• Journal of Chest Surgery
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• v.38 no.2 s.247
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• pp.110-115
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• 2005

Background: The aims of this paper were to review the mid term clinical results and to analyze the preoperative risk factors of isolated aortic valve replacement (AVR). Material and Method: Between January 1992 and February 2003, 80 patients underwent isolated AVR. 58 were male and 22 were female patients, raging from 12 to 75 years of age (mean :$46.8{\pm}13.0$ years). 74 patients except one early death and 5 follow-up loss were contacted by OPD or by telephone. The mean duration of follow-up was $44.2{\pm}29.7$ months and the total cumulative period was 272.8 patient-year. Result: The complications in hospital occurred in 35 cases : 12 wound problems (11 superficial, 1 deep), 11 arrhythmias (9 temporary, 2 persistent), 3 low cardiac output, and so forth. The late deaths were 4 cases : the heart-related deaths were 2 cases ($0.7\%$ patient-year). Conclusion: The risk factors that influenced the early mortality and morbidity were older age (> 60 years)(p=0.04), poor preoperative NYHA functional class (> 3) (p=0.048), high preoperative serum creatinin level (> 1.2 mg/100 ml)(p=0.031), long operation time (aortic clamping time>90 min)(p=0.042). The same factors influenced the late mortality and morbidity. Freedom from valve-related complication was $86.4{\pm}5.3\%,$ actuarial survival rate were $96.8{\pm}2.3\%$ at 3 years and $90.8{\pm}4.6\%$ at 10 years.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.5 no.2
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• pp.158-165
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• 2002

Purpose: We designed this retrospective study to establish the incidence of diagnosic delay in children diagnosed with acute appendicitis and to identify associated factors with delayed diagnosis and its impact on the clinical course. Methods: All cases of children under 15 years of age who underwent appendectomy from 1996 to 2001 at Gangneung Asan Hospital were reviewed. We reviewed signs and symptoms, type of health professional first contacted, the advice given by the health professional and a history of appendicitis in first degree relatives. Diagnostic period is the time elapsed between first complaints and definitive diagnosis. Delay was defined as diagnostic period exceeded the 48 hours. Postoperative course and complications were also reviewed. Results: Incidence of diagnostic delay differed by whether diarrhea and fecalith on X-ray were present. Also children whose parents were advised to observe them at home were more likely to have a diagnostic delay. In almost half of the cases in delayed group, initial diagnosis was not acute appendicitis but gastroenteritis. The perforation rate in non-delayed group was 22%, whereas 87% in delayed group. The delayed group showed a higher number of postoperative complication and a longer hospitalization period. Conclusions: Diarrhea with abdominal pain and fever in children should not be dismissed as gastroenteritis, respiratory infections or other common disorders. Our study suggests that physicians have a responsibility to prevent diagnostic delay and resultant perforation of acute appendicitis in children by having a high index of suspicion about acute appendicitis.

• Journal of Yeungnam Medical Science
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• v.18 no.1
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• pp.75-84
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• 2001

Background: The accidental swallowing of foreign body is a common problem in the children. Ingested foreign bodies may be managed by endoscopy, observation, or surgery. So we analyzed the methods of removal, type, location and complications of foreign bodies. Materials and Methods: This report reviewed 37 cases of ingested foreign body in the gastrointestinal tract at the Department of Pediatrics, Yeungnam University Hospital between January 1997 and April 2001. Results: The age ranged from 8 months to 8 years. The most prevalent age group was between 1 year and 2 years of age(19%). The male to female ratio was 2.1:1 with 25 male and 12 female patients. The type of foreign bodies were coins in 20 cases(54%), nail in 4 cases(11%), key in 4 cases(11%), pin in 2 cases(5.5%), necklace in 2 cases(5.5%) and others. The locations of foreign bodies were upper esophagus in 12 cases(32.5%), lower esophagus in 4 cases(10.8%), stomach in 16 cases(43.2%), small bowel in 5 cases(13.5%). 4. Presenting symptoms were variable with asymptomatic(59.4%), vomiting(19.0%), epigastric pain(8.1%), dysphagia(5.4%) and others. The methods for removal of foreign bodies included 20 cases of endoscopic removal(54.0%). 3 cases of spontaneous removal(8.1%) and there was no surgical removal. 14 cases(37.9%) did not confirmed removal of foreign body because of no revisit of our hospital. Endoscopic finding of patients were normal(15 cases), ulceration(2 cases), erosion(1 case), inflammation(1 case), mucosal scratch(1 case). Conclusion: It appears that the endoscopic approach is the preferable method for the removal of upper gastrointestinal foreign bodies in the children.

