• Advances in pediatric surgery
• /
• v.8 no.1
• /
• pp.68-70
• /
• 2002

Enterocolitis associated with Hirschsprung's disease has been a major cause of morbidity and even mortality, and before and after definitieve surgical treatment. It shows typical clinical characteristics, however, its pathogenesis has been poorly understood. Treatment is diverse, and consists of conservative tertment with intravenous hydration, antibiotics and rectal wash out, and surgical tertment with temporatory enterostomy, and other surgical procedures.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.36 no.6
• /
• pp.548-552
• /
• 2010

The submandibular gland is the second largest major salivary gland, which secretes 40% of the total daily saliva. Owing to its anatomic characteristics as well as the high viscosity and basicity of the saliva, sialolithiasis is found most commonly in the submandibular gland. Sialolithiasis that cannot be treated by conservative treatment is conventionally removed by an excision of the submandibular gland. Generally, an excision of the submandibular gland is performed via an extra-oral approach but the disadvantages of this treatment include a risk of injuring the facial nerve and scar formation. Case reports have revealed an even less invasive intraoral surgical technique for the removal of sialolith that does not affect the submandibular gland function. The functional recovery of the gland, complications and recurrence rates after surgery with this conservative intraoral procedure were all successful. We report 5 patients from the department of Oral and Maxillofacial Surgery at Dental Hospital, Yonsei University, who had undergone a resection of the sialolith though the intraoral approach with successful results.

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

• Clinics in Shoulder and Elbow
• /
• v.24 no.1
• /
• pp.9-14
• /
• 2021

Background: Recent studies about completely displaced midshaft clavicle fractures have reported that their nonunion/malunion rates were significantly higher in conservatively treated patients compared to surgically treated patients. The purpose of this study was to evaluate the factors associated with treatment decisions for midshaft clavicle fractures and also the factors that affect patient satisfaction with their treatment choice. Methods: We retrospectively reviewed the records of 75 patients who had been diagnosed with a midshaft clavicle fracture and were treated conservatively at a single institution between March 1, 2013, and December 31, 2014. Their medical records were reviewed to investigate the severity of the initial vertical displacement. A telephone survey was carried out to identify the presence of any patient-perceived deformity and determine if the patient eventually underwent surgery and whether the patient would prefer surgery if the injury recurred. Results: Significantly more patients with vertical displacement ≥100% (9/28) eventually underwent surgery compared to patients with vertical displacement <100% (3/32, p=0.028). Patients with vertical displacement ≥100% (13/28) were significantly more likely to prefer surgery compared to patients with vertical displacement <100% (7/32, p=0.044). Among the conservatively treated patients, nine of 32 participants with a patient-perceived deformity and one of 16 without a patient-perceived deformity responded that they would prefer to receive surgery in same situation in the future (p=0.079). Conclusions: Patients with a midshaft clavicle fracture with vertical displacement of ≥100% may eventually require surgical treatment. When conservative treatment is carried out, the long-term patient results may be unsatisfactory due to perceived residual deformities.

• Asian Pacific Journal of Cancer Prevention
• /
• v.15 no.11
• /
• pp.4727-4732
• /
• 2014

Background: Breast cancers are becoming more frequently diagnosed at early stages with improved long term outcomes. Late normal tissue complications induced by radiotherapy must be avoided with new breast radiotherapy techniques being developed. The aim of the study was to compare dosimetric parameters of planning target volume (PTV) and organs at risk between conformal (CRT) and intensity-modulated radiation therapy (IMRT) after breast-conserving surgery. Materials and Methods: A total of 20 patients with early stage left breast cancer received adjuvant radiotherapy after conservative surgery, 10 by 3D-CRT and 10 by IMRT, with a dose of 50 Gy in 25 sessions. Plans were compared according to dose-volume histogram analyses in terms of PTV homogeneity and conformity indices as well as organs at risk dose and volume parameters. Results: The HI and CI of PTV showed no difference between 3D-CRT and IMRT, V95 gave 9.8% coverage for 3D-CRT versus 99% for IMRT, V107 volumes were recorded 11% and 1.3%, respectively. Tangential beam IMRT increased volume of ipsilateral lung V5 average of 90%, ipsilateral V20 lung volume was 13%, 19% with IMRT and 3D-CRT respectively. Patients treated with IMRT, heart volume encompassed by 60% isodose (30 Gy) reduced by average 42% (4% versus 7% with 3D-CRT), mean heart dose by average 35% (495cGy versus 1400 cGy with 3D-CRT). In IMRT minimal heart dose average is 356 cGy versus 90cGy in 3D-CRT. Conclusions: IMRT reduces irradiated volumes of heart and ipsilateral lung in high-dose areas but increases irradiated volumes in low-dose areas in breast cancer patients treated on the left side.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.36 no.2
• /
• pp.145-148
• /
• 2010

Maxillofacial injuries are less common in children than in adolescents and adults. This lower incidence is a result of the relatively small size of mandible, the resilient nature of the bones, and a relatively protected environment, which distinguish the treatment principles of pediatric mandibular fractures from those of the adult. The bone of child is malleable, so pediatric fractures tend to be less displaced and rarely comminuted. Moreover, high regeneration potential of the wound allows more conservative treatment modalities for the pediatric mandibular fracture. High risk of damaging unerupted tooth bud renders many clinicians to resort to more conservative treatment modality for the reduction of displaced segments. This case report describes two successful treatment cases using the circummandibular wiring which was applicated to the fracture on parasymphysis of mandible. Circummandibular wiring can protect the tooth buds, and there is no need for intermaxillary fixation so that it prevents the possible complications of intermaxillary fixation such as the temporomandibular joint ankylosis and the facial growth disturbances. The acrylic splint was removed after 3 weeks, which showed clinically good union across the fracture line without complications. They showed complete clinical and radiological bone healing with an optimum occlusion.

