• Journal of Chest Surgery
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• v.39 no.6 s.263
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• pp.434-439
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• 2006

Background: Deep hypothermic circulatory arrest during repair of aortic arch anomalies may induce neurological complications or myocardial injury. So we surveyed if the regional cerebral and myocardial perfusion might eliminate those potential side effects. Material and Method: From March 2000 to December 2004, 62 neonates or infants with aortic arch anomaly underwent one stage biventricular repair using the regional perfusion technique by single surgeon. Preoperative diagnosis of the arch anomaly consisted of coarctation (n=46), interruption of the aorta (n=12), hypoplastic left heart syndrome (n=2) and truncus areteriosus (n=2). Combined anomalies were ventricular septal defect (n=51), TAPVR (n=1), PAPVR (n=1) and atrioventricular septal defect (n=2). Arterial cannula was inserted at the innominate artery. Result: The mean regional perfusion time of brain was $28{\pm}10min$. Operative mortality rates was 0 (0/62). Late death was 1 (1/62) during $11{\pm}7$ months of follow-up. Neurologic complications consisted of transient chorea in 1 case. There was no reoperation associated with arch anolamy. Pulmonary complication associated with arch repair occurred in f case which was managed by aortopexy. Conclusion: One-tage rch repair using the regional profusion is safe and effective in minimizing the neurologic and myocardial complications.

• Journal of Genetic Medicine
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• v.7 no.2
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• pp.145-150
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• 2010

Acrodysostosis is an extremely rare disorder characterized by short fingers and toes with peripheral dysostosis, nasal hypoplasia, and mental retardation. We report a 16-year-old Korean boy with acrodysostosis who had characteristic clinical features and cervical spine stenosis manifested by neurologic symptoms. On presentation, he complained of difficulty in raising his arms, and suffered from intermittent pain and weakness in both upper extremities. He had short stature and dysmorphic facial features, including a broad, depressed nasal bridge, small, upturned nose, bilateral epicanthal folds, and mild hypertelorism. Moderate mental retardation and sensorineural hearing loss in both ears were also present. Radiological findings included broad, short metacarpals and phalanges with cone-shaped epiphyses, bilateral Madelung deformities, hypertrophied first metatarsals, and thickening of the calvarium. Magnetic resonance imaging findings included stenosis of the cervical spine, platybasia with compression into the cervicomedullary junction, and downward displacement of the cerebellar tonsils. Here, we report a case of acrodysostosis with symptoms and signs of cervical spinal stenosis first in Korea. If it is diagnosed in the early stages, possible life-threatening complications, including spinal canal stenosis, can be managed properly and permanent neurologic sequelae might be avoided. Therefore, it is important to consider acrodysostosis in the differential diagnosis of peripheral dysostosis.

• Journal of Chest Surgery
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• v.33 no.12
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• pp.941-947
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• 2000

Background: Central nervous system complication after coronary artery bypass grafting(CABG) is one of the major prognostic determinants and the use of the cardiopulmonary bypass(CPB) may increase the incidence of this devastating complication. In this study, the outcomes after off-pump CABG were studied and compared with those following the conventional CABG using CPB. Material and Method: Among the consecutive isolated CABG's performed in SNUH during Feb. 1995 and Jun. 1999, 338 coronary artery bypass grafting were divided into two groups. 223 patients underwent CABG using the CPB(Group I), and 115 patients underwent CABG without CPB(OPCAB)(Group II). All patients enrolled in this study received extensive preoperative examinations including thorough neurologic examination before and after surgery, transcranial doppler study, carotid duplex ultrasonography, and magnetic resonance angiography if necessary. Central nervous system(CNS) complications were defined as stroke, seizure, metabolic or hypoxic encephalopathy and transient delirium after surgery. Result: There were 61 cases(27.3%) who developed postoperative CNS complication in Group I, whereas 8 cases(7.0%) of CNS complications developed postoperatively in group II(p<0.05). Statistically significant predictors of postoperative CNS complications in group I were age and the use of cardiac assist devices perioperatively. Conclusion: This study suggested that omitting the use of CPB in CABG resulted in significant decrease of the postoperative CNS complications. OPCAB should be more widely applied especially to the elderly who have preexisting cerebrovascular disease.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.25 no.4
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• pp.356-360
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• 1999

