• Clinics in Shoulder and Elbow
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• v.16 no.2
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• pp.73-83
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• 2013

Purpose: The goal of this study is to evaluate the minimum three-year follow-up results of reverse total shoulder arthroplasty (RTSA) for glenohumeral (GH) arthritic and pseudoparalytic patients with severe rotator cuff deficiency. Materials and Methods: We evaluated 13 patients (three males and 10 females) who underwent RTSA from July 2007 to July 2010. The average follow-up duration was 54.2 months (range, 37~74 months). Clinical results were evaluated using the Visual Analog Scale (VAS) for pain, active Range of Motion (ROM): active forward flexion (aFF); active external rotation at the side (aERs); active internal rotation to the back (aIRb), American Shoulder and Elbow Surgeons (ASES) score, Korean Shoulder Score (KSS), and intraoperative and postoperative complications. Results: VAS score improved from 7.5(6~10) points to 1.5(0~4), and ROM of active forward elevation improved from $42.7(10{\sim}100)^{\circ}$ to $129.1(110{\sim}180)^{\circ}$. In addition, ASES score improved from preoperative 32.9 (11.7~46.7) points to 80.2(58.3~95.0) postoperatively, and KSS score improved from 36.8(24~47) points to 78.4 (61~92). Twelve out of 13 cases showed various degrees of scapular notching at the last follow-up. There was one case of intraoperative anterior glenoid fracture and two cases of temporary nerve injury. Revision surgery was performed in two cases for treatment of delayed postoperative deep infection. Conclusion: According to minimum three-year follow-up results, RTSA may be an effective treatment option for glenohumeral (GH) arthritic and pseudoparalytic patients. However, considering the possibility of complications related to delayed deep infection or surgeon's technique, RTSA should be judiciously and carefully indicated by expert surgeons.

• Journal of Yeungnam Medical Science
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• v.2 no.1
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• pp.11-22
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• 1985

Femur neck fracture is well known as one of the major death cause after trauma in elderly patients, and unsolved fracture due to its frequent association with complications such as avascular necrosis and nonunion. Through meticulous evaluation of the patient, hip and surgeon's experiences, reduction of mortality and morbidity as well as rapid recovery of the patient to the preinjury social and ambulatory status without local complications and revision after treatment is urgently needed. Many factors about this fracture In itself were noted, but we have analyzed 18 femur neck fractures of the patients older than 50 years preliminarily according to age, fracture pattern, osteoporosis, etiology and method of treatment with its delay in association with major complications especially avascular necrosis and nonunion. The results are as follows; 1. Of these 18 fractures, 11 were in females, 8 were caused by minor trauma such as slip-down accident and 4 were associated with definite osteoporosis according to the Sing's classification. 2. Fracture pattern of these 18 are undisplaced in 4, displaced subcapital in 11, displaced transcervical in 3. 11 fractures in the patients older than 60 year are composed of 3 undisplaced or impacted fractures and 8 displaced subcapital fractures. 3. These 18 fractures were treated by closed reduction and Internal fixation with multiple pins in 13, and hemiarthroplasty in 4, but one was not treated to die after discharge from hospital. 4. 4 undisplaced or impacted fractures and 3 displaced transcervical fractures were not associated with any complications such as avascular necrosis or nonunion. But 4 of 6 displaced subcapital fractures were complicated by avascular necrosis, 3 of which were reduced in the varus position within 1 week, and the other was reduced in the good position on 1 week after trauma. There was no complication in 2 displaced subcapital fractures reduced in valgus position within 3 days after trauma. According to the above results, the prognosis of the femur neck fracture is dependent upon the fracture pattern and delay in its treatment. So it is inevitable to reduce the fracture in anatomical or valgus position as early as possible. But the arthroplasty may be needed in displaced subcapital fractures delayed for several days, with its reluction in extreme varus position or impossible and with pre-existing disease in the same hip Joint (total hip replacement).

