• Journal of Korean Neurosurgical Society
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• 제59권2호
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• pp.117-121
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• 2016

Objective : Hemorrhagic moyamoya disease (hMMD) is associated with a poor clinical course. Furthermore, poorer clinical outcomes occur in cases of recurrent bleeding. However, the effect of hemodynamic insufficiency on rebleeding risk has not been investigated yet. This study evaluated the prognostic implications of the perfusion status during the clinical course of adult hMMD. Methods : This retrospective study enrolled 52 adult hMMD patients between April 1995 and October 2010 from a single institute. Demographic data, clinical and radiologic characteristics, including hemodynamic status using single photon emission computed tomography (SPECT), and follow up data were obtained via a retrospective review of medical charts and imaging. Statistical analyses were performed to explore potential prognostic factors. Results : Hemodynamic abnormality was identified in 44 (84.6%) patients. Subsequent revascularization surgery was performed in 22 (42.3%) patients. During a 58-month (median, range 3-160) follow-up assessment period, 17 showed subsequent stroke (hemorrhagic n=12, ischemic n=5, Actuarial stroke rate $5.8{\pm}1.4%/year$). Recurrent hemorrhage was associated with decreased basal perfusion (HR 19.872; 95% CI=1.196-294.117) and omission of revascularization (10.218; 95%; CI=1.532-68.136). Conclusion : Decreased basal perfusion seems to be associated with recurrent bleeding. Revascularization might prevent recurrent stroke in hMMD by rectifying the perfusion abnormality. A larger-sized, controlled study is required to address this issue.

• Asian Pacific Journal of Cancer Prevention
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• 제15권15호
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• pp.6005-6008
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• 2014

Aim: To compare recurrence rates of large loop excision of the transformation zone (LLETZ) with those of contour-loop excision of the transformation zone (C-LETZ) in the management of cervical intraepithelial neoplasia (CIN). Materials and Methods: The medical records of 177 patients treated consecutively by LLETZ and C-LETZ for CIN at Rajavithi Hospital between 2006 and 2009 were retrospectively reviewed. Results: Of the 87 women in the C-LETZ group, 2 cases (2.30%) had recurrence compared with 13 cases (14.4%) of the 90 women in the LLETZ group, the higher recurrence rate in the latter being statistically significant (p<0.05). Median times of follow up in the C-LETZ and LLETZ groups were 12 months and 14 months respectively (p>0.05). The C-LETZ group showed less intraoperative bleeding compared to the LLETZ group, but the rate of achievement of single specimens and positive margins were similar in the two groups. Conclusions: The present study demonstrated the superiority of C-LETZ over LLETZ in terms of efficacy; C-LLETZ is associated with a lower recurrence rate and also carries a smaller risk of intraoperative bleeding than LLETZ. The rotating technique still has a potential role in treating precancerous lesions of the cervix.

• Journal of Oral Medicine and Pain
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• 제48권4호
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• pp.169-173
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• 2023

Hemangioma is a lesion characterized by vascular proliferation of endothelial origin, manifesting neoplastic features. The occurrence of central hemangioma in the oral and maxillofacial region is exceptionally rare, and in two-thirds of cases, it is predominant in the mandible rather than the maxilla. The main symptoms and signs associated with central hemangiomas include pulsation, bone expansion, bruit, teeth displacement, and root resorption of the adjacent teeth. Bleeding may manifest periodically from the sulcus surrounding the affected teeth, particularly when accompanied by hypermobility in the primary dentition. One of the most noteworthy complications is the potential for severe bleeding during tooth extraction or surgical procedures conducted in proximity to unrecognized hemangiomas. Such situations may pose a life-threatening risk. Taking this into consideration, we present two cases of central hemangiomas in adolescent patients who sought consultation, with subsequent embolization performed by the Department of Radiology in Chosun University Hospital.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제45권6호
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• pp.343-350
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• 2019

Objectives: The aims of this study were to determine the effectiveness of local compression in patients presenting to the emergency room with intraoral bleeding and to identify when complex haemostatic measures may be required. Materials and Methods: Five hundred forty patients who had experienced intraoral haemorrhage were retrospectively reviewed. The outcome variable was the haemostasis method used, i.e., simple (local compression with gauze) or complex (an alternative method after local compression has failed). Predictor variables were sex, age, American Society of Anesthesiologists (ASA) class, hepatic cirrhosis, bleeding disorder, use of antithrombotic agents, and site/cause of haemorrhage. Results: The mean patient age was 48.9±23.9 years, 53.5% were male, 42.8% were ASA class II or higher, and 23.7% were taking antithrombotic agents. Local compression was used most often (68.1%), followed by local haemostatic agents, sutures, systemic tranexamic acid or blood products, and electrocautery. The most common site of bleeding was the gingiva (91.7%), and the most common cause was tooth extraction (45.7%). Risk factors for needing a complex haemostasis method were use of antithrombotic agents (odds ratio 2.047, P=0.009) and minor oral surgery (excluding extraction and implant procedures; odds ratio 6.081, P=0.001). Conclusion: A haemostasis method other than local compression may be needed in patients taking antithrombotic agents or having undergone minor oral surgery.

