• Nuclear Medicine and Molecular Imaging
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• v.42 no.4
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• pp.285-291
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• 2008

Purpose: Although automatic quantification software of myocardial perfusion SPECT provides highly objective and reproducible quantitative measurements, there is still some limitation in the direct use of quantitative measurements. In this study we derived parameters using normal variation of perfusion measurements, and tried to test the usefulness of these parameters. Materials and Methods: In order to calculate normal variation of perfusion measurements on myocardial perfusion SPECT, 55 patients (M:F = 28:27) of low-likelihood for coronary artery disease were enrolled and $^{201}TI$ rest/$^{99m}Tc$-MIBI stress SPECT studies were performed. Using 20-segment model, mean (m) and standard deviation (SD) of perfusion were calculated in each segment. As a myocardial viability assessment group, another 48 patients with known coronary artery disease, who underwent coronary artery bypass graft surgery (CABG) were enrolled. $^{201}TI$ rest/$^{99m}Tc$-MIBI stress / $^{201}TI$ 24-hr delayed SPECT was performed before CABG and SPECT was followed up 3 months after CABG. From the preoperative 24-hr delayed SPECT, $Q_{delay}$ (perfusion measurement), ${\Delta}_{delay}$ ($Q_{delay}$ - m) and $Z_{delay}$ (($Q_{delay}$ - m)/SD) were defined and diagnostic performances of them for myocardial viability were evaluated using area under curve (AUC) on receiver operating characteristic (ROC) curve analysis. Results: Segmental perfusion measurements showed considerable normal variations among segments. In men, the lowest segmental perfusion measurement was $51.8{\pm}6.5$ and the highest segmental perfusion was $87.0{\pm}5.9$, and they are $58.7{\pm}8.1$ and $87.3{\pm}6.0$, respectively in women. In the viability assessment $Q_{delay}$ showed AUC of 0.633, while those for ${\Delta}_{delay}$ and $Z_{delay}$ were 0.735 and 0.716, respectively. The AUCs of ${\Delta}_{delay}$ and $Z_{delay}$ were significantly higher than that of $Q_{delay}$ (p = 0.001 and 0.018, respectively). The diagnostic performance of ${\Delta}_{delay}$, which showed highest AUC, was 85% of sensitivity and 53% of specificity at the optimal cutoff of -24.7. Conclusion: On automatic quantification of myocardial perfusion SPECT, the normal variation of perfusion measurements were considerable among segments. In the viability assessment, the parameters considering normal variation showed better diagnostic performance than the direct perfusion measurement. This study suggests that consideration of normal variation is important in the analysis of measurements on quantitative myocardial perfusion SPECT.

• Journal of Korean Neurosurgical Society
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• v.29 no.3
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• pp.379-388
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• 2000

Objective : Although transoral transpharyngeal approach is a very useful method for the lesions of craniovertebral junction, it is not frequently used because of anatomical unfamilarity, risk of cerebrospinal fluid(CSF) leakage, and resultant postoperative meningitis. To evaluate the usefulness of transoral transpharyngeal approach for various lesions of craniovertebral junction, clinical characteristics and the results of this approach are investigated. Methods : Transoral transpharyngeal approaches were performed in eight cases between 1996 and 1999. Among them, there were three basilar invaginations due to congenital anomalies, two odontoid type I fractures, two atlantoaxial dislocations, and one pseudotumor. Surgical methods included five cases of anterior decompression and posterior fusion, two anterior approaches for decompression and one transoral approach for biopsy. Results : This procedure allowed immediate clinical improvement in all cases. In seven patients with preoperative motor deficit showed a progressive neurological improvement. The follow-up plain x-rays demonstrated successful bony fusion in all patients. Only one patient suffered from postoperative wound dehiscence, but she completely recovered after wound revision. There was no complication of postoperative CSF leakages. Conclusions : Transoral transpharyngeal approach for the ventral lesions of craniovertebral junction, can be used as a relatively simple and effective method.

