Progression of a Fracture Site Impaction as a Prognostic Indicator of Impacted Femoral Neck Fracture Treated with Multiple Pinning

Pil Whan Yoon,Young Ho Shin,유정준,윤강섭,김희중 대한정형외과학회 2012 Clinics in Orthopedic Surgery Vol.4 No.1

Background: We evaluated the clinical and radiologic results of impacted femoral neck fractures treated with multiple pinningand determined the infl uence of the progression of impaction at the fracture site on clinical outcome. Methods: There were 34 patients with a mean age of 65.5 years. The mean follow-up period was 3.4 years. Progression offracture site impaction was measured using an articulo-trochanteric distance index and the percentage decrease in the articulotrochantericdistance index between follow-up intervals. The failure of treatment was clarifi ed as non-union and avascular necrosis. Other characteristics of the patients, including mean waiting time for surgery, preoperative Singh index score, and body massindex, were also measured to evaluate the infl uence on the clinical outcome of surgery. Results: There were 6 fractures which were not treated successfully (3 non-union, 8.8% and 3 avascular necrosis, 8.8%). Themean percentage decrease of the articulo-trochanteric distance index within the fi rst 6 weeks after surgery was 4.5% in the successfulgroup and 25.1% in the failure group (p < 0.001). There was also a signifi cant mean percentage decrease in the articulotrochantericdistance index between 6 weeks and 3 months (p < 0.001). Conclusions: Primary stabilization with Knowles pins for impacted femoral neck fractures had a reasonable clinical outcome withlow morbidity. Despite a signifi cant difference of a mean percentage decrease in the articulo-trochanteric distance index betweenthe successful group and the failure group, we could not verify it as a risk factor for failure of treatment because the odds ratiowas not statistically signifi cant.

Culture-Expanded Autologous Adipose-Derived Mesenchymal Stem Cell Treatment for Osteonecrosis of the Femoral Head

Pil Whan Yoon,Jong Yeal Kang,Chul-Ho Kim,Soong Joon Lee,Jeong Joon Yoo,Hee Joong Kim,Sung Keun Kang,Ju Hyeon Min,윤강섭 대한정형외과학회 2021 Clinics in Orthopedic Surgery Vol.13 No.1

Background: Outcomes of traditional treatment for osteonecrosis of the femoral head (ONFH) are not always satisfactory. Hence, cell-supplementation therapy has been attempted to facilitate necrotic-tissue regeneration. Adipose-derived mesenchymal stem cell (ADMSC) transplantation is potentially advantageous over bone marrow-derived MSC implantation, but its outcomes for ONFH remain unclear. The aim of this study was to determine 2-year radiological and clinical outcomes of culture-expanded autologous ADMSC implantation for ONFH. Methods: Eighteen hips with necrotic lesions involving ≥ 30% of the femoral head were included. ADMSCs were harvested by liposuction and culture expanded for 3 passages over 3 weeks. With a 6-mm single drilling, ADMSCs were implanted into the necrotic zone. All patients underwent magnetic resonance imaging (MRI), single-photon emission computed tomography/computed tomography (SPECT/CT) at screening and 6 months, 12 months, and 24 months postoperatively. The primary outcome was the change in the size of necrotic area on MRI. Secondary outcomes were changes in clinical scores and radioisotope uptake on SPECT/CT. Conversion total hip arthroplasty (THA) was defined as the endpoint. Results: Preoperatively, the necrotic lesion extent was 63.0% (38.4%–96.7%) of the femoral head. The mean Harris hip score was 89.2, the University of California at Los Angeles (UCLA) score was 5.6, and Western Ontario and McMaster Universities Arthritis index (WOMAC) was 79.4. Three patients underwent THA and 1 patient died in an accident. Finally, 11 patients (14 hips) were available for ≥ 2-year follow-up. At the last follow-up, no surgery-related complications occurred, and 14 of 17 hips (82%) were able to perform daily activities without THA requirement. There was no significant decrease in lesion size between any 2 intervals on MRI. However, widening of high signal intensity bands on T2-weighted images inside the necrotic lesion was observed in 9 of 14 hips (64%); 11 of 14 hips (79%) showed increased vascularity on SPECT/CT at 2 years postoperatively. No significant differences were observed between preoperative and 24-month mean Harris hip score (89.2 vs. 88.6), WOMAC (79.4 vs. 75.7), and UCLA score (5.6 vs. 6.2). Conclusions: Our outcomes suggest that culture-expanded ADMSC implantation is a viable option for ONFH treatment without adverse events.

