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The Result of Bone Grafting for Fibrous Dysplasia (섬유성 골 이형성증에서 시행한 골 이식술의 결과 분석)

  • Jeong, Won-Ju;Kim, Tae-Seong;Cho, Hwan-Seong;Yoon, Jong-Pil;Park, Il-Hyung
    • The Journal of the Korean bone and joint tumor society
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    • v.20 no.2
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    • pp.74-79
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    • 2014
  • Purpose: Fibrous dysplasia is related to the mutation of gene encoding the alpha-subunit of a signal-transducing G-protein and has variable clinical course. Operation can be performed to prevent functional disorder or structural deformity. After curettage, autologous bone graft were used to fill the defects after curettage. The aim of this study is to compare the result of autogenous cancellous bone grafting and allogenic bone grafting for fibrous dysplasia. Materials and Methods: Among the patients who visit our hospital during the period of April, 1997 to October, 2013, we selected 34 patients who diagnosed fibrous dysplasia and visited our clinic over 1 year. There were 13 males and 21 females. Average age was 26.4 (range 2 to 57) years old. Autogenous bone graft (group I) in 5 cases, Non-autogenous bone graft (group II) in 30 cases. Iliac bone is used in all cases of autogenous bone graft. There were no significant difference in age, follow-up period, preoperational laboratory finding between two groups. Radiographic image was done to evaluate the recurrence of fibrous dysplasia or secondary degeneration. Results: There were four cases in recurrence (group I: 1 case, group II: 3 cases, p=0.554). In all recurrent cases, reoperations were done using curettage and autogenous iliac bone graft. There was no re-recurrence after reoperation. One case of secondary aneurysmal bone cyst was confirmed (group II) and 1 cases of pathologic fractures had developed (group I: 0 case, group II: 1 cases, p=0.559). No malignant change occurred. Conclusion: There were no significant difference between autogenous bone graft group and non-autogenous bone graft group. Our result suggested that autogenous bone graft seems to be good method to treat fibrous dysplasia, in the case of small volume of tumor lesion or non-weight bearing portion.

Assessment of Nutrition Status and Quality of Life after Curative Resection in Patients with Upper Gastric Cancer: Comparison of Total Gastrectomy and Proximal Gastrectomy (상부 위암에 대한 근위부 위절제술 뜻 위전절제술을 시행한 환자의 영양상태와 삶의 질 비교)

  • Lee, Hyun-Soo;Park, Jong-Hyun;Choi, Hun;Kim, Jae-Hee;Min, Lac-Kee;Lee, Sang-Il;Noh, Seung-Moo
    • Journal of Gastric Cancer
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    • v.5 no.3 s.19
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    • pp.152-157
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    • 2005
  • Purpose: A total gastrectomy is generally peformed for the treatment of upper third gastric cancer. However, the optimal extent of resection for early-stage upper third gastric cancer is still controversial. In this research, we compared the nutritional status and the quality of life in patients who underwent a total gastrectomy with uncut Roux en Y esophagojejunostomy with those in patients who underwent a proximal gastrectomy with esophagogastrostomy for treatment of upper third gastric cancer. Materials and Methods: We reviewed 50 patients with no evidence of recurrent disease following curative surgery for upper third gastric cancer. Among this group, 25 patients underwent a total gastrectomy (TG) and 25 patients a proximal gastrectomy (PG). 8 TG and 4 PG patients were excluded from this study because of death, refusal to interview etc. The nutritional status was assessed by measuring body weight, serum albumin, serum hemoglobin, and serum total protein. The gastrointestinal function and the quality of life were assessed by Cuschieri grading and modified Visick qrading. Results: In analysis of covariance of age and preoperative serum albumin, PG patients demonstrated lower weight loss (P=0.038), elevated serum albumin (P=0.049), and better outcome based on modified Visick grading (P=0.016) than TG, but there were no significant differences in the serum hemoglobin change (P=0.165), serum total protein change (P=0.435), and Cuschieri grading (P=0.064) between the preoperative and the postoperative data. Conclusion: In this study, a proximal gastrectomy led to a better nutritional status and quality of life than a total gastrectomy, as judged from the low weight loss, elevated serum albumin and better modified Visick grade.

