• Journal of Chest Surgery
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• v.31 no.9
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• pp.855-860
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• 1998

Background: Adequate exposure of the mitral valve is a prerequisite for mitral procedures including the repair. An extended transseptal approach in mitral valvular operations is known to have certain technical advantages in recent years because of the anatomic posterior location of the mitral valve, especially in reoperations and in the presence of the small atrium in spite of the possibility of arrhythmia due to injury of sinus nodal artery. Material and Method: We compared the preoperative status, operative, and postoperative factors among patients in two study groups, transseptal only (Group I, n=10) and extended transseptal approach(Group II, n=25). Result: There were no differences in age, sex, NYHA functional class, left atrial size, and left ventricular function. The incidence of the redo-operation was high and early postoperative arrhythmia, which was improved later, appeared in 3 patients in Group II, but not in Group I. Conclusion: We believe that atrial septal incision could be extended up to the atrial roof whenever exposure of the mitral valve during a transseptal approach is inadequate because the late results were similar.

• Journal of Chest Surgery
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• v.29 no.12
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• pp.1299-1305
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• 1996

The rat thoracic aorta was harvested to determine whether either hyperkalemla or hypothermia impairs the endothelium-dependent re axation of the vascular smooth muscle. Isolated thoracic aorta segments were studied in five groups(n=10 in each group). In group I(control), the isolated aortic seglnents were suspended in organ bath without any intervention. In group ll(endotheilum removAl). the endothelium of the aortic segment was removed by gentle rubbing of the intimal surface with a pair of forceps. In group III(457), IV(4mST), and V(3757), the aortic segments were exposed for 45minutes to 4$^{\circ}C$ St. Thomas hospital cardioplegic solution(57 : NaCl, 144.3; KCI, 19.6, MgCl:, 15.7 : CaCl, 2.2 mmol/L).4$^{\circ}C$ modified St. Thomas hospital cardioplegic solution(NaCl, 144.3 : KCI. 140.0 : MgCl:, 15.7; CaCl:. 2.2 mmol/L). and 37$^{\circ}C$ 57, before suspending in the organ bath, respectively. Then, aorta segments were suspended in organ baths(physiologic salt solution, 37$^{\circ}C$, 95% oxygen and 5% carbon dioxide) for Isometric tension recording. The vasodilatation to acetylcholine (10-2 to 10-2mol/L) was not impaired in control, 457, 4mST, nd 3757 groups. The vasodilatation to acetylcholine was impaired in endothelium removal group. The vasodilatation to sodium nitroprusslde (10-2 to 10-2 mol/L) was not impaired in all groups. In conclusion, both hyperkalemia and hypothermia do not alter irreversibly the function of the rondothelium of the thoracic aorta of the rat.

• Journal of Chest Surgery
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• v.40 no.1 s.270
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• pp.1-7
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• 2007

Backgound: It has been shown that the endothelium of cardiac valves and adjacent great vessels have a reduced immune reaction compared to other vessels. We investigated the clinical feasibility of using immunologically untreated xenogenic valves, in a pig-to-goat pulmonary valve conduit implantation model. Material and Method: Porcine pulmonary valve conduits were prepared without specific immunologic treatment and implanted into the right ventricular outflow tract of goats while undergoing cardiopulmonary bypass. Two goats each were assigned to the following observation time intervals: one day, one week, three months, six months and twelve months. Echo-cardiographic examinations were performed prior to sacrifice of the goat to evaluate pulmonary valve function. After the xenograft specimens were retrieved, histological changes were evaluated microscopically. Result: Ten of the twelve animals survived the predetermined observation time intervals. Aneurysmal dilatations, of the anterior wall of the implanted pulmonary artery, were observed at each of three and twelve month-survival animals. A variable degree of pulmonary valve regurgitation was observed on echocardiography. However, valve stenosis, thrombotic occlusion and vegetation were not seen. Microscopically, the nuclei of the donor tissue disappeared as a result of pyknosis and karyolysis; however the three components of the implanted xenografts (the pulmonary artery, the valve and the infundibulum) were gradually replaced by host cells over time, while maintaining their structural integrity. Conclusion: Immunologically untreated xenogenic pulmonary valve conduits were replaced by host cells with few observed clinical problems in a pig to goat pulmonary valve implantation model. Therefore, they might be an alternative bioprosthesis option.

