• Archives of Plastic Surgery
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• v.50 no.4
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• pp.415-421
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• 2023

The revision of the Korea Organ Transplantation Act (KOTA) in 2018 included hand/arm among the organs that can be transplanted. The first hand transplantation since the revision of KOTA took place in January 2021. A 62-year-old male patient experienced hand amputation on July 13, 2018, by a catapult injury. The patient first visited our institute 3 months after the injury. After serial interviews and an overall evaluation, the patient was registered on the hand transplantation waiting list in January 2020. On January 9, 2021, the patient underwent hand transplantation at the right distal forearm level. The total operation time was 17 hours 15 minutes, and the cold ischemic time was 4 hours 9 minutes. Postoperative immunosuppression was administered based on the protocol used for kidney transplantation. Two acute rejection episodes occurred, on postoperative days 33 and 41. Both rejection episodes were reversible with rescue therapy of a higher tacrolimus trough level, steroid pulse therapy, and topical immunosuppressants. Controlled passive range of motion exercise was started on postoperative day 10. Dynamic splint was applied on postoperative day 18. At 1 year, graft maintenance and functional improvement were satisfactory, and the patient showed a Disabilities of Arm, Shoulder and Hand score of 25.8. We successfully performed the first hand transplantation surgery under the KOTA amendment. It came from the organic and effective cooperation of plastic, orthopaedic, and transplantation departments and we believe it will guarantee the future ongoing success.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.8 no.1
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• pp.6-10
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• 2015

Purpose: To evaluate the effectiveness of extracorporeal shock wave therapy (ESWT) for postoperative pain after surgery around ankle. Materials and Methods: We included 21 patients who performed an operation around ankle from 2009 to 2013. 4 times ESWT were applied to the patients who have tenderness more than visual analog scale (VAS) point 4. We evaluated the VAS at each sessions and final follow-up, and American Orthopedic Foot and Ankle Society ankle-hindfoot score (AFOAS) was checked at preoperative and final follow-up. Patient's satisfaction and complications were surveyed. Results: Preoperative VAS was mean 4.7, postoperative pain VAS was mean 6.0 at 4.5 months follow-up. The VAS after ESWT each session at 1, 2, 3 weeks and final follow-up were 4.8, 3.2, 2.3, 2.9, respectively. Mean final follow-up period was 9.4 months. Final VAS were significantly decreased (p<0.001). Final VAS were increased from VAS at last session of ESWT, however, not significant (p=0.189). AOFAS significantly improved from preoperative 60 to final follow-up 86 (p<0.001). Excellent was 12 patients (57%), good was 4 patients (19%), no change was 3 patients (14%) and poor was 2 patients (9%). 1 patient complained a dizziness and nausea during ESWT. Conclusion: ESWT for postoperative pain after ankle surgery shows satisfactory pain reduction in 76% of all patients without severe complication.

• Journal of Korean Neurosurgical Society
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• v.30 no.12
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• pp.1399-1405
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• 2001

Objectives : Gliomatosis cerebri is an uncommon primary brain tumor characterized by diffuse neoplastic proliferation of glial cells, with the preservation of the underlying cytoarchitecture. The aim of this study is to evaluate clinical features, outcome of surgical treatment and adjuvant therapy of gliomatosis cerebri. Methods : Between Jan. 1990 and Dec. 2000, 12 patients were diagnosed with gliomatosis cerebri based on characteristic radiological and histological findings. The patients' age ranged from 18 to 77(mean 44) years and the male to female ratio was 7 : 5. Nine patients underwent decompressive surgery and three, biopsy only. Postoperative radiation therapy was given in all cases except three. In addition to radiation therapy, four patients received chemotherapy. The mean duration of follow-up period was 18.8 months. Results : The most common presenting symptom were seizure and motor weakness. The mean duration of symptom was 5.9 months. There was 5 bilateral lesions and tumor involved corpus callosum in 5, basal ganglia-thalamus in 4, and brain stem in 2. There was no operative mortality but four patients died during the follow-up. The mean survival period for 11 patients was 20.5 months from the time of diagnosis. In univariate analysis, the lesion involving corpus callosum, basal ganglia-thalamus and brain stem correlated significantly with the short length of survival(p<0.05). Also, postoperative radiation as a adjuvant therapy prolonged the patient's survival(p<0.05). Conclusions : In the management of gliomatosis cerebri patients, early detection by MR imaging, active management of increased intracranial pressure, decompressive surgical removal and postoperative adjuvant therapy such as radiation is thought to be a good treatment modality.

