• Title/Summary/Keyword: Operative strategy

Search Result 92, Processing Time 0.027 seconds

Crossed Renal Ectopia and Aorto-Occlusive Disease: A Management Strategy

  • Ng, Eugene;Campbell, Ian;Choong, Andrew MTL;Dunglison, Nigel;Aziz, Maged
    • Journal of Chest Surgery
    • /
    • v.48 no.5
    • /
    • pp.371-374
    • /
    • 2015
  • We present a rare case of a patient with aortoiliac occlusive disease on the background of type A crossed renal ectopia, for whom open surgical intervention was required. Aortic exposure in patients with concomitant crossed renal ectopia can present technical challenges to the vascular surgeon. The knowledge of variations in the ectopic renal blood supply is of paramount importance when performing surgery to treat this condition and affects the choice of surgical exposure. We present and discuss the operative details of our patient and outline an approach to this subset of patients.

Staging in Vestibular Schwannoma Surgery : A Modified Technique

  • Kim, Eal-Maan;Nam, Sung-Il
    • Journal of Korean Neurosurgical Society
    • /
    • v.43 no.1
    • /
    • pp.57-60
    • /
    • 2008
  • The authors herein propose the staged excision as a novel strategy to preserve facial nerve and minimize complication during microsurgery of large vestibular schwannoma (VS). At the first stage, for reducing mass effect on the brain stem and cerebellum, subtotal tumor resection was performed via a retrosigmoid craniotomy without intervention of meatal portion of tumor. With total resection of the remaining tumor, the facial nerve was decompressed and delineated during the second stage translabyrinthine approach at a later date. A 38-year-old female who underwent the staging operation for resection of her huge VS is illustrated.

Strategy for the Patient with Tuberculum Sellae Meningioma Combining Bilateral Internal Artery Aneurysm

  • Cha, Ki-Yong;Park, Sang-Keun;Hwang, Yong-Soon;Kim, Tae-Hong
    • Journal of Korean Neurosurgical Society
    • /
    • v.38 no.2
    • /
    • pp.151-154
    • /
    • 2005
  • A 43-year-old woman was admitted with the chief complaint of progressive visual disturbance and her brain radiological studies disclosed well demarcated tumor at tuberculum sellae area and bilateral mirror image paraclinoid internal carotid artery saccular aneurysms. A larger left side aneurysm was pointing medialy and almost encased by the tumor. Although a brain tumor and intracranial aneurysm can be simultaneously treated by surgery, the high risk of intra-operative aneurysm rupture should be considered. Therefore, the author secondly performed tumor resection after the endovascular embolization of the aneurysm which was embedding the tumor using a Guglielmi detachable coil. After successful treatment of the patient with tuberculum sellae meningioma associated with bilateral mirror image paraclinoid aneurysms using endovascular and surgical techniques, the authors present the case with a review of the related literatures.

Priority Setting in Damage Control Surgery for Multiple Abdominal Trauma Following Resuscitative Endovascular Balloon Occlusion of the Aorta

  • Heo, Yoonjung;Lee, Seok Won;Kim, Dong Hun
    • Journal of Trauma and Injury
    • /
    • v.33 no.3
    • /
    • pp.181-185
    • /
    • 2020
  • Damage control surgery (DCS) is an abbreviated laparotomy procedure that focuses on controlling bleeding to limit the surgical insult. It has become the primary treatment modality for patients with exsanguinating truncal trauma. Herein, we present the case of a 47-year-old woman with liver, kidney, and superior mesenteric vein (SMV) injuries caused by a motor vehicle collision. The patient underwent DCS following resuscitative endovascular balloon occlusion of the aorta (REBOA). In this case report, we discuss the importance of priority setting in DCS for the treatment of multisystem damage of several abdominal organs, particularly when the patient has incurred a combination of major vascular injuries. We also discuss the implications of damage control of the SMV, perihepatic packing, and right-sided medial visceral rotation. Further understanding of DCS, along with REBOA as a novel resuscitation strategy, can facilitate the conversion of uniformly lethal abdominal injuries into rescuable injuries.

