• Journal of Korean Neurosurgical Society
• /
• v.48 no.3
• /
• pp.213-218
• /
• 2010

Objective : Pituitary apoplexy (PA) is described as a clinical syndrome characterized by sudden headache, vomiting, visual impairment, and meningismus caused by rapid enlargement of a pituitary adenoma, We retrospectively analyzed the clinical presentation and surgical outcome in PA presenting with cranial neuropathy. Methods : Twelve cases (33%) of PA were retrospectively reviewed among 359 patients diagnosed with pituitary adenoma, The study included 6 males and 6 females, Mean age of patients was 49,0 years, with a range of 16 to 74 years, Follow-up duration ranged from 3 to 20 months, with an average of 12 months, All patients were submitted to surgery, using the transsphenoidal approach (TSA). Results : Symptoms included abrupt headache (11/12), decreased visual acuity (12/12), visual field defect (11/12), and cranial nerve palsy of the third (5/12) and sixth (2/12) Mean height of the mass was 29.0 mm (range 15-46) Duration between the ictus and operation ranged from 1 to 15 days (mean 7.0) The symptom duration before operation and the recovery period of cranial neuropathy correlated significantly (p = 0.0286) TSA resulted in improvement of decreased visual acuity in 91.6%, visual field defect in 54.5%, and cranial neuropathy in 100% at 3 months after surgery. Conclusion : PA is a rare event, complicating 3.3% in our series, Even in blindness following pituitary apoplexy cases, improvement of cranial neuropathy is possible if adequate management is initiated in time, Surgical decompression must be considered as soon as possible in cases with severe visual impairment or cranial neuropathy.

• Advances in pediatric surgery
• /
• v.20 no.1
• /
• pp.17-22
• /
• 2014

The aim of this study was to identify the risk factor related to the need for operative treatment and avoid unnecessary non-operative management for intussusception in children. We retrospectively reviewed medical records of patient treated for intussusception at our institution between January 2006 and January 2013. Clinical features such as gender, age, seasonal variation, symptoms and signs, treatment results were analyzed. Univariate and multivariate analyses including a chi-square test for categorical variables and logistic regression analysis were performed. During the study period, 356 patients were treated for intussusception. 328 (92.1%) was treated successfully by the non-operative pneumoreduction, and 28 (7.9%) required operative management. On univariate analysis, risk factors which were related to the need for operative treatment were age, vomiting, bloody stool, lethargy, and symptoms duration. A logistic regression analysis in order to assess for independent predictors of operative treatment was performed. Age (<6 vs ${\geq}12$ months) (OR 4.713, 95% CI 1.198~18.539, p=0.027) and symptoms duration longer than 48 hours (OR 4.534, 95% CI 1.846~11.137, p=0.001) were significantly associated with a requirement for operative treatment. We conclude that younger age and a longer duration of symptoms (${\geq}48$ hours) are the independent risk factor related to the need for operative treatment for intussusception. Early surgical intervention or transfer to a hospital with pediatric surgical capabilities should be considered for patients with these findings.

• Journal of Chest Surgery
• /
• v.48 no.1
• /
• pp.46-51
• /
• 2015

Background: Maintenance of adequate vascular access for hemodialysis is important in patients with end-stage renal disease. Once arteriovenous fistula (AVF) occlusion occurs, the patient should be treated with rescue therapy. This study was performed to evaluate the results of a rescue therapy for AVF occlusion. Methods: From January 2008 to December 2012, 47 patients who underwent surgical rescue therapy for AVF occlusion after graft AVF formation, were enrolled in this study. The patients were divided into two groups, namely the graft repair group (group A, n=19) and the thrombectomy group (group B, n=28). Postoperative results of both groups were analyzed retrospectively. Results: There were no statistically significant differences in the clinical characteristics between the two groups. In terms of the duration of AVF patency after the first rescue therapy, group A showed a longer AVF patency duration than group B ($24.5{\pm}21.9$ months versus $17.7{\pm}13.6$ months), but there was no statistically significant difference (p=0.310). In terms of the annual frequency of AVF occlusion after the rescue therapy of group A was lower than that of group B (0.59 versus 0.71), but there was no statistically significant difference (p=0.540). The AVF patency rates at 1, 2, 3, and 5 years after the first rescue therapy in group A were 52.6%, 31.5%, 21.0%, and 15.7%, respectively, and those in group B, they were 32.1%, 25.0%, 17.8%, and 7.14%, respectively. There was no statistically significant difference (p=0.402). Conclusion: Graft repair revealed comparable results. Although there was no statistically significant difference, the patent duration and annual frequency of AVF occlusion of group A were better than those of group B. Therefore, graft repair is considered as a safe and useful procedure for maintaining graft AVF.

