• 한국임상수의학회지
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• 제41권1호
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• pp.37-42
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• 2024

This case report discusses the successful surgical resection of cardiac hemangiosarcoma in a dog using an articulated surgical stapler. Cardiac tumors, particularly hemangiosarcomas, have a poor prognosis. Recommended treatment involves surgical removal of the primary tumor, along with chemotherapy. However, the use of staples for cardiac tumor resection has not yet been extensively documented in the veterinary literature. A 10-year-old dachshund with pericardial effusion underwent surgery to remove a right atrial mass. An articulated linear cutting stapler was used for tumor resection. The patient experienced chylothorax as a complication but recovered well. However, the patient later developed respiratory symptoms and died, most likely due to aspiration pneumonia. The surgical stapler provided stability, convenience, and a shorter surgical time during tumor resection. Surgical resection combined with chemotherapy improves the survival of dogs with cardiac hemangiosarcoma. The stability and adjustability of the stapling device make it advantageous for cardiac tumor resection. Although complications, such as chylothorax, can arise, appropriate management can lead to positive outcomes. This case report demonstrates the feasibility and safety of using an articulated surgical stapler for cardiac tumor resection in dogs. Insights from this case can guide future research and clinical practice.

• 대한의용생체공학회:의공학회지
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• 제45권1호
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• pp.26-36
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• 2024

Functional brain imaging techniques have been used to diagnose psychiatric disorders such as dementia, depression, and autism. Recently, these techniques have also been actively used to study hearing loss. The present study reviewed the application of the functional brain imaging techniques in auditory research, especially those focusing on hearing loss, over the past decade. EEG, fMRI, fNIRS, MEG, and PET have been utilized in auditory research, and the number of research studies using these techniques has been increasing. In particular, fMRI and EEG were the most frequently used technique in auditory research. EEG studies mostly used event-related designs to analyze the direct relationship between stimulus and the related response, and in fMRI studies, resting-state functional connectivity and block designs were utilized to analyze alterations in brain functionality in hearing-related areas. In terms of age, while studies involving children mainly focused on congenital and pre- and post-lingual hearing loss to analyze developmental characteristics with and without hearing loss, those involving adults focused on age-related hearing loss to investigate changes in the characteristics of the brain based on the presence of hearing loss and the use of a hearing device. Overall, ranging from EEG to PET, various functional brain imaging techniques have been used in auditory research, but it is difficult to perform a comprehensive analysis due to the lack of consistency in experimental designs, analysis methods, and participant characteristics. Thus, it is necessary to develop standardized research protocols to obtain high-quality clinical and research evidence.

• Journal of Gastric Cancer
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• 제24권1호
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• pp.108-121
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• 2024

Anastomotic leaks and fistulas are significant complications of gastric surgery that potentially lead to increased postoperative morbidity and mortality. Surgical intervention is reserved for cases with severe symptoms or hemodynamic instability; however, surgery carries a higher risk of complications. With advancements in endoscopic treatment options, endoscopic approaches have emerged as the primary choice for managing these complications. Endoscopic clipping is a traditional method comprising 2 main categories: through-the-scope clips and over-the-scope clips. Through-the-scope clips are user friendly and adaptable to various clinical scenarios, whereas over-the-scope clips can close larger defects. Another promising approach is endoscopic stent insertion, which has shown a high success rate for leak closure, although vigilant monitoring is required to monitor stent migration. Infection control is essential in post-surgical leakage cases, and endoscopic internal drainage provides a relatively safe and noninvasive means to manage fluids, contributing to infection control and wound healing promotion. Endoscopic suturing offers full-thickness wound closure, but requires additional training and endoscopic versatility. As a promising tool, endoscopic vacuum therapy potentially surpasses stent therapy by draining inflammatory materials and closing defects. Furthermore, the use of tissue sealants, such as fibrin glue and cyanoacrylate, has been reported to be effective in selected situations. The choice of endoscopic device should be tailored to individual cases and specific patient conditions, with careful consideration of the nature of the defect. Further extensive studies involving larger patient populations are required to provide more robust evidence on the efficacy of endoscopic approach in managing post-gastric anastomotic leaks.

