• Journal of the Korean Society of Radiology
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• v.11 no.2
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• pp.139-144
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• 2017

Percutaneous vertebroplasty (PVP) is increasingly used to treat osteoporotic vertebral fractures, myeloma and osteolytic vertebral metastases. The purpose of this study was to measure the absorbed radiation exposure dose and time during PVP and to assess the possibility of deterministic radiation effects to the operator and patient. The radiation dose and time measure by three pain physicians performed consecutive procedures using the twenty case PVP. Patient's dosimeter placed at the anteroposterior(AP) side was treatment of the vertebra body located in the upper level 2-3 and lateral(LAT) side was flank proximal to C-arm tube of back. Operator's dosimeter placed at the apron outside of upper sternum (thyroid), left chest, lower extremity and apron inside of left chest. Results: Radiation exposure times were $3.6{\pm}0.71min$. Measurements on the Patient radiation dose were AP $121.4{\pm}48.1{\mu}Sv$, LAT side $614.7{\pm}177.1{\mu}Sv$. Operator radiation dose were outside of the lead apron upper sternum $33.7{\pm}7.3{\mu}Sv$, outside of the lead apron chest $49.2{\pm}15.0{\mu}Sv$, outside of the lead apron lower extremity $12.8{\pm}3.8{\mu}Sv$ and inside of the lead apron chest $4.2{\pm}1.4{\mu}Sv$. To escape from the danger of radiation first long distance from the c-arm tube second exposure time reduced second lead apron used fluoroscopy during PVP is more safety patient and operation from the radiation exposure.

• Investigative Magnetic Resonance Imaging
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• v.6 no.2
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• pp.152-157
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• 2002

Purpose : The differential diagnosis between Modic type I degenerative spine and infectious spondylitis sometimes is difficult, because the affected bone marrows in both disease show similar signal intensity on conventional MR imaging. We evaluate the usefulness of diffusion-wighted MR imaging for differential diagnosis between Modic type I degenerative spine and infectious spondylitis. Materials and methods : The spin-echo and diffusion-weighted MR images of eight patients with Modic type I degenerative spines and 14 patients with infectious spondylitis diagnosed by clinical findings or CT-guided biopsies we re analyzed. The diffusion-weighted imaging sequence was based on reversed fast imaging with steady-state precession (PSIF). Signal intensity changes of the vertebral bone marrow on conventional spin-echo and diffusion-weighted MR imaging were compared between degenerative spine and infectious spondylitis. Results : On T1-weighte d images, the affeted bone marrow in both disease showed hypointense signals. On T 2-weighted images, all of type I degenerative spine and 11 of infectious spondylitis showed hyperintensity, and three of infectious spondylitis showed heterogeneo us mixed signal intensity. On diffusion-weighted MR images, all of type I degenerative spine were hypointense with peripheral high signal intensity to normal vertebral body, but infectious spondylitis was hyperintense (n = 11) and hypointense (n=3). Conclusion : Diffusion-weighted MR imaging is useful to differentiate Modic type I degenerative spine from infectious spondylitis. On diffusion-weighted images, the high singal intensity of bone marrow suggests infectious spondylitis, whereas the low signal intensity of bone marrow with peripheral focal high signal intensity suggests type I degenerative spine.

• The Korean Journal of Pain
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• v.1 no.1
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• pp.34-46
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• 1988

