1.Complete denture rehabilitation of fully edentulous patient with severe bone resorption and class II jaw relation using piezography.
Wooil KWON ; Young Gyun SONG ; Joon Seok LEE
The Journal of Korean Academy of Prosthodontics 2016;54(4):445-450
Piezography, prosthetic space recorded by pronunciation, can be used as a reference for arrangement of artificial teeth and polishing surface of a denture. In this case, a 67 year old female patient was presented for new dentures. Old dentures had class II relationship and poor retention. For fabrication of stable dentures, using piezography and lingualized occlusion was planned. After taking impressions with conventional method, conventional denture bases with wax rim were fabricated. Then, additional mandibular denture base was fabricated for piezography. With fast setting silicon impression material, piezography was recorded by using six pronunciations, 'si', 'so', 'me', 'te', 'de', and 'mu'. According to the piezographic space, mandibular artificial teeth were arranged and modified for lingualized occlusion. As a result, the patient was satisfied with new dentures functionally and esthetically.
Bone Resorption*
;
Denture Bases
;
Denture, Complete*
;
Dentures
;
Female
;
Humans
;
Jaw*
;
Methods
;
Rehabilitation*
;
Silicon
;
Tooth, Artificial
2.Management of Upper Extremity Deep Vein Thrombosis with a Superior Vena Cava Filter - A Case Report -.
Wooil KWON ; Ho Geol RYU ; Hannah LEE ; Yongjae YOO
The Korean Journal of Critical Care Medicine 2013;28(1):59-63
Upper extremity deep vein thrombosis (UEDVT) is relatively uncommon and superior vena cava (SVC) filter placements are not often encountered due to strict indication. A 33-year old male with underlying protein C/S deficiency and secondary liver cirrhosis was admitted because of hematemesis. The patient was conservatively managed, but underwent elective splenectomy to prevent aggravation of gastric varix. During postoperative care, the patient underwent cholecystectomy for acalculous cholecystitis. During the postoperative course, UEDVT was detected and heparinization was initiated. The patient experienced repeated attacks of severe dyspnea, which was accompanied by chest pain that lasted for 3 to 10 minutes. Repeated episodes of pulmonary thromboembolism were suspected and SVC filter was placed. Warfarin treatment was initiated and the SVC filter was removed about one month later. The case highlights the clinical significance of UEDVT and reports rare case of SVC filter placement. Intensivists should have comprehensive understanding of UEDVT and its management.
Acalculous Cholecystitis
;
Chest Pain
;
Cholecystectomy
;
Dyspnea
;
Esophageal and Gastric Varices
;
Hematemesis
;
Heparin
;
Humans
;
Liver Cirrhosis
;
Male
;
Postoperative Care
;
Pulmonary Embolism
;
Splenectomy
;
Upper Extremity
;
Upper Extremity Deep Vein Thrombosis
;
Vena Cava Filters
;
Vena Cava, Superior
;
Warfarin
3.Which method of pancreatic surgery do medical consumers prefer among open, laparoscopic, or robotic surgery? A survey.
Wooil KWON ; Jin Young JANG ; Jae Woo PARK ; In Woong HAN ; Mee Joo KANG ; Sun Whe KIM
Annals of Surgical Treatment and Research 2014;86(1):7-15
PURPOSE: The consumers' preferences are not considered in developing or implementing new medical technologies. Furthermore, little efforts are made to investigate their demands. Therefore, their preferred surgical method and the factors affecting that preference were investigated in pancreatic surgery. METHODS: Six-hundred subjects including 100 medical personnel (MP) and 500 lay persons (LP) were surveyed. Questionnaire included basic information on different methods of distal pancreatectomy; open surgery (OS), laparoscopic surgery (LS), and robotic surgery (RS). Assuming they required the operation, participants were told to indicate their preferred method along with a reason and an acceptable cost for both benign and malignant conditions. RESULTS: For benign disease, the most preferred method was LS. Limiting the choice to LS and RS, LS was preferred for cost and well-established safety and efficacy. OS was favored in malignant disease for the concern for radicality. Limiting the choice to LS and RS, LS was favored for its better-established safety and efficacy. The majority thought that LS and RS were both overpriced. Comparing MP and LP responses, both groups preferred LS in benign and OS in malignant conditions. However, LP more than MP tended to prefer RS under both benign and malignant conditions. LP thought that LS was expensive whereas MP thought the cost reasonable. Both groups felt that RS was too expensive. CONCLUSION: Though efforts for development of novel techniques and broadening indication should be encouraged, still more investments and research should focus on LS and OS to provide optimal management and satisfaction to the patients.
