• Archives of Plastic Surgery
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• v.39 no.5
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• pp.546-550
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• 2012

Background This study was designed to introduce the feasibility of toe tissue transfer without venous outflow for fingertip reconstruction. Methods Five cases of fingertip defects were treated successfully with this method. Four cases were traumatic fingertip defects, and one case was a hook-nail deformity. The lateral pulp of a great toe or medioinferior portion of a second toe was used as the donor site. An arterial pedicle was dissected only within the digit and anastomosis was performed within 2 cm around the defect margin. The digital nerve was repaired simultaneously. No additional dissection of the dorsal or volar pulp vein was performed in either the donor or recipient sites. Other surgical procedures were performed following conventional techniques. Postoperative venous congestion was monitored with pulp temperature, color, and degree of tissue oxygen saturation. Venous congestion was decompressed with a needle-puncture method intermittently, but did not require continuous external bleeding for salvage. Results Venous congestion was observed in all the flaps, but improved within 3 or 4 days postoperatively. The flap size was from $1.5{\times}1.5cm^2$ to $2.0{\times}3.0cm^2$. The mean surgical time was 2 hours and 20 minutes. A needle puncture was carried out every 2 hours during the first postoperative day, and then every 4 hours thereafter. The amount of blood loss during each puncture procedure was less than 0.2 mL. In the long-term follow-up, no flap atrophy was observed. Conclusions When used properly, the free toe tissue transfer without venous anastomosis method can be a treatment option for small defects on the fingertip area.

• Journal of Chest Surgery
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• v.27 no.5
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• pp.345-352
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• 1994

We have performed left lung transplantation followed by ligation of right pulmonary artery in 14 dogs at the Chest Disease Research Institute, Yonsei University College of Medicine from May 1992 to February 1994. Excised left lung was perfused with 1500cc of 4$^{\circ}$C cold Euro-Collin`s[E-C] solution at a pressure of 30cmH2O through main pulmonary artery and preserved in 4$^{\circ}$C cold E-C solution for one hour. Left lung transplantation were proceeded in order of left atrium, left main bronchus, left pulmonary artery and right pulmonary artery ligation as usual method. The femoral artery and pulmonary artery pressures were monitored for more than 5 hours after the transplantations in 14 dogs. Six recipient dogs had elevated mean pulmonary artery pressure to greater than 30mmHg after the left lung transplantation and ligation of right pulmonary artery. The cause of elevated mean pulmonary artery pressure was due to inadequate preservation resulting in ischemic damage to donor lungs in 3 cases, and inadequate surgical techniques in 3 cases. Two recipient dogs without surgical complications died immediate post-operatively due to hemorrhagic shock. The bleeding focuses were LA anastomotic site in one case and femoral artery puncture site in another case. The remaining 6 recipient dogs showed mean pulmonary arterial pressure less than 30mmHg. However, one dog had spontaneous pneumothorax in post-operative 4 days, and another dog had rejection phenomenon in post-operative 5 days which was confirmed by pathologic findings of extracted transplanted lung. One dog succumbed of severe hemoptysis which was due to lung abscess with pin point stenosis of bronchial anastomosis in post-operative 38 days. In conclusion, elevated mean pulmonary arterial pressure greater than 30mmHg in immediate postoperative period can be due to inadequate preservation of extracted lung or poor surgical techniques. And the two dogs succumbed of hemorrhagic shock even though the mean pulmonary arterial pressure was less than 30mmHg. It is thought that careful preservation of the extracted donor lung in 4oC E-C solution and complete surgical techniques are the most important factors early and late complications.

• Journal of Korean Neurosurgical Society
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• v.48 no.6
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• pp.528-531
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• 2010

Ehlers-Danlos syndrome (EDS) type IV is characterized by its clinical manifestations, which are easy bruising, thin skin with visible veins, and rupture of arteries, uterus, or intestines. Arterial complications are the leading cause of death in vascular EDS because they are unpredictable and surgical repair is difficult due to tissue fragility. The authors report a case presented with cervical radiculopathy due to a segmental fusiform aneurysm of the cervical vertebral artery. Transfemoral cerebral angiography (TFCA) was done to verify the aneurysmal dilatation. However, during TFCA, bleeding at the puncture site was not controlled, skin and underlying muscle was disrupted and profound bleeding occurred during manual compression after femoral catheter removal. Accordingly, surgical repair of the injured femoral artery was performed. At this time it was possible to diagnose it as an EDS with fusiform aneurysm on cervical vertebral artery. Particularly, cervical fusiform aneurysm is rare condition, and therefore, connective tissue disorder must be considered in such cases. If connective tissue disorder is suspected, the authors suggest that a noninvasive imaging modality, such as, high quality computed tomography angiography, be used to evaluate the vascular lesion to avoid potential arterial complications.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.3
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• pp.1191-1196
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• 2015

