• Journal of Chest Surgery
• /
• v.36 no.5
• /
• pp.343-347
• /
• 2003

Background: The femoral artery is the most common site of canuulation for cardiopulmonary bypass in surgery for type A aortic dissection. Recently, many surgeons prefer the axillary artery to the femoral artery as the arterial cannulation site for several benefits. We evaluated the safety and usefulness of axillary artery cannulation in surgery for acute type A aortic dissection. Material and Method: Between Oct. 1995 and Sep. 2001, 71 patients underwent operations for acute type A aortic dissection. The arterial cannula was inserted into the axillary artery in 31 patients (AXILLARY group, mean age=56), and into the femoral artery in 40 patients (FEMORAL group, mean age=57). We retrospectively compared the incidence of mortality, morbidities, and hospital course. Result: The mean duration of cardiopulmonary bypass and circulatory arrest were significantly shorier in the AXILLARY group (207 min and 39min, respectively) than in the FEMORAL group (263min and 49 min, respectively; P<0.05). Postoperative hospital stay was significantly shorter in the AXILLARY group than in the FEMORAL group (mean 15 days vs. 35 days, p<0.05). Although there was no difference in the incidence of new-onset permanent neurological dysfunction (3.2%, in the AXILLARY group, 2.5% in the FEMORAL group), the incidence of transient neurological dysfunction was significantly lower in the AXILLARY group (12.9% vs. 25%, p<0.05). In the FEMORAL group, two patients needed urgent conversion to cannulation site due to arch vessel malperfusion. In the AXILLARY group, there was only one patient who had a complication related to the cannulation, i.e., median nerve injury. Conclusion: Axillary artery cannulation was safe and helpful in decreasing the cerebral ischemic time and incidence of transient neuroligcal dysfunction in surgery for acute type A aortic dissection, It enabled us to approach the patients with aortic arch pathology more aggressively.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.21 no.1
• /
• pp.54-59
• /
• 1999

This study was based on a series of 164 patients with zygomatic bone fracture treated at Department of Oral and Maxillofacial Surgery of Chonnam University Hospital from January 1992 to December 1996. The male-to-female ratio was 7:1. Their ages ranged from 8 to 78 years, with a median age of 35.6 years. The age frequency was highest in the second decade (30.5%), and third decade (23.8%), fifth decade (16.5%) in orders. The monthly distrbution of incidence showed October to be the month in which the greatest percentage occured (14.0%). The major cause of zygomatic bone fracture was alleged traffic accidents (53.7%). The incidence of concomitant facial bone fractures was 69,5%, and maxilla fracture (52.4%) was most frequently combined. The admission route was through emergency room (72.3%) and through outpatient department (26.8%). The incidence of associated injuries was 37.2%. The intraoral approach was the major method of treatment in zygomatic bone fracture (57.1%). The most frequent type of zygoma fracture was class IV (33.5%), and class III (25.6%) was next in order of frequency. Complications were enophthalmos (7.3%), facial asymmetry (6.7%), paresthesia (6.1%), and diplopia (2.4%) These results suggest that correct diagnosis and treatment of severity of fracture, concomitant fracture, and associated injuries are necessary, and co-operative treatment with medical department should be performed to reduce postoperative complication.

• Tuberculosis and Respiratory Diseases
• /
• v.49 no.6
• /
• pp.676-683
• /
• 2000

