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The appropriate plot effectively conveys the author’s conclusions to the readers. Journal of Korean Medical Science will provide a series of special articles to show you how to more easily make consistent and excellent plots. In this article, we will cover plots with numeric data.
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The appropriate plot effectively conveys the author’s conclusions to the readers. Journal of Korean Medical Science (JKMS) will provide a series of special articles to show you how to make consistent and excellent plots more easily. In this article, we will cover pyramid charts. A pyramid chart is a simple yet popular tool for looking at the structure of a population by age and gender. Other variables can also be applied. This article helps researchers use these charts more easily by introducing effective tools and explaining how to use them.
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The appropriate plot effectively conveys the author's conclusions to the readers. JKMS will provide a series of special articles to show you how to make consistent and excellent plots easier. In this article, we will cover plots with categorical data. We will show what ‘Bubble Plot,’ ‘Matrix Bubble Plot,’ and ‘Matrix Bar Plot’ are and how to make them.
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A transparotid approach, with a retromandibular or preauricular incision, is an alternative surgical approach for treating a subcondylar fracture and reducing the potential for complications such as injury to the facial nerves. However, retromandibular and preauricular incisions are both created far away from the parotid gland–dissection area. Thus, it is necessary to undermine the skin and retract it anteriorly to access the surgical field. Here, we introduce a modified approach wherein the incision allows for direct access to the fracture site. This approach may be adopted to shorten the incision length, reduce the retraction trauma at the surgical site, and help prevent injury to the facial nerve.
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A transparotid approach, with a retromandibular or preauricular incision, is an alternative surgical approach for treating a subcondylar fracture and reducing the potential for complications such as injury to the facial nerves. However, retromandibular and preauricular incisions are both created far away from the parotid gland–dissection area. Thus, it is necessary to undermine the skin and retract it anteriorly to access the surgical field. Here, we introduce a modified approach wherein the incision allows for direct access to the fracture site. This approach may be adopted to shorten the incision length, reduce the retraction trauma at the surgical site, and help prevent injury to the facial nerve.
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Background/Aims@#This study aimed to assess adherence to physical activity guidelines in cancer survivors and to investigate related factors. @*Methods@#The cross-sectional data of 39,845 community-dwelling participants aged ≥ 20 years (1,254 cancer survivors) in the Korea National Health and Nutrition Examination Survey were analyzed. The age- and sex-stratified prevalence for meeting exercise guidelines was obtained. The correlates of meeting exercise recommendations were evaluated by using complex-sample logistic regression models. @*Results@#Overall, 36.2% and 20.5% of cancer survivors met the recommendations for aerobic and resistance exercises, respectively. Cancer survivors and noncancer controls had similar low adherence to exercise recommendations in most age and sex groups, except young female cancer survivors (20 to 49 years old) who showed higher engagement in aerobic exercise than female noncancer controls in the same age group. Old cancer survivors (≥ 65 years) were less likely to engage in recommended levels of aerobic exercise than young cancer survivors (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.24 to 0.79). Female cancer survivors were less likely to meet resistance exercise guidelines than male cancer survivors (OR, 0.32; 95% CI, 0.21 to 0.50). In addition, cancer survivors with current smoking status and cardiovascular disease were less likely to meet aerobic exercise recommendations. @*Conclusions@#The prevalence of meeting exercise guidelines are low in Korean cancer survivors and varied by age and sex. Old age is associated with an insufficient level of aerobic exercise, and female sex is associated with low participation in resistance exercise.
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Objectives@#The number of patients undergoing oral anticoagulant therapy for cardiovascular and cerebrovascular disease is increasing. However, the risk of bleeding after tooth extraction in patients receiving warfarin is unclear. Here, we assess the risk of bleeding after tooth extraction in patients on warfarin. @*Materials and Methods@#The study included 260 patients taking warfarin who underwent tooth extraction (694 teeth). The patients were divided into those whose teeth were extracted while they were taking warfarin, those who discontinued warfarin before extraction, and those who underwent extraction while receiving heparin bridging therapy. Bleeding complications in the two groups were compared. @*Results@#Of the 260 patients, 156 underwent extraction while taking warfarin, 70 stopped taking warfarin before extractions, and 34 received heparin bridging therapy and stopped taking either medication before extractions. Bleeding complications occurred in 9 patients (3.5%) and 9 tooth sites (1.3%). Among the 9 patients with bleeding complications, 6 underwent extraction while taking warfarin, 2 stopped warfarin before extraction, and 1 underwent extraction after receiving heparin bridging therapy. No significant difference was seen between patient groups regarding bleeding after extractions (p=0.917). @*Conclusion@#Warfarin use does not increase the risk of post-extraction bleeding and can therefore be continued during tooth extraction.
