• Journal of Chest Surgery
• /
• v.33 no.8
• /
• pp.630-637
• /
• 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.

• Journal of Korean Neurosurgical Society
• /
• v.38 no.1
• /
• pp.28-34
• /
• 2005

Objective : This study is performed to compare older with younger groups about clinical characteristics and overall outcome of treatments for the intracranial aneurysms. Methods : We retrospectively investigated 633 patients with cerebral aneurysms who were admitted to our institute from January 2000 to May 2004. The authors divided the patients of cerebral aneurysm into two groups, one the third, fourth decades and the other eighth, ninth decades, analyzed clinical characteristics and overall outcome of treatments. Results : There were 57 patients [9.0%] under 39years old and 58 patients [9.2%] over 70. The female to male sex ratio was 0.5 : 1 in the younger group[YG] and 7.3 : 1 in the older group[OG], showing a female predominance with increasing age. In the YG, aneurysms were found in anterior communicating artery[A-com] [44.8%], middle cerebral artery [31.0%]. In the OG, aneurysm of posterior communicating artery [30.1%] was most common followed by that of A-com [26.9%]. More smokers and alcoholics were found in the YG. Older age was related to poor Hunt-Hess grade, Fisher's grade on admission, high incidence of unruptured aneurysms, and endovascular surgery. There was a higher prevalence of hypertension, intraventricular hematoma, hydrocephalus, and rebleeding in the preoperative state in the OG and postoperative complications including hydrocephalus, subdural fluid collection, and systemic complications. Overall outcome was poorer with advancing age [p=0.01]. Conclusion : The patients with aneurysms in the YG have distinct characteristics compared to those in the OG. Because of a good clinical grade on admission, a thin subarachnoid clot, and Low incidence of perioperative complications, the overall outcomes of the young patients were better than those of the old patients.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.21 no.5
• /
• pp.451-459
• /
• 2021

Background: Lignocaine with adrenaline is routinely used as a local anesthetic for dental procedures. Adrenaline was added to increase the duration of anesthesia. However, epinephrine containing a local anesthetic solution is not recommended in conditions such as advanced cardiovascular diseases and hyperthyroidism. Recently, ropivacaine has gained popularity as a long-acting anesthetic with superior outcomes. The goal of this study was to assess and compare the effectiveness of 0.75% ropivacaine alone and 2% lignocaine with adrenaline (1:80,000) in the removal of bilateral maxillary wisdom teeth using the posterior superior alveolar nerve block technique. Methods: This was a single-blind, randomized, split-mouth, prospective study assessing 15 systemically sound outpatients who needed bilateral removal of maxillary third molars. We randomly allocated the sides and sequences of ropivacaine and lignocaine with adrenaline administration. We evaluated the efficacy of both anesthetics with regard to the onset of anesthesia, intensity of pain, variation in heart rate, and blood pressure. Results: The onset of anesthesia was faster with lignocaine (138 s) than with ropivacaine (168 s), with insignificant differences (p = 0.001). There was no need for additional local anesthetics in the ropivacaine group, while in the lignocaine with adrenaline group, 2 (13.3%) patients required additional anesthesia. Adequate intraoperative anesthesia was provided by ropivacaine and lignocaine solutions. No significant difference was observed in the perioperative variation in blood pressure and heart rate. Conclusion: Ropivacaine (0.75%) is a safe and an adrenaline-free local anesthetic option for posterior superior alveolar nerve block, which provides adequate intraoperative anesthesia and a stable hemodynamic profile for the removal of the maxillary third molar.

• Journal of Bone Metabolism
• /
• v.25 no.4
• /
• pp.227-233
• /
• 2018

Background: Few studies have investigated the effects of sarcopenia on postoperative outcomes including mortality rates following surgery for osteoporotic hip fractures. The purpose of the present study was to determine the prevalence of sarcopenia and the relationship between sarcopenia and 1- and 5-year mortality rates in a consecutive series of patients with osteoporotic hip fractures. Methods: Among patients who underwent hip surgery for osteoporotic hip fractures, this study included 91 patients subjected to abdominal computed tomography within 1 year of hip surgery. We defined sarcopenia using sex-specific cut-off points for the skeletal muscle index at the level of the third lumbar vertebra. All patients were divided into 2 groups according to the presence or absence of sarcopenia and the 1- and 5-year mortality rates were compared. To confirm factors affecting mortality in addition to sarcopenia, we examined patient age, sex, American Society of Anesthesiologists grade, location of fracture, type of surgery, and bone mineral density. Results: The 1- and 5-year mortality rates were 20.9% and 67.2%, respectively. Among the 45 patients with sarcopenia, the 1- and 5-year mortality rates were 22.2% and 82.7%, respectively. Of the 46 patients without sarcopenia, the 1- and 5-year mortality rates were 19.6% and 52.7%, respectively. Results of the Kaplan-Meier analysis showed that sarcopenia did not affect the 1-year mortality rate (P=0.793), but had a significant effect on the 5-year mortality rate (P=0.028). Both perioperative sarcopenia (P=0.018) and osteoporosis (P=0.000) affected the 5-year mortality rate. Conclusions: Sarcopenia increases the risk of 5-year mortality in patients with osteoporotic hip fractures.