Consumer Satisfaction
;
Humans
;
Investments
;
Laparoscopy
;
Methods
;
Pancreas
;
Pancreatectomy
;
Surveys and Questionnaires
4.Primary Hyperparathyroidism: A 26-year Experience at Seoul National University Hospital.
Wooil KWON ; Myung Cheol JANG ; Dong Young NOH ; Yeo Kyu YOUN ; Seung Keun OH
Korean Journal of Endocrine Surgery 2007;7(3):147-154
PURPOSE: As the incidence of primary hyperparathyroidism is on the increase, a 26-year experience of primary hyperparathyroidism is described along with a review of the literature. METHODS: A total of 113 patients underwent surgery at Seoul National University Hospital from 1981 to 2006. Age, sex, presenting symptoms, biochemical analyses, imagefindings, operative findings, histopathology, and information on follow-ups were retrospectively investigated. Furthermore, patients were divided into two period groups and comparative analysis was performed. RESULTS: Among the 113 patients, 41 patients (36.3%) were male and 72 patients (73.7%) were female. The mean age of the patients was 51 years. Thirty-two patients (28.3%) were incidentally discovered and among the symptomatic patients, the presence of a urinary stone was the most frequent presentation. The average serum calcium level and PTH level were 12.4 mg/dl and 452.36 pg/ml, respectively. The calcium level of all patients was normalized the day after surgery, and the PTH level of all patients was reduced remarkably after surgery. Preoperative imaging studies included ultrasonography, computer tomography (CT), and scans such as a (99m)Tc-sestamibi scan and a ²⁰¹Tl-⁹⁹Tc subtraction scan. The sensitivities of CT, the (99m)Tc-sestamibi scan and ²⁰¹Tl-⁹⁹Tc subtraction scan were 80.2%, 68.8% and 75.4%, respectively. Unilateral neck exploration was performed in 97 cases (85.8%), and bilateral neck exploration was carried out in the remaining 16 cases (14.2%). Histopathology revealed 102 cases (90.3%) of adenoma, 3 cases (2.7%) of hyperplasia, 7 cases (6.2%) of carcinoma, and one case that was indeterminate between adenoma and hyperplasia. Fifty-six patients (49.6%) developed transient hypocalcemia, and onepatient required a second surgery due to postoperative bleeding. There was one case of a recurrent carcinoma during a mean follow-up period of 18.7 months. CONCLUSION: Primary hyperparathyroidism is on the increase and is a surgically curative disease. Understanding the nature of the disease is necessary for detection and management.
Adenoma
;
Calcium
;
Female
;
Follow-Up Studies
;
Hemorrhage
;
Humans
;
Hyperparathyroidism, Primary*
;
Hyperplasia
;
Hypocalcemia
;
Incidence
;
Male
;
Neck
;
Parathyroidectomy
;
Retrospective Studies
;
Seoul*
;
Ultrasonography
;
Urinary Calculi
5.Management of bronchopleural fistula using a modified single lumen tube.
Seung Yeon SHIN ; Hannah LEE ; Wooil KWON ; Ho Geol RYU
Korean Journal of Anesthesiology 2013;65(6 Suppl):S127-S129
No abstract available.
Fistula*
6.Management of bronchopleural fistula using a modified single lumen tube.
Seung Yeon SHIN ; Hannah LEE ; Wooil KWON ; Ho Geol RYU
Korean Journal of Anesthesiology 2013;65(6 Suppl):S127-S129
No abstract available.
