• Archives of Reconstructive Microsurgery
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• v.14 no.2
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• pp.95-104
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• 2005

The aim of this study was to investigate the major vascular system to supply flap, flap survival rate and complications after flap elevation in order to evaluate possibility of the vascularized face/scalp allotransplantation. Forty New Zealand white rabbits were divided into two groups: control group and experimental group. Individuals of control group had a face/scalp composite unit which was composed of skin, subcutaneous tissue and platysma muscle, supplying by bilateral facial artery, temporal artery and auricular artery and draining by external jugular vein. After a flap was elevated, bilateral facial artery, temporal artery and auricular artery were ligated. On the other hand, those of experimental group had the same composite unit as control group with bilateral facial artery, temporal artery and auricular artery being not ligated. We had measured survival area of flaps of the sixteen individuals survived for four weeks in the control group and fourteen in the experimental group by Grid method. The mean survival durations of the flap were 3.7days in the control group, 20.0days in the experimental group. The significant differences in the mean survival durations and survival rate at the 28days were found between the control and experimental group (p<0.05). Mean values about the survival area's fractions of all were $1.3{\pm}4.%$ in the control group and $63.1{\pm}4.8%$ in the experimental group. Those of experimental group was significantly higher than control group statistically (p<0.05). The composite face/scalp flap which we have elevated, supplied by bilateral facial artery, temporal artery, auricular artery and drained by external jugular vein has flap viability enough to be transplanted after its elevation.

• Journal of the Korean Society of Radiology
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• v.82 no.6
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• pp.1619-1627
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• 2021

Central venous stenosis is a relatively common complication in hemodialysis patients; however, jugular venous reflux (JVR) and increased intracranial pressure are rare, and associated progressive visual disturbance was reported in only a few cases. Here, we report a case of JVR with visual disturbance and increased intracranial pressure. Notably, the MRI was accompanied by a dilatation of the superior ophthalmic vein, which was mistaken for a cavernous sinus dural arteriovenous fistula (CSdAVF). The patient had JVR on time-of-flight MR angiography (TOF-MRA) and severe stenosis of the left brachiocephalic vein on conventional angiography. After balloon angioplasty for central venous stenosis, he was discharged after improvement of his visual disturbance. Although JVR due to central venous stenosis and CSdAVF might show similar symptoms, treatment plans are different. Therefore, it is important to distinguish radiologically based on a thorough review of MRI and TOF-MRA and confirm the central venous stenosis on cerebral angiography for the accurate diagnosis.

• Journal of Chest Surgery
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• v.29 no.12
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• pp.1401-1404
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• 1996

Central venous line insertion is an essential procedure in a cardiac operation. For this, percuteneous Insertion is usually done in the internal jugular vein or the subclavian vein. However, this method can create such complications as pneumothorax and hemothorax, and repeated failure in inserting the cathet r, especially in infant and child patients, can waste excessive time. Consequently, in our hospital, catheterization of the innominate vein was done after the completion of sternotomy in the cardiac operation of infant and child patients weighing under 1 Okg. During operation, the catheter was placed in the left atrium through the foramen ovate or pulmonary artery to be used for pressure monitoring. When the patient's hemodynamic became stabilized, the catheter was withdrawn to either the right atrium or superior vena casa to be used as the channel for fluid replacement or drug administration. In our hospital, this procedure has been used in 96 cases since 1989. No complications such as pneumothorax and hemothorax occilrred, and neither bleeding after the removal of the catheter was seen.

• Journal of Chest Surgery
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• v.35 no.7
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• pp.530-534
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• 2002

Background: In aortic surgery, division and ligation of the left brachiocephalic vein(LBV) may improve exposure of the aortic arch but controversy continues about the safety of this division and whether a divided vein should be reanastomosed after arch replacement was completed. The safety of LBV division and the fate of the left subclavian venous drainage after LBV division were studied. Material and Method: From November 1998 to January 2001, planned division and ligation of the LBV on the mid-line after median sternotomy was peformed in 10 patients during the aortic surgery with the consideration of local anatomy and distal aortic anastomosis. Assessment for upper extremity edema and neurologic symptoms, measurement of venous pressure in the right atrium and left internal jugular vein, and digital subtraction venography(DSV) of the left arm were made postoperatively. Result: In 10 patients there was improvement in access to the aortic arch for procedures on the ascending aorta or aortic arch. The mean age of patients was 62 years(range 24 to 70). Follow-up ranged from 3 weeks to 13 months. One patient died because of mediastinitis from methicilline-resistant staphylococcus aureus strain. All patients had edema on the left upper extremity, but resolved by the postoperative day 4. No patient had any residual edema or difficulty in using the left upper extremity during the entire follow-up period. No patient had postoperative stroke. Pressure difference between the right atrium and left internal jugular vein was peaked on the immediate postoperative period(mean peak pressure difference = 25mmHg), but gradually decreased, then plated by the postoperative day 4. In all DSV studies left subclavian vein flowed across the midline through the inferior thyroid venous plexus. Conclusion: We conclude that division of LBV is safe and reanastomosis is not necessary if inferior thyroid vein, which is developed as a main bridge connecting the left subclavian vein with right venous system, is preserved.

