• Archives of Reconstructive Microsurgery
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• v.8 no.2
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• pp.97-107
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• 1999

The osteogenic capacity of the vascularized periosteum autograft has been extensively demonstrated by experimental works. The objective of this study was to characterize the behavior of experimental model of vascularized periosteal flap(VPF) by observing sequential stages of osteogenesis after simulated VPF in rabbits. In experimental group, segmental resection of bone including the periosteum was performed in 22 radii of 22 New Zealand white rabbits preserving the periosteal circulation of median artery to the periosteum. In order to simulate the transplantation of VPF, the vascular pedicle consisting of median artery and veins was dissected from adjacent soft tissue and the periosteum was longitudinally incised to remove the bone followed by repair of the periosteum. From the first to sixteenth week after the simulated VPF, the changes in VPFs were observed by radiological, light microscopical, scanning electron microscopical methods and the activity of osteocalcin was measured by immunohistochemical method. In control group, the bone tissue and periosteum were completely removed from the mid-shaft of radius and the findings were observed by radiological and light microscopical methods. From the results of this study, it is demonstrated that the experimental model of VPF is vigorously and uniformly osteogenic. Therefore it is thought that VPF can be used as a measure to treat bone defect of shaft of long bone.

• Advances in pediatric surgery
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• v.11 no.2
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• pp.141-149
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• 2005

Ulcerative colitis, an inflammatory bowel disease, is primarily managed medically with a combination of 5-ASA and steroids. However, this chronic disease requires surgical management if symptoms persist or complications develop despite medical management. The clinical course, indications and outcome of surgical management of 21 patients under the age of 15 who were endoscopically diagnosed with ulcerative colitis at the Seoul National University Children's Hospital between January, 1988 and January, 2003 were reviewed. Mean follow up period was 3 years and 10 months. The mean age was 10.3 years old. All patients received medical management after diagnosis and 8 patients (38 %) eventually required surgical management. Of 13 patients who received medical management only, 7 patients (53 %) showed remission, 4 patients are still on medical management, and 2 patients expired due to congenital immune deficiency and hepatic failure as a result of sclerosing cholangitis. In 8 patients who received surgical management, the indications for operation were, 1 patient sigmoid colon perforation and 7 patients intractability despite medical management. The perforated case had a segmental colon resection and the other 7 patients underwent total colectomy with ileal pouch-anal anastomosis. One patient expired postoperatively due to pneumonia and sepsis. and 1 is still on medical management because of mild persistent hematochezia after surgery. Six other operated patients are doing well without medical therapy. Pediatric ulcerative colitis patients can be surgically managed if the patient is intractable to medical management or if complications such as perforation are present. Total colectomy & ileal pouch-anal anastomosis is thought to be the adequate surgical method.

• The Journal of the Korean bone and joint tumor society
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• v.3 no.2
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• pp.112-118
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• 1997

Multicentric chondrosarcoma other than the mesenchymal subtype is rare separate entity. We experienced a case with nonmonomelic synchronous multicentric chondrosarcoma without any preexisting lesions of Oilier's disease or Maffucci's syndrome. To our knowledge, there was no report of synchronous nonmonomelic multicentric chondrosarcoma. A thirty-three year old man had right distal thigh pain of one and half year. Bone scan showed hot lesions on medial condyle of right femur and shaft of left femur. Plain X-ray showed osteolytic lesion on right femur and slight cortical thickening and calcific lesion was observed on left femoral shaft. Curettage and bone cement filling was done on both lesions. The pathology reports were grade I chondrosarcoma on both side of femur. At one month from operation, pathologic fracture of left femur occurred on bone cement-host bone junction. Conservative treatment and radiotherapy of 60Gy was done. At 8 months from operation, nonunion was evident. Segmental resection of left femur with contralateral fibula graft and second look operation on right condyle lesion were done. At 6 months from revision, fracture occurred at host-graft bone junction. We removed previous hardware and applied long DCP and massive autogenous bone graft. Afterwards, the patient looks good and union was progressing. But at 4 years from last operation, hypertrophic nonunion occurred. Another revision was done with condylar plate and bone graft and now he is well without any sign of local recurrence or metastasis.

