• Journal of Korean Neurosurgical Society
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• v.40 no.1
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• pp.11-15
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• 2006

Objective : Acute cerebral infarction is often accompanied by transtentorial herniation which can be fatal. The aim of this study is to determine the timing of surgical intervention and prognostic factors in patients who present with acute cerebral infarction. Methods : We reviewed retrospectively 23 patients with acute cerebral infarction, who received decompressive craniectomy or conservative treatment from January 2002 to December 2004. We divided patients into two groups according to the treatment modalities [Group 1 : conservative treatment, Group 2 : decompressive craniectomy]. In all patients, the outcome was quantified with Glasgow Outcome Scale and Barthel Index. Results : Of the 23 patients, 11 underwent decompressive craniectomy. With decompressive craniectomy at the time of loss of pupillary light reflex, we were able to prevent death secondary to severe brain edema in all cases. Preoperative Glasgow Coma Scale and loss of pupillary light reflex were significant to the clinical outcome statistically. With conservative treatment, 9 of the 12 patients died secondary to transtentorial herniation. The clinical outcomes of remaining 3 patients were poor. Conclusion : This study confirms the value of life-saving procedure of decompressive craniectomy after acute cerebral infarction. We propose that the loss of pupillary light reflex should be considered one of the most important factors to determine the timing of the decompressive craniectomy.

• Journal of Oral Medicine and Pain
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• v.38 no.4
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• pp.319-324
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• 2013

Dislocation of the temporomandibular joint (TMJ) occurs when the mandibular condylar head is displaced completely out of the glenoid fossa and cannot be reduced by the patient. The occurrence of bilateral anterior dislocation is the most common. Dislocations can be classified into three types in terms of duration and frequency of dislocation, i.e., acute, chronic and recurrent. There are various treatment modalities for dislocation from conservative try to surgical intervention. The selection for the appropriate modality mainly depends on the types of dislocation as previously stated. The authors report three cases of dislocation with different treatment modalities according to the duration of dislocation. In particular, we tried prosthetic approach instead of surgical intervention in the patient with chronic dislocation.

• Journal of Dental Rehabilitation and Applied Science
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• v.26 no.3
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• pp.349-357
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• 2010

Physical factors and intra- and extra-oral factors of a patient have to be considered in order to decide a treatment plan for the skeletal class III malocclusion patient. Most of cases, the pre-prosthodontic treatment requires the orthodontic approaches and maxillofacial surgery. However, in some cases, patients' economic or medical condition makes impracticable situation for the orthodontic or surgical intervention. For those cases, the compromised prosthetic treatment which provides more stable and persistent occlusal stabilization is recommended. In this case report, a woman patient has a skeletal class III maxillomandibular relationship and misses multiple teeth. The prosthetic treatment without orthodontic and surgical intervention is performed due to her physical problem. The functional and esthetic results are achieved by the fixed prosthesis.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.7 no.1
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• pp.78-82
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• 2004

Henoch-$Sch{\ddot{o}}nlein$ purpura (HSP) is a vasculitis of the small vessels in skin, joints, gastrointestinal (GI) tract and kidney. GI symptoms occur in up to 85% of patients and may lead to severe problems such as intussusception, obstruction, and perforation. GI symptoms may not be easily controlled, showing refractoriness to the conventional corticosteroid therapy. Although GI involvements of HSP are acute, and self-limited in most instances, they may cause fatal results in some unusual cases. In such conditions all the possible therapeutic modalities should be considered. We report two cases of severe small bowel involvement of HSP. One case presented with severe abdominal pain showing refractoriness to corticosteroid, but improved with IV immunoglobulin therapy. In the second case, HSP with transmural infarction in the small bowel could be cured with surgical intervention.

