• Journal of the Korean Society of Radiology
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• v.16 no.1
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• pp.53-59
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• 2022

DEXA, as the standard areal bone mineral density (aBMD) measurement method, often shows an insuficient correlation between aBMDs of the measured bones and referring bones and is inaccurate due to the mass effect. In contrast, quantitative computer tomography (QCT), as a volumetric BMD (vBMD) measurement method, is being advanced so that it uses less radiation before, owing to improved CT device and computer imaging technology. Because dual-energy CTs can modulate the image signals showing tumor or specific chemicals as well as the ability to measure vBMD, they are expanding their application. For pre-checking vBMD of surgeon-specific bone volume at implantation candidate sites, a finite element creation-based local vBMD measurement technique was developed. The local vBMD measurement function for surgeon-specific shape volumes will be added to clinical imaging systems.

• Journal of International Society for Simulation Surgery
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• v.1 no.1
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• pp.41-44
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• 2014

The aim of this report is showing the case that we could give exact navigation of perigastric vessels for gastrectomy with 3D CTA. A 74-year-old male patient visited hospital with gastric cancer. Early gastric cancer, type IIb was found at stomach antrum great curvature side. Before surgery, he underwent 3D CT angiography. 3D volume rendering images and MIP images were made by post processing. He had replaced Lt. hepatic artery arising from Lt. gastric artery. Surgeon could get patient's specific vascular anatomy before surgery including surgically relevant anatomical distance and direction and could finish gastrectomy within 4 hours and just 53ml blood loss.

• Archives of Plastic Surgery
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• v.41 no.6
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• pp.686-692
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• 2014

Background Restoring orbital volume in large blowout fractures is still a technically challenge to the orbital surgeon. In this study, we restored the orbital wall using the combination of transorbital and transnasal approach with additional supports from the paranasal sinuses, and we compared the surgical outcome to that of a conventional transorbital method. Methods A retrospective review of all patients with pure unilateral blowout fractures between March 2007 and March 2013 was conducted. 150 patients were classified into two groups according to the surgical method: conventional transorbital method (group A, 75 patients, control group), and the combination of transorbital and transnasal approach with additional supports from the paranasal sinuses (group B, 75 patients, experimental group). Each group was subdivided depending on fracture location: group I (inferior wall), group IM (inferomedial wall), and group M (medial wall). The surgical results were assessed by the Hertel scale and a comparison of preoperative and postoperative orbital volume ratio (OVR) values. Results In the volumetric analysis, the OVR decreased more by the experimental groups than each corresponding control groups (P<0.05). Upon ophthalmic examination, neither the differences among the groups in the perioperative Hertel scale nor the preoperative and postoperative Hertel scales were statistically significant (P>0.05). Conclusions Our surgical results suggest that orbital volume was more effectively restored by the combination of transorbital and transnasal approach with additional supports from the paranasal sinuses than the conventional method, regardless of the type of fracture.

• Journal of Gastric Cancer
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• v.18 no.2
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• pp.172-181
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• 2018

Purpose: This study aimed to evaluate the surgical outcomes and investigate the feasibility of reduced-port laparoscopic gastrectomy using learning curve analysis in a small-volume center. Materials and Methods: We reviewed 269 patients who underwent laparoscopic distal gastrectomy (LDG) for gastric carcinoma between 2012 and 2017. Among them, 159 patients underwent reduced-port laparoscopic gastrectomy. The cumulative sum technique was used for quantitative assessment of the learning curve. Results: There were no statistically significant differences in the baseline characteristics of patients who underwent conventional and reduced-port LDG, and the operative time did not significantly differ between the groups. However, the amount of intraoperative bleeding was significantly lower in the reduced-port laparoscopic gastrectomy group (56.3 vs. 48.2 mL; P<0.001). There were no significant differences between the groups in terms of the first flatus time or length of hospital stay. Neither the incidence nor the severity of the complications significantly differed between the groups. The slope of the cumulative sum curve indicates the trend of learning performance. After 33 operations, the slope gently stabilized, which was regarded as the breakpoint of the learning curve. Conclusions: The surgical outcomes of reduced-port laparoscopic gastrectomy were comparable to those of conventional laparoscopic gastrectomy, suggesting that transition from conventional to reduced-port laparoscopic gastrectomy is feasible and safe, with a relatively short learning curve, in a small-volume center.

