• Clinical Endoscopy
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• v.55 no.5
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• pp.655-664
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• 2022

Background/Aims: Endoscopic submucosal dissection (ESD) for residual or recurrent colorectal lesions after incomplete resection is challenging because of severe fibrosis. This study aimed to compare the efficacy of the pocket-creation method (PCM) with a traction device (TD) with that of conventional ESD for residual or recurrent colorectal lesions. Methods: We retrospectively studied 72 patients with residual or recurrent colorectal lesions resected using ESD. Overall, 31 and 41 lesions were resected using PCM with TD and conventional ESD methods, respectively. We compared patient background and treatment outcomes between the PCM with TD and conventional ESD groups, respectively. The primary endpoints were en bloc resection and R0 resection rates. The secondary endpoints were the dissection speed and incidence of adverse events. Results: En bloc resection was feasible in all cases with PCM with TD, but failed in 22% of cases of conventional ESD. The R0 resection rates for PCM with TD and conventional ESD were 97% and 66%, respectively. Dissection was significantly faster in the PCM with TD group (13.0 vs. 7.9 mm²/min). Perforation and postoperative bleeding were observed in one patient in each group. Conclusions: PCM with TD is an effective method for treating residual or recurrent colorectal lesions after incomplete resection.

• Korean Circulation Journal
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• v.54 no.9
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• pp.565-576
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• 2024

Background and Objectives: The K-ELUVIA study aimed to investigate the clinical effectiveness and safety of Eluvia^TM, a polymer-coated, paclitaxel-eluting stent, for femoropopliteal artery disease using data from a prospective Korean multicenter registry. Methods: A total of 105 patients with femoropopliteal artery disease who received endovascular treatment (EVT) with Eluvia^TM stents at 7 Korean sites were enrolled in a prospective cohort and followed for 2 years. The primary endpoint was the 2-year clinical patency. The secondary endpoint was 2-year freedom from clinically driven target lesion revascularization (TLR). Results: Mean patient age was 68.2±10.4 years, and most patients (82.7%) were male. Mean lesion length was 168.3±117.6 mm. Chronic total occlusion was found in 57.7% of patients. Trans-Atlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) type C or D lesions were present in 46.1% of patients. Procedural success was achieved in 99.0% of patients. The clinical patency rate was 84.4% at 1 year after EVT and 76.3% at 2 years post-EVT. The freedom from TLR rate was 89.1% at 1 year after EVT and 79.1% at 2 years post-EVT. Chronic total occlusion (hazard ratio [HR], 3.53; 95% confidence interval [CI], 1.08-11.67; p=0.039) and smaller mean stent diameter (HR, 0.40; 95% CI, 0.16-0.98; p=0.044) were identified as independent predictors of loss of clinical patency at 2 years. Conclusions: The K-ELUVIA study demonstrated favorable 2-year clinical effectiveness and safety outcomes of Eluvia stent for femoropopliteal artery lesions in real-world practice.

• The Journal of the Korean bone and joint tumor society
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• v.20 no.1
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• pp.7-13
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• 2014

Purpose: As well as patient survival, the restoration of postoperative function such as ambulation is important in limb salvage operations for treatment of malignant bone tumors involving the proximal femur. The authors analyzed clinical outcomes of limb salvage operations using tumor prostheses for metastatic or primary malignant bone tumors in the proximal femur. Materials and Methods: From February 2005 to January 2014, 20 cases (19 patients) with malignant bone tumor involving the proximal femur with pain or complicated pathologic fracture were treated with segmental resection and limb salvage operations with tumor prostheses. Mean age was 63.1 years (range 35-86). Fourteen patients were male and six ones were female. The mean follow-up period was 20 months (1-94 months). There were 15 cases of metastatic bone tumor, 4 cases of osteosarcoma, and 1 case of multiple myeloma. The primary tumors of the metastatic bone tumors included 4 lung cancers, 3 hepatocellular carcinomas, and 3 renal cell carcinomas. Other primary tumors were breast cancer, thyroid cancer, colon cancer, prostate cancer, and malignant spindle cell tumor, each in 1 case. Modular tumor prostheses were used in all cases; (Kotz's$^{(R)}$ Modular Tumor prosthesis (Howmedica, Rutherford, New Jersey) in 3 cases, MUTARS$^{(R)}$ proximal femur system (Implantcast, Munster, Germany) in 17 cases). Perioperative pain was assessed with Visual Analogue Scales (VAS). Postoperative functional outcome was assessed with Musculoskeletal Tumor Society (MSTS) grading system. Results: Out of 20 cases (19 patients), 11 cases (10 patients) survived at the last follow-up. Average postoperative survival of the 9 deceased patients was 10.1 months (1-38 months). VAS score improved from pre-operative average of 8.40 (5-10) to 1.35 (0-3) after operation. Average postoperative MSTS function score was 19.65 (65.50%, 7-28). The associated complications were 2 local recurrences, 3 hematomas, 3 infections, 2 scrotal swellings, and 1 dislocation. There was no case of periprosthetic fracture or loosening. Conclusion: Limb salvage operation with tumor prosthesis is an appropriate treatment for early pain reduction and functional restoration in malignant bone tumors in the proximal femur with pain an/or complicated pathologic fractures.

