• Archives of Plastic Surgery
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• v.34 no.3
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• pp.305-313
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• 2007

Purpose: Wound healing is a result of complex processes whose components, such as cells, extracellular matrix, proteolytic enzymes, and their inhibitors receive effects from immune compartments, cytokines, chemokines, and growth factors. Impairment of normal physiologic response to wounding makes nonhealing chronic wounds. Wound infection and exacerbated proteolytic process may induce uncontrolled tissue degradation or exudates formation, which may result in the development of a nonhealing chronic wound. Thus proper management of wound infection and exudates is critical to prevent and treat nonhealing wound. The aim of this study is to evaluate effects of Aquacel AG, silver-containing carboxymethylcellulose dressing on treatment for exudative infected wound. Methods: The study included 31 patients with nonhealing wound. Wound was dressed with Aquacel AG. The effect of dressing was investigated by serial bacterial culture and wound exudates assessment. Each infection and exudates control time was determined and statistically analyzed. Results: Wound infection and exudates were effectively managed using Aquacel AG dressing. Mean infection and exudates control time were $3.4{\pm}1.2$ and $5.7{\pm}1.4$ weeks, respectively. Statistical analysis of the data indicated that infection control time correlated positively to age and exudates control time (p<0.05). Conclusion: There is as yet no ideal dressing for the topical treatment of chronic nonhealing wound. But silver-containing carboxymethylcellulose dressing can be used effectively for exudative, infected nonhealing wound.

• Archives of Plastic Surgery
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• v.43 no.4
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• pp.360-364
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• 2016

Background Venous thromboembolism, a spectrum of diseases ranging from deep venous thrombosis to pulmonary embolism, is a major source of morbidity and mortality. The majority of cases described in plastic surgery involve abdominoplasty. Risk assessment and prophylaxis are paramount in such patients. General recommendations were recently developed, but the evidence in the literature was insufficient to prepare exhaustive guidelines regarding the medication, dosage, timing, or length of the prophylaxis. Methods A thromboprophylaxis protocol was developed for patients undergoing abdominoplasty. The protocol consisted of preoperative, intraoperative, and postoperative measures. Enoxaparin was administered as chemoprophylaxis in selected patients. The study involved 253 patients. The patients were analyzed for age, body mass index, enoxaparin dosage, risk factors, and complications. Results Deep venous thrombosis was documented in two cases (0.8%). No pulmonary embolism occurred. Three patients (1.2%) presented mild subcutaneous abdominal hematoma within the first postoperative week that spontaneously resorbed with neither aesthetic nor functional complications. Two patients (0.8%) presented severe hematoma requiring surgical re-intervention for drainage and hemostasis revision. Statistical analysis showed no significant correlation between enoxaparin dosage and hematoma (P=0.18) or deep venous thrombosis (P=0.61). Conclusions The described thromboprophylaxis protocol proved to be effective in the prevention of thrombotic events, with an acceptable risk of hemorrhagic complications. Furthermore, it provides new evidence regarding the currently debated variables of chemoprophylaxis, namely type, dosage, timing, and length.

• Clinics in Shoulder and Elbow
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• v.4 no.2
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• pp.186-190
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• 2001

Purpose: The aim of this study was to investigate the diagnostic accuracy of Neer, Hawkins provocative tests and supraspinatus manual muscle test for the assessment of impingement syndrome, partial tear and small complete tear of De rotator cuff. Materials and Methods: Seventy-one female and 115 male patients were included in the study. Patients were divided into four groups of no impingement, impingement without tear, partial tear and small complete tear of the rotator cuff, which were confirmed by sonogram, magnetic resonance imaging and surgery. Neer and Hawkins provocative tests and supraspinatus manual muscle test were performed respectively. SAS 6.12 version was used in statistical analysis. Results: We found that Neer test had 94% sensitivity, 54% specificity for impingement without tear and 89% sensitivity, 78% specificity for partial tear and 96% sensitivity, 23% specificity for small tear. Hawkins test revealed 95% sensitivity, 54% specificity for impingement without tear and 93% sensitivity, 78% specificity for partial tear and 100% sensitivity, 23% specificity for small tear. Supraspinatus manual muscle test revealed 27% sensitivity, 94% specificity for impingement without tear and 29% sensitivity, 82% specificity for partial tear and 48% sensitivity, 82% specificity for small tear. Conclusion: Neer and Hawkins tests have high sensitivity, low specificity for impingement syndrome, partial and small tear. Supraspinatus manual muscle test had low sensitivity and high specificity. However this test was not effective to differentiate the partial and small rotator cuff tear. We thought that more effective provocative test should be designed to detect the partial and small rotator cuff tear.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.122-131
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• 2012

