• Clinical and Experimental Pediatrics
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• 제61권12호
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• pp.397-402
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• 2018

Purpose: Transcatheter device closure of patent ductus arteriosus (PDA) is challenging in early infancy. We evaluated PDA closure in infants less than 6 months old. Methods: We performed a retrospective review of infants less than 6 months of age who underwent attempted transcatheter device closure in our institution since 2004. To compare clinical outcomes between age groups, infants aged 6-12 months in the same study period were reviewed. Results: A total of 22 patients underwent transcatheter PDA closure during the study period. Patient mean age was $3.3{\pm}1.5months$, and weight was $5.7{\pm}1.3kg$. The duct diameter at the narrowest point was $3.0{\pm}0.8mm$ as measured by angiography. The most common duct type was C in the Krichenko classification. Procedural success was achieved in 19 patients (86.3%). Major complications occurred in 5 patients (22.7%), including device embolization (n=1), acquired aortic coarctation (n=2), access-related vascular injury requiring surgery (n=1), and acute deterioration requiring intubation during the procedure (n=1). Two patients had minor complications (9.1%). Twenty-four infants aged 6-12 months received transcatheter device closure. The procedural success rate was 100%, and there were no major complications. The major complication rate was significantly higher in the group less than 6 months of age (P=0.045). There was a trend toward increased major complication and procedural failure rates in the younger age group (P<0.01). Conclusion: A relatively higher incidence of major complications was observed in infants less than 6 months of age. The decision regarding treatment modality should be individualized.

• Archives of Plastic Surgery
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• 제46권5호
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• pp.455-461
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• 2019

Background Various surgical management methods have been proposed for ischial sore reconstruction, yet it has the highest recurrence rate of all pressure ulcer types. A novel approach combining the advantages of a perforator-based fasciocutaneous flap and a muscle flap is expected to resolve the disadvantages of previously introduced surgical methods. Methods Fifteen patients with ischial pressure ulcers with chronic osteomyelitis or bursitis, who underwent reconstructive procedures with an inferior gluteal artery perforator (IGAP) fasciocutaneous flap and a split inferior gluteus maximus muscle flap from January 2011 to June 2016, were analyzed retrospectively. The split muscle flap was rotated to obliterate the deep ischial defect, managing the osteomyelitis or bursitis, and the IGAP fasciocutaneous flap was rotated or advanced to cover the superficial layer. The patients' age, sex, presence of bursitis or osteomyelitis, surgical details, complications, follow-up period, and ischial sore recurrence were reviewed. Results All ischial pressure ulcers were successfully reconstructed without any flap loss. The mean duration of follow-up was 12.9 months (range, 3-35 months). Of 15 patients, one had a recurrent ulcer 10 months postoperatively, which was repaired by re-advancing the previously elevated fasciocutaneous flap. Conclusions The dual-flap procedure with an IGAP fasciocutaneous flap and split inferior gluteus maximus muscle flap for ischial pressure ulcer reconstruction is a useful method that combines the useful characteristics of perforator and muscle flaps, providing thick dual padding with sufficient vascularization while minimizing donor morbidity and vascular pedicle injury.

• Clinical Pain
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• 제19권2호
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• pp.116-119
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• 2020

Cervical transforaminal epidural steroid injection (TFESI) is commonly performed to provide relief of pain caused by radiculopathy. Intra-arterial injection of particulate steroid or direct needle injury can lead to spinal artery embolism or thrombosis. Also there is a possibility of vascular spasm. To our knowledge, this is the first reported case of spinal cord infarction that occurred after TFESI with non-particulate steroid in Korea. A 47-year-old female patient underwent C7 TFESI at local pain clinic. Injected materials were dexamethasone and mepivacaine. Right after the intervention, she felt muscle weakness and decreased sensation. On physical examination, she had decreased sensation from C4 to T2 dermatome in light touch and pin-prick test. Proprioception and vibration were intact. The motor grades of upper extremities were grade 1. Cervical and thoracic spine MRI was checked. Diffusion-weighted image and apparent diffusion coefficient image showed long extension of spinal cord infarction from C2 to T1 level.

