• Journal of Chest Surgery
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• v.37 no.4
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• pp.356-363
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• 2004

Esophageal cancer is an aggressive disease with a poor prognosis. Recently, every effort has been made to improve the long term survival, but the general prognosis for patients with this disease remains poor. In this study, we reviewed 8 years of experiences with esophageal cancer patients managed in our department at Dong-A University Hospital and evaluated the effectiveness of cervical lymph node dissection performed selectively. Material and Method: From January 1995 to August 2003, 70 patients underwent esophagectomy for esophageal cancer in our department. Among them, 51 patients who underwent curative resection, had no double primary tumors and no neoadjuvant therapy were analyzed retrospectively. In most patients, intrathoracic esophagectomy and cervical esophago-gastrostomy was performed. Since 1997, 3-field lymph node dissection was performed selectively. Result: There were 46 men and 15 women. The median age was 60 years. The tumor was located in the upper third part in 10 patients (19%), middle third in 21 (41%), and lower third in 20 (40%). Majority of the patients (90%) had squamous cell carcinoma. Cervical anastomosis was made in 41 patients, and intrathoracic anastomosis in 10. 2-field lymph node dissection was done in 40 patients, and 3-field lymph node dissection in 11. The pathologic staging were as follows: stage I in 9 patients (17.6%), IIA in 20 (39.2%), IIIB in 7 (13.7%), III in 11 (21.6%), IVA in 2 (3.9%), and IVB in 2 (3.9%). The in-hospital mortality was 3.9% (2 patients) and complications occurred in 24 patients (47%). Overall actuarial 1, 3, and 5-year survival rates were 74.4%, 48.4%, and 48.4% including operative mortality. The 4-year survival rate did not differ significantly between 3-field lymph node dissection group (50.5%) and 2-field lymph node dissection group (48.9%). In 3-field lymph node dissection group, the respiratory complications were more frequent and operative time was significantly longer. Conclusion: We think that curative resection for esophageal cancer can be performed with acceptable mortality, and aggressive surgical approach may improve the long term survival. even for advanced stages. Effectiveness of 3-field lymph node dissection needs further investigations.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.19
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• pp.8503-8508
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• 2014

Background: After the WHO recommended HPV vaccination of the general population in 2009, government support of HPV vaccination programs was increased in many countries. However, this policy was not implemented in Korea due to perceived low cost-effectiveness. Thus, the aim of this study was to analyze the cost-utility of HPV vaccination programs targeted to high risk populations as compared to vaccination programs for the general population. Materials and Methods: Each study population was set to 100,000 people in a simulation study to determine the incremental cost-utility ratio (ICUR), then standard prevalence rates, cost, vaccination rates, vaccine efficacy, and the Quality-Adjusted Life-Years (QALYs) were applied to the analysis. In addition, sensitivity analysis was performed by assuming discounted vaccination cost. Results: In the socially vulnerable population, QALYs gained through HPV vaccination were higher than that of the general population (General population: 1,019, Socially vulnerable population: 5,582). The results of ICUR showed that the cost of HPV vaccination was higher for the general population than the socially vulnerable population. (General population: 52,279,255 KRW, Socially vulnerable population: 9,547,347 KRW). Compared with 24 million KRW/QALYs as the social threshold, vaccination of the general population was not cost-effective. In contrast, vaccination of the socially vulnerable population was strongly cost-effective. Conclusions: The results suggest the importance and necessity of government support of HPV vaccination programs targeted to socially vulnerable populations because a targeted approach is much more cost-effective. The implementation of government support for such vaccination programs is a critical strategy for decreasing the burden of HPV infection in Korea.

• Journal of Korean Neurosurgical Society
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• v.49 no.4
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• pp.248-251
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• 2011

