Treatment of Langerhans Cell Histiocytosis / 대한정형외과학회잡지

Histiocytosis X patients present with a variety of clinical manifestations and outcomes. The principal difficulty in the establishment of a definite protocol for treatment is based on the poor understanding of the basic nature of this disease, the absence of reliable prognostic criteria, and the problems with nomenclature. The objectives of this study were to analysis the course of the disease and the results of treatment in patients who had Langerhans cell histiocytosis and to suggest prognostic factors and guidelines for management. We reviewed the thirty patient who had Langerhans cell histiocytosis for past ten years. These patients were followed for an average 4.8 years (range, excluding patients who died of the disease, two to eleven years). The patients were divided into tow group; eighteen patients who Langerhans cell histiocytosis localized in skeleton (group I) and twelve patients who had Langerhans cell histiocytosis disseminate in both skeleton and extra-skeleton (group II). Methods of treatment included curettage with or without bone graft, radiotherapy, or watchful observation alone in group I; chemotherapy, chemotherapy and radiotherapy, or curettage in group II. All eighteen patients in group I had a complete response to the therapy. Seventeen of these eighteen patients had not a recurrence by the time of the latest follow-up examination; one had a recurrence. Four of twelve patients in group II had a complete response to the therapy, four had a partial response, and four had no response. Eight of these twelve patients had a recurrence; four did not. Two patients in group II died of the disease. The significant prognostic factor was the extent of the disease, limited to the skeleton or not, and the age of onset was an indirect prognostic factor predictin multiple organ involvement.

Conservative Treatment in Thoracolumbar Fracture and Fracture-Dislocations / 대한정형외과학회잡지

The thoracolumbar fracture and fracture-dislocations are ever increasing today as the traffic accidents and industrial accidents frequently occur. But the controversy as to the relative values of early surgical instrumentation and conservative means has continued for well over a decade. The duration of this dispute without final resolution suggests an absence of significant differences in the results of surgical and non-surgical method. The purpose of this study is to review the results of conservative treament for 132 patients with thoracolumbar fracture and fracture-dislocations, who were admitted and treated at Yonsei University Severance Hospital from January, 1980 to December, 1984. And we obtained following results. l. In cases of stable fracture without neurologic deficit, especially when the wedging deformity of vertebral body is below 50%, it seems to be better to treat conservatively; that is, immediate postural reduction and after 2 or 3 weeks of bed rest, to start ambulation with back brace or cast. 2. In cases of stable fracture with neurologic deficit, operative treament is necessary when the frac-fragment is protruded into the spinal canal and neural compression sign is evident. But if not so, attempt to treat by conservative means may be done. 3. In cases of unstable fracture without neurologic deficit, it is more retional to treat conservatively by bed rest for a suffient time and then wearing back brace or cast. If the spinal deformity is so severe that it needs spinal fusion, the operation can be performed later on. 4. In cases of unstable fracture with neurologic deficit, spinal instrumentation and fusion do nothing to enhance neural recovery but are done to provide anatomic spinal alignment and stability to allow early the patient mobilization and rehabilitation.