal of Chest Surgery
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• v.35 no.2
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• pp.144-148
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• 2002

The present study was done to determine the efficacy and safety of varicose vein removal using a minimally invasive, powered vein-extracting device with cutaneous transillumination and tumescent anesthesia techniques and then compared this to a retrospective group of conventional phlebectomy operations. There were 133 limbs in 104 patients(72 women, 32 men) treated with the use of the vein extractor aided by transcutaneous illumination. The hydrodissection was performed with Trivex™ Irrigated illuminator(Smith & Nephe $w^{ R}$) system using normal saline after the 2~3mm sized skin incision. Varicose clusters were extracted by the use of TriveTM esector(Smith & Nephe $w^{ R}$) system under transillumination. After the varisoce vein extraction, the operation area was compressed with surgical pad for bleeding control. The complication rate was 3.84% The mean number of incisions was 3.24 and mean operative time per limb was 65.9 minutes. The mean hospitalization was 1.86 days. The varicose vein extraction using transilluminated powered phlebectomy(TIPP) is a safe, efficacious and cosmetically satisfactory method. The procedure decreases the operating time and the number of incisions required to remove varicose clusters. Further evaluation and long term follow up will be necessary to determine the recurrence rate and long termcomplications.to determine the recurrence rate and long termcomplications.

• Journal of Chest Surgery
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• v.31 no.5
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• pp.519-524
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• 1998

From January 1996 to December 1996, we performed 137 thoracic sympathetic ganglionectomies with VATs for primary hyperhidrosis in the department of thoracic and cardiovascular surgery at Anam hospital, Korea university medical center. There were 83 men and 54 women whose ages ranged from 13 to 63 years old(mean age: 25years). Of these patients, 128 patients had complained of palmar hyperhidrosis and 26 of facial hyperhidrosis. Thoracoscopic sympathetic ganglionectomies procedures included lower 1/3 Stellate ganglionectomies in 4 patients; lower 1/3 Stellate ganglionectomies and T2-sympathetic ganglionectomies in 18 patients; T2-sympathetic ganglionectomies in 86 patients; T2 and T3 sympathetic ganglionectomies in 10 patients; and T2, T3 and T4 sympathetic ganglionectomies in 19 patients. The mean operating time was 59 minutes(range: 25 to 162 minutes), and the mean hospital stay was 3.8 days(range: 2 to 8 days). Common complications were compensatory hyperhidrosis(109 patients) and causalgia(18 patients). At the end of the follow-up period(mean: 8 months) ninety-seven percent of the patients reported satisfactory results. Thoracic sympathetic ganglionectomy with VATs is an efficient, safe, and minimally invasive surgical procedure for primary hyperhidrosis.

• Journal of Chest Surgery
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• v.31 no.4
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• pp.374-379
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• 1998

From March 1985 to June 1997, 451 patients of spontaneous pneumothorax treated at Kangbuk Samsung Hospital were reviewed retrospectively. Most of the patients were male (male to female ratio, 8.2:1). The mean age of the primary spontaneous pneumothorax (PSP) was 26.8 years, and that of secondary spontaneous pneumothorax(SSP) was 53.1 years. 330 out of 451 patients(73%) were PSP. The causes of the SSP were mostly pulmonary tuberculosis and COPD: 87 patients(72%), and 24 patients(19.2%), respectively. All the patient were treated by one of the following modalities: 1)rest and oxygen therapy in 42 patients, 2) closed thoracostomy in 208 patients, 3) thoracotomy in 156 patients, 4) VATS bullectomy in 45 patients. The mean duration of postoperative chest tube drainage was as following: thoracotomy 8.3 days, VATS bullectomy 4.7 days. For recent 3 consecutive years, VATS bullectomy has become the more frequently applied operative procedure than thoracotomy in the treatment of surgically indicated PSP, from 33% in 1994 to 78% in 1996. With the minimally invasive thoracoscopic surgery being more prevalent, VATS bullectomy will be able to be the 1st choice of treatment not only for the recurrent pneumothoracies but also for the some selected cases of the 1st episode pneumothoracies. To verify this approach as clinically acceptable one in terms of cost-effectiveness, recurrence rate, etc, a large scale of multi-institutional clinical study will be needed in a sooner time.

