PURPOSE: We analyzed the clinical outcome of osteosarcoma developed in distal radius and the effect of delayed treatment on prognosis. MATERIALS AND METHODS: Twelve patients with distal radius osteosarcoma were analysed. We categorized patients into two groups of standard treatment or non-standard treatment. The patients of standard treatment group are all stage IIB and non-standard treatment group includes five stage IIB and one stage III. RESULTS: Five-year overall survival and disease-free survival rates of standard treatment group were 100% and 83%. Five-year overall survival rate of non-standard treatment group was 44%. Between two group, there are differences in age, tumor size, surgery type, symptom duration. CONCLUSION: Distal radius osteosarcoma have good prognosis than other extremity osteosarcoma. Survival rate of non-standard treatment group were lower than standard treatment group. Although the prognosis of non standard treatment group is poorer, the duration till death was longer than that of other sites with similar condition. Further multi-institutional study should be needed.
Disease-Free Survival ; Extremities ; Humans ; Osteosarcoma ; Prognosis ; Radius ; Survival Rate

It is generally considered that enteral feeding is superior to parenteral nutritional support. Thus enteral meal should be given whenever patients have proper gastrointestinal function to take enteral feeding. Because the morbidity and mortality for surgical jejunostomy have been reported as high as 50% and 10% respectively, direct percutaneous endoscopic jejunostomy has been developed to reduce the morbidity and mortality. A 55-year-old male patient, who was suffering from dysphagia and oropharyngeal aspiration, was transferred to the division of gastroenterology to be done permanent enteral feeding. His stomach was resected (subtotal gastrectomy with billroth II anastomosis) due to peptic ulcer hemorrhage 10 years before. We performed direct percutaneous endoscopic jejunostomy