• Journal of Korean Neurosurgical Society
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• v.59 no.6
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• pp.610-614
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• 2016

Objective : The purpose of this study was to present the outcome of the microsurgical foraminotomy via Wiltse paraspinal approach for foraminal or extraforaminal (FEF) stenosis at L5-S1 level. We investigated risk factors associated with poor outcome of microsurgical foraminotomy at L5-S1 level. Methods : We analyzed 21 patients who underwent the microsurgical foraminotomy for FEF stenosis at L5-S1 level. To investigate risk factors associated with poor outcome, patients were classified into two groups (success and failure in foraminotomy). Clinical outcomes were assessed by the visual analogue scale (VAS) scores of back and leg pain and Oswestry disability index (ODI). Radiographic parameters including existence of spondylolisthesis, existence and degree of coronal wedging, disc height, foramen height, segmental lordotic angle (SLA) on neutral and dynamic view, segmental range of motion, and global lumbar lordotic angle were investigated. Results : Postoperative VAS score and ODI improved after foraminotomy. However, there were 7 patients (33%) who had persistent or recurrent leg pain. SLA on neutral and extension radiographic films were significantly associated with the failure in foraminotomy (p<0.05). Receiver-operating characteristics curve analysis revealed the optimal cut-off values of SLA on neutral and extension radiographic films for predicting failure in foraminotomy were $17.3^{\circ}$ and $24^{\circ}s$, respectively. Conclusion : Microsurgical foraminotomy for FEF stenosis at L5-S1 level can provide good clinical outcomes in selected patients. Poor outcomes were associated with large SLA on preoperative neutral (>$17.3^{\circ}$) and extension radiographic films (>$24^{\circ}$).

• Journal of Korean Neurosurgical Society
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• v.61 no.1
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• pp.89-96
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• 2018

Objective : Morphometric data for the lumbar posterior longitudinal ligament (PLL) was investigated to identify whether there is a difference in the morphometry of the PLL of the lumbar spine at each level with respect to the pattern of intervertebral disc displacement. Methods : In 14 formalin-fixed adult cadavers (12 males and 2 females), from L1 to L5, the authors measured the width and height of the PLL and compared them with other landmarks such as the disc and the pedicle. Results : Horizontally, at the upper margin of the disc, the central portion of the superficial PLL covered 17.8-36.9% of the disc width and the fan-like portion of the PLL covered 63.9-76.7% of the disc width. At the level of the median portion of the disc, the PLL covered 69.1-74.5% of the disc width. Vertically, at the level of the medial margin of the pedicle, the fan-like portion of the PLL covered 23.5-29.9% of the disc height. In general, a significant difference in length was not found in the right-left and male-female comparisons. Conclusion : This study presents the morphometric data on the pattern of intervertebral disc displacement and helps to improve the knowledge of the surgical anatomy of the lumbar PLL.

• The Journal of Pediatrics of Korean Medicine
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• v.18 no.1
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• pp.105-129
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• 2004

Methods: It was studied on the 47 kinds of oriental medical literature for fecal blood. Results: Fecal blood means bleeding with faces from anus and indicates all the three cases such as blooding before and after evacuation, evacuation of feces mixed with blood, and simple melena. The main causes are fire(火) and deficiency of spleen qi (脾氣虛). According to the color of fecal blood and the region of the bleeding, first, if the blood color is dark-red and blood discharges after emptying the bowels, it is called deposited poison into Jang(臟毒) or distant bleeding(遠血), and if the color of blood is clear and bowel emptying occurs after bleeding, it is bloody stool due to intestinal wind(腸風) or nearby bleeding(近血). For treating methods(治法). removing heat from the blood and stopping bleeding(淸熱凉血止血), removing dampness and stopping bleeding(淸熱除濕止血), invigorating Ki for promoting Hul-controJ(益氣攝血), warming the spleen and stomach to dispel cold and stopping bleeding(溫中散寒止血) etc are applied. As for the treating prescriptionl(治法), a Hwangtotang(黃土湯). Jeoksodudanggwitang(赤小豆當歸散). Gwihwasan(槐花散). Wipungtang(胃風湯). Hwangnyeonhwan modifying(黃連丸加減). Samultang modifying(四物湯加減). Paedoksan modifying(敗毒散加減) etc are used. As for acupuncture and moxibustion(鍼灸療法). if etiology(病因) is damp-heat(濕熱), acupuncture(刺鍼) at Janggang(長强); Charyo(BL 32); Sangeoheo(ST 37)(上巨虛); Seungsan(BL 57)(承山穴), and in case of deficiency of spleen Gi(脾氣虛), acupunture(刺鍼) with tonification(補法) at I Baek(EX-UE 2)(二白); Gwanwon(CC 4)(關元); Joksamni(ST 36)(足三里) Taebaek(SP 3)(太白); Hoeeum(CC 1)(會陰穴), or mxibuston(灸) at Baekoe(GC 2O)(百會); Myeongmun9GC (命門) or the point of opposite to umbilicus among spinal vertebrae(脊中對臍穴) are used. The external treatment(外治療法) was consisted of plastering umbilicus therapy(敷臍法) and enema therapy(灌腸法).

