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Experimental study of retorgrade cerebral perfusion during hypothermic circulatory arrest.

Chi Kyoung KIM ; Jse Chun SHIN ; Young Hwan KIM ; Moon Sub KWACK ; Se Wha KIM ; Hong Kyun LEE

The Korean Journal of Thoracic and Cardiovascular Surgery.1993;26(7):513-520.

No abstract available.
Perfusion*

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Role of Barium Swallow in Diagnosing Clinically Significant Anastomotic Leak following Esophagectomy.

Simon ROH ; Mark D IANNETTONI ; John C KEECH ; Mohammad BASHIR ; Peter J GRUBER ; Kalpaj R PAREKH

The Korean Journal of Thoracic and Cardiovascular Surgery.2016;49(2):99-106. doi:10.5090/kjtcs.2016.49.2.99

BACKGROUND: Barium swallow is performed following esophagectomy to evaluate the anastomosis for detection of leaks and to assess the emptying of the gastric conduit. The aim of this study was to evaluate the reliability of the barium swallow study in diagnosing anastomotic leaks following esophagectomy. METHODS: Patients who underwent esophagectomy from January 2000 to December 2013 at our institution were investigated. Barium swallow was routinely done between days 5-7 to detect a leak. These results were compared to clinically determined leaks (defined by neck wound infection requiring jejunal feeds and or parenteral nutrition) during the postoperative period. The sensitivity and specificity of barium swallow in diagnosing clinically significant anastomotic leaks was determined. RESULTS: A total of 395 esophagectomies were performed (mean age, 62.2 years). The indications for the esophagectomy were as follows: malignancy (n=320), high-grade dysplasia (n=14), perforation (n=27), benign stricture (n=7), achalasia (n=16), and other (n=11). A variety of techniques were used including transhiatal (n=351), McKeown (n=35), and Ivor Lewis (n=9) esophagectomies. Operative mortality was 2.8% (n=11). Three hundred and sixty-eight patients (93%) underwent barium swallow study after esophagectomy. Clinically significant anastomotic leak was identified in 36 patients (9.8%). Barium swallow was able to detect only 13/36 clinically significant leaks. The sensitivity of the swallow in diagnosing a leak was 36% and specificity was 97%. The positive and negative predictive values of barium swallow study in detecting leaks were 59% and 93%, respectively. CONCLUSION: Barium swallow is an insensitive but specific test for detecting leaks at the cervical anastomotic site after esophagectomy.
Anastomotic Leak* ; Barium* ; Constriction, Pathologic ; Esophageal Achalasia ; Esophagectomy* ; Esophagus ; Humans ; Mortality ; Neck ; Postoperative Period ; Sensitivity and Specificity ; Wound Infection

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Minimally Invasive Repair of Pectus Carinatum in Patients Unsuited to Bracing Therapy.

Jee Won SUH ; Seok JOO ; Geun Dong LEE ; Seok Jin HAAM ; Sungsoo LEE

The Korean Journal of Thoracic and Cardiovascular Surgery.2016;49(2):92-98. doi:10.5090/kjtcs.2016.49.2.92

BACKGROUND: We used an Abramson technique for minimally invasive repair of pectus carinatum in patients who preferred surgery to brace therapy, had been unsuccessfully treated via brace therapy, or were unsuitable for brace therapy because of a rigid chest wall. METHODS: Between July 2011 and May 2015, 16 patients with pectus carinatum underwent minimally invasive surgery. RESULTS: The mean age of the patients was 24.35±13.20 years (range, 14-57 years), and all patients were male. The percentage of excellent aesthetic results, as rated by the patients, was 37.5%, and the percentage of good results was 56.25%. The preoperative and postoperative Haller Index values were 2.01±0.19 (range, 1.60-2.31), and 2.22±0.19 (range, 1.87-2.50), respectively (p-value=0.01), and the median hospital stay was 7.09±2.91 days (range, 5-15 days). Only one patient experienced postoperative complications. CONCLUSION: Minimally invasive repair is effective for the treatment of pectus carinatum, even in adult patients.
Adult ; Braces* ; Humans ; Length of Stay ; Male ; Postoperative Complications ; Surgical Procedures, Minimally Invasive ; Thoracic Wall

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Staple Line Coverage with a Polyglycolic Acid Patch and Fibrin Glue without Pleural Abrasion after Thoracoscopic Bullectomy for Primary Spontaneous Pneumothorax.

