• Journal of Chest Surgery
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• v.7 no.2
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• pp.163-168
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• 1974

Five cases of traumatic diaphragmatic hernia were repaired in the Department of Thoracic Surgery, Seoul National University Hospital, during the period from 1967 to 1974. The first case, a 14-year aid girl, was diagnosed as diaphragmatic hernia during laparotomy because of jejunal perforation 3 days after traffic accident. Herniated stomach, transverse colon, spleen and left lobe of the liver were repositioned and the diaphragmatic rupture on left posterolateral portion was repaired with two layers of nonabsorbable sutures by transthoracic approach. The second case, a 26-year old man,was diagnosed immediately after traffic accident at a local clinic and transferred to this hospital 24 hours later. Herniated stomach, transverse colon and jejunum were repositioned amd diaphragmatic rupture,about 9 cm in length,from the posterolat.edge to the base of pericardium was sutured in two layers. The third case, a 26-year old man who had stab wound on the left lower lateral chest two years ago,was admitted with sudden abdominal pain and vomiting. Upper gastrointestinal series with barium meal revealed diaphragmatic hernia. The herniated stomach and transverse colon through the defect,about 3.5cm in diameter, at anterolateral portion on the left side,were repositioned and repaired with two layers of nonabsorbable sutures. The forth case, a 26-year old man, sustained blunt trauma to the chest by a roller and was transferred to the emergency room complaining of dyspnea 40 minutes after the accident. The diaphragmatic rupture extended from left midaxillary line to contralateral anterior axillary line,about 20cm long, at anterior portion of diaphragm, which was repaired with two layers, of nonabsorbable sutures. The fifth case, a 4-year old girl, had two separate diaphragmatic ruptures on both sides, which were caused by traffic accident. Immediate upper gastrointestinal series after injury showed herniated stomach, colon and spleen into left Chest cavity. Another small rupture with anterior edge of right lobe of the liver in chest cavity was noted. These were repaired with non-absorbable sutures via thoracotomy.

• The Korean Journal of Pain
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• v.18 no.2
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• pp.192-197
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• 2005

Background: Radicular pain, associated with herniated intervertebral disc, has been treated with either conservative treatments or a traditional surgical discectomy. Several modalities for minimally invasive percutaneous procedures have been developed as alternatives to a surgical discectomy. Percutaneous decompression using a $Dekompressor^{(R)}$ probe has been recently introduced. Herein, we report the outcome of percutaneous decompression with a $Dekompressor^{(R)}$ for the treatment of a herniated intervertebral disc. Methods: Between August 2004 and April 2005, percutaneous decompression was performed using a $Dekompressor^{(R)}$, 1.5-mm percutaneous lumbar discectomy probe in 17 patients with a herniated lumbar intervertebral disc resistant to conservative treatments, with the results reviewed retrospectively. The procedure was performed under fluoroscopic guidance after local anesthesia. Disc access was gained with a posterolateral approach on the symptomatic side and intradiscal placement of the discectomy probe in the herniated disc confirmed from the anteroposterior and lateral views on the fluoroscopy. Results: We obtained satisfactory clinical results in 14 patients with a decrease in the initial Visual analogue scale (VAS) of more than 55% and the elimination or reduction of analgesic medication, with a follow-up of 3 to 11 months. Conclusion: We concluded that a percutaneous discectomy with a $Dekompressor^{(R)}$ probe might be an effective alternative for the treatments of painful disc herniations resistant to conservative managements when performed under proper selection criteria.