• Journal of the Korean Arthroscopy Society
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• v.4 no.2
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• pp.97-104
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• 2000

Purpose : The majority of PCL deficient knees have some intact remnant PCL bundles. In these cases, the remnant PCL bundles were removed fur easy passage of graft(especially in bone-patellar tendon-bone graft). The purpose of study is to report the results of PCL reconstruction by posterior transseptal portal technique and by preserving the remnant posterior cruciate ligament bundles. Materials & Methods : From November 1993 to June 1999, 44 arthroscopic posterior cruciate ligament reconstructions have been performed by one surgeon. We studied 37 knees those were followed up over 1 year among them. The mean age($14\~56$ years) was 31.8 years. The average follow-up period was 17.8 months($12\~61$ months). The graft materials were 29 double-loop hamstring autografts, 4 double-loop hamstring allografts and 4 Achilles tendon-bone allograft. Results : There are significant improvement of the preoperative subjective symptoms. The last follow-up shows that the average Lysholm knee score was markedly improved from 59.8 pre-operation to 89.2 post-operation and the average KT 2000 side difference was decreased from 11.1mm pre-operation to 2.3 mm post-operation. Follow-up MRI showed that the graft was healed with remnant posterior cruciate ligament bundles as one ligament. Conclusion : The posterior trans-septal portal makes it possible to locate the exact tibial tunnel. The arthroscopic PCL reconstruction preserving the remnant of original PCL bundles seems to provide the good result.

• Journal of the Korean Arthroscopy Society
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• v.4 no.2
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• pp.159-165
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• 2000

Purpose : Endoscopic carpal tunnel release technique was developed and has being used to decrease postoperative morbidity and complications. The purpose of this study was to evaluate the clinical results and clinical usefulness of endoscopic carpal tunnel release using single portal technique. Methods and Materials : 18 carpal tunnel syndrome patients who were diagnosed by means of clinical symptoms, physical examination, and electrodiagnostic study had endoscopic carpal tunnel release using single portal technique with about 1 cm oblique wrist incision on 30 hands. And then they were followed-up and reviewed in the same way. Late results of operation were analysed by grading system according to patient's own assessments of relief of symptoms at the final fellow-up. The follow-up period ranged 6 to 13 months from surgery. Results : There were postoperative improvements with respect to clinical symptoms, physical examination, and electrodiagnostic study. 23 of 30 hands$(76.7\%)$ had complete resolution of symptoms. 27 hands$(90\%)$ were able to return to normal activities and work within 6 weeks, and 30 hands$(100\%)$ returned within 8 weeks. In grip strength study, 29 hands$(96.6\%)$ regained preoperative strength in 6 months. 12 of 22 hands$(55\%)$ had improvement with respect to thenar atrophy within 6 months. Late results were as follows . 23 hands$(76.7\%)$ was graded as excellent, 6 hands$(20\%)$ graded as good and 1 hand$(3.3\%)$ graded as fair, and there was no poor result. Conclusion : We think that endoscopic carpal tunnel release with single portal technique is technically safe and simple, if the surgeon takes step to stay within the safety zone based on local anatomy and selects an appropriate patient and that endoscopic carpal tunnel release does have advantages over open release. We agree that the surgeon must be prepared to perform an open technique, if technical difficulties arise, difficulty in introducing the device into the carpal tunnel is encountered, or the transverse fibers of the transverse carpal ligaments are not clearly seen.

• Journal of the Korean Arthroscopy Society
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• v.14 no.3
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• pp.180-187
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• 2010

Purpose: Rotator cuff tears involving the subscapularis are less common than those involving the superior and posterior rotator cuff. The purpose of the present study was to report the clinical results of repair of isolated traumatic tears of the subscapularis tendon. Materials and Methods: Fifteen patients (13 males, 2 females; mean age 46.2 years; range 35 to 52) with unilateral ruptures of the subscapularis tendon after trauma who underwent arthroscopic repair between February 2003 and October 2008 were reviewed retrospectively. All the cases were isolated tears of the subscapularis without the involvement of any other rotator cuff tendon and were followed for at least two years (mean 28 months). The entire subscapularis was involved in 9 cases and the tear was localized to the upper two thirds in 6 cases. The preoperative and postoperative status of patients with isolated subscapularis tears were analyzed using the Constant Score, American Shoulder and Elbow Society Index (ASES Index) and postoperative integrity was determined through magnetic resonance imaging. Results: The average clinical outcome scores and strength were all improved significantly at the time of the final follow-up. The constant shoulder score improved from 41.5 to 81.3 points (P<0.05) compared to before surgery and ASES index improved from 46.4 to 89.6 points (P<0.05) postoperatively. Thirteen patients (87%) were satisfied with the result of the treatment. The total tears were significantly more improved by surgery than the partial tears. In 12 of 15 patients (80%) were judged to reveal healed tendon on magnetic resonance imaging at a mean of 13 months postoperatively. The postoperative score was significantly lower for the patients with a failed repair than it was for those with an intact repair (P<0.05). Conclusion: Repair of traumatic isolated subscapularis tears through arthroscopic techniques effectively restores patient function with regard to pain, mobility, strength and postoperative tendon integrity. The postoperative integrity of the repair correlates with the functional results and the total tears were more improved by surgery than the partial tears, but future studies may be needed.

