• Journal of Korean Neurosurgical Society
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• v.57 no.5
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• pp.359-363
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• 2015

Objective : Ventriculoperitoneal (VP) shunt complication is a major obstacle in the management of hydrocephalus. To study the differences of VP shunt complications between children and adults, we analyzed shunt revision surgery performed at our hospital during the past 10 years. Methods : Patients who had undergone shunt revision surgery from January 2001 to December 2010 were evaluated retrospectively by chart review about age distribution, etiology of hydrocephalus, and causes of revision. Patients were grouped into below and above 20 years old. Results : Among 528 cases of VP shunt surgery performed in our hospital over 10 years, 146 (27.7%) were revision surgery. Infection and obstruction were the most common causes of revision. Fifty-one patients were operated on within 1 month after original VP shunt surgery. Thirty-six of 46 infection cases were operated before 6 months after the initial VP shunt. Incidence of shunt catheter fracture was higher in younger patients compared to older. Two of 8 fractured catheters in the younger group were due to calcification and degradation of shunt catheters with fibrous adhesion to surrounding tissue. Conclusion : The complications of VP shunts were different between children and adults. The incidence of shunt catheter fracture was higher in younger patients. Degradation of shunt catheter associated with surrounding tissue calcification could be one of the reasons of the difference in facture rates.

• Journal of Yeungnam Medical Science
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• v.16 no.2
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• pp.347-356
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• 1999

Background: Exit site/tunnel infection causes considerable morbidity and technique failure in CAPD patients. We presently use a unique revision method for the treatment of refractory ESI/TI in CAPD patients and mupirocin prophylaxis for high risk patients. Materials and Methods: We reviewed 139 CAPD patients about the ESI/TI from October 1993 to February 1999 at Yeungnam University Hospital. At the beginning of the ESI. we usually started medications with rifampicin and ciprofloxacin and then changed the antibiotics according to the sensitivity test. If the ESI had persisted and there were TI symptoms (purulent discharge, abscess lesion around exit site). we performed catheter revision(external cuff shaving, disinfection around tunnel and new exit site on opposit direction) with a combination of proper antibiotics. We applied local mupirocin ointment at the exit site three times per week to the 34 patients who had the risk of ESI starting from October 1998. Results: The total follow-up was 2401 patient months(pt. mon). ESI occurred on 105 occasions in 36 out of 139 patients, and peritonitis occurred on 112 occasions in 67 out of 139 patients. The total number of incidences of ESI and peritonitis was 1 per 23.0 pt. mon and 1 per 2l.6 pt.mon. The most common organism responsible for ESI was Staphylococcus aureus (26 of 54 isolated cases, 48%), followed by the Methicillin resistant S. aureus(MRSA) (13 cases, 24%). Seven patients(5: MRSA. 2: Pseudomonas) had to be treated with a revision to control infection. Three patients experienced ESI relapse after revision. One of them improved with antibiotics, while another needed a second revision and the remaining required catheter removal due to persistent MRSA infection with re-insertion at the same time. But, there was no more ESI in these 3 patients who were received management to relapse (The mean duration: 14.0 months). The rates of ESI were significantly reduced after using mupirocin than before(1 per 12.7 vs 34.0 pt.mon, P<0.01). Conclusions: In summary, revision technique can be regarded as an effective method for refractory ESI/TI before catheter removal. Also local mupirocin ointment can play a significant role in the prevention of ESI.

• Journal of Korean Neurosurgical Society
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• v.29 no.7
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• pp.886-890
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• 2000

Objective : placement of ventricular catheter is important to achieve long-term patency of the shunt system. We describe a method of calculating the insertion site, trajectory, and the length of the ventricular catheter using CT parameters in shunt surgery. Patients and Methods : These can be rapidly obtained using a caliper from a scout cut and two axial scans at lateral ventricular and upper 3rd ventricular level. To compare this technique with traditional one, we analyzed 40 consecutive patients who underwent shunt surgery. Results : Of 20 patients undergoing ventriculoperitoneal shunt insertion using this technique, none had poor location of the proximal catheter. In the counterpart, 9 patients had poor location(p＝0.001). The number of patients who required revision surgery were also lower in the group using this technique, but it was not statistically significant (4 versus 2, p＝0.422). Mean follow-up period was shorter in this technique group. Conclusion : This technique provides an accurate placement of the proximal catheter without special instrument or additional expenses.

