• Journal of Chest Surgery
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• 제24권7호
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• pp.719-724
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• 1991

A case of pulmonary atresia with intact ventricular septum was presented in a 10-month-old cyanotic female patient, which was congenitally rare. Infant with pulmonary atresia and intact ventricular septum usually require urgent surgical intervention. Angiogram showed the pulmonary atresia at the level of the pulmonary valve, the hypoplasia of tricuspid valve and atrial septal defect without patent ductus arteriosus. We performed the pericardial patch graft on the right ventricular outflow tract and pulmonary artery after ventriculotomy using pacemaker wire as electrical saw and main pulmonary arteriotomy and then modified Waterston shunt from the ascending aorta to patch on the right ventricular outflow tract without extracorporeal circulation. Patient was postoperatively good condition.

• Journal of Chest Surgery
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• 제27권1호
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• pp.36-42
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• 1994

Between January 1990 and June 1993, the retrospective analysis was done in 48 consecutive patients with hemoptysis. According to clinical condition of patients, managements were divided into 3 subgroups; group 1[percutaneous bronchial artery embolization, group 2[operation after percutaneous bronchial artery embolization],group 3[delayed and emergency operation]. It was characterized that recurrence of hemoptysis was very frequent and most frequent underlying cause was pulmonary tuberculosis. In 40 patients[83%] urgent examination with flexible broncoscope was done and localization of the bleeding source was possible only in 24[60%] patients. The amount of hemoptysis was variable but there are no difference between groups and 22 patients[45%] had a prior episode of hemoptysis usually within 3 months of their admission. The recurrence was limited only in group 1[3/22] and the mortality rate was 6%[3/48]. We suggest that percutaneus bronchial artery embolization may be effective in recurrent massive hemoptysis but definitive management was operation.

• Journal of Chest Surgery
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• 제36권6호
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• pp.422-426
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• 2003

심장에 발생하는 원발성 악성종양의 발생빈도는 아주 낮게 보고되고 있으며, 국내의 증례보고도 미미한 수준이다. 29세 남자 환자가 최근 2개월간 점증되는 심계 항진과 운동 시 호흡곤란으로 본원 심장내과에 내원하여 검사를 진행하던 중에 심초음파상에 좌심방내의 종괴가 발견되어 좌심방점액종으로 진단하고 긴급수술로 개심술하에 종양절제술을 시행하였다. 수술소견에서 35$\times$90$\times$50 mm의 점액성 종양의 기저부가 광범위하게 좌심방후벽과 우상폐정맥의 입구로 침윤되어 있었으며 단순박리로 종양은 절제되었으나 좌심방후벽과 우상폐정맥,그리고 좌하폐정맥의 입구의 종양의 침윤을 육안으로 확인하였다. 수술 후 병리조직 검사 결과 악성 점액섬유성육종으로 진단되었다. 환자는 수술 후 18일째에 경쾌 퇴원하였으며, 수술 후 방사선치료와 6차례의 항암제 치료를 진행하여 술 후 10개월 간 추적 관찰에서 재발이나 전이의 소견 없이 잘 생활하고 있다.

• 한국간담췌외과학회지
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• 제26권3호
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• pp.277-280
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• 2022

Backgrounds/Aims: Biliary colic is a common cause of emergency department (ED) visits; however, the natural history of the disease and thus the indications for urgent or scheduled surgery remain unclear. Limitations of previous attempts to elucidate this natural history at a population level are based on the reliance on the identification of biliary colic via administrative codes in isolation. The purpose of our study was to validate the use of International Statistical Classification of Diseases and Related Health Problems codes, 10th Revision, Canadian modification (ICD-10-CA) from ED visits in adequately differentiating patients with biliary colic from those with other biliary diagnoses such as cholecystitis or common bile duct stones. Methods: We performed a retrospective validation study using administrative data from two large academic hospitals in Toronto. We assessed all the patients presenting to the ED between January 1, 2012 and December 31, 2018, assigned ICD-10-CA codes in keeping with uncomplicated biliary colic. The codes were compared to the individually abstracted charts to assess diagnostic agreement. Results: Among the 991 patient charts abstracted, 26.5% were misclassified, corresponding to a positive predictive value of 73% (95% confidence interval 73%-74%). The most frequent reasons for inaccurate diagnoses were a lack of gallstones (49.8%) and acute cholecystitis (27.8%). Conclusions: Our findings suggest that the use of ICD-10 codes as the sole means of identifying biliary colic to the exclusion of other biliary pathologies is prone to moderate inaccuracy. Previous investigations of biliary colic utilizing administrative codes for diagnosis may therefore be prone to unforeseen bias.

