BACKGROUND: Occlusive complications after arterial revascularization are difficult to treat and have high recurrence rate. This study was performed to establish an effective treatment modality and to evaluate the factors affecting the occlusive complications by analysis of clinical data. MATERIAL AND METHOD: During the period of 5 years. 33 patients (55 reoperations) were studied at the Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital following 173 arterial revascularization surgeries. The clinical characteristics, operating methods, the time intervals of reoperation, used graft, and the results of treatment were evaluated retrospectively. RESULT: All the patients were men except one and the mean age was 63.5 years old. The mean time internal from first operation to reoperation was 11.9 months. The cause of arterial occlusive diseases were 28 atherosclerosis and 5 Burger's diseases, Associated diseases were Hypertension (57.6%), Diabetes mellitus (33.3%), heart failure (18.2%), and so on. The mean rate of reoperation was 1.67 times and the most common type of first operation was femoro-popliteal bypass grafting (57.6%). The graft that used revascularization surgery were 25 cases of PTFE and 6 case were Dacron. There was no statistical difference between two groups. The kinds of reoperations were thrombectomy in 20 cases, angioplasty 18 cases, re-bypass surgery in 13 cases, and lumbar sympathectomy in 4 cases. The results of reoperation were 15 cases of functional recovery, 7 cases of limb salvage, 5 cases of above-knee amputation. 3 cases of below-knee amputation and 3 deaths. CONCLUSION: The main cause of occlusive complications are occlusion of inflow or outflow artery. Treatments were different according to the first operation methods and graft used. The most frequent time of reoperation was within one year after the first operation. We believe that graft surveillance especially during the first year is very important factor in observing the patient. We can look forward to improving limb salvage rate to perform additional treatment such as radiological interventions and lumbar sympathectomy.
Amputation ; Angioplasty ; Arterial Occlusive Diseases ; Arteries ; Atherosclerosis ; Busan ; Diabetes Mellitus ; Graft Occlusion, Vascular ; Graft Survival ; Heart Failure ; Humans ; Hypertension ; Limb Salvage ; Lower Extremity* ; Male ; Peripheral Vascular Diseases ; Polyethylene Terephthalates ; Polytetrafluoroethylene ; Recurrence ; Reoperation ; Retrospective Studies ; Sympathectomy ; Thrombectomy ; Transplants

A femoral artery aneurysm (FAA) is a rare disease with the symptoms of nerve and vein compression, lower extremity ischemia, local pain, pulsating mass, and rupture. Compression of the femoral vein may cause the symptoms of lower extremity venous insufficiency, which accounts for nearly 10% of FAA patients. (Case) A 55 year-old female was hospitalized, suffering from swelling, heaviness and venous ectasia of the left lower extremity. Preoperative CT angiography revealed a 3 cm-sized FAA and compression of the femoral vein due to the aneurysm in her left inguinal area. The aneurysm extended from the distal external iliac artery (EIA) to both the proximal superficial femoral artery (SFA) and profunda femoris artery (PFA). After an aneurysmectomy, interposition grafting from the EIA to the SFA with reimplantation of PFA was done. Immediately after the operation, the symptoms dramatically disappeared, and the follow-up CT revealed the decompressed femoral vein.
Aneurysm* ; Angiography ; Arteries ; Dilatation, Pathologic ; Female ; Femoral Artery* ; Femoral Vein ; Follow-Up Studies ; Humans ; Iliac Artery ; Ischemia ; Leg* ; Lower Extremity ; Middle Aged ; Rare Diseases ; Replantation ; Rupture ; Transplants ; Veins ; Venous Insufficiency

BACKGROUND: Extra-anatomic bypass was performed in the patient who could not use anatomic bypass due to many causes. The purpose of this study is to evaluate the efficacy of extra-anatomic bypass surgery. MATERIALS AND METHOD: We reviewed 31 patients who underwent extra-anatomic bypass surgery at Pusan national university hospital. We analysed the combined diseases, etiologic diseases, symptoms, patency rate and the factors affecting patency rate retrospectively. RESULT: There were 26 cases of femoro-femoral bypass and 5 cases of axillo-bifemoral bypass among 31 patients. The mean age was 70.23 years. Combined disease were hypertension, hyperlipidemia, and ischemic heart disease in order of frequency. The indications for surgery were disabled claudication, tissue necrosis, rest pain, and a cute ischemia. We analysed the ages, smoking history, hypertension, ischemic heart disease, severity of limb ischemia, and hyperlipidemia as factors affecting patency rate. We could not find any statistical differences between these factors. The primary graft patency rates were 73.65% one year, 73.65% two year, and 65.46% three year respectively according to the Kaplan-Meier method. CONCLUSION: Nevertheless extra- anatomic bypass has a relatively low patency rate, it has good merits that is less dangerous, simple and easy re-do surgery compared to anatomic bypass. We think that extra-anatomic bypass is one of the good treatment modalities for the high risk vascular patients.
Busan ; Extremities ; Humans ; Hyperlipidemias ; Hypertension ; Ischemia ; Myocardial Ischemia ; Necrosis ; Retrospective Studies ; Smoke ; Smoking ; Transplants

