• Journal of Chest Surgery
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• 제51권1호
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• pp.1-7
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• 2018

Background: Sutureless aortic valve replacement (SU-AVR) has been developed as an alternative surgical treatment for patients with symptomatic severe aortic stenosis (AS). The aim of this study was to evaluate the clinical outcomes of SU-AVR through an assessment of hemodynamic performance and safety. Methods: From December 2014 to June 2016, a total of 12 consecutive patients with severe AS underwent SU-AVR. The endpoints were overall survival and valve-related complications (paravalvular leakage, valve thrombosis, migration, endocarditis, and permanent pacemaker implantation). The mean follow-up duration was $18.1{\pm}8.6months$. Results: The mean age of the patients was $77.1{\pm}5.8years$ and their mean Society of Thoracic Surgeons score was $9.2{\pm}17.7$. The mean cardiopulmonary bypass and aortic cross-clamp times were $94.5{\pm}37.3$ minutes and $54.9{\pm}12.5minutes$, respectively. Follow-up echocardiography showed good prosthesis function with low transvalvular pressure gradients (mean, $13.9{\pm}8.6mm\;Hg$ and peak, $27.2{\pm}15.0mm\;Hg$) at a mean of $9.9{\pm}4.2months$. No cases of primary paravalvular leakage, valve thrombosis, migration, or endocarditis were reported. A new permanent pacemaker was implanted in 1 patient (8.3%). The 1-year overall survival rate was $83.3%{\pm}10.8%$. Conclusion: Our initial experience with SU-AVR demonstrated excellent early clinical outcomes with good hemodynamic results. However, there was a high incidence of permanent pacemaker implantation compared to the rate for conventional AVR, which is a problem that should be solved.

• 대한임상독성학회지
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• 제4권2호
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• pp.113-121
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• 2006

Purpose: Previous studies have reported that plasma cholinesterase (AchE) concentration can serve as a useful prognostic parameter in cases of acute organophosphate (OP) poisoning. However, there has been considerable disagreement regarding the degree of its prognostic value. Earlier cross-sectional and one- time point studies were plagued with methodologic flaws, making it difficult to interpret their results. The purpose of this study was to clarify the prognostic value of time-variable cholinesterase levels and their relationship with clinical outcomes in OP poisoning. Methods: We reviewed medical and intensive care records of patients with acute OP poisoning admitted to our emergency department between March 1998 and Sep 2006. We collected patient information regarding poisoning, clinical, and demographic features. Patients were assessed for clinical outcomes and AchE concentrations on days 1, 2, 3, 5, and 7 and on the final day. Results: During the study period, 58 patients were enrolled in this study. There was a statistically significant difference in the AchE differentials on 1-3 days for patients requiring mechanical ventilation and for patients with mild poisoning (p<0.05). Also, the decrease in the log AchE concentration correlated with longer durations of mechanical ventilation (r=-0.411, p=0.002). Conclusion: In severe OP poising, measurements of time-variable AchE concentrations can be helpful in the prediction of mortality, the development of intermediate syndrome, and duration of mechanical ventilation.

• 대한두개안면성형외과학회지
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• 제19권2호
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• pp.108-113
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• 2018

Background: The aim of our retrospective study is to evaluate the management of isolated orbital floor fractures considering the clinical, functional and aesthetic results according to the surgical approach and the type of materials used. Methods: Retrospectively, clinical, radiological, surgical, and ophthalmological data from 79 patients were collected from January 2010 to December 2016. Furthermore, included patients were interrogated on functional and aesthetic satisfaction. Results: The main causes of trauma were physical aggression followed by accidents. The median time between trauma and surgery was 4 days. The most common surgical approaches were the subciliary and the transconjunctival ones. Alloplastic materials were used in 75 patients. In two patients, we used a combination of two grafts. Patients experienced minor immediate complications. On follow-ups, none of our patients suffered from ocular movement restrictions. Patients treated by subciliary approach had higher risk of retractile scaring compared to other surgical approaches. In our study, patients agreed to complete a questionnaire assessing functional and aesthetic outcomes with a high satisfaction score. No association between the implant material used and the results has been assessed. Conclusion: This study describes the results of orbital floor reconstructions. Despite a variety of materials used and surgical approaches performed, we believe that the transconjunctival approach is the most suitable option with a high satisfaction score.

