• Journal of Korean Neurosurgical Society
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• v.51 no.6
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• pp.350-358
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• 2012

Objective : Life expectancy for humans has increased dramatically and with this there has been a considerable increase in the number of patients suffering from lumbar spine disease. Symptomatic lumbar spinal disease should be treated, even in the elderly, and surgical procedures such as fusion surgery are needed for moderate to severe lumbar spinal disease. However, various perioperative complications are associated with fusion surgery. The aim of this study was to examine perioperative complications and assess risk factors associated with lumbar spinal fusion, focusing on geriatric patients at least 70 years of age in the Republic of Korea. Methods : We retrospectively investigated 489 patients with various lumbar spinal diseases who underwent lumbar spinal fusion surgery between 2003 and 2007 at our institution. Three fusion procedures and the number of fused segments were analyzed in this study. Chronic diseases were also evaluated. Risk factors for complications and their association with age were analyzed. Results : In this study, 74 patients experienced complications (15%). The rate of perioperative complications was significantly higher in patients 70 years of age or older than in other age groups (univariate analysis, p=0.001; multivariate analysis, p=0.004). However, perioperative complications were not significantly associated with the other factors tested (sex, comorbidities, operation procedures, fusion segments involved). Conclusion : Increasing age was an important risk factor for perioperative complications in patients undergoing lumbar spinal fusion surgery whereas other factors were not significant. We recommend good clinical judgment and careful selection of geriatric patients undergoing lumbar spinal fusion surgery.

• The Journal of the Korean dental association
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• v.53 no.4
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• pp.249-258
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• 2015

Snoring and obstructive sleep apnea are the representative sleep disordered breathings, caused by the temporary and repetitive constriction or obstruction of upper airway during sleep. They present with excessively vibratory noise and repetitive cease of respiration. These disorders commonly result in sleep disturbance and the subsequent daytime sleepiness, chronic fatigue. Furthermore, they can cause the serious and extensive complications including increased risk of hypertension, cardiac arrhythmia, cardiovascular disease, cerebrovascular accident, neurocognitive disturbance, traffic and occupational accidents, type II diabetes, childhood growth interruption, awakening headache and finally, relatively increased mortality rate. Because appropriate therapeutic intervention is best way for patients to relieve their symptoms and prevent their possible complications, it is very important for dentists to recognize their own role and responsibility in diagnosis and treatment of these disorders. For this, the present article provides the understanding of the clinical features, possible complications, various treatment modalities, and suitable treatment strategies for snoring and obstructive sleep apnea.

• Journal of Korean Neurosurgical Society
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• v.47 no.3
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• pp.199-202
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• 2010

Objective : Balloon kyphoplasty is a minimally invasive procedure that is mainly performed for refractory pain due to osteoporotic compression fractures. The purpose of this study was to evaluate the results of balloon kyphoplasty performed at different times after an injury. Methods : In this retrospective study, the records of 99 patients who underwent one level of balloon kyphoplasty between January 2005 and December 2007 were reviewed. The patients were divided into three groups : 21 patients treated within 3 weeks of an injury (the acute group), 49 treated within 3 weeks to 2 months of an injury (the subacute group), and 29 patients treated at more than 2 months after an injury (the chronic group). Clinical outcomes were assessed using a visual analogue scale (VAS). In addition, modified MacNab's grading criteria was used to assess the subjective patient outcome. The radiology findings, including vertebral height restoration and procedure related complications, were analyzed based on the different time intervals after the injury. Results : Patients in all three groups achieved marked pain relief in terms of the VAS within 7 days of the procedure. Good or excellent results were achieved by most patients in all three groups. However, the height restoration, the main advantage to performing a balloon kyphoplasty, was not achieved in the chronic group. Moreover, evidence of complications including cement leakage was observed significantly less frequently in the subacute group compared to the other two groups. Conclusion : Although balloon kyphoplasty is an effective treatment for osteoporotic compression fractures, with regard to pain relief, the subacute stage appears to be optimal for treating patients with a balloon kyphoplasty in terms of achieving the best outcomes with minimal complications.

