• 대한족부족관절학회지
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• 제20권4호
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• pp.182-186
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• 2016

The tibialis anterior tendon functions as a major dorsiflexor of the ankle. A rupture in this tendon can cause serious problems in the ambulatory function. A closed traumatic rupture without open wound or an atraumatic rupture can delay diagnosis and treatment. There are not enough guidelines for an effective surgical treatment on this chronic condition. Herein, we report two cases of chronic tibialis anterior disruption successfully treated by semitendinosus autograft.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권4호
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• pp.345-348
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• 2004

Cephalic tetanus is a rare subtype of tetanus in which trismus is a charateristic symptom. The paralysis of one or more cranial nerves can occur. The 7th cranial nerve is most frequently involved. It account for 1 to 3% of the tetanus and has a mortality of 15 to 30%. The incubation period is 1 to 14 days, and approximately two thirds of tetanus cases progress to generalized tetanus. Generally, the symptoms of cephalic tetanus can include : facial pain, trismus, dysphagia, muscle twitching spasms of the face and jaw (risus sardonicus), neck stiffness and malaise. We present a case of cephalic tetanus who 54-year male patient had trismus and dysphagia. There was no history of trauma. As there was a delay in diagnosis of cephalic tetanus, respiratory disorder and intermittent general spasm occurred. The patient was treated by injection of antibiotics, muscle relaxant, and human anti-tetanus immunoglobulin. His symptoms were disappeared, and he was discharged ambulatory.

• 대한치과마취과학회지
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• 제7권2호
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• pp.120-125
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• 2007

Background: Propofol has been used extensively for short-acting intravenous sedative agent during monitored anesthesia care (MAC). This study was designed to evaluate the safety and availability of MAC using propofol in implant surgery of the one-day admission patients. Methods: In this study, subjects were divided into two groups according to ASA physical status. The heart rate, blood pressure, peripheral oxygen saturation and ECG of a patient were estimated under MAC by an anesthesiologist and the vital signs were recorded in recovery room periodically afterwards. The subjective satisfaction with regard to outpatient ambulatory surgery under MAC procedure was evaluated the next day. Results: Systolic and diastolic blood pressure were significantly decreased during MAC in ASA I group, but other remarkable changes in vital sign were not observed. There was no significant difference in pain and anxiety level between ASA I and ASA II, III group. Satisfaction rate was high in both groups. Conclusion: Monitored-Anesthesia Care using propofol during implant surgery of the one-day admission patients might be safe and available procedure because heart rate, blood pressure and oxygen saturation are stable before and during surgery, and adequate control of pain and anxiety is supported.

• Journal of Chest Surgery
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• 제45권5호
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• pp.316-319
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• 2012

Background: The standard operative treatment of primary spontaneous pneumothorax (PSP) is thoracoscopic wedge resection, but necessity of pleurodesis still remains controversial. Nevertheless, pleural procedure after wedge resection such as pleurodesis has been performed in some patients who need an extremely low recurrence rate. Materials and Methods: From January 2000 to July 2010, 207 patients who had undergone thoracoscopic wedge resection and pleurodesis were enrolled in this study. All patients were divided into two groups according to the methods of pleurodesis; apical parietal pleurectomy (group A) and pleural abrasion (group B). The recurrence after surgery had been checked by reviewing medical record through follow-up in ambulatory care clinic or calling to the patients, directly until January 2011. Results: Of the 207 patients, the recurrence rate of group A and B was 9.1% and 12.8%, respectively and there was a significant difference (p=0.01, Cox's proportional hazard model). There was no significant difference in age, gender, smoking status, and body mass index between two groups. Conclusion: This study suggests that the risk of recurrence after surgery in PSP is significantly low in patients who underwent thoracoscopic wedge resection with parietal pleurectomy than pleural abrasion.

