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1.
Clinical Endoscopy ; : 744-753, 2023.
Article in English | WPRIM | ID: wpr-1000061

ABSTRACT

Background/Aims@#This study aimed to evaluate the prevalence and natural progression of subepithelial lesions (SELs) in the upper gastrointestinal (UGI) tract. @*Methods@#The medical records of patients with UGI SELs who underwent endoscopic screening at eight university hospitals between January and December 2010 were retrospectively investigated. The follow-up evaluations were performed until December 2016. @*Results@#UGI SELs were found in 1,044 of the 65,233 participants screened (endoscopic prevalence, 1.60%; the total number of lesions, 1,062; mean age, 55.1±11.2 years; men, 53.6%). The median follow-up period was 48 (range, 8–74) months. SELs were most frequently found in the stomach (63.8%) and had a mean size of 9.9±6.1 mm. Endoscopic ultrasonography (EUS) was performed in 293 patients (28.1%). The most common lesions were leiomyomas, followed by gastrointestinal stromal tumors (GISTs), and ectopic pancreas. The proportions of SELs with malignant potential according to size were 3% (<1 cm), 22% (1–2 cm), 27% (2–3 cm), and 38% (≥3 cm). In gastric SELs larger than 1 cm, resections were performed in 20 patients because of an increase in size, of which 12 were found to be GISTs. @*Conclusions@#The prevalence of UGI SELs was 1.60%. Further, 23% of gastric SELs ≥1 cm were precancerous lesions, most followed by EUS and clinical decisions without initial pathological confirmation.

2.
Archives of Craniofacial Surgery ; : 230-235, 2023.
Article in English | WPRIM | ID: wpr-999530

ABSTRACT

Solitary fibrous tumor (SFT) is an infrequently occurring neoplasm most commonly observed in the pleura, but it can develop in the head and neck region in occasional cases. However, no reports have described SFT in the temporalis muscle. Herein, we present the first known case of SFT in the temporalis muscle. A 47-year-old man complained of a painless palpable mass on his right temple. Facial enhanced computed tomography identified a 4.0× 2.9× 1.4 cm mass presenting as a vascular tumor in the right temporalis muscle under the zygomatic arch. The mass was excised from the right temporalis muscle under general anesthesia. A histopathologic examination revealed that the mass was an SFT. No complications occurred after surgery, including functional disability or sensory loss. The patient was followed up for 3 months without complications. Although SFT in extrapulmonary regions is rare, it should be considered in the differential diagnosis of masses that occur in the temporal area.

3.
Archives of Craniofacial Surgery ; : 117-123, 2023.
Article in English | WPRIM | ID: wpr-999522

ABSTRACT

Background@#Midfacial fractures frequently involve the maxillary sinus, leading to maxillary sinus pathology. We aimed to examine the incidence and contributing factors of maxillary sinus pathology in patients who underwent open reduction and internal fixation (ORIF) for midfacial fractures. @*Methods@#A retrospective analysis was conducted on patients who underwent ORIF for midfacial fractures at our department over the past 10 years. The incidence of maxillary sinus pathology was identified clinically and/or by computed tomography findings. Factors that significantly influenced the groups with and without maxillary sinus pathology were examined. @*Results@#The incidence of maxillary sinus pathology in patients who underwent ORIF for midfacial fractures was found to be 11.27%, with sinusitis being the most common pathology. Maxillary sinus pathology was significantly associated with the presence of a blowout fracture involving both the medial and the inferior orbital walls. Factors such as sex, age, diabetes mellitus, hypertension, smoking, inflammatory disease, follow-up period, use of absorbable plates, and use of titanium plates did not have a significant impact on the development of maxillary sinus pathology. @*Conclusion@#The incidence of maxillary sinus pathology in patients who underwent ORIF for midfacial fractures was relatively low, and in most cases, it resolved without the need for specific treatment. Consequently, there may not be a significant need for concern regarding postoperative maxillary sinus pathology.

