• Journal of Chest Surgery
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• v.34 no.4
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• pp.311-321
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• 2001

배경: 본 연구에서는 16년간 본원에서 시행한 완전방실중격결손 환자의 수술성적을 고찰하고 수술후 사망 및 술후 잔존 좌측방실판막부전의 발생에 관여하는 위험인자들을 분석하고자 하였다. 대상 및 방법: 본원에서 84년 7월부터 2000년 6월까지 수술한 완전방실중격결손 환자 70명의 임상기록을 후향적으로 연구관 하였다. 70명의 대상환자중 남아 환아는 36명 여아 환아는 34명이었고 연령분포는 1개월에서 19세였다.(평균나이는 32.$\pm$71.9개월). 이중 다운증후군이었던 환자는 39명(55.7%)이었으며 술후 라스텔리 분류 A형이 42명(60.0%), B형이 6명(8.6%), C형이 20명(28.6%)이었고 기록상으로 분류를 확인 할 수 없는 경우가 2명 (2.9%)이었다. 결과: 9(12.9%)명에서 술후 조기사망했으며, 이를 기간별로 비교해 보면 1996년 이전은 20.0%, 1996년 이후 최근 5년간은 7.7% 였으며 둘 사이의 통계학적 유의한 차이는 없었다. 술후 10명(14.3%)에서 3도이상의 잔존좌측방실판막부전을 보였다. 5년 및 10년 장기 생존율은 79.4%였고, 4명의 환자에서 5례의 재수술을 시행하였으며 5년간의 7.7% 였으며 둘이상의 통계학적 유의한 차이는 없었다. 술후 10명(14.3%)에서 3도이상의 잔존 좌측방실판막부전을 보였다. 5년 및 10년 장기 생존율은 79.4% 였고, 4명의 환자에서 5례의 재수술을 시행했으며 5년 및 10년 장기 재수술 회피율은 91.4%였다. 수술후 사망에 관여하는 위험인자 분석을 시행하여 술후 잔존좌측방식판막부전이 3도 이상인 겨우 오즈비가 38.5 (p<0.001)로 통계적으로 유의한 위험 인자로 나타났다. 또한 술후 잔존좌측방실판막부전의 발생에 관여하여 위험인자 분석을 시행하여 술후 좌측방실판막의 교련을 교정한 경우 오즈비가 6.72(p=0.02)로 통계적으로 유의한 위험인자로 나타났다. 결론: 1세이하 환아를 포함한 완전방실중격결손증의 수술은 낮은 수술사망율과 재수술율 그리고 양호한 장기성적으로 보였다. 또한 이에는 3도 이상의 잔존 좌측방실판막부전의 발생이 술후 사망에 중요한 위험인자로 기여하여 수술적 교정후 잔존 좌측방실판막부전의 정도를 줄이고 좌측방실판막의 양호환 교합을 유지하기 위해서는 완전방실중격결손증의 방실판막의 다양한 해부학적 형태로 따른 개별적인 접근법이 유효하다고 생각한다.고 생각한다.

• Journal of Chest Surgery
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• v.34 no.10
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• pp.763-768
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• 2001

Background: The high pressure zone(HPZ) at the gastroesophageal junction is an important barrier for prevention of gastroesophageal reflux. Smooth muscle layers in the lower esophageal sphincter mainly contributes to HPZ at the throacoabdominal junction. The purpose of this study was to investigate the manometric characteristics of the thora-coabdominal junction in patients after surgical removal of the lower esophageal sphincter. Material and Method: Twenty two patients with prior esophagogastrectomy(10 Ivor-Lewis method and 12 left thoracotomy) and 30 normal adults(control group) were studied manometrically. Result: Esophageal manometry showed a HPZ and pressure inversion points distal to the anastomosis in 12 of 22 patients(2 of 10 patients with Ivor-Lewis method and 10 of 12 patients with left thoracotomy) and a HPZ in 30 of 30 normal adults. The location of HPZ front nostril was not significant different between the two groups(42.5$\pm$0.9cm in patients and 43.9$\pm$2.1cm in the control), while the length of HPZ was shorter in patients than in the control(2.13$\pm$0.6cm vs 2.83$\pm$0.59cm). By SPT and RPT, pressures of HPZ at rest were lower in patients(13.78$\pm$1.63mmHg, 28.58$\pm$6.06mmHg) than in control(20.3$\pm$4.95mmHg, 42.80$\pm$15.91mmHg). The HPZ relaxed partially in response to deglutition(84.4% in patient, 90.5% in control group) and contracted in response to increased intra- abdominal pressure induced by leg lifts(HPZ/ Intra-abdominal pressure= 1.81$\pm$0.23 in patient, 2.13$\pm$ 0.58 in control group).

