• Journal of Chest Surgery
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• v.31 no.5
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• pp.540-543
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• 1998

A patient with post-pneumonectomy empyema was treated sucessfully by modification of Clagett's operation after closure of bronchopleural fistula using a transsternal, transpericardial approach. His primary disease was pulmonary tuberculosis, and he had a past history of left upper lobe lobectomy 34 year ago. Recently recurred pulmonary tuberculosis with aspergilloma in the remaining left lung, empyema with bronchopleural fistula had developed on the post-operative 4th day after completion pneumonectomy. Closed thoracostomy was done at the lowest point of the left pleural cavity immediately. The pleural cavity was irrigated with small amount of normal saline through pigtail catheter. The 2nd operation was done by closure of bronchopleural fistula using a stapler through transsternal, transpericardial approach, and then the pleural space was irrigated with normal saline with Tobramycin which shows sensitivity to isolated organism from pleural cavity. After negative conversion of pleural fluid culture, we performed modified Clagett's operation under local anesthesia. The patient had no evidence of recurrence of empyema and discharged from hospital after 10 days of the 3rd procedure.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.20 no.2
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• pp.133-138
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• 1998

Choanal atresia may be membrane or bony, unilateral or bilateral. Approximately 90% of the choanal atresia are bony type. Unilateral choanal atresia often eludes the diagnosis because of the absence of subjective symptoms in the neonatal period. However, bilateral choanal atresia presents at birth with cyclic respiratory distress aggravated by feedings. So complete bilateral choanal atresia is considered as a neonatal emergency. Examinations for the diagnosis of chonal atresia include 1) attempt at passing a rubber catheter or probe through the patient s nose, 2) mirror examination of the nasopharynx, 3) digital examination of the nasopharynx, 4) X-ray examination after installation of radiopaque materal into the nasal cavity. But, computed tomography has become accepted method for evaluation of choanal atresia. Surgical repair of choanal atresia is accomplished via transnasal or transpalatal approach. Advantages of the transpalatal approach are improved exposure and the preservation of mucosal flap along the newly formed apertures. On the other hand, the transpalatal approach carries the risk of injury to the greater palatine neurovascular complex, and requires longer operative time. After careful physical and radiographic examinations, we accomplished the surgical repair of the complete bony bilateral choanal atresia via transpalatal approach without complications.

• Journal of Chest Surgery
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• v.51 no.2
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• pp.146-148
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• 2018

Left atrial appendage (LAA) aneurysm is a rare, pathologic condition that may lead to atrial tachyarrhythmia or thromboembolic events. A 49-year-old man presented with aggravated palpitation and dizziness. He suffered from refractory atrial fibrillation despite a previous history of radiofrequency catheter ablation. Echocardiography revealed a 57-mm LAA aneurysm. Surgical ablation was performed through a right mini-thoracotomy, and the LAA aneurysm was obliterated with a 50-mm AtriClip (Atricure Inc., Westchester, OH, USA). However, follow-up computed tomography showed residual communication, so the patient is still taking warfarin. We report that a minimally invasive strategy for treating LAA aneurysm can be considered, but incomplete closure may occur; thus, caution is needed.

• Archives of Plastic Surgery
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• v.43 no.1
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• pp.88-92
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• 2016

There are two general categories of lateral osteotomy techniques-the external perforating method and the internal continuous method. Regardless of which technique is used, procedural effectiveness is hampered by limited visualization in the surgical field. Considering this point, we devised a new technique that involves using a wide subperiosteal dissection and internal perforation under direct visualization. Using an intranasal approach, whereby the visibility of the intended fracture line was maintained, enabled a greater degree of control, and in turn, results that were more precise, and thus predictable and reproducible. Traditionally, it has been taken as dogma that the periosteum must be preserved, considering the potential for dead space and bony instability; however, under sufficient visualization of the surgical field with an internal perforating method, complete osteotomy with fully preserved intranasal mucosa could be conducted exactly as intended. This intact mucosal lining compensates for the elevated periosteum. Compressive dressing and drainage through a Silastic angio-needle catheter enabled the elimination of dead space. Therefore, precise, reproducible, and predictable osteotomy minimizing the potential for associated complications such as ecchymosis, that is, bruising owing to hemorrhage, could be performed. In this article, we introduce a novel technique for lateral osteotomy with improved visualization.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.117-120
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• 1997