Intractable pain from advanced carcinoma of the upper abdomen is difficult to manage. One method used to control pain associated with these malignancies is to block off the splanchnic nerve. In 1919 Kappis described a technique by which the splanchnic nerve of the upper abdomen could be anesthetized, using a percutaneous injection. This method has been used for the relief of upper abdominal pain due to hematoma and cancer of the pancreas, stomach, gall bladder, bile duct, and colon. During the Period from November 1968 to January 1986, this method was used in 208 cases of malignancy at Severance Hospital and clinically evaluated. Patients were retroactively grouped according to the stage of development of technique used. Twelve patients who received the treatment in the period from November 1968 to March 1977 were designate4i as group 1, 26 patients from April 1977 to April 1979 as group 2, and 170 from May 1979 to January 1986 as group 3. The results are as follows: 1) The number of patients receiving splanchnic nerve block has been increasing since 1977. 2) A total of 208 patients, including 133 males and 75 females, ranging in age from 18 to 84 and averaging 51. 3) The causes of pain were stomach cancer 90, pancreatic cancer 69, and miscellaneous cancer 49 cases respectively. 4) There were 57.7% who had surgery. and 3.7% of whom had chemotherapy before the splanchnic nerve block was done. 5) These blocks were carried out with the patient in the prone position as described by Dr. Moore. For group 2 and 3, C-arm image intensifier was used. In group 1, a 22 gauze loom long needle was inserted at the lower border of the 12th rib on each aide about 7\;cm from the midline. The average distance from the midline was $6.60{\pm}0.61\;cm$ on the left side and $6.60{\pm}0.83\;cm$ on the right side in group 2, and $5.46{\pm}0.76\;cm$ on the left side and $5.49{\pm}0.69\;cm$ on the right side in group 3. The average depth to which the needle was inserted was $8.60{\pm}0.52\;cm$ on the left side and $8.74{\pm}0.60\;cm$ on the right side in group 2, and $8.96{\pm}0.63\;cm$ on the left side and $9.18{\pm}0.57\;cm$ on the right side in group 3. 6) The points of the inserted needles were positioned in the upper quarter anteriorly, 51.8% on the left side and 54.4% n the right side of the L1 vertebra by lateral roentgenogram in group 3. The inserted needle points were located in the upper and anterolateral part, of the L1 vertebra 68.5% on the left side and 60.6won the right side, on the anteroposterior rentgenogram in group 3. The needle tip was not advanced beyond the anterior margin of the vertebral body. 7) In some case of group 3, contrast media was injected before the block was done. It shows, the spread upward along the anterior mal gin of the vertebral body. 8) The concentration and the average amount of drug used in each group was as follows: In group 1, $39.17{\pm}6.69\;ml$ of 0.5% -l% lidocaine or 0.25% bupivacaine were injected for the test block and one to three days after the test block $40.00{\pm}4.26\;ml$ of 50% alcohol was injected for the semipermanent block. In group 2, $13.75{\pm}4.88\;ml$ of 1% lidocaine were used as the test block and followed by $46.17{\pm}4.37\;ml$ of 50% alcohol was injected as the semipermanent block. In group 3, $15.63{\pm}1.19\;ml$ of 1% lidocaine for test block followed by $15.62{\pm}1.20\;ml$ of pure alcohol and $16.05{\pm}2.58\;ml$ of 50% alcohol for semipermanent block were injected. 9) The result of the test block was satisfactory in all cases. However the semipermanent block was 83.3 percent of the patients in group 1 who received relief from pain for at least 2 weeks after the block, 73.1% in group 2, and 91.8% in group 3. In these unsuccessful cases, 2 cases in group 1 were controlled by narcotics but 7 cases in group 2 and 14 cases in group 3 received the same splanchnic nerve block 1 or 2 times again within 2 weeks. But, in some cases it was 3 to i months before the 2nd block and in 1 cases even 7 years. 10) The most common complications of splanchnic nerve block were hypotensino(25.5%) occasional flushing of the face, nausea, vomiting, and chest discomfort. 11) For the patients in group 3, the supplemental block most commonly used was a continuous epidural block; it was used as a diagnostic block and to afford relief from pain before the splanchnic nerve block was done. 12) The interval between the receiving of the alcohol block and discharge was from 5 to 8 days in 61 cases(31.1%) and from 1 to 2 days in 48 cases(24.5%). From the above results, it can be concluded that the splanchnic nerve block done in the prone position with pure and 50% alcohol immediately after an effective test block with 1% lidocaine under C-arm fluoroscopic control is satisfactory and reliable. How to minimize the repeat block is still a problem to be solved.

