• Journal of Korean Neurosurgical Society
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• v.40 no.3
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• pp.143-147
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• 2006

Objective : Brachial plexus injury can produce a intractable chronic neuropathic pain. This study was undertaken to assess the long term outcome of microsurgical dorsal root entry zonotomy[MDT]. Methods : Between October 1997 and December 2002, 21 patients received MDT because of a intractable pain resulting from brachial plexus injury. Of these, 19 patients were followed for more than 2 years. Fourteen of 19 patients were male and patient ages ranged from 22 to 69 years. Mean pain duration was 36.8 months and all patients had severe pain of $9{\sim}10$ visual analogue scale. To achieve complete destruction of abnormal dorsal horns, thermocoagulation of the posterolateral sulcus were performed and careful gluing was done to prevent postoperative adhesion and pain recurrence. Results : Of the 19 patients, 15 patients had excellent [>75% reduction in pain] and good [$51{\sim}75%$ pain relief] results in a average postoperative period of 4.1 years. One patient had a poor [less than 25% pain relief] result. Three patients were considered to have a fair result [$26{\sim}50%$ pain relief]. Postoperative complications were 2 transient ipsilateral ataxia and 1 CSF fistula that resolved without surgical revision. Conclusion : These results indicate that MDT provides excellent long-term pain relief in medically intractable chronic neuropathic pain following brachial plexus injury without significant complications.

• Journal of Chest Surgery
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• v.51 no.1
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• pp.8-14
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• 2018

Background: Minimally invasive direct coronary artery bypass grafting (MIDCAB) has the advantage of allowing arterial grafting on the left anterior descending artery without a sternotomy incision. We present our single-center clinical experience of 66 consecutive patients. Methods: All patients underwent MIDCAB through a left anterior small thoracotomy between August 2007 and July 2015. Preoperative, intraoperative, postoperative and follow-up data - including major adverse cardiovascular and cerebrovascular events (MACCE), graft patency, and the need for re-intervention - were collected. Results: The mean age of the patients was $69.4{\pm}11.1years$ and 73% were male. There was no conversion to an on-pump procedure or a sternotomy incision. The 30-day mortality rate was 1.5%. There were no cases of stroke, although 2 patients had to be re-explored for bleeding, and 81.8% were extubated in the operating room or on the day of surgery. The median stay in the intensive care u nit and in the hospital were 1.5 and 9.6 days, respectively. The median follow-up period was 11 months, with a 5-year overall survival rate of $85.3%{\pm}0.09%$ and a 5-year MACCE-free survival rate of $72.8%{\pm}0.1%$. Of the 66 patients, 32 patients with 36 grafts underwent a postoperative graft patency study with computed tomography angiography or coronary angiography, and 88.9% of the grafts were patent at $9.7{\pm}10.8months$ postoperatively. Conclusion: MIDCAB is a safe procedure with low postoperative morbidity and mortality and favorable mid-term MACCE-free survival.

• Radiation Oncology Journal
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• v.33 no.1
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• pp.29-35
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• 2015

