• Clinics in Shoulder and Elbow
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• 제27권2호
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• pp.237-246
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• 2024

Proximal humeral fractures (PHFs) are a common injury among the older population. An ideal therapeutic protocol has yet to be developed, and numerous clinical trials are being conducted to find the best therapeutic approach. The purpose of this study is to evaluate the current body of knowledge available via interventional clinical trials. In December 2022, interventional clinical trials relating to PHFs on Clinicaltrials.gov were screened. Trial characteristics included duration, status, intervention, phase, outcomes, location, and study design. Publications associated with each trial were searched on PubMed/Medline using the ClinicalTrials.gov registry number. The final dataset comprised 64 trials. The most common trial status was completed (36%). The majority did not have a Food and Drug Administration-defined phase (67%), was randomized (81%), involved a single facility (72%), used a parallel assignment intervention model (80%), and used an open-label approach (45%). Eleven trials were associated with a publication, and the publication rate was 17%. Average enrollment was 86 participants, and mean trial duration was 51.4 months. Europe/UK/Russia/Turkey participated in the most trials (70%). Most of the trials were initiated after 2010 (87.5%). Procedure-related interventions (55%) were most common. Disability/function was the most common primary outcome assessed (61%). The low publication rate and the multitude of trials conducted after 2010 highlight the urgency and need for trial results to be published to establish an ideal therapeutic protocol. Since the majority of the trials involved a single institution and an open-label approach, reinforcing blinding and establishing multi-centered trials can improve the validity of the clinical trial results.

• 대한두개안면성형외과학회지
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• 제16권3호
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• pp.119-124
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• 2015

Background: The Kirschner wire (K-wire) technique allows stable fixation of bone fragments without periosteal dissection, which often lead to bone segment scattering and loss. The authors used the K-wire fixation to simplify the treatment of laborious comminuted zygomatic bone fracture and report outcomes following the operation. Methods: A single-institution retrospective review was performed for all patients with comminuted zygomatic bone fractures between January 2010 and December 2013. In each patient, the zygoma was reduced and fixed with K-wire, which was drilled from the cheek bone and into the contralateral nasal cavity. For severely displaced fractures, the zygomaticofrontal suture was first fixated with a microplate and the K-wire was used to increase the stability of fixation. Each wire was removed approximately 4 weeks after surgery. Surgical outcomes were evaluated for malar eminence, cheek symmetry, K-wire site scar, and complications (based on a 4-point scale from 0 to 3, where 0 point is 'poor' and 3 points is 'excellent'). Results: The review identified 25 patients meeting inclusion criteria (21 men and 4 women). The mean age was 52 years (range, 15-73 years). The mean follow up duration was 6.2 months. The mean operation time was 21 minutes for K-wire alone (n=7) and 52 minutes for K-wire and plate fixation (n=18). Patients who had received K-wire only fixation had severe underlying diseases or accompanying injuries. The mean postoperative evaluation scores were 2.8 for malar contour and 2.7 for K-wire site scars. The mean patient satisfaction was 2.7. There was one case of inflammation due to the K-wire. Conclusion: The use of K-wire technique was associated with high patient satisfaction in our review. K-wire fixation technique is useful in patient who require reduction of zygomatic bone fractures in a short operating time.

• 대한약침학회지
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• 제13권4호
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• pp.5-41
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• 2010

Objectives: This study was performed to analyse four week repeated dose toxicity of Sweet Bee Venom(Sweet BV) extracted from the bee venom in Beagle dogs. Methods: All experiments were conducted under the regulations of Good Laboratory Practice (GLP) at Biotoxtech Company, a non-clinical study authorized institution. Male and female Beagle dogs of 5-6 months old were chosen for the pilot study of four week repeated dose toxicity of Sweet BV which was administered at the level of 0.56mg/kg body weight which is eighty times higher than the clinical application dosage as the high dosage, followed by 0.28 and 0.14mg/kg as midium and low dosage, respectively. Equal amount of excipient(normal saline) to the Sweet BV experiment groups was administered as the control group every day for four weeks. Results: 1. No mortality was witnessed in all of the experiment groups. 2. All experiment groups were appealed pain sense in the treating time compared to the control group, and hyperemia and movement disorder were observed around the area of administration in all experiment groups, and higher occurrence in the higher dosage treatment. 3. For weight measurement, Neither male nor female groups showed significant changes. 4. In the urine analysis, CBC and biochemistry didn't show any significant changes in the experiment groups compared with control group. 5. For weight measurement of organs, experiment groups didn't show any significant changes compared with control group. 6. To verify abnormalities of organs and tissues, thigh muscle which treated with Sweet BV, cerebrum, liver, lung, kidney, and spinal cords were removed and conducted histologocal observation with H-E staining. In the histologocal observation of thigh muscle, cell infiltration, inflammatory, degeneration, necrosis of muscle fiber, and fibrosis were found in both thigh tissue. And the changes were depend on the dose of Sweet BV. But another organs were not detected in any abnormalities. 7. The proper high dosage of Sweet BV for the thirteen week repeated test in Beagle dogs may be 0.28mg/kg in one time. Conclusion: Above findings suggest that Sweet BV is relatively safe treatment medium. Further studies on the subject should be conducted to yield more concrete evidences.

