• Title/Summary/Keyword: Less invasive

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Demineralized Bone Matrix (DBM) as a Bone Void Filler in Lumbar Interbody Fusion : A Prospective Pilot Study of Simultaneous DBM and Autologous Bone Grafts

  • Kim, Bum-Joon;Kim, Se-Hoon;Lee, Haebin;Lee, Seung-Hwan;Kim, Won-Hyung;Jin, Sung-Won
    • Journal of Korean Neurosurgical Society
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    • v.60 no.2
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    • pp.225-231
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    • 2017
  • Objective : Solid bone fusion is an essential process in spinal stabilization surgery. Recently, as several minimally invasive spinal surgeries have developed, a need of artificial bone substitutes such as demineralized bone matrix (DBM), has arisen. We investigated the in vivo bone growth rate of DBM as a bone void filler compared to a local autologous bone grafts. Methods : From April 2014 to August 2015, 20 patients with a one or two-level spinal stenosis were included. A posterior lumbar interbody fusion using two cages and pedicle screw fixation was performed for every patient, and each cage was packed with autologous local bone and DBM. Clinical outcomes were assessed using the Numeric Rating Scale (NRS) of leg pain and back pain and the Korean Oswestry Disability Index (K-ODI). Clinical outcome parameters and range of motion (ROM) of the operated level were collected preoperatively and at 3 months, 6 months, and 1 year postoperatively. Computed tomography was performed 1 year after fusion surgery and bone growth of the autologous bone grafts and DBM were analyzed by ImageJ software. Results : Eighteen patients completed 1 year of follow-up, including 10 men and 8 women, and the mean age was 56.4 (32-71). The operated level ranged from L3/4 to L5/S1. Eleven patients had single level and 7 patients had two-level repairs. The mean back pain NRS improved from 4.61 to 2.78 (p=0.003) and the leg pain NRS improved from 6.89 to 2.39 (p<0.001). The mean K-ODI score also improved from 27.33 to 13.83 (p<0.001). The ROM decreased below 2.0 degrees at the 3-month assessment, and remained less than 2 degrees through the 1 year postoperative assessment. Every local autologous bone graft and DBM packed cage showed bone bridge formation. On the quantitative analysis of bone growth, the autologous bone grafts showed significantly higher bone growth compared to DBM on both coronal and sagittal images (p<0.001 and p=0.028, respectively). Osteoporotic patients showed less bone growth on sagittal images. Conclusion : Though DBM alone can induce favorable bone bridging in lumbar interbody fusion, it is still inferior to autologous bone grafts. Therefore, DBM is recommended as a bone graft extender rather than bone void filler, particularly in patients with osteoporosis.

Sensitivity of Dimercaptosuccinic Acid(DMSA) Renal Scan in Children with Acute Pyelonephritis (급성 신우신염 환아들의 나이에 따른 Dimercaptosuccinic Acid Renal Scan 민감도)

  • Jang Kyung-Ah;Yang Jeong-A;Hah Tae-Sun;Park Hye-Won;Lee Jun-Ho
    • Childhood Kidney Diseases
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    • v.7 no.1
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    • pp.38-43
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    • 2003
  • Purpose : Accurate diagnosis of acute pyelonephritis(APN) using clinical and laboratory parameters is often difficult in children. Clinical and experimental studies have demonstrated that renal scarring can be prevented or diminished by early diagnosis and aggressive treatment of acute pyelonephritis. dimercaptosuccinic acid(DMSA) renal scan has been reported to be useful in children for confirmation of the diagnosis of acute pyelonephritis. An analysis was undertaken to correlate the clinical and laboratory manifestations of APN With the results of the DMSA renal scan in different age groups. Methods : We determined the sensitivity of DMSA renal scan in febrile urinary tract infections(UTI) in two groups according to age : group I in less than 2 years; group II in older than 2 years. During the period March 2001 through September 2002, 67 children presented with febrile UTIs. All patients had DMSA renal scan done in the acute period, 55 had voiding cystourethrography(VCUG) and 66 had renal ultrasonogram(RUS) done. Results : There were no significant difference between the two groups in DMSA renal scan (P>0.05). But, in group I sensitivity of DMSA renal scan was 47%; in group II sensitivity of DMSA renal scan was 70%. The grade of reflux correlated with a positive DMSA renal scan. Vesicoureteral reflux did not correlate with age. RUS did not correlate with a positive DMSA renal scan in any age group. Abnormality of RUS did not correlate with age. Conclusion : At present, we believe that DMSA renal scan is the prevailing method in differention of the APN. In addition, it is not invasive and less costly. Even though there is no statistical difference in the sensitivity of DMSA renal scan between young and older children, we can observe that in the younger group, the sensitivity of DMSA renal scan seemed to be lower(47%).

