• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제19권1호
• /
• pp.87-92
• /
• 1997

Treatment of infected mandibular fracture is confronted with various difficult problem, e.g. nosocomial wound infection, non-union of fracture, osteomyelitis. Recently, nosocomial infection has become a major health problem because of excessive morbidity, personal distress, and cost. Frequently, isolated causative microorganisms of nosocomial infection were staphylococcus aureus, pseudomonas aeruginosa, klebsiella species. The various manifestation of the disease related to the pathogenesis and the clinical course tend to give a bad prognosis after operation. This is a report of case that post-operative infected mandibular fracture in 53-year-old man was not healed even through aggressive I & D and antibiotic treatment.

• Asian Pacific Journal of Cancer Prevention
• /
• 제14권4호
• /
• pp.2529-2532
• /
• 2013

Background: Pelvic exenteration is a procedure which includes enbloc resection of pelvic organs followed by surgical reconstruction. Aims include both cure and palliation but data for pelvic exenteration in Thailand are very limited. Objective: This study was conducted to evaluate characteristics of patients, operative procedure outcomes and complications. Materials and Methods: This retrospective review covered all of the charts of exenteration patients during January 2002 to December 2011. Baseline characteristic of the patients were collected as well as details of clinical results. Results: A total of 13 cases of pelvic exenteration were included. Most underwent total pelvic exenteration (9 cases) and the remainder posterior and anterior exenteration. Their primary cancers were ovarian, cervical and vulva. Mean operative time was 532 minutes (SD 160.2, range 270-750) and estimated blood loss was 2830 ml (1850, 1000-8000). Mean tumor size was 7.33 cm (3.75, 4-15). Mean hospital stay was 35.2 days (29.8, 13-109). The most common post operative complication was urinary tract infection. Overall disease free survival with a negative surgical margin was significantly better than in positive surgical margin patients (p=0.014). Conclusions: Surgical margin was the most significant prognostic factor for disease free survival, in line with earlier studies.

• 대한치과의사협회지
• /
• 제50권12호
• /
• pp.727-731
• /
• 2012

An ulcer is defined as loss of epithelium. Although many oral ulcers have similar clinical appearances, their etiologies encompass many disorders, including trauma, infection, immunologic disease, and malignant oral cancer. Oral squamous cell carcinoma(SCC) occupying about 90% of oral cancer, usually manifests as unhealed ulcer over 2 weeks. Oral SCC can metastasize to the cervical neck lymph node, and therefore the surgical therapeutic modality for oral SCC could encompass the neck node dissection as well as wide excision for primary lesions, which should leave the post-operative complication of functional damage like dysphagia and facial deformity. Therefore, it is important to discriminate oral SCC from other ulcerative conditions to make a prompt management. The knowledge for the pathogenesis of the ulcerative lesions could help the clinicians to understand the differences of clinical features and to practice an appropriate therapeutics.

• Asian Pacific Journal of Cancer Prevention
• /
• 제17권9호
• /
• pp.4381-4389
• /
• 2016

Background: Surgery is the corner stone for the management of rectal cancer. The purpose of this study was to demonstrate the optimal time of surgical resection after the completion of neoadjuvant chemo-radiotherapy (CRT) in treatment of locally advanced rectal cancer. Materials and Methods: This study compared 2 groups of patients with locally advanced rectal cancer, treated with neoadjuvant CRT followed by surgical resection either 6-8 weeks or 9-14 weeks after the completion of chemo-radiotherapy. The impact of delaying surgery was tested in comparison to early surgical resection after completion of chemo-radiotherapy. Results: The total significant response rate that could result in functional preservation was estimated to be 3.85% in group I and 15.4% in group II. Some 9.62% of our patients had residual malignant cells at one cm surgical margin. All those patients with positive margins at one cm were in group I (19.23%). There was less operative time in group II, but the difference between both groups was statistically insignificant (P=0.845). The difference between both groups regarding operative blood loss and intra operative blood transfusion was significantly less in group II (P=0.044). There was no statistically significant difference between both groups regarding the intra operative complications (P=0.609). The current study showed significantly less post-operative hospital stay period, and less post-operative wound infection in group II (P=0.012 and 0.017). The current study showed more tumor regression and necrosis in group II with a highly significant main effect of time F=61.7 (P<0.001). Pathological TN stage indicated better pathological tumor response in group II (P=0.04). The current study showed recurrence free survival for all cases at 18 months of 84.2%. In group I, survival rate at the same duration was 73.8%, however none of group II cases had local recurrence (censored) (P=0.031). Disease free survival (DFS) during the same duration (18 months) was 69.4 % for patients in group I and 82.3% for group II (P=0.429). Conclusions: Surgical resection delay up to 9-14 weeks after chemo-radiation was associated with better outcome and better recurrence free survival.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제32권1호
• /
• pp.62-67
• /
• 2010

