• Journal of Trauma and Injury
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• 제28권4호
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• pp.241-247
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• 2015

Purpose: To evaluate the influence of how the trauma care system is applied on the management of trauma patients. Methods: We divided the patients into a pre-trauma system group and a post-trauma system group according to the time when we began to apply the trauma care system in our institution. We compared the general characteristics, injury severity score, initial response time to the trauma patients, number of preventable deaths, and clinical outcomes between the two groups. Results: The numbers of patients in the pre-trauma system group and the post-trauma system group were 188 and 257, respectively. No differences in the patient's median ages, trauma scores (ISS, RTS, TRISS) and proportions of severe trauma patients (ISS>15) were observed between the two groups. The number and the proportion of patients who were admitted to our hospital were increased in the post-trauma system group. The time interval from trauma CP activation to emergency surgery or angio-embolization, and the patient's time spent in emergency room were shortened in the post-trauma system group. However, the lengths of the ICU stay and the hospital stay, and the number of in-hospital mortalities were not improved in the post-trauma system group. In severe trauma patients (ISS>15), there were no differences between the two groups in the number and the proportion of admitted patients, and the time interval from trauma CP activation to performing a diagnostic and therapeutic procedure was not shortened in the post-trauma system group. Conclusion: Application of the trauma care system has shortened the time between the initial response and patient management. However, this improvement was not enough to result in better clinical outcomes. More trauma physicians, multidisciplinary cooperation, and a well-organized trauma management process will be needed if the maximum efficacy of the trauma system is to be achieved.

• Journal of Gastric Cancer
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• 제18권3호
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• pp.296-304
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• 2018

Purpose: This study aimed to examine the outcomes of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal metastasis (PM) of advanced gastric cancer (AGC). Materials and Methods: Between May 2015 and June 2017, 38 CRS and HIPEC procedures were performed in patients with PM of AGC at the Dankook University Hospital. We prospectively collected and analyzed data regarding PM grade, morbidity and mortality rates, and short-term follow-up results (median, 13.5 months). Results: The mean peritoneal cancer index was 15 (range, 0-39). Complete cytoreduction was achieved in 21 patients (55.2%), whereas complications occurred in 16 (42.1%) and 2 (5.7%) patients died. The overall median patient survival time was 19 months. The patients who underwent complete cytoreduction had a median survival time of 26 months, which was significantly longer than the median survival time of 16 months in the patients who did not undergo complete cytoreduction (P=0.006). Conclusions: CRS with HIPEC may have a beneficial effect in patients with PM of AGC. However, the rates of complications and mortality associated with this combined therapeutic approach are high. Therefore, this treatment should be performed only in selected patients by surgeons experienced in the field of gastric cancer with PM.

• Archives of Plastic Surgery
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• 제49권5호
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• pp.696-700
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• 2022

We performed distal bypass and free flap transfer in a single-stage operation to repair an extensive soft tissue defect in an ischemic foot of an 84-year-old woman. The nutrient artery of the free flap was anastomosed to the bypass graft in an end-to-side manner. Subsequently, the bypass graft became occluded on several occasions. Although intravascular and surgical interventions were performed each time, the bypass graft eventually became completely occluded. However, despite late occlusion of the nutrient artery, the free flap has remained viable and the patient is ambulatory. The time required for a transplanted free flap to become completely viable without a nutrient artery is likely longer for an ischemic foot compared with a healthy foot. However, the exact period of time required is not known. A period of month was required in our patient. We report this case to help clarify the process by which a free flap becomes viable when applied to an ischemic foot.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.43.1-43.5
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• 2015

Image-guided surgery potentially enhances intraoperative safety and outcomes in a variety of craniomaxillofacial procedures. We explore the efficiency of one intraoperative navigation system in a single complex craniofacial case, review the initial and recurring costs, and estimate the added cost (e.g., additional setup time, registration). We discuss the potential challenges and benefits of utilizing image-guided surgery in our specific case and its benefits in terms of educational and teaching purposes and compare this with traditional osteotomies that rely on a surgeon's thorough understanding of anatomy coupled with tactile feedback to blindly guide the osteotome during surgery. A 13-year-old presented with untreated syndromic multi-suture synostosis, brachycephaly, severe exorbitism, and midface hypoplasia. For now, initial costs are high, recurring costs are relatively low, and there are perceived benefits of imaged-guided surgery as an excellent teaching tool for visualizing difficult and often unseen anatomy through computerized software and multi-planar real-time images.