Cancer is a devastating disease, and the treatment of related pain is an extremely challenging task. Providing adequate analgesia while avoiding unnecessary drug effects often requires a polypharmacologic approach in cancer pain management. A 36-year old woman with breast cancer metastatic to the axial skeleton and bilateral hip joints was admitted to hemato-oncology service with complaints of intractable abdominal and hip pain. Despite rapidly increasing doses of intravenous morphine up to 350 mg per day; transdermal fentanyl; midazolam; ketorolac; lorazepam; dexamethasone, the patient continued to describe her pain as 10 of 10, refusing all surgical/diagnostic interventions not directly related to pain control. She did, however, consent to lumbar epidural catheter placement. The patient was sedated with titrating doses of propofol to assist with positioning. Even though the procedure was not successful due to significant thoracolumbar scoliosis, the patient admitted feeling better than she has in months during attempted placement. After continuous infusion of propofol was initiated at subhypnotic dose, the patient's analgesic demand was drastically reduced and described her pain as "1 to 3" of "10". Approximately 96 hours after the propofol infusion was started, the patient expired comfortably. There had been no change in her medical regimen during fecal 48 hours. In the case described, propofol was extremely advantageous as an adjuvant in the management of cancer related pain.

• Journal of Chest Surgery
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• v.7 no.2
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• pp.201-208
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• 1974

The purpose of this paper is to present author's experience with 6 cases of ruptured aneurysm of sinus of Valsalva which were treated surgically during last 10 years. Among the 6 cases, 5 were male and one was female. All of them originated from the right coronary sinus and 5 cases were ruptured into the RV while remained one into RA. The diagnosis was obtained in 4 cases by cineangiocardiogram. Clinically, we had difficulties in differential diagnosis with combined cases of VSD with A.I. and had special experience in its differentiation during cardiac catheterization. By simultaneous trans-venous and trans-arterial catheterization, identified two catheter tips in the RV, and pull back tracing obtained aortic pressure directly from RV, and RA from RV pressure which were benefit in confirm ruptured aneurysm of the aortic sinus. Surgical correction was performed by means of direct suture closure or combined Teflon pledget Of patch enforcement graft after aneurysm resection by trans-RA or trans-RV approach. All patients had no history of bacterial endocarditis, syphilis, or tuberculosis and operative findings revealed intact coronary sinus except involved one moreover 3 cases combined with high VSD which uggested congenital in origin although pathologic reports revealed only fibrosis. Post-operative course were uneventful in all cases but one who had bleeding and 2 months to 9 years follow up results were good and spend their usual life in all cases.

• Journal of Trauma and Injury
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• v.27 no.2
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• pp.33-37
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• 2014

Central venous catheterization through a subclavian approach is indicated for some special purposes but it may cause many complications such as infection, bleeding, pneumothorax, thrombosis, air embolization, arrhythmia, myocardial perforation, and nerve injury. A case involving a mistaken central venous catheterization into the right vertebral artery through the subclavian artery is presented. A 33-year-old man who had deteriorated mentality after head injury underwent an emergency craniotomy for acute epidural hematomas on the right frontal and temporal convexities. His mentality improved rapidly, but he complained of continuous severe pain in the right posterior neck even though he had no previous symptom or past medical history of such pain. Three-dimensional cervical spine computed tomography (3D-CT) was performed first to rule out unconfirmed cervical injuries and it revealed a linear radiopaque material intrathoracically from the level of the 1st rib up to the level of C6 in the right vertebral foramen. An additional neck CT was performed, and the subclavian catheter was indwelling in the right vertebral artery through right subclavian artery. For the purpose of proper fluid infusion and central venous pressure monitoring, the subclavian vein catheterization had been performed in the operation room after general anesthesia induction before the craniotomy. Sufficient anatomical consideration and prudence is essential because inadvertent arterial cannulation at a non-compressible site is a highly risky iatrogenic complication of central venous line placement.