• Journal of Chest Surgery
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• v.47 no.3
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• pp.240-248
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• 2014

Background: Open heart surgery using cardiopulmonary bypass (CPB) is considered one of the most frequent surgical procedures in which acute kidney injury (AKI) is a frequent and serious complication. The aim of the present study was to evaluate the efficiency of neutrophil gelatinase-associated lipocalin (NGAL) as an early AKI biomarker after CPB in cardiac surgery (CS). Methods: Thirty-seven adult patients undergoing CS with CPB were included in this retrospective study. They had normal preoperative renal function, as assessed by the creatinine (Cr) level, NGAL level, and estimated glomerular filtration rate. Serial evaluation of serum NGAL and Cr levels was performed before, immediately after, and 24 hours after the operation. Patients were divided into two groups: those who showed normal immediate postoperative serum NGAL levels (group A, n=30) and those who showed elevated immediate postoperative serum NGAL levels (group B, n=7). Statistical analysis was performed using Statistical Package for the Social Sciences version 18. Results: Of the 37 patients, 6 (6/37, 16.2%) were diagnosed with AKI. One patient belonged to group A (1/30, 3.3%), and 5 patients belonged to group B (5/7, 71.4%). Two patients in group B (2/7, 28.5%) required further renal replacement therapy. Death occurred in only 1 patient (1/37, 2.7%), who belonged to group B. Conclusion: The results of this study suggest that postoperative plasma NGAL levels can be used as an early biomarker for the detection of AKI following CS using CPB. Further studies with a larger sample size are needed to confirm our results.

• Journal of Dental Rehabilitation and Applied Science
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• v.37 no.3
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• pp.171-176
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• 2021

Pneumomediastinum is a very rare and potentially catastrophic complication of dental procedures. Its common causes are tooth extraction, endodontic treatment, and subgingival curettage using handpieces and high-pressure air/water syringes. We present a case of massive pneumomediastinum with subcutaneous emphysema in a 61-year-old female who underwent bone grafting into the maxilla for pretreatment of dental implantation using a syringe. The patient suffered from abrupt severe odynophagia and loss of consciousness. The patient transferred to emergency department and images work-up revealed a pneumomediastinum and subcutaneous emphysema on the entire face and neck. We performed conservative treatments including prophylactic antibiotics, oxygen inhalation, and fasting meals, and then discharge after 7 days uneventfully. The patient's syncope might be resulting from hypotension and pain shock induced by pneumomediastinum with a sudden chest compression. The pneumomediastinum could be resulting from concurrent perforation and massive air infiltration into the maxillary sinus during bone grafting. We suggest that pneumomediastinum needs prompt diagnosis and management because of the risk of airway obstruction when a patient present syncope in the dental room.

• Journal of Chest Surgery
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• v.55 no.1
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• pp.49-54
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• 2022

Background: We compared the safety and effectiveness of robotic anatomical resection and video-assisted thoracoscopic surgery (VATS). Methods: A retrospective analysis was conducted of the records of 4,283 patients, in whom an attempt was made to perform minimally invasive anatomical resection for lung cancer at Seoul National University Hospital from January 2011 to July 2020. Of these patients, 138 underwent robotic surgery and 4,145 underwent VATS. Perioperative outcomes were compared after propensity score matching including age, sex, height, weight, pulmonary function, smoking status, performance status, comorbidities, type of resection, combined bronchoplasty/angioplasty, tumor size, clinical T/N category, histology, and neoadjuvant treatment. Results: In total, 137 well-balanced pairs were obtained. There were no cases of 30-day mortality in the entire cohort. Conversion to thoracotomy was required more frequently in the VATS group (VATS 6.6% vs. robotic 0.7%, p=0.008). The complete resection rate (VATS 97.8% vs. robotic 98.5%, p=1.000) and postoperative complication rate (VATS 17.5% vs. robotic 19.0%, p=0.874) were not significantly different between the 2 groups. The robotic group showed a slightly shorter hospital stay (VATS 5.8±3.9 days vs. robotic 5.0±3.6 days, p=0.052). N2 nodal upstaging (cN0/pN2) was more common in the robotic group than the VATS group, but without statistical significance (VATS 4% vs. robotic 12%, p=0.077). Conclusion: Robotic anatomical resection in lung cancer showed comparable early outcomes when compared to VATS. In particular, robotic resection presented a lower conversion-to-thoracotomy rate. Furthermore, a robotic approach might improve lymph node harvesting in the N2 station.

