• Journal of Korean Neurosurgical Society
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• v.59 no.5
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• pp.498-504
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• 2016

Objective : Although subdural hematoma (SDH) is commonly treatable by burr hole surgery in the late subacute or chronic stage, there is no clear consensus regarding appropriate management and exact predictive factors for postoperative recurrence also remain unclear. The aim of this study was to evaluate risk factors associated with recurrence of SDH that requires burr hole surgery in the late subacute or chronic stage. We also identified the appropriate timing of surgery for reducing the recurrence. Methods : We retrospectively reviewed 274 patients with SDH in the late subacute or chronic stage treated with burr hole surgery in our hospital between January 2007 and December 2014. Excluding patients with acute intracranial complications or unknown time of trauma onset left 216 patients included in the study. Results : Of 216 patients with SDH in the late subacute or chronic stage, recurrence was observed in 36 patients (16.7%). The timing of the operation in patients with late subacute stage (15-28 days) resulted in a significant decrease in recurrence (RR, 0.33; 95% CI, 0.17-0.65; p=0.001) compared to chronic stage (>28 days). Otherwise, no significant risk factors were associated with recurrences including comorbidities and surgical details. Conclusion : The results indicated that time from trauma onset to burr hole surgery may be important for decreasing the risk of recurrence. Therefore, unless patients can be treated conservatively without surgery, prompt surgical management is recommended in patients diagnosed as having late subacute or chronic subdural hematoma treatable by burr hole surgery, even when neurological deficits are unclear.

• Archives of Plastic Surgery
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• v.49 no.1
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• pp.61-69
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• 2022

Background Single free flaps are a commonly used reconstructive method for multiple soft tissue defects in digits. We analyzed the flap size, division timing, and degree of necrosis in cases with various types of flap division. Methods We conducted a retrospective review of the medical charts of patients who had undergone single free flap reconstruction for multiple soft tissue defects across their digits from 2011 to 2020. The flap types included were the lateral arm free flap, venous forearm free flap, thenar free flap, hypothenar free flap, anterolateral thigh free flap, medial plantar free flap, and second toe pulp free flap. Flap size, anastomosed vessels, division timing, and occurrence of flap necrosis were retrospectively investigated and then analyzed using the t-test. Results In total, 75 patients were included in the analysis. The success rate of the free flaps was 97.3%. All flaps were successfully divided after at least 17 days, with a mean of 47.17 days (range, 17-243 days) for large flaps and 42.81 days (range, 20-130 days) for the medium and small flaps (P=0.596). The mean area of flap necrosis was 2.38% in the large flaps and 2.58% in the medium and small flaps (P=0.935). Severe necrosis of the divided flap developed in two patients who had undergone flap division at week 6 and week 34. Conclusions In cases where blood flow to the flap has been stable for more than 3 weeks, flap division can be safely attempted regardless of the flap size.

• Journal of Chest Surgery
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• v.48 no.6
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• pp.411-414
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• 2015

Interrupted aortic arch with an aortopulmonary window is a rare congenital entity that is associated with high morbidity and mortality, especially in premature low-birth-weight infants, and the proper timing of surgical correction remains a matter of debate. We present the case of a premature infant weighing 1.6 kg who successfully underwent one stage surgical repair to treat interrupted aortic arch with an aortopulmonary window. The therapeutic management of this patient is described below, and a review of the literature is presented.

• Journal of Gastric Cancer
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• v.2 no.2
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• pp.96-100
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• 2002

Purpose: The proper reconstructive technique after a partial gastrectomy for an adenocarcinoma of the stomach is often debated, but few data exist to clarify the issue. The aim of this study was to compare retrospectively the early postoperative results and complications after different anastomoses used during a partial gastrectomy for a gastric adenocarcinoma. Materials and Methods: We reviewed the hospital records of 218 patients who had undergone a subtotal gastrectomy for gastric cancer at Chosun University Hospital between January 1997 and July 2000. Of the 218 subtotal gastrectomies performed with curative intent, 127 reconstructions were Billroth I gastrectomies and 91 were Billroth II gastrectomies. The following data were analyzed: age, sex, tumor size, gastric resection margin, timing of removal of the nasogastric tube, first bowel movement, resumption of oral feeding, and postoperative complications. Results: The timing of removal of the nasogastric tube was significantly earlier in the Billroth Igroup than in the Billroth II group ($27.9\pm13.9$ hours and $69.7\pm68$ hours, respectively)(P<0.05). Resumption of oral feeding was possible on day $4.6\pm1.5$ in the Billroth I group and on dsy $5.2\pm1.5$ in the Billroth II group (P<0.05). There were no anastomotic leakage, postoperative bleeding, and postoperative mortality among the patients in either group. Conclusions: the Billroth lgastrectomy should be considered for patients undergoing a partial gastric resection for gastric cancer due to its physiological benefits and acceptable rate of complication.

