• Title/Summary/Keyword: Conservative methods

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The Effect of Percutaneous Bilateral Metalic Stent for Hilar Cholangiocarcinoma (간문부 담관암 환자에서 경피경관 양측성 금속 배액관의 효과)

  • Kim, Kum-Rae;Kim, Joo-Hyung;Park, Won-Kyu;Jang, Jay-Chun;Cho, Jae-Ho;Kim, Tae-Nyen;Kim, Jun-Hwan;Jang, Byeng-Ik
    • Journal of Yeungnam Medical Science
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    • v.22 no.2
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    • pp.211-220
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    • 2005
  • Background: The purpose of this study was to determine the effectiveness of a percutaneously placed self-expanding metallic stent for the relief of biliary obstruction in patients with hilar cholangiocarcinoma. Materials and Methods: From November 2001 to December 2004, 48 patients with hilar cholangiocarcinoma were prospectively studied. After percutaneous placement of bilateral selfexpanding, uncovered metallic stents, follow-up evaluation was carried out until July 2005. Results: There were 4 cases of Bismuth type II, 21 cases of Bismuth type IIIa, 8 cases of Bismuth type IIIb and 15 cases of Bismuth type IV. Stent placement was technically successful in all patients. All patients had satisfactory biliary drainage, resulting in one week drainage rate of 72.8% and final drainage rate of 91.1%. There were 12 cases (21.3%) of abdominal pain requiring analgesics and 1 case (7.1%) of cholangitis; both were successfully managed with conservative treatments. Late complications occurred in four patient (8.3%), including two patients with cholangitis, one patient with liver abscess, and one patient with biloma; all were appropriately managed by percutaneous drainage. The average length and median durations of stent patency and median survival time were 303 days (range, 60~815) and 338 days (range, 60~1175), respectively. Conclusion: Placement of a percutaneous metallic stent is an effective and safe method for palliation of patients with hilar cholangiocarcinoma.

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External Tibial Torsion with Proximal Tibia Vara in Total Knee Arthroplasty of Advanced Osteoarthritis with Severe Varus Deformed Knees (심한 내반 변형의 진행성 관절염 환자의 인공 슬관절 전치환술 시 경골 근위부의 내반을 동반한 외회전 변형)

  • Sun, Doo-Hoon;Song, In-Soo;Kim, Jun-Beom;Kim, Cheol-U;Jung, Deukhee;Jeong, Uitak
    • Journal of the Korean Orthopaedic Association
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    • v.55 no.1
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    • pp.62-70
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    • 2020
  • Purpose: External tibia torsion and proximal tibial vara have been reported in severe varus deformed osteoarthritis, which is a tibio-femoral angle of more than 20°. The radiology measurements were compared with those of control group and the preoperative and follow-up radiology and clinical results were examined. Materials and Methods: From January 2007 to March 2016, 43 knees from 37 persons, who underwent total knee arthroplasty for a severe varus deformity of more than 20° on the tibio-femoral angle on the standing radiographs and had a follow-up period more than two years, were examined. The mean follow-up period was 45.7 months. The control group, who underwent conservative treatments, had Kellgren-Lawrence grade three osteoarthritis and a tibio-femoral angle of less than 3° varus. The external tibial torsion of enrolled patients and control group were estimated using the proximal tibio-fibular overlap length and the tibial torsion values on computed tomography. The proximal tibia vara was measured using the proximal tibial tilt angle. The preoperative and postoperative proximal tibio-fibular overlap length, tibial torsion value, proximal tibial tilt angle, and hospital for special surgery (HSS) score were evaluated. Results: The mean proximal tibio-fibular overlap length was 18.6 mm preoperatively and 11.2 mm (p=0.031) at the follow-up. The control group had a mean proximal tibio-fibular overlap length of 8.7 mm (p=0.024). The mean tibial torsion value was 13.8° preoperatively and 14.0° (p=0.489) at the follow-up. The control group had a mean tibial torsion value of 21.9° (p=0.012). The mean proximal tibial tilt angle was 12.2° preoperatively and 0° (p<0.01) at the follow-up. The control group had a mean proximal tilt angle of 1.2° (p<0.01). The preoperative tibiofemoral angle and mechanical axis deviation were corrected from preoperative 28.3° and medial 68.4 mm to postoperative 0.7° and medial 3.5 mm (p<0.01, p<0.01), respectively. The HSS scores increased from 34 points of preoperatively to 87 points at the last follow-up (p=0.028). Conclusion: Patients with advanced osteoarthritis with a severe varus deformity of more than 20° had significant increases in the external tibial torsion and varus of the proximal tibia. The tibial torsion value before and after surgery in the enrolled patients was not changed statistically, but good clinical results without complications were obtained.

