• Journal of the Korean Orthopaedic Association
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• v.53 no.6
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• pp.478-489
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• 2018

Total knee arthroplasty has become a standard procedure for advanced knee arthritis to relieve pain and improve function. Computer-assisted navigation systems have been used in total knee arthroplasty to improve the mechanical axis of the limb as well as the alignment and position of the components. A computer-assisted navigation system has the advantage of real-time feedback during surgery, such as mediolateral balance in extension and flexion gap, alignment of the lower limb, and components. On the other hand, the computer-assisted navigation system requires an additional stab wound for tracker fixation, which can increase the likelihood of superficial wound infection and stress fractures and increase the operation time and cost of surgery. The clinical efficacy of computer-assisted navigation in total knee arthroplasty is also controversial. Compared to the conventional technique, computer navigation improves the accuracy of the postoperative mechanical axis within outliers of $3^{\circ}$ varus or $3^{\circ}$ valgus. This paper reviews the surgical technique, pitfalls, clinical and radiological outcomes, useful clinical cases, and future perspectives in computer-assisted navigation total knee arthroplasty.

• Journal of Chest Surgery
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• v.46 no.6
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• pp.426-432
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• 2013

Background: Heart transplantation has become a widely accepted surgical option for end-stage heart failure in Korea since its first success in 1992. We reviewed early postoperative complications and mortality in 239 patients who underwent heart transplantation using bicaval technique in Asan Medical Center. Methods: Between January 1999 and December 2011, a total of 247 patients aged over 17 received heart transplantation using bicaval technique in Asan Medical Center. After excluding four patients with concomitant kidney transplantation and four with heart-lung transplantation, 239 patients were enrolled in this study. We evaluated their early postoperative complications and mortality. Postoperative complications included primary graft failure, cerebrovascular accident, mediastinal bleeding, renal failure, low cardiac output syndrome requiring intra-aortic balloon pump or extracorporeal membrane oxygenation insertion, pericardial effusion, and inguinal lymphocele. Follow-up was 100% complete with a mean follow-up duration of $58.4{\pm}43.6$ months. Results: Early death occurred in three patients (1.3%). The most common complications were pericardial effusion (61.5%) followed by arrhythmia (41.8%) and mediastinal bleeding (8.4%). Among the patients complicated with pericardial effusion, only 13 (5.4%) required window operation. The incidence of other significant complications was less than 5%: stroke (1.3%), low cardiac output syndrome (2.5%), renal failure requiring renal replacement (3.8%), sternal wound infection (2.0%), and inguinal lymphocele (4.6%). Most of complications did not result in the extended length of hospital stay except mediastinal bleeding (p=0.034). Conclusion: Heart transplantation is a widely accepted option of surgical treatment for end-stage heart failure with good early outcomes and relatively low catastrophic complications.

• Journal of Korean Foot and Ankle Society
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• v.24 no.2
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• pp.81-86
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• 2020

Purpose: Ankle fractures with dislocations and pilon fractures at the distal tibia are usually associated with soft tissue damage caused by high-energy damage. Recently, a two-stage operation to perform internal fixation after the application of external fixation devices for stabilizing soft tissues has been accepted as the treatment of choice. This paper reports the clinical result of these injuries treated with threaded trans-calcaneal pin external fixation devices. Materials and Methods: Thirty-three patients diagnosed with ankle fractures with dislocations or tibial pilon fractures without open wounds. They underwent surgical treatment with threaded trans-calcaneal pin external fixation from January 2008 to February were enrolled in this study. This study evaluated the visual analogue scale (VAS), foot function index (FFI), and Olerud & Molander score as well as whether complications occurred. Results: The average VAS showed a meaningful decrease (p<0.001) from 7.4 before surgery to 2.6 after application of the external fixation device, and 1.4 at 12 months after surgery. The FFI also decreased significantly from 84.3 preoperatively to 20.3 at 12 months postoperatively (p<0.001). The Olerud & Molander score averaged 71.4 points, showing good clinical results. Complete bone union was observed in all patients. One patient each underwent debridement due to wound necrosis and infection in the pin insertion site. At the final follow-up, seven patients had posttraumatic ankle joint arthritis, according to a radiological examination. Conclusion: Manual reduction and external fixation using a threaded trans-calcaneal pin is a suitable surgical technique that is easy to perform and shows good clinical outcomes in stabilizing soft tissue damage in fractures and dislocations of ankle fracture or tibia pilon fractures in foot and ankle injury.