The spreading pathways which is the cause of infection on head and neck area are submandibular space, masticatory space, parapharyngeal space, retropharyngeal space, carotid sheath and mediastinum, etc. If spread to parapharyngeal area involving airway, such infection can be life-threatening by airway obstruction, or can cause vascular injury followed by hemorrhage, nerve injuries. Also, if spread to superficially, necrotizing fasciitis and many complications may occur including gangrene of skin. The key to successful treatment of infection on head and neck area is recognition of spreading pathways, early diagnosis and following therapeutic management. Our department present two cases, one is infection progressed superficially to suprasternal space, another is spreading deep according to parapharyngeal space, subclavian space and carotid sheath followed by airway obstruction, and obtained significant results with surgical incision and drainage, administration of selected antibiotics, continuous post-operative treatment. We report these 2 cases with literatures review.

• Journal of Chest Surgery
• /
• 제17권2호
• /
• pp.244-249
• /
• 1984

Surgical treatment of partial endocardial cushion defect was accomplished in Feb. 1984 in this department. The 5 year old male patient had history of frequent upper respiratory tract infection and since his age of 3 years dyspnea on exertion and palpitation were noted but there were no cyanosis and clubbing. A thrill was palpable on the apex and grade IV/IV harsh systolic ejection murmur and diastolic murmur was audible on it. Liver was palpable about 3 finger breadths and no ascites. Chest X-ray revealed increased pulmonary vascularity, moderate cardiomegaly [C-T ratio; 0.69], and enlarged left atrium. EKG showed first degree heart block, RVH, LVH, and LAD. Echocardiogram showed paradoxical ventricular septal movement and abnormal diastolic movement of the anterior leaflet of mitral valve. Right heart catheterization resulted left to right shunt [Qp:Qs:2.1:1 ] and moderate pulmonary hypertension [60/40 mmHg]. Left ventriculogram showed mitral regurgitation [Grade III/IV] and filling of left atrium and right atrium nearly same time. Operative findings were: 1.Primum type atrial septal defect [3x2 cm] 2.Cleft on the anterior leaflet of mitral valve. 3.No interventricular communication and cleft of tricuspid valve leaflet. The mitral cleft was repaired with 4 interrupted sutures. The primum type atrial septal defect was closed with Dacron patch intermittently at endocardial cushion and continuously remainder. The post operative course was uneventful and discharged on 22nd postoperative day in good general conditions.

• 대한족부족관절학회지
• /
• 제12권2호
• /
• pp.128-134
• /
• 2008

Purpose: We evaluated the complications and failures after total ankle arthroplasty during at least 2 years short term follow up. Materials and Methods: There were 45 cases of 42 patients of HINTEGRA$^{{R}}$ (Newdeal SA, Lyon, France) model from November 2004 to August 2006. Follow up averaged at least 2 year. We evaluated the complications and analyzed the cause of the failures. Results: There were totally 15 cases of complication, 5 cases of medial impingement syndrome, 3 cases of varus malposition, 2 cases of delayed healing of wounds, and each one case of deep peroneal nerve problem, medial malleolus fracture, post-operative deep infection, gouty arthritis pain, and Achilles tendinitis. Conclusion: Total ankle arthroplasty had higher complication rate than any other joint arthroplasty, so we need a more meticulous preoperative and peri-operative care.

