• Title/Summary/Keyword: 제한적 절제술

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Operative Treatment of Patients Over 75 Years Old with Gastric Cancer (75세 이상 고령 위암환자들의 수술치료 성적에 의한 임상적 특성)

  • Lee, Yeon-Ah;Jung, Gui-Ae;Min, Young-Don
    • Journal of Gastric Cancer
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    • v.5 no.4 s.20
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    • pp.217-221
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    • 2005
  • Purpose: The incidence of gastric neoplasms is increasing in the elderly population, and a rational method of treatment for gastric cancer in the elderly is needed to improve survival. The purpose of the present study was to clarify whether the patient's age is an independent prognostic factor and to determine clinicopathological characteristics in the elderly. Material and Methods: Curative or palliative surgery for gastric cancer was carried out on 706 patients in Chosun University Hospital from March 1995 to February 2002. They were divided into the following two groups: elderly group (75 years or older) and control group (under 74 years old). The clinicopathologic features of these patients were reviewed retrospectively, and a multivariate analysis was performed. Results: There was no difference in clinicopathological appearances between the two groups, and the postoperative morbidity and mortality rates were similar in the two groups. The two groups showed similar survival rates. Conclusion: In this study, age was not a prognostic factor in surgery for gastric cancer. In the elderly, an oncologically correct surgical procedure can safely be prosecuted with satisfactory early and late results.

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High Dose Rate Interstitial Brachytherapy in Soft Tissue Sarcomas : Technical Aspect (연부조직종양에서 고선량율 조직내 방사선치료: 기술적 측면에서의 고찰)

  • Chun Mison;Kang Seunghee;Kim Byoung-Suck;Oh Young-Taek
    • Radiation Oncology Journal
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    • v.17 no.1
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    • pp.43-51
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    • 1999
  • Purpose : To discuss the technical aspect of interstitial brachytherapy including method of implant, insertion time of radioactive source, total radiation dose, and complication, we reviewed patients who had diagnoses of soft tissue sarcoma and were treated by conservative surgery, interstitial implant and external beam radiation therapy Materials and Methods : Between May 1995 and Dec. 1997, ten patients with primary or recurrent soft tissue sarcoma underwent surgical resection (wide margin excision) and received radiotherapy including interstitial brachytherapy. Catheters were placed with regular intervals of 1 ~l.5 cm immediately after tumor removal and covering the critical structures, such as neurovascular bundle or bone, with gelform, muscle, or tissue expander in the cases where the tumors were close to those structures. Brachytherapy consisted of high dose rate, iridium-192 implant which delivered 12~15 Gy to 1 cm distance from the center of source axis with 2~2.5 Gy/fraction, twice a day, starting on 6th day after the surgery, Within one month after the surgery, total dose of 50~55 Gy was delivered to the tumor bed with wide margin by the external beam radiotherapy. Results : All patients completed planned interstitial brachytherapy without acute side effects directly related with catheter implantation such as infection or bleeding. With median follow up duration of 25 months (range 12~41 months), no local recurrences were observed. And there was no severe form of chronic complication (RTOGIEORTC grade 3 or 4). Conclusion : The high dose rate interstitial brachytherapy is easy and safe way to minimize the radiation dose delivered to the adjacent normal tissue and to decrease radiation induced chronic morbidity such as fibrosis by reducing the total dose of external radiotherapy in the management of soft tissue sarcoma with conservative surgery.

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Effects of Knee Position during the Graft Fixation of the Arthroscopic Anterior Cruciate Ligament Reconstruction with Autogenous Hamstring Graft (이식 건 고정 시 슬관절 위치가 자가 슬괵건을 이용한 관절경적 전방 십자 인대 재건술 후 결과에 미치는 영향)

