Clinical Results of Subtotal Fasciectomy for Treatment of Dupuytren Contracture / 대한정형외과학회잡지

PURPOSE: In the treatment of Dupuytren's contracture, the aim of optical treatment is to lower the recurrence rate and reduce complications. This paper reports the results of subtotal fasciectomy in Dupuytren's contracture, extending the excision of palmar fascial structures from the diseased to normal appearing adjacent fascial structure. MATERIALS AND METHODS: From 2007 to 2017, 45 patients with Dupuytren's contracture treated by subtotal fasciectomy were reviewed retrospectively. The mean follow-up period was 45.9 months. Ninety-two digits were involved (index: 2, middle: 10, ring: 44, little: 36). The predisposing factors and affected joint were reviewed and the preoperative and postoperative contracture was measured. For clinical results, quick disabilities of the arm, shoulder, and hand (quick DASH) were used. Complications, including wound or skin problems, nerve injuries, hematoma, and complex regional pain syndrome, were assessed. RESULTS: Preoperative flexion contracture was 43.2° in the proximal interphalangeal joint and 32.9° in the metacarpophalangeal joint. In nine cases, patients had residual contracture of 9.7° (range, 5°–20°) on average and if the total number of cases were included, the mean residual contracture was 2.3° on average. The quick DASH score at the 12 months follow-up was 12.4. The overall complication rate was 26.6%. CONCLUSION: Subtotal fasciectomy can be a good surgical treatment option for Dupuytren's contracture with a low recurrence and low complication rate compared to other open procedures.

The Effects of Clinical Pathway of Nursing on Pulmonary Function Index and Complications in Patients with COPD / 昆明医科大学学报

Objective To explore the effects of clinical pathways of nursing on pulmonary function index and complication in patients with COPD. Methods From October 2015 to June 2017, 94 patients with COPD were divided into two groups according to the order of admission and the nursing method: 47 patients undergoing routine nursing care and 47 patients receiving clinical pathways of nursing. We compared the incidence of complications, lung function, satisfaction, sense of comfort, anxiety, average hospitalization, health knowledge score and hours of ventilator use between the observation group and the control group. Results The incidence of complications in the observation group was significantly lower than that in the control group (P＜0.05) . The lung function index of the observation group was better than that of the control group, but the difference was not statistically significant (P＞0.05) . In the observation group, the satisfaction, the sense of comfort and the health knowledge score were higher.The anxiety degree was lower and the average hospital stay and hours of ventilator use were shorter compared to the control group (P＜0.05) . Conclusion The clinical pathways of nursing are used to reduce the incidence of complications, to improve the lung function index, the nursing satisfaction, sense of comfort and health knowledge score,and to reduce the average length of hospital stay, anxiety and hours of ventilator use in patients with COPD care.

Comparison of the curative effect and safety of rifapentine and rifampicin in smear positive pulmonary tuberculosis patients / 中国生化药物杂志

Objective To compare the clinical therapeutic effect and safety of rifapentine and rifampicin in smear positive pulmonary tuberculosis patients.Methods A total of 80 patients with smear positive pulmonary tuberculosis were chosen in Changshan People's Hospital from June 2015 to July 2016,the patients were randomly divided into control group(n=40)and observation group(n=40).The control group used rifampicin treatment,observation group were treated with rifapentine therapy,the therapeutic effect and incidence of complications between two groups were compared.Results Proportion of the sputum smear negative,cavity closure and lesions absorption in the observation group after 6 months of treatment were significantly higher than those in the control group; peripheral blood T lymphocyte subsets CD3+,CD4+,CD8+ levels in two groups before treatment had no statistically significant differences; peripheral blood of T lymphocyte subsets CD3+,CD4+,CD8+ levels in the observation group after treatment were significantly higher than those in the control group(P<0.05); incidence of complications in observation group(7.5％)after treatment was significantly lower than that in the control group(17.5％)(P<0.05).Conclusion Compared with rifampicin in treatment of smear positive pulmonary tuberculosis patients,rifapentine has ideal treatment effect,can improve the immune function,low incidence of complications.

