• 대한족부족관절학회지
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• 제22권2호
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• pp.62-67
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• 2018

Purpose: To evaluate the clinical significance and usefulness of a bone scan in accessory navicular bone. Materials and Methods: Eighty-five patients with foot pain and accessory navicular bone on radiography, who underwent bone scan from 2012 to 2015, were analyzed retrospectively. The subjects was divided into a symptomatic and asymptomatic group according to the presence of navicular bone tenderness. The grade of bone scan uptake was divided into 3 grades. Age, gender, grade of bone scan and size of the accessory navicular bone were analyzed. The symptomatic group were divided into a low (grade 0, 1) and high uptake (grade 2) group to determine the appropriate treatment. The low uptake group was treated conservatively for 3 months. The high uptake group was initially treated conservatively for 3 months and surgery was performed if pain persisted. For the clinical evaluation, the visual analogue scale, American Orthopaedic Foot and Ankle Society midfoot scale were evaluated in the first examination and last follow-up date. The patient's satisfaction grade was also evaluated at the last follow-up. Results: The asymptomatic group mostly showed no uptake in the bone scan. On the other hand, some patients in the asymptomatic group showed an increase in uptake. In these patients, the size of accessory navicular bone was related to the grade of bone scan uptake, showing that the bone scan uptake grade can be predicted when applying different cut off values for the bone size. The symptomatic group mostly showed uptake in the bone scan and the grade of uptake had a positive correlation with the size of the accessory navicular bone (p<0.05). Age and gender were not related to the bone scan uptake. In the clinical evaluation, conservative and surgical treatment showed a good outcome. Conclusion: The bone scan uptake grade alone cannot be used to completely predict the symptoms. On the other hand, the size of the accessory bone can increase the bone scan uptake. Therefore, the size of the accessory bone, and patient symptoms should be considered in patients with a high uptake when deciding treatment.

• 대한두경부종양학회지
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• 제16권2호
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• pp.228-234
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• 2000

Objectives: Esthesioneuroblastoma is a rare malignant neoplasm that originates from the olfactory sensory cells. This tumor grows from the upper nasal cavity and ethmoid sinus and invades surrounding structures through the cribriform plate into intracranium or orbit in advanced stage. Even though there has been some controversies in determining standard treatment due to rarity of this tumor, the combination treatment of surgery and adjuvant radiation has been recommended for the locally advanced esthesioneuroblastomas. However, the recent clinical experiences of advanced cases showed that combination chemotherapy is highly effective to reduce tumor mass and improve clinical outcomes. Materials and Methods: The authors conducted a retrospective analysis of 6 esthesioneuroblastoma patients who were treated in our hospital from 1986. Results: The age of these patients was between 19 and 86 year-old. Among the 6 cases, 2 were diagnosed at stage B and 4 at stage C, according to Kadish classification. Anti-tumor treatments were performed in 5 patients. One patient refused active treatment and was lost to follow-up. Better survival outcome were observed in 3 patients who were treated with combination chemotherapy alone or combined modality treatment including chemotherapy. Conclusion: Based on our retrospective study, the combined treatment consisting of surgery, radiotherapy, and combination chemotherapy should be used to improve treatment results. And furthermore, innovative clinical approaches such as neoadjuvant chemotherapy, high-dose chemotherapy and autologous peripheral stem cell transplantation, which have been reported to have good therapeutic results, should be considered and applied actively.

