• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제50권3호
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• pp.146-152
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• 2024

Objectives: This prospective observational study aimed to assess the clinical outcomes of perioperative airway and ventilatory management in patients undergoing surgery for oral cavity cancer. The study described the frequencies and types of procedures for securing the airway and the duration and types of postoperative ventilatory support. We compared the findings with those of the TRACHY study. Patients and Methods: One hundred patients undergoing oral cavity oncological surgeries were included. Airway assessment included inter-incisor gap, Mallampati class, neck movements, and radiological features. Surgical parameters, postoperative ventilatory support, and complications were documented. Results: The buccal mucosa was the most common cancer site (48.0%), and direct laryngoscopy was deemed difficult in 58.0% of patients. Awake fibreoptic intubation or elective tracheostomy was required in 43.0% of cases. Thirty-three patients were extubated on the table, and 34 patients were successfully managed with a delayed extubation strategy. In comparison with the TRACHY study, variations were observed in demographic parameters, tumour characteristics, and surgical interventions. Our mean TRACHY score was 1.38, and only five patients had a score ≥4. Prophylactic tracheostomy was performed in 2.0% of cases, in contrast to the TRACHY study in which 42.0% of patients underwent the procedure. Conclusion: The study emphasizes the challenges in airway management for oral cavity cancer surgery. While prophylactic tracheostomy may be necessary in specific cases, individualized approaches, including delayed extubation, are preferrable to maximize safety. Our findings contribute to better understanding and managing perioperative challenges in oral cancer patients and highlight the need for personalized strategies. Scoring systems like TRACHY should not be accepted as universally applicable.

• Hip & pelvis
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• 제35권4호
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• pp.228-232
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• 2023

Purpose: Prosthetic joint infection (PJI) has an enormous physiological and psychological burden on patients. Surgeons rightly wish to minimise this risk. It has been shown that a standardised, evidence-based approach to perioperative care leads to better patient outcomes. A review of current practice was conducted using a cross-sectional survey among surgeons at multiple centers nationwide. Materials and Methods: An 11-question electronic survey was circulated to hip and knee arthroplasty consultants nationally via the BOA (British Orthopaedic Association) e-newsletter. Results: The respondents included 56 consultants working across 19 different trusts. Thirty-four (60.7%) screen patients for asymptomatic bacteriuria (ASB) preoperatively, with 19 (55.9%) would treating with antibiotics. Fifty-six (100%) screen for methicillin-resistant Staphylococcus aureus and treat if positive. Only 15 (26.8%) screen for methicillin-sensitive S. aureus (MSSA) or empirically eradicate. Zero (0%) routinely catheterize patients perioperatively. Forty-one (73.2%) would give intramuscular or intravenous gentamicin for a perioperative catheterisation. All surgeons use laminar flow theatres. Twenty-six (46.4%) use only an impervious gown, 6 (10.7%) exhaust pipes, and 24 (42.3%) surgical helmet system. Five different antimicrobial prophylaxis regimens are used 9 (16.1%) cefuroxime, 2 (3.6%) flucloxacillin, 19 (33.9%) flucloxacillin and gentamicin, 10 (17.9%) teicoplanin, 16 (28.6%) teicoplanin and gentamicin. Twenty-two (39.3%) routinely give further doses. Conclusion: ASB screening, treatment and intramuscular gentamicin for perioperative catheterisation is routinely practiced despite no supporting evidence base. MSSA screening and treatment is underutilised. Multiple antibiotic regimens exist despite little variation in organisms in PJI. Practice varies between surgeons and centers, we should all be practicing evidence-based medicine.

• Journal of Chest Surgery
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• 제57권4호
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• pp.342-350
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• 2024

