• Journal of Periodontal and Implant Science
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• 제48권2호
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• pp.92-102
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• 2018

Purpose: This study investigated the validity of the Charlson comorbidity index (CCI) as a predictor of periodontal disease (PD) over a 12-year period. Methods: Nationwide representative samples of 149,785 adults aged ${\geq}60$ years with PD (International Classification of Disease, 10th revision [ICD-10], K052-K056) were derived from the National Health Insurance Service-Elderly Cohort during 2002-2013. The degree of comorbidity was measured using the CCI (grade 0-6), including 17 diseases weighted on the basis of their association with mortality, and data were analyzed using multivariate Cox proportional-hazards regression in order to investigate the associations of comorbid diseases (CDs) with PD. Results: The multivariate Cox regression analysis with adjustment for sociodemographic factors (sex, age, household income, insurance status, residence area, and health status) and CDs (acute myocardial infarction, congestive heart failure, peripheral vascular disease, cerebral vascular accident, dementia, pulmonary disease, connective tissue disorders, peptic ulcer, liver disease, diabetes, diabetes complications, paraplegia, renal disease, cancer, metastatic cancer, severe liver disease, and human immunodeficiency virus [HIV]) showed that the CCI in elderly comorbid participants was significantly and positively correlated with the presence of PD (grade 1: hazard ratio [HR], 1.11; P<0.001; grade ${\geq}2$: HR, 1.12, P<0.001). Conclusions: We demonstrated that a higher CCI was a significant predictor of greater risk for PD in the South Korean elderly population.

• 대한한방내과학회지
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• 제27권4호
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• pp.845-854
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• 2006

Objectives : This study aimed at investigating whether aqueous extract of Radix et Rhizoma Rhei (AR) ameliorates renal and vascular complications in diabetic rats. Methods : The experiment operated for 6 weeks. The rats were divided into 4 groups: normal group, diabetic group (control group), diabetic group treated with AR (100 mg/kg/day) for the last 3 weeks, and diabetic group treated with AR (200 mg/kg/day) for the last 3 weeks. Results : There were no significant changes in the renal functional parameters by treatment of AR in the diabetic rats. Aorta segment in the diabetic rats revealed a thickening of intima and media, which was ameliorated by treatment with AR. The aortic expression level of endothelin-1 was also significantly attenuated by treatment with AR. Conclusions : Treatment with AR could not ameliorate renal functional defects, but improved vascular complication in diabetic rats.

• Journal of Chest Surgery
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• 제27권3호
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• pp.226-229
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• 1994

VATS is now used by many thoracic surgeons and in various anatomic locations such as lung parenchyme, pleura and mediastinum, etc. VATS of mediastinal masses has special characteristics compared to that of other diseases. Those are no positional changes of the mass during collapse of the lung and close proximity of the mass to major vascular structures, nerves and other vital organs. From 1992. July to 1993. August, 10 mediastinal masses were treated with video assisted thoracoscopy. There were five males and five females, ages ranged from 11 years to 65 years with average 37.7 17.7 years old. Of the 10 patients, 4 were bronchogenic cysts, 2 were teratoma, and the others were thymoma, neurilemmoma, pericardial cyst, and thymic cyst. Needle aspiration was done in large cysts and the working thoracotomy[or utility thoracotomy] was done in large solid masses for the purpose of easy dissection, easy handling and easy delivery of the mass. The average operation time were 155.6 6.8 minutes and the duration of air leakage were 1 2.2 days. The duration of the chest tube drainage were 3.3 2.6 days. The lengths of the postoperative hospitalization were 5.1 2.7 days which were shorter than those of 12 mediastinal masses treated with conventional thoracotomy during the same periods [p<0.05]. There was 1 patient converted to thoracotomy because of a bleeding at innominate vein. 3 postoperative complications were occured. Those were persistent air leakage for 7 days, diaphragmatic palsy and hoarseness which were recovered within 1 month. We conclude that mediastinal mass can be excised with video assisted thoracoscopy and the posthospitalization is reduced. But careful attention is required for avoiding injury to major vascular structures, nerves, and other vital organs.

• Journal of Trauma and Injury
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• 제27권4호
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• pp.215-218
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• 2014

Blunt abdominal trauma may often cause multiple vascular injuries. However, common iliac artery injuries without associated bony injury are very rarely seen in trauma patients. In the present case, a 77-year-old male patient who had no medical history was admitted via the emergency room with blunt abdominal trauma caused by a forklift. At admission, the patient was in shock and had abdominal distension. On abdomino-pelvic computed tomography (CT), the patient was seen to have hemoperitoneum, right common iliac artery thrombosis and left common iliac artery rupture. During surgery, an additional injury to inferior vena cava was confirmed, and a primary repair of the inferior vena cava was successfully performed. However, the bleeding from the left common iliac artery could not be controlled, even with multiple sutures, so the left common iliac artery was ligated. Through an inguinal skin incision, the right common iliac artery thrombosis was removed with a Forgaty catheter and a femoral-to-femoral bypass graft was successfully performed. After the post-operative 13th day, on a follow-up CT angiography, the femoral-to-femoral bypass graft was seen to have good patency, but a right common iliac artery dissection was diagnosed. Thus, a right common iliac artery stent was inserted. Finally, the patient was discharged without complications.

