• Journal of Korean Neurosurgical Society
• /
• 제45권6호
• /
• pp.386-389
• /
• 2009

On rare occasions, percutaneous vertebroplasty (PV) may be associated with adverse spinal and extraspinal events. Subarachnoid hemorrhage (SAH) has not been reported complication following a PV. This is a report of two elderly women with spine compressions who developed idiopathic SAH after injecting polymethylmethacrylate into the thoracolumbar region transcutaneously. PV was performed as an usual manner on prone position under local anesthesia for these patients. During the interventions, two patients complained of a bursting nature of headache and their arterial blood pressure was jumped up. Computed tomography scans revealed symmetric SAH on the both hemispheres and moderate degree of hydrocephalus. Any intracranial vascular abnormalities for their SAH were not evident on modern neuroangiography modalities. One patient received a ventricular shunt surgery, but both fully recovered from the procedure-related SAH. The pathophysiologic mechanism that induce SAH will be discussed, with suggesting the manner that prevent and minimize this rare intracranial complication after PV.

• Journal of Dental Anesthesia and Pain Medicine
• /
• 제19권4호
• /
• pp.181-189
• /
• 2019

Local anesthetic systemic toxicity (LAST) refers to the complication affecting the central nervous system (CNS) and cardiovascular system (CVS) due to the overdose of local anesthesia. Its reported prevalence is 0.27/1000, and the representative symptoms range from dizziness to unconsciousness in the CNS and from arrhythmias to cardiac arrest in the CVS. Predisposing factors of LAST include extremes of age, pregnancy, renal disease, cardiac disease, hepatic dysfunction, and drug-associated factors. To prevent the LAST, it is necessary to recognize the risk factors for each patient, choose a safe drug and dose of local anesthesia, use vasoconstrictor, confirm aspiration and use incremental injection techniques. According to the treatment guidelines for LAST, immediate application of lipid emulsion plays an important role. Although lipid emulsion is commonly used for parenteral nutrition, it has recently been widely used as a non-specific antidote for various types of drug toxicity, such as LAST treatment. According to the recently published guidelines, 20% lipid emulsion is to be intravenously injected at 1.5 mL/kg. After bolus injection, 15 mL/kg/h of lipid emulsion is to be continuously injected for LAST. However, caution must be observed for >1000 mL of injection, which is the maximum dose. We reviewed the incidence, mechanism, prevention, and treatment guidelines, and a serious complication of LAST occurring due to dental anesthesia. Furthermore, we introduced lipid emulsion that has recently been in the spotlight as the therapeutic strategy for LAST.

• Radiation Oncology Journal
• /
• 제10권2호
• /
• pp.187-192
• /
• 1992

영남대학교 의료원 치료방사선과에서 1988년 6월 15일에 위암 환자의 수술중 방사선치료를 시작한 이래 1992년 8월 30일까지 총 58예에서 시도하여 그중 53예에서 IORT를 실시하였으며, 정기적인 추적 검사에서 한명의 국소재발 환자도 보고되지 않고 있다. 출혈(3예), 장관폐쇄(3예), 폐혈증(2예), 골수기능저하(1예)를 포함한 총 9예($17\%$)의 합병증이 보고되었고, 이중 6예 ($13\%$)가 사망하였다. IORT(1500 cGy), 외부 방사선치료(-4500 cGy)와 강한 항암제를 병합치료 하였음에도 불구하고 주등(수술과 항암제 치료)의 $25.2\%$, 김등(수술 불가능한 환자에서 항암제 투여)의 $18\%$, 리등(수술)의 $18.5\%$, Kramling등(IORT 2800-3500 cGy)의 $35.3\%$에 비해 낮은 합병증을 보여 IORT가 위암의 치료에 공헌할 수 있음을 시사하였다. 그러나 비교적 높은 치사율($11.3\%$)은 더욱 세심한 수술수기 및 수술 후 환자의 치료가 필요하며 외부 방사선치료와 항암제치료의 적절한 시기 조절 및 치료선량의 가감이 필요할 것으로 생각된다.

• Archives of Plastic Surgery
• /
• 제38권1호
• /
• pp.81-84
• /
• 2011

Purpose: Nerve injury is one of the complication which can develop after brow lift. Peripheral nerve ending which is stretched from supraorbital nerve and supratrochlear nerve can be injured and symptoms such as pain, dysesthesia may appear. Usually, developed pain disappeared spontaneously and does not go on chronic way. We experienced a case that a patient complained chronic pain after brow lift which was not controlled by conservative management such as medications, local nerve block and report a successful surgical treatment of chronic pain after brow lift. Methods: A 24-year-old male who received brow lift with hairline incision at local hospital was admitted for chronic pain at the right forehead. The pain was continued for 3 months even though fixed thread was removed. Local nerve block at trigger point with mixed 1 mL 2% lidocaine and 1 mL Triamcinolone acetonide was done and oral medications, Gabapentine and carbamazepine, were also applied but there was no difference in the degree of pain. Therefore the operation was performed so that careful dissection was carried out at right supraorbital neurovascular bundle and adhered supraorbital nerve was released from surrounding tissues and covered with silastic sheet to prevent adhesion. Results: The pain was gradually relieved for a week. The patient was discharged without complications. No evidence of recurrence has been observed for 2 years. Conclusion: The pain developed after brow lift was engaged with nerve injury and sometimes remains chronically. Many kinds of conservative management to treat this complication such as medications, local nerve block have been reported and usually been used. But there are some chronic cases that conservative treatment do not work. In sum, we report 1 case of successful surgical treatment for relief of intractable pain developed after brow lift surgery.

