• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.25 no.1
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• pp.50-61
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• 2023

Objective: To describe the roadmapping technique and our three-year experience in the management of intracranial aneurysms in the hybrid operating room. Methods: We analyzed all patients who underwent surgical clipping for cerebral aneurysms with the roadmapping technique from January 2017 to September 2019. We report demographic, clinical, and morphological variables, as well as clinical and radiological outcomes. We further describe three illustrative cases of the technique. Results: A total of 13 patients were included, 9 of which (69.2%) presented with subarachnoid hemorrhage, with a total of 23 treated aneurysms. All patients were female, with a mean age of 47.7 years (range 31-63). All cases were anterior circulation aneurysms, the most frequent location being the ophthalmic segment of the internal carotid artery (ICA) in 11 cases (48%), followed by posterior communicating in 8 (36%), and ICA bifurcation in 2 (8%). Intraoperative clip repositioning was required in 9 aneurysms (36%) as a result of the roadmapping technique in the hybrid operating room. There were no residual aneurysms in our series, nor reported mortality. Conclusions: The roadmapping technique in the hybrid operating room offers a complementary tool for the adequate occlusion of complex intracranial aneurysms, as it provides a real time fluoroscopic-guided clipping technique, and clip repositioning is possible in a single surgical stage, whenever a residual portion of the aneurysm is identified. This technique also provides some advantages, such as immediate vasospasm identification and treatment with intra-arterial vasodilators, balloon proximal control for certain paraclinoid aneurysms, and simultaneous endovascular treatment in selected cases during a single stage.

• Journal of Chest Surgery
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• v.39 no.5 s.262
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• pp.354-358
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• 2006

Background: Pulsatile pumps for extracorporeal circulation have been known to be better for tissue perfusion than non-pulsatile pumps but be detrimental to blood corpuscles. This study is intended to examine the risks and benefits of $T-PLS^{TM}$ through the comparison of clinical effects of $T-PLS^{TM}$ (pulsatile pump) and $Bio-pump^{TM}$ (non-pulsatile pump) used for coronary bypass surgery. Material and Method: The comparison was made on 40 patients who had coronary bypass using $T-PLS^{TM}\;and\;Bio-pump^{TM}$ (20 patients for each) from April 2003 to June 2005. All of the surgeries were operated on pump beating coronary artery bypass graft using cardiopulmonary extra-corporeal circulation. Risk factors before surgery and the condition during surgery and the results were compared. Result: There was no significant difference in age, gender ratio, and risk factors before surgery such as history of diabetes, hypertension, smoking, obstructive pulmonary disease, coronary infarction, and renal failure between the two groups. Surgery duration, hours of heart-lung machine operation, used shunt and grafted coronary branch were little different between the two groups. The two groups had a similar level of systolic arterial pressure, diastolic arterial pressure and mean arterial pressure, but pulse pressure was measured higher in the group with $T-PLS^{TM}\;(46{\pm}15\;mmHg\;in\;T-PLS^{TM}\;vs\;35{\pm}13\;mmHg\;in\;Bio-pump^{TM},\;p<0.05)$. The $T-PLS^{TM}$-operated patients tended to produce more urine volume during surgery, but the difference was not statistically significant $(9.7{\pm}3.9\;cc/min\;in\;T-PLS^{TM}\;vs\;8.9{\pm}3.6\;cc/min\;in\;Bio-pump^{TM},\;p=0.20)$. There was no significant difference in mean duration of respirator usage and 24-hour blood loss after surgery between the two groups. Plasma free Hb was measured lower in the group with $T-PLS^{TM}\;(24.5{\pm}21.7\;mg/dL\;in\;T-PLS^{TM}\;versus\;46.8{\pm}23.0mg/dL\;in\;Bio-pump^{TM},\;p<0.05)$. There was no significant difference in coronary infarction, arrhythmia, renal failure and morbidity rate of cerebrovascular disease. There was a case of death after surgery (death rate of 5%) in the group tested with $T-PLS^{TM}$, but the death rate was not statistically significant. Conclusion: Coronary bypass was operated with $T-PLS^{TM}$ (Pulsatile flow pump) using a heart-lung machine. There was no unexpected event caused by mechanical error during surgery, and the clinical process of the surgery was the same as the surgery for which $Bio-pump^{TM}$ was used. In addition, $T-PLS^{TM}$ used surgery was found to be less detrimental to blood corpuscles than the pulsatile flow has been known to be. Authors of this study could confirm the safety of $T-PLS^{TM}$.

• Journal of Sasang Constitutional Medicine
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• v.9 no.1
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• pp.339-352
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• 1997

The oriental medicine based on the traditional chinese medicine has developed according to the historical and racial character respectively in China, Korea and Japan etcs. Particularly, the distinctive feature of Korea & Japan is characterized by the development of constitutional medicine compared with chinese medicine; Sasang Medicine of Korea and Ikkando Medicine of Japan. The constitutional medicines were so far developed by many clinical doctors, and in recent years much interest has centered on the application of these medicines in regarding originality, easiness and effectiveness etcs in treatment. Thus far only few attempts have been made at Ikkando medicine in Korea, what seems to be lacking, however, is practical application in clinic. Thus authors intend to help the clinical application by introducing Ikkando medicine to Korea oriental medicine through this paper. The Ikkando medicine was established by Dohaku Mori(1869~1931) and was known through the "Kampo Ikkando Medincine" which was published by his disciple, Kaku Yakazu(1893~1966), classified human beings into three types; type of blood stasis, type of stroke and type of allergy. The type of blood stasis may be responsible for factors which have occurred by a state of insufficient bleed circulation and blood stasis causing lesione of endothelial cells, and Tongdosan is mainly administrated. The predisposing factor of stroke's type is known as the excessive diet, and the prevalence of cerebrovascular accident is probably higher. In this type, it is likely that patients are prevented and cured with Bangpungtongsunsan. Allergy's type have three distinct types of childhood, adolescence and adult as to the age. Allergy's type of childhood predisposes patients such as these to upper respiratory infection and tuberculosis etcs, and Sihocheonggansan is frequently administrated. Allergy's type of adolescence has a tendency to rhinitis and infection of face legion etcs, and Heunggyeyeoungyotang is mainly administrated. Allergy's type of adult is subject to urogenital infection, and is more commonly treated with Yongdamsagantang. Judging from the above, we can say with fair certainty that Ikkando Medicine has considerable validity to clinical practice, though it should not be pushed too far.