OBJECTIVE: Decompressive craniectomy (DC) is a useful surgical method to achieve adequate decompression in hypertensive intracranial patients. This study suggested a new skin incision for DC, and analyzed its efficacy and safety. METHODS: In the retrograde reviews, 15 patients underwent a newly suggested surgical approach using n-shape skin incision technique (Group A) and 23 patients were treated with conventional question mark skin incision technique (Group B). Two groups were compared in the terms of the decompressed area of the craniectomy, protruded brain volume out of the skull layer, the operation time from skin incision to bone flap removal, and modified Rankin Scale (mRS) which was evaluated for 3 months after surgery. RESULTS: The decompressed area of craniectomy (389.1 cm² vs. 318.7 cm², p=0.041) and the protruded brain volume (151.8 cm³ vs. 116.2 cm³, p=0.045) were significantly larger in Group A compared to the area and the volume in Group B. The time interval between skin incision and bone flap removal was much shorter in Group A (23.3 minutes vs. 29.5 minutes, p=0.013). But, the clinical results were similar between 2 groups. Group A showed more favorable outcome proportion (mRS 0-3, 6/15 patients vs. 5/23 patients, p=0.225) and lesser mortality cases proportion 1/15 patients vs. 4/23 patients, but these differences were not significantly observed (p=0.225 and 0.339). CONCLUSION: DC using n-shaped skin incision was a feasible and safe surgical technique. It may be an easier and faster method for the purpose of training neurosurgeons.
Brain ; Decompression ; Decompressive Craniectomy* ; Dermatologic Surgical Procedures ; Humans ; Methods ; Mortality ; Neurosurgeons ; Skin* ; Skull ; Surgical Flaps ; Surgical Procedures, Operative

PURPOSE: The purpose of this study is to assess the periopertive morbidity and mortality rates in relation to the principal variables in aged patients who undergo laparoscopic colorectal resection. METHODS: From March 2001 to March 2006, the prospective laparoscopic colorectal resection database was used to identify 233 patients. Among them, 132 were 70 years of age or older and they were classified as the aged group. 101 were younger than 70 years of age and they were classified as the younger group. RESULTS: Comorbidity was more common in the aged group than in the younger group (67.4% and 53.5%, respectively) (P=0.030). There were higher ASA scores in the aged group (I: 2.3% II: 68.2% III: 29.5%) than in the younger group (I: 27.7% II: 56.4% III: 15.8%) (P<0.0001). There was a higher postoperative complication rate for the aged group than for the younger group (25.0% and 8.9%, respectively) (P=0.002). Only one case of mortality (0.8%) was found in the aged group. The period of the postoperative hospital stay was longer for the aged group than that for the younger group (21.9+/-3/416.3 days and 16.3+/-3/48.1days, respectively) (P= 0.002). For the aged group, univariate analysis revealed that the operative procedure, disease, the T stage and the operation time were significant variables for the postoperative complications, and multivariate analysis identified the operation time as an independent variable faor the postoperative complications. CONCLUSION: More prudent care is needed to prevent postoperative complications for the aged patients who undergo laparoscopic colorectal resection, and particularly for those who can be expected to have a longer operation time.
Comorbidity ; Humans ; Length of Stay ; Mortality ; Multivariate Analysis ; Postoperative Complications ; Prospective Studies ; Surgical Procedures, Operative

The purpose of treatment for metastatic spine tumor is to improve the quality of life. So, it is very important to carefully select the surgical candidates to prevent unnecessary surgery-related morbidity and mortality. For this purpose, the authors have surveyed 200 cases of spinal metastasis treated by radiotherapy alone or radiotherapy plus surgery to determine prognostic factors. In this study, we attempted to examine retrospectively the four factors, e.g.,primary tumor, pretreatment neurologic status, general condition and degree of cancer extension, affecting the prognosis of metastatic spine tumors. Each factor was ranked from 1 to 3 points according to the severity and the total score for each patient was obtained by adding the these points. As a result, it was found that the total score was highly correlated to the survival period. While the patients with a total score of 6 or lower survived 100 days or less, those of 10 or higher survived 300 days or more on average. Therefore, authors believe this scoring system would be helpful to the determine treatment modalities and the selection of the most suitable operative procedures.
Humans ; Mortality ; Neoplasm Metastasis ; Prognosis ; Quality of Life ; Radiotherapy ; Retrospective Studies ; Spine* ; Surgical Procedures, Operative