CASE REPORT : Aspergillus Septic Arthritis of the Hip in an Immunocompetent Middle-aged Female with Undiagnosed Recurrent Pulmonary Aspergillosis

( Pil Whan Yoon ),( Joo Ho Song ),( Kang Sup Yoon ),( Jae Suk Chang ),( Hee Joong Kim ),( Kee Hyung Rhyu ) 대한고관절학회 2015 Hip and Pelvis Vol.27 No.3

We present a case of Aspergillus septic hip arthritis in an immunocompetent patient with undiagnosed recurrent pulmonary aspergillosis who underwent arthroscopic surgery. Biopsy specimens of synovium revealed fungal hyphae, confirming Aspergillus infection. Aspergillus septic hip arthritis can occur inimmunocompetent patients, and arthroscopy can be a noninvasive surgical option in these cases.

변형된 측방 접근법으로 시행한 무시멘트형 인공고관절 전치환술에서 알루미나 관절면을 사용한 티타늄 테이퍼형 스템의 최소 5년 추시 결과

윤필환(Pil Whan Yoon),정현장(Hyeon Jang Jeong),이지호(Ji-Ho Lee),강승백(Seung-Baik Kang),이재협(Jae Hyup Lee),조현철(Chris H. Jo),한혁수(Hyuk Soo Han),이승환(Seung Hwan Rhee),김지형(Jihyeung Kim),윤강섭(Kang Sup Yoon) 대한정형외과학회 2012 대한정형외과학회지 Vol.47 No.4

목적: 변형된 측방 접근법으로 시행한 무시멘트형 인공고관절 전치환술에서 알루미나 관절면을 사용한 티타늄 테이퍼형 스템의 최소 5년추시 결과를 평가해 보고자 한다. 대상 및 방법: 단일 병원, 단일 집도의에 의해 인공고관절 전치환술을 시행 받은 102명, 120예를 대상으로 후향적 분석을 시행하였다. 남자가 53명, 여자가 49명이었고, 평균 연령은 54세였으며, 추시 기간은 평균 5.9년이었다. Harris 고관절 점수와 대퇴부 동통 및 파행 유무를 조사하여 임상 결과를 평가하고, 수술 후 시행한 방사선 사진으로 인공관절 삽입물의 고정 상태를 평가하였다. 결과: 평균 Harris 고관절 점수는 수술 전 46점에서 최종 추시 때 94점으로 호전되었다. 2예에서 활동 시 대퇴부 동통을 호소하였고, 4예에서 경도의 파행이 관찰되었다. 최종 추시 방사선 사진상 대퇴 스템은 모든 예에서 안정된 골성 고정이 확인되었다. 합병증으로 수술 후 3예에서 고관절 탈구가 발생하였고, 2예에서 squeaking이 발생하였다. 결론: 저자들의 방법으로 시행한 무시멘트형 인공고관절 전치환술의 최소 5년 이상 추시 결과, 환자의 연령과 근위 대퇴골의 형태와 상관없이 만족스러운 임상 및 방사선학적 결과를 확인할 수 있었다. Purpose: The purpose of the current study is to evaluate the clinical and radiographic outcomes of primary total hip arthroplasty (THA) using a single titanium tapered stem with alumina bearing, which was performed through a modified direct lateral approach. Materials and Methods: One hundred twenty consecutive primary THAs were performed in 102 patients, and retrospectively reviewed. There were 53 men and 49 women of mean age 54 years, and all patients were followed for a minimum follow-up period of 5 years (range, 5-8.1 years). Clinical outcomes assessment consisted of calculation of the Harris hip score (HHS), and evaluation of the presence of thigh pain or limp. Sequential radiographs were evaluated for implant migration, osteolysis, reactive line, cortical hypertrophy, or evidence of component loosening. Results: At the final follow-up, the mean preoperative HHS of 46 points improved to 94 points; and activity-related thigh pain occurred in two hips, and mild limps in four hips. There was no evidence of implant migration, osteolysis, or component loosening. Audible squeaking was present in two hips, without pain and radiographic abnormality. Dislocation occurred in three hips. Conclusion: The minimum 5-year results of titanium tapered stem with alumina bearing in cementless primary THA, using a modified direct lateral approach, were encouraging.

