• Journal of the korean academy of Pediatric Dentistry
• /
• v.41 no.1
• /
• pp.40-46
• /
• 2014

Treacher Collins syndrome (TCS) is autosomal dominant disorder that occurs approximately 1 in 25,000 to 50,000 live births. The main signs of syndrome are hypoplasia of facial bone and microtia. One in third of them is associated with cleft palate and often shows dental hypoplasia. TCS patients need several number of surgery with general anesthesia throughout their life time for recovery of function and esthetic. Endotracheal intubation of TCS patient is very difficult due to microstomia, retrognathia, choanal stenosis, and decreased oropharyngeal airway. Therefore, general anesthesia of adolescent TCS patient with immature incisor roots has high risk of causing dental trauma. This case is regarding TCS patient who was referred to the Department of Pediatric Dentistry, Yonsei University for avulsed upper left central incisor during endotracheal intubation. The purpose of this report is to emphasize the usefulness of mouth guard to prevent dental trauma when endotracheal intubation is needed for TCS patient.

• Journal of Chest Surgery
• /
• v.37 no.10
• /
• pp.827-832
• /
• 2004

Background: The significance of MIDCAB is emerging topics recently as OPCAB is going to be universalized, and long-term outcome of bypass graft surgery was proved to be more excellent than balloon dilation or stent insertion. We report our MIDCAB results in 73 patients in the last three years. Material and Method: Retrospective analysis of medical records was done from November 1, 2000 through November 31, 2003. There were 47 males and 26 females ranging in age from 31 years to 79 years (average $61.3\pm9.8$ years). Observation periods after operative procedures were 10 to 1238 days (average $763\pm319.8$ days). Left longitudinal parasternal incision as a standard procedure was done to approach the heart after dissection of the left internal thoracic artery by partial or total resection of 3rd to 5th ribs. Result: Of those patients, 46 patients were transferred to ICU after extubation at operation room and 58 patients were extubated within 3 hours after operation. Average ICU staying periods was $26.8\pm11.5$ hours. Follow-up angiography during admission was done in 36 patients and showed 100% patency. Only one patient died on the 10$^{th}$ post operative day because of sudden CVA. Complications included wound problems in 4 patients, and constructing pericardial window using thoracoscopy due to continuous pericardial effusion in 1. Permanent pacemaker was inserted in one patient owing to sick sinus syndrome. In one patient with recurrence of angina 8 months after operation, stenosis at anastomic site was found and improved with balloon dilatation. Conclusion: We were satisfied with our results of MIDCAB in single and multi-vessel coronary artery disease. These results have made the cardiologists tried to operate positively and we expect widening operative indications including hybrid revascularization.

• Tuberculosis and Respiratory Diseases
• /
• v.58 no.3
• /
• pp.295-298
• /
• 2005

We report a case of a 48-year-old man with a paradoxic upper airway obstruction and central sleep apnea that developed after an anterior cervical spinal fusion. Nine months before being admitted to this hospital, he was diagnosed with a herniated intervertebral disc between the 5th and 6th cervical spine, and the first operation was carried out. Two months later, a pseudoarthrosis has developed and a second operation, an anterior interbody fusion of the C5 and C6 using autogenous strut bone graft, was performed. After the second operation, he began to complain of snoring, excessive daytime sleepiness, insomnia, and a bizarre sound heard near the upper airway during breathing. Nasopharyngoscope and magnetic resonance imaging disclosed a paradoxical narrowing of the nasopharynx during expiration. On the overnight polysomnography, the apnea index was 8.7/h (central apnea, 7.0/h; obstructive apnea, 1.7/h). Nasal continuous positive airway pressure was applied, but he complained of pressure-intolerance, and laser-assisted uvulopalatoplasty was then performed. Two months after surgery, clinical symptoms as well as the apneas had improved markedly. We suggest that this paradoxic upper airway obstruction might be associated with the anterior cervical spinal surgery even though the mechanism is unclear. This case also emphasizes that an upper airway obstruction can contribute to the development of central sleep apnea.