• Journal of Korean Neurosurgical Society
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• 제30권5호
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• pp.575-580
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• 2001

Purpose : In general, pineal region tumors are managed by using microsurgical approach or stereoctactic biopsy. However, in selected cases endoscopic approach to pineal lesions might prove to be as effective as microsurgery and less invasive. We report an alternative surgical strategy for managing certain patients with pineal neoplasms that allows treatment of the symptomatic hydrocephalus as well as tumor biopsy under direct vision in the same sitting. Materials and Methods : Twenty-two patients with pineal region tumors with associated hydrocephalus were treated in one session by endoscopic third ventriculostomy and endoscopic tumor biopsy at our institution from October 1996 to January 2000. All patients were retrospectively evaluated. Results : There was no operative mortality. There was one cause of significant bleeding during biopsy, but was controlled endoscopically, and the patient recovered completely without neurologic deficit resulting from intra-operative bleeding. The symptoms related to increased intracranial pressure(ICP) have resolved in all patients, and the need for a shunt is completely eliminated. Histological diagnosis was achieved in 21 of the 22 patients by this procedure. A biopsy was not obtained in one patient. Although this pineal region tumor was seen endoscopically, this could not be biopsied because of technical difficulties in working around an enlarged massa intermedia. The lesions included fourteen germinomas, three mixed germ cell tumors, and one each of the followings: pineocytoma, pineoblastoma, pineocytoma/pineoblastoma(intermediate type), meningioma, and low grade glioma. Five of the 22 patients subsequently underwent formal microsurgical tumor removal. Additional chemotherapy or radiotherapy could then be initiated according to the histological diagnosis. Conclusion : We consider that endoscopy affords a minimally invasive way of reaching three objectives by one-step surgery in the management of pineal region tumors with associated hydrocephalus : 1) cerebrospinal fluid(CSF) sample for analysis of tumour markers and cytology, 2) treatment of hydrocephalus by third ventriculostomy, and 3) several biopsy specimens can be obtained identifying tumors which will require further open surgery or adjuvant radiation and/or chemotherapy. However, complications and morbidities should be emphasized so as to be avoided with further technical experience.

• Journal of Korean Neurosurgical Society
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• 제60권6호
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• pp.723-729
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• 2017

Objective : Acute subdural hematoma (ASDH) is generally considered a condition that should be managed surgically. However, some patients initially receive conservative treatment, a subset of whom require surgical intervention later. This study aimed to evaluate the predictors of delayed surgical intervention in ASDH patients who are initially managed conservatively. Methods : From January 2007 to December 2015, 842 patients diagnosed with ASDH were treated at our institution. Among them, 158 patients with convexity ASDH were initially treated conservatively. Patients were divided into a delayed surgery group and a conservative group. Demographic characteristics, past medication and medical histories, and radiological and laboratory data were collected by retrospective chart review. Independent risk factors were identified with univariate and multivariate analyses. Results : Twenty-eight patients (17.7%) underwent delayed surgical intervention. Their mean age was 69.0 years, and 82.1% were male. Hypertension, diabetes mellitus, and heart disease prevalence and use of anti-platelet agents did not significantly differ from the conservative group. However, age (p=0.024), previous cerebral infarction history (p=0.026), increased maximal hematoma thickness (p<0.001), midline shifting (p=0.001) and accompanying subarachnoid hemorrhage (p=0.022) on initial brain computed tomography (CT) scan, low hemoglobin level (p<0.001), high leukocyte count (p=0.004), and low glucose level (p=0.002) were significantly associated with delayed surgical intervention. In multivariate analysis, increased maximal hematoma thickness (odds ratio [OR]=1.279, 95% confidence interval [CI] 1.075-1.521; p=0.006), low hemoglobin level (OR=0.673, 95% CI 0.467-0.970; p=0.034), and high leukocyte count (OR=1.142, 95% CI 1.024-1.272; p=0.017) were independent risk factors for delayed surgical intervention. Conclusion : Due to the high likelihood of delayed surgical intervention among minimal ASDH patients with a thicker hematoma on initial brain CT, lower hemoglobin level, and higher leukocyte count, these patients should receive more careful observation.