• 대한치과의사협회지
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• 제48권1호
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• pp.38-44
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• 2010

Nowadays, medically compromised patients who could not receive dental treatments in the past are able to go through minor oral surgeries with adequate preoperative measures. Thorough understanding of the systemic disease and its complications is needed as well as the management them. Frequent complications of surgical procedures are bleeding, infection, delayed healing, systemic reactions by stress and they can be aggravated due to the patients' systemic conditions. Therefore, understanding of the systemic disease of patient visiting dental office and treatment modification according to the systemic status is needed. Also consultation to the medical doctor is imperative, through which perioperative risk and complications can be reduced. Among the high frequency complications of dental treatment of medically compromised patients, bleeding, infection, delayed healing, systemic reactions by stress will be discussed with the management of each one.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제12권2호
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• pp.221-225
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• 2009

저자들은 구토와 심와부 통증을 주소로 내원한 12세 여아에서 복부 전산화 단층촬영을 시행하여 급성 췌장염과 함께 동반된 비정맥 혈전증을 진단하였고, 정맥류출혈이나 비장 비대 등의 증상을 보이지 않아 보존적치료 후 추적 관찰한 증례를 경험하였기에 보고하는 바이다.

• Clinical and Experimental Reproductive Medicine
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• 제39권4호
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• pp.187-192
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• 2012

Heterotopic pregnancy is rare event and the risk is increased with assisted reproductive technology procedures. Heterotopic cervical pregnancy is even more unusual. We report a rare case of heterotopic cervical pregnancy that was managed successfully. A 36-year-old women who conceived by IVF-ICSI was diagnosed with heterotopic cervical pregnancy. She visited the emergency room with vaginal bleeding at 5 weeks of gestation and underwent careful intracervical gestational sac reduction with forceps under abdominal guidance the next day. The postoperative course was uneventful and with regular check-ups, the intrauterine pregnancy (IUP) progressed unremarkably through 41 weeks with delivery of a healthy newborn. We reviewed a total of 37 cases of heterotopic pregnancy that have been reported in the English language literature. There have been many attempts to eliminate the cervical embryo while preserving the IUP, and complete cervical evacuation is important in order to avoid infection, bleeding, and premature birth.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.42.1-42.5
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• 2015

In the field of oral-maxillofacial surgery, vascular malformations present in various forms. Abnormalities in the size of the tongue by vascular malformations can cause mandibular prognathism and skeletal deformity. The risk in surgical treatment for patients with vascular malformation is high, due to bleeding from vascular lesions. We report a rare case of macroglossia that was treated by partial glossectomy, resulting in an improvement in the swallowing and mastication functions in the patient. A 25-year-old male patient with severe open-bite and mandibular prognathism presented to our department for the management of macroglossia. The patient had a difficulty in food intake because of the large tongue. Orthognathic surgery was not indicated because the patient had severe jaw bone destruction and alveolar bone resorption. Therefore, the patient underwent partial glossectomy under general anesthesia. There was severe hemorrhaging during the surgery, but the bleeding was controlled by local procedures.

• Journal of Trauma and Injury
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• 제26권3호
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• pp.238-242
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• 2013

Idiopathic thrombocytopenic purpura (ITP) is the condition of having an abnormally low platelet count with an unknown cause. Acute subdural hematomas (ASDHs) usually develop in trauma patients and often involve a high bleeding tendency. However, ITP patients rarely have a large ASDH, and when a traditional decompressive craniectomy is performed on patients with coagulopathy, the mortality rate is higher because of the greater bleeding risk. We report the case of an ITP patient with a large ASDH who treated with a burr-hole trephination and irrigation and who was discharged without any neurological deficit.

• 한국임상약학회지
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• 제32권3호
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• pp.238-250
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• 2022

Objective: The aim of this study was to examine the impact of ATP-binding cassette subfamily B member 1 (ABCB1) C3435T polymorphism on the treatment response of patients to vitamin K antagonists (VKAs). Methods: In this systematic review and meta-analysis, the PubMed/Medline, Embase, and Cochrane Library databases were searched for eligible articles for the period up to November 2020. Articles that reported treatment response to VKAs according to the ABCB1 C3435T polymorphism were included in this study. Results: A total of 13 and 9 articles were included in the systematic review and meta-analysis, respectively. The weekly maintenance dose of warfarin was significantly lower in patients with the ABCB1 3435CT or TT polymorphism type than in those with the ABCB1 3435CC type (weighted mean difference [WMD], -2.53 mg/week; 95% confidence interval [CI], -3.64 to -1.43, p<0.001). However, the weekly maintenance dose of acenocoumarol was not significantly associated with the ABCB1 C3435T polymorphism (WMD, 1.02; 95% CI, -0.61 to 2.65, p=0.22). Conclusion: The ABCB1 C3435T polymorphism was significantly associated with the weekly maintenance dose of warfarin. Further research is needed to confirm the association between the ABCB1 C3435T polymorphism and the incidence rate of bleeding events.