• Journal of Chest Surgery
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• v.43 no.5
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• pp.513-517
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• 2010

Background: Diaphragmatic plication through a thoracoscopic approach has been an effective modality to treat diaphragmatic enventration. However, the conventional technique for thoracoscopic plication has some disadvantages. We have developed an improved and simplified technique with utilizing the head up position, $CO_2$ insufflation and figure-of-eight sutures. Material and Method: Between October 2005 and September 2009, 9 patients with diaphragmatic paralysis underwent repair using our modified technique. The mean patient age was $38.5{\pm}53.0$ years (range: 2~76 years). Result: The mean operation time was $46.7{\pm}15.9$ min (range: 30~85 min). None of the patients died due to this procedure, but there was one case of prolonged air leakage, and a case of re-expansion pulmonary edema, which required 3 days of ventilator support after the procedure. The mean hospital stay was $6.22{\pm}2.04$ days (range: 4~11 days). The mean follow-up duration was $27.2{\pm}11.6$ months (range: 2~43 months). All the patients had their symptoms relieved and there was no recurrence of eventration except for one patient who developed more than 2 cm elevation of the diaphragm compared to the immediate post-operation status. Conclusion: With our technique, thoracoscopic diaphragmatic plication was feasible via using only three 5 mm ports and without a working window and the midterm results were favorable. Therefore, we advocate thoracoscopic diaphragmatic plication as a preferred technique to the conventional open plication technique.

• Journal of Chest Surgery
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• v.17 no.1
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• pp.82-88
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• 1984

Total 310 cases of spontaneous pneumothorax in 281 patients were analyzed to review the results of surgical treatment for this condition. Clinical data on the age & sex distribution, recurrence, etiologic conditions and on the other aspects of spontaneous neumothorax were summarized. The results of surgical management of spontaneous pneumothorax are followings; 205 out of 310 cases[66.1%] were cured by closed thoracostomies. 82 cases[26.5%] were cured by thoracotomy. The indications of thoracotomy were 1] persistent air leakage, 2] history of recurrences, 3] blebs or bullae on thoracoscopy, 4] associated parenchymal lesion, 5] pneumothorax caused by paragonimiasis. Other reasons of thoracotomy were bilateral pneumothorax and inadequate expansion due to chronicity. Excision of blebs or wedge resection was performed in most cases with good result. Lobectomy [9 case] or pneumonectomy [3 cases] was carried out depending on the pathological involvement of the lung. There was no operative death and only one case showed recurrent pneumothorax during follow-up after thoracotomy.

• Journal of Chest Surgery
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• v.22 no.1
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• pp.50-58
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• 1989

The emergence and expansion of cardiac surgery over the past decade has resulted in an increasing number of patients undergoing cardiac operations but many kinds of heart surgery was realized only palliative, resulting in increasing numbers of secondary cardiac procedures. From 1978 to 1988, 10 cases of various congenital heart diseases and 17 cases of acquired heart diseases were reoperated at Hanyang University Hospital. The leading indication of second operation was residual shunt or valvular malfunction due to technical failure in congenital heart disease and primary valve failure, endocarditis, paravalvular leakage were for acquired heart disease. The mortality of reoperation was 0% for congenital heart disease and 11.7%[2 death among the 17 patients] for acquired heart disease. The leading causes of death were myocardial failure, sepsis with endocarditis, acute renal failure and congestive heart failure.

• Journal of Chest Surgery
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• v.22 no.1
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• pp.10-15
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• 1989

Excision of bullous emphysema or decortication of chronic empyema commonly results in a prolonged air leakage. Prolonged air leakage requires prolonged intercostal drainage, delays recovery, and can be followed complications such as pneumothorax, atelectasis, incomplete expansion of remained lung, secondary infection. To minimize these complications free muscle grafts can be used like a patch to close the opening of visceral pleura and reinforce suture lines without undue tension. From a preliminary study using the latissimus dorsi muscle as a free muscle graft in the rabbit pleural space, viable muscle fibers that seems the result of the process of regeneration can be consistently identified around the degenerating muscle fibers. Voluminous connective tissues and numerous blood vessels are also observed in the peripheral zone. Further studies in that free muscle graft will be sutured with visceral pleura and lung parenchyme will hopefully provide additional information before clinical application.

