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Cho Y.K.,Seoul Veterans Hospital | Kim J.K.,Chung - Ang University | Kim W.T.,Seoul Veterans Hospital | Chung J.W.,Seoul National University
Hepatology | Year: 2010

No adequate randomized trials have been reported for a comparison between hepatic resection (HR) versus radiofrequency ablation (RFA) for the treatment of patients with very early stage hepatocellular carcinoma (HCC), defined as an asymptomatic solitary HCC <2 cm. For compensated cirrhotic patients with very early stage HCC, a Markov model was created to simulate a randomized trial between HR (group I) versus primary percutaneous RFA followed by HR for cases of initial local failure (group II) versus percutaneous RFA monotherapy (group III); each arm was allocated with a hypothetical cohort of 10,000 patients. The primary endpoint was overall survival. The estimates of the variables were extracted from published articles after a systematic review. In the parameter estimations, we assumed the best scenario for HR and the worst scenario for RFA. The mean expected survival was 7.577 years, 7.564 years, and 7.356 years for group I, group II, and group III, respectively. One-way sensitivity analysis demonstrated that group II was the preferred strategy if the perioperative mortality rate was greater than 1.0%, if the probability of local recurrence following an initial complete ablation was<1.9% or if the positive microscopic resection margin rate was>0.3%. The95%confidence intervals for the difference in overall survival were-0.18-0.18 years between group I and II, 0.06-0.36 years between group I and III, and 0.13-0.30 years between group II and III, respectively. Conclusion: Primary percutaneous RFA followed by HR for cases of initial local failure was nearly identical to HR for the overall survival of compensated cirrhotic patients with very early stage HCC. Copyright © 2010 by the American Association for the Study of Liver Diseases.


Oh K.-J.,Konkuk University | Goodman S.B.,Stanford University | Yang J.-H.,Seoul Veterans Hospital
Journal of Arthroplasty | Year: 2011

A randomized, prospective, comparative study was performed in 2 related, adjacent generation posterior stabilized total knee prostheses, to evaluate whether the newer design improved the clinical and radiographic outcome for treatment of advanced osteoarthritis of the knee. Ninety one total knee arthroplasties in 84 patients (45 Insall-Burstein II and 46 NexGen Legacy posterior stabilized [both from Zimmer, Warsaw, Ind] prostheses) with an average of 10.3 years of follow-up (range, 9-11.8 years) were included. The preoperative diagnoses were primary osteoarthritis in all patients. At the latest evaluation, there were no significant differences detected in the mean clinical and functional knee scores, average postoperative active range of motion, and anterior knee pain between the Insall-Burstein II and the NexGen Legacy groups postoperatively. © 2011 Elsevier Inc.


Yang J.-H.,Seoul Veterans Hospital | Chouhan D.K.,Konkuk University | Oh K.-J.,Konkuk University
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2010

Percutaneous screw fixation of the anterior column of the acetabulum has been a challenging task because of its unique anatomy and a risk of intra-articular penetration. Evidence is lacking for any tools to provide visual scrutiny of fracture reduction and intra-articular screw penetration. We report 2 cases of fracture of the acetabulum that developed in young female athletes, in which the anterior column was fixed with a percutaneous screw by use of hip arthroscopy as an assisting tool for intra-articular observation. In our experience this method was found to be promising in terms of anatomic reduction of the fracture site, avoiding articular penetration during screw insertion, with additional advantages of joint debridement, lavage, and reduction in radiation exposure. © 2010 Arthroscopy Association of North America.


Kim J.H.,Seoul Veterans Hospital
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi | Year: 2012

Recently, variable gastrointestinal track tumors including early stage malignancies are treated by endoscopic procedure. However, the discrepancy of histologic diagnosis may sometimes exist between the pretreatment forceps biopsy results and those of post treatment specimen. So the prediction of malignant lesion is important in the aspect of treatment selection. In this study, we investigated the predictable factors of the histologic discrepancy through the clinical, endoscopic features of the lesion diagnosed as adenocarcinoma in the post-endoscopic treatment specimen after the adenoma was diagnosed by the endoscopic forceps biopsy. From March 2005 to April 2009, 129 gastric tumor lesions (129 patients) which were not diagnosed as malignancy and treated with endoscopic procedure were enrolled retrospectively. We compared the pretreatment endoscopic forceps biopsy results and post-treatment specimen biopsy results, then, analyzed the tumor characteristics. Twenty-one cases (16.3%) were diagnosed as malignancy after endoscopic treatment. Especially, discrepancy occurred more frequently in depressed lesions than in flat or elevated lesions (41.7% vs. 13.7%, p=0.012), and in lesions diagnosed as high grade adenomas than low or moderate grade adenomas (33.3% vs. 11.1%. p=0.004). In cases of depressed type lesions in the pretreatment endoscopy or those diagnosed as high grade adenoma in the pretreatment forceps biopsy, we should consider combined malignant lesion. Therefore, treatment modalities ensuring accurate diagnosis and potentially curative resection, should be carefully selected and performed in cases which have these features.


