• Journal of Chest Surgery
• /
• v.25 no.12
• /
• pp.1542-1549
• /
• 1992

From March 1986 to August 1992, 18 patients underwent diaphragmatic plication for the diaphragmatic paralyses complicating various pediatric cardiac procedures. Age at operation ranged from 16 day to 84 months with mean age of 11.8 months. In order of decreasing incidence, the primary cardiac procedures included modified Blalock-Taussig shunt [ 5 ], Arterial switch operation [ 4 ], modified Fontan operation [ 2 ], and others [ 7 ]. The suspicious causes of phrenic nerve injury included overzealous pericardial resection [ 7 ], direct trauma during the procedure [ 6 ], dissection of fibrous adhesion around the phrenic nerve [ 3 ] and unknown etiology [ 2 ]. The involved sides of diaphragm were right in 10, left in 7 and bilateral in one. The diagnosis was suspected by the elevation of hem-idiaphragm on chest x-ray and confirmed by fluoroscopy. The interval between primary operation and plication ranged from the day of operation to 38 postoperative days [mean : 14 days]. The method of plication were "Central pleating technique" described by Schwartz in 16 and other techniques in 2. Five patients expired after plication and the cause of death were not thought to be correlated directly with the plication itself. In the remaining 13 survivors, extubation or cessation of positive ventilation could be done between the periods of the day of plication and 14th postoperative days [mean; 3.8day]. We have made the following conclusions : 1] Phrenic nerve paralyses are relatively common complication after pediatric cardiac procedures and the causes of phrenic nerve injury are mostly preventable; 2] Phrenic nerve palsy is associated with corisiderable morbidity; 3] diaphragmatic plication is safe, reliable and can be applicable in patients who are younger age and require prolonged positive pressure ventilation.ntilation.

• Korean Journal of Head & Neck Oncology
• /
• v.23 no.2
• /
• pp.170-173
• /
• 2007

About 20% of non-Hodgkin' lymphoma occur in the extra-nodal region in the head and neck area and more than half of extra-nodal lymphoma in the head and neck area involves the Waldeyer' ring. Malignant lymphoma arising in the parotid glands are relatively rare, although 90% of all salivary gland lymphomas, appear in parotid gland and are classified as extranodal non Hodgkin' lymphoma. We experienced one rare case of non-Hodgkin' lymphoma in the right parotid gland, with a painless swelling of the cheek region as the chief complaint. We treated with CHOP(cyclophosphamide, $750mg/m^2$ i.v. day1 ; doxorubicin, $50mg/m^2$ i.v. day 1 ; vincristine, $1.4mg/m^2$ i.v. day 1;prednisone, $50mg/m^2$ orally days 1 to 5. repeat every 21 days) and Rituximab combination therapy. We aimed to report here one case of non-Hodgkin' lymphoma in the right parotid gland with review of literature.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.20 no.3
• /
• pp.250-255
• /
• 1998

The purpose of this study was to evaluate the histologic change of the inferior alveolar nerve according to distraction amount following mandibular lengthening. Seven rabbits weighing about 2 kg were used. Corticotomy was performed on the mandibular body anterior to the right first premolar region and unilateral external fixation device was placed. Every effort was made to preserve the inferior alveolar nerve during the corticotomy. The rabbits were then allowed to heal for 7 days without distraction of the device. The mandible was lengthened 0.36 mm/day, 0.76 mm/day, or 1.0 mm/day. Corticotomy and lengthening of mandible were not performed in control group. After the completion of the lengthening process, a 14-day-consolidation period was allowed. After consolidation, rabbits were sacrificed, and histologic examination of the inferior alveolar nerve was performed. The results obtained were as follows : 1. In the control group, normal trifascicular pattern of inferior alveolar nerve was observed. Epineurium, perineurium, endoneurium, and axon with myelin sheath were observed in normal appearance. 2. In 0.36 mm/day distraction group, the trifascicular pattern was normally shown, and there was no destruction in epineurium, perineurium, and endoneurium. The mild changes including myelin attenuation, axoplasmic swelling and darkening were observed. 3. In 0.72 mm/day distraction group, it was possible to differentiate the epineurium from the perineurium. Two normal fascicles and one injuried fascicle were observed with a partially destructed perineurium. Most of the axons had axoplasmic swelling and darkening. 4. In 1 mm/day distraction group, it was difficult to differentiate the nerve structures such as fascicles, epineurium, perineurium, and endoneurium. The axons were severely destroyed, except few which showed decreases in size and changes in shape. Some collagen matrices were observed around the axons. These results suggest that the higher the distraction amount, the more severe the injury to the inferior alveolar nerve, fascicles, axons. Although distraction osteogenesis may be useful, the amount of distraction should be carefully selected.

