• Journal of the Korea Academia-Industrial cooperation Society
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• v.17 no.2
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• pp.66-74
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• 2016

This study examined the effects of nursing information provision using a booklet on the patients' anxiety and uncertainty with an endoscopic submucosal dissection before the procedure, which is a non-equivalent controlled pre-post test designed study. Twenty three patients in a control group received the existing intervention, which is the general education prior to the procedure without standardized format as well as an oral explanation, and 23 patients in the experimental group received nursing information with a booklet developed by the investigator of this study. The collected data were analyzed using a ${\chi}^2$ test and Fisher's exact t-test on SPSS 21.0. The experimental group reported significantly lower anxiety (t=3.319, p=.002) and anxiety behavioral responses (t=3.508, p=.001) than those in the control group. There were no significant differences in uncertainty between the groups (t=.745, p=.460). Nursing information using the booklet is a useful nursing intervention to reduce the anxiety of patients with endoscopic submucosal dissection before the procedure.

• Journal of radiological science and technology
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• v.31 no.2
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• pp.115-121
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• 2008

Purpose: Aortic Dissection is very dangerous, prognostic disease, which the bloodstream flow out of the true lumen of the aorta by the bursting of aortic intima resulting in a rapid dissociation of inner and outer layer from the media. It is difficult to diagnose aortic dissection clinically by normal X-ray. This study was to investigate the occurrence frequency by age and number of patients who are identified to be aortic dissection by CT (Computed Tomography) scan. Materials and methods: We investigated the trend of yearly fluctuation, gender, age, and department of clinical research of the 112 patients who conducted CT scan in C- University Hospital for two years from January 2005 to December 2006. The MIP and SSD which reconstructed CT image and the VRT image were obtained for the accurate observation. The result was investigated by comparing normal X-ray and CT scan. Results and Conclusion: 1. The yearly check of 112 patients conducted CT scan showed 37 people (41.9%) in 2005, and it was increased to 65 (58.1%) in 2006 by 1.4 times. 2. The gender distribution of patients given a CT scan showed 45 males (40.1%), and female 67 (59.9 %). The aortic dissection patients were 9 (20%) out of 45 males, 21 (31.3%) out of 67 females and women were 1.6 times more than men. Women are also 1.5 times more than men in the number of examinee. 3. The age distribution of patient's who conducted CT scan revealed that there was no patient under 30 years old while 88.3% of all patients were through 41 to 80 years old. The higher the age was, the higher the occurrence of aortic dissection was. The difference in the occurrence frequency of age was statistically significant (p<0.01). 4. The departments that requested CT scan were the emergency department 46 (41.1%), circulatory internal medicine 37 (33.0%), chest surgery 13 (11.6%), and others 6 (14.3%). The combined ratio of emergency medicine and circulatory internal medicine was 74.1% of all. The results show that the aortic dissection is a very dangerous disease whose patients visit mainly via the emergency room. 5. The aortic dissection patients had normal X-ray readings in 22 (73.3%) out of 30, and only 8 (26.7 percent) are abnormal in the X-ray diagnosis. Therefore, the CT scan needs to be enforced in order to assess accurately the disease of aortic dissection.

• Journal of Gastric Cancer
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• v.21 no.3
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• pp.258-267
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• 2021

Purpose: As the rate of endoscopic resection for early gastric cancer (EGC) has increased in patients with comorbid diseases, it is necessary to elucidate the efficacy of endoscopic submucosal dissection (ESD) for EGC in patients with comorbidities. This study aimed to analyze the clinical outcomes of ESD for EGC in patients with comorbidities. Materials and Methods: A total of 969 patients with 1,015 lesions who underwent ESD for EGC at Seoul National University Hospital between 2010 and 2014 were analyzed. The short- and long-term clinical outcomes were evaluated according to the comorbidity status. Results: Comorbidities were observed in 558 patients (57.6%). The comorbidity group had a higher proportion of patients using antithrombotic agents (29.5% vs. 0.9%; P<0.0001). Although procedure-related complications (bleeding and perforation) were not significantly different between the two groups, the length of hospital stay was significantly longer (1.8 vs. 1.4 days, P=0.023), while survival was significantly shorter in the comorbidity group (5-year overall survival rate: 90.5% vs. 97.2%, P<0.0001; 5-year disease-specific survival rate: 97.9% vs. 100%, P=0.018; 5-year disease-free survival rate: 83.4% vs. 89.2%, P=0.007). Conclusions: Gastric ESD can be performed in patients with comorbidities without increasing the risk of complications.