• 대한후두음성언어의학회지
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• 제33권2호
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• pp.97-102
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• 2022

Background and Objectives Tracheostomy is a relatively safe procedure, and the recent emergence of COVID-19 has raised the need to perform tracheostomy immediately in the bed of an intensive care unit (ICU) rather than an operating room. The purpose of this study was to determine the occurrence of complications related to surgical tracheotomy performed in the ICU by an ENT specialist. Materials and Method From March 2019 to January 2022, a total of 101 patients underwent tracheostomy in the ICU. Demographics and complications were classified according to postoperative period. Results Within 24 hours after the procedure, bleeding events were confirmed in 2 patients (2.0%) with mild bleeding. One case (1.0%) of ventricular fibrillation occurred shortly after the procedure. There were no complications from 24 hours to 1 week after procedure. After one week, 4 patients (4.5%) had a local infection, and 3 patients (3.4%) had a tube obstruction. During all follow-up periods, there were no serious side effects such as death, major vascular injury, pneumothroax. No complications were observed throughout the entire period in 6 COVID-19 patients. Conclusion The number of complications of surgical tracheotomy in the ICU performed by a specialist was lower than in previous studies, and there were no complications that delayed treatment or endangered life. The ENT training hospitals should provide sufficient training opportunities for residents to perform surgical tracheostomy and strive to minimize complications associated with the procedure and pre- and post-operative management under the detailed guidance and supervision of specialists.

• Journal of Digestive Cancer Research
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• 제5권1호
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• pp.23-27
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• 2017

Although laparoscopic pancreaticoduodenectomy (LPD) is considered as minimally invasive surgery, an advanced level of laparoscopic skill is still required. LPD comprises various procedures including reconstruction. Therefore, establishment of a safe approach at each step is needed. Prevention of intraoperative bleeding is the most important factor in safe completion of LPD. The establishment of effective retraction methods is also important at each site to prevent vascular injury. I also recommend the "uncinate process first" approach during initial cases of LPD, in which the branches of the inferior pancreaticoduodenal artery are dissected first, at points where they enter the uncinate process. This approach is performed at the left side of the superior mesenteric artery (SMA) before isolating the pancreatic head from the right aspect of the SMA, which allows safe dissection without bleeding. Safe and reliable reconstruction is also important to prevent postoperative complications. Laparoscopic pancreatojejunostomy requires highly skilled suturing technique. Pancreatojejunostomy through a small abdominal incision, as in hybrid-LPD, facilitates reconstruction. In LPD, the surgical view is limited. Therefore, we must carefully verify the position of the pancreaticobiliary limb. A twisted mesentery may cause severe congestion of the pancreaticobiliary limb following reconstruction, resulting in severe complications. We must secure the appropriate position of the pancreaticobiliary limb before starting reconstruction. We describe the incidence of intraoperative and postoperative complications and appropriate technique for safe performance of LPD.

• Archives of Plastic Surgery
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• 제51권2호
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• pp.208-211
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• 2024

Intraneural hematoma is a rare disease that results in an impaired nerve function because of bleeding around the peripheral nerve, with only 20 cases reported. Trauma, neoplasm, and bleeding disorders are known factors for intraneural hematoma. However, here we report atypical features of asymptomatic and spontaneous intraneural hematoma which are difficult to diagnose. A 60-year-old woman visited our clinic with the complaint of a palpable mass on the right calf. She reported no medical history or trauma to the right calf and laboratory findings showed normal coagulopathy. Ultrasonography was performed, which indicated hematoma near saphenous vein and sural nerve or neurogenic tumor. We performed surgical exploration and intraneural hematoma was confirmed on sural nerve. Meticulous paraneuriotomy and evacuation was performed without nerve injury. Histological examination revealed intraneural hematoma with a vascular wall. No neurologic symptoms were observed. In literature review, we acknowledge that understanding anatomy of nerve, using ultrasonography as a diagnostic tool and surgical decompression is key for intraneural hematoma. Our case report may help establish the implications of diagnosis and treatment. Also, we suggested surgical treatment is necessary even in cases that do not present symptoms because neurological symptoms and associated symptoms may occur later.

