• Health Policy and Management
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• v.7 no.2
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• pp.1-18
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• 1997

This study was conducted to analyze patient days and medical care benefits of finger-amputated patients due to industrial accident. The 161 personal data on medical care for finger-amputated patients due to industrial accident(88 in 1994, 73 in 1995) of Regional Labor Office and hospital characteristics were analyzed. The major results of this study were as follows : According to stepwise multiple regression analysis of patient days, number of amputated finger, location of hospital, bed capacity of hospital, presence of plastic surgery in hospital, number of orthopedic specialist per 100 beds, sick leave benefits per day were the major significant variables in order. In stepwise multiple regression analysis with medical care benefits as a dependent variable, presence of plastic surgery in hospital, number of orthopedic specialist per 100 beds, number of amputated finger, sick leave benefits per day, age, bed capacity of hospital were the major significant variables in order. The minimum optimal size with the lowest medical care benefits was a hospital with 300 beds. This shows that the economy of scale is also applicable for hospital industry. In summary, presence of plastic surgery in hospital, number of orthopedic specialist per 100 beds, number of amputated finger, sick leave benefits per day, bed capacity of hospital were the major significant variables in both patient days and medical care benefits.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.4
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• pp.381-390
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• 1991

The purpose of this study was to select the absorbable suture material with the lowest level of foreign body reaction in the extraoral field. The absorbable sutures tested were polyglactin 910(Vicryl), polyglycolic acid(Dexon), and chromic gut. Black silk served as to control suture. Eighteen domestic rabbits served as the animal model for testing purposes. After shaving the fur, A six centimeter incision was made in the hind quarter of all eighteen animals. Each wound was then closed wit two Vicryl, two Dexon, and two chromic gut sutures. All wounds were closed in the same manner. A similar wound was made on the oppsite side and closed with black silk suture. Three rabbits were then sacrificed on postoperative day one, three, seven fourteen, twenty-one, and twenty-eight. The surgical sites were then examined histologically. 1. On days one, three, and seven all suture materials as a similar severe level of inflammatory response. On the fourteenth day the inflammatory reaction of Vicryl was minimal, chromic gut was moderate, and Dexon was severe, Black silk control groups demosnstrated the most severe levels of inflammation of all sutures tested from day fourteen to twenty-eight. 2. On the fourteenth day all absorbable suture materials demonstrated similar minimal levels of resorption. At twenty-eight days Vicryl demonstrated a greater amount of resorption than Dexon or cromic gut suture. There was no resorption noted in the black silk control groups through day twenty-eight. 3. Due to its decreased level of inflammatory response in the animal model, Vicryl might be expected to as a decreased level of response in humans. It is felt that Vicryl is preferred to Dexon or chromic gut for extraoral suturing.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.20 no.4
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• pp.316-333
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• 1998

Obstructive sialadenitis of major salivary glands is a common entity that occurs either in sialolithiasis or in foreign-body obstruction of the excretory ducts. This is characterized histologically by the presence of duct-like structural groups in a highly fibrotic stroma. Although the pathologic features are well recognized, the various cell types involved in the atrophy and subsequent regeneration of the obstructed salivary gland have been controversial. For this reason, an animal model of obstructive sialadenitis that induced atrophy in the salivary gland was used. Experimental study was performed to observe changes of submandibular gland in rabbit and apply the results to clinical activity. Forty-five rabbits each weighing about 3Kg were used and divided into control and experimental group. In the experimental group, ducts of submandibular gland was ligated and cutted divided into each twenty rabbits. Rabbits were serially sacrificed on the 3rd, 5th, 14th, 30th day of experiment. The submandibular glands were dissected out at sacrifice and stained with H&E, MT, immunohistochemical stain and the histological examinations were carried out under the light and transmission electron microscope. After examination and comparison of all specimens, the results of this study were as follows: 1. In the features of H&E stain, moderate infiltration of inflammatory cell were present at 3rd day of experiment. The features of ductal metaplasia was observed after 7th day in the ligation group and destructive changes was continued. In the cutting group, atrophic changes were less severe than ligation group but the small ductule were separated from stroma after 7th day. 2. In the feature of MT stain, apposition of connective tissue was increased in all group, more active in ligation group. 3. In the features of immunohistochemical stain, ligation group showed increased PCNA positive response at 7th day and the higher activity of duct cells was observed. Severance group showed more PCNA positive response than ligation group at 30th day. 4. In TEM features, ductal metaplasia was started at 7th day and degenerative change with margination of nucleus had been severe. Although ductal metaplasia was seen in the severance group, more numerous granule in different size was founded than ligation group. From above results, degenerative change was identified with ductal metaplasia, apically apposition of granule, r-ER destruction in ligation group. Severance of duct elicit degenerative change of grandular cells but the change was less severe than ligation group and more PCNA positive cell was founded at acinar cell.