• Asian Pacific Journal of Cancer Prevention
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• 제17권7호
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• pp.3271-3276
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• 2016

Background: Intracranial nonvestibular schwannomas arising from various cranial nerves excluding CN VIII are uncommon. Recently, stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (SRT) have been widely reported as effective treatment modalities for nonvestibular schwannomas. The purpose of this study was to study the long term clinical outcome for nonvestibular schwannomas treated with both X-Knife and CyberKnife (CK) radiosurgery at one institution. Materials and Methods: From 2004 to 2013, fifty-two nonvestibular schwannoma patients were included in this study, 33 patients (63%) were treated with CK, and 19 (37%) were treated with X-Knife. The majority of the tumors were jugular foramen schwannomas (38%) and trigeminal schwannomas (27%). HSRT was given for 45 patients (86%), whereas CSRT was for 6 (12%) and SRS for 1 (2%). Results: The median pretreatment volume was $9.4cm^3$ (range, $0.57-52cm^3$). With the median follow up time of 36 months (range, 3-135), the 3 and 5 year progression free survival was 94 % and 88%, respectively. Tumor size was decreased in 13 (25%), stable in 29 (56%), and increased in 10 (19%). Among the latter, 3 (30%) required additional treatment because of neurologic deterioration. No patient was found to develop any new cranial nerve deficit after SRS/SRT. Conclusions: These data confirmed that SRS/SRT provide high tumor control rates with low complications. Large volume tumors and cystic expansion after radiation should be carefully followed up with neurological examination and MRI, because it may frequently cause neurological deterioration requiring further surgery.

• Archives of Plastic Surgery
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• 제46권3호
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• pp.221-227
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• 2019

Background Gynecomastia is a common condition that can cause severe emotional and physical distress in both young and older men. Patients in whom symptomatic recalcitrant gynecomastia persists for a long time are potential candidates for surgery. Methods From January 2014 to January 2016, 15 patients underwent correction of gynecomastia through a single 3-mm incision at our institution. Only patients with true gynecomastia underwent surgery with this new technique. Through the small incision, sharp dissection was performed in a clockwise and counterclockwise direction describing two half-circles. Health-related quality of life and aesthetic outcomes were evaluated using a modified version of the Breast Evaluation Questionnaire (BEQ). Results The patients' average age was 23.5 years (range, 18-28 years), and their average body mass index was $23.2kg/m^2$ (range, $19.2-25.3kg/m^2$). One case was unilateral and 14 cases were bilateral. The weight of glandular tissue resected from each breast ranged from 80 to 170 g. No excess skin was excised. Bleeding was minimal. The mean operating time was 25 minutes (range, 21-40 minutes). No complications were recorded. All lesions were histologically benign. The patients' average score was 3.5 (on a 5-point Likert scale) in all domains of the BEQ for themselves and their partners. Conclusions In this study, we demonstrated the safety and reliability of a new technique that allows mastectomy through an imperceptible 3-mm incision. We obtained high patient satisfaction scores using our surgical technique, and patients reported considerable improvement in their social, physical, and psychological well-being after surgery.