• Investigative and Clinical Urology
• /
• v.59 no.6
• /
• pp.392-398
• /
• 2018

Purpose: To evaluate the initial experience and outcome of photo-selective vaporization of the prostate (PVP) for benign prostatic hyperplasia (BPH) in Pakistan with the use of a 980 nm diode laser. Materials and Methods: A prospective study was performed from November 2016 to December 2017. A total of 100 patients diagnosed with bladder outlet obstruction secondary to BPH who planned for PVP were enrolled in the study. PVP was carried out with a diode laser at 980 nm (Biolitec Diode 180W laser) in a continuous wave with a 600 nm (twister) fiber. Baseline characteristics and perioperative data were compared. Postoperative outcomes were evaluated by International Prostate Symptom Score (IPSS), post void residual (PVR) and maximum urinary flow rate (Qmax) at 3 and 6 months after surgery. Results: The mean age was $65.82{\pm}10.42$, mean prostate size was $67.35{\pm}16.42$, operative time was $55.85{\pm}18.01$ and total energy was $198.68{\pm}49.12kJ$. At 3 months and 6 months, significant improvements were noted (p<0.001) in IPSS $7.04{\pm}1.69$ (-18.92), Qmax $19.22{\pm}4.75mL/s$ (+13.09) and and PVR $18.89{\pm}5.39mL$ (-112.80). Most frequent problems were burning micturition (35%) and terminal dysuria (29%). No significant difference in postoperative hemoglobin was seen in patients who were on anti-platelet drugs. Conclusions: PVP with a diode laser is a safe and effective procedure for the treatment of BPH and is also safe in patients who are on anti-platelet agents.

• Journal of Korean Foot and Ankle Society
• /
• v.23 no.2
• /
• pp.52-57
• /
• 2019

Purpose: An ingrown nail is common in military trainees who are exposed to highly demanding activities. Although the matrixectomy procedure has been the main treatment modality, several drawbacks may follow after the procedure, such as infection, periostitis, and continued pain that causes a delayed return to duty. This study examined the outcomes of a simple partial nail extraction with the hypothesis that this procedure may bring an earlier return to duty, lower the perioperative complications, and produce a comparable recurrence rate. Materials and Methods: The medical records of patients who had surgical treatment for an ingrown nail in the authors' institution between April 2016 and December 2017 were reviewed retrospectively. Under the inclusion and exclusion criteria, 28 patients with a simple partial nail extraction (group A) and 29 patients with a partial nail extraction with matrixectomy (group B) were investigated. As the clinical outcome, the visual analogue scale (VAS) and satisfaction score, time to return to duty, complications, and recurrence rate were checked and compared between the groups. Results: The VAS scores of group B were significantly higher during the first (p<0.001) and second (p=0.026) follow-up week than group A. The time to return to duty was shorter in group A (7.8 days) than group B (10.1 days), and this difference was significant (p<0.001). Group B had five patients with complications, whereas group A had none (p=0.028). No differences in the recurrence rate (p=0.197) and patient satisfaction (p=0.764) were found between the groups. Conclusion: In this study, simple partial nail extraction in military trainees resulted in lower postoperative pain, lower complication rates, and earlier return to duty than the procedure with matrixectomy. Military trainees are temporarily exposed to highly demanding activities. Thus, a satisfactory outcome would be expected with simple partial nail extraction without performing a radical procedure, such as a matrixectomy.

• Journal of Chest Surgery
• /
• v.56 no.1
• /
• pp.35-41
• /
• 2023

Background: We analyzed our experience with descending necrotizing mediastinitis (DNM) treatment and investigated the efficacy of video-assisted thoracoscopic surgery (VATS) for mediastinal drainage. Methods: This retrospective analysis included patients who underwent surgical drainage for DNM at our hospital from 2005 to 2020. We analyzed patients' baseline characteristics, surgical data, and perioperative outcomes and compared them according to the mediastinal drainage approach among patients with type II DNM. Results: Twenty-five patients (male-to-female ratio, 18:7) with a mean age of 54.0±12.9 years were enrolled in this study. The most common infection sources were pharyngeal infections (60%). Most patients had significantly increased white blood cell counts, elevated C-reactive protein levels, and decreased albumin levels on admission. The most common DNM type was type IIB (n=16, 64%), while 5 and 4 patients had types I and IIA, respectively. For mediastinal drainage, the transcervical approach was used in 15 patients and the transthoracic approach (VATS) in 10 patients. The mean length of hospital stay was 26.5±23.8 days, and the postoperative morbidity and in-hospital mortality rates were 24% and 12%, respectively. No statistically significant differences were found among patients with type II DNM between the transcervical and VATS groups. However, the VATS group showed shorter mean antibiotic therapy duration, drainage duration, and hospital stay length than the transcervical group. Conclusion: DNM manifested as severe infection requiring long-term inpatient treatment, with a mortality rate of 12%. Thus, active treatment with a multidisciplinary approach is crucial, and mediastinal drainage using VATS is considered relatively safe and effective.