• Radiation Oncology Journal
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• v.16 no.3
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• pp.265-274
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• 1998

Purpose : This prospective study has been conducted to assess the value of three dimensional conformal radiation therapy (3DCRT) for lung cancer and to determine its potential advantage over current treatment approaches. Specific aims of this study were to 1) find the most ideal 3DCRT technique 2) establish the maximum tolerance dose that can be delivered with 3DCRT and 3) identify patients at risk for development of radiation pneumonitis. Materials and Methods : Beginning in Nov. 1994, 95 patients with inoperable non-small cell lung cancer (stage I; 4, stage II; 1, stage IIIa; 14, stage IIIb; 76) were entered onto this 3D conformal trial Areas of known disease and elective nodal areas were initially treated to 45 Gy and then using 3DCRT technique 65 to 70 Gy of total dose were delivered to the gross disease. Sixty nine patients received 65 Gy of total dose and 26 received 70 Gy Seventy eight patients (82.1$\%$) also received concurrent MVP chemotherapy. 3DCRT plans were compared with 2D plans to assess the adequacy of dose delivery to target volume, dose volume histograms for normal tissue, and normal tissue complication Probabilities (NTCP). Results : Most of plans (78/95) were composed of non-coplanar multiple (4-8) fields. Coplanar segmented conformal therapy was used in 17 pateints, choosing the proper gantry angle which minimize normal lung exposure in each segment. 3DCRT gave the full dose to nearly 100$\%$ of the gross disease target volume in all patients. The mean NTCP for ipsilateral lung with 3DCRT (range; 0.17-0.43) was 68$\%$ of the mean NTCP with 2D treatment planning (range; 0.27-0.66). DVH analysis for heart showed that irradiated volume of heart could be significantly reduced by non-coplanar 3D approach especially in the case of left lower lobe lesion. Of 95 patients evaluable for response, 75 (79$\%$), showed major response including 25 (26$\%$) with complete responses and 50 (53$\%$) with partial responses. One and two rear overall survivals of stage III patients were 62.6$\%$ and 35.2$\%$ respectively. Twenty percent (19/95) of patients had pneumonitis; Eight patients had grade 1 pneumonitis and 11 other patients had grade 2. Comparison of the average of NTCP for lung showed a significant difference between patients with and without radiation pneumonitis. Average NTCP for Patients without complication was 62$\%$ of those with complications. Conclusions : This study showed that non-coplanar multiple fields (4-8) may be one of the ideal plans for 3DCRT for lung cancer. It also suggested that 3DCRT may provide superior delivery of high dose radiation with reduced risk to normal tissue and that NTCP can be used as a guideline for the dose escalation.

• The Journal of Korean Society for Radiation Therapy
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• v.13 no.1
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• pp.91-103
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• 2001

In those patients who underwent radiation therapy with 10 MV X-ray for bone marrow transfer, compared the effect of high dose irradiation on peripheral blood were investigated in randomly selecting 18 patients. thus, changes in the levels of peripheral blood (WBC, Seg. neutrophil, Lymphocyte, RBC, Hemoglobin, Hematocrit ratio, GOT, GPT) were observed for 25 days after irradiation with the peripheral blood levels before irradiation in these patients and in 32 controls. Among changes in peripheral blood, the level of WBC was $8.63\%$ after radiation therapy with as much decrease as $0.22{\times}103{\pm}0.19{\times}103/mm^3$ compared with $2.51{\times}103{\pm}1.29{\times}103/mm^3$ before radiation therapy, and was only $6.35\%$ of $7.17{\times}103/mm^3{\pm}1.46{\times}103/mm^3$ in the controls, showing statistical significance (P<0.01, r2=0.9151). In the morphologic test of WBC, the level of Seg. neutrophil was decreased as much as to $20.53\%$ with $14.17{\pm}21.60\%$ compared with $69.00{\pm}25.60\%$ before irradiation, and decreased down to $24.39\%$ compared with $58.09{\pm}7.62\%$ in the controls (P<0.05, r2=0.6316). The number of lymphocyte increased as much as 3.94 folds at $79.91{\pm}27.30\%$ compared with $20.29{\pm}21.15\%$ before irradiation and was 2.39 times higher than $33.46{\pm}6.79\%$ in the controls (P<0.05, r2=0.7337). Although the change in the number of RBC was little with $3.18{\times}106{\pm}0.41{\times}106/mm^3$ before irradiation and $4.66{\times}106{\pm}0.43{\times}106/mm^3$ in the controls, no statistical significance was present (P>0.05). In addition, The number of hemoglobin was low compared with before irradiation and with the controls, but none showed statistical significance (P>0.05). Similarly, although the hematocrit ratio was low compared with before irradiation and with the controls, no statistical significance was present (P>0.05). In the values of the histologic examinations GOT and GPT, there is statistical significance between those from with before irradiation and with the controls (P<0.05). Thus, among peripheral blood, the number of WBC decreased drastically for a certain period after total body irradiation with high dose radiation, and the levels of Seg. neutriphil and lymphocyte decreased significantly after irradiation in the lymphocyte morphologic test. The results of the present study suggest that the possibility of developing the first to determine initially those patients who might develop radiation acute impairment using the usual peripheral blood test of patients to be exposed to high dose irradiation.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.20 no.3
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• pp.263-268
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• 1998