PURPOSE : This is to review the complicated jaw fractures that had been referred for revision of the unsatisfactory results, and to provide proper managements for the easily complicated jaw fractures. MATERIALS & METHODS : Twenty-nine patients who had been revised due to malunion or complicated fractures of facial bones for last 3 years were reviewed. The main problems required for revision, type of fractures complicated, the primary managements to be reclaimed, the specialties to be involved, the management to be reclaimed, time elapsed to seek reoperation, type of revision surgeries, residual complication were analysed with medical records, radiographs and final examinations. RESULTS: The major complaints were malocclusion(79.3%), facial disfigurement(41.3%), TMJ problems (13.7%), neurologic problems(10.3%), non-union(10.3%), and infection(6.8%). Unsatisfactory results were occurred most frequently after improper management of the multiple fractures of the mandible (62.2%), combined fractures of maxilla and mandible (20.6%), fracture of zygomatico-maxillary complex and midpalate (17.2%). The complications to be corrected were widened or collapsed dental arches (79.3%), improperly reduced condyles (41.3%), painful TMJ (34.4%), limited jaw excursion (31.0%), over-reduction of zygoma (13.7%), and nonunion with infection(13.7%). and dysesthesia (10.3%). The primary managements were nendereet by plastic surgeons in 82.7%(24/29) and by oral surgeons in 7.6%(2/29). Main causes of malunion are inadequate ORIF in 76%, unawareness & delay in 17%, and delayed due to systemic cares in 17%. 76% of 29 patients had been in state of intermaxillary fixation for over 4 weeks. Revision were done by means of "refracture and ORIF"in 48.2%(14/29), orthognathic osteotomies with bone grafts in 55.1%(16/29), and camouflage countering & alloplastic implantations in 37.9%(11/29), TMJ surgeries in 17.2%, micro-neurosurgeries in 11.6%. Residual complications were limited mouth opening in 24.1% (7/29), paresthesia in 13.7%, resorption of reduced condyle in 10.3%. CONCLUSIONS : Failure of initial treatment of jaw fractures is due to improper diagnosis and inadequate treatment with lack of sufficient knowledge of stomatognathic system. It is crucial to judge jaw fracture and patients accurately, moreover, the best way of treatments has to be selected. Consideration of these factors in treatment could minimize the complication of jaw fractures.

• Archives of Craniofacial Surgery
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• v.11 no.1
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• pp.28-32
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• 2010

Purpose: In accordance with the increasing number of accidents caused by various reasons and recently developed fine diagnostic skills, the incidence of orbital blow-out fracture cases is increasing. As it causes complications, such as diplopia and enophthalmos, surgical reduction is commonly required. This article reports a retrospective series of 5 blow-out fracture cases that had unusual nerve injuries after reduction operations. We represents the clinical experiences about treatment process and follow-up. Methods: From January 2000 to August 2009, we treated total 705 blow-out fracture patients. Among them, there were 5 patients (0.71%) who suffered from postoperative neurologic complications. In all patients, the surgery was performed with open reduction with insertion of $Medpor^{(R)}$. Clinical symptoms and signs were a little different from each other. Results: In case 1, the diagnosis was oculomotor nerve palsy. The diagnosis of the case 2 was superior orbital fissure syndrome, case 3 was abducens nerve palsy, and case 4 was idiopathic supraorbital nerve injury. The last case 5 was diagnosed as optic neuropathy. Most of the causes were extended fracture, especially accompanied with medial and inferomedial orbital blow-out fracture. Extensive dissection and eyeball swelling, and over-retraction by assistants were also one of the causes. Immediately, we performed reexploration procedure to remove hematomas, decompress and check the incarceration. After that, we checked VEP (visual evoked potential), visual field test, electromyogram. With ophthalmologic test and followup CT, we can rule out the orbital apex syndrome. We gave $Salon^{(R)}$ (methylprednisolone, Hanlim pharmaceuticals) 500 mg twice a day for 3 days and let them bed rest. After that, we were tapering the high dose steroid with $Methylon^{(R)}$ (methylprednisolon 4 mg, Kunwha pharmaceuticals) 20 mg three times a day. Usually, it takes 1.2 months to recover from the nerve injury. Conclusion: According to the extent of nerve injury after the surgery of orbital blow-out fracture, the clinical symptoms were different. The most important point is to decide quickly whether the optic nerve injury occurred or not. Therefore, it is necess is to diagnose the nerve injury immediately, perform reexploration for decompression and use corticosteroid adequately. In other words, the early diagnosis and treatment is most important.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.16 no.1
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• pp.47-51
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• 2016

