• Journal of Chest Surgery
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• v.24 no.3
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• pp.292-295
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• 1991

Pulmonary sequestration is a rare congenital malformation of the lung and occasionally accompanied with upper gastrointestinal anomalies. Based on the embryologic development, they are grouped as broncho-pulmonary foregut malformation. We present one the case of the intralobar pulmonary sequestration with gastric duplication. The sequestrated pulmonary tissue was 9x7x8cm in dimension, multiseptated and multiloculated, and supplied by a systemic artery of 7mm diameter from the abdominal aorta. The gastric duplication was 8cm in diameter located at the posterior wall of the stomach without communication with the gastric lumen.

• Journal of Gastric Cancer
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• v.15 no.3
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• pp.191-200
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• 2015

Purpose: This study evaluated the functional and oncological outcomes of proximal gastrectomy (PG) in comparison with total gastrectomy (TG) for upper-third early gastric cancer (EGC). Materials and Methods: The medical records of upper-third EGC patients who had undergone PG (n=192) or TG (n=157) were reviewed. The PG group was further subdivided into patients who had undergone conventional open PG (cPG; n=157) or modified laparoscopy-assisted PG (mLAPG; n=35). Patients who had undergone mLAPG had a longer portion of their intra-abdominal esophagus preserved than patients who had undergone cPG. Surgical morbidity, recurrence, long-term nutritional status, and the incidence of reflux esophagitis were compared between the groups. Results: The rate of postoperative complications was significantly lower for PG than TG (16.7% vs. 31.2%), but the five-year overall survival rate was comparable between the two groups (99.3% vs. 96.3%). Postoperative levels of hemoglobin and albumin were significantly higher for patients who had undergone PG. However, the incidence of reflux esophagitis was higher for PG than for TG (37.4% vs. 3.7%; P<0.001). mLAPG was related to a lower incidence of reflux esophagitis after PG (P<0.001). Conclusions: Compared to TG, PG showed an advantage in terms of postoperative morbidity and nutrition, and there was a comparable prognosis between the two procedures. Preserving the intra-abdominal esophagus may lower the incidence of reflux esophagitis associated with PG.

• Advances in pediatric surgery
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• v.12 no.2
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• pp.221-231
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• 2006

Solid pseudopapillary tumor (SPT) of the pancreas occurs most frequently in the second or third decades of life, and is prevalent in females. Unlike other pancreatic malignancy, SPT usually has a low malignancy potential. This study reviews our clinical experience and surgical treatment of pancreatic SPT. Admission records and follow-up data were analyzed retrospectively for the period between January 1996 and January 2003. Five patients with a pancreatic mass were operated upon and SPT was confirmed by pathology in each case. The male to female ratio was 1: 4. The median age was 13.8 years. Findings were vague upper abdominal pain (n=5, 100 %) and an abdominal palpable mass (n=3, 60 %). The median tumor diameter was 6.8cm and the locations were 2 in the pancreatic head (40 %) and 3 in the pancreatic tail (60 %). Extra-pancreatic invasion or distant metastasis was not found at the initial operation in all five cases. A pyloruspreserving pancreaticoduodenectomy (n=1) and a mass enucleation (n=1) were performed in two patients of pancreatic head tumors. For three cases of tumors in pancreatic tail, distal pancreatectomy (n=2) and combined distal pancreatectomy and splenectomy (n=1) were performed. The median follow-up period was 60 months(12-117month). During the follow-up period, there was no local recurrence, nor distant metastasis. Postoperative adjuvant chemotherapy or radiotherapy was not carried out. All five children were alive during the follow up period without any evidence of disease relapse. SPT of the pancreas in childhood has good prognosis and surgical resection of the tumor is usually curative.

• Journal of Chest Surgery
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• v.27 no.6
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• pp.489-493
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• 1994

Our patient was a 2.3 kg, male of 33 weeks gestation and spontaneous vaginal delivery. Copious salivary secretion, mild aspiration pneumonia episode due to tracheoesophageal fistula and intermittent cyanotic appearance due to hypoxia were noted shortly after birth. Head up position, frequent upper pouch suction, and adequate fluid and antibiotic therapy were done in incubator. Combined Chest and abdominal film was revealed gas in the stomach and an haziness in right chest with mediastinal shift to the right side. Esophagogram revealed markedly dilated proximal esophagus as blind pouch, and Two dimensional echocardiography showed the Ventricular Septal Defect. The conclusion was congenital esophageal atresia with tracheoesophageal fistula, Vogt-Gross type C, Waterston Risk Category B. Surgical correction with Beardmore anastomosis was performed extrapleurally through 3rd rib bed after the cannulation of umbilical vein and preliminary gastrostomy. The fistula was closed by triple ligation and the upper pouch was then brought down to the presenting surface of the lower esophageal segment that incised, and end to side anastomosis was underwent using interrupt suture placed through the full thickness of both upper pouch and lower esophageal segment. The postoperative patient was well tolerated and recovered uneventfully, permitted feeding on 7th postoperative day after esophagogram.

