• Journal of the Korean Arthroscopy Society
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• v.16 no.1
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• pp.40-46
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• 2012

Purpose: This study evaluated the clinical outcome of arthroscopic debridement of anterior compartment and mini-open resection of posterior osteophyte for the treatment of primary osteoarthritis of the elbow. Materials and Methods: Between March 2003 and Feburary 2010, 19 cases who were performed arthroscopic debridement of anterior compartment and resection of posterior osteophyte through mini-open procedure for refractory osteoarthritis of the elbow were enrolled. Average follow-up period was 19 months. Mean age was 49 years old. Clinical results were evaluated by the scoring system of Andrew-Carson Rating Scale (ACRS) and Mayo Elbow Performance Score (MEPS). Results: In the range of motion, flexion contracture was improved from $28.7^{\circ}$ preoperatively to $17.9^{\circ}$ postoperatively, further flexion was improved from $105.1^{\circ}$ to $121.8^{\circ}$. In the scoring system of MEPS, score was improved from 51.1 points preoperatively to 87.9 points in last follow up, 3 cases had in excellent result, 13 good and 3 fair. According to the scoring system of ACRS, score was improved from 92.9 points to 168.2 points, 3 excellent, 14 good and 2 fair. Except one case, all cases returned to preoperative ordinary daily living activity and their own job. Conclusion: For the treatment of refractory osteoarthritis of the elbow, arthroscopic debridement of the anterior compartment and mini-open resection of posterior osteophyte would be helpful on pain relief and functional recovery of the elbow. But this procedure was required long term follow-up in aspect of recurrence of osteophytes and progress of arthritis of the elbow.

• The Korean Society of Law and Medicine
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• v.16 no.2
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• pp.27-53
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• 2015

Recently, a plastic surgery hospital in Seoul, has been raided following suspicions that ghost surgery was performed by an unauthorized substitute surgeon on a chinese woman who lapsed into a death. Following the incident, an organization to eradicate ghost surgery was created in March by Consumers Korea, founded to protect consumer rights, and the Korea Alliance of Patients Organization. The organization has received reports of illegal medical practices. To substitute another physician without the patient's consent and without his knowledge of the substitution is fraud and deceit and a violation of a basic ethical concept. The patient as a human being is entitled to choose his own physician and he should be permitted to acquiesce in or refuse to accept the substitution. It should be noted that it is the operating surgeon to whom the patient grants his consent to perform the operation. The patient is entitled to the services of the particular surgeon with whom he contracts. The surgeon, in accepting the patient, obligates himself to utilize his personal talents in the performance of the operation to the extent required by the agreement creating the physician-patient relationship. He cannot properly delegate to another the duties which the patient authorizes him to perform personally. 'Ghost surgery' comes under Article 257(Inflicting Bodily Injury on Other or on Lineal Ascendant) of the Criminal Code. Substitution another physician without the patient's consent and without his knowledge of the substitution shall be performed Inflicting Bodily Injury. This is a controversial issue that'ghost surgery' comes under Article 347(Fraud) of the Criminal Code. It maybe controversial that operation substituted by another physician without the patient's consent and without his knowledge of the substitution becomes the component of Fraud. Also, Ghost surgery' comes under Article 27 (Prohibition of Unlicensed Medical Practice, etc.), Article 22 (Medical Records, etc.), Article 33 (Establishment) of the Medical Service Act. The surgeon's obligation to the patient requires him to perform the surgical operation: (1) within the scope of authority granted him by the consent to the operation; (2) in accordance with the terms of the contractual relationship; (3) with complete disclosure of all facts relevant to the need and the performance of the operation; and (4) to utilize his best skill in performing the operation.

• Journal of Korean Ophthalmic Optics Society
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• v.17 no.2
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• pp.241-247
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• 2012

Purpose: This study was conducted to assess the association of metabolic syndrome and its components with glaucoma. Methods: We investigated the associations of metabolic syndrome and its components (abdominal obesity, impaired fasting glucose, high blood pressure, and dyslipidemia) with glaucoma using data from 19,162 adults aged 40 or above among the Korean National Health and Nutrition Examination Survey III (2005), IV (2007-9), V (2010). The logistic regression analysis was used for assessing those associations after adjusting demographic, lifestyle, and social economic status and for assessing the association of metabolic medication intakes with glaucoma risks. Results: After adjusting for age and sex, the risk of glaucoma was significantly higher in the subjects with impaired fasting glucose(Odds Ratio (95% confidence interval): 1.78 (1.25, 2.53)) and metabolic syndrome (1.45 (1.01, 2.08)) than subjects without those. These associations increased when additional adjusting for smoking, alcohol use, regular physical activity, income, education status(impaired fasting glucose: 1.89 (1.29, 2.77), metabolic syndrome: 1.52 (1.03, 2.25)). Glaucoma prevalence was borderline significantly increased according to the number of metabolic abnormalities(age and sex adjusted p for trend = 0.055). Use of antihypertensive medication was significantly associated with the risk of glaucoma. Conclusions: Metabolic syndrome and impaired fasting glucose were significantly associated with the increased glaucoma risk. Use of antihypertensive medication was also significantly associated with the increased glaucoma risk.