• Journal of Yeungnam Medical Science
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• 제10권2호
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• pp.380-387
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• 1993

초기 유방암의 일차적인 치료법으로 시행한 보존적 유방절제술과 근치적인 방사선 치료의 효과를 확인하기 위하여 1988년 3월 1일부터 1992년 8월 31일까지 영남대학교 의과대학 부속병원에서 침윤성 유방암으로 확진되어 치료를 시행한 환자중 진료기록이 충실하고 최근까지 추적이 가능하였던 28명을 대상으로 임상적특징, 치료방법, 치료방법에 따른 치료성적, 치료와 연관된 부작용, 치료 후 미용상 만족도를 분석하여 아래의 결과를 얻었다. 평균 연령은 43.5세(중앙값)이었으며, 폐경기 이전이 17명, 폐경기 이후가 11명이었고, 임상적 병기는 I기가 12명, II기가 16명이었다. 수술은 단순 절제가 17명, 광범위 절제가 4명, 유선 1/4절제가 7명이었으며 대상환자 모두에서 액와 임파선 절제를 시행한 결과 7명에서 임파선 전이를 보였다. 치료법은 15명에서 방사선 치료, 항암제 투여 및 내분비 요법을 시행하였으며, 치료 방법에 따른 치료 성적의 차이는 없었다. 일반적으로 수술후 2-3주에 시행된 방사선 치료는 원발 병소의 상태에 따라 다양하게 시행되었으며 원발 병소는 55-65Gy, 지역 임파선부위는 45-50Gy를 조사하였다. 방사선 치료와 연관된 부작용의 발생은 병합요법시 현저히 증가하여 18명중 5명이었으나 방사선 치료만 시행된 경우는 10명중 1명이었다. 치료 완료후 27개월간 추적 조사한 결과 유방이나 지역 임파선 부위의 재발 및 원격 전이는 없었으며 미용상 28명중 26명에서 우수한 성적을 보였다. 그러나 전체 대상 환자가 적고 추적 기간이 한정된 관계로 추후 더 많은 환자를 대상으로 장기간의 추적 조사가 필요하리라 사료된다.

• 대한두경부종양학회지
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• 제9권2호
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• pp.210-220
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• 1993

Histologically proven 465 cases of neck mass in children were analized for the determination of the nature of lesions. Pathologic specimens were obtained during 10 years from January 1981 to December 1989 at Severance Hospital, Yonsei University, College of Medicine. 1) Congenital lesion was most common in neonate(80%) and congenital lesion and inflamatory disease were common in infancy and inflammatory disease was most common in more than one year old children. Thyroglossal duct cyst was most common(35.4%) disease of the congenital lesion. followed by cytic hygroma(34%) and branchial cleft remnants(29.2%). 2) Benign tumors were discovered most frequently in adolescence (55.2%) and thyroid adenoma(23.7%) and epithelial tumor(21.1%) and hemangiomas(19.7%) were most common. Most common malignant tumors were malignant lymphoma (50%) and Hodgkin's disease and were present in the older children. Metastatic cancers were very rare and their primary sites were deductable in all cases. 3) Reactive hyperplasia of lymph node was most common in inflammatory disease(23.7%). Tuberculosis lymphadenitis was more common than nonspecific lymphadenitis. 4) Bilaterality of lesion was commonly seen in malignant disease(41.7%), reactive hyperplasia of lymph node (38.85%) and metastatic disease(33.3%). Size and duration of the masses were not helpful in the differential diagnosis of the cause of the masses. Pediatric neck mass must be evaluated with its characteristics. sites, bilaterality, size and its cange, duration and patient's age but any of these alone cant not be predicted its causes without biopsy or excision. Biopsy or excision can be done with few complication but biopsy of lymph node for diagnosis is carefully made because a large number of lymph node biopsy showed no definite diagnosis in these selected cases of patients.

• Journal of Chest Surgery
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• 제43권5호
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• pp.506-512
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• 2010