• Archives of Plastic Surgery
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• v.39 no.1
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• pp.31-35
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• 2012

Background : Orbital roof fractures are frequently associated with a high energy impact to the craniofacial region, and displaced orbital roof fractures can cause ophthalmic and neurologic complications and occasionally require open surgical intervention. The purpose of this article was to investigate the clinical features and treatment outcomes of orbital root fractures combined with neurologic injuries after early reconstruction. Methods : Between January 2006 and December 2008, 45 patients with orbital roof fractures were admitted; among them, 37 patients were treated conservatively and 8 patients underwent early surgical intervention for orbital roof fractures. The type of injuries that caused the fractures, patient characteristics, associated fractures, ocular and neurological injuries, patient management, and treatment outcomes were investigated. Results : The patients underwent frontal craniotomy and free bone fragment removal, their orbital roofs were reconstructed with titanium micromesh, and associated fractures were repaired. The mean follow up period was 11 months. There were no postoperative neurologic sequelae. Postoperative computed tomography scans showed anatomically reconstructed orbital roofs. Two of the five patients with traumatic optic neuropathy achieved full visual acuity recovery, one patient showed decreased visual acuity, and the other two patients completely lost their vision due to traumatic optic neuropathy. Preoperative ophthalmic symptoms, such as proptosis, diplopia, upper eyelid ptosis, and enophthalmos were corrected. Conclusions : Early recognition and treatment of orbital roof fractures can reduce intracranial and ocular complications. A coronal flap with frontal craniotomy and orbital roof reconstruction using titanium mesh provides a versatile method and provides good functional and cosmetic results.

• Journal of Trauma and Injury
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• v.34 no.1
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• pp.31-38
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• 2021

Purpose: Traumatic vertebral injuries have a prevalence of 4-5% at level I centers. Studies have demonstrated that isolated thoracolumbar transverse process fractures (iTPF) rarely require brace or surgical interventions. We hypothesized that similarly isolated thoracolumbar spinous process fractures (iSPF) would have less need for bracing and operative interventions than SPFs with associated vertebral body (VB) fractures (SPF+VB). We performed a similar analysis for iTPF compared to transverse process fractures associated with VB injury (TPF+VB). Methods: In this single-center, retrospective study from 2012 to 2016, patients were classified into iSPF, SPF+VB, iTPF, and TPF+VB groups. Data including the fracture pattern, neurologic deficits, and operative intervention were obtained. The primary outcome studied was the need for bracing and/or surgery. A statistical analysis was conducted. Results: Of 98 patients with spinous process fractures, 21 had iSPF and 77 had SPF+VB. No iSPF patients underwent surgery, whereas 24 (31.17%) SPF+VB patients did undergo surgery (p=0.012). In the iSPF group, three patients (15%) received braces only for comfort, whereas 37 (48.68%) of the SPF+VB group required bracing (p=0.058). Of 474 patients with transverse process fractures, 335 had iTPF and 139 had TPF+VB. No iTPF patients underwent surgery, whereas 28 (20.14%) TPF+VB patients did (p≤0.001). Of the iTPF patients, six (1.86%) were recommended to receive braces only for comfort, while 68 (50.75%) of the TPF+VB patients required bracing (p<0.001). Conclusions: No patients with iSPF or iTPF required surgical intervention, and bracing was recommended to patients in these groups for comfort only. It appears that these injures may be safely managed without interventions, calling into question the need for spine consultation.

• Journal of Pharmacopuncture
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• v.24 no.4
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• pp.196-205
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• 2021

Objectives: Bruising is an important side effect of enoxaparin injection. Comfrey (Symphytum officinale) is used to treat different types of wounds, bone fractures, and bruising in traditional medicine in many countries for centuries. This study aimed to determine the effects of the Comfrey ointment on the bruise size and color following enoxaparin injection. Methods: This double-blind randomized clinical trial was conducted on 80 patients with acute coronary syndrome (ACS). The participants were randomly divided into two groups of 40, namely Comfrey and Placebo. Changes in bruise size and color in both groups were assessed daily before and after the intervention. Results: The Comfrey and Placebo groups were homogeneous in demographic and clinical variables. A downward trend was observed in the bruise size in both groups throughout the study. However, the bruise size was smaller in the Comfrey group than the Placebo group on day 2-5 of the intervention. Moreover, there was a significant difference in bruise color between the groups, with a shorter healing course in the Comfrey group. Conclusion: The Comfrey ointment accelerated the healing process of enoxaparin injection-induced bruising in patients with ACS. It is recommended as a safe and simple approach for these patients.

