• Journal of Chest Surgery
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• v.54 no.6
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• pp.466-472
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• 2021

Background: Major intraoperative hemorrhage reportedly predicts unfavorable survival outcomes following surgical resection for esophageal carcinoma (EC). However, the factors predicting the amount of blood lost during thoracoscopic esophagectomy have yet to be sufficiently studied. We sought to identify risk factors for excessive blood loss during video-assisted thoracoscopic surgery (VATS) for EC. Methods: Using simple and multiple linear regression models, we performed retrospective analyses of the associations between clinicopathological/surgical factors and estimated hemorrhagic volume in 168 consecutive patients who underwent VATS-type esophagectomy for EC. Results: The median blood loss amount was 225 mL (interquartile range, 126-380 mL). Abdominal laparotomy (p<0.001), thoracic duct resection (p=0.014), and division of the azygos arch (p<0.001) were significantly related to high volumes of blood loss. Body mass index and operative duration, as continuous variables, were also correlated positively with blood loss volume in simple linear regression. The multiple linear regression analysis identified prolonged operative duration (p<0.001), open laparotomy approach (p=0.003), azygos arch division (p=0.005), and high body mass index (p=0.014) as independent predictors of higher hemorrhage amounts during VATS esophagectomy. Conclusion: As well as body mass index, operation-related factors such as operative duration, open laparotomy, and division of the azygos arch were independently predictive of estimated blood loss during VATS esophagectomy for EC. Laparoscopic abdominal procedures and azygos arch preservation might be minimally invasive options that would potentially reduce intraoperative hemorrhage, although oncological radicality remains an important consideration.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.13
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• pp.5355-5358
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• 2014

Background: To assess the role of sonographic endometrial thickness and hysteroscopic polyp size in predicting premalignant and malignant polyps in postmenopausal women. Materials and Methods: A total of 328 postmenopausal women with abnormal uterine bleeding and thickened endometrium underwent operative hysteroscopy due to detection of endometrial polyps were included in this retrospective study. Preoperative endometrial thickness measured by transvaginal ultrasonography and polyp size on hysteroscopy were noted. Hysteroscopic resection with histology was performed for endometrial polyps. Endometrial thickness and polyp size were evaluated on the basis of final diagnosis established by histologic examination. Receiver operator characteristic curves were calculated to assess the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of endometrial thickness and polyp size for detecting pemalignant and malignant polyps. Results: Premalignant and malignant polyps were identified in 26 (7.9%) of cases. Sonographic measurement showed a greater endometrial thickness in cases of premalignant and malignant polyps when compared to benign polyps. On surgical hysteroscopy, premalignant and malignant polyps were also larger. Endometrial thickness demonstrated a sensitivity of 53.8%, specificity of 85.8%, PPV of 24.6% and NPV of 95.6% at a cut-off limit of 11.5 mm with diagnostic accuracy of 83.2%. Polyp size has a diagnostic accuracy of 94.8% with a sensitivity of 92.3%, specificity of 95.0%, PPV of 61.5% and NPV of 99.3% at a cut-off point of 19.5mm. Conclusions: Endometrial thickness measured by transvaginal ultrasonography is not sufficient in predicting premalignant and malignant endometrial polyps in postmenopausal women with abnormal uterine bleeding and thickened endometrium. Polyp size on hysteroscopy is a more accurate parameter, because of better sensitivity and specificity. However, while polyp size ${\geq}19.5mm$ seems to have a great accuracy for predicting premalignancy and malignancy, histologic evaluation is still necessary to exclude premalignant and malignant polyps.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.9
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• pp.4525-4529
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• 2012

Objectives: To determine the prevalence and predicting factors of ovarian metastasis, and evaluate the histology of other ovarian neoplasms in women with early-stage cervical cancer. Methods: The medical records of women with cervical cancer stage IA-IIA who underwent primary surgical treatment at Siriraj Hospital, Mahidol University from January 2007 to December 2011 were used for the study. Demographic, clinical and histopathologic data of the women who underwent salpingo-oophorectomy were reviewed. Results: Of 264 women, the mean age was 52.3 years. The types of hysterectomy procedures were composed of 210 radical hysterectomy, 9 modified radical hysterectomy, 40 simple hysterectomy, and 5 abandoned hysterectomy. The prevalence of ovarian metastasis was 0.76% (2/264). All of ovarian metastatic patients were older than 60 years old, postmenopause, and had macroscopical stage IB1 cervical cancer. Others ovarian tumors were found in 7 patients including 1 synchronous ovarian carcinoma, 1 serous cystadenoma, 1 fibroma, and 4 teratoma. Conclusions: In cases of early-stage cervical carcinoma of the population studied, ovarian preservation could be another option in <60-year-old patients, with non-neuroendocrine cell type, stage IA, and no extracervical or ovarian lesions.