• 보건행정학회지
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• 제7권2호
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• pp.46-64
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• 1997

Background & Objectives : Korea is face with the social need for health care technology assessment so that it is urgently needed to found principles and methodology in technology assessment in health care. As a groundwork for health care technology assessment, we tried to prioritize medical technology for assessment. Among medical technologies, procedure is somewhat difficult to assess, compared to drug or equipment. In this study, we aimed at the prioritisation of medical procedure to be assessed, in terms of efficay, safety, and adequacy. Method : For the standardized classification of medical procedure, ICD-9-CM(International Classification of Diseases 9th edition - Clinical Modification) was used. Among the list the procedures coming under otorhinolaringjology and thoracic surgery were selected by three family physicians. The list of procedure was mailed to the board certified surgeons of both disciplines, with the question asking about the necessity for assessment in terms of efficay, safety, and adequacy. Replied questionnaires were analyzed in each procedure. Results : Of 560 otorhinolaryngologist and 480 thoracic surgeon, 114 surgeons replied. Of otorhinolaryngological procedure, incision, excision, and destruction of inner ear : fenestration of inner ear : stapedectomy and its revision were the most urgent technology to assess in the aspect of safety. For adequacy, operations on Eustachian tube: fenestration of inner ear: incision, excision, and destruction of inner ear were highly ranked in necessity, and for efficary, operations on Eustachian tube; external maxillary antrotomy; fenestration of inner ear. Thoracic surgeons replied thoracic procedures, lung transplantation; heart transplantation; implantation of heart assist system [pump] are most important for evaluation in terms of safety; and heart transplantation; Lung transplantation; Implantation of heart assist system [pump] in terms of adequacy, and surgical collapse of lung [Artificia니 pnemothorax or pnuexoperitoeum]; lung transplantation; periarterial sympathectomy in terms of efficacy. As a whole, surgeons regard safety evaluation is more urgent than adequacy or efficary. In addition, otorhinolaryngological surgeons regard evaluation of their procedures more urgent than thoracic surgeons regard theirs. Conclusion : By the questionnaire to board certified physicians, we get some preliminary data for prioritisation of technologies to assess. Through the questionnaire like this, much information would be gathered for technology assessment, especially for medical procedure, if not enough. In the near future, well structured expert opinion gathering research, such as modified Delphi or nominal group technique, should be done succeedingly.

• Archives of Plastic Surgery
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• 제47권5호
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• pp.460-466
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• 2020

Background Sternoclavicular joint (SCJ) osteomyelitis is a rare pathology requiring urgent intervention. Several operative approaches have been described with conflicting reports. Here, we present a multi-institutional study utilizing multiple surgical pathways for SCJ reconstruction. Methods A multi-institutional retrospective cohort study was conducted to identify patients who underwent surgical repair for sternoclavicular osteomyelitis between 2008 and 2019. Patients were stratified according to reconstruction approach: single-stage reconstruction with advancement flap and delayed-reconstruction with flap following initial debridement. Demographics, operative approach, type of reconstruction, and postoperative outcomes were analyzed. Results Thirty-two patients were identified. Mean patient age was 56.2±13.8 years and 68.8% were male. The average body mass index (BMI) was 30.0±8.8 kg/㎡. The most common infection etiologies were intravenous drug use and bacteremia (both 25%). Fourteen patients (43.8%) underwent one-stage reconstruction and 18 (56.2%) underwent delayed two-staged reconstruction. Both single and delayed-stage groups had comparable rates of reinfection (7.1% vs. 11.1%, respectively), surgical site complications (21.4% vs. 27.8%), readmissions (7.1% vs. 16.6%), and reoperations (7.1% vs. 5.6%; all P>0.05). The single-stage reconstruction group had a significantly lower BMI (26.2±5.7 kg/㎡ vs. 32.9±9.1 kg/㎡; P<0.05) and trended towards shorter hospital length of stay (11.3 days vs. 17.9 days; P=0.01). Conclusions Both single and delayed-stage approaches are appropriate methods with comparable outcomes for reconstruction for SCJ osteomyelitis. When clinically indicated, a single-stage reconstruction approach may be preferable in order to avoid a second operation as associated with the delayed phase, and possibly shortening total hospital length of stay.