Hip&Pelvis : ORIGINAL ARTICLE : Arthroscopic Treatment for External Snapping Hip

( Jae Youn Yoon ),( Hong Suk Kwak ),( Kang Sup Yoon ),( Jae Suk Chang ),( Pil Whan Yoon ) 대한고관절학회 2014 Hip and Pelvis Vol.26 No.3

Purpose: The purpose of this study was to evaluate the clinical outcome of arthroscopic treatment for recalcitrant external snapping hip. Materials and Methods: Between September 2011 and June 2013, we evaluated 7 patients (10 cases) with snapping hip who were refractory to conservative treatments for at least 3 months. Two patients (4 cases) were impossible to adduct both knees in 90。of hip flexion. Surgery was done in lateral decubitus position, under spinal anesthesia. We made 2 arthroscopic portals to operate the patients, and used cross-cutting with flap resection technique to treat the lesion. We performed additional gluteal sling release in those 2 patients (4 cases) with adduction difficulty. Average follow-up length was 19 months (range, 12-33 months). Clinical improvement was evaluated with visual analog scale (VAS), modified Harris hip score (mHHS), and also investigated for presence of limping or other complications as well. Results: The VAS decreased from 6.8 (range, 6-9) preoperatively to 0.2 (range, 0-2) postoperatively, and the mHHS improved from 68.2 to 94.8 after surgery. None of the patients complained of post-operative wound problem or surgical complications. Conclusion: The clinical outcome of arthroscopic treatment for recalcitrant external snapping hip was encouraging and all patients were also satisfied with the cosmetic results.

The Association of CHADS-P2A2RC Risk Score With Clinical Outcomes in Patients Taking P2Y12 Inhibitor Monotherapy After 3 Months of Dual Antiplatelet Therapy Following Percutaneous Coronary Intervention

Pil Sang Song,Seok-Woo Seong,Ji-Yeon Kim,Soo Yeon An,Mi Joo Kim,Kye Taek Ahn,Seon-Ah Jin,Jin-Ok Jeong,Jeong Hoon Yang,Joo-Yong Hahn,Hyeon-Cheol Gwon,Woo Jin Jang,Hyuck Jun Yoon,Jang-Whan Bae,Woong Gil 대한심장학회 2024 Korean Circulation Journal Vol.54 No.4

