Objective: Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. Methods: Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. Results: Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. Conclusion This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

Purpose: To investigate the status of protein supply by comparing the recommended amount with the delivered amount of protein in patients in the trauma and surgical intensive care units (ICU). Feedback on the protein supply status was presented to each hospital, and we evaluated whether the protein supply had increased to an appropriate level. Methods: In this retrospective observational multicenter study, nutritional information on patients in the trauma and surgical ICUs who had received nutritional support intervention was collected on the 1st Wednesday of each month at two-month intervals from August 2020 to June 2021, from nine domestic hospitals in Korea. Every two months, the nutritional status of each hospital was shared with all hospitals, and each nutritional support team received feedback on protein supply status. Results: There were 246 patients from nine hospitals included in this study, and data over the study period from six protein days, were analyzed. The mean ratios of delivered calories to calculated required calories were 74.0%, 80.8%, 85.4%, 77.9%, 71.3%, and 82.1% on Protein Days 1, 2, 3, 4, 5, and 6, respectively. The mean ratios of delivered protein to calculated required protein were 73.0%, 77.2%, 78.9%, 79.3%, 69.4%, and 89.6% on Protein Days 1, 2, 3, 4, 5, and 6, respectively. Conclusion Protein supply increased to an appropriate level, feedback on protein supply status may have increased the protein supply ratio and promoted appropriate protein supply and nutritional support for patients in the trauma and surgical ICUs.

To conduct a kinetic study of paraquat (PQ), we investigated 9 patients with acute PQ intoxication. All of them ingested more than 20 ml of undiluted PQ herbicide to commit suicide and arrived at our hospital early, not later than 7 h after PQ ingestion. The urine dithionite test for PQ in all of the nine patients was strongly positive at emergency room. Blood samples were obtained every 30 min for the first 2~3 h and then every 1 or 2 h, as long as the clinical progression was stable among the patients for 30 h after PQ ingestion. The area under the plasma concentration-time curve (AUCinf), which was extrapolated to infinity, was calculated using the trapezoidal rule. Toxicokinetic parameters, such as the terminal elimination half-life, apparent oral clearance, and apparent volume of distribution (Vd/F) were calculated. The maximum PQ concentration (Cmax) and the time to reach maximum PQ concentration (Tmax) were also obtained. Plasma PQ concentrations in nine patients were well described by a bi-exponential curve with a mean terminal elimination half-life of 13.1+/-6.8 h. Cmax and AUCinf were 20.8+/-25.7 mg/l and 172.5+/-160.3 h.mg/l, respectively. Apparent volume of distribution and apparent oral clearance were 50.9+/-61.3 l/kg and 173.4+/-111.2 l/h, respectively. There were a significant correlation (r =0.84; p<0.05) between the PQ amount ingested and Cmax. AUCinf also showed a significant correlation (r =0.83; p<0.05) with the PQ amount ingested. These correlations provide evidence that PQ has dose-linear toxicokinetic characteristics.
Dithionite ; Eating ; Emergency Service, Hospital ; Half-Life ; Humans ; Paraquat* ; Pharmacokinetics* ; Plasma ; Poisoning* ; Suicide

PURPOSE: We investigate the outcomes of treatment of patients with severe comminuted distal radius fractures with volar plate fixation using a pronator-preserving approach. MATERIALS AND METHODS: Fourteen patients with severe comminution of the distal radius fractures for whom anatomical reduction of the fractures was deemed difficult to achieve with traditional approaches were enrolled. The gender ratio was 8 males to 6 females, and the average age of the patients was 64.9 years. According to the AO/OTA classification of fractures, 2 patients had 23-A3 fractures, 7 patients had 23-C2, and 5 patients had 23-C3. Radial length, radial inclination, and volar tilt were measured for radiologic evaluation. Modified Mayo wrist score (MMWS) was used for clinical outcome. RESULTS: Bony union was achieved in all 14 patients without signs of complications. The average time-to-union was 4.3 months (3-6 months). The radiological findings at the final follow-up were as follows: the average radial inclination was 20.5degrees; the average volar tilt, 7.57degrees; and the average radial length, 11.8 mm. At the final follow-up, the results of the MMWS were 'Fair' in 1 patient, 'Good' in 4, and 'Excellent' in 9. CONCLUSION: We propose that a pronator-preserving approach is an effective treatment for severe comminuted distal radius fracture.
Classification ; Female ; Follow-Up Studies ; Humans ; Male ; Radius Fractures* ; Palmar Plate ; Wrist

Since the pancreas and the spleen lie in close proximity, splenic complications during the course of pancreatitis are possible, but uncommon. No previously published report in Korean has described splenic subcapsular hematoma due to pancreatitis, and we now report one such case.
Hematoma* ; Pancreas ; Pancreatitis ; Pancreatitis, Chronic* ; Spleen*

