• 대한기관식도과학회지
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• 제7권1호
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• pp.29-33
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• 2001

Background and Objectives： Adenoid cystic carcinoma (ACC) is an aggressive, often indolent tumor, with a high incidence of distant metastasis (DM). Relatively little has been written about the factor that influence distant spread and subsequent survival because it is uncommon and has protracted clinical course. We attempted to reemphasize the biologic behavior of ACC by investigating the relationship between the clinical features and prognosis. Materials and Methods : We have retrospectively studied 24 determinate patiens who received definitive treatment in our hospital between 1984 and 1995 for ACC in all salivary sites. Inclusion criteria were no prior treatment elsewhere other than excisional biopsy and eligibility for follow-up of at least 5 years. Variables assessed for their impact on distant metastasis included age, gender, size, node status, stage, histologic pattern, locoregional treatment failure. Results : Treatment failure occurred in a total of 16 of 24 determinate Patients (64%), 12 of whom had DM (50%). This was usually associated with locoregional recurrence (8 patients), but DM was the only indication of failure in 4 whose primary tumor was controlled. Of the 12 patients with known DM, the lung was recored as the only involved site in 7 Patients, lung was involved in addition to other sites in 1, bone and liver metastasis occurred in 2 respectively. Disease-free intervals varied from 3 month to 14 years (median 3 years). The only significant factors influencing survival were the size of the primary tumor, locoregional recurrence. Conclusion : The high incidence of DM with locoregional failure confirms the importance of aggressive initial surgery. combined with irradiation, for high-stage tumors or involved surgical margins. Large tumor size and locoregional recurrence, rather than microscopic appearance, were predictive of DM.

• 구강회복응용과학지
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• 제16권3호
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• pp.171-185
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• 2000

The treatment objectives of the complete oral rehabilitation are : (1) comfortably functioning temporomandibular joints and stomatognathic musculature, (2) adherence to the basic principle of occlusion advocated by Schuyler, (3) anterior guidance that is in harmony with the envelope of function, (4) restorations that will not violate the patient's neutral zone. There may be many roads to achieving these objectives, but they all convey varing degrees of stress and strain on the dentist and patient. There are no "easy" cases of oral rehabilitation. Time must be taken to think, time must be taken to plan, and time must be taken to perform, since time is the critical element in both success and failure. Moreover, a systematized and integrated approach will lead to a prognosis that is favorable and predictable. This approach facilitates development of optimum oral function, comfort, and esthetics, resulting in a satisfied patient. Such a systematized approach consists of four logical phase : (1) patient evaluation, (2) comprehensive analysis and treatment planning, (3) integrated and systematic reconstruction, and (4) postoperative maintenance. Firstly, we must evaluate the mandibular position. The results of a repetitive, unstrained, nondeflective, nonmanipulated mandibular closure into complete maxillomandibular intercuspation is not so much a "centric" occlusion as it is a stable occlusion. Accordingly, we ought to concern ourselves less with mandibular centricity and more with mandibular stability, which actually is the relationship we are trying to establish. The key to this stability is intercuspal precision. Once neuromuscular passivity has been achieved during an appropriate period of occlusal adjustment and provisionalization, subsequent intercuspal precision becomes the controlling factors in maintaining a stable mandibular position. Secondly, we must evaluate the planned vertical dimension of occlusion in relationship to what may now be an altered(generally diminished), and avoid the hazard of using such an abnormal position to indicate ultimate occlusal contacting points. There are no hard and fast rules to follow, no formulas, and no precise ratios between the vertical dimension of occlusion. Like centric relation, it is an area, not a point.

