• Journal of Chest Surgery
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• v.49 no.1
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• pp.22-28
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• 2016

Background: Carotid endarterectomy (CEA) with selective shunting is the surgical method currently used to treat patients with carotid artery disease. We evaluated the incidence of major postoperative complications in patients who underwent CEA with selective shunting under transcranial Doppler (TCD) at our institution. Methods: The records of 45 patients who underwent CEA with TCD-based selective shunting under general anesthesia from November 2009 to June 2015 were reviewed. The risk factors for postoperative complications were analyzed using univariate and multivariate analysis. Results: Preoperative atrial fibrillation was observed in three patients. Plaque ulceration was detected in 10 patients (22.2%) by preoperative computed tomography imaging. High-level stenosis was observed in 16 patients (35.5%), and 18 patients had contralateral stenosis. Twenty patients (44.4%) required shunt placement due to reduced TCD flow or a poor temporal window. The 30-day mortality rate was 2.2%. No cases of major stroke were observed in the 30 days after surgery, but four cases of minor stroke were noted. Univariate analysis showed that preoperative atrial fibrillation (odds ratio [OR], 40; p=0.018) and ex-smoker status (OR, 17.5; p=0.021) were statistically significant risk factors for a minor stroke in the 30-day postoperative period. Analogously, multivariate analysis also found that atrial fibrillation (p<0.001) and ex-smoker status (p=0.002) were significant risk factors for a minor stroke in the 30-day postoperative period. No variables were identified as risk factors for 30-day major stroke or death. No wound complications were found, although one (2.2%) of the patients suffered from a hypoglossal nerve injury. Conclusion: TCD-based CEA is a safe and reliable method to treat patients with carotid artery disease. Preoperative atrial fibrillation and ex-smoker status were found to increase the postoperative risk of a small embolism leading to a minor neurologic deficit.

• Korean Journal of Acupuncture
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• v.26 no.2
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• pp.91-108
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• 2009

Objectives: Single colorectal instillation of trinitrobenzenesulphonic acid (TNBS) causes a dose-dependent increase of visceral motor response (VMR) and severity of inflammation. In this study we compared the effects of electroacupuncture in the different acupoints in the acute colitis induced by TNBS intracolonic injection in rats. Methods: In Male Sprague-Dawley rats, weighing $250{\sim}400g$, a single colorectal administration of TNBS 5mg/kg and 50% ethanol under isoflurane anaesthesia after an overnight fast. Electrodes for electromyography (EMG) recording were stitched into the external oblique musculature under general anesthesia. Acupoints of LI4, ST25, or ST36 were stimulated by electroacupuncture, respectively. The balloon was inserted intra-anally and visceral motor response (VMR) to colorectal distensioin (CRD) was quantified with an EMG recording system. Results: At an observation of the visceral hyperalgesia in the day-time series, the visceromotor response increased significantly 3 days after TNBS intra-rectalcolonic injection in rats. Electroacupuncture on either ST25 or ST36 suppressed the visceromotor response to colorectal distension, but not LI4, at 3 days after TNBS injection. Pretreatment of naltrexone (10 mg/kg, i.p.), opioids antagonist, inhibited the VMR suppress of 10Hz EA to ST36 but not phentolamine (5 mg/kg, i.p.). Pretreatment of either naltrexone or phentolamine inhibited effects of 10Hz EA to ST25. Conclusions: Data show that EA at either ST25 or ST36 potently inhibits hypersensitivity of colorectum after TNBS induced colitis and is differently mediated through the endogenous opioid system and adrenergic system.

• Korean Journal of Acupuncture
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• v.26 no.2
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• pp.75-89
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• 2009

Objectives: Warm needling combines simultaneously the effects of acupuncture and moxibustion. This study was to investigate whether warm needling could relieve acute knee arthritis induced by carrageenan in rats. Methods: To illuminate the underlying mechanisms of the warm needling-induced antinociception, weight bearing force (WBF) was observed on the acute knee arthritic rat model. Under general anesthesia, ST36, SP9, Hakjung extra point, LI4 were punctured and stimulated with 30 mg moxa ball combustion on top of the needle (${\emptyset}0.18{\times}8mm$). Results: In behavioral test, rats subsequently showed a reduced stepping force of the affected limb 3 hours after the induction of arthritis. Warm needling on the contralateral or ipsilateral ST36 failed to show antinociceptive effect on the acute knee arthritis. Warm needling on the contralateral SP9 or LI4 increased WBF values to normal level in the acute stage of the arthritis. Warm needling on the Hakjung extra-point resulted in the significant antinociceptive effects through acute stage. These effects of warm needling were suppressed by opioids receptor antagonist naltrexone (10 mg/kg, i.p.) and alpha adrenoceptor antagonist phentolamine (5 mg/kg, i.p.). Conclusion: The data suggest that warm needling-induced antinociception is differently mediated by acupoints and accomplished by activating the descending inhibitory systems including endogenous opioids and $\alpha$-adrenoceptors.

• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.4
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• pp.297-305
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• 2017

Background: Fiberoptic nasotracheal intubation (FNI) is performed if it is difficult to open the mouth or if intubation using laryngoscope is expected to be difficult. However, training is necessary because intubation performed by inexperienced operators leads to complications. Methods: Every resident performed intubation in 40 patients. Success of FNI was evaluated as the time of FNI. First intubation time was restricted to 2 min 30 s. If the second attempt was unsuccessful, it was considered a failed case, and a specialist performed nasotracheal intubation. If the general method of intubation was expected to be difficult, awake intubation was performed. The degree of nasal bleeding during intubation was also evaluated. Results: The mean age of the operators (11 men, 7 women) was 27.8 years. FNI was performed in a total of 716 patients. The success rate was 88.3% for the first attempt and 94.6% for the second attempt. The failure rate of intubation in anesthetized patients was 4.9%, and 13.6% in awake patients. When intubation was performed in anesthetized patients, the failure rate from the first to fifth trial was 9.6%, which decreased to 0.7% when the number of trials increased to > 30 times. In terms of awake intubation, there was no failed attempt when the resident had performed the FNI > 30 times. The number of FNIs performed and nasal bleeding were important factors influencing the failure rate. Conclusion: The success rate of FNI increased as the number of FNI performed by residents increased despite the nasal bleeding.

• Archives of Craniofacial Surgery
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• v.12 no.1
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• pp.63-66
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• 2011

Purpose: Cranial fasciitis is a rare type of benign tumor that occurs mostly in children younger than 6 years. It arises from the deep fascia, periosteum, or fibromembranous layer that covers fontanelles. The etiology is unknown, although prior trauma has been postulated to be an underlying cause. There is a 2:1 male predominance. Despite its rapid growth, this tumor has a benign clinical course and can be cured by total excision. Methods: A 16-year-old male presented with a 3 cm-sized palpable mass in the left lateral eyebrow region that he first noticed 4 months before presentation. The mass had grown rapidly since it was first noticed. Preoperative brain computed tomography showed a well-demarcated mass approximately 3 cm in size extending from the subcutaneous layer to the periosteum. Preoperatively, the presumed diagnosis was a dermoid cyst. An operation was performed with the patient under general anesthesia. The subcutaneous mass was completely excised by periosteal dissection. Results: Histological diagnosis revealed the presence of cranial fasciitis. After 20 months of follow-up, there have been neither complications nor evidence of local recurrence besed on clinical examination. Conclusion: Although cranial fasciitis is quite rare, it should be considered in the differential diagnosis for lytic skull lesions in patient whose clinical presentation suggests this possibility. This condition could be occasionally mistaken for malignant or locally aggressive lesions. To prevent local recurrence, curettage of the underlying bone is recommended for patients with bone involvement.

• Archives of Craniofacial Surgery
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• v.14 no.1
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• pp.69-72
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• 2013

Lateral eyebrow mass with primary skull lesion are rare in pediatric population. Although epidermoid cyst and dermoid cyst are the most commonly encountered skull lesions in pediatric population, Langerhans cell histiocytosis (LCH) is rarely reported. We report a case of LCH arising from the lateral eyebrow with osteolytic lesion involving the frontal bone. A 5-year-old boy was presented with a hard, fixed mass in his lateral eyebrow. Contrast magnetic resonance imaging revealed inhomogeneous enhancement of the mass with direct invasion of the frontal bone and adjacent dura mater. Under general anesthesia, linear incision at the lateral eyebrow region was made. Intraoperative evaluation revealed hard, fixed and well-defined soft tissue mass. The final extirpated mass was $2.5{\times}2.4cm$ in size, and was accompanied by a $1{\times}1cm$ sized defect on the frontal bone with intact dura mater. The surgical wound was closed primarily by a layer-by-layer fashion. Histologic examination was later performed for definite diagnosis. The histologic examination revealed abnormal proliferation of Langerhans cell with granuloma formation. Radionuclide bone scan and positron emission tomography was taken and revealed free of multi-organ involvement. At 3 months after surgery, natural looking contour at the lateral eyebrow region was observed with no tumor recurrence. Differential diagnosis of the hard and fixed mass at the lateral eyebrow region affecting the primary skull lesion from pediatric population includes epidermoid cyst, dermoid cyst and LCH. Generally, brief physical examination with plain X-ray view can be performed for clinical evaluation, but for a definite diagnosis, contrast MRI may be helpful.

