• Journal of Gastric Cancer
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• v.5 no.3 s.19
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• pp.169-173
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• 2005

Background: Gastric polyps encompass a wide variety of lesions that most commonly arise from the gastric epithelium. However, coincidental gastric carcinomas have rarely been reported, being found in $1.5{\sim}2.1%$ of patients with hyperplastic polyps. The sizes and the pathologies of polyps seem to be important in the application of treatment. Therefore, it is necessary to classily gastric polypoid lesions after a gastrectomy. Materials and Methods: During a follow-up endoscopy study, 23 patients were found to have developed gastric polyps after a gastrectomy. Most of those polyps were removed by using an endoscopic polypectomy. We performed clinical and pathologic evaluations of the gastric polyps in the remainding in the stomach after a gastrectomy, Results: The mean age of the patients was 64.5 years old with the incidence of polyps remainding in the stomach after a gastrectomy increasing after the first year following the gastrectomy. The sizes of the polyps ranged from 0.3cm to 3.5cm in diameter and the numbers of polyps below 1.0cm were 19 (82.6%). The anastomotic site was the most prevalent place 10 (43.2%), followed by the cardia 6 (26.0%) and the body 4 (17.3%). Among 23 gastric polypoid lesions Yamada types of gastric polyps in the remainding in the stomach were as follows: 1 case in type I, 12 cases in type II, 9 cases in type III, 1 case in type IV. The pathologic diagnoses of the polyps were hyperplastic polyps in 6 cases, tubular adenomas in 2 cases and inflammatory polyps in 15 cases. Conclusion: Endoscopic polypectomy is believed to be important in assessing the precise diagnosis of gastric polyps remainding in the stomach. In this study, hyperplastic polyps were found to have no malignant potential, despite their sizes. As a result aggressive biopsy with a polypectomy of gastric polyp afier gastrectomy is recommended and frequent follow-up be performed.

• Genomics & Informatics
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• v.9 no.2
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• pp.52-58
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• 2011

Osteoporotic fracture (OF), along with bone mineral density (BMD), is an important diagnostic parameter and a clinical predictive risk factor in the assessment of osteoporosis in the elderly population. However, a genome-wide association study (GWAS) on OF has not yet been clarified sufficiently. To identify OF-associated genetic variants and candidate genes, we conducted a GWAS in a population-based cohort (Korean Association Resource [KARE], n=1,427 [case: 288 and control: 1139]) and performed a de novo replication study in hospital-based individuals (Asan and Catholic Medical Center [ACMC], n=1,082 [case: 272 and control: 810]). In a combined meta-analysis, a newly identified genetic locus in an intergenic region at 10p11.2 (near genes FZD8 and ANKRD30A ) showed the most significant association (odd ratio [OR] = 2.00, 95% confidence interval [CI] = 1.47~2.74, p=$1.27{\times}10^{-6}$) in the same direction. We provide the first evidence for a common genetic variant influencing OF and genetic information for further investigation in bone metabolism.

• Progress in Medical Physics
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• v.24 no.4
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• pp.271-277
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• 2013

In prostate IMRT planning, the planning target volume (PTV), extended from a clinical target volume (CTV), often contains an overlap air volume from the rectum, which poses a problem inoptimization and prescription. This study was aimed to establish a planning method for such a case. There can be three options in which volume should be considered the target during optimization process; PTV including the air volume of air density ('airOpt'), PTV including the air volume of density value one, mimicking the tissue material ('density1Opt'), and PTV excluding the air volume ('noAirOpt'). Using 10 MV photon beams, seven field IMRT plans for each target were created with the same parameter condition. For these three cases, DVHs for the PTV, bladder and the rectum were compared. Also, the dose coverage for the CTV and the shifted CTV were evaluated in which the shifted CTV was a copied and translated virtual CTV toward the rectum inside the PTV, thus occupying the initial position of the overlap air volume, simulating the worst condition for the dose coverage in the target. Among the three options, only density1Opt plan gave clinically acceptable result in terms of target coverage and maximum dose. The airOpt plan gave exceedingly higher dose and excessive dose coverage for the target volume whereas noAirOpt plan gave underdose for the shifted CTV. Therefore, for prostate IMRT plan, having an air region in the PTV, density modification of the included air to the value of one, is suggested, prior to optimization and prescription for the PTV. This idea can be equally applied to any cases including the head and neck cancer with the PTV having the overlapped air region. Further study is being under process.