Background : Surgery may have a role when medical treatment alone is not successful in patients with multidrug resistant (MDR) pulmonary tuberculosis (PTB). To document the role of resection in MDR PTB, we analyzed 4 years of our experience. Methods : A retrospective review was performed on thirteen patients that underwent pulmonary resection for MDR PTB between May 1996 and February 2000. All patients had organisms resistant to many of the first-line drugs including isoniazid (INH) and rifampicin (RFP). Results : The thirteen patients were $37.5{\pm}12.4$ years old (mean${\pm}$S.D.)(M : F=5:8), and their sputum was culture positive even with adequate medication for prolonged periods ($109.7{\pm}132.0$ months), resistant to 2-8 drugs including isoniazid and rifampin. All patients had localized lesion(s) and most (92.3%) had cavities. At least 3 sensitive anti-TB medications were started before surgery in all patients according to the drug sensitivity test. The preoperative $FEV_1$ was $2.37{\pm}0.83$ L. Lobectomy was performed in 11 patients and pleuropneumonectomy in two. Postoperative mortality did not occur, but pneumonia occurred as a complication in one (7.7%). After $41.5{\pm}58.9$ days (range 1~150 days) follow up, negative conversion of sputum culture was achieved in all patients within 5 months. Only one patient (7.7%) recurred 32 months after lung resection. Conclusion : When medical treatment alone is not successful, surgical resection can be a good treatment option in patients with localized MDR PTB.

• Clinics in Shoulder and Elbow
• /
• v.12 no.1
• /
• pp.27-32
• /
• 2009

Purpose: We wanted to evaluate the effectiveness of inferior capsular plication for treating the anterior instability of the shoulder by comparing the prospective outcomes and the incidence of complications of the group (group1) that underwent arthroscopic vertical shift of the anteroinferior capsulo-labral complex and plication of the anterior band of inferior glenohumeral ligament and the group (group2) that underwent inferior capsular plication that was augmentated by the same method. Materials and Methods: From March 2005 to August 2007, we compared group 1 (42 cases) that underwent arthroscopic vertical shift of the anteroinferior capsulo-labral complex and plication of the anterior band of the inferior glenohumeral ligament and group 2 (33 cases) that underwent augmentated inferior capsular plication for recurrent anterior instability of the shoulder. The mean age was 22.5 years (range: 17~31 years) in group I, and 21.8 years (range: 16~30 years) in group II. The mean follow up was 23.5 months (range: 12~45 months in group I, and 20.1 months (range: 12~49 months) in group II. We checked the Rowe score and ROM preoperatively and at postoperative 6 months, 1 year and at the last follow up and we compared the incidence of complications. Results: The Rowe score increased from a preoperative mean of 20.6 to the last follow up mean of 86.8 after surgery in group I, and the Rowe score increased from a preoperative mean of 20.5 to the last follow up mean of 94.1 after surgery in group II. For the anterior instability of the shoulder, arthroscopic reconstruction had a good outcome in all of the cases, but group II had better outcomes and less complications than did group I (p<0.05). Conclusion: We thought that arthroscopic vertical shift of the anteroinferior capsulo-labral complex and plication of the anterior band of the inferior glenohumeral ligament with inferior capsular plication can lower the complication rate and show better outcomes.

• Journal of the Korean Orthopaedic Association
• /
• v.56 no.6
• /
• pp.484-490
• /
• 2021

Purpose: A rheumatoid forefoot deformity includes severe hallux valgus and claw toe of the four lateral toes. The authors intended to analyze the mid-term results of the modified Hoffman procedure for a rheumatoid forefoot deformity. Materials and Methods: Twenty-two feet of eighteen patients were followed up for more than two years after the modified Hoffman procedure. The mean age was 54.7 years, and the mean follow-up period was three years and four months. Clinically visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) MP-IP score were analyzed preoperatively and postoperatively. The postoperative complications, the satisfaction of patients, and the presence of plantar callosity were also analyzed. Radiographically, the hallux valgus angle, the 1st intermetatarsal angle, the 1st interphalangeal angle, the 1st interphalangeal joint arthritic change after the operation, and the dorsiflexion angle and the time to union of the 1st metatarsophalangeal joint were analyzed. Results: Clinically, the VAS and AOFAS score were respectively improved from 7.1 points and 30.3 points preoperatively to 1.5 points and 83.1 points postoperatively (p<0.001). All patients were satisfied with the results. Plantar callosity disappeared in all cases. Radiographically, the mean hallux valgus angle, the 1st intermetatarsal angle, and the 1st interphalangeal angle changed from 52.8°, 13.3°, and 7.5° preoperatively to 16.2°, 8.7°, and 14.6° postoperatively (p<0.001). The mean dorsiflexion angle of the 1st metatarsophalangeal joint was 17.2° postoperatively. The mean time to radiographic union of the 1st metatarsophalangeal joint was 11.1 weeks. There were two cock-up deformities of the lesser toe, one wound problem, and two hallux interphalangeal joint arthritis as a complication. There were no cases of nonunion of the 1st metatarsophalangeal joint. Conclusion: The modified Hoffman procedure appears to be a safe and satisfactory procedure for a rheumatoid forefoot deformity.

