• Journal of Yeungnam Medical Science
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• v.11 no.1
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• pp.153-159
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• 1994

Extracapsular cataract extraction with posterior chamber intraocular lens in 24 eyes of 24 diabetics, with and without diabetic retinopathy, were followed up postoperatively for an average of 14 months to determine the incidence of progression of diabetic retinopathy, the final visual acuity and factors predictive of progression of retinopathy and final visual acuity. Overall, retinopathy progressed in 52% of operated-on eyes. Cataract extraction was highly associated with progression of diabetic retinopathy. Women had a significantly increased risk of progression of retinopathy in the operated-on eye compared to men. Visual acuity improved in 22 of 24 orerated-on eyes : however, only 11 eyes achieved a visual acuity of 0.5 or better and only 7 eyes achieved a visual acuity of 0.7 or better. Patients treated with oral hypoglycemic agents had a worse visual prognosis than those treated with insulin. The prognosis of patients with diabetic retinopathy about to undergo cataract surgery, even extracapsular cataract extraction with placement of a posterior chamber lens, is guarded.

• Journal of Chest Surgery
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• v.35 no.6
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• pp.449-453
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• 2002

Intra-aortic balloon pump (IABP) is well known for its hemodynamic benefit but still has its own complications. Proper use of IABP is the best way to obtain maximum benefit with low complication rate. Material and Method： Twenty one(men 10, female 11) patients were included in this study among the 100 consecutive adult cardiac surgery patients in our hospital. Eighteen(85.7%) were ischemic heart disease patients. They all received IABP therapy due to postcardiotomy cardiogenic shock according to the well-known indications. Their preoperative conditions, intraoperative factors including hemodynamics, postoperative conditions and IABP-related complications were analyzed. Result： Nineteen patients(90.5%) were successfully weaned from IABP. There were 2 patients of operative death and the mortality rate was 9.5%. Duration of IABP use was 40.7$\pm$24.3 hours. There were 2 cases(9.5 %) of IABP-related vascular complications that required surgical intervention. Conclusion： We concluded that IABP could be used effectively and safely for postcardiotomy cardiogenic shock patients with low complication rate.

• Tuberculosis and Respiratory Diseases
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• v.47 no.6
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• pp.775-785
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• 1999

Background : Though surgery plays an important role in the management of patients with Mycobacterium tuberculosis infection, there is little information regarding the timing of resection. We tried to find out the ideal timing of operation. Method: A retrospective review was performed in 69 patients underwent pulmonary resection for pulmonary tuberculosis between January 1993 and December 1997. They were categorized into various groups according to the length of preoperative specific drug therapy. The rates of treatment failure, realpse and complication in each group were compared statistically by $x^2$-test. Results: Eighty one point two percent were men and 18.8 % women with a median age of 33 years(range, 16 to 63 years). The mean number of resistant drugs was 3.l(range, 0 to 9). Patients were treated preoperatively with multidrug regimens, which mean number of preoperative specific drugs was 4.6, in an effort to reduce the mycobacterial burden with the mean length of preoperative drug therapy, 5.0 months. Postoperative treatment was conducted for a mean period of 13.0 months with a mean number of postoperative specific drugs, 4.4. Postoperative treatment failures were confirmed in 8 among 69 patients(11.6%). 2 of these 8 patients were showed up in the preoperative 3 to 4 months medication group and each of the rest was occurred in the preoperative 2 to 3, 5 to 6, 6 to 7, 12 to 13, 17 to 18 months, less than one month medication group, respectively. 59 of 69 patients were available for evaluation of the relapse rate with the mean duration of the postoperative follow-up, 19.8 months. In 4 patients bacterial relapse was confirmed(6.8%). Each of these 4 was in the preoperative 1 to 2, 2 to 3, 3 to 4, 5 to 6 months medication group. Categorized into various groups according to the length of preoperative specific therapy, there were no statistical significances of the treatment failure rate, relapse rate and complication rate in the groups. There were seven treatment failures of 28 who were AFB culture positive until the time of operation(25%, p<0.01). Categorized the preoperative AFB culture positive group into various groups according to the length of preoperative drug therapy, there were no statistical significances, either. Conclusion: We believe that operation plays an important ancillary role in the treatment of pulmonary tuberculosis. Our results indicate that the timing of resection according to the length of preoperative drug therapy may not cause trouble.

