• Journal of Korean Neurosurgical Society
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• 제58권5호
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• pp.448-453
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• 2015

Objective : Recently, the survival of patients with hepatocellular carcinoma (HCC) has been prolonged with improvements in various diagnostic tools and medical treatment modalities. Consequently, spine metastases from HCC are being diagnosed more frequently. The accurate prediction of prognosis plays a critical role in determining a patient's treatment plan, including surgery for patients with spinal metastases of HCC. We investigated the clinical features, surgical outcomes, and prognostic factors of HCC presenting with spine metastases, in patients who underwent surgery. Methods : A retrospective review was conducted on 33 HCC patients who underwent 36 operations (three patients underwent surgical treatment twice) from February 2006 to December 2013. The median age of the patients was 56 years old (range, 28 to 71; male : female=30 : 3). Results : Overall survival was not correlated with age, sex, level of metastases, preoperative Child-Pugh classification, preoperative ambulatory function, preoperative radiotherapy, type of operation, administration of Sorafenib, or the Tokuhashi scoring system. Only the Tomita scoring system was shown to be an independent prognostic factor for overall survival. Comparing the Child-Pugh classification and ambulatory ability, there were no statistically differences between patients pre- and post-operatively. Conclusion : The Tomita scoring system represents a practicable and highly predictive prognostic tool. Even though surgical intervention may not restore ambulatory function, it should be considered to prevent deterioration of the patient's overall condition. Additionally, aggressive management may be needed if there is any ambulatory ability remaining.

• Journal of Korean Neurosurgical Society
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• 제50권5호
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• pp.434-440
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• 2011

Objective : The goals of surgical intervention for metastatic spinal cord compression (MSCC) are prolonging survival and improving quality of life. Non-ambulatory paraplegic patients, either at presentation or after treatment, have a much shorter life expectancy than ambulatory patients. We therefore analyzed prognostic factors for survival and postoperative ambulation in patients surgically treated for MSCC. Methods : We assessed 103 patients with surgically treated MSCC who presented with lower extremity weakness between January 2001 and December 2008. Factors prognostic for overall survival (OS) and postoperative ambulation, including surgical method, age, sex, primary tumor site, metastatic spinal site, surgical levels, Tokuhashi score, and treatment with chemo- or radiation therapy, were analyzed retrospectively. Results : Median OS was significantly longer in the postoperatively ambulatory group [11.0 months; 95% confidence interval (CI), 9.29-12.71 months] than in the non-ambulatory group (5.0 months; 95% CI, 1.80-8.20 months) ($p$=0.035). When we compared median OS in patients with high (9-11) and low (0-8) Tokuhashi scores, they were significantly longer in the former (15.0 months; 95% CI, 9.29-20.71 months vs. 9.0 months; 95% CI, 7.48-10.52 months; $p$=0.003). Multivariate logistic regression analysis showed that preoperative ambulation with or without aid [odds ratio (OR) 5.35; 95% CI 1.57-18.17; $p$=0.007] and hip flexion power greater than grade III (OR 6.23; 95% CI, 1.29-7.35; $p$=0.038) were prognostic of postoperative ambulation. Conclusion : We found that postoperative ambulation and preoperative high Tokuhashi score were significantly associated with longer patient survival. In addition, preoperative hip flexion power greater than grade III was critical for postoperative ambulation.

• Journal of Korean Neurosurgical Society
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• 제51권3호
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• pp.127-134
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• 2012