• Archives of Plastic Surgery
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• v.39 no.1
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• pp.25-30
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• 2012

Background : The soft palate functions as a valve and helps generate the oral pressure required for normal speech resonance. Speech problems and nasal regurgitation can result from a soft palatal defect. Reduction of the size of the velopharyngeal orifice is required to compensate for the lack of mobility in a reconstructed soft palate. We suggest a large volume folded free flap for reduction of the caliber and a palmaris longus tendon sling for suspension of the reconstructed palate. Methods : Six patients had total soft palate resection for tonsillar cancer and reconstruction with a large volume folded radial forearm free flap combined with a palmaris longus sling. A single surgeon and speech therapist examined the patients with three standardized speech assessment tools: nasometer test, consonant articulation test, and speech acuity test performed for speech evaluation. Results : Mean nasalance score was 76.20% for sentences with nasal sounds and 43.60% for sentences with oral sounds. Hypernasality was seen for oral sound sentences. The mean score of the picture consonant articulation test was 84% (range, 63% to 100%). The mean score of the speech acuity test was 5.84 (range, 5 to 6). These mean ratings represent a satisfactory level of speech function. Conclusions : The large volume folded free flap with a palmaris longus tendon sling for total soft palate reconstruction resulted in satisfactory prognosis for speech despite moderate hypernasality.

• Journal of Gastric Cancer
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• v.12 no.4
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• pp.223-231
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• 2012

Purpose: Clinical staging of gastric cancer appears to be important more and more for tailored therapy. This study aimed to verify the accuracy of clinical T staging in a low-volume institute. Materials and Methods: We retrospectively reviewed prospectively collected data of gastric cancer patients who underwent resection. A total of 268 patients of gastric cancer were enrolled from March 2004 to June 2012. These demographics, tumor characteristics, and clinical stages were analyzed for identification of diagnostic value of clinical T staging. Results: The predictive values for pT1 of endoscopy and computed tomography were 90.0% and 89.4%, respectively. In detail, the predictive values of endoscopy for pT1a, pT1b, and pT2 or more were 87%, 58.5%, and 90.6%, respectively. The predictive values of computed tomography for pT1a, pT1b, and pT2 or more were 68.8%, 73.9%, and 84.4%, respectively. The factors leading to underestimation of pT2 or more lesions by gastroscopy were the middle third location, the size greater than 2 cm, and younger age. Those for overestimation of pT1 lesion by computed tomography were male, age more than 70 years, elevated type, and size greater than 3 cm. Conclusions: Diagnostic accuracy of early gastric cancer was 90%, which is comparable to those of high volume center. In patients with early gastric cancer, limited gastrectomy or minimal invasive surgery can be safely introduced at a low volume center also. However, the surgeon of low-volume institute should consider the accuracy of clinical staging before extending the indication of limited treatment.

• Imaging Science in Dentistry
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• v.43 no.3
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• pp.135-143
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• 2013

Purpose: This study was performed to obtain a quantitative evaluation of the cortical and cancellous bone graft harvestable from the mental and canine regions, and to evaluate the cortical vestibular thickness. Materials and Methods: This study collected cone-beam computed tomographic (CBCT) images of 100 Italian patients. The limits of the mental region were established: 5 mm in front of the medial margin of each mental foramen, 5 mm under the apex of each tooth present, and above the inferior mandibular cortex. Cortical and cancellous bone volumes were evaluated using SimPlant software (SimPlant 3-D Pro, Materialize, Leuven, Belgium) tools. In addition, the cortical vestibular thickness (minimal and maximal values) was evaluated in 3 cross-sections corresponding to the right canine tooth (3R), the median section (M), and the left canine tooth (3L). Results: The cortical volume was $0.71{\pm}0.23mL$ (0.27-1.96 mL) and the cancellous volume was $2.16{\pm}0.76mL$ (0.86-6.28 mL). The minimal cortical vestibular thickness was $1.54{\pm}0.41mm$ (0.61-3.25 mm), and the maximal cortical vestibular thickness was $3.14{\pm}0.75mm$ (1.01-5.83 mm). Conclusion: The use of the imaging software allowed a patient-specific assessment of mental and canine region bone availability. The proposed evaluation method might help the surgeon in the selection of the donor site by the comparison between bone availability in the donor site and the reconstructive exigency of the recipient site.

