• Archives of Plastic Surgery
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• v.34 no.1
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• pp.93-98
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• 2007

Purpose: Many options are available for the incision and pocket selection in breast augmentation. Each method has its advantages and disadvantages. To leave an invisible operation scar and to achieve easier pocket dissection by the central location of the incision on the breast, we made a transareolar-perinipple incision. To overcome the disadvantages of the transareolar incision, originally advocated by Pitanguy in 1973, we modified the direction of incision line and dissection plane. Methods: To avoid the injury of 4th intercostal nerve responsible for nipple sensation, we made perinipple incision on the medial side of the nipple instead of trans-nipple incision and made the transareolar incision as 11-5 o'clock on the left side and 1-7 o'clock on the right side instead of 3-9 o'clock on both sides. To avoid the possible infection and breast feeding problem caused by the injury to the lactiferous duct, and the possible implant hernia caused by the incisions lying on a same plane of pocket dissection, we made a subcutaneous dissection just above the breast tissue medially down to the bottom of breast tissue and made a subglandular or subfascial pocket, which may avoid the injury of lactiferous duct and create different planes for skin incision and pocket dissection. Other advantages of the transareolar-perinipple incision include easier pocket dissection, less chance of hematoma, and as a result less postoperative pain because of the central location of the approach which allow finger dissection and meticulous bleeding control with direct vision, without any specialized instrument such as an endoscope or long mammary dissectors. As for pocket selection, we made dual pockets. We prefer subglandular or subfascial pocket. Also, we made a subpectoral pocket in the upper 1/4 of the pocket to add more volume on the upper part of the augmented breast, which can make aesthetically more desirable breasts in thin Asian women with small breasts. Possible disadvantages of our method are subclinical infection and scar widening, which could be overcome by meticulous operation techniques, antibiotic therapy, and intradermal tattooing. Results: From September, 2003 to August, 2005, 12 patients underwent breast augmentation using round smooth surface saline implants by our method. During the mean follow-up period of 13 months, there were no complications such as infection, hematoma, capsular contracture, and sensory change of nipple, and results were satisfactory. Conclusion: We suggest breast augmentation via transareolar-perinipple incision and dual pockets(subpectoral-subglandular or subfascial) as a valuable method in thin oriental women with small breasts.

• Archives of Plastic Surgery
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• v.32 no.6
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• pp.753-756
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• 2005

In the cases of severe arrythmia and conduction failure, a permanent implanted pacemaker is considered an essential treatment modality with less complication rate, broad indications and low morbidity. However, some pacemakers needs to be removed or replaced due to infection, in need of a lead upgrade, elective replacement, conduction failure or insulation failure. The most common indication for pacemaker extraction is infection. Conservative treatments such as administration of intravenous antibiotics and limitation of debridement are not effective and the removal of the entire pacing system is considered to be the best approach to pacemaker pocket infection. Although a locking stylet, a laser sheath and other newer methods of transvenous lead extraction have been proven to be effective, all leads cannot be removed. Moreover, major complications such as, cardiac tamponade and respiratory arrest during leads extraction procedure should not be ignored. We experienced two cases of exposed pacemakers in the subclavicular region. After removing the pacemaker body, exposed proximal lead was pulled out and cut off. The end of remnant external insulation tube was tied to prevent infection propagation between external insulation tube and inner metalic coil. Wounds were covered by local flap coverage. No other problems were detected during the one-year follow-up. Since there are few reports on lead-preserving method of treating limited infection of exposed pacemakers, we would like to present our new method for treating exposed pacemakers.

• Journal of Chest Surgery
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• v.28 no.4
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• pp.404-408
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• 1995

Infection, although uncommon, can be the most lethal of all potential complication after transvenous pacemaker implantation. When infection is present, removal of the electrode is the only successful means of therapy. The entrapped electrode can be removed by continuous traction, by use of endoscopic forceps and snares, and by operation. We report 2 cases of removal of infected transvenous pacemaker successfully. In one case of staphylococcus aureus endocarditis associated with a retained pacemaker electrode, the electrode was removed by hand traction. The other case of skin infection of generator pocket, the electrode removed by orthopedic pulley system. Consequently, we recommended removal of all hardware if there is infection of the pacemaker system.