Objective : In the field of spinal surgery, a few laboratory results or clinical cases about robotic spinal surgery have been reported. In vivo trials and development of related surgical instruments for spinal surgery are required before its clinical application. We investigated the use of the da $Vinci^{(R)}$ Surgical System in spinal surgery at the craniovertebral junction in a human cadaver to demonstrate the efficacy and pitfalls of robotic surgery. Methods : Dissection of pharyngeal wall to the exposure of C1 and odontoid process was performed with full robotic procedure. Although assistance of another surgeon was necessary for drilling and removal of odontoid process due to the lack of appropriate end-effectors, successful robotic procedures for dural sutures and exposing spinal cord proved its safety and dexterity. Results : Robot-assisted odontoidectomy was successfully performed in a human cadaver using the da $Vinci^{(R)}$ Surgical System with few robotic arm collisions and minimal soft tissue damages. Da $Vinci^{(R)}$ Surgical System manifested more dexterous movement than human hands in the deep and narrow oral cavity. Furthermore, sutures with robotic procedure in the oral cavity demonstrated the advantage over conventional procedure. Conclusion : Presenting cadaveric study proved the probability of robot-assisted transoral approach. However, the development of robotic instruments specific to spinal surgery must first precede its clinical application.

• The Korean Journal of Pain
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• v.11 no.1
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• pp.101-104
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• 1998

Backgrouds: Twent five years have passed since the opening of the first pain clinic in korea, in 1973 at Yonsei University Hospital. The number of pain clinics are gradually increasing in recent times. It is important to plan for future pain clinics with emphasis on improving the quality of pain management. Therefore we reviewed the patients in our hospital to help us in planning for the future of our pain clinic. Methods: We analyzed 2656 patients who had visited our Kim Chan Pain Clinic, accordance to age, sex, disease, and type of treatment block, from July 1996 to August 1997. Results: The prevalent age group was in the fifties, 27.3%, seventy years and older compromised 9.2%. The most common disease were as follows: lower back pain(46.2%); cervical and upper extremities pain(23.1%); trigeminal neuralgia(7.2%); and hyperhydrosis(5.8%) Both nerve blocks and medication were prescribed as treatment. Lumbar epidural block(16.3%) and stellate ganglion block(15.6%) were the most frequent blocks performed among various nerve blocks. Among nerve block under C-arm guidance, lumbar facet joint block(24.4%) and lumbar root block(22.5%) were performed most frequently. Trigeminal nerve block(18.4%), thoracic(17.0%) and lumbar sympathetic ganglion block(11.4%) were next most prevalent blocks performed frequent block. Conclusions: Treatments at our hospital were focused on nerve blocks and medications prescriptions. Nerve blocks are of particular importance in the diagnosis and treatment of chronic pain. However in future, to raise the quality of pain management, we need to fucus on a multidisciplinary/interdisciplinary team approach.

• Journal of Korean Neurosurgical Society
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• v.42 no.6
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• pp.436-440
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• 2007

Objective : Spinal cord hemangioblastoma is an uncommon vascular neoplasm with a benign nature and is associated with von Hippel-Lindau (VHL) disease in 20-30% of patients. Total removal of these tumors without significant neurological deficit remains a great challenge. The purpose of this study was to investigate the efficacy of VHL mutation analysis and to evaluate surgical outcome of patients with spinal cord hemangioblastomas. Methods : This study included nine patients treated for spinal cord hemangioblastomas at our institute between December 1994 and March 2006. There were four male and five female patients. Mean age was 37.8 years. The mean follow-up period was 22.4 months. Magnetic resonance imaging (MRI) of the complete neuraxis was done in all cases and VHL mutation analysis was performed in three cases for a definite diagnosis. Results : Six patients had intramedullary tumor, and the remaining patients had intradural extramedullary lesions. Five patients were associated with VHL disease. The von Hippel-Lindau mutation analysis was done in three patients and two of them showed VHL gene abnormality. Tumors were located in the cervical cord in five cases and in the thoracic cord in four cases. All patients underwent surgical intervention, and total removal was achieved in six cases. All patients showed improvement or, at least, clinically stationary state. Surgical complications did not develop in any cases. Conclusion : Spinal hemangioblastoma in this series has been safely and effectively removed via a posterior approach. Postoperatively, clinical outcome was excellent in the majority of cases. The VHL mutation analysis was useful in patients with family history and in those with multiple hemangioblastomas.

