• Archives of Plastic Surgery
• /
• v.46 no.5
• /
• pp.426-432
• /
• 2019

Background The mandible is an important structure that is located in the lower third of the face. Large mandibular defects after tumor resection cause loss of its function. This study assessed the outcomes and tumor recurrence after immediate mandibular reconstruction using a free fibula osteocutaneous flap following radical resection of ameloblastoma. Methods This is a retrospective non-randomized study of outcomes and tumor recurrence of all patients diagnosed with mandibular ameloblastoma from August 1997 until August 2017 (20 years) requiring free fibula osteocutaneous flap reconstruction at a single institution. The patients were identified through an electronic operative database; subsequently, their medical records and photo documentation were retrieved. Results Twenty-seven patients were included in this study. Eighteen patients were male, while nine were female. The majority of the patients (48.1%) were in their third decade of life when they were diagnosed with ameloblastoma. All of them underwent radical resection of the tumor with a surgical margin of 2 cm (hemimandibulectomy in cases with a large tumor) and immediate mandibular reconstruction with a free fibula osteocutaneous flap. Two patients required revision of a vascular anastomosis due to venous thrombosis postoperatively, while one patient developed a flap recipient site infection. The flap success rate was 100%. There was no tumor recurrence during a mean follow-up period of 5.6 years. Conclusions Mandibular ameloblastoma should be treated with segmental mandibulectomy (with a surgical margin of 2 cm) to reduce the risk of recurrence. Subsequent mandibular and adjacent soft tissue defects should be reconstructed immediately with a free fibula osteocutaneous flap.

• Journal of Korean Neurosurgical Society
• /
• v.65 no.5
• /
• pp.710-718
• /
• 2022

Objective : Although endovascular treatment for intracranial aneurysms is considered effective and safe, its durability is still debated. Also, few studies have described angiographic follow-up plan after endovascular treatment of intracranial aneurysm, especially in ruptured cases. Hence, we report the long-term results of follow-up angiography protocol. Methods : Radiological records of 639 cases of coil embolization with ruptured aneurysms from March 2003 to December 2016 were retrospectively reviewed. Patients who received treatment of a saccular aneurysm less than 7 mm resulted with near complete occlusion were included. Two hundred thirty-eight aneuryms which received the follow-up angiography at least once were enrolled. We classified four periods of follow-up as follows : post-treatment 1 year (defined as the first period), from 1 to 2 years (the second period), 2 to 5 years (the third period), and over 5 years (long-term). Results : We identified 14 cases (6.4%) of recurrence from 218 aneurysms in follow-up angiography in the first period. Among 143 aneurysms in the second period, five cases (3.5%) of recurrence were identified. There were no findings suspicious of recanalization in 97 patients in the third period. Of the total 238 cases, there were 19 recurrences, for a recurrence rate of 8.0%. Six (31.6%) out of 19 recurrences showed a tendency toward repeat recurrences even after additional treatment. Twenty-eight received long-term follow-up over 5 years and there was no recurrence. Conclusion : Most of the recurrence were found during the first and the second year. We suggest that at least one digital subtraction angiography examination may be necessary around post-treatment 2 years, especially in ruptured cases. If the angiographic results are favorable at 2 years post-treatment, long-term result should be favorable.

• The Journal of Korean Medicine
• /
• v.28 no.1 s.69
• /
• pp.224-236
• /
• 2007

Background : Chunghyul-dan is a combinatorial herbal medicine; previous studies reported it had therapeutic effects for microangiopathy, a major part in the progression of small vessel disease, as well as having anti-hypertensive, anti-hyperlipidemic, anti-apoptotic, anti-oxidative, and anti-inflammatory activities. Therefor, we examined the inhibitory effect of Chunghyul-dan on stroke recurrence in patients with small vessel disease. Methods : We prescribed Chunghyul-dan at 600 mg a day to patients with small vessel disease, and monitored stroke recurrence, drug compliances, and adverse effect for 1 year. We then performed follow-up brain MRI to find new vascular lesions after 1 year of Chunghyul-dan medication. For the subjects lost to follow-up, we assessed their prognosis after 1 year by telephone. Results : There were 73 subjects treated with Chunghyul-dan for 1 year; new vascular events were found in 3. Of the 85 subjects lost to follow-up, fifty four could be contacted, and eight of them had stroke recurrence. One year of Chunghyul-dan medication reduced the odds ratio of stroke recurrence by 75% compared to the subjects lost to follow-up and the rate increased to 88%, when adjusted for other relevant risk factors for stroke recurrence. These reductions were much higher than those of aspirin and other kinds of conventional anti-platelets. There was no adverse effect in any of the study subjects. Conclusions : We suggest Chunghyul-dan could be useful for inhibition of stroke recurrence. Further study with a randomized controlled trial is needed to confirm this suggestion.

