• Title/Summary/Keyword: conventional medicine

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Supercharged Technique in TRAM flap Breast Reconstruction (과급 횡복직근피판술(Supercharged TRAM)을 이용한 유방재건술)

  • Yang, Jung-Dug;Song, Jae-Min;Lee, Sang-Yun;Chung, Ho-Yun;Cho, Byung-Chae;Park, Ho-Yong;Jung, Jin-Hyang
    • Archives of Plastic Surgery
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    • v.37 no.5
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    • pp.577-582
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    • 2010
  • Purpose: When reconstruction for patients who have the large contralateral breast or a following large defect after mastectomy is required, conventional pedicled TRAM flap shows the unpredictable occurrence of fat necrosis and skin flap loss in a relatively high percentage due to insufficient blood supply. In an effort to obtain more stable TRAM flap blood circulation, we have performed a supercharged technique using deep inferior epigastric perforators (DIEP) with conventional pedicled TRAM flap. Methods: From September of 2006 to December of 2008, Fourteen supercharged TRAM flap were performed for breast reconstruction after modified radical mastectomy. The contralateral DIEP was anastomosed to the internal mammary vessels in contralateral pedicled TRAM flap or thoracodorsal vessels in ipsilateral pedicled TRAM flap. Nutrient vessels were selected by Multi-Detector Computed tomography (MD-CT) modalities. For the nutrient vessel, we used deep inferior epigastric vessels (DIEV) of the ipsilateral side in 8 patients, DIEV of the contralateral side in 6 patients. In addition, for the recipient vessel, we used thoracodorsal vessels in 8 patients, internal mammary vessels in 5 patients, intercostals artery perforators in 1 patient. Results: The mean age was 46.8 years and the average follow-up interval was 14 months. There were 11 immediate and 3 delayed breast reconstructions. Fat necrosis incidence rate in supercharged TRAM group was lower than in conventional TRAM flap group. There were no differences of the incidences of abdominal hernia in both groups. Conclusion: The supercharged TRAM flap produces an improvement in vascularity that permits use of all four zones of the flap. The breast reconstruction with supercharged technique is reliable and valuable methods which provide sufficient soft tissue from abdomen without significant complications.

Comparison between Tissue Adhesive and Suture by Using Modified Hollander Score for Facial Wounds Treated in the Emergency Department (응급실 얼굴 열상 환자에서 Modified Hollander 점수에 의한 조직 접착제 사용과 봉합사를 이용한 봉합 후 결과 비교)

  • Hong, Suk-Ho;Yang, Young-Mo;Lee, Jang-Young;Lee, Won-Suk;Bark, Koung-Nam;Yang, Hee-Bum
    • Journal of Trauma and Injury
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    • v.24 no.2
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    • pp.143-150
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    • 2011
  • Purpose: The object of this study is to compare the patient satisfaction in the view of scarring, cost, and hospital stay between the conventional suture method and a method using Histoacryl$^{(R)}$ (2-N-butylcyanoacrylate) adhesive for treating facial lacerations in the emergency department. Method: This study is a randomized prospective trial, which was conducted from December 2009 to January 2010. The participants include 109 patients who visited the emergency room in Deajon Eulji Medical Center. The ages ranged from 1 to 59 (mean age of 18.7), and all had facial lacerations of less than 3 cm. In order to treat the facial lacerations, an emergency medicine doctor used tissue adhesive (2-N-butylcyanoacrylate, Histoacryl$^{(R)}$) for 41 patients in the experimental group, and a plastic surgeon performed conventional suturing for 68 patients in the control group. The ER-stay and the primary treatment fee were compared in the two groups, and the scarring was evaluated 10 to 11 months from suturing by using the Modified Hollander Method and the 10-cm scaled VAS (visual analogue scale: score 0=no scar, score 10=very severe scar) Result: The ER stay was 76 minutes for the experimental group and 107 minutes for the control group, showing that statistically significantly less time of 31 minutes was taken in the experimental group. The cost of the experimental group was 40000 won (50.1%) more expensive than the control group, with an average cost of 121900 won for the experimental group and 81200 won for the control group. As for scar evaluation, 10.56 months after suturing, the experimental group showed a better result with a score of 2.6 compared to a score of 3.4 in the control group; however, this difference was not statistically significant ($p$ <0.05). As to a detailed evaluation of scar characteristics, the experimental group had a statistically significantly better result in scar elevation, with a score of 0.6 compared to a score of 1.65 for the control group. Conclusion: If appropriate patients are selected, the method using tissue adhesive directly applied by an EM doctor not only decreases ER stay but also creates similar patients satisfaction, with statistically better result in scar elevation, compared to the conventional suture method; thus, ultimately general patient satisfaction is increased.

