• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제42권5호
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• pp.295-300
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• 2016

Submucosal infiltration and the topical application of epinephrine as a vasoconstrictor produce excellent hemostasis during surgery. The hemodynamic effects of epinephrine have been documented in numerous studies. However, its metabolic effects (especially during surgery) have been seldom recognized clinically. We report two cases of significant metabolic effects (including lactic acidosis and hyperglycemia) as well as hemodynamic effects in healthy patients undergoing orthognathic surgery with general anesthesia. Epinephrine can induce glycolysis and pyruvate generation, which result in lactic acidosis, via ${\beta}2$-adrenergic receptors. Therefore, careful perioperative observation for changes in plasma lactate and glucose levels along with intensive monitoring of vital signs should be carried out when epinephrine is excessively used as a vasoconstrictor during surgery.

• Advances in pediatric surgery
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• 제7권1호
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• pp.26-30
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• 2001

Gastrointestinal duplications are rare congenital malformation that may require surgical intervention in the neonate, infant, and occasionally the older child. Symptoms produced by duplications vary according to their location, size, type and histology. We report the clinical characteristics and the surgical results of 9 cases of the gastrointestinal duplications treated at at Asan Medical Center between 1989 and 2000. Five patients were boys and four were girls; age of patients ranged from 5 days to 10 years. Eight duplications were cystic and one was tubular. One involved the stomach; five were in the ileum, and two in the cecum. The most common presentation was intestinal obstruction. There was associated anomaly in one patient, pulmonary sequestration and double ureter. Ectopic gastric mucosa was found in two. All patients underwent surgical resection. There was no perioperative mortality or morbidity. Although gastrointestinal duplication is a rare entity. consideration of associated anomalies and being familiar with the anatomy and clinical features are required for adequate management. In cystic form. complete excision is recommended but planned surgery is required for long segment tubular lesion.

• 대한후두음성언어의학회지
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• 제10권1호
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• pp.30-36
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• 1999

Background and Objectives : Laryngeal Evoked Electromyography(EEMG) is a objective, quantitative technique to determine innervation status of larynx. The possible applications of this technique are to confirm the etiology of impaired vocal fold motion and monitor perioperative vagus nerve trauma. The purpose of this study is to develop a novel method for determining the amount of reinnervation of recurrent laryngeal nerve with accurate, inexpensive, and minimally invasive technique in human. Materials and Methods : Laryngeal EEMG was performed for 16 adults with intact vocal folds motion and 2 patients diagnosed as unilateral vocal fold paralysis. for the purpose of searching what is the optimal and noninvasive technique for laryngeal EEMG, we used 2 types of stimulation configurations(transcutaneous vs percutaneous) and 2 types of recording configurations(intramuscular vs. surface). Results and Conclusions : Percutaneous needle stimulation and surface recording of laryngeal EEMG was reliable and comparable to standard needle stimulation and invasive intramuscular needle recording. But the laryngeal EEMG by the surface recording and transcutaneous surface stimulation was not reliable and repeatable. Therefore we recommended that laryngeal EEMG by surface recording and percutaneous needle stimulation would be minimally invasive, reliable technique to know the status of reinnervation in e patients with vocal fold paralysis.

• Journal of Chest Surgery
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• 제28권2호
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• pp.131-135
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• 1995

Fifteen patients[10 female and 5 male from 13 to 73 years of age[mean age 46 years underwent excision of atrial myxomas between 1981 and 1993 at the Chonnam University Hospital. Fourteen patients presented with exertional or resting dyspnea, six with palpitation, five with systemic embolization, and three with syncope. Symptoms were present from 1 week to 14 months before operation. Fourteen tumors originated from the atrial septum of left atrium and one of bilateral atrium. All tumors were pedunculated; tumor sizes were variable from 2x1x1cm to 7x6x5cm. No ventricular tumors identified. The myxomas were successfully removed in all patients, either by shaving them from the atrial septum[n=7 or excising a portion of normal atrial septum with the tumor and ASD patch closure[n=8 . There was no perioperative or late death in our experience. Follow-up is current and complete in all cases[range 6 months to 13 years . Thirteen patients are in New York Heart Association Class I, and the remaining two patients are in Class II. One recurrent left atrial myxoma was identified at 20 months after operation. In this series, excellent results were obtained by simple excision of the tumor, with or without a margin of normal atrial septum. Long-term clinical & echocardiographic follow-up is recommended since late recurrence, although rare, has been reported.

• 대한치과의사협회지
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• 제48권1호
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• pp.38-44
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• 2010

Nowadays, medically compromised patients who could not receive dental treatments in the past are able to go through minor oral surgeries with adequate preoperative measures. Thorough understanding of the systemic disease and its complications is needed as well as the management them. Frequent complications of surgical procedures are bleeding, infection, delayed healing, systemic reactions by stress and they can be aggravated due to the patients' systemic conditions. Therefore, understanding of the systemic disease of patient visiting dental office and treatment modification according to the systemic status is needed. Also consultation to the medical doctor is imperative, through which perioperative risk and complications can be reduced. Among the high frequency complications of dental treatment of medically compromised patients, bleeding, infection, delayed healing, systemic reactions by stress will be discussed with the management of each one.

