• Title/Summary/Keyword: Bleeding focus

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Timing and Causes of Vascular Compromise in Breast Reconstruction with Free TRAM flap (복직근 유리 피판을 이용한 유방 재건에서 혈관성 이상 소견에 의한 재수술의 시점 및 원인)

  • Kim, Ji yeon;Chang, Hak;Minn, Kyung Won
    • Archives of Plastic Surgery
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    • v.36 no.5
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    • pp.555-558
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    • 2009
  • Purpose: The high success rate of free flap transfers is well documented in previous literature, and is possible due to the early detection of vascular compromise and timely reoperation. We specifically analyzed the operative results of immediate and delayed reconstruction with free transverse rectus abdominis musculocutaneous(TRAM) flap respectively in order to reveal its distinctive features on timing and causes of vascular compromise. Methods: The senior author operated on 158 patients, 161 cases of free TRAM flap for breast reconstruction. 51 patients underwent delayed reconstruction, whilst immediate reconstruction was performed in the other 107 patients. All patients were monitored every 3 hours for the first 3 days. We reviewed medical records of all patients, and tested statistical significance with the Fisher's test. Results: Reoperation was performed in 20 cases, but the cases include hematoma with bleeding focus and arterial anastomosis site rupture due to abrupt arm abduction. We performed reoperation in 15 cases of suspicious vascular compromise. Flap compromise was noticed mostly within 24 hours, but not longer than 72 hours. Venous compromise was dominant by 11 cases (73.3%). There was difference in the timing of flap compromise between immediate and delayed reconstruction. All the cases of delayed reconstruction did not show signs of vascular compromise after 12 hours postoperatively. On the other hand, cases of vascular compromise were observed until 72 hours postoperatively in cases of immediate reconstruction. Conclusion: Delayed reconstruction showed vascular compromise within 12 hours postoperatively, while immediate reconstruction showed compromised until the 3rd postoperative day. If more aggressive monitoring is maintained during this period, we believe salvage of flaps may be increased with more efficiency.

Modern Contraception and Anaemia Among Reproductive-age Women in India: Results From a Household Survey

  • Mihir Adhikary;Poulami Barman;Bharti Singh;Abhishek Anand
    • Journal of Preventive Medicine and Public Health
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    • v.57 no.4
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    • pp.339-346
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    • 2024
  • Objectives: Chronic anaemia is a significant health concern, particularly among women of childbearing age. Factors such as menstrual blood loss, childbirth, inadequate nutrition, closely spaced pregnancies, and recurrent gastrointestinal bleeding increase the risk of anaemia. This study investigated whether current contraceptive methods are associated with anaemia in Indian women of reproductive age. Methods: Cross-sectional data from the fifth round of the National Family Health Survey, conducted in 2019-2021, were used for this investigation. We included only non-pregnant and non-amenorrhoeic women in our analysis, resulting in a final analytical sample of 673 094 women aged 15-49. Bivariate cross-tabulations and multivariable logistic regression were employed to analyse the data. Results: The prevalence of anaemia was 57%, and the adjusted regression models found no significant association between the use of any contraceptive methods and women's haemoglobin status. Women using traditional contraceptive methods had 1.08 (95% confidence interval, 1.05 to 1.11) times higher odds of having anaemia. Among the modern methods, other than injectables, all other methods-such as an intrauterine device, barrier use, and sterilisation-were associated with higher odds of anaemia compared to women who used contraceptive pills. Conclusions: This study explored the relationship between modern contraceptives and haemoglobin levels in India, revealing that injectables were associated with a notable reduction in the odds of anaemia, whereas traditional contraceptives and other modern methods exhibited positive associations with anaemia. These findings prompt policymakers to focus on anaemia reduction and safe contraceptives. More research is needed to inform decisions, given the scant literature.

Surgical Management of Multidrug Resistant Pulmonary Tuberculosis (다제내성 폐결핵 환자에서의 수술적 치료)