• Journal of Korean Foot and Ankle Society
• /
• v.23 no.4
• /
• pp.159-165
• /
• 2019

Purpose: This study investigated the recurrence rate after performing hallux valgus correction using scarf and Akin osteotomy, and also identified the correlation and cut-off values of both the preoperative and postoperative radiographic parameters as risk factors for the recurrence of hallux valgus. Materials and Methods: We reviewed 87 hallux valgus patients (122 feet) who received scarf and Akin osteotomy from January 2007 to August 2015. The clinical outcomes were evaluated using the visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores. The radiological outcome measures included the hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) as determined on the serial weight bearing radiographs. Recurrence was defined as more than 20 degrees of HVA noted on the final follow-up radiograph. Those radiological factors associated with recurrence were evaluated and analyzed. Results: The mean follow-up duration was 20.6 months (12.0~46.5 months) and the mean age was 44 years (13~80 years). The VAS and AOFAS scores were significantly improved at the time of the final follow-up (7.0 to 2.0, p<0.001; 78.0 to 92.0, p<0.001; respectively). Significant corrections in the HVA, IMA, and DMAA were obtained (p<0.001). Eleven (9.0%: 11/122) cases experienced recurrent hallux valgus deformity. The postoperative IMA, DMAA and HVA showed significant moderate to strong correlation with HVA at the final follow-up (Pearson correlation coefficient: 0.44, 0.70, and 0.88, respectively; p<0.001). Postoperative HVA>16.7 degrees, postoperative DMAA>13.9 degrees, and postoperative IMA>8.2 degrees showed statistically significant correlation with radiological recurrence at the last follow-up, and the odds ratio of each variable was high in order. Conclusion: Our radiographic results indicated that postoperative HVA>16.7 degrees, postoperative DMAA>13.9 degrees, and postoperative IMA>8.2 degrees can be risk factors for hallux valgus recurrence. These risk factors may be helpful for modifying surgical procedures and preventing the recurrence of hallux valgus.

• Korean Journal of Head & Neck Oncology
• /
• v.12 no.1
• /
• pp.26-31
• /
• 1996

Radiation therapy in T1 glottic cancer offers an excellent cure rate with preservation of voice. From 1983 to 1992 eighty nine patients with TNM staged T1N0M0 invasive squamous cell carcinoma of the glottis were treated at the Dept. of Radiation Oncology, Yonsei Cancer Center, Yonsei University. There were 84 men and 5 women with median age of 59 years. All patients were treated either with Co-60 teletherapy unit or 4MV linear accelerator with an median dose of 6400 cGy(6000-7000 cGy), 200 cGy per day, 5 days in a week. Fourteen local failures have been observed and the median time to local recurrence was 17 months. There were no nodal failure without local recurrence or distant metastases. The 5 year local control rate was 84.3%. The 5 year actuarial surivival rate and the 5 year disease free survival rate were 89.2%, 87.5%, respectively. The 5 year actuarial survival rate and the 5 year disease free survival rate of the nineteen patients with anterior commissure involvement were 77.8% and 74.5% which were lower than those of seventy patients without anterior commissure involvement(91.6%, 90.6%)(p < 0.05). Among the several influencing factors, anterior commissure involvement was the significant prognostic foctor. Final local control rate, taking into account the salvage surgery, was 89.9% at 5 years.

• The Journal of Internal Korean Medicine
• /
• v.39 no.6
• /
• pp.1136-1149
• /
• 2018