Fistula*
7.Clinicopathologic Features of Polypoid Lesions of the Gallbladder and Risk Factors of Gallbladder Cancer.
Wooil KWON ; Jin Young JANG ; Seung Eun LEE ; Dae Wook HWANG ; Sun Whe KIM
Journal of Korean Medical Science 2009;24(3):481-487
It is difficult to differentiate benign and malignancy in polypoid lesions of the gallbladder (PLG) by solely depending on imaging studies. Therefore clinicopathologic features of benign and malignant polyps are compared in an attempt to identify the risk factors of malignant polypoid lesions. The medical records of 291 patients who were confirmed to have PLG through cholecystectomy were reviewed and analyzed for age, sex, symptom, associated gallstone, morphology of PLG, size of PLG, number of PLG, and preoperative tumor markers. Benign PLG was found in 256 patients (88.0%) and malignant PLG in 35 patients (12.0%). Compared with benign group, the malignant group were older (61.1 yr vs. 47.1 yr, P<0.001), more often accompanied with symptoms (62.9% vs. 28.9%, P<0.001). Malignant PLG tended to be sessile (60.0% vs. 10.5%, P<0.001), larger (28.0 mm vs. 8.6 mm, P<0.001) and single lesion (65.7% vs. 44.1%, P<0.016). Age over 60 yr (P=0.021, odds ratio [OR], 8.16), sessile morphology (P<0.001, OR, 7.70), and size over 10 mm (P=0.009, OR, 8.87) were identified as risk factors for malignant PLG. Careful decision making on therapeutic plans should be made with consideration of malignancy for patients over 60 yr, with sessile morphology of PLG, and with PLG size of over 10 mm.
Adult
;
Age Factors
;
Aged
;
Aged, 80 and over
;
Female
;
Gallbladder Neoplasms/*diagnosis/pathology
;
Humans
;
Male
;
Middle Aged
;
Polyps/*pathology
;
ROC Curve
;
Risk Factors
8.Clinicopathologic Features of Polypoid Lesions of the Gallbladder and Risk Factors of Gallbladder Cancer.
Wooil KWON ; Jin Young JANG ; Seung Eun LEE ; Dae Wook HWANG ; Sun Whe KIM
Journal of Korean Medical Science 2009;24(3):481-487
It is difficult to differentiate benign and malignancy in polypoid lesions of the gallbladder (PLG) by solely depending on imaging studies. Therefore clinicopathologic features of benign and malignant polyps are compared in an attempt to identify the risk factors of malignant polypoid lesions. The medical records of 291 patients who were confirmed to have PLG through cholecystectomy were reviewed and analyzed for age, sex, symptom, associated gallstone, morphology of PLG, size of PLG, number of PLG, and preoperative tumor markers. Benign PLG was found in 256 patients (88.0%) and malignant PLG in 35 patients (12.0%). Compared with benign group, the malignant group were older (61.1 yr vs. 47.1 yr, P<0.001), more often accompanied with symptoms (62.9% vs. 28.9%, P<0.001). Malignant PLG tended to be sessile (60.0% vs. 10.5%, P<0.001), larger (28.0 mm vs. 8.6 mm, P<0.001) and single lesion (65.7% vs. 44.1%, P<0.016). Age over 60 yr (P=0.021, odds ratio [OR], 8.16), sessile morphology (P<0.001, OR, 7.70), and size over 10 mm (P=0.009, OR, 8.87) were identified as risk factors for malignant PLG. Careful decision making on therapeutic plans should be made with consideration of malignancy for patients over 60 yr, with sessile morphology of PLG, and with PLG size of over 10 mm.
Adult
;
Age Factors
;
Aged
;
Aged, 80 and over
;
Female
;
Gallbladder Neoplasms/*diagnosis/pathology
;
Humans
;
Male
;
Middle Aged
;
Polyps/*pathology
;
ROC Curve
;
Risk Factors
9.Comparison of the Clinicopathologic Characteristics of Intraductal Papillary Neoplasm of the Bile Duct according to Morphological and Anatomical Classifications.
