• Journal of Chest Surgery
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• 제27권8호
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• pp.650-655
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• 1994

The author analyzed 99patients with VSD weighting less than 10kg of body weight who underwent surgical correction from 1981 to 1992 at cardiovascular department of Hanyang University hospital. Patients occupied 29.3% of total cases who were underwent surgical corrections for congenital heart diseases during that time. Of the 99 patients, 51 patients were male [52%] and 48 patients[48%] were female. Age ranged from 28 days to 36 months with mean age of 13.6 months. Mean body weight was 7.53kg. According to Kirklin`s anatomical classification, type II defect was most common [61.6%]. Associated anomaly was found in 48 patients [48.5%]. Patent foramen ovale was most commonly associated cardiac anomaly [14.1%] and followed by atrial septal defect [12.1%], patent ductus arteriosus [10.1%]. Cardiac catheterization data were analyzed. The most common range of Qp/Qs, Rp/Rs, Pp/Ps were above 3.0, 0.1 - 0.25, and above 0.75 respectively. Among the indications of surgical correction, there were pulmonary hypertention in 69 patients, congestive heart failure in 44 patients, frequent respiratory infection in 47 patients, growth retardation in 33 patients. The most common surgical approach and method for VSD closure were right atriotomy[48.3%] and dacron patch closure[93.3%]. Complication rate was 13.1% [13 cases], and overall mortality was 17.1% [17 cases]. The cause of death consisted of low cardiac output syndrome[11 cases], acute renal failure[3 cases], sepsis[2 cases] and pulmonary insufficiency[1 case] in order of frequency.

• Journal of Chest Surgery
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• 제37권12호
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• pp.1010-1014
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• 2004

급성 폐동맥 혈전색전증은 대부분 혈전용해제나 항응고제 등을 이용하여 내과적으로 치료하나, 폐동맥 혈전색전증에 의한 급성 우심실 부전이 발생하는 경우에는 신속히 수술을 하지 않으면, 단시간 내에 치명적인 결과를 가져올 수 있으며, 우심혈전이 동반되어 있는 경우 그 사망률은 훨씬 높아지고, 개방형 난원공을 통한 역리성 색전증(paradoxical embolism)이 보고되고 있다. 그러나 본 증례에서와 같이 우심방의 혈전이 심방중격결손을 통해 좌심방으로 유입되는 것이 관찰되는 예는 극히 드물다. 직장암으로 저위전방절제술을 받은 63세 남자 환자에서 수술 직후 심부정맥혈전증에 의해 생긴 우심실부전을 동반한 급성 페동맥 혈전색전증을 응급개심술을 통해 좋은 결과를 얻었기에 보고하는 바이다.

• The Korean Journal of Pain
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• 제1권2호
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• pp.154-163
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• 1988

In 1983, Sten H$\ddot{a}$kanson first reported the clinical safety and efficacy of retrogasserian glycerol injection as a treatment of typical trigeminal neuralgia in 96 of 100 patients during a follow-up period of 1~6 years. Since September 1987, we have injected sterile pure glycerol into the trigeminal cistern using an anterior percutaneous approach via the foramen ovale (H$\ddot{a}$rtel route) for treatment of tic douloureux in 12 patients who were suffering from attacks pain of following discontinuation of carbamazepine. The results were as follows; 1) Eight patients were completely free from pain attacks with a single dose of glycerol (0.4 ml). The remaining four patients needed a second dose (0.4 ml) several days later following the single dose. The degree of patient's subjective satisfaction by those injections was very good in 11 and fair in one. 2) During the follow-up period (1~13 months), persistent sensory deficit as determined by the pin prick test, appeared to be mild in 10 and moderate in one patient. There was no sensory deficit in one patient. further attacks of pain from those injections were still noted. 3) As a transient complication, there was headache in all patient, facial hematoma in 4, nausea and vomiting in two each, and vertigo and herpes simplex in one each. In conclusion, we confirmed that the above glycerol injections into the trigeminal cistern were clinically very effective as a treatment of tic douloureux even though the follow-up period was short.