Clinical significance of the expression of VEGF and bFGF in the mucosa of hepatogenic ulcer / 国际检验医学杂志

Objective To investigate the expression of vascular endothelial growth factor(VEGF) and basic fibroblast growth factor(bFGF) in gastric mucosa of patients with hepatogenic ulcer,and to analysis the relationship between them and the incidence of complications and disease progression in patients.Methods During July 2014 to May 2016,133 cases of patients with hepatocir rhosis and portal hypertension associated with gastric or duodenal ulcer were selected as study object.Marginal tissue of ulcer were collected,and normal mucosa tissue were collected as control group.Reverse transcription-polymerase chain reaction(RT-PCR) detect the expression of VEGF mRNA and bFGF mRNA in 133 cases of normal gastric mucosa and 133 cases of marginal tissue of ulcer,including 52 cases of gastric ulcer activity period(GA),45 cases of gastric ulcer healing period(GH) and 36 cases of gastric ulcer scar period(GS).Spearman correlation coefficient analysis the correlation between the expression of VEGF mRNA and bFGF mRNA and complication rate.Results The expression of VEGF mRNA and bFGF mRNA in ulcer marginal tissues was significantly higher than that in normal mucosa tissues,the difference was statistically significant(P＜0.05).The expression of VEGF mRNA in GH and GS of patients was significantly higher than that in GA patients,the difference was statistically significant (P＜0.05),the expression of bFGF mRNA in GS of patients was significantly higher than that of GA patients,the difference was statistically significant(P＜0.05).Spearman correlation analysis showed VEGF mRNA and bFGF mRNA was negatively correlated with incidence rate of ulcer complications (rs=-0.672,-0.508,P＜0.05).Conclusion bFGF mRNA and VEGF mRNA may play an important role in the repair of hepatogenic ulcer.It is a potential clinical marker.

Clinical significance of the expression of VEGF and bFGF in the mucosa of hepatogenic ulcer / 国际检验医学杂志

Objective To investigate the expression of vascular endothelial growth factor(VEGF) and basic fibroblast growth factor(bFGF) in gastric mucosa of patients with hepatogenic ulcer,and to analysis the relationship between them and the incidence of complications and disease progression in patients.Methods During July 2014 to May 2016,133 cases of patients with hepatocir rhosis and portal hypertension associated with gastric or duodenal ulcer were selected as study object.Marginal tissue of ulcer were collected,and normal mucosa tissue were collected as control group.Reverse transcription-polymerase chain reaction(RT-PCR) detect the expression of VEGF mRNA and bFGF mRNA in 133 cases of normal gastric mucosa and 133 cases of marginal tissue of ulcer,including 52 cases of gastric ulcer activity period(GA),45 cases of gastric ulcer healing period(GH) and 36 cases of gastric ulcer scar period(GS).Spearman correlation coefficient analysis the correlation between the expression of VEGF mRNA and bFGF mRNA and complication rate.Results The expression of VEGF mRNA and bFGF mRNA in ulcer marginal tissues was significantly higher than that in normal mucosa tissues,the difference was statistically significant(P＜0.05).The expression of VEGF mRNA in GH and GS of patients was significantly higher than that in GA patients,the difference was statistically significant (P＜0.05),the expression of bFGF mRNA in GS of patients was significantly higher than that of GA patients,the difference was statistically significant(P＜0.05).Spearman correlation analysis showed VEGF mRNA and bFGF mRNA was negatively correlated with incidence rate of ulcer complications (rs=-0.672,-0.508,P＜0.05).Conclusion bFGF mRNA and VEGF mRNA may play an important role in the repair of hepatogenic ulcer.It is a potential clinical marker.

