• Journal of Korean Neurosurgical Society
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• 제48권4호
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• pp.325-329
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• 2010

Objective : Traditionally, peritoneal catheter is inserted with midline laparotomy incision in ventriculoperitoneal (V-P) shunt procedures. Complications of V-P shunt is not uncommon and have been reported to occur in 5-37% of cases. The aim of this study is to compare the clinical outcomes and the operation time between laparotomy and laparoscopic groups. Methods : A total of 155 V-P shunt procedures were performed to treat hydrocephalic patients of various origins in our institute between June 2006 to January 2010; 95 of which were laparoscopically guided and 65 were not. We reviewed the operation time, surgery-related complications, and intraoperative and postoperative problems. Results : In the laparoscopy group, the mean duration of the procedure (52 minutes) was significantly shorter (p < 0.001) than the laparotomy group (109 minutes). There were two cases of malfunctions and one incidence of diaphragm injury in the laparotomy group. In contrast, there were neither malfunction nor any internal organ injuries in the laparoscopy group (p = 0.034). There were total of two cases of infections from both groups (p = 0.7). Conclusion : Laparoscopically guided insertions of distal shunt catheter is considered a fast and safe method in contrast to the laparotomy technique. This method allows the exact localization of the peritoneal catheter and a confirmation of its patency.

• Journal of Chest Surgery
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• 제23권5호
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• pp.962-967
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• 1990

The anomalous pulmonary venous return of the entire left lung was an extremely rare congenital anomaly. The reported surgical experience with correction of this disorder was limited. The 3-year-old female patient underwent an operation upon the unilateral total anomalous pulmonary venous return from the left lung, in which the left superior pulmonary vein drained into innominate vein and the left inferior pulmonary vein into the coronary sinus, in Yeungnam University Hospital. The symptoms were nonspecific except frequent upper respiratory infection. Cyanosis was not seen. On auscultatory findings, a grade 2/6 systolic ejection murmur was audible over left second intercostal space of left sternal border and second heart sound had an increased pulmonary component which was widely splitted. The electrocardiogram demonstrated a right ventricular hypertrophy and right axis deviation and chest X-ray showed slightly increased pulmonary vascularity and bulged pulmonary conus. The echocardiogram demonstrated increased right atrial, ventricular, and pulmonary arterial dimension, and also secundum atrial septal defect and enlarged coronary sinus. The cardiac catheterization confirmed the left-to-right with a Qp/Qs of 2.0: 1 and oxygen step-up was seen in pulmonary artery, right ventricle, right atrium, and left innominate vein, and the catheter was not been introduced into the left pulmonary vein. A median sternotomy incision was done. Left superior pulmonary vein was drained to the innominate vein through anomalous vertical vein and the left inferior pulmonary vein drained to right atrium through the coronary sinus. The diversion of the left inferior pulmonary vein to posterior wall of left atrium was done after division in the proximity of coronary sinus. The anomalous vertical vein was diverted to base of left atrial auricle and then a atrial septal defect was sutured directly. The postoperative course was uneventful and she was discharged on the eleventh postoperative day. In the postoperative follow-up-2 months, she has been well without specific problems.

• Journal of Chest Surgery
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• 제41권6호
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• pp.803-806
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• 2008

너스 수술은 미용적으로 우수한 수술법이나 전종격동 박리 시 출혈과 장기 손상을 유발할 수 있다. 저자들은 기존의 전종격동 통과방법이 갖고 있는 단점을 극복하기 위해 노력해 왔고, 보다 안전하고 간편하게 양측에 1cm의 수술 창으로 수술을 진행 할 수 있는 광투시 진입기구를 개발하게 되었다. 총 67명의 환자가 광투시 진입기구를 이용한 너스 수술을 시행 받았다. 36명은 광투시 진입기구만을 사용하였고(나이 <14), 31명은 흉강경을 추가로 이용하였다(나이 ${\geq}14$). 너스 수술 중이나 후에 흉강내 대량 출혈이나 장기손상 같은 주요합병증은 얼었다. 너스 수술에서 광투시 진입기구를 사용함으로써 출혈과 장기 손상 등 치명적인 합병증 없이 안전하고 간단하게 전종격동 박리를 할 수 있었다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제39권4호
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• pp.193-196
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• 2013

Artecoll (Artes Medical Inc., San Diego, CA, USA) has recently been developed as a permanent synthetic cosmetic filler. We experienced an inflammatory granuloma resulting from a previous injection of Artecoll at the upper lip, which was regarded as a rare side effect of this filler. A 50-year-old female patient complained of swelling, dull pain, and heat in the right upper nasolabial fold area, which had started one week before her visit to Kyungpook National University Hospital. The patient received topical steroid therapy at a local clinic, which was not effective. At the injection site, a hard nodule was palpated and erythema was observed with mild tenderness. Antibiotic treatment and subsequent incision and drainage did not result in complete cure of the facial swelling, and the facial swelling and pain persisted. Computed tomography showed a lesion approximately 1-cm in size without clear boundaries and relatively increased nodular thickening. Finally, a subdermal lesion was removed via an intraoral vestibular approach. The lesion was diagnosed as inflammatory granuloma by a permanent biopsy. The patient had healed at two months after the filler injection. Although the soft tissue filler is widely used for cosmetic purposes, there is potential for complication, such as the inflammatory granuloma should be considered before treatment.