Background: The maintenance of antiplatelet therapy increases the risk of bleeding during lung cancer surgery. Conversely, the perioperative interruption of antiplatelet therapy may result in serious thrombotic complications. This study aimed to investigate the safety of continuing antiplatelet therapy in the context of lung cancer surgery. Methods: We retrospectively reviewed a cohort of 498 elderly patients who underwent surgery for lung cancer. These patients were categorized into 2 groups: group N, which did not receive antiplatelet therapy, and group A, which did. Group A was subsequently subdivided into group Am, where antiplatelet therapy was maintained, and group Ai, where antiplatelet therapy was interrupted. We compared the incidence of bleeding-related and thrombotic complications across the 3 groups. Results: There were 387 patients in group N and 101 patients in group A (Ai: 70, Am: 31). No significant differences were found in intraoperative blood loss, thoracotomy conversion rates, transfusion requirements, volume of chest tube drainage, or reoperation rates for bleeding control between groups N and A or between groups Am and Ai. The duration of hospital stay was longer for group A compared to group N (7 days vs. 6 days, p=0.005), but there was no significant difference between groups Ai and Am. The incidence of cardiovascular or cerebrovascular complications did not differ significantly between groups Ai and Am. However, group Ai included a severe case of in-hospital ST-elevation myocardial infarction. Conclusion: The maintenance of antiplatelet therapy was found to be safe in terms of perioperative bleeding and thrombotic complications in elderly lung cancer surgery patients.

• Archives of Plastic Surgery
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• 제46권6호
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• pp.511-517
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• 2019

Background Cleft treatment is frequently performed in Indonesia, mostly in charity missions, but without a postoperative protocol it is difficult to establish the risks and complications of cleft treatment. The present study was designed to give an overview of current cleft lip and palate treatment strategies in Indonesia and to assess the complication rates during and after surgery. Methods This prospective study evaluated anesthetic, intraoperative surgical, and short-term postoperative complications in patients undergoing primary, secondary, or corrective surgery for cleft lip and palate deformities. The population consisted of 98 non-syndromic cleft patients. The main anesthetic complication that occurred during general anesthesia was high blood pressure, whereas the main intraoperative surgical complication was excessive bleeding and the main early postoperative complication was extremely poor wound hygiene. Results In this study, there were no cases of perioperative or postoperative mortality. However, in 23 (23.4%) of the 98 operations performed, at least one perioperative complication related to anesthesia occurred. The intraoperative and early postoperative complications following cleft lip and/or palate were assessed. There was a significant difference in the complication rate between procedure types (χ²=0.02; P<0.05). However, no relationship was found between perioperative complications related to anesthesia and the occurrence of postoperative complications (χ²=1.00; P>0.05). Nonetheless, a significant difference was found between procedure types regarding perioperative complications and the occurrence of postoperative complications (χ²=0.031; P<0.05). Conclusions Further evaluation of these outcomes would help direct patient management toward decreasing the complication rate.

• 한국임상약학회지
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• 제27권1호
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• pp.15-21
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• 2017

Objective: The perioperative management of antithrombotic therapy is often challenging and it requires a fine balance between the risk of hemorrhage and thrombosis. We aimed to evaluate the antithrombotic management for moderate to high risk patients in real world setting. Methods: Among the patients who were consulted to the neurologist for the evaluation of perioperative risk from 2010 to 2012, patients undergoing moderate to high risk surgery and taking antithrombotics within 30 days were identified. We analyzed the timing of discontinuation and reinitiation of antithrombotic drugs before or after surgery as well as the status of bridging therapy. In addition, the conformity with the guideline suggested by American College of Chest Physicians was assessed. The rate of thromboembolic event and major hemorrhage were also investigated. Results: A total of 329 patients were included. The concordance rate of warfarin stop and restart time with guideline was 23.4% and 10.3%, respectively. Continuing aspirin in patients undergoing coronary artery bypass surgery or non-cardiac surgery in patients with high risk for cardiovascular events were 59.2% and 2.6%, respectively. Bridging therapy was adopted in 92.9% and 81.2% in patients who had received anticoagulant before surgery and who were at high and low risk thromboembolism, respectively. In entire cohorts, 30-day incidence of major bleeding and thromboembolic event were 31.9% and 3.0%. Co-morbid renal disease were shown as independent predictor for major bleeding (adjusted OR 2.65. 95% CI 1.33-5.28). Conclusion: The concordance rate with guideline regarding perioperative antithrombotic use was low and bridging therapy was prevalent in patients undergoing moderate to high risk surgery.