Drug Utilization in Korean Children with Kawasaki Disease

BACKGROUND: Kawasaki disease (KD) is an acute febrile, systemic vasculitis as a leading cause of acquired heart disease in children. Intravenous immunoglobulin G (IVIG) and aspirin are the standard initial therapy in the treatment of acute KD. The purpose of this study was to investigate drug utilization in children with KD, and to compare “IVIG + high-dose aspirin” and “IVIG + moderate-dose aspirin” in preventing cardiac complications. METHODS: We analyzed pediatric patient sample data compiled by the Health Insurance Review & Assessment Service from 2010 to 2015. We identified patients with KD using the KCD-6 code of M30.3. We excluded patients in chronic phase or ≥10 years. We also excluded patients who were diagnosed KD in November or December. Drug utilization pattern were assessed in acute KD patients and 30-day and 60-day cardiac complications were investigated between “IVIG + high-dose aspirin” group and “IVIG + moderate-dose aspirin” group. RESULTS: In acute phase, IVIG was administered to 95.8% patients, and 57.1% patients were prescribed moderate-dose aspirin and 25% patients were with highdose aspirin. Steroid use was rapidly increased from 4.0% in 2010 to 11.3% in 2015. Both 30-day and 60-day cardiac complications occurred less in “IVIG + high-dose aspirin” group compared to “IVIG + moderate-dose aspirin” group, but not statistically significant (0.9% vs 1.8%, p=0.252 for 30-day complication rate; 1.5% vs 2.7%. p=0.073 for 60-day complication rate). CONCLUSION: We were not able to demonstrate which aspirin therapy is superior for preventing cardiac complications in acute KD patients and further research is warranted.

Modified Peritoneal Dialysis Catheter Insertion: Comparison with a Conventional Method

PURPOSE: The conventional trocar and cannula method in peritoneal dialysis (PD) catheter insertion has its limitation in clinical setting. The aim of this study was to compare a modified method for percutaneous PD catheter insertion with the conventional method, and demonstrate advantages of the modified method. MATERIALS AND METHODS: Patients at a single center who had percutaneous PD catheters inserted by nephrologists from January 2006 until September 2012, using either a modified method (group M) or the conventional trocar and cannula method (group C), were retrospectively analyzed, in terms of baseline characteristics, complications experienced up to 3 months after the procedure, and the suitability of the procedure for patients. RESULTS: Group M included 82 subjects, while group C included 66 cases. The overall early complication rate in group M (1.2%) was significantly lower than that in group C (19.7%) (p<0.001). The catheter revision rate during timeframe for early complications was significantly lower in group M (0%) than in group C (6.1%) (p=0.024). When comparing Procedure time (1 h 3 min+/-16 min vs. 1 h 36 min+/-19 min, p<0.01), immediate post-procedural pain (2.43+/-1.80 vs. 3.14+/-2.07, p<0.05), and post-procedure days until ambulation (3.95+/-1.13 days vs. 6.17+/-1.34 days, p<0.01), group M was significantly lower than group C. There was no significant difference in total hospitalization period (14.71+/-7.05 days vs. 13.86+/-3.7 days). CONCLUSION: Our modified PD catheter insertion method shows its advantages in early complication rate, early complications revision rate, and the patients' conveniences.

The Result of Total Contact Cast with High Concentrate Silver (Ag+) Coated Foam Dressing in Diabetic Foot Ulcers / 대한족부족관절학회지

PURPOSE: The treatment of diabetic foot ulcers with total contact cast has been reported to be associated with numerous undesirable complications. This study shows that our technique of total contact casting that incorporates high concentration silver coated foam dressing. MATERIALS AND METHODS: Forty-four diabetic foot ulcers were treated with total contact cast along with high concentration silver coated foam dressing. Complication and healing rates were evaluated. RESULTS: Eighty five percent of the ulcers healed within 6 weeks with an overall complication rate of 7%. There were only two cases (5%) of infection and no recurrent ulceration and no another site new pressure ulcer in our study. CONCLUSION: Total contact casting incorporates high concentration silver coated foam dressing resulted in fewer complications rate and healing rate that is comparable to other studies.

Complications of Endoscopic Sinus Surgery in Geriatric Chronic Sinusitis

BACKGROUND AND OBJECTIVES: With advancement in technique and the skills of endoscopic sinus surgery (ESS), this surgery is being performed more on elderly people than before. We compared the complication in patients undergoing ESS who were > or =65 years of age with those <65 years. MATERIALS AND METHODS: We reviewed our database of cases that had ESS between 2002 and 2005. Demographics and patient characteristics and complications encountered intraoperatively and immediately postoperatively were reviewed. RESULTS: One hundred patients were older than 65 years of age compared with 100 patients who were 16-65 years old. The older group had a 5% revision rate compared with 3% in the younger group. Complication rates were 11% for the elderly compared with 8% for the younger group. There was a slight higher complication rate in the older group of people than in the younger group of people, but statistically no difference. CONCLUSION: In geriatric population, complications of ESS were mainly minor such as synechiae, orbital entry, hemorrhage, periorbital ecchymosis. Complication rate was not significantly different between geriatric group and adult control group. Therefore ESS in the geriatric group is as safe as that performed in the adult control group.