• Journal of Chest Surgery
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• v.31 no.8
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• pp.804-810
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• 1998

Background: Multiple trauma patients have rapidly increased due to traffic accidents, industrial disasters, incidental accidents, and violence. Multiple trauma can involve injuries to the heart, lung, and great vessels and influence the lives, necessitate prompt diagnosis and treatment. Most of the thoracic injuries can be managed with conservative method and simple surgical procedures, such as closed thoracostomy, but in certain cases open thoracotomy is necessary. Materials and methods: The author analyzed the surgical result of 70 cases of open thoracotomy after multiple organ injury including thoracic organ. Results: The most common type of thoracic lesion was hemothorax with or without pneumothorax and diaphragmatic rupture was the second. Sixty percent of the patients were associated with bone fractures, 42.9% with abdominal injuries, and 37.1% with head injuries. The modes of operation were ligations of torn vessels for bleeding control(48.6%), repair of diaphragm(35.7%), and repair of lung laceration(25.7%) in this order of frequency and additional procedures were splenectomy(14.3%), hepatic lobectomy (8.6%) and repair of liver lacerations(5.7%). Postoperative complications were atelectasis (8.6%), wound infection (8.6%), and pneumonia(4.3%). Postoperatively six patients died(The mortality rate was 8.6%) and the causes of death were respiratory failure(2), acute renal failure(2), sepsis(1), and hypovolemic shock(1).

• Journal of Chest Surgery
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• v.29 no.4
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• pp.403-407
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• 1996

One hundred and twenty three patients underwent 137 thoracostomies for spontaneous pneumothorax in the department of Thoracic and Cardiovascular Surgery, Gyeongsang National University from January 1987 to December 1994. There were 118 men and 6 women and average age was )2.4 years. The two most common surgical Indications were recurrent pneumothorax and continuous air leakage. Other indications were visible bullae on simple X-ray, previous contralateral pneumothorax, incomplete expansion of the lung, and bilateral pneumothoraces. Methods of thoracotomy were subaxillary thoracotomy in 82 cases, lateral minithoracotomy in 12 cases and posterolateral thoracotomy in 43 cases. Operation time was 63.0 $\pm$ 30.8, 98.3 $\pm$ 37.9, 186.9 $\pm$ 87.9 minutes respectively, and postoperative chest tube keeping time was 5.2 $\pm$ 4.1 days in subaxillary thoracotomy, 6.2 $\pm$ 5.0 days in minithoracotomy and 10.0 $\pm$ 5.8 days in posterolateral thoracotomy Bullae were present mostly at the apex in spontaneous and tuberculous pneumothorax comparred to the cases of chronic obstructive or emphysematous lung disease, where there were no redilection of presence of bullae (p< 0.01). Operative procedures were wedge resection, bullae obliteration and lobectomy. Postoperative complications were continuous air leakage, bleeding, brachial plexus injury, empyema, and wound infection, but all the complications were cured by the time of discharge. There was no mortality.

• Journal of Korean Neurosurgical Society
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• v.42 no.4
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• pp.311-316
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• 2007

