• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.27 no.1
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• pp.54-60
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• 2001

The treatment of maxillary cancer has been commonly performed by the surgery and radiation therapy, alone or in combination. Multimodal treatment has been introduced with improvement of chemotherapy and immunotherapy. Multimodal treatment for the maxillary cancer is composed of surgery, radiation therapy, and regional intra-arterial chemotherapy. The present study was performed to evaluate the effectiveness of the multimodal treatment with Morita's method, with a slight modification, for the maxillary cancer. Twenty-four cases of the maxillary cancer were analyzed. The multimodal treatment increased the 5-year-survival rate up to 66% and reduced the need for maxillectomy. This method made the morphological and funtional preservation possible. This method may be recommended for the treatment of maxillary cancer.

• Journal of Korean Neurosurgical Society
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• v.58 no.5
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• pp.419-425
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• 2015

Objective : Acute vertebrobasilar artery occlusion (AVBAO) is a devastating disease with a high mortality rate. One of the most important factors affecting favorable clinical outcome is early recanalization. Mechanical thrombectomy is an emerging treatment strategy for achieving a high recanalization rates. However, thrombectomy alone can be insufficient to complete recanalization, especially for acute stroke involving large artery atheromatous disease. The purpose of this study is to investigate the safety and efficacy of mechanical thrombectomy in AVBAO. Methods : Fourteen consecutive patients with AVBAO were treated with mechanical thrombectomy. Additional multimodal treatments were intra-arterial (IA) thrombolysis, balloon angioplasty, or permanent stent placement. Recanalization by thrombectomy alone and multimodal treatments were assessed by the Thrombolysis in Cerebral Infarction (TICI) score. Clinical outcome was determined using the National Institutes of Health Stroke Scale (NIHSS) at 7 days and the modified Rankin Scale (mRS) at 3 months. Results : Thrombectomy alone and multimodal treatments were performed in 10 patients (71.4%) and 4 patients (28.6%), respectively. Successful recanalization (TICI 2b-3) was achieved in 11 (78.6%). Among these 11 patients, 3 (27.3%) underwent multimodal treatment due to underlying atherosclerotic stenosis. Ten (71.4%) of the 14 showed NIHSS score improvement of >10. Overall mortality was 3 (21.4%) of 14. Conclusion : We suggest that mechanical thrombectomy is safe and effective for improving recanalization rates in AVBAO, with low complication rates. Also, in carefully selected patients after the failure of recanalization by thrombectomy alone, additional multimodal treatment such as IA thrombolysis, balloons, or stents can be needed to achieve successful recanalization.

• Journal of Chest Surgery
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• v.51 no.1
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• pp.35-40
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• 2018

Background: The treatment of malignant pleural mesothelioma (MPM) is challenging, and multimodal treatment including surgery is recommended; however, the role of surgery is debated. The treatment outcomes of MPM in Korea have not been reported. We analyzed the outcomes of MPM in the context of multimodal treatment, including surgery. Methods: The records of 29 patients with pathologically proven MPM from April 1998 to July 2015 were retrospectively reviewed. The treatment outcomes of the surgery and non-surgery groups were compared. Results: The overall median survival time was 10.6 months, and the overall 3-year survival rate was 25%. No postoperative 30-day or in-hospital mortality occurred in the surgery group. Postoperative complications included tachyarrhythmia (n=4), pulmonary thromboembolism (n=1), pneumonia (n=1), chylothorax (n=1), and wound complications (n=3). The treatment outcomes between the surgery and non-surgery groups were not significantly different (3-year survival rate: 31.3% vs. 16.7%, respectively; p=0.47). In a subgroup analysis, there was no significant difference in the treatment outcomes between the extrapleural pneumonectomy group and the non-surgery group (3-year survival rate: 45.5% vs. 16.7%, respectively; p=0.23). Conclusion: Multimodal treatment incorporating surgery did not show better outcomes than non-surgical treatment. A nationwide multicenter data registry and prospective randomized controlled studies are necessary to optimize the treatment of MPM.

