• Title/Summary/Keyword: closure duration

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EXPERIMENTAL STUDY OF LARYNGEAL BRAIN STEM EVOKED RESPONSE IN CAT (고양이에서 상후두신경자극에 의한 후두뇌간유발반응에 대한 실험적 연구)

  • 김광문;김기령;윤주헌;김창규;박용재
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1991.06a
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    • pp.14-14
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    • 1991
  • 후두의 생리적 기능은 하기도를 보호하는 방어기능과 호흡기능 그리고 발성기능으로 대별할 수 있는데 이 가운데 계통발생적으로 가장 원시적이지만 중요한 기능은 하기도 방어기능으로 이는 다른 기능과 달리 전적으로 불수의적이고 반사적으로 이루어진다. 이 기능은 후두내 점막에 존재하는 촉각 수용체(tactile receptor)가 자극되면서 후두근육이 수축 반사를 일으켜 성문이 닫히는 성문폐쇄반사(glottic closure reflex)로서 다접합뇌간반사(polysynaptic brain stem response)이다. 현재까지 후두의 신경장애에서 그 부위나 정도 또는 신경재생 상태 등을 검사하는 방법으로 근전도검사가 주로 쓰여져 왔으나 그것이 주는 정보가 극히 제한되어 있다. 그러나 최근 청각뇌간유발반응과 같이 후두뇌간유발반응 이라 명명된 wave가 존재한다는 사실이 밝혀져 이에 대한 연구가 이루어지고 있어 이것이 임상에 쓰여질 수 있다면 현재 성문폐쇄반사의 소실이나 이상이 원인으로 사료되는 idiopathic laryngospasm, gastroesophageal reflux, spastic dysphonia, stuttering, sudden infant death syndrome과 같은 질환의 진단과 치료에 커다란 진전이 있을 것이다. 이에 저자들은 고양이 6마리를 이용하여 상후두신경을 전기적으로 자극하여 유발되는 반응을 far field recording을 이용 평균 가산법으로 그 wave를 측정하여 다음과 같은 결과를 얻었다. 1. 상후두신경자극(2㎃, stimuli frequency 3/s, Band filter 320-1000, 0.2 ㎳ duration)에 의한 반회신경에의 유발 반응을 기록하였고 그 잠복시간은 평균 8.2 ㎳ 였다. 2. 상후두신경을 자극하여 후두뇌간유발반응을 기록하였고 후두뇌간유발반응은 4개의 양 wave와 4개의 음 wave로 구성되었다. 3. 각 wave의 평균 잠복시간은 P1은 0.8㎳, P2는 2.3㎳, P3는 3.6㎳, P4는 4.3㎳였고 N1은 1.5㎳, N2 은 2.7㎳, N3는 3.9㎳, N4는 5.5㎳ 였다.

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A Comparison of the Epidural Nalbuphine to Epidural Morphine in Post-Cesarean Section Patients (제왕절개술후 통증치료를 위해 경막외강에 투입된 Morphine과 Nalbuphine의 비교 연구)

  • Moon, Bong-Kee;Lee, Youn-Woo;Lee, Ja-Won;Yoon, Duck-Mi;Oh, Hung-Kun
    • The Korean Journal of Pain
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    • v.6 no.1
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    • pp.60-66
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    • 1993
  • The clinical effects of epidural nalbuphine were compared to those of epidural morphine in sixty Cesarean delivery. They were physical status 1 or 2 by ASA classification and randomly divided into three groups. They were administered nalbuphine 5 mg(Group N5), nalbuphine 10 mg(Group N10) or morphine 3 mg(Group M3) through an indwelling epidural catheter at the time of peritoneal closure. During the first postoperative 24 hours, their analgesic effects were evaluated by visual analogue scale(0-10), respiration rates and Trieger dot test. The severity of side effects(0-2) was also evaluated. The results were as follows ; 1) The number of patients who needed additional epidural analgesics was least in group M3 (p<0.05). There was no significant difference between group N5 and group N10. 2) The duration between the first and second epidural administration was ; 19.2 hours in group M3, 8.6 hours in group N10 and 5.4 hours in group N5. There was a significant difference each group (p<0.05). 3) From the fourth post operative hour, both groups receiving nalbuphine showed a higher VAS score compared to group M3(p<0.05). 4) The incidence of pruritus, nausea, vomiting and voiding difficulty were more severe in group M3 compared with the other groups. However the severity did not increase with increasing nalbuphine dosage. 5) There were no patients showing objective sedation or low respiration rate(10 times/minute). We concluded that epidural administration of nalbuphine 5 mg or 10 mg is one way of post operative pain control. Its side effects were less than epidural morphine, but it is a less convenient in the method of analgesia.

