• Maxillofacial Plastic and Reconstructive Surgery
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• 제41권
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• pp.30.1-30.8
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• 2019

Background: Advancements in the field of microvascular surgery and the widespread adoption of microvascular surgical techniques have made the use of osteocutaneous fibula free flaps the standard of care in the surgical management of segmental mandibular defects. Although the literature possesses abundant evidence to support the effectiveness of fibula free flaps as a reconstructive method, there are relatively few studies reporting on outcomes as objectively measured by videofluoroscopic swallowing studies (VFSS). The purpose of this study is to explore the potential correlation between early postoperative VFSS and the long-term swallowing outcomes in patients who underwent mandibular reconstruction with fibula free flaps. Methods: We performed a retrospective chart review of 36 patients who underwent mandibular reconstruction with osteocutaneous fibular free flaps between 2009 and 2012. Demographics, clinical variables, VFSS data, and diet information were retrieved. Penetration and aspiration findings on VFSS, long-term oral feeding ability, and the need for gastrostomy tube were statistical endpoints correlated with postoperative clinical outcomes. Results: Thirty-six patients were reviewed (15 females and 21 males) with a mean age of 54 years (7-81). Seventeen cases were treated for malignancy. The size of the bony defect ranged from 3 to 15 cm (mean = 9 cm). The cutaneous paddle, a surrogate for soft tissue defect, ranged from 10 to 125 ㎠ (mean = 52 ㎠). A gastrostomy tube was present in patients preoperatively (n = 8), and postoperatively (n = 14). Seventeen patients had neoadjuvant exposure to radiation. Postoperative VFSS showed penetration in 13 cases (36%) and aspiration in seven (19%). Overall, 29 patients (80.6%) achieved unrestricted diet, and this was statistically correlated with age (p = 0.037), radiation therapy (p = 0.002), and preoperative gastrostomy tube (p = 0.03). The presence of penetration or aspiration on VFSS was a strong predictor for long-term unrestricted oral diet (p < 0.001). Conclusion: Early postoperative VFSS is an excellent predictor for long-term swallowing outcomes in patients undergoing mandibular reconstruction with osteocutaneous fibula free flaps.

• Asian Pacific Journal of Cancer Prevention
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• 제15권24호
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• pp.10879-10882
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• 2015

Objective: To investigate the effect of intraoperative glucose fluctuation and postoperative interlukin-6 (IL-6), tumor necrosis factor-${\alpha}$ (TNF-${\alpha}$), C-reactive protein (CRP) levels on the short-term prognosis of patients with intracranial supratentorial neoplasms. Materials and Methods: Eighty-six patients undergoing intracranial excision were selected in The Second Hospital of Jilin University. According to the condition of glucose fluctuation, the patients were divided into group A (glucose fluctuation <2.2 mmol/L, n=57) and group B (glucose fluctuation ${\geq}2.2mmol/L$, n=29). Glucose was assessed by drawing 2 mL blood from internal jugular vein in two groups in the following time points, namely fasting blood glucose 1 d before operation ($T_0$), 5 min after anesthesia induction ($T_1$), intraoperative peak glucose ($T_2$), intraoperative lowest glucose ($T_3$), 5 min after closing the skull ($T_4$), immediately after returning to intensive care unit (ICU) ($T_5$) and 2 h after returning to ICU ($T_6$). 1 d before operation and 1, 3 and 6 d after operation, serum IL-6 and TNF-${\alpha}$ levels were detected with enzyme-linked immunosorbent assay (ELISA), and CRP level with immunoturbidimetry. Additionally, postoperative adverse reactions were monitored. Results: There was no statistical significance between two groups regarding the operation time, anesthesia time, amount of intraoperative bleeding and blood transfusion (P>0.05). The glucose levels in both groups at $T_1{\sim}T_6$ went up conspicuously compared with that at $T_0$ (P<0.01), and those in group B at $T_2$, $T_4$, $T_5$ and $T_6$ were significantly higher than in group A (P<0.01). Serum IL-6, TNF-${\alpha}$ and CRP levels in both groups 1, 3 and 6 d after operation increased markedly compared with 1 d before operation (P<0.01), but the increased range in group A was notably lower than in group B (P<0.05 or P<0.01). Postoperative incidences of hypoglycemia, hyperglycemia and myocardial ischemia in group A were significantly lower than in group B (P<0.05), and respiratory support time obviously shorter than in group B (P<0.01). Conclusions: The glucose fluctuation of patients undergoing intracranial excision is related to postoperative IL-6, TNF-${\alpha}$ and CRP levels and those with small range of glucose fluctuation have better prognosis.