Purpose: Diffuse axonal injury (DAI) is clinically defined as a coma of over six hours in a head trauma victim without a focal mass lesion. The emergency physician usually resuscitates and stabilizes a comatose head trauma victim in the emergency Department. After assessment and treatment, the prognosis is very important to both the victim and the physician. The prognosis for DAI is based on Glasgow Coma Scale (GCS) and other imaging data. We investigated the prognostic value of computed tomography (CT) and gradient-echo magnetic resonance imaging (GRI) for head trauma victims with DAI. Methods: Fifty-three(53) head trauma victims of DAI were enrolled in this study from 2007 to 2012. During the study period of six years, data on trauma victims were collected retrospectively. We analyzed the differences in the Glasgow Outcome Scale (GOS) result between the CT and the GRI modalities. Results: We classified the study group by using GOS. Between the good outcome subgroup (GOS scores of 4 and 5) and the poor outcome subgroup (GOS score of 1-3), there were no statistical difference in sex, age, initial vital signs and initial GCS score. The good outcome subgroup had non-hemorrhage on CT(52%), which was correlated with good outcome and a shorter awakening time, while a larger number and a deeper location of hemorrhagic lesions on in GRI were correlated with poor outcome in DAI. Conclusion: We conclude that the existence of hemorrhagic lesions on CT, and the number and location of those lesions on GRI had good prognostic value for head trauma victims with DAI.

• Korean Journal of Veterinary Research
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• v.50 no.1
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• pp.43-48
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• 2010

Animal disease surveillance system, defined as the continuous investigation of a given population to detect the occurrence of disease or infection for control purposes, has been key roles to assess the health status of an animal population and, more recently, in international trade of animal and animal products with regard to risk assessment. Especially, for a system aiming to determine whether or not a disease is present in a population sensitivity of the system should be maintained high enough not to miss an infected animal. Therefore, when planning the implementation of surveillance system a number of factors that affecting surveillance sensitivity should be taken into account. Of these parameters sample size is of important, and different approaches are used to calculate sample size, usually depending on the objective of surveillance systems. The purpose of this study was to evaluate the sensitivity of the current national serological surveillance programs for four selected bovine diseases assuming a specified sampling plan, to examine factors affecting the probability of detection, and to provide sample sizes required for achieving surveillance goal of detecting at least an infection in a given population. Our results showed that, for example, detecting low level of prevalence (0.2% for bovine tuberculosis) requires selection of all animals per typical Korean cattle farm (n = 17), and thus risk-based target surveillance for high risk groups can be an alternative strategy to increase sensitivity while not increasing overall sampling efforts. The minimum sample size required for detecting at least one positive animal was sharply increased as the disease prevalence is low. More importantly, high reliability of prevalence estimation was expected with increased sampling fraction even when zero-infected animal was identified. The effect of sample size is also discussed in terms of the maximum prevalence when zero-infected animals were identified and on the probability of failure to detect an infection. We suggest that for many serological surveillance systems, diagnostic performance of the testing method, sample size, prevalence, population size, and statistical confidence need to be considered to correctly interpret results of the system.

• The Korean Journal of Nuclear Medicine
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• v.26 no.2
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• pp.235-243
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• 1992

Patterns of abnormality in regional cerebral perfusion and its relation to clinical severity was evaluated with 32 head injury patients using $^{99m}Tc-HMPAO$ single photon emission tomography (SPECT). The findings were compared with computed tomography (CT) done within 48 hours of each SPECT study. The initial SPECT study was done within 7 days of injury in 16 cases, between 1 week and 2 months in 12, and after over 2 months in 4. Nineteen of the patients underwent followup SPECT and CT after a mean interval of 1 to 2 months. The initial SPECT showed abnormalities in 96% (31/32) of the patients while CT showed abnormal findings in only 81% (26/32). There were a total of 54 supratentorial SPECT lesions in all. Ninity percent (49/54) of these were of regional hypoperfusion, while 5 lesions showed focal hyperperfusion. The lesions were most often localized in the frontal and temporal lobes. Fifty five percent (30/54) were areas not detected as a lesion on CT. Cerebellar diaschisis was observed in 50% (16/32) of the patients. The degree of perfusion abnormality was quantified by the product of differential activity and a size factor. Correlation between the degree of perfusion abnormality and the clinical severity (Glasgow coma scale) failed to show statistical significance (p=0.053). The amount of change in the degree of perfusion abnormality on follow up SPECT was compared to the amount of change in clinical severity. Perfusion abnormality showed a tendancy to improve in most patients, and the degree of improvement showed significant correlation with the amount of clinical improvement (p < 0.01).