• Journal of Korean Biological Nursing Science
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• v.23 no.4
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• pp.298-307
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• 2021

Purpose: This study aimed to investigate the risk factors for cardiac implantable electronic device (CIED)-related infections within the first post-procedural year after CIED insertion. Methods: This study included 509 adult patients undergoing CIED implantation procedures between January 1, 2011 and December 31, 2015. The data were analyzed by t-test, chi-square test, Fisher's exact test, and logistic regression analysis using SPSS/WIN 23.0. Results: Fifteen infections and 494 non-infections were examined. The CIED-related infection rate was 2.9%; patients with 14 pocket infections and one bacteremia were included in the CIED-related infection. The risk factors of CIED-related infections were the estimated glomerular filtration rate (eGFR) of ≤ 45 mL/min/1.73 m² (Odds ratio [OR]= 4.03, 95% confidence interval [CI],1.15-14.10) and taking a new oral anticoagulant (NOAC) (OR = 4.50, 95% CI 1.09-18.55). Conclusion: These results identified the CIED infection rate and risk factors of CIED-related infection. It is necessary to consider these risk factors before the CIED implantation procedure and to establish the relevant nursing interventions.

• Journal of Chest Surgery
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• v.17 no.1
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• pp.125-128
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• 1984

The management of the exposed cardiac pacemaker or its lead is a new challenge to the plastic surgeon. This complication is not rare. Coburn et al. [1972] reported less than 5 percent, but Sowton et al. [1974] showed that over a period of 19 years, in a series of 372 patients, the pacing system had to be removed because of local wound breakdown or infection in 10 percent of the cases. The methods used to treat exposure may vary from removal and re-introduction at anterior site to the rotation of local flaps to cover the exposed pacemaker. Recently we have experienced 6 times of migration and recurrent skin ulcerations without pyogenic infection overlying the pacemaker in one patient. We developed a new technique, anchoring the pacemaker to the clavicle by a wire through the hole of clavicle and by creating a pocket under the pectoralis major muscle. Then we would like to emphasize this operating method could be choice of treatment to prevent the migration of pacemaker and the ulceration of skin when complication of implantation of pacemaker is occurred.

• Journal of fish pathology
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• v.16 no.1
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• pp.31-38
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• 2003

The mortality of wild mullet, Mugil cephalus was detected in Kwang- Yang bay on February, 2002. The mullet were infected with Myxobolus sp., the cysts of Myxobolus sp. were found in the mesentery, liver, gill and pharyngeal pocket. The histological findings suggested a systemic infection by the Myxobolus sp.. The spores were measured 10-12 (10.9)${\mu}m$ in length, 9-10 (9.4) ${\mu}m$ in width, 6.4-7.2 (6.8) ${\mu}m$ in thickness, with polar capsules of 4-5.2 (4.4) ${\mu}m$ in length and 2.5-3.3 (2.9) ${\mu}m$ in width.

• Archives of Plastic Surgery
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• v.37 no.1
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• pp.71-74
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• 2010

Purpose: Nowadays spinal cord stimulator is frequently used for the patients diagnosed as complex regional pain syndrome. The lead is placed above the spinal cord and connected to the stimulation generator, which is mostly placed in the subcutaneous layer of the abdomen. When the complication occurs in the generator inserted site, such as infection or generator exposure, replacement of the new generator to another site or pocket of the abdomen would be the classical choice. The objective of our study is to present our experience of the effective replacement of the existing stimulation generator from subcutaneous layer to another layer in same site after the wound infection at inexpensive cost and avoidance of new scar formation. Methods: A 50-year-old man who was diagnosed as complex regional pain syndrome after traffic accident received spinal cord stimulator, Synergy$^{(R)}$ (Medtronic, Minneapolis, USA) insertion 1 month ago by anesthetist. The patient was referred to our department for wound infection management. The patient was presented with erythema, swelling, thick discharge and wound disruption in the left upper quadrant of the abdomen. After surgical debridement of the capsule, the existing generator replacement beneath the anterior layer of rectus sheath was performed after sterilization by alcohol. Results: Patient's postoperative course was uneventful without any complication and had no evidence of infection for 3 months follow-up period. Conclusion: Replacement of existing spinal cord stimulation generator after sterilization between the anterior layer of rectus sheath and rectus abdominis muscle in the abdomen will be an alternative treatment in wound infection of stimulator generator.