• Clinical and Experimental Pediatrics
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• v.49 no.5
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• pp.519-522
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• 2006

Purpose : Alagille syndrome is an autosomal dominant disorder with developmental abnormalities affecting the liver, heart, eyes, vertebrae, and craniofacial region. The Jagged1(JAG1) gene, which encodes a ligand of Notch, has been found mutated in Alagille syndrome. The aim of the study was to investigate the mutation analysis of JAG1 gene in Korean patients with Alagille syndrome. Methods : Genomic DNA was extracted from peripheral leukocytes of 6 patients. The 26 exons of JAG1 gene were amplified and PCR products were directly sequenced. Results : Two novel frameshift mutations were found. 118delC in exon 2 was found in a patient who developed hepatocellular carcinoma at 4 years of age. 999-1000delTG was identified in exon 7. Conclusion : Mutations identified in this study are expected to give rise to truncated proteins.

• Archives of Plastic Surgery
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• v.33 no.5
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• pp.627-631
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• 2006

Purpose: Ischial region is common site of pressure sore as well as greater trochanteric area. In general, ischial pressure sore associated with a large subcutaneous bursa often requires radical surgical treatment. The authors performed sclerotherapy using absolute ethanol which was considered as an alternative in treating recurrent ischial pressure sore. Methods: From may 2005 to February 2006, 11 ischial pressure sore patients were treated sclerotherapy using absolute ethanol. The authors performed sclerotherapy using absolute ethanol in 11 patients in whom the ischial sore has recurred despite of multiple radical surgical treatment. The patients' original disorders were spinal cord injury in 9 patients, cerebral palsy in 1 patient and giant cell tumor in thoracic vertebrae 1 patient. Results: Recurrence of pressure sore was not found in any patient during the follow-up period. The swap of the bursa taken before the surgery was germ cultured and compared with the discharge from an end of the inserted drain tube. The germ cultured results after the surgery were tested negative in all patients. Conclusion: This method involves causing the bursa to become scarred and closing it up by sterilizing, fixing, and denaturing by the pharmacologic effect of absolute ethanol instead of surgical excision of the bursa. We felt that aforementioned treatment modality may be considered as an alternative in treating recurrent ischial pressure sore.

• The Korean Journal of Pain
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• v.19 no.1
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• pp.56-62
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• 2006

Background: Balloon kyphoplasty is the new technique that helps to decrease the pain and improve mobility as well as restore the vertebral body height and kyphotic curve in fractured vertebrae. We evaluated the outcome of balloon kyphoplasty in the reduction of vertebral body height, kyphotic curve and clinical improvement in the patients with painful vertebral compression fractures. Methods: From July 2002 to February 2005, 84 levels of vertebral compression fractures in 66 patients were treated with balloon kyphoplasty. The assessment criteria were the changes over time in visual analogue scale (VAS) and mobility score. We evaluated the vertebral body height and kyphotic curve at preoperative 1 day and postoperative 1 day. Results: Procedures were performed in 66 patients with a total of 84 affected vertebral bodies. The anterior wall height was restored in 74 / 84 (88%) levels with a mean increment of 2.9 mm, and the mid-vertebral body height was restored in 79 / 84 (94%) levels with a mean increment of 4.2 mm. Kyphosis correction was achieved in 60 / 84 (71.4%) from 10.1 degrees to 7.5 degrees. Pain intensity reduced by 60% in one day after operation and by 75-85% in later time. Mobility scores of all patients were improved immediately after the procedure. Cement leakage occurred in 3 levels but there was no clinical problem. Conclusions: Kyphoplasty is an efficient and safe treatment of painful vertebral compression fracture in pain relief, mobility improvement, and reduction of deformity.

• The Korean Journal of Pain
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• v.31 no.1
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• pp.27-38
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• 2018

Background: Related to escalating health care costs and the questionable effectiveness of multiple interventions including lumbar facet joint interventions, cost effectiveness or cost utility analysis has become the cornerstone of evidence-based medicine influencing coverage decisions. Methods: Cost utility of therapeutic lumbar facet joint nerve blocks in managing chronic low back pain was performed utilizing data from a randomized, double-blind, controlled trial with a 2-year follow-up, with direct payment data from 2016. Based on the data from surgical interventions, utilizing the lowest proportion of direct procedural costs of 60%, total cost utility per quality adjusted life year (QALY) was determined by multiplying the derived direct cost at 1.67. Results: Patients in this trial on average received $5.6{\pm}2.6$ procedures over a period of 2 years, with average relief over a period of 2 years of $82.8{\pm}29.6$ weeks with $19{\pm}18.77$ weeks of improvement per procedure. Procedural cost for one-year improvement in quality of life showed USD $2,654.08. Estimated total costs, including indirect costs and drugs with multiplication of direct costs at 1.67, showed a cost of USD $4,432 per QALY. Conclusions: The analysis of therapeutic lumbar facet joint nerve blocks in the treatment of chronic low back pain shows clinical effectiveness and cost utility at USD $2,654.08 for the direct costs of the procedures, and USD $4,432 for the estimated overall cost per one year of QALY, in chronic persistent low back pain non-responsive to conservative management.