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Transcutaneous Oxygen Pressure to Predict Wound Healing in Mild Diabetic Feet (경증의 당뇨발에서 창상치유 예측인자로서의 경피산소분압치)

  • Jang, Seo-Yoon;Jeong, Tae-Won;Han, Seung-Kyu;Kim, Woo-Kyung
    • Archives of Plastic Surgery
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    • v.38 no.5
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    • pp.585-589
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    • 2011
  • Purpose: Microcirculation of diabetic patients is commonly comporomised, regardless of the condition of the macrocirculation. Therefore, direct tissue oxygenation measurement is recommended in determining tissue viability and predicting wound healing potential. This study was designed to determine cut-off value of the tissue oxygenation in predicting wound healing in diabetic foot patients. Methods: This study included 41 feet of 41 diabetic foot patients who were treated in the Diabetic Wound Center of author's institution between January and June, 2009. Main inclusion criteria were type 1 or 2 diabetes and a foot ulcer (duration > 3 weeks) and ulcer area (from 1 $cm^2$ to 4 $cm^2$). Measurements of the area of diabetic foot ulcer were carried out before treatment. Transcutaneous oxygen pressure ($TcpO_2$) was measured at adjacent site of ulcer. The healing wound was defined as complete wound closure within 12 weeks. Results: Average diabetic foot ulcer areas with healing and nonhealing wounds were $2.67{\pm}0.76$ and $2.59{\pm}0.75\;cm^2$, respectively. There was no significant difference in the wound area between the groups. Average foot $TcpO_2$ in healing and nonhealing wounds were $68.56{\pm}23.07$ and $30.98{\pm}16.66$ mmHg, respectively ($p$ <0.01). The rate of healing wound increased as $TcpO_2$ increased. In particular, $TcpO_2$ lower than 40 mmHg and higher than 40 mmHg showed the most significant difference (wound healing rates of 25% and 71%, respectively). Conclusion: Based on the results of the study, the minimal $TcpO_2$ value thought to be required for adequate wound healing in diabetic wounds (cut-off value) is 40 mmHg.

Risk Factors for the Development of Incisional Hernia in Mini-laparotomy Wounds Following Laparoscopic Distal Gastrectomy in Patients with Gastric Cancer

  • Jang, Eun Jeong;Kim, Min-Chan;Nam, So-Hyun
    • Journal of Gastric Cancer
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    • v.18 no.4
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    • pp.392-399
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    • 2018
  • Purpose: To determine the incidence of incisional hernia (IH) in mini-laparotomy wounds and analyze the risk factors of IH following laparoscopic distal gastrectomy in patients with gastric cancer. Materials and Methods: A total of 565 patients who underwent laparoscopic distal gastrectomy for gastric cancer at Dong-A University Hospital, Busan, South Korea, between June 2010 and December 2015, were enrolled. IH was diagnosed through physical examination or computed tomography imaging. Incidence rate and risk factors of IH were evaluated through a long-term follow-up. Results: Of those enrolled, 16 patients (2.8%) developed IH. The median duration of follow-up was 58 months (range, 25-90 months). Of the 16 patients with IH, 15 (93.7%) were diagnosed within 12 months postoperatively. Multivariate analysis showed that female sex (odds ratio [OR], 3.869; 95% confidence interval [CI], 1.325-11.296), higher body mass index (BMI; OR, 1.229; 95% CI, 1.048-1.422), and presence of comorbidity (OR, 3.806; 95% CI, 1.212-11.948) were significant risk factors of IH. The vast majority of IH cases (15/16 patients, 93.7%) developed in the totally laparoscopic distal gastrectomy (TLDG) group. However, the type of surgery (i.e., TLDG or laparoscopy-assisted distal gastrectomy) did not significantly affect the development of IH (P=0.060). Conclusions: A median follow-up of 58 months showed that the overall incidence of IH in mini-laparotomy wounds was 2.8%. Multivariate analysis showed that female sex, higher BMI, and presence of comorbidity were significant risk factors of IH. Thus, surgeons should monitor the closure of mini-laparotomy wounds in patients with risk factors of IH undergoing laparoscopic distal gastrectomy.

