• Title/Summary/Keyword: surgey

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A Study of Pathogenesis and Treatment of Spontaneous Pneumothorax (자연성 기흉의 성인과 치료에 대한 고찰)

  • 홍완일;김진식
    • Journal of Chest Surgery
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    • v.1 no.1
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    • pp.11-18
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    • 1968
  • Author studied the possible pathogenesis of spontaneous pneumothorax and its effective treatment in 33 cases, and the results obtained as follows:1) Of the 33 cases, 15 cases were originated from pulmonary tuberculosis, 11 cases were non-tuberculous natures and 7 cases were followed by traumatic chest injuries which were not associated with a laceration of the lung or rib fractures.2) So called "Idiopathic spontaneous pneumothorax" seemed mostly to be caused by rupture of the emphy- sematous blebs.3) Spontaneous pneumothorax, in process of the pulmonary tuberculosis, seemed to be caused by the rupture of blebs which was formed with a pathological process of chronic pulmonary tuberculosis.4) Author experienced interesting cases of giant blebs which had been fully occupied the right thoracic cavity. At first, it was misdiagnosed as extensive spontaneous pneumothorax on X-ray which was revealed extensive pleural air shadow with total atelectasis of the right lung. A pneumonectomy was performed together with the giant multiple blebs.5] Generally, closed thoracotomy with water-sealed drainage is the treatment of choice in spontaneous pneumothorax. However, open thoracotomy and adequate surgical procedures should be undertaken in patients with continuous air leakage or recurrent attack of spontaneous pneumothorax.aneous pneumothorax.

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Mitral Valve Repair for Congenital Mitral Regurgitation in Children (선천성 승모판막 페쇄부전증이 있는 소아에서 승모판막 성형술에 대한 임상적 고찰)

  • Kim, Kun-Woo;Choi, Chang-Hyu;Park, Kook-Yang;Jung, Mi-Jin;Park, Chul-Hyun;Jeon, Yang-Bin;Lee, Jae-Ik
    • Journal of Chest Surgery
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    • v.42 no.3
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    • pp.292-298
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    • 2009
  • Background: Surgery for mitral valve disease in children carries both technical and clinical difficulties that are due to both the wide spectrum of morphologic abnormalities and the high incidence of associated cardiac anomalies. The purpose of this study is to assess the outcome of mitral valve surgery for treating congenital mitral regurgitation in children. Material and Method: From 1997 to 2007, 22 children (mean age: 5.4 years) who had congenital mitral regurgitation underwent mitral valve repair. The median age of the patients was 5.4 years old and four patients (18%) were under 12 months of age. 15 patients (68%) had cardiac anomalies. There were 13 cases of ventricular septal defect, 1 case of atrial septal defect and 1 case of supravalvar aortic stenosis. The grade of the preoperative mitral valve regurgitation was II in 4 patients, III in 15 patients and IV in 3. The regurgitation was due to leaflet prolapse in 12 patients, annular dilatation in 4 patients and restrictive leaflet motion in 5 patients. The preoperative MV Z-value and the regurgitation grade were compared with those obtained at follow-up. Result: MV repair was possible in all the patients. 19 patients required reduction annuloplasty and 18 patients required valvuloplasty that included shortening of the chordae, papillary muscle splitting, artificial chordae insertion and cleft closure. There were no early or late deaths. The mitral valve regurgitation after surgery was improved in all patients (absent=10, grade I=5, II=5, III=2). MV repair resulted in reduction of the mitral valve Z-value ($2.2{\pm}2.1$ vs. $0.7{\pm}2.3$, respectively, p<0.01). During the mid-term follow-up period of 3.68 years, reoperation was done in three patients (one with repair and two with replacement) and three patients showed mild progression of their mitral reguration. Conclusion: our experience indicates that mitral valve repair in children with congenital mitral valve regurgitation is an effective and reliable surgical method with a low reoperation rate. A good postoperative outcome can be obtained by preoperatively recognizing the intrinsic mitral valve pathophysiology detected on echocardiography and with the well-designed, aggressive application of the various reconstruction techniques.

Stabilization in the Anterior Shoulder Instability' Where Do We Stand Today? (견관절 전방 불안정성에서 치료방침의 결정)

  • 이용걸
    • The Academic Congress of Korean Shoulder and Elbow Society
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    • 2004.11a
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    • pp.112-116
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    • 2004
  • 전방 탈구인 경우 첫탈구이거나 생애에 몇번만 탈구를 경험하고 일상생활에 별 지장이 없다면 보존적으로 치료하는 것이 바람직하다. 다만 early surgey가 요구되는 경우는, 첫탈구가 teen aged이면 관절경적 수술을, 골편이 큰 Bankart병변이 있는 첫탈구는 수술하는 것이 좋다. 전방 불안정성인 경우, collision sports는 개방술로, non-athletes이거나 throwing 또는 contact sports는 관절경술로 시행해 주는 것이 바람직하다. 우리가 명심하여야 할 것은 전방 불안정성을 다루는데 환자의 입장에서 서야 한다는 것이다. 의사의 능력 정도나 욕망보다도 환자의 상태, 활동 정도와 환자의 요구에 맞추어 환자를 치료하여야 한다.