  • Lee, Churl-Woo;Yoo, Jae-Doo;Roh, Kwon-Jae;Park, Seong-Pil
    • Journal of the Korean Arthroscopy Society
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    • v.9 no.2
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    • pp.143-147
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    • 2005
  • Purpose: In case of anterior cruciate ligament (ACL) reconstruction, graft tendon is generally fixed in tibial tunnel with knee extended. When reconstructing ACL using hamstring tendon, the authors aim to find out the effect of knee joint position during graft fixation on postoperative knee joint stability and range of motion. Materials and Methods: Prospective study was done on patients who have undergone ACL reconstruction using hamstring tendon from May 2002 to January 2003 We used Rigifix system (Mitek Product, Johnson and Johnson, USA) and Intrafix system for fixation. Thirty nine patients received ACL reconstruction during this period. Excluding 2 patients lost in the follow-up, 37 patients were analyzed. The mean follow-up period was 14 months $(13{\sim}25months)$. Knee position was decided alternatively without any bias. Clinical evaluation was based on Lachman test, pivot shift test, Lysholm score, IKDC(international knee documentation committee) assessment and side to side KT-1000 maximal manual arthrometer difference. Results: After the last follow-up, average postoperative Lysholm score was 93.1 poins(65-98points). According to IKDC score, 26 cases were normal, 10 cases were nearly normal, 1 case was abnormal and we had no case of severe abnormality. The mean difference from the normal side was 2.5 mm under maximal manual loading KT-1000 arthrometer. According to postoperative Lachman test, 32 cases were normal,2 cases were grade I and 1 case was grade II. There were 34 cases of normal, 2 cases of grade I and 1 case of grade II. When using maximal manual KT-1000 arthrometer side to side difference, the difference from the normal side while fixing the tibia at 20'knee flexion was 2.3 mm and at full extention the difference was 2.7 mm. The range of motion at postoperative 1 year showed 5 degree flexion contracture in 1 case at 20 degrees knee flexion and 10 degrees of flexion limitation was observed in 2 cases at full extension. Conclusion: When ACL reconstruction using autogenous hamstring tendon, anterior laxity showed no difference in its stability between two groups. Tibial side fixation at full extension may be helpful in preventing flexion contracture due to overconstrained graft tendon.

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Localized Giant Cell Tumor of Tendon Sheath Arising from the Anterior Cruciate Ligament of the Knee - 2 Cases Report - (슬관절 전방십자인대에 발생한 국소형 건막 거대세포종 - 2례 보고 -)

  • Koo, Bon Seop;Kim, Kyung Chul;Lee, Ho Jooog
    • Journal of the Korean Arthroscopy Society
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    • v.3 no.2
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    • pp.146-149
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    • 1999
  • The localized form of a giant cell tumor of tendon sheath rarely affected the large weight-bearing joints. Only four cases of localized giant cell tumor arising in the knee joint could be found in the literatures. Physical examination of the affected knee could show pain, swelling, locking, giving way and limitation of extension, but it was difficult to differentiate from meniscal tear or cruciate ligament tear. Two cases of localized giant cell tumor of tendon sheath were incidentally found in the knees during the reconstruction of the anterior cruciate ligaments. Both tumors arising from the anterior cruciate ligament were excised arthroscopically and were confirmed to be localized giant cell tumor of tendon sheath by microscopic examination. The clinical results were good after complete excision, so we reported these cases with a review of the literatures.

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Clinicopathological Characteristics of Superficially Spreading Early Gastric Cancer (표층 확장형 조기위암의 임상병리학적 특성)

  • Kwon, Sung-Joon;Kim, Hyoung-Ju
    • Journal of Gastric Cancer
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    • v.5 no.4 s.20
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    • pp.288-294
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    • 2005
  • Purpose: Superficially spreading (SS) early gastric cancer (EGC) is characterized by wide horizontal extension without deep vertical invasion. It is a relatively rare form of EGC, and it's clinicopathological (C-P) characteristics are not evident. This study aimed to clarify their C-P characteristics. Materials and Methods: We defined SS EGC as invading less than the submucosal layer that measured more than 60 mm in diameter or wider than $5{\times}5cm \;(25cm^2)$ in width. The C-P characteristics and prognosis were compared between 69 patients with SS EGC and 319 patients with the common type EGC (EGC except SS type). Results: For SS EGC lymph node metastases, Lauren's diffuse type, lymphatic invasion were significantly higher than in common type EGC. In patients with SS EGC, all of the metastatic lymph nodes were anatomically distributed within the paragastric region, with fewer along the left gastric artery and common hepatic artery. In 6 cases of SS EGC with resection marqins less than 10 mm, there was no death during the follow-up period (4 to 13 years after operation) if margins were not involved. Age (>58 yrs), tumor site (upper 1/3), lymph node metastasis, submucosal invasion were statistically significant poor prognostic factor in univariate survival analysis. In multivariate survival analysis, age and lymph node metastasis were independent prognostic factors. However, tumor diameter or width was not a significant prognostic factor. Conclusion: Although SS EGC has histologically distinct properties, gastrectomy with free surgical margins and appropriate lymph node dissection $(D1+{\beta})$ could be a suitable treatment.