Surgical correction for Tessier number 7 craniofacial cleft using a medially overcorrected design

  • Ryu, Jeong Yeop;Eo, Pil Seon;Tian, Lulu;Lee, Joon Seok;Lee, Jeong Woo;Choi, Kang Young;Yang, Jung Dug;Chung, Ho Yun;Cho, Byung Chae
    • Archives of Plastic Surgery
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    • v.46 no.1
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    • pp.16-22
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    • 2019
  • Background Various surgical techniques have been used to correct Tessier number 7 craniofacial cleft, which involves macrostomia, ear deformity, and hemifacial microsomia. To achieve symmetrical and satisfactory results in patients with macrostomia, the authors performed a 1-mm medial overcorrection on the cleft side and evaluated the results of this procedure. Methods A retrospective medical record review of patients diagnosed with Tessier number 7 craniofacial cleft from March 1999 to February 2017 was performed. Using clinical photographs, outpatient clinic records, and operative records, information was recorded regarding concurrent congenital anomalies, postoperative complications, and follow-up. Using Photoshop CS2, the length of both sides of the lip was compared. The ratio of these lengths was calculated to evaluate lip symmetry. Results Of the patients treated at the Department of Plastic and Reconstructive Surgery at Kyungpook National University Chilgok Hospital, 11 (male-to-female sex ratio, 7:4) were diagnosed with Tessier number 7 craniofacial cleft. Concurrent congenital anomalies included skin tag, hemifacial microsomia, and cleft palate. The mean duration of follow-up was $78.273{\pm}72.219$ months and the mean ratio of the lengths of both sides of the lip was $1.048{\pm}0.071$. Scar widening occurred as a postoperative complication in some patients. No cases of wound infection, bleeding, or wound dehiscence occurred. Conclusions For the successful correction of macrostomia, plastic surgeons should consider both functional and aesthetic problems of the lip. Adequate repair of the orbicularis oris muscle, skin closure with Z-plasty, and medial overcorrection of the neo-oral commissure led to good results in our patients.

Clinical review of Typhoid Fever Patients (장티브스에 관한 임상적 관찰)

  • 최정신
    • Journal of Korean Academy of Nursing
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    • v.6 no.1
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    • pp.60-71
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    • 1976
  • The author reviewed the medical records of 96 typhoid fever patients who were diagnosed, admitted, and treated at Sea grave Memorial Hospital from January 1 , 1973 through August 31, 1975. Diagnosis was determined by clinical observation, aerology and bacteriology, eighty patients were treated medically, the remaining 16 patients required surgical intervention. The following results were obtained: 1) The age distribution of the patients revealed that 33.3% wert between 10 and 19 years old 21.9% were between 20 and 29, and 19.8% were between 30 and 39. The majority of patients were from these more active age groups. Male to female sex ratio was 1.3 : 1 2) Seasonal distribution was observed. Most illness occurred in the summer and autumn month 5. 3) 84. 3%of the patients came from farm families. 4) Duration between onset and admission averaged 16.0 days. The group without compilations was admitted after an average of 15. 1 days; The group with complications was ad-matted after an average of 19.4 days. 5) Methods of treatment before admission were as follows: 10.4% at medical clinics, 61, 5% at pharmacies (antibiotics 47.9%, other. drugs 13.5%), 7.3% by herb medications, 20.8% had no treatment. 6) Main clinical symptoms were as follows: fever 93.8%, headache 47.9%, abdominal pain 47.9%, chills 38.5%, cough 36.5%, general weakness 26.0%, nausea e vomiting 24.0% and generalized pain 21.9%. 7) Temperature of patients on admission: 22.9% were 39f or more, 67.6% were between 37℃ and 38℃, and 9.4% were 37℃ or less. 8) Occurrence of intensional bleeding after onset of disease averaged 9.3 days; perforation occurred at an average of 19. 1 days. 9) Interval between onset of major complication and surgical intervention averaged 2.8 days. 10) Among the 68 patients who underwent the bacteriological test the positive rate was 44.1% (30). The positive ,ales to, each separate culture method were as follows: 20.4% in the blood culture, 40.4% in the stool culture and 6.7% in the urine culture. Among these bacteriological positive patients 15 patients had a negative results or less than 160 titer of vidal reaction. 11) The initial vidal test of the total group showed a counts of 160 titer or more in 60.4% and less than 160 titer in 39.6%, 12) W. B. C. Counts in the uncomplicated group indicated that 32.5% were 6,000/㎣ or less, 47.5% were between 6,000 and 10,000, arid 20.0% were 10,000/㎣ or more. In the complicated group, 37.6% were 6,000/㎣ or less, 25,0% were 6,000-10,000/㎣ and 37.6% were 10,000/㎣ or more. 13) Duration of hospital stay of the patients averaged 6.4 days in the uncomplicated group and 12.7 days in the complicated group. 14) Subdiaphragmatic free air simple X-ray was found in 91.7% of the perforated cases. 15) Duration of antibiotic therapy until an febrile state was attained averaged 4.8 days in the uncomplicated group and 6.5 days in the complicated group. 16) Operative procedures were as follows: one layer simple closure of their perforation with or without debasement in 56.3%, drainage only in 6.3%, small bowel resection with primary anastomosis in 18.8% , externalization in 6.3%, cholecystectomy in 6.3%, The clinical findings of this study suggest the following recommendations. According to Top's report; 1% of typhoid fever patients treated with chlorarnphenicol and 2% of patients treated with other drugs become chronic carriers. Therefore, importance should be given to the strict control of these carriers. Immunization, improvement of sanitation and living standards are all needed for the prevention and treatment of disease, but a more serious problem is a lack of knowledge on the part of patients and their families. Thus it is most urgent to enlighten the citizens about the transmission and hygiene related to contagious disease. Legal restriction of sale of antibiotics at drug stores without a physician's prescription is an urgent matter for public health administrators. An even more important nursing responsibility is the reemphasis on health education both in the clinical setting and in the home.

