• Journal of Chest Surgery
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• v.46 no.3
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• pp.185-191
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• 2013

Background: Cardiopulmonary bypass (CPB) induces variable systemic inflammatory reactions associated with major organ dysfunction via polymorphonuclear neutrophils (PMNs). Ulinastatin, a urinary trypsin inhibitor, inhibits PMN activity and reduces systemic inflammatory responses. The aim of this study is to evaluate the effect of ulinastatin on postoperative blood loss and laboratory changes in patients undergoing open heart surgery. Materials and Methods: Between January 2008 and February 2009, 110 patients who underwent atrioventricular valve surgery through right thoracotomy were divided into two groups. Patients received either 5,000 U/kg ulinastatin (ulinastatin group, n=41) or the equivalent volume of normal saline (control group, n=69) before aortic cross clamping. The primary end points were early coagulation profile changes, postoperative blood loss, transfusion requirements, and duration of intubation and intensive care unit stay. Results: There were no statistically significant differences between the two groups in early coagulation profile, other perioperative laboratory data, and postoperative blood loss with transfusion requirements. Conclusion: Administration of ulinastatin during operation did not improve the early coagulation profile, postoperative blood loss, or transfusion requirements of patients undergoing open heart surgery. In addition, no significant effect of ulinastatin was observed in major organs dysfunction, systemic inflammatory reactions, or other postoperative profiles.

• 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.

• Journal of Yeungnam Medical Science
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• v.40 no.2
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• pp.172-178
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• 2023

Background: Laparoscopic cholecystectomy (LC) is a noninvasive surgery, but postoperative pain is a major problem. Studies have indicated that erector spinae plane block (ESPB) has an analgesic effect after LC. We aimed to compare the efficacy of different ESPB anesthetic concentrations in pain control in patients with LC. Methods: This retrospective study included patients aged 20 to 75 years scheduled for LC with the American Society of Anesthesiologists physical status classification I or II. ESPB was administered using 0.375% bupivacaine in group 1 and 0.25% in group 2. Both groups received general anesthesia. Postoperative tramadol consumption and pain scores were compared and intraoperative and postoperative fentanyl requirements in the postanesthesia care unit (PACU) were measured. Results: Eighty-five patients were included in this analysis. Tramadol consumption in the first 12 hours, second 12 hours, and total 24 hours was similar between groups (p>0.05). The differences between postoperative numeric rating scale (NRS) scores at rest did not differ significantly. The postoperative NRS scores upon bodily movement were not statistically different between the two groups, except at 12 hours. The mean intraoperative and postoperative fentanyl requirements in the PACU were similar. The difference in the requirement for rescue analgesics was not statistically significant (p=0.788). Conclusion: Ultrasound-guided ESPB performed with different bupivacaine concentrations was effective in both groups for LC analgesia, with similar opioid consumption. A lower concentration of local anesthetic can be helpful for the safety of regional anesthesia and is recommended for the analgesic effect of ESPB in LC.

• Health Policy and Management
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• v.11 no.2
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• pp.16-28
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• 2001

This study was to compare multidimensional outcomes of patient's satisfaction after cataract surgery and to identify factors influencing satisfaction after operation. Patient's satisfaction was measured with three dimensions : interpersonal care, physician explanation and hospital care. Overall satisfaction was measured as means of three dimensional scores. For the study, a prospective study was performed with 389 patients who had undergone cataract surgery for either one eye or both eyes. The surgery was performed by 20 ophthalmologists who were practicing at university hospitals and general hospitals. Patients were interviewed and clinical data (the visual acuity of operated eye, visual function, symptom score and satisfaction with vision) were obtained. The doctors were questioned with self-reported questionnaire forms. Medical records were also examined to understand surgery Process. The survey was conducted before(389) and after operation(327). Alter excluding cases with incomplete data, 3n cases were enrolled In this study. Both the overall satisfaction and the satisfaction with physician explanation increased after the operation whereas the satisfaction with interpersonal care and hospital care did not change significantly. Multiple regression analysis showed that the level of education, baseline satisfaction scores and the degree of vision improvement were statistically significant variables. The preoperative lower level of education, higher level of overall satisfaction (interpersonal care, physician explanation, hospital care scores) and the more the satisfaction with vision improvement were associated with the improvement of postoperative satisfaction scores.

• Journal of Trauma and Injury
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• v.31 no.3
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• pp.174-176
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• 2018

Most of aortic injuries after blunt chest trauma usually occur at the aortic isthmus and are identified in the emergency department soon after arrival. Delayed aortic injures by fractured posterior ribs, however, are relatively rare and have been reported only a few times. We recently experienced an iatrogenic descending aortic injury sustained as a result of a direct puncture by a sharp rib end after surgical stabilization of rib fractures.

