Retinal Nerve Fiber Layer Thickness Measurement Using Swept Source Optical Coherence Tomography in Healthy Korean

PURPOSE: To investigate retinal nerve fiber layer (RNFL) thickness using swept source (SS)-optical coherence tomography (OCT) in healthy Koreans and to evaluate the effects of age on the distributional variability of thickness. METHODS: We performed a retrospective review of 309 normal eyes presenting for examination of peripapillary nerve fiber layer thickness measured by SS-OCT (DRI OCT-1, Atlantis SS-OCT, Topcon, Tokyo, Japan) from July 2014 to February 2016. The patients were between the ages of 20 and 79 without systemic or ocular disease. The patients were divided into 3 age groups of 20 to 39 years (85 eyes), 40 to 59 years (140 eyes), and 60 to 79 years (84 eyes). The groups were matched based on average RNFL thickness and quadrant and 12 o'clock position RNFL thickness. RESULTS: The average RNFL thickness of the inferior quadrant was the thickest of the layers and revealed a bimodal distribution. In the three groups, the thicknesses of the average RNFL, quadrant, and 12 o'clock RNFL decreased with age. There was significant difference in the measurements (p < 0.05) of quadrant RNFL thickness except that in the nasal quadrant (p = 0.068). CONCLUSIONS: The thickness of the circumpapillary retinal nerve fiber layer measured by SS-OCT differs according to age and analysis of normal values by age can be useful in the diagnosis of disease.

Retinal Nerve Fiber Layer Thickness Measurement Using Swept Source Optical Coherence Tomography in Healthy Korean

PURPOSE: To investigate retinal nerve fiber layer (RNFL) thickness using swept source (SS)-optical coherence tomography (OCT) in healthy Koreans and to evaluate the effects of age on the distributional variability of thickness. METHODS: We performed a retrospective review of 309 normal eyes presenting for examination of peripapillary nerve fiber layer thickness measured by SS-OCT (DRI OCT-1, Atlantis SS-OCT, Topcon, Tokyo, Japan) from July 2014 to February 2016. The patients were between the ages of 20 and 79 without systemic or ocular disease. The patients were divided into 3 age groups of 20 to 39 years (85 eyes), 40 to 59 years (140 eyes), and 60 to 79 years (84 eyes). The groups were matched based on average RNFL thickness and quadrant and 12 o'clock position RNFL thickness. RESULTS: The average RNFL thickness of the inferior quadrant was the thickest of the layers and revealed a bimodal distribution. In the three groups, the thicknesses of the average RNFL, quadrant, and 12 o'clock RNFL decreased with age. There was significant difference in the measurements (p < 0.05) of quadrant RNFL thickness except that in the nasal quadrant (p = 0.068). CONCLUSIONS: The thickness of the circumpapillary retinal nerve fiber layer measured by SS-OCT differs according to age and analysis of normal values by age can be useful in the diagnosis of disease.

Fundus Photography with a Smartphone

PURPOSE: To evaluate the clinical usefulness, convenience, and possibility of using the medical records of fundus photography with a smartphone. METHODS: We used an ophthalmoscope to examine the images using a smartphone (iphone 6, Apple Inc., Cupertino, CA, USA) and +20D and +28D condensing lenses. Twenty-four subjects were selected for comparison with the conventional funduscopic camera. The posterior pole of the 45° range of the right eye and the fundus photograph taken using the smartphone were analyzed. We measured the distances between specific points on three photographs taken of the patient and calculated the photographing range. RESULTS: The +20 D lens was 0.80 ± 0.06 times smaller than that of the fundus camera and +1.12 ± 0.06 times bigger than that of the fundus photograph. When the area of the funduscope was converted to 45°, +20 D could visualize an area of 36.10 ± 2.82°, and +28 D could visualize a 50.56 ± 2.68° area. CONCLUSIONS: Without expensive equipment, a smart phone and a condensing lens can be used to easily perform fundus examination without the need for a special technique. Therefore, this technique is not only useful clinically, but also is very convenient for keeping medical records as fundus photographs.

