A Recurrent Angiosarcoma Isolated to the Eyelid without the Recurrence on the Primary Lesion of the Forehead

Angiosarcoma is a highly malignant vascular tumor of endothelial origin. Initially, a cutaneous manifestation presents as a singular or multifocal bruise-like patches on the skin, most frequently on the face, the scalp or the neck regions. On progression, the lesions become violaceous, and ill-defined spongy nodular tumors appear. Our patient was a 71-year-old man with a previous history of angiosarcoma on the right forehead and was treated with an excision and local radiation 3 years ago. Several months after the treatment, a dark brownish to violaceous patch with edema arose from the right upper eyelid and spread out to the lower eyelid. Clinically, an ecchymosis caused by trauma or other hemangioma was suspected more than a recurrent angiosarcoma. Histopathologic examinations including immunohistochemical studies were consistent with cutaneous angiosarcoma. Herein, we report a rare case of a recurrent isolated angiosarcoma without the recurrence of a primary lesion.

Solitary Congenital Erosion in a Newborn: Report of a Solitary Congenital Self-Healing Reticulohistiocytosis

Congenital self-healing reticulohistiocytosis (CSHRH) is a rare, cutaneous, self-limited form of Langerhans cell histiocytosis. Whereas multiple lesions are common, a solitary lesion is rare. A 14-day-old neonate presented with a solitary, 5-mm, oval, reddish, and eroded papule with crust on the left thigh that had existed since birth. No systemic involvement was found. Histopathology revealed dense infiltration of large histiocytes with scattered eosinophils and lymphocytes in the dermis. Immunohistochemistry showed S-100 and CD1a positivity. Two months later, the skin lesion involuted spontaneously, without evidence of recurrence and extracutaneous involvement. On the basis of the characteristic clinical course and typical histopathological findings, a diagnosis of solitary CSHRH was made.

A Case of Multiple SCCs in situ and BCC Induced Probably by Chronic Exposure to Arsenic-containing Pills (Hwan-Yak) / 대한피부과학회지

Not legally, arsenic has been used for various medical purposes. Chronic exposure to arsenic can induce different kinds of cutaneous diseases, including arsenic keratosis, Bowen's disease, squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and other pigment disorders. Also, arsenic induces internal malignancies, including tumors of the pulmonary and urogenital systems. To prevent these malignancies, the use of arsenics should be strictly prohibited. We describe a 72-year-old man who developed SCC in situ and BCC after chronic exposure to arsenics.

Adult Onset Still's Disesae: A Case Report / 대한피부과학회지

Adult-onset Still's disease (AOSD) is a systemic inflammatory disease of an unknown etiology, and AOSD is characterized by high fever, skin rash, arthritis, lymphadenopathy, hepatomegaly, sore throat and serositis. The typical skin rash of AOSD patients is an evanescent, erythematous maculopapular lesion. There is no single diagnostic test; therefore, the diagnosis is based upon the clinical criteria. Treatment consists of anti-inflammatory medications such as aspirin, NSAIDs, corticosteroids, anti-rheumatics and immunosuppressants. We report here on a case of AOSD in which a 53 year-old female patient presented with a high fever, a typical rash, arthritis, a sore thoat and mild splenomegaly.

Comparison of Monosegment Instrumented Posterior Lumbar Interbody Fusion with and without a Metal Cage in Degenerative Spine / 대한정형외과학회잡지

PURPOSE: To compare the radiological and clinical results of a local bone graft with those of a single cage in monosegement instrumented posterior lumbar interbody fusion (PLIF) for a spinal stenosis or low-grade spondylolisthesis at the L4-5 level. MATERIALS AND METHODS: Eighteen patients underwent PLIF using a local bone block and a chip bone without a cage (no-cage group) and 24 patients underwent PLIF using a local bone graft with a single non-threaded metal cage (cage group). All the patients were followed up for a minimum of 2 years. The disc space height, disc lordosis, bone union and clinical results according to Lin's criteria of both groups were reviewed and compared retrospectively. RESULTS: The disc space heights of the no-cage and cage groups increased by 27% and 44% at the immediate postoperative and 12% and 27% at the latest follow-up, respectively. The cage group showed significantly better restoration of the disc space height (p0.05). Clinical satisfactory results were obtained in 72% of the no-cage group and 84% of the cage group without a significant difference (p>0.05). CONCLUSION: Both groups had a significant loss of restored disc space height 3 months after surgery. PLIF using a cage showed better restoration of the disc space height but there was significant loss of disc lordosis during the follow-up. A cage with sufficient height is recommended for restoring the disc space as well as preventing a loss of disc lordosis.