• Journal of the Korean Burn Society
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• v.22 no.1
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• pp.15-19
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• 2019

Purpose: Pain management in burn treatment is important in improving wound healing and quality of life. Ibuprofen is a proven pain relieving agent in patients with partial thickness burn by intraveous injection. The purpose of this study is to evaluate the efficacy of Biatain Ibu^® (polyurethane foam containing ibuprofen) in pain control for outpatients with partial thickness burns. Methods: A prospective randomized clinical trial was performed in outpatients with partial thickness burn from August 1, 2017 to July 31, 2018. Acute pain, chronic pain, complications, days for re-epithelialization and patient's satisfaction were compared between Biatain Ibu^® and Biatain^® groups. Results: A total of 20 patients (Biatain Ibu^®, n=10; Biatain^®, n=10) were assessed in the trial. On Burn days 3, 5, 7, 11, 13, and 15, the acute pain levels were significantly lower in the Biatain Ibu^® group than in the Biatain^® group. Complications, chronic pain levels and days for re-epithelialization were not significantly different between the two groups. Patient's satisfaction was not statistically significant but was higher in the Biatain Ibu^® group. Conclusion: Biatain Ibu^® is effective in relieving pain in outpatients with partial thickness burn without decreasing patient satisfaction, wound healing ability or developing any complications.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.25 no.1
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• pp.1-12
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• 2023

Objective: Although chronic carotid artery occlusion seems to be associated with significant risk of ischemic stroke, revascularization techniques are neither well established nor widespread. In contrast, extracranial-intracranial bypass is common despite the lack of evidence regarding neurological improvement or prevention of ischemic events. The aim of current review is to evaluate the effectiveness of various methods of recanalization of chronic carotid artery occlusion. Methods: Comprehensive literature search through PubMed, Scopus, Cochrane and Web of Science databases performed. Various parameters were assessed among patients underwent surgical, endovascular and hybrid recanalization for chronic carotid artery occlusion. Results: 40 publications from 2005 to 2021 with total of more than 1300 cases of revascularization of chronic carotid artery occlusion have been reviewed. Further parameters were assessed among patients underwent surgical, endovascular and hybrid recanalization for chronic carotid artery occlusion: mean age, male to female ratio, mean duration of occlusion before treatment, rate of successful recanalization, frequency of restenosis and reocclusion, prevalence of ischemic stroke postoperatively, neurological or other symptoms improvement and complications. Based on proposed through reviewed literature indications for revascularization and predictive factors of various recanalizing procedures, an algorithm for clinical decision making have been formulated. Conclusions: Although treatment of chronic carotid artery occlusion remains challenging, current literature suggests revascularization as single option for verified neurological improvement and prevention of ischemic events. Surgical and endovascular procedures should be taken into account when treating patients with symptomatic chronic carotid artery occlusion.

• Journal of Korean Neurosurgical Society
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• v.50 no.2
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• pp.103-108
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• 2011

Objective : There are few studies comparing small and large craniotomies for the initial treatment of chronic subdural hematoma (CSDH) which had non-liquefied hematoma, multilayer intrahematomal loculations, or organization/calcification on computed tomography and magnetic resonance imaging. These procedures were compared to determine which would produce superior postoperative results. Methods : Between 2001 and 2009, 317 consecutive patients were surgically treated for CSDH at our institution. Of these, 16 patients underwent a small craniotomy with partial membranectomy and 42 patients underwent a large craniotomy with extended membranectomy as the initial treatment. A retrospective review was performed to compare the postoperative outcomes of these two techniques, focusing on improvement of neurological status, complications, reoperation rate, and days of post-operative hospitalization. Results : The mean ages were $69.4{\pm}12.1$ and $55.6{\pm}9.3$ years in the small and large craniotomy groups, respectively. The recurrence of hematomas requiring reoperation occurred in 50% and 10% of the small and large craniotomy patients, respectively (p<0.001). There were no significant differences in postoperative neurological status, complications, or days of hospital stay between these two groups. Conclusion : Among the cases of CSDH initially requiring craniotomy, the large craniotomy with extended membranectomy technique reduced the reoperation rate, compared to that of the small craniotomy with partial membranectomy technique.

• Archives of Plastic Surgery
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• v.45 no.6
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• pp.495-503
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• 2018

With significant improvements in success rates for free flap reconstruction of the head and neck, attention has turned to donor site morbidity associated with osteocutaneous free flaps. In this review, we address the morbidity associated with harvest of the four most commonly used osteocutaneous flaps; the free fibula flap, the scapula flap, the iliac crest flap and the radial forearm flap. A comprehensive literature search was performed to identify articles relevant to donor site morbidity for these flaps. We assessed morbidity in terms of incidence of delayed healing, chronic pain, aesthetic outcomes, site specific complications and patient satisfaction/quality of life. Weighted means were calculated when sufficient studies were available for review. The radial forearm and free fibula flaps are associated with high rates of delayed healing of approximately 20% compared to the scapular (<10%) and iliac flaps (5%). The radial forearm flap has higher rates of chronic pain (16.7%) and dissatisfaction with scar appearance (33%). For the majority of these patients harvest of one of these four osteocutaneous does not limit daily function at long-term follow-up. The scapular osteocutaneous flap is associated with the lowest relative morbidity and should be strongly considered when the recipient defect allows. The radial forearm is associated with higher morbidity in terms of scarring, fractures, chronic pain and wrist function and should not be considered as first choice when other flap options are available.

