No abstract available.
Aphasia* ; Humans ; Stroke*

We experienced a case of 1 patient who died from rhabdomyolysis-related complications after colonoscopy. A 60-year-old man had undergone an ‘uncomplicated’ colonoscopic polypectomy. Approximately 10 hours following this procedure, the patient complained of increasing left abdominal pain. His computed tomography image showed free gas, but his operative findings revealed no macroscopic perforation or abscess formation. Eight hours after the operation, the patient presented with myoglobulinuria, and we diagnosed the condition to be rhabdomyolysis. Based on this case, we recommend that rhabdomyolysis be added to the list of complications following a colonoscopic procedure. Moreover, for prevention and early treatment, endoscopists should be attentive to the risk factors and signs/symptoms of rhabdomyolysis.
Abdominal Pain ; Abscess ; Colonoscopy ; Humans ; Middle Aged ; Rhabdomyolysis ; Risk Factors

No abstract available.
Carney Complex* ; Humans ; Neurilemmoma*

PURPOSE: It is difficult to objectively evaluate the outcomes of plastic surgical procedures. The combination of aesthetic and medical factors makes outcome quantification difficult. In this study, fracture reduction accuracy was objectively evaluated in patients with zygomatic complex fractures. Patients satisfaction with the accuracy was also examined. In addition, the patients' overall satisfaction and discomfort due to complications were analyzed. METHODS: Eighty-five patients who had surgeries via bicoronal incision for zygomatic complex fracture from March 2006 to December 2009 were included in this study. Two plastic surgeons evaluated the accuracy of the fracture reduction with postoperative computed tomography. A survey questionnaire was administered to evaluate the patients' overall satisfaction and the impact of symptoms associated with the procedure on the patients' daily lives. RESULTS: The overall patient satisfaction rate was 82.1 +/- 10.9% (range, 45~100%). The level of deformation was 6.7 +/- 10.9%, the levels of discomfort in daily life due to pain, paresthesia, scar, and facial palsy were 8.5 +/- 13.2%, 5.8 +/- 8.9%, 4.4 +/- 9.9%, and 1.9 +/- 9.2%, respectively. According to the visual analogue scale, paresthesia was found to be the most frequent symptom (43.5%), and pain was the most troublesome symptom. CONCLUSION: The use of bicoronal incision for treating zygomatic complex fractures can cause various complications due to wide incision and dissection. However, this technique can provide optimized reduction and rigid fixation. Most of these postoperative complications can cause significant discomfort in the patient. It is thought that the use of correct surgical technique and the accurate knowledge of craniofacial anatomy will result in a reduction of complications and significantly increase patient satisfaction.
Cicatrix ; Facial Paralysis ; Humans ; Paresthesia ; Patient Satisfaction ; Postoperative Complications ; Questionnaires

In perforator flap reconstruction, vascular mapping using preoperative computed tomography (CT) angiography is widely used to confirm the existence and location of an appropriate perforator. This study proposes a rapid, accurate, and convenient method for marking the perforator location on the skin surface. For 12 patients who underwent perforator flap reconstruction between November 2011 and November 2013, metal clips were fixed on the skin surface at the anticipated perforator locations, which were decided using a handheld Doppler. CT angiography was used to compare the location between the metal clip and the actual perforator. The metal clip was moved and repositioned, if needed, on the basis of the CT images. The locations of the appropriate perforator and the metal clip, which were observed during the surgery, were then compared. In CT angiography, the mean distance between the metal clip and the perforator was 3+/-3.9 mm, and the mean distance that was measured during surgery was 0.8+/-0.8 mm. In conclusion, we report a simple, rapid, and precise technique to indicate the accurate location of the appropriate perforator on the skin surface.
Angiography* ; Humans ; Multidetector Computed Tomography ; Perforator Flap* ; Skin ; Ultrasonography, Doppler

BACKGROUND: Packing after closed reduction of a nasal bone fracture causes inconvenient nasal obstruction in patients. We packed the superior meatus with Vaseline gauze to support the nasal bone, and packed the middle nasal meatus with a Doyle Combo Splint consisting of an airway tube, a silastic sheet, and an expandable sponge to reduce the inconvenience. In addition, we aimed to objectively identify whether this method not only enables nasal respiration but also sufficiently supports the reduced nasal bone. METHODS: Nasal ventilation was measured via spirometry 1 day before surgery and compared to 1 day after surgery. To compare support of the reduced nasal bone by the 2 methods, 2 plastic surgeons assessed the displacementon X-rays taken after the surgery and after removing the packing. The extent of nasal obstruction, dry mouth, sleep disturbance, headache, and swallowing difficulty were compared with visual analog scales (VAS) on a pre-discharge survey. RESULTS: In the experimental group, the nasal respiration volume 1 day after surgery remained at 71.3%+/-6.84% on average compared to 1 day prior to surgery. Support of the reduced bone in the experimental group (2.80+/-0.4) was not significantly different from the control group (2.88+/-0.33). The VAS scores for all survey items were lower in the experimental group than in the control group, where a lower score indicated a lower level of inconvenience. CONCLUSIONS: The nasal cavity packing described here maintained objective measures of nasal respiration and supported the reduced bone similar to conventional methods. Maintaining nasal respiration reduced the inconvenience to patients, which demonstrates that this packing method is useful.
Airway Management ; Deglutition ; Dimethylpolysiloxanes ; Headache ; Humans ; Mouth ; Nasal Bone ; Nasal Cavity ; Nasal Obstruction ; Nasal Surgical Procedures ; Petrolatum ; Porifera ; Respiration ; Silicones ; Spirometry ; Splints ; Ventilation ; Weights and Measures

