• Title/Summary/Keyword: Patient's Situation

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Use of Heparin Cream for Venous Congestion in the Extended Reverse Metacarpal Artery Flap: A Case Report

  • Tatar, Burak Erguun;Sabanciogullarindan, Fahri;Gelbal, Caner;Bozkurt, Mehmet
    • Archives of Plastic Surgery
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    • v.49 no.5
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    • pp.663-667
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    • 2022
  • Finger dorsum defects are a challenging situation. Many reconstruction methods are used in these defects. Extended reverse dorsal metacarpal artery (RDMA) flap is used in dorsal finger reconstruction. Venous congestion in this flap is most important cause of flap failure. In this case, we presented a case in which we used heparin cream due to development of venous congestion in our patient who underwent an extended RDMA flap. A 24-year-old female patient presented to the emergency department with a defect of dorsal of left-hand fourth finger. Defect was covered with an extended RDMA flap. On postoperative first day, venous congestion was observed, and heparin cream was applied three times a day on flap. The signs of venous congestion were regressed. Tissue healed as a result of superficial epidermolysis and skin grafting. No functional limitation was observed in sixth-month postoperative control. Venous congestion is the most important cause of flap failure of extended RDMA flaps. Generally, subcutaneous heparin administration and leech therapy are used. In our case, heparin was applied as a cream instead of subcutaneously, and flap healing was observed as a result of superficial epidermolysis. Heparin cream application can also be used as a treatment option in flaps with venous congestion.

Discrepancies in Soft Tissue Profile of Patients for Orthognathic Surgery between Preoperative Lateral Facial Photograph, Lateral Cephalogram and Supine Position on Operation Table

  • Jung, Young-Eun;Yang, Hoon-Joo;Hwang, Soon-Jung
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.34 no.3
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    • pp.180-185
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    • 2012
  • Purpose: An accurate preoperative analysis of the patient is essential in orthognathic surgery in order to acquire superior results. In profile, the location of the chin's position may change according to the neck's inclination. This may ultimately affect the amount of surgical movement. During acquisition of cephalometric radiographs, or in supine position, there is a discrepancy in the neck's inclination. This means that there are also various discrepancies between the actual profile and the various preoperative profile images. In the clinical situation, the decision in performing genioplasty usually lies in the analysis of the patient's profile on the operating table at the final stages of orthognathic surgery. This study aims to analyze the different preoperative profile images and to compare their discrepancies. Methods: Fifty eight patients undergoing orthognathic surgery were chosen. These patients were divided into three groups according to angle's classification of malocclusion, as class I, II or III. The right profile of these patients in centric occlusion was taken in natural head position (NHP). This was set as the 'actual profile image.' Another right profile image was taken on the operating table after insertion of the nasotracheal intubation and with muscle relaxants in effect. This was also taken in centric occlusion. The angle (denoted 'A') between the soft tissue glabella-pognion and the true vertical plane was found in the above-mentioned profile images and in the cephalometric radiographs. The differences of these values were analyzed. Results: There were differences in Angle 'A' in all of the preoperative images. These values were however, not statistically significant. Conclusion: In order to gain an esthetic profile during orthognathic surgery, the NHP is shown to be the most reliable position. Images reproducing such head positions should be used in the treatment planning process.

Clinical Analysis of Dog Bite Injuries (개에 의한 교상의 임상 분석)

