• Archives of Plastic Surgery
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• 제47권2호
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• pp.153-159
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• 2020

Background Perforator artery flaps based on the branches of intercostal arteries and lateral thoracic artery can be used for reconstruction after breast-conserving surgery (BCS). Although described more than a decade ago, these have not been adopted widely in clinical practice. We report on short-term and long-term surgical outcomes of partial breast reconstruction using chest wall perforator flaps from a prospective multicenter audit. Methods All patients operated for BCS and partial breast reconstruction using intercostal artery perforator or lateral thoracic artery perforator flaps from January 2015 to October 2018 were included in the analysis. Oncoplastic breast surgeons with appropriate level of training performed all tumor excisions and reconstructions as a single-stage procedure. Patient characteristics, treatment details and surgical outcomes were noted. Specific outcomes recorded were margin re-excision and complication rates. Results One hundred and twelve patients underwent the procedure in the given study period. The median age was 54 years. Median specimen weight was 62.5 g and median volume of excision was 121.4 mL. Fifteen patients (13.39%) underwent a margin re-excision for close or positive margins without additional morbidity. One patient required a completion mastectomy. Eight patients (7.14%) had an early complication. None of the patients required a contralateral symmetrization procedure. The results were comparable across the participating centers. Conclusions Chest wall artery perforator-based flaps are an excellent option for lateral and inferior quadrant partial breast reconstructions. The short and long-term surgical outcomes are comparable across sites and can be performed with minimal morbidity. Patient-reported outcome measures need to be studied.

• Korean Journal of Acupuncture
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• 제33권3호
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• pp.102-113
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• 2016

Objectives : This study is aimed at developing and discussing the prediction model of blood stasis pattern of traditional Korean medicine(TKM) using machine learning algorithms: multiple logistic regression and decision tree model. Methods : First, we reviewed the blood stasis(BS) questionnaires of Korean, Chinese, and Japanese version to make a integrated BS questionnaire of patient-reported outcomes. Through a human subject research, patients-reported BS symptoms data were acquired. Next, experts decisions of 5 Korean medicine doctor were also acquired, and supervised learning models were developed using multiple logistic regression and decision tree. Results : Integrated BS questionnaire with 24 items was developed. Multiple logistic regression models with accuracy of 0.92(male) and 0.95(female) validated by 10-folds cross-validation were constructed. By decision tree modeling methods, male model with 8 decision node and female model with 6 decision node were made. In the both models, symptoms of 'recent physical trauma', 'chest pain', 'numbness', and 'menstrual disorder(female only)' were considered as important factors. Conclusions : Because machine learning, especially supervised learning, can reveal and suggest important or essential factors among the very various symptoms making up a pattern identification, it can be a very useful tool in researching diagnostics of TKM. With a proper patient-reported outcomes or well-structured database, it can also be applied to a pre-screening solutions of healthcare system in Mibyoung stage.

• Archives of Plastic Surgery
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• 제46권4호
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• pp.350-358
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• 2019

Background Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy with a high morbidity and healthcare-related costs. Currently there is no consensus about the best treatment option. The purpose of this prospective cohort study conducted at a single institution was to evaluate the clinical outcomes and patient satisfaction following a mini-open carpal tunnel release for idiopathic CTS. Methods A total of 72 patients (53 female and 19 male patients; mean age, $57.8{\pm}15.3$ years; range, 24-94 years) had a mini-open carpal tunnel release performed by a single senior surgeon between June 2015 and June 2016. The patients were evaluated preoperatively, and at 3 and 12 months post-intervention. At every follow-up, the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) and visual analogue scale (VAS) scores for pain and satisfaction were completed. Digital sensibility (using Semmes-Weinstein monofilaments) was assessed and pinch and grip strengths were measured. Results Statistically significant and clinically relevant improvement was found in terms of digital sensibility, grip and pinch strength (except for 2-point pinch), BCTSQ scores and pain scores. The complication rate was minimal, and no major complications occurred. Two patients experienced recurrence. The availability of follow-up records (including patient-reported outcomes, BCTSQ and VAS scores, and the complication rate) at 1-year post-intervention varied between 69% and 74% (50-53 patients) depending on which parameter was assessed. Patient satisfaction was high (mean, $80.9{\pm}26.0$; range, 0-100). Conclusions This study demonstrates that mini-incision carpal tunnel release is clinically effective in the short and long term.

