BACKGROUND: The purpose of this study is to compare the efficacy and safety of multisession radiosurgery to those of single dose radiosurgery for metastatic brain tumors. METHODS: Between February 2008 and February 2012, 90 patients with 196 metastatic brain tumors were treated with cyberknife radiosurgery, and we reviewed these patients retrospectively. Among them, 57 patients underwent single dose radiosurgery, and 33 patients multisession radiosurgery. Tumors involving the eloquent area and large tumors (>5 cc) were treated with multisession radiosurgery. The median tumor volume and the median treatment dose of single dose radiosurgery were 2.05+/-0.72 cc and 19.76+/-1.54 Gy respectively, and in the case of multisession radiosurgery, 5.30+/-1.70 cc and 29.6+/-1.70 Gy respectively. The frequency of multisession dose was 3 to 5 times, on average 3.55 times, and 8.91 Gy were given per 1 session on average. RESULTS: The overall survival (OS) of multisession radiosurgery was 16.0 months, whereas that of single dose radiosurgery was 11.5 months. The radiologic tumor response rates were 90% in single dose radiosurgery and 95.4% in multisession radiosurgery, respectively. Over 6-month and 1-year periods, the OS rates of single dose radiosurgery were 71.4% and 44.9%, whereas those of multisession radiosurgery were 69.1% and 58.3%, respectively (p=0.83). Toxicities were seen in 18.1% in the single dose radiosurgery group versus 4% in the multisession radiosurgery group. The difference was significant (p<0.05). CONCLUSION: In this study, the multisession radiosurgery group, despite the location and size constraints, did not differ from the single dose radiosurgery group when comparing the survival and recurrence rates, but complications and toxicity were lower. Thus, multisession radiosurgery is thought to be beneficial for treatment of large tumors and tumors located in the eloquent area.
Brain Neoplasms* ; Brain* ; Humans ; Radiosurgery* ; Recurrence ; Retrospective Studies ; Tumor Burden

PURPOSE: To evaluate the clinical result of the Wolter plate fixation for the acromioclavicular joint dislocation and the necessity of coracoclavicular ligament repair with the operation. MATERIALS AND METHODS: Twenty three patients operated between January 2003 to September 2005 with over 6 months of follow-up period were studied. The Constant-Murley scoring system was administered on 6 months postoperatively and stress films were taken for the surveillance of acromioclavicular joint and coracoclavicular distance after plate removal. All patients were classified into two groups in that coracoclavicular ligament was repaired (10 cases) or not (13 cases) and the clinical indices described above were compared. RESULTS: With the Wolter plate fixation for the acromioclavicular joint dislocations, 20 cases of Constant-Murley scores were more than 'good' except complicated 3 cases. The scores of the repaired group were 7 cases of excellent, 2 cases of good and 1 case of moderate to poor, and that of not-repaired group were 6 cases, 5 cases and 2 cases respectively. With mean coracoclavicular interspace on x-ray at postoperative 6 months, repaired group showed residual 9% of displacement from initial 194% but not-repaired group showed 28% from initial 188%. There's no statistically significant difference in clinical scores between two group (p=0.072) and neither was residual coracoclavicular interspace displacement (p=0.067). CONCLUSION: Short term follow-up of Wolter plate fixation for the acromioclavicular dislocation showed acceptable clinical results and there was no statistically significant difference between two groups of repaired coracoclavicular ligaments and not repaired.
Acromioclavicular Joint* ; Dislocations* ; Follow-Up Studies ; Humans ; Ligaments*

PURPOSE: To assess the suitability of the Korean KOOS (Knee injury and osteoarthritis outcome score) as a patient-centered clinical measurement of the validity, reliability and responsiveness to the treatment of knee injuries. MATERIALS AND METHODS: One hundred and eight patients who had experienced an arthroscopic ACL reconstruction or a menisectomy between Jan. 2002 and Jun. 2003 were examined immediately after surgery, and 6 and 12 months after surgery. The SF-36 and Lysholm knee scale were administered simultaneously to each case in order to calculate the inter-item correlation. RESULTS: Measurements of the test-retest reliability showed that all intra-class coefficients (ICC) were measured as r=0.75-0.89 and Cronbach's alpha was 0.73-0.81. Regarding the validity, there was a strong correlation with the SF-36 and the Lysholm, subscales (SF-36 vs KOOS: Physical functioning vs ADL (r=0.67)/Physical functioning vs Sports and recreational activities (r=0.61)/Bodily pain vs Pain (r=0.63)). In terms of the responsiveness, the average score measured preoperatively, and three, six and nine months showed a gradual increase. The effect size of pain, symptoms and ADL at postoperative 6 months was 0.8-1.1. A larger effect size was observed in the QOL (1.5) and sports and recreational function (1.3) at 3 months after surgery (n=25). CONCLUSION: The validity, reliability and responsiveness of the Korean KOOS was confirmed and is considered to be a useful clinical metrology for a knee injury.
Activities of Daily Living ; Humans ; Knee Injuries* ; Knee* ; Osteoarthritis* ; Sports