• Journal of Chest Surgery
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• v.40 no.9
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• pp.613-616
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• 2007

Background: Spontaneous hemopneumothorax is a rare disease and can be life threatening; it occurs in $1{\sim}12%$ of patients with spontaneous pneumothorax. We analyzed clinical reviews and treatments, as well as complications of spontaneous hemopneumothorax patients that were treated to aid in the optimal management. Material and Method: We studied retrospectively 30 cases with spontaneous hemopneumothorax for 11 years, from 1995 to 2006, at our hospital. Result: All the patients were male and most of the patients were under 30 years. The sides with the disorder were as follows: right in 15 cases and left in 15 cases. Patients showed mostly initial symptoms of chest pain, dyspnea and hypovolemic shock. All patients underwent a closed thoracostomy and 27 patients underwent surgery. Chemical pleurodesis was peformed because of postoperative persistent air leakage and one case was treated in the ICU due to re-expansion pulmonary edema, There were no other complications such as fibrothorax seen during the follow-up periods. Conclusion: The most important finding is proper initial management, as the spontaneous hemopneumothorax can potentially lead to a life-threatening condition. Recently, video assisted thoracoscopic surgery (VATS) is common procedure for general thoracic surgery and overcomes the weak points of performing a thoracotomy. The results of VATS are encouraging.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.655-662
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• 2010

Background: Despite the rapid expansion of percutaneous endovascular repair, open surgical repair is still recognized as an option to achieve a cure. We retrospectively analyzed over a 6 year period the surgical outcomes, the complications and the mortality-related factors for patients with abdominal aortic aneurysms. Material and Method: We analyzed 36 patients who underwent surgery for abdominal aortic aneurysms between May 2001 and June 2005, and between April 2007 and November 2009. The indications for surgery were rupture, a maximal aortic diameter > 50 mm, and medically intractable hypertension or pain. Result: The mean patient age was $69.67{\pm}6.97$ years (range: 57 to 84 years). Thirty two patients (88.9%) were males and 4 patients (11.1%) were females. Extension to the iliac artery existed in 28 patients (77.8%). Thirteen patients (36.1%) had ruptured aortic aneurysms. The mean maximal diameter of the aorta was $73.7{\pm}13.3$ mm (60 to 100 mm). Surgery was performed by a midline laparotomy and 10 patients (27.8%) underwent emergency surgery. The mortality rate was 8.3%; the mortality rate for the patients with ruptured aneurysms was 23.1 % and the mortality rate for patients with unruptured aneurysms was 0%. The postoperative complications included wound infection (3 cases), sepsis (2 cases), renal failure (2 cases) and pneumonia (1 case). Unstable vital signs, pre-operative transfusion, ruptured aneurysm, emergency surgery, comorbidity (DM and syncope) and complications (sepsis and renal failure) were the statistically significant mortality-related factors (p < 0.05). Conclusion: Emergency surgery for ruptured aortic aneurysms continues to have high mortality, but the unruptured cases are repaired with relative safety. Even though endovascular aortic repair is the trend for abdominal aortic aneurysms, an elective operation of the unruptured aneurysms could decrease the procedure's morbidity and the inconvenient for repeat evaluation with good surgical results.

• Journal of Chest Surgery
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• v.40 no.4 s.273
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• pp.292-296
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• 2007

Background: This retrospective study was undertaken to assess the effectiveness of the 8-French (Fr) catheter ($Pleuracan^{(R)}$) for the initial treatment of primary spontaneous pneumothorax. Material and Method: Between July 2004 and July 2006, 59 patients (72 cases) underwent a closed thoracostomy for primary spontaneous pneumothorax. We divided these patients into two groups: group T (large bore (>20 Fr) chest tube group) and group P ($Pleuracan^{(R)}$ group). Result: Initially, the $Pleuracan^{(R)}$ catheters were inserted in 41 cases. There were four catheter malfunctions (9.8%) : three cases had a subsequent closed thoracostomy with a large bore chest tube. Ultimately, there were 34 cases in group T and 38 cases in group P. There were no significant differences in indwelling catheter time ($T:\;2.1{\pm}1.5\;days,\;P:\;2.1{\pm}1.3\;days$), hospital stay ($T:\;6.4{\pm}5.4\;days,\;P:\;5.2{\pm}2.9\;days$) and complications (T: 3%, P: 0%) between the two groups. The percentage of cases that needed intravenous analgesics in group P was 60% (23/38); this was significantly lower than the number for group T (90%, 31/34) (p=0.003). In a subgroup of patients that did not undergo bullectomy(T: 17 cases, P: 19 cases), there were no significant differences in the duration of air leakage ($T:\;0.5{\pm}0.7\;days,\;P:\;0.5{\pm}1.2\;days$) and in the percentage of patients with complete lung re-expansion (T: 94%, P: 84%) between the two groups. Conclusion: Application of the $Pleuracan^{(R)}$ catheter for the initial treatment of primary spontaneous pneumothorax was as effective as the large bore chest tube.