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.2
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• pp.519-525
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• 2016

Background: The objective of this study was to report the types and relative frequency of oral malignancies and precancer in the Jazan region of Saudi Arabia during the period 2009-2014. Materials and Methods: Pathology reports were retrieved from the archives of Histopathology Department, King Fahd hospital in Jazan. Demographic data on tobacco habits, clinical presentation and histologic grading of oral precancer and cancer cases were transcribed from the files. Results: 303 (42.7%) oral pre-malignant and malignant cases were found out of 714 oral biopsy lesions. A pathology diagnosis of squamous cell carcinoma (85.1%) was most frequent, followed by premalignant lesions/epithelial dysplasia (8.6%), verrucous carcinoma (3.3%) and malignancy of other histological types (3%) such as ameloblastic carcinoma, salivary gland malignancy and sarcomas. Oral squamous cell carcinoma was predominant in females with a male to female ratio of 1:1.9. Patient age ranged from 22 to 100 years with a mean of $65{\pm}13.9$. Almost 44.6% of oral cancer had occurred after 65 years of age. Only 16.3% cases were reported in patients younger than 50 years, predominantly females. The majority of female patients had the habit of using shammah with a long duration of usage for more than 45 years. Buccoalveolar mucosa (52.3%) was the common site of involvement followed by tongue/floor of the mouth (47.7%) and clinically presented mostly as ulceration/swelling clinically. Moderately differentiated tumours (53.9%) were common followed by well differentiated (32.2%) and poorly differentiated tumours (5.8%). The prevalence of oral verrucous carcinoma (3.3%) was comparatively low with an equal distribution in both males and females. Both bucco-alveolar mucosa and tongue were predominantly affected. Oral precancer/epithelial dysplasia (8.6%) was common in females with a shammah habit. Bucco-alveolar mucosa was commonly involved and clinically presented mostly as white/red patches. Most cases were mild followed by moderate and severe dysplasia. Tumours of other histological types (3%) include 1 ameloblastic carcinoma, 3 malignant salivary gland tumours and 5 sarcomas. Conclusions: In this study, it was found that oral cancers reported in the pathology service to be a common occurrence. This study reconfirms previous reports of the high burden of oral cancer in this population This indicates that conventional preventive programs focused on oral cancer are in need of revision. In addition, further research into identifying new risk factors and molecular markers for oral cancer are needed for screening high risk individuals.

• Journal of Korean Academy of Nursing
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• v.28 no.3
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• pp.705-717
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• 1998

Ostomates have suffered from many difficulties due to their physical, psychosocial handicaps and changes of life style to include ostoma management that influences their daily and quality of life. An appropriate nursing education for ostoma management is very important. Practical educational materials needs revision because those were developed by pharmaceutical companies and hospital institutions. The purpose of this study is to provide more practical and reasonable education materials for ostomates by doing analysis and survey of educational materials now being used. We surveyed 8 types of educational materials used in 23 university hospitals and medical centers in Seoul ; four of them were developed by department of nursing and the remainder by an Ostomy Company Data, collected from July 14, 1997 through July 31, 1997 were analyzed. The results are as follows ; 1. The analysis of education guide, on ostomate included 14 subcategories : introduction, structure and function of gastrointestinal tracts, definition of stoma, types of ostomy, definition of peristalsis, methods of defecation management, selection of instrument, resolution of problems and general situations following surgery, daily life, where to ask for help, explanations for terms, information about where to buy instrument, explanations for enterostomal therapist, a matter of consultation with doctor, etc. 2. Introduction contained specific contents on practical ostomate management that ostomates would experience through their lives. Ostomate education guides were developed 3 hospitals except one which missed this point. 3. Most ostomate education guides, except one hospital, helped ostomates to understand their physical structure changes with specific explanations on gastrointestinal tracts with figures. 4. Six institutions did not talk about the definition of peristalsis. 5. All institutions, except two, helped ostomates to understand types of ostomy with figures. 6. More detailed explanations on natural defecation are needed. The benefits and pitfalls of natural defecation should be more specified. 7 No psychosocial difficulties of ostomy management were addressed. 8. The efficiency of enema can be better understood through all explanations with figures. Some institutions did not mention items about definition, benefits, pitfalls of enema, sequency of enema, how to wash, cautions performing and enema, skin management, cleaning instrument after enema proper time to spend. 9. There were no detailed contents and what to do in case of not being able to do enema. 10. Only one educational material mentioned emotional aspects after the surgrey. 11. Most institutions explained subcategory of daily life but did not provide specific contents on the difficulties of physical, psychological, and sociocultural controls. 12. The subcategory of ureterostomy education guides included explanations on normal structure and function of urinary tracts, types of ureterostomy, how to manage skin, usage and types of instrument, commercial urostomy, how to manage instrument, daily life, introduced the general contents. However, more specific explanations were needed.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.4
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• pp.331-338
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• 2004