Objective : The objective of this study is to investigate the safety, surgical efficacy, and advantages of a polyaxial screw-rod system for posterior occipitocervicothoracic arthrodesis. Methods : Charts and radiographs of 32 patients who underwent posterior cervical fixation between October 2004 and February 2006 were retrospectively reviewed. Posterior cervical polyaxial screw-rod fixation was applied on the cervical spine and/or upper thoracic spine. The surgical indication was fracture or dislocation in 18, C1-2 ligamentous injury with trauma in 5, atlantoaxial instability by rheumatoid arthritis (RA) or diffuse idiopathic skeletal hyperostosis (DISH) in 4, cervical spondylosis with myelopathy in 4, and spinal metastatic tumor in 1. The patients were followed up and evaluated based on their clinical status and radiographs at 1, 3, 6 months and 1 year after surgery. Results : A total of 189 screws were implanted in 32 patients. Fixation was carried out over an average of 3.3 spinal segment (range, 2 to 7). The mean follow-up interval was 20.2 months. This system allowed for screw placement in the occiput, C1 lateral mass, C2 pars, C3-7 lateral masses, as well as the lower cervical and upper thoracic pedicles. Satisfactory bony fusion and reduction were achieved and confirmed in postoperative flexion-extension lateral radiographs and computed tomography (CT) scans in all cases. Revision surgery was required in two cases due to deep wound infection. One case needed a skin graft due to necrotic change. There was one case of kyphotic change due to adjacent segmental degeneration. There were no other complications, such as cord or vertebral artery injury, cerebrospinal fluid leak, screw malposition or back-out, or implant failure, and there were no cases of postoperative radiculopathy due to foraminal stenosis. Conclusion : Posterior cervical stabilization with a polyaxial screw-rod system is a safe and reliable technique that appears to offer several advantages over existing methods. Further biomechanical testings and clinical experiences are needed in order to determine the true benefits of this procedure.

• Korean Journal of Head & Neck Oncology
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• v.8 no.2
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• pp.72-81
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• 1992

Thyroid cancer, the most common cancer of endocrine neoplasms, has tremendous variation in tumor biologic behavior. There is no consensus about treatment mode to prevent recurrences despite of recent advance in understanding characteristics of thyroid cancer. So, we have made a clinical analysis and follow-up study of recurred 27 cases among 189 cases treated under the diagnosis of thyroid carcinoma in the department of surgery, Chonnam University Hospital from February, 1982 to February, 1992 to clarify our experience about the characteristics of recurred thyroid cancer. The results were as follow: According to the pathological classification of recurred thyroid cancer, recurrence rate was 11.6% in papillary carcinoma, 15.6% in follicular carcinoma, 37.5% in medullary carcinoma, 66.7% in undifferentiated carcinoma, respectively, and the mean recurrence rate of thyroid cancer was 14.3%. The recurrence rate according to age was 28.6% in 8th decade and 17.9% in 4th decade. The recurrence rate according to sex was not singificant(15.6% in male: 14% in female). The mean period to relapse was 4 years 6 months in papillary carcinoma, 2 years 5 months in follicular carcinoma, 2 years 1 months in medullary carcinoma, 2 years 6 months in undifferentiated carcinoma. The recurrence rate according to previous operating methods, such as performing lymph node dissection or not, mode of thyridectomy, type of lymph node dissection was statisfically non-specific. Common recurrent sites of papillary and follicular carcinoma was cervical lymph node and remained thyroid tissue. Medullary and undifferentiated carcinoma was noted in multiregional or systemic involvement Reoperation was performed with complete resection of recurred or metastatic mass, such as radical neck dissection or mass extirpation from involved organs as possible. The postoperative complications were 2 cases of horseness, and 1 case with hematoma, transient hypocalcemia, wound infection, and pulmonary insufficency, respectively. 5-year survival rate was 85.5% in papillary carcinoma, 66.7% in follicular carcinoma. 50% in medullary carcinoma, and 50% in undifferentiated carcinoma. We concluded that recurrence in thyroid cancer give a reconsideration to previous conservative therapy and more extensive surgical procedures for thyroid cancer including lymphatic dissection are recommanded to prevent recurrences in selected cases if possible.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.9
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• pp.5141-5144
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• 2013

