• Journal of Chest Surgery
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• v.13 no.4
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• pp.496-496
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• 1980

A 37 year old male patient was suffered from severe labored breathing caused by post tracheostomy stenosis, which was localized at the mediastinal trachea [cuffed tracheal stenosis] and ranged 1.5 cm in length and approximately 3 ram. in diameter on tracheogram. After dilation of tracheal stenosis with dilator, endotracheal intubation was tried for induction of anesthesia and control of respiration during operation. A tube was placed just beyond the tracheal stenosis without respiratory difficulty. Under the endotracheal anesthesia, circumferential resection of the mediastinal trachea containing the stenosis, approximately 2 cm in length [4 tracheal rings}, was carried out and primary direct end to end anastomosis was performed with interrupted submucosal sutures [3-0 Dexon] and mobilization of trachea Postoperative tracheostomy was not performed. The patient was completely relieved from dyspnea immediately after operation. Post-operative convalescence was entirely uneventful and at present, about 3 months after operation, he is now conducting a usual life. From the literature and our experience, the etiology and treatment of post-tracheostomy stenosis were discussed.

• Korean Journal of Bronchoesophagology
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• v.1 no.1
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• pp.50-54
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• 1995

Despite improvement in respiratory care, including widespread use of low pressure and high volume cuffed tubes, tracheal stenosis remains a feared complication of prolonged intubation and tracheostomy. In such patients, other coexisting problems such as vocal cord paralysis, tracheoesophageal fistula, noncontiguous stenotic segments and laryngeal stenosis may occasionly be encountered. Therefore tracheal stenosis still presents a significant management problem, despite recent endoscopic advances and surgical techniques. Between 1991 and 1994, authors preformed tracheal resection with end-to-end anastomosis on 11 patients with tracheal stenosis. The total success rate (asymptomatic patients with patent airway) was 72.7% and there were no serious complication. This report reviews our experience about this procedure and surgical results. And it investigates associated factors for successful results.

• Korean Journal of Bronchoesophagology
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• v.1 no.1
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• pp.82-93
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• 1995

Three-dimensional reconstruction of computed tomographic image(3D CT) is a well-established imaging modality which has been investigated in various clinical settings. It is commonly performed in case of congenital or developmental abnormalities, and traumatic fracture of skull and face that requires reconstruction of osseous structure. However reporting the 3D CT in laryngeal or tracheal stenosis is rare and its results are obscure. The authors performed 3D CT in six cases of tracheal stenosis and found diagnostic value of 3D CT. A Comparision of diagnostic information obtained from plain X-ray, 2D CT and 3D CT has performed in total six cases of tracheal stenosis. Surgical treatment of the tracheal stenosis was following in these cases : tracheal end to end anastomosis In 1 case, laryngotracheal end to end anastomosis in 2 cases. 3D CT information was compared with operative finding. In two of six cases, satisfactory information was not obtained from 3D CT in evaluating an exact stenosis of trachea. Future, it will be helped in evaluating of tracheal stenosis by 3D CT.

• Journal of Chest Surgery
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• v.25 no.11
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• pp.1299-1304
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• 1992

We experienced 5 cases of tracheal stenosis and 7 cases bronchial stenosis treated surgically at the Department of Thoracic and Cardiovascular Surgery, School of Medicine, Hanyang University during 5 years. The causes of tracheal stenosis were prolonged endotracheal intubation 1 case, tracheostomy 1 case, the sequela of endobronchial tuberculosis 2 cases and tracheomalacia 1 case. The causes of bronchial stenosis were all endobronchial tuberculosis. The managements of tracheal stenosis were tracheal resection and end to end anastomosis. The resected lengths of trachea were 1.5cm, 3cm and 7.5cm. One case of suglottic stenosis was underwent the resection of trachea, 8cm in length, and the laryngotracheal anastomosis was done, but the re-stenosis of trachea was developed after 4 weeks post-operatively. One case of tracheomalacia was done permanent tracheostomy only, because the entire trachea was adhered to the surrounding tissue. The managements of bronchial stenosis were resection of involved lobe or one lung, in the 5 case. One case with Lt. main bronchial stenosis and atelectasis of Lt. upper lobe was done the lobectomy of Lt. upper lobe only and then, the Lt. pneumonectomy was done re-operatively because the atelectasis of Lt. lower lobe had continued. The other one case with stenosis of Rt. main bronchus, failed the insertion of metalic stent, was underwent the Rt. upper lobe lobectomy, sleeve resection and side to end anastomosis

