• 제목/요약/키워드: Extent of surgery

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Conventional Posterior Approach without Far Lateral Approach for Ventral Foramen Magnum Meningiomas

  • Sohn, Seil;Chung, Chun Kee
    • Journal of Korean Neurosurgical Society
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    • 제54권5호
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    • pp.373-378
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    • 2013
  • Objective : We present our experience of conventional posterior approach without fat lateral approach for ventral foramen magnum (FM) meningioma (FM meningioma) and tried to evaluate the approach is applicable to ventral FM meningioma. Methods : From January 1999 to March 2011, 11 patients with a ventral FM meningioma underwent a conventional posterior approach without further extension of lateral bony window. The tumor was removed through a working space between the dura and arachnoid membrane at the cervicomedullary junction with minimal retraction of medulla, spinal cord or cerebellum. Care should be taken not to violate arachnoid membrane. Results : Preoperatively, six patients were of Nurick grade 1, three were of grade 2, and two were of grade 3. Median follow-up period was 55 months (range, 20-163 months). The extent of resection was Simpson grade I in one case and Simpson grade II in remaining 10 cases. Clinical symptoms improved in eight patients and stable in three patients. There were no recurrences during the follow-up period. Postoperative morbidities included one pseudomeningocele and one transient dysphagia with dysarthria. Conclusion : Ventral FM meningiomas can be removed gross totally using a posterior approach without fat lateral approach. The arachnoid membrane can then be exploited as an anatomical barrier. However, this approach should be taken with a thorough understanding of its anatomical limitation.

갑상선종양환자(甲狀腺腫瘍患者)에서의 혈청(血淸) Thyroglobulin치(値)에 관(關)한 임상적(臨床的) 고찰(考察) (A Clinical Study of Serum Thyroglobulin Levels in Patients with Thyroid Tumor)

  • 이충규;유병희;이우형;유형준;이종석
    • 대한핵의학회지
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    • 제17권1호
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    • pp.25-31
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    • 1983
  • Serum thyroglobulin(Tg) was measured by radioimmunoassay in 81 patients with thyroid tumor who were treated in the department of Internal medicine of National Medical Center from January, 1981 to June, 1982. The results were as follows: 1) The mean serum thyroglobulin level in thyroid tumor was significantly higher than normal subjects (p<0.001). 2) The mean serum thyroglobulin level in benign tumor was lower than malignant tumor (p<0.05). 3) The thyroid carcinoma with metastasis had significant high level of serum thyroglobulin than without metastasis (p<0.001). 4) The mean postoperative serum thyroglobulin level was significantly lower than preoperative level (p<0.001). Data from our study show that serum thyroglobulin determination is useful for assessing the presence of malignant thyroid tumor, metastasis and the extent of residual or recurrent thyroid cancer after surgery.

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만성통증 치료에서 Deep Dry Needling의 모델들과 중재적 근육 및 신경자극 요법 (The Deep Dry Needling Techniques, and Interventional Muscle & Nerve Stimulation (IMS) for the Treatment of Chronic Pain)

  • 이영진;안강;이상철
    • The Korean Journal of Pain
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    • 제19권1호
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    • pp.1-7
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    • 2006
  • Chronic pain can cause disability, mild to severe suffering and high medical costs. Some unfortunate patient do not improve despite administering conservative treatment and then the various interventional therapies, including oriental medical treatment and/or surgery, and they find themselves in search of a more effective pain relief. Deep dry needling is one of the newer treatment modalities for these patients. The last 10 years have seen a lot of progress in understanding the neural pathways and the type and extent of tissue involvement during chronic pain. This in turn has stimulated the development of new treatment techniques, and deep dry needling is one of them. So, the authors of this paper discuss the individual theories, the characteristics and future directions of several deep dry needling techniques, and we examine the new dry needling technique that has been recently developed in Korea.

