ABSTRACT
The number of cancer survivors is increasing dramatically. Many cancer survivors face lifetime risks associated with their cancer therapy, with a significant proportion at risk for serious morbidity and premature mortality. Concerns regarding the long-term physical, psychosocial, and economic effects of cancer treatment on cancer survivors and their families are increasingly being recognized and addressed by public and private sector. This article summarizes economic burden of cancer survivors, main post-treatment health problems including secondary primary cancer and comorbidities, health behaviors such as smoking, exercise and physical activity, nutrition, and psychosocial problems. Faced with various health and psychosocial problems specific to this population, several healthcare and policy models are being suggested to address these issues, including 'shared care model' and 'integrative supportive care service delivery system for cancer survivors'. More effort is needed to make the cancer survivorship agenda a reality, attended by a wide variety of stakeholders including researchers, patients, providers, and policy makers.
Subject(s)
Humans , Delivery of Health Care , Health Behavior , Health Services Needs and Demand , Mental Health , Neoplasms/economics , Neoplasms, Second Primary/epidemiology , Public Health , Republic of KoreaABSTRACT
A cosmetic incision for minimal invasive cardiac surgery is described. Through a small submammary skin incision combined with partial low sternotomy some kinds of cardiac operations are possible without extra-difficulty but with excellent cosmetic effect, No special instruments nor techniques are required. By this method routine cannulations for cardiopulmonary bypass as well as aortic cross clamping bicaval snaring and venting of cardiac chambers are possible, We performed 5 cases of open heart surgeries using this approach which includes two cases of atrial septal defect closure one case of ventricular septal defect closure one case of pulmonic valvotomy and one case of mitral valve replacement.
Subject(s)
Cardiopulmonary Bypass , Catheterization , Constriction , Heart , Heart Septal Defects, Atrial , Heart Septal Defects, Ventricular , Mitral Valve , Skin , SNARE Proteins , Sternotomy , Thoracic SurgeryABSTRACT
BACKGROUND: Funnel chest is one of the most common anomaly of chest wall, which is manifested by depression of sternum and costal cartilage. Popular operative methods were Ravitch operation and Wada operation. MATERIAL AND METHOD: From 1983 to 1996, 21 cases of funnel chest were corrected surgically in the department of thoracic surgery, National Medical Center. Investigated age and sex distribution, combined anomaly,clinical symptom, degree of correction and complication, postoperative satisfaction. We used 2 different surgical methods, one was Wada & its variants(17 cases), the other was Ravitch and it variants(4 cases). Most of operative indications were cosmetic problems. RESULT: The pre-operative Welch index was 4.188, but this index decreased to 3.46 after the operations.(p=0.046) The degree of correction was higher in Wada & it variant operation than the modified Ravitch operation.(p=0.54) Their results were satisfactory in 20 patients, while unsatisfactory in 1 patient because of a k-wire fracture. There was no recurrence of chest wall depression or postoperative death during the OPD follow up period. CONCLUSION: We recommend Wada operation in symmetric and small degree of depressive chest wall deformity in preand post school age.
Subject(s)
Humans , Cartilage , Congenital Abnormalities , Depression , Follow-Up Studies , Funnel Chest , Postoperative Complications , Recurrence , Sex Distribution , Sternum , Thoracic Surgery , Thoracic WallABSTRACT
BACKGROUND: In spite of the development of chemotherapy, prognosis of metastatic lung cancer was poor. On the other hand, surgical intervention has proven itself to bring out superior results, therefore more operations are being praticed based on this superiority against chemotherapy and other modalities on metastatic lung cancer. MATERIAL AND METHOD: We analyzed the surgical cases performed from 1983 to 1997 on 17 cases and estimated 5 year survival rate using Kaplan-Meier method. RESULT: Average age was 42.8, ratio between male and female was 10:7. We had 8 single lobe resections,3 pneumonectomies,1 wedge resection,2 bilobectomy and 3 cases of lobar resection with wedge resection. 5 deaths have occured and among the 5, 3 patients were caused by recurrence of ca. The remaining 12 patients are being followed up in OPD basis among these, 3 recurrence were observed and 9 are still free of cancer. The average survival time was 40.5 months and 5 year survival rate obtained through the Kaplan-Meier method was 60.4%. CONCLUSION: Even though we are a bit short of cases, we recommend that a thoracic surgeon approach this disease through a surgical method as possibly as he could.