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Closure of Atrial Septal Defects through a Video-assisted Mini-thoracotomy (흉강경하 최소절개를 이용한 심방중격결손의 폐쇄)

  • Min, Ho-Ki;Yang, Ji-Hyuk;Jun, Tae-Gook;Park, Pyo-Won;Choi, Seon-Uoo;Park, Seung-Woo;Min, Sun-Kyung;Lee, Jae-Jin
    • Journal of Chest Surgery
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    • v.41 no.5
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    • pp.568-572
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    • 2008
  • Background: Minimally invasive surgery is currently popular, but this has been applied very sparingly to cardiac surgery because of some limitations. Our study evaluated the safety and efficacy of atrial septal defect (ASD) closure through a video-assisted mini-thoracotomy. Material and Method: Fifteen patients were analyzed. Their mean age was $31{\pm}6$ years. The mean ASD size was $24{\pm}5mm$ and there were 3 cases of significant tricuspid regurgitation. The working window was made through the right 4th intercostal space via a $4{\sim}5cm$ inframammary skin incision, CPB was conducted with performing peripheral cannulation. After cardioplegic arrest, the ASDs were closed with a patch (n=11) or direct sutures (n=4), and the procedures were assisted by using a thoracoscope. There were 3 cases of tricuspid repair and 1 case of mitral valve repair. The mean CPB time and aortic occlusion time were $160{\pm}47\;and\;70{\pm}26 $minutes, respectively. Result: There was no mortality, but there were 3 minor complications (one pneumothorax, one wound dehiscence and one arrhythmia). The mean hospital stay was $5.9{\pm}1.8$ days. The mean follow-up duration was $10.7{\pm}6.4$ months. The follow-up echocardiogram noted no residual ASD or significant tricuspid regurgitation. Three patients suffered from pain or numbness. Conclusion: This study showed satisfactory clinical and cosmetic results. Although the operative time is still too long, more experience and specialized equipment would make this technique a good option for treating ASD.

Clinical Experiences of Cardiac Surgery Using Minimal Incision (소절개선을 이용한 심장수술의 임상고찰)

  • Kim, Kwang-Ho;Kim, Joung-Taek;Lee, Seo-Won;Kim, Hae-Sook;Lim, Hyun-Kung;Lee, Choon-Soo;Sun, Kyung
    • Journal of Chest Surgery
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    • v.32 no.4
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    • pp.373-378
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    • 1999
  • Background: Minimally invasive technique for various cardiac surgeries has become widely accepted since it has been proven to have distinct advantages for the patients. We describe here the results of our experiences of minimal incision in cardiac surgery. Material and Method: From February 1997 to November 1998, we successfully performed 31 cases of minimally invasive cardiac surgery. Male and female ratio was 17:14, and the patients age ranged from 1 to 75 years. A left parasternal incision was used in 9 patients with single vessel coronary heart disease. A direct coronary bypass grafting was done under the condition of the beating heart without cardiopulmonary bypass support(MIDCAB). Among these, one was a case of a reoperation 1 week after the first operation due to a kinked mammary artery graft. A right parasternal incision was used in one case of a redo mitral valve replacement. Mini-sternotomy was used in the remaining 21 patients. The procedures were mitral valve replacement and tricuspid annuloplasty in 6 patients, mitral valve replacement 5, double valve replacement 2, aortic valve replacement 1, removal of left atrial myxoma 1, closure of atrial septal defect 2, repair of ventricular septal defect 2, and primary closure of r ght ventricular stab wound 1. The initial 5 cases underwent a T-shaped mini-sternotomy, however, we adopted an arrow-shaped ministernotomy in the remaining cases because it provided better exposure of the aortic root and stability of the sternum after a sternal wiring. Result: The operation time, the cardiopulmonary bypass time, the aorta cross-clamping time, the mechanical ventilation time, the amount of chest tube drainage until POD#1, the chest tube indwelling time, and the duration of intensive care unit staying were in an acceptable range. There were two surgical mortalities. One was due to a rupture of the aorta cannulation site after double valve replacement on POD#1 in the mini-sternotomy case, and the other was due to a sudden ventricular arrhythmia after MIDCAB on POD#2 in the parasternal incision case. Postoperative complications were observed in 2 cases in which a cerebral embolism developed on POD#2 after a mini-sternotomy in mitral valve replacement and wound hematoma developed after a right parasternal incision in a single coronary bypass grafting. Neither mortality nor complication was directly related to the incision technique itself. Conclusion: Minimally invasive surgery using parasternal or mini-sternotomy incision can be used in cardiac surgeries since it is as safe as the standard full sternotomy incisions.

