• Journal of Dental Anesthesia and Pain Medicine
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• v.15 no.2
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• pp.77-83
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• 2015

Background: To prepare for possible emergency situations during dental treatment, it is helpful to know how often and what kinds of emergencies may arise. This study set out to evaluate the incidences, causes, treatments, and outcomes of emergency situations in the outpatient clinic of a dental teaching hospital in Korea. Methods: We retrospectively reviewed the records of patients who had experienced an emergency situation and emergency response team activated in a selected outpatient clinic between November 2004 and November 2013. Specific information about the emergency cases was collected, including the patient characteristics and the frequency, types, treatments, and outcomes of the emergency situations. Results: We identified 35 instances of emergency situations in 2,890,424 patients (incidence = 0.012 per 10,000 outpatients). The number of cases was as follows: 10 (28.6%) in the Department of Periodontics, 10 (28.6%) in the Department of Oral and Maxillofacial Surgery, 6 (17.1%) in the Department of Oral and Maxillofacial Radiology, 4 (11.4%) in the Department of Prosthodontics, 2 (5.7%) in the Department of Conservative Dentistry, 2 (5.7%) in the Department of Pediatric Dentistry, and 1 (2.9%) in the Department of Orthodontics. Three (8.6%) of the emergency situations arose before treatment, 22 (62.9%) during treatment, 7 (20.0%) after treatment, and 2 (5.7%) in a patient's guardian. Conclusions: In accordance with the growing elderly population and more aggressive dental procedures, the number of emergency situations may increase in the future. We recommend that clinicians keep in mind airway management and the active control of emergency situations.

• Archives of Plastic Surgery
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• v.40 no.1
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• pp.57-61
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• 2013

Background Von Recklinghausen disease or neurofibromatosis type 1 is an autosomal dominant genetic disorder of chromosome 17q11.2. The most common characteristic findings of NF 1 include multiple and recurrent cutaneous neurofibromas associated with psychosocial distress. Methods Sixteen patients (9 female, 7 male; average age, 31 years; range, 16 to 67 years) with multiple cutaneous neurofibromas between March 2010 and February 2012 were included in the study. All patients were treated with radiosurgical ablation and excision under general anesthesia. Results All 16 patients were satisfied with the results, when questioned directly during the outpatient department follow-up. The only complaint from a few patients was minimal scarring, but acceptable results were obtained in the end. Conclusions The radiofrequency procedure is almost bloodless and quick, creating a smaller necrotizing zone. Therefore, instead of employing the time consuming traditional surgery, such as laser therapy and electrosurgical excision, that produces uncertain results and can affect normal adjacent tissue, treatment of neurofibromas with radiofrequency ablation and excision can be an alternative choice of treatment for patients with a large number of neurofibromas.

• Korean Journal of Head & Neck Oncology
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• v.40 no.1
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• pp.15-17
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• 2024

Clear cell carcinoma is a rare variant of salivary gland carcinoma, and its occurrence in the tongue base is even rarer. We present a case of a 55-year-old female patient with clear cell carcinoma of the tongue base. The patient initially presented with a 3-month history of palpable tongue mass, leading to her visit to the otolaryngology outpatient clinic. The patient underwent a complete resection of the tumor under general anesthesia. Postoperative follow-up imaging studies showed no evidence of recurrence. This case report highlights the diagnostic and management challenges associated with clear cell carcinoma of tongue base and demonstrates that a high index of suspicion is required to diagnose clear cell caricnoma, given its rarity and overlapping features with other clear cell neoplasms.

• Archives of Plastic Surgery
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• v.38 no.1
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• pp.7-14
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• 2011

Purpose: Many patients have fear for surgery owing to the injection of lidocaine and the possible pain in the course of the operation. To resolve such a problem the cases to do plastic surgery with monitored anesthetic care are increasing, in which something like sedatives is injected into vein without endotracheal intubation and under voluntary respiration, but the usage is now under the controversy. Methods: There were 25 patients who had surgery with local anesthesia, and another 25 patients who had surgery with monitored anesthetic care which belongs to ASA class 1 and 2 from January to April, 2009. Their anesthesia records were collected and surveys were given before and after the surgery and the surgery staff recorded OAA/S during the surgery. The postoperative surveys included the awakening during the surgery, pain, anxiety, and the degree of patient's satisfaction through visual analogue scale to identify the difference between the two methods. Results: The OAA/S results according to time lapse show that it is possible to lead a fast effective sedation and recovery with monitored anesthetic care, and monitored anesthetic care enhances both surgeon's convenience level and patient's satisfaction level, and reduces awakening, pain, and anxiety, compared to local anesthesia. Conclusion: The current paper shows about the plastic surgery, particularly the outpatient surgery, when monitored anesthetic care method is applied, it could gain a fast sedation and recovery or an effective sedation of patients. The method also has some affirmative effects in regard with surgeon's convenience and the patients' satisfaction degree and the reduction of their awakening, pain, and anxiety. With careful and adequate watch on the measures about vital signs like electrocardiogram, the degree of oxygen saturation, and blood pressure, it could clinically be very useful.