• The Korean Journal of Nuclear Medicine
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• v.34 no.1
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• pp.22-29
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• 2000

Purpose: We compared the first postoperative diagnostic and post-therapy scans of patients who received therapeutic doses of I-131, to investigate the difference in clinical outcomes between patients with concordant findings of diagnostic and post-therapy scans and patients with discrepant (more lesions in post-therapy scan) findings. Materials and Methods: The first postoperative diagnostic and post-therapy radioiodine scans of one hundred forty three patients with well differentiated thyroid carcinoma were reviewed. Diagnostic scans were obtained following ingestion of 185 MBq of I-131 and post-therapy scans were obtained after therapeutic dose of $3.7{\sim}9.3$ GBq of I-131. Successful ablation was defined as no radioiodine uptake on diagnostic radioiodine scan and normal range of serum thyroglobulin level (<10 ng/ml) during serum TSH elevation. Results: Discrepant scan findings were noted in 25 (17.5%) patients. Twenty-two patients (15.4%) showed more lesions in post-therapy scan and 3 patients (2.1%) showed stunning effect. Nine (64.3%) of 14 patients with distant metastasis revealed metastatic lesion(s) only on post-therapy scan. Stunning effect was considered as sublethal damage in 1 patient and treatment by a diagnostic dose in 2 patients. Ablation was achieved in 52.4% (75/143) of all patients. Ablation rate and mean cumulative radioiodine dose were not different statistically between concordant and discrepant groups. Conclusion: There were 17.5% difference between diagnostic and post-therapy scan findings when using 185 MBq of I-131 as a diagnostic dose. However, 64.3% of distant metastases were revealed only on post-therapy scan. Ablation rate and mean cumulative radioiodine dose were not different statistically between concordant and discrepant groups. The stunning effect was considered as not only sublethal damage but also treatment by a small diagnostic dose of radioiodine.

• Journal of Soil and Groundwater Environment
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• v.12 no.2
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• pp.27-36
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• 2007

A recent study showed that MTBE can be degraded by Fenton's Reagent (FR). The treatment of MTBE with FR, however, has a definite limitation of extremely low pH requirement (optimum pH $3{\sim}4$) that makes the process impracticable under neutral pH condition on which the ferrous ion precipitate forming salt with hydroxyl anion, which result in the diminishment of the Fenton reaction and incompatible with biological treatment. Consequently, this process using only FR is not suitable for in-situ remediation of MTBE. In order to overcome this limitation, modified Fenton process using NTA, oxalate, and acetate as chelating reagents was introduced into this study. Modified Fenton reaction, available at near neutral pH, has been researched for the purpose of obtaining high performance of oxidation efficiency with stabilized ferrous or ferric ion by chelating agent. In the MTBE degradation experiment with modified Fenton reaction, it was observed that this reaction was influenced by some factors such as concentrations of ferric ion, hydrogen peroxide, and each chelating agent and pH. Six potential chelators including oxalate, succinate, acetate, citrate, NTA, and EDTA were tested to identify an appropriate chelator. Among them, oxalate, acetate, and NTA were selected based on their remediation efficiency and biodegradability of each chelator. Using NTA, the best result was obtained, showing more than 99.9% of MTBE degradation after 30 min at pH 7; the initial concentration of hydrogen peroxide, NTA, and ferric ion were 1470 mM, 6 mM, and 2 mM, respectively. Under the same experimental condition, the removal of MTBE using oxalate and acetate were 91.3% and 75.8%, respectively. Optimum concentration of iron ion were 3 mM using oxalate which showed the greatest removal efficiency. In case of acetate, $[MTBE]_0$ decreased gradually when concentration of iron ion increased above 5 mM. In this research, it was showed that modified Fenton reaction is proper for in-situ remediation of MTBE with great efficiency and the application of chelatimg agents, such as NTA, was able to make the ferric ion stable even at near neutral pH. In consequence, the outcomes of this study clearly showed that the modified Fenton process successfully coped with the limitation of the low pH requirement. Furthermore, the introduction of low molecular weight organic acids makes the process more available since these compounds have distinguishable biodegradability and it may be able to use natural iron mineral as catalyst for in situ remediation, so as to produce hydroxyl radical without the additional injection of ferric ion.

