• Journal of Chest Surgery
• /
• v.30 no.9
• /
• pp.876-884
• /
• 1997

Fourteen patients underwent orthotopic heart transplantation between March 1994 and May 1996 in Seoul National University Hospital. There were 9 male and 5 female patients, and the mean age was 40.8 $\pm$ 12.4 years ranged from 12 to 56 years. All patient were in NYHA Fc III or IV preoperatively. The underlying heart diseases were dilated cardiomyopathy in 11 and restrictive cardiomyopathy in 3. The mean age of donors was 24.9$\pm$ 10.2 years and the causes of the brain death were head trauma by traffic accidents in 8, subarachnoid hemorrhage in 2, 1 asphyxia, 1 fall down injury, 1 brain tumo , and 1 drowning, respectively The blood type was identical in 11, compatible in 2, and incompatible in 1 patient. The direct bicaval anastomosis technique was used in 11 cases, and standard right atrial anastomosis was done in the remaining 3 cases. The graft ischemic time was 158$\pm$44 minutes ranged 94 to 220 minutes. There were two hospital deaths(14.3%). The causes of deaths were 1 right ventricular failure followed by suspected cyclosporine induced hemolytic uremic syndrome and rejection, and 1 delayed massive bleeding, probably from rupture of the anastomotic pseudoaneurysm, respectively. The follow-up duration was 16$\pm$9 months(3 to 28 months). There was one late death(8.3%). All the other patients were in NYHA Fc I except one patient who was in hospital because of the acute rejection. The actuarial survival rates including hospital deaths were 93.7% at 1 month, 86.9% at 6 months, and 77$\pm$12% at 2 years. Conclusively, heart transplantation is the good strategy for the management of end stage heart disease with acceptable operative mortality and early follow-up results.

• Journal of Chest Surgery
• /
• v.34 no.3
• /
• pp.212-223
• /
• 2001

배경: 이식폐의 보존 및 재관류 동안 cyclic adenosine monophosphate(cAMP)와 nitric oxide(NO)는 폐혈관 내 순환조절을 유지하는데 있어 중심적인 역할을 한다. 그러나 내치세포내의 cAMP와 NO 모두 허혈-재관류 과정 동안에 현저하게 감소한다. 이에 저자는 low potassium dextran(LPD) 폐조본액에 cAMP의 유사체인 dibutyry1 cAMP(db-cAMP)와 NO의 공여물질인 nitroglycerin(NTG)을 첨가하여 이들의 폐보존 효과를 알아보고, 이들은 첨가한 폐보존액 들의 효과를 비교하였다. 대상 및 방법: 토끼 폐장 분리관류 모형에 실험군은 각각 6마리씩 4개군으로 단순 LPD 페보존액만 사용한 경우(I군), LPD 용액에 NTG 만 참가한 경우(II군), cAMP 만 첨가한 겨우(III군) 그리고 두가지 모두를 첨가한 경우는 IV군으로 분류하였으며, 폐보존액이 주입된 심폐블록은 영상 1$0^{\circ}C$에서 24시간 동안 보관한 다음 100% 산소농도에서 기계호흡을 하면서 신선 정맥혈로 30분 동안 재관류를 시행하였다. 재관류폐의 평가를 위해 폐기능 및 폐부종 정도를 정량 측정하였으며, 유출로 혈액으로부터 tumor necrosis factor $\alpha$(TNF-$\alpha$)와 간접적인 NO의 총량을 알기 위해 nitrite/nitrate의 양을 측정하였다. 또한 재관류가 끝난 후 광학 및 전자현미경학적 소견을 관찰하였다. 결과: 모든 실험군 중 제 IV군 의 폐보존 능력이 가장 우수하였으나, 제 II, III, IV군 사이는 통RP적으로 유의한 차이가 없었다. 제 I군은 제 II, III, IV군들에 비해 유의하게 폐기능이 가장 나쁘고 폐부종 정도가 가장 심했다(p<0.05). 제 II군은 제 III군에 비해 더 좋은 폐기능을 보였고, 폐부종 정도가 덜 하였으나 통계적은 유의성은 없었다. TNF-$\alpha$ 는 제 IV 군이 Irns에 비해 유의하게 분비량이 적었다. (p<0.05). 총 NO의 양은 제 II군과 IV 군이 제 I 군과 III군보다 유의하게 높았으나(p<0.001), 제 II군과 IV군, 제 I군과 III군 사이 비교에서 유의한 차이는 없었다. 또한 제 I 군과 III군에서는 시간이 지남에 따라 유의하게 NO의 양이 점차 감소하였다. (p<0.05). 광학 및 전자현민경 소견상 폐포 및 폐혈관 구조가 제 II, III, IV 군이 I 군에 비해 더 잘 보존되어있었다. 결론: LPD 폐보존액에 db-cAMP 및 NTG의 첨가는 폐보존 효과가 모두 우수함을 확인하였고 이들의 폐보존 효과 차이는 거의 없음을 알수 있었다. 그렇지만 이들의 병합사용이 폐혈관 항상성을 더 잘 유지시킬 수 있고 허혈-재관류 손상을 줄여 폐보존 효과를 높일 수 있을 것이라고 기대된다.

