This report describes the open surgical or endovascular treatment of two patients with bilateral internal iliac artery aneurysms (IIAA). To prevent pelvic ischemia, complete aneurysmal resection and pelvic revascularization with an interposition graft was performed in the open surgical case. Endovascular repair including coil embolization of IIAA and stent-graft placement in the common iliac artery was done successfully in the other case. The contralateral IIAA was left undisturbed and followed for 36 months with no change in size. Prevention of pelvic ischemia is important in the simultaneous treatment of bilateral IIAA.
Aneurysm ; Embolization, Therapeutic ; Humans ; Iliac Aneurysm* ; Iliac Artery ; Ischemia ; Transplants

No abstract available.
Carbon*

Purpose: Traumatic duodenal injury is uncommon and due to its difficult diagnosis and accessibility there is an increased risk of mortality and morbidity. Methods: Electronic medical records of a single center were reviewed retrospectively from March 2008 to December 2020 and a total of 7 cases of traumatic duodenal injury were managed by surgical exploration. The site of duodenal perforation, injury mechanisms, operation method, and postoperative outcomes were assessed. Results: The mean age was 55.72 years (range, 34-78), and there were 5 men in the study. The most common mechanism was in-car traffic accident (4 cases), and 1 case each of pedestrian accident, accident during work, and self-injured stab wound. The most common site of injury was between the 3rd and 4th portion (3 cases), followed by the bulb and 1st portion (2 cases), and 2nd portion (2 cases). Segmental resection of the duodenum and primary anastomosis was performed in the 3rd and 4th portion perforation. In cases of 1st and 2nd portion, injury was managed by primary repair or pylorus preserving pancreaticoduodenectomy. Complications developed in 4 patients, and the most common complication was a problem with the wound; wound seromas developed in 4 cases, entero-cutaneous fistula in 1, and biliary complications in 2 cases. Two patients suffered from intraperitoneal abscess or fluid collection managed by percutaneous drainage. The mean duration of hospital stay was 34 days, and postoperative mortality did not develop. Conclusion Favorable clinical outcomes were observed in patients with traumatic duodenal injury managed by various surgical approaches.

No abstract available.
Female ; Luteal Phase*

In 1974, Casson et. al. reported midfacial degloving approach to repair the midfacial bone fracture. After then, this approach has been used frequently to treat the lesions on nasal cavity, nasopharynx, facial plastic surgery and midfacial trauma. Midfacial degloving approach consists of 1) bilateral sublabial incision 2) complete transfixion incision/ septocolumellar incision 3) bilateral intercartilaginous incision 4) bilateral pyriform aperature incision. This approach provides proper access for midfacial bone structure without facial scar but has post-operative complications such as transient epistaxis, infraorbital nerve paresthesia and nasal crust. We treated three patients using midfacial degloving approach to correct traumatic deformity in midface area. In two patients, rhinoplasty with autogenous rib graft was done simultaneously. So we report these cases with review of literatures.
Cicatrix ; Congenital Abnormalities ; Epistaxis ; Fractures, Bone* ; Humans ; Nasal Cavity ; Nasopharynx ; Paresthesia ; Rhinoplasty ; Ribs ; Surgery, Plastic ; Transplants

PURPOSE: We studied the voiding dysfunction after surgical treatment of female stress urinary incontinence and diagnosis and treatment. MATERIALS AND METHODS: Three hundred women with stress urinary incontinence underwent surgical procedure between January 1998 and December 2004. Ninety two patients(30.6%) experienced the postoperative voiding dysfunction. As the primary procedure for the management of postoperative voiding dysfunction alpha-blockers medication and clean intermittent catheterization(CIC) were performed. Then, hegar dilation and urethral pull-down procedure were performed as a secondary measure. For the patients who showed persistent obstructed symptoms, cutting of mesh or sling materials were performed. RESULTS: In 57 patients, symptoms improved by alpha-blockers medication and CIC. The others were received hegar dilation and urethral pull-down procedure, and 29 patients were improved. 6 patients were not controlled by conservative treatment, of which 3 patients underwent cutting of mesh or sling. De novo urgency was developed in 12 patients. Anticholinergics were taken, symptoms were diminished in 10 patients after 5 months of medication. CONCLUSION: Most voiding dysfunction after surgery may be effectively managed by conservative treatment. In cases of failure, hegar dilation and urethral pull-down procedure may be useful within postoperative first weak. Finally, cutting of mesh or sling must be considered in patient whose the secondary measure is failed.
Cholinergic Antagonists ; Diagnosis ; Female* ; Humans ; Urinary Incontinence*

