• Journal of Chest Surgery
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• v.35 no.7
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• pp.517-522
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• 2002

Background: Congenital heart surgery may lead to myocardial swelling and hemodynamic instability. Delayed sternal closure may be beneficial in this setting. The purpose of this study was to assess mortality and mediastinal infection rate associated with delayed sternal closure after congenital heart surgery and to evaluate the risk factors which affect mortality and mediastinal infection rate. Material and Method: We retrospectively reviewed 40 patients who underwent delayed sternal closure after repair of congenital heart disease at Yonsei Cardiovascular Hospital, from January 1994 to May 2001. In these patients, we assessed the mortality and mediastinal infection rate, and evaluated their risk factors including operation time, bypass time, aortic cross clamp time, duration to sternal closure and postoperative artificial ventilation time. Mediastinal infection was defined to have positive culture in mediastinum. Result: Hemodynamic instability was the most common indication for delayed sternal closure(n=36) and other indications included postoperative bleeding(n=2) and conduit compression(n=2). The median age at operation was $14.4{\pm}33.4$months old(range, 2days-12years). The patients with postoperative bleeding and conduit compression were much older than the others. The sternum was left open for $4.5{\pm}3.4$ days(range, 1-20days). Overall mortality was 25%(10/40) and mediastinal infection occured in 24.3%(9/37) (3 patients were excluded in mediastinal infection for early death). In risk factor analyses, only aortic cross clamp time had statistical significance for mortality in univariate analyses. However, multivariate analyses revealed that there were no significant predictors for risk of mortality and mediastinal infection. Conclusion: Delayed sternal closure after repair of congenital cardiac disease had relatively high mortality and mediastinal infection rate. But, in patients with hemodynamic instability, postoperative bleeding and conduit compression after repair of congenital cardiac disease, delayed sternal closure may be an effective life saving method.

• Tuberculosis and Respiratory Diseases
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• v.44 no.4
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• pp.742-755
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• 1997

Background : Endobronchial tuberculosis(ET) is still relatively common disease in Korea. We intended to evaluate the length of endobronchial lesion, peribronchial thickness, luminal irregularity and associated mediastinal lymph node enlargement with Chest CT to get information for such aggressive treatment as electrocautery, laser therapy and so on of bronchial stricture in ET, and also to compare the change of Chest CT finding with that of bronchoscopic finding after one month of anti-tuberculosis treatment. Method : We performed CT in 26 patients who were diagnosed as ET by bronchoscopy at Boramae Hospital from November 1991 to March 1996. After classifying ET into seven subtypes according to bronchoscopic finding, we analyzed the CT finding of each subtype. And we followed up the bronchoscopy, CT, and PIT after one month of anti-tuberculosis treatment, and compared the change of CT findings with those of bronchoscopic findings in nine patients. Results : Age of the patients was from 17 to 73 years old, and the ratio of male to female was 1 : 25 with absolute female predominance. The site(s) of bronchial involvement by tuberculosis is one in 14 cases, two in nine cases and three in one case, respectively, and the left main bronchus was the most frequently involved site (13 cases for multiple involvements and 7 cases for single involvement among 26 cases). The length of bronchial involvement by tuberculosis which was measured by CT was from 10 to 55 mm, and there was a tendency that the length of involved lesion in fibrostenotic type was shorter than that of actively caseating type. Bronchial stricture on CT was noticed in 25 (96%) cases and the range of severity was from total occlusion to near-normal and also showed wide variation even though the subtype of ET was same. The increase of peribronchial thickness which was measured by CT, was noticed in 21 cases (91%) among 23 cases (in which the measurement was possible), and there was no improvement of peribronchial thickness in those cases which showed little improvement in bronchial stricture despite anti-tuberculosis treatment. There was no difference in the luminal irregularity of involved bronchi on CT in relation to bronchoscopic subtypes. The mediastinal lymph node enlargement, defined as the diameter of lymph node was larger than 1cm on CT, was detected in 20 cases (77%), and right side was more frequently involved (L : R = 1 : 5.2). The CT finding usually showed extrinsic bronchial compression but showed direct invasion in two cases which were bronchoscopically classified as tumorous type. When follow-up bronchoscopy and CT was performed after one month of anti-tuberculosis treatment in nine patients, CT showed significant improvement in peribronchial thickness and mediastinal lymph node enlargement. Bronchial stricture was also improved in 6 cases but aggravated in 3 cases despite anti-tuberculosis therapy. In two cases which were classified as fibrostenotic type by bronchoscopy, CT showed significant improvement in bronchial stricture, interestingly. Conclusion : We concluded that the role of Chest CT was complimentary to bronchoscopy in ET, since CT was useful in evaluating the length of bronchial involvement, peribronchial thickness, and mediastinal lymph node enlargement.