• Korean Journal of Clinical Oncology
• /
• v.14 no.2
• /
• pp.69-75
• /
• 2018

Purpose: We analyzed our 10-year experience in a single-center, public hospital and thereby evaluated the changing trends of clinico-pathologic and surgical characteristics as well as treatment outcomes in patients with gastric cancer. Methods: The current single-center, retrospective study was conducted with patients who had been treated at department of our medical institution during a period ranging from March 1, 2007 to June 16, 2018. The eligible patients were divided into two groups: group I (March 2007-April 2012) and II (May 2012-June 2018). Then, we compared time-dependent changes in clinico-pathologic characteristics between the two groups. Results: The mean age was $63.0{\pm}11.3$ years in group I and $65.8{\pm}10.5$ years in group II, respectively (P=0.017). The American Society of Anesthesiologist (ASA) score was 34.9% for 1 point, 38.3% for 2 points, and 26.9% for 3 points or more in group I, and 31.1% for 1 point, 52.5% for 2 points, and 16.4% for 3 points or more in group II, which was statistically significant (P=0.012). The average follow-up duration was significantly different between the two group ($39.8{\pm}39.7$ vs. $23.4{\pm}20.6$) (P<0.001). The duration of postoperative hospital stay was 1.8 days longer in group II than group I (P=0.047). Tumor depth, node metastasis and distant metastasis were significantly different between the two groups (P<0.001, P=0.009, and P=0.019, respectively). Conclusion: There were significant differences in the age, ASA score, average follow-up duration, postoperative hospital stay, tumor depth, node metastasis and distant metastasis between the two groups.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.19 no.4
• /
• pp.201-208
• /
• 2019

Background: After tooth extraction, pain due to dry socket and pain in the adjacent tooth are common. The aim of this study was to retrospectively analyze pain in the adjacent tooth after surgical extraction of the mandibular third molar. Methods: Postoperative pain due to dry socket, pain in the adjacent tooth, and pain from other causes were present. Group A included patents with dry socket alone; group B included patients with pain in the adjacent tooth alone; and group C included patients with both. The duration of symptoms was recorded. In addition, the prognosis of pain was divided into the complete improvement, improvement, maintenance, deterioration, and complete deterioration groups. Results: A total of 312 mandibular third molars were extracted from 13, 60, and 10 patients in groups A, B, and C, respectively. The mean duration of symptoms was 5 days in group A and B and 15.2 days in group C. There were statistically significant differences in the duration of symptoms between groups A and C and groups B and C. Conclusion: Pain in the adjacent tooth after third molar extraction can be caused by inflammatory reactions and pressure on this tooth. The pain caused by pressure on the periodontal ligament and alveolar bone results from the cytokines released by osteoclasts, which are responsible for bone destruction. However, pain from periodontal ligament damage caused by excessive pressure may be misunderstood as pulpal pain. Unconscious parafunctional habits, such as clenching and bruxism, could also be associated with post-extraction pain.

• Journal of Chest Surgery
• /
• v.54 no.6
• /
• pp.466-472
• /
• 2021

Background: Major intraoperative hemorrhage reportedly predicts unfavorable survival outcomes following surgical resection for esophageal carcinoma (EC). However, the factors predicting the amount of blood lost during thoracoscopic esophagectomy have yet to be sufficiently studied. We sought to identify risk factors for excessive blood loss during video-assisted thoracoscopic surgery (VATS) for EC. Methods: Using simple and multiple linear regression models, we performed retrospective analyses of the associations between clinicopathological/surgical factors and estimated hemorrhagic volume in 168 consecutive patients who underwent VATS-type esophagectomy for EC. Results: The median blood loss amount was 225 mL (interquartile range, 126-380 mL). Abdominal laparotomy (p<0.001), thoracic duct resection (p=0.014), and division of the azygos arch (p<0.001) were significantly related to high volumes of blood loss. Body mass index and operative duration, as continuous variables, were also correlated positively with blood loss volume in simple linear regression. The multiple linear regression analysis identified prolonged operative duration (p<0.001), open laparotomy approach (p=0.003), azygos arch division (p=0.005), and high body mass index (p=0.014) as independent predictors of higher hemorrhage amounts during VATS esophagectomy. Conclusion: As well as body mass index, operation-related factors such as operative duration, open laparotomy, and division of the azygos arch were independently predictive of estimated blood loss during VATS esophagectomy for EC. Laparoscopic abdominal procedures and azygos arch preservation might be minimally invasive options that would potentially reduce intraoperative hemorrhage, although oncological radicality remains an important consideration.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.48 no.2
• /
• pp.85-93
• /
• 2022

