• 한국간담췌외과학회지
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• 제27권3호
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• pp.227-240
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• 2023

Hilar cholangiocarcinomas are highly aggressive malignancies. They are usually at an advanced stage at initial presentation. Surgical resection with negative margins is the standard of management. It provides the only chance of cure. Liver transplantation has increased the number of 'curative' procedures for cases previously considered to be unresectable. Meticulous and thorough preoperative planning is required to prevent fatal post-operative complications. Extended resection procedures, including hepatic trisectionectomy for Bismuth type IV tumors, hepatopancreaticoduodenectomy for tumors with extensive longitudinal spread, and combined vascular resection with reconstruction for tumors involving hepatic vascular structures, are challenging procedures with surgical indications expanded. Liver transplantation after the standardization of a neoadjuvant protocol described by the Mayo Clinic has increased the number of patients who can undergo operation.

• Journal of Chest Surgery
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• 제19권4호
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• pp.569-577
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• 1986

Between October 1979 and June 1986, modified Fontan procedures have been performed on 22 patients by the Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine. Twelve patients had tricuspid atresia; one, congenital tricuspid stenosis; five, single ventricle; two, I-transposition of the great vessels; one, double outlet right ventricle, and one, pulmonary atresia with an intact ventricular septum. There were 9 operative deaths [mortality; 40.9%]. The causes of death were right heart failure in six patients and pulmonary venous hypertension in one who misdiagnosed preoperatively. Another two were deceased due to sepsis and cerebrovascular accident at postoperative 35 and 34 days in each. There were 7 patients below 4 years of age at the time of operation and among them 4 patients were deceased. The operative death was not related with patients` age above and below 4[p=0.211]. The relation between operative death of tricuspid anomaly and another cardiac malformations was statistically significant [p=0.048]. The operative procedures with or without valved conduit [woven dacron] was related significantly [p=0.043] in the case of the 21 of the patients, but the modified Fontan operation with a valved conduit was performed early stage in this series. Since 1982, we operated on 4 patients, doing a right atrium-right ventricle anastomosis without a conduit. All survived and remained in functional class I [NYHA]. The right atrial pressure [RAP] was elevated significantly after operation [mean 9.9$\pm$4.8 ~16.9$\pm$3.6 mmHg, p<0.001]. The relation between the postoperative RAP of the survival group [16.5$\pm$4.3 mmHg] and the group who died [17.4$\pm$2.2 mmHg] was statistically significant [p=0.047]. There was no relation between any operative death and any previous palliation. All patients were followed for 4 months to 80 months, except one who was lost to follow up at 2 months following surgery [mean 11.4 months, 238 patient. months]. All were in functional class I with 5 on medications and 7 not. One was reoperated at 70 months following the first operation, due to conduit stenosis. She was moderately impaired in activity, with hepatomegaly after the second operation.

• Restorative Dentistry and Endodontics
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• 제30권2호
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• pp.102-111
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• 2005

본 연구는 근관치료시의 flare-up발생률과 환자의 술 전 상태 및 술식 등에 따른 flare-up의 발생 빈도를 알아보고자 한 것이다. 자료는 근관치료 받은 840개 치아로부터 얻었다. 심한 동통이나 종창으로 응급 내원하여 보다 적극적인 치료를 필요로 하는 경우만을 flare-up으로 분류하였다. 1. 전체 840개 치아 중 13개에서 발생, $155\%$의 발생률을보였다. 2. 성별 및 치아에 따른 유의차는 없었다. 3. 술 전 증상이 존재하는 경우 및 치근단 병소가 존재하는 경우가 높은 발생률을 보였다. 4. 무수치의 경우가 생활치나 비가역성 치수염 보다 높은 발생률을 보였다. 5. 다내원 근관치료의 경우 높은 발생률을 보였다. 6. 재근관치료시 높은 발생률을 보였다. 이상의 결론을 통해 flare-up은 환자의 술 전 증상, 치아의 술 전 상태 및 재근관치료 여부에 따라 높은 발생률을 보이고 있음을 알 수 있었다.