• Journal of Chest Surgery
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• v.54 no.6
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• pp.480-486
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• 2021

Background: Although various methods are already used to calculate predicted postoperative forced expiratory volume in 1 second (FEV₁) based on preoperative FEV₁ in lung surgery, the predicted postoperative FEV₁ is not always the same as the actual postoperative FEV₁. Observed postoperative FEV₁ values are usually the same or higher than the predicted postoperative FEV₁. To overcome this issue, we investigated the relationship between the number of resected lung segments and the discordance of preoperative and postoperative FEV₁ values. Methods: From September 2014 to May 2020, the data of all patients who underwent anatomical lung resection by video-assisted thoracoscopic surgery (VATS) were gathered and analyzed retrospectively. We investigated the association between the number of resected segments and the differential FEV₁ (a measure of the discrepancy between the predicted and observed postoperative FEV₁) using the t-test and linear regression. Results: Information on 238 patients who underwent VATS anatomical lung resection at Kyung Hee University Hospital at Gangdong and by DH. Kim for benign and malignant disease was collected. After applying the exclusion criteria, 114 patients were included in the final analysis. In the multiple linear regression model, the number of resected segments showed a positive correlation with the differential FEV₁ (Pearson r=0.384, p<0.001). After adjusting for multiple covariates, the differential FEV₁ increased by 0.048 (95% confidence interval, 0.023-0.073) with an increasing number of resected lung segments (R²=0.271, p<0.001). Conclusion: In this study, after pulmonary resection, the number of resected segments showed a positive correlation with the differential FEV₁.

• Journal of Chest Surgery
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• v.57 no.4
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• pp.351-359
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• 2024

Background: Major pulmonary resection after neoadjuvant concurrent chemoradiation therapy (nCCRT) is associated with a substantial risk of postoperative complications. This study investigated postoperative complications and associated risk factors to facilitate the selection of suitable surgical candidates following nCCRT in stage IIIA-N2 non-small cell lung cancer (NSCLC). Methods: We conducted a retrospective analysis of patients diagnosed with clinical stage IIIA-N2 NSCLC who underwent surgical resection following nCCRT between 1997 and 2013. Perioperative characteristics and clinical factors associated with morbidity and mortality were analyzed using univariable and multivariable logistic regression. Results: A total of 574 patients underwent major lung resection after induction CCRT. Thirty-day and 90-day postoperative mortality occurred in 8 patients (1.4%) and 41 patients (7.1%), respectively. Acute respiratory distress syndrome (n=6, 4.5%) was the primary cause of in-hospital mortality. Morbidity occurred in 199 patients (34.7%). Multivariable analysis identified significant predictors of morbidity, including patient age exceeding 70 years (odds ratio [OR], 1.8; p=0.04), low body mass index (OR, 2.6; p=0.02), and pneumonectomy (OR, 1.8; p=0.03). Patient age over 70 years (OR, 1.8; p=0.02) and pneumonectomy (OR, 3.26; p<0.01) were independent predictors of mortality in the multivariable analysis. Conclusion: In conclusion, the surgical outcomes following nCCRT are less favorable for individuals aged over 70 years or those undergoing pneumonectomy. Special attention is warranted for these patients due to their heightened risks of respiratory complications. In high-risk patients, such as elderly patients with decreased lung function, alternative treatment options like definitive CCRT should be considered instead of surgical resection.

