• Journal of Korean Neurosurgical Society
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• v.50 no.3
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• pp.185-190
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• 2011

Objective : To investigate the efficacy of extracranial-intracranial (EC-IC) bypass surgery using a radial artery interposition graft (RAIG) for surgical management of cerebrovascular diseases. Methods : The study involved a retrospective analysis of 13 patients who underwent EC-IC bypass surgery using RAIG at a single neurosurgical institute between 2003 and 2009. The diseases comprised intracranial aneurysm (n=10), carotid artery occlusive disease (n=2), and delayed stenosis in the donor superficial temporal artery (STA) following previous STA-middle cerebral artery bypass surgery (n=1). Patients were followed clinically and radiographically. Results : Bypass surgery was successful in all patients. At a mean follow-up of 53.4 months, the short-term patency rate was 100%, and the long-term rate was 92.3%. Twelve patients had an excellent clinical outcome of Glasgow Outcome Scale (GOS) 5, and one case had GOS 3. Procedure-related complications were a temporary dysthesia on the graft harvest hand (n=1) and a hematoma at the graft harvest site (n=1), and these were treated successfully with no permanent sequelae. In one case, spasm occurred which was relieved with the introduction of mechanical dilators. Conclusion : EC-IC bypass using a RAIG appears to be an effective treatment for a variety of cerebrovascular diseases requiring proximal occlusion or trapping of the parent artery.

• Journal of the korean academy of Pediatric Dentistry
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• v.32 no.4
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• pp.687-692
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• 2005

Delayed eruption of a maxillary incisor results in midline shift, the space occupied by adjacent teeth and different levels of alveolar height. Extraction or surgical/orthodontic therapy is the most common treatment for a impacted maxillary incisor. Surgical repositioning provides another option for treatment of this problem. The advantages of this approach include immediate esthetic improvement, use of a single and simplified surgical procedure, simple and short orthodontic therapy, a normal gingival margin and the possibility of the developing root adapting to the new position. Autotransplantation of an immature tooth provides for possible adaptation of the developing root apex to the new position. A root with an open apex has good chance of pulp revascularization after transplantation.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.3
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• pp.257-265
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• 1999

To investigate the sequential changes in microvascular architecture and osseous regeneration during the bony healing after an application of the guided tissue regeneration method, we made artificial defects measuring $0.7cm{\times}0.3cm$ in size on femoral bones of rats measuring about 200gm and applied non-absorbable TEFE membrane at experimental sites but not at control sites. Then we observed the sequential changes and correlations between new vacuolation and bony regeneration using microvascular corrosion cast method and routine light microscopic observation at 1, 2 and 3 weeks after operation, respectively. The results showed that there were close relationships between regeneration of microvasculature and bone. In early phase, the invasion of granulation tissue at control sites delayed bony regeneration, however, in later phase, there was no remarkable differences in bony regeneration between control and experimental sites. The placement of barrier also affected in revascularization of regenerating bony defects. This is, the experimental sites showed parallel arranged nutritional vessels along long axis with well developed retiform plexus whereas the control revealed vertical invasion of microvasculature from outside of marrow space through bony defects which was also rearrange with time into parallel pattern with a vertical plexus but lesser organized than that of experimental sites. These findings suggest that the reconstruction of regenerating vasculature within the marrow cavity only may be sufficient and/or more be efficient in regeneration of bony defects.

• Journal of Chest Surgery
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• v.40 no.7 s.276
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• pp.480-484
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• 2007

Background: Major vascular injuries can jeopardize a patient's life or imperil limb survival. We performed this study to establish an optimal management plan for vascular injuries. Material and Method: We retrospectively reviewed 26 cases of vascular injury that were treated at Pusan National University Hospital from May, 1999 to September, 2004. The age and sex distribution, the locations and causes of vascular injury, the diagnostic tools, the degree of injuries, clinical manifestations, the treatment modality and complications were reviewed. Result: The mean age was 39.5 years (range: $12{\sim}86$) and the male to female ratio was 22 : 4. The injuries were in 6 descending thoracic aortas, 4 femoral arteries, 4 popliteal veins and so on. The causes of injury were iatrogenic in 8 cases, traffic accident in 7, stab injury in 6 and industrial accident in 5. The most commonly used diagnostic tools were CT and angiography. The degrees of arterial injury were pseudoaneurysm in 10 cases, partial severance in 5, complete severance in 3 and thrombosis in 3. The degrees of venous injury were partial severance in 6 cases, complete severance in 2 and arteriovenous fistula in 2. The clinical manifestations were absence of pulse in 8 cases, coldness in 7, chest pain in 6, swelling in 5, bleeding in 5 and so on. The most frequently used type of revascularization was graft interposition in 11 cases. Two arteriovenous fistulae were repaired by endovascular procedure. There was one case of mortality due to multi-organ failure after hemorrhagic shock, There were three major amputations, and two of them were due to delayed diagnosis and treatment. Conclusion: A system for the early diagnosis and treatment is essential for improving limb salvage and patient mortality. As a consequence of the widespread application of endovascular procedures, the incidence of iatrogenic injuries has recently increased. Educating physicians is important for the prevention of iatrogenic injury. Easy communication and cooperation for earlier involvement of a vascular surgeon is also an important factor.