• Archives of Plastic Surgery
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• v.33 no.6
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• pp.769-772
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• 2006

Purpose: Benign symmetrical lipomatosis(Madelung's disease) is a disease of uncertain etiology that manifests as massive lipomatous deposits in specific area of the body. It is usually located on the neck, shoulder, proximal regions of the extremities and the abdomen. Madelung's disease is found many in middle-aged, Mediterranean man. Imaging using either computed tomography or magnetic resonance imaging is often recommended. Dietary restriction provides no relief of disease. Abstinence with alcohol may delay further progression but does not regression tumor mass. The objective of this study is to prove effectiveness of liposuction for treatment of benign lipomatosis. Methods: We conducted liposuction as a treatment for benign lipomatosis. After general anesthesia, We conducted power assisted liposuction and amount of suctioned volume was about 2500 cc. After surgery, we did compressive dressing and then followed by pressure garment. Results: Six months after surgery, patient was examined for follow up at outpatient department. Recurred lipoma was not observated. Patient was satisfied with result.Conclusion: The only effective therapy for Madelung's disease is surgical removal but recurrence could be occurring. Also multiple surgical scars will be visible. We report a patient with multiple large lipomatosis successfully treated with liposuction.

• Archives of Craniofacial Surgery
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• v.20 no.6
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• pp.388-391
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• 2019

Schwannoma is a slow-growing, well-demarcated, benign soft tissue tumor of the peripheral nerve sheath. It commonly develops in the head and neck region, usually in the parapharyngeal space. In this case, a 42-year-old woman visited the outpatient department to manage a painless mass on her left cheek. She had no history of concern and no neurological symptoms were observed. In the enhanced computed tomography scan, a 2.8×2.8×1.8 cm, heterogeneously enhanced tumor was detected in the left masseter muscle. A tumor resection under general anesthesia was planned. For the resection, a facelift incision was chosen; branches of the facial nerve were identified and retrogradely dissected. A well-marginated, yellowish, solid mass was found in the left masseter muscle. The mass was excised and given a histopathological diagnosis of schwannoma. A definite diagnosis of schwannoma, originating in the masseter muscle, is difficult to arrive at with radiographic findings alone; it is often misdiagnosed as intramuscular hemangioma. Histopathological examinations, including fine-needle aspiration or histological biopsy after surgery, are necessary. Using a facelift incision with retrograde facial nerve dissection, tumor resection in an intramasseteric lesion can be performed efficiently, without nerve damage, or leaving conspicuous scars on the face.

• Journal of Korean Academy of Nursing
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• v.22 no.2
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• pp.157-173
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• 1992

The purposes of study were to investigate the prenatal psychological adaptation and the perception of birth experience, and to identify the relationship between them. The subjects consisted of 162 women who visited the obstetrical outpatient clinic for prenatal examinations and who delivered the in babies at SNUH during the period from June 20 to August 10, 1990. The tools used for measurement were Lederman's Prenatal Self Evaluation Questionnaire and Marut & Mercer's scale of the Perception of Birth. The results are summarized as follows : 1. The orders and item means of psychosocial adaptation in pregnancy were the Acceptance of pregnancy(1.58). Identification of motherhood role(1.63). Relationship with husband(1.65) and Relationship with mother(1.67). The preparation for labor, concern for wellbeing of self and baby, and fear of pain, helplessness and loss of control were found to be less adaptive. 2. The level of the perception of the birth experience was mid-range(item mean : 3.22). The score of the perception of birth experience for primiparas was higher than for multiparas. However there was not a significant difference the groups. There were significant differences in the perception of the birth experience between certain general characteristics, namely, sex of the baby(p＜0.05), type of delivery(p＜0.005), and type of anesthesia(p＜0.005). 3. There were significant differences in the perception of the birth experience between the groups below the mean and above the mean of concerti for wellbeing of self and baby, Fear of pain, Helplessness and loss of control, Relationship with husband and Identification of motherhood role (p＜0.05). The perception of the birth experience was predicted by Fear of pain, Helplessness and loss of control (11%), Type of Delivery(6%), Concern for wellbeing of self and baby(3%), Preparation for labor(1%), sex of baby(1%), Relationship with mother(1%), Parity(1%) and Identification of motherhood role(1%). The Childbirth education should be revised to improve the psychosocial adaptation in pregnancy.

