• The Korean Journal of Pain
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• v.9 no.2
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• pp.354-362
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• 1996

Background: We started postoperative pain management service using an intravenous patient-controlled analgesia (IV-PCA, PCA), which is known as convenient and effective analgesic method. In this report, we describe the efficacy and safety of PCA and the experience of developing an acute pain service to treat postoperative pain using a PCA. Methods: Practices of an acute pain service were started at a ward for general surgery after preparation of the standardized protocols for PCA. In each patient, PCA was connected following administration of initial loading doses of analgesics at recovery room after operation. All patients were checked by acute pain service team once or twice daily. The scope of acute pain service was gradually spread to other departments such as orthopedic, thoracic, obstetric and gynecologic departments by requests of patients or surgeons. We managed 1,590 patients during first 22 months. among them, nine hundred seventy two cases were prospectively evaluated for their analgesis efficacy and side effects of PCA. Results: The number of patients was increased day by day. the most common type of operation was gastrectomy (21.6%). Commonly used analgesics were nalbuphine (59%) and morphine (37%). The mean duration of PCA attachment was 3.3 days. The degree of analgesia on operation day was good in 44.8% and tolerable in 52.6% of patients. Only 3.9% of patients complained severe pain during their postoperative periods. One elderly patient experienced respiratory depression (0.06%) owing to accidental misuse of PCA by his relatives. Overall patient's satisfaction was over 93%. Conclusion: According to our experiences, we conclude that PCA is an effective, relatively safe and highly satisfactory method for postoperative pain management. Because of these advantages of PCA, the creation of our acute pain service using a PCA was successful and expanded rapidly.

• The Journal of the Korean bone and joint tumor society
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• v.9 no.1
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• pp.77-83
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• 2003

Aggressive fibromatosis is a rare soft tissue tumor with locally invasive and infiltrative characteristics. The mechanism of this invasive nature was not reported until now. Mutations or reduction of PTEN, tumor suppressor gene, in cancer tissues, have been found to be associated with invasiveness and metastatic properties of cancer cells. To know the pattern of expression of PTEN in aggressive fibromatosis, we analysed the expression of PTEN with immunohistochemical stain and immunoblotting. PTEN was homogeneously expressed in the normal musculoaponeurotic tissues, but absent or very faint in tissues of patients with aggressive fibromatosis as evidenced by western blot analysis and immunohistochemical examinations. Although the meaning of decreased PTEN expression in aggressive fibromatosis is not certain, it might be involved in the growth of the aggressive fibromatosis, and associated with phenotype of aggressive fibromatosis.

• The Journal of the Korean bone and joint tumor society
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• v.10 no.1
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• pp.56-60
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• 2004

A bone island represents a focus of mature compact bone within the cancellous bone. It can be diagnosed based on characteristic clinical and radiologic features. The lesion is typically asymptomatic with a preference for the pelvis, femur, and other long bones. On the radiologic study, the lesion appears as an ovoid, round, or oblong homogeneously dense and sclerotic focus in the cancellous bone. Characteristic feature of this lesion is radiating bony streaks, known as "thorny radiations" or "pseudopodia". Most bone islands are small, and majority of the lesions measure from 0.1 to 2.0 cm. Giant bone island, defined as a diameter greater than 2 cm, has been rarely reported in the literature. We report a case of giant bone island measured by 10${\times}$1.7${\times}$1 cm in the diaphysis of right tibia in 31-year-old man.

• The Journal of the Korean bone and joint tumor society
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• v.10 no.1
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• pp.45-49
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• 2004

Chondroblastoma is a benign chondroid-forming tumor usually originating in the epiphysis. The base of metatarsal bone contains neither an epiphysis nor a secondary ossification center and so is the rare site of chondroblastoma. Here, we present a case of chondroblastoma of the base of fifth metatarsal bone in 34-year-old man. Histologically, the osteoclast-like giant cells were abundant enough to simulate a giant cell tumor. And the chondroid intercellular matrix was intermixed but scanty. However, the background mononuclear cells showed irregular and indented nuclei with longitudinal clefts and positive immunoreactivity for S-100 protein, as the evidence of chondroblasts.

