Spontaneous coronary artery dissection (SCAD) is a very rare cause of peripheral artery thromboembolism. It is especially rare to show symptoms of acute limb ischemia without chest symptoms during a hospital visit. In this case, a rare case of SCAD led to left heart failure and caused left ventricle thrombi, which in turn caused peripheral thromboembolism.
Arteries* ; Coronary Vessels* ; Extremities ; Heart Failure ; Heart Ventricles* ; Ischemia ; Thorax ; Thromboembolism*

The authors analyzed 52 patients with traumatic cervical fracture and dislocation admitted to the department of neurosurgery, Gyeongsang National University Hospital between July, 1989 and December, 1993. The most common age group was 21-30 years old, and 46 were male. The most frequent cause of injury was motor vehicle accident. High cervical injuries were 11 cases and mid-low cervical injuries were 41 cases. 34 cases had surgical intervention by anterior approach with bone graft only(5), anterior approach with bone graft and instrumentation(9), posterior approach with wiring and bone graft(18) and total laminectomy(2). The others had conservative treatment and immobilized by traction(9), Halo-vest(8) or neck collar(1). The average post of immobilization of conservatively treated patients was 9.7weeks, anterior approach without instrumentation was 9 weeks and posterior approach was 5.4 weeks, but patients who treated by anterior approach with instrumentation keep soft collar only. At final follow-up, no significant differences were noted between surgically and conservatively treated group but initial neurologic state correlates with prognosis, independent of modality of treatment. Thus the surgical intervention does not significantly influence the prognosis of the patient but shortens the duration of postoperative immobilization.
Dislocations* ; Follow-Up Studies ; Humans ; Immobilization ; Male ; Motor Vehicles ; Neck ; Neurosurgery ; Prognosis ; Transplants

Surgery is a demanding and stressful field in Korea. Occupational stress can adversely affect the quality of care, decrease job satisfaction, and potentially increase medical errors. The aim of this study was to investigate the occupational stress and career satisfaction of Korean surgeons. We have conducted an electronic survey of 621 Korean surgeons for the occupational stress. Sixty-five questions were used to assess practical and personal characteristics and occupational stress using the Korean occupational stress scale (KOSS). The mean KOSS score was 49.31, which was higher than the average of Korean occupational stress (45.86) or that of other specialized professions (46.03). Young age, female gender, long working hours, and frequent night duties were significantly related to the higher KOSS score. Having spouse, having hobby and regular exercise decreased the KOSS score. Multiple linear regression analysis showed that long working hours and regular exercise were the independent factors associated with the KOSS score. Less than 50% of surgeons answered that they would become a surgeon again. Most surgeons (82.5%) did not want to recommend their child follow their career. Korean Surgeons have high occupational stress and low level of career satisfaction.
Adult ; Burnout, Professional/*psychology ; Female ; Humans ; *Job Satisfaction ; Male ; Middle Aged ; Quality of Health Care ; Questionnaires ; Republic of Korea ; Stress, Psychological/*psychology ; Surgeons/*psychology

Surgery is a demanding and stressful field in Korea. Occupational stress can adversely affect the quality of care, decrease job satisfaction, and potentially increase medical errors. The aim of this study was to investigate the occupational stress and career satisfaction of Korean surgeons. We have conducted an electronic survey of 621 Korean surgeons for the occupational stress. Sixty-five questions were used to assess practical and personal characteristics and occupational stress using the Korean occupational stress scale (KOSS). The mean KOSS score was 49.31, which was higher than the average of Korean occupational stress (45.86) or that of other specialized professions (46.03). Young age, female gender, long working hours, and frequent night duties were significantly related to the higher KOSS score. Having spouse, having hobby and regular exercise decreased the KOSS score. Multiple linear regression analysis showed that long working hours and regular exercise were the independent factors associated with the KOSS score. Less than 50% of surgeons answered that they would become a surgeon again. Most surgeons (82.5%) did not want to recommend their child follow their career. Korean Surgeons have high occupational stress and low level of career satisfaction.
Adult ; Burnout, Professional/*psychology ; Female ; Humans ; *Job Satisfaction ; Male ; Middle Aged ; Quality of Health Care ; Questionnaires ; Republic of Korea ; Stress, Psychological/*psychology ; Surgeons/*psychology

