PURPOSE: To investigate the effects of Nasopore(R) as a nasal packing material on the surgical success rate and prevalence of postoperative complications after endonasal dacryocystorhinostomy (DCR). METHODS: The present study included a total of 558 patients (699 eyes) with primary acquired nasolacrimal duct obstruction who underwent endonasal DCR; 227 eyes were packed with Nasopore(R) and 472 eyes were packed with Merocel(R). The surgical success rate and postoperative complications such as synechiae, granulation, wound healing (osteal mucosal epithelium epithelialization), postoperative bleeding, infection, and revision rate were compared between the packing materials. RESULTS: The surgical success rate of the Nasopore(R) group (99.1%, 98.6%) showed significantly better results than the Merocel(R) group (97.2%, 95.1%) at postoperative 1 and 3 months (p = 0.04, 0.03 Pearson chi-square test), whereas there was no statistically significant difference between the 2 groups in postoperative surgical success rate at 1 week and 6 months. In comparison of postoperative complications, the Nasopore(R) group (0%) showed a lower incidence of delayed wound healing (delayed epithelialization of osteal mucosal epithelium) than the Merocel(R) group (2.3%; p = 0.013), whereas there was no difference in granulation, synechiae, postoperative bleeding, infection and revision rate (p > 0.05). CONCLUSIONS: The Nasopore(R) group showed a lower proportion of delayed wound healing and improvement of the surgical success rate at an early postoperative period after endonasal DCR compared to non-absorbable nasal packing material.
Dacryocystorhinostomy ; Epithelium ; Eye ; Hemorrhage ; Humans ; Incidence ; Nasolacrimal Duct ; Postoperative Complications ; Postoperative Period ; Prevalence ; Wound Healing

BACKGROUND: Pneumonectomy remains the ultimate curative treatment modality for destroyed lung caused by tuberculosis despite multiple risks involved in the procedure. We retrospectively evaluated patients who underwent pneumonectomy for treatment of sequelae of pulmonary tuberculosis to determine the risk factors of early and long-term outcomes. MATERIALS AND METHODS: Between January 1980 and December 2008, pneumonectomy or pleuropneumonectomy was performed in 73 consecutive patients with destroyed lung caused by tuberculosis. There were 48 patients with empyema (12 with bronchopleural fistula [BPF]), 11 with aspergilloma and 7 with multidrug resistant tuberculosis. RESULTS: There were 5 operative mortalities (6.8%). One patient had intraoperative uncontrolled arrhythmia, one had a postoperative cardiac arrest, and three had postoperative respiratory failure. A total of 29 patients (39.7%) suffered from postoperative complications. Twelve patients (16.7%) were found to have postpneumonectomy empyema (PPE), 4 patients had wound infections (5.6%), and 7 patients required re-exploration due to postoperative bleeding (9.7%). The prevalence of PPE increased in patients with preoperative empyema (p=0.019). There were five patients with postoperative BPF, four of which occurred in right-side operation. The only risk factor for BPF was the right-side operation (p=0.023). The 5- and 10-year survival rates were 88.9% and 76.2%, respectively. The risk factors for late deaths were old age (> or =50 years, p=0.02) and low predicted postoperative forced expiratory volume in one second (FEV1) (<1.2 L, p=0.02). CONCLUSION: Although PPE increases in patients with preoperative empyema and postoperative BPF increases in right-side operation, the mortality rates and long-term survival rates were found to be satisfactory. However, the follow-up care for patients with low predicted postoperative FEV1 should continue for prevention and early detection of pulmonary complication related to impaired pulmonary function.
Arrhythmias, Cardiac ; Empyema ; Fistula ; Follow-Up Studies ; Forced Expiratory Volume ; Heart Arrest ; Hemorrhage ; Humans ; Lung ; Pneumonectomy ; Postoperative Complications ; Prevalence ; Respiratory Insufficiency ; Retrospective Studies ; Risk Factors ; Survival Rate ; Tuberculosis ; Tuberculosis, Pulmonary ; Wound Infection

OBJECTIVE: To determine the prevalence of post-tonsillectomy bleeding in our institution and to describe the clinical characteristics, tonsillectomy techniques and post-tonsillectomy bleeding intervention in these patients.

METHODS:
Design: Observational descriptive study
Setting: Tertiary private hospital
Population: All patients who were treated for post-tonsillectomy bleeding were retrospectively reviewed from medical records of all patients who had undergone tonsillectomy between January 1, 2007 and June 30, 2009. Age and sex, indication for surgery, tonsil grade, Body Mass Index (BMI), surgical technique, post-operative medications, length of hospital stay, interval between tonsillectomy and onset of bleeding and interventions to address post-operative bleeding were noted.