• Journal of Chest Surgery
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• 제22권6호
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• pp.996-1000
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• 1989

Open heart surgery begun at 1959 in Korea. From that time to 1979, the surgery was performed below 100 cases in a year. However,that was performed above, 1,000 cases in a year from 1981. During the recent three years, i.e., 1985, 1986, and 1987, the annual operative cases were 3614,4503, and 4906, and then the mortality rates were progressively decreased to 6.2%, 5.3 %, and 5.0 %. In these time, overall mortality rate above 1 year old was 5.0 % versus that below 1 year old 17.9 9o in congenital heart diseases. These results are statistically different between two groups. Of the valvular heart disease cases, which occupied 97 % of total acquired heart disease, individual incidence was in mitral 68 %, and aortic 28%. The operative method was mainly valve replacement. Operative mortality for valve surgery in total was 4.4 %. Until 1985, bioprosthetic valve was frequently implanted but mechanical valve has been done more frequently in these days. Coronary artery bypass graft was large portion [67 * 75 %] of open heart surgery in western, but was below 1 % in Korea. However our diet patterns have been changed. Therefore we think the incidence of coronary artery disease will be increased. So we will be familiar to this field.

• Journal of Chest Surgery
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• 제13권1호
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• pp.41-47
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• 1980

Fifty one consecutive patients undergoing open heart surgery, twenty eight congenital and twenty three acquired heart disease, were studied between May and August 1979 in Dept. of Thoracic and Cardiovascular Surgery SNUH. During the same time 10 patients of PDA were included in this study as control group. Four out of fifty one OHS patients, two ASD and two pulmonic stenosis patients, were operated without aortic cross-clamp. In all patients, serial determination of total level of creatine phosphokinase [CPK], lactic dehydrogenase [LDH], glutamic oxaloacetic transaminase [SGOT] were made preoperatively, operative day [immediate post-op], and post-operative days up to 7th day. Electrocardiograms were also evaluated serially. Open heart surgery patients were divided into two groups; Group A was aorta clamp time beyond SO minutes, and Group B was below 50 minutes. The peak level of each enzyme was compared, and electrocardiographic changes were also compared between groups. Although the electrocardiographic changes were more frequent in Group A [50%] than Group B [24%], the peak levels of each enzymes were almost same in Group A and Group B.

• Journal of Chest Surgery
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• 제14권1호
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• pp.1-8
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• 1981

Alterations in serum enzymes were studied in twenty-five patients who underwent open heart surgery in N.M.C. during the period from June 1979, to Feb. 1980. There were fifteen congenital and ten acquired heart diseases. In all patients, Rygg-Kyvsgaard five head roller pump and Polystan bubble oxygenator were used and serial determination of total level of Creatine phosphokinase [CPK], Lactic dehydrogenase [LDH], Glutamic oxaloacetic transaminase [SGOT] were made preoperatively, operation day [just after aortic clamp release, 2 hrs later, 4 hrs later, 6 hrs later], and postoperative days up to 5th day. Immediate postoperative clinical courses were also evaluated. Twenty-five patients were divided into two groups: Group A[13] was cardiopulmonary bypass time more than 95 minutes and aortic clamp time more than 45 minutes. Group B[12] was cardiopulmonary bypass time less than 95 minutes and aortic clamp time less than 45 minutes. The peak levels of SGOT, LDH in Group A were more significantly elevated than Group B [P<0.05]. But peak levels of CPK were not significant between two groups. In the view of clinical evaluation, poor clinical courses were more frequent in Group A [54%] than Group B[8%].

