• Journal of Chest Surgery
• /
• v.34 no.10
• /
• pp.769-774
• /
• 2001

Background: Descending necrotizing mediastinitis(DNM) is a serious complication originating in odontogenic or oropharyngeal infection with previously reported mortality rates of 25% to 40%. We retrospectively reviewed the 4 years of our surgical drainage and debridement in DNM. Material and Method: We studied 7 cases diagnosed as DNM from 1997 through 2000. Primary oropharyngeal infection lead to DNM in four cases(57%) and odontogenic abscess in three cases(43%). All patients were received emergent cervicotomy and thoracotomy or sternotomy for debridement of necrotic tissue and mediastinal or pleural drainage. Result: Five cases were evolved well and were discharged after a mean of 42 days. Two patients(28.6%) died. Three patients required reoperation due to local surgical complication; empyema(two) and impending cardiac tamponade. One of these patients died on 12 post-reoperative day due to great vessel erosion, renal and respiratory insufficiency. The other patient died of broncho- esophageal fistula and asphyxia on 10 postoperative day without reoperation. Conclusion: On the basis of experience accrued in treating these patients, early diagnosis by cervicothoracic computed tomographic scan of neck and thorax aids in rapid indication of a surgical approach of DNM. We emphasize that performing early surgical drainage and debridement of necrotic tissues with intensive postoperative care can significantly reduce the mortality rate.

• Journal of Korean Neurosurgical Society
• /
• v.64 no.6
• /
• pp.882-890
• /
• 2021

Objective : The aim of this study to investigate the benefits of patient-based 3-dimensional (3D) cerebral arteriovenous malformation (AVM) models for preoperative surgical planning and education. Methods : Fifteen patients were operated on for AVMs between 2015 and 2019 with patient-based 3D models. Ten patients' preoperative cranial angiogram screenings were evaluated preoperatively or perioperatively via patient-based 3D models. Two patients needed emergent surgical intervention; their models were solely designed based on their AVMs and used during the operation. However, the other patients who underwent elective surgery had the modeling starting from the skull base. These models were used both preoperatively and perioperatively. The benefits of patients arising from treatment with these models were evaluated via patient files and radiological data. Results : Fifteen patients (10 males and five females) between 16 and 66 years underwent surgery. The mean age of the patients was 40.0±14.72. The most frequent symptom patients observed were headaches. Four patients had intracranial bleeding; the symptom of admission was a loss of consciousness. Two patients (13.3%) belonged to Spetzler-Martin (SM) grade I, four (26.7%) belonged to SM grade II, eight (53.3%) belonged to SM grade III, and one (6.7%) belonged to SM grade IV. The mean operation duration was 3.44±0.47 hours. Three patients (20%) developed transient neurologic deficits postoperatively, whereas three other patients died (20%). Conclusion : Several technological innovations have emerged in recent years to reduce undesired outcomes and support the surgical team. For example, 3D models have been employed in various surgical procedures in the last decade. The routine usage of patient-based 3D models will not only support better surgical planning and practice, but it will also be useful in educating assistants and explaining the situation to the patient as well.

• Quality Improvement in Health Care
• /
• v.1 no.2
• /
• pp.44-59
• /
• 1994

Medical consumers(patients) want evening-clinic because of busy work. For patient's convenience and improving service, hospital should accept it. Considering payment system and patient's demand, personnel expenses, hospital can not accept. The practice of shift system to accept patient's demand and hospital's economic aspect was made. To analysis the effect of the system and probability to alternative to evening clinic this study was done. This study was composed of basal study, intervention, evaluation of effect. The basal study were composed of studying demand on evening clinic, the number of beds, doctors employee, the time table of practice and work, and the number of patients at arrival time. The intervention composed of changing of practice time, changing of working time by the number of patients at arrival time, increasing of employee. The evaluation of effect were composed of evaluating the number of patient at time, the effect of shift system, the comparison of the number of in and out patients and questionnairing the practice of shift system. In the practice time at 2 shift system First team works 7-15 hours and Second team 12-20 hours. there are no lunch and supper time. At 18-20 hours the number of patients were 25-30. The number of patient a depart were 6-7. The number of out-patient increase in 13% and inpatient increase in 10% before the system. Doctors(100%), employee(94.6%), and patients(86.4%) approved this system. The advantage of this system were utilization of surplus time, lengthen the practice time, even distribution of patients and shortening of waiting time, rapid treatment of emergent patients. The disadvantage of this system were shortage of manpower, not all depart practice, continuity of practice, no lunch and supper time, irregular rounding. At present because of small Demanding on evening clinic, this shift system was economical. To succeed this study more effectively all depart in hospital participate. But because of economical reason it is impossible for hospital to do it. If the government assist the economic loss that all depart participate in this system it is very helpful for hospital to succeed in implementing this system more early.

• Journal of Trauma and Injury
• /
• v.23 no.2
• /
• pp.68-74
• /
• 2010

Purpose: The purpose of this study is, first, to analyze the risk factors that influence the severity of injury in pediatric multiple trauma patients and, second, to present solutions for the problems related to the treatment of such patients. Our living situations are so complicated that the danger of accidents is truly open to children who are not prepared. We need to draw attention to the increased numbers of various accidents involving children. Methods: We studied patients who visited the Emergency Medical Center at Chosun University Hospital from January 1, 2006, to December 31, 2008. Using medical records, we evaluated the general characteristics: the mechanism of injury, the vital signs, the revised trauma score (RTS), the injury severity score (ISS), and the hemoglibin value, which was checked at the time of visit, and the presence or the absence of emergent on regular surgery. We divided the level of injury as follows: light level (1-8 points), mid level (9-15 points), and serious level (above 16 points). We analyzed the medical data by using SPSS 17.0 for windows. Results: The average age of the patients examined was 8.6 years. The number of 6- to 11-year-old patients was 96, which was the largest, but the degree of injury severity was the highest among infant (0-2 years), according to ISS 7.95(${\pm}6.85$). The frequency of accidents was highest on sunny days, and most accidents occurred from 16:00 to 20:00. The cause of multiple trauma for children was the greatest in the traffic accident, (95 patients, 49.0%). In addition, the trauma caused by traffic accidents showed the highest ISS value ($9.02{\pm}6.42$) and the most serious degree (P=0.004). The ISS level of injury ($8.40{\pm}6.64$) for patients moved from a secondary hospital was higher than that ($6.49{\pm}5.57$) for patients who visited the medical center directly. The severity of injury was highest for patients who used a 119 ambulance ($8.84{\pm}5.80$). According to the injured parts of body, Injuries to the arms and the feet most frequent (79 patients, 40.7%), but the level of injury was the highest for internal organs and chest, $16.42{\pm}8.56$ and $11.23{\pm}6.97$, respectively. Conclusion: We used Abbreviated Injury Scale (AIS) in order to examine the characteristics by injured body part for pediatric multiple trauma patients. Because the degree of injury was the highest for internal organs or the chest, we need to more seriously examine and provide for patients who are suspected of having injuries to the internal organs or the chest. We need to quickly determine the need for surgery in patients with serious injuries to the arms and the feet, which is the greatest in frequency. In particular, we need to consider the surgical care of patients who are not very high in the severity of injury to their brains.