Association between Medial Temporal Atrophy, White Matter Hyperintensities, Neurocognitive Functions and Activities of Daily Living in Patients with Alzheimer’s Disease and Mild Cognitive Impairment / 정신신체의학

Objectives@#：The aim of this study was to compare activities of daily living (ADLs) according to degenerative changes in brain [i.e., medial temporal lobe atrophy (MTA), white matter hyperintensities] and to examine the association between neurocognitive functions and ADLs in Korean patients with dementia due to Alzheimer's disease (AD) and mild cognitive impairment (MCI). @*Methods@#：Participants were 111 elderly subjects diagnosed with AD or MCI in this cross-sectional study. MTA in brain MRI was rated with standardized visual rating scales (Scheltens scale) and the subjects were divided into two groups according to Scheltens scale. ADLs was evaluated with the Korean version of Blessed Dementia Scale-Activity of daily living (BDS-ADL). Neurocognitive function was evaluated with the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease assessment packet (CERAD-K). Independent ttest was performed to compare ADLs with the degree of MTA. Pearson correlation and hierarchical multiple regression analyses were performed to analyze the relationship between ADLs and neurocognitive functions. @*Results@#：The group with high severity of the MTA showed significantly higher BDS-ADL scores (p<0.05). The BDS-ADL score showed the strongest correlation with the word list recognition test among sub-items of the CERAD-K test (r=-0.568). Findings from the hierarchical multiple regression analysis revealed that the scores of MMSE-K and word list recognition test were factors that predict ADLs (F=44.611, p<0.001). @*Conclusions@#：ADLs of AD and MCI patients had significant association with MTA. Our study, which identi-fies factors correlated with ADLs can provide useful information in clinical settings. Further evaluation is need-ed to confirm the association between certain brain structures and ADLs.

Comparative Study of Endoscopic Thyroidectomy: Total Thyroidectomy versus Near Total Thyroidectomy / 대한내분비외과학회지

PURPOSE: The aim of this study was to evaluate and compare the surgical outcomes of endoscopic total and near-total thyroidectomies in patients with thyroid cancer. METHODS: Between February 2000 and January 2009, among 387 patients who underwent endoscopic thyroidectomy in our hospital, we evaluated 50 patients who underwent endoscopic total or near-total thyroidectomy. Thirtyfive and 15 patients underwent endoscopic total thyroidectomy and near-total thyroidectomy, respectively. We analyzed the patients' clinicopathologic characteristics and post-operative complications between the two groups. RESULTS: The mean size of tumors was 1.08 cm (range, 0.1 ~3.5 cm) and the mean operative time was 192 minutes. Forty-nine tumors were papillary cancers and 1 tumor was a follicular cancer. Two patients in the endoscopic total thyroidectomy group underwent re-operation because of bleeding. In the near-total thyroidectomy group, one patient had transient hypocalcemia and one patient had temporary recurrent laryngeal nerve palsy. In the total thyroidectomy group, nine patients had transient hypocalcemia and one patient had temporary recurrent laryngeal nerve palsy. There was no statistical difference in the post-operative complicationrates between the two groups (P=0.254 for hypocalcemia and P=0.470 for injury to the recurrent laryngeal nerve). CONCLUSION: Based on our experience, endoscopic total thyroidectomy is a safe and feasible alternative to endoscopic near-total thyroidectomy.