• Journal of Chest Surgery
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• 제28권6호
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• pp.533-541
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• 1995

We recently developed a new model of moving actuator type totally implantable artificial heart[TIAH , based on the reverse position of the aortic and pulmonary conduits. This concept was proposed by one of surgeons in our team[Joon-Ryang Rho, M.D. to facilitate anatomical fitting of TIAHs. The moving actuator type electromechanical TIAH consisted of the left and right blood sacs, and the moving actuator including a motor. The inverted umbrella type polyurethane valves were used in the blood pumps. The aortic conduit was positioned anterior to the pulmonary conduit, which was the opposite relation to the conventional configuration of other total artificial hearts. We also adapted slip-in connectors for the aortic and pulmonary conduits. Two sheep , weighing 60-69 kg, were used for implantation. After small cervical incision and trans-sternal bilateral thoracotomy, cardiopulmonary bypass [CPB was administered using an American Optical 5-head pump and a membrane oxygenator[Univox-IC, Bentley . The anterior and posterior vena cavae were drained separately for venous return. An arterial return cannula was inserted into the right common carotid artery. During CPB, almost all of the ventricular myocardium was excised down to the atrioventricular groove and the artificial heart was implanted. We achieved 3-day survival in the first sheep and 2-day survival in the second. The day after operation the first sheep was successfully extubated and the second sheep was weaned from a respirator with good condition. After extubation, the first sheep walked around in the cage and fed herself. Serial laboratory and hemodynamic examinations were done during the experiments. In both sheep, pulmonary dysfunction was gradually developed, which was accompanied by acute renal failure. The animals were sacrificed and autopsy was done. Unexpected pregnnacy was incidentally found in both sheep. To our knowledge this is the first report of significant survival cases in the orthotopic implantation of electric TIAH using sheep.

• Advances in pediatric surgery
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• 제1권1호
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• pp.40-45
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• 1995

Anal fistula and perianal abscess in pediatric patients have been reported to have several characteristics, e.g. prevalent in less than 2 years of age, male preponderance, straight course of tract, and low type of fistula. We performed a retrospective study of twenty nine pediatric patients to see these characteristics comparing with the transitional age group of adolescents. Between June 1989 and December 1993, twenty-nine pediatric (<15year-old) and sixteen adolescent patients(${\geqq}$15, <25 year-old) with anal fistula and perianal abscess were treated by surgical intervention. Perianal abscess and anal fistula in the pediatric group had the predilection for male(100%), age less than two years (72.4%), low type(100%), and lateral localization(87.5%). But the features of the adolescent group were similar to those of adult. Twenty-one(87.5%) and 10(66.7%) enteric bacterial colonies were isolated from 16 pediatric and 11 adolescent patients, respectively. Considering the predominance of low type and the organisms cultured in the pediatric group, crypt-glandular infection seems to be a major preceding event. Incision and drainage were sufficient for cure in 15 among 16 perianal abscesses, and fistulas were cured by either fistulotomy or fistulotomy in all the 14 patients. The importance of effective drainage of perianal abscess and fistulotomy including internal opening cannot be overemphasized.

• 대한두개안면성형외과학회지
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• 제10권1호
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• pp.55-60
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• 2009

Purpose: For blowout fracture of the medial orbital wall, the goals of treatment are complete reduction of the herniated soft tissue and anatomic reconstruction of the wall without surgical complications. Surgeons frequently worry about damage to the optic nerve from the dissection, when the part over the posterior ethmoidal foramen was fractured. The authors performed small incision and inlay grafting for reconstruction of medial orbital wall fracture. Methods: Between January 2007 and April 2008, 15 out of 32 patients were included in an analysing the outcome of corrected medial orbital wall fracture. In 15 patients of posterior comminuted fracture of medial orbital wall, insertion of porous polyethylene($Medpor^{(R)}$ channel implant, Porex, USA) to ethmoidal sinus was performed in multiple layer, through the transconjunctival approach (inlay grafting). Results: In all cases, the orbital bone volume was reconstructed in its normal anatomical position. The associated ocular problems disappeared except for mild enophthalmos in 2 patients and there were no surgical complications associated with inlay grafting. Conclusion: The advantage of inlay grafting include anatomical reconstruction of the orbital wall; the avoidance of optic nerve injury; the simplicity of the procedure; and consequently, the absence of surgery-related complications. This technique is presented as one of the preferred treatments for posterior comminuted fracture of medial orbital wall.

