• Journal of Chest Surgery
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• 제14권1호
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• pp.17-25
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• 1981

In 1980, 416 cases of open heart surgery were done in this Department with over all operative mortality of 12.3%. 1. There were 288 congenital anomalies consisting of 174 acyanotic and 114 cyanotic varieties, which showed operative mortality of 6.9% and 25.4% respectively. 2. There were 128 cases of acquired lesions, 124 valvular disease and 3 myxoma being the main lesions. 3. There were 128 cases of valve replacement with operative mortality of 7.8%. 4. The most frequently operated anomaly was VSD, 90 pure VSD and 21 cases were associated with one or 2 cardiac anomalies. Over all operative mortality in 111 VSD cases was 8.1% but in 90 pure VSD cases it was 6.7%. 5. Tetralogy of Fallot showed the highest incidence in cyanotic group with 88 cases, consisting of 68 pure and 20 with other cardiac anomalies. Over all mortality in 88 cases was 19.3% but in pure form 16.2%. 6. In 128 valve replacement cases over all mortality was 9.4%. There were 85 mitral, 11 aortic, 2 tricuspid, 21 mitral with aortic, 6 mitral with tricuspid, 3 mitral, aortic, and tricuspid valve replacement cases. For mitral valve replacement operative mortality was 5.9%. 7. Twenty-one cases of babies under 10kg body weight were operated on with over all operative mortality of 28.6%. Sixteen cases of VSD were found with operative mortality of 25%. 8. Among 128 cases of valve replacement 7 were under the age of 15 years and 12 were between 15 and 20 years old. Five pediatric cases underwent mitral valve replacement without mortality, 9 year old boy was the youngest among them. In this Department open heart surgery for infancy and complex anomalies showed still hip operative risk which should be improved in the coming years. For open heart surgery Shiley oxygenators and 2 sets of A-O de-lux 5 head roller pump were utilized exclusively. For valve replacement Ionescu-Shiley bovine pericardial xenografts were mainly used. In pediatric and rural patients Persantin with aspirin regimen was satisfactorily administered for anticoagulation after valve replacement. Routinely Coumadin was administered for one year after valve replacement* In patients who had thrombus on valve sites, chronic atrial fibrillation, and giant left atrium Persantin-Aspirin regimen was used when one year coumadin administration was discontinued.

• Journal of Chest Surgery
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• 제25권11호
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• pp.1337-1345
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• 1992

One hundred and fourty-one Bjork-Shiley Monostrut valves were implanted in 105 consecutive patients from November 1983 to February 1990. There were 61 male and 44 female patients with a mean age of 33.6 years at the surgery. The cummurative follow-up was 370.3 patient-years with a mean of 44.0 months per patient. The operative mortality rate was 3.8%, and the linealized late mortality was 1.18%/patient-year. The incidence of major complications were 4.59%/patient-year, and the actuarial rate of freedom from valve-related morbidity was 80.2$\pm$4.4% at 7 years. The 7-year survival rate was 90.5$\pm$4.1%, and the actuarial rate of freedom from thromboembolism at 7 years was 93.3$\pm$2.3%. The linealized annual rates of complication were ; structural valve failure 0.27% /patient-year, non-structural valve failure 0.54% /patient-year, thromboembolism 1.62% /patient-year; bleeding 1.62% /patient-year; endocarditis 0.54% /patient-year. On the basis of our experience, we judged the Bjork-Shiley Monostrut valve reliable, with similar incidence of valve-related morbidity of other mechanical prosthetic valves.

