Kim M.,Sacred Heart College
Spine | Year: 2017
STUDY DESIGN.: Retrospective comparative cohort analysis. OBJECTIVE.: To evaluate the effect of postoperative airway management protocol (ASAN Extubation Protocol, AEP) on incidence of airway complications for patients undergoing anterior cervical spine surgery (ACSS). SUMMARY OF BACKGROUND DATA.: Postoperative airway compromise remains crucial for patients undergoing ACSS. Despite the potential severity of these complications, the data in the published literature addressing this issue is sparse. METHODS.: A retrospective cohort study was performed regarding airway complications (postoperative airway edema requiring unplanned reintubation or tracheostomy) between groups of patients undergoing ACSS prior to and after applying our standardized protocol (AEP) for postoperative extubation. The AEP was developed based on 5 clinical risk factors reported having relation to airway complication. Postoperative patients with any 1 or more risk factors were kept intubated for at least overnight and extubation was conducted according to the amount of prevertebral soft tissue swelling. RESULTS.: A total of 538 ACSS patients were identified from 2008 to 2016. The Non-protocol group (prior to protocol application, 275 patients) and the Protocol group (after protocol, 263 patients) were compared; airway complication rates were significantly different between 2 groups (Non-protocol: 3.64% (10/275) vs. Protocol: 0.76% (2/263), p?=?0.024). The possible factors that may increase airway complication include operative indications (p?=?0.002), trauma (p?=?0.000), medical comorbidity risk (p?=?0.011), combined anterior and posterior surgery (p?=?0.002), and operation time longer than 5?hours (p?=?0.045). In multivariate analysis, medical comorbidity risk, trauma and airway protocol adoption were significant factors. AEP reduced the airway complication rate by odds ratio 0.125 (p?=?0.013). CONCLUSIONS.: Postoperative airway complication is not very common after ACSS. AEP contributed to reduce the incidence of airway complications. The potentially life – threatening event of loss of airway patency, even though it is a rare complication, should be cautiously analyzed with identification of risk factors before the surgery.Level of Evidence: 2 Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Na H.Y.,Sacred Heart College
American Journal of Surgical Pathology | Year: 2016
Despite recent progress in comprehensive genetic analysis, little is known about the molecular pathogenesis of sebaceous carcinoma. On the basis of the ontogenic proximity of sebaceous and mammary glands, we designed an intrinsic classification for sebaceous carcinoma adapted from that of breast cancer and evaluated its clinical significance. We investigated 42 cases of sebaceous carcinoma, including 32 ocular and 10 extraocular cases. Immunohistochemical analyses for estrogen receptor (ER), progesterone receptor (PR), androgen receptor (AR), HER2, Ki67, and CK5/6 and fluorescence in situ hybridization for the HER2 gene were performed. The immunohistochemistry for ER, PR, and AR showed positivity in 18 (42.9%), 11 (26.2%), and 34 (81.0%) cases, respectively. Expression of the HER2 protein was found in 10 (33.8%) cases, whereas extra copies were found in 3 (7.1%). According to our system, there were 16 (38.1%) cases of the luminal 1 subtype, 4 (9.5%) of the luminal 2 subtype, and 7 (16.7%) of the HER2 subtype, respectively. Fifteen cases (35.7%) belonged to the triple-negative group. In univariable analysis, loss of AR was significantly associated with shorter disease-free survival (P=0.020), whereas the expression of HER2 was associated with a better outcome with borderline significance (P=0.060). The luminal 2 subtype showed the best survival, and the all-negative subtype showed the worst (P=0.001). In multivariable analysis, negativity of PR or AR, low CK5/6, and female sex were independent poor prognostic factors (all P<0.05). This is the first study to categorize sebaceous carcinoma on the basis of the possible link between its molecular pathogenesis and future therapeutic applications. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
An T.S.,Sacred Heart College
Korean journal of ophthalmology : KJO | Year: 2013
Branch retinal artery occlusion (BRAO) and branch retinal vein occlusion (BRVO) rarely cause neovascular glaucoma (NVG). A 58-year-old woman with hypertension and type 2 diabetic mellitus complained of progressive visual loss in her right eye for the previous 3 months. At initial examination, visual acuity was 20 / 63 in the right eye. Angle neovascularization was observed and the intraocular pressure (IOP) was 30 mmHg in her right eye. Fundus examination and fluorescein angiography showed BRAO combined with BRVO. We immediately injected intravitreal and intracameral bevacizumab in her right eye. The next day, we performed scatter photocoagulation in the nonperfusion area. One month later, visual acuity was 20 / 20 in her right eye and the IOP was 17 mmHg with one topical antiglaucoma agent. The neovascularization had regressed completely. We report a case of unilateral NVG which was caused by BRAO with concomitant BRVO and advise close ophthalmic examination of the iris and angle in BRVO with BRAO.