• 대한골관절종양학회지
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• 제15권1호
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• pp.13-25
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• 2009

서론: $O^6$-methylguanine-DNA methyltransferase (MGMT)는 DNA 염기 손상에 의해 형성된 $O^6$-methylguanine에서 알킬기를 제거하여 DNA 염기 손상을 복구하는 역할을 한다. MGMT의 후생유전적 불활성화가 인체 종양에서 보고되고 있으며, 항암 치료에 대한 저항성에 영향을 주는 요소로 알려져 있다. 본 연구에서는 연부조직육종에서 이러한 MGMT 불활성화가 미치는 영향에 대해 살펴보고자 하였다. 재료 및 방법: 총 62예의 연부조직육종조직에서 메틸화 특이 중합효소연쇄반응을 이용하여 MGMT 유전자의 촉진자 부위 메틸화 정도를 알아보고, 면역조직화학염색을 통하여 MGMT 단백 발현의 소실 양상을 살펴보았다. 결과: MGMT 단백 발현 소실은 진행성 병기(p=0.000), 조직학적 고등급(p=0.005), 종양의 재발 또는 전이(p=0.011), 그리고, 낮은 생존률(p=0.017)과 통계학적 유의성을 보였다. MGMT 유전자 촉진자 부위 메틸화는 조직학적 고등급, 종양의 재발 또는 전이, 그리고, 낮은 생존률과 관련성을 보였다. 또한, MGMT 단백 발현의 소실은 MGMT 유전자 촉진자 부위 과메틸화와 높은 상관성을 나타내었다(p=0.000). 결론: 본 연구는 MGMT 단백 발현의 소실과 MGMT 유전자 촉진자 부위 과메틸화가 연부조직 육종에서 흔히 발생하며 종양의 공격적인 양상 및 나쁜 예후와 관련성이 있다는 것을 보여준다. 또한 MGMT 단백 발현의 소실은 대개 MGMT 유전자 촉진자 부위 과메틸화로 인해 발생한다는 사실을 보여주고 있다.

• Clinics in Shoulder and Elbow
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• 제20권3호
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• pp.133-137
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• 2017

Background: To determine the natural progression of conservatively treated rotator cuff tears, we evaluated changes in radiologic and clinical parameters in patients whose recalcitrant tears were neglected after conservative treatment. Methods: A total of 73 patients with recalcitrant rotator cuff tears in spite of conservative treatment were included in this study. We measured changes in tear size and in the extent of fatty infiltration of the rotator cuff by comparing the initial and final follow-up magnetic resonance imagings (MRIs). To determine factors influencing the change in tear size, we collected the medical history of patients taken at the time of initial admission. Results: The average follow-up period was 20.1 months, and the average increase in tear size across this period was 6.2 mm. In terms of steroid injection, we found that the increases in tear size of the steroid injection group (p=0.049) and of the sub-group that had received more than three steroid injections (p=0.010) were significantly greater than that of the non-steroid injection group. Conclusions: We found that the increase in cuff tear size was on average 6.2 mm across the follow-up period, indicating that neglecting cuff tears may cause them to progress into more severe tears. We also observed that a history of steroid injection might be a possible risk factor for a worse prognosis of cuff tears. Therefore, we suggest that patients with rotator cuff tears and a history of steroid injection are recommended aggressive modes of treatment such as surgery.

• Journal of Chest Surgery
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• 제44권1호
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• pp.44-50
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• 2011

Background: Cardiovascular complications are major causes of morbidity and mortality following non-cardiac thoracic operations. Recent studies have demonstrated that elevation of N-Terminal Pro-B-type natriuretic peptide (NT-proBNP) levels can predict cardiac complications following non-cardiac major surgery as well as cardiac surgery. However, there is little information on the correlation between lung resection surgery and NT-proBNP levels. We evaluated the role of NT-proBNP as a potential marker for the risk stratification of cardiac complications following lung resection surgery. Material and Methods: Prospectively collected data of 98 patients, who underwent elective lung resection from August 2007 to February 2008, were analyzed. Postoperative adverse cardiac events were categorized as myocardial injury, ECG evidence of ischemia or arrhythmia, heart failure, or cardiac death. Results: Postoperative cardiac complications were documented in 9 patients (9/98, 9.2%): Atrial fibrillation in 3, ECG-evidenced ischemia in 2 and heart failure in 4. Preoperative median NT-proBNP levels was significantly higher in patients who developed postoperative cardiac complications than in the rest (200.2 ng/L versus 45.0 ng/L, p=0.009). NT-proBNP levels predicted adverse cardiac events with an area under the receiver operating characteristic curve of 0.76 [95% confidence interval (CI) 0.545~0.988, p=0.01]. A preoperative NT-proBNP value of 160 ng/L was found to be the best cut-off value for detecting postoperative cardiac complication with a positive predictive value of 0.857 and a negative predictive value of 0.978. Other factors related to cardiac complications by univariate analysis were a higher American Society of Anesthesiologists grade, a higher NYHA functional class and a history of hypertension. In multivariate analysis, however, high preoperative NT-proBNP level (>160 ng/L) only remained significant. Conclusion: An elevated preoperative NT-proBNP level is identified as an independent predictor of cardiac complications following lung resection surgery.

