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Aortic Valvuloplasty in Pediatric Age (소아연령군에서의 대동맥판막성형술)

  • 임홍국;박천수;황호영;김웅한;이정렬;노준량;김용진
    • Journal of Chest Surgery
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    • v.37 no.8
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    • pp.652-659
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    • 2004
  • Background: In this study, we retrospectively analyzed the outcomes of aortic valvuloplasty in pediatric age. Material and Method: Between January 1993 and March 2004, 35 patients underwent aortic valvuloplasty for aortic stenosis (AS) or aortic regurgitation (AR). The mean age was 81.1$\pm$61.5 (1∼223) months. The mean follow up was 50.8$\pm$30.2 (3∼121) months. Nine patients had AS, 21 had AR, and 6 had AS and AR. Valve morphology was tricuspid in 24 patients, bicuspid in 9, quadricuspid in 1, and unicuspid in 1. The mean peak pressure gradients of AS were 72.0$\pm$33.0 mmHg, and the mean grades of AR were 3.1$\pm$0.9. Result: There was one late mortality without early mortality. After operation, AS improved with mean peak pressure gradients of 23.5$\pm$21.0 mmHg (p < 0.05), and AR improved with mean grades of 1.9$\pm$0.8 (p < 0.05). At mean follow up of 35.0$\pm$23.0 months, AS maintained with mean peak pressure gradients of 31.5$\pm$24.0 mmHg, but AR progressed with mean grades of 2.8$\pm$1.3 (p < 0.05). Reoperation was required in 6 patients 38.3$\pm$21.8 months after the original operation. The actuarial figures for freedom from reoperation at 2, 5 and 8 years were 96.9$\pm$3.1%, 79.5$\pm$5.5%, and 56.8$\pm$11.4%, respectively. Age at operation, presence of AS, preoperative severity of AS or AR, and morphology of aortic valve were not significant risk factors for reoperation, and improvement of AS or AR. Conclusion: Aortic valvuloplasty showed good immediate postoperative valve function. Aortic valvuloplasty offers children many years with tolerable valve function and allows to postpone aortic valve replacement or Ross procedure in pediatric patients.

A Study on the Risk of Conflict between Elderly or Non-elderly Pedestrians and Vehicles (고령/비고령 보행자와 차량간의 상충위험도 측정연구)

  • JANG, Jeong Ah;LEE, Hyunmi;CHOI, Keechoo
    • Journal of Korean Society of Transportation
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    • v.35 no.6
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    • pp.499-510
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    • 2017
  • Traffic accident fatalities in Korea in 2016 was 4,292 and 1,732 cases were deaths of elderly people. In spite of this, the researches on behaviors of the elderly when crossing roads, are rather limited. The purpose of this study is to investigate and analyze road crossing behavior characteristics of the elderly, when crossing roads, especially focusing on the characteristics of pedestrians and vehicles. Cross-sectional data was collected from six different sites in two regions and the following results was identified. First, at road crossings, 528 cases(84.3%) out of 626 conflict situations of the elderly and 303 cases(63.3%) out of 478 conflict situations of the non-elderly pedestrians were found to be dangerous, respectively. The elderly tend to face a statistically significant risk of 3.11 times higher than that of non-elderly people. Second, 519 cases(82.9%) of jaywalking occurred in 626 conflict cases of the elderly and 375 cases(78.5%) of jaywalking in 478 conflict events of non-elderly persons, which indicates the elderly's 1.34 times higher trend compared with the non-elderly's. Third, the pedestrian safety margin (PSM) analysis showed that the PSM of the elderly and the non-elderly were 3.33 seconds and 4.04 seconds respectively, which is 17.5% high. Fourth, the difference in pedestrian safety interval was examined by dividing the speed of approaching vehicle into less than 30km/h, above 30km/h and less than 50km/h, and over 50km/h. There was no significant difference between the PSM of coming vehicles with the speed less than 30km/h and the PSM of approaching with the speed 30km/h~50km/h, but the conflicts with vehicle of the speed above 50km/h show significantly lower PSM than with vehicle speed of 30km/h~50km/h. Finally, when the risk threshold is set to less than 2.5 seconds, the analysis shows that older pedestrians tend to cross roads dangerously 1.59~2.53 times than younger pedestrians. The results set forth here can be used as a basis for constructing the elderly safety measures at present and a potential basis for autonomous vehicle safety application in the future for solving the issue of the difference in crossing behavior between elderly and non-elderly pedestrians.