• Korean Journal of Fisheries and Aquatic Sciences
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• v.14 no.3
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• pp.179-188
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• 1981

The authors made an investigation concerning the geographical distribution and some major differentiations in morphological characteristics associated with the each habitat, of the pond smelt, Hypomesus olidus, which was introduced into Korea more than 50 years ago. Major characteristics utilized for the comparison study were upper jaw (maxillary), number of fin rays, scale structure, vertebral count, number of pyloric caeca, number of gill rakers, and the relative measurements of these and other internal characters. 1. The main areas of natural distribution are Paro Lake, Soyang Lake, Han River, Euirim Lake, and Ogjeong Lake (or Unam Lake) and the tributaries of these waters. 2. Morphological variations varied when the mean values of measurements from each area were compared with the standard measurement value by mosaic comparison, and in some instances a significant variation was found. 3. The most significant variations were found in the number of fin rays of pectoral and anal fins; the lengths from the tip of snout to the origin of pectoral fin, from snout to ventral fin, and from snout to anal fin, relative to standard body length; eye depth relative to head length; upper jaw: the number of pyloric caeca and the scale structure. Variations, on the other hand, by each habitat were not clear in the numbers of ventral and dorsal fin rays, gill rakers, vertebrae and lateral line scale : and the depth of caudal peduncle and distance from the tip of snout to the origin of dorsal fin relative to standard body length. 4. The scales of pond smelt showed some differences in the shape of scales, the shape and position of the focus and the number of ridges according to the scale positions on the body. No radii were present. The relations between longitudinal and transverse diameters of the scale suggest that the pond smelts of Soyang Lake and Un-am Lake are closely related, and those of Han River and Euirim Lake are also closely related. 5. The geographical variations in morphology of the pond smelt seem to have resulted from the variations in turbidity, water temperature, salinity (rather conductivity) and currents. 6. From the results obtained, it may be concluded that such factors as supramaxillary, relation between scale length and its breadth, number of caudal vertebrae and eye depth relative to head length may be used as the key characters for the classification of geographical varieties of Pond smelt.

• Journal of Society of Preventive Korean Medicine
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• v.9 no.2
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• pp.59-75
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• 2005

The experiments were undertaken to evaluate the effects of Bosaengtang in pregnant rats and fetuses. Female Sprague-Dawley rats were orally administered with Bosaengtang at the dose of 5mg/kg/day for 20 days. Pregnant rats were sacrificed at the 20th day of gestation, and observed internal and reproductive organs. Fetuses were randomly selected and fixed in 95% ethanol. Fetuses were stained with alcian blue and alizarin red S, and observed skeletal malformations. The results obtained were as follows : Bosaengtang administered group showed higher maternal body weight than the control group, but both groups showed increase in weight. Bosaengtang administered group showed lower than the control group, and higher liver and kidney weight than the control group, but the differences were minimal. There were no significant changes between the control and treated group in blood chemistry values and hematological values but all the groups were within in normal ranges. There were no significant changes in the number of corpus luteum, implantation, live fetus and implantation rate, delivery rate, late resorption rate, sex ratio, but Bosaengtang administered group showed higher early resorption rate than control group. comparing the control and Bosaengtang group, neonatal body weight and the number of fetuses were increased in Bosaengtang group. The fetuses of dams treated with Oriental medicine didn't showed external malformation. Vertebral and sternal variations were observed in Bosaengtang group, but the differences were not apparent compared to the control group. The number of ribs, cervical, thoracic and lumbar vertebrae were normal. The number of sacral was similar and the number of caudal was increased. Fetuses showed significant difference in the number of caudal vertebrae. (P<0.01) From these results, we can carefully conclude that Bosaengtang showed beneficial effects on maternal body weight, early resorption rate, number of live fetus. There were no significant changes in organ weight, hematoscopy, reproduction organs. External malformation wasn't visible. Skeletal variations were showed in vertebrae and sternum but compared to the control group, these variations weren't much different.

