• Journal of Chest Surgery
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• v.48 no.4
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• pp.258-264
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• 2015

Background: This study aimed to evaluate the therapeutic results and safety of pectoralis major muscle turnover flaps in the treatment of mediastinitis after coronary artery bypass grafting (CABG) procedures. Methods: Data regarding 33 patients with post-CABG deep sternal wound infections (DSWIs) who underwent pectoralis major muscle turnover flap procedures in the Emam Reza and Ghaem Hospitals of Mashhad, Iran were reviewed in this study. For each patient, age, sex, hospital stay duration, remission, recurrence, and associated morbidity and mortality were evaluated. Results: Of the 2,447 CABG procedures that were carried out during the time period encompassed by our study, DSWIs occurred in 61 patients (2.5%). Of these 61 patients, 33 patients (nine females [27.3%] and 24 males [72.7%]) with an average age of $63{\pm}4.54$ years underwent pectoralis major muscle turnover flap placement. Symptoms of infection mainly occurred within the first 10 days after surgery (mean, $10.24{\pm}13.62days$). The most common risk factor for DSWIs was obesity (n=16, 48.4%) followed by diabetes mellitus (n=13, 39.4%). Bilateral and unilateral pectoralis major muscle turnover flaps were performed in 20 patients (60.6%) and 13 patients (39.4%), respectively. Complete remission was achieved in 25 patients (75.7%), with no recurrence in the follow-up period. Four patients (12.1%) needed reoperation. The mean hospitalization time was $11.69{\pm}6.516days$. Four patients (12.1%) died during the course of the study: three due to the postoperative complication of respiratory failure and one due to pulmonary thromboembolism. Conclusion: Pectoralis major muscle turnover flaps are an optimal technique in the treatment of post-CABG mediastinitis. In addition to leading to favorable therapeutic results, this flap is associated with minimal morbidity and mortality, as well as a short hospitalization time.

• Journal of Yeungnam Medical Science
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• v.11 no.1
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• pp.127-134
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• 1994

The aim of this study was to identify the usefulness of pelviscopy in treatment besides its diagnostic value. The advantages of pelviscopic surgery are low cost, rapid recovery, good cosmetic effect, low incidence of complication and postoperative adhesion. So most of the pelvic exploration in gynecologic patients are replaced by the pelviscopic surgery these days. Pelviscopic surgery was performed on 136 patients at the Department of Obstetrics and Gynecology, College of Medicine, Yeungnam University from May 1991 to July 1993. The results obtained were as follows : The age distribution of the patients was from 19 to 55 with age of 31.2 years, and the mean parity was 0.96, the most common indication of pelviscopic surgery was tubal pregnancy(66.9%), the second most common indications was ovarian cyst(10.3%) and the other indications were endometriosis, corpus luteum cyst rupture, parovarian cyst, foreign body, tubal ligation, hydrosalpinx, uterine myoma and diagnostic procedure. The main types of surgery were salpingectomy in 58.8% and salpingoophorectomy in 16.3%. The mean duration of hospitalization was 2.1 days without specific complications. According to these results, it was postulated that the pelviscopic surgery was a useful operative tool in gynecologic treatment and its application could be extended to many other areas of gynecology with safety by the development of surgical techniques and instruments.

• Journal of the Korean Arthroscopy Society
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• v.15 no.1
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• pp.13-18
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• 2011

Purpose: The purpose of this study is to evaluate the radiologic and clinical results of the arthroscopic coracoclavicular fixation of the acute acromioclavicular dislocation using $TightRope^{(R)}$ (Arthrex, Inc, Naples, FL). Materials and Methods: We performed the arthroscopic coracoclavicular fixation using $TightRope^{(R)}$ in twenty patients with the Rockwood type III or V acute acromioclavicular dislocation between February, 2009, and February, 2010. Mean follow-up was 13.4(range 8~22) months. Radiologic results were evaluated by comparing the distances between the clavicle and the coracoid process with those in the contralateral sides using the acromioclavicular stress radiographs. Clinical results were made according to the KSS(Korean Shoulder Scoring System), and the cosmetic satisfaction of the patient was assessed. Results: Radiologically, 18 cases showed excellent, 1 case showed good and 1 case showed fair results. Clinically, KSS was mean 98.5 (range 92~100) points and all cases revealed satisfactory cosmetic results. Because one case complained of skin tenderness and discomfort of palpation, we closed the knot with surrounding muscle & fascia. Then local wound infection occurred, so we treated it by incision and drainage under local anesthesia and antibiotic therapy for 2 weeks. Conclusion: Arthroscopic coracoclavicular fixation using $TightRope^{(R)}$ for treating the Rockwood type III or V acute acromioclavicular dislocation showed satisfactory radiologic and clinical results. It seems to be a good treatment method that has little postoperative complication, provides an early rehabilitation and an excellent cosmetic result, and does not require secondary operation for removal of metal implant.