The effect of Er:YAG laser irradiation on the surface microstructure and roughness of TiO2 implant / 대한치주과학회지

PURPOSE: The aim of this study was to evaluate the effect of Er:YAG laser on microstructure and roughness of TiO2 blasting implant surface. MATERIALS AND METHODS: Ten TiO2 blasting implant were used in this experiment. One implant was control group, and nine TiO2 blasting implant surfaces were irradiated with Er:YAG laser under 100 mJ/pulse, 140 mJ/pulse, and 180 mJ/pulse condition for 1 min, 1.5 min, and 2 min respectively. Optical interferometer and scanning electron microscopy was utilized to measure roughness and microstructure of specimens. RESULTS: The surface roughness was decreased after Er:YAG laser irradiation in all groups, but there was no significant difference. 100 mJ/pulse and 140 mJ/pulse group did not alter the TiO2 blasting implant surface in SEM study while 180 mJ/pulse group altered the TiO2 blasting implant surface. Implant surfaces showed melting, microfracture and smooth surface in 180 mJ/pulse group. CONCLUSION: Detoxification of implant surface using Er:YAG laser must be irradiated with proper energy output and irradiation time to prevent implant surface alteration.

Analysis of the Diagnostic Maneuver and Timing of Operation in Adult Intussusception

PURPOSE: Intestinal intussusception in adults is a rare entity and its clinical course and etiology differ from pediatric counterpart. About 90% have a primary pathologic lesion, especially malignancy consists of etiology as 30% in small bowel and 66% in large bowel. The purpose of this study is to investigate of accurate diagnosis, treatment, and timing of operation by review of clinical symptom, physical examination, laboratory finding, pathologic finding, and operation finding of adult intussusception patients. METHODS: We studied 20 adult patients who were diagnosed as intussusception between July 1993 and September 2005. Intussusception by operation and rectal prolapse were excluded. Clinicopatholgic findings were analyzed retrospectively through the medical record. RESULTS: There was 15 males and 5 females in all 20 patients, and mean age was 52.3 years with a range of 29 to 78 years. Preoperative diagnosis was suspected in 14 of 20 patients (70%). We performed emergency operation in 8 cases (40%) and elective operation in 12 cases (60%). Two cases of them which preoperative diagnosis were strangulation and peritonitis accompanied with small bowel necrosis and leukocytosis. There were 12 small bowel lesions (60%) and 6 colonic lesions (30%). In two cases, there were no primary lesions. Of the cases with a defined cause, 12 cases were malignant (60%) and 6 cases were benign (30%). CONCLUSION: The most useful diagnostic method is computed tomography to reveal adult intussusception. Two cases of all were strangulated and also had a leukocytosis. In adult intussusception, most common cause is malignancy. If there is no evidence of strangulation such as leukocytosis, we recommend that elective surgery is adequate.

Mesenteric and Omental Cysts in Children

Mesenteric and omental cysts are rare intra-abdominal lesions in childhood, and may present various clinical features such as an asymptomatic mass or an acute abdomen. Therefore, these entities are frequently misdiagnosed preoperatively or are found only incidentally at operation for other conditions. We analyzed our experiences of 19 cases in a 19 year period from 1981 to 1999, at College of Medicine, Catholic University of Korea. There were 12 boys and 7 girls with a mean age of 4.8 years (range, 3 days to 15 years). Common presenting symptoms were abdominal pain (47%), abdominal distension (31%), abdominal mass (24%), vomiting (15%) and fever (10%). Ultrasonography was the most preferred method of diagnosis. Other diagnostic modalities include CT, MRI, and abdominal ascites tapping in selected patients. Location of the mesenteric cysts was small bowel mesentery in nine, the right mesocolon and retroperitoneum in one, the left mesocolon in one, and the jejunum, sigmoid-colon mesentery in one. Most of the patients underwent cyst excision, but six patients required concomitant bowel resection for complete removal of the lesions, and two patients underwent unroofing and simple aspiration respectively. There was one mortality case due to sepsis.

