• Korean Journal of Head & Neck Oncology
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• v.37 no.2
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• pp.19-24
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• 2021

Background/Objectives: The aim of this national population-based retrospective study was to analyze the status and treatment outcome in patients with hypopharyngeal cancer. Materials & Methods: Participants were included in the KNHIS national sample cohort who received a KNHIS health check-up in 2008 and 2009, and we followed these individuals until 2017. Patients were defined as having hypopharynx cancer if they had admissions records for hypopharynx cancer in their national health insurance data from 2010 to 2017. Results: The study cohort included 3,922 patients. According to our nationwide data, 3,533(90.1%) were male with a median age of 65.03±11.04 years at the time of diagnosis. Among parametric models for hypopharyngeal cancer prognosis, old age (Hazard ratio [HR]:1.92; 95% confidence interval[CI]:1.76-2.09), female (HR:0.77; 95% CI:0.66-0.89), and low socioeconomic status (HR:1.216; 95% CI:1.114-1.327) were significantly associated with survival. Compared with concurrent chemoradiotherapy, patients who received no treatment (HR, 1.88; 95% CI, 1.31-2.70), neoadjuvant chemotherapy followed by surgery (HR, 1.21; 95% CI, 1.04-1.41), and chemotherapy alone (HR, 1.16; 95% CI, 1.03-1.27) showed poor prognosis in hypopharyngeal cancer. Conclusion: Our data indicated that age, sex, and income were significant predictors of lifetime survival in patients with hypopharyngeal cancer. Treatment modalities were also associated with prognosis. The data have implications for treatment investigations and prevention strategies.

• Archives of Plastic Surgery
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• v.49 no.5
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• pp.569-579
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• 2022

Open and closed rhinoplasty are two main approaches to perform nasal modifications. According to current literature, there is no current consensus among plastic surgeons and otolaryngologists on which technique is preferred in terms of aesthetic result, complications, and patient satisfaction. This study uses published research to determine whether open or closed rhinoplasty leads to superior patient outcomes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews were followed and a literature search was conducted in four databases based on our search strategy. Articles were then imported into COVIDENCE where they underwent primary screening and full-text review. Twenty articles were selected in this study after 243 articles were screened. There were 4 case series, 12 retrospective cohort studies, 1 prospective cohort study, 1 case-control, and 2 outcomes research. There were three cosmetic studies, eight functional studies, and nine studies that included both cosmetic and functional components. Sixteen studies utilized both open and closed rhinoplasty and four utilized open rhinoplasty. Both techniques demonstrated high patient and provider satisfaction and no advantage was found between techniques. Based on available studies, we cannot conclude if there is a preference between open or closed rhinoplasty in terms of which technique leads to better patient outcomes. Several studies determined that open rhinoplasty and closed rhinoplasty leads to comparative patient satisfaction. To make outcome reporting more reliable and uniform among studies, authors should look to utilize the Nasal Obstruction and Septoplasty Effectiveness scale and the Rhinoplasty Outcome Evaluation.

• Journal of Korean Clinical Nursing Research
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• v.28 no.2
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• pp.167-176
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• 2022

Purpose: Driveline infection (DLI) is one of the major adverse events of Left Ventricular Assist Device (LVAD). The purpose of this study was to explore the incidence of DLI according to the driveline dressing methods. Methods: This study was a retrospective cohort study that investigated the medical records of 75 patients who implanted LVAD from January 2015 to December 2020 at a hospital in Seoul, Korea. Traditionally, sandwich dressing method was applied until October 2019, after which newly winded dressing method was adopted for driveline dressing to LVAD patients. The outcome variables were compared between sandwich dressing method applied group (n=41) and winded dressing method applied group (n=34). The follow-up period for DLI was 1 year. Results: When compared participants' characteristics, there was no difference between the two groups, except the type of LVAD device. The incidence of DLI was 17.1% in sandwich dressing group, while no infection was found in winded dressing group (p=.011). Conclusion: Although there were difference in the LVAD devices, it is considered that winded dressing contributed to the reduction of DLI. Further research on standardized dressing methods was required for DLI prevention in Korea.

• Journal of Chest Surgery
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• v.56 no.5
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• pp.336-345
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• 2023

