• Journal of Trauma and Injury
• /
• v.21 no.1
• /
• pp.8-14
• /
• 2008

Iatrogenic ureteral injury is a complication that can occur during a variety of pelvic or abdominal surgeries. The most frequent causes are gynecological ones, followed by colon and vascular surgeries. Management of ureteric injury depends on the time of diagnosis and the severity of organ damage. Injuries diagnosed intraoperatively should be treated immediately. Occasionally, intraoperative ureteral injury is overlooked, and symptoms of the late diagnosis of ureteral injury are usually nonspecific; therefore, the diagnosis is delayed for days or weeks postoperatively. Management of injuries diagnosed postoperatively is more complex. There are differing opinions on whether an initial conservative or immediate operative intervention is the best line of action. Delayed repair is suggested on the grounds that it will reduce inflammation and tissue edema. However, many authors are in favor of early repair, perhaps because tissue planes are easier to find before fibrosis becomes too dense. Ureteral injuries occurring at the level of the pelvic brim should be best managed with an end-to-end anastomosis, preferably around a ureteric stent. More distal injuries also should be ideally managed with an end-to-end anastomosis, after excision of the crushed or compromised segments. However, if the remaining distal segment is short, ureteral reimplantation is the procedure of choice. The Boari flap technique for ureteral reimplantation is invaluable in cases with a short proximal segment. Delayed recognition of iatrogenic ureteral injury may be associated with serious complications, so prompt recognition of ureteral injuries is important. Recognition of the injury before closure is the key to easy, successful, and complications-free repair. Increased awareness of the risk for ureteral damage during certain operative maneuvers is vital to prevent injury, and to decrease the incidence of iatrogenic injury. A sound knowledge of abdominal and pelvic anatomy is the best prevention.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.16 no.7
• /
• pp.4651-4655
• /
• 2015

The subclavian artery pseudoaneurysm in blunt trauma is uncommon and rarely occurs secondary to penetrating injury. Subclavian artery injuries represent an uncommon complication of blunt chest trauma, this structure being protected by subclavius muscle, the clavicle, the first rib, and the deep cervical fascia as well as the costo-coracoid ligament, a clavi-coraco-axillary fascia portion. Subclavian artery injury appears early after trauma, and arterial rupture may cause life-threatening hemorrhages, pseudoaneurysm formation and compression of brachial plexus. Most injuries were related to clavicle fracture, gunshot, other penetrating trauma, and complication of central line insertion. The presence of large hematomas and pulsatile palpable mass in supraclavicular region should raise the suspicion of serious vascular injury and these clinical evidences must be carefully worked out by physical examination of the upper limb. Since the first reports of endovascular treatment for traumatic vascular injuries in the 1993, an increasing number of vascular lesions have been treated this way. We report a case of subclavian artery pseudoaneurysm 10 days after blunt chest trauma due to traffic accident, treated by endovascular stent grafting.

• Journal of Korean Neurosurgical Society
• /
• v.55 no.2
• /
• pp.96-98
• /
• 2014

Vascular complications after percutaneous angiography include hematoma, pseudoaneurysm, arteriovenous fistula, thromboembolism, arterial laceration and infection. Hematomas may occur in the groin, thigh, retroperitoneal, intraperitoneal, or abdominal wall. A 54-year-old female underwent percutaneous transfemoral angiography for the evaluation of cerebral aneurysm. Renal subcapsular hematoma developed 3 hours after the procedure. Renal subcapsular hematoma after percutaneous angiography is very rare. We investigated the possible causes of renal subcapsular hematoma. To avoid this rare complication, we need to perform guide-wire passage carefully from the beginning of the procedure under full visual monitoring.