• Journal of Chest Surgery
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• v.40 no.2 s.271
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• pp.136-139
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• 2007

Bilateral popliteal artery entrapment syndrome is a rare vascular disease, which leads to ischemic claudication as a result of disturbance to the blood flow from the abnormal relationship of the popliteal artery to the gastrocnemius muscle, a fibrous band or the popliteus muscle in the young male population. A 58-years-old male patient, complaining of ischemic claudication, coldness and 3rd toe gangrene of left leg of 1 month's duration was admitted to our institution. His left ankle-brachial index was decreased; therefore, a femoral artery angiography was peformed, which revealed a total occlusion below the distal superficial femoral artery of the left leg. An EKG revealed atrial fibrillation, suggestive of a thromboembolism of the popliteal artery due to atrial fibrillation; therefore, Urokinase thrombolysis was attempted. After the Urokinase thrombolysis, popliteal artery entrapment syndrome was diagnosed, with MRI then performed for an anatomical diagnosis. The popliteal artery entrapment was type 1, where the popliteal artery was displaced medial to the Gastrocnemius head. After complete removal of the popliteal artery aneurysm, interposition was performed with a contra lateral greater saphenous vein graft. A mild right popliteal artery aneurysm still remained, but surgery was not performed. Currently, the patent is surviving, without complications. Herein, the good results obtained for the surgical treatment of a severely affected leg, and the conservative treatment of a mildly affected leg, are reported.

• Journal of Veterinary Clinics
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• v.31 no.6
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• pp.483-489
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• 2014

This study describes a surgical technique and evaluates the clinical outcomes in small breed dogs with cranial cruciate ligament rupture (CCLR) treated with tibial plateau leveling osteotomy (TPLO). Seven skeletally mature dogs weighing less than 15 kg underwent unilateral TPLO to stabilize the stifle joint with CCLR. Clinical evaluation was performed via visual lameness score, range of motion (ROM), and thigh girth circumference (TC). Postoperative complications were recorded. All patients reached a grade 1 score at 1 week and grade 0 at 8 weeks postoperatively. The mean operated limb extension angle was 98.11%, 99.07%, and 98.73% of the mean extension angle of the contralateral limb at 4 weeks, 8 weeks, and 12 weeks postoperatively, respectively. The mean operated limb flexion angle was 98.07%, 95.88%, and 96.35% of the mean flexion angle of the contralateral limb at 4 weeks, 8 weeks, and 12 weeks postoperatively, respectively. The mean TC of the operated limb was 92.95%, 93.68%, and 95.44% of the mean TC of the normal limb at 4 weeks, 8 weeks, and 12 weeks postoperatively, respectively. Our outcomes for TPLO in small breed dogs are not worse than those previously reported for large breed dogs. Based on the result in the present study, CCLR in small dogs can be successfully managed with TPLO, as done in large breed dogs.

• Archives of Reconstructive Microsurgery
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• v.7 no.1
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• pp.62-67
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• 1998

The gracilis muscle is well suited to small and medium-sized soft tissue defects that cannot be adequately handled by simple rotational flaps and it will conform well to irregular contours, can be split longitudinally at both ends to allow cavities and awkwardly shaped spaces and can be transferred in part or in whole. The gracilis muscle used as a free muscle or musculocutaneous flap is small with a long, narrow contour and its vascular pedicle is a terminal branch of the medial femoral circumflex artery and vein. The aims of soft tissue reconstruction are to cover soft tissue defects, to clear up infection and to prepare for further surgical procedures. Authors have performed 12 gracilis muscle flaps in the lower extremities at Chonbuk National University Hospital from June 1994 through March 1998. The results were as follows. 1. 11 cases of 12(91.7%) were sustained from the crushing injury and secondary complications from the traffic accident. 2. The microsurgical anastomosis of one artery and two veins have performed in 6 cases(50%) of 12 and 11(91.7%) cases of 12 were successful at the third postoperative week and in the final result. 3. Gracilis muscle flap is the infetion-resistant and aesthetically acceptable performed in the lower leg 1/3 and the foot.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup1
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• pp.85-90
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• 2001

