• Archives of Plastic Surgery
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• 제37권4호
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• pp.452-456
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• 2010

Purpose: The schwannoma is a benign peripheral nerve tumor arising from the Schwann cell of the nerve sheath. Only 2-8% of schwannomas arise in the hand and wrist. Misdiagnosis is frequent such as ganglion and neurofibroma. This article documents and clarifies the clinical features of schwannomas arising in the hand and wrist, and emphasizes importance of differential diagnosis and meticulous surgical extirpation under magnification. Methods: The author reviewed clinical features of 15 patients with pathologic final diagnosis of schwannoma developed in hand and wrist during the last 12 years from 1998 through 2009. The review included the sex, age of onset, duration, preoperative diagnosis, location, involved nerve, preoperative symptoms and. Postoperative sequelae after surgical extirpation of the lesion with magnification, or without magnification of the surgical fields. Results: The chief complaints were slow growing firm mass in all patients, and followed by pain in 40%, and paresthesia in 40% respectively. The lesions were developed solitarily in 14 patients (93%). The postoperative pathologic diagnosis and preoperative diagnosis were coincided with only in 6 patients (40%). Other preoperative diagnosis were soft tissue tumor in 4 patient (26.6%), and ganglion in 3 patients (20%), and neurofibroma in 2 patients (13%). In all patients who were undergone surgical excision under the fields of magnification, all symptoms were subsided without any sequelae. Meanwhile muscle weakness, paresthesia, hypoesthesia and /or accidental nerve resection developed after surgical excision with naked eye. Conclusion: Schwannoma in hand most commonly appears as a slow growing solitary mass with pain or paresthesia. The chance of preoperative misdiagnosis was 60% in this series. To provide good prognosis and less sequelae, careful and elaborate diagnostic efforts and meticulous surgical excision under the magnification are necessary in management of schwannoma.

• 성인간호학회지
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• 제23권2호
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• pp.180-188
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• 2011

Purpose: This study was to identify nursing diagnosis-outcome-intervention (NANDA- NOC-NIC: NNN) linkages applied to inpatients in general surgical nursing units. Methods: We developed the NNN linkage computerized nursing process program, which consisted of the 107 nursing outcomes and the 190 nursing interventions linked to the 39 nursing diagnoses. This program was applied to 324 patients who admitted to those nursing units from July, 2004 to February, 2005. Results: First, nursing outcomes of each nursing diagnosis were identified as follows: for 'acute pain', pain control, pain level, and comfort level; for 'risk for infection', wound healing: primary intention, wound healing: secondary intention, and infection status; for 'nausea', nutritional status: food & fluid intake, comfort level, symptom severity and hydration. Second, major nursing interventions for each nursing outcome were analyzed as follows: for pain control or comfort level, pain management and medication management; for pain level, pain management and analgesic administration; for wound healing: primary intention, incision site care and wound care; for Wound healing: secondary intention or infection status, infection control; for nutritional status: food & fluid intake, fluid monitoring; for comfort level, nausea management; for symptom severity, nausea management and vomiting management; for hydration, fluid/electrolyte management. Conclusion: This identified NNN linkages will facilitate the use of nursing process in surgical nursing practice and documentation systems.

• 한국건강관리협회지
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• 제1권1호
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• pp.21-25
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• 2003

Vomiting in pediatric patient is frequently encountered problem in emergency room or outpatient clinic. In differential diagnosis, age of the patient or accompanying symptoms should be considered in the differential diagnosis. Accurate diagnosis is very important because surgical treatment is necessary in some of the conditions. Imaging diagnosis of conservative modality such as upper gastrointestinal series or colon study is still important radiological examination in the initial differential diagnosis, but recently ultrasonography offers accurate diagnosis in many situations. The cause of vomiting in pediatric are diverse according to the age group :neonatal sepsis, necrotizing enterocolitis, or hypertrophic pyloric stenosis in neonates : gastroesophageal reflux, viral enteritis, or intussusception in infant: midgut volvulus, appendicitis, metabolic disorders, or increased intracranial pressure also an be the cause. knowledge of radiological findings of normal gastrointestinal tract is important to recognize abnormalities. A discussion of radiological findings in variable surgical conditions to present as vomiting in pediatric patients is offered.