Ki Pyo HONG ; Do Kyun KIM ; Kyung Hoon KANG

The Korean Journal of Thoracic and Cardiovascular Surgery.2016;49(2):85-91. doi:10.5090/kjtcs.2016.49.2.85

BACKGROUND: This study was conducted to determine the efficacy of staple line coverage using a polyglycolic acid patch and fibrin glue without pleural abrasion to prevent recurrent postoperative pneumothorax. METHODS: A retrospective analysis was carried out of 116 operations performed between January 2011 and April 2013. During this period, staple lines were covered with a polyglycolic acid patch and fibrin glue in 58 cases (group A), while 58 cases underwent thoracoscopic bullectomy only (group B). RESULTS: The median follow-up period was 33 months (range, 22 to 55 months). The duration of chest tube drainage was shorter in group A (group A 2.7±1.2 day vs. group B 3.9±2.3 day, p=0.001). Prolonged postoperative air leakage occurred more frequently in group B than in group A (43% vs. 19%, p=0.005). The postoperative recurrence rate of pneumothorax was significantly lower in group A (8.6%) than in group B (24.1%) (p=0.043). The total cost of treatment during the follow-up period, including the cost for the treatment of postoperative recurrent pneumothorax, was not significantly different between the two groups (p=0.43). CONCLUSION: Without pleural abrasion, staple line coverage with a medium-sized polyglycolic acid patch and fibrin glue after thoracoscopic bullectomy for primary spontaneous pneumothorax is a useful technique that can reduce the duration of postoperative pleural drainage and the postoperative recurrence rate of pneumothorax.
Chest Tubes ; Drainage ; Fibrin Tissue Adhesive* ; Fibrin* ; Follow-Up Studies ; Pneumothorax* ; Polyglycolic Acid* ; Recurrence ; Retrospective Studies

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Outcomes of the Tower Crane Technique with a 15-mm Trocar in Primary Spontaneous Pneumothorax.

Yooyoung CHONG ; Hyun Jin CHO ; Shin Kwang KANG ; Myung Hoon NA ; Jae Hyeon YU ; Seung Pyung LIM ; Min Woong KANG

The Korean Journal of Thoracic and Cardiovascular Surgery.2016;49(2):80-84. doi:10.5090/kjtcs.2016.49.2.80

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) pulmonary wedge resection has emerged as the standard treatment for primary spontaneous pneumothorax. Recently, single-port VATS has been introduced and is now widely performed. This study aimed to evaluate the outcomes of the Tower crane technique as novel technique using a 15-mm trocar and anchoring suture in primary spontaneous pneumothorax. METHODS: Patients who underwent single-port VATS wedge resection in Chungnam National University Hospital from April 2012 to March 2014 were enrolled. The medical records of the enrolled patients were reviewed retrospectively. RESULTS: A total of 1,251 patients were diagnosed with pneumothorax during this period, 270 of whom underwent VATS wedge resection. Fifty-two of those operations were single-port VATS wedge resections for primary spontaneous pneumothorax performed by a single surgeon. The median age of the patients was 19.3±11.5 years old, and 43 of the patients were male. The median duration of chest tube drainage following the operation was 2.3±1.3 days, and mean postoperative hospital stay was 3.2±1.3 days. Prolonged air leakage for more than three days following the operation was observed in one patient. The mean duration of follow-up was 18.7±6.1 months, with a recurrence rate of 3.8%. CONCLUSION: The tower crane technique with a 15-mm trocar may be a promising treatment modality for patients presenting with primary spontaneous pneumothorax.
Chest Tubes ; Chungcheongnam-do ; Drainage ; Follow-Up Studies ; Humans ; Length of Stay ; Male ; Medical Records ; Pneumothorax* ; Recurrence ; Retrospective Studies ; Surgical Instruments* ; Sutures ; Thoracic Surgery, Video-Assisted

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Early Experiences with the Endovascular Repair of Ruptured Descending Thoracic Aortic Aneurysm.