• Journal of Chest Surgery
• /
• v.18 no.2
• /
• pp.205-213
• /
• 1985

It is well documented that calcium is essential to cardiac contraction and the amplitude of contractility is proportional to the ionized calcium not to total calcium. Changes of serum ionic calcium before and after extracorporeal circulation were observed in fifty two patients operated on at Dept. of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, from May 21st, 1984, to July 6th, 1984. They were 28 males and 24 females including 21 acyanotic congenital heart diseases, 21 cyanotic congenital heart diseases, and 10 acquired valvular heart diseases. In general, preoperative serum ionic calcium was around the normal level, but those of immediate postoperative day and postop-first day were decreased subnormally with significance [P<0.05 vs. preop.]. From postop-third day, serum ionic calcium was returned to normal range. No significant difference was noticed in subgroups divided by 10 Kg of body weight and by the methods of myocardial protection. But the change of serum ionic calcium in the patients with prolonged pump time over 90 minutes was remarkable and the values were as follow; on immediate postop-day 1.780.18 mEq/L vs. 1.970.20 mEq/L [P<0.005],on postop-first day, 1.940.20mEq/L vs. 2.060.12 mEq/L [P<0.025], on postop-third day, 2.030.11mEq/L vs. 2.150.13mEq/L [P<0.01], and on postop-seventh day, 2.030.09mEq/L vs. 2.190.11mEq/L [P<0.005]. In summary, the serum ionic calcium was lowered after extracorporeal circulation and even severer degree according to the prolongation of bypass time. So, after extracorporeal circulation esp. in the cases with prolonged bypass time, early correction of lowered serum ionic calcium would be helpful to the postoperative hemodynamics.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.20 no.4
• /
• pp.355-361
• /
• 1998

The purpose of this study was to examine the effects of the fibrin adhesive (Beriplast$^{(R)}$) on healing of full-thickness wounds in the rat's hard palate. Twenty Spraque-Dawley strain white male rats, each weighing 250~300 gm were used. Creation of full-thickness wounds of $4{\times}4mm$ in size were performed on the hard palate. Beriplast$^{(R)}$, a wound dressing material, was applied immediately in the experimental group, but not applied in the control group. All wounds were protected with palatal resin splints. The animals were sacrificed on the 2nd, 4th, 7th, 14th, and 28th day after the operation for macroscopic and microscopic examinations. Results obtained were as follows ; 1. On the 7th day after the operation, epithelial proliferation was greater in the experimental group than that in the control group. 2. The inflammatory reaction of the experimental group was less than the control group on the 2nd and 4th day after the operation. Beriplast was resorbed on the 7th day after the operation. 3. In the control group, the epithelial proliferation occurred from the 7th to the 14th day after the operation, and in the experimental group, epithelial proliferation occurred from the 4th day after the operation. 4. On the 14th and 28th day after the operation, there was no prominent difference between the two groups in histological findings. These results suggest that the use of fibrin adhesive (Beriplast$^{(R)}$) as a palatal wound dressing results in greater epithelial proliferation and less inflammation in the early stage of wound healing.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.21 no.1
• /
• pp.23-28
• /
• 1999

