• Journal of Korean Foot and Ankle Society
• /
• v.22 no.1
• /
• pp.21-25
• /
• 2018

Purpose: To analyze the correlation between a rupture of the hypovascular zone and early single heel raising after Achilles tendon repair. Materials and Methods: From January 2012 to August 2015, 68 patients, who underwent surgical treatment for a Achilles tendon rupture using Krackow method, were analyzed retrospectively. The patients were divided into two groups according to possibility of single heel raises within 3 months postoperatively. During the periodic outpatient observations, the visual analogue scale, Achilles tendon total rupture score (ATRS), and timing capable single heel raises were evaluated. In addition, the preoperative defect size and distance between the calcaneal osteotendinous junction and the rupture site were measured by ultrasound in all cases. Results: Twenty-three patients could perform a single heel raise within 3 months after surgery (early single heel raise group), and fortyfive patients could perform a single heel raise after 3 month postoperatively. The age, gender, body mass index, smoking, and operation delay were similar in the two groups. In addition, the defect size and distance between the calcaneal osteotendinous junction and rupture site as measured by preoperative ultrasound were similar (p=0.379 and p=0.631, respectively). On the other hand, when the rupture site was divided into the hypovascular zone (4~7 cm from calcaneal osteotendinous junction) and non-hypovascular zone, the hypovascular zone rupture rate was significantly lower in the early single heel raise group (60.9%, 14/23; 91.1%, 41/45; p=0.003). In logistic regression analysis, the odds of the hypovascular zone rupture group being capable of early single heel raise were 0.189 (p=0.017). The ATRS score at 3 months and 1 year after surgery were significantly higher in the early single heel raise group (p<0.001). Conclusion: Achilles tendon rupture at the hypovascular zone is a poor prognostic factor for early single heel raise and might affect the prognosis significantly after an Achilles tendon rupture operation.

• Archives of Plastic Surgery
• /
• v.38 no.2
• /
• pp.161-165
• /
• 2011

Purpose: Zygomaticomaxillary complex (ZMC) fracture is one of the most common facial injuries after facial trauma. As ZMC composes major facial buttress, it is a key element of the facial contour. So, when we treat these fractures, the operator should have a concern with the symmetry to restore normal appearance and function. But sometimes, unfavorable results may occur. The aim of this study is to analyze the unsatisfied midfacial contour after ZMC fractures reduction retrospectively and to point out the notandum. Methods: 369 patients, treated for fractures of the ZMC were included in the study. After the operation, such as open reduction and internal fixation (ORIF with titanium or absorbable materials), open reduction, and closed reduction, midfacial contour was evaluated with plain films and 3-dimensional computed tomography. And unfavorable asymmetric midfacial contours were correcterd by secondary correction and re-evaluated. Gross photographs were obtained at outpatient clinic. Results: Total of 38 patients had got a facial asymmetry and among of them 24 patients were treated secondary revisional ORIF operations for correction of unfavorable result of after primary reduction. Two of them had received tertiary operations, three patients had got osteotomy more than after one year and six patients had got minor procedures. The etiology of asymmetry were lateral displaced simple fracture of arch (n=2), lateral displaced comminuted fracture of arch (n=6), comminuted arch fracture combined posterior root fracture (n=9), and communited arch and body fracture (n=12), severely contused soft tissue (n=9). After the manipulations outcomes were acceptable. Conclusion: To prevent the asymmetry in ZMC fracture reduction, complete analysis of fracture, choice of appropriate operation technique, consider soft tissue, and secure of zygoma position are important. Especially, we should be more careful about communited fracture of zygomatic body and lateral displacement, root fracture of zygomatic arch. Because they are commom causes that make facial asymmetry. To get optimal result, ensure the definite bony reduction.

