ABSTRACT
PURPOSE: Eversion carotid endarterectomy (ECEA) has been used in western countries with acceptable early and late results. However, there has been no report of ECEA in Korea with regard to its safety and efficacy. The goal of the present study was to determine the early results of ECEA in Korea. METHODS: From October 2008 to December 2009, 19 ECEAs were performed on 18 patients by one vascular surgeon. The patient data and radiology results were prospectively collected according to the hospital protocol. The frequency of early postoperative stroke, myocardial infarction and mortality were evaluated. In addition, the frequency of procedure-induced new brain lesions (NBL) detected by diffusion-weighted MRI (DW-MRI) within one day after the procedure and the post-procedural complications were evaluated. RESULTS: All ECEAs were performed under regional anesthesia; shunts were not necessary in any of the cases. Among a total of 19 ECEAs, there were no cases of early postoperative stroke, myocardial infarction or mortality. Other early postoperative complications included one case of temporary cerebral hyperperfusion syndrome and two hematomas that spontaneously resolved. No NBL was detected on the postoperative DW-MRI. The external carotid artery lesion was aggravated in five cases and was detected on CT angiography before discharge. CONCLUSION: The results of this study showed no strokes or NBLs after ECEA under regional anesthesia. ECEA may be used safely for the management of atherosclerotic severe carotid stenosis in Korean patients; however, further study for long-term complications of ECEA is necessary.
Subject(s)
Humans , Anesthesia, Conduction , Angiography , Brain , Carotid Artery, External , Carotid Stenosis , Endarterectomy , Endarterectomy, Carotid , Hematoma , Korea , Myocardial Infarction , Postoperative Complications , Prospective Studies , StrokeABSTRACT
A virus-associated hemophagocytic syndrome is characterized by high fever, liver dysfunction, coagulation abnormalities, pancytopenia, and a benign histiocytic proliferation with prominent hemophagocytosis in bone marrow, lymph node, spleen, and liver. Three phases of disease progression can be defined. In the first week, there is mild leukocytosis and myeloid hyperplasia in the marrow and the fever is resistant to antipyretics and antibiotics. In the second phase, usually corresponding to the 2nd to 3rd week of the illness, the fever persists and jaundice and hepatosplenomegaly may develop and the marrow now reveals the presence of atypical or transformed T lymphocytes and a scattering of histiocytes with hemophagocytosis. In the third phase, the disease progresses to a full-blown hemophagocytic syndrome with coagulopathy and lung infiltrates. The marrow in this stage is usually hypoplastic with florid histiocytic proliferation and hemophagocytosis and the patients usually die within 1-2 months. We describe a pregnant woman with fatal hemophagocytic syndrome. Virologic study strongly suggests that Epstein-Barr virus implicated in the pathogenesis of this patient.
Subject(s)
Female , Humans , Pregnancy , Anti-Bacterial Agents , Antipyretics , Bone Marrow , Disease Progression , Fever , Herpesvirus 4, Human , Histiocytes , Hyperplasia , Jaundice , Leukocytosis , Liver , Liver Diseases , Lung , Lymph Nodes , Lymphohistiocytosis, Hemophagocytic , Pancytopenia , Pregnant Women , Spleen , T-LymphocytesABSTRACT
To increase the survival area of the venous flap, we studied the arterialized venous flap in a rabbit ear model. The ears of 12 New Zealand white rabbits(n=24) were randomized into three groups, group A receiving arterio-venous anastomosis 14 days before the arterialized venous flap elevation; group B receiving bipedicled flap elevation 14 days before arterialized venous flap elevation; group C receiving no pretreatment before the arterialized venous flap elevation. Tc -pertechnetate scan was performed on all groups immediately after the arterialized venous flap elevation to evaluate the blood flow of the flap. The survival area of the flap was measured 14 days after the arterialized venous flap elevation. Average ratio of survival area was 92% in Group A, 88% in group B, which were comparatively higher than the 12% in group C. The entire flap was visualized in groups A and B on scan images, however, only the proximal area of the anterior and posterior marginal vein was visualized in group C. Flap survival pattern was similar to that of the scan image and the slope of time-activity curve of groups A and B was much steeper than that of group C. High survival rate of group A, which received the arterio-venous anastomosis as a pretreatment, may be due to the decrease of resistance of outflow during the 14 days. Anticipated mechanisms involved are, valve insufficiency due to high pressure arterial inflow, development of vascular collaterals in the flap, and opening of arteriovenous(A-V) shunt. Bipedicled flap elevation as a pretreatment may not effect on valves, however, may impair the sympathetic nerve and cause ischmic stimuli which in turn may develop vascular collaterals and make an opening of the A-V shunt.
