• The Journal of the Korean bone and joint tumor society
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• v.15 no.2
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• pp.122-129
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• 2009

Purpose: To evaluate treatment outcomes of malignant melanoma and to analyze the factors that contributes to outcomes. Materials and Methods: We reviewed the 51 cases of malignant melanoma from March, 1997 to March, 2004 and were followed up more than 5 years. Average age was 49.4. We compared 5-year survival rate for each age, gender, site of occurrence, depth of tumor, metastasis of regional lymph node and immuno-chemo therapy. Results: 5-year survival rate was 88.5% for the age group below 65, 88.0% for the age group 65 and above, 62.5% for male and 100% for female. 5-year survival rate for the site of occurrence showed 100% in upper extremities, and 80.0% in lower extremities and 100% in other sites. 5-year survival rate was 100% for the stage below Clark stage III and 79.3% for the stage above IV. In surgical resection, 5-year survival rate was 66.7% for lymph node metastasis group and 94.9% for non-lymph node metastasis group. Conclusion: The prognostic factors of malignant melanoma were gender, tumor site, depth of tumor (Clark's stage) and metastasis of regional lymph node. But, there was no relation between the age and the survival rate in our study.

• Journal of Korean Foot and Ankle Society
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• v.19 no.2
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• pp.51-57
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• 2015

Purpose: Minimal incision distal metatarsal osteotomy (MIDMO) is known to be an effective surgical procedure for mild to moderate hallux valgus. However, the result of MIDMO on moderate to severe hallux valgus is controversial; therefore, we investigated the radiological and clinical results of MIDMO on moderate to severe hallux valgus. Materials and Methods: We reviewed 51 feet (48 patients) with moderate to severe hallux valgus. The mean age was 67.0 years and the mean follow-up period was 32.2 months. Radiological data of hallux valgus angle, first intermetatarsal angle, and distal metatarsal articular angle on plain radiographs were analyzed. Recurrence, union, lateral translation of distal fragment and angulation were also analyzed. The clinical data were obtained using American Orthopaedic Foot and Ankle Society (AOFAS) score of preoperation and last follow-up. Receiver operating characteristic (ROC) curve was used to determine a cut-off value. Results: The mean hallux valgus angle measured at preoperation was $37.7^{\circ}$ and $15.9^{\circ}$ at last follow-up. The mean first intermetatarsal angle of preoperation and last follow-up were $15.2^{\circ}$ and $8.3^{\circ}$. The mean distal metatarsal articular angle changed from $12.6^{\circ}$ at preoperation to $7.8^{\circ}$ at last follow-up. Preoperative hallux valgus angle (p=0.0051) and distal metatarsal articular angle (p=0.0078) were statistically significant factors affecting postoperative AOFAS score. Cut-off value of each was $37^{\circ}$ and 13o, respectively. Lateral translation of distal fragment in 5 recurrent cases was 23.0% compared to 45.3% of 46 non-recurrent cases. The result was statistically significant and the cut-off value was 38%. Conclusion: Sufficient lateral translation over 38% in MIDMO on moderate to severe hallux valgus patients with preoperative hallux valgus angle under $37^{\circ}$ and distal metatarsal articular angle under $13^{\circ}$ can lead to good clinical results without recurrence.

• Journal of Korean Neurosurgical Society
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• v.59 no.6
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• pp.577-583
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• 2016

Objective : The inter-rater reliability of the modified Knosp's classification was measured before the analysis. The clinical validity of the parasellar extension grading system was evaluated by investigating the extents of resection and complication rates among the grades in the endoscopic endonasal transsphenoidal surgery (EETS) for pituitary adenomas. Methods : From November 2008 to August 2015, of the 286 patients who underwent EETS by the senior author, 208 were pituitary adenoma cases (146 non-functioning pituitary adenomas, 10 adrenocorticotropic hormone-secreting adenomas, 31 growth hormone-secreting adenomas, 17 prolactin-secreting adenomas, and 4 thyroid-stimulating hormone-secreting adenomas; 23 microadenomas, 174 macroadenomas, and 11 giant adenomas). Two neurosurgeons and a neuroradiologist independently measured the degree of parasellar extension on the preoperative sellar MRI according to the modified Knosp's classification. Inter-rater reliability was statistically assessed by measuring the intraclass correlation coefficient. The extents of resection were evaluated by comparison of the pre- and post-operative MR images; the neurovascular complications were assessed by reviewing the patients' medical records. The extent of resection was measured in each parasellar extension grade; thereafter, their statistical differences were calculated. Results : The intraclass correlation coefficient value of reliability across the three raters amounted to 0.862. The gross total removal (GTR) rates achieved in each grade were 70.0, 69.8, 62.9, 21.4, 37.5, and 4.3% in Grades 0, 1, 2, 3A, 3B, and 4, respectively. A significant difference in the extent of resection was observed only between Grades 2 and 3A. In addition, significantly higher complication rates were observed in the groups above Grade 3A. Conclusion : Although the modified Knosp's classification system appears to be complex, its inter-rater reliability proves to be excellent. Regarding the clinical validity of the parasellar extension grading system, Grades 3A, 3B, and 4 have a negative predictive value for the GTR rate, with higher complication rates.