• Journal of Chest Surgery
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• v.37 no.9
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• pp.787-792
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• 2004

Even though there well developments in various treatment techniques for acute limb ischemia, this disease is both life threatening and limb threatening. We investigated early and mid-term results of operation for acute limb ischemia with symptoms, the combined diseases, location of occlusion, complication in our patients. Material and Method: A retrospective review was conducted in 54 patients (43 men, 11 women, mean age 67.2 years) presenting with acute limb ischemia due to arterial thrombosis or embolism between Jan. 1996 and Dec. 2003, initially underwent thromboembolectomy. Result: In 33 patients (61.1%) the timeinterval from the onset of symptom to admission was within 24 hours. Causes of acute limb ischemia were embolic occlusion (27.8%), native arterial thrombosis (66.7%), and bypass graft thrombosis (5.6%). The distribution of arterial occlusion location was at 8 aortoiliac (14.8%) and 43 distal to femoral (79.6%) and brachial (5.6%). Clinical categories were grade I in 64.8%, IIa in 24.1%, IIb in 7.4%, and III in 3.7%, All the patients were received embolectomy. Underlying diseases were heart disease (72.2%), hypertension (33.3%), cerebrovascular accident (16.7%) and diabetes (18.5%). History of smoking was noted in 96,3% of the cases. Mortality rate was 5.6％ and overall amputation rate was 9.3% (5/54). The 1-year limb salvage rate was 93.62%. Postoperative complications were 1 wound infection, 1 G1 bleeding, 3 acute renal failure, and 1 compartment syndromes. The functional outcomes of the salvaged limb according to the recommended scale for gauging changes in clinical status, revised version in 1997 were +3 in 68.5%, +2 in 9.3%, +1 in 7.4%, -1 in 5.6%, -2 in 3.7%, and -3 in 5.6%. Conclusion: This study revealed 5.6% mortality and the amputation rate was 9.3%. We have retrospectively shown good results from early diagnosis & early operation. To improve outcome, early diagnosis and understand the underlying diseases, prompt treatment and operation would be appreciated.

• Clinical and Experimental Pediatrics
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• v.52 no.7
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• pp.791-797
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• 2009

Purpose : We aimed to investigate the clinical manifestations of and antibiotic resistance in culture-proven childhood salmonellosis. Methods : Clinical manifestations and laboratory data of and antibiotic use in subjects with culture-proven childhood salmonellosis, who were treated at the Chonbuk National University Hospital between September 1998 and August 2008, were analyzed retrospectively. Patients with underlying diseases or concomitant illnesses were excluded. Results : We assessed a total of 72 patients. There were 68 stool culture-positive cases, 7 blood culture-positive cases, and 3 both stool culture- and blood culture-positive cases. Salmonella group D was the most frequent pathogen in stool (63.9%) and blood (71.4%) cultures. Salmonella typhi was isolated in 1 case. Of the 72 patients, 45 (62.5%) were male children, of which 29 (40.3%) were aged <3 years. The patients most commonly presented with diarrhea (90.2%) and fever (83.3%). Leukocytosis (leukocyte count, >$15,000/{\mu}L$) and leukopenia (leukocyte count, <$4,000/{\mu}L$) were detected in 8.3% and 5.6% of the patients, respectively. Elevated serum C-reactive protein concentration (>5 mg/dL) and erythrocyte sedimentation rate (>20 mm/h) were observed in 88.9% and 58.3% of the patients, respectively. Fifty-two (85.2%) of 61 patients who had undergone antibiotic treatment received a third-generation cephalosporin as definitive antibiotic therapy. Multidrug resistance rate was 40.0 % in the first 5 years of the study and 71.4% in the last 5 years. No fatalities occurred in this series. Conclusion : Children with culture-proven salmonellosis showed relatively benign clinical outcomes. Appropriate antibiotic treatment of <2 weeks is probably adequate for those without a suppurative focus of infection. The incidence of antibiotic resistant isolates was recently seen to increase.