Background: The objective of this study was to demonstrate the safety, efficacy, and feasibility of intraoperative monitoring of the recurrent laryngeal nerves during thoracoscopic and robotic 3-field esophagectomy. Methods: This retrospective analysis details our initial experience using intraoperative nerve monitoring (IONM) during minimally invasive 3-field esophagectomy. Data were obtained from a prospectively maintained database and electronic medical records. The study included all patients who underwent minimally invasive (video-assisted thoracic surgery/robotic) transthoracic esophagectomy with neck anastomosis. The patients were divided into those who underwent IONM during the study period and a historical cohort who underwent 3-field esophagectomy without IONM at the same institution. Appropriate statistical tests were used to compare the 2 groups. Results: Twenty-four patients underwent nerve monitoring during minimally invasive 3-field esophagectomy. Of these, 15 patients underwent thoraco-laparoscopic operation, while 9 received a robot-assisted procedure. In the immediate postoperative period, 8 of 24 patients (33.3%) experienced vocal cord paralysis. Relative to a historical cohort from the same institution, who were treated with surgery without nerve monitoring in the preceding 5 years, a 26% reduction was observed in the nerve paralysis rate (p=0.08). On follow-up, 6 of the 8 patients with vocal cord paralysis reported a return to normal vocal function. Additionally, patients who underwent IONM exhibited a higher nodal yield and a decreased frequency of tracheostomy and bronchoscopy. Conclusion: The use of IONM during minimally invasive 3-field esophagectomy is safe and feasible. This technique has the potential to decrease the incidence of recurrent nerve palsy and increase nodal yield.

• Journal of Periodontal and Implant Science
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• v.53 no.3
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• pp.184-193
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• 2023

Purpose: The present study was designed to compare the incidence of periodontitis according to menopausal status and to investigate the possible effect of hormone replacement therapy (HRT) on periodontitis in postmenopausal women using a common data model (CDM) at a single institution. Methods: This study involved retrospective cohort data of 950,751 patients from a 20-year database (2001 to 2020) of Ewha Womans University Mokdong Hospital converted to the Observational Medical Outcomes Partnership CDM. One-way analysis of variance models and the χ² test were used to analyze the statistical differences in patient characteristics among groups. A time-dependent Cox regression analysis was used to calculate hazard ratios and 95% confidence intervals, and P values less than 0.05 were considered to indicate statistical significance. Results: Of the 29,729 patients, 1,307 patients were diagnosed with periodontitis and 28,422 patients were not. Periodontitis was significantly more common among postmenopausal patients regardless of HRT status than among the non-menopausal group (P<0.05). Time-dependent Cox regression analysis showed that the postmenopausal patients had a significantly higher chance of having periodontitis than non-menopausal patients (P<0.05), but after adjustment for age, body mass index, and smoking status, the difference between the non-menopausal and post-menopausal HRT-treated groups was insignificant (P=0.140). Conclusions: Postmenopausal women had a significantly greater risk of periodontitis than non-menopausal women. Additionally, the use of HRT in postmenopausal women could reduce the incidence of periodontitis.

• Journal of Yeungnam Medical Science
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• v.40 no.4
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• pp.402-411
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• 2023

Background: We hypothesized that fatty liver disease (FLD) is associated with a high prevalence of hearing loss (HL) owing to metabolic disturbances. This study aimed to evaluate the association between FLD and HL in a large sample of the Korean population. Methods: We used a dataset of adults who underwent routine voluntary health checkups (n=21,316). Fatty liver index (FLI) was calculated using Bedogni's equation. The patients were divided into two groups: the non-FLD (NFLD) group (n=18,518, FLI <60) and the FLD group (n=2,798, FLI ≥60). Hearing thresholds were measured using an automatic audiometer. The average hearing threshold (AHT) was calculated as the pure-tone average at four frequencies (0.5, 1, 2, and 3 kHz). HL was defined as an AHT of >40 dB. Results: HL was observed in 1,370 (7.4%) and 238 patients (8.5%) in the NFLD and FLD groups, respectively (p=0.041). Compared with the NFLD group, the odds ratio for HL in the FLD group was 1.16 (p=0.040) and 1.46 (p<0.001) in univariate and multivariate logistic regression analyses, respectively. Linear regression analyses revealed that FLI was positively associated with AHT in both univariate and multivariate analyses. Analyses using a propensity score-matched cohort showed trends similar to those using the total cohort. Conclusion: FLD and FLI were associated with poor hearing thresholds and HL. Therefore, active monitoring of hearing impairment in patients with FLD may be helpful for early diagnosis and treatment of HL in the general population.

• Journal of Chest Surgery
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• v.57 no.3
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• pp.302-311
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• 2024

Background: Unexpected conversion to thoracotomy during planned video-assisted thoracoscopic surgery (VATS) can lead to poor outcomes and comparatively high morbidity. This study was conducted to assess preoperative risk factors associated with unexpected thoracotomy conversion and to develop a risk scoring model for preoperative use, aimed at identifying patients with an elevated risk of conversion. Methods: A retrospective analysis was conducted of 1,506 patients who underwent surgical resection for non-small cell lung cancer. To evaluate the risk factors, univariate analysis and logistic regression were performed. A risk scoring model was established to predict unexpected thoracotomy conversion during VATS of the lung, based on preoperative factors. To validate the model, an additional cohort of 878 patients was analyzed. Results: Among the potentially significant clinical variables, male sex, previous ipsilateral lung surgery, preoperative detection of calcified lymph nodes, and clinical T stage were identified as independent risk factors for unplanned conversion to thoracotomy. A 6-point risk scoring model was developed to predict conversion based on the assessed risk, with patients categorized into 4 groups. The results indicated an area under the receiver operating characteristic curve of 0.747, with a sensitivity of 80.5%, specificity of 56.4%, positive predictive value of 1.8%, and negative predictive value of 91.0%. When applied to the validation cohort, the model exhibited good predictive accuracy. Conclusion: We successfully developed and validated a risk scoring model for preoperative use that can predict the likelihood of unplanned conversion to thoracotomy during VATS of the lung.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.28 no.1
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• pp.80-91
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• 2024