• Proceedings of the KOSOMBE Conference
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• v.1995 no.05
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• pp.104-108
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• 1995

Von Mises stress and compliance distribution was evaluated using a finite element analysis on the anastomosis of an artery with length of 20mm, inner diameter of 4mm, thickness of 0.5mm and a PTFE graft with length of 5.7mm, Inner diameter of 2mm. thickness of 0.2mm. When anastomotic angle was taken as $45^{\circ}$ and inner pressure of $1330\;dyne/mm^2$ was applied inside the 2 conduits. From the analysis results were obtained as follows. (1)Artery diameter increased in both horizontal x and vertical y directions and the magnitude of that in x direction was bigger than in y direction. (2) The compliance was maximum on the anastomosis. especially on that with acute angle. This reduced approaching to the right or left end. (3) The equivalent stress was maximum on top in the y direction and winimum on the nodes around $110^{\circ}$ in circumferential direction from the top. (4) The equivalent stress was maximum in the vicinity of anastomosis with acute angle along the longitudinal direction of the artery. This trend was also observed along the PTFE graft.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.2
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• pp.133-141
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• 2000

Purpose : The purpose of this study is to estabilish clinical guidance of microvascular anastomosis in diabetic patients. This study was performed with experimental microvascular anastomosis in streptozotocin induced diabetic rats and observed histopathologic change and endohelial healing process. Materials and Methods : 70 Sprague-Dawley rats, weighting 200 to 250grams, were used for the experiment. 35 induced diabetic rats with streptozotocin and 35 control group were selected. After end-to-end carotid artery microvascular anastomosis was done, the experimental rats were sacrificed at different time interval (1st day, 3rd day, 1st week, 2nd, 4th, 6th and 8th week) for histologic examination. Light microscope observation was used in this study. Results : 1. Histopathologic changes are nearly the same healing process in two groups. But period of tissue reaction was faster in the control than diabetic group. 2. In endotheliall healing, control group started at 1 week after and completed at 4 weeks after, but diabetic group was observed partially at 4 weeks after and complete healing was not observed still at 8 weeks after. 3. In subintimal hyperplasia, control group was observed at 6 weeks after but diabetic group was observed at 6 weeks after and partially at 8 weeks after. 4. All groups showed severe inflammatory response in the early period. This respond is decreased at 2 weeks after in control group but still remained at 8 weeks after in the diabetic group. 5. In media, inflammatory response and degeneration were observed in early period. Regeneration of smooth muscle cell was observed at 1 week after in control group but 4 weeks after in the diabetic group. Conclusions : As the results of study, it could be thought that vascular regeneration process was not failured but delayed in the diabetes. It was considered that diabetes mellitus was not absolute contraindication of microvascular anastomosis.

• Journal of Chest Surgery
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• v.27 no.3
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• pp.238-240
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• 1994

We performed post-operative hemodynamic evaluation and lung perfusion scan after left lung transplantation in dog. The heart & lungs were extracted from donor dog while the both lungs were flushed with 4oC Euro-Collin`s solution after heparinization & infusion of prostaglandin E1.In the recipient dog, anastomosis of the left atrial cuff was performed by continuous 4-0 Prolene everted suture, and bronchial anastomosis by telescope method with 4-0 Prolene continuous suture. The end-to-end anastomosis of left main pulmonary arteries was performed with continuous 6-0 Prolene suture. After closure of left thoracotomy incision, the lung perfusion scan was performed post operative 2 days for evaluation of the function of the transplanted lung which showed good perfusion. The dog was sacrificed in the post-operative 5 days for autopsy.

