Clinical Value of Intraoperative Flow Measurements of Brachiocephalic Arteriovenous Fistulas for Hemodialysis

Background@#The aim of this study was to analyze the clinical outcomes of autogenous brachiocephalic arteriovenous fistulas and to investigate the factors associated with 1-year patency after initiation of hemodialysis. @*Methods@#We retrospectively reviewed the medical records of 41 patients who underwent surgery to create an autogenous brachiocephalic arteriovenous fistula between January 2015 and December 2017, received hemodialysis at the same hospital for longer than 1 year, and were monitored for their vascular access status. Intraoperative flow was measured using transit-time ultrasonography. @*Results@#The 1-year primary and secondary patency rates were 61% (n=25) and 87.8% (n=36), respectively. The functional group (subjects who required no intervention to maintain patency within the first year after hemodialysis initiation) displayed a significantly higher median intraoperative flow rate (450 mL/min) than the non-functional group (subjects who required intervention at least once regardless of 1-year patency) (275 mL/min) (p=0.038). Based on a receiver operating characteristic curve analysis, all patients were additionally subdivided into a high-flow group (>240 mL/min) and a low-flow group (≤240 mL/min). The high-flow group included a significantly greater number of functional brachiocephalic arteriovenous fistulas than the low-flow group (74.2% vs. 20%, respectively; p=0.007). @*Conclusion@#Transit-time flow, as measured with intraoperative transit-time ultrasonography, was associated with patency without the need for intervention at 1 year after initiation of hemodialysis.

Hair Control during Scalp Surgery Using a Sterile Gel Technique

It is necessary to organize and arrange the hair before performing surgery on the scalp. The hair is preserved in most cases, and the remaining hair makes it difficult to apply and maintain the drape. Moreover, hair that has not been properly sterilized can be a risk factor for infection. Accordingly, the authors of the present study benchmarked a method of hair control within the operative field using a sterile gel. Prior to surgery, the hair around the lesion can be organized and rearranged to the desired shape by using a sterile medical gel as a hairstyling product. Subsequently, chlorhexidine-isopropyl alcohol can be used for aseptic skin preparation, followed by draping for surgery. By controlling the hair using this method, hair can be prevented from falling into the operative field, thereby reducing the risk of surgical site infection.

Inverted Nipple Correction Using a Combination of the Perpendicular Suture Method and the Purse-String Suture Method

While various surgical methods are used for inverted nipple correction, an optimal technique has not been established. We describe a combination of suture methods including purse-string sutures, based on a report by Gould et al. This is a simple and safe method for inverted nipple correction.

Inverted Nipple Correction Using a Combination of the Perpendicular Suture Method and the Purse-String Suture Method

While various surgical methods are used for inverted nipple correction, an optimal technique has not been established. We describe a combination of suture methods including purse-string sutures, based on a report by Gould et al. This is a simple and safe method for inverted nipple correction.

Non-Melanocytic Skin Cancers of the Head and Neck: A Clinical Study in Jeju Province

BACKGROUND: Jeju Island is geographically and socioeconomically distinct from the mainland of South Korea. Thus, the presentation and management of non-melanocytic skin cancers (NMSC) of the head and neck may differ from those in other regions of the country. We compared the clinical characteristics and treatment modalities of NMSC on Jeju Island with the findings of similar regional studies. METHODS: Patient data, including age, sex, diagnosis, tumor site, treatment, and recurrence, were obtained from the medical and pathology records of patients diagnosed with NMSC between January 2010 and June 2015. RESULTS: In total, 190 patients (57 men) with a mean age of 75 years (range, 42–97) were assessed. Overall, 203 NMSCs were diagnosed, including 123 basal cell carcinomas and 80 squamous cell carcinomas. The tumor sites included the nose, cheeks, periorbital area, and lips (n=55, 54, 25, and 20, respectively). We identified 92 T1-stage and 60 T2-stage tumors, and 120 cases were treated with wide surgical resection and 17 cases were treated with radiation therapy at the medical center. Of the 120 cases treated surgically, 69 required reconstructive surgery using a local skin flap, 22 required full-thickness skin grafting, and 12 underwent primary closure. Basal and squamous cell carcinomas recurred in 2 and 1 cases, respectively. CONCLUSIONS: Compared to the reports from other regions, the average patient age was 10 years higher, with a marked female preponderance. While the proportion of squamous cell carcinoma was higher than in other regions, the tumor distribution and surgical management profiles were similar.