• Journal of Korean Foot and Ankle Society
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• v.8 no.2
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• pp.153-156
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• 2004

Purpose: To investigate the status of foot, preventive foot care and appropriateness of shoe size in patients with diabetes. Materials and Methods: One hundred and sixty-five patients who visited endocrinology clinic due to clinically proven diabetes mellitus were studied. Average age was 59.3 years (range, 36-90 years) and average duration of diabetes was $9.6{\pm}8.2$ years. Patients were questioned about their basic educational level and their foot and ankle problems. Physical examination of the foot was done including sensation testing of four areas of plantar surface with the 5.07 monofilament. Both feet and shoes were measured for width, length and the height of toes and toebox. Shoes were defined as properly fitting the foot if it is 5mm wider than the foot, and $20{\pm}30\;mm$ longer than the foot, and the height of toebox is more than 5mm higher than the height of the toes. Results: 48.5 percent of the patients were educated about how to select an appropriate shoewear. 47.3 percent of the patients had symptoms of neuropathy and 42.4 percent of patients were unable to feel the monofilament in at least one area. 25.5 percent of the patients had appropriate shoes in length, 63.6 percent of the patients in width, and 72.7 percent of the patients in the height of toebox. Conclusion: This study suggets that more patients needs to be educated about foot care and appropriate shoes which have adequate height of toebox as well as the length and width.

• Journal of Korean Foot and Ankle Society
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• v.12 no.1
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• pp.41-46
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• 2008

Purpose: This study was designed to evaluate characteristics of foot pressure distribution with or without partial prosthetic foot in transmetatarsal amputee. Materials and Methods: The subjects were 9 transmetatarsal amputees. Foot pressures were measured at hallux, the $1^{st}-5^{th}$ metatarsal head (MTH), mid-foot, condyle area by F-scan system in amputated or contralateral foot during active walking. Results: In amputated foot, mean peak pressure was greatest in midfoot without prosthetic foot but it was greatest in hindfoot with prosthetic foot. In unaffected foot, although mean peak pressure was higher in hallux, and $1-5^{th}$ MTH compared to amputated foot, it was greatest in hind foot both with and without prosthetic foot. However, in unaffected foot, mean peak pressure significantly decreased in hallux and $5^{th}$ MTH after wearing the prosthetic foot. There was a significant difference in mean peak pressure in hallux and $5^{th}$ MTH between amputated and unaffected foot after wearing prosthetic foot. However, other region had no significant difference with or without prosthetic foot between feet. Conclusions: The use of partial prosthetic foot tends to shift weight bearing from the heel area to forefoot and could significantly reduce hind foot peak pressure and redistributed to peak pressure. The partial prosthetic foot can also offer the peak pressure to reduction both amputated foot and unaffected foot and help to toe off during walking.

• Journal of Korean Neurosurgical Society
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• v.56 no.2
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• pp.121-129
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• 2014

Objectives : Patients with cervical ossification of posterior longitudinal ligament (OPLL) are susceptible to cord injury, which often develops into myelopathic symptoms. However, little is known regarding the prognostic factors that are involved in minor trauma. We evaluated the relationship between minor trauma and neurological outcome of OPLL and investigated the prognostic factors with a focus on compressive factors and intramedullary signal intensity (SI). Methods : A total of 74 patients with cervical myelopathy caused by OPLL at more than three-levels were treated with posterior decompression surgeries. We surveyed the space available for spinal cord (SAC), the severity of SI change on T2-weighted image, and diabetes mellitus (DM). The neurological outcome using Japanese Orthopedic Association (JOA) scale was assessed at admission and at 12-month follow-up. Results : Among the variables tested, preoperative JOA score, severity of intramedullary SI, SAC, and DM were significantly related to neurological outcome. The mean preoperative JOA were $11.3{\pm}1.9$ for the 41 patients who did not have histories of trauma and $8.0{\pm}3.1$ for the 33 patients who had suffered minor traumas (p<0.05). However, there were no significant differences in the recovery ratios between those two groups. Conclusions : Initial neurological status and high intramedullary SI in the preoperative phase were related to poorer postoperative outcomes. Moreover, the patients with no histories of DM and larger SACs exhibited better improvement than did the patients with DM and smaller SACs. Although the initial JOA scores were worse for the minor trauma patients than did those who had no trauma prior to surgery, minor trauma exerted no direct effects on the surgical outcomes.

