• Title/Summary/Keyword: Day-surgery center

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Risk Factors of the 2-Year Mortality after Bipolar Hemiarthroplasty for Displaced Femoral Neck Fracture

  • Jung Wook Huh;Han Eol Seo;Dong Ha Lee;Jae Heung Yoo
    • Hip & pelvis
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    • v.35 no.3
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    • pp.164-174
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    • 2023
  • Purpose: This study investigates the relationship between preoperative neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-C-reactive protein ratio (LCR), albumin, and 2-year mortality in elderly patients having hemiarthroplasty for displaced femoral neck fracture (FNF). Materials and Methods: We retrospectively reviewed 284 elderly patients who underwent hemiarthroplasty for Garden type IV FNF from September 2014 to September 2020. Using the receiver operating characteristic curve, optimal cutoff values for LCR, NLR, and albumin were established, and patients were categorized as low or high. Associations with 2-year mortality were evaluated through univariate and multivariate Cox regression analyses. Results: Of the 284 patients, 124 patients (45.9%) died within 2 years post-surgery. The optimal cutoff values were: LCR at 7.758 (specificity 58.5%, sensitivity 25.0%), NLR at 3.854 (specificity 39.2%, sensitivity 40.0%), and albumin at 3.750 (specificity 65.9%, sensitivity 21.9%). Patients with low LCR (<7.758), high NLR (≥3.854), and low albumin (<3.750) had a statistically significant reduced survival time compared to their counterparts. Conclusion: Lower preoperative LCR and albumin levels, along with higher NLR, effectively predict 2-year mortality and 30-day post-surgery complications in elderly patients with Garden type IV FNF undergoing hemiarthroplasty.

Massive Hemothorax Occurring with Intramural Hematoma of the Descending Aorta in the Early Postpartum Period

  • Yun, Jeong Hee;Jeon, Yeong Jeong;Hong, Tae Hee;Byun, Joung Hun;Hwang, Sang Won;Park, Jae Hong
    • Journal of Chest Surgery
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    • v.49 no.2
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    • pp.122-125
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    • 2016
  • Postpartum aortic intramural hematoma (IMH) is a rare but potentially lethal condition. We report a case of aortic IMH with massive hemothorax in a postpartum woman. The patient was a 31-year-old woman who had delivered twins by cesarean section. Two days after delivery, she complained of sudden-onset dyspnea. Chest computed tomography revealed a massive left hemothorax. Exploratory thoracotomy was performed, and we found a defect measuring approximately 6 mm in the adventitial layer of the thoracic aorta and an IMH. We repaired the defect primarily, and no more bleeding was observed. The patient was discharged on the 19th postoperative day without any complications.

Life-Threatening Acute on Chronic Pulmonary Thromboembolism Requiring Extracorporeal Membrane Oxygenation

  • Lee, Heemoon;Kim, Min Soo;Kim, Wook Sung;Kim, Yong Han;Cho, Sung Ho;Lee, Jae Jin
    • Journal of Chest Surgery
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    • v.51 no.3
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    • pp.205-208
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    • 2018
  • A 71-year-old female patient was admitted to the emergency department with sudden aggravation of chest pain and severe dyspnea. Computed tomography showed extensive pulmonary thromboembolism. Venoarterial extracorporeal membrane oxygenation (ECMO) was instituted due to sudden bradycardia and hypotension. An emergency operation was performed. However, chronic pulmonary thromboembolism combined with an acute pulmonary embolism was detected in the operating room. Embolectomy and endarterectomy were performed. ECMO was then discontinued. The patient was discharged on postoperative day 13 with warfarin for anticoagulation. The patient was followed up for 46 months as an outpatient without further thromboembolic events.

Pain Control after Dental Surgery: Myprodol Versus Ibuprofen Versus Codeine (치과 수술후의 통증 관리: Myprodol 대 Ibuprofen 대 Codeine)

  • Han, Tae-Hyung;Shin, Byung-Seop;Kim, Jeong-Hye
    • The Korean Journal of Pain
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    • v.11 no.1
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    • pp.74-80
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    • 1998
  • Background: Myprodol, a newly introduced combination analgesics with codeine, ibuprofen and paracetamol was evaluated in the dental surgery patients for its efficacy and side effects. Methods: Total 60 ASA I or II outpatients dental surgical patients were randomly assigned into three groups(n=20 each). After various oral procedures, one of three oral analgesics, myprodol, ibuprofen or codeine, was prescribed to each patients in double blind fashion for three days. Each patient was followed carefully by daily phone calls for verbal analog pain scale, side effects and patient's satisfaction level. Results: Demographic data and duration of surgery revealed no statistical differences in all three groups. Myprodol group showed better verbal analgesic scores consistently for the study period than ibuprofen or codeine group. Adverse effects were minimal. Patients' satisfaction level was high in all three groups. Conclusion: We conclude that myprodol is an excellent oral analgesic for day-surgery based dental procedure patients. This effect appears to be synergistic among different analgesics rather than additive.

