Survival Time Analysis of Severly Burned Patients

PURPOSE: The authors analyzed the survival time of severely burned patients who died and reviewed the time of the death after the burn injury. We aimed to determine any relation to the survival time with most important prognostic factors of the surface area burned and the age. METHODS: Statistical analysis was performed on 275 severely burned victims who died at our burn center of Hangang Sacred Heart Hospital from January 1, 2010 to December 31, 2015 for 6 years. RESULTS: 1. The mean age was 50.12±18.2 years and the average burn size was 61.0±27.1% of total body surface area. 2. Most of the patients (90%) died within 45 days, and 80% died within 30 days. 40% of the patients died within 10 days after burn injury, 20% of the patients died between 10 to 20 days after burn injury, 20% of the patients died between 20 to 30 days after burn injury and the rapid decrease in the number of death was observed after 30 days of burn injury time. 3. The shorter survival time (x-axis) time was observed in the patients with larger area of the burned size (y-axis) and the longer survival time was observed with smaller area of the burned size. The negative correlation was shown as figure 1. 4. There was no correlation shown between the age and the survival time of burn victims after burn injury. CONCLUSION: The mortality rate was significantly decreased at 30 to 40 days after burn injury. Therefore, the burn surgeons need more carefully and diversely plan and perform for the initial treatments since the initial surgical procedures determine the survival of severely burned patients.

Proper Management of Posttraumatic Tension Pneumocephalus / 대한신경손상학회지

Pneumocephalus is commonly seen after craniofacial injury. The pathogenesis of pneumocephalus has been debated as to whether it was caused by ball valve effect or combined episodic increased pressure within the nasopharynx on coughing. Discontinuous exchange of air and cerebrospinal fluid due to “inverted bottle” effect is assumed to be the cause of it. Delayed tension pneumocephalus is not common, but it requires an active management in order to prevent serious complication. We represent a clinical case of a 57-year-old male patient who fell down from 3 m height, complicated by tension pneumocephalus on 5 months after trauma. We recommend a surgical intervention, but the patient did not want that so we observe the patient. The patient was underwent seizure and meningitis after 7 months after trauma, he came on emergency room on stupor mentality. Tension pneumocephalus may result in a neurologic disturbance due to continued air entrainment and it significantly the likelihood of intracranial infection caused by continued open channel. Tension pneumocephalus threat a life, so need a neurosurgical emergency surgical intervention.

Outcomes and recurrence pattern after non-anatomic liver resection for solitary hepatocellular carcinomas

BACKGROUNDS/AIMS: Anatomic resection (AR) is preferred for eradicating portal tributaries in patients with hepatocellular carcinoma (HCC). However, the extent of resection is influenced by underlying liver disease and tumor location. We compared the surgical outcomes and recurrence pattern between non-anatomic resection (NR) and AR. METHODS: From March 2009 to February 2012, 184 patients underwent surgical resection for HCC. Among these, 79 patients who were primarily treated for a single tumor without rupture or macroscopic vascular invasion were enrolled. The patients were divided into 2 groups based on the extent of resection: AR (n=31) or NR (n=48). We compared the clinical characteristics, overall survival, disease-free survival, pattern of recurrence, and biochemical liver functions during the perioperative period between the two groups. RESULTS: The extent of resection had no significant effect on overall or disease-free survival rates. The overall 1- and 3-year survival rates were 97% and 82% in the AR group, and 96% and 89% in the NR group, respectively (p=0.49). In addition, the respective 1- and 3-year disease-free survival rates for the AR and NR groups were 84% and 63%, and 85% and 65%, respectively (p=0.94). On the other hand, the presence of hepatic cirrhosis and a tumor size of >5 cm were significant risk factors for recurrence according to multivariate analysis (p<0.001 and p=0.003, respectively). The frequency of early recurrence, the first site of recurrence, and the pattern of intrahepatic recurrence were similar between the 2 groups (p=0.419, p=0.210, and p=0.734, respectively); in addition, the frequency of marginal recurrence did not differ between the 2 groups (1 patient in the AR group and 2 in the NR group). The NR group showed better postoperative liver function than the AR group. CONCLUSIONS: Non-anatomic liver resection can be a safe and efficient treatment for patients with a solitary HCC without rupture or gross vascular invasion.

