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Oropharyngeal Complications Associated with Laryngomicrosurgery(LMS) (후두 미세수술과 연관된 구강 및 후두 합병증)

  • 강진욱;최승효;남순열
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.14 no.1
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    • pp.5-9
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    • 2003
  • Introduction : Laryngomicrosurgery(LMS) is frequent procedure applying to benign and early malignant larygeal disease such as vocal cord polyp, nodule and early glottic cancer. LMS has been known as safe procedure and short time consuming treatment. So few reports about complications in LMS was done. In this study, complications and problems from LMS were investigated and reported. Method : From 2000, January to 2001, December, 180 patients who were treated with LMS in Asan medical center were studied by retrograde chart review. Results : In these patients, total 9 patients(5%) were suffered from complication. 4 patients (2%) had teeth injury and 4(2%) were suffered from foreign body sensation in tongue and 1(1%) had hypoglossal nerve injury. Main mechanism of complications is thought by pressure injury by laryngoscope blade. No definite correlation between procedure and complication was observed. Conclusion : There are few neural complications with LMS such as lingual and hypoglossal nerve injury. Before operation of LMS, warning and informing of complications by mechanical stress must be done. Gentle procedure and short operation time are necessary to avoid these problems. And patients who have risk factors of oral complications such as dental disease or dental prosthesis must have dental evaluation and treatment before LMS procedure.

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Prediction of medication-related osteonecrosis of the jaw (MRONJ) using automated machine learning in patients with osteoporosis associated with dental extraction and implantation: a retrospective study

  • Da Woon Kwack;Sung Min Park
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.49 no.3
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    • pp.135-141
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    • 2023
  • Objectives: This study aimed to develop and validate machine learning (ML) models using H2O-AutoML, an automated ML program, for predicting medication-related osteonecrosis of the jaw (MRONJ) in patients with osteoporosis undergoing tooth extraction or implantation. Patients and Methods: We conducted a retrospective chart review of 340 patients who visited Dankook University Dental Hospital between January 2019 and June 2022 who met the following inclusion criteria: female, age ≥55 years, osteoporosis treated with antiresorptive therapy, and recent dental extraction or implantation. We considered medication administration and duration, demographics, and systemic factors (age and medical history). Local factors, such as surgical method, number of operated teeth, and operation area, were also included. Six algorithms were used to generate the MRONJ prediction model. Results: Gradient boosting demonstrated the best diagnostic accuracy, with an area under the receiver operating characteristic curve (AUC) of 0.8283. Validation with the test dataset yielded a stable AUC of 0.7526. Variable importance analysis identified duration of medication as the most important variable, followed by age, number of teeth operated, and operation site. Conclusion: ML models can help predict MRONJ occurrence in patients with osteoporosis undergoing tooth extraction or implantation based on questionnaire data acquired at the first visit.

A study of statistical techniques for clinical data about cerebrovascular diseases (중풍임상자료(中風臨床資料)에 대한 통계적(統計的) 분석방법연구(分析方法硏究))

  • Kang, Hyo-Shin;Kwon, Young-Kyu;Park, Chang-Gook;Shin, Yang-Kyu;Kim, Sang-Chul
    • The Journal of Korean Medicine
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    • v.17 no.1 s.31
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    • pp.302-328
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    • 1996
  • I . Objective and significance of the study To design a data acquisition chart, which facilitates data collection and analysis. The chart is also useful for solving problems that arise from personal variations in clinical symptoms and filling the knowledge base of an expert system. II. Content and scope 1. Collect the diagnosis knowledge of cerebrovacular diseases from doctors and analyze it. 2. Design a data acquisition chart. 3. Compare ODS and doctors with respect to their diagnosis results 4. Select patients who are determined to suffer from cerebrovascular diseases using CT(computed tomographic) scan, collect clinical data from them. III. Results and Application The chart be used for data collection and analysis in different medical hospitals, The results of data analysis facilitates collecting clinical data about other diseases and implementing the knowledge base. Also, the collected data serves as a tool for medical education, and cooperative diagnosis of oriental and western medical doctors.

