• Journal of Korean Neurosurgical Society
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• 제60권6호
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• pp.749-754
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• 2017

Objective : To quantitatively measure the degree of bone flap resorption (BFR) following autologous bone cranioplasty and to investigate factors associated with BFR. Methods : We retrospectively reviewed 29 patients who underwent decompressive craniectomy and subsequent autologous bone cranioplasty between April 2005 and October 2014. BFR was defined as : 1) decrement ratio ([the ratio of initial BF size/craniectomy size]-[the ratio of last BF/craniectomy size]) >0.1; and 2) bone flap thinning or geometrical irregularity of bone flap shape on computed tomographic scan or skull plain X-ray. The minimal interval between craniectomy and cranioplasty was one month and the minimal follow-up period was one year. Clinical factors were compared between the BFR and no-BFR groups. Results : The time interval between craniectomy and cranioplasty was $175.7{\pm}258.2$ days and the mean period of follow up was $1364{\pm}886.8$ days. Among the 29 patients (mean age 48.1 years, male : female ratio 20 : 9), BFR occurred in 8 patients (27.6%). In one patient, removal of the bone flap was carried out due to severe BFR. The overall rate of BFR was $0.10{\pm}0.11$ over 3.7 years. Following univariate analysis, younger age ($30.5{\pm}23.2$ vs. $54.9{\pm}13.4$) and longer follow-up period ($2204.5{\pm}897.3$ vs. $1044.1{\pm}655.1$) were significantly associated with BFR (p=0.008 and 0.003, respectively). Conclusion : The degree of BFR following autologous bone cranioplasty was 2.7%/year and was associated with younger age and longer follow-up period.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제33권4호
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• pp.322-330
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• 2007

Backgrounds: To overcome limited amount of autogenous mucosa for the reconstruction of various mucosal defect including oral mucosal defect, tissue engineered mucosa has been recently introduced. However, introduced conventional technique of tissue engineered mucosa still have serious pitfalls such as long fabrication time, fragility of the reconstructed mucosa, and complexity of the technique. Aim of the study: To examine whether the complex of preconfluent autologous keratinocytes and autologous PRP(Platelet rich plasma) can reconstruct oral mucosa on the muscular flap with easier and faster way compared to conventional mucosal tissue engineering technique. Materials and methods: One day before the operation, oral mucosa(3mm in diameter) were taken and treated for extraction of oral keratinocytes according to the routine manner. The day of operation, oral keratinocytes were prepared in the laboratory and then moved to the operating theater. Autologous PRP was also prepared and then mixed with oral keratinocytes just before grafting on the prepared muscular flap. After keratinocyte-PRP complex was seated, then a sterilized rubber sheet was placed on the graft and the elevated skin flap was replaced and sutured. Biopsies were proceeded at 3, 5, 7, 14 and 21 days. Tissue samples were evaluated clinically, histologically, and immunohistochemically. Results: All of the oral keratinocyte-PRP complexes were successfully grafted on the recipient sites(100%). On 3 days after the operation, 1-2 continuous epithelial layer and many inflammatory cells were observed. On 5 days after the operation, increase of layers of keratinocyte was observed with less inflammatory response. Thickness of the layers was gradually increased from 7 to 21 days after the operation. Cytokeratin confirms epithelium in every specimen. Conclusions: Preconfluent graft of autogenous oral keratinocytes mixed with autogenous PRP have successfully reconstructed myo-mucosal flap. This technique could be a useful alternative for oral mucosal reconstruction in the near future.

• IMMUNE NETWORK
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• 제2권1호
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• pp.49-52
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• 2002