Hinge Fracture during Cervical Open-door Laminoplasty: Does it Affect Clinical and Radiographic Outcomes?

OBJECTIVE: The purpose of this study was to determine whether the status of the hinge gutter affected clinical and radiographic outcomes of cervical open door laminoplasty. METHODS: We retrospectively analyzed 43 patients who had undergone cervical open door laminoplasty. 23 CT scans were performed at 2 days post-operation. The number of CT scans at 3, 6, 12 and 24 months were 16, 12, 21 and 11, respectively. We collected perioperative and follow-up data, including clinical and radiographic results. RESULTS: There were 7 patients without a hinge fracture and 16 patients with one or more hinge fractures at 2 days postoperation. There were 90 hinges, and the rate of ideal greenstick deformation of the hinge was 63% on 2-day-postoperative CT scans. Postoperative VAS scores of neck pain (p=0.012) in patients without a hinge fracture were higher than in patients with hinge fractures. The hinge healing rates were 37% at 3 months, 57.4% at 6 months, 86.4% at 12 months, and 85.4% at 24 months. Among the patients, 14 patients had healed hinges, and 7 patients had one or more hinge(s) that was/were not healed at 12 months post-operation. However, in clinical and radiographic outcomes, there was no difference between these patients. CONCLUSION: Cervical open door laminoplasty was safe and provided stable reconstruction of laminar expansion. In radiographs, the difference between hinges that had healed and hinges that had not healed was statistically negligible. Hinge fractures might not influence the clinical and radiographic outcomes of cervical open door laminoplasty.

Brain Metastases of Papillary Thyroid Carcinoma with Horner's Syndrome

Papillary thyroid carcinoma (PTC) is the most common type of thyroid malignancy and has relatively favorable prognosis. Blood-borne metastases of PTC are very rare among the thyroid malignancies. Moreover a case of blood-borne central nervous system metastasized PTC with only unilateral Horner's syndrome, and without any abnormalities in laboratory or physical examinations has not been described before. A 53-year-old female patient had been managed in ophthalmologic clinic due to vague symptoms of right monocular blurred vision with eye dryness for 3 months, but showed no signs of improvement. So it was performed a magnetic resonance imaging and magnetic resonance angiography to evaluate the possibilities of cerebral lesion. And a left frontal mass was incidentally found, and the tumor turned out to be a PTC that had metastasized to brain, regional lymph node, cervical, thoracic spine, and lung. We describe a PTC with extraordinary initial symptoms that metastasized to an unusual site. We recommend that if a papillary thyroid tumor with unusual symptoms or at an advanced stage is found, further investigation should be performed for distant metastasis.

A Case of Nevus Sebaceous in the External Ear / 대한이비인후과학회지

Nevus sebaceous is a rare tumor in the external ear. It is clinically important because this tumor has chance to progress to benign or malignant neoplasm. This change generally occurs after adolescent age. The most common malignant neoplasm arising in this lesion is basal cell carcinoma. Therefore, many authorities recommend complete excision before puberty. A 9-year-old boy visited our clinic with multiple nevi sebaceous involving the pinna and external auditory canal. The tumors were removed completely and the defect was covered with skin graft. There has been no evidence of recurrence as of 10 months following the surgery. We report this case with a review of literature.

Bilateral Pneumothorax and Pneumomediastinum Following Total Thyroidectomy with Central Neck Dissection

We describe a 60-year-old woman who developed extensive emphysema, bilateral pneumothorax, and pneumomediastinum after total thyroidectomy and central neck dissection with sacrifice of a recurrent laryngeal nerve. In this report, we discuss the possisle etiology of those rare complications.

