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World neurosurgery 210건

  1. [해외논문]   In Situ Decompression to Spinal Cord During Anterior Controllable Antedisplacement Fusion Treating Degenerative Kyphosis with Stenosis: Surgical Outcomes and Analysis of C5 Nerve Palsy Based on 49 Patients  

    Yang, Haisong (To whom correspondence should be addressed: Jiangang Shi, M.D.) , Sun, Jingchuan , Shi, Jiangang , Yang, Yong , Guo, Yongfei , Zheng, Bing , Wang, Yuan
    World neurosurgery v.115 ,pp. e501 - e508 , 2018 , 1878-8750 ,

    초록

    Objective To observe outcomes of anterior controllable antedisplacement fusion (ACAF) in treatment of degenerative kyphosis with stenosis (DKS) and analyze probability of C5 nerve palsy. Methods From 2016 to 2017, a consecutive cohort of adults with DKS underwent ACAF. All patients underwent cervical radiography, computed tomography, and magnetic resonance imaging. Operative duration, blood loss, and hospital stay were estimated. Radiologic assessment included kyphotic correction, decompression width, and spinal canal area. Postoperative curvature of spinal cord was observed on sagittal magnetic resonance imaging. Japanese Orthopaedic Association score was used to evaluate neurologic status. C5 nerve palsy and other complications were recorded. Results The study included 49 patients. There was significant kyphosis correction postoperatively (−19.4° vs. 3.5°, P 2 . On sagittal magnetic resonance imaging, spinal cord curvature was classified into 5 types: type I, lordosis; type II, straight with no shifting; type III, straight with shifting; type IV, sigmoid; and type V, kyphosis. After ACAF, the spinal cord was maintained in good curvature with no shifting in all patients. No patient presented with C5 nerve palsy. Mean postoperative Japanese Orthopaedic Association score was significantly better than preoperatively (14.9 points vs. 9.0 points, P Conclusions ACAF provides in situ decompression and good curvature to the spinal cord. Good neurologic recovery is obtained with lower incidence of C5 nerve palsy when ACAF is used to treat DKS. Highlights ACAF provides good kyphotic correction, sufficient decompression, better outcomes, and fewer complications for DKS. ACAF results in in situ decompression and good curvature to the spinal cord. The incidence of C5 nerve palsy is very low. There is no spinal cord posterior shifting, no iatrogenic foraminal stenosis and no posterior column change during ACAF.

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  2. [해외논문]   Cervical Spine and Cord Angle Mismatch in the Pathogenesis of Myelopathy  

    Tykocki, Tomasz (Department of Musculoskeletal, Spinal Unit, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom ) , du Plessis, Johannes (Department of Neuroradiology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom ) , Wynne-Jones, Guy (Department of Musculoskeletal, Spinal Unit, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom)
    World neurosurgery v.115 ,pp. e272 - e278 , 2018 , 1878-8750 ,

    초록

    Background Cervical myelopathy is a complex pathology and dynamic compression of the tethered cervical cord, which may be responsible for clinical symptoms. Methods Patients with cervical canal stenosis who had magnetic resonance imaging in flexion and extension positions were retrospectively reviewed. All cases were evaluated in Nurick grade. The cervical parameters—cervical cord (CC) angle, cervical lordosis, and spine/cord (S/C) angle ratio—were measured on the magnetic resonance imaging. Mean values of these parameters were compared between nonmyelopathic (Nurick grade 0) and myelopathic groups (Nurick grades 1–5). A multinomial ordinal logistic regression was used to predict outcome for Nurick grade using the CC angle, the cervical lordosis angle, and the S/C angle ratio as independent variables. Results A total of 65 patients (35 men) with the mean age of 58.6 ± 11.4 years were analyzed. A comparison of means between Nurick grade 0 against each of myelopathic grades 1–5 revealed significant differences only for the S/C angle ratio. A cumulative comparison between nonmyelopathic and myelopathic grades for the S/C angle ratio showed significant difference of 0.29 (1.16 ± 0.5 vs. 1.45 ± 0.6, respectively; P Conclusions A positive correlation between Nurick grade and cervical spine and cord angle mismatch was found. Highlights A mismatch between cervical spine and cord angle in flexion and extension positions was found to be correlated with the severity of myelopathy. More spine/cord angle ratio was associated with higher Nurick grade. A comparison between patients with and without myelopathiac also found a significant difference for spine/cord angle ratio. Mismatch between cervical spine and cord angulation in the dynamic positions may cause repetitive microtrauma of the spinal cord.