• Journal of the Korean Arthroscopy Society
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• v.2 no.1
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• pp.25-32
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• 1998

The distinction between isolated and combined injuries is crucial both for treatment and prognosis. For most combined injuries, surgical treatment continues to be favored over nonoperative treatment. It is generally agreed that isolatel PCL injuries do well without surgery. There has been an interest by many authors to fix the graft directly to the posterior aspect of the tibia(tibial inlay). With this procedure, tibial graft fixation will be more direct and theoretically reduce the bending effects of the graft with a fixation site far away from the tibial insertion. Modified tibial inlay technique, which is the posterior approach does not require the patient to be in the prone or lateral decubitus position during the operation. Use of a double-bundle reconstructive technique is attractive and has been performed by some surgeons. At this time, this procedure is still being investigated and should not be routinely used in the clinical setting until studies have indicated an advantage over current single-bundle techniques. However theologically, double-bundle reconstructive technique is more useful in severe posterior unstable knee. Recent advances have increased our knowledge of the anatomy and mechanical characteristics of the PCL. Basic science research has further increased our awareness of the interaction of the posterolateral structures with the PCL. To achieve restoration of normal posterior laxity, it is critical to address the posterior as well as the postero-lateral structures. Surgical treatment is often complex and requires a wide range of surgical techniques and skills to treat associated injuries. When the PCL is reconstructed, most surgeons choose to reconstruct the anterolateral component using a graft of sufficient size and strength. The initial postoperative rehabilitation should be addressed cautiously in an effort to avoid excessive forces on delicate repairs and reconstructions in these complex injuries. Further research is necessary to evaluate new surgical approaches such as double-bundle reconstructions and tibial inlay techniques as well as improved techniques for capsular and collateral ligament injuries.

• Journal of Chest Surgery
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• v.43 no.4
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• pp.454-457
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• 2010

A 42 year old male was admitted for a bony mass on the posterior arc of the left $6^{th}$ rib, which was detected in a multiphasic health screening test. According to the chest computed tomography scan and bone scan, osteochondroma was suspected. He underwent VATS rib resection. There was no vessel or nerve injury. The patient was discharged without any complication on the $4^{th}$ post operative day. The pathological diagnosis was benign fibrous histiocytoma. Generally, posterolateral thoracotomy is needed for rib resection, but we found that there was no difficulty in doing this kind of surgery under a thoracoscopic approach, which has the advantage of better cosmesis.

• Journal of Chest Surgery
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• v.50 no.1
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• pp.22-29
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• 2017

Background: The aim of this study was to analyze the preoperative attributes and clinical impacts of complete pericardiectomy in chronic constrictive pericarditis. Methods: A total of 26 patients were treated from January 2001 to December 2013. The pericardium was resected as widely as possible. When excessive bleeding or hemodynamic instability occurred intraoperatively, a cardiopulmonary bypass (CPB; n=3, 11.5%) or an apical suction device (n=8, 30.8%) was used. Patients were divided into 2 groups: those who underwent ${\geq}80%$ resection of the pericardium (group A, n=18) and those who underwent <80% resection of the pericardium (group B, n=8). Results: The frequency of CPB use was not significantly different between groups A and B (n=2, 11.1% vs. n=1, 12.5%; p=1.000). However, the apical suction device was more frequently applied in group A than group B (n=8, 30.8% vs. n=0, 0.0%; p=0.031). The postoperative New York Heart Association functional classification improved more in group A (p=0.030). Long-term follow-up echocardiography also showed a lower frequency of unresolved constriction in group A than in group B (n=1, 5.60% vs. n=5, 62.5%; p=0.008). Conclusion: Patients with chronic constrictive pericarditis demonstrated symptomatic improvement through complete pericardiectomy. Aggressive resection of the pericardium may correct constrictive physiology and an apical suction device can facilitate the approach to the posterolateral aspect of the left ventricle and atrioventricular groove area without the aid of CPB.

• Journal of Chest Surgery
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• v.15 no.4
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• pp.432-439
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• 1982