• Tuberculosis and Respiratory Diseases
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• v.47 no.4
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• pp.549-556
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• 1999

Benign pulmonary tumors are rare entities, and among them bronchial lipomas are the most uncommon. Up to date, about 80 cases have been reported in the English literature. But, the bronchial lipoma with extrabronchial growth causing middle lobe syndrome and pneumonia is extremely rare. Bronchial lipomas, mainly arising from normal fatty tissue of the proximal portion of the lobar or segmental bronchi, are histologically benign. But if diagnosis and treatments are delayed, they can produce extensive pulmonary parenchymal damage and irreversible brochiectasis distally. So whenever possible, the treatment of choice is resection by means of bronchoscopy via early diagnosis. But if endoscopic removal is not possible because the distal end of the tumor could not be visualized by fiberoptic bronchoscopy or if the nature of the tumor is unclear, surgery is necessary, with lobectomy or pneumonectomy being required in most cases due to the extensively damaged pulmonary parenchyma. We present a case of bronchial lipoma with extrabronchial growth, with a review of the literature and report of an unusual case.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.1
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• pp.41-47
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• 1999

The route of bony invasion and spread pattern of tumor in the mandible are important in management of gingival cancer. Ten patients with gingival cancer involving mandibular body region were operated by composite resection. The radiographic and histopathologic features of the mandibular invasion and spread were analysed and compared. Our results showed that histopathologic extent of tumor invasion were greater than the radiographic prediction, especially in width of the tumor. And the pattern of bony invasion in the body area was mostly found in transmedullary spread rather than perineural spread. The vertical involvement in the mandibular body with tumor was evaluated. It indicated that if a oncologic surgeon was to ensure an adequate safety margin for extirpation of tumor, in most cases, the maintenance of the mandibular continuity is difficult. If the mandibular involvement by gingival cancer was identified radiographically and clinically, segmental mandibulectomy was required for the adequate safety margin, in consideration of the spread pattern in the body area.

• Journal of Yeungnam Medical Science
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• v.26 no.1
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• pp.49-55
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• 2009

Peritonitis is a serious problem in patients undergoing peritoneal dialysis. Rarely pneumatosis intestinalis can occur as a complication of this infectious process. Pneumatosis intestinalis is a potential life threatening condition with a challenging management. The mortality of peritoneal dialysis patients with pneumalosis intestinalis secondary to mesenteric ischemia is almost 100%. We describe a rare case of pneumatosis intestinalis in a peritoneal dialysis patient who developed Staphylococcus aureus peritonitis which was initially treated with appropriate antibiotics. Since initial response to therapy was not achieved, an abdominal computerized tomography was done which revealed a pneumatosis intestinalis. A laparotomy was performed and small bowel necrosis was seen. A segmental resection with ileostomy, jejunostomy was done. Though surgical treatment was performed, the patient died in 2 weeks after admission. Pneumocystitis intestinalis in peritoneal dialysis peritonitis is a uncommon complication which requires prompt evaluation to rule out mesenteric ischemia as it carries a high mortality and its management will be surgical.

• Journal of Trauma and Injury
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• v.34 no.1
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• pp.39-43
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• 2021

Purpose: Determining appropriate ways to assess health care quality within the National Health Insurance System is of interest to both the Korean government and the medical community. However, in the trauma field, the number of indicators used to evaluate surgical quality is limited. Using data collected over 5 years at Wonju Severance Christian Hospital Trauma Center in Korea, this study aimed to determine whether the unplanned reoperation rate in the field of trauma surgery could be used to assess the quality of an institution's surgical care. Methods: In total, 665 general surgical procedures were performed at the Trauma Center in 453 patients with abdominopelvic injuries from January 2015 to December 2019. Data were collected from the Trauma Center's data registry and medical records, and included information regarding patients' demographic characteristics, the type of index operation, and the reason for unplanned reoperations. Results: A total of 453 index operations were evaluated. The proportion of patients with an Injury Severity Score (ISS) >15 was 48-70% over the 5-year period, with an unplanned reoperation rate of 2.1-9.3%. Patients had an average ISS score of 17.5, while the average Abbreviated Injury Scale Score was 2.87. Unplanned reoperations were required in about 7% of patients. The most common complications requiring reoperation were recurrent bleeding (26.9%), wound problems (26.9%), intestinal infarction (15.4%), and anastomosis site leakage (7.7%). The procedures most frequently requiring unplanned reoperations were bowel surgery (segmental resection, primary repair, enterostomy, etc.) (24.5%) and preperitoneal pelvic packing (10.6%). Conclusions: The proportion of reoperations was confirmed to be affected by injury severity.

