Perceptions of fatherhood and confidence regarding neonatal care among fathers of high-risk neonates in South Korea: a descriptive study

Purpose@#The purpose of this study was to investigate perceptions of fatherhood among fathers of high-risk neonates and their confidence regarding neonatal care. @*Methods@#A study was conducted of 100 fathers whose neonates had been admitted to a neonatal intensive care unit (NICU) for at least 48 hours. Perceptions of fatherhood, neonatal characteristics, and fathers' confidence regarding neonatal care were measured using a self-reported questionnaire. The survey took approximately 10 minutes to complete and was completed anonymously. The factors that affected fathers' confidence regarding neonatal care were analyzed using multiple regression. @*Results@#The scores for positive and negative perceptions of fatherhood were relatively high at 4.27 and 3.42 out of 5 points, respectively. A positive perception of fatherhood was found to influence fathers' confidence regarding neonatal care. @*Conclusion@#NICU nurses should encourage fathers to effectively perform their parenting roles by implementing educational programs and interventions to promote positive perceptions of fatherhood and fathers' confidence regarding neonatal care after discharge.

Introduction of Multidisciplinary Team Approach for Head and Neck Cancer: Patient Satisfaction / 대한이비인후과학회지

Background and Objectives@#The head and neck multidisciplinary team (MDT) approach plays a crucial role in bringing together the ideas of various medical professionals. This study aimed to evaluate the early characteristics of the MDT approach for head and neck cancer and analyzed patients’ satisfaction.Subjects and Method We analyzed 450 head and neck cancer patients who received MDT care from August 2014 to June 2022. Patient satisfaction with MDT care was evaluated by selfadministered questionnaires consisting of 9 questions. @*Results@#Of 450, 298 (66.2%) were male and 152 (33.8%) were female. The mean age was 60.8±14.7 year. The most common primary site was the larynx (17.3%), followed by the oral cavity and oropharynx. A total of 726 cases of the MDT approach were performed in 266 MDT sessions, and the mean number of patients per MDT session was 2.74. The number of medical professionals participating in MDT ranged from a minimum of 3 to a maximum of 9, with a mean of 5.11. The mean running time of MDT meetings per case was 19.51 minutes. The time of the 2nd MDT was significantly shorter than that of the 1st or 3rd MDT. The mean score was close to very satisfactory in each of the 9 patient satisfaction questions. @*Conclusion@#We believe that the MDT approach is feasible and recommend its introduction for the treatment of head and neck cancer as most patients have shown very high satisfaction. Further studies on the role and efficacy of MDT care for head and neck cancer are necessary.

Analysis of Characteristics of Peripheral Arterial Ischemia in Premature Babies and Effects of Nitroglycerin Patch Application

Purpose@#The aim of this retrospective study was to analyze the characteristics of peripheral arterial ischemia and tissue necrosis in premature babies, as well as the effects of nitroglycerin. @*Methods@#In total, 513 newborns were enrolled who were admitted to the neonatal intensive care unit with a gestational age of 34 weeks or younger. Data were collected on general personal and clinical information, peripheral arterial ischemia, and nitroglycerin patch application in the premature infants. The collected data were analyzed using the x2 test, t-test, Mann-Whitney U test, logistic regression. @*Results@#Thirty-six (7.0%) infants had peripheral arterial ischemia, while 477 (93.0%) infants did not. Lower gestational age (x2=35.97, p<.001), lower birth weight (x2=29.40, p<.001), lower blood pressure (x2=23.10, p<.001), and insertion of an umbilical artery catheter (p<.001) were significantly associated with the occurrence of peripheral arterial ischemia. Among the preterm infants in whom nitroglycerin patches were applied, 30 (83.3%) premature infants without necrosis improved without complications, 4 (11.1%) showed hypotension, and 2 (5.6%) showed skin damage. @*Conclusion@#Based on a review of our experiences with nitroglycerin patches, we recommend closely observing skin color and using nitroglycerin patches on the skin to help improve flow in premature infants with peripheral arterial ischemia.