An Outbreak of Glutaraldehyde Colitis / 대한소화기내시경학회지

BACKGROUND/AIMS: Disinfecting solutions of endoscope, including glutaraldehyde cause colonic damage if allowed to contact mucosa. Glutaraldehyde colitis occurs due to inadvertent contact during colonoscopy and sigmoidoscopy. We experienced unexpectedly glutaraldehyde colitis. We describe symptoms, signs and clinical courses of glutaraldehyde colitis. METHODS: Colonoscopy and sigmoidoscopy were performed at one session after bowel cleaning with polyethylene glycol ingestion 2~3 liters. Within 24 hours, all of them visited emergency room because of bloody diarrhea, vomiting and colicky abdominal pain. We performed sigmoidoscopy again in one patient. RESULTS: Sigmoidoscopic findings was diffuse edematous, hyperemic mucosa and shallow ulcerations similar to the findings of ischemic colitis. But, un-contacted mucosa was normal findings which can be completely distinguished from contacted mucosa. Microscopically, colonic mucosa showed edema, polymorphonuclear leukocytes infiltration and fibroprulent exudates with surface erosions. Laboratory findings were non-specific except leukocytosis of peripheral blood. Both bacterial cultures of blood and stool were negative in all patients. Symptoms subsided within 7 days and duration of admission is almost within 9 days. All of patients recovered completely without any complication. CONCLUSIONS: The clinical features of glutaraldehyde colitis resembled colonic ischemia in symptoms and endoscopic findings. This complication should be suspected in patients who develop hemorrhagic colitis suddenly after undergoing colonoscopy.

A case of hypereosinophilic syndrome with eosinophilic pneumonia, and bronchitis / 천식및알레르기

Idiopathic hypereosinophilic syndrome is characterized by multiorgan involvement without any cause, and peripheral eosinophilia(1,500/microliter) for more than 6 months. Clinically, many organs can be involved, but the heart is the most commonly involved organ. Although lung involvement is usual(20-30%)1) in hypereosinophilic syndrome, there are few reports of eosinophilic pneumonia proven by biopsy confirmation in Korea. We experienced a case of hypereosinophilic syndrome with eosinophilic pneumonia and bronchitis confirmed by biopsy, and we report it here with a review of the literature.

A Case of Pneumatosis Cystoides Intestinalis Presented with Nonspecific Symptom / 대한소화기내시경학회지

Pneumatosis cystoides intestinalis is a relatively rare condition, characterized by multiple gas-filled cysts of varying size in the wall of gastrointestinal tract. Although the etiology of pneumatosis intestinalis remains uncertain, the possibility that both the gas-forming bacteria and mechanical theories develop pneumocysts has recently been advocated. We experienced a case of pneumotosis cystoides intestinalis found by colonoscopy in a 31-year old woman with intermittent abdominal pain.

The Changes of Cerebral Metabolic and Hemodynamic Parameters , Brain Histology , and Serum Levels of Neuron-Specific Enolase During Retrograde Cerebral Perfusion Under Pofound Hypothermic total Circulatory Arrest in Pigs / 대한흉부외과학회지