Factors for Survival and Complications of Malignant Bone Tumor Patients with a Total Femoral Replacement (대퇴골 전치환술 받은 악성 골종양 환자의 생존인자와 합병증)

  • Cho, Wan Hyeong;Jeon, Dae-Geun;Song, Won Seok;Park, Hwan Seong;Nam, Hee Seung;Kim, Kyung Hoon
    • Journal of the Korean Orthopaedic Association
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    • v.55 no.3
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    • pp.244-252
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    • 2020
  • Purpose: Total femoral replacement (TFR) is an extreme form of limb salvage. Considering the rarity of this procedure, reports have focused on the complications and a proper indication is unclear. This study analyzed 36 patients with TFR who were asked the following: 1) prognostic factors related to survival in patients who underwent TFR with a tumoral cause; 2) overall implant and limb survival; 3) complications, functional outcome, and limb status for patients surviving for more than 3 years. Materials and Methods: According to the causes for TFR, 36 patients were categorized into three groups: extensive primary tumoral involvement (group 1, 15 cases), tumoral contamination by an inadvertent procedure or local recurrence (group 2, 16 cases), and salvage of a failed reconstruction (group 3, 5 cases). The factors that may affect the survival of patients included age, sex, cause of TFR, and tumor volume change after chemotherapy. Results: The overall five-year survival of the 36 patients was 31.5%±16.2%. The five-year survival of 31 patients with tumoral causes was 21.1%±15.6%. The five-year survival of 50.0%±31.0% in patients with a decreased tumor volume after chemotherapy was higher than that of increased tumor volume (p=0.02). The five-year survival of 12 cases with a wide margin was 41.7%±27.9%, whereas that of the marginal margin was 0.0%±0.0% (p=0.03). The ten-year overall implant survival of 36 patients was 85.9%±14.1%. The five-year revision-free survival was 16.6%±18.2%. At the final follow-up, 12 maintained tumor prosthesis, three underwent amputation (rotationplasty, 2; above knee amputation, 1), and the remaining one had knee fusion. Among 16 patients with a follow-up of more than three years, 14 patients underwent surgical intervention and two patients had conservative management. Complications included infection in 10 cases, local recurrences in two cases, and one case each of hip dislocation, bushing fracture, and femoral artery occlusion. Conclusion: Patients showing an increased tumor volume after chemotherapy and having an inadequate surgical margin showed a high chance of early death. In the long-term follow-up, TFR showed a high infection rate and the functional outcome was unsatisfactory. Nevertheless, this procedure is an inevitable option of limb preservation in selected patients.

Arthroscopic Full-Thickness Rotator Cuff Repair in Elderly Patients (고령 환자의 관절경적 회전근 개 봉합술의 결과)