Switching Genioplasty- a New Genioplasty Technique in Order to Resolve Asymmetry of Chin Area: Case Report (이부 비대칭 치료를 위한 새로운 이부 성형술의 소개 - 전환 이부성형술: 증례보고)

  • Seo, Hyun-Soo;Lee, Young-Joo;Byeon, Kwang-Seob;Hong, Soon-Min;Park, Jun-Woo;Hong, Ji-Sook;Park, Yang-Ho
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.33 no.1
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    • pp.55-61
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    • 2011
  • Conventional slinding genioplsty has the risk of mental nerve injury after operation and difficult to correct vertical asymmetry of chin. So, authors propose a new genioplasty to correct asymmetry of chin. Switching genioplasty is a modification method of conventional genioplasty. Between mandibular right and left canine, osteotomy line of triangular shape make until mandibular lower border. In large side, osteotome line of wedge shape is added to reduction. After osteotomy, segment of wedge shape was separated from chin. Distal segment was rotated to reduction side. Because of rotation of distal segment, space is made in opposite side. Seperated segement of wedge shape from large side is switched this space to fill. So, stability of distal segment is achieved. Authors applied to swiching genioplasty the patients who was remained the chin asymmetry after both sagittal split ramus osteotome was done because mandible asymmetry. After operation, patient and operator were satisfied with excellent esthetic results without any other complication. The switching genioplasty is effective surgical technique for chin asymmetry because it has more advantages than conventional sliding genioplasty. First, other donor side does not need for bone graft. Second, the switching genioplasty can reduce infection, bone resroption, dehiscence, capsular contraction after allograft. Third, have little mental nerve damage. Forth, anteroposterior correction is possible. Fifth, operation time is less than other genioplasty for chin asymmetry.

Conventional versus Doxorubicin-Eluting Beads Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma: a Tertiary Medical Centre Experience in Malaysia

  • Rahman, F Abdul;Naidu, J;Ngiu, CS;Yaakob, Y;Mohamed, Z;Othman, H;Jarmin, R;Elias, MH;Hamid, N Abdul;Mokhtar, N Mohd;Ali, RA Raja
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.8
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    • pp.4037-4041
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    • 2016
  • Background: Hepatocellular carcinoma (HCC) is a common cancer that is frequently diagnosed at an advanced stage. Transarterial chemoembolisation (TACE) is an effective palliative treatment for patients who are not eligible for curative treatment. The two main methods for performing TACE are conventional (c-TACE) or with drug eluting beads (DEB-TACE). We sought to compare survival rates and tumour response between patients undergoing c-TACE and DEB-TACE at our centre. Materials and Methods: A retrospective cohort study of patients undergoing either treatment was carried out from January 2009 to December 2014. Tumour response to the procedures was evaluated according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Kaplan-Meier analysis was used to assess and compare the overall survival in the two groups. Results: A total of 79 patients were analysed (34 had c-TACE, 45 had DEB-TACE) with a median follow-up of 11.8 months. A total of 20 patients in the c-TACE group (80%) and 12 patients in the DEB-TACE group (44%) died during the follow up period. The median survival durations in the c-TACE and DEB-TACE groups were $4.9{\pm}3.2$ months and $8.3{\pm}2.0$ months respectively (p=0.008). There was no statistically significant difference noted among the two groups with respect to mRECIST criteria. Conclusions: DEB-TACE demonstrated a significant improvement in overall survival rates for patients with unresectable HCC when compared to c-TACE. It is a safe and promising approach and should potentially be considered as a standard of care in the management of unresectable HCC.

Effects of an Infection Control Protocol for Coronavirus Disease in Emergency Mechanical Thrombectomy