RESULTS: Of the 662 patients who underwent tonsillectomy, 37 (5.6%) were managed for post-operative hemorrhage. Most had grade 2 or 3 tonsils (18 or 48.6% and 16 or 43.2% respectively) and were obese (25 or 67.5%). The highest proportion of post-operative bleeding was 9.2% for bipolar cauterization technique (18 of 196 patients) followed by 7.4% with cold knife, monopolar cauterization and suturing (11 of 148 patients); 6.9% with harmonic scalpel (2 of 29 patients); 6.5% with monopolar and bipolar cauterization (3 of 46 patients), and 2.8% for cold knife or Fischer knife (3 of 109 patients). Seven patients (18.9%) required blood transfusion. Onset of bleeding occurred between 4-12 days following surgery (mean: 8 days). Possible causes of bleeding included heavy physical activity and cough but most had no identifiable cause. Majority of the patients (29 out of 37) required surgical exploration under general anesthesia.

CONCLUSION: Post-tonsillectomy bleeding is still a clinically significant complication despite advances in surgical techniques. Surgeons must always consider trade-offs between benefits and risks of the procedure and be continually vigilant of this potentially serious complication.

Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Child ; Child Preschool ; Tonsillectomy ; General Surgery ; Postoperative Hemorrhage-prevalence, Postoperative Complications ; Postoperative Care ; Wound Closure Techniques ; Medical Records ; Anesthesia

OBJECTIVE: To investigate the association between obesity and peri- or postoperative outcome after abdominal or vaginal hysterectomies for benign gynecologic disorder. METHODS: We retrospectively reviewed the charts of all women who underwent abdominal or vaginal hysterectomy for benign gynecologic disorders in Kangnam Sacred Heart Hospital between Jan and Dec, 2006. We analyzed the rate of operative and postoperative complications, length of hospital stay, operative time, and perioperative hemoglobin change for abdominal or vaginal hysterectomy. RESULTS: The study group consisted of 915 women, of who 643 underwent vaginal, and 272 abdominal hysterectomy. Obesity was related to longer operation time for vaginal hysterectomy only. No association was found between BMI and serious complications such as postoperative bleeding, transfusion, urinary tract injury, febrile morbidity, bowel injury, wound complication, ileus, infection. CONCLUSION: Obesity is not a contraindication of vaginal or abdominal hysterectomy. Obese patients did not experience an increased risk of serious morbidity compared to normal weight women. Hysterectomy can be successfully performed, with acceptable morbidity, in obese women.
Body Mass Index* ; Female ; Heart ; Hemorrhage ; Humans ; Hysterectomy* ; Hysterectomy, Vaginal ; Ileus ; Length of Stay ; Obesity ; Operative Time ; Postoperative Complications ; Prevalence* ; Prognosis* ; Retrospective Studies ; Urinary Tract ; Wounds and Injuries

PURPOSE: Hepatocellular carcinoma is a highly malignant disorder that carries a poor prognosis. It is a fatal disease with a high incidence, especially in areas with an already high prevalence of hepatitis types B & C. The primary sites for extrahepatic metastases include the lung and adrenal glands, while bone, especially the skull, is rarely affected. This paper notes a rare case of extrahepatic metastasis to the skull. METHODS: A 62-year-old male, with a previous history of hepatitis B, developed hepatocellular carcinoma. The patient received several treatments of TACE(Transarterial chemoembolization) and PEI(Percutaneous ethanol injection) with no resolution, which prompted a hepatology follow-up. Recently, patient requested to have an enlarging mass on the forehead removed, for which an incisional biopsy was perfomed since the mass involved bone. Pathologic findings confirmed metastatic HCC. RESULTS: The only complication encountered during the incisional biopsy was profuse bleeding from the incision site. There was some difficulty in controlling the bleeding, but hemostasis was achieved using Gelfoam. There were no postoperative complications. The patient was treated with radiotherapy and follow-up CONCLUSION: Patients with cranial metastasis of HCC presents with a subcutaneous mass and a headache while simple X-rays show osteolytic lesions, computed tomography studies are needed for a definitive diagnosis. Treatement options include radiotherapy, surgery and chemotherapy. In this case the patient received radiotherapy. Skull metastases should be considered in the differential diagnosis of patients who present with a subcutaneous mass and an osteolytic defect on X-ray films of the skull.
Adrenal Glands ; Biopsy ; Carcinoma, Hepatocellular ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Ethanol ; Follow-Up Studies ; Forehead ; Gastroenterology ; Gelatin Sponge, Absorbable ; Headache ; Hemorrhage ; Hemostasis ; Hepatitis ; Hepatitis B ; Humans ; Incidence ; Lung ; Male ; Middle Aged ; Neoplasm Metastasis ; Postoperative Complications ; Prevalence ; Prognosis ; Radiotherapy ; Skull* ; X-Ray Film