• 대한두개안면성형외과학회지
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• 제9권1호
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• pp.17-22
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• 2008

Purpose: For several decades, open reduction has been a controversial issue in mandibular condyle fracture. The authors have successfully used the open reduction and internal fixation with retromandibular approach and have found it to be satisfactory for mandibular condyle fracture. Methods: A total of 10 patients with mandibular condyle fracture underwent open surgical treatment using retromandibular approach. The incision for the retromandibular approach was carried below the ear lobe and the facial nerve branches were identified. Dissection was continued until the fracture site was exposed and internal fixation was performed with miniplate following intermaxillary fixation. The average period of joint immobilization was 1 weeks and the arch bars were removed in 3 weeks on average. The preoperative and postoperative panoramic view and three-dimensional computed tomography were compared. During the follow up period, we evaluated the presence of malocclusion, chin deviation, trismus, pain, click sound, facial nerve palsy, hypertrophic scar and skin fistula. Results: According to the radiographic findings, the fractured condyle was reducted satisfactorily in all patients without any symptoms of facial palsy. During the follow up period ranged form 6 to 12 months, all clinical symptoms were improved except in one case with chin deviation and malocclusion. Conclusion: Using open reduction and internal fixation of mandibular condyle fracture with retromandibular approach, all results were satisfactory with good functional outcomes and minimal complication. We concluded that the open surgical treatment should be considered as the first choice for mandibular condyle fracture management.

• 한국전기전자재료학회논문지
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• 제21권8호
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• pp.770-775
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• 2008

Autonomic nervous system of the anesthetized patients can be influenced by the many kinds of stimulations such as intubation, surgical incision and so on. The changes of the heart rates and blood pressures are surrogates of responses of the autonomic system to the external stimulations. Recently, the power spectral analysis of the heart rate variability (HRV) made it easy to know the fractions and changes of sympathetic and parasympathetic autonomic systems. In this study, the changes of pulse transit time, one of the response of vessels to stimulations, was investigated in relation to the HRV. Ten patients were examined and average age is 22.5 $\pm$ 11.04, average weight is 63 $\pm$ 14.4 kg. The patients were anesthetized only by sevoflurane inhalation. Pulse transit time is determined by calculating the difference of the time between the R peak of ECG and the characteristic point of the plethysmography. Power spectral density (PSD) of the HRV was achieved in the frequency of 0.04-0.15 (LF) and 0.15-0.4 (HF). Compared to preanesthetic period the values of LF and LF/HF ratio of HRV were decreased (p<0.05). HF and PTT was increased in anesthetic state with sevoflurane. Otherwise, after intubation, the HF was decreased and LF, LF/HF ratio and PTT were increased. PSD of the HRV is well-known for the index of the autonomic nervous activity. Not only HRV but PTT analysis also is a useful index reflecting the autonomic responses to various stimulations. And this analysis is useful in bed side monitoring because the calculating method is simple and it takes shorter processing time compared to the HRV analysis.

• Archives of Plastic Surgery
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• 제38권1호
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• pp.81-84
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• 2011

Purpose: Nerve injury is one of the complication which can develop after brow lift. Peripheral nerve ending which is stretched from supraorbital nerve and supratrochlear nerve can be injured and symptoms such as pain, dysesthesia may appear. Usually, developed pain disappeared spontaneously and does not go on chronic way. We experienced a case that a patient complained chronic pain after brow lift which was not controlled by conservative management such as medications, local nerve block and report a successful surgical treatment of chronic pain after brow lift. Methods: A 24-year-old male who received brow lift with hairline incision at local hospital was admitted for chronic pain at the right forehead. The pain was continued for 3 months even though fixed thread was removed. Local nerve block at trigger point with mixed 1 mL 2% lidocaine and 1 mL Triamcinolone acetonide was done and oral medications, Gabapentine and carbamazepine, were also applied but there was no difference in the degree of pain. Therefore the operation was performed so that careful dissection was carried out at right supraorbital neurovascular bundle and adhered supraorbital nerve was released from surrounding tissues and covered with silastic sheet to prevent adhesion. Results: The pain was gradually relieved for a week. The patient was discharged without complications. No evidence of recurrence has been observed for 2 years. Conclusion: The pain developed after brow lift was engaged with nerve injury and sometimes remains chronically. Many kinds of conservative management to treat this complication such as medications, local nerve block have been reported and usually been used. But there are some chronic cases that conservative treatment do not work. In sum, we report 1 case of successful surgical treatment for relief of intractable pain developed after brow lift surgery.