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  3. [해외논문]   Can We Assess the Success of Surgery for Degenerative Spinal Diseases Using Patients' Recall of Their Preoperative Status?  

    Rodrigues, Ricardo (Faculty of Medicine, University of Porto, Porto, Portugal ) , Silva, Pedro Santos (Faculty of Medicine, University of Porto, Porto, Portugal ) , Cunha, Marisa (Faculty of Medicine, University of Porto, Porto, Portugal ) , Vaz, Rui (Faculty of Medicine, University of Porto, Porto, Portugal ) , Pereira, Paulo (Faculty of Medicine, University of Porto, Porto, Portugal)
    World neurosurgery v.115 ,pp. e768 - e773 , 2018 , 1878-8750 ,

    초록

    Background Patients' recall of their preoperative status is seldom used to assess surgical outcomes because of concerns about inaccuracy and bias. The present study aimed to measure the significance of this recall bias and its repercussion on patients' recollection of their preoperative status. Methods Patients submitted to surgery due to degenerative spine diseases over a 1-year period (n = 198) were included in this study. Each patient completed the EuroQol Five-Dimensional Questionnaire (including a visual analog scale), Core Outcome Measures Index (COMI) for neck (including neck pain and shoulder/arm pain numeric rating scale [NRS]), COMI back (including back pain and buttock/leg pain NRS), Neck Disability Index, and Oswestry Disability Index preoperatively. At 1 year after surgery, the patients were asked to complete 2 sets of the same questionnaires, one set regarding their postoperative status and the other set regarding their recall of their preoperative status. Results There was poor to moderate agreement between recalled and collected preoperative scores for all patient-reported outcome measures. Patients' recollection of their preoperative status was accurate for patients who underwent cervical spine surgery, but not for those who underwent lumbar spine surgery. Patients satisfied with the outcome after lumbar spine surgery recalled significantly worse scores compared with the actual preoperative scores. Conclusions Using patients' recall of their preoperative status may lead to overestimation of the effectiveness of surgery, particularly for lumbar spine surgery. The self-assessed effectiveness of surgery interferes with the recollection of baseline status. Highlights Cervical spine surgery recipients accurately recalled their preoperative status at 1 year after surgery. Lumbar spine surgery recipients recalled significantly worse scores compared with scores reported preoperatively. The effectiveness of surgery influences patients' recall bias. Data collected retrospectively are not likely to be accurate, especially in lumbar surgery recipients.

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  4. [해외논문]   Risk Factors, Additional Length of Stay, and Cost Associated with Postoperative Ileus Following Anterior Lumbar Interbody Fusion in Elderly Patients  

    Horowitz, Jason A. (Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA ) , Jain, Amit (Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia, USA ) , Puvanesarajah, Varun (Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA ) , Qureshi, Rabia (Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA ) , Hassanzadeh, Hamid (Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA)
    World neurosurgery v.115 ,pp. e185 - e189 , 2018 , 1878-8750 ,

    초록

    Objective To identify independent risk factors, additional length of stay, and additional cost associated with postoperative ileus following anterior lumbar interbody fusion in elderly patients. Methods The PearlDiver Patient Records Database was queried for all Medicare patients ≥65 years of age undergoing 1- or 2-level primary elective anterior lumbar interbody fusion from 2005 to 2014. Independent risk factors, additional length of stay, and additional cost associated with postoperative ileus were evaluated with multivariate analysis. Results There were 13,139 patients identified, and 642 patients experienced postoperative ileus within 3 days after surgery. Multivariate analysis identified perioperative fluid or electrolyte imbalance (odds ratio = 4.03; 95% confidence interval, 3.37–4.80; P P P P Conclusions Patients with perioperative fluid and electrolyte imbalances were 4 times as likely to experience postoperative ileus. Fluid balance and electrolyte levels should be carefully monitored during the perioperative period in patients undergoing anterior lumbar interbody fusion as a potential means to reduce the incidence of postoperative ileus and the additional length of stay and cost burden associated with this complication. Highlights Postoperative ileus after ALIF was associated with additional LOS of 2.83 days and additional cost of $2349. Male sex and perioperative fluid and electrolyte imbalances were independent risk factors for postoperative ileus. Patients with perioperative fluid and electrolyte imbalances were 4 times as likely to experience postoperative ileus. Fluid balance and electrolytes should be carefully monitored during the perioperative period in patients undergoing ALIF.