Primary Malignant Fibrous Histiocytoma of the Pleura / 결핵및호흡기질환

Malignant fibrous histiocytoma, a type of sarcoma, is a malignant neoplasm with uncertain origin that arises in both the soft tissues and the bone. The occurrence of primary malignant fibrous histiocytoma of the pleura is extremely rare. We report a case of a 65-year-old Korean man who is being diagnosed with primary malignant fibrous histiocytoma of the pleura.

Neuropsychological Characteristics of Mild Cognitive Impairment with Late life Depression

OBJECTIVES: The depression in the elderly often accompany with cognitive decline and the mild cognitive impairment (MCI) commonly accompany with depressive symptoms. This study was performed to compare the differences in neuropsychological characteristics between the MCI without depression and the MCI with depression. METHODS: The subjects for this study were 366 MCI patient who enrolled through 'Clinical Research Center for Dementia of South Korea (CREDOS) study' gathered between December, 2005 and February, 2011. We divided the MCI patient into non-depressed group (n=187) and depressed group (n=179), and evaluated each cognitive domain with the Seoul Neuropsychological Screening Battery (SNSB) and analyzed the two group. RESULTS: In the depressed group compared to the non-depressed group, Korean version of Mini-mental State Examination (K-MMSE) scores were lower (p<0.05), and Instrumental Activities of Daily Living (I-ADL) impairment was pronounced (p<0.05). In SNSB, the test scores of the two groups had similar levels on memory (p=0.403), language domain (p=0.098). But the test scores on attention (p<0.05), visuospatial function (p<0.05), executive function (p<0.05) domain in depression group was significantly lower than in non-depression group. CONCLUSION: This study shows differences in the clinical feature and neuropsychologic characteristics between the two different situations. MCI subjects with coexisting depression showed severer cognitive decline and had multiple cognitive domain impairment rather than single memory domain impairment.

The Role and Significance of Biomarker for Plasma G-CSF in Patients with Primary Lung Cancer / 결핵및호흡기질환

BACKGROUND: Biomarkers for cancer have several potential clinical uses, including the following: early cancer detection, monitoring for recurrence prognostication, and risk stratification. However, no biomarker has been shown to have adequate sensitivity and specificity. Many investigators have tried to validate biomarkers for the early detection and recurrence of lung cancer. To evaluate plasma G-CSF as such a biomarker, protein levels were measured and were found to correlate with the clinicopathological features of primary lung tumors. METHODS: Between December 2006 and May 2008, 100 patients with histologically-validated primary lung cancer were enrolled into this study. To serve as controls, 127 healthy volunteers were enrolled into this study. Plasma G-CSF levels were measured in lung cancer patients using the sandwich ELISA system (R & D inc.) prior to treatment. RESULTS: The mean plasma G-CSF levels were 12.2+/-0.3 pg/mL and 46.0+/-3.8 pg/mL (mean+/-SE) in the normal and in the cancer groups, respectively. In addition, plasma G-CSF levels were higher in patients with early lung cancer than in healthy volunteers (p<.001). Plasma G-CSF levels were higher in patients who were under 65 years old or smokers. Within the cancer group, plasma G-CSF levels were higher in patients with non small cell lung cancer than in patients with small cell lung cancer (p<.05). Overall, plasma G-CSF levels were shown to increase dependent upon the type of lung cancer diagnsosed. In the order from highest to lowest, the levels of plasma G-CSF tended to decrease in the following order: large cell carcinoma, squamous cell carcinoma, adenocarcinoma, and bronchioloalveolar carcinoma. Plasma G-CSF levels tended to be higher in patients with advanced TNM stage than in localized TNM stage (I, II

Outpatient Chest Tube Management with Using a Panda Pneumothorax Set with a Heimlich Valve / 대한흉부외과학회지