INTRODUCTION: Nasopharyngeal angiofibroma is a rare histologically benign tumor which occurs almost exclusively in adolescent boys. The morbidity and mortality associated with this tumor are related to its prominent vascularity and its propensity for aggresive local growth. MATERIALS AND METHOD: From November 1990 through February 1996, 8 patients with a diagnosis of nasopharyngeal angiofibroma were managed at Asan Medical Center. For the devasculation of the tumor before the surgery, preoperative arterial embolization was performed on 6 patients. RESULTS: The main tumor supplying vessel was ipsilateral internal maxillary artery in all cases. According to Chandler classfication(Table 1), stage II was 4 cases and stage III was 4 cases. Operative procedures were midfacial degloving approach(4 cases), transpalatal approach(1 case), transantral approach(1 case), combined approach(1 case: Caldwell-Luc op & endoscopic op), medial maxillectomy(1 case). There were no treatment-related deaths and no major surgical complications.
Adolescent ; Angiofibroma* ; Chungcheongnam-do ; Diagnosis ; Humans ; Maxillary Artery ; Mortality ; Surgical Procedures, Operative

PURPOSE: To propose a new, multivariable risk-scoring model for predicting 30-day mortality in individuals underwent repair of abdominal aortic aneurysms (AAA). METHODS: Four hundred eighty-five consecutive patients who underwent AAA repair from January 2000 to December 2010 were included in the study. Univariate and multivariate analyses were performed to evaluate the risk factors, and a risk-scoring model was developed. RESULTS: Multivariate analysis identified three independent preoperative risk factors associated with mortality, and a risk-scoring model was created by assigning an equal value to each factor. The independent predictors were location of the AAA, rupture of AAA, and preoperative pulmonary dysfunction. The multivariable regression model demonstrated moderate discrimination (c statistic, 0.811) and calibration (Hosmer-Lemeshow test, P = 0.793). The observed mortality rate did not differ significantly from that predicted by our risk-scoring model. CONCLUSION: Our risk-scoring model has excellent ability to predict 30-day mortality after AAA repair, and awaits validation in further studies.
Aortic Aneurysm, Abdominal* ; Calibration ; Discrimination (Psychology) ; Endovascular Procedures* ; Humans ; Mortality* ; Multivariate Analysis ; Risk Factors ; Rupture ; Surgical Procedures, Operative ; Treatment Outcome

PURPOSE: Although common femoral artery endarterectomy (CFAE) is regarded as the standard treatment modality for common femoral artery (CFA) disease, availability of advanced endovascular techniques has resulted in an increased number of CFA disease being treated. We evaluated clinical outcomes in a contemporary series of patients who were treated for CFA disease using endarterectomy alone or combined with endovascular treatment. MATERIALS AND METHODS: We retrospectively reviewed 46 patients from November 2001 through December 2007. The treated lesions were divided into 4 groups based on operative procedure: group I (n=11), CFAE alone; group II (n=15), CFAE and iliac artery (IA) endovascular treatment; group III (n=6), CFAE and superficial femoral artery (SFA) endovascular treatment; group IV (n=14), CFAE and IA and SFA endovascular treatment or bypass surgery. RESULTS: The degree of CFA steno-occlusion was not different among the groups. The 3-year primary patency rates of each group were 88.9±10.5%, 60.0±14.5%, 62.5±21.3%, and 83.9±10.4%, respectively. The 3-year primary assisted patency rates were 100%, 70.0±13.0%, 62.5±21.3%, and 89.3±10.4%, while 3-year secondary patency rates were 100%, 80.0±13.0%, 62.5±21.3%, and 92.3±7.4%, respectively. There was no procedure-related mortality. Significant improvement of ankle-brachial index was achieved in all groups. CONCLUSION: CFAE alone is the treatment of choice for excellent patency and clinical improvement in steno-occlusive lesions confined to the CFA. In multiple steno-occlusive diseases, this procedure could be combined with endovascular procedures to reduce the operative risk in conditions with high morbidity.
Ankle Brachial Index ; Endarterectomy ; Endovascular Procedures ; Femoral Artery ; Humans ; Iliac Artery ; Mortality ; Retrospective Studies ; Surgical Procedures, Operative

