• 대한구순구개열학회지
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• 제2권1_2호
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• pp.15-22
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• 1999

It is well known that the postoperative skeletal instability after Le Fort I osteotomy for advancement of maxilla in the cleft patients is one of the major surgical problems. So we had tried to compare the amount of relapse after Le Fort I advancement surgery in the horizontal and vertical positional change, angular change of reference points between cleft patients and non-cleft patients. Longitudinal records of 10 consecutive cleft patients (test group) and 20 non-cleft patients (control group) were analyzed. Lateral cephalograms were taken preoperatively, immediately postoperatively, and 2, 6, 12 months postoperatively. We measured horizontal and vertical changes (ANS, PNS, AI) and angular change (SNA) of the reference points and lines. In the test group, horizontal relapse of ANS, PNS, AI point are 36.4%, 37.5%, 32.0% respectively at 12 months postoperatively. The vertical relapse of ANS, PNS, AI are 25.3%, 32.3%, 39.1% respectively at 12 months postoperatively. The angular change of SNA is 33.6% at 12 months postoperatively. In the control group, horizontal relapse of ANS, PNS, AI point are 23.8%, 30.2%, 21.7% respectively at 12 months postoperatively. The vertical relapse of ANS, PNS, AI are 22.7%, 27.3%, 25.1% respectively at 12 months postoperatively. The angular change of SNA is 22.2% at 12 months postoperatively. The cleft patients have a larger tendency of skeletal and dental relapse compared with non-cleft patients after Le Fort I surgery. So the oral and maxillofacial surgeons must keep in mind these facts in order to minimize the relapse phenomenon from the beginning of surgical planning to postoperative care.

• Journal of Gastric Cancer
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• 제15권3호
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• pp.176-182
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• 2015

Purpose: To compare the surgical outcomes of laparoscopic total gastrectomy between elderly and non-elderly patients. Materials and Methods: Between 2008 and 2015, a total of 273 patients undergoing laparoscopic total gastrectomy for gastric carcinoma were divided into two age groups: elderly (${\geq}70$ years, n=71) vs. non-elderly (<70 years, n=172). Postoperative outcomes, including length of hospital stay, morbidity, and mortality were compared between the groups. Results: The elderly group showed a significantly higher rate of comorbidities and American Society of Anesthesiologists scores than those in the non-elderly group. No significant differences were found with respect to lymphadenectomy or combined organ resection between the groups. After surgery, the elderly group showed a significantly higher incidence of grade III and above complications than the non-elderly group (15.5% vs. 4.1%, P=0.003). Among the complications, anastomosis leakage was significantly more common in the elderly group (9.9% vs. 2.9%, P=0.044). Univariate and multivariate analyses showed that old age (${\geq}70$ years) was an independent risk factor (odds ratio=4.42, 95% confidence interval=1.50~13.01) for postoperative complications of grade III and above. Conclusions: Elderly patients are more vulnerable to grade III and above complications after laparoscopic total gastrectomy than non-elderly patients. Great care should be taken to prevent and monitor the development of anastomosis leakage in elderly patients after laparoscopic total gastrectomy.

• Journal of Gastric Cancer
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• 제17권1호
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• pp.21-32
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• 2017