BACKGROUND: Prolonged air leakage and pleural fluid drainage from a chest tube may delay removing the chest tube after a patient undergoes video-assisted thoracoscopic wedge resection and the patient is otherwise ready for discharge. We reviewed 37 outpatients patients who were being managed with a postoperative chest tube (a Panda Pneumothorax set with a Heimlich valve). MATERIAL AND METHOD: From January 2005 to December 2007, 294 patients underwent video-assisted thoracoscopic wedge resections & pleurodesis. Of them, 37 patients met the criteria for outpatient chest drainage management with using a Panda Pneumothorax set with a Heimlich valve. The patients received written instructions, and they demonstrated competence with using the Panda system. The patients returned for chest tube removal after satisfactory resolution of their air leak and pleural fluid drainage. RESULT: The patients discharged with a Panda pneumothorax set had a longer duration of hospital stay (mean: 10.3+/-1.7 days, range: 11 to 17 days) as compared with the patients without a Panda pneumothorax set (mean: 6.2+/-1.5 days, range: 4 to 7 days). The chest tube was removed successfully from the patients with a Panda pneumothorax set at an average of 9.8+/-1.6 days (range: 9~18 days) after discharge. There were no major complications. Four patients experienced minor complications. Thirty six patients (97.3%) experienced uneventful and successful outpatient chest tube management. CONCLUSION: Successful postoperative outpatient chest tube management with using the Panda set was accomplished in 36 selected patients. This program resulted in a substantially reduced hospital cost and enhanced patient satisfaction by allowing earlier discharge.

Clinical Results Following T3, 4 vs T3 Thoracoscopic Sympathicotomy in 30 Axillary Hyperhidrosis Patients / 대한흉부외과학회지

BACKGROUND: Video-assisted thoracic sympathicotomy is a definitive minimally invasive treatment for axillary hyperhidrosis. Different techniques exist for controlling axillary hyperhidrosis, but they are temporary and expensive. We compared the results after using two different levels of sympathicotomy for treating axillary hyperhidrosis: T3-T4 and T4. MATERIAL AND METHOD: Between June 2002 and May 2007, 30 patients with isolated axillary hyperhidrosis underwent either T3-T4 or T4 thoracoscopic sympathicotomy in the Department of Thoracic & Cardiovascular Surgery at Wonkwang University Hospital. The patients were divided into two groups. Group I (n=15) was composed of patients who underwent T3-T4 sympathicotomy (thermal ablation), and Group II (n=15) was composed of patients who underwent T4 sympathicotomy (thermal ablation). The procedures were bilateral and simultaneous, involving the use of two 2-mm trocars and a 0-degree 2-mm thoracoscope under general anesthesia with single endotracheal intubation. Outcome parameters included satisfaction rate of treatment, degree of compensatory sweating, and postoperative complications. Patients were interviewed by telephone regarding satisfaction and compensatory hyperhidrosis. RESULT: There were no differences in age between group I and group II. The mean follow-up for the T3-T4 group was 38.7+/-2.3 months, and the mean follow-up for the T4 group was 18.7+/-3.6 months. The immediate therapeutic success rate (within 2 weeks postoperative) was 100% in both groups, and there were no recurrences in either group during the long-term follow-up period. The satisfaction rate was higher (93.3%) in the T4 group than in the T3-T4 group (53.3%), and the incidence of compensatory hyperhidrosis was lower in the T4 group (6.7%) than in the T3-T4 group (46.7%). Postoperative complications included one mild pneumothorax and two instances of intercostal neuralgia. Digital infrared thermographic imaging (DITI) correlated well with postoperative satisfaction. CONCLUSION: Both techniques proved effective for controlling isolated axillary hyperhidrosis. The T4 group had a higher satisfaction rate and lower severity of compensatory hyperhidrosis. Hence, thermal ablation of the lower interganglionic fibers of the third thoracic sympathetic ganglion on the fourth rib is a more practical and minimally invasive treatment than is the T3-T4 surgical method, according to the degree of compensatory sweating in isolated axillary hyperhidrosis.

