• Journal of Korean Orthopaedic Sports Medicine
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• v.3 no.2
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• pp.128-133
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• 2004

Purpose: This study was planned to evaluate complications? of posterior cruciate ligament (PCL) reconstruction with tibial inlay technique using autogenous bone-patellar tendon-bone graft. Materials and Methods: From September 1994 to January 2004, we analyzed surgical complications in fifty-seven patients with fifty-eight cases who underwent PCL reconstruction. Fifty of them were male and seven female. The mean age of the patients was 35(15$\~$73). Twenty eight cases of injury were isolated PCL, while thirty cases had associated injury of knee. The causes of injury were thirty-nine cases of traffic accident, seven sport injuries, seven fall down injuries, and five of others. The follow-up study was done at 4 weeks, 3 months,6 months and 1 year after surgery. KT-2000 arthrometer and posterior stress X-ray were used to examine the stability of the knee joint and the Lysholm Knee Score and a variety of clinical complications were evaluated. Results: Although the mean score of the preoperative Lysholm Knee Score was 43.2, the postoperative score was increased to 87.9. The preoperative mean value of knee stability using KT-2000 arthrometer was 8.75 mm(6.2$\~$14.3 mm) but the postoperative mean was 3.41 mm(2.1$\~$10.6 mm). The intraoperative complications were: one case of popliteal artery injury with compartment syndrome, one case of patellar fracture, two cases of 20$^{\circ}$ flexion loss, and two cases of anterior cortical penetration of the screw through proximal tibia during screw fixation. The postoperative complications were: eleven cases of knee instability, one case of patellar fracture, five cases of extension loss, thirteen cases of flexion loss, twenty-one cases of around knee pain and eight cases of kneeling pain. Conclusion: After PCL reconstruction with tibial inlay technique using autogenous bone-patella tendon-bone graft, complications were observed in this study. Careful attention during and after the operation, as well as rehabilitation must be required.

• Journal of Chest Surgery
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• v.42 no.2
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• pp.184-192
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• 2009

Background: Although complications from transfusion are known to happen, transfusion is performed during most open heart surgeries. The aim of this study was to investigate the possibility of performing cardiac surgery without allogenic blood transfusion. Material and Method: Between January to August 2007, 44 consecutive patients who underwent open heart surgery with using various blood conservation methods were retrospectively enrolled. They were divided into group I (the onpump group, n=17) and group II (the offpump group, n=27). The blood conservation methods were intraoperative autologous donation, cell saver, retrograde autologous priming, conventional ultrafiltration and modified ultrafiltration. Antianemic agents were administered to all the patients postoperatively. We analyzed the possibility of bloodless operations, the causes of homologous transfusion, the serial change of the hematocrit and the postoperative chest tube drainage, and we compared the results between the two groups. If comparison between the two groups was not reasonable, then we compared two groups with the individual control groups I and II (49 patients) in 2006. Result: 40 (90.9%) of 44 patients were successfully operated on without transfusion and the success rate was 88.2% (15/17) for group I and 92.6% (25/27) for group II. There was no statistical difference between the two groups (p=NS). The causes of transfusion were 2 cases of postoperative bleedings, 1 case of intraoperative bleeding and 1 mistake of the indication for transfusion. There was no statistical difference of the total chest tube drainage (Group I: $417{\pm}359mL$, Group II: $451{\pm}237mL$) (p=NS), but the total chest tube drainages of the two groups were less than each of the control groups 1 and II (p<0.05). The lowest hematocrit level of Group I was $16.4{\pm}2%$, and this occurred just after infusion of cardioplegics and the hematocrits of both groups were recovered to the preoperative level at 2 months postoperatively. Conclusion: In this study, bloodless open heart surgery could be performed in 90.9% of the patients with intraoperative autologous donation, cell saver, retrograde autologous priming, conventional ultrafiltration and modified ultrafiltration. A combination of various blood conservation methods is the most important and bloodless cardiac surgery could be performed with meticulous bleeding control and strictly following the transfusion indications.

