Fournier's gangrene is an infective necrotizing fasciitis of the perineal, genital or perianal regions. Management of this disease has involved prompt surgical debridement with initiation of broad spectrum antibiotics and intensive supportive care. Multiple debridements orchiectomy, urinary deversion, and fecal diversion should be performed as clinically indicated. Hyperbaric oxygen therapy and topical application of unprocessed honey may prove to be useful adjuncts as new therapies. After excision of all necrotic tissue, the tissue losses have been managed by primary repair. split-thickness skin grafts, rotational or free myocutaneous flaps and omental flaps. Skin graft did not take on bare testis lacking the tunica vaginalis, and gracilis myocutanous flap was too bulky to cover the scrotal area. The progress of necrosis ceased by using intravenous PGE1 injection in the aspect of characteristic obliterative endarteritis causing cutaneous and subcutaneous vascular thrombosis and necrosis of tissue in Fournier's gangrene. We have reconstructed large scrotal defects with bilateral superomedial thigh flap in three Fournier's gangrene patients after stopping tissue necrosis with PEG1 treatment and several surgical debridements of the wounds. The use of this flap ensures a virtually normal sensation, which is important for the erotic propensity of the scrotum. Easy flap design and dissection, as well as primary closure of the donor site, are another benefits of this method.
Alprostadil* ; Anti-Bacterial Agents ; Debridement ; Endarteritis ; Fasciitis, Necrotizing ; Fournier Gangrene* ; Honey ; Humans ; Hyperbaric Oxygenation ; Myocutaneous Flap ; Necrosis ; Orchiectomy ; Scrotum ; Sensation ; Skin ; Testis ; Thigh* ; Thrombosis ; Tissue Donors ; Transplants ; Wounds and Injuries

Alveolar Bone Loss ; Animals ; Dental Implants ; Dogs ; Electrodes ; Femur ; Implants, Experimental ; Osseointegration ; Plasma ; Porosity ; Titanium ; Vacuum

No abstract available.
Catheters*

OBJECTIVE: The number of elderly patients with cerebral aneurysm has markedly increased. We investigate the clinical characteristics and the surgical outcomes of cerebral aneurysms of elderly patients aged over 65 years comparing with those of control group aged under 65 years. METHODS: Total 439 patients were done aneurysm surgery between January 1998 to December 2002. The clinical data of 78 old-aged patients and 361 control group patients were reviewed to assess the relationship between sex, Hunt-Hess grade at admission, Fisher's grade at admission, site of aneurysm, timing of surgery, vasospasm, hydrocephalus, surgical outcome and age. RESULTS: The proportion of female, poor Hunt-Hess grade, poor Fisher's grade and hydrocephalus were significantly higher in old-aged patients than those of control group. But aneurysmal site and the rate of vasospasm were not different significantly in these two groups. Favorable outcomes were 75.6% for control group patients and 67.9% for old-aged patients. The surgical outcome was not statistic significantly different between two groups. The main causes of unfavorable outcome among elderly patients were attributed to their poorer Hunt-Hess grades on admission and postoperative medical complications. CONCLUSION: We conclude that old age is not a contra-indication for aneurysm surgery for elderly patients. And also after surgery, aggressive treatment and prevention of medical complications can lead to a better outcome.
Aged* ; Aneurysm ; Female ; Humans ; Hydrocephalus ; Intracranial Aneurysm* ; Subarachnoid Hemorrhage*

