• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.41 no.2
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• pp.90-96
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• 2015

Necrotizing fasciitis (NF) is an infection that spreads along the fascial planes, causing subcutaneous tissue death characterized by rapid progression, systemic toxicity, and even death. NF often appears as a red, hot, painful, and swollen wound with an ill-defined border. As the infective process continues, local pain is replaced by numbness or analgesia. As the disease process continues, the skin initially becomes pale, then mottled and purple, and finally, gangrenous. The ability of NF to move rapidly along fascial planes and cause tissue necrosis is secondary to its polymicrobial composition and the synergistic effect of the enzymes produced by the bacteria. Treatment involves securing the airway, broad-spectrum antimicrobial therapy, intensive care support, and prompt surgical debridement, repeated as needed. Reducing mortality rests on early diagnosis and prompt aggressive treatment.

• Journal of Trauma and Injury
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• v.31 no.2
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• pp.91-95
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• 2018

Managing large infected midline abdominal defects are clinically challenging and technically demanding. The alloplastic materials, regional flaps, and component separation are usually infeasible because of the size, location, depth, and state of the defects. In these cases, the free flap is the only option with a large well-vascularized tissue that is free to inset regardless of the location. Herein, we report a case of 44-year-old man with a large infected midline abdominal wall defect who was completely treated with a latissimus dorsi myocutaeous free flap followed by negative pressure wound therapy.

• Imaging Science in Dentistry
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• v.31 no.1
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• pp.57-65
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• 2001

Osteoradionecrosis is one of the most serious complication after heavy irradiation of bone and most particularly following treatment of cancers within the head and neck. The irradiated bone has the decreased vascularity and is easily infected. As a result, the spread of infection may cause a nonhealing wound that is very difficult to be treated. A comprehensive prophylactic dental care as well as proper blocking of the radiation field before radiotherapy must be considered to reduce the risk of osteoradionecrosis. We present three cases of osteoradionecrosis which developed after extraction of teeth in irradiated patients.

• Journal of Chest Surgery
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• v.52 no.3
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• pp.162-164
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• 2019

A male patient weighing 2.5 kg was admitted for respiratory difficulty, and a large ventricular septal defect (VSD) was diagnosed. During care, sudden right leg swelling with a femur shaft fracture occurred. The patient's father had a history of recurrent lower extremity fractures; thus, osteogenesis imperfecta was considered. The patient's respiratory difficulty became aggravated, and VSD repair in the neonatal period was therefore performed with gentle sternal traction and great vessel manipulation under total intravenous anesthesia to prevent malignant hyperthermia. The patient was discharged without notable problems, except minor wound dehiscence. Outpatient genetic testing revealed that the patient had a COL1A1/COL1A2 mutation.

• Neonatal Medicine
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• v.25 no.4
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• pp.191-195
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• 2018

Leukocyte adhesion deficiency is a rare primary immunodeficiency and autosomal recessive disorder caused by a mutation in the gene encoding CD18, which is a constituent of leukocyte integrins. Clinical features usually begin with a delay in the separation of the umbilical cord in the neonatal period, and are characterized by marked leukocytosis with infection, delayed wound healing, and repeated bacterial and fungal infections. We experienced a case of leukocyte adhesion deficiency diagnosed in the neonatal period, in which a late preterm infant admitted to neonatal intensive care unit presented with a septic hip. Flow cytometry analysis of whole blood showed a decrease in the expression of CD11b/CD18. This is the first case of leukocyte adhesion deficiency with neonatal septic hip diagnosed in Korea.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.6
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• pp.473-480
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• 2010

Introduction: Tooth requiring extraction before radiotherapy in head and neck cancer patients should be performed as long as possible before the initiation of radiation therapy. Conventionally, a minimum 2-week waiting primary healing period is recommended. Although the above 2-week period is ideal, it is not uncommon for the radiotherapist and cancer patient to feel an urgent need to proceed with radiotherapy despite the need for dental care. Therefore, alternative approaches for early radiotherapy, including conservative endodontic treatment and a 1-week waiting primary healing period after dental extraction at the time of radiotherapy were considered and applied based on a literature review Materials and Methods: The clinical study involved 120 head and neck cancer patients who were treated at Wonju Christian Hospital, Wonju College of Medicine, Yonsei University, from January 1995 to December 2004. Results: In the clinical study, there were no specific complications, such as, post-extraction wound infections, radiation osteitis and osteoradionecrosis over the recent 10 years despite the early radiotherapy. Conclusion: Based on the clinical study, a minimum 1-week waiting primary healing period for oral care before radiotherapy is suitable for early radiotherapy in head and neck cancer patients.

