• Journal of Chest Surgery
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• v.31 no.7
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• pp.692-696
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• 1998

For the management of a secondary spontaneous pneumothorax, videothoracoscopic surgery may offer the potential therapeutic benefits of a minimally invasive approach. We report on a series of 36 patients(33 men and 3 women) with a mean age of 56.3 years(range, 31 to 80 years) who underwent thoracoscopic surgical procedures for the treatment of secondary spontaneous pneumothorax. Twenty-one patients had emphysema and 20 patients had old pulmonary tuberculosis. Nineteen patients presented a persistent severe air leak more than 3 days preoperatively and 15 patients had more than one recurrence. Bullectomy or exclusion of the lesion was performed in 33 patients. Mechanical pleurodesis was performed in the entire patients, talc was sprayed in 22 and vibramycin in 14. Mild pleural adhesion at the upper lobe was shown in 10 patients and severe pleural adhesion in 7 patients. One patient with persistent air leak died of persistent air leak and respiratory failure. The mean postoperative stay was 7.0 days(range, 2 to 17 days). At a mean follow-up of 15.8 months (range, 5 to 45 months), no pneumothorax had recurred. In comparison with the result of the treatment for 112 patients with primary spontaneous pneumothorax, the operating time was not significantly longer and there were no more primary treatment failures, but the duration of postoperative chest drainage and hospital stay was longer. Videothoracoscopic surgery has proved to be an effective treatment for secondary spontaneous pneumothorax in elderly patients who represent high-risk candidates for thoracotomy.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.2
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• pp.707-712
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• 2014

Purpose: Anastomotic leakage (AL) is associated with high morbidity and mortality, high reoperation rates, and increased hospital length of stay. Here we investigated the risk factors for AL after anterior resection for rectal cancer with a double stapling technique. Patients and Methods: Data for 460 patients who underwent primary anterior resection with a double stapling technique for rectal carcinoma at a single institution from 2003 to 2007 were prospectively collected. All patients experienced a total mesorectal excision (TME) operation. Clinical AL was defined as the presence of leakage signs and confirmed by diagnostic work-up according to ICD-9 codes 997.4, 567.22 (abdominopelvic abscess), and 569.81 (fistula of the intestine). Univariate and logistic regression analyses of 20 variables were undertaken to determine risk factors for AL. Survival was analysed using the Cox regression method. Results: AL was noted in 35 (7.6%) of 460 patients with rectal cancer. :Median age of the patients was 65 (50-74) and 161 (35%) were male. The diagnosis of AL was made between the 6th and 12th postoperative day (POD; mean 8th POD). After univariate and multivariate analysis, age (p=0.004), gender (p=0.007), tumor site (p<0.001), preoperative body mass index (EMI) (p<0.001), the reduction of TSGF on 5th POD less than 10U/ml (p=0.044) and the pH value of pelvic dranage less than or equal to 6.978 on 3rd POD (p<0.001) were selected as 6 independent risk factors for AL. It was shown that significant differences in survival of the patients were AL-related (p<0.001), high ASA score related (p=0.036), high-level EMI related (p=0.007) and advanced TNM stage related

• Journal of the Korean Arthroscopy Society
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• v.15 no.1
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• pp.13-18
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• 2011

Purpose: The purpose of this study is to evaluate the radiologic and clinical results of the arthroscopic coracoclavicular fixation of the acute acromioclavicular dislocation using $TightRope^{(R)}$ (Arthrex, Inc, Naples, FL). Materials and Methods: We performed the arthroscopic coracoclavicular fixation using $TightRope^{(R)}$ in twenty patients with the Rockwood type III or V acute acromioclavicular dislocation between February, 2009, and February, 2010. Mean follow-up was 13.4(range 8~22) months. Radiologic results were evaluated by comparing the distances between the clavicle and the coracoid process with those in the contralateral sides using the acromioclavicular stress radiographs. Clinical results were made according to the KSS(Korean Shoulder Scoring System), and the cosmetic satisfaction of the patient was assessed. Results: Radiologically, 18 cases showed excellent, 1 case showed good and 1 case showed fair results. Clinically, KSS was mean 98.5 (range 92~100) points and all cases revealed satisfactory cosmetic results. Because one case complained of skin tenderness and discomfort of palpation, we closed the knot with surrounding muscle & fascia. Then local wound infection occurred, so we treated it by incision and drainage under local anesthesia and antibiotic therapy for 2 weeks. Conclusion: Arthroscopic coracoclavicular fixation using $TightRope^{(R)}$ for treating the Rockwood type III or V acute acromioclavicular dislocation showed satisfactory radiologic and clinical results. It seems to be a good treatment method that has little postoperative complication, provides an early rehabilitation and an excellent cosmetic result, and does not require secondary operation for removal of metal implant.