• Journal of Trauma and Injury
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• v.26 no.3
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• pp.183-189
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• 2013

Purpose: The aim of this study was to identify the optimal insertion angle between the skin and the needle in ultrasound-guided internal jugular vein (IJV) catheterization with trauma patients. Methods: From March 2012 to December 2012, consecutive trauma patients who were planned to receive IJV catheterization were prospectively enrolled. We measured the distances from the skin to IJV's anterior-posterior (AP) vessel wall on the longitudinal scan's midline in supine-positioned patients. We calculated the AP diameter of IJV and the angle between skin and the imaginary line from the puncture site to the IJV's internal center on screen's midline (defined as optimal angle which is considered as the safest approach) on the longitudinal scan. We divided the patients into 3 groups based on the CVP (low CVP <5 $cmH_2O$, $5{\leq}$ middle CVP ${\leq}10\;cmH_2O$, and high CVP>10 $cmH_2O$) and compared their mean anterior posterior (AP) diameters and optimal angles. Results: A total of 56 patients were enrolled. Of these 21 were women(35.4%). The mean AP diameter of low CVP group was significantly lower than middle and high CVP groups($0.68{\pm}0.30$, $1.06{\pm}0.31$, and $1.23{\pm}0.49$ cm respectively, p=0.003 vs. 0.002). There was no significant difference among 3 groups' mean optimal angles ($28.1{\pm}6.1$, $30.1{\pm}4.5$, and $28.0{\pm}5.0$ degree respectively). Conclusion: The optimal angle between the skin and the needle in ultrasound-guided IJV catheterization with trauma patients is not changed as about 30 degrees regardless of CVP even though IJV's diameter is altered in proportion to the CVP.

• Journal of Pharmaceutical Investigation
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• v.9 no.3
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• pp.27-38
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• 1979

This study was attempted to investigate the pharmacological action, especially depressor action of Phellodendri cortex and to elucidate the mechanism of its action, making use of Phellodendri cortex methanol extract (PCME) because its hypotensive action is not clear. Influence of PCME on the blood pressure of the rabbits and cats were observed in this study. PCME, when given intravenously in the rabbits and cats, elicited the hypotensive action, but intraventricular PCME in the rabbits did not show depressor action. Accumulation and tachyphylaxis by PCME administered into the ear-vein of the rabbits were not shown. Depressor effect of PCME in the rabbits was attenuated significantly by pretreatment with phentolamine, guanethidine, chorisondamine and atropine, but not by propranolol, diphenhydramine, cyproheptadine and vagotomization. The pressor activity of angiotensin was unimpaired after injection of maximal hypotensive doses (100mg/kg) of PCME, but the pressor activity of norepinephrine and carotid occlusion was abolished markedly. In addition, PCME given into jugular vein of the cats weakened norepinephrine pressor responses and caused the reversal of epinephrine pressor responses. These results suggest that the hypotensive action of PCME may be due to dual mechanisms by interference with peripheral sympathetic function, alpha adrenoceptor blocking action, and peripheral parasympathomimetics action, muscarinic action.