• 대한두개안면성형외과학회지
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• 제25권3호
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• pp.123-132
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• 2024

Background: The introduction of presurgical nasoalveolar molding represented a significant departure from traditional molding methods. Developed by Grayson and colleagues in 1993, this technique combines an intraoral molding device with a nasal molding stent. This study aimed to compare the Grayson nasoalveolar molding appliance versus DynaCleft appliance as two methods of presurgical nasoalveolar molding. Methods: A single-blinded, randomized, parallel-arm clinical trial was conducted. Sixteen infants with complete unilateral cleft lip and palate were enrolled and divided into two groups of eight. Group 1 was treated with a modified Grayson nasoalveolar molding appliance that included a nasal stent, while group 2 was treated with DynaCleft elastic adhesive tape and an external nasal elevator. Standardized digital photographs of each infant were taken at baseline and post-treatment using a professional camera. Nine extraoral anthropometric measurements were obtained from each image using image measurement software. Results: The modified Grayson nasoalveolar appliance demonstrated a more significant improvement compared to DynaCleft in terms of alar length projection (on both sides), columella angle, and nasal tip projection. Symmetry ratios also showed enhancement, with significant improvements observed in nasal width, nasal basal width, and alar length projection (p< 0.05). Conclusion: Both the modified Grayson nasoalveolar appliance and DynaCleft appear to be effective presurgical infant orthopedics treatment options, demonstrating improvements in nasolabial aesthetics. The modified Grayson appliance, equipped with a nasal stent, improved nasal symmetry more effectively than DynaCleft, resulting in a straighter columella and a more medially positioned nasal tip.

• Journal of Yeungnam Medical Science
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• 제41권1호
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• pp.48-52
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• 2024

While simultaneous bilateral partial nephrectomy with a conventional multiport robot has been consistently reported since the 2010s, the introduction of the DaVinci SP system (Intuitive Surgical, Sunnyvale, CA, USA) could provide a novel way to perform surgery on bilateral kidneys while innovatively reducing the number of incisions. In our first report worldwide, the patient with bilateral small renal mass (2.0 cm for the left and 1.5 cm for the right side) and preoperative normal renal function was placed in the lateral decubitus position on an inverted bed. After tilting the bed to be as horizontal as possible, a 4-cm incision was made in the lower part of the umbilicus for the floating trocar technique. The partial nephrectomy was performed reliably as with the conventional transperitoneal approach, and then the patient could be repositioned to the contralateral side for the same procedure, maintaining all trocars. Total operation time (skin to skin), total console time, and the left- and right-side warm ischemic times were 260, 164, 27, and 23 minutes, respectively, without applying the early declamping technique. The estimated blood loss was 200 mL. The serum creatinine right after the operation, on the first day, 3 days, and 90 days after surgery were 0.92, 0.77, 0.79, and 0.81 mg/dL, respectively. For 90 days after the procedure, no complications or radiologic recurrence were observed. Further clinical studies will reveal the advantages of using the DaVinci SP device for this procedure over traditional multiport surgery, maximizing the benefit of a single port-based approach.

• 경영정보학연구
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• 제19권2호
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• pp.57-70
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• 2017

IT 기술의 발달과 평균 수명의 연장 등의 이유로 모바일 헬스케어 시장이 주목받고 있다. 대학병원 등 의료기관들도 모바일 기기를 이용한 환자 교육 및 설명서비스를 통해 편의성과 치료효율성이라는 목적을 동시에 달성하기 위해 노력하고 있다. 본 연구는 삼성서울병원이 출시한 모바일 기반의 환자교육 서비스인 '스마트설명서비스' 앱 구축 및 사용 사례를 비즈니스 모델 분석 방법로인 린 캔버스를 적용하여 분석하였다. 아울러 환자 및 의료진과의 인터뷰를 통해 모바일 환자 교육 서비스의 필요성과 효과성에 대한 의견을 수집하였다. 본 연구의 결과는 모바일 기반의 환자 교육 서비스를 준비 중인 의료기관과 관련 업계에 유의미한 시사점을 제공할 것으로 기대한다.

• Korean Journal of Radiology
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• 제2권3호
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• pp.145-150
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• 2001

Objective: To investigate the effectiveness of the newly designed Niti-S stent in the management of iliac arterial stenoses and occlusions. Materials and Methods: Stenoses (n=25) or occlusions (n=5) in the iliac arteries of 25 patients (30 limbs) were treated. The site of the lesions was the common (n=15) or external (n=11) iliac artery, or both (n=4). Eight limbs were treated for diffuse disease, six for highly eccentric lesion, five for occlusive lesion, and 11 for failed angioplasty. Results: In all patients, technical success was achieved without major complications. One death, not procedure-related, occurred within 30 days. Ankle-brachial indexes improved from 0.63 0.30 to 0.99 0.21, and ischemic symptoms showed improvement in 22 patients (88%). Fontaine classifications before stenting, namely IIa(n=3), IIb(n=16), III(n=2), and IV(n=4) improved to I(n=17), IIa(n=5), and IV(n=3). Follow-up over a 27 (mean, 19.8 8)-month period showed that cumulative patency rates were 95.8% at 1 year and 86.2% at 2 and 3 years. No significant decrease in the mean ankle-brachial index was observed. Conclusion: The Niti-S stent appears to be a safe and effective device for the treatment of iliac stenoses and occlusions. These preliminary results require confirmation with a larger series.