ALP (alkaline phosphatase) is a membrane-bound metalloenzyme that is expressed in osteoblasts, hepatocytes, lung, kidney, endothelial cells, leukocytes and other cells. Normal soft tissue and skin show little tissue nonspecific ALP (TN-AP), However, scar tissue contains high levels of TN-AP activity, and in fact, TN-AP is expressed intensely in regenerating connective tissue after the wounding. The purpose of this study was to evaluate the change of ALP expression in hypertrophic scar model in rabbits and the effect of triamcinonolone on ALP expression. Adult male New Zealand white rabbits, weighing about 2.5 kg, were used. After full-thickeness wounding over the ventral surface of each ear, either saline (control ear) or triamcinolone (contralateral ear) was injected on day 16. Rabbits were sacrificed on day 3, 7, 15, 17, 19, 23, and the specimens were retrieved en bloc. Histologic and immunohistochemical examinations of tissue samples were done. The results obtained were as follows: On day 3, ALP reaction was observed on fibroblasts and inflammatory cells in wound margin. On day 7, ALP reaction was more intense than day p in capillaries, inflammtory cells, and fibroblasts behind newly formed epithelium. On day 15, ALP reaction was lessened in both groups and appeared mainly in subepidermal capillary network, Since day 17, ALP reaction was lessened in both groups and weaker in triamcinolone-injected group than in saline-injected group. These results suggest that ALP reaction isn't increased in triamcinolone-injected scar and triamcinolone reduces scar not by increasing TN-AP expression but other mechanism.

• Journal of Korean Foot and Ankle Society
• /
• v.26 no.4
• /
• pp.177-182
• /
• 2022

Purpose: The efficacy and safety of low-dose pregabalin and alpha lipoic acid in diabetic neuropathy were evaluated and analyzed. Materials and Methods: This study designed a retrospective study that included patients with diabetic neuropathic pain. From 2009 to 2022, 100 patients who suffered from diabetic neuropathic pain were included in this study. The patients were divided into group I (pregabalin 150 mg/day with alpha lipoic acid 600 mg/day) and group II (pregabalin 300 mg/day with alpha lipoic acid 600 mg/day). The visual analogue scale (VAS), medication side effects, and neurometer results were compared. Results: The mean follow-up period of the above patients was 120.23 weeks in group I and 149.05 weeks in group II. The average VAS score in group I decreased by 3.23 points, and the average VAS score in group II decreased by 2.86 points. Approximately 24.3% of group I had side effects, such as dizziness, sleepiness, and gastrointestinal trouble, while 76.7% of patients in group II had side effects. Sixtyseven patients had a neurometer examination before and after the medication, and there is no statistical difference between the two groups. Conclusion: The combination of low-dose pregabalin (pregabalin 150 mg/day) and alpha lipoic acid in diabetic neuropathy had a similar clinical effect and less frequent medication side effects than regular dose pregabalin (pregabalin 300 mg/day) and alpha lipoic acid. Therefore, low-dose pregabalin (pregabalin 150 mg/day) and alpha lipoic acid should be considered in treating diabetic neuropathy.

• Archives of Plastic Surgery
• /
• v.38 no.5
• /
• pp.576-584
• /
• 2011

Purpose: The shape and location, the amount of the wound and the characteristics of the remaining tissues are known to influence wound contraction. The previous studies using small animals have not been an appropriate model because the wound healing mechanisms and skin structures are different from those of the human. The purpose of this study is to evaluate wound contraction according to the shape and location of the wound using a $Micropig^{(R)}$. Methods: Four $Micropigs^{(R)}$ (Medikinetics, Pyeongtaek, Korea) that were 10 months of age weighed 25 kg were used. Full thickness skin defects were made by clearing all the tissues above the fascial layer in the shape of square, a regular triangle and a circle of 9 $cm^2$ each on the back around the spine. Eight wounds were created on the back of each pig, 50 mm apart from each other. The randomly chosen wound shapes included 11 squares, 11 regular triangles, and 10 circles. Wound dressing was done every other day with polyurethane foam. The wound size was measured using a Visitrak $Digital^{(R)}$ (Smith & Nephew, Hull, UK) on every other day after surgery from day 2 to day 28. A biopsy was performed on day 3, and 1, 2, 3 and 4 weeks to investigate the degree of acute and chronic inflammation, the number of microvesssel and myofibroblast density using H & E stain and immunohistochemistry. The wound contraction rate was calculated to figure out the differences among each of the shapes and the locations. Results: The ultimate shape of the circle wound was oval, and that of the regular triangle and square were stellate. The maximum contraction rate was obtained on 8 to 10 days for all the shapes, which corresponds with the immunohistochemical finding that myofibroblast increases in the earlier 2 weeks whereas it decreases in the later 2 weeks. Epithelialization was seen in the wound margin on day 7 and afterwards. The final wound contraction rates were highest for the regular triangle shapes; however, there were no statistically significant differences. The wound contraction rates by locations showed statistically significant differences. The wound in the cephalic area presented more contractions than that of the wounds in the caudal area. Conclusion: The location of a wound is more important factor than the wound shape in wound contraction.