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  5. [해외논문]   Effect of Subthalamic Deep Brain Stimulation on Upper Limb Dexterity in Patients with Parkinson Disease  

    Nozaki, Takao (Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan ) , Asakawa, Tetsuya (Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan ) , Sugiyama, Kenji (Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan ) , Koda, Yuki (Department of Rehabilitation, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan ) , Shimoda, Ayumi (Department of Rehabilitation, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan ) , Mizushima, Takashi (Department of Rehabilitation, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan ) , Sameshima, Tetsuro (Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan ) , Namba, Hiroki (Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan)
    World neurosurgery v.115 ,pp. e206 - e217 , 2018 , 1878-8750 ,

    초록

    Objective The efficacy of deep brain stimulation (DBS) of the subthalamic nucleus (STN) on dexterity remains controversial despite its recognition as an effective strategy for Parkinson disease. The present study investigated the efficacy of STN-DBS for ameliorating bradykinesia and dexterity compared with dopaminergic medications. Methods Part III of the Unified Parkinson's Disease Rating Scale was used for the evaluation of bradykinesia, whereas the Purdue Pegboard Test and the Box and Block test were selected for dexterity. Results Our findings indicate that bradykinesia is significantly improved with both DBS and dopaminergic medication, whereas dexterity is improved only with DBS. Dopaminergic medication did not show a satisfactory efficacy on dexterity, and there was little synergistic effect of dopaminergic medication and STN-DBS for improving dexterity associated with Parkinson disease. Conclusions Our results suggest that DBS is potentially more effective than dopaminergic medications for improving dexterity. The disparities in efficacy for bradykinesia and dexterity between DBS and dopaminergic medication hint at the potential mechanisms of STN-DBS. We speculate that DBS follows at least 2 different mechanisms for improving parkinsonian symptoms: 1) the dopaminergic system, primarily for the improvement of bradykinesia and 2) the nondopaminergic system, for the improvement of dexterity. This hypothesis requires further verification and investigation. Highlights STN-DBS improved both bradykinesia and dexterity. Dopaminergic medications showed weak effects on dexterity in PD cases. Nondopaminergic mechanisms may play a crucial role in the efficacy for dexterity caused by STN-DBS.

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  6. [해외논문]   Number of Fractured Calvarial Bones Predicts Outcome in Traumatic Brain Injury Patients After Early Craniotomy  

    Wu, Xiaohua (Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China ) , He, Lingzhe (Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China ) , Shi, Feina (Department of Neurology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China ) , Dong, Fei (Department of Radiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China ) , Zeng, Qiang (Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China)
    World neurosurgery v.115 ,pp. e688 - e694 , 2018 , 1878-8750 ,

    초록

    Background Prognostic markers are important for neurosurgeons to evaluate the indications for aggressive surgical management. The purpose of this study was to investigate whether the number of fractured calvarial bones could predict the outcome in patients with traumatic brain injury (TBI) after early craniotomy. Methods TBI patients who underwent early craniotomy were reviewed. The number of fractured calvarial bones was recorded by referring to preoperative computed tomographic (CT) images. Accordingly, patients were assigned to no calvarial fracture group, single calvarial fracture group, and multiple calvarial fractures group. Good outcome was defined as Glasgow Outcome Scale scores of 4 and 5 at discharge. Logistic regression analyses were used to assess the effect of calvarial fracture on outcome. A receiver operating characteristic curve was generated for the final model. Results In all, a total of 141 patients were enrolled. Patients with no calvarial fracture had a significantly lower rate of good outcome (12.5%) than did those with a single calvarial fracture (62.2%, P P = 0.005). Binary logistic regression showed that the number of fractured calvarial bones was an independent imaging marker for predicting outcome ( P = 0.003) after adjustment for age, Glasgow Coma Scale score on admission, and decompressive craniectomy. The area under the curve of the final model was 0.863. Conclusions The number of fractured calvarial bones is an independent predictor of outcome in TBI patients after early craniotomy. No calvarial facture is associated with poor outcome in these patients. Highlights More than half of patients with traumatic brain injury had a single calvarial facture. No calvarial facture is associated with poor outcome in these patients. The number of fractured calvarial bones is an independent predictor of outcome.