• Clinics in Shoulder and Elbow
• /
• v.1 no.1
• /
• pp.66-71
• /
• 1998

The fractures of lateral end of clavicle can be treated by conservative or operative treatment, but many authors report the higher rate of non-union with conservative treatment and that the operative treatment is more effective for the type II fractures. The authors reviewed and analysed 15 cases of lateral end fracture of clavicle which had been treated at Department of Orthopedic Surgery, Kyungpook National University Hospital from 1991 to 1996. The results were as follows; 1. Among the 15 patients, male was 6,female 9 and the average age was 46.2 years ranged from 21 to 72 years. 2. According to the classification by Rockwood, type II a was 8 cases and II b was 7 cases. 3. We treated operatively 12 cases, 9 cases with tension band wiring and 3 cases with intramedul-Iary K-wire fixation. And we treated conservatively 3 cases with Velpeau cast, but I case of nonunion was treated with tension band wiring. 4. The average follow-up was 3.2 years ranged from 2.1 to 4.7 years. 5. The functional results were evaluated with Weitzman's classification. 6. In the operatively treated cases, there were 4 cases(30.7%) in excellent, 7 cases(53.8%) in good and 2 cases(15.3%) in fair result. But, in the conservatively treated cases, there were 2 cases in good and I case in poor result, and the poor case did not united and had open reduction and internal fixation. 7. In conclusion, the operative treatment revealed good functional results in most cases (10/12) and early open reduction and internal fixation was better method than conservative treatment.

• Archives of Plastic Surgery
• /
• v.42 no.2
• /
• pp.173-178
• /
• 2015

Background Various focal heating devices are popular in Korea under the cultural influence of the traditional ondol under-floor method of home heating. These devices can cause severe burn-like injuries resulting from device malfunction or extended with low heat contact. In addition to injuries under these high heat contact, burns can be occurred by low heat exposure with prolonged periods despite the devices are properly functioning. In order to develop strategies to reduce the duration of periods of illness due to low-temperature burns, we analyzed and compared treatment methods and therapeutic periods for this type of injury. Methods This retrospective study included 43 patients burned under low heat conditions. Patients were divided into an operative group and a conservative group. The patients in the operative group underwent at least one surgical excision, and were further subdivided into early and late visit groups. The conservative group was treated only with dressings. We compared the treatment periods between the operative group and the conservative group, and also compared the preparation periods and treatment periods between the two operative groups. Results The average treatment period was significantly shorter in the operative group (P=0.02). In the early visit operative group, both wound preparation and treatment were briefer than in the late visit group. Conclusions We recommend that early proper burn care and early surgical intervention, including appropriate excision, are feasible ways to reduce the treatment period of lowtemperature burn patients.

• Journal of the Korean Arthroscopy Society
• /
• v.1 no.1
• /
• pp.112-115
• /
• 1997

While the cruciate ligament has a profuse vascular response following injury, spontaneous repair does not occur. This may result from the fact that synovial fluid dilution of the hematoma following injury prevents the formation of a fibrin clot and thus the initiation of the healing mechanism. Another theory suggests that the dynamic nature of the fascicles of the anterior cruciate ligament(ACL) through even small ranges of motion prohibits spontaneous union to these fibers. But we experienced two cases of spontaneous healing of partially injured ACL. Initially they showed more than grade II anterior instability. 6 mm difference by stress roentgenographs(pull view) and difference of 8 mm by KT 1000TM arthrometer between the ACL injured knee and normal side knee. Lax, nearly complete tear of ACL and synovial bleeding were noted during arthroscopic examination but the continuity of synovial membrane was seemed to be intact. These cases were treated by conservative management rather than reconstructive procedure. Postoperatively they showed excellent clinical results, no anterior instability and unlimited athletic activity. Based on our clinical experience. we think that cruciate ligament has the spontaneous healing potential in acute stage and middle aged patient. We consider the microfracture technique and initial immobilization for accelleration of healing response of the ACL.

• Journal of Cerebrovascular and Endovascular Neurosurgery
• /
• v.25 no.4
• /
• pp.380-389
• /
• 2023

Objective: Middle meningeal artery embolization (MMAe) has burgeoned as a treatment for chronic subdural hematoma (cSDH). This study evaluates the safety and short-term outcomes of MMAe patients relative to traditional treatment approaches. Methods: In this retrospective large database study, adult patients in the National Inpatient Sample from 2012-2019 with a diagnosis of cSDH were identified. Cost of admission, length of stay (LOS), discharge disposition, and complications were analyzed. Propensity score matching (PSM) was utilized. Results: A total of 123,350 patients with cSDH were identified: 63,450 without intervention, 59,435 surgery only, 295 MMAe only, and 170 surgery plus MMAe. On PSM analysis, MMAe did not increase the risk of inpatient complications or prolong the length of stay compared to conservative management (p>0.05); MMAe had higher cost ($31,170 vs. $10,768, p<0.001) than conservative management, and a lower rate of nonroutine discharge (53.8% vs. 64.3%, p=0.024). Compared to surgery, MMAe had shorter LOS (5 vs. 7 days, p<0.001), and lower rates of neurological complications (2.7% vs. 7.1%, p=0.029) and nonroutine discharge (53.8% vs. 71.7%, p<0.001). There was no significant difference in cost (p>0.05). Conclusions: MMAe had similar LOS and decreased odds of adverse discharge with a modest cost increase compared to conservative management. There was no difference in inpatient complications. Compared to surgery, MMAe treatment was associated with decreased LOS and rates of neurological complications and nonroutine discharge. This nationwide analysis supports the safety of MMAe to treat cSDH.