• Clinics in Orthopedic Surgery
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• v.10 no.4
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• pp.439-447
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• 2018

Background: Since open Wiltse approach allows limited visualization for foraminal stenosis leading to an incomplete decompression, we report the short-term clinical and radiological results of unilateral biportal endoscopic foraminal decompression using $0^{\circ}$ or $30^{\circ}$ endoscopy with better visualization. Methods: We examined 31 patients that underwent surgery for neurological symptoms due to lumbar foraminal stenosis which was refractory to 6 weeks of conservative treatment. All 31 patients underwent unilateral biportal endoscopic far-lateral decompression (UBEFLD). One portal was used for viewing purpose, and the other was for surgical instruments. Unilateral foraminotomy was performed under guidance of $0^{\circ}$ or $30^{\circ}$ endoscopy. Clinical outcomes were analyzed using the modified Macnab criteria, Oswestry disability index, and visual analogue scale. Plain radiographs obtained preoperatively and 1 year postoperatively were compared to analyze the intervertebral angle (IVA), dynamic IVA, percentage of slip, dynamic percentage of slip (gap between the percentage of slip on flexion and extension views), slip angle, disc height index (DHI), and foraminal height index (FHI). Results: The IVA significantly increased from $6.24^{\circ}{\pm}4.27^{\circ}$ to $6.96^{\circ}{\pm}3.58^{\circ}$ at 1 year postoperatively (p = 0.306). The dynamic IVA slightly decreased from $6.27^{\circ}{\pm}3.12^{\circ}$ to $6.04^{\circ}{\pm}2.41^{\circ}$, but the difference was not statistically significant (p = 0.375). The percentage of slip was $3.41%{\pm}5.24%$ preoperatively and $6.01%{\pm}1.43%$ at 1-year follow-up (p = 0.227), showing no significant difference. The preoperative dynamic percentage of slip was $2.90%{\pm}3.37%$; at 1 year postoperatively, it was $3.13%{\pm}4.11%$ (p = 0.720), showing no significant difference. The DHI changed from $34.78%{\pm}9.54%$ preoperatively to $35.05%{\pm}8.83%$ postoperatively, which was not statistically significant (p = 0.837). In addition, the FHI slightly decreased from $55.15%{\pm}9.45%$ preoperatively to $54.56%{\pm}9.86%$ postoperatively, but the results were not statistically significant (p = 0.705). Conclusions: UBEFLD using endoscopy showed a satisfactory clinical outcome after 1-year follow-up and did not induce postoperative segmental spinal instability. It could be a feasible alternative to conventional open decompression or fusion surgery for lumbar foraminal stenosis.

• Journal of Korean Foot and Ankle Society
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• v.25 no.4
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• pp.157-164
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• 2021

Purpose: This study aimed to report the current trends in the management of the hallux valgus (HV) deformity over the last few decades through a survey of the Korean Foot and Ankle Society (KFAS) members. Materials and Methods: A web-based questionnaire containing 34 questions was sent to all KFAS members in September 2021. The questions were mainly related to the preferred techniques and clinical experience in correction in patients with an HV deformity. Answers with a prevalence of ≥50% of respondents were considered a tendency. Results: One hundred and nine (19.8%) of the 550 members responded to the survey. The most common symptom for determining surgical treatment was bunion pain (68.8%), and different surgical techniques were selected according to the following radiological parameters: HV angle 30 to 40 degrees and intermetatarsal angle 15 to 20 degrees. The two procedures most preferred by the respondents were distal chevron osteotomy (55.0%), and proximal chevron osteotomy (21.1%). In an average of 71.6% of respondents, Arkin osteotomy was performed simultaneously during HV surgery. HV accompanied by an overriding deformity of the second toe was most often addressed with a combination of second metatarsal osteotomy and soft tissue rebalancing procedure (35.8%). After HV surgery, the recurrence rate of HV deformity was found to be 12.2% on average and the surgeons who had performed minimally invasive surgery (MIS) for HV comprised 34.9% of the total respondents. Conclusion: This study provides updated information on the current trends in the management of the HV deformity in Korea. Both consensus and variation in the approach to patients with HV were identified by this survey study. Although MIS for HV has increased, it appears the consensus for selecting this method has not yet been established.

• 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.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.434-440
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• 2009

Background: Surgical closure of a patent ductus arteriosus (PDA) can be considered when conservative medical treatment is ineffective or contraindicated. Low weight and earlier gestational age neonates who are treated with conservative medical therapy generally showed a higher failure rate. The morbidity of surgical PDA closure in such extremely low birth weight (ELBW) neonates is also high. Here we present the early results of a new technique for approaching the PDA through a dorsal minithoracotomy. Material and Method: From March 2006 to November 2008, 24 premature neonates underwent surgical PDA closure. The procedures were performed in the newborn intensive care unit via a 2 cm long dorsal minithoracotomy with the baby in the prone position with the left hemithorax elevated 30$^{\circ}$. Bimanual cotton swab blunt dissection completed the extrapleural accesstothe PDA and then two clips were applied. Tube thoracostomy was avoided if there was no meaningful pleural laceration. Result: The infants mean gestational age was 26.5$\pm$2.1 weeks (range: 23 to 30 weeks) and the average age at operation was 11$\pm$11 days. The mean body weight at operation was 933$\pm$271 grams (range: 570 to 1,700 grams). Eight patients expired, but there was no procedure-related death. Postoperative echocardiography revealed two cases of residual shunt but none of these shunts were detected on the follow up echocardiogram that was performed on the post operative 5 and 59 days. Conclusion: We concluded that the technique described here is an effective procedure in view of the satisfactory operative exposure and the low rate of complications.