• 대한두개안면성형외과학회지
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• 제18권3호
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• pp.186-190
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• 2017

We report a case of free flap deterioration which may have been induced by pressure gradient resulting from cranial defect overlying a ventriculoperitoneal shunt (VP shunt). The patient, male and aged 78, had a VP shunt operation for progressive hydrocephalus. Afterwards, the scalp skin flap surrounding the VP shunt collapsed and showed signs of necrosis, exposing part of the shunt catheter. After covering the defect with a radial forearm free flap, the free flap site showed signs of gradual sinking while the vascularity of the flap remained unimpaired. An agreement was reached to remove the shunt device and observe the patient for any neurological symptoms, and after the shunt was removed and the previous cranial opening filled with fibrin glue by Neurosurgery, we debrided the deteriorated flap and provided coverage with 2 large opposing rotational flaps. During 2 months' outpatient follow-up no neurological symptoms appeared, and the new scalp flap displayed slight depression but remained intact. The patient has declined from any further follow-up since.

• Journal of Digestive Cancer Research
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• 제2권1호
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• pp.21-23
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• 2014

식도암으로 인한 기관지 식도 누공 환자는 음식물을 섭취하면 누공을 통하여 기관지로 음식물이 흡입되어 폐렴과 같은 합병증을 유발할 수 있다. 특히 전신쇠약이 동반되고 면역력이 저하되어 있는 식도암 환자에게는 치명적인 결과를 초래할 수 있다. 기관지 식도 누공의 내시경적 치료는 환자에게 경구 섭취를 가능하게 하고, 합병증의 발생을 예방할 수 있을 것으로 생각된다. 하지만 아직까지 장기간의 효과 지속성이나 재발에 관하여는 만족스러운 결과가 없는 실정이다. 향후 새로운 내시경 치료법의 개발 및 치료 효과에 대한 연구가 필요하다고 생각한다.

• Clinical Endoscopy
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• 제56권4호
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• pp.409-422
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• 2023

Endoscopic resection (ER) is widely utilized as a minimally invasive treatment for upper gastrointestinal tumors; however, complications could occur during and after the procedure. Post-ER mucosal defect leads to delayed perforation and bleeding; therefore, endoscopic closure methods (endoscopic hand-suturing, the endoloop and endoclip closure method, and over-the-scope clip method) and tissue shielding methods (polyglycolic acid sheets and fibrin glue) are developed to prevent these complications. During duodenal ER, complete closure of the mucosal defect significantly reduces delayed bleeding and should be performed. An extensive mucosal defect that comprises three-quarters of the circumference in the esophagus, gastric antrum, or cardia is a significant risk factor for post-ER stricture. Steroid therapy is considered the first-line option for the prevention of esophageal stricture, but its efficacy for gastric stricture remains unclear. Methods for the prevention and management of ER-related complications in the esophagus, stomach, and duodenum differ according to the organ; therefore, endoscopists should be familiar with ways of preventing and managing organ-specific complications.

• Journal of Trauma and Injury
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• 제25권2호
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• pp.57-62
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• 2012

Gunshot wounds are rare in Korea, but they have tended to increase recently. We experienced an interesting case of penetrating gunshot injuries to the cervical spine with migration the fragments of the bullet within the dural sac of the cervical spine, so discuss the pathomechanics, treatment and complications of gunshot wounds to the spine and present a review of the literature. A 38-year-old man who had tried to commit suicide with a gun was admitted to our hospital with a penetrating injury to the anterior neck. the patient had quadriplegia. A Computed tomography (CT) scan and 3-dimensional CT of the spine showed destruction of the left lateral mass and lamina of the 5th cervical vertebra; the bullet and fragments were found at the level of the 5th cervical vertebra. The posterior approach was done. A total laminectomy and removal of the lateral mass of the 5th cervical vertebrae were performed, and bone fragments and pellets were removed from the spinal canal, but an intradurally retained pellets were not totally removed. A dural laceration was noted intraoperatively, and CSF leakage was observed, so dura repair was done watertightly with prolene 6-0. The dura repair site was covered with fibrin glue and Tachocomb$^{(R)}$. Immediately, a lumbar drain was done. Radiographs included a postoperative CT scan and X-rays. The postoperative neurological status of the patient was improved compared with the preoperative neurological status. however, the patients developed symptoms of menigitis. He received lumbar drainage(200~250 cc/day) and ventilator care. After two weeks, panperitonitis due to duodenal ulcer perforation was identified. Finally, the patient died because of sepsis.

