• The Korean Journal of Nuclear Medicine
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• v.33 no.3
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• pp.273-281
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• 1999

Purpose: We investigated whether myocardial SPECT had additional usefulness to clinical, functional or surgical indices for the preoperative evaluation of cardiac risks in noncardiac surgery. Materials and Methods: 118 patients (M: F=66: 52, $62.7{\pm}10.5$ years) were studied retrospectively. Eighteen underwent vascular surgeries and 100 nonvascular surgeries. Rest T1-20l/ stress Tc-99m-MIBI SPECT was performed before operation and cardiac events (hard event: cardiac death and myocardial infarction; soft event: ischemic ECG change, congestive heart failure and unstable angina) were surveyed through perioperative periods ($14.6{\pm}5.6$ days). Clinical risk indices, functional capacity, surgery procedures and SPECT findings were tested for their predictive values of perioperative cardiac events. Results: Perioperative cardiac events occurred in 25 patients (3 hard events and 22 soft events). Clinical risk indices, surgical procedure risks and SPECT findings but functional capacity were predictive of cardiac events. Reversible perfusion decrease was a better predictor than persistent decrease, Multivariate analysis sorted out surgical procedure risk (p=0.0018) and SPECT findings (p=0.0001) as significant risk factors. SPECT could re-stratify perioperative cardiac risks in patients ranked with surgical procedures. Conclusion : We conclude that myocardial SPECT provides additional predictive value to surgical type risks as well as clinical indexes or functional capacity for the prediction of preoperative cardiac events in noncardiac surgery.

• Journal of Chest Surgery
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• v.29 no.1
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• pp.73-78
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• 1996

From June 1989 to May 1994, 23 patients with myasthenia gravis underwent thymectomy in the Department of Thoracic Surgery, Asan Medical Center. For the evaluation of the effect of thymectomy, clinical analysis including age and sex distribution, preoperative disease severity, duration of the symptoms, thymic pathology, and postoperative clinical improvement was performed. The mean follow-up period was 15 mon hs(range : 5∼60mon1hs). The effectiveness of thymectomy according to the postoperative symptoms and drug dose was graded as follow : a) complete remission in 5 cases (21.7%), b) clinical improvement with dose reduction in II cases (47.9%), c) clinical improvement without dose reduction in 3 cases(13.0%), 4) unchanged in 2 cases (8.8%), e) early death in 1 case(4.3%) and f) recurrence in 1 case(4.3%). According to the preoperative disease stage by Modified Osserman classification, 6(66.7%) of the 9 patients in stage I and 13 (92.9%) of 14 patients in stage II were clinically improved after thymectomy. although there was no significant statistical differences between these two groups (p> 0.05). According to the thymic pathology, 4 (100%) of 4 cases with normal thymus were clinically improved. Ten (90.9%) of 11 cases with thymic hyperplasia and 5 (62.5%) of 8 cases with thymoma were clinically improved, but there was no significant statistical differences in these three groups (p> 0.05 . The thymectomy resulted in dramatic clinical improvement in 19 (82.5%) out of 23 patients. According to the preoperative disease stage by Modified Osserman classification or the thymic pathology, there was no significant statistical differeneces in the effect of thyinectomy (p> 0.05).

• Journal of Chest Surgery
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• v.35 no.10
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• pp.730-735
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• 2002