Maternal Parenting Stress and Sense of Competence in Children with Seizure Disorders / 신경정신의학

OBJECTIVES: While parents who foster children with epilepsy would have considerable parenting difficulties, the parenting stress and sense of competence have not been investigated. We investigated maternal parenting stress, parenting satisfaction and sense of parenting competence in children with seizure disorders, and the associations with seizure-related variables. METHODS: Mothers of 79 children with seizure disorders (41 boys, 38 girls; mean age, 9.9+/-2.3 years) and 79 healthy comparison subjects matched for age and sex were recruited for this study. The Korean version of the Parenting Stress Index (K-PSI-SF) and the Parenting Sense of Competence (K-PSOC) were used to assess parenting stress, parenting satisfaction and parenting efficacy. RESULTS: Mothers of children with seizure disorders showed higher scores on stress related to difficult child and child learning and parenting anxiety compared to mothers of healthy children. In addition, scores on stress related to parental-child interaction and child learning were significantly associated with parental economic status. Scores on stress from parental-child interaction was also correlated with seizure severity, and stress from child learning was correlated with seizure type. Sense of parenting competence and anxiety scores were correlated with paternal educational status, respectively. CONCLUSION: These findings suggest that mothers of children with epilepsy have greater parenting stress and anxiety and social and seizure-associated factors may affect the parenting stress and anxiety.

Clinical Results Following Early Tailoring Thoracoplasty in Patients Undergoing Pulmonary Resection / 대한흉부외과학회지

BACKGROUND: Thoracoplasty has become a rarity in current clinical practice, although it has been widely employed for well over a century as a procedure for reducing the capacity of the thoracic cavity. Yet we have perform tailoring thoracoplasty following or concomitant with pulmonary resection in 20 patients. The aim of this study is to evaluate the early and late clinical results and also the significance of tailoring thoracoplasty. MATERIAL AND METHOD: From March 1995 to June 2005, modified thoracoplasty following or concomitant with pulmonary resection was performed in 20 patients out of a total of 298 pulmonary resections for closing air leaks and for treating persistent pleural space following pulmonary resections, and to tailor the thoracic cavity to accept a diminished lung volume. Of the 20 patients, 14 patients had tailoring thoracoplasty performed concomitant with pulmonary resection, and the remaining 6 patients also had tailoring thoracoplasty performed following pulmonary resection. The subjects ages ranged from 24 to 77 (mean 59.1+/-6.4) and a male preponderance was noted (17:3); the number of left and right surgeries was equal. The preoperative primary underlying diseases were lung cancer in 7 patients, pneumothorax with giant bullous change in 6 patients, bronchiectasis in 2 patients, previous pulmonary tuberculosis associated with aspergilloma in 2 patients, empyema with fibrothorax in 2 patients and multiple lung abscesses & destruction due to previous trauma in 1 patient. The operative methods were apicolysis and subperiosteal removal of the 2nd, 3rd and 4th ribs (the costochondral junction to the posterior portions of the ribs) with preservation of the first rib and compression of the anterior chest via cotton bags and elastic bandages. RESULT: The mean duration of the air leaks after thoracoplasty was 1.6+/-0.2 days (range: 0~7 days) and the mean duration of an indwelling chest tube was 7 days (range: 5~11 days); the mean duration of hospitalization was 19.2+/-2.8 days (range: 8~47 days). The postoperative complications were wound infection (2) and pneumonia (2); reoperation was done due to bleeding (1) in one patient who underwent concomitant thoracoplasty and there was 1 case of wound infection (1) after postresection thoracoplasty. The mortality was 1 patient in the early phase and 4 patients in the late phase. CONCLUSION: We conclude that tailoring thoracoplasty may be performed to close anticipated persistent pleural spaces and to accommodate the diminished lung volume with acceptable cosmetic results when this procedure is combined with pulmonary resection in selected patients.

