• Journal of Chest Surgery
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• v.46 no.5
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• pp.346-352
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• 2013

Background: Transcatheter aortic valve implantation (TAVI) has been an alternative to conventional aortic valve replacement (AVR) in old and high risk patients. The goal of this study is to compare the early outcomes of conventional AVR vs. TAVI in high risk severe AS patients. Methods: From January 2008 to July 2012, 44 high risk severe aortic stenosis patients underwent conventional AVR, and 15 patients underwent TAVI. We compared echocardiographic data, periprocedural complication, and survival. The mean follow-up duration was $14.5{\pm}10$ months (AVR), and $6.8{\pm}3.5$ months (TAVI), respectively. Results: AVR group was younger ($78.2{\pm}2.4$ years vs. $82.2{\pm}3.0$ years, p<0.001) and had lower operative risk (Euroscore: $9.4{\pm}2.7$ vs. $11.0{\pm}2.0$, p=0.044) than TAVI group. There was no significant difference in early mortality (11.4% vs. 13.3%, p=0.839), and 1 year survival ($87.4%{\pm}5.3%$ vs. $83.1%{\pm}1.1%$, p=0.805). There was no significant difference in postoperative functional class. There was no significant difference in periprocedural complication except vascular complication (0% [AVR] vs. 13.3% [TAVI], p=0.014). TAVI group had more moderate and severe paravalvular leakage. Conclusion: In this study, both groups had similar periprocedural morbidity, and mortality. However, TAVI group had more greater than moderate paravalvular leakage, which can influence long-term outcome. Since more patients are treated with TAVI even in moderate risk, careful selection of the patients and appropriate guideline need to be established.

• Journal of Chest Surgery
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• v.53 no.2
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• pp.41-48
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• 2020

Background: Chylothorax after congenital heart surgery is not an uncommon complication, and it is associated with significant morbidity. However, consensus treatment guidelines are lacking. To improve the treatment outcomes of patients with postoperative chylothorax, we implemented a standardized management protocol at Severance Hospital in September 2014. Methods: A retrospective review of patients treated at a single center was done. All corrective and palliative operations for congenital heart disease performed at our institution between January 2008 and April 2018 were reviewed. The incidence and treatment outcomes of postoperative chylothorax were analyzed. Results: The incidence of chylothorax was 1.9%. Sixty-one percent of the patients could be managed with a low-fat diet, while 28% of the patients required complete restriction of enteral feeding. Thoracic duct embolization was performed in 2 patients and chest tube drainage decreased immediately after the procedure. No patient required thoracic duct ligation or pleurodesis. After implementation of the institutional management protocol, the number of chest tube drainage days decreased (median, 24 vs. 14 days; p=0.45). Conclusion: Implementing a strategy to reduce postoperative chylothorax resulted in an acceptable incidence of postoperative chylothorax. Instituting a clinical practice protocol helped to curtail the treatment duration and to decrease the requirement for surgical treatment. Image-guided embolization of the thoracic duct is an effective treatment for postoperative chylothorax.

• Archives of Reconstructive Microsurgery
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• v.25 no.2
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• pp.49-55
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• 2016

Purpose: Soft tissue defects in the lumbosacral area can be challenging to treat, and various methods to accomplish this have been proposed, including the use of perforator flaps. Herein, we present our experience with superior gluteal artery perforator (SGAP) and inferior gluteal artery perforator (IGAP) flaps for the reconstruction of lumbosacral defects. Materials and Methods: From March 2013 to July 2016, 28 cases (27 patients) of lumbosacral defects were treated by reconstruction with SGAP or IGAP flaps. The defects were caused by pressure sores (21 cases), burns (3 cases), tumor resection (2 cases), scars (1 case), or foreign body infection (1 case). Reliable perforators around the defect were found using Doppler ultrasound. The perforator flaps were elevated with a pulsatile perforator and rotated to cover the defects. Results: Twenty-three SGAP and 5 IGAP flap reconstructions were performed. The mean flap size was $9.2{\times}6.1cm^2$ (range, $5{\times}3cm^2$ to $16{\times}10cm^2$). Donor sites were closed by primary closure. Partial flap necrosis occurred in two cases, and minor complications of wound dehiscence occurred in 3 cases, which were healed by primary closure. The mean follow-up period was 4.4 months (range, 1~24 months). Conclusion: Gluteal-based perforator flaps can be safely harvested due to pliability and reliable vascularity in the gluteal area, reducing donor site morbidity without sacrificing the underlying muscles. Thus, these flaps are useful options for the reconstruction of lumbosacral defects.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.26 no.1
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• pp.58-62
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• 2015