• The Korean Journal of Pain
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• v.31 no.3
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• pp.191-198
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• 2018

Background: Patient-controlled epidural analgesia (PCEA) is known to provide good postoperative analgesia in many types of surgery including laparoscopic surgery. However, no study has compared PCEA with patient-controlled intravascular analgesia (PCIA) in laparoscopic radical prostatectomy (LARP). In this study, the efficacy and side effects of PCEA and PCIA after LARP were compared. Methods: Forty patients undergoing LARP were randomly divided into two groups: 1) a PCEA group, treated with 0.2% ropivacaine 3 ml and 0.1 mg morphine in the bolus; and 2) a PCIA group, treated with oxycodone 1 mg and nefopam 1 mg in the bolus. After the operation, a blinded observer assessed estimated blood loss (EBL), added a dose of rocuronium, performed transfusion, and added analgesics. The numeric rating scale (NRS), infused PCA dose, and side effects were assessed at 1, 6, 24, and 48 h. Results: EBL, added rocuronium, and added analgesics in the PCEA group were less than those in the PCIA group. There were no significant differences in side-effects after the operation between the two groups. Patients were more satisfied with PCEA than with PCIA. The NRS and accumulated PCA count were lower in PCEA group. Conclusions: Combined thoracic epidural anesthesia could induce less blood loss during operations. PCEA showed better postoperative analgesia and greater patient satisfaction than PCIA. Thus, PCEA may be a more useful analgesic method than PICA after LARP.

• The Korean Journal of Pain
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• v.31 no.4
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• pp.277-288
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• 2018

Background: Neck and back pain are leading sources of disability placing substantial burden on health care systems. Surgical interventions in managing chronic neck pain secondary to various disorders continue to increase. Even though surgical interventions are effective, a significant proportion of patients continue to have symptomatology and develop cervical post-surgery syndrome. This study was performed to know the effectiveness of cervical interlaminar epidural injections with or without steroids. Methods: The effectiveness of fluoroscopic cervical interlaminar epidural injections in post-surgery syndrome was evaluated in a randomized, active controlled trial. The study population included 116 patients assigned to 2 groups. Group 1 received cervical interlaminar epidural injections with local anesthetic alone and Group 2 received injection with local anesthetic and steroids. The main outcomes were defined as significant improvement (greater than 50%) of pain relief using the numeric rating scale and/or functional status improvement using the Neck Disability Index (NDI). Results: Both groups had similar results with significant improvement (${\geq}50%$ pain relief and functional status improvement) in 69% of the patients in Group I, whereas, in Group II, 71% of the patients showed significant improvement at the end of 2 years. During a 2-year period, the average number of procedures was 5 to 6, with an average of approximately 12 weeks of significant improvement per procedure. Conclusions: Fluoroscopic cervical interlaminar epidural injections administered in cervical post-surgery syndrome using local anesthetic, regardless of the use of steroids, may be effective in approximately 70% of the patients at 2-year follow-up.

• Korean Journal of Fisheries and Aquatic Sciences
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• v.48 no.4
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• pp.474-482
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• 2015

This study aims to investigate the patterns and incidence rates of morphological deformities during artificial fingerling production of blackhead seabream (BSB, Acanthopagrus schlegeli) juveniles by visual and soft X-ray observations of BSB juveniles (n=881) collected from four industrial hatcheries. Using both methods, we observed seven types of external deformity ($11.2{\pm}4.4%$) and eight types of skeletal deformity ($53.4{\pm}5.1%$). Lordosis occurred in all hatcheries with the highest frequency and the mean frequency was $13.1{\pm}4.4%$ (24.5% in total abnormal) by soft X-ray. Although they had a similar standard length (SL), juveniles with lordosis had a significantly lower condition factor and body weight than normally developed juveniles (P<0.05); normal distribution curves of histogram of body proportions, i.e., body height (BH)/head length (HL) and trunk (=SL-HL)/BH, indicated differences between normally developed juveniles and those with lordosis. In addition, 59% of juveniles with lordosis had vertebral curvature of less than $20^{\circ}$, generally at the $17^{th}$ vertebrae. It is expected that the above results will be used as basic data necessary for determining the cause of lordosis and for developing techniques to prevent this symptom in the fingering production industry of BSB juveniles.