• Journal of Gastric Cancer
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• 제14권4호
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• pp.238-245
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• 2014

Purpose: Gastric cancer often occurs in the elderly but is uncommon in young individuals. Whether young patients have different clinical behaviors and outcomes from those of older patients remain unclear. Materials and Methods: We identified 1,366 cases of newly diagnosed noncardia gastric adenocarcinoma from the Kaiser Permanente Northern California Cancer Registry between 2000 and 2010. We then compared the clinicopathological features and survival among the different age groups. Results: The male : female ratio differed significantly between the younger and older patient groups (0.84 in age <50 years vs. 1.52>60 years, P<0.01). More younger patients were Hispanic (54% patients <40 years vs. 19% patients ${\geq}70$ years, P<0.0001), while more older patients were Caucasian (49% patients ${\geq}70$ years vs. 15% patients <40 years; P<0.0001). The diffuse/mixed histological type was more prevalent in younger patients (70% patients <40 years vs. 27% patients ${\geq}70$ years; P<0.0001), whereas the intestinal type was more frequent in older patients (71% in patients ${\geq}70$ years vs. 30% in patients <40 years; P<0.0001). Poorly differentiated adenocarcinoma was more common in the younger patients (80% in patients <40 years vs. 60% in patients ${\geq}70$ years; P=0.016). Survival rates at 1, 2, and 5 years gradually declined with increasing age (overall P=0.0002). Conclusions: Young patients with gastric cancer had more aggressive disease but higher overall survival rates than older patients. Younger Hispanic patients and older Caucasian patients were more likely to be diagnosed with gastric cancer. These differences may be due to biological predisposition and/or environmental exposure.

• 대한족부족관절학회지
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• 제12권2호
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• pp.163-167
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• 2008

Purpose: To evaluate the incidence of avascular necrosis (AVN), prognostic reliability of the Hawkins sign, and clinical outcomes after operative treatment of fracture and dislocations of the talar neck. Materials and Methods: We analysed 16 patients with fracture and dislocations of the talar neck which were treated by open reduction and internal fixation and followed up for more than 2 years. The postoperative radiographs were examined for Hawkins sign and avascular necrosis was confirmed by bone scan. The assessment of clinical results was based on the Hawkins scoring system. Results: AVN was occurred in 2 of 16 cases (12.5%) only in type III. Hawkins sign was found 11 of 16 cases (68.8%), which included 8 cases in type II, 2 cases in type III and 1 case in type IV. The Hawkins sign was not observed in two cases with AVN. In contrast, only 2 of the 5 cases with a negative Hawkins sign developed AVN. According to Hawkins scoring system, 4 patients (25.0%) was in excellent, 7 patients (43.8%) in good, 4 patients (25.0%) in fair and 1 patient (6.3%) in poor. Conclusion: Incidence of AVN after operative treatment of fracture and dislocations of the talar neck was lower than that of previous reports. Hawkins sign had a high prognostic reliability, but absence of Hawkins' sign should not be considered a totally reliable indicator of development of avascular necrosis.

• Clinics in Shoulder and Elbow
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• 제15권1호
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• pp.43-51
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• 2012

목적: 쇄골 골절의 치료에 관한 광범위한 자료 검토를 통해 현 시점에서의 적절한 쇄골 골절 치료방법을 찾고자 한다. 대상 및 방법: 성인에서 발생한 쇄골 골절과 관련된 전반적인 내용, 즉 쇄골 골절의 역학, 분류, 수술 적응증, 최근 도입된 치료 방법의 현황 및 결과를 문헌 고찰을 통해 정리하였다. 또한, 쇄골 중간 부위 골절의 수술 적응증의 확대와, 새로운 치료법의 하나로 주목받고 있는 anatomically precontoured plate의 도입을 비롯한 최신 지견에 대해 살펴보았다. 결과 및 결론: 지금까지 쇄골 골절은 비수술적 방법으로 대부분 치료되어 왔다. 하지만 최근 들어 기존에 추산되었던 것 보다 많은 수의 불유합, 부정유합 발생이 보고되면서 수술적 치료의 적응증이 점점 확대되는 추세이다. 하지만 아직까지는 쇄골 골절에 대한 이상적인 치료 방침이 확립되지 않았음을 고려할 때, 환자 개개인의 임상 정보와 선호도를 세심히 고려한 맞춤형 치료가 이루어져야 하겠다.