Background: This study aimed to determine clinical outcomes of local excision for early rectal cancer from a University Hospital in Thailand. Materials and Methods: We performed a retrospective review of 22 consecutive patients undergoing local excision for early rectal cancer (clinical and radiological T1/T2) from 2005-2010 at the Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok. Data were collected from patients' medical records, including demographic and clinical characteristics, pathological report and surgical outcomes. Results: This study included 10 males and 12 females, with average age of 68 years. Nineteen patients (86%) underwent transanal excision and the others had trans-sacral excision. Median operative time was 45 minutes. Postoperative complications occurred in 2 patients (9%); 1 fecal fistula and 1 wound infection following trans-sacral excision. There was no 30-day postoperative mortality. Median hospital stay was 5 days. Pathological reports revealed T1 lesion in 12 cases (55%), T2 lesion in 8 cases (36%) and T3 lesion in 2 cases (9%). Eight patients received additional treatment; one re-do transanal excision, two proctectomies, and five adjuvant chemoradiation. During the median follow-up period of 25 months, local recurrence was detected in 4 patients (18%); two cases of T2 lesions with close or positive margins, and two cases of T3 lesions. Three patients with local recurrence underwent salvage abdominoperineal resection. No local recurrence was found in T1/T2 lesions with free surgical margins. Conclusions: Local excision is a feasible and acceptable alternative to radical resection only in early rectal cancer with free resection margins and favorable histopathology.

• Clinical and Experimental Pediatrics
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• v.50 no.7
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• pp.665-671
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• 2007

Purpose : The purpose of this study was to investigate the clinical features and outcome in newborns undergoing cardiac surgery. Methods : Eighty two neonates underwent heart surgery for congenital heart defect at Kyungpook National University Hospital between March 2000 and February 2006. Patient characteristics (sex, age, diagnosis), pre-operative conditions, operation type, postoperative complications and mortality were reviewed retrospectively. Results : In 82 patients, 41 (50%) were male. The mean age and weight at operation were 12 days and 3.2 kg, respectively. The common cardiac anomalies were complete transposition of the great arteries (TGA), Tetralogy of Fallot (TOF), pulmonary atresia with intact ventricular septum, and single ventricle variants. Fifty seven operations were performed with cardiopulmonary bypass and corrective surgery was done on 54 patients. Arterial switch operation and modified Blalock-Taussig shunt were most frequently performed as corrective and palliative operations, respectively. The early hospital mortality rate was 7%; the late mortality was 3.9%. Complications were acute renal insufficiency, delayed sternal closure, wound infection, arrhythmia, and brain hemorrhage. Conclusion : During the last 6 years, the outcomes of cardiac surgery for congenital heart defects in neonates improved by progress in perioperative, anaesthetic, surgical, and postoperative care.

• The Journal of the Korea Contents Association
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• v.22 no.2
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• pp.794-802
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• 2022

This retrospective study was to investigate the characteristics of unplanned readmission and factors affecting readmission within 30 days of discharge in patients who underwent heart valve surgery through electronic medical records. The participants were 423 unplanned re-hospitalization within 30 days after heart valve surgery at a tertiary hospital in Seoul from January 2018 to August 2019. A total of 48 patients (11.3%) were unplanned readmissions, and the most common causes were atrial fibrillation in 13 cases (27.1%) and pain at the surgical site in 13 cases (27.1%). Other causes were: 10 cases (20.8%) of warfarin inappropriate treatment concentration, 7 cases of general weakness (14.6%), 5 cases of hypotension (10.4%), 4 cases of pericardial effusion (8.3%), 3 cases of surgical wound infection (6.3%), 3 cases of hemorrhage (6.3%), 3 cases of high fever (6.3%), and 1 case of cerebral infarction (2.1%). Variables influencing readmission were history of cancer (OR = 2.60, 95% CI 1.13-6.03, p = .025) and the patients who went to a home rather than a hospital after discharge (OR = 2.91, 95% CI 1.33-6.36, p = .008), as a type of valve surgery, mitral valve valvuloplasty had a higher readmission rate than aortic valve replacement (OR = 1.21, 95% CI 1.21-4.98, p = .012). In order to reduce unplanned readmissions, an tailored education program is needed to enable patients and caregivers to manage their comorbid chronic diseases before discharge and assess risk factors for readmission in advance.