• Clinics in Shoulder and Elbow
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• v.16 no.2
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• pp.73-83
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• 2013

Purpose: The goal of this study is to evaluate the minimum three-year follow-up results of reverse total shoulder arthroplasty (RTSA) for glenohumeral (GH) arthritic and pseudoparalytic patients with severe rotator cuff deficiency. Materials and Methods: We evaluated 13 patients (three males and 10 females) who underwent RTSA from July 2007 to July 2010. The average follow-up duration was 54.2 months (range, 37~74 months). Clinical results were evaluated using the Visual Analog Scale (VAS) for pain, active Range of Motion (ROM): active forward flexion (aFF); active external rotation at the side (aERs); active internal rotation to the back (aIRb), American Shoulder and Elbow Surgeons (ASES) score, Korean Shoulder Score (KSS), and intraoperative and postoperative complications. Results: VAS score improved from 7.5(6~10) points to 1.5(0~4), and ROM of active forward elevation improved from $42.7(10{\sim}100)^{\circ}$ to $129.1(110{\sim}180)^{\circ}$. In addition, ASES score improved from preoperative 32.9 (11.7~46.7) points to 80.2(58.3~95.0) postoperatively, and KSS score improved from 36.8(24~47) points to 78.4 (61~92). Twelve out of 13 cases showed various degrees of scapular notching at the last follow-up. There was one case of intraoperative anterior glenoid fracture and two cases of temporary nerve injury. Revision surgery was performed in two cases for treatment of delayed postoperative deep infection. Conclusion: According to minimum three-year follow-up results, RTSA may be an effective treatment option for glenohumeral (GH) arthritic and pseudoparalytic patients. However, considering the possibility of complications related to delayed deep infection or surgeon's technique, RTSA should be judiciously and carefully indicated by expert surgeons.

• Journal of Chest Surgery
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• v.41 no.5
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• pp.610-618
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• 2008

Background: There are various treatment modalities for atherosclerotic arterial obstructive disease at the lower limbs, for example, conservative physical therapy, medication, operation etc. Yet it has been established that an arterial bypass operation is the most effective treatment. The aim of this study is to evaluate the effect of arterial bypass operation within our experience and to determine the indicators of treatment. Material and Method: Ninety six patients received arterial bypass operation for atherosclerotic arterial obstructive disease from June 2002 to April 2006. We evaluated the feasibility of arterial bypass operation based on the improvement of symptoms and the ankle-brachial index (ABI) and the surgical outcomes, as based on the complications, the amputation rates and the patency rates. We also assessed the possible risk factors such as gender, age, a smoking history, co-morbidities, the anastomotic sites, the graft size and the graft type. We retrospectively reviewed the medical records of the patients. The total mean follow-up period was $29.4{\pm}13.1$ months. Result: The mean age was $65.95{\pm}9.61$ and there were 88 male patients. The most common clinical manifestation was ischemic resting pain in the lower extremities. The underlying combined diseases were hypertension (61%), diabetes (43%), cardiac problems (35%) and smoking (91.7%). The most frequent site of arterial obstruction was the superficial femoral artery (44 cases, 40%). A femoropopliteal artery bypass operation with a Polytetrafluoroethylene(PTFE) synthetic graft was done in 44 cases (40%) and the great saphenous vein graft was used in 11 cases. The postoperative ABI increased significantly from $0.30{\pm}0.11$ preoperatively to $0.63{\pm}0.11$ (p<0.001) postoperatively. In 8 cases, amputations above the ankle level were necessary. The graft patency rates were 86.4% and 68.0% after 1 and 3 years, respectively. There were 29 cases (30.21%) of patency failure; the male gender, smokers and hypertension were significantly more frequent in the failure group. Of these, hypertension was the most powerful risk factor (p=0.042). Conclusion: The arterial bypass operation is an effective treatment modality for controlling the symptoms such as pain and claudication, and for preventing major amputations for the patients with atherosclerotic arterial obstructive disease. This study suggests quitting smoking, strict blood pressure control, selection of an appropriate graft, regular outpatient follow up and proper medication would offer higher patency rates and more favorable outcomes.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.12 no.1
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• pp.115-124
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• 2001