• 대한두개안면성형외과학회지
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• 제18권2호
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• pp.92-96
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• 2017

Background: All nasal bone fractures have the potential for worsening of olfactory function. However, few studies have studied the olfactory outcomes following reduction of nasal bone fractures. This study evaluates posttraumatic olfactory dysfunction in patients with nasal bone fracture before and after closed reduction. Methods: A prospective study was conducted for all patients presenting with nasal bone fracture (n=97). Each patient consenting to the study underwent the Korean version of Sniffin' Sticks test (KVSS II) before operation and at 6 month after closed reduction. The nasal fractures were divided according to the nasal bone fracture classification by Haug and Prather (Types I-IV). The olfactory scores were compared across fracture types and between preoperative and postoperative settings. Results: Olfactory dysfunction was frequent after nasal fracture (45/97, 46.4%). Our olfactory assessment using the KVSS II test revealed that fracture reduction was not associated with improvements in the mean test score in Type I or Type II fractures. More specifically, the mean posttraumatic Threshold, discrimination and identification score decreased from 28.8 points prior to operation to 23.1 point at 6 months for Type II fracture with septal fracture. Conclusion: Our study has revealed two alarming trends regarding post-nasal fracture olfactory dysfunction. First, our study demonstrated that almost half (46.4%) of nasal fracture patients experience posttraumatic olfactory dysfunction. Second, closed reduction of these fractures does not lead to improvements olfaction at 6 months, which suggest that olfactory dysfunction is probably due to factors other than the fracture itself. The association should be further explored between injuries that lead to nasal fracture and the mechanism behind posttraumatic olfactory dysfunction.

• 의학교육논단
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• 제17권3호
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• pp.110-121
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• 2015

Competency-based medical education (CBME) is an outcome-oriented curriculum model for medical education that organizes learning activities and assessment methods according to defined competencies as the learning outcomes of a given curriculum. CBME emerged to address the accountability of medical education in response to growing concerns about the patient safety in North America in the 1970s, and the number of medical schools adopting CBME has dramatically increased since 1990. In Korea, CBME has been under consideration as an alternative curriculum model to reform medical education since 2006. The purpose of this paper is three-fold: (1) to review the literature on CBME to identify the challenges and benefits reported in North America, (2) to summarize the process and experiences of planning and implementing CBME at Inje University College of Medicine, and finally (3) to provide recommendations for Korean medical schools to be better prepared for the successful adoption of CBME. In conclusion, one of the key factors for successful CBME implementation in Korea is how well an individual school can modify the current curriculum and rearrange the existing resources in a way that will enhance students' competencies while maximizing the strengths of the school's existing curriculum.

• 대한물리의학회지
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• 제8권2호
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• pp.245-252
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• 2013

PURPOSE: The aim of this study is to verify the effectiveness of modified constraint-induced movement therapy(mCIMT) on upper function and activities of daily living in people with subacute stroke patients. METHODS: Eighteen participants, with subacute stroke that were randomly assigned to either the experimental group(n=9) or the control group(n=9). For subjects from the experimental group modified Constraint-Induced Movement Therapy was performed. exercise program, the patient trained in affected side upper extremity with restricted non-affected side for 1 hour and using in activity daily living for 4 hours for five times per week, during 4 weeks. For subjects from the control group, conventional upper extremity training was performed. Outcomes such as the box and block test(BBT), Fugl-Meyer motor function assessment(FMA), and modified Barthel index(MBI) were measured before and after training. Between-group and within-group comparisons were analyzed by using Independent t-test and Paired t-test respectively. RESULTS: These finding suggest that experimental group was significant increase in BBT, FMA, MBI(p<.05). In comparison of two group, experimental group was high upper function and activity daily living than control group. CONCLUSION: This study showed experimental group can be used to improve upper function and activity daily living than control group. Thus it indicates that mCIMT will be more improved through the continued upper extremity exercise program.

• Journal of Chest Surgery
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• 제46권4호
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• pp.249-255
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• 2013

Background: The continuous suture (CS) technique has several advantages as a method for simple, fast, and secure aortic valve replacement (AVR). We used a simple CS technique without the use of a pledget for AVR and evaluated the surgical outcomes. Materials and Methods: Between October 2007 and 2012, 123 patients with aortic valve disease underwent AVR alone (n=28) or with other concomitant cardiac procedures (n=95), such as mitral, tricuspid, or aortic surgery. The patients were divided into two groups: the interrupted suture (IS) group (n=47), in which the conventional IS technique was used, and the CS group (n=76), in which the simple CS technique was used. Results: There were two hospital deaths (1.6%), which were not related to the suture technique. There were no significant differences in cardiopulmonary bypass time or aortic cross-clamp time between the two groups for AVR alone or AVR with concomitant cardiac procedures. In the IS group, two patients had prosthetic endocarditis and one patient experienced significant perivalvular leak. These patients underwent reoperations. In the CS group, there were no complications related to the surgery. Postoperatively, the two groups had similar aortic valve gradients. Conclusion: The simple CS method is useful and secure for AVR in patients with aortic valve disease, and it may minimize surgical complications, as neither pledgets nor braided sutures are used.