• Korean Journal of Head & Neck Oncology
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• v.25 no.2
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• pp.119-122
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• 2009

Objectives : Ablation of carcinoma of the tongue leads to deficits in speech and swallowing, but none to date has provided all of the qualities of mobility and sensation to simulate the complex function of the tongue. The authors evaluated postoperative swallowing and pronouncing function in patients who underwent tongue reconstruction using free flap. Material and Methods : This is a retrospective review documenting the outcome of 42 patients between January of 1991 and August of 2008. We classified patients according to the size of resection of the tongue like as 7 partial glossectomy, 25 hemiglossectomy, 2 subtotal glossectomy, and 8 total glossectomy. Swallowing function was graded into 4 point scale and pronouncing function was analyzed using picture consonant articulation test. Aspiration was evaluated with videofluoroscopic swallowing study. Results : The average points for swallowing function were 3.43 in partial glossectomy, 3.52 in hemiglossectomy, 3 in subtotal glossectomy, and 2.63 in total glossectomy. The percentage of consonants correct showed 76.5% in partial glossectomy, 72.29% in hemiglossectomy, 47.69% in subtotal glossectomy, and 29.94% in total glossectomy. Aspiration was noted in 3 patients(1 hemiglossectomy and 2 total glossectomy) and 2 total glossectomy patients were taken permanent feeding gastrostomy. Conclusion : Free flap gave us proper volume in tongue reconstruction and showed good result in preserving swallowing function. Swallowing function difference according to the size of defect showed no statistical significance, whereas articulation function was shown to decrease in accuracy as the size of defect was larger.

• Journal of Preventive Medicine and Public Health
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• v.33 no.2
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• pp.165-173
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• 2000

Objectives : To assess the availability of the glycophorin A (GPA) assay to detect the biological effect of ionizing radiation in workers exposed to low-doses of radiation. Methods : Information on confounding factors, such as age and cigarette smoking was obtained on 144 nuclear power plant workers and 32 hospital workers, by a self-administered questionnaire. Information on physical exposure levels was obtained from the registries of radiation exposure monitoring and control at each facility. The GPA mutant assay was performed using the BR6 method with modification by using a FACScan flow cytometer. Results : As confounders, age and cigarette smoking habits showed increasing trends with GPA variants, but these were of no statistical significance. Hospital workers showed a higher frequency of the GPA variant than nuclear power plant workers in terms of the NO variant. Significant dose-response relationships were obtained from in simple and multiple linear regression models. The slope of the regression equation for nuclear power plant workers was much smaller than that of hospital workers. These findings suggest that there may be apparent dose-rate effects. Conclusion : In population exposed to chronic low-dose radiation, the GPA assay has a potential to be used as an effective biologic marker for assessing the bone marrow cumulative exposure dose.

• Journal of Preventive Medicine and Public Health
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• v.41 no.3
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• pp.173-180
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• 2008

Objectives : The purposes of this study were to examine the health-related quality of life(HRQoL) and to identify its related factors for a group of rural adults. Methods : The study subjects were 1,901 adults who were aged 40-70 years and who were living in Naju City, Jeollanamdo. The sociodemographic characteristics, health-related behavior, health status and global self-rated health were collected for statistical analysis. The health-related quality of life was measured by the Euroqol EQ-5D instrument. The differences on the EQ-5D index between the groups were assessed with t-test, ANOVA and hierarchical multiple regression analysis. Results : Overall, the mean value of the EQ-5D index was $0.884{\pm}0.140$ and this score was significantly different according to the socioeconomic characteristics, the health-related behavior, the health status and the global self-rated health. According to the results from the hierarchical multiple regression analysis, the HRQoL was significantly reduced for females, older subjects, and other subjects with no spouse and the subjects with osteoporosis, obesity, mental distress or poorer global self-rated health. Conclusions : The HRQoL for rural adults was related to the socioeconomic characteristics, the health status and the global self-rated health, A better understanding of the factors related to the HRQoL would help to improve the rural adults' quality of life.

• Archives of Plastic Surgery
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• v.44 no.6
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• pp.530-538
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• 2017

Background A pharyngocutaneous fistula is a common and difficult-to-manage complication after head and neck reconstruction. It can lead to serious complications such as flap failure, carotid artery rupture, and pharyngeal stricture, and may require additional surgery. Previous radiotherapy, a low serum albumin level, and a higher T stage have been proposed as contributing factors. We aimed to clarify the risk factors for pharyngocutaneous fistula in patients who underwent flap reconstruction and to describe our experiences in treating pharyngocutaneous fistula. Methods Squamous cell carcinoma cases that underwent flap reconstruction after cancer resection from 1995 to 2013 were analyzed retrospectively. We investigated several significant clinical risk factors. The treatment modality was selected according to the size of the fistula and the state of the surrounding tissue, with options including conservative management, direct closure, flap surgery, and pharyngostoma formation. Results A total of 127 cases (18 with fistulae) were analyzed. A higher T stage (P=0.048) and tube-type reconstruction (P=0.007) increased fistula incidence; other factors did not show statistical significance (P>0.05). Two cases were treated with conservative management, 1 case with direct closure, 4 cases with immediate reconstruction using a pectoralis major musculocutaneous flap, and 11 cases with direct closure (4 cases) or additional flap surgery (7 cases) after pharyngostoma formation. Conclusions Pharyngocutaneous fistula requires global management from prevention to treatment. In cases of advanced-stage cancer and tube-type reconstruction, a more cautious approach should be employed. Once it occurs, an accurate diagnosis of the fistula and a thorough assessment of the surrounding tissue are necessary, and aggressive treatment should be implemented in order to ensure satisfactory long-term results.