Quality of life of patients with nasal bone fracture after closed reduction.

BACKGROUND: Closed reduction is the standard treatment for nasal bone fractures, which are the most common type of facial bone fractures. We investigated the effect of closed reduction on quality of life. METHODS: The 15-dimensional health-related quality of life survey was administered to 120 patients who underwent closed reduction under general anesthesia for nasal bone fractures from February 2018 to December 2019, on both the day after surgery and 3 months after surgery. Three months postoperatively, the presence or absence of five nasal symptoms (nose obstruction, snoring, pain, nasal secretions, and aesthetic dissatisfaction) was also evaluated. RESULTS: The quality of life items that showed significant changes between immediately after surgery and 3 months postoperatively were breathing, sleeping, speech, excretion, and discomfort. Low scores were found at 3 months for breathing, sleeping, and distress. There were 31 patients (25.83%) with nose obstruction, 25 (20.83%) with snoring, 12 (10.00%), with pain, 11 (9.17%) with nasal secretions, and 29 (24.17%) with aesthetic dissatisfaction. CONCLUSION: Closed reduction affected patients' quality of life, although most aspects improved significantly after 3 months. However, it was not possible to rule out deterioration of quality of life due to complications and dissatisfaction after surgery.

A retrospective study of changes in skin cancer characteristics over 11 years.

BACKGROUND: The incidence of skin cancer, which is primarily caused by exposure to ultraviolet radiation, has steadily increased in recent years. The authors of the present study sought to investigate changes in the epidemiology of skin cancer by conducting a retrospective review of patients diagnosed with skin cancer who received related care at a single medical institution.
. METHODS: The present study included patients who were diagnosed with skin cancer and received treatment at Gyeongsang National University Hospital from 2008 to 2018. The site and type of skin cancer, the number of patients with skin cancer each year, the sex and sex ratio of the patients, and changes in patients' age at first diagnosis were examined through retrospective chart reviews.
. RESULTS: The number of patients with skin cancer significantly increased, but statistically significant changes were not found in patients' sex, skin cancer sites, or the types of skin cancer. However, patients' age at the first diagnosis of skin cancer showed a statistically significant decrease starting in 2015.
. CONCLUSION: In this study, the number of patients with skin cancer increased over time. However, patients' age at first diagnosis has decreased since 2015. Therefore, younger patients should take care to prevent skin cancer, and further research on the causes of skin cancer in younger patients is needed.

The clinical usefulness of closed reduction of nasal bone using only a periosteal elevator with a rubber band.

BACKGROUND: Closed reduction of nasal fracture with various instrument is performed to treat nasal fracture. Depending on the type of nasal fracture and the situation in which it is being operated, the surgeon will determine the surgical tool. The objective of this study was to investigate whether a periosteal elevator (PE) was a proper device to perform closed reduction for patients with simple nasal fractures. METHODS: From March 2018 to December 2018, 50 cases of simple nasal bone fracture underwent closed reduction performed by a single surgeon. These patients were divided into two groups randomly: nasal bone reduction was performed using only PE (freer) and nasal bone reduction was performed using Walsham, Asch forcep, and Boies elevator (non-freer, non-PE). RESULTS: The paranasal sinus computed tomography was performed on patients before and after operation to carry out an accurate measurement of reduction distance at the same level. According to the results, the interaction between instruments and fracture types had a significant influence on reduction distance (p = 0.021). To be specific, reduction distance was significantly (p= 0.004) increased by 2.157 mm when PE was used to treat patients with partial displacement compared to that when non-PEs were used. CONCLUSION: Closed reduction using PE and other elevator is generally an effective treatment for nasal fracture. In partial-displacement type of simple nasal fracture, closed reduction using PE can have considerable success in comparison with using classic instruments.

Immediate regraft of the remnant skin on the donor site in split-thickness skin grafting.

BACKGROUND: Skin defects of head and neck need reconstruction using various local flaps. In some cases, surgeons should consider skin graft for large skin defect. It is important to heal skin graft and donor sites. The authors investigated wound healing mechanisms at the donor sites with split-thick-ness skin graft (STSG). In this study, the authors compared two types of immediate regraft including sheets and islands for the donor site after facial skin graft using remnant skin. METHODS: The author reviewed 10 patients who underwent STSG, from March 2015 to May 2017, for skin defects in the craniofacial area. The donor site was immediately covered with the two types using remnant skin after harvesting skin onto the recipient site. Depending on the size of the remnant skin, we conducted regraft with the single sheet (n= 5) and island types (n= 5). RESULTS: On postoperative day 1 and 3 months, the scar formation was evaluated using the Patient and Observer Scar Assessment Scale (POSAS) and Vancouver Scar Scale (VSS). Total POSAS and VSS scores for the island type were lower than in single sheet group after 3 months postoperatively. There was significant difference in specific categories of POSAS and VSS. CONCLUSION: This study showed a reduction in scar formation following immediate regrafting of the remnant skin at the donor site after STSG surgery. Particularly, the island type is useful for clinical application to facilitate healing of donor sites with STSG.