Subject(s)
Female , Humans , Male , Drug Therapy , Hand , Lung Neoplasms , Lung , Neoplasm Metastasis , Prognosis , Recurrence , Survival RateABSTRACT
Bronchogenic cyst is an uncommon congenital lesion which is derived from the primitive foregut. Most bronchogenic cyst may develope at the tracheal bifurcation, both main bronchi, the lung parenchymeand the mediastinum. A 40-year old male was evaluated for dyspnea and chest tightness. Computed tomography revealed a well dermarcated, 7.2 x 7.9 cm sized, homogeneous mass compressing the left atrium. 2D-echo showed grade III mitral regurgitation. We completely removed the cystic mass and then confirmed the bronchogenic cyst in the pathological diagnosis. During the follow up period, the patient progressed well without any symptoms and showed grade I mitral regurgitation on the 2D-Echo. Therefore, we report a case of the bronchogenic cyst causing grade III mitral regurgitation.
Subject(s)
Adult , Humans , Male , Bronchi , Bronchogenic Cyst , Diagnosis , Dyspnea , Follow-Up Studies , Heart Atria , Lung , Mediastinum , Mitral Valve Insufficiency , ThoraxABSTRACT
Partial anomalous pulmonary venous connection is frequently found in any ASD(atrial septal defect) patients. These patients are usually symptomatic, therefore, easily diagnosed as just simple ASD. We experienced a case of a 37-year-old female patient with ASD in which the left upper pulmonary vein was connected to SVC by the left inominate vein. The patient was diagnosed as simple ASD previously. During cardiac catheterization, we found a meaningful oxygen saturation step up between the SVC and its upper portion. Angiogram confirmed PAPVC. The surgical correction of anastomosis of PAPVC with left atrial appendage and direct closure of ASD were done. The patient was discharged 15 days later.
Subject(s)
Adult , Female , Humans , Atrial Appendage , Cardiac Catheterization , Cardiac Catheters , Heart Septal Defects, Atrial , Oxygen , Pulmonary Veins , VeinsABSTRACT
A case of esophagopleural fistula after pleuropneumonectomy is reported. A 59 years old male underwent right pleuropneumonectomy due to tuberculous empyema. The postoperative small esophagopleural fistula was confirmed by esophagogram and was initially managed by a conservative treatment. There was a persistent fistula on follow up esophagogram, therefore we planned the next treatment modality for obstruction of the fistula. For poor general conditions and arrhythmia, an esophageal stent was applied as a non-surgical method. At first, a covered-form stent was inserted, but it migrated to the stomach after 3 months. By using an uncovered-form stent, a complete obstruction of the esophagopleural fistula was achieved.
Subject(s)
Humans , Male , Middle Aged , Arrhythmias, Cardiac , Empyema, Tuberculous , Esophageal Fistula , Fistula , Follow-Up Studies , Pneumonectomy , Stents , StomachABSTRACT
BACKGROUND: Left main coronary artery (LMCA) angioplasty is another option in the surgical treatment for LMCA disease because of its advantages over the conventional coronary artery bypass grafting (CABG). MATERIAL AND METHOD: Between July 1994 and December 1997, 15 patients underwent left main coronary angioplasty for the stenoses of LMCA. There were 8 males and 7 females with the mean age of 53.3+/-8.8 years. The locations of the LMCA stenoses were proximal one-third of the LMCA in 9, middle one-third in 1, distal one-third in 3, and the whole length of the LMCA in 2 cases. Nine patients had peripheral coronary lesions in addition to the LMCA stenosis. The LMCA was approached anteriorly with or without transsection of the main pulmonary artery. The angioplasty was performed with onlay patch widening using an autologous pericardium (14 cases) or saphenous vein (1 case). Additional graftings were required in 9 cases, and both LMCA angioplasty and right coronary ostial angioplasty were done in 1 case. RESULT: There was no operative mortality. One case needed redo CABG due to the stenosis of the angioplasty site which developed 4 months postoperatively. Coronary angiography was performed in 8 cases one year postoperatively, and revealed good patency of the angioplasty site except for one who showed 50% stenosis at the angioplasty site. No patient complained of angina with a mean follow up of 23+/-11 months. CONCLUSION: Surgical angioplasty of the LMCA stenosis can be performed in selected cases with safety and good mid-term results.
