• Journal of Chest Surgery
• /
• v.39 no.1 s.258
• /
• pp.68-71
• /
• 2006

We operated on a 41-year-old man using venous bypass shunt for superior vena cava (SVC) syndrome caused by mediastinal fibrosis. The patient had substantially high venous pressure and high risk of postoperative neurologic deficits. The collateral veins were deemed to be interrupted during the surgical reconstruction of SVC. Treatment included resection of the obstructed SVC and innominate vein and reconstruction with an autologous pericardial tube graft. During the operation, venous drainage from upper body was maintained with an extraluminal bypass shunt. The shunt was effective at prompt relief of venous hypertension, eliminating the time constraints, and preventing the postoperative complications.

• Journal of Korean Neurosurgical Society
• /
• v.60 no.3
• /
• pp.306-314
• /
• 2017

Endoscopic third ventriculostomy (ETV) has now become an accepted mode of hydrocephalus treatment in children. Varying degrees of success for the procedure have been reported depending on the type and etiology of hydrocephalus, age of the patient and certain technical parameters. Review of these factors for predictability of success, complications and validation of success score is presented.

• Korean Journal of Bronchoesophagology
• /
• v.4 no.2
• /
• pp.177-181
• /
• 1998

Provox is now widely used for voice rehabilitation for total laryngectomized patient because of its low airway resistance and easiness for phonation. This study was designed to reveal the influence of radiation therapy on Proven complications. Forty-four patients who underwent total laryngectomy were grouped into group A (no radiation), group B(radiation and then Provox insertion), group C(Proven insertion and then radiation). Provox complications were leakage, granulation tissue formation, malfunction and infection. The average survival time of Provox was longer in group C (9.2 me) than group A(8.6 m) or group B (7.3 me), but no statistical significance was found. The first time of Provox change was 10.2, 8.6 and 9.7 months respectively. The incidence of complication was not significantly different among groups. The cases of Provox remeval due to shunt failure were 5, 4 and 2 respectively. Even though a significant statistically difference was not found partialy due to the small numbers of patients, a special caution should be exercised in inserting Provox to prevent a serious complication for the patients who had a history of previous radiation.

• Journal of Korean Neurosurgical Society
• /
• v.62 no.3
• /
• pp.336-343
• /
• 2019

Epilepsy surgery revealed dramatically improved seizure outcomes over medical therapy in drug-resistant epilepsy patients. Children with epilepsy, however, have multiple epileptic focuses which require multilobar resection for better seizure outcome. Multilobar resection has not only the several severe surgical complications, such as hydrocephalus and shunt-related craniosynostosis, due to intracranial volume reduction. Isolation method (disconnection surgery) was progressively studied over epileptic focus removal (resective surgery) for seizure control. This concept was first introduced for functional hemispherotomy, and its primary principle is to preserve the vital vascularized brain that is functionally disconnected from the contralateral healthy brain. Currently in most epilepsy centers, the predominant disconnection surgical methods, including functional hemispherotomy, are continually being refined and are showing excellent results. They allow the functional isolation of the hemisphere or multi-lobe, affected by severe epilepsy. This review describes recent findings concerning the indication, surgical technique, seizure outcome and complications in several disconnection surgeries including the functional hemispherotomy for refractory pediatric epilepsy.

• Journal of Korean Neurosurgical Society
• /
• v.66 no.3
• /
• pp.289-297
• /
• 2023

Technological advances in neonatology led to the improvement of the survival rate in preterm babies with very low birth weights. However, intraventricular hemorrhage (IVH) has been one of the major complications of prematurity. IVH is relevant to neurodevelopmental disorders, such as cerebral palsy, language and cognitive impairments, and neurosensory and psychiatric problems, especially when combined with brain parenchymal injuries. Additionally, severe IVH requiring shunt insertion is associated with a higher risk of adverse neurodevelopmental outcomes. Multidisciplinary and longitudinal rehabilitation should be provided for these children based on the patients' life cycles. During the infantile period, it is essential to detect high-risk infants based on neuromotor examinations and provide early intervention as soon as possible. As babies grow up, close monitoring of language and cognitive development is needed. Moreover, providing continuous rehabilitation with task-specific and intensive repetitive training could improve functional outcomes in children with mild-to-moderate disabilities. After school age, maintaining the level of physical activity and managing complications are also needed.

• Journal of Trauma and Injury
• /
• v.26 no.3
• /
• pp.248-251
• /
• 2013

Introduction: A post-traumatic mesenteric arteriovenous fistula (AVF) is extremely rare. Case Report: A previously healthy 26-year-old male was injured with an abdominal stab wound. Computed tomography (CT) showed liver injury, pancreas injury and a retropancreatic hematoma. We performed the hemostasis of the bleeding due to the liver injury, a distal pancreatectomy with splenectomy and evacuation of the retropancreatic hematoma. On the 5th postoperative day, an abdominal bruit and thrill was detected. CT and angiography showed an AVF between the superior mesenteric artery (SMA) and the inferior mesenteric vein with early enhancement of the portal vein (PV). The point of the AVF was about 4 cm from the SMA's orifice. After an emergent laparotomy and inframesocolic approach, the isolation of the SMA was performed by dissection and ligation of adjacent mesenteric tissues which was about 6 cm length from the nearby SMA orifice, preserving the major side branches of the SMA, because the exact point of the AVF could not be identified despite the shunt flow in the PV being audible during an intraoperative hand-held Doppler-shift measurement. After that, the shunt flow could not be detected by using an intraoperative hand-held Doppler-shift measuring device. CT two and a half months later showed no AVF. There were no major complications during a 19-month follow-up period. Conclusion: Early management of a post-traumatic mesenteric AVF is essential to avoid complications such as hemorrhage, congestive heart failure and portal hypertension.

