• Journal of Korean Neurosurgical Society
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• v.55 no.6
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• pp.383-386
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• 2014

Objective : Symptomatic thoracic disc herniation often requires prompt surgical treatment to prevent neurological deterioration and permanent deficits. Anterior approaches offer direct visualization and access to the herniated disc and anterior dura but require access surgeons and are often associated with considerable postoperative pain and pulmonary complications. A disadvantage with using posterior approaches in the setting of central calcified thoracic disc herniation however, has been the limited visualization of anterior dura and difficulty to accurately assess the extent of decompression. Methods : We report our experience with intraoperative ultrasound (US) guidance during a modified posterior transpedicular approach for removal of a central calcified thoracic disc herniation with a review of pertinent literature. Results : The herniated thoracic disc was successfully removed with posterior approach with the aid of intraoperative US. The patient had significant neurological improvement at three months follow-up. Conclusion : Intraoperative ultrasound is a simple yet valuable tool for real-time imaging during transpedicular thoracic discectomy. Visualization provided by intraoperative US increases the safety profile of posterior approaches and may make thoracotomy unnecessary in a selected group of patients, especially when a patient has existing pulmonary disease or is otherwise not medically fit for the transthoracic approach.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.22 no.2
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• pp.15-20
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• 2016

Background: The purpose of this study was to compared of scapular position between operation side and non-operation side to the rotator cuff surgery. Methods: This study was carried out with a total 34 patients: male (n=14), female (n=20). Shoulder range of motion (ROM), the quadruple visual analogue scale (QVAS), the shoulder pain and disability index (SPADI), and the scapular index (SI) were used to assess shoulder posture and function. SI was the resting position of the scapular was determined by measuring the distance from the mid-point of the sternal notch (SN) to the medial aspect of the coracoid process (CP) and the horizontal distance from the posterolateral angle of the acromion (PLA) to the thoracic spine (TS) with a soft tape measure. The SI was calculated using the equation: [(SN to CP/PLA to TS) ${\times}$ 100]. Results: There were no significant difference in ROM, QVAS to rotator repair patients according to SI (p>.05). There were significant differences in SI between the operation side and the non-operation side (p<.01). Conclusions: Scapular position was operation side more internal rotation, protraction, abduction than non-operation side. Therefore, health professionals managing for rotator cuff tear repair patients should consider scapular position.

• Journal of Chest Surgery
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• v.30 no.4
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• pp.467-470
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• 1997

Hibernoma is a rare, benign soft tissue tumor that is derived from the remnants of fetal brown tissue. The term hibernoma was proposed in 1914 by Cery because of its morphologic similarity to the cel s of the so-called hibernating gland of animals. The most common site of hibernomas is the subcutaneous tissue of the back, especially the interscapular area. These tumors are considered benign and malignant transformation has not been reported. We experienced a case of hibernoma, 60-year-old woman had suffered from the palpable mass without pain or tenderness on posterolateral lower chest wall, left. The tumor was extirpated under the impression of angiolipoma, but was confirmed hibernoma. She was discharged without complication.

• Journal of Chest Surgery
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• v.15 no.4
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• pp.447-450
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• 1982

A 45 year old male officer was admitted due to upper substernal pain for 1 month, which was aggravated by swallowing. On past and family history, there was no specific history except heavy drinking. Simple chest x-ray revealed no specific abnormal findings. Preoperative esophagofiberscopy and Barium study showed midesophageal diverticulum, pulsion type, at about 2 cm below the left main bronchus. The opening of the diverticulum was located at the left posterolateral aspect of esophagus. Midesophageal false diverticulum, measuring 2 x 2 x 1 .S cm in size, was noted at about 5 cm under the aortic arch protruding through a slit-like muscular defect. After inversion of diverticular sac, interrupted sutures with 3-0 silks were done on muscular defect site, and mediastinal pleura was reinforced on the lesion with interrupted sutures. On 4th postoperative day, esophagography revealed no diverticulum or stenosis. Also esophagofiberscopy showed smooth mucosal tag without disturbance of passage. On 14th postoperative day, the patient was discharged uneventfully, and follow-up for 3 months after discharge revealed nothing abnormal symptoms. The authors report one case of midesophageal, pulsion type, false diverticulum.

• Journal of Chest Surgery
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• v.23 no.3
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• pp.572-576
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• 1990

A complete transection of left main bronchus was repaired by end to end anastomosis 5 months after the chest trauma in the Yeungnam University Hospital. The patient was a 36 years old male who had been injured bluntly by a heavy package on the left chest. The initial symptoms and signs were dyspnea, chest pain and subcutaneous emphysema on the left neck, but on admission at our hospital his chief complaint was only mild left chest discomfort. The preoperative chest X-ray findings 5 months after the trauma revealed total collapse of the left lung, deviation of trachea to the left, elevation of left diaphragm, abrupt discontinuation in the course of an air-filled left main bronchus and bronchoscopy showed that the left main bronchus was completely occluded, without any signs of inflammation, approximately 4 cm from the carina. The operation was performed through standard posterolateral thoracotomy incision at the fifth intercostal space. There was not any suppuration within the transected lung but plenty of white mucus which was removed by forceful suction. The transected bronchial edges were debrided and anastomosed primarily by end to end with interrupted nonabsorbable sutures. The suture line was reinforced with a pleural flap. The postoperative course was uneventful and pulmonary function following operation improved progressively and proved the delayed repair to have a reasonable decision.