Background and Objectives: Concerns remain that early aspirin cessation may be associated with potential harm in subsets at high risk of ischemic events. This study aimed to assess the effects of P2Y12 inhibitor monotherapy after 3-month dual antiplatelet therapy (DAPT) vs. prolonged DAPT (12-month or longer) based on the ischemic risk stratification, the CHADS-P2A2RC, after percutaneous coronary intervention (PCI). Methods: This was a sub-study of the SMART-CHOICE trial. The effect of the randomized antiplatelet strategies was assessed across 3 CHADS-P2A2RC risk score categories. The primary outcome was a major adverse cardiac and cerebral event (MACCE), a composite of all-cause death, myocardial infarction, or stroke. Results: Up to 3 years, the high CHADS-P2A2RC risk score group had the highest incidence of MACCE (105 [12.1%], adjusted hazard ratio [HR], 2.927; 95% confidence interval [CI], 1.358–6.309; p=0.006) followed by moderate-risk (40 [1.4%], adjusted HR, 1.786; 95% CI, 0.868–3.674; p=0.115) and low-risk (9 [0.5%], reference). In secondary analyses, P2Y12 inhibitor monotherapy reduced the Bleeding Academic Research Consortium (BARC) types 2, 3, or 5 bleeding without increasing the risk of MACCE as compared with prolonged DAPT across the 3 CHADS-P2A2RC risk strata without significant interaction term (interaction p for MACCE=0.705 and interaction p for BARC types 2, 3, or 5 bleeding=0.055). Conclusions: The CHADS-P2A2RC risk score is valuable in discriminating high-ischemic-risk patients. Even in such patients with a high risk of ischemic events, P2Y12 inhibitor monotherapy was associated with a lower incidence of bleeding without increased risk of ischemic events compared with prolonged DAPT.

Purification and Characterization of Protein Carboxyl O-Methyltransferase from Porcine Spleen

Yoon, Sung-Pil,Son, Min-Sik,Han, Jeung-Whan,Lee, Hyang-Woo,Hong, Sung-Youl Korean Society for Biochemistry and Molecular Biol 1997 Journal of biochemistry and molecular biology Vol.30 No.6

We purified a protein carboxyl O-methyltransferase (protein methylase II) from porcine spleen to homogeneity. The molecular weight of the porcine spleen protein methylase II (ps-PM II) was estimated to be 27,500 daltons on SDS-PAGE. Amino acid sequence of N-terminal 28 residues for ps-PM II was identified. Amino-terminal three amino acid residues of ps-PM II were deleted when compared to those of other protein carboxyl methytransferase. S-Adenosyl-L-homocysteine competitively inhibits ps-PM II with a K, value of $1.63{\times}10^{-7}M$. Myelin basic protein exhibited the highest methyl-accepting capacity among the proteins tested.

Control of Intracranial Disease Is Associated with Improved Survival for Patients with Brain Metastases from Hepatocellular Carcinoma

( Pil Soo Sung ),( Dong Jin Yoon ),( Do Seon Song ),( Jung Hyun Kwon ),( Soon Woo Nam ),( Jeong Won Jang ),( Jong Young Choi ),( Seung Kew Yoon ),( Seok Whan Moon ),( Hong Seok Jang ),( Si Hyun Bae ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: We performed a retrospective study to identify prognostic factors and determine outcomes for patients with brain metastases from hepatocellular carcinoma (HCC). Methods: A total of 72 patients with brain metastases from HCC were identified from two institutions; 26 of 72 patients received tumor-removing surgery or stereotactic radiosurgery with or without whole-brain radiotherapy (WBRT), 23 of 72 received WBRT only, and 23 of 72 received conservative treatment. Estimates for overall survival (OS) after brain metastases were determined and clinical prognostic factors were identified by Cox proportional hazards modeling. Results: Median OS after development of brain metastases was 48 days (one day to 536 days). The median age at the time patients were diagnosed with brain metastasis was 54 years. Fifty-one patients (71%) were male, and 62 patients (86%) were infected with hepatitis B virus. Median time from diagnosis of HCC to brain metastasis was 17.2 months, and 4 patients had brain metastases at the time diagnosis. Intracranial hemorrhage was frequently associated (42%) with brain metastasis. The most common presenting symptoms were motor weakness, mental change, and headache. Sixty-three patients (88%) had lung metastases, 25 patients (35%) had bone metastases, 18 patients (25%) had metastatic lymphadenopathy, and 7 (10%) patients had peritoneal seeding when diagnosed with brain involvement, and there was only one patient without metastasis to other organs. Univariate analyses showed that treatment with curative intent (surgery or SRS) and serum AFP levels were associated with improved survival (P<0.001, and 0.045, respectively), whereas a single brain metastasis, size of metastatic tumor, or intracranial hemorrhage were not. We further divided patients with three groups by the treatment modality; surgery or radiosurgery (group1), WBRT (group 2), or conservative treatment (group 3). Group 1 showed best survival, followed by group 2 and group 3, sequentially (P<0.001). Subgroup analysis with patients with single brain metastasis showed similar results. Multivariate analysis showed that treatment modality was the only factor that is associated with improved OS (P=0.001) Conclusions: When patients with lung metastases from HCC present neurologic symptoms, brain imaging is required to confirm intracranial metastases. Although the overall prognosis of patients with brain metastases from HCC is extremely poor, patients actively treated with surgery or radiosurgery have prolonged survival, suggesting that interventions to control intracranial disease are important treatment modalities.