Effects of an Educational Program for the High Risk Group of Cardio-cerebrovascular Disease: Awareness of the Warning Signs and Symptoms of Acute Myocardial Infarction and Stroke in the Aged at Senior Centers / 農村醫學 地域保健

OBJECTIVES: This study was performed to investigate the effects of a health education program for the aged on knowledge about the warning signs and symptoms of acute myocardial infarction and stroke. METHODS: Data from 337 elderly people (159 participated and 178 non-participated) at senior centers in Jeju-si were collected by 1 to 1 interview from January to March 2012, one year after the education program provided. Two stages of study were performed: Cross-sectional, case-control study on the level of knowledge about the warning signs and symptoms; and multivariate logistic regression to fine out predictors of optimal awareness. RESULTS: No significant discrepancy of knowledge level between case and control group was found. The knowledge level as high as a surge was shown in both groups one year later. A surge of knowledge had been shown after the education provided in one month. The factors affecting the optimal level of knowledge were education (Odds ratio 3.01; Confidence Interval 1.72-5.26; P-value <0.001) and 7 days of watching TV news per week (2.97; 1.68-5.23; P<0.001). However, participation in the health education was not significant (1.60; 0.98-2.61; P=0.059). CONCLUSIONS: The effects of a targeted program in high-risk groups for cardio-cerebrovascular disease are only guaranteed in the enhancement by a population-based mass-media education campaign.

The Oral Cavity Burn by Firework Explosion

Facial injury by firework is not rare, but there are few reports on oral firework explosion injury. The authors of this article present a case of an 18-year-old male with intraoral injury from a firework explosion with literature review.

Reconstruction of Lower Face with Submental Artery Perforator Flap

A submental artery perforator flap was applied to the defect site after surgical excision of basal cell carcinoma on the right lower face. Three points were beneficial: it was perfect for assuring the safe margin of the mandibular branch of the facial nerve as well as intact platysma muscle, functionally; harvesting the flap was much easier than that of submental artery flap, surgically; and the color and contour were well matched aesthetically.

Citrus Fruit Intake and Breast Cancer Risk: A Quantitative Systematic Review / 한국유방암학회지

PURPOSE: We investigated the association between dietary intake of citrus fruits and breast cancer risk. METHODS: The PubMed and EMBASE were searched for relevant articles on diet and breast cancer up to January 2012. All of the epidemiological studies that assessed dietary intake of citrus fruits and presented risk estimates of the association between citrus fruits intake and risk of breast cancer were reviewed. Multivariable-adjusted odds ratios (OR) and associated 95% confidence intervals (CI) for highest versus lowest intake of dietary citrus fruits level were extracted. Overall summary OR was calculated by using a fixed-effect meta-analysis. RESULTS: Six case-control studies out of five articles were eligible. Overall summary OR showed a 10% reduction in risk of breast cancer associated with high intake of citrus fruits (summary OR, 0.90; 95% CI, 0.85-0.96; p<0.001); results were consistent across the studies (I 2=0). Visual inspection of the results did not suggest a publication bias. CONCLUSION: Pooled results from observational studies showed an inverse association between citrus fruits intake and the risk of breast cancer.

Debridement of Necrotic Tissues Using Sterilized Peeler

Debridement of necrotic tissue can be done by mass, dermatome(hand, electrical), laser, or ultrasound. The authors aims to introduced the another way of debridement of necrotic tissue using sterilized peeler.

Protection of the Reconstructed Nipple by Using a Breathing Bag Connection Tube

As the newly reconstructed nipple tends to be flattened, especially if submitted to pressure, prudent dressings using various protective devices as a physical support against pressure on a new nipple is important. We used a breathing bag connecting tube as a protective device in nipple reconstruction. A breathing bag connecting tube recycled was cut and trimmed at 1cm above the height of the reconstructed nipple. Before stitch out, the newly reconstructed nipple with a local flap was dressed and protected in this way for 10 days after surgery. After stitch out, patients learnt how to manage the new nipple at home. The sole means of nipple dressing was affixing the breathing bag connecting tube with adhesive tape. Two patients had worn the tube for two months with the best compliance. Owing to the soft composition of the tube material, it is possible for a surgeon to have an easy cutting and trimming of the tube at appropriate heights as well as for a patient to show better compliance yielding better results. The cost factor is another advantage.

