• Journal of Korean Foot and Ankle Society
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• v.19 no.4
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• pp.142-150
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• 2015

Purpose: Restoration of ankle stability through the strengthening exercise of peroneus muscles is considered an important factor for achievement of successful outcomes, in the rehabilitation program following ankle ligament injuries. However, there were few definitive data on normal muscle strength, including eversion power by peroneus muscles. This study was conducted to evaluate the muscle strength of ankle joint measured using an isokinetic dynamometer in normal Koreans. Materials and Methods: Sixty adults (120 ankles) were recruited and divided into three groups (20 in their twenties, 20 in thirties, and 20 in forties). Each group consisted of 10 males and 10 females. The selection criteria were no history of ankle injury and no evidence of instability. The peak torque, total work, and deficit ratio were measured using the Biodex$^{TM}$ (Biodex Medical Systems). Differences in muscle strength by age, gender and dominant versus non-dominant side were analyzed. Results: The peak torque of dorsiflexion was average 31.5 Nm at $30^{\circ}/s$ of angular velocity and 18.8 Nm at $90^{\circ}/s$; average 69.3 Nm ($30^{\circ}/s$) and 42.4 Nm ($90^{\circ}/s$) on plantarflexion; average 19.6 Nm ($30^{\circ}/s$) and 10.8 Nm ($90^{\circ}/s$) on inversion; average 12.9 Nm ($30^{\circ}/s$) and 8.0 Nm ($90^{\circ}/s$) on eversion. The deficit ratio of strength in women was average 61.1% of men on dorsiflexion; average 66.2% on plantarflexion; average 48.5% on inversion; average 55.4% on eversion. The deficit ratio in non-dominant foot was average 88.6% of dominant foot on dorsiflexion; average 90.1% on plantarflexion; average 85.1% on inversion; average 85.6% on eversion. Conclusion: The muscle strength of the ankle joint showed a tendency to weaken with age. There were significant differences in muscle strength by gender and dominancy. Further studies for comparison of patients with ankle instability, a comparison between before and after surgery for instability, the correlation between clinical outcomes and the recovery in muscle strength will be needed.

• Journal of Korean Neurosurgical Society
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• v.65 no.3
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• pp.422-429
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• 2022

Objective : Extracranial supra-aortic dissections (ESADs) with severe stenosis, occlusion and/or pseudoaneurysm presents potential risk of stroke. Endovascular stenting to reconstruct non acute phase ESADs (NAP-ESADs) is an alternative to anticoagulant or antiplatelet therapy. However, its feasibility, safety and efficacy of stenting in NAP-ESADs is unclear. This study aims to investigate the long-term outcomes of the feasibility, safety and efficacy of stenting in NAP-ESADs. Methods : Seventy-four patients with 91 NAP-ESAD vessels with severe stenosis, occlusion and/or pseudoaneurysm presents potential risk of stroke who underwent stent remodeling were enrolled into this respective study from December 2008 to March 2020. Technical success rate, complications, clinical and angiographic results were harvested and analyzed. Results : Success rate of stent deployment was 99% (90/91) with no procedural mortality or morbidity. Transient ischemic attack occurred in three patients during operation (4.1%, 3/74). Asymptomatic embolisms of distal intracranial vessels were found in two patients (2.7%, 2/74). One hundred and forty-two stents deployed at 85 carotid (135 stents) and six vertebral (seven stents) vessels. Six stent types (Wingspan, 28/135, 20.7%; Solitaire, 10/135, 7.4%; Neuroform, 8/135, 5.9%; LVIS, 2/135, 1.5%; Precise, 75/135, 55.6%; Acculink, 12/135, 8.9%) were deployed at carotid arterial dissection while two types (Wingspan, 5/7, 71.4%; Solitaire 2/7, 28.6%) at vertebral arterial dissection. Digital subtracted angiography (56%, 51/91), computational tomography angiography (41.8%, 38/91) and high resolution magnetic resonance imaging (2.2%, 2/91) were adopted for follow up, with a mean time of 17.2±15.4 months (5-77). All patient modified Rankin Scale scores showed no increase at discharge or follow-up. Angiographically, dissections in 86 vessels in 69 patients (94.5%, 86/91) were completely reconstructed with only minor remnant dissections in four vessels in four patients (4.4%, 4/91). Severe re-stenosis in the stented segment required re-stenting in one patient (1.1%, 1/91). Conclusion : Stent remodeling technique provides feasible, safe and efficacious treatment of ESADs patients with severe stenosis, occlusion and/or pseudoaneurysm.