PURPOSE: Abrupt abstinence from alcohol in cause of chronic alcohol addiction can trigger alcohol withdrawal syndrome. The authors studied the effect of post-operative alcohol withdrawal syndrome in patients who require intensive care due to trauma. METHODS: For the study group, we selected 70 patients who had undergone emergency surgery from May 2003 to March 2007 due to trauma and who had been treated with prophylactic thiamine. Data was collected retrospectively. We excluded those who extended their hospital stay for other than traumatic causes, those who died within 3 days of surgery after trauma, those who transferred to other institutions, and those who received a psychiatric diagnosis. Patient groups were determined by the existence or the non-existence of withdrawal syndrome. Age, sex, injury mechanism, mortality, complications, durations of hospital stay and intensive care, use of mechanical ventilator, and sedative use were investigated. A Chi-square test and The Mann-Whitney method were used for statistical analysis in this study. RESULTS: Twenty-four (24) patients from the 58 who had an ISS of 16 or more showed alcohol withdrawal syndrome, and men were shown to be affected with the syndrome significantly more than women. Although ISS was higher in the group with alcohol withdrawal syndrome, statistically, the difference was not significant (p<0.08). The total hospital stay in the patient group with alcohol withdrawal syndrome was on average 10 days longer. However, the difference was not significant (p<0.054). The duration of intensive care in the patient group with alcohol withdrawal syndrome was significantly longer (p<0.029). The patients with alcohol withdrawal syndrome showed no significant difference in the duration of mechanical ventilator use (p<0.783), or in the duration of sedative use (p<0.284). Respiratory distress, pneumonia, upper airway infection, sepsis, acute renal failure, and mortality in the alcohol withdrawal syndrome group were investigated, but no statistically significant difference were noted. CONCLUSION: We found that the duration of intensive care in chronic alcohol abusers was longer due to the development of alcohol withdrawal syndrome. We also discovered that, when the patients overcame the symptoms of alcohol withdrawal syndrome after intensive care, no difference was found in the frequency of developing complications, the morbidity, and the mortality. Therefore, we conclude that intensive care in trauma patients who are chronic alcohol abusers decreases the incidence of complications found in patients with postoperative alcohol withdrawal syndrome and does not adversely impact the prognoses for those patients.
Acute Kidney Injury ; Critical Care ; Emergencies ; Female ; Humans ; Incidence ; Injury Severity Score ; Length of Stay ; Male ; Mental Disorders ; Pneumonia ; Prognosis ; Retrospective Studies ; Sepsis ; Thiamine ; Ventilators, Mechanical

Verrucous carcinoma is an uncommon low-grade variant of squamous cell carcinoma. It is clinically characterized by its verrucous and fungating appearance and it is histologically characterized by well-differentiated epithelial proliferations that push the underlying dermis. There are some reports of verrucous carcinoma associated with abscess or fistula, but there have been no case reports of verrucous carcinoma complicated with a subcutaneous abscess involving the adjacent tissue in Korea. We report here on a case of verrucous carcinoma that presented with focal verrucous nodule infiltrating the adjacent subcutaneous tissue with diffuse subcutaneous abscess formation.
Abscess ; Buttocks ; Carcinoma, Squamous Cell ; Carcinoma, Verrucous ; Dermis ; Fistula ; Korea ; Subcutaneous Tissue

