• Clinical and Experimental Reproductive Medicine
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• 제2권1호
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• pp.19-38
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• 1975

A total of 185 vasovasostomies were carried out for 11 years. Various factors which are of importance in fluencing the successful vasovasostomies are analysed and presented as follows: In recent years, demand of reanastomosis of the vas deferens increased considerably. An average age of the subjects is 39, and that of their wives, 33 in this series. An average interval between vasectomy and vasovasostomy is 4 years. An average number of living chidren is 2.6 at the time of vasectomy. and 2.1 at the time of time of vasovasostomy. Merchant and public official are the most commonly encounterd occupation in the present series. Coital frequencies are 2.2/week after vasovasostomy. The most common reasons for requesting the vasovasostomy are remarriage and deaths of children, especially son. Success rate is considerably higher among younger group than that of the older. Success rate is somewhat higher among groups of shorter interval between the operations (vasectomy and vasovasostomy) than that of longer interval group. Success rate is higher among bilateral vasovasostomy group than that of any others. Success rate is higher in solid splint group and no splint group than hollow splint group. The closed dressing technique of the end of splint on the scrotum is found to be reasonably effective in preventing infection. Ordinary end-to-end anastomosis and folded side-to-side anastomosis techniques are proved to be the most ideal form of modified operation for the successful vasovasostomies. The most common causes of failure are infection, injuries of blood supply, avascular necrosis due to extensive mobilization, inadequate approximation of both vasal end, hematoma, changes of epididymal environment, and early ambulation in this series. Overall success rate of the author's series is found the 81 per cent, and impregnation rate is 35 per cent. Overall results reported by other workers are that success rate regarding appearance of sperm in the semen after operation is 64 per cent, and that of impregnation after vasovasostomy is 33 per cent. The results of semen assessment performed on same cases prior to vasectomy and following vasovasostomy showed that post-vasovasostomy sperm count scarcely reached three-quaters of pre-vasectomy count.

• Journal of Gastric Cancer
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• 제3권2호
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• pp.93-96
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• 2003

Purpose: Synthetic absorbable monofilaments offer excellent glide characteristics and cause minimal tissue trauma as a result of their smooth monofilament structure and gradual absorption within the healing tissues. For these reasons, these suture materials are commonly used in various surgical fields such as gastroenterology, urology, gynecology, and plastic surgery. The aim of this study was to evaluate the safety and usefulness of a new synthetic absorbable monofilament, Glycoside-..-caprolactone-trimethylene carbonate interpolymer (GCT), in gastrointestinal anastomosis and closure. Materials and Methods: We evaluated 55 gastrointestinal anastomoses and closures using GCT $MONOSYN^{R}$, B. Braun, Germany) in 47 patients who underwent gastric surgery between December 2001 and May 2002 at Seoul National University Hospital. Patient's characteristics, operative procedure, surgeon's opinion of handling properties of GCT, and suture-related complications were analyzed. Results: There were 34 males and 13 females (M:F= 2.6:1) with an average age of 54.2 years old. Forty-five cases of gastrointestinal anastomosis (20 gastrojejunostomies and 25 jejunojejunostomies) and 10 cases of intestinal closure (7 gastrostomy closures and 3 duodenal stump closures) were performed in 41 cases of stomach cancer, three of peptic ulcer disease, two of GIST, and one MALToma. The handling properties of GCT according to the criteria of knot breaking load, knot security, and placing property were always scored with 7 to 9 points (10=excellent, 1=very poor). Two cases of postoperative complications ($3.6\%$) were noted. One was a leak of the gastrojejunostomy site which was successfully managed conservatively, and the other was a stricture of the gastrojejunostomy site which was managed by reoperation (side-to-side jejunojejunostomy). Conclusion: GCT seems to be an applicable suture material for various gastrointestinal anastomoses and closures.