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Clinical Manifestations of 15 Cases of Pulmonary Sequestration (폐격리증 15예의 임상양상에 관한 고찰)

  • Park, Kwang-Joo;Kim, Eun-Sook;Kim, Hyung-Jung;Chang, Joon;Ahn, Chul-Min;Kim, Sung-Kyu;Lee, Won-Young;Kim, Sang-Jin;Lee, Doo-Yun
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.2
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    • pp.401-408
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    • 1997
  • Background : Pulmonary sequestration is a rare congenital malformation, which is manifested by formation of nonfunctioning lung tissue lacking normal communication with the tracheobronchial tree. The preoperative diagnostic rate has been relatively low, and without consideration of pulmonary sequestration, unexpected bleeding from aberrant vessels may be a serious problem during the operation. The purpose of our study is to describe the clinical features of pulmonary sequestration based on a review of 15 cases treated by operation. Method : Fifteen patients with pulmonary sequestration who had undergone surgical treatment from 1991 through May 1996 at Yongdong Severance Hospital and Severance Hospital were reviewed retrospectively. Results : The mean age of the patients was 22.5 years (range 5~57), and male to female ratio was 9 : 6. Clinical presentations varied from recurrent respiratory infections such as fever, cough, and sputum or chest pain to no symptom. The chest simple X-rays showed multicystic shadow(10/15) and solid mass-like shadow(5/15). The chest CT scans, done in twelve cases, showed multicystic lesion with or without lung infiltration(8/12), solid mass-like lesion(4/12), The chest MRIs, done in three cases, revealed the aberrant arteries originating from descending aorta(2/3). Aortograms, done in four cases, showed the aberrant arteries originating from descending thoracic aorta(2/4), abdominal aorta(I/4), and intercostal artery(1/4). and the venous returns were via the pulmonary veins. Pulmonary sequestration was considered preoperatively in six patients of fifteen. Other preliminary diagnosis were lung tumor(3/15), lung abscess(21/15), bronchiectasis(2/15), and mediastinal tumor(2/15). In the operative findings, twelve cases were of intralobar type and three cases of extralobar type. The left lower lobe was most often affected(9/15) and one extralobar sequestration was in the pericardium. The aberrant arteries originated from descending thoracic aorta(6/15), abdominal aorta(1/15), internal thoracic arteries (2/15), intercostal artery(1/15), pericardiophrenic artery(1/15), but in four cases, the origins could not be defined. There was no mortality or complication postoperatively. Conclusion : In our study, preoperative diagnostic rate was relatively low, and clinical features were similar to previous reports. Preoperative vigorous diagnostic approach including aortography is strongly advocated not only for its diagnostic value, but also for accurate localization of the aberrant vessels, which is major concern to surgical procedure.

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Talc Pleurodesis via Video-Assisted Thoracoscopic Surgery(VATS) in Malignant Pleural Effusions (악성 흉막삼출 환자에서 비디오 흉강경을 이용한 Talc 흉막유착술)