  • Cheon, Sang Jin;Lee, Dong Ho;Park, Yong Geon;Son, Seung Min
    • Journal of the Korean Orthopaedic Association
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    • v.55 no.1
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    • pp.38-45
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    • 2020
  • Purpose: To examine the clinical and structural outcomes of an at least two-year follow-up of arthroscopic full-thickness rotator cuff repairs with a single-row or suture-bridge technique in patients more than 65 years of age. Materials and Methods: Patients diagnosed with a full-thickness rotator cuff tear who were more than 65 years of age, underwent arthroscopic rotator cuff repair after at least six months of conservative treatment, agreed to take a follow-up magnetic resonance imaging (MRI) six months postoperatively, and visited outpatient for at least two years were enrolled in this study. Clinical evaluations were done using The University of California Los Angeles score, Constant Shoulder Score, and visual analogue scale evaluated two years after the surgery. The structural integrity was analyzed using follow-up MRI. During surgery, a suture-bridge technique was used if the rotator cuff tendon could cover half of the footprint under constant tension. Otherwise, single-row repair was performed. Results: The samples were 158 cases, consisting of 93 single-repairs and 65 suture-bridge repairs. A preoperative comparison of the age distribution, fatty degeneration of supraspinatus and infraspinatus muscle, medial retraction of torn cuff tendon, and tear size between the two groups were not significant. The clinical scores were improved significantly in all cases. The distribution of the structural integrity by Sugaya classification were 49 cases in type 1 (31.0%), 62 cases in type 2 (39.2%), 30 cases in type 3 (19.0%), 11 cases in type 4 (7.0%), and six cases in type 5 (3.8%). The re-tear rate of the single-row group was 9.7% (nine out of 93 cases) and 12.3% (eight out of 65 cases) for the suture-bridge group. Conclusion: Satisfactory clinical and radiological outcomes were achieved after arthroscopic full-thickness rotator cuff repair in patients more than 65 years of age. Both single-row and suture-bridge techniques would be beneficial for the elderly.

Outcome of Type 3 Talar Neck Fractures by Means of Medial Malleolar Osteotomy and Large Distractor (족관절 내과 절골술 및 대형신연기를 이용한 제3형 거골 경부 골절의 치료 결과)

  • Park, Sung Hae;Lee, Jun Young;Lee, Jung Woo
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.1
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    • pp.45-51
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    • 2019
  • Purpose: The clinical and radiological results of patients with type 3 talar neck fractures treated with the anteromedial approach using medial malleolar osteotomy and large distractor were analyzed retrospectively. Materials and Methods: From March 2009 to August 2016, 12 patients with a type 3 talar neck fracture, who underwent the anteromedial approach using a medial malleolar osteotomy and large distractor and who could be followed-up for more than 12 months after the operation, were examined. The patients were examined for the presence of Hawkins signs by anteroposterior and lateral radiographs and osteonecrosis by magnetic resonance imaging (MRI) on the postoperative 3 months. Subsequently, every 3 months, radiographic union was assessed by a simple radiograph and clinical symptoms. Twelve months postoperatively, posttraumatic arthritis was assessed and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was analyzed. Results: In 7 cases, osteonecrosis was found on MRI performed 3 months after surgery. On the other hand, at the 12 months follow-up, all of them obtained AOFAS scores of 83.86±4.53 without surgical treatment. Radiographic union was achieved in all cases. The mean union period was 5.3 months. In 10 cases, traumatic arthritis was found after the radiographical and clinical evaluation. In addition, all of them could carry on everyday life by conservative treatment. The AOFAS ankle-hindfoot score was measured to be 85.17 on average. Other complications included superficial wound infection in 2 cases. Conclusion: An anteromedial approach using a medial malleolar osteotomy and a large distractor in the surgical treatment of patients with type 3 talar neck fractures can achieve anatomical reduction of the displaced fragment without a lateral dissection. This is considered to be another good surgical option.

Relationship between the Progression of Kyphosis in Thoracolumbar Osteoporotic Vertebral Compression Fractures and Magnetic Resonance Imaging Findings (흉요추 골다공증성 압박 골절에서의 후만 변형의 진행과 자기공명영상 소견 사이의 관계)

