• Journal of the Korean Arthroscopy Society
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• v.17 no.1
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• pp.24-30
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• 2013

Purpose: To evaluate the outcome of arthroscopic posterior cruciate ligament (PCL) augmentation using an autogenous hamstring tendon graft and the posterior-posterior triangulation technique with preservation of ligament remnant or elongated ligament. Materials and Methods: From January 2002 to December 2009, we performed PCL augmentation using an autogenous hamstring tendon graft and the posterior-posterior triangulation technique in 32 patients. The mean age was 35.2 years. Twenty two cases were male and 10 cases were female. Average follow-up period was 5 years and 5 months (range: 2-7.9). Subjective and objective parameters were utilized in analyses, such as the mean range of motion, post. drawer test, Lysholm knee score, Tegner activity score, International Knee Documentation Cominittee (IKDC) grade, and second look arthroscopic examination. Results: At last follow up posterior displacement by the Telos stress test decreased from $10.8{\pm}5.1\;mm$ to $2.8{\pm}3.7\;mm$ (p<0.05). The final Lysholm knee score improved from $60.4{\pm}5.8$ to $84.6{\pm}4.8$. Tegner activity score improved from 3.2 to 4.8. The final IKDC grade was A in 18, B in 11, C in 3. Postoperative Lysholm knee score, IKDC grades, Tegner activity scale, and posterior displacement demonstrated statistically significant improvement compared to the preoperative state (p<0.05). Conclusion: Arthroscopic PCL reconstruction using an autogenous hamstring tendon with preservation of ligament remnant showed a good clinical results and posterior stability.

• Journal of Chest Surgery
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• v.29 no.10
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• pp.1095-1101
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• 1996

From July 1983 to June 1995, 95 consecutive patients with mitral stenosis were treated surgically in the Department of Thoracic and Cardiovascular Surgery, Chonbuk national University Hospital, mitral valve replacement(MVR) in 62 patients and open mitral commissurotomy(OMC) in 33 patients. Mitral stenosis combined with coronary artery disease, with aortic valve disease, or wish mitral valvular Insufficiency, were excluded from this study. Surgical procedures for mitral stenosis were evaluated, according to complication, reoperation, mor- tality, nd functional change at mid- and long-term postoperative period. Cardiothoracic ratio in the MVR group was greater than the OMC group(0.59 $\pm$0.07 in MVR, 0.53 $\pm$0. 07 in OMC, p<0.05), but other variables(age, sex, MYHA functional classification, EKG finding, echocardiographic finding) did not show significant difference between two groups in the preoperative periods. Even though pathologic valvular lesion(Sellor's pathologic type m: 35 in MVR, 13 in OMC) and valvular calcification(35 in MVR, 11 in OMC) were severe in the MVR group(p=0.001) at intraoperative observation, OMC was possible in 11 patients(23.9%) among 46 patients with valvular calcification and in 13 patients(27.1 %) among 61 patients with Sellor's pathologic type IH . There was no significant difference in early and late mortality, actuarial survival(75% in MVR, 87.6% in OMC at 12 year), but early and late hemorrhagic, thromboembolic complications in the MVR group were greater than in the OMC. Functional changes in NYHA functional classification, EKG lEnding, cardiothoraclc ratio, and echocardiographic finding(EF, LVIDS, LWDd, LAD) did not differ between two groups in mid- and long-term postoperative periods. We conclude that our efforts for preservation of the native valve would be continued, because hemorrhagic and thromboembolic complications in the MVR were greater than in the OMC, and OMC was possible even in patients with severely stenotic and calcified mitral valve, although there was no sis-nificant difference in the functional change, mortality, and survival between the M VR and OMC.

• Journal of Gastric Cancer
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• v.10 no.1
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• pp.19-25
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• 2010