• Journal of Chest Surgery
• /
• v.56 no.3
• /
• pp.171-176
• /
• 2023

Background: This study analyzed and described the clinical characteristics and surgical outcomes of diaphragmatic hernia (DH) repair according to the operative approach. Methods: After excluding cases with a combined approach and hiatal hernias, we analyzed 26 patients who underwent DH repair between 1994 and 2018. The baseline and perioperative characteristics of the thoracic approach group and the abdominal approach group were described and analyzed. Results: Fifteen of the 26 patients were treated through the thoracic approach, including 5 patients who underwent video-assisted thoracic surgery (VATS). Eleven patients underwent the abdominal approach. The thoracic approach was associated with a longer duration of DH than the abdominal approach (2 vs. 0.1 months), herniation of the right-sided abdominal organs, and herniation of the retroperitoneal organs. During the median follow-up of 23 months, there was no recurrence of DH. Conclusion: The surgical approach should be chosen considering the duration of DH and the location of herniated organs. VATS might be a safe and feasible option for repairing DH.

• Journal of Chest Surgery
• /
• v.56 no.4
• /
• pp.264-271
• /
• 2023

Background: The optimal management strategy for aortoiliac occlusive disease (AIOD) remains debatable. This study compared early and late outcomes between direct surgical bypass and kissing stents for AIOD treatment. Methods: We retrospectively reviewed data, including age, sex, risk factors, comorbidities, symptoms, TransAtlantic Inter-Society Consensus (TASC) II classification, operation time, perioperative complications, in-hospital mortality, and length of hospital stay, from a cohort of 46 patients treated for AIOD (24 with kissing stents and 22 with direct surgical bypass) at Pusan National University Hostpital from January 2007 to December 2016. The primary, assisted primary, and secondary patency rates in both groups were compared. Results: The hospital stay (direct surgical bypass vs. kissing stents: 16.36±5.19 days vs. 9.08±10.88 days, p=0.007) and operation time (direct surgical bypass vs. kissing stents: 316.09±141.78 minutes vs. 99.54±37.95 minutes, p<0.001) were significantly shorter for kissing stents. Kaplan-Meier analysis revealed that the primary, assisted primary, and secondary patency rates in the direct surgical bypass group were 95.5%, 95.5%, and 95.5%, respectively, at 1 year; 86.4%, 86.4%, and 95.5% at 3 years; and 77.3%, 77.3%, and 95.5% at 5 years. The primary, assisted primary, and secondary patency rates in the kissing stent group were 100.0%, 100.0%, and 100.0%, respectively, at 1 year; 95.8%, 95.8%, and 100.0% at 3 years; and 95.8%, 95.8%, and 100.0% at 5 years. Conclusion: Except for special cases wherein endovascular revascularization is difficult, kissing stents are more advantageous for TASC II C and D lesions.

• Journal of Chest Surgery
• /
• v.57 no.3
• /
• pp.263-271
• /
• 2024

Background: Delirium is a recognized neurological complication following cardiac surgery and is associated with adverse clinical outcomes, including elevated mortality and prolonged hospitalization. While several clinical risk factors for post-cardiac surgery delirium have been identified, the pathophysiology related to the immune response remains unexamined. This study was conducted to investigate the immunological factors contributing to delirium in patients after thoracic aortic surgery. Methods: We retrospectively evaluated 43 consecutive patients who underwent thoracic aortic surgery between July 2017 and June 2018. These patients were categorized into 2 groups: those with delirium and those without it. All clinical characteristics were compared between groups. Blood samples were collected and tested on the day of admission, as well as on postoperative days 1, 3, 7, and 30. Levels of helper T cells (CD4), cytotoxic T cells (CD8), B cells (CD19), natural killer cells (CD56+CD16++), and monocytes (CD14+CD16-) were measured using flow cytometry. Results: The median patient age was 71 years (interquartile range, 56.7 to 79.0 years), and 21 of the patients (48.8%) were male. Preoperatively, most immune cell counts did not differ significantly between groups. However, the patients with delirium exhibited significantly higher levels of interleukin-6 and lower levels of tumor necrosis factor-alpha (TNF-α) than those without delirium (p<0.05). Multivariate analysis revealed that lower TNF-α levels were associated with an increased risk of postoperative delirium (p<0.05). Conclusion: Postoperative delirium may be linked to perioperative changes in immune cells and preoperative cytokine levels. Additional research is required to elucidate the pathophysiological mechanisms underlying delirium.