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Pop-up Chart for Managing CRRT Improves the Quality of CRRT Care (전자의무기록 팝업차트를 활용한 CRRT 관리의 질향상 활동)

  • Go, Su-Ryeong;Lee, An-Na;Kim, Ki-Pyo;Chin, Ho-Jun;Na, Ki-Young;Chae, Dong-Wan;Kim, Se-Joong
    • Quality Improvement in Health Care
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    • v.25 no.1
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    • pp.43-51
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    • 2019
  • Purpose: The time lag between the decision to initiate continuous renal replacement therapy (CRRT) and its actual initiation remains a major barrier in our intensive care units. We developed a CRRT pop-up chart on EMR for managing CRRT machines. Methods: This study measured time interval between the decision to prepare the CRRT machine and the actual use of the machine before and after using a CRRT pop-up chart. This study conducted a questionnaire of the medical staff to assess the changes in the quality of CRRT preparation. Results: A total of 95 patients on CRRT is analyzed. The time to find an available CRRT machine is decreased by 24.6%. The time to move a CRRT machine to the patient's bedside is decreased by 55.8%. Medical surveys of 44 nurses gave the following results. 1) The time to apprehend machines for 1 to 3 minutes is improved from 29.5% to 81.8%, and the time to apprehend machines over 3 minutes is decreased from 70.5% to 18.2%. 2) The number (6-all) of known machine locations is improved from 22.7% to 63.4%. 3) Interruption of a nurse's work due to telephone calls asking for the possession of movable CRRT equipment also is improved. Scores of 1-4 are improved from 15.9% to 41%. Scores of 5-7 are reduced from 52% to 15.9%. Conclusions: CRRT pop-up chart is shortened the time lag of CRRT machine preparation, reduced the nurse's phone workload and helped to improve the quality of CRRT care.

The comparative study with administrative and clinical standard of conservative treatment on herniated intervertebral lumbar disc patients (요추 추간판 탈출증 환자에 대한 보존적 치료의 행정기준과 임상기준에 관한 비교 연구)

  • Ghang, Goon-Yong;Kim, Young-Bae
    • Journal of Korean Physical Therapy Science
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    • v.13 no.3
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    • pp.27-40
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    • 2006
  • The purpose of this study is comparative with administrative and clinical standard of conservative treatment on herniated intervertebral lumbar disc patients. The persons who diagnosed to herniated intervertebral lumbar disc were attended in this study. The number of cases were 120 cases. We evaluated their chart, X-ray and MRI. The result of the group 1 study(60 cases) were as follows; 1. The patients who treated for 41days were improved 100%, which was 3cases(5%). 2. The patients who treated for 45days were improved 90%, which was 13cases(22%). 3. The patients who treated for 43days were improved 80%, which was 28cases(47%). 4. The patients who treated for 39days were improved 70%, which was 6cases(10%). 5. The patients who treated for 28days were improved 60%, which was 5cases(28%). 6. The patients who treated for 22days were improved 50%, which was 4cases(7%). 7. The patient who treated for 28days were improved 40%, which was 1case(2%). The result of the group 2 study(60 cases) were as follows; 1. The patients who treated by administrative standard were improved 40%, which was 8cases(13%). 2. The patients who treated by administrative standard wereimproved 30%, which was 32cases(53%). 3. The patients who treated by administrative standard wereimproved 20%, which was 7cases(12%). 4. The patients who treated by administrative standard were improved 10%, which was 9cases(15%). 5. The patients who treated by administrative standard wereimproved 0%, which was 4cases(7%). Conclusion ; In herniated intervertebral lumbar disc patients who had conservative treatment. The highest improve patients were 28 cases(47%), who treated for 43 days in group 1. The lowest improve patient were 4 case(7%), who treated by administrative standard in group 2. The Effective duration of conservative treatment was more than 43 days in group 1. Group 1 which applied to clincal standard was much batter than group 2 which applied to administrative standard.

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Correlation Between the Osmolar Gap and Serum Ethanol Level and the Accuracy of Estimated Ethanol Level in Trauma Patients and Non-Trauma Patients (외상 환자와 비외상 환자에서 삼투압차와 에탄올 농도의 상관관계 및 추정 에탄올 농도의 정확도)