PMA-induced up-regulation of MMP-9 is regulated by a PKCalpha-NF-kappaB cascade in human lung epithelial cells

Expression of matrix metalloproteinase-9 (MMP-9) is associated with airway remodeling and tissue injury in asthma. However, little is known about how MMP-9 is up-regulated in airway epithelial cells. In this study, we show that phorbol myristate acetate (PMA) induces MMP-9 expression via a protein kinase Calpha(PKCalpha)-dependent signaling cascade in BEAS-2B human lung epithelial cells. Pretreatment with either GF109203X, a general PKC inhibitor, or Go6976, a PKCalpha/beta isozyme inhibitor, inhibited PMA-induced activation of the MMP-9 promoter, as did transient transfection with PKCalpha antisense oligonuclotides. PMA activated NF-kappaB by phosphorylating IkappaB in these cells and this was also inhibited by GF109203X and Go6976, suggesting that PKCalpha acts as an upstream regulator of NF-kappaB in PMA-induced MMP-9 induction. Our results indicate that a "PKCalpha-NF-kappaB"-dependent cascade is involved in the signaling leading to PMA-induced MMP-9 expression in the lung epithelium.

Efficacy of the Harmonic Scalpel in Parotidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The use of the harmonic scalpel recently has been described in various surgery, such as thyroidectomy, tonsillectomy and submandibular gland resection. It appears that the use of harmonic scalpel results in decreased operative time and blood loss compared to conventional techniques of vessel ligation and tissue division without increasing the incidence of nerve injury. The aim of this study was to determine whether the application of harmonic scalpel in parotidectomy was effective and safe compared to conventional parotidectomy techniques. SUBJECTS AND METHOD: From March 2001 through Jun 2005, 21 patients who underwent parotidectomy under aid of Harmonicscalpel were compared with 38 patients of conventional parotidectomy techniques. Intraoperative blood loss, operation time, facial nerve injury, wound complication, postoperative drainage and hospital stay were compared between two groups. RESULTS: There were no significant differences between two groups with postoperative wound complication, facial nerve function and hospital stay. But the use of harmonic scalpel was associated with a significant reduction in operation time and intraoperative blood loss. CONCLUSION: The application of harmonic scalpel was very useful and relatively safe in parotidectomy. However, further research involving a randomized study is needed.

Olfactory Neuroblastoma Arising from the Inferior Meatus of Nasal Cavity: A Case Report and Review of the Literature / 대한이비인후과학회지

Olfactory neuroblastoma is a rare tumor of nasal cavity arising from the olfactory neuroepithelium. It is usually presented as a polypoid mass high in the nasal vault including cribriform plate, superior turbinate, and superior portion of nasal septum. Recently, we experienced a case of olfactory neuroblastoma occurred from very atypical location. An 89-year-old man visited our department with symptoms of occasional left nasal bleeding and obstruction. On the endoscopic examination, a polypoid mass with bleeding tendency was observed in the left inferior meatus, but other portions of nasal cavity showed normal appearance. Biopsy was performed and the final pathologic report turned out as olfactory neuroblastoma. We report this unusually presenting case of olfactory neuroblastoma with a review of the literature.

Comparative Study on the Long-Term Effectiveness between Coblator- and Microdebrider-Assisted Partial Turbinoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various surgical methods have been tried to relieve the symptoms of nasal obstruction in patients with inferior turbinate hypertrophy. Recently, coblators that use radiofrequency and microdebriders are increasingly used in turbinate surgery. The aim of this study was to compare the long-term postoperative outcome between the coblator-assisted and microdebrider-assisted partial turbinoplasty. SUBJECTS AND METHOD: We selected 60 patients who had nasal obstruction and hypertrophied turbinate mucosa that was refractory to medical treatment. Thirty patients were treated with coblator (group 1) and 30 patients were treated with microdebrider (group 2). Postoperative changes in degree of nasal obstruction were evaluated prospectively at 3, 6 and 12 months after the procedure. Cross-sectional area of second notch and volume of nasal cavity were compared at 12 months after operation. Operation time, duration of crust formation, postnasal drip and postoperative bleeding were also compared. RESULTS: Nasal obstruction was improved significantly in both groups. However, statistical significance of improvement and rate of patient's satisfaction at 12 months after surgery was higher in group 2. There were no significant differences in the degree of postnasal drip, operation time and duration of crust formation between two groups. CONCLUSION: This study suggests that microdebrider-assisted partial turbinoplasty is more effective and satisfactory in long-term relief of nasal obstruction and reduction of mucosal volume in the anterior head of inferior turbinate.