• Journal of Chest Surgery
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• v.36 no.6
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• pp.391-396
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• 2003

Background: Recently transilluminated powered phlebectomy was introduced and used as a method of surgical treatment for varicose vein in lower extremities. The advantage of transilluminated powered phlebectomy are minimal scar and good cosmetic effect. However, the disadvantages of transilluminated powered phlebectomy is that a high priced Trivex system must be used which increases the patient's expenses. Therefore, we performed a transilluminated powered phlebectomy using an existing arthroscopic equipment instead of Trivex system and observed the effect of treatment and efficiency of the treatment. Material and Method: From March, 2000 to February, 2003, 78 patients (113 limbs) underwent transilluminated powered phlebectomy with an arthroscopic equipment. Patient's disease history, the number of operative scars and complications were reviewed. Result: The operation was performed in 133 limbs of the 78 patients (34 men, 44 women) and the age of patients were ranged from 16 to 72 years with mean age of 41.8 years. Operative time ranged from 20 to 65 minutes (average 48.7 minutes) per limb. The number of operative scar per limb from 2 to 7 (average 4.9). Postoperative complications are transient ecchymosis (78 cases) that desappeared spontaneously, edema persisting longer than 3 weeks (6 cases), remnant varicose vein (4 cases), skin perforation during operative procedure (2 cases), and contact dermatitis due to compression stocking (4 cases) The mean hospitalization day was 3.09 days. Subjective mean satisfaction degree of operation by the patients using a visual analogue scale was 92.6%. Conclusion: Our findings demonstrated that transilluminated powered phleectomy using arthroscopic equipment was possible and had good cosmetic results with acceptable complications.

• Journal of the korean academy of Pediatric Dentistry
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• v.44 no.2
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• pp.243-255
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• 2017

Cardiopulmonary resuscitation (CPR) is an emergency treatment that stimulates blood circulation and breathing when the function of the heart stops or stops breathing. CPR can be divided by basic life support (BLS) and advanced life support (ALS). BLS involves the use of chest compression to force the blood flow to the main organs, rescue breathing to improve the breathing to the respiratory failure patient and the use automated external defibrillator (AED). The categories of advanced life support include advanced cardiovascular life support (ACLS) for adult and pediatric advanced life support (PALS) for children. In the treatment of dental care for children, which is extremely difficult to deal with, and for a variety of reasons, the use of sedation is considered to treat the children who are unlikely to cooperate with dentistry. This is why there is an increasing possibility of an emergency situation involving cardiac arrest. PALS includes the BLS, and it presents a systematic algorithm to treat respiratory failure, shock and cardiogenic cardiac arrest. In order to manage emergency situations in the pediatric dental clinic, respiratory support is most important. Therefore, mastering professional PALS, which includes respiratory care and core cases, particularly upper airway obstruction and respiratory depression caused by a respiratory control problem, would be highly desirable for a physician who treats pediatric dental patients. Regular training and renewal training every two years is necessary to be able to immediately implement professional skills in emergency situations.

• Journal of the Korean Data and Information Science Society
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• v.27 no.2
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• pp.409-417
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• 2016

The purpose of this study was to demonstrate the effect on the degree of fatigue and accuracy of cardiopulmonary resuscitation according to the different time delays (3 minutes, 4 minutes). Carrying out repeated measures of variance (repeated ANOVA), we have shown that time effect (F = 7.835, p <.01) and group effect (F = 8.695, p<.01) and the interaction effect between time and group (F = 12.582, p<.001) were all statistically significant. It means, in the test of the main effect of group and time (3 minutes, 4 minutes) using the Bonferroni method, it turned out that the amount of lactic acid of the experimental group was larger than that of the control group (p<.01), and there was no difference until 3 minutes, but the difference of the amount of lactic acid was shown between before the experiment and after 4 minutes, and between 3 minutes and 4 minutes (p <.05), respectively. Then, in the result of the corresponding sample t-test, for comparing the according to the measurement time, the accuracy after 3 minutes became higher than the case of 4 minutes (t = 4.584, p <.001). Therefore, before 119 arrives performing cardiopulmonary resuscitation for emergency, rescuers need to perform cardiopulmonary resuscitation alternating with others before 3 minutes.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.11
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• pp.290-296
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• 2017