Jae Sung CHOI ; Se Jin OH ; Yong Won SUNG ; Hyun Jong MOON ; Jung Sang LEE

The Korean Journal of Thoracic and Cardiovascular Surgery.2016;49(2):73-79. doi:10.5090/kjtcs.2016.49.2.73

BACKGROUND: The aim of this study was to report our early experiences with the endovascular repair of ruptured descending thoracic aortic aneurysms (rDTAAs), which are a rare and life-threatening condition. METHODS: Among 42 patients who underwent thoracic endovascular aortic repair (TEVAR) between October 2010 and September 2015, five patients (11.9%) suffered an rDTAA. RESULTS: The mean age was 72.4±5.1 years, and all patients were male. Hemoptysis and hemothorax were present in three (60%) and two (40%) patients, respectively. Hypovolemic shock was noted in three patients who underwent emergency operations. A hybrid operation was performed in three patients. The mean operative time was 269.8±72.3 minutes. The mean total length of aortic coverage was 186.0±49.2 mm. No 30-day mortality occurred. Stroke, delirium, and atrial fibrillation were observed in one patient each. Paraplegia did not occur. Endoleak was found in two patients (40%), one of whom underwent an early and successful reintervention. During the mean follow-up period of 16.8±14.8 months, two patients died; one cause of death was a persistent type 1 endoleak and the other cause was unknown. CONCLUSION: TEVAR for rDTAA was associated with favorable early mortality and morbidity outcomes. However, early reintervention should be considered if persistent endoleak occurs.
Aneurysm ; Aorta ; Aortic Aneurysm, Thoracic* ; Atrial Fibrillation ; Cause of Death ; Delirium ; Emergencies ; Endoleak ; Follow-Up Studies ; Hemoptysis ; Hemothorax ; Humans ; Male ; Mortality ; Operative Time ; Paraplegia ; Rupture ; Shock ; Stents ; Stroke

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Clinical and Histo-Pathological Analysis for Recurrence after Curative Surgery of Esophageal Cancer.

Jae Kil PARK ; Jae Kwang LEE ; Moon Sub KWACK

The Korean Journal of Thoracic and Cardiovascular Surgery.2000;33(7):570-575.

BACKGROUND: Surgical resection remains the mainstay of treatment for esophageal cancer. Despite recent advances in surgical therapy, i.e. en bloc resection and extended lymphadenectomy, the overall long-term prognosis of patients with esophageal carcinoma has not, however, improved during the last decades. One of the major reasons in its relatively high recurrence rate. MATERIAL AND METHOD: A retrospective review of recurrent patterns of cancer in 42 patients who underwent curative surgery for primary esophageal cancer was performed clinically and histo-phthologically. RESULT: Nineteen patients had developed recurrece during the 18 to 52 months(mean 34.2 nonths), 8 had local recurrences, 1 had both, and 11 had systemic recurrences. Twelve patients(63%) had developed recurrence within 1 year, 5 patients(26%) between 1 year to 2 patients(11%) after 2 years. The recurrence rate according to growth pattern of tumor or presence of microinvasive findings was not statistically significant, but it increased significantly in clinical tumor stage III than stage IIA, B and in patients with the number of metastatic lymph node over ten. CONCLUSION: Post-operative recurrences of esophageal cancer appear as a high rate even though curative wide resection was done. Several clinical and histo-pathological factors correlate with the recurrence.
Esophageal Neoplasms* ; Humans ; Lymph Node Excision ; Lymph Nodes ; Prognosis ; Recurrence* ; Retrospective Studies

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Surgical Treatment of Tracheal Stenosis.

Jun Young CHOI ; In Seok JANG ; Jong Woo KIM ; Byung Kyun KIM ; Jung Eun LEE ; Sung Ho KIM ; Sang Ho RHIE

The Korean Journal of Thoracic and Cardiovascular Surgery.2000;33(7):565-569.

BACKGROUND: Post-intubation injury is known to be the most common cause of tracheal stenosis. Treatment strategy for tracheal stenosis varies accoring to the extent of pathologic lesion. Focal mucosal lesion can be treated with laser photoablation, but full thickness tracheal lesion should be treated with resection and anastomosis. MATERIAL AND METHOD: From Aptil 1998 to May 1999, twelve patients suffering from tracheal stenosis as a complication of endotracheal intubation were managed by resection and end-to-end anastomosis in the Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital. RESULT: There was no operative mortality. Five temporary vocal cord paralysis and one wound infection occurred as early complications. During 18 months of follow-up, re-stenosis was not found. CONCLUSION: Tracheal resection and anastomosis can be considered as an excellent surgical treatment for tracheal stenosis which developed as a complication of endotracheal intubation.
Follow-Up Studies ; Humans ; Intubation, Intratracheal ; Mortality ; Tracheal Stenosis* ; Vocal Cord Paralysis ; Wound Infection

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The Effects of Aprotinin on ACT and the Total Amount of Heparin for Open Heart Surgery.

