• 제목/요약/키워드: General Surgery

검색결과 3,344건 처리시간 0.031초

대동맥판막재치환술 후 발생한 발살바동 파열을 동반한 심박조율도관 심내막염 (Pacemaker Lead Endocarditis Combined with Rupture of Sinus Valsalva after Redo Aortic Valve Replacement)

  • 백만종;나찬영;오삼세;김웅한;황성욱;이철;강창현;장윤희;조원민;김재현;서홍주;김종환
    • Journal of Chest Surgery
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    • 제36권10호
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    • pp.780-783
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    • 2003
  • 심박조율도관 관련 심내막염은 드물지만 치명적인 합병증이다. 과거 기계판막을 이용한 이중판막치환술 및 영구 심박조율기 삽입 후 발생한 발살바동 파열이 있었던 45세 남자로 간헐적인 고열을 주소로 입원하였다. 혈액균배양 검사에서 streptococcus viridans 배양 및 경식도초음파 검사에서 조율도관 및 삼첨판막에 유동성이 있는 큰 증식물이 관찰되어 심박조율도관 관련 심내막염으로 진단하였다. 항생제 치료 후 조율도관의 제거술과 증식물 및 감염조직의 절제술을 시행하였다. 술 후 4주 동안 항생제 투여를 지속하였으며 경과는 양호하였다. 퇴원 후 심내막염의 재발 소견이나 증상없이 외래통원 치료중이다.

Dynamic Reconstruction of Anal Sphincter with Camera Shutter Style Double-Opposing Gracilis Flaps

  • Allen Wei-Jiat Wong;Grace Hui-Min Tan;Frederick Hong-Xiang Koh;Min Hoe Chew
    • Archives of Plastic Surgery
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    • 제50권5호
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    • pp.496-500
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    • 2023
  • Fournier's gangrene is a life-threatening infection which requires prompt recognition, early surgical debridement of unhealthy tissue, and initiation of broad-spectrum antibiotics. Relook debridement are usually performed until all the devitalized tissue has been removed. Involvement of the anal sphincter may result in significant morbidity such as permanent incontinence. Dynamic reconstruction of the anal sphincter has always been one of the holy grails in the field of pelvic reconstruction. We demonstrate a new method of camera shutter style double-opposing gracilis muscle flaps that allows dynamic sphincteric function without the need for electrostimulation. The bilateral gracilis muscles are inset in a fashion that allows orthograde contraction of the muscle to narrow and collapse the neoanal opening. With biofeedback training, the patient is able to regain dynamic continence and return to function without a stoma. There was also no need for neurotization or microsurgery techniques to restore sphincteric function to the anus. The patient was able to reverse his stoma 14 months after the initial insult and reconstruction with biofeedback training without the use of electrostimulation.

Low-cost model for pancreatojejunostomy simulation in minimally invasive pancreatoduodenectomy

  • Hiang Jin Tan;Adrian Kah Heng Chiow;Lip Seng Lee;Suyue Liao;Ying Feng;Nita Thiruchelvam
    • 한국간담췌외과학회지
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    • 제27권4호
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    • pp.428-432
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    • 2023
  • Minimally invasive pancreatoduodenectomy (MIS PD) is a well reported technique with several advantages over conventional open pancreatoduodenectomy. In comparison to distal pancreatectomy, the adoption of MIS PD has been slow due to the technical challenges involved, particularly in the reconstruction phase of the pancreatojejunostomy (PJ) anastomosis. Hence, we introduce a lowcost model for PJ anastomosis simulation in MIS PD. We fashioned a model of a cut pancreas and limb of jejunum using economical and easily accessible materials comprising felt fabric and the modelling compound, Play-Doh. Surgeons can practice MIS PJ suturing using this model to help mount their individual learning curve for PJ creation. Our video demonstrates that this model can be utilized in simulation practice mimicking steps during live surgery. Our model is a cost-effective and easily replicable tool for surgeons looking to simulate MIS PJ creation in preparation for MIS PD.

Long-term outcomes of nail bed reconstruction

  • Koh, Sung Hoon;You, Youngkee;Kim, Yong Woo;Kim, Jin Soo;Lee, Dong Chul;Roh, Si Young;Lee, Kyung Jin;Hong, Min Ki
    • Archives of Plastic Surgery
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    • 제46권6호
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    • pp.580-588
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    • 2019
  • Background There are various reconstructive options for nail bed defects. However, it is challenging not to leave a deformity. In this study, we investigated differences in outcomes depending on the reconstruction method, attempted to determine which method was better, and analyzed other factors that may affect outcomes. Methods The long-term outcomes of nail bed reconstruction were reviewed retrospectively. We performed three types of reconstruction depending on the defect type: composite grafts of severed segments, nail bed grafts from the big toe, and two-stage surgery (flap coverage first, followed by a nail bed graft). Subsequent nail growth was evaluated during follow-up, and each outcome was graded based on Zook's criteria. The reconstruction methods were statistically analyzed. Other factors that could contribute to the outcomes, including age, the timing of surgery, germinal matrix involvement, defect size, and the presence of bone injuries, were also compared. Results Twenty-one patients (22 digits) who underwent nail bed reconstruction were evaluated. The type of reconstruction method did not show a significant relationship with the outcomes. However, patients who sustained injuries in the germinal matrix and patients with a defect larger than half the size of the nail bed had significantly worse outcomes than the comparison groups. Conclusions The results suggest that no operative method was superior to another in terms of the outcomes of nail bed reconstruction. Nevertheless, involvement of the germinal matrix and defect size affected the outcomes.