• Korean Circulation Journal
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• v.54 no.6
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• pp.325-335
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• 2024

Background and Objectives: The number of sensitized heart failure patients on waiting lists for heart transplantation (HTx) is increasing. Using the Korean Organ Transplantation Registry (KOTRY), a nationwide multicenter database, we investigated the prevalence and clinical impact of calculated panel-reactive antibody (cPRA) in patients undergoing HTx. Methods: We retrospectively reviewed 813 patients who underwent HTx between 2014 and 2021. Patients were grouped according to peak PRA level as group A: patients with cPRA ≤10% (n= 492); group B: patients with cPRA >10%, <50% (n=160); group C patients with cPRA ≥50% (n=161). Post-HTx outcomes were freedom from antibody-mediated rejection (AMR), acute cellular rejection, coronary allograft vasculopathy, and all-cause mortality. Results: The median follow-up duration was 44 (19-72) months. Female sex, re-transplantation, and pre-HTx renal replacement therapy were independently associated with an increased risk of sensitization (cPRA ≥50%). Group C patients were more likely to have longer hospital stays and to use anti-thymocyte globulin as an induction agent compared to groups A and B. Significantly more patients in group C had positive flow cytometric crossmatch and had a higher incidence of preformed donor-specific antibody (DSA) compared to groups A and B. During follow-up, group C had a significantly higher rate of AMR, but the overall survival rate was comparable to that of groups A and B. In a subgroup analysis of group C, post-transplant survival was comparable despite higher preformed DSA in a desensitized group compared to the non-desensitized group. Conclusions: Patients with cPRA ≥50% had significantly higher incidence of preformed DSA and lower freedom from AMR, but post-HTx survival rates were similar to those with cPRA <50%. Our findings suggest that sensitized patients can attain comparable post-transplant survival to non-sensitized patients when treated with optimal desensitization treatment and therapeutic intervention.

• Journal of The Korean Society of Clinical Toxicology
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• v.18 no.2
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• pp.110-115
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• 2020

Purpose: Acute kidney injury (AKI) in patients with glyphosate poisoning has a poor prognosis. This study aimed to predict the risk factors for AKI in patients with glyphosate poisoning at the emergency department (ED). Methods: Clinical data on glyphosate poisoning patients at ED who were older than 18 years were collected retrospectively between January 2013 and December 2019. The clinical characteristics and clinical outcomes of the AKI group in patients with glyphosate poisoning were compared with the non-AKI (NAKI) group. Results: Of 63 glyphosate poisoning patients, AKI was observed in 15 (23.8%). The AKI patients group showed the following: old age (p=0.038), low systolic blood pressure (p=0.021), large amount of ingestion (p=0.026), delayed hospital visits (p=0.009), high white blood cells (WBC) (p<0.001), high neutrophil counts (p<0.001), high neutrophil-lymphocyte (LN) ratios (p<0.001), high serum potassium (p=0.005), low arterial blood pH (p=0.015), and low pO2 (p=0.021), low bicarbonate (p=0.009), and high Poisoning Severity Score (PSS) (p<0.001). AKI patients required hemodialysis, ventilator care (p<0.001, p=0.002), and inotropics (p<0.001). They also showed more intensive care unit admission (p<0.001), longer hospitalization (p<0.001), and high mortality (p<0.001). Logistic multivariate regression analysis showed that high WBCs (OR, 1.223) and increased LN ratios (OR, 1.414) were independently associated with the occurrence of AKI. Conclusion: In patients with glyphosate poisoning at ED, high WBCs and increased LN ratios can help predict the occurrence of AKI.

• Clinical and Experimental Reproductive Medicine
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• v.23 no.1
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• pp.51-59
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• 1996

