• Journal of Korean Neurosurgical Society
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• v.30 no.8
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• pp.1004-1012
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• 2001

Objective : The spinal cord tumors(including vertebral tumors) are increasingly diagnosed and operated due to development of refined diagnostic and therapeutic tools. It is necessary to re-evaluate clinical features and surgical results of spinal cord tumors with increasing cases and developing treatment modalities. The authors reviewed the spinal cord tumor cases to evaluate their clinical characteristics. Material and Methods : The retrospective review of 654 cases of spinal cord tumors between 1973 and 1999 was done. The clinical features, pathological analysis and surgical results were analyzed and compared to the literature. The results of the study are analyzed with a more detailed consideration of each of major pathologies : neurogenic tumors, meningeal tumors, neuroepithelial tumors, and metastatic tumors. Results and Conclusion : The spinal cord tumor was most common in the 5th decade of age(145 cases, 22.1%) and 78 cases(11.9%) were found in children under 15 years of age. The ratio of male to female was 1.2 : 1. The pathologic diagnosis was neurogenic tumor in 266 cases(40.7%), neuroepithelial tumor in 131(20.0%), metastatic tumor in 118(18.0%), and meningeal tumor in 94(14.4%) in the order of frequency. The tumor was located most frequently in the thoracic area(36.5%) and in the intradural extramedullary space(38.1%). The most common initial presentation was pain(40.1%) and the mean duration for presentation to operation was 14.8 months. The total or gross total removal was possible in 404 cases(61.7%) and the surgical result on the postoperative one month was recovery or improvement in 424 cases(64.8%), stationary in 188(28.7%), progression in 42(6.4%). As a surgical complication, there was a spinal deformity(12 cases), wound infection(5 cases), aspiration pneumonia(5 cases) etc. Neurogenic tumors and menigiomas showed good surgical results, whereas neuroepithelial tumors(except ependymoma) and metastatic tumors showed relatively poor prognosis.

• Journal of Gastric Cancer
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• v.11 no.2
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• pp.116-121
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• 2011

Purpose: Gastric cancer surgery is a common operation in East Asia, such as Korea and Japan, and there has been a significant increase in the need for this procedure due to the aging population. As a result, surgery for the treatment of gastric cancer for elderly patients is expected to increase. This study examined the effect of old age on gastric cancer surgery, and analyzed the operative risk factors for elderly patients. Materials and Methods: From November 2008 to August 2010, 590 patients, who underwent a curative resection for gastric cancers, were enrolled. Patients who underwent palliative or emergency surgery were excluded. A retrospective analysis of the correlation between surgical outcomes and age was performed. The elderly were defined as patients who were over the age of 65 years. Results: The mean age of all patients was 58.3 years, and complications occurred in 87 cases (14.7%). The most common complication was wound infection and severe complications requiring surgical, endoscopic, or radiologic intervention developed in 52 cases (8.8%). The rate of complications increased with increasing age of the patients. Univariate analysis revealed age, comorbidity, extent of resection, operation time, and combined resection to be associated with surgical complications. In particular, age over 75 years old, operation time, and comorbidity were predictive factors in multivariate analysis. In the elderly, only comorbidity was associated with surgical complications Conclusions: The patients' age is the most important factor for predicting surgical complications. Surgeons should pay an attention to the performance of gastric cancer surgery on elderly patients. In particular, it must be performed carefully for elderly patients with a comorbidity.

• Journal of Chest Surgery
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• v.33 no.3
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• pp.207-211
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• 2000

Backgroud: Conventional cardiac transplantation with each atrial anastomosis designed by Shumway and associates has been used widely in cardiac transplantation because of its simplicity and efficiency. There have been many reports about the postoperative atrioventricular value regurgitation resulting from the alteration in atrial geometry after cardiac transplantation by Shumway's technique. New surgical technique of direct anastomosis of superior vena cava, inferior vena cava, right pulmonary vein and left pulmonary vein was introduced to overcome the those problems. We performed this study to test the feasibility of this new surgical technique prior to application to clinical practice. Material and Method: Conventional cardiac transplantation was performed on 12 mongrel dogs(Group I) and cardiac transplantation with new surgical mthod of direct anastomosis of SVC, IVC, left and right pulmonary veins was performed on 11 mongrel dogs(Group II). After weaning from cardiopulmonary bypass, we compared the postoperative rhythm, hemodynamic data, and echocardiographic findings between two groups. Result : The cardiopulmonary bypass time and graft ischemic time were 119.0$\pm$4.4 minutes, 162.0$\pm$4.5 minutes respectively in group I, and 140.0$\pm$7.1 minutes, 180.5$\pm$5.4 minutes respectively in group II. The cardiopulmonary time and graft ischemic time in group II were longer than those of group I (p<0.05). There were 3 cases of failure to weaning from cardipulmonary bypass onein group I and two in group II, and this difference was not significant statistically. Sinus rhythm was regained postoperatively in 58% (group I) and 82%(group II), without statistical significant between 2 groups. Postoperative echolcardiography showed 2 cases of tricuspid value regurgitation and 1 case of mitral regurgitation in group I, and no regurgitation of atrioventricular value in group II. Conclusion: Although these was no statistically significant difference between 2 groups, there was tendency of less arrhythmia and less atrioventricular valvular regurgitation in group II. We suggested that the new surgical technique could be a useful strategy in heart transplantation, especially in the case of size mismatching between donor and recipient.

