• Journal of Chest Surgery
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• 제54권2호
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• pp.106-116
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• 2021

Background: We evaluated the mid-term outcomes and angiographic patency of redo coronary artery bypass grafting (CABG). Methods: Of 2,851 patients who underwent isolated CABG at Seoul National University Hospital from 2000 to 2017, 88 underwent redo CABG. Patients' mean age at redo CABG was 66.0±8.0 years. The mean interval between the first-time and redo CABG was 113.0±62.4 months. The mean follow-up duration was 86 months. Early and mid-term clinical outcomes were evaluated. Angiographic patency rates were evaluated early (1-2 days), 1 year, and 5 years after surgery. Comparative analyses between on-pump and off-pump CABG were also performed. Results: The culprits for reoperation were previous grafts (65.6%), native coronary vessels (17.8%), and both (16.7%). Off-pump CABG was performed in 75 cases (85.2%), and the mean number of distal anastomoses was 1.8±0.8. The saphenous vein (39.7%) was used most frequently, followed by the right internal thoracic artery (28.4%), right gastroepiploic artery (21.3%), left internal thoracic artery (7.8%), and radial artery (2.8%). Operative mortality was 1.1%. The overall survival, cumulative incidence of cardiac death, and cumulative incidence of major adverse cardiac events were 71.3%,12.0%, and 23.3% at 5 years after surgery, respectively. The overall angiographic patency rates were 95.7%, 90.1%, and 92.2% on early, 1-year, and 5-year angiograms, respectively. The angiographic patency rates of saphenous vein grafts were 93.1%, 85.6%, and 91.3% on early, 1-year, and 5-year angiograms, respectively. No significant differences in clinical outcomes or angiographic patency rates were observed between the on-pump (n=13) versus off-pump (n=75) groups. Multivariable analysis revealed that age (hazard ratio [HR], 1.07; p=0.005) and chronic kidney disease (HR, 3.85; p=0.001) were risk factors for all-cause mortality. Conclusion: Redo CABG could mostly be performed using the off-pump technique and did not show increased operative mortality and morbidities.

• 대한화상학회지
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• 제22권1호
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• pp.1-9
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• 2019

Purpose: The aim of this study was to investigate the characteristics of Acute Kidney Injury Network (AKIN)-defined nephrotoxicity in patients undergoing intravenous colistimethate sodium (CMS) therapy for major burns. Methods: This retrospective study included burn patients who received more than 48 h of intravenous CMS between September 2009 and December 2015. Data collection was performed using the institution's electronic medical record system. Patients assigned to the developed nephrotoxic group experienced aggravation of current AKIN stage during CMS treatment; those assigned to the non-nephrotoxic group experienced no change in current or exhibited improved AKIN stage during CMS therapy. Results: A total of 306 patients were included in this study. All patients were grouped according to AKIN stage: AKIN 0 (n=152); AKIN 1 (n=6); AKIN 2 (n=9); AKIN 3 (n=139). The baseline creatinine (Cr) level was 0.73 mg/dL. The incidence of nephrotoxicity was 50.3% according to AKIN stage; overall mortality was 45.8%. The non-nephrotoxic group consisted of 127 (74.7%) patients and 43 (25.3%) were in the developed nephrotoxic group. In patients requiring continuous renal replacement therapy (CRRT), baseline Cr level was 0.83 mg/dL, pre-CMS Cr level was 1.17 mg/dL, and post-CMS Cr level was 1.34 mg/dL. Conclusion: CMS can be administered without signs of nephrotoxicity for a certain period (approximately 1 week), it can be used relatively safely for 2 weeks. Application of CMS is a reasonable option for treating infections caused by multi-drug resistant gram-negative bacteria in patients with major burns. The caution should be exercised nevertheless.

• Journal of Chest Surgery
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• 제30권10호
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• pp.1051-1053
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• 1997

악성신경초종은 Schwan cell 또는 신경초 세포(nerve sheath cell)에서 발생하는 아주 드문 종양으로 빈번히 신경섬유종증(Von Rechlinghausen's disease)과 연관되어 있다. 환자는 64세 남자로 우측 가슴에 내원 2개월전부터 있던 무통성 종물을 주소로 내원하였으며 신경섬유종 증과의 동반은 없었다 전산화 단층촬영상 종물의 크기는 6 $\times$ 6 cm였으며, 11번 늑골과 횡경막을 침범하였 고 우신을 앞쪽으로 밀고 있었다. 본 교실에서는 흉벽에 발생한 악성신경초종을 경험하였기에 문헌고찰과 함께 보고한다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제19권4호
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• pp.377-382
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• 1997