• Clinical and Experimental Pediatrics
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• v.63 no.3
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• pp.88-95
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• 2020

Accurate localization of the seizure onset zone is important for better seizure outcomes and preventing deficits following epilepsy surgery. Recent advances in neuroimaging techniques have increased our understanding of the underlying etiology and improved our ability to noninvasively identify the seizure onset zone. Using epilepsy-specific magnetic resonance imaging (MRI) protocols, structural MRI allows better detection of the seizure onset zone, particularly when it is interpreted by experienced neuroradiologists. Ultra-high-field imaging and postprocessing analysis with automated machine learning algorithms can detect subtle structural abnormalities in MRI-negative patients. Tractography derived from diffusion tensor imaging can delineate white matter connections associated with epilepsy or eloquent function, thus, preventing deficits after epilepsy surgery. Arterial spin-labeling perfusion MRI, simultaneous electroencephalography (EEG)-functional MRI (fMRI), and magnetoencephalography (MEG) are noinvasive imaging modalities that can be used to localize the epileptogenic foci and assist in planning epilepsy surgery with positron emission tomography, ictal single-photon emission computed tomography, and intracranial EEG monitoring. MEG and fMRI can localize and lateralize the area of the cortex that is essential for language, motor, and memory function and identify its relationship with planned surgical resection sites to reduce the risk of neurological impairments. These advanced structural and functional imaging modalities can be combined with postprocessing methods to better understand the epileptic network and obtain valuable clinical information for predicting long-term outcomes in pediatric epilepsy.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.14.1-14.10
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• 2019

Background: Condylar dislocation can arise as a complication in patients who required mandibular and/or condylar reconstruction and were operated on with fibula free flap (FFF) using surgical guides designed using simulation surgery. Surgeons should be aware of the complications in these present cases when planning and performing reconstructions as well as predicting prognoses. Cases presentation: Two cases showed condylar dislocation in mandibular reconstruction using a FFF fixed with a reconstruction plate. Three cases showed condylar dislocation in mandibular reconstruction using a fibula free flap fixed with a mini-plate. Conclusion: Despite the lack of clinical symptoms in these cases following mandibular reconstruction using an FFF, the mandibular condyle was severely displaced away from the glenoid fossa. A surgeon must have sufficient time to consider the use of a long flap with thickness similar to that of the mandible, ways to minimize span and bending, and methods of fixation. The patient, moreover, should be educated on condylar dislocation. Customized CAD/CAM-prototyped temporomandibular condyle-connected plates may be a good alternative even if virtual simulation surgery is to be performed before surgery. These considerations may help reduce the incidence of complications after mandibular reconstruction.

• Journal of Oral Medicine and Pain
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• v.39 no.2
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• pp.35-45
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• 2014

Many therapeutic modalities including continuous positive airway pressure, surgery, and oral appliances are used to treat patients with sleep-disordered breathing. However, there are no definitive treatment modalities for individual patients due to various causes of sleep-disordered breathing. Clinicians should have select best options for individual patients and it is quite challenging process. Oral appliances attracted clinical attention for its convenience and safety. Several designs of oral appliances are introduces such as soft palate lifter, tongue retaining device, and various appliances which aimed to mandibular advancement. Among these oral appliances, mandibular advancement devices (MADs) are considered the most excellent based on their effectiveness and patient tolerance. Although MADs are not guarantee dramatic outcome and less consistent than continuous positive airway pressure, they offer several advantages over continuous positive airway pressure and surgical methods, including non-invasiveness, silence, portability, and tolerability, simplicity. Therefore, general dental practitioner who had passed sleep dental curriculum or coursework can treat the patients with sleep problems. This article reviews the history, clinical indications, suggested mechanism of actions, various positive effects and several side effects, factors predicting a favorable outcome, determining amounts of mandibular advancement, compliance and long-term efficacy of MADs use.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.sup1
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• pp.46-51
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• 2008