• Advances in pediatric surgery
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• 제10권2호
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• pp.87-91
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• 2004

As prenatal ultrasonography becomes popular, the number of prenatal diagnosis of congenital surgical diseases is also increasing. To evaluate the impact of antenatal ultrasonography on outcome the mortality rate in neonatal surgical emergencies was studied. The authors retrospectively reviewed 281 patients (congenital diaphragmatic hernia: 44, tracheoesophageal fistula: 78, intestinal atresia: 98, omphalocele: 28 and gastroschisis: 33 who had been managed at Seoul National University Childrens Hospital, from January 1991 to December 2000. The patients were divided into two groups; group A (1991 to 1995; 139 patients) and group B (1996 to 2000; 142 patients). These two groups were subdivided into prenatally diagnosed subgroup and postnatally diagnosed subgroup. We analyzed the changes of prenatal diagnosis rate, total mortality rate, and mortality rate of subgroups. Prenatal diagnosis rate was increased significantly in group B (Group A: 24.5 % and Group B: 45.1 %). Total mortality rate of group A was 21.6 %, and that of group B was 10.6 %, showing a significant decrease in group B. However, in both group A and B, when compared antenatally diagnosed subgroup with postnatally diagnosed subgroup, the mortality rate was lower in postnatally diagnosed subgroups but statistically not significant. The authors conclude that although prenatal diagnosis rate has been increased, prenatal diagnosis itself has not resulted in significant improvement in outcome.

• 한국간담췌외과학회지
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• 제27권1호
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• pp.102-106
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• 2023

Hepatocellular carcinoma (HCC) accounts for most of the hepatic neoplasms and can also occur in ectopic liver tissue. We present a case of a 55-year-old male complaining of weight loss. The imaging studies reported a 2.9 cm nodule in the pancreatic body, with a neuroendocrine tumor diagnosis by cytology. A corpo-caudal pancreatectomy was performed. Pathology showed a well-differentiated HCC developed in ectopic liver tissue with free margins and no lymph node metastases. HCC presenting in ectopic liver tissue is rare. In this case, the preoperative study did not establish the diagnosis, warranting the need for suspicion of this neoplasm.

• Advances in pediatric surgery
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• 제15권1호
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• pp.38-43
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• 2009

With the widespread use of the obstetrical ultrasound, identification of a fetal suprarenal mass becomes more common. Most of these masses prove to be congenital neuroblastomas (CNB) postnatally. However, the diagnosis is often confused with other benign lesions and the post-natal management remains controversial. The medical records of 13 patients that underwent primary surgical excision for an antenatally detected adrenal CNB, between January 1995 and April 2009, were reviewed retrospectively. The clinical, radiological, surgical, and pathological data on the suprarenal mass were collected. Staging evaluation was performed after histological confirmation of the CNB. Most of the CNBs were stage I (N=11), with 1 stage IV and 1 stage IV-S. Four patients (3 stage I and 1 stage IV-S) had N-myc gene amplification. The stage I patients were cured by surgery alone, and stage IV patients underwent 9 cycles of adjuvant chemotherapy and currently have no evidence of disease after 39 months of follow-up. The patient with stage IV-S is currently receiving chemotherapy. There were no post-operative complications. For early diagnosis and treatment, surgical excision should be considered as the primary therapy for an adrenal CNB detected before birth. The surgery can be safely performed during the neonatal period and provides a cure in most cases. Surgical diagnosis and treatment of CNB is recommended in neonatal period.

• Advances in pediatric surgery
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• 제7권1호
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• pp.37-41
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• 2001

In hepatoblastoma, encouraging cure rates have been achieved with recent advances in chemotherapy and surgical techniques, The aim of this study is to evaluate the role of combined therapeutic modalities and surgical resection in hepatoblastoma. Fifteen cases of hepatoblastoma were treated from January 1993 to August 2000. Six patients had resectable tumors at initial diagnosis. All underwent surgical resection and in four patients postoperative adjuvant chemotherapy was needed. Nine out of 15 patients had unresectbale tumors at initial diagnosis, and preoperative chemotherapy was applied. There was one operative mortality and 14 patients showed good prognosis after surgery. Although various treatment modalities should be combined for the unresectable hepatoblastoma. surgical resection remains the major curative procedure.

