• Archives of Reconstructive Microsurgery
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• v.23 no.1
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• pp.18-20
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• 2014

Two aged patients who had open tibial fractures with arterial injury caused by high energy accidents underwent emergency arterial reconstruction using a greater saphenous vein and soft tissue repair using free flaps. In the patients, soft tissue necrosis developed and tibias were exposed at postoperative third week. Follow-up angiography through the superficial femoral artery showed occlusion of the anterior tibial artery. The anterior tibial artery was reconstructed using the contralateral greater saphenous vein graft and the latissimus dorsi myocutaneous and rectus abdominis muscle free flaps were transplanted for repair of necrotic soft tissue. The reconstructed arteries showed good perfusion to the new free flaps until union of the tibias occurred. The patients were followed-up for 21 years and 17 years postoperatively, respectively. In management of open comminuted fracture of the tibia, injury of the arterial system must be ruled out by angiography in addition to evaluation of the degree of soft tissue injury.

• Korean Journal of Cleft Lip And Palate
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• v.16 no.1
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• pp.1-8
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• 2013

Purpose : To introduce a more effective and efficient protocol for protraction of maxillary complex in CLP patient and demonstrate it by case presentation. Methods : Miniplates are placed on zygomatic buttress and anterior part of mandible, at the time of secondary alveolar bone graft. During the night time, the orthopedic force is applied by wearing elastics from maxillary miniplates to facemask (500 g per side). During the day time, the intermaxillary elastics connecting maxillary miniplates to mandibular miniplates are applied (200 g per side). During the orthopedic treatment, dental alignment is possible. Results and conclusion : By the new protocol, the intermaxillary relation and occlusion are improved due to the stable intraoral anchorage and better cooperation of patients.

• Advances in biomechanics and applications
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• v.1 no.4
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• pp.279-292
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• 2014

This paper presents some simulations of fluxes and pressures in the coronary network, in the case of very severe coronary disease (several stenoses on the left branches and total occlusion of the right coronary artery). In that case, coronary artery bypass graft surgery is the commonly performed procedure. However, the success of the intervention depends on many factors. Modeling of the coronary circulation is thus important since it can help to understand the influence of all these factors on the coronary haemodynamics. We previously developed an analog electrical model that includes the eventual presence of collateral flows, and can describe the different revascularization strategies (two grafts, three grafts, ...). The aim of the present work is to introduce in our simulations the time-dependence of the coronary microvascular resistances, in order to better represent the effect of the systolic ventricular contraction (which induces an elevation of the resistances because the vessels are squeezed).

• Journal of Chest Surgery
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• v.26 no.12
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• pp.920-925
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• 1993

Extra-anatomic bypass was proposed by Freeman in 1952 and has been used for patient with lower extremity arterial occlusion who had very high operative risk, especially elderly or severly illed patient.We had performed 14 cases of extra-anatomic bypasses from Jan. 1991 till July 1993 and having been following up them. Their results were summarized as follow. Among total 14 patients, 13 was male. Their mean age was 64.8 years old, ranged from 48 to 80. The most common complaint was pain on lower limb and they visited hospital 6.1 months in average after onset of symptom. Frequently, they were associated with systemic diseases such as generalized atherosclersis, hypertension, diabetes mellius, etc. Axillary artery was used as donor artery in 8 cases and crossover femoro-femoral or femoro-popliteal bypass was performed in 6 cases. Postoperative complications were notedd in 8 cases so their morbidity rate was 42.8%. Except for two contraindicated cases, one or more anticoagulants were used routinely . Among them, combined use of aspirin and persantine was most commonly applied.After bypass graft, nine cases were occluded beteween 10 and 53 months. So their average duration of freedom from reocclusion was 35.7 months and 3-year patency rate was 63%.

• Journal of Chest Surgery
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• v.21 no.1
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• pp.55-61
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• 1988

This report provides follow-up data on 116 patients with congenital cyanotic heart disease, aging 1 month to 13 years [median: 1.8 years], who underwent the modified Blalock-Taussig shunt using polytetrafluoroethylene graft at Seoul National University Hospital between September, 1984 and June, 1987. Among 116 patients complete follow-up studies were done on 95 patients. The mean preoperative arterial oxygen tension was 36 torr. Thirty-Six patients [38%] underwent operation in infancy. Conduit diameters included 4mm [15 cases], 5mm [47 cases], and 6mm [33 cases] sizes. The mean postoperative arterial oxygen tension was 52 torr [P<0.001]. The effectiveness of shunts was evaluated clinically and by shunt murmur, echocardiography and cardiac catheterization with angiography 1 to 31 months after operation. The incidence of shunt occlusion was 9.5% and the mortality was 14.8%. The actuarial patency rate was 83.1 * 6.4% and the actuarial survival rate was 82.5 * 4.5% at 30 months` follow-up for all patients. The effectiveness of the 4mm diameter conduit may be limited. Blalock-Taussig procedure is an effective alternative to the classic B-T shunt in congenital cyanotic heart disease.

