• Journal of Korean Foot and Ankle Society
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• v.23 no.3
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• pp.91-99
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• 2019

Purpose: This retrospective study reports the intermediate-term clinical outcomes including the practical function in daily and sports activities after total ankle arthroplasty for end-stage rheumatoid arthritis, as well as the effects of modification of perioperative anti-rheumatic medications. Materials and Methods: Twelve patients were followed for a minimum of 2 years after total ankle replacement for end-stage rheumatoid arthritis. Perioperative anti-rheumatic medications in all patients were modified based on a specific guideline. Clinical evaluations consisted of American Orthopaedic Foot and Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM) scores. Periodic radiographic evaluation was conducted to detect changes in ankle alignment and postoperative complications. Results: Mean AOFAS, FAOS, and FAAM scores improved significantly from 37.5 to 81.2, 39.1 to 72.4, and 33.8 to 64.0 points at final follow-up, respectively (p<0.001). Functional outcomes in daily and sports activities at final follow-up were found to be 76.5 and 55.8 points for the FAOS and 70.5 and 57.5 points for the FAAM, respectively. As early postoperative complications, there was one case of local wound necrosis, one case of medial malleolar fracture, and one case of deep peroneal nerve injury. Radiological evaluation revealed two cases of asymptomatic heterotopic ossification and one case of progressive arthritis in the talonavicular joint. Reoperation was performed in only one patient (8.3%) with a medial soft tissue impingement at a mean of 35.6 months follow-up. Conclusion: Total ankle arthroplasty appears to be an effective surgical option for end-stage rheumatoid arthritis. Practical functions in daily and sports activities were significantly improved at intermediate-term follow-up. Modification of perioperative anti-rheumatic medications can be one of the solutions to reduce the postoperative complication rate.

• Clinics in Shoulder and Elbow
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• v.18 no.1
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• pp.2-7
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• 2015

Background: The purpose of this study was to evaluate the usefulness and safety of the anterosuperior deltoid splitting approach for fixation of displaced proximal humeral fractures by analyzing the surgical outcomes. Methods: Twenty-three patients who could be followed-up for at least 8 months after the treatment of displaced proximal humeral fractures through the anterosuperior deltoid splitting approach were enrolled. We evaluated the reduction of the fractures and surgery-related complications at the last follow-up using X-ray results and clinical outcomes comprising the University of California at Los Angeles (UCLA) scoring system and the Korean Shoulder Society (KSS) score. Results: At the last follow-up of patients treated using the anterosuperior deltoid splitting approach for internal fixation of proximal humeral fractures, we found 22 cases (95.6%) of bone union, a mean UCLA score of 28.3 (range, 15 to 34) and a mean KSS score of 82.1 (range, 67 to 95). Various surgery-related complications were noted; a case of varus malunion after fracture displacement, a case of nonunion, a case of delayed union, two cases of impingement, and a case of partial axillary nerve injury, which recovered completely through the follow-up. Conclusions: Plate fixation using the anterosuperior deltoid splitting approach could be another reliable option for treating displaced proximal humeral fractures.

• The Journal of Internal Korean Medicine
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• v.29 no.1
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• pp.189-199
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• 2008

Background & Objective : Jichul-hwan(JCH) has been used for the treatment of functional dyspepsia, regarded as a gastric dysmotility disease. We investigated the effects of JCH on gastric motility and its mechanisms of action in rats. Methods : The gastric wall was injured by tracting a part of stomach body in rats. Gastric emptying was measured after administration of normal saline(NS) or JCH in normal rats and gastric wall injured rats. To evaluate the mechanism of JCH under delayed gastric emptying conditions, normal rats were treated with atropine sulfate(1mg/kg, s.c.), quinpirole HCl(0.3mg/kgg, i.p.), $NAME(N^{G}-nitro-L-arginine$ methyl ester, 75mg/kg s.c.) and cisplatin(10mg/kg, i.p.). The gastric slow waves were measured for 30 minutes before and after administration of each solution(NS, JCH). Results : JCH 110.1mg/kg improved gastric emptying for 2 hrs(p=0.014). JCH 110.1mg/kg improved gastric emptying in the gastric wall injured rats(p=0.001). Under the delayed gastric emptying, JCH 110.1mg/kg improved gastric emptying in the group treated with atropine $sulfate(1.83{\pm}0.96$ vs $8.43{\pm}8.46$, p=0.003), but aggravated it with quinpirole $HCl(4.7{\pm}2.9$ vs $1.61{\pm}2.09$, p=0.021). Administration JCH 110.1mg/kg increased EGG power in rats. Conclusions : JCH stimulates gastric motility through the cholinergic pathway, so we expect that it would be effective in the treatment of dysmotility-like functional dyspepsia with low activity of vagus nerve.