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Operative Treatment of Mitral Valve Regurgitation due to Papillary Muscle Rupture from Acute Myocardial Infarction Under ECMO -A case report- (급성심근경색 후 발생한 유두근 파열로 인한 승모판 판막 폐쇄부전의 체외막 산소화 장치하 승모판막 치환술 - 1예 보고 -)

  • Joo, Seok;Choo, Suk-Jung;Jung, Sung-Ho;Je, Hyoung-Gon
    • Journal of Chest Surgery
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    • v.43 no.2
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    • pp.172-175
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    • 2010
  • A 61-year-old man presented with chest pain and ST elevation, and he underwent coronary angiography under the impression of acute myocardial infarction. Coronary intervention under intra-aortic balloon pumping was necessary due to his hemodynamic instability from the acute total occlusion of a large obtuse marginal branch. In spite of successful intervention, the cardiogenic shock persisted, and so extracoporeal membranous oxygenation was performed to treat this. Afterwards, the cardiogenic shock still persisted, and the auscultatory and echocardiographic findings revealed severe acute mitral valve regurgitation. Emergency mitral valve replacement was then performed. The ECMO and IABP were removed on the $2^{nd}$ postoperative day. The patient was discharged on the $48^{th}$ postoperative day.

Treatment of Vasculopathy in Diabetic Foot by Percutaneous Transluminal Angioplasty (경피적 동맥확장술을 이용한 당뇨족 허혈의 치료)

  • Kim, Hong-Ryul;Han, Seung-Kyu;Rha, Seung-Woon;Kim, Hyon-Surk;Kim, Woo-Kyung
    • Archives of Plastic Surgery
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    • v.37 no.2
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    • pp.148-152
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    • 2010
  • Purpose: In treating diabetic foot ulcers, satisfactory vascularity is an essential prerequisite. To improve vascularity, a bypass graft has long been carried out. Recently, however, percutaneous transluminal angioplasty (PTA) has also been tried since the PTA is less invasive than the bypass graft. However, publication demonstrating the improvement of vascularity after the PTA are lacking. Therefore, this study was designed to show usefulness of the PTA in treating vasculopathy of diabetic foot. Materials: and Methods This study included 30 feet of 24 ischemic diabetic foot patients. Inclusion criteria were diabetes (duration > 5 years) and a significant lower extremity ischemia, as determined by a transcutaneous oxygen pressure ($TcpO_2$) < 30 mmHg. The PTA was carried out in 61 arteries. PTA procedure was considered successful, when residual stenosis was less than 30%. The procedure was considered failed when residual stenosis was more than 50%. Residual stenosis between 30% and 50% was considered acceptable. For evaluation of PTA effect, foot $TcpO_2$ and infrared thermography were measured before and 7th day after PTA. Results: Immediately after PTA performed in 61 arteries, 58 and 3 arteries were evaluated as being successful and acceptable, respectively. Before PTA, average foot $TcpO_2$ was $12.6{\pm}8.8$ mmHg and its value was increased to $44.2{\pm}23.9$ on 7th day after PTA (p<0.01). Average skin temperature was $31.8{\pm}1.2^{\circ}C$ before PTA and it was increased to $33.5{\pm}1.1^{\circ}C$ on 7th day after PTA (p<0.01). Conclusion: PTA procedure increases tissue oxygenation of ischemic diabetic feet which do not have wound healing potential due to low tissue oxygenation, to the level of possible wound healing. In addition, PTA increases skin temperature of ischemic diabetic feet which can imply an improvement of peripheral circulation.

Comparative Analysis of Platelet-rich Plasma Effect on Tenocytes from Normal Human Rotator Cuff Tendon and Human Rotator Cuff Tendon with Degenerative Tears

  • Yoon, Jeong Yong;Lee, Seung Yeon;Shin, Sue;Yoon, Kang Sup;Jo, Chris Hyunchul
    • Clinics in Shoulder and Elbow
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    • v.21 no.1
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    • pp.3-14
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    • 2018
  • Background: Platelet-rich plasma (PRP) stimulates cell proliferation and enhances matrix gene expression and synthesis. However, there have been no comparative study of the PRP effect on the normal and degenerative tenocytes. The purpose of this study was to compare the effect of PRP on tenocytes from normal and degenerative tendon. Methods: Tendon tissues were obtained from patients undergoing arthroscopic repair (n=9) and from healthy donors (n=3). Tenocytes were cultured with 10% (vol/vol) platelet-poor plasma, PRP activated with calcium, and PRP activated with calcium and thrombin. The total cell number was assessed at days 7 and 14. The expressions of type I and III collagen, decorin, tenascin-C, and scleraxis were evaluated by quantitative real-time reverse transcriptase polymerase chain reaction. The total collagen and glycosaminoglycan (GAG) synthesis was evaluated at days 7 and 14. Results: No differences were observed between the groups at day 7, but cell proliferation was remarkably increased in tenocytes from the degenerative tendon at day 14. In both tenocyte groups, the gene expressions of type I and III collagen were up-regulated. GAG synthesis was greater in the normal tendon, whereas the expressions of decorin and tenascin-C were increased in tenocytes from the degenerative tendon. Tenocytes from the degenerative tendon had higher fold-change of GAG synthesis and a lower collagen III/I ratio than normal tenocytes. Conclusions: PRP promoted the cell proliferation and enhanced the synthesis of tendon matrix in both groups. PRP has a greater positive effect on cell proliferation, matrix gene expression and synthesis in tenocytes from degenerative tendon.