• Journal of Korean Biological Nursing Science
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• v.16 no.3
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• pp.182-191
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• 2014

Purpose: The aim of this study was to identify necessary emergency treatment and nursing activities for severe trauma patients according to elapsed time and vital signs. Methods: A survey was conducted with 121 patients over 15 points ISS on EMR from June 1, 2011 to May 31, 2012. Collected data were analyzed with descriptive statistics, applying McNemar's test using SPSS 12.0. Results: Almost all of the subjects were men and the mean age was 46.9. Run-time for primary diagnosis, treatment decision, and leaving for the hospital room was 0.19, 4.36, and 4.21 hours, respectively, and stayover time was 9 hours. Regardless of vital signs, emergency treatments involving ambu-bagging, intubation, ventilator, and central vein catheterization insertion were offered within an hour. Central venous pressure, Foley catheter/Levin tube preparation and maintenance were performed in cases of unstable vital sign patients within an hour. Unrelated to vital signs, nursing activities for consciousness assessment, skin assesment and wound care, bed sore/fall down assesment and care, intravenous injection insertion and maintenance were conducted for all severe trauma patients within an hour. Foley catheter/Levin tube drainage care was performed for patients who had unstable vital signs within an hour. Conclusion: Emergency treatment and nursing activities for severe trauma patients were specific according to elapsed time and vital signs.

• Journal of Korean Academy of Nursing
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• v.41 no.6
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• pp.814-820
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• 2011

Purpose: This study was performed to compare the effects of standardized peristomal skin care (SPSC) and crusting technique (CT) on the peristomal skin of ostomates. SPSC was developed by a consensus among the expert group based on a comprehensive review of the relevant literature and hospital protocols. Methods: A randomized controlled pilot trial with 2 parallel arms was used. A total of 81 ostomates, who were recruited from a tertiary hospital, completed the baseline, 1-month, 2-month, and 3-month follow-up (SPSC group, n=45; CT group, n=36). SPSC consisted of water cleansing and direct application of ostomy appliances. CT involved crusting hydrocolloid powder and patting with water sponge or protective barrier liquid film. The outcomes of the study were assessed by skin problems, such as discoloration, erosion and tissue overgrowth; the domains of the evaluation tool used in examining the peristomal skin. A generalized estimating equation model was used to examine the effects according to time and group. Results: In both SPSC and CT groups, the likelihood of occurrence of discoloration (OR, 1.99; 95% CI, 1.61-2.46), erosion (OR, 1.87; 95% CI, 1.55-2.25) and tissue enlargement (OR, 1.94; 95% CI, 1.36-2.77) increased with time. There was no significant difference in discoloration between the groups, whereas the probability of erosion (OR, 0.38; 95% CI, 0.16-0.89) and tissue overgrowth (OR, 0.09; 95% CI, 0.02-0.55) was lower in the SPSC group than in CT group. Conclusion: SPSC was sufficient in preventing peristomal skin problems of ostomates compared to the CT.

• Journal of Trauma and Injury
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• v.34 no.1
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• pp.39-43
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• 2021

Purpose: Determining appropriate ways to assess health care quality within the National Health Insurance System is of interest to both the Korean government and the medical community. However, in the trauma field, the number of indicators used to evaluate surgical quality is limited. Using data collected over 5 years at Wonju Severance Christian Hospital Trauma Center in Korea, this study aimed to determine whether the unplanned reoperation rate in the field of trauma surgery could be used to assess the quality of an institution's surgical care. Methods: In total, 665 general surgical procedures were performed at the Trauma Center in 453 patients with abdominopelvic injuries from January 2015 to December 2019. Data were collected from the Trauma Center's data registry and medical records, and included information regarding patients' demographic characteristics, the type of index operation, and the reason for unplanned reoperations. Results: A total of 453 index operations were evaluated. The proportion of patients with an Injury Severity Score (ISS) >15 was 48-70% over the 5-year period, with an unplanned reoperation rate of 2.1-9.3%. Patients had an average ISS score of 17.5, while the average Abbreviated Injury Scale Score was 2.87. Unplanned reoperations were required in about 7% of patients. The most common complications requiring reoperation were recurrent bleeding (26.9%), wound problems (26.9%), intestinal infarction (15.4%), and anastomosis site leakage (7.7%). The procedures most frequently requiring unplanned reoperations were bowel surgery (segmental resection, primary repair, enterostomy, etc.) (24.5%) and preperitoneal pelvic packing (10.6%). Conclusions: The proportion of reoperations was confirmed to be affected by injury severity.

• Journal of Korean Clinical Nursing Research
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• v.15 no.1
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• pp.107-122
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• 2009

Purpose: The purpose of this study was to identify nursing interventions frequently used with cancer patients. Nursing records from 5 general hospitals for patients with stomach, liver, lung or colon cancer were analyzed. Method: A descriptive study methodology was used and nursing records for 15 patients in each disease category at each hospital, who were admitted and discharged during June 2007 were analyzed. Results: Five domains of NIC were found and the physiological(basic) domain was most frequent (31.52%). Twenty two classes of NIC were identified with risk management for safety being most frequent (22.49%). For the 119 nursing interventions identified, the most frequent was pain management with 7,827 (12.31%), followed by prevention of falls (11.76%), surveillance (6.79%) and wound care (5.12%). Nursing activities of pain management and prevention of falls were comparable to activities listed in literature on guidelines for evidence based and best practices in nursing care. Eight of the 17 nursing activities for pain management, and 9 of 14 for fall prevention were consistent with these guidelines. Conclusion: In this study, nursing interventions were found to be focused on physical care, monitoring patients' condition and education. We have to develop diverse nursing interventions and a convenient recording process.