Long-Term Follow-Up Results of Anterior Cervical Inter-Body Fusion with Stand-Alone Cages

Kim, Woong-Beom,Hyun, Seung-Jae,Choi, Hoyong,Kim, Ki-Jeong,Jahng, Tae-Ahn,Kim, Hyun-Jib The Korean Neurosurgical Society 2016 Journal of Korean neurosurgical society Vol.59 No.4

Objective : The purpose of this study was to evaluate long-term follow-up radiologic/clinical outcomes of patients who underwent anterior cervical discectomy and inter-body fusion (ACDF) with stand-alone cages (SAC) in a single academic institution. Methods : Total 99 patients who underwent ACDF with SAC between February 2004 and December 2012 were evaluated retrospectively. A total of 131 segments were enrolled in this study. Basic demographic information, radiographic [segmental subsidence rate, fusion rate, C2-7 global angle, and segmental angle changes)/clinical outcomes (by Odom's criteria and visual analog score (VAS)] and complications were evaluated to determine the long-term outcomes. Results : The majority were males (55 vs. 44) with average age of 53.2. Mean follow-up period was 62.9 months. The segmental subsidence rate was 53.4% and fusion rate was 73.3%. In the subsidence group, anterior intervertebral height (AIH) had more tendency of subsiding than middle or posterior intervertebral height (p=0.01). The segmental angle led kyphotic change related to the subsidence of the AIH. Adjacent segmental disease was occurred in 18 (18.2%) patients. Total 6 (6%) reoperations were performed at the index level. There was no statistical significance between clinical and radiological outcomes. But, overall long-term clinical outcome by Odom's criteria was unsatisfactory (64.64%). The neck and arm VAS score were increased by over time. Conclusion : Long-term outcomes of ACDF with SAC group were acceptable but not satisfactory. For optimal decision making, more additional comparative long-term outcome data is needed between ACDF with SAC and ACDF with plating.

복강경 전복막외 서혜부 탈장 수술의 장기 성적

최요한,설지영 대한내시경복강경외과학회 2012 Journal of Minimally Invasive Surgery Vol.15 No.4

Purpose: Laparoscopic inguinal herniorrhaphy, especially laparoscopic TEP repair, has become a standard method of inguinal herniorrhaphy. Favorable short-term results of laparoscopic inguinal hernia repair, compared with open surgery,have been reported, however, data on the long-term outcome are limited. Based now on more than 55 months of follow-up,we report here on the long-term results for patients who underwent laparoscopic TEP inguinal hernia repair. Methods: Between January 2002 and December 2007, of patients who underwent laparoscopic TEP repair for an inguinal hernia by a single surgeon, 180 patients who have had a follow-up check with a physical examination or telephone interview were enrolled. Results: A total of 196 TEP procedures in 180 patients (age range 15∼88 years; men, 88.3%) were performed successfully without conversion to transabdominal preperitoneal (TAPP) or open surgery. During the follow-up period of more than 55 months (55∼120 months), chronic inguinal discomfort or pain was noted in 14 patients (n=14, 7.7% per patient or 7.1% per repair) and the severity of pain was mild (n=11),moderate (n=2), or severe (n=1). In most patients, occurrence of groin pain was very infrequent and the duration of the pain varied from a few seconds to a few minutes. There was one suspicious recurrence (0.5%), which was comparable to that of open surgery. Four cases of mesh infection (2.03%)were noted. Chronic mesh infection may be more frequent than previously reported. Otherwise, most of the patients were satisfied with their results. Conclusion: According to the long-term results of the study,laparoscopic TEP is a safe procedure for repair of inguinal hernia, with a low incidence of chronic pain and very low recurrence rate. However, among mesh-related complications,mesh infections have become increasingly important. For clinicians the possibility of mesh infection should be promptly considered in any patient who has undergone hernia surgery involving mesh, and who has any manifestations of abdominal wall.

