• Journal of Chest Surgery
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• v.20 no.1
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• pp.106-111
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• 1987

Twenty eight patients with atrial septal defect operated on from May, 1983, to July, 1986 at the Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, were analyzed retrospectively. Among the 28 patients of atrial septal defect, 8 were male and 20 were female. Their ages ranged from 4.6 years to 52.5 years old with the mean of 15.3 years. The main clinical symptoms on admission were exertional dyspnea [82%], frequent respiratory infection [75%], palpitation [54%] and easy fatigability [25%]. Electrocardiographic findings were as follows: Regular sinus rhythm [100%], RVH [54%], RBBB [25%] and first degree of A-V block [4%]. Hemodynamic studies were performed in all cases and mean pulmonary systolic arterial pressure was 34.1*11.8mmHg. and mean Qp/Qs was 2.6*0.9. All 28 patients were operated under direct vision using extracorporeal circulation. 23 cases were secundum type defect and a single hole was found in 22 cases. The associated cardiovascular anomalies were found in 11 patients: ventricular septal defect in 3, patent ductus arteriosus in 1, partial anomalous pulmonary venous drainage in 2, mitral regurgitation in 2, tricuspid regurgitation in 1, anomalous left atrial septation in 1 and valvular pulmonary stenosis in 1. The defect closed directly in 22 cases and with patches in 6 cases. Postoperative complications were wound infection, arrhythmia bleeding, intracardiac patch detachment, pneumothorax and urethral injury. But there was no operative mortality.

• Journal of Chest Surgery
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• v.26 no.8
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• pp.613-619
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• 1993

As developing surgical techniques and postoperative cares, a pneumonectomy is a relatively popular surgical method in disease which is not treated completely with other type of pulmonary resection, but a postpneumonectomy complication is a life-threatening serious problem if it occurred. We performed one hundred twenty-five cases of pneumonectomy for treatment of various causes of pulmonary diseases in Kosin Medical College during about ten years, and we experienced 41 cases of postoperative complications in 29 patients, so we analyzed them. The most common complication is an empyema thoracis in 13 cases[10.4%], of which one case combined with bronchopleural fistula died on early postoperative day. Of them except one case, the early postoperative empyema thoracis[within 30 days] were 6 cases, and the late postoperative empyema thoracis[above 30 days] were 6 cases. The main etiologic pathogens were a staphylococcus in early postoperative empyema and a streptococcus in late postoperative empyema, but the most cases were mixed infections with pseudomonas, klebsiella, acinectobacter, and candida. The treatment of postoperative empyema thoracis were that 4 cases were treated with open drainage using chest tube, 7 cases with Clagett`s operation, and 1 case with thoracoplasty. The next common complication was a postoperative serious respiratory insufficiency in 7 cases. And the other complications were massive postoperative bleeding in 5 cases, of which 2 cases advanced to occurrence of postoperative empyema thoracis, and wound disruption in 4 cases, cardiac arrhythmia in 3 cases, contralateral pneumothorax and pneumonia in each of 2 cases, esophagopleural fistula in 1 case. The postoperative deaths were 9 cases[7.2%] of 125 cases, the causes of death were respiratory insufficiency in 6 cases, sepsis in 2 cases, and cardiac arrhythmia in 1 case.

• Journal of Chest Surgery
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• v.28 no.1
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• pp.42-46
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• 1995