Propionic acidemia (PA) is an autosomal recessively inherited disorder of the organic acid metabolism. It is caused by a deficiency of propionyl-CoA carboxylase (PCC). PCC is a heteropolymeric enzyme composed of ${\alpha}$- and ${\beta}$-subunits. The clinical symptoms of PA are heterogeneous and present vomiting, dehydration, hypotonia, and lethargy, and it can result in death. The typical presentations of neonatal onset PA are life-threatening metabolic acidosis and hyperammonemia. Here, we described a case of neonatal onset PA with mild clinical presentations. She was born to a healthy mother without complications. No significant illness was observed until nine days after birth. She started exhibiting poor oral feeding, vomiting, lethargy, and hypotonia at ten days old. Her laboratory results showed mild hyperammonemia and acidosis. The initial diagnosis was neonatal sepsis and she was treated with antibiotics. However, her clinical symptoms didn't improve. So we considered a metabolic disease. She was given nothing by mouth and intravenous hydration and nutrition support was performed. Propionylglycine and 3-hydroxypropionic acid were showed high concentrations in urine by gas chromatograph mass spectrometry (GC-MS). C3 level of acylcarnitine analysis elevated 10.4 uM/L (range, 0.200-5.00) in plasma. We took gene analysis for PA to be based on the symptoms and laboratory results. We detected PCCB gene mutation and diagnosed PA. She survived without severe neurologic defects and complications and was hospitalized only three times with upper respiratory tract infections for 7 years. We report a case of a ten days old neonate with PA presenting without severe metabolic acidosis and hyperammonemia who was effectively treated with early aggressive care and conventional methods.

• Korean Journal of Head & Neck Oncology
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• v.25 no.1
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• pp.24-27
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• 2009

Backgrounds and Objectives : Most patients with neck schwannomas are asymptomatic. Surgical management of neck schwannomas could cause various complications. The aim of this study is to evaluate the necessity of surgical management in all of the neck schwannoma patients. Material and Methods : Thirty-four patients diagnosed and undergone surgical management as neck schwannomas and 30 patients diagnosed and observed closely by OPD base from 1996 to 2005 were included. The medical records were reviewed retrospectively. Results : In surgical management group, mean age was 39.3 years and mean size of tumors was 4.4cm. Twenty-five patients had their tumors at parapharyngeal space, 2 at anterior neck and 7 at lateral neck. Nerves of origin were vagus nerve in 12 patients, cervical sympathetic chain in 11. Presenting symptoms were neck mass in 22 patients and no symptom in 9. On the other hand, in close observation group, mean age was 47.1 years and mean size of tumor was 3.7cm. Seventeen patients had their tumors at parapharyngeal space, 5 at anterior neck and 8 at lateral neck. Presenting symptoms were neck mass in 13 patients and no symptom in 13. There were no patients with neurologic complications. Mean follow-up duration was 38.2 months and there were only 2 patients whose size of tumors was increased and no patients who had newly emerged symptoms. Conclusion : Neck schwannomas grows slowly, has little chance of malignant transformation, but can complicate serious problems after surgical management. Therefore close observation could be considered in many asymptomatic patients.