Evaluation of a polyurethane foam dressing impregnated with 3% povidone-iodine (Betafoam) in a rat wound model

PURPOSE: The purpose of this study was to evaluate the efficacy of Betafoam in terms of wound healing and safety. METHODS: Fifty-four male adult Sprague-Dawley rats (weight, 200–250 g) were used in the study. Full-thickness skin defects were created on the back of each rats. The rats were assigned to 6 groups according to the type of wound dressing used (n = 9 for each group): Betafoam, Allevyn-Ag, Mepilex-Ag, Medifoam silver, Polymem-Ag, and gauze. The wound size, histological findings, and amount of DNA on the changed dressings for each group were analyzed and compared. RESULTS: All groups showed an effective decrease in wound size. However, the differences between Betafoam and the other dressings were statistically significant on day 14 (P < 0.05). The number of newly generated blood vessels in the Betafoam group was significantly higher than in the gauze, Allevyn-Ag, and Medifoam silver groups (P < 0.001). In the Betafoam group, the proportion of collagen deposition was highest and showed a significantly superior arrangement of collagen fibers compared with the gauze, Allevyn-Ag, Mepilex-Ag, and Medifoam silver groups. The total content of the remaining DNA counts of the exchanged dressings were significantly lower in the Betafoam group than the others. CONCLUSION: Betafoam is effective in wound healing and provides the best performance amongst the various types of dressing materials in terms of re-epithelialization, angiogenesis, collagen deposition, and tissue invasion.

Squamous Cell Carcinoma Arising from an Epidermal Inclusion Cyst

No abstract available.

Laparoscopic gastric tube formation with pyloromyotomy for reconstruction in patients with esophageal cancer

PURPOSE: To analyze the benefit and feasibility of this procedure compared with those of open method. METHODS: Abdominal procedure includes laparoscopic gastric mobilization, celiac axis lymph node dissection, formation of the gastric tube, and pyloromyotomy. The actual procedure performed during open surgery is the same as those of laparoscopic surgery except for the main incision. Minimally invasive esophagectomy (MIE) was performed on 54 patients with esophageal cancer. The short-term outcomes, including postoperative complications were analyzed and compared with 44 cases of open method. RESULTS: Although the total operative time was not different between 2 groups (349.8 minutes vs. 374.8 minutes, P = 0.153), the operation time of abdominal procedure was shorter in laparoscopic group (90.6 minutes vs. 162.1 minutes, P < 0.001). Operation related complications and hospital stay were not significantly different between the 2 groups. The number of transfused patients was significantly smaller in laparoscopic group (11.1% vs. 27.9%, P = 0.030). CONCLUSION: Laparoscopic gastric tubing with pyloromyotomy is a feasible and safe treatment option for patients with esophageal cancer.

Soft Tissue Reconstruction Using Perforator Flap in Patients with Infected Knee Prosthesis

PURPOSE: Soft-tissue reconstruction in the knee area requires thin, pliable, and tough skin. The range of motion of the knee also acts as a limitation in using only local flaps for coverage. The author has successfully used various perforator flaps for soft tissue reconstruction around the knee while preserving its functional and cosmetic characteristics. MATERIALS AND METHODS: Out of the twenty patients assessed from April 2009 to March 2011, seven received anterolateral thigh perforator flaps, four received medial sural perforator island flaps, four received lateral supragenicular perforaor perforator flaps, and five received medial genicular artery flaps. The age of the patients ranged from 44 to 79 and the size of the defects ranged from 4x5 cm to 17x11 cm. Fifteen of the twenty patients had histories of total knee replacement (TKR) surgery. RESULTS: There were no flap losses in any of the twenty patients assessed. Two patients showed partial losses in the distal area of the flap, but were treated through careful wound care. One patient presented with pedicle adhesion at the drainage site from a past TKR, but it did not hinder the flap survival. Primary closure at the donor site was possible in nine patients, while split skin graft was necessary for the other 13. CONCLUSION: In soft tissue reconstruction of the knee, various perforator flaps can be used depending on the condition of the preoperation scar, wound site, and size. It also proved to provide better functional and cosmetic results than in primary wound closure or skin grafts.