Human Activated Lymphocyte Treated with Anti-CD3, CD16, CD56 Monoclonal Antibody and IL-2

BACKGROUND: Throughtout the last three decades, the therapy of leukemias and lymphoma has set the stage for curative cancer therapy in systemic malignant disease. This was the result of an integrated work of basic reaserch and clinical investigators leading to more aggressive albeit tolerable protocol of chemotherapy and radiotherapy. High dose therapy marks the most elaborated strategies in this field today. However, intensification of conventional therapeutic modalities as mentioned has to be based on new approaches and the exploration of new antineoplastic mechanisms. This insight has resulted in immune therapy of cancer. Among the cells of the immune system, natural killer (NK) cells and T cells are of major interest for the development of therapeutic strategies. METHODS: Cytotoxicity to target cells was measured by LDH release method, Characterization of activated lymphocyte was measured by Flow cytometry analysis. Anti-CD3, 16, 56 monoclonal antibody and IL-2 were used for the activation of NK and T cell. The analysis of effect of activated lymphocyte, in vivo, were used by Balb/c nude mouse. RESULTS AND CONCLUSION: Cytotoxicity to K562 cells was significantly higher in the mixture group of NK and T cells than that of a group of activating T cells. The survivors and the rate of reduction of size of tumor craft of nude mouse group treatment with activated lymphocyte was higher than that of the group without treatment with activated lymphocyte. Therefore, this results are suggested that the activated lymphocytes by anti-CD3, CD16 and CD56 can reduce the malignancy effect of lymphoma.

Breast Metastases from Malignant Melanoma / 한국유방암학회지

Breast metastases from extramammary primary tumors are uncommon, accounting for approximately 1.3~6.6% of all malignant mammary tumors. Apart from hematopoietic neoplasms, malignant melanoma is one of the most common neoplasms with which secondary involvement of the mammary parenchyme is known. Although they are so rare, breast metastases from such neoplasms can mimic primary breast carcinoma clinically and on imaging studies. Approximately 20% of the patients affected by malignant melanoma will develop metastases, the commonest sites being liver, lung, and brain; metastases to the breast from malignant melanoma are rare, and in about 40% of the patients affected the breast lesion is the first manifestation of disease. Correct management of metastatic disease to the breast can prevent unnecessary mutilation; in fact, in the majority of patients so far widespread metastases have appeared rapidly despite various systemic treatments, showing that major surgery gives very poor results in terms of controlling the disease. In this paper, we present the case of a 49-year-old woman with a history of a malignant cutaneous melanoma of nasal cavity that had been surgically excised in 2004. She was admitted to our Breast Division 6 months later because a screening mammogram and anultrasound evaluation had revealed the presence of a nodular opacity in the both breast, without any clinical manifestations. For this reason, in September 2004 the patient underwent a simple mastectomy of both breasts.

Intraductal Mucosal Spreading Mucin Secreting Intrahepatic Cholangiocarcinoma / 한국간담췌외과학회지

Peripheral cholangiocarcinoma refers to an adenocarcinoma arising from the bile ducts peripheral to the secondary confluence. The growth pattern of the peripheral cholangiocarcinoma may be classified into the mass-forming type, the infiltrating type, the intraductal polypoid type and the combined type. Intraductal mucosal spreading, mucin secreting intrahepatic cholangiocarcinoma is a rare subtype of peripheral cholangiocarcinoma. Its existence has been neglected due to its paucity. A 59-year old male who presented with jaundice was admitted to our hospital because of recurrent cholangitis. A MRI of the abdomen showed the dilated intrahepatic duct without mass lesions. Left hepatectomy was done with negative surgical margins. The pathologic diagnosis was intraductal mucinous type cholangiocarcinoma without stromal invasion. Intrahepatic duct stone was found. The postoperative duodenal ulcerous bleeding was treated by suture ligation of the bleeding vessels of the duodenum. The patient discharged 65 days after the operation.