• Journal of Chest Surgery
• /
• v.42 no.5
• /
• pp.597-603
• /
• 2009

Background: Atrioventricular valve regurgitation in pediatric patients with a functional single ventricles (FSV) - has been known as one of the important risk factors for death and unfavorable long-term results after a Fontan operation. We evaluated early and mid-term results of bivalvation valvuloplasty in FSV patients. Material and Method: We retrospectively evaluated 11 patients with a functional single ventricle who underwent bivalvationvalvuloplasty between 1999 and 2007. The degree of common atrioventricular valve regurgitation (CAVVR) was determined by color Doppler echocardiography (regurgitation grade scoring, trivial; 1, mild; 2, moderate; 3, severe; 4). Mean age at valve surgery was $6.9{\pm}7.0$ months (median 4 months, 24 days$\sim$21 months)and mean body weight was $6.2{\pm}2.8\;kg$ ($3.1{\sim}11.3\;kg$). Nine patients had isomerism heart and two of them had TAPVC. The concomitant procedures were performed in all but one patient. Additional commissural closure was performed in 3 patients and commissural annuloplasty in another 3 patients. Result: There was one hospital death after. surgery. A 32-day old patient who had been preoperatively dependent on a ventilator died of air way and lung problems 4.3 months after pulmonary artery banding and bivalvation valvuloplasty. Mean follow-up duration was 40 months ($4.3{\sim}114$ months). Mean preoperative CAVVR score was $3.3{\pm}0.6$, which decreased to $1.9{\pm}0.7$ postoperatively (p<0.0001). This residual regurgitation slightly increased to $2.2{\pm}0.4$ (no statistical significance) after a mean follow-up of 1.4.3 months. Six patients (60%) required re-operations for residual regurgitation at a subsequent bidirectionalcavopulmonary shunt or Fontan operation. One patient with Ebsteinoid malformation of the right sided atrioventricular valve required valve replacement due to stenoinsufficiency. Another patient required edge-to-edge repair at the right sided AV valve (between the right mural leaflet and the bridging leaflets). The remaining 4 patients required additional suture placements between bridging leaflets with or without commissural annuloplasty. All survivor had trivial or mild CAVVR at the latest follow-up. Conclusion: Bivalvation valvuloplasty for CAVVR in FSV patients is. an effective and safe procedure. However, significant numbers of the patients have small residual regurgitation and require additional valve procedures at subsequent operations. Long-term observations to monitor progression of the CAVVR is mandatory.

• Journal of Oral Medicine and Pain
• /
• v.34 no.4
• /
• pp.371-377
• /
• 2009

Objectives: The aim of this study was to evaluate the differences in the polysomnography data between positional and non-positional obstructive sleep apnea (OSA) patients. Methods: Forty-seven patients diagnosed with OSA were evaluated using full night polysomnography. According to the criteria of Cartwright et al., the patients were classified into two groups with 37 positional (supine apnea-hypopnea index [AHI] $\geq$ 2x's the lateral AHI) and 10 non-positional (supine AHI < 2x's the lateral AHI) OSA patients, and the differences of polysomnography data between the two groups were evaluated. Results: There were no significant differences in demographic variables (age, gender, and BMI), daytime sleepiness, overall AHI, total arousal index, and percent time of snoring between two groups. However, AHI, arousal index, and mean oxygen saturation ($SpO_2$) of the REM sleep stage were significantly more severe in the positional OSA group than the non-positional OSA group. Mean $SpO_2$ and the lowest $SpO_2$ during overall sleep stage were also significantly lower in the positional OSA group than the non-positional OSA group. Conclusions: Our results of differences in the polysomnography data of REM sleep stage suggest that non-positional OSA patients may have higher collapsibility of the oropharyngeal airway during sleep than positional OSA patients.