Purpose: Laparoscopy-assisted gastrectomy (LAG) is gaining wider acceptance as a minimally invasive treatment for early gastric cancer, but the safety, efficacy and clinical benefits of this type of surgery are still unclear. The purpose of this study is to compare laparoscopy-assisted gastrectomy (LADG) and conventional open distal gastrectomy (CODG) for early gastric cancer (EGC) according to the changes of the postoperative nutritional status and acute inflammatory reaction. Materials and Methods: Eighty seven patients with EGC and who underwent a LADG between March 2006 and May 2009 at Daegu Catholic University Hospital, was enrolled. Over the same period, we enrolled 30 patients who underwent CODG and they were confirmed to have EGC from their pathology. The clinico-pathological features and serologic parameters were evaluated from the medical records and then retrospectively analyzed. Results: There were no differences in the preoperative white blood cell (WBC), C-reactive protein (CRP) level, albumin level, the T4/T8 ratio and the other clinical data between the two groups. The total WBC counts gradually increased and they were significant lower at the $1^{st}$ and $3^{rd}$ postoperative days in the LADG group than that in the CODG group (P=0.001 and 0.008, respectively). The postoperative CRP levels were significantly lower at postoperative $5^{th}$ day in the LADG group (P<0.001). The postoperative albumin and T4/T8 ratio gradually decreased, and the T4/T8 ratio was significantly higher at the $3^{rd}$ postoperative day in the LADG group compared to that in the CODG group (P=0.003). Conclusion: This study demonstrates that the LADG has less of an influence on an acute inflammatory reaction than does CODG. Therefore, it is one of the safe and feasible procedures for the treatment of early gastric cancer.

• Journal of Gastric Cancer
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• v.8 no.1
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• pp.35-39
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• 2008

Purpose: This study was aimed to evaluate the efficacy and safety of of intravenous iron sucrose ($Venoferrum^{(R)}$) for treating the perioperative anemic gastrectomy patients. Materials and Methods: From September 2006 to February 2007 at Seoul National University Hospital, the gastrectomy patients who displayed perioperative anemia (7.0 g/dl $\leq$ hemoglobin levels (Hb) < 11.0 g/dl) and who were admitted or visited the outpatient clinic of the Department of surgery, were divided into two groups. The preoperative (${\leq}\;2{\sim}3$ weeks before gastrectomy) or postoperative ($\geq$ 1 month after gastrectomy) patients without evidence of acute bleeding were included into Group 1. The immediate postoperative (< 1 month after gastrectomy) patients with stable vital signs were included into Group 2. The age, gender, diagnosis, Hb, hematocrit (Hct), mean corpuscular volume (MCV), serum ferritin (SF), total iron binding capacity (TIBC), serum iron and reticulocyte counts (RC) were evaluated before and after intravenous iron sucrose administration. The adverse effects of drugs were investigated. Results: The number of patients of group 1 and group 2 was 79 and 46, respectively. In group 1, there was a statistically significant difference in the Hb, Hct, MCV, SF, RC and TIBC with each mean change of 1.3 g/dl, 4.1%, 3.1ft, 195 ng/ml, 0.2% and -86.4 ug/dl, respectively. In group 2, there was a statistically significant difference in the Hb, Hct, MCV, SF and RC with each mean change of 1.8 g/dl, 6.1%, 3.4fl, 260 ng/ml and 0.3%, respectively. Two patients (1.6%) suffered local thrombophlebitis as an adverse effect. Conclusion: Intravenous iron sucrose for the perioperative anemia of gastrectomy patients was efficacious in the short period without significant adverse effects.

• The Journal of the Korean bone and joint tumor society
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• v.9 no.2
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• pp.131-138
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• 2003

Purpose: We analyzed our malignant peripheral nerve sheath tumor (MPNST) cases to find out their oncologic results following by each treatment modalities. Materials and Methods: Thirty four patients with MPNST were registered in Korea Cancer Center Hospital from Feb. 1986 to Nov. 1996. Seventeen cases were male and 17, female. Average age was 41 years (range 18 to 74). Location of the tumor was as follows; 17 in lower extremity, 11 upper extremity, 4 trunk, and 2 retroperitoneum. Following the AJC classification, stage IA were 2 cases, stage IIA 2, stage IIB 6, stage III 16 and stage IV 8. Twenty six patients took operations and adjuvant chemotherapy and/or radiation therapy, 3 operation only and 3 adjuvant chemotherapy or radiation therapy. Average follow up period was 33.5 months (5.6 to 146.1). Kaplan-Meiyer method was done for survival curve, and log rank test for comparison analysis. Results: Fourteen cases were continuous disease free, 2 no evidence of disease, 2 alive with disease and 14 dead of disease states at final follow up. Actual 5-year and 10-year survival rates were 53.5%, 35.7%. Local recurrence rate after operation was 24.1%. 5-year survival rates of stage I/II/III were 100/85.7/55.9% and 2-year survival rate of stage IV was 14.3% (p=0.04). In 21 cases operated with stage II-III, wide margin (15cases) had 76.0% 5-year survival rate, and marginal or intralesional marigin (6cases) had 40.0%. The actual 5-year survival rate of the group which were done 4 or more cycles chemotherapy (8cases) was 71.4% and the actual 3-year survival rate less than 4cycles chemotherapy (6cases) was 83.3% (p=0.96). In 19 cases operated with stage II-III and which had no radiotherapy, marginal or intralesional margin (5cases) had 3 cases of local recurrences (60.0%), though wide margin (14cases) had 4 cases recurrences (28.6%). There was no local recurrence in 8cases which had pre-or post-operative radiotherapy. Conclusions: Surgical margin is an important factor in local recurrence. Resection margin has a tendency to influence the survival despite insufficient statistical significance. Conventional chemotherapy has no defnite statistical sigficance in the effect on local control and survival. Preoperative and postoperative radiotherapy has some positive effect on local control.