Reconstruction of nasal ala and tip following skin cancer resection.

BACKGROUND: Defects of the nasal ala and tip have a complex three-dimensional structure that makes them challenging to reconstruct. Many reconstructive options have been described for nasal ala and tip defects, ranging from primary closure to local flaps and skin grafts. However, it is difficult to determine which method will yield the best cosmetic results in each individual case. Thus, the purpose of this study was to determine which surgical procedures for reconstructing defects of the nasal ala and tip have better cosmetic results. METHODS: From 2008 to 2018, 111 patients underwent surgery to reconstruct skin defects after resection of skin cancer in the nasal ala or tip. Their charts were reviewed to obtain data on age, sex, surgical location, size of the defect, surgical method, and cosmetic results using a visual analog scale (VAS). RESULTS: For nasal ala reconstruction, the most commonly used surgical technique was the nasolabial flap (n= 42). This method also had the highest VAS score (7/10). The most commonly selected surgical method for nasal tip reconstruction was the bilobed flap (n= 13), and bilobed flaps and primary closure had the highest VAS score (7/10). CONCLUSION: Nasolabial flaps showed excellent cosmetic results for the reconstruction of nasal ala defects, while primary closure and bilobed flaps yielded excellent cosmetic results for the reconstruction of nasal tip defects.

Effect of Antiadhesion Barrier Solution and Fibrin on Capsular Formation After Silicone Implant Insertion in a White Rat Model.

INTRODUCTION: One of the most serious complications of breast reconstruction and augmentation using silicone implants is capsular contracture. Several preventive treatments, including vitamin E, steroids, antibiotics, and cysteinyl leukotriene inhibitors, have been studied, and their clinical effects have been reported. However, the problem of capsular contracture has not yet been completely resolved. This study was performed to compare anti-adhesion barrier solution (AABS) and fibrin in their ability to prevent fibrotic capsule formation and simultaneously evaluated their effect when used in combination by capsular thickness analysis and quantitative analysis of matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinases (TIMPs), and type I collagen within the fibrous capsule. MATERIALS AND METHODS: This study used female six-week-old Sprague-Dawley rats. Eighty rats were equally subdivided into the four following groups: AABS-treated, fibrin-treated, AABS and fibrin combined-treated, and untreated control groups. Each rat received two silicone chips under the panniculus carnosus muscle layer. The test materials were applied around the silicon chips. Four weeks later, the implantation sites including the skin and muscle were excised to avoid the risk of losing the fibrous capsule around the implants. The capsular thickness was analyzed by Masson's trichrome stain. Quantitative analysis of type I collagen, MMPs, and TIMPs was performed by real-time PCR, Western blot, and zymography. RESULTS: The mean capsular thickness was 668.10 ± 275.12 µm in the control group, 356.97 ± 112.11 µm in the AABS-treated group, 525.96 ± 130.97 µm in the fibrin-treated group, and 389.24 ± 130.51 µm in the AABS and fibrin combined-treated group. Capsular thickness was significantly decreased in all experimental groups (p < 0.05). Capsular thickness was greater in the fibrin-treated group than in the AABS-treated group (p < 0.05). There was no statistically significant difference in capsular thickness between the AABS and fibrin combined-treated group and the AABS- or fibrin-treated group (p > 0.05). Compared to the control group, the experimental groups had significantly lower expressions of type I collagen and MMP-1 (p < 0.05), but there was no statistically significant difference in expressions of type I collagen and MMP-1 between the AABS-, fibrin-, and AABS and fibrin combined-treated groups (p > 0.05). The expressions of MMP-2 and TIMP-2 were not significantly different between the control and the experimental groups (p > 0.05). CONCLUSION: AABS is more effective in reducing capsular thickness compared with fibrin treatment in a white rat model.

Effects of hospitalist-directed interdisciplinary medicine floor service on hospital outcomes for seniors with acute medical illness.