• Journal of Korean Medicine Rehabilitation
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• v.24 no.2
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• pp.115-130
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• 2014

Objectives The objective of this study is to interpretate Yangsaeng-Doinbub presented in "Zhu-Bing-Yuan-Hou-Lun Yao-Bei-Bing-Zhu-Hou" in a modern kineologic approach Methods Based on the interpretation of "Zhu-Bing-Yuan-Hou-Lun Yao-Bei-Bing-Zhu-Hou" and implementation of its kinesiology, this study presents similar kineologies and their purposes, with the reference to various documents on modern kinesiology. Results 1) Yangsaeng-Doinbub presented in "Zhu-Bing-Yuan-Hou-Lun Yao-Bei-Bing-Zhu-Hou" is similar to stretching, active exercise and resistance exercise. 2) Exercises in Yangsaeng-Doinbub presented in "Zhu-Bing-Yuan-Hou-Lun Yao-Bei-Bing-Zhu-Hou", which are similar to resistance exercise, can be used for isometic exercise of cervical extensor. 3) Exercises in Yangsaeng-Doinbub presented in "Zhu-Bing-Yuan-Hou-Lun Yao-Bei-Bing-Zhu-Hou", which are similar to Stretching exercise, has its purpose to stretch quadratus Lumborum, lateral side of body, gluteus Maximus, quadriceps femoris, shoulder extensor, hamstrings, hip joint, ankle dorsi flexor, thoracic rotator,inferior shoulder joint. 4) Exercises in Yangsaeng-Doinbub presented in "Zhu-Bing-Yuan-Hou-Lun Yao-Bei-Bing-Zhu-Hou", which are similar to active exercise, can be used for strengthen exteral oblique. 5) Doctors can make various applications of Yansaeng-Doinbub. For example, it can be used to correct improper low back and neck exercise patterns. 6) Yangsaeng-Doinbub also describes breathing methods, which help normalization of breathing exercises and increase the efficiency of spine exercises. Conclusions The modern interpretation on kinesiology of Yangsaeng-Doinbub presented in "Zhu-Bing-Yuan-Hou-Lun Yao-Bei-Bing-Zhu-Hou" leads to a conclusion that Yangsaeng-Doinbub consists of numourous exercises for various body parts. In particular, breathing methods increase efficiency of such exercises. Plus, the exercises in Yangsaeng-Doinbub can be applied to various uses by doctors.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.17
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• pp.7463-7466
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• 2015

Aims: To analyse the predictors of recurrence, disease free survival and overall survival in cases with endometrial cancer. Materials and Methods: A total of 152 women diagnosed with endometrial cancer were screened using a prospectively collected database including age, smoking history, menopausal status, body mass index, CA125, systemic disorders, tumor histology, tumor grade, lymphovascular space invasion, tumor diameter, cervical involvement, myometrial invasion, adnexal metastases, positive cytology, serosal involvement, other pelvic metastases, type of surgery, fertility sparing approach to assess their ability to predict recurrence, disease free survival and overall survival. Results: In ROC analyses tumor diameter was a significant predictor of recurrence (AUC:0.771, P<0.001). The optimal cut off value was 3.75 with 82% sensitivity and 63% specificity. In correlation analyses tumor grade (r=0.267, p=0.001), tumor diameter (r=0.297, p<0.001) and the serosal involvement (r=0.464, p<0.001) were found to significantly correlate with the recurrence. In Cox regression analyses when some different combinations of variables included in the model which are found to be significantly associated with the presence of recurrence, tumor diameter was found to be a significant confounder for disease free survival (OR=1.2(95 CI,1.016-1.394, P=0.031). On Cox regression for overall survival only serosal involvement was found to be a significant predictor (OR=20.8 (95 % CI 2.4-179.2, P=0.006). In univariate analysis of tumor diameter > 3.75 cm and the recurrence, there was 14 (21.9 %) cases with recurrence in group with high tumor diameter where as only 3 (3.4 %) cases group with smaller tumor size (Odds ratio:7.9 (95 %CI 2.2-28.9, p<0.001). Conclusions: Although most of the significantly correlated variables are part of the FIGO staging, tumor diameter was also found to be predictor for recurrence with higher values than generally accepted.