Deep Infection following Instrumented Posterior Fusion / 대한정형외과학회잡지

PURPOSE: This study evaluated the diagnosis, treatment and related results for cases with a deep infection after instrumented posterior fusion. MATERIALS AND METHODS: Among the 306 cases of posterior instrumented spinal fusion, Seventeen cases who developed deep infection were reviewed retrospectively. RESULTS: The incidence of deep infections was 5.6% and the mean age of the cases with a deep infection was 55 years old. Nine out of 17 cases had the preoperative risk factors such as old age, diabetes, malnutrition, obesity, etc. The mean duration to diagnosis of a postoperative infection was 12.9 days (4-8 days). The clinical manifestations were fever, night pain and abscess drainage. In all cases, the value of the WBC, ESR and CRP were elevated. All cases were treated surgically as soon as possible with abscess drainage, debridement and the insertion of antibiotics-mixed cement beads without the removal of the instrument. The most common bacterial organisms were Coagulase negative Staphylococcus aureus in 11 cases. Vancomycin was used as the antibiotic. During the follow-up period, 2 cases were treated with the removal of the instruments due to metal failure and a delayed deep infection with loosening. The average follow-up was 32 months (12-56 months). 15 cases were controlled successfully without needing to remove the instruments and without complications. CONCLUSION: The meticulous care for a deep infection after posterior instrumented spinal fusion is essential. Favorable results can be achieved by surgery with drainage, debridement, and the insertion of antibiotics-mixed cement beads along with systemic antibiotics as soon as possible without removing the instruments.

Comparison of the Results of Percutaneous Vertebroplasty for Treating Osteoporotic Vertebral Compression Fracture and Posttraumatic Vertebral Collapse (Kummell's disease) / 대한척추외과학회지

STUDY DESIGN: The comparison was based on the radiographc and clinically differences of 96 vertebroplasty cases. PURPOSE: This study evaluated the clinical and radiological results of performing percutaneous vertebroplasty for acute or subacute osteoporotic vertebral compression fracture (group A) and for posttraumatic vertebral collapse (Kummell's disease) (group B). SUMMARY OF LITERATURE REVIEW: Percutaneous vertebroplasty is a minimal invasive procedure for the treatment of a painful collapsed vertebral body MATERIALS AND METHODS: We experienced 67 cases of group A and 29 cases of group B, and we followed these patients for 2 years or more. We evaluated the clinical results by using the serial visual analogue scale (VAS) and the radiological results were evaluated by measuring the restoration of the anterior vertebral height and the change of the kyphotic angle. We also compared both groups for their bone mineral density (BMD) and new fracture rate. RESULTS: Statistically significant pain relief was obtained by both groups in the perioperative period. The average VAS change was 6.5 (from 8.7 preoperatively to 2.2 postoperatively) in group A, and 7.1 (from 9.1 preoperatively to 2.0 postoperatively) in group B on a 10 point pain scale. The anterior vertebral height increased an average of 4.9mm (16.5%), (from 16.8mm preoperatively to 21.7 mm postoperatively) in group A, and 6.5 mm (21%) (from 12.8 mm preoperatively to 19.3 mm postoperatively) in group B on the perioperative period. But the height was minimally decreased more that it was measured at the immediate postoperative period: 18.7 mm in group A, and 16.2 mm in group B on the last follow up. The kyphotic angle was restored an average of 5.2 degrees (from 32.4 degrees preoperatively to 27.2 degrees postoperatively) in group A, and 4.9 degrees (from 39.5 degrees preoperatively to 34.6 degrees postoperatively) in group B on the perioperative period. But the angle was increased more than that measured preoperatively: about 1.7 degree in group A and group B on the last follow up. There's no significant difference in the BMD between the groups. New fracture developed in 17.9% (12) of group A, and 20.7% (6) of group B. We did this procedure for 15 cases of new fracture, and then the VAS change was an average 5.0 immediately after the operation. CONCLUSIONS: Percutaneous vertebroplasty was an effective treatment method for both groups and there were no statistically significant differences in the clinical and radiological results. Care must be taken due to the relatively high rate of new fracture and this can be resolved by repeat vertebroplasty