• Journal of Chest Surgery
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• v.17 no.4
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• pp.593-606
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• 1984

With the ligation of patent ductus arteriosus by Gross in 1938, surgeons first entered the field of congenital heart disease. Interruption of a ductus is one of the most satisfactory and curative operations in the field of surgery for congenital heart disease. 27 cases of isolated patent ductus arteriosus were operated from Jan. 1978 to July 1984 at the Department of Thoracic & Cardiovascular Surgery in Kyung-Hee University Hospital. Retrospective clinical analysis of these patients were: 1. Sex ratio, female: male, was 2:1. 2. Mean age at operation was 9.85\ulcorner.58 years. The youngest patient was a 23 month-old girl and the oldest one was a 24 year-old male. 3. More than half of the patients had less than 50 percentile of growth retardation. 4. Chief complaints of the patients were frequent URI [52%], dyspnea on exertion [33%], generalized weakness [22%], palpitation [7%], but 7 patients [26%] had no subjective symptoms. 5. Continuous machinery murmur could be heard at the 2nd or 3rd intercostal space on the left sternal border in 22 patients [81%]. The other S patients made systolic murmur with accentuation of the second heart sound and those were associated with pulmonary hypertension. 6. Radiologic findings of Chest P-A were cardiac enlargement in 15 patients [55%], enlargement of pulmonary conus and/or increasing density of pulmonary vascularity in 20 patients [74%]. 7. Electrocardiographic findings of the patients were within normal limit in 13 patients [48%], LVH in 4 patients [15%], biventricular hypertrophy in 3 patients [11%]. 8; echocardiogram was obtained from 11 patients. Ductus was directly visualized in 7 patients. Left atrial enlargement is the secondary change of left to right shunt, 10 patients had LA/Ao ratio more than 1.2. 9. Cardiac catheterization performed in 25 patients. The mean value of the results were:SO2[PA-RV]= 14.72\ulcorner6.01%, Qp/Qs=2.22\ulcorner.80, peak systolic pulmonary arterial pressure=48.28\ulcorner1.60 mmHg. 10. 26 patients were operated through the left posterolateral thoracotomy: closure of ductus by double ligation in 14 cases, triple ligation in 5 cases, and division with suture in 8 cases. One patient suffer from aneurysmal rupture of main pulmonary artery, endocarditis, hemopericardium was treated with cardiopulmonary bypass via median sternotomy and closure of ductus through the ruptured main pulmonary artery. 11.There was no death associated with the operation, but 3 cases were experienced with intraoperative rupture around the ductus resulting in massive bleeding. The other complications were transient hoarseness in one patient, atelectasis in left lower lobe in 3 patients, and postoperative systemic hypertension in 4 patients with unknown etiology. 12. Pulse pressure was reduced, 11.47+5.92 mmHg, postoperatively, as compare to preoperative status. 13. Intraoperative wedge lung biopsy from lingular segment for the evaluation of the pulmonary vascular disease was taken in S patients with severe pulmonary hypertension. The result was Heath-Edward grade I in one case, grade II in two cases, and grade III in two cases.

• Journal of Yeungnam Medical Science
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• v.11 no.1
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• pp.55-62
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• 1994

The use of intraoperative application of Mitomycin C at the filtration site has been known to improve the surgical outcome in glaucomatous eyes with high risk for failure of trabeculectomy. The author performed trabeculectomies with intraoperative Mitomycin C on 25 eyes of 20 patients with poor surgical prognosis to study the efficacy and safety of this technique in glaucomatous patients with high risk for failure of trabeculectomy. After the preparation of a scleral flap, 0.2mg/ml solution of Mitomycin C was applied between Tenon's capsule and the sclera for 2 minutes. The exposed area was then irrigated with 200 ml of balanced salt solution. The follow-up period was from 1 to 7 months (mean 3.8 months). The mean preoperative intraocular pressure (IOP) was $38.6{\pm}6.6mmHg$. The mean final postoperative IOP was $11.7{\pm}3.8mmHg$. Twenty three (88%) of the 25 eyes were successfully controlled with the IOP of less than or equal to 20 mmHg without glaucoma medication. There were early postoperative complications of hyphema in 5 eyes (20%), shallow anterior chamber in 4 eyes(16%), punctate keratopathy in 3 eyes (12%), aqueous leaking from conjunctival wound in 2 eyes (8%), encapsulated bleb in 1 eye (4%) and choroidal detachment in 1 eye (4%), and 4 eyes had long term hypotony lasting more than 2 months. Although Mitomycin C is simple to use and effective adjunct to trabeculectomy, further study will be needed to determine the mechanism of action, indication, dosage and optimal exposure time of Mitomycin C.

