• Journal of Chest Surgery
• /
• 제18권1호
• /
• pp.36-45
• /
• 1985

During the twelve-year period from March 1973 through July 1984, 23 consecutive operations for coarctation of the aorta were performed at Seoul National University Hospital. The patients included 19 male and 4 female in the range of 4 months and 16 years old. Associated cardiac anomalies were present in 19 patients [70%] and they were VSD+PDA [9 patients], VSD[2], PDA[1], VSD+ASD+PDA[1], VSD+MS+AS+PDA[1], D-TGA+VSD+PDA[1], P-ECD[1], MS[1], Al[1], and DORV+PDA[1]. The preoperative main symptoms included congestive heat failure, hypertension, subacute bacterial endocarditis and nonspecific symptoms. Congestive heart failure was the most common symptom in the group younger than 2 years and hypertension in the adult group. Operative techniques for coarctation of the aorta were resection and end to end anastomosis in 10 patients, prosthetic patch aortoplasty in 8, subclavian flap aortoplasty in 4, and LSCA-aortic anastomosis in 1. There were 4 operative deaths among the nine patients less than 2 years old[44.4% mortality]: all of these patients had associated cardiac anomalies. And only one operative death occurred in patients older then 2 years old[7.1% mortality]. No hospital death occurred in patients with isolated coarctation of the aorta. Operation of the coarctation was performed primarily in 6 patients associated with ventricular septal defect and subsequently underwent successful VSD closure except one operative death.

• Advances in pediatric surgery
• /
• 제6권1호
• /
• pp.40-44
• /
• 2000

Congenital esophageal stenosis (CES) is a narrowing of the esophageal lumen from birth. Three types of CES have been described; tracheobronchial remnants (TBR), membranous web (MW), and fibromuscular stenosis (FMS). We reviewed the clinical features and the surgical outcome of 14 patients, pathologically confirmed as CES. Nine patients had TBR, 3 FMS, and 2 MVV. The mean age at operation was 3.8 years. Five patients were boys and 9 girls. Four patients had other congenital anomalies. Segmental resection of the lesion and end to end anastomosis was utilized in all cases except one who underwent myotomy. The stenotic segment was located at the distal esophagus in all patients. There were 8 complications in 6 patients, but no mortality. The mean follow-up period was 68 months. There were no feeding problems but 3 patients had minor gastroesophageal reflux. Our result indicates that segmental resection and anastomosis is a satisfactory surgical procedure in the management of CES.

• 한국임상수의학회지
• /
• 제39권6호
• /
• pp.405-410
• /
• 2022

An 11-year-old thoroughbred post-partum broodmare presented with the symptoms of colic. The physical and clinical examinations indicated a large colon displacement or volvulus. Immediate surgical intervention was performed, and a strangulating large colon volvulus (LCV) was defined as a volvulus of >540° in the counterclockwise direction. After correcting and assessing the gut viability, approximately 80% of the entire large colon was resected and anastomosed using an end-to-end technique. With supportive care after surgery, the horse regained its appetite and vitality without significant clinical complications and was discharged on postoperative day 9. This report presents the first surgical correction using a large colon resection and anastomosis (LCRA) and the critical care for a strangulating LCV in a horse in Korea. This case enhances the current knowledge of clinical LCV and the related considerations for treatment.