Controlled Ovarian hyperstimulation(COH) is generally used to obtain synchronous high quality oocytes in in vitro fertilization-embryo transfer(IVF-ET). Many investigators have studied the relationship between serum hormone levels and outcomes of IVF-ET because there is no accurate estimation method of oocyte quality. Early premature luteinization of follicles before oocyte retrieval is the most troublesome problem in COH for IVF-ET. Gonadotropin-releasing hormone agonists(GnRH-a) are used as adjuncts with gonadotropins for COH in patients undergoing in IVF. The possible benefits of GnRH-a pretreatment include improving oocyte quality, allowing a more synchronous cohort of follicles to be recruited, and preventing premature lueinization hormone surges. In COH of IVF cycles, we investigated whether an elevated progesterone(P4) level on the day of human chorionic gonadotropin(hCG) administration indicates premature luteinization and is associated with a lower fertilization rate. Many investigators have studied that the lower fertilization rates seen in patients with elevated P4 levels might result from an adverse effect of P4 on the oocytes. We hypothesizes that serum P4 levels around the day of hCG may be helpful prediction of out come in IVF-ET cycles. Success rates after COH of IVF-ET cycles are dependent upon many variable factors. Follicular factors including the number of follicles, follicular diameters and especially serum estradiol(E2) levels as an indirect measurement of follicular function and guality have been thought to influence the outcomes of IVF-ET. To assess whether serum P4 and E2 levels affect the fertilization and pregnancy rate, we reviewed the stimulation cycles of 113 patients (119 cycles) undergoing IVF-ET with short protocol with GnRH-a, from March 1993 to August 1994 retrospectively. The serum P4 and E2 levels were compared on the day of hCG in the pregnant group, 45 patients(47 cycles) and in the non-pregnant group, 68 patients (72 cycles) respectively. The serum E2 level in non-pregnant group was $1367{\pm}875.8$ pg/ml which was significantly lower than that of pregnant group, $1643{\pm}987.9$ pg/ml( p< 0.01 ). And the serum P4 level in non-pregnant group was $2.1{\pm}1.4$ ng/ml which was significantly higher than that of pregnant group, $1.0{\pm}0.7$ ng/ml( p< 0.001 ). The fertilization rate was $61.3{\pm}21.3%$ in pregnant group which was higher than that of non-pregnant group, $41.1{\pm}20.2%$ (p< 0.01). We suggest that the serum levels of P4 and E2 on the day of hCG administration are additional parameters that predict the outcomes of IVF-ET cycles.

• Journal of Gastric Cancer
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• v.5 no.2
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• pp.95-100
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• 2005

Purpose: Critical pathways (CP), also known as clinical pathways, are management plans that display goals for patients and have led to improved outcomes for many disease entities. This study was aimed at developing a critical pathway for the surgical treatment of gastric cancer patients and evaluating its usefulness. Materials and Methods: A CP was developed and implemented by a team of surgeons, nurses, nutritionists, and administrative officials. Among the 117 patients who received curative gastrectomies for gastric cancer at Kangnam St. Mary's Hospital, The Catholic University of Korea, between October 2003 and August 2004, 26 patients were treated according to the CP. We evaluated its usefulness by comparing the clinical characterisctics, postoperative progress, hospital stays, and costs between the CP and the non-CP groups. Patient satisfaction was also surveyed with questionnaires. Results: Of the initial 26 patients in the CP group, two were excluded from the final evaluation; one patient had a duodenal stump leakage, and the other had a gastric stasis postoperatively. In 8 patients, protocol violation occurred; six patients refused to be discharged on the $7^{th}$ postoperative day, one patient who had an gastric staisis postoperatively stayed for 2 additional days, and one patient who needed ICU care stayed for 4 additional days. The drop-out rate was $7.7\%$ (2/26), and the variance rate was $30.8\%$ (8/26). The mean hospital stay was 11.3 days ($10\~15$ days) for the CP group compared with 17.5 days ($9\∼68$ days) for the non-CP group, resulting in a difference of about 6 days (P<0.05). The mean hospital stays after surgery were 10.3 days ($7\∼68$ days) and 8.3 days ($7\∼12$ days) for the non-CP and the CP groups, respectively, but the difference was statistically not significant (P>0.05). The mean charge during the hospital stay was higher in the non-CP group ( $\\$ 6,292,200) than in the CP group ( $\\$ 4,863,685). The charge per hospital day was higher in the CP group ( $\\$ 430,414) than in the non-CP group ( $\\$ 359,554). Patient satisfaction was higher in the CP group than in the non-CP group. Conclusion: By developing and applying a critical pathway in the surgical treatment of stomach cancer patients, we could reduce the length of hospital stay as well as the cost. A multi-centered prospective study to establish a standard treatment pathway and to demonstrate its effectiveness is needed in the future.

• Korean Journal of Head & Neck Oncology
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• v.14 no.2
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• pp.182-190
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• 1998

Background: Most of the cancers of maxillary sinus are the squamous variety, but various histopathologic types of malignant tumor can occur in the maxillary sinus. These non-squamous cell tumors have quite different patterns of clinical behavior compared with squamous variety, such as invasive characters, route of metastasis, treatment modality, and so on. Objectives: The authors intend to establish the clinical characteristics and treatment modalities of non-squamous cell tumors of the maxillary sinus. Material and Methods: We experienced 16 cases of non-squamous cell tumors arisen from the maxillary sinus during the 10-year period from 1987 to 1996. We analyzed their clinical features, therapeutic modalities and results with review of literatures. Results: According to AJCC TNM system, 13 patients presented with $T_{1-2}$, 3 with $T_{3-}4$, Two patients were treated with surgery after radiotherapy, 3 patients with surgery after chemotherapy and radiotherapy, 4 patients with chemotherapy and radiotherpy, 5 patients with chemotherapy and radiotherapy after surgery. Conclusion: In cases of adenoid cystic carcinoma, adenocarcinoma and sarcoma, we believe that the best form of therapy is wide surgical excision. If there is microscopic evidence of disease at or close to the resection margin, postoperative radiation was used to achieve better local control. In cases of undifferentiated carcinoma, preoperative chemotherapy and radiation therapy showed improved outcomes.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.196-202
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• 2012