• Archives of Craniofacial Surgery
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• v.14 no.1
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• pp.50-52
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• 2013

Povidone-iodine (PVP-I, Betadine) has many advantages as a disinfectant solution for preoperative preparations, especially for oral surgery. It is widely used because of its low toxicity and excellent bactericidal effect. The authors report a case of pneumonia secondary due to the aspiration of PVP-I, which was used as an oral disinfectant. We present a case of aspiration pneumonia that resulted from the careless use of PVP-I during preoperative preparation. The patient was a 10-month-old female scheduled for elective surgery to correct a complete cleft of secondary palate. During the preparation of the oral cavity for that cleft palate patient, PVP-I was incidentally aspirated to the airway. The lung resistance was noted with positive pressure and pneumonic infiltration on chest radiograph was seen. The operation was postponed and the patient underwent respiratory care. Three months later, elective palatoplasty under general anesthesia was performed without complication. Based on the experiences of this case, the authors advise that throat-packing should be placed before oral preparation to prevent serious pulmonary complications.

• Journal of Veterinary Clinics
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• v.33 no.6
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• pp.332-339
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• 2016

Polycaprolactone (PCL) scaffold have been developed as an alternative to natural donor tissue to repair a large osteochondral defect. The objective of this study is to evaluate efficacy and biocompatibility of bilayer PCL scaffold implanted for osteochondral repair in rabbit. Twenty-two male New Zealand White rabbits were used in this animal experiment. Rabbits were divided into three groups. Experimental surgery was carried out under general anesthesia. Osteochondral defects (5 mm diameter and 5 mm deep) were made in the center of the patellar groove using a 5 mm diameter biopsy punch. In group I (3D plotting) and group II (salt-leaching), the scaffold was implanted using the press-fitted technique into the defect. In control group, after osteochondral defect was created, the defect was left without implant. After four and eight weeks, rabbits were sacrificed and the defects were evaluated by macro -and microscopical methods. There were not found animal death and severe inflammatory evidence during the experimental periods. There were no significant differences between the experimental groups in gross evaluation. However the group I scored significantly higher than group II at 8 weeks in histological evaluation (P < 0.05). The 3-D plotting PCL scaffold was more suitable method for reconstruction of osteochondral defect than a salt-leaching PCL scaffold.

• Korean Journal of Bronchoesophagology
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• v.3 no.1
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• pp.115-121
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• 1997

We have clinico-statically analysed the 235 cases of esophageal foreign body during the period the past 12 years from March InS to December 1996 at the Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Guro Hospital. The results were as follow : 1) Coin was the most frequent foreign body in the esophagus(172 cases : 73.2%). Bone was the next frequent foreign body (21 cases 8.8%). 2) In sex distribution, 124 cases(52.8%) of patients were the female and 111 cases(47.2%) were the male, so the sex ratio was 1:1.12. 3) In the age distribution, 134 cases(56.9%) were under 5 years of age, coin was the most frequent materials in this age group(111 cases 47.2%). 4) The most common symptom was vomiting(136 cases : 57.9%). The next common symptom was dysphagia and odynophagia was 41 cases(17.4%) 5) The most prevalent site of lodgement was the first narrowing(181 cases : 77.0%), the third narrowing(31 cases : 13.2%) and the second narrowing of esophagus(23 cases 9.8%) in order. 6) In duration of lodgement, 207 cases(88.1%) were lodged for one day. 7) The foreign bodies of esophagus were removed successfully by esophagoscopic procedure under local or general anesthesia. There were 3 cases of complication, one case of esophageal bleeding and two cases of esophageal rupture.

• Korean Journal of Bronchoesophagology
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• v.15 no.1
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• pp.28-34
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• 2009

Background and Objectives: Foreign bodies of upper aerodigestive tract are common problem for primary care physicians. Delayed diagnosis or failure of removal might cause fatal problemsand complications. Therefore proper diagnosis and management is imperative. In this study, we described clinical features of upper aerodigestive tract foreign body, and analyzed efficacy of different management modality. Materials and Methods: 250 cases of foreign bodies in the esophagus and trachea, between Jan. 1998 through Jan. 2009 has been retrospectively analyzed. A total of 24 cases and 226 cases had been found each as airway foreign bodies and esophageal foreign bodies. The clinical features are described and treatment outcomes, prognosis, and rate of complications of each management modality have been compared. Results: In airway foreign bodies, ventilating bronchoscopy yielded better results, 19 success out of 19 trials than fiberoptic bronchoscopy, 3 success out of 5 trials. Hospitalization days after removal of foreign body didn't show difference between two treatment modalities, although patients who had ventilating bronchoscopy had gone through general anesthesia. And there was no complication after removal of foreign body. In esophageal foreign bodies, rigid esophagoscope yielded better results, 99% of successful removal rate, compared to the EGD, only 78% of successful removal rate. There was no difference of hospitalization days between two modalities. And complication rate was even low in patients who had done rigid esophagoscopic foreign body removal. Conclusion: In upper aerodigestivetract foreign body. Rapid diagnosis and successful foreign body removal is important. Removal by rigid scope(ventilating bronchoscope, rigid esophagoscope) revealed less failure in both airway and esophageal foreign bodies.