• Title/Summary/Keyword: Indication of surgical treatment

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Surgical Treatment for Acute, Severe Brain Infarction

  • Park, Je-On;Park, Dong-Hyuk;Kim, Sang-Dae;Lim, Dong-Jun;Park, Jung-Yul
    • Journal of Korean Neurosurgical Society
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    • v.42 no.4
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    • pp.326-330
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    • 2007
  • Objective : Stroke is the most prevalent disease involving the central nervous system. Since medical modalities are sometimes ineffective for the acute edema following massive infarction, surgical decompression may be an effective option when medical treatments fail. The present study was undertaken to assess the outcome and prognostic factors of decompressive surgery in life threatening acute, severe, brain infarction. Methods : We retrospectively analyzed twenty-six patients (17 males and 9 females; average age, 49.7yrs) who underwent decompressive surgery for severe cerebral or cerebellar infarction from January 2003 to December 2006. Surgical indication was based on the clinical signs such as neurological deterioration, pupillary reflex, and radiological findings. Clinical outcome was assessed by Glasgow Outcome Scale (GOS). Results : Of the 26 patients, 5 (19.2%) showed good recovery, 5 (19.2%) showed moderate disability, 2 (7.7%) severe disability, 6 (23.1%) persistent experienced vegetative state, and 8 (30.8%) death. In this study, the surgical decompression improved outcome for cerebellar infarction, but decompressive surgery did not show a good result for MCA infarction (30.8% overall mortality vs 100% mortality). The dominant-hemisphere infarcts showed worse prognosis, compared with nondominant-hemisphere infarcts (54.5% vs 70%). Poor prognostic factors were diabetes mellitus, dominant-hemisphere infarcts and low preoperative Glasgow Coma Scale (GCS) score. Conclusion : The patients who exhibit clinical deterioration despite aggressive medical management following severe cerebral infarction should be considered for decompressive surgery. For better outcome, prompt surgical treatment is mandatory. We recommend that patients with severe cerebral infarction should be referred to neurosurgical department primarily in emergency setting or as early as possible for such prompt surgical treatment.

2018 심방세동 카테터 절제술 대한민국 진료지침: PART I

  • Park, Hyeong-Seop;Jeong, Dong-Seop;Yu, Hui-Tae;Park, Hui-Nam;Sim, Jae-Min;Kim, Ju-Yeon;Kim, Jun;Lee, Jeong-Myeong;Kim, Gi-Hun;No, Seung-Yeong;Jo, Yeong-Jin;Kim, Yeong-Hun;Yoon, Namsik
    • International Journal of Arrhythmia
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    • v.19 no.3
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    • pp.186-234
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    • 2018
  • Catheter and surgical ablation of atrial fibrillation (AF) have evolved from investigational procedures to their current role as effective treatment options for patients with AF. Surgical ablation of AF is available in most major hospitals throughout the world. Catheter ablation of AF is even more widely available, and is now the most commonly performed catheter ablation procedure. Management of patients with AF has traditionally consisted of three main components: (1) anticoagulation for stroke prevention; (2) rate control; and (3) rhythm control. With the emergence of large amounts of data, which have both defined and called attention to the interaction between modifiable risk factors and the development of AF and outcomes of AF management, we believe it is time to include risk factor modification as the fourth pillar of AF management. Catheter and surgical ablation of AF are highly complex procedures, therefore a decision to perform catheter or surgical AF ablation should only be made after a patient carefully considers the risks, benefits, and alternatives to the procedure.

Treatment of Congenital Muscular Torticollis with Unipolar Release (단극개방완화를 이용한 선천성 근육성 사경의 치료)

  • Park, Myong Chul;Song, Hyun Suk;Kim, Chee Sun;Yim, Shin Young;Park, Dong Ha;Pae, Nam Suk;Lee, Il Jae
    • Archives of Plastic Surgery
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    • v.36 no.1
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    • pp.38-45
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    • 2009
  • Purpose: The congenital muscular torticollis is a neck deformity involving shortening of the sternocleidomastoid muscle, which is detected at birth or shortly after birth. This childhood disease is the third most common congenital musculoskeletal anomaly. The indication for surgery is a persistent head tilt with dificit of passive rotation and lateral bending of the neck and a tight band or tumor in the sternocleidomastoid muscle even after physical therapy. The purpose of this article is to report surgical outcomes with patients who had no or little response to physical therapy. Methods: Surgery was performed on 29 patients and their average age was 4.1 years (from 6 months to 20.1 years). The unipolar open release and partial myectomy were done in 28 cases and the muscle lengthening was done in 1 case. Physical therapy was started from postoperative seventh day. Follow - up period was ranged from 2 months to 5.4 years(mean follow - up, 20.4 months). Result: There were neither rotation nor lateral bending deficit after surgical treatment. Mild head tilt was noticed in 3 cases and residual bend was observed in 4 cases. The subjective assessments of surgical results by parents were excellent. Conclusion: Our surgical outcome encourages the surgical treatment of congenital muscular torticollis for patients who failed to respond to physical therapy.