• Archives of Plastic Surgery
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• v.44 no.1
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• pp.42-47
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• 2017

Background Skin erosion is a dire complication of implantable cardiac pacemakers and defibrillators. Classical treatments involve removal of the entire generator and lead systems, however, these may result in fatal complications. In this study, we present our experience with a simplified salvage technique for exposed implantable cardiac electronic devices (ICEDs) without removing the implanted device, in an attempt to reduce the risks and complication rates associated with this condition. Methods The records of 10 patients who experienced direct ICED exposure between January 2012 and December 2015 were retrospectively reviewed. The following surgical procedure was performed in all patients: removal of skin erosion and capsule, creation of a new pocket at least 1.0-1.5 cm inferior to its original position, migration of the ICED to the new pocket, and insertion of closed-suction drainage. Patients with gross local sepsis or septicemia were excluded from this study. Results Seven patients had cardiac pacemakers and the other 3 had implantable cardiac defibrillators. The time from primary ICED placement to exposure ranged from 0.3 to 151 months (mean, 29 months. Postoperative follow-up in this series ranged from 8 to 31 months (mean follow-up, 22 months). Among the 10 patients, none presented with any signs of overt infection or cutaneous lesions, except 1 patient with hematoma on postoperative day 5. The hematoma was successfully treated by surgical removal and repositioning of the closed-suction drainage. Conclusions Based on our experience, salvage of exposed ICEDs is possible without removing the device in selected patients.

• Research in Community and Public Health Nursing
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• v.28 no.4
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• pp.431-439
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• 2017

Purpose: This study aims to examine the factors influencing sexually transmitted infection (STI) in Korean adolescents 12 to 18 years. Methods: Using statistics from 10-11th Korea Youth Risk Behavior Web-based Survey, secondary analysis was conducted. The study sample consisted of 4,886 boys and 1,998 girls who had reported initiating sexual intercourse. Results: The proportion of adolescents who had a sexually transmitted infection was 8.8% of boys and 11.0% of girls. In multiple regression analysis, grade, smoking, first intercourse before middle school, intercourse after drinking alcohol, living without family, large amounts of pocket money were factors associated with sexually transmitted infection for both boys and girls. Use of condom is related to STI contraction of boys only. Formal sex education was not associated with reducing risk of STI. Conclusion: The results of this study show the factors associated with STI among Korean adolescents. Gender-related effective interventions should be taken into consideration in school-based sex education programs.

• Asian-Australasian Journal of Animal Sciences
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• v.18 no.6
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• pp.879-883
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• 2005

The integral relationship between the occurrence of lymphocyte nuclear pockets (LNPs) and BLV-infection was examined in Holstein-Friesian dairy cattle in Korea. Transmission electron microscope (TEM) was used to detect LNP in peripheral blood lymphocytes. Morphologically, the membranes of LNP were composed of two layers of double nuclear membrane. The full thickness of LNP membranes including inner and outer nuclear membrane was 60 to 70 nm. LNP prevalence was different according to the bovine leukemia virus (BLV) infection status; in BLV-seropositive cattle, LNP prevalence was 48.4% and in BLV-seronegative cattle prevalence was 5.9%. Moreover, even in seropositive animals, leukemic group was the highest at 70% positive among the groups, followed by suspect group (42.4%) and aleukemic group (23.1%). Consequently, the numbers of LNP were increased in proportion to increase of the numbers of leukocytes among BLV-seropositive cattle. The numbers of LNP per lymphocyte were increased in BLVseropositive cattle compared with seronegative cattle. The mean numbers of LNP per 100-lymphocytes were 0.35, 0.77, 1.64 and 4.7 in BLV-seronegative, BLV-seropositive aleukemic, suspect and leukemic groups, respectively. Thus, it is reasonable that LNP test can be used as the one of the diagnostic criteria of BLV infection.