BACKGROUND: Retrograde cerebral perfusion(RCP) is currently used for brain protection during aorta surgery, however, for the safety of it, various data published so far are insufficient. We performed RCP using pig and investiaged various parameters of cerebral metabolism and brain injury after RCP under deep hypothermia. MATERIAL AND METHOD: We used two experimental groups: in group I(7 pigs, 20 kg), we performed RCP for 120 minutes and in group II (5 pigs, 20 kg), we did it for 90 minutes. Nasopharyngeal temperature, jugular venous oxygen saturation, electroencephalogram were continuously monitored, and we checked the parameters of cerebral metabolism, histological changes and serum levels of neuron-specific enolose(NSE) and l actic dehydrogenase(LDH). Central venous pressure during RCP was mainained in the range of 25 to 30 mmHg. RESULT: Perfusion flow rates(ml/min) during RCP were 130+/-57.7(30 minutes), 108.6+/-55.2(60 minutes), 107.1+/-58.8(90 minutes), 98.6+/-58.7(120 minutes) in group I and 72+/-11.0(30 minutes), 72+/-11.0(60 minutes), 74+/-11.4(90 minutes) in group II. The ratios of drain flow to perfusion flow were 0.18(30 minutes), 0.19(60 minutes), 0.17(90 minutes), 0.16(120 minutes) in group I and 0.21, 0.20, 0.17 in group II. Oxygen consumptions(ml/min) during RCP were 1.80+/-1.37(30 minutes), 1.72+/-1.23(60 minutes), 1.38+/-0.82(90 minutes), 1.18+/-0.67(120 minutes) in group I and 1.56+/-0.28(30 minutes), 1.25+/-0.28(60 minutes), 1.13+/-0.26(90 minutes). We could observe an decreasing tendency of oxygen consumption after 90 minutes of RCP in group I. Cerebrovascular resistance(dynes sec cm-5) during RCP in group I incrased from 71370.9+/-369145.5 to 83920.9+/-49949.0 after the time frame of 90 minutes(p<0.05). Lactate(mg/min) appeared after 30 minutes of RCP and the levels were 0.15+/-0.07(30 minutes), 0.18+/-0.10(60 minutes), 0.19+/-0.19(90 minutes), 0.18+/-0.10(120 minutes) in group I and 0.13+/-0.09(30 minutes), 0.19+/-0.03(60 minutes), 0.29+/-0.11(90 minutes) in group II. Glucose utilization, exudation of carbon dioxide, differences of cerebral tissue acidosis between perfusion blood and drain blood were maintained constantly during RCP. Oxygen saturation levels(%) in drain blood during RCP were 22.9+/-4.4(30 minutes), 19.2+/-4.5(60 minutes), 17.7+/-2.8(90 minutes), 14.9+/-2.8(120 minutes) in group I and 21.3+/-8.6(30 minutes), 20.8+/-17.6(60 minutes), 21.1+/-12.1(90 minutes) in group II. There were no significant changes in cerebral metabolic parameters between two groups. Differences in serum levels of NSE and LDH between perfusion blood and drain blood during RCP showed no statistical significance. Serum levels of NSE and LDH after resuming of cardipulmonary bypass decreased to the level before RCP. Brain water contents were 0.73+/-0.03 in group I and 0.69+/-0.06 in group II and were higher than those of the controls(p<0.05). The light microscopic findings of cerebral neocortex, basal ganglia, hippocampus(CA1 region) and cerebellum showed no evidence of cerebral injury in two groups and there were no different electron microscopy in both groups(neocortex, basal ganglia and hippocampus), but they were thought to be reversible findings. CONCLUSIONS: Although we did not proceed this study after survival of pigs, we could perform the RCP successfully for 120 minutes with minimal cerebral metabolism and no evidence of irreversible brain damage. The results of NSE and LDH during and after RCP should be reevaluated with survival data.

Effect of Serum magnesium Concentration on Postoperative Arrhythmias after Open Heart Surgery / 대한흉부외과학회지

BACKGROUND: Magnesium is one of the important intracellular cations. Hypomagnesemia is common after an open heart surgeryand may affect the development of posoperative arrhythmias. The aims of this study were to identify 1) the severity of the hypomagnesemia 2) the adequate dose of the magnesium replacement and 3) the effect of magnesium replacement on the postoperative arrhythmias. MATERIAL AND METHOD: The serum magnesium level was measured in 20 patients in whom magnesium was replaced postopertively(6gm at the operative day 4gm at the 1st postoperative day and 2gm at the 2nd postoperative day) and compared with that of the 13 patients in whom magnesium was not replaced postopertively The serum magnesium level was normalized after magnesium replacement. We analyzed the development of arrhythmias in the patients groups who did not receive magnesium and were operated on between Oct. 1994 and Oct. 1995(Group I; n=206) and who received the magnesium postoperatively and were operated on between Nov. 1995 and Aug. 1996(Group II; n=133) RESULT: There were no differences in the preoperative risk factors and the rate of postoperative supraventricular or ventricular tachyarrhythmia occurrences irrespectivel of the magnesium replacement. Magnesium replacement could prevent the aggrevation of the occurrence of postoperative arrhythmias in high risk groups of ventricular tachyarrhytnmia in old age but magnesium could not prevent postoperative arrhythmia in other high risk groups. CONCLUSIONS: The magnesium replacement after open heart surgery could prevent the development of ventricular tachyarrhythmias especially in old age groups but could not prevent atrial tachyarrhthmias.