• Journal of Chest Surgery
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• 제27권3호
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• pp.191-195
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• 1994

Twenty-four patients with left main coronary artery stenosis exceeding 50% underwent coronary artery bypass grafting from January 1991 through June 1993. Four patients [17%] had stenosis only in left main coronary artery and 20 patients [83%] had associate lesion[s] in left anterior descending , circumflex, or right coronary artery. Sixteen patients [67%] had higher degrees of stenosis [>70%] in left main coronary artery. Preoperatively 18 patients [75%] had unstable angina pectoris even during aggressive medical treatment. Preoperatively aggressive medical treatment was performed to relieve the symptom in patients with unstable angina. All patients were perioperatively treated with continuous infusion of isosorbide dinitrate to stabilize symptomatic and hemodynamic states. Twenty patients underwent elective coronary bypass surgery and 4 patients urgent operations due to severe unstable angina. There was no thirty-day mortality or late death. Angina recurred in 1 patient, but coronary angiographic study showed good patency of grafts and the symptom was relieved with medical treatment. We concluded that coronary artery bypass grafting can be safely performed by perioperative efforts, including continuous infusion of isosorbide dinitrate, for hemodynamic stabilization in patients with left main coronary artery stenosis.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권6호
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• pp.473-480
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• 2010

Introduction: Tooth requiring extraction before radiotherapy in head and neck cancer patients should be performed as long as possible before the initiation of radiation therapy. Conventionally, a minimum 2-week waiting primary healing period is recommended. Although the above 2-week period is ideal, it is not uncommon for the radiotherapist and cancer patient to feel an urgent need to proceed with radiotherapy despite the need for dental care. Therefore, alternative approaches for early radiotherapy, including conservative endodontic treatment and a 1-week waiting primary healing period after dental extraction at the time of radiotherapy were considered and applied based on a literature review Materials and Methods: The clinical study involved 120 head and neck cancer patients who were treated at Wonju Christian Hospital, Wonju College of Medicine, Yonsei University, from January 1995 to December 2004. Results: In the clinical study, there were no specific complications, such as, post-extraction wound infections, radiation osteitis and osteoradionecrosis over the recent 10 years despite the early radiotherapy. Conclusion: Based on the clinical study, a minimum 1-week waiting primary healing period for oral care before radiotherapy is suitable for early radiotherapy in head and neck cancer patients.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제18권4호
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• pp.626-635
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• 1996

치성감염에 의한 이차적인 후측인두부나 종격동 감염은 매우 드물게 나타나지만 이러한 감염은 초기의 정확한 진단과 즉각적인 치료가 매우 중요하다. 이의 진단을 위해서는 후측인두부 감염시에 나타나는 임상증상을 잘 이해하고 주의깊은 환자의 관찰을 요하며 전산화 단층촬영이 질환의 진단과 치료에 매우 유용하게 이용될 수 있다. 후측인두부나 종격동 농양 형성시에는 적절한 항생제요법과 광범위한 외과적 배농 그리고 세심한 술후 처치가 치료의기본이 된다. 저자들은 치성감염에 의해 후측인두 및 종격동 농양이 발생된 3명의 환자에서 이를 조기에 진단하고 광범위한 외과적 배농과 적절한 항생제요법을 시행하여 양호한 치료 결과를 얻었다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제37권3호
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• pp.169-175
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• 2011

Background: Teeth requiring extraction before radiotherapy in head & neck cancer patients should be removed as long as possible before the initiation of radiation therapy. Conventionally, a minimum 2-week waiting primary healing period is recommended. Although the above 2-week period is ideal, it was not uncommon for the radiotherapist and cancer patient to feel an urgent need to process with radiotherapy despite the need for dental care. Therefore, alternative approaches for early radiotherapy, including conservative endodontic treatment and a 1-week waiting primary healing period after dental extraction at the time of radiotherapy, were considered and applied based on the experimental study Materials and Methods: Eighteen dogs were processed for histopathologic wound healing. The effect of the primary endodontic treatment and extraction before early radiotherapy was examined. Results: No specific complication, such as, post-extraction wound infection, radiation osteitis and osteoradionecrosis, were encountered despite the early radiotherapy. Conclusion: Based on the experimental study, a minimum 1-week waiting primary healing period for oral care before radiotherapy is suitable for the early radiotherapy in head and neck cancer patients.