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  7. [해외논문]   Meta-Analysis of Predictive Significance of the Black Hole Sign for Hematoma Expansion in Intracerebral Hemorrhage  

    Zheng, Jun (To whom correspondence should be addressed: Lu Ma, M.D.) , Yu, Zhiyuan , Guo, Rui , Li, Hao , You, Chao , Ma, Lu
    World neurosurgery v.115 ,pp. e711 - e716 , 2018 , 1878-8750 ,

    초록

    Objective Hematoma expansion is related to unfavorable prognosis in intracerebral hemorrhage (ICH). The black hole sign is a novel marker on non–contrast computed tomography for predicting hematoma expansion. However, its predictive values are different in previous studies. Thus, this meta-analysis was conducted to evaluate the predictive significance of the black hole sign for hematoma expansion in ICH. Methods A systematic literature search was performed. Original researches on the association between the black hole sign and hematoma expansion in ICH were included. Sensitivity and specificity were pooled to assess the predictive accuracy. Summary receiver operating characteristics curve (SROC) was developed. Deeks' funnel plot asymmetry test was used to assess the publication bias. Results Five studies with a total of 1495 patients were included in this study. The pooled sensitivity and specificity of the black hole sign for predicting hematoma expansion were 0.30 and 0.91, respectively. The area under the curve was 0.78 in SROC curve. There was no significant publication bias. Conclusions This meta-analysis shows that the black hole sign is a helpful imaging marker for predicting hematoma expansion in ICH. Although the black hole sign has a relatively low sensitivity, its specificity is relatively high. Highlights This study is about black hole sign for predicting HE. Sensitivity and specificity of black hole sign were pooled. SROC plot was constructed to show the predictive accuracy.

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  8. [해외논문]   Cerebral Microbleeds Could Be Independently Associated with Intracranial Aneurysm Rupture: A Cross-Sectional Population-Based Study  

    Zhang, Xin (National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China ) , Yao, Zhi-Qiang (National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China ) , Karuna, Tamrakar (Department of Neurosurgery, CMS-Teaching Hospital, Bharatpur, Chitwan, Nepal ) , Duan, Chuan-Zhi (National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China ) , Wang, Xue-Min (Key Laboratory of) , Li, Xi-Feng , Yin, Jia-He , He, Xu-Ying , Guo, Shen-Quan , Chen, Yun-Chang , Liu, Wen-Chao
    World neurosurgery v.115 ,pp. e218 - e225 , 2018 , 1878-8750 ,

    초록

    Objective To determine whether the presence of cerebral microbleeds (CMBs) is independently associated with intracranial aneurysm rupture and to identify the time interval of CMB-related intracranial aneurysm rupture. Methods This cross-sectional study included 1847 patients with unruptured and ruptured intracranial aneurysms from January 2010 to November 2017. Clinical records and imaging, including T2-weighted gradient-recalled echo sequence magnetic resonance imaging that identified the presence of CMBs preoperatively, were evaluated. Univariate analysis and multivariate logistic regression were done to determine which parameters were independent factors for aneurysm rupture. The time interval of CMB-related intracranial aneurysm rupture was also evaluated. Results CMBs confirmed by magnetic resonance imaging were present in 142 patients (142/1847; 7.7%). Of 142 patients with CMBs, 56 patients (including 17 ruptured aneurysms) who received endovascular treatment and another 86 consecutive patients who did not receive embolization or surgery for various reasons were followed for 3–49 months. The incidence of CMB-related intracranial aneurysm rupture was 27.9% (24/86) during the follow-up period. The time interval of CMB-related intracranial aneurysm rupture was 3–27 months (median 9.5 months). Multivariate analyses showed CMBs were significantly correlated with intracranial aneurysm rupture (odds ratio = 1.6; 95% confidence interval, 1.1–2.4; P = 0.010). Conclusions CMBs were independently associated with intracranial aneurysm rupture. Patients with CMBs have a 60% increased risk of aneurysm rupture compared with patients without CMBs. Highlights The presence of CMBs is independently associated with subsequent intracranial aneurysm rupture. Patient with CMBs has 60% increased risk of aneurysm rupture. The time interval of CMB-related intracranial aneurysm rupture is 3–27 months. When CMBs are confirmed by MRI, patients with CMBs should be monitored. Early intervention is highly recommended if needed to prevent adverse events.