• Journal of Korean Academy of Nursing
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• v.25 no.2
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• pp.210-221
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• 1995

The purpose of this study was to identify relationships between a preoperative video program as nursing intervention and the perception of postoperative pain. The subjects consisted of an experimental group of 17 children and a control group of 13 children, for a total of 30 patients who were admitted the ENT Department for tonsilectomies. Data were collected from August 1, 1993 to September 31. The video program was made by the pediatric operating theater nursing staff. Postoperative painwas measured using the Face Pain Rating Scales devised by Beyer in 1984. The data were analyzed by a SPSS using frequencies, means, percentages, t-test and ANOVA to analyze the variables and demographic characteristics. The results of this study are as follows : The hypothesis, “Score of the experimental group which was shown the preoperative video program as a nursing intervention will be lower than the control group which did not see the video in postoperative pain perception.” was rejected by t=-.42, p>.05. No significant difference was found between the experimental group and the control group according demographic characteristics. From the above findings, this study suggests the following : 1. Further studies as randomized control-group pretest-posttest design are needed to control the extraneous variables. 2. A review will be suggested to be done by the preoperative video program as nursing intervention and an exploration to improve preoperative nursing care for pediatric patients with the inclusion such activities as preoperative visiting, operation theater tour etc.

• Journal of Chest Surgery
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• v.50 no.5
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• pp.382-385
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• 2017

A 47-year-old man with myasthenia gravis (MG) was admitted for a lung transplant. He had bronchiolitis obliterans after allogeneic hematopoietic stem cell transplantation due to acute myeloid leukemia. MG developed after stem cell transplantation. Bilateral sequential lung transplantations and a total thymectomy were performed. The patient underwent right diaphragmatic plication simultaneously due to preoperatively diagnosed right diaphragmatic paralysis. A tracheostomy was performed and bilevel positive airway pressure (BiPAP) was applied on postoperative days 8 and 9, respectively. The patient was transferred to the general ward on postoperative day 12, successfully weaned off BiPAP on postoperative day 18, and finally discharged on postoperative day 62.

• Journal of Chest Surgery
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• v.37 no.9
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• pp.805-808
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• 2004

A 69-year-old man was admitted due to blood-tinged sputum. The preoperative examination revealed 5${\times}$2.8cm sized nodular mass on left upper lobe of the lung. The patient underwent left upper lobectomy and radical Iymph node dissection under impression of lung cancer. Postoperative pathologic examination revealed as primary choriocarcinoma of the lung. The patient expired at postoperative 58 days despite meticulous postoperative care. We planned on immediate adjuvant chemotherapy but was delayed due to postoperative pneumonia and the choriocarcinoma progressed rapidly. Primary choriocarcinoma is an extremely rare clinical entity in lung cancer with no established therapeutic guidelines available. We report a case of the primary pulmonary choriocarcinoma which was diagnosed postoperatively.

• Journal of Chest Surgery
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• v.25 no.11
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• pp.1192-1202
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• 1992

Postoperative cardiac outputs and other hernoaynamic values were serially measured in fifteen patients of cyanotic congenital heart disease, after use of blood cardioplegic solution. Cardiac indices showed no change untill eight postoparative hours, then it began to decline to reach as low as 3.22$\pm$0.7L/min/m2 at 12 hours. After then gradual increse occ-ured to recover upto immediate postoperative value at 20 hours. Sharp decrese of heart rate and increse of systemic vascular resistance during 8~16 hours and steady increase of stroke indices during the whole study periods were observed. These observations suggested that the myocardium recovered gradually after open heart surgery, and that the decrease of cardiac indices during 8~16 hours could be a result of decrease of heart rates and increase of afterload. The changes of cardiac indices correlated with the changes of heart rate, postoperative time and mixed venous oxygen saturation [p<0.05]. No other hemodynamic values found to be in statistically significant correlation with the changes of cardiac indices. Left ventricular dysfunction seemed to occur more frequently during 8~12 hours, but it was not statistically significant. [p=0.73] In conclusion, great care must be taken during 2~3 days after the operation of cyanotic congenital heart disease, not to fall into a low cardiac output state, by maintaing adequate heart rates and reducing afterload especially when the systemic vascular resistance increases.

• Biomedical Science Letters
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• v.11 no.3
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• pp.407-416
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• 2005

Cardiopulmonary bypass (CPB) for cardiac surgery induces the production and release of numerous chemotactic substances and cytokines, ensuing systemic inflammatory response that causes postoperative major organ dysfunctions. We performed a randomized, prospective study to investigate clinical effects of preoperative treated-methylprednisolone for preventing inflammation in pediatric cardiac surgery with CPB. Thirty pediatric patients scheduled for elective cardiac surgery were randomized to either control(n=15) or steroid group (n=15, 10 mg/kg of methylprednisolone). Arterial blood samples were taken before and after the operations for measuring total leukocyte (T-WBC) and differential counts, platelet counts, interleukin-6 (IL-6), myeloperoxidase (MPO), neuron specific enolase (NSE), troponin-I (TNI), aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN), and creatinine levels. Postoperative parameters such as pulmonary index (PI, $PaO_2/FiO_2$), 24 hrs and total bleeding volumes, mechanical ventilating (MVP) and intensive care unit (ICU)-staying periods, and hospitalization were assessed. T-WBC, neutrophil fraction, IL-6, MPO, NSE, TNI, AST and creatinine levels, bleeding volumes, PI, and MVP at the postoperative periods were lower or shorter in steroid group than in control group (P<0.05). These findings indicated that preoperative administration of methylprednisolone attenuated CPB-induced inflammatory reactions, contributing to postoperative recovery of patients underwent cardiac surgery.