• Journal of Korean Physical Therapy Science
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• v.1 no.1
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• pp.145-163
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• 1994

This study was done to determine differences in effect of postoperative pain control in patients receiving auricular electroacustimulation vs transcutaneous electrical nerve stimualtion following total knee replacement surgery. Thirty-one cases referred to physical therapy department after treated by total knee replacement surgery by orthopedic surgery department at the Pohang St. Mary's Hospital from January 1993 through June 1994. Of 31 total knee replacement cases, 13 cases were auricular electroacustimulation group, 11 cases were transcutaneous electrical nerve stimulation group, and 7 cases were control group. The results of the study summerized are as follows: Thirty-one total knee replacement cases(male in 12 cases, female in 19 cases), ranging in age from 34 to 61 years(mean${\pm}$SD=49.90 7.56) with diagnoses of degenerative arthritis(20 cases), rheumatoid arthritis(9 cases), and other(2 cases). In auricular electroacustimulation group, there was a significant change of pain intensity, unpleasantness, and active range of motion after treatment(p<0.01). In transcutaneous electrical nerve stimulation group, there was a significant change of pain intensity, unpleasantness, and active range of motion after treatment(p<0.01). In control group, did not show significant pre-posttreatment differences in pain intensity, unpleasantness, active range of motion(p>0.05). The mean change in pain intensity and unpleasantness, active range of motion from pretreatment baseline for the 3 groups. Auricular electroacustimulation group showed the large magnitude of increase in pain intensity and unpleasantness, active range of motion when compared to its own pretreatment cycle. Transcutaneous electrical nerve stimulation group showed small magnitude of increase in pain intensity and unpleasantness, active range of motion when compared to its own pretreatment cycle. No significant changes were observed in control group. Highly significant differences in pain intensity, unpleasantness, and active rage of motion were found using an ANOVA measures between treatment groups and control group(p<0.01). The squares correlation coefficients of pain and function measures pretreatment-posttreatment differences for each group. In treatment group, there was significant correlation between pain scale and function(p<0.001). In control group, there was no correlation between the pain scale and function (p>0.05). The continuous study is needd for many interesting issues of auricular electroacustimulation in new future.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.1
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• pp.42-48
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• 2006

Open reduction and rigid internal fixation is the most popular treatment method for maxillofacial fracture patients, and it is unevitable that postoperative pain can be developed. Many surgeons including oral & maxillofacial surgeons have made constant efforts to decrease postoperative pain. This study is a comparison of postoperative analgesia and intramuscular analgesia in patients with mandibular fractures. In this study, twenty-one patients (Experimental group) were randomly selected and they were injected with IV patient-controlled analgesia (PCA; Walkmed$^{(R)}$, USA). For control group another twenty-one patients were injected with intramusclar non-steroid anti-inflammatory drugs (Rheoma$^{(R)}$, Samsung Pharm. Co.). And then, we measured visual analogue scale (VAS) scores from first postoperative day to second day at regular time interval. The following results were uptained; 1. In patient group who with open reduction and rigid internal fixation, there was significant difference of postoperative analgesic effect during the first postoperative day(p<0.05). 2. In patient group with over 90 minutes surgery time, there was significant difference of postoperative analgesic effect during the first and second postoperative day when compared between experimental group and control group(p<0.05). 3. In patient group with less than 90 minutes surgery time, there was no significant difference of postoperative analgesic effect during the first and second postoperative day when compared between experimental group and control group(p>0.05). 4. In patient group with surgery of open reduction using rigid internal fixation at single fractured site, there was no significant difference of postoperative analgesic effect during the first and second postoperative day when compared between experimental group and control group(p>0.05). 5. In patient group with surgery at two fractured sites, there was significant difference of postoperative analgesic effect during the first postoperative day when compared between experimental group and control group(p<0.05). As mentioned above, it suggest that patient-controlled analgesia is more effective for postoperative pain relief than intramuscular injection in patients with rigid internal fixation by open reduction after mandibular fracture occurred. Especially, it is considered that in patient with more than 90 minutes surgery time or in cases with multiple fractured sites had more effective results with PCA therapy than conventional intramuscular analgesics.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.9
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• pp.4013-4018
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• 2015

