• Journal of Chest Surgery
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• v.57 no.4
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• pp.413-417
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• 2024

A 70-year-old man with dilated cardiomyopathy underwent left ventricular assist device (LVAD) implantation, using a HeartWare ventricular assist device, as a bridge to candidacy. After 26 months, computed tomography (CT) angiography indicated stenosis in the LVAD outflow graft; however, the patient was asymptomatic, prompting a decision to manage his condition with close monitoring. Ten months later, the patient presented with dizziness and low-flow alerts. Subsequent CT angiography revealed a critical obstruction involving the entire LVAD outflow graft. The patient underwent emergency surgery, during which an organized seroma causing the graft obstruction was found between a wrapped expanded polytetrafluoroethylene (ePTFE) graft and a Dacron outflow graft. The covering of the outflow graft was removed, along with the organized seroma. Following removal of the ePTFE wrap and decompression of the outflow graft, normal LVAD flow was reestablished. The practice of wrapping the outflow graft with synthetic material, commonly done to facilitate later redo sternotomy, may pose a risk for outflow graft obstruction.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.20 no.3
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• pp.191-200
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• 1998

This study was intended to perform the influence of condyle positional change after surgical correction of skeletal Class III malocclusion after orthognathic surgery in 37 patients(male 13, female 24) using computed tomogram that were taken in centric occlusion before, immediate after, and long term after surgery and lateral cephalogram that were taken in centric occlusion before, 7 days within the period of intermaxillary fixation, at the 24 hours later removing intermaxillary fixation and long term after surgery. 1. Mean intercondylar distance was $84.42{\pm}5.30mm$ and horizontal long axis of condylar angle was $12.79{\pm}4.92^{\circ}$ on the right, $13.53{\pm}5.56^{\circ}$ on the left side. Condylar lateral poles were located about 12mm and medial poles about 7mm away from the reference line(AA') on the axial tomogram. Mean intercondylar distance was $83.15{\pm}4.62mm$ and vertical axis angle of condylar angle was $76.28{\pm}428^{\circ}$ on the right, $78.30{\pm}3.79^{\circ}$ on the left. 2. In amount of set back, We found the condylar change(T2C-T1C) which had increasing tendency in group III (amount of setback : 10-15mm). but there was no statistical significance(p>0.05). 3. There was some correlation between condylar change(T2C-T1C) and TMJ dysfunction. It seemed that postoperative condylar change had influenced postoperative TMJ dysfunction, through there was no statistical significance (p>0.05). As we have observed the change of condylar axis in the group that complained of TMJ dysfunction in cases of large amount of mandibular setback. So we consider that the more trying to conserve condylar position will decrease occurrence rate of post operational TMJ dysfunction.

• Journal of Chest Surgery
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• v.30 no.9
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• pp.862-868
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• 1997

Shone's syndrome is a congenital cardiac malformation that consists of multiple levels of left heart obstruction including supravalvular mitral ring, congenital mitral stenosis(parachute mitral valve), subaortic stenosis, and coarctation of aorta. This syndrome is a very rare congenital anomaly and its prognosis is poor. We experienced 9 patients with Shone's syndrome between 1985 and 1994. There were 8 male and 1 female patients, and mean age was 33.0$\pm$31.0 months ranged from 2 months to 1 1 years. The congenital mitral, stenosis and coarctation of aorta existed in all patients and the supravalvular mitral ring and subaortic stenosis in 4 patients. Two patients had all four anatomic lesions. 3 patients underwent one stage total correction and the other 6 patients underwent two staged operation that was initial coarctoplasty with thoracotomy and later correction of intracardiac anomalies with median sternotomy. A third operation was performed in 2 patients. These procedures included reoperation for coarctation and replacement of mitral valve for persistent mitral stenosis. There was no operative death at the first operation but two operative deaths at the second operation. The cause of death in two cases was severe heart failure secondary to left ventricular hypoplasia. There was no operative death at the third operation. The seven survivors have beeli followed from 11 months to 12 years(mean follow-up 6.7 $\pm$ 3.6 years). There was no late death and the New York HeArt Association activity level was class I for all patients. We conclude that a food lone-term outcome can be expected by proper surgical treatment tailred to each individual's anatomy and pathophysiology although the operative mortality and morbidity of Shone's syndrome are high.