Purpose: To analyze the prognostic factors for survivals and to evaluate the impact of postoperative whole pelvic radiotherapy (WPRT) on pelvic failure in patients with uterine sarcoma treated with radical surgery. Materials and Methods: We retrospectively analyzed 75 patients with uterine sarcoma who underwent radical surgery with (n = 22) or without (n = 53) radiotherapy between 1990 and 2010. There were 23 and 52 patients with carcinosarcoma and non-carcinosarcoma (leiomyosarcoma, 22; endometrial stromal sarcoma, 25; others, 5), respectively. The median follow-up period was 64 months (range, 17 to 269 months). Results: The 5-year overall survival (OS) and pelvic failure-free survival (PFFS) of total patients was 64.2% and 83.4%, respectively. Multivariate analysis revealed that mitotic count (p = 0.006) was a significant predictor of OS. However, factors were not found to be associated with PFFS. On analyzing each of the histologic subtypes separately, postoperative WPRT significantly reduced pelvic failure in patients with carcinosarcoma (10.0% vs. 53.7%; p = 0.046), but not in patients with non-carcinosarcoma (12.5% vs. 9.9%; p = 0.866). Among the patients with carcinosarcoma, 4 patients (17%) had recurrence within the pelvis and 3 patients (13%) had recurrence in other sites as an initial failure, whereas among the patients with non-carcinosarcoma, 3 patients (6%) experienced pelvic failure and 13 patients (25%) experienced distant failure. Conclusion: The most significant predictor of OS was mitotic count. Based on the improved PFFS after postoperative WPRT only in patients with carcinosarcoma and the difference in patterns of failure between histologic subtypes, optimal adjuvant treatment options should be offered to patients based on the risk of recurrence patterns.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.36.1-36.8
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• 2019

Background: This study aims to examine the outcome of simultaneous maxillary sinus lifting, bone grafting, and vertical ridge augmentation through retrospective studies. Methods: From 2005 to 2010, patients with exhibited severe alveolar bone loss received simultaneous sinus lifting, bone grafting, and vertical ridge augmentations were selected. Fifteen patients who visited in Seoul National University Bundang Hospital were analyzed according to clinical records and radiography. Postoperative complications; success and survival rate of implants; complications of prosthesis; implant stability quotient (ISQ); vertical resorption of grafted bone after 1, 2, and 3 years after surgery; and final observation and marginal bone loss were evaluated. Results: The average age of the patients was 54.2 years. Among the 33 implants, six failed to survive and succeed, resulting in an 81.8% survival rate and an 81.8% success rate. Postoperative complications were characterized by eight cases of ecchymosis, four cases of exposure of the titanium mesh or membrane, three cases of periimplantitis, three cases of hematoma, two cases of sinusitis, two cases of fixture fracture, one case of bleeding, one case of numbness, one case of trismus, and one case of fixture loss. Prosthetic complications involved two instances of screw loosening, one case of abutment fracture, and one case of food impaction. Resorption of grafted bone material was 0.23 mm after 1 year, 0.47 mm after 2 years, 0.41 mm after 3 years, and 0.37 mm at the final observation. Loss of marginal bone was 0.12 mm after 1 year, and 0.20 mm at final observation. Conclusions: When sinus lifting, bone grafting, and vertical ridge augmentation were performed simultaneously, postoperative complications increased, and survival rates were lower. For positive long-term prognosis, it is recommended that a sufficient recovery period be needed before implant placement to ensure good bone formation, and implant placement be delayed.

• Journal of Chest Surgery
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• v.33 no.1
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• pp.20-25
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• 2000

Background: Median sternotomy remains the standard approach used by surgeons for most intracardiac operations but the residual scar is cosmetically unsatisfactory. To avoid an unsightly midline scar we have tried to use alternative skin incision (bilateral subm-ammary skin incision) to median sternal skin incision, In this study we have tried to compare different postoperative results of wound between two different skin incisional methods. Material and Method: Between June 1997 and June 1998, a bilateral subma-mmary skin incision combined with vertical sternotomy was performed in 21 pediatric female patients (submammary group)to repair acyanotic congenital heart disease. after the period we carried out a retrograde study about postoperative wound states comparing this incision with median sternal skin incision controls in whom there were 23 pediatric pat-ients (control group). Result: Patients' age ranged from 14 to 96 months(mean 38.2 months) Mean duration of subcutaneous drains using Hemovac which was used only in the patients of submammary group was 4.2 days and total amount of the drained effusion was 51.1 ml. Postoperative wound complications included wound eruption in one patient wound disruption in one patient and skin necrosis in 3 patients in submammary group and included wound disruption in 4 patients in controls. mean duration required for wound healing was 15,5 days in submammary group versus 10.4 days in controls. The mean scar length was 12.5 cm in submammary group versus 11.3 cm in controls. The average follow-up was 8.2 months in submammary group versus 9.0 months in controls. In submammary group 3 patients parents(14.3%) were pleased with their cosmetic results of wound scar but 8(38.1%) were dissatisfied. Among the 23 patients in control group 8(34.8%) were pleased but 8(34.8%) complained ofunhappiness with the scar.