• Radiation Oncology Journal
• /
• v.25 no.2
• /
• pp.79-92
• /
• 2007

[ $\underline{Purpose}$ ]: For the first time, a nationwide survey in the Republic of Korea was conducted to determine the basic parameters for the treatment of esophageal cancer and to offer a solid cooperative system for the Korean Pattern of Care Study database. $\underline{Materials\;and\;Methods}$: During $1998{\sim}1999$, biopsy-confirmed 246 esophageal cancer patients that received radiotherapy were enrolled from 23 different institutions in South Korea. Random sampling was based on power allocation method. Patient parameters and specific information regarding tumor characteristics and treatment methods were collected and registered through the web based PCS system. The data was analyzed by the use of the Chi-squared test. $\underline{Results}$: The median age of the collected patients was 62 years. The male to female ratio was about 91 to 9 with an absolute male predominance. The performance status ranged from ECOG 0 to 1 in 82.5% of the patients. Diagnostic procedures included an esophagogram (228 patients, 92.7%), endoscopy (226 patients, 91.9%), and a chest CT scan (238 patients, 96.7%). Squamous cell carcinoma was diagnosed in 96.3% of the patients; mid-thoracic esophageal cancer was most prevalent (110 patients, 44.7%) and 135 patients presented with clinical stage III disease. Fifty seven patients received radiotherapy alone and 37 patients received surgery with adjuvant postoperative radiotherapy. Half of the patients (123 patients) received chemotherapy together with RT and 70 patients (56.9%) received it as concurrent chemoradiotherapy. The most frequently used chemotherapeutic agent was a combination of cisplatin and 5-FU. Most patients received radiotherapy either with 6 MV (116 patients, 47.2%) or with 10 MV photons (87 patients, 35.4%). Radiotherapy was delivered through a conventional AP-PA field for 206 patients (83.7%) without using a CT plan and the median delivered dose was 3,600 cGy. The median total dose of postoperative radiotherapy was 5,040 cGy while for the non-operative patients the median total dose was 5,970 cGy. Thirty-four patients received intraluminal brachytherapy with high dose rate Iridium-192. Brachytherapy was delivered with a median dose of 300 cGy in each fraction and was typically delivered $3{\sim}4\;times$. The most frequently encountered complication during the radiotherapy treatment was esophagitis in 155 patients (63.0%). $\underline{Conclusion}$: For the evaluation and treatment of esophageal cancer patients at radiation facilities in Korea, this study will provide guidelines and benchmark data for the solid cooperative systems of the Korean PCS. Although some differences were noted between institutions, there was no major difference in the treatment modalities and RT techniques.