• Journal of Chest Surgery
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• v.27 no.3
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• pp.177-186
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• 1994

Pentastarch is a hydroxyethyl starch similar to hetastarch, but lower average molecular weight and fewer hydroxyethyl groups which result in enhanced enzymatic hydrolysis and faster renal elimination.This report was performed to compare the clinical efficacy and safety of 10 % pentastarch[Pentaspan , group I] for plasma volume expansion after open heart surgery with that of 5% albumin[Plasmanate, group II]. There were no statistically significant differences between the group I [n=18] and group II [n:19] in the preoperative parameters [age, sex, body weight] and operative parameters[bypass time, aorta cross clamping time]. During the first 24 hours after arrival of the patient in the surgical intensive care unit, colloid solution [500--1000 ml] was infused to maintain left atrial pressure of more than 8 mmHg, or cardiac index of 2.0 L/min/M2 of more. In results, there were 3 complications of hypotension immediately after infusion of 5 % albumin solution and 2 among the 3 patients were excluded for the study. However there was no complication after infusion of 10 % pentastarch solution. Hemodynamic responses to infusion was similar for both groups, although in group I a greater increase in both left atrial pressure[mean 1.8 versus 0.7 mmHg, p< 0.05] and right atrial pressure [mean 2.2 versus 1.7 mmHg, p < 0.05] was observed during infusion of the first 500 ml. There were no significant differences in any of the measured respiratory parameters[PaO2, intrapulmonary shunt, and effective lung compliance]. Homodilution with colloid significantly reduced hemoglobin [mean 1.2 versus 0.8 gm/dl], and serum protein and albumin level[total protein;4.8$\pm$ 0.5 versus 5.2 $\pm$0.5 gm/dl, p < 0.05: albumin: 3.2 $\pm$0.4 versus 3.6 $\pm$0.6 gm/dl, p < 0.05] by 6:00 AM on 1 day postoperatively, however there were no significant differences on 7 day postoperatively. The mean serum colloid osmotic pressure and osmolarity was similar in both group.There were no abnormal findings of liver function and kidney function in all the patients. There were no significant between-group differences in bleeding time, platelets, prothrombin time, activated partial thromboplastin time and amount of chest tube output measured on 1st and 7th postoperative day. These findings demonstrated that 10% pentastarch is more effective and safe for plasma volume expension than 5 % albumin solution with no adverse effects on coagulation. Also 10 % pentastarch is less expensive than 5 % albumin and it would appeare to be a reasonable first choice for plasma volume expansion.

• Journal of Chest Surgery
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• v.33 no.4
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• pp.310-315
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• 2000

Background: A retrospectiye study was done for understanding morbidity and mortality after major lung resection. Material and Method: From June 1994 to August 1998, 203 patients received major lung resections for various causes. There were 142 males and 62 females with a mean age of 47.5 years. Initial complains were cough in 47.8%, sputum in 33.0%, hemoptysis or blood-tinged sputum in 23.2%, dyspnea in 18.2%, chest pain in 15.3%, weight loss in 10.8%, fever and chill in 4.9%. There were no complaints in 5.9% of the total patients. The underlying diseases were lung tumor(102 cases/50.2%), bronchectasis(28 cases/13.8%), aspergillosis(24 cases/1.8%), tuberculosis(20 cases/9.9%) and others (29 cases/66.5%) and pneumonectomy(68 cases/33.5%). The postoperative complications were classified as : empyema, BPF, respiratory problem, persistent air leakage over 7 days, arrhythmia, ventilator applied over 24 hours, bleeding, wound infection and chylothorax. The postlobectomy complications were revealed as follow: empyema(3.7%), BPF(2.2%), respiratory problem(5.2%), persistent air leakage over 7days(8.9%), arrhythmia(2.2%), ventilator applied over 24 hours(2.2%), bleeding(1.5%), wound infection(2.9%), chylothorax(0.7%). The postpneumonectomy complications were revealed as follow : empyema(5.9%), BPF (5.9%), respiratory problem(17.6%), persistent air leakage over 7days(0%), arrhythmia(5.4%), ventialtor apply over 24 hours(7.4%), bleeding (7.4%), wound infection(2.9%) and chylothorax(1.5%). Reoperation was done in 8 cases (4.0%). There were 5.8% operative mortalities in pneumonectomy and 0.7% in lobectomy.