• 대한핵의학회지
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• 제33권3호
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• pp.273-281
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• 1999

목적: 우리는 비심장 수술 환자에서 수술전후의 심장사건의 위험도를 평가할 때 미국 순환기학회/미국 심장학회(이하ACC/AHA)에서 제시한 임상적 여러 지표에 더하여 심근관류 SPECT가 도움되는지 연구하였다. 대상 및 방법: 1997년에 비심장 수술을 시행한 118명(혈관수술 18, 비혈관수술 100)을 대상으로 수술 전에 휴식 T1-201/부하 Tc-99m MIBI 심근관류 SPECT를 시행하고 중한 심장사건과 경한 심장사건의 발생을 조사하였다. 임상적 지표, 운동능력, 수술 종류에 따라 분류한 것의 심장사건 예측률과 심근관류 SPECT 소견을 가역관류감소, 지속관류감소, 정상으로 나누었을 때 심장사건 예측률을 조사하였다. 임상적 지표들에 대해 심근관류 SPECT가 부가 효용이 있는지 다변량 로짓 회귀분석을 하였다. 결과: 심장사건은 전체 환자의 21%에서 발생하였으며 심근관류 SPECT에 가역적 심근관류 이상이 있는 경우에 심장사건의 발생빈도가 높았다. 임상적 분류와 수술 종류도 사건 발생을 예측할 수 있었으나 다변량 분석에 수술 종류(p=0.0018)와 심근관류 SPECT 소견(p=0.0001)이 유의한 예측지표이었다. 심근관류 SPECT 결과가 수술 종류에 따른 위험 예측을 더욱 계층화할 수 있었다. 결론: 비심장수술 환자에서 수술 종류에 더하여 심근관류 SPECT가 심장사건 발생을 예측하는 유용한 지표이었다.

• Clinical and Experimental Pediatrics
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• 제45권2호
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• pp.208-213
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• 2002

목 적 : 수술 중, 후의 심근 손상은 선천성 심질환에 대한 개심술 후 심장 기능 부전의 주원인이다. 이 연구에서는 심근 세포에서만 발견되는 cardiac troponinI를 측정함으로서 수술 중, 후 심근 손상 정도와 회복 여부를 반영할 생화학적 표지자로서의 가치를 확인하고자 하였다. 방 법: 2001년 4월부터 7월까지 선천성 심질환으로 진단받고 개심술을 위해 본원에 입원한 환아 34명을 대상으로 하였다. Cardiac troponin I 치의 측정을 위해 술전 24시간 이내, 술후 1, 2, 3, 7일째에 각각 채혈을 시행했고, CPB 시간, ACC 시간, 기도 삽관시간, 수술 후 입원 기간을 측정하였다. 결 과 : Cardiac troponin I 치는 수술 후 1일째가 수술 전에 비해 유의한 증가가 있었고, 2, 3, 7일째에는 점차적으로 유의한 감소를 보였다. 심질환 별로는 수술 후 1일째 대혈관 전위에서 cardiac troponin I 치가 가장 높았고, 활로씨 4징, 방실중격결손, 심실중격결손, 심방중격결손 순으로 높은 치를 나타내었다. 심장폐 우회술 시간이 길수록, ACC 시간이 길수록 수술 후 1일째 cardiac troponin I 농도가 높았고, cardiac troponin I 농도가 높을수록 기도삽관 시간이 길었으나 입원 기간과는 상관관계가 없었다. 결 론: 개심술 후 시간에 따라, 개심술을 시행한 심질환에 따라 cardiac troponin I 농도의 의미 있는 증가와 점차적인 감소를 보임으로써 cardiac troponinI는 개심술 후 심근 손상의 정도 및 심근 손상에서의 회복 여부를 반영하는 생화학적 표지자로 가치가 있을 것으로 생각된다.

• 한국산학기술학회논문지
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• 제18권5호
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• pp.343-354
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• 2017

본 연구는 수술실 종사자를 대상으로 방사선 방어에 대한 지식, 인식도, 자기효능감 및 수행도를 조사하였다. 방사선 방어행위의 수행도에 영향을 미치는 요인을 파악하여, 효과적인 방사선 방어교육프로그램개발에 기초 자료를 제공하고자 시행되었다. 표본 수는 이 연구에 참여하기로 동의한 수술실 종사자 166명이다. 자료 분석은 SPSS 23.0 프로그램을 사용하여 independent t-test, one-way ANOVA, Pearson correlation coefficient, Multiple regression으로 분석하였다. 본 연구의 결과 수술실 종사자들은 평균 3-4시간 방사선에 노출되고 있으며, 방사선 피폭 교육 검험이 있는 대상자는 11.4%있었다. 방사선 방어관련 지식정도는 $8.61{\pm}2.51$점이었으며, 방어관련 인식도, $4.59{\pm}0.64$점, 수행도는 $2.99{\pm}0.90$점이었다. 방사선 방어지식과 수행도는 직종별 유의한 차이를 보였다(p<001). 방사선 방어관련 지식은 인식도와 유의미한 상관관계를 가졌으며, 방사선 방어관련 수행도는 지식과 유의미한 상관관계를 보였다. 방사선 수행도를 높이기 위해서는 방사선 방어관련 지식과 인식도를 높여야 한다. 그러므로 향후 방사선 방어교육 강화를 통한 방사선 방어 지식을 개선하여 방사선 방어 수행도를 촉진하는 것이 중요할 것이다.