• Journal of Chest Surgery
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• v.34 no.12
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• pp.895-900
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• 2001

Background : This study aimed to evaluate the usefulness of preoperative placement of intraaortic balloon pump(IABP) in reducing operative risk and facilitating posterior vessel OPCAB in high risk patients with left main disease( 75％ stenosis), intractable resting angina, postinfarction angina, or left ventricular dysfunction(ejection fraction 35％). Material and Method : One hundred eighty- nine consecutive patients who underwent multi-vessel OPCAB including posterior vessel revascularization were studied. The patients were divided into group I(n=74) that received preoperative or intraoperative IABP and group II(n=115) that did not receive IABP. In group I, there were 39 patients with left main disease, 40 patients with intractable resting angina, 14 patients with left ventricular dysfunction and 7 patients with postinfarction angina. Ten patients received intraoperative IABP support due to hemodynamic instability during OPCAB. Result : There was one operative mortality in group I and two mortalities in group II. The average number of distal anastomoses was not different between group I and group II(3.5$\pm$0.9 vs 3.4$\pm$0.9, p=ns). There were no significant differences in the number of posterior vessel anastomosis per patient between the two groups. There were no differences in ventilator support time, length of hospital stay, and morbidity between the two groups. There was one case of IABP-related complication in group I. Conclusion : IABP facilitates posterior vessel OPCAB in high risk patients, with comparable surgical results to low risk patients

• The Journal of Korean Society for Radiation Therapy
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• v.27 no.1
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• pp.13-22
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• 2015

Purpose : We investigated the safety of Intrabeam$^{TM}$ system, X-ray unit for Intraoperative Radiotheray (IORT) by measuring surface dose using Optically Stimulated Luminescent Dosimeter(OSLD). Materials and Methods : 30 patients were selected, who were in breast cancer patients and had an operation of breast conserving surgery (BCS). At the inner surface of tumor bed, 20 Gy were described, and 5 Gy at 1cm depth from the inner surface. Along the size of tumor bed which could be decided after resection of tumor, the size of applicator were determined. Usual treatment time were from 18 to 40 minutes. For the measurement of surface doses, OSLD were placed at superior(U1,2), inferior(D1,2), lateral(L1,2) and medial(M1,2) directions from the center of applicator. Each direction, two OSLD were placed at 0.5 cm and 1.5 cm from the center. Mean, maximum, and minimum doses were analyzed to be compared. Results : Mean values were U1 $2.23{\pm}0.80Gy$, U2 $1.54{\pm}0.53Gy$, D1 $1.73{\pm}0.63Gy$, D2 $1.25{\pm}0.45Gy$, L1 $1.95{\pm}0.82Gy$, L2 $1.38{\pm}0.42Gy$, M1 $2.03{\pm}0.70Gy$, and M2 $1.51{\pm}0.58Gy$. Maximum values were 4.34 Gy at U1, and Minimum values were 0.45 Gy at M2. 13.3 % of patient (4pts out of 30) were reported that surface dose were over 4 Gy. Conclusion : The fact that skin dose of all patients were less than 5 Gy based on OSLD measurement showed the safety of Intrabeam$^{TM}$ system. In the relatively small breast volume, the tendency that surface dose was increased had been shown, which was analyzed by the data of patients who irradiated over 4Gy at skin surface. Therefore, for appropriate indication for IORT, it is suggested that breast volume as well as the size and position of tumor should be carfully considered.