  • 성숙환;강창현;김영태;김주현
    • Journal of Chest Surgery
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    • v.32 no.3
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    • pp.287-293
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    • 1999
  • Background: Medical treatment of multiple drug resistant(MDR) pulmonary tuberculosis has been quite unsuccessful. We analyzed our experience to identify the benefits and complications of the pulmonary resection in MDR pulmonary tuberculosis. Material and Method: A retrospective review was performed in 27 patients who unerwent pulmonary resection for MDR pulmonary tuberculosis between January 1994 and March 1998. Mean age was 40 years and the average history of diagnosis prior to surgery was 3.1 years. All had resistance to an average of 4.4 drugs, and received second line drugs selected according to the drug sensitivity test. Most patients (93%) had cavitary lesions as the main focus. Bilateral lesions were identified in 19 patients (70%), however, the main focus was recognized in one side of the lung. Eleven patients (41%) were converted to negative sputum smear and/or culture before surgery. Result: Pneumonectomy was performed in 9 patients, lobectomy in 16 and segmentectomy in 2. There was no operative mortality. Morbidity had occurred in 7 patients (26%), prolonged air leak in 3 patients, reoperation due to bleeding in 2, bronchopleural fistula in 1, and reversible neurologic defect in 1. Median follow up period was 15 months (3-45 months). Sputum negative conversion was initially achieved in 22 patients (82%), and with continuous postopertive chemotherapy negative conversion was achieved in other 4 patients (14%). Only one pneumonectized patient (4%) failed due to considerable contralateral cavity. Conclusion: For patients with localized MDR pulmonary tuberculosis and with adequate pulmonary reserve function, surgical pulmonary resection combined with appropriate pre and postoperative anti-tuberculosis chemotherapy can achieve high success rate with acceptable morbidity.

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Special quality research about action output waveform change by gap (1.0mm and 1.6mm)difference of skin excessive expense $CO_2$ Laser (피부과용$CO_2$ 레이저의 공극(1.0mm및 1.6mm)차이에 따른 동작출력 파형변화에 관한 특성 연구)

  • Kim, Whi-Young
    • Journal of the Korea Computer Industry Society
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    • v.8 no.2
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    • pp.107-112
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    • 2007
  • Laser wave length can have evaporation effect by absorption because outer skin or tissue of focus is consisted of water almost though absorption of water occurs more than 90% almost in formation thickness of very thin floor. Can operate outer skin, steam by floor and correct incision of formation is available. Suture surgical operation is available to vein or lymph system and surgical operation region can dry and see as eye and radish bleeding surgical operation is available. Specially, stability of tube both end output about pulse by weight very, this research can cause various curative effect because can reduce bulk and control easily current wave style of medical laser using electric power conversion device of high frequency way. If introduce ZVS (Zero Voltage Switching) or ZVZCS (Zero Voltage and Zero Current Switching), is more profitable because can reduce switching damage. Because electric power department of proposed medical laser can do stable soft-switching in wide subordinate extent introducing ZVZCS technique by the first help and control department composes microcontroller, output current waveform user have free form make Result that experiment because design and manufacture, brought result that improve of 20% than existing equipment, and will be bought to get into superior result if supplement as systematic late.

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A Study on the Collateral Vessel Pathology(絡脈病機) of Blood Disease(血證) in Onbyeong(溫病) with focus on Ju-Gaek-Gyo(主客交, guest-host minglement) and Dry Blood(乾血) (온병(溫病) 혈증(血證)의 낙맥병기(絡脈病機)에 대한 고찰 -주객교(主客交)와 건혈(乾血)을 중심으로-)

  • Kim, Dong-Hui;Jeong, Chang-Hyun;Jang, Woo-Chang;Lyu, Jeong-Ah;Baik, You-Sang
    • Journal of Korean Medical classics
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    • v.25 no.1
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    • pp.89-115
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    • 2012
  • Objective : Blood disease is common these days due to modern man's excessiveness in Yang heat (陽熱) and vulnerability of the Eum blood(陰血). This exposes them to warmheat/ dampness-heat diseases, where pathogenic heat easily penetrates the blood dimension(血分) creating stagnated blood(瘀血). Consequently, pathogenic symptoms in the collateral vessels increase, making it crucial to understand the pathogenic mechanism of the disease. Method : This paper examines the condition and region of the collateral vessel diseases(CVD) according to the blood diseases of Onbyeong, by analyzing each prescription's matching symptom. The disease in question in this paper is 'stagnated blood fixated in the collateral vessels'. Therefore diseases with stagnated blood in the Yang collaterals and Viscera collaterals or viscera themselves from the chapter of "On-Yeok-Ron(溫疫論)", and < Dry Blood-DaeWhangJaChungWhan(大黃蟅蟲丸) > chapter of "Geum-Gue-Yo-Rak(金匱要略)", were examined respectively. Result & Conclusion : The process of CVD according to the blood diseases of Onbyeong can be summarized as follows. First, bleeding in the Yang and Bowel collaterals, then stagnation in the Yang and Bowel collaterals, and finally stagnation in the viscera collaterals or Liver itself. The refractory nature of blood stagnation symptoms of the collateral vessels is mainly due to the characteristics of the collateral vessel itself. In structure, they are very narrow and small, situated at the most terminal part of the body where it is difficult for the Jeong Gi(精氣) to reach. Also, as they are symptomatic of degeneration of Jeong Gi, the root of the disease is very deep. Therefore to resolve blood stagnation in the cases of Ju-Gaek-Gyo and Dry Blood, general approaches using 'Gi communication(行氣)' or 'Blood vitalizing(活血)' medicinals will not suffice. Special medicinals such as crustacean and insects need to be appropriately applied.