OBJECTIVE: Lumbar spinal stenosis is increasingly recognized as a common cause of low back pain in elderly patients. Conservative treatment has been initially applied to elderly patients, however, surgical treatment is sometimes indispensable to relieve severe pain. We retrospectively examine the age-related effects on the surgical risk, and results following general anesthesia and operative procedure in geriatric patients for two different age groups of at least 65years old. METHODS: Consecutive 51patients (> or = 65years), who underwent open surgical procedure for degenerative lumbar spinal stenosis, were selected in the study. Patients were divided into two groups. Group A included all patients who were between 65 and 69years of age at the time of surgery. Group B included all patients who were at least 70years of age at the time of surgery. We reviewed medical history including preoperative American Society of Anesthesiologists(ASA) classification of physical status, anesthetic risk factor, operative time, estimated blood loss, transfusion requirements, hospital stay, operated level, and clinical outcome to look for comparisons between two age groups (65~69 and over 70years). RESULTS: In preoperative evaulation, mean anesthetic risk factor of patients was numerically similar between the groups. The American Society of Anesthesiologists classification of physical status was similar between two groups. There was no difference in operated level, operative time, estimated blood loss, hospital stay, and anesthetic risk factor between the two groups. The clinical successful outcome showed 82.7% for Group A and 81.8% for group B. The overall postoperative complication rates were similar for both group A and B. CONCLUSION: We conclude that advanced age per se, did not increase the associated morbidity and mortality in surgical decompression for spinal stenosis.
Aged ; Anesthesia, General ; Classification ; Decompression, Surgical ; Humans ; Length of Stay ; Low Back Pain ; Mortality ; Operative Time ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Spinal Stenosis* ; Surgical Procedures, Operative

BACKGROUND: The location of intimal tear can vary in type A acute aortic dissection. The aim of this study was to assess the operative result according to the intimal tear site. MATERIAL AND METHOD: From January, 1995 to May, 2003, 18 patients underwent surgery for acute type A aortic dissection. The patients were classified according to the intimal tear site. In Group I (n=11), the intimal tear site was located within the ascending aorta, in Group II (n=7), the intimal tear site was located in the aortic arch, descending aorta, or intramural hematoma only. All clinical data were analyzed retrospectively. RESULT: In Group I, the operative time, cardiopulmonary bypass time, aorta cross clamp time and circulatory arrest time were 381.5+/-81.0 min, 223.5+/-42.5 min, 146.4+/-34.8 min and 36.5+/-17.4 min, respectively; and in group II, 461.7+/-54.0 min, 252.5+/-45.3 min, 162.5+/-45.3 min and 47.0+/-14.4 min respectively. All of those were greater in group II. The overall hospital mortality rate was 27.8% (5/18) and was significantly higher in Group II (57.1%)(p=0.003) compared to that in Group I (9.1%). The causes of death were hemorrhage (n=1) in group I and hemorrhage (n=2), multiple organ failure (n=1), and rupture of abdominal aorta (n=1) in group II. CONCLUSION: Surgical treatment of acute type A aortic dissection with intimal tear in the ascending aorta results in an acceptable mortality rate, but in patients with intimal tear in the aortic arch or descending aorta, the operative mortality still remains high when only ascending aorta replacement was performed. In these circumstances, in order to improve surgical results, efforts to include the intimal tear site in the operative procedure will be needed.
Aorta ; Aorta, Abdominal ; Aorta, Thoracic ; Cardiopulmonary Bypass ; Cause of Death ; Hematoma ; Hemorrhage ; Hospital Mortality ; Humans ; Mortality ; Multiple Organ Failure ; Operative Time ; Retrospective Studies ; Rupture ; Surgical Procedures, Operative

