• 대한두개안면성형외과학회지
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• 제13권2호
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• pp.99-103
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• 2012

Purpose: Many surgical methods for reconstruction of orbital floor fracture have been reported, which include subciliary approach, transconjunctival approach, transantral and transnasal endoscopic approach, etc. The purpose of this study is to demonstrate a surgical technique and analyze the results of transnasal endoscopic approach with Foley catheter ballooning without implantation of artificial surgical material through subciliary approach. Methods: Between February 2007 and November 2010, 29 orbital floor fracture patients, who had no herniated muscles through bone fragments, were treated through transnasal endoscopic approach with Foley catheter ballooning. Under the endoscopic view, the operator identified the opening of maxillary sinus. After widening of the opening using forceps, the operator reduced the fragmented bone with curved suction tip. Thereafter, 18-Fr Foley catheter was inserted. Four weeks after the operation, the catheter was removed. Results: Preoperatively, 6 patients had diplopias, 4 patients had limitations of extraocular motions and 3 patients had enophthalmos. After removal of the Foley catheter 4 weeks after the operation, 2 patients had diplopias, 1 patient had a limitation of extraocular motion, 1 patient has an enophthalmos and 1 patient had numbness on the cheek. These symptoms were resolved about 6 months after the surgery. Conclusion: The operative technique of Foley catheter ballooning through transnasal endoscopic approach without implantation of the artificial surgical material through subciliary approach can be considered one of the appropriate techniques for orbital floor fracture.

• The Korean Journal of Pain
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• 제25권1호
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• pp.43-46
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• 2012

The superior hypogastric plexus block (SHPB) is used for treating pelvic pain, especially in patients with gynecological malignancies. Various approaches to this procedure have been reported due to the anatomic obstacles of a high iliac crest or large transverse process of the $5^{th}$ lumbar vertebra. Here, we report a new technique of superior hypogastric plexus block using a unilateral single-needle approach to block the bilateral superior hypogastric plexus with a Tuohy needle and epidural catheter. We have confidence that this new technique can be another option in performing the SHPB when the conventional bilateral approach is difficult to perform.

• 대한영상의학회지
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• 제84권6호
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• pp.1350-1360
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• 2023

목적 악성 담관 폐쇄 환자에서 경피경간 담도 배액술을 시행할 때 유증상 이탈을 유발하는 예측 인자에 대해 연구를 진행하고자 한다. 대상과 방법 2010년 1월부터 2015년 2월까지 572명의 악성 담관 폐쇄 환자에서 시행한 733건의 경피경간 담도 배액술을 대상으로 후향적 연구를 시행하였다. 카테터의 거치 기간, 접근 위치, 카테터 팁의 위치, 삽입 각도, 피그테일 루프의 유무, 도관 직경을 평가하였다. 결과 추적관찰 기간 동안 157명의 환자에서 224건(30.56%)의 도관 이탈이 발생하였다. 그중 146건(19.92%)가 유증상 도관 이탈이었다. 배액관 이탈 발생까지의 기간은 평균 30일(범위: 1-159일)이었다. 유증상 도관 이탈은 배액관의 교체(137명) 또는 담관 스텐트 삽입(9명)을 통해 치료하였다. 남성(교차비: 1.636, 95% 신뢰구간: 1.131-2.367, p = 0.009), 우측 접근(교차비: 1.567, 95% 신뢰구간: 1.080-2.274, p = 0.018), 도관 삽입 각도 증가(교차비: 1.015, 95% 신뢰구간: 1.005-1.026, p = 0.005), 불완전 피그테일 루프(교차비: 1.672, 95% 신뢰구간: 1.098-2.545, p = 0.016)가 독립적인 경피경간 담도 배액술 도관 유증상 이탈의 예측 인자였다. 결론 유증상 이탈을 유발하는 예측인자에는 남성, 우측 접근, 도관 삽입 각도 증가, 불완전 피그테일 루프가 있다.