Kinematic Analysis of Airborne Movement of Dismount from High Bar(I) (철봉 내리기 공중 동작의 운동학적 분석(I))

  • Choi, Ji-Young;Kim, Youg-Ee;Jin, Young-Wan
    • Korean Journal of Applied Biomechanics
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    • v.12 no.2
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    • pp.159-177
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    • 2002
  • The purpose of this study was to investigate the relations between the segments of the body, the three dimensional anatomical angle and the angular velocity of the air born phase and understand the control mechanism of the high-bar movement, the somersault, the double somersault, the double somersault with full twist. For this study seven well trained university gymnastic volunteered, Zatsiorky and Seluyanov(1983, 1985)'s sixteen segment system anatomical model was used for this study. For the movement analysis three dimensional cinematographical method(Arial Performance Analysis System : APAS) was used and for the calculation of the kinematic variables a self developed program was used with the LabVIEW 5.1 graphical profromming(Johnson, 1999) program. By using Eular's equations the three dimensional anatomical Cardan angles of the joint and angular velocity were defined. As a result of this study 1. As the rotation of the body increased in the air born phase the projection angle of the CM of the total increased, this resulted the increased of the max hight of the CM. 2. In three dimensional angular velocity the Z axis(vertical direction) projection angular velocity increased as the rotation of the body increased in the airborn phase, but the Y axis and the X axis projection angular velocity did not show significant differences. 3. As the rotation of the body increased in the air born phase the angular movement of the shoulder and the hip showed significant change. These movement act as the starter in the preparation phase. 4. The somersault angle, the twist angle, the tilt angle of the upper body related to the global reference frame in the releas phase the average somersault angle of the three types of high-bar movement was $57.7^{\circ}$, $38.8^{\circ}$, $39.7^{\circ}$, the average tilt angle was $-1.5^{\circ}$, $-5.4^{\circ}$, $-8.4^{\circ}$, the average twist angle was $13.4^{\circ}$, $10.6^{\circ}$, $23.3^{\circ}$. This result showed that the somersault with full twist had the largest movement.

A Study on the Characteristics of Humanistic Landscape in Pyongyang Castle through Pictorial Maps in the Late Joseon Dynasty (조선후기 회화식 고지도를 통해 본 평양성의 인문경관 특성)