• Journal of Chest Surgery
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• v.35 no.5
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• pp.350-355
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• 2002

Background: Most of pulmonary regurgitation with or without stenosis appears to be well tolerated early after the repair of pulmonary outflow tract. However, it may result in symptomatic right ventricular dilatation, dysfunction and arrhythmias over a long period of time. We studied the early outcome of pulmonary valve replacement with tissue valves for patients with the above clinical features. Material and Method: Sixteen consecutive patients who underwent pulmonary valve replacement from September 1999 to February 2002 were reviewed(9 males and 7 females). The initial diagnoses included tetralogy of Fallot(n=11), and other congenital heart anomalies with pulmonary outflow obstruction(n=5). Carpentier-Edwards PERIMOUNT Pericardial Bioprostheses and Hancock porcine valves were used. The posterior two thirds of the bioprosthetic rim was placed on the native pulmonary valve annulus and the anterior one third was covered with a bovine pericardial patch. Preoperative pulmonary regurgitation was greater than moderate degree in 13 patients. Three patients had severe pulmonary stenosis. Tricuspid regurgitation was present in 12 patients. Result: Follow-up was complete with a mean duration of 15.8 $\pm$ 8.5months. There was no operative mortality. Cardiothoracic ratio was decreased from 66.0 $\pm$ 6.5% to 57.6 $\pm$ 4.5%(n=16, p=0.001). All patients remained in NYHA class I at the most recent follow-up (n=16, p=0.016). Pulmonary regurgitation was mild or absent in all patients. Tricuspid regurgitation was less than trivial in all patients. Conclusion: In this study we demonstrated that early pulmonary valve replacement for the residual pulmonary regurgitation with or without right ventricular dysfunction was a reasonal option. This technique led to reduce the heart size, decrease pulmonary regurgitation and tricuspid regurgitation as well as to improve the patients'functional status. However, a long term outcome should be cautiously investigated.

• Journal of Chest Surgery
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• v.37 no.10
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• pp.833-838
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• 2004

Background: Despite the excellent early results after the repair of congenital bicuspid aortic valve (BAV) disease, the mid-term durability of the repaired valve has still controversies. Material and Method: To evaluate the mid-term results of BAV repair, retrospective review of medical records and echocardiographic data were done. Between 1994 and 2003, twenty-two patients underwent reparative procedure for either regurgitant or stenotic congenital bicuspid aortic valve (BAV). Result: Mean age was $41\pm14$ years with male predominance (Male=17, Female=5). The pathophysiologies of the BAV were regurgitation-dominant in 20 (91%) and stenosis-dominant in 2 (9%) cases. Various repair techniques were used for raphe, prolapsed leaflet, thickened leaflet, and commissures; 1) release of raphe in 19 (86%), 2) wedge resection and primary repair in 11 (50%), pericardial patch reinforcement after plication of the leaflet in 6 (27%), and plication of the leaflet in 3 (14%), 3) slicing of thickened leaflet was used in 12 (55%) cases, 4) commissuroplasty in 8 (36%), and commissurotomy in 6 (27%) cases. There was no in-hospital mortality. During the mean follow-up of $38\pm17$ months, one patient underwent aortic valve replacement after developing acute severe regurgitation from dehiscence of the suture on postoperative 2 months. New York Heart Association functional class was improved from $1.9\pm0.6$ to $1.2\pm0.5$ (p<0.01). Left ventricular end-systolic and diastolic dimension (LVESD/LVEDD) were also improved from $45\pm9$ and $67\pm10$ to $37\pm10$ and $56\pm10,$ respectively (p<0.01). The grade of aortic regurgitation (AR) was improved from preoperative $(3.1\pm1.2)$ to post-bypass $(0.9\pm0.7).$ However, the grade at last follow-up $(1.7\pm1.1)$ was deteriorated during the follow-up period (p<0.01). Freedom from grade III and more AR at one, three, and four year were 89.7%, 89.7%, and 39.9% respectively. Conclusion: Midterm clinical result of the BAV repair was favorable. But, the durability of the repaired valve was not satisfactory.