• Journal of Chest Surgery
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• v.29 no.3
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• pp.346-349
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• 1996

This 32 year old female patient underwent left radical mastectomy due to ductal carcinoma on May 1990, and treated with FAM (5-fluorouracil, Adriamycin and Mitomycin C) regimen postoperatively. However, right cervical Iymph node enlargement and facial edema progressively developed since December 199). On April 1994, operation was performed, and findings were as followes; x4$\times$5$\times$7 to 1 : 1 $\times$ 1 cm sized multiple enlarged and hyperemic Iymph nodes were scatterred throughout submandibular area to the junction of superior vents cave and pericardium, and partially invaded both anterior segmental lobe, sternum and both distal tip of clavicles. After radical dissection of the nodes of neck and mediastinal nodes, and wedge resection of both anterior segments of lung, and partial resection of both clavicle tips and total sternum. The both innominate veins and superior vena cava were partially obstructed by invaded cancer SVC reconstruction was done with preclotted 10$\times$ 10$\times$ 18mm Y shap d woven Dacron graft, which was anastomosed to the point of the junction of subclavian vein and jugular vein after cross clamping both veins and 2cm above the pericardial junction with one arm clamp. After maintaining blood drainage to the SVC from the right side, left innominate vein was anastomosed with 4-0 Prolene continuous running suture. Bone cement was used for resected sternal portion and clavicular ends were fixed to postal portion with 18 Gauge wires. The patient was treated with radiation and chemotherapy after discharge, and there were no evidence of regrowing of the mass nor obstruction of the graft inspite of no antithrombotic therapy.

• Journal of The Korean Society of Emergency Medicine
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• v.29 no.6
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• pp.636-640
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• 2018

Objective: Central venous catheter (CVC) misplacement can result in incorrect readings of the central venous pressure, vascular erosion, and intravascular thrombosis. Several studies have examined the correlation between the guidewire J-tip direction and misplacement rate. This study examined whether the guidewire J-tip direction (cephalad vs. caudad) affects the misplacement rate in right subclavian venous catheterization. Methods: This prospective randomized controlled study was conducted between February 2016 and February 2017. The subjects were divided into two groups (cephalad group vs. caudad group) and the misplacement rate was compared according to guidewire J-tip direction in each group. Results: Of 100 patients, the cephalad and caudad groups contained 50 patients each. The age, sex, and operator experience were similar in the two groups. In the cephalad group, misplacement of CVC insertion into the ipsilateral internal jugular vein occurred in two cases. In the caudad group, misplacement of CVC insertion into the contralateral subclavian vein occurred in one case, with loop formation in the brachiocephalic trunk in one case. Guidewire J-tip direction showed no significant correlation with CVC misplacement. Conclusion: The guidewire J-tip direction does not influence the rate of misplacement.

• Tuberculosis and Respiratory Diseases
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• v.51 no.4
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• pp.379-385
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• 2001

Sternocostoclavicular hyperostosis is an uncommon disease, characterized by an inflammatory arthrosteitis of the sternocostoclavicular region. Clinically, it manifests as a painful swelling of the upper anterior chest wall, which is associated with occasional pustulosis palmaris and plantaris. A 48-year-old man had suffered from pain in both shoulders and the upper anterior part of the chest for 6 months. On examination, a venous engorgement in the neck with dilated collateral veins in the upper chest and shoulders was observed. Swelling was noticed in his face, neck and both arms. Radiologically, the clavicles, the sternum and the first ribs were enlarged with complete fusion between them. 99Tc scintigraphy showed increased uptake in the clavicles and the sternum. Selective venography resulted in a bilateral subclavian and brachiocephalic vein occlusion, which resulted from a subclavian vein thrombosis. All the above suggested a sternocostoclavicular hyperostosis. He underwent a vascular graft interposition between the right jugular vein and the left innomianate vein (using 8mm ringed Gore-Tex graft) and a resection of the bilateral medial half of clavicle and 1st rib. Here, we present a case on sternoclavicular hyperostosis with subclavian and brachiocephalic vein thrombosis, and report this case study with a review of the appropriate literature.

• Journal of Chest Surgery
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• v.13 no.3
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• pp.219-228
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• 1980

The heart block and bradyarrhythmia with or without Stokes-Adams attacks are serious, usually terminal events and the immediate mortality is very high. Stimulation with an artificial pacemaker is now an accepted form of treatment in cases of Stokes-Adams syndrome in which medication in unable to produce any lasting improvement. Permanent pacemaker therapy is indicated in these circumstances. The purpose of this report is to describe the successful use of pacemaker in 3 cases of Stokes-Adams syndromes and a case of sinoatrial block with bradyarrhythmia at the Department of Thoracic and Cardiovascular Surgery, Kyungpook National University School of Medicine. Electrode catheter was passed through the right external jugular vein and attached to the endocardial surface of the right ventricle. In case 1, fixed type generator was used at first and for the case 2, 3, 4, and case 1 at second, demand type generators were used. The bipolar electrode catheters were used for the three cases and unipolar electrode catheter for case 4. The results of immediate and late period were satisfactory.