• 대한두개안면성형외과학회지
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• 제14권1호
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• pp.16-23
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• 2013

Background: Even though degrees of deformation of microform cleft lip are not high, it has to be corrected with various procedures upon conditions and areas since it has various expressions. Many studies have focused on the classifications and procedures, but there are only a few studies on how much these procedures are performed in the actual field. This study aims to analyze the utilization of various procedures upon major correction points. Methods: A total of 52 patients who had been corrected by one surgeon from 1995 to 2011 were enrolled as subjects. Based on the medical records, it was checked whether the incision was made or not along with the correction procedures for alar base and philtral column, Cupid's bow, and vermillion free margin. Results: In case of an incision, full incision (42 times) was conducted most frequently. For alar base and philtral column, muscle re-approximation (25 times) was performed most frequently. However, recently, it was shown that excision on only the affected area and correction with dermis were more likely to be used. For Cupid's bow and vermilion free margin, elliptical excision on the only affected area followed by re-approximation was performed most frequently for 46 times (Cupid's bow) and 44 times (vermilion free margin), respectively. Conclusion: For the correction of microform cleft lip, less invasive procedures are preferred. However, in the actual field, if needed, aggressive procedures consisting of incisions have been conducted to correction. These trends are somewhat changed to utilization of a simple procedure, such as excision on the modified area, followed by a re-approximation rather than complicated procedures using the muscle.

• Journal of Chest Surgery
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• 제16권1호
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• pp.183-190
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• 1983

Pectus Excavatum is a congenital anomaly of the anterior chest wall with a sharp concave curvature of the body of the sternum, from above downward and from side to side, especially just before the junction of gladiolo-xiphoid. We have experienced 14 cases of Pectus Excavatum with several operative procedures, i.e., Ravitch operation in 1 case, Wada operation [Sternal turn-over} in 3 cases, Wada operation and K-wire splint in 5 cases, Modified Wada operation [Rectus Abdominis muscle pedicle attached sternal turn-over] in 5 cases. Nearly all patients developed flail chest treated with internal fixation, and necrotic chondritis was developed postoperatively and treated with excision and curettage in one case with Wada operation. Follow-up Vertebral Index showed 48% preoperatively and 33% postoperatively, average decrement of 15%. We report 14 cases of Pectus Excavatum and their operative treatments.

• Restorative Dentistry and Endodontics
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• 제8권1호
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• pp.97-106
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• 1982

The purpose of this study was to evaluate the effect of different polishing procedures on the surfaces of composite resins. Two-paste type comosite restorative resin (Hipol) was selected for this study. 70 cavities prepared on the plaster-stone dies, 6mm in diameter and 2mm in depth, was filled with composite resin according to the manufacturer's specifications and by polymerizing against mylar strips. The polymerized composite resin specimens were polished (surface finished) by using 6 polishing devices; white stones, diamond finishing points, 12-fluted carbide finishing burs, green stones, sand paper disks, and Quasite rubber disk after polished with sand paper disks and green stones. A profilometer (Bendix type) was used to record in microinches the surface roughness of each surface finished composite resin specimens. The results were as follows. 1. The best finished surface that can be obtained is a surface formed by the mylar matrix strip 2. The white stones produced the smoothest surface in the experimental group. 3. The green stones produced the roughest surface in the experimental group. 4. It was proved that the gradual use of finishing instruments from a rough one to fine ones reduced the surface roughness.

• Clinical and Experimental Reproductive Medicine
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• 제20권1호
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• pp.71-78
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• 1993

Since the successful advent of IVF-ET, reproductive surgeons have been forced to compare pregnancy outcomes of surgical procedures for tubal infertility with those of IVF-ET. The current study was designed in an effort to determine the usefulness of pre-operative infertility work-up, especially diagnostic laparoscopy, in predicting the pregnancy rate and in assessing the reversal feasibility. 109 patients who underwent a microsurgical tubal reversal were reviewed. The patients were followed over one year. The total intrauterine pregnancy, spontaneous abortion, and ectopic pregnancy rates were 66.4%, 3.7%, and 7.3%, respectively. The result showed that the use of loupe might increase the chance of the ectopic pregnancy. I found that the final tubal length, especially the longest tubal length, the site of reanastomosis, and the methods of sterilization affected the pregnancy rates. A 85% intrauterine pregnancy rate was achieved in the patients with good preoperative assessments(Group II-1). There was only 10% incidence of intrauterine pregnancy in the patients with bad assessments(Group II-2). It is concluded that the pre-operative infertility work-up, especially diagnostic laparoscopy, is a good diagnostic tool in assessing the reversal feasibility.