Related Clinical Finding Result on Complication of Tsutsugamushi Patients

BACKGROUND: Tsutsugamushi disease is an acute, rashed febrile disease that shows widely varying prognoses from unsymptomatic infection to death. Early diagnosis and treatment lead to speedy recovery. Otherwise, many complications develop. This research was carried out to analyze the factors that affect the development of complications by comparing Tsutsugamushi patients with complicaions with those without complications. METHODS: Among the acute febrile disease patients who visited the emergency center of Chosun University Hospital from January to December 2000, 41 patients were clinically and serologically confirmed as having Tsutsugamushi disease. They were divided into two groups; 14 patients with complications and 27 patients without complications. We analyzed the two groups for correlations between complications and sex, age, period of occurrence, transfer or not, vital signs, laboratory findings, period before treatment, and checks for the existence of underlying disease, eschar, eruption, chest Xrays, and early diagnosis. RESULTS: 1) The aged have a high incidence of the disease, but there was no correlation between age and complications. Also, there was no correlation based on sex. 2) Although fall has a high incidence of the disease, the other seasons have higher complication rates. 3) The complication incidence rate has no correlation with either blood pressure or heart rate, also it does no correlate with eschar and skin rashes. 4) In the laboratory findings, hemoglobin and platelet, and Bun/Cr correlate with the complicaton incidence rate, but the white blood cell count and AST/ALT do not. 5) The complication incidence rate was high when treatment was started 10 days after the onset of Tsutsugamushi disease and no early diagnosis had been given. CONCLUSION: Early diagnosis and treatment are most important in preventing complications of Tsutsugamushi disease because the factors that affect the developement of complications of Tsutsugamushi disase are found during early diagnosis. Patients with doubtful clinical symptoms and abnormal lab findings should be started on a program of antibiotic treatment.

Prospective Study on Success and Complication Rate of Central Venous Catheterization in a University-affiliated Hospital / 대한내과학회지

OBJECTIVES: The reported success rate of central venous catheterization ranged from 84% to 97.5%, and the complication rate from 0.3% to 12%. The most important contributing factor for complications reported by several authors was the physician's experience. We investigated the success and complication rates of central venous catheterization prospectively. We also evaluate the factors that contributed to complications at our institution as part of our quality assurance study. METHODS: Four hundred sixty five central venous catheterizations were conducted at the medical intensive care unit and the general ward of the hematology/ oncology Department of Asan Medical Center in Korea, from June to November, 1997. We surveyed the date and place of the procedures, ID numbers, age and sex of the patients, the training level of physicians, the types of catheters, initial puncture sites, success or failure, and complications. We grouped the purpose of procedures into 5 categories, such as hemodynamic monitoring, fluid therapy, chemotherapy, total parenteral nutrition, and others. RESULTS: The initial success rate, defined as the initial performer being able to insert the catheter without changing the skin puncture site, was 78.5%. The overall success rate for initial performers, including those who required multiple skin puncture sites, was 82.8%. The total success rate, including changing the performers (up to 4 performers), was 96.1%. The overall complication rate was 5.2% including pneumothorax (2.8%), hemothorax (0.2%), subcutaneous hematoma (1.1%), catheter tip malposition (0.9%), and air-embolism (0.2%). There were no differences in the complication rates with regards to the sex and age of the patient, initial puncture sites, the physician's training level between 1st and 2nd year residency, and vein localization. However, the complication rate differed significantly in relation to the number of initial punctures. Patients with 1-3 punctures had a complication rate of 4.3%, while patients with 4 or more punctures had a complication rate of 18.5%. CONCLUSION: The overall complication rate was 5.2% and pneumothorax occured in 2.8%. We expect that we can decrease the number of complications by taking over the procedure if the initial performer fails on the first or second attempt and by attempting the skin puncture not more than 4 times at initial trial.