Yonsei medical journal
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Yonsei medical journal · Feb 2004
Meta AnalysisIs laparoscopic appendectomy useful for the treatment of acute appendicitis in Korea? A meta-analysis.
We performed a meta-analysis using results in the Korean literatures to determine whether laparoscopic appendectomy (LA) or open appendectomy (OA) provide the better outcome in possible acute appendicitis patients. To perform the meta-analysis, an extensive literature search was conducted, giving priority to the Journal of the Korean Surgical Society, and domestic literature in its search database, published since January 1993, to ascertain the usefulness of LA in the treatment of acute appendicitis. The criteria used for the quality evaluation were as follows: 1) study subjects must have been evaluated clinically for suspected acute appendicitis, and 2) articles were included only if sufficient data (e.g. patient number, mean and standard deviation of patient outcome variables) were available regarding patient outcomes for LA or OA treated appendicitis. ⋯ Overall effect size in terms of the time required to return to full functioning was 1.9757 (95% CI 1.0066 to 2.9448), and LA reduced the time required by about 2 days versus OA. Considering the overall odds ratio (0.33) and 95% CI (0.20 to 0.55) the incidence of wound infection was significantly lower in LA than in OA. This review of the published evidence suggests that LA is more useful for treating acute appendicitis, especially when perforated appendicitis is suspected.
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Yonsei medical journal · Feb 2004
Comparative StudyPredictive comparisons of procalcitonin (PCT) level, arterial ketone body ratio (AKBR), APACHE III score and multiple organ dysfunction score (MODS) in systemic inflammatory response syndrome (SIRS).
Procalcitonin (PCT) is a newly introduced marker of systemic inflammation and bacterial infection. A marked increase in circulating PCT level in critically ill patients has been related with the severity of illness and poor survival. The goal of this study was to compare the prognostic power of PCT and three other parameters, the arterial ketone body ratio (AKBR), the acute physiology, age, chronic health evaluation (APACHE) III score and the multiple organ dysfunction score (MODS), in the differentiation between survivors and nonsurvivors of systemic inflammatory response syndrome (SIRS). ⋯ PCT values of the three groups were not significantly different on the first day between survivors and nonsurvivors. Receiver operating characteristic (ROC) curves for prediction of mortality by PCT, AKBR, APACHE III score and MODS were 0.690, 0.320, 0.915 and 0.913, respectively, on the admission day. In conclusion, PCT could have some use as a mortality predictor in SIRS patients but was less reliable than APACHE III score or MODS.
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Yonsei medical journal · Feb 2004
Clinical Trial Controlled Clinical TrialPharmacotherapy and regional cerebral blood flow in children with obsessive compulsive disorder.
While regional cerebral blood flow (rCBF) studies on adults involving the caudate, prefrontal, orbitofrontal, and cingulated areas have been reported, no such published data on children exist. In this study, we aimed to determine the significance of pre- and post-treatment regional cerebral blood flow (rCBF) differences in children with obsessive compulsive disorder (OCD) and compared them with healthy controls. Eighteen drug-free obsessive compulsive children, aged 11 to 15, without comorbid states except for anxiety disorders--participated in this study. ⋯ These areas, in addition to the right anteromedial temporal, showed significant rCBF reduction after treatment with paroxetine. The mean percentage of change in obsession scores during the treatment correlated significantly with the baseline and post- treatment rCBF level of the right caudate, post-treatment left caudate, and baseline left caudate. Our findings on children are consistent with adult studies and support the theory of a cortical-striatal-thalamic-cortical loop disturbance in OCD.
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Yonsei medical journal · Dec 2003
Comparative StudyThe comparison of VATS ramicotomy and VATS sympathicotomy for treating essential hyperhidrosis.
This study was undertaken to determine if better results could be achieved by comparing the results of a thoracic sympathetic ramicotomy (division of rami communicantes) with a conventional thoracic sympathicotomy (division of sympathetic trunk) for treating essential hyperhidrosis. From August 2001 to February 2002, 29 consecutive patients underwent surgery of the sympathetic nerves in order to treat severe essential hyperhidrosis. Of these patients, a ramicotomy was performed under VATS (VATS-R) in 13 patients, sympathicotomy under VATS (VATS-S) in 13, a unilateral ramicotomy and contralateral sympathicotomy under VATS (VATS-RS) in 2 and a sympathicotomy via a thoracotomy (T-S) in 1. ⋯ Postoperatively, almost all ramicotomy patients had no functional problems in daily life or in their occupational activity, because they could maintain hand humidity. Moreover, they showed no more than a mild degree of compensatory sweating and reported high long-term satisfaction rates. Therefore, a sympathetic ramicotomy rather than a conventional sympathicotomy is recommended as a more selective and physiologic modality for treating essential hyperhidrosis.
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Yonsei medical journal · Dec 2003
Standardization of flap design for oropharyngeal reconstruction after cancer ablation surgery.
A variety of residual defects containing many sulci and fossae in the oropharyngeal cavity make it extremely difficult to achieve an adequate flap design as well as the functional reconstruction of the complex defects after ablation surgery for oropharyngeal tumors. This study attempted to standardize flap design for the different types of defects in order to produce a better functional reconstruction of intra-oral defects. The oropharyngeal defects were classified into 6 Zones. ⋯ In all patients, the decannulation was successful, and the swallowing and deglutination functions were within the normal parameters. There was less nasal escape of the voice and the regurgitation of food than that observed using the conventional flap design method. Effective and functional reconstructions with minimal morbidities are possible with the application of the standardized forearm free flap design in oropharyngeal defects.