• 한국임상약학회지
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• 제22권3호
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• pp.211-219
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• 2012

Nonsteroidal antiinflammatory drugs (NSAIDs) are used in the treatment of extensive diseases related to various symptoms; inflammation, pain and fever. NSAIDs work by blocking prostaglandin synthesis, but adverse drug events (ADEs) have been increasing dramatically such as gastrointestinal bleeding, perforation and stenosis, a kind of serious ADEs. Therefore, NSAID-related ulcer complication guidelines have been announced containing various risk factors and symptoms. Thus, this study aims to evaluate of NSAID usage and appropriateness for prevention of NSAID-related ulcer complication based on American journal of gastroenterology (AJG) guideline 2009. Further, the study suggests Korean guideline for prevention of NSAID-related ulcer compared to AJG guideline. For this study, data was collected through electronic medical record (EMR) at Seoul national university of Bundang hospital. The primary end point was a composite of NSAID-related ulcer risk factor, types of NSAIDs, co-prescribed NSAID ulcer prevention drugs and NSAID-related ulcer after taking NSAID. The risk factors include over 65 years, high dose NSAID, previous ulcer history and taking drugs (e.g. aspirin, anticoagulant and steroid) causing ulcer. If a patient has 3 or 4 factors, that patient was classified high risk group. And if 1 or 2 factors that patient was classified moderate risk group. The patient who has no risk factor was in low risk group. I studied 8,120 patients who received NSAID from 1 January 2009 to 31 December 2009. High risk group was 16(0.2%), moderate risk group was 4,364(53.7%), and low risk group was 3,740(46.1%). The results show that high risk group should be prescribed COX-2 inhibitors with ulcer prevention drugs, and moderate or low risk group need traditional NSAIDs with ulcer prevention drugs. This may be different with 2009 AJG guideline because AJG guideline suggested taking COX-2 inhibitor alone in moderate group or taking traditional NSAID alone in low risk group could get higher ulcer complication. The results indicated that choosing preventive drug is important in case that how many risk factors the patients have. The proper drugs would be helpful for safe and effective NSAID usage in each patient group.

• Journal of Chest Surgery
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• 제30권12호
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• pp.1251-1253
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• 1997

개심 수술후 위장관 계통의 합병증은 드물게 발생하지만 사망률은 매우 높은 심각한 합병증 중의 하나이 며 특히 십이지장의 합병증은 그 빈도가 매우 드문 것으로 알려져 있다. 본원에서는 개심 수술후 십이지장 출혈 1례, 십이지장 궤양 천공 2례를 치험하였다. 출혈의 경우 빈맥, 현기증, 흑색변 등의 증상이 임상적 의 심의 단서가 되었으며, 천공의 경우는 복통을 동반한 복부 팽만, 빈맥, 저혈압, 핍뇨 등이 임상적 단서가 되 었고 복막펀자술로 확진을 내릴 수 있었다. 십이지장 출혈의 경우 항제산제의 복용, 수혈 등 보존적인 방법 으로 치료되었으나 십이지장 천공의 경우에는 2례 모두에서 응급 개복수술을 필요로 하였고 1례는 병발되는 합병증으로 가퇴원하였으며, 나머지 1례에서는 장기간의 중환자실 처치를 필요로 하였다. 따라서 수술전 과 거력상 위장관 계통의 증상, 장시간의 심폐바이패스 사용등 위십이지장궤양의 위험인자가 있는 환자들에서 는 개심수술후 항궤양 약물의 예방적 사용뿐만 아니라 십이지장 합병증에 대한 임상적 의심, 조기 진단과 시의 적절한 치료가 십이지장 합병증의 이환율과 사망률을 줄이는데 필요한 것으로 생각된다.

• 대한두경부종양학회지
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• 제26권1호
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• pp.30-32
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• 2010

Tracheo-gastric fistula is a very rare late complication of total laryngopharyngoesophagectomy with gastric pull-up procedure. It usually occurs after transhiatal esophagectomy, but it has only rarely been reported after total laryngopharyngoesophagectomy with gastric pull-up procedure. Chronic irritation and gastric ulcer may be the cause of tracheogastric fistula. To prevent fistula formation, active management of gastric ulcer and avoidance of mucosal irritation are necessary. We report a case of a tracheogastric fistula which occurred two years after total laryngopharyngoesophagectomy with gastric pull-up procedure that maybe occurred by chronic irritation and gastric ulcer.