Objective：The purpose of this study was to compare the clinical features of children with three subdiagnoses of tic disorder(transient tic disorder(TTD), chronic tic disorder(CTD) and Tourette’s disorder (TD)) and to exam the factors related with illness severity of them. Method：Subjects were 69 children who met DSM-IV criteria for tic disorder and 43 control children. All subjects were investigated demographic and clinical factors related to tic. The severity of tic was assessed with the Yale Global Tic Severity Scale(YGTSS) in tic disorder children. The Child Behavior Checklist(CBCL) was accomplished by parents of all subjects. Results：Children with TTD had not only shorter duration of tic symtoms but also milder tic severity and impairment than those with CTD and TD. They also had significantly lower scores on most CBCL subscales than children with CTD and TD, while they were similar with controls in all the CBCL subcale scores except aggressive behavior. Children with CTD and those with TD were similar to each other in clinical variables except number of tic symptom and scores on CBCL social problem subscale. The interference and intensity of motor tic symptoms and duration of tic symptoms were significant predictors of global impairment score on YGTSS, while the presence of comorbid ADHD was a preictor of the total behavior problem score of CBCL. Conclusion：These findings indicate that duration of tic symptoms and the presence of comorbid ADHD as well as the severity of tic symptoms strongly associated with the illness severity of children with tic disorder. These results also suggest that those clinical factors may be more important for assessing the severity of illness and determining the treatment strategy than the sub-diagnosis itself in children with tic disorder.

• Journal of the Korean Arthroscopy Society
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• v.16 no.2
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• pp.107-113
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• 2012

Purpose: The purpose of this study was to evaluate the posterior cruciate ligament (PCL) reconstruction with single bundle, single-incision technique using Achilles tendon and tibialis anterior allograft with ligament remnant preservation. Materials and Methods: Twenty six patients underwent PCL reconstruction was included. There were 21 males and 5 females. Mean age was 32 years. Used graft was a fresh frozen Achilles tendon allograft (group I, 14 cases) and tibialis anterior allograft (group II, 12 cases). Arthroscopic PCL reconstruction was performed using transtibial, single-incision and single bundle technique with remnant preserving as possible. For clinical evaluation, range of motion, posterior drawer test, Lysholm score, Tegner activity scale, International Knee Documentation Committee (IKDC) grade and posterior stress radiograph were used. The mean follow-up period was 21.6 months (12-40 months). Associated injuries were 5 medial collateral ligament injuries, which were treated by conservative method. Results: Range of motion (ROM) was returned to normal range in 24 cases, but ROM deficit under $10^{\circ}$ flexion was 2 cases at final follow-up period. Preoperative posterior drawer test was 17 cases in grade II and 9 cases in grade III. At final follow-up 13 cases returned within normal grade, 7 cases grade I and 6 cases grade II posterior instability. Lysholm mean score was improved from preoperatively 62 to 90 at final follow-up period. Tegner activity mean scale improved from preoperatively 3.5 to 5.6 at final follow-up period. IDKC grade was grade A was 3 cases, grade B 17 cases, grade C 6 cases. In posterior stress radiograph, posterior displacement was improved from mean 12 mm preoperative to 4.5 mm at final follow-up. There were no statistical differences between two groups in clinical evaluations. There were two cases of re-rupture of graft at the bone-tendon junction in group I. Conclusion: We had successful results of PCL reconstruction with single-incision, single bundle technique using Achilles and tibialis anterior allograft without difference between two groups in patients with PCL injury. There were more re-rupture of graft in Achilles tendon group.

• Journal of the Korean Society of Radiology
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• v.9 no.3
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• pp.147-168
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• 2015

In this research, we have analyzed the impact factors on the bone mineral density thru the examination of bone density difference in the entire femur, femoral neck and lumbar of adult women before the menopause in accordance with the general features, lifestyle, eating habits, health and body composition. The survey was conducted among adult women before the menopause and older than 30 years based on the data of the National Health and Nutrition Examination Survey carried out in the 4th term (2008-2009) and 5th term (2010-2011) and we would like to provide the research results for the establishment of recommendations or guidelines for the treatment of adult women before the menopause with regard to the impact factors on the bone mineral density and for the development of health education materials for the accurate measurement of bone mineral density of young women in order to prevent the postmenopausal osteoporosis. With respect to the general features of adult women before the menopause, the bone mineral density was higher in the entire femur at age 40-44, femoral neck at 35-39, in high-school education level, in the earlier menarche group, without smoking experiences, with regular walking time and exercise frequency and with the habits of eating no hamburger or pizza. With regard to the body composition, the bone mineral density was higher in obesity and lower in underweight cases, higher among people with abdominal obesity and weight control experiences. In terms of total body fat ratio, total amount of fat and muscle, the bone mineral density got gradually increased from the 1st quarter (Q1) to the 4th quarter(Q4). The obesity, disease, total amount of fat and muscle were shown to be significantly related with the bone mineral density in this research and it is required for young women to keep the adequate weight and the normal BMI in order to increase the bone mineral density. For the prevention of osteoporosis, it is advised to keep the right habits including regular exercise and no smoking discipline from the growing period and achieve the maximum bone mass thru the control of proper weight from a young age.