4.
Archives of Craniofacial Surgery ; : 10-17, 2023.
Article in English | WPRIM | ID: wpr-966335

ABSTRACT

Background@#Lipomas are common benign tumors of mesenchymal origin that are composed of mature adipocytes. Giant lipomas have a diameter ≥ 10 cm in one or more dimensions or weigh at least 1,000 g. The surgical excision of a giant lipoma requires extensive dissection, increasing the risk of a seroma, which can cause surgical site complications such as wound infection and necrosis. Sclerotherapy with Abnobaviscum (Viscum album extract) is a relatively new technique used to reduce malignant pleural effusion. In this study, we evaluated the effectiveness of prophylactic sclerotherapy using Abnobaviscum to decrease seroma after giant lipoma excision. @*Methods@#We conducted a retrospective medical record review of patients who underwent surgical excision for giant lipoma of the neck from January 2019 to December 2022. Sclerotherapy was performed on the first postoperative day in patients who consented to the procedure, and Abnobaviscum was instilled through the existing Hemovac drain. We compared the clinical course between those who underwent postoperative sclerotherapy and those who did not. @*Results@#Among the 30 patients who underwent giant lipoma excision, we applied sclerotherapy with Abnobaviscum to 15 patients. The average time from surgery to Hemovac removal was statistically shorter in patients who underwent sclerotherapy (p= 0.004). Furthermore, seroma formation was significantly reduced in patients receiving sclerotherapy (p= 0.003). @*Conclusion@#In patients undergoing giant lipoma excision, sclerotherapy using Abnobaviscum helps reduce postoperative seroma formation during the initial postoperative period. It can be an excellent method to reduce complications related to seroma and attenuate patients’ postoperative burden.

5.
Archives of Craniofacial Surgery ; : 37-40, 2023.
Article in English | WPRIM | ID: wpr-966331

ABSTRACT

Penetrating wounds to the face are cosmetically devastating and can be life-threatening. If the foreign body causing the penetrating wound is a piece of wood, small remnants might be left behind after the initial treatment. A 33-year-old male patient presented to the emergency center after a piece of lumber pierced his face as a passenger in a traffic accident. The patient’s vital signs were stable, and emergency surgery was performed to remove the foreign body and repair the soft tissue. No noteworthy complications were seen after open reduction and internal fixation of the facial bone fractures. Seven months after the accident, the patient underwent scar revision along with full-thickness skin grafting for post-traumatic scars. After the surgery, pus-like discharge which was not previously present was observed, and the graft did not take well. A residual foreign body, which was the cause of graft failure, was found on computed tomography and the remaining foreign body was removed through revision surgery. The patient is receiving outpatient follow-up without any complications 6 months after surgery. This case demonstrates the importance of performing a careful evaluation to avoid missing a residual foreign body, especially if it is of wooden nature.

6.
Archives of Craniofacial Surgery ; : 119-124, 2022.
Article in English | WPRIM | ID: wpr-937202

ABSTRACT

Background@#Many severe nasal bone fractures present with septal fractures, causing postoperative septal deviation and negatively affecting the patients’ quality of life. However, when a septal fracture is absent, it is difficult to predict whether surgical correction can help minimize nasal septal deviation postoperatively. This study determined whether performing closed reduction on even mildly displaced nasal bone fracture could deter the outcome of septal deviation. @*Methods@#We retrospectively reviewed the data of 116 patients aged 21–72 years who presented at the outpatient clinic and emergency room with fractures of nasal bones only without any involvement of the septum from January 2014 to December 2020. Patients were classified into three fracture type groups: A (unilateral), B (bilateral), and C (comminuted with depression). The degree of septal deviation was calculated by measuring the angle between the apex of the most prominent point and the crista galli in the coronal view on computed tomography images. The difference between the angles of the initial septal deviation and that of the follow-up was calculated and expressed as delta (Δ). @*Results@#Closed reduction tended to decrease the postoperative septal deviation in all fracture types, but the values were significantly meaningful only in type A and B fractures. In the surgical group, with type A as the baseline, type B showed a significantly larger Δ value, but type C was not significantly different, although type C showed a smaller Δ value. In the conservative group, with type A as the baseline, the other fracture types presented significantly lower Δ values. @*Conclusion@#For all fracture types, closed reduction significantly decreased the extent to which the nasal septum likely deviated. Therefore, when a patient is reluctant to undergo closed reduction, physicians should address the possible outcomes and prognosis of untreated nasal bone fractures.