• Archives of Plastic Surgery
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• 제44권2호
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• pp.124-135
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• 2017

Background In cases of total knee arthroplasty (TKA) threatened by potential hardware exposure, flap-based reconstruction is indicated to provide durable coverage. Historically, muscle flaps were favored as they provide vascular tissue to an infected wound bed. However, data comparing the performance of muscle versus fasciocutaneous flaps are limited and reflect a lack of consensus regarding the optimal management of these wounds. The aim of this study was to compare the outcomes of muscle versus fasciocutaneous flaps following the salvage of compromised TKA. Methods A systematic search and meta-analysis were performed to identify patients with TKA who underwent either pedicled muscle or fasciocutaneous flap coverage of periprosthetic knee defects. Studies evaluating implant/limb salvage rates, ambulatory function, complications, and donor-site morbidity were included in the comparative analysis. Results A total of 18 articles, corresponding to 172 flaps (119 muscle flaps and 53 fasciocutaneous flaps) were reviewed. Rates of implant salvage (88.8% vs. 90.1%, P=0.05) and limb salvage (89.8% vs. 100%, P=0.14) were comparable in each cohort. While overall complication rates were similar (47.3% vs. 44%, P=0.78), the rates of persistent infection (16.4% vs. 0%, P=0.14) and recurrent infection (9.1% vs. 4%, P=0.94) tended to be higher in the muscle flap cohort. Notably, functional outcomes and ambulation rates were sparingly reported. Conclusions Rates of limb and prosthetic salvage were comparable following muscle or fasciocutaneous flap coverage of compromised TKA. The functional morbidity associated with muscle flap harvest, however, may support the use of fasciocutaneous flaps for coverage of these defects, particularly in young patients and/or high-performance athletes.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권6호
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• pp.516-525
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• 2004

Mandibular symphyseal distraction osteogenesis is an alternative approach for correcting mandibular transverse deficiencies and dental crowding. The traditional approaches for these are extraction of teeth and arch expansion with traditional orthodontic treatment. Also extractions are usually unavoidable in patients with severe crowding. The purpose of this study is to evaluate the effect of mandibular symphyseal distraction osteogenesis by use of tooth-borne expansion appliance. All of 12 patients had been performed distraction osteogenesis. The surgical procedures were accomplished under local anesthesia and intravenous sedation in an ambulatory surgical setting using a routine distraction protocol. The latency period was 5 days or 7 days after symphyseal osteotomies. The rate & rhyth is a intermittent, 0.75mm or 1.0 mm per day and stabilized for 6, 8 weeks after distraction. The time of orthodontic tooth movement after distraction was variable from 2 weeks to 8 weeks (mean 3 weeks). All patients had been evaluated with study casts, plain periapical films, panorama radiograms before & after surgery. Mandibular symphyseal distraction osteogenesis increased mandibular arch width and corrected dental crowding, with paralleling tooth-borne movement, without proclination of the mandibular incisors.

• Archives of Plastic Surgery
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• 제34권2호
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• pp.203-208
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• 2007

Purpose: Myocutaneous flap was widely used for trochanteric pressure sore but it had many drawbacks such as donor site morbidity, dog-ear deformity and functional muscle sacrifice. We have performed fasciocutaneous flap based on perforating vessels and succeeded in overcoming its drawbacks. Methods: We experienced 11 cases of perforator-based fasciocutaneous flap for the coverage of trochanteric pressure sore in 9 patients, 2 cases of which were bilateral. The ambulatory status of patient group is as follows: 6 of them used a wheelchair, 2 of them are free walking, 1 of them use a wheelchair or crutches. Flap was supplied by cutaneous perforating vessel of descending branch of the lateral circumflex femoral artery and the third perforating artery of the deep femoral artery. The size of wounds were from $4{\times}6.5cm$ to $10{\times}13cm$. Results: We did not find any flap loss or congestion except 2 partial wound dehiscences and 1 wound infection. Donor site morbidity was not found. We observed no recurrence of the pressure sore during the 2.5 year follow-up period. Conclusion: We considered that perforator-based fasciocutaneous flap could overcome the traditional drawbacks of the conventional myocutaneous flap and its modified flap for trochanteric pressure sore. And this flap has many advantages for covering trochanteric pressure sore without any donor site deformity and morbidity, which would greatly improve the aesthetic result.