• Sleep Medicine and Psychophysiology
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• v.3 no.1
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• pp.85-95
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• 1996

Obstructive sleep apnea syndrome(OSAS) in childhood is unique and different n-om that in adulthood in several aspects, including pathophysiology, clinical features, diagnostic criteria, complications, management, and prognosis. Characteristic features of childhood OSAS in comparison with the adult form are the variety of severe complications such as developmental delay, more prominent behavioral and cognitive impairments, vivid cardiovascular symptoms, and increased death risk, warranting a special attention to the possible diagnosis of OSAS in children who snore. However, the childhood OSAS is often neglected and unrecognized. We, therefore, report a case of very severe OSAS in a 5-year-old boy who was sucessfully treated with continuous positive airway pressure(CPAP) treatment. Interestingly, the patient was comor-bid with the attention deficit hyperactivity disorder. Prior to the initial visit to us, adenotonsillectomy had been done at the age of 4 with no significant improvement of apneic symptoms and heavy snoring. On the initial diagnostic procedures, marked degree of snoring was audible even in the daytime wake state and the patient was observed to be very hyperactive. Increased pulmonary vascularity with borderline cardiomegaly was noted on chest X-ray. The baseline polysomnography revealed that the patient was very sleep-apneic and snored very heavily, with the respiratory disturbance index(RDI) of 46.9 per hour of sleep, the mean SaO2 of 78.8%, and the lowest SaO2 of 40.0%(the lowest detectable oxygen level by the applied oxymeter). The second night polysomnography was done for CPAP titration and the optimal pressure turned out to be $8.0\;cmH_2O$. The applied CPAP treatment was well tolerated by the patient and was found to be very effective in alleviating heavy snoring and severe repetitive sleep apneas. After 18 months of the CPAP treatment, the patient was followed up with nocturnal polysomnography(baseline and CPAP nights) and clinical examination. Sleep apneas were still present without CPAP on the baseline night. However, the severity of OSAS was significantly decreased(RDI of 15.7, mean SaO2 of 96.2%, and the lowest SaO2 of 83.0%), compared to the initial polysomnographic findings before initiation of long-term CPAP treatment. Wechsler intelligence tests done before and after the CPAP treatment were compared with each other and surprising improvement of intelligence(total 9 points, performance 16 points) was noted. Clinically he was found to be markedly improved in his attention deficit hyperactive behavior after CPAP treatment, but with minimal change of TOVA(test of variables of attention) scores except conversion of reaction time score into normal range. On the chest X-ray taken after 18 months of CPAP application, the initial cardiopulmonary abnormalities were not found at all. We found that the CPAP treatment in a young child is very effective, safe, and well-tolerated and also improves the co-morbid attention deficit hyperactive symptoms. Overall, the growth and development of the child has been facilitated with the long-term use of CPAP. Cardiovascular complications induced by OSAS have been also normalized with CPAP treatment. We suggest that early diagnosis and active treatment intervention of OSAS in children are crucial in preventing and ameliorating possible serious complications caused by repetitive sleep apneas and consequent hypoxic damage during sleep.

• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.189-198
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• 2009

Purpose: We wanted to evaluate the clinical results of the Latarjet procedure for treating anterior shoulder instability combined with a glenoid bone defect. Materials and Methods: Between Oct. 2006 and May. 2007, fourteen patients underwent a Latarjet operation to treat their anterior shoulder instability combined with a glenoid bone defect. The mean follow-up period was 15 months (range: 12 to 19 months), and the average age at the time of surgery was 29.9-years-old (range: 19 to 44 years). There were 13 males and 1 female. Eight patients exhibited involvement of the right shoulder. The dominant arm was involved in 8 patients. Six patients had undergone a previous arthroscopic Bankart repair before their Latarjet operation and 2 patients had a history of seizure. Results: The average Rowe score improved from 51.8 to 80.2 with 9 excellent, 4 good, and 1 fair results. The average Korean shoulder score for instability improved from 61.6 to 82.1 postoperatively. The active forward flexion and external rotation at the side of the involved shoulder was an average of $8^{\circ}$ and $16^{\circ}$ less than that of the uninvolved shoulder. The muscle strength of the involved shoulder measured 78.7% in forward flexion and 82.5% in external rotation, as compared with that of the uninvolved shoulder. There was 1 case of dislocation, 1 transient subluxation, 2 fibrotic unions, 1 resorption of the transferred coracoid process, 1 intraoperative broken bone, 1 transient musculocutaneous nerve injury and 1 case of stiffness. Conclusion: The Latarjet procedure for treating anterior shoulder instability combined with a significant glenoid defect effectively restores function and stability through extending the articular arc at the expense of external rotation. We should be cautious to avoid or detect complications when performing coracoid transfer.