Hyun Woo LEE ; Jae Woong LEE ; Chul Hyun PARK ; Kook Yang PARK

The Korean Journal of Thoracic and Cardiovascular Surgery.2000;33(7):560-564.

BACKGROUND: Aprotinin, which is a nonspecific serine protease inhibitor, has an antiinflammatory and thrombogenic effect. However, it has an antithrombogenic effect during the cardiopulmonary bypass. This study was performed to evaluated the effects of aprotinin on the activated clotting time(ACT) and the total amount of the heparin used during the cardiopulmonary bypass. MATERIAL AND METHOD: From December 1998 to November 1999, 82 consecutive patients electively underwent open heart surgery at Gachon medical school. The patients were older than 18 years. Eighty two patients were classified into a control group(group C, n=36) and a aprotinin-treated group(group A, n=46). Body weight, height, body surface area(BSA), pump time(PT), aortic cross clamping time(ACCT), and body temperature(BT) were determined. Total amount of heparin and protamine during the CPB were also measured. ACT was determined before heparin administration, at 20, 40 and 60 minutes after heparin administration, and after protamine administration. RESULT: No significant differences were noted in either group in body weight, height, BSA, BT, and the total amoun of heparin and protamine. Group A demonstrated a significant(p<0.05) increase in age, PT, ACCT, and ACT at 20, 40, and 60 minutes after heparin administration. CONCLUSION: In summary, the use of aprotinin prime resulted in an increase in ACT. The total amount of heparin in aproinin-treated patient was similar to that of the control group in spite of having the prolonged pump time. Therefore aprotinin may reduce the requirement of heparin.
Aprotinin* ; Body Height ; Body Weight ; Cardiopulmonary Bypass ; Constriction ; Heart* ; Heparin* ; Humans ; Schools, Medical ; Serine Proteases ; Thoracic Surgery*

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Long Term Results of Carbomedics Mechanical Valve.

Byung Yul KIM ; Yong Taek LIM ; Sung Hyuk CHUNG ; Kyung Hoon KANG ; Jung Ho LEE

The Korean Journal of Thoracic and Cardiovascular Surgery.2000;33(7):552-559.

BACKGROUND: The aim of this study is to evaluate our clinical experience with the Carbomedics heart valve prosthesis. MATERIAL AND METHOD: Between Aug. 1988 and Dec. 1998, 294 Carbomidics valves were implanted in 235 patients(mitral; 143, mitral and aortic; 59, aortic; 33) The mean age at operation is 40.0+/-12.3 years(range 7 to 68 years); 63.8% (150patients) were woman. Follow up was 97.4% complete and mean follow up time was 5.7years with a total of 1209.2 patient-years. RESULT: The hospital mortality was 8.9%(mitral; was 95.2+/-1.6%(mitral ; 94.9+/-2.1%, mitral and aortic 95.0+/-3.7%, aortic 96.2+/-3.8%). Actual freedom rates from complications(linearized rates in parentheses) were fllowings; thromboembolism 96.2+/-1.5%(0.59%pt-yr), valve thrombosis 96.7+/-1.4%(0.5%/pt/yr), anticoagulant related hemorrhage 98.3+/-1.0%(0.25%/pt-yr), perivalvular leak 99.0+/-1.4%(0.5%/pt-yr), endocarditis 98.7+/-1.0%(0.25%/pt-yr), perivalvular leak 99.0+/-0.7%(0.17%pt-yr), endocarditis 98.7+/-1.0%(0.17%+/-pt-yr) and overall valve-related complications 88.9+/-2.5%(1.68%/pt-yr). CONCLUSION: The clinical performance of the Carbomedics valve was quite satisfactory with a low incidence of valve related mortality and morbidity.
Endocarditis ; Female ; Follow-Up Studies ; Freedom ; Heart Valve Prosthesis ; Hemorrhage ; Hospital Mortality ; Humans ; Incidence ; Mortality ; Thromboembolism ; Thrombosis

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