• Journal of Chest Surgery
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• 제1권1호
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• pp.19-24
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• 1968

A clinical investigation was reported on 17 cases of spontaneous pneumothorax requiring surgical mana-gement. Males outnumbered females 15:2. Determination of the etiology in this series showed that the majority were pulmonary tuberculosis and paragonimiasis. Several others had pneumonia, lung abscess, cyst and blebs. It is of particular interest that the acute inflammation of respiratory system was younger age group, pulmonary tuberculosis & paragonimiasis were between 2 nd and 3 rd decades, and lung abscess, cyst, blebs were above 4 th decade. Pulmonary tuberculosis was far advanced bilateral and active. The ratio of right to left side was 13:6 and both side involved in 2 cases. In about half cases of patients, above 50%-collapsed lung associated with mediastinal shifting developed. The complications were pleural effusion and bronchopleural fistula. The former was 13 cases [76.4%] in which 3 cases combined with mixed infection, and latter was 5 cases. As the management, 11 cases were subjected to intercostal or rib resection drainage with continuous suc-tion. Among 11 drainage cases, 8 cases were successful in acute stage and 3 cases failed in chronic stage. This faiure was due to interference with re-expansion of collapsed lung for peel formation and broncho-pleural fistula. The open thoractomy was applied in 9 cases, among which primary operation were 5 cases and drainage failure were 4 cases. Among 11 cases subjected to the open thoracotomy, wedged resection was performed in 3 cases including paragonimiatic cyst, and pneumonectomy in 1 case-tuberculosis, and decortication only was performed in 2 cases in paragonimiasis. Decortication & lung resection was carried out in 2 patients among which ruptured lung abscess 1 case and ruptured multiple blebs 1 case. There was no case of death but prognosis of the tuberculosis may be poor because of far advanced bilateral and active pulmonary tuberculosis.

• Journal of Chest Surgery
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• 제9권2호
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• pp.323-327
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• 1976

Eleven cases of traumatic diaphragmatic injuries were treated at the department of Surgery from Jan. 1972 to Nov. 1976 were reviewed in this study. 1. Sex ratio of the observed patients was 10 : 1 showing definitely high incidence male patients. 2. The age distribution in this series ranged from 4 to 49 years of age, and average age was 26 years age. 3. Seven cases were received blunt injury on lower chest and upper abdomen, three cases were stabbed by knife and gunshot injury case was on case 4. Six cases were diagnosed and treated early post-traumatic stage within 24 hours, three cases were repaired within I0 days, and the last case was repaired after 5 years post-trauma. 5. The operative mortality was 10% (1/10), the cause of death was liver failure, after right lobectomy of the liver for traumatic liver rupture.

• Journal of Chest Surgery
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• 제17권4호
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• pp.657-665
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• 1984

Thirty-seven patients had undergone repair of a endocardial cushion defect between 1977 and Aug. 1983 in Seoul National University Hospital. Twenty eight had a partial defect, one intermediate defect and eight complete endocardial cushion defect. Tricuspid cleft was found in 4 cases and mitral cleft was in all p-ECD. Seven patients were of type C anatomy in c-ECD. Four patients had associated major anomalies, including three TOF in c-ECD, one coarctation in p- ECD. In p-ECD patients, the septal defect was closed with patch in all cases and the atrioventricular valvular insufficiency was corrected with MVR in 4 cases, TVR in 1 case and simple interrupted sutures in remainders. In c-ECD patients the septal defect was closed with single patch except one case. The atrioventricular valve was repaired with simple interrupted sutures except one MVR and TVR case. The operative mortality was 14.2% in p-ECD, 44.4% in c-ECD, but recent 3 years [1980-1983] mortality was 8.7% in p-ECD, 20% in c-ECD. More than grade III systolic regurgitant murmur was oted postoperatively in 4 cases of c-ECD and 3 cases of p-ECD. The operative risk factors were preoperative NYHA classification, cyanosis, Rp/Rs, systolic pressure of main pulmonary artery and the degree of regurgitation of atrioventricular valves. The causes of death were low cardiac output syndromes, pulmonary complications and arrhythmias.

• The Korean Journal of Pain
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• 제28권4호
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• pp.254-264
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• 2015

Background: Pain medicine often requires medico-legal involvement, even though diagnosis and treatments have improved considerably. Multiple guidelines for pain physicians contain many recommendations regarding interventional treatment. Unfortunately, no definite treatment guidelines exist because there is no complete consensus among individual guidelines. Pain intervention procedures are widely practiced and highly associated with adverse events and complications. However, a comprehensive, systemic review of medical-dispute cases (MDCs) in Korea has not yet been reported. The purpose of this article is to analyze the frequency and type of medical dispute activity undertaken by pain specialists in Korea. Methods: Data on medical disputes cases were collected through the Korea Medical Association mutual aid and through a private medical malpractice liability insurance company. Data regarding the frequency and type of MDCs, along with brief case descriptions, were obtained. Results: Pain in the lumbar region made up a major proportion of MDCs and compensation costs. Infection, nerve injury, and diagnosis related cases were the most major contents of MDCs. Only a small proportion of cases involved patient death or unconsciousness, but compensation costs were the highest. Conclusions: More systemic guidelines and recommendations on interventional pain management are needed, especially those focused on medico-legal cases. Complications arising from pain management procedures and treatments may be avoided by physicians who have the required knowledge and expertise regarding anatomy and pain intervention procedures and know how to recognize procedural aberrations as soon as they occur.