Background: Epidermal growth factor-like domain multiple 7 (EGFL7), recently identified as a secreted protein regulated by oxygen exposure, plays a critical role in promoting metastasis of hepatocellular carcinoma (HCC). Transcatheter arterial embolization (TAE) is widely used for treatment of HCC, resulting in hypoxia in tumors and surrounding liver tissues. Accordingly, we proposed the hypothesis that there could be a relationship between expression of EGFL7 and response to TAE. Materials and Methods: We established a rabbit VX2 liver tumor model using percutaneous puncture technique guided by computed tomography. TAE and sham embolization were performed and the results were confirmed by MRI 3 weeks after inoculation. We investigated the EGFL7 expression of the two groups at 6h and 3 days after intervention by means of immunohistochemistry and Western blotting. Results: Immunohistochemical staining demonstrated that the levels of EGFL7 protein significantly increased in the TAE-treated tumors compared with the control group at 6 hours (P=0.031) and 3 days (P=0.020) after intervention. Meanwhile, the relative EGFL7 protein detected in TAE group also up-regulated compared with the control group at 6 hours (P=0.020) and 3 days (P=0.024) after intervention. Conclusions: This study reveals an increase of EGFL7 expression in rabbit VX2 liver tumors after TAE. The role of EGFL7 in HCC, especially its biological behavior after TAE, needs further investigation.

• Journal of Korean Neurosurgical Society
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• v.63 no.2
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• pp.188-201
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• 2020

Objective : The purpose of this study was to suggest that computed tomography angiography (CTA) is valuable as the only preliminary examination for mechanical thrombectomy (MT). MT after single examination of CTA including noncontrast computed tomography (NCCT) and maximum intensity projection (MIP) improves door-to-puncture time as well as results in favorable outcomes. Methods : A total of 157 patients who underwent MT at Dong Kang Medical Center from April 2015 to March 2019 were divided into two groups based on the examination performed prior to MT : CTA group who underwent CTA with NCCT and MIP, and NCCT+magnetic resonance image (MRi) group who underwent MRI including perfusion images after NCCT. In the two groups, time to CTA imaging or NCCT+MRi imaging after symptom onset, and time to arterial puncture and reperfusion were characterized as time-related outcomes. The evaluation of vascular recanalization after MT was defined as a modified thrombolysis in cerebral infarction (mTICI) scale. National Institutes of Health Stroke Scale (NIHSS) was assessed at the time of the visit to the emergency room and modified Rankin Scale (mRS) was assessed after 90 days. Results : Typically, there were 34 patients in the CTA group and 33 patients in the NCCT+MRi group. A significantly shorter delay for door-to-puncture time was observed (mean, 86±22.1 vs. 176±47.5 minutes; <0.01). Also, a significantly shorter door-to-imege time in the CTA group was observed (mean, 13±6.8 vs. 93±30.8 minutes; p<0.01). Moreover, a significantly shorter onset-to-puncture time was observed (mean, 195±128.0 vs. 314±157.6 minutes; p<0.01). Reperfusion result of mTICI ≥2b was 100% (34/34) in the CTA group and 94% (31/33) in the NCCT+MRi group, and mTICI 3 in 74% (25/34) in the CTA group and 73% (24/33) in the NCCT+MRi group. Favorable functional outcomes (mRS score ≤2 at 90 days) were 68% (23/34) in the CTA group and 60% (20/33) in the NCCT+MRi group. Conclusion : A single-phase CTA including NCCT and MIP images was performed as a single preliminary examination, which led to a reduction in the time of the procedure and resulted in good results of prognosis. Consequently, it is concluded that this method is of sufficient value as the only preliminary examination for decision making.

• Journal of Chest Surgery
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• v.38 no.5 s.250
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• pp.396-399
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• 2005

Manual or mechanical compression followed by 4 to 8 hours of bed rest is still the standard technique for accessing site management of the femoral arterial puncture site. But these methods are often uncomfortable and delay hospital discharge. Recently, a number of new devices to achieve hemostasis have been developed. These devices uses collagen to facilitate local hemostasis. But many complications associated with the use these devices have been reported internationally. We present a case of successful treatment of Rt. femoral and Rt. popliteal arteries thrombosis caused by Angioseal.