• 임상간호연구
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• 제30권1호
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• pp.35-44
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• 2024

Purpose: The purpose of this study is to compare the predictive validity of pressure injury risk assessment, Braden, Braden Q and Braden QD for pediatric patients. Methods: Prospective observational study included patients under the age of 19 who were hospitalized to general wards, intensive care units of a children's hospital. Characteristics related to pressure injury were collected, and predicted validity was compared by calculating the areas under the curve (AUC) of the Braden, Braden Q, and Braden QD scales. Results: A total of 689 patients were included in the study. A total of 13 (1.9%) patients had pressure injuries, and the number of pressure injuries was 17. Factors related to the occurrence of pressure injuries were 9 (52.9%) immobility-related and 8 (47.1%) medical device-related. The AUC for each scale was .91 (95% CI .89~.94) for Braden, .92 (95% CI .90~.95) for Braden Q, and .94(95% CI .92~.96) for Braden QD. The optimal cut-off points were identified as 16 for Braden (sensitivity=88.8%, specificity=86.4%), 17 for Braden Q(sensitivity=63.6%, specificity=94.9%), and 12 for Braden QD (sensitivity=94.4%, specificity=88.7%). Conclusion: The Braden QD scale demonstrated the highest predictive validity for pressure injuries in pediatric patients and is expected to be valuable tool in preventing pediatrics pressure injuries.

• Korean Circulation Journal
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• 제53권11호
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• pp.727-743
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• 2023

Although cardiac rehabilitation (CR) has been shown to improve exercise tolerance and prognosis in patients with cardiovascular diseases, there remains low participation in outpatient CR. This may be attributed to the patients' busy schedules and difficulty in visiting the hospital due to distance, cost, avoidance of exercise, and severity of coronary disease. To overcome these challenges, many countries are exploring the possibility of remote CR. Specifically, there is increasing attention on the development of remote CR devices, which allow transmission of vital information to the hospital via a remote CR application linked to a wearable device for telemonitoring by dedicated hospital staff. In addition, remote CR programs can support return to work after hospitalization. Previous studies have demonstrated the effects of remote CR on exercise tolerance. However, the preventive effects of remote CR on cardiac events and mortality remain controversial. Thus, safe and effective remote CR requires exercise risk stratification for each patient, telenursing by skilled staff, and multidisciplinary interventions. Therefore, quality assurance of telenursing and multi-disciplinary interventions will be essential for remote CR. Remote CR may become an important part of cardiac management in the future. However, issues such as cost-effectiveness and insurance coverage still persist.

• Clinical Endoscopy
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• 제57권2호
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• pp.196-202
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• 2024

Background/Aims: Hypoxemia is a common side effect of propofol sedation during endoscopy. Applying mild positive airway pressure (PAP) using a nasal mask may offer a simple way to reduce such events and optimize the conditions for diagnostic and therapeutic upper gastrointestinal endoscopies. Methods: We compared overweight patients (body mass index >25 kg/m²) with a nasal PAP mask or standard nasal cannula undergoing upper gastrointestinal endoscopies by non-anesthesiologists who provided propofol sedation. Outcome parameters included the frequency and severity of hypoxemic episodes. Results: We analyzed 102 procedures in 51 patients with nasal PAP masks and 51 controls. Episodes of hypoxemia (oxygen saturation [SpO₂] <90% at any time during sedation) occurred in 25 (49.0%) controls compared to 8 (15.7%) patients with nasal PAP masks (p<0.001). Severe hypoxemia (SpO₂ <80%) occurred in three individuals (5.9%) in both groups. The mean delta between baseline SpO₂ and the lowest SpO₂ recorded was significantly decreased among patients with nasal PAP mask compared to controls (3.7 and 8.2 percentage points difference, respectively). There were significantly fewer airway interventions performed in the nasal PAP mask group (15.7% vs. 41.2%, p=0.008). Conclusions: Using a nasal PAP mask may be a simple means of increasing patient safety and ease of examination.