Pulmonary Endometriosis (폐 자궁내막 증식증 1예)

  • Kim, Ki-Joong;Cho, Yoon-Hyung;Choi, Byeong-Kee;Choi, Eui-Young;Chang, Yoon-Su;Kim, Hyung-Jung;Ahn, Chul-Min;Cho, Sang-Ho;Rhu, Jin-A.
    • Tuberculosis and Respiratory Diseases
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    • v.47 no.3
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    • pp.389-393
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    • 1999
  • Endometriosis is defined as an extrauterine growth of endometrial tissue and it is primarily limited in the pelvis but it can also occur in the pleural cavity as well as pulmonary parenchyme. The diagnosis of pulmonary endometriosis is usually based on the clinical history of recurrent hemoptysis in association with menstrual cycle and by histopathologic confirmation of endometrial tissue in the lung parenchyme. Pulmonary endometriosis was first reported by Lattes in 1956. and dozens of cases have been reported so far. We experienced a case of 25 year old single woman with a history of hemoptysis in association with her menstruation. The bleeding focus was localized with chest CT scan and repeated fibrooptic bronchoscopy and basal segmentectomy of the right lower lobe was performed. The resected specimen shows endometrial stroma and glands of early proliferative phase with respiratory epithelium on the laterobasal bronchus. Her postoperative course was uneventful with no recurrence of hemoptysis during 6 months of follow-up in the outpatient clinic.

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The study of Needs and Demands for First Aid Education of School Health Educator (보건교사의 응급처치 교육 필요도 및 교육 요구도에 관한 연구)

  • Choi, Uk-Jin;Cho, Keun-Ja
    • The Korean Journal of Emergency Medical Services
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    • v.12 no.1
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    • pp.27-41
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    • 2008
  • Purpose : With increasing number of school accidents, it is crucial to find out necessity of first aid training among school health educator. This study has been conducted to have an clear idea on the demands and necessity for first aid training and what kind of training is most required from school health educator. Method : In this study, questionnaires from 87 school health educator in elementary, middle and high school health educator in the city D were analyzed. The survey was carned out from May 26, 2008 to June 7, 2008 and from the collected data, frequency, independent two samples t-test, paired T-test, one way ANOVA and pearson's correlation were conducted with SPSS 14.0. Result: 1. 51.61 % of nurse-teachers experienced emergency situations and the relations between the necessity they felt from experiencing those situations and demands for first aid training were not statistically meaningful(t=1.87, p= .175). 2. Necessity and demands for the first-aid training were checked with three point scale and there were statistical significance between the two with $2.44{\pm}.47$ and $2.24{\pm}.47$ respectively(t=3.275, p= .000). 3. 86.20%(75 persons) of the respondents have had received first aid training and the training they received were CPR 82.75%(72 persons), primary survey 81.60%(7l persons), contact to 911 79.30%(69 persons) and wounds treatment(lacerated wounds, bum and chilblains) 75.86%( 66 persons) in order. 4. As for the questions that ask on confidence of first-aid treatment, 80% answered they are confident on some limited kinds of treatments, 16% said they are confident and 4% answered they lack confidence. As for the treatment that they can show the highest confidence, wounds treatment topped the list with 93.24%, nose bleeding and removing foreign substance, and stanching followed the list with 82.43% and 81.08% respectively. 5. 97.67% of respondents said they were willing to take training and 89.62% answered to take the training to deal with emergency situations that are taking place in their schools. As for the question that asks for the most wanted treatments, CPR topped the list with 32.18%(28 persons) and treatment for obstruction of airway and shock followed the list with 35.63%(31 persons) and 27.59%(24 persons). Conclusion : Currently, first aid treatment has been centered on CPR, primary survey, contact to 119 and wounds treatment. However, since most of school health educator are fairly confident with wounds treatment, stanching and other first aids, in future training it will be more desirable to focus on CPR and treatment for obstruction of airway and shock that were shown to be most wanted by school health educator.