• Journal of Chest Surgery
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• v.23 no.4
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• pp.707-714
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• 1990

Despite of mortality and morbidity rates that are higher than other forms of therapy, surgical resection has been mainstay for the treatment of esophageal cancer because of a prompt completeness as well as a high possibility of cure. But a substantial numbers of patients are unsuitable for surgical treatment and those undergoing resection have still poor long term survival rate. With hopes of improving long term survival, we have attempted multimodal approach, composed of preoperative induction chemotherapy utilizing Cisplatin and 5 \ulcornerFU, surgery and postoperative loco-regional radiotherapy for the treatment of esophageal cancer since 1985. During the period of 1967 \ulcorner1985, 27 patients[group A] were treated by surgery only and during recent 5 years 28 patients[group B] by multimodal treatment, Clinical review and comparison between the two groups were as follows: l. Applied surgical procedures were hand-sewn esophagogastrostomy, esophagocologastrostomy and esophagojejunostomy in group A. In group B, only esophagogastrostomy was underwent using stapler mainly. 2. Incidence of peri and postoperative complication showed no remarkable differences between the two groups, but the occurrences of leakage from the anastomotic site were 5[19% ] out of group A and 1[4%] out of group B. 3. The response rate to induction chemotherapy was 36% in group B, 4. The number of local cancer recurrence at the site of anastomosis was 6[22%] out of group A, whereas 2[7%] out of group B. 5. Postoperative I year and 2 year survival were 61%, 15% in group A and 75%, 42% in group B.

• Journal of Gastric Cancer
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• v.15 no.3
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• pp.218-221
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• 2015

Gastric metastasis from ovarian carcinoma is extremely rare and the prognosis for patients is poor. We report a case of multimodal treatment improving the survival time of a patient with gastric metastasis from ovarian cancer. A 73-year-old woman with known serous ovarian cancer was admitted to the hospital due to epigastric pain and dyspepsia. On esophagogastroduodenoscopy, a protruding mass was noted at the gastric antrum. She underwent distal gastrectomy with Billroth I anastomosis and lymph node dissection, including the para-aortic lymph nodes. The final pathology revealed gastric metastasis from ovarian serous adenocarcinoma. In this case, after cytoreductive surgery, chemotherapy was performed each time a recurrence was diagnosed, and remission was accomplished. She survived for 108 months after the first diagnosis of the metastatic tumor in the stomach. Multimodal treatment of metastatic lesions since the first diagnosis allowed the patient to survive longer than those in previous reports.

• Clinical Pain
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• v.18 no.2
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• pp.121-125
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• 2019

Arthritis of hip joints deteriorates the quality of life in ankylosing spondylitis (AS) patients. Secondary to the articular inflammatory process, the shortened hip-girdle muscles contribute to the decreased joint mobility which may lead to the functional impairment. As the limitation of range of motion (ROM) usually progress slowly, clinicians regard it as a chronic condition and prescribe long-term therapy. However, by short-term intensive multimodal treatment, a 20-year-old man diagnosed as AS with severely limited hip joint ROM who relied on crutches doubled the joint angle and could walk independently only within 2 weeks. The combination included intra-articular steroid injection, electrical twitch obtaining intramuscular stimulation, extracorporeal shock wave therapy, heat, manual therapy, and stretching exercises. The management focused on the relaxation of hip-girdle muscles as well as the direct control of intra-articular inflammation. Hereby, we emphasize the effectiveness of intensive multimodal treatment in improving the function even within a short period.

• Journal of Chest Surgery
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• v.55 no.5
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• pp.405-412
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• 2022

Background: Malignant pleural mesothelioma (MPM) is an aggressive pleural malignancy, and despite all multimodal treatment modalities, the 5-year overall survival rate of patients with MPM is less than 20%. In the present study, we aimed to analyze the surgical and prognostic outcomes of patients with MPM who received multimodal treatment. Methods: In this retrospective, single-center study, the records of patients who underwent surgery for MPM between January 2010 and December 2020 at our department were reviewed retrospectively. Results: Sixty-four patients were included in the study, of whom 23 (35.9%) were women and 41 (64.1%) were men. Extrapleural pneumonectomy, pleurectomy/decortication, and extended pleurectomy/decortication procedures were performed in 34.4%, 45.3%, and 20.3% of patients, respectively. The median survival of patients was 21 months, and the 5-year survival rate was 20.2%. Advanced tumor stage (hazard ratio [HR], 1.8; p=0.04), right-sided extrapleural pneumonectomy (HR, 3.1; p=0.02), lymph node metastasis (HR, 1.8; p=0.04), and incomplete multimodal therapy (HR, 1.9; p=0.03) were poor prognostic factors. There was no significant survival difference according to surgical type or histopathological subtype. Conclusion: Multimodal therapy can offer an acceptable survival rate in patients with MPM. Despite its poor reputation in the literature, the survival rate after extrapleural pneumonectomy, especially left-sided, was not as poor as might be expected.