A case of thoracic epidural malignant melanoma metastasized from the eyeball is presented. The patient is a 28 year old male with the chief complaint of paraparesis. He underwent laminectomy and gross total removal of the mass Chemotherapy was thean administered postoperatively. The literature on this subject is briefly reviewed.
Adult ; Drug Therapy ; Epidural Space* ; Humans ; Laminectomy ; Male ; Melanoma* ; Orbit* ; Paraparesis

PURPOSE: Transumbilical laparoscopic-assisted appendectomy (TULA) is a single incision technique that uses a combined intra- and extracorporeal method. The aim of this study was to compare surgical outcomes of TULA with conventional 3-port laparoscopic appendectomy (LA). METHODS: A retrospective review of medical records between 2010 and 2014 identified 303 pediatric patients who underwent LA with uncomplicated acute appendicitis. Of these, 85 patients underwent TULA and 218 patients underwent conventional LA. Demographic data, clinical characteristics, perioperative outcomes and postoperative complications were compared between the 2 groups. RESULTS: The mean operation time in the TULA group was 30.39 minutes, which was significantly shorter than that of the LA group (47.83 minutes) (P < 0.001). The first day of oral intake after surgery was earlier (1.05 days vs. 1.32 days; P < 0.001) and the length of hospital stay was also shorter (2.54 days vs. 3.22 days; P < 0.001) for the TULA group than the LA group. Furthermore, the postoperative complication rate was lower in the TULA group (1 of 85, 1.25%) compared to the LA group (19 of 218, 8.7%) (P = 0.018). CONCLUSION: In conclusion, TULA procedure is recommended for uncomplicated appendicitis in children due to its simplicity and better postoperative outcomes.
Appendectomy* ; Appendicitis* ; Child ; Humans ; Laparoscopy ; Length of Stay ; Medical Records ; Methods ; Postoperative Complications ; Retrospective Studies ; Umbilicus

PURPOSE: An intracranial aneurysm, with or without subarachnoid hemorrhage (SAH), is a relevant health problem. The rupture of an intracranial aneurysm is a critical concern for individual health; even an unruptured intracranial aneurysm is an anxious condition for the individual. The aim of this guideline is to present current and comprehensive recommendations for the management of intracranial aneurysms, with or without rupture. MATERIALS AND METHODS: We performed an extensive literature search, using Medline. We met in person to discuss recommendations. This document is reviewed by the Task Force Team of the Korean Society of Interventional Neuroradiology (KSIN). RESULTS: We divided the current guideline for ruptured intracranial aneurysms (RIAs) and unruptured intracranial aneurysms (UIAs). The guideline for RIAs focuses on diagnosis and treatment. And the guideline for UIAs focuses on the definition of a high-risk patient, screening, principle for treatment and selection of treatment method. CONCLUSION: This guideline provides practical, evidence-based advice for the management of patients with an intracranial aneurysm, with or without rupture.
Advisory Committees ; Diagnosis ; Humans ; Intracranial Aneurysm* ; Mass Screening ; Rupture ; Subarachnoid Hemorrhage

An endoscopic mucosal resection (EMR) is considered to be a potential alternative to surgery for a gastrointestinal tumor on account of it being an improved technique. Since its introduction in Japan in the early 1980s, it is now an accepted modality for removing precancerous lesions or early gastric cancer from the GI tract because it is minimally invasive and preserves the patient's quality of life. The major complications of EMR is bleeding and perforation. The treatment guidelines for iatrogenic perforation after EMR have not been established. Herein, we report a successful case of EMR induced gastric perforation with fluid collection that was successfully treated with non-surgical management.
Gastrointestinal Tract ; Hemorrhage ; Japan ; Quality of Life ; Stomach Neoplasms