• Journal of Gastric Cancer
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• v.7 no.3
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• pp.132-138
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• 2007

Purpose: In Korea, the number of laparoscopy-assisted distal gastrectomies for early gastric cancer patients has been on the increase. Although minimally invasive surgery is more beneficial, no reported case of a total laparoscopic gastrectomy has been reported because of difficulty with intracorporeal anastomosis. This study attempts, through our experience, to determine the safety and feasibility of a total laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linears stapler in treating early gastric carcinomas. Materials and Methods: We investigated the surgical results and clinicopatholgical characteristics of 81 patients that underwent a totally laparoscopic distal gastrectomy at our department between June 2004 and May 2007. The intracorporeal anastomoses were performed by using laparoscopic linear staplers. Results: The mean operative time was 287 minutes, the mean anastomotic time was 40 minutes, and the mean number of laparoscopic linear staplers used for an operation was 7.5. The mean time to the first flatus, the first food intake, and discharge from hospital was 2.9, 3.6, and 10.3 days respectively. There were 11 cases of postoperative complications, but no case of postoperative mortality or conversion to an open procedure. In 75 patients with an adenocarcinoma, the mean number of lymph nodes harvested was 38.1 and the stage distribution was as follows: stage I, 72 patients; stage II, 2 patients; stage IV, 1 patient. During the mean follow-up period of 14 months, 5 patients died of other causes and there were no cases of cancer recurrence. Conclusion: A total laparoscopic gastrectomy with intracorporeal anastomosis by using a laparoscopic linear stapler was found to be safe and feasible. We were able to obtain acceptable surgical outcomes in terms of minimal invasiveness.

• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.189-198
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• 2009

Purpose: We wanted to evaluate the clinical results of the Latarjet procedure for treating anterior shoulder instability combined with a glenoid bone defect. Materials and Methods: Between Oct. 2006 and May. 2007, fourteen patients underwent a Latarjet operation to treat their anterior shoulder instability combined with a glenoid bone defect. The mean follow-up period was 15 months (range: 12 to 19 months), and the average age at the time of surgery was 29.9-years-old (range: 19 to 44 years). There were 13 males and 1 female. Eight patients exhibited involvement of the right shoulder. The dominant arm was involved in 8 patients. Six patients had undergone a previous arthroscopic Bankart repair before their Latarjet operation and 2 patients had a history of seizure. Results: The average Rowe score improved from 51.8 to 80.2 with 9 excellent, 4 good, and 1 fair results. The average Korean shoulder score for instability improved from 61.6 to 82.1 postoperatively. The active forward flexion and external rotation at the side of the involved shoulder was an average of $8^{\circ}$ and $16^{\circ}$ less than that of the uninvolved shoulder. The muscle strength of the involved shoulder measured 78.7% in forward flexion and 82.5% in external rotation, as compared with that of the uninvolved shoulder. There was 1 case of dislocation, 1 transient subluxation, 2 fibrotic unions, 1 resorption of the transferred coracoid process, 1 intraoperative broken bone, 1 transient musculocutaneous nerve injury and 1 case of stiffness. Conclusion: The Latarjet procedure for treating anterior shoulder instability combined with a significant glenoid defect effectively restores function and stability through extending the articular arc at the expense of external rotation. We should be cautious to avoid or detect complications when performing coracoid transfer.

• Journal of Chest Surgery
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• v.34 no.6
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• pp.454-464
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• 2001