• Journal of Chest Surgery
• /
• v.32 no.6
• /
• pp.561-566
• /
• 1999

Background: It is not easy to surgically correct caustic pharyngeal strictures and a lot of effort is required to restore normal swallowing after the surgery. The authors reviewed the course in patients who underwent pharyngocolostomy. Material and Method: From August 1995 to March 1998, 6 patients with caustic stricture underwent esophageal reconstruction surgery. The time of injury to the replacement of the esophagus was from 3 months to 2 years and 4 months. The left colon was used in all patients. The surgical route was used under the sternum in 5 patients and through the esophageal hiatus in 1 patient. In the cervical anastomoses, the cervical pharyngocolic anastomosis was performed on the left pyriform sinus after a partial resection of the thyroid cartilage in 3 patients and on the posterolateral aspect of the inferior pharyngeal constrictor in 3 patients. Result: Postoperative complications consisted of a dysphagia in 3 patients and left vocal cord palsy in 1 patient. There was no cervical anastomotic stricture. Revisional procedures consisted of an esophageal dilation and free jejunal graft in 1 patient, supraglottic scar band resection in 1 patient, and colonic mucosal resection in 1 patient. Swallowing training was required in the 3 patients with dysphagia. Restoration of normal swallowing was obtained in all patients between the 9th and the 303rd day. Conclusion: Pharyngocolostomy is a satisfactory method of treatment for patients with intractable caustic stricture. Pharyngocolojejunostomy is an effective alternative for esophagocologastrostomy in cases where gastric outlets are involved.

• Journal of Chest Surgery
• /
• v.30 no.7
• /
• pp.733-738
• /
• 1997

Sequential bilateral lung transplantation may result in a variety of perioperative and postoperative complications, showing high perioperative morbidity and mortality rates. This research was performed to investigate the hemodynamic changes in adult mongrel dogs after bilateral reimplantation, two methods preferred for avoiding or minimizing graft rejection. The anterior portion of the pulmonary artery and the left atrium proximal to the superior and the inferior pulmonary veins were resected out and then re-anastomosed one hour later to prevent torsion or stenosis of the anastomotic site and the formation of a thrombosis in the left atrium. An everted suture technique was employed for the left atrium; An hour after the division, however, the main bronchus was tightly anastomose by interrupted sutures of No. 4-0 prolene in a telescope method. A modified I-C solution mixed with PGEI was infused into the cut portion of the pulmonary artery at the rate of 15 mllkglmin and at a pressure of 40 cmH20 for a total dosage of 70 mlfkg in order to preserve the transected lung. Topical cooling using wet gauzes soaked with cold I-C solution was performed for one hour to prevent ischemic lung injury. The above procedures are considered to be beneficial for achieving a satisfactory outcome for bilateral lung reimplantation.

