• Journal of Veterinary Clinics
• /
• 제39권5호
• /
• pp.277-281
• /
• 2022

The dog with tetraplegia was presented for magnetic resonance imaging and cervical ventral slot decompression. Intra-abdominal pressure (IAP) was measured every hour after surgery, along with respiratory rate, heart rate, and arterial pressure. Three hours after surgery, abdominal distension with agitation and respiratory distress were observed, and IAP rose to 12 mmHg, indicating mild intra-abdominal hypertension (IAH). Additional fentanyl and ketamine CRI did not alleviate IAH and acepromazine (0.01 mg/kg, IV) was administered to alleviate the agitation and respiratory distress. After acepromazine administration, the agitation subsided and IAP dropped to 4 mmHg. During the next 24 hours, the patient's vital signs and IAP remained stable, with normal urine output. This case report suggests the possibility of postoperative IAH monitoring in dogs. However, considering the nature of a single surgical case of cervical ventral slot, further study is required for indication of IAH monitoring.

• Tuberculosis and Respiratory Diseases
• /
• 제86권4호
• /
• pp.245-250
• /
• 2023

The healing process of tracheobronchial tuberculosis (TB) results in tracheobronchial fibrosis causing airway stenosis in 11% to 42% of patients. In Korea, where pulmonary TB is still prevalent, post-TB tracheobronchial stenosis (PTTS) is one of the main causes of benign airway stenosis causing progressive dyspnea, hypoxemia, and often life-threatening respiratory insufficiency. The development of rigid bronchoscopy replaced surgical management 30 years ago, and nowadays PTTS is mainly managed by bronchoscopic intervention in Korea. Similar to pulmonary TB, tracheobronchial TB is treated with combination of anti-TB medications. The indication of rigid bronchoscopy is more than American Thoracic Society (ATS) grade 3 dyspnea in PTTS patients. First, the narrowed airway is dilated by multiple techniques including ballooning, laser resection, and bougienation under general anesthesia. Then, most of the patients need silicone stenting to maintain the patency of dilated airway; 1.5 to 2 years after indwelling, the stent could be removed, this has shown a 70% success rate. Acute complications without mortality develop in less than 10% of patients. Subgroup analysis showed successful removal of the stent was significantly associated with male sex, young age, good baseline lung function and absence of complete one lobe collapse. In conclusion, rigid bronchoscopy could be applied to PTTS patients with acceptable efficacy and tolerable safety.

• Clinical Endoscopy
• /
• 제57권4호
• /
• pp.501-507
• /
• 2024

Background/Aims: Polyps greater than 30 mm are classified as "giants". Their endoscopic removal represents a technical challenge. The choice of the endoscopic removal technique is important because it provides a resection sample for precise histopathological staging. This is pivotal for diagnostic, prognostic, and management purposes. Methods: From a retrospective analysis, we obtained a sample of 38 giant polyps. Eighteen polypectomies were performed using the epinephrine volume reduction (EVR) method, nine polypectomies utilized endo-looping or clipping methods, and 11 patients underwent surgery. Results: We obtained en bloc resection with the EVR method in all cases; histology confirmed the correct indication for endoscopic resection in all cases. Moreover, no early or delayed complications were observed, and no patient required hospitalization. Using endo-looping or clipping methods, we observed advanced histology in 1/9 (11.1%) cases, while another patient (1/9, 11.1%) had delayed bleeding. Among patients who underwent surgery, 5/11 (45.5%) were deemed overtreated and three had post-surgical complications. Conclusions: We propose EVR as an alternative technique for giant polyp resection due to its safety, effectiveness, cost-efficiency, and the advantage of avoiding the need to postpone polypectomy to a later time. Further prospective studies might help improve this experience and enhance the technique.

• Journal of Chest Surgery
• /
• 제31권12호
• /
• pp.1195-1199
• /
• 1998

Bafckground: Thr role and indication of surgery in the treatment of small cell lung cancer(SCLC) is currently limited and unsettled. Material and Method: We analyzed the surgical results of 9 patients with SCLC at Yosei Medical Center from January 1990 to December 1996. There were 8 males and 1 female, and their mean age was 57.2 years (range; 35-76). Preoperatively SCLC was confirmed in 5, but the other 4 cases were diagnosed as undifferentiated squamous cell carcinoma. All patients underwent pulmoinary resection(lobectomy;5, lobectomy, segmentectomy and en-bloc resection of rib;1, bilobectomy; 2, pneumonectomy;1) and mediastinal lymph node dissection. Results: There were no operative mortality with two complications(postoperative bleeding;1, arrhythmia;1). All cases were diagnosed as SCLC histologically and their TNM staging were confirmed as follows: T1N0M0;1, T2N0M0;4, T3N0M0;1, T3N1M0;1, T2N2M0; 1, T4N0M0;1. All patients had received postoperative chemotherapy, and radiotherapy was combined in 4 patients. During follow up period(range 1-63 months; mean 33.0months), there was only one metastasis to pelvic bone among 8 patients without lymph node metastasis, and all patients were alive. On the other hand, among 3 patients who had regional and/or mediastinal lymph node metastasis or T4 lesion, all patients had recurrences(local;2, brain;1), and 2 patients died. Conclusion: We suggest that the use of TNM staging is beneficial, and surgical resection should be recommended in the patients with early staged SCLC as an important treatment modality.