• Journal of Gastric Cancer
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• 제9권3호
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• pp.104-109
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• 2009

목적: 조기위암 및 림프절 전이에 대한 수술 중 외과적 병기판정의 정확도에 대하여 분석하고, 외과적 병기에 근거한 수술 범위 판단의 유용성에 대하여 조사하고자 하였다. 대상 및 방법: 2006년에서 2007년까지 위암으로 위 절제술을 시행 받은 369명을 대상으로 조기위암 및 림프절 전이에 대한 수술 전 검사 및 외과적 병기판정의 민감도, 특이도 및 정확도를 비교 분석하였다. 결과: 조기위암에 대한 외과적 병기판정의 민감도, 특이도, 정확도는 각각 74.5%, 95.7%, 83.7%였으며 양성 예측도는 95.7%였다. 이는 수술 전 검사에 의한 조기위암의 진단에 비하여 높은 특이도와 양성 예측도를 보였다. 림프절 전이에 대한 외과적 병기판정의 민감도, 특이도 및 정확도는 73.2%, 78.1%. 76.4%였다. 127명의 림프절 전이 환자 중 수술 전 진단에서 59명(46.5%)이, 외과적 병기판정에 의해서는 34명(26.8%)만이 림프절 전이 없음으로 저 평가되었다. 조기위암의 진단에서 술 전 진단과 외과적 병기 사이에 불일치를 보인 70예 가운데, 63예(90%)는 외과적 병기판정이, 7예(10%)는 수술 전 진단이 정확하였다. 결론: 수술 중 외과의사에 의한 외과적 병기판정은 조기 위암 및 림프절 전이에 대하여 수술 전 검사에 비하여 높은 정확도를 보이고 진행위암의 조기위암으로의 저 평가를 현저히 줄인다. 따라서 위암의 수술 시 외과적 병기는 수술 범위를 결정하는데 있어서 중요한 인자로 고려되어야 한다.

• Journal of Periodontal and Implant Science
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• 제45권3호
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• pp.82-93
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• 2015

Purpose: This retrospective study evaluated the relationship between the timing of peri-implantitis diagnosis and marginal bone level after a 5-year follow-up of non-surgical peri-implantitis treatment. Methods: Thirty-three patients (69 implants) were given peri-implantitis diagnosis in 2008-2009 in Seoul National University Bundang Hospital. Among them, 31 implants from 16 patients were included in this study. They were treated non-surgically in this hospital, and came for regular maintenance visits for at least 5 years after peri-implantitis treatment. Radiographic marginal bone levels at each interval were measured and statistical analysis was performed. Results: Timing of peri-implantitis was one of the significant factors affecting initial bone loss and total bone loss not additional bone after peri-implantitis diagnosis. Patients with cardiovascular disease and diabetic mellitus were positively influenced on both initial bone loss and total bone loss. Patients who needed periodontal treatment after implant placement showed a negative effect on bone loss compared to those who needed periodontal treatment before implant placement during entire periods. Implant location also significantly influenced on amounts of bone loss. Mandibular implants showed less bone loss than maxillary implants. Among surgical factors, combined use of autogenous and xenogenic bone graft materials showed a negative effect on bone loss compared to autogenous bone graft materials. Use of membrane negatively affected on initial bone loss but positively on additional bone loss and total bone loss. Thread exposure showed positive effects on initial bone loss and total bone loss. Conclusions: Early peri-implantitis diagnosis led to early non-surgical intervention for peri-implantitis treatment, which resulted in the maintenance of the bone level as well as preservation of the implant.

• 대한족부족관절학회지
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• 제17권3호
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• pp.215-219
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• 2013

Purpose: To review the outcomes of surgical treatment for superficial peroneal nerve entrapment. Materials and Methods: Ultrasonogram was used for diagnosis and surgical treatment. Seven superficial peroneal nerve entrapment were surgically treated with follow up of average 16 months (range, 6~29 months). Three patients were male and four patients were female with mean age 36.7 years (range, 19~51 years). Four cases developed after repetitive ankle sprain and three cases had no etiology. Results: Operation was performed mini-open and subcutaneous fasciotomy under local anesthesia. The results were excellent in two cases, good in four cases, fair in one case. Conclusion: Ultrasonogram was useful for diagnosis and surgical treatment of superficial peroneal nerve entrapment syndrome.