• 대한후두음성언어의학회지
• /
• 제19권1호
• /
• pp.31-37
• /
• 2008

Patients with impaired ability to eat require nutritional support enterally or parenterally. Gastrostomy is a preferred method because total parenteral nutrition has many complications and high cost. Surgical gastrostomy has been a traditional and well-established method prior to the development of percutaneous gastrostomy. Since then, percutaneous gastrostomy has been established as an effective, safe, easy technique with a low morbidity and mortality rate. Consequently, percutaneous gastrostomy has been the first method for long-term enteral nutrition. The purpose of this review is to describe the techniques, indications, complications of percutaneous radiologic gastrostomy/gastrojejunostomy and to compare with endoscopic method.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제45권6호
• /
• pp.364-368
• /
• 2019

A Le Fort I osteotomy is a common procedure for correcting dental and facial deformities in orthognathic surgery. In rare cases, a delayed hemorrhage can occur as early as several hours or up to 12 weeks, postoperatively. The most frequently involved blood vessels in a delayed hemorrhage are the descending palatine artery, the internal maxillary artery, and the pterygoid venous plexus of veins. Intraoral bleeding accompanied by severe epistaxis in these cases makes it difficult to locate the precise bleeding focus. Eventual uncontrolled bleeding would require Merocel packing or surgical intervention. In general, a severe late postoperative hemorrhage is most effectively managed by angiography and embolization. Herein we describe a delayed hemorrhage case in which the cause was not evident on angiography. We were able to detect the bleeding point through an endoscopic nasal approach and treat it using direct cauterization.

• 대한소화기학회지
• /
• 제72권5호
• /
• pp.262-266
• /
• 2018

Surgery has been the standard treatment for perforated duodenal ulcers, with mostly good results. However, the resolution of postoperative leakage after primary repair of perforated duodenal ulcer remains challenging. There are several choices for re-operation required in persistent leakage from perforated duodenal ulcers. However, many of these choices are complicated surgical procedures requiring prolonged general anesthesia that may increase the chances of morbidity and mortality. Several recent reports have demonstrated postoperative leakage after primary repair of a perforated duodenal ulcer treated with endoscopic insertion using a covered self-expandable metallic stent, with good clinical results. We report a case with postoperative leakage after primary repair of a perforated duodenal ulcer treated using a covered self-expandable metallic stent.

• Journal of Yeungnam Medical Science
• /
• 제20권2호
• /
• pp.105-116
• /
• 2003

위암은 한국에서뿐만 아니라 세계적으로도 가장 중요한 암 사망 원인의 한가지로 보고되고 있다. 현재까지 외과적 수술이 위암에 대한 유일한 근치적 치료수단으로 인정되고 있으며, 가능한 한 조기에 발견하여 근치적 절제술을 시행하는 것이 가장 중요하다. 근치적 수술을 위한 술기의 표준화 및 각 수술 술기의 우열에 대한 논란이 현재까지 그치지 않고 있으나, 여기에서는 한국 및 일본에서 가장 보편적으로 인정되고 있는 위암에 대한 수술 치료의 원칙을 기술하고자 한다. 위장 절제술은 위아전절제술과 위전절제술로 대별되며 절제연은 종양의 침윤이 없는 충분한 정상조직을 확보하여야 하고 주변 림프절의 동반절제가 포함되어야 한다. 병변의 상태에 따라 주변장기의 동반절제와 광범위한 림프절 곽청술이 요구되기도 한다. 소화관의 복구는 구조적 혹은 기능적인 면에서 환자의 삶의 질과 밀접한 관련을 가지므로 상황에 따라 적절한 방법의 선택을 요한다. 술 후 환자의 삶의 질을 향상시키기 위해서 저침습성 혹은 최소한의 절제를 목적으로 하는 새로운 술기들이 소개되기도 하였다. 유문보존 위절제술, 복강경을 이용한 위설상절제 및 위아전절제술, 내시경점막절제술등을 그 예로 들수 있으며, 이러한 시술의 적응증과 안전성은 향후 임상성적의 분석을 통해 정립되어야 한다. 근치적 절제술이 불가능한 위암환자에서는 환자의 고통감소와 경구적 영양 섭취를 위해서 고식적 수술을 시행할 수 있으며, 특히, 진행성 위암에 의한 합병증으로 인해 생명이 위태로운 경우에는 응급수술이 요구되기도 한다. 진행성 위암은 수술적 치료를 하더라도 예후가 불량하므로 조기에 발견하는 것이 가장 중요하다. 최근, 한국에서는 상부 위장관에 대한 내시경 시술의 보편화로 전체 위암에서 조기위암이 차지하는 비율이 향상되고 있으며, 적절한 근치적 수술을 통해 위암의 생존율이 향상되고 있다.

