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Pak Yujin,Baek Sujin,Bang Minhae,Kim Hoseop,Jo Yumin,Oh Chahyun,Hong Boohwi 조선대학교 의학연구원 2023 Medical Bilogical Science and Engineering Vol.6 No.1
Regional anesthesia has become an alternative to general anesthesia in patients with risk factors that may cause perioperative complications. The transversalis fascial plane block (TFPB) is a useful regional technique for blocking the ilioinguinal and iliohypogastric nerves. An 87-yearold female patient with symptomatic severe aortic stenosis was scheduled to undergo open reduction and fixation with an autogenous iliac crest bone graft (ICBG) for the nonunion of the proximal shaft of an ulnar fracture. General anesthesia was avoided due to cardiac comorbidities; therefore, regional anesthesia was considered. ICBG can be performed under spinal anesthesia. However, we performed TFPB since severe aortic stenosis is a contraindication for spinal anesthesia. A brachial plexus block was performed for the primary forearm surgical site. The surgery proceeded safely without any hemodynamic compromise or special events. TFPB for ICBG can be a useful alternative in patients with severe cardiac comorbidities to avoid perioperative risks.
Adenocarcinoma Arising at a Urostomy: Case Report and Literature Review
Jeon Sungmi,Myung Yujin,Pak Changsik 대한창상학회 2020 Journal of Wound Management and Research Vol.16 No.2
We report a case of adenocarcinoma originating in a urostomy site 35 years after bladder cancer operation and urostomy formation. While ileostomy adenocarcinoma has been reported as a rare complication after colectomy and ileostomy formation for inflammatory bowel disease or familial adenomatous polyposis, there were no previously published cases of parastomal carcinoma in patients with urostomy. In our case, a series of work-ups, including immunohistochemical staining (cytokeratin 7 and 20, p63), revealed no evidence of primary adenocarcinoma of the skin or any other primary tumor. The patient underwent surgical excision with urostomy reformation and the skin defect was successfully reconstructed using local flap and split-thickness skin graft. This case poses a diagnostic challenge for clinicians because skin primary adenocarcinoma (i.e., malignant adnexal tumor) is likely to be ruled out due to its low incidence, and the symptoms may be considered those of a rare subcutaneous metastasis from a visceral malignancy (e.g., colon cancer) in the patient with a history of a prior malignancy (bladder cancer). This underscores the need for a multidisciplinary approach and patient education for early diagnosis.
조유민,Park Seyeon,오차현,Pak Yujin,Jeong Kuhee,Yun Sangwon,Noh Chan,정우석,김윤희,고영권,홍부휘 대한마취통증의학회 2022 Korean Journal of Anesthesiology Vol.75 No.3
Background: Various regional analgesia techniques are used to reduce postoperative pain in patients undergoing video-assisted thoracic surgery (VATS). This study aimed to determine the relative efficacy of regional analgesic interventions for VATS using a network meta-analysis (NMA). Methods: We searched the Medline, EMBASE, Cochrane Controlled Trial Register, Web of Science, and Google Scholar databases to identify all randomized controlled trials (RCTs) that compared the analgesic effects of the following interventions: control, thoracic paravertebral block (TPVB), erector spinae plane block (ESPB), serratus plane block (SPB), and intercostal nerve block (INB). The primary outcome was opioid consumption during the first 24-h postoperative period. Pain scores were also collected during three different postoperative periods: the early (0–6 h), middle (6–18 h), and late (18–24 h) periods. Results: A total of 21 RCTs (1391 patients) were included. TPVB showed the greatest effect on opioid consumption compared with the control (mean difference [MD] = −13.2 mg; 95% CI [−16.2, −10.1]). In terms of pain scores in the early period, ESPB had the greatest effect compared to control (MD = −1.6; 95% CI [−2.3, −0.9]). In the middle and late periods, pain scores showed that TPVB, ESPB and INB had superior analgesic effects compared to controls, while SPB did not. Conclusions: TPVB had the best analgesic efficacy following VATS, though the analgesic efficacy of ESPBs was comparable. However, further studies are needed to determine the optimal regional analgesia technique to improve postoperative pain control following VATS.