Stress transfer to the surrounding tissues is one of the factors involved in the design of dental implants. Unfortunately, insufficient data are available for stress transfer within the regenerated bone surrounding dental implants. The purpose of this study was to investigate the concentration of stresses within the regenerated bone surrounding the implant using three-dimensional finite element stress analysis method. Stress magnitude and contours within the regenerated bone were calculated. The $3.75{\times}10-mm$ implant (3i, USA) was used for this study and was assumed to be 100% osseointegrated, and was placed in mandibular bone and restored with a cast gold crown. Using ANSYS software revision 6.0, a program was written to generate a model simulating a cylindrical block section of the mandible 20 mm in height and 10 mm in diameter. The present study used a fine grid model incorporating elements between 165,148 and 253,604 and nodal points between 31,616 and 48,877. This study was simulated loads of 200N at the central fossa (A), at the outside point of the central fossa with resin filling into screw hole (B), and at the buccal cusp (C), in a vertical and $30^{\circ}$ lateral loading, respectively. The results were as follows; 1. In case the regenerated bone (bone quality type IV) was surrounded by bone quality type I and II, stresses were increased from loading point A to C in vertical loading. And stresses according to the depth of regenerated bone were distributed along the implant evenly in loading point A, concentrated on the top of the cylindrical collar loading point B and C in vertical loading. And, In case the regenerated bone (bone quality type IV) was surrounded by bone quality type III, stresses were increase from loading point A to C in vertical loading. And stresses according to the depth of regenerated bone were distributed along the implant evenly in loading point A, B and C in vertical loading. 2. In case the regenerated bone (bone quality type IV) was surrounded by bone quality type I and II, stresses were decreased from loading point A to C in lateral loading. Stresses according to the depth of regenerated bone were concentrated on the top of the cylindrical collar in loading point A and B, distributed along the implant evenly in loading point C in lateral loading. And, In case the regenerated bone (bone quality type IV) was surrounded by bone quality type III, stresses were decreased from loading point A to C in lateral loading. And stresses according to the depth of regenerated bone were distributed along the implant evenly in loading point A, B and C in lateral loading. In summary, these data indicate that both bone quality surrounding the regenerated bone adjacent to implant fixture and load direction applied on the prosthesis could influence concentration of stress within the regenerated bone surrounding the cylindrical type implant fixture.

• Journal of Korean Neurosurgical Society
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• v.63 no.6
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• pp.738-746
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• 2020

Objectives : The purpose of this study was to evaluate surgical outcomes and complications of spinal deformity associated with neurofibromatosis type-1 (NF-1). Methods : From 2012 to 2018, patients suffering from spinal deformity associated with NF-1 who underwent surgical correction were identified. Demographic data and radiographic measures were retrospectively reviewed. Pre- and postoperative whole spine radiograph images were used to determine both coronal and sagittal Cobb angles. All of patients underwent 3-dimentional computed tomographic scan and magnetic resonance imaging scan to confirm dystrophic features. For evaluation of clinical outcomes, we surveyed the pre- and postoperative scoliosis research society-22r (SRS-22r) score. Results : Seven patients with spinal deformity associated with NF-1 were enrolled in this study. The mean age of patients was 29.5±1.2 years old. The mean follow-up period was 2.8±1.4 years. The apex of the deformity was located in cervicothoracic (n=1), thoracic (n=4), and lumbar region (n=2). Most patients have poor bone quality and decreased bone mineral density with average T-score of -3.5±1.0. All patients underwent surgical correction via posterior approach. The pre- and postoperative mean coronal and sagittal Cobb angle was 61.6±22.6° and 34.6±38.1°, 56.8±18.5° and 40.2±9.1°, respectively. Mean correction rate of coronal and sagittal angle was 44.7% and 23.1%. Ultimate follow-up SRS-22r score (average score, 3.9±0.4) improved comparing to preoperative score (average score, 3.3±0.9). Only one patient received revision surgery due to rod fracture. No serious complication occurred, such as neurological deficit, and viscerovascular injury. Conclusion : The surgical correction of patients having spinal deformity associated with NF-1 is challenging, however the radiographic and clinical outcomes are satisfactory. The all posterior approach can be a safe and effective surgical option for patients having dystrophic curves associated with NF-1.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.3
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• pp.248-254
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• 2005