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    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  9. [해외논문]   The Quest for Predicting Sustained Shunt Response in Normal-Pressure Hydrocephalus: An Analysis of the Callosal Angle's Utility  

    Grahnke, Kurt (Department of Neurological Surgery, Loyola University School of Medicine, Maywood, Illinois, USA ) , Jusue-Torres, Ignacio (Department of Neurological Surgery, Loyola University School of Medicine, Maywood, Illinois, USA ) , Szujewski, Caroline (Department of Neurological Surgery, Loyola University School of Medicine, Maywood, Illinois, USA ) , Joyce, Cara (Department of Public Health Sciences, Loyola University School of Medicine, Maywood, Illinois, USA ) , Schneck, Michael (Department of Neurology, Loyola University School of Medicine, Maywood, Illinois, USA ) , Prabhu, Vikram C. (Department of Neurological Surgery, Loyola University School of Medicine, Maywood, Illinois, USA ) , Anderson, Douglas E. (Department of Neurological Surgery, Loyola University School of Medicine, Maywood, Illinois, USA)
    World neurosurgery v.115 ,pp. e717 - e722 , 2018 , 1878-8750 ,

    초록

    Background Diagnosing normal-pressure hydrocephalus (NPH) and selecting patients who will experience a sustained benefit from fluid diversion surgery remains challenging. This study seeks to evaluate the association between the callosal angle (CA) and the long-term postoperative response to ventriculoperitoneal shunt surgery in a different subgroup population than previously studied to assess its generalizability. Methods We studied 72 patients with idiopathic NPH who underwent ventriculoperitoneal shunt surgery and had at least 18 months of follow-up between 2000 and 2016. We recorded their pre- and postoperative symptoms according to the NPH Eide scale and their comorbidities with the Kiefer index. Their CA, as well as Evans' Index, ventricular height, and transependymal signal were measured. Multivariable statistical models were used to determine which factors were associated with postoperative improvement while we controlled for the presence of the NPH triad. Results Fifty-nine patients (82%) demonstrated a successful response to surgery at their first postoperative follow-up. However, this declined to 54 patients (75%) at 1 year and 45 (62.5%) patients at their last follow-up. When we controlled for the presence of the triad of symptoms, the CA significantly predicted a good, sustained response to surgery; for every degree decrease in the CA, a patient is 4% more likely to experience benefit from surgery. Conclusions The CA is a useful preoperative prognostic tool for predicting which patients will experience a sustained benefit from surgery. Further studies are required to clarify this disease in the context of old age, comorbidity, and possible concomitant neurodegenerative diseases. Highlights 82% percent of patients improved immediately after surgery. At long-term follow-up only 62.5% still demonstrated improvement. A smaller CA was associated with clinical improvement when controlling for presence of the NPH triad preoperatively.

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  10. [해외논문]   How to Deal with the Empty Space After Organ Removal for Transplantation: A Single Medical Center Experience  

    Sun, Ding-Ping (Section of Transplantation Medicine, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan ) , Lee, Ling-Hsien (Section of Transplantation Medicine, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan ) , Tian, Yu-Feng (Section of Transplantation Medicine, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan ) , Zheng, Hong-Xiang (Division of General Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan ) , Kuo, Jinn-Rung (Division of General Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan ) , Wang, Che-Chuan (Division of General Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan)
    World neurosurgery v.115 ,pp. e299 - e304 , 2018 , 1878-8750 ,

    초록

    Objective Dealing with the empty space after organ removal for transplantation has not been investigated. Methods From January 28, 2005, to November 21, 2017, 111 organ donors were enrolled in this study. They were divided into 3 groups: no replacement, replaced with paper printed with organ graphics, or replaced with 3-dimensional (3D) printed simulated organs. The organs were removed at different periods. The donor's age, gender, etiology of admission, characteristics, clinical pictures, time interval between admission and date of donation, and time interval between donor coordinator consultations were evaluated. Results A total of 82 men and 29 women with mean age of 43 ± 15.1 years were enrolled. Overall, 329 organs and 126 corneas were transplanted. The major causes of brain death were traumatic brain injury (44.1%) and cerebrovascular disease (32.4%). Twelve donors initially presented with out-of-hospital cardiac arrest. Ten patients with solid cancers and 3 with septic shock donated both of their corneas. The mean time interval between donor coordinator and social worker consultation to organ donation was 3 (2–5 days) (median [interquartile range]). Periods I and II averaged 7–8 donors per year. Fourteen donors and 41 organs were replaced with 3D-printed simulated organs at the families' request in 1 year. Conclusions This is the first study to provide a replacement method dealing with the empty space after organ removal. We used 3D-printed simulated organs in addition to providing grief assistance and spiritual support. It also has the potential effect of increasing the organ donation rate. Highlights Keeping body integrity is an important predictor when considering organ donation in Asian societies. This is the first study to provide a replacement method dealing with the empty space after organ removal. Both a paper printed with organ graphics and 3D printer to print simulated organs can mimic organ integrity. These methods have supportive psychological effects on the family, and it may raise the organ donation rate potentially.

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    무료다운로드 유료다운로드

    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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