• Tuberculosis and Respiratory Diseases
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• v.42 no.6
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• pp.878-887
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• 1995

Background: It is reported that frequency of pulmonary involvement in the patients with rheumatoid arthritis reaches 10 to 50% and pulmonary involvement is a principal cause of death. As immunology and radiology has developed, interest for the early diagnosis of pulmonary involvement is increasing. Method: Among the patients at Hanyang University Hospital from March, 1990 to July, 1995, we compared the 29 patients having pulmonary involvement with the 18 patients controls in clinical and chest high resolution computed tomography(HRCT) findings by immunological markers and findings of pulmonary function test. We sought useful markers for early diagnosis of pulmonary involvement with noninvasive investigations. Results: The ratio of males to females was 14 : 15 in the group of pulmonary involvement, and all of the 18 patients were females in the control group. Smoking history was 31%(9/29) in the former group and none in the latter group. Rheumatoid factor(RF) was positive in 95.5%(28/29) of the pulmonary involvement group and in 100%(18/18) of the control group(p=0.12). Antiperinuclear factor(APF) showed a significant difference: 86.9%(20/23, average value: 2.0) was positive in the pulmonary involvement group and 50%(8/16, average value: 1.1) in the control group(p=0.04). Antinuclear antibody(ANA) was positive in 60.7%(17/28) of the pulmonary involvement group and in 72.2%(13/18) of the control group(p=0.33). Cryoglobulin also showed a significant difference: 72%(18/25) in the pulmonary involvement group was positive and 56.2%(9/16) in the control group was positive(p=0.02). Bony erosion was positive in 61.5%(16/26) of the pulmonary involvement group and in 77.7%(14/18) of the control group(p=0.8). On the pulmonary function test, the average value of alveolar volume corrected diffusion capacity and residual volume in the pulmonary involvement group and in the control group were 1.07mmol/rnin/KPa(predicted value: 64.2%), 1.32L(predicted value: 70%) and 1.44mmol/min/KPa, 3.75L(predicted value: 86.6%), respectively(p=0.003, p=0.004), showing a significant difference. Conclusion: APF or cryoglobulin on the serological test, the measurement of residual volume and alveolar volume corrected diffusion capacity may be used as effective markers in the diagnosis of pulmonary involvement of the patients with rheumatoid arthritis.

• Journal of Chest Surgery
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• v.38 no.12 s.257
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• pp.828-834
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• 2005

Background: Off-pump coronary artery bypass grafting (OPCAB) has shown better outcome in chronic renal failure (CRF) patients by avoiding the effects of cardiopulmonary bypass. We evaluated renal function after OPCAB in CRF patients. Material and Method: 656 patients underwent OPCAB between January, 2001 and December, 2004. Data were collected in 26 CRF patients (Cr > 1.7 mg/dL). Preoperative/postoperative creatinine (Cr) levels, creatinine clearance and postoperative data were evaluated. We divided the patients into group 1 (Cr < 3 mg/dL) and group 2 (Cr $\geq$ 3 mg/dL). Result: Three patients started dialysis after surgery. Preoperative mean creatinine level (4.19$\pm$3.4 mg/dL) was elevated to 4.36$\pm$2.7 mg/dL at the third postoperative day and decreased below Preoperative level at the fifth postoperative day. In group 1 (mean Cr level=1.87$\pm$0.25 mg/dL), Cr level reached its peak level of 2.19$\pm$0.52 mg/dL at the fourth postoperative day (p=0.017), with subsequent decrease. Patients without pre- or postoperative dialysis (n=15) showed peak Cr elevation on postoperative day four (p=0.017) and subsequent decrease (p=0.01). Postoperative creatinine clearance showed reverse correlation with creatinine level. Conclusion: Creatinine level was elevated at third/fourth postoperative day, but decreased 5 days after surgery. Thus, if urgent dialysis is not indicated, postoperative renal replacement therapy in CRF patients may be better to be considered after four days observation.