• Hip & pelvis
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• 제35권2호
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• pp.99-107
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• 2023

Purpose: Bipolar hemiarthroplasty has recently been acknowledged as an effective option for treatment of unstable intertrochanteric fracture. Trochanteric fragment nonunion can cause postoperative weakness of the abductor muscle and dislocation; therefore, reduction and fixation of the fragment is essential. The purpose of this study was to perform an evaluation and analysis of the outcomes of bipolar hemiarthroplasty using a useful wiring technique for management of unstable intertrochanteric fractures. Materials and Methods: A total of 217 patients who underwent bipolar hemiarthroplasty using a cementless stem and a wiring technique for management of unstable intertrochanteric femoral fractures (AO/OTA classification 31-A2) at our hospital from January 2017 to December 2020 were included in this study. Evaluation of clinical outcomes was performed using the Harris hip score (HHS) and the ambulatory capacity reported by patients was classified according to Koval stage at six months postoperatively. Evaluation of radiologic outcomes for subsidence, breakage of wiring, and loosening was also performed using plain radiographs at six months postoperatively. Results: Among 217 patients, five patients died during the follow-up period as a result of problems unrelated to the operation. The mean HHS was 75±12 and the mean Koval category before the injury was 2.5±1.8. A broken wire was detected around the greater trochanter and lesser trochanter in 25 patients (11.5%). The mean distance of stem subsidence was 2.2±1.7 mm. Conclusion: Our wiring fixation technique can be regarded as an effective additional surgical option for fixation of trochanteric fracture fragments during performance of bipolar hemiarthroplasty.

• Journal of Gastric Cancer
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• 제24권2호
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• pp.137-144
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• 2024

Purpose: Laparoscopic proximal gastrectomy (LPG) is a viable choice for treating proximal gastric lesions. However, the occurrence of severe reflux has limited its widespread adoption. To address this issue, the double flap technique (DFT), which incorporates artificial lower esophageal sphincteroplasty, has been developed to prevent reflux problems after proximal gastrectomy. In this study, we aimed to investigate the usefulness of this technique using high-resolution manometry (HRM), impedance pH monitoring, and esophagogastroduodenoscopy (EGD). Materials and Methods: The findings of pre- and postoperative 6-month HRM, pH monitoring, and EGD were compared for 9 patients who underwent LPG with DFT for various proximal gastric lesions at Incheon St. Mary's Hospital from January 2021 to December. Results: A total of 9 patients underwent proximal gastrectomy. Approximately half of the patients had Hill's grade under II preoperatively, whereas all patients had Hill's grades I and II in EGD findings. In the HRM test, there was no significant difference between distal contractile integral (1,412.46±1,168.51 vs. 852.66±495.62 mmHg·cm·s, P=0.087) and integrated relaxation pressure (12.54±8.97 vs. 8.33±11.30 mmHg, P=0.27). The average lower esophageal sphincter (LES) pressure was 29.19±14.51 mmHg preoperatively, which did not differ from 19.97±18.03 mmHg after the surgery (P=0.17). DeMeester score (7.02±6.36 vs. 21.92±36.17, P=0.21) and total acid exposure time (1.49±1.48 vs. 5.61±10.17, P=0.24) were slightly higher, but the differences were not statistically significant. Conclusions: There is no significant functional difference in HRM and impedance pH monitoring tests after DFT. DFT appears to be useful in preserving LES function following proximal gastrectomy.

• Journal of Yeungnam Medical Science
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• 제31권1호
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• pp.25-27
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• 2014

Patients treated with peritoneal dialysis have increased intra-abdominal pressure and a high prevalence of abdominal wall complications. Hernias can lead to significant morbidity in patients on peritoneal dialysis. Hernias are clinically important because of the risk of incarceration, strangulation and subsequent bowel obstruction, rupture, and peritonitis. In this paper, a case of incarcerated umbilical hernia with small bowel obstruction in a continuous ambulatory peritoneal dialysis (CAPD) patient is reported. The small bowel obstruction improved after herniorrhaphy, and the peritoneal dialysis was resumed 2 weeks after the herniorrhaphy. The patient had been undergoing CAPD without technical failure until the 2 months follow-up after the herniorrhaphy. This case shows that early detection of incarcerated umbilical hernia and herniorrhaphy can prevent resection of a strangulated small bowel so that it can remain on CAPD without post-operative technical failure. Umbilical hernias should be carefully observed and intestinal obstruction should be considered when a CAPD patient with an umbilical hernia has abdominal pain.