• Archives of Plastic Surgery
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• 제34권5호
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• pp.617-621
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• 2007

Purpose: With the necessity of comprehensive care for the breast cancer patients, Breast Care Center of our hospital started to work in March 2004. This study examined the 3-year execution of Breast Care Center. The role of Breast Care Center was evaluated in aspect of clinical activities in quality and quantity. Methods: A retrospective review was carried out from 2001 to 2007 with breast cancer patients. The number and type of breast cancer surgery and breast reconstruction procedure were compared before and after Breast Care Center's foundation. Time required for the diagnosis and treatment was also compared. Regression analysis and T-test were used to identify the statistical significance. Results: The number of breast cancer surgery did not statistically increase compared with progressive increase of breast cancer. QUART(quadrantectomy, axillary dissection, radiotherapy) procedure statistically significantly increased and MRM(Modified Radical Mastectomy) procedure decreased for breast cancer surgery after foundation of Breast Care Center. The number of breast reconstruction procedures statistically significantly increased. The number of immediate TRAM free flap (Transverse Rectus Abdominal muscle free flap) procedures has grown 3.8 times after foundation of Breast Care Center. The time required for diagnosis and treatment was also shortened. Conclusion: After foundation of Breast Care Center, the number of breast reconstruction surgery increased, while the counselling time in breast reconstruction was reduced. Breast Care Center provided a prompt and comprehensive care to the breast cancer patients through the multidisciplinary therapeutic approaches.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제32권5호
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• pp.478-483
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• 2010

Bisphosphonates are synthetic analogue and have high affinity on bone remodeling site. Since they have a long half-reduction time, they accumulate at bone and act for a long time. They are widely used in osteo-porosis derived from imflammatory bowel disease or postmenopausal osteoporosis patient for bone mineral density improvement. In addition, they neutralize hypercalcemia owing to bone metastasis of malignancy. However, a jaw bone necrosis was recently reported in some patients who have taken bisphosphonates for a long time. It is called Bisphosphonate Related Osteonecrosis of Jaws (BRONJ). It can come spontaneous-ly, but more often after oral surgery including tooth extraction. In this case, a 80-year-old woman was treated with bisphosphonate (sodium alendronate) for 2 years to improve bone mineral density. She had her left lower second molar tooth extracted at local clinic. After extraction, she had inflammatory symptoms like a pain, a cheek swelling, and a discharge of pus. She was referred to our clinic for treatment. We treated meticulously from dressing to surgery. After following up about 1.5 years, the jaw lesion was successfully healed. So we report this case.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제16권3호
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• pp.447-457
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• 1994

Authors have studied retrospectively the facial nerve injury after TMJ surgery through the preauricular approach routine. The study material used was 4 patients of all 113 patients who were diagnosed as internal derangement and have been operated from March 1989 to February 1991 in Youngdong severance hospital, and were induced postoperatived facial nerve injury. The patient group who had the postoperative injured facial nerve was recognized degree of injury using the diagnostic method, Electromyography(EMG) and Nerve conduction test(NCT) which are used widely at present and was treated as conservative care and we identified the recovery time as the same method. The results as follows : 1. The meticulous care and precious surgical technique are needed in both operation and postoperation. During the TMJ surgery, the excessive retraction of the flap and frequent use of nerve stimulator and electric surgical knife should be avoided as possible and postoperative hematoma and swelling should be minimized. 2. The 4 patients were experienced with the postoperative facial nerve injury of all 133 patients who had been operated the TMJ surgery through the routine preauricular approach on our hospital. And the incidence of postoperative facial nerve injury happened was about 0.3% and its incidence was relatively low comparing with any other previous reports. 3. EMG and NCT were considered as useful methods which can diagnose the nerve injury objectively and identified the effect of treatment and recovery time. 4. The faical nerve-injured patients who were induced postoperatively after TMJ surgery, were diagnosed as second-degree nere injury through the EMG and NCT. And the patient group was treated well as conservative physical therapy for about 2 to 4 months.