Uijeongbu St Marys Hospital

Vijongbu, South Korea

Uijeongbu St Marys Hospital

Vijongbu, South Korea
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Park K.W.,Seoul National University | Kang S.-H.,Seoul National University | Kang H.-J.,Seoul National University | Koo B.-K.,Seoul National University | And 20 more authors.
Journal of the American College of Cardiology | Year: 2014

Objectives This study sought to test whether the newly developed platinum chromium (PtCr)-based everolimus-eluting stent (EES) is noninferior to the cobalt chromium (CoCr)-based zotarolimus-eluting stent (ZES) in all-comers receiving percutaneous coronary intervention (PCI). Background PtCr provides improved radial strength, conformability, and visibility compared with the CoCr alloy, but PtCr-based stents have not been tested in a wide range of patients receiving PCI. Also, recent case series have raised the issue of longitudinal stent deformation (LSD) with newer drug-eluting stents. Methods We randomly assigned 3,755 all-comers receiving PCI to PtCr-EES or CoCr-ZES. The primary outcome was target lesion failure (TLF) at 1-year post-PCI, defined as the composite of cardiac death, nonfatal target vessel-related myocardial infarction, and ischemia-driven target lesion revascularization. Post-hoc angiographic analysis was performed to qualitatively and quantitatively analyze LSD. Results At 1 year, TLF occurred in 2.9% and 2.9% of the population in the PtCr-EES and CoCr-ZES groups, respectively (superiority p = 0.98, noninferiority p = 0.0247). There were no significant differences in the individual components of TLF as well as the patient-oriented clinical outcome. Of 5,010 stents analyzed, LSD occurred in 0.2% and 0% in the PtCr-EES and CoCr-ZES groups, respectively (p = 0.104). There was no significant difference in post-deployment stent length ratio between the 2 stents (p = 0.352). Conclusions At 1 year, PtCr-EES was noninferior to CoCr-ZES in all-comers receiving PCI. Although LSD was observed only in PtCr-EES, both the stent length ratio and the frequency of LSD were not significantly different between the 2 stent types, and PtCr-EES was not associated with adverse clinical outcomes. (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis-SAfety & EffectiveneSS of Drug-ElUting Stents & Anti-platelet REgimen [HOST-ASSURE]; NCT01267734). © 2014 by the American College of Cardiology Foundation. Published by Elsevier Inc.


Koh I.J.,Uijeongbu St Marys Hospital | Koh I.J.,Catholic University of Korea | Cho W.-S.,University of Ulsan | Choi N.Y.,Catholic University of Korea | And 2 more authors.
Clinical Orthopaedics and Related Research | Year: 2014

Background: Failure after total knee arthroplasty (TKA) may be related to emerging technologies, surgical techniques, and changing patient demographics. Over the past decade, TKA use in Korea has increased substantially, and demographic trends have diverged from those of Western countries, but failure mechanisms in Korea have not been well studied. Questions/purposes: We determined the causes of failure after TKA, the risk factors for failure, and the trends in revision TKAs in Korea over the last 5 years. Methods: We retrospectively reviewed 634 revision TKAs and 20,234 primary TKAs performed at 19 institutes affiliated with the Kleos Korea Research Group from 2008 to 2012. We recorded the causes of failure after TKA using 11 complications from the standardized complication list of The Knee Society, patient demographics, information on index and revision of TKAs, and indications for index TKA. The influences of patient demographics and indications for index TKA on the risk of TKA failure were evaluated using multivariate regression analysis. The trends in revision procedures and demographic features of the patients undergoing revision TKA over the last 5 years were assessed. Results: The most common cumulative cause of TKA failure was infection (38%) followed by loosening (33%), wear (13%), instability (7%), and stiffness (3%). However, the incidence of infections has declined over the past 5 years, whereas that of loosening has increased and exceeds that of infection in the more recent 3 years. Young age (odds ratio [OR] per 10 years of age increase, 0.41; 95% confidence interval [CI], 0.37-0.49) and male sex (OR, 1.88; 95% CI, 1.42-2.49) were associated with an increased risk of failure. The percentage of revision TKAs in all primary and revision TKAs remained at approximately 3%, but the annual numbers of revision TKAs in the more recent 3 years increased from that of 2008 by more than 23%. Conclusions: Despite a recent remarkable increase in TKA use and differences in demographic features, the causes and risk factors for failures in Korea were similar to those of Western countries. Infection was the most common cause of failure, but loosening has emerged as the most common cause in more recent years, which would prompt us to scrutinize the cause and solution to reduce it. Level of Evidence: Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence. © 2013 The Association of Bone and Joint Surgeons®.