• Journal of Chest Surgery
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• 제18권1호
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• pp.54-61
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• 1985

One-hundred-and-seven patients were the consecutive cases of double replacement of the mitral and the aortic valves at the same time using the lonescu-Shiley bovine pericardial xenograft valve during the period between May, 1979 and June, 1984. They were 64 males and 43 females, and their ages ranged from 13 to 62 years [mean age, 34.011.9 years]. Eight patients died within 30 days after surgery [operative mortality rate, 7.5%], and 7 others thereafter [late mortality rate, 6.5%; or 4.21%/patient-year]. Ninety-nine early survivors were followed up for a total duration of 166.1 patient-years [mean duration, 20.116.1 months]. Two patients experienced thromboembolic complication with no death [1.20%/patient-year]; five developed prosthetic valve endocarditis [3.01%/patient-year] with one death; and three had a new development of aortic regurgitant murmur and they were, along with a mortality from endocarditis, classified into the cases of tissue valve failure [2.41%/patient-year]. The actuarial survival rate including the operative mortality was 82.24.7% at 6 years after surgery. The probabilities of freedom from thromboembolism and from valve failure were 97.61.7% and 88.67.6% at 6 years respectively. Symptomatic improvement was excellent in most of the cases at the follow-up end, showing the mean of the postoperative NYHA Classes of 1.120.33 from the preoperative one of 2.860.54. These results compares favorably with the ones reported from the major institutions. Clinical results of isolated replacement of the mitral valve and of the aortic valve were previously reported. The clinical results of a total and consecutive patients with replacement of single mitral and single aortic and double mitral and aortic valves on the mortality rate, survival rate, complication frequency, and symptomatic improvement all fully stands for the good therapeutic modalities of the valvular heart diseases with severely damaged lesions.

• 대한골대사학회지
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• 제22권1호
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• pp.17-21
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• 2015

Background: There has been lack of epidemiology of proximal humerus fracture using nationwide database in Asia. The purpose of this study was to investigate the incidence of proximal humerus fracture and its mortality following proximal humerus fracture in Korean over 50 years of age. Methods: The Korean National Health Insurance data were evaluated to determine the incidence and mortality of proximal humerus fracture aged 50 years or older from 2008 through 2012. Results: Proximal humerus fracture increased by 40.5% over 5 year of study. The incidence of fracture increased from 104.7/100,000 in 2008 to 124.7/100,000 in 2012 in women and from 45.3/100,000 in 2008 to 52.0/100,000 in 2012 in men, respectively. One year mortality rate after proximal humerus fracture was 8.0% in 2008 and 7.0% in 2012. One year mortality rate were 10.8% for men and 7.0% for women in 2008 and 8.5% for men and 6.4% for women in 2012. Conclusions: Our study showed that the proximal humerus fracture in elderly was recently increasing and associated with high mortality in Korea. Considering proximal humerus fracture was associated with an increased risk of associated fractures and an increased mortality risk, public health strategy to prevent the proximal humerus fracture in elderly will be mandatory.

• Journal of Gastric Cancer
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• 제22권1호
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• pp.35-46
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• 2022

Background: The correlation between hospital volume and postoperative outcomes has led to the centralization of complex procedures in several countries. However, the results reported in relation to gastric cancer (GC) are contradictory. This study aimed to analyze GC surgical volumes and 30-day postoperative mortality in Italy and to provide a simulation for modeling centralization of GC resections based on district case volumes. Methods: A national registry was used to identify all GC resections, record mortality rates, and track the national in-border GC resection health travel. Hospitals were grouped according to caseload. Centralization of all GC procedures performed within the same district was modeled. The outcome measures were a minimal volume of 25 GC resections/year and the 30-day postoperative mortality. Results: In 2018, 5,873 GC resections were performed in 498 Italian hospitals (mean resections per hospital per year: 11.8); the postoperative mortality rate (5.51%) was tracked from 2016-2018. GC resection health travel ranged from 2% to 50.5%, with a significant (P<0.001) difference between northern and central/southern Italy. The mean mortality rate was 7.7% in hospitals performing one to 3 GC resections per year, compared with 4.7% in those with >17 GC resections/year (P≤0.01). Most Italian districts achieved 25 procedures/year after centralization; however, 66.3% of GC cases in southern Italy vs. 42.2% in central and 52.7% in the northern regions (P<0.001) required reallocation. Conclusion: Postoperative mortality after GC resection correlated with hospital volume. Despite health travel, most Italian districts can reach a high-volume threshold, but discrepancies in mortality rates are alarming.Trial RegistrationResearch Registry Identifierresearchregistry6869