Vertical axillary muscle sparing thoracotomy is newly appeared and excellent alternative method of standard posterolateral thoracotomy.It has many advantages compared to standard posterolateral thoracotomy , less postoperative pain, well preserved thoracic muscle strength, full range of motion of the shoulder girdle and attractive cosmetic results. We performed vertical axillary muscle sparing thoracotomy in 36 patients from November 1993 to July 1994. The ages of the patients ranged from 6 months to 71 years[mean 45.1 years , and the patients consisted of 20 males and 16 females.The preoperative diagnosis were as follows : lung cancer in 17 patients, tbc destroyed lung in 7, bronchiectasis in 3, bullous emphysema in 3 and the others are mediastinal tumor, bronchogenic cyst, lung abscess, empyema, esophageal diverticulum, and CCAM [congenital cystic adenomatoid malformation . The operative procedures were as follows : lobectomy and bilobectomy in 16 patients, segmentectomy in 4, wedge resection in 3, penumonectomy in 7, and the others were open biopsy, lobectomy with diaphragm excision, sleeve right upper lobectomy, decortication, mediastinal mass excision, and esophageal diverticulectomy. We had 6 complications : postoperative bleeding in 2 cases, operative wound infection, arrrhythmia[atrial fibrillation , Horner`s syndrome, hoarseness. The subcutaneous seroma occurred in 4 cases but did not require drainage and relieved within 4 weeks spontaneously. We concluded that vertical axillary muscle sparing thoracotomy could be done in most of all thoracic surgery with safety. Comparing to standard posterolateral thoracotomy vertical axillary muscle sparing thoracotomy has many advantages such as less postoperative pain, well preserved muscle strengths and good cosmetic results.

• Research in Community and Public Health Nursing
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• v.18 no.1
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• pp.165-176
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• 2007

Purpose: The purpose of this study was to investigate the needs of home care nursing services in relation to the patients in hospital. Method: Subjects were 129 patients who admitted hospital and were selected through convenience sampling. Data were collected using the Home Health Care Need Assessment Questionnaire constructed by the Korea Health Industry Development Institute. Data were analyzed using SAS 8.12 program by applying percentage. Results: 1. According to the diagnosis of the subjects, the majority had cancer (25.0%), followed by musculoskeletal disease (15,6%), neuro/cerebral vascular disease (14.1%), digestive (10.9%) and respiratory disease (10.9%). 2. With regard to fundamental nursing service, subjects wanted to receive home care services for the following reasons: Problem identification and diagnosis (77.5%), vital sign check (49.6%); and intake and output measure (20.9%). 3. With regard to clinical laboratory tests, 62.8% wanted to receive blood tests, and followed by urine tests 26.4%, and wound drainage 26.4%. 4. With regard to medication and treatment service, 40.3% of the subjects wanted to receive intravenous fluid therapy, 26.4% intravenous antibiotics, and 26.4% the monitoring of fluid therapy. 5. With regard to therapeutic nursing service, 33.3% wanted to receive wound care, 26.4% ROM exercise, and 27.9% foley catheter change and care. 6. With regard to educational needs, 42.6% wanted education on infection monitoring, 41.4% on medication, and 34.9% on diet. 7. With regard to counseling needs, 65.9% wanted to receive telephone counseling about patient condition, 52.7% counseling about re-admission and 51.9% direct counseling about patient condition. In the group of injury and toxicity, and cardiovascular/circulatory diseases, 100% wanted telephone and direct counseling about the patient condition. Conclusion: Therefore, in order to improve the quality of hospital based home health care services, various factors that affect to the need of home health care should be analyzed and specified nursing care should be looked into.

• Archives of Plastic Surgery
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• v.36 no.4
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• pp.432-436
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• 2009

Purpose: Negative pressure therapy has been used in various conditions to promote wound healing. It has also been used to secure a skin graft by improving microcirculation and improving tight adhesion between the graft and the recipient bed. To reduce post burn scar contracture and improve aesthetical result, many types of dermal substitutes have been invented and used widely. The goal of this study was evaluate usefulness of the VAC (Kinetic concepts Inc., San Antonio, TX) in improving the take rate and time to incorporation of Integra$^{(R)}$ in reconstruction of burn scar contracture. Methods: A retrospective study was performed from October, 2006 to December, 2008. The VAC was utilized for 11 patients. The average patient's age was 19.7 years (range 5 - 27) and average surface area was $785cm^2$ (range 24 - 1600). The burn scars were excised deep into normal subcutaneous tissue to achieve complete release of the scar, Integra$^{(R)}$ was sutured in place with skin staple와 Steri - strip$^{(R)}$. Then slit incisions were made on silicone sheet only with No.11 blade for effective drainage. The VAC was used as a bolster dressing over Integra$^{(R)}$. Negative - Pressure ranging from 100 to 125 mm Hg was applied to black polyurethane foam sponge trimmed to the appropriate wound size. An occlusive seal over the black polyurethane foam sponge was maintained by a combination of the occlusive dressing, OP - site$^{(R)}$. The VAC dressing changes were performed every 3 or 4 days until adequate incorporation was obtained. The neodermis appeared slightly yellow to orange color. When the Integra$^{(R)}$ deemed clinically incorporated, The VAC was removed and take was estimated with visual inspection. Very thin STSG(0.006 ~ 0.008 inches) was performed after silicone sheet removal. Result: The mean time for clinically assessed incorporation of Integra$^{(R)}$ was 10.00 days (range 9 - 12). The mean dressing change was 3.5 times until take was obtained. In All patients, Integra$^{(R)}$ had successful incorporation in tissue without serious complications. Conclusion: Integra$^{(R)}$ in combination with Vacuum - Assisted Closure(VAC) may be incorporated earlier than conventional dressing method.