  • Kim, Jae Won;Kim, Yong Kyu;Chung, Sung Mo
    • Archives of Plastic Surgery
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    • v.35 no.2
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    • pp.165-168
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    • 2008
  • Purpose: The dog bite injury is expected to increase as westernizing lifestyle and the number of pet raisers increase. The bite injuries may cause serious sequelae. The purpose of this study is to contributes to establish a suitable management and treatment principle for domestic situation with a clinical analysis data of the dog bite injuries. Methods: We reviewed the hospital records of 76 patients with dog bite injuries who were treated in the emergency unit or out patient department of our hospital from January 2000 to May 2006. Results: The majority of patients were children less than 10 years of age, 21 case(27.6%). Injuries occurred most often in May and 14 patients(18.4%) were bitten by the kinds of Cockerspaniel. By Lackmann's classification, 36 patients(47.4%) had Stage I injuries, 27 patients (35.5%) Stage II, 11 patients(14.5%) Stage III and 2 patients(2.6%) Stage IVa. The most frequent injury site was the head and neck area with 55 cases(72.4%). Also, 58 cases(76.3%) were received the initial treatment within 30 minutes after being bitten and the most of case except emergency operation repaired within 3 days.Conclusion: The dog bite injuries increased by more than 20% every year over the study period and it says that it may continue to increase more in the future. However, There are little report or literature for suitable management and treatment principle for domestic situation. The authors think this clinical analysis data and treatment experience can be useful for establishing a suitable treatment principle for domestic situation.

Development of Computerized Anthropometric Analysis Model in Cleft Lip Nasal Deformity Using 3D Laser Scanned Facial Cast Model (구순구개열의 비구순변형에서 3차원 입체 laser 스캐너를 이용한 계측분석 프로그램의 개발)

  • Kim, Suk Wha;Park, Jong Lim;Kim, Jae Chan;Baek, Seung Hak;Son, Woo Gil
    • Archives of Plastic Surgery
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    • v.35 no.3
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    • pp.303-308
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    • 2008
  • Purpose: The purpose of this study is to develop three-dimensional computerized anthropometry(3DCA) and to compare its reliability and accuracy 3DCA with manual anthropometry(MA) for measurement of lips and nasal deformities in unilateral cleft lips and palate(UCLP) patients. Methods: Samples were consisted of six UCLP patients whose facial plaster models were available immediately before and 3 months after the cleft lip surgery. MA of the facial plaster models was carried out using an electronic caliper. In 3DCA, three-dimensional auto-measuring program was used to digitize landmarks and to measure three-dimensional virtual facial models (3DVFM), which was generated with a laser scanner and 3D virtual modeling program. Intraclass correlation coefficients(ICC) were calculated to evaluate reliability and reproducibility of the variables in both methods, and Wilcoxon's signed rank test was done to investigate the difference in values of the same variables of facial models of each patient between two methods. Results: All ICC values were higher than 0.8, so both methods could be considered reliable. Although most variables showed statistical differences between two methods(p<0.05), differences between mean values were very small and could be considered not significant in clinical situation. Conclusion: In clinical situation, 3DCA can be an objective, reliable and accurate tool for evaluation of lips and nasal deformities in the cleft patients.

Comparative Analysis of COVID-19 Outbreak and Changes in Neurosurgical Emergency Patients

  • Lee, Min Ho;Jang, Seu-Ryang;Lee, Tae-Kyu
    • Journal of Korean Neurosurgical Society
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    • v.65 no.1
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    • pp.130-137
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    • 2022
  • Objective : COVID-19 has spread worldwide since the first case was reported in Wuhan, China, in December 2019. Our institution is a regional trauma and emergency center in the northern Gyeonggi Province. The changing trend of patient care in the emergency room of this hospital likely reflects the overall trend of patients in the area. In the present study, whether changes in the surrounding social environment following the outbreak of COVID-19 changed the incidence of neurosurgical emergency patients and whether differences in practice existed were investigated. Methods : The overall trend was analyzed from January 2020 which is before the outbreak of COVID-19 to September 2020. To remove bias due to seasonal variation, the previous 2 year's records during the same period were reviewed and compared. Confirmed COVID-19 patients in the northern Gyeonggi Province were identified using data released by the government. And patients who came to the emergency department with head trauma and stroke were identified. Results : Based on the present study results, the total number of neurosurgery emergency patients decreased over the study period. In the trauma patient group, the number of patients not involved in traffic accidents significantly decreased compared with patients involved in traffic accidents. Among the stroke cases, the rate of ischemic stroke was lower than hemorrhagic stroke, although a statistically significant difference was not observed. Meanwhile, an increase in the risk of mortality associated with trauma or stroke cases was not observed during the COVID-19 outbreak compared with the same time period in the previous year. Conclusion : Due to the occurrence of COVID-19, non-essential activities have decreased and trauma cases not associated with traffic accidents appeared to decrease. Due to the decrease in overall activity, the number of stroke patients has also decreased. This trend is expected to continue even in the post-COVID-19 era, and accordingly, the results from the present study are relevant especially if the current situation continues.

