• Journal of Chest Surgery
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• 제44권6호
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• pp.423-426
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• 2011

We report on two women who underwent myocardial revascularization associated with antiphospholipid syndrome (APS) with different pathogenic patterns. The first woman presented with acute myocardial infarction, and preoperative angiograms demonstrated rapidly progressing coronary lesions, presumptive unstable plaque, and dissection. Operative findings, however, showed fresh thrombi in the coronary arteries, and she was diagnosed postoperatively as having APS. Her one-year angiogram demonstrated improved coronary lesions and a competitive flow pattern in the grafts. The second woman presented with unstable angina and had been treated for systemic lupus erythematosus and secondary APS for more than 14 years. She underwent myocardial revascularization due to accelerated coronary atherosclerosis. Her one-year angiogram demonstrated patent grafts.

• Journal of Chest Surgery
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• 제24권7호
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• pp.685-692
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• 1991

Twelve patients underwent surgical interventions for aortic aneurysms consecutively from September 1986 to September 1990 in the Department of Thoracic and Cardiovascular Surgery, Yeungnam University Hospital. They were all men ranging in age from 25 to 68 years with the mean age of 48 years. Five patients of them had aneurysms involving ascending aorta, one aneurysm involving both ascending and descending aorta, four aneurysms involving descending thoracic aorta, and the others had aneurysms involving abdominal aorta. According to morphological classification, six cases of them were in dissection and the others in fusiform aneurysms. All the cases were pathologically true aneurysms and four of them were in acute status. According to causal classification, seven patients of them had atherosclerosis, three cystic medial necrosis, and the others had syphilis and trauma respectively. Six patients with ascending aortic aneurysm had annuloaortic ectasia with aortic regurgitation and underwent ascending aortic graft and aortic valve replacement[Bentall`s operation]. The others with descending thoracic and abdominal aortic aneurysms underwent Dacron graft replacement. Both hemorrhage necessitating reopening of the chest and wound dehiscence were observed in three patients and hoarseness in one patient. Cerebrovascular accident occurred three and a quarter years postoperatively in one patient and he died two days later. The others were followed up via OPD and have been doing well postoperatively.

• 대한정형외과학회지
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• 제54권3호
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• pp.287-291
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• 2019

쇄골의 급성 골절은 비교적 흔한 골절이지만 쇄골에 발생한 피로 골절은 드물고, 쇄골 근위부의 피로 골절은 극히 드물다. 경부근치술 또는 목 주변의 방사선 조사 이후 발생한 쇄골 근위부의 피로 골절 사례들이 종종 보고되고 있으며, 전문 운동 선수에서 과도하게 반복되는 운동 중 발생한 쇄골 근위부의 피로 골절 사례들이 드물게 보고되고 있다. 저자들은 특별한 선행 요인이 없는 젊은 남성에서 평행봉 운동 중 발생한 쇄골 근위부의 피로 골절을 경험하였고 국내에서 유사한 사례가 보고된 바 없어 이를 문헌 고찰과 함께 보고하고자 한다.

• The Korean Journal of Pain
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• 제13권2호
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• pp.149-155
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• 2000

Background: Pulsed radiofrequency (RF) lesioning is a painless procedure and causes no neurodestruction and neuritis-like reaction are common following conventional RF lesioning. There is little data about the effect of pulsed RF especially with regard to its suitability for the treatment of acute pain. The possibility of a placebo effect cannot be ruled out because a double-blind study was not performed in previous studies. There is also no neuropathologic study about pulsed RF. Methods: The rats were anesthetized with sodium pentobarbital (40 mg/kg, i.p.; supplemented as necessary). The common sciatic nerve was exposed by blunt dissection through biceps femoris. Pulsed RF was administered to the common sciatic nerve using a 30 ms/s pulse with for 120 seconds. The temperature reached was no more than $42^{\circ}C$. Analgesia was determined using hot-plate assay shortly and, 3 days and 1 week before, and 2 weeks after operation. Lesions were examined with LM (light microscope) and EM (electron microscope) 2 weeks later. Results: There were no differences in response latencies between the control and experimental group. There were many vacuoles with hyaline bodies in the Schwann cell cytoplasm rather than axon in LM and larger electron dense bodies. No changes were found in the axon or unmyelinated fibers. Only small changes were found in the sheaths of myelinated fibers and Schwann cells. Conclusions: We therefore do think that any analgesic effect of pulsed RF is not a result of block of neural conduction. But rather than it can be attributed to others factors. It was also ineffective as a treatment for acute pain such as that caused by the hot-plate test.