BACKGROUND: The purpose of this study was to estimate the economical impacts of surgical site infection (SSI) after general surgeries. METHODS: A prospective study was performed with the surgeries from September to December, 2002 and the SSI cases were collected based on the definitions of Centers for Disease Control and Prevention, The length of stay (LOS) and the hospital charge for the SSI group were compared with the non-SSI (NSSI) group by a matched cohort study for age, sex, operation procedure, and NNIS risk groups. RESULTS: There were 1,007 cases of surgeries and the 52 cases of SSI and the 26 cases have been matched. The LOS of the SSI group was 5.2 days longer than that of the NSSI group (P<0.05) which was significant, The injection and dressing meal, and total hospital charge were \157,562, \72,251, and \2,153,964 more in SSI group than those of NSSI group (P<0,05) for post-operation stay. The charge of medication and room in SSI group were \558,146 and \723,114 more than those of the NSSI group, but there were no significant difference. CONCLUSION: The SSI could increase the LOS and the hospital charge; therefore, this economic loss had an impact on the hospitals as well as the patients. To estimate the economic impacts of SSI precisely, however, further studies are needed to analyze and control other factors for the cost such as a type of surgery. In addition, the scope and setting of cost analysis should be expanded into the aspects of an individual, the hospital, and society.
Bandages ; Centers for Disease Control and Prevention (U.S.) ; Cohort Studies ; Costs and Cost Analysis ; Hospital Charges ; Humans ; Length of Stay ; Meals ; Prospective Studies

The prognosis of pontine hemorrhage has been reported to be extremely poor, but the wide-spread use of CT scan and MRI has led to the discovery of ssmall pontinehemorrhage which previously could not have been discovered. We analysed 28 cases of pontine hemorrhage for evaluation of contributing factors to the patients prognosis from January 1994 to December 1996. A good prognosis was achieved in patients with no or mild disturbance of consciousness, 20mm or less in the transverse diameter of the hematoma, small numbers of slices in which the hematoma was found, and the hematoma localized in the tegmentum. Two patients underwent suboccipital craniectomy with removal of hematoma. But all patients died immediate postoperative period. A comatose state on admission, transverse diameter of hematoma over 20mm, large numbers of slices in which the hematoma was found, and the hematoma localized in the basotegmentum were significant poor prognostic factors.
Coma ; Consciousness ; Hematoma ; Hemorrhage* ; Humans ; Magnetic Resonance Imaging ; Postoperative Period ; Prognosis* ; Tomography, X-Ray Computed

PURPOSE: This study was conducted to perform a comparative analysis of the efficacy and safety of conventional transurethral resection of the prostate (TUR-P), transurethral resection in saline (TURIS), and TURIS-plasma vaporization (TURIS-V) when performed by a single surgeon for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: The clinical data of 73 consecutive men who underwent conventional TUR-P (39), TURIS (19), or TURIS-V (15) for BPH were retrospectively analyzed. All procedures were carried out by a single surgeon between October 2007 and April 2010. The patients were assessed preoperatively and perioperatively and were followed at 1, 3, and 6 months postoperatively. Patient baseline characteristics, perioperative data, and postoperative outcomes were compared, and major complications were recorded. RESULTS: In all groups, significant improvements in subjective and objective voiding parameters were achieved and were sustained throughout follow-up. TURIS-V had the shortest operation time compared with conventional TUR-P and TURIS (p=0.211). TURIS-V significantly decreased procedural irrigation fluid volume, postoperative irrigation duration, catheter duration, and hospital stay compared with conventional TUR-P and TURIS. There were no significant differences between the groups in hemoglobin levels or serum sodium levels before and after the operations. There were three transfusions and four clot retentions in the TUR-P group, and one transfusion and one clot retention in the TURIS group. The TURIS-V group had no complications. CONCLUSIONS: TURIS and TURIS-V were effective for the surgical treatment of BPH in addition to conventional TUR-P. TURIS-V was not inferior to conventional TUR-P or TURIS in terms of safety.
Catheters ; Follow-Up Studies ; Hemoglobins ; Humans ; Length of Stay ; Male ; Pilot Projects ; Prostate ; Prostatectomy ; Prostatic Hyperplasia ; Retention (Psychology) ; Retrospective Studies ; Sodium ; Transurethral Resection of Prostate ; Urologic Surgical Procedures ; Volatilization