Many myocutaneous flaps have been used for the reconstruction of intraoral defects caused by the excision of oral cancer. Among these myocutaneous flaps, cervical island flap has been introduced by Farr et al. Although different in detail, this flap was designed as the platysma myocutaneous flap by Futrell et al in the supraclavicular site. Since many authors applied this flap to cover intraoral defect, they discussed deeply the blood supply of this flap. To improve further flap survival, it was modified by Tashiro et al. This flap makes its vascularity highly reliable. The amount of tissue needed for reconstruction can be accurately planned. The surgical and reconstruction procedure can be performed simply, rapidly, and effectively. Oral functions including deglutition, speech, and denture fitting are not compromised. With it's minimal deformity, new donor fields is not necessory. Of course, we keep in mind that this flap has limitations in patients where much bulk of tissue defects is needed and more than 3000 rad radiation due to the metastasis of neck lymph node is exposed. In three patients with intraoral squamous cell carcinoma($T_{1-3}N_0M_0$), we performed induction chemotherapy with FP regimen including pepleomycin. Thereafter, we ablated oral cancer and peformed reconstruction of intraoral defects with cervical island flap designed by Tashiro et al. Due to these significant benefits and minimal limitations, we have found that this flap is adequate for reconstruction of most intraoral defects following cancer ablation.

• Journal of the Korean Arthroscopy Society
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• v.5 no.1
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• pp.22-26
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• 2001

Purpose : To confirm the efficacy of arthroscopic synovectomy fur the pigmented villonodular synovitis in the knee. Materials and Methods : Between October 1996 and February 2000, the arthroscopic synovectomy had been performed in six patients(six knee joints), whose diagnoses were confirmed by pathologist. All patients complained of painful swelling in involved knee and four of the six patients had trauma history. There were three male and three female patients. Average age was 35.8 years ranging from 16 to 67 years. Follow up period was average 22.7 months(range, $13\~53$ months). Results : According to arthroscopic findings, there were three localized forms and three diffuse forms. At their last follow-up examinations, all patients had improvement in pain, swelling and range of motion and there was no evidence of recurrence. Conclusion : Complete arthroscopic excision is the definitive treatment for localized pigmented villonodular synovitis and meticulous arthroscopic excision through all portals including posterior portal can be considered as a valid alternative to traditional open synovectomy for the patients with diffuse pigmented villonodular synovitis.

• The Journal of the Korean bone and joint tumor society
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• v.9 no.1
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• pp.12-17
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• 2003

Purpose: In this report we are going to discuss about the functional evaluation and the outcome of treatment of metastatic tumor in the lower extremities treated with tumor prosthetic arthroplasty. Materials and Methods: This report is based on nine patients diagnosed as a metastatic tumor and treated by tumor prosthetic arthroplasty, from June 1998 to December 2001. Age of the patients ranged from 49 to 63 with the average of 56.3. The average follow up period was 23.4 months. Two patients had lung cancer, three had breast cancer, two had renal cancer, one colon cancer, and one had multiple myeloma. All these were primary cancers. The site of metastasis were six in proximal femur, two in distal femur, and one in proximal tibia. Tumor excision was performed after biopsy in following the principle of primary tumor management. Excision with wide surgical margin was tried as possible could. Six cases were treated with tumor prosthesis, and the other three cases were reconstructed with bone cement and arthroplasty. Results: The functional evaluation in the extremities at the last follow up was performed on Enneking evaluation score with 6 categories. The highest scored 26, and the lowest scored 10, with an average of 19.5. A case in which the patient died 15 days after the operation was excluded from the evaluation. Among the categories, emotional acceptance to postoperative function and pain relief were highly scored. At the final follow up, seven patients survived, and one colon cancer patient died 68 days after operation. Conclusion: Metastatic tumor occurring in joints of lower extremities could be treated in accordance to the treatment principle of primary tumor. By insertion of tumor prosthesis, we can get satisfactory results of function in the lower extremity and pain relief especially. So, this aspect of medical favor must be considered in treating patients.