Background: It has been recognized that systemic inflammatory reaction and oxygen free radical formed by activated leukocyte in the procedure of cardiopulmonary bypass(CPB) frequently produce postoperative cardiac and pulmonary dysfunction. The purpose of this study was to evaluate the efficacy of leukocyte-depleting filters in the cardiopulmonary bypass circuit for patients undergoing open heart surgery(OHS). Material and method: The study involved 15 patients who underwent OHS with a Leukoguard-6 leukocyte filter placed in the arterial limbs of the bypass circuit(filter group, n=15) and 15 patients who did not have the filter(control group, n=15). We analyzed the differences between the groups in intraoperative changes of peripheral blood leukocyte and platelet counts, pre- and postbypass changes of malondialdehyde(MDA), troponin-T(TnT), 5'-nucleotidase(5'-NT) in coronary sinus blood, spontaneous recovery rate of heart beat after CPB, pre-and postoperative cardiac index(Cl) and pulmonary vascular resistance(PVR), and the amounts of postoperative bleeding and sternal wound complication. Result: During CPB, total leukocyte count of the filter group(9,567$\pm$ 842/㎣) was significantly less than that of the control group(13,573+1,167/㎣) (p<0.01), but there was no significant difference in platelet count between the groups. Postoperative levels of MDA(3.78+0.32 $\mu$mol/L vs 5.86+0.65 $\mu$mo1/L, p<0.01), TnT(0.40$\pm$0.04 ng/mL vs 0.59$\pm$0.08 ng/mL, p<0.05) and 5'-NT(3.88$\pm$0.61 U/L vs 5.80$\pm$0.90 U/L, p<0.05) were all significantly lower in the filter group than the control group. Postoperative Cl was higher in the filter group than the control group(3.26$\pm$0.18 L/$m^2$min vs 2.75$\pm$0.17 L/$m^2$/min, p=0.05). PVR of the filter group was lower than that of the control group(65.87$\pm$7.59 dyne/sec/cm$^{5}$ vs 110.80+12.22 dyne/sec/cm$^{5}$ , p<0.01). Spontaneous recovery rate of heart beat in the filter group was higher than that in the control group(12 patients vs 8 patients, p<0.05). Postoperative wound infection occurred in one case in the filter group and 4 case in the control group(p<0.05). Postoperative 24 hour blood loss of the filter group was more than that of the control group (614$\pm$107 mL vs 380+71 mL, p=0.05).

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.5 no.2
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• pp.174-180
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• 2002

Purpose: Ursodeoxycholic acid (UDCA) is known to decrease hepatic injury by promoting the biliary secretion of retained toxic endogenous bile acids in hepatobiliary diseases complicated by total parenteral nutrition (TPN). However, most studies have focused on treatment for complications after TPN. We investigated the preventive role of early administration of UDCA in TPN-induced hepatobiliary complications by a randomized, double-blind, placebo-controlled trial. Methods: Between May 2000 and May 2002, thirteen patients, who were given TPN more than 10 days in the hospital, were assigned randomly to two groups. One was the case group (7 patients) who were given UDCA simultaneously with TPN regimen, and the other, the control group (6 patients) who were given placebo. Their age ranged from 1 day to 13 years. They were affected with diseases impossible for enteral nutrition, such as prematurity, cerebral palsy, chronic diarrhea, anorexia nervosa, pancreatitis, and cyclic vomiting. The duration of TPN ranged from 10 to 70 days. Hematologic parameters including liver function test were measured at regular intervals, and the duration, composition, administration rate, total calorie of TPN were recorded. The serum levels of total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase were compared between groups after cessation of the study. Results: The autoregressive coefficient of the control group was 0.4419 (p=0.0651) in bilirubin, -0.0431 (p=0.7923) in AST, 0.2398 (p=0.2416) in ALT, and 0.2459 (p=0.1922) in alkaline phosphatase by mixed procedure model when the parameters were referred to the case group. Conclusion: The serum level of total bilirubin did not increase in comparison with that of the control group, but statistically insignificant, when both TPN and UDCA were administered simultaneously from the beginning.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.289-293
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• 2001