정상과 자간전증 임부의 태반내 지질과산화치와 항산화능

김윤하(Yoon Ha Kim),송태복(Tae Bok Song),안봉환(Bong Whan Ahn),양성렬(Sung Yeul Yang),이소윤(So Yoon Lee),김석모(Seok Mo Kim),정광필(Kwang Pil Jeong),변지수(Ji Soo Byun),조문경(Moon Kyoung Jo) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.8

목적 : 정상과 자간전증 임부의 태반내 지질과산화, 항산화능 및 항산하 비타민의 양태를 과악하여 이들이 자간전증의 병태생리에 어떤 역활을 하는지 알고자 하였다. 연구 방법 : 임신 33주 이상의 정상 임부 B3명과 자간전증 환자 18명으로부터 분만후 태반조직을 채취하여 태반조직균질액을 얻었다. Enzyme-linked immunoassay (ELISA)를 이용하여 tumor necrosis factor-α (TNF-α)를 측정하였고, thiobarbituric acid (TBA)반응을 이용하여 지질과산화 정도를 측정하였으며, 2,2`azobis-2-amidinopopane (ABAP)를 사용한 total peroxyl radical-trapping antioxidant parameter (TRAP) 검사를 통하여 총 항산화능을 측정하였고, high performance liquid chromatography (MPLC)를 이용하여 아스코르빈산 (ascorbic acid), 요산 (uric acid). 레티놀 (retinol), 알과-토코페롤 ( α-tocopherol) 및 감마-토코페를 (γ-tocopherol) 농도를 측정하였다. 결과 : 1. 정상 임신군과 자간전증군의 태반조직균질액내 TNF-α 농도는 각각 10.3±1.06pg/㎖과 21.4±3.39 pg/㎖으로 자간전증군에서 정상 임신군보다 의의있게 증가하였다 (p<0.05). 2. 정상 임신군과 자간전증군의 태반조직균질액내 지질과산화물은 4.98±0.37 nmol/㎎ protein과 6.65±0.57 nmol/㎎ protein으로 자간전증군에서 정상 임신관보다 의의있게 증가하였다 (p<0.05). 3. 정상 임신군과 자간전증군의 태반조직균질액내 TRAP 값은 0.31±0.03 mM과 0.24±0.02 mM으로 자간 전증군에서 정상 임신군보다 의의있게 감소하였다 (p<0.05). 4. 정상 임신군과 자간전증군의 태반조작균질액내 아스코르빈산 농도는 333.3±32.8 nmol/㎖과 217.0±21.0 nmol/㎖으로 자간전증군에서 정상 임신군보다 의의있게 감소하였다 (p<0.05). 결론 : 자간전증 환자의 태반내에서 지질과산화치는 정상임신군보다 증가하고 항산화능은 감소하였으며 특히 아스코르빈산이 감소하였다. 이는 자간전증이 산화촉진물과 항산화제의 불균형을 보이는 산화적 스트레스를 동반하는 소견이며, 자간전증 태반에서 TNF-α가 증가가 산화적 스트레스를 일으키는 한 원인인 것으로 시사되었다. 또한 자간전증의 병태생리에 태반내 지질과산화물의 증가와 항산화능의 감소가 주요 인자로 관여 할 것으로 사료되었다. Objective : Our purpose was to investigate lipid peroxide levels, total peroxyl radical-trapping antioxidative parameter (TRAP) values, and antioxidant vitamin levels in placental tissues of women with preeclampsia and to evaluate their roles in the pathophysiology of preeclampsia. Study Design : Samples of placental tissue homogenates were obtained from 23 normal and 18 preeclamptic women between 33 and 40 weeks gestation. TNF-α was assayed by an enzyme-linked immunoassay. Lipid peroxide levels measured by thiobarbituric acid reaction. The TRAP values were measured by modified Wayners method. Ascorbic acid, uric acid, retinol, α-tocopherol, and γ-tocopherol were measured by high performance liquid chromatography (HPLC) CoulArray detector. Results : TNF-α levels in placental tissue homogenates of women with preeclampsia were significantly higher than that of women with preeclampsia (21.4±3.39 vs. 10.3±1.06 pg/㎖, p<0.05). Lipid peroxide levels in placental tissue homogenates of women with preeclampsia were significantly higher than that of women with preeclampsia (6.65±0.57 vs. 4.98±0.37 nmol/㎎ protein, p<0.05). TRAP values in placental tissue homogenates of women with preeclampsia were significantly lower than that of women with normal pregnancy (0.24±0.02 vs. 0.31±0.03 mM, p<0.05). Ascorbic acid levels in placental tissue homogenates of women with preeclampsia were significantly lower than that of women with normal pregnancy (217.0±21.0 vs. 333.3±32.8 nmol/㎖, p<0.05). Conclusion : The above results suggest that increased oxidative stress in placenta is involved in the pathophysiology of preeclampsia and ascorbic acid may act as an important preventive factor in the development of preeclampsia.