• The Korean Society of Law and Medicine
• /
• v.24 no.1
• /
• pp.101-130
• /
• 2023

Korea has very easy access to tertiary hospitals, including university hospitals, among OECD countries, and patients can reach the emergency room of a university hospital within 1-2 hours. However, there are many so-called 'essential medical' blind spots where people die because they do not receive surgery in time. In particular, in the case of essential medical care in the surgical field, despite basic surgery, there is a shortage of medical staff to perform outpatient surgery in emergency situations at university hospitals. Although this lack of manpower has a problem with low insurance premiums for surgery, it also has a very large impact on the burden of criminal liability for medical malpractice, which increases the incidence in case of emergencies. Here, we propose crime immunity to solve the manpower shortage of converged smart surgical essential medical (SES) hospitals. Currently, the medical community agrees on the need for crime immunity, but it is an ambiguous scope of immunity that has not reached a national consensus. We would like to present clear standards for essential medical practices (surgery) that require criminal immunity.

• Journal of Trauma and Injury
• /
• v.37 no.1
• /
• pp.60-66
• /
• 2024

Purpose: This study investigated changes in interpersonal violence and utilization of trauma recovery services during the COVID-19 pandemic. At an urban level I trauma center, trauma recovery services (TRS) provide education, counseling, peer support, and coordination of rehabilitation and recovery to address social and mental health needs. The COVID-19 pandemic prompted considerable changes in hospital services and increases in interpersonal victimization. Methods: A retrospective analysis was conducted between September 6, 2018 and December 20, 2020 for 1,908 victim-of-crime patients, including 574 victims of interpersonal violence. Outcomes included length of stay associated with initial TRS presentation, number of subsequent emergency department visits, number of outpatient appointments, and utilization of specific specialties within the year following the initial traumatic event. Results: Patients were primarily female (59.4%), single (80.1%), non-Hispanic (86.7%), and Black (59.2%). The mean age was 33.0 years, and 247 patients (49.2%) presented due to physical assault, 132 (26.3%) due to gunshot wounds, and 76 (15.1%) due to sexual assault. The perpetrators were primarily partners (27.9%) or strangers (23.3%). During the study period, 266 patients (mean, 14.9 patients per month) presented before the declaration of COVID-19 as a national emergency on March 13, 2020, while 236 patients (mean, 25.9 patients per month) presented afterward, representing a 74.6% increase in victim-of-crime patients treated. Interactions with TRS decreased during the COVID-19 period, with an average of 3.0 interactions per patient before COVID-19 versus 1.9 after emergency declaration (P<0.01). Similarly, reductions in length of stay were noted; the pre-COVID-19 average was 3.6 days, compared to 2.1 days post-COVID-19 (P=0.01). Conclusions: While interpersonal violence increased, TRS interactions decreased during the COVID-19 pandemic, reflecting interruption of services, COVID-19 precautions, and postponement/cancellation of elective visits. Future direction of hospital policy to enable resource and service delivery to this population, despite internal and external challenges, appears warranted.

• Journal of Chest Surgery
• /
• v.36 no.6
• /
• pp.444-447
• /
• 2003

Sleeve pneumonectomy can be a method of treatment in a selected patient with bronchogenic carcinoma involving carina. A 64 years old male with a history of mitral valve replacement via midsternotomy 13 years ago and resection of papilloma of the vocal cord 2 years ago. The patient was admitted due to blood-tinged sputum. Bronchoscopy and computerized tomogram of the chest revealed 3.5 cm mass at lower margin of the trachea and totally obstructing the left main bronchus. A biopsy revealed squamous cell carcinoma. He underwent left sleeve pneumonectomy through sequential bilateral thoracotomy without cardiopulmonary bypass, and the pathologic stage was T4N0M0 stage IIIB. The patient is being followed through the outpatient clinic in good general condition.