  • Park, Sang-Joon;Ahn, Seok-Jin;Kang, Kyeong-Woo;Koh, Young-Min;Suh, Gee-Young;Chung, Man-Pyo;Kim, Ho-Joong;Kwon, O-Jung;Kim, Kwhan-Mien;Kim, Jhin-Gook;Shim, Young-Mog;Rhee, Chong-H
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.4
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    • pp.785-794
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    • 1998
  • Background: Chemical pleurodesis is a widely used method for the control of symptomatic and recurrent malignant pleural effusions. Talc has been accepted to be the most effective sclerosing agent for chemical pleurodesis. This study was undertaken to evaluate the usefulness of talc pleurodesis via video-assisted thoracoscopic surgery (VATS) in treatment of malignant pleural effusions. Methods : A retrospective analysis of the medical records and radiographic findings was performed. The success of the procedure was defined as daily pleural fluid drainage below 100ml within 1 week after pleurodesis and complete expansion of the lung on simple chest radiograph. Recurrence was defined as reaccumulation of pleural fluid on follow-up chest radiographs, and complete response as no fluid accumulation on follow-up chest radiographs. Results: Between October 1994 and August 1996, talc pleurodesis via VATS was performed in 35 patients. Duration of follow-up ranged from 5 days to 828 days(median 79days). The initial success rate of procedure was 88.6%(31 of 35 cases). Complete responses were observed in 92.8% at 30 days, 75.7% at 90 days and 64.9% at 180 days. Postoperative complications were fever (54.3%), subcutaneous emphysema(11.4%), reexpansion pulmonary edema(2.9%) and respiratory failure(5.7%). But procedure related mortality or respiratory failure was not found. Conclusion: Talc pleurodesis via VATS is a safe and effective method for the control of symptomatic malignant pleural effusions.

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APOPTOTIC EFFECT IN COMBINATION OF CYCLOSPORIN A AND TAXOL ON ORAL SQUAMOUS CELL CARCINOMA CELL LINE THROUGH THE PI-3 KINASE/AKT1 PATHWAY (구강 편평세포암종 세포주에서 Cyclosporin A와 Taxol 투여시 PI-3 kinase/Akt1 Pathway에 의한 세포사멸 병용효과)

  • Kim, Kyu-Young;Lee, Jae-Hoon
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.33 no.5
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    • pp.426-436
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    • 2007
  • Oral cancer take up 2-6% of all carcinomas and squamous cell carcinoma, which is the most common type in oral cancer, has a poor prognosis due to its high metastasis and recurrence rates. In treating oral cancer, chemotherapy to the primary, metastasized and recurrent lesion is a very important and useful treatment, even though its widespread usage is limited due to high general toxicity and local toxicity to other organs. Taxol, a microtubule stabilizing agent, is an anticancer drug that induces cell apoptosis by inhibiting depolymerization of microtubules in between the metaphase and anaphase of the cell mitosis. Recently, its effectiveness and mechanism on various tumor has been reported. However, not much research has been done on the application of Taxol to oral squamous cell carcinoma. Cyclosporin A, which is an immunosuppressant, is being used on cancers and when co-administered with Taxol, effectiveness of Taxol is enhanced by inhibition of Taxol induced multidrug resistance. In this study, Cyclosporin A with different concentration of Taxol was co-administered to HN22, the oral squamous cell carcinomacell line. To observe the cell apoptosis and the mechanisms that take part in this process, mortality evaluation of tumor cell using wortmannin, c-DNA microarray, RT-PCR analysis, cytometry analysis and western blotting were used, and based upon the observation on the effect and mechanism of the agent, the following results were obtained: 1. The HN22 cell line viability was lowest when $100{\mu}M$ of Wortmannin and $5{\mu}g/ml$ of Taxol were co-administered, showing that Taxol participates in P13K-AKT1 pathway. 2. In c-DNA microarray, where $1{\mu}g/ml$ of cyclosporine A and 3mg/ml of Taxol were co-administered, no up regulation of AKT1, PTEN and BAD c-DNA that participate in cell apoptosis was observed. 3. When $1{\mu}g/ml$ of Cyclosporin A was applied alone to HN22 cell line, no difference was found in AKT1, PTEN and BAD mRNA expression. 4. Increased AKT1, mRNA expression was observed when $3{\mu}g/ml$ of Taxol was applied alone to HN22 cell line. 5. When $1{\mu}g/ml$ of Cyclosporin A and Taxol($3{\mu}g/ml\;and\;5{\mu}g/ml$) were co-administered to HN22 cell line, PTEN mRNA expression increased, whereas AKT1 and BAD mRNA decreased. 6. As a result of cytometry analysis, in the group of Cyclosporin A($1{\mu}g/ml$) and Taxol($3{\mu}g/ml$) co-administration, increased Annxin V was observed, which shows that apoptosis occurred by deformation of plasma membrane. However, no significant difference was observed with vary ing concentration. 7. In western blot analysis, no caspase 3 was observed in the group of Cyclosporin A($1{\mu}g/ml$) and Taxol($3{\mu}g/ml$) co-administration. From the results of this study, it can be concluded that synergistic effect can be observed in combination therapy of Taxol and Cyclosporin A on oral squamous cell carcinoma cell line, where decreased activity of the cell line was observed. This resulted in decreased AKT1 and BAD mRNA and increased PTEN mRNA expression and when wortmannin and Taxol were co-administered, the viability decreased which confirms that Taxol decreases the viability of tumor cell line. Hence, when Taxol and cyclosporine A are co-administered, it can be assumed that cell apoptosis occurs through AKt1 pathway.

