• Journal of Korean Neurosurgical Society
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• 제46권1호
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• pp.31-37
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• 2009

Objective : This study was performed to elucidate the technical and patient-specific risk factors for postoperative ischemia in patients undergoing temporary arterial occlusion (TAO) during the surgical repair of their aneurysms. Methods : Eighty-nine consecutive patients in whom TAO was performed during surgical repair of an aneurysm were retrospectively analyzed. The demographics of the patients were analyzed with respect to age. Hunt and Hess grade on admission, Fisher grade of hemorrhage, aneurysm characteristics, timing of surgery, duration of temporary occlusion, and number of temporary occlusive episodes. Outcome was analyzed at the 3-month follow-up, along with the occurrence of symptomatic and radiological stroke. Results : In overall, twenty-seven patients (29.3%) had radiologic ischemia attributable to TAO and fifteen patients (16.3%) had symptomatic ischemia attributable to TAO. Older age and poor clinical grade were associated with poor clinical outcome. There was a significantly higher rate of symptomatic ischemia in patients who underwent early surgery (p=0.007). The incidence of ischemia was significantly higher in patients with TAO longer than 10 minutes (p=0.01). In addition, patients who underwent repeated TAO, which allowed reperfusion, had a lower incidence of ischemia than those who underwent single TAO lasting for more than 10 minutes (p=0.011). Conclusion : Duration of occlusion is the only variable that needs to be considered when assessing the risk of postoperative ischemic complication in patients who undergo temporary vascular occlusion. Attention must be paid to the patient's age, grade of hemorrhage, and the timing of surgery. In addition, patients undergoing dissection when brief periods of temporary occlusion are performed may benefit more from intermittent reperfusion than continuous clip application. With careful planning, the use of TAO is a safe technique when used for periods of less than 10 minutes.

• Journal of Chest Surgery
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• 제47권4호
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• pp.344-349
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• 2014

Background: The Damus-Kaye-Stansel (DKS) procedure is a method for mitigating the risk of systemic ventricular outflow tract obstruction (SVOTO). However, there have been few reports on which surgical technique shows a better outcome. The objective of this study was to compare the outcome of the DKS procedure according to the surgical technique used. Methods: We retrospectively reviewed 12 consecutive patients who underwent the DKS procedure from March 2004 to April 2013. When the relationship of the great arteries was anterior-posterior, the double-barrel technique (group A) was performed. If the relationship was side-by-side, the ascending aortic flap technique (group B) was performed. Results: There was no early mortality and 1 late mortality in group B. There was no statistically significant difference in the median peak pressure gradient of preoperative subaortic stenosis in both groups: 14 mmHg (range, 4 to 53 mmHg) in group A and 15 mmHg (range, 0 to 30 mmHg) in group B (p=0.526). Further, a significant postoperative pressure gradient was not observed in either group A or group B. More than moderate postoperative neoaortic regurgitation was observed in 1 patient of group B; this patient underwent neoaortic valve replacement 66 months after the DKS procedure. No one had a recurrent SVOTO during follow-up. Conclusion: The DKS procedure is an effective way to minimize the risk of SVOTO, and there is little difference in the outcomes of the DKS procedure according to the surgical technique used.

• Archives of Reconstructive Microsurgery
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• 제21권2호
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• pp.118-130
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• 2012

Background: Women receiving mastectomy usually prefer a single-stage surgical procedure without the need for additional surgery. Hence, nipple sparing mastectomy was introduced, and the follow-up data on the aesthetic outcome and recurrence of breast cancer were investigated in this study. Materials and Methods: The study subjects comprised 22 patients who received nipple-sparing mastectomy and immediate breast reconstruction using the free transverse abdominal rectus abdominis myocutaneous flap between June of 2007 and June of 2012. The patients' aesthetic outcomes were measured with 2 methods for the objective result: Breast size measurements and breast volume calculation both at preoperative phase and postoperative 1 years phase. Also, the patients' satisfaction was evaluated at postoperative 1 year with the self-assessment questionnaire. Follow up check for assessing cancer recurrence was performed for an average period of postoperative 1063 days. Results: First, in objective aesthetic outcome, there were no significant differences between the preoperative and postoperative results on both the breast size and the volume. Second, the patient satisfaction analysis scores were graded as very good in 15 patients (68.2%), and as good in 6 patient (27.3%). Most of the patients were very satisfied with our surgery method. Last, there was no local or distant recurrence in these 22 patients during the follow-up period. Conclusion: In this study, the nipple-sparing mastectomy achieved satisfactory results for the breast scar and shape with a single-stage surgical procedure, and the cancer recurrence rate was not significantly different from that of the conventional mastectomy. Besides, the nipple-sparing mastectomy is more cost-effective than the conventional mastectomy since it reduces the need for additional procedures. However, we think that it is necessary to determine the long-term outcomes about the recurrence rate.

