Background: Radiation therapy (RT) is frequently used for supportive treatment and management of advanced head and neck cancers. This study performed a retrospective review of the treatment methods that were used for intractable draining fistulas in seven patients who had received RT for head and neck cancers. Treatment methods used for two of the seven patients are presented in detail. Methods From 2009 to 2020, seven patients underwent reconstructive surgery for intractable fistulas which occurred after RT for head and neck cancers. Patient characteristics, medical history, treatment method, and treatment outcome were reviewed for each case. The type of surgery performed, failure rate, and treatment period were also analyzed. Results: In this study, a total of seven patients received additional management for radiation-induced fistulas. Patients underwent a mean of 3.3± 1.4 surgeries (maximum: six surgeries) to resolve their fistulas. The mean time interval from the first surgery to the last surgery for the patients to achieve resolution of the fistula was 8.7 months. Loco-regional flaps have performed an average of 1.9± 1.5 times. However, all loco-regional flaps failed. Instead, the patients’ intractable fistulas were resolved with the use of distant flaps or free tissue transfers. Conclusion: Fistulas that develop after head and neck cancer treatment following RT are difficult to treat with simple loco-regional flap procedures. Therefore, more aggressive treatment techniques, such as distant flap or free tissue transfer, may be needed to shorten patients’ treatment periods and avoid unnecessary surgeries.

Objective: To investigate the predictive value of intraplaque neovascularization (IPN) for cardiovascular outcomes. Materials and Methods: We evaluated 217 patients with coronary artery disease (CAD) (158 men; mean age, 68 ± 10 years) with a maximal carotid plaque thickness ≥ 1.5 mm for the presence of IPN using contrast-enhanced ultrasonography. We compared patients with (n = 116) and without (n = 101) IPN during the follow-up period and investigated the predictors of major adverse cardiovascular events (MACE), including cardiac death, myocardial infarction, coronary artery revascularization, and transient ischemic accident/stroke. Results: During the mean follow-up period of 995 ± 610 days, the MACE rate was 6% (13/217). Patients with IPN had a higher maximal thickness than those without IPN (2.86 ± 1.01 vs. 2.61 ± 0.84 mm, p = 0.046). Common carotid artery-peak systolic velocity, left ventricular mass index (LVMI), and ventricular-vascular coupling index were significantly correlated with MACE. However, on multivariate Cox regression analysis, increased LVMI was independently related to MACE (p < 0.05). The presence of IPN could not predict MACE. Conclusion The presence of IPN was related to a higher plaque thickness but could not predict cardiovascular outcomes better than conventional clinical factors in patients with CAD.

Growth hormone (GH) deficiency is caused by congenital or acquired causes and occurs in childhood or adulthood. GH replacement therapy brings benefits to body composition, exercise capacity, skeletal health, cardiovascular outcomes, and quality of life. Before initiating GH replacement, GH deficiency should be confirmed through proper stimulation tests, and in cases with proven genetic causes or structural lesions, repeated GH stimulation testing is not necessary. The dosing regimen of GH replacement therapy should be individualized, with the goal of minimizing side effects and maximizing clinical improvements. The Korean Endocrine Society and the Korean Society of Pediatric Endocrinology have developed a position statement on the diagnosis and treatment of GH deficiency. This position statement is based on a systematic review of evidence and expert opinions.

Hypertension and obesity are important modifiable risk factors for cardiovascular disease, the leading cause of death in Korea. Therefore, we assessed the association between dietary pattern and obesity in hypertensive patients to formulate health promotion strategies for the older population. Dietary information was collected from hypertensive patients visiting community health education and information center by using 24 hour recall method. The 2005 DRIs for Koreans was used to evaluate the dietary adequacy. When subjects were categorized by body mass index (BMI) as normal, overweight and obese, no significant difference in energy intake was found among groups. Dietary intakes of folate, and vitamin C in obese hypertensive patients were significantly lower than in normal weight patients (p < 0.05). When we compare the nutritional status by waist circumferences, dietary intakes of zinc, vitamin A, thiamin, vitamin C and folate were significantly lower in the obese group. Vegetable intake was significantly lower in the obese group according to BMI as well as waist circumference. Energy intake from carbohydrate was significantly higher in obese hypertensive patients (p < 0.05). Obese hypertensive patients had a higher risk of nutritional inadequacy compared to normal weight patients. Our results indicated the need for developing interventions that encourage greater consumption of vegetables while cutting down salt intake with wise selection of staple foods, for obese hypertensive patients.
Aged ; Ascorbic Acid ; Body Mass Index ; Cardiovascular Diseases ; Cause of Death ; Energy Intake ; Folic Acid ; Health Education ; Health Promotion ; Humans ; Hypertension ; Information Centers ; Korea ; Nutritional Status ; Obesity ; Obesity, Abdominal ; Overweight ; Risk Factors ; Vegetables ; Vitamin A ; Waist Circumference ; Zinc