7.
Archives of Aesthetic Plastic Surgery ; : 1-8, 2022.
Article in English | WPRIM | ID: wpr-913552

ABSTRACT

Background@#A recent concern in breast reconstruction procedures is skin color mismatch of the pedicled transverse rectus abdominis myocutaneous (TRAM) flap. With the goal of objectively quantifying the skin tone of the TRAM flap donor site, contralateral breast, and flap, a comparative study was conducted. @*Methods@#This study was conducted in July 2021, included 17 patients who received delayed breast reconstruction via TRAM flaps from January 2016 to December 2020 with at least 12 months of follow-up. Melanin levels and redness values of the flap, abdomen, and contralateral breast were measured in patients using a skin pigmentation analyzer. Furthermore, in 20 healthy women in their 40s to 60s, measurements were made of the abdomen, as well as breast. @*Results@#The contralateral breast had lower mean melanin and redness than the abdomen. The flaps had slightly higher melanin levels than the contralateral breasts. The flaps tended to have higher redness values, but the difference was not significant. The difference between the flap and abdomen was significant for melanin, but not redness. Preoperative radiotherapy did not affect skin tone. The upper abdomen showed lower melanin and redness than the lower abdomen. @*Conclusions@#The breast had a brighter skin tone than the abdomen. The upper abdomen showed brighter skin tone than the lower abdomen, and the area used as the donor site of the TRAM flap presented the same tendency. In the process of TRAM flap engrafting, the melanin level of the tissue decreases, and the redness value tends to increase slightly compared to the contralateral breast.

8.
Journal of Korean Medical Science ; : e181-2022.
Article in English | WPRIM | ID: wpr-925909

ABSTRACT

Background@#The number of users of electric scooters, which provide swift and convenient mobility options, has increased sharply over recent years as their distribution as a shared service has expanded. Although the number of accidents and related damage has increased accordingly, limited research has analyzed data on the new types of accidents arising from electric scooters. This study aimed to analyze data on trauma characteristics due to accidents that occurred during electric scooter use. @*Methods@#A retrospective chart review was conducted for patients who visited the regional trauma center of our institute due to electric scooter accidents from April 2018 to October 2021. Information was extracted on helmet-wearing status, sex, age, drinking status, accident timeframe, accident mechanism, electric scooter proficiency (period of use), injury severity, severe trauma, lethality, admission to the intensive care unit, surgery under general anesthesia, and the trauma region. @*Results@#Among the 108 patients involved in electric scooter accidents, 92 patients were not wearing a helmet. Eighty-nine patients (85.2%) were male. The average age of the patients without a helmet was 31.3 years, while that of patients with a helmet was 34.1 years. The most frequent causes of accidents were lack of electric scooter operation experience and falling off the scooter due to obstacles (90 cases). Whether surgery was performed under general anesthesia was not associated with helmet use or non-use, although all patients who underwent facial fracture surgery were not wearing a helmet. @*Conclusion@#The craniofacial region was most frequently affected in electric scooter accidents and wearing a helmet was the best way to prevent craniofacial trauma. Although helmetwearing is mandatory, the majority of treated patients were not wearing a helmet at the time of injury. Thus, there is an urgent need to introduce a helmet rental system, as well as strict legal requirements, to improve this situation.

9.
Gut and Liver ; : 474-482, 2022.
Article in English | WPRIM | ID: wpr-925027

ABSTRACT

Background/Aims@#Endoscopic ultrasonography (EUS) provides high-resolution images and is superior to computed tomography (CT) scan in diagnosing small pancreatic ductal adenocarcinoma (PDAC). As a result, the use of EUS for early detection of PDAC has attracted attention. This study aimed to identify the clinical and radiological characteristics of patients with PDAC diagnosed by EUS but not found on CT scan. @*Methods@#The medical records of patients diagnosed with PDAC at 12 tertiary referral centers in Korea from January 2003 to April 2019 were reviewed. This study included patients with pancreatic masses not clearly observed on CT scan but identified on EUS. The clinical characteristics and radiological features of the patients were analyzed, and survival analysis was performed. @*Results@#A total of 83 patients were enrolled. The most common abnormal CT findings other than a definite mass was pancreatic duct dilatation, which was identified in 61 patients (73.5%). All but four patients underwent surgery. The final pathologic stages were as follows: IA (n=31, 39.2%), IB (n=8, 10.1%), IIA (n=20, 25.3%), IIB (n=17, 21.5%), III (n=2, 2.5%), and IV (n=1, 1.4%). The 5-year survival rate of these patients was 50.6% (95% confidence interval, 38.8% to 66.7%). Elevated liver function testing and R1 resection emerged as significant predictors of mortality in the multivariable Cox regression analysis. @*Conclusions@#This multicenter study demonstrated favorable long-term prognosis in patients with PDAC diagnosed by EUS but indeterminate on CT scan. EUS should be considered for patients with suspected PDAC but indeterminate on CT scan.

10.
Gut and Liver ; : 354-374, 2021.
Article in English | WPRIM | ID: wpr-898451

ABSTRACT

Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy (KSGE) appointed a task force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in eight categories intended to help physicians make evidence-based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice.