Off-Pump Coronary Artery Bypass Grafting / 대한흉부외과학회지

BACKGROUND: We analyzed the result of the "Off-Pump" Coronary Artery Bypass grafting (OPCAB) performed to minimize inflammatory responses to cardiopulmonary bypass and myocardial ischemia during the aortic cross-clamp period. MATERIAL AND METHOD: The preoperative diagnosis operative procedure mortality complication and postoperative course of the 50 patients who underwent OPCAB between January 1998 and September 1998 were analyzed. There were 34 males and 16 females with mean age of 60+/-9 years. Preoperative clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and postinfarction angina in 3(6%) patients. Preoperative angiographic diagnoses were three-vessel disease in 25(50%) two-vessel disease in 5(10%) one-vessel disease in 7(14%) and left main disease in 13(26%) patients. There were elective operation in 37 cases and urgent operation in 13 cases. RESULT: The mean number of grafts was 3.2+/-1.2 per patient. Grafts used were unilateral internal thoracic artery in 43 greater saphenous vein in 37 radial artery in 7 bilateral internal thoracic arteries in 4 and right gastroepiploic artery in 2 cases Forty sequential anastomoses were performed in 18 cases. Vessels accessed were left anterior descending artery in 48 diagonal branch in 41 obtuse marginal branch in 30 right coronary artery in 24 posterior descending artery in 9 ramus intermedius in 5 and posterolateral branch in 5 anastomoses. Predischarge coronary angiography performed in 44 patients demonstrated the patency rate of 89.5%(128/143) Operative mortality was 2%(1/150) Postoperative complications were arrhythmia in 5 graft occlusion that needed reoperation in 4. perioperative myocardial infarction in 2 femoral artery thromboembolism developed after the application of IABP in 1 postoperative transient delirium in 1 peripheral compression neuropathy in 1 case. Sixteen patients(32%) were extubated at the operating room and the other patients were extubated at the mean 13+/-20 hours after the operation. Mean duration of stay in intensive care unit was 49+/-46 hours. Thirteen patients(26%) required blood transfusions perioperatively and the amount of perioperative blood transfusion was mean 0.70+/-1.36 pack/patient. CONCLUSIONS: OPCAB is suggested to be the ideal technique with less postoperative complication less hospitalization time and less cost.

Early Results of Mitral Valve Reconstruction in Mitral Regurgitation / 대한흉부외과학회지

BACKGROUND: Reconstruction surgery of mitral valve regurgitation is now considered as an effective operative technique and has shown good long-term results. Although reconstructive surgery of mitral valve has been performed since 1970s, we have started only in early 1990s in full scale because of small number of the mitral regurgitation compared to mitral stenosis and lack of knowledge from the viewpoint of patients and physicians. MATERIAL AND METHOD: From January 1992 to December 1996, 100 patients underwent repair of the mitral valve for mitral regurgitation with or without mitral stenosis in Seoul National University Hospital. 45(45%) of the patients were men and 55(55%) were women. The mean age was 39.9+/-14.4 years. The causes of the mitral regurgitation were rheumatic in 61, degenerative in 28 and others in 11. According to the Carpentier's pathological classification of mitral regurgitation 5 patients were type I. 55 patients were type II and 40 patients were type III. 7 patients underwent concomitant aortic valvuloplasty and 8 patients underwent aortic valve replacement. 7 patients underwent Maze operation or pulmonary vein isolation. RESULT: There were no operative death but 3 major operative complications: 2patients were postoperative low cardiac output syndrome(needed intra-aortic ballon pump support) and 1 patient was postoperative bleeding. There was one late death(1.0%) The cause of death was sepsis secondary to acute bacterial endocarditis. 3 patients required reoperation for recurred mitral regurgitation. There were no statistically significant risk factors for reoperation. The other 96 patients showed no or mild degree of mitral regurgitation 99 survivors were in NYHA functional class I or II. There were two throumboembolisms but no anticoagulation-related complications. CONCLUSIONS: We concluded that mitral valve repair could be performed successfully in most cases of mitral regurgitation even in the rheumatic and combined lesions with very low operative mortality and morbidity. The early results are very promising.