BACKGROUND: Recently the cases of varicose veins are increasing because the patients with latent disease have come to realize that they want a positive treatment. Accordingly, the purpose of this study is to compare and analyze two methods the conventional phlebectomy (CP) and transiliuminated powered phlebectomy (TIPP). MATERIAL NAD METHOD: From March 2001 to December 2004, 114 patients (167 legs) with varicose vein were operated in Pusan National University Hospital. A retrospective review was performed on the clinical records. We analyzed age, sex, duration of illness, chief complaints, duplex doppler findings, number of skin incisions, operative time, length of hospitalization, complications, and remnant lesions. RESULT: Operative time was significantly shorter in the TIPP group than CP group (for one leg 108.4+/-27.6 min vs 83.4+/-24.4 min, for both legs 184.7+/-28.4 min vs 137.8+/-24.4 min). There was significant statistical difference in average number of skin incisions per leg between the CP group and the TIPP group (5.9+/-2.2 vs 4.2+/-1.6). Mean duration of hospitalization was significantly shorter in the TIPP group than CP group (4.4+/-1.0 days vs 5.8+/-1.9 days). Complications were pain (15.9%), remnant lesion (9.5%), and ecchymosis (4.8%) in the CP group and ecchymosis (19.6%), pain (7.8%), and remnant lesion (7.8%) in TIPP group. Sclerotherapy or reopertaion was done for the patients who had remnant lesions. CONCLUSION: Transilluminated powered phlebectomy in varicose vein could reduce operative time and number of skin incisions, and almost completely removed the multiple lesions. Although there were postoperative complications such as ecclymosis, they were absorbed within 2 months and patients were satisfied. Therefore, TIPP is a more effective operative technique than conventional phlebectomy in varicose veins.

PURPOSE: This study examined the effectiveness of a hand massage combined with analgesics on pain control in hospice patients with terminal cancer. METHODS: This study is a quasi-experimental study with a single group time series design. The study included 25 terminal cancer patients who were admitted to a hospice ward. Each patient’s pain level was measured after analgesics use only (control group). When patients complained of pain again, the pain level was assessed after administering a combination of hand massage and analgesics (experimental group). As for the experimental treatment, the participants were provided with oil hand massage on each hand for 5 minutes. RESULTS: The experimental group and the control group showed no significant differences in the changes of pain score (F=0.74, P=0.3939). CONCLUSION: Although the pain level of the experimental group did not significantly improve compared with the control group, their pain levels tended to be low to begin with. Thus, a complementary utility value of hand massage cannot be completely excluded in terminal cancer patients. Since the pain level significantly changed according to the dosage of analgesic, nurses need more education and research on analgesic drug therapy for terminal cancer patients.
Analgesics* ; Drug Therapy ; Education ; Hand* ; Hospice Care ; Hospices ; Humans ; Massage* ; Non-Randomized Controlled Trials as Topic

A tracheo-innominate artery fistula is a highly lethal complication following tracheostomy; therefore, it's early recognition and prompt treatment is mandatory. A 37-years-old man who had undergone a tracheostomy several days earlier, following brain surgery, was found to have a tracheo-innominate artery fistula with an exsanguinating hemorrhage from his tracheostomy site. After temporary control of the bleeding with ballooning, a stent graft was implanted through the femoral artery into the innominate artery. The patient experienced rebleeding from the mouth 50 days later. Aortoinnominate interposition grafting and patch closure of the trachea were performed for the permanent control of bleeding and to maintain the airway. This delayed operation is easier and safer than an emergency operation; therefore, we could expect better operative results under such circumstances. 12 months after surgery, the patient is in a state of well being.
Arteries* ; Blood Vessel Prosthesis* ; Brachiocephalic Trunk ; Brain ; Emergencies ; Exsanguination ; Femoral Artery ; Fistula* ; Hemorrhage ; Humans ; Mouth ; Stents* ; Trachea ; Tracheostomy ; Transplants