Improved performance of molten carbonate fuel cells with (Li/Na)₂CO₃ electrolytes by using BYS coated cathode at low operating temperatures

Lee, Chang-Whan,Kwon, Byeong Wan,Kang, Min-Goo,Ham, Hyung-Chul,Yoon, Sung-Pil,Han, Jonghee,Kim, Young Jin,Lee, Min Chul Elsevier 2017 INTERNATIONAL JOURNAL OF HYDROGEN ENERGY - Vol.42 No.29

<P><B>Abstract</B></P> <P>In order to improve the stack life time of MCFCs, it is necessary to reduce the operating temperature of MCFCs below 600 °C, because reduced operating temperature minimizes electrolyte loss due to evaporation and corrosion. However, at the low operating temperature below 600 °C, the cell performance of MCFCs with (Li/Na)<SUB>2</SUB>CO<SUB>3</SUB> electrolyte is too low to operate the fuel cell stack and system. In this study, we have performed wettability control of the liquid molten carbonate electrolyte by coating NiO cathodes with poor wetting property of the mixed ionic and electronic conductor (MIEC) such as BYS (Bi<SUB>1.5</SUB>Y<SUB>0.3</SUB>Sm<SUB>0.3</SUB>O<SUB>3-δ</SUB>). From experiments with symmetrical cells, each polarization component with various temperatures and gas conditions were studied. To investigate effects of the BYS coated cathode on the performance of MCFCs, a 100 cm<SUP>2</SUP> single cell of MCFCs was employed. The performance of a 100 cm<SUP>2</SUP> single cell with BYS coated cathode was better than that with conventional cathode by a factor of 1.84, because BYS coated cathode reduces activation polarization and mass transfer resistance greatly.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Wettability of NiO cathodes was controlled by coating BYS powders. </LI> <LI> Effects of the BYS coated cathode on the performance of MCFCs were investigated. </LI> <LI> BYS coated cathode reduces polarizations and mass transfer resistance. </LI> </UL> </P>