• 한방안이비인후피부과학회지
• /
• 제13권1호
• /
• pp.237-252
• /
• 2000

Pressure sore is an area of ulceration and necrosis of the skin and underlying tissues usually occuring over the bony prominences of the body after prolonged or often repeated pressure. We reviewed and summarized the published articles and treatise on the treatment of pressure sore. The results were as follows : 1. Pressure sore occur due to prolonged or often repeated pressure. So it is better than decubitus ulcer that is called pressure sore. 2. The most common lesions of pressure sore are sacrum, ischial tuberosity, greater trochanter. 3. The cause of pressure sore are change of comprehension. urine, moisture, change of the ability of activity and exercise, shearing force. 4. The elements to influence on wound healing are collagen accumulation velocity, nutrition condition, Vitamine C, copper, iron. oxygen pressure, steroids, cell-toxic drug, radiation. 5. Non-operative treatments are managements of skin such as avoiding consistant pressure, dressing, preventing moisture, understanding patient and protecter, preventing spasm, improvement of systemic nutrition condition. 6. Operative treatements are debridement, suture, skin transplantation, muscle flap and musculaocutaneous flap surgery. Recently V-${\Gammer}$ advancement surgery in use of muscle and musculocutaneous flap is generally maded. 7. Complications of post-operation are wound rupture, infection, disappearance of transmitted skin, necrosis of flaps.

• 대한관절경학회지
• /
• 제3권1호
• /
• pp.35-39
• /
• 1999

급성 외상에 의해 발생한 슬개골전 점액낭염 중 그 크기가 거대하고 보존적 요법에 반응하지 않는 3례에 대하여 관절경을 통해 점액낭을 절제하고 경피적 다발성 연차봉합을 시행한 바, 그 술기를 소개하고 1년이상 추시상 모든예에서 합병증이나 재발없이 만족할 만한 결과를 얻었기에 그 증례를 보고하고자 한다. 본 술기는 통상적인 절개방법에서의 피부 반흔에 따른 문제와 감염 및 재발 등의 합병증을 최소화하기 위한 보완적 술기로 고안되었으며 얇고 손상받기 쉬운 피부를 보호할 수 있는 장점이 있고 점액낭이 제거된 공간에 부가적인 연차봉합을 통해 사강(dead space)을 배제하고 분리된 조직간의 견고한 접촉을 유지해 줌 으로써 술후 조기 운동을 가능케하고 재발의 가능성을 줄일 수 있어 선택적으로 적용할만한 유용한 술기라 사료된다.

• 대한간호학회지
• /
• 제17권3호
• /
• pp.227-240
• /
• 1987

Infection has assumed increased importance as a cause of death among thermally injured individuals. Decreased treatment effectiveness and an increase in mortality are the hallmarks of nosocomial infection. Infection control is a monumental task that must be achieved to reduce mortalities. This was a retrospective study to survey the epidemiological features of nosocomial infections in a burn unit and to identify the possibilities for infection control. During the past 6 year 2 month period from July, 1981 to August, 1987, 306 burn patients were treated in the burn unit of university hospital. Among of these, 290 cases were the subjects of this study. The data were collected from the patients' records after discharge. All data collected were analyzed using percent, x$^2$-test, t-test with SPSS program. The results of this study are summariged as follows: 1) Infection rate was 40%. According to site, there were 67 cases of wound infection, 60 cases of post-operative skin graft infection, 20 cases of septicemia and 20 cases of donor site infection. As far as the burn size was concerned, the infection rate for patients whose burn size ranged 61 to 70%, was shown to be 100%, followed by the infection rate of 93.8%, for patients whose burn size ranged from 41~50%. As far as the period of time over which the infection developed, 5 to 7 days showed the highest frequency. Further infection was the main cause of deaths and complications. 2) Based upon the results obained by comparing the general characteristics, between a hospital infection-group and non-hospital infection group, there was a significant defference according to age, the time of the year when the accident happened, the place of accident or length of hospital-admission. And according to the result obtained by comparing the general characteristics of the burn, there was a significant difference according to burn size, burn depth, burn type, and burn site. And also based upon the result obtained by comparing the two groups according to method of treatment, there was a significant difference according to the use of antibiotics and to the type of wound-treatment, and for the 8 different binds of treatment related to infection, there was a significant difference for all. In conclusion, age, length of hospital-admission, burn size, burn type, burn site, burn depth, type of woundtreatment and the 8 different binds of treatment, which are related to burns, were shown to be the factors which affect the infection rate in burn patients.