Objective: To analyze the prognostic factors thought to be related with survival time after a spinal metastasis operation. Methods: We retrospectively analyzed 217 patients who underwent spinal metastasis operations in our hospital from 2001 to 2009. Hematological malignancies, such as multiple myeloma and lymphoma, were excluded. The factors thought to be related with postoperative survival time were gender, age (below 55, above 56), primary tumor growth rate (slow, moderate, rapid group), spinal location (cervical, thoracic, and lumbo-sacral spine), the timing of radiation therapy (preoperative, postoperative, no radiation), operation type (decompressive laminectomy with or without posterior fixation, corpectomy with anterior fusion, corpectomy with posterior fixation), preoperative systemic condition (below 5 points, above 6 points classified by Tomita scoring), pre- and postoperative ambulatory function (ambulatory, non-ambulatory), number of spinal metastases (single, multiple), time to spinal metastasis from the primary cancer diagnosis (below 21 months, above 22 months), and postoperative complication. Results: The study cohort mean age at the time of surgery was 55.5 years. The median survival time after spinal operation and spinal metastasis diagnosis were 6.0 and 9.0 months. In univariate analysis, factors such as gender, primary tumor growth rate, preoperative systemic condition, and preoperative and postoperative ambulatory status were shown to be related to postoperative survival. In multivariate analysis, statistically significant factors were preoperative systemic condition (p=0.048) and postoperative ambulatory status (p<0.001). The other factors had no statistical significance. Conclusion: The factors predictive for postoperative survival time should be considered in the surgery of spinal metastasis patients.

• Advances in pediatric surgery
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• 제9권2호
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• pp.77-80
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• 2003

Continuous Ambulatory Peritoneal Dialysis (CAPD) has now become an established form of renal replacement therapy in children. Despite of technical improvements, there are various complications in CAPD. We reviewed medical records of children who received CAPD at Seoul National University Children's Hospital in the period between May 1991 and June 2002. Ninety-three procedures of CAPD catheter insertion in 70 patients were included in this study. Complication rate was 64.5%, and CAPD catheter related peritonitis was most common. In conclusion, CAPD catheter related peritonitis develops in considerable number of pediatric patients. Although the peritonitis could be treated with empirical antibiotics therapy, further investigation to prevent complication is required.

• Journal of Yeungnam Medical Science
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• 제5권1호
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• pp.9-15
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• 1988

• Journal of Chest Surgery
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• 제22권1호
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• pp.146-150
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• 1989

Dysphagia is common in patients with cancer of the esophagus. The rate of resectability of the lesion is low, and the majority of the patients require palliation to relieve the dysphagia. Celestin tube intubation was performed in patients with unresectable carcinoma of the esophagus, of one with malignant bronchoesophageal fistula. Dysphagia and respiratory symptoms were relieved and the patients became able to eat semi-solid food and fully ambulatory.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.712-716
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• 2010

Purpose: Extensive lumbosacral defects after removal of spinal tumors have a high risk of wound healing problems. Therefore it is an effective reconstructive strategy to provide preemptive soft tissue coverage at the time of initial spinal surgery, especially when there is an instrument exposure. For soft tissue reconstruction of a lumbosacral defect, a variation of the gluteal flap is the first-line choice. However, the musculocutaneous flap or muscle flap that is conventionally used, has many disadvantages. It damages gluteus muscle and causes functional disturbance in ambulation, has a short pedicle which limits areas of coverage, and can damage perforators, limiting further surgery that is usually necessary in spinal tumor patients. In this article, we present the superior gluteal artery perforator turn-over flap that reconstructs complex lumbosacral defects successfully, especially one that has instrument exposure, without damaging the ambulatory function of the patient. Methods: A 67 year old man presented with sacral sarcoma. Sacralectomy with L5 corpectomy was performed and resulted in a $15{\times}8\;cm$ sized complex soft tissue defect in the lumbosacral area. There was no defect in the skin. Sacral stabilization with alloplastic fibular bone graft and reconstruction plate was done and the instruments were exposed through the wound. A $18{\times}8\;cm$ sized superior gluteal artery perforator flap was designed based on the superior gluteal artery perforator and deepithelized. It was turned over 180 degrees into the lumbosacral dead space. Soft tissue from both sides of the wound was approximated over the flap and this provided in double padding over the instrument. Results: No complications such as hematoma, flap necrosis, or infection occurred. Until three months after the resection, functional disturbances in walking were not observed. The postoperative magnetic resonance imaging scan shows the flap volume was well maintained over the instrument. Conclusion: This superior gluteal artery perforator turn-over flap, a modification of the conventional superior gluteal artery perforator flap, is a simple method that enabled the successful reconstruction of a lumbosacral defect with instrument exposure without affecting ambulatory function.