• Archives of Plastic Surgery
• /
• v.42 no.2
• /
• pp.194-200
• /
• 2015

Background Surgical site infections (SSIs) result in significant patient morbidity following immediate tissue expander breast reconstruction (ITEBR). This study determined a single institution's 30-day SSI rate and benchmarked it against that among national institutions participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Methods Women who underwent ITEBR with/without acellular dermal matrix (ADM) were identified using the ACS-NSQIP database between 2005 and 2011. Patient characteristics associated with the 30-day SSI rate were determined, and differences in rates between our institution and the national database were assessed. Results 12,163 patients underwent ITEBR, including 263 at our institution. SSIs occurred in 416 (3.4%) patients nationwide excluding our institution, with lower rates observed at our institution (1.9%). Nationwide, SSIs were significantly more common in ITEBR patients with ADM (4.5%) compared to non-ADM patients (3.2%, P=0.005), and this trend was observed at our institution (2.1% vs. 1.6%, P=1.00). A multivariable analysis of all institutions identified age ${\geq}50$ years (odds ratio [OR], 1.4; confidence interval [CI], 1.1-1.7), body mass index ${\geq}30kg/m^2$ vs. < $25kg/m^2$ (OR, 3.4; CI, 2.6-4.5), and operative time >4.25 hours (OR, 1.9; CI, 1.5-2.4) as risk factors for SSIs. Our institutional SSI rate was lower than the nationwide rate (OR, 0.4; CI, 0.2-1.1), although this difference was not statistically significant (P=0.07). Conclusions The 30-day SSI rate at our institution in patients who underwent ITEBR was lower than the nation. SSIs occurred more frequently in procedures involving ADM both nationally and at our institution.

• Clinics in Shoulder and Elbow
• /
• v.26 no.4
• /
• pp.380-389
• /
• 2023

Background: Total shoulder arthroplasty (TSA) with a nonspherical humeral head component and inlay glenoid is a successful bone-preserving treatment for glenohumeral arthritis. This study aimed to describe the 90-day complication profile of TSA with this prosthesis and compare major and minor complication and readmission rates between inpatient- and outpatient-procedure patients. Methods: A retrospective review was performed of a consecutive cohort of patients undergoing TSA with a nonspherical humeral head and inlay glenoid in the inpatient and outpatient settings by a single surgeon between 2017 and 2022. Age, sex, body mass index, American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), and 90-day complication and readmission rates were compared between inpatient and outpatient groups. Results: One hundred eighteen TSAs in 111 patients were identified. Mean age was 64.9 years (range, 39-90) and 65% of patients were male. Ninety-four (80%) and 24 (20%) patients underwent outpatient and inpatient procedures, respectively. Four complications (3.4%) were recorded: axillary nerve stretch injury, isolated ipsilateral arm deep venous thrombosis (DVT), ipsilateral arm DVT with pulmonary embolism requiring readmission, and gastrointestinal bleed requiring readmission. There were no reoperations or other complications. Outpatients were younger with lower ASA and CCI scores than inpatients; however, there was no difference in complications (1/24 vs. 3/94, P=1.00) or readmissions (1/24 vs. 1/94, P=0.37) between these two groups. Conclusions: TSA with a nonspherical humeral head and inlay glenoid can be performed safely in both inpatient and outpatient settings. Rates of early complications and readmissions were low with no difference according to surgical setting. Level of evidence: IV.