• Archives of Plastic Surgery
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• 제45권5호
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• pp.418-424
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• 2018

Background Complication rates after flap coverage for pressure ulcers have been high historically. These patients have multiple risk factors associated with poor wound healing and complications including marginal nutritional status, prolonged immobilization, and a high comorbidities index. This study utilizes the National Surgical Quality Improvement Program (NSQIP) to examine perioperative outcomes of flap coverage for pressure ulcers. Methods Data from the NSQIP database (2005-2015) for patient undergoing flap coverage for pressure ulcers was identified. Demographic, perioperative information, and complications were reviewed. One-way analysis of variance and Pearson chi-square were used to assess differences for continuous variables and nominal variables, respectively. Multivariate logistic regression was performed to identify independent risk factors for complications. Results There were 755 cases identified: 365 (48.3%) sacral ulcers, 321 (42.5%) ischial ulcers, and 69 (9.1%) trochanteric ulcers. Most patients were older male, with some degree of dependency, neurosensory impairment, high functional comorbidities score, and American Society of Anesthesiologists class 3 or above. The sacral ulcer group had the highest incidence of septic shock and bleeding, while the trochanteric ulcer group had the highest incidence of superficial surgical site infection. There was an overall complication rate of 25% at 30-day follow-up. There was no statistical difference in overall complication among groups. Total operating time, diabetes, and non-elective case were independent risk factors for overall complications. Conclusions Despite patients with poor baseline functional status, flap coverage for pressure ulcer patients is safe with acceptable postoperative complications. This type of treatment should be considered for properly selected patients.

• Archives of Reconstructive Microsurgery
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• 제10권2호
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• pp.154-162
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• 2001

Diabetic foot ulcer is a serious complication which result from long-standing diabetes. Especially, severe infected diabetic foot ulcer results in unwanted lower extremity amputation. The diabetic patient is considered the relative contraindication for microsurgery because of the severe peripheral vascular disease. Recently, microvascular free tissue transfer technique applied to diabetic foot ulcer. It is well known that free tissue transfer provides immediate soft tissue coverage and control of infection. So it is possible that preservation of the lower extremity through free tissue transfer. A retrospective study of diabetic patients who had infected foot ulcer from 1999 to 2000 with foot defects reconstructed with free tissue transfer were reviewed. Thirteen patients were studied with mean follow-up of 12.7 months. There were two deaths during follow-up period. There were two failures after free flap surgery. All eleven survived patients were ambulatory. There was no recurrence of ulcer. No patient need amputation above the ankle joint. We have found that free tissue transfer for infected diabetic foot ulcer is very effective surgical technique. Careful patient selection and regular follow-up is important.

• 대한상부위장관⦁헬리코박터학회지
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• 제18권4호
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• pp.235-241
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• 2018

Peptic ulcer bleeding is a common complication of peptic ulcer disease and the most common cause of upper gastrointestinal bleeding. Despite advances in drug usage and endoscopic modalities, no significant improvement is observed in the mortality rate of bleeding ulcers. The purpose of this review is to discuss various endoscopic hemostatic methods to treat peptic ulcer bleeding. Endoscopic hemostatic techniques can be classified into injection, mechanical, electrocoagulation, hemostatic powder, and endoscopic Doppler-guided hemostatic therapies (the last mentioned being a newly developed technique). Endoscopic hemostasis can be performed as mono or combination therapy using the aforementioned methods. Endoscopic hemostasis is the most important treatment for patients with peptic ulcer bleeding. Endoscopists should consider the treatment approach for peptic ulcer bleeding based on patient characteristics, the size and shape of the lesion, the endoscopist's expertise, and the resources and circumstances at each hospital. Follow-up studies are needed to evaluate the efficacy of newly developed hemostatic powder therapy and endoscopic Doppler-guided hemostasis.

• Advances in pediatric surgery
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• 제10권1호
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• pp.22-30
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• 2004

A total of 30 cases of the peptic ulcer in children, who underwent operations from January 1981 to December 1995 because of complications at Department of the Surgery, Chonbuk National University Medical School, is reviewed. Twenty-three were males (76.7%), 7 females (23.3%) and male was preponderant at 3.3:1. There were 25 cases (83.3%) age 10 to 15 years, 3(10.0%) between 2 and 9 years, and 2 (6.7%) below 2. The ulcer was located at duodenum in 27(90.0%), and at stomach in 3 cases (10.0%). Complications were perforation in 19 cases (63.3%), pyloric obstruction in 9 (30.0%) and bleeding in 2 (6.7%). For perforation, truncal vagotomy with pyloroplasty was done in 11 cases, truncal vagotomy with hemigastrectomy and gastrojejunostomy in 6, and simple closure in 2 cases. For obstruction, truncal vagotomy with hemigastrectomy and gastrojejunostomy was done in 5, and truncal vagotomy and pyloroplasty in 3 cases. For bleeding lesions, truncal vagotomy and pyloroplasty was performed in 2 cases. Ten postoperative complications developed in 9 patients: adhesive ileus in 5, recurrence in 2, pneumonia 2, and wound seroma 1 case. One patient developed a primary duodenal perforation and another a recurrent obstruction. Both of patients had symptoms for more than 3 years and were treated with truncal vagotomy and pyloroplasty for the primary operations. Hospital stay was 11.5 days for the patient with perforated ulcer, 11.0 days for the patient with pyloric obstruction, and 14.5 days for the child with bleeding. Average hospital period was 11.6 days. To reduce recurrences after operation, extensive procedure such as distal gastrectomy with vagotomy at the first operation should be considered in case with severe complication or with patients who have been symptomatic for long periods.