Flexible Intramedullary Nail Fixation of Pediatric Femoral Shaft Fracture

PURPOSE: To traditional treatment of pediatric femoral shaft fracture has been a traction and spica cast application. But flexible intramedullary nail fixation has been introduced as an alternative to other treatment modalities. With this in mind, we analyzed the clinical and radiologic results of flexible intramedullary nail fixation of pediatric femoral shaft fractures. MATERIALS AND METHODS: We analyzed 12 patients (13 cases) who were treated with flexible intramedullary nail and followed up for at least 6 months at the department of Orthopedic Surgery, Inje University Ilsan Paik Hospital since May, 2002. RESULTS: In all 12 patients (13 cases) involving 1 case with reoperation because of reduction failure, average duration of bone union was 12.6 weeks. There were no considerable complications except mild post-op knee pain and limitation of motion. CONCLUSION: In spite of relatively short term study, a flexible intramedullary nail fixation seems to be a useful method without serious complications on pediatric femoral shaft fracture. However, in big or older pediatric patients, interlocking intramedullary nail fixation may be a better choice rather than a flexible nail fixation because of it's insufficient stability.

Lateral fat pad Impingement Syndrome: A Case Report

Lateral fat pad impingement syndrome is rare disease characterized by anterior knee pain, painful click and palpable cord-like thickening at the lateral side of patellar tendon. We report a case of lateral fat pad impingement syndrome on walking, which developed in a 22-year-old female and was treated successfully with arthroscopic resection of enlarged fat pad.

Change of Pillar Pain after Endoscopic Carpal Tunnel Release / 대한정형외과학회잡지

PURPOSE: Endoscopic carpal tunnel release has been reported to offer the advantages of reduced pain and complications, and to allow a rapid return to work. It was, therefore, introduced as an alternative to open carpal tunnel release. With this in mind, we analyzed changing pillar pain after endoscopic carpal tunnel release. MATERIALS AND METHODS: We analyzed 22 patients (35 cases) who were treated by endoscopic carpal tunnel release, and followed for over l year, from November 1999. RESULTS: According to Cseuz's criteria, 27 cases were excellent and 5 were good. Levine's Symptom Severity Scale improved from 35 preoperatively to 14 postoperatively. CONCLUSION: While endoscopic carpal tunnel release was confirmed to offer the advantages of reduced pain and palmar scarring, there seemed to be no difference in the clinical results compared with the open method. Therefore, endoscopic carpal tunnel release may be a useful method if it is done skillfully and carefully. However, even in the case of endoscopic release, pillar pain remains a problem. Long term results need to be examined to evaluate recurrence.

Effects of Low Intensity Ultrasound on the Co-Culture of Human Osteoblastic Cells (SaOS-2) with Endothelial Cells (HUVEC) / 대한정형외과연구학회지

PURPOSE: We investigated the effects of low intensity ultrasound on the co-culture of human osteoblastic cells with endothelial cells and analysed cell proliferation and growth factors that might be involved in bone formation. METHODS: Cell culture system was established with human osteoblastic cells (SaOS-2) and primary isolated human umbilical vein endothelial cells (HUVEC). Low intensity ultrasound (1 MHz) treatment was administered for 20 minutes per day to each well for 4 consecutive days and its effects were determined by analysing cell proliferation activity, alkaline phosphatse and amount of growth factors such as basic fibroblast growth factor, transforming growth factor beta and transforming growth factor beta in the conditioned medium. RESULTS: Low intensity ultrasound treatment increased cell proliferation activity, level of the basic fibroblast growth factor and transforming growth factor beta in the co-culture system. The levels of alkaline phosphatase and transforming growth factor beta in the conditioned medium were not changed. We could not observe the change of cell proliferation or amount of various growth factors in a culture system of SaOS-2 or HUVEC. CONCLUSION: The low intensity ultrasound treatment can increase osteogenesis by certain interaction between the two cells and increase in bFGF and TGF beta participate in the process.

Necrotizing Fasciitis of the Low Extremity: A Case Report / 대한정형외과학회잡지

Necrotizing fasciitis is a rare soft tissue infection with very high rate of mortality unless promptly recognized and agressively treated. Early recognition and prompt medical and surgical treatment are mandatory to acheive a successful outcome. We report upon a case of neco-tizing fasciitis, which developed in a 53-year-old female and was treated successfully with early antibiotic teatment, hyperbaric oxygen therapy and fasciotomy.