Purpose: Perioperative chemotherapy improves survival outcomes in locally advanced (LA) gastric cancer. Materials and Methods: We retrospectively analyzed patients with LA gastric cancer who were offered perioperative chemotherapy consisting of epirubicin, oxaliplatin, and capecitabine (EOX) from May 2013 to December 2015 at Tata Memorial Hospital in Mumbai. Results: Among the 268 consecutive patients in our study, 260 patients (97.0%) completed neoadjuvant chemotherapy, 200 patients (74.6%) underwent D2 lymphadenectomy, and 178 patients (66.4%) completed adjuvant chemotherapy. The median follow-up period was 17 months. For the entire cohort, the median overall survival (OS), 3-year OS rate, median progression-free survival (PFS), and 3-year PFS rate were 37 months, 64.4%, 31 months, and 40%, respectively. PFS and OS were significantly inferior in patients who presented with features of obstruction than in those who did not (P=0.0001). There was no difference in survival with respect to tumor histology (well to moderately differentiated vs. poorly differentiated, signet ring vs. non-signet ring histology) or location (proximal vs. distal). Survival was prolonged in patients with an early pathological T stage and a pathological node-negative status. In a multivariate analysis, postoperative pathological nodal status and gastric outlet obstruction on presentation significantly correlated with survival. Conclusions: EOX chemotherapy with curative resection and D2 lymphadenectomy is a suggested alternative to the existing perioperative regimens. The acceptable postoperative complication rate and relatively high resections, chemotherapy completion, and survival rates obtained in this study require further evaluation and validation in a clinical trial.

• Child Health Nursing Research
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• 제4권1호
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• pp.17-30
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• 1998

In order to investigate the effects of a decreased activity on skinfold thickness, circumference and muscle strength of the extremities during the recovery period following heart surgery, skinfold thickness, circumference and muscle strength of the extremities were measured on days 0, 3, 6, and 9 following the surgery, and compared with those on the arrival day of intensive care unit. Skinfold thickness was measured using a skinfold caliper(Saehan Cor., Korea), circumference of the limbs were measured with a tape measure, upper extremity strength was determined using the Takei grip dynamometer and lower extremity strength was measured by pressing the flatfoot on an electronic digital health meter while tying on a bed. Results from this study were thus : 1. Skinfold thickness of triceps, quadriceps and gastrocnemius muscle on days 3, 6, 9 following the heart surgery was not significantly different from that of on the day of operation. 2. Circumference of midupperarm and midthigh on days 3, 6, 9 following the heart surgery was not significantly different from that of on the day of operation. Circumference of midcalf on days 3, 6 following the heart surgery was not significantly different from that of on the day of operation, while that of midcalf on day 9 following the surgery decreased significantly compared with that of on the day of operation. 3. Muscle strength of the upper extremity was not significantly different from that of on the day of operation, while that of the lower extremity on day 9 following the surgery decreased significantly compared with that of on the day of operation. From these results, it may be concluded that circumference and muscle strength of lower extremity can be decreased due to the postoperative inactivity following heart surgery in congenital heart disease children.

• Archives of Reconstructive Microsurgery
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• 제10권2호
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• pp.75-80
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• 2001

Purpose : We have evaluated the morbidity of donor site after transfer of free fibular osseous and osteocutaneous flap to defect site of bone and soft tissue due to chronic osteomyelitis of long tubular bone, open fracture with bony defect, bone or soft tissue tumor and congenital anomaly. Materials and methods : The 54 cases of 79 cases to be carried out from May, 1982 to May, 2001 which could be followed up were reviewed. There were forty nine in male and five in female. The mean age was 35(4 to 66)years old and mean follow up period is 21.3 month(12 to 72). We have retrospectively analyzed the various postoperative complications such as compartment syndrome, donor site infection, skin defect, hypesthesia, hammer toes, ankle instability and activity of daily living by help of questionnaire, telephone, physical examination, follow up x-ray study and chart. Results : In the total 54 cases the medication period for pain control after operation were classified into three groups under 2 weeks(49 cases), from 2 weeks to 6 weeks(3 cases) and over 6 weeks(2 cases). The postoperative morbidity were occurred in total 12 cases(compartment syndrome: 0, infection : 2, skin defect: 1, hypesthesia: 5, hammer toe: 2 ankle pain: 2 discomfort in activity of daily living: 0), and also the morbidity rates of donor site were 23.5% in osseous flap and 21.6% in osteocutaneous flap were occurred. There was no statistical significonce in morbidity between osseous and osteocutaneous free fibular flap transfer(P>0.05). Discussion : In general the morbidity of free fibular flap transfer was relatively high but it did not have any effect on daily activity of living. We think that the meticulous operation technique, detailed wound care and early range of motion exercise will reduce the morbidity of donor site of flap.