Objective: To explore the clinical application of recombinant human endostatin (Endostar) in the treatment of patients with non-small cell lung cancer (NSCLC) in Chinese mainland. Materials and Methods: A total of 75 patients diagnosed as NSCLC were randomly divided into control group (37 cases) and treatment group (38 cases). Control group was treated with postoperative complementary chemotherapy containing two-agent platinum protocol on postoperative d21, 3 weeks as a cycle, for totally 4~6 cycles. On this basis, treatment group was added with Endostar $7.5mg/m^2$ on postoperative d8~9, 3~4 h/time, qd, 14 weeks as a cycle, for totally 4 cycles. The interval between every two cycles was 7 d. The 5-year progression-free survival (PFS), 5-year survival time and complications in both groups were observed. Results: Compared with control group, the average PFS increased evidently in treatment group by 9.8 months (41.6 months vs. 31.8 months), and there was significant difference (P<0.05). And the median PFS was 42.5 months in treatment group, obviously longer than that in control group (33.7 months) by 8.8 months (P<0.05). Additionally, the 5-year overall survival rate (OS), average survival time and median survival time (MST) were 47.4%, 50.1 months and 59.3 months in treatment group, significantly higher than the 29.7%, 42.1 months and 43.5 months in control group (P<0.05). Only 1 patient showed poor healing of surgical wound in treatment group, but no surgery-associated complication was found in control group. Moreover, the postoperative complementary therapy-connected complication rates were 63.2% (24/38) and 59.5% (22/37) in treatment group and control group respectively, but there was no significant difference (P>0.05). Conclusions: The application of Endostar combined with sensitive platinum-contained chemotherapeutic agents in the postoperative complementary chemotherapy can be widely used in clinic because it can significantly prolong the long-term survival time of patients with NSCLC.

• Radiation Oncology Journal
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• v.18 no.3
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• pp.177-181
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• 2000

Purpose : Rarity of olfactory neuroblastoma makes it difficult for treating Physician to Practice with a consistent protocol. This study is peformed to analyze our experience with various treatment modalities for patients with olfactory neuroblastoma. Discussion includes review of some recently published literatures. Methods and Materials : Between June of 1979 and April of 1997, 20 patients were treated under the diagnosis of olfactory neuroblastoma at Seoul National University Hospital. There were 14 male and 6 female patients. Age at initial treatment ranged from l3 to 77 years with median or 24 years. fifteen or 20 patients had Kadish stage C. They were treated with various combinations of surgery, radiation therapy and chemotherapy; surgery+postoperative radiation therapy+adjuvant chemotherapy for 2 patients, surgery+postoperative radiation therapy for 6, neoadjuvant chemotherapy+surgery for 1, surgery+adjuvant chemotherapy for 1, surgery only for 2, neoadiuvant chemotherapy+ radiation therapy for 3, radiation therapy+adjuvant chemotherapy for 1, radiation therapy only for 3, and no treatment for 1 patient. Results : Follow-up ranged from 2 month to 204 months with mean of 39.6 months. The overall 5- and 10-year survival rates are 20% and 10%, respectably. Four patients are alive at the time of data analysis. One of four living patients was treated with radical surgery, postoperative radiation therapy and adjuvant chemotherapy, two patients with radical surgery and postoperative radiation therapy, and one with radical surgery only. Conclusion : Multidisciplinary approach, including radical surgery, pre- or post-operative radiation therapy and chemotherapy, should be addressed at the initial time of diagnosis. Although limited by small number of the patients, this study suggests importance of local treatment modality, especially radical surgery in the treatment of lofactory neuroblastoma.