Objective : DREZotomy is effective for the treatment of deafferentation pain as a consequence of root avulsion, postparaplegic pain, posttraumatic syrinx, postherpetic neuralgia, spinal cord injury, and peripheral nerve injury. We performed microsurgical DREZotomy to the patients with deafferentation pain and relieved pain without any serious complication. The purpose of this study is to evaluate the usefulness of the microsurgical DREZotomy for deafferentation pain. Methods : We evaluated 4 patients with deafferntation pain who were intractable to medical therapy. Two of them were brachial plexus injury with root avulsion owing to trauma, one was axillary metastasis of the squamous cell carcinoma of the left forearm, and the last was anesthesia dolorosa after surgical treatment(MVD and rhizotomy) of trigeminal neuralgia. Preoperative evaluation was based on the neurologic examination, radiologic imaging, and electrophysiological study. In the case of anesthesia dolorosa, we produced two parallel lesions in cephalocaudal direction, 2mm in distance, from the C2 dorsal rootlet to the 5mm superior to the obex including nucleus caudalis, after suboccipital craniectomy and C1-2 laminectomy, with use of microelectrode. In the others, we confirmed lesion site with identification of the nerve root after hemilaminectomy. We performed arachnoid dissection along the posterolateral sulcus and made lesion with microsurgical knife and microelectrocoagulation, 2mm in depth, 2mm in distance, to the direction of 30-45 degrees in the medial portion of the Lissauer's tract and the most dorsal layers of the posterior horn at the one root level above and below the lesion. Results : Compared with preoperative state, microsurgical DREZotomy significantly diminished dosage of the drugs and relieved pain meaningfully. One patient showed tansient ipsilateral ataxia, but recovered soon. There was not any serious complication. Conclusion : It may be concluded that microsurgical DREZotomy is very useful and safe therapeutic modality for deafferentation pain, especially segmentally distributed intermittent or evoke pain. Complete preoperative evaluation and proper selection of the patients and lesion making device are needed to improve the result.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup1
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• pp.55-60
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• 2001

Objective : The purpose of the present study was to examine neurologic changes, fusion rate and degree of kyphosis from the surgical results of those patients who underwent multi-level anterior interbody fusion and internal fixation. Methods : Among 63 cases of the patients who received multi-level anterior interbody fusion and internal fixation in 5 years between 1995 to 1999 at the neurosurgery department, we performed a retrospective study in 52 cases that could be followed up with dynamic view imaging ; the results were compared and analyzed. The analysis was based on the results of history taking, physical findings and radiologic findings, and Odom criteria were used to classify those cases with neurologic changes. Results : Among those 52 cases in whom the follow-up was possible for at least a year and dynamic view imaging was possible, bone fusion was seen in 93% of the trauma cases and 95% in the non-trauma cases and overall bone fusion was observed in 94% of the cases. Bone fusion was seen in 93% of the autobone cases, 95% of the allobone cases, and 94% of the Mesh cases. Radiologic changes were observed by comparing the lateral view after surgery ; kyphosis was seen in 53% of the autobone cases, in 70% of the allobone cases, and in 35% of Mesh cases ; in 45% and 60% of the non-trauma cases and trauma cases, respectively ; and in 55% of the 2 level fusion cases and 46% of the 3 level fusion cases. Neurologic changes classified according to Odom criteria showed excellent result in 48% of all the cases, good in 23%, fair in 4%, and poor in 25%. Conclusion : Even those cases with multi-level fusion, a high fusion rate could be obtained by performing anterior interbody fusion and internal fixation ; those cases with kyphosis were related more with the presence or absence of posterior compartment injury rather than the fusion level ; and those trauma cases showed not much difference in the fusion rate compared with non-trauma cases but had a high possibility of kyphosis.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.300-308
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• 2001