Ninety-six cases of intestinal obstruction that were surgically managed at the Department of General Surgery, Pohang St. Mary,s Hospital, during the 5 years from July 1991 to June 1996 were analyzed, and the results are as follows; 1) The most frequent age group was the first decade(32.3%), and the male to female ratio was 2.56:1. The most prevalent age group for strangulated intestinal obstructions was the third decade, and the male to female ratio was 1:2.93. 2) The main causes of intestinal obstruction were postoperative adhesion(41.7%) and incarcerated hernia(18.8%). The main causes of simple intestinal obstruction were postoperative adhesion(37%) and incarcerated hernia(18.5%) and those of strangulated intestinal obstruction were postoperative adhesion (66.6%) and incarcerated hernia(20%). 3) Previous abdominal operations leading to an intestinal obstruction were appendectomies(34.6%) and gastroduodenal operations(28.8%). The most common previous abdominal operation leading to a simple intestinal obstruction was appendectomy(39.0%), but the most common ones for a strangulated intestinal obstruction were a gastroduodenal operation(36.4%) and a gynecologic operation(36.4%). 4) The presence of continuous abdominal pain, rebound tenderness, localized tenderness, fever(>38oC) or the presence of 2 or more of the 6 classic findings(continuous abdominal pain, rebound tenderness, localized tenderness, fever(>38oC), tachycardia(>100/min), and leukocytosis(>10,000/mm3)) were more prevalent in the group with strangulated intestinal obstructions. 5) As for operative procedure, an adhesiolysis was done in 30 cases(31.3%), a resection of the small bowel in 18 cases(18.8%), a hernioplasty in 16 cases(16.7%), and a surgical reduction in 13 cases(13.5%). The most common operative procedure for a simple intestinal obstruction was an adhesiolysis, but that for a strangulated intestinal obstruction was a resection of the small bowel. 6) The incidence of postoperative complications was 14.5%. The incidence of postoperative complications for a simple intestinal obstruction was 9.9%, and that for a strangulated intestinal obstruction was 40%. The overall mortality rate was 2.1%.
Abdominal Pain ; Female ; Gyeongsangbuk-do ; Herniorrhaphy ; Humans ; Incidence ; Intestinal Obstruction* ; Male ; Mortality ; Postoperative Complications ; Surgical Procedures, Operative

BACKGROUND: Many institutes are interested in lung metastatectomy than before because of the improved long term survival, low mortality, and low morbidity after lung metastatectomy. However, prognostic factors affecting long term survival are controversial. We attempt to analyze the prognostic factors affecting retrospectively by comparing the results of lung metastasectomy. MATERIAL AND METHOD: Between Jan. 1990 and Dec. 1997, 74 operations were taken in 63 patients with pulmonary metastases in various primary sites. We analyzed the postoperative long term survival according to sex, cell type, laterality, disease free interval(DFI), operation, the number of metastases, and the size of the largest metastasis. RESULT: There were 27 male and 36 female patients. Sex did not appeared to affect survival time(p=0.849). The primary tumor was carcinoma in 32, sarcoma in 28, and others in 3. Cell type, considering carcinoma and sarcoma, did not relate to survival time(p=0.071). DFI had no influence on the outcome(p=0.902). The type of operative procedure had no influence on the outcome(p=0.556). The laterality of metastases, 47 unilateral(74.6%) and 16 bilateral(25.4%), had no influence on the outcome(p=0.843). The number of metastases excised(one, two or three, four or more) did not appear to affect survival(p=0.263). The size of largest metastasis(<=10mm, 11mm-30mm, and >30mm) did not appear to affect survival(p=0.751). Previous factors were evaluated in both the carcinoma and sarcoma patients respectively. DFI was the only significant prognostic factor in metastatic lung sarcoma(p=0.0026). CONCLUSION: Survival was not related to sex, cell type, laterality, DFI, operative procedure, number of metastases, nor the size of the largest metastasis. DFI was related to the survival time in sarcoma group but further study is needed.
Academies and Institutes ; Female ; Humans ; Lung Neoplasms* ; Lung* ; Male ; Metastasectomy ; Mortality ; Neoplasm Metastasis ; Retrospective Studies ; Sarcoma ; Surgical Procedures, Operative