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Surgical Decision for Elderly Spine Deformity Patient (노인 척추 변형 환자의 수술적 결정)

  • Kim, Yong-Chan;Juh, Hyung-Suk;Lee, Keunho
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.1
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    • pp.1-8
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    • 2019
  • Globally, the elderly population is increasing rapidly, which means that the number of deformity correction operations for elderly spine deformity patient has increased. On the other hand, for aged patients with deformity correction operation, preoperative considerations to reduce the complications and predict a good clinical outcome are not completely understood. First, medical comorbidity needs to be evaluated preoperatively with the Cumulative Illness Rating Scale for Geriatrics or the Charlson Comorbidity Index scores. Medical comorbidities are associated with the postoperative complication rate. Managing these comorbidities preoperatively decreases the complications after a spine deformity correction operation. Second, bone densitometry need to be checked for osteoporosis. Many surgical techniques have been introduced to prevent the complications associated with posterior instrumentation for osteoporosis patients. The preoperative use of an osteogenesis inducing agent - teriparatide was also reported to reduce the complication rate. Third, total body sagittal alignment need to be considered. Many elderly spine deformity patients accompanied degenerative changes and deformities at their lower extremities. In addition, a compensation mechanism induces the deformed posture of the lower extremities. Recently, some authors introduced a parameter including total body sagittal alignment, which can predict the clinical outcome better than previous parameters limited to the spine or pelvis. As a result, total body sagittal alignment needs to be considered for elderly spine deformity patients after a deformity correction operation. In conclusion, for elderly spine deformity patients, medical comorbidities and osteoporosis need to be evaluated and managed preoperatively to reduce the complication rate. In addition, total body sagittal alignment needs to be considered, which is associated with better clinical outcomes than the previous parameters limited to the spine or pelvis.

The Effects of Autologous Blood Pleurodesis in the Pneumothorax with Persistent Air Leak (지속성 기흉에서 자가혈액을 이용한 흉막유착술의 효과)

  • Yoon, Su-Mi;Shin, Sung-Joon;Kim, Young-Chan;Shon, Jang-Won;Yang, Seok-Chul;Yoon, Ho-Joo;Shin, Dong-Ho;Chung, Won-Sang;Park, Sung-Soo
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.6
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    • pp.724-732
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    • 2000
  • Background : In patients with severe chronic lung diseases even a small pneumothorax can result in life-threatening respiratory distress. It is important to treat the attack by chest tube drainage until the lung expands. Pneumothorax with a persistent air leak that does not resolve under prolonged tube thoracostomy suction is usually treated by open operation to excise or oversew a bulla or cluster of blebs to stop the air leak. Pleurodesis by the instillation of chemical agents is used for the patient who has persistent air leak and is not good candidate for surgical treatment. When the primary trial of pleurodesis with common agent fails, it is uncertain which agent should be used f or stopping the air leak by pleurodesis. It is well known that inappropriate drainage of hemothorax results in severe pleural adhesion and thickening. Based on this idea, some reports described a successful treatment with autologous blood instillation for pneumothorax patients with or without residual pleural space. We tried pleurodesis with autologous bood for pneumothorax with persistent air leak and then we evaluated the efficacy and safety. Methods : Fifteen patients who had persistent air leak in the pneumothorax complicated from the severe chronic lung disease were enrolled. They were not good candidates for surgical treatment and doxycycline pleurodesis failed to stop up their air leaks. We used a mixture of autologous blood and 50% dextrose for pleurodesis. Effect and complications were assessed by clinical out∞me, chest radiography and pulmonary function tests. Results : The mean duration of air leak was 18.4${\pm}$6.16 days before ABP (autologous blood and dextrose pleurodesis) and $5.2{\pm}1.68$ days after ABP. The mean severity of pain was $2.3{\pm}0.70$ for DP(doxycycline pleurodesis) and $1.7{\pm}0.59$ for ABDP (p<0.05). There was no other complication except mild fever. Pleural adhesion grade was a mean of $0.6{\pm}0.63$. The mean dyspnea scale was $1.7{\pm}0.46$ before pneumothrax and $2.0{\pm}0.59$ after ABDP (p>0.05). The mean $FEV_1$ was $1.47{\pm}1.01$ before pneumothorax and $1.44{\pm}1.00$ after ABDP (p>0.05). Except in 1 patient, 14 patients had no recurrent pneumothorax. Conclusion : Autologous blood pleurodesis (ABP) was successful for treatment of persistent air leak in the pneumothorax. It was easy and inexpensive and involved less pain than doxycycline pleurodesis. It did not cause complications and severe pleural adhesion. We report that ABP can be considered as a useful treatment for persistent air leak in the pneumothorax complicated from the severe chronic lung disease.