Oriental blepharoplasty or the commonly called "double eyelid" operation is the most common cosmetic procedure among Orientals because the Orientals tend to be conscious of the fold due to the influx of Caucasians and social westernimtion. Anatomically, the upper eyelids of the Orientals are considerably digerent from those of Caucasians, and nearly half of them have single eyelids. Considering the anatomic characteristics of the Koreans, an appropriate design and operative technique must be selected carefully to obtain an aesthetically satisfactory result. However, the incidence of complications occurs frequently. Patients who are faced with unsatisfactory results are perplexed by the fact that such a commonly performed procedures yield such a high dissatisfaction rate, and that secondary revisions can not be easily done. An unfavorable result does not necessarily imply a postoperative complication. Equally important is the unsatisfaction of the patient, whose goal may not be based on good aesthetic principles. The most common source of dissatisfaction in patients who underwent double eyelid operation is postoperative asymmetry and high level of the lid fold. During the eight years from 1991 to 1997, a total 72 patients underwent the secondary blepharoplasty either by transversely slitting and removing multilaminated septal structures exposed to the previous operative scar and or by spreading the preaponeurotic fat, that was extruded into a thin layer. The average age of the patients was 26.5 years and average follow up period was 2 years. No remarkable complications were encountered after operarion by our method and desired aesthetic improvements were acquired in the majority of the patients.
Blepharoplasty ; Cicatrix ; Eyelids* ; Follow-Up Studies ; Humans ; Incidence ; Postoperative Complications

BACKGROUND AND OBJECTIVE: The aim of this study was to compare the residual diameter stenosis after PTCA with fractional flow reserve (FFR) and coronary flow reserve (CFR), and investigate the correlation between FFR and CFR in patients with acute myocardial infarction (AMI). MATERIALS AND METHOD: The study population consisted of twenty seven patients with myocardial infarction. Baseline and hyperemic average peak velocity (APV) were measured using Doppler wire 15 minutes after restoration of infarct-related artery (IRA). CFR was obtained by the ratio of distal hyperemic APV to baseline APV. Distal coronary arterial pressure (Pd) was measured with advancing the wire distal to the lesion of IRA. Simultaneous proximal aortic pressure (Pa) was measured using guiding catheter. Myocardial FFR was obtained by the ratio of hyperemic Pd to hyperemic Pa. RESULTS: Post-interventional CFR and FFR were 0.85+/-0.44, 0.91+/-0.09. CFR did not show significant correlation with luminal diameter stenosis (%ST). There was no significant correlation between FFR and CFR with a correlation coefficient of 0.29 (p=.25). But, significant correlation was found between %ST and FFR, %ST and hyperemic PG (hPG) with correlation coefficient of -0.70 (p=.0012) and 0.68 (p=.0018). CONCLUSION: In AMI patients, %ST has a significant correlation with FFR and hPG after PTCA. But, there was no significant correlation between FFR and CFR.
Arterial Pressure ; Arteries ; Catheters ; Constriction, Pathologic ; Humans ; Myocardial Infarction* ; Phenobarbital

Purpose: A steady increase in Clostridioides difficile enteritis (CDE) has been reported recently.CDE is associated with intestinal dysbiosis, and vitamin D receptors are known to play an important role in this microbial imbalance as immunological regulators. We investigated the difference in vitamin D levels between children with CDE and those with other acute infectious enteritis. Methods: This retrospective study was conducted on children below 18 years of age who visited the Gil hospital, underwent investigation to assess vitamin D levels, and had confirmed gastrointestinal infection between January 2015 and December 2018. Patients were divided into two groups: the “CDE group” (n=18) and the “other infectious enteritis group” (n=88); their clinical characteristics, other laboratory results, and vitamin D levels were analyzed. Results: There was no difference in gender, age, and seasonal distributions between the CDE and other infectious enteritis groups. Other laboratory results were not significantly different between two groups, excluding serum albumin level (4.52±0.45 g/dL vs. 4.31±0.28 g/dL, p=0.011). The mean 25-hydroxy vitamin D level in the CDE group was higher than that in the control group (18.75±8.11 ng/mL vs. 14.50±6.79 ng/mL, p=0.021). Conclusion Vitamin D levels in the CDE group were lower than normal but higher than the other infectious enteritis group. These results suggested that CDE has a different mechanism or susceptibility associated with vitamin D in children, and even marginal changes in vitamin D levels can act as a risk factor for infection.