• Korean Journal of Head & Neck Oncology
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• v.34 no.1
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• pp.21-27
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• 2018

Background/Objectives: This study aimed to evaluate the changes of uptake around the sternoclavicular joint (SCJ) according to 18F-FDG PET images in patients with head and neck cancer who underwent neck dissection. Materials & Methods: Retrospectively, the medical records of patients who received selective or comprehensive neck dissection were reviewed. Preoperative and 1-year postoperative 18F-FDG PET images, if available, were analyzed by nuclear medicine physicians in both qualitative and quantitative manners. Correlation between the changes of uptake around SCJ and perioperative data were statistically analyzed. Results: Thirty-seven patients satisfying the inclusion criteria were enrolled. Seven patients with increased uptake around SCJ on 1-year postoperative 18F-FDG PET showed a correlation with radical or comprehensive neck dissection, accessory nerve sacrifice, and high postoperative SUVmax. When 20 patients with increased uptake around SCJ according to quantitative measurement were compared with other patients without increased uptake, no parameter was significantly different, except postoperative SUVmax. Bivariate logistic regression analysis revealed that the clinical symptom (shoulder or sternal pain) was significantly correlated with the extent of neck dissection (OR 0.227, CI 0.053-0.966, p=0.045) and spinal accessory nerve sacrifice (OR 13.500, CI 1.189-153.331, p=0.036). Conclusions: Increased uptake around SCJ on 1-year postoperative 18 F-FDG PET was correlated with either the radical or comprehensive procedure, as well as with accessory nerve sacrifice. This suggests that subjective analysis of 18F-FDG PET can be used to detect subclinical shoulder instability.

• Korean Journal of Head & Neck Oncology
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• v.26 no.2
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• pp.183-186
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• 2010

Purpose : Papillary thyroid carcinoma (PTC) is known for malignant tumor which has a favorable prognosis and long-term survival. Although the prognosis for patients with PTC is generally good, PTC tends to have highly metastatic property. The purpose of this study was to analyze the central compartment lymph node in papillary thyroid cancer with no lymph node metastasis clinically and to assess the significance of prophylactic node dissection. Methods : A retrospective review was carried out in 394 patients with PTC who underwent surgery for the period from January 2004 to December 2006. The positive rate of the lymph node metastasis was analyzed. The relations between the central compartment lymph nodes and the patients' age, gender, tumor size, exrathyroidal extension(ETE), multifocality, and bilaterality were comparatively analyzed in PTC patients with preoperative no lymph node metastasis. Results : The enrolled patients were 40 male and 354 female cases. The 118 cases of them were found to have cervical lymph node metastasis. The mean age was 46 years(range, 15-77years). Tumor size(p=0.000), ETE(p=0.001), multifocality(p=0.014), and bilaterality(p=0.001) were significantly related factors for cervical lymph node metastasis clinically in papillary thyroid cancer. However, age and gender were not significantly related with lymph node metastasis. Conclusion : Although no lymph node metastasis clinically, prophylactic neck node dissection can be performed to avoid risks of local recurrence and reoperation in the light of PTC nature. The pathological status and high positive rate of central compartment lymph node relate to tumor size and extrathyroidal extension. Close surveillance for nodal status is required in follow-up.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.46 no.2
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• pp.99-107
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• 2020

Objectives: We accessed the various clinico-histopathological factors, and their association with occult metastasis (OM) in oral tongue squamous cell carcinoma (OTSCC). Materials and Methods: One hundred-nine patients with OTSCC were divided into the elective neck dissection (END) group and the watchful waiting (WW) group. Age, sex, T-stage, depth of invasion and differentiation were evaluated to determine the correlation between clinico-histopathological factors and OM. For immunohistochemical analysis, paraffin-embedded blocks of 41 OTSCC specimens were examined with antibodies (VEGF-c, c-Met, and ROR1). Results: The group with tumor thickness of oral tongue cancer ≥3 mm had higher incidence of OM than those with a thickness of <3 mm. The depth of invasion was statistically correlated with OM (P=0.022). Immunohistochemical analysis showed that high expression of VEGF-c (P=0.043), c-Met (P=0.009), and ROR-1 (P=0.003) were statistically correlated with OM. Conclusion: The analysis of these clinico-histopathological and immunohistochemical factors can help to determine neck dissection in clinically negative (cN0) patients.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.20
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• pp.8917-8921
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• 2014

Objective: To observe and compare the effects of multi-patch biopsy under conventional white light imaging endoscopy (C-WLI) and precise targeted biopsy under magnifying narrow-band imaging endoscopy (M-NBI) on the endoscopic submucosal dissection (ESD) of early gastric cancers and intraepithelial neoplasias. Methods: According to the way of selecting biopsy specimens, patients were divided into C-WLI and M-NBI groups, 20 cases. The ESD operations of the 2 groups were compared quantitively. Results: The mean frequency of biopsy in M-NBI group was ($1.00{\pm}0.00$), obviously lower than in the C-WLI group ($4.78{\pm}1.02$) (P<0.01).The average total number of selected biopsy specimens was also fewer ($1.45{\pm}0.12$ and $7.82{\pm}2.22$, respectively, P<0.01). There was no significant difference in the time of determining excision extension, marking time and the time of specimen excision of 2 groups during the ESD (P>0.05), whereas submucosal injection time, mucosal dissection time, stopping bleeding time, wound processing time in the M-NBI group were significantly shorter than in the C-WLI group (P<0.01). Conclusion: Precise targeted biopsy under M-NBI can obviously shorten the time of ESD operation, with small quantity of tissues but high pathological positive rate.