PURPOSE: To compare the effectiveness of a trochanter stabilizing plate with a dynamic hip screw, with using a dynamic hip screw only in the treatment of an unstable intertrochanteric fracture of elderly patients. MATERIALS AND METHODS: From January 2000 to December 2004, 70 patients, who were treated surgically for unstable intertrochanteric fractures, were evaluated. The patient s age were above 65 years and the T-score <-3.0 and they were followed up for more than 6 months. The patient were divided into two groups. One group was treated with DHS only (Group 1, 38 cases), and the other was treated with DHS and TSP (Group 2, 32 cases). The two groups were compared clinically and radiologically. RESULTS: There was no difference in the prevalence of lag screw sliding. However, there were significant differences in the extent of sliding between the two groups, (an average of 8.8 mm p<0.05). There was a significant difference between two groups in the extent of lateralization of the great trochanter, (An average of 6.0 mm p<0.05). However, there was no difference in the leg length between two groups (p>0.05), but the postoperative functional loss of the hip joint was significantly lower in the group 2 (p<0.05), who required additional surgery due to reduction loss or metal failure. CONCLUSION: Although it is a relatively simple technique, the use of DHS with TSP is more effective for the buttress effect on proximal fragment and additional fixation of great trochanter than just DHS only. It decreases the excessive slippage of the lag screw, lateral displacement of the greater trochanter and postoperative functional loss of the hip joint. Therefore, it may be a useful treatment for unstable or comminuted intertrochanteric fractures in elderly patients with osteoporosis.
Aged ; Femur* ; Hip Fractures* ; Hip Joint ; Hip* ; Humans ; Leg ; Osteoporosis ; Prevalence

PURPOSE: The purpose of this study is to elucidate the clinical feature of the hasbitual patella dislocation in the skeletally immature patients and evaluate the result of modified Galeazzi procedure. MATERIAL AND METHODS: From Aug, 1997 to Jan, 2002 we operated 9 knees in 7 patients. Mean age at surgery was 13.3 years. There were 3 males with 3 knees and 4 females with 6 knees. The lateral retinaculum was released and the medial retinaculum was reefed. Patella was tenodesed with semitenidinosus tendon. The operated knees were immobilized with plaster of cast for 3 weeks and progressive range of motion exercise with hinged brace was permitted. RESULTS: Based on the clinical and radiological evaluation, there were improved results. Especially congruence angle was decreased from preoperative +72 degrees to postoperative +20 degrees. There was 1 recurrence that had increased femoral anteversion and 1 arthrofibrosis that had past history of ipsilateral thigh infection. CONCLUSION: Satisfactory clinical results were obtained with modified Galeazzi procedure for treatment of habitual patella dislocation in skeletally immature patient.
Braces ; Dislocations* ; Female ; Humans ; Knee ; Male ; Patella* ; Range of Motion, Articular ; Recurrence ; Tendons ; Thigh

Type 1 Neurofibromatosis(von Recklinghausen's disease) characterized by cafe-au-lait spot and multiple skin nodules, may involve any part of the body. The incidence of multiple spinal neurofibromas is about 15% of all spinal neurofibromas and the majority of them are located in cauda equina. However, thoracic spine is uncommon site of multiple spinal neurofibrmas in type 1 neurofibromatosis. The authors describe a case of bilateral large neurofibromas of the thoracic spine associated with type 1 neurofibromatosis in a 27-year-old man.
Adult ; Cafe-au-Lait Spots ; Cauda Equina ; Humans ; Incidence ; Neurofibroma ; Neurofibromatoses* ; Neurofibromatosis 1 ; Skin ; Spine

PURPOSE: To evaluate prospectively the results of interventional radiologic placement of tunneled centralve-nous catheters, and subsequent complications. MATERIALS AND METHODS: Between April 1997 and April 1998, a totalof 557 tunneled central venous catheters were percutaneously placed in 517 consecutive patients in aninterventional radiology suite. The indications were chemotherapy in 533 cases, total parenteral nutrition in 23and transfusion in one. Complications were e-valuated prospectively by means of a chart review, chest radiography,central vein angiography and blood/catheter culture. RESULTS: The technical success rate for tunneled centralvenous catheter placement was 100% (557/557 cases). The duration of catheter placement ranged from 4 to 356 (mean,112 +/-4.6) days; Hickman catheters were re-moved in 252 cases during follow-up. Early complications included 3cases of pneumothorax(0.5%), 4 cases of local bleeding/hematoma(0.7%), 2 cases of primary malposition(0.4%), and 1case of catheter leakage(0.2%). Late complications included 42 cases of catheter-related infection(7.5%), 40 casesof venous thrombosis (7.2%), 18 cases of migration (3.2%), 5 cases of catheter / pericatheter of occlusion(0.8%),and 1 case of pseudoa-neurysm(0.2%) . The infection rate and thrombosis rate per 1000 days were 1.57 and 1.50,respectively. CONCLUSIONS: The technical success rate of interventional radiologic placement of tunneled centralvenous catheters was high. In comparison to conventional surgical placement , it is a more reliable method andleads to fewer complications.
Angiography ; Catheters ; Central Venous Catheters* ; Drug Therapy ; Follow-Up Studies ; Humans ; Parenteral Nutrition, Total ; Prospective Studies ; Thorax ; Thrombosis ; Veins ; Venous Thrombosis