• Archives of Plastic Surgery
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• v.37 no.1
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• pp.59-66
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• 2010

Purpose: In the finger, there are three major palmar arches in the arterial system. The location of this arches are constant. The middle and distal transverse arches are consistently large (almost 1 mm) and may be used for arterial vessel repairs either proximally or distally, depending on the length and direction needed. This paper describes our experiences in reconstruction and replantation of the finger using rerouting the transverse digital palmar arch. Methods: 31 patients with injuries according to our classification were treated from March of 2005 to October of 2008. In this study the authors subdivided injuries into those with amputation distal to the insertion of the flexor digitorum profundus (Class I, 31 fingers); those with amputation distal to the insertion of the flexor digitorum superficialis (Class II, 4 fingers). Replantation was performed using the artery-only technique with neither vein nor nerve repair. Because the artery has been damaged, it is still possible to make a direct suture by transposing the arterial arch in an inverted Y to I arterial configuration or converting the arch. Venous drainage was provided by an external bleeding method with partial nail excision, medical leech, and repaired margin. Results: The success rate was 87% (n=27) in class I and 75% (n=4) in class II. The authors conclude that crushing and complete avulsion injuries & amputations are salvageable, with acceptable functional results in select patients, especially those with amputation distal to the insertion of the flexor digitorum superficialis. Conclusion: We performed replantation and reconstruction with only-arterial transposing anastomosis successfully, resulting in good recovery of aesthetic and functional outcome. Three major digital palmar arches, especially distal two branches, give us additional treatment options. In the finger replantation and reconstructive techniques using rerouting healthy the transverse digital palmar arch increase the survival rate of the finger.

• 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 Chest Surgery
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• v.24 no.1
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• pp.54-63
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• 1991

Post-thoracotomy pain is so severe that lead to postoperative complications, such as sputum retention, segmental or lobar atelectasis, pneumonia, hypoxia, respiratory failure due to the patient`s inability to cough, deep breathing and movement. Many authors have been trying to reduce the post-thoracotomy pain, but there is no method of complete satisfaction. In 1974, Nelson and associates introduced the intercostal nerve block using the cryoprobe. The application of cold directly to the nerves causes localized destruction of the axons while preserving the endoneurium and connective tissue, thereby introducing a temporary pain block and able to complete regeneration of intercostal nerves. One hundred and two patients, who undergoing axillary or posterolateral thoracotomy at the Department of Thoracic and Cardiovascular Surgery in Korea University Medical Center between April 1990 and August 1990, were evaluated the effects of cryoanalgesia for the post-thoracotomy pain reduction. The patients were divided into two groups: Group A, control, the patients without the cryoanalgesia[No.=50], Group B, trial, the patients with cryoanalgesia[No.=52]. Before the thorax closed, in the group A, local anesthetics, 2% lidocaine 3cc, were injected to the intercostal nerves[one level with the thoracotomy, one cranial and caudal intercostal level and level of drainage tube insertion]. In the group B, cryoprobe was directly applied for 1 minute at the same level. Postoperative analgesic effects were evaluated by the scoring system which made arbitrary by author: The pain score 0 to 4, The limitation of motion score 0 to 3, The analgesics consumption score 0 to 3, The total score, the sum of above score, 0 to 10. For the evaluation of immediate analgesic effects, the score were evaluated at the operative day, the first postoperative day, the second postoperative day, and the seventh postoperative day. The effects of incision type, and rib cut to the post-thoracotomy pain were also evaluated. The results were as follows; 1. The intercostal block with cryoanalgesia reduced the immediate postoperative pain significantly compare with control group. 2. The intercostal block with cryoanalgesia improved the motion of the operation side significantly compare with control group. 3. The intercostal block with cryoanalgesia reduced the analgesics requirements at the immediate postoperative periods significantly. 4. The intercostal block with cryoanalgesia lowered the total score significantly compare with control group. 5. The intercostal block with cryoanalgesia were more effective to the mid-axillary incision than to the posterolateral incision 6. The intercostal block with cryoanalgesia were more effective to the patients without rib cut than to the patients with rib cut. 7. No specific complication need to be treated were not occurred during follow-up.