배경: 이 연구는 비소세포암 환자에서 종격동 임파선 전이 여부를 정확히 예측하기 위해서 PET/CT에서 종격동 임파선과 폐종괴의 FDG 섭취비와 폐종괴의 Glut-1 발현 정도를 이용하여 분석 하고자 하였다. 대상 및 방법: PET/CT에서 폐종괴와 종격동 임파선에서 측정할 수 있는 정도의 FDG섭취가 있는 환자를 대상으로 하였다. FDG 섭취비는 종격동 임파선의 섭취를 폐종괴의 섭취로 나누어 구하였다. 폐종괴의 Glut-1 발현은 발현 면적으로 나타내었다. 결과: 폐종괴와 종격동 임파선의 mSUV값은 악성군에서 각각 $7.4{\pm}2.2$와 $4.2{\pm}2.2$, 양성군에서 각각 $7.6{\pm}3.7$와 $2.8{\pm}6.9$였다. FDG의 섭취비는 악성군과 양성군에서 각각 $0.58{\pm}0.23$과 $0.45{\pm}0.20$ (p<0.05)였다. FDG 섭취비와 Glut-1 발현 정도를 결합한 모델 중에서 {p/(1-p)}=ratio+glut+ratio${\times}$glut의 식으로 표시된 모델이 FDG 섭취비만을 이용한 모델 보다 정확히 종격동 임파선의 악성 정도를 예측할 수 있었다. 결론: 염증성 폐질환의 병력이 있는 일부 폐암 환자에서 Glut-1 발현 정도를 고려한 FDG 섭취비를 분석한 모델은 종격동 임파선의 악성 정도를 정확히 진단할 수 있다.

• 한국임상수의학회지
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• 제32권3호
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• pp.224-230
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• 2015

본 연구는 키토산 알지네이트 수화겔을 사용하여 제작된 연골세포의 3차원 구조를 유지하며 생물학적, 생리학적인 기능을 유지하는데 적합한 poly (L-Lactic-co-${\varepsilon}$-Caprolactone) (PLCL) 지지체의 효과에 대한 연구이다. 체내에서 수화겔은 단독으로 지지체 역할을 하기에는 부하를 견디기에 약하다. 이에 본 연구에서는 연골세포와 유사한 세포, 세포외 기질의 3차원적 구성을 만들기 위해 PLCL 지지체와 수화겔을 사용하여 합성 지지체를 제작하였다. 염화나트륨을 사용한 입자 침출 기법으로 85%의 다공성, $300-500{\mu}m$ 크기의 구멍을 가진 탄성력 높은 지지체를 제작하였다. 소의 연골세포와 키토산 알지네이트 겔 혼합물이 PLCL 지지체에 적용되었고 대조군의 알지네이트와 비교 연구하였다. 키토산 알지네이트 수화겔과 연골세포가 혼합된 경우에 알지네이트 단독 사용에 비해 세포 성숙, 증식, 세포외 기질의 합성, sGAG 생성과 II 형 콜라겐의 발현 등의 효과가 좋은 것으로 확인되었다. 본 연구 결과를 통해 PLCL 지지체에 연골세포와 키토산 알지네이트 겔 혼합물을 적용할 경우 세포 증식과 기질의 합성에 적합한 환경을 만들 수 있으며 연골의 복구와 재생에 효과적으로 사용될 수 있을 것으로 기대된다.

• 대한두경부종양학회지
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• 제14권2호
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• pp.228-235
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• 1998