Effects of CP AP Therapy on Systemic Blood Pressure, Cardiac Rhythm and Catecholamines Concentration in Patients with Obstructive Sleep Apnea (폐쇄성 수면 무호흡에서 CPAP 치료가 전신성 혈압, 심조율 및 catecholamines 농도에 미치는 영향)

  • Kang, Ji-Ho;Lee, Sang-Haak;Choi, Young-Mee;Kwon, Soon-Seog;Kim, Young-Kyoon;Kim, Kwan-Hyoung;Song, Jeong-Sup;Park, Sung-Hak;Moon, Hwa-Sik
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.6
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    • pp.715-723
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    • 2000
  • Background : Obstructive sleep apnea syndrome (OSAS) affects systemic blood pressure and cardiac function. The development of cardiovascular dysfunction including the changes of systemic blood pressure and cardiac rhythm, suggests that recurrent hypoxia and arousals from sleep may increase a sympathetic nervous system activity. Continuous positive airway pressure (CPAP) therapy has been found to be an effective treatment of OSAS. However, only a few studies have investigated the cardiovascular and sympathetic effects of CPAP therapy. We evaluated influences of nasal CPAP therapy on the cardiovascular system and the sympathetic activity in patients with OSAS. Methods : Thirteen patients with OSAS underwent CPAP therapy and were monitored using polysomnography, blood pressure, heart rate, presence of arrhythmia and the concentration of plasma catecholamines, before and with CPAP therapy. Results: The apnea-hypopnea index (AHI) was significant1y decreased (p<0.01) and the lowest arterial oxygen saturation level was elevated significantly after applying CPAP (p<0.01). Systolic blood pressure tended to decrease after CPAP but without statistical significance. Heart rates during sleep were not significantly different after CPAP. However, the frequency and number of types of arrhythmia decreased and sinus bradytachyarrhythmia disappeared after CPAP. Although there was no significant difference in the level of plasma epinephrine concentration, plasma norepinephrine concentration significantly decreased after CPAP (p<0.05). Conclusion : CPAP therapy decreased the apnea-hypopnea index, hypoxic episodes and plasma norepinephrine concentration. In addition, it decreased the incidence of arrhythmia and tended to decrease the systemic blood pressure. These results indicate that CPAP may play an important role in the prevention of cardiovascular complications in patients with OSAS.

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Periodontal Management strategies for the future in Korea (2000년대 치주처치의 전략)