좌골신경 손상 모델에서 보양환오탕 처리에 의한 축삭 재생반응성 분석 (Improved axonal regeneration by Boyanghwano-tang treatment in mice given sciatic nerve injury)

  • 장인애;김기중;남궁욱
    • 혜화의학회지
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    • 제25권1호
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    • pp.99-108
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    • 2016
  • While axons in the peripheral nerve can regenerate and lead to functional recovery to a certain extent after injury, its efficacy varies depending on the severity and duration of the injury. Here, we investigated the effects of Boyanghwano-tang (BYHOT) treatment on the regenerative responses in the sciatic nerves after prolonged transection and coaptation surgery. In mice given crush injury, axonal regeneration was completed when analyzed 1 week later and did not show any difference in regenerative reponses in the distal portion of the nerve between saline- and BYHOT-treated groups. In animal models with transection and reconnection, axonal regeneration was markedly retarded compared to animals with crush injury. Regenerating axons were extended into the reconnected distal portion of the nerve more actively in animals treated with BYHOT than saline controls. Cdc2 protein was similarly induced in nerves with crush injury and with transection and recollection, and its level was lower in BYHOT-treated animal than saline control when measured 2 weeks after nerve reconnection. These results suggest that BYHOT may be useful to promote axonal regeneration in the peripheral nerve after severe injury.

Clinical Implementation of Precision Medicine in Gastric Cancer

  • Jeon, Jaewook;Cheong, Jae-Ho
    • Journal of Gastric Cancer
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    • 제19권3호
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    • pp.235-253
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    • 2019
  • Gastric cancer (GC) is one of the deadliest malignancies in the world. Currently, clinical treatment decisions are mostly made based on the extent of the tumor and its anatomy, such as tumor-node-metastasis staging. Recent advances in genome-wide molecular technology have enabled delineation of the molecular characteristics of GC. Based on this, efforts have been made to classify GC into molecular subtypes with distinct prognosis and therapeutic response. Simplified algorithms based on protein and RNA expressions have been proposed to reproduce the GC classification in the clinical field. Furthermore, a recent study established a single patient classifier (SPC) predicting the prognosis and chemotherapy response of resectable GC patients based on a 4-gene real-time polymerase chain reaction assay. GC patient stratification according to SPC will enable personalized therapeutic strategies in adjuvant settings. At the same time, patient-derived xenografts and patient-derived organoids are now emerging as novel preclinical models for the treatment of GC. These models recapitulate the complex features of the primary tumor, which is expected to facilitate both drug development and clinical therapeutic decision making. An integrated approach applying molecular patient stratification and patient-derived models in the clinical realm is considered a turning point in precision medicine in GC.

Extent of Disc Degeneration after Single-Level Cervical Anterior Microforaminotomy Analyzed with Long-Term Radiological Data

  • Han, Chul;Kim, Myung-Hyun
    • Journal of Korean Neurosurgical Society
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    • 제56권3호
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    • pp.200-205
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    • 2014
  • Objective : To prove the extents and details of cervical degeneration after anterior microforaminotomy (AMF) with 6-years follow-up. Methods : A retrospective study of 24 patients, underwent single-level AMF, was performed. Clinical and radiologic data were analyzed with office charts, questionaires, and picture achieving and communication system images. Results : According to Odom's criteria, 91.6% achieved favorable outcome. The mean visual analog scale score was improved from 8.6 to 3, and the mean neck disability index was improved from 27.9 to 7.3 (p<0.01). Eighteen cases (75%) showed disc height (DH) decrease. The disc invasion was correlated with DH decrease (p<0.05). The disc height decrease correlated with static, dynamic changes of shell angle and spur formation (p<0.05). Any radiological parameters did not affect the clinical outcome. Conclusion : AMF is an effective technique for treating unilateral cervical radiculopathy. It showed excellent surgical outcomes even in long-term follow-ups. However, a decrease in DH occurred in a considerable number of patients. Disc invasion during surgery may be the trigger of sequential degeneration.

소아 환자에서의 단단문합술에 의한 기관협착 치험 9 례 (Resection and End-to-End Anastomosis in Pediatric Tracheal Stenosis)

  • 김광현;성명훈;이재서;신진성;최승호
    • 대한기관식도과학회:학술대회논문집
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    • 대한기관식도과학회 1993년도 제27차 학술대회 초록집
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    • pp.81-81
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    • 1993
  • 소아의 기관협착은 대부분이 장기간의 기관내삽관에 의해 초래되며 그 치료방법은 기관 협착의 정도 및 부위에 따라 다르다. 협착의 정도가 경하고 주로 육아조직에 의한 경우는 반복적인 내시경적인 처치만으로도 치유가 되지만 협착부위가 광범위하거나 정도가 심한 경우는 수술적인 기관재건이 필요하게 된다. 저자들은 이러한 기관재건술로 윤상갑상연골절제 및 연골이식, 그리고 협착부절제 및 단단문합의 방법 등을 현재까지 사용하였으며 괄목할 만한 결과를 얻었다. 저자들은 지금까지 경험한 9 명의 소아 기관협착 환자에서의 단단문합술에 의한 치험과 단단문합술의 적응증을 제시하고자 한다.