PURPOSE: Laparoscopic surgery has became or is being tried as a standard procedure in most of abdominal surgeries due to the advantages of little postoperative pain, shortened of hospital stay, early return to daily life, the cosmetic effect etc. In this article, we examine the availability of laparoscopic herniorrhaphy through a clinical review of patients who had undergone by laparoscopic or conventional herniorrhaphy. METHODS: The records and data of 137 inguinal hernia patients who underwent laparoscopic herniorrhaphy (n=57) or conventional herniorrhaphy (n=80), with similar sex and age distribution, were retrospectively analyzed. Laparoscopic herniorrhaphy equated to transabdominal preperitoneal repair and conventional herniorrhaphy to Bassini's or Ferguson's repair. As statistical method, the Chi-square and T-test was used. RESULTS: There was no significant difference noted between the groups in relation to sex, age, site and type of hernia, complication rate, or recurrence rate in both group. The laparoscopic group had a longer mean operative time (87.3 vs 68.6 min) and less frequent postoperative analgesic use (49.1 vs 72.6%) as compared to the conventional group. However there was no statistical significance. The laparoscopic group had a significantly shorter mean postoperative hospital day (3.6 vs 7.8 days) and the mean period of return to work (6.2 vs 15.2 days) as compared to the conventional group. CONCLUSION: Laparoscopic herniorrhaphy is thought to be becoming the preferred operative procedure for young patients with a flourishing social activity particularly due to its shortening of the postoperative hospital stay and facilitating the early return to work. There is a need for the complication and recurrence rate to be reestimated following a sufficient and strict follow up. After studying more cases, a reevaluation must be done concerning the advantage of laparoscopic herniorrhaphy.
Age Distribution ; Follow-Up Studies ; Hernia ; Hernia, Inguinal ; Herniorrhaphy* ; Humans ; Laparoscopy ; Length of Stay ; Operative Time ; Pain, Postoperative ; Recurrence ; Retrospective Studies ; Return to Work ; Surgical Procedures, Operative

PURPOSE: This study was undertaken to evaluate retrospectively the clinical results of surgery for the rectal villous adenoma. METHODS: The study took place from the period of Mar. of 1988 to Feb. 1998 at the Dept. of Surgery, Sungkyunkwan Univ., Medical college. The study consisted of : Among the 97 cases diagnosed with colon & rectal villous adenoma, and 59 were rectal villous adenoma, and 42 cases underwent resection. We focused on these 42 cases, especially on the position of tumor, its size, surgical technique, histologic results & keeping close follow up post-surgically. RESULTS: The sex ratio was 2:1 with male predominence, 18 cases were in their fifties with the average age of 55. In 30 cases, the lesion was situated within the 8 cm of anal verge. The average size of tumor was 3.64 cm. The applied methods were; rectotomy 19 cases, anterior resection 13 cases (including low anterior resection), endoscopic excision and transanal excision were 7 cases, and 2 cases, respectively. And in one case where the tumor size was 14.5 cm and which was situated within 3 cm of anal verge, Miles' operation was conducted. Death due to post-operative complication was not observed. 2 cases of wound infection in postoperation, one case of transient urinary incontinence & hematoma were found. And in the case of explo-laparotomy, anastomosis site leakage, in one case, anastomosis site stricture in 2 cases were noted. malignant cells were observed in total of 73.8%, among these, 80% were from villous adenoma, 70% from tubullovillous adenoma. In the case of tumor size less 1 cm, and tumor size greater than 1 cm, the probability of finding malignant lesion were 33.3% and 76.9%, respectively. CONCLUSIONS: We suggest that wideexcision through York-Mason approach is a safe and effective technique for huge villous adenomas of the rectum.
Adenoma ; Adenoma, Villous* ; Colon ; Constriction, Pathologic ; Follow-Up Studies ; Hematoma ; Histological Techniques ; Humans ; Male ; Rectum ; Retrospective Studies ; Sex Ratio ; Urinary Incontinence ; Wound Infection