성인 미세 변화형 신증후군 환자의 장기 추적 성적

장국진 ( Kuk Jin Chang ),박성배 ( Sung Bae Park ),김현철 ( Hyun Chul Kim ) 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.2

배경 : 미세 변화형 신증후군은 성인 신증후군의 20-30%를 차지하며 스테로이드 치료에 반응이 매우 우수하고 신부전으로 진행하지 않는다. 우리나라 성인에서는 미세 변화형 신증후군에 대한 평가가 적을 뿐만 아니라 장기 추적 관찰을 분석한 성적은 거의 드문 실정이다. 방법 : 1978년 12월부터 2002년 5월까지 계명대학교 동산의료원 내과에서 신생검을 통해 성인 미세 변화형 신증후군으로 진단된 355예의 환자들 가운데 2년 이상 장기적으로 추적 관찰했던 145예에 대해서 임상적 특징, 치료 반응 및 경과에 대해 후향적인 분석을 실시하였다. 결과 : 2년 이상 추적 관찰이 가능했던 145예 가운데 조기 재발군 47.6%, 후기 재발군 37.2%, 2년 이상 관해를 유지한 군 15.2%였고, 조기 재발군에 비해 후기 재발군에서 평균 발병 연령이 낮고, 재발이 흔하며, 재발시 평균 스테로이드 사용 기간이 짧았으며 관해 유지 기간도 유의하게 짧았다 (p<0.05). 이차 면역억제 약제 및 Cs A로 치료받았던 45예의 적응증은 스테로이드 의존형이 42%, 빈번 재발자 28.8%, 스테로이드 부작용 17.8%, 빈번하지 않은 재발이 4.5%, 스테로이드 저항형 4.5%, 이차성 스테로이드 저항형 2.2% 순이었다. 이 가운데 Cs A 단독 요법을 실시한 29예의 치료 결과는 완전 관해 79.3%, 부분 관해 13.8%, Cs A 저항형 6.9% 순이었고, 완전 관해군에서 Cs A의 사용 기간이 짧고, 혈중 농도가 낮으며, 평균 관해 유지 기간도 유의하게 길었다 (p<0.05). 2년 이상 추적 관찰이 가능했던 145예의 최종 임상 양상은 지속적 관해가 39.3%, 빈번하지 않은 재발이 33.8%로 대부분을 차지하였으며, 그 외 Cs A 의존형 13.2%, 스테로이드 의존형 11.0%, 사망 1.3%, 신부전 0.7% 순이었다. 5년 동안 추적 관찰 시 스테로이드 반응도의 경시적 변화는 지속적 관해는 감소하는 경향을, 추적 관찰 2년 이후 빈번하지 않은 재발이 급격히 증가하는 양상을 보였으며, 이러한 증가의 대부분은 스테로이드 의존형 및 빈번한 재발의 감소에 기인하였다. 결론 : 이상의 결과로 성인 미세 변화형 신증후군은 신부전으로의 진행이 매우 낮은 양성 신질환임을 확인할 수 있었고 향후 부작용이 적고 관해 상태를 장기간 유지할 수 있는 새로운 치료 요법에 대한 전향적 연구가 필요할 것으로 생각된다. Background : Audlt-onstet minimal change nephrotic syndrome has been associated with a good response to corticosteroids and a benign prognosis. However, there are few longterm outcome data reported. Methods : A series of 355 patients with adult-onset minimal change nephrotic syndrome (MCNS) who were admitted to Keimyung University Dongsan Medical Center from December 1978 to May 2002, was retrospectively analyzed to evaluate the initial response to corticosteroids, subsequent response to cytotoxic agents, the stability of remission, and long-term follwo-up outcome. Results : Of the 145 patients who followed up greater than two years, 69 patients (47.6%) showed early relapse, late relapser in 54 patienst (37.2%), and no relapse in 22 patients (15.2%). Early relapsers showed younger age at onste, more frequent relapse, and longer duration of total corticosteroid treatment and shorter duration of corticosteroid used duration at relapse. Alkylating agents or cyclosporine were administered to 45 patients (19 steroid dependent, 13 frequent relapses, 8 steroid side effect, 2 infrequent relapses, 3 steroid resistant), 36 patients achieved complete remission, five in partial remission, and four in no response at all. Among 29 patients who were treated with cyclosporine, 23 patients showed complete remission, 4 achieved partial remission, and 2 showed no response. Final outcome of 145 patients who were followed for at least more than 2 years, were cyclosporine A dependent in 19 (13.2%) patients. steroid dependent in 16 (11.0%), persistent remission in 57 (39.3%), infrequent relapse in 49 (33.8%), death 2 (1.3%), renal failure 1 (0.7%), and no response to any therapy in 1 (0.7%). Conclusion : Adult-onset minimal change nephrotic syndrome shows favorable response to corticosteroid therapy with good long-term outcome and rarely progress to end-stage renal failure. However, new treatment regimens to minimize drug-related side effects and to maintain longer remission period should be evaluated prospectively.