• Advances in pediatric surgery
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• v.12 no.2
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• pp.137-146
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• 2006

Pediatric surgery could establish a definitive position in the medical field on the basis of a stable patient population. Neonatal surgery, the core of pediatric surgery, requires highly skilled surgeons. However, recent advancement of prenatal diagnosis followed by intervention and decreased birth rate has resulted in a significant decrease in the neonatal surgical population and the number of surgical operations. The purpose of this study is to examine the outcome of neonatal surgeries and to propose a guide for the future surgeries. A total of 359 neonatal surgical patients operated upon at the Department of Surgery, Ewha Medical Center, during past 21 years were studied. The study period hasbeen divided into two time periods: from 1983 to 1993 and from 1994 to 2004. Analysis was based on the Clinical Classification System and mortality pattern, frequency of disorders, occurrence and cause of death, and other changes. Neonatal surgery was 6.4 % of all pediatric surgery during the total 21 year period, 9.9 % in the first period and 4.8 % in the second. Male to female ratio increased from 2.7:1 to 2.1:1. The overall mortality was 6.7 %, and there was significant decrease from 7.4 % in the first period to 6.0 % in the second. The clinical classification system (CCS) for death cases included class II 2, III 4, and IV 7 during the first period and class III 3, and IV 8 during the second, respectively. According to the mortality pattern by Hazebroek, there were 6 preventable death cases during the first period, and only one in the second, and 2 non-preventable death cases during the first period and 8 in second, respectively. Although the patients in the second period had more serious diseases, surgical mortality has been decreased in the second period, which may be the result of improved surgery methods for newborns and advanced patient care.

• Korean Journal of Adult Nursing
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• v.14 no.3
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• pp.428-437
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• 2002

Purpose: The purpose of this study is to examine the changes of surgical patients' body temperature in applying warming to patients. The study of an effective nursing intervention, which aims to prevent hypothermia during surgical operations, use of anesthesia, and to remove dermal discomforts. The nonequivalent control group pre-test/post-test design was used for this quasi-experimental study. Method: The study subjects were adult patients who would take a surgical operation under general anesthesia in C Hospital; the surgical operations done were, total abdominal hysterectomy or Myomectomy; 20 patients were included in experimental group I, 20 patients were included in experimental group II, and 20 patients were in the comparative group. The total number of study subjects was 60. The data was collected from September the 1st, 2001 to October the 20th, 2001. The data was analyzed by SPSS program, F-test and Repeated measures of ANOVA. Multi-comparison method of DUNCAN was used for the sections that show the significant differences at the level of p<.05, which was a posterior examination. Result: 1) "The body temperatures of the three groups of patients will be respectively different at the end of the operations; experimental group I to which warming was applied before the operations, experimental group II to which warming was applied during the operations, and the comparative group with no warming being given," showed (F=12.609, p=.000). 2) "Degrees of shivering symptoms for the three groups will be respectively different at the end of the operations; experimental group I which applied warming before operations, experimental group II which applied warming during operations and the comparative group with no warming." Showed assumed (F=6.626, p=.000). Conclusion: Summing up the above study, the warming assumed during operations was a more effective nursing intervention for preventing patients' hypothermia than the warming assumed before operations.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.37
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• pp.20.1-20.7
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• 2015

Background: The objectives of the present study were to investigate the reliability and outcomes of computer-assisted techniques in mandibular reconstruction with a fibula flap and verify whether the surgical navigation system was feasible in mandible reconstructive surgery. Methods: Eight cases were enrolled in the computer assisted surgery (CAS) group and 14 cases in the traditional group. The shaping and fixation of the fibula grafts were guided by computer assisted techniques, which could be monitored with the BrainLAB surgical navigation system. The variation of mandible configuration was evaluated by CT measurement in the Mimics software, including the variation of length, width, height and gonial angle of the mandible. The 3D facial soft tissue alteration was also analyzed in 3D chromatogram by Geomagic software. Results: All 22 fibula flaps survived. The mandibular configurations and facial contours had a better clinic result in the CAS group. The length, width, height and gonial angle of the reconstructive mandible were more similar to the original one. The Wilcoxon rank sum test analysis suggested significant differences in the measurements. The chromatographic analysis also visually showed superiority over the traditional group. Conclusions: The computer assisted surgical navigation method used in mandibular reconstruction is feasible and precise for clinical application. The contour of the reconstructed mandible and facial symmetry are improved with computer techniques.