• The Korean Journal of Vision Science
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• v.20 no.4
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• pp.497-504
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• 2018

Purpose : The purpose of this study was to investigate the temperature changes of the ocular surface before and after cataract surgery using thermography of a thermal imaging camera. Methods : The study included 75 patients (75 eyes) aged from 50 to 79 years who underwent cataract surgery. In the past, those who underwent corneal-related surgery, wearing contact lens, disorder of tear secretion and taking medication for systemic disease were excluded from this study. The temperature changes of the eyeball surface were measured using a thermal imager (Cox CX series, Answer, Korea) following Tear Break Up Time (TBUT) test, Mcmonnies questionnaire and Schirmer's Test in real time, Results : While the temperature of preoperative ocular surface was $35.20{\pm}0.54^{\circ}C$ and that of postoperative temperature was $35.30{\pm}0.53^{\circ}C$, the difference was not significant. The temperature changes in the ocular surface were statistically significant at $-0.12{\pm}0.08{\Delta}$ ($^{\circ}C/sec$) before the surgery and $-0.18{\pm}0.07{\Delta}$ ($^{\circ}C/sec$) after the surgery. In comparison of the age groups, it was shown that the changes in the surface temperature before the surgery were from $-0.19{\pm}0.05{\Delta}$ ($^{\circ}C/sec$) to $-0.14{\pm}0.09{\Delta}$ ($^{\circ}C/sec$) in the 50s group, and from $-0.12{\pm}0.08{\Delta}$ ($^{\circ}C/sec$) to $-0.15{\pm}0.07{\Delta}$ ($^{\circ}C/sec$) in 60s group, and $-0.18{\pm}0.07{\Delta}$ ($^{\circ}C$) to $-0.12{\pm}0.08{\Delta}/sec$) in the 70s group, showing significant changes in the ocular surface temperature at all ages. Conclusion : Following the cataract surgery, all the indicators of dry eye syndrome were decreased, and eye surface temperature changes were significant. The thermography technique of the ocular surface would be expected to be useful for the evaluation of various dry eye syndromes because it is easy to evaluate dry eye syndrome noninvasively and can be quantified.

• The Korean Journal of Vision Science
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• v.20 no.4
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• pp.443-451
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• 2018

Purpose : To find out the reliability of autorefractometer after laser refractive surgery Methods : We measured and compared spherical and cylinder powers of those undergone LASEK surgery with 1.0 of naked vision after at least 3 months of the surgery with an autorefractometer(CANON Full Auto Ref-Keratometer RK-F1, Japan) and a retinoscope(Streak Retinoscope 18200, WelchAllyn, USA), and also applied spherical equivalent powers. The refractive status before surgery was divided into high, medium, and low myopia according to the results measured using an autorefractometer, and then analyzed again the reliability of the autorefractometer after surgery according to the preoperative refractive status. The agreement of two methods was identified using Bland-Altman(Bland-Altman limits of agreement(LoA)). Results : After the surgery, when comparing spherical, cylinder and equivalent powers in the whole data measured by autorefractometry and retinoscopy significant differences were found(p<0.01). According to the degree of refractive errors, all sort of refractive errors was shown significantly different(p<0.01) except for cylinder power of the medium myopia. In general, the refractive errors especially spherical and spherical equivalent powers by autorefractometry were shown a myopic trend from -0.38 D to -0.53 D. On the other hand, it was shown a hyperopic trend of approximately +0.30 D using retinoscopy. In comparison of two objective refractions, it was shown a myopic trend as $-0.51{\pm}0.45D$(LoA +0.36 D ~ -1.39 D) and compatible. Conclusion : Even though it would be positive in terms of compatibility of the methods, it is necessary that the glasses should be prescribed by subjective refraction since autorefractometry is shown myopic in those undergone the surgery and suffering from myopic regression.

