• Journal of Chest Surgery
• /
• 제25권12호
• /
• pp.1502-1507
• /
• 1992

Between February and July 1992, videothoracoscopic bullectomy was performed in nineteen patients with primary spontaneous pneumothorax. The indications of this surgery are recurrent in 12, persistent airleakage in 4 and previous contralateral pneumothorax in 3 patients. For the good operative field, we used double lumen endotracheal tube and put the CO2 gas into the thoracic cavity to make the lung collapse. We usually apply the endoGIA or electric cauterization for handling the bleb or bullae and there were 9 cases with of endoGIA only, 4 electric cauterization only and 6 both procedures. To evaluate the advantage of the Videothoracoscopic surgery, we compared surgical results with that of the tho-racotomy group[19 patients]. There were significant differences in operative time[93.8$\pm$41.9 min and 17.1$\pm$53.9 min, p< 0.01] and postoperative airleakage duration[35.6$\pm$113.3 hours and 117.9$\pm$214.4 hours, p<0.05] between the Videothoracoscopy and thoracotomy group. Tube indwelling time was shortened in Videothoracoscopy group[p<0.05]. The hospital stay was very short[p<0.01] and the patients needed analgesic injection less frequentley in videthoracoscopic group[p<0.05] In conclusion, we prefer the Videothoracoscopic procedure to the thoracotomy in uncomplicateed patients with pneumothorax because of simple procedure and good results.

• Imaging Science in Dentistry
• /
• 제33권4호
• /
• pp.223-229
• /
• 2003

Purpose: To compare the effects of the conservative treatment and operative treatment by observation of osseous changes of the TMJ and mandibular asymmetry in condylar fracture patients. Materials and Methods: 33 condylar fracture patients (17 with conservative and 16 with operative treatment) were included in this study. After a minimum of 6 months after the surgical procedure, patients were given a follow up examination of the osseous changes using a transcranial view. Differences in the osseous changes of both groups were compared and the asymmetry indices were calculated on a postero-anterior skull view. Results: The TMJ of the operative treatment group showed more significant osseous changes than the conservative treatment group. The affected TMJ showed more significant osseous changes than the unaffected TMJ in the both groups. The unaffected TMJ of the conservative group and the affected TMJ of the operative group showed significant osseous changes. The mandibular asymmetry indices in the conservative and operative group were 5.12 and 7.30 respectively at the time of treatment, and 2.39 and 3.41 respectively at the follow-up. But the mandibular asymmetry between the both groups showed no statistical differences. Conclusion: The TMJ of the operative group showed more significant osseous changes than the conservative group, but the mandibular asymmetry between the both groups showed no statistical difference.

• Journal of Chest Surgery
• /
• 제42권1호
• /
• pp.9-13
• /
• 2009

서론: 좌심형성부전증후군은 사망률이 높은 질환이다. 이번 연구는 노우드(Norwood) 수술을 거쳐 최종적으로 폰탄 수술을 시행한 좌심형성부전증후군 환자에서 외과적 치료 및 폰탄 수술 후 결과를 알아 보기 위한 것이다. 대상 및 방법: 1997년 10월부터 2005년 5월까지 좌심형성부전증후군으로 노우드 수술을 시행한 21명의 환자 중 최종적으로 폰탄(Fontan) 수술을 시행한 6명의 환자를(M : F=4 : 2) 대상으로 역행적 조사를 하였다. 노우드 수술 시 평균 나이는 $17.3{\pm}10.8$일(9~36일)이었고, 양방향성 글렌수술은 $8.9{\pm}7.1$개월(4.6~23.3개월), 그리고 폰탄 수술은 $32.4{\pm}9.8$개월(20.9~43.9개월)에 시행하였다. 한 명의 환자에서 삼첨판 역류가 보여, 2차 수술 시 판막 성형술을 시행하였다. 모든 환자에서 고어텍스 도관을 이용한 심장외 폰탄 수술(20 mm 2명, 18 mm 4명)을 하였으며 1명에서 개방창(fenestration)을 두었다. 결과: 노우드 수술 사망률은 30% (7/21)이며, 4명의 중간단계사망이 있어, 10명만이 양방향성 글렌수술을 시행 하였다. 10명의 환자 중 1명의 만기 사망과 1명의 외래 관찰 누락이 있었으며, 6명의 환자는 현재 폰탄 수술을 시행한 후 외래 관찰 중이고, 2명은 폰탄 수술을 위해 대기 중이다. 폰탄 수술 후에는 1명에서 출혈로 재수술을 한 이외의 합병증은 없었다. 모든 환자가 정상 동성 리듬을 보였다. 수술 후 시행한 초음파에서 모든 환자에서 좋은 심실기능을 관찰할 수 있었으며, 삼첨판 역류는 2명에서만 Grade I으로 관찰되었다. 환자들은 현재 평균 $19.6{\pm}14.9$개월(1.5~39.1개월)간 외래 관찰 중이며, 현재 모든 환자에서 항 혈소판제(아스피린) 및 심장약을 투약하고 있으며, 모두 NYHA functional class I의 상태이다. 결론: 좌심형성부전증후군으로 Norwood 술식을 거쳐 최종적으로 폰탄 수술을 시행한 환자에서 1차 수술 후 높은 사망률을 보임에도 불구하고 만족할만한 혈류역학과 임상상태를 확인할 수 있었고, 단계적 수술 교정법은 이 질환에서, 보다 적극적으로 고려되어야 된다고 사료된다.