OBJECTIVE: To compare the advantages and disadvantages between total vaginal hysterectomy (VTH) and laparoscopically assisted vaginal hysterectomy (LAVH) including the indications and safety. METHODS: We reviewed the medical records of patients who underwent VTH from July 1998 to December 1999 and those who underwent LAVH from January 2000 to April 2002. We evaluated age, parity, previous abdominal operations, indications for hysterectomy, combined operations, operation time, bleeding amount, hemoglobin change, weight of uterus, and postoperative complications. RESULTS: 1. Age was not a notable factor but parity was significantly lower in LAVH group. 2. In VTH group, 48% of patients had previous operations compared with 46% in LAVH group. 3. The most common indication for hysterectomy of both group was uterine myoma. 4. The weight of hysterectomized specimen was 256 g in VTH group and 237 g in LAVH group. 5. In VTH group, 38% received concurrent surgical procedures of which colporrhaphy was the most common (14 cases). In LAVH group, 72.5% received concurrent surgical procedures of which salpingoo- phorectomy was most common. 6. The operation time showed a notable difference; 78.6 min. in VTH group and 105.4 min. in LAVH. 7. There was no significant difference in bleeding amount and hemoglobin change. 8. Postoperative complication was higher in VTH group (14%) than LAVH group (7.5%). However all the patients recovered with conservative treatment and close observation. CONCLUSION: Both VTH and LAVH had the following advantages compared with abdominal hysterectomy: less pain, shorter hospital stay, cosmetic advantages, lower prevalence. In this study we found out that in VTH, the procedure could be done safely even if the uterus was big or with previous abdominal operations. Limited operation field and the fact that we couldn't check the abdominal cavity were some disadvantages. In comparison, LAVH offered a view of the abdominal cavity which make easy adnexal operation but because of expensive operative tools, cost was a problem. In order to satisfy the patient and lower the cost, appropriate study on the indications and training on procedures will be necessary.
Abdominal Cavity ; Bleeding Time ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Leiomyoma ; Length of Stay ; Medical Records ; Parity ; Postoperative Complications ; Prevalence ; Uterine Prolapse* ; Uterus

OBJECTIVE: To study the prevalence, indications, and outcome of cesarean hysterectomy in women delivered at the Gil Medical Center, Gacheon Medical School. METHOD: This is a retrospective study of all cases of cesarean hysterectomy performed between January 1995 and December 1999. RESULTS: The incidence of cesarean hysterectomy was 0.4% (122/31,481). Cesarean hysterectomy was performed in 100 of 17,829 cesarean sections (0.6%) and in 22 of 13,652 vaginal deliveries(0.2%). The higher the age and the parity of patients, the higher the incidence of cesarean hysterectomy was noted. The most common indication of cesarean hysterectomy was uterine atony(50 cases, 41.9%), followed by 25 cases of placenta previa with adhesive placenta(20.5%), 14 cases of adhesive placenta(11.5%), 11 cases of uterine myoma with pregnancy(9.0%), 9 cases of uncontrolled bleeding with placenta previa(7.4%), 7 cases of uterine rupture(5.7%) and 6 cases of extension of uterine incision(4.9%). All patients who had cesarean hysterectomy received transfusion from 0 pint to 78 pints. Live births were 115 cases(94.3%) and 3 infants were still birth(2.5%). Four infants were dead during early neonatal period(3.3%), so perinatal mortality rate was 5.7%. The postoperative complications were bladder injury, ureteral injury, febrile morbidity, disseminated intravascular coagulopathy, hematoma, wound disruption, postpartum cardiomyopathy, and vaginal stump bleeding. There was two maternal deaths due to acute, severe hemorrhage and DIC. CONCLUSIONS: Cesarean hysterectomy remains a necessary procedure for life saving during abdominal and vaginal deliveries. The procedure itself is usually associated with considerable perioperative morbidity. Obstetricians should identify patients at risk and anticipate the procedure and complications.
Adhesives ; Cardiomyopathies ; Cesarean Section ; Dacarbazine ; Female ; Hematoma ; Hemorrhage ; Humans ; Hysterectomy* ; Incidence ; Infant ; Leiomyoma ; Live Birth ; Maternal Death ; Parity ; Perinatal Mortality ; Placenta ; Placenta Previa ; Postoperative Complications ; Postpartum Period ; Pregnancy ; Prevalence ; Retrospective Studies ; Schools, Medical ; Ureter ; Urinary Bladder ; Uterine Inertia ; Wounds and Injuries