An analysis of HPV subtype in the uterine cervix and clinical usefulness of HPV DNA chip test / 대한산부인과학회지

OBJECTIVE: Human papillomavirus (HPV) has been identified more than 100 HPV subtypes. The distributions of subtypes are different according to nations and regions. We analysed subtype of infection with HPV among women who live in Pusan and surburbs of Pusan. We accessed the clinical usefulness of HPV DNA chip test as a supplementary method of Pap smear in the evaluation of cervical lesion. METHOD: This study was undertaken from January 2002 to January 2005 and the samples were collected from the patients who had abnormal Pap smear. We analysed subtypes of 143 positive cases with HPV DNA chip (Biomedlab) test and estimated pathologic reports of 115 patients except 28 patients who had not biopsy. We investigated pathologic results of 54 of 115 patients who had atypical squamous cells / low grade squamous intraepithelial lesion (ASC/LSIL) in Pap smear and examined high risk HPV in 54 pathologic results. RESULTS: The prevalence of HPV subtypes was 42 cases of HPV-16, 20 cases of HPV- 58, 16 cases of HPV-52, 10 cases of HPV-35, 9 cases of HPV-56, 7 cases of HPV-51, 6 cases of HPV-18 in descending order of incidence in high risk HPV group and 3 cases of HPV-6, 3 cases of HPV-42, 2 cases of HPV-34, 2 cases of HPV-43 in descending order of incidence in low risk HPV group. The results of HPV DNA chip test and 115 pathologic reports were estimated by comparative study. A pure infection with low risk HPV group was detected in low grade lesion. Infection with high risk HPV group was also detected in low grade lesion but was mainly detected in high grade lesion. The pathologic results of 54 patients who had ASC / LSIL in Pap smear were 13 patients had above high grade lesion include 2 cases of invasive carcinoma so false negative rate of Pap smear in the detection of high grade lesion was 24%. CONCLUSION: HPV subtypes were detected HPV 16, 58, 52, 35, 56, 51, 18 types in descending order of incidence and prevalence. Mass study and integrated data from larger population and various regions in many hospitals will be needed. And the supplementary use of HPV DNA chip test may provide clinical usefulness because it can reduce the false negative rate of Pap smear and improve the positive predictive value in the detection of high grade cervical lesion and it enables to decrease the incidence of cervical cancer.

A Case of Post-total hysterectomy with bilat. salpingooophorectomy Retroperitoneal Endometrial Stromal Sarcoma / 대한산부인과학회지

Endometrial stromal sarcoma (ESS) is a relatively rare form of uterine sarcoma. Endometrial stromal sarcoma (ESS) of the myometrium compose just 0.2% of uterine malignant tumors. Low-grade stromal sarcoma has extended beyond the uterus in 40% of cases at the time of diagnosis, but the extra-uterine spread is confined to the pelvis in two thirds of the cases. A few cases of extra-uterine endometrial stromal sarcoma have been reported in literature concerning the ovary and pelvis. We have experienced a Post-total hysterectomy with bilateral salpingooophorectomy retroperitoneal endometrial stromal sarcoma, so we report this case with a brief review of literature.

Myxofibrosarcoma Originating from Chest Wall / 대한흉부외과학회지

Myxofibrosarcoma represents one of the most common soft tissue sarcomas of the extremities in adult and elderly patients. However, it only rarely occurs in the chest wall. A 58 years old woman presented with a huge painless lump (8x6.5 cm) in the right lower parasternal area which recurred a few months following excision from General surgery of our hospital. Histology showed an infiltrative deep seated dermal and subcutaneous tumor. It had a distinctive lobular growth pattern with prominent myxoid change and moderate cellularity. Tumor cells were spindle-shaped with varying degrees of pleomorphism and frequent mitotic figures. Numerous blood vessels with curvilinear growth pattern were also seen. Immunostains for S-100, CD68, Mac 387, and FX IIIa were all negative, but positive for Vimentin. The histologic feature was of an intermediate grade myxofibrosarcoma. Wide excision was performed and recovered in good condition without any physical disabilities and was discharged at one month later. Currently she is waiting for the skin graft without chemotherapy and radiotherapy.