• Journal of Embryo Transfer
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• v.29 no.2
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• pp.183-188
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• 2014

A study was carried out on 16 indigenous ewes in Bangladesh in order to assess the reproductive physiology, the pattern of vaginal cell exfoliation and progesterone profiles during the estrous cycle period. The mean estrous cycle length and duration of estrus were $15.8{\pm}0.12$ days and $31.1{\pm}0.57$ h respectively. The exfoliated epithelial cells were categorized into parabasal, intermediate, superficial and keratinized and their relative occurrences. The percentages of parabasal, intermediate and superficial cell type during proestrus were similar. The percentage of superficial cell type during estrus was 61.7%, which was significantly (p<0.01) differ from other types of cells and stages of estrus cycle. Metoestrus was predominant with neutrophils in addition with other cell types. Dioestrus was dominated by neutrophils. On days 0 to 5 of the cycle the progesterone concentration was 0.09 to $1.6{\pm}0.07ng/ml$. The length of diestrus was 5~10 days with a range of mean progesterone level of $1.6{\pm}0.07$ to $2.8{\pm}0.11ng/ml$. Progesterone levels increased significantly (p<0.01) after Day 5 and maximum level was $2.8{\pm}0.11ng/ml$ observed on Day 10 of the estrous cycle. Thereafter it dropped rapidly to basal level of $0.11{\pm}0.04ng/ml$ on Day 0 (p<0.01). These results indicate that the pattern of exfoliation of vaginal cells along with progesterone concentration could be used to determine the reproductive stages of indigenous ewe.

• Advances in pediatric surgery
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• v.15 no.1
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• pp.18-26
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• 2009

The survival of Very Low Birth Weight (VLBW) infants has been improved with the advancement of neonatal intensive care. However, the incidence of accompanying gastrointestinal complications such as necrotizing enterocolitis has also been increasing. In intestinal perforation of the newborn, enterostomy with or without intestinal resection is a common practice, but there is no clear indication when to close the enterostomy. To determine the proper timing of enterostomy closure, the medical records of 12 VLBW infants who underwent enterostomy due to intestinal perforation between Jan. 2004 and Jul. 2007 were reviewed retrospectively. Enterostomy was closed when patients were weaned from ventilator, incubator-out and gaining adequate body weight. Pre-operative distal loop contrast radiographs were obtained to confirm the distal passage and complete removal of the contrast media within 24-hours. Until patients reached oral intake, all patients received central-alimentation. The mean gestational age of patients was $26^{+2}$ wks ($24^{+1}{\sim}33^{+0}$ wks) and the mean birth weight was 827 g (490~1450 g). The mean age and the mean body weight at the time of enterostomy formation were 15days (6~38 days) and 888 g (590~1870 g). The mean body weight gain was 18 g/day (14~25 g/day) with enterostomy. Enterostomy closure was performed on the average of 90days (30~123 days) after enterostomy formation. The mean age and the mean body weight were 105 days (43~136 days) and 2487 g (2290~2970 g) at the time of enterostomy closure. The mean body weight gain was 22 g/day after enterostomy closure. Major complications were not observed. In conclusion, the growth in VLBW infants having enterostomy was possible while supporting nutrition with central-alimentation and the enterostomy can be closed safely when the patient's body weights is more than 2.3 kg.