  • Eun, Jin;Lee, Min-Hyung;Im, Sang-Hyuk;Joo, Won-Il;Ahn, Jae-Geun;Yoo, Do-Sung;Park, Hae-Kwan
    • Journal of Korean Neurosurgical Society
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    • v.65 no.2
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    • pp.224-235
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    • 2022
  • Objective : Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, neurointerventionists have been increasingly concerned regarding the prevention of infection and time delay in performing emergency thrombectomy procedures in patients with acute stroke. This study aimed to analyze the effects of changes in mechanical thrombectomy protocol before and after the COVID-19 pandemic on procedure time and patient outcomes and to identify factors that significantly impact procedure time. Methods : The last-normal-to-door, first-abnormal-to-door, door-to-imaging, door-to-puncture, and puncture-to-recanalization times of 88 patients (45 treated with conventional pre-COVID-19 protocol and 43 with COVID-19 protection protocol) were retrospectively analyzed. The recanalization time, success rate of mechanical thrombectomy, and modified Rankin score of patients at discharge were assessed. A multivariate analysis was conducted to identify variables that significantly influenced the time delay in the door-to-puncture time and total procedure time. Results : The door-to-imaging time significantly increased under the COVID-19 protection protocol (p=0.0257) compared to that with the conventional pre-COVID-19 protocol. This increase was even more pronounced in patients who were suspected to be COVID-19-positive than in those who were negative. The door-to-puncture time showed no statistical difference between the conventional and COVID-19 protocol groups (p=0.5042). However, in the multivariate analysis, the last-normal-to-door time and door-to-imaging time were shown to affect the door-to-puncture time (p=0.0068 and 0.0097). The total procedure time was affected by the occlusion site, last-normal-to-door time, door-to-imaging time, and type of anesthesia (p=0.0001, 0.0231, 0.0103, and 0.0207, respectively). Conclusion : The COVID-19 protection protocol significantly impacted the door-to-imaging time. Shortening the door-to-imaging time and performing the procedure under local anesthesia, if possible, may be required to reduce the door-to-puncture and door-to-recanalization times. The effect of various aspects of the protection protocol on emergency thrombectomy should be further studied.

Development of a Web Based Pattern Identification System with Questionnaire Optimization (설문 최적화를 통한 개방형 웹 변증 시스템 개발)

  • Lee, Jae Chul;Jin, Hee Jeong
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.27 no.6
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    • pp.827-831
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    • 2013
  • This study aims to develop a pattern identification system (PIS) for general users to check up their body condition. We collected previous 3 PI questionnaires, with internal consistency reliability or validity of the diagnosis by experts, through a field test. For defining weights of pattern indices, we applied the analytic hierarchy process (AHP) method with 11 experts. PIS receive two kinds of symptoms of users : body region based symptoms and core symptoms for PIS. PIS suggest possible patterns and health information on the basis of selected symptoms with analysis by AHP. This study showed PIS could be easily used for general user who wants to access Korean Medicine compared to conventional PI system. Furthermore, it could be utilized with mobile environment or as remote medicine care.

A Case of Paranasal Sinus Papilloma with Increased FDG Uptake (부비동 유두종에서의 FDG 섭취 증가를 보인 예)

  • An, Young-Sil;Park, Yong-Koo;Kim, Deog-Yoon
    • Nuclear Medicine and Molecular Imaging
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    • v.42 no.5
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    • pp.419-421
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    • 2008
  • The false-positive FDG uptakes on head and neck areas are common due to benign lesion, iatrogenic and physiologic changes. The Schneiderian papilloma is uncommon benign tumor arising from the mucosa of the paranasal sinuses and nasal cavity. The findings of paranasal papilloma on conventional modality such as CT and MRI are non-specific and they could be confused with inflammatory polyp or retention cyst. Despite of benign tumor, the papilloma usually shows locally aggressive growth with malignant potential, therefore the FDG can be actively accumulated in this lesion. We describe the case of 18F-FDG PET/CT finding in a 77-year-old woman who demonstrates oncocytic papilloma in maxillary sinus.

Histologic Base of Mild $^{18}F$-FDG Uptake in Simple Bone Cyst of Adult Rib: A Case Report with Multi-image Correlation (성인 늑골에 생긴 단순성 골낭종 $^{18}F$-FDG섭취의 조직학적 근거: 증례보고 및 여러 영상검사 소견과의 비교검토)

  • Bahk, Yong-Whee;Kang, You-Mee;Kim, Sung-Hoon;O, Joo-Hyun
    • Nuclear Medicine and Molecular Imaging
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    • v.42 no.4
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    • pp.328-332
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    • 2008
  • Simple bone cyst (SBC) is very rare in adult ribs. The diagnosis basically relies on conventional radiography and occasionally on a. There has been no earlier publication on PET/CT diagnosis of SBC. We report a case of adult costal SBC diagnosed by positive $^{18}F$-fluorodeoxyglucose (FDG) uptake. Histology showed the FDG uptake to be associated with reactive woven bone formation and nonspecific chronic inflammation. Correlation of PET, CT, plain radiography and sonography are also described.