  • Kim, Mi-Jung;So, Hyun-Su
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.38 no.2
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    • pp.14-30
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    • 2020
  • This study focuses on the fact that pictorial maps in the late Joseon Dynasty were conceptual diagrams with the place names perceived by the people at the time of their production. In this regard, targeting on five pictorial maps, the humanistic landscape characteristics of Pyongyang, which had cultural identities such as a historically old, commercial, and Pungnyu(appreciation for the arts) city, were derived as follows. First, the historic legitimacy of Pyongyang Castle was represented by ritual and religious facilities. They include 'Dangunjeon' and 'Gijagung' related to the nation founder, 'Munmujeong': the remains of Goguryeo, 'Sajikdan' & 'Pyongyanggangdan': the place of the national rites, Hyanggyo and Seowon: education & rite functions, Buddhism and Taoist facilities, 'Yongsindang', 'Sanshindang', and 'Jesindan': folk religion facilities. Gija-related facilities, which became symbols of Pyongyang due to the importance of Small-Sinocentrism and Gija dignity tendency, were distributed throughout Pyongyang Castle though, the facilities related to King Dongmyeong of Goguryeo and the spaces of religion praying for blessings are spread in Bukseong and on the riverside of Daedonggang each. Second, as a Pyongando Province's economic center, Pyongyang's commercial landscape was represented by logistics and transportation facilities. The Daedonggang River, which was in charge of transportation functions, had many decks such as 'Yangmyeongpo', 'Cheongryongpo' and 'Waeseongjin' and bridges, such as 'Yeongjegyo' and 'Gangdonggyo', which connected major transportation routes. The road network was created in Oeseong area to facilitate logistics transportation and management, and many warehouses named after the jurisdiction of Pyongyangbu were distributed near the roads and Provincial Offices of the main gates. In addition, it was characterized by the urban area systematically divided with hierarchical roads, 'Bukjangnim' of willow trees planted on the main entrance roads of Pyongyang Castle, a linear landscape created by 'Simnijangnim' consisting of mixed forests with elm trees. Third, Pungnyu City is realized by the distribution of amusement facilities. The riverside of Daedonggang adjacent to Naeseong exhibits characteristics of artificial landscape such as a canal leading to the inside of the castle, a docking facility with embankments, and a port with cargo ships anchored. However, Bukseong of the natural surroundings had numerous pavilions and platforms such as 'Bubyeongnu', 'Eulmildae', 'Choeseungdae', 'Jebyeokjeong' and engraved letters such as 'Cheongnyubyeok', 'Jangbangho'. 'Osunjeong', 'Byeogwolji', 'Banwolji' near 'Sachang', and 'Aeryeondang', built on the island of a square pond, created waterscape in Naeseong invisible from the Daedonggang, and for practical purposes, ponds and repeated willow vegetation landscape related to Gija were placed in the western rampart of Jungseong. In addition, 'Seonyeondong', a cemetery of Gisaeng, located near by Chilseongmun, was used as poem titles and themes by literary people, contributing to the creation of the Pungnyu image of Pyongyang.

Operative Treatment of Congenitally Corrected Transposition of the Great Arteries(CCTGA) (교정형 대혈관 전위증의 수술적 치료)

  • 이정렬;조광리;김용진;노준량;서결필
    • Journal of Chest Surgery
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    • v.32 no.7
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    • pp.621-627
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    • 1999
  • Background: Sixty five cases with congenitally corrected transposition of the great arteries (CCTGA) indicated for biventricular repair were operated on between 1984 and september 1998. Comparison between the results of the conventional(classic) connection(LV-PA) and the anatomic repair was done. Material and Method: Retrospective review was carried out based on the medical records of the patients. Operative procedures, complications and the long-term results accoding to the combining anomalies were analysed. Result: Mean age was 5.5$\pm$4.8 years(range, 2 months to 18years). Thirty nine were male and 26 were female. Situs solitus {S,L,L} was in 53 and situs inversus{I,D,D} in 12. There was no left ventricular outflow tract obstruction(LVOTO) in 13(20%) cases. The LVOTO was resulted from pulmonary stenosis(PS) in 26(40%)patients and from pulmonary atresia(PA) in 26(40%) patients. Twenty-five(38.5%) patients had tricuspid valve regurgitation(TR) greater than the mild degree that was present preoperatively. Twenty two patients previously underwent 24 systemic- pulmonary shunts previously. In the 13 patients without LVOTO, 7 simple closure of VSD or ASD, 3 tricuspid valve replacements(TVR), and 3 anatomic corrections(3 double switch operations: 1 Senning+ Rastelli, 1 Senning+REV-type, and 1 Senning+Arterial switch opera tion) were performed. As to the 26 patients with CCTGA+VSD or ASD+LVOTO(PS), 24 classic repairs and 2 double switch operations(1 Senning+Rastelli, 1 Mustard+REV-type) were done. In the 26 cases with CCTGA+VSD+LVOTO(PA), 19 classic repairs(18 Rastelli, 1 REV-type), and 7 double switch operations(7 Senning+Rastelli) were done. The degree of tricuspid regurgitation increased during the follow-up periods from 1.3$\pm$1.4 to 2.2$\pm$1.0 in the classic repair group(p<0.05), but not in the double switch group. Two patients had complete AV block preoperatively, and additional 7(10.8%) had newly developed complete AV block after the operation. Other complications were recurrent LVOTO(10), thromboembolism(4), persistent chest tube drainage over 2 weeks(4), chylothorax(3), bleeding(3), acute renal failure(2), and mediastinitis(2). Mean follow-up was 54$\pm$49 months(0-177 months). Thirteen patients died after the operation(operative mortality rate: 20.0%(13/65)), and there were 3 additional deaths during the follow up period(overall mortality: 24.6%(16/65)). The operative mortality in patients underwent anatomic repair was 33.3%(4/12). The actuarial survival rates at 1, 5, and 10 years were 75.0$\pm$5.6%, 75.0$\pm$5.6%, and 69.2$\pm$7.6%. Common causes of death were low cardiac output syndrome(8) and heart failure from TR(5). Conclusion: Although our study could not demonstrate the superiority of each classic or anatomic repair, we found that the anatomic repair has a merit of preventing the deterioration of tricuspid valve regurgitations. Meticulous selection of the patients and longer follow-up terms are mandatory to establish the selective advantages of both strategies.