• Korean Journal of Veterinary Research
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• v.62 no.3
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• pp.26.1-26.7
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• 2022

This study was aimed to evaluate the prophylactic anti-glaucoma effect of topical 5% betaxolol (BTX) and 2% dorzolamide (DRZ) on the second eye in dogs with unilateral primary angle closure glaucoma (PACG). Medical records of 60 dogs with unilateral PACG who received prophylactic anti-glaucoma eyedrops in the second eye, from 2016 to 2021, were reviewed. The prophylactic effects of BTX were maintained on 28/60 (46.7%) eyes until last visit and BTX failure was observed on median 510 (range, 53-1,927) days in 32/60 (53.3%) eyes. After DRZ instillation in BTX failure eyes, the prophylactic effects were extended at median 610 (range, 157-2,270) days in 21/32 (65.6%) eyes. DRZ failure eyes (17/21, 81.0%) eyes required chemical ablation or surgical intervention due to uncontrolled intraocular pressure. The duration of prophylactic effects was decreased with aging (R² = 0.334, p = 0.006). The predominant breeds were Shih-Tzu (41.9%) and American Cocker Spaniel (30.6%) with no significant differences in survival curves (p = 0.210). The average prophylactic effects of BTX persisted more than 1.5 year and could be selected the first prophylactic eye drop in unilateral PACG. Also, early surgical intervention should be considered in prophylactic medications failure cases.

• Journal of Trauma and Injury
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• v.35 no.4
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• pp.291-296
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• 2022

The therapeutic approach for colon injury has changed continuously with the evolution of management strategies for trauma patients. In general, immediate laparotomy can be considered in hemodynamically unstable patients with positive findings on extended focused assessment with sonography for trauma. However, in the case of hemodynamically stable patients, an additional evaluation like computed tomography (CT) is required. Surgical treatment is often required if prominent mesenteric extravasation, free fluid, bowel infarction, and/or colon wall perforation are observed. However, immediate intervention in hemodynamically stable patients without indications for surgical treatment remains questionable. Three patients with colon and mesocolon injuries caused by blunt trauma were treated by nonoperative management. At the time of admission, they were alert and their vital signs were stable. Colon and mesocolon injuries, large hematoma, colon wall edema, and/or ischemia were revealed on CT. However, no prominent mesenteric extravasation, free fluid, bowel infarction, and/or colon wall perforation were observed. In two cases, conservative treatment was performed without worsening abdominal pain or laboratory tests. Follow-up CT showed improvement without additional treatment. In the third case, follow-up CT and percutaneous drainage were performed in considering the persistent left abdominal discomfort, fever, and elevated inflammatory markers of the patient. After that, outpatient CT showed improvement of the hematoma. In conclusion, nonoperative management can be considered as a therapeutic option for mesocolon and colon injuries caused by blunt trauma of selected cases, despite the presence of large hematoma and ischemia, if there are no clear indications for immediate intervention.

• Journal of Gastric Cancer
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• v.24 no.1
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• pp.108-121
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• 2024

Anastomotic leaks and fistulas are significant complications of gastric surgery that potentially lead to increased postoperative morbidity and mortality. Surgical intervention is reserved for cases with severe symptoms or hemodynamic instability; however, surgery carries a higher risk of complications. With advancements in endoscopic treatment options, endoscopic approaches have emerged as the primary choice for managing these complications. Endoscopic clipping is a traditional method comprising 2 main categories: through-the-scope clips and over-the-scope clips. Through-the-scope clips are user friendly and adaptable to various clinical scenarios, whereas over-the-scope clips can close larger defects. Another promising approach is endoscopic stent insertion, which has shown a high success rate for leak closure, although vigilant monitoring is required to monitor stent migration. Infection control is essential in post-surgical leakage cases, and endoscopic internal drainage provides a relatively safe and noninvasive means to manage fluids, contributing to infection control and wound healing promotion. Endoscopic suturing offers full-thickness wound closure, but requires additional training and endoscopic versatility. As a promising tool, endoscopic vacuum therapy potentially surpasses stent therapy by draining inflammatory materials and closing defects. Furthermore, the use of tissue sealants, such as fibrin glue and cyanoacrylate, has been reported to be effective in selected situations. The choice of endoscopic device should be tailored to individual cases and specific patient conditions, with careful consideration of the nature of the defect. Further extensive studies involving larger patient populations are required to provide more robust evidence on the efficacy of endoscopic approach in managing post-gastric anastomotic leaks.