Background: The possibility that G-CSF recruits leukemic cells from the G0 to S phase, which may lead to a greater susceptibility to cytotoxic drugs, such as ara-C, has been presented in Harada's study. Methods: In this study, we referred to the protocol of Harada et al 1 to try G-CSF combined marrow-ablative chemotherapy and autologous PBSCT, for the treatment of AML patients in CR1 status. Between January 1997 and March 1998, six AML patients (3: children, 3: adults) in CR1 status were autografted and followed up to 3 years. Results: The major regimen related toxicity was composed of mucositis and diarrhea without death. The time of ANC recovery to 500/L and 1,000/L was 11~48 and 16~81 days, respectively. The mean time of platelet recovery to 20,000/L and 50,000/L was 21~233 and 35~370 days, respectively. The platelet recovery time to 50,000/L was markedly prolonged for more than 100 days in four patients (66.7%). Moreover, four patients (66.7%) experienced a relapse of leukemia after transplantation, with a mean interval of 147.5 days after PBSCT. Two patients were in CR status for 53 and 51 months after PBSCT, respectively. Conclusion: The G-CSF combined marrow-ablative chemotherapy and autologous PBSCT resulted in a markedly delayed platelet recovery and no advantages for decreasing the relapse rate of AML. But, further studies will be warranted.

• 대한두개안면성형외과학회지
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• 제16권1호
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• pp.11-16
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• 2015

Background: Source material used to fill calvarial defects includes autologous bones and synthetic alternatives. While autologous bone is preferable to synthetic material, autologous reconstruction is not always feasible due to defect size, unacceptable donor-site morbidity, and other issues. Today, advanced three-dimensional (3D) printing techniques allow for fabrication of titanium implants customized to the exact need of individual patients with calvarial defects. In this report, we present three cases of calvarial reconstructions using 3D-printed porous titanium implants. Methods: From 2013 through 2014, three calvarial defects were repaired using custom-made 3D porous titanium implants. The defects were due either to traumatic subdural hematoma or to meningioma and were located in parieto-occipital, fronto-temporo-parietal, and parieto-temporal areas. The implants were prepared using individual 3D computed tomography (CT) data, Mimics software, and an electron beam melting machine. For each patient, several designs of the implant were evaluated against 3D-printed skull models. All three cases had a custom-made 3D porous titanium implant laid on the defect and rigid fixation was done with 8 mm screws. Results: The custom-made 3D implants fit each patient's skull defect precisely without any dead space. The operative site healed without any specific complications. Postoperative CTs revealed the implants to be in correct position. Conclusion: An autologous graft is not a feasible option in the reconstruction of large calvarial defects. Ideally, synthetic materials for calvarial reconstruction should be easily applicable, durable, and strong. In these aspects, a 3D titanium implant can be an optimal source material in calvarial reconstruction.

• Archives of Plastic Surgery
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• 제46권2호
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• pp.140-146
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• 2019

Background Thoracodorsal vessels (TDVs) and internal mammary vessels (IMVs) have both been widely employed as recipient vessels for use in free muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps. However, whether TDVs or IMVs are preferable as recipient vessels for autologous breast reconstruction with a free MS-TRAM flap remains controversial. The purpose of this study was to compare the clinical outcomes when TDVs were used as recipient vessels to those obtained when IMVs were used as recipient vessels for autologous breast reconstruction with a free MS-TRAM flap. Methods A retrospective matched-cohort study was performed. We retrospectively reviewed data collected from patients who underwent a free MS-TRAM flap for autologous breast reconstructions after mastectomy between March 2003 and June 2013. After a one-to-one matching using age, 100 autologous breast reconstructions were selected in this study. Of the 100 breast reconstructions, 50 flaps were anastomosed to TDVs and 50 to IMVs. Patient demographics and clinical outcomes including operation time, length of hospital stay, postoperative complications, and aesthetic score were compared between the two groups. Results No statistically significant differences were found between the two groups in patient demographics and clinical outcomes, including the complication rates and aesthetic scores. There were no major complications such as total or partial flap loss in either group. Conclusions The results of our study demonstrate that both TDVs and IMVs were safe and efficient as recipient vessels in terms of the complication rates and aesthetic outcomes.

• Archives of Plastic Surgery
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• 제49권3호
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• pp.324-331
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• 2022