• Tuberculosis and Respiratory Diseases
• /
• v.50 no.5
• /
• pp.591-598
• /
• 2001

Background : Primary adenoid cystic carcinoma arising in the bronchus is an uncommon disease that is histologically and ultrastructurally identical to the salivary gland tumor of the same name and regarded as a slow growing low-grade malignancy. We examined its clinical characteristics. Method : We collected 13 Korean cases of primary adenoid cystic carcinoma arising in the bronchus including 5 cases of our own and 8 cases from the literature. Result : The patients ages ranged from 20 to 74. Men numbered 9 and women 4. The presenting symptoms were cough, dyspnea, and hemoptysis. The fiberoptic bronchoscopic findings were primarily hypervascular polypoid mass with a smooth surface that obstructed airway totally or near totally. There were three inoperable cases including two cases with distant metastasis to bone or cervical lymph node and one case with mediastinal invasion. The remaining 10 patients underwent surgical resection. Among them, two patients received postoperative radiotherapy. The median survival was 21 months in the 8 surgical and evaluable cases. One patient lived 13 years without recurrence. The prognosis was relatively favorable in operable cases. Conclusion : It was not common for primary adenoid cystic carcinoma arising in the bronchus to have distant metastasis or invasion to the mediastinum on presentation. The prognosis was relatively favorable in operable cases. It would be important to perform flexible bronchoscopy for early diagnosis and to do surgical treatment if possible.

• Tuberculosis and Respiratory Diseases
• /
• v.45 no.1
• /
• pp.169-175
• /
• 1998

Background: Heliox is known to decrease $PaCO_2$ in patients with increased airway resistance by increasing minute ventilation and reducing work of breathing(WOB). Besides these effect, heliox is expected to decrease functional anatomic dead space owing to improvement of peak expiratory flow rate(PEFR) and enhancement of gas distribution. We investigated whether heliox can decrease $PaCO_2$ even at the same minute ventilation (VE) and WOB with $N_2-O_2$ to speculate the effect of the heliox on the anatomic dead space. Material and Method: The subjects were 8 mechanically ventilated patients with asthma or upper airway obstruction(M : F=5 : 3, $68{\pm}10$years) who were under neuromuscular paralysis. The study was consisted of three 15-minutes phases: basal $N_2-O_2$ heliox and washout Heliox was administered via the low pressure inlet of servo 900C, and respiratory parameters were measured by pulmonary monitor(CP-100 pulmonary monitor, Bicore, Irvine, CA, USA). To obtain the same tidal volume(Vt) in heliox phase, the Vt on monitor was adjusted by the factor of relative flow rate of heliox to $N_2-O_2$. Dead space was calculated by Bohr equation. Results: 1) Vt, VE, peak inspiratory pressure(PIP) and peak inspiratory flow rate(PIFR) were not different between $N_2-O_2$ and heliox. 2) PEFR was higher on heliox($0.52{\pm}0.19$L/sec) than $N_2-O_2$($0.44{\pm}0.13$L/sec)(p=0.024). 3) $PaCO_2$(mmHg) were decreased with heliox($56.1{\pm}14.1$) compared to $N_2-O_2$($60.5{\pm}15.9$)(p=0.027). 4) Dead space ventilation(%) were decreased with heliox($73{\pm}9$ with $N_2-O_2$ and $71{\pm}10$ with heliox)(p=0.026). Conclusion: Heliox decreased $PaCO_2$ even at the same VE and WOB with $N_2-O_2$, and the effect was considered to be related with the reduction of anatomic dead space.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.46 no.4
• /
• pp.369-381
• /
• 2019