Long-term neurological cognitive, behavioral, functional, and quality of life outcomes after fetal myelomeningocele closure: a systematic review

Siahaan Andre Marolop Pangihutan,Susanto Martin,Lumbanraja Sarma Nursani,Ritonga Dwi Herawati 대한소아청소년과학회 2023 Clinical and Experimental Pediatrics (CEP) Vol.66 No.1

Background: Myelomeningocele is a lifelong condition that features several comorbidities, such as hydrocephalus, scoliosis, club foot, and lower limb sensory and motor disabilities. Its management has progressed over time, ranging from supportive care to early postnatal closure to prenatal closure of the defect. Recent research discovered that fetal myelomeningocele closure (fMMC) provided superior neurological outcomes to those of postnatal closure. When performed at 12 months of age, fMMC can avert or delay the need for a ventriculoperitoneal shunt and reversed the hindbrain herniation. Moreover, fMMC reportedly enhanced motor function and mental development at 30 months of age. However, its long-term outcomes remain dubious.Purpose: This systematic review aimed to determine the long-term neurological cognitive, behavioral, functional, and quality of life (QoL) outcomes after fMMC.Methods: The PubMed, Directory of Open Access Journals, EBSCO, and Cochrane databases were extensively searched for articles published in 2007–2022. Meta-analyses, clinical trials, and randomized controlled trials with at least 5 years of follow-up were given priority.Results: A total of 11 studies were included. Most studies revealed enhanced long-term cognitive, behavioral, functional, and QoL outcomes after fMMC.Conclusion: Our results suggest that fMMC substantially enhanced patients’ long-term neurological cognitive, behavioral, functional, and QoL outcomes.

Long-Term Outcome of Time-Staged Gamma Knife Radiosurgery for Large Arteriovenous Malformations

Myeong Ho Sung,Jeong Sang Soon,Kim Jung Hoon,Lee Jae Meen,Park Kwang Hyon,Park Kawngwoo,Park Hyun Joo,Park Hye Ran,Yoon Byung Woo,Hahn Seokyung,Lee Eun Jung,Kim Jin Wook,Chung Hyun Tai,Kim Dong Gyu,Pa 대한의학회 2024 Journal of Korean medical science Vol.39 No.29

Background: Treatment for large (> 10 mL) arteriovenous malformations (AVMs) remains highly challenging. This study evaluated long-term effect of time-staged gamma knife radiosurgery (GKS) for large AVMs. Methods: For patients with large AVMs treated by time-staged GKS over 10 years, timestaged GKS was repeated every three years targeting the entire nidus if total obliteration was not achieved. Obliteration rate and post-GKS complications were assessed based on 10 mL volume interval of AVMs. Prognostic factors for these outcomes were evaluated using Cox regression analysis. Results: Ninety-six patients were analyzed. For AVMs in the 10–20 mL subgroup, a dose ≥ 13.5Gy yielded higher obliteration rate in the first GKS. In the 20–30 mL subgroup, a second GKS significantly boosted obliteration. AVMs > 30 mL did not achieve any obliteration with the first GKS. Among 35 (36.4%) cases lost to follow-up, 7 (7.2%) were lost due to GKS complications. Kaplan-Meier analysis showed that each subgroup needed different time for achieving 50% favorable obliteration outcome rate: 3.5, 6.5, and 8.2 years for 10–20 mL, 20–30 mL, and > 30 mL subgroup, respectively. Total obliteration rate calculated by intention-to-treat method: 73%, 51.7%, 35.7%, respectively, 61.5% overall. Post-GKS hemorrhage and chronic encapsulated expanding hematoma (CEEH) occurred in 13.5% and 8.3% of cases, respectively. Two patients died. Dose and volume were significant prognostic factors for obliteration. Initial AVM volume was a significant prognostic factor of post-GKS hemorrhage and CEEH. Conclusion: Time-staged GKS for large AVMs less than 30 mL has highly favorable long-term outcome and a tolerable complication rate.