Miniplate의 사용은 Champy등의 보고 이후 구강외과 영역에 있어서 외상 혹은 악교정수술등 많은 분야에 이용되기 시작했다. 전통적인 악간고정 방법에 비해 miniplate는 사용하기 쉽고, 정확한 해부학적 정복 및 고정을 가능케 하며 결과적으로 빠른 치유를 가능케 한다는 장점들을 갖고 있다. 그러나 감염, wound dehiscence, 부식, 나사의 헐거워짐, 주위조직의 변색 그리고 stress shielding effect등의 후유증들이 보고되어 왔으며 가장 무해한 금속이라고 알려진 titanium 또한 주위조직 및 lung, spleen, liver 그리고 kidney 등과 같은 조직으로 metal을 전이시키는 것으로 보고되고 있다. 특히 안와골 주변과 같은 상부 연조직이 얇은 곳에 miniplate를 사용할 경우 miniplate가 만져지거나 보일수도 있다는 점이 보고되었으며 따라서 술후 사용되었던 miniplate를 제거 해야만 할 것인가가 또한 주된 관심사로 보고되고 있다. 이에 저자는 이러한 금속성 miniplate의 단점을 개선하고자 자가 두개골을 이용한 플레이트를 고안하였다. '자가 두개골 플레이트'의 적응증은, enophthalmos 개선의 목적으로 두개골을 채취해 임플란트로 사용하는, enophthalmos를 동반한 관골 및 안와골의 복합골절환자에 있어 두개골의 추가채취가 가능한 경우가 될 수 있겠다. 자가 두개골을 이용해 플레이트를 고안하려고 본 증례에서의 시도는 구강외과 영역에 있어서 자가 두개골이 골편이 고정재료로도 쓰일 수 있다는 가능성을 보여주었다는 점에서 의미가 있다고 저자는 생각한다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권21호
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• pp.9113-9116
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• 2014

Purpose: : To assess the clinic value of application of laparospic ultrasonography (LU) in partial nephrectomy of small renal cell carcinoma. Materials and Methods: From 2007 to 2011, 28 small renal cell carcinoma patients in ou clinic underwent laparoscopic partial nephrectomy with LU. For comparison with preoperative conventional ultrasound and CT, we collected ultrasonic performance of the affected side kidney, renal tumor location, size, echo change, blood supply situation and the relationship with the surrounding tissue. Results: LU could more clearly show the tumor interior structure and blood supply, as well as the relationship with the surrounding tissue. It also can provided doctor assistance with real-time tumor resection, reducing operative complications. Conclusions: LU can clearly show tumor internal structure and blood supply, which is helpful for explicit diagnosis. Moreover, it supplies accurate information for surgeons and assists surgery. Therefore LU has an important guiding value in partial nephrectomy for small renal cell carcinoma.

• 성인간호학회지
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• 제24권3호
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• pp.284-293
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• 2012

Purpose: The aim of this study was to compare the levels of anxiety, depression, and quality of life (QOL) among kidney or liver transplant candidates and recipients. Methods: A cross-sectional descriptive design was utilized. The 160 subjects were recruited and assigned to three different conditions: awaiting transplant group; post-transplantation (TPL) group within less than one year of surgery; and post-TPL group with one year and no more than two years post surgery. The levels of anxiety and depression were measured by the Hospital Anxiety and Depression Scale. The level of quality of life was measured by the Medical Outcomes Study Short Form-36 version 2. Results: The anxiety score was significantly higher in the waiting group compared with the 1~2 years post TPL group. The depression score was significantly higher in the waiting group compared with the post TPL groups. The QOL was significantly lower in the waiting group compared with the post TPL groups. Conclusion: Our results show a high prevalence of anxiety and depression and a marked reduction in the QOL in transplant candidates compared to the recipients. This study indicates that the group waiting for transplants may have unmet needs during that time period. Health professionals should be encouraged to attend to the psychological distress of the transplant candidates in order to improve their quality of life.