• Radiation Oncology Journal
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• 제32권3호
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• pp.187-197
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• 2014

Purpose: We aimed to analyze the treatment outcome and long-term toxicity of 70 Gy hypofractionated intensity-modulated radiotherapy (IMRT) for localized prostate cancer using a customized rectal balloon. Materials and Methods: We reviewed medical records of 86 prostate cancer patients who received curative radiotherapy between January 2004 and December 2011 at our institution. Patients were designated as low (12.8%), intermediate (20.9%), or high risk (66.3%). Thirty patients received a total dose of 70 Gy in 28 fractions over 5 weeks via IMRT (the Hypo-IMRT group); 56 received 70.2 Gy in 39 fractions over 7 weeks via 3-dimensional conformal radiotherapy (the CF-3DRT group, which served as a reference for comparison). A customized rectal balloon was placed in Hypo-IMRT group throughout the entire radiotherapy course. Androgen deprivation therapy was administered to 47 patients (Hypo-IMRT group, 17; CF-3DRT group, 30). Late genitourinary (GU) and gastrointestinal (GI) toxicity were evaluated according to the Radiation Therapy Oncology Group criteria. Results: The median follow-up period was 74.4 months (range, 18.8 to 125.9 months). The 5-year actuarial biochemical relapse-free survival rates for low-, intermediate-, and high-risk patients were 100%, 100%, and 88.5%, respectively, for the Hypo-IMRT group and 80%, 77.8%, and 63.6%, respectively, for the CF-3DRT group (p < 0.046). No patient presented with acute or late GU toxicity ${\geq}$grade 3. Late grade 3 GI toxicity occurred in 2 patients (3.6%) in the CF-3DRT group and 1 patient (3.3%) in the Hypo-IMRT group. Conclusion: Hypo-IMRT with a customized rectal balloon resulted in excellent biochemical control rates with minimal toxicity in localized prostate cancer patients.

• Radiation Oncology Journal
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• 제32권3호
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• pp.147-155
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• 2014

Purpose: This study was conducted to observe the outcomes of postoperative radiotherapy (PORT) with or without concurrent chemotherapy in resected non-small cell lung cancer (NSCLC) in single institution. Materials and Methods: From 2002 to 2013, 78 patients diagnosed with NSCLC after curative resection were treated with radiotherapy alone (RT, n = 48) or concurrent chemoradiation (CCRT, n = 30). The indications of adjuvant radiation therapy were N2 node positive (n = 31), close or involved resection margin (n = 28), or gross residual disease due to incomplete resection (n = 19). The median radiation dose was 57.6 Gy (range, 29.9 to 66 Gy). Results: Median survival time was 33.7 months (range, 4.4 to 140.3 months). The 5-year overall survival (OS) rate was 49.5% (RT 46% vs. CCRT 55.2%; p = 0.731). The 3-year disease-free survival rate was 45.5% (RT 39.4% vs. CCRT 55.3%; p = 0.130). The 3-year local control rate was 68.1% (RT 64.4% vs. CCRT 77.7%; p = 0.165). The 3-year DMFS rate was 56.1% (RT 52.6% vs. CCRT 61.7%; p = 0.314). In multivariate analysis, age ${\geq}66$ years and pathologic stage III were significant poor prognostic factors for OS. Treatment failure occurred in 40 patients. Four patients had radiologically confirmed grade 3 radiation pneumonitis. Conclusion: In NSCLC, adjuvant RT or CCRT after curative surgery is a safe and feasible modality of treatment. OS gain was seen in patients less than 66 years. Postoperative CCRT showed a propensity of achieving better local control and improved disease-free survival compared to RT alone according to our data.

• 대한관절경학회지
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• 제12권1호
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• pp.69-73
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• 2008

활액막 연골종증은 흔하지 않은 질환으로 견관절에 발생하는 경우는 드물다. 15세 여자 환자가 견관절 통증을 호소하여, 단순 방사선 검사 및 MRI 검사로 활액막 연골종증으로 진단하였고, 병변이 견관절뿐만 아니라 상완 이두건 건초 내로 침범 되었다. 저자들은 견관절 병변은 관절경 시술로, 그리고 상완 이두건 건초 내 병변에 대해서는 소절개를 통한 유리체 제거 및 활액막 전 절제술을 시행하였다. 비록 견관절경 시술이 적은 합병증 및 우수한 수술 시야를 제공하지만, 관절경 시술로는 이두 구내의 활액막과 건초 병변에 대한 완벽한 치료는 매우 어렵다. 이에 저자들은 이두 구까지 침범된 견관절에 발생한 활액막 연골종증의 완벽한 치료를 위해, 관절경적 활액막 전 절제술 및 유리체 제거술과 더불어 상완 이두건 건초의 소절개를 통한 병소의 완전 제거가 필요하여 문헌고찰과 함께 보고하고자 한다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제4권1호
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• pp.54-67
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• 1993