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Treatment of Vallecular Cyst Using Laryngopharyngoscope (Laryngopharyngoscope를 이용한 후두개곡낭종의 치료)

  • 임상철;조재식
    • Korean Journal of Bronchoesophagology
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    • v.6 no.2
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    • pp.143-146
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    • 2000
  • Cystic lesion which is located in vallecular area is sometimes symptomatic and need surgey. But surgical route to this area is divided external approach into internal one. Internal approach via transoral route with suspension laryngoscope can avoid disadvantages of external approach but conventional laryngoscope is not suitable for this type of procedure. We used Steiner laryngopha-ryngoscope in surgery for vallecular cyst and we could excise cyst easily. Of 20 cases, complete excision was tried in 18 cases and marsupialization in 2 cases. Recurrence was 1 case. We suggest that surgery using laryngopharyngoscope is effective in treating cyst which is located in vallecular area.

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Video-Assisted Thoracoscopic Pleural Adhesiotomy and Decortication for Complicated Pleural Space Occupying Lesions (복잡한 흉막강내 공간차지병소의 흉강경적 흉막 유착박리술 및 박피술)

  • Jo, Min-Seop;Cho, Deog-Gon;Moon, Seok-Whan;Moon, Young-Kyu;Kang, Chul-Ung;Cho, Kyu-Do;Jo, Keon-Hyeon
    • Journal of Chest Surgery
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    • v.42 no.3
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    • pp.350-354
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    • 2009
  • Background: Complicated pleural space occupying lesions (SOL) have been treated by thoracentesis, closed thoracotomy drainage (CTD) or surgical intervention with using a video thoracosocpe or open thoracotomy depending on the extent of the disease. With the development of video assisted thoracoscopic surgery (VATS), VATS pleural adhesiolysis and decortication have revealed good results as compared to those for open thorcotomy. To assess the effectiveness of VATS pleural adhesiolysis and decortication, we retrospectively analyzed the medical record and radiologic findings of the patients with complicated pleural SOL and who were treated by this surgery. Material and Method: From May 1996 to April 2006, 64 patients (mean age: 41.8 years) with complicated pleural SOL underwent 65 VATS. To analyze the surgical outcome, we classified the postoperative findings on the simple chest X-rays into 4 classes as Class I: no or minimal pleural lesion, Class II: blunting of the cardiophrenic angle and mild pleural thickening, Class III: an elevated diaphgram or persistent lung collapse and Class IV: complicated or recurrent effusion. Result: Before VATS, the patients underwent the diagnostic or therapeutic procedures: single or repeat diagnostic tapping for 41, thoracoscotomy drainage for 11, pigtail catheter drainage for 10 and intrapleural fibrinolytics for 10. The mean duration between the onset of symptom and surgery was 18.4 days. There was neither mortality nor severe complications. The surgical outcomes were class 1 for 28, class 2 for 13, class 3 for 19 and class 4 for 5. There were statistically significant differences between the symptom duration and the classes, and between the operation time and the classes. Conclusion: VATS pleural adhesiolysis and decortication are effective, safe treatments for managing complicated pleural SOL, and an earlier operation is needed for obtaining a better surgical outcome.

Injuries and Prevention methods Associated with In-Line Skate (인라인 스케이트시 발생한 손상 밑 예방)

  • Lim Hong Chul;Chun Seung Joo;Rho Young Jin;Hwang Jin Ho;Park Chan Eung;Kim Tae Un
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.2 no.2
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    • pp.163-167
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    • 2003
  • Purpose: The purpose of this study is to describe causes and injury mechanisms during inline skating and to find preventive measures .Materials and Methods: We have carefully selected 57 patients who have been treated in our hospital and nearby hospital. There are 37 males and 20 females, and mean age is 9 years 9 months (range,6-40 years old) . We have meticulously investigated their injured sites, their favorite location for inline skating , their use of protective means while they were on the wheels and their injury mechanisms . Results: Injury consisted of 50 fractures,1 meniscal tear,2 medial collateral ligament rupture and 4 contusion or sprain. Fracture sites varied as follows : 33(66$\%$) cases in distal radius and ulna,5(10$\%$) in elbow. 3(6$\%$) in diaphysis of humerus, etc Location at the time of injury varied as follows : 22 cases(39$\%$) in their apartment complex, 19 cases in (33$\%$) narrow streets, and 16 cases(28$\%$) in parks Only five patients admitted that any means of protection were used.2 cases only had knee pad on , 1 case put on elbow pad in addition, and 2 cases put on wrist guard as well. However none of the patients had helmet on Conclusion: We would strongly like to stress the importance of using sufficient protections and of choosing area where it is safe to ride, in order to reduce the risk of accidents. In addition, continuous and effective prior education from inline skate circles may be in order before riding the inline skate.