11.
Clinical Endoscopy ; : 161-181, 2021.
Article in English | WPRIM | ID: wpr-897748

ABSTRACT

Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy (KSGE) appointed a Task Force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in 8 categories intended to help physicians make evidence-based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice.

12.
The Korean Journal of Gastroenterology ; : 73-93, 2021.
Article in English | WPRIM | ID: wpr-903564

ABSTRACT

Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy appointed a Task Force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in eight categories intended to help physicians make evidence-based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues.This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice

13.
Korean Journal of Pancreas and Biliary Tract ; : 125-147, 2021.
Article in Korean | WPRIM | ID: wpr-902372

ABSTRACT

Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy appointed a Task Force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in eight categories intended to help physicians make evidence-based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice.

14.
Korean Journal of Pancreas and Biliary Tract ; : 1-9, 2021.
Article in Korean | WPRIM | ID: wpr-875251

ABSTRACT

Pancreatic neuroendocrine tumors (PNETs) are rare tumors with malignant potential, but their incidence has appreciably increased over the last few decades. Diagnosis of PNETs is often difficult with conventional imaging methods. Cross-sectional imaging localizes less than 10% of PNETs less than 1 cm in diameter. Endoscopic ultrasound (EUS) has been shown to be superior to other imaging techniques in the preoperative localization and diagnosis of PNETs. The finding of a hyperenhanced lesion on contrastenhanced EUS was highly predictive of PNETs different from adenocarcinoma. Preoperative assessment of tumor differentiation and Ki-67 is an important prognostic factor for grading. Thus, EUS-guided fine needle biopsy may play a key role in the work-up of nonfunctioning PNETs, and attempts to measure Ki-67 on cytologic and histologic samples have been made. According to the European Neuroendocrine Tumor Society guidelines, there is no clear evidence of a survival benefit of surgery for nonfunctioning G1 PNETs <2 cm in diameter. The benefits of curative surgery must be weighed against operative morbidity and mortality. Although surgical resection remains the mainstay for PNETs, EUS-guided ablation offers a relatively safe and effective treatment option in patients deemed unfit for, or who do not want to undergo, surgery. EUS-guided ablation provides an attractive therapeutic nonsurgical option for patients; however, further studies that better elucidate the long-term outcomes with standardization of technique will help define its role in the treatment of PNETs. The role of EUS in the diagnosis and treatment of PNETs is expected to make much progress in the future.

15.
Archives of Plastic Surgery ; : 3-9, 2021.
Article in English | WPRIM | ID: wpr-874267

ABSTRACT

Background@#For an attractive and natural tip contour in Asian rhinoplasty, insertion of a nasal implant and reinforcement of the cartilaginous framework are essential. However, scar contracture, which often results from augmentation with implant insertion and inadequate soft tissue coverage of the framework, is one of the most common causes of alar retraction. This study reports a novel method of redraping soft tissue along the alar rim to prevent alar retraction in Asians. @*Methods@#Twenty young Asian men who underwent primary rhinoplasty with septoplasty were retrospectively reviewed. After the usual rhinoplasty procedures, alar rim redraping was conducted for the soft tissue along the transcolumellar and bilateral infracartilaginous incisions. The longest axis of the nostril (a) and the height of the nostril from that axis (b) were measured in anterior-posterior and lateral views. The preoperative and postoperative ratios (b/a) were analyzed using the paired t-test. @*Results@#All 20 patients showed natural contours of the nasal tip, nostrils, and alae after a mean follow-up of 53.6 weeks (range, 52–60 weeks). The ratio of the nostril axes significantly decreased postoperatively in all patients except one, by an average of 11.08%±6.52% in the anterior-posterior view and 17.74%±8.49% in the lateral view (P<0.01). There were no complications, including asymmetry, contracture, subdermal plexus injury, flap congestion, or infection. @*Conclusions@#A quantitative analysis of alar retraction by evaluating the ratio of nostril axes showed that alar rim redraping is a simple and effective adjuvant technique for preventing alar retraction in rhinoplasty for young Asian men.