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Comparision of Risk Factors in Lung Cancer Surgery of Above 70-Year Old Patients (70세이상 환자에 대한 폐암 수술의 위험성 비교)

  • 장인석;심영목;김진국;김관민;유정우
    • Journal of Chest Surgery
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    • v.32 no.1
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    • pp.32-37
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    • 1999
  • Background: Early detection and surgical resection offer the most advantage out of all cures for lung cancer. Elderly patients may fail to benefit maximally from these interventions because of their general condition and residual lung function. To study the impact of age on stages, histology, symptoms, and treatments of the patients with non-small cell lung cancer, we undertook a retrospective review. Material and Method : Two hundred eleven patients with non-small cell lung cancer were operated on at Samsung Seoul hospital between October 1994 and June 1997. Patients were arbitrarily arbitrarily by age less than 70 years(176 patients) and 70 years or more(35 patients), and their medical records were reviewed. Result: There were no differences in pathologic staging and diagnosis. But there were differences in surgical methods, complications, and mortality rates between the two groups. There were much more complications in the 70 years or more group(p=0.02). We chose less invasive surgical methods in the 70 years or more group. Conclusion: More complications were experienced in the 70 years or more group. Although thoracic operation imparts the greatest survival advantage, this benefit is diminished in elderly patients because of their high complications and mortality rate. We recommend serious consideration of surgical indications and operative methods.

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A Comparative Study of Endotracheal Aspirates and Protected Specimen Brush in the Quantitative Cultures of the Ventilator-Associated Pneumonia (기계호흡기 관련 폐렴환자의 정량적 배양에 있어서 Endotracheal Aspirates과 Protected Specimen Brush의 비교 관찰)

  • Roo, Kyoung-Ryeol;Kim, Min-Gu;Kim, Gi-Yang;Jung, Ho-Gyeong;Park, Young-Ho;Kang, Byeng-Sun;Kim, Ho-Chul;Hwang, Young-Sil
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.5
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    • pp.737-743
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    • 1995
  • Background: Pneumonia is a frequent complication in patients undergoing mechanical ventilation, Quantitative culture of protected specimen brush(PSB) have shown satisfactory diagnostic accuracy for the diagnosis of ventilator-associated pneumonia. However PSB method is invasive, expensive, and require a bronchoscopic procedure. But endotracheal aspiration(EA) is simple and less expensive. The purpose of our study was to investigate the diagnosic value of EA quantitative cultures. Method: We studied 15 cases of ventilator-associated pneumonia(for >72h of mechanical ventilation) patients. Patients were divided into two diagnostic categories. Group I was the patients who were suspicious of clinical pneumonia, Group II was the patients for control. The obtained samples by EA and PSB were homogenized for quantitative culture with a calibrated loop method in all patients. Result: Using $10^3cfu/ml$, $10^5cfu/ml$ as threshold in quantitative culture of PSB, EA respectively, we found that EA quantitative cultures represented a relatively sentive(70%) and relatively specific (60%) method to diagnose the ventilator-associated pneumonia. Conclusion: Although EA quantitative cultures are less specific than PSB for diagnosing ventilator-associated pneumonia. EA quantitative cultures correlated with PSB quantitative culture in patients with clinical pneumonia and may be used to treat these patients when bronchoscopic procedures are not available.

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3,3'-Diindolylmethane (DIM) decrease adhesion, migration and invasion in human prostate cancer cells (3,3'-Diindolylmethane (DIM)이 인체 전립선암 세포의 부착, 이동 및 침윤성에 미치는 영향)

  • Kim, Hyeon-A
    • Food Science and Preservation
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    • v.22 no.1
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    • pp.19-26
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    • 2015
  • Indole 3-carbinol (I3C), important component of cruciferous vegetables and its major acid-catalyzed metabolite, 3,3'-diindolylmethane (DIM) have been suggested to have an inhibitory effect on the tumor growth and metastasis. This study investigated the effect of DIM on the adhesion, migration and invasion of highly invasive PC3 and DU145 human prostate cancer cell lines. Cells were grown in Dulbecco's modified Eagle's medium (DMEM) supplemented with 3.0 g/L glucose, 3.7 g/L sodium bicarbonate and 10% fetal bovine and were incubated in a humidified incubator at $37^{\circ}C$ and 5% $CO_2$. DIM reduced the adhesion of PC3 and DU145 cells in a dose dependent manner. The pretreatment of PC3 cells with DIM reduced the adhesion dose dependantly, but inhibition was less effective than the treatment with DIM during the adhesion assay. The migration and invasion of PC3 and DU145 cells were reduced by DIM dose dependantly, and the inhibition of DIM was less effective in the DU145 cells than in the PC3 cells. The pretreatment of PC3 cells with DIM for 24 hr before the assay reduced invasion of PC3 cells by 37%. These results suggest that DIM inhibits adhesion, migration and invasion of the PC3 and DU145 cells and may be an effective antimetastatic therapy in addition to traditional chemotherapy.