Transumbilical Laparoscopic Assisted Single Port Appendectomy (Hybrid Appendectomy) in Children

PURPOSE: Laparoscopic appendectomy isused as a three port technique for appendectomy. In children, single port laparoscopic appendectomy is difficult because they have a small peritoneal cavity for manipulation of laparoscopic instruments. We performed transumbilical laparoscopic assisted single port appendectomy (hybrid appendectomy) in children. METHODS: From March 2010 to July 2012, we performed transumbilical laparoscopic assisted single port appendectomy in 53 children. We made a vertical incision to the umbilicus approximately 1.5 cm, and a wound retractor (Applied Medical Resources Co., Ltd., Rancho Santa Margarita) was placed in the umbilical incision, and appendix exteriorized the extraperitoneum through the wound retractor. Appendectomy was performed conventionally. We had no conversion cases for laparotomy. RESULTS: A total of 53 patients, 29 females and 24 males, with a mean age of 8.5+/-2.0 years were enrolled in this retrospective study. The mean operative time was 29.4+/-9.4 minutes. There was no occurrence of complication or mortality. BMI was 17.8+/-4.9 kg/m2. And mean hospital stay was 3.2+/-1.0 days. CONCLUSION: In children, transumbilical single port laparoscopic appendectomy is technically difficult because they have a small peritoneal cavity. However, transumbilical laparoscopic assisted single port appendectomy (hybrid appendectomy) appearsto be a safe and effective technique for use in children, which allows for achievement of nearly scarless surgery.

Immunohistochemical Expression of Stem Cell Markers during the Wound Healing Process of Cutaneous Burn

PURPOSE: A cutaneous wound healing requires a well-orchestrated integration of the complex biological and molecular events of cell migration and proliferation, extracellular matrix deposition, angiogenesis and remodeling. Finally, skin regeneration is the main goal. Stem cells are self-renewing multipotent progenitors with the broadest developmental potential in a given tissue at a given time. The aim of this study was to examine the role of stem cells during the wound healing process of cutaneous burn in hairless mice by using immunohistochemical stainings (nestin, cytokeratin 15 and CD31). METHODS: Each mouse received 2 burns at the dorsal area by applying a metal stick heated in boiling water. Burn wound sites were dressed with duoderm. The mice were sacrificed at 0, 2, 7, 14 and 21 days after burn. Histological findings and immunohistochemical expression for stem cell markers were observed. RESULTS: Nestin was expressed in the stromal cells beneath the epidermis, hair follices, dermal cysts and endothelial cells. Cytokeratin 15 was expressed in the epidermis except in basal cells. On 7 and 14 days after burn, the regenerated epidermis didn't express cytokeratin 15. CD31 was expressed in the endothelial cells on 7 and 14 days after burn. The amount of nestin expression was the highest. CONCLUSION: Our results showed that nestin may have various effects on burn wound healing. Cytokeratin 15 was expressed before burn and after burn. It is likely that other cytokeratin may stimulate epithelial regeneration. CD31 may act in vascular regeneration during burn healing.

