• Journal of the Korean Arthroscopy Society
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• v.10 no.1
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• pp.61-69
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• 2006

Purpose: Open lateral release and complete lateral release have been conducted as a surgical method in patients with patellofemoral malalignment. But authors sought to find out the best method by conducting selective release, with minimal excision of the involved lesion, and comparative analyzing the result, as postoperative satisfaction and complication. Materials and Methods: Over the 68 patients of 90 cases who underwent arthroscopic release, among 94 patients of 129 cases who underwent lateral retinacular release, from January 1993 to June 1998 were followed up prospectively. A radiological evaluation of patellar inclination, patellar tilt, congruence angle, and Q-angle and a clinical evaluation of HSS-Knee score and modified patellar score were used for analysis data before operation and data at 1 year and 5 year after operation. Results: According to the radiologic evaluation, the patellar tilt and translation revealed improvement of the results, from $13.4^{\circ}$ and 12.1mm to $3.6^{\circ}$ and 3.8mm with arthroscopic lateral complete release, and from $12.3^{\circ}$ and 11.2mm to $4.8^{\circ}$ and 5.2mm with selective release, and from $13.6^{\circ}$ and 12.3mm to $3.3^{\circ}$ and 3mm with open release. But they were not significantly related to the clinical results. HSS-Knee score was 84.2%(48/57), 81.8%(27/33), 82.1%(32/39) and modified patellar score was 82.5%(47/57), 81.8%(27/33), 82.1%(32/39) respectively, which revealed satisfactory results. And no significant difference among the operative methods were shown. Conclusion: Arthroscopic lateral retinacular release which is one of the surgical method for patellofemoral malalignment enhances rehabilitation and satisfaction of the patient, by releasing the involved retinaculum within lesser surgical extent, compared to open and complete lateral release without complications such as adhesion.

• Journal of The Korean Dental Society of Anesthesiology
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• v.10 no.2
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• pp.159-165
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• 2010

배경: 매복지치의 수술적 발치 시 propofol과 remifentanil을 이용한 목표조절농도주입(Target controlled infusion) 의식하 정주진정법의 적절한 주입농도를 제시하고 그 안전성을 평가하고자 하였다. 방법: 매복지치의 수술적 발치가 예정된 미국마취학회 신체 등급 분류 1, 2에 속하는 15-65세, 142명(여 83명, 남 59명)의 환자를 대상으로 소급 연구하였다. 환자는 수술 전 목표조절농도주입법을 이용한 의식하 진정법 사용에 관한 동의서를 작성하였다. 정맥내 삽관을 시행하고 수액을 공급을 시작하고, 4-5 L/min의 산소를 비관을 통해서 공급하였다. Propofol과 remifentanil의 초기 목표 혈중농도는 각각 $0.5\;{\mu}g/ml$와 1.0 ng/ml로 정하였다. 수술 중, 환자의 불안 통증 정도에 따라 목표농도를 조절하였으며 최저 농도와 최대 농도, 평균 농도, 주입된 총 용량을 기록하였다. 또한 수축기혈압과 맥박 수, 산소포화도, 호기 말 이산화탄소량을 수술 시작 전, 수술 중 5분 간격으로 확인하고 기록하였다. 모든 측정치는 평균 $\pm$ 표준편차나 환자의 수, 초기 측정치에서의 백분율 편차로 표시하였다. 결과: 수술 동안의 목표 혈중농도의 평균은 propofol은 $0.54{\pm}0.11\;{\mu}g/ml$이고, remifentanil은 $1.11{\pm}0.30\;ng/ml$였다. 수술 중 조절된 최대농도는 propofol은 $0.6{\pm}0.23\;{\mu}g/ml$이고, remifentanil은 $1.3{\pm}0.63\;ng/ml$였다. 이는 의식하 진정에 해당되는 범의의 농도라고 할 수 있겠다. 진정동안 환자의 언어적 의사소통은 유지 되었으며 산소 포화도는 4-5 L/min 의 산소 보충 하에 98%이상으로 유지되었다. 수축기 혈압과 맥박은 대부분의 환자에서 정상변위범위(${\pm}20%$)내에서 유지되었다. 결론: 본 연구는 목표조절 농도주입 의식하 진정에서 사용된 농도(propofol $0.5\;{\mu}g/ml$, remifentanil 1.0 ng/ml)는 안전하게 의식하 진정을 가능한 것을 보여준다. 이는 치과 치료 시 목표조절농도 주입의식하 진정법에서 적절한 목표농도를 제시한다.