• Archives of Plastic Surgery
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• v.44 no.4
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• pp.293-300
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• 2017

Background Simulation training is becoming an increasingly important component of skills acquisition in surgical specialties, including Plastic Surgery. Non-living simulation models have an established place in Plastic Surgical microsurgery training, and support the principles of replacement, reduction and refinement of animal use. A more sophisticated version of the basic chicken thigh microsurgery model has been developed to include dissection of a type 1-muscle flap and is described and validated here. Methods A step-by-step dissection guide on how to perform the chicken thigh adductor profundus free muscle flap is demonstrated. Forty trainees performed the novel simulation muscle flap on the last day of a 5-day microsurgery course. Pre- and post-course microvascular anastomosis assessment, along with micro dissection and end product (anastomosis lapse index) assessment, demonstrated skills acquisition. Results The average time to dissect the flap by novice trainees was $82{\pm}24$ minutes, by core trainees $90{\pm}24$ minutes, and by higher trainees $64{\pm}21$ minutes (P=0.013). There was a statistically significant difference in the time to complete the anastomosis between the three levels of training (P=0.001) and there was a significant decrease in the time taken to perform the anastomosis following course completion (P<0.001). Anastomosis lapse index scores improved for all cohorts with post-test average anastomosis lapse index score of $3{\pm}1.4$ (P<0.001). Conclusions The novel chicken thigh adductor profundus free muscle flap model demonstrates face and construct validity for the introduction of the principles of free tissue transfer. The low cost, constant, and reproducible anatomy makes this simulation model a recommended addition to any microsurgical training curriculum.

• Korean Journal of Clinical Oncology
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• v.14 no.2
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• pp.120-127
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• 2018

Purpose: The purpose of this study was to determine the immunologic role of lymph node (LN) and stage migration by assessing LN count and metastatic LN count. Methods: A total of 2,117 patients with gastric adenocarcinoma located in the body and antrum who underwent distal/subtotal gastrectomy with D2 LN dissection between January 1, 1998 and December 31, 2008 were enrolled. LN count and number of metastases were determined in the N1 tier (area of D1 dissection) and N2 tier (area of D2 dissection). The lower and upper quartiles of LN counts in the same pN stage were grouped to compare the prognosis and LN positivity according to the LN tier. Results: Stage migration from N1 tier to N2 tier occurred in 3.2% of cases. The 5-year disease-specific survival rates of the upper and lower LN count groups within the N1 tier were 91.0% and 86.7% (P=0.01), respectively. LN positivity in the N2 tier of the lower LN count group was higher than that of the upper LN count group (14.1% vs. 8.2%, P<0.01). Stage migration in the N2 tier of the lower LN count group was also higher than that of the upper LN count group (4.6% vs. 1.8%, P<0.01). Conclusion: The lower LN count group had a decreased survival rate compared to that of the upper LN count group, suggesting that perigastric LN has an immunological defense role in weakening the disseminating power of metastatic tumor cells, as indicated by the LN count.

• Archives of Craniofacial Surgery
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• v.18 no.2
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• pp.105-111
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• 2017

Background: The author analyse the impact of extracapsular lymph node spread and bone engagement in the ipsilateral neck of patients suffering squamous cell carcinoma (SCC) of the lower lip. Methods: The data of 56 neck dissections performed in patients suffering SCC of the lower lip between January 2000 and December 2008 were retrospectively analysed. Statistical analysis was performed with the Kaplan-Meier life table method, and the survival rate was investigated with the log rank statistic and significance test. The values were considered statistically significant at p<0.05. Results: Nine patients took advantage from simultaneous treatment of tumor and prophylactic neck dissection (level I-III), reaching 100% survival rate. Patients suffering metastasized disease, who received radical neck dissection at the time of tumor treatment, presented 83.3% survival rate. Patients who underwent previous surgery and radiotherapy presented worse prognosis although radical neck dissection in case of extra-capsular spread only (24.7%) and osseous engagement (22.2%). Conclusion: Prophylactic neck dissection (level I-III) is recommended in T3-T4 N0 SCC. Simultaneous treatment of tumor and cervical lymph nodes provides a better prognosis as respect to delayed nodal management. Extra-capsular spread with or without bone engagement represents independent risk factor responsible for high mortality rate of SCC of the lower lip.