Recent Developments and Policy Directions in Fisheries Finance in Korea (IMF 이후 한국수산금융의 현황과 정책방향)

  • 김경호
    • The Journal of Fisheries Business Administration
    • /
    • v.32 no.2
    • /
    • pp.1-22
    • /
    • 2001
  • In recent years Korea fisheries have been much more influenced than ever before by domestic and foreign environmental changes such as market liberalization, sustainability, efficiency and effectiveness of domestic fisheries, fisher's welfare etc. Under the wide range of environmental changes, government is carrying out various fisheries policies. However, it seems insufficient to accomplish policy goals under the existing policy instruments. The main focus of the paper is to investigate structural changes and policy directions of fisheries finance in Korea after asian economic crisis. The results of the study are as follows; Fisheries sector in whole economy has been lowering in its proportion. To survive in emerging global competition, fisheries sector is needed structural reformation. In particular the strategy that increases operative efficiency and effectiveness on government financial policy in fisheries sector is much expected. Also, it is necessary to minimize costs, to reform institution and management for increasing efficiency and effectiveness.

  • PDF

Abstract Minimally Invasive Aort ic Valve Surgery -A Report of Two Cases (최소 침습성 대동맥 판막 수술 -2례 보고-)

  • 백완기;김현태
    • Journal of Chest Surgery
    • /
    • v.30 no.11
    • /
    • pp.1139-1141
    • /
    • 1997
  • Recently, minimally invasive approach via limited incision becomes one of the rapidly developing strategy in cardiac surgery as it gives less surgical trauma and is more satisfactory to the patients in respect to operative scar although the surgical technique is more demanding. Here, we report two cases of aortic valve replacement via limited transsternal incision. The methodology is described with review of the relevant literature.

  • PDF

Product Phase Control During Interdiffusion Reactions (상호 확산 반응 중의 생성상 제어)

  • Park, Joon-Sik;Kim, Ji-Hoon;Perepezko, John R.
    • Journal of Korea Foundry Society
    • /
    • v.26 no.1
    • /
    • pp.27-33
    • /
    • 2006
  • Phase evolutions involving nucleation stages together with diffusional growth have been examined in order to provide a guideline for determining rate limiting stages during phase evolutions. In multiphase materials systems in coatings, composites or multilayered structures, diffusion treatments often result in the development of metastable/intermediate phases at the reaction interfaces. The development of metastable phases during solid state interdiffusion demonstrates that the nucleation reaction can be one controlling factor. Also, the concentration gradient and the relative magnitudes of the component diffusivities provide a basis for a phase selection and the application of a kinetic bias strategy in the phase selection. For multicomponent alloy systems, the identification of the operative diffusion pathway is central to control phase formation. Experimental access to the nucleation and growth stage is discussed in thin film multi layers and bulk samples.

Chronic postsurgical pain: current evidence for prevention and management

  • Thapa, Parineeta;Euasobhon, Pramote
    • The Korean Journal of Pain
    • /
    • v.31 no.3
    • /
    • pp.155-173
    • /
    • 2018
  • Chronic postsurgical pain (CPSP) is an unwanted adverse event in any operation. It leads to functional limitations and psychological trauma for patients, and leaves the operative team with feelings of failure and humiliation. Therefore, it is crucial that preventive strategies for CPSP are considered in high-risk operations. Various techniques have been implemented to reduce the risk with variable success. Identifying the risk factors for each patient and applying a timely preventive strategy may help patients avoid the distress of chronic pain. The preventive strategies include modification of the surgical technique, good pain control throughout the perioperative period, and preoperative psychological intervention focusing on the psychosocial and cognitive risk factors. Appropriate management of CPSP patients is also necessary to reduce their suffering. CPSP usually has a neuropathic pain component; therefore, the current recommendations are based on data on chronic neuropathic pain. Hence, voltage-dependent calcium channel antagonists, antidepressants, topical lidocaine and topical capsaicin are the main pharmacological treatments. Paracetamol, NSAIDs and weak opioids can be used according to symptom severity, but strong opioids should be used with great caution and are not recommended. Other drugs that may be helpful are ketamine, clonidine, and intravenous lidocaine infusion. For patients with failed pharmacological treatment, consideration should be given to pain interventions; examples include transcutaneous electrical nerve stimulation, botulinum toxin injections, pulsed radiofrequency, nerve blocks, nerve ablation, neuromodulation and surgical management. Physical therapy, cognitive behavioral therapy and lifestyle modifications are also useful for relieving the pain and distress experienced by CPSP patients.