Mycobacterium abscessus 폐질환 치료의 장기 성적

조경욱 ( Kyung Uk Jo ),박수정 ( Soo Jung Park ),홍석찬 ( Seok Chan Hong ),오연목 ( Yeon Mok Oh ),이상도 ( Sang Do Lee ),김우성 ( Woo Sung Kim ),김동순 ( Dong Soon Kim ),김원동 ( Won Dong Kim ),심태선 ( Tae Sun Shim ) 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.62 No.2

연구배경: M. abscessus 폐질환은 최근 우리나라에서 유병률이 증가하는 질환이다. 국내 M. abscessus 폐감염증에 대한 치료성적 및 치료 후 장기결과에 대해서 알아보고자 의무기록을 후향적으로 분석하였다. 방법: 1996년부터 2003년까지 서울아산병원에서 미국흉부학회진단기준에 부합하는 35명의 M. abscessus 폐질환 환자 중 치료를 받은 29명의 환자를 대상으로 임상적 특징과 치료, 치료 후 추적결과에 대해 분석하였다. 결과: 29명의 평균 나이는 56.1세(± 13.6)였고 여성이 76% 이었으며(22/29), 20명(69%)에서 결절 기관지확장증형이었다. 29명 중 19명(65.5%)에서 치료성공하였고 9명(31%)은 치료실패하였다. 1명은 약물부작용으로 치료를 중단하였다. 치료성공군은 중앙값 543일(범위 176 - 1,160)동안 치료를 받았고, 균배양 음전까지의 기간은 중앙값 42일(범위 15-362)이었다. 수술은 5명에서 시행되었으며 한 엽에만 국한된 병변을 가진 두 환자에서 치료성공하였다. 치료 완료 후 중앙값 931일 (범위 230-2294일)동안 추적관찰이 이루어졌고, 19명 중 1명(5.3%)이 재발하였다. 결론: M. abscessus 폐질환의 세균학적 치료 성적은 외국의 보고에 비하여 우수한 편이며 치료성공 후 재발률은 낮았다. Background: Although there is an increasing incidence of Mycobacterium abscessus pulmonary disease in Korea, the optimal therapeutic regimen has not yet been established and there are no reports of the long-term treatment outcomes. This study examined the long-term treatment outcomes of M. abscessus pulmonary disease. Methods: Twenty-nine patients diagnosed with M. abscessus pulmonary according to the American Thoracic Society criteria and treated from January 1996 to December 2003 were enrolled in ghis study. The clinical characteristics, radiological findings, treatment outcome, and follow up data were analyzed retrospectively. Results: The mean age of the 29 patients was 56.1 (± 13.6) years and there was a female (22/29) dominance. The chest radiography revealed the nodular bronchiectatic type to be dominant (69%, 20/29). Twenty-seven (93.1%) were prescribed clarithromycin-containing regimens, and injectable drugs, mainly aminoglycosides, were included in the regimen of nineteen patients. The most predominant regimen (48.3%) consisted of clarithromycin and amikacin. The treatment success, failure, and default were achieved in 19(65.5%), 9(31.0%), and 1(3.4%), respectively. The median duration to culture conversion was 42 days (range 15-362) and the median duration of treatment in the success group was 543 days (range 176-1,160). An adjunctive surgical resection was performed in five patients, which resulted in treatment success in two patients. After the completion of treatment, nineteen patients were followed up for a median duration of 931 days (range 230-2,294). Only one (5.3%) patient relapsed 45 days after completing treatment. Conclusion: Treatment with clarithromycin-containing regimens resulted in a successful treatment in approximately two thirds of patients with M. abscessus pulmonary disease. The long-term relapse rate was also quite low. (Tuberc Respir Dis 2007; 62: 98-104)