• Journal of Chest Surgery
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• 제23권4호
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• pp.791-798
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• 1990

Takayasu’s disease produces the occlusive and aneurysmal lesions of major branches of the aorta. Angiography is the most important diagnostic procedure in Takayasu’s disease. Surgical treatment is often justified to avoid the possible lethal consequences of hypertension on the heart, kidney, and brain, as well as in the case of aneurysm because of its risk of rupture. We experienced one case of the Takayasu’s disease associated with abdominal coarctation and renovascular hypertension. The patient was 17 years old female and had suffered from hypertension for 14 months. On physical examination, BP was 150/100 mmHg in the right arm and 120/80 mmHg in the left arm. The pulses of the left brachial and femoral arteries were weakly palpable. Aortogram showed the stenosis of the left common and subclavian arteries, coarctation of the abdominal aorta, and stenosis of the right renal artery and complete occlusion of the left renal artery. The stenosis of the right renal artery and the occlusion of the left renal artery produced the renovascular hypertension. She underwent aorta-aortic bypass for the coarctation of the abdominal aorta and aorta-renal bypass for treatment of renovascular hypertension Postoperatively, both femoral pulses were equally palpable. On discharge, antihypertensive drugs were discontinued. She has remained normotensive for last one year.

• Journal of Chest Surgery
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• 제18권4호
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• pp.667-672
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• 1985

Primary cardiac tumors are uncommon in all age group. In contrast, tumors metastatic to the heart are significantly more common. On rare occasions, tumor may extend into the heart chamber via inferior vena cava from other parts of the body, such as liver, kidney, and uterus cava. With recent advancement in diagnostic imaging modalities and surgical techniques, cardiac tumors are now potentially curably form of heart disease. The most important factor in diagnosing the tumor is a high index of clinical suspicion. Six patients underwent surgical removal of intracardiac tumor during a 5-year period. The mean age of the 4 women and two men was 40 years [range 23 to 60]. All patients were operated on in the last five years of the studied period. All patients had symptoms varying in duration from 1 month to 4 years [average 13 months]. 2-Dimensional echocardiography contributed most to preoperative diagnosis, confirming presence of an intracardiac tumor in all examined patients. Of the six intracardiac tumor, 5 were myxomas [4 left atrial and 1 right ventricular] and one right atrial metastasis from hepatocellular carcinoma of the liver. In all cases, tumor masses were successfully excised. One patient expired after the operation on account of low cardiac out-put syndrome. Remained one patient among six, tumor mass extended into RA and RV with a stalk via IVC. On later follow-up study showed cold area on liver scan [hepatocellular ca.], so she was transferred to internal medicine, department for chemotherapy. Follow up results showed no signs of tumor recurrence in 4 myxoma cases.

• Childhood Kidney Diseases
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• 제14권1호
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• pp.100-104
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• 2010

국소 분절성 사구체 경화증은 소아 말기 신부전의 중요한 원인이며, 신이식 후에도 재발되는 특징을 보이는데, 이러한 재발에 대한 치료로는 혈장교환술과 사이클로스포린과 같은 면역억제제의 투여 등이 있다. 이에 저자들은 신이식 전 혈장교환술과 예방적 사이클로스포린을 투여하여 국소 분절성 사구체 경화증의 재발을 효과적으로 예방한 경험 2례를 보고하는 바이다.

• 보험의학회지
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• 제2권1호
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• pp.218-232
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• 1985

Congenital hereditary disease is in devided into Infantile type and Adult type, Adult type is hidden for many years and keeps normal renal function till middle age. Cyst is stimultaneously made in both sides and becomes lowered in renal function in 30's to 40's. Infantile type is generally born with the big kidneys, renal failure, undergrowth of intrahepatic bile duct. Both infantile and childhood type have ureteral dilatation and portal hypertension In infantile type, it is mostly developed into renal failure, but generally faces death as a result of hepatic disease. The reason of death is that an abnormal condition of recessive autosome affects the liver and kidneys. While the incidence of infantile type is rare as $0.017{\sim}0.07%$ and it is autosomal recessive heredity, Adult type can rarely exist in infantile period. Though it exists in middle period, 50% of patients can live for 2-4 years after the first symptom incidence and 25% can less than 2 years. It is hard to cure completely in medicine and surgery. Three difficulties in familial incidence are comparative decrease of the donor who have no affection on renal transplantation. For another consideration it is to show the family history for several generations. We, the Med. Dept. of Dae Han Kyouk Life Insurance Co. Ltd., used the ultrasonic apparatus in diagnosing the one case of adult type bilateral polycystic kidney and then doubted the family history. As a result of inspecting the family we experienced bilateral polycystic kidney from 3 persons out of 4 who can be inspected. The results are as follows: 1) We could confirm the polycystic kidney from 3 persons out of 4(75%). 2) Then when they came for check up, chief complaint was the pain in all 3 cases(100%). 3) Accompanying disease was hypertension in 2 cases(67%). 4) In early disease incidence, we couldn't observe the specific change in pathological opinion. 5) All 3 cases are not accompanied with cystic lesion in liver, spleen, pancreas.