• Journal of the Korean Arthroscopy Society
• /
• v.17 no.1
• /
• pp.44-49
• /
• 2013

Purpose: To compare of the results between anterior cruciate ligament (ACL) reconstruction alone and combined with high tibial osteotomy for ACL ruptured knees with varus alignment. Materials and Methods: We retrospectively reviewed 8 cases of ACL reconstruction combined with high tibial osteotomy (Group I) and 13 cases of ACL reconstruction alone (Group II) for varus angulated ACL ruptured knees (from March 2005 to February 2007). Mean age were 34.1 years (range: 20-53) in Group I, 34.9 years (range: 21-50) in Group II. Average follow up period were 22.6 months (range: 12-35) in Group I, 20 months (range: 13-33) in Group II. We analyzed clinical and radiological results. Results: There were no significant differences in clinical and radiologic results between two groups for IKDC scores, Lysholm knee scores, Lachman test, pivot shift test, KT-2000 arthrometer, $30^{\circ}$ and $90^{\circ}$ anterior drawer stress radiographs. Tegner activity scales and Cincinnati knee ligament rating scales were 4.9, 57.9 in Group I, and 5.6, 72.9 in Group II. Group I was statistically lower than Group II for Tegner activity scales and Cincinnati knee ligament rating scales (p<0.05). Conclusion: There were no significant differences in daily living between ACL reconstruction alone and combined with high tibial ostetomy for varus angulated ACL ruptured knees. However, ACL reconstruction combined with high tibial osteotomy could limit sport activity ability.

• Journal of Chest Surgery
• /
• v.30 no.4
• /
• pp.413-418
• /
• 1997

From January, 1992 to June, 1996, )7 patients with flail chest were treated at Sonnchunhyang university hospital. 15 patients were managed by internal fixation of fractured ribs, whereas the remaining 22 patients were managed by endotracheal intubation and intermittent positive-pressure ventilation alone. There were no difference between two groups in age, sex, the severity of injury to the chest wall and the nature of associated injuries. Average dur'Btion of assisted ventilation was 5.7 $\pm$ 1.7 days in the patients treated by internal fixation versus 8.7 $\pm$ 3.3 days In the patients treated by continuous me hanical ventilation. Average stay in the intensive care unit was 8.3 $\pm$ 3.9 days for the patients treated by internal fixation, whereas it was $13.2\pm4.1$ days in the group treated by continuous mechanical ventilation alone. In the group treated by internal fixation, complications were 3 atelectases(20.0%), 1 pneumonia(6.7%), 2 operative wound problems(12.3%) and 1 barotrauma(6.7%). In the other group, 7 atelectases(31.8%), 4 pneumonitis(18.2%), 2 empyemas(9.1%) and 3 barotraumas(1).6%). The mortality rate was 13.3%(2/15) in the surgically treated patients, whereas it was 22.7%(5122) in the other group. The treatment of flail chest by internal fixation resulted in speedy recovery, decreased complications and mortalities, and better ultimatc cosmetic and functional results.

• The Korean Journal of Nuclear Medicine
• /
• v.37 no.2
• /
• pp.110-119
• /
• 2003

Purpose: Radioiodine (I-131) therapy is an effective modality to reduce both recurrence and mortality rates in differentiated thyroid cancer. Whether higher doses shows higher therapeutic responses was still debatable. The purpose of this study was to validate curve-fitting (CF) method measuring maximum permissible dose (MPD) by a biological dosimetry using metaphase analysis of peripheral blood lymphocytes. Materials and Methods: Therapeutic effects of MPD was evaluated in 58 patients (49 females and 9 males, mean age $50{\pm}11$ years) of papillary thyroid cancer. Among them 43 patients were treated with ${\Leq}7.4GBq$, while 15 patients with ${\geq}9.25GBq$. The former was defined as low-dose group, and the latter high-dose group. Therapeutic response was defined as complete response when complete disappearance of lesions on follow-up I-131 scan and undetectable serum thyroglobulin levels were found. Statistical comparison between groups were done using chi-square test. P value less than 0.05 was regarded as statistically significant. Results: MPD measured by CF method using tracer and therapeutic doses were $13.3{\pm}1.9\;and\;13.8{\pm}2.1GBq$, respectively (p=0.20). They showed a significant correlation (r=0.8, p<0.0001). Exposed doses to blood measured by CF and biological methods were $1.54{\pm}0.03\;and\;1.78{\pm}0.03Gy$ (p=0.01). They also showed a significant correlation (r=0.86, p=0.01). High-dose group showed a significantly higher rate of complete response (12/15, 80%) as compared to the low-dose group (22/43, 51.2%) (p=0.05). While occurrence of side effects was not different between two groups (40% vs. 30.2%, p=0.46). Conclusion: Measurement of MPD using CF method is reliable, and the high-dose I-131 therapy using MPD gains significantly higher therapeutic effects as compared with low-dose therapy.