Backgrounds/Aims: Optimal intravenous fluid management during the perioperative period for patients undergoing pancreaticoduodenectomy (PD) within the framework of enhanced recovery after surgery (ERAS) is unclear. Studies have indicated that excessive total body salt and water can contribute to the development of oedema, leading to increased morbidity and extended hospital stays. This study aimed to assess the effects of an intravenous therapy regimen during postoperative day (POD) 0 to 2 in PD patients within ERAS. Methods: A retrospective interventional cohort study was conducted, and it involved all PD patients before and after implementation of ERAS (2009-2017). In the ERAS group, a targeted maintenance fluid regimen of 20 mL/kg/day with a sodium requirement of 0.5 mmoL/kg/day was administered. Outcome measures included the mmol of sodium and chloride administered, length of stay, and morbidity (postoperative pancreatic fistula, POPF; acute kidney injury, AKI; ileus). Results: The study included 169 patients, with a mean age of 64 ± 11.3 years. Following implementation of the intravenous fluid therapy protocol, there was a significant reduction in chloride and sodium loading. However, in the multivariable analysis, chloride administered (mmoL/kg) did not independently influence the length of stay; or rates of POPF, ileus, or AKI (p > 0.05). Conclusions: The findings suggested that a postoperative intravenous fluid therapy regimen did not significantly impact morbidity. Notably, there was a trend towards reduced length of stay within an increasingly comorbid patient cohort. This targeted fluid regimen appears to be safe for PD patients within the ERAS program. Further prospective research is needed to explore this area.

• Journal of Korean Neurosurgical Society
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• v.59 no.2
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• pp.129-136
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• 2016

Objective : The purpose of this study was to figure out the radiologic findings and risk factors related to adjacent segment degeneration (ASD) after anterior cervical discectomy and fusion (ACDF) using 3-year follow-up radiography, computed tomography (CT), and magnetic resonance image (MRI). Methods : A retrospective matched comparative study was performed for 64 patients who underwent single-level ACDF with a cage and plate. Radiologic parameters, including upper segment range of motion (USROM), lower segment range of motion (LSROM), upper segment disc height (UDH), and lower segment disc height (LDH), clinical outcomes assessed with neck and arm visual analogue scale (VAS), and risk factors were analyzed. Results : Patients were categorized into the ASD (32 patients) and non-ASD (32 patients) group. The decrease of UDH was significantly greater in the ASD group at each follow-up visit. At 36 months postoperatively, the difference for USROM value from the preoperative one significantly increased in the ASD group than non-ASD group. Preoperative other segment degeneration was significantly associated with the increased incidence of ASD at 36 months. However, pain intensity for the neck and arm was not significantly different between groups at any post-operative follow-up visit. Conclusion : The main factor affecting ASD is preoperative other segment degeneration out of the adjacent segment. In addition, patients over the age of 50 are at higher risk of developing ASD. Although there was definite radiologic degeneration in the ASD group, no significant difference was observed between the ASD and non-ASD groups in terms of the incidence of symptomatic disease.

• Journal of Periodontal and Implant Science
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• v.46 no.4
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• pp.266-276
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• 2016

Purpose: The aim of the present study was to retrospectively investigate the influence of potential risk indicators on the development of peri-implant disease. Methods: Overall, 103 patients referred for implant treatment from 2000 to 2012 were randomly enrolled. The study sample consisted of 421 conventional-length (>6 mm) non-turned titanium implants that were evaluated clinically and radiographically according to preestablished clinical and patient-related parameters by a single investigator. A non-parametric Mann-Whitney U test or Kruskal-Wallis rank test and a logistic regression model were used for the statistical analysis of the recorded data at the implant level. Results: The diagnosis of peri-implant mucositis and peri-implantitis was made for 173 (41.1%) and 19 (4.5%) implants, respectively. Age (${\geq}65$ years), patient adherence (professional hygiene recalls <2/year) and the presence of plaque were associated with higher peri-implant probing-depth values and bleeding-on-probing scores. The logistic regression analysis indicated that age (P=0.001), patient adherence (P=0.03), the absence of keratinized tissue (P=0.03), implants placed in pristine bone (P=0.04), and the presence of peri-implant soft-tissue recession (P=0.000) were strongly associated with the event of peri-implantitis. Conclusions: Within the limitations of this study, patients aged ${\geq}65$ years and non-adherent subjects were more prone to develop peri-implant disease. Therefore, early diagnosis and a systematic maintenance-care program are essential for maintaining peri-implant tissue health, especially in older patients.