• Journal of Trauma and Injury
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• 제25권2호
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• pp.57-62
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• 2012

Gunshot wounds are rare in Korea, but they have tended to increase recently. We experienced an interesting case of penetrating gunshot injuries to the cervical spine with migration the fragments of the bullet within the dural sac of the cervical spine, so discuss the pathomechanics, treatment and complications of gunshot wounds to the spine and present a review of the literature. A 38-year-old man who had tried to commit suicide with a gun was admitted to our hospital with a penetrating injury to the anterior neck. the patient had quadriplegia. A Computed tomography (CT) scan and 3-dimensional CT of the spine showed destruction of the left lateral mass and lamina of the 5th cervical vertebra; the bullet and fragments were found at the level of the 5th cervical vertebra. The posterior approach was done. A total laminectomy and removal of the lateral mass of the 5th cervical vertebrae were performed, and bone fragments and pellets were removed from the spinal canal, but an intradurally retained pellets were not totally removed. A dural laceration was noted intraoperatively, and CSF leakage was observed, so dura repair was done watertightly with prolene 6-0. The dura repair site was covered with fibrin glue and Tachocomb$^{(R)}$. Immediately, a lumbar drain was done. Radiographs included a postoperative CT scan and X-rays. The postoperative neurological status of the patient was improved compared with the preoperative neurological status. however, the patients developed symptoms of menigitis. He received lumbar drainage(200~250 cc/day) and ventilator care. After two weeks, panperitonitis due to duodenal ulcer perforation was identified. Finally, the patient died because of sepsis.

• Journal of Chest Surgery
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• 제49권6호
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• pp.427-434
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• 2016

Background: Recent studies have demonstrated the benefits of off-pump coronary bypass grafting over the on-pump technique in patients with chronic kidney disease (CKD). To further reduce the risk of acute kidney injury and the need for renal replacement therapy, even in patients undergoing off-pump coronary artery bypass grafting, we adopted protocol-based perioperative management for patients with CKD. Methods: From December 2012 to March 2015, 265 patients underwent isolated off-pump coronary artery bypass grafting. To analyze renal function in a stable condition, we excluded 12 dialysis-dependent end stage renal failure and 10 emergency or urgent cases. Among the remaining 243 patients, 208 patients had normal kidney function (normal group), and 35 patients had CKD (CKD group). Minimizing contrast exposure, ensuring adequate hydration, using strict drug dosage adjustment, and optimizing hemodynamic status were key elements of the protocol for the CKD group. Results: The risk of acute kidney injury was about ${\times}3$ higher in the CKD group than in the normal group (p=0.01). Estimated glomerular filtration rates and serum creatinine levels deteriorated until the third postoperative day in the CKD group. However, by adopting protocol-based perioperative management, this transient renal dysfunction recovered to preoperative levels by the fifth postoperative day without requiring renal replacement therapy in all cases. Conclusion: Off-pump coronary bypass surgery combined with this protocol-based perioperative management strategy in patients with non-dialysis-dependent CKD could mostly be performed without renal replacement therapy.

• Journal of Korean Neurosurgical Society
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• 제42권4호
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• pp.276-280
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• 2007