• Journal of Chest Surgery
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• v.25 no.12
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• pp.1508-1515
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• 1992

Between 1975 and 1992, forty five patients with trachea stenosis received tracheoplasty for relief of obstruction. The causes of airway problem are brain contusion[19 cases, 40%], cerebrovascular disease[3 cases, 7%], drug intoxication[8 cases, 18%], psychotic problem[2 cases, 4%], trachea tumor[3 cases, 7%], adult respiratory distress syndrome[9 cases, 20%] and direct trauma[1 case, 2%]. Direct causes of trachea stenosis were complications of tracheostomy[36 cases, 80%], complications of nasotracheal intubation[5 cases, 11%], tumor[3 cases, 6%] and trauma[1 case, 2%]. Thirty one patients underwent the sleeve resection and end-to-end anastomosis. Five patients performed a wedge resection and end-to-end anastomosis. Forteen patients received the Montgomery T-tube for relief of airway obstruction. Four patients have done simple excision of granulation tissue. Two, subglottic stenosis patients were received Rethi procedure[anterior division of cricoid cartilage, wedge partial resection of lower thyroid cartilage and Montgomery T-tube molding] and the other subglottic stenosis patient underwent permanent trachea fenestration. Including cervical flexion in all patients postoperatively, additional surgical techniques for obtain tension-free anastomosis were hyoid bone release technique in two cases, and hilar mobilization, division of inferior pulmonary ligament and mobilization of pulmonary vessel at the pericardium were performed in one case. Cervical approach was used in 39 cases, cervicomediastinal in 12 cases and transthoracic in one case. Complications of tracheoplasty were formation of granulation tissue at the anastomosis site[3 cases], restenosis[9 cases], trachea-innominate artery fistula[2 cases], wound infection[2 cases], separation of anastomosis[2 cases], air leakage[3 cases], injury to a recurrent laryngeal nerve[temporary 8 cases, permanent 2 cases] and hypoxemia[1 case]. Surgical mortality for resection with primary reconstruction was 6.7%, with one death due to postoperative respiratory failure and two deaths due to tracheo-innominate artery fistula.

• Archives of Plastic Surgery
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• v.39 no.4
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• pp.397-403
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• 2012

Background Nonabsorbable sutures are favorable for repairing flexor tendons. However, absorbable sutures have performed favorably in an animal model. Methods Two-strand sutures using the interlocking modified Kessler method with polydioxanone absorbable sutures 4-0 were used to repair completely ruptured flexor tendons in 55 fingers from 41 consecutive patients. The medical records of average 42 follow up weeks were analyzed retrospectively. The data analyzed using the chi-squared test, and Fisher's exact test was used for postoperative complications. The results were compared with those of other studies. Results Among the index, middle, ring, and little fingers were injured in 9, 17, 16, and 13 fingers, respectively. The injury levels varied from zone 1 to 5. Of the 55 digits in our study, there were 26 (47%) isolated flexor digitorum profundus (FDP) injuries and 29 (53%) combined FDP and with flexor digitorum superficialis injuries. Pulley repair was also conducted. Concomitant injuries of blood vessels and nerves were found in 17 patients (23 fingers); nerve injuries occurred in 5 patients (10 fingers). Two patients had ruptures (3.6%), and one patient had two adhesions (3.6%). Using the original Strickland criteria, all the patients were assessed to be excellent or good. Also, fibrosis and long-term foreign body tissue reactions such as stitch granuloma were less likely occurred in our study. Compared to the Cullen's report that used nonabsorbable sutures, there was no significant difference in the rupture or adhesion rates. Conclusions Therefore, this study suggests that appropriate absorbable core sutures can be used safely for flexor tendon repairs.