Objectives: The aim of this study was to compare morbidities and duration of surgery, as well as bone formation in alveolar defects reconstructed with symphysis bone combined with allograft and iliac crest bone graft in patients with cleft palate. Patients and Methods: This randomized clinical trial was performed with 22 patients with unilateral alveolar cleft with a follow-up period of 12 months. In 12 patients, alveolar defects were reconstructed with chin bone graft plus allograft (Group A), while for the other 10 patients, iliac bone crest was used as donor site (Group B). Duration of surgery as well as occurrence of morbidities and complications were recorded. In addition, cone-beam computed tomographic (CBCT) scans were performed before surgery and 12 months after surgical procedures in order to compare bone formation between the two groups. Results: Postoperative CBCT demonstrated a mean bone fill percentage of 76.9% of the alveolar defect in Group A, compared with 77.0% in Group B. Paresthesia in the lower lip or chin did not occur in any patients of Group A. The mean duration of the surgical process was significantly shorter for Group A (40 minutes vs 76 minutes, P<0.001). In addition, patients in Group A regained normal gait faster than patients in Group B (1 day vs 9.5 days). Conclusion: Mandibular symphysis bone graft in combination with allograft results in favorable outcomes in patients with unilateral alveolar clefts.

• Journal of Korean Neurosurgical Society
• /
• v.64 no.1
• /
• pp.88-99
• /
• 2021

Objective : The treatment of choice for spinal epidural abscess (SEA) generally is urgent surgery in combination with intravenous antibiotic treatment. However, the optimal duration of antibiotic treatment has not been established to date, although 4-8 weeks is generally advised. Moreover, some researchers have reported that bacteremia is a risk factor for failure of antibiotic treatment in SEA. In this study, we investigated the clinical characteristics of SEA accompanied by bacteremia and also determined whether the conventional 4-8 weeks of antibiotic treatment is sufficient. Methods : We retrospectively reviewed the medical records and radiological data of 23 patients with bacterial SEA who underwent open surgery from March 2010 to April 2020. All patients had bacteremia preoperatively and underwent weeks of perioperative antibiotic treatments based on their identified organisms until all symptoms of infection disappeared. All patients underwent microbiological studies of peripheral blood, specimens from SEA and concomitant infections. The mean follow-up duration was 35.2 months, excluding three patients who died. Results : The male : female ratio was 15 : 8, and the mean age was 68.9 years. The SEA most commonly involved the lumbar spinal segment (73.9%), and the mean size was 2.9 vertebral body lengths. Mean time periods of 8.4 days and 16.6 days were required from admission to diagnosis and from admission to surgery, respectively. Concomitant infections more frequently resulted in delayed diagnosis (p=0.032), masking the symptoms of SEA. Methicillin-sensitive Staphylococcus aureus was the most commonly identified pathogen in both blood and surgical specimens. Seventeen patients (73.9%) showed no deficits at the final follow-up. The overall antibiotic treatment duration was a mean of 66.6 days, excluding three patients who died. This duration was longer than the conventionally advised 4-8 weeks (p=0.010), and psoas or paraspinal abscess required prolonged duration of antibiotic treatment (p=0.038). Conclusion : SEA accompanied by bacteremia required a longer duration (>8 weeks) of antibiotic treatment. In addition, the diagnosis was more frequently delayed in patients with concomitant infections. The duration of antibiotic treatment should be extended for SEA with bacteremia, and a high index of suspicion is mandatory for early diagnosis, especially in patients with concomitant infections.

