• Journal of Chest Surgery
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• v.37 no.5
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• pp.444-447
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• 2004

A 59 year-old male diagnosed as unstable angina underwent off-pump coronary artery bypass surgery using in situ left internal mammary and right gastroepiploic artery grafts. During harvesting the right gastroepiploic artery, there was no abnormal finding in intraabdominal organs including stomach and liver. He was discharged at the 3rd postoperative day without complication. In case of using in situ right gastroepiploic artery, we recommend gastrofberscopic study at regular follow-up, The patient underwent the gastrofiberscopic study at postoperative 3rd month and diagnosed as advanced gastric cancer on the posterior wall of gastric fundus. At 5th postoperative month, total gastrectomy without intraoperative injury of the right gastroepiploic artery was performed at the department of general surgery. He was discharged at the 9th postoperative day. Follow-up coronary angiography performed at the 1st postoperative year demonstrated patent grafts including right gastroepiploic artery.

• The Journal of the Korean bone and joint tumor society
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• v.11 no.1
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• pp.71-81
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• 2005

Purpose: Due to local recurrence of tumor, metal failure usually develops in patients who underwent internal fixation or hip joint arthroplasty after curettage in the case of metastatic tumor of proximal femur. The aim of this study is to find out the appropriateness of reconstruction using recycling autograft after wide excision in the case of metastatic bone tumor by performing recycling autograft and hip joint arthroplasty after wide excision, and through presence or absence of local recurrence, functions of lower limbs and occurrence of complications. Materials and Methods: Five patients, in 6 cases, who had undergone reconstruction using recycling autograft prosthetic composite after wide excision in the metastatic tumor from May 2000 to May 2003 were included in this study. The average age of the patients was 60.8 years of age with male to female ratio of 3:2. Average duration of lives following surgery was 23.3 month (7-57 months). Primary lesion included 2 cases of lung cancer, and 1 each of stomach cancer, renal cancer and multiple myeloma. After wide excision, the hip joint was reconstructed with recycling autograft prosthetic composite ; 4 cases of extracorporeal irradiation and 2 cases of pasteurization. Musculoskeletal Tumor Society (MSTS) score(1993) for 6-month period after surgery, as well as presence of complication and local recurrence during the rest of their lives, were studied. Results: Average Musculoskeletal Tumor Society (MSTS) score over the 6-month period after surgery was 63.3% and 1 case of dislocation of hip joint, as a complication following surgery, was discovered. Local recurrence during the lives of the patients was not observed. Conclusion: In the case of metastatic tumor of proximal femur, in which the life span following surgery is expected to be more than 6 months, undergoing reconstruction using recycling autograft after wide excision, in comparison to internal fixation or hip joint arthroplasty after curettage, is deemed to have better results in prevention of local recurrence, and preservation of the functions of all limbs during the life span of the patient.

• Tuberculosis and Respiratory Diseases
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• v.62 no.6
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• pp.516-522
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• 2007

Background: Postoperative pulmonary complications are important problems that prolong the length of the hospital stay and increase patient mortality. However, our knowledge of the postoperative factors that increase the risk of these complications is less than complete. Methods: We conducted a prospective study to determine the risk factors for postoperative pulmonary complications. A total of 199 patients were referred to the Pulmonology Department for preoperative pulmonary evaluation. We reviewed the perioperative variables according to the National Surgical Quality Improvement Program (NSQIP). Postoperatively, we collected data on the occurrence of postoperative pulmonary complications and we evaluated the relationship between the perioperative variables and outcomes. Results: Twenty two patients (11%) had pulmonary complications; 6 had respiratory failure, 4 had pneumonia, 13 had pleural effusion and, 2 had atelectasis. Five variables were statistically significantly associated with pulmonary complications on the bivariate analyses. Multiple logistic regression analyses revealed that three of these variables were independently associated with an increased risk of pulmonary complications; a high cardiac risk index (OR 16.5, p=0.002), emergency surgery (OR 10.3, p=0.017), and thoracic/abdominal surgery (OR 3.8, p=0.047). Conclusion: The risk factors for postoperative pulmonary complications are a high cardiac risk index, emergency surgery and thoracic/abdominal surgery.