• 대한치과마취과학회지
• /
• 제4권1호
• /
• pp.21-24
• /
• 2004

Facial nerve paralysis following the administration of a local anaesthetic can be alarming. By reading reports of such incidents, dentists who find themselves in similar situations will be able to reassure their patients and act accordingly. This article reviews the classifications of anesthetic complication, local complications, etiology, prevention, treatment of facial nerve paralysis fellowing the administration of a local anaesthetic. A thorough knowledge of the relevant anatomy pertinent to the various injections used in dental surgery is essential.

• Archives of Reconstructive Microsurgery
• /
• 제9권2호
• /
• pp.158-163
• /
• 2000

Over the past several years, countless patients have benefitted from the use of leeches in microsurgery. As we know, leeches are used to overcome the problem of venous congestion by creating prolonged localized bleeding uniquely characteristics of leech bite. Venous congestion, a common complication of digital replantation, often has been treated through surgical repair like arteriovenous anastomosis. The leech produces a number of important substances which contribute to the special property of the bite, including an anticoagulant, a local vasodilator and local anesthetics. The bite usually bleeds for 1 to 2 hours and under special circumstances may bleed for up to 24 hours. So venous congestion is relieved. However, leeches increase the possibility of infection through their gut content. Infection associated medical leech application is significant risk. Other risk include allergic reaction, adverse psychologic reaction and blood loss requiring transfusion. The 65 cases of medical leech application were performed between August, 1997 and May, 2000 according to an established protocol. The complication were 18 cases ; infection (13 cases), hemorrhage (2 cases), allergic reaction (1 case), psychologic problem (1 case) and hypochromic anemia (1 case). Then our study was performed on the base of indication. As a result, Aeromonas hydrophilia was cultured from gut of medical leech and Klebsiella, Staphylococcus and Pseudomonas were cultured from media. We present the clinical risk-benefit of the medical leech therapy through several cases following digital replantation.

• Archives of Plastic Surgery
• /
• 제44권5호
• /
• pp.457-468
• /
• 2017

Background Abdominoplasty, with or without liposuction, is among the most frequently performed aesthetic procedures. Its main objective is to improve the body contour by means of excising redundant skin and fat tissue. Although abdominoplasty is considered a safe procedure with high satisfaction rates, intraoperative and postoperative complications can become a challenge for the surgical team. The aim of this article is to offer a synopsis of the most common complications arising after abdominoplasty, along with evidence-based guidelines about how to prevent and treat them. Methods A systematic MEDLINE search strategy was designed using appropriate Medical Subject Headings (MeSH) terms, and references were scanned for further relevant articles. Results According to the published case series, local complications are considerably more common than complications with systemic repercussions. Approximately 10% to 20% of patients suffer a local complication following abdominoplasty, while fewer than 1% suffer a systemic complication. Prevention and management strategies are critically discussed for complications including seroma, haematoma, infection, skin necrosis, suture extrusions, hypertrophic scars, neurological symptoms, umbilical anomalies, deep venous thrombosis and pulmonary thromboembolism, respiratory distress, and death. Conclusions The complications of abdominoplasty vary in severity and in the impact they have on the aesthetic outcomes. Recommendations for prevention and management are based on various levels of evidence, with a risk of observer bias. However, most complications can be treated appropriately following the current standards, with satisfactory results.

• Korean Journal of Radiology
• /
• 제22권10호
• /
• pp.1730-1741
• /
• 2021

Objective: Although thermal ablation is effective in treating low-risk papillary thyroid microcarcinomas (PTMCs), comparison of treatment outcomes between thermal ablation and surgery has not yet been systematically evaluated. This study aimed to compare the efficacy and safety of thermal ablation and surgery for the treatment of low-risk PTMCs. Materials and Methods: Ovid-MEDLINE and EMBASE databases were searched for studies reporting comparisons of treatment results between thermal ablation and surgery for patients with low-risk PTMC published up to April 6, 2020. The analysis evaluated the efficacy (local tumor recurrence, occurrence of new tumor, metastasis, and rescue surgery) and safety (complication rate) of thermal ablation and surgery. Results: This systematic review included four studies with a total of 339 PTMCs in 339 patients who underwent thermal ablation and 320 PTMCs in 314 patients who underwent surgery. There was no local tumor recurrence or distant metastasis in either group. There was no significant difference in the pooled proportion of lymph node metastasis (2.6% with thermal ablation vs. 3.3% with surgery, p = 0.65), occurrence of new tumors (1.4% with thermal ablation vs. 1.3% with surgery, p = 0.85), or rescue surgery (2.6% with thermal ablation vs. 1.6% with surgery, p = 0.62). However, the pooled complication rate was significantly higher in the surgery group than in the ablation group (3.3% with thermal ablation vs. 7.8% with surgery, p = 0.03). Conclusion: Both thermal ablation and surgery are effective and safe options for the management of low-risk PTMCs, with thermal ablation achieving a lower complication rate. Therefore, thermal ablation may be considered as an alternative treatment option for low-risk PTMC in patients who refuse surgery and active surveillance or are ineligible for surgery.