• Radiation Oncology Journal
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• v.12 no.1
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• pp.99-107
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• 1994

Among the 63 patients with histopathologically proven primary squamous cell anal cancer who were managed in Presbyterian Medical Center and Yonsei University Cancer from Jan. 1971 to Dec. 1991, 34 patients, who were managed with surgery alone(abdominoperineal resection) or post-operative radiotherapy and concurrent chemoradiotherapy were analysed. With mean follow up time of 81.3 months, 30 Patients(88$ \% $) were followed up from 17 to 243 months. In methods, 10 patients were treated with surgery alone. 9 Patients were treated with combined surgery and postoperative radiotherapy(50$\∼$60 Gy in 28$\∼$30 fractions). 15 patients were treated with concurrent chemoradiotherapy. Chemotherapy (Mitomycin C 15 mg/squ, bolus injection day 1;5-FU, 750 mg/squ, 24hr infusion, day 1 to 5) and radiotherapy started the same day. A dose of 30 Gy was given to the tumor and to the pelvis including inguinal nodes, in 15 fractions. After 2 weeks a boost of radiotherapy(20 Gy) to the ano-perineal area and second cycle of chemotherapy completed the treatment. The overall 5-year survival rate was 56.2$ \% $. Concurrent chemoradiotherapy group was 70$ \% $ and surgery alone group was 16.7$ \% $. According to the cox proportional harzard model, there was significant difference between survival with concurrent chemoradiotherapy and surgery alone(p=0.0129), but post-operative radiotherapy was 64.8$ \% $, which was not stastically significant(p=0.1412). In concurrent chemoradiotherapy group, the anal funtion Preservation rate was 87$ \% $ and the severe complication rate(grade 3 stenosis and incontinence) was 13.3$ \% $. In conclusion, we conclude that the concurrent chemoradiotherapy may be effective treatment modality in patients with anal cancer.

• Journal of Chest Surgery
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• v.32 no.1
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• pp.53-57
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• 1999

We describe a case of successful extracorporeal membrane oxygenation(ECMO) in a small infant with cardiopulmonary resuscitation(CPR) failure after an open heart surgery. A 35-day-old male infant weighing 4.4 kg who had congestive heart failure and pulmonary hypertension underwent patch closure of ventricular septal defect without any intraoperative event. Postoperative course was unremarkable in the intensive care uint for about 5 hours before the junctional ectopic tachycardia developed. Sudden cardiac decompensation with bradycardia occurred about 50 minutes after the development of junctional ectopic tachycardia. He was put on ECMO by arterial cannulation at the ascending aorta and by venous cannulation at the right atrial appendage after 4 hours' CPR. The hemodynamics were stable with enough urine output during ECMO. He was weaned from ECMO 38.5 hours after initiation. Delayed sternal closure was attempted. He was extubated on postoperative day 7 and discharged home on postoperative day 21 without any neurologic sequelae.

• The Korean Journal of Pain
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• v.33 no.1
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• pp.40-47
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• 2020

Background: Duloxetine is an antidepressant that is also useful in chronic neuropathic and central origin pain. In this study, the role of duloxetine in decreasing acute postoperative pain after lumbar canal stenosis surgery is explored. Methods: In this single center, triple blinded, and placebo-controlled trial, 96 patients were randomized for statistical analysis. The intervention group received oral duloxetine 30 mg once a day (OD) for 2 days before surgery, 60 mg OD from the day of surgery to the postoperative second day and 30 mg OD for the next 2 days (a total duration of 7 days). A placebo capsule was given in the other group for a similar time and schedule. The same standard perioperative analgesia protocols were followed in both groups. Results: Total morphine consumption up to 24 hours was significantly decreased in the duloxetine group (P < 0.01). The time to the first analgesia requirement was similar in both groups but the time to the second and third dose of rescue analgesia increased significantly in the duloxetine group. The time to ambulation was decreased significantly (P < 0.01) in the duloxetine group as compared to the placebo group. Pain scores remained similar during most of the time interval. No significant difference was observed in the complication rate and patient satisfaction score recorded. Conclusions: Duloxetine reduces postoperative pain after lumbar canal stenosis surgery with no increase in adverse effects.