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Engineering Characteristics of Wet-mixing Solidified Soil in Pavement Surfacing (습식 경화교반토 포장의 공학적 특성)

  • Yoo, Ji-Hyeung;Shu, Dong-Hyuk;Lee, Seong-Won
    • International Journal of Highway Engineering
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    • v.6 no.3 s.21
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    • pp.1-7
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    • 2004
  • Roads, like bikeways, parkways and walks, are to be just capable of supporting light traffic and traveling public, but they are required to be human friendly and environmental-oriented. Lately soil-solidifier mixture, a kind of soil-cement, has developed and has been applied to the recycling and environment-oriented pavement as the surfacing material. Soil-solidifier pavement structure has been designed by only experience. To design this pavement mechanically, it is necessary to find out basic engineering properties of soil-solidifier mixture. This study focuses on finding out mechanical characteristics of the mixture according to mixture proportions and aging. Test molds with various mixture proportions are made, and then unconfined strength tests are performed for test molds with aging of the mixture. As the result of this study, it is found that the strength of the mixture increases with amount of cement and that maximum strength is achieved at 6%$\sim$8% of the ratio of solidifier and water. The strength increase rapidly until 14 days, after then slowly. After 28 days the strength of the mixture approaches to the constant value. The heat of hydration during curing of the mixture is measured no significantly. It also shows that temperature characteristics of the mixture is similar to that of soil. Since this mixture is mixed with soil and is able to improve engineering problems in pavement due to temperature, this mixture is expected to use effectively in the environment-oriented pavement for light traffic.

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Para-articular chondroma in the infrapatellar fat pad - A case report - (슬개하 지방체에 발생한 관절 주위 연골종 - 증례 보고 -)

  • Nam, Il-Hyun;Ahn, Gil-Yeong;Moon, Gi-Hyuk;Lee, Yeong-Hyeon;Choi, Seong-Pil;Kim, Jung-Hyun;Paik, Ae-Lan
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.10 no.2
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    • pp.105-108
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    • 2011
  • Extra-skeletal chondroma, characterized by its lack of connection with the adjacent bone, includes synovial chondromatosis, intra-articular and para-articular chondroma, and soft tissue chondroma. Among them, the last two lesions are extremely rare. This is the case about 20-year-old soldier, who had complained of tenderness of the knee, pain and fullness during knee flexion and limitation of motion after a hard military training. We found a mass in the x-ray and MRI and resect the mass surgically, which was a $5.5{\times}4{\times}3$ cm size hard solitary mass. On microscopic finding, it was consisted of lobulated hyaline cartilage and outer fibrous capsule, and we ascertained it as para-articular chondroma. We experienced a case of para-articular chondroma in the infrapatellar fat pad of the knee joint and present its clinical, radiologic and pathologic findings with literature review.

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Alternative Fixation Technique for Bony Bankart Lesion with Using Suture Anchor (봉합나사와 골터널을 이용한 골성 반카르트 병변의 고정)

  • Kim, Byung-Kook;Lee, Ho-Jae;Kim, Go-Tak;Dan, Jinmyoung
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.6
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    • pp.574-578
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    • 2019
  • For the treatment of a bony Bankart lesion accompanied by an acute traumatic shoulder dislocation, anatomical reduction and stable fixation of the bone fragment and glenohumeral ligament are essential to avoid chronic instability or degenerative changes. If the Bankart lesion has large bony pieces or comminuted fragments, it can be difficult to perform precise and secure fixation of the big intraarticular fragment to the fracture site because of the limited visualization of the arthroscopic procedure. In addition, in the case of the open procedure, it requires an extensive surgical dissection to access the fractured fragment, which may cause surgical approach-related morbidity, such as neurovascular complications, delayed subscapularis healing, and increased risk of stiffness. This paper describes an alternative open suture anchor technique for a large bony Bankart lesion, which was secured anatomically with squared knots after a shuttle relay through bony tunnels and adjacent soft tissue and labrum. This technique can achieve anatomical and firm fixation under direct vision, and reduce the number of surgery related morbidities.