• Journal of Chest Surgery
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• v.39 no.2 s.259
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• pp.111-116
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• 2006

Background: Perforation of the esophagus is a deadly injury that requires expert management for survival. The mediastinal contamination with microorganisms, gastric acid, and digestive enzymes results in a mediastinitis that is often fatal if untreated. Material and Method: Between January 1990 and June 2004, 38 patients with esophageal perforation were treated in our hospital. Retrospective review of these cases has been performed. Result: There were 28 males and 10 females. The mean age was 43.84$\pm$18.89 years (range $1{\~}73$ years). Spontaneous rupture was found in $34\%$ of perforations, iatrogenic perforation in $32\%$ and traumatic perforation in $34\%$. Perforation occurred in the cervical esophagus in 8 cases, thoracic esophagus in 29 and abdominal esophagus in 1. In the cervical esophageal perforation, managements were primary closure in 8 and drainage in 2. In the thoracic esophageal perforation, managements were primary closure in 14, resection in 3 and conservative management in 12. The mortality rate was $25\%$ in cervical esophageal perforation and $34.5\%$ in thoracic esophageal perforation. We revealed risk factor of esophageal perforation to be peropertaive septic condition (p=0.005). Conclusion: Most important risk factor of esophageal perforation was preoperative septic condition. Preoperative prompt and aggressive preoperative treatment may improve the survival rate of esophageal perforation.

• Journal of Chest Surgery
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• v.36 no.1
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• pp.21-25
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• 2003

Video-assisted thoracoscopic surgery (VATS) for decortication or debridement in the management of empyema thoracis has increased the available treatment options but requires validation. We present and evaluate our technique and experience with thoracoscopic management of pleural empyema, irrespective of chronicity. Material and Method : VATS debridement or decortication was performed with endoscopic shaver system in 40 consecutive patients presented with pleural space infections. A retrospective review was performed and the effect of this technique on perioperative outcome was assessed. Result : VATS evacuation of infected pleural fluid and decortication was successfully performed in 35 of 40 patients. The mean duration of preoperative symptoms before referral was 23$\pm$1.8 days. The mean duration of hospitalization before transfer was 13.5$\pm$1.5 days. Blood loss was 250 to 200 mL. Intercostal drainage was required for 5$\pm$3 days. The postoperative hospital stay was 5 $\pm$0.7 days. There were no operative mortalities. Conclusion : Video-assisted evacuation of infected pleural fluid and decortication is an effective modality in the management of the fibropurulent stage of empyema. An organized empyema should be approached thoracosco-pically, but may require open decortication.

• Korean Journal of Agricultural and Forest Meteorology
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• v.13 no.1
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• pp.28-34
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• 2011

This study was carried out to estimate monthly mean of daily maximum and minimum temperature across North Korea at a 30 m grid spacing for a climatological normal year (1971-2000) and the 4 decadal averages (1971-1980, 1981-1990, 1991-2000, and 2001-2010). A geospatial climate interpolation method, which has been successfully used to produce the so-called 'High-Definition Digital Climate Maps' (HD-DCM), was used in conjunction with the 27 North Korean and 17 South Korean synoptic data. Correction modules including local effects of cold air drainage, thermal belt, ocean, solar irradiance and urban heat island were applied to adjust the synoptic temperature data in addition to the lapse rate correction. According to the final temperature estimates for a normal year, North Korean winter is expected colder than South Korean winter by $7^{\circ}C$ in average, while the spatial mean summer temperature is lower by $3^{\circ}C$ than that for South Korea. Warming trend in North Korea for the recent 40 years (1971-2010) was most remarkable in spring and fall, showing a 7.4% increase in the land area with 15 or higher daily maximum temperature for April.