• Journal of Dental Rehabilitation and Applied Science
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• v.30 no.4
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• pp.278-288
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• 2014

Purpose: The aim of the study was to evaluate preprosthetic initial survival rate and factors associated with survival of osseointegrated implants placed in edentulous area of maxilla and mandible and to suspect the possible causes leading to failure. Materials and Methods: A total of 2158 endosseous implants that had been inserted between 2004 through 2013 were placed in 770 patients. The clinical comparisons were performed to evaluate implant loss in relation to age and gender of patients, position, system, length and diameter of implant, and bone graft technique. Results: According to position, the survival rates were 98.23% in maxillary anterior site, 96.98% in maxillary posterior site, 97.85% in mandibular anterior site and 98.76% in mandibular posterior site (P < 0.05). According to diameter of implant, the survival rates were 100% under 3.0 mm, 97.09% between 3.0 to 3.5 mm, 98.19% between 3.5 to 4.0 mm and 98.29% between 4.0 to 4.5 mm but relatively lower survival rate was 75% in 5.0 mm-over (P < 0.05). The survival rates of implants were 89.51%, 98.28%, 98.34% and 99.27% in the group with isolated sinus graft, with isolated GBR, with sinus graft and GBR simultaneously and without bone graft, especially (P < 0.05). Conclusion: This study establishes a relationship between survival rate of implant and position, diameter of implant system and bone graft technique. In conclusion, there were low survival rates in maxillary posterior site, in dental implants with wide diameter of 5 mm-over, and in the group with isolated sinus graft.

• Journal of Chest Surgery
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• v.30 no.4
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• pp.378-382
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• 1997

To evaulate the effectiveness and risk factors for shunt failure of the Blalock-Taussig shunt in neonates, we analyzed the 21 neonates who were undergone Blalok-Taussig shunt operation at Dong-A University Hospital from December 1991 to Feburary 1996. We evaluated operative mortality, patency of the shunt. and distortion of pulmonary artery. We also determined the risk factors for the shunt failure. Age at operation was from 1 day to 30 days(mean 11.7 days). We ghts were 2.4 to 4.5kg(mean 3.1 kg). The underlying lesions included severe tetralogy of Fallot with pulmonary stenosls or atresia(N=11) and single ventricle varieties with. pulmonary stenosis or atresia(N=10). Prostaglandin El was given in 13 neonates prior to operation. The mean preoperative(prior to prostaglandin El therapy) and postoperative arterial oxygen tension were 30.1 mmHg and 46.3 mmHg respectively(P(0.01). The shunt was performed through a left thoracotomy in 11 patients and through a right thoracotomy In 10. A 5 mm graft was used in 15 patients and a 4 mm graft in 6 patients. The incidence of early shunt occlusion was 9.5%(2 patients). The hospital mortality was 9.5%(2 patients with early shunt occlusion). Univariate analysis revealed that body weight of 2.6 kg or less(p=0.021), pulmonary artery size of 3mm or less(p=0.008), and 4 mm graft (p=0.021) were risk factors predictive of early shunt failure. The patency rate of the shunt in hospital survivors was 100% at mean ollow-up of ll.3 months(There was not death or reoperation related to shunt failure). 10 patients were catheterized during postoperative follow-up. There was no significant distorsion of pulmonary artery. So we concluded that the modified Blalock-Taussig shunt in neonates was excellent in the hospital survivors.