• Clinical and Experimental Pediatrics
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• v.60 no.8
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• pp.237-244
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• 2017

During the last 10 years, there have been major technological achievements in pediatric interventional cardiology. In addition, there have been several advances in cardiac imaging, especially in 3-dimensional imaging of echocardiography, computed tomography, magnetic resonance imaging, and cineangiography. Therefore, more types of congenital heart diseases can be treated in the cardiac catheter laboratory today than ever before. Furthermore, lesions previously considered resistant to interventional therapies can now be managed with high success rates. The hybrid approach has enabled the overcoming of limitations inherent to percutaneous access, expanding the application of endovascular therapies as adjunct to surgical interventions to improve patient outcomes and minimize invasiveness. Percutaneous pulmonary valve implantation has become a successful alternative therapy. However, most of the current recommendations about pediatric cardiac interventions (including class I recommendations) refer to off-label use of devices, because it is difficult to study the safety and efficacy of catheterization and transcatheter therapy in pediatric cardiac patients. This difficulty arises from the challenge of identifying a control population and the relatively small number of pediatric patients with congenital heart disease. Nevertheless, the pediatric interventional cardiology community has continued to develop less invasive solutions for congenital heart defects to minimize the need for open heart surgery and optimize overall outcomes. In this review, various interventional procedures in patients with congenital heart disease are explored.

• Journal of Veterinary Clinics
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• v.33 no.6
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• pp.372-375
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• 2016

A four-year old, intact male, mixed-breed dog had a history of chronic snoring sound and dyspnea. Based on the results of computed tomography, the patient was diagnosed as nasopharyngeal stenosis. Balloon dilatation in the area of stenosis was performed using a balloon dilator inserted retrograde fashion through the working channel of an endoscope. Clinical signs were relieved but reappeared after 3 weeks. Thirty-four days following the first balloon dilatation treatment, a second procedure was performed; the balloon catheter was inserted in antegrade fashion through the left nostril and was filled with contrast agent under fluoroscopic guidance. Because of the relapse of clinical signs after 6 months, the patient received additional balloon dilatation procedure by the antegrade approach. At the one-year follow-up, the owner said that the clinical signs of nasopharyngeal stenosis had been completely resolved. Balloon dilatation could be a minimally invasive and effective treatment for nasopharyngeal stenosis, although the repetition of the procedure may be required.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.2
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• pp.157-160
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• 2006

Nasotracheal intubation is performed routinely in maxillofacial surgery to optimize visualization of the surgical field. The CaldwellLuc operation is an approach to the maxillary sinus through the labiogingival sulcus and canine fossa. The operation is used to treat chronic maxillary sinusitis, and involves curettage of the mucosa of the maxillary sinus and the creation of an inferior meatal antrostomy. After the operation, a nasal Foley catheter is inserted into the inferior nasal meatus for the discharge of blood and tissue fluid. Then, the nostril is packed with vaseline gauze. Before the patients awaken, they experience impaired switching from nasal to oral breathing. Pulmonary edema can result from excessive negative intrathoracic pressure caused by acute airway obstruction in patients breathing spontaneously. During anesthesia and sedation, airway obstruction can occur at the levels of the pharynx and larynx. Even in patients who are awake, alteration in the ability to change the breathing route from nasal to oral may affect breathing in the presence of an airway obstruction, causing this catastrophic event. We experienced a case in which acute pulmonary edema resulted from acute airway obstruction triggered by the patient's inability to switch the breathing route from nasal to oral during emergence from anesthesia.