• Journal of Korean Neurosurgical Society
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• v.56 no.6
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• pp.482-487
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• 2014

Objective : We assessed the life-time prevalence (LTP) of chronic low back pain (LBP) in young Korean males. We also evaluated the relationship between lumbar spinal lesions and their health related quality-of-life (HRQOL). Methods : A cross-sectional, self-reported survey was conducted in Korean males (aged 19-year-old) who underwent physical examinations for the conscript. We examined 3331 examinees in November 2014. We included 2411 subjects, who accepted to participate this study without any comorbidities. We interviewed using simple binary questions for their LBP experience and chronicity. HRQOL was assessed by Short-Form Health-Survey-36 (SF-36) in chronic LBP and healthy control groups. Radiological assessment was performed in chronic LBP group to determine whether there were any pathological causes of their symptoms. Results : The LTP of chronic LBP was 13.4%. Most (71.7%) of them didn't have any lumbar spinal lesions (i.e., non-specific chronic LBP). The SF-36 subscale and summary scores were significantly lower in subjects with chronic LBP. Between specific and non-specific chronic LBP group, all physical and mental subscale scores were significantly lower in specific chronic LBP group, except mental health (MH) subscale score. In MH subscale and mental component summary score, statistical significant differences didn't appear between two groups (p=0.154, 0.126). Conclusion : In Korean males 19 years of age, the LTP of chronic LBP was 13.4%, and more than two-thirds were non-specific chronic LBP. Chronic LBP had a significant impact on HRQOL. The presence of lumbar spinal pathoanatomical lesions affected mainly on the physical aspect of HRQOL. It influenced little on the mental health.

• Journal of Korean Neurosurgical Society
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• v.54 no.3
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• pp.194-200
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• 2013

Objective : Lumbar spine stenosis (LSS) can result in symptomatic compression of the neural elements, requiring surgical treatment if conservative management fails. Minimally invasive surgery has come to be more commonly used for the treatment of LSS. The current study describes outcomes of bilateral microdecompression by unilateral or bilateral laminotomy (BML) for degenerative LSS after a minimum follow-up period of 3 years and investigates factors that result in a poor outcome. Methods : Twenty-one patients who were followed-up for at least 3 years were included in this study. For clinical evaluation, the Japanese Orthopedic Association (JOA) scoring system for low back pain was used. The modified grading system of Finneson and Cooper was used for outcome assessment. Radiographic evaluation was also performed for spondylolisthesis, sagittal rotation angle, and disc height. Results : Twenty-one patients (10 men, 11 women) aged 53-82 years ($64.1{\pm}8.9$ years) were followed-up for a minimum of 3 years (36-69 months). During follow-up, two patients underwent reoperation. Average preoperative JOA score and clinical symptoms, except persistent low back pain, improved significantly at the latest follow-up. There were no significant differences in radiological findings preoperatively and postoperatively. Thirteen patients (61.9%) had excellent to fair outcomes. Conclusion : BML resulted in a favorable and persistent outcome for patients with degenerative LSS without radiological instability over a mid-term follow-up period. Persistent low back pain unrelated to postoperative instability adversely affects mid-term outcomes.

• Journal of Korean Neurosurgical Society
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• v.59 no.6
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• pp.604-609
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• 2016

Objective : The aim of this study was to compare the clinical and radiological outcomes associated with the use of hydroxyapatite (HA) spacer and allogeneic bone (AB) spacer in laminoplasty. Methods : From January 2006 to July 2014, 79 patients with cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament underwent cervical laminoplasty. The radiologic parameters were obtained from plain radiography and three-dimensional computed tomography. All images were taken before and after surgery. Cervical lordosis, spinal canal dimension, fusion between lamina and spacer, and resorption of spacer were checked. Clinical outcomes were assessed using visual analog scale and Japanese Orthopedic Association. Results : Double-door laminoplasty was performed on 280 levels : 182 in the HA group and 98 in the AB group. The mean follow-up was 23.1 months (range : 4-69 months). Similar fusion rates were found in these groups (p=0.3). The resorption rate between lamina and spacer was lower in the HA group (p<0.001). During the immediate postoperative period, the canal dimension of both groups increased compared with the results in the preoperative period. However, the canal dimension of the AB group decreased over time compared with that of the HA group (p<0.001). Conclusion : Double-door laminoplasty improved the clinical outcomes of both groups. However, the spinal canal dimension in the AB group showed a greater degree of reduction than in the HA group at the final postoperative follow-up. Therefore, we suggest that surgeons consider the use of larger-sized AB spacers in double-door laminoplasties.