Large myxomatous odontogenic tumor in the jaw: a case series

  • Nguyen, Truc Thi Hoang;Eo, Mi Young;Cho, Yun Ju;Myoung, Hoon;Kim, Soung Min
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.47 no.2
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    • pp.112-119
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    • 2021
  • Objectives: Myxomatous odontogenic tumors (MOTs) are the third most common odontogenic tumors in the oral and maxillofacial region. Due to its slow-growing, but locally invasive nature, the tumor is usually detected by accident or only when it becomes a large mass, which causes facial deformity. Materials and Methods: Current study reports three unusual cases of MOT including huge myxoma involve the mandible in middle-aged man, MOT with ossifying fibroma pattern in mandible, and MOT in maxilla of young female patient. The diagnosis and treatment strategy of MOTs was also summarized and updated. Results: In reported three cases of patients with large MOTs, surgical treatment was indicated with fibular free flap reconstruction in the mandible and plate reconstruction in the maxilla. The tumors were successfully treated with radical resection and did not show signs of recurrence during the follow-up period. Conclusion: Surgical treatment indication depends on size, the position of the lesion, patient systemic condition and surgeon individual experience. In the case of a large tumor, radical resection and reconstruction is the standard surgical strategy. The conservative surgical treatment including enucleation with wide curettage is still under controversy. The recurrence rate for MOTs is significantly high, up to 30%, therefore long-term follow-up is essential.

Permanent Surgical Treatment for Posthemorrhagic Hydrocephalus in Preterm Infants

  • Atsuko Harada
    • Journal of Korean Neurosurgical Society
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    • v.66 no.3
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    • pp.281-288
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    • 2023
  • While the standard management for posthemorrhagic hydrocephalus (PHH) has not been determined, many patients initially receive temporary treatment such as a ventricular drainage, a ventricular reservoir, or a ventriculosubgaleal shunt. Subsequently, approximately 15% of patients with PHH will require permanent cerebrospinal fluid diversion. Shunt placement is most commonly performed for PHH as permanent treatment. However, shunting still has high complication rates. Since the development of the neuroendoscopic technique has progressed, and indication has been expanded, endoscopic third ventriculostomy with or without choroid plexus cauterization has performed more frequently in recent years in patients with PHH. In this paper, the permanent treatment for PHH will be reviewed based on the latest evidence.

Traumatic Brachial Plexus Injury: Preoperative Evaluation and Treatment Principles (상완 신경총 손상에서의 수술 전 평가와 치료 계획)

  • Yoo, Jae-Sung;Park, Sung-Bae;Kim, Jong-Phil
    • Archives of Hand and Microsurgery
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    • v.22 no.3
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    • pp.137-146
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    • 2017
  • Brachial plexus injury is regarded as one of the most devastating injuries of the upper extremity. Accurate diagnosis is important to obtain the successful results. Basic preoperative evaluation includes simple radiography, cervical myelography. Magnetic resonance imaging, angiography, electrophysiologic studies and intraoperative studies. Furthermore, proper timing of surgery, surgical indication, plan and sufficient understanding of patients about the prognosis are the key for the satisfactory outcomes. This article provides an overview of the evaluation, diagnosis, intraoperative monitoring, and proper surgical planning for the treatment of posttraumatic brachial plexus injuries.

Comparison of Ankle Arthrodesis and Total Ankle Arthroplasty in End-Stage Ankle Arthritis (말기 발목 관절염 환자에서 발목 유합술과 발목관절 전치환술의 비교)

  • Young Sik, Yoon;Dong Yeon, Lee
    • Journal of Korean Foot and Ankle Society
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    • v.26 no.4
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    • pp.151-156
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    • 2022
  • The proportion of patients with end-stage ankle arthritis is increasing. The leading surgical methods for treating patients with end-stage ankle arthritis are ankle arthrodesis and total ankle arthroplasty. Ankle arthrodesis is considered the standard treatment for end-stage ankle arthritis. Many studies have been conducted on the two procedures, but it is unclear which is superior, and total ankle arthroplasty cannot be said to be a clear indication. Therefore, this review compares the advantages and disadvantages of two representative surgical methods for treating end-stage ankle arthritis.