• Advances in pediatric surgery
• /
• 제16권2호
• /
• pp.126-133
• /
• 2010

Malrotation is a congenital anomaly that becomes symptomatic more frequently during infancy. The indication for surgical treatment at that age is straightforward. In older children, the diagnosis may be more difficult because of chronic and vague complaint. The aim of this study is to compare the symptoms, rate of volvulus and surgical findings in children younger and older than one year. A retrospective study of 40 patients in a a single medical center diagnosed with malrotation from April 1996 to May 2010 was performed. There were 20 (50 %) boys and 20 (50 %) girls. At the time of operation, 27 (67.5 %) patients were younger and 13 (32.5 %) were older than 1 year. Vomiting was seen in 20 cases (74.1 %) of the younger group compared to 2 cases (15.4 %) of the older group. Abdominal sonography and upper gastrointestinal series showed a sensitivity of 100%. Operative findings: 12 (44.4 %) of the younger group presented with volvulus compared to none of the older group. The Ladd's procedure was routinely performed with appendectomy in all cases and bowel resection was requires when volvulus included bowel necrosis or other anomalies were found. After definite procedures, surgical correction for adhesive obstruction was necessary in 5 menbers (18.5 %) of the younger group and 1 patient (7.7 %) in the older group. There was 1 death due to respiratory failure and pneumonia. Abdominal pain was more frequent symptom and bilious vomiting was less frequent. Volvulus did not occur in the older group. Malrotation should be diagnosed promptly in children over 1 year of age by upper gastrointestinal series and abdominal ultrasonography even though symptoms are not as clear cut as in infants.

• The Journal of the Korean bone and joint tumor society
• /
• 제14권2호
• /
• pp.140-145
• /
• 2008

After limb salvage operation becomes popular, reconstruction method of epi-metaphyseal osteosarcoma is relatively standardized though it may be operator's matter of preference. Most limb salvage techniques presently used are prosthesis reconstruction and osteoarticular allograft. In the case of prosthesis, it is very stable and shows good postoperative functional score, however, finally, it has a weak point of requirement for removal procedure due to failure. In the long run, allograft reconstruction has a good merit. But, it has a weak point of difficulties in securing the demanded size and shape. Allograft reconstruction should be performed only in the case of safe margin and established indication. In limb salvage operation, intercalary reconstruction is useful method in diaphyseal osteosarcoma, however, in metaphyseal osteosarcoma, the indication is not confirmed. We treated 17 year old osteosarcoma patient with localized in the tibial medial condyle with proximal medial condylectomy and pasteurized bone reconstruction in the conviction of safe surgical margin. We report this case because we guess if this procedure may be applied to premature patients, despite failure hemiarthroplasty can be tried successfully.

• Advances in pediatric surgery
• /
• 제1권1호
• /
• pp.18-26
• /
• 1995

For the prevention of later contralateral hernia as well as unnecessary contralateral exploration in pediatric patients with unilateral inguinal hernias, a reasonable indication of contralateral exploration is required. To examine the contralateral positivity, a prospective selective contralateral exploration has been performed by the author from Sept. 1985 to Dec. 1993, at Pediatric Surgical Section of the Department of Surgery, Kangnam St. Mary's Hospital, Catholic University Medical College. Among the total 1200 cases of pediatric inguinal hernias, 580 cases of contralateral side were explored at hernia operations, by the indications as; male with infant onset, 2)female of all age, 3)prematurity, 4)profuse ascites due to cirrhosis, nephrotic syndrome, and ventriculoperitoneal shunt, and 5)remarkable silk sign. Overall positive rate was 71.4%, and positive rates of each indication were 80.7%, 70.4%, 73.1%, 66.7%, and 72.0%, respectively. Right side hernia showed 67.0%, left s ide 75.7%, and positive familial history 71.8% of contralateral positivities. In male, getting older revealed lower positive rates and the rate suddenly dropped after 12 years of age. Birth order, mother's age at delivery, postmaturity did not show any significant differences between the rates. Recurrence was seen in 3(0.5%) ipsilateral and 2(0.3%) contralateral, both of which were negative esplorations on previons operations. Overall complication rate was 3.8%, including 1 infection, 14 fluid or blood accumulation, 5 edemas, 3 temporary testicular edemas, 2 persisting fevers, 2 enures is and one delayed recovery from anesthesia. Among 38 cases with contralateral hernias developed after unilateral surgery by authors(6 cases) or surgeons in other institutions, 14 were males with infant onset, 4 were prematurities and 9 were females. Therefore, 27(71.7%) cases were originally under the contralateral exploration indications. The primary site of the hermia was right in 25 and left in 13. With above results, the following indications for contralateral exploration could be suggested ; 1)under one year of age, both sex, 2)prematurity, 3) remarkable silk sign, 4)in the double checked suspicions among males with infant onset, all age females, ascites, left hernia and familial history. After 12 years of age, exploration is not required. Considering complications, contralateral explorations could be considered only in the following situations; 1)expert, experienced pediatric surgeon, 2)experienced pediatric anesthesiologist, 3)operations could be done smoothly in an hour, 4)good general condition of the patient.