• Journal of Chest Surgery
• /
• 제10권2호
• /
• pp.281-294
• /
• 1977

Superior vena cava to pulmonary arterial shunting operation was made between the superior vena cava and the right pulmonary artery in the fashion of end-to-end anastomosis in 20 mongrel dogs. The experimental animals were divided into three group and blood flow in the superior vena cava was occluded for 20, 30 and 60 minutes respectively, and observations were made for the changes in caval pressure and cerebrospinal fluid pressure. And pathologic examinations were also performed. On occluding the caval blood flow, the superior vena caval pressure was sharply and immediately elevated from $103.5{\pm}19.8mmH_2O$ at thoracotomy to $556.4{\pm}86.lmmH_2O$ within 2 minutes to make its plateau thereafter, and the cerebrospinal fluid pressure followed closely the changes of the superior vena caval pressure in its level and pattern being elevated from $102.0{\pm}19.9mmH_2O$ to $490.5{\pm}79.9mmH_2O$. The drops of both the caval and cerebrospinal fluid pressures were definite and marked on opening the shunt flow through the anastomosis, but these postoperative pressures retained still higher ones above their levels measured at thoracotomy. The pathological examinations of the brain and the spinal cord were also performed in six animals. Characteristic changes uniformly seen in all area and in all animals were the findings of capillary congestion and perivascular edema. On the other hand, ischemic nerve cell changes were rather evident, revealing their degrees and extents being related to the prolongation of the time of caval occlusion which has followed by the sustained high pressures in both the superior vena and the cerebrospinal fluid. The experiment suggests the safety of this surgical procedure with minimal, if any, permanent damage as long as the occlusion of the caval blood flow is not prolonged beyond the expected.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제22권1호
• /
• pp.22-32
• /
• 2000

Purpose : Histopathologic observation was performed in order to determine which type of suture material is superior in microvascular anastomoses. Materials & Methods : The interrupted end to end anastomosis of the transected carotid arteries of 105 Sprague-Dawley rats, weighing 180 to 200g, were performed using 9-0 polypropylene ($Prolene^{TM}$, Ethicon, U.K.), 9-0 polyglactin 910 monofilament($Vicryl^{TM}$, Ethicon, U.K.), and 9-0 polyamide($Ethilon^{TM}$, Ethicon, U.K.) under intramuscular Ketamine and Xylazine anesthesia(5mg/100g). In all cases, 10 to 12 sutures were placed to complete the anastomoses. The specimens were obtained at 1, 2, 3 days, and 1, 2, 4 and 6 weeks after the surgery and prepared with H&E and Van-Gieson stains and investigated the histologic changes in anastomotic sites under light microscope. The histologic changes we were concerned about were followings- thrombus formation, intimal edema, infiltration of inflammatory cells in media and adventitia, proliferation of endothelial cells and subintimal hyperplasia. Results : 1. All of the anastomosed arteries were patent when they were exposed for examination. 2. Thrombus formation and intimal edema were most severe in Vicryl group, followed by Ethilon, Prolene group in order. 3. The inflammatory cells infiltrated to the media and the adventitia most severely in Ethilon group, followed by Vicryl, Prolene group in order. 4. There was little difference in proliferation of endothelial cells in each group. 5. Subintimal hyperplasia was greater in Vicryl group than the others, but there was no significant difference between the Prolene and Ethilon groups. Conclusions : On the basis of these observations, we could conclude that Prolene may be the better suture material for microvascular anastomoses regarding the tissue responses than Ethilon and Vicryl.

• Journal of Chest Surgery
• /
• 제33권7호
• /
• pp.565-569
• /
• 2000

배경; 기관 협착의 가장 흔한 원인은 기관 삽관에 따른 합병증이다. 기관 협착에 대한 치료 방침은 병변의 범위에 따라 달라진다. 전막부분의 국소적인 병변의 경우에는 레이저 절제요법을 적용할 수 있지만, 기관의 전층에 병변이 있는 경우는 기관 절제 후 단단 문합 수술을 시행하여야 좋은 치료 결과를 얻을 수 있다. 대상 및 방법; 경상대학교병원 흉부외과에서는 1998년 4월부터 1999년 5월까지 기관 삽관의 합병증으로 발생한 기관협착증 환자 12명에게 기관협착부위를 절제하고 단단 문합 수술을 시행하였다. 결과; 수술 후 사망자는 없었고, 조기 합병증으로 일시적인 성대마비가 5명, 창상 감염이 1명에서 발생하였다. 수술 후 평균 18개월간 추적하는 동안 재협착은 발견되지 않았다. 결론; 기관 삽관 후 발생한 기관협착증에 대한 외과적 치료로서 절제 및 단단 문합술은 비교적 우수한 치료버빙라 할 수 있다.