• 대한약침학회지
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• 제11권2호
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• pp.21-31
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• 2008

Objective This study was performed to investigate whether Bee Venom Pharmacopuncture(BVP) could be a more effective modality than Warm Needling(WN) in relieving pain and symptoms of knee osteoarthritis(OA). Design Prospective, randomized and controlled clinical trial. Setting Single center trial in Korea Patients 49 volunteers with knee OA participated in the study. All the participants were screened through an inclusion and exclusion criteria. 33 participants were completed the clinical trial. Intervention The subjects were randomly assigned to one of two groups. One group received BVP(n=18), while the other group received WN(n=15). Sixteen sessions of BVP or WN were given at the pain region of the problematic knee for 8 weeks. Primary outcome measure is the Korean translation of Western Ontario and McMaster Universities Osteoarthritis Index scores(Korean WOMAC, KWOMAC). Secondary outcome measure is the physical health scores based on the 36-Item Short-Form Health Survey(SF-36) and Patient Global Assessment(PGA). KWOMAC and SF-36 were measured third (baseline, 4 and 8 weeks). PGA was measured twice(4 and 8 weeks). Results BVP group showed significant decrease compared to WN group in pain, function and total scores of KWOMAC according to the Mann-Whitney U-test. In the PGA, BVP group, compared to WN group, showed a significant increase. Conclusions BVP was more effective in relieving pain of knee OA than WN. These findings suggest that BVP is a promising alternative for treating knee OA.

• Clinics in Shoulder and Elbow
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• 제19권4호
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• pp.216-222
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• 2016

Background: We investigated the effectiveness of fibular strut allograft augmentation of proximal humerus fractures to prevent varus deformity in patients over the age of 65 years with insufficient medial support. Methods: We analyzed the clinical and radiological outcomes of locking plate fixation with adjunct fibular strut allograft augmentation in 21 patients with proximal humeral fractures. The inclusion criteria were age (65-year-old or older); presence of severe medial comminution; inadequate medial support; and those who could participate in at least a one year follow-up. The average age was 76.4 years. We analyzed each patient's Constant score, our indicator of clinical outcome. As radiological parameters, we analyzed time-to-bone union; restoration of the medial hinge; difference between the immediately postoperative and the last follow-up humeral neck-shaft angles;; and anatomical reduction status, which was assessed using the Paavolainen method. Results: A successful bone union was achieved in all patients at an average of 11.4 weeks. We found that the average Constant score was 74.2, showing a satisfactory outcome. The average difference in the humeral neck-shaft angles between the immediately postoperative time-point and at the final follow-up was $3.09^{\circ}$. According to the Paavolainen method, the anatomical reduction was rated excellent. The medial hinge was restored in 14 of 21 patients. Although we did not find evidence for osteonecrosis, we found that a single patient had a postoperative complication of screw cut-out. Conclusions: Fibular strut allografting as an adjunct treatment of proximal humeral fractures may reduce varus deformity in patients with severe medial comminution.

• Asian Pacific Journal of Cancer Prevention
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• 제15권23호
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• pp.10307-10311
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• 2015

Background: The Bethesda System for Reporting Thyroid Cytopathology is one of the main classification systems for thyroid nodules. It expects that 7% of all fine needle aspiration biopsies will be reported as atypia or follicular lesions of undetermined significance, and 5-15% of these undetermined nodules are malignant. Our study is a retrospective analysis of variables that may be associated with outcome in patients with indeterminate thyroid nodules. Materials and Methods: Patients who underwent thyroidectomy in our institution between 2010 and 2014 were retrieved from the institutional records database. Patient demographics and medical histories were recorded. All ultrasonography reports were examined for nodule features and biochemical blood levels, hormone levels and complete blood counts were recorded. Results: A total of 103 patient cytopathology reports were regarded as belonging to the undetermined category. Some 35% of patients had malignant nodules. Median preoperative red cell distribution width (RDW) level was 13.6 inthe benign group, while it was 14.3 in patients with malignancy, demonstrating a significant correlation (p=0.003). Only calcification presence was significantly different between benign and malignant groups on ultrasonography (p=0.034). Conclusions: Ultrasonography is one of the primary tools for this matter. RDW levels may become another promising tool to predict malignancy.

