• 제목/요약/키워드: Early surgery

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저체온하 순환정지를 이용한 소아 개심술 후의 신경계 이상에 대한 펑가 (Evaluation of Neurologic Abnormalities After Deep Hypothermic Circulatory Arrest for Pediatric Cardiac Surgery)

  • 박계현;전태국;지현근;이정렬;김용진;노준량;서경필
    • Journal of Chest Surgery
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    • 제29권1호
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    • pp.14-23
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    • 1996
  • Circulatory arrest under deep hypothermia is an important auxiliary means for cardiac surgery, especially useful in pediatric patients. However, its clinical safety, particularly with regard to the neurologic outcome after long duration of circulatory arrest, is still not established. This study is a review of the eight years'clinical experience of hypothermic circulatory arrest at the Seoul national University Children's Hospital. During an eight-year period from January 1986 through December 1993, a total of 589 consecutive cardiac operations were done using circulatory arrest under deep hypothermia. Among them, 434 consecutive patients, in whom the duration of arrest was 20 minutes or more, are the subject of this study. The duration of arrest ranged from 20 minutes to 82 minutes (mean = 38.7 minutes) under rectal temperature in the range from 12.5$^{\circ}C$ to 25.8$^{\circ}C$. Early neurologic abnormalities occurred in 47 patients : seizure attacks in 28 patients, motor paralyses with or w thout seizure in 12, blindness in 2, and no recovery of consciousness in 5 patients. The rate of incidence of early neurologic abnormalities was calculated at 15.7%. 25 patients showed late neuropsychologic sequelae, such as motor paralysis (9 patients), recurrent seizures (6), developmental delay (8), and definitely low intelligence (2). The rate of incidence of late neurologic sequelae was 8.5%, By statistical analysis, the following factors were identified as the risk factors for post-arrest neurologic abnormalities ; 1) long duration of circulatory arrest, 2) lower-than-ideal body weight, 3) preexisting neurological abnormalities, 4) associated non-cardiovascular congenital anouialies, and 5) low blood pressure during the early post-arrest period. It is concluded that circulatory arrest under deep hypothermia is a relatively safe means for pediatric cardiac surgery with acceptable risk. However, to warrant maximal safety, it is desirable to limit the duration of arrest to less th n 40 minutes. In addition, it is our contention that the early post-arrest period is a very critical period during which maintenance of adequate perfusion pressure in important for the neurologic outcome.

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Early Gastric Cancer with Signet Ring Cell Histology Remained Unresected for 53 Months

  • Lee, Seung-Soo;Ryu, Seung-Wan;Kim, In-Ho;Sohn, Soo-Sang
    • Journal of Gastric Cancer
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    • 제11권3호
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    • pp.189-193
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    • 2011
  • The natural course of untreated patients with signet ring cell carcinoma of the stomach remains poorly understood while assumptions have been made to distinguish it from other types of gastric cancer. A 74-year-old Korean woman was diagnosed with early gastric cancer with signet ring cell histology and refused surgery. A satellite lesion was identified 46 months after the initial diagnosis. The patient finally agreed to undergo distal subtotal gastrectomy 53 months following the initial diagnosis. Postoperative histological examination of both lesions confirmed signet ring cell carcinoma associated with submucosal invasion. There was no evidence of lymph node metastasis.

개심술후 조기 혈행동태심실중격결손증 교정과 승모판재건술에 대한 비교 (Hemodynamic studies early after open heart surgery: comparison of repair of ventricular septal defect and mitral valvular reconstruction)

  • 문병탁
    • Journal of Chest Surgery
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    • 제17권1호
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    • pp.59-66
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    • 1984
  • After open heart surgery, the patient must be carefully observed and adequately managed for his survival. This report reviewed 10 cases of ventricular septal defect and 12 mitral valvular diseases as hemodynamics early after open heart surgery. For postoperative 24 hours, clinical status was evaluated for left atrial pressure, central venous pressure,DP[LAP-CVP], peak systolic pressure, heart rate, urine amount, and other clinical findings. Especially, on postoperative fourth hour, cardiac output was most decreased, when the changes of monitoring were compared with two groups with or without using cardiotonics. Finally, we concluded as followings; 1.Postoperatively, variation of CVP was noted in VSD, but mitral valvular disease was more variable change of LAP. 2.DP was 1.3\ulcorner.4 cmH2O in VSD, and 6.4\ulcorner.2 cmH2O in mitral valvular disease. 3.Parameter using cardiotonic was CVP in VSD, and LAP in mitral valvular disease.

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관통성 흉부손상 176례에 대한 임상적 고찰 (Penetrating Injuries of the Chest- Analysis of 176 Cases -)

  • 허용;유회성
    • Journal of Chest Surgery
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    • 제15권1호
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    • pp.3-12
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    • 1982
  • Although most patients with penetrating injuries can be managed successfully with early tube thoracotomy, blood volume replacement & close observation, the remainder can be saved only by an aggressive operative intervention. From January 1959, to August 1980, 176 cases with penetrating injuries had been treated at the Department of Cardiothoracic Surgery, National Medical Center. The ratio of male to female patient of penetrating chest wounds was 4.3:1 in male predominance and age from 10 to 40 occupied 76.7% of the total cases. Stab wounds was the most common penetrating injuries and followed by gunshot & glass wounds. To prevent early complications of penetrating chest injuries, thoracentesis were done in 29 cases [16%], and closed thoractomy in 40 cases [22.7%]. Open thoractomy, however, had to be done in 37 cases [21%] because of massive bleeding, hemopericardium, foreign body.

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The diathermy scratch pad: A cheap and efficient tool for chemical and explosion-related burns

  • Wong, Allen Wei-Jiat;Hong, Qi En;Hui, Cheryl Li Yu;Chong, Si Jack
    • Archives of Plastic Surgery
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    • 제46권1호
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    • pp.88-91
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    • 2019
  • The burn center in our hospital is a national and regional (Southeast Asia) center. Of all admissions, 10% are related to blast explosions, and 8% due to chemical burns. In the acute burn management protocol of Singapore General Hospital, early surgical debridement is advocated for all acute partial-thickness burns. The aim of early surgical debridement is to remove all debris and unhealthy tissue, preventing wound infection and thereby expediting wound healing. In chemical burns, there can be stubborn eschars that are resistant to traditional debridement. We would like to present a novel technique using the diathermy scratch pad as a cheap and efficient tool for the dual purpose of surgical debridement and dermabrasion.

A Record Book of Open Heart Surgical Cases between 1959 and 1982, Hand-Written by a Cardiac Surgeon

  • Kim, Won-Gon
    • Journal of Chest Surgery
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    • 제49권4호
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    • pp.317-320
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    • 2016
  • A book of brief records of open heart surgery underwent between 1959 and 1982 at Seoul National University Hospital was recently found. The book was hand-written by the late professor and cardiac surgeon Yung Kyoon Lee (1921-1994). This book contains valuable information about cardiac patients and surgery at the early stages of the establishment of open heart surgery in Korea, and at Seoul National University Hospital. This report is intended to analyze the content of the book.