Development of the Information Delivery System for the Home Nursing Service (가정간호사업 운용을 위한 정보전달체계 개발 I (가정간호 데이터베이스 구축과 뇌졸중 환자의 가정간호 전산개발))

  • Park, J.H;Kim, M.J;Hong, K.J;Han, K.J;Park, S.A;Yung, S.N;Lee, I.S;Joh, H.;Bang, K.S
    • Journal of Home Health Care Nursing
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    • v.4
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    • pp.5-22
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    • 1997
  • The purpose of the study was to development an information delivery system for the home nursing service, to demonstrate and to evaluate the efficiency of it. The period of research conduct was from September 1996 to August 31, 1997. At the 1st stage to achieve the purpose, Firstly Assessment tool for the patients with cerebral vascular disease who have the first priority of HNS among the patients with various health problems at home was developed through literature review. Secondly, after identification of patient nursing problem by the home care nurse with the assessment tool, the patient's classification system developed by Park (1988) that was 128 nursing activities under 6 categories was used to identify the home care nurse's activities of the patient with CAV at home. The research team had several workshops with 5 clinical nurse experts to refine it. At last 110 nursing activities under 11 categories for the patients with CVA were derived. At the second stage, algorithms were developed to connect 110 nursing activities with the patient nursing problems identified by assessment tool. The computerizing process of the algorithms is as follows: These algorithms are realized with the computer program by use of the software engineering technique. The development is made by the prototyping method, which is the requirement analysis of the software specifications. The basic features of the usability, compatibility, adaptability and maintainability are taken into consideration. Particular emphasis is given to the efficient construction of the database. To enhance the database efficiency and to establish the structural cohesion, the data field is categorized with the weight of relevance to the particular disease. This approach permits the easy adaptability when numerous diseases are applied in the future. In paralleled with this, the expandability and maintainability is stressed through out the program development, which leads to the modular concept. However since the disease to be applied is increased in number as the project progress and since they are interrelated and coupled each other, the expand ability as well as maintainability should be considered with a big priority. Furthermore, since the system is to be synthesized with other medical systems in the future, these properties are very important. The prototype developed in this project is to be evaluated through the stage of system testing. There are various evaluation metrics such as cohesion, coupling and adaptability so on. But unfortunately, direct measurement of these metrics are very difficult, and accordingly, analytical and quantitative evaluations are almost impossible. Therefore, instead of the analytical evaluation, the experimental evaluation is to be applied through the test run by various users. This system testing will provide the viewpoint analysis of the user's level, and the detail and additional requirement specifications arising from user's real situation will be feedback into the system modeling. Also. the degree of freedom of the input and output will be improved, and the hardware limitation will be investigated. Upon the refining, the prototype system will be used as a design template. and will be used to develop the more extensive system. In detail. the relevant modules will be developed for the various diseases, and the module will be integrated by the macroscopic design process focusing on the inter modularity, generality of the database. and compatibility with other systems. The Home care Evaluation System is comprised of three main modules of : (1) General information on a patient, (2) General health status of a patient, and (3) Cerebrovascular disease patient. The general health status module has five sub modules of physical measurement, vitality, nursing, pharmaceutical description and emotional/cognition ability. The CVA patient module is divided into ten sub modules such as subjective sense, consciousness, memory and language pattern so on. The typical sub modules are described in appendix 3.