• Journal of Korean Clinical Nursing Research
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• v.29 no.3
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• pp.211-222
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• 2023

Purpose: This study was conducted to update the existing evidence-based nursing clinical practice guideline for indwelling urinary catheterization (IUC). Methods: The guideline have been revised in 22 steps based on international standards. The quality of the practice guidelines to be used for revision was evaluated using the Appraisal of Guidelines for Research and Evaluation II. The evaluation of the content appropriateness and applicability of the draft recommendations of the revised practice guidelines was performed using the RAND/UCLA Appropriateness Method, a decision-making method developed by the RAND Corporation. Four guidelines were used for the revision. Results: The updated nursing practice guideline for IUC consisted of 9 domains and 134 recommendations. The numbers of recommendations in each domain were: 4 Assessment, 20 Equipment, 11 Catheter insertion, 52 Catheter maintenance, 4 Catheter and drainage bag change, 9 Catheter removal, 22 Complications management, 5 Education and consult, and 7 Hospital support. The recommended grade was 8.2% for A, 38.1% for B, and 53.7% for C. Among these, the major revision was done in 11 recommendations (8.2%). A total of 29 recommendations (21.6%) were newly added. 30 (22.4%) recommendations had minor revisions such as changes or addition for some words or sentences, and 13 (9.7%) recommendations were deleted. Conclusion: Revised nursing practice guideline is expected to serve as an evidence-based practice guideline for IUC in Korea. This guideline will provide health care providers, patients, and caregivers with information to help manage IUC, leading to improved patient outcomes.

• Journal of Korean Neurosurgical Society
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• v.53 no.3
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• pp.150-154
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• 2013

Objective : To evaluate the effect of electromagnetic (EM) navigation system on ventriculoperitoneal (VP) shunt failure rate through comparing the result of standard shunt placement. Methods : All patients undergoing VP shunt from October 2007 to September 2010 were included in this retrospective study. The first group received shunt surgery using EM navigation. The second group had catheters inserted using manual method with anatomical landmark. The relationship between proximal catheter position and shunt revision rate was evaluated using postoperative computed tomography by a 3-point scale. 1) Grade I; optimal position free-floating in cerebrospinal fluid, 2) Grade II; touching choroid or ventricular wall, 3) Grade III; tip within parenchyma. Results : A total of 72 patients were participated, 27 with EM navigated shunts and 45 with standard shunts. Grade I was found in 25 patients from group 1 and 32 patients from group 2. Only 2 patients without use of navigation belonged to grade III. Proximal obstruction took place 7% in grade I, 15% in grade II and 100% in grade III. Shunt revision occurred in 11% of group 1 and 31% of group 2. Compared in terms of proximal catheter position, there was growing trend of revision rate according to increase of grade on each group. Although infection rate was similar between both groups, the result had no statistical meaning (p=0.905, chi-square test). Conclusion : The use of EM navigation in routine shunt surgery can eliminate poor shunt placement resulting in a dramatic reduction in failure rates.

• Archives of Plastic Surgery
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• v.35 no.2
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• pp.159-164
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• 2008

Purpose: Microvascular free tissue transfer has become a reliable technique for the reconstruction of complex wounds. Occasionally, unexpected intraoperative thrombosis and/or spasm of recipient artery might be annoying problems even for the technically competent microvascular surgeons. If such problems are not treated properly, they will inevitably cause to flap failure. Methods: From January 2006 to February 2007, soft tissue reconstructions by free tissue transfers were performed on 21 patients having complex defects in the lower extremity. Although segmental revision and various pharmacologic agents were repeatedly applied, arterial occlusions were not managed in 6 cases. For removal of thrombi and release of spasm, Fogarty No. 2 or No. 3 catheters were inserted into the lumen to the proximal recipient artery. Its balloon was then inflated after passing through a resistant area. Next, the catheter was gently withdrawn backward. Results: After the Fogarty catheter was inserted two or three times, the pulsatile arterial flow was restored. When the catheter was inserted into the lumen, a feeling of resistance existed in a 5-10cm more proximal portion that could not be easily accessed from the vascular end. After the reestablishment of blood flow, successful anastomoses were achieved and immediate rethrombosis or spasm did not occur. No long-term sequelae associated with balloon trauma to the arterial wall were observed. Conclusion: The use of the Fogarty catheter can be an effective method in treating pedicle thrombosis and spasm. This is a very simple and rapid technique that offers microvascular surgeons another option to increase the success rate of microvascular anastomosis in free tissue transfers.