Purpose: The purpose of this study was to compare the effects of CPR training according to the mannequin used for CPR training using Little $Anne^{(R)}$, $BRAYDEN^{(R)}$, and $HeartiSense^{(R)}$. Method: Research subjects were 90 firefighters who were not paramedics. They were divided into three groups, A, B, and C. Theoretical education was conducted for 50 minutes, and practical education was conducted in groups of three for 50 minutes, using Little $Anne^{(R)}$ for 30 people in Group A; $BRAYDEN^{(R)}$ for 30 people in Group B; and $HeartiSense^{(R)}$ for 30 people in Group C. The results of CPR were printed out using Resusci Anne $SkillReporter^{(R)}$, and the subjects were asked to fill in a questionnaire. Results: The following significant differences were noted: satisfaction index according to the mannequin, $x^2=81.050$, p<.000; reason for satisfaction, $x^2=91.050$, p<.000; ratio of accurate chest compression, F=5.087, p<.004; and ratio of accurate ventilation, F=10.54, p<.000. Conclusion: For the subjects who require accurate and efficient CPR training, it is judged that a mannequin that provides information to allow corrections in real-time would be effective, and have a high educational effect.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.21 no.8
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• pp.325-333
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• 2020

This study compares the rapidity and subjective convenience of T-AED and SC-AED for health care providers and the general public. Subjects were randomly allocated to T-AED (n=77) and SC-AED (n=79) groups. Each group conducted defibrillation, with subsequent measurement of the rapidity of defibrillation in peri-shock pause, pre-shock pause, hesitation pause, and post-shock pause. Defibrillation and chest compression delay times for both equipment were analyzed by t-test. On conclusion of the experiment, subjects answered a questionnaire on the subjective convenience of defibrillation, as measured for confidence, convenience, and clear decision. Comparisons of subjective convenience analyzed by t-test revealed significantly shortened peri-shock pause (11.22s), pre-shock pause (11.04s), and hesitation pause (2.15s) in the SC-AED group, as compared to the T-AED group (p<0.001). However, no significant differences were observed for post-shock pause values. Comparing subjective convenience, confidence (T-AED: 7.62±1.25VAS vs. SC-AED: 7.80±0.98VAS, p=0.358) was not significant, whereas convenience (T-AED: 7.05±1.36VAS vs. SC-AED: 8.95±0.89VAS, p<0.001) and clear decision (T-AED: 6.58±1.73VAS vs. SC-AED: 9.08±0.98VAS, p=0.001) showed statistically significant differences. Our results indicate that compared to T-AED, SC-AED has significantly shortened pauses. Moreover, it is more convenient for the user, and significantly aids in clear decisions.

• 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.

• Journal of Chest Surgery
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• v.42 no.5
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• pp.677-683
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• 2009

May-Thurner syndrome is a deep vein thrombosis of the ilio-femoral vein due to compression of the left common iliac vein by the overlying right common iliac artery. Although, catheter directed thrombectomy (CDT) and thrombolysis with stent insertion has become the standard treatment method for acute or subacute May-Thurner syndrome, because of technical feasibility and lower recurrence rate, however, sometimes this methods make fatal complications. Furthermore, there are few reports on optimal treatment strategies for patients in a chronic state of May-Thurner syndrome. We now present two cases of chronic (> 1 month since onset of symptoms) May-Thurner syndrome treated by surgical thrombectomy and femoral arteriovenous shunt with simultaneous stent insertion after failed endovascular treatment. This technique may provide a significant benefit for patients who are not suitable for conventional endovascular treatment.

• Journal of Chest Surgery
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• v.37 no.11
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• pp.911-917
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• 2004

Background: There are limited number of reports on May-Thurner syndrome (Iliac vein compression syndrome) in Korea, We analysed the clinical features, diagnostic modalities and endovascular treatment of May-Thurner syndrome. Material and Method: We reviewed 12 cases of May-Thurner syndrome between March 2001 and June 2003. Mean age was $57.6\pm2$ years. We were used in venography, color doppler and computed tomographic angiography as diagnostic modalities and in thrombolysis, thrombectomy, angioplasty and stent insertion as endovascular treatment. Result: Clinical features showed edema of lower extremities in 4 patients, pain of lower extremities in 1 patient, edema with pain in 5 patients, and all in 1 patient. In one patient, he did not have any pain and any edema of lower extremities but was diagnosed as May-Thurner syndrome using venography due to varicose veins on lower extremities. Diagnostic modalities included venography, computed tomographic angiography in all patients with clinical presentation except in one patient and color doppler was only performed only in 4 patients. Four kinds of endovascular treatment were performed for May-Thurner syndrome, angioplasty in 11 patients, stent insertion in 10 patients, thrombectomy in 9 patients and thrombolysis for 7 patients. Nine patients were followed up and we can show good blood flow in Left iliac vein for 7 of 9 patients. Conclusion: it is necessary to recognize the possibility of May-Thurner syndrome in Deep vein thrombosis patients and we should use a variety of modalities to diagnose May-Thurner syndrome. Finally, endovascular treatment is a safe and effective therapy for May-Thurner syndrome.