• Journal of Preventive Medicine and Public Health
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• 제56권2호
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• pp.154-163
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• 2023

Objectives: Systemic lupus erythematosus (SLE) or lupus patients usually experience various physical and psychological challenges. Since the coronavirus disease 2019 pandemic, these challenges have become even harsher. Using the participatory action research approach, this study evaluated how an e-wellness program (eWP) impacted SLE-related knowledge and health behaviors, mental health, and quality of life among lupus patients in Thailand. Methods: A 1-group, pretest-posttest design study was conducted among a purposive sample of lupus patients who were members of Thai SLE Foundation. The 2 main intervention components were: (1) online social support, and (2) lifestyle and stress management workshops. Sixty-eight participants completed all the study requirements, including the Physical and Psychosocial Health Assessment questionnaire. Results: After being in the eWP for 3 months, participants' mean score for SLE-related knowledge increased significantly (t=5.3, p<0.001). The increase in sleep hours was statistically significant (Z=-3.1, p<0.01), with the percentage of participants who slept less than 7 hours decreasing from 52.9% to 29.0%. The percentage of participants reporting sun exposure decreased from 17.7% to 8.8%. The participants also reported significantly lower stress (t(66)=-4.4, p<0.001) and anxiety (t(67)=-2.9, p=0.005). The post-eWP quality of life scores for the pain, planning, intimate relationship, burden to others, emotional health, and fatigue domains also improved significantly (p<0.05). Conclusions: The overall outcomes showed promising results of improved self-care knowledge, health behaviors, mental health status, and quality of life. It is recommended that the SLE Foundation continues to use the eWP model to help the lupus patient community.

• 한국간담췌외과학회지
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• 제27권4호
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• pp.366-371
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• 2023

Backgrounds/Aims: Biliary surgery in patients with extrahepatic portal vein obstruction with portal cavernoma (PC) is technically challenging, and associated with the risk of bleeding. Therefore, prior portal vein decompression is usually recommended before definitive biliary surgery. Only a few studies have so far reported the safety of isolated laparoscopic cholecystectomy. We aimed to evaluate our experience of laparoscopic cholecystectomy in patients with PC without prior portal decompression. Methods: Prospectively maintained data for patients with PC who underwent laparoscopic cholecystectomy for symptomatic gallstone disease without portal decompression were analyzed. Clinical features, imaging, intraoperative factors, conversion rate, complications of surgery, and long-term outcomes were assessed. Results: Sixteen patients underwent cholecystectomy without portal decompression from 2012 to 2021, of which interventions 14 were laparoscopic cholecystectomies. One patient required conversion (7.1%) to open surgery. Jaundice was present in 5 patients (35.7%), and underwent endoscopic stone clearance before surgery. Median intraoperative blood loss, operative time, and hospital stay were 100 mL (20-400 mL), 105 min (60-220 min), and 2 days (1-7 days), respectively. Blood transfusion was required in two patients (14.2%). Prior endoscopic or percutaneous intervention was associated with significant blood loss and prolonged intraoperative time. Conclusions: In centers with experience, prior portal decompression can be avoided in patients with PC requiring isolated cholecystectomy to treat gallstones or their complications. Laparoscopic surgery is safe and feasible for these patients, and gives excellent outcomes in the selected group.

• Hip & pelvis
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• 제36권1호
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• pp.26-36
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• 2024

Total hip arthroplasty (THA) is a frequently performed procedure; the objective is restoration of native hip biomechanics and achieving functional range of motion (ROM) through precise positioning of the prosthetic components. Advanced three-dimensional (3D) imaging and computed tomography (CT)-based navigation are valuable tools in both the preoperative planning and intraoperative execution. The aim of this study is to provide a thorough overview on the applications of CT scans in both the preoperative and intraoperative settings of primary THA. Preoperative planning using CT-based 3D imaging enables greater accuracy in prediction of implant sizes, leading to enhancement of surgical workflow with optimization of implant inventory. Surgeons can perform a more thorough assessment of posterior and anterior acetabular wall coverage, acetabular osteophytes, anatomical landmarks, and thus achieve more functional implant positioning. Intraoperative CT-based navigation can facilitate precise execution of the preoperative plan, to attain optimal positioning of the prosthetic components to avoid impingement. Medial reaming can be minimized preserving native bone stock, which can enable restoration of femoral, acetabular, and combined offsets. In addition, it is associated with greater accuracy in leg length adjustment, a critical factor in patients' postoperative satisfaction. Despite the higher costs and radiation exposure, which currently limits its widespread adoption, it offers many benefits, and the increasing interest in robotic surgery has facilitated its integration into routine practice. Conducting additional research on ultra-low-dose CT scans and examining the potential for translation of 3D imaging into improved clinical outcomes will be necessary to warrant its expanded application.