• Journal of Chest Surgery
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• 제21권4호
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• pp.649-655
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• 1988

One hundred and one patients with tetralogy of Fallot who were older than 16 years of age underwent a total correction of the anomaly between May, 1964 and July, 1987. This group comprised 14.9% of the 679 consecutive patients who had repair of the tetralogy at our institution during the same period. Of the 101 patients, 8 had a previous shunt procedure for palliation. The preoperative mean hemoglobin value was 16.9*1.0% and the mean systemic oxygen saturation, 84.4*0.9%. In 76 patients[75.2%], a type II ventricular septal defect was seen whereas in 14 patients[13.9%], the defect was type I. In 72 patients[71.3%], other cardiac anomalies were present which included patent foramen ovale in 37.6%, atrial septal defect in 8.99b, vegetations in 6.9%, right sided aortic arch in 5.9% and coronary artery anomaly in 5.0%. The right ventricular outflow obstruction was caused most commonly by combination of infundibular and valvular stenosis[74.3%], followed by isolated infundibular stenosis[19.8%] and valvular stenosis [5.9%] alone in order. The preoperative mean diameter of the pulmonary valve ring size was 10.2*0.5 mm in diameter. A transannular patch enlargement of the right ventricular outflow tract was performed in 28 patients and, in 12 a pericardial monocusp was utilized. Major anomalous aorto-pulmonary vessels were encountered in 5 patients which were detected before or during the operation. In 3 patients, they were ligated beforehand to control the flooding of the operative field. Postoperatively, the mean systolic pressure gradient between the right ventricle and the main pulmonary artery was 16.2*2.3 mmHg and the mean systolic pressure- ratio between the right and the left ventricle was 45.3*2.0%. Perioperative complications including bleeding in 8.9%, pleural effusion in 7.9%, dysrrhythmia in 4.9%, and residual VSD in 4.0%. Operative mortality was 8.9%. There has been no operative death in the recent 65 cases since 1981. There were 2 late deaths, 68 and 113 months after surgery. There were 2 late detachment of the VSD patch during the follow-up period. Of the 6 patients with patch detachment found during the postoperative period, 3 had subacute bacterial endocarditis before or after the operation indicating The serious nature of this complication. Two of these patients subsequently underwent a successful reoperation.

• Anatomy and Cell Biology
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• 제49권2호
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• pp.143-150
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• 2016

Understanding of morphological structures such as the sphenoid spine and pterygoid processes is important during lateral transzygomatic infratemporal fossa approach. In addition, osseous variations such as pterygospinous and pterygoalar bridges are significant in clinical practice because they can produce various neurological disturbances or block the passage of a needle into the trigeminal ganglion through the foramen ovale. Two hundred and eighty-four sides of Korean adult dry skulls were observed to carry out morphometric analysis of the lateral plate of the pterygoid process, to investigate, for the first time among Koreans, the incidence of the pterygospinous and pterygoalar bony bridges, to compare the results with those available for other regional populations, and to discuss their clinical relevance as described on literatures. The mean of maximum widths of the left and right lateral plates of the pterygoid process were 15.99 mm and 16.27 mm, respectively. Also, the mean of maximum heights of the left and right lateral plates were 31.02 mm and 31.01 mm, respectively. The ossified pterygospinous ligament was observed in 51 sides of the skulls (28.0%). Ossification of the pterygospinous ligament was complete in four sides (1.4%). In 47 sides (16.6%), the pterygospinous bridge was incomplete. The ossified pterygoalar ligament was observed in 24 sides of the skulls (8.4%). Ossification was complete in eight sides (2.8%) and incomplete in 16 sides (5.6%). This detailed analysis of the lateral plate of the pterygoid process and related ossification of ligaments can improve the understanding of complex clinical neuralgias associated with this region.