• Journal of Chest Surgery
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• 제2권2호
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• pp.155-166
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• 1969

Heterotopic abdominal homograft of canine heart was carried out in 20 pairs of dogs. Of these 12 cases were subjected as a control and 8 were subjected to immunosuppressive group. The dosage of immunosuppressive agent was 5mg/kg/day of Imuran [Azathioprine] for 3 days preoperatively, 10mg/kg on operative day and 5mg/kg/day postoperatively. For reducing the metabolic demand, the donor heart was preserved in 4degree heparinized saline solution for approximately I4 minutes. In the most of the cases, transplantation was performed with the technique of end-to-side aorto-aortic anastomosis and end-to-side pulmonary artery-inferior vena cava anastomosis at the infrarenal portion. Five out of 20 grafted dogs were survived more than one day. The longest survived 18 days in the control group and survive more than 60 days in the treated group. The survival cases were 3 out of 8[37. 5%] in the group of dogs treated with lmuran and 2`out of 12 [16.6%] in the group of non-treated. A prominent gross findings of the grafted heart was a minimal to moderate degree of dilatation of the heart with or without thrombosis in the cardiac chambers and/or anastomotic site. The case number 10, 15, and 19 showed moderate hypertrophy in grossly. The microscopic findings were as follows; 1. There were early hypersensitive histologic reactions such as interstitial edema, cellular infiltrations and early degenerative changes in the myocardium in the cases of 3 hour survival. 2. In the cases of more than 6 hours survival, organizing thrombosis of myocardial vessels, vasculitis,myocardial necrosis and lymphocyte, plasma cell, round cell infiltrations were noted. In the cases of more than 12 hours survival, the degree of these histologic changes especially in the non-treated group were more intensified than in the treated. 3. In the cases which survived more than one day, so called homograft specific histologic changes were milder in the immunosuppressive group compared with the control. 4. All the host hearts showed no evidence of pathologic findings histologically. Among the homologous canine cardiac transplantation tissue reaction, was milder and suvival time longer in the group treated with immunosuppressive drug.

• Nuclear Medicine and Molecular Imaging
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• 제42권4호
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• pp.267-274
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• 2008

목적: 일과성 신경학적 악화(transient neurological deterioration, TND)는 재관류술 이후에 발생할 수 있는 합병증 중 하나이며, 수술 직후 발생하는 일과성 과관류로 발생하는 것으로 생각된다. 본 연구에서는 TND 발생에 따른 수술 전후 뇌관류의 변화 양상에 대해 알아보고자 하였다. 대상 및 방법: 2003년 9월부터 2006년 7월까지 시행된 60건의 천측두동맥-중대뇌동맥 문합술을 받은 환자 56명(남:여=29:27, 평균연령: $50{\pm}16$세, 죽상경화성혈관 질환: 33건, 모야모야병 27건)을 대상으로 하였다. 수술전과 술후 10일에 $^{99m}Tc$-ECD 기저/아세타졸아미드 부하 뇌관류 SPECT를 시행하여 기저 뇌관류와 뇌혈류예비능을 측정하였다. 그리고, 술후 3일과 10일에 뇌관류 SPECT를 시행하여 기저 뇌관류를 측정하였다. 각 뇌관류 SPECT에서 나온 결과를 SPM을 이용하여 통계적으로 분석하였다. 결과: 60건의 STA-MCA 우회술 중 6건(10%)에서 술후 TND가 발생하였다. 전체 환자에서 수술 전 병측 부위 중간대뇌동맥영역의 뇌관류가 반대측에 비해 유의하게 낮았으며(p=0.002), 술후 3일과 10일의 기저뇌관류는 수술 전보다 유의하게 증가하였다(p=0.001, p=0.02). TND가 발생환 환자가 나머지 환자에 비해 수술 전기저뇌관류와 뇌혈류예비능이 유의미하게 낮았으며(p=0.01, p=0.05), 기저뇌관류의 증가율도 술후 3일에 유의미하게 높았다(p=0.008). 그러나, 술후 3일과 10일에 TND 환자와 나머지 환자간에 뇌관류의 유의한 차이는 없었다(p=n.s.). 반대측 부위를 기준으로 하여 병측 부위의 뇌관류량의 비율을 구한 상대적 관류량은 TND 환자가 나머지 환자에 비해 술후 3일에 유의하게 높았으나(p=0.002), 술 전과 술후 10일에는 유의한 차이가 없었다(p=n.s.). 결론: 이 연구에서는 TND 발생군에서 비발생군에 비해 술후 상대적인 중등도의 과관류가 관찰되었다. 이러한 결과는 TND의 병태생리를 이해하는 데 도움을 줄 것으로 기대한다.