• Journal of Chest Surgery
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• v.29 no.7
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• pp.769-776
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• 1996

The application of video-assisted thoracic surgery (VATS) in the examination of the thoracic cavity can be a new option in patients with mediastinal tumor because it provides outstanding visibility of the structures of the mediastinum. By clear viewing through the thoracoscope, a mediastinal tumor can be biopsied or resected, depending on the findings during an operation. We reviewed all patients who underwent curative or diagnostic operations from March 1990 to August 1995 under the impression of a mediastinal mass. The total number of patients were 113 with 59 males and 54 females. Group A underwent resection of tu or by thoracotomy(38 patients: 18 males, 20 females), and group B underwent resection of tumor by VATS (36 patients : 20 males and 16 females). Seven patients in group B were excluded because they underwent thoracotomy due to pleural adhesion or intra-operative bleeding ; therefore, the true VATS group numbered 29 cases. Group C underwent Iymph node biopsy by VATS(33 patients'16 males, 17 females), and group D(6 patients: 5 males, 1 female) underwent Iymph node biopsy through anterior mediastinotomy. The mean age in group A was 36.2 years compared to 41.3 years In group B. We compared operation time, frequency of injection for pain control, duration of chest tube insertion, postoperative hospital stay, and diagnostic yield. In group A, they were 164 minutes, 3.4 times, 5.2 days, and 11.3 days, respectively, in comparison to 152 minutes, 2 times, 4.7 days, and 8.3 days, respectively, in group B. These data revealed that the day of discharge was significantly shorter in group B (p valu : 0.03). In group C, the mean age was 45.8 years (range 1 ∼70). The operation time was from 30 to 335 minutes (mean 105), pain control was required from 0 to 15 times(mean 3.2), and a chest tube was needed for 1 to 36 days (mean 6.1). In group D, mean age was 53.3 years, operation time 121 minutes, pall control injec- tion frequency 2.6 times, and mean chest tube duration 10.5 days. The diagnostic yield in group C was 8 oyo compared to 100 oyo in group D although the number of patients in group D is small.

• Clinical and Experimental Pediatrics
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• v.53 no.2
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• pp.195-202
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• 2010

Purpose : Despite recent advances in pulmonary hypertension management and surgery, appropriate guidelines remain to be developed for operability in congenital heart disease with pulmonary artery hypertension (PAH). Our aim was to evaluate clinical outcomes of patients with severe PAH who underwent surgical closure of left-to-right shunt lesions (LRSL) on the basis of pulmonary reactivity. Methods : We retrospectively reviewed 21 patients who underwent surgical closure of LRSL with severe PAH (${\geq}8$ Wood unit) from January 1995 to April 2009. The median age at operation was 26 years. Atrial septal defect, ventricular septal defect (VSD), VSD and patent ductus arteriosus (PDA), and PDA was present in 11, 4, 4, and 2 patients, respectively. Results : Operability was based on vasoreactivity of PAH. Of the 21 patients, 5 showed response to pulmonary vasodilator therapy and 8 showed vasoreactivity after balloon occlusion of defects. The remaining 8 patients were considered operable because of significant left-to-right shunt (Qp/Qs ${\geq}1.5$). Five patients underwent total closure of defects and 16 were left with small residual shunts. The median follow-up duration was 32 months. There was no significant postoperative mortality or morbidity. Systolic pulmonary artery pressure (PAP) decreased in all but 2 patients. All patients except 1 showed improvement of New York Heart Association functional class. Conclusion : Closure of LRSL in patients with severe PAH on the basis of pulmonary vasoreactivity seems reasonable. PAP and clinical symptoms improved in most patients. Further research is needed for the evaluation of long-term results.

• Journal of Chest Surgery
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• v.38 no.7 s.252
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• pp.476-482
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• 2005

