• Clinical and Experimental Pediatrics
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• v.52 no.4
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• pp.494-498
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• 2009

Purpose : Applicability of transcatheter closure of atrial septal defect (ASD) has been expanded by accumulation of clinical experiences and evolutions of the device. This study was performed to evaluate the safety and efficacy of transcatheter closure of ASD with Amplatzer septal occluder (ASO) in young children less than 3 years of age. Methods : From May 2003 to December 2005, 295 patients underwent transcatheter closure of ASD with ASO in the Severance Cardiovascular Hospital, Yonsei University Health System. Among them, 51 patients less than 3 years of age were enrolled in this study. We investigated procedural success rate, rate of residual shunt, frequency of complications, procedure/fluoroscopy time, and need of modified techniques for device implantation. Results : The median age was 2.1 years and median body weight was 12 kg. Implantation of device was successful in 50 patients (98%). Seven patients (15%) showed a small residual shunt 1 day after the procedure, but complete occlusion had been documented at 6 month follow-up in all patients (100%). The pulmonary to systemic flow ratio (Qp/Qs), peak systolic pulmonary artery pressure, and peak systolic right ventricular pressure had decreased significantly after closure of ASD. There were 2 complications including device embolization (1, 2%) and temporary groin hematoma (1, 2%). Conclusion : Transcatheter closure of ASD with ASO can be performed with satisfactory results and acceptable risk even in young children less than 3 years of age. We could suggest that even in very young children with ASD, there is no need to wait until they grow to a sufficient size for the transcatheter closure.

• Journal of Gastric Cancer
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• v.4 no.4
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• pp.252-256
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• 2004

Purpose: Anastomosis site stricture is a common complication after a total gastrectomy. End-to-end anastomosis (EEA) stapler devices are preferred to a hand-sewn esophagojejunostomy these days. However, stapling devices have been reported not to reduce the incidence of esophagojejunostomy site stricture considerably. Materials and Methods: From Sep. 1998 to Dec. 2000, at Korea Gastic Cancer Center, Seoul Paik Hospital, Inje University, we experienced 228 total gastrectomies in which EEA stapling devices had been used. We investigated the correlation of the stricture with the size of the EEA stapling device, the type of esophagojejunal reconstruction, reflux esophagitis, and duration of stricture development. Results: Among the 228 cases, as far as the patient's age was concerned, the 7th decade was the most common 64 cases, followed by the 5th decades. The Male-to-female ratio was 2.3：1. A loop esophagojejunostomy was used in 223 cases, and the Roux-en-Y method was used in 5 cases. The 32 patients with anastomosis site stricture were patients with loop esophagojejunal anastomosis. Anastomosis site stricture occurred in $14\%$ (32/228) of the total gastrectomy cases, in$15.9\%$ (11/69) of the total gastrectomies involving stapler devices with a 25-mm diameter, and in $13.2\%$ (21/159) of the total gastrectomies involving staper devices with a 28-mm diameter. There was no correlation between the incidence of stricture and EEA- stapling device size (P>0.05). Reflux esophagitis occurred in 56 of the 228 cases, with 7 of those 56 cases ($12.5\%$) and 25 of the remaining 172 cases ($14.5\%$) having strictures. There was no considerable difference in the stricture incidence rate according to the presence of reflux esophagitis (P>0.05). The onset of stricture development, occurred within 6 months in 16 cases, including 4 cases of reflux esophagitis, between 7 and 18 months in 14 cases, including 3 cases of reflux eshophagitis, and after 19 months in 2 cases. Conclusion: An esophagojejunostomy site stricture after a total gastrectomy was not correlated with the esophagojejunal reconstruction type, the size of the stapling device, or the presence of reflux esophagitis. General anastomosis technical factors (e.g., adequate blood supply, tension-free manner, adequate hemostasis) may be more important to prevent anastomosis site stricture after an esophagojejunostomy during a total gastrectomy.