Objectives : The optimal treatment of craniopharyngioma is controversial. Despite recent advances in microsurgical management, complete surgical removal of craniopharyngioma remains very difficult. Radiation added to surgery is effective, but radiation therapy resulted in untoward side effect in young patient. Gamma knife radiosurgery offers the theoretical advantage of a reduced radiation dose to surrounding structures during the treatment of residual or recurrent craniopharyngioma compared with fractionated radiotheraphy. We described retrospective analysis of tumor size and clinical symptoms of patients after gamma knife radiosurgery in residual or recurrent craniopharyngioma were performed. Material and Methods : From September 1990 to January 2000, 18 patients of craniopharyngioma were treated by gamma knife radiosurgery. All patient had undergone surgery, but residual or recurrent tumor was found and all of them treated postoperative gamma knife radiosurgery. The mean age was 19(from 6 to 66) and male to female ratio was 10 to 8 and 8 patients were below 15 years old. In young age group(below age 15), the average volume of the tumor was $2904.8mm^3$ and mean maximal gamma knife dose was 34.9Gy. In old age group(older than 15), the average volume of the tumor was $2590.4mm^3$ and mean maximal gamma knife dose was 45.2Gy. The size of the tumor was average $2730.1mm^3$($88-12000mm^3$), mean average radiation dose was 40.7Gy and the mean prescription dose was 17.6 Gy(4-35Gy) delivered to a median prescription 50.7% isodose. Results : The follow up was from 1 year to 9 years(mean 59.1 months) after gamma knife radiosurgery. The tumor was controlled in 13(72.2%) patients. The tumor decreased in 9 patients and not changed in 4 patients. The tumor size increased in 4(22.2%) patients during follow up period. In two cases the tumor size increased because of its cystic portion was increased, but their solid portion of the tumor was not changed. In another two patients, the solid portion of the tumor was increased. So, one patient underwent reoperation and the other patient underwent operation and repeated gamma knife radiosurgery. The tumor recurred in one case(5.6%) that is a outside of irradiated site. The presenting symptoms were improved in 4 patients(improved visual acuity in 1, controlled increased intracranial presure sign in 3 patients). In one case, visual acuity decreased after gamma knife radiosurgery. The endocrine symptoms were not influenced by gamma knife radiosurgery. Conclusion : Craniopharyngioma can be treated successfully by gamma knife radiosurgery. Causes of the tumor regrowth are inadequate dose planning because of postoperatively poor margination of the tumor, close approximation of optic nerve and residual tumors outside the target lesion. Recurrence can develop 4 years after gamma knife radiosurgery. Volume is important, but the accurate targeting is more important to prevent tumor recurrence. If the tumor definition is not clear during planning gamma knife surgery, long-term image follow up is required.

• Journal of the Korean Arthroscopy Society
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• v.8 no.2
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• pp.89-93
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• 2004

Purpose: To evaluate the clinical stability and function after arthroscopic anterior cruciate ligament(ACL) reconstruction using fresh-frozen tibialis tendon allograft. Materials and Methods: Of the patients who underwent ACL reconstruction using tibialis tendon allograft from July 2002 to June 2003, thirty-one patients could be evaluated and the mean follow-up period was 19 months. Evaluations included were Lysholm knee score, 2000 International knee Documentation Committee (IKDC) subjective knee score, Lachman test, pivot shift test, KT-1000 arthrometer measurement and 2000 IKDC knee examination. Results: The mean Lysholm score was 88. Twenty-eight patients (90.3%) were good or exellent for the measured parameters. Twenty-seven patients(87.1%) was over 70 in IKDC subjective knee score. Thirty patients (96.8%) had 1+ firm end or negative Lachman test. 27 patients (87.1%) had a negative pivot shift. Thirty patients (96.8%) had less than 5mm difference of maximal manual difference by KT-1000 arthrometer. Twenty -nine patients (93.5%) were nearly normal or normal grade by 2000 IKDC knee examination. Complications were 1 case of failure and 1 case of infection. Conclusion: ACL reconstruction with the double-stranded fresh-frozen tibialis tendon allograft resulted in a reliable and predictable outcome after short-term follow-up.

• The Journal of Korean Academy of Prosthodontics
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• v.59 no.4
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• pp.487-496
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• 2021

Full mouth rehabilitation is re-organizing the occlusion of the remaining teeth and missing teeth considering the functions, esthetics, and neuromuscular harmony. With the loss of multiple teeth, the patient's occlusal plane gradually collapses and the vertical dimension can be reduced. Since reduced vertical dimension can be a potential etiology of the temporomandibular joint and masticatory muscles, prosthetic restoration with increased vertical dimension is required. This case report is about a 68 years old patient with vertical dimension loss due to worn dentition and multiple loss of teeth. In this case, the loss of vertical dimension is assessed carefully using the digital dentistry technology. Using CAD software in digital analysis step, the occlusal plane was established and evaluated using several criteria. Orienting the position of the bone and teeth using CBCT image, patient's condition was visualized in 3 dimension and treatment planning was possible virtually. The information that matches the patient's condylar position with the articulator, which is the virtual face bow, is reproduced on the actual articulator, and evaluated again. After the evaluation, provisional prosthesis was fabricated and it was confirmed that the patient adapts without any abnormality. This was implemented as a final prosthesis. As a result, the patient obtained satisfying results, utilizing the benefits of digital dentistry technology and traditional methods.