A Case of Left Brachiocephalic Vein Total Occlusion Due to Acute Thrombosis Soon after Permanent Pacemaker Insertion

Symptomatic pacing lead-associated thrombosis is very uncommon occurring in 0.5-3.5% of pacemaker implants. Especially thrombisis-induced total occlusion occures almost in late stage over several months to years but acute thrombosis occurring several days after venous pacing has not been reported. In this case, We performed upper limb venography in the patient who presented edema and pain of neck, left upper limb and headache as well as intermittent cough occurring in bending forward. A venogram confirmed acute thrombus completely occluding the left brachiocephalic vein and the patient received intravenous heparin and was maintained on warfarin. Repeated veno- graphy after treatment for 30 days revealed persistent thrombus with total occlusion which not be improved signi- ficantly copmpared to previous venogram and collateral veins diverting the blood to the contralateral side and into the superior vena cava was developed. The patient's symptoms resolved almost and that is likely to be due to the development of collateral venous channels.

Establishment of Transsphenoidal Approach in Skull Base Surgery: A Historical Analysis / 의사학

Many approaches are being used for exposure of the anterior cranial base regions, ranging from extracranial to intracranial, such as transsphenoidal approach. This intracranial approach, developed in the beginning of the twentieth century, has recently become one of the most commonly used approaches after many incremental improvements. This thesis aims at examining the development of the approach and those who contributed to this procedure. The author also contemplate problems which may occur in the historical analysis. From the nineteenth century, advances have been made in anesthesiology, sterilization, cerebral localization and knowledge of anatomical and physiologic aspects of the skull base. The development of new knowledge and technique has helped to overcome obstacles, making surgery of the skull base through extracranial approach both technically feasible and therapeutically effective. To avoid serious postoperative complications after the extracranial approach, transsphenoidal approach had been developed in the beginning of the twentieth century. Transsphenoidal approach had been widely used right after its introduction. But it had not been used popularly since late 1920s in the United States. In early 1960s, this technique, spread from Europe, has regained popularity and become one of the most widely-used approaches. In the history of the transsphenoidal approach, it has been thought that the effort of Harvey Cushing and Oskar Hirsch, the endeavor of Cushing's scholars, several new attempts of otolaryngologists played an important role. However, comparing to great appreciation of neurosurgeons, especially Harvey Cushing on their significant contribution to the further development of this technique, the role of other pioneering doctors have been underestimated in previous historical studies on the transsphenoidal approach. It was because dynamical relationships among several specialties had influence on the historical analysis. This cases shows that historical analysis is influenced not only by past figures but also by current situations.