BACKGROUND/AIMS: We studied the patterns of recurrence after resection of relatively small hepatocellular carcinoma, defined as less than 5 cm in diameter, with tumor-free margin, and risk factor for recurrence were re-evaluated for these group. METHODS: The subjects were 25 patients who had undergone tumor removal with tumor-free margin for hepatocellular carcinoma at our department from 1995 to 1998. Tumor-free survival rates of patients with various risk factors were calculated and differences between groups were evaluated. RESULTS: The tumors recurred in 17 patients (68.0%), with 11 patients (64.7% of recurrences) recurring within 1 year of surgery. Recurrent disease was nearly intrahepatic. Univariate retrospective analysis in this study showed the absence of tumor capsule to be significant risk factor. But there is no significant difference in survival rate between capsule (+) groups and capsule (-) groups. CONCLUSION: It was concluded that small hepatocellular carcinoma has no significant difference in clinicopathologic variables except tumor capsule.
Carcinoma, Hepatocellular* ; Humans ; Recurrence* ; Retrospective Studies ; Risk Factors ; Survival Rate

PURPOSE: The follicular variant of papillary thyroid carcinoma (FVPTC) is difficult to diagnose due to pathologic features. There is also debate on the optimal extent of surgery. We separated FVPTC into two groups and compared the clinical features in an attempt to apply the treatment. METHODS: All 40 patients with FVPTC who were diagnosed between 1990 and 2009 were reviewed and separated into two groups, an encapsulated group and an infiltrative group, based on whether a capsule was formed or infiltration occurred. These two different subtypes of FVPTC were compared on the traits of sensitivity of diagnosis and clinicopathologic features. RESULTS: After review by a pathologist, 21 of 40 patients (55%) were found to have encapsulated tumors, and 18 patients (45%) had infiltrative tumors. There was no difference in age, sex, or size. Patients with encapsulated FVPTC had a significantly lower rate of lymph node metastasis (4.5%), multicentric tumors (18.2%), and thyroid capsular invasion (9.1%) compared with the infiltrative tumor group (50%, 50% and 50%, P<0.05). There was no difference in FNA sensitivity between the two groups, but the sensitivity to frozen biopsy was higher in the infiltrative group. There was no recurrence in the encapsulated group, but 4 patients (22.2%) experienced recurrence in the infiltrative group. CONCLUSION: FVPTC can be separated into two subgroups by histologic features, and there are some clinicopathologic differences between the two groups. Patients who had encapsulated FVPTC had a lower rate of lymph node metastasis, multicentric tumors, and thyroid capsular invasion. They also showed a lower rate of recurrence than the infiltrative group. It is suggested that the encapsulated group can be treated with limited surgery and the infiltrative group needs aggressive treatment.
Biopsy ; Diagnosis ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Recurrence ; Thyroid Gland* ; Thyroid Neoplasms*

OBJECTIVES: Monitoring viability of flap is important. The flap survival depends on the vascularity of the flap, on which the skin temperature depends. The authors applied digital infrared thermographic imaging (DITI) for monitoring the vascular supply of the flap and for the prediction of the prognosis of the flap survival. METHODS: Eight male New Zealand white rabbits with average weight of 3kg were used. A 10 x 10 cm unipedicled fasciocutaneous island flap was elevated based on the left superficial inferior epigastric vessel. The surface temperatures on designed flap were checked with DITI for 24 hours after the operation. On 14th day after the operation, the surviving area was measured and compared with DITI image which was taken on 24 hours after the operation using digital analysis software ImageJ. Statistical analysis was evaluated by paired T-test. RESULTS: On DITI image 24 hours after the flap elevation, distal portion of the flap showed remarkable color change. The average percentage and the standard deviation of the survival area of the flap which is predicted by DITI and the average percentage and the standard deviation of the survival area of the flap which was actually measured 2 weeks after flap elevation were 55.3 (16.6), 56.2 (18.0), respectively. This shows no significant difference between the two. CONCLUSIONS: This study shows that DITI system could be used in evaluation of flap vascularity with ease, quickness and safety for patient and flap. Thus, it could be used clinically for the prediction of flap survival.
Humans ; Male ; Prognosis ; Rabbits ; Skin Temperature* ; Skin*