Subject(s)
Female , Humans , Male , Angioplasty , Constriction, Pathologic , Coronary Angiography , Coronary Artery Bypass , Coronary Artery Disease , Coronary Stenosis , Coronary Vessels , Follow-Up Studies , Inlays , Mortality , Pericardium , Pulmonary Artery , Saphenous Vein , TransplantsABSTRACT
BACKGROUND: Post-pneumonectomy empyema(PPE) is an uncommon but a serious complication. The management remains as challenge for general thoracic surgeons. MATERIAL AND METHOD: During the period of January 1990 to December 1996, we evaluated the results of 20 patients with post-pneumonectomy empyema. RESULT: Sex ratio were 15 male and 5 female patients with mean age of 41.5+/-21.5 yrs. The occurrence ratio of left to right side was 8:12. The most common disease for prior pneumonectomy was pulmonary tuberculosis. The duration between pneumonectomy and PPE was variable in 1 month to 6yrs. Fever was the most frequent symptom and S. aureus was the most frequent pathogen. In 13 cases, there were combined with BPF. Four patients underwent trans-sternal closure, and Clagett procedure was performed. There was one recurrence that later underwent muscle plombage and omentopexy later. Nine patients underwent omentopexy, muscle plombage and thoracoplasty. There were 7 cases that were not combined with BPF. All 7 patients underwent thoracoplasty, and two of them were combined with muscle plombage. Mean follow-up duration is 40+/-32.3 months. There were no late deaths nor recurrences of PPE. CONCLUSION: We conclude that early diagnosis and proper drainage in PPE patients are important in its initial stage of management, and also management is completely achieved in thoracoplasty with muscle plombage or omentopexy.
Subject(s)
Female , Humans , Male , Drainage , Early Diagnosis , Empyema , Fever , Follow-Up Studies , Pneumonectomy , Recurrence , Sex Ratio , Thoracoplasty , Tuberculosis, PulmonaryABSTRACT
Purpose of the study. The purpose of this study was to evaluate the result of treatment of the infected total knee arthroplasty by two-stage revision. Material. Out of twenty eight total knee arthroplasty revisions, 13 revisions were performed for infected total knee arthroplasties between 1985 and l.996. Two cases of infected total knee arthroplasties were treated by immediate replacement and four cases by arthrodesis. Seven infected total knee arthroplasties had been revised by two-stage revision and followed-up for 38.6 months in average (range, 18-105 months). They were one male and six female patients of 61.6 years old in average. The primary cause of arthroplasty was osteoarthritis in all. Infection was diagnosed by preoperative aspiration, culture of the pus from draining sinus and culture of surgical specimen. Five cases revealed positive growth of causative bacteria, while two were not identified. METHOD: The protocol for two-stage revision began with tbe removal of infected implants and cement. The surrounding bony and soft tissue were thoroughly debrided and cleaned. The dead space between femur and tibia was filled with antibiotics-impregnated cement spacer and beads. Wound was closed and the leg was placed in soft knee brace. Patients received intravenous antibiotic therapy based on culture results for 4-6 weeks. Reimplantation was followed using total condylar prosthesis of posterior stabilizing type in five and semiconstrained type in two cases. RESULT: Two-stage revision was successful in six cases. One case revealed the recurrence of infection eleven months after reimplantation and underwent the repetition of the same two-stage procedure. At the final follow-up, the average Hospital for Special Surgery score was 81.l points, the average Knee Society knee score was 78.6 points and the average functional score was 76.7 points. Patients could regain average 100 degrees of knee flexion. CONCLUSION: The result of two-stage revision for infected total knee arthroplasty was satisfactory, showing that this can be the method of choice for infection treatment and functional restoration. This procedure using antibiotics-impregnated cement spacer and beads can control infection and improve functional results.
