• Journal of Korean Neurosurgical Society
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• v.50 no.4
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• pp.299-303
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• 2011

Objective : Brainstem metastases are rarely operable and generally unresponsive to conventional radiation therapy or chemotherapy. Recently, Gamma Knife Radiosurgery (GKRS) was used as feasible treatment option for brainstem metastasis. The present study evaluated our experience of brainstem metastasis which was treated with GKRS. Methods : Between November 1992 and June 2010, 32 patients (23 men and 9 women, mean age 56.1 years, range 39-73) were treated with GKRS for brainstem metastases. There were metastatic lesions in pons in 23, the midbrain in 6, and the medulla oblongata in 3 patients, respectively. The primary tumor site was lung in 21, breast in 3, kidney in 2 and other locations in 6 patients. The mean tumor volume was $1,517mm^3$ (range, 9-6,000), and the mean marginal dose was 15.9 Gy (range, 6-23). Magnetic Resonance Imaging (MRI) was obtained every 2-3 months following GKRS. Follow-up MRI was possible in 24 patients at a mean follow-up duration of 12.0 months (range, 1-45). Kaplan-Meier survival analysis was used to evaluate the prognostic factors. Results : Follow-up MRI showed tumor disappearance in 6, tumor shrinkage in 14, no change in tumor size in 1, and tumor growth in 3 patients, which translated into a local tumor control rate of 87.5% (21 of 24 tumors). The mean progression free survival was 12.2 months (range, 2-45) after GKRS. Nine patients were alive at the completion of the study, and the overall mean survival time after GKRS was 7.7 months (range, 1-22). One patient with metastatic melanoma experienced intratumoral hemorrhage during the follow-up period. Survival was found to be associated with score of more than 70 on Karnofsky performance status and low recursive partitioning analysis class (class 1 or 2), in terms of favorable prognostic factors. Conclusion : GKRS was found to be safe and effective for management of brainstem metastasis. The integral clinical status of patient seems to be important in determining the overall survival time.

• 한국환경농학회:학술대회논문집
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• 2009.07a
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• pp.3-18
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• 2009

It is difficult for consumers to satisfy high safety request with post-management method such as inspection and surveillance, as various changes in-and-out of the country associated with food safety. In terms of food safety problems related to foods, it is crucial to recognize public health and consumer protection and construct pre-preventive Food Control System. A joint committee, FAO/WHO made the following consultations to the National Food Safety System. ${\circ}$ Approach entirely from farm to table ${\circ}$ Get ready for Risk Analysis System ${\circ}$ Secure transparency ${\circ}$ Establish the optimal policy by evaluating the effect of regulation When it comes to summarizing the consultation, it would be accumulated as two key words; "Efficiency" and "Credibility". Whereas the problem of efficiency focuses on precaution rather than post-management, it requires policy option to maximize consumer's benefit by evaluating the cost for the Food Safety Management and its benefit. Also, analyzing risk's character and amount, demanding an optimal means, and introducing scientific analysis system put much value on the stakeholder's communications are procedure's security which can satisfy both "Efficiency" and "Credibility" simultaneously. Especially, it is emphasized here that Risk Assessment need to be separated from Risk Management. This action is a valid means of credibility security throughout improving transparency. A number of nations and organizations have reformed the method of food management passing through reflection and examination of the prior National Food Safety Management since BSE occurred in Britain, 1996. FSA; Food Standard Agency, AFFSA, EFSA, BfR, and FSC are Risk Assessment Organization functionally separated from Risk Management Organization, JECFA, JMCFA, JMPR, JEMRA in Codex charge Risk Assessment internationally. In case of advanced countries excluding several those such as The U.S. and so forth, though these Risk Assessment Organizations are either separated functionally within Risk Management Organization or operated as apart organ, common factors are in which it has independence as Science Base. While securing independence of Risk Assessment Function, it is a tendency Risk Management should be functionally unified into efficiency as well. Though Germany constructs integral Risk Management System of diverse ways according to social and political conditions of each country such as GFOCP, DVFA, SNFA, CFIS and AQIS, there is a key word in the center, "Securing efficiency of Food Safety Management". However our nation has a representative plural；diversified system with The U.S., we took a step forward for unification as empowering policy's generalization；adjustment and Risk Assessment Function by means of enacting the "Food Safety Fundamental Law" in 2008 and establishing the "Food Safety Policy Commission" with private and governmental sectors in the Prime Minister's office. Even though the unification of Risk Management hereby increased, there is the lack of strengthening function of Risk Assessment and securing independence. It needs to be required for the professional committee in Food Safety Policy Commission to develop as a exclusive office of Risk Assessment by separating from a policy decision. Administrative Branches should reinforce feeble functions such as fundamental investigation；research for carrying out Risk Assessment with securing efficiency throughout reassessment of prior Risk Management Means.

• Journal of Korean Foot and Ankle Society
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• v.15 no.2
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• pp.51-57
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• 2011

Pilon fractures involving distal tibia remain one of the most difficult therapeutic challenges that confront the orthopedic surgeons because of associated soft tissue injury is common. To introduce and describe the diagnosis, current treatment, results and complications of the pilon fractures. In initial assessment, the correct evaluation of the fracture type through radiographic checkup and examination of the soft tissue envelope is needed to decide appropriate treatment planning of pilon fractures. Even though Ruedi and Allgower reported 74% good and excellent results with primary open reduction and internal fixation, recently the second staged treatment of pilon fractures is preferred to orthopedic traumatologist because of the soft tissue problem is common after primary open reduction and internal fixation. The components of the first stage are focused primarily on stabilization of the soft tissue envelope. If fibula is fractured, fibular open reduction and internal fixation is integral part of initial management for reducing the majority of tibial deformities. Ankle-spanning temporary external fixator is used to restore limb alignment and displaced intraarticular fragments through ligamentotaxis and distraction. And the second stage, definitive open reduction and internal fixation of the tibial component, is undertaken when the soft tissue injury has resolved and no infection sign is seen on pin site of external fixator. The goals of definitive internal fixation should include absolute stability and interfragmentary compression of reduced articular segments, stable fixation of the articular segment to the tibial diaphysis, and restoration of coronal, transverse, and sagittal plane alignments. The location, rigidity, and kinds of the implants are based on each individual fractures. The conventional plate fixation has more advantages in anatomical reduction of intraarticular fractures than locking compression plate. But it has more complications as infection, delayed union and nonunion. The locking compression plate fixation provides greater stability and lesser wound problem than conventional implants. But the locking compression plate remains poorly defined for intraarticular fractures of the distal tibia. Active, active assisted, passive range of motion of the ankle is recommended when postoperative rehabilitation is started. Splinting with the foot in neutral is continued until suture is removed at the 2~3 weeks and weight bearing is delayed for approximately 12 weeks. The recognition of the soft tissue injury has evolved as a critical component of the management of pilon fractures. At this point, the second staged treatment of pilon fractures is good treatment option because of it is designed to promote recovery of the soft tissue envelope in first stage operation and get a good result in definitive reduction and stabilization of the articular surface and axial alignment in second stage operation.