• Asian Pacific Journal of Cancer Prevention
• /
• v.13 no.1
• /
• pp.195-198
• /
• 2012

To date, there was no controlled-study regarding awareness and knowledge of colorectal cancer in the Turkish population. We therefore designed a questionnaire consisting of items related to socio-demographic parameters, medical and family history and questions of awareness and knowledge about colorectal cancer for use in a descriptive cross-sectional study. An interviewer-administered technique was applied and 450 subjects were interviewed in the outpatient clinics at Near East University Hospital. Among all subjects, 337 were found to be eligible for the study group. Exclusion criteria were age below 18 years, any cancer history, family history of colorectal cancer, current colorectal problems, history of any diagnostic or therapeutic interventions for colorectal diseases. All participants stated that they heard about colorectal cancer. When asked about the lifetime risk of colorectal carcinoma, only 25.4% of women and 37.9% of men estimated correctly. Univariate analysis revealed that the total awareness score was significantly correlated with age, marital status, parenthood and fecal occult blood testing history. On multivariate analysis of independent predictors for awareness of colorectal cancer were found to be history of fecal occult blood testing, age and marital status were found to be the most important determinants. As a conclusion, opportunistic screening with fecal occult blood test by physicians from non-gastrointestinal specialties not only helps to reduce the mortality but also increases the awareness of colorectal cancer.

• Asian Pacific Journal of Cancer Prevention
• /
• v.16 no.6
• /
• pp.2303-2306
• /
• 2015

Objective: Skin tumors are the most commonly seen cancer type worldwide. Regarding pathogenesis, it is thought that disruption of kinetics through T lymphocyte-mediated development of chronic inflammation may be involved. The present study was intended to identify role of inflammatory cells such as neutrophils, monocytes and lymphocytes in the determination of risk for skin cancer. Materials and Methods: We retrospectively reviewed charts of 569 cases diagnosed as having primary skin tumors. Data regarding age, gender and histopathological subtype were recorded. Blood parameters studied on the day before surgery including WBCs, neutrophils, and lymphocyte counts, neutrophil:lymphocyte and neutrophil:monocyte ratios were also recorded. Two-hundred and two healthy individuals presented for check-up in an outpatient clinic were selected as the control group. Parameters studied in cases with skin cancer were compared to those healthy individuals. Findings: Of the cases with skin cancer, 401 were basal cell carcinoma (BCC) while 144 were squamous cell carcinoma (SCC) and 13 were malignant melanoma (MM). WBC, neutrophil and monocyte counts and the neutrophil:lymphocyte ratio were found to be lower in the patient group than in the healthy control group (p<0.001) while no significant difference was found in other parameters reviewed (p>0.05). No significant difference was found in WBC, neutrophil, neutrophil: monocyte ratio according to gender (p>0.05). Monocyte count was found to be $0.68{\pm}0.61$ in men and $0.55{\pm}0.25$ in women, indicating strong statistical significance (p<0.001). WBC, neutrophil and monocyte values were highest in control group while lowest in BCC. When BCC and SCC groups were compared to controls, significant differences found (p<0.001). There were no significant differences in lymphocyte counts among groups (p=0.976). Neutrophil:lymphocyte ratios were 3.24 in BCC, 3.59 in SCC, 3.44 in MM and 5.06 in control group (p<0.001). Conclusions: In our study, it was found that there were significant differences in complete blood count, neutrophil, monocyte and neutrophil:lymphocyte levels among groups. Neutrophil: lymphocyte ratio was found to be lowest in BCC among skin cancers.

• Journal of Korean Neurosurgical Society
• /
• v.60 no.6
• /
• pp.684-690
• /
• 2017