• Perspectives in Nursing Science
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• 제3권1호
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• pp.35-45
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• 2006

In Korea, about 8.3% over aged 65 are suffering from Alzheimer's disease or other type of dementia. Among dementia-related behaviors, wandering is the one of strongest factors on burden and stress of caregivers. On Lee and Kwon's report with community living persons with dementia, upto 85% of caregivers reported wandering as a problem. Wandering is a frequently encountered problem in communities and long-term care facilities, but it is among least understood dementia. related behavior. Despite the prevalence of wandering, its significant adverse outcomes, and the increase in persons with dementia in Korea, no systematic research has been conducted in Korea. The purpose of this study is to review on literature related to wandering behavior among persons with dementia. The specific topics related to wandering are included: definition, the prevalence of dementia and wandering behavior, the influencing factor on wandering, outcomes of wandering behavior, and the measurement method. Wandering is defined as "aimless walking" and "Meandering, aimless or repetitive locomotion that exposes one to harm and is incongruent with boundaries, limits, or obstacles". Wandering is viewed as a problematic behavior, however, it has to be understood as need-driven compromised behavior. For example, wandering may be an expression of searching for familiar person and/or place. Recently, in Korea, there is an effort for establishing the therapeutic environment for elders who are wanderers in long-term-care facilities. Cognitive impairment of persons with dementia is found to be a consistent factor on wandering behavior through many national and international studies. The adverse outcomes of wandering are serious problem in persons with dementia as well as their caregivers. The adverse outcomes include falls, fractures, getting lost, use of restraints, or even death. In fact, wandering is one of the major reasons for a patient to be institutionalized. For measurement of wandering behavior, two methods are broadly used: observation using stop watch, and survey form. A revised instrument of the Korean version of Algase wandering scale (K_RAWS) is established the psychometric properties (Son, Song, & Lim, 2006) demonstrating valid and reliable instrument in measuring wandering behavior among persons with dementia who are residing in communities. K_RAWS has a 39 items with six subscales including persistent walking, repetitive walking, spatial disorientation, eloping behavior, negative outcome, and mealtime impulsivity. In conclusion, studies including the prevalence of wandering behavior and predictive factors on wandering should be conducted to understand wandering clearly before developing any types of intervention.

• 동서간호학연구지
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• 제23권1호
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• pp.53-62
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• 2017

Purpose: This study aimed to evaluate the adherence to the clinical guideline for endotracheal suction in nurses working at intensive care units (ICU) and to identify the characteristics of nurses with good adherence. Methods: This study was a descriptive study to evaluate the pattern of adherence and its related factors to endotracheal suction. One hundred fifty five nurses working at ICU participated in this study. We used a questionnaire developed based on American Association for Respiratory Care (AARC) guidelines and other associated factors from previous studies. Results: Around half of the participants reported that their adherence to the clinical guideline was poor. Items deviated from the recommended guideline were reasons for initiating a suctioning, applied suction pressure ranged from 20 to 200mmHg, and applied catheter size from 6 to 17 french. Other factors deviated were the depth of inserted catheter, and inappropriate use of normal saline instillation. The most significant factor was related to hospital; the misused or misled clinical protocol. Conclusions: The adherence to the clinical guidelines of the endotracheal suction in ICU nurses was not appropriate, which might contribute to the patient health outcomes. More enhanced continuing education as well as hospital regulation is warranted.