Seizure and Thyroid Dysfunction Associated with High Dose of Quetiapine: Case Report / 신경정신의학

We report a case of seizure and thyroid dysfunction in a patient receiving quetiapine. A 31-year-old Korean woman with bipolar I disorder was observed to have a seizure attack after reduction of quetiapine from 1,200 mg/day to 1,000 mg/day and discontinuance of clonazepam 1 mg/day. Her thyroid function test also showed hyperthyroidism after quetiapine use. She had no known risk factors of seizure, and no known history of lithium ingestion. The patient was taking high dose quetiapine due to her manic symptoms. Using high dose of quetiapine may have resulted in a seizure attack in our patient with bipolar I disorder. Also, in this patient, quetiapine was probably associated with hyperthyroidism. It is not common that seizure occur with atypical antipsychotics, such as quetiapine, except clozapine, but special attention is required using high dose of atypical antipsychotics.

A Preliminary Study of the Efficacy and Safety of Bupropion as the Second-Line Drug in Children with Attention Deficit Hyperactivity Disorder / 대한정신약물학회지

OBJECTIVES: This study was aimed to examine the efficacy and safety of bupropion in methylphenidate-inapplicable children with attention deficit hyperactivity disorder (ADHD) due to insufficient treatment response or intolerable adverse effects. METHODS: Twelve children (8.8+/-2.1 years, 10 boys, total IQ 105.3+/-10.7) were recruited for this study from September 2004 to August 2005. ADHD was confirmed by K-SADS-PL. The efficacy was assessed by ADHD rating scale (ADHDRS) for investigator, Conner's parental rating scale-revised (CPRS-R), ADHDRS school version, clinical global impression (CGI), and computerized neurocognitive function test. 168.8 mg (SD=85.4 mg) of bupropion was medicated for 37.4 days (SD=8.7 days). RESULTS: Total score of ADHDRS assessed by investigator (p=0.018), CGI-S score (p=0.026), CPRS-R score (p=0.018), total score (p=0.027) and inattentive score (p=0.041) of ADHDRS school version were significantly decreased after bupropion application. Six subjects (50%) were assessed as "very much improved" or "much improved" by CGI-Improvement in the end of trial. Response time of word color test was also significantly decreased after medication (p=0.043). Decreased appetite (2 subjects), weight loss (1 subject), insomnia (1 subject), anxiety (1 subject), and nausea (1 subject) were observed during this study period. CONCLUSION: Bupropion was effective and well-tolerated for the methylphenidateinapplicable children with ADHD.

Comparison of Conventional Thoracoscopic Wedge Resection and Modified Transaxillary Minithoracotomy with Thoracoscopy for the Treatment of Primary Spontaneous Pneumothorax / 대한흉부외과학회지

BACKGROUND: Retrospective study was carried out on patients with primary spontaneous pneumothorax with the aim of determining if conventional thoracoscopic wedge resection is superior to modified transaxillary minithoracotomy with thoracoscopy in the surgical treatment. MATERIALS AND METHOD: 160 patients, aged 14 to 35 years with primary spontaneous pneumothorax were involved in this study. Patients were assigned to two groups by surgical technique; Conventional thoracoscopic wedge resection (group A; n=80) and modified transaxillary minithoracotomy with thoracoscopy (group B; n=80). Apical pleural abrasion & talc poudrage were performed in all cases. This study evaluated the following factors: duration of operation, days of analgesics used after operation, number of no air leak on the first postoperative day, duration of indwelling chest tube, hospital stay, postoperative complications, chronic chest pain (during follow-up) and resumption of normal activity. Relapses (ipsilateral recurrence after discharge) during follow-up periods were evaluated. RESULT: No significant differences were found in any of the factors studied in either group. CONCLUSION: Conventional thoracoscopic wedge resection and modified transaxillary minithoracotomy with thoracoscopy offer similar results in the surgical treatment of primary spontaneous pneumothorax. The rate of complication is low and the level of pain is acceptable without long-term sequele. Therefore, modified transaxillary minithoracotomy with thoracoscopy method appears as a valuable alternative surgical technique.