  • Jun, Deuk Soo;Baik, Jong-Min;Kwon, Hyuk Min
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.4
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    • pp.336-342
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    • 2019
  • Purpose: To examine the relationship between the progression of a kyphotic deformity and the magnetic resonance imaging (MRI) findings in conservatively treated osteoporotic thoracolumbar compression fracture patients. Materials and Methods: This study categorized the patients who underwent conservative treatment among those patients who underwent treatment under the suspicion of a thoracolumbar compression fracture from January 2007 to March 2016. Among them, this retrospective study included eighty-nine patients with osteoporosis and osteopenia with a bone density of less than -2.0 and single vertebral body fracture. This study examined the MRI of anterior longitudinal ligament or posterior longitudinal ligament injury, superior or inferior endplate disruption, superior of inferior intravertebral disc injury, the presence of low signal intensity on T2-weighted images, and bone edema of intravertebral bodies in fractured intravertebral bodies. Results: In cases where the superior endplate was disrupted or the level of bone edema of the intravertebral bodies was high, the kyphotic angle, wedge angle, and anterior vertebral compression showed remarkably progression. In the case of damage to the anterior longitudinal ligament or the superior disc, only the kyphotic angle was markedly prominent. On the T2-weighted images, low signal intensity lesions showed a high wedge angle and high anterior vertebral compression. On the other hand, there were no significant correlations among the posterior longitudinal ligament injury, inferior endplate disruption, inferior disc injury, and the progression of kyphotic deformity and vertebral compression. The risk factors that increase the kyphotic angle by more than 5° include the presence of injuries to the anterior longitudinal ligament, superior endplate disruption, and superior disc injury, and the risk factors were 21.3, 5.1, and 8.5 times higher than those of the uninjured case, and the risk differed according to the level of bone edema. Conclusion: An osteoporotic thoracolumbar compression fracture in osteoporotic or osteopenic patients, anterior longitudinal ligament injury, superior endplate and intravertebral disc injury, and high level of edema in the MRI were critical factors that increases the risk of kyphotic deformity.

Importance and requirements for dental prosthesis order platform services: a survey of dental professionals (치과 보철물 거래 플랫폼 서비스의 중요성과 요구사항: 치과 전문가 설문조사)

  • Gyu-Ri Kim;Keunbada Son;Du-Hyeong Lee;So-Yeun Kim;Myoung-Uk Jin;Kyu-Bok Lee
    • Journal of Dental Rehabilitation and Applied Science
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    • v.39 no.3
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    • pp.105-118
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    • 2023
  • Purpose: This study aimed to gain better understanding of the importance of dental prosthesis order platform services and to identify the essential elements for their enhancement and wider adoption among dental professionals. Materials and Methods: A survey was conducted to assess the perspectives of dentists, dental technicians, dental hygienists, and dental industry professionals toward dental prosthesis ordering and associated platform services (a total of 53 respondents). The questionnaire was devised after an expert review and assessed for reliability using Cronbach's alpha coefficient. Factor analysis revealed that 57 factors across five categories accounted for 88.417% of the total variance. The survey was administered through an online questionnaire platform, and data analysis was conducted using a statistical software, employing one-way analysis of variance and Tukey's honestly significant difference test (α = 0.05). Results: The essential elements identified were accurate information input, effective communication, delivery of distortion-free impressions, convenience in data transmission and storage, development of stable and affordable platform services (P < 0.05). Furthermore, significant differences were observed in the importance of these items based on age, dental profession, and career experience (P < 0.05). Conclusion: The dental prosthesis ordering platform services, the requirements of dental personnel were stability, economic efficiency, and ease of transmitting and storing prosthesis data. The findings can serve as important indicators for the development and improvement of dental prosthesis order platform services.

Feasibility of Deep Learning Algorithms for Binary Classification Problems (이진 분류문제에서의 딥러닝 알고리즘의 활용 가능성 평가)