Xanthoma disseminatum (XD) is a benign, non-Langerhans cell histiocytosis characterized by disseminated xanthomatous lesions with face, flexures, and mucosa. Most of XD develops in mucocutaneous lesions including skin, oral cavity and pharynx, however laryngeal involvement is uncommon. While the natural course of XD is usually benign and often self-limiting, but XD develop in critical anatomical locations may result in morbidity and mortality. Localized mucous lesions in oropharynx and larynx lead to dysphagia, dyspnea and air way obstruction. The diagnosis of XD was based on clinical, histological and immunohistochemical findings. The treatment is complex and non-consensual. Local treatment with cryotherapy, radiotherapy, surgery, and carbon dioxide lasers have been attempted with various results. Systemic medication with peroxisome proliferator-activated gamma receptors, statins, fenofibrate, chlorodeoxyadenosine, cyclophosphamide, doxycycline, and cyclosporine have also been reported, but none have proven particularly successful. A 59-year-old man presented with respiratory symptoms because of laryngeal involvement of XD. We had to remove the obstructive lesion for relieving the symptoms. We experienced XD in Larynx that was rare in otorhinolaryngology. So we report this case with review of literatures.

• Archives of Reconstructive Microsurgery
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• v.13 no.1
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• pp.1-6
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• 2004

Advances in microvascular techniques and refinements in microsurgical tissue transfers have enabled surgeons to combine different tissue components and reconstruction into a single-stage operation in extensive or composite defect following injury. Some problems and consideration for extensive or composite defects are form, shape, function, and dimension of the defect sites. Therefore combination of two or more flaps is required to reconstruct extensive or composite defect. This paper presents our clinical experience of four cases of combined free flaps with or without sequential microanastomosis in reconstruction of upper extremity based on peroneal flowthrough, thoracodorsal, and dorsalis pedis vascular system. Satisfactory results were obtained without flap loss and complications. The free flaps were combined in th following fashion; two cases by bridge fashion, one by chimeric microanastomosis and one by simple chimeric fashion. The median follow-up time on all patients was 21.7 months. Donor site morbidity was minimal. Extensive soft tissue or composite defects can be effectively covered by various combined flaps. Even though the risk for complication exists, the options of combination with or without sequential microanastomosis can add a functional or sensory dimension to reconstruction of complex wounds.

• Clinical and Experimental Reproductive Medicine
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• v.37 no.4
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• pp.293-305
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• 2010

Ovarian hyperstimulation syndrome (OHSS) is a life-threatening iatrogenic complication of ovulation induction. Before ovarian stimulation, identification of patients vulnerable to developing OHSS is necessary. And ovarian stimulation should be started with low doses of gonadotropin or GnRH antagonist protocol. During monitoring of ovarian stimulation with risk of OHSS, coasting, low doses hCG and GnRH agonist for triggering ovulation are considered. If severe OHSS is predicted, cycle cancellation and cryopreservation of all embryos should be considered to reduce late-onset OHSS and morbidity. And metformin and dopamine agonist for reducing OHSS are being proposed as a prophylactic treatment for OHSS.

• Journal of Korean Neurosurgical Society
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• v.49 no.3
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• pp.157-162
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• 2011

Objective : Vasospasm of cerebral vessels remains a major source of morbidity and mortality after an aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study was to evaluate the safety and efficacy of transluminal balloon angioplasty (TBA) for SAH-induced vasospasm. Methods : Eleven patients with an angiographically confirmed significant vasospasm (>50% vessel narrowing and clinical deterioration) were studied. A total of 54 vessel segments with significant vasospasm were treated by TBA. Digital subtraction angiography was used to confirm the presence of vasospasm, and TBA was performed to dilate vasospastic arteries. Medical and angiographic reports were reviewed to determine technical efficacy and for procedural complications. Results : TBA using Hyper-Glide or Hyper-Form balloons (MicroTherapeutics, Irvine, CA) was successfully accomplished in 88.9% vasospastic segments (48 of 54), namely, in the distal internal carotid artery (100%, n=7), the middle cerebral artery (100%), including the M1 (n=10), M2 (n=10), and M3 segments (n=4), in the vertebral artery (100%, n=2), basilar artery (100%, n=1), and in the anterior cerebral artery (ACA), including the A1 (66%), A2 (66%), and A3 segments (100%). Vessel diameters significantly increased after TBA. There were no cases of vessel rupture or thromboembolic complications. GCS at one day after TBA showed an improvement in all patients except one. Conclusion : This study suggests that TBA using Hyper-Glide or Hyper-Form balloons is a safe and effective treatment for subarachnoid hemorrhage-induced cerebral vasospasm.