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The Effectiveness of Progressive Tension Suture at Latissimus Dorsi Muscle Harvest (광배근 근피판 거상 후 점진적 긴장 봉합술의 유용성)

  • Moon, Joo Bong;Park, Jung Min;Kwon, Yong Seok;Lee, Keun Cheol;Kim, Seok Kwun;Cho, Se Heon
    • Archives of Plastic Surgery
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    • v.34 no.5
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    • pp.611-616
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    • 2007
  • Purpose: The latissimus dorsi muscle flap is a versatile flap used in a variety of reconstructive procedures. The most common complication of LD muscle flap is donor site seroma, reported to occur in 20 to 79 percent of cases. The formation of dead space under the flap is intimately associated with seroma formation. The authors think that the use of progressive tension suture at closing donor site can decrease the formation of dead space and ultimately reduce the incidence of donor site seroma. Methods: A retrospective review was performed with 38 patients who underwent latissimus dorsi muscle harvest for breast reconstruction from March 2003 to September 2004. Progressive tension sutures were used during donor site closure in 22 patients. This group was compared with controls group(16 patients) who underwent latissimus dorsi muscle harvest without using this technique. Operation time, length of hospital stay, period of drainage, complication, and satisfaction about postoperative scar of donor site were examined. Results: The average length of hospital stay was 10.2 days and 12.7 days, and the mean duration of drainage were 7.3 days and 11.7 days in each progressive suture group and control group. These results were statistically significant (p<0.05). In the 22 patients who underwent progressive tension suture, none had seroma, hematoma or skin necrosis. In control group(16 patients), there happened one seroma formation and one partial skin necrosis. These complications were healed by aspiration of seroma and wound revision. The patients' satisfaction was not statistically significant, but the higher points were given by the patients who underwent progressive tension suture. Conclusion: This technique, progressive tension suture, is an effective method to reduce or eliminate donor site seroma, which is the most common complication associated with latissimus dorsi muscle harvest.

Minimally Invasive Cardiac Surgery - Three different approaches - (최소 침습성 심장수술 -세가지 다른 접근법-)

  • Chung, Sung-Hyuk;Yang, Ji-Hyuk;Nam, Hye-Won;Kim, Ki-Bong;Ahn, Hyuk
    • Journal of Chest Surgery
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    • v.32 no.5
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    • pp.438-441
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    • 1999
  • Background: Minimally invasive cardiac surgery has emerged as a new approach to the conventional median sternotomy. The suggested advantages of the minimally invasive technique includes improved cosmesis, simplicity of opening and closing the chest, less postoperative pain, less risk of infection and bleeding, early rehabilitation, and reduced length of hospital stay. Material and Method: Between March 1997 and December 1997, we performed 36 cases of minimally invasive cardiac surgery via three different approaches ; right paramedian, transverse sternotomy and mini-sternotomy with upper sternal split. Result: There was no operative mortality. Postoperative complications were atrial fibrillation in 4 patients, bleeding that required reoperation in 1 patient, and delayed wound closure in 1 patient who underwent 3rd redo operation. Average length of skin incision was 9.1${\pm}$0.9 cm. Average duration of stay in the intensive care unit was 48${\pm}$29 hours and the patients were discharged 10${\pm}$7 days after the operation. Conclusion: In spite of the difficulties in defibrillation, deairing, and cardiac decompensation, minimally invasive approaches will be applied increasingly because of the suggested advantages.

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