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Background@#Tumoral calcinosis is characterized by the deposition of calcific masses around major joints, and it often causes significant impairment of joint function. Dermatologists sometimes encounter patients with a subcutaneous hard mass around the joint. However, there are few studies about tumoral calcinosis in the dermatologic literature, especially in Korea. @*Objective@#The aim of this study was to determine the clinical characteristics of tumoral calcinosis. @*Methods@#We reviewed the clinical photographs, medical records, and biopsy specimens of 11 cases of tumoral calcinosis seen at our clinic in 10 years. @*Results@#All 11 patients were female, and the mean age at onset was 58.5 years. The mean duration of the disease was 7.1 years. Most patients (9, 81.8%) presented with an asymptomatic subcutaneous hard mass around the iliac crest. None of the patients had a family history, or abnormal serum calcium, phosphorus, and parathyroid hormone levels. All patients underwent surgery for treatment. @*Conclusion@#Tumoral calcinosis can occur sporadically without metabolic disease. Therefore, careful history taking and biochemical work-up involving the metabolism of calcium and phosphorus should be performed. If there is no peculiarityon examination, the lesion is cured by resection. Although the sample size of this study is small, it can be inferred that the characteristics of tumoral calcinosis in Korea can be described by its predominant sex preponderance and location, that is, the female sex and the iliac crest, respectively.
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A poroma is a benign adnexal neoplasm originating from the sweat gland duct. It usually presents clinically as a soft erythematous or flesh-colored papule, plaque, or nodule on the palms and soles. In most cases, poromas manifest as a solitary lesion, but rarely, multiple lesions have been reported and are defined as poromatosis.Although the pathogenesis is unclear, poromatosis is known to be associated with actinic damage, human papillomavirus infection, radiation therapy, or polychemotherapy. Herein, we describe a 53-year-old woman who had multiple erythematous papules on her feet for a year. She had a medical history of acute lymphoblastic leukemia and had undergone polychemotherapy with stem cell transplantation. To our knowledge, poromatosis related to chemotherapy is a rare entity, and our case could be attributed to the theory that using polychemotherapy can induce poromatosis.
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Background@#Osteoporotic vertebral compression fractures (OVCFs) are often associated with delayed myelopathy. Surgical treatment of delayed myelopathy following an OVCF comprises spinal canal decompression and stable fixation of the vertebral column with an acceptable sagittal alignment. However, such surgical methods are not usually feasible because of medical comorbidities and osteoporosis. We devised a novel, simple technique to decompress the spinal canal and reconstruct the middle column by translating the fractured vertebral body anteriorly through a posterior approach and verified the validity of the new technique. @*Methods@#We conducted a single-center, retrospective study. Patients who underwent vertebral body anterior translation (VBaT) between 2014 and 2017 due to delayed myelopathy after OVCFs were included. Through a posterior approach, discs between the fractured vertebra and the adjacent vertebrae were released. The fractured vertebra was translated anteriorly with pedicle screws and rods to realign the middle column. Radiological and functional improvement was analyzed. @*Results@#There were 12 consecutive patients. The mean age was 70.3 ± 9.4 years. There were 8 female and 4 male patients. Follow-up period was 35.9 ± 13.1 months. Nine patients had pedicle screw augmentation with polymethyl methacrylate. The mean number of fusion segments was 3.4 (range, 2–4). There were 3 types of spinal canal invasion. Five patients had vertebral body vacuum clefts with posterior wall fractures. Five patients had vertebral body angulation with endplate protrusion. Two patients had 3 column fractures. In radiological analysis, the regional kyphotic angle was 35.1° ± 9.1° preoperatively and improved to 8.8° ± 6.8° postoperatively and 9.8° ± 6.1° at the final follow-up (p < 0.001). The anterior vertebral body height ratio was 27.6% ± 7.0% preoperatively and improved to 80.5% ± 13.7% postoperatively and 83.7% ± 12.5% at the final follow-up (p < 0.001). The spinal canal invasion ratio was 52.6% ± 9.1% preoperatively and improved to 25.2% ± 10.4% postoperatively (p < 0.001). Neurological deficit was improved in all patients by 1–3 grades according to Nurick’s grading system. @*Conclusions@#In delayed myelopathy following an OVCF, although the posterior cortex invades the spinal canal, it is usually already in the union state. Therefore, it can bear compression force as a middle column if realigned to be in line with the adjoining vertebrae. VBaT demonstrated satisfactory reduction of kyphosis and maintenance of stability until the last follow-up.