  • Kim, Kitae;Lee, Bomi;Kim, Jong Woo
    • Journal of Intelligence and Information Systems
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    • v.23 no.1
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    • pp.95-108
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    • 2017
  • Recently, AlphaGo which is Bakuk (Go) artificial intelligence program by Google DeepMind, had a huge victory against Lee Sedol. Many people thought that machines would not be able to win a man in Go games because the number of paths to make a one move is more than the number of atoms in the universe unlike chess, but the result was the opposite to what people predicted. After the match, artificial intelligence technology was focused as a core technology of the fourth industrial revolution and attracted attentions from various application domains. Especially, deep learning technique have been attracted as a core artificial intelligence technology used in the AlphaGo algorithm. The deep learning technique is already being applied to many problems. Especially, it shows good performance in image recognition field. In addition, it shows good performance in high dimensional data area such as voice, image and natural language, which was difficult to get good performance using existing machine learning techniques. However, in contrast, it is difficult to find deep leaning researches on traditional business data and structured data analysis. In this study, we tried to find out whether the deep learning techniques have been studied so far can be used not only for the recognition of high dimensional data but also for the binary classification problem of traditional business data analysis such as customer churn analysis, marketing response prediction, and default prediction. And we compare the performance of the deep learning techniques with that of traditional artificial neural network models. The experimental data in the paper is the telemarketing response data of a bank in Portugal. It has input variables such as age, occupation, loan status, and the number of previous telemarketing and has a binary target variable that records whether the customer intends to open an account or not. In this study, to evaluate the possibility of utilization of deep learning algorithms and techniques in binary classification problem, we compared the performance of various models using CNN, LSTM algorithm and dropout, which are widely used algorithms and techniques in deep learning, with that of MLP models which is a traditional artificial neural network model. However, since all the network design alternatives can not be tested due to the nature of the artificial neural network, the experiment was conducted based on restricted settings on the number of hidden layers, the number of neurons in the hidden layer, the number of output data (filters), and the application conditions of the dropout technique. The F1 Score was used to evaluate the performance of models to show how well the models work to classify the interesting class instead of the overall accuracy. The detail methods for applying each deep learning technique in the experiment is as follows. The CNN algorithm is a method that reads adjacent values from a specific value and recognizes the features, but it does not matter how close the distance of each business data field is because each field is usually independent. In this experiment, we set the filter size of the CNN algorithm as the number of fields to learn the whole characteristics of the data at once, and added a hidden layer to make decision based on the additional features. For the model having two LSTM layers, the input direction of the second layer is put in reversed position with first layer in order to reduce the influence from the position of each field. In the case of the dropout technique, we set the neurons to disappear with a probability of 0.5 for each hidden layer. The experimental results show that the predicted model with the highest F1 score was the CNN model using the dropout technique, and the next best model was the MLP model with two hidden layers using the dropout technique. In this study, we were able to get some findings as the experiment had proceeded. First, models using dropout techniques have a slightly more conservative prediction than those without dropout techniques, and it generally shows better performance in classification. Second, CNN models show better classification performance than MLP models. This is interesting because it has shown good performance in binary classification problems which it rarely have been applied to, as well as in the fields where it's effectiveness has been proven. Third, the LSTM algorithm seems to be unsuitable for binary classification problems because the training time is too long compared to the performance improvement. From these results, we can confirm that some of the deep learning algorithms can be applied to solve business binary classification problems.

LINAC-based Stereotactic Radiosurgery for Meningiomas (수막종에 대한 선형가속기형 정위방사선수술)