• Archives of Reconstructive Microsurgery
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• 제16권2호
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• pp.100-107
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• 2007

Treatment of giant cell tumor of distal radius can be treated in several ways according to the aggressiveness of the tumor. But the management of giant cell tumor involving juxta-articular portion has always been a difficult problem. In some giant cell tumors with bony destruction, a wide segmental resection may be needed for preventing to recur. But a main problem is preserving of bony continuity in bony defect as well as preservation of joint function. We have attempted to overcome these problems by using a microvascular technique to transfer the fibula with peroneal vascular pedicle or anterior tibial vessel as living bone graft. From April 1984 to July 2005, we performed the reconstruction of wide bone defect after segmental resection of giant cell tumor in 14 cases, using Vascularized Fibular Graft, which occur at the distal radius. VFG with peroneal vascular pedicle was in 8 cases and anterior tibial vessel was 6 cases. Recipient artery was radial artery in all cases. Method of connection was end to end anastomosis in 11 cases, and end to side in 3 cases. An average follow-up was 6 years 6 months, average bone defect after wide segmental resection of lesion was 6.8 cm. All cases revealed good bony union in average 6.5 months, and we got the wide range of motion of wrist joint without recurrence and serious complications. Grafted bone was all alive. In functional analysis, there was good in 7 cases, fair in 4 cases and bad in 1 case. Pain was decreased in all cases but there was nearly normal joint in only 4 cases. Vascularized fibular graft around wrist joint provided good functional restoration without local recurrence.

• Archives of Reconstructive Microsurgery
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• 제14권2호
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• pp.117-124
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• 2005

Purpose: To present our experience and design modification of an anterolateral thigh flap in soft tissue reconstruction. Materials and Methods: Between April of 2004 and May of 2005, 26 anterolateral thigh flaps were used in 26 patients. There were 22 males and 4 females between 23 and 60 years (mean, 40years). The mean follow-up period was 11($4{\sim}18$) months. All cases were a cutaneous flap. Twenty-two were musculocutaneous perforator flaps(85%) and 4 were septocutaneous perforator flaps(15%). Four flaps were used as a sensate flap. While the donor sites were closed directly in 14 cases(54%), 12 cases(46%) underwent skin grafting of the donor site. During the flap design, a triangular skin design was added to a vascular anastomosis site in 14(54%) patients and used as a roof of the tunnel. The healing period of the skin graft between those performed above the fascia and above the muscle were compared. Results: The average size of the flaps was $16{\times}9(11-20{\times}7-12)\;cm$. The overall flap success rate was 96%. Complications encountered were infection in 4 cases, and marginal skin necrosis in 1 case. The healing period was delayed with the infection in 3 of the 6 cases involving a skin graft over the fascia. All 14 cases with the triangular skin design survived, but there was 1 flap failure and 1 marginal necrosis in 12 cases without a triangular skin design. Conclusions: It may be better to undergo a skin graft above the muscle than above the fascia in covering a donor site defect, and to use a triangular skin design in order to prevent vascular insufficiency. An anterolateral thigh flap is a versatile flap for a soft tissue reconstruction because its thickness and volume can be adjusted to the extent of the defect with minimal donor site morbidity.

• Journal of Chest Surgery
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• 제54권1호
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• pp.31-35
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• 2021

Background: Arteriovenous fistula (AVF) for hemodialysis is essential for patients with end-stage renal disease. However, it is difficult to maintain AVF reliably. It is vitally important to select proper blood vessels for AVF formation. In a previous study, a minimum diameter of 3 mm for the autologous vein was proposed. However, patients who did not meet the minimum vascular diameter before anesthesia, but fulfilled other criteria, showed satisfactory venous dilatation after brachial plexus block (BPB). This study investigated the extent of vein expansion by BPB and the surgical outcomes of dilated veins after BPB. Methods: Sixty-one patients who underwent AVF formation using an autologous vein between August 2018 and December 2019 were included in the study. The clinical characteristics of the patient groups, hemodynamic parameters including the diameter of blood vessels before and after BPB, and complications were investigated. Based on the venous diameter measured by sonography before anesthesia, patients were divided into group A (26 patients) and group B (35 patients), with venous diameters <3 mm and ≥3 mm, respectively. Results: The venous diameter expanded after anesthesia by 41% overall, by 62% in group A, and by 25% in group B. This difference between groups A and B was statistically significant (p=0.001). No other variables showed statistically significant differences. Conclusion: Sufficient venous dilatation was observed after BPB. Therefore, if the vein is sufficiently dilated after BPB, even in patients with a pre-anesthesia venous diameter <3 mm, surgery may still be performed with an expected desirable outcome.