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전방 십자 인대 재건술에서 이식건 선택 (Graft Selection in ACL Reconstruction)

  • 이동철
    • 대한정형외과스포츠의학회지
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    • 제2권2호
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    • pp.92-99
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    • 2003
  • 스포츠 활동과 사고로 인하여 전방십자인대 재건술이 많이 증가하고 있으며 여러 종류의 자가 및 동종이식건이 많이 사용되어지고 있다. 자가 골-슬개건-골을 이용한 전방십자인대 재건술이 제일 대표적인 이식건으로 사용되고 있으나 공여부의 합병증과 전방슬관절통 등의 문제가 발생될 수 있으며 환자에 따라서 이러한 문제를 줄일 수 있는 다른 이식건의 사용도 필요할 수 있다. 여러 이식건의 생역학적인 특성, 장점 및 단점, 합병증을 충분히 이해함으로써 환자 개인에 맞는 적절한 이식건을 선택할 수 있으며 수술후 환자의 만족도를 높일 수 있을 것으로 생각된다

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견관절 불안정성에 대한 이학적 검사 (Physical Examination of Shoulder Instability)

  • 김재화
    • Clinics in Shoulder and Elbow
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    • 제11권1호
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    • pp.1-5
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    • 2008
  • 견관절 불안정성에 대한 진단은 상세한 병력 청취, 이학적 검사, 이에 따른 각종 방사선학적 검사를 통해 이루어진다. 그러나 이학적 검사는 진단에 결정적인 역할을 하고 있음에도 불구하고 어려움을 느끼는 경우가 많다. 정확한 이학적 검사를 위해서는 충분한 해부학적 지식과 많은 경험을 필요로 하며, 또한 정상적인 전이와 병적인 이완의 정도는 매우 구별하기가 용이하지 않은 경우가 많기 때문이다. 견관절의 정상적인 안정성에 대한 해부학적, 생역학적 이해와 정확한 이학적 검사를 통해 불안정성의 방향과 정도뿐만 아니라 동반 병소까지 정확히 진단되어야 성공적인 수술의 전제 조건이 될 것이다.

Factors Affecting Tibial Tuberosity-Trochlear Groove Distance in Recurrent Patellar Dislocation

  • Prakash, Jatin;Seon, Jong-Keun;Ahn, Hyeon-Woon;Cho, Kyu-Jin;Im, Chae-Jin;Song, Eun Kyoo
    • Clinics in Orthopedic Surgery
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    • 제10권4호
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    • pp.420-426
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    • 2018
  • Background: The tibial tuberosity-trochlear groove (TT-TG) distance is used to determine the necessity of tibial tubercle osteotomy. We conducted this study to determine the extent to which each of the tibial tuberosity lateralization, trochlear groove medialization, and knee rotation angle affects the TT-TG distance in both normal and patella dislocated patients and thereby scrutinize the rationale for tuberosity transfer based on the TT-TG distance. Methods: Retrospective analysis of rotational profile computed tomography was done for patella dislocated and control group patients. Femoral anteversion, tibial torsion, knee rotation angle, tuberosity lateralization, and trochlear groove medialization were assessed in all patients. Relationship of these parameters with the TT-TG distance was investigated to evaluate their effects on the TT-TG distance. Results: We observed that the patellar dislocation group, compared to the control group, had increased TT-TG distance (mean, 19.05 mm vs. 9.02 mm) and greater tuberosity lateralization (mean, 64.1% vs. 60.7%) and tibial external rotation in relation to the femur (mean, $7.9^{\circ}$ vs. $-0.81^{\circ}$). Conclusions: Tuberosity lateralization and knee rotation were factors affecting patellar dislocation. These factors should be considered in addition to the TT-TG distance to determine the need for tibial tubercle osteotomy in patients with patellar dislocation.