PURPOSE: The aim of the study is to present surgical techniques and treatment outcomes of re-banding and sleeve gastrectomy after removal of eroded adjustable gastric band. MATERIALS AND METHODS: A retrospective database analysis was performed to study re-banding or LSG as revisional surgery for band erosion. Technical advancement we adopted included adhesiolysis of liver edge and cardia, retrogastric tunneling, and stapling away from fibrotic cardia. Main outcome measures were success of therapeutic strategies, morbidity, and body mass index (BMI), percentage excess weight loss [%EWL] before and after revision. RESULTS: From 2013 to 2017, a total of 11 patients underwent revisional surgery. Male to female was ratio was 1:10. Six patients underwent revisional sleeve gastrectomy, and five patients underwent re-banding. One patient in sleeve gastrectomy group was diagnosed to have minor leak on CT scan, and recovered by conservative management. The median BMI of the six patients who underwent sleeve gastrectomy was 29.5 kg/m² (27.9 kg/m²–40.8 kg/m²), their median follow-up was 24.8 months (6.5–54.7 months), and their BMI and %EWL at last follow-up was 24.4 kg/m² (22.5 kg/m²–34.6 kg/m²) and 78.4% (19.2%–110.2%) respectively. The median BMI of the five patients who underwent rebanding was 27.3 kg/m² (26.1 kg/m²–41.4 kg/m²), their median follow-up was 16.5 months (4.5–36.4 months), and their BMI and %EWL at last follow-up was 23.5 kg/m² (22.0 kg/m²–30.1 kg/m²) and 83.9% (36.4–123.3%) respectively. CONCLUSION: With advanced surgical techniques we adopted, both re-banding and sleeve gastrectomy are safe and effective as a revisional procedure after removal of eroded gastric band.
Body Mass Index ; Cardia ; Cytochrome P-450 CYP1A1* ; Female ; Follow-Up Studies ; Gastrectomy* ; Humans ; Liver ; Male ; Outcome Assessment (Health Care) ; Retrospective Studies ; Tomography, X-Ray Computed ; Weight Loss

PURPOSE: Deep vein thrombosis (DVT) is a serious disease which causes life-threatening pulmonary embolism and chronic venous insufficiency. In order to prevent pulmonary embolism, inferior vena cava (IVC) filter placement is commonly performed nowadays. We carried out this study to analyze the patterns of the indications for IVC filter placement, the complications associated with procedure, and the follow-up results. METHOD: We treated 42 patients with acute DVT between September 2001 and November 2002 at Gil Medical Center. Our subjects included 10 patients who underwent IVC filter placement during the same period. Duplex sonography and CT venography were performed in all cases. The filter was placed by one interventional radiologist just after checking the nonselective venography. The patients were followed monthly with a physical examination. Plain abdominal film was checked every 3 months, and CT venography every 6 months. RESULT: The mean age was 55.6 years (range 35~72) and the male-to-female ratio was 1:4. The associated diseases were advanced cancer in 3 cases, intracranial hemorrhage in 2 and spinal cord injury and ankylosis of the hip joint in 1. There were 8 cases of hypercoagulable states; 7 of protein S deficiency, 3 of protein C deficiency and 1 of antithrombin III deficiency. Indications for filter insertion were a contraindication to anticoagulation in 5 cases, recurrent pulmonary embolism in 2, floating IVC thrombosis in 2, complication of anticoagulation in 1, prophylactic use before catheter-directed thrombolysis in 1, and quadriplegia in 1. Four Greenfield filters and six TrapEase filters were used. Filters were deployed at infrarenal IVC in 8 cases and suprarenal IVC in 2 cases. There were no major complications related to the procedure. Late complications were not detected during the 7-month follow-up (range 2~16 months). CONCLUSION: We performed 10 IVC filter placements for therapeutic purpose without any serious complications. A wider range of indications, including prophylactic use, might be considered in the future practice for DVT.
Ankylosis ; Antithrombin III Deficiency ; Follow-Up Studies ; Hip Joint ; Humans ; Intracranial Hemorrhages ; Phlebography ; Physical Examination ; Protein C Deficiency ; Protein S Deficiency ; Pulmonary Embolism ; Quadriplegia ; Spinal Cord Injuries ; Thrombosis ; Vena Cava Filters* ; Vena Cava, Inferior* ; Venous Insufficiency ; Venous Thrombosis*