• The Korean Journal of Pain
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• v.28 no.2
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• pp.109-115
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• 2015

Background: This study sought to determine safe ranges of oblique angle, skin entry point and needle length by reviewing computed tomography (CT) scans and to evaluate the usefulness of a bent tip needle during celiac plexus block (CPB). Methods: CT scans of 60 CPB patients were reviewed. Image of the uppermost margin of L2 vertebral body was used to measure the minimal and maximal oblique angles and the distances from the midline to skin puncture point. The imaginary needle trajectory distance was calculated by three-dimensional measurement. When the procedure was performed by using a $10^{\circ}$ bent tip needle under a $20^{\circ}$ oblique X-ray fluoroscopic view, the distance (GF/G'F) from the midline to the actual puncture site was measured. Results: The imaginary safe oblique angle range was $26.4-34.2^{\circ}$ and $27.7-36.0^{\circ}$ on the right and left, respectively. The distance from the midline to skin puncture point was 6.1-7.6 cm on the right and 6.3-7.6 cm on the left. The needle trajectory distance at minimal angle was 9.6-11.6 cm on the right and 9.5-11.5 cm on the left. The distance of GF/G'F was 5.1-6.5 cm and 5.0-6.4 cm on the right and left, respectively. All imaginary parameters were correlated with BMI except for GF/G'F. All complications were mild and transient. Conclusions: We identified safe values of angles and distances using a straight needle. Furthermore, using a bent tip needle under a $20^{\circ}$ oblique fluoroscopic view, we could safely perform CPB with smaller parameter values.

• Korean Journal of Acupuncture
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• v.29 no.3
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• pp.385-395
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• 2012

Objectives : Meridian sinew theory was introduced in Miraculous Pivot, Huangdi's Internal Classic, to explain in relation with locations of meridian sinews, causes, mechanisms, and treatment of diseases. The meridian sinews are understood to include muscles, tendons and ligaments, or muscles in the superficial body made up with muscles, ligaments, tendons, fascia etc. This theory shows the similarity or organic relationship between the meridian sinews and muscles. From the Hippocrates(460-385 BC) ages, traction therapy was used as a treatment method on muscular diseases such as low back pain, scoliosis, etc in western medicine. The effects of traction therapy, however, were unclear so that this study was purposed to illustrate the effectiveness of continuous traction therapy and to develop meridian sinews treatment. Methods : We made 2 hypotheses to explain the cause of scoliosis occurrence, muscles contraction and relaxation. As the hypothesis, we made the spinal model having 3 joints with wood and rubber bands. Each of the three joints in the spinal model represents the case of normal(NT; control), contraction(AT 1)and relaxation(AT 2) condition, and distance between the vertebrae joints was measured. Results : Under normal circumstance models, the normal type 1(NT 1; muscle relax state) and normal type 2(NT 2; muscle contract state) all joints were being towed equally. But in an unusual contracted situation, regardless of the relationship of joint area, contracted part of joint was not released. And in a relaxed situation, regardless of joint areas, released parts of joint were further released. These observation results mean that the effects of traction might be different from the purpose of traction therapy of Hippocrates. Conclusions : To explain the effect of traction therapy for scoliosis, the spinal cord model and scoliosis model were made. After vertebral bodies were pulled with different tensile forces, we compared the observed length of the each joints pulled. The results suggested that there were no effects of traction in objected parts with traction method from Hippocrates' design, continuous traction method. Moreover, it may worsen the symptom in worst case. Of course, our results are just the result of experimental models and clinical results may be different. More careful studies, therefore, are required.

• Journal of Korean Neurosurgical Society
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• v.30 no.4
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• pp.451-455
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• 2001

Objectives : There have been several studies documenting the changing level of the conus throughout infancy and childhood, but there is only a little detailed study that documents the range of conus positions in a living adult population, especially in Korean, without spinal deformity. Methods : we made a sequential study of magnetic resonance images of the lumbar spine to determine the variation in position of the conus medullaris in 650 living korean adults population without spinal deformity who checked MRI to identify the cause of low back pain. The study population consisted of patients over the age of 16 years. A T1-weighted, midline, sagittal image was reviewed for identifying the postion of conus. This location was recorded in relation to the upper, middle, or lower third of the adjacent vertebral body or the adjacent intervertebral disc. Results : The study group consisted of 305 men(47%) and 345 women(53%) with a mean age 45.9 years(range, 16-79 years). The conus existed commonly at the middle third of L1(131cases, 20.2%), at the L1-2 intervertebral space(129cases, 19.8%), and the lower third of L1(123cases, 18.9%). The mean position of conus was the lower third of L1(range, middle third of T12 to middle third of L3). Conclusions : The mean position of conus was at the lower third of L1(range, middle third of T12 to middle third of L3). This results was same as that of foreign study. Our results of living korean adult population could allow for safe clinical procedures such as lumbar puncture, spinal anesthesia, and help to explain the differences among observed neurologic injuries from fracture-dislocation at the thoracolumbar junction.