• Clinics in Shoulder and Elbow
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• 제25권3호
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• pp.195-201
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• 2022

Background: This study aimed to examine the preliminary clinical results of the infraspinatus rotational transfer procedure for irreparable posterosuperior rotator cuff tears. Methods: This study included 34 patients (mean age, 68.4 years). Their mean tear width and length measurements were 50.9 mm and 50.6 mm, respectively. The functional outcomes, including physician-determined and patient-reported scores, were evaluated before and at 1 year after surgery. The structural outcomes determined using the magnetic resonance imaging examination results were also assessed. Results: The clinical scores significantly improved after surgery compared with the scores before surgery: the Constant-Murley score (53.3±21.1 to 76.8±10.5), University of California at Los Angeles Shoulder score (15.6±3.6 to 27.8±6.7), American Shoulder and Elbow Surgeons Shoulder score (51.8±18.3 to 89.1±13.5), and WORC score (925.0±436.8 to 480.3±373.2) (all p<0.001). Postoperative re-tears were noted in two patients (5.9%). Conclusions: One year postoperatively, the patient's clinical scores significantly improved, with a re-tear rate of 5.9%.

• Journal of Preventive Medicine and Public Health
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• 제34권2호
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• pp.175-181
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• 2001

Objectives : To compare the multiple outcomes of patients with cataract surgery at perioperative time,3-4 months and 12 months after surgery and to assess patient outcomes associated with visual improvement(visual acuity of operated eye, visual function-14(VF-14), symptom score). Methods : For this assessment, a prospective study was conducted with 389 patients who had undergone cataract surgery for either one eye or both eyes. The surgery was peformed by 20 ophthalmologists who were practicing at university hospitals and general hospitals. Patients were interviewed and clinical data were obtained. Doctors were questioned with self-reported questionnaire forms. Medical records were examined in order to measure variables related to the surgical process such as surgical methods and ocular comorbidity. The survey was 'conducted at 4 stages' : preoperative time(389 cases), perioperative time(344 cases, 88.4%), postoperative 3-4 months (343 cases, 88.2%), and postoperative 12 months (281 cases, 72.2%). After excluding cases with incomplete data, 198 cases were enrolled in the study. Patient outcomes was measured for any improvement in the functional outcomes(visual acuity of operated eye, visual function, symptom score) at postoperative 3-4 months. Results : The visual acuity(operated, weighted average), symptom score, VF-14 score, satisfaction with vision, and subjective health status were shown to be improved at the perioperative time, postoperative 3-4 months and 12 mouths. An improvement in the Snellen visual acuity score was observed in 190 patients(96.0%), whereas improvements of the VF-14 score and cataract symptom sure were observed in 151 patients(76.3%) and 179 patients(90.4%), respectively. All three outcome measures demonstrated improvement in 137 patients(09.2%). The improvement of the three functional outcomes at 3-4 months after receiving surgery was associated with a lower level of visual function and a higher level of cataract symptom score at perioperative time, as well as a greater experience level of the surgeon. Conclusions : In this study, the estimates of the proportion of patients benefiting from cataract surgery varied with the outcome measure of benefit. Preoperative VF-14 score, a measure of functional impairment related to vision, and symptom score may be better measures of the benefit derived from cataract surgery than the change in visual acuity.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제41권
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• pp.59.1-59.10
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• 2019

Background: Primary rhinoplasty outcomes may not meet individual expectations. Consequently, reoperation may be advocated to improve results. This study examines the prevalence of individuals considering revision rhinoplasty, while identifying the main cosmetic and functional complaints and factors associated. Methodology: This is a cross-sectional study conducted in Saudi Arabia using a self-reported online questionnaire distributed through social media channels. The sample included 1370 participants who were all Saudi nationals over the age of 16 who had undergone primary rhinoplasty at least 1 year prior. Results: The prevalence of individuals considering revision rhinoplasty was 44.7%. The primary reason for considering it was the desire for further esthetic improvement in an already acceptable result (50.16%). The most common cosmetic complaints subjectively reported were poorly defined nasal tip (32.35%). The most prevalent nasal function symptom was nasal obstruction (56.9%). Significant factors associated with considering revision rhinoplasty included the physician not understanding the patient's complaints, short consultation time, low monthly income, inadequate information about the expected results, not using computer imaging to predict outcomes, lack of rapport with the surgeon, and inadequate information about the risks and complications. Conclusions: A thorough understanding of patient concerns and expectations, as well as thoughtful consideration of risk factors, may help surgeons achieve more successful outcomes and potentially reduce the incidence of revision rhinoplasties. Level of evidence: III.

• 보건행정학회지
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• 제11권2호
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• pp.16-28
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• 2001

This study was to compare multidimensional outcomes of patient's satisfaction after cataract surgery and to identify factors influencing satisfaction after operation. Patient's satisfaction was measured with three dimensions : interpersonal care, physician explanation and hospital care. Overall satisfaction was measured as means of three dimensional scores. For the study, a prospective study was performed with 389 patients who had undergone cataract surgery for either one eye or both eyes. The surgery was performed by 20 ophthalmologists who were practicing at university hospitals and general hospitals. Patients were interviewed and clinical data (the visual acuity of operated eye, visual function, symptom score and satisfaction with vision) were obtained. The doctors were questioned with self-reported questionnaire forms. Medical records were also examined to understand surgery Process. The survey was conducted before(389) and after operation(327). Alter excluding cases with incomplete data, 3n cases were enrolled In this study. Both the overall satisfaction and the satisfaction with physician explanation increased after the operation whereas the satisfaction with interpersonal care and hospital care did not change significantly. Multiple regression analysis showed that the level of education, baseline satisfaction scores and the degree of vision improvement were statistically significant variables. The preoperative lower level of education, higher level of overall satisfaction (interpersonal care, physician explanation, hospital care scores) and the more the satisfaction with vision improvement were associated with the improvement of postoperative satisfaction scores.