Objectives: Papillary microcarcinoma of the thyroid was evaluated as to the effectiveness of diagnostic modalities, lymphatic spread pattern, and therapeutic decision according to tumor size. Material and Methods: We retrospectively analyzed a clinicopathologic findings of 72 papillary microcarcinoma patients who were treated at the over 11 years between 1985 and 1995. The authors divided papillary microcarcinoma of the thyroid into two subgroups according to tumor size: $0{\leqq}5mm$ and $5<0{\leqq}10mm$. An analysis including age and gender distribution, diagnostic tools(thyroid sonogram, thyroid scan, thyroid function test, fine needle aspiration cytology, frozen section), pathological examination of lymphnode, and surgical procedures was carried out in each subgroups. Results: The carcinoma of smaller than 5mm were found in 32 patients, and of 6 -10mm were in 40 patients. The average age of patients was 45years and all of them were female. Cold nodules on thyroid scan were noticed in 53 patientss and normal findings were in 15 patients. Suspicious malignant lesions(fine calcification, solid mass, irregular margin) on thyroid sonography were detected in 23 patients and the sonography was more useful in detecting $0{\leqq}5mm$ small sized lesions than other diagnostic methods. FNAC were performed in 17 patients, and 7 patients were diagnosed as having thyroid papillary cancer. But diagnotic rate in $0{\leqq}5mm$ small sized lesions was very low(one of eights).Frozen section were performed in all patients, among these 15 patients were diagnosed as being benign diseases and false negative rates were higher in $0{\leqq}5mm$ small sized lesions than in $5<0{\leqq}10mm$ sized lesions(p-value<0.006). Only thyroidectomies were performed in 24 patients and thyroidectomy with node dissections in 48 patients. The lymphnode metastatic rates were much higher in multifocal lesions(61.5%) than in single lesion. The incidence of cervical lymphnode metastasis was 19.4% in $0{\leqq}5mm$ sized lesions and 47.9% in $5<0{\leqq}10mm$ sized lesions. Postoperative management were performed with TSH suppression therapy(T4, synthroid) in all patients and RI therapy in 29 patients. Conclusion: On the basis of our study, improved preoperative diagnostic tools for papillary microcarcinoma of the thyroid was helpful in the choice of surgical treatment. As a result of techninological progress(ultrasonography, FNAC), the pencentage of the discovery of papillary microcarcinoma has been increased. The thyroid ultrasonography was useful in detecting small sized lesions($0{\leqq}5mm$), but FNAC may not be beneficial in detecting small sized lesions($0{\leqq}5mm$). In the surgical procedure, thyroid lobectomy alone should be avoided because of the high rate of bilaterality and multifocality.

• Journal of Chest Surgery
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• 제31권5호
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• pp.441-450
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• 1998

본 연구는 동맥혈압의 조절에 결정적 역할을 하는 상부연수 복외측부에 존재하는 심맥관계 활동과 관련 있는 신경세포들에 대해 iontophoresis 법으로 투여한 신경흥분전달물질의 작용기전을 규명하고자 하였다. 이를 위해서 $\alpha$-chloralose로 마취한 고양이를 실험동물로 하여 연수의 복외측부에 multibarrel 전극을 삽입하여 심맥관계 활동과 관련 있는 신경세포의 활동을 세포외기록법으로 확인한 후 세포에 iontophoresis법으로 투여한 glutamate, GABA(\ulcorner-aminobutyric acid) 및 bicuculline의 효과를 관찰하여 다음과 같은 결과를 얻었다. 1) 자발적으로 활동전압을 보이지 않는 세포에서 glutamate를 10초 주기로 5초간 iontophoresis할 때 주기적인 세포활동을 기록할 수 있었고 이 활동은 동시에 가한 GABA에 의하여 억제되었다. 2) 자발적으로 활동하고 있는 세포들에 대하여 glutamate를 투여하였을 때 활동전압의 빈도가 증가하였고 GABA에 의해서 억제되었다. 3) GABA억제제인 bicuculline을 단독으로 투여시 활동전압 빈도의 증가는 뚜렷하지 않았으나 GABA와 동시 투여시에는 GABA의 억제작용을 차단하였다. 4) GABA의 작용은 RVLM(rostral ventrolateral medulla) 세포의 주기적 활동과 basal discharge 모두를 감소시켰으나 주기적 양상이 없어진 세포는 드물었다. 5) 말초에 가한 유해자극에 의하여 유발된 신경세포 활동이 GABA에 의하여 억제되었다. 이상의 결과로부터 $\alpha$-chloralose로 마취한 고양이에서 GABA는 RVLM에 존재하는 심맥관계 신경세포들에 대하여 억제적으로 작용하나 bicuculline의 투여후에도 이들 세포들의 주기적 활동이 유지되는 점으로 보아 RVLM세포의 자발적 흥분에 대하여 감압반사의 흥분이 기여하는 바가 크지는 않을 것으로 사료된다.