Prior abdominal liposuction can be viewed as a relative or absolute contraindication to abdominally based autologous breast reconstruction given concerns for damaged perforators and scarring complicating intraoperative dissection. This systematic review aims to explore the outcomes of abdominally based breast reconstruction in patients with a history of abdominal liposuction. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided literature search was conducted using PubMed, Scopus, and Web of Science from the earliest available date through June 2020. Deep inferior epigastric perforator, muscle-sparing transverse rectus abdominis musculocutaneous (TRAM), superficial inferior epigastric artery, and pedicled TRAM flaps were included for evaluation. Complications included total or partial flap loss, fat necrosis, seroma, delayed wound healing, and donor site complications. After inclusion criteria were applied, 336 non-duplicate articles were screened, yielding 11 for final review, representing 55 flaps in 43 patients. There was no instance of total flap loss, eight (14.5%) flaps developed partial loss or fat necrosis, three (5.4%) flaps had delayed wound healing, and two (4.6%) patients had donor site complications. Most authors (8/11) utilized some type of preoperative imaging. Doppler ultrasonography was the most used modality, and these patients had the lowest rate of partial flap loss or flap fat necrosis (8%), followed by those without any preoperative imaging (10%). In conclusion, this review supports that patients undergoing abdominally based autologous breast reconstruction with a history of abdominal liposuction are not at an increased risk of flap or donor site complications. Although preoperative imaging was common, it did not reliably decrease complications. Further prospective studies are needed to address the role of imaging in improving outcomes.

• Clinics in Shoulder and Elbow
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• 제25권1호
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• pp.57-64
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• 2022

Background: There are various conservative treatment options for lateral epicondylitis (LE). The aim is to evaluate pain, daily functioning, and complications after ultrasound-standardized autologous blood injections in patients with LE. Methods: For this prospective cohort study, consecutive patients (>18 years) diagnosed with LE were included. Autologous blood was injected using a medical device containing an injection disposable with 12 small needles (Instant Tennis Elbow Cure [ITEC]) device. Patient-Rated Tennis Elbow Evaluation (PRTEE), subjective elbow score (SES), palpation and provocation pain, satisfaction, and complications of treatment were measured at baseline and two months after treatment. Paired t-tests and Fisher's exact tests were used for calculating the difference between pre- and post-treatment outcomes. Results: Fifty-five elbows were analyzed. Mean time between pre- and post-treatment was 11.1 weeks (standard deviation [SD], 8.9 weeks). The mean PRTEE score decreased from 68.2 (SD, 15.7) before surgery to 53.2 (SD, 25.9; p<0.001) after. The mean SES improved from 36.9 (SD, 20.8) to 51.7 (SD, 27.4; p<0.001). Despite this improvement, only 44.7% of patients showed relevant clinical improvement in PRTEE, and 37.3% showed significant clinical improvement based on SES. Four patients reported a complication and the injection disposable failed three times. Conclusions: Ultrasound-standardized autologous blood injection using the ITEC device is not an effective tool in reducing symptoms related to LE. This study showed that only half of all patients experienced a positive effect. In this heterogeneous cohort of patients, we showed no added value of ultrasound standardization.

• 대한족부족관절학회지
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• 제27권4호
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• pp.148-153
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• 2023

Traditionally, arthroscopic microfracture and autologous osteochondral autograft transplantation have been the primary surgical treatments for osteochondral lesions of the talus. On the other hand, recent advancements have introduced alternative approaches, such as autologous chondrocyte transplantation, matrix-derived autologous chondrocyte transplantation, intra-articular injection of concentrated bone marrow aspirate concentrate, and the use of fibrin glue to address chondral defects. Furthermore, some studies have explored a combination of bone marrow aspirate and matrix-derived chondrogenesis. In light of these developments, this report presents a case study of a young male patient in his early twenties with a relatively large osteochondral lesion exceeding 1.5 cm² on the medial talar dome. Instead of removing the osteochondral lesion, a surgical approach was employed to retain the lesion while addressing the unstable cartilage in the affected area. This approach involved a combination of bone marrow aspirate concentrate and matrix-derived chondrogenesis. The treatment yielded favorable clinical outcomes and ultimately successfully induced the bony union of osteochondral lesions. This paper reports the author's experience with this innovative approach with a review of the relevant literature.