16.
Archives of Craniofacial Surgery ; : 280-284, 2021.
Article in English | WPRIM | ID: wpr-913565

ABSTRACT

Primary cutaneous marginal zone B-cell lymphoma (PCMZL) is an uncommon type of malignant lymphoma that mainly occurs in the trunk and upper extremity, with less frequent incidence observed on the head. Herein, we report the early diagnosis and treatment of a rare case of facial PCMZL in an Asian patient. A 51-year-old man presented with masses on the forehead and nose tip, which he had incidentally discovered 2 months previously. The masses appeared as a papule on the forehead and a patch on the nose. There were no signs of infection or bleeding, and the patient reported no other symptoms. After complete surgical excision, PCMZL was diagnosed based on the permanent biopsy. The histopathological findings revealed lymphoid aggregations with multifocal granulomas. Further treatment and follow-up were conducted at the hematology and oncology department. Despite its rarity in Asian populations, cutaneous lymphoma should be included in the differential diagnosis of facial masses. Early diagnosis and treatment based on a physical examination, imaging study, and excisional biopsy are important for a favorable prognosis.

17.
Archives of Craniofacial Surgery ; : 310-318, 2021.
Article in English | WPRIM | ID: wpr-913560

ABSTRACT

Background@#Transcutaneous lower eyelid approaches are associated with a risk of postoperative scarring depending on the distance between the incision line and the lower eyelid margin. The lower eyelid crease of Caucasians corresponds to a ridge-shaped fold in young Asians. However, this relationship has not been sufficiently evaluated in the latter. The authors, therefore, investigated the location of the scar and the lower eyelid crease or ridge to find the optimal location for the incision line. @*Methods@#This study included 60 out of 139 patients who underwent inferior orbital wall reconstruction through a lower eyelid skin incision between July 2019 and June 2020. According to the location of the scar, the patients were classified into three groups: group A ( ≥ 2 mm above the lower eyelid crease or ridge), group B (within the lower eyelid crease or ridge to 2 mm above the lower eyelid crease or ridge), and group C (within the lower eyelid crease or ridge to 2 mm below the lower eyelid crease or ridge). At 6 or 12 months after surgery, the Patient and Observer Scar Assessment Scale (POSAS) score was obtained, the distance between the lower eyelid margin and the scar (DMS) and the distance between the margins of the peripheral pupil and the lower eyelid (DMPE) were measured, and the occurrence of ectropion was evaluated. @*Results@#Group B had the lowest POSAS score (A: 22.7 ± 8.0, B: 20.9 ± 2.4, C: 32.5 ± 4.1, p < 0.001). Linear regression analysis showed that the DMS was positively correlated with the POSAS score (p < 0.001) and that the risk of DMPE widening increased as the DMS decreased (p = 0.029). None of the patients had ectropion. @*Conclusion@#When using the transcutaneous approach for inferior orbital wall reconstruction, the optimal incision site is within the lower eyelid crease or ridge to 2 mm above the lower eyelid crease or ridge.

18.
Archives of Craniofacial Surgery ; : 168-172, 2021.
Article in English | WPRIM | ID: wpr-897068

ABSTRACT

Posttraumatic pseudoaneurysm of the face is caused by blunt, penetrating, or surgical trauma. Although its incidence is low, pseudoaneurysm rupture can cause a life-threatening, massive hemorrhage. A 48-year-old man visited our emergency center due to a fall-down accident. Three-dimensional computed tomography (CT) showed a comminuted zygomaticomaxillary complex fracture of the left face. After open reduction and internal fixation, the surgical wound healed without any complications. However, the patient was readmitted 10 days after surgery due to pus-like discharge from the wound. Contrast-enhanced CT to find the abscess unexpectedly revealed a pseudoaneurysm in the left retromaxillary area. Massive oral bleeding occurred on the night of re-hospitalization and emergency surgery was done. The bleeding site was identified as a pseudo-aneurysmal rupture of the posterior superior alveolar artery in the retromaxillary area. Hemostasis was achieved by packing Vaseline gauze in the maxillary sinus using an endoscope. Delayed rupture and massive bleeding of posttraumatic retromaxillary pseudoaneurysm after a zygomaticomaxillary fracture is a low-probability, but high-impact event. Therefore, additional contrast-enhanced CT should be considered to evaluate the possibility of a posttraumatic pseudoaneurysm in cases of severe comminuted zygomaticomaxillary fracture.

19.
The Korean Journal of Gastroenterology ; : 73-93, 2021.
Article in English | WPRIM | ID: wpr-895860

ABSTRACT

Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy appointed a Task Force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in eight categories intended to help physicians make evidence-based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues.This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice

20.
Korean Journal of Pancreas and Biliary Tract ; : 125-147, 2021.
Article in Korean | WPRIM | ID: wpr-894668

ABSTRACT

Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy appointed a Task Force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in eight categories intended to help physicians make evidence-based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice.

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