• Journal of Institute of Control, Robotics and Systems
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• v.22 no.8
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• pp.585-589
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• 2016

Recently, the robotic assist system for cardiovascular intervention gets continuously growing interest. The robotic cardiovascular intervention systems are largely two folds, systems for cardiac ablation procedure assist and systems for vascular intervention assist. For the systems, the clinician controls the catheter inserted through blood vessel to the heart via a master console or master manipulator. Most of the current master manipulators have structure of joystick-like pivoting 2 degree of freedom (DOF) handle in the core, which is used in parallel with other sliding switches and input devices. It however is desirable to have customized and optimized design manipulator that can provide clinician with intuitive control of the catheter motion fully utilizing the advantage of the use of robotic structure. A 6 DOF kinematic mechanism that can capture the motion control intention of the clinician in translational 3 DOF and rotational 3 DOF is proposed in this paper. Also, a master-slave motion relationship specially designed for the cardiac catheter manipulation motion is proposed and implemented in an experimental prototype. Design revision for implementation of more efficient motion and experiment in combination with an experimental slave robot system for catheter manipulation are underway.

• Archives of Plastic Surgery
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• v.47 no.1
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• pp.97-101
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• 2020

Although the success rate of deep inferior epigastric perforator (DIEP) flaps has increased, late flap failures still occur and have a low salvage rate. The present article describes a case of salvage of a case of late flap failure using the pedicle vein as a vein graft source. A 50-yearold woman underwent a bilateral DIEP free flap procedure. On postoperative day 6, she experienced flap compromise and underwent emergency flap revision. In the flap revision, flap venous drainage and the superficial inferior epigastric vein were completely obstructed. A Fogarty catheter was used to remove a thrombus from the completely obstructed pedicle vein, and this pedicle vein was used as a graft source and was ligated in retrograde fashion to the flap vein stump. After injection of urokinase into the arterial branch, venous flow to the flap was restored. At a 6-month follow-up visit in the outpatient clinic, only partial fat necrosis at the flap was noted. By dissecting various perforators in the initial operation, decisions regarding immediate revision can be made with more confidence. Additionally, the combined procedures performed in this case may be helpful even for practitioners treating cases of late flap compromise.

• Journal of the Korean Society of Radiology
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• v.84 no.4
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• pp.934-940
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• 2023

Ventriculoperitoneal shunting is the most common neurosurgical procedure for treatment of hydrocephalus. Shunt-related complications are relatively common and associated with a high rate of shunt revision. However, migration of the distal ventriculoperitoneal shunt, especially into the cardiac and intravascular regions, has rarely been reported. Awareness of this rare but potentially hazardous complication is important owing to its significant morbidity, which can be prevented by prompt management. Here, we introduce a case of a 23-year-old male with migration of the distal shunt catheter through the left internal jugular vein into the cardiac chamber and both pulmonary arteries, which occurred 2 months after receiving ventriculoperitoneal shunting. Furthermore, we discuss the possible mechanisms and management of this condition.

• Tuberculosis and Respiratory Diseases
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• v.79 no.2
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• pp.98-100
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• 2016

We present a rare case of critically compromised airway secondary to a massively dilated sequestered colon conduit after several revision surgeries. A 71-year-old male patient had several operations after the diagnosis of gastric cancer. After initial treatment of pneumonia in the pulmonology department, he was transferred to the surgery department for feeding jejunostomy because of recurrent aspiration. However, he had respiratory failure requiring mechanical ventilation. The chest computed tomography (CT) scan showed pneumonic consolidation at both lower lungs and massive dilatation of the substernal interposed colon compressing the trachea. The dilated interposed colon was originated from the right colon, which was sequestered after the recent esophageal reconstruction with left colon interposition resulting blind pouch at both ends. It was treated with CT-guided pigtail catheter drainage via right supraclavicular route, which was left in place for 2 weeks, and then removed. The patient remained well clinically, and was discharged home.