The purpose of this study was to investigate the distribution of stress within the regenerated bone surrounding the implant using three dimensional finite element stress analysis method. Using ANSYS software revision 6.0 (IronCAD LLC, USA), a program was written to generate a model simulating a cylindrical block section of the mandible 20 mm in height and 10 mm in diameter. The $5.0{\times}11.5-mm$ screw implant (3i, USA) was used for this study, and was assumed to be 100% osseointegrated. And it was restored with gold crown with resin filling at the central fossa area. The implant was surrounded by the regenerated type IV bone, with 4 mm in width and 7 mm apical to the platform of implant in length. And the regenerated bone was surrounded by type I, type II, and type III bone, respectively. The present study used a fine grid model incorporating elements between 250,820 and 352,494 and nodal points between 47,978 and 67,471. A load of 200N was applied at the 3 points on occlusal surfaces of the restoration, the central fossa, outside point of the central fossa with resin filling into screw hole, and the functional cusp, at a 0 degree angle to the vertical axis of the implant, respectively. The results were as follows: 1. The stress distribution in the regenerated bone-implant interface was highly dependent on both the density of the native bone surrounding the regenerated bone and the loading point. 2. A load of 200N at the buccal cusp produced 5-fold increase in the stress concentration at the neck of the implant and apex of regenerated bone irrespective of surrounding bone density compared to a load of 200N at the central fossa. 3. It was found that stress was more homogeneously distributed along the side of implant when the implant was surrounded by both regenerated bone and native type III bone. In summary, these data indicate that concentration of stress on the implant-regenerated bone interface depends on both the native bone quality surrounding the regenerated bone adjacent to implant and the load direction applied on the prosthesis.

• Journal of Biomedical Engineering Research
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• v.40 no.5
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• pp.197-205
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• 2019

The existing Extracorporeal membrane oxygenation(ECMO) and Cardiopulmonary bypass system(CPB) have been developed and applied to various devices according to their respective indications. However, due to the complicated configuration and difficult usage method, it causes inconvenience to users and there is a risk of an accident. Therefore, smart all-in-one cardiopulmonary circulation device is being developed recently. The smart all-in-one cardiopulmonary assist device consists of a blood pump for cardiopulmonary bypass, a blood oxidizer for cardiopulmonary bypass, a blood circuit for cardiopulmonary bypass, and an artificial cardiopulmonary device. It is an integrated cardiopulmonary bypass device that can be used for a variety of purposes such as emergency, intraoperative, post-operative intensive care, and long-term cardiopulmonary assist, combined with CPB used in open heart surgery and ECMO used when patient's cardiopulmonary function does not work normally. The smart all-in-one cardiopulmonary assist device does not exist as a standard and international standard applicable to advanced medical devices. Therefore, in this study, we will refer to the International Standard for Blood Components, the International Standard for Blood, the Guideline for Blood Products, and prepare applicable performance and safety guidelines to help quality control of medical devices, and contribute to the improvement of the health of people. The guideline, which is the result of conducted a survey of the method of safety and performance test, is based on the principle of all-in-one cardiopulmonary aiding device, related domestic foreign standards, the status of domestic and foreign patents, related literature, blood pump(ISO 18242), blood oxygenator (ISO 7199), and blood circuit (ISO 15676) for cardiopulmonary bypass.The items on blood safety are as follows: American Society for Testing and Materials ASTM F1841-97R17), and in the 2010 Food and Drug Administration's Safety Assessment Guidelines for Medical Assisted Circulatory Devices. In addition, after reviewing the guidelines drawn up through expert consultation bodies including manufacturers / importers, testing inspectors, academia, etc. the final guideline was established through revision and supplementation process. Therefore, we propose guidelines for evaluating the safety and performance of smart all-in-one cardiopulmonary assist devices in line with growing technology.