• Journal of Korean Neurosurgical Society
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• 제48권1호
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• pp.37-45
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• 2010

Objective : Craniovertebral junction (CVJ) consists of the occipital bone that surrounds the foramen magnum, the atlas and the axis vertebrae. The mortality and morbidity is high for irreducible CVJ lesion with cervico-medullary compression. In a clinical retrospective study, the authors reviewed clinical and radiographic results of occipitocervical fusion using a various methods in 32 patients with CVJ instability. Methods : Thirty-two CVJ lesions (18 male and 14 female) were treated in our department for 12 years. Instability resulted from trauma (14 cases), rheumatoid arthritis (8 cases), assimilation of atlas (4 cases), tumor (2 cases), basilar invagination (2 cases) and miscellaneous (2 cases). Thirty-two patients were internally fixed with 7 anterior and posterior decompression with occipitocervical fusion, 15 posterior decompression and occipitocervical fusion with wire-rod, 5 C1-2 transarticular screw fixation, and 5 C1 lateral mass-C2 transpedicular screw. Outcome (mean follow-up period, 38 months) was based on clinical and radiographic review. The clinical outcome was assessed by Japanese Orthopedic Association (JOA) score. Results : Nine neurologically intact patients remained same after surgery. Among 23 patients with cervical myelopathy, clinical improvement was noted in 18 cases (78.3%). One patient died 2 months after the surgery because of pneumonia and sepsis. Fusion was achieved in 27 patients (93%) at last follow-up. No patient developed evidence of new, recurrent, or progressive instability. Conclusion : The authors conclude that early occipitocervical fusion to be recommended in case of reducible CVJ lesion and the appropriate decompression and occipitocervical fusion are recommended in case of irreducible craniovertebral junction lesion.

• Asian Pacific Journal of Cancer Prevention
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• 제16권18호
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• pp.8513-8517
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• 2016

Background: GLOBOCAN12 recently reported high cancer mortality in Malaysia suggesting its cancer health services are under-performing. Cancer survival is a key index of the overall effectiveness of health services in the management of patients. This report focuses on Subang Jaya Medical Centre (SJMC) care performance as measured by patient survival outcome for up to 5 years. Materials and Methods: All women with breast cancer treated at SJMC between 2008 and 2012 were enrolled for this observational cohort study. Mortality outcome was ascertained through record linkage with national death register, linkage with hospital registration system and finally through direct contact by phone or home visits. Results: A total of 675 patients treated between 2008 and 2012 were included in the present survival analysis, 65% with early breast cancer, 20% with locally advanced breast cancer (LABC) and 4% with metastatic breast cancer (MBC). The overall relative survival (RS) at 5 years was 88%. RS for stage I was 100% and for stage II, III and IV disease was 95%, 69% and 36% respectively. Conclusions: SJMC is among the first hospitals in Malaysia to embark on routine measurement of the performance of its cancer care services and its results are comparable to any leading centers in developed countries.

• 한방재활의학과학회지
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• 제27권3호
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• pp.117-124
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• 2017

Objectives Collaboration medicine means cooperate with western medicine and traditional korean medicine to treat the one disease. In Korea, Interest in collaboration medicine is increasing, But the number of studies is scare. Therefore we will conduct collaboration medicine study for the low back pain. Methods This study composes prospective cohort registry study. If the patients who need collaboration medicine by doctor come, we will ask regist this study. And patient select collaboration treatment group and single treatment group. Total 120 patients will recruit from collaboration pilot project hospitals. Each group patient will observed 4 weeks. Telephone research will conducted after 1 month from the last follow up. During the treatment, patients are treated usual treatment type of each medicine. Primary outcome is NRS and secondary outcomes are EQ-5D and ODI. We will analyze difference of 1 week and 4 week outcome result. Conclusions This study is the first large sample size study effect of collaboration medicine in Korea for low back pain. We check present collaboration system and improve collaboration system. Aim of this study is to find the effectiveness collaboration medicine for low back pain in the real condition. And we expect this pilot study will provide the clinical collaboration information and basis.

• Radiation Oncology Journal
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• 제32권4호
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• pp.238-246
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• 2014

Purpose: To evaluate the clinical outcome of high-dose-rate (HDR) interstitial brachytherapy (IBT) in patients with oral cavity cancer. Materials and Methods: Sixteen patients with oral cavity cancer treated with HDR remote-control afterloading brachytherapy using $^{192}Ir$ between 2001 and 2013 were analyzed retrospectively. Brachytherapy was administered in 11 patients as the primary treatment and in five patients as salvage treatment for recurrence after the initial surgery. In 12 patients, external beam radiotherapy (50-55 Gy/25 fractions) was combined with IBT of 21 Gy/7 fractions. In addition, IBT was administered as the sole treatment in three patients with a total dose of 50 Gy/10 fractions and as postoperative adjuvant treatment in one patient with a total of 35 Gy/7 fractions. Results: The 5-year overall survival of the entire group was 70%. The actuarial local control rate after 3 years was 84%. All five recurrent cases after initial surgery were successfully salvaged using IBT ${\pm}$ external beam radiotherapy. Two patients developed local recurrence at 3 and 5 months, respectively, after IBT. The acute complications were acceptable (${\leq}grade$ 2). Three patients developed major late complications, such as radio-osteonecrosis, in which one patient was treated by conservative therapy and two required surgical intervention. Conclusion: HDR IBT for oral cavity cancer was effective and acceptable in diverse clinical settings, such as in the cases of primary or salvage treatment.