• Journal of Yeungnam Medical Science
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• v.16 no.1
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• pp.94-100
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• 1999

The aim of this retrospective study was to determine whether a nephron sparing surgery might be feasible in patients with a small solid renal tumor. Materials and methods: Between 1988 and 1999, 21 patients with a radiologically detectable small solid renal tumor underwent enucleoresection, wedge resection and polar segmental nephrectomy. The mean age of the 11 men and 10 women in this study was 43 years (range 14 to 68). According to the preoperative radiological diagnosis, 15 among the 21 patients were considered to have renal cell carcinoma, 4 were considered to have angiomyolipoma, and in the remaining 2 patients, radiological differentiation of renal tumors was difficult. Among 15 patients considered to have renal cell carcinoma, 14 were found to have renal cell carcinoma and the remaining one patient was diagnosed as having oncocytoma on pathologic examination. Radiological determination of angiomyolipoma in four patients was confirmed to be correct on pathological examination. The 2 patients whose radiological diagnose was difficult were found to have cavernous hemangioma and angiomyolipoma. One patient with renal cell carcinoma developed arteriocaliceal fistula, the only immediate complication in this series and underwent nephrectomy on postoperative 10th day. The mean follow up duration for the 14 patients with renal cell carcinoma was 18.6 months (range:1-103). There was no other tumor involvement in the resection margins following the nephron sparing surgery. These results suggest that nephron sparing surgery provides an effective treatment for patients with a single, small, unilateral, localized renal tumor. Longer follow-up is suggested for more definite verification of the role of nephron sparing surgery.

• Advances in pediatric surgery
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• v.10 no.2
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• pp.99-106
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• 2004

Intestinal atresia is a frequent cause of intestinal obstruction in the newborn. We reviewed the clinical presentation, associated anomalies, types of atresias, operative managements, and early postoperative complications in 36 cases of intestinal atresia treated at the Department of Surgery, Kyungpook National University Hospital between January 1994 and February 2003. Location of the lesion was duodenum in 17 patients, jejunum in 11 patients and ileum in 8 patients. The male to female ratio was 1:1.4 in duodenal atresia (DA), 2.7:1 in jejunal atresia (JA) and 7:1 in ileal atresia (IA). The most common type was type III (41.1 %) in DA, and type I (52.6 %) in JA and IA. The most common presenting symptoms was vomiting(88.2 %) in DA, but in jejunoileal atresia, vomiting(89.4 %) and abdominal distension(89.4 %) were the most common sign and symptom. All cases of DA were diagnosed by plain abdominal radiography. There were 6 cases of DA with congenital heart disease, 3 cases of DA with Down syndrome and 3 cases of JA with meconium peritonitis. Segmental resection was performed in 13 cases, duodenoduodenostomy in 11 cases, membrane excision in 7 cases, jejunojejunostomy in 2 cases, gastroduodenostomy in 2 cases and ileocolic anastomosis in 1 case. There were 9 postoperative complications including 3 each of anastomotic leakage, wound infection, and intestinal obstruction 3 cases. The mortality rate for DA was 11.8 %(2/17). Both deaths in DA were attributed to congenital heart disease. The mortality rate for JA was 18% (2/11). Both cases died with sepsis and short bowel syndrome.

• Archives of Reconstructive Microsurgery
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• v.3 no.1
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• pp.32-39
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• 1994

One hundred and sixty patients had reconstructive surgery of the lower extremity with the microsurgical technique at the department of orthopaedic surgery, Yonsei University College of Medicine from 1982 to 1989. There were ninty-six cases of men and sixty-four cases of women, in which the mean age was 23.8 years. These patients were followed for 21.4 months. The causes were 114 cases from traffic accidents, 18 cases from tumors, 12 cases from machinery injuries, 5 cases from burns, 2 cases from explosive injuries, and 9 cases from other reasons. There were 55 cases of scapular flap, 35 cases of groin flap, 23 cases of free vascularized osteocutaneous flap, 18 cases of parascapular flap, 9 cases of combined scapular and latissimus dorsi flaps, and 8 cases of segmental resection and rotationplasty. Success in reconstructive surgery with the microsurgical technique was achieved in one hundred and thirty four cases, and function and cosmetic results were excellent. Free vascularized flap with development of the microsurgical technique has taken an important role in reconstruction of large extremity defects where skin graft and distant flap were not applicable. Reconstruction of the lower extremity with the microsurgical technique is indicated with free vascularized osteocutaneous flap when there is a large defect of bone, a need for injured nerve replacement, and in the case of needed multiple staged operations. In these instences, this technique is regarded as simple one-staged reconstructive surgery.