상악골에 발생한 비뇌감염형 Mucormycosis 1례 (RHINOCEREBRAL MUCORMYCOSIS ON MAXILLA : A CASE REPORT)

  • 허원실;이민정;강승우;오상윤;백경식;최규철
    • Maxillofacial Plastic and Reconstructive Surgery
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    • 제15권1호
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    • pp.21-25
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    • 1993
  • We experienced a case of rhinocerebral form of mucormycosis in a 9-year-old male suffered from acute lymphocytic leukemia (FAB $L_2$). On 15th day of induction chemotherapy (Hospital day 23) pain, tenderness and swelling on left maxillary area of face were noticed. We confirmed mucormycosis by biopsy of mass in left maxillary sinus. He expired on Hospital day 47.

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족근 관절외에 발생한 활액막 연골종증의 치료 - 1예 보고 - (Treatment of Extraarticular Synovial Chondromatosis of the Ankle - A Case Report -)

  • 이원용;박병문;송경섭;임대의;김형규;강영훈
    • 대한족부족관절학회지
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    • 제6권1호
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    • pp.111-116
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    • 2002
  • Synovial chondromatosis is an uncommon benign lesion characterized by metaplastic cartilage formation within the synovial connective tissue, usually intraarticular, commonly affects the knee, hip and elbow. An extraarticular lesion is rare, most often seen in a synovial sheath and bursa of the hand or foot. We present a case of extraarticular synovial chondromatosis in the left ankle, originated from the FHL tendon sheath of a 31 year-old-female diagnosed by a radiography, MRI confirmed histopathologically.

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Prognostic Value of Preoperative Inflammation-Based Prognostic Scores on Hospital Mortality after Gastric Cancer Surgery

  • Dinc, Tolga;Yildiz, Baris Dogu;Kayilioglu, Ilgaz;Sozen, Isa;Tez, Mesut;Coskun, Faruk
    • Asian Pacific Journal of Cancer Prevention
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    • 제15권18호
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    • pp.7909-7911
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    • 2014
  • Gastric cancer is the fourth most common malignancy worldwide. Poor prognosis in gastric cancer is linked with hypoalbuminemia. Previous studies demonstrated relationships between gastric cancer and chronic inflammation. The aim of this study was to assess the prognostic value of preoperative inflammation-based prognostic scores regarding hospital mortality after gastrectomy. Unlike other recent articles on the same topic; we could only verify prognostic value of prognostic nutritional index for in hospital mortality after surgery.

Could Tumor Size Be A Predictor for Papillary Thyroid Microcarcinoma: a Retrospective Cohort Study

  • Wang, Min;Wu, Wei-Dong;Chen, Gui-Ming;Chou, Sheng-Long;Dai, Xue-Ming;Xu, Jun-Ming;Peng, Zhi-Hai
    • Asian Pacific Journal of Cancer Prevention
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    • 제16권18호
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    • pp.8625-8628
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    • 2016
  • Background: Central lymph node metastasis(CLNM) is common in papillary thyroid microcarcinoma (PTMC). The aim of this study was to define the pathohistologic risk grading based on surgical outcomes. Materials and Methods: Statistical analysis was performed to figure out the optimal cut-off values of size in preoperative ultrasound images for defining the risk of CLNM in papillary thyroid microcarcinoma. Receiver operating characteristic curves (ROC) studies were carried out to determine the cutoff value(s) for the predictor(s). All the patients were divided into two groups according to the above size and the clinic-pathological and immunohistochemical parameters were compared to determine the significance of findings. Results: The optimal cut-off value of tumor size to predict the risk of CLNM in papillary thyroid microcarcinoma was 0.575 cm (area under the curve 0.721) according to the ROC curves. Significant differences were observed on the multifocality, extrathyroidal extension and central lymph node metastasis between two groups which were divided according to the tumor size by the cutoff values. Patients in two groups showed different positive rate and intensity of Ki67. Conclusions: The size of PTMC in ultrasound images are helpful to predict the aggressiveness of the tumors, it could be an easy predictor for PTMC prognosis and assist us to choose treatment.