Choi W.J.,Yonsei University | Choi G.W.,Seoul Veterans Hospital | Kim J.S.,Yonsei University | Lee J.W.,Yonsei University
American Journal of Sports Medicine | Year: 2013

Background: Uncontained osteochondral lesions of the talar shoulder are associated with an increased risk of clinical failure in patients treated with current cylindrical osteochondral autograft techniques. Whether the same holds true in patients undergoing arthroscopic treatment is unknown. Purpose: To determine the relative prognostic significance of the containment (shoulder vs nonshoulder type) and location (medial vs lateral) of an osteochondral lesion of the talus (OLT). Hypothesis: Arthroscopic treatment may not be ideal for uncontained lesions of the talar shoulder due to a lack of structural support. Study Design: Cohort study; Level of evidence, 3. Methods: Arthroscopic treatment for OLT was performed on the ankles of 399 patients between 2001 and 2009. Analyses were performed by grouping the patients according to type of containment (shoulder, n = 181; nonshoulder, n = 218), location (medial, n = 274; lateral, n = 125), and both type of containment and location (medial shoulder, n = 129; medial nonshoulder, n = 145; lateral shoulder, n = 52; lateral nonshoulder, n = 73). To evaluate the role of containment and location independently of OLT size, patients were grouped according to quartile of defect size, and outcomes were analyzed within each group. Results: Patients with shoulder-type OLT had a substantially worse clinical outcome than did those with nonshoulder-type OLT, even after adjustment for OLT size (P <.05). However, there was no significant difference in clinical outcome between patients with medial OLT and those with lateral OLT, and the clinical failure rates of the 2 groups were similar (P>.05). A Cox proportional hazards regression model demonstrated that OLT containment, but not location, exerted an independent prognostic effect. Conclusion: Patients with uncontained OLT of the talar shoulder experienced a more complicated clinical outcome than did those with contained, nonshoulder-type OLT even after adjustment for OLT size and regardless of location. © 2013 The Author(s).


Yang H.S.,Seoul Veterans Hospital | Choi S.,Seoul Veterans Hospital
Cornea | Year: 2013

Purpose: To evaluate the effectiveness of conjunctivoplasty using an argon green laser in symptomatic patients with conjunctivochalasis (CCh). Methods: Twenty-nine eyes of 18 patients with various grades of CCh were included in this study. All the patients, who were refractory to the conventional therapy, were treated using an argon green laser. The ocular symptoms and signs, including the CCh grade, the tear Ocular Surface Disease Index, the breakup time, the Schirmer test, and the abnormal ocular surface findings, were evaluated preoperatively and postoperatively. Results: The mean age of the patients was 69.1 ± 8.4 years. The grade of CCh in 25 eyes (86%) decreased at 6 months after the laser conjunctivoplasty. When the grade reduction rates were calculated, the reduction rates of grades 1, 2, and 3 were 100%, 69%, and 48%, respectively. Most of the patients showed a significant symptomatic improvement, and the Ocular Surface Disease Index scores decreased from 0.41 to 0.22 (P < 0.001). The breakup time increased from 9.1 to 10.2 (P = 0.007), but the Schirmer test results did not show any differences after the surgery (P = 0.257). Conclusions: Conjunctivoplasty using an argon green laser is a simple and effective choice to treat symptomatic patients with CCh, especially in cases of mild-to-moderate grade CCh. © 2013 Lippincott Williams & Wilkins.


Choi W.J.,Yonsei University | Choi G.W.,Seoul Veterans Hospital | Lee J.W.,Yonsei University
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2013

Purpose: To evaluate the outcome of arthroscopic synovectomy of the ankle joint in patients with early-stage rheumatoid arthritis (RA). Methods: Between 2005 and 2009, 18 consecutive patients with RA involving the ankle underwent arthroscopic synovectomy. Pain was measured using a visual analog scale (VAS), and clinical outcome was determined by calculating the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score with a mean follow-up of 5 years (60 months). Assessments were performed preoperatively, at 6 and 12 months postoperatively, and then yearly thereafter. Clinical success was defined as the absence of synovitis symptoms or when patients demonstrated good or excellent outcomes (AOFAS Ankle-Hindfoot Scale score ≥80) with >50% improvement in VAS score for pain. Demographic, laboratory, and radiological variables were evaluated to determine possible factors predicting clinical outcome. Results: VAS and AOFAS scores were significantly improved at the final follow-up (60 months; P <.0001). The greatest improvements in clinical scores were observed after 12 months; thereafter, they steadily declined. Of the 18 patients examined, 14 (77.8%) were considered to have had clinical success with no reintervention. Variables predictive of clinical success were short duration of symptoms (P =.042) and minimal radiographic changes based on the Larsen grading system (P =.030). Conclusions: Arthroscopic synovectomy is a safe and successful procedure in ankle joints affected by RA. The best clinical outcomes are achieved when the procedure is performed early in the disease course and when there is no evidence of cartilage degeneration. Level of Evidence: Level IV, prognostic case series. © 2013 by the Arthroscopy Association of North America.