Subject(s)
Ear , New Zealand , Survival Rate , VeinsABSTRACT
Tanzer introduced the auricular reconstruction using autologous rib cartilage & full thickness skin graft for congential microtia correction in 1959. After then, many surgeons adapted various modified methods for total ear reconstruction. However, there are some problems in the stage of ear elevation with the conservative technique. Due to scar contracture, the auriculocephalic angle cannot be maintained with the skin graft alone. Nagata tried to overcome this problem by inserting rib cartilage covered by temporoparietal fascia to the elevated cartilage frame. However, this technique also induced several problems. 1st, it leaves a long scar and alopecia on the temporal scalp. 2nd, Nagata method requires a lot of cartilage in order to fabricate the 3-dimensional framework, sometimes leaving no cartilages to be used for the semilunar pillow in the ear elevation procedure. 3rd, this method cannot be used if the temporoparietal fascia was already used for another reason such as cartilage framework exposure. To overcome these problems, we used the silicone block and mastoid fascia flap instead of semilunar cartilage pillow and temporoparietal fascia flap. Since silicone is not an absorbable material, it can maintain good auriculocephalic angle. Furthemore, due to the excellent blood circulation of the mastoid fascia flap, there is a strong resistance to postoperative complications such as infection and extrusion. Other advantages are that it leaves short scars and is esthetically tolerable. This method may preserve the temporoparietal fascia and therefore, may be prepared for the 2ndary operation in case of the exposure of framework. From March 1995 to July 1997, 18 patients (14 males and 4 females) who ranged in age from 9 to 23 years underwent ear elevation using the silicone block and mastoid fascia flap. These patients had previous rib cartilage graft operations at 6 months before these operations. We did not find any complications such as infection, silicone implant extrusion and decreased auriculocephalic angle. During 6 to 26 months follow-up period (average follow-up period; 12 months), there was no case of decreased auriculocephalic angle. The clinical result of this technique was excellent at the stage of ear elevation.
Subject(s)
Humans , Male , Alopecia , Blood Circulation , Cartilage , Cicatrix , Contracture , Ear , Fascia , Follow-Up Studies , Mastoid , Menisci, Tibial , Postoperative Complications , Ribs , Scalp , Silicones , Skin , TransplantsABSTRACT
Tie-over dressing is commonly used in order to immobilize the skin graft. The classic method takes too much time and effort, and various apparatuses of the other modifications are somewhat large and bulky, especially in the surgery for hands, therefore, we have developed a simplified method for tie-over dressing. We placed several key stitches with absorbable suture material, and passed silk sutures from one margin of the graft to the opposite without tying. Then after putting saline-soaked cotton balls below and above the silk sutures, we tied the silk suture together applying appropriate pressure. This method has the following advantages: 1. speed of application 2. double compression 3. easy to remove
Subject(s)
Bandages , Hand , Silk , Skin , Sutures , TransplantsABSTRACT
The purpose of this study was to determine the efficacy of the CO2-laser energy in the operation of cleft palate and pharyngeal fiap compared with the traditional scalpel surgery. This investigation involved a series of 34 patients who underwent CO2-laser assisted palatoplasty and pharyngeal flap between 1995 and 1997. The 19 males and 15 females ranged from 13 months to 36 years in age (mean age of 5.6 years) at the time of surgery. The postoperative clinical follow-up ranged from 6 to 24 months (mean 12 months). The CO??-laser provided the surgeon with bloodless operative field with reduction in blood loss giving greater visibility. It also offered an advantage in deep surgical cavity in Ro-pharynx through an operative arm, reaching areas that would otherwise have been difficult to access by traditional means. There was less bleeding during the surgery using, and therefore, complication. associated with bleeding was minimalized. There were no significant differences in their wound healing between the traditional scapel method and the laser method. The mean hospitalization in the group using the laser was approximately one day less than the group using the scapel. Preliminary findings suggest that the laser assisted palatoplasty and pharyngeal flap has a definitive advantage in providing the surgeon with bloodless operative field, reduction of blood loss, early recovery. Disadvantages of the laser surgery is a learning curve, the expenses of equipment, and safety precaution.
Subject(s)
Female , Humans , Male , Arm , Cleft Palate , Follow-Up Studies , Hemorrhage , Hospitalization , Laser Therapy , Learning Curve , Wound HealingABSTRACT
Habitual snoring is common among males, especially among those who are overweight, and gets worse with the age. Snoring Is related to physical obstruction of breathing during sleep. This obstruction occurs when the palatal muscles, uvula muscles, and sometimes tonsiles relax during deep sleep and acts as vibrators. We have treated, with laser assisted uvulopalatoplasty(LAUP), twenty patients who suffer from snoring. CO2 laser was used and approximately I5-30 minutes of operation time was required. There were no singnificant complications, such as bleeding and asphyxia, in the 20 patients treated with LAUP. Results observed in the short term showed that 90% of the patients treated with LAUP considered thems to be essentially improved. Two patients developed scars at the posterior pillars. LAUP is a relatively simple and safe method which is performed at the hospital on an outpatient basis under local anesthesia.
Subject(s)
Humans , Male , Anesthesia, Local , Asphyxia , Cicatrix , Hemorrhage , Lasers, Gas , Muscles , Outpatients , Overweight , Palatal Muscles , Palatine Tonsil , Respiration , Snoring , UvulaABSTRACT
No abstract available.