• Nuclear Medicine and Molecular Imaging
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• v.43 no.2
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• pp.120-128
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• 2009

Purpose: Early detection of recurrence is an important factor for long term survival of patients with colorectal cancer. Measurement of serum levels of CEA, CA 19-9, CT and PET/CT has been commonly used in the postoperative surveillance of colorectal cancer. The purpose of this study was to compare the diagnostic ability of PET/CT, tumor marker and CT for recurrence in colorectal cancer patients after treatment. Materials and Methods: F-18 FDG PET/CT imaging was performed in 189 colorectal cancer patients who underwent curative surgical resection and/or chemotherapy. Measurement of serum levels of CEA, CA 19-9 and CT imaging were performed within 2 months of PET/CT examination. Final diagnosis of recurrence was made by biopsy, radiologic studies or clinical follow-up for 6 months after each study. Results: Overall sensitivity, specificity of PET/CT was 94.7%, 91.1%, while those of serum CEA were 44.7% and 97.3%, respectively. Sensitivity and specificity were 94.2%, 90.4% for PET/CT and better than those of combined CEA and CA 19-9 measurement(52.1%, 88.5%) in 174 patients measured available both CEA and CA 19-9 data. In 115 patients with both tumor markers and CT images available, PET/CT showed similar sensitivity but higher specificity(92.9%, 91.3%) compared to combination of tumor markers and CT images(92.9%, 74.1%). Conclusion: PET/CT was superior for detection of recurred colorectal cancer patients compared with both CEA, CA 19-9, and even with combination of both tumor markers and CT. Therefore PET/CT could be used as a routine surveillance examination to detect recurrence or metastasis of colorectal cancer.

• Radiation Oncology Journal
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• v.27 no.4
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• pp.189-193
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• 2009

Purpose: To report on the changes in the patterns of care and survival over time for esthesioneuroblastoma. Materials and Methods: We retrospectively analyzed 42 previously untreated and histologically confirmed esthesioneuroblastoma patients seen between March 1989 and June 2007. According to Kadish's classification, 3 patients (7%) were stage A, 6 (14%) at stage B, and 33 (79%) at stage C. Of the 33 Kadish C patients, 19 and 14 patients were treated from 1989 through 2000 and from 2001 through 2007, respectively. Treatment included surgical resection, radiotherapy, chemotherapy, or a combination of these methods. Chemotherapy was administered to 8 of 19 patients (42%) seen from 1989 through 2000, whereas all of the 14 patients seen from 2001 through 2007 received chemotherapy (p<0.001). No patient was treated by three-dimensional conformal radiotherapy (3D-CRT) from 1989 through 2000, however 8 of 14 patients (67%) seen from 2001 through 2007 underwent 3D-CRT (p<0.001). The median follow-up time for surviving patients was 6.5 years (range, 2.2~15.8 years). Results: The 5-year overall survival (OS) and progression-free survival (PFS) rates for the entire cohort were 53% and 39%, respectively. The 5-year OS was 100% for Kadish stages A or B and 39% for stage C (p=0.007). For patients with stage C disease who were treated from 1989 to 2000 and from 2001 to 2007, the 5-year OS rate was 26% and 59% (p=0.029), respectively and the corresponding 5-year PFS rate was 16% and 46% (p=0.001), respectively. Intraorbital extension and treatment era (1989~2000 vs. 2001~2007) were found as independent factors for OS and PFS in a multivariate analyses. Conclusion: The results of this study suggest that treatment era, which features a distinction in treatment modality and technique with the introduction of 3D-CRT, may be the cause of improved OS and PFS in Kadish stage C patients. To achieve better outcomes for patients with Kadish stage C, combined chemoradiotherapy, especially 3D-CRT, is recommended in addition to surgery.

