• The Journal of Internal Korean Medicine
• /
• v.44 no.6
• /
• pp.1294-1317
• /
• 2023

Background: Post-COVID-19 pulmonary fibrosis (PCPF) is a common complication in severe COVID-19 cases, often associated with acute respiratory distress syndrome or mechanical ventilation. Patients with PCPF frequently experience a decline in their quality of life due to persistent COVID-19 sequelae, including cough and chest pain. However, there is currently no established standard treatment, and the efficacy of existing medications remains uncertain. Case Report: A 65-year-old female patient presenting with cough, dyspnea, chest pain, and fatigue due to PCPF received Korean medicine treatment for 25 days. Symptom evaluation utilized the modified Medical Research Council scale, the Leicester Cough Questionnaire, and the Numeral Rating Scale. Quality of life and functional status were assessed using the Post-COVID-19 Functional Status and the EuroQol 5-Dimensional 5-Level. The extent of pulmonary fibrosis was assessed by comparing chest computed tomography (chest CT) scans before and after hospitalization. Following treatment, the patient demonstrated clinically meaningful improvement in clinical symptoms, enhanced quality of life, and decreased fibrotic lesions on CT scans. Conclusion: This case report suggests that Korean medicine treatment may be effective in improving clinical symptoms, such as cough and dyspnea caused by PCPF, while also enhancing post-COVID-19 quality of life and ameliorating pulmonary fibrotic lesions.

• Journal of Chest Surgery
• /
• v.57 no.2
• /
• pp.160-168
• /
• 2024

Background: Data on perioperative outcomes of emergent versus elective resection in esophageal cancer patients requiring esophagectomy are lacking. We investigated whether emergent resection was associated with increased risks of morbidity and mortality. Methods: Data on patients with esophageal malignancy who underwent esophagectomy from 2005 to 2020 were retrospectively analyzed from the American College of Surgeons National Surgical Quality Improvement Program database. Thirty-day complication and mortality rates were compared between emergent esophagectomy (EE) and non-emergent esophagectomy. Logistic regression assessed factors associated with complications and mortality. Results: Of 10,067 patients with malignancy who underwent esophagectomy, 181 (1.8%) had EE, 64% had preoperative systemic inflammatory response syndrome, sepsis, or septic shock, and 44% had bleeding requiring transfusion. The EE group had higher American Society of Anesthesiologists (ASA) class and functional dependency. More transhiatal esophagectomies and diversions were performed in the EE group. After EE, the rates of 30-day mortality (6.1% vs. 2.8%), overall complications (65.2% vs. 44.2%), bleeding, pneumonia, prolonged intubation, and positive margin (17.7% vs. 7.4%) were higher, while that of anastomotic leak was similar. On adjusted logistic regression, older age, lower albumin, higher ASA class, and fragility were associated with increased complications and mortality. McKeown esophagectomy and esophageal diversion were associated with a higher risk of postoperative complications. EE was associated with 30-day postoperative complications (odds ratio, 2.39; 95% confidence interval, 1.66-3.43; p<0.0001). Conclusion: EE was associated with a more than 2-fold increase in complications compared to elective procedures, but no independent increase in short-term mortality. These findings may help guide data-driven critical decision-making for surgery in select cases of complicated esophageal malignancy.

• Journal of Korean Neurosurgical Society
• /
• v.67 no.3
• /
• pp.354-363
• /
• 2024

