• Journal of Clinical Otolaryngology Head and Neck Surgery
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• v.29 no.2
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• pp.276-280
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• 2018

It is important to choose which approaches should be used to correct the fracture if the operation is indication for surgery in patients with orbital floor fracture. Transorbital, transantral, and endonasal approaches are methods for correcting the orbital floor fracture. The approach needs to be considered the location of the fracture, the degree, the severity of the fracture, the least remaining patient's disability, and preference of the surgeon. We report a case of orbital floor fracture using transorbital approach and endonasal catheter ballooning to resolve the limitations of transorbital approach alone.

• Journal of Trauma and Injury
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• v.36 no.3
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• pp.290-294
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• 2023

Generally, patients with severe burst fractures, instability, or neurological deficits require surgical treatment. In most cases, circumferential reconstruction is performed. Surgical methods for three-column reconstruction include anterior, lateral, and posterior approaches. In cases involving an anterior or lateral approach, collaboration with general or thoracic surgeons may be necessary because the adjacent anatomical structures are unfamiliar to spinal surgeons. Risks include vascular or lumbar plexus injuries and cage displacement, and in most cases, additional posterior fusion surgery is required. However, the posterior approach is the most common and anatomically familiar approach for surgeons performing spinal surgery. We present a case in which three-column reconstruction was performed using only the posterior approach to treat a patient with a severe lumbar burst fracture.

• The Korean Journal of Pain
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• v.35 no.2
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• pp.202-208
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• 2022

Background: Neurolytic celiac plexus block (NCPB) is a typical treatment for severe epigastric cancer pain, but the therapeutic effect is often affected by the variation of local anatomical structures induced by the tumor. Greater and lesser splanchnic nerve neurolysis (SNN) had similar effects to the NCPB, and was recently performed with a paravertebral approach under the image guidance, or with the transdiscal approach under the guidance of computed tomography. This study observed the feasibility and safety of SNN via a transdiscal approach under fluoroscopic guidance. Methods: The follow-up records of 34 patients with epigastric cancer pain who underwent the splanchnic nerve block via the T11-12 transdiscal approach under fluoroscopic guidance were investigated retrospectively. The numerical rating scale (NRS), the patient satisfaction scale (PSS) and quality of life (QOL) of the patient, the dose of morphine consumed, and the occurrence and severity of adverse events were recorded preoperatively and 1 day, 1 week, 1 month, and 2 months after surgery. Results: Compared with the preoperative scores, the NRS scores and daily morphine consumption decreased and the QOL and PSS scores increased at each postoperative time point (P < 0.001). No patients experienced serious complications. Conclusions: SNN via the transdiscal approach under flouroscopic guidance was an effective, safe, and easy operation for epigastric cancer pain, with fewer complications.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.126-129
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• 1996

Background: Advantages of paramedian approach over midline approach include less tissue trauma and less dependence on patient's ability to assume a fetal position. When midline approach fails in patients who are difficult to take a position with lumbar spine flexed, paramedian approach to interlaminar space may succeed. Methods: Success rates of spinal anesthesia were measured for 47 flexed patients by midline approach, 48 flexed patients by paramedian approach, 23 straightened patients receiving spinal anesthesia by midline approach, and 23 straightened patients by paramedian approach. Results: Success rates in flexed patients were 100% by midline approach and 100% by paramedian approach. Success rates for straightened patients were 13.0% by midline approach and 78.3% by paramedian approach. For straightened patients there were no correlations between success fate and age, weight, Ponderal Index but there were correlations between height and midline approach of spinal anesthesia. Conclusion: Pertaining to adult Koreans, success rates of spinal anesthesia for strainghtened patients were less than those for flexed patients. Success rate of paramedian approach of spinal anesthesia among strainghtened patients were better than those of midline approach.

• Journal of Chest Surgery
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• v.54 no.2
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• pp.99-105
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• 2021

Background: The number of heart transplantations (HTx) is increasing annually. Due to advances in medical and surgical support, the outcomes of HTx are also improving. Extracorporeal circulatory life support (ECLS) provides patients with decompensated heart failure a chance to undergo HTx. A medical approach involving collaboration among experienced experts in different fields should improve the outcomes and prognosis of ECLS-bridged HTx. Methods: From December 2003 to December 2018, 1,465 patients received ECLS at Samsung Medical Center. We excluded patients who had not undergone HTx or underwent repeated transplantations. Patients younger than 18 years were excluded. We also excluded patients who received an implantable durable left ventricular assist device before HTx. In total, 91 patients were included in this study. A multidisciplinary team approach began in March 2013 at our hospital. We divided the patients into 2 groups depending on whether they were treated before or after implementation of the team approach. Results: The 30-day mortality rate was significantly higher in the pre-ECLS team group than in the post-ECLS team group (n=5, 18.5% vs. n=2, 3.1%; p=0.023). The 1-year survival rate was better in the post-ECLS team group than in the pre-ECLS team group (n=57, 89.1% vs. n=19, 70.4%; p=0.023). Conclusion: We found that implementing a multidisciplinary team approach improved the outcomes of ECLS-bridged HTx. Team-based care should be adapted at HTx centers that perform high-risk HTx.

• Journal of the Ergonomics Society of Korea
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• v.29 no.4
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• pp.473-478
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• 2010

For the medical approaches of work-related musculoskeletal diseases, it is important to consider occupational relatedness and occupational fitness. Clinical approach includes physical examination, radiologic tests and other related tests and we should choose proper management which is suitable to workers' status for the prevention of early disease's progression and later disabilities. Also, it suggests that occupational prevention program consultation for work-related musculoskeletal diseases considering workers' variable circumstances should be done via occupational relatedness and occupational fitness.