• Archives of Plastic Surgery
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• v.35 no.4
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• pp.439-445
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• 2008

Purpose: Malignant fibrous histiocytoma(MFH) is the most common soft tissue sarcoma in adult. As to this date, tissue development, treatment and prognosis of the tumor has not been definitely clarified, however, it has been reported that wide surgical resection of the tumor along with the radiotheraphy and chemotheraphy is needed for treatment. In MFH with high recurrence rate, the reconstruction method and points to be considered for reconstruction in recurrent case were studied in 10 patients who were treated in our hospital. Methods: From August of 1991 to August 2007, location of tumor, initial mass size, 1st recurred period, lymph node metastasis, recurrence rate, treatment modality, complication, reconstruction in recurrent defect, and follow up period was studied in 10 patients who underwent reconstruction at our Plastic surgery department following wide excision. Results: The average age was 62.8(46 - 73) years old, average follow up period was 7.7(1 - 17) years. Various reconstructions has been performed for recurrent cases and postoperative chemotheraphy and radiotheraphy was done. As for reconstruction in recurrent cases, After wide excision, local flap was performed in 6 cases, and free flap in 2 cases. After radiotherapy, osteoradionecrosis was occurred in 4 cases. Recurrence rate was 1 - 5(2.6) times and reconstruction due to recurrence was 7 out of 10 cases(70%). Conclusion: The treatment modality of MFH is not yet defined. Due to it's high recurrence rate, radiotherapy and chemotherapy is commonly combined with surgery. Even still, additional excision and reconstruction may be required. Therefore, possibility of re-operation must be considered when performing every excision and reconstruction; in case a recurrence or osteoradionecrosis occurs. Free flap coverage should be left as the last resort, according to the principle of reconstruction. Nevertheless, if the defect is large or osteoradionecrosis is present, it will benefit greatly to the patient's quality of life.

• Archives of Plastic Surgery
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• v.38 no.2
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• pp.207-211
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• 2011

Purpose: Surgery for thyroid gland requires skin incisions that can result in postsurgical neck scar. To overcome this, many surgeons performed a endoscopic thyroidectomy. But, this approach had a some problems. One of postoperative problems, iatrogenic cervical dystonia (CD) may occur. At common, CD is defined as a syndrome characterized by prolonged muscle contraction causing twisting, repetitive movements or abnormal posture. Botulinum toxin A (BTA, Botox$^{(R)}$, Allergan, Irvine, CA, USA) is well known treatment agent in the treatment of CD. So, the authors applied BTA injection in rare case with iatrogenic CD resulting in endoscopic thyroidectomy. Methods: A 43-year-old female had endoscopic subtotal thyroidectomy operation 3 years ago. She had symptoms such as progressive cervical pain, abnormal neck posture, depression, and sleep difficulty. About 1 year later, the patient who had previous myomectomy of the clavicular head of sternocleidomastoid muscle, however, symptoms were not improved. And then the patient received BTA therapy in our department. The 2 units per 0.1 mL solution was administered in a 1 mL tuberculin syringe. Results: The dose of BTA used in the patient was 36 units for vertical platysmal bands, superficially, and 10 units for ipsilateral sternocleidomastoid muscle, intramuscularly. After 2 weeks, additional the dose of BTA used in the patient was 5 points for remained scar bands, superficially. Complications related to injection such as significant swallowing difficulties, neck muscle weakness, or sensory change were not observed. In 9 months follow-up, the patient maintained a good result from the method of BTA injection alone. Conclusion: The basic concept is selective denervation for the hyperactive individual muscles and scar bands. We conclude that BTA is an effective and safe treatment for CD despite the iatrogenic and complex presentation of this complication.