• 한국임상수의학회지
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• 제19권1호
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• pp.100-102
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• 2002

Nonsteroidal anti-inflammatory drugs are widely used for treatment of animals. Their use is limited by frequent side effects commonly involving the gastrointestinal tract, most important of which is development of ulcerating lesions principally In the stomach. Unfortunately, presence of such lesions is often unsuspected because clinical signs may be overlooked until a complication develops. A 5-year-old, female mongrel dog was referred to Veterinary Teaching Hospital in Chungbuk National University. She was showed vomiting, anorexia and lethargy after administration of ibuprofen (400 mg/body, qid, oral) for 5 days. General examination and plain radiography were performed in the patient. Physical examination, hematologic values, chemical profiles, urinalysis and radiographs were normal. Therefore, endoscopic examination was performed in this patient and confirmed to show the gastric ulcer in pyloric region of the stomach. Drug therapy was performed successfully in this case. This article reports the development of a gastric ulcer associated with orthopedic disease treated by ibuprofen.

• 대한치과의사협회지
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• 제50권12호
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• pp.727-731
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• 2012

An ulcer is defined as loss of epithelium. Although many oral ulcers have similar clinical appearances, their etiologies encompass many disorders, including trauma, infection, immunologic disease, and malignant oral cancer. Oral squamous cell carcinoma(SCC) occupying about 90% of oral cancer, usually manifests as unhealed ulcer over 2 weeks. Oral SCC can metastasize to the cervical neck lymph node, and therefore the surgical therapeutic modality for oral SCC could encompass the neck node dissection as well as wide excision for primary lesions, which should leave the post-operative complication of functional damage like dysphagia and facial deformity. Therefore, it is important to discriminate oral SCC from other ulcerative conditions to make a prompt management. The knowledge for the pathogenesis of the ulcerative lesions could help the clinicians to understand the differences of clinical features and to practice an appropriate therapeutics.

• Journal of Ginseng Research
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• 제46권6호
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• pp.771-779
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• 2022

Background: As a kind of common complication of the surgery of perianal diseases, perianal ulcer is known as a nuisance. This study aims to develop a kind of 20(S)-ginsenoside Rg3 (Rg3)-loaded hydrogel to treat perianal ulcers in a rat model. Methods: The copolymers PLGA₁₆₀₀-PEG₁₀₀₀-PLGA₁₆₀₀ were synthesized by ring-opening polymerization process and Rg3-loaded hydrogel was then developed. The perianal ulcer rat model was established to analyze the treatment efficacy of Rg3-loaded hydrogel for ulceration healing for 15 days. The animals were divided into control group, hydrogel group, free Rg3 group, Rg3-loaded hydrogel group, and Lidocaine Gel® group. The residual wound area rate was calculated and the blood concentrations of interleukin-1 (IL-1), interleukin-6 (IL-6), and vascular endothelial growth factor (VEGF) were recorded. Hematoxylin and eosin (H&E) staining, Masson's Trichrome (MT) staining, and tumor necrosis factor α (TNF-α), Ki-67, CD31, ERK1/2, and NF-κB immunohistochemical staining were performed. Results: The biodegradable and biocompatible hydrogel carries a homogenous interactive porous structure with 10 ㎛ pore size and five weeks in vivo degradation time. The loaded Rg3 can be released sustainably. The in vitro cytotoxicity study showed that the hydrogel had no effect on survival rate of murine skin fibroblasts L929. The Rg3-loaded hydrogel can facilitate perianal ulcer healing by inhibiting local and systematic inflammatory responses, swelling the proliferation of nuclear cells, collagen deposition, and vascularization, and activating ERK signal pathway. Conclusion: The Rg3-loaded hydrogel shows the best treatment efficacy of perianal ulcer and may be a candidate for perianal ulcer treatment.