• Journal of Chest Surgery
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• v.44 no.6
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• pp.399-405
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• 2011

Background: Left ventricular (LV) hypertrophy caused by aortic valve stenosis (AS) leads to cardiovascular morbidity and mortality. We sought to determine whether aortic valve replacement (AVR) decreases LV mass and improves LV function. Materials and Methods: Retrospective review for 358 consecutive patients, who underwent aortic valve replacement for degenerative AS between January 1995 and December 2008, was performed. There were 230 men and 128 women, and their age at operation was $63.2{\pm}10$ years (30~85 years). Results: There was no in-hospital mortality, and mean follow-up duration after discharge was 48.9 months (2~167 months). Immediate postoperative echocardiography revealed that LV mass index and mean gradient across the aortic valve decreased significantly (p<0.001), and LV mass continued to decrease during the follow-up period (p<0.001). LV ejection fraction (EF) temporarily decreased postoperatively (p<0.001), but LV function recovered immediately and continued to improve with a significant difference between preoperative and postoperative EF (p<0.001). There were 15 late deaths during the follow-up period, and overall survival at 5 and 10 years were 94% and 90%, respectively. On multivariable analysis, age at operation (p=0.008), concomitant coronary bypass surgery (p<0.003), lower preoperative LVEF (<40%) (p=0.0018), and higher EUROScore (>7) (p=0.045) were risk factors for late death. Conclusion: After AVR for degenerative AS, reduction of left ventricular mass and improvement of left ventricular function continue late after operation.

• Journal of Chest Surgery
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• v.49 no.6
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• pp.435-442
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• 2016

Background: Blunt traumatic cardiac rupture is rare. However, such cardiac ruptures carry a high mortality rate. This study reviews our experience treating blunt traumatic cardiac rupture. Methods: This retrospective study included 21 patients who experienced blunt traumatic cardiac rupture from 1999 to 2015. Every patient underwent surgery. Several variables were compared between survivors and fatalities. Results: Sixteen of the 21 patients survived, and 5 (24%) died. No instances of intraoperative mortality occurred. The most common cause of injury was a traffic accident (81%). The right atrium was the most common location of injury (43%). Ten of the 21 patients were suspected to have cardiac tamponade. Significant differences were found in preoperative creatine kinase-myocardial band (CK-MB) levels (p=0.042) and platelet counts (p=0.004) between the survivors and fatalities. The patients who died had higher preoperative Glasgow Coma Scale scores (p=0.007), worse Trauma and Injury Severity Scores (p=0.007), and higher Injury Severity Scores (p=0.004) than those who survived. Conclusion: We found that elevated CK-MB levels, a low platelet count, and multi-organ traumatic injury were prognostic factors predicting poor outcomes of blunt cardiac rupture. If a patient with blunt traumatic cardiac rupture has these factors, clinicians should be especially attentive and respond promptly in order to save the patient's life.

• Korean Journal of Head & Neck Oncology
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• v.16 no.2
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• pp.201-205
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• 2000

Objectives: Despite of high prevalence of tuberculosis in Korea, thyroid tuberculosis is very rare and only a few records are available. This study was carried out to evaluate the clinicopathologic characteristics of thyroid tuberculosis and to find out optimal therapeutic strategies for these lesions. Materials & Methods: From Jan. 1986 to July. 2000, of 5,493 patients who were underwent thyroidectomy, only 8(0.14%) had discovered to have thyroid tuberculosis. The medical records of them were analyzed retrospectively. Results: There were one man and seven women with a mean age of 40.3 years. Only one had tuberculosis sequalae on chest X-ray and two had past history of tuberculous lymphadenitis. However, none of them had symptomatic pulmonary tuberculosis. Most frequent symptom was palpable neck mass. The preoperative U/S, CT and FNAB failed to diagnose thyroid tuberculosis. The pathologic reports were chronic granulomatous thyroiditis with caseous necrosis in all the cases and AFB stain was positve in 5 cases. All cases were successfully treated by surgical resection and anti-Tbc. medications. Conclusions: The incidence of thyroid tuberculosis was extremely low and most of them have been presented as a palpable neck mass especially in relatively young-aged female patients. Although any diagnosis for thyroid tuberculosis prior to microscopical study of tissue removed at operation was not yielded, the preoperative diagnostic workups will be available with experience. Surgical resection and anti- Tbc medication would be the choice in the management of thyroid tuberculosis.