PURPOSE: Fine needle aspiration is a safe and relatively accurate procedure for distinguishing benign and malignant lesions. We determined the diagnostic value of ultrasoundguided fine needle aspiration using an extension tube and examination by an endocrine surgeon. METHODS: We reviewed the medical records of 257 consecutive patients receiving surgery for thyroid nodules in the Department of Surgery, Jesus Hospital, from January, 2006, to August, 2008. All patients received ultrasound-guided fine needle aspiration with an extension tube. RESULTS: The male to female ratio was 1:5.5. Definitive histopathological diagnosis revealed benign lesions in 120 cases (47%) and malignant lesions in 137 cases (53%). Benign lesions were composed of nodular goiter (102 cases), follicular adenoma (13 cases), and Hashimoto thyroiditis (5 cases). Malignant lesions were composed of papillary carcinoma (131 cases) and follicular carcinoma (6 cases). Fine needle aspiration cytology revealed benign lesions in 103 cases and malignant lesions in 126 cases. The Overall results of ultrasound-guided FNA were: sensitivity, 94.5%, specificity, 95.0%, positive predictive value, 96.0%, negative predictive value, 93.2%, accuracy rate, 94.7%, false negative, 5.4%, and false positive, 4.9%. Most specimens (96.4%) were amenable for diagnosis. CONCLUSION: Fine needle aspiration is a good method for the differential diagnosis of thyroid nodules. High resolution ultrasound-guided FNA with an extension tube is helpful for obtaining good specimens.
Adenoma ; Biopsy, Fine-Needle* ; Carcinoma, Papillary ; Diagnosis ; Diagnosis, Differential ; Female ; Goiter, Nodular ; Hashimoto Disease ; Humans ; Male ; Medical Records ; Methods ; Sensitivity and Specificity ; Thyroid Nodule

BACKGROUND: Central venous catheterization allows the measurement of hemodynamic variables, the delivery of medications and nutritional support. It also has been used as a means to treat sepsis, cardiogenic and hemodynamic shocks. Arterial puncture, hematoma, and pneumo-hemothorax are the most common mechanical complications during the insertion of central venous catheters. This study was done to find out the factors attributing to the increase of puncture attempts in subclavian venous catheter insertion. METHODS: We have conducted surveys in residents who had previous experience with insertion of subclavian venous catheterization in Ilsan hospital from 01/09/2003 to 30/11/2003. A total of 40 cases were marked as two groups, those with less than three puncture attempts and those with more than or equal to three attempts. RESULTS: The incidence of three or less insertion attempts were 23, whereas in 17 cases three or more attempts were required. The results of the comparison between these two groups proved that the patient's hemoglobin level, skeletal deformity, the level of experience (more than 20), puncture site marking and insertion in the mid-clavicular line were significant factors (P<0.05). CONCLUSION: It seemed necessary to try three or less puncture attempts in order to decrease the incidence of mechanical complications. The operator factors such as previous experience with the procedure, puncture site marking prior to insertion, and insertion in the mid-clavicular line had affected the number of puncture attempts.
Catheterization ; Catheterization, Central Venous* ; Catheters ; Central Venous Catheters* ; Congenital Abnormalities ; Hematoma ; Hemodynamics ; Incidence ; Nutritional Support ; Punctures ; Sepsis ; Shock ; Subclavian Vein

BACKGROUND: Numerous diabetes patients do not know the name of hypoglycemic agents that they are taking, even though they have taken them for a long time. The aim of this study was to find out the percentage of diabetes patients who recognize the name of their hypoglycemic agents and to clarify whether such recognition have effect on their glycemic control. METHODS: A cross-sectional questionnaire survey was done from March to May 2004, targeting in-patients and out-patients who had been taking oral hypoglycemic agents for diabetes treatment in 2 hospitals. RESULTS: 134 patients (89.3%) of 150 completed the questionnaire. Only 20 (14.9%) patients accurately knew the name of at least one of the hypoglycemic agents they were taking. Smoking (P=0.0086), recognition of the name of hypoglycemic agents (P<0.0001), history of change of prescribed hypoglycemic agents (P=0.0095), diet and exercise (P<0.0001), explanation of hypoglycemic agents (P=0.0231), and forgetting to toke medicine (P<0.0001) were significantly related to the HbA1c level. Among these factors, history of change of prescribed hypoglycemic agents (P=0.0006), diet and exercise (P=0.0002), and forgetting to take medicine (P<0.0001) were the independent related factors after adjustment. CONCLUSION: The recognition rate of the name of hypoglycemic agents was low. It may be associated with patients' HbA1c, but was not an independent related factor.
Diet ; Hemoglobin A, Glycosylated ; Humans ; Hypoglycemic Agents* ; Outpatients ; Smoke ; Smoking ; Surveys and Questionnaires