A Case of Secondary Amyloid Colitis in Rheumatoid Arthritis

Amyloidosis is known as a disease caused by the deposition of a insoluble and fibrous amyloid protein in the extracellular space of various organs and tissue. Intestinal amyloid deposition may develop motility disturbance, malabsorption, bleeding and perforation. A 70-year old woman with lower abdominal pain, watery diarrhea was admitted and had the past history of diabetes mellitus, hypertension for 8 years and rheumatoid arthritis for 10 year. On colonoscopic examination for evaluation of diarrhea, multiple edematous and shallow ulcers was found from distal sigmoid to terminal ileum. A green colored positive birifringent stained amorphous material was found in polarizing microscopy of colon biopsy specimen stained with Congo-red on microscopic examination,. We report a case of amyloidosis causing colon ulcers confirmed by colonoscopic biopsy with review literature.

Surgical Management of Aortic Insufficiency in Behcet's Disease / 대한흉부외과학회지

BACKGROUND: Cardiac involvement of Behcets disease is very rate, however, the prognosis of Behcet disease depends on cardiovascular complications. In this article, we described surgical treatment of aortic insufficiency with Behcets disease. MATERIAL AND METHOD: From March 1986 to February 1998, we operated on 10 patients of aortic insufficiency with Behcets disease. Male to female ratio was 8 to 2, and age ranged from 21 to 40 years(mean 32.8 years). There were 8 patients with evidence of Behcets disease and another 2 patients had some suspicious findings of Behcets disease(i.e., prosthetic value dehiscence, hypertrophied aortic wall). Adequate preoperative medical treatment for Behcets disease was done in 3 patients. RESULT: We performed 24 open heart surgeries in 10 patients. Redo value replacements using prosthetic valves were done in 4 patients. Among them, 2 patients were operated on for a second redo valve replacement and one of them operated on for a 4th and 5th operation because of recurrent paravalvular leakage. These 4 patients expired. 1 patient who had undergons tissue value replacement is alive. 1 patient who underwent Cabrol operation expired dut to rupture of graft anastomosis site. We used homografts in 3 patients. In 2 of them, we performed aortic root replacement and subcoronary valve replacement in another patient. The patient who underwent subcoronary valve insertion had remnant aortic insufficiency, so we are closely observing him. We also performed Ross operation in a 24 year old female who suffered severs aortic insufficiency and endocarditis after aortic valvuloplasty. 5 patients are alive and mean follow up duration is 49.0 months. Among them, we used homografts or sutografts in 4 patients. We could observe excellent clinical results in the patients who underwent aortic root replacement using homograft and they were treated medically for Behcets disease. CONCLUSIONS: We concluded that adequate preporative diagnosis, clinical suspicion, and periopertive medical treatment for Behcets disease are very important for the result of surgical management of aortic insufficiency with Behcets disease. The use of homograft or autograft was helpful for the healing of anastomosis site and we should carefully observe the long term follow up results.