• Radiation Oncology Journal
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• 제38권1호
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• pp.26-34
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• 2020

Purpose: Intensity-modulated radiotherapy (IMRT) allows for more precise treatment, reducing unwanted radiation to nearby structures. We investigated the safety and feasibility of IMRT for anaplastic ependymoma patients below 3 years of age. Materials and Methods: A total of 9 anaplastic ependymoma patients below 3 years of age, who received IMRT between October 2011 and December 2017 were retrospectively reviewed. The median equivalent dose in 2 Gy fractions was 52.0 Gy (range, 48.0 to 60.0 Gy). Treatment outcomes and neurologic morbidities were reviewed in detail. Results: The median patient age was 20.9 months (range, 12.1 to 31.2 months). All patients underwent surgery. The rates of 5-year overall survival, freedom from local recurrence, and progression-free survival were 40.6%, 53.3%, and 26.7%, respectively. Of the 9 patients, 5 experienced recurrences (3 had local recurrence, 1 had both local recurrence and cerebrospinal fluid [CSF] seeding, and 1 had CSF seeding alone). Five patients died because of disease progression. Assessment of neurologic morbidity revealed motor dysfunction in 3 patients, all of whom presented with hydrocephalus at initial diagnosis because of the location of the tumor and already had neurologic deficits before radiotherapy (RT). Conclusion: Neurologic morbidity is not caused by RT alone but may result from mass effects of the tumor and surgical sequelae. Administration of IMRT to anaplastic ependymoma patients below 3 years of age yielded encouraging local control and tolerable morbidities. High-precision modern RT such as IMRT can be considered for very young patients with anaplastic ependymoma.

• 음성과학
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• 제10권4호
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• pp.201-219
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• 2003

Background: The perceptual assessment is generally performed by the voice specialist. The objective evaluation is performed in a voice laboratory. Research in voice laboratories has generated a variety of different objective tests and parameters. The perceptual evaluation is one of the most controversial topics in voice research. Review of literature reveals a wide variety of rating scales and reliability data fluctuating from study to study. Unfortunately, there is no widely accepted valid method for classifying voice disorders and assessing outcome after voice treatment. Objectives: The goals of this research were to identify important objective acoustic parameters of vocal quality, and to establish an objective and quantitative correlate of the perceived vocal quality. Materials and Methods : We evaluated the voice analyzed data from 122 dysphonic patients and 20 normal volunteers. A computerized speech lab. 4300B(CSL) was used to carry out the analysis of each voice sample. Results: Three dysphonia severity indices(DSI) were created using discriminant analysis. DSI is based on the weighted combination of the following selected set of acoustic parameters: absolute jitter(Jita in us), smoothed pitch period perturbation (sPPQ in %), amplitude perturbation quotient(APQ in %), soft phonation index(SPI), average fundamental frequency(Fo in Hz), lowest fundamental frequency(Flo in Hz), and smoothed amplitude perturbation quotient(sAPQ in %). The DSI, being the discriminating rule calculated by the logistic regression, consists of three equation based on statistically significant acoustic parameters. Three DSI were created to reflects best the degree of hoarseness as expressed by G from the GRBAS scale. The more positive this DSI is for a patient, the worse the vocal quality. The more it is negative, the better it is. The effect of sex is included implicitly in the DSI-1 and DSI-2, so that a separate DSI-1 and DSI-2 for males and females need not be used. The DSI is objective because no perceptual input is required for its calculation. Conculsion : This research demonstrates that the voice function values calculated from three different multivariate objective dysphonia severity indices are significantly associated with subjective voice assessments. These multivariate objective dysphonia severity indices may be appropriate for use in clinical trials and outcomes research on treatment effectiveness for voice disorders.

• 대한족부족관절학회지
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• 제18권4호
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• pp.202-207
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• 2014

Purpose: The purpose of this study was to evaluate the radiological and clinical outcomes of tibiotalocalcaneal arthrodesis using retrograde compressive intramedullary nail for patients with complex hindfoot problems, including Charcot arthropathy, osteonecrosis of talus, combined arthritis of the ankle and subtalar joint, failure of previous ankle arthrodesis, and failed total ankle arthroplasty. Materials and Methods: Eighteen consecutive patients (10 men and 8 women) with an average age of 54 years (range, 42~72 years) underwent tibiotalocalcaneal arthrodesis using retrograde compressive intramedullary nail fixation. The mean duration of follow-up was 16 months (range, 12~23 months). Radiological evaluation included assessment of the union status of ankle and subtalar joints. Clinical evaluations included visual analogue scale (VAS) for pain and patient satisfaction, and postoperative complications were analyzed. Results: Radiological union was achieved in 14 ankle joints (77%) and 16 subtalar joints (88%) at an average of 16 weeks (range, 14~40 weeks) and 14 weeks (range, 12~24 weeks), respectively. The preoperative VAS were 4.6 (range, 4~8) at rest and 8.2 (range, 7~10) during walking, and the postoperative VAS were 2.2 (range, 0~3) and 4.6 (range, 4~6), respectively (p<0.05). There were 6 nonunions (4 ankle joints and 2 subtalar joints), 3 tibia fractures, 2 delayed union of ankle joints, and 2 breakage of the implant. Conclusion: Tibiotalocalcaneal arthrodesis using retrograde compressive intramedullary nail may be considered as a viable option in patients with complex hindfoot problems.