• 대한두개안면성형외과학회지
• /
• 제10권1호
• /
• pp.33-36
• /
• 2009

Purpose: Fractures of the mandibular condylar area are common injuries that account for 29% to 40% of fractures of the facial bones and represent 20% to 62% of all mandibular fractures. Currently 3 main methods are being used in the treatment of mandibular subcondylar fractures: closed reduction; open reduction and internal fixation; Endoscopic reduction and internal fixation. Each method has its proponents and opponent as well as advantages and disadvantages, and indications for each vary among surgeons. There are six approaches of open reduction: submandibular, retromandibular, preaurilcular, postauricular, intraoral, transparotid approach. Among them, transparotid approach has been described for subcondylar exposure with dissection in the direction of facial nerve fibers to expose the bone through the parotid gland. This approach carries the risk of a parotid glandular fistula as well as facial nerve injury but has the advantage of being directly over the fracture site. We report safety and efficacy of surgical treatment using a transparotid approach for direct plating. Methods: A 43-year-old man sustained multiple facial bone fractures by driver traffic accident. Mandibular subcondyle was fractured and dislocated internally. We performed open reduction and internal fixation by transparotid approach. Fractured site was fixed by titanium mini plate & screw. We applicated arch bar for approximately 3 weeks. Results: Follow-up length was about 5months. Scar of surgical incision was indistinct, there was no symptoms and signs of facial nerve and parotid gland injury, and maximal mouth opening was measured 49.5 mm. Conclusion: Transparotid approach has high risks of facial nerve and parotid gland injury, but paradoxically it is the most effective technique in saving facial nerve. Open reduction and internal fixation of mandibular subcondylar fracture by transparotid approach with precise and versed procedure, best outcome can be expected.

• Journal of Korean Neurosurgical Society
• /
• 제49권5호
• /
• pp.262-266
• /
• 2011

Objective : The endocrine dysfunction after the operation for suprasellar arachnoid cysts is not rare. The careful operation to prevent structures can prevent this complication, but it is not enough and effective to prevent it. Authors present technical surgical considerations to prevent this complication with a review of our suprasellar arachnoid cyst patients who had postoperative endocrine dysfunction. Methods : From January 2002 to December 2009, eight patients who had suprasellar arachnoid cysts with visual impairment underwent surgery. The mean age was 57.1 years (range, 33-77). Preoperatively, their endocrine function was clinically normal, and laboratory hormonal levels were within normal ranges. Cyst fenestration was performed by craniotomy (n=6) or by a neuro-endoscopic procedure (n=2), and, simultaneously, along with a cyst wall biopsy. Results : The surgery was uneventful in all eight patients, and there were no neurological morbidities. However, in four patients, endocrine dysfunction occurred postoperatively. We compared these four patients (group A) to the other 4 patients without endocrine dysfunction (group B) with intraoperative findings and with the histopathological findings of the cyst wall biopsy. The group A patients had more abundant vasculature on the cystic wall than the group B patients according to both the intraoperative findings and the histopathological findings. Conclusion : When performing a surgical cyst wall fenestration, surgeons should try to minimize the destruction of the cystic wall vasculature and not to make the fenestration at a site that contains many vascular striae.

• Journal of Korean Neurosurgical Society
• /
• 제30권8호
• /
• pp.992-997
• /
• 2001

Objectives : Essential hyperhidrosis is a common condition characterized by excessive body sweating. Excessive sweating beyond what is necessary to maintain normal body temperature need not be considered pathological unless it interferes with one's occupation and/or life-style. The existing non-operative therapeutic options seldom give sufficient relief or show a transient effect. In this regard, the thoracic sympathectomy may provide a definitive cure. In the past, surgical procedures were highly invasive and caused significant morbidity, but the minimally invasive thoracoscopic procedure provided detailed visualization of sympathetic ganglia and is associated with minimally postoperative morbidity. Nowadays, thoracoscopic transthoracic sympathectomy is accepted as the treatment of choice for essential hyperhidrosis. In palmar hyperhidrosis, however, the level of sympathetic chain to be blocked has been somewhat obscure. It is assumed that the incidence of compensatory hyperhidrosis may closely related to the extent of thoracic sympathectomy. Material & Methods : To compare the results of posterior midline approach with endoscopic sympathectomy, and the results of T2 with T2, 3 sympathectomy or sympathicotomy, we retrospectively studied 62 patients treated for palmar hyperhidrosis between September 1993 and May 2000. We reviewed medical records and recently interviewed the patients by telephone calls. Results : The treatment effect of T2 sympathectomy is no different from T2, 3 sympathectomy. But, the incidence of compensatory hyperhidrosis is less in the T2 sympathectomy group than the T2, 3 sympathectomy group. Conclusion : Thoracoscopic sympathectomy is considered a simple, safe, and effective method for treating palmar hyperhidrosis, with a shorter operation time, fewer hospital days, and a better cosmetic result, as compared with the open approaches. However, sympathicotomy seems to provide the advantages of a limited extent of denervation and the resultant decrease of compensatory hyperhidrosis compared to sympathectomy.