• Journal of the Korea Convergence Society
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• v.5 no.4
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• pp.61-68
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• 2014

In the present study, we aimed to examine the effects of Schroth exercise(three-dimensional convergence exercise) on pulmonary function(vital capacity, and chest expansion), Cobb's angle, scoliometer angle, and erector spinae muscle activity. We examined 40 students with idiopathic scoliosis(Cobb's angle $10^{\circ}$). They were divided into the Schroth and conventional exercise groups, with 20 people in each group. Statistical analysis was performed by using SPSS 18.0 with a paired t-test(pre-post difference) and an independent t-test(between-group differnence). the result of were as follows; 1) After 8 weeks of Schroth exercise, significant improvements were observed in Cobb's angle, rib hump, vital capacity, chest expansion, and right thoracic longissimus muscle activity. 2) After 8 weeks of conventional exercise, a significant improvement was observed only in chest expansion. These findings indicate that the Schroth exercise program improved the Cobb's angle, rib hump, pulmonary function, and sEMG results. Therefore, this study demonstrates the usefulness of the Schroth exercise program for idiopathic scoliosis.

• Proceedings of the KOSOMBE Conference
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• v.1994 no.12
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• pp.88-91
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• 1994

It is well known that multipoint and computerized intraoperative mapping systems improve the results of surgery for Wolff-Parkinson-White syndrome and show tremendous potential for opening an entirely new era of surgical intervention for the more common and lethal types of supraventricular tachyarrhythmias such as atrial flutter and atrial fibrillation. In addition, the ability to map and ablate the sometimes fleeting automatic atrial tachycardia is greatly enhanced by computerized mapping systems. In this study, we have developed 64 channel computerized data analysis system using microcomputer (Macintosh IIx) for basic research of electrophysiology and electrical propagation. The bipolar electrogram information is acquired from 64 cardiac sites simultaneously at a sampling rate of 1ksamples/sec with continuous and total data storage of up to 30 seconds. When the reference electrogram is selected and reference point is picked up, delay time from the reference point in displayed on two dimensional diagram of the heart. System design permits easy expansion to almost 256 simultaneous sites, This system is expected to enable us to study pathophysiology of cardiac arrhythmia and to improve the results of diagnosis and surgical treatment for cardiac arrhythmia.

• Journal of Trauma and Injury
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• v.28 no.4
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• pp.262-265
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• 2015

An arteriovenous fistula (AVF) from the renal artery following a penetrating abdominal trauma is not common. We report the case of a 19-year-old male who presented with a knife stab wound in the right upper quadrant. Due to unstable vital signs and to the protrusion of the mesentery through the stab wound, providing definite evidence of peritoneal violation, an emergent exploratory laparotomy was carried out. There were injuries at the proximal transverse mesocolon and the second portion of the duodenum, with bile leakage. There was also a mild amount of retroperitoneal hematoma near the right kidney, without signs of expansion or pulsation. The mesocolon and the duodenum were repaired. After the operation, abdominal computerized tomography (CT) was performed, which revealed contrast from the right renal artery shunting directly into the vena cava. Transcatheter arterial embolization with a coil and vascular plug was performed, and the fistula was repaired. The patient recovered completely and was discharged without complication. For further and thorough evaluation of an abdominal trauma, especially one involving the retroperitoneum, a CT scan is recommended, when possible, either prior to surgery or after surgery when the patient is stabile. Furthermore, a lateral retroperitoneal hematoma and an AVF after a penetrating trauma may not always require exploration. Sometimes, it may be safely treated non-operatively or with embolization.