  • Chang, Hyung Woo;Sim, Min Seob;Han, Sang Kuk;Song, Hyoung Gon
    • Journal of Trauma and Injury
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    • v.22 no.2
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    • pp.148-153
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    • 2009
  • Purpose: The osmolar gap increases in proportion to the ethanol level. Some previous studies have shown that the correlation between the osmolar gap and the ethanol level is weak in trauma patient by using an indirect comparison with other patients. We conducted a direct comparison of the correlation of the osmolar gap to the ethanol level between trauma patients and non-trauma patients. We also analyzed the accuracy of the estimated ethanol level between the two groups. Methods: The research candidates were adult patients who had visited the emergency department of our hospital from December 2003 to November 2008. By using a retrospective chart review, we classified them into three subgroups: non-trauma without shock, trauma without shock, and trauma with shock. In each group, we compared the correlation between the osmolar gap and the measured ethanol level, and we analyzed the accuracy of the estimated ethanol level by using Lin's concordance correlation coefficient. Results: Four hundred forty-seven patients were enrolled in this study. For correlation of the osmolar gap and the measured ethanol level, Pearson's correlation coefficient was 0.916 in all patients, 0.939 in non-trauma without shock patients, 0.917 in trauma without shock patients, and 0.844 in trauma with shock patients. In the analysis of the accuracy of the estimated ethanol level by using Lin's concordance correlation coefficient, the accuracy in trauma with shock patients was lower than that in non-trauma without shock patients. Conclusion: We found that the correlation between the osmolar gap and the measured ethanol level in the patient group with trauma was lower than it was in the patient group without trauma. Moreover trauma patients with shock had a lower accuracy of the estimated ethanol level than non-trauma patients.

Evaluation of the Pectoralis Major Myocutaneous Flap for Oral and Maxillofacial Reconstructive Surgery (구강악안면 영역의 재건을 위한 대흉근피판의 임상적 평가)

  • Na, Kwang Myung;Kim, Jin-Wook;Lee, Ho-Jin;Kim, Chin-Soo;Kwon, Tae-Geon;Lee, Sang-Han
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.35 no.5
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    • pp.277-283
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    • 2013
  • Purpose: Well vascularized pectoralis major myocutaneous flap (PMMF) had been a commonly used versatile flap in reconstructive oromaxillofacial surgery since the 1970s. However, after the advent of microvascular surgery in the 1980s, the PMMF was used less frequently. But, to date, PMMF has been useful and has some advantages such as covering wide defects, covering vital structures, back-up procedure in cases of free flap failure, and reconstruction for radiotherapy patients. The purpose of this study is to evaluate the role, indication, complications, functional, and aesthetic results of this flap in the era of free flap with a literature and chart review. Methods: A retrospective study was conducted of 16 oral cancer patients undergoing reconstructive surgery with PMMF for reconstruction of defects from 2001 to 2012 at Kyungpook National University Hospital. The male to female ratio was 10:6, with a mean age of 63 years (16~79 years). Basic demographic data, previous treatment history, indications, dimension of the flap, site of reconstruction, postoperative complications, and patients' final status were systemically analyzed from chart review. Results: The pathology of the disease included squamous cell carcinoma in the majority of cases (n=14). The remaining cases were fibrosarcoma and mucoepidermoid carcinoma. Of the 16 PMMF reconstructions, 13 flaps were applied as primary reconstructive procedures, whereas three flaps were; salvage; procedures (vascularized free flap failure). Twelve patients had complications such as wound dehiscence, infection, hematoma, fistula, flap bulkiness, and partial flap necrosis. The higher complication rates showed an association with utilization of the flap in preoperative radiotherapy cases. However, all patients were discharged without failure. Conclusion: In reconstructive oromaxillofacial surgery, the PMMF is still a useful flap for huge defects. In addition, the PMMF can be used as a salvage procedure after vascularized free flap failure and reconstruction for patients with a history of preoperative radiotherapy.

A Retrospective Study of Autism Spectrum Disorder in Children Treated by Korean Medicine (한의학적 치료를 받은 자폐 스펙트럼 장애 환아 63례에 대한 후향적 차트리뷰)

  • Park, So Hyun;Kim, Ye Ji;Park, Sul Gi;Lee, Sun Haeng;Lee, Jihong;Park, Yong Seok;Kim, Jae Hyun;Chang, Gyu Tae;Lee, Jin Yong
    • The Journal of Pediatrics of Korean Medicine
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    • v.35 no.3
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    • pp.43-52
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    • 2021
  • Objectives This study aimed to analyze the clinical characteristics of 63 patients with autism spectrum disorder (ASD) who received Korean medicine treatment. Methods This study identified and retrospectively reviewed the first visit records and clinical characteristics of all of the patients who visited the Kyung Hee University Korean Medicine Hospital and Kyung Hee University Korean Medicine Hospital at Gangdong in South Korea with ASD as their chief complaints. The herbal medicines that were prescribed according to the patient's symptoms were analyzed by separating them into categories. Results The data of 83 children with ASD were collected. Among them, the primary medical record charts of 63 patients were reviewed. Additional analysis was performed for 56 patients who were treated with herbal medicine. Through a retrospective chart review, the patients' clinical characteristics and the tendency of the prescribed herbal medicine was identified. Conclusions This study was conducted to provide preliminary data that proposes Korean medicine as a new alternative medical treatment. Our study is meaningful as it used the demographic and clinical records of 63 patients with ASD in Korea who visited an Korean medicine hospital in the last 11 years to identify tendencies and analyzed the prescriptions of two or more Korean medicine pediatricians.