• Journal of Korean Foot and Ankle Society
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• v.24 no.1
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• pp.31-36
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• 2020

Purpose: Leg elevation is known as an effective method for reducing leg swelling, and it has been routinely used in medical practice. However, the effect of swelling reduction in relation to the degree of elevation height is not known. This study evaluated the swelling of the leg after acute ankle fracture operations at two different elevation heights and the elevated leg heights were compared. Materials and Methods: A total of 66 patients with postoperative acute ankle fractures were classified into two groups depending on the presence of different leg elevation heights: high-elevated (HE, case) and low-elevated groups (LE, control). We checked leg swelling, pain, subjective satisfaction for the elevation device, and the American Orthopedic Foot and Ankle Society (AOFAS) score, and we retrospectively compared them between both the groups. Results: Leg swelling and pain were reduced in both groups. However, they did not show any significant differences between both the groups (p>0.05). Nineteen patients in the HE group replied with uncomfortable, while no patients in LE group did so. The AOFAS score at 1 year postoperatively did not show any significant differences between both the groups (p=0.46). Conclusion: High elevation of the leg after ankle fractures did not show a significant difference from low elevation in regard to leg swelling, pain, and function. Furthermore, high leg elevation resulted in discomfort during the postoperative period. Thus, low elevation with a pillow is enough for acute ankle fracture patients with little discomfort and satisfactory swelling reduction.

• Biomedical Science Letters
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• v.10 no.4
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• pp.459-465
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• 2004

The use of hemofiltration has been proposed to reduce excessive body fluid and inflammatory mediators produced during cardiac surgery with cardiopulmonary bypass (CPB) in infants and children. This study was undertaken to evaluate the efficacy of hemofiltration in adult cardiac surgery using (CPB). Twenty adult patients scheduled for elective cardiac surgery were randomly assigned to control group without hemofiltration (n=10) or hemofilter group with hemofiltration during CPB (n=lO). CBC and serum levels of interleukin-6 (IL-6), D-dimer, endothelin-l (ET-1), and cortisol were measured at before the initiation and immediately after the termination of CPB (Pre-CPB and End-CPB, respectively). Clinical data were assessed at postoperative period. In hemofilter group hematocrit was significantly higher (30.04±2.63％ vs 23.30±2.71％, P=0.0014) whereas total leukocyte count was lower than in control group (7.71±1.78×10³/㎣ vs 16.01 ±3.12x10³/㎣, P=0.021) at End-CPB. Increased rate of IL-6 (311.56±97.31％ vs 825.45±102.56％, P=0.012) and D-dimer levels (154.55±89.04％ vs 308.33±157.64％, P=0.026) at End-CPB were significantly less in hemofilter group than in control group. Postoperative blood transfusion in hemofilter group was low compared with that of control group (741.00±38.07 ml vs 1,137.50±169.82 ml, P=0.037). There were no significant differences between two groups in platelet count, ET -1, cortisol, pulmonary index, mechanical ventilation, postoperative blood loss, ICU-stay and hospitalization. Hemofiltration technique applied in the present study provided partly beneficial effect in adult cardiac surgery.