• Journal of Veterinary Clinics
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• v.32 no.3
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• pp.268-271
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• 2015

About 2-year old northern goshawk (Accipiter gentilis) which is designated as natural monument (#323-1) in Republic of Korea was rescued by a local farmer and presented with a 2-weeks history of pain, swelling, stiffness and limping. On physical examination, plantar pododermatitis and digit IV weakness were observed. Radiographic findings also showed bone lyses with soft tissue swelling in the foot. A definite diagnosis was made as stage III bumble foot after multidisciplinary approach of the patient. Bacterial culture was performed, and concurrently antibiotic susceptibility testing is determined using wound site exudates specimen. Bacterial isolates were identified as Staphylococcus aureus, known normal skin flora. Treatment was initiated with surgical incision and necrotized tissues removal. Lavage-drainage and ball bandage were applied with topical mupirocin ointment application. Doughnut shaped pad was attached on bottom of the ball bandage to reduce weight bearing. After three weeks of intensive care, the wound site completely healed but digit IV weakness remained permanently. The goshawk returned to nature after eight weeks after treatment.

• Archives of Plastic Surgery
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• v.34 no.5
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• pp.611-616
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• 2007

Purpose: The latissimus dorsi muscle flap is a versatile flap used in a variety of reconstructive procedures. The most common complication of LD muscle flap is donor site seroma, reported to occur in 20 to 79 percent of cases. The formation of dead space under the flap is intimately associated with seroma formation. The authors think that the use of progressive tension suture at closing donor site can decrease the formation of dead space and ultimately reduce the incidence of donor site seroma. Methods: A retrospective review was performed with 38 patients who underwent latissimus dorsi muscle harvest for breast reconstruction from March 2003 to September 2004. Progressive tension sutures were used during donor site closure in 22 patients. This group was compared with controls group(16 patients) who underwent latissimus dorsi muscle harvest without using this technique. Operation time, length of hospital stay, period of drainage, complication, and satisfaction about postoperative scar of donor site were examined. Results: The average length of hospital stay was 10.2 days and 12.7 days, and the mean duration of drainage were 7.3 days and 11.7 days in each progressive suture group and control group. These results were statistically significant (p<0.05). In the 22 patients who underwent progressive tension suture, none had seroma, hematoma or skin necrosis. In control group(16 patients), there happened one seroma formation and one partial skin necrosis. These complications were healed by aspiration of seroma and wound revision. The patients' satisfaction was not statistically significant, but the higher points were given by the patients who underwent progressive tension suture. Conclusion: This technique, progressive tension suture, is an effective method to reduce or eliminate donor site seroma, which is the most common complication associated with latissimus dorsi muscle harvest.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.1
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• pp.85-92
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• 2000

Common dental procedures(dental extraction & minor operation) are potentially stress-inducing in many patients, especially medically compromised patients. The body's response to dental stress involves the cardiovascular system(an increase in cardiovascular workload), the respiratory organ and the endocrine system(change in metabolism). To minimize the stress to the medical risk patient, the stress reduction protocol was established. The obtained contents were as follows: (1) Recognize the patient's degree of medical risk (2) Complete medical consultation before dental therapy (3) Schedule the patient's appointment in the morning (4) Monitor and record preoperative and postoperative vital signs (5) Use psychosedation during therapy (6) Use adequate pain control during therapy (7) Short length of appointment : do not exceed the patient's limits of tolerance (8) Follow up with postoperative pain/anxiety control (9) Telephone the higher medical risk patient later on the same day that treatment was given Though the stress reduction protocol above was applied to the dental extraction in medically compromised patients with the advanced infected teeth, the final responsibility for the complications(syncope, bleeding & infection, etc.) in a patient rests with the dentist who ultimately treats him. For the prevention of postextraction complications & poor prognosis, the authors treated the advanced infected teeth with the pulp extirpation, opening drainage through the canal and complete occlusal reduction. The final extraction and wound closure were then done after $1{\sim}2$ weeks. The final prognosis was comfortable without common complications.

