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Seo J.-G.,Sungkyunkwan University | Moon Y.-W.,Sungkyunkwan University | Park S.-H.,National Health Insurance Corporation Ilsan Hospital | Kim S.-M.,Sungkyunkwan University | Ko K.-R.,Sungkyunkwan University
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2013

Purpose: Reduction in blood loss during surgery stabilizes hemodynamic status and aids in recovery after total knee arthroplasty (TKA). In this study, the authors examined whether different administration routes of tranexamic acid (TNA) might affect the amount of blood loss after TKA. Methods: A total of 150 patients were prospectively allocated to each of the three groups (intravenous, intra-articular, and placebo group) and underwent unilateral TKA. During closing the operative wound, TNA (1.5 g mixed in 100 cc of saline) was administered intravenously or intra-articularly according to the enrolled group, and an equivalent volume of normal saline was administered into the knee joint cavity and intravenously in the placebo group, respectively. The amount of blood loss and transfusion, and changes in haemoglobin levels were documented accordingly. Results: The mean blood loss in the intravenous, intra-articular, and placebo groups were 528 ± 227, 426 ± 197, and 833 ± 412 ml, respectively. About 66 % (intravenous), 80 % (intra-articular), and 6 % (placebo) of each group did not require transfusion for any reason, and the mean amount of transfusion was 273.6, 129.6, and 920.8 ml, respectively. Preoperative haemoglobin values decreased by 1.6 ± 0.8, 1.8 ± 0.8, and 2.0 ± 0.9 mg/dl, respectively. Conclusion: Compared to intravenous administration, intra-articular administration of TNA seems to be more effective in terms of reducing blood loss and transfusion frequency. TNA may improve the general conditions of patients given TKA by maintaining a hemodynamically stable state, aiding in recovery, and reducing the chance of transfusion-associated side effects and complications. Level of evidence: II. © 2012 Springer-Verlag.


Sung K.S.,National Health Insurance Corporation Ilsan Hospital | Hak C.,Seoul National University
Journal of Craniofacial Surgery | Year: 2012

Alloplastic synthetic dura is widely used in dura mater reconstruction. Although the incidence of postoperative alloplastic dura infection is not common, the possibility of intractable postoperative wound infection despite appropriate antibiotic use exists. Rectus free flap is composed of well-vascularized muscle and fascial tissues. This flap is appropriate for volumetric replacement in large defects, whereas the fascia is appropriate for dura mater reconstruction. We report a case of successful reconstruction in a patient who had intractable postsurgical wound infection with staged operation using vascularized rectus muscle and fascial flap in a patient with meningioma reconstructed with alloplastic dura graft (Neuropatch; B. Braun Melsungen AG, Melsungen, Germany) and additionally achieved aesthetic results. In the first step, vascularized rectus fascia and muscle were transferred to contaminated reconstructed dura after craniectomy. The removed calvarial bone was banked to the abdominal donor-site pocket after cleansing. Finally, in the second stage, cranioplasty was performed with the banked autologous calvarial bone. Copyright © 2012 Mutaz B. Habal, MD.


Jeon T.Y.,Sungkyunkwan University | Jeon P.,Sungkyunkwan University | Jeon P.,National Health Insurance Corporation Ilsan Hospital | Kim K.H.,Sungkyunkwan University
Korean Journal of Radiology | Year: 2011

Objective: To evaluate the prevalence of incidentally found unruptured intracranial aneurysms (UIAs) on the brain MR angiography (MRA) from a community-based general hospital. Materials and Methods: This was a prospectively collected retrospective study, carried out from January 2004 to December 2004. The subjects included 3049 persons from a community-based hospital in whom MRA was performed according to a standardized protocol in an outpatient setting. Age- and sex-specific prevalence of UIAs was calculated. The results by MRA were compared with intra-arterial digital subtraction angiography (DSA) findings. Results: Unruptured intracranial aneurysms were found in 137 (5%) of the 3049 patients (M:F = 43:94; mean age, 60.2 years). The prevalence of UIAs was 5% (n = 94) in women and 4% (n = 43) in men, respectively (p = 0.2046) and showed no age-related increase. The most common site of aneurysm was at the distal internal carotid artery (n = 64, 39%), followed by the middle cerebral artery (n = 40, 24%). In total, 99% of aneurysms measured less than 12 mm, and 93% of aneurysms measured less than 7 mm. Direct comparisons between MRA and DSA were available in 70 patients with 83 UIAs; the results revealed two false positive and two false negative results. Conclusion: This community-hospital based study suggested a higher prevalence of UIAs observed by MRA than previously reported. These findings should be anticipated in the design and use of neuroimaging in clinical practice.