Long-term Follow-up of Patients with Chronic HCV Following Treatment with DAAs: Maintenance of SVR, Persistence of Resistance and Clinical Outcomes

( W. Ray Kim ),( Eric J. Lawitz ),( Peter Ruane ),( Catherine Stedman ),( Graham Foster ),( Robert H. Hyland ),( Sarah Coogan ),( Stephanie Moody ),( Hadas Dvory-sobo ),( Steven J. Knox ),( Diana M. B 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: Significant advances in the treatment of chronic hepatitis C have been made with direct acting antiviral (DAA) regimens. While SVR rates may now be achieved in the majority of patients, data describing long-term virologic and clinical outcomes with these regimens are needed. Methods: We report interim data from two 3-year registry studies capturing long-term outcomes in patients with chronic hepatitis C treated with DAAs. Subjects are enrolled into two registries according to SVR status; SVR (SVR registry) versus non-SVR (Sequence registry). We determined the durability of SVR, relapse and reinfection rates. The persistence of resistance associated variants (RAVs) in treatment failures is followed. Liver disease progression is assessed by periodic clinical & labroratory evaluations. Results: 5433 patients enrolled in the SVR registry with a median (range) follow-up of 71 (0-156) weeks. 536 patients enrolled in the Sequence registry with a median (range) of follow-up of 44 (0-159) weeks. Demographic and disease characteristics are described below. In the SVR registry, at the time of data analysis, 99.7% (5414/5433) of patients have maintained SVR with 0.3% (19/5433) having emergent virus (6 relapses, 8 new infections, 5 to be confirmed). Viral emergence occurred by Week 96 in all patients. In the Sequence registry of 89 patients who received an NS5A inhibitor and had baseline sequencing data, 91.0% (81/89) had NS5A RAVs at Week 96. HCC was reported in 0.3% (16/5433) and 0.9% (5/536) of patients in the SVR and Sequence registries through Week 96 respectively. There were no significant changes in laboratory evaluations or liver disease assessments. Conclusions: SVR achieved following treatment with DAA regimens is durable. In patients failing NS5A-containing regimens, treatment- emergent NS5A RAVs persist. Rates of clinical disease progression and HCC are low. Ongoing reporting from these registry studies will be required to confirm these findings.

Long-term Outcomes of Laparoscopic Surgery for Colorectal Cancer

이정은,조용걸,유상화,정규영,김승한,정춘식,이동근,김선한 대한대장항문학회 2011 Annals of Coloproctolgy Vol.27 No.2

Purpose: The long-term results of a laparoscopic resection for colorectal cancer have been reported in several studies, but reports on the results of laparoscopic surgery for rectal cancer are limited. We investigated the long-term outcomes, including the five-year overall survival, disease-free survival and recurrence rate, after a laparoscopic resection for colorectal cancer. Methods: Using prospectively collected data on 303 patients with colorectal cancer who underwent a laparoscopic resection between January 2001, and December 2003, we analyzed sex, age, stage, complications, hospital stay, mean operation time and blood loss. The overall survival rate, disease-free survival rate and recurrence rate were investigated for 271 patients who could be followed for more than three years. Results: Tumor-node-metastasis (TNM) stage I cancer was present in 55 patients (18.1%), stage II in 116 patients (38.3%),stage III in 110 patients (36.3%), and stage IV in 22 patients (7.3%). The mean operative time was 200 minutes (range, 100to 535 minutes), and the mean blood loss was 97 mL (range, 20 to 1,200 mL). The mean hospital stay was 11 days and the mean follow-up period was 54 months. The mean numbers of resected lymph nodes were 26 and 21 in the colon and the rectum, respectively, and the mean distal margins were 10 and 3 cm. The overall morbidity rate was 26.1%. The local recurrence rates were 2.2% and 4.4% in the colon and the rectum, respectively, and the distant recurrence rates were 7.8% and 22.5%. The five-year overall survival rates were 86.1% in the colon (stage I, 100%; stage II, 97.6%; stage III, 77.5%; stage IV,16.7%) and 68.8% in the rectum (stage I, 90.2%; stage II, 84.0%; stage III, 57.6; stage IV, 13.3%). The five-year disease-free survival rates were 89.8% in the colon (stage I, 100%; stage II, 97.7%; stage III, 74.2%) and 74.5% in the rectum (stage I,90.0%; stage II, 83.9%; stage III, 59.2%). Conclusion: Laparoscopic surgery for colorectal cancer is a good alternative method to open surgery with tolerable oncologic long-term results.