BACKGROUND/AIMS: Two most common functional anorectal pains, levator ani syndrome and proctalgia fugax, have a significant overlap in diagnosis and a controversy in pathogenic mechanism. Our aim was to evaluate the differences of anorectal symptoms and physiologic findings between the patients with levator ani syndrome and proctalgia fugax. METHODS: Eight patients and 10 patients, who fulfilled Rome II criteria for levator ani syndrome and proctalgia fugax respectively, were evaluated for the various anorectal symptoms using questionnaire and diary, anorectal manometry, balloon defecation, and defecography. RESULTS: Compared with patients with proctalgia fugax, the patients with levator ani syndrome showed higher percentage of symptoms of straining (87.5+/-30.6% vs. 40.5+/-44.9%, p<0.05), and tended to have higher percentage of the sensation of incomplete evacuation (88.1+/-26.4% vs. 53.0+/-41.9%, p=0.056). In anorectal manometric findings, squeezing pressure of the distal anal sphincter tended to be higher in patients with levator ani syndrome (201.7+/-127.7 mmHg vs. 113.0+/-43.9 mmHg, p=0.056). CONCLUSIONS: Levator ani syndrome may be related to the constipation and hyper-contractile external anal sphincter, suggesting that different mechanisms may play a role in the development of anorectal pains in patients with levator ani syndrome and proctalgia fugax.
Anal Canal ; Constipation ; Defecation ; Defecography ; Diagnosis ; Humans ; Manometry ; Sensation ; Surveys and Questionnaires

BACKGROUND: Electrical breathing pacing has many advantages over mechanical ventilation. However, clinically permanent diaphragmatic pacing has been applied to limited patients and few temporary pacing has been reported. Our purpose is to investigate the feasibility of temporary electrical diaphragm pacing in explothoracotomy canine cases. METHODS: Five dogs were studied under the general anesthesia. Left 5th intercostal space was opened. Self designed temporary pacing leads were placed around the left phrenic nerve and connected to the myostimulator. Chest wall was closed after tube insertion with underwater drainage. Millar catheter was introduced to the aorta and right atrium. Swan-Ganz catheter was introduced to the pulmonary artery. When the self respiration was shallow with deep anesthesia, hemodynamic and tidal volume were measured with the stimulator on. RESULTS: Tidal volume increased from 143.3 +/- 51.3 ml to 272.3 +/- 87.4 ml(p=0.004). Right atrial diastolic pressure decreased from 0.7 +/- 4.0 mmHg to -10.5 +/- 4.7 mmHg(p=0.005). Pulmonary arterial diastolic pressure decreased from 6.1 +/- 2.5 mmHg to 1.2 +/- 4.8 mmHg(p<0.001). The height of water level in chest tube to show intrathoracic pressure change was from 10.3 +/- 6.7cmH2O to 20.0 +/- 5.3 cmH2O. CONCLUSION: Temporary electrical diaphragmatic pacing is a simple method to assist respiration in explothoracotomy canine cases. Self designed pacing lead is implantable and removable. Negative pressure ventilation has favorable effects on the circulatory system. Therefore, clinical application of temporary breathing pacing is feasible in thoracotomy patients to assist cardiorespiratory function.
Anesthesia ; Anesthesia, General ; Animals ; Aorta ; Blood Pressure ; Catheters ; Chest Tubes ; Diaphragm ; Dogs ; Drainage ; Heart Atria ; Hemodynamics ; Humans ; Phrenic Nerve ; Pulmonary Artery ; Respiration ; Respiration, Artificial ; Thoracic Wall ; Thoracotomy ; Tidal Volume ; Ventilation ; Water

No Abstract Available.
Methicillin Resistance* ; Methicillin* ; Methicillin-Resistant Staphylococcus aureus* ; Staphylococcus aureus* ; Staphylococcus*