• Archives of Plastic Surgery
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• v.36 no.6
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• pp.806-810
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• 2009

Purpose: Gynecomastia is an abnormal increase in the volume of the male breast. Subcutaneous mastectomy was the first surgical treatment for gynecomastia. But because of the complications such as nerve injury and scar formation, subcutaneous mastectomy has been substituted with liposuction. Recently various techniques including ultrasound - assisted liposuction has been used for treatment of gynecomastia. The purpose of this study is to evaluate the results of XPS$^{(R)}$ microresector(Shaver) for treatment of gynecomastia. Methods: 17 patients, 33 breasts of gynecomastia, Simon grade I or II have been treated with XPS$^{(R)}$ microresector(Shaver). The mean age was 24.5. The subcutaneous tissue and glandular tissue were removed with XPS$^{(R)}$ microresector(Shaver). The operation time, the weight of removed tissue and patients' satisfaction score were accessed. Results: The mean operation time was 78.2 minutes. The mean weight of removed tissue was 113.8 g. There was no significant complications such as necrosis, hematoma, infection or scar contracture. Patients' satisfactory score of scar, shape and confidence were 8.4, 8.2 and 8.4 respectively. As the average score was 8.3, almost patients were satisfied with their breasts. Conclusion: The authors have treated 17 patients suffering from gynecomastia with XPS$^{(R)}$ microresector(Shaver). We obtained short operation time, early recovery, minimal operative scar and less complications with XPS$^{(R)}$ microresector(Shaver) for the treatment of gynecomastia, and patients were satisfied with the results of our method. We concluded XPS$^{(R)}$ microresector(Shaver) is an alternative option for the treatment of gynecomastia.

• Journal of Physiology & Pathology in Korean Medicine
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• v.21 no.2
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• pp.432-437
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• 2007

Reactive oxygen species (ROS) are toxic agents that may be involved in various neurodegenerative diseases. Recent studies indicate that ROS are also involved in persistent pain through a spinal mechanism. In the present study, whole cell patch clamp recordings were carried out on substantia gelatinosa (SG) neurons in spinal cord slice of neonatal rats to investigate the effects of ROS on neuronal excitability and excitatory synaptic transmission. In current clamp condition, tert-buthyl hydroperoxide (t-BuOOH), an ROS donor, induced a electrical hyperexcitability during t-BuOOH wash-out followed by a brief inhibition of excitability in SG neurons. Application of t-BuOOH depolarized membrane potential of SG neurons and increased the neuronal firing frequencies evoked by depolarizing current pulses. Phenyl-N-tert-buthylnitrone (PBN), an ROS scavenger, antagonized t-BuOOH induced hyperexcitability. IN voltage clamp conditions, t-BuOOH increased the frequency and amplitude of spontaneous excitatory postsynaptic currents (sEPSCs). In order to determine the site of action of t-BuOOH, miniature excitatory postsynaptic currents (mEPSCs) were recorded. t-BuOOH increased the frequency and amplitude of mEPSCs, indicating that it may modulate the excitability of the SG neurons via pre- and postsynaptic actions. These data suggest that ROS generated by peripheral nerve injury can induce central sensitization in spinal cord.