Diaphragm is innervated by phrenic nerve and lower intercostal nerves. For patients with avulsion injury of brachial plexus, an in situ graft of phrenic nerve is frequently used to neurotize a branch of the brachial plexus. We studied short-term and mid-term changes of diaphragmatic level and movement in patients with dissection of phrenic nerve for neurotization. Material and Method : Thirteen patients with division of either-side phrenic nerve for neurotization of musculocutaneous nerve were included in this study. With endoscopic surgical procedure, the intrathoracic phrenic nerve was entirely dissected and divided just above the diaphragm. The dissected phrenic nerve was taken out through thoracic inlet and neck wound and then anastomosed to the musculocutaneous nerve through a subcutaneous tunnel. With chest films and fluoroscopy, levels and movements of diaphragm were measured before and after operation. Result : There was no specific technical difficulty or even minor postoperative complications following endoscopic division of phrenic nerve. After division of phrenic nerve, diaphragm was soon elevated about 1.7 intercostal spaces compared with the preoperative level, but it did not show paradoxical motion in fluoroscopy. More than 1.5 months later, diaphragm returned downward close to the preoperative level (average level difference was 0.9 intercostal spaces; p＝NS). Movement of diaphragm was not significantly decreased compared with the preoperative one. Conclusion : After division of phrenic nerve, the affected diaphragm did not show a significant decrease in movement, and the elevated diaphragm returned downward with time. However, the decreased lung volumes in the last spirometry suggest the decreased inspiratory force following partial paralysis of diaphragm.

• Journal of Korean Orthopaedic Sports Medicine
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• v.8 no.2
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• pp.89-94
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• 2009

Purpose: The purpose of this study was to evaluate the factors affecting the treatment results of medial meniscus posterior horn tear. Materials and Methods: Forty seven patients who had been performed the arthroscopic surgery for medial meniscus posterior horn tear were enrolled in this study. We analyzed the clinical outcomes with Lysholm score and Tegner activity score in accordance with the factors such as patients' age, tibiofemoral angle, uptake in bone scintigraphy, surgical methods and patterns of meniscal tears, respectively. Results: The patients' age didn't affect to the results, but the preoperative tibiofemoral angle over valgus $4^{\circ}$ and the preoperative normal uptake in scintigraphic assessment showed a positive influence on the clinical outcomes. The partial meniscectomy and repair in surgical methods had no statistically significance. In addition, the pattern of meniscal tear did not have an effect on the clinical results. Conclusion: We can conclude that many factors should be considered to get satisfactory results. Among them, preoperative bone scintigraphy may be a good assessment factor for the postoperative prognosis, reflecting the condition of meniscal tear and the periarticular bone and soft tissue.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.8 no.1
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• pp.6-10
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• 2015

Purpose: To evaluate the effectiveness of extracorporeal shock wave therapy (ESWT) for postoperative pain after surgery around ankle. Materials and Methods: We included 21 patients who performed an operation around ankle from 2009 to 2013. 4 times ESWT were applied to the patients who have tenderness more than visual analog scale (VAS) point 4. We evaluated the VAS at each sessions and final follow-up, and American Orthopedic Foot and Ankle Society ankle-hindfoot score (AFOAS) was checked at preoperative and final follow-up. Patient's satisfaction and complications were surveyed. Results: Preoperative VAS was mean 4.7, postoperative pain VAS was mean 6.0 at 4.5 months follow-up. The VAS after ESWT each session at 1, 2, 3 weeks and final follow-up were 4.8, 3.2, 2.3, 2.9, respectively. Mean final follow-up period was 9.4 months. Final VAS were significantly decreased (p<0.001). Final VAS were increased from VAS at last session of ESWT, however, not significant (p=0.189). AOFAS significantly improved from preoperative 60 to final follow-up 86 (p<0.001). Excellent was 12 patients (57%), good was 4 patients (19%), no change was 3 patients (14%) and poor was 2 patients (9%). 1 patient complained a dizziness and nausea during ESWT. Conclusion: ESWT for postoperative pain after ankle surgery shows satisfactory pain reduction in 76% of all patients without severe complication.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.15 no.9
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• pp.5621-5627
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• 2014

To specify the standard of LASEK surgery, this study examined the determination factors affecting the high order aberrations (HOAs) in preoperative and postoperative LASEK. 51 adult patients (102 eyes) were evaluated at the baseline and 2 months after LASEK surgery from Nov 2011 to Jul 2012. The postoperative HOAs ($0.538{\mu}m$) were higher than the preoperative ($0.341{\mu}m$). In linear regression analysis, the refractive components that affected the postoperative HOAs were $J_0$ of corneal astigmatism (CA, 0.400), $J_0$ of refractive astigmatism (RA, 0.389), corneal astigmatism (CA, 0.282), spherical equivalent (SE, 0.239), refractive astigmatism (RA, 0.213), and pupil size (PS, 0.194) with a high R. In multiple regression, $J_0$ of CA, PS and SE were significant factors with the postoperative HOAs. In conclusion, both HOAs and $J_0$ of CA should be considered when determining the suitable factors for LASEK surgery.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.6
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• pp.628-635
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• 2000