• Radiation Oncology Journal
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• 제21권3호
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• pp.192-198
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• 2003

목적: 급성 골수성 백혈병에서 자가 조혈모세포 이식은 무병생존율에 도움을 주며 1차 관해된 급성 골수성 백혈병에서 자가 조혈모세포 이식은 점차 늘어나고 있는 추세이다. 본 연구는 1차 관해된 급성 골수성 백혈병에서 자가 조혈모세포 이식을 위한 전처치 요법으로 cytarabine, melphalan과 전신 방사선치료를 시행하여 그 효과를 알아보고자 하였다. 대상 및 방법: 1995년 1월부터 1999년 12월까지 급성 골수성 백혈병으로 1차 관해 후 자가 조혈모세포 이식을 받은 29명을 대상으로 하였다. 환자의 중앙연령은 33세(16~47세)이었다. 자가 조혈모세포 이식을 위한 전처치 요법은 cytarabine ($3.0\;gm/m^2$, 3일), melphalan ($100\;gm/m^2$, 1일)과 전신 방사선치료를 시행하였다. 전신 방사선치료는 6MV 선형가속기를 이용하여 200 cGy를 1일 2회씩 5회 분할 조사하여 총 조사선량은 1000 cGy이었다. 결과: 추적 관찰기간은 3~58개월이었으며 중앙값은 40개월이었다. 전체 환자의 4년 무병생존율은 69.0%이었으며 중앙생존기간은 41.5개월이었다. 4년 재발률은 27.6%이었다. 무병생존율과 재발률에 영향을 미치는 인자 분석에서는 FAB 분류만이 유의한 예후인자로 분석되었다($M_3$군 vs. $M_3$를 제외한 군; p=0.048, p=0.043). 대 상 환자 중 9명에서 사망하였으며 치료와 관련된 사망은 1명이었고 8명은 재발로 사망하였다. 결론: 1차 관해된 급성 골수성 백혈병에서 자가 조혈모세포 이식을 위한 melphalan, cytarabine과 전신 방사선치료는 비교적 효과적인 전처치 요법이었다.

• 대한관절경학회지
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• 제12권1호
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• pp.1-6
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• 2008

목적: 자가 슬괵건과 자가 슬개건을 이용한 관절경적 전방 십자 인대 재건술의 결과를 비교하였다. 대상 및 방법: 2000년 1월부터 2004년 12월까지 자가 슬괵건과 자가 슬개건을 이용하여 전방 십자인대 재건술을 시행한 각각 60명의 환자군을 대상으로 하였다. 추시기간은 슬건 군은 평균 42개월(범위$24{\sim}69$개월)이였으며 슬개건 군은 평균 51개월(범위 $24{\sim}84$개월)이었다. 술 전과 최종 추시에 이학적 검사로 수술 전 후 관절운동범위를 측정하였으며, Lachman 검사 및 pivot shift 검사를 실시하였다. 환자의 활동도와 만족도, 기능적 상태는 전방 슬관절 통증 여부, Lysholm 점수, IKDC 활동도 등급, Tegner 활동도 점수를 조사하였으며 KT-2000 arthrometer를 이용하여 전방 안정성을 객관적으로 평가하였다. 결과: 최종 추시점에서 자가 슬괵건과 슬개건을 이용하여 관절경적 전방 십자 인대 재건술을 시행한 군들 간의 비교에서, Lachman 검사는 음성 또는 경도의 양성이 각각 51예(85%)와 54예(90%)였으며, Pivot shift 검사에서는 각각 5예(8%)와 3예(5%)에서 양성으로 양군 모두 차이가 없었다.(p>0.05) 최종 추시시 KT-2000 검사에서 건측과 비교한 최대 도수 전방 전위차는 3 mm미만이 각각 51예(85%), 54예(90%)였다. Lysholm 점수는 슬괵건군은 평균 51.0점에서 평균 79.1점으로, 슬개건 군은 평균 52점에서 평균 82.2점으로 호전되었으며, IKDC 활동도 등급은 술후 각각 52예(87%)와 50예(83%)에서 정상 또는 거의 정상 소견을 보였다. Tegner 활동도 검사도 슬괵건 군에서 평균 4.8점에서 평균 7.1점으로, 슬개건 군은 평균 4.5점에서 평균 7.3점으로 호전되었다. 또한 전방 슬관절 동통은 슬괵건군 4예(7%), 슬개건군 6예(10%)에서 관찰되었다. 결론: 자가 슬괵건 또는 자가 슬개건을 이용한 관절경적 전방 십자 인대 재건술 후 추시 결과, 두 군 모두 우수한 결과를 보였으나 두 군 간에 최종 추시시의 결과는 통계적으로 유의한 차이가 없었다.