• Journal of Korean Orthopaedic Sports Medicine
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• v.9 no.1
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• pp.7-15
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• 2010

Anterior knee pain syndrome would best be defined as a painful condition that arises in or around the patellofemoral joint and is insidious in onset and bilateral, with an enigmatic entity with multiple causes. Although its etiology is uncertain, the cause is often considered to be abnormal lower limb biomechanics, pathology of extensor mechanism, disorder of patellofemoral joint, malalignment or lateral tracking of the patella, soft tissue tightness, muscle weakness. The measurement of patellar alignment has come to be accepted as an integral part of the examination of anterior knee pain syndrome. Various measurement techniques exist, both clinical and radiological, and these have been frequently used in the diagnosis and treatment of the condition.?Treatment depends on the underlying cause of anterior knee pain and should be directed to the cause rather than to the results. Most often, this involves non-surgical measures, such as anti-inflammatory medications, quadriceps exercises, and hamstring stretching. Shin splint, or medial tibial stress syndrome refers a syndrome of pain running along the inner distal 2/3 of tibia shaft. Shin splint is a common problem for athletes whose sport involves a repeated, jarring impact to the leg. A major factor determining the efficacy of the treatment is that correct diagnosis be made of the problem. The varied etiology has led to the development of several theories as to the cause, treatment, rehabilitation and prevention of shin splint. The management is rest, ice massages, pain relief by medication, and muscle strengthening exercise. Proper rehabilitation and preventative measures can ensure that there is no further recurrence.

• Asian Oncology Nursing
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• v.1 no.2
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• pp.204-216
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• 2001

The purpose of this study was to test the effects of foot reflexology on pain and mood in patients who have just had a mastectomy. The research design was a nonequivalent control group, non-synchronized design. The participants for this study were 28 patients with breast cancer on first or second day after mastectomy surgery. The first 12 patients were assigned to the control group and the second 16 to the experimental group. The study was conducted from October 28, 2001 to December 22, 2001 on a surgical unit of Y Medical Center in Seoul, Korea. Pain intensity, blood pressure, pulse rate and mood were measured as dependent variables. The instrument used for pain intensity and mood was a 10 cm visual analogue scale. Cronbach alpha for this study was .70. For the experimental group pre and post tests were done immediately before and 15 minutes after completion of foot reflexology. Foot reflexology was performed once for 20 minutes. After the pretest, patients in the control group were instructed to have a quiet time for a 35 minute period and then the post-test was done. The number of participants was small so the data were analyzed by Mann-Whitney U test, and Wilcoxon signed ranks test. The results of this study are as follow : 1. In the experimental group there were significant decreases between the pre and post tests for pain intensity (z=-3.47, p<.001), diastolic blood pressure (z=-2.67, p<.01) and pulse rate (z=-3.44, p<.001) but there was no difference between the two groups on the post test. 2. The systolic blood pressure, diastolic blood pressure and pulse rate were also not significantly different between the experimental group and the control group on the post test. 3. The mood score was significantly improved after foot reflexology(z=-3.52, p=.000) and the difference between the two groups was also significant (u=49.0, p=.03). In conclusion, there was a statistically significant difference in mood between the two groups, but no difference for pain intensity, blood pressure, or pulse rate. However, there were significant differences between the pretest and post-test for pain intensity, diastolic blood pressure and pulse rate in the experimental group. On the basis of the above findings, this study suggests that foot reflexology can be an effective method of relieving pain and improving mood in clinical practice in women who have had mastectomy surgery.