AIM: To examine whether a hospitalist-directed interdisciplinary (ITD) team in an internal medicine residency program enhances the hospital and clinical outcomes for seniors with acute medical illness. METHODS: Seniors admitted to a USA teaching hospital medical floor-teaching services were allocated to the ITD (n = 379) and usual care teams (n = 383). Compared with the usual care team, the ITD team physicians carried out daily "geriatric" assessment and management, and led ITD team meetings. RESULTS: The mean probability of functional decline on hospital discharge in the ITD team (25%; 95% CI 19-30%) was significantly lower than that in the usual care team (36%; 95% CI 30-43%; OR 0.35; 95% CI 0.10-0.92; P < 0.001). The mean probability of delirium in the ITD team (26%; 95% CI 20-32%) was significantly lower than that in the usual care team (34%; 95% CI 28-41%; OR 0.48; 95% CI 0.16-0.97; P = 0.03). The mean probability of transition to an institution in the ITD team (18%; 95% CI 13-23%) was significantly lower than that in the usual care team (26%; 95% CI 19-32%; OR 0.41; 95% CI 0.14-0.95; P = 0.01). CONCLUSIONS: Hospitalist-directed ITD team care is associated with reductions of functional decline, delirium and transition to an institution for seniors with acute medical illness.

The association between quality of care and quality of life in long-stay nursing home residents with preserved cognition.

OBJECTIVES: To assess the overall quality of life of long-stay nursing home residents with preserved cognition, to examine whether the Centers for Medicare and Medicaid Service's Nursing Home Compare 5-star quality rating system reflects the overall quality of life of such residents, and to examine whether residents' demographics and clinical characteristics affect their quality of life. DESIGN/MEASUREMENTS: Quality of life was measured using the Participant Outcomes and Status Measures-Nursing Facility survey, which has 10 sections and 63 items. Total scores range from 20 (lowest possible quality of life) to 100 (highest). SETTING/PARTICIPANTS: Long-stay nursing home residents with preserved cognition (n = 316) were interviewed. RESULTS: The average quality- of-life score was 71.4 (SD: 7.6; range: 45.1-93.0). Multilevel regression models revealed that quality of life was associated with physical impairment (parameter estimate = -0.728; P = .04) and depression (parameter estimate = -3.015; P = .01) but not Nursing Home Compare's overall star rating (parameter estimate = 0.683; P = .12) and not pain (parameter estimate = -0.705; P = .47). CONCLUSION: The 5-star quality rating system did not reflect the quality of life of long-stay nursing home residents with preserved cognition. Notably, pain was not associated with quality of life, but physical impairment and depression were.

Effects of health insurance on racial disparity in osteoporosis medication adherence.

OBJECTIVE: To explore whether racial disparity in osteoporosis drug therapy maintenance varies by health insurance coverage status. DESIGN: Longitudinal observation study. SETTING: Cleveland Clinic Health System (Cleveland, OH) from January 2006 to December 2009. PATIENTS: 3,901 black and white female Medicare beneficiaries starting osteoporosis drug therapy. INTERVENTION: Analysis of the health system's integrated electronic medical records. MAIN OUTCOME MEASURES: Drug therapy adherence (medication possession ratio ≥80%) for more than 12 of 15 surveillance units and occurrence of extended nonadherence gaps for at least two surveillance units in a row. RESULTS: Among patients with supplementary health insurance (n = 2,278), no difference was observed for drug therapy adherence ( P = 0.17) and extended nonadherence gaps ( P = 0.53) between black and white participants. When patients did not have supplementary health insurance (n = 1,623), blacks (36% [95% CI 28-47]) were less likely to adhere to drug therapy than whites (47% [38-57]; odds ratio [OR] 0.34 [95% CI 0.09-0.92], P = 0.004). Blacks (25% [19-32]) also were more likely to have an extended nonadherence gap episode than whites (18% [11-26]; OR 2.42 [1.13-3.50], P = 0.03). CONCLUSION: Similar to previous research on racial disparity in health services, racial disparity in osteoporosis drug therapy maintenance between black and white female older patients existed when supplementary health insurance was not affordable.

Factors associated with remaining in a skilled nursing facility for over 90 days from admission: residents' participation in therapy and desire to return to the community.