• 한방재활의학과학회지
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• 제31권4호
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• pp.129-143
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• 2021

Objectives This study was aimed to evaluate clinical practice guidelines (CPGs) of traffic injuries, which has already been developed at domestic or outside of country, and to explore the Korean medical treatments included in the CPGs. Methods Twelve electronic databases (PubMed, Cochrane library, China National Knowledge Infrastructure [CNKI {Chinese Academic Journals, CAJ}], Research Information Sharing Service [RISS], Oriental Medicine Advanced Searching Integrated System [OASIS], KoreaMed, Korean Medical Guideline Information [KoMGI), National Guideline Clearinghouse [AHRQ], Core Outcome Measures in Effectiveness Trials Initiative Website [COMET], Turning Research into Practice [TRIP], The National Institute for Health and Care Excellence [NICE], and Medical Research Information Center [MedRIC]) up to July 2021 were searched. Only systematically developed CPGs for traffic injuries were selected and appraised. The appraisal was conducted by using Appraisal of Guidelines for Research & Evaluation (AGREE) II tool. Results Six CPGs were included and evaluated. All CPGs were appraised as highly recommended because they exceeded 60% in more than 4 among 6 domains of AGREE II, including domain of 'rigor of development', and 30% in the rest. Recommendations related to Korean medicine treatments such as on manual therapy related to Chuna were given in 6 CPGs, 4 for acupuncture, 1 for Qigong and 1 for Taping. Conclusions The 6 CPGs were developed up to now through a systematic development methodology and there were many recommendations for Korean medical treatments related to manual (Chuna) treatment, acupuncture and Qigong. However, the evidence for the side effects and risk factors of Korean medical treatments was scantly reflected in CPGs. Therefore, it is considered that balanced CPG with benefits and risks should be developed, covering Korean medical diagnosis, treatment and prognosis.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제22권4호
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• pp.303-329
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• 2019

Intestinal failure (IF) is the critical reduction of the gut mass or its function below the minimum needed to absorb nutrients and fluids required for adequate growth in children. Severe IF requires parenteral nutrition (PN). Pediatric IF is most commonly due to congenital or neonatal intestinal diseases or malformations divided into 3 groups: 1) reduced intestinal length and consequently reduced absorptive surface, such as in short bowel syndrome (SBS) or extensive aganglionosis; 2) abnormal development of the intestinal mucosa such as congenital diseases of enterocyte development; 3) extensive motility dysfunction such as chronic intestinal pseudo-obstruction syndromes. The leading cause of IF in childhood is the SBS. In clinical practice the degree of IF may be indirectly measured by the level of PN required for normal or catch up growth. Other indicators such as serum citrulline have not proven to be highly reliable prognostic factors in children. The last decades have allowed the development of highly sophisticated nutrient solutions consisting of optimal combinations of macronutrients and micronutrients as well as guidelines, promoting PN as a safe and efficient feeding technique. However, IF that requires long-term PN may be associated with various complications including infections, growth failure, metabolic disorders, and bone disease. IF Associated Liver Disease may be a limiting factor. However, changes in the global management of IF pediatric patients, especially since the setup of intestinal rehabilitation centres did change the prognosis thus limiting "nutritional failure" which is considered as a major indication for intestinal transplantation (ITx) or combined liver-ITx.