Subject(s)
Female , Humans , Male , Anti-Bacterial Agents , Arthrodesis , Arthroplasty , Bacteria , Braces , Femur , Follow-Up Studies , Knee , Leg , Osteoarthritis , Prostheses and Implants , Recurrence , Replantation , Suppuration , Tibia , Wounds and InjuriesABSTRACT
The partial splenectomy was performed on the basis of the arterial distribution in order to reduce complications. The spleen consists of the various histologic components that have different functions. But we can not find the reports whether the distribution of red pulp, white pulp and trabecula is uniform or not according to the regions of the spleen. We used 15 spleens from Korean[male 8, female 7 and age 17-74]. The volume was measured with the mass cylinder. The 1cm3 blocks were selected in 5 different regions. Whole splenic slices by celloidin embedding were made from two spleens. The point counting method with eyepeice reticule was used for the measurement of the distribution of red pulp, white pulp and trabecula. The results were as follows : 1. The volume of the spleen was ranged 45-158ml and the individual difference was marked. The male spleen was larger than female`s [p<0.05]. 2. The ratio of red pulp, white pulp and trabecula of the paraffin embedding preparations was 83.2, 10.9, and 5.9% respectively. There was no significant difference in the distribution of the histologic components among five regions[upper, hilum, middle, outer, and lower]. 3. The distribution of red and white pulps in whole splenic slices was not uniformity. The ratio of red pulp, white pulp and trabecula in whole splenic slices was 80.1, 13.4 and 6.5% respectively. These results showed no significant difference with those of five regions of the spleen.
Subject(s)
Female , Humans , Male , Collodion , Individuality , Paraffin Embedding , Spleen , SplenectomyABSTRACT
Ninety-three dry mandibles in Korean adults were radiographed and fifty-two hemimandibles were sectioned in an attempt to analyze the intramandibular courses of the mandibular canal and the internal structure of the mandibles. On radiographs, the intramandibular course of the mandibular canals was most in which located in the middle portion of the mandible, the shape of the mandibular canals was almost round and the average diameter of the mandibular canals was 2.0 +/- 0.4mm, encapsulated by thin cortical plates of 0.5mm thickness on sectioned specimens. In regard of facio-lingual relation, the prevalence of pattern which the mandibular canal ran nearly to the lingual cortical plate, and turned abruptly towards the buccal side was 70% of observed specimens. According to superior-inferior relation, the prevalence in which mandibular canals ran inferiorly, anteriorly and then, had an angle superiorly in the second mandibular molar region was 39.0%. Taken all together, in most of the case, the anterior border of the mandibular canal is located around the premolar region, and the mental foramen is opened nearly the second premolar. Therefore, it may be suggested that osteotomy has to be taken at the anterior place next to the canine region, at the 2.4mm below to the mental foramen on genioplasty.
Subject(s)
Adult , Humans , Bicuspid , Genioplasty , Mandible , Molar , Osteotomy , Prevalence , RadiographyABSTRACT
A casts of Barrett's esophagus complicated with stricture is reported. A 82 years old male was undergone distal esophagectomy and esophagogastrostomy on suspicion of malignancy. The microscopic examination of specimen taken from the lesion revealed the "tall columnar cells" which were indicative of Barrett's esophagus, hence the diagnosis. Barrett's esophagus is a rare disease in Korea. Because of the malignant potential of the disease, surgery involving esophagectomy is often required.
Subject(s)
Aged, 80 and over , Humans , Male , Barrett Esophagus , Constriction, Pathologic , Diagnosis , Esophageal Stenosis , Esophagectomy , Korea , Rare DiseasesABSTRACT
Nonimmune hydrops fetals is defined as generalized edema of the fetal soft tissue in utero and may be associated with effusion in the serous cavities without hematologic evidence of isoimmunization. The most common demonstrable causes are cardiac anomalies, followed by chromosomal disorders, congenital malformations, alpha-thalassemia, and the twin-twin transfu-sion syndrome. We have experienced a case of nonimmune hydrops fetalis in identical twin which caused by congenital mitral valve insufficiency and disappeared spontaneously at 35 wks. Now we report a case of nonimmune hydrops fetalis that slowly and spontaneously imp-roved without interventions with a brief review of related literatures.