• Journal of Preventive Medicine and Public Health
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• v.49 no.6
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• pp.386-393
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• 2016

Objectives: General practitioners (GPs) retention in rural and underserved areas highly effects on accessibility of healthcare facilities across the country. Education seems to be a critical factor that affects GPs retention. Thus, the present study aimed at inquiry into medical education challenges that limit their retention in rural and underserved areas. Methods: A qualitative approach was applied for the aim of this study. Data were gathered via 28 semi-structured interviews with experts at different levels of Iran's health system as well as GPs who retained and refused to retain working in rural settings. Interviews mainly were performed face-to-face and in some cases via telephone during 2015 and then coded and analyzed using content analysis approach. Results: Iran's medical education is faced with several challenges that were categorized in four main themes including student selection, medical students' perception about their field of study, education setting and approach, curriculum of medical education. According to experts this challenges could results in making GP graduates disinterested for practicing in rural and underserved areas. Conclusions: Challenges that were found could have negative effects on retention. Modification in student's perception about rural practice could be done via changing education setting and approach and curriculum. These modifications could improve GPs retention in rural and underserved areas.

• Journal of Chest Surgery
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• v.52 no.4
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• pp.227-231
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• 2019

Background: There is no established surgical procedure for the treatment of epiphrenic esophageal diverticulum. The aim of this study was to compare the clinical outcomes of esophageal diverticulectomy using abdominal and thoracic approaches. Methods: We retrospectively reviewed 30 patients who underwent esophageal diverticulectomy through the thoracic or abdominal approach for an epiphrenic diverticulum at a single center between 1996 and 2018. We compared clinical outcomes, including the postoperative length of stay, time from the operation to oral feeding, leakage rate, and reoperation rate between the 2 groups. Results: The median age was 56 years. Of the 30 patients, 18 (60%) underwent diverticulectomy via the thoracic approach and 12 (40%) underwent the abdominal approach. The median hospital stay was 10 days (range, 5-211 days) in the thoracic approach group and 9.5 days (range, 5-18 days) in the abdominal approach group. The median time from the operation until oral feeding was 6.5 days (range, 3-299 days) when the thoracic approach was used and 5 days (range, 1-11 days) when the abdominal approach was used. In the thoracic approach group, the leakage rate was 16.67% and the reoperation rate was 27.78%. However, there were no cases of leakage or reoperation in the abdominal approach group. Conclusion: The abdominal approach for esophageal diverticulectomy is a feasible and appropriate alternative to the thoracic approach.

• Journal of Korean Neurosurgical Society
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• v.30 no.6
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• pp.755-760
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• 2001

Objective : To determine the feasibility of translabyrinthine approach in the vestibular schwannoma patients, the authors reviewed eighteen consecutive cases, focusing at their functional outcome and operative complications. Materials and Method : To evaluate the functional outcome, we reviewed preoperative radiological findings such as size of tumors and location of jugular bulb as well as the preoperative neurological status including audiometric analysis and cranial nerve function in 18 patients, diagnosed as vestibular schwannoma. Also the surgical outcome was evaluated according to the functional preservation of facial nerve and incidence of the surgical complication as well as the extent of surgical resection. Results : The age of patients ranged from 21 to 62 years, with a mean of 50 years. Of 18 patients operated in our center by the translabyrinthine approach, wide exposure with total removal of the mass was possible in 16 cases (88.8%). The facial nerve was anatomically preserved in 88.8%. At six-month follow-up, facial nerve function was good(Grade I-II) in 15 patients(83%) and acceptable(I-IV) in all patients. Although the jugular bulb was highly placed is five patients, gross total resection was possible without facial nerve injury in all patients by the translabyrinthine approach. One patient experienced CSF leakage after surgery, but there was no patient with disabling deficit. Conclusion : Use of the translabyrinthine approach for removal of vestibular schwannomas resulted in good anatomical and functional preservation of the facial nerve, with minimal incidence of morbidity and no mortality. In cases of high jugular bulb impacted into mastoid bone, total removal was possible by displacing the jugular bulb with Surgicel cellulose and placement of bone wax.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.25 no.2
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• pp.90-95
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• 2014

Background and Objectives : Arytenoid adduction procedure is one of the main surgical options addressed for the correction of glottal incompetence in patients with unilateral vocal cord paralysis. Traditionally, a midline approach is used for identifying and suturing around the muscular process, which often needs over-traction of the thyroid cartilage and results in patient's discomfort as well as surgeon's distress. The authors investigated the advantage of a modified procedure, lateral approach, in which the arytenoid cartilage is exposed through the space between strap muscles and sternocleidomastoid muscle. Materials and Methods : Retrospective chart review was performed for 66 patients who received arytenoid adduction surgery at Samsung Medical Center, between the year 1997 and 2014. Operation time, types of anesthesia, voice outcomes and complications were compared between the midline (n=22) and the lateral (n=44) approach group. Results : Operation time was shorter in the lateral approach group ($125{\pm}24min$) than in the midline group ($144{\pm}24min$). Arytenoid adduction was proceeded under local anesthesia in 66% (n=29/44) and 14% (n=3/22) of patients with lateral and midline approach group, respectively. Voice outcomes and complication rates were comparable between the two groups. Injection laryngoplasty in conjunction with arytenoid adduction resulted in more favorable voice outcomes. Conclusion : A lateral approach for the arytenoid adduction procedure showed comparable voice outcomes and similar complication rates with those of a midline approach. However, lateral approach provided less discomfort to the patients and less distress to a surgeon, and therefore, shorter operation time was needed and local anesthesia could be more frequently applied for this modified procedure.