• Archives of Plastic Surgery
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• v.36 no.1
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• pp.38-45
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• 2009

Purpose: The congenital muscular torticollis is a neck deformity involving shortening of the sternocleidomastoid muscle, which is detected at birth or shortly after birth. This childhood disease is the third most common congenital musculoskeletal anomaly. The indication for surgery is a persistent head tilt with dificit of passive rotation and lateral bending of the neck and a tight band or tumor in the sternocleidomastoid muscle even after physical therapy. The purpose of this article is to report surgical outcomes with patients who had no or little response to physical therapy. Methods: Surgery was performed on 29 patients and their average age was 4.1 years (from 6 months to 20.1 years). The unipolar open release and partial myectomy were done in 28 cases and the muscle lengthening was done in 1 case. Physical therapy was started from postoperative seventh day. Follow - up period was ranged from 2 months to 5.4 years(mean follow - up, 20.4 months). Result: There were neither rotation nor lateral bending deficit after surgical treatment. Mild head tilt was noticed in 3 cases and residual bend was observed in 4 cases. The subjective assessments of surgical results by parents were excellent. Conclusion: Our surgical outcome encourages the surgical treatment of congenital muscular torticollis for patients who failed to respond to physical therapy.

• Archives of Plastic Surgery
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• v.36 no.6
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• pp.743-749
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• 2009

Purpose: Many researches about various surgical method for blepharoptosis have already been introduced. But researches for complications after blepharoptosis correction is relatively insufficient. So, this study was performed to recognize common complications that arised depending on the severity of blepharoptosis, levator function and surgical method. Methods: 250 patients who have underwent surgical treatment for blepharoptosis from 1987 to 2006 were employed in this study. Patients were categorized by severity of blepharoptosis, levator function and surgical method that has been used. Complications after blepharoptosis correction were analyzed. Result: Total of 64 patients had occurred complications, the specifics are as following; undercorrection 22, asymmetry 13, overcorrection 12, lagophthalmos 4, abnormal eyelid contour 4, exposure keratitis 3, ectropion 2, inclusion cyst 2, infection 1 and conjunctival prolapse 1. Among above patients, 3 patients had two kinds of complications. 21 patients was underwent secondary surgery due to complication. Conclusion: Evaluating the outcomes of the secondary surgery, the early correction was better than the late correction. The most of the complications were recovered through conservative and surgical treatments. The most of the complications (47 patients) were undercorrection, asymmetry, overcorrection and took 73.4% of the total complications. The more severe the blepharoptosis and the more poor the levator function, the rate of complications were higher. According to the operation methods, most complications were occurred in levator operation, frontalis transfer and OOM flap.

• Journal of Chest Surgery
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• v.39 no.11 s.268
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• pp.810-814
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• 2006

Background: Tumors of the heart are uncommon. The aim of this study is to review our clinical experience and outcome of surgical treatment of cardiac neoplasm. Material and Method: From March 1990 to December 2005, 35 patients(14 males and 21 females) with mean age of 52.4 years underwent surgical treatment of cardiac neoplasm. The clinical and pathologic data were analyzed retrospectively. Surgical treatment consisted in complete resection of the tumor in all cases but 1 patient who was left ventricular fibroma received biopsy only. Result: Thirty cases were benign and five cases were malignant tumor. Benign tumors were myxoma(29 cases) and fibroma(1 case). Five malignant tumors were osteosarcoma, hepatocellular carcinoma, renal cell cancer, yolk sac tumor, and unclassified myxoid spindle cell type sarcoma. There were no operative mortality in benign cases and twenty seven cases of myxoma were followed up for 8 months to 15 years without recurrence. But four patients of malignant tumor were expired within six months after operation. Conclusion: Left atrial myxomas are most common benign neoplasm. Surgical treatment is effective for the benign cardiac tumors but prognosis is poor in patients with malignant cardiac tumors.

• Clinics in Shoulder and Elbow
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• v.8 no.1
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• pp.49-56
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• 2005

Purpose: To review the surgical results of stiff elbow using the posterior extensile approach which provides a wide surgical view with a single posterior skin incision. Materials and Methods: From February 1999 to May 2002, we performed 6 surgical correction of stiff elbow using posterior extensile approach and followed the patients more than 1 year. In order to get better result, we performed cadaver study (four elbows of two fresh cadavers). Average duration of follow up was 15.7 months $(14{\sim}21)$. Functional results was analyzed using Brobery and Morrey analysis scale. Results: The approach through the plane between the extensor carpi radialis longus and the extensor carpi radialis brevis was ideal, because it preserves normal anatomy and provides a wide surgical view of the anterior joint. The posterior joint could be approached directly between the medial head of the triceps brachii and brachialis medially, the lateral head of triceps brachii and brachioradialis laterally. In all patients, an improved ROM was obtained with intra and extra-articular adhesiolysis: an average $61.7^{\circ}$ improvement $(50{\sim}75)$. Functional results were as follows: five excellent, one good. In addition, the patients' satisfaction was high since the scar from the operation was only a single line at the posterior surface of the elbow. Conclusion: In the treatment of stiff elbow, posterior extensile approach is thought to be useful because this method provides wide anterior and posterior surgical view.