• Journal of Yeungnam Medical Science
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• v.37 no.1
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• pp.32-39
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• 2020

Background: Rhinoplasty is one of the most commonly performed cosmetic surgery procedures. Most Asians desire elevation of their relatively flat nasal dorsum and tip to make them appear more prominent. This study introduces a simple method of nasal tip plasty using three-dimensional (3D)-printed polycaprolactone (PCL) (Smart Ball^®), which provides the required length and volume for this purpose and enables the creation of a nasal tip of the desired shape in a safe and simple manner. Methods: Between September 2014 and May 2017, 22 patients participated in a survey to assess postoperative satisfaction levels. Additionally, three plastic surgeons compared patients' pre- and 1-year postoperative photographs to evaluate the results. All patients underwent 2- to 4-year postoperative follow-up. Results: Levels of subjective satisfaction among patients were 3.59, 3.50, 3.82, 3.73, 3.55, and 3.82 for each of the 6 categories evaluated, with a mean of 3.67/4 points, indicating high satisfaction levels. The mean plastic surgeon-reported score for the 22 patients was 4.47/5 points, which also indicates highly successful outcomes. Postoperative nasal tip rotation and tip projection were ideal in most patients. Conclusion: Our novel method using 3D-printed PCL (Smart Ball^®) provides the optimal length and volume required for nasal tip plasty and enables the creation of a nasal tip of the desired shape, in a safe and simple manner. An advantage of our method is that it retains the original nasal structure in contrast to structural changes observed with the use of conventional methods.

• Journal of Korea Multimedia Society
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• v.21 no.6
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• pp.678-684
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• 2018

In order to broaden the indication of middle ear implant, research has been actively conducted on the reverse output method that stimulates the round window. However, it is very difficult to transmit the vibration output effectively because the indivisual anatomical difference of the round window niche is very large and also the visual field is not secured even by a skilled otolaryngologic surgeon. In this paper, we propose a new reverse stimulation method of middle ear implants that transmits energy to the inner ear by using air as a medium. This can compensate for the disadvantages of the conventional method of transmitting vibration energy and minimizes the energy transfer efficiency interference due to the combination of the excitation point and the output device. It was shown that forward and backward transfer characteristics were obtained by cadaveric experiments, and it was shown that it can overcome the acoustical impedance of high round window and transmit energy to inner ear. The receiver, which is the output device of the conventional hearing aids, can generate a constant volume velocity, so it can have a high output at a limited volume, such as a round window niche. So, suggested method can overcome the high acoustical impedance of the round window and deliver acoustic energy to the inner ear.

• Archives of Plastic Surgery
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• v.39 no.5
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• pp.504-508
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• 2012

Background The most common complication of latissimus dorsi myocutaneous flap in breast reconstruction is seroma formation in the back. Many clinical studies have shown that fibrin sealant reduces seroma formation. We investigated any statistically significant differences in postoperative drainage and seroma formation when utilizing the fibrin sealant on the site of the latissimus dorsi myocutaneous flap harvested for immediate breast reconstruction after skin-sparing partial mastectomy. Methods A total of 46 patients underwent immediate breast reconstruction utilizing a latissimus dorsi myocutaneous island flap. Of those, 23 patients underwent the procedure without fibrin sealant and the other 23 were administered the fibrin sealant. All flaps were elevated with manual dissection by the same surgeon and were analyzed to evaluate the potential benefits of the fibrin sealant. The correlation analysis and Mann-Whitney U test were used for analyzing the drainage volume according to age, weight of the breast specimen, and body mass index. Results Although not statistically significant, the cumulative drainage fluid volume was higher in the control group until postoperative day 2 (530.1 mL compared to 502.3 mL), but the fibrin sealant group showed more drainage beginning on postoperative day 3. The donor site comparisons showed the fibrin sealant group had more drainage beginning on postoperative day 3 and the drain was removed 1 day earlier in the control group. Conclusions The use of fibrin sealant resulted in no reduction of seroma formation. Because the benefits of the fibrin sealant are not clear, the use of fibrin sealant must be fully discussed with patients before its use as a part of informed consent.