• Journal of Yeungnam Medical Science
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• v.15 no.1
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• pp.67-74
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• 1998

Successful management of duodenal obstruction in newborn infant implies not only satisfactory nutrition but also achievement of normal growth. To aid early diagnosis and management, we evaluated the diagnostic methods, operative interventions and clinical characteristics of thirty-nine infants with congenital duodenal obstructions. In the 11-year period from July 1986 through June 1997, thirty-nine patients with congenital duodenal obstruction (23 males and 16 females) were treated and reviewed at the Department of Pediatric Surgery, Yeungnam University Hospital. The ratio of male to female was 1.4:1, and 29 cases(74.1%) among total 39 patients were newborn. There were 5 premature patients and 16 patients of small for gestational age. The most common causes of the congenital duodenal obstruction was malrotation (26 cases, 66.7%) and followed by annular pancreas (9 cases, 23.1 %), type 1 atresia (3 cases, 7.7%) and wind-sock anomaly (1 case, 2.6%). Common symptoms were vomiting, abdominal distention, jaundice. Plain abdominal X-ray study combined with upper gastrointestinal series was the most commonly used diagnostic method. The operative procedures were performed by same pediatric surgeon utilizing Ladd's procedure in 26, duodenoduodenostomy in 8, duodenojejunostomy in 4, excision of wind-sock membrane in 1. A total of 15 associated congenital anomalies were found in 9 patients. Postoperative complications occurred in 13(33.3%). Overall mortality was 2.6%(1/39). Bilious vomiting and plain abdominal radiologic study were most useful for the diagnosis of congenital duodenal obstruction. Early diagnosis and operative intervention were important to prevent complications such as sepsis and peritonitis.

• The Korean Journal of Pain
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• v.11 no.1
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• pp.41-46
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• 1998

Background: Preoperative analgesia may prevent nociceptive inputs generated during surgery from sensitizing central neurons and therefore may preempt postoperative pain. Although preemptive analgesia has shown to decrease postinjury pain in animals, studies in human are not consistent. We studied whether epidural morphine injection before surgical incision could affect postoperative pain and analgesic demands, compared with injection after removal of specimen. Methods: Forty patients scheduled for radical subtotal gastrectomy were randomly assigned to one of two groups for prospective study in a double-blind manner. Group 1 received an epidural injection of 3 mg of morphine in 8 ml of 0.9% saline before surgical incision, and Group 2 after removal of specimen. Postoperative pain relief was provided with I.V. patient controlled analgesia (PCA) system. Numerical rating scales for pain and mood, Prince Henry Hospital scores for pain, cumulative PCA analgesic consumptions, and incidence of side effects were assessed at 2, 6, 12, 24, 48 hours after operation. Results: Cumulative PCA analgesic consumption in group 1 was significantly less than in group 2 at 2, 6 hours after surgery. Pain scores and the incidence of side effects were similar in both groups. Conclusions: Preoperative analgesia with epidural morphine showed little difference in patient controlled analgesic consumption after upper abdominal surgery compaired to intraoperative morphine.

• The Korean Journal of Pain
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• v.5 no.2
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• pp.229-233
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• 1992