• Journal of Chest Surgery
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• v.35 no.3
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• pp.182-187
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• 2002

Background: There have been many reports of coronary angiographic findings after coronary bypass grafting, most of which are focused on the graft patency rate of the bypass conduits. However, postoperative angiography can provide numerous informations other than patency rates that are useful for establishing operative strategy. Material and Method: We studied 73 patients in whom coronary angiography was done after more than 1 month of CABG. Mean interval from the operation to coronary angiography was 10.6 months and the reasons for coronary angiography follow up were residual or recurrent angina in 54 patients, abnormalities on myocardial perfusion scan or echocardiography in 13 patients, and for simple follow up in 6 patients. Result: Overall graft patency rate was 80.9% (internal thoracic artery 100%, saphenous vein 75.0%) in patients of simple follow up and 61.6%(internal thoracic artery 81.1%, saphenous vein 55.3%) in patients with ischemia. Progression of native coronary arterial disease proximal to the grafting site was found in 50 patients(68.5%). Among 201 coronary arterial branches that had not been completely occluded preoperatively, ninty five branches(47.3%) revealed progression of diameter stenosis by more than 20% on the follow up study. Among them, 64 branches(31.8%) progressed to total occlusion. The incidence of disease progression was highter in the coronary arteries with patent grafts(57.5%) than in those with occluded grafts(36.3%)(p<0.05), Comparing internal thoracic artery graft with saphenous vein graft, internal thoracic artery was superior to saphenous vein, not only in terms of patency(83.3% vs 56.6%), but also in terms of result of later percutaneous intervention success rate(100% vs 62%, p<0.05). Conclusion: Due to the considerable incidence of progression of native coronary artery stenosis in the early postoperative periods, bypass grafting of a vessel with borderline stenosis, especially with vein graft, must be done prudently. And it was confirmed again that revascularization of left anterior descending artery is most important and that internal thoracic artery was superior to saphenous vein.

• Tuberculosis and Respiratory Diseases
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• v.51 no.4
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• pp.379-385
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• 2001

Sternocostoclavicular hyperostosis is an uncommon disease, characterized by an inflammatory arthrosteitis of the sternocostoclavicular region. Clinically, it manifests as a painful swelling of the upper anterior chest wall, which is associated with occasional pustulosis palmaris and plantaris. A 48-year-old man had suffered from pain in both shoulders and the upper anterior part of the chest for 6 months. On examination, a venous engorgement in the neck with dilated collateral veins in the upper chest and shoulders was observed. Swelling was noticed in his face, neck and both arms. Radiologically, the clavicles, the sternum and the first ribs were enlarged with complete fusion between them. 99Tc scintigraphy showed increased uptake in the clavicles and the sternum. Selective venography resulted in a bilateral subclavian and brachiocephalic vein occlusion, which resulted from a subclavian vein thrombosis. All the above suggested a sternocostoclavicular hyperostosis. He underwent a vascular graft interposition between the right jugular vein and the left innomianate vein (using 8mm ringed Gore-Tex graft) and a resection of the bilateral medial half of clavicle and 1st rib. Here, we present a case on sternoclavicular hyperostosis with subclavian and brachiocephalic vein thrombosis, and report this case study with a review of the appropriate literature.

• Journal of Trauma and Injury
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• v.26 no.3
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• pp.243-247
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• 2013

Introduction: Surgical treatment of subclavian artery (SA) injury is challenging because approaching the lesion directly and clamping the proximal artery is difficult. This can be overcome by using an endovascular technique. Case 1: A 37-year-old male was drawn into the concrete mixer truck. He had a right SA injury with multiple traumatic injuries: an open fracture of the right leg with posterior tibial artery (PTA) injury, a right hemothorax, and fractures of the clavicle, scapula, ribs, cervical spine and nasal bone. The injury severity score (ISS) was 27. Computed tomography (CT) showed a 30-mm-length thrombotic occlusion in the right SA, which was 15 mm distal to the vertebral artery (VA). A self-expandable stent($8mm{\times}40mm$ in size) was deployed through the right femoral artery while preserving VA flow, and the radial pulse was palpable after deployment. Other operations were performed sequentially. He had a viable right arm during a 13-month follow-up period. Case 2: A 25-year-old male was admitted to our hospital due to a motorcycle accident. The ISS was 34 because of a hemothorax and open fractures of the mandible and the left hand. Intraoperative angiography was done through a right femoral artery puncture. Contrast extravasation of the SA was detected just outside the left rib cage. After balloon catheter had been inflated just proximal to the bleeding site, direct surgical exploration was performed through infraclavicular skin incision. The transected SA was identified, and an interposition graft was performed using a saphenous vein graft. Other operations were performed sequentially. He had a viable left arm during a 15-month follow-up period. Conclusion: The challenge of repairing an SA injury can be overcome by using an endovascular approach.