Development and Effectiveness of a Program for Relieving 'Hwa-Byung' Symptoms / 간호학회지

PURPOSE: This one group experimentation was designed to develop a program for relieving 'Hwa-Byung'(HB) symptoms and examine its effects on HB symptoms, pain threshold emotions like anger, anxiety and depression. METHOD: The program consisted of three components the change of the cognitive thoughts, the formation of a supportive network, and induction of mind-body relaxation. Sixteen middle-aged women with HB were divided into three groups for group dynamics according to the time of the recruitment. Data was collected for nine months at three time points, before, immediately after, and one month later of its application. RESULT: There were statistically significant differences in the severity level of state anger, state anxiety, depression, and HB symptoms according to the time interval. The means of state anger and state anxiety were reduced after the intervention, but it was slightly increased one month later. The means of depression and HB symptoms were continuously reduced after the intervention and one month later. CONCLUSION: This was the first management program for HB women in Korea. A future study must be done with the research design formethodological strength revision of the program.

Recurrence and Management of Hepatitis C after Liver Transplantation / 대한간학회지

BACKGROUND/AIMS: End-stage liver disease caused by viral hepatitis C has been increasing recently in Korea. In this study, we investigated the clinical progress, recurrence, and management of hepatitis C patients who underwent liver transplantation. METHODS: We retrospectively reviewed the clinical progress and management of 16 patients (2.7%) with hepatitis C among 587 liver transplant patients from August 1992 to August 2002. RESULTS: Eleven cases among 16 patients were males. The median age was 56 +/- 6 (42-62) years and the median follow-up period was 6 +/- 13 (1-41) months. Thirteen cases underwent living donor liver transplantation and three had cadaveric whole liver transplantation. Clinical recurrence occurred in nine cases (56.3%) and mean time of recurrence was 5.2 months. Histological recurrence cases were eight (50%). A positive result of HCV RNA PCR was found in 90.9%, and all cases of clinical and histological recurrence in groups in the same periods were PCR-positive. Among eight cases showing histological recurrence, five patients were managed by ribavirin monotherapy, two patients received interferon and ribavirin combination therapy, and one patient was not treated at all. The serum aminotransferase level was normalized in six cases (75%) of them. CONCLUSIONS: We observed that the HCV reinfection rate of a transplanted liver was high in this study, as in other reports in the literature. The prevention of HCV recurrence and the management of post-recurrent cirrhotic change are crucial for graft and patient survival. We think customized protocols are needed for every situation of recurrent hepatitis C.

Clinical Analysis of the New Handling Method of Pancreatic Cut Surface in Pancreatoduodenectomy / 한국간담췌외과학회지

BACKGROUND/AIMS: Pancreatoduodenectomy is a common procedure for benign or malignant periampulary diseases. But the morbidity and mortality of the procedure are usually high. Being related with morbidity and mortality, the most important procedure of pancreatoduodenectomy is how handle the remnant pancreas. We analysed retrospectively the efficiency of the new method for low morbidity and low mortality in handling of the remnant pancreas in the procedures of pancreatoduodenectomy. METHODS: 118 consecutive patients who had undergone a pancreatoduodenectomy and pancreaticojejunostomy performed by one surgeon, between September 1994 and June 1999, were evaluated retrospectively. The cases were analysed by age, sex, pathologic dianosis, operation time, the amount of transfusion during operation, the hospital stay, postoperative complications and state of survival. RESULTS: The average age of 118 patients was 57.6 years, and the male and female ratio was 1.19:1. The classification by patholoic diagnoses were distal common bile duct cancers (29%), the ampulla of Vater cancers (23%), the pancreas head cancers (14%), the duodenal cancers (1.7%) and the others (32%) including benign diseases. The average operation time was 8 hours 3 minutes, the average amount of transfusion was 0.84 unit and the average hospital stay was 26.1 days. There are 12 (10.2%) postoperative complications. The most were 6(5%) cases of delayed gastric emptying, and the others were 2 (1.7%) cases of leakage of pancreaticojejunostomy, 1 (0.8%) case of ARDS, 1 (0.8%) case of gastroduodenal artery bleeding, 1 (0.8%) case of remnant pancreas bleeding, and 1 (0.8%) case of pseudoaneurysmal bleeding of gastroduodenal artery. The 2 cases of leakage of pancreaticojejunostomy developed at the patients of duodenal cancer and ampulla of Vater cancer. The patient who diagnosed by ampulla of Vater cancer died for sepsis due to leakage of the pancreaticojejunostomy (1/118, 0.8%). CONCLUSION: We had good results in pancreatoduodenectomy and pancreaticojejunostomy by a new method that protect the anastomotic leakge from pancreaticojejunostomy site. This method include pancreas transection by elctrocoagulation, not doing sutures of remnant pancreas to prevent ischemic change of pancreatic cut surface and complete drainage of pancreatic juice using stent that was inserted at remnant pancreatic duct and externally ligated by vicryl with keeping the lumen.