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Fertility preservation for patients with gynecologic malignancies: The Korean Society for Fertility Preservation clinical guidelines

  • Lee, Sanghoon;Kim, Seul Ki;Hwang, Kyung Joo;Kim, Tak;Kim, Seok Hyun
    • Clinical and Experimental Reproductive Medicine
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    • v.44 no.4
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    • pp.175-180
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    • 2017
  • Fertility preservation plays a central role in cancer care since an increasingly large number of cancer patients are surviving as a result of improvements in diagnostic and therapeutic strategies. Physicians who take part in the initial diagnosis and management of gynecologic cancer should understand the importance of fertility preservation. Since indications for fertility preservation are limited to early-stage gynecologic cancer, a surgeon must carefully consider each indication. Before performing fertility-sparing surgery, health professionals should compare its oncologic and pregnancy outcomes with those of other standard treatments. Individualized treatment strategies should be delivered depending on the patient's situation, and physicians should provide timely information and appropriate counseling.

Evaluation of the medical staff effective dose during boron neutron capture therapy using two high resolution voxel-based whole body phantoms

  • Golshanian, Mohadeseh;Rajabi, Ali Akbar;Kasesaz, Yaser
    • Nuclear Engineering and Technology
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    • v.49 no.7
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    • pp.1505-1512
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    • 2017
  • Because accelerator-based boron neutron capture therapy (BNCT) systems are planned for use in hospitals, entry into the medical room should be controlled as hospitals are generally assumed to be public and safe places. In this paper, computational investigation of the medical staff effective dose during BNCT has been performed in different situations using Monte Carlo N-Particle (MCNP4C) code and two voxel based male phantoms. The results show that the medical staff effective dose is highly dependent on the position of the medical staff. The results also show that the maximum medical staff effective dose in an emergency situation in the presence of a patient is ${\sim}25.5{\mu}Sv/s$.

Relationship between Hyperhydrosis and Sasang Constitution (건강인에서 다한증과 사상체질과의 상관성 연구)

  • Oh, Jin-Ah;Ko, Ho-Yeon;Shin, Mi-Ran
    • Journal of Sasang Constitutional Medicine
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    • v.28 no.1
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    • pp.27-39
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    • 2016
  • Objectives The study is to investigate the correlations for the characteristics of perspiration and the ordinary symptoms between normal and hyper-hidrosis patient's group according to Sasang Constitution.Methods We have investigated to survey about ordinary symptoms, the characteristics of perspiration and quality of life of Normal group and Hyper-hidrosis group.Results & Conclusions Taeeumin showed a tendency of overeat and was sensitive to Heat. Soeumin showed a tendency of Emotional anxiety and was sensitive to Cold. Sweating situation : Taeeumin showed a tendency of sweating a lot in many situations. Nervous was related to hyper-hidrosis in Taeeumin and Soeumin. Taeeumin and Soeumin showed a tendency of sweating at back in Normal group. In hyper-hidrosis group, Taeeumin and Soeumin showed a tendency of sweating at hand and foot and. Soyangin showed a tendency of sweating at foot.

A Concept Analysis of 'Facilitator' in Simulation Nursing Education (시뮬레이션 간호 교육에서의 '촉진자(facilitator)' 개념분석)

  • Kim, Jiyoung
    • The Journal of Korean Academic Society of Nursing Education
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    • v.24 no.1
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    • pp.39-49
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    • 2018
  • Purpose: This study was to identify and define the concept of a facilitator and specific attributes for providing basic data on simulation nursing education. Methods: Using Walker and Avant's (2005) criteria that identify the attributes, antecedents, and consequences of facilitators in simulation nursing education, the findings of research articles published from 2001 to 2017 were reviewed. Results: There were three aspects of the facilitator concept in simulation nursing education: (1) continuous support throughout the entire simulation process; (2) skilled progress based on clinical expertise; (3) guidance for learners to actively understand and reflect on the situation. Conclusion: This concept analysis helps us to better understand better facilitators in simulation nursing education.