• Journal of Korean Academy of Nursing
• /
• v.25 no.4
• /
• pp.653-667
• /
• 1995

Post - operative wound infections have been a serious problem in nursing care in the operating room and appear to be strongly related to the infection occurring during the performance of operation. The purpose of this study is to identify patterns in duration of surgical hand scrub (SHS), to evaluate the method of SHS and to examine the rate of glove perforation. Subjects for this study include 244 doctors and 169 nurses working in the operative theatre of a hospital in Seoul area. Test samples and related data were collected from this medical facility between April 1, through 15, and July 1, through 5, 1995 by the author and a staff member working in the operating room. For the study, data on the SHS of doctors and nurses were obtained at the time of operation and multiple batches of surgical gloves worn by the operating doctors were collected after each operation. The duration of SHS was measured with a stop watch and the method of SHS was evaluated according to Scoring Hand Scrub Criteria (SHS Criteria) and expressed as SHS scores. For the analysis of the data, t-test was used to compare the differences in the duration and the SHS scores of doctors and nurses, and Pearson's correlation coefficient was used to examine the relationship between the SHS duration and the SHS scores. The results of the study are summarized as follows. 1) The mean time spent in each SHS was 167 seconds in nurses, and 127 seconds in doctors. The data comparing nurses and doctors indicated that there were significant differences in Our ation of SH S between these two groups (t=5.58, p=.000). 2) The mean time spent in the first SHS was 145 seconds and that in the End SHS, 135 seconds, and there was not a significant difference in the duration of the SHS between doctors and nurses (t=1.44, P=.156). 3) The mean time spent in the SHS by OS (Orthopaedic surgery) doctors was 162 seconds, 150 seconds by NS(Neurologic surgery), 121 seconds by GS(General surgery), 94 seconds by OPH(Opthalmology) and DS(Dental surgery), 82 seconds by URO(Urology), 78 seconds by PS(Plastic surgery) and 40 seconds by ENT(Ear, Nose & Throat) These also showed a significant difference in the duration of the SHS among the medical specialities (t=4.8, P=.0001). 4) The average SHS score of the nurses was 15.2, while that of doctors was 13.1. The statistical analysis showed that t-value was 3.66, p was. 000. This indicates that the nurses actually clean their hands more thoroughly than the doctors do. 5) The average SHS score of NS doctors was 15.5, 15.3 for doctors for OPH,14.3 for OS,12.7 for GS, 12.0 for DS, 11.7 for URO, 10.1 for PS, 7.5 for ENT. Comparison of the average SHS scores from 8 specialties showed that there was a significant differences in the patterns of the SHS (F=5.08, P=.000) among medical specialties. 6) It appears that the operating personnel scrub the palms and dorsum of their hand relatively well, however, less thorough the nails and fingers. 7) The more the operating personnel spend their time in hand scrubbing, the more correctly they clean their hands(r=.6427, P<.001). 8) The overall frequencies of perforation in all post-operative gloves tested was 38 out of 389 gloves (10.3%). The perforation rate for PS was 13%, 12.1% for GS,8.8% for 05, and 3.3% for NS.

• Journal of Chest Surgery
• /
• v.36 no.8
• /
• pp.583-589
• /
• 2003

With the purpose of identifying significant risk factors in poststernotomy sternal wound infection and mediastinitis, we underwent a retrospective analysis of the whole patients operated on at the our department of cardiovascular surgery for the two years. Material and Method: From March 200f to March 2003 at the depart-ment of cardiovascular surgery, medical school of Soonchunhyang University, major sternal wound infections had been developed in 12 (9.76%) of 123 consecutive patients. These patients underwent open-heart procedure through a midline sternotomy and survived long enough for infection to appear. For this group of patients, we evaluated possible risk factors such as age, sex, diabetes mellitus, chronic obstructive pulmonary disease, obesity, interval between hospital admission and operation, type of surgical procedure, elective or emergency surgical procedure, reoperation, duration of surgical procedures, duration of cardiopulmonary bypass, amount of blood transfused, post-operative blood loss, chest reexploration, rewiring of a sterile sternal dehiscence, duration of mechanical ventilation, and days of stay in the intensive care unit and analyzed these factors. Result: Analysis represented that age, sex, diabetes mellitus, type and mode of surgical procedure, reoperation, duration of operation, duration of cardio-pulmonary bypass, and interval between hospital admission and operation were not significantly associated with wound infection. For all other predisposing factors, p-values of less than .05 were demonstrated. Eight emerged as significant: early chest reexploration (p=0.001), sternal rewiring (p< 0.0001), chronic obstructive pulmonary disease (p<0.0001), blood transfusions (p<0.05), postoperative bleeding (p=0.008), days of stay in the intensive care unit (p< 0.0001), duration of mechanical ventilation (p=0.001), and obesity (p=.003). Conclusion: Contamination of pa-tients may occur before, during, and after the operation, and any kind of reintervention may predispose the patient to wound infection.