• 대한의용생체공학회:학술대회논문집
• /
• 대한의용생체공학회 1997년도 춘계학술대회
• /
• pp.334-337
• /
• 1997

Von Mises stress and compliance distribution was evaluated using a finite element analysis on the end-to-side anastomosis of an artery with length of $20\sim24mm$, inner diameter of 4mm, thickness of 0.5mm and a PTFE graft with length of 10mm, inner diameter of 2mm, thickness of 0.2mm when the anastomotic angle was taken from $30^{\circ}\sim90^{\circ}$ in every $10^{\circ}$ and the diameter ratio from $0.1\sim1$ in every 0.1. The inner pressure of $1330dyne/mm^2$ was applied inside the 2 conduits. It was found that the compliance whose magnitude is larger on the acute angle anastomotic side than on the acute angle side became larger as the anastomotic angle became smaller and the diameter ratio larger and that the equivalent stress on the acute angle anastomotic side was larger than that on the abtuse angle side and became larger as the anastomotic angle and the diameter ratio became larger.

• 대한의용생체공학회:의공학회지
• /
• 제19권2호
• /
• pp.183-188
• /
• 1998

동맥과 PTFE 재료로 된 대체혈관이 혈관폐색이 생긴 부위를 우회하기 위하여 단측문합이 되었을 때 문합각의 변화에 의한 영향을 살펴보기 위하여 두 혈관의 직경비를 0.5로 고정하고 문합각을 30$^{\circ}$에서 90$^{\circ}$까지 $10^{\circ}$간격으로 변화시켜 컴플라이언스와 응력의 분포형태를 살펴보고 또한 직경비의 영향도 살펴보기 위하여 문합각을 45$^{\circ}$로 고정하고 직경비를 0.1에서 1까지 0.1간격으로 변화시켜 컴플라이언스와 응력의 변화를 살펴보았다. 단측문합비에 사용된 모델은 20-24mm, 내경 4mm, 두께 0.5mm의 동맥과 길이 10mm, 내경 2mm, 두께 0.2mm의 PTFE 대체혈관이 사용되었으며 문합각이 작아지거나 직경비가 커질수록 예각 문합부의 컴플라이언스가 점점 더 커진다는 것을 알았다.

• 대한의용생체공학회:의공학회지
• /
• 제15권2호
• /
• pp.143-150
• /
• 1994

Wall shear rate or stress is believed to be a major hemodynamic variable influencing atherosclerosis and artery-graft anastomic intimal hyperplasia. The purpose of this study is to verify the effects of radial wall motion, artery-graft compliance and diameter mismatch, and impedance phase angle on the wall shear rate distribution near an end-to-end artery-graft anastomosis model. The results show that radial wall motion of the elastic artery model lowers the mean wall shear rates under pulsatile flow condition by 15 to 20 % comparing to those under steady flow condition at the same mean flow rate. Impedance phase angle seems to have small effects on the mean and amplitude of the wall shear rate distribution. In order to study the effects of compliance and diameter mismatch on the wall shear rates, two models are studied-Model I has 6% and Model I has 6% and Model II has 11% smaller graft diameter. Divergent geometry caused by diameter mismatch near the distal sites reduces the mean wall shear rates significantly, and this low shear region is believed to be prone to intimal hyperplasia.

• Journal of Chest Surgery
• /
• 제23권5호
• /
• pp.1021-1026
• /
• 1990

The patients with tracheal stenosis have become more increasing in recent due to the increased use of tracheostomy and assisted ventilation Anesthetic management during tracheal reconstruction is a concern to the anesthetist and the surgeon, who must share the airway as a operation field and at the same time provide good gas exchange. Multiple technique such as the tube ventilation system or C \ulcornerP bypass method have been recommended to achieve this goals. However, these methods have disadvantages of poor surgical exposure and hemorrhagic complication from using C \ulcornerP bypass The technique for HFJV was first described for bronchoscopy, and it involves positive-pressure breathing with high flow[40 \ulcorner60L/min] of oxygen This flow is directed to a semirigid catheter inserted in the endotracheal tube and the tracheal reconstruction can be done without interruption. From Dec. 1986 to July 1990 we have experienced 6 patients of tracheal stenosis necessitating circumferential resection and end to end anastomosis; 5 patients with tracheal stenosis following cuffed tracheostomy or intubation, a patient with tracheal stenosis due to invasive thyroid cancer. The specific advantages during tracheal reconstruction are unobstructed field during surgical reconstruction and good gas exchange through the procedure.