• Archives of Plastic Surgery
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• v.37 no.2
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• pp.182-186
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• 2010

Purpose: Intramuscular stimulation (IMS) shows good results in the treatment of chronic pain patients who did not respond to other treatments such as oral analgesics, trigger point injection, nerve block and epidural steroid injection. But, IMS procedure especially, patients with diabetes mellitus (DM) has sometimes serious problem. So, we present a very rare case of intramuscular abscess in the sternocleiomastoid muscle after IMS with literature review. Methods: A 66 year old male visited our department 7 days after IMS in the neck. His premorbid conditions and risk factors of deep neck infection was DM and old age. Computed tomographic scans of the head and neck region were performed in this patient: signs of deep neck infection, were seen enhanced abscess in the sternocleidomastoid muscle, cellulitis overlying tissue of the neck, and air bubbles involved muscle. Necrotic wound was excised serially and we treated this with the Vacuum-assisted closure (VAC, Kinetics Concepts International, San Antonio, Texas) system device. After appropriately shaping the sponge in the pockets, continuous negative pressure of 125 mmHg was applied. The VAC therapy was utilized for a period of 12 days. Results: We obtained satisfactory results from wide excision, drainage of the abscess with the VAC system, and then primary closure. The postoperative course was uneventful. Results: We suggest that many of the infectious complications may be preventable by strict adherence to aseptic techniques and that some of the other complications may be minimized by refining the techniques with a clear understanding of the medical disorders of patients. And, the refined technique using the VAC system can provide a means of simple and effective management for the cervical intramuscular abscess, with better cosmetic and functional results.

• Journal of Chest Surgery
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• v.18 no.1
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• pp.111-121
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• 1985

A clinical analysis was performed on 312 cases of the chest trauma experienced at department of thoracic surgery, Chosun University Hospital during the past 6 years 10 months period from January 1978 to October 1984. 1. The ratio of male to female patient of the chest trauma was 3.1:1 in male predominance and age from 20 to 50 occupied 71.2% of the total cases. 2. The most common cause of the chest trauma was traffic accidents [45.5%] in this series. 244 cases [78.2%]were injured due to non-penetrating injuries and the remainders [68 cases, 21.8%] were injured due to penetrating injuries. 3. The frequently injured site of the chest trauma was left side of the chest [56.4%], the right side was 33% and the both side was 10.6%. 4. The most common symptoms were chest pain and dyspnea, and common signs were diminished breathing sound and subcutaneous emphysema. 5. The Hemothorax, Pneumothorax, Hemopneumothorax, and Hemopericardium were observed in 190 cases [60.9%] of the total cases, and etiologic distribution revealed 76.5% due to penetrating injuries and 56.6% due to non-penetrating injuries. 6. The rib fractures were observed in 210 cases [67.3%] of the total cases and the most common site of the rib fracture was 6th rib 140 cases [19.2%]. The common site of the rib fracture was from 4th rib to 7th rib [63.8%]. 7. The lung injuries were observed in 150 cases [48.1%] and the other organ injuries were observed in 260 cases [83.3%]. 8. Conservative treatment including thoracentesis were performed in 153 cases [49.1%], Closed thoracotomy with water seal drainage were performed in 112 cases [35.9%], and open thoracotomy were performed in 45 cases [14.4%]. 9. The complications of the chest trauma were developed in 63 cases [20.2%] and the common complications were atelectasis, wound infection and pneumonitis etc. 10. Overall mortality was 0.96% [3 cases] and the cause of death was bacteremia, hypovolemic shock, heart failure and pulmonary edema.