• Journal of Yeungnam Medical Science
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• 제38권2호
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• pp.136-141
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• 2021

Background: Postoperative acute kidney injury (AKI), which increases the risk of postoperative morbidity and mortality, poses a major concern to surgeons. We conducted this study to analyze the risk factors associated with the occurrence of AKI after orthopedic surgery. Methods: This was a retrospective study that included 351 patients who underwent total hip or knee replacement surgery at Inje University Haeundae Paik Hospital between January 2012 and December 2016. Results: AKI occurred in 13 (3.7%) of the 351 patients. The patients' preoperative estimated glomerular filtration rate (eGFR) was 66.66 ±34.02 mL/min/1.73 m² in the AKI group and 78.07±21.23 mL/min/1.73 m² in the non-AKI group. The hemoglobin levels were 11.21±1.65 g/dL in the AKI group and 12.39±1.52 g/dL in the non-AKI group. Hemoglobin level was related to increased risk of AKI (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.02-0.68; p=0.016). Administration of crystalloid or colloid fluid alone and the perioperative amount of fluid did not show any significant relationship with AKI. Further analysis of the changes in eGFR was performed using a cutoff value of 7.54. The changes in eGFR were significantly related to decreased risk of AKI (OR, 0.74; 95% CI, 0.61-0.89; p=0.002). Conclusion: Renal function should be monitored closely after orthopedic surgery if patients have chronic kidney disease and low hemoglobin level. Predicting the likelihood of AKI occurrence, early treatment of high-risk patients, and monitoring perioperative laboratory test results, including eGFR, will help improve patient prognosis.

• Journal of Korean Neurosurgical Society
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• 제66권4호
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• pp.446-455
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• 2023

Objective : Chronic subdural hematoma (CSDH) is a common neurosurgical disease and generally treated with burr-hole surgery alone. Tranexamic acid (TXA) is an antifibrinolytic agent that potentially reduces recurrence rates and the residual hematoma volume. However, the role of postoperative TXA medication remains unclear to date. This study aimed to verify the effectiveness of adjunctive TXA in the view of early hematoma resolution. Methods : Between January 2018 and September 2021, patients with CSDH who underwent burr-hole trephination in a single tertiary institute were reviewed. The study population was divided into three groups, TXA, non-TXA, and antithrombotics (AT) groups, according to the medical history of cardio-cerebrovascular disease and TXA administration. The primary endpoint was CSDH recurrence, defined as re-appearance or re-accumulation of CSDH requiring neurosurgical interventions. The secondary outcome was CSDH resolution, defined as complete or near-complete resorption of the CSDH. The CSDH resolution time and serial changes of hematoma thickness were also investigated. Results : A total of 240 patients was included in the analysis consisting of 185 male and 55 female, with a median age of 74 years. During the median imaging follow-up period of 75 days, 222 patients were reached to the primary or secondary endpoint. TXA was administered as an adjunctive therapy in 41 patients (TXA group, 16.9%) while 114 patients were included in the non-TXA group (47.9%) and 85 were in the AT group. The recurrence rate was the lowest in the TXA group (2.4%), followed by non-TXA (7.0%) and AT (8.2%) groups. However, there was no statistical significance due to the small number of patients with recurrence. CSDH resolution was achieved in 206 patients, and the median estimated time to resolution was significantly faster in the TXA group (p<0.001). Adjunctive TXA administration was a significant positive factor for achieving CSDH resolution (p<0.001). The hematoma thickness was comparable among the three groups at the initial time and after surgery. However, CSDH thickness in the TXA group decreased abruptly in a month and showed a significant difference from that in the other groups (p<0.001). There was no TXA-related adverse event. Conclusion : The adjunctive use of TXA after CSDH surgery significantly facilitated the resorption of residual CSDH and resulted in the early CSDH resolution. Adjunctive TXA may be an effective treatment option to reduce recurrence by enhancing CSDH resolution in the selective patients.