• Archives of Plastic Surgery
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• v.39 no.6
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• pp.631-635
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• 2012

Background The evaluation of a breast after breast reconstruction depends on a surgeon's subjective criteria. We used computed tomography (CT) scans to obtain an objective evaluation of the postoperative results by measuring the breast volume of patients who had undergone breast reconstruction using pedicled transverse rectus abdominis myocutaneous (TRAM) flaps. This research will help in the objective postoperative evaluation of reconstructed breasts, and also in the preoperative flap size designs. Methods A total of 27 patients underwent breast reconstruction using pedicled TRAM flaps after mastectomy from September 2007 to July 2010. Of these, 10 patients who were followed up and underwent CT scans 2 or more times during the follow-up period were included in this study. We evaluated the change in breast volume over time using CT scans, and the interval breast volume change between CT scans. Results All of the 10 patients' reconstructed breasts showed a volume decrease over time. The breast volume changes in the intervals between CT scans were as follows: 5.65% decrease between the first CT and second CT scan, 2.3% decrease between the second CT and third CT scan, (statistically significant) and 1.89% decrease between the third CT and forth CT scan. (not statistically significant). Conclusions This research shows the possibility of objectively evaluating the postoperative breast volume changes. The findings will be helpful in designing the size of TRAM flaps to use on defects after mastectomy. Based on these results, we should also closely observe the reconstructed breast volume for at least 2 years.

• Journal of Korean Neurosurgical Society
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• v.37 no.1
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• pp.8-15
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• 2005

Objective: We evaluate temporal correlations between postoperative symptomatic and electrophysiological improvements, and assessed the recovery time required for patients with carpal tunnel syndrome(CTS) before returning to routine activities. Methods: 30 CTS patients were treated via the endoscopic monoportal approach, from March 2001 to September 2003. We assessed the symptoms (hyperesthesia in the finger tips, or abnormal sensations and painful numbness or night pain) and electrophysiological changes in the preoperative state, 1 month and 6 months after surgery. We marked the times at which patients became able to return to activities of daily living and work, after undergoing endoscopic carpal tunnel release. Results: At the end of the follow-up period, high levels of achievement and good outcomes were observed, with respect to both the symptoms and electrophysiological studies. We discovered significant differences between the preoperative and postoperative periods, especially in terms of motor nerve onset latency from $4.50{\pm}1.43$ to $3.97{\pm}0.69$ and sensory nerve conduction velocity, the wrist-to-finger from $19.81{\pm}10.03$ to $28.18{\pm}11.01$ and wrist-to-palm from $23.34{\pm}13.40$ to $31.79{\pm}13.38$(P<0.05 for each comparison). The average time interval required before return to activities of daily living was 26.4 days, and time interval required before return to work was 48.08 days. Conclusion: Electrophysiological improvements are largely consistent with symptomatic relief, but there is some disparity between electrophysiological and symptomatic improvement.

• Journal of Korean Neurosurgical Society
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• v.60 no.2
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• pp.257-261
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• 2017

Objective : This study was conducted to assess the surgical results of one-stage posterior minimal laminectomy and video-assisted thoracoscopic surgery (VATS) for the treatment of thoracic dumbbell tumor and to describe its precise technique. In addition, we investigated the technique's usefulness and limitations. Methods : Seven cases of thoracic dumbbell tumor (two men and five women, mean age, 43 years) were analyzed retrospectively. Pathological findings included schwannoma in four patients, neurofibroma in two patients, and hemangioma in one patient. The location of tumors varied from T2/3 to T12/L1. Dumbbell tumors were resected by one-stage operation using posterior laminectomy followed by VATS without instrumentation. Clinical data were reviewed. Results : The mean follow-up period was 25 months (range, 3-58 months), and the operative time ranged from 255 to 385 min (mean, 331 min), with estimated blood loss ranging from 110 to 930 mL (mean, 348 mL). The tumor was completely resected without instrumentation and postoperative instability in all cases. Postoperative complications included atelectasis and facial anhydrosis in one case each. Conclusion : One-stage posterior minimal laminectomy and VATS may be a safe and less invasive technique for removal of thoracic dumbbell tumor without instability. This method has the advantage of early ambulation and rapid recovery because it reduces blood loss and postoperative pain.