The purpose of this study was to evaluate the result after 2-phase surgical-orthodontic treatment without preoperative orthodontic treatment for the skeletal Cl III malocclusion patient and to obtain an adequate protocol on the bases of this result. This retrospective study of ten patients who underwent 2-phase treatment were done to evaluate 1) the surgical stability and relapse pattern 2) the facial esthetics 3) the TMJ problem 4) the total time of the treatment. Results were followed : 1) The horizontal relapse of the mandible was 26.8% and didn't show significant differences compared to the conventional 3-phase treatment. But, it was considered that this amount of relapse was the sum of true relapse and autoratation of mandible due to decreased vertical dimension during orthodontic treatment. 2) It was estimated that there's no difference on the ratio of anterior facial height between the subjects and the normal patients. On the horizontal analysis, the mandible of the subjects was located more anteriorly than that of the normal patients. This result showed that there was a need for the accurate preoperative esthetic evaluation and the additional methods for reducing the relapse due to the occlusal interference. 3) Wide variation was noted on the TMJ symptoms of the subjects, however, it was estimated that there's no significant differencees of symptoms compared to that of the conventional 3-phase treatment on literatures. 4) The average of the overall period of treatment was 20.8 months and we obtained reduction of the treatment time compaired to 3-phase treatment on many literatures. Most of the results of this study were similar to the findings of the 3-phase treatment(preoperative orthodontic-orthognathic surgery-postoperative orthodontic), but total time of the treatment was shorter in patients with 2-phase treatment than in those with the conventional 3-phase treatment. With 2-phase treatment, we experienced many advantages compared to the conventional method considering that it was favarable conditions for the teeth, it had the flexibility for the treatment, and it could be the adequate treatment approach for the stomatognathic system. Although this retrospective pilot study had some limitations, due to small samples, the authors would hope that it could serve as a guide for the future researches, and the clinical applications.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.1
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• pp.347-350
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• 2013

The aim of the present study was to determine whether allogeneic red blood cell transfusions showed a deleterious effect and what might be preoperative risk factors for blood transfusion in patients with TNM stage II colon cancer. Total 470 patients who fulfilled inclusion criteria were selected for a further 10-year follow-up study. We found that there were statistical significance between non-transfused and transfused group in mortality (P=0.018), local recurrence (P=0.000) and distant metastasis (P=0.040). Local recurrence and distant metastasis between 1 to 3 units and more than 3 units group did not show any significant differences. There was no difference in survival rate between non-transfused and 1 to 3 units group (log rank=0.031, P=0.860). The difference between different blood transfusion volume in transfused patients was found (78.77% vs 63.83%, P=0.006). Meanwhile, the significant difference of survival rate was existed between non-transfused group and more than 3 units group (84.83% vs 63.83%, P=0.002 ). Univariate analysis showed the following 3 variables to be associated with an increased risk of allogeneic blood transfusions: preoperative CEA level (P<0.05), location of tumor (P<0.01) and diameter of tumor (P<0.01). Multivariate analysis revealed that location of tumor and diameter of tumor are two independent factors for requirement of perioperative transfusions. Therefore, allogeneic transfusion increase the postoperative tumor mortality, local recurrence and distant metastasis in patients with stage II colon cancer. The postoperative tumor mortality, local recurrence and distant metastasis were not associated with the blood transfusion volume. The blood transfusion volume was associated with the survival rate. Location of tumor and diameter of tumor were the independent preoperative risk factors for blood transfusion.