Surgical Treatment of Cervical Myelopathy Due to Soft Disc Herniation / 대한정형외과학회잡지

PURPOSE: To analyze the characteristics and surgical results in cervical myelopathy patients caused by soft disc herniation. MATERIALS AND METHODS: From June 1997 to August 1998. The authors treated cervical myelopathy patients who had a soft disc herniation. We evaluated the symptoms and signs, simple X-rays, the MRI, the JOA score and Hirabayashi's recovery rate. RESULTS: On simple X-ray, the narrowest A-P diameter was 13 mm, as the average was 14.9 mm, and no bony structural stenosis was found. On MRI, the average of the cord compression was 2.92 mm, and the average A-P compression ratio was 40.2%. An intermediate to high signal change in the cord was found in 8 cases. All patients improved after surgery and the average Hirabayashi's recovery rate was 61.1%. CONCLUSION: If, cord compression due to posterior soft disc herniation is severe, patients can have cervical myelopathy. Lateral disc herniation can also be a cause of cervical myelopathy. Cervical myelopathy due to soft disc herniation can be treated with a good results by using an anterior discectomy and interbody fusion method.

Cannulated Screw Fixation with Figure-Eight Wiring of Displaced Transverse Patella Fractures / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical results of displaced transverse patella fractures which were treated with figure-eight wiring by means of parallel cannulated screws. MATERIALS AND METHODS: Ten patients who had displaced non-comminuted transverse patella fractures were seen between August 1998 to March 2000 and then followed up for more than one year, were prospectively evaluated with regard to their clinical and radiologic results. RESULTS: Clinical union occurred at an average of eight weeks and radiologic union at twelve weeks. Clinical results were evaluated at six months and one year postoperatively. The flexion contracture was 3.3degrees, the further flexion was 127.6degrees At six months the flexion contracture was 2degrees, and the further flexion was 135degrees at one year. Functional results according to the Wilkinson classification system were excellent in 8 cases, good in 2 cases at six months excellent in 9 cases, and good in 1 case at twelve months. There was no soft tissue irritation caused by the wire and screw, loosening or an implant migration. CONCLUSION: Cannulated screw fixation and figure-eight wiring is one of the useful methods for the repair of displaced transverse patella fractures.

Ganglion around the Cruciate Ligament in the Knee / 대한정형외과학회잡지

PURPOSE: To evaluate clinical diagnosis, treatment and results of the intraarticular ganglion of the knee joint. MATERIALS AND METHODS: From April 1996 to May 1999, nine patients were taken arthroscopic excision of the intraarticular ganglion. Diagnosis was based on history, thorough physical examination and MRI and confirmed by biopsy. RESULTS: As seen in the internal derangement of the knee, symptoms of the intraarticular ganglion were varied from asymptom to pain, effusion and limitation of motion. After arthroscopic excision, eight of nine patients were improved satisfactorily. CONCLUSION: The diagnostic rate of the intraarticular ganglion in the knee would be increased after the introduction of MRI and the results would be improved using arthroscopy. In the case of chronic nonspecific knee pain and limitation of motion, the possibility of the intraarticular ganglion might be considered.

Studies on Unreduced Fragments in Closed Interlocking Nailing of Comminuted Femoral Fracture / 대한정형외과학회잡지

PURPOSE: During interlocking nailing the displaced butterfly fragments can be left in situ or reduced by opening the fracture site. The purpose of this study is to investigate the fate of the displaced comminuted butterfly fragments when left unreduced and factors that influences fracture union in comminuted femoral fracture after closed interlocking nailing. MATERIALS AND METHODS: Out of 95 closed interlocking nailings done for fractured femur from July 1990 to July 1993, 43 femoral fractures that had comminuted fragments larger than 1 cm were followed for more than 18 months postoperatively, The correlations between the size of the comminuted fragments, its distance from the femoral shaft, the angulation of the fragment, the gap of the main fracture sites and bone union were analyzed. RESULTS: The distance between the fragment and the femoral shaft and angulation spontaneously decreased gradually, even the fractures having inverted fragments were united uneventfully, and the union rate of the fractures with gap less than 3 mm was higher than those with gap greater than 3 mm. CONCLUSIONS: The displaced fragment need not be reduced by open method and minimizing the fracture gap is recommended in increasing the union rate.