• 대한두개안면성형외과학회지
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• 제25권1호
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• pp.22-26
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• 2024

Background: This study analyzed the demographic characteristics of patients with facial palsy who were treated using either dynamic or static procedures. This study aimed to compare the frequency of procedure implementation and age distribution between the two groups. Methods: This study retrospectively analyzed the medical records of patients treated for facial palsy at a single institution from 2014 to 2022. Among cases included in our study, dynamic procedures involved cross-facial nerve graft and latissimus dorsi or gracilis muscle flap transfer. Static procedures included gold weight insertion, canthopexy, browlift, and thread lift/static slings. Results: Among the 31 patients included in our study, eight (25.8%) incorporated dynamic techniques, and the average age of patients was 44.75 years (range, 24-68 years) with a male to female ratio of 1:4. The remaining 23 patients (74.2%) underwent a static procedure, of which the average age was 59.17 years (range, 23-81 years) which was statistically significantly higher than the average age of 44.75 of dynamic patients (p= 0.013). Regarding the timing of treatment after diagnosis, no patient underwent dynamic procedures more than 20 years after initial diagnosis. A greater diversity in the timing of treatment was observed in the static group. All patients who underwent dynamic procedures were treated using static procedures during the study period. Conclusion: Because aesthetics-based static techniques are typically quick outpatient procedures that can be performed under local anesthesia, our study shows that these are often preferred treatments for all age groups, especially for debilitated or older patients. Further research is required to investigate the long-term functional outcomes of these surgical techniques in a wider population of patients.

• Archives of Plastic Surgery
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• 제50권1호
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• pp.125-129
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• 2023

Three-dimensional (3D) video exoscopes are high-magnification stereo cameras that project onto monitors mounted in the operating room, viewable from different angles. Outside of plastic surgery, exoscopes have been shown to successfully improve the ergonomics of microsurgery, though sometimes with prolonged operating times. We compare a single surgeon's early experience performing free flap procedures from 2020 to 2021 using either a binocular microscope or a 3D video exoscope. Ten procedures were performed with the standard operating microscope and 8 procedures with the 3D exoscope. The microsurgeon, having minimal prior experience using an exoscope, reported less neck discomfort following the free flap procedures performed with the exoscope compared with the binocular surgical microscope. Total average operating time was comparable between the standard surgical microscope and the 3D exoscope (13.7 vs. 13.4 hours, p = 0.34). Our early experience using a 3D exoscope in place of a standard optical microscope demonstrated that the exoscope shows promise, offering an ergonomic alternative during microvascular reconstruction without increasing overall operating times. Future studies will compare free flap ischemia time between cases performed using the exoscope and the conventional binocular microscope. Medical Subject Headings authorized following words: free tissue flaps; operating rooms; ergonomics; microsurgery.

• Journal of Chest Surgery
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• 제25권10호
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• pp.1025-1029
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• 1992

We experienced eleven cases of pulmonary aspergllosis treated surgically in the period from 1981 to 1992. There were 5 men and 6 women, ranging in age from 28 to 64 years [mean age 40.4 years]. The most common chief complaint of the patients was hemoptysis and blood tinged sputum[7 cases, 63.6%], On preoperativechest film, the case of cavity with fungus ball[7 cases] and only cavity[4 cases] were seen. The location of the lesion were both upper lobe[6 cases] and lower lobe[5 cases]. The underlying disease were tuberculosis[5 cases], bronchiectasis[2 cases], tuberculosis and bronchiectasis[1 case], pneumonia[1 case] and none[2 cases]. The operative procedures of pulmonary aspergillosis were lobectomy[8 cases], cavernostomy[1 case] and thoracoplasty[2 cases]. The postoperative complications were postoperative massive bleeding[reoperation, 2 cases], wound infection[2 cases] and no operative mortality.