• Childhood Kidney Diseases
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• v.3 no.1
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• pp.88-94
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• 1999

Purpose : Malformation of urinary tract is among the most common of all congenital anomalies and can progress to irreversible renal damage before diagnosis due to difficulty of early diagnosis. Present study was undertaken to determine the clinical characteristics of urinary tract anomaly and to find out the most appropriate diagnostic and therapeutic measures for children with these anomalies. Methods : During the past 10 years from 1987 to 1998, review of medical records revealed 65 children with congenital anomaly of urinary tract and the following results were obtained. Results : The most common anomalies were ureteropelvic junction obstruction occuring in 26 cases ($36\%$), followed by ureteral duplication in 11 cases, renal agenesis in 10 cases and ureterovesical function obstruction in 7 cases. Complex anomaly of urinary tract was found in 8 cases and anomaly of other systems such as congenital heart disease was detected in 11 cases. The most frequent age group at the time of diagnosis was below 1 year of age constituting 39 cases ($60\%$) and male preponderance was noted as male to female ratio being 2.25:1. Presenting symptoms were urinary tract infection in 25 cases, followed by hematuria, abdominal mass, abdominal pain and voiding difficulty, etc, and in 11 cases, the anomaly was picked up by routine prenatal ultrasonography. Azotemia was noted in 9 cases and the underlying anomaly was obstructive uropathy in 4 out of these 9 cases. Surgical correction was undertaken in 38 cases (most frequently in cases of obstructive uropathy) and in 2 out off cases with obstructive uropathy in whom surgical correction was done, azotemia disappeared during follow up period of 1-5years. No new cases of deteriorating renal function appeared during follow-up period. Conclusion : In spite of high incidence of congenital malformation of urinary tract, early diagnosis is still hampered by nonspecific symptoms and signs. Therefore, in patients with symptoms such as urinary tract infection, abdominal pain and voiding problems, etc, it Is advisable to take various diagnostic tests promptly to pick up any urinary tract anomaly and to apply proper therapy in order to avoid progression to irreversible renal damage. In this regard, prenatal ultrasonography should be utilized more widely as a routine procedure to detect any urinary tract anomalies before birth.

• The korean journal of orthodontics
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• v.29 no.4 s.75
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• pp.457-466
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• 1999

It has been reported that skeletal relapse and dental change after mandibular setback do occur not only after intermaxillary fixation(IMF) removal but also during IMF The side effects of skeletal relapse during IMF have clinical importance because they can cause many Postoperative orthodontic Problems. Generally, the Prevention of solid union between segments, compensatory tooth movement, anterior openbite, etc. have been cited as the side effects of jaw displacement. The purpose of this study was to evaluate the skeletal relapse and dental change during IMF. The material consisted of 28 patients who were treated by BSSRO(bilateral sagittal split ramus osteotomy), wire osteosynthesis, IMF for correction of mandibular prognathism. Through cephalometric analysis, the amount and direction of surgical movement, skeletal relapse and dental change during IMF were measured. The correlation between surgical movement and skeletal relapse, between skeletal relapse and dental changes were evaluated. The following conclusions were obtained; 1. Distal segment was repositioned backward and upward, proximal segment showed clockwise rotation during surgery. 2. During ]m, anterior portion of distal segment was displaced backward and posterior portion was displaced upward. Proximal segment was displaced upward with forward movement of p-Go(gonion of proximal segment). Backward surgical movement of p-GO was significantly correlated with forward displacement of p-Go. 3. Overjet and overbite were not changed during IMF. The compensatory tooth movements during IMF were characterized by retroclination of upper incisors md retroclination, extrusion of lower incisors. These compensatory tooth movements had statistically significant correlation with upward displacement of d-Go (gonion of distal segment).

• Journal of Chest Surgery
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• v.32 no.6
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• pp.567-572
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• 1999