• Journal of Chest Surgery
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• v.33 no.1
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• pp.38-44
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• 2000

Background: We analyzed the result of the "Off-Pump" Coronary Artery Bypass grafting (OPCAB) performed to minimize inflammatory responses to cardiopulmonary bypass and myocardial ischemia during the aortic cross-clamp period. Material and Method : The preoperative diagnosis operative procedure mortality complication and postoperative course of the 50 patients who underwent OPCAB between January 1998 and September 1998 were analyzed. There were 34 males and 16 females with mean age of 60$\pm$9 years. Preoperative clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and postinfarction angina in 3(6%) patients. Preoperative angiographic diagnoses were three-vessel disease in 25(50%) two-vessel disease in 5(10%) one-vessel disease in 7(14%) and left main disease in 13(26%) patients. There were elective operation in 37 cases and urgent operation in 13 cases. Result: The mean number of grafts was 3.2$\pm$1.2 per patient. Grafts used were unilateral internal thoracic artery in 43 greater saphenous vein in 37 radial artery in 7 bilateral internal thoracic arteries in 4 and right gastroepiploic artery in 2 cases Forty sequential anastomoses were performed in 18 cases. Vessels accessed were left anterior descending artery in 48 diagonal branch in 41 obtuse marginal branch in 30 right coronary artery in 24 posterior descending artery in 9 ramus intermedius in 5 and posterolateral branch in 5 anastomoses. Predischarge coronary angiography performed in 44 patients demonstrated the patency rate of 89.5%(128/143) Operative mortality was 2%(1/150) Postoperative complications were arrhythmia in 5 graft occlusion that needed reoperation in 4. perioperative myocardial infarction in 2 femoral artery thromboembolism developed after the application of IABP in 1 postoperative transient delirium in 1 peripheral compression neuropathy in 1 case. Sixteen patients(32%) were extubated at the operating room and the other patients were extubated at the mean 13$\pm$20 hours after the operation. Mean duration of stay in intensive care unit was 49$\pm$46 hours. Thirteen patients(26%) required blood transfusions perioperatively and the amount of perioperative blood transfusion was mean 0.70$\pm$1.36 pack/patient. Conclusion: OPCAB is suggested to be the ideal technique with less postoperative complication less hospitalization time and less cost.less cost.

• Archives of Craniofacial Surgery
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• v.17 no.3
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• pp.128-134
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• 2016

Background: Blowout fracture is one of the most common facial fractures, and patients usually present with accompanying ocular complications. Many studies have looked into the frequency of persistent ocular symptoms, but there is no study on assault patients and related ocular symptoms. We evaluated the incidence of residual ocular symptoms in blowout fractures between assaulted and non-assaulted patients, and sought to identify any connection among the degree of enophthalmos, defect size, and assault-related injury. Methods: A retrospective review was performed for any patient who sustained a unilateral blowout fracture between January 2010 to December 2014. The collected data included information such as age, gender, etiology, and clinical ocular symptoms as examined by an ophthalmologist. This data was analyzed between patients who were injured through physical altercation and patients who were injured through other means. Results: The review identified a total of 182 patients. Out of these, 74 patients (40.7%) have been struck by a fist, whereas 108 patients (59.3%) have sustained non-assault related injuries. The average age was 36.1 years, and there was a male predominance in both groups (70 patients [94.6%] in the assaulted group and 87 patients [80.6%] in the non-assault group). Diplopia and enophthalmos were more frequent in patients with assault history than in non-assaulted patients (p<0.05). Preoperatively, 25 patients (33.8%) with assault history showed diplopia, whereas 20 patients (18.5%) showed diplopia in the non-assaulted group (p<0.05). Preoperative enophthalmos was present in 34 patients (45.9%) with assault history, whereas 31 patients (28.7%) showed enophthalmos in the non-assaulted group (p<0.05). Conclusion: Patients with an assault history due to a fist blow experienced preoperative symptoms more frequently than did patients with non-assault-related trauma history. Preoperative diplopia and enophthalmos occurred at a higher rate for patients who were assaulted. Surgeons should take into account such characteristics in the management of assaulted patients.