• Journal of Korean Neurosurgical Society
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• 제63권4호
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• pp.455-462
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• 2020

Objective : Recent studies have reported that arachnoid plasty (ARP) using gelatin sponges with fibrin glue reduced the occurrence of chronic subdural hematoma (CSDH) following clipping surgery for unruptured intracranial aneurysm (UIA). This meta-analysis was conducted to collate further evidence for the efficacy of ARP in preventing postoperative CSDH. Methods : Data of patients who underwent clipping surgery were extracted from PubMed, EMBASE, and Cochrane Central Register of Controlled Trials by two independent reviewers. A random effects model was used to investigate the efficacy of ARP by using odd ratios (ORs) and 95% confidence intervals (CIs). A meta-regression analysis for male sex was additionally preformed. Results : Data from six studies with 1715 patients were consecutively included. Meta-analysis revealed that ARP was significantly associated with lower rates of CSDH development after surgical clipping for UIA (ARP group vs. control group : 3.2% vs. 7.2%; OR, 0.40; 95% CI, 0.18-0.93; I²=44.3%; p=0.110). Meta-regression analysis did not highlight any modifying effect of the male sex on postoperative CSDH development (p=0.951). Conclusion : This meta-analysis indicated that ARP reduced the incidence rates of CSDH following clipping surgery for UIA. If feasible, ARP would be implemented as an additional surgical technique to prevent postoperative CSDH development during surgical clipping of UIA.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제29권3호
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• pp.241-249
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• 2007

An augmentation of the maxillary sinus floor facilitates placement of dental implants in the posterior atrophic maxilla. However, a maxillary sinus augmentation has potential complications that can lead to early failure and loss of the bone graft. One specific complication is sinus membrane perforation. Especially, large perforations may cause loss of the graft materials into the sinus and infection, so, early failure of the sinus lift. Attempts at managing sinus membrane perforations are difficult because of the limited access to them and friability of the thin Schneiderian membrane. Repair of sinus membrane perforations intraoperatively may be performed using a variety of techniques and materials, including sutures, collagen membranes, fibrin glue. Inspite of various repair technique, as has been reported extensively in the literature, large perforations represent an absolute contraindication to the continuation of surgery. But, we obtained clinically favorable results in cases that show repair of the perforated sinus membrane with a micro-suture technique by 4X Loupe ($Surgitel^{(R)}$ Loupe, General Scientific Corporation) in large perforation. The objective of this presentation is to report of several cases of repair of the perforated sinus membrane with micro-suture technique using 7.0 or 8.0 suture materials, to make a brief review of the literature about various technique managing perforated sinus membrane.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제43권6호
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• pp.373-387
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• 2017

Objectives: The purpose of this study was to introduce our three experiments on bone morphogenetic protein (BMP) and its carriers performed using the critical sized segmental defect (CSD) model in rat fibula and to investigate development of animal models and carriers for more effective bone regeneration. Materials and Methods: For the experiments, 14, 16, and 24 rats with CSDs on both fibulae were used in Experiments 1, 2, and 3, respectively. BMP-2 with absorbable collagen sponge (ACS) (Experiments 1 and 2), autoclaved autogenous bone (AAB) and fibrin glue (FG) (Experiment 3), and xenogenic bone (Experiment 2) were used in the experimental groups. Radiographic and histomorphological evaluations were performed during the follow-up period of each experiment. Results: Significant new bone formation was commonly observed in all experimental groups using BMP-2 compared to control and xenograft (porcine bone) groups. Although there was some difference based on BMP carrier, regenerated bone volume was typically reduced by remodeling after initially forming excessive bone. Conclusion: BMP-2 demonstrates excellent ability for bone regeneration because of its osteoinductivity, but efficacy can be significantly different depending on its delivery system. ACS and FG showed relatively good bone regeneration capacity, satisfying the essential conditions of localization and release-control when used as BMP carriers. AAB could not provide release-control as a BMP carrier, but its space-maintenance role was remarkable. Carriers and scaffolds that can provide sufficient support to the BMP/carrier complex are necessary for large bone defects, and AAB is thought to be able to act as an effective scaffold. The CSD model of rat fibula is simple and useful for initial estimate of bone regeneration by agents including BMPs.