Background: Surgical correction of the full spectrum of esophageal atresia with tracheoesophageal fistula has improved over the years, but the mortality and morbidity assoiated with repair of these anomalies still remains high. Material and Method: We retrospectively analyzes 27 surgically treated patients with esophageal atresia and tracheoesophageal fistula at Dong-A University Hospital between January 1992 and March 1997. Result: There were 21 male and 6 female patients. Mean birth weight was 2.62$\pm$.385 kg(2.0~3.4 kg). Twenty- four(88.9%) had esophageal atresia with distal tracheoesophageal fistula, and 3(11.1%) had pure esophageal atresia. Four(14.8%) infants were allocated to Waterston risk group A, 18(66.7%) to group B, and 5(18.5%) to group C. In eighteen(66.7%) infants with associated anomalies, cardiovascular anomalies were the most common. Three had a gap length of 3.5 cm or greater(ultra-long gap) between esophageal segments, 7 had 2.0 to 3.5 cm(long gap), 8 had 1.0 to 2.0 cm(medium gap), and 9 had 1 cm or less(short gap) gap length. Among 27 neonates, 3 cases underwent staged operation, late colon interposition was done in 2, and all other 24 cases underwent primary esophageal anastomosis. Oerative mortality was 2/27(7.4%). Causes of death included acute renal failure(n=1), empyema from anastomotic leak(n=1), necrotizing enterocolitis(n=1), sepsis(n=1), insulin-dependent diabetus mellitus(n=1 . There were 4 anastomosis- related complications including stricture in 3, leakage in 1. Mortality was related to the gap length(p<.05). Conclusion: Although the complication rate associated with surgical repair of these anomalies is high, this does not always implicate the operative mortality. The overall survival can be improved by effective treatment for combined anomalies and intensive postoperatve care.

• Journal of Chest Surgery
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• v.42 no.6
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• pp.749-756
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• 2009

Background: Vascular ring is a rare anomaly of the aortic arch. We did surgical repair procedures on 16 cases of vascular ring over the past 12 years. This article reviews our results. Material and Method: Between 1995 and 2007, 16 patients (5 with double aortic arch, 7 with right aortic arch-left ligamentum, 4 with pulmonary artery sling) underwent surgical repair. Mean age at the time of the operation were as follows: double aortic arch, $5.7{\pm}5.5$ years; right aortic arch-left ligamentum, $6.1{\pm}13.4$ years; pulmonary artery sling, $2.9{\pm}2.6$ years. Five patients (71%) with right aortic arch-left ligamentum had an associated Kommerell's diverticulum. Two patients (40%) with double aortic arch, 2 patients (28.6%) with right aortic arch-left ligament and 4 patients (100%) with pulmonary artery sling had associated airway stenosis. Cardiac anomalies were present in 8 of 16 patients. Result: There was no peri-operative or post-operative mortality. The mean hospital stay was $27.1{\pm}38.2$ days. None of our patients underwent reoperation. Conclusion: Vascular ring is rare, but, it needs surgical correction. It is important to suspect the diagnosis and to validate with echocardiography. Preoperative and postoperative computed tomography and bronchoscopy are useful to evaluate the airway and surrounding structures.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.25 no.2
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• pp.1-19
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• 2012

Objective : The purpose of this study is to investigate about comparison of Eastern-Western medicine on the acne. Methods : We searched Eastern and Western medicine books for acne. We analyzed these books and examined category, definition, etiology, classification, internal and external methods of treatment of acne. Results : The results were as follows. 1. In Eastern medicine, Acne belongs to the category of the Bunja(粉刺), Jwachang(痤瘡), Pyepungbunja(肺風粉刺). In Western medicine, the other name of Acne is acne vulgaris. 2. In Eastern medicine, the definition of Acne includes manual extraction of comedones and skin appearance. In Western medicine, Acne is a common skin disease during adolescence and a chronic inflammatory disease of pilosebaceous unit of self localization. It is characterized by noninflammatory, open or closed comedones and by inflammatory papules, pustules, and nodules and it affects the areas of skin with the densest population of sebaceous follicles, these areas include the face, neck, back, and the upper part of the chest. 3. In Eastern medicine, the cause and mechanism of Acne arose from the state of internal dampness-heat and spleen-stomach internal qi deficiency due to dietary irregularities and then invaded external pathogen such as wind-dampness-heat-cold-fire in lung meridian lead to qi and blood heat depression stagnation. So it appears in skin. In Western medicine, the etiology and pathogenesis of Acne is clearly not identified, but there are most significant pathogenic factors of blood heat depression stagnation. So it appears in skin. In Western medicine, the etiology and pathogenesis of Acne is clearly not identified, but there are most significant pathogenic factors of Acne; Androgen-stimulated production of sebum, hyperkeratinization and obstruction of sebaceous follicles, proliferation of Propionibacterium acnes and inflammation, abnormaility of skin barrier function, genetic aspects, environmental factors etc. 4. In Eastern medicine, differentiation of syndromes classifies clinical aspects, and cause and mechanism of disease; the former is papular, pustular, cystic, nodular, atrophic, comprehensive type; the latter is lung blood heat, intestine-stomach dampness-heat, phlegm-stasis depression, thoroughfare-conception disharmony, heat toxin type. In Western medicine, it divides into an etiology and invasion period, and clinical aspects; Acne neonatorum, Acne infantum, Acne in puberty and adulthood, Acne venenata; Acne vulgaris, Acne conglobata, Acne fulminans, Acne keloidalis. 5. In Eastern medicine, Internal methods of treatment of Acne are divided into five treatments; general treatments, the treatments of single-medicine and experiential description, the treatments depending on the cause and mechanism of disease, and clinical differentiation of syndromes, dietary treatments. In Western medicine, it is a basic principles that regulation on production of sebum, correction on hyperkeratinization of sebaceous follicles, decrease of Propionibacterium acnes colony and control of inflammation reaction. Internal methods of treatment of Acne are antibiotics, retinoids, hormone preparations etc. 6. In Eastern medicine, external methods of treatment of Acne are wet compress method, paste preparation method, powder preparation method, pill preparation method, acupuncture and moxibustion therapy, ear acupuncture therapy, prevention and notice, and so on. In Western medicine, external method of treatments of Acne are divided into topical therapy and other surgical therapies. Topical therapy is used such as antibiotics, sebum regulators, topical vitamin A medicines etc and other surgical therapies are used such as surgical treatments, intralesional injection of corticosteroids, skin dermabrasion, phototherapy, photodynamic therapy, and so on. Conclusions : Until now, there is no perfect, effective single treatment. We think that Eastern medicine approach and treatment can be helpful to overcome the limitations of acne cure.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.35 no.6
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• pp.360-367
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• 2013