BACKGROUND: Onychomycosis, especially toenail onychomycosis has become one of the common fungal infection and has historically been regarded as a cosmetic rather than medical problem by many patients, even by physicians. Recently, however, there are several reports that this is a refractory disease which may cause a deleterious effect on patients' quality of life (QOL). OBJECTIVE: The purpose of this study was to investigate the impact of toenail onychomycosis on QOL in Korea and to assess the changes of QOL after treatment. METHODS: Total 1004 patients with toenail onychomycosis which was confirmed by clinical findings and KOH preparation were enrolled at 47 dermatologic centers in Korea, and interviewed with standardized QOL questionnaire before and after systemic antifungal treatment. Responses to the questionnaire were scored by f-point scale (0~4) and averaged, and were analyzed for 5 dimensions of emotional impact, social impact, symptom and functional impact, patients' views concerning treatment, and relationship with doctor. RESULTS: 1. Before and after treatment, the most serious impact was emotional dimension showing 1.90 and 1.30 in average score (AS), and social (AS: 1.14 and 0.83) and symptom and functional impact (AS: 1.05 and 0.92) was also affected. 2. In female rather than male, statistically more significant impact on patients' QOL was observed in all dimensions. 3. After treatment, 3 of 5 dimensions were improved significantly - emotional dimension (AS: from 1.90 to 1.30), social dimension (AS: from 1.14 to 0.83), patients' view concerning treatment(AS: from 1.34 to 1.02) 4. The degree of patients' satisfaction at the therapeutic effect was very high - 62.4% (immediately after. treatment) and 65.8% (9 months after initiation of treatment) of patients answered excellent or good. CONCLUSION: This study confirms that toenail onychomycosis has significant Impact on the overall QOL of patients. Also the effect of antifungal therapy on patients' QOL were satisfactory. Therefore, both doctor and patient should pay more attention to the treatment of onychomycosis.
Female ; Humans ; Korea* ; Male ; Nails* ; Onychomycosis* ; Quality of Life* ; Social Change ; Surveys and Questionnaires

Pseudomyxoma peritonei is a benign mucin producing tumor of the peritoneum which is usually diagnosed using a laparotomy. It is uncommon to find a case of pseudomyxoma peritonei which has been diagnosed using a peritoneoscopy in Korea; there are only two cases reported in the literature. We recently experienced a case of pseudomyxoma peritonei in a 61 year old woman who manifested a typical case using a peritoneoscopy. Thick, jelly-like materials were adherent to polypoid nodular masses of the parietal peritoneum, which originated from the mucinous cystadenocarcinoma of an ovary. In this report we discuss the case with relevant review of the literature.
Cystadenocarcinoma, Mucinous ; Female ; Humans ; Korea ; Laparoscopes ; Laparoscopy ; Laparotomy ; Middle Aged ; Mucins ; Ovary ; Peritoneum ; Pseudomyxoma Peritonei*

The employment of segmental pedicle screw instrumentation has greatly enhanced the correction of scoliotic deformity. However there is still much controversy on the ability of the system to correct the rotational deformity. This prospective study with 12 idiopathic throacic scoliosis patients subjected to segmental pedicle screw instrumentation was performed to determine the effect of the system on the rotational deformity of idiopathic throacic scoliosis. In addition to the standing films to measure the magnitude of scoliotic curvatures, preand postoperative CT were utilized for the measurement and comparison of angle of rotation relative to the sagittal plane(RAsag.), relative rotation with reference to the upper and lower end vertebrae(RAend), relative rotation with reference to the sacrum(RAsac.), frontal translation(TF) and sagittal translation(TS) for the apical vertebrae. Despite the high correction rate obtained in the frontal plane(average 71.1%) and normalization of sagittal contour, the rotational corrections were statistically insignificant in all parameters and showed no significant correlation to the correction of the curvatures nor horizontal plane displacement as represented by the frontal and sagittal displacement. In conclusions, the segmental pedicle screw instrumentation with rod derotation does not produce significant derotation by itself.
Congenital Abnormalities ; Employment ; Humans ; Prospective Studies ; Scoliosis* ; Spine