  • Shin Seong Soo;Kim Dae Yong;Ahn Yong Chan;Lee Jung Il;Nam Do-Hyun;Lim Do Hoon;Huh Seung Jae;Yeo Inhwan J;Shin Hyung Jin;Park Kwan;Kim BoKyoung;Kim Jong Hyun
    • Radiation Oncology Journal
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    • v.19 no.2
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    • pp.87-94
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    • 2001
  • Purpose : To evaluate the role of LINAC-based stereotactic radiosurgery (SRS) in the management of meningiomas, we reviewed clinical response, image response, neurological deficits for patients treated at our institution. Methods and materials : Between February 1995 and December 1999, twenty-six patients were treated with SRS. Seven patients had undergone prior resection. Nineteen patients received SRS as the initial treatment. There were 7 male and 19 female patients. The median age was 51 years (range, $14\~67\;years$). At least one clinical symptom presented at the time of SRS in 17 patients and cranial neuropathy was seen in 7 patients. The median tumor volume was $4.7\;cm^3\;(range,\;0.7\~16.5\;m^3)$. The mean marginal dose was 15 Gy (range, $10\~20\;Gy$), delivered to the $80\%$ isodose surface (range, $46\~90\%$). The median clinical and imaging follow-up periods were 27 months (range, 1-71 months) and 25 months (range, $1\~52\;months$), respectively. Results : Of 14 patients who had clinical follow-up of one year or longer, thirteen patients $(93\%)$ were improved clinically at follow-up examination. Clinical symptom worsened in one patient at 4 months after SRS as a result of intratumoral edema, who underwent surgical resection at 7 months. OF 14 patients who had radiologic follow-up of one year or longer, tumor volume decreased in 7 patients $(50\%)$ at a median of 11 months (range, $6\~25\;months$), remained stable in 6 patients $(43\%)$, and increased in one patient $(7\%)$, who underwent surgical resection at 44 months. New radiation-induced neurological deficits developed in six patients $(23\%)$. Five patients $(19\%)$ had transient neurological deficits, completely resolved by conservative treatment including steroid therapy. Radiation-induced brain necrosis developed in one patient $(3.8\%)$ at 9 months after SRS who followed by surgical resection of tumor and necrotic tissue. Conclusions : LINAC-based SRS proves to be an effective and safe management strategy for small to moderate sized meningiomas, inoperable, residual, and recurrent, but long-term follow-up will be necessary to fully evaluate its efficacy. To reduce the radiation-induced neurological deficit for large size meningioma and/or in the proximity of critical and neural structure, more delicate treatment planning and optimal decision of radiation dose will be necessary.

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Clinical Results after Repair of Rotator Cuff Tear in Patients with Accompanying AC Joint Pathology: Clinical Comparison of Non-operative Treatment (회전근개 파열과 동반된 견봉 쇄골 관절 병변이 회전근개 봉합술 후 결과에 미치는 영향: 비수술적 치료를 통한 임상적 비교)

  • Yoo, Moon-Jib;Seo, Joong-Bae;Lee, Dae-Hee;Kim, Sung-Jin
    • Clinics in Shoulder and Elbow
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    • v.15 no.2
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    • pp.86-90
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    • 2012
  • Purpose: We studied the need for distal clavicle resection by comparing rotator cuff tear patients who underwent non-surgical treatment with and without acromioclavicular joint pathology. Materials and Methods: 45 cases that had been under follow up care for at least 9 months after receiving rotator cuff repair in our hospital between Jan. 2005 and Jun. 2011 had been studied. Acromioclavicular joint pathology group and control group were classified by physical examination and MRI findings. The temporal changes in shoulder joint abduction, internal and external rotation strength, ASES and KSS score of the two groups were measured and analyzed. Results: The acromioclavicular joint pathology complicated rotator cuff injury group's strength measurements for abduction, internal rotation, external rotation were each 8.05 (${\pm}4.54$), 11.33 (${\pm}6.05$), 10.24 (${\pm}5.27$) preoperatively and improved to 13.26 (${\pm}5.50$), 17.51 (${\pm}6.80$), 15.60 (${\pm}5.37$) post operatively while the KSS score and ASES score were each 49.07 (${\pm}15.28$) and 48.65 (${\pm}13.27$) preoperatively, improving to 84.48 (${\pm}10.96$) and 84.65. (${\pm}9.86$). The measurements for the group without complicating acromioclavicular pathology are as follows. The strength for abduction, internal rotation, external rotation was each 6.42 (${\pm}3.11$), 7.59 (${\pm}4.81$) and 7.93 (${\pm}4.49$) preoperatively, improving to 15.85 (${\pm}7.35$), 19.18 (${\pm}9.14$), 16.95 (${\pm}5.70$) post operatively, while the KSS score and ASES score each went from 42.12 (${\pm}6.43$) and 41.37 (${\pm}7.42$) to 83.44 (${\pm}6.30$) and 83.17 (${\pm}7.01$) respectively. The measurements for the two groups, however, did not show a statistically significant difference (p>0.05). Conclusion: Analysis of the rotator cuff injury groups with and without AC joint pathology showed that both groups had improved strength, ASES and KSS scores with no statistical difference difference among the groups. As such, it thought that conservative treatment is an acceptable alternative to distal clavicle resection.