Recently a non-electronic, disposable and portable infusor, Baxter $Infusor^{(R)}$, has developed for delivering not only a continuous drug infusion but also extradoses of medication on a demand basis. The present study examined the impact of two methods of pain management on recovery in 20 patients undergoing upper abdominal surgery for stomach cancer. One group, 10 patients, received IV meperidine in the recovery room and IM meperidine on the ward on a PRN basis(PRN group). In the other group, 10 patients, a loading dose of nalbuphine 0.1mg/kg was given when the patient first complained of pain in the recovery room and patient controlled analgesia with IV nalbuphine, 0.5mg/kg day for continuous infusion, was initiated and continued for 72 hours(PCA group). The devices for PCA group was Baxter Infusor with patient control module which had flow rate 0.5ml/hr and lockout time was 15 min. As results of this study, the patients of PCA group get less pain than PRN group on operation day, the first and second days after surgery. VAPS values are $6.47{\pm}1.64$ vs $4.44{\pm}1.38$, $5.02{\pm}1.22$ vs $2.62{\pm}0.93$ and $3.22{\pm}1.47$ vs $2.02{\pm}0.71$ respectively pertaining to PRN and PCA groups(p<0.05). In conclusion, PCA group with IV nalbuphine provided more effective postoperative analgesia than PRN group with conventional meperidine IM.

• Archives of Plastic Surgery
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• v.36 no.6
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• pp.707-713
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• 2009

Purpose: The deep inferior epigastric perforator(DIEP) free flap is well known as an ideal donor site for the breast reconstruction. The flap can provide huge amount of fat tissue for breast and buttock contour, while it is also very useful as a thin skin flap to reconstruct the upper and lower extremities. We used a DIEP free flap in various site reconstructions besides the breast and would like to reinsure the usefulness of this flap. Methods: Twenty nine consecutive patients who underwent DIEP free flap surgery from 2001 January to 2007 December were reviewed. The case constituted seven male patients and twenty two female patients. There were sixteen breast reconstructions, five face reconstructions, five lower extremity reconstructions, two upper extremity reconstructions, and one buttock contour reconstruction. All clinical data were based on the patient's medical records. Results: All DIEP free flaps survived without major complications. There was no hematoma, seroma, or partial necrosis. The donor sites were closed primarily with linear scar on lower abdomen. The thinnest part of flap was 0.7 cm in thickness. The size of the largest flap was $38{\times}13cm$. The flaps were used in various types of skin and adipose tissue, adipose tissue only, and skin only according to the requirement of recipient site. Conclusion: The DIEP free flap was enough to provide a thin and huge flap for both breast and extremity reconstructions. It was able to provide versatile designs with sufficient adipose tissue. So we use it for 3 - dimentional face and buttock contour reconstructions. The DIEP free flap is a valuable reconstructive donor for face, upper and lower extremity in addition to breast without compromising the integrity of abdominal wall.

• Journal of Chest Surgery
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• v.11 no.4
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• pp.456-460
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• 1978

Desmoid tumor is found most often in the anterior abdominal wall of parous women. Although it may originate in virtually any musculotendinous structure, those of the chest wall are rare. We experienced a case of large dumb bell shaped desmoid tumor originated in intercostal muscle and invaded anterior chest wall, pericardium, pleura and the lung. The patient was healthy in appearance except a painful swelling on the anterior chest wall. Roentgenographic studies demonstrated a huge homogenous mass in the right anterior chest cavity. He was treated with resection of the tumor including .anterior chest wall, a portion of the pericardium, middle lobe, and part of upper & lower lobes of the right lung because of tumor invasion. The tumor composed with two parts, one [$5{\times}4{\times}3$cm in size] is over the rib cage and another [$10{\times}15{\times}10$cm in size] is in the right chest cavity. Postoperative course was uneventful and there was no evidence of recurrence until last visit, 5 months after surgery.

• The Korean Journal of Pain
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• v.2 no.2
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• pp.167-173
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• 1989

Inadequate pain relief after upper abdominal surgery increases the incidence of pulmonary complications due to the difficulty in coughing and deep breathing. Kvalheim and Reiestad (1984) introduced intrapleural administration of local anesthetic solutions to produce analgesia following cholecystectomy performed through a subcostal incision, unilateral breast surgery and renal surgery. We studied continuous intrapleural administration of bupivacaine and epinephrine, and its effect in controlling pain after cholecystectomy. In 9 patients, an intermittent dosage technique was used. An intrapleural catheter was inserted and 20 ml of 0.5% bupivacaine and 1:100,000 epinephrine was administered. Results were as following: 1) Mean analgesic duration from the initial intrapleural injection to secondary administration of supplementary bupivacaine was 13.5 hours. 2) No specific changes were noted on vital signs and arterial blood gases. 3) Effective analgesia, produced by intrapleural bupivacaine resulted in significant improvement in tidal volume as measured by spirometry. 4) No signs of systemic toxicity and complications were encountered. 5) Intrapleural administration of a local anesthetics after cholecystectomy provides a satisfactory duration of analgesia.