• Journal of Chest Surgery
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• v.40 no.5 s.274
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• pp.351-355
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• 2007

Background: Postinfarction ventricular septal rupture is associated with mortality as high as $85\sim90%$, if it is treated medically. This report documents our experience with postinfarction ventricular septal rupture that was treated surgically, Material and Method: We retrospectively reviewed the medical records of 11 patients who were operated on due to postinfarction ventricular septal rupture between August 1996 and August 2006. There were 4 men and 7 women, with a mean age of $70{\pm}11$ years (age range: $50\sim84$ years). The location of the rupture was anterior in 7 cases and posterior in 4 cases. The interval between the onset of acute myocardial infarction and the occurrence of the ventricular septal rupture was $2.0{\pm}1.3$ days (range: $1\sim5$ days). Operation was performed at an average of $2.4{\pm}2.7$ days (range: $0\sim8$ days) after the diagnosis of septal rupture. Preoperative intraaortic balloon pump therapy was performed in 10 patients. Result: The infarct exclusion technique was used in all cases. Coronary artery bypass grafting was done in 8 cases, with the mean number of distal anastomosis being $1.0{\pm}0.8$. There was one operative death. In 2 patients, reoperation was performed due to a residual septal defect. The postoperative morbidities were transient atrial fibrillation (n=7), paroxysmal supraventricular tachycardia (n=1), low cardiac output syndrome (n=3), bleeding reoperation (n=2), delayed sternal closure (n=2), acute renal failure (n=2), pneumonia (n=1), intraaortic balloon pump-related thromboembolism (n=1), and transient delirium (n=2). Nine patients have been followed up for a mean of $38{\pm}40$ months except for one follow-up loss. There have been 3 late deaths. At the latest follow-up, all 6 survivors were in a good functional class. Conclusion: We demonstrated satisfactory operative and midterm results with our strategy of preoperative intraaortic balloon pump therapy, early repair of septal rupture by infarct exclusion and combined coronary revascularization.

• Journal of Chest Surgery
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• v.34 no.12
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• pp.901-908
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• 2001

Background : Coronary artery bypass graft(CABG) in patients with advanced left ventricular dysfunction has often been regarded as having high mortality rate, despite the great improvement in operative result of CABG. With recent advances in surgical technique and myocardial protection, surgical revascularization improved the symptom and long-term survival of these high risk patients more than the medical conservative treatment. Material and Methold : Clinical data of 31(4.1％) patients with preoperative ejection fraction less than 30% among 864 CABGs performed between January 1995 and March 1999 were retrospectively analyzed and pre- and postoperative changes of the ejection fraction on echocardiography were analyzed. There were 26 men and 5 women. The mean age was 60.7 years(range 41 to 72 years). History of myocardial infarction(30 cases, 98％) was the most common preoperative risk factor. There were seven irreversible myocardial infarction on thallium scan. Most patients had triple vessel diseases(26 cases, 84％) and first degree of Rentrop classification(16 cases, 52％) on coronary angiography. The mean number of distal anastomosis during CABG was per patient was 4.9${\pm}$0.8 sites in each patient. In addition to long saphenous veins, the internal mammary artery was used in 20 patients. Total bypass time was 244.7${\pm}$3.7 minutes(range, 117 to 567 minutes), and mean aortic cross-clamp time was 77.9 ${\pm}$ 1.6 minutes(range, 30 to 178 minutes). There were five other reparative procedures such as two left ventricular aneurysrmectomy, two mitral repair, and one aortic valve replacement. There were twelve postoperative complications such as three cardiac arrhythmia, two bleeding(re-operation), one delayed sternal closure, eleven usage of intra-aortic balloon counterpulsation for low cardiac output. Two patients died, postoperative mortality was 6.5% . Twenty-nine patients were relieved of chest pain and left ventricular ejection fraction after operation was significantly higher(38.5${\pm}$11.6%, p 0.001) as compared with preoperative left ventricular ejection fraction(25.3${\pm}$2.3%). The follow up period of out patient was 25. 3 months. Conclusion: In patients with coronary artery disease and advanced left ventricular dysfunction, coronary artery bypass grafting can be performed relatively safely with improvement in left ventricular function, but it will be necessary to study long term results.