Laparoscopic versus Open Appendectomy for Complicated Appendicitis / 대한내시경복강경외과학회지

PURPOSE: The value of laparoscopic appendectomy for complicated appendicitis is still controversial. The purpose of this clinical study was to evaluate the efficacy of laparoscopic appendectomy in patients with complicated appendicitis. METHODS: This study involved a total of 108 consecutive patients who had undergone appendectomy for complicated appendicitis between January 2008 and August 2009. Those patients were divided into two groups; laparoscopic appendectomy (LA) and open appendectomy (OA). The demographic data, the incidence of drainage tube insertion, the operative time, the duration of pain, the time to a soft oral diet, the hospital days and the complication rate for the two groups were analyzed. RESULTS: There were no significant differences of the operative time (OA group: 65.2+/-27.31 min vs the LA group: 64.6+/-23.6 min) (p=0.233). However, in the LA group, there were benefits for number of drainage tube insertions (OA group: 48/60 vs the LA group: 8/48) (p<0.001), the use of analgesics (OA group: 3.2+/-3.9 times vs the LA group: 1.4+/-1.3 times) (p<0.001), the time to start a soft diet (OA group: 2.8+/-1.3 days vs the LA group: 1.4+/-1.3 days) (p=0.020), the hospital stay (OA group 7.5+/-3.4 days vs LA group 3.7+/-2.2 days) (p=0.040) and the complication rate (OA group: 18/60 vs the LA group: 8/48) (p<0.001). CONCLUSION: These results suggest that laparoscopic appendectomy for treating complicated appendicitis is a safe procedure that may prove to have significant clinical advantages over open appendectomy.

Clinical Analysis of Inguinal Hernia in Adult Using Prolene Hernia System

PURPOSE: The aim of this study was to detail clinical experiences with a type of tension-free herniorrhaphy using the prolene hernia system (PHS) and analyze the system's usefulness. METHODS: We retrospectively reviewed the medical records of 122 patients who underwent an inguinal hernia repair using PHS between March 2004 and August 2008. RESULTS: There were 116 male and 6 female patients ages 14 to 99; 79 indirect, 33 direct, 10 pantaloon hernias. The right inguinal hernias were more frequent (64.7%). The mean operative time for inguinal hernia repair using PHS was 45.2+/-1.5 minutes and the mean postoperative hospital stay was 3.5+/-1.5 days (101+/-82.9 hours). The most frequent combined disease was hypertension. The most frequent complication of PHS repair was hematoma. The mean number of used analgesics was 3.1+/-3.3. There were no postoperative recurrences. CONCLUSION: Tension-free herniorrhaphy using PHS is thought to be a useful method of inguinal hernia repair in adults because it offers lower postoperative pain, shorter operation time and shorter postoperative hospital stay.

Paraesophageal Hernia with Small Bowel Strangulation

Paraesophageal hernias are usually classified into three distinct types: type I, sliding hernias; type II, paraesophageal hernias; type III, a combination of type I and II. Herniation of other abdominal organs can be classified as type IV, and is a rare situation at the esophageal hiatus. We report herein a 73-year-old female patient who presented with epigastric pain and diagnosed as type IV paraesophageal hernia. Initial evaluation was focused on myocardial ischemia. There was no evidence of myocardial ischemia in the coronary angiography, but follow-up chest X-ray revealed air-fluid levels in the left mediastinum suggested hiatal hernia. On computed tomography, herniation and strangulation of proximal jejunum into the hemithorax via left diaphragmatic defect was found. After reduction of small bowel and resection of strangulated segment, the defect was closed. Fluid collection in the hernia sac was detected at postoperative day nine, but she was discharged without complication.

The Effect of Vertebral Wedge Angle to the Change of Kyphotic Angle by the Posterior Instrumentation Method in Thoracolumbar Spine Fracture / 대한척추외과학회지