• Journal of Yeungnam Medical Science
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• 제21권1호
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• pp.114-119
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• 2004

This report concerns an unusual case of acute postoperative pulmonary edema without any apparent causes in a 45-year-old man. The patient was subjected to the removal of a previously placed device on the left tibia, and the excision of a benign mass on the right forearm. Unexpected acute bilateral pulmonary edema occurred immediately after the completion of the procedures. The etiologies were reviewed in relation to the patient's condition and clinical manifestations. Fluid overloading was excluded as a cause in view of the patient's perioperative state and postoperative chest X-ray results. We could not find any symptoms of upper airway obstruction during emergence from general anesthesia. We had doubts about tourniquet or fentanyl-induced pulmonary edema, but these factors were not sufficient to bring about pulmonary edema in this case. To our knowledge, the cause of acute pulmonary edema in this case is indeterminate.

• Journal of Korean Neurosurgical Society
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• 제39권2호
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• pp.109-113
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• 2006

Objective : Meningioma is a benign tumor which has a high occurrence rate of postoperative hematomas. The purpose of this study is to analyze risk factors for postoperative hemorrhages after meningioma surgery. Methods : One hundred and fifty three patients with intracranial meningiomas, operated at the Department of Neurosurgery, National Medical Center, between January 1995 and December 2003 were included in this retrospective study. Risk factors considered to be related with postoperative hematomas were age, sex, preoperative pharmacological anticoagulants for medical co-morbidity, tumor location, histological type of the meningioma, infiltration of dural sinus and arachnoid, removal range of tumors, and the perioperative coagulation status including prothrombin time, partial thromboplastin time, and platelet count. Results : Patients' aged more than 70 years with a platelet count of less than $150{\times}10^9{\ell}^{-1}$ after surgery had statistically significant relations to the occurrence rate of postoperative hematomas. The other factors had no statistical significance. Conclusion : Various and intensive preoperative examinations for coagulation factors of patients, especially of older age, and proper transfusion before meningioma surgery are necessary for preventing postoperative hematoma.

• Journal of Chest Surgery
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• 제26권7호
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• pp.526-531
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• 1993

Sixty-one consecutive patients with coronary artery bypass graft for myocardial revascularization were retrospectively reviewed to analyze various pattern of postoperative complication and death during hospital stay from Nov. 1988 to Oct. 1992. Fortytwo of the patients were male and nineteen female. The mean age was 56 and 51 years in male and female. Preoperative diagnosises were unstable angina in 14 of patients, stable angina in 28, postmyocardial infarction state in 15, and state of failed percutaneous transluminal coronary angioplasty in 4. 141 stenosed coronary arteries were bypassed with use of 20 pedicled internal mammary artery and 124 reversed saphenous vein grafts. Postoperative complications and perioperative death were as follows: 1. Of 61 patients undergoing operation, peri and postoperative over all complication occured in 15 patients [ 25% ]; newly developed myocardial infarction in 4, intractable cardiac arrhythmia including atrial fibrillation and frequent ventricular premature contraction in 3, bleeding from gastrointestinal tract in 2, persistent vegetative state as a sequele of brain hypoxia in 1, wound necrosis in 1, left hemidiaphragmatic palsy in 3 and poor blood flow through graft in 2. 2. Operative mortality was 8%[5 patients]. 3 out of these died in operating room; 1 patient by bleeding from rupture of calcified aortic wall, 1 by air embolism through left atrial vent catheter, 1 by low cardiac output syndrome. 2 patients died during hospital stay; 1 by acute respiratory distress syndrome with multiuple organ failure, 1 by brain death after delayed diagnosis of pericardial tamponade.

• Journal of Chest Surgery
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• 제27권3호
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• pp.191-195
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• 1994

Twenty-four patients with left main coronary artery stenosis exceeding 50% underwent coronary artery bypass grafting from January 1991 through June 1993. Four patients [17%] had stenosis only in left main coronary artery and 20 patients [83%] had associate lesion[s] in left anterior descending , circumflex, or right coronary artery. Sixteen patients [67%] had higher degrees of stenosis [>70%] in left main coronary artery. Preoperatively 18 patients [75%] had unstable angina pectoris even during aggressive medical treatment. Preoperatively aggressive medical treatment was performed to relieve the symptom in patients with unstable angina. All patients were perioperatively treated with continuous infusion of isosorbide dinitrate to stabilize symptomatic and hemodynamic states. Twenty patients underwent elective coronary bypass surgery and 4 patients urgent operations due to severe unstable angina. There was no thirty-day mortality or late death. Angina recurred in 1 patient, but coronary angiographic study showed good patency of grafts and the symptom was relieved with medical treatment. We concluded that coronary artery bypass grafting can be safely performed by perioperative efforts, including continuous infusion of isosorbide dinitrate, for hemodynamic stabilization in patients with left main coronary artery stenosis.

• Journal of Chest Surgery
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• 제37권1호
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• pp.88-91
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• 2004

Takayasu씨 동맥염 환자에서 대동맥판막 폐쇄부전은 종종 발생하는 합병증이다. 급성 및 진행성 염증으로 대동맥의 뇌혈관 분지에 협착 또는 폐쇄를 가진 환자에서 실신 등의 허혈성 뇌증상은 대동맥판막 폐쇄부전증의 합병으로 더 악화될 수 있다. 양측 경동맥의 폐쇄와 양측 척추동맥의 협착, 우관상동맥의 폐쇄, 대동맥판막 폐쇄부전증으로 실신 및 호흡곤란을 호소하는 34세 남자 환자에서 수술 전후에 스테로이드의 투여, 양측 쇄골하 동맥에 스텐트의 삽입 및 대동맥판막 치환술로써 증상의 호전을 가져올 수 있었다.