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Quarantine often provokes negative psychological consequences. Thus, we aimed to identify the psychological and behavioral responses and stressors of caregivers quarantined with young patients after a close contact to a coronavirus disease 2019 case at a children's hospital. More than 90% of the caregivers reported feelings of worry and nervousness, while some of them reported suicidal ideations (4.2%), and/or homicidal ideations (1.4%). Fear of infection of the patient (91.7%) and/or oneself (86.1%) were most frequently reported stressors. A multidisciplinary team including infection control team, pediatrician, psychiatrist, nursing staff and legal department provided supplies and services to reduce caregiver's psychological distress. Psychotropic medication was needed in five (6.9%), one of whom was admitted to the psychiatry department due to suicidality. Quarantine at a children's hospital makes notable psychological impacts on the caregivers and a multidisciplinary approach is required.
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Background@#We investigated the efficacy of a maxillary Jackson-Pratt (J-P) suction drain for preventing maxillary sinus hematoma and facial swelling after maxillary Le Fort I osteotomy (LF1). @*Methods@#We retrospectively evaluated 66 patients who underwent LF1 at a single institution. Of these, 41 had a J-P suction tube inserted in the mandible and maxilla (maxillary insertion), and 25 had a J-P drain inserted in the mandible only (no maxillary insertion). Facial CT was obtained before and 4 days after surgery. We compared mean midfacial swelling and maxillary sinus haziness by t test and examined correlations between bleeding amount and body mass index (BMI). @*Results@#For the maxillary-insertion group, the ratio of total maxillary sinus volume to haziness (57.5 ± 24.2%) was significantly lower than in the group without maxillary drain insertion (65.5% ± 20.3; P = .043). This latter group, however, did not have a significantly greater midfacial soft tissue volume (7575 mm3) than the maxillary-insertion group (7250 mm3; P = .728). BMI did not correlate significantly with bleeding amount or facial swelling. @*Conclusions@#Suction drainage in the maxilla reduced maxillary sinus haziness after orthognathic surgery but did not significantly reduce midfacial swelling.
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The appropriate plots effectively convey the author’s conclusions to the readers. ‘Hip and Pelvis’ will provide a series of special articles to show how to make consistent and excellent plots easier. In this article, we will cover plots with error bars.
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Background@#We investigated the efficacy of a maxillary Jackson-Pratt (J-P) suction drain for preventing maxillary sinus hematoma and facial swelling after maxillary Le Fort I osteotomy (LF1). @*Methods@#We retrospectively evaluated 66 patients who underwent LF1 at a single institution. Of these, 41 had a J-P suction tube inserted in the mandible and maxilla (maxillary insertion), and 25 had a J-P drain inserted in the mandible only (no maxillary insertion). Facial CT was obtained before and 4 days after surgery. We compared mean midfacial swelling and maxillary sinus haziness by t test and examined correlations between bleeding amount and body mass index (BMI). @*Results@#For the maxillary-insertion group, the ratio of total maxillary sinus volume to haziness (57.5 ± 24.2%) was significantly lower than in the group without maxillary drain insertion (65.5% ± 20.3; P = .043). This latter group, however, did not have a significantly greater midfacial soft tissue volume (7575 mm3) than the maxillary-insertion group (7250 mm3; P = .728). BMI did not correlate significantly with bleeding amount or facial swelling. @*Conclusions@#Suction drainage in the maxilla reduced maxillary sinus haziness after orthognathic surgery but did not significantly reduce midfacial swelling.
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The appropriate plots effectively convey the author’s conclusions to the readers. ‘Hip and Pelvis’ will provide a series of special articles to show how to make consistent and excellent plots easier. In this article, we will cover plots with error bars.
