• 제목/요약/키워드: Surgery-first approach

검색결과 243건 처리시간 0.026초

Two Cases of Advanced Gastric Carcinoma Mimicking a Malignant Gastrointestinal Stromal Tumor

  • Shin, Ha Song;Oh, Sung Jin;Suh, Byoung Jo
    • Journal of Gastric Cancer
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    • 제15권1호
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    • pp.68-73
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    • 2015
  • Gastric cancer that mimics a submucosal tumor is rare. This rarity and the normal mucosa covering the protuberant tumor make it difficult to diagnosis with endoscopy. We report two cases of advanced gastric cancer that mimicked malignant gastrointestinal stromal tumors preoperatively. In both cases, the possibility of cancer was not completely ruled out. In the first case, a large tumor was suspected to be cancerous during surgery. Therefore, total gastrectomy with lymph node dissection was performed. In the second case, the first gross endoscopic finding was of a Borrmann type II advanced gastric cancer-like protruding mass with two ulcerous lesions invading the anterior wall of the body. Therefore, subtotal gastrectomy with lymph node dissection was performed. Consequently, delayed treatment of cancer was avoided in both cases. If differential diagnosis between malignant gastrointestinal stromal tumor and cancer is uncertain, a surgical approach should be carefully considered due to the possible risk of adenocarcinoma.

경동맥 협착을 동반한 관상동맥 질환의 수술적 치료 -2례 보고- (Surgical Management of Coronary Artery Disease Combined with Carotid Artery Stenosis -A Report of Two Cases-)

  • 이창하
    • Journal of Chest Surgery
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    • 제28권9호
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    • pp.876-880
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    • 1995
  • The optimal surgical approach to the patients with coronary artery disease combined with carotid artery stenosis is controversial. We report two cases of successful surgical management of the patients with combined obstructive coronary and carotid artery disease. The first case was a 69-year-old female who had unstable angina pectoris and a past medical history of left carotid endarterectomy. She was revealed to have triple vessel coronary disease and nearly total occlusion of right internal carotid artery. She was undergone staged right carotid endarterectomy 10 days before coronary bypass surgery. The second case, a 54-year-old male with a past medical history of left hemiparesis and dysarthria, was admitted due to unstable angina pectoris. He was revealed to have triple-vessel coronary disease and more than 90% stenosis of left internal carotid artery and 50% stenosis of right internal carotid artery. In the latter case, a combined coronary bypass surgery and left carotid endarterectomy was done. In both cases, postoperative neurologic complications were not observed.

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Successful Treatment of Severe Sympathetically Maintained Pain Following Anterior Spine Surgery

  • Woo, Jae Hee;Park, Hahck Soo
    • Journal of Korean Neurosurgical Society
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    • 제56권1호
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    • pp.66-70
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    • 2014
  • Sympathetic dysfunction is one of the possible complications of anterior spine surgery; however, it has been underestimated as a cause of complications. We report two successful experiences of treating severe dysesthetic pain occurring after anterior spine surgery, by performing a sympathetic block. The first patient experienced a burning and stabbing pain in the contralateral upper extremity of approach side used in anterior cervical discectomy and fusion, and underwent a stellate ganglion block with a significant relief of his pain. The second patient complained of a cold sensation and severe unexpected pain in the lower extremity of the contralateral side after anterior lumbar interbody fusion and was treated with lumbar sympathetic block. We aimed to describe sympathetically maintained pain as one of the important causes of early postoperative pain and the treatment option chosen for these cases in detail.

Current Issues in Minimally Invasive Esophagectomy

  • Na, Kwon Joong;Kang, Chang Hyun
    • Journal of Chest Surgery
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    • 제53권4호
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    • pp.152-159
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    • 2020
  • Minimally invasive esophagectomy (MIE) was first introduced in the 1990s. Currently, it is a widely accepted surgical approach for the treatment of esophageal cancer, as it is an oncologically sound procedure; its advantages when compared to open procedures, including reduction in postoperative complications, reduction in the length of hospital stay, and improvement in quality of life, are well documented. However, debates are still ongoing about the safety and efficacy of MIE. The present review focuses on some of the current issues related to conventional MIE and robot-assisted MIE based on evidence from the current literature.