• Advances in pediatric surgery
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• 제16권1호
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• pp.25-31
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• 2010

Hickman catheters are tunneled central venous catheters used for long-term venous access in children with malignancies. The appropriate management for various kinds of catheter related complications has become a major issue. We retrospectively analyzed the clinical, demographic, and surgical characteristics in 154 pediatric hemato-oncology patients who underwent Hickman catheter insertion between January 2005 and December 2009. There were 92 boys and 62 girls. The mean age at surgery was $7.6{\pm}5.1$ years old. The mean operation time was $67.4{\pm}21.3$ minutes and C-arm fluoroscopy was used in 47(30.5 %). The causes of Hickman catheter removal were termination of use in 82 (57.3 %), catheter related bloodstream infection in 44(30.8 %), mechanical malfunction in 11(7.7 %), and accidents in 6(4.2 %). Univariate and multivariate analysis for associated factors with catheter related bloodstream infection showed that there were no statistically significant associated factors with catheter related infection complications. All cases except two showed clinical improvement with catheter removal and relevant antibiotics treatment. The mean catheter maintenance period in patients of catheter removal without complications was $214.9{\pm}140.2$ days. And, The mean catheter maintenance period in patients of late catheter related bloodstream infection was $198.0{\pm}116.0$ days. These data suggest that it is important to remove Hickman catheter as soon as possible after the termination of use. When symptoms and signs of complications were noticed, prompt diagnostic approach and management can lead to clinical improvements.

• Journal of Chest Surgery
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• 제47권1호
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• pp.1-5
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• 2014

Background: Recently, a hybrid surgical-electrophysiological (EP) approach for confirming ablation lines in patients with atrial fibrillation (AF) was suggested. The aim of this approach was to overcome the limitations of current surgery- and catheter-based techniques to yield better outcomes. Methods: Ten consecutive patients with AF underwent total thoracoscopic ablation (TTA) following transvenous catheter EP ablation (residual gap and cavotricuspid isthmus [CTI] ablation). Holter monitoring was performed 6 months postoperatively. Results: Ten patients (90% with persistent AF) underwent successful hybrid procedures, and there was no in-hospital mortality. An EP study was performed in 8 patients and showed that successful antral ablation in all pulmonary veins was achieved in 7 of them. The median follow-up duration was 7.63 months (range, 6.7 to 11.6 months). Nine patients underwent Holter monitoring 6 months postoperatively, and the results indicated an underlying sinus rhythm without AF, atrial flutter, or atrial tachycardia lasting more than 30 seconds in all of the patients. There was no recurrence of AF during follow-up. Conclusion: A hybrid approach that consists of TTA followed by transvenous catheter EP ablation (residual gap and CTI ablation) yielded excellent outcomes in our patient population. A hybrid approach should be considered in patients with a high risk of AF recurrence.

• 임상이비인후과
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• 제29권2호
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• pp.276-280
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• 2018

It is important to choose which approaches should be used to correct the fracture if the operation is indication for surgery in patients with orbital floor fracture. Transorbital, transantral, and endonasal approaches are methods for correcting the orbital floor fracture. The approach needs to be considered the location of the fracture, the degree, the severity of the fracture, the least remaining patient's disability, and preference of the surgeon. We report a case of orbital floor fracture using transorbital approach and endonasal catheter ballooning to resolve the limitations of transorbital approach alone.

• Archives of Plastic Surgery
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• 제37권1호
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• pp.99-103
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• 2010

Purpose: Blow-out fractures are reduced through transcutaneous or transconjunctival incisions. But the field of orbital surgery is difficult due to lack of visualization of fracture site, blind dissection of orbital floor, susceptibility of injury of orbital structures. In these situations, the former technique of using an antral balloon catheter has advantages over other methods for reconstruction because of its rapidity, simplicity, and inexpensiveness. Furthermore, the antral balloon catheter allows not only elevation of the orbital bone fragment but also expansion of the maxillary sinus in cases where there is a fracture of its walls. But postoperative follow-up method using computed tomography is expensive. Hence, we report a simple and inexpensive follow-up method using radiopaque dye inflation. Methods: We performed endoscopic transantral approach in 5 cases of blow-out fracture under general anesthesia. To accomplish this technique, a rigid 4 mm, 0 or 30 degree angled endoscopy was inserted into the maxillary sinus. Inflation of the catheter started gradually, with 10 to 15 mL of saline mixed radiopaque dye (saline: dye, 5 : 1) by syringe and while observing the elevation of the fracture site with endoscope until a proper contour was reached. For the maintain of the position of fractured site, 12 French urinary balloon foley catheter were used in fracture site for 7 - 10 days. Results: Postoperative assessment was performed by means of clinical and simple radiographic examination to secure the catheter under the inferior orbital wall and in the maxillary sinus. No specific complications occurred related to this procedure. Results of the surgery and follow-up in all cases were satisfactory. Conclusion: It may be a better alternative to the conventional follow-up method, with less cost and effectiveness of the catheter patency. The advantages of using the urinary balloon foley catheter with the radiopaque dye include the following : it is safe, efficacy, simple, and especially low cost. On drawback of this method is the discomfort to the patient caused by the catheter during the treatment.

