• Annals of Clinical Neurophysiology
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• 제12권1호
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• pp.3-6
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• 2010

The British guideline for early management of persistent low back pain, published in 2009, indicated that physicians should offer exercise or medication, rather than radiological interventions or injections, as first choice of treatment in the patients with chronic low back pain (CLBP). However, there had been great controversies regarding the effectiveness of interventional treatment of patients with CLBP. Both somatic (discogenic, instability, etc) and psychosocial factors contribute to the pathophysiology of chronic low back pain (CLBP). Although it can be difficult in many occasions, thorough interview with the patients and specific diagnostic approaches can help us to identify which is the main etiology in individual patient. With the recent progress in medical radiology and development of new therapeutic modalities, some subgroups of patients of CLBP caused by somatic factors appear to be good candidates of interventional therapy. Interventional therapy can be considered in patients with CLBP caused by annulus rupture, facet joint degeneration, disc degeneration, and vertebral column instability. Among other subgroups of CLBP, carefully selected patients with disc degeneration show the most favorable result by interventional therapy. In this regard, discogenic pain, either as a form of CLBP or acute discogenic radiculopathy, seems to be a good indication of interventional therapy. Because many spine specialists generally consider those with radiculopathy are easier to be treated, patients with CLBP tend to be subjects of conventional conservative therapy. For these reasons, clinicians should make their best effort to identify every possible somatic cause in patients with CLBP before regarding them as hypochondriacs. In this review, some of the recent evidence on the role of interventional treatment in patients with CLBP will be discussed, and some of our cases who showed favorable results by interventional therapy will be presented.

• Korean Journal of Radiology
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• 제19권6호
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• pp.1130-1139
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• 2018

Objective: To compare the therapeutic efficacy between conventional transarterial chemoembolization (cTACE) and combined therapy using cTACE and radiofrequency ablation (RFA) in ultrasound (US)-invisible early stage hepatocellular carcinoma (HCC). Materials and Methods: From January 2008 to June 2016, 167 patients with US-invisible early stage HCCs were treated with cTACE alone (cTACE group; n = 85) or cTACE followed by immediate fluoroscopy-guided RFA targeting intratumoral iodized oil retention (combined group; n = 82). Procedure-related complications, local tumor progression (LTP), time to progression (TTP), and overall survival (OS) were compared between the two groups. Multivariate analyses were performed to identify prognostic factors. Results: There was no major complication in either group. The cTACE group showed higher 1-, 3-, and 5-year LTP rates than the combined group; i.e., 12.5%, 31.7%, and 37.0%, respectively, in the cTACE group; compared to 7.3%, 16.5%, and 16.5%, respectively, in the combined group; p = 0.013. The median TTP was 18 months in the cTACE group and 24 months in the combined group (p = 0.037). Cumulative 1-, 3-, and 5-year OS rates were 100%, 93.2%, and 87.7%, respectively, in the cTACE group and 100%, 96.6%, and 87.4%, respectively, in the combined group (p = 0.686). Tumor diameter > 20 mm and cTACE monotherapy were independent risk factors for LTP and TTP. Conclusion: Combined therapy using cTACE followed by fluoroscopy-guided RFA is a safe and effective treatment in US-invisible early stage HCCs. It provides less LTP and longer TTP than cTACE alone.

• 디지털융복합연구
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• 제11권8호
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• pp.243-250
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• 2013

본 연구는 허리엉치 안정화 운동프로그램이 만성 허리통증환자의 허리통증장애와 보행속도에 미치는 영향을 알아보고자 만성 허리통증환자 34명을 대상으로 실험군 18명과 대조군 16명을 무작위 추출 하였다. 실험 전 오스웨스트리-허리통증장애지수(Oswestry disability index) 검사와 보행속도 분석을 한 후, 실험군은 허리엉치 안정화 운동과 함께 물리치료의 전통적 중재 기법을 시행하고 대조군은 전통적 중재 기법만을 주 4회, 하루 30분, 4주간 시행하여 사후검사를 한 후, 집단별 실험 전과 실험 후의 허리통증장애지수와 보행속도를 비교하였다. 허리통증장애지수는 실험군과 대조군의 집단 내에서 유의한 차이가 있었고(p>.01)(p>.05), 보행속도는 실험군 집단 내와 집단간에서 유의한 차이가 있었다(p>.001)(p>.05).