Reduction and Fixation Methods for Fractured Anterior Maxillary Sinus Wall Using Suture Tie

The anterior maxillary sinus walls are the most frequently injured sites in midfacial fractures. The maxillary sinus is a difficult surgical site for reduction and fixation due to its narrow surgical field, and has a chance of developing sinusitis when sufficient treatment is not given. In this study, the methods developed by the authors for managing such are introduced. Two small openings were made on both sides of the fracture line, then a suture knot was tied instead of wiring for reduction and fixation. Then an absorbable mesh was applied on top of the fracture site, with a suture knot for additional fixation. This method was applied on an actual patient, and it was a convenient method despite the narrow surgical field that was provided. The authors believe that using suture knots to fixate fractured segments and absorbable mesh is relatively convenient and economically efficient when it comes to the reduction and fixation of the maxillary sinus wall fracture with several fragments.

Trends in the Incidence of Hospitalized Acute Myocardial Infarction and Stroke in Korea, 2006-2010

This study attempted to calculate and investigate the incidence of hospitalized acute myocardial infarction (AMI) and stroke in Korea. Using the National Health Insurance claim data, we investigated patients whose main diagnostic codes included AMI or stroke during 2006 to 2010. As a result, we found out that the number of AMI hospitalized patients had decreased since 2006 and amounted to 15,893 in 2010; and that the number of those with stroke had decreased since 2006 and amounted to 73,501 in 2010. The age-standardized incidence rate of hospitalized AMI, after adjustment for readmission, was 41.6 cases per 100,000-population in 2006, and had decreased to 29.4 cases in 2010 (for trend P < 0.001). In the case of stroke was estimated at 172.8 cases per 100,000-population in 2006, and had decreased to 135.1 cases in 2010 (for trend P < 0.001). In conclusion, the age-standardized incidence rates of both hospitalized AMI and stroke in Korea had decreased continuously during 2006 to 2010. We consider this decreasing trend due to the active use of pharmaceuticals, early vascular intervention, and the national cardio-cerebrovascular disease care project as the primary and secondary prevention efforts.

Reconstruction of Cheek Defect with Facial Artery Perforator Flap

PURPOSE: To reconstruct the midface, local flaps such as nasolabial flaps have been frequently used. These local flaps, however, have the shortcomings of requiring a secondary operation or limitations in the movement of the flap. Thus, new methods have been developed. This paper reports a case wherein the basal cell carcinoma on the cheek was resected and the skin and soft tissue defect was successfully treated using a facial artery perforator flap. METHODS: A 68-year-old female consulted the authors on the basal cell carcinoma that developed on her cheek. The mass was fully resected and revealed a 2.3 x 2.3 cm defective region. Using a Doppler ultrasonography, the facial artery path was traced, and using a loupe magnification, the facial artery perforator flap was elevated and the defective region was covered with the flap. RESULTS: The flap developed early venous congestion, but it disappeared without any treatment. Six months after the surgery, the patient was satisfied with the postoperative result. CONCLUSION: The facial artery perforator flap has a thin pedicle. It offers a big arc of the rotation that allows free movement and one-stage operation. These strengths make the method useful for the reconstruction of the midface among other procedures.

Clinical and MRI Profiles Predicting Clinical Overt Stroke in Patients with CADASIL

BACKGROUND: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited arteriopathy caused by mutation in the Notch 3 gene. Cognitive impairment, which is the second most frequent clinical manifestation, worsens with recurrent stroke. Comparison studies between the pre- and poststroke phases in CADASIL have not yet been performed in Asia. Here we describe the clinical characteristics of both the preand poststroke phases and identified the risk factors for stroke in CADASIL. METHODS: Fifty-three consecutive patients were investigated. Patients were divided into two groups depending on the presence (poststroke group; n=31) or absence (prestroke group; n=22) of clinically overt stroke. All patients underwent an MRI scan with the same protocol. Cognition was assessed by applying detailed neuropsychological tests. RESULTS: The poststroke group exhibited an increase in lacunae and cerebral microbleeds. The memory scores on the Alzheimer's Dementia Assessment Scale cognitive subscale and the number of correct Stroop color-naming scores were lower in the poststroke group than in the prestroke group. Hypertension was more prevalent in the poststroke group, while chronic headache was more prevalent in the prestroke group. CONCLUSIONS: These findings suggest that cerebral microbleeds as well as lacunae predict the risk of clinically overt stroke, which leads to a worsening of frontal-lobe function in CADASIL.