Objectives: The aim of this study was to perform a meta analysis of randomized controlled trials (RCTs) that applied Opae-san to peptic ulcer. Methods: The databases NDSL, RISS, KISS, KISTI, Oasis, DBpia, Cochrane, EMBASE, Pubmed, and CNKI were searched to identify RCTs that evaluated the therapeutic response to Opae-san on peptic ulcer. The selected studies were assessed using Cochrane Group's risk of bias tool. Results: 12 RCTs were selected from a total of 312 identified. Combined therapies of Opae-san plus triple therapy were superior to only triple therapy in achieving the effective rate (risk ratio=1.26, 95% CI: 1.17 to 1.35, p<0.001, I2=0%), the helicobacter pylori eradication rate (risk ratio=1.23, 95% CI: 1.12 to 1.34, p<0.001, I2=7%) and the recurrence rate (risk ratio=0.31, 95% CI: 0.12 to 0.82, p=0.02, I2=0%). But only Opae-san was not superior in achieving the effective rate compared to anti gastric secretion drugs. Conclusions: The current evidence suggests that combined therapies of Opae-san plus triple therapy yield a higher effective rate, and helicobacter pylori eradication rate and a lower recurrence rate. However, in most of these studies, it is difficult to evaluate the bias and therefore better designed studies are needed.

• Journal of Chest Surgery
• /
• v.41 no.5
• /
• pp.619-624
• /
• 2008

Background: Secondary spontaneous pneumothorax is caused by various underlying lung diseases, and this is despite that primary spontaneous pneumotherax is caused by rupture of subpleural blebs. The treatment algorithm for secondary pneumothorax is different from that for primary pneumothorax. We studied the recurrence rate, the characteristics of recurrence and the treatment outcomes of the patients with secondary spontaneous pneumothorax. Material and Method: Between March 2005 to March 2007, 85 patients were treated for their first episodes of secondary spontaneous pneumothorax. We analyzed the characteristics and factors for recurrence of secondary spontaneous pneumothorax by conducting a retrospective review of the medical records. Result: The most common underlying lung disease was pulmonary tuberculosis (49.4%), and the second was chronic obstructive lung disease (27.6%), The recurrence rate was 47.1% (40/85). The second and third recurrence rates were 10.9% and 3.5%, respectively. The mean follow up period was $21.1{\pm}6.7$ months (range: $0{\sim}36$ month). For the recurrence cases, 70.5% of them occurred within a year after the first episode. The success rates according to the treatment modalities were thoracostomy 47.6%, chemical pleurodesis 74.4%, blob resection 71% and Heimlich valve application 50%. Chemical pleurodesis through the chest tube was the most effective method of treatment. The factor that was most predictive of recurrence was 'an air-leak of 7 days or more' at the first episode. (p=0.002) Conclusion: The patients who have a prolonged air-leak at the first episode of pneumothorax tend to have a higher incidence of recurrence. Further studies with more patients are necessary to determine the standard treatment protocol for secondary spontaneous pneumothorax.

• Journal of Korean Neurosurgical Society
• /
• v.30 no.3
• /
• pp.349-357
• /
• 2001

Purpose : Meningeal hemangiopericytoma(M-HPC), characterized by a high local recurrency and metastatic potential, is a rare neoplasm arising from perivascular pericytes. A retrospective study was performed to identify the recurrence and extraneural metastasis in M-HPC. Materials and Methods : We reviewed the records of 31 M-HPC patients treated from 1982 through 1999 at our institution. The time to recurrence and the various parameters affecting recurrence were determined. Extreneural metastasis was also analyzed. Results : The rate of local recurrency was 38.7%(12/31). The overall average recurrence-free period(RFP) before the first recurrence was 104 months, with overall recurrence-free rates(RFRs) at 5 and 10 years after first surgery of 59.2% and 33.6%, respectively. Of the 12 patients who experienced local recurrence, 4 had recurrences 5 years later after the first surgery. Complete excision at the first operation significantly extended the average time before first recurrence from 43 to 111 months. The 5-year RFRs for the groups of complete excision and incomplete excision were 72.7% and 20.8%, respectively(p=0.0060). Although there was no statistical significance, complete excision followed by adjuvant radiotherapy of more than 50Gy extended the RFP. The 5-year RFRs for the groups of complete excision and complete excision with adjuvant radiotherapy were 70.3% and 100%, respectively(p=0.3359). Four patients(12.9%) presented one or more extraneural metastases that were developed at an average of 107 months after the first operation with the 5- and 10-year metastasis rates of 4.4% and 24.9%, respectively. Conclusions : M-HPC has a propensity to recur either locally or at distant sites after surgical resection. Complete excision is the most important factor to reduce recurrence. However, even with complete excision, adjuvant radiotherapy of more than 50Gy significantly reduces the risk of recurrence. Local and distant recurrences may occur after a prolonged disease-free interval, emphasizing the need for long-term follow-up.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.22 no.2
• /
• pp.217-232
• /
• 2000