• Journal of Chest Surgery
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• v.42 no.2
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• pp.206-213
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• 2009

Background: Previous series have suggested that younger patients with primary lung cancer exhibit a more aggressive disease course with a worse prognosis, as compared to older patients, although this issue is still debatable. Material and Method: We reviewed the medical records of 79 patients (32 patients 50 years and younger (Group I) and 47 patients 70 years and older (Group II)) who underwent curative resection for primary lung cancer between July 2000 and June 2008. Result: The median age of the patients was 46.5 years in Group I and this was 73 years in Group II. The older patients were more likely to have major comorbidities (44% versus 77%, respectively; p=0.003). Histological examinations identified that the minor histological types (excluding non-small cell lung cancer (NSCLC)) were predominantly found in the Group I patients (16% versus 2%, respectively; p=0.037). For the TNM staging of the NSCLC, with excluding the minor histologic types, a higher proportion of patients had stage III disease in Group I (33% versus 13%, respectively; p=0.038). There was no significant difference in major morbidity (16% versus 30%, respectively; p=0.148) and operative mortality (0% versus 4.3%; p=0.512) between the groups. The mean follow-up interval was 33 months (range: $1{\sim}98$ months) for patients in both groups. For the patients with NSCLC, the five-year overall survival rate was 52.3% for Group I and 53.7% for Group II (p=0.955). The rate of freedom from recurrence at five years was significantly lower for the Group I patients than for the Group II patients (39.4% versus 70.4%, respectively; p=0.027), and only being a member of Group I impacted recurrence, based on the Cox proportional hazard analysis (p=0.034). Of the patients who had recurrence, four patients in Group I underwent aggressive surgical treatment. All of these patients exhibited long-term survival (range: $46{\sim}87$ months). Conclusion: In our study, the early outcome and long-term survival were similar for the younger and older patients after curative resection of primary lung cancer. However, we think that younger patients require meticulous follow-up as they had a tendency to proceed to surgery with advanced stage disease, a higher recurrence rate than did the older patients and the survival rates were improved, even for the recurred cases, with early aggressive treatment.

• Journal of Chest Surgery
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• v.42 no.1
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• pp.46-52
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• 2009

Background: Vascular injuries to the extremities are potentially devastating and they can lead to limb loss and mortality if they are not appropriately managed. The vascular trauma caused by traffic and industrial accidents has recently increased according to the developing industry and transport system in Korea. Early recognition and treatment of these injuries are mandatory to achieve satisfactory outcomes. Material and Method: We retrospective reviewed 43 patients with vascular injuries that were due to blunt and penetrating trauma and they underwent emergency operations from January of 1998 to December of 2006. Result: There were 38 men and 5 women patients with a mean age of $42.0{\pm}16.8$ years (range: 17~77). The cause of vascular injuries were 28 traffic accidents (65%), 6 industrial accidents (14%), 6 glass injuries (14%) and 3 knife injuries (7%). The average time from admission to the operating room was $319.0{\pm}482.2$ minutes (range: 27~2,400 minutes). The average time from admission to discharge was $53.1{\pm}56.0$ days (range: 2~265 days). The anatomic injuries included the femoral artery in 16 cases (37%), the popliteal artery in 8 cases (19%), the brachial artery in 8 cases (19%), and the subclavian and axillary arteries in 7 cases (16%). The associated injuries were 23 bone fractures (53%), 18 muscle injuries (42%) 5 nerve injuries (12%) and 11 vein injuries (26%). The operation methods were 20 end to end anastomoses (46%), 16 interposition grafts (36%), 2 repairs with using patches (5%) and 5 others (12%). The number of amputations and cases of mortality were 3 cases (7%) and 4 cases (9%), respectively. Conclusion: Minimizing ischemia is an important factor for maximizing salvage of extremities. Prompt diagnosis and treatment can reduce the amputation and mortality rates.

• Clinics in Shoulder and Elbow
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• v.15 no.2
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• pp.123-129
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• 2012

Objective: To evaluate if acromial locking in hook plate is necessary for surgical treatment of acromioclavicular dislocation by compare Wolter plate and AO hook plate. Methods: Seventy one patients who have Rockwood type III to V acromioclavicular joint dislocation treated with AO hook plate and Wolter plate were involved. Among them, 39 patients were treated with Wolter hook plate and 32 patients with AO hook plate. The Constant-Murley score and the range of motion of shoulder joint were measured on postoperative 1st ,$3^{rd}$, $6^{th}$ and $12^{th}$ months, and the radiological complications involving plate and bone were investigated. Results: Constant-Murley score of postoperative one year were $83.2{\pm}6.8$ in AO hook plate group and $85.2{\pm}5.3$ in Wolter plate group without statistical difference (p<0.05). Faster recover of forward elevation and external rotation were examined in Wolter plate group at first and third months after surgery than those of AO hook plate group, but there were no significant difference between after six months or later after surgery. Four cases of loosen or broken screws and one case of pull-out of plate were found in Wolter plate group. Seven cases of subacromial bony erosion and one periprosthetic fracture were found in AO hook plate group. Conclusion: Although clinical outcomes of both two methods were same, no matter if acromial locking system was or not. More radiological complication of plate and bone were found in AO hook plate than that of Wolter plate. However also had disadvantage like larger incision during surgery.