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Evaluation of Etiological Factors for Injuries at Oral and Maxillofacial Area (구강악안면부 외상발생의 역학적 평가)

  • Bae, Sung-Suk;Hwang, Soon-Jung
    • Journal of dental hygiene science
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    • v.12 no.4
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    • pp.310-319
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    • 2012
  • In this study, 1,495 cases of computerized data collected as disease entities of oral and maxillofacial injuries among patient visiting S university hospital located in Seoul in 2009 were analyzed and following results were obtained. It was found that the injury incidence in male was greater than in female (1.49:1), it occurred most frequently in the age of 7~14 years old (19.6%), and its most frequent cause was falling down (25.9%). Injuries occurred in other place including beach and open-air (24.7%) most frequently, often developed in anterior teeth (43.2%) and posterior teeth (43.1%), their incidence was relatively higher between 15:00~17:00 (10.4%) and 19:00~23:00 (7.1%) O'clock. In the relationship between causes of the injury and the diagnosis based on the international classification of disease), falling, fall, impingement, violence, traffic accident, sports and own making accident caused most frequently lip and oral open injuries (S01.5), open fracture of tooth (S02.51), close fracture of tooth (S02.50), close fracture of mandible (S02.60), close fracture of tooth (S02.50), respectively. From the above results, it is necessary to understand general characteristics of oral and maxillofacial injuries and to consider their trends for the establishment of systematic complement policies and for the performing safety training and public relations activities.

The Use of Arthroscopic UU Stich for Rotator Cuff Tear and Clinical Results (회전근 개 파열의 관절경하 봉합에서 새로운 봉합 방법의 이용)

  • Ko, Sang-Hun;Shin, Seung-Myeong;Choi, Young-Jin;Cha, Jae-Ryong;Park, Han-Chang
    • Clinics in Shoulder and Elbow
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    • v.14 no.1
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    • pp.67-72
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    • 2011
  • Purpose: There are various known methods for arthroscopic rotator cuff repair. The purpose of this retrospective study is to report on the clinical results and anatomical results of UU repair surgery, which is a new repair method. Materials and Methods: We enrolled 156 patients (88 men and 68 women) who underwent UU repair for rotator cuff tears from January 2009 to May 2010 in our hospital. Their average age was 55 years old (range: 38~75 years old) and the average follow-up period was 12 months (range: 6~23 months). For determining the results, we evaluated the VAS for pain, the daily living index (ADL) in the ASES scores, the UCLA and KSS scores, and all these tests were conducted at the first hospital visit and 6 months and 1 year after surgery and at the final follow-up. During the follow-up period, MRI was performed 3 and 6 months after surgery only in the patients who consented to MRI scans to confirm the presence of re-rupture. Results: The average scores of the VAS as a pain indicator decreased from 7.0 before surgery to 2.7 after surgery (p<0.05). The UCLA and KSS scores increased from 22.2 to 32.5 and from 83.7 to 91.5, and the changes was significant (p<0.05). For the active joint range of motion, the average forward flexion was improved from 125 to 175 degrees, the average lateral external rotation was improved from 38 to 58 degrees, and the average abduction was improved from 104 to 169 degrees. Out of a total of 156 patients, re-rupture was observed in 4 cases (3%) of 117 cases (75%) for which MRI was performed (with consent) between 3 and 6 months after surgery. Conclusion: UU repair surgery as arthroscopic repair of rotator cuff tear is a good repair method that shows excellent clinical results and a low re-rupture rate.