• The Korean Journal of Physiology and Pharmacology
• /
• v.3 no.6
• /
• pp.597-603
• /
• 1999

Caldesmon (CaD), one of microfilament-associated proteins, plays a key role in microfilament assembly in mitosis. We have investigated the effects of overexpression of the high molecular weight isoform of CaD (h-CaD) on the physiology of vascular smooth muscle cells (VSMCs). Rat aortic VSMCs were stably transfected with plasmids carrying a full length human h-CaD cDNA under control of cytomegalovirus promoter. The majority of the overexpressed h-CaD appears to be localized predominantly on cytoskeleton structures as determined by detergent lysis. The overexpression of h-CaD, however, does not decrease the level of endogenous low molecular weight isoform of CaD. h-CaD overexpressing VSMCs (h-CaD/VSMCs) show a decreased growth rate than that of vector-only transfected cells when determined by $[^3H]thymidine$ uptake and cell counting after fetal bovine serum (FBS) stimulation. h-CaD/VSMCs were smaller than vector-transfected cells by 18% in cell diameter. These data suggest that overexpression of h-CaD can inhibit the poliferation and the cell volume of VSMCs stimulated by growth factors and that the gene therapy with h-CaD may be helpful to prevent the conditions associated with hypertrophy and/or hyperplasia of VSMCs after arterial injuries.

• Journal of Plant Biology
• /
• v.29 no.4
• /
• pp.295-315
• /
• 1986

Structure and differentiation mechanism of the seed coat of Panax ginseng are studied with light and electron microscopes to clarify the developmental processes of seed coat and the structural changes during the differentiation of the seed. The seed coat of ginseng is differentiated from the inner cell layers of ovary wall, which can be compared with the seed coat differentiated from integument(s) in other plants. The single integument is differentiated into endothelium, which is degenerated to one layer of 4${\mu}{\textrm}{m}$ in thickness, composed of remants of cell wall components in fully ripened seed. The ripened seed coat is composed of three layers; fringe layer, inner layer and palisade layer, and all of the them are crossed at right angles with one another. This may be the cause of protection of the kernel from other mechanical injuries. The thickness of fully ripened seed coat is about 300~600 ${\mu}{\textrm}{m}$, and arrangements of sclereids are irregular. However, the raphe region of seed coat is thin about 200 ${\mu}{\textrm}{m}$ in thickness and sclereids in that region are arranged regularly. This is the important cause for the cleavage of the seed coat during post-maturation process. The vascular bundles on the raphe are still remaining after sarcocarps are removed, and one of the branches of vascular bundles entered into the seed coat through the hilum and extended to chalazal region. During post-maturation process, the supply of water being necessary for growth of embryo may be accompolished by the vascular bundles entered into the seed coat through the opened hilum.

• Journal of Chest Surgery
• /
• v.6 no.2
• /
• pp.209-212
• /
• 1973

Because of the. rise in the incidence of high speed automobile accident and various gun shot wound, complicated vascular injuries are becoming more frequent. Inferior vena caval injury seems to be also in high incidence, but reports in the literature were rare. because of potentially lethal. Recently we have experienced a case of inferior vena caval injury due to stab wound on the posterior aspect of the right abdomen. This was successfully treated with inferior caval ligation on the both, proximal and distal of the injured infrarenal vena cava.

• Journal of Chest Surgery
• /
• v.17 no.2
• /
• pp.315-320
• /
• 1984

A vascular complication caused by lumbar disc surgery is not infrequent till recently after the report by Linton and White in 1945. Thereafter, many reports about the accidental injuries to the great vessels anterior to the lumbar area had been reported. In June, 1982, we experienced one case of arteriovenous fistula between right common lilac artery and inferior vena cava which was corrected surgically. The arteriovenous fistula caused by lumbar disc surgery and its review of the literature and presented.