• Advances in pediatric surgery
• /
• v.8 no.2
• /
• pp.143-155
• /
• 2002

A survey on biliary atresia was made among 26 members of the Korean Association of Pediatric Surgeons. The members were required to complete a questionnaire and a case registration form for each patient during the twentyone-year period of 1980-2000. Three hundred and eighty patients were registered from 18 institutions. The average number of patients per surgeon was one to two every year. The male to female ratio was 1:1.3. The age of patients on diagnosis with biliary atresia was on average $65.4{\pm} 36.2$ days old. The national distribution was 32.8% in Seoul, 25.3% in Gyoungki-Do, 21.6% in Gyoungsang-Do, 9.27% in Choongchung-Do, etc. in order. The most common clinical presentation was jaundice (98.4%) and change of stool color (86.2%) was second. Two hundred eighty (74.7%) of 375 patients were operated by 80 days of age. Three hundred thirty six (9 1.9%) of 366 patients were operated on by the original Kasai procedure, and 305 (84.3%) of 362 patients were observed by bile-drainage postoperatively. The overall postoperative complication rate was 18.5% and the overall postoperative mortality rate was 6.8%. The associated anomalies were observed in 72 cases (22.5%). One hundred ninty five (64.7%) of 302 patients have been alive in follow-up and 49 (25.1%) have survived over 5 years without problem after operation. Ascending cholangitis, varices and ascites affected survival significantly, and the important long-term prognostic factor was the occurrence of complications.

• Journal of Chest Surgery
• /
• v.41 no.3
• /
• pp.320-328
• /
• 2008

Background: Numerous surgical devices for mitral repair have been used in the past with good results. In this study we describe a simple annuloplasty technique with using a new device ($Mitracon^{(R)}$). The aim of this study was to assess its efficacy and surgical results with using $Mitracon^{(R)}$. Material and Method: From May 2003 to October 2005, 46 patients (21 women and 25 men (mean age of $51.4{\pm}17.8$ years) with mitral regurgitation from various causes were treated with either the $Mitracon^{(R)}$ (the $Mitracon^{(R)}$ group) or the Capentier Edward rigid ring (the CE group). The median follow-up duration was 18.9 months. Result: The mean grade of mitral regurgitation before and immediately after surgery in the $Mitracon^{(R)}$ group and the CE group decreased from $3.2{\pm}0.8$ to $0.6{\pm}0.7$ and $3.4{\pm}0.7$ to $0.3{\pm}0.5$, respectively. There were no significant changes in the ejection fraction either between the two groups or before and immediately after surgery. No deaths were seen in either group. Early postoperative echocardiography of all 46 patients showed only trivial mitral regurgitation or none at all. Echocardiography at a median of 18.9 months also showed no progression in mitral regurgitation. The mean grade of mitral regurgitation in the $Mitracon^{(R)}$ group at this time point decreased from $3.2{\pm}0.8$ to $0.8{\pm}0.7$ (p<0.05). The CE group also showed a similar degree of decrease from $3.4{\pm}0.7$ to $0.3{\pm}0.6$ (p<0.05). The mitral valve area in the $Mitracon^{(R)}$ group at 1 year follow-up was $3.3{\pm}0.9cm^2$. The mitral valve area in the CE group was $2.7{\pm}0.6cm^2$. The mean mitral pressure gradient in the $Mitracon^{(R)}$ group at 1 year follow-up was $3.1{\pm}1.3$ mmHg. The mean pressure gradient in the CE group was $4.5{\pm}2.1$ mmHg, although any statistical significant difference for this between the groups was not reached. Conclusion: The present study showed the described technique to be safe and effective in the intermediate term. Because long term results are unavailable, a more extensive prospective randomized multicenter trial may be warranted to determine whether this procedure should be generally applied for repair of mitral valve disease.