• Journal of Chest Surgery
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• 제30권5호
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• pp.501-505
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• 1997

초 저체온 및 순환정지하 개심수술시 Aprotinin을 사용하는 경우 혈관내 응고와 관련된 신기능장애 등의 합병증이 증가된다는 보고가 있다. 저자들은 1992년 11월부터 95년 8월까지 초저체온 및 순환정지하에서 대 동맥 수술을 한 44례 환자 중 고농도 Aprotinin을 사용한 20명의 환자를 대상으로 수술 후 주요장기에 미치 는 aprotinin의 영향을 조사하였다. 초저체온하 순환정지 시에는 좌측대퇴동맥을 통하려 저혈류로 순환시켜 흉부대동맥내로 공기유입이 되지 않도록 하였으며 순환정지시간이 길어질 것으로 예상되거나 대동맥궁을 치 환하는 경우에는 선택적뇌관류를 하였다. 순환정지시 활성응고시간은 639초에서 1531초로 1례를 제외한 모 든 환자에서 활성응고시간을 750초 이상 유지하였다. 대상환자 20례중 수술사망은 4례에서 발생하였다. 사망원인은 출혈 1례, 폐출혈 1례, 좌 관상동맥 박리에 따른 좌심실 기능부전이 1례, 근리고 다발성 뇌경색이 1례 있었다. 수술 후 뇌손상이 2례에서 발생하였으나 1례는 수술전 부터 자측 총경동맥 박리가 원인이었고 1례에서는 그 원인을 알 수 얼었다. 생존한 환자중 수 술 후 신 기능이나 간기능의 이상은 얼\ulcorner다. 결론적으로 초저체온 및 순환정지를 이용한 대동맥수술시 avotinin을 사용한 결과 ACT를 750초이상 충분 히 유지하고, low flow retrograde perfusion을 유지하는 경우 신기능의 장애를 포함한 혈관내 응고와 관련된 합 병증이 증가되지 않고, 안전하게 사용할 수 있는 것으로 나타났다.

• Journal of Chest Surgery
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• 제44권3호
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• pp.215-219
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• 2011

Background: Selective antegrade perfusion via axillary artery cannulation along with circulatory arrest under deep hypothermia has became a recent trend for performing surgery on the ascending aorta and aortic arch and when direct aortic cannulation is not feasible. The authors of this study tried using moderate hypothermia with right brachial and femoral artery perfusion to complement the pitfalls of single axillary artery cannulation and deep hypothermia. Materials and Methods: A retrospective analysis was performed on 36 patients who received ascending aorta or aortic arch replacement between July 2005 and May 2010. The adverse outcomes included operative mortality, permanent neurologic dysfunction and temporary neurologic dysfunction. Results: Of these 36 patients, 32 (88%) were treated as emergencies. The mean age of the patients was 61.9 years (ranging from 29 to 79 years) and there were 19 males and 17 females. The principal diagnoses for the operation were acute type A aortic dissection (31, 86%) and aneurysmal disease without aortic dissection (5, 14%). The performed operations were ascending aorta replacement (9, 25%), ascending aorta and hemiarch replacement (13, 36%), ascending aorta and total arch replacement (13, 36%) and total arch replacement only (1, 3%). The mean cardiopulmonary bypass time was $209.4{\pm}85.1$ minutes, and the circulatory arrest with selective antegrade perfusion time was $36.1{\pm}24.2$ minutes. The lowest core temperature was $24{\pm}2.1^{\circ}C$. There were five deaths within 30 post-op days (mortality: 13.8%). Two patients (5.5%) had minor neurologic dysfunction and six patients, including three patients who had preoperative cerebral infarction or unconsciousness, had major neurologic dysfunction (16.6%). Conclusion: When direct aortic cannulation is not feasible for ascending aorta and aortic arch replacement, the right brachial and femoral artery can be used as arterial perfusion routes with the patient under moderate hypothermia. This technique resulted in acceptable outcomes.

• Archives of Reconstructive Microsurgery
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• 제8권1호
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• pp.56-63
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• 1999

저자들은 1994년부터 1997년까지 수부에 급성 연부조직 손실과 신근건 결손을 가진 2명의 환자에 대해 지연처치후 동맥화된 족배 정맥 건피판술을 시행하였다. 피판의 생존 표면적은 2명 모두 100%였다. 피판 크기는 각각 $10{\times}10cm,\;6{\times}6cm$였다. 술후 2주째 능동적 굴곡운동과 수동적 신전 운동을 시작하였고 점진적인 저항운동을 5주간 실시하였다. 피판은 수부의 정상 피부와 비슷한 색깔과 피부상태를 보였다. 지연처치후 동맥화된 정맥 건피판은 순수 정맥피판이나 동맥화된 정맥피판보다 큰 피판을 만들 수 있으며 동맥화후 정맥피판의 생존율을 높여 복합 피판이 가능하게 하며 공여부의 주 동맥을 보존할 수 있고 얇은 조직을 얻을 수 있으며 피판을 심부 박리 없이 쉽게 거상할 수 있는 장점을 가진다. 단점으로는 두 단계의 수술이 필요하고 공여부 반흔과 족지의 신전이 약해질 수 있다.