Binesh C.P.,Sacred Heart College
Diseases of Aquatic Organisms | Year: 2013
Heavy mortality was observed in an experimental lot of 2 ornamental fish species, zebrafish Danio rerio (F. Hamilton, 1822) and goldfish Carassius auratus (Linnaeus, 1758). The fishes showed typical symptoms of viral nervous necrosis before death. Gross morphological examination revealed no visible lesions except in the brain, visible as a creamy opaque patch through the dorsal side of the head. Parasitic and bacteriological analysis revealed no pathogenic agents. Histopathological analysis revealed severe vacuolation in the brain and spinal cord of the samples. A fragment within the variable region of genomic RNA2 of betanodavirus was amplified from the samples by reverse transcription polymerase chain reaction using specific primers designed previously. The analysis suggests that the observed mortality in the fishes was due to betanodavirus infection. This is the first report of natural infection of betanodavirus in laboratory fishes causing viral nervous necrosis leading to mortality. The observation is alarming, as the ornamental fish culture and trade is being popularized in India where the fatal disease may cause severe setbacks in the industry. It emphasizes the need for quarantine and control strategies to prevent the spread of the virus and outbreak of the disease. © Inter-Research 2013.
Son G.-H.,Sacred Heart College
American journal of obstetrics and gynecology | Year: 2015
Pushing bulging fetal membranes back into the uterine cavity effectively without rupture of fetal membranes during emergency cerclage is a concern to obstetricians. We have developed a new uniconcave balloon device for repositioning fetal membranes into the uterus during emergency cerclage. Our technique can be accomplished easily with few complications. Copyright © 2015 Elsevier Inc. All rights reserved.
Lee J.P.,Sacred Heart College
Korean journal of ophthalmology : KJO | Year: 2011
We used the Swedish interactive threshold algorithms (SITA) standard strategy of Humphrey perimetry, to analyze the pattern of visual field (VF) defects and evaluate the quantitative correlation between the tumor volume and severity of VF defects in patients with pituitary macroadenoma. We reviewed 50 patients with pituitary macroadenoma who received VF test and 11 patients were excluded. VF analysis was performed with Humphrey perimeter using the SITA standard strategy. The tumor volume was assessed radiologically via brain magnetic resonance images and was calculated using Cavalieri's principle. We used the mean deviation (MD) and pattern standard deviation (PSD) of the Humphrey parameter to measure VF defect severity, and then analyzed the correlation of tumor volume with VF defects. Twenty nine patients (74%) showed abnormal VF and bitemporal field changes, which were the most common field defects on presentation. Seven patients (18%) had unilateral VF defects, 22 patients (56%) had bilateral VF defects. The tumor volume of the patients with VF defects was significantly larger than that of patients with normal VF (p = 0.006). The tumor volume exhibited significant negative correlation with MD (r = -0.693; p < 0.001) and significant positive correlation with PSD (r = 0.589; p < 0.001). In patients with pituitary macroadenoma, there was a variety of VF defects and a high correlation between the tumor volume and the severity of VF defects. SITA standard strategy can be a fast and quantitative method for evaluating central VF defects.
Park M.S.,Sacred Heart College
Spine | Year: 2016
STUDY DESIGN.: National population-based cohort study. OBJECTIVE.: To evaluate re-operation rates of cervical spine surgery for cervical degenerative conditions utilizing a national population database. SUMMARY OF BACKGROUND DATA.: There is an inherently low incidence of reoperation after surgery for cervical degenerative disease. Therefore, it is difficult to sufficiently power studies to detect differences between reoperation rates of different cervical surgical procedures. National population-based databases provide large, longitudinally followed cohorts that may help overcome this challenge. METHODS.: We used the Korean Health Insurance Review & Assessment Service national database to select our study population. We included patients with diagnosis of cervical spondylotic radiculopathy or myelopathy who underwent cervical surgeries from January 2009 to June 2014. We separated patients into three groups based on surgical procedures: discectomy or corpectomy with anterior fusion, laminoplasty, or laminectomy with posterior fusion. Age, sex, presence of diabetes, osteoporosis, associated comorbidities, number of operated cervical disc levels, and hospital types were considered potential confounding factors. Reoperation rates were analyzed over early and late time periods. RESULTS.: The reoperation rate over the entire follow-up period was 3.31%. Overall, the reoperation rate was significantly higher after laminectomy with posterior fusion or laminoplasty than after discectomy or corpectomy with anterior fusion. A similar pattern was seen during the late time period. In the early period, rates were higher only after laminectomy with posterior fusion than after discectomy or corpectomy with anterior fusion. Sex, presence of diabetes, associated comorbidities, and hospital types were noted to be risk factors for reoperation. CONCLUSIONS.: The reoperation rate was higher after laminectomy with posterior fusion or laminoplasty. Given clinical scenarios in which either anterior or posterior approaches can be utilized, risk of reoperation can be another variable to consider in surgical planning and patient education.Level of Evidence: 3 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Lee J.J.,Sacred Heart College