• Journal of Chest Surgery
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• 제36권8호
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• pp.630-632
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• 2003

인공심폐기를 사용하지 않는 관상동맥우회술에서 이식편의 근위부 문합을 상행대동맥에 시행하는 경우 상행대동맥의 조작으로 인한 공기나 대동맥조직, 죽종(atheroma) 등으로 인한 색전증과 대동맥 손상으로 유발되는 대동맥박리, 가성동맥류 등의 합병증을 유발할 수 있다 대동맥근부치환술 시 양측관상동맥의 재이식 시 도관을 사용하는 Cabrol 술식을 관상동맥우회술 시 적용하였다. 요골동맥이식편은 복재정맥과 다르게 혈관 내 판막이 없다는 이점을 고려하여 근위부 문합을 상행대동맥에 평행하게(side to side) 문합하여 하나의 근위부 문합으로 요골동맥이식편의 양측으로 혈류를 공급하는 Cabrol 술식을 이용하여 근위부 문합 수를 줄일 수 있으며 상행대동맥의 조작 수를 줄여 대동맥의 외상을 줄일 수 있다고 생각한다.

• Journal of Chest Surgery
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• 제3권2호
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• pp.91-106
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• 1970

Two groups of left pulmonary-subclavian artery anastomosis were done in 26 adult mongorel dogs. For the first group. the distal end of the subclnvian artery was nnastomosed to the side of the left pulmonary artery, and for the second group, the subclavian end wns anastomosed to the proximal end of the left lower lobe pulmonary artery. Among them, 6 died of bleeding or anesthetic failure during the day of operation, 10 survived 1 to 106 days and the other 10 were sacrificed at various interval. To investigate the relationship between hemodynamic stress and temporal evolution of the pulmonary vascular lesions. the pulmona try and femoral artery pressures, arteriogram and pathohistological specimens were obtained. The following results were obtained. 1. The postoperative pulmonary artery pressures were within normal limits except 2 dogs in the first group, but in nil 12 dogs of the second group, they were in moderate to maked pulmonary hypertension level. 2 After subclavian pulmonary anastomosis, both groups dogs showed increased femond artery pulse pressure. 3. The pulmonary vascular changes were more severe and appeared earlier in the second group dogs compared with the first group.4. The earliest vascular changes appeared in the media of the small muscular arteries and arterioles. 5. Various vascular chaDges were produced in 2 or 3 months. Thereafter, the changes were stationary. 6. Among the first group, two long-term servivors (No. 705 & 713) which had normal pulmonary artery pressure under the anesthesia, also showed various vascular changes as other pulmonary hypertensive dogs. 7. In the early stage medial hypertrophy. interruptio~l of elastic lamellae were found in the small muscular arteries and arterioles, which were followed by intimal proliferation and thrombosis. These findings may suggest some evidences of trauma to the vessels. 8. Pulmonary arteriograms showed irregularity of the intima of the large and medium sized arteries, abrupt ending of some of the small arteries and narrowing of the anastomosis.

• Journal of Gastric Cancer
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• 제9권2호
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• pp.57-62
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• 2009