• Korean Journal of Head & Neck Oncology
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• v.26 no.2
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• pp.183-186
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• 2010

Purpose : Papillary thyroid carcinoma (PTC) is known for malignant tumor which has a favorable prognosis and long-term survival. Although the prognosis for patients with PTC is generally good, PTC tends to have highly metastatic property. The purpose of this study was to analyze the central compartment lymph node in papillary thyroid cancer with no lymph node metastasis clinically and to assess the significance of prophylactic node dissection. Methods : A retrospective review was carried out in 394 patients with PTC who underwent surgery for the period from January 2004 to December 2006. The positive rate of the lymph node metastasis was analyzed. The relations between the central compartment lymph nodes and the patients' age, gender, tumor size, exrathyroidal extension(ETE), multifocality, and bilaterality were comparatively analyzed in PTC patients with preoperative no lymph node metastasis. Results : The enrolled patients were 40 male and 354 female cases. The 118 cases of them were found to have cervical lymph node metastasis. The mean age was 46 years(range, 15-77years). Tumor size(p=0.000), ETE(p=0.001), multifocality(p=0.014), and bilaterality(p=0.001) were significantly related factors for cervical lymph node metastasis clinically in papillary thyroid cancer. However, age and gender were not significantly related with lymph node metastasis. Conclusion : Although no lymph node metastasis clinically, prophylactic neck node dissection can be performed to avoid risks of local recurrence and reoperation in the light of PTC nature. The pathological status and high positive rate of central compartment lymph node relate to tumor size and extrathyroidal extension. Close surveillance for nodal status is required in follow-up.

• Journal of Korean Neurosurgical Society
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• v.40 no.4
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• pp.273-276
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• 2006

Although cavernous angioma itself is not rare, the epidural spinal localization is uncommon and makes preoperative differential diagnosis difficult. An extraordinary case of a thoracic epidural cavernous angioma in very young age, causing sudden paraplegia is presented. Only 79 cases have been reported in the literatures and among them, this kid was the youngest. A 23-month-old boy was referred to us with a 2-day history of sudden both lower limb weakness. Two days before admission, he got up at morning and was unable to stand and even to move the legs. MRI revealed an epidural mass surrounding spinal cord associated with cord compression at the level of the C5 through T3. Through posterior approach with exposure of C6 to T3 level, the hematomatous mass was removed subtotally due to intraoperative bleeding and its ventral location. After the first operation, the weakness of bilateral lower extremities was improved so as to move gainst the gravity. But the next day, the limb weakness was aggravated as same as preoperative status due to mass effect of new hematoma. The second operation was performed to remove the hematoma and to control the bleeding focus. Several weeks later, the limb weakness was improved and he was able to walk. The literatures about spinal cavernous angioma are reviewed.

• Journal of Korean Neurosurgical Society
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• v.29 no.10
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• pp.1322-1327
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• 2000

Objectives : To assess the surgical results for patients with multiple intracranial aneurysms and factors related to prognosis of patients. Materials and Methods : We retrospectively analyzed the clinical characteristics of 47 patients with multiple intracranial aneurysms and assessed the types of surgical treatment and prognosis of 44 patients who received surgical treatment from January 1986 to March 1999. Results : The 47 patients presented altogether 108 aneurysms with male to female ratio of 1 : 3.7, and average age 54.9 years(range 33-81 years). Common locations for multiple aneurysms were P-com(31%), MCA(30%) and Acom( 15%). The postoperative good and poor outcomes were 30 cases(68%) and 11 cases(25%), respectively and there were 3 deaths(7%). The analyzed results for 44 surgically treated patients were as follows ; 1) The size of aneurysm was relevant to frequency of rupture ; the lowest for lesions less than 1cm(21%), rising to 85% for lesions greater than 3cm(p<0.05). 2) The surgical outcome was significantly correlated with preoperative clinical status of the patients(p<0.05). 3) The good outcome was associated with surgery within 7 days(especially 24 hours) after clinical onset of symptoms but not with type of operation and laterality of aneurysms. Conclusion : With regard to the surgical treatment for multiple aneurysm cases, surgeons should consider the salient factors in a good prognosis such as patient's preoperative status, size of aneurysm, timing of surgery, and type of operation.

• Journal of Korean Neurosurgical Society
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• v.42 no.5
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• pp.382-387
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• 2007

Objective : Cubital tunnel syndrome is the second most common entrapment neuropathy of the upper extremity. Although many different operative techniques have been introduced, none of them have been proven superior to others. Simple cubital tunnel decompression has numerous advantages, including simplicity and safety. We present our experience of treating cubital tunnel syndrome with simple decompression in 15 patients. Methods : According to Dellon's criteria, one patient was classified as grade 1, eight as grade 2, and six as grade 3. Preoperative electrodiagnostic studies were performed in all patients and 7 of them were rechecked postoperatively. Five patients of 15 underwent simple decompression using a small skin incision (2 cm or less). Results : Preoperative mean value of motor conduction velocity (MCV) within the segment (above the elbow-below the elbow) was $41.8{\pm}15.2\;m/s$ and this result showed a decrease compared to the result of MCV in the below the elbow-wrist segment ($57.8{\pm}6.9\;m/s$) with statistical significance (p<0.05). Postoperative mean values of MCV were improved in 6 of 7 patients from $39.8{\pm}12.1\;m/s$ to $47.8{\pm}12.1\;m/s$ (p<0.05). After an average follow-up of $4.8{\pm}5.3$ months, 14 patients of 15 (93%) reported good or excellent clinical outcomes according to a modified Bishop scoring system. Five patients who had been treated using a small skin incision achieved good or excellent outcomes. There were no complications, recurrences, or subluxation of the ulnar nerve. Conclusion : Simple decompression of the ulnar nerve is an effective and successful minimally invasive technique for patients with cubital tunnel syndrome.