  • Chung, Hyun-Ju;Son, Sung-Hee
    • Journal of Periodontal and Implant Science
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    • v.27 no.3
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    • pp.533-547
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    • 1997
  • In periodontics, much progress was made in the understanding of periodontal disease from 1960s to 1980s and in prevention and management of periodontal disease since the end of 1980s. This presentation will discuss about the prevalence of periodontal disease, treatment need, and provision of periodontal treatment in Korea, and how we could manage the periodontal disease efficiently in the future. According to an epidemiological study in Korea, periodontal disease(including gingivitis) was present in 82% of general population and periodontitis in 30-40% in adult population over 30y and juvenile periodontitis in 0.1% of adolescents. If we consider that at least 17% of these patients may have recurrent or refractory forms, there is obviously an abundance of disease that needs treatment, As a result of increase in life expectancy, senile population over 65 y will be increased from 6% in 1996 to 6.9% in 2000, and tooth retention rate and periodontal treatment need are expected to increase. Periodontists need all the help they can get from the general dentists to control periodontal disease. As for provision, postgraduate course in periodontics started in 1957 in Korea and produced over 700 specialized dentists in periodontics. One report indicated that the periodontists as well as general practitioners did periodontal therapy on only a few periodontal patients, because of specific control by current medical insurance system in Korea. Comprehensive periodontal examination is rarely done in local dental clinic. Therefore, enhancement of periodontal care in medical insurance system and education of simplified periodontal examination such as Periodontal Screening & Recording will make dentists diagnose and manage the management of adult patients is based on the recognition that there are multiple diseases, including gingivitis, chronic adlt periodontitis, and other more aggressive forms of periodontitis, and requires the earliest possible recognition of these three disease categories. In this presentation, we discuss practical approach using PSR to diagnose, manage and refer the patients, to facilitate the separation of the simple from the complex and the predictable from the unpredictable form of periodontal diseases and to integrate diagnostic and therapeutic techniques into private practice today.

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Radiographic Evaluation of Adenoidal Size and Assessment of Impedance Audiometry in Children (소아 인두편도의 방사선적 고찰 및 Impedance 청력검사 소견)

  • 김주일;김철우;이병희;천경두
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1981.05a
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    • pp.41.2-41
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    • 1981
  • Tonsillectomy and adenoidectomy are the most common operations in the ENT field. Recent emphasis on careful selection of patients for these procedures derives from concern for complications of surgery, as well as the immunologic and anatomic functions of tonsils and adenoids. Adenoidectomy can relieve nasopharyngeal airway obstruction caused by enlarge adenoids, and can prevent complications such as heart failure and recurrent or chronic otitis media. We researched 117 cases of tonsilloadenoidectomy patients and 266 patients having routine examination from March, 1979 to February, 1981, and described the A/N ratio derived from linear measurements of lateral radiographs of the nasopharynx. The results of Impedance Audiometry and X-ray films from 117 cases of T&A patients were compared: 1) The average A/N ratio by age groups for 266 cases of normal children showed: 0.508 for age group, 0 to 3 years old, 0.533 for age group, 4 to 6 years old, 0.524 for age group, 7 to 9 years old, 0.519 for age group, 10 to 12 years old, 0.507 for age group, 13 to 15 years old, 0.481 for age group over 15 years old. The peak value lies in the age group of 4 to 6 years old. The sex difference of A/N ratio was not significant. 2) The average A/N ratio by age groups from 117 cases of T&A patients showed: 0.709 for age group, 0 to 3 years old, 0.733 for age group, 4 to 6 years old, 0.693 for age group, 7 to 9 years old, 0.707 for age group, 10 to 12 years old, 0.620 for age group, 13 to 15 years old, 0.756 for age group over 15 years old. 3) Among the 117 cases of T&A patients, the average A/N ratio for 57 cases in normal tympanogram was 0.688 and the average A/N ratio for 60 cases in abnormal tympanogram was 0.705. 4) Among 57 cases in abnormal tympanogram: 6 cases (10.5%) showed 0.40-0.59 of A/N ratio, 44 cases (77.2%) showed 0.60-0.79 of A/N ratio, and 7 cases (12.3%) showed 0.80-0.99 of A/N ratio. 5) Among 117 cases of T&A patients, 3 of 15 cases showing A/N ratio under 0.6, and 67 of 102 cases showing A/N ratio over 0.6, had paranasal sinusitis.