• Progress in Medical Physics
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• v.10 no.2
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• pp.89-94
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• 1999

We developed a sterotactic radiosurgery system which is comprised of 1) collimators with small circular aperture, 2) an angiographic target localizer, 3) a target localizer used for alignment of planned target position with isocenter of treatment machine, and 4) a treatment planning system named LinaPel. In this study, we performed a series of treatment simulations to specify and analyze geometrical errors contained our in-house radiosurgery system. As results, 1) using Geometrical Phantom(Radionics,USA), the accuracy of target localization by LinaPel was determined as Avg. =(equation omitted) the accuracy of mechanical isocenter was found out to be 0.6 $\pm$ 0.2 mm, 3) the positional difference of target localization which determined by CT and angiography was 0.8 mm, and their size difference was 1.5 mm, and 4) the positional error during whole treatment was found out to be 0.9 $\pm$ 0.3 mm. With these results, we concluded that our in-house radiosurgery system can be used clinically. However, these range of accuracies need periodical quality assurance strongly.

• Journal of radiological science and technology
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• v.33 no.4
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• pp.379-386
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• 2010

This study evaluated the motion of tumors during the entire period of therapy and the accuracy of radiosurgery among forty eight lung tumor patients who were underwent radiosurgery using the CyberKnife Synchrony Respiratory Tracking System. The motion of lung tumor was measured by the coordinates of a gold acupuncture needle inserted into the tumor or the area around the tumor using the CyberKnife image guided system. Then the accuracy of radiosurgery was evaluated based on the error of correlation computed with the motion tracking system. The lung tumor motion is Cranio-Caudal direction by an average of $2.63{\pm}1.87\;mm$, moved left-right direction by $1.13{\pm}0.71\;mm$, and anterior-posterior direction by $1.74{\pm}1.16\;mm$. The degree of rotational movement was $1.66{\pm}1.66^{\circ}$ on X axis, $1.20{\pm}0.97^{\circ}$ on Y axis, and $1.18{\pm}0.73^{\circ}$ on Z axis. The vector of translation movement was measured to be $3.78{\pm}2.00\;mm$ on the average. The results show that directions of Cranio-Caudal(p < 0.001), anterior-posterior direction(p < 0.029), and three dimensional vector value(p < 0.002) showed statistical significance, because the lower side of tumor showed more intensive movement compared to the upper side of tumor. The radiosurgery was carried out by compensating the motion of tumor after accurate investigation of the correlation error with the average of $0.95{\pm}0.62\;mm$ during the lung tumor radiosurgery with the CyberKnife Synchrony Respiratory Tracking System.

• Journal of the Korean Orthopaedic Association
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• v.56 no.1
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• pp.61-67
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• 2021

Purpose: To evaluate the prognostic factors affecting poor functional outcomes in patients with retear after rotator cuff repair. Materials and Methods: From January 2013 to December 2018, among 631 patients who underwent arthroscopic repair of a rotator cuff tear, 42 patients, who could be followed-up for more than one year and showed a retear of the repaired cuff on magnetic resonance imaging (MRI), were collected retrospectively. The preoperative demographic data, range of motion, American Shoulder and Elbow Surgeons (ASES) score, fatty degeneration, and tear progression on postoperative MRI, as well as other factors that could affect the clinical outcomes, were analyzed. Patients who scored <80 points on the ASES score were allocated to the poor function group. The risk factors for poor clinical outcomes were compared with the group with ASES scores of 80 or above. Results: The postoperative functional results in the group with retear (n=42) after arthroscopic rotator cuff repair showed significant improvement. Univariate analysis revealed the preoperative visual analogue scale (VAS) score and tear progression to have associations with a poor shoulder function. In addition, subscapularis repair was found to be associated with a good shoulder function. The preoperative VAS score and tear progression except for subscapularis repair were independent factors associated with poor clinical outcomes according to multivariate logistic regression analysis. Conclusion: In patients with retear after rotator cuff repair, the preoperative VAS and tear progression in postoperative MRI are factors predicting a poor functional outcome.