• Journal of Gastric Cancer
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• v.7 no.4
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• pp.200-205
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• 2007

Purpose: The aim of this study was to analyze the post operative outcome of reconstruction with using the stomach after performing total pharyngolaryngoesophagectomy in patients with hypopharyngeal cancer or cervical esophageal cancer. Materials and Methods: We conducted a retrospective chart review of 23 patients who underwent gastric pull up for esophageal substitution at the Department of Surgery, Yonsei University College of Medicine, between January 1991 and December 2006. All the patients had transhiatal esophagectomy performed without thoracotomy. Results: There were seventeen males and six females with a median age of 58.1 years (range: 40-70 years). 19 cases were hypopharyngeal cancer, 13 cases had cancer in the pyriform sinus, 15 cases had cancer in the postcricoid area and one case had cancer in the glottic area. The rest were cervical esophageal cancers. The pathologic result was squamous cell carcinoma in all cases. The median total follow-up period was 33 months (range: 1-62 months) and there were two (8.6%) postoperative deaths: one was due to carotid rupture and the other was due to hepatic failure with liver metastasis. The complications were leakage in 1 patient (4.4%), pneumothorax in 1 patient (4.4%) and pneumonia in 1 patient (4.4%). Conclusion: The use of stomach for esophageal reconstruction has many benefits for treating hypopharyngeal cancer or cervical esophageal cancer, So, we made sure there was a sufficient length for the anastomosis after pharyngolaryngoesophagectomy and a rich blood supply from the stomach. There was a low incidence of the leakage at the anastomotic site, along with a low incidence of stenosis and bleeding.

• Journal of Chest Surgery
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• v.30 no.12
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• pp.1190-1196
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• 1997

Between July 1994 and August 1995, 78 patients underwent coronary artery bypass graft at Seoul National University Hospital. Coronary angiogram was performed one year after coronary artery bypass graft in 49 patients(62.8%) for evaluation of the graft patency and analysis of the risk factors for graft occlusion. The patency rates of both the internal mammary artery and the radial artery grafts were 100% , although three internal mammary artery grafts(5.0%) were narrowed(string sign). And that of the saphenous vein grafts were 85.2%. Multivariate analysis for the preoperative, operative, and postoperative factors was done between the widely patent and the narrowed internal mammary artery graft groups, and between the patent and the occluded saphenous vein graft groups by the general linear models procedure. Patient's age($\geq$60 years), postoperative intraaortic balloon pump insertion, bleeding, and acute renal failure were found to be the significant risk factors for internal mammary artery graft narrowing, and coronary artery size(< 1.5 mm) was the significant risk factor for the saphenous vein graft occlusion (p<0.05) . This study confirms that the arterial graft is superior to the vein graft at one-year patency rate, and suggests the risk factors for graft occlusion during the first postoperative year. Knowledge of this study may provide a basis for estimating the risk factors for graft occlusion, and thereby modifying surgical strategy and postoperative surveillance.

• Korean Journal of Head & Neck Oncology
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• v.30 no.2
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• pp.109-114
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• 2014

갑상선절제술은 내분비 외과의사가 하는 수술 중 가장 안전한 수술이지만 수술 중 기도나 식도가 손상 받을 수 있으므로 각별한 주의를 기울여야 한다. 특히 기도 괴사와 같이 생명에 위협을 주는 합병증이 있음을 유념해야 한다. 본 논문은 갑상선 전 절제술과 승모판 치환술을 함께 받은 72세 여성환자가 수술 후 3일만에 기도 괴사가 발생한 케이스이다. 3개의 기관륜에 걸쳐 괴사가 발생되어 있었다. 괴사된 조직을 제거하고, 이후 지속적인 괴사조직에 대한 제거와 치료와 적으로 기관개창술을 시행하고, 자연폐쇄를 유도하여 성공적으로 치료되었다. 비슷한 여러 논문들을 살펴본 결과 기도 괴사를 유발하는 요인으로는 조절되지 않는 기침, 여성, 갑상샘중독 결절, 기도 삽관 시 발생되는 손상, 삽관튜브 커프의 과팽창으로 기도가 장시간 높은 압력으로 압박되었을 때, 적절하기 않은 커프 크기, 삽관튜브 커프의 공기를 빼지 않고 무리하게 움직였을 때, 출혈이 많을 때, 과도한 전기소작으로 인한 손상, 기도로 가는 혈관손상으로 인한 혈액공급의 차단, 감염 등으로 보고 있다. 치료는 기도의 괴사와 감염의 정도에 따라 달라질 수 있다. 일차 봉합술, 일시적 스토마 형성, 일시적 기관조루술, 단단연결술, 기도 스텐트 설치술, 근육피판 재건술, 보존적 치료 등을 시행할 수 있다. 기도 괴사에 대한 위험인자와 치료에 대해서는 아직 확실히 적립되지 않은 상태이다. 드문 합병증이지만 생명을 위협할 수 있는 이러한 합병증에 대해 항상 염두 해 두고 수술 시 신중을 기하고 문제 발생시 신속한 대응을 해야겠다.