BACKGROUND: To identify the factors associated with stay in a skilled nursing facility (SNF) among new enrollees who did not fully participate in therapy sessions. METHODS: Data (n = 36,133) were obtained from the Minimum Data Set version 2.0 in the state of Michigan in 2009. Study participants were new SNF enrollees (n = 699) who did not fully participate in therapy sessions despite their desire to return to the community. Multivariate logistic regressions were performed to identify factors contributing to remaining in a nursing home for 91 days or longer. RESULTS: New SNF enrollees were more likely to remain in nursing home when they were depressed (odds ratio [OR] = 1.41; 95% confidence interval [CI], 1.09-2.08; P = .01), experiencing delirium (OR = 3.20; 95% CI, 1.48-5.92; P < .001), were not in pain (OR = 0.83; 95% CI, 0.60-0.95; P = .03), or in less complex care (OR = 0.57; 95% CI, 0.44-0.81; P < .01). CONCLUSIONS: A higher number of new SNF enrollees than previously reported were likely to stay in nursing homes (28.0%). Depression and delirium were associated with stay in an SNF, while pain and higher complexity of care were associated with returning to the community.

Effects of an internal medicine floor interdisciplinary team on hospital and clinical outcomes of seniors with acute medical illness.

AIM: To examine whether an internal medicine interdisciplinary floor team enhances the hospital and clinical outcomes for seniors with acute medical illness. METHODS: Seniors admitted to medical floor teaching services of a USA teaching hospital were recruited and allocated to the interdisciplinary (ITD; n = 236) and usual care teams (n = 248). Compared with the usual care team, the interdisciplinary team physicians carried out daily "geriatric" assessment and management, and led the interdisciplinary team meeting designed for improving interprofessional collaboration. RESULTS: After controlling for patient and physician characteristics, the mean hospital length of stay in the ITD team (6.1 days; 95% CI 5.2-7.7 days) was 0.7 days shorter than that in the usual care team (6.8 days; 95% CI 5.7-8.3 days; P = 0.008). There was no significant difference in delirium and 30-day hospital readmission between care groups. CONCLUSIONS: Notwithstanding partly positive associations, the results from the present study suggest that interdisciplinary team-based care is, at best, associated with enhancing the clinical and hospital outcomes for seniors with acute medical illness.

Intensified rehabilitation therapy and transitions to skilled nursing facilities in community-living seniors with acute medical illnesses.

AIM: To examine whether rehabilitation therapy type would be associated with transitions to skilled nursing facilities (SNF) in community-living seniors with acute medical illnesses. METHODS: Using administrative and clinical data, multivariate regression analysis examined the relationship between the extent of rehabilitation therapy and transitions to SNF in all participants, as well as participants by physical function at admission. RESULTS: In all participants (n=929), the intensified rehabilitation therapy was associated with a lower probability of transitions to SNF (14% vs 21%; odds ratio [OR] 0.59; 95% confidence intervals [CI] 0.22-0.96; P=0.02). In participants with mild physical limitations (n=270), less frequent transitions to SNF occurred when patients received intensified rehabilitation therapy [16% vs 23%; OR 0.46; 95% CI 0.17-0.94; P=0.01]. In participants with moderate to severe physical limitations (n=265), the decreased frequency of transitions to SNF associated with rehabilitation therapy became more pronounced (18% vs 28%; OR 0.34; 95% CI 0.07-0.89; P=0.004). By contrast, in participants without physical limitation (n=394), the number of transitions to SNF did not change significantly when they received intensified rehabilitation therapy (P=0.53). CONCLUSIONS: We found a significant relationship between intensified rehabilitation therapy and the decrease of transitions to SNF in community-living seniors with acute medical illness. The magnitude of this relationship increased in participants with more physical limitations, but not in participants without physical limitations at admission.

Expression of estrogen receptors in gastric cancer and their clinical significance.

BACKGROUNDS AND OBJECTIVES: The male predominance of gastric cancer suggests that female sex hormones may have a protective effect against gastric cancer. We evaluated the expression of estrogen receptors in gastric cancer tissue and cells and the clinical significance of ER-ß expression in gastric cancer. METHOD: ER-α, ER-ß proteins extracted from normal stomach, gastric cancer tissues, and cultured gastric cancer cells (KATO-III, mkn28, mkn45, and mkn74) were assessed by Western blot analysis. The clinical significance of ER-ß was explored using tissue microarray methods and immunohistochemical staining of specimens from 148 gastric cancers. RESULTS: Both ER-α and ß protein expression were noted in normal and gastric cancer tissues. However, in cultured gastric cells, only ER-ß was noted in mkn28 and mkn74. Of 148 gastric cancers, 67 (45.3%) were ER-ß positive. The ER-ß positive group was associated with lower tumor stage, Lauren's intestinal type, negative perineural invasion, and free of recurrence. The ER-ß positive group had a better 3-year survival compared with the negative group in survival analysis. CONCLUSION: Our results suggest that the presence of ER-ß in gastric cancer could have a protective effect against invasiveness of gastric cancer. Further studies are needed to clarify the role of ER-ß in gastric cancers.