• Journal of Chest Surgery
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• v.39 no.6 s.263
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• pp.449-455
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• 2006

Background: Female sex was known to be a risk factor for mortality after coronary bypass grafting (CABG), and women showed higher in-hospital mortality than men. Material and Method: Between 1992 and 1996, 147 consecutive patients (98 men and 49 women) undergoing CABG were included in the study. Most patients had undergone CABG with left internal thoracic artery and saphenous vein under cardiopulmonary bypass. We examined the influence of gender on survival after CABG and looked for risk factors for survival. Result: There was no in-hospital mortality in women, but 3 death (3.0%) in men. During the mean follow-up period of $138.5{\pm}23.0$ months, mortality was lower in women than in men (20.4% vs 44.9%, p=0.004), and the most common cause of death in women was chronic renal failure (40%). Survival in women at 1, 5, 10, and f4 years was 100%, $98.0{\pm}2.0%,\;81.2{\pm}5.6%,\;and\;78.4{\pm}6.1%$, respectively, which was better than in men (p=0.004). Although preoperative left ventricular ejection fraction was higher in women than in men, this did not affect early and long-term survival difference between two sexes (p=0.15). Risk factor for long-term survival in women was diabetes (p=0.033) and in men number of diseased coronary artery (p=0.006). Conclusion: Long-term survival after CABG was better in women than men. Risk factor for long-term survival in women was morbid disease rather than cardiac disease.

• Journal of Chest Surgery
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• v.33 no.7
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• pp.547-551
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• 2000

Background; The purpose of this study was to analyze the early and midterm results of Cabrol technique to assist in making future decisions on a more adequate technique for repairing aortic root diseases. Material and Method; From August 1993 to July 1999, we performed Cabrol technique in 18 patients ; 12 annuloaortic ectasia, 6 Stanford type A aortic dissection. Male and female ratio was 11;7, mean age was 46.9$\pm$12.3 years and mean follow up period was 22.5$\pm$21.5 months. We analysed the factors influencing postoperative complications and early mortality. The factors were old age(>60 years), high NYHA(>III), preoporative concomitant disease, urgency of operation, concomitant procedure, long pump preoperative concomitant disease, urgency of operation, concomitant procedure, long pump time(>200 minute), and hospital stay time (>30 days). Result; Operative mortality was 11.1%, late mortality was 11.1%, and overall mortality was 22.2%. The causes of operative death were a heart failure and an arrhythmia. The causes of late death were an acute myocardial infarction and an unknown etiology. Postoperative complications were bleeding, wound infection, toxic hepatitis, acute renal failure, and cerebral infarction. The factors influencing postoperative complications were hihg MYHA Fc(>III) (p=0.044), concomitant disease (p=0.044), long pump time(>200 minute)(p=0.015), and concomitant procedure(p=0.004). There were no significant factors influencing early mortality. Conclusion; The lower postoperative bleeding rate and no complication related to tension of anastomosis after Cabrol technique warrant its consideration in patients requiring aortic root replacement, especially without feasible mobilization of coronary arteries. However, to confirm the graft thrombosis, a more detailed study including periodic angiography will be required.

• Journal of Chest Surgery
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• v.40 no.5 s.274
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• pp.341-350
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• 2007

Background: We present here the early and midterm surgical results for infective endocarditis and we especially focus on the effect of aggressive reconstruction or root implantation after wide debridement. Material and Method: Between January 1995 and Jun 2006, we enrolled 79 adult infective endocarditis patients who underwent surgical treatment. There were 63 and 16 native and prosthetic valve endocarditis cases, respectively. They included 27 cases of culture negative endocarditis. With performing valve replacement or repair, 28 of the patient underwent a more aggressive surgical option, for example, aortic root replacement or reconstruction, or heart base reconstruction etc. Result: There were statistical relationships between the in-hospital mortality and staphylococcal infection, urgent-based operation and operation during the active phase of endocarditis. Wide debridement and aggressive reconstruction were not related to either the post operative mortality or the early morbidity. Culture negative endocarditis was not related to the postoperative mortality and morbidity. Conclusion: Physicians must pay attention to patients' medical treatment during the preoperative period of the infective endocarditis. If surgery is considered for treating infective endocarditis, it should be performed before the downhill course of the disease so that the surgical outcome is improved. Wide debridement and more aggressive reconstruction are also warranted.