• Journal of the Korean Orthopaedic Association
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• v.53 no.6
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• pp.505-512
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• 2018

Purpose: Many reconstruction methods have been attempted after an en-bloc resection of the proximal humerus. In particular, the introduction of reverse shoulder arthroplasty (RSA) has made a breakthrough in the functional recovery of the shoulder. Nevertheless, RSA has limitations when the humeral bone stock loss is significant. In addition, it is unclear if RSA is effective in patients showing failure with non-operative treatment of a proximal humeral tumor. Materials and Methods: A reconstruction was performed using an overlapping allograft-RSA composite for 11 patients with a failed proximal humeral construct. Delayed RSA was performed on 6 patients with failed non-operative treatment. The pre- and postoperative Musculoskeletal Tumor Society (MSTS) score and the complications were addressed. Results: Overlapping allograft-RSA composite afforded a stable construct in 11 failed proximal humeral reconstructions and the patient's chief complaints were resolved. The mean time to the union of overlapped allograft-host junction was 5.5 months. Average preoperative MSTS score of 20.3 point increased to 25.7 point, postoperatively. Four of the six patients who had RSA within 4 years from the index operation showed arm elevation of more than $90^{\circ}$ whereas the remaining 5 patients showed some disability. The complications include one case each of dislocation and aseptic infection, which were resolved by changing the polyethylene liner and scar revision, respectively. None of the 6 patients who underwent delayed RSA after the failure of non-operative treatment showed arm elevation more than $90^{\circ}$. Conclusion: An overlapping allograft-RSA composite is a simple and reliable reconstructive modality in patients with massive bone loss. In patients with metastatic cancer necessitating a surgical resection at presentation, early conversion to RSA is recommended to secure functional recovery.

• Journal of the Korean Orthopaedic Association
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• v.53 no.6
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• pp.490-497
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• 2018

Purpose: To evaluate the utility of ceramic-on-polyethylene articular bearing surface when cementless total hip arthroplasty is performed in patients older than 65 years through an analysis of the minimum five-year follow-up results using the ceramic femoral head and cross-linked polyethylene liner. Materials and Methods: From March 2010 to September 2012, 51 patients (56 hips) who were older than 65 years were enrolled in this retrospective study. The mean age at surgery was $70.9{\pm}5.1years$ old. A clinical assessment was analyzed using the Harris hip score. For the radiographic assessment, the cup inclination and anteversion, stem alignment, and wear amount were measured. The postoperative complications were also determined. Results: The mean Harris hip score was improved from preoperative 48 points to postoperative 87 points (p<0.05). The mean cup inclination was $40.9^{\circ}{\pm}6.4^{\circ}$ and the mean cup anteversion was $20.3^{\circ}{\pm}8.1^{\circ}$. The mean cup anteversion of the elevated liner-used group (16 cases) was $14.3^{\circ}{\pm}7.9^{\circ}$ and the mean cup anteversion of the neutral liner used group (40 cases) was $22.4^{\circ}{\pm}9.1^{\circ}$ (p<0.05). The mean stem alignment angle was $0^{\circ}$ (range, varus $4^{\circ}$-valgus $4^{\circ}$). The mean linear wear amount was $0.458{\pm}0.041mm$ and the average annual linear wear rate was $0.079{\pm}0.032mm/yr$. Six cases (10.7%) of intraoperative periprosthetic femoral fractures were encountered. Conclusion: Based on these results, the use of a ceramic-on-polyethylene articular bearing surface in elderly patients with cementless total hip arthroplasty is beneficial. On the other hand, careful effort is needed to prevent intraoperative periprosthetic femoral fractures.

• Korean Journal of Psychosomatic Medicine
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• v.27 no.1
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• pp.42-49
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• 2019

Objectives : Living donor liver transplantation (LDLT) is a life-saving therapy for patients with terminal liver disease. Many studies have focused on recipients rather than donors. The aim of this study was to assess the emotional status and personality characteristics of LDLT donors. Methods : We evaluated 218 subjects (126 male, 92 female) who visited Daegu Catholic University Medical Center from August 2012 to July 2018. A retrospective review of their preoperative psychological evaluation was done. We investigated epidemiological data and the Minnesota Multiphasic Personality Inventory-2 questionnaire. Subanalysis was done depending on whether subjects actually underwent surgery, relationship with the recipient, and their gender. Results : Mean age of subjects was $32.19{\pm}10.91years$. 187 subjects received LDLT surgery (actual donors) while 31 subjects didn't (potential donors). Donor-recipient relationship included husband-wife, parent-children, brother-sister etc. Subjects had statistical significance on validity scale L, F, K and all clinical scales compared to the control group. Potential donors had significant difference in F(b), F(p), K, S, Pa, AGGR, PSYC, DISC and NEGE scales compared to actual donors. F, D and NEGE scales were found to be predictive for actual donation. Subanalysis on donor-recipient relationship and gender also showed significant difference in certain scales. Conclusions : Under-reporting of psychological problems should be considered when evaluating living-liver donors. Information about the donor's overall psychosocial background, mental status and donation process should also be acquired.