Congenital posterolateral diaphragmatic hernia [Bochdalek hernia] is the result of a congenital diaphragmatic defect in the posterior costal part of the diaphragm in the region of the tenth and eleventh ribs. There is usually free communication between the thoracic and abdominal cavities. The defect is most commonly found on the left [90%], but may occurs on the right, where the liver often prevents detection. The male to female ratio is 2:1. Owing to the negative intrathoracic pressure, herniation of abdominal contents through the defects occurs, with resultant collapse of the lung. Shifting of mediastinum to the opposite side and compression of the opposite lung occurs. Most often these hernias are manifestated by acute respiratory distress in the newborn. A second, but less well recognized, group of patient with Bochdalek hernia survive beyond the neonatal period, usually present at a later time with "failure of thrive, intermittent vomiting, or progressive respiratory difficulty. " The diagnosis can often be made on clinical ground from the presence of respiratory distress, absence of breath sounds on the chest presence of bowel sounds over the chest . Roentgenogram of the chest confirm the diagnosis. Obstruction and strangulation have been reported but are rare. Treatment consists of early reliable identification of these congenital diaphragmatic hernia with high risk and surgical repairment. and postoperative pharmacological management with extracorporeal membranous oxygenation [=ECMO] support in the period of intensive care. On the surgical approach, for defects on left side, an abdominal incision is preferred, because of the high incidence of malrotation and obstructing duodenal bands. In the neonate, the operative mortality may be appreciable, but, later repair almost always is successful. During the period from 1972 to 1982, 4 cases of congenital Bochdalek hernia were experienced at the Kyung-Hee University Hospital.

• Journal of Chest Surgery
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• v.19 no.3
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• pp.443-448
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• 1986

Aortic dissection is a serious disease that mortality does not approach to zero despite of medical and surgical improvement. Recently two cases of aortic dissection were treated with good results by the two other methods. Case 1 [57-Y-0-Male]; Chief complaint was chest pain radiating to the back. Preoperatively he was controlled by Minipress, dichlotride, & sodium nitroprusside. Aortography showed DeBakey Type III aortic dissection extending from just below the Lt. subclavian artery to the proximal portion of the origin of the renal artery. Through the midline long incision Flow reversal & Thrombo-exclusion method was used, and bypass course was proximal anastomosis at the ascending aorta - through the Rt. thoracic cavity - midportion of the diaphragm - posterior to the liver, stomach, & pancreas - distal anastomosis at the abdominal aorta proximal to its bifurcation. Bypass graft was preclotted 20 mm Dacron Woven Graft, and the aortic arch between the Lt. subclavian artery & Lt. common carotid artery was divided and meticulously sutured. Control aortogram which was done at 4th postoperative month revealed obstruction of the false lumen by thrombosis, and complications were not noticed. Case 2 [53-Y-0-Male]; Chief complaint was chest pain radiating to the abdomen. DeBakey Type III aortic dissection which was similar to the case 1 was detected by the aortography, and involvement of the Lt. subclavian & common carotid arteries was suspicious. Through the Lt. posterolateral thoracotomy the Ringed Intraluminal Sutureless Graft, No. 22 mm, was inserted from just below the Lt. common carotid artery to the midportion of the descending thoracic aorta under total circulation arrest using a F-F bypass, and the Lt. subclavian artery was ligated. Postoperatively hospital course was uneventful with antihypertensive drugs, and any specific complications were not noticed.

• Advances in pediatric surgery
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• v.14 no.1
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• pp.21-26
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• 2008

There is significant morbidity and mortality associated with the combination of esophageal atresia (EA) and duodenal atresia (DA). Nevertheless, the management protocol for the combined anomalies is not well defined. The aim of this study is to review our experience with the combined anomalies of EA and DA. From May 1989 to August 2006, seven neonates were diagnosed as EA with DA at Asan Medical Center. In all cases, the type of EA was proximal EA and distal tracheoesophageal fistula (TEF). The diagnosis of DA was made in theprenatal period in 1, at birth in 4, 4 days after birth in 1 (2 days after EA repair) and at postmortem autopsy in 1. Except the one case where DA was missed initially, primary simultaneous repair was attempted. DA repair with gastrostomy followed by EA repair in 2, EA repair followed by DA repair without gastrostomy in 2, and TEF ligation followed by DA repair with gastrostomy in 1. There were two deaths. One baby had a large posterolateral diaphragmatic hernia, and operative repair was not attempted. The other infant who had a TEF ligation and DA repair with gastrostomy expired from cardiac failure due to a large patent ductus arteriosus. Simultaneous repair of EA and DA appears to be an acceptable management approach for the combined anomalies, but more experience would be required for the selection of the primary repair of both anomalies.