• The Journal of the Korean bone and joint tumor society
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• v.11 no.2
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• pp.134-140
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• 2005

Purpose: We evaluated the effectiveness of temporary using the extendible external fixator (EF) for lengthening of soft tissue that contracture caused by tumor prosthesis removal in the treatment of complications after limb salvage surgery like deep infection and loosening. Materials and Methods: Five patients six cases were included who underwent extendible EF (Dyna-extor(r)). EF was applied after insertion of half pin to the proximal and distal bone of defect area. EF lengthening started at third day of post-operation, above 2-3 mm per day in the range of no neurological sign. Results: The treatment area was three in femur and two in tibia. Mean age when the time of EF apply was 22.2 years old (range 15-29), but its primary limb salvage operation had done in 13.4 years old (range 9-19), therefore mean times of interval between initial tumor prosthesis reconstruction and temporary EF apply was 8.8 years (range 3-14). One patient had EF for 150 days with 7.2 cm lengthening. Others 5 cases of 4 patients had EF for mean 37 days (range 25-50) and mean soft tissue lengthening was 5.8 cm. Three patients underwent re-insertion of tumor prosthesis and two patients underwent knee fusion as final operation and showed no evidence of infection through mean 22 months follow up period. Conclusion: Temporary using of extendible EF is an effective method for correction of leg shortening which occurred by soft tissue contracture in the complications of limb salvage operation or their treatment process, and it could be provide easily application of tumor prosthesis and knee fusion as final operation.

• Journal of the Korean Orthopaedic Association
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• v.56 no.2
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• pp.173-177
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• 2021

Recurrent spontaneous hemarthrosis is a relatively rare complication of total knee arthroplasty. This paper reports a case of a patient treated with arterial embolization for recurrent spontaneous hemarthrosis even after undergoing arthroscopic surgery. The patient had several relapses after total knee arthroplasty.

• Journal of Yeungnam Medical Science
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• v.24 no.2
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• pp.243-251
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• 2007

Purpose : This study was conducted to assess the surgical outcomes of limbal lensectomy with or without anterior vitrectomy for the management of lens subluxation. Materials and Methods : The medical records of 20 consecutive patients (33 eyes) with lens subluxation who had undergone limbal lensectomy with or without anterior vitrectomy from February 1999 to January 2004 were retrospectively reviewed. Results : All the patients, except one high axial myopic patient, were implanted with scleral sutured posterior chamber intraocular lens. We evaluated the preoperative, postoperative visual acuity and postoperative complications and compared the results in group I (limbal lensectomy with anterior vitrectomy, 27 eyes) to those in group II (limbal lensectomy without anterior vitrectomy, 6 eyes). The preoperative best-corrected visual acuity was 0.21 and postoperative best-corrected visual acuity was improved by 2 lines or more in all 27 eyes in group I, and in 5 eyes in group II (p>0.05). The most frequent postoperative complication was intraocular lens dislocation in four eyes (14.8%) in group I alone. No retinal detachment occurred in either group, even in patients with high myopia. Conclusion : Limbal lensectomy without anterior vitrectomy improved visual acuity similarly to limbal lensectomy with anterior vitrectomy without significant increase of postoperative complications. This results of this study suggest that anterior vitrectomy is not necessarily required for the management of lens subluxation.

• Journal of Chest Surgery
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• v.32 no.4
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• pp.399-403
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• 1999

Background: Funnel chest is one of the most common anomaly of chest wall, which is manifested by depression of sternum and costal cartilage. Popular operative methods were Ravitch operation and Wada operation. Material and Method: From 1983 to 1996, 21 cases of funnel chest were corrected surgically in the department of thoracic surgery, National Medical Center. Investigated age and sex distribution, combined anomaly,clinical symptom, degree of correction and complication, postoperative satisfaction. We used 2 different surgical methods, one was Wada & its variants(17 cases), the other was Ravitch and it variants(4 cases). Most of operative indications were cosmetic problems. Result: The pre-operative Welch index was 4.188, but this index decreased to 3.46 after the operations.(p=0.046) The degree of correction was higher in Wada & it variant operation than the modified Ravitch operation.(p=0.54) Their results were satisfactory in 20 patients, while unsatisfactory in 1 patient because of a k-wire fracture. There was no recurrence of chest wall depression or postoperative death during the OPD follow up period. Conclusion: We recommend Wada operation in symmetric and small degree of depressive chest wall deformity in preand post school age.