• Archives of Reconstructive Microsurgery
• /
• v.10 no.1
• /
• pp.38-43
• /
• 2001

Introduction : The goal in the management of soft tissue injuries of the lower extremity is to obtain a closed stable wound as soon as possible. Recently, An anatomic study that has shown the role of the vascular axis that follows the superficial sensory nerves in supplying the skin developed the concept of a neuroskin island flap. It has been suggested that skin island flaps supplied by the vascular network of the saphenous nerve is one of the most reliable treatment to skin defect below the knee joint. Purpose : The aim of this article is to present a clinical experience of neuroskin island flaps based on the saphenous nerve and to estimate the clinical utilities of distally based saphenous neuroskin flap. Materials and Methods : From September 1995 to May 2000, a total 12 distally based neuroskin island flaps supplied by the vascular axis of the saphenous nerve were performed to cover defects in pretibial area below the knee. Result : flap necrosis due to reactivation of existing infection developed in a case that skin defect had been on infected nonunion site of tibia. But other 11 cases survived completely without any specific complications. Conclusion : The distally based neuroskin pedicled island flap using the vascular network of the saphenous nerve are versatile and reliable and especially indicated for limited defects in pretibial area below the knee joint which are not good indications for other better-known flaps.

• Journal of Trauma and Injury
• /
• v.36 no.4
• /
• pp.376-384
• /
• 2023

Purpose: The Armed Forces Trauma Center of Korea was established in April 2022. This study was conducted to report our 1-year experience of treating soldiers with open fractures of the lower extremity. Methods: In this case series, we reviewed the medical records of 51 Korean soldiers with open fractures of the lower extremity between April 2022 and March 2023 at a trauma center. We analyzed patients with Gustilo-Anderson type II and III fractures and reported the duration of transportation, injury mechanisms, injured sites, and associated injuries. We also presented laboratory findings, surgery types, intensive care unit stays, hospital stays, rehabilitation results, and reasons for psychiatric consultation. Additionally, we described patients' mode of transport. Results: This study enrolled nine male patients who were between 21 and 26 years old. Six patients had type II and three had type III fractures. Transport from the accident scene to the emergency room ranged from 75 to 455 minutes, and from the emergency room to the operating room ranged from 35 to 200 minutes. Injury mechanisms included gunshot wounds, landmine explosions, grenade explosions, and entrapment by ship mooring ropes. One case had serious associated injuries (inhalation burn, open facial bone fractures, and hemopneumothorax). No cases with serious blood loss or coagulopathies were found, but most cases had a significant elevation of creatinine kinase. Two patients underwent vascular reconstruction, whereas four patients received flap surgery. After rehabilitation, six patients could walk, one patient could move their joints actively, and two patients performed active assistive movement. Eight patients were referred to the psychiatry department due to suicidal attempts and posttraumatic stress disorder. Conclusions: This study provides insights into how to improve treatment for patients with military trauma, as well as medical services such as the transport system, by revising treatment protocols and systematizing treatment.

• Journal of Chest Surgery
• /
• v.53 no.5
• /
• pp.291-296
• /
• 2020

Background: We report our 10-year experience with traumatic peripheral arterial injury repair at an urban level I trauma center. Methods: Between January 2007 and December 2016, 28 adult trauma patients presented with traumatic peripheral arterial injuries. Data were retrospectively collected on demographic characteristics, the mechanism of injury, the type of vascular injury, and physiological status on initial assessment. The analysis also included the Mangled Extremity Severity Score (MESS), Injury Severity Score, surgical procedures, and outcome variables including limb salvage, hospital stay, intensive care unit stay, and postoperative vascular complications. Results: Four (14.3%) patients required amputation due to failed revascularization. MESS significantly differed between patients with blunt and penetrating trauma (8.2±2.2 vs. 5.8±1.3, respectively; p=0.005). The amputation rate was not significantly different between patients with blunt and penetrating trauma (20% vs. 0%, respectively; p=0.295). The overall mortality rate was 3.6% (1 patient). Conclusion: Blunt trauma was associated with higher MESS than penetrating trauma, and amputation was more frequent. In particular, patients with blunt trauma had significantly higher MESS than patients with penetrating trauma (8.2±2.2 vs. 5.8±1.3, respectively; p=0.005), and amputation was performed when revascularization failed in cases of blunt trauma of the lower extremity. Therefore, particular care is needed in making treatment decisions for patients with peripheral arterial injuries caused by blunt trauma.