BACKGROUNDS: Insufficient intermaxillary space is caused by non-restoration following tooth extraction in the past, and this involves eruption of the opposing teeth and changes of the arch structure. Such cases are difficult just by a simple prosthetic approach, and diversified treatment plans should be established. Among these, posterior maxillary segmental osteotomy (PMSO) is an efficient treatment option than extraction of opposing teeth as it surgically repositions multiple erupted teeth and alveolar bone. PMSO can preserve the natural teeth; therefore, it is being regarded as a treatment method which can improve insufficient intermaxillary space significantly. CASE PRESENTATION: In this case report, the first patient received PMSO in order to place an implant in the mandibular edentulous space after decreased vertical dimension is restored, and the second patient received PMSO along with orthodontic treatment to obtain the intermaxillary space and balance the interarch molar width. CONCLUSION: PMSO is the treatment of choice when occlusion is compromised in the presence of decreased vertical dimension or arch length discrepancy.
Humans ; Methods ; Molar ; Orthognathic Surgery ; Osteotomy* ; Tooth ; Tooth Extraction ; Vertical Dimension

BACKGROUND: Thymectomy was known as an effective treatment modality of myasthenia gravis. In this paper, we analyzed the result of thymectomy and the factors affecting the postoperative symptom improvement. MATERIAL AND METHOD: We analyzed the medical records of 50 patients who received the thymectomy for myasthenia gravis from January 1997 to December 2001. RESULT: 39 patients showed symptom improvement. The effect ofthymectomy as a treatment is 78%. There was no statistically significant correlation between postoperative improvement and Sex, Age, the Weight of thymic tissue, preoperative symptom duration, and preoperative mestinon dosage. However, the thymic pathology and low grade preoperative symptoms were affecting the postoperative prognosis. CONCLUSION: Thymic hyperplasia showed good prognosis compared to thymoma. Low grade preoperative symptoms (Group I or IIA) also showed good prognosis. So, early thymectomy is recommendable for the good treatment results of myasthenia gravis.
Humans ; Medical Records ; Myasthenia Gravis ; Pathology ; Prognosis ; Pyridostigmine Bromide ; Thymectomy* ; Thymoma ; Thymus Hyperplasia

BACKGROUND: Issues concerning with the classification accuracy of Korean Outpatient Groups (KOPGs) have been raised by providers and researchers. The KOPG is an outpatient classification system used to measure casemix of outpatient visits and to adjust provider risk in charges by the Health Insurance Review & Assessment Service in managing insurance payments. The objective of this study were to refine KOPGs to improve the classification accuracy and to evaluate the refinement. METHODS: We refined the rules used to classify visits with multiple procedures, newly defined chemotherapy drug groups, and modified the medical visit indicators through reviews of other classification systems, data analyses, and consultations with experts. We assessed the improvement by measuring % of variation in case charges reduced by KOPGs and the refined system, Enhanced KOPGs (EKOPGs). We used claims data submitted by providers to the HIRA during the year 2012 in both refinement and evaluation. RESULTS: EKOPGs explicitly allowed additional payments for multiple procedures with exceptions of packaging of routine ancillary services and consolidation of related significant procedures, and discounts ranging from 30% to 70% were defined in additional payments. Thirteen chemotherapy drug KOPGs were added and medical visit indicators were streamlined to include codes for consultation fees for outpatient visits. The % of variance reduction achieved by EKOPGs was 48% for all patients whereas the figure was 40% for KOPGs, and the improvement was larger in data from tertiary and general hospitals than in data from clinics. CONCLUSION: A significant improvement in the performance of the KOPG was achieved by refining payments for visits with multiple procedures, defining groups for visits with chemotherapy, and revising medical visit indicators.
Classification ; Drug Therapy* ; Fee-for-Service Plans ; Fees and Charges ; Health Care Costs ; Hospitals, General ; Humans ; Information Systems ; Insurance ; Insurance Claim Review ; Insurance, Health ; Outpatients* ; Product Packaging ; Prospective Payment System ; Referral and Consultation

Background: The number of aging physicians is increasing as the global population ages. With aging, anesthesiologists would be expected to experience changes in their professional position. Therefore, we aimed to investigate the current professional status of Korean anesthesiologists aged over 60 years. Methods: Registered anesthesiologists aged over 60 years in Korea were invited for a survey. The questionnaire addressed 10 subjects with 40 questions that focused on demographics, practical activities, work conditions, difficulties experienced due to physical changes caused by aging, and economic status. Results: In total, 122 anesthesiologists responded to the survey (response rate: 15.7%). Of them, 30.3% were working in honorary and advisory positions at tertiary hospitals, while 19.7% were working as pain physicians. Majority of the respondents were working for 5 days a week (41.8%) and 6–8 hours/day (48.4%). Majority of them (79.5%) were generally satisfied with their present life. Conclusions Majority of the senior anesthesiologists were working at general hospitals and they reported being “satisfied” with the current status of their life. However, the clinical practice and retirement strategies of senior anesthesiologists need to be evaluated systematically to prepare for the continuing gradual increase in the number of senior anesthesiologists.