• Annals of Clinical Neurophysiology
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• 제10권2호
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• pp.83-97
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• 2008

Cervical and thoracic radiculopathies are among the most common causes of neck pain. The most common causes are cervical disc herniation and cervical spondylosis in patients with cervical radiculopathy, and diabetes mellitus and thoracic disc herniation in thoracic radiculopathy. A thorough history, physical examination, and testing that includes electrodiagnostic examination and imaging studies may distinguish radiculopathy from other pain sources. Although various electrodiagnostic examinations may help evaluate radiculopathy, needle electromyography is the most important, sensitive, and specific method. Outcome studies of conservative treatments have shown varying results and have not been well controlled or systematic. When legitimate incapacitating symptoms continue despite conservative treatment attempts, more invasive spinal procedures and intradiscal treatment may be appropriate. Surgery has been shown to have excellent clinical outcomes in patients with disc extrusion and neurological deficits. However, patients with minimal disc herniation have fair or poor surgical outcomes. In addition, conventional open disc surgery entails various inadvertent surgical related risks. Although there has not yet been a non-surgical interventional procedure developed with the therapeutic efficacy of open surgery, conservative procedures can offer substantial benefits, are less invasive, and avoid surgical complications. While more invasive procedures may be appropriate when conservative treatment fails, prospective studies evaluating cervical and thoracic radiculopathies treatment options would help guide practitioners toward optimally cost-effective patient evaluation and care.

• Korean Journal of Radiology
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• 제24권8호
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• pp.719-728
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• 2023

Radiofrequency ablation (RFA) has been widely used to manage hepatocellular carcinomas (HCCs) equal to or smaller than 3 cm. No-touch RFA has gained attention and has recently been implemented in local ablation therapy for HCCs, despite its technical complexity, as it provides improved local tumor control compared to conventional tumor-puncturing RFA. This article presents the practice guidelines for performing no-touch RFA for HCCs, which have been endorsed by the Korean Society of Image-Guided Tumor Ablation (KSITA). The guidelines are primarily designed to assist interventional oncologists and address the limitations of conventional tumor-puncturing RFA with describing the fundamental principles, various energy delivery methods, and clinical outcomes of no-touch RFA. The clinical outcomes include technical feasibility, local tumor progression rates, survival outcomes, and potential complications.

• The Korean Journal of Pain
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• 제20권2호
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• pp.199-202
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• 2007

Failed back surgery syndrome (FBSS) is a condition characterized by extreme pain after spinal surgery. Treatment of FBSS is aimed at improving function, using interdisciplinary approaches that encompass rehabilitation, psychological therapy, and pain management. If no response to conventional treatment is noted, a more interventional technique such as spinal cord stimulation (SCS) should be used. SCS is a well-established method of managing a variety of chronic neuropathic pain conditions. A 32 year-old male patient afflicted by FBSS that was irresponsive to both medication and several repeated nerve blocks showed improvement of symptoms after cervical and thoracic SCS with a single electrode. Centered on the midline of the spinal cord, single-electrode SCS can be an effective method for relieving pain and improving function.

• Journal of Chest Surgery
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• 제39권8호
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• pp.604-610
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• 2006

배경 : 최근 중재적 시술과 심부전에 대한 내과적 치료의 발전으로 관상동맥우회술의 대상이 되는 허혈성 심근질환을 가진 환자들이 늘어나고 있다. 우리는 좌심실 기능이 감소된 이러한 환자들에 시행 된 관상동맥우회술의 결과를 후향적으로 분석하여 중단기 결과를 알아보고자 한다. 대상 및 방법: 2001년 1월부터 2005년 6월까지 관상동맥우회술을 시행 받은 1,143 명의 환자 중 죄심실박출지수가 35% 이하인 환자는 144명이었다. 인공심폐기를 사용하지 않고 관상동맥우회술(‘off-pump’ coronary artery bypass grafting, OPCAB) 을 시행한 경우가 66예(45.8%), 인공심폐기를 사용하고 뛰는 심장에서 관상동맥우회술(on-pump beating heart coronary artery bypass grafting)을 시행한 경우가 34예(23.6%), 전통적인 관상동맥우회술(conventional coronary artery bypass grafting)을 시행한 경우가 44예(30.6%) 였다. 동반된 심장수술로는 승모판륜 성형술을 포함하여 35명(24.3%)의 환자들에서 48건이 시행되었다. 결과: 환자당 원위 문합수는 $3.5{\pm}1.3%$개였고 술 후 중환자실 체류기간과 재원기간의 중간값은 각각 2일과 8일이었다. 조기 사망은 6명(4.2%)으로 심실성 빈맥으로 인한 경우가 5명, 소장경색이 1명이었다. 평균 추적기간은 $21{\pm}14%(2{\sim}54$개월)였다. 1년 생존율은 $95{\pm}2%$, 3년 생존율은 $83{\pm}7%$였고 심장관련 event-free 1년, 3년 생존율은 각각 ${88{\pm}3%,\;69{\pm}7%}$였다. 결론: 만족할 만한 중단기 결과에 따라 허혈성 심근질환에서도 적극적으로 관상동맥우회술이 시행되어야 할 것으로 생각되며 술 후 심실성 빈맥에 대한 치료를 집중적으로 시행한다면 더 좋은 결과를 보이리라 생각된다.