Postoperative Echocardiographic Hemodynamic Comparison between Recently Available Bileaflet Mechanical Valves (수종의 기계판막치환후 초음파심음향도를 이용한 판막간의 혈류역학적 비교)

  • Kang Joon Kyu;Hong Joon Hwa;Kim Hyung Tai;Park In Duk;Lee Cheol Joo
    • Journal of Chest Surgery
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    • v.38 no.7 s.252
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    • pp.496-500
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    • 2005
  • There was no difference between the bileaflet mechanical valves on the midterm and longterm clinical outcome. We reviewed the hemodynamic comparison between recently available mechanical valves by Doppler Echocardiography. Material and Method: We retrospectively reviewed 396 postoperative hemodynamic datas (EOA, MDPG, and MSPG) by doppler echocardiography in 345 patients. Mechanical valves from 5 venders (Sorin Bicarbon, SJM, ATS, On-X, and Edward MIRA) were compared. There were 232 valves in mitral position, 162 in aortic, and 2 in tricuspid. Result: There were 178 men (mean age; $50.6\pm13.9$ years old) and 167 women $(52.6\pm,4.6)$. MDPG/EOA of 27 mm in mitral position was Sorin; $4.2\pm1.5 mmHg/3.0\pm0.9cm^2,\;SJM;\;2.3\pm1.2/3.5\pm0.6$. In 29mm, Sorin, SJM, ATS, On-X, MIRA revealed $3.4\pm1.2/3.1\pm0.6,\;3.3\pm1.1/2.7\pm0.4,\;3.8\pm0.8/3.2\pm0.6,\;4.0\pm3.0/3.1\pm0.9,\;2.9\pm0.9/3.0\pm0.8$ In 31mm, Sorin, SJM, ATS, MIRA revealed $3.9\pm1.9/2.9\pm0.6,\;3.5\pm1.2/3.0\pm0.6,\;3.4\pm0.8/2.8\pm0.2,\;3.7\pm1.5/2.7\pm0.7$. In 33mm, Sorin, SJM, MIRA revealed $4.4\pm0.9/2.5\pm0.4,\;3.4\pm1.5/3.3\pm0.5,\;4.7\pm2.4\3.0\pm0.3$. MSPG/EOA of 19mm aortic position was Sorin, SJM, ATS, On-X, MIRA $18.0 mmHg/1.2cm^2,\;25.6\pm8.7/1.1\pm0.3,\;25.9\pm12.6/1.2\pm0.3,\;23.0/1.3,\;27.9\pm7.1/1.2\pm0.1$ in that order. In 21mm, SJM, ATS, On-X, MIRA revealed $18.3\pm6.7/1.5\pm0.5,\;13.7\pm2.1/1.7\pm0.3,\;17.0/1.4,\;17.1\pm5.5/1.8\pm0.5$. In 23mm Sorin, SJM, ATS, On-X, MIRA revealed $14.0\pm4.6/1.7\pm0.6,\;12.8\pm3.2/2.0\pm0.2,\;16.8\pm12.2/2.1\pm0.9,\;14.0/1.5,\;15.0\pm5.5/1,8\pm0.5$. In 25mm, SJM and MIRA revealed $14.0\pm5.1/1.8\pm1.0,\;11.0/2.3$. There was no statistically significant difference in these values between the venders given the same position and size. 2 redo valve replacements were performed, 1 due to severe hemolysis in ATS and 1 due to leaflet immobilization in SJM. Conclusion: Postoperative hemodynamic comparison by doppler echocardiography shows no statistically significant difference between recently available mechanical valves in this country.