Korean Clinical Imaging Guidelines for the Appropriate Use of Chest MRI (한국형 흉부 MRI 영상 진단 정당성 권고안)

  • Jiyoung Song;Bo Da Nam;Soon Ho Yoon;Jin Young Yoo;Yeon Joo Jeong;Chang Dong Yeo;Seong Yong Lim;Sung Yong Lee;Hyun Koo Kim;Byoung Hyuck Kim;Kwang Nam Jin;Hwan Seok Yong
    • Journal of the Korean Society of Radiology
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    • v.82 no.3
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    • pp.562-574
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    • 2021
  • MRI has the advantages of having excellent soft-tissue contrast and providing functional information without any harmful ionizing radiation. Although previous technical limitations restricted the use of chest MRI, recent technological advances and expansion of insurance coverage are increasing the demand for chest MRI. Recognizing the need for guidelines on appropriate use of chest MRI in Korean clinical settings, the Korean Society of Radiology has composed a development committee, working committee, and advisory committee to develop Korean chest MRI justification guidelines. Five key questions were selected and recommendations have been made with the evidence-based clinical imaging guideline adaptation methodology. Recommendations are as follows. Chest MRI can be considered in the following circumstances: for patients with incidentally found anterior mediastinal masses to exclude non-neoplastic conditions, for pneumoconiosis patients with lung masses to differentiate progressive massive fibrosis from lung cancer, and when invasion of the chest wall, vertebrae, diaphragm, or major vessels by malignant pleural mesothelioma or non-small cell lung cancer is suspected. Chest MRI without contrast enhancement or with minimal dose low-risk contrast media can be considered for pregnant women with suspected pulmonary embolism. Lastly, chest MRI is recommended for patients with pancoast tumors planned for radical surgery.

Analysis of Urine Iodine Excretion Decrease by Two-Week Stringent Low Iodine Diet for Remnant Thyroid Ablation with Radioactive Iodine in Korean Patients with Thyroid Cancer; Prospective Study (한국 갑상선암 환자들에서 잔여갑상선 제거를 위한 방사성요오드 치료 전 2주간의 엄격한 저요오드식이에 의한 소변 내 요오드량 감소 분석; 전향적 연구)

  • Choi, Joon-Hyuk;Kim, Hoon-Il;Park, Jang-Won;Song, Eun-Hoon;Ko, Bong-Jin;Cheon, Gi-Jeong;Kim, Byung-Il
    • Nuclear Medicine and Molecular Imaging
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    • v.42 no.5
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    • pp.375-382
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    • 2008
  • A low iodine diet (LID) is the recommended preparation for radioactive iodine treatment. However, the recommended duration and stringency of LID are different among each recommendation. More stringent LID is expected in Korea because Korea is a iodine-rich region. We investigated the decrement of urine iodine excretion by two-week stringent LID for remnant thyroid ablation with radioactive iodine in Korean patients with thyroid cancer, prospectively. Material and Method: From November 2006, patients who referred to our hospital for remnant ablation after total thyroidectomy were included in this study. To decrease total body iodine, our protocol included three strategies. First, we checked medication which could inhibit the radioactive iodine uptake. Second, the date of 1-131 treatment was scheduled at least 3 months later if contrast agent had been used. The last strategy was two-week stringent LID education by specialized nutritionist. Before and after two-week stringent LID, 24hr-urine iodine was analyzed respectively. 24hr-urine creatinine was also analyzed for determining more valid 24hr urine sampling subgroup. Results: Total 51 patients were finally enrolled. Average of 24hr-urine iodine excretion was significantly lowered ($787{\pm}2242\;{\rightarrow}\;85{\pm}85\;{\mu}g/d$, p=0.03) after LID and 74.4% of patients reached below the recommended urine iodine excretion level ($<100\;{\mu}g/d$). In subgroup (n=14), similar results was showed ($505{\pm}666\;{\rightarrow}\;99{\pm}116\;{\mu}g/d$, p=0.05) and 78.6% of patients met the criteria. Conclusion: Most patients could reach below the recommended urine iodine level after two-week stringent LID. Therefore, in our opinion, at least two-week stringent LID should be recommended in Korea.