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Periodontal pathogens and the association between periodontitis and rheumatoid arthritis in Korean adults

  • Kim, Jin-Hee;Choi, In Ah;Lee, Joo Youn;Kim, Kyoung-Hwa;Kim, Sungtae;Koo, Ki-Tae;Kim, Tae-Il;Seol, Yang-Jo;Ku, Young;Rhyu, In-Chul;Song, Yeong Wook;Lee, Yong-Moo
    • Journal of Periodontal and Implant Science
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    • v.48 no.6
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    • pp.347-359
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    • 2018
  • Purpose: Periodontitis and rheumatoid arthritis (RA) share a similar inflammatory pathogenesis. Porphyromonas gingivalis (Pg) can induce anticyclic-citrullinated peptide autoantibodies (anti-CCP antibodies), a key factor in the development of RA. This study aimed at evaluating the relationships between the 2 diseases and identifying the clinical implications thereof, with a focus on periodontal pathogens in Korean adults. Methods: A total of 260 RA patients and 86 age- and sex-matched control patients without arthritis were enrolled in this prospective cross-sectional study. Periodontal indices and the prevalence and amount of periodontal pathogens were compared between the groups. Correlations between periodontal and RA indices were examined, as were correlations between 9 periodontal pathogens and RA indices. Results: The RA group had significantly higher values than the control group for all investigated periodontal indices (P<0.05) except the number of teeth. The gingival index (GI) was correlated with the disease activity score 28 (DAS28) (r=0.125, P=0.049), RA disease duration (r=0.253, P<0.001), erythrocyte sedimentation rate (ESR) (r=0.162, P=0.010), and anti-CCP antibody titer (r=0.205, P=0.004). Probing pocket depth (PPD) was correlated with ESR (r=0.139, P=0.027) and anti-Pg antibody titer (r=0.203, P=0.001). Bleeding on probing (BOP) was correlated with DAS28 (r=0.137, P=0.030), RA disease duration (r=0.202, P=0.001), ESR (r=0.136, P=0.030), anti-Pg antibody titer (r=0.177, P=0.005), and anti-CCP antibody titer (r=0.188, P=0.007). Clinical attachment level (CAL) and periodontitis severity were correlated with anti-Pg antibody titer (the former r=0.201, P=0.002; the latter r=0.175, P=0.006). The quantity of Pg was positively correlated with the serum anti-Pg antibody titer (r=0.148, P=0.020). Conclusions: The GI, BOP, and PPD showed positive relationships with several RA indices. The anti-Pg antibody titer had positive relationships with PPD, BOP, CAL, and periodontitis severity. Thus, increasing values of periodontal indices could be used as a risk indicator of disease development in RA patients, and an increasing anti-Pg antibody titer could be considered as a warning sign in RA patients suffering with periodontitis.

Case Study on an Oral Health Care Program for Older Adults Based on a Public-Private-Academic Partnership

  • Jin-Sun Choi;Soo-Myoung Bae;Sun-Jung Shin;Bo-Mi Shin;Hye-Young Yoon;Hyo-Jin Lee
    • Journal of dental hygiene science
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    • v.24 no.2
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    • pp.115-123
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    • 2024
  • Background: The population of Gangneung City in South Korea has shown a gradual increase in the proportion of individuals aged 65 years and older, and the most frequently reported diseases for several years have consistently been periodontal diseases, including gingivitis and periodontitis. The regional imbalance in the distribution of dental personnel and resources has emerged as a problem of inequality in the use of dental care. It has been advocated to identify areas with disadvantages in dental care and develop public dental policies based on that. This study aimed to develop a customized oral healthcare program for local seniors based on a Public-Private-Academic Partnership, and to evaluate the oral health status of older adults in Gangneung City. Methods: The participants were residents aged 60 years and above in Gangneung City. A questionnaire including general information, systemic health status, and oral health status was administered to the participants. In addition, oral healthcare and education tailored to each individual's health status were provided once or twice based on their oral health status. The collected data were analyzed using IBM SPSS Statistics 25 for descriptive statistical analysis. Results: Among the older adults in Gangneung City, 75% had at least one prosthesis and exhibited symptoms of gingivitis or periodontitis. Additionally, the modified sulcus bleeding index decreased among participants who underwent the program twice. Over 90% of the participants expressed satisfaction with the program. Conclusion: The program appeared to contribute positively to the oral health promotion among local seniors. Further oral healthcare programs should focus on seniors in rural and old urban areas to reduce disparities in oral health across regions.