A Studyof Psychiatric Treatment Compliance in Referred Patients at a General Hospital (자문의뢰된 입원환자의 특성과 정신과 치료 순응도에 대한 연구)

  • Shim, In-Bo;Ko, Young-Hoon;Lee, Moon-Soo;Kim, Yong-Ku;Han, Chang-Su
    • Korean Journal of Psychosomatic Medicine
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    • v.19 no.2
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    • pp.66-73
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    • 2011
  • Objectives:The present study investigates the status of inpatient psychiatric consultations at a general hospital in order to find factors that contribute to treatment compliance related to psychiatric consultations. Methods:The subjects were 333 patients who were hospitalized at Korea University Medical Center Ansan Hospital from 1 September 2009 to 31 July 2010.The patients were referred for psychiatric consultation during hospitalization. This study investigates demographic data, request department, referral causes, requestor, psychiatric history and diagnosis, andpsychiatric treatment compliance. Treatment compliance was defined as whether or not the patient had accepted psychiatric treatment during hospitalization or outpatient department(OPD) follow-up. This study ascertains the factors that have impact on compliance, by taking binary logistic regression with compliance and other variables. Results:Among the patients that were offered psychiatric treatment during hospitalization(N=310), treatment compliance was 82.9%. Among the patients that were offered OPD treatment(N=111), compliance was 55.8%. Elderly group(>65 years) showed better compliance to treatment during hospitalization than the younger patient group(OR=4.838, p=0.004). Patients with secondary psychiatric disorders showed better OPD follow-up compliance than patients with secondary psychiatric disorders(OR=8.520, p=.008). Conclusion:Elderly patients showed better compliance for psychiatric treatment during hospitalization. However they commonly have disorders such as delirium and mood disorders that have impact on the patient's physical state, hence further active measures should be carried out. Patients referred due to primary psychiatric disorders showed poor OPD compliance. Therefore clinicians have to suggest multidisciplinary interventions that will improve treatment compliance of such patients.

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CT-guided Percutaneous Thermoablation for the Treatment of Osteoid Osteoma (경피적 고주파 열 치료를 이용한 유골 골종의 치료)

  • Sung, Ki-Sun;Seo, Jai-Gon;Ha, Hae-Chan
    • The Journal of the Korean bone and joint tumor society
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    • v.10 no.2
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    • pp.88-95
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    • 2004
  • Purpose: Current treatment for osteoid osteomas is usually surgical excision of the nidus. Various minimal invasive techniques have been reported to overcome the invasiveness of the surgical excision. We treated 22 patients with osteoid osteoma by percutaneous thermoablation of the nidus under computed-tomography guidance. Materials and Methods: Twenty two consecutive patients underwent CT-guided percutaneous radio-frequency thermoablation between April 1999 and May 2004. The mean age was 26.5(7~55) years. In three cases, the diagnosis was confirmed pathologically before the prodedure while the others clinically and radiologically. Computed tomography (CT)-guided percutaneous RF ablation was performed with general or spinal anesthesia. With an RF electrode, the lesion was heated to 80 or 90 degrees C for 6(3~8) minutes. Clinical success was assessed at a mean of 30(4~62) months after the procedure at out patient clinic or by telephone interview. Results: The procedure was technically successful in all cases except a complication. Patients were discharged on 1.9 days after the procedure and resumed normal activities immediately. All patients but three (86%) remained pain free during follow-up (range 4~62 months). A second thermoablation treatment relieved the recurrent symptoms in 2 patients and the remained had persistent pain without a second prodedure. Conclusion: Percutaneous thermoablation appears to be safe and effective for osteoid osteomas, and is a minimally invasive procedure alternative to surgical resection.

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