• Biomedical Science Letters
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• v.8 no.3
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• pp.127-135
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• 2002

Anterior subcapsular cataract was developed by opacification with transdifferentiation and abnormal proliferation of lens epithelial cells (LECs) and pathological accumulation of extracellular matrix (ECM). After-cataract also be caused by a similar transdifferentiation of LECs remaining after surgery and the accompanying increase of ECM deposits. It is blown that prostaglandin E2 and cytokine, such as TGF-$\beta$, bFGF, and IL-1, were associated with abnormal proliferation and transdifferentiation of LECs. The aim of this study was to detect the expression of transforming growth factor-$\alpha$ (TGF-$\alpha$), transforming growth factor-$\beta_1$(TGF-$\beta_1$) and basic fibroblast growth factor (bFGF) in LECs of senile and diabetic cataract. The expressions of these growth factors in lens epithelial cells were determined. The sample for growth factor determination were collected in senile cataract patients without metabolic disorder, especially diabetes mellitus and diabetic cataract patients. The mRNA expression of growth factors was detected by semi-quantitative reverse transcription - polymerase chain reaction (RT-PCR) followed by Southern blot analysis. Statistics were analysed using Wilcoxon rank sum test. Semi-quantitative RT-PCR/southern analysis of RNA obtained from thirty surgical specimens demonstrated that the level of mRNA expression of TGF-$\alpha$, -$\beta_1$ and bFGF was increased in diabetic cataract lens tissues compared with senile cataract specimens but non-significant, bFGF and TGF-$\beta_1$ mRNA expression were detected in most patients, expression level of TGF-$\beta_1$ was most high on the basis of normal ocular concentration. Detection rate of TGF-$\alpha$ in diabetic cataract was 1.5 fold higher than in senile cataract (P=0.098). TGF-$\alpha$, TGF-$\beta_1$, and bFGF mRNA expression of LECs were detected in senile and diabetic cataract. In both patient groups, expression level of TGF-$\beta_1$, mRNA was high, so We suggest TGF-$\beta_1$ strong influence in development of senile cataract and of diabetic cataract also. TGF-$\alpha$ expression level was similar but more frequently detected in diabetic cataract than in senile cataract. In conclusion, TGF-$\alpha$ may be associated with early development of diabetic cataract.

• The Korean Journal of Nuclear Medicine
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• v.16 no.2
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• pp.29-36
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• 1982

Quantification of the regurgitation amount is important before and after valvular replacement surgery. Until now cardiac catheterization with cineventriculography, echocardiography have been used to measure the regurgitation amount, but also have many limitations. EKG gated cardiac blood pool scan provides a simple, non-invasive -method for quantify the regurgitation amount. By calculating the ratio of left ventricular to right ventricular stroke counts (stroke volume ratio) in gated bood pool scan, we measured the left ventricular regurgitation amount in 28 cases of valvular regurgitation and 25 cases of normal group. 1. Stroke volume ratio was higher in cases of valvular regurgitation $(2.11{\pm}0.58)$ than in cases of normal control $(1.15{\pm}0.31)$. (p<0.01). 2. Stroke volume ratio was classified by regurgitation grade using X-ray cineventriculography. In grades of mild regurgitation $(Grade\;I{\sim}II)$, stroke volume ratio was $2.02{\pm}0.29$, and in grades of severe regurgitation $(Grade\;III{\sim}IV)$, stroke volume ratio was $2.55{\pm}0.34$, so stroke volume ratio was well correlated with the grade of X-ray cineventriculography. 3. Stroke volume ratio was classfied by functional class made in New York Heart Association. In classes of mild regurgitation $(class\;I{\sim}II)$, stroke volume ratio was $2.08{\pm}0.26$, and in classes of severe regurgitation $(class\;III{\sim}IV)$, stroke volume ratio was $2.55{\pm}0.38$, Stroke volume ratio well represented the functional class. 4. After aortic and mitral valve replacement in 28 patients, the stroke volume ratio, decreased from $2.11{\pm}0.58\;to\;1.06{\pm}0.26$. Gated blood pool scan provides a noninvasive method of qnantifying valvular regurgitation and assessing the result of surgical interventions.