• Journal of Chest Surgery
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• 제42권5호
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• pp.576-587
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• 2009

배경: Nitric oxide (NO)-cGMP 신호전달체계의 상향 조절(up-regulation)이 급성심근경색 3일 후 흰쥐의 혈관반응성의 변화에 관여한다고 알려져 있으나 그 기전에 대해서는 명확히 규명되지 않았다. 대상 및 방법: 좌전하행관상동맥을 30분간 폐쇄한 후 급성심근경색을 유도한 군을 AMI군으로, 동일한 모의 수술(sham operation)을 하였으나 관상동맥을 폐쇄하지 않은 군을 SHAM군으로 하였다 AMI 혹은 SHAM수술 3일 후 흰쥐의 대동맥 고리절편(내피를 보존한 대동맥 절편을 E(+), 내피를 제거한 대동맥 절편을 E(-))에서 phenylephrine (PE), KCl, acetylcholine (Ach) 및 sodium nitroprusside (SNP)에 대한 농도-반응 관계를 측정하였다 AMI군의 E(+) 대동맥 절편에서 PE의 농도-반응 관계를 NO synthase (NOS) 억제제인 $N{\omega}$-nitro-L-arginine methyl ester (L-NAME)와 cyclooxygenase 억제제인 indomethacin으로 각각 전처치한 대동맥 절편과 비교하였다. 혈장 nitrite/nitrate 농도는 Griess reaction으로 측정하였고, 방사면역 분석법을 이용한 흉부 대동맥 절편의 cGMP정량과 real time PCR을 이용한 endothelial nitric oxide synthase (eNOS) mRNA 발현양상 측정을 하였다. 결과: AMI군에서의 심근경색의 평균 크기는 $21.3{\pm}0.62%$였다. AMI군에서 심박수와 수축기 및 이완기 혈압은 의미있는 변화가 없었다. E(+)와 E(-) 대동맥 절편에서 PE와 KCl에 대한 수축반응의 민감도는 AMI군 대동맥 절편에서 의미 있게 감소하였다(p<0.05). L-NAME은 이러한 수축반응을 완전하게 역전시켰으나 indomethacin은 효과가 없었다(p<0.05). 또한 AMI군에서 Ach에 대한 이완반응의 민감도가 의미 있게 감소하였다(p<0.05). AMI군에서 SHAM군에 비해 혈장 nitrite/nitrate 농도(p<0.05), 기저 cGMP 농도(p<0.05), 및 eNOS mRNA 발현양상(p=0.056)이 증가하였다. 결론: 이상의 결과들로 보아 eNOS의 발현 증가와 NO-cGMP 신호전달체계의 상향조절이 급성심근경색 3일 후 흰쥐 흉부대동맥에서의 수축 및 이완 반응성 감소의 원인으로 생각된다.

• Journal of Chest Surgery
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• 제32권5호
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• pp.413-421
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• 1999