A Simplified Treatment Algorithm of Frontal Sinus Fractures: A Paradigm Shift?

PURPOSE: The management of frontal sinus fractures and frontal sinus outflow tract (=FSOT) injuries is controversial. Traditional treatments include frontal sinus obliteration with a variety of material grafts, which all employ complicated algorithms for treatment planning. A simplified algorithm aiming for frontal sinus ventilation, however, can be achieved through the advanced technology of image guided endoscopic surgery and instruments. The authors explain this simplified treatment algorithm of frontal sinus fractures. METHODS: The authors reviewed articles on the management of frontal sinus fractures. RESULTS: Complicated treatment planning algorithms of frontal sinus fractures aiming for obliteration were replaced with a simplified algorithm aiming for ventilation of the frontal sinus. CONCLUSION: The authors suggest that a simplified algorithm can replace the complicated algorithms in selective cases.

Participation Determinants in the DRG Payment System of Obstetrics and Gynecology Clinics in South Korea / 예방의학회지

OBJECTIVES: The Diagnosis Related Group (DRG) payment system, which has been implemented in Korea since 1997, is based on voluntary participation. Hence, the positive impact of this system depends on the participation of physicians. This study examined the factors determining participation of Korean obstetrics & gynecology (OBGYN) clinics in the DRG-based payment system. METHODS: The demographic information, practice-related variables of OBGYN clinics and participation information in the DRG-based payment system were acquired from the nationwide data from 2002 to 2007 produced by the National Health Insurance Corporation and the Health Insurance Review & Assessment Service. The subjects were 336 OBGYN clinics consisting of 43 DRG clinics that had maintained their participation in 2003-2007 and 293 no-DRG (fee-for-service) clinics that had never been a DRG clinic during the same period. Logistic regression analysis was carried out to determine the factors associated with the participation of OBGYN clinics in the DRG-based payment system. RESULTS: The factors affecting participation of OBGYN clinics in the DRG-based payment system were as follows (p<0.05): (1) a larger number of caesarian section (c/sec) claims, (2) higher cost of a c/sec, (3) less variation in the price of a c/sec, (4) fewer days of admission for a c/sec, and (5) younger pregnant women undergoing a c/sec. CONCLUSIONS: These results suggest that OBGYN clinics with an economic practice pattern under a fee-for-service system are more likely to participate in the DRG-based payment system. Therefore, to ensure adequate participation of physicians, a payment system with a stronger financial incentive might be more suitable in Korea.

Enamel surface evaluation on various removal technique of bracket (DBS): a study with the scanning electron microscopy / 대한치과교정학회지

With modification of the acid etch technique and improvements of the physical and mechanical properties of the acrylic reain, the removal of directly bonded attachments and the finishing of the underlying enamel have become an acute clinical problem. This study was to evaluation the efficacy of recently introduced instrumentation and techniques to remove bonded brackets and residual resin, and restore the affected enamel surface to an acceptable clinical condition. Fortyeight premolar which were scheduled for extractio for orthodontic purposes were bonded with brackets usion super-C oftho. Four additional premolars with untreated surfaces were used as controls. After one weak the grackets were removed and the residual resin removed by hand scaler, green stone, green rubber wheel, sandpaper disc, tungsten carbide bur, Sof-lex disc. Half the experimental teeth were given a final pumicing and then all were extracted and stored in 50 percent ethanol. The scanning electron microscopy was used to evalusted the enamel surface. Following results were obtained; 1. A satisfactory result was obtained by means of the Sof-lex disc. 2. The order of the scratch formation was the procedure using hand scaler, green stone, tungsten carbide bur, sandpaper disc, green rubber wheel, and Sof-lex disc. 3. The procedures using green stone and tungsten carbide bur showed many groove formations and the other procedures showed none. 4. Final pumicing serves effectively to remove residual adhesive and restore the enamel surface.