Analysis of Arthroscopic Management for Degenerative Knee / 대한정형외과학회잡지

PURPOSE: To correlate clinical results of arthroscopic debridement of degenerative knee with preoperative factors. MATERIALS AND METHODS: A retrospective survey of 61 patients (81 knees) with degenerative arthritis of knee treated with arthroscopic debridement from June 1995 to June 1997 was conducted. The average follow-up period was 22.7 months (12-35 months). There were 6 male and 55 female patients. The average age was 61.1 years. The arthroscopic procedure included excision of osteophytes, removal of loose body, meniscal trimming, synovectomy and irrigation of the knee joint. Statistical analysis was done for parameters such as knee alignment, joint space narrowing, flexion contracture, meniscal tear, articular cartilage degeneration, age, follow-up period and preoperative Insall knee score. RESULTS: A statistically significant difference in clinical results was noted in the separate subgroups for radiographic alignment (chi-square test, P=0.007) and degree of cartilage degeneration (P=0.006). Those patients with joint space narrowing, flexion contracture, meniscal tear or low Insall knee score had poor results after arthroscopic surgery. CONCLUSIONS: Though the result of arthroscopic debridement of degenerative knee is known to be unpredictable, some preoperative factors are correlated with poor outcomes, and arthroscopic treatment should be carefully selected.

Failed Back Surgery Syndrome: Etiology and the Results of the Treatment / 대한척추외과학회지

STUDY DESIGN: We retrospectively analyzed 26 cases of failed back surgery syndrome. OBJECTIVE: To reveal the cause of failure, to analyze the results of treatment and to report how to prevent failure. SUMMARY OF LITERATURE REVIEW: The trend term failed back surgery syndrome(FBSS) is used to describe a heterogenous group of patients whose unifying factor is a persisting complaint of back and leg pain. FBSS is a serious problem to both patient and surgeon, and incidence is about 10-15 percent. MATERIALS AND METHOD: Twenty-six patients, who diagnosed as FBSS were followed up for 28 months on an average from 1994 to 1997. We analyzed cause of failure, treatment modalities and results of treatment. Clinical result was evaluated by Kirkaldy-Willis criteria. RESULTS: The causes of FBSS were recurred disc(9 cases), spinal stenosis(7 cases), epidural fibrosis(4 cases), segmental instability(2 cases) infection(2 cases), hematoma and worker's compensation(1 case each). The clinical results were good in case of recurved disc and having symptom free interval more than 6 months. According to kirkaldy-willis criteria, excellent and good results were in 18 cases of 26 cases and most of excellent results were obtained from recurred disc and combined spinal stenosis. CONCLUSION: Removal of mechanical cause and decompression were the most commonly used treatment modalities and posterolateral or anterior fusion was performed when instability was suspected.

Effects of Interleukin-1 on Cell Proliferation in UMR-106-01 Osteoblast-like cells / 대한정형외과학회잡지

Interleukin 1(IL-1), a 17.5 KD glycoprotein, is known to be associated with local bone resorption. In the present study, we examined the effects of IL-1, compared with insulin and parathyroid hormone (PTH), on DNA, protein and collagen synthesis in UMR-106-01 rat osteoblastic osteosarcoma cells. When 200 units/mL IL-1 was administered to UMR-106-01 cells, [3H]-thymidine uptake increased to 119% of the untreated control. But when 10 nM insulin was added to the cells, [3H]- thymidine uptake increased to 130% and when 1 nM PTH was added, the uptake decreased to 89% of the control. On the other hand, protein and collagen synthesis, measured by [3H]-leucine and [3H]-proline incorporation respectively, were not affected by IL-1 administration compared to the other hormones. These results indicate that IL-1 effects osteoblast-like cells, stimulating DNA synthesis via a different mechanism to the well-known cell growth factor, insulin.

Sacrococcygeal Chordomas with Wide spread Metastases: Report of Two Cases and Review of Literature / 대한방사선종양학회지

Chordomas are rere tumors arising from the primitive notochord. The commonest affected segment is the sacrum and these chordomas frequently follow a progressive course eith multiple recurrences and metastases and eventual death due to tumor.This report describes two cases of sacrococygeal chordomas with widespread metastases treated by surgery and adjuvant radiation therapy.