• Journal of Yeungnam Medical Science
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• v.13 no.2
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• pp.199-210
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• 1996

Infantile hypertrophic pyloric stenosis(IHPS), which occurs three of 1,000 live births, is a major cause of nonbilious vomiting of early infancy but its etiology and pathogenesis are still obscure. The operation of pyloromyotomy as described by Ramstedt in 1912 remains the standard of care for the treatment of IHPS. From January 1993 to October 1996, 35 infants with IHPS were surgically treated and the following results were obtained. 1. Thirty-five patients comprised 32 males and 3 females, and the ratio of male to female was 10.7:1. 2. The most prevalent age group was between 2 weeks and 8 weeks. 3. Of 35 infants, first born babies were 23 cases(65.7%). 4. Breast feeding was in 23 cases(65.7%). 5. The body weight percentile at admission was lower than 50 percentile in all 35 cases. 6. Onset of symptoms was predominantly between 1week and 2 weeks in 11 cases(31.4%). 7. All had a history of nonbilious vomting, generally projectile in nature. 8. In the measured serum electrolytes, hypokalemia was noted in 9 cases(25.7%), hypochloremia was observed in 14 cases(40.0%). 9. In the preoperative ultrasonography, the average muscle thickness, diameter, and length of the pylorus were 6.2mm, 12.1mm, and 17.9mm, respectively. 10. Among 35 cases, significant sonographic criteria of IHPS, muscle thickness of 5mm or more, were noted in 26 cases(83.9%). 11. A total of seven associated anomalies were noted in six patients. 12. All 35 cases were treated with Fredet-Ramstedt pyloromyotomy. 13. There were postoperative complications of wound infection in 2 cases. Intermittent nonprojectile vomiting was presented in 8 cases(22.9%) after operation, but one of them was relieved in 13 days and the rest were relieved within one week by adjustment of oral intake.

• Journal of the Korean Arthroscopy Society
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• v.12 no.1
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• pp.1-6
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• 2008

Purpose: The purpose of this study is to compare the results of the arthroscopic reconstruction of ACL using autologous hamstring tendon and autologous bone-patellar tendon-bone. Materials and Methods: From January, 2000 to December, 2004, 120 patients underwent arthroscopic ACL reconstruction using autologous hamstring tendon(60 cases) and autologous bone-patellar tendon-bone(BPTB)(60 cases). The mean followed up period of hamstring tendon group was 42 months(range $24{\sim}69$ months) and patellar tendon group was 52 months(range $24{\sim}84$ months). At the time of the final follow up, sixty patients in each group were evaluated the results of physical examination, activity level, patients' satisfaction, functional status, and objective anteriror stability using KT-2000 arthrometer. Results: At the time of the final follow up we compared the two groups who had ACL reconstruction using either autologous hamstring tendon or BPTB, and the final results of the Lachman test showed negative, or mildly positive in 85%(51 cases) of the hamstring tendon group and 90%(54 cases) of the BPTB group. Pivot shift test indicated positive in both groups, 8%(5 cases) and 5%(3 cases) respectively and showed no statistically significant difference. The evaluation of the anterior laxity using the KT-2000 arthrometer revealed no significant difference in the hamstring and BPTB groups: differences less than 3 mm compared to the healthy side were 85%(51 cases) and 90%(54 cases)(p>0.05). The Lysholm score improved from a preoperative score of 51 to a postoperative score of 79.1 in the hamstring groups and from 52 to 82.2 in the BPTB groups. According to the IKDC rating system, 87%(52 cases) were normal or near normal in the hamstring group. In the BPTB group, 83%(50 cases) were normal or near normal. The Tegner score for the hamstring groups was 4.8 preoperatively and 7.1 at the final follow up, and the Tegner score for the BPTB groups was 4.5 preoperatively and 7.3 after the last follow-up. The anterior knee pain was found in 7%(4 cases) in the hamstring tendon group and 10%(6 cases) in the patellar tendon group. Conclusion: Arthroscopic ACL reconstruction using both the autologous hamstring tendon and the patellar tendon during their mid term follow up period demonstrated excellent results. However, the final results during their last follow up showed no statistically significant difference between the two groups.