• Journal of Oral Medicine and Pain
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• v.16 no.1
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• pp.33-72
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• 1991

The purpose of this study was to investigate the stress distribution and the displacement in the temporomandibular joints following the teeth loss patterns. The three dimensional finite element method was used for a mathematical model. The finite element model was composed of 1,632 elements and 2,411 nodes in the mandible with articular disc and mandibular fossa of the temporal bone. The masseter, the temporal and the internal pterygoid muscle forces were applied at each insertion site, bisecting point of gonion and antegonion, tip of the coronoid process, and gonion at the ration of 2:2:1 respectively. The directions of muscles force were obtained from frontal and lateral cephalometric tracings using bony landmarks of the skull. The results were as follows : 1. In control model, the minimum principal stresses were concentrated on the region of anterosuperior part of the condyle head and articular disc, and maximum principal stresses on the anterior part of the condyle head and posterolateral part of the articular disc. 2. In case of unilateral teeth loss, the greater principal stress appeared at the teeth loss side and the principal stresses increased at the teeth loss side as the number of the posterior teeth loss went up. 3. In case of bilateral teeth loss, the principal stresses were greater than those of the control model and as the number of the posterior teeth loss increased, the grater principal stresses on the temporomandibular joints appeared at the both side. 4. When the posterior teeth existed bilateral, the principal stress patterns were similar to those of the control model. 5. The displacement ws directed mainly upward and backward in the upper part of the temporomandibular joints and upward and forward in the largest part of the condyle head. The displacement increased as the number of the posterior teeth loss went up.

• Journal of Korean Neurosurgical Society
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• v.45 no.2
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• pp.67-73
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• 2009

Objective : Although endoscopic procedures for lumbar disc diseases have improved greatly, the postoperative outcomes for high grade inferior migrated discs are not satisfactory. Because of anatomic limitations, a rigid endoscope cannot reach all lesions effectively. The purpose of this study was to determine the feasibility of endoscopic transforaminal suprapedicular approach to high grade inferior-migrated lumbar disc herniations. Methods : Between May 2006 and March 2008, a suprapedicular approach was performed in 53 patients with high grade inferior-migrated lumbar disc herniations using a rigid endoscope and a semi-rigid flexible curved probe. One-to-four hours after surgery, the presence of remnant discs was checked with MRI. The outcomes were evaluated with the visual analogue scale (VAS) score and the Oswestry Disability Index (ODI) one week after surgery. Results : The L2-3 level was involved in 2 patients and the L3-4 level was involved in 14 patients, while the L4-5 level was involved in 39 patients. There were single piece-type in 34 cases and a multiple piece-type in 19 cases. Satisfactory results were obtained in all cases. The mean preoperative VAS for leg pain was $9.32{\pm}0.43$ points (range, 7-10 points), whereas the mean ODI was $79.82{\pm}4.53$ points (range, 68-92 points). At the last follow-up examination, the mean postoperative VAS for leg pain was $1.78{\pm}0.71$ points and the mean postoperative ODI improved to $15.27{\pm}3.82$ points. Conclusion : A high grade inferior migrated lumbar disc is difficult to remove sufficiently by posterolateral endoscopic lumbar dscectomy using a rigid endoscope. However, a satisfactory result can be obtained by applying a transforaminal suprapedicular approach with a flexible semi-rigid curved probe.

• Journal of Chest Surgery
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• v.30 no.7
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• pp.724-728
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• 1997

We experienced a case of thoracic aortic aneurysm combined with coronary artery disease. A 68-year-old man complained of anginal pain in the left anterior chest and nonspecific pain in the posterior chest. The aneurysm was extending from left subclavian artery to the diaphragm and sign of impending rupture was noted in the chest CT. Coronary angiograms r vealed significant obstruction of left circumflex coronary artery(>95%) and left anterior descending artery(>50%). Exposure was obtained through the left posterolateral thoracotomy incision in the 4th intercostal space and then partial femoro-femoral cardiopulmonary bypass was established. After aortic cross clamping, the aneurysmal sac was opened and repaired with interposition of 26 mm Hemashield graft. Under the beating heart with femoro-femoral cardiopulmonary bypass, aorto-left circumflex coronary bypass with autogenous saphenous vein used as conduit was performed. Postoperatively multiple cerebral infarction ensued due to intraoperative hypovolemic shock and hypoxic brain damage during cardiopulmonary bypass. Currently, the patient's mental status is drowsy and in an improving state.

• 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.

• Journal of Korean Foot and Ankle Society
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• v.17 no.4
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• pp.294-301
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• 2013

Purpose: To report the clinical outcomes and complications of flexor hallucis longus (FHL) tendoscopy using 3 portals. Materials and Methods: Between January 2012 and April 2013, 10 patients (10 ankles) received tendoscopic surgery for the treatment of FHL tenosynovitis. Patients complaining of pain and tenderness along the course of FHL despite over 6 months of conservative treatments were indicated for surgery. The mean age was 41.7 years (range: 18-57) and the follow up period was 12.7 months (range: 6-20). Tendoscopy was performed using posteromedial, posterolateral, and plantar portals. Clinical evaluations included preoperative and postoperative visual analogue scale (VAS), American orthopaedic foot and ankle society (AOFAS) score, and patients' satisfaction. Results: Tendoscopic findings included tenosynovitis in 10 cases, degenerated vinculae in 6 cases, stenosis of the tendon at its entrance into the fibro-osseous tunnel in 5 cases, and degenerative partial tendon tear in 3 cases. Two cases had associated symptomatic os trigonum and 3 cases had posterior ankle impingement syndrome. Preoperative pain decreased from median VAS 6 (range: 4-10) to 2.1 (range: 1-5) at the last follow up and AOFAS score improved from 50.1 (range: 36-63) to 82.1 (range: 61-89) (p<0.05). Nine patients were satisfied or very satisfied with the outcome. Injury of the lateral plantar nerve occurred in one case. Conclusion: FHL tendoscopy using 3 portals is a feasible and useful minimal invasive surgical technique for the management of FHL tenosynovitis.