• Journal of Korean Foot and Ankle Society
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• v.15 no.4
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• pp.201-206
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• 2011

Purpose: Subtalar distraction arthrodesis is useful treatment option for restore hindfoot alignment. but, using structural autograft have high risk of donor site morbidity. Recently, by replacing the structural allograft has been reported satisfactory clinical results. Therefore, the authors reviewed the results of subtalar distraction arthrodesis using a structural allograft, retrospectively. Materials and Methods: From January 2008 to May 2010, 12 patients (12 feets; 9 male, 3 female) underwent subtalar distraction arthrodesis using frozen structural allograft. 9 cases were calcaneal malunion, 2 were nonunion or malunion after subtalar arthrodesis, 1 was other cause. Mean age was 38.9 (12~66) years old and follow up period was 16.5 (12~36) months. Surgical was performed with posterolateral approach and tricortical allobone block of frozen femoral neck was used. Analysis was done with retorspective manner to evaluate preoperative, postoperative, and final follow up radiologic measurement and AOFAS ankle-hindfoot scale. Results: There was statistically significant increase (p<0.05) of ankle-hindfoot scale from preoperative 27.5 points to postoperative 72.5 points, talocalcaneal height by 6.62 mm, calcaneal pitch angle by 5.73 degrees, lateral talocalcaneal angle by 6.38 degrees and significant decrease (p<0.05) of tali-1st metatarsal angle by 5.23 degrees. 11 feet (91.7%) acquired bony union and it takes average 5.1 months. Final post-operative result revealed talocalcaneal height changed by 2.57 mm, calcaneal pitch anble, lateral talocalcaneal angle, talar-1st metatarsal angle were changed by 2.63 degrees, 1.62 degrees, 1.18 degrees, respectively (p<0.05). 3 cases of partial osteonecrosis of posterior facet of calcaneus were observed in operation field, 4 cases of complication were developed (1 case of nonunion, 1 collapse of allobone graft, 1 screw loosening, 1 superficial skin necrosis). Conclusion: Subtalar distraction arthrodesis using frozen structural allobone graft is useful alternative treatment method of arthrodesis with structural autobone graft.

• The Korean Journal of Pain
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• v.36 no.1
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• pp.128-136
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• 2023

Background: The authors aimed to compare the effects of a one-time ultrasound (US)-guided subacromial corticosteroid injection and three-time ozone (O₂-O₃) injection in patients with chronic supraspinatus tendinopathy. Methods: Participants were randomly assigned to the corticosteroid group (n = 22) or ozone group (n = 22). Injections in both groups were administered into subacromial bursa with an US-guided in-plane posterolateral approach. Primary outcome measure was the change in the Western Ontario Rotator Cuff Index (WORC) score between baseline and 12-weeks post-injection. Secondary outcome measures included visual analog scale and Shoulder Pain and Disability Index scores. Assessments were recorded at baseline, and 4-weeks and 12-weeks post-injection. Results: Forty participants completed this study. Based on repeated measurement analysis of variance, a significant effect of time was found for all outcome measures in both groups. Both the groups showed clinically significant improvements in shoulder pain, quality of life, and function. Baseline, 4-week post-injection, and 12-week post-injection WORC scores (mean ± standard deviation) were 57.91 ± 18.97, 39.10 ± 20.50 and 37.22 ± 27.31 in the corticosteroid group, respectively and 69.03 ± 15.89, 39.11 ± 24.36, and 32.26 ± 24.58 in the ozone group, respectively. However, no significant group × time interaction was identified regarding all outcome measures. Conclusions: Three-time ozone injection was not superior to a one-time corticosteroid injection in patients with chronic supraspinatus tendinopathy. It might be as effective as corticosteroid injection at 4-weeks and 12-weeks post-injection in terms of relieving pain and improving quality of life and function.