Hybrid Approach for Treatment of Multiple Traumatic Injuries of the Heart, Aorta, and Abdominal Organs

  • Kim, Seon Hee;Song, Seunghwan;Cho, Ho Seong;Park, Chan Yong
    • Journal of Chest Surgery
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    • 제52권5호
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    • pp.372-375
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    • 2019
  • A 55-year-old man was admitted to the trauma center after a car accident. Cardiac tamponade, traumatic aortic injury, and hemoperitoneum were diagnosed by ultrasonography. The trauma surgeon, cardiac surgeon, and interventional radiologist discussed the prioritization of interventions. Multi-detector computed tomography was carried out first to determine the severity and extent of the injuries, followed by exploratory sternotomy to repair a left auricle rupture. A damage control laparotomy was then performed to control mesenteric bleeding. Lastly, a descending thoracic aorta injury was treated by endovascular stenting. These procedures were performed in the hybrid-angio room. The patient was discharged on postoperative day 135, without complications.

Osteoradionecrosis of Jaw in Head and Neck Cancer Patient Treated with Free Iliac Bone and Umbilical Fat Pad Graft

  • Choi, Yuri;Kim, Su-Gwan;Moon, Seong-Yong;Oh, Ji-Su;You, Jae-Seek;Jeong, Kyung-In;Lee, Sung-Seok
    • Maxillofacial Plastic and Reconstructive Surgery
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    • 제36권2호
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    • pp.62-66
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    • 2014
  • Osteoradionecrosis is one of the most serious complications of patients receiving radiation therapy. It is characterized by hypovascularity, hypocellularity, and hypoxia-inducing necrosis of bone and soft tissue following delayed healing. In this case, a 72-year-old man was referred to the Department of Oral and Maxillofacial Surgery complaining of trismus following extraction three months before first visit. He had a history of right tonsillectomy, radical neck dissection and radiotherapy performed due to right tonsillar cancer seven years prior. After the diagnosis of osteoradionecrosis on right mandibular body and angle, conservative antibiotic therapy was used first, but an orocutaneous fistula gradually formed, and extensive bony destruction and sequestrum were observed. Sequestrectomy, free particulated iliac bone and umbilical fat pad graft were performed via a submandibular approach under general anesthesia. Preoperative regular exams and delicate wound care led to secondary healing of the wound without vascularized free flap reconstruction.

Bisphosphonate-related osteonecrosis of jaw의 치료에 대한 고찰 (Consideration for treatment of bisphosphonate-related osteonecrosis of the jaw)

  • 유경하;윤규호;배정호;박재안;박군찬;신재명;백지선;정정권
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • 제36권3호
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    • pp.206-210
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    • 2010
  • Bisphosphonates are widely used to treat osteoporosis, hypercalcemia of malignant tumor. Despite their clinical benefit, bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a newly documented complication to patients receiving these drugs and first recognized by Marx in 2003. Thus, consideration of prevention and needs regarding unequivocal treatment regimen have emerged. Recently, several authors emphasized reports on appropriate clinical availability of surgical approach. It serves to concern about guideline for surgical and conservative treatment modalities. So, it is the purpose of this paper to review the current literatures about treatment regimens of BRONJ.

한국 구강악안면외과 수련병원의 구순구개열 환자의 치료경향에 관한 조사 (A survey of trend in cleft lip and palate management in oral & maxillofacial surgery in Korea.)