Acute Myocardial Infarction after the Use of Sildenafil Citrate(Viagra(R))

Erectile dysfunction(ED) is defined as the inability to achieve and/or maintain an erection which is sufficient for satisfactory sexual activity. Risk factors for ED include many of the same risk factors for cardiovascular disease: hypertension; lipid abnormalities, including low high-density lipoprotein cholesterol; diabetes; and smoking. Therefore, some patients with ED will have ischemic heart disease. Viagra(R), an oral therapy for ED, is the citrate salt of sildenafil, a selective inhibitor of cyclic guanosine monophosphate(cGMP)-specific phosphodiesterase 5(PDE5). The adverse effects of sildenafil include headache, flushing, dyspepsia, nasal congestion, visual disturbance, and cardiovascular complications. A general impression exists that cardiovascular complications of sildenafil occur mainly when the drug is taken concomitantly with nitrate. We report the case of a 52-year-old man who developed an acute myocardial infarction shortly after taking one tablet of sildenafil without sexual activity. The patient had not been using nitrates. Physicians treating patients with chest pain should be aware of the potential consequences of giving nitrates to patients taking sildenafil. We suggest that before initiating therapy, the history of sildenafil ingestion be obtained from patients with suspected myocardial infarction.

A Case of Ankyloblepharon Filiforme Adnatum

Fusion of the eyelid margins is normal in human fetal development, but it is abnormal at birth. The approximated margins of developing eyelids fuse during the 9 th week of gestation and remain fused until the end of the 5 th month of gestation. Subsequently, they became separated although the process may not be completed until the 7 th month of gestation. On occasion, the entire or a portion of eyelid margins remain fused postnatally, resulting in a spectrum of eyelid abnormalities that are usually classified according to the morphology. Ankyloblepharon filiforme adnatum comprises single or multiple fine bands of extensile tissue connecting the lid margins at the grey line and it reduces the palpebral fissure by interfering with the movements of lids. This abnormality has been reported as an isolated finding, in association with other anomalies, or as a part of a well-defined syndrome. We have experienced a case with this syndrome. Then we report this rare case with brief review of literature.

Exposure to lonizing Radiation in the Emergency Department from Performed Portable Radiographs

To accurately assess the potential hazard of exposure to ionizing radiation from portable radiographs taken in the emergency department,.a study was performed to measure such radiation at different distances from the edge of an irradiated field during portable cervical spine, portable chest radiographs, and portable anteroposterior pelvis radiographs. For all three types of portable radiographs, radiation exposure is high at the edge from the beam. However, radiation exposure is deceased at 20, 40, 80, 160cm away from the beam. This study confirms and supports the evidence that although radiation exposure is dependent on distance from the primary radiograph beam, exposure in the ED is minimal. Medical personnel should not have to leave a patient care area for fear of undue acute and chronic radiation exposure while portable radiographs are performed in the ED. By using protective garments and standing appropriate distance away from the patient, continuous patient care can be maintained while portable radiographs are taken in the ED.