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Arthroscopic Reconstruction in Anterior Shoulder Instability - Prospective Comparison of Anteroinferior Plication Versus Inferior Plication - (견관절 전방 불안정성의 관절경하 재건술 - 전하방 관절낭 중첩술과 하방 관절낭 중첩술의 전향적 비교 -)

  • JP, Warner Jon;Ko, Sang-Hun;Jeon, Hyung-Min
    • Clinics in Shoulder and Elbow
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    • v.12 no.1
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    • pp.27-32
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    • 2009
  • Purpose: We wanted to evaluate the effectiveness of inferior capsular plication for treating the anterior instability of the shoulder by comparing the prospective outcomes and the incidence of complications of the group (group1) that underwent arthroscopic vertical shift of the anteroinferior capsulo-labral complex and plication of the anterior band of inferior glenohumeral ligament and the group (group2) that underwent inferior capsular plication that was augmentated by the same method. Materials and Methods: From March 2005 to August 2007, we compared group 1 (42 cases) that underwent arthroscopic vertical shift of the anteroinferior capsulo-labral complex and plication of the anterior band of the inferior glenohumeral ligament and group 2 (33 cases) that underwent augmentated inferior capsular plication for recurrent anterior instability of the shoulder. The mean age was 22.5 years (range: 17~31 years) in group I, and 21.8 years (range: 16~30 years) in group II. The mean follow up was 23.5 months (range: 12~45 months in group I, and 20.1 months (range: 12~49 months) in group II. We checked the Rowe score and ROM preoperatively and at postoperative 6 months, 1 year and at the last follow up and we compared the incidence of complications. Results: The Rowe score increased from a preoperative mean of 20.6 to the last follow up mean of 86.8 after surgery in group I, and the Rowe score increased from a preoperative mean of 20.5 to the last follow up mean of 94.1 after surgery in group II. For the anterior instability of the shoulder, arthroscopic reconstruction had a good outcome in all of the cases, but group II had better outcomes and less complications than did group I (p<0.05). Conclusion: We thought that arthroscopic vertical shift of the anteroinferior capsulo-labral complex and plication of the anterior band of the inferior glenohumeral ligament with inferior capsular plication can lower the complication rate and show better outcomes.

Accelerated Rehabilitation After Arthroscopic Bankart Repair - A Prospective Randomized Clinical Study - (관절경적 Bankart 봉합술후 적극적 재활치료 - 전향적 임상연구 -)

  • Kim Seung-Ho;Ha Kwon-Ick;Jung Min-Wook;Lim Moon-Sup;Kim Young-Min;Park Jong-Hyuk;Cho Yang-Bum
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.1 no.1
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    • pp.79-88
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    • 2002
  • Purpose: In this prospective, randomized study, we compared the results of early motion versus conventional immobilization after the arthroscopic Bankart repair. Materilal and Methods : We performed an arthroscopic Bankart repair using suture anchors in 62 patients with traumatic anterior shoulder instability and randomized them into two groups; Group 1 (n=28; mean age, 28 years) underwent three-week of immobilization and conventional rehabilitation program, while Group 2 (n=34; mean age, 29 years) underwent an accelerated rehabilitation program with staged range of motion and strengthening exercises starting from the immediate postoperative day. Selected patients were non-athletes with a classic Bankart lesion and a robust labrum. Analysis of outcome included pain scores (6-week and follow-up: 31(9 months), range of motion, return to activity, recurrence, patients’ satisfaction with each program, and shoulder scores (ASES, UCLA, and Rowe). Results : The recurrent rate was not different between the two groups (2 anterior apprehension from each group) (p=0.842). Patients with accelerated rehabilitation resumed functional range-of-motion faster and returned earlier to the functional level of activity (p<0.05). Accelerated rehabilitation decreased postoperative pain and more patients were satisfied with this program (p<0.05). No differences were found between the two groups at the follow-up with regards to the shoulder scores, return to activity, pain score, and the range-of-motion. Conclusions : Early mobilization after arthroscopic Bankart repair does not increase the recurrence rate in selected patients. Although the final outcomes are similar in both groups, the accelerated rehabilitation program promotes functional recovery and reduces postoperative pain, which enables patients an early institution of desired activities.

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