• Medical Lasers
• /
• 제8권1호
• /
• pp.35-38
• /
• 2019

Thread-lifting is a minimally invasive procedure that shows good results and fewer complications as compared with those results and complications of standard surgery. Many procedures and techniques have been developed to create a younger appearance of facial/neck skin for aging people, and the demand for an improved aesthetic appearance is increasing. Since the incidence of side effects is much less than that of non-absorbable threads, which can lead to complications such as foreign body reactions, polydioxanone (PDO) threads are predominantly used for face lift procedures. A 66-year-old woman presented to our clinic with inflamed palpable masses. She had undergone a face lift with absorbable threads in our clinic 5 months previously. Excisional biopsy was performed with the patient under local anesthesia. During the operation, any threads were not detected and there was both fibrotic scar tissue and granulomatous tissue. For effectively promoting healing and managing the scars, treatment with LDM^®-MED was performed on the day after surgery. The treatment was performed according to the author's protocol. Although foreign body granuloma as a complication after using non-absorbable thread types have been previously reported, it is relatively rare to find this type of complication after using absorbable thread. In this report, we present a case in which a 66-year-old female with foreign body granuloma after undergoing a face lift using absorbable threads was treated with the application of dual-frequency ultrasound, which promoted wound healing.

• Radiation Oncology Journal
• /
• 제7권1호
• /
• pp.59-70
• /
• 1989

자궁경부암은 치료후의 생존율이 좋은 암으로 인정되고 있으나 전 자궁경부암의 $44\%$는 재발되며 재발암의 대부분은 국소재발이다. 더욱이 재발된 암은 어떤 방법으로 치료한다 하더라도 5년 생존율은 $2\~9\%$에 불과하다고 보고되고 있다. 이러한 사실은 적극적인 국소치료법이 필요함을 시사하고 있으나 국소방사선 조사선량을 증가시켜 치료율을 높이려 할 경우 필연적으로 따라오는 합병증의 증가가 우려되어 불충분함을 인정하면서도 전골반에 4500cGy이하, A점에 8500cGy정도가 사용되어 왔다. 1986년 4월부터 1987년 12월까지 영남대찰 치료방사선과에서 중앙차폐없이 전골반에 5000cGy, 고선량률 강내치료로 A점에 3900cGy, 외부선량을 포함한 A점 총 선량 8900cGy를 조사함으로서 종래의 치료보다 $500~1000cGy$를 더 조사받은 자궁경부암 환자 103명중 추적 치료가 불가능 하였던 환자를 제외한 96명을 대상으로 장관합병증을 분석하였다. 종래보다$500\~1000cGy$를 더 조사 받았으나 합병증이 증가되지 않았음을 보고함으로서 합병증의 증가 없이 생존율의 증가를 얻을 수 있는 최고선량을 결정하는 기초자료로 삼고자 본 연구를 시도하였다. 평균 추적기간은 21개월이었고 대부분의 증상은 12개월 이내에 나타났단. 이급후증(tenesmus), 하복부 동통을 포함한 장관합병증은 $46\%$였고 입원치료를 받은 환자는 6명 $(0\%)$이었으나 수술이 필요한 환자는 1명분이었다. X선 대장촬영과 직장경 검사를 실시하였으나 바리움 대장촬영에서 1명만이 비정상적인 소견을 보여 직장손상의 진단에 효율이 적음을 시사하였다. 환자의 연령, 총 조사선량, 총 TDF, 직장조사선량과 장관합병증은 무관함을 보여주었다. 입원치료가 필요한 6명의 환자 중 5명이 축소조사야를 사용한 추가치료를 했던 환자로서 추가치료가 합병중의 위험 인자임을 시사하였다(p<0.01). 심한 합병증을 보인 6명중 3명 이 방사선 치료전 수술경험이 있었으며 직장선량이 다른 환자들의 평균직장선량(7300cGy) 보다 작음에도 불구하고 (5252 cGy) 심한증상을 보여 치료전의 수술기왕력 이 위험 인자가 될 수 있음을 시사하였다. 종래의 치료양보다 $500\~1000cGy$ 더 높은 선량에도 불구하고 입원치료가 필요하였던 환자는 $6\%$, 수술이 필요하였던 환자는 $1\%$로 합병증의 증가 없이 A점에 8900cGy, 직장에 7300cGy정도의 국소치료가 가능함을 보여 주었으나 생존율에 대한 추후 분석이 따라야 할 것으로 사료된다.