  • 최진영;정재화;민병일
    • 대한구순구개열학회지
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    • 제3권2호
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    • pp.67-73
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    • 2000
  • The purpose of this survey was to obtain an overall view of the status of cleft lip and palate management in Oral and Maxillofacial Surgery(OMFS) in Korea. Korea Cleft lip and Palate Association conducted mailed survey which was composed of 29 questions conceming pre-operative and post-operative management in CLP surgery and completed by 58 training hospital. Of 58 questionnaires sent, 23 were returned(response rate of 40%). Authors compared this results with those of other similar surneys, which reveal much difference between OMFS and Plastic Surgery(PS) in CLP treatment. In OMFS, many surgeons were in favor of presugical orthopaedics than lip adhesion to manage protruded premaxilla. It reflects interdisciplinary team approach between OMFS and orthodontic department reduces the need of lip adhesion through presurgical orthopaedics. Timing of palatal surgery was later than that of PS, which reflects concern for an impediment of maxillaty growth. To our knowledge, this survey may be the first on organization and management for cleft patient in OMFS in Korea.

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Pott's puffy tumor of the upper eyelid misdiagnosed as simple abscess: a case report and literature review

  • Kuylhee Kim;Donghyun Lee;Soyeon Jung;Chul Hoon Chung;Yongjoon Chang
    • 대한두개안면성형외과학회지
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    • 제25권3호
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    • pp.141-144
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    • 2024
  • A 76-year-old woman, initially thought to have a simple abscess on her right upper eyelid, presented to our department of plastic and reconstructive surgery. Enhanced three-dimensional facial computed tomography (CT) revealed an abscess on the right upper lid, with a pyomucocele present in the right frontal sinus, accompanied by bone erosion in the superior wall of the right orbit. Based on the results of the CT scan, we diagnosed an atypical Pott's puffy tumor (PPT) with an abscess on the upper lid originating from the frontal sinusitis. First, surgical incision and drainage were performed in our department, and a percutaneous vacuum drain was placed. To provide a more definitive treatment, endoscopic sinus surgery (ESS) was subsequently performed by otorhinolaryngologists. The patient was discharged without any complications 5 days after ESS. At a 1-year follow-up, no recurrence or notable neurological symptoms were observed. In the case we observed, the patient presented with an upper eyelid abscess and cellulitis, indicating possible orbital involvement. For such patients, a CT scan is necessary. Given the possibility of PPT, it is critical to perform a comprehensive differential diagnosis rather than defaulting to a straightforward approach involving abscess treatment.

안와하연 골절에서 눈썹하절개 경로를 통한 접근 후 발생하는 하안검 뒤당김과 공막의 노출 (Lower Eyelid Retraction and Scleral Show induced by Subciliary Approach in Inferior Orbital Rim Fracture)

  • 박용준
    • Archives of Plastic Surgery
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    • 제34권6호
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    • pp.724-728
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    • 2007
  • Purpose: The objective of this study is to prevent postoperative lower eyelid retraction and scleral show. There are several approaches for orbital rim reconstruction. But these techniques are sometimes difficult to perform, and have some merits and faults. Maybe most common unwanted and unpleasant result that we have experienced by subciliary incision preseptal approach is the lower eyelid retraction and the scleral show. Therefore, I want to find out the causes and the solutions for such complication. We must know the mechanics for those unpleasant result first of all. Methods: We conducted a comparison of postoperative photographs between retroseptal approach group and preseptal approach group, both with subciliary incision. In experimental retroseptal group, incision was applied at subciliary region. After elevating skin flap to preserve pretarsal muscle, not with muscle flap elevation, but direct oblique incision through the muscle, retroseptal dissection was applied to the ROOF and the septum. Fixating fracture line, periosteal and septal repair was followed by skin repair. The light compressive dressings and protection were kept in place for 7 days. The effectiveness of this operative method was made comparison with control group which the preseptal approach was applied to, by postoperative 2nd week and 2nd month. Results: Author's technique had been used in 20 patients and control group was composed of 50 patients over 19months period. There were better results in experimental group than in control group and all of experimental group had no complaint about the lower eyelid retraction and the scleral show. Conclusion: It must be known about the reason of the lower eyelid retraction and the scleral show induced by subciliary and preseptal approach. Mechanically it can be easily proved. And the solution maybe will be easier if we get more information about the mechanics. I recommend the retroseptal subciliary approach