• Journal of Korean Neurosurgical Society
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• 제41권4호
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• pp.236-240
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• 2007

Objective : The aim of this study is to analyze on the external ventricular drainage [EVD] related ventriculitis, especially on their risk factors, management, and prevention. Methods : From January 2003 to December 2005, a total of 174 EVD catheters were placed in 112 patients at our institution. Of these patients, EVD-related ventriculitis were developed in 15 cases. Clinical variables such as age, sex, prior clinical diagnosis, placement of EVD insertion, duration of EVD, total numbers of EVD per person, and outcome were analyzed in theses cases to verify the risk factors, causative agents and outcomes. Results : Fifteen cases of EVD related ventriculitis were noted presenting infection incidence of 13.39 % per patient and 8.62% per procedure. Of these, five patients died from sepsis, seven patients were recovered from infection but neurological complications remained and three patients were recovered without any complications. Microbes were obtained from cerebrospinal fluid only in six patients. Acinetobactoer baumanii was the most common pathogen in our study [4 cases]. Among the various risk factors, only the prior clinical diagnosis showed the statistical significance. Patients who underwent decompressive craniectomy after severe brain trauma showed unfavorable outcome because of possible contaminative environment compared with other cases. Conclusion : EVD is considered as a safe procedure with good control of intracranial pressure if meticulous care is provided for EVD procedure and maintenance. With regards to risk factors and prevention, the higher incidence and unfavorable outcome was seen especially in patients with severe head trauma. Thus, special attention is required in these clinical settings.

• Journal of Trauma and Injury
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• 제28권4호
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• pp.223-231
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• 2015

Purpose: Delayed, traumatic, intraparenchymal hemorrhage (DTIPH) is a well-known contributing factor to secondary brain damage that evokes severe brain edema and intracranial hypertension. Once it has occurred, it adversely affects the patient's outcome. The aim of this study was to evaluate the prognosis factors for DTIPH by comparing clinical, radiological and hematologic results between two groups of patients according to whether surgical treatment was given or not. Methods: The author investigated 26 patients who suffered DTIPH during the recent consecutive five-year period. The 26 patients were divided according to their having undergone either a decompressive craniectomy (n=20) or continuous conservative treatment (n=6). A retrospective investigation was done by reviewing their admission records and radiological findings. Results: This incidence of DTIPH was 6.6% among the total number of patients admitted with head injuries. The clinical outcome of DTIPH was favorable in 9 of the 26 patients (34.6%) whereas it was unfavorable in 17 patients (65.4%). The patients with coagulopathy had an unexceptionally high rate of mortality. Among the variables, whether the patient had undergone a decompressive craniectomy, the patient's preoperative clinical status, and the degree of midline shift had significant correlations with the ultimate outcome. Conclusion: In patients with DTIPH, proper evaluation of preoperative clinical grading and radiological findings can hamper deleterious secondary events because it can lead to a swift and proper decompressive craniectomy to reduce the intracranial pressure. Surgical decompression should be carefully selected, paying attention to the patient's accompanying injury and hematology results, especially thrombocytopenia, in order to improve the patient's neurologic outcomes.

• Asian Pacific Journal of Cancer Prevention
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• 제16권7호
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• pp.2903-2908
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• 2015