• Archives of Plastic Surgery
• /
• 제39권5호
• /
• pp.483-488
• /
• 2012

Background Pediatric hand burns are a difficult problem because they lead to serious hand deformities with functional impairment due to rapid growth during childhood. Therefore, adequate management is required beginning in the acute stage. Our study aims to establish surgical guidelines for a primary full-thickness skin graft (FTSG) in pediatric hand burns, based on long-term observation periods and existing studies. Methods From January 2000 to May 2011, 210 patients underwent primary FTSG. We retrospectively studied the clinical course and treatment outcomes based on the patients' medical records. The patients' demographics, age, sex, injury site of the fingers, presence of web space involvement, the incidence of postoperative late deformities, and the duration of revision were critically analyzed. Results The mean age of the patients was 24.4 months (range, 8 to 94 months), consisting of 141 males and 69 females. The overall observation period was 6.9 years (range, 1 to 11 years) on average. At the time of the burn, 56 cases were to a single finger, 73 to two fingers, 45 to three fingers, and 22 to more than three. Among these cases, 70 were burns that included a web space (33.3%). During the observation, 25 cases underwent corrective operations with an average period of 40.6 months. Conclusions In the volar area, primary full-thickness skin grafting can be a good indication for an isolated injured finger, excluding the web spaces, and injuries of less than three fingers including the web spaces. Also, in the dorsal area, full-thickness skin grafting can be a good indication. However, if the donor site is insufficient and the wound is large, split-thickness skin grafting can be considered.

• Journal of Yeungnam Medical Science
• /
• 제11권1호
• /
• pp.127-134
• /
• 1994

The aim of this study was to identify the usefulness of pelviscopy in treatment besides its diagnostic value. The advantages of pelviscopic surgery are low cost, rapid recovery, good cosmetic effect, low incidence of complication and postoperative adhesion. So most of the pelvic exploration in gynecologic patients are replaced by the pelviscopic surgery these days. Pelviscopic surgery was performed on 136 patients at the Department of Obstetrics and Gynecology, College of Medicine, Yeungnam University from May 1991 to July 1993. The results obtained were as follows : The age distribution of the patients was from 19 to 55 with age of 31.2 years, and the mean parity was 0.96, the most common indication of pelviscopic surgery was tubal pregnancy(66.9%), the second most common indications was ovarian cyst(10.3%) and the other indications were endometriosis, corpus luteum cyst rupture, parovarian cyst, foreign body, tubal ligation, hydrosalpinx, uterine myoma and diagnostic procedure. The main types of surgery were salpingectomy in 58.8% and salpingoophorectomy in 16.3%. The mean duration of hospitalization was 2.1 days without specific complications. According to these results, it was postulated that the pelviscopic surgery was a useful operative tool in gynecologic treatment and its application could be extended to many other areas of gynecology with safety by the development of surgical techniques and instruments.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제37권5호
• /
• pp.343-348
• /
• 2011

Introduction: Third molar extraction is one of the most common procedures in oral and maxillofacial surgery. The impacted third molar causes many pathological conditions, such as pericoronitis, caries, periodontitis, resorption of adjacent teeth, and cyst or tumors associated with impacted teeth. Extraction is often considered the treatment of choice for impacted lower third molars. On the other hand, imprudent extraction of deeply impacted third molars can cause permanent complications, such as inferior alveolar nerve damage. Therefore, guidelines for the extraction of lower third molars should be set to prevent embarrassing complications. This study examined the indication and current trends of the extracted lower third molars in the dental hospital of a dental college. Materials and Methods: 557 extracted third molars were evaluated at the department of oral and maxillofacial surgery of Yonsei University. The chief complaint, diagnosis, age and degree of impaction were analyzed to determine the tendency for the extraction of asymptomatic lower third molars. Results: The percentage of asymptomatic third molars was 40.8%. In cases of full impacted tooth or full erupted tooth, the percentage of asymptomatic teeth was more than 50% (52.4% and 54.3, respectively). Among those partially impacted teeth, 73.1% of them showed symptoms, such as pain, tenderness and swelling. In terms of age, pericoronitis was evident at a younger age, and dental caries/periodontitis was the main cause of removal in those aged over 50. Twenty nine cases (1.6%) had teeth associated with pathological changes Conclusion: The incidence of pathological changes to the lower third molar was relatively low. Surgical extraction is recommended in cases of partially impacted teeth. In Korea, the incidence of asymptomatic third molar extraction was relatively higher than in European countries. More careful attention would be desirable to consider the risks and benefits of lower third molar extraction.