• Archives of Plastic Surgery
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• 제39권2호
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• pp.113-117
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• 2012

Background : Nasal pyramid fractures accompanied by saddle nose deformities are not easily corrected by closed reduction. We used an absorbable plate as a perpendicular strut to support the collapsed "keystone area" and obtained good results. Methods : Between September 2008 and June 2011, 18 patients who had nasal pyramid fractures with saddle nose deformities underwent surgery. Pre- and postoperative facial computed tomographic images and photographs were taken to estimate outcomes. The operative technique included the mucoperichondrial dissection of the nasal septum, insertion of an absorbable plate prepared to an appropriate length to support the "keystone area", and fixation of the absorbable plate strut to the cartilaginous septum. Results : Functional and esthetic outcomes were satisfactory in all patients. Eleven patients assessed the postoperative appearance of the external nose as 'markedly improved' and 7 patients as 'improved'. The 5 surgeons scored the results as a mean of 4.5 on a 5-point scale. Conclusions : The use of an absorbable plate as a perpendicular strut requires no additional procedures because the plate is gradually absorbed. The mechanical strength provided by a buttress between the "keystone area" and the maxillary crest lasts for a long time before the strut is absorbed.

• Journal of Chest Surgery
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• 제46권1호
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• pp.27-32
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• 2013

Background: Minimal infusion of cardioplegic solution (CPS) during aortic surgery using total circulatory arrest (TCA) may reduce several potential side effects: clamping on a diseased aorta, insult of coronary ostia, and edema. Materials and Methods: From 2006 to 2009, 72 patients underwent aortic surgery without infusion of cardioplegic solution at the initiation of circulatory arrest. The diagnoses were acute aortic dissection (44), aneurysm (22), and intramural hematoma (6). Results: The duration of TCA, the lowest nasopharyngeal temperature, bypass time, and aortic clamp time was 45 minutes, $16.4^{\circ}C$, 162 minutes, and 100 minutes, respectively. The amount of CPS was 1,050 mL, and 15 patients underwent surgery without CPS. The average inotrope score was 113 points (range, 6.25 to 5,048.5 points) corresponding to the dopamine infusion of 5 mcg/kg/min for 1 day. Seven patients showed a level of creatine kinase-MB above 50 ng/mL, postoperatively, compared with the average of 12.75 ng/mL. The ischemic change was found on electrocardiogram in 5 patients, postoperatively. There was no cardiac morbidity requiring mechanical assist. The average of intensive care unit stay and postoperative hospital stay was 40 hours (range, 15 to 482 hours) and 11 days, respectively. Conclusion: Minimal infusion of only retrograde CPS during rewarming without initial infusion at TCA in aortic surgery is feasible and can be used with acceptable results.

• Archives of Plastic Surgery
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• 제38권3호
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• pp.329-332
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• 2011

Purpose: In developed countries, vesicovaginal fistula occur from various pelvic operations including total hysterectomy, leading to urinary leakage and incontinence. Although various methods have been proposed for adequate tissue coverage in fistula repair, the surgical treatment of is not simple and still controversial. We report a case of neobladder-vaginal fistula repair using modified Martius fat pad flap. Methods: A 62-year-old female patient underwent radical cystectomy with total abdominal hysterectomy and neobladder formation due to invasive bladder tumor 5 years ago. For 3 years following the operation, urine leakage was observed. Exploration demonstrated neobladder-vaginal fistula and primary repair including fistulectomy and direct closure was performed. Urinary incontinence relapsed 2 years after primary repair, and after demonstrating the recurrence of fistula on urography, repair of recurrent fistula was performed. After dissection of vagina and neobladder and closure of fistula by urologic surgeon, fibroadipose flap was elevated, rotated and advanced through the tunnel at vaginal sidewall, and interpositioned to the fistula site between neobladder and vagina. Results: There was no acute complication after the surgery and urethral catheter was extracted on the 8th day after the operation. During six month follow-up period after the operation, there is no clinical evidence of fistula recurrence. Conclusion: From our clinical experience and literature review, we think Martius fat pad flap is a useful technique in management of neobladder-vaginal fistula, for it provides enough vascularity, major epithelization surface and better lymphatic drainage, and also prevents overlapping of vesical, vaginal suture lines at the same time.