• Journal of Chest Surgery
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• 제54권3호
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• pp.179-185
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• 2021

Background: The use of ProGlide as a percutaneous vascular closure device in cardiac surgery remains inconclusive. This study investigated the clinical outcomes of using ProGlide in the percutaneous cannulation of femoral vessels in adult cardiac surgery. Methods: From September 2017 to July 2018, 131 consecutive patients underwent femoral vessel cannulation during cardiac surgery. The ProGlide (Abbott Vascular Inc., Santa Clara, CA, USA) with percutaneous cannulation was used in 118 patients (mean age, 55.7±15.5 years). The accessibility of femoral cannulation was evaluated through preoperative computed tomography. For cannulation, sonography was routinely used. The postoperative ankle-brachial index (ABI) was used to evaluate femoral artery stenosis. Results: Of the 118 patients, 112 (94.9%) and 6 (5.1%) underwent minimally invasive cardiac surgery and median sternotomy, respectively. Most femoral cannulations were performed on the right side (98.3%) using 15F to 19F arterial cannulas. The technical success rate of cannulation with ProGlide was 99.2%, with no delayed bleeding or cannulation site-related complications during hospitalization. During follow-up, only 1 patient showed femoral artery stenosis with claudication and was treated with interventional balloon angioplasty. The postoperative ABI revealed no significant difference in functional stenosis between the cannulation and non-cannulation sides (n=86; cannulation vs. non-cannulation, 1.2±0.1 vs. 1.1±0). Conclusion: Percutaneous femoral cannulation with ProGlide was safe and feasible in adult cardiac surgery. This technique may be a good alternative option in patients requiring femoral vessel cannulation for cardiac surgery.

• 대한정형외과학회지
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• 제56권6호
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• pp.535-539
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• 2021

대퇴골 골절 이후 발생하는 혈관계 합병증은 드물지만 발생할 경우 심각한 문제를 초래할 수 있다. 근위 대퇴골 골절에서 직접적인 외상 혹은 근위대퇴골 골수 정 고정술 후 발생한 가성동맥류에 대해서는 몇 차례 증례보고가 있었다. 저자들은 85세 여환에서 원위대퇴골 골절에 대하여 역행성 골수 정 고정술 시행 후, 수술 후 9일째부터 혈색소 감소와, 종창, 통증이 발생했던 것에 대해 수술 후 일시적인 혈종 및 통증으로 오인하였다가, 수술 후 16일째가 되어서야 근위 교합 나사 주변부에서 외측 대퇴 회선 동맥의 하행분지에서 기원한 가성동맥류를 진단하였고, 경피적 혈관 색전술을 시행하여 치료 하였다. 시술 후 혈색소 상승 및 종창, 통증 감소 소견을 보이며 회복하였다.

• Journal of Chest Surgery
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• 제40권7호
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• pp.480-484
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• 2007

서론: 주요 혈관 손상 시 적절한 진단 및 치료가 지연될 경우 환자가 생명을 잃거나 사지를 절단해야 할 위험이 있게 된다. 이러한 혈관 손상의 적절한 치료를 위한 지침을 세워보고자 본원에서 치료한 증례를 분석하였다. 대상 및 방법: 1999년 5월부터 2004년 9월까지 치료받은 외상성 혈관 손상 환자 26명을 대상으로 연령 및 성별 분포, 혈관 손상의 위치, 원인, 진단방법, 혈관 손상의 형태, 임상소견, 치료방법, 합병증 등을 살펴보았다. 결과: 환자의 연령분포는 평균 39.5세($12{\sim}86$세)였고 손상입은 혈관은 하행대동맥 6예, 대퇴 동맥 4예, 슬와 정맥 4예 등의 순으로 빈번하게 발생하였다. 손상의 원인으로는 의인성 손상이 8예로 가장 많았고 그 다음이 교통사고 7예, 자상 6예, 산업재해 5예 순이었다. 진단방법은 CT와 Arteriogram이 각각 9예씩으로 가장 많았고 수술 중에 발생한 의인성인 경우는 이학적 검사만으로도 진단이 가능하였다. 혈관손상의 형태는 동맥인 경우 가성 동맥류가 10예로 가장 많았고. 부분 절단된 경우가 5예, 완전 절단된 경우가 3예, 폐색이 3예 등이었다. 정맥손상의 경우는 부분절단이 6예, 완전 절단이 2예였고 동정맥루의 형태가 2예 등이었다. 임상 소견은 맥박손실 8예, 냉감 1예, 흉통 6예, 부종 5예, 출혈 5예 등이었다. 치료는 동맥손상인 경우 Graft interposition이 11예로 가장 많았고 primary repair가 4예, 단단 문합이 2예였고 동정맥루 2예는 모두 중재적 시술(endovascular repair)을 시행하였다. 심각한 합병증으로는 지연된 진단 및 치료로 인한 지체 소실이 3예 있었고 3예에서 동반된 신경손상으로 인한 운동장애 그리고 1예에서 다발성 장기 부전으로 사망하였다. 결론: 사지 보존율을 높이고 사망률을 줄이기 위해서는 즉각적인 진단과 치료를 시행할 수 있는 시스템 확보가 필수적이다. 또한 중재적 시술이 증가하는 요즘 경향을 볼 때 발생의 예방을 위한 의사 교육이 중요하며 발생 시 즉각적으로 혈관 외과의사가 개입할 수 있도록 원활한 의사 교환 및 협진 체제가 중요하다고 하겠다.