Background: Head and neck cancer (HNC) is the eighth most common cancer as estimated from worldwide data. The incidence of HNC in Peninsular Malaysia was reported as 8.5 per 100,000 population. This study was aimed to determine the treatment outcomes for HNC patients treated in the Oncology Unit of University Malaya Medical Centre (UMMC). Materials and Methods: All newly diagnosed patients with squamous cell carcinoma of head and neck (HNSCC) referred for treatment to the Oncology Unit at UMMC from 2003-2010 were retrospectively analyzed. Treatment outcomes were 5-year overall survival (OS), cause specific survival (CSS), loco-regional control (LRC) and radiotherapy (RT) related side effects. Kaplan-Meier and log rank analyses were used to determine survival outcomes, stratified according to American Joint Committee on Cancer (AJCC) stage. Results: A total of 130 cases were analysed. Most cases (81.5%) were at late stage (AJCC III-IVB) at presentation. The 5-year OS for the whole study population was 34.4% with a median follow up of 24 months. The 5-year OS according to AJCC stage was 100%, 48.2%, 41.4% and 22.0% for stage I, II, III and IVA-B, respectively. The 5-year overall CSS and LCR were 45.4% and 55.4%, respectively. Late effects of RT were documented in 41.4% of patients. The most common late effect was xerostomia. Conclusions: The treatment outcome of HNSCC at our centre is lagging behind those of developed nations. Efforts to increase the number of patients presenting in earlier stages, increase in the use of combined modality treatment, especially concurrent chemoradiotherapy and implementation of intensity modulated radiotherapy, may lead to better outcomes for our HNC patients.

• Clinics in Shoulder and Elbow
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• 제18권3호
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• pp.144-151
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• 2015

Background: The consensus is that a bony Bankart lesion shorter than 25% of the length of glenoid does not affect the clinical result; hence, such lesions were often neglected. However, small bony Bankart lesions are associated with various types of capsulolabral lesions. Methods: A total of 82 patients who had undergone arthroscopic capsulolabral lesion repair surgery for anterior shoulder dislocation were reviewed. The prevalence rates of early and late type of capsulolabral lesions were compared between a group of patients with and a group without small bony Bankart lesions. In addition, the types of accompanying capsulolabral lesion were analyzed according to the type of bony Bankart lesion. Finally, the clinical outcomes were evaluated (active range of motion, American Shoulder and Elbow Surgeons score and Rowe's score). Results: Among the 13 patients who had small bony Bankart lesions, the prevalence rate of early and late type of capsulolabral lesions was 38.5% and 61.5%, respectively. Among the 69 patients without bony Bankart lesion, the prevalence rates of early and late type of capsulolabral lesions were 74% and 26%, respectively. Significantly worse clinical outcome was observed for the group of patients with both small bony Bankart lesions and late type of capsulolabral lesion. Conclusions: More severe type of small bony Bankart lesion appears to be associated with late type of capsulolabral lesion. The significantly worse clinical outcome for patients with both small bony Bankart lesion and late type of capsulolabral lesion indicates that small bony Bankart lesions cannot always be neglected.

• Journal of Korean Neurosurgical Society
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• 제57권3호
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• pp.159-166
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• 2015

Objective : We reviewed the feasibility, safety and efficacy as well as the clinical outcome and long-term angiographic results of endovascular treatment (EVT) of the anterior communicating artery (ACoA) aneurysms. Methods : A total of 429 ACoA aneurysms in 426 patients were treated using coil embolization between March 1996 and October 2010 in a single institution. Pretreatment aneurysmal features were checked using angiogram. We had usually used tailored steam shaped microcatheter according to individual angiographic architectures. Immediate postembolization outcomes were evaluated using an angiographic outcome scale and clinical evaluation was performed using the Glasgow Outcome Scale (GOS). Results : Postembolization angiograms demonstrated total occlusion of aneurysm in 290 of 429 (67.6%) aneurysms, neck remnant in 80 (18.6%) and body filling in 59 (13.8%). Dome direction and aneurysm angle was not associated with initial angiographic outcomes. The procedure-related morbidity rate was 0.9% (4 of 429). Clinical and imaging follow-up more than 6 months were available in 382 (89.0%) patients with a mean of 26.2 months. Overall rate of major recanalization was 7.9% (30 of 382) and all of them were retreated without complications. At the last follow-up, 233 (99.2%) of 235 patients had GOS of 5 in unruptured group, and 152 (79.5%) of 191 patients showed good clinical outcomes (GOS of 4 or 5) in ruptured group. Conclusion : Tailored steam shaping of the microcatheter is vital to achieve good angiographic outcomes regardless of aneurysmal direction. EVT is feasible and safe for most ACoA aneurysms with acceptable immediate and long-term outcomes.