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OBJECTIVE: To investigate longitudinal changes in language function in left-hemispheric ischemic stroke patients as well as factors that influence language recovery until 1 year after stroke onset.METHODS: We analyzed data from 235 patients with first-ever left-hemispheric ischemic stroke. All patients completed the Korean version of the Frenchay Aphasia Screening Test (K-FAST) at 7 days (T1), 3 months (T2), 6 months (T3), and 1 year (T4) after stroke onset. Repeated measures analysis of variance (ANOVA) was used to investigate changes in language function between time points. Subgroup analysis was performed according to the K-FAST scores at T1. Stroke lesion volume was assessed using diffusion tensor images, and involvement of language-related brain regions was examined. Multiple regression analysis was used to analyze factors influencing improvement of K-FAST score.RESULTS: The K-FAST scores at T1, T2, T3, and T4 differed significantly (p < 0.05). In the subgroup analysis, only the severe group showed continuous significant improvement by 1 year. Factors that negatively influenced improvement of language function were the age at onset, initial National Institutes of Health Stroke Scale (NIHSS) score, and initial K-FAST score, whereas education level and stroke lesion volume positively affected recovery. Involvement of language-related brain regions did not significantly influence long-term language recovery after ischemic stroke.CONCLUSION: Recovery of language function varied according to the severity of the initial language deficit. The age at stroke onset, education level, initial severity of aphasia, initial NIHSS score, and total stroke lesion volume were found to be important factors for recovery of language function.
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Humans , Age of Onset , Aphasia , Brain , Diffusion , Education , Mass Screening , Prognosis , Rehabilitation , Stroke Volume , StrokeABSTRACT
BACKGROUND: The incidence of cardiovascular and neurovascular diseases has been increasing with the aging of the population, and antiplatelet drugs (APDs) are more frequently used than in the past. With the average age of spinal surgery patients also increasing, there has been a great concern on the adverse effects of APD on spine surgery. To our knowledge, though there have been many studies on this issue, their results are conflicting. In this study, we aimed to determine the influence of APDs on spine surgery in terms of intraoperative bleeding and postoperative spinal epidural hematoma complication. METHODS: Patients who underwent posterior thoracolumbar decompression and instrumentation at our institution were reviewed. There were 34 APD takers (APDT group). Seventy-nine non-APD takers (NAPDT group) were selected as a control group in consideration of demographic and surgical factors. There were two primary endpoints of this study: the amount of bleeding per 10 minutes and cauda equina compression by epidural hematoma measured at the cross-sectional area of the thecal sac in the maximal compression site on the axial T2 magnetic resonance imaging scans taken on day 7. RESULTS: Both groups were homogeneous regarding age and sex (demographic factors), the number of fused segments, operation time, and primary/revision operation (surgical factors), and the number of platelets, prothrombin time, and activated partial thromboplastin time (coagulation-related factors). However, the platelet function analysis-epinephrine was delayed in the APDT group than in the NAPDT group (203.6 seconds vs. 170.0 seconds, p = 0.050). Intraoperative bleeding per 10 minutes was 40.6 ± 12.8 mL in the APDT group and 43.9 ± 9.9 mL in the NAPDT group, showing no significant difference between the two groups (p = 0.154). The cross-sectional area of the thecal sac at the maximal compression site by epidural hematoma was 120.2 ± 48.2 mm2 in the APDT group and 123.2 ± 50.4 mm2 in the NAPDT group, showing no significant difference between the two groups (p = 0.766). CONCLUSIONS: APD medication did not increase intraoperative bleeding and postoperative spinal epidural hematoma. Therefore, it would be safer to perform spinal surgery without discontinuation of APD therapy in patients who are vulnerable to cardiovascular and neurovascular complications.
Subject(s)
Humans , Aging , Blood Platelets , Cauda Equina , Decompression , Hematoma , Hematoma, Epidural, Spinal , Hemorrhage , Incidence , Magnetic Resonance Imaging , Partial Thromboplastin Time , Platelet Aggregation Inhibitors , Prothrombin Time , SpineABSTRACT
OBJECTIVES@#We report a case of spinal subarachnoid hematoma that developed after spinal anesthesia in a female patient who had no risk factors.SUMMARY OF LITERATURE REVIEW: Few case reports of spinal subarachnoid hematoma (SSH) after spinal anesthesia have been published. The incidence of SSH is much less than that of epidural hematoma.@*MATERIALS AND METHODS@#A 56-year-old female patient underwent arthroscopic surgery on her right knee under spinal anesthesia. Automated patient-controlled analgesia (PCA) was applied after surgery. On day 2, the patient complained of lower back pain, headache, nausea, and vomiting, but there were no neurological signs in the lower extremity. At day 5, she had a moderate fever (38.4°) and continuous nausea and vomiting. Magnetic resonance imaging (MRI) was conducted on day 5 and a large subarachnoid hematoma was found. We immediately performed surgical hematoma evacuation. Her low back and buttock pain improved immediately, and all symptoms disappeared in a week without any neurological sequelae.@*RESULTS@#The unusual and vague symptoms in this case made the diagnosis difficult, but spinal MRI confirmed SSH. Immediate surgical hematoma evacuation improved all symptoms and left no neurologic sequelae.@*CONCLUSIONS@#SSH after spinal anesthesia may have cerebral symptoms that mimic the side effects of PCA. Early diagnosis by MRI and surgical evacuation of the SSH are a reasonable approach for this complication.