• Journal of Trauma and Injury
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• 제26권3호
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• pp.151-156
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• 2013

Purpose: Traumatic cervical SCI is frequently accompanied by dural tear and the resulting cerebrospinal fluid (CSF) leak after surgery can be troublesome and delay rehabilitation with increasing morbidity. This study evaluated the incidence of intraoperative CSF leaks in patients with traumatic cervical spinal cord injury (SCI) who underwent anterior cervical surgery and described the reliable management of CSF leaks during the perioperative period. Methods: A retrospective study of medical records and radiological images was done on patients with CSF leaks after cervical spine trauma. Results: Seven patients(13.2%) were identified with CSF leaks during the intraoperative period. All patients were severely injured and showed structural abnormalities on the initial magnetic resonance image (MRI) of the cervical spine. Intraoperatively, no primary repair of dural tear was attempted because of a wide, rough defect size. Therefore, fibrin glue was applied to the operated site in all cases. Although a wound drainage was inserted, it was stopped within the first 24 hours after the operation. No lumbar drainage was performed. Postoperatively, the patients should kept their heads in an elevated position and early ambulation and rehabilitation were encouraged. None of the patients developed complications related to CSF leaks during admission. Conclusion: The incidence of CSF leaks after surgery for cervical spinal trauma is relatively higher than that of cervical spinal stenosis. Therefore, one should expect the possibility of a dural tear and have a simple and effective management protocol for CSF leaks in trauma cases established.

• Journal of Chest Surgery
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• 제26권11호
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• pp.851-855
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• 1993

Among elevn consecutive cases having undergone Completion Pueumonectomy[CP]between 1958 and Aug. 1993 at the Dep. of Thoracic & Cardiovascular Surgery in National Medical Center. The patient`s mean age was 43 years[range 28 yrs, to 68yrs.],& they consisted with 10 males and 1 female. The indications for CP were benign diseases in 9 cases & 2 cases of lung cancer. The mean interval between the first operation & CP was 62.3 months[from 17 days to 288 months]. The several special intraoperative procedures such as intrapericardial pulmonary vesselsdivision & suture ligation, reinforcement of bronchial stumpmargin, & applied the Fibrin glue & hemostatics. The mean intra operative bleeding was 3582ml.[1500ml. to 6500ml.] The post orerative complication were developed in 5 cases[45.5%] they were empyema with BPF in 2 cases, empyema in 2 cases, & 1 case of repiratoy insufficiency which leading to death. We concluded that the C P noted high morbidity & mortality compared with ordinary first pulmonary resectional surgery. But, it will be a challenge to improved the morbidity because of increasing trend of completion pneumonectomy in a furture time.

• 폴리머
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• 제37권5호
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• pp.625-631
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• 2013

점막접착 기능은 인체의 다양한 장기에 적용되는 의료용 접착제에 요구되는 중요한 특성이며, 점막접착 기능을 갖는 고분자를 개발하기 위하여 많은 연구가 이루어지고 있다. 최근 많은 연구자들이 생체모방 기술을 통한 점막접착형 고분자를 개발하고 있고, 그 중 해양 부착 생물인 홍합의 접착 기능 및 특성이 접착제 연구의 주요 대상이 되어왔다. 본 연구에서는 홍합 접착 물질 속에 과량 존재해 표면 접착 기능을 발현하는 카테콜 구조가 도입된 생체모방형 고분자를 합성하였고, 핵자기공명분광법 및 젤투과크로마토그래피를 사용하여 분석하였다. In vitro 상에서 돼지의 소장점막하조직 sheet를 준비하여 전단 시편을 제작하고 점막접착력을 측정하였다. 점막접착형 고분자는 현재 상업적으로 사용되고 있는 대조군인 피브린글루와 비교할 때 월등한 접착력을 보였다. 또한, 다양한 인자를 변화시키며 최적의 점막접착력을 나타내는 조건을 확립하였다. 이러한 결과들을 토대로 우수한 점막접착형 특성을 나타내는 고분자를 개발하였고 다양한 임상적용 및 의료용 기기에 도입가능한 소재의 기초연구를 수행하였다고 사료된다.