• Archives of Craniofacial Surgery
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• v.13 no.1
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• pp.54-56
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• 2012

Purpose: Dandy-Walker syndrome is a rare congenital brain malformation that occurs one in every 25,000-35,000 live births, mostly in females. It is characterized by cystic enlargement of the fourth ventricle, agenesis or hypogenesis of the cerebellar vermis and enlargement of the posterior fossa. In this report, the authors aimed to address a rare case of a 14-months-old female Dandy-Walker syndrome patient that is presented with submucous cleft palate. Methods: A 14-months-old female patient admitted to our outpatient clinic, via the department of pediatrics, with the complaints of nasal regurgitation, choking and breathing difficulties. She was diagnosed as Dandy-Walker syndrome by magnetic resonance imaging evaluation, at another hospital and underwent a shunt operation for the hydrocephalus continuing treatments. On physical examination, she had structural abnormality of bifid uvula, and palpable notch in the posterior surface of the hard palate. Her submucous cleft palate was corrected, which used a double opposing Z-plasty under general anesthesia. Results: In a follow-up period of 2 months, no complications, such as wound dehiscence, necrosis and infection occurred, which shows satisfactory results. She consulted with pediatric neurologists and physical therapists for further evaluation and management of the abnormalities in the central nervous system. Conclusion: Dandy-Walker syndrome patient with a cleft palate is a very rare case to find, which only a few cases are reported around the world. Authors would like to share this case of Dandy-Walker syndrome patient, with submucous cleft palate, who underwent a double opposing Z-plasty that shows satisfactory results.

• Korean Journal of Occupational Health Nursing
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• v.17 no.1
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• pp.86-95
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• 2008

Purpose: The objectives for this study are to produce the comprehensive management indexes and find their application strategies for appropriate medical care in primary care clinics under workers' compensation insurance. Method: Data of this study was workers' compensation insurance medical fees claim's data from July 2006 to June 2007. Data were analyzed using SAS 9.1 version by applying descriptive statistics and Pearson's correlation. The indexes such as costliness index(CI), standard medical fee were calculated based on the fourth revision of korean classification of diseases(KCD-4.). Results: The CI, visiting index(VI), outliers index(OI), and medical review adjustment percentage were positively correlated in the both inpatient and outpatient medical fees in primary care clinics under workers' compensation insurance. The major medical specialities were neurological surgery, general medicine, general surgery, rehabitational medicine, and orthopedic surgery. The CIs were slightly high in rehabitational medicine among major medical specialities. The CIs were mostly high in diagnosis, test, anesthesia, and rehabitational assistive device fees among major medical specialities. The CIs were slightly high in Kwangju, Daegu, Daejeon, and Busan districts among district management centers of Korea Workers' Compensation and Welfare Service. Conclusions: We suggest the continuous development of appropriate disease classification system and medical care quality indicators to successfully take root the comprehensive management for appropriate medical care under workers' compensation.

• Korean Journal of Head & Neck Oncology
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• v.38 no.2
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• pp.29-32
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• 2022

Lipoma is one of the most common benign soft tissue tumors. However, giant lipomas compressing and deforming the neurovascular structure rarely occur in the lateral neck. A 70-year-old man visited our outpatient clinic for treatment of a visible painless neck mass that had been identified 2 years prior. Neck magnetic resonance imaging revealed that a 10 × 9 × 4 cm fatty mass located between the sternocleidomastoid and sternohyoid muscles invaded the carotid sheath. Under general anesthesia, the mass was excised without damage to the adjacent neurovascular structures. Upon histopathological examination, the mass was identified as a lipoma. During the surgery, enlargement of the internal jugular vein was observed under the resected mass. However, on ultrasound examination, the function of the internal jugular vein was evaluated as good. No recurrence or neurological and vascular complications were reported during a 6-month follow-up after the surgery. As a giant lipoma located in the deep layer of the lateral neck can deform important cervical structures, its impact on the surrounding structures should be carefully assessed preoperatively to minimize the rate of possible complications.