STUDY DESIGN: Retrospective study OBJECTIVES: To examine the effect of transpedicular screw fixation on fractured vertebrae about the vertebral wedge angle (VWA) after posterior instrumentation of the thoracolumbar fracture, determine the effect of reduced VWA on the change in the Kyphotic angle (KA), and minimize loss of reduction of KA. SUMMARY OF THE LITERATURE REVIEW: Maintenance of the KA of a thoracolumbar fracture after surgery is important for the radiologic and functional outcome. MATERIALS AND METHODS: Forty patients, who had undergone posterior instrumentation in a thoracolumbar fracture between February 2006 and February 2008 and followed-up for more than one year, were enrolled in this study. The patients were divided into two groups according to transpedicular screw fixation (Group A) or not (Group B) including fractured vertebrae. The evaluation was performed by measuring the changes in the KA and VWA taken after the injury, immediate after surgery and 1 year after surgery. RESULTS: There was correlation between groups A (transpedicular screw fixation on fractured vertebrae) and B (no transpedicular screw fixation on the fractured vertebrae) regarding the correction of the VWA and the loss of correction KA, (p<0.05). CONCLUSIONS: Reduction of the VWA is an important factor for preventing reduction loss of the KA, and transpedicular screw fixation including fractured vertebrae would help reduce the VWA. Therefore, the operator must pay attention to the increase in VWA to maintain the KA through short segment transpedicular screw fixation including fractured vertebrae.

Retrograde Nailing for Supracondylar Fracture after Total Knee Replacement: The Compatibility of Femoral Implant with Supracondylar Nail

PURPOSE: Retrograde intrameullary nail is one of the treatment of periprosthetic supracondylar femoral fracture after total knee replacement (TKR), but all TKRs will not permit to insert a supracondylar nail. Therefore, we have investigated the compatibility of the TKRs with supracondylar nail. MATERIALS AND METHODS: Using trial femoral component of the 5 used TKRs in Korea and saw bone model, we checked their compatibility and measured the dimensions of the intercondylar notches in both cruciate retaining (CR) and posterior stabilized (PS) type. RESULTS: Although most CR prostheses had an intercondylar notch large enough to accept a supracondylar nail, in some case, this was not possible due to the notch being situated too far posteriorly. The position of the intercondylar notch is also important factor in the PS prostheses. CONCLUSION: The notch position, rather than the notch size, was the most important factor in determining nail compatibility with femoral stem.

Bouquet Pin Intramedullary Nail Technique of the 5th Metacarpal Neck Fractures

PURPOSE: To evaluate radiologic and clinical results of bouquet pin intramedullary nail technique for the 5th metacarpal neck fracture. MATERIALS AND METHODS: Between April, 2005 and February, 2006, 17 patients treated by bouquet pin intramedullary nail technique for the 5th metacarpal neck fracture were evaluated. All patients were reviewed clinically and radiologically after operation. RESULTS: All of 17 cases of fractures were completely united. In the anteroposterior radiographs, the average of preoperative angulation was corrected from 34.4° to 5.2°. Also, in the oblique radiographs, radiographic results of angulation correction were satisfactory which was corrected from 44.2° to 11.7°. Although, the averages of difference between postoperative and final follow-up angulations were 1.5° in the anteroposterior radiographs and 0.9° in the oblique radiographs, they were not statistically different. All patients were excellent clinically except 1 patient who has moderate joint stiffness after operation. CONCLUSION: Selecting of appropriate patients who is indicated, bouquet pin intramedullary nail technique for the 5th metacarpal neck fracture could be a good treatment method without complications.

Efficacy of Purified Vi Polysaccharide Typhoid Vaccine

This experiment was conducted to assess the efficacy of typhoid vaccine newly produced by purifying Vi antigen of Salmonella typhi. With Karber method, LD50 of challenging organism (S. typhi ty2) was determined as 6.31 CFU/mouse, and then the organism was used for the study. With Probits method, ED50 of the vaccine was determined as 0.016 microgram / 0.5 ml / mouse. The ELISA titer (0.5097+/-0.0606) was 4 times in the group treated with high dose (0.25 microgram/0.5ml) as in control (0.1113+/-0.0110). Six major protein bands of 66, 55, 35, 33, 18, and 9 kd were detected in Western blot analysis with serum of a vaccine treated mouse, whereas only one weak band of about 35 kd was detected with serum of a control mouse. We concluded that typhoid vaccine produced by purifying Vi antigen of S. typhi very effectively prevent S. typhi infection in mice.