• 생명과학회지
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• 제20권10호
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• pp.1458-1467
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• 2010

이 연구는 관상동맥질환 수술기주위의 결과예측에 있어 수술 전 백혈구 및 D-dimer 수치가 유용한 인자가 될 수 있는지를 규명하기 위해 회고적으로 실시하였다. 수술 전 백혈구 수는 수술 전 및 후의 심장표지자인 troponin-I, creatine kinase-MB, C-반응단백 각각의 농도와 정의 상관성이 있었다. 수술 전 D-dimer 농도 역시 수술기주위의 심장표지자들과 정의 상관관계를 보였다. 수술 전 백혈구 수는 간표지자인 aspartate aminotransferase 및 alanine aminotransferase의 수술 전후 농도와 정의 상관관계를 보였는데 비해, 수술 전 D-dimer 농도는 수술 전후 빌리루빈 농도, 수술 전 글루코스 농도, 수술 후 크레아티닌 농도와 각각 정 또는 역의 상관관계가 있었다. 수술 전 백혈구 및 D-dimer 수치 둘 다 수술 전 고밀도콜레스테롤 농도 및 좌심실구출계수와 각각 역의 상관관계가 있었다. 수술전 백혈구 수는 수술시간 및 수술 후 기계보조 호흡시간과 각 정의 상관관계를 보였고, 수술 전 D-dimer 농도는 수술 후 기계보조 호흡시간, 중환자실 치료기간, 재원기간과 각 정의 상관관계가 있었다. 이 회고적 조사의 결과는 수술 전 백혈구 및 D-dimer 수치가 관상동맥수술 환자들의 수술기주위 결과예측에 있어 임상적으로 유용한 인자들이 될 수 있음을 시사하고 있다.

• Journal of Preventive Medicine and Public Health
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• 제34권2호
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• pp.175-181
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• 2001

Objectives : To compare the multiple outcomes of patients with cataract surgery at perioperative time,3-4 months and 12 months after surgery and to assess patient outcomes associated with visual improvement(visual acuity of operated eye, visual function-14(VF-14), symptom score). Methods : For this assessment, a prospective study was conducted with 389 patients who had undergone cataract surgery for either one eye or both eyes. The surgery was peformed by 20 ophthalmologists who were practicing at university hospitals and general hospitals. Patients were interviewed and clinical data were obtained. Doctors were questioned with self-reported questionnaire forms. Medical records were examined in order to measure variables related to the surgical process such as surgical methods and ocular comorbidity. The survey was 'conducted at 4 stages' : preoperative time(389 cases), perioperative time(344 cases, 88.4%), postoperative 3-4 months (343 cases, 88.2%), and postoperative 12 months (281 cases, 72.2%). After excluding cases with incomplete data, 198 cases were enrolled in the study. Patient outcomes was measured for any improvement in the functional outcomes(visual acuity of operated eye, visual function, symptom score) at postoperative 3-4 months. Results : The visual acuity(operated, weighted average), symptom score, VF-14 score, satisfaction with vision, and subjective health status were shown to be improved at the perioperative time, postoperative 3-4 months and 12 mouths. An improvement in the Snellen visual acuity score was observed in 190 patients(96.0%), whereas improvements of the VF-14 score and cataract symptom sure were observed in 151 patients(76.3%) and 179 patients(90.4%), respectively. All three outcome measures demonstrated improvement in 137 patients(09.2%). The improvement of the three functional outcomes at 3-4 months after receiving surgery was associated with a lower level of visual function and a higher level of cataract symptom score at perioperative time, as well as a greater experience level of the surgeon. Conclusions : In this study, the estimates of the proportion of patients benefiting from cataract surgery varied with the outcome measure of benefit. Preoperative VF-14 score, a measure of functional impairment related to vision, and symptom score may be better measures of the benefit derived from cataract surgery than the change in visual acuity.