• Archives of Plastic Surgery
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• v.49 no.5
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• pp.633-641
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• 2022

Introduction In chronic facial palsy, synkinetic muscle overactivity and shortening causes muscle stiffness resulting in reduced movement and functional activity. This article studies the role of multimodal therapy in improving outcomes. Methods Seventy-five facial palsy patients completed facial rehabilitation before being successfully discharged by the facial therapy team. The cohort was divided into four subgroups depending on the time of initial attendance post-onset. The requirement for facial therapy, chemodenervation, or surgery was assessed with East Grinstead Grade of Stiffness (EGGS). Outcomes were measured using the Facial Grading Scale (FGS), Facial Disability Index, House-Brackmann scores, and the Facial Clinimetric Evaluation scale. Results FGS composite scores significantly improved posttherapy (mean-standard deviation, 60.13 ± 23.24 vs. 79.9 ± 13.01; confidence interval, -24.51 to -14.66, p < 0.0001). Analysis of FGS subsets showed that synkinesis also reduced significantly (p < 0.0001). Increasingly, late clinical presentations were associated with patients requiring longer durations of chemodenervation treatment (p < 0.01), more chemodenervation episodes (p < 0.01), increased doses of botulinum toxin (p < 0.001), and having higher EGGS score (p < 0.001). Conclusions This study shows that multimodal facial rehabilitation in the management of facial palsy is effective, even in patients with chronically neglected synkinesis. In terms of the latency periods between facial palsy onset and treatment initiation, patients presenting later than 2 years were still responsive to multimodal treatment albeit to a lesser extent, which we postulate is due to increasing muscle contracture within their facial muscles.

• Journal of Korean Neurosurgical Society
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• v.55 no.1
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• pp.36-39
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• 2014

Treatment of complex aneurysms usually entails not only direct clipping but also alternative treatment modality. We recently experienced a case of vertebral artery dissecting aneurysm and obtained good treatment outcomes. Our case suggests that the endovascular segmental occlusion with posterior inferior cerebellar artery (PICA) to PICA side anastomosis might be a good treatment option in patients with complex vertebral artery dissecting aneurysms. A 45-year-old woman has a left vertebral dissecting aneurysm with dizziness. Based on the aneurysmal morphology and the involvement of PICA, the patient underwent side to side anastomosis of the PICA. This was followed by the endovascular segmental coil occlusion. The aneurysmal sac was completely obliterated. At a 2-year follow-up, the patient achieved a good patency of both PICA. In conclusion our case suggests that the endovascular segmental occlusion of the parent artery followed by PICA to PICA bypass surgery through a midline suboccipital approach is a reasonable multimodal treatment option in patients with complex vertebral artery dissecting aneurysms.

• Journal of Korean Neurosurgical Society
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• v.44 no.5
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• pp.314-319
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• 2008

Objective: For patients with giant or dissecting aneurysm, multimodal treatment consisting extracranial-intracranial bypass surgery plus clip or coil for parent artery occlusion may be necessary. In this study, the safety and efficacy of multimodal treatment in 15 patients with complex aneurysms were evaluated retrospectively. Methods: From January 1995 to June 2007, the authors treated 15 complex aneurysms that were unable to be clipped or coiled. Among them, nine patitents had unruptured aneurysms and 6 had ruptured aneurysms. Aneurysms were located in the internal cerebral artery (ICA) in 11 patients (4 in the dorsal wall. 4 in the terminal ICA, 1 in the paraclinoid, and 2 in the cavernous ICA), in the middle cerebral artery (MCA) in 2, and in the posterior circulation in two patients Results: Fifteen patients with complex aneurysms were treated with bypass surgery previously. Thirteen patients were treated with external carotid middle cerebral artery (ECA-MCA) anastomosis, and one patient with superficial temporal to posterior cerebral artery (STA-PCA) and another patient with occipital artery to posterior inferior cerebellar artery (OA-PICA) anastomosis. Parent artery occlusion was then performed with a clip in 9 patients, with a coil in 4, with balloon plus coil in one patient. All 15 aneurysms were successfully treated with clip or coil combined with bypass surgery. Follow-up angiograms showed good patency of anastomotic site in 10 out of 11 patients, and perfusion study showed sufficient perfusion in 6 out of 9 patients. Conclusion: These findings indicate that for patients with complex aneurysms, clip or coil for parent vessel occlusion with additive bypass surgery can successfully exclude the aneurysm from the neurovascular circulatory system.