Traditional Korean Medicine Management of Complications of Breast Surgery - A Case Report of Complications After Breast Surgery (유방수술 후 발생한 견관절 기능장애와 상지 저림에 대한 치험 2례)

  • Kwon, Ji-Myung;Kim, Dong-Chul
    • The Journal of Korean Obstetrics and Gynecology
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    • v.23 no.4
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    • pp.176-186
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    • 2010
  • Purpose: To review the effectiveness affecting to the shoulder functionalities and upper numbness by Traditional Korean Medical treatment who are given a surgical operation for breast resection by breast tumor Method: To report the patients with dysfunction of shoulder joint and numbness in upper limb after breast surgery who improved by Traditional Korean Medical treatment and to study Traditional Korean Medicine(TKM) management of complications of breast surgery. Results: After about 2weeks treatment, patient's symptoms and signs were improved. TKM management was effective in recovery of shoulder function and upper limb numbness after breast surgery. Conclusion: We need to actively participate in management of complications of breast surgery as adjuvant therapy. And more study is needed for developing Traditional Korean Medical indication of complications of breast surgery.

미숙아와 신생아의 동맥과 개존증에 대한 수술요법(소개흉 결찰술과 흉강경 보조하의 clipping과의 비교)

  • 장지원;한재진;원용순;원태희;안재호;박영식;최수승
    • Journal of Chest Surgery
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    • v.33 no.1
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    • pp.26-31
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    • 2000
  • Background: This study was aimed at analyzing the preoperative conditions post-operative results indication and methods of surgical closure of patent ducturs arterio년 in prematures low birth weight infants and neonates. Patients and Methods: We retro-spectively studied two groups of patients (prematures group and neonates group) who underwent surgical closure of the patent ductus arteriosus between March 1995 and June 1998. Results: The premature group consisted of 9 patients(3 males and 6 females) Their mean gestational period was 30.7 weeks(ranging from 26 weeks to 33 weeks) mean age 27.8 days(11 days to 55 days) and mean body weight 1.56 kg. Prominent preoperative symptoms were dependency on mechanical ventilation generalized edema and hepatomegaly. We performed PDA ligation via thoracotomy in all premature patients. The neonate group consisted of 16 patients and their mean body weight was 3.75 kg. Major symptoms of this group was tachypnea and intercostal retraction resistant to medical treatment. We performed video-assisted PDA clipping to them all. There were no postoperative complications or operation-related mortality in both groups. Comparing the ratio of size of PDA(mm)/body weight(kg) the ratio of premature group (ligation through thoracotomy) was higher than that of neonate group ( video-assisted clipping) that is 3,89:1.21(p=0.03) Conclusion : We conclude that the surgical closure of PDA can be a safe method of treatment for prematures low birth weight infants and neonates with compromised general conditions. Choice of surgical technique depends on the surgeon's preference but there was a tend-ency to choose the ligation method through thoracotomy for patients with small body weight and large PDA.

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Clinical Review of Metastatic Lung Tumor (전이성폐종양에 대한 고찰)

  • 김진식;손말현;서정회
    • Journal of Chest Surgery
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    • v.7 no.1
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    • pp.37-46
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    • 1974
  • 52 cases of metastatic lung tumor, including 22 [42.3%] choriocarcinoma., 13[25%] liver cancer, 6 [7.5%] stomach cancer, 2 bone tumor, etc, were reviewed at Busan National University Hospital, during a 5 year period ending with 1974. The age distribution of metastatic lung tumor were same in second decade to 5th decade. The most common appearances of roentgenograms of metastatic lung tumor were that of multinodular [42.3%], diffuse acinar [21.1%],infiltrative or pneumonic[21.1%], solitary lesion [9.6%] and diffuse micronodular [5.7%]. The metastatic lesions originated from choriocarcinoma revealed multinodular and acinar in roentgenogram, and the lesions originated from liver and stomach cancer revealed infiltrative and acinar. In our series, the positive hilar lymph node enlargement was encountered in 12 cases, of which 4 were in liver cancer and 3 were in stomach cancer. Pleural effusion was also encountered in 5 cases, of which 3 were in liver cancer. The treatment of this series was almost conservative except of 2 cases of pulmonary resection, and the reason of this limited cases of surgical treatment was seemed due to the delayed direction of metastasis to lung beyond the proper indication of surgery.

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