Long-term Survival after CABG in Patients with Abnormal LV Wall Motion after MI / 대한흉부외과학회지

BACKGROUND: Wall motion abnormalities may be a significant predictor for long-term survival after coronary bypass surgery (CABG). The aim of this study is to see whether post-infarction wall motion abnormality of left ventricle affect on the long-term survival after CABG. MATERIAL AND METHOD: One-hundred and thirty-three patients (male/ female, 92/41) undergoing CABG more than 9 years ago were included in this study. Fifty-six patients (M/F, 42/14; mean age, 59.2+/-9.2 years) with LV wall motion abnormalities were compared to 77 patients (M/F, 50/27; mean age, 58.0+/-7.6 years) without the wall motion abnormalities. Most patients (112/133, 84.2%) had undergone on-pump CABG with the in-situ left internal thoracic artery and free grafts of saphenous vein, in which the proximal and distal anastomoses were done for the single aortic cross-clamping period. RESULT: Ejection fraction of left ventricle was lower in the group with LV wall motion abnormalities (mean ejection fraction, 48.7+/-13.2%) compared to the group without wall motion abnormalities (mean ejection fraction, 57.1+/-10.1%)(p=0.0001). Risk-unadjusted survivals after CABG in the group without wall motion abnormalities were 85.7+/-4.0%, 76.2+/-4.9%, and 57.2+/-10.3% at 5, 10, and 13 years, respectively, and in the group with wall motion abnormalities were 80.4+/-5.3%, 58.7+/-7.3%, and 51.9+/-7.9% at 5, 10, and 13 years, respectively (p=0.1). In univariate analysis, predictable factors of long-term survival in the patients with LV wall motion abnormalities were LV ejection fraction and post operative outpatient treatment. In multivariate analysis, predictable factor of long-term survival in the patients with the wall motion abnormalities was postoperative outpatient treatment, and that in those without the wall motion abnormalities was female. CONCLUSION: Although there was no significant survival difference after CABG between the group with LV wall motion abnormalities and that without wall motion abnormalities, the survival in the group with wall motion abnormalities seems to be more decreased. For the patients with LV wall motion abnormalities after myocardial infarction, the post-CABG outpatient treatment is suggested to be an important factor for the long-term survival.

Relation between Changes of DITI and Clinical Results according to the Level and Extent of Sympathicotomy in Essential Hyperhidrosis / 대한흉부외과학회지

BACKGROUND: Video-assisted sympathicotomy is a safe and effective method for the treatment of essential hyperhidrosis with immediate symptomatic improvement. However, this is offset by the occurrence of a high rate of side-effects, such as embarrassing compensatory hyperhidrosis. Therefore, by comparing and assessing the relationship between temperature change measured by DITI (digital infrared thermographic imaging) and clinical results according to the level and extent of sympathicotomy in essential hyperhidrosis. we tried to obtain a more precisely and objectively, the distribution and degree of compensatory sweating by DITI and also for ascertaining the clinical usefulness. MATERIAL AND METHOD: From January 2000 to June 2002, the thoracoscopic sympathicotomy was performed in 28 patients suffering from essential hyperhidrosis in Dept. of Thoracic and Cardiovascular Surgery, Wonkwang University Hospital. The patients were divided into four groups, Group I: patients having undergone T2 sympathicotomy, Group II: patients having undergone T3 sympathicotomy, Group III: patients having undergone T3,4 sympathicotomy, and Group IV: patients having undergone T2,3,4 sympathicotomy. The parameters were composed of the satisfaction rate of treatment, the degree of compensatory and plantar sweating, and temperature changes of entire body measured by DITI RESULT: There was no difference in age and follow-up period among the groups. All of the treated patients obtained satisfactory alleviation of essential hyperhidrosis in immediate postoperative period. However, the rate of long-term satisfaction were 85.8%, 85.8%, 42.9%, and 28.6% in group I, II, III, and IV (p<0.05). More than embarrassing compensatory sweating was present in 14.2%, 14.2%, 57.1%, 71.4% in group I, II, III, and IV (p<0.05) In regard to plantar sweating, decrease in sweating was expressed in each of four groups, but was not significant between groups. An apparent increase of temperature measured by DITI indicated sufficient denervation and predicted long-lasting relief of essential hyperhidrosis and also decrease in temperature of trunk and lower extremity by DITI had correlated well with postoperative satisfaction, and also postoperative compensatory sweating. CONCLUSION: We suggested that the incidence and degree of compensatory sweating was closely related to the site and the extent of thoracic sympathicotomy. Resection of the lower interganglionic neural fiber of the second thoracic sympathetic ganglion on the third rib is the most practical and minimally invasive treatment than other surgical methods. We were also to anticipated the distribution and degree of compensatory sweating by DITI precisely and objectively and for ascertaining the clinical usefulness.