배경: 폐장의 허혈-재관류 손상은 폐이식에서 발생하는 조기 이식장기 실패의 주요 원인의 하나로 알려져 있다. 최근 갑상선 호르몬의 활성형인 삼요드티로닌 (T3)이 심장을 비롯한 여러 장기의 허혈 손상을 줄여주는 효과가 있음을 시사하는 보고가 있다. 본 연구에서는 이러한 T3의 허혈-재관류 손상에 대한 효과가 폐장의 허혈 손상에도 효과가 있을 것으로 기대하고 덱스트란을 주성분으로 하는 세포외액성 폐보존액에 T3를 추가한 새로운 폐보존액을 제조하여 그 효과를 검증하고자 하였다. 대상 및 방법: 12마리의 황견을 6마리씩 두 군으로 나누어 제 1군에서는 새로 개발한 폐보존액을 사용하고, 제 2군에서는 유로콜린스 용액을 사용하여 폐를 적출 하였다. 적출한 폐장은 각각의 보존액에 담그어 섭씨 4도에서 20시간 보관한 후, 각 군에 6마리씩 총 12례의 좌측 폐이식을 시행하였다. 이식된 좌측폐만의 기능을 관찰하기 위해서 폐이식 후 재관류를 15분시킨 후에 우측 주폐동맥과 우측 주기관지를 결찰하고, 2시간 동안 혈역학적 변수와 가스분석을 시행하고, 측정이 종료된 후 바로 희생하여 폐조직 일부를 떼어내어 조직검사와 수분 함량 및 MDA양을 측정 비교하였다. 결과: 동맥혈 산소분압은 제 1군에서 재관류 후 60분, 90분 120분에 각각 147$\pm$25 mmHg, 148$\pm$22 mmHg, 159$\pm$21 mmHg, 제 2군에서는 각각 133$\pm$26 mmHg, 132$\pm$29 mmHg, 135$\pm$30 mmHg로 제 1군에서 조금 높은 경향을 보였으나 통계적으로 유의성은 없었다. 각 시간에서의 최대 흡기압은 제 1군에서 14.0$\pm$0.5 cmH2O, 14.2$\pm$0.6 cmH2O, 15.7$\pm$0.8 cmH2O, 제 2군에서는 17.8$\pm$2.0 cmH2O, 18.0$\pm$1.9 cmH2O, 19.3$\pm$2.7 cmH2O으로 제 1군에서 조금 낮은 경향을 보였으나 통계적 유의성은 없었다. 동맥혈 이산화탄소 분압은 제 1군에서 각 시간에 27.9$\pm$2.2 mmHg, 27.7$\pm$2.4 mmHg, 28.0$\pm$3.0 mmHg, 제 2군에서는 36.8$\pm$6.0 mmHg, 43.2$\pm$8.1 mmHg, 53.1$\pm$17.4 mmHg로 제 1군에서 유의하게 낮았다 (p<0.05). 폐혈관 저항 및 조직 MDA양은 두 군간에 유의한 차이가 없었다. 폐 조직 수분 함량은 제 1군에서 유의하게 낮았고, 조직학 검사상 폐조직 손상의 정도도 제 1군에서 적었다. 결론: 이상의 결과에서 T3를 포함한 새로 개발한 폐보존액이 유로콜린스 용액과 비교하여 폐보존능이 우수함을 확인할 수 있었고, 이는 T3가 폐이식시 폐장의 효과적 보존에 유용한 역할을 함을 시사하였다.

• Tuberculosis and Respiratory Diseases
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• 제54권1호
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• pp.91-103
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• 2003

연구배경 : 히스타민은 폐 내에 널리 분포하며 강력한 폐혈관수축 작용과 모세혈관 투과성 증가 작용이 있을 뿐만 아니라 폐포내피세포 표면에서 P-selectin의 발현을 증가시키고 IL-8 분비를 촉진시켜 호중구의 조직 내 이동 및 활성화에 관여한다고 보고되고 있어. 호중구의 역할이 중요한 내독소로 유도되는 급성폐손상의 발병기전에 내인성 히스타민이 관여할 것으로 추정되나 자세한 역할은 아직 잘 알려져 있지 않다. 이에 본 연구는 내독소로 유도되는 급성폐손상의 발병기전에서 내독소는 폐장내에서 히스타민의 생성을 증가시키며, 이렇게 생성된 내인성 히스타민은 H2 수용체를 통하여 호중구의 폐내 침윤에 관여할 것이라고 가정하고 이를 검증하려 하였다. 방법 : Sprague-Dawley 쥐를 이용하여 생리 식염수를 기도 내 투여한 대조군, 내독소를 기도 내 투여한 내독소군, H1 수용체 차단제(mepyramine) 및 H2 수용체 차단제(ranitidine)를 정주한 H1 처치군 및 H2 처치군, H3 수용체 차단제(thioperamide)를 복강내 투여한 H3 처치군 등 모두 다섯 군으로 나누어 내독소 투여 후 각각 1,2,6 시간에 시간대 별로 혈청 및 폐포세척액내에서 히스타민의 농도를 측정하였고, 각군에서 폐 염증 및 폐 손상 지표로써 폐포세척액 내 총세포 수, 호중구 수 및 폐포세척액 단백량를 측정하여 내독소 투여군과 비교하였다. 또한, 내독소 투여 후 6시간째에 폐 관류 후 얻은 폐 조직에서 폐 조직 내 호중구 침윤을 반영하는 myeloperoxidase 활성도를 비교하였다. 결과 : 내독소군에서 내독소 투여 2시간째 폐포세척액 히스타민 농도가 대조군에 비해 유의하게 높았으며, 폐포세척액 총 세포 수와 호중구 수는 내독소 투여 6시간째에 유의하게 높았다. 폐조직내 MPO 활성도 역시 대조군에 비해 유의하게 높았다. H2 처치군에서 폐포세척액 총 세포 수 및 호중구 수는 내독소 투여 후 6시간 째에 내독소군에 비해 유의하게 낮았으며, 폐 조직 내 MPO 활성도 역시 내독소군에 비해 유의하게 낮았다 폐포세척액 단백량은 각 군에서 내독소군에 비해 유의한 차이를 보이지 않았다. 결론 : 이상의 결과로 내독소로 유도되는 급성 폐손상에서 내독소 투여 2시간 후 폐포세척액 히스타민 농도가 증가하며 내인성 히스타민은 주로 H2 수용체를 매개하여 호중구의 폐내 침윤 기전에 관여할 것으로 추정되었다.

