• 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.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.502-508
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• 2009

Background: Rib fractures are the most common injuries that are caused by blunt chest trauma. However, fractures of the costal cartilage generally go unnoticed on chest X-rays unless they involve a calcified cartilage. For this reason, the sensitivity of conventional radiography for detecting rib fractures is low, and especially those involving the cartilaginous part of the rib. Thus, we have evaluated the usefulness of ultrasonography for detecting fractures of the costal cartilage that were overlooked on the conventional radiographs of patients who suffered minor blunt chest traumas. Material and Method: A total of 45 patients who suffered minor blunt chest trauma and who had no evidence of rib fractures or other major fractures on conventional radiographs were admitted for ultrasonography between April 2008 and March 2009. There were 24 women and 21 men, and the mean age of the patients was 50.4$\pm$15.91 years (range: 17$\sim$76 years). They were examined for the detection of fractures of the costal cartilage by performing ultrasonography with a 7.5-MHz linear transducer. Result: A total of 30 patients (67%) had fractures of the costal cartilage, whereas 15 patients (33%) had no evidence of chondral rib fractures. The mean number of fracture sites of the fractured costal cartilage was 1.6$\pm$0.81 (range: 1$\sim$4 sites) in 30 patients. Periosteal hematoma was the most common finding associated with fractures of the costal cartilage (n=7, 17%), followed by sternum fracture (n=5, 12%). However, periosteal hematoma was noticed in 1 patient (2%) who was without fracture of the costal cartilage, and sternum fracture was noticed in 1 patient (2%) who was without fractures of the costal cartilage. Conclusion: The results of this study suggest that ultrasonography may be a useful imaging modality for detecting fractures of the costal cartilage that are overlooked on the conventional radiographs of patients who suffer minor blunt chest trauma.

• Journal of Chest Surgery
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• v.41 no.6
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• pp.736-741
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• 2008

Background: Pneumonia continues to be the most common major infection in trauma patients. Despite the advances in prevention, diagnosis, and treatment for pneumonia, it remains a major cause of morbidity and mortality. The aim of this retrospective study is to identify the risk factors and clinical features of ventilator-associated pneumonia among chest trauma patients. Material and Method: The study population consisted of 78 mechanically ventilated patients admitted to the ICU of Chonnam National University Hospital between January, 2001, and December, 2006. The patients were divided into two groups: those with pneumonia (Group I) and without pneumonia (Group II). Clinical predictors of the occurrence and mortality for ventilator associated pneumonia were analyzed. Result: There were 57 men and 21 women, with a mean age of $48.3{\pm}19.9$ years. Almost half of the patients, 48.7% (38 of 78), had pneumonia. The mortality rate was 21.0% (8 of 38) in Group I and 2.5% (1 of 40) in Group II. The predictors of ventilator-associated pneumonia were the duration of mechanical ventilation (17.4 days vs 6.5 days, p<0.001), the mean stay in the ICU (21.7 days vs 9.7 days, p<0.001), the use of inotropics due to hemodynamic instability (63.1% vs 25.0%, p=0.001), and the serum level of CRP ($11.3{\pm}7.8$ vs $6.4{\pm}7.3$, p=0.006). Conclusion: Posttraumatic ventilator-associated pneumonia was significantly related with the duration of mechanical ventilation, the mean stay in ICU, and the use of inotropics due to hemodynamic instability. The serum level of CRP at admission was higher in the pneumonia group. Morbidity and mortality can be reduced by early identification of predictive factors for developing pneumonia in chest trauma patients.