• The Korean Journal of Pain
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• v.26 no.2
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• pp.191-194
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• 2013

Pseudoaneurysm of the abdominal wall is a possible but very rare clinical entity. It is a known complication of surgery, trauma, or arterial puncture, but it is rarely spontaneous. Even though it can usually present with a wide range of local symptoms, it can cause referred pain via spinal cord, which is cross-excited with afferent sympathetic nervous system. We report a case of right arm pain which was referred from a small abdominal pseudoaneurysm like a referred pain from gall bladder. This rare entity should be considered in the differential for pain management in case that the pain does not resolve with medication or interventional pain management.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.1
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• pp.81-85
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• 2021

Central venous catheter (CVC) insertion is commonly used in the operating room and intensive care unit to monitor central venous pressure and secure an intravenous route to deliver medications and nutritional support that cannot be safely infused into peripheral veins. However, CVC insertion may be associated with serious complications such as arterial puncture, hematoma, pneumothorax, hemothorax, catheter infections, and thrombosis. Several methods have been recommended to prevent these complications. Here we report a case of massive hemothorax caused by attempts of CVC insertion into the internal jugular vein and subclavian vein in a patient with multiple trauma. CVC placement should be performed or supervised by an experienced physician to decrease the incidence of CVC-related complications. CVC insertion under ultrasound guidance is recommended.

• Perspectives in Nursing Science
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• v.7 no.1
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• pp.55-64
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• 2010

Purpose: The purpose of this study was to examine the effects of position change from supine to Fowler's on back pain and discomfort in patients who remained on bed rest after undergoing PCIs with a vascular closure device. Methods: Data was collected from 35 inpatients who were hospitalized in coronary-care unit to perform PCIs with a vascular closure device at S hospital in Seoul from December, 2006 to May, 2007. Back pain, discomfort, presence and grade of bleeding and hematoma from femoral arterial puncture site and blood pressure/pulse rate were measured prior to, 10 minutes, 1 hour and 2 hours after position change. Data was analyzed with descriptive statistics, $x^2$ tests and t-tests using SPSS/WIN 12.0 for Windows program. The level of significance (${\alpha}$) was set at 0.05 for this study. Results: We found that there was no significant difference in back pain and discomfort in 10 minutes after position change between the two groups. However, the experimental group reported significantly less back pain and discomfort than the control group in 1 hour (p<.01, respectively) and 2 hour (p<.01, respectively) after position change. There was no significant difference in the presence and grade of bleeding and hematoma at the puncture site, blood pressure, and pulse rate in 10 minutes, 1hour and 2hours after position change between the two groups. Conclusion: Fowler's position change after PCIs in, therefore, safe and effective method of reducing back pain and physical discomfort without causing additional bleeding and changes in blood pressure and pulse rate.

• Journal of Korean Neurosurgical Society
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• v.53 no.4
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• pp.213-217
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• 2013

Objective : Transradial angiography has become popular among many cardiologists as a diagnostic and therapeutic tool. However, transradial cerebral angiography is not utilized to the same extent. The purpose of this study is to present our experience regarding the usefulness of transradial cerebral angiography, especially in elderly patients. Methods : Between May 2011 and February 2012, a total of 126 cerebral angiographies were performed via a transradial approach in a single center. Of them, only 47 patients were over 60 years old. In our institution, we shifted the initial access from the right femoral artery to the right radial artery in all patients requiring cerebral angiography in 2011. We did not attempt radial access in 40 cases for variable reasons. Results : The procedural success rate was 92.2%. We have four failures of transradial angiography; two because of loop formations of the radial and brachial artery and two due to multiple puncture failures. All supra-aortic vessels were successfully catheterized. However, the selective catheterization rates of the left side distal vessels were lower, as success rates were 89.7% for the right internal carotid artery and 75% for the left internal carotid artery. Procedure-related vascular complications, such as puncture site hematoma, hand ischemia, pseudoaneurysm, arteriovenous fistula and arterial dissection were not observed in our series. However, intraprocedural thrombosis developed in one patient, which was resolved completely by intraarterial thrombolytic agents. Conclusion : With advancing patient's age, we believe that transradial cerebral angiography is a useful tool to decrease patient's discomfort and more effectively manage the vessel tortuosity.