• Journal of Korean Neurosurgical Society
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• 제60권2호
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• pp.155-164
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• 2017

Objective : To evaluate the efficacy of balloon guiding catheter (BGC) during thrombectomy in anterior circulation ischemic stroke. Methods : Sixty-two patients with acute anterior circulation ischemic stroke were treated with thrombectomy using a Solitaire stent from 2011 to 2016. Patients were divided into the BGC group (n=24, 39%) and the non-BGC group (n=38, 61%). The number of retrievals, procedure time, thrombolysis in cerebral infarction (TICI) grade, presence of distal emboli, and clinical outcomes at 3 months were evaluated. Results : Successful recanalization was more frequent in BGC than in non-BGC (83% vs. 66%, p=0.13). Distal emboli occurred less in BGC than in non-BGC (23.1% vs. 57.1%, p=0.02). Good clinical outcome was more frequent in BGC than in non-BGC (50% vs. 16%, p=0.03). The multivariate analysis showed that use of BGC was the only independent predictor of good clinical outcome (odds ratio, 5.19 : 95% confidence interval, 1.07-25.11). More patients in BGC were successfully recanalized in internal carotid artery (ICA) occlusion with small retrieval numbers (<3) than those in non-BGC (70% vs. 24%, p=0.005). In successfully recanalized ICA occlusion, distal emboli did not occur in BGC, whereas nine patients had distal emboli in non-BGC (0% vs. 75%, p=0.001) and good clinical outcome was superior in BGC than in non-BGC (55.6% vs. 8.3%, p=0.01). Conclusion : A BGC significantly reduces the number of retrievals and the occurrence of distal emboli, thereby resulting in better clinical outcomes in patients with anterior circulation ischemic stroke, particularly with ICA occlusion.

• Journal of Korean Neurosurgical Society
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• 제52권5호
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• pp.441-446
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• 2012

Objective : Shunt-dependent chronic hydrocephalus (SDCH) is known to be a major complication associated with aneurysmal subarachnoid hemorrhage (aSAH). Old age is known to be one of numerous factors related to the development of SDCH. This study investigated whether postoperative cisternal drainage affects the incidence of SDCH and clinical outcome in elderly patients with aSAH. Methods : Fifty-nine patients participated in this study. All patients underwent aneurysmal clipping with cisternal cerebrospinal fluid (CSF) drainage. Clinical variables relevant to the study included age, sex, location of ruptured aneurysm, CT finding and clinical state on admission, clinical outcome, and CSF drainage. We first divided patients into two groups according to age (<70 years of age and ${\geq}70$ years of age) and compared the two groups. Secondly, we analyzed variables to find factors associated with SDCH in both groups (<70 years of age and ${\geq}70$ years of age). Results : Of 59 patients, SDCH was observed in 20 patients (33.9 %), who underwent shunt placement for treatment of hydrocephalus. Forty seven percent of cases of acute hydrocephalus developed SDCH. In the elderly group (${\geq}70$ years of age), the duration and amount of CSF drainage did not affect the development of chronic hydrocephalus. Conclusion : In elderly patients, although the incidence of SDCH was significantly higher, clinical outcome was acceptable. The duration and the amount of cisternal drainage did not seem to be related to subsequent development of chronic hydrocephalus within elderly patients aged 70 or older.

• 한방안이비인후피부과학회지
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• 제26권2호
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• pp.78-87
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• 2013

Objectives : This work aimed to review clinical trial trend of Korean medicine's face rejuvenation and suggest future trial using embedded needle(Maesun) based on Evidence-based medicine's PICO Model. Methods : 46 papers were searched from Oasis and DBPia, then 8 papers were engaged in review of clinical trial trend. Based on PICO model, clinical trial's patient, intervention, and outcome measurement were suggested. Results : Evidence level of clinical trials is relatively low, because their study designs are almost case report or case series. No study have comparison groups. Outcome measurement is varied, however, 3D face scanner were used to measure before-after changes of face. Based on review, we suggested that necessity of intervention standardization, measuring of normal control group and 2D/3D combined outcome measurement of face. Conclusions : There are many demands for revealing efficacy and safety of Korean medicine's intervention, also for face rejuvenation using embedded needle. For meeting the level of demands, more rigorous works are needed.