Jang J.Y.,Yonsei University | Kim Y.S.,National Health Insurance Corporation Ilsan Hospital
Korean Journal of Urology | Year: 2012

Purpose: The results of all prostate biopsies may be positive and suggestive of adenocarcinoma in patients with prostate-specific antigen (PSA) values higher than 100 ng/ml. We considered that the prostate cancer in patients with high PSA might be advanced disease and therefore that the treatment strategy should not be changed according to pathological reports. Thus, we assessed the role of prostate biopsy when diagnosing prostate cancer in patients with extremely high PSA levels. Materials and Methods: We reviewed the records of 1,150 cases undergoing prostate biopsies. Patients with urinary tract infection and acute urinary retention were excluded. According to the pre-biopsy PSA level, patients were divided into 6 groups (group A, 4 to 20 ng/ml; B, 20 to 40 ng/ml; C, 40 to 60 ng/ml; D, 60 to 80 ng/ml; E: 80 to 100 ng/ml; and F, above 100 ng/ml). Results: The calculated positive predictive value (PPV) for prostate cancer was 22% in group A, 54% in group B, 73% in group C, 75% in group D, 89% in group E, and 100% in group F, respectively. Pathological diagnosis was adenocarcinoma in all patients in group F (n=56). Among them, 38 patients (67.9%) had lymph node metastasis or extra-prostatic disease or both and 43 patients (76.8%) had bony metastasis. In group F, all cases were advanced prostate cancer (stage III or IV). All of them received hormonal therapy following diagnosis. Conclusions: We suggest the possibility for biopsy-free diagnosis of prostate cancer in patients with extremely high levels of serum PSA and evidence of advanced disease in imaging studies, especially in older patients with comorbid medical problems. © The Korean Urological Association, 2012.


Kang J.W.,Yonsei University | Choi H.S.,National Health Insurance Corporation Ilsan Hospital | Kim K.,Hallym University | Choi J.Y.,Yonsei University
American Journal of Clinical Nutrition | Year: 2014

Background: Previous animal studies have shown that vitamins may prevent age-related hearing loss. However, no concrete conclusions have been reached about the association between vitamin intake and presbycusis in humans. Objective: We investigated the association between dietary vitamin intake and hearing thresholds in adults between 50 and 80 y of age by using data from a large population-based survey. Design: We used data from the 2011 Korea National Health and Nutrition Examination Survey. A pure-tone audiogram and physical examination of the ear were performed, and vitamin intake was calculated by using the 24-h recall method. Data from 1910 participants were analyzed through univariate and multivariate linear regression analyses. Results: After adjustment for age, sex, smoking, and exposure to occupational and explosive noise, intake of vitamin C correlated with better hearing at midfrequency (2000 and 3000 Hz) (coefficient: 20.012; 95% CI: 20.022, 20.002). Dietary supplement use was positively associated with better hearing at all frequencies. The univariate analysis indicated that dietary intakes of retinol, riboflavin, niacin, and vitamin C were positively correlated with better hearing at most frequencies. In contrast, serum concentrations of vitamin D were associated with worse hearing at mid and high (4000 and 6000 Hz) frequencies. Conclusions: Dietary intake of vitamin C was associated with better hearing in the older population. Because less than one-half of elderly participants in this study consumed a sufficient amount of vitamins, and vitamin intake decreased with age, we should consider proper diet counseling to prevent hearing decline. © 2014 American Society for Nutrition.

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