Determination of Early Graft Patency Using CT Angiography after Coronary Artery Bypass Surgery / 대한흉부외과학회지

BACKGROUND: CT angiography is now available to evaluate the early graft patency after coronary bypass surgery. We investigated whether patency or occlusion of the bypass grafts can be visualized by CT angiography and what factors effect the visuality. MATERIAL AND METHOD: Fifty patients underwent scanning with a 4-slice computed tomographic scanner (Somatom Volume ZoomTM; Siemens, Germany) before being discharged after coronary artery bypass grafting. To evaluate graft patency and relationship between the quality of graft image and the characteristics of the diseased coronary vessels, 50 internal thoracic artery grafts, 18 radial artery grafts, and 56 vein grafts were included in this study. RESULT: All vein grafts (24 grafts; 32 anastomoses) to left coronary artery system were well visualized, but 3 grafts (4.7%) of 30 vein grafts (35 anastomoses) to right coronary artery system were not visualized. The latter was also occluded in invasive coronary angiographic study. Thirty-nine (78%) internal thoracic artery grafts were well visualized, 8 (16%) faintly visualized, and 3 (6%) not visualized, but all the internal artery grafts were well patent in invasive coronary angiographic study. CONCLUSION: Unvisualized vein grafts in CT angiography means occlusion of the grafts, but unvisualized arterial grafts in CT angiography may not mean occlusion of the graft but result from competitive flow between the graft and coronary artery. To confirm patency of the unvisualized arterial grafts, invasive coronary angiography is needed.

Vein Injury and Wound Complications Associated with Techniques of Saphenous Vein Harvest / 대한흉부외과학회지

BACKGROUND: Although arterial grafts are widely used due to the advantage of long-term patency in coronary bypass surgery, greater saphenous vein is still an important additional conduit. It was reported that preservation of the adventitia of vein graft and the adjacent tissues may bring the improved long-term graft patency. The aim of this study is to look for a harvest technique that can reduce vein injury and wound complications. MATERIAL AND METHOD: In thirty-four patients that vein grafts were used for coronary bypass surgery, 50 harvest sites were included for the study. In 25 harvest sites in calf below knee (group 1), vein was exposed through a long incision and then clearly dissected from the adjacent tissue. Ten endoscopic vein harvests were performed in the thighs (group 2). Fifteen other vein grafts that were bluntly dissected were harvested from the thighs through three separate incisions (group 3). RESULT: Vein harvest time was longest in endoscopic harvest group (44.7+/-9.8 minutes) and shortest in group 3 (24.2+/-5.9 minutes) (p=0.000). Most avulsion injuries of vein branches happened in the endoscopic group. Sequential grafting numbers per vein were 1.72+/-0.98 with thigh vein graft and 1.16+/-0.37 with calf vein (p=0.02). Swelling of foot and/or leg, which was the most common wound complication after vein harvest, was most commonly presented in group 1 (20/25 sites; p=0.000). Tingling, the most common neurologic complication, was also most prevalent in group 1 (7/25 sites; p=0.013). The risk factor of the wound complication was vein harvest from calf, and the vein harvest technique was not a risk for wound complication. CONCLUSION: Vein harvest technique through three separate incisions from thigh presented shorter harvest time and less vein injury and wound complication compared with the endoscopic harvest technique from thigh or the harvest through a long incision from calf.