Objective : This study aims to determine the optimal dose of recombinant-human bone morphogenic protein-2 (rhBMP-2) for successful bone fusion in minimally invasive lateral lumbar interbody fusion (MIS LLIF). Previous studies show that rhBMP is an effective alternative to autologous iliac crest bone graft, but the optimal dose remains uncertain. The study analyzes the fusion rates associated with different rhBMP doses to provide a recommendation for the optimal dose in MIS LLIF. Methods : Ninety-three patients underwent MIS LLIF using demineralized bone matrix (DBM) or a mixture of rhBMP-2 and DBM as fusion material. The group was divided into the following three groups according to the rhBMP-2 usage : group A, only DBM was used (n=27); group B, 1 mg of rhBMP-2 per 5 mL of DBM paste (n=41); and group C, 2 mg of rhBMP-2 per 5 mL of DBM paste (n=25). Demographic data, clinical outcomes, postoperative complication and fusion were assessed. Results : At 12 months post-surgery, the overall fusion rate was 92.3% according to Bridwell fusion grading system. Groups B and C, who received rhBMP-2, had significantly higher fusion rates than group A, who received only DBM. However, there was no significant increase in fusion rate when the rhBMP-2 dosage was increased from group B to group C. The groups B and C showed significant improvement in back pain and Oswestry disability index compared to the group A. The incidence of screw loosening was decreased in groups B and C, but there was no significant difference in the occurrence of other complications. Conclusion : Usage of rhBMP-2 in LLIF surgery leads to early and increased final fusion rates, which can result in faster pain relief and return to daily activities for patients. The benefits of using rhBMP-2 were not significantly different between the groups that received 1 mg/5 mL and 2 mg/5 mL of rhBMP-2. Therefore, it is recommended to use 1 mg of rhBMP-2 with 5 mL of DBM, taking both economic and clinical aspects into consideration.

• Korean Journal of Community Nutrition
• /
• v.29 no.2
• /
• pp.129-143
• /
• 2024

Objectives: The objective of this study is to compare a nutritionally balanced soft blend diet (SBD) with a soft fluid diet (SFD) on the health of inpatients who have undergone oral and maxillofacial (OMF) surgery, ultimately aiming to enhance care outcomes, improve health-related quality of life (QOL), and increase satisfaction with the hospital. Methods: Thirty-two patients were randomized into two groups: sixteen received SFD and sixteen received SBD. Anthropometric, laboratory evaluations were conducted upon admission and discharge. Patients filled out questionnaires on demographics, diet satisfaction, food intake amount, and health-related QOL on the day of discharge, assessed using the EuroQoL 5 Dimensions 3 Level and EuroQoL Visual Analogue Scale (EQ-VAS) instruments. Data were analyzed with descriptive statistics, χ² tests for group differences, and paired nonparametric t-tests for within-group comparisons. The Mann-Whitney U test evaluated inter-group differences in preoperative weight and body mass index (BMI), postoperative changes, meal satisfaction, intake, health-related QOL, and self-assessed health status. P-values were set at a significance level of 0.05. Results: The SBD group had higher dietary intake (63.2% vs. 51.0%) and greater diet satisfaction (80.6 vs. 48.1, P < 0.0001) compared to SFD group. Health-related QOL, measured by EQ-VAS, was better in SBD group (70.3 vs. 58.8, P < 0.05). Postoperative weight and BMI decreased in SFD group but increased in SBD group (P < 0.01). Changes in laboratory results showed more stability in the SBD group. No postoperative infections were reported in SBD group, whereas SFD group had a 31.25% complication rate. Conclusions: While SFD is often recommended after OMF surgery to protect oral wound healing process, our study reveals that SBD not only enhances physical and psychological outcomes but also, somewhat unexpectedly, supports wound healing and reduces complications. Essentially, SBD promotes physical recovery and enhances health-related QOL than SFD by supporting both somatic and mental healing aspects.