The author studied on the 128 cases of benign odontogenic tumors which had been diagnosed with biopsy during the period of Jan. 1989 to Dec. 1998 at the Kyungpook National University Hospital, Yeungnam University Medical Center, Keimyung University Dongsan Medical Center, and Taegu Catholic Medical Center. This study contained the clinicostatistical analysis of the frequency in relation to sex, age, locations, chief complaints, duration, radiographic findings, recurrence, teeth, and treatment methods. The results were as follow : 1. Of a total of 128 benign odontogenic tumors, ameloblastomas(57 cases; 44.5%) and odontomas (44 cases ; 34.4%) mostly occupied. The other types of lesions were 8 calcifying odontogenic cysts, 7 benign cementoblastomas, 4 myxomas, 3 adenomatoid odontogenic tumors, 2 calcifying epithelial odontogenic tumors, 2 ameloblastic fibro-odontomas, and 1 odontogenic fibroma. 2. In age and sex distribution, benign odontogenic tumors occured slightly more often in males(53.9%) than females(46.1%) and the majority of cases(79.7%) were found during 2nd, 3rd, and 4th decade. 3. There was a predilection for mandibular lesions(mandible-maxilla ratio, 2.6 : 1). 4. The most common chief complaint was swelling(29.7%) and in respect to duration, the cases less than 1 year(50.0%) mainly appeared. 5. There were 7 cases(13.0%) of recurrence on ameloblastoma and there was no recurrence in the others. 6. In Ameloblastoma It commonly occured during 3rd and 4th decade(59.6%) and mean age was 30.2 years. The majority of cases were occurred in mandible(96.5%) , especially mandibular molar and angle area(71.9%). The most common chief complaint was swelling(47.4%) and in respect to duration, the cases less than 1 year(52.6%) mainly appeared. In relation to teeth, there were resorption of root(52.6%), displacement of teeth(31.6%), and in relation to impacted teeth(43.9%). There was higher recurrence rate in the cases by conservative treatment(14.7%) than radical treatment(10.0%). As regards radiographic findings, conservative treatments were prevalent in the cases of unilocular type(85.7%) as compared with multilocular type(48.5%). and there was higherrecurrence rate in the cases of multilocular type(18.2%) than unilocular type(4.8%). As regards the type of treatment in relation to age, conservative treatments were prevalent in patients younger than 20 years of age. 7. In Odontomas It commonly occured during 2nd decade(50.0%) and in maxillary anterior teeth(40.9%). The most common chief complaint was delayed retention and permanent impaction of teeth(72.7%), and most frequently associated with impacted teeth(79.5%).

• Asian Pacific Journal of Cancer Prevention
• /
• v.14 no.11
• /
• pp.6935-6940
• /
• 2013

Background: This study aimed to develop a prognostic model in patients with early-stage cervical squamous cell carcinoma based on clinicopathological features, including invasive margin characteristics. Materials and Methods: Clinicopathological features and outcomes of 190 patients with FIGO stage IB-IIA cervical squamous cell carcinoma treated by surgery were collected and analyzed for factors associated with tumor recurrence. In addition to well-recognized pathological risk factors, the pathological characteristics of invasive margin (type of invasive pattern and degree of stromal desmoplasia and peritumoral inflammatory reaction) were also included in the analysis. Multiple scoring models were made by matching different clinicopathological variables and/or different weighting of the score for each variable. The model with the best performance in the prediction of recurrence and decreased survival was selected. Results: The model with the best performance was composed of a combined score of invasive pattern, lymphovascular space invasion (LVSI), and degree of inflammatory reaction and stromal desmoplasia (total score =10). Compared to those with score ${\leq}8$, the patients with score 9-10 had a significantly higher recurrence rate in the overall group (p<0.001) and the subgroup without adjuvant therapy (p<0.001), while the significance was marginal in the subgroup with adjuvant therapy (p=0.069). In addition, the patients with score 9-10 had a higher rate of tumor recurrence at distant sites (p=0.007). The disease-free survival was significantly lower in the patients with score 9-10 than those with score ${\leq}8$ among the overall patients (p<0.001), in the subgroup without adjuvant therapy (p<0.001), and the subgroup with adjuvant therapy (p=0.047). Conclusions: In this study, a prognostic model based on a combination of pathological characteristics of invasive margin and LVSI proved to be predictive of tumor recurrence and decreased disease-free survival in patients with early-stage cervical squamous cell carcinoma.