• Journal of Microbiology and Biotechnology
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• v.25 no.4
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• pp.521-525
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• 2015

Bacteremia and sepsis are common causes of morbidity and mortality worldwide, with incorrect or delayed diagnoses being associated with increased mortality. New tests or markers that allow a more rapid and less costly detection of bacteremia and sepsis have been investigated. The aim of this study was to clarify the cutoff value of the neutrophillymphocyte ratio (NLR) according to procalcitonin (PCT) level in the decision-making processes for bacteremia and sepsis. In addition, other white blood cell subgroup parameters, which are assessed in all hospitals, for bacteremia and sepsis were explored. This retrospective study included 1,468 patients with suspected bacteremia and sepsis. Patients were grouped according to the following PCT criteria: levels <0.05 ng/ml (healthy group), 0.05-0.5 ng/ml (local infection group), 0.5-2 ng/ml (systemic infection group), 2-10 ng/ml (sepsis group), and >10 ng/ml (sepsis shock group). One important finding of this study, which will serve as a baseline to measure future progress, is the presence of many gaps in the information on pathogens that constitute a major health risk. In addition, clinical decisions are generally not coordinated, compromising the ability to assess and monitor a situation. This report represents the first study to determine the limits of the use of NLR in the diagnosis of infection or sepsis using a cutoff value of <5 when sufficient exclusion criteria are used.

• Journal of Periodontal and Implant Science
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• v.47 no.1
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• pp.2-12
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• 2017

The aim of this narrative review is to describe treatment options for the posterior regions of the mandible and the maxilla, comparing short implants vs. longer implants in an augmented bone. The dental literature was screened for treatment options enabling the placement of dental implants in posterior sites with a reduced vertical bone height in the maxilla and the mandible. Short dental implants have been increasingly used recently, providing a number of advantages including reduced patient morbidity, shorter treatment time, and lower costs. In the posterior maxilla, sinus elevation procedures were for long considered to be the gold standard using various bone substitute materials and rendering high implant survival rates. More recently, implants were even placed without any further use of bone substitute materials, but the long-term outcomes have yet to be documented. Vertical bone augmentation procedures in the mandible require a relatively high level of surgical skill and allow the placement of standard-length dental implants by the use of autogenous bone blocks. Both treatment options, short dental implants, and standard-length implants in combination with vertical bone augmentation procedures, appear to result in predictable outcomes in terms of implant survival rates. According to recent clinical studies comparing the therapeutic options of short implants vs. long implants in augmented bone, the use of short dental implants leads to a number of advantages for the patients and the clinician.

• Advances in pediatric surgery
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• v.6 no.1
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• pp.10-18
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• 2000

Multisystem organ failure resulting from gram negative bacterial sepsis is associated with high morbidity and mortality in surgical neonates. There are differences in the clinical characteristics of organ failure in neonates and adults. The purpose of this study is to identify the differences and determine the order of organ failure between baby rats and adult rats after induction of gram negative sepsis. Fifty baby rats less than 30-day-old and another 50 adult rats more than 2-month-old were divided into control group (G1) and experimental group (G2). The G1 consisted of 10 baby- and 10 adult-rats, and the G2 consisted of 40 babies and 40 adults. E. coli ($10^8/mL$ per 100g of body weight) were injected into the peritoneal cavity in G2 and same amount of saline was injected in G 1. Blood samples were obtained before injection, 24 hour, 48 hour, 72 hour and after death. WEC, platelet, $PaO_2$, $PaCO_2$, total bilirubin, BUN, creatinine, albumin and abdominal wall thickness were measured to evaluate the sequence of organ failure. The mortality was 55.0 % in G2-babies and 32.5 % in G2-adults. In baby rats, microvascular, hematologic and renal failure appeared within 24 hours after injection and pulmonary failure followed. Pulmonary, renal and liver failure developed within 24-48 hours in adult rats; however, microvascular failure did not appear until they were moribund. Thrombocytopenia, hypoalbuminemia, increased BUN and generalized edema was the earlist sign of sepsis in baby rats.