• Journal of Chest Surgery
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• 제46권5호
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• pp.340-345
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• 2013

Background: This study aims to evaluate whether or not the method of right vertical axillary minithoracotomy (RVAM) is preferable to and as reliable as conventional sternotomy surgery, and also assesses its cosmetic results. Methods: Thirty-three patients (7 males, 26 females) with atrial septal defect were admitted to the Cardiovascular Surgery Clinic of Cukurova University from December 2005 until January 2010. The patients' ages ranged from 3 to 22. Patients who underwent vertical axillary minithracotomy were assigned to group I, and those undergoing conventional sternotomy, to group II. Group I and group II were compared with regard to the preoperative, perioperative and postoperative variables. Group I included 12 females and 4 males with an average age of $16.5{\pm}9.7$. Group II comprised 14 female and 3 male patients with an average age of $18.5{\pm}9.8$ showing similar features and pathologies. The cases were in Class I-II according to the New York Heart Association (NYHA) Classification, and patients with other cardiac and systemic problems were not included in the study. The ratio of the systemic blood flow to the pulmonary blood flow (Qp/Qs) was $1.8{\pm}0.2$. The average pulmonary artery pressure was $35{\pm}10$ mmHg. Following the diagnosis, performing elective surgery was planned. Results: No significant difference was detected in the average time of the patients' extraportal circulation, cross-clamp and surgery (p>0.05). In the early postoperative period of the cases, the duration of mechanical ventilator support, the drainage volume in the first 24 hours, and the hospitalization time in the intensive care unit were similar (p>0.05). Postoperative pains were evaluated together with narcotic analgesics taken intravenously or orally. While 7 cases (43.7%) in group I needed postoperative analgesics, 12 cases (70.6%) in group II needed them. No mortality or major morbidity has occurred in the patients. The incision style and sizes in all of the patients undergoing RVAM were preserved as they were at the beginning. Furthermore, the patients of group I were mobilized more quickly than the patients of group II. The patients of group I were quite pleased with the psychological and cosmetic results. No residual defects have been found in the early postoperative period and after the end of the follow-up periods. All of the patients achieved functional capacity per NYHA. No deformation of breast growth has been detected during 18 months of follow-up for the group I patients, who underwent RVAM. Conclusion: To conclude, the repair of atrial septal defect by RVAM, apart from the limited working zone for the surgeon in these pathologies as compared to sternotomymay be considered in terms of the outcomes, and early and late complications. And this has accounted for less need of analgesics and better cosmetic results in recent years.

• 대한지역사회영양학회지
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• 제29권2호
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• pp.129-143
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• 2024

Objectives: The objective of this study is to compare a nutritionally balanced soft blend diet (SBD) with a soft fluid diet (SFD) on the health of inpatients who have undergone oral and maxillofacial (OMF) surgery, ultimately aiming to enhance care outcomes, improve health-related quality of life (QOL), and increase satisfaction with the hospital. Methods: Thirty-two patients were randomized into two groups: sixteen received SFD and sixteen received SBD. Anthropometric, laboratory evaluations were conducted upon admission and discharge. Patients filled out questionnaires on demographics, diet satisfaction, food intake amount, and health-related QOL on the day of discharge, assessed using the EuroQoL 5 Dimensions 3 Level and EuroQoL Visual Analogue Scale (EQ-VAS) instruments. Data were analyzed with descriptive statistics, χ² tests for group differences, and paired nonparametric t-tests for within-group comparisons. The Mann-Whitney U test evaluated inter-group differences in preoperative weight and body mass index (BMI), postoperative changes, meal satisfaction, intake, health-related QOL, and self-assessed health status. P-values were set at a significance level of 0.05. Results: The SBD group had higher dietary intake (63.2% vs. 51.0%) and greater diet satisfaction (80.6 vs. 48.1, P < 0.0001) compared to SFD group. Health-related QOL, measured by EQ-VAS, was better in SBD group (70.3 vs. 58.8, P < 0.05). Postoperative weight and BMI decreased in SFD group but increased in SBD group (P < 0.01). Changes in laboratory results showed more stability in the SBD group. No postoperative infections were reported in SBD group, whereas SFD group had a 31.25% complication rate. Conclusions: While SFD is often recommended after OMF surgery to protect oral wound healing process, our study reveals that SBD not only enhances physical and psychological outcomes but also, somewhat unexpectedly, supports wound healing and reduces complications. Essentially, SBD promotes physical recovery and enhances health-related QOL than SFD by supporting both somatic and mental healing aspects.