목적: 원형 봉합기를 이용한 위십이지장연결술의 가장 대표적인 두 가지 방법(단측연결과 단단연결)의 수술 후 결과를 토대로 그 장단점을 확인하고자 본 연구를 고안하였다. 대상 및 방법: 2005년 3월부터 2008년 2월까지 순천향 대학병원에서 위암 진단 하 위십이지장 연결술을 시행한 134명을 대상으로 하였다. 2005년 3월부터 2006년 9월까지는 연속적으로 단측연결을(단측군, 76명), 2006년 11월부터 2008년 2월까지는 연속적으로 단단연결을 시행했다(단단군, 58명). 두 군을 대상으로 전향적 자료 수집을 통해 수술후 경과를 비교 분석하였다. 결과: 두 근간 모든 임상병리학적 요인에 차이가 없었다. 평균 수술시간은 단측군이 157분($\pm56$), 단단군이 150분($\pm49$)이었으며, 입원기간의 경우 단측군이 10.5일($\pm3.5$), 단단군이 9.4일($\pm2.9$)로 이 역시 두 군간에 차이는 없었다. 합병증과 관련해서 전체적으로 단측군이 15예(19.7%), 단단군은 8예(13.8%)에서 발생하였으며(P=0.489), 연결부위 관련해서 단측군에서 출혈이 2예 및 협착이 2예 있었으며, 단단군의 경우 출혈이 2예에서 있었다(P=0.698). 결론: 원형 봉합기를 이용한 위십이지장연결술은 두 방법 모두 기술적으로 용이하며 안전하였다. 통계적 의의는 없었지만, 연결 부위 협착과 관련해서는 단측군에서만 2예 발생하여 단단군이 더 나은 경향을 보였다.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• 제26권2호
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• pp.196-203
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• 2024

Isolated middle cerebral artery dissection (MCAD) is rare but increasingly recognized as a significant clinical entity, particularly in younger adults. Ischemic stroke is the most common manifestation in symptomatic cases but symptoms can vary in severity from headaches to severe neurologic deficits. Due to its rarity and unpredictable clinical course, there is no established treatment strategy for isolated MCAD. Through two case reports, we reviewed the post-operative clinical course of MCAD under different treatment modalities. Case 1 was a 21-year-old woman who presented to the emergency department with headaches and left-side hemiparesis. Isolated MCAD was diagnosed and she was successfully treated with the placement of a self-expandable stent and subsequent chemical angioplasty for post-stent vasospasm. Case 2 was a 35-year-old woman who presented to the emergency department with left-side hemiparesis and dysarthria. Isolated MCAD was diagnosed and she was successfully treated with superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis.

• Archives of Reconstructive Microsurgery
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• 제9권2호
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• pp.134-138
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• 2000

Arthrodesis of the ankle joint is inevitable in the cases of severe arthrosis or defective bony structures around ankle joint. There have been many kinds of arthrodesis methods were introduced. In cases with failed athrodesis with previous arthrodesis surgery and neuropathic joints have difficulty to achieve fusion of joint with conventional methods. Authors underwent four cases of ankle fusion with vascularized fibular graft from 1997 in the cases of three failed fusions and one diabetic neuropatic joint. Two of four performed free vascularized fibular transplantation from contralateral side leg with microvascular anastomosis, two of four performed with pedicled fibular transposition to the ankle joint in same side leg. Three of four cases achieved arthrodesis average 9.2 months after surgery, one case was failed due to vascular thrombosis of the anastomosed site in diabetic neuropathic condition. The result of this technique revealed 75%(three of four) success rate and longer bone union time required. However, in these cases had no recommendable options with conventional bone graft and additional ankle joint fusions procedure because of poor bone quality and defect of distal tibia and talus portions. Free vascualrized fibular transfer to the failed athrodesis of ankle joint is one of the effective alternative methods in failed ankle fusion cases, especially the quality of the bone around previous fusion site is poor.

• 한국간담췌외과학회지
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• 제27권3호
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• pp.287-291
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• 2023

Backgrounds/Aims: Pancreaticoduodenectomy (PD) is commonly performed pancreatic procedure for tumors of periampullary region. Delayed gastric emptying (DGE) and pancreatic fistula are the most common specific complications following PD. DGE can lead to significant morbidity, resulting in prolonged hospital stay and increased cost. Various factors might influence the occurrence of DGE. We hypothesized that kinking of jejunal limb could be a cause of DGE post PD. Methods: Antecolic (AC) and retrocolic (RC) side-to-side gastrojejunostomy (GJ) groups in classical PD were compared for the occurrence of DGE in a prospective study. All patients who underwent PD between April 2019 and September 2020 in a tertiary care center in south India were included in this study. Results: After classic PD, RC GJ was found to be superior to AC in terms of DGE rate (26.7% vs. 71.9%) and hospital stay (9 days vs. 11 days). Conclusions: Route of reconstruction of GJ can influence the occurrence of DGE as RC anastomosis in classical PD provides the most straight route for gastric emptying.