Koh I.J.,Uijeongbu St Marys Hospital | Koh I.J.,Catholic University of Korea | Kwak D.-S.,Catholic University of Korea | Kim T.K.,Seoul National University | And 4 more authors.
Journal of Arthroplasty | Year: 2014

We investigated the quantitative effect and risk factors for over-release during multiple needle puncturing (MNP) for medial gap balancing in varus total knee arthroplasty (TKA). Of the ten pairs of cadaveric knees, one knee from each pair was randomly assigned to undergo MNP in extension (E group), while the other knee underwent MNP in flexion (F group). The increased extension and 90° flexion gaps after every five needle punctures were measured until over-release occurred. The extension gap (< 4. mm) and the 90° flexion gap (< 6. mm) gradually increased in both groups. The 90° flexion gaps increased more selectively than did the extension gaps. MNP in the flexed knee, a narrow MCL, and severe osteoarthritis were associated with a smaller number of MNPs required to over-release. © 2014 Elsevier Inc.


Koh I.J.,Uijeongbu St Marys Hospital | Chang C.B.,Seoul National University | Seo E.S.,National Medical Center | Kim S.J.,Korea University | And 2 more authors.
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2012

Purpose: We aimed to determine the efficacy of periarticular (PA) multimodal drug cocktail (MDC) infiltration for pain control after anterior cruciate ligament reconstruction with an autogenous bone-patellar tendon-bone graft. Methods: We randomly assigned 100 patients to five study groups (20 per group): control group, no injection; intra-articular (IA) ropivacaine group, IA injection of ropivacaine alone; IA MDC group, IA injection of MDC; PA MDC group, PA injection of MDC; and IA + PA MDC group, IA and PA injections of MDC. The MDC consisted of ropivacaine, morphine, ketorolac, epinephrine, and cefuroxime. The five groups were compared in terms of pain levels during the first night after surgery and on postoperative days 1, 2, and 14; patient satisfaction was assessed on postoperative day 14. Results: The PA MDC and IA + PA MDC groups had less pain during the first night than patients in the other three groups (P <.001) and were more likely to have the same amount of pain or less pain on postoperative day 1 than their preoperative expectation (P =.05). However, there were no group differences in patient satisfaction on postoperative day 14. No MDC-related side effect was reported. Conclusions: The MDC injection, particularly when delivered periarticularly, provides an effective, safe means of reducing early postoperative pain after anterior cruciate ligament reconstruction at minimal cost. In addition, a single IA injection would have no value in pain relief, regardless of types of drugs. Level of Evidence: Level I, randomized controlled trial. © 2012 Arthroscopy Association of North America.


Koh I.J.,Uijeongbu St Marys Hospital | Koh I.J.,Catholic University of Korea | Chang C.B.,Seoul National University | Lee J.H.,Seoul National University | And 2 more authors.
Clinical Orthopaedics and Related Research | Year: 2013

Background: Dexamethasone is a potent analgesic and antiemetic. However, the benefit of dexamethasone after TKA is unclear, as is the efficacy in a current multimodal regime. Questions/purposes: We determined (1) whether the addition of dexamethasone to a protocol including ramosetron further reduces postoperative emesis compared with ramosetron alone; (2) whether it reduces postoperative pain; and (3) whether it increases the risk for wound complications in a current multimodal regime after TKA. Methods: We randomized 269 patients undergoing TKAs to receive dexamethasone (10 mg) 1 hour before surgery and ramosetron immediately after surgery (Dexa-Ra group, n = 135), or ramosetron alone (Ra group, n = 134). We recorded the incidence of postoperative nausea and vomiting (PONV), severity of nausea, incidence of antiemetic requirement, complete response, pain level, and opioid consumption. Patients were assessed 0 to 6, 6 to 24, 24 to 48, and 48 to 72 hours postoperatively. In addition, patients were evaluated for wound complications and periprosthetic joint infections at a minimum of 1 year after surgery. Results: The Dexa-Ra group had a lower incidence of PONV during the entire 72-hour evaluation period and experienced less severe nausea for the first 6 hours after TKA, although not between 6 to 72 hours. Overall use of a rescue antiemetic was less frequent, and complete response was more frequent in the Dexa-Ra group. Patients in the Dexa-Ra group experienced lower pain and consumed less opioids during the 6- to 24-hour period and during the overall study period. No differences were found in wound complications between the groups, and each group had one case of periprosthetic joint infection. Conclusions: Patients who received prophylactic dexamethasone in addition to ramosetron had reduced postoperative emesis and pain without increased risks for wound complications, compared with patients who received ramosetron alone in patients managed using a multimodal regimen after TKA. Level of Evidence: Level I, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. © 2013 The Association of Bone and Joint Surgeons®.