• 한국간담췌외과학회지
• /
• 제28권2호
• /
• pp.214-219
• /
• 2024

Backgrounds/Aims: Open cholecystectomy is becoming obsolete and laparoscopic cholecystectomy has become the treatment of choice in gallstone diseases. Difficult gallbladders are encountered whenever there is a frozen calot's triangle, obliterated cystic plate, or both. Rather than converting to open procedure, there has been a growing preference for laparoscopic subtotal cholecystectomy (LSC) during difficult gallbladders. This study aimed to assess the advantages, indications, and viability of LSC in difficult gallbladders. Methods: The study included patients undergoing laparoscopic cholecystectomy in NIMS Hospital, Jaipur, from January 2021 to January 2023. Data of the patients who underwent LSC for difficult gallbladders included demographics, comorbidities, operative time, conversion to open cholecystectomy, length of hospital stay, and complications. LSC was classified into three types depending on the part of the gallbladder remnant. Results: A total of 728 patients underwent laparoscopic cholecystectomy. Among them, 41 patients (5.6%) were attempted for LSC. However, one patient was converted to an open procedure and the rest 40 underwent LSC. LSC was divided into 3 types, 4 patients underwent LSC type I, 34 patients underwent type II, and 2 patients type III. The average operating time and postoperative length of hospital stay were 86.2 minutes and 2.1 days, respectively. Two patients had surgical site infection. No patient had a bile leak and none required intensive care unit care. Conclusions: LSC is a safe and feasible option for use in difficult gallbladders.

• Archives of Plastic Surgery
• /
• 제37권6호
• /
• pp.775-778
• /
• 2010

Purpose: Reconstruction of soft tissue defects with osteomyelitis in the lower third of the leg represents a challenge to plastic surgeons. Moreover, it is more arduous in multimorbid patients. One excellent option for reconstruction of these defects is to use a delayed distally based sural flap. Methods: We successfully used delayed distally based sural flap with a two-step procedure. During the first operation, radical debridement and elevation of flap were performed. The raised flap was fixed again at the donor site. The delay period ranged from seven to ten days. Between August 2008 and July 2009, we underwent operations for five patients using this technique. The size of flap varied from $10{\times}6\;cm$ to $12{\times}14\;cm$. Results: All flaps successfully survived. Partial skin loss of the grafted site was seen in two patients but no further surgical procedure was required for wound healing. Complaints of hypoesthesia on the lateral part of the foot was observed. In a three month follow-up period, hypoesthesia was resolved spontaneously. Conclusion: Delayed procedure improves the viability of distally based sural flap in high risk, critically multimorbid patients. We recommend that, if a two-stage operative approach is required, the delayed procedure should be considered.

• 대한간호학회지
• /
• 제50권2호
• /
• pp.159-177
• /
• 2020

Purpose: This study aimed at identifying factors related to persistent postoperative pain after cardiac surgery and estimating their effect sizes. Methods: The literature search and selection was conducted in four different databases (CINAHL, Cochrane Library, PubMed, and PQDT) using the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement. A total of 14 studies met the inclusion criteria and were systematically reviewed. For the meta-analysis, R was used to analyze 30 effect sizes of for both individual and operative factors as well as publication biases from a total of nine studies. Results: The meta-analysis revealed that persistent postoperative pain after cardiac surgery was related to one individual factor (gender) and two operative factors (acute postoperative pain and use of the internal mammary artery). Operative factors (OR=5.26) had a larger effect size than individual factors (OR=1.53). Conclusion: Female gender, acute pain after surgery, and use of the internal mammary artery are related factors to persistent postoperative pain. The development of interventions focusing on modifiable related factors, such as acute postoperative pain, may help to minimize or prevent PPP after cardiac surgery.

• 대한두경부종양학회지
• /
• 제15권2호
• /
• pp.194-199
• /
• 1999

Introduction: Since 1996, Dr. James Norman has successfully performed mimimally invasive radio-guided parathyroidectomy(MIRP) using intraoperative nuclear mapping with $^{99m}Tc$ sestamibi scanning and radioactivity detection probe. Objectives: We aimed to introduce this new surgical technique and evaluate it's efficacy by our own experiences. Method: From May to October 1999, five consecutive patients with primary hyperparathyroidism underwent parathyroidectomy by using modified MIRP technique. $^{99m}Tc$ sestamibi scanning was performed 1.0 or 1.5 hour before operation. After intraoperative localization of the tumor under the guidance of quantitative gamma counting with a NEVIGATOR probe, an unilateral small skin incision(3.0-4.0cm) was placed. Without a skin flap, the strap muscle was directly divided with the use of a Harmonic scalpel. After careful dissection, the parathyroid tumor was removed. Result: In all patients, a single adenoma could be easily detected and removed by this new technique. Mean incision length was 3.2cm(3.0-4.0cm) and operative time ranged from 40 to 110minute. All the patients were discharged within 2 days of surgery without any complication. Conclusion: This new operative technique could become the most minimally invasive alternative to the standard operative procedure for parathyroid adenoma.