• Tuberculosis and Respiratory Diseases
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• 제82권2호
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• pp.102-117
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• 2019

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrosing interstitial pneumonia, which presents with a progressive worsening dyspnea, and thus a poor outcome. The members of the Korean Academy of Tuberculosis and Respiratory Diseases as well as the participating members of the Korea Interstitial Lung Disease Study Group drafted this clinical practice guideline for IPF management. This guideline includes a wide range of topics, including the epidemiology, pathogenesis, risk factors, clinical features, diagnosis, treatment, prognosis, and acute exacerbation of IPF in Korea. Additionally, we suggested the PICO for the use of pirfenidone and nintendanib and for lung transplantation for the treatment of patients with IPF through a systemic literature review using experts' help in conducting a meta-analysis. We recommend this guideline to physicians, other health care professionals, and government personnel in Korea, to facilitate the treatment of patients with IPF.

• 대한족부족관절학회지
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• 제26권2호
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• pp.95-102
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• 2022

Purpose: This study was based on the Korean Foot and Ankle Society (KFAS) member survey and aimed to report the current trends in the management of syndesmotic injuries over the last few decades. Materials and Methods: A web-based questionnaire containing 36 questions was sent to all KFAS members in September 2021. The questions were mainly related to the preferred techniques and clinical experiences in the treatment of patients with syndesmotic injuries. Answers with a prevalence ≥50% of respondents were considered a tendency. Results: Seventy-six (13.8%) of the 550 members responded to the survey. The results showed that the most preferred method to diagnose a syndesmotic injury was magnetic resonance imaging (MRI). Intraoperatively, the external rotation stress test and the Cotton test were most frequently used to confirm syndesmotic diastasis. The reduction was usually done by a reduction clamp. One 3.5-mm screw was used most frequently over three cortices at 2~4 cm above the ankle joint. The preferred ankle position during fixation was 0° dorsiflexion. Removal of the syndesmotic screw was routinely done by most surgeons, mainly because of the limitation of movement and risk of screw breakage. Factors that affect suture button selection included non-rigid fixation which enables adequate fixation, early weight-bearing, and an infrequent need to remove the hardware. Inadequate reduction was considered the main factor that affects poor prognosis. Conclusion: This study proposes updated information about the current trends in the management of syndesmotic injuries in Korea. Consensuses in both the diagnostic and therapeutic approach to patients with syndesmotic injury were identified in this survey study. This study may raise the awareness of the various possible approaches toward the injury and should be used to further establish a standard protocol for the management of syndesmotic injuries.

• 대한임상독성학회지
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• 제19권2호
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• pp.83-92
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• 2021

Purpose: Glyphosate herbicide (GH) is a widely used herbicide and has been associated with significant mortality as poisoned cases increases. One of the reasons for high toxicity is thought to be toxic effect of its ingredient with glyphosate. This study was designed to determine differences in the clinical course with the salt-type contained in GH. Methods: This was a retrospective study conducted at a single hospital between January 2013 and December 2017. We enrolled GH-poisoned patients visited the emergency department. According to salt-type, patients were divided into 4 groups: isopropylamine (IPA), ammonium (Am), potassium (Po), and mixed salts (Mi) groups. The demographics, laboratory variables, complications, and their mortality were analyzed to determine clinical differences associated with each salt-type. Addtionally, we subdivided patients into survivor and non-survivor groups for investigating predictive factors for the mortality. Results: Total of 348 GH-poisoned patients were divided as follows: IPA 248, Am 41, Po 10, and Mi 49 patients. There was no difference in demographic or underlying disease history, but systolic blood pressure (SBP) was low in Po group. The ratio of intentional ingestion was higher in Po and Mi groups. Metabolic acidosis and relatively high lactate level were presented in Po group. As the primary outcome, the mortality rates were as follows: IPA, 26 (10.5%); Am, 2 (4.9%); Po, 1 (10%); and Mi, 1 (2%). There was no statistically significant difference in the mortality and the incidence of complications. Additionally, age, low SBP, low pH, corrected QT (QTc) prolongation, and respiratory failure requiring mechanical ventilation were analyzed as independent predictors for mortality in a regression analysis. Conclusion: There was no statistical difference in their complications and the mortality across the GH-salt groups in this study.