• Journal of Korean Neurosurgical Society
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• v.39 no.1
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• pp.32-35
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• 2006

Objective : Hemangiopericytoma is known as a malignant tumor originating from pericytes and rarely occurs in the central nervous system. We present 6 cases of pathologically confirmed meningeal hemangiopericytoma. Methods : Retrospective study was done based on patient's recordings including radiological studies. Each case of tumors was treated surgically and postoperative radiotherapy was done. Results : There were 5 cases of intracranial and 1 case of spinal hemangiopericytomas. Three of 5 intracranial hemangiopericytomas were located at tentorial region. Total tumor removal was done in 4 cases and postoperative local recurrence (or regrowth) was noted in 3 cases despite of postoperative external radiation therapy, 2 of which had died. Conclusion : Our cases show more frequent tentorial locations and poor clinical outcomes of hemangiopericytomas compared with meningiomas.

• Journal of Chest Surgery
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• v.20 no.4
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• pp.780-785
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• 1987

Pulmonary atresia with VSD is uncommon congenital anomaly with high mortality in neonatal period. Recently we experienced surgical correction of 2 cases of pulmonary atresia with VSD. The first case was 7-year old female patient and diagnosed as pulmonary atresia with VSD combined PDA. So, total correction was undertaken which consisted of PDA ligation, patch repair of VSD, transannular enlargement of RVOT with woven Dacron vascular graft, and closure of PFO. Postoperative systemic Rt. ventricular and radial artery pressure ratio was 0.44 and her postoperative course was uneventful. The second case was 6-year old male patient diagnosed as pulmonary atresia with VSD and large systemic-pulmonary collateral arteries. There were two large systemic-pulmonary collaterals, one was simply controlled by ligation, but the other was considered to supply Rt. upper lung. So end to side anastomosis was performed to the RVOT patch. Postoperative systolic Rt. ventricular and radial artery pressure ratio was 0.54. During the follow up period he showed clinical picture of Rt. heart failure, which is relatively well controlled with anticongestive therapy.

• Journal of Chest Surgery
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• v.23 no.3
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• pp.522-526
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• 1990

We have experienced 2 cases vocal cord paralysis after open heart surgery. One was a postoperatively developed right unilateral vocal cord paralysis after prosthetic mitral valve replacement with tricuspid valve annuloplasty. The other was a postoperative left unilateral vocal cord paralysis after prosthetic aortic and mitral valve replacement with tricuspid annuloplasty. They were intubated for forty-eight and seventy-two hours but after extubation complained of hoarseness, aphonia, anxiety, and ineffective coughing Indirect laryngoscopy performed at about postoperative one week, revealed partial paralysis and decreased mobility of the vocal cord. After active phonation therapy, symptoms were improved gradually and in the follow up indirect laryngoscopy, the vocal cord paralysis was improved. The symptoms were recovered completely at about postoperative one month in both. The cause of vocal cord paralysis after open heart surgery may be any retraction or stretching injury to the recurrent laryngeal nerve, especially right side, during median sternotomy retraction and open heart operation procedures. As a result, avoid of excessive spread of median sternotomy retractor and excessive manipulation and retraction of the heart during open heart procedures will reduce the occurrence of the vocal cord paralysis.