Koh I.J.,Uijeongbu St Marys Hospital | Koh I.J.,Catholic University of Korea | Kim T.K.,Seoul National University | Chang C.B.,Seoul National University | And 2 more authors.
Clinical Orthopaedics and Related Research | Year: 2013

Background: The use of total knee arthroplasty (TKA) has increased substantially in most Western countries. However, the trends in TKA use and changes in demographic characteristics of patients having TKA in Korea remain unclear. Questions/purposes: We documented the trends in TKA use and in the demographics of patients undergoing TKA in Korea over the past decade and determined whether current TKA use in Korea corresponds to worldwide trends. Methods: Using the Health Insurance Review and Assessment Service of Korea database, we analyzed TKA records (n = 398,218) from 2001 to 2010 in Korea. Trends in TKA use and demographics, including numbers and rates of primary and revision TKA, growth rate and the revision burden, and age- and sex-specific rates, were estimated. They were compared with nationwide TKA registry reports from other countries, and a systematic review was performed. Results: Over the past decade, the primary and revision TKA rates increased by 407% and 267%, respectively. However, the revision burden remained 2%. The highest proportion was observed in 65 to 74 years old and the greatest increase in 75 to 84 years old, but a decrease was observed in those 55 to 64 years old. Women consistently had a ninefold higher TKA rate. The primary TKA rate was comparable with that of other countries, but the revision burden remained lower. In addition, old and female patients comprised considerably higher proportions in Korea. Conclusions: During the past decade, TKA use in Korea has markedly increased and caught up with the use levels of most developed Western countries. Trends toward consistent growth in elderly patients and higher rates in females were observed. Appropriate healthcare strategies reflecting these trends in demographics are urgently needed in Korea. © 2012 The Association of Bone and Joint Surgeons®.


Kim T.K.,Seoul National University | Chang C.B.,Seoul National University | Koh I.J.,Uijeongbu St Marys Hospital
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2014

Purpose: This systematic review was undertaken to answer three specific questions relating to the clinical values of tranexamic acid (TNA) in total knee arthroplasty (TKA): (1) Whether there are differences in blood-saving effects between the systemic and topical administrations; (2) Whether blood-saving effects of TNA differ by doses and timings of administration; and (3) Whether the use of TNA is safe at all reported doses, timings, and routes of administration with respect to the incidences of symptomatic deep-vein thrombosis (DVT) and pulmonary embolism (PE). Methods: A systematic review was carried out with 28 randomised controlled trials to evaluate the efficacy and safety of TNA use in TKA identified from the literature. Results: Both systemic and topical administrations reduced blood loss after TKA, but transfusion reducing effects varied in studies whether systemic or topical administrations. The effects of TNA were influenced by doses and timings of administration. No increased incidences of symptomatic DVT and PE were found for all reported doses, timings, and routes of TNA administration. Conclusion: Surgeons can consider incorporating the use of TNA to their blood-saving protocols in TKA without serious concern of adverse events but need to adopt optimal doses, timings, and routes of TNA administrations. Level of evidence: Systematic review of randomised controlled trials, Level I. © 2013 Springer-Verlag Berlin Heidelberg.


Oh J.S.,Uijeongbu St Marys Hospital | Kim K.W.,Uijeongbu St Marys Hospital | Cho H.J.,Uijeongbu St Marys Hospital
Journal of the Korean Surgical Society | Year: 2012

Situs inversus totalis is a rare inherent disease in which the thoracic and abdominal organs are transposed. Symptoms of appendicitis in situs inversus (SI) may appear in the left lower quadrant, and the diagnosis of appendicitis is very difficult. We report a case of left-sided appendicitis diagnosed preoperatively after dextrocardia that was detected by chest X-ray, although the chief complaint of the patient was left lower-quadrant pain. The patient underwent an emergent laparoscopic appendectomy under the diagnosis of appendicitis after abdominal computed tomography (CT). In patients with left lower quadrant pain, if the chest X-ray shows dextrocardia, one should suspect left-sided appendicitis. A strong suspicion of appendicitis and an emergency laparoscopic operation after confirmation of the diagnosis by imaging modalities including abdominal CT or sonography can reduce the likelihood of misdiagnosis and complications including perforation and abscess. Laparoscopic appendectomy in SI was technically more challenging because of the mirror nature of the anatomy. © 2012, the Korean Surgical Society.