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Flow Analyses of Upper Airway Before and After Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea Patient (폐쇄성 수면무호흡증 환자의 상하악 전진술 후 상기도 내 유동해석)

  • Kim, Hyoung-Ho;Suh, Sang-Ho;Choi, Jin-Young;Kim, Taeyun
    • Transactions of the Korean Society of Mechanical Engineers B
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    • v.39 no.5
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    • pp.443-448
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    • 2015
  • Obstructive sleep apnea (OSA) is a syndrome characterized by the repetitive episodic collapse of the upper airway. Maxillomandibular advancement surgery is one of the most effective surgical treatment methods in treating obstructive sleep apnea. The advancement of both maxill and mandible can enlarge the cross-sectional areas and volumes of the postero-superior airway. The purpose of this study is to analyze flow patterns in the upper airway before and after maxillomandibular advancement surgery. Here, we analyzed flow phenomena of inspiration and expiration to prevent obstructive sleep apnea patient from happening side effect. Modeling of the upper airway carried out from clinical CT scanned images. We used time-dependent values for boundary condition. CFD analyses were performed and evaluated section of minimum area (SMA), compared with patient inside upper airway before and after maxillomandibular advancement surgery in SMA, and negative pressure effects. The study showed the greatest enlargment of the section of minimum cross-sectional area. Moreover, the velocity and the negative airway pressure were decreased. According to the result of this study, the maxillomandibular advancement surgery stabilizes the airflow in the postero-superior airway of OSA patients.

Effects of Delirium Prevention Program in Patients after Hip Joint Surgery (고관절 수술환자에게 적용한 섬망 예방프로그램의 효과)

  • SaGong, Eun Mi;Kim, Sook Young
    • The Journal of the Korea Contents Association
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    • v.18 no.10
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    • pp.134-144
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    • 2018
  • The purpose of this study was to examine the effects of delirium prevention program in patients after hip joint surgey. A non equivalent control group post-test only design was utilized. Sixty four patients aged 65 and older who admitted to a surgical intensive care unit after hip joint surgery were assigned to either a experimental group (n=33) or a control group (n=31). The experimental group was provided with delirium prevention program consisting of orientation intervention, activity intervention, physiological intervention, nutritional intervention, sleep intervention, environmental intervention. Data were analyzed using ${\chi}^2-test$ and independent t-test. The experimental group showed lower incidence of delirium than the control group(${\chi}^2=7.048$, p=.008). The experimental group showed lower ICU stay and length of hospitalization than the control group although the difference was not statistically significant. Findings indicate that the dilirium prevention program is effective in reducing incidence of delirium in patients after hip joint surgery and delirium prevention program is recommended as a guide for the prevention of delirium.

The Effect of a Preoperative Patient-Controlled Analgesia Education Program on Postoperative Pain Control in Older Patients with Spine Surgery (수술 전 자가통증조절기 교육 프로그램 적용이 노인 척추 수술 환자의 통증 조절에 미치는 효과)

  • Park, Hye Ran;Jeong, Eun Ju;Yoo, Mi Jung;Lee, Seul Gi;Jeong, Su Yeon;Kang, Bada
    • Journal of Korean Clinical Nursing Research
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    • v.30 no.1
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    • pp.45-53
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    • 2024
  • Purpose: This study aimed to investigate the effectiveness of preoperative patient-controlled analgesia(PCA) education program on older patients with spine surgery. Methods: A quasi-experimental research with a non-equivalent control group pretest-posttest design was conducted to investigate the impact of a PCA education program before surgery on postoperative pain, pain knowledge and attitudes, and frequency of additional analgesic use. The sample size for experimental and control group was 55 respectively. Results: The experimental group, which underwent the PCA education program, had lower postoperative pain scores compared to the control group. Furthermore, the experimental group exhibited a higher level of knowledge on PCA (p<.001) and more positive attitudes toward analgesic use (p<.001). While there was a significant difference in the use of opioid analgesics for additional pain relief between two groups (p<.001), there was no significant difference in the use of non-opioid analgesics. Conclusion: The implementation of the PCA education program was found to increase knowledge and positive attitudes on the use of PCA. Moreover, it significantly alleviated pain, particularly during physical activity, within initial 48 hours after spinal surgey in older patients. Therefore, the findings of this study supported that the PCA education program could be used as a preoperative intervention to alleviate postoperative pain for older patients with spinal surgery.