• Journal of Chest Surgery
• /
• v.27 no.9
• /
• pp.764-769
• /
• 1994

From november, 1985 to May, 1993, 222 arteriovenous fistulae were made in 201 patients with chronic renal failure. Among them, a total of 183 arteriovenous fistulae in 173 patients were reviewed to evaluate the factors influencing patency rate of the vascular access. The results were revealed as follows: There were 102 men and 71 women,aged 10 to 76 years [mean = 45.7 years]. Sixteen patients of them had previous shunts. The procedures included establishment of 214 radiocephalic or brachioocephalic fistulae, 203 side to end, 9 side to side, 2 end to end, 2 autologous saphenous vein grafts, 6 Gore-Tex grafts. There were 28 early shunt failures[12%] due to use of 23 inadequate veins and 5 thrombosis.There were 32 late complications[14%]; 19 thrombosis, 4 aneurysm, 4 venous hypertension, 3 steal syndrome, 2 infections. There were 32 diabetic patients [17 %]. No significant differences in graft patency were noted between diabetic and nondiabetic individuals. There were no significant difference in graft patency between male and female. Overall shunt patency in 183 cases with chronic renal failure was 96% at I month, 95% at 3 months, 93% at I year, 91% at 2 years, 84% at 3 years, 56% at 5years.This Study showed that early postoperative thrombosis and diabetic vasculopathy were most causes of the vascular access failure and suggested that prevention of thrombi and well control of diabetes mellitus were most important to enhance patency rates of the vascular access.

• Journal of Chest Surgery
• /
• v.32 no.8
• /
• pp.749-752
• /
• 1999

Over the past several years, a number of centers have reported favorable results of anatomical repair for the congenitally corrected transpositions. However, there have been subsequent problems related mainly to the results of atrial switch procedures in patients who had small atriums because of venoatrial obstructions or supraventricular arrhythmias, especially in patients with apicocaval juxtaposition. Cavopulmonary shunt may be a useful addition to the double switch operation in certain circumstances as a means of avoiding potential atrial complications. Herein, we describe the successful anatomical repair of congenitally corrected transposition of the great artery with pulmonary atresia, ventricular septal defect, and cavo apical juxtaposition with this modification.

• Clinical and Experimental Pediatrics
• /
• v.48 no.2
• /
• pp.216-220
• /
• 2005

Pulmonary arteriovenous fistulas(PAVFs) is a rare disorder that occurs in two to three children per 100,000 population. It is presented as absence of intervening capillary beds between the pulmonary artery and vein with resultant persistent right to left shunt. Other causes include trauma, liver cirrhosis, malignancy and schistosomiasis. It is mostly asymptomatic, but it may present with respiratory difficulty, cyanosis, clubbed fingers induced by right to left shunt or hemoptysis, polycythemia and epistaxis. Major complications, such as brain abscess, brain embolism, paradoxical embolism and subacute infective endocarditis can be devastating, so therapeutic intervention is recommended in all patients. However, removal of low-resistance fistulas can aggrevate pulmonary hypertension, so detection of increased pulmonary pressure is important. We report two patients : One a 42 year-old male with PAVFs treated with coil embolization, and a 42 year-old female who was treated with anticoagulants due to pulmonary hypertension.

• Journal of Chest Surgery
• /
• v.25 no.7
• /
• pp.777-784
• /
• 1992

The 67 patients who were operated as a tetralogy of Fallot during the period from 1985 to 1991 at the Department of Thoracic and Cardiovascular Surgery, Hanyang University were reviewed retrospectively. The age ranged from 3 month to 43 years old[mean 10.4 years old]. 39 patients were male and 25 patients were female. The body surface area ranged 0.4m2~1.6m2[mean 0.77m2] and body weight ranged 5.2kg~57kg[mean 20.2kg]. The 22 patients have history of previous shunt operation and average interval between shunt and total repair is 1.8years. The 43 patients were operated as primary total correction. The 53 patients were operated using transannular patch for right ventricular outflow reconstruction. And 12 patients were operated as right ventricular outflow recontruction only. Six patients were died postoperatively among 67 patients and with mortality rate of 8.7%. In patients group less than 0.7 of PRV/LV, there was no expired case but in patient group over than this level 3 patients were died among 14 patients. There were 6 death among the transanular patch group and no death in right ventricular outflow recontruction performed group. Postoperative complications were found in 9 cases including bleeding; 3 cases, residual VSD; 2 cases, wound infection: 2 cases, chylothorax 1 case and Lt. phrenic nerve palsy 1 case.