Enhancing value of quality assurance rounds in improving radiotherapy management: a retrospective analysis from King Hussein Cancer Center in Jordan

  • Khader, Jamal K.;Al-Mousa, Abdelatif M.;Mohamad, Issa A.;Abuhijlih, Ramiz A.;Al-Khatib, Sondos A.;Alnsour, Anoud Z.;Asha, Wafa A.;Ramahi, Shada W.;Hosni, Ali A.;Abuhijla, Fawzi J.
    • Radiation Oncology Journal
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    • v.37 no.1
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    • pp.60-65
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    • 2019
  • Purpose: The quality assurance (QA) chart rounds are multidisciplinary meetings to review radiation therapy (RT) treatment plans. This study focus on describing the changes in RT management based on QA round reviews in a single institution. Materials and Methods: After 9 full years of implementation, a retrospective review of all patients whose charts passed through departmental QA chart rounds from 2007 to 2015. The reviewed cases were presented for RT plan review; subcategorized based on decision in QA rounds into: approved, minor modifications or major modifications. Major modification defined as any substantial change which required patient re-simulation or re-planning prior to commencement of RT. Minor modification included treatment plan changes which didn't necessarily require RT re-planning. Results: Overall 7,149 RT treatment plans for different anatomical sites were reviewed at QA rounds. From these treatment plans, 6,654 (93%) were approved, 144 (2%) required minor modifications, while 351 (5%) required major modifications. Major modification included changes in: selected RT dose (96/351, 27%), target volume definition (127/351, 36%), organs-at-risk contouring (10/351, 3%), dose volume objectives/constraints criteria (90/351, 26%), and intent of treatment (28/351, 8%). The RT plans which required major modification according to the tumor subtype were as follows: head and neck (104/904, 12%), thoracic (12/199, 6%), gastrointestinal (33/687,5%), skin (5/106, 5%), genitourinary (16/359, 4%), breast (104/2387, 4%), central nervous system (36/846, 4%), sarcoma (11/277, 4%), pediatric (7/251, 3%), lymphoma (10/423, 2%), gynecological tumors (2/359, 1%), and others (11/351, 3%). Conclusion: Multi-disciplinary standardized QA chart rounds provide a comprehensive and an influential method on RT plans and/or treatment decisions.

A retrospective study of changes in skin cancer characteristics over 11 years

  • Park, Young Ji;Kwon, Gyu Hyeon;Kim, Jun Oh;Kim, Nam Kyun;Ryu, Woo Sang;Lee, Kyung Suk
    • Archives of Craniofacial Surgery
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    • v.21 no.2
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    • pp.87-91
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    • 2020
  • Background: The incidence of skin cancer, which is primarily caused by exposure to ultraviolet radiation, has steadily increased in recent years. The authors of the present study sought to investigate changes in the epidemiology of skin cancer by conducting a retrospective review of patients diagnosed with skin cancer who received related care at a single medical institution. Methods: The present study included patients who were diagnosed with skin cancer and received treatment at Gyeongsang National University Hospital from 2008 to 2018. The site and type of skin cancer, the number of patients with skin cancer each year, the sex and sex ratio of the patients, and changes in patients' age at first diagnosis were examined through retrospective chart reviews. Results: The number of patients with skin cancer significantly increased, but statistically significant changes were not found in patients' sex, skin cancer sites, or the types of skin cancer. However, patients' age at the first diagnosis of skin cancer showed a statistically significant decrease starting in 2015. Conclusion: In this study, the number of patients with skin cancer increased over time. However, patients' age at first diagnosis has decreased since 2015. Therefore, younger patients should take care to prevent skin cancer, and further research on the causes of skin cancer in younger patients is needed.