• Journal of Korean Neurosurgical Society
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• v.55 no.5
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• pp.267-272
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• 2014

Objective : Differentiation of demyelination in white matter from axonal damage can be determined using diffusion tensor imaging (DTI). In this study using meningioma patients an attempt was made to evaluate the relationship between preoperative weakness and the changes of diffusion parameters in the corticospinal tract (CST) using DTI. Methods : Twenty-six patients with meningioma were enrolled in this study. Eleven of them suffered from objective motor weakness and were classified as Group 1. The remaining 15 patients did not present motor weakness and were classified as Group 2. Fiber tractography and CST diffusion parameters were obtained using DTIStudio. The ratios (lesion side mean value/contralateral side mean value) of CST diffusion parameters were compared with 1.0 as a test value using a one-sample t-test. Results : In Group 1, fractional anisotropy (FA), tensor trace (TT), and radial diffusivity (RD, ${\lambda}2$ and ${\lambda}3$) of the CST were significantly different between two hemispheres, but axial diffusivity (AD, ${\lambda}1$) of the CST was not significantly different between two hemispheres. In Group 2, FA and ${\lambda}3$ of CST did not differ significantly between the hemispheres. In Group 2, TT, ${\lambda}1$, and ${\lambda}2$ of CST in the ipsilateral hemisphere were significantly higher than those of the unaffected hemisphere. However, the differences were small. Conclusion : Motor weakness was related to a low FA and high TT resulting from increased RD of the CST fibers. CST diffusion changes in patients with weakness are similar to those for demyelination.

• Journal of Korean Neurosurgical Society
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• v.55 no.6
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• pp.337-342
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• 2014

Objective : To determine deformity correction by postural correction and subsequent balloon inflation in acute vertebral compression fractures (OVCFs) and to examine the effect of bone mineral density on deformity correction. Methods : A totol of 50 acute OVCFs received balloon kyphoplasty. Lateral radiographs were taken and analyzed at five different time points : 1) preoperative, 2) after placing the patient in prone hyperextended position, 3) after balloon inflation, 4) after deposition of the cement, and 5) postoperative. All fractures were analyzed for height restoration of anterior (Ha), middle (Hm) and posterior (Hp) vertebra as well as Cobb angle and Kyphotic angle. The bone mineral density (BMD) of lumbar spine was measured by dual-energy X-ray absorptiometry. According to the T-score, the patients were divided into two groups which were osteoporosis group and osteopenia group. Results : Postoperative measurements of Ha, Hm and the Cobb angle demonstrated significant reduction of 4.62 mm, 3.66 mm and $5.34^{\circ}$ compared with the preoperative measurements, respectively (each p<0.05). Postural correction significantly increased Ha by 5.51 mm, Hm by 4.35 mm and improved the Cobb angle by $8.32^{\circ}$ (each p<0.05). Balloon inflation did not demonstrate a significant improvement of Ha, Hm or the Cobb angle compared with baseline prone hyperextended. Postural correction led to greater improvements of Ha, Hm and Cobb angle in osteoporosis group than osteopenia group (each p<0.05). Conclusion : In acute OVCFs, the height restoration was mainly attributed to postural correction rather than deformity correction by balloon inflation. BMD affected deformity correction in the process of postural correction.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.6
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• pp.2651-2654
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• 2014

Background: Lung cancer (LC) is still the primary cause of cancer deaths worldwide, and late diagnosis is a major obstacle to improving lung cancer outcomes. Recently, elevated preoperative or pretreatment neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and mean platelet volume (MPV) detected in peripheral blood were identified as independent prognostic factors associated with poor survival with various cancers, including colon cancer, esophageal cancer, gastric cancer and breast cancer. Objective: The aim of this study was to examine whether MPV, NLR and PLR could be useful inflammatory markers to differentiate lung cancer patients from healthy controls. An investigation was also made of the relationship between these markers and other prognostic factors and histopathological subgroups. Materials and Methods: Retrospectively eighty-one lung cancer patients and 81 age-sexes matched healthy subjects included into the study. Patients with hypertension, hematological and renal disease, heart failure, chronic infection, hepatic disorder and other cancer were excluded from the study. The preoperative or pretreatment blood count data was obtained from the recorded computerized database. Results: NLR and PLR values were significantly higher in the LC patients compared to the healthy subjects.( NLR: 4.42 vs 2.45 p=0.001, PLR: 245.1 vs 148.2 p=0.002) MPV values were similar in both groups (7.7 vs 7.8). No statistically significant relationship was determined between these markers (MPV, NLR and PLR) and histopathological subgroups and TNM stages. Conclusions: NLR and PLR can be useful biomarkers in LC patients before treatment. Larger prospective studies are required to confirm these findings.