• Journal of Korean Neurosurgical Society
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• v.49 no.3
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• pp.163-166
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• 2011

Objective : Both the paraspinal muscle sparing approach and percutaneous screw fixation are less traumatic procedures in comparison with the conventional midline approach. These techniques have been used with the goal of reducing muscle injury. The purpose of this study was to evaluate and to compare the safety and efficacy of the paraspinal muscle sparing technique and percutaneous screw fixation for the treatment of L5-S1 spondylolisthesis. Methods : Twenty patients who had undergone posterior lumbar interbody fusion (PLIF) at the L5-S1 segment for spondylolisthesis were prospectively studied. They were divided into two groups by screw fixation technique (Group I : paraspinal muscle sparing approach and Group II: percutaneous screw fixation). Clinical outcomes were assessed by Low Back Outcome Score (LBOS) and Visual Analogue Scale (VAS) for back and leg pain at different times after surgery. In addition, modified MacNab's grading criteria were used to assess subjective patients' outcomes 6 months after surgery. Postoperative midline surgical scarring, intraoperative blood loss, mean operation time, and procedure-related complications were analyzed. Results : Excellent or good results were observed in all patients in both groups 6 months after surgery. Patients in both groups showed marked improvement in terms of LBOSs all over time intervals. Postoperative midline surgical scarring and intraoperative blood loss were lower in Group II compared to Group I although these differences were not statistically significant. Low back pain (LBP) and leg pain in both groups also showed significant improvement when compared to preoperative scores. However, at 7 days and 1 month after surgery, patients in Group II had significantly better LBP scores compared to Group I. Conclusion : In terms of LBP during the early postoperative period, patients who underwent percutaneous screw fixation showed better results compared to ones who underwent screw fixation via the paraspinal muscle sparing approach. Our results indicate that the percutaneous screw fixation procedure is the preferable minimally invasive technique for reducing LBP associated with L5-S1 spondylolisthesis.

• Journal of Electrodiagnosis and Neuromuscular Diseases
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• v.20 no.2
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• pp.98-105
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• 2018

Objective: To evaluate whether the increase of the amplitude of motor evoked potentials (MEPs) during surgery can imply favorable prognosis postoperatively in spinal cord tumor surgery. Method: MEPs were monitored in patients who underwent spinal cord tumor surgery between March 2016 and March 2018. Amplitude changes at the end of monitoring compared to the baselines in limb muscle were analyzed. Minimum and maximum changes were set to $MEP_{min}$ (%) and $MEP_{max}$ (%). Strengths of bilateral 10 key muscles which were documented a day before ($Motor_{pre}$), 48 h ($Motor_{48h}$) and 4 weeks ($Motor_{4wk}$) after the surgery were reviewed. Results: Difference of $Motor_{48h}$ from $Motor_{pre}$ ($Motor_{48h-pre}$) and $Motor_{4wk}$ from $Motor_{pre}$ ($Motor_{4wk-pre}$) positively correlated with $MEP_{min}$, suggesting that smaller the difference of MEPs amplitude, less recovery of muscle strength. There was a negative correlation between the amount of bleeding and $MEP_{min}$, indicating that the greater the amount of bleeding, the smaller the $MEP_{min}$, implying that MEPs amplitude is less likely to improve when the amount of bleeding is large. It also showed significant difference between patients with improved or no change of motor status and patients with motor deterioration after surgery according to anatomical tumor types. Conclusion: Improve of muscle strength was less when the increase of MEPs amplitude was small, and improvement of MEPs amplitude was less when the amount of bleeding was large. Correlation between changes of status of muscle strength after surgery and tumor types was observed. With amplitude increase in MEPs monitoring, restoration of muscle strength can be expected.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.28 no.1
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• pp.42-47
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• 2024

Backgrounds/Aims: Hepatolithiasis and choledocholithiasis are frequent pathologies and unfortunately, with the current treatment strategies, the recurrence incidence is still high. This study aimed to assess the outcomes of laparoscopic choledochotomy using cholangioscopy via the percutaneous-choledochal tube for the treatment of hepatolithiasis and choledocholithiasis in Vietnamese patients. Methods: A cross-sectional study of patients with hepatolithiasis and/or choledocholithiasis who underwent laparoscopic choledochotomy using intraoperative cholangioscopy via percutaneous-choledochal tube at the Department of Hepatopancreatobiliary Surgery, 108 Military Central Hospital, from June 2017 to March 2020. Results: A total of 84 patients were analyzed. Most patients were females (56.0%) with a median age of 55.56 years. Among them, 41.8% of patients had previous abdominal operations, with 33.4% having choledochotomy. All patients underwent successful laparoscopic common bile duct exploration followed by T-tube drainage without needing to convert to open surgery. Most patients (64.3%) had both intrahepatic and extrahepatic stones. The rate of stones ≥ 10 mm in diameter was 64.3%. Biliary strictures were observed in 19.1% of patients during cholangioscopy. Complete removal of stones was achieved in 54.8% of patients. Intraoperative complications were encountered in two patients, but there was no need to change the strategy. The mean operating time was 121.85 ± 30.47 minutes. The early postoperative complication rate was 9.6%, and all patients were managed conservatively. The residual stones were removed through the T-tube tract by subsequent choledochoscopy in 34/38 patients, so the total success rate was 95.2%. Conclusions: Laparoscopic choledochotomy combined with cholangioscopy through the percutaneous-choledochal tube is a safe and effective strategy for hepatolithiasis and/or choledocholithiasis, even in patients with a previous choledochotomy.