Kim Y.M.,Seoul Veterans Hospital
Korean journal of ophthalmology : KJO | Year: 2011

A 79-year-old male presented with left ocular pain. Evisceration and silicone ball implantation were performed after a diagnosis of phthisis. He returned six weeks later because of left facial erythematous swelling, tenderness, mild fever, chills and cough. His condition was diagnosed as orbital cellulitis. Despite two weeks of empirical antibiotic therapy, the symptoms worsened. A subsequent orbital computed tomography scan revealed enhanced soft tissue infiltrations in his left orbit and eyelid. Biopsy showed a diffusely infiltrating tumor of signet ring cell cytology. A systemic evaluation revealed multiple bone metastases. Based on this evidence, the patient was diagnosed with a very rare case of histiocytoid variant eccrine sweat gland carcinoma with multiple bone metastases.


Yang J.H.,Seoul Veterans Hospital
Orthopedics | Year: 2010

This report compares the radiologic and early clinical results of total knee arthroplasty (TKA) performed by the same surgeon using 3 techniques. In this prospective study, 75 knees were randomized to conventional technique (25 knees), image-free navigation system (25 knees), or minimally invasive surgery (MIS) (25 knees). Age range of the 43 women (65 knees) and 5 men (10 knees) was 58 to 81 years. Posterior stabilized knee prosthesis was used in all patients. Data was collected according to Knee Society System for radiologic evaluation of x-rays. Knee Society clinical (KS-C) and functional knee scores were measured preoperatively and at 6 weeks, 3 months, 6 months, 1 year, and 2 years. The postoperative KS-C was not statistically better in the MIS group (mean, 88 ± 11.5; range, 70-100) than the conventional (mean, 85.9 ± 7.8; range, 74-94) (P=.68) or navigation group (mean, 85 ± 11; range, 63-100) (P=.59). Mean postoperative delta (mechanical axis) angle was significantly different (P=.014): 2.38° in the conventional group (SD=2.88°; 95% CI, 1.19°-3.57°; range, -1.59° to 6.86°), 0.61° in the navigation group (SD=2.07°; 95% CI, -0.24° to 1.46°; range, -2.07° to 4.25°), and 4.25° in the MIS group (SD=6.52°; 95% CI, 1.56°-6.94°; range, -6.72° to 15.60°). Significant difference could be elicited between navigation-assisted and MIS groups, with navigation-assisted surgery providing more accurate alignment of the mechanical axis (P=.014). Of the three techniques, navigation-assisted surgery gives superior prosthesis alignment and promising longevity of TKA. Copyright 2010, SLACK Incorporated.


Yang J.-H.,Seoul Veterans Hospital | Yoon J.-R.,Seoul Veterans Hospital | Oh C.-H.,Seoul Veterans Hospital | Kim T.-S.,Seoul Veterans Hospital
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2012

Purpose: A rotating-hinge total knee prosthesis may be utilized for the treatment of global instability or severe bone loss around the knee. The outcome of primary total knee arthroplasty (TKA) using Endo-Modell (Link ®) rotating-hinge prosthesis was evaluated. Methods: Retrospectively, review of 50 cases (40 patients) at a mean follow-up of 15 years (range, 10-18) who underwent primary TKA using Endo-Modell (Link ®) was performed. Indications included severe primary osteoarthritis with substantial ligament laxity, severe rheumatic arthritis with extreme ligament instability and bone loss, supracondylar nonunion, charcot arthropathy, and posttraumatic arthritis. Knee Society Score (KSS) and radiographic analysis were done for preoperative and at latest follow-up. Statistical analysis was done using the Student's t test with the level of significance of p < 0.05. Results: Overall, the rotating-hinge arthroplasty resulted in improved knee functioning. The KSS improved (p < 0.001) from a preoperative mean of 38 ± 14.3 (SD) points to a postoperative mean of 73 ± 12.8 points; the functional score improved (n. s.) from 36 ± 19.5 points to 47 ± 23.5 points. Mean range of motion at the most recent clinical follow-up evaluation was 102 ± 9°. However, all (100%) patients needed some form of assisted devices for walking and a relatively large number of deep infections (14%) were encountered. Conclusions: Reconstruction with a rotating-hinge total knee prosthesis provided substantial improvement in function and reduction in pain. However, the possibility of assisted walking and high rate of deep infection should be encountered. Level of evidence: Retrospective therapeutic study, Level IV. © 2011 Springer-Verlag.

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