• Journal of Chest Surgery
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• v.35 no.5
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• pp.369-374
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• 2002

Background: Proper construction of vascular access and adequate maintenance are essential for the prognosis of the hemodialysis patients. Though arteriovenous fistula using autogenous vessel is the first of choice, the incidence of arteriovenous fistula using artificial graft is gradually increasing. The aim of this study was to analyse the patency rates between autogenous and artificial fistula, among artificial graft types, according to the accompanied disease. Material and Method: A retrospective study was conducted on 186 patients who underwent 292 arteriovenous fistula operations for hemodialysis at Korea University Guro Hospital between 1996 and 2000. Mean age of the patients was 54.37 $\pm$ 12.79years, and the male: female ratio 99:87. Result: Among 292 operations, there were 156 autogenous fistula and 116 graft fistula. The other 20 operations were thrombectomy, takedown of graft, revision, and balloon dilatation. Patency rates of autogenous fistula were 92.78 $\pm$ 2.35% at 1 year and 39.03$\pm$9.08% at 5 years, and those of graft fistula were 96.09 $\pm$ 2.22% at 1 year and 16.45 $\pm$ 10.15% at 5 scars. However, there was no statistical significance between the two operations. The patients who had hypertension, diabetes or both had no statistical significance in the patency rate compared to that of patients without underlying disease. In addition, the type of graft used did not affect the patency rate. Second operation was needed in 62 patients and third operation in 31 patients, but their patency rate again had no statistical significance compared to that of the first operation. Conclusion: The patency of the artificial graft fistula was comparable to the autogenous fistula, but the patency according to types of graft need to be studied further. Furthermore, the underlying diseases did not affect the fistula patency.

• Journal of Chest Surgery
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• v.36 no.2
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• pp.73-78
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• 2003

The Fontan operation has undergone a number of major modifications and clinical results have been improving over time. Nevertheless, during the follow-up period, life-threatening complications develop and affect the long-term outcomes. Surgical interventions for these complications are needed and are increasing. Material and Method: From April 1988 to January 2000, 16 patients underwent reoperations for complications after Fontan operation. The mean age at reoperation was 8.8 :-5.5 years. Initial Fontan operations were atriopulmonary connections in 8 and total cavopulmonary connections in 8. Total cavopulmonary connections were accomplished with intracardiac lateral tunnel in 5 and extracardiac epicardial lateral tunnel in 3. Five patients had variable sized fenestrations. The reasons for reoperations included residual shunt in 6, pulmonary venous obstruction in 3, atrial flutter in 3, atrioventricular valve regurgitation in 2, Fontan pathway stenosis in 1, and protein-losing enteropathy in 1 Result: There were 3 early and late deaths respectively Patients who had residual shunts underwent primary closure of shunt site (n=2), atrial reseptation for separation between systemic and pulmonary vein (n=2), conversion to lateral tunnel (n=1), and conversion to one and a half ventricular repair (n=1). Four patients who had stenotic lesion of pulmonary vein or Fontan pathway underwent widening of the lesion (n=3) and left pneumonectomy (n=1) In cases of atrial flutter, conversion to lateral tunnel after revision of atriopulmonary connections was performed (n=3). For the atrioventricular valve regurgitation (n=2), we performed a replacement with mechanical valve. In one patient who had developed protein-losing enteropathy, aorto-pulmonary collateral arteries were obliterated via thoracotomy. Cryoablation was performed concomitantly in 4 patients as an additional treatment modality of atrial arrhythmia. Conclusion: Complications after Fontan operation are difficult to manage and have a considerable morbidity and mortality. However, more accurate understanding of Fontan physiology and technical advancement increased the possibility of treatment for such complications as well as Fontan operation itself. Appropriate surgical treatment for these patients relieved the symptoms and improved the functional class, Although the results were not satisfactory enough in all patients.