Animal Experiment of the Pneumatic Ventrivular Assist Device / 대한흉부외과학회지

BACKGROUND: Ventricular assist devices(VADs) are being used for patients in postcvardiotomy cardiogenic shock status bridge to cardiac transplant settings and in post-myocardial infarction cardiogenic shock. The VAD which was developed at the Deparment of medical engineering in Dankook University College of Medicine was a pneumatically driven device and can maintain pulsatile flow. The goal of this study is to develop animal experimental models using the VAD and to clarify the reliability and hemodynamic property adequacy of end organ perfusion durability and severity of thrombotic-hemolytic tendency of the device. MATERIAL AND METHOD: The pneumatic VAD was applied to 8 adult female lambs, We examined some hemodynamic parameters such as arterial blood pressure pulmonary capillary wedge pressure(pcwp) pulmonary artery pressure(PAP) left atrial pressure hour urine output cardiac index VAD flow EKG to determine the reliability of the VAD and hemodynamic compatibility of the experimental animals within 24 hours of experiment. We also observed the end organ perfusion durability of the VAD and thrombotic-hemolytic property of the VAD after 24 hours of VAD insertion. RESULT: We could monitor all hemodynamic parameters including pcwp PAP cardiac index EKG, adn hour urine as true clinical settings. We observed that the reliability of the VAD was excellent and the hemodynamic property of the experimental animal and end organ perfusion were adequate within 24 hours of experiment. In four lambs surviving 24 hours after insertion the reliability of the VAD and end organ perfusion were excellent and no thrombotic-hemolytic tendency was noted. However after 15 days of experiment the diaphragm of the VAD was torn and it was recommende that the durability of the VAD should be extended. CONCLUSION: e conclude that the pneumatic VAD developed at Dankook University Biomedical Engineering has good hemodynamic property and low thromboembolic tendency and presents adequate end organ perfusion but we noted that the durability of the device should be expanded further. It will be possible to do more reliable experiment in the future according to the animal experimental method developed in this study especially with the heart failure models.

Comparison of VATS with Thoracotomy for the Treatment of Spontaneous Pneumothorax / 대한흉부외과학회지

BACKGROUND: Video-assisted thoracoscopic surgery(VATS) has been established as a new method for treatment of spontaneous pneumothorax. We compared the clinical results of VATS with those of thoracotomy performed during the recent 5 years. MATERIAL AND METHOD: We analyzed 126 patients whose medical records were available among the 154 patients who underwent operations for spontaneous pneumothorax from 1992 to 1996. The mean age was 27.1 years(15 to 75 years). 87 patients were operated on by VATS(Group A) and the other 39 by thoracotomy(Group B). The mean follow-up period was 14.7 months. RESULT: The operation time was shorter in group A than in group B(90.6+/-38.6minutes: 117.2+/-58.9minutes, p<0.05). The duration of postoperative hospital stay was shorter in group A than in group B(6.7+/-4.2: 9.4+/-3.3 days, p<0.05). The amount of analgesics(nalbuphin HCl, ketoprofen) used postoperatively were 2.4+/-2.8 ampules in group A, which is less than the 6.5+/-5.6 ampules in group B(p<0.05). The number of staples used in group A was smaller(2.7+/-1.3 in group A, 1.76+/-1.1 in group B, p<0.05). The duration of chest tube indwelling(4.3+/-4.0 days in group A, and 5.6+/-3.0 days in group B, NS), the recurrence rate(13.8% in group A, 2.6% in group B, NS), and the duration of air leakage(1.3+/-3.3 days in group A, and 1.0+/-2.5days in group B, NS) were not statistically different between the two groups. CONCLUSION: The application of VATS for the treatment of spontaneous pneumothorax has brought in better clinical results(shorter operation time, shorter hospital stay, less pain, and better cosmetic merits) than the thoracotomy without increasing any morbidity. However no advantages in recurrence rates and duration of postoperative air leakages are revealed.