• Journal of Trauma and Injury
• /
• v.33 no.3
• /
• pp.144-152
• /
• 2020

Purpose: This retrospective multicenter study analyzed trauma patients who underwent resuscitative endovascular balloon occlusion of the aorta (REBOA) in the Republic of Korea. Methods: This study was conducted from February 2017 to May 2018 at three regional trauma centers in the Republic of Korea. The patients were divided into two groups (cardiopulmonary resuscitation [CPR] and No-CPR) for comparative analysis based on two criteria (complication and mortality) for logistic regression analysis (LRA). Results: There were significant differences between the CPR and No-CPR groups in mortality (p=0.003) and treatment administered (p=0.016). By LRA for complications, total occlusion has significantly lesser risk than intermittent or partial occlusion in both univariate (odds ratio [OR] 0.06, 95% confidence interval [CI] 0.00-0.36, p=0.01) and multivariate (OR 0.05, 95% CI 0.00-0.38, p=0.01) analyses. The Rescue had a higher risk than the Coda or Reliant in univariate analysis (OR 4.91, 95% CI 1.14-34.25, p=0.05); however, it was not statistically significant in multivariate analysis (OR 6.98, 95% CI 1.03-74.52, p=0.07). By LRA for mortality, the CPR group was the only variable that had a significantly higher risk of mortality than the No-CPR group in both univariate (OR 17.59, 95% CI 3.05-335.25, p=0.01), and multivariate (OR 24.92, 95% CI 3.77-520.51, p=0.01) analyses. Conclusions: This study was conducted in the early stages of REBOA implementation in the Republic of Korea and showed conflicting results from studies conducted by multiple institutions. Therefore, additional research with more accumulated data is needed.

• Journal of Trauma and Injury
• /
• v.30 no.4
• /
• pp.113-119
• /
• 2017

Purpose: Despite the numerous protocols and evidence-based guidelines that have been published, application of the therapeutics to eligible patients is limited in clinical settings. Therefore, a rounding checklist was developed to reduce errors of omission and the implementation results were evaluated. Methods: A checklist consisting of 12 components (feeding, analgesia, sedation, thromboembolic prophylaxis, head elevation, stress ulcer prevention, glucose control, pressure sore prevention, removal of catheter, endotracheal tube and respiration, delirium monitoring, and infection control) was recorded by assigned nurses and then scored by the staff for traumatized, critically ill patients who were admitted in the trauma intensive care unit (ICU) of Dankook University Hospital for more than 2 days. A total of 170 patients (950 sheets) between April and October 2016 were divided into 3 periods (period 1, April to June; period 2, July to August; and period 3, September to October) for the analysis. Questionnaires regarding the satisfaction of the nurses were conducted twice during this implementation period. Results: Record omission rates decreased across periods 1, 2, and 3 (19.9%, 12.7%, and 4.2%, respectively). The overall clinical application rate of the checklist increased from 90.1% in period 1 to 93.8% in period 3. Among 776 (81.7%) scored sheets, the rates of full compliance were 30.2%, 46.2%, and 45.1% for periods 1, 2, and 3, respectively. The overall mean score of the questionnaire regarding satisfaction also increased from 61.7 to 67.6 points out of 100 points from period 1 to 3. Conclusions: An ICU rounding checklist could be an effective tool for minimizing the omission of preventative measures and evidence-based therapy for traumatized, critically-ill patients without overburdening nurses. The clinical outcomes of the ICU checklist will be evaluated and reported at an early date.

• Journal of Chest Surgery
• /
• v.37 no.2
• /
• pp.113-118
• /
• 2004

The studies on cryopreserved arterial allograft have been focused on cooling methods, pre-treatment, cryoprotectant agents, and preservation temperature. But recently, several studies have reported that thawing methods also play an important role in the occurrence of macroscopic and microscopic cracks. This study was designed to investigate the cell injury after thawing, using a rabbit model to clarify the effect of thawing methods on cryopreserved arteries. Material and Method: Segments of the rabbit aorta were obtained and divided into 3 groups (n=60) according to whether the specimens were fresh (control, n=20), cryopreserved and rapidly thawed (RT) at 37$^{\circ}C$ (n=20), or cryopreserved and subjected to controlled, automated slow thawing (ST)(n=20). Cell damage was established using the TUNEL method and the morphological changes were also evaluated. Result: In the group that was rapidly thawed, the expression of TUNEL (＋) cells increased significantly more than in the slowly thawed group. In addition, the endothelial denudation, microvesicles and edema were significant in the rapidly thawed group compared with those changes in the slowly thawed group. Conclusion: Our study suggests that the rapid thawing method may be one of the major causes of cellular damage and delayed rupture in cryopresewed arterial allografts. The expression of TUNEL (＋) cells and structural changes were significantly low in the slowly thawed group, which might have contributed to the improvement of graft failure after transplantation.