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association | Year: 2014
PURPOSE: The aim of this study was to compare the results of ultrasonographically guided axillary nerve block (ANB) combined with suprascapular nerve block (SSNB) with those of SSNB alone on postoperative pain and satisfaction within the first 48 hours after arthroscopic rotator cuff repair.METHODS: Forty-two patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled in this study. Among them, 21 patients were randomly allocated to group 1 and received both SSNB and ANB with 10 mL ropivacaine. The other 21 patients were allocated to group 2 and received SSNB with 10 mL 0.75% ropivacaine and ANB with 10 mL saline. Visual analog scale (VAS) pain score, patient satisfaction (SAT), and lateral pain index (LPI) was checked at 1, 3, 6, 12, 18, 24, 36, and 48 hours postoperatively.RESULTS: Group 1 showed a significantly lower mean VAS score at postoperative 1, 3, 6, 12, 18, and 24 hours compared with group 2 (5.1 < 7.6, 4.4 < 6.3, 3.7 < 5.3, 3.2 < 4.5, 2.7 < 4.0, and 2.7 < 3.4, respectively). A significantly high mean SAT and low mean LPI was observed in group 1 at postoperative 1, 3, 6, 12, 18, 24, and 36 hours (4.9 > 2.4, 5.9 > 3.7, 6.3 > 5.0, 6.8 > 5.7, 7.3 > 6.2, 7.5 > 6.6, and 7.7 > 7.0, respectively), (1.1 < 3.0, 0.8 < 2.5, 0.7 < 2.0, 0.7 < 1.6, 0.6 < 1.3, 0.6 < 1.0, and 0.4 < 0.7, respectively). The frequency of rebound pain decreased in group 1 compared with group 2 (P = .032). In addition, rebound phenomenon showed a correlation with ANB on univariate logistic regression (P = .034; odds ratio, 0.246).CONCLUSIONS: Ultrasonographically guided ANB combined with SSNB in arthroscopic rotator cuff repair showed an improved mean VAS in the first 24 hours after surgery compared with SSNB alone. The mean SAT and LPI of the combined blocks were better than those of the single block within the first 36 hours. Ultrasonographically guided ANB combined with SSNB also decreased the rebound phenomenon.LEVEL OF EVIDENCE: Level I, randomized controlled trial. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
Park M.S.,Sacred Heart College
Spine | Year: 2016
STUDY DESIGN.: National population-based cohort study OBJECTIVE.: To compare the reoperation rates between cervical spondylotic radiculopathy and myelopathy in a national population of patients. SUMMARY OF BACKGROUND DATA.: There is an inherently low incidence of reoperation after surgery for cervical degenerative disease. Therefore, it is difficult to sufficiently power studies to detect differences between reoperation rates of different cervical diagnoses. National population-based databases provide large, longitudinally followed cohorts that may help overcome this challenge. METHODS.: We used the Korean Health Insurance Review & Assessment Service national database to select our study population. We included patients with the diagnosis of cervical spondylotic radiculopathy or myelopathy who underwent anterior cervical discectomy and fusion from January 2009 to June 2014. We separated patients into two groups based on diagnosis codes: cervical spondylotic radiculopathy or cervical spondylotic myelopathy. Age, sex, presence of diabetes, osteoporosis, associated comorbidities, number of operated cervical disc levels, and hospital types were considered potential confounding factors. RESULTS.: The overall reoperation rate was 2.45%. The reoperation rate was significantly higher in patients with cervical spondylotic myelopathy than in patients with cervical radiculopathy (myelopathy: p?=?0.0293, hazard ratio?=?1.433, 95% confidence interval 1.037–1.981). Male gender, presence of diabetes or associated comorbidities, and hospital type were noted to be risk factors for reoperation. CONCLUSIONS.: The reoperation rate after anterior cervical discectomy and fusion was higher for cervical spondylotic myelopathy than for cervical spondylotic radiculopathy in a national population of patients.Level of Evidence: 3 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Kim C.S.,Sacred Heart College
Diabetes technology & therapeutics | Year: 2010
BACKGROUND: We designed a system for diabetes patients treated with glargine, a long-acting insulin, to make an automatic adjustment of insulin dose based on glucose level data and to provide the patients with the needed insulin dose by using a short message service (SMS). We also compared diabetes patients who used our system with patients who received the conventional titration scheme. METHODS: Included were 100 type 2 diabetes patients whose blood glucose was suboptimally controlled on their previous antidiabetes treatment. Each participant was assigned to either the intervention or control group, each with 50 patients, using adaptive randomization. We applied our system to the intervention group for 12 weeks, whereas the control group received a conventional titration scheme, seeking a target fasting blood glucose of <120 mg/dL. RESULTS: The fasting and postprandial glucose levels of the intervention group declined earlier than those of the control group. Lastly, a greater (P = 0.023) reduction in hemoglobin A(1C) from baseline to the end point was observed in the intervention group (from 9.8 +/- 1.3% to 7.4 +/- 0.7%) than in the control group (from 9.8 +/- 1.2% to 7.8 +/- 0.8%). The incidence of symptomatic, asymptomatic, and nocturnal hypoglycemia was similar in both groups. There was a small increase in body weight from baseline to the end point with both the intervention (2.4 +/- 3.0 kg) and control (2.2 +/- 2.8 kg) groups. CONCLUSIONS: This study demonstrated that SMS based on our specialized Internet-supported system is an effective and safe approach to long-acting insulin dose adjustments in patients with type 2 diabetes.