Objective : The purpose of this study was to review the characteristics of falcine meningioma retrospectively and to identify the parameters associated with tumor recurrence. Methods : The analysis included; age, sex, extent of resection, and radiologic and pathologic findings. Falcine meningiomas were classified by location as anterior, middle, or posterior as described for parasagittal meningiomas. Results : Of the 795 meningioma patients treated between 1990 and 2004 at the authors' institution, 68 patients with meningiomas arising from the falx underwent craniotomies. There were 22 male and 46 female patients (1:2.1). Mean age was 55 years and ranged from 14 to 77 years. Locations of falcine meningioma were; the anterior third in 33 cases, middle in 20, and posterior in 15. Mean tumor volume was 42 cc and ranged from 4 to 140 cc. In 58 of the 68 patients tumors were totally removed. Additional surgery for recurrence was performed in 6 patients over 15 years. Of these 6 patients, only two patients underwent gross total tumor resection at first operation; the other four underwent subtotal tumor resection. Based on pathologic reports, the largest tumor subtype was transitional. There were four patients with a high grade tumor-three atypical and one anaplastic meningioma. Of the 68 patients, 59 achieved a good outcome (no neurological deficit or recurrence), six had temporary complications, two suffered new permanent postoperative deficits, and the remaining one died due to severe brain swelling despite postoperative intensive care. Extent of surgical resection was found to be significantly related to tumor recurrence. Conclusion : Falcine meningioma accounted for 8.5% of intracranial meningiomas and the transitional meningioma was the most common subtype of falcine meningioma. Gross total resection of tumor was the single most important predictor of an improved surgical outcome.

• 한방재활의학과학회지
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• 제30권3호
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• pp.151-162
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• 2020

Objectives This study aimed to evaluate the effectiveness of postoperative Korean rehabilitation treatment for patients with musculoskeletal disorders. Methods The medical records of patients undergoing Korean medical rehabilitation after a musculoskeletal surgery, from January 1, 2016, to December 31, 2019, were analyzed retrospectively. The effect of treatment was evaluated by using a numeric rating scale (NRS) and questionnaire for each surgical site. When the same patient was re-admitted after discharge, it was treated as the same case if it was within 7 days from the discharge date; otherwise, it was treated separately. If the period of hospitalization was within 7 days or the chief complaint was not related to musculoskeletal surgeries, the case was excluded. Results In total, 480 cases were included in this study. Acupuncture (99.8%), moxibustion (95.6%), cupping (97.5%), Chuna manual therapy (81.5%), Korean medical physiotherapy (61.0%), Daoyin exercise therapy (26.3%), and herbal medicine (87.7%) were used as the Korean medical rehabilitation treatments. A significant improvement was noted when comparing the NRS and questionnaire results for each surgical site at the time of admission and discharge. Conclusions Korean medical rehabilitation can be effectively used for patients who have undergone musculoskeletal surgeries, to relieve pain and enable returning to daily activities. However, further research with a high level of evidence is necessary to support this finding.

• Archives of Plastic Surgery
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• 제41권1호
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• pp.57-62
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• 2014

Background Achieving symmetry is a key goal in breast reconstruction. Anatomically shaped tabbed expanders are a new tool in the armamentarium of the breast reconstruction surgeon. Suture tabs allow for full control over the expander position and thus inframammary fold position, and, in theory, tabbed expanders mitigate many factors responsible for poor symmetry. The impact of a tabbed expander on breast symmetry, however, has not been formally reported. This study aims to evaluate breast symmetry following expander-implant reconstruction using tabbed and non-tabbed tissue expanders. Methods A chart review was performed of 188 consecutive expander-implant reconstructions that met the inclusion criteria of adequate follow-up data and postoperative photographs. Demographic, oncologic, postoperative complication, and photographic data was obtained for each patient. The photographic data was scored using a 4-point scale assessing breast symmetry by three blinded, independent reviewers. Results Of the 188 patients, 74 underwent reconstruction with tabbed expanders and 114 with non-tabbed expanders. The tabbed cohort had significantly higher symmetry scores than the non-tabbed cohort ($2.82/4{\pm}0.86$ vs. $2.55/4{\pm}0.92$, P=0.034). Conclusions The use of tabbed tissue expanders improves breast symmetry in tissue expander-implant-based breast reconstruction. Fixation of the expander to the chest wall allows for more precise control over its location and counteracts the day-to-day translational forces that may influence the shape and location of the expander pocket, mitigating many factors responsible for breast asymmetry.