• 대한화상학회지
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• 제24권2호
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• pp.21-29
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• 2021

Purpose: Frostbite is a hazard to people exposed to cold environments. With the progression of modern industrial development and change of leisure behavior encountering cold environments, frequent accidental exposure to frostbite injury during work and human behavior is increasing, and the predisposing factors of frostbite were greatly changed than before. The purpose of this study was to make epidemiological analysis, and to review the treatment outcomes of frostbite. Methods: From March 2010 to February 2021, this study has included 27 patients with second- to third-degree frostbite injuries in Advanced Burn Reconstruction Center, Bundang Jesaeng Hosptial. A retrospective study was made about the distribution of age, gender, predisposing factors, prevalent area, type of managements, and the length of treatment period. Results: In our institution, acute management of frostbite patients has included rewarming, anticoagulation therapy (acetylsalicylic acid), and agents to improve vascular perfusion (lipo-prostaglandin E1 [Eglandin^®]). The 25 frostbite patients with second-degree frostbite (92.6%) were successfully managed by the conservative treatment alone with a mean of 20.3 days healing time. Two patients with third-degree frostbite (7.4%) also showed good outcomes after surgical reconstruction with a mean of 59 days healing time. In our clinical experiences of third-degree frostbite, definitive surgical reconstruction should be recommended to wait for more than 4~6 weeks for identification of clear demarcation of necrotic tissue caused by frostbite. In this study, 43 frostbite injuries site in 27 frostbite patients occurred. Among them, 15 patients (55.6%) had multiple-site frostbite injury. The most common predisposing cause of frostbite was refrigerant gas accidents (44.4%), followed by outdoor activity in cold environments (40.8%), misapplying ice pack for treatment purposes (7.4%), barefoot walking on the cold ground (3.7%), and loss of consciousness in cold grounds (3.7%). The most prevalent sites of frostbite injuries revealed as the hand (58.1%), followed by the foot (32.6%), face (7.0%), and abdomen (2.3%). And in the winter season from the November to March, the incidence rate of frostbite injuries was high at 74.1%. Conclusion: This study included 27 frostbite patients with 43 frostbite sites since last decade in a single institution at the community hospital. The frostbite patients with second-degree frostbite (92.6%) were successfully healed by the conservative treatment alone with a mean of 20.3 days healing time. The most common predisposing cause of frostbite was refrigerant gas accidents (44.4%), followed by outdoor activity in cold environments, etc. The most prevalent site of frostbite injuries was the hand (58.1%). And the most prevalent seasonal incidence of frostbite was from November to March (74.1%).