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal neoplasm of the gastrointestinal tract, and can be distinguished from the smooth muscle or neural tumors in approximately 95% of patients by expression of the KIT receptor tyrosine kinase (CD117). GISTs are known to have high malignant potential and none can be labeled definitely as benign. However, GISTs are unresponsive to standard sarcoma chemotherapy, and only complete surgical resection provides chance for cure. Although the imaging modality of choice is enhanced CT scan in patients with GIST, FDG PET can reflect the malignant potential of GIST. Clinical management of patients with GISTs has dramatically changed with the introduction of novel therapeutics, such as imatinib mesylate (Glivec). This has created a need to re-evaluate the existing criteria used to assess treatment response. FDG PET as functional imaging modality proved to be significantly more accurate than CT alone when assessing GIST response to imatinib. And, FDG PET and PET ICT have been found to be highly sensitive in detecting early response, and to be useful in predicting long-term response to imatinib in patients with recurrent or metastatic GISTs.

• Journal of Korean Foot and Ankle Society
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• v.10 no.2
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• pp.196-200
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• 2006

Purpose: To study prognostic factors of unilateral calcaneus fracture underwent surgery. Materials and Methods: We selected appropriate 60 cases of 236 calcaneus fracture cases between March 1985 and March 2004, and analyzed the correlation between sex, age, smoking, injury mechanism, Essex-Lopresti classification of calcaneus fracture, preoperative Bohler angle, postoperative Bohler angle, postoperative 1 year Bohler angle and Visual Analogue Scale (VAS), P.S. Kerr's Calcaneal Fracture Score (CFSS). The average age was 41.4 and average follow up period was 74 (12 to 240) months. Results: For follow up period, average VAS is 3.43 and CFSS is 81.23. The sex, age, smoking, injury mechanism, and preoperative, postoperative, postoperative 1 year Bohler angle had no correlation with the prognosis. But the Essex-Lopresti classification of calcaneus fracture, tongue type had better prognosis than joint depression type (VAS : p=0.041, CFSS : p=0.021). Conclusion: In unilateral calcaneus fracture, the sex, age, smoking, injury mechanism, preoperative Bohler angle, postoperative Bohler angle, postoperative 1 year Bohler angle had no correlation with the prognosis of fracture, but in Essex-Lopresti classification, the tongue type fracture had better prognosis than the joint depression type.

• Korea Journal of Hospital Management
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• v.15 no.4
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• pp.125-142
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• 2010

Objective : To determine demographic, clinical, health care utilization factors predicting unplanned readmission(within 28 days) to the hospital. Methods : A case-control study was conducted from January to December 2009. Multiple logistic regression was used to examine risk factors for readmission. 180 patients who had been readmitted within 28 days and 1,784 controls were recruited from an university hospital in Seoul. Results : Six risk factors associated with readmission risk were identified and include mail sex, medical service rather than surgical service, number of comorbid diseases, type of patient's room, lenth of stay, number of admissions in the prior 12 months. Conclusions : One of the association with readmission risk identified was the number of hospital admissions in the previous year. This factor may be the only risk factor necessary for assessing prior risk and has the additional advantage of being easily accessible from computerized medical records without requiring other medical record review. This risk factor may be useful in identifying a group at high readmission risk, which could be targeted in intervention studies. Multiple risk factors intervention approach should be considered in designing future prevention strategies.

• Clinical and Experimental Reproductive Medicine
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• v.20 no.1
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• pp.71-78
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• 1993

Since the successful advent of IVF-ET, reproductive surgeons have been forced to compare pregnancy outcomes of surgical procedures for tubal infertility with those of IVF-ET. The current study was designed in an effort to determine the usefulness of pre-operative infertility work-up, especially diagnostic laparoscopy, in predicting the pregnancy rate and in assessing the reversal feasibility. 109 patients who underwent a microsurgical tubal reversal were reviewed. The patients were followed over one year. The total intrauterine pregnancy, spontaneous abortion, and ectopic pregnancy rates were 66.4%, 3.7%, and 7.3%, respectively. The result showed that the use of loupe might increase the chance of the ectopic pregnancy. I found that the final tubal length, especially the longest tubal length, the site of reanastomosis, and the methods of sterilization affected the pregnancy rates. A 85% intrauterine pregnancy rate was achieved in the patients with good preoperative assessments(Group II-1). There was only 10% incidence of intrauterine pregnancy in the patients with bad assessments(Group II-2). It is concluded that the pre-operative infertility work-up, especially diagnostic laparoscopy, is a good diagnostic tool in assessing the reversal feasibility.