The aim of this study was to analyze the changes and improvements in symptoms of sleep-disordered breathing (SDB) using semi-rapid maxillary expansion (SRME) in children with narrow maxilla and SDB symptoms. Subjects were 15 patients with sleep disorder (apnea-hypopnea index, AHI ≥ 1) and narrow maxillary arch between 7 and 9 years of age. Before the SRME was applied, all subjects underwent pediatric sleep questionnaires (PSQ), lateral cephalometry, and portable sleep monitoring before expansion (T0). All subjects were treated with SRME for 2 months, followed by maintenance for the next 3 months. All subjects had undergone PSQ, lateral cephalometry, and portable sleep monitoring after expansion (T1). Adenoidal-nasopharyngeal ratio (ANR), upper airway width and hyoid bone position were measured by lateral cephalometry. The data before and after SRME were statistically analyzed with frequency analysis and Wilcoxon signed rank test. As reported by PSQ, the total PSQ scale was declined significantly from 0.45 (T0) to 0.18 (T1) (p = 0.001). Particularly, snoring, breathing, and inattention hyperactivity were significantly improved (p = 0.001). ANR significantly decreased from 0.63 (T0) to 0.51 (T1) (p = 0.003). After maxillary expansion, only palatopharyngeal airway width was significantly increased (p = 0.035). There was no statistically significant difference in position of hyoid bone after expansion (p = 0.333). From analysis of portable sleep monitoring, changes in sleep characteristics showed a statistically significant decrease in AHI and ODI, and the lowest oxygen desaturation was significantly increased after SRME (p = 0.001, 0.004, 0.023). In conclusion, early diagnosis with questionnaires and portable sleep monitoring is important. Treatment using SRME will improve breathing of children with SDB.

• Journal of Chest Surgery
• /
• v.32 no.3
• /
• pp.215-223
• /
• 1999

Background: The replacement of the narrowed long-segment trachea with various prosthetic materials or tissue grafts remains a difficult and unsolved surgical problem. Homologous cryopreserved tracheal transplantation has been considered to treat the irreversibly-damaged organs, such as in the lung or heart transplantation and also to overcome the limited supply of donor organs. We examined the morphological changes and the immunosuppressive effects of the cryopreserved trachea after the heterotopic transplantation in the rats. Material and Method: Sixty tracheal segments harvested from 30 donor Wistar rats were heterotopically implanted into the peritoneal cavity of 20 recipient Wistar rats and 40 Sprague Dawley rats. The 60 recipient rats were divided into 6 groups(10 rats/ group). In groups I, II, and III, 30 tracheal segments were implanted immediately after the harvesting and in groups IV, V, and VI, the segments were implanted 28 days after the cryopreservation. Groups I and IV were Wistar syngeneic controls. Groups II and V were Sprague Dawley recipients receiving no immunosuppression and Groups III and VI, were Sprague Dawley recipients receiving immunosuppressive agents. At 28 days all rats were sacrificed and the tracheal segments were evaluated grossly and histologically. Result: Immunosuppression of the tracheal segments had a significant influence on the changes of the tracheal lumen and tracheal epithelial cells, irrespective of the cryopreservation of the trachea(p<0.001). In groups III and VI receiving immunosuppressive agents, the tracheal lumen was patent and the normal epithelial cells were observed, however in the other groups not receiving the immunosuppressive agents, there were almost luminal obliteration by the proliferation of the fibrous tissues and a loss of the epithelial cells, the findings were similar to those in the case of obliterative bronchiolitis after a lung and a heart-lung transplantation. Conclusion: With the appropriate immunosuppressive agents, the lumen and the respiratory epithelium of the transplanted tracheal segment were well preserved, even after the cryopreservation of the tracheal segment, which shows the possibility of the long-term preservation and homologous transplantation of the trachea. But fibroproliferative obliteration of the tracheal lumen and the loss of the normal respiratory epithelial cells, characteristic findings of obliterative bronchiolitis, were observed in the groups without the immunosuppression. This experiment using the rat trachea may be useful in studying the pathogenesis, treatment, and prevention of obliterative bronchiolitis after a lung and a heart-lung transplantation.