Evaluation of the Microvascular Research Center Training Program for Assessing Microsurgical Skills in Trainee Surgeons

  • Komatsu, Seiji;Yamada, Kiyoshi;Yamashita, Shuji;Sugiyama, Narushi;Tokuyama, Eijiro;Matsumoto, Kumiko;Takara, Ayumi;Kimata, Yoshihiro
    • Archives of Plastic Surgery
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    • v.40 no.3
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    • pp.214-219
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    • 2013
  • Background We established the Microvascular Research Center Training Program (MRCP) to help trainee surgeons acquire and develop microsurgical skills. Medical students were recruited to undergo the MRCP to assess the effectiveness of the MRCP for trainee surgeons. Methods Twenty-two medical students with no prior microsurgical experience, who completed the course from 2005 to 2012, were included. The MRCP comprises 5 stages of training, each with specific passing requirements. Stages 1 and 2 involve anastomosing silicone tubes and blood vessels of chicken carcasses, respectively, within 20 minutes. Stage 3 involves anastomosing the femoral artery and vein of live rats with a 1-day patency rate of >80%. Stage 4 requires replantation of free superficial inferior epigastric artery flaps in rats with a 7-day success rate of >80%. Stage 5 involves successful completion of one case of rat replantation/transplantation. We calculated the passing rate for each stage and recorded the number of anastomoses required to pass stages 3 and 4. Results The passing rates were 100% (22/22) for stages 1 and 2, 86.4% (19/22) for stage 3, 59.1% (13/22) for stage 4, and 55.0% (11/20) for stage 5. The number of anastomoses performed was $17.2{\pm}12.2$ in stage 3 and $11.3{\pm}8.1$ in stage 4. Conclusions Majority of the medical students who undertook the MRCP acquired basic microsurgical skills. Thus, we conclude that the MRCP is an effective microsurgery training program for trainee surgeons.

Postoperative Vasospasm in Unruptured Intracranial Aneurysm

  • Lee, Suk-In;Park, Cheol-Wan;Hong, Won-Jin;Park, Chan-Woo
    • Journal of Korean Neurosurgical Society
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    • v.40 no.2
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    • pp.131-134
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    • 2006
  • The cerebral vasospasm after clipping surgery of unruptured aneurysm is uncommon. A 44-year-old man with unruptured left middle cerebral artery[MCA] aneurysm had clipping surgery. From the third postoperative day, he presented with drowsy mentality, dysphasia and right hemiparesis. Computed tomographic scans showed low density area in frontotemporal lobe and midline shift. Transfemoral cerebral angiography revealed severe vasospasm in supraclinoid internal carotid artery, anterior cerebral artery, and MCA on the operative side. We performed left frontotemporoparietal craniectomy and hypertensive-hypervolemic therapy. He recovered without neurological deficits but for dysphasia. Neurosurgeon should be alert to the possibility of vasospasm after clipping surgery even in case of unruptured cerebral aneurysm.

The Development of a Intrahepatic Biliary Cyst after Kasai Operation for Biliary Atresia (카사이 수술 후 발생한 간내 담관 낭종)

  • Park, Woo-Hyun;Choi, Soon-Ok
    • Advances in pediatric surgery
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    • v.5 no.2
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    • pp.126-129
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    • 1999
  • A 6 and a half year-old girl developed recurrent cholangitis following hepatic portoenterostomy for biliary atresia. Computed tomogram showed an ovoid cyst ($4.5{\times}4.0$ cm in size) in the left hepatic lobe and another tubular dilatation ($2.0{\times}0.8$ cm in size) in the right hepatic lobe. Percutaneous transhepatic cholangiodrainage(PTCD) and cystogram showed an ovoid cyst in the left hepatic lobe (Tsuchida type A), measuring $6.6{\times}5.0$ cm in size. Following drainage and administration of parenteral antibiotics she became afebrile and anicteric. However she continued to drain 45-150 cc of bile per day via the tube over the next 2 weeks. The patient successfully underwent intrahepatic cystojejunostomy with intraoperative ultrasonographic guidance. This case illustrates relapsing cholangitis caused by Tsuchida type A intrahepatic cyst, successfully managed with PTCD followed by an internal drainage procedure.

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