Purpose: The purpose of this study was to perform three-dimensional (3D) assessment of facial soft tissue in patients with skeletal Class III and mandibular asymmetry after orthognathic surgery. Methods: Samples consisted of 3D facial images obtained from five patients with A point-nasion-B point angle less than 2 degrees, and more than 5 mm of menton deviation. All patients had been treated at Gangneung-Wonju National University Dental Hospital from 2009 to 2012. They had undergone orthognathic surgery of Lefort I, and sagittal split osteotomy for correction of skeletal deformity, and orthodontic treatment. Facial scanning was performed before treatment (T1) and post-surgical orthodontic treatment (T2). Linear and angle variables of soft tissue landmarks, antero-posterior facial depth, and facial volume were measured. Results: No significant differences in width of the alar base, mouth width, and nasal canting were observed between T1 and T2. However, lip deviation, menton deviation, alar canting, lip canting, and menton deviation angle were significantly reduced at T2. Antero-posterior facial depth on the axial plane parallel to the left cheilion was significantly reduced on the deviated side and significantly increased on the non-deviated side at T2. Volume of the lower lateral and lower medial parts of the face was reduced on the deviated side, and volume of upper lateral and lower lateral parts on the non-deviated side was significantly increased at T2. Conclusion: After orthognathic surgery, facial asymmetry of soft tissue was improved following skeletal changes, especially the mandibular region. Although the length of the alar base and mouth width did not change, lip and soft tissue menton were displaced to the medial side after treatment. Facial depth also became symmetric after treatment. Facial volume showed a decrease on the lower part of the deviated side and that on lateral parts of the non-deviated side showed an increase after treatment.

• The korean journal of orthodontics
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• v.27 no.2
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• pp.197-208
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• 1997

Class III malocclusion patients can be approached with many different types of treatment methods, and thus, each patient's problems must be accurately evaluated to allow selection of the best possible treatment method. Cephalometric analysis is an essential part of diagnosis and treatment planning of orthodontic patients, and it would certainly be helpful if reliable cephalometric guidelines could be set. The author divided 482 Class III malocclusion patients(253 males and 229 females) into fourgroups according to different types of treatment methods they have received to correct imbalance between upper and lower jaws: 1) orthopedic appliance (face mask & RPE), 2) camouflage treatment with fixed appliance, 3) surgical-orthodontic treatment, 4) cross-bite correction with removable plates/ functional appliance. Cephalometric values at the time of first clinical examination were compare among the four groups. Cephalometric analysis indicates the following results: 1)the amounts of antero-posterior and vertical skeletal discrepancies and dental compensation were greatest in surgery group 2) SNB, Wits, distance from Nasion Perpendicular Plane to point a facial angle, facial convexity, and APDI were greater in orthopedic appliance group than fixed appliance(camouflage) group, but there was no statistical difference 3) removable plates/ functional appliance group showed least amounts of skeletal discrepancies and dental compensation with statistical significance.