• Journal of Chest Surgery
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• 제22권1호
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• pp.1-9
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• 1989

We have performed one case of autotransplantation and 11 cases of orthotopic homotransplantation using Korean mongrel dogs, and have scrutinized the hematologic and hemodynamic results. The mean weight of recipients was 15.42*1.2kg and varied from 14kg to 20kg. During the operation, anesthesia and other technical procedures including cardiopulmonary bypass were similar to the usual methods in human cardiac transplantation. It was found that the hematologic values were similar to those of human beings although there was wide variance. Hemodynamically the mean systolic and diastolic arterial pressures were 165.0* 12.9 mmHg and 100.0 *11.8 mmHg respectively, and the mean heart rate was 155.5*23.5/min. All cases died within 24hrs, and the mean survival in all but 6 cases where operative death occurred was 6.83*8.01 hrs[range 2-21 hrs]. The major causes of deaths were bleedings in 7 cases, failure to protect myocardium during the procedure in 2 cases, pulmonary edema in 1 case and multiorgan failure in 2 cases. From the above results we concluded that the most frequent complication was bleeding, and the cardiopulmonary bypass flow of 50-500ml/kg min was not suitable to the dog in CPB. In further experiment after this study, the technical and the bypass flow was increased. Bleeding was not significant. And the immunosuppresion during operation and postoperative period was tried.

• Journal of Chest Surgery
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• 제27권8호
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• pp.650-655
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• 1994

The author analyzed 99patients with VSD weighting less than 10kg of body weight who underwent surgical correction from 1981 to 1992 at cardiovascular department of Hanyang University hospital. Patients occupied 29.3% of total cases who were underwent surgical corrections for congenital heart diseases during that time. Of the 99 patients, 51 patients were male [52%] and 48 patients[48%] were female. Age ranged from 28 days to 36 months with mean age of 13.6 months. Mean body weight was 7.53kg. According to Kirklin`s anatomical classification, type II defect was most common [61.6%]. Associated anomaly was found in 48 patients [48.5%]. Patent foramen ovale was most commonly associated cardiac anomaly [14.1%] and followed by atrial septal defect [12.1%], patent ductus arteriosus [10.1%]. Cardiac catheterization data were analyzed. The most common range of Qp/Qs, Rp/Rs, Pp/Ps were above 3.0, 0.1 - 0.25, and above 0.75 respectively. Among the indications of surgical correction, there were pulmonary hypertention in 69 patients, congestive heart failure in 44 patients, frequent respiratory infection in 47 patients, growth retardation in 33 patients. The most common surgical approach and method for VSD closure were right atriotomy[48.3%] and dacron patch closure[93.3%]. Complication rate was 13.1% [13 cases], and overall mortality was 17.1% [17 cases]. The cause of death consisted of low cardiac output syndrome[11 cases], acute renal failure[3 cases], sepsis[2 cases] and pulmonary insufficiency[1 case] in order of frequency.

• Clinical and Experimental Pediatrics
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• 제45권12호
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• pp.1512-1518
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• 2002

목 적 : 쌍태 임신에서 일측 태아가 자궁내 사망한 경우 생존아의 사망률이 높고 범발성 혈관내 응고병증, 패혈증 및 뇌손상 등을 증가시킨다고 알려져 있다. 본 연구는 일측 태아의 자궁내 사망 후 생존아들의 주산기 합병증 및 이와 연관된 위험 인자들에 대해 알아보고자 하였다. 방 법 : 1995년 1월부터 2000년 12월까지 쌍태 임신 중 일측 태아가 자궁내 사망한 후 생존 출생한 15례의 의무 기록지를 후향적으로 분석하였다. 생존아에서는 말초 혈액과 혈액 응고계 검사, 두부 초음파 및 뇌 자기공영상 검사를, 그리고 산모에서는 말초 혈액과 혈액 응고계 검사 및 임신과 관련된 합병증에 대해 의무 기록지를 통하여 후향적으로 조사하였고, 생존아에서 주산기 합병증에 대한 위험 인자로 융모막 상태, 출생 체중, 재태 주령 및 일측 태아의 자궁내 사망 후 분만까지의 기간에 대해 관찰하였다. 결 과 : 1) 일측 태아의 자궁내 사망 후 생존 출생아 15례의 재태 주령은 $33.7{\pm}3.2$주, 출생 체중은 $1,992{\pm}592g$, 분만까지의 기간은 $32.4{\pm}29.5$일이었고, 조산아 11례(73.3%), 만삭아 4례(26.7%)로 조산의 원인은 조기 진통과 조기 양막 파수가 주였다. 2) 산모에서 시행한 혈액 검사상 범발성 혈관내 응고병증은 1례도 없었고, 산모의 말초 혈액 검사(백혈구수, 혈소판수, PT, aPTT, fibrongen, FDP) 소견과 생존아의 범발성 혈관내 응고병증 및 뇌연화증 발생과는 연관이 없었다. 3) 생존아 총 15례 중 6례(40.0%)는 정상이었고, 범발성 혈관내 응고병증 3례(20.0%), 뇌연화증 3례(20.0%), 자궁내 발육 지연 1례, 쌍태아간 수혈 증후군(recepient) 1례, 선천성 심장기형(심방 중격 결손 및 폐동맥 협착)이 동반된 경우 1례 있었다. 4) 생존 출생아에서 범발성 혈관내 응고장애 및 뇌연화증의 발생은 융모막 상태, 출생 체중, 재태 주령 및 일측 태아의 자궁내 사망 후 생존아 분만까지의 기간과 통계학적 유의성이 없었다. 결 론 : 본 연구에서는 자궁내에서 일측 태아가 사망한 경우 산모에서 혈액학적 이상은 발견할 수 없었고 생존아에서 주산기 합병증을 예측할 수 있는 의의 있는 위험 인자를 발견할 수 없었지만 약 20.0%에서 뇌연화증 및 범발성 혈관내 응고병증이 발생하였기에 쌍태 임신 중 임신 제2, 3기에 일측 태아가 자궁내 사망한 경우 생존 출생아에 대한 면밀한 혈액학적 및 신경학적 검사가 필요하다고 사료되었다.