• 한국인구학
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• 제8권1호
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• pp.87-117
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• 1985

In Principle, the distriction should be understood between projections and forecasts. When the author or user of a projection is willing to describe it as indicating the most likely population at a give date, then he has made a forecast Population change since 1 960 has been reviewed briefly in order to forecast the population of Korea in the year 2,000 which is a leading factor in long term national development plan for which Korea Institute for Population and Health (KIPH) has been participated since 1983. The author of this paper introduced the population forecast prepared for the long term national development plan and an attempt of comparisons with other forecasts such as D.P. Smith's, T. Frejka's, Economic Planning Board's (EPB), UN's and S.B. Lee's was made. Those six forecasts of Korean future population in year 2,000 varried from 48.5 million to 50.0 million due to the base population and assumption of fertility and mortality however the range of total population size is not large enough. Taking four forecasts such as KIPH, EPB, UN, and Lee based on 1980 population census results and latest data of fertility and mortality, KIPH and UN forecast are close in total population size even though there was a slight difference in fertility and mortality assumptions. The smallest size of total population was shown by S.B. Lee (see Table 13) although the difference between KIPH and Lee was approximately one million which is two percent of total population in year 2,000. As a summary of conclusion the author pointed out that one can take anyone of forecasts prepared by different body because size and proportion wise of the Korean population until early I 990s can not be different much and new population projections must be provided by using 1985 population census data and other latest fertility and mortality information coflected by Korea Institute for Population and Health and Economic Planning Board in forth comming year.

• Journal of Chest Surgery
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• 제19권1호
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• pp.83-91
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• 1986

The Carpentier-Edwards porcine xenograft valve was used in 21 patients at Seoul National University Hospital during the period between 1977 and 1979. Twenty-four Carpentier-Edwards valves were implanted along with 2 others. Three patients died within 30 days of operation, an operative mortality rate of 14.3%. Eighteen early survivors were followed up for a total 67.5 patient-years [mean, 45.0$\pm$32.0 months]. There were 2 late deaths with a linealized late mortality rate of 2.96%/patient-year; one died from cerebral bleeding [1.48% bleeding/patient-year] and the other from prosthetic valve endocarditis [1, 48% endocarditis/patient-year]. There was no case of thromboembolism. Two patients developed mitral regurgitation [2.96% failure/patient-year]. Symptomatic improvement was excellent. The actuarial survival rate and the probability of freedom from overall valve failure were 75.3$\pm$9.6% and 80.7$\pm$12.9% at 9 years after surgery respectively. During the period from October, 1968, through June, 1985, 1, 190 substitute heart valves were used in a total of 967 patients at Seoul National University Hospital; of which, 90.9% were either porcine aortic or bovine pericardial xenograft valves. For the evaluation of the xenograft tissue valves, the consecutive patients with lonescu-Shiley valve in the mitral, aortic and both positions, Angell-Shiley valve and Carpentier-Edwards valve were recently studied on the clinical ground. They were 531 patients, and 643 xenograft valves were used. The operative mortality rate was 6.97% and a linealized late mortality rate 2.94%/patient-year. A total of 490 early survivors were followed up for 917.6 patient-years [mean, 22.5 months], and 70% of patients completed the follow-up. The linealized incidences of complications were: 2.29% emboli/patient-year, 1.98% bleeding/patient-year, 1.20% endocarditis/patient-year, and 3.49% failure/patient-year. These clinical resutls are fully comparable with those in the major reports. The durability of the glutaraldehydepreserved xenograft heart valves remains as a great concern and a continuing debate, expecially for the group of patients in the pediatric age. The need of more durable material for the improved tissue valves was also discussed.