• Journal of Chest Surgery
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• v.18 no.4
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• pp.718-731
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• 1985

Renal dysfunction is a common complication of open-heart surgery: a form of controlled hemorrhagic shock, and successful perioperative management of renal dysfunction depends on recognition of the risk factors and optimal management of factors influencing renal function, including cardiopulmonary bypass, and early detection of renal failure. Changes in renal functional parameters including Ccr, Cosm, CH2O, FENa, and RFI were observed prospectively in forty five patients operated on at Dept. of Thoracic and Cardiovascular Surgery, S.N.U.H., from April to June, 1985. They were 23 males and 22 females with 35 acquired and 10 congenital heart diseases and the mean age and body surface area of them were 38.010.3 years [22-63] and 1.5518 M2[1.151.92] respectively. Followings are the conclusion. 1. The Ccr, representative of renal function, is significantly improved from 90.231.3 ml/min/M2 preoperatively to 101.536.4 ml/min/M2 postoperative and day [P<0.05], and all patients were classified as postoperative renal functional class I of Abel, which representing adequate renal protection during our cardiopulmonary bypass. 2. The Cosm is significantly elevated at immediate postperfusion time and remained high at postoperative one day representing osmotic diuresis at that time, but CH2O shows no significant changes at immediate postperfusion period and is decreased significantly at postoperative one day, representing recovery of renal concentrating ability at that time with decreasing urine flow. 3. The absolute value and changing tendency in FENa and RFI during perioperative period shows no diagnostic reliability on these parameters, but those of CH2O appear to reveal future renal function more accurately than Ccr 4. The depth of hypothermia may be protective upon renal function against the ill effects of prolonged nonpulsatile cardiopulmonary bypass. 5. The depth of the hypothermia, pump time of more than 150 minutes, poor cardiac function, and intraoperative events such as embolism appear to be related with immediate postperfusion renal function. 6. Hemoglobinuria and hemolysis, poor preoperative renal function, history of cardiac surgery, and massive transfusion associated with bleeding appear not to be related with renal dysfunction.

• Journal of Clinical Nutrition
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• v.10 no.2
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• pp.51-55
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• 2018

Purpose: This study was conducted to assess how extreme obesity affects 30-day mortality in this patient group. Methods: A total of 802 patients who underwent emergency gastrointestinal surgery from January 2007 to December 2017 were retrospectively reviewed. Patients were divided into three groups according to their body mass index (BMI): group 1, normal weight (BMI: $18.5{\sim}22.9kg/m^2$); group 2, overweight (BMI: $23.0{\sim}29.9kg/m^2$ ); and group 3, obesity ($BMI{\geq}30kg/m^2$). Patients with a BMI under 18.5 were excluded from the analysis. Chi-squared test, Fisher's exact test, Kaplan-Meier survival analysis, and the log-rank test were used to assess and compare 30-day mortality rates between groups. Results: The mortality rates of group 1, group 2, and group 3 were 11.3%, 9.0%, and 26.9%, respectively (P<0.017). The mortality rate did not differ significantly between group 1 and 2 (11.3% vs. 9.0%; P=0.341), but group 1 and 2 showed better survival rates than group 3 (11.3% vs. 26.9%; P=0.028, 9.0% vs. 26.9%; P=0.011). Kaplan-Meier survival analysis revealed that group 3 had higher mortality than the other two groups (P=0.001). Conclusion: Obesity ($BMI{\geq}30kg/m^2$) was one of the risk factors influencing critically ill patients who underwent emergency surgery.