Clinical Analysis of 500 Cases of Coronary Artery Bypass Grafting / 대한흉부외과학회지

BACKGROUND: We analyzed five hundred patients who underwent either isolated or concomitant coronary artery bypass grafting(CABG) between November 1981 and June 1997. MATERIAL AND METHOD: There were 330 males and 170 females with a mean age of 57.4+/-8.9 years. To evaluate the preoperative status, we performed electrocardiograghy, echocardiography, MIBI scan, Duplex sonogram, common blood test including CK and LDH and coronary angiography. RESULT: Preoperative clinical diagnoses were unstable angina in 282 (56.4%), stable angina in 141 (28.2%), postinfarction angina in 58 (11.6%), acute myocardial infarction in 8 (1.6%), variant angina in 7 (1.4%) and failed percutaneous transluminal coronary angioplasty in 4 (0.8%) patients. Preoperative angiographic diagnoses were three-vessel disease in 263 (52.6%), two-vessel disease in 93 (18.6%), one-vessel disease in 71 (14.2%), left main disease in 68 (13.6%), and others in 5 (1.0%) patients. Patients had various risk factors for coronary disease, and the frequency of the risk factors such as hypertension, diabetes and smoking showed increasing tendency year by year. We used saphenous vein grafts in 1143, internal thoracic artery grafts in 442, radial artery graft in 17, and gastroepiploic artery graft in 1 anastomosis. The mean number of grafts was 3.2+/-1.2 per patient. Concomitant operations were prosthetic valve replacement or valvuloplasty in 31, coronary endarterectomy and angioplasty in 27, left main coronary angioplasty in 13, carotid endarterectomy in 5, and neurologic problems, bleeding, and perioperative myocardial infarction. The mean follow-up period was 25+/-23 months and there were 5 cases of reoperation. CONCLUSION: We hope that the surgical results would improve with the accumulation of experience, application of new myocardial protection technique, and timely intervention of mechanical assisted devices.

Minimally Invasive Cardiac Surgery: Three different approaches / 대한흉부외과학회지

BACKGROUND: Minimally invasive cardiac surgery has emerged as a new approach to the conventional median sternotomy. The suggested advantages of the minimally invasive technique includes improved cosmesis, simplicity of opening and closing the chest, less postoperative pain, less risk of infection and bleeding, early rehabilitation, and reduced length of hospital stay. MATERIAL AND METHOD: Between March 1997 and December 1997, we performed 36 cases of minimally invasive cardiac surgery via three different approaches ; right paramedian, transverse sternotomy and mini-sternotomy with upper sternal split. RESULT: There was no operative mortality. Postoperative complications were atrial fibrillation in 4 patients, bleeding that required reoperation in 1 patient, and delayed wound closure in 1 patient who underwent 3rd redo operation. Average length of skin incision was 9.1+/-0.9 cm. Average duration of stay in the intensive care unit was 48+/-29 hours and the patients were discharged 10+/-7 days after the operation. CONCLUSION: In spite of the difficulties in defibrillation, deairing, and cardiac decompensation, minimally invasive approaches will be applied increasingly because of the suggested advantages.

Surgical Angioplasty of the Left Main Coronary Artery Stenosis / 대한흉부외과학회지

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.

A Clinical Study of Isolated Aortic Valve Replacement with CarboMedics and St. Jude Prosthesis / 대한흉부외과학회지

MATERIALS AND METHODS: Between 1984 to 1994, 136 patients underwent primary and isolated aortic valve replacement with 79 Carbomedics and 57 St. Jude prostheses. RESULTS: Age ranged from 16 to 67 year (mean : 44.5+/-12.7 years). Statistically significant differences in preoperative clinical characteristics between two groups were not found. There was one early death in the St. Jude group and none in the Carbomedics group. Early prosthetic valve-related complications including death were not significantly different between the two groups (p value= 0.572). One hundred thirty five early survivors were followed for a total of 354.2 patient-years (mean=31.5+/-16 months). In the CarboMedics group, actuarial survial rate at 5 years was 97.1+/-1.9%, and in the St. Jude group, it was 95.9+/-2.8%. In the CarboMedics group, actuarial free rate from all valve-related events at 5 years was 92.1+/-3.1%, and in St. Jude group, it was 89.8+/-5.0%. CONCLUSION: We conclude that early and late results after performing isolated aortic valve replacement with CarboMedics and St. Jude valve are not significantlly different.