• 문화기술의 융합
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• 제1권2호
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• pp.85-89
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• 2015

국내에서 원격의료에 관련한 연구개발 사업은 지난 20년 동안 약 70여 개가 진행되었다. 지방자치제도의 시행으로 각 지방자치제는 경쟁적으로 원격의료사업을 시도하고 있지만, 시범사업 후에는 사장되는 게 현실이다. 사업의 연속성을 유지할 수 없는 주요 원인의 하나로 원격의료에 대한 법적 제도적 지원이 전혀 이루어지지 않고 있는 실정을 꼽고 있다. 환자 및 정보가 먼 거리로 떨어져 있거나 시간적으로 많은 차이가 발생하는 등 여러 가지 문제로 인해 도달할 수 없는 경우 의료정보 및 전문적 조언을 원격으로 제공하는 시스템으로, 환자 진료뿐만 아니라 의료행정, 의학교육, 자문과 의뢰 등을 포함하는 포괄적인 개념으로 쓰인다. 이에 본 논문에서는 원격의료의 법적인 규제현황을 살펴보고, 규제개선 항목과 쟁점사항을 분석한다.

• Journal of Chest Surgery
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• 제20권4호
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• pp.695-705
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• 1987

This report provides follow - up data on 37 patients, aged 7 days to 25 years [median: 6.5 months], who underwent repair of total anomalous pulmonary venous connection at Seoul national University Hospital between May, 1978 and June, 1987. The patients were 22 males and 17 females and the sex ratio was 1.6 to 1, showing a male predominance. Sixteen patients had supracardiac, 13 cardiac, 3 infracardiac and 5 had a mixed type. The duration of follow up was from 1 month to 60 months [median: 14 months] There were eight early and one late deaths, and the overall mortality was 24%. The deaths during 1 year of life were eight [89%] and only one death [11%] occurred above 1 year of age. The mortality of cardiac type was unusually high, accounting for 56 percent of the total death, which was probably due to the preoperative poor clinical condition such as pulmonary edema and congestive heart failure. The major cause of death was the perioperative myocardial failure, and the survival was closely related to the preoperative clinical status, age and moderately elevated pulmonary arterial pressure, the sign of the elevated pulmonary vascular resistance and pulmonary venous obstruction. Early diagnosis and early application of surgical intervention is essential to the improved postoperative survival

• Asian Pacific Journal of Cancer Prevention
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• 제13권6호
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• pp.2541-2545
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• 2012

Objective: To investigate any association between XRCC1 and XRCC3 polymorphisms and outcome of platinum-based chemotherapy in ovarian cancer patients. Methods: With a prospective study design was cases were consecutively collected from January 2005 to January 2007. All 310 included patients were followed-up until the end of January 2010. Genotyping of XRCC1 and XRCC3 polymorphisms was conducted by TaqMan Gene Expression assays. Results: A total of 191 patients died during follow-up. Our study showed a lower survival rate in XRCC1 399 Arg/Arg genotype than Gln/Gln, with a significant increased risk of death (HR=1.69, 95%CI=1.07-2.78). Similarly, those carrying XRCC3 Thr/Thr genotype had a increased risk as compare to the Met/Met genotype, with a HR (95% CI) of 1.90 (1.12-3.41). There was no significant association between XRCC1 Arg194Trp and XRCC1Arg280His gene polymorphisms and ovarian cancer death. Conclusion: Our study demonstrates that polymorphisms in DNA repair genes have roles in the susceptibility and survival of ovarian cancer patients.