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OBJECTIVES@#To identify clinical features and risk factors helpful for the prevention and early diagnosis of neurological complications.OVERVIEW OF LITERATURE: Previous studies have investigated postoperative complications only for specific disease entities and did not present distinctive clinical features.@*MATERIALS AND METHODS@#This was an observational study of patients who underwent posterior thoracolumbar spinal surgery in the orthopedic department of a single hospital over the course of 19 years (1995-2013). The incidence, cause, onset time, and risk factors of complications were investigated. Neurological deterioration was graded on a 5-point numeric scale: G1, increased leg pain or sensory loss, G2, unilateral motor weakness; G3, bilateral motor weakness; G4, cauda equina syndrome; and G5, complete paraplegia.@*RESULTS@#Sixty-five cases out of 6574 (0.989%) developed neurological complications due to the following causes: epidural hematoma, 0.380%; instrumentation with inadequate decompression, 0.213%; mechanical injury, 0.167%; inadequate discectomy, 0.061%; and unknown cause, 0.167% (p=0.000). The grade of neurological deterioration was G1 in 0.167% of patients, G2 in 0.517%, G3 in 0.228%, G4 in 0.046%, and G5 in 0.030%. Neurological deterioration was most severe in patients who experienced epidural hematoma, followed by those in whom complications occurred due to instrumentation with inadequate decompression, unknown causes, mechanical injury, and inadequate discectomy, in order (p=0.009). Revision surgery was a significant risk factor (p=0.000; odds ratio, 2.741). The time that elapsed until symptom development was as follows, in order: unknown cause, 0.6 hours; epidural hematoma, 5.4 hours; mechanical injury, 6.6 hours; inadequate discectomy, 18.0 hours; and instrumentation with insufficient decompression, 36.0 hours (p=0.001).@*CONCLUSIONS@#The incidence of neurological complications in our cohort was 1%. Revision surgery increased the risk by 3 times. Severe cases (cauda equina syndrome or complete paraplegia) rarely developed, occurring in 0.08% of patients. The major causes of neurological decline were epidural hematoma and instrumentation with inadequate decompression. Close observation in the early period was important for the diagnosis because most patients developed symptoms within 12 hours. Delayed diagnosis was most common in complications caused by instrumentation with inadequate decompression.
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STUDY DESIGN: Case report. OBJECTIVES: We report a case of spinal subarachnoid hematoma that developed after spinal anesthesia in a female patient who had no risk factors. SUMMARY OF LITERATURE REVIEW: Few case reports of spinal subarachnoid hematoma (SSH) after spinal anesthesia have been published. The incidence of SSH is much less than that of epidural hematoma. MATERIALS AND METHODS: A 56-year-old female patient underwent arthroscopic surgery on her right knee under spinal anesthesia. Automated patient-controlled analgesia (PCA) was applied after surgery. On day 2, the patient complained of lower back pain, headache, nausea, and vomiting, but there were no neurological signs in the lower extremity. At day 5, she had a moderate fever (38.4°) and continuous nausea and vomiting. Magnetic resonance imaging (MRI) was conducted on day 5 and a large subarachnoid hematoma was found. We immediately performed surgical hematoma evacuation. Her low back and buttock pain improved immediately, and all symptoms disappeared in a week without any neurological sequelae. RESULTS: The unusual and vague symptoms in this case made the diagnosis difficult, but spinal MRI confirmed SSH. Immediate surgical hematoma evacuation improved all symptoms and left no neurologic sequelae. CONCLUSIONS: SSH after spinal anesthesia may have cerebral symptoms that mimic the side effects of PCA. Early diagnosis by MRI and surgical evacuation of the SSH are a reasonable approach for this complication.