• Radiation Oncology Journal
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• v.17 no.1
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• pp.36-41
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• 1999

Purpose : We reviewed the treatment results for the patients with locally recurrent rectal carcinoma. The object was to evaluate the treatment outcome and to identify the prognostic factors influencing the survival. Methods and Materials: Twenty-eight patients with locally recurrent rectal carcinoma treated principally with external-beam radiation therapy between 1982 to 1996 in the Department of Radiation Oncology at Paik and Hanyang Hospital were reviewed retrospectively Of these, 17 patients had initially abdominoperineal resection, 9 had low anterior resection, and 2 had local excision. No patients had received adjuvant radiation therapy for the primary disease. There were 14 men and 14 women whose ages ranged from 31 to 72 years (median age:54.5). Median time from initial surgery to the start of radiation therapy for local recurrence was 11 months (4~47 months). Radiation therapy was given with total doses ranging from 27 to 64.8 Gy (median=51.2 Gy). Results : The median survival was 16.7 months. The 2-year and 5-year survival rates were 20.1%, 4.1% respectively. Upon multivariate analysis, overall survival was positively correlated with duration of intervals from initial surgery to local recurrence (P=0.039). Relief of pelvic symptoms was achieved in 17 of 28 patients (60.7%). Pain and bleeding responded in 40% and 100% of patients, respectively Conclusions : Patients with locally recurrent rectal carcinoma treated with radiotherapy have benefited symptomatically, and might have increased survivals with a small chance of cure. But, patient were rarely cured (median survival : 10 months, 5-year survival : less than 5%). Overall survival was positively correlated with long intervals from initial surgery to local recurrence. Future efforts should be directed to the use of effective therapy for patients with locally recurrent rectal carcinoma and adjuvant therapy for patients with rectal cancer to reduce the incidence of pelvic recurrence.

• Radiation Oncology Journal
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• v.21 no.1
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• pp.75-81
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• 2003

Purpose : This study quantitatively evaluated the apoptosis In human peripheral blood lymphocytes using flow cytometry, and investigated the possibility of using this method, with a small amount of blood, and the time and dose dependence of radiation-induced apoptosls. Materials and Methods : Peripheral blood lymphocyes were isolated from the heparinized venous blood of 11 healthy volunteers, 8 men and 3 women, with each 10 ml of blood being divided Into IS samples. The blood lymphocytes were Irradiated using a linear accelerator at a dose rate of 2.4 Gy/min, to deliver doses of 0.5, 1, 2 and S Gy. The control samples, and Irradiated cells, were maintained in culture medium for 24, 48 and 72 hours fellowing the Irradiation. The number of apoptotic cells after the in vitro X-irradiation was measured by flow cytometry after Incubation periods of 24, 48 and 72 hours. We also observed the apoptotic cells using a DNA fragmentation assay and electron microscopy. Results : The rate oi spontaneous apoptosis increased in relation to the time interval following irradiation (1.761 ${\pm}$0.161, 3.563${\pm}$0.554, 11.098${\pm}$2.849, at 24, 48, and 72 hours). The apoptotli cells also increased In the samples irradiated with 0.5, 1, 2 and 5 Gy, In a radiation dose and time interval after Irradiation manner, with the apoptosls being too great at 72 hours after Irradiation. The dose-response curves were characterized by an Initial steep Increase In the number of apoptotic cells for Irradiation doses below 2 Gy, with a flattening of the curves as the dose approached towards 5 Gy. Conclusion :The flow cytometric assay technique yielded adequate data, and required less than 1 mL of blood. The time and dose dependence of the radiation-induced apoptosis, was also shown. It is suggested that the adequate time Interval required for the evaluation of apoptosis would be 24 to 48 hours after blood sampling.

• Journal of Korean Neurosurgical Society
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• v.50 no.3
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• pp.166-172
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• 2011