• Journal of the Korean Orthopaedic Association
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• v.53 no.6
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• pp.522-529
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• 2018

Purpose: To compare the clinical outcomes of ultrasound-guided percutaneous repair (USPR) and open repair in a ruptured Achilles tendon. Materials and Methods: The outcomes of 12 patients with USPR (group A) and 18 patients with open repair (group B) from January 2015 to February 2017 were analyzed retrospectively. The postoperative clinical evaluations were performed using the Arner-Lindholm scale, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Achilles tendon total rupture score (ATRS), and visual analogue scale for the overall satisfaction and cosmetic satisfaction with the scar, and the starting time of single heel raises. The complications were also evaluated. Results: The Arner-Lindholm scale, AOFAS ankle-hindfoot score, ATRS, starting time of single heel raises were similar in both groups (all p>0.05). Group A showed a significantly higher overall patient's satisfaction and cosmetic satisfaction in than group B (all p<0.05). Two cases of Achilles tendon elongation were encountered in group A, and 1 case of re-rupture with deep infection and 1 case of superficial infection were experienced in group B. Conclusion: USPR showed good clinical outcomes and high satisfaction as well as a low rate of complications, such as sural nerve injury. Therefore, USPR can be considered as an effective surgical treatment option for Achilles tendon ruptures.

• Clinics in Shoulder and Elbow
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• v.16 no.1
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• pp.33-39
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• 2013

Purpose: The aim of this study is to evaluate the clinical result of intra-articular fractures of the distal humerus (AO type C) in elderly osteoporotic patients treated with double tension band osteosynthesis. Materials and Methods: From January 2006 to December 2010, 10 elderly osteoporotic patients(1 male, 9 females) with intra-articular fractures of the distal humerus (AO type C) were treated with double tension band osteosynthesis. The mean age of patients at the time of surgery was 74.6(66~84) years and the mean follow-up period was 39.2(20~74) months. The fracture union and complications were assessed and the functional result was evaluated by the rating system of Jupiter et al. and the Mayo elbow performance index. Results: Bone union was achieved in all patients with no secondary displacement. The mean time for union was 16.6(13~22) weeks. The average postoperative arc of elbow flexion was 119(100~140) degrees with a mean flexion contracture of 8.5(0~15) degrees. The recovery in two patients was rated as excellent, in 7 as good, and in 1 as fair in terms of the Mayo elbow performance index with average value of 82(70~90) points. Seven patients were rated as excellent, 1 as good, and 2 as fair in terms of the rating system of Jupiter et al. Changing tension band wiring was performed in one patient as skin irritation was noticed due to tension band knots. Heterotopic ossification developed in one patient but had no symptom. Conclusion: Double tension band osteosynthesis in intra-articular fractures of distal humerus (AO type C) in elderly osteoporotic patients can provide sufficient and secure stability to allow early rehabilitation.

• Clinical and Experimental Pediatrics
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• v.48 no.7
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• pp.731-736
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• 2005

Purpose : Acute pyogenic osteomyelitis is uncommon in children. Delayed diagnosis and inappropriate treatment are leading to growth failure and deformation. We review the clinical manifestations and treatment of acute osteomyelitis in children according to age. Methods : A retrospective analysis was made of 32 patients who underwent antibiotic management or operation between Aug 1989 and Dec 2003 for acute pyogenic osteomyelitis in age from 0 to 15 years old. Results : The study group was composed of 21 boys and 11 girls. The subjects were divided into four groups according to age : 0-1 yr(n=6), 1-5 yr(n=11), 6-10 yr(n=8), and 11-15 yr(n=7). Nineteen cases were diagnosed in Winter. Femur was the most common infected site(37.5%). There were no predisposing factor in 17 patients, and 7 of 15 patients had trauma history. Sepsis was important predisposing factor in neonates. The chief complaints were pain, swelling and fever. S. aureus(61%) is the most common organism. Twenty-nine patients were treated with operation and concomitant antibiotics. Two cases had sequelae in follow-up period : One is avascular necrosis of femur and the other is discrepancy of leg length. Conclusion : In our review, because of poor prognosis in septic neonates, we recommend to treat actively neonatal sepsis and prevent or detect osteomyelitis early. Because most of patients were diagnosed and treated in orthopedic surgery, the rate of operation was too high. So, protocol for further evaluation and management of acute osteomyelitis in pediatric patients were needed.