• Journal of Chest Surgery
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• v.16 no.2
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• pp.231-242
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• 1983

A clinical study was performed on 75 cases of the esophageal cancer and benign esophageal diseases experienced at Department of thoracic & cardiovascular surgery, School of Medicine, Keimyung University during 3 year period from 1978 to 1982. Of 75 cases of the surgical esophageal diseases, there were 35 patients of the esophageal cancer. 17 patients of benign esophageal stenosis, 10 patients of esophageal perforation, 4 patients of diverticulum. 3 patients of achalasia, 2 patients of congenital T-E fistula, one of upper esophageal web, one of esophageal foreign body, one of leiomyoma and patient of hemangioma. First, esophageal carcinoma was more frequent in men than in women by a ratio of five to one, and the peak incidence occurred in the 5th to 6th decade. Dysphagia was the most common symptom in 88.6 percent of our cases. The tumor was located mostly in the middle & the lower one third [91.4%]. The histological diagnosis was made in 35 cases. The squamous cell carcinoma was the most common [82.9%] and the rest was the adenocarcinoma in the lower one third [17.1%]. Thirty-five cases were operated and resection was feasible in the twenty-five patients [71.4%] with 2 cases of hospital mortality [5.7%]. All but two of the esophageal stenosis were caused by corrosive esophagitis and ages ranged from 7 to 70 years with average age of 32 years. Corrective operations were performed on 17 patients of esophageal stenosis of whom 12 patients had esophagocologastrostomy, 3 patients esophagogastrostomy and in non-corrosive esophageal stenosis one case and esophagoplasty and another case had release of external compression. There was one complication of stenosis of the esophageal perforation were traumatic in five cases, empyema in three cases, caustics in one case and postemetic in one case. 10 patients of the esophageal perforation underwent operation: primary closure in 5 cases, two staged colon interposition in 2, esophagogastrostomy in 1 and closed thoracotomy in 2 cases There were 2 complications of leakage of anastomosis sites in postoperative period. 4 patients of traction type of diverticulum underwent diverticulectomy & 3 patients of achalasia underwent modified Heller`s operation. 2 patients of congenital esophageal atresia had distal tracheoesophageal fistula & underwent one staged operation with the results of one death caused by pneumonia. Upper esophageal web had divulsion through the esophagoscope and foreign body in upper esophagus was removed through cervical esophagotomy. One case of leiomyoma in esophagus had esophagectomy and reconstruction with right colon. And one case of hemangioma in esophagus had esophagectomy & esophagogastrostomy.

• Journal of Chest Surgery
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• v.30 no.8
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• pp.803-808
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• 1997

There were 105 patients with multiple rib fracture or flail chest who had underwent surgical rib fixation using judet's strut from Aug. 1989 to Aug. 1995. They were 86 men and 19 women, and the age distribution was from 17 to 77(mean $48\pm12).$ The most common cause of accident was a traffic accident(81%), The mean number of rib fracture was 5.5 and the distribution of patient were flail chest(72, 64.7%), severe displaced rib Fracture(18, 17.1%), traumatic chest wall deformity(10, 95%) and others(5, 4.7%). The operative mortality was 1 patient(0.96%) and the incidence of postoperative complication were 13 patients(12.3%). The duration of perioperative artificial ventilator therapy was $90.5\pm22.6$ hours. Our method allowed shorter duration of an artificial ventiatin and decreased a functional sequelae. We find this technique to be better than previously published methods, since it provides better stabilization and immobilization of he ribs and thus obviates the need for artificial ventilation and prevents post-traumatic chest deformity.

• Tuberculosis and Respiratory Diseases
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• v.46 no.4
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• pp.591-595
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• 1999

Pulmonary gangrene is a rare complication of severe pulmonary infection in which a pulmonary segment or lobe is sloughed. It is a part of a spectrum of disease in which lung tissue is devitalized(such as necrotizing pneumonia, pulmonary abscess), but apart from them, pulmonary gangrene has more extensive area of necrosis and thrombosis of large vessels plays a prominent role in the pathogenesis. We experienced a case of pulmonary gangrene in 71 year old female obstructive pneumonia patient with non-small cell lung carcinoma. She complained high fever, chill and despite treatment with antibiotics, pneumonia progressed to empyema. At that time chest radiograph showed a large cavity including sloughed lung tissue, freely moving to dependent position at both lateral decubitus view. RML and RLL were resected and compression of pulmonary vessels by enlarged lymph nodes was observed. Defervescence was obtained immediate postoperative period and the patient was discharged after infection control with antibiotics, chest tube drainage. The perivascular lymph nodes dissected during lobectomy were proved to be reactive hyperplasias. We speculated that the carcinoma caused obstructive pneumonia, in turn, resulted in reactive hyperplasia of the draining lymph nodes surrounding the large vessels and finally the lung tissues supplied by them necrotized and sloughed.