OBJECTIVES: Allergen is closely related with local features and cultural environment and a new approach method regarding causes triggering aggravation is especially required due to complex and variety of ordinary residence and pollution of living environment recently. We, therefore, performed this study to inspire the necessity of identification of causative afeuts in aothmatic patients in pusan area. METHODS: We measured serum specific IgE antibody by means of chemiluminescent analyzer employing MAST, classified the level from class 0 to 4 and interpreted the result in order to identify allergen on total 262 patients consisted of inpatients and outpatients who had been presumed as extrinisic asthma and treated in this hospital during 2 and a half years from June of 1994 to December of 1996. RESULTS: 1. With regard to sex and age distribution, the rate of men versus women was 1 : 1.3, while in the distribution by age, the twenties and the thirties were the most as 29% and 26% respectively. 2. The result of interpretation of the test showed positive in 75%, 78% of which showed positive reaction compounded of 2 kinds or more. 3. If we take a look at the distribution of total IgE class in the positive area, we can find that ; Class III and class II showed the highest frequency as 47% and 37% respectively. 4. If we take a look at the distribution by age and allergen, the twenties(32%) and the thirties(30%) showed the highest frequency, the fifties, the forties and the teens showed middle frequency as 10~13% and the sixties and the seventies showed the lowest frequency as about 1%. The causative allergen appeared in the order of pollen(40%), dust(20%), food(18%), fungus(13%) and epidermis(8%). 5. The distribution of allergen by season generally showed high rate of positive appearance in spring and fall as pollen appeared in spring(44%) and fall(27%), dust appeared in fall(32%) and summer(23%), food appeared in spring(34%) and fall(29%), fungus appeared in fall(30%) and spring(28%) and epidermis appeared in spring(30%) and fall(28%). 6. With regard to the allergen: (1) In pollen allergens, trees showed higher positive frequency than weeds and trees were in the order of birch(14%), alder(13%) and hazelnut mix(12%) and weeds showed similar positive values. (2) In dust allergens, mite(D. pteronyssinus and D. farinae) showed high positive rate as 39% each. (3) In epidermal allergens, it also showed relatively even positive value among which cat's halr-dandruff was the highest as 40%. (4) In food allergens, shrimp showed the highest as 22% and others were similar as evenly positive values. (5) In fungus allergens, Candida and Stemphylium showed the highest value as 19% each. CONCLUSION: The analysis of allergen by means of MAST could be used as a valuable guide post for identifing cousative antigens for active treatment of extrinsic asthma.
Adolescent ; Age Distribution ; Allergens ; Asthma* ; Busan* ; Candida ; Corylus ; Dust ; Epidermis ; Female ; Fungi ; Humans ; Immunoglobulin E ; Inpatients ; Male ; Outpatients ; Pollen ; Seasons ; Trees

From April, 1983 through April, 1989, we have treated histologically proven 21 patients with oligodendroglima using 6 MV linear accelerator at the Division of Radiation Therapy, Kangnam St. Mary's Hospital Catholic University Medical College. These are 8% of the irradiated 246 primary brain tumors during the same period. To investigate influencing factors on the survival of irradiated 21 patients with oligodendroglioma, we analyzed the cerebral location of the nvolvements, initial symptoms, CT findings and survival rates, retrospectively. One case was lost to flow up and excluded from survival data. Of the 21 patients, thirteen were male and 8 female. Ages ranged from 5 to 68 years with a median age of 38 years. Radiation doses varied from 3960 cGy to 6480 cGy and were given for 5 to 8 weeks. All but one were supratentorial. The involvement of the frontal and parietal lobes were 10 (48%) patients in each and temporal lobe in 8 (38.1%). Histological diagnosis was made by stereotactic biopsy in 3 and postoperatively in 18. The type of surgery was divided into partial, subtotal and total resection in 7,9 and 2 cases respectively. In 6 cases, chemotherapy was also tried during or after radiation therapy. Major presenting respectively in decreasing order. In CT analysis, low density (62%), cystic mass (33%), calcification (66%) and positive contrast enhancement (42.8%) were observed as the highest frequency. Mean survival duration after radiation therapy was 38 months (K-M methods). We could not achieve statistically significant factors influencing on the survival rate after radiation therapy for oligodendrogliomas by one or two tail test.
Biopsy ; Brain Neoplasms ; Diagnosis ; Drug Therapy ; Female ; Humans ; Male ; Oligodendroglioma* ; Parietal Lobe ; Particle Accelerators ; Retrospective Studies ; Survival Rate ; Temporal Lobe

Eight patients with intracranial tumors or arteriovenous malformation (AVM)s which were less than 3 cm in diameter were treated by a technique of stereotactic radiotherapy during the 4 months period from July 1988 through October 1988 at the Division of Radiation Therapy, Kang-Nam St. Mary's Hospital, Catholic University Medical College. The patients were diagnosed as AVMs in 3 cases, acoustic neurinoma, craniopharyngioma (recurrent), hemangioblastoma, pineocytoma, and pituitary microadenoma in each case. There are several important factors in this procedure, such as localization system, portal, field size, radiation dose, and perioperative supportive care. It is suggested that stereotactic radiotherapy may be performed safely with a radiation dose of 12-30 gy. So this noninvasive procedure can be used to treat unresectable intracranial tumors or AVMs. Of these, clinical symptoms had been regressed in AVMs in 2 cases at 3 months and 2 months after Stereotactic radiotherapy, one of whom was confirmed slightly regressed on the follow-up angiogram. And also craniopharyngioma and pineocytoma was minimally regressed on 3 month follow-up CT.
Arteriovenous Malformations ; Craniopharyngioma ; Follow-Up Studies ; Hemangioblastoma ; Humans ; Neuroma, Acoustic ; Particle Accelerators* ; Pinealoma ; Portal System ; Radiotherapy*