• Korean Journal of Head & Neck Oncology
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• v.14 no.1
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• pp.94-98
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• 1998

Background: Completion thyroidectomy can most accurately be described as reexploration of the neck to remove the contralateral thyroid lobe. This procedure has commonly been performed when the histopatholoic condition of the ipsilateral thyroid lobe reveals papillary or follicular carcinoma of the thyroid. Because of a definitely increased risk of complications with completion thyroidectomy, avoiding its routine use is important. But this operation is safe procedure with minimal morbidity by coinsidering interval, surgical approach, surgeon's experience. The purpose of this review is to define the indication, and the safety of completion thyroidectomy. Materials & Methods: Recent 2 years(1995. 1 to 1996. 12), we have performed 161 thyroid operations. Fourteen of these patients were treated by completion thyroidectomy. The patients ranged in age from 21 to 66 years. We have routinely used ultrasound guided needle biopsy and intraoperative frozen section. Result: The completion thyroidectomized specimen contained papillary carcinoma in 12 (86%), follicular carcinoma in 1(7%) and follicular adenoma(no residual tumor) in 1(7%). The complication of completion thyroicetomy was absent, although case number was a few. The indication of completion thyroidectomy in our study was defined recurrence in 9 and staging in 5. The site of recurrence consists of residual thyroid in 7 and residual thyroid added cervical lymph node in 2. The staging consists of incomplete thyroidectomy 3, questionable frozen biopsy 1, and huge follicular carcinoma. Conclusion: The incidence of completion thyroidectomy appear to be increasing by application of ultrasonogram in follow-up of thyroidectomized patients, especially, for the improving of well differentiated thyroid carcinoma. Experience suggests that the morbidity of completion thyroidectomy is low, so we recommend completion thyroidectomy as an efficient and safe method of surgical treatment.

• Journal of Korean Neurosurgical Society
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• v.47 no.2
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• pp.102-106
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• 2010

Objective : To evaluate the clinical results of gross total resection in the surgical approach to spinal ependymoma. Methods : Between June 1995 and May 2009,13 males and 8 females (mean age 34) diagnosed with intramedullary or extramedullary spinal ependymoma were surgically treated at our centre. The neurological and functional state of each patient were evaluated according to the modified McCormick scale. Results : The average follow-up duration was 54 months (ranging from 12 to 168 months). The locations of the lesions were : thoracic region (4, 19%), lumbar region (7, 34%), cervical region (4, 19%), cervicothoracic region (3, 14%) and conus medullaris (3, 14%). Four patients (19%) had deterioration of neurological function in the early postoperative period. The neurological function of three patients was completely recovered at the 6th postoperative month, while that of another patient was recovered at the 14th month. In the last assessment of neurological function, 20 patients (95%) were assessed as McCormick grade 1. No perioperative complications developed in any of our patients. In one patient's 24-month assessment, tumour recurrence was observed. Re-operation was not performed and the patient was taken under observation. Conclusion : Two determinants of good clinical results after spinal ependymoma surgery are a gross total resection of the tumour and a good neurological condition before the operation. Although neurological deficits in the early postoperative period can develop as a result of gross total tumour resection, significant improvement is observed six months after the operation.

• Journal of Chest Surgery
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• v.2 no.2
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• pp.147-154
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• 1969

This is a report on a total of 11 cases of esophageal perforation in the department of thoracic surgery, Chonnam University Hospital during the period of 8 years from 1962 to 1969. They occurred by the following agents, that is,lye solution[7 cases], fish bone[2 cases]. compress air [one case], strong acid [one case]. The perforated portions of esophagus were cervical esophagus in 2 cases, upper third of esophagus in 5 cases, middle third of esophagus in 3 cases and lower third of esophagus [abdominal esophagus] in one case. 4 cases out of cases of esophageal perforation after ingestion of Lye solution were due to Bougination to improve esophageal stenosis: 2 cases occurred 2 months after ingestion of Lye solution and the remaining 2 cases, 2 to 3 weeks after Lye solution ingestion. Therefore, It is realized that Bougination for esephageal stricture by Lye solution is particularly dangerous. The complication after esophageal perforation were mediastinitis,[10 cases], right pyothorax with mediastinitis [8 cases], peritonitis [4 cases], esophago-bronchial fistula[one case]. Owing to the various complications above mentioned, surgical approach to esophageal perforation is accordingly complicated and a combination of more than two of the following different procedures were properly used case by case, that is. gastrostomy or jejunostomy for feeding and esophageal rest,thoracotomy and chest drainage, lung decortication for pyothorax, primary closure of compress air perforation and esophago-bronchial fistula, mediastinostomy, retrosternal esophagoplasty using right colon to Lye stricture etc. 5 cases[45. 5%] of 11 cases were expired and the rest of 6 cases[54.5%]were survived with complete accomplishment of surgical procedures and satisfactory healing in 4 cases and interruption of follow up in 2 cases because of poor economical condition of the patients.