• Hip & pelvis
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• 제35권3호
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• pp.206-215
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• 2023

Purpose: Delay in performance of hip fracture surgery can be caused by medical and/or administrative reasons. Although early surgery is recommended, it is unclear what constitutes a delayed surgery and whether the impact of delayed surgery can differ depending on the reason for the delay. Materials and Methods: A total of 269 consecutive hip fracture patients over 50 years of age who underwent surgery were prospectively enrolled. They were divided into two groups: early and delayed (time from reaching the hospital to surgery less than or more than 48 hours). Patients were also categorized as fit or unfit based on anesthetic fitness. One-year mortality was recorded, and regression analyses were performed to assess the impact of delay on mortality. Results: A total of 153 patients (56.9%) had delayed surgery with a mean time to surgery of 87±70 hours. A total of 115 patients (42.8%) were considered medically fit to undergo surgery. No difference in one-year mortality was observed between patients with early surgery and those with delayed surgery (P=0.854). However, when assessment of the time to surgery was performed in a continuous manner, mortality increased with prolonged time to surgery, particularly in unfit patients, and higher mortality was observed when the delay exceeded six days (fit: P=0.117; unfit: P=0.035). Conclusion: The effect of delay on mortality was predominantly observed in patients who were not considered medically fit, suggesting that surgical delays might have a greater impact on patients with medical reasons for delay.

• Journal of Chest Surgery
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• 제18권1호
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• pp.46-53
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• 1985

A single aortic valve replacement using the lonescu-Shiley bovine pericardial xenograft valve was performed in 66 consecutive patients during the period from February, 1979 to June, 1984. They were 49 males and 17 females with ages ranging from 9 to 61 [mean, 31.113.1] years, and 9 of them were children younger than 15 years of age. Twenty-seven patients [40.9%] required the combined operative procedures to either other valvular lesions or congenital defects. There were 9 early deaths within 30 days of surgery [operative mortality rate, 13.6%] and 2 late deaths thereafter [late mortality rate, 3.0%; or 1.75%/patient-year]. The 57 early survivors were followed for a total duration of 114.2 patient-years [mean, 24.016.0 months]. Four patients experienced thromboembolic complication with no death [3.50%/patient-year]; one died from intracranial bleeding related to anticoagulation [0.88%/patient-year]; one recovered from prosthetic valve endocarditis [0.88%/patient-year]; and four developed aortic regurgitant murmur with none or minimal cardiac symptoms and they were classified into cases of tissue valve failure [3.50%/patient-year]. The actuarial survival rate was 82.34.7% at 6 years, and the actuarial probabilities of freedom from thromboembolism and valve failure were 93.33.9% and 89.15.8% at postoperative 6 years respectively Symptomatic improvement was excellent in most late survivors at the follow-up end with the mean of NYHA Classes of 1.040.19 while the one was 2.290.67 at the time of operation. Excluding the higher operative mortality rates, these clinical results are fully comparable with the ones of reports from the major institutions using the porcine aortic or the bovine pericardial tissue valves and warrants the continued use of the xenograft valve in the aortic position. The importance of more detailed preoperative evaluation of the myocardial function and the need of improved myocardial preservation during surgery for the improved early clinical results were discussed.

• Journal of Chest Surgery
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• 제22권1호
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• pp.32-41
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• 1989

We scrutinized the 64 cases of TGA and Taussig-Bing anomaly who underwent Senning and Mustard operations from Jan. 1981 to May 1988. The ratio of male to female was 45; 19, and the age at operation varied from 2 months to 18 years [mean 18.9*32.9 months]. The in-hospital mortality was in 24 cases [37.5%] and the major causes were myocardial failure and congestive heart failure associated with arrhythmias. The risk factors for hospital mortality were complex TGA, prolonged bypass time and high postoperative CVP. In addition, mortality increased during the first year the procedure was used. Late mortality occurred in 6 cases and the major causes was congestive heart failure, and there was not any significant risk factor noted in late mortality. Early arrhythmia developed in 37.5%, all of which were transient and self limited and 7 cases of early mortality were related to the arrhythmias. Late arrhythmias developed in 8 cases, but 7 cases were transient. One case died with junctional tachycardia. Of significance the one case that died late by arrhythmia had a similar junctional tachycardia in the early postoperative period. The survival rate in all cases disregarding initial in-hospital mortality 1YSR 89.8% and 5YSR 84.3%, but because of short duration of follow up this is not significant. We concluded that early hospital mortality could be decreased by operating at an earlier age and by adjusting the appropriate operation method.