• Journal of Korean Neurosurgical Society
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• v.50 no.4
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• pp.392-395
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• 2011

Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a rare inflammatory disease characterized by hypertrophic inflammation of the dura mater and various clinical courses that are from myelopathy. Although many associated diseases have been suggested, the etiology of IHSP is not well understood. The ideal treatment is controversial. In the first case, a 55-year-old woman presented back pain, progressive paraparesis, both leg numbness, and voiding difficulty. Initial magnetic resonance imaging (MRI) demonstrated an anterior epidural mass lesion involving from C6 to mid-thoracic spine area with low signal intensity on T1 and T2 weighted images. We performed decompressive laminectomy and lesional biopsy. After operation, she was subsequently treated with steroid and could walk unaided. In the second case, a 45-year-old woman presented with fever and quadriplegia after a spine fusion operation due to lumbar spinal stenosis and degenerative herniated lumbar disc. Initial MRI showed anterior and posterior epidural mass lesion from foramen magnum to C4 level. She underwent decompressive laminectomy and durotomy followed by steroid therapy. However, her conditions deteriorated gradually and medical complications occurred. In our cases, etiology was not found despite through investigations. Initial MRI showed dural thickening with mixed signal intensity on T1- and T2-weighted images. Pathologic examination revealed chronic nonspecific inflammation in both patients. Although one patient developed several complications, the other showed slow improvement of neurological symptoms with decompressive surgery and steroid therapy. In case of chronic compressive myelopathy due to the dural hypertrophic change, decompressive surgery such as laminectomy or laminoplasty may be helpful as well as postoperative steroid therapy.

• Archives of Reconstructive Microsurgery
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• v.23 no.2
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• pp.97-100
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• 2014

The number of patients with chronic renal failure who require renal replacement therapy is increasing and dialysis is still the mainly used renal replacement therapy. The first choice of surgical technique currently used is side-to-end anastomosis of the radial artery and the cephalic vein. The authors report on a case of an effective arteriovenous shunt operation performed using microscopy. A 53-year-old male with chronic renal failure was referred to plastic and reconstructive surgery department to undergo an arteriovenous shunt operation. Venography was performed before surgery in order to find the appropriate vessel for the arteriovenous shunt operation. The cephalic vein on the wrist showed a diameter of over 4 mm, which was appropriate for an arteriovenous shunt operation. Anastomosis of the vessels was performed under microscopy using Nylon #9-0. Blood flow and vessel diameter were evaluated by venography after surgery and showed well maintained function of the shunt. Complications such as bleeding, edema of the upper arm, and wound dehiscence did not occur. Many factors and certain complications may affect the long-term patency of an arteriovenous shunt; however, exquisite surgical technique is the most important factor in a successful operation. Thus, arteriovenous shunt operation using microscopy is thought to be a good treatment option.

• Korea-Australia Rheology Journal
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• v.17 no.3
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• pp.117-123
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• 2005

Background: Reduced deformability of red blood cells (RBCs) may play an important role on the pathogenesis of chronic vascular complications of diabetes mellitus. However, available techniques for measuring RBC deformability often require washing process after each measurement, which is not optimal for day­to-day clinical use at point of care. The objectives of the present study are to develop a device and to delineate the correlation of impaired RBC deformability with diabetic nephropathy. Methods: We developed a disposable ektacytometry to measure RBC deformability, which adopted a laser diffraction technique and slit rheometry. The essential features of this design are its simplicity (ease of operation and no moving parts) and a disposable element which is in contact with the blood sample. We studied adult diabetic patients divided into three groups according to diabetic complications. Group I comprised 57 diabetic patients with normal renal function. Group II comprised 26 diabetic patients with chronic renal failure (CRF). Group III consisted of 30 diabetic subjects with end-stage renal disease (ESRD) on hemo-dialysis. According to the renal function for the diabetic groups, matched non-diabetic groups were served as control. Results: We found substantially impaired red blood cell deformability in those with normal renal function (group I) compared to non-diabetic control (P = 0.0005). As renal function decreases, an increased impairment in RBC deformability was found. Diabetic patients with chronic renal failure (group II) when compared to non-diabetic controls (CRF) had an apparently greater impairment in RBC deformability (P = 0.07). The non-diabetic cohort (CRF), on the other hand, manifested significant impairment in red blood cell deformability compared to healthy: control (P = 0.0001). Conclusions: The newly developed slit ektacytometer can measure the RBC deformability with ease and accuracy. In addition, progressive impairment in cell deformability is associated with renal function loss in all patients regardless of the presence or absence of diabetes. In diabetic patients, early impairment in RBC deformability appears in patients with normal renal function.