Long-term outcome of ingenol mebutate gel in patients with actinic keratosis

( Young Bin Shin ),( Chang Il Kwon ),( Jeong Won Jo ),( Yun Sun Moon ),( Eui Chang Jung ),( Chi Yeon Kim ),( Tae Jin Yoon ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Actinic keratosis is an ultraviolet light-induced skin lesion. It is represented as ill-defined, multiple erythematous or brownish colored, scaly plaques in chronic sun exposed-areas of old people. The incidence of AK is increasing worldwide and it is accepted as the most frequent pre-malignant lesion in humans such as invasive squamous cell carcinoma. Because of these risk, there has been a need for improved medical approaches to the treatment of actinic keratosis. Ingenol mebutate gel shows a therapeutic effect by necrosis of dysplastic cells through a neutrophil-mediated immune effect. The distinctive advantage of ingenol mebutate gel is its short treatment schedule of two or three applications in consecutive days. It can lead to better adherence to therapy, especially in elderly patients who have poor compliance with long-term treatment. Compared to the frequency of using ingenol mebutate gel, there are a few study of its long-term effect. Therefore, we report a case of long-term outcome for 4 years of ingenol mebutate gel with good therapeutic and maintenance effect in patient with actinic keratosis.

Long-term outcomes of infantile spasms

오석희,이은혜,정민희,염미선,고태성 대한소아청소년과학회 2010 Clinical and Experimental Pediatrics (CEP) Vol.53 No.1

Purpose:The aims of this study were to investigate the long-term outcomes in children with infantile spasms (IS) and to identify the prognostic factors influencing their neurodevelopment. Methods:We retrospectively evaluated seventy two children over five years old who were treated for IS at Asan Medical Center, Seoul, Korea, between 1994 and 2007. Forty-three children were contacted by telephone or medical follow-up to assess their current neurodevelopmental status. Multiple logistic regression was used to calculate odds ratios (ORs) and 95% confidence interval (95% CIs) of risk factors for unfavorable outcomes. Results:The mean follow-up duration for these 43 children was 7.2±1.5 years (range, 4.5 to 13.0 years). Of these, 13 (30.2%) had cryptogenic and 30 (69.8%) had symptomatic IS. Eleven (25.6%) children were initially treated with adrenocorticotrophic hormone (ACTH) therapy, with a mean treatment lag of 1.3±1.9 months (range; 0.1 to 7.0 months). Eighteen (41.8%) children clinically responded to initial treatment, as shown by EEG response. Overall, 22 (51.2%) children had at least moderate neurodevelopmental disorders and 2 (4.8%) died. In univariate analysis, etiology (symptomatic) and poor electroclinical response to initial treatment were related to long-term unfavorable outcomes. In multivariate analysis, response to primary treatment was the sole significant independent risk factor with a high OR. Conclusion:Overall prognosis of children with IS was poor. Electroclinical non-responsiveness to initial treatment was related to unfavorable long-term outcomes, indicating that initial control of seizures may be important in reducing the likelihood of poor neurodevelopment.