• Journal of Korean Neurosurgical Society
• /
• v.63 no.6
• /
• pp.738-746
• /
• 2020

Objectives : The purpose of this study was to evaluate surgical outcomes and complications of spinal deformity associated with neurofibromatosis type-1 (NF-1). Methods : From 2012 to 2018, patients suffering from spinal deformity associated with NF-1 who underwent surgical correction were identified. Demographic data and radiographic measures were retrospectively reviewed. Pre- and postoperative whole spine radiograph images were used to determine both coronal and sagittal Cobb angles. All of patients underwent 3-dimentional computed tomographic scan and magnetic resonance imaging scan to confirm dystrophic features. For evaluation of clinical outcomes, we surveyed the pre- and postoperative scoliosis research society-22r (SRS-22r) score. Results : Seven patients with spinal deformity associated with NF-1 were enrolled in this study. The mean age of patients was 29.5±1.2 years old. The mean follow-up period was 2.8±1.4 years. The apex of the deformity was located in cervicothoracic (n=1), thoracic (n=4), and lumbar region (n=2). Most patients have poor bone quality and decreased bone mineral density with average T-score of -3.5±1.0. All patients underwent surgical correction via posterior approach. The pre- and postoperative mean coronal and sagittal Cobb angle was 61.6±22.6° and 34.6±38.1°, 56.8±18.5° and 40.2±9.1°, respectively. Mean correction rate of coronal and sagittal angle was 44.7% and 23.1%. Ultimate follow-up SRS-22r score (average score, 3.9±0.4) improved comparing to preoperative score (average score, 3.3±0.9). Only one patient received revision surgery due to rod fracture. No serious complication occurred, such as neurological deficit, and viscerovascular injury. Conclusion : The surgical correction of patients having spinal deformity associated with NF-1 is challenging, however the radiographic and clinical outcomes are satisfactory. The all posterior approach can be a safe and effective surgical option for patients having dystrophic curves associated with NF-1.

• Journal of Chest Surgery
• /
• v.30 no.1
• /
• pp.48-54
• /
• 1997

Between 1987 and 1995, eleven patients with severe chronic corrosive stenosis of the hypopharynx and esophagus underwent surgical restoration of digestive continuity at Inje University Seoul Palk Hospital. There were 7 male and 4 female patients aged from 21 to 47 years (mean, 34 years). The caustic material was acid in 6 patients and alkali in 5 patients. The esophagus was reconstructed using the right colon In 9 and left colon in 2. The cervical approach and the side of proximal anastomosis depended on the status of the pyriform slnus of the hypopharynx. In the neck, J-formed incision was made along the sternocleidomastoid muscle. The sternohyoid and thyrohyoid muscles were divided transversely to expose the thyroid cartilage. Hypopharyngeal opening for proximal anastomosis was made by reverse triangular formed resection of the thyroid cartilage after elevation of perichondrium. Immediately after operation, dysphagia and aspiration into trachea were common, so training of swallowing was required. Feeding gastrostomy was usually maintained for 3 months until restoration of swallowing function was confirmed . There was graft necrosis in 3 patients, who were treated with jejunal free graft. Revisional procedures for stenosis of cervical anastomosis in B patients consisted of widening of pharyngocecostomy site in 2 and resection of adhesive band in one. Return of normal swallowing assuring normal nutrition was obtained in 10 of 11 cases.

• Journal of Life Science
• /
• v.17 no.4 s.84
• /
• pp.515-521
• /
• 2007

Aprotinin, a serine protease inhibitor, has been used to ameliorate the inevitable consequences, including blood component injury after cardiac surgery with cardiopulmonary bypass (CPB). However, there are many arguments on its dosage or usage. We assessed whether administration of low dose of aprotinin in only priming solution has any beneficial effect or reduces its side effects on cardiac surgery. Thirty patients scheduled for elective cardiac surgery were randomly assigned to aprotinin group (n=15) which received aprotinin in priming solution (two million kallikrein inhibitory unit, KIU) and added one million KIU at 1 hour after the beginning of CPB or control group (n=15) which did not receive it. Hematological and biochemical variables, cytokines and cardiac marker levels, and postoperative outcomes were compared between two groups at before, during or after operation. Platelet count in aprotinin group was higher than that of control group at postoperative 24 hr. Activated partial thromboplastin time in aprotinin group was longer than that of control group at intensive care unit (ICU). Troponin-I level and postoperative blood loss volumes in aprotinin group were lower than those of control group at ICU. There were no significant differences between the two groups on the others. These results showed that low dosage of only priming solution during cardiac surgery with CPB reduced platelet destruction and postoperative bleeding, and attenuates myocardial damage. However, further studies need to be carried out with more population or pediatric patients for evaluating various aprotinin usage.