• 대한소아치과학회지
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• 제25권3호
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• pp.506-512
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• 1998

심신장애자, 심한 불안과 공포가 있는 경우, 너무 어려서 의사소통이 되지 않는 환자 등, 일반적인 행동조절방법이 가능하지 않은 경우에 전신마취를 고려하게 된다. 이런 환자들은 대부분 소아 치과에서 치료하게 되므로 소아치과의사의 역할이 중요하다. 전신마취하에 시행되는 치과치료를 고려할 때, 환자의 전신적 건강상태, 환자의 현재 구강 형태, 필요한 치과치료의 종류, 책임감 있는 보호자의 유무에 따라서 입원없이 행해지는 외래환자수술을 고려할 수 있다. 전신마취하에 치과치료를 시행하고자 할 때, 치과의사나 보호자의 편의를 위해서 사용되어져서는 안되며, 적절한 환자 선택하에 시행된다면, 보통의 방법으로 치과치료를 받기 어려운 장애아동에게 유리한 치료가 될 수 있다.

• Journal of Chest Surgery
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• 제57권2호
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• pp.205-212
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• 2024

Background: Postoperative atrial fibrillation (A-fib) is a serious complication of cardiac surgery that is associated with increased mortality and morbidity. Traditional 24-hour Holter monitors have limitations, which have prompted the development of innovative wearable electrocardiogram (ECG) monitoring devices. This study assessed a patch-type wearable ECG device (MobiCARE-MC100) for monitoring A-fib in patients undergoing cardiac surgery and compared it with 24-hour Holter ECG monitoring. Methods: This was a single-center, prospective, investigator-initiated cohort study that included 39 patients who underwent cardiac surgery between July 2021 and June 2022. Patients underwent simultaneous monitoring with both conventional Holter and patchtype ECG devices for 24 hours. The Holter device was then removed, and patch-type monitoring continued for an additional 48 hours, to determine whether extended monitoring provided benefits in the detection of A-fib. Results: This 72-hour ECG monitoring study included 39 patients, with an average age of 62.2 years, comprising 29 men (74.4%) and 10 women (25.6%). In the initial 24 hours, both monitoring techniques identified the same number of paroxysmal A-fib in 7 out of 39 patients. After 24 hours of monitoring, during the additional 48-hour assessment using the patch-type ECG device, an increase in A-fib burden (9%→38%) was observed in 1 patient. Most patients reported no significant discomfort while using the MobiCARE device. Conclusion: In patients who underwent cardiac surgery, the mobiCARE device demonstrated diagnostic accuracy comparable to that of the conventional Holter monitoring system.

• 한국산학기술학회논문지
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• 제19권1호
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• pp.456-465
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• 2018

본 연구의 목적은 위암 수술환자의 구체적 자기효능감, 가족지지와 자가간호수행의 관계를 파악하기 위함이다. 자료수집은 2013년 10월 11일에서 동년 11월 15일까지였으며, B시에 소재한 D대학병원에서 위암 진단 후 치료목적으로 수술을 받은 후 3개월이 경과하고 5년 이내의 추후관리 중인 환자 121명을 대상으로 설문조사 하였다. 자료분석은 SPSS/PC WIN 18.0 프로그램을 이용하여 실수와 백분율, 평균, 평균평점과 표준편차, t-test, ANOVA와 Scheffe's test, Pearson's correlation coefficients 및 stepwise multiple regression으로 분석하였다. 위암 수술환자의 제특성에 따른 자가간호수행 정도는 성별(t=-2.25, ｐ=.027), 종교(F=3.67, ｐ=.028), 직업(F=4.17, ｐ=.008)에 따라 통계적으로 유의한 차이가 있었다. 위암 수술환자의 자가간호수행은 구체적 자기효능감과 정적인 상관관계를 보여주었다(r=.60, ｐ<.001). 위암 수술환자의 자가간호수행 관련요인은 구체적 자기효능감, 종교 및 성별로 나타났다. 전체 설명력은 37.9%였으며, 가장 큰 영향요인은 구체적 자기효능감 (${\beta}=.53$)으로 나타났다. 따라서 위암 수술환자의 자가간호수행을 돕기 위해서는 구체적 자기효능감을 높이는 중재를 제공하는것이 필요하며, 종교 및 성별을 활용한 실질적인 방안을 마련해야 할 것이다.