• Clinical and Experimental Pediatrics
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• v.48 no.6
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• pp.594-598
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• 2005

Purpose : Phimosis is the inability to retract the foreskin of the penis over the glans of the penis. Even though phimosis is not pathogenic, the presence of phimosis is known to increase the risk of urinary tract infection in infancy. The use of topical steroids has been advocated as a safe and economical alternative to surgical intervention. The purpose of the study was to assess the effectiveness of topical steroids for the treatment of phimosis in young boys. Methods : A total of 53 boys with phimosis were divided into two groups to distinguish between the efficacy of low-potency topical steroid(group 1, 27 cases) and of high-potency topical steroid (group 2, 26 cases). Results : The success rate increased in the process of time. After 6 weeks, the success rate was 21 cases in group 1 and 22 cases in group 2. There was no significant differences in treatment outcomes between the two groups. The age of the boys, the appearance of prepuce prior to treatment, and the presence of previous symptoms, including symptoms of UTI, and ballooning of the prepuce at micturation had no significant difference on treatment outcomes. Conclusion : Topical steroid was effective in treatment of phimosis in boys younger than 4 years old. Although treatment outcomes between low- and high-potency topical steroids were not significantly different, those treated with a high-potency steroid cream showed more fast improvement. Further studies are necessary to assess systemic side effects of steroid treatment, duration of treatment and prevention of genitourinary tract infection in male infants.

• Clinical and Experimental Reproductive Medicine
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• v.34 no.3
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• pp.149-157
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• 2007

Objective: This study was performed to compare the expression of osteopontin (OPN) mRNA and protein in the eutopic and ectopic endometrial tissues in women with endometriosis and endometrial tissues in women without endometriosis. Methods: A total of 32 women with histologically confirmed endometriosis were recruited for study group. For controls, 34 women undergoing operative treatment for cervical intraepithelial neoplasia (CIN) or benign gynecologic condition other than endometriosis were recruited. At the time of laparoscopy or laparotomy, a biopsy specimen was taken from the endometrial cavity and peritoneal endometrial implant or endometrioma whenever appropriate. We employed real time quantitative RT-PCR to quantify OPN mRNA expression of these tissues and performed western blot analysis to measure the quantity of OPN. Results: The expression of OPN mRNA was significantly higher in both eutopic and ectopic endometrial tissues of women with endometriosis than in endometrial tissues of controls during both proliferative and secretory phase. In the eutopic endometrial tissue of women with endometriosis, OPN mRNA expression significantly increased during the secretory phase compared to the proliferative phase in women with endometriosis as well as controls. However, in the ectopic endometrial tissue, OPN mRNA expression significantly decreased during the secretory phase compared to the proliferative phase. The expression of OPN protein was significantly higher in women with endometriosis than in controls. Conclusion: This study shows the marked expression of OPN mRNA and protein in eutopic and ectopic endometrial tissues in women with endometriosis may be associated with the adhesion and invasion of endometrial explants.

• Journal of the Korean Arthroscopy Society
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• v.16 no.2
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• pp.153-159
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• 2012

Purpose: This study aims at evaluating our results with a 5-year follow up of arthroscopic pull-out suture repair of posterior root tear of the medial meniscus. Materials and Methods: This study enrolled 30 cases who underwent a arthroscopic pull-out suture repair to treat the posterior root tear of the medial meniscus from January 2001 to May 2005 and followed up at least 5 years. The average follow-up period was 76 months (range, 60-90 months). Clinical results by use of the Lysholm knee score and radiographic grade by use of the Kellgren-Lawrence classification were evaluated and second-look arthroscopy was done in all cases. The clinical results were compared with trauma history, obesity, varus deformity and time to operation. Results: At the last follow up, the Lysholm knee score improved from 55 points to 86 points. For the radiological results, 23 cases displayed maintenance or improvement of the medial joint space on the follow up X-ray, but 7 cases displayed decrease of the medial joint space, and 1 case was lately performed total knee replacement due to progressive osteoarthritic change. Conclusion: Arthroscopic pull-out suture repair has a good result at 27 cases (90%) in minimum 5 years follow-up. The clinical improvement was significantly reduced in more severe varus angle.