• Journal of Trauma and Injury
• /
• 제24권2호
• /
• pp.111-117
• /
• 2011

Purposes: Pancreatic injury is rare in abdominal trauma patients (3%~12%). but it could result in significant morbidity and even mortality. Early and adequate decision making are very important in the management of patients with traumatic pancreatic injury. The purpose of this study was to assess the kinds of management and outcome through the review of our experience of pancreatic injury with multiple trauma. Methods: We reviewed 17 patients with traumatic pancreas injury via electronic medical records from Jan. 2002 and April. 2011. We collected demographic findings; the type, location and grade of pancreas injury, the treatment modality, and patient's outcomes, such as complications, length of hospital stay (LOS), and mortality. Results: Total 17 patients were reviewed, and man was 13 (88%). Traffic accident was the most common cause of injury. Pancreas neck was the most common injured site, and occured in 5 patients. Ductal injury was detected in 7 cases. Eleven patients were treated by surgical procedure, and in this group, 3 patients underwent the endoscopic retrograde pancreas drainage procedure coincidently. ERPD was tried in 8 patients, and failed in 2 patients. The major complications were post-traumatic fluid collection and abscess which accounted for 70 % of all patients. The hospital stay was 35.9 days, and it was longer in patient with ductal injury ($38.0{\pm}18.56$ vs. $34.5{\pm}33.68$ days). Only one patient was died due to septic shock associated with an uncontrolled retroperitoneal abscess. Conclusion: Early diagnosis is the most important factor to apply the adequate treatment option and to manage the traumatic pancreas injury. Aggressive treatment should be considered in patients with a post-operative abscess.

• 대한두개안면성형외과학회지
• /
• 제9권1호
• /
• pp.1-7
• /
• 2008

Osteomas are most often located in the femur, tibia, humerus, spine, and talus. They are rare in the skull. Osteomas in the head and neck regions are benign bone neoplasms usually found in the frontoethmoid area. The developmental theory postulates that osteomas develop at the sites of fusion of tissues different embryological origin such as occur at the junction of the embryonic cartilaginous frontal and ethmoid bones. Trauma and infection have also been implicated as causative factors, but many patients with osteoma deny any preceding history of these. Osteomas are usually produce symptoms primary to cosmetic problems and secondary to pressure on adjacent structures. The objects of this study are from a 5-year period of April of 2002 to April of 2007, consisting of 48 male patients and 52 female. There were 33 cases of frontal bone osteomas, 5 cases of madibular bone osteomas, 5 cases of occipital bone osteomas, 6 cases of symptomatic paranasal sinus osteomas, 48 cases of asymptomatic paranasal sinus osteomas, and 3 cases of mastoid osteomas. We reviewed medical records of patients to find out their presentations, diagnostic considerations, therapeutic options, and outcomes. Patients were followed up six months postoperatively on the average. The authors experienced 48 cases of osteoma in the head and neck lesion, which were removed via direct approach or endoscopic approach. The 100 cases who came to the hospital with or without symptoms after diagnosis healed completely without sequelae. During the follow-up periods, excellent functional and cosmetic results were observed with an inconspicuous scar. There was no specific complications related to this procedure. Results of surgery in most cases were satisfied. We discussed the surgical procedure and the characteristics of the osteomas, and we report several cases with the review of literatures.

• Journal of Gastric Cancer
• /
• 제16권1호
• /
• pp.14-20
• /
• 2016

Purpose: Early diagnosis of gastric cancer is still the exception in Western countries. In the East, as in Japan and Korea, this disease is an endemic disorder. More conservative surgical procedures are frequently performed in early gastric cancer cases in these countries where sentinel lymph node navigation surgery is becoming a safe option for some patients. This study aims to evaluate preliminary outcomes of patients with early gastric cancer who underwent sentinel node navigation surgeries in Brazil, a country with non-endemic gastric cancer levels. Materials and Methods: From September 2008 to March 2014, 14 out of 205 gastric cancer patients underwent sentinel lymph node navigation surgeries, which were performed using intraoperative, endoscopic, and peritumoral injection of patent blue dye. Results: Antrectomies with Billroth I gastroduodenostomies were performed in seven patients with distal tumors. The other seven patients underwent wedge resections. Sentinel basin resections were performed in four patients, and lymphadenectomies were extended to stations 7, 8, and 9 in the other 10. Two patients received false-negative results from sentinel node biopsies, and one of those patients had micrometastasis. There was one postoperative death from liver failure in a cirrhotic patient. Another cirrhotic patient died after two years without recurrence of gastric cancer, also from liver failure. All other patients were followed-up for 13 to 79 months with no evidence of recurrence. Conclusions: Sentinel lymph node navigation surgery appears to be a safe procedure in a country with non-endemic levels of gastric cancer.