• Tuberculosis and Respiratory Diseases
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• 제64권3호
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• pp.219-223
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• 2008

저자들은 대량 객혈로 내원한 환자에서 폐 출혈과 함께 반복적인 심인성 폐부종, 카테콜라민 유도성 심부전이 합병된 드문 형태의 갈색세포종을 경험하여 이러한 임상 증상시 폐나 심장 질환 외에 갈색세포종에 대한 고려가 필요할 것으로 생각되어 문헌고찰과 함께 보고하는 바이다.

• The Korean Journal of Pain
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• 제29권4호
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• pp.239-248
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• 2016

Background: The present study was undertaken to evaluate the incidence of chronic persistent post-surgical pain (CPPP) and the role of signal transduction genes in patients undergoing staging laparotomy for carcinoma ovary. Methods: The present observational study was undertaken following institutional ethical committee approval and informed consent from all the participants. A total 21 patients of ASA grade I to III with age 20-70 years, scheduled for elective staging laparotomy for carcinoma ovary were included. Patients were excluded if had other causes of pain, cognitive dysfunction or chronic neurological disorders. Statistical analysis of pool data was done using SPSS version-17. For various scales like GPE, PDQ, NPSI, the visual analogue scale (VAS), global perceived effect (GPE), the pain DETECT questionnaire (PDQ), and neuropathic pain symptoms inventory (NPSI), one factor repaeted measure ANOVA applied with simple contrast with baseline as on post-operative day 1 (considered as reference and compared with subsequent time-interval), and the P values were adjusted according to "Bonferroni adjustments". In patients with CPPP, the ${\Delta}ct$ values of mRNA expressions of genes at the end of postoperative day 90 were compared with the baseline control values by one factor repeated ANOVA. P value < 0.005 significant. Results: The present study demonstrates 38.1% (8 out of 21 patients) incidence of CPPP. The functional status and quality of life as were observed to be significantly diminished in all patients with chronic pain. An up-regulation in the mRNA expression of signal transduction and a positive correlation was noted between the mRNA expression of signal transduction genes and VAS score in all patients with CPPP at the end of postoperative day 90. Conclusions: The reported incidence of CPPP in patients with carcinoma ovary was 38.1%. An up-regulation and positive correlation between mRNA expression of signal transduction genes and VAS score depicts its potential role in the pathogenesis of CPPP.

• 한국산학기술학회논문지
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• 제16권2호
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• pp.1264-1272
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• 2015

본 연구는 간호사가 지각하는 핵심기본간호술의 중요성과 실제 빈도가 일반병동과 특수병동에서 차이가 있는지를 확인하기 위한 비교 조사연구로 2011년 10월 1일에서 2011년 10월 30일까지 D광역시 소재 Y 대학병원 간호사 182명을 대상으로 하였다. 간호평가원에서 제시한 핵심기본간호술 20개 문항에 대해 자가 보고식으로 작성하였다. 자료 분석은 SPSS 20.0 program으로 분석하였다. 연구결과에서 일반병동과 특수병동의 핵심기본간호술에 대한 중요성 인식은 일반병동이 특수병동에 비해 피내주사(p=.011), 수혈요법(p=.028), 단순도뇨(p=.047), 배출관장(p=<.001), 수술 전 후 간호(p=.035), 입원관리하기(p=.027)와 비강 캐뉼라를 이용한 산소 요법(p=.002)이 유의하게 높았다. 일반병동과 특수병동의 핵심기본간호술에 대한 실제 수행 빈도는 일반병동이 특수병동에 비해 수혈요법(p=.002), 간헐적 위관영양(p=.032), 단순도뇨(p=<.001), 배출관장(p=<.001), 수술 전 간호(p=.001), 수술 후 간호(p=<.001), 입원관리하기(p=.001), 격리실 출입시 보호장구 착용(p=.021)과 비강캐뉼라를 이용한 산소요법(p=<.001)이 유의하게 높았다. 본 연구를 통해, 일반병동에서 중요하고, 실제로 특수병동보다 많이 수행하는 일반병동에서의 핵심기본간호술과 특수병동에서 중요하고, 일반병동에 비해 많이 수행하는 특수병동에서의 핵심기본간호술을 분류할 수 있었다. 이는 핵심기본간호술 학습을 체계화할 수 있는 교과과정을 개발하는데 초석이 되리라 사료된다.