• Journal of Gastric Cancer
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• v.7 no.3
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• pp.152-159
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• 2007

Purpose: Recently, the use of laparoscopic assisted gastrectomy for early gastric cancer has been on the increase and the procedure has been quickly adopted by clincians. However, there are few reports regarding the safety and risk of this type of surgery. The aim of this study is to evaluate the morbidity and to verify the safety of laparoscopic assisted gastrectomy for early gastric cancer. Materials and Methods: A total of 376 patients that had undergone laparoscopic assisted gastrectomy for early gastric cancer between April 2004 and December 2006 were reviewed retrospectively. The clinicopathological characteristics, operative complications, and factors related to complications were evaluated. Results: The overall operative morbidity and mortality rates were 10.6% and 0%, intraoperative morbidity was 1.1% (4 of 376 patients) and post operative morbidity was 9.6% (36 of 376 patients). Most complications required no surgery except for an intestinal obstruction in two cases. Multivariate analysis of risk factors related to operative morbidity determined that age was an independent factor associated with morbidity (P=0.021). Conclusion: The complication rate of laparoscopic assisted gastrectomy is low and most complications can be managed by conservative methods rather than with surgery. There were no specific predicting factors for complications except old age. Laparoscopy is a technically feasible and acceptable surgical modality for early gastric cancer.

• Journal of Chest Surgery
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• v.24 no.9
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• pp.853-860
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• 1991

A clinical study on 139 cases of operated PDA was performed during period from Aug. 1982 to Apr. 1991 at the Dept. of Thoracic and Cardiovascular Surgery of Chonbuk National University Hospital. The following results are obtained. 1. The 35 males and 104 females ranged in age from 6 months to 40 years. [mean 10.2 yrs. ] 2. Chief complaints of the patients were frequent URI in 50%, dyspnea on exertion in 31.2%, palpitation in 11.1%, and no subjective symptoms in 28.78% 3. On auscultation, continuous machinery murmur heard in 79.86% and systolic murmur in 20.14%. 4. Radiologic findings of chest P-A showed increased density of pulmonary vascularity in 80.58%, cardiomegaly in 61.87%, and within normal limit in 19.42% of the patients. 5. The signs of LVH[44.4%], RVH[17.4%], BVH[7.6%] were noted on the EKC. 6. Cardiac catheterizations were performed in 114 patients. The mean Qp/Qs was 2.65 and the mean Pp /Ps was 0.41 and the mean systolic pulmonary artery pressure was 46.6 mmHg. 7. Operative methods were as followed: The 130 cases[93.52%] of ligation and 3 cases[2.16%] of division & suture for PDA were performed through the left posterolateral thoracotomy. And the remained cases were managed under the cardiopulmonary bypass. 8. Operative complications were hoarseness in 8 cases, atelectasis in 6 cases, intraoperative ductal rupture under the left thoracotomy approach 2 cases, recannalization 1 case and others in 3 cases. 9. One patient died due to ductal rupture intraoperatively and the overall mortality was 0.7%.

• Journal of Gastric Cancer
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• v.13 no.4
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• pp.266-272
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• 2013

We report our experience with two cases of situs inversus totalis, both involving patients diagnosed with gastric cancer. These were a 52-year-old male with a preoperative staging of cT1bN0M0 and a 68-year-old male with a staging of cT2N0M0, both of whom underwent surgery. The former was found to have vascular anomalies in the preoperative computed tomography, so we performed a computed tomography angiography with three-dimensional reconstruction. Laparoscopy-assisted distal gastrectomy with Billroth I anastomosis was performed with D1+ lymph node dissection, and a small laparotomy was made for extracorporeal anastomosis. In contrast, the latter case showed no vascular anomalies in the preoperative computed tomography, and totally laparoscopic distal gastrectomy with delta anastomosis was performed with D1+ lymph node dissection. There were no intraoperative problems in either patient and they were discharged without postoperative complications. Histopathological examination revealed a poorly differentiated adenocarcinoma (pT2N0M0) and a well-differentiated adenocarcinoma (pT1aN0M0), respectively.