• Proceedings of the Korea Water Resources Association Conference
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• 2007.05a
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• pp.97-105
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• 2007

수문학적 토양유형은 복잡하게 세분되어 있는 토양의 종류를 수문학적인 목적에 따라 단순화하기 위해 만든 것으로 미농무성 토양보전국에서 고안한 개념이다. 우리나라 토양을 이 방법으로 구분하고자 하는 몇번의 시도가 있으며 그 중 대표적인 것이 정 등(1995)이 분류한 수문학적 토양군이다. 이는 토양의 침투 투수특성에 대한 실측자료가 부족한 우리나라의 실정을 감안하여 토성속(textural family), 배수등급(drainage class), 불투수층(impermeable layer), 투수성(permeability)의 네가지 토양특성을 분류특성으로 하여 각각에 1-4점 범위로 점수를 매긴 후 합산한 점수를 기준으로 수문학적 토양유형을 분류하는 것이다. 최근에는 토양의 한계침투속도에 따라 수문학적 토양유형을 분류하고자 하는 시도가 있으며 본 논문에서는 새로운 방법으로 분류할 때 기존의 방법과 어떠한 차이가 있는지 비교하고자 하였다. 정 등(1995)의 분류방법은 개념상 몇가지 문제점을 안고 있다. 먼저 토양의 수리특성은 같은 토성속이라 하여도 토양생성 과정과 토지이용 방법에 따라 그 차이가 매우 큼에도 불구하고 이에 대해 고려하지 못하였으며 다음으로 지표유거가 많아 배수가 양호한 토양의 강우 유출을 과소평가한다. 또한 얕은 토심에 존재하는 불투수층이 존재하는 경우 토양의 수리특성에 관계없이 적은 양의 강우에도 유출이 발생하므로 별도의 제한인자로 간주하여야 한다. 토양의 한계 침투속도를 이용한 분류방법은 이러한 문제점을 상당 부분 개선할 수 있다. 토양의 한계침투속도를 산정하기 위해 현장에서 지표 한계침투속도와 투수속도를 측정하였으며 이 자료를 확장하여 해석하기 위해 입자특성을 이용한 Pedo Transfer Function을 개발하였다. 토심 50 cm 포화시 토양 투수성을 한계 침투속도로 가정하였으며 50 cm 이내에 암반층과 지하수위가 존재할 경우 투수성에 관계없이 D유형으로 분류하였다. 새로운 방법으로 분류한 결과 기존의 분류와 몇가지 차이점이 발견되었다. 가장 큰 차이는 대부분의 논토양이 느린 한계침투속도의 영향으로 D유형에 속한 것이다. 산림토양과 밭토양은 기존 방법과 마찬가지로 A, B유형이 많았으며 암반층을 고려하기 전에는 기존 분류에 비해 강우 유출 가능성이 적은 쪽으로 평가되었다. 그러나 암반층이 존재하는 토양을 고려한 결과 A 또는 B 유형에 속하던 상당수의 산림토양이 새로운 분류에서 D유형으로 분류되었다. 지표 유거가 많아 배수등급이 매우양호로 분류되던 토양은 정 등(1995)의 분류와 비교하여 대부분 강우 유출 가능성이 큰 쪽으로 조정되었다. 새로운 수문학적 토양유형을 이용할 경우 낮은 토심에서 암반층이 발견되는 산림토양이 분포한 유역이나 산림, 밭 등에 식질 토양이 많이 분포하는 유역에서는 기존의 방법을 이용하는 것보다 강우 유출량이 높게 평가될 것으로 판단된다. 앞으로 강우 유출량 실측자료와의 비교를 통해 지속적인 보정을 하여야 할 것이며 특히 불투수층의 존재시 일괄적으로 D유형으로 분류된 토양의 경우 깊이에 따라 C 또는 D 유형으로 세분하여 조정할 필요가 있다.