Meckel's diverticulum is an embryologic derivative of the omphalomesenteric duct and the most commonly encountered congenital anomaly of the gastrointestinal tract, affecting 1% to 2% of the general population. Although this prevalence is relatively low, Meckel's diverticulum is occasionally encountered as an incidental identification during abdominal exploration and can be associated with several life-threatening disease states, such as massive intestinal bleeding, intestinal obstruction, or on rare occasion, perforation. The management of a Meckel's diverticulum found incidentally on laparotomy is controversial because the rate of complications developing from the diverticulum remains uncertain. The data in this report are based on 18 cases of Meckel's diverticulum which were treated at the Department of Surgery, InJe University Sanggye Paik Hospital, during the 7 years between January 1990 and December 1996. The results are as follows: 1) The overall sex ratio of males to females was 5 : 1 and in the symptomatic group, the ratio was 6 : 1. 2) Ninety percent of the patients were under 40 years of age, and 56% were under 10. 3) The diverticula were located from 20 cm to 100 cm proximal to the ileocecal valve, and the average range was 53 cm from the ileocecal valve. Fifteen cases were located at the antimesenteric border, and 3 cases at the mesenteric border of the ileum. 4) The lengths of the diverticula ranged from 1cm to 6cm, and the diameters ranged from 0.5 cm to 4.5 cm. 5) Appendicitis and intestinal obstruction were the most frequent preoperative diagnoses in the symptomatic group. 6) The common complications were intestinal obstruction and inflammation. 7) Heterotopic tissues were found in three patients and all of them were ectopic gastric mucosa. 8) The treatment was a diverticulectomy or a segmental resection of the involved bowel. 9) Postoperative complications were found in three of the asymptomatic group: two early intestinal obstructions and one wound infection.
Appendicitis ; Choristoma ; Diagnosis ; Diverticulum ; Female ; Gastric Mucosa ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Ileocecal Valve ; Ileum ; Inflammation ; Intestinal Obstruction ; Laparotomy ; Male ; Meckel Diverticulum* ; Postoperative Complications ; Prevalence ; Sex Ratio ; Vitelline Duct ; Wound Infection

After the introduction of the surgical microscope, microsurgical direct intracranial approach became a standard technique for the treatment of ruptured intracranial aneurysms with satisfactory results. Nevertheless, aneurysms of the anterior communicating artery present particular difficulties, because of their critical location, prevalence of local vascular anomalies, serious circulatory disturbances of the perforating vessels after the rupture of the aneurysm or vasospasm, and their marked tendency to fatal recurrent hemorrhage. The authors analyzed 102 cases of anterior communicating artery aneurysms surgically treated in the Department of Neurosurgery, Yonsei University Hospital from 1971 throught August 1981. Of the 102 cases, 84 operations were performed by microsurgical pterional approach. The analysis and evaluation was made with particular emphasis on the microsurgical treatment. The results of analysis were summarized as follows. 1) The anterior communicating artery aneurysms ruptured most frequently in the 5th decade(37.2%), and 81.7% of the patients were in their 30s to 50s. Anterior communicating artery aneurysms were more common in men than women(60:42). 2) Presenting symptoms and signs of rupture of the anterior communicating artery aneurysms were headache(98.6%), stiff neck(95.1%), brief lapse of consciousness(83.4%), vomiting(81.8%), hypertension(41.6%), and impaired conscious level(34.3%). 3) The prechiasmatic projection of the anterior communicating artery was slightly mjore frequent than the interhemispheric projection(43:39) in our series. The aneurysms were fed by the left anterior cerebral artery in 55.9% and by the right in 33.3%. Angiographic vasospasm was noted in 45.1% and the incidence of the multiple aneurysm was 8.8%. 4) The brain CT scan showed subarachnoid hemorrhage in 47.3%, hydrocephalus in 43.7%, and cerebral infarction in 27.3%. The aneurysms appeared as enhancing small lesions when the diameter of the aneurysm was larger was larger than 10mm. The actual size of the giant aneurysm was measured more precisely with the CT scan than by the angiogram. 5) Patients in Botterell's Grade I and II occupied 70.2% of the microsurgically treated cases. Majority of cases(82.1%) were operated in the second to fourth weeks after the last bleeding. 6) All of the 84 microsurgically treated cases were operated by pterional approach, and the gyrus rectus resection was frequently performed. Clipping of the aneurismal neck was possible in 82.1% of the series. 7) Fourteen cases of postoperative vasospasm, 4 cases of intracranial hematoma, and 7 cases of serious electrolyte imbalance were found as the major postoperative complications. Four patients died of these major complications. 8) Operative mortality of the microsurgical pterional approach was 4.8% and the morbidity 5.9%. Mortality rate of 9 premature rupture cases was 11.1%. Among the 18 cases which were operated on without the aid of microscope before 1975, the mortality rate was 16.7%, and the morbidity, 44.4%.
Aneurysm ; Anterior Cerebral Artery ; Arteries ; Brain ; Cerebral Infarction ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Incidence ; Intracranial Aneurysm* ; Male ; Mortality ; Neck ; Neurosurgery ; Postoperative Complications ; Prevalence ; Rupture ; Subarachnoid Hemorrhage ; Tomography, X-Ray Computed