본 연구는 자폐아 어머니 160명을 대상으로 자폐아 어머니의 스트레스와 스트레스 정도에 영향을 끼치는 자폐아 어머니와 아동의 특성을 파악하여, 자폐아 어머니를 위한 간호전략 수립을 위한 기초 자료를 제공하는데 그 목적을 두고 본 연구를 시도하였다. 이를 위하여 본 연구자가 개발한 자폐아 어머니의 스트레스에 관한 도구는, 어머니의 일상 생활에 관련된 스트레스(11문항),어머니의 가족, 사회적 관계 에서의 스트레스(26문항), 아이의 장애 원인, 치료, 교육 및 예후에 관련된 스트레스 (28문항) 및 어머니의 부정적 심리 상태에 관련된 스트레스(9문항) 등 74개 문항으로 구성되어 있으며 도구 신뢰도는 Cronbach's ${\alpha}$ =0.94였다. 연구 결과는 다음과 같다1) 자폐아 어머니의 스트레스 정도는 영역별로 볼 때 장애원인, 치료, 교육 및 예후에 관련된 스트레스 평점이 3.19로 가장 높았으며 어머니의 부정적 심리상태에 관련된 스트레스 평점은 2.85, 어머니의 일상생활애 관련된 스트레스 평점은 2.45,그리고 가족, 사회적 관계에서의 스트레스 평점은 2.05의 순으로 나타났다. 2) 총 74개의 스트레스 항목 인지정도의 평점은 2.62였다 스트레스 정도가 가장 높게 인지된 항목은 '자폐아에 대한 사회의 이해가 부족하다', '부모가 사망한다면 누가 이 아이를 돌볼 수 있을지 걱정이다', '아이가 성장함에 따라 단계적으로 교육받을 수 있는 시설이 없다' 등이었으며, 낮은 스트레스로 인지된 항목은 '남편이 아이를 미워한다', '남편과 이혼하고 싶다' 등이었다. 3) 자폐아 어머니 특성 중에서 자녀의 수, 아이 문제에 대한 인지 정도는 스트레스 정도에 유의한 차이를 나타내었는데 자녀의 수가 많을수록, 문제 인지가 심할수록 어머니가 느끼는 스트레스가 높았다.

• 한국의학물리학회지:의학물리
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• 제18권1호
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• pp.7-12
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• 2007

유방암 환자의 방사선치료에서 유방의 모양에 따른 윗부분과 아랫부분의 두께의 차이 때문에 적절한 선량분포를 얻기 위해서는 쐐기모양 보상체가 필수적으로 이용된다. 유방보존절제술을 시행한 유방암 환자들을 방사선치료 할 때 일반적으로 비껴방향 치료방법으로 치료를 한다 비껴방향 치료방법에서 중심 쪽에서 가장자리 쪽으로 치료하는 빔에서는 쐐기모양 보상체에 빔이 일차적으로 부딪칠 때 저에너지의 방사선이 발생하여 피부에 영향을 미치게 된다. 이 때 피부에 조사되는 저 에너지 방사선을 최소화하기 위하여 가상 쐐기모양 보상체를 사용할 수 있다. 본원이 보유하고 있는 Eclipse 치료계획장치에는 가상 쐐기모양 보상체로 치료계획을 할 수 있도록 장착되어 있다. 저자들은 본원이 갖고 있는 실제 쐐기모양 보상체 15도, 30도, 45도, 60도와 가상 쐐기모양 보상체 15도, 30도, 45도, 60도의 선량분포 특성을 비교하여 유방암 환자에서 가상 쐐기모양 보상체의 임상 적용 타당성을 살펴본 결과 치료면적 $10{\times}10cm$의 대칭도의 비교에서 쐐기의 각도에 따른 차이가 없음을 알 수 있었으며, 치료면적의 크기에 따른 각각의 쐐기 각도에 대한 투과율의 특성에서 대칭도의 비교는 거의 선형적으로 변함을 볼 수 있어 가상 쐐기의 임상적용이 적합함을 알 수 있었다.