• Journal of Biomedical Engineering Research
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• v.20 no.5
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• pp.593-599
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• 1999

수축절정기에 0.2mm, 0.4mm 두께의 소구경 인조혈관의 내경3.2mm의 동맥에 문합한 단단문합 주위의 유동과 구조해석을 동시에 수행하였다. 유동해석 결과 속도분포 및 벽단전률은 타 연구결과와 매우 유사하며 이론해와 매우 유사함을 보였다. 유동에 의해서 문합부 주위에 작용하는 응력은 문합부에 집중되며 이는 수십만 pa에 달했다. 또한 인조혈관과 동맥에 작용하는 원주방향의 응력을 이론해와 비교한 결과 서로 유사함을 보였으며 두께가 얇은 인조혈관을 사용하는 경우 문합부의 compliance mismatch 는 개선되나 반대로 응력은 더 많이 받음을 알 수 있었다. 본 연구를 통해서 유체에 의하여 혈관이 영향을 받는 심혈관계 현상을 연구하는데 있어서 이와 같은 유체-구조 상호작용을 고려하여 동시에 해결 하는 방법은 매우 유용할 것으로 생각된다.

• Proceedings of the KOSOMBE Conference
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• v.1994 no.05
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• pp.115-118
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• 1994

Three-dimensional steady and pulsatile flows in an end-to-side anastomosis were investigated using a finite difference method in order to understand the flow dynamics in the preferential development of distal anastomotic intimal hyperplasia or thrombosis. Steady flow results revealed that a double helical vortex was formed in the host artery and flow recirculations near tow and heel regions were limited due to the secondary flow. Oscillating wall shear stress with significant secondary flow might be the flow dynamic reason of developing intimal hyperplasia or thrombosis.

• Journal of Chest Surgery
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• v.3 no.2
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• pp.91-106
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• 1970

Two groups of left pulmonary-subclavian artery anastomosis were done in 26 adult mongorel dogs. For the first group. the distal end of the subclnvian artery was nnastomosed to the side of the left pulmonary artery, and for the second group, the subclavian end wns anastomosed to the proximal end of the left lower lobe pulmonary artery. Among them, 6 died of bleeding or anesthetic failure during the day of operation, 10 survived 1 to 106 days and the other 10 were sacrificed at various interval. To investigate the relationship between hemodynamic stress and temporal evolution of the pulmonary vascular lesions. the pulmona try and femoral artery pressures, arteriogram and pathohistological specimens were obtained. The following results were obtained. 1. The postoperative pulmonary artery pressures were within normal limits except 2 dogs in the first group, but in nil 12 dogs of the second group, they were in moderate to maked pulmonary hypertension level. 2 After subclavian pulmonary anastomosis, both groups dogs showed increased femond artery pulse pressure. 3. The pulmonary vascular changes were more severe and appeared earlier in the second group dogs compared with the first group.4. The earliest vascular changes appeared in the media of the small muscular arteries and arterioles. 5. Various vascular chaDges were produced in 2 or 3 months. Thereafter, the changes were stationary. 6. Among the first group, two long-term servivors (No. 705 & 713) which had normal pulmonary artery pressure under the anesthesia, also showed various vascular changes as other pulmonary hypertensive dogs. 7. In the early stage medial hypertrophy. interruptio~l of elastic lamellae were found in the small muscular arteries and arterioles, which were followed by intimal proliferation and thrombosis. These findings may suggest some evidences of trauma to the vessels. 8. Pulmonary arteriograms showed irregularity of the intima of the large and medium sized arteries, abrupt ending of some of the small arteries and narrowing of the anastomosis.