PURPOSE: Stercoral perforation of colon is a rare disease with poor prognosis. But according to recent reports, the incidence of stercoral perforation in the colon seemed to have been underestimated. The reason might be the lack of recognition and overlook by surgeons. The purposes of this study were to represent the definition of stercoral perforation, and to help the diagnosis and treatment of stercoral perforation. METHODS: Among the patients who underwent emergency operation for colon perforation at the Department of Surgery, Korea University College of Medicine, from January 1992 to December 2001, 9 patients were diagnosed as stercoral perforation and their medical records were reviewed retrospectively regarding the clinical characteristics, managements and mortality. RESULTS: The age distribution of the patients was from 32 to 76 years. Male to female ratio was 1.3:1. All patients had history of chronic constipation. Six cases (33.3%) had free air, and 5 cases (55.6%) had fecaloma at preoperative simple X-ray. The site of perforation were sigmoid colon (8 cases) and descending colon (1 case). The size of perforation ranged from 1 cm to 6.5 cm (mean: 3.1 2.7 cm). The methods of operation were Hartmann's procedure (8 cases), primary repair and sigmoid loop colostomy (1 case). There were two deaths for sepsis. CONCLUSIONS: The stercoral perforation is not rare as commonly thought. If elderly patients who had history of chronic constipation and symptoms of panperitonitis visit hospital, surgeon should be aware of the possibility of this fatal disease and do early surgical intervention with the aggressive therapy for reducing the mortality.
Age Distribution ; Aged ; Colon* ; Colon, Descending ; Colon, Sigmoid ; Colostomy ; Constipation ; Diagnosis ; Emergencies ; Female ; Humans ; Incidence ; Korea ; Male ; Medical Records ; Mortality ; Prognosis ; Rare Diseases ; Retrospective Studies ; Sepsis

PURPOSE: To analyze the risk factors for postoperative lymphocele, for predicting and preventing complications. METHODS: We evaluated 92 kidney transplant recipients with multidetector CT (MDCT) at 1-month posttransplantation. From admission and 1-month postoperative records, data including diabetes, dialysis type, immunosuppressant use, steroid pulse therapy, and transplantation side were collected. Lymphocele volume was measured with 3-dimensional reconstructed, nonenhanced MDCT at one month postoperatively. The correlations between risk factors and lymphocele volume and between risk factors and symptomatic lymphocele (SyL) were analyzed. The cutoff was calculated by using the receiver operating characteristic (ROC) curve for SyL volume. RESULTS: Among 92 recipients, the mean volume was 44.53 ± 176.43 cm³ and 12 had SyL. Univariable analysis between risk factors and lymphocele volume indicated that donor age, retransplantation, and inferiorly located lymphocele were statistically significant. The ROC curve for SyL showed that 33.20 cm³ was the cutoff, with 83.3% sensitivity and 93.7% specificity. On univariable analysis between risk factors and SyL, steroid pulse, inferiorly located lymphocele, and >33.20 cm³ were statistically significant. Multivariable analysis indicated that steroid pulse, >33.20 cm³, and serum creatinine level at one month were significant factors. CONCLUSION: Risk factors including donor age, retransplantation, steroid pulse therapy, and inferiorly located lymphocele are important predictors of large lymphoceles or SyL. In high-risk recipients, careful monitoring of renal function and early image surveillance such as CT or ultrasound are recommended. If the asymptomatic lymphocele is >33.20 cm³ or located inferiorly, early interventions can be considered while carefully observing the changes in symptoms.
Cone-Beam Computed Tomography ; Creatinine ; Dialysis ; Early Intervention (Education) ; Humans ; Imaging, Three-Dimensional ; Kidney Transplantation ; Kidney* ; Lymphocele* ; Risk Factors ; ROC Curve ; Sensitivity and Specificity ; Tissue Donors ; Transplant Recipients* ; Ultrasonography