Objective : The intralaminar screw (ILS) fixation technique offers an alternative to pedicle screw (PS) and lateral mass screw (LMS) fixation in the C7 spine. Although cadaveric studies have described the anatomy of the pedicles, laminae, and lateral masses at C7, 3-dimensional computed tomography (CT) imaging is the modality of choice for pre-surgical planning. In this study, the goal was to determine the anatomical parameter and optimal screw trajectory for ILS placement at C7, and to compare this information to PS and LMS placement in the C7 spine as determined by CT evaluation. Methods : A total of 120 patients (60 men and 60 women) with an average age of $51.7{\pm}13.6$ years were selected by retrospective review of a trauma registry database over a 2-year period. Patients were included in the study if they were older than 15 years of age, had standardized axial bone-window CT imaging at C7, and had no evidence of spinal trauma. For each lamina and pedicle, width (outer cortical and inner cancellous), maximal screw length, and optimal screw trajectory were measured, and the maximal screw length of the lateral mass were measured using m-view 5.4 software. Statistical analysis was performed using Student's t-test. Results : At C7, the maximal PS length was significantly greater than the ILS and LMS length (PS, $33.9{\pm}3.1$ mm; ILS, $30.8{\pm}3.1$ mm; LMS, $10.6{\pm}1.3$; p<0.01). When the outer cortical and inner cancellous width was compared between the pedicle and lamina, the mean pedicle outer cortical width at C7 was wider than the lamina by an average of 0.6 mm (pedicle, $6.8{\pm}1.2$ mm; lamina, $6.2{\pm}1.2$ mm; p<0.01). At C7, 95.8% of the laminae measured accepted a 4.0-mm screw with a 1.0 mm of clearance, compared with 99.2% of pedicle. Of the laminae measured, 99.2% accepted a 3.5-mm screw with a 1.0 mm clearance, compared with 100% of the pedicle. When the outer cortical and inner cancellous height was compared between pedicle and lamina, the mean lamina outer cortical height at C7 was wider than the pedicle by an average of 9.9 mm (lamina, $18.6{\pm}2.0$ mm; pedicle, $8.7{\pm}1.3$ mm; p<0.01). The ideal screw trajectory at C7 was also measured ($47.8{\pm}4.8^{\circ}$ for ILS and $35.1{\pm}8.1^{\circ}$ for PS). Conclusion : Although pedicle screw fixation is the most ideal instrumentation method for C7 fixation with respect to length and cortical diameter, anatomical aspect of C7 lamina is affordable to place screw. Therefore, the C7 intralaminar screw could be an alternative fixation technique with few anatomic limitations in the cases when C7 pedicle screw fixation is not favorable. However, anatomical variations in the length and width must be considered when placing an intralaminar or pedicle screw at C7.

• The korean journal of orthodontics
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• v.25 no.5 s.52
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• pp.613-625
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• 1995

The purpose of this study was to investigate the degree of relapse following orthognathic surgery and the relationship between preoperative state and the methods of orthognathic surgery in skeletal Class III patients. Thirty-one patients were selected(17 men, and 14 women) for this study, who had received orthognathic surgery(20 one jaw surgery, and 11 two jaw surgery). The mean age was 22.5 years. Their lateral cephalograms, that were taken preoperatively, immediate postoperatively and follow-up over one year, were traced and analysed. The results were as follows : 1. In two jaw surgery, mandibular length, lower facial height and lower lip length were 4.24mm, 4.64mm and 4.13mm longer than in one jaw surgery, respectively But in two jaw surgery, overjet was 3.13mm shorter than in one jaw surgery. 2. In one jaw surgery, mandible was moved back $8.95\pm4.45mm$ at B point. In two jaw surgery, maxilla was moved forward $5.15\pm3.46mm$ and mandible was moved back $7.24\pm9.11mm$ at B point. 3. Between postoperation and follow-up over one year, A point, A' point, Pn and Sn were moved backward 1.02 $\pm$ 2.14mm, $1.73\pm1.63mm,\;1.05\pm1.48mm\;and\;1.55\pm1.37mm$ in two jaw surgery, respectively. 4. Between postoperation and follow-up over one year, in one jaw surgery, B point was moved forward $2.58\pm4.22mm$ and B' point was moved forward $1.95\pm4.39mm$. In two jaw surgery, B point was moved forward $0.65\pm2.88mm$ and B' point was moved forward $0.19\pm3.32mm$. In one jaw surgery, relapse rate was $28\%$ at B point and $24\%$ at B' point, whereas in two jaw surgery, relapse rate was $8\%$ at B point and $3\%$ at B' point.