Recently, coronary artery obstructive disease and coronary artery bypass graft surgery have increased, and the operative result has been improved. We reviewed 154 cases of coronary artery bypass graft surgery from Jan. 1985 to Jun. 2004. Material and Method: We reviewed 148 patients, 154 cases of coronary artery bypass surgery from Jan. 1985 to Jun. 2004. This investigation is designed to illustrate the preoperative diagnosis, severity of disease, operative method, the kind of used bypass graft used, number of distal anasomosis, associated surgery, and postoperative morbidity and mortality. Result: There were 84 males, 64 females and the average age was $58.9\pm8.3$ years old. Preoperative clinical diagnosis were unstable angina in 97 cases $(63.0\%)$, stable angina in 31 cases $(20.1\%)$, acute myocardial infarction in 12 cases $(7.8\%)$ and postinfartion angina in 14 cases $(9.1\%)$. Preoperative angiographic diagnosis were three-vessel disease in 68 $(44.2\%)$, two-vessel disease in 39 $(25.3\%)$, one-vessel disease in 35$(22.7\%)$, and left main disease in 12$(7.8\%)$ cases. There were 78 cases of on-pump coronary artery bypass graft surgery and 76 cases of off-pump coronary artery bypass graft surgery. The total distal anastomoses number was 319, mean number of anastomoses was $2.06\pm0.96$. There were 10 concomitant procedures. Postoperative intra-aortic balloon pump was used in 21$(13.6\%)$ cases, but only 4 cases were used at off-pump coronary artery bypass surgery. Total early mortality was $7.8\%$. The mortality was decreased as $4.5\%$ from Jan. 2001 to Jun. 2004. Post operative complication was perioperative yocardial infarction in 9cases$(5.8\%)$, low cardiac output syndrome in 17 cases$(11\%)$, and arrhythmia in 30 cases$(19.5\%)$ cases. Conclusion: Since 1985, The result of coronary artery bypass graft surgery has been improved because of more refined technique, use of off-pump coronary artery bypass surgery, use of internal thoracic artery and radial artery as bypass graft. We should study the long-term follow up more for better operative results.

• Journal of Chest Surgery
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• v.40 no.2 s.271
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• pp.90-96
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• 2007

Background: Postoperative atrial fibrillation is the most frequently arrhythmic complication associated with coronary artery bypass graft surgery. This study was designed to investigate the incidence of atrial fibrillation in patients undergoing OPCAB and on-pump CABG and to identify the risk factors associated with its development. Material and Method: 247 consecutive patients were evaluated among 306 patients who underwent the coronary artery bypass graft surgery between January, 2002 and December, 2005. 178 patients underwent OPCAB (OPCAB group) and 69 patients underwent On-pump CABG (On-pump CABG group). The incidence and the risk factors of atrial fibrillation in two groups were determined. Result: There were no significant differences between two groups with respect to the preoperative demographic characteristics of the patients. The incidences of postoperative atrial fibrillation were 25 cases (14%) in OPCAB group and 15 cases (21%) in On-pump CABG group. Age over 65 years, net positive fluid imbalance for postoperative 3 days, and chest tube bleeding for postoperative 3 days were independent predictive factors in OPCAB group. Age over 65 years and net positive fluid imbalance for postoperative 3 days were independent predictive factors in On-pump CABG group. In multivariate analysis, age over 65 years was the only risk factor of postoperative atrial fibrillation in both groups. Conclusion: Atrial fibrillation is a common complication after procedures of myocardial revascularization. There wasn't a low incidence of postoperative atrial fibrillation in OPCAB, compared with On-pump CABG. Age over 65 years was associated with postoperative atrial fibrillation irrespective of the use of cardiopulmonary bypass.

• Journal of Chest Surgery
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• v.37 no.3
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• pp.228-234
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• 2004

Primary cardiac tumors are rare disease and they present nonspecific symptom. They are divided in benign and malignant tumors and require surgical therapy and/or additional therapy. From March 1995 to March 2003, twenty one patients were diagnosed as having primary cardiac tumors. We analysed them retrospectively in terms of various perioperative factors and early and late results. 6 men and 15 women and their average age was 45.44$\pm$18.76. Pathology revealed eighteen benign (fourteen myxoma, two fibroelastoma, one hemangioma and one paraganglioma) disease and three malignant (one angiosarcoma, one mesothelioma and one myxofibrosarcoma) disease. There was one (myxoma) operative mortality and three late death (hemangioma, angiosarcoma and mesothelioma) during additional therapy and follow up. Surgical treatment of primary cardiac tumor is important and sometimes additional therapy is required but the prognosis of malignant cardiac tumor is still very poor.