Kim S.H.,Catholic University of Korea | Choi S.P.,Catholic University of Korea | Park K.N.,Catholic University of Korea | Youn C.S.,Catholic University of Korea | And 3 more authors.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Year: 2013

Background: This study evaluated the association between the results of immediate brain computed tomography (CT) scans and outcome in patients who were treated with therapeutic hypothermia after cardiac arrest. The evaluation was based on the changes in the ratio of gray matter to white matter.Methods: A total of 167 patients who were successfully resuscitated after cardiac arrest from March 2009 to December 2011 were included in this study. We selected 51 patients who received a brain CT scan within 1 hour after the return of spontaneous circulation (ROSC) and who had been treated with therapeutic hypothermia. Circular regions of measurement (10 mm2) were placed over regions of interest (ROIs), and the average attenuations in gray matter (GM) and white matter (WM) were recorded in the basal ganglia, at the level of the centrum semiovale and in the high convexity area. Three GM-to-WM ratios (GWRs) were calculated: one for the basal ganglia, one for the cerebrum and the average of the two. The neurological outcomes were assessed using the Cerebral Performance Category (CPC) scale at the time of hospital discharge, and a good neurological outcome was defined as a CPC score of 1 or 2.Results: The average GWR was the strongest predictor of poor neurological outcome as determined using receiver operating characteristic curves (basal ganglia area under the curve (AUC) = 0.716; cerebrum AUC = 0.685; average AUC = 0.747). An average GWR < 1.14 predicted a poor neurological outcome with a sensitivity of 13.3% (95% confidence interval (CI) 3.8-30.7), a specificity of 100% (95% CI 83.9-100), a positive predictive value of 100% (95% CI 2.5-100), and a negative predictive value of 44.7% (CI 28.9-58.9).Conclusions: Our study demonstrated that low GWRs in the immediate brain CT scans of patients treated with therapeutic hypothermia after ROSC were associated with poor neurological outcomes. Immediate brain CT scans could help predict outcome after cardiac arrest. © 2013 Kim et al.; licensee BioMed Central Ltd.


Lee J.,Catholic University of Korea | Cho S.-G.,Seoul St Marys Hospital | Chung S.-M.,Catholic University of Korea | Ryu M.R.,Uijeongbu St Marys Hospital | And 3 more authors.
Annals of Hematology | Year: 2013

Extranodal natural killer/T-cell lymphoma (ENKL) is a very aggressive disease frequently involving the nasal cavity and upper aerodigestive tract. We retrospectively reviewed the treatment outcomes and treatment-associated complications of the patients with stage I-II early localized ENKL. A total of 24 patients were included. All patients were treated with combined chemoradiotherapy. Three, sixteen, and five patients were initially treated with radiation therapy, chemotherapy, and surgical procedures, respectively. Nine patients underwent hematopoietic stem cell transplantation (HSCT), and four patients administered immunotherapy with pegylated-interferon alpha. The mean observation time was 71.6 months (range, 29.7-183.6 months). Twenty patients achieved complete remission; thus, the overall response rate was 83.3 %. The 5-year overall survival (OS) and relapse-free survival (RFS) rates were 70.3 % and 62.2 %, respectively. In univariate analysis, HSCT was a significant prognostic indicator for OS and RFS. By combining HSCT, the 5-year OS and RFS rates were 100.0 % vs. 52.5 % (p = 0.018) and 88.9 % vs. 45.7 % (p = 0.045), respectively. Also, absence of B symptoms was a good prognostic factor for RFS, the 5-year RFS rate, 75.0 % vs. 25.0 % (p = 0.010), and B symptoms were significant for RFS in multivariate analysis (odds ratio = 7.4, confidence interval = 1.6~34.1, p = 0.011). However, a total of four cases of grade 3 toxicities were reported. Radiation dose range (≤4,500 vs. >4,500 cGy) was significantly correlated with late complications, as more severe complications occurred more frequently with a radiation dose >4,500 cGy (p = 0.026, in multivariate analysis). For more efficient treatment of ENKL, chemotherapy, HSCT, and/or immunotherapy can be combined with radiation therapy to prolong long-term survival and achieve good local control. Also, lower radiation dose could be administered to avoid severe late complications. © 2012 Springer-Verlag Berlin Heidelberg.

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