• Journal of Korean Neurosurgical Society
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• 제64권5호
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• pp.827-836
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• 2021

Objective : Trigeminal neuralgia is one of the most common causes of facial pain. Our aim is to investigate the efficacy and borders of percutaneous radiofrequency thermocoagulation in the treatment of trigeminal neuralgia. Methods : Between May 2007 and April 2017, 156 patients with trigeminal neuralgia were treated with radiofrequency thermocoagulation. These 156 patients underwent 209 procedures. In our study, we investigated the early and late results of percutaneous radiofrequency thermocoagulation under guiding fluoroscopic imaging in the treatment of trigeminal neuralgia. Barrow Neurological Institute (BNI) pain scale was used for grading the early results. In addition, Kaplan-Meier survival analysis was used to assess long-term outcomes. Of the 156 patients who underwent radiofrequency thermocoagulation for trigeminal neuralgia, 45 had additional disease. Patients with this condition were evaluated with their comorbidities. Early and late results were compared with those without comorbidity. Results : In 193 of 209 interventions BNI pain scale I to III results were obtained. Out of the 193 successful operation 136 patients (65.07%) were discharged as BNI I, 14 (6.70%) as BNI II, 43 (20.58%) as BNI III. Sixteen patients (7.65%) remained uncontrolled (BNI IV and V). While the treatment results of trigeminal neuralgia patients with comorbidity seem more successful in the early period, this difference was not observed in follow-up examinations. Conclusion : Finally, we concluded that percutaneous radiofrequency thermocoagulation of the Gasserian ganglion is a safe and effective method in the treatment of trigeminal neuralgia. However, over time, the effectiveness of the treatment decreases. Neverthless, the reapprability of this intervention gives it a distinct advantage.

• Journal of Yeungnam Medical Science
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• 제3권1호
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• pp.221-227
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• 1986

영남대학교 의과대학 흉부외과학교실에서는 1984년부터 1986년까지 총 99명의 심실중격 결손증 환자들을 수술 치험하였던 바 다음과 같은 결론을 얻었다. 1. 남여비는 1.2 : 1로 남자가 약간 많았다. 2. 연령분포는 다양하였으며 전체의 $\frac{2}{3}$가 3세에서 12세 사이였다. 3. 체중분포는 10kg미만이 13예이고 21kg이상이 44 예였다. 4. 입원시 주소는 잦은 상기로 감염증이 78예로 제일 많은 빈도를 보였다. 5. 심도자 검사상 폐 체동맥압비가 0.75이상인 경우가 6명, 폐 체 혈관 저항비가 0.5 이상인 경우는 0명, 폐 체 혈류량비가 3이상인 경우가 13명으로 대부분이 중등도의 병변을 보였다. 6. 동반된 심기형은 개방성 난원공, 폐동맥 협착증, 개방성 동맥관 등의 순이었다. 7. 심실중격 결손의 부위는 막변연 유입부 결손이 45예로 제일 많았으며 근육형은 1예로 없었다. 8. 술후 합병증은 완전 혹은 불완전 우각 차단증이 52예로 가장 많았다. 9. 술후 사망은 2예였으며 2%의 발생율을 보였다.

• Neonatal Medicine
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• 제17권1호
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• pp.109-115
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• 2010

신생아의 지속성 폐동맥 고혈압증(PPHN)은 출생 후 폐동맥의 저항이 낮아지고 전신 혈관 저항이 올라가면서 폐로 가는 혈류가 증가하고 난원공과 동맥관을 통한 폐와 전신의 평행 순환에서 연속 순환인 신생아 순환으로 바뀌게 되는 과정에 문제가 있는 것이다. 저자들은 태변흡인이 있었던 두 명의 만삭아에서 고빈도 환기 요법과 흡인성 일산화질소 가스를 이용하여 PPHN을 치료하였으나 치료에 반응하지 않고 전신 장기에 산소화가 문제가되어 정맥-정맥도관체외막형산소섭취(V-V ECMO)를 시행하였고 두 증례 모두 체외막형 산소 섭취를 이탈하여 생존할 수 있었다. 현재까지 태변 흡인 증후군에 의해 생긴 PPHN 환아들에서 ECMO를 적용하여 치료한 국내 보고가 없고, 특히 V-V ECMO 적용으로 신생아를 치료한 보고 또한 없다. 이에 저자들은 태변 흡입 증후군에 의해 생긴 PPHN 환아들에서 V-V ECMO로 생존한 2례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제32권1호
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• pp.5-9
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• 1999