• Archives of Reconstructive Microsurgery
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• v.18 no.1
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• pp.27-30
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• 2009

Purpose: Recently, replantation of fingertip amputation, Zone I by Yamano classification, is still difficult because digital arteries branch into small arteries and also digital veins are hard to separate from the immobile soft tissue. However the replantation of fingertip in adults is a well-established procedure, but the replantation in infant or child is still uncommon. Therefore we present one case of replantation of the fingertip of the small finger in 12-months-old patient. Methods: We experienced a 12-months-old male amputation of small finger. It had been amputated completely at the level of Zone I by Yamano classification. Replantation was performed using the arteryonly technique with neither vein nor nerve repair. Because the artery has been damaged, it is still possible to make a direct suture by transposing the arterial arch in an inverted Y to I arterial configuration. Venous drainage was provided by an external bleeding method with partial nail excision and repaired margin for approximately 7 days. Results: We were performed replantation in infant with only-arterial anastomosis successfully, result in good recovery of aesthetic and functional outcome. Conclusion: In conclusion, although fingertip injury was difficult to replantation in infant and child, we must try it. Because of its functional and cosmetic advantage.

• Clinics in Shoulder and Elbow
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• v.8 no.2
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• pp.105-109
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• 2005

Purpose: To Analyze the exit site of pin inserted at the anterior glenoid rim in the reconstruction of the Bankart lesion and SLAP lesion using transglenoid suture technique. Materials and Methods: In the twenty adult right cadeveric scapula, insertions of pin were performed using guide at the position of 1, 2, 3 O'clock of glenoid rim. We measured the exit site of dorsal surface of the scapula by medial distance from sagittal plane of lateral border of scapular spine and the vertical distance from posterior border of the scapular spine. Results: When the pin was inserted caudally within 10 degree, at the position of 1, 2, 3 O'clock, the medial distance from lateral border of the scapula is averaged 29.4, 19.2, 34.0 mm respectively and the vertical distance from posterior border of the scapular spine is averaged 15.0, 18.6, 17.2 mm respectively. When the pin was inserted caudally within 20-30 degree, the medial distance is averaged 14.6, 14.2, 15.8 mm respectively and the vertical distance is averaged 31.6, 31.9, 32.1 mm respectively. Conclusion: When the pin was inserted caudally within ten degrees using the guide, the pin exit appeared at the more medial side of the base of scapular spine and the more inferior of scapular spine. This can make the firm suture tied over scapular spine during repair SLAP and the Bankart lesion, and also prevent the injury of suprascapular nerve.

• Korean Journal of Head & Neck Oncology
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• v.15 no.2
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• pp.205-210
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• 1999

Objectives: Major salivary gland tumor mainly develops in the parotid gland and pleomorphic adenoma is a large percentage. The aim of this study is to get clinicopathologic characteristics of overall major salivary gland tumors and suggestions regarding surgical management through collective review of 315 cases. Materials and Methods: This is a clinicopathologic review of 315 cases of major salivary gland tumor who were treated surgically at Department of Surgery, Head and Neck Clinic, Pusan Paik Hospital, Inje University during the period of 18 years from 1980 to 1997. Analysis was performed regarding the incidence, classification, surgery and its complications, and survival rate of salivary gland cancer. Results : 1) Parotid gland was the most prevalent site of salivary gland tumor(78%) and submandibular gland(21%) was next in order. Benign tumors were 257cases(81%) and malignant tumors were 58 cases(19%). 2) Male to female sex ratio was 1:1.2, the most prevalent age group was 3rd decade and the second group was 4th decade. 3) Histopathologically, the most common benign salivary gland tumor was pleomorphic adenoma. Warthin's tumor was next common. Among the malignant tumors, mucoepidermoid carcinoma was most common, and the next were adenoid cystic carcinoma and acinic cell carcinoma. 4) In pleomorphic adenoma, superficial parotidectomy was performed in 129 cases, and extracapsular tumorectomy was performed in 3 cases. In non-pleomorphic benign tumor, tumorectomy was performed in 21 cases. In 40 cases of deep lobe tumor, total parotidectomy was performed in only 2 cases and deep parotidectomy was performed in 38 cases. 5) Surgical complications were facial nerve injury 19 cases, Frey syndrome 13 cases, and salivary fistula 3 cases. 6) Overall 5-year survival rate of salivary gland cancer was 63%. Conclusion: Postoperative recurrence rate is low in benign tumor, but high in cancer of salivary gland tumor. Surgical procedure should not be aggressive in benign tumor, especially in parotid tumor, but should be aggressive in malignant salivary gland tumors.