• 한국의료질향상학회지
• /
• 제7권1호
• /
• pp.90-104
• /
• 2000

Background : This study was designed to assess the effects of information on the satisfaction of parents and families whose children underwent elective surgery in the Pediatric Operating Room. Methods : We measured parent and family satisfaction with information given before and after offering informational interventions. The data were collected from 510 patients parents and families whose children had undergone elective surgery in the Pediatric Operating Room of Seoul National University Hospital in Seoul. South Korea. The data collection ran from May 3. 1999 to May 30. 1999 and from September 6, 1999 to September 30, 1999. The research instrument consisted of four categories (pre-operative period, intra-operative period, post-operative period, others) and 24 questionnaires. SPSS was used to analyze the data. Results : The major findings of this study are summarized as follows: 1. Before surgery, the satisfaction with the following was increased: the explanations of the necessary preparation for the surgery (6.0%), the time the patient would enter the operating room (20.6%), the operative procedure (2.0%), and the use of the waiting room (10.0%). 2. During the operation, the satisfaction with the situation board (15.1%), public announcements in the waiting room (8.4%), and the answering of the families questions (12.2%) was increased. however, the satisfaction with the surgeons explanations of the surgical outcomes decreased by 8.3%, even though the frequency of these explanations increased by 5%. 3. After surgery, the satisfaction with the following was increased: the explanations of patient's status of recovery(10.3%) the time the patient would be moved from the recovery room (17.6%), how the patient would be transferred to the ward (19.2%), and post-operative care (6.3%). Conclusion : Based upon the above findings, we concluded that pre-, intra-, and post-operative informational interventions were effective in increasing the satisfaction of the parents and families of children undergoing elective surgery.

• Journal of Korean Neurosurgical Society
• /
• 제37권5호
• /
• pp.357-363
• /
• 2005

Objective: The microvascular decompression(MVD) for trigeminal neuralgia(TN) is known as an effective surgical technique. But the failed MVD cases have been reported in long term follow-up studies. This study is to evaluate the efficacy of MVD through our operative techniques, offending vessels in operative field, failed cases with the review of the literatures. Methods: We analyzed total 63 cases of TN which underwent MVD from 1955 to 2003 according to characters of pain, operative findings, operative results related to causative vessel compression and operative method, progonotic factor. Statistical analysis was performed using paired t-test with SPSS Ver 11.0. Results: In TN, the most common offending vessel was superior cerebellar artery(45.0%). In compression group of nerve root by offending vessel, the cure rate was 91.7%. However, the cure rate of the contact group was 64.7% and the cure rate of the negative group was 37.5%. There was no statistical significance between the degree of compression by vessel and the operative result(p=0.076). In 51 cases with MVD only, the cure rate was 84.3% and in 3 cases with PSR only, 42.8% and in 2 cases with PSR(partial sensory rhizotomy) with MVD, 50.0%. TN recurred in 7 cases within the follow-up period and reoperations(PSR) were added in 2 cases of them. Conclusion: This study shows that MVD provided a high rate of success with a minor risk of complications, which has been regarded as the most safe and effective procedure for trigeminal neuralgia. Additional MVD in recurred TN by severe adhesion of teflon showed poor outcome. But, revisional operation(PSR) in recurred TN showed relatively good outcome. PSR should be considered for treatment of recurrent TN after MVD.

• Archives of Plastic Surgery
• /
• 제32권2호
• /
• pp.227-230
• /
• 2005

The surgical treatment of craniofacial disorders, using metallic internal osteofixation system has inspired an evolution with advanced operative technique and fixation devices over past two decades. As any other surgical procedures, this procedure also associates problems such as infection, palpability, loosening, and restrict craniofacial skeleton growth, which lead to undue secondary operations for removal. These problems are improved by using bioabsorbable osteofixation system. We compared the patient's subjective symptoms using bioaborbable system versus metallic osteofixation system in zygomatic bone fracture. we should take the individual steps (postoperative 2 weeks, and 1 year) in treating fractured zygoma. From August, 2001 to August, 2003, we used bioabsorbable osteofixation system in 28 patients in zygomatic fracture ($Biosorb^{TM}FX^{(R)}$) and compared 23 patients who were treated with metallic osteofixation system. There was no significant difference in the both groups in subjective symptoms and postoperative result.