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A Study on the Psychosocial Characteristics and Quality of Life in Functional Gastrointestinal Disorders (기능성위장질환 환자들의 정신사회적 특성 및 삶의 질의 관계에 관한 연구)

  • Kim, So-Won;Jang, Seung-Ho;Ryu, Han-Seung;Choi, Suck-Chei;Rho, Seung-Ho;Lee, Sang-Yeol
    • Korean Journal of Psychosomatic Medicine
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    • v.27 no.1
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    • pp.25-34
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    • 2019
  • Objectives : This study aimed to compare the psychosocial characteristics among patients with functional gastrointestinal disorder (FGID), adults with functional gastrointestinal symptoms, and normal control group and investigate factors related to quality of life (QoL) of FGID patients. Methods : 65 patients diagnosed with FGID were selected. 79 adults were selected as normal control group based on the Rome III diagnostic criteria, and 88 adults who showed functional gastrointestinal symptoms were selected as "FGID positive group". Demographic factors were investigated. Psychosocial factors were evaluated using the Korean-Beck Depression Inventory-II, Korean-Beck Anxiety Inventory, Korean-Childhood Trauma Questionnaire, Multi-dimensional Scale of Perceived Social Support, Connor-Davidson Resilience Scale and WHO Quality of Life Assessment Instrument Brief Form. A one-way ANOVA was used to compare differences among groups. Pearson correlation test was used to analyze correlations between QoL and psychosocial factors in patients with FGID. Results : There were group differences in the education level. Depression (F=29.012, p<0.001), anxiety (F=27.954, p<0.001) and Childhood trauma (F=7.748, p<0.001) were significantly higher in FGID patient group than in both FGID-positive and normal control group. Social support (F=5,123, p<0.001), Resilience (F=9.623, p<0.001) and QoL (F=35.991, p<0.001) were significantly lower in the FGID patient group than in others. QoL of FGID patients showed a positive correlation with resilience (r=0.475, p<0.01), and showed a negative correlation with depression (r=-0.641, p<0.01), anxiety (r=-0.641, p<0.01), and childhood trauma (r=-0.278, p<0.05). Conclusions : FGID patients have distinctive psychosocial factors compared to the both FGID-positive and normal control group. Therefore, the active interventions for psychosocial factors are required in the treatment of patients with FGID.

Investigation of the location of Jagiso eunchon in Goheung-hyeon and review the characteristics of Undae-ri kiln (고흥현 자기소(磁器所) 은촌(犾村)의 위치 탐색과 운대리 가마터 성격 검토)

  • SUNG Yungil
    • Korean Journal of Heritage: History & Science
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    • v.56 no.4
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    • pp.72-92
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    • 2023
  • As described above, the location of Jagiso eunchon in Goheung-hyeon and the nature of Undae-ri kiln site were examined. Goheung-hyeon's administrative agency was moved to Joyang-hyeon, which is now Joseong-myeon, Boseong-gun in 1395. Therefore, Goheung-hyeon Jagiso Eunchon in Sejongsillok Jiriji corresponding to 1424~1432 should be found in the west of Joseong-myeon, Boseong, where the administrative agency was moved in 1395. Among the four boundaries of Goheung-hyeon recorded in the 『Sejongsillok』 Jiriji, it is recorded as 2-ri by the sea in the south and 8-ri by Nakan in the east. If the current Goheung-hyeon is Goheung-hyeon's administrative agency in the Sejongsillok Jiriji Records Compilation Period, it cannot be the boundary the south and east mentioned above. This is because it cannot be 2-ri from the current Goheung-eup to the sea in the south, and Nakan is close to the north, not the east, as recorded. However, it has already been suggested that Joyanghyeonseong(朝陽縣城), located in Gonae Village, Ucheon-ri, Josung-myeon, Boseonggun is an Goheunghyeon's administrative agency. And if the four-way boundary of Goheung-hyeon was converted into the current distance unit based on this place(Joyanghyeonseong, 朝陽縣城), an approximate result could be obtained even if it did not exactly match. Therefore, it is highly likely that Goheung-hyeon's administrative agency, which was moved to Joyang-hyeon, Boseong in 1395, is Gonae Village, Ucheon-ri, JoSeong-myeon, Boseong. Jagiso eunchon(犾村) in Goheung-hyeon can be interpreted as a "dog-shouting village." It is thought to be a meaning structure of "animal + sound". A place name thought to have the same structure was identified in Jeongheung-ri, west of Ucheon-ri, Joseongmyeon, Boseong. It is the name of a village called Hoeum-dong(虎吟洞), and it is interpreted as the sound of a tiger or the bark of a tiger, which is the same as the meaning structure of Eunchon. However, there is Gaesan Village in the south of Hoeum-dong, and a Buncheong ware kiln site was identified around it. At this kiln site, a fragment of carved Buncheong ware engraved with the character "Eon", which corresponds to the right stroke of the character "Seom (贍)" in the name "Naeseom (內贍)" was identified. A small amount of Buncheong ware and Joseon celadon pieces were also identified. It can be seen that the Buncheong ware paid to the government was made by checking the Buncheong ware with the government name engraved on it. On the west side of Joyanghyeonseong Fortress in Ucheon-ri, joseong-myeon, Boseong, which was the administrative agency of Goheung-hyeon and the area around the Gaesan Buncheong ware kiln site in Jeongheung-ri, where the Buncheong ware paid to the government was, is thought to be Jagiso Eunchon, Goheung-hyeon. Jagiso and Dogiso are located in the four directions based on the administrative agency. Naturally, the location of Jagiso and Dogiso is also determined on where the administrative agency of Hyeon is. Since the Goheung-hyeon's administrative agency in the early Joseon Dynasty was moved to Ucheon-ri, joseong-myeon, Boseong-myeon, it is necessary to naturally find Jagiso and Dogiso in Boseong. In addition, regarding the nature of the kiln site in Undae-ri, the aspects of the excavated relics were considered. As a result, it is believed that the Undae-ri kiln site functioned as a jagiso in Heungyang-hyeon from February 1441 to the 1470s. If so, the "Ye" Buncheong ware, which was collected around Undae-ri kiln No. 7, could be naturally understood.