• 대한두개안면성형외과학회지
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• 제10권2호
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• pp.86-90
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• 2009

Purpose: Inferior blow-out fracture is the common facial fracture. Unsatisfactory functional and aesthetic outcomes are frequent when it is treated inappropriately. If fractures are extended and reach the posterior end of orbital floor, enophthalmos frequently followed as complication. The purpose of this study was to evaluate reduction technique of extensive inferior blow-out fracture with ballooning of foley catheter through endoscopic transnasal approach and implantation of $Medpor^{(R)}$ through subciliary approach. Methods: A retrospective study was performed on 14 patients with extensive inferior blow-out fracture who underwent ballooning of foley catheter through endoscopic transnasal approach with implantation of $Medpor^{(R)}$ through subciliary approach. Patients were operated from May 2005 to November 2007. Data for 14 patients were acquired from patient's charts. Preoperative and postoperative data for enophthalmos, diplopia, limitation of extraocular motion were reviewed. Preoperative and postoperative CT scan were also checked. The patients were followed up from 4 to 18 months. Results: The enophthalmos was corrected in all patients. Among 7 patients with diplopia preoperatively, diplopia was resolved in three patients postoperatively. The diplopia persisted in four patients and two of them also had limitation of extraocular motion postoperatively. The limitation of extraocular motion occurred in seven patients preoperatively. But five patients recovered after operation immediately. These symptoms were resolved about three months after the operation. Conclusion: The ballooning of foley catheter through endoscopic transnasal approach with implantation of $Medpor^{(R)}$ through subciliary approach can be considered one of the appropriate technique for extensive inferior blowout fracture.

• Journal of Chest Surgery
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• 제54권5호
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• pp.377-382
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• 2021

Background: Subclavian vein (SV) catheterization is a method for the delivery of fluids, drugs, and blood products, venous blood sampling, and central vein pressure monitoring in cardiac surgery. Catheter occlusion is a serious complication of SV catheterization during cardiac surgery, especially after sternal retractor expansion. Methods: In this observational study, 303 patients who had successful right infraclavicular SV catheterization from September 2019 to April 2020 were enrolled to determine the incidence of catheter occlusion. After catheterization, the lumens of all catheters were checked for the ability to infuse and withdraw blood from the catheter before and after sternal retractor expansion. The patients' characteristics, cannulation approach, on-pump or off-pump technique, occlusion of the catheter and its lumens, and any associated complications were recorded. The data were analyzed using IBM SPSS ver. 22.0 (IBM Corp., Armonk, NY, USA). Results: Of the 303 patients studied, 205 were male (67.7%) and 98 were female (32.3%). Catheter occlusion occurred in 11 patients with on-pump cardiopulmonary bypass (CPB) (227 patients) and 4 patients with off-pump CPB (76 patients) (p=0.863). The incidence of catheter occlusion was 4.95% (15 of 303 patients) with no cases of simultaneous 3-lumen occlusion in a catheter. The most commonly occluded lumen was the distal lumen (57.92%). Simultaneous 2-lumen occlusion occurred in 4 patients. Catheter occlusion was found in 3 of 13 malpositioned catheters (23.07%). Conclusion: The current study showed that malpositioning of the catheter tip was a risk factor for catheter occlusion and that the distal lumen of a triple-lumen catheter was the most commonly occluded lumen.

• Journal of Chest Surgery
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• 제21권2호
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• pp.366-372
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• 1988

Cardiac tamponade occurring after open heart surgery is a rare, but fatal complication necessitating urgent drainage, though postoperative pericardial effusion is common. Two-dimensional echocardiographic study provides excellent postoperative visualization of pericardial effusion. Catheter insertion guided by two-dimensional echocardiography has been used to accomplish nonoperative drainage of symptomatic postoperative pericardial effusion in 4 cases. This technique offers simplicity, safety, and cost effectiveness.