Is Lymph Node Size a Reliable Factor for Estimating Lymph Node Metastasis in Early Gastric Cancer?

  • Kim, Dong Jin;Kim, Wook
    • Journal of Gastric Cancer
    • /
    • v.18 no.1
    • /
    • pp.20-29
    • /
    • 2018
  • Purpose: Pre-operative lymph node (LN) size is a valuable parameter for determining treatment strategy for gastric cancer. However, a correlation between LN size and metastasis has not been established. Materials and Methods: Thirty-six LN-positive (LNP) and matched 36 LN-negative (LNN) patients were included, and pathology slides of the LNs of these patients were reviewed. All the LNs were measured along the long-axis (LA) and short-axis (SA), manually. Results: Average retrieved LNs were $37.3{\pm}19.8$ and $40.5{\pm}11.6$ in the LNN and LNP groups, respectively. In total 2,800 LNs, including 136 metastatic LNs (MLNs) and 2,664 non-metastatic LNs (nMLNs), were evaluated. Mean length was significantly more in MLNs along both, the LA and SA (MLN_LA vs. nMLN_LA: $4.97{\pm}3.84$ vs. $3.37{\pm}2.40mm$, MLN_SA vs. nMLN_SA: $3.86{\pm}3.19$ vs. $2.43{\pm}1.59mm$; P<0.001). However, 92.6% (126/136) and 95.6% (130/136) of MLNs were <10 mm along the LA and SA, respectively. In addition, only 22.2% of the LNP group exhibited an MLN as the largest LN. Conclusions: Pre-operative multi-detector computed tomography has limited ability in estimating the presence of metastasis in LNs because most MLNs are less than 10 mm, and only a small proportion of the LNP group exhibits an MLN as the largest MLN.

Free Toe Tissue Transfer using Infiltration Method of Local Anesthetic Agent (국소 침윤마취법을 이용한 족지조직 유리 피판술)

  • Seo, Dong-Lin;Park, Seung-Ha;Lee, Byung-Ihl
    • Archives of Reconstructive Microsurgery
    • /
    • v.16 no.2
    • /
    • pp.63-67
    • /
    • 2007
  • This study was designed to introduce free toe tissue transfer using infiltration method of local anesthetic agent. Four toe pulp tissues were transferred to reconstruct finger tip defect in four patients who were not suitable for general anesthesia. Two flaps taken from the lateral side of the great toe was used for reconstruction of thumb defect and two flaps from the medial side of the second toe for resurfacing of the index and fifth finger. Flap sizes were various from $2.0{\times}2.0\;cm^2$ to $1.6{\times}4.0\;cm^2$. Anesthesia was induced by infiltration of 2% lidocaine hydrochloride (with 1:100,000 epinephrine) with dilution of normal saline in same volume unit, as like as in ordinary digital block. All vessels were anastomosed within 2 cm of distance from the proximal margin of the defect. Whole operative procedures were carried out by one team. All flaps were successfully taken without complication. The average operation time was 4 hours 10 minutes. The amount of anesthetic agent used in whole operative procedures was roughly 4 mL in the toe, 8 mL in the finger, and 12 mL totally. In conclusion, free toe tissue transfer using infiltration method of local anesthetic agent would be good strategy for finger tip reconstruction in the patient not suitable for general anesthesia.

  • PDF