• Journal of Chest Surgery
• /
• v.39 no.3 s.260
• /
• pp.184-193
• /
• 2006

Background: Off-pump coronary artery bypass grafting (OPCAB) has been proven to result in less morbidity. The patients who have left ventricular dysfunction may have benefits by avoiding the adverse effects of the cardiopulmonary bypass. The present study compared early and midterm outcomes of off-pump versus on-pump coronary artery bypass grafting (On pump CABG) in patients with severe left ventricular dysfunction. Material and Method: Ninety hundred forth six patients underwent isolated coronary artery bypass grafting by one surgeon between January 2001 and Febrary 2005.. Data were collected in 100 patients who had left ventricular ejection fraction (L VEF) less than $35\%$ (68 OPCAB; 32 On pump CABG). Mean age of patients were 62.9$\pm$9.0 years in OPCAS group and 63.8$\pm$8.0 years in On pump CABG group. We compared the preoperative risk factors and evaluated early and midterm outcomes. Result: In OPCAB and On pump CABG group, mean number of used grafts per patient were 2.75$\pm$0.72, 2.78$\pm$0.55 and mean number of distal anastomoses were 3.00$\pm$0.79, 3.16$\pm$0.72 respectively. There was one perioperative death in OPCAB group ($1.5\%$). The operation time, ventilation time, ICU stay time, CK-MB on the first postoperative day, and occurrence rate of complications were significantly low in OPCAB group. Mean follow-up time was 26.6$\pm$12.8 months (4${\~}$54 months). Mean LVEF of OPCAB and On pump CABG group improved significantly from $27.1\pm4.5\%$ to $40.7\pm13.0\%$ and $26.9\pm5.4\%$ to $33.3\pm13.7\%$. The 4-year actuarial survival rate of OPCAB and On pump CABG group were $92.2\%,\;88.3\%$ and the 4-year freedom rates from cardiac death were $97.7\%,\;96.4\%$ respectively. There were no significant differences between two groups in 4 year freedom rate from cardiac event and angina. Conclusion: OPCAS improves myocardial function and favors early and mid-term outcomes in patients with severe left ventricular dysfunction compared to On pump CABG group. Therefore, OPCAB is a preferable operative strategy even in patients with severe left ventricular dysfunction.

• Journal of Chest Surgery
• /
• v.35 no.6
• /
• pp.420-429
• /
• 2002

Moderate hypothermic cardiopulmonary bypass (CPB) has commonly been used in cardiac surgery. Several cardiac centers recently practice normothermic CPB in cardiac surgery, However, the clinical effect and safety of normothermic CPB on cerebral metabolism are not established and not fully understood. This study was prospectively designed to evaluate the clinical influence of normothermic CPB on brain metabolism and to compare it with that of moderate hypothermic CPB. Material and Method: Thirty-six adult patients scheduled for elective cardiac surgery were randomized to receive normothermic (nasopharyngeal temperature ＞34.5 $^{\circ}C$, n=18) or hypothermic (nasopharyngeal temperature 29~3$0^{\circ}C$, n=18) CPB with nonpulsatile pump. Middle cerebral artery blood flow velocity (VMCA), cerebral arteriovenous oxygen content difference (CAVO$_{2}$), cerebral oxygen extraction (COE), modified cerebral metabolic rate for oxygen (MCMRO$_{2}$), cerebral oxygen transport (TEO$_{2}$), cerebral venous desaturation (oxygen saturation in internal jugular bulb blood$\leq$50 %), and arterial and internal jugular bulb blood gas analysis were measured during six phases of the operation： Pre-CPB (control), CPB-10 min, Rewarm-1 (nasopharyngeal temperature 34 $^{\circ}C$ in the hypothermic group), Rewarm-2 (nasopharyngeal temperature 37 $^{\circ}C$ in the both groups), CPB-off and Post-CPB (skin closure after CPB-off). Postoperaitve neuropsychologic complications were observed in all patients. All variables were compared between the two groups. Result： VMCA at Rewarm-2 was higher in the hypothermic group (153.11$\pm$8.98%) than in the normothermic group (131.18$\pm$6.94%) (p＜0.05). CAVO$_{2}$ (3.47$\pm$0.21 vs 4.28$\pm$0.29 mL/dL, p＜0.05), COE (0.30$\pm$0.02 vs 0.39$\pm$0.02, p＜0.05) and MCMRO$_{2}$ (4.71 $\pm$0.42 vs 5.36$\pm$0.45, p<0.05) at CPB-10 min were lower in the hypothermic group than in the normothermic group. The hypothermic group had higher TEO$_{2}$ than the normothermic group at CPB-10 (1,527.60$\pm$25.84 vs 1,368.74$\pm$20.03, p＜0.05), Rewarm-2 (1,757.50$\pm$32.30 vs 1,478.60$\pm$27.41, p＜0.05) and Post-CPB (1,734.37$\pm$41.45 vs 1,597.68$\pm$27.50, p＜0.05). Internal jugular bulb oxygen tension (40.96$\pm$1.16 vs 34.79$\pm$2.18 mmHg, p＜0.05), saturation (72.63$\pm$2.68 vs 64.76$\pm$2.49 %, p＜0.05) and content (8.08$\pm$0.34 vs 6.78$\pm$0.43 mL/dL, p<0.05) at CPB-10 were higher in the hypothermic group than in the normothermic group. The hypothermic group had less incidence of postoperative neurologic complication (delirium) than the normothermic group (2 vs 4 patients, p＜0.05). Lasting periods of postoperative delirium were shorter in the hypothermic group than in the normothermic group (60 vs 160 hrs, p<0.01). Conclusion: These results indicate that normothermic CPB should not be routinely applied in all cardiac surgery, especially advanced age or the clinical situations that require prolonged operative time. Moderate hypothermic CPB may have beneficial influences relatively on brain metabolism and postoperative neuropsychologic outcomes when compared with normothermic CPB.