Jae Ri KIM ; Kyoung Bun LEE ; Wooil KWON ; Eunjung KIM ; Sun Whe KIM ; Jin Young JANG
Journal of Korean Medical Science 2018;33(42):e266-
BACKGROUND: Intraductal papillary neoplasm of the bile duct (IPNB) is a recently defined entity and its clinical characteristics and classifications have yet to be established. We aimed to clarify the clinical features of IPNB and determine the optimal morphological classification criteria. METHODS: From 2003 to 2016, 112 patients with IPNB who underwent surgery were included in the analysis. After pathologic reexamination by a specialized biliary-pancreas pathologist, previously suggested morphological and anatomical classifications were compared using the clinicopathologic characteristics of IPNB. RESULTS: In terms of histologic subtypes, most patients had the intestinal type (n = 53; 48.6%) or pancreatobiliary type (n = 33; 30.3%). The simple “modified anatomical classification” showed that extrahepatic IPNB comprised more of the intestinal type and tended to be removed by bile duct resection or pancreatoduodenectomy. Intrahepatic IPNB had an equally high proportion of intestinal and pancreatobiliary types and tended to be removed by hepatobiliary resection. Morphologic classifications and histologic subtypes had no effect on survival, whereas a positive resection margin (75.9% vs. 25.7%; P = 0.004) and lymph node metastasis (75.3% vs. 30.0%; P = 0.091) were associated with a poor five-year overall survival rate. In the multivariate analysis, a positive resection margin and perineural invasion were important risk factors for survival. CONCLUSION: IPNB showed better long-term outcomes after optimal surgical resection. The “modified anatomical classification” is simple and intuitive and can help to select a treatment strategy and establish the proper scope of the operation.
Bile Duct Neoplasms
;
Bile Ducts*
;
Bile Ducts, Extrahepatic
;
Bile Ducts, Intrahepatic
;
Bile*
;
Cholangiocarcinoma
;
Classification*
;
Humans
;
Lymph Nodes
;
Multivariate Analysis
;
Neoplasm Metastasis
;
Pancreaticoduodenectomy
;
Risk Factors
;
Survival Rate
10.Comparison of clinical outcomes according to the history of previous gastrectomy in patients undergoing pancreatoduodenectomy: a propensity score matching analysis
Jae Ri KIM ; Wooil KWON ; Jihoon CHANG ; Jin-Young JANG ; Sun-Whe KIM
Annals of Surgical Treatment and Research 2020;98(4):177-183
Purpose:
Although pancreatoduodenectomy (PD) in patients who have previously undergone gastrectomy is challenging, little is known about the clinical outcomes and the differences compared to those with conventional PD. We collected cases and conducted studies in retrospective review.
Methods:
Of the 1,722 patients who underwent PD at Seoul National University Hospital between 2000 and 2014, 49 (2.8%) underwent previous gastrectomy. Clinical outcomes including operation-related factors and postoperative morbidities were analyzed.
Results:
Among the 49 patients with curative surgery, 25 patients were male (51.0%) and the mean age was 64.7 years. Gastric cancer was the most frequent cause of previous gastrectomy (93.8%). With one-to-one propensity score matching analysis, lower preoperative body mass index (22.6 kg/m2 vs. 20.8 kg/m2, P = 0.002), higher EBL (390.0 mL vs. 729.5 mL, P = 0.027), and higher transfusion rates (10.2% vs. 36.7%, P = 0.002) were shown in the gastrectomy group. Operation time, postoperative hospital stay, and rate of clinically relevant pancreatic fistula were comparable.
Conclusion
Secondary PD after prior gastrectomy remains challenging, with higher EBL and rate of transfusion. However, when performed by experienced surgeons, the patients with or without previous gastrectomy show comparable postoperative clinical outcomes, such as similar duration of postoperative hospital stay and rate of postoperative pancreatic fistula.