• Clinics in Shoulder and Elbow
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• v.10 no.2
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• pp.220-226
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• 2007

Purpose: The distal clavicle has a biomechanical structure different from that of the proximal or middle 1/3 clavicle, and delayed union or nonunion occurs frequently in a distal clavicle fracture. The authors obtained favorable results from an open reduction and bone grafting of the distal clavicle nonunion. We report the results together with review of the relevant literature. Materials and Methods: The subjects were 8 patients(average age, 38.9) who had undergone surgery for distal clavicle nonunion from August 2003 to May 2006. Nonunion occurred after surgical treatment in 4 cases, and after conservative treatment in the other 4. In all cases, the patients complained of pain. Results: The mean follow-up duration was 14 months, and radiological union was observed in 8 weeks on average. In all cases, the range of shoulder joint motion was normal at the end of the follow-up observation. In the functional evaluation, 7 cases showed excellent results and 1 case showed good results. Conclusion: Surgical treatment is a safe and reliable treatment for distal clavicle fracture nonunion because it can achieve early rehabilitation and union.

• Journal of the Korean Arthroscopy Society
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• v.13 no.3
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• pp.249-253
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• 2009

Purpose: We evaluated the clinical and radiographic results of arthroscopic ankle arthrodesis using 3 cannulated screws for the treatment of arthritis of ankle. Materials and Methods: From May 2006 to February 2009, 17 cases of arthritis of ankle were treated by ankle arthrodesis using 3 cannulated screws under arthroscopy. There were 8 male and 7 female and the average age was 62.2 years. We evaluated them clinically using AOFAS ankle-hindfoot functional scale, VAS pain score and patient’s satisfaction. For the radiographic evaluation, we checked them by simple AP, lateral and mortise view. The average follow-up period was 24.2 months. Results: The ankle-hindfoot functional scale was improved from an average of 47.4 points preoperatively to an average of 82.5 points at the last follow-up. The visual analogue scale pain score was decreased from an average of 8.6 to 2.4. Patient's satisfaction had favorable results with excellent in 7 cases(41.2%), good in 8 cases(47.0%), fair in 1 case(5.9%) and poor in1 case(5.9%). All ankles were successfully fused and the mean period of fusion was 9.1 weeks. Conclusion: Arthroscopic ankle arthrodesis using 3 cannulated screws was good modality of ankle arthrodesis with good clinical results and high union rate in the case of advanced ankle arthritis.

• Journal of Gastric Cancer
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• v.8 no.3
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• pp.160-165
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• 2008