• Journal of Chest Surgery
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• 제54권3호
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• pp.206-213
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• 2021

Background: Tracheoesophageal fistula (TEFs) is a rare condition that requires complex surgical treatment. We analyzed the surgical outcomes of TEF reported in the literature and at Pusan National University Yangsan Hospital using standardized techniques. Methods: This retrospective study included 8 patients diagnosed with acquired benign TEF between March 2010 and December 2019. The surgical method was determined based on the size of the fistula observed within the endoscope. Results: TEF occurred in 7 patients (87.5%) after intubation or tracheostomy and in 1 patient (12.5%) after esophageal surgery due to conduit necrosis. For tracheal management, 5 and 2 patients underwent tracheal resection and end-to-end anastomosis and primary repair, respectively. The median length of resection was 2.5 cm (range, 1.3-3.4 cm). For esophageal management, 6 patients underwent primary repair and 1 patient underwent esophageal diversion. One patient underwent TEF division with a stapler. Interposition of a muscle flap was performed in 2 patients. TEF recurrence, esophageal stenosis, and dehiscence or granulation occurred in 1, 1, and 2 patients, respectively. A long-term tracheostomy tube or T-tube was used in 2 patients for >2 months. Conclusion: Although TEF surgery is complex and challenging, good results can be achieved if surgical standards are established and experience is accumulated.

• Journal of Korean Neurosurgical Society
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• 제63권4호
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• pp.495-503
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• 2020

Objective : Thyroid-stimulating hormone (TSH)-secreting pituitary adenoma (PA) is an extremely rare functioning form of PA that accounts for 0.7-2% of all such cases. The previously reported outcomes of the surgical removal of TSH-PA are poor. Owing to its extremely low incidence, most available reports on TSH-PA are case reports or small case series. Thus, we investigated the clinical and endocrinological outcomes of surgically treated TSH-PA through our institutional series. Methods : We retrospectively reviewed 14 consecutive cases of surgically treated TSH-PA, focusing on the clinical, radiological, surgical, and endocrinological data. Results : There were seven male (50%) and seven female (50%) patients. The mean age was 42.5 years (range, 19-63). The mean tumor size was 16.6 mm (range, 4-30). Optic chiasm compression was noted in six patients (42.9%), and no patient showed cavernous sinus invasion. Thirteen of 14 patients (92.8%) underwent transnasal transsphenoidal approach (TSA), and one patient underwent TSA followed by transcranial approach for residual tumor removal. Thirteen of 14 patients (92.8%) showed endocrinological remission; all patients who experienced remission showed subnormal levels of TSH (<0.4 μU/mL) on postoperative day 2. Recurrence occurred in two patients (14.2%). One patient underwent subsequent revision transnasal TSA for recurrent tumor removal, and the other patient underwent gamma knife radiosurgery for recurrence. Conclusion : Surgical treatment showed excellent surgical outcomes. The TSH level in the immediate postoperative period may be a predictor for endocrinological remission.

• Archives of Plastic Surgery
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• 제38권4호
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• pp.391-397
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• 2011

Purpose: The injection of various materials, including medical fillers and unregulated products, is widespread, potentially causing the development of foreign body granulomas. Should this occur on the nose, the contour deformity and inflammatory signs that result from these granulomas are aesthetically undesirable to patients. The purpose of our study is to share our experiences using different surgical approaches, depending on the affected portion of the nose, to optimize management of this challenging problem and to evaluate patient's satisfaction using our in-house questionnaire along with degree of improvement by two independent plastic surgeons. Methods: We treated 18 patients who underwent surgical excision of nasal foreign body granulomas via a perilesional approach to the lesion (n=12) or by transcolumellar incision (n=6) at our hospital over a period of seven years from March 2003 to October 2010. Nonparametric statistics were used and are presented as medians (25th-75th). Patient satisfaction was evaluated on a scale of 1 to 5 using an in-house questionnaire. All pre-and post-operative photographs were analyzed by two independent plastic surgeons. Post-operative outcomes were evaluated based on the surgeons' consensus ratings. Results: All patients receiving the transcolumellar approach reported a high level of satisfaction with the results. All but two patients who received the perilesional approach were satisfied with the outcome. No outcomes were rated as no change or worse by the consensus ratings. Conclusion: For the upper two-thirds of the nose, perilesional surgical excision can lead to substantial patient satisfaction with modified contour deformity and infection control. The transcolumellar approach resulted in better outcomes and patient satisfaction for the lower one-third of the nose.