• 문화기술의 융합
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• 제5권2호
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• pp.329-336
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• 2019

본 연구는 간호학생의 성과기반교육 달성도에 영향 미치는 요인을 확인하기 위해 364명의 간호학생을 대상으로 의사소통능력, 비판적 사고성향, 셀프리더십, 연구능력, 성과기반교육 달성도로 구성된 자가보고 질문지로 자료를 수집하였다. 간호학생의 성과기반교육 달성도는 학년, 성과기반교육 이해도 및 만족도, 임상실습 경험여부에 따라 통계적으로 유의한 차이가 있었다. 성과기반교육 달성도는 의사소통능력, 비판적 사고성향, 셀프리더십, 연구능력과 양의 상관관계로 나타났다. 간호학생의 성과기반교육 달성도에 영향을 미치는 요인은 성과기반교육 만족도(${\beta}=0.33$, p<0.001), 셀프리더십(${\beta}=0.21$, p<0.001), 연구능력(${\beta}=0.18$, p<0.001), 비판적 사고성향(${\beta}=0.17$, p=0.003), 의사소통능력(${\beta}=0.14$, p=0.006), 임상실습 경험(${\beta}=0.10$, p=0.023)의 순으로 나타났으며, 성과기반교육 달성도에 대한 이들 변수의 총 설명력은 38.1%였다. 성과기반교육의 달성도를 높이기 위해 셀프리더십, 연구능력, 비판적 사고성향 및 의사소통능력을 향상시킬 수 있는 교과 및 비교과 활동 전략을 개발하고 운영해야 할 것이다.

• 대한족부족관절학회지
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• 제18권4호
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• pp.165-172
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• 2014

Purpose: We evaluated the correlation of postoperative clinical outcomes and radiologic findings using computed tomography and simple X-ray in intra-articular calcaneal fractures. Materials and Methods: The current study is based on 41 feet, 38 patients with displaced intra-articular fracture who underwent surgical treatment with at least one year of follow-up. Evaluation of clinical outcome included American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS) score, and subjective satisfaction. A simple X-ray was used in evaluation of preoperative and postoperative Gissane angle, B${\ddot{O}}$hler angle, and calcaneal fracture width. Computed tomography scan was performed for evaluation of preoperative and postoperative articular step-off and articular gap in all cases. Finally, we evaluated the correlation of the postoperative clinical outcomes and radiologic findings based on the measurement. Results: The average postoperative AOFAS score and VAS score was $84.1{\pm}8.5$ and $2.2{\pm}2.2$. Subjective satisfaction was excellent in 15 cases, good in 19 cases, and fair in seven cases. The average B${\ddot{O}}$hler angle was restored from $11.1^{\circ}$ to $24.7^{\circ}$(p<0.05), Gissane angle was changed from $121.0^{\circ}$ to $119.0^{\circ}$ (p>0.05), and the average width was restored from 45.8 to 35.0 mm (p<0.05). The average articular step-off and gap were decreased from 6.3 to 2.0 mm and from 11.1 to 4.6 mm, respectively (p<0.05). No significant correlations were observed between the clinical outcome and Gissane angle, B${\ddot{O}}$hler angle, and width, and there was no significant correlation between the clinical outcome and Sanders classification. However, postoperative articular step-off showed correlation with VAS and AOFAS score and articular gap showed correlation with VAS score. Conclusion: The clinical outcome did not show correlation with B${\ddot{O}}$hler angle and Gissane angle but did show correlation with anatomical reduction of the posterior facet joint.