배경: Ebstein 기형은 삼첨판, 우심실 및 우심방의 특징적인 변형을 보이는 희귀한 선천성 심질환이다. 이 질환의 외과적인 치료는 삼첨판성형술과 판막치환술로 두가지가 시행되고있으나 가장 좋은 술식에 대해서는 의견이 일치되고 있지는 않다. 대상 및 방법: 본원에서 1984년 1월부터 1996년 12월까지 Ebstein기형의 수술적 교정을 한 8례를 대상으로 하였으며 대상 환자의 연령 및 성별분포, 임상증상, 흉부 방사선학적 소견, 술전 검사소견, 수술소견, 수술방법, 수술 결과등을 비교검토하였다. 결과: 성비는 남자 5명, 여자 3명이었고, 연령분포는 최소 2세에서 최고 28세로 평균연령은 17.6세였다. 모든예에서 전형적인 삼첨판의 변형을 보였으며 동반된 심기형으로는 개방성 난원창, 심방중격 결손증, 폐동맥 협착증이 있었다. 수술적 방법으로는 삼첨판막 치환술과 삼첨판륜 성형술 및 주름 성형술을 각각 4례씩 실시하였다. 술후 합병증으로 Danielson 술식을 받은 2례에서 빈맥이 있었으며 삼첨판 치환술을 받은 2례에서 완전 방실차단이 생겨 인공심박동기를 설치하였다. 2례의 술후 사망례가 있었으며 생존한 6례에서는 술후 평균 64.83 개월간 추적 관찰결과 NYHA class I-II로 별문제 없이 지내고 있고 술전보다 양호한 심기능을 보였다. 술후 5례에서 심초음파를 실시하였고 삼첨판의 역류정도는 술전 중등도이상에서 술후 경증도로 개선되었다. 결론: Ebstein 기형의 수술적 방법의 선택은 각환자의 해부학적 특성에 따라 다르지만, 삼첨판의 기형과 변형이 작고 판막치환이 필요하지않다면 삼첨판륜성형과 주름성형술이 좋은 술식이라고 판단된다.

• 대한치매학회지
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• 제22권1호
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• pp.28-42
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• 2023

Background and Purpose: We investigated the correlation between the deep distribution of white matter hyperintensity (WMH) (dWMH: WMH in deep and corticomedullary areas, with minimal periventricular WMH) and a positive agitated saline contrast echocardiography result. Methods: We retrospectively recruited participants with comprehensive dementia evaluations, an agitated saline study, and brain imaging. The participants were classified into two groups according to WMH-distributions: dWMH and dpWMH (mainly periventricular WMH with or without deep WMH.) We hypothesized that dWMH is more likely associated with embolism, whereas dpWMH is associated with small-vessel diseases. We compared the clinical characteristics, WMH-distributions, and positive rate of agitated saline studies between the two groups. Results: Among 90 participants, 27 and 12 met the dWMH and dpWMH criteria, respectively. The dWMH-group was younger (62.2±7.5 vs. 78.9±7.3, p<0.001) and had a lower prevalence of hypertension (29.6% vs. 75%, p=0.008), diabetes mellitus (3.7% vs. 25%, p=0.043), and hyperlipidemia (33.3% vs. 83.3%, p=0.043) than the dpWMH-group. Regarding deep white matter lesions, the number of small lesions (<3 mm) was higher in the dWMH-group(10.9±9.7) than in the dpWMH-group (3.1±6.4) (p=0.008), and WMH was predominantly distributed in the border-zones and corticomedullary areas. Most importantly, the positive agitated saline study rate was higher in the dWMH-group than in the dpWMH-group (81.5% vs. 33.3%, p=0.003). Conclusions: The dWMH-group with younger participants had fewer cardiovascular risk factors, showed more border-zone-distributions, and had a higher agitated saline test positivity rate than the dpWMH-group, indicating that corticomedullary or deep WMH-distribution with minimal periventricular WMH suggests embolic etiologies.