• Advances in pediatric surgery
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• v.10 no.1
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• pp.17-21
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• 2004

Improvement in prenatal ultrasonography is leading to diagnose choledochal cyst before birth and before onset of classical symptom more frequently. But, there is a controversy about optimal timing for Cyst excision of prenatally diagnosed asymptomatic choledochal cyst. To identify the most appropriate timing for surgery in prenatally diagnosed choledochal Cysts, we analyzed 6 patients who had operation for choledochal cysts within 30days after birth at the division of Pediatric Surgery, Samsung Medical Center and Inha University School of Medicine, from June 1995 to June 2002. Males were four and females 2, the mean age at operation was 11.2 days, and the median age 8.0 days. The range of gestational ages of the antenatal diagnosis of bile duct dilatation was 24 weeks to 32 weeks, mean was 38.3 weeks, and mean birth weight was 3,298.3 g. After birth, abdominal ultrasonography, hepatobiliary scintigraphy, and magnetic resonance cholangiopancratography (MRCP) were performed. Mean age at operation was 11.2 days. All patients had the cyst excision and Rouxen-Y hepaticojejunostomy. Immediate postoperative complication was not found. During the median follow-up period of 41 months, one patient was admitted due to cholangitis, and the other due to variceal bleeding. Early operative treatment of asymptomatic newborn is safe and effective to prevent developing complications later in life.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.5
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• pp.341-350
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• 2021

Dexamethasone has been used in oral and maxillofacial surgery for postoperative pain, swelling, and trismus following third molar surgeries. It is a potent and powerful drug that can alleviate the aforementioned postoperative sequelae. Dexamethasone is responsible for inhibiting the release of inflammatory mediators in the inflammation process to improve patient quality of life after surgical intervention. There are several available routes of administering dexamethasone. This article will help determine the suggested routes of administration, dosage, parameters, and dexamethasone timing for third molar surgeries.

• Advances in pediatric surgery
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• v.3 no.2
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• pp.164-167
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• 1997

Conjoined twins are one of the rarest and most challenging congenital anomalies in pediatric surgery. Successful surgical separation is difficult because it the majority of conjoined twins in is technically typical to separate shared vital organs successfully. The timing of separation is variable, but separation is usually delayed until such infants are relatively mature(i.e, 9-12 months of age). Operative survival was 50 % in the neonatal period, but 90 % in those over 4 months of age. The present case was successfully separated early beacase of cardiac problems in one of the twins. These twins were omphalopagus and only the liver was shared through a bridge. The vascular and biliary trees were independent from each other. Successful surgical separation was on 11th day of life, but one died of sepsis 18 days after operation.

• Journal of Chest Surgery
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• v.48 no.2
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• pp.151-154
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• 2015

Extensive tumoral calcinosis affecting a large joint is uncommon in patients with systemic sclerosis. We report the case of a 52-year-old female patient referred for a growing calcified mass in the shoulder. She was diagnosed with interstitial lung disease and progressive systemic sclerosis. Although the pain and disability associated with the affected joint was not severe, the patient underwent surgical excision because the mass continued to grow and was likely to produce shoulder dysfunction and skin ulceration. The patient appeared well 10 months after surgery with no signs of recurrence. This report highlights the timing and indication of surgical excision in similar cases.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.36 no.6
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• pp.266-272
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• 2014

Purpose: This study was conducted in order to investigate the therapeutic effect of closed reduction according to a classification in patients with nasal bone fracture. Methods: The study was conducted retrospectively on 186 patients with a mean age of 38 years (range: 7 to 80 years). All patients were diagnosed by clinical and radiologic examination, and then classified according to Hwang's classification by computed tomography. The patients were further classified by their age, gender, causes of fracture, operation timing after fracture, concurrent facial bone fracture, and complications. All patients underwent the same reduction and treatment protocol and were then followed up regularly for at least three months. Results: The cause of the fracture was slip down, and the highest prevalence was shown in the 20s. The mean operation timing after fracture was 4.1 days (range: 1 to 14 days), and it tended to be longer in the case of defected septal bone or more severe fracture. The most common concurrent facial bone fracture was orbital blow-out fracture, and zygomaticomaxillary complex and maxillary fracture occured frequently. The largest number of complications occurred in class III and IIBs patients, and the main complication was postoperative pain. Conclusion: Results of nasal bone closed reduction on the 186 patients showed that serious complications rarely occurred. Closed reduction is generally an effective treatment for nasal bone fracture. However, in the case of severe concurrent septal bone fracture or comminuted fracture with depression, open reduction should be considered. Further study with a larger number of patients and further classification is required.

• Journal of Gastric Cancer
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• v.11 no.1
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• pp.46-54
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• 2011

Purpose: There are few studies that have focused on the predictors of recurrence after gastrectomy for gastric carcinoma. This study analyzed the patients who died of recurrent gastric carcinoma and we attempted to clarify the clinicopathologic factors that are associated with the timing of recurrence. Materials and Methods: From June 1992 to March 2009, 1,795 patients underwent curative gastric resection at the Department of Surgery, Hanyang University College of Medicine. Among them, 428 patients died and 311 of these patients who died of recurrent gastric carcinoma were enrolled in this study. The clinicopathologic findings were compared between the 72 patients who died within one year after curative gastrectomy (the early recurrence group) and the 92 patients who died 3 years after curative gastrectomy (the late recurrence group). Results: Compared with the late recurrence group, the early recurrence group showed an older age, a more advanced stage, a poorly differentiated type of cancer and a significantly higher tendency to have lymphatic invasion, vascular invasion and perineural invasion.Especially in the gastric cancer patients with a more advanced stage (stage III and IV), the early recurrence group was characterized by a significantly higher preoperative serum carcino embryonic antigen level, perineural invasion and a relatively small number of dissected lymph nodes. Conclusions: The clinicopathologic characteristics of recurrent gastric cancer are significantly different according to the stage of disease, and even in the same stage. For the early detection of recurrence after curative surgery, it is important to recognize the clinicopathological factors that foretell a high risk of recurrence. It is mandatory to make an individualized surveillance schedule according to the clinicopathologic factors.