Palliative Management of Gastric Cancer with Outlet Obstruction: Stent versus Bypass (위배출구 폐색을 동반한 위암환자의 치료)

  • Kim, Hyung-Ho
    • Journal of Gastric Cancer
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    • v.9 no.1
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    • pp.6-9
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    • 2009
  • Gastric cancer with gastric outlet obstruction has a high incidence of direct invasion into neighboring organs, with a low resection rate and a poor prognosis. Traditionally, open gastrojejunostomy has been the standard palliative treatment in these patients. Recently, endoscopic self-expanding metal stents have been used increasingly for the palliative treatment of malignant gastric outlet obstruction, but the choice of modality to treat the obstruction caused by gastric cancer is still controversial. Many studies have shown that endoscopic stenting is less invasive and offers not only a shorter time to oral intake and length of hospital stay, but also less frequent complications compared to open gastrojejunostomy. However, recurrent obstruction by tumor overgrowth and ingrowth occur more frequently and re-intervention for recurrent obstructive symptoms are more frequently performed after stent placement than after gastrojejunostomy. Thus, stent placement may be associated with more favorable results in patients with a relatively short life expectancy, while gastrojejunostomy is preferable in patients with a more prolonged prognosis. Also, open surgery affords a greater chance for curative surgery. However, most underlying diseases analyzed in previous studies were pancreaticobiliary malignancies, and there have been few prospective studies specific for patients with gastric cancer. Additional randomized controlled trials with larger sample sizes are expected to decide the treatment modality for unresectable gastric cancer with gastric outlet obstruction.

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Spread and distribution characteristics of ecosystem-disturbing plant Alliaria petiolata(M. Bieb.) Cavara & Grande in Korea (생태계교란식물 마늘냉이의 확산과 분포 특성)

  • Yeon-Ji Lee;Bo-Ram Hong;Kyu-Song Lee
    • Korean Journal of Environmental Biology
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    • v.42 no.1
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    • pp.62-79
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    • 2024
  • Garlic mustard (Alliaria petiolata) is a species that has devastated the United States and Canada. It is known to play a role in destroying the ecosystem. In this study, the domestic distribution of garlic mustard was confirmed and a detailed distribution map was created for the Samcheok region, where the largest population has been established in South Korea. This study investigated the growth environment, life cycle, and population dynamics of the species in the Samcheok region. Garlic mustard was found in a total of 301 locations in Samcheok, with a total distribution area of 2,957 square meters. Annual plants germinated in mid-April, overwintered in rosette form, underwent vegetative growth from April 10 to April 24 the following year, and flowered from April 24 to May 7. Individuals producing seeds began to die off from June. Both annual and biennial individuals showed a trend of increasing and then decreasing in number around April 27 (118 days). Garlic mustard grew well under favorable light conditions in early spring. They showed less growth on leaf litter, short distance from roads, lower altitude, deciduous broad-leaved forest of middle and lower parts of the slope and forest edge. Without proper control measures in the Samcheok region, it is likely to spread more rapidly in deciduous broad-leaved forests along hiking trails in the Galyasan Mountains. In particular, it is more likely to extend to oak community where light enters the site during flowering than to pine community where there is less light in the site.

A Necessity for Lumbar Puncture and VCUG in Febrile UTI Infants less than 3 Months of Age (고열을 동반한3개월 미만 요로 감염 영아에서 척추천자와 배뇨성 방광요도조영술의 필요성)

  • Kim, Ji-Hee;Lee, Jun-Ho
    • Childhood Kidney Diseases
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    • v.13 no.1
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    • pp.33-39
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    • 2009
  • Purpose : Our aim is to reduce the rate of lumbar spinal tapping and voiding cystourethrography (VCUG) in febrile urinary tract infection (UTI) infants less than 3 months of age. Methods : We reviewed the prevalence of UTI, sepsis, meningitis and UTI with bacterial meningitis in febrile infants less than 3 months of age during the period from Jan. 2001 to Jun. 2008. Renal ultrasonography, Technetium-99m dimercaptosuccinic acid (DMSA) renal scan or VCUG were performed in infants with UTI. Infants with UTI were divided into two groups according to the presence of abnormal findings of ultrasonography and DMSA renal scan : group 1-Infants in whom both ultrasonography and DMSA were normal, group 2-Infants in whom ultrasonography or DMSA were abnormal. Prevalence of VUR was compared between the two groups. We followed up the clinical course of patients who had VUR in group 1. Results : Among 1962 Infants, UTI, sepsis and bacterial meningitis were diagnosed in 620 (31.6%), 63 (3.2%), 8 (0.4%) respectively. Lumbar puncture was performed in 413 (66.6%) infants with UTI and we did not detect a case of bacterial meningitis in association. 348 infants with proven UTI were undergone ultrasonography, DMSA, VCUG. In group 1 with 110 infants (31.6%), the presence of VUR was 4 (3.6%). In group 2 with 238 infants (68.4%), the presence of VUR was 51 (21.4%). Abnormal findings of ultrasonography or DMSA renal scan were closely related with high grade VUR. Most of patients with VUR in group1 had good prognosis. Conclusion : Lumbar puncture and VCUG are invasive procedures. Therefore we should decide whether to perform lumbar puncture or VCUG in infants less than 3 months. of age with their first febrile UTI.