• Journal of Chest Surgery
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• 제42권2호
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• pp.233-237
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• 2009

배경: 하지정맥류의 외래수술을 위한 마취로 Bupivacaine에 fentanyl을 첨가하여 시행한 척추마취가 적당한지 알아보고자 하였다. 대상 및 방법: 척추마취를 이용하여 하지정맥류 수술을 받은 30명을 대상으로 하였다. 척추마취제로 bupivacaine 4mg과 fentanyl 25ug을 사용한 군(FB4군)과 bupivacaine 8mg을 사용한 군(B8군)으로 분류하였다. 두 군 간 적정한 마취유지, 수술중 심혈관계 합병증, 감각 및 운동차단회복시간, 수술 후 합병증을 비교 분석하였다. 결과: 마취성공은 두 군 간 통계적으로 차이가 없었다(13 of 15 [FB4군], 15 of 15 [B8군]). 두 군 모두 수술 중 통증 때문에 전신마취로 전환은 없었다. 수술 중 치료가 필요한 심혈관계 합병증은 두 군 모두에서 없었다. Modified Bromage scale로 측정한 척추마취 후 두 시간째 수술측과 비수술측 운동차단정도는 FB4군에서 통계적으로 유의하게 낮았다(p<0.05). 척추마취로부터 감각 및 운동차단회복은 FB4군이 B8군보다 유의하게 빨랐다(p<0.05). 맘대로소변보기는 통계적으로 유의한 차이는 없었으나(6.5시간 대 4.5시간 [p=0.143]) 배뇨 장애로 넬라톤 카테터를 삽입한 경우는 B8군에서는 2예 있었고 FB4군에서는 없었다. 결론: bupivacaine 4mg과 fentanyl 25ug을 이용한 척추마취는 수술 중 심혈관계의 안정성이 유지되고 적당한 감각차단이 이루어지고 수술 후 운동차단 시간을 감소시켜 빠른 보행이 가능하여 하지정맥류 외래수술에 적당한 마취방법이라고 생각된다.

• 센서학회지
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• 제23권2호
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• pp.82-86
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• 2014

This paper reports the development of a platform for tracking and analysis of animal locomotion. The platform is composed of a commercial webcam, a metal stand for the webcam, and a plastic bathtub as a cage. Using it, researchers can track and analyze an animal's movement within the plastic bathtub's dimensions of $100cm{\times}100cm{\times}55cm$ in a cost-effective manner. After recording the locomotion of an animal with $1920{\times}1080$ resolution at a rate of 30 frames per second, finding the position of the animal in each frame and analyzing the ambulation pattern were executed with custom software. To evaluate the performance of the platform, movements of imprinting control region mice and transgenic mice were recorded and analyzed. The analysis successfully compared velocity, moving pattern, and total moving distance for the two mouse groups. In addition, the developed platform can be used not only in simple motion analysis but also in various experimental conditions, such as a water maze, by easy customization of the platform. Such a simple and cost-effective platform yields a powerful tool for animal ambulatory analysis.

• 한국발생생물학회지:발생과생식
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• 제22권1호
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• pp.105-109
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• 2018

A 40-year-old G1 P0 L0 A1 woman was referred to our clinic with 6-year history of infertility. Before visiting the clinic, she had 3 cycles of In-Vitro Fertilization (IVF) procedures (2 cycles of Controlled Ovarian Stimulation-IVF and 1 cycle of frozen-thawed Embryo Transfer (ET)) at other clinic. She had medical history of abortion at early gestation following FET (frozen-thawed-ET). The patient had complete type of septate uterus, double cervix and longitudinal vaginal septum. Vaginal septotomy was done first and 1 month later, hysteroscopic septoplasty was followed using ballooning filled with dye. After septoplasty, we inserted ballooning and left for several days to compress septal endometrium on the septectomy area. All procedures were done in the ambulatory operating room without laparoscopy or admission. 3 months later, she had in vitro fertilization-embryo transfer (IVF-ET) and FET procedures in our clinic. She had successful pregnancy and now is at 22 weeks of gestation. New ambulatory septoplasty using dye-filled ballooning is easy, safe and minimally invasive surgery for treatment of complete septate uterus.