• The Journal of Korean Medicine
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• v.25 no.4
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• pp.95-107
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• 2004

Objective : The inappropriate or excessive apoptosis has been known to be associated with neurodegenerative disorders including intracranial hemorrhage(ICH). Paeoniae radix, in traditional Korean medicine, has played its role as blood­nourisher and yin-astringent. In the present study, the effect of Paeoniae radix on the inhibition of neurodegeneration in the brain of rats after artificial ICH and on the resulting apoptosis was investigated. Methods : 30 rats were divided into 6 equal groups ; the sham-operation group, the hemorrhage-induction group, the hemorrhage-induction with 10, 50, 100, and 200 mg/kg Paeoniae radix-treated group, respectively. Stereotactic surgery was performed and collagenase was infused to induce ICH in the region of CA1 of hippocampus of rats. The sham group took only saline infusion. For 7 days after the surgery, 4 testing groups had intraperitoneal injections of Paeoniae radix extract. The step-down inhibitory avoidance task, measurement of neurodegeneration degree in the CA1 region of the hippocampus, and detection of caspase-3 and newly generated cells in the dentate gyrus were done after animal sacrifice. Results : Rats receiving Paeoniae radix extract showed increased latency time in the inhibitory avoidance task. The extension of neuron-deprived areas in the CA1 region was significantly suppressed in the Paeonia treated groups. Also expressions of caspase-3 in the CA1 region and cortex were significantly inhibited in the Paeonia treated groups. The cell proliferation was evaluated by means of BrdU methods and proved to be decreased in the Paeonia treated groups. Conclusion : These results suggest that Paeoniae radix has potential to suppress short-tenn memory loss after devastating neurologic accidents. Also it was proved that Paeoniae radix has a neuroprotective effect and alleviates central nervous complications following intracerebral hemorrhage. Furthermore, it may imply that this medicinal plant can be widely used for vascular dementia and other neurodegenerative disorders.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.3
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• pp.277-283
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• 1999

This study was aimed at furnishing the data of Naso-orbito-ethmoidal fractures and aiding treatmenting Naso-orbito-ethmoidal fractures A 5-year review of Naso-orbito-ethmoidal fractures and concomitant injuries is presented. The patients were treated in the Dept. of Oral and Maxillofacial Surgery of Wankwang University Hospital from Jan. 1, 1993 to Dec. 31, 1997. The results were as followes: Male predominated over female by a ratio of 4.6 : 1. The most common reasons is traffic accident(88.2%). The elapsed time from injury to operation is average 9.2 days, and the mean admission days were 79 days and removal of plates were average 217.3 days. The most associated facial bone fractures is Zygomatico-Maxillary complex fracture(20%). Associated injuries were neurologic injury(29.4%), orthopedic injury(23.5%), opthalmologic injury(17.6%), body injury(5.8%), neuropsychologic injury(5.8%) and otolaryngologic injury(5.8%) in this order. The most injured teeth were upper and lower incisors. The intubation methods for surgery were orotracheal(29.57%), submental(29.5%), and nasotracheal technique(41%). Most patients had complications, that were post-traumatic telecanthus, nasal depression, scar formation. This results suggest that early diagnosis and treatment is prerequisits to satisfactory result. Aggressive management of NOE fracture with direct or bicoronal exposure with aid of CT is now an accepted norm.

• The Korean Journal of Pain
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• v.28 no.2
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• pp.105-108
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• 2015

Background: The most definitive diagnosis of neck pain caused by facet joints can be obtained through cervical medial branch blocks (CMBBs). However, intravascular injections need to be carefully monitored, as they can increase the risk of false-negative blocks when diagnosing cervical facet joint syndrome. In addition, intravascular injections can cause neurologic deficits such as spinal infarction or cerebral infarction. Digital subtraction angiography (DSA) is a radiological technique that can be used to clearly visualize the blood vessels from surrounding bones or dense soft tissues. The purpose of this study was to compare the rate of detection of intravascular injections during CMBBs using DSA and static images obtained through conventional fluoroscopy. Methods: Seventy-two patients were included, and a total of 178 CMBBs were performed. The respective incidences of intravascular injections during CMBBs using DSA and static images from conventional fluoroscopy were measured. Results: A total of 178 CMBBs were performed on 72 patients. All cases of intravascular injections evidenced by the static images were detected by the DSAs. The detection rate of intravascular injections was higher from DSA images than from static images (10.7% vs. 1.7%, P < 0.001). Conclusions: According to these findings, the use of DSA can improve the detection rate of intravascular injections during CMBBs. The use of DSA may therefore lead to an increase in the diagnostic and therapeutic value of CMBBs. In addition, it can decrease the incidence of potential side effects during CMBBs.