The Short Term and Intermediate Term Results of using a T-tube in Patients with Tracheal Stenosis (기관 협착 환자에서의 T-튜브의 중단기 결과)

  • Sa, Young Jo;Moon, Seok-Whan;Kim, Young-Du;Jin, Ung;Park, Jae-Kil;Kim, Jae Jun;Kim, Chi-Kyung;Jo, Keon Hyon;Park, Chan Beom;Yim, Hyeon Woo
    • Journal of Chest Surgery
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    • v.42 no.1
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    • pp.63-71
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    • 2009
  • Background: The treatment of tracheal stenosis includes less invasive bronchoscopic intervention and more invasive segmental resection & anastomosis. Depending on the patient's clinical features, sometimes all these methods are inappropriate. Silicone T-tube stenting has recently been used as an alternative, safe management of tracheal stenosis. We studied the short term and Intermediate term results of using T-tubes in patients with tracheal stenosis, and this tracheal stenosis was caused by various underlying diseases. Material and Method: We retrospectively reviewed 57 patients with tracheal stenosis and who were treated with T-tubes between Jan 1997 and Apr 2007. Based on the patient's medical records and the imaging studies, we evaluated the clinical findings and status of T-tube removal. Result: There was no T-tube related morbidity or mortality in this series. On follow-up, one patient underwent sleeve resection and end-to-end anastomosis. The T-tube could be successfully removed from 13 patients (13/57, 22.8%) without additional interventions. For another four patients, a T-tube was again inserted after removal of the first T-tube due to tracheomalacia or recurrent stenosis. Four patients died of underlying disease and cancer. The patients' gender and previous tracheostomy significantly affected T-tube removal. By contrast, multiple logistic regression analysis identified gender as a predictor of successfully removing a T-tube. Gender (p=0.033) and previous tracheostomy (p=0.036) were the two factors for success or failure of T-tube removal. Conclusion: A T-tube provided reliable patency of a stenotic airway that was caused by any etiology. We have proven that using a T-tube is safe and effective therapy for patients with tracheal stenosis for the short term or the intermediate term.

The Results of Combined Modality Treatment with Transurethral Resection, Cisplatin and Radiation Therapy for Invasive Bladder Cancer (침윤성 방광암에서 경요도적절제술 및 Cisplatin과 방사선의 병용치료의 효과)

  • Oh, Yoon-Kyeong
    • Radiation Oncology Journal
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    • v.9 no.2
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    • pp.311-317
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    • 1991
  • Ten patients with deep muscle-invading bladder carcinoma (clinical stages T3a to T4b) who were not candidates for cystectomy were treated with combined modality treatment with transurethral resection, cisplatin chemotherapy and pelvic irradiation from 1989 through 1990, and were analyzed retrospectively. All patients were not candidates for cystectomy because the tumors were judged unresectable or they were not fit for a radical cystectomy. Of the patients 5 had clinical stage T3a, 3 stage T3b and 2 stage T4b disease. The minimum follow-up was 16 months. The complete response rate is 60$\%$ for all patients. The complete responses were achieved in 4 of 5(80$\%$) with stage cT3a, in 2 of 3(67$\%$)with stage cT3b and in none of 2(0$\%$) with stage cT4b. The partial responses were achieved in 2, so an overall response rate was 80$\%$. All six patients with grade I or II transitional cell carcinoma showed complete responses. Four patients with higher grade tumors showed partial responses in 2 and no response in 2, and all died of their bladder cancer. Six patients who showed complete responses after treatment are alive and only one of them showed a local recurrence 10 months after treatment. Distant metastases developed in 3 patients: lungs in 2(cT4b) of those who were never locally free of disease and spine in 1 patient (cT3b) among those with a partial response. Two patients died of metastases to lungs. During the follow-up diarrhea occurred in one which was improved after conservative treatment. On the basis of this analysis it is suggested that combined modality treatment seems to be a tolerable regimen and can be offered with a relatively high probability of success and conservation of bladder function in those with less advanced tumors by clinical stage and low grade.

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