Comparative study of the prevention of seroma formation in immediate breast reconstruction with latissimus dorsi myocutaneous flaps

Background@#Latissimus dorsi (LD) flaps are often used in breast reconstruction procedures, but seroma formation is a frequent complication. To decrease the incidence of seroma formation, fibrin sealants and/or quilting sutures have been proposed, with controversial results. The primary objective of this study was to assess the effectiveness of the Harmonic scalpel in association with Tisseel and three-point deep dermal sutures in reducing the incidence of this complication. @*Methods@#A retrospective study was conducted of 108 patients undergoing immediate unilateral breast reconstruction with LD flaps over a 3-year period (2016–2018) by a single surgeon. In the experimental group, 37 patients underwent the procedure with a Harmonic scalpel and three-point deep dermal sutures (a modified version of quilting sutures), and the other 71 received conventional electrocautery. Fibrin sealant was applied to the donor site of all patents to reduce seroma formation. @*Results@#Statistically significant differences in the incidence of seroma were found between the two groups. There was a lower incidence of seroma formation in the group of patients treated with a Harmonic scalpel and three-point deep dermal sutures than in the other group. The total drainage amount and drain removal date between the two groups were not significantly different. @*Conclusions@#Within the limitations of this study, we suggest that Harmonic scalpel use can be a good choice among the many ways to reduce seroma formation following LD flap procedures, and that this technique will be very helpful for patients.

Unilateral blindness due to retrobulbar hematoma after lower blepharoplasty

Blepharoplasty is one of the most popular cosmetic surgical procedures for people who are concerned with minimizing the effects of aging and maintaining an aesthetically attractive appearance. If periorbital surgery is not performed by an expert, the risk of complications increases. In particular, retrobulbar hematoma, which is the most serious complication after blepharoplasty, can lead to permanent blindness. We report a rare case of unilateral permanent blindness due to careless and unprofessional treatment following a retrobulbar hematoma after lower blepharoplasty. In conclusion, it is necessary to check for symptoms and signs including pain, proptosis, visual acuity, and light reflex after the operation. Careful instructions should then be given to patients and their caregivers to avoid actions that may cause postoperative bleeding. We emphasize that if a patient complains of symptoms, painkillers should not be used and computed tomography should be performed for an accurate and rapid diagnosis. Appropriate procedures must then be taken to prevent permanent vision loss.

Treatment of Third Degree Burn due to Low-Temperature Contact Burn on Acquired Immune Deficiency Syndrome (AIDS) Patient: Low-Temperature Burn on AIDS Patient

Satisfaction Survey on Information Technology-Based Glucose Monitoring System Targeting Diabetes Mellitus in Private Local Clinics in Korea

BACKGROUND: Private local clinics in Korea have little experience with information technology (IT)-based glucose monitoring (ITGM). Our aim is to examine user satisfaction and the possibility of using ITGM service practically. METHODS: Patients sent their blood glucose levels to physicians in local clinics. The physicians reviewed the blood glucose values online and provided personal consultations through text messaging or phone calls. Thereafter, a satisfaction survey on the ITGM service, the modified Morisky scale, and patient assessment of chronic illness care were administered. RESULTS: One hundred and seventy patients from seven private local clinics used the ITGM. Overall satisfaction, including that about the ITGM service, the device, and its usefulness, was rated higher than “mostly satisfied” (score 4.2±0.8 out of 5.0) and even higher among the elderly. Satisfaction was positively associated with age, especially in those older than 60 years. The main reason for intent for future use of the service was the time/place flexibility. Highly motivated patients tended to answer positively regarding information satisfaction (P=0.0377). CONCLUSION: Our study is the first to investigate ITGM satisfaction in private local clinics. The feasibility of users utilizing ITGM should be clarified, and future clinical research on the service's clinical effects and cost-benefit analysis is needed.

Two Cases of Autoaugmentation Cystoplasty in Spastic Neurogenic Bladder with Vesicoureteral Reflux / 대한비뇨기과학회지

Urinary incontinence is an annoying complaint in patients with imbalanced upper motor neuron lesion, and prevention of vesicoureteral reflux and urinary tract infection is important for the preservation of renal function. We present two cases of autoaugmentation cystoplasty and extravesical ureteral reimplantation (Lich-Gregoir Technique) in paraplegics who have upper motor neuron lesion with vesicoureteral reflux.

The Clinical Experience of Torsion of Testicular Appendix with Acute Scrotal Pain / 대한비뇨기과학회지

PURPOSE: Acute scrotal pain is one of the most alarming urologic symptoms, concealing testicular inflammation, testicular torsion, torsion of testicular appendix and a variety of miscellaneous diseases. Even with careful physical examination with recently developed diagnostic equipments, a reliable diagnosis may not be achieved in a significant number of patients. In these cases an operation is necessary for exclusion of testicular torsion. MATERIALS AND METHODS: Between 1991 and 1998, we reviewed 17 patients diagnosed as having torsion of testicular appenix, whose ages varied from 3 years to 15 years during recent 8 years. RESULTS: 16 cases out of seventeen patients(94%) were younger 12 years and prevalent age was 11 years(6/17). The average interval that elapsed from onset of symptoms until the patient was seen for the first time on the hospital was 64 hours, with a range varying from three hours to seven days. The most frequently observed symptoms and signs were diffuse scrotal pain, swelling and erythema of the affected scrotum. The explorative scrototomy were performed in 16 cases out of 17 patients who had appendix testis torsion, and the 1 case had conservative treatment after getting confirmative diagnosis by ultrasonography. The scrotal pain disappeared mostly within 1 day after operation, and the complications didn`t happen. CONCLUSIONS: There is controversy as whether the majority of children with torsion of the testicular appendix develop sufficiently grave symptoms to justify the surgical exploration. For this reason, once a diagnosis of torsion of the spermatic cord is ruled out, some investigators prefer conservative treatment. However, differential diagnosis with torsion of the spermatic cord is difficult and acute scrotal pain disappear within 24hours after excision of the twisted appendix. Therefore, we are in favor of surgical treatment.

A Case of Metastatic Renal Cell Carcinoma to the Gallbladder / 대한비뇨기과학회지

Metastatic renal cell carcinoma is common, but dissemination to the gallbladder is extrem-ely rare. The patient was diagnosed as having distal CBD stone and renal cell carcinoma before she underwent operation, but postoperative pathologic examination revealed clear cell type renal cell carcinoma within the gallbladder. We report a case of renal cell carcinoma with synchronous metastasis to the gallbladder.