Primary papillary thyroid carcinoma previously treated incompletely with radiofrequency ablation.

Radiofrequency ablation (RFA) recently has been applied to benign thyroid nodules, mainly for the cosmetic reasons, and limited cases of local recurrences or focal distant metastases of well-differentiated thyroid cancer, in the high-risk reoperative condition or for the palliative purpose. But no report has been made on the RFA for primary thyroid cancer to date. We report on a patient with primary papillary carcinoma of thyroid gland who had undergone RFA before the cytological diagnosis of malignancy, later referred and treated with robotic surgery successfully. We can learn the following lessons from our case; (1) the RFA for operable primary thyroid malignancy should be avoided, because of the possibility of remnant viable cancer and undetectable nodal metastasis, and (2) robotic or endoscopic thyroid surgery may be a feasible operative method for benign or malignant thyroid nodules previously treated with RFA.

Acquired omental cystic lymphangioma after subtotal gastrectomy: a case report.

We herein describe a case of cystic lymphangioma in the greater omentum of the remnant stomach, which is thought it to be related with subtotal gastrectomy 10 yr ago for early gastric cancer. A 76-yr-old man was admitted to our department with postprandial abdominal discomfort and bowel habit change. Intraabdominal multilocular cystic mass was detected by ultrasonography and computed tomography. We performed a complete En-bloc tumor resection including spleen and distal pancreas, and histological examination confirmed cystic lymphangioma originated from the greater omentum of the remnant stomach. Although the etiology of omental lymphangioma remains largely unclear, these findings suggested strongly that obstruction of the lymphatic vessels after gastric resection for gastric carcinoma might be the most plausible cause. The surgical extirpation with resection of organs involved appears to be a treatment of choice for such unusual case.

Laparoscopic resection of a hepatocellular carcinoma arising from an ectopic liver.

Ectopic livers are rarely seen intra-abdominal lesions. Ectopic hepatocellular carcinoma (HCC) can be defined as an HCC arising from hepatic parenchyma located in an extrahepatic organ or tissue. The authors report a case of a primary, well-differentiated HCC arising from ectopic liver tissue in the left subphrenic space at the upper portion of the gastrorenal ligament that was successfully treated by laparoscopic resection. A 59-year-old man was referred to our department for the management of an intra-abdominal mass, which was incidentally found in a follow-up abdominal computed tomography scan for splenic laceration. The preoperative diagnosis suggested that it was a nonspecific stomach mass of maximal diameter 4.5 cm, such as, a gastrointestinal stromal tumor, located between the diaphragm and spleen. A computed tomography scan identified no mass in the liver. Laparoscopic resection was performed, and the final pathologic result confirmed that it was a HCC. The patient's postoperative course was unremarkable. This is the first reported case of a laparoscopically treated ectopic HCC. Moreover, laparoscopic resection was found to be safe and reliable in this case.

Laparoscopic treatment of a huge cystic lymphangioma: partial aspiration technique with a spinal needle.

A cystic lymphangioma is a rare intra-abdominal lesion. Treatment is a complete excision of the cyst because of complications and a rare chance of malignancy. In this paper we report on 2 patients with a huge cystic lymphangioma who were treated by laparoscopic surgery successfully. Each of the cysts were 13 and 11 cm in diameter, were diagnosed by ultrasonography and computed tomography scan. After partial aspiration of the cysts, using a spinal needle, we were prone to grasp the cysts without spillage. Traction and dissection were easy without spillage or injury of the mesenteric vessels. The laparoscopic approach can be successfully and safely performed by an experienced surgeon in keeping with oncologic principles.

Fast-growing pseudoangiomatous stromal hyperplasia of the breast: report of a case.

Pseudoangiomatous stromal hyperplasia (PASH) is a rare type of benign mesenchymal proliferative disease of the breast. Histologically, it is composed of a proliferation of spindle cells with inter-anastomosing vascular-like arrangement in the interlobular or interductal stroma. Clinically, pseudoangiomatous stromal hyperplasia is usually found in premenopausal women as a discrete, painless mass, which is firm and movable. We report a case of pseudoangiomatous stromal hyperplasia of the breast, which mimicked a malignant mass in that it grew rapidly and ultrasonography showed a lobulating contoured heterogeneous echotexture.