• Archives of Plastic Surgery
• /
• v.51 no.1
• /
• pp.42-51
• /
• 2024

Background Increasing concerns regarding the safety of textured surface implants have resulted in surgeons transitioning from textured tissue expanders (TEs) to smooth TEs. Given this change has only recently occurred, this study evaluated outcomes between smooth and textured TEs. Methods Women who underwent two-stage breast reconstruction using TEs from 2013 to 2022 were included. TE-specific variables, perioperative information, pain scores, and complications were collected. Chi-squared, t-test, and linear regression analyses were performed. Results A total of 320 patients received a total of 384 textured and 152 smooth TEs. Note that 216 patients received bilateral reconstruction. TEs were removed in 9 cases. No significant differences existed between groups regarding comorbidities. Smooth TEs had a higher proportion of prepectoral placement (p < 0.001). Smooth TEs had less fills (3±1 vs. 4±2, p < 0.001), shorter expansion periods (60±44 vs. 90±77 days, p < 0.001), smaller expander fill volumes (390±168 vs. 478±177 mL, p < 0.001), and shorter time to exchange (80±43 vs. 104±39 days, p < 0.001). Complication rates between textured and smooth TEs were comparable. Smooth TE had a greater proportion of TE replacements (p = 0.030). On regression analysis, pain scores were more closely associated with age (p = 0.018) and TE texture (p = 0.046). Additional procedures at time of TE exchange (p < 0.001) and textured TE (p = 0.017) led to longer operative times. Conclusion As many surgeons have transitioned away from textured implants, our study shows that smooth TEs have similar outcomes to the textured alternatives.

• Journal of the Korean Society of Radiology
• /
• v.85 no.3
• /
• pp.661-667
• /
• 2024

Afferent loop syndrome (ALS) is a rare complication of gastrectomies and gastrointestinal reconstruction. This can predispose patients to fatal conditions, such as cholangitis, pancreatitis, and duodenal perforation with peritonitis. Therefore, emergency decompression is necessary to prevent these complications. Herein, we report two cases in which transcholecystic duodenal drainage, an alternative decompression treatment, was performed in ALS patients without bile duct dilatation. Two patients who underwent distal gastrectomy with Billroth II anastomosis sought consultation in an emergency department for epigastric pain and vomiting. On CT, ALS with acute pancreatitis was diagnosed. However, biliary access could not be achieved because of the absence of bile duct dilatation. To overcome this problem, a duodenal drainage catheter was placed to decompress the afferent loop after traversing the cystic duct via a transcholecystic approach. The patients were discharged without additional surgical treatment 2 weeks and 1 month after drainage.

• Journal of the Korean Society of Radiology
• /
• v.85 no.3
• /
• pp.682-690
• /
• 2024

Acute necrotizing encephalopathy (ANE) is a rare immune-mediated complication of a viral infection commonly involving the bilateral thalamus and has been reported mainly in children. Here, we describe the MRI findings of coronavirus disease 2019 (COVID-19)-associated ANE in two pediatric patients, including a 7-year-old girl with fever and mental change, and a 6-year-old girl with fever and generalized seizures. Brain MRI revealed symmetrical T2 fluid attenuated inversion recovery high-signal intensity lesions in the bilateral thalamus with central hemorrhage. In one patient, the thalamic lesions showed a tri-laminar pattern on the apparent diffusion coefficient map. This report emphasizes the importance of creating awareness regarding these findings in patients with COVID-19, particularly in children with severe neurological symptoms. Furthermore, it provides a literature review of several documented cases of COVID-19 presenting with bilateral thalamic hemorrhagic necrosis, suggesting a diagnosis of ANE.

• Journal of the Korean Society of Radiology
• /
• v.85 no.2
• /
• pp.363-371
• /
• 2024