• Journal of Trauma and Injury
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• v.29 no.3
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• pp.93-97
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• 2016

Hepatic duct confluence injury, which is developed by blunt abdominal trauma, is rare. Conventionally, bile duct injury was treated by surgical intervention. In recent decades, however, there had been an increase in radiologic or endoscopic intervention to treat bile duct injury. In a hemodynamically stable patient, endoscopic intervention is considered as the first-line treatment for bile duct injury. A 40 year-old man was transferred to the emergency department of ${\bigcirc}{\bigcirc}$ trauma center after multiple blunt injuries. Contrast-enhanced abdominal computed tomography performed in another hospital showed a liver laceration with active arterial bleeding, fracture of the sacrum and left inferior pubic ramus, and intraperitoneal bladder rupture. The patient presented with hemorrhagic shock because of intra-peritoneal hemorrhage. After resuscitation, angiographic intervention was performed. After angiographic embolization of the liver laceration, emergency laparotomy was performed to repair the bladder injury. However, there was no evidence of bile duct injury on initial laparotomy. On post-trauma day (PTD) 4, the color of intra-abdominal drainage of the patient changed to a greenish hue; bile leakage was revealed on magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP). Bile leakage was detected near the hepatic duct confluence; therefore, a biliary stent was placed into the left hepatic duct. On PTD 37, contrast leakage was still detected but both hepatic ducts were delineated on the second ERCP. Stents were placed into the right and left hepatic ducts. On PTD 71, a third ERCP revealed no contrast leakage; therefore, all stents were removed after 2 weeks (PTD 85). ERCP and biliary stenting could be effective treatment options for hemodynamically stable patients after blunt trauma.

• Radiation Oncology Journal
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• v.6 no.2
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• pp.211-226
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• 1988

Among 165 patients of esophagus cancer treated by either radiation alone or postoperative radiation, median survival period was 6.6 months, $16\%$ 3 years and $8\%$ 5years crude survival. In biphasic plotting of survival curve semilogarithmically all nonresponder died within one year regardless of treatments and in responder each 1, 2, 3 years survival rate was $80\%,\;70\%,\;60\%$ in the group of postoperative radiation among 20 patients ($54\%$ of 37 patients) respectively and $62\%,\;38\%,\; 23\%$ each in the group of radiation alone among 61 patients ($48\%$ of 128 patients) respectively, better survival rate of postoperative radiation vs radiation alone in 3 year (P<0.01). The most common cause of death was dysphagia $55\%$, and majority of patients died by failure to control the disease locally $62\%,\;88\%$ of stricture were associated with persistenece of cancer in esophagus. $50\%$ of patients was found to have locoregional metastatc nodes. Preoperative diagnostic failure rate was for metastatic locoregional nodes was $54\%$, for grossly metastatic nodes $29.7\%$, for blood borne organ metastasis $13.5\%$, and for local extent of the disease $14\%$. The residual cancer at surgical margin o. postitive node was not effectively killed by either 5000 to 5500 cGy conventional radiation or 5290 to 5750 cGy with 115 cGy fraction in 2 times daily; hyperfractionated radiation. However hyperfractionation schedule decreased the both acute and late complications in this study.

• Korean Journal of Head & Neck Oncology
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• v.17 no.2
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• pp.174-178
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• 2001

Background and Objective: Percutaneous ethanol injection therapy has been used in the treatment of the benign thyroid diseases. Although the reported side-effects of the therapy was mild and transient, some side-effects including local or radiating pain are troublesome to the patients. Radioactive iodine-131($Ra-^{131}I$) also has been effectively and safely used for management of the benign thyroid diseases. So we developed the percutaneous intranodular injection therapy of $Ra-^{131}I$ as an alternative of percutaneous ethanol injection therapy. Materials and Methods: From December 1998 to October 1999, we treated 29 outpatients (25 women and 4 men, mean age: $47{\pm}12$ years). Inclusion criteria were follows; age >30 years, cytologically benign, with normal thyroid function, cold nodule on thyroid scintigram, solid or mixed natured nodules in sonographical evaluation. Nodular volume was estimated by sonography according to the ellipsoid formula. $Ra-^{131}I$(0.1mCi/ml) was administered in a single dose injection. Follow-up studies every 3 months consisted of full history, thyroid function test, and sonography. We determined the therapeutic response is effective if the volume reduction of the nodule occurred above 30%. Results: After at least 3 months follow-up, 11 patients showed effective response, 12 patients showed minimal or unchanged response and 6 patients showed progression. Although side-effects such as injection pain, febrile reaction, and hormonal changes were absent, an infectious complication in injection site was developed from 1 case. Conclusion: Although we need a more prolonged follow-up to evaluate the delayed sequelae, we can suggest that percutaneous intranodular injection therapy of $Ra-^{131}I$ may be an attractive non-surgical treatment in selected cases of benign thyroid nodules.