Objectives : Anterior cervical discectomy and interbody fusion has become a well-accepted surgical treatment of degenerative cervical diseases. Implatable cages have a stabilizing effect without plates and no need for autogenous bone graft. The authors evaluates the effect of implatable titanium cage(RABEA) on the clinical and radiological outcomes. Methods : 34 patients with symptomatic cervical degenerative diseases due to one level disc pathology were underwent anterior cervical discectomy and interbody fusion with titanium cages(RABEA) which were not filled with cancallous bone grafts from January 1999 to May 2001. Patients with osteoporosis and older than 65 years were not included. Among them, 15 patients could be followed-up for at least 1 year. The authors retrospectively reviewed the charts and radiographic data. Mean follow-up period was $1.3{\pm}0.2years$. Results : Clinical results according to the Odom's criteria was exellent and good in 14(93%) patients. One patient with fair result showed complete loss of the disc space height due to settlement of the cage. Preoperatively, the mean height of the disc space(${\pm}$standard deviation) was $3.42{\pm}1.10mm$(range 2.0-5.5mm), and at 1 day postoperatively it was $7.88{\pm}0.90mm$(range 6.50-9.0). The mean height of the disc space after 1 year was $6.50{\pm}1.38mm$(range 3.0-8.0). The restoration of the height was statistically significant(p<0.05). The mean height after 1 year was $82.7{\pm}15.9%$ of the height at 1 day postoperatively. Preoperatively the mean value of the cervical lodortic angle was $21.8{\pm}11.8^{\circ}$ and 1 year postopertively, it was $24.5{\pm}8.3^{\circ}$, which was statistically not significant. All patients showed no abnormal movements on flexion and extension lateral film after 6 months. Conclusion : Implantable titanium cages appear safe and effective in selected patients, and their use helps to avoid complications associated with bone graft harvest. Subsidence of the cage seems to be a potential risk factor for recurrence of the symptoms. For long-term results, a longer follow-up is required.

• Journal of the Korean Arthroscopy Society
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• v.4 no.2
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• pp.111-116
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• 2000

Purpose : We reviewed the results of arthroscopic posterior cruciate ligament reconstruction using Achilles tendon allograft, and the efficacy of the surgical technique using gradual tibial tunneling and posterior transseptal technique. Materials and Methods : From september 1997 to September 1999, 8 patients with complete PCL injury were treated by arthroscopic PCL reconstruction using Achilles tendon allograft. Mean follow-up period was 21.7 months. Mean preoperative posterior laxity was 14mm. The clinical outcome was assessed by Telos stress test, Lysholm knee score and IKDC score. Result : There was no complication such as infection and neurovascular injury. Posterior translation using Telos device was less than 5mm in 6 cases$(75\%)$, and between 6 to 10mm in 2 cases$(25\%)$. The mean Lysholm knee score was 45 preoperatively and improved to 87 postoperatively. In IKDC system, 2 of 8 patients were group A and 6 were group B. Conclusion : Arthroscopic PCL reconstruction using achilles tendon allograft and posterior transseptal technique shows reliable stability, short operative time and minimizing donor site morbidity but needs more long term follow-up.

• The Journal of Korean Academy of Prosthodontics
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• v.57 no.4
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• pp.456-466
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• 2019

As digital dentistry technology is being developed, it is being used in various ways. This case covers how digital dentistry technology is being applied on the treatment of patients with loss of vertical dimension due to worn dentition and multiple loss of teeth. The loss of vertical dimension was carefully assessed and recovered, and implants were placed with surgical guides, designed considering the final restoration. The movement of the mandibular was measured with the electronic instrument for recording mandibular movement. Wax-up process was done with Naturgemäße Aufwachs-Technik (N.A.T.) and Natural functional reconstruction (N.F.R.). It was scanned, and the provisional restoration was fabricated using Computer-Aided-Design/Computer-Aided-Manufacturing (CAD/CAM) technology, and the adjustment process was done at the clinic to meet with the satisfaction both functionally and esthetically, and then, using double scanning and CAD/CAM technology, it was carried out as a final restoration. As a result, the patient obtained satisfying results, utilizing the benefits of digital dentistry technology and traditional methods.