Purpose Acute cholecystitis is a complication of transarterial chemoembolization (TACE) that occasionally requires surgical intervention. We aimed to analyze the incidence and risk factors of cholecystitis requiring surgical intervention in patients with embolic material uptake on cone beam CT (CBCT) performed immediately after various TACE procedures. Materials and Methods After a retrospective review of 2633 TACE procedures performed over a 6-year period, 120 patients with embolic material retention in the gallbladder wall on CBCT immediately after TACE were selected. We analyzed the incidence of and risk factors for acute cholecystitis. Results The overall incidence of acute cholecystitis requiring surgical intervention was 0.45% (12 of 2633 TACE procedures); however, it was present in 10% (12 of 120) of procedures that showed high-density embolic material retention in the gallbladder wall on CBCT performed immediately after TACE. Acute cholecystitis requiring surgical intervention occurred in eight patients (66.7%) who underwent direct cystic arterial embolization. Surgical intervention was performed 15 days (mean) after TACE. Conclusion Most unintended chemolipiodol deposits in the gallbladder wall resolved without intervention or surgery. However, superselective direct cystic arterial chemoembolization was associated with a high incidence of acute cholecystitis requiring surgery, and patients who undergo this procedure should be closely monitored.

• Clinical and Experimental Pediatrics
• /
• v.52 no.4
• /
• pp.488-493
• /
• 2009

Purpose : The aim of this study was to assess the efficacy and safety of recent-generation patent ductus arteriosus (PDA) closure devices applied by a new selection strategy according to the characteristics of each PDA. Methods : From February 2003 to January 2006, 138 patients underwent transcatheter closure of PDA (study group). According to the size and morphology of each ductus, a COOK Detachable Coil or 'flex' PFM Nit-Occlud was used for a small ductus (group 1, n=43); 'medium' PFM Nit-Occlud (group 2, n=49) for a moderate ductus; and an Amplatzer Duct Occluder (group 3, n=46) for a large ductus. The 83 patients who underwent transcatheter closure of PDA from February 2000 to January 2003 were defined as the comparison group. The Qp/Qs ratio, pulmonary/aorta pressure ratio, and MD of the ductus were compared. Immediate and follow-up results including residual shunts and complications were also evaluated and compared among groups. Results : In all 138 patients, complete occlusions were confirmed without major complications, while procedure failure (n=2, 2.2%), device embolization (n=1, 1.1%), and persistent residual shunt (n=4, 4.5%) were documented in the comparison group. Total complication rates were lower in the study group than in the comparison group (study group, 1.4%; comparison group, 9.0%; P<0.05). Conclusion : A novel strategy adopting the merits of various recent-generation devices for transcatheter closure of PDA provides excellent clinical results with minimal risk.

• Clinical and Experimental Pediatrics
• /
• v.50 no.1
• /
• pp.65-73
• /
• 2007

Purpose : Short stature is an important complication that impairs the quality of life in survivors of childhood brain tumors. We studied their final adult height (FAH) to evaluate risk factors for short stature. Methods : We reviewed the medical data of 95 survivors of childhood brain tumors (64 males and 31 females) who had been followed up from 1982 to 2006, reached FAH, and had a more than five year-disease-free survival. Results : Final adult height standard deviation score (FAHTSDS: $mean{\pm}SD$) of the patients was lower than those of general population ($-1.15{\pm}1.72$), HTSDS at diagnosis ($-0.13{\pm}1.57$), and target HTSDS ($-0.49{\pm}0.69$). FAHTSDS of craniopharyngioma patients did not decrease ($0.57{\pm}1.17$), but those of germ cell tumor and medulloblastoma patients were significantly reduced ($-1.20{\pm}1.45$, $-2.70{\pm}1.46$; P<0.05). The patients treated with craniospinal radiation or chemotherapy had lower FAHTSDS ($-1.93{\pm}1.58$, $-2.27{\pm}1.44$; P<0.01). In the spinal irradiation group, the younger the age at diagnosis was, the more the loss of FAH (r=0.442, P<0.01). Growth hormone replacement (GHR) didn't improve FAHTSDS, but starting GHR under 12 years was an independent factor for improving FAH once treatment methods were taken into account (P=0.01). Conclusion : The younger age at diagnosis, spinal radiation and chemotherapy were all important risk factors of height loss, and height gain was expected in patients who received GHR under the age of 12 years. Therefore, regular check-ups of growth and early intervention with growth hormones are needed for high risk groups to improve FAH.