Purpose: With the introduction of H. pylori eradication and proton pump inhibitor, the operative treatments for the acute or chronic complications of peptic ulcer, such as perforation, bleeding and stricture, have decreased. Also owing to the development of non-operative treatment such as interventional endoscopic treatment, the surgical approach to the acute complications, like perforation and bleeding, has diminished. The non-operative treatments for the stricture and obstruction of chronic peptic ulcer in part related to discontinuation of medication have not been satisfactory. We analyzed the clinical outcomes of the patients who underwent operative treatment for outlet obstruction with peptic ulcer. Materials of Methods: From January 1994 to December 2007, we reviewed 31 patients who had been operated on at the National Medical Center for peptic ulcer obstruction. We excluded the cases of adhesive obstructions that were caused by a former ulcer operation and also the cases of obstructions found during emergency operations for treating perforation and bleeding. We classified the surgical treatment group into the bypass operation group and the surgical resection group. We evaluated the effects of the operations by the Visick score. The recurrences were confirmed only by the endoscopic observation of peptic ulcer. Results: The number of patients in the bypass operation group was 6 (19.4%) and that of resection group was 25 (80.6%). The mean age was 57.5 (25~81) years. The number of male patients was 29 (93.5%) and the number of females was 2 (6.5%). The mean symptom duration was 29.6 months. There were 19 smokers (61.3%), 6 NSAID users (19.4%) and 7 H. pylori positive patients (22.6%). Two patients underwent endoscopic balloon dilatation with no success. The locations of lesion were the stomach, the duodenum and both in 9, 20 and 2 cases, respectively. There were operative complications in 13 cases (41.9%), recurrent ulcers in 2 cases (6.5%), and reoperations in 4 cases. The mean Visick score was 1.8 (1~4). There were no statistically significant clinicopathologic differences between the bypass operation group and the resection group. The two groups had 1 case each of recurrence. Although the bypass group had a greater complication rate (83.3%) than the resection group (32%), this was not statistically meaningful (P=0.175). The mean Visick score was 3.0 in the bypass group and 1.6 in the resection group, so the resection group was better (P=0.001). Conclusion: For a case of chronic peptic ulcer with outlet obstruction, even though it has been reported that endoscopic balloon dilatation worked well, surgery is still regarded as an important treatment. If you consider the patients' satisfaction and the difficulty of diagnosing malignant ulcers, surgical resection should be recommended more often than a bypass operation.

• Journal of the Korean Society of Radiology
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• v.82 no.2
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• pp.298-314
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• 2021

Owing to the anatomic complexity of the hepatic hilum, it has been considered difficult to diagnose and treat peri-hilar cholangiocarcinoma. Currently, imaging studies, including contrast-enhanced CT and MRI, play a crucial role in the detection, characterization, staging, and resectability assessment of peri-hilar cholangiocarcinoma. In this review, the classification of perihilar cholangiocarcinoma and proposed imaging protocol for the evaluation will be discussed. The typical imaging finding of peri-hilar cholangiocarcinoma, evaluation of longitudinal tumor extent, adjacent vascular invasion, and distant metastasis will also be mentioned. Finally, traditional concepts and recent updates for the resectability assessment of peri-hilar cholangiocarcinoma will be introduced.

• Journal of Gastric Cancer
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• v.8 no.3
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• pp.141-147
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• 2008

Purpose: The aim of this study was to compare the short-term operative outcomes of laparoscopy-assisted total gastrectomy (LATG) with those of open total gastrectomy (OTG) for patients suffering with advanced upper gastric cancer. Materials and Methods: Of the 47 patients who underwent LATG with $D1+{\beta}$ or D2 lymphadenectomy from July 2004 to March 2008, 29 patients with pathologically proven advanced gastric cancer were compared with 35 patients who underwent conventional OTG during the same time period. The comparison was based on the clinicopathological characteristics, the surgical outcome, the follow-up survival and tumor recurrence. Results: The patients' age, gender and body mass index were similar between the two groups. However, there were statistically differences in tumor size ($9.2{\pm}3.9$ vs $6.1{\pm}3.6cm$, P=0.002) and the proximal resected margin ($2.1{\pm}2.0$ vs $3.6{\pm}2.1cm$ P=0.004). There was no significant difference in most of the peri- and post-operative courses such as the time to first flatus, the time to starting a solid diet and the length of the hospital stay, except for a longer operating time (289.0 vs. 361.3 minutes, P<0.001) in the LATG group. The complication rate was higher in the LATG group (13.8%) than that in the OTG group (5.7%). The mean overall survival and disease free survival times were 32 and 31 months, and 24 and 28 months, respectively, with an average 18.8 months follow-up duration. The main recurrent sites were peritoneum and lymph node in both groups. Conclusion: The early results of the current study suggest that LATG for AGC is technically feasible and it does not show any inferiorities of the postoperative outcomes as compared to those of conventional open total gastrectomy.