• The korean journal of orthodontics
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• v.38 no.6
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• pp.397-406
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• 2008

Objective: The purpose of this study was to provide clinical guidelines to indicate the best location for mini-implants as it relates to the cortical bone thickness and root proximity. Methods: CT images from 14 men and 14 women were used to evaluate the buccal interradicular cortical bone thickness and root proximity from mesial to the central incisor to the 2nd molar. Cortical bone thickness was measured at 4 different angles including $0^{\circ}$, $15^{\circ}$, $30^{\circ}$, and $45^{\circ}$. Results: There was a statistically significant difference in cortical bone thickness between the second premolar/first permanent molar site, central incisor/central incisor site, between the first/second permanent molar site and in the anterior region. A statistically significant difference in cortical bone thickness was also found when the angulation of placement was increased except for the 2 mm level from the alveolar crest. Interradicular spaces at the 1st/2nd premolar, 2nd premolar/1st permanent molar and 1st/2nd permanent molar sites are considered to be wide enough for mini-implant placement without root damage. Conclusions: Given the limits of this study, mini-implants for orthodontic anchorage may be well placed at the 4 and 6 mm level from the alveolar crest in the posterior region with a $30^{\circ}$ and $45^{\circ}$ angulation upon placement.

• Journal of the Korean Arthroscopy Society
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• v.4 no.1
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• pp.61-66
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• 2000

Purpose : The diagnosis of the causes of residual pain after ankle fractures and the treatment is not simple. The authors analyzed the clinical results of the patients with residual pain after ankle fracture fur whom ankle arthroscopy was undertaken, for the purpose of evaluating the efficacy of arthroscopic diagnosis and treatment. Materials and Methods : From January 1997 to June 1998, ankle arthroscopy was done for the seventeen patients suffering from residual ankle pain and limitation of motion after ankle fracture. Their symptoms were not improved despite conservative treatment. There were sixteen men and one woman, and their mean age was 37.4 years. Result : Radiological examination revealed loose bodies in two patients, and osteophytes at the anterior rim of the tibia in fourteen patients. By the classification of osteoarthritic change, three ankles were assigned to grade 0, eight to grade I, six to grade II, and none to grade III. On arthroscopic examination, soft tissue impingement was found In thirteen cases, loose bodies in five cases, and osteochondral lesions in four cases. For arthroscopic treatments, removal of soft tissue, abrasion of osteophytes, cartilage shaving and removal of loose bodies were done. Clinical results were evaluated using Evanski and Waugh score. Preoperative overall score of 58.7 points jumped to 74.6 points after the operation, and in fourteen patients$(82\%)$ the symptoms were improved. Conclusion : Ankle arthroscopy is considered to be a very useful diagnostic and treatment method fer the patients with residual complaints after ankle fracture.

• Korean journal of communication and information
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• v.34
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• pp.132-160
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• 2006

The main purpose of this study is based on the comparative analysis over news framing of the family headship(Hoju) abolition in Korean society. This study examined the newspaper articles involving the Hoju abolition, which had been printed on the three major dailies, Chosun, Kukmin, Hankyoreh through February of 1990 to July of 2005. First, the news articles were analyzed and classified on the basis of their lengths, news types, main characters, news framing and systematic framing. Second, the articles that this study looked into were divided into the five major periods when the issue of the Hoju abolition in Korean society surfaced as a main social agenda to be discussed. Third, the main differences between the noticeable frame and unnoticeable frame in each period were analyzed through the three different perspectives which can also can be sub-divided into the six different attributes. This study found that the Hoju abolition as an attribute had developed into political, legal and social fields. The analysis of the research shows that the articles related to the patriarchy abolition showed more dominant frame which reflected the social change or the general tendency of the times. However, the analysis indicates that the articles in the level of an attribute included more dominant frame which mirrored a male chauvinism society. It also points out that the articles contained more dominant frame which was be used as a standard to find out the readers' political inclination. The articles also showed the dominant frame which included the revision and legal process of family laws before presidential or general election campaigns. The study also found that there were major differences among the three dailies. First of all, Chosun, regarded the Hoju as a custom by stressing that 'it is necessary to keep Hoju system to intensify the role and crisis of family if the Hoju will be abolished'. However, Hankyoreh recognized the issue as an important one to improve feminism and female rights by maintaining that 'it is the time to balance the inequality out between men and women with the abolition of patriarchy'. Finally, Kukmin treated the issue as an first step to acknowledge the dignity of females by emphasizing that 'a revision of the law is essential to accept the changing ethics of the times'.