• Journal of Chest Surgery
• /
• v.35 no.9
• /
• pp.643-652
• /
• 2002

As the prevalence of coronay artery disease is increasing, the surgical treatment has been universalized and operative outcome has been improved. We analyzed the short and mid-term results of 292 CABGs performed in Kangdong Sacred Heart Hospital. Material and Method: From June 1994 to December 2001, 292 patients underwent coronary artery bypass grafting. There were 173 men and 119 women and their ages ranged from 39 to 84 years with a mean of $61.8{\pm}9.1$ years. We analyzed the preoperative risk factors, operative procedures and operative outcome. In addition, we analyzed the recurrence of symptoms, long-term mortality and complications via out-patient follow-up for discharged patients. Result: Preoperative clinical diagnoses were unstable angina in 137(46.9%), stable angina in 34(11.6%), acute myocardial infarction in 40(13.7%), non-Q myocardial infarction in 25(8.6%), postinfarction angina in 22(7.5%), cardiogenic shock in 30(10.3%) and PTCA failure in 4(1.4%) patients. Preoperative angiographic diagnoses were three-vessel disease in 157(53.8%), two-vessel disease in 35 (12.0%), one-vessel disease in 11(3.8%) and left main disease in 89(30.5%) patients. We used saphenous veins in 630, internal thoracic arteries in 257, radial arteries in 50, and right gastoepiploic arteries in 2 distal anastomoses. The mean number of distal anastomoses per patient was $3.2{\pm}1.0$ There were 18 concomitant procedures ; valve replacement in 8(2.7%), left main coronary artery angioplasty in 6(2.1%), patch closure of postinfarction ventricular septal defect(PMI-VSD) in 2(0.7%), replacement of ascending aorta in 1(0.3%) and coronary endarterectomy in 1(0.3%) patient. The mean ACC time was $96.6{\pm}35.3 $ minutes and the mean CPB time was $179.2{\pm}94.6$ minutes. Total early mortality was 8.6%, but it was 3.1% in elective operations. The most common cause of early mortality was low cardiac output syndrome in 6(2.1%) patients. The stastistically significant risk factors for early mortality were hypertension, old age($\geq$ 70 years), poor LV function(EF＜40%), congestive heart failure, preoperative intraaortic balloon pump, emergency operation and chronic renal failure. The most common complication was arrhythmia in 52(17.8%) patients. The mean follow-up period was $39.0{\pm}27.0$ months. Most patients were free of symptoms during follow-up. Fourteen patients(5.8 %) had recurrent symptoms and 7 patients(2.9%) died during follow-up period. Follow-up coronary angiography was performed in 13 patients with recurrent symptoms and they were managed by surgical and medical treatment according to the coronary angiographic result. Conclusion: The operative and late results of CABG in our hospital, was acceptable. However, There should be more refinement in operative technique and postoperative management to improve the results.

• Journal of Chest Surgery
• /
• v.38 no.7 s.252
• /
• pp.489-495
• /
• 2005

In the surgical treatment of aortic dissection, aortic arch replacement under total circulatory arrest is often performed after careful inspection to determine the severity of disease progression. Under circulatory arrest, antegrade or retrograde cerebral perfusion is required for brain protection. Recently, antegrade cerebral perfusion has been used more, because of the limitation of retrograde cerebral perfusion. This study is to compare these two methods especially in the respect to neurological complications. Material and Method: Forty patients with aortic dissection involving aortic arch from May 2000 to May 2004 were enrolled in this study, and the methods of operation, clinical recovery, and neurological complications were retrospectively reviewed. Result: In the ACP (antegrade cerebral perfusion) group, axillary artery cannulation was performed in 10 out of 15 cases. In the RCP (retrograde cerebral perfusion) group, femoral artery Cannulation was performed in 24 out of 25 cases. The average esophageal and rectal temperature under total circulatory arrest was $17.2^{\circ}C\;and\;22.8^{\circ}C$ in the group A, and $16.0^{\circ}C\;and\;19.7^{\circ}C$ in the group B, respectively. Higher temperature in the ACP group may have brought the shorter operation and cardiopulmonary bypass time. However, the length of period for postoperative clinical recovery and admission duration did not show any statistically significant differences. Eleven out of the total 15 cases in the ACP group and thirteen out of the total 25 cases in the RCP group showed neurological complication but did not show statistically significant difference. In each group, there were 5 cases with permanent neurological complications. All 5 cases in the ACP group showed some improvements that enabled routine exercise. However all 5 cases in RCP group did not show significant improvements. Conclusion: The Antegrade, cerebral perfusion, which maintains orthordromic circulation, brings moderate degree of hypothermia and, therefore, shortens the operation time and cardiopulmonary bypass time. We concluded that Antegrade cerebral perfusion is safe and can be used widely under total circulatory arrest.