Purpose: This study aimed to recognize the frequency of near-hanging patients with elevated Troponin-I (Tn-I), to obtain information necessary for treatment and prediction of prognosis by analyzing the clinical feature of near-hanging patients, and to evaluate the relevance of elevated Tn-I to abnormal result of other cardiac-related examinations. Methods: A retrospective review for the near-hanging patients, clinical record was conducted at two urban training hospitals between April, 2001 and December, 2011. We divided included patients into two groups, which one with elevated Tn-I level ($Tn-I{\geq}0.1ng/dL$) and one without it, and compared the differences in initial vital signs, cardiac enzyme tests, an electrocardiogram, echocardiography, chest X-ray, and the clinical outcomes. Results: A total of 39 patients were included, out of them, 14 patients showed rise in Tn-I level. The length of hospital stay and ICU hospitalization was more prolonged in the patient group with elevated Tn-I level than non-elevated group. As well as the incidence of endotracheal intubation and abnormal findings in echocardiography or chest X-ray was higher in the Tn-I elevated group, which is statistically significant. Conclusion: The rising of serum Tn-I level in near-hanging patients were not uncommonly observed. We believe that the cardiac-related test including Tn-I is necessary for near-hanging patients, and those who are shown abnormal result in cardiac-related test may need close observation and intensive care.

• Journal of Life Science
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• v.26 no.9
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• pp.1088-1096
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• 2016

Despite that moderate hyperthermia can exert various antitumor activities such as direct cytotoxic effects on tumor cells, effects on tumor vasculatures and immunological effects, hyperthermia has been usually combined with radiotherapy or chemotherapy due to its limited efficacy in cancer treatment, showing some positive clinical benefits with generally well-tolerated side effects. Since heat shock responses itself can interfere with the anti-tumor effects of hyperthermia, not all of these studies might have demonstrated positive clinical outcomes in cancer patients. Therefore, the negative anti-tumor effect of hyperthermia should be reduced to enhance the effectiveness of hyperthermia. Although the responses to heat stress of tumor tissues containing vessels, immune cells, connective tissues as well as cancer cells, are very complicated, it is needed to study in the near future if some clinically available drugs, which can modulate heat stress responses, can improve the efficacy of hyperthermia in patients with cancer. In this review, the effect of clinical hyperthermia centered on non-invasive external hyperthermia using radiofrequency at moderate temperature will be discussed, since it is the state-of-the-art technology in the current clinical practice of hyperthermia, and a moderate operational temperature is used to increase the therapeutic effectiveness of conventional therapy without additional toxicity to normal tissues.

• The Journal of Internal Korean Medicine
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• v.43 no.6
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• pp.1045-1062
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• 2022

Objectives: The aim of this study was to analyze the latest clinical studies on Korean medicine treatment of idiopathic thrombocytopenic purpura (ITP) in the Chinese National Knowledge Infrastructure (CNKI) database. Methods: We searched the last 6 years of clinical studies discussing Oriental medicine-based treatments for ITP in the CNKI database. A meta-analysis of 13 RCTs was performed by synthesizing the outcomes, including the measured platelet count and total effective rate. The quality of the studies was assessed using Cochrane's risk of bias (RoB) tool. RevMan 5.4.1 software was used for data analysis. Results: Of the 15 selected studies, 1 was a non-randomized controlled trial (nRCT), 2 were case series, and 12 were randomized controlled trials (RCTs). Treatments in all studies included oral herbal medicine. The most frequently used herbal decoction was the Liangxue Jiedu prescription (凉血解毒方), and the most commonly used herb was Agrimonia pilosa (仙鶴草), Astragali Radix (黃芪), Fossilia Glycyrrhizae Radix et Rhizoma (甘草), and Rehmannia glutinosa Liboschitz ex Steudel (地黃). The meta-analysis showed significantly better improvement in platelet counts and total effective rate for ITP in the treatment group than in the control group. Conclusion: Treatment with herbal medicine was effective in treating ITP. However, the significance of this conclusion is somewhat limited due to the low quality of the available studies. Multifaceted and scientifically designed clinical studies are required to develop treatments for ITP based on Korean medicine. The results of this study could be used as basic data for further ITP studies.