Objective : As increasing the size of the geriatric population, the number of elderly patients, who need the surgery for painful degenerative spinal stenosis has been increasing. The geriatric population may be relatively high complications, because of age and age-associated medical conditions. However, there is a lack of studies addressing the perioperative complications and outcomes in elderly patients with posterior lumbar inter body fusion with screw augmentation (PLIF). Methods : We retrospectively reviewed the medical records and radiographic studies of geriatric patients who had spine surgery of PLIF due to spinal stenosis for 11 years. We divided into 2 groups (A; 70-75 years, B; over then 76 years) according to the age. Surgical level of each groups, hospital day and postoperative day, co-morbidities, complications, clinical outcomes were analyzed. Operative reports, hospital and outpatient clinic charts, and radiographic studies were reviewed. Results : Group A was composed of 80 patients, their mean age was 72.21 and female dominant (n=46), and their mean surgically fused level was 1.52 level. Group B was 36 patients, their mean age was 78.83 and female dominant (n=20), and their mean surgically fused level was 1.36 level. Comparing between two groups, complications, postoperative hospital stay were slightly increase in group B and co-morbidity was statistically high in group B, however clinical outcomes were similar between two groups. Conclusion : Increasing age might be an important risk factor for complications in patients undergoing PLIF, however, we would like to recommend that if the situation of spine of extreme geriatric patients need PLIF, it should be in the surgeon's consideration after careful selection and clinical judgement.

• Journal of Korean Foot and Ankle Society
• /
• v.15 no.3
• /
• pp.165-169
• /
• 2011

Purpose: The objective of this study was to analyze diabetic foot patients' direct service costs until the cure of the disease. Materials Methods: The subjects of this study were randomly sampled 60 patients who had been treated for diabetic foot at one of two tertiary hospitals and cured of the disease during from January 2008 to December 2009, and whose diagnostic code was E11.5 or E14.5. Data were collected from medical records and direct service costs were analyzed using data on the payments of individual service charges. Direct service costs spent at other medical institutions for the same disease were excluded. Collected data were analyzed using descriptive statistics. Results: The subjects' mean hospital stay was 29 days, and mean period until cure was 132 days. The inpatient cost per patient was 10,844,648 won, outpatient cost was 715,751 won, and home care services cost was 641,854 won, so total direct service cost per patient was 11,913,419 won. The total direct service cost in patients who had their foot amputated was 12,769,822 won, 1.3 times higher than without amputation, who had vascular intervention was 16,219,477 won, 1.9 times higher than non-vascular intervention, who had both infection and artery occlusion was 17,522,435 won, 2.0 times higher than either infection or artery occlusion. Conclusion: In diabetic foot patients, the direct service cost was highest as 17,522,435 won in patients accompanied with both infection and occlusion of lower extremity artery.

• Asian Pacific Journal of Cancer Prevention
• /
• v.14 no.7
• /
• pp.4199-4203
• /
• 2013

Background: This investigation focused on possible relationships between skin cancers and ABO/Rh blood groups. Materials and Methods: Between January 2005 and December 2012, medical data of 255 patients with skin cancers who were admitted to Kayseri Training and Research Hospital, Radiation Oncology and Plastic Surgery Outpatient Clinics were retrospectively analyzed. Blood groups of these patients were recorded. The control group consisted of 25701 healthy volunteers who were admitted to Kayseri Training and Research Hospital, Blood Donation Center between January 2010 and December 2011. The distribution of the blood groups of the patients with skin cancers was compared to the distribution of ABO/Rh blood groups of healthy controls. The association of the histopathological subtypes of skin cancer with the blood groups was also investigated. Results: Of the patients, 50.2% had A type, 26.3% had O type, 16.1% had B type, and 7.5% had AB blood group with a positive Rh (+) in 77.3%. Of the controls, 44.3% had A type, 31.5% had 0 type, 16.1% had B type, and 8.1% had AB blood group with a positive Rh (+) in 87.8%. There was a statistically significant difference in the distribution of blood groups and Rh factors (A Rh (-) and 0 Rh positive) between the patients and controls. A total of 36.8% and 20.4% of the patients with basal cell carcinoma (BCC) had A Rh (+) and B Rh (+), respectively, while 39.2% and 27.6% of the controls had A Rh (+) and B Rh (+), respectively. A significant relationship was observed between the patients with BCC and controls in terms of A Rh (-) (p=0.001). Conclusion: Our study results demonstrated that there is a significant relationship between non-melanoma skin cancer and ABO/Rh factors.