• Journal of Yeungnam Medical Science
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• v.30 no.2
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• pp.116-119
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• 2013

A burnt-out prostate cancer tumor is a very rare clinical entity. The term 'burnt-out' refers to a primary tumor that has spontaneously and nearly completely regressed without treatment. Since metastasis of prostate cancer is usually encountered in the presence of advanced disease, distant metastasis with an undetectable primary tumor is very rare. We report herein a case of a burnt-out prostate cancer tumor that metastasized to the thoracic (T) spine and caused cord compression. A 66-year-old man visited the Emergency Department due to weakness of both legs for the past two days. His blood and urine tests were normal at the time. His spine magnetic resonance imaging (MRI) scans looked like bone metastasis that involved the T-7 vertebral body and a posterior element, and caused spinal cord compression. Other images, including from the brain MRI, neck/chest/abdomino-pelvic computed tomography (CT) scan and 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) and endoscopy, revealed no lesions that suggested malignancy. After total corpectomy T-7 and screw fixation/fusion at T5 to T10, the pathology report revealed a metastatic carcinoma that was strongly positive for prostate-specific antigen (PSA). The serum PSA value was 1.5 ng/mL. The transrectal 12-core prostate biopsy and ultrasonography showed no definitive hypoechoic lesion, but one specimen had slight (only 1%) adenocarcinoma with a Gleason score of 6 (3+3). The final diagnosis was burned-out prostate cancer with an initial normal PSA value. Although metastatic disease with an unknown primary origin was confirmed, a more aggressive approach in seeking the primary origin could provide a more specific treatment strategy and greater clinical benefit to patients.

• The Korean Journal of Pain
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• v.3 no.2
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• pp.108-118
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• 1990

Splanchnic nerve block (SNB) is performed to relieve intractable upper abdominal pain caused by carcinoma of the upper G-I tract. Not all patients achieve satisfactory pain relief; therefore, a second or third nerve block trial may need to be performed. In this study, an attempt was made to analyze the possible factors which might affect the result of repeated SNB in 42 the patients among 264 patients who received SNB at Severance Hospital during the period from January 1985 to December 1989. The results are as follows: 1) Among the 42 patients, including 30 males and 12 females, the fifties and forties were the major age groups. 2) Among the underlying diseases, stomach cancer was the most common (18 cases) and pancreatic cancer was next (14 cases). 3) The main locations of pain were the upper abdomen, epigastrium and entire abdomen in decreasing order. 4) Among the thirty-nine cases of first SNB combined with ascites, 13 cases received a repeat block, 81.0% of whom had had metastatic lesion. 5) There were 54.2% who had had single or combined treatment, operation, chemotherapy or radiotherapy before SNB. 6) Twently seven cases (64.3%) had received opioid medication for pain control. 7) In the 75% alcohol group, 11.7% of patients required a second block, and in the pure and 50% alcohol group, 9.6% of patients required a second block within two weeks of the first block. Three cases in both of these repeated block groups required a third block; representing 3.9%, of the 75% alcohol group and 1.6% of the pure and 50% alcohol group. 8) The volume of alcohol used was more than 16 ml bilaterally in both cases. 9) The points of the inserted needle were positioned in the upper and anterolateral part of the $L_1$ vertebra on both sides on the anteroposterior roentgenogram. The contrast media was spread upward along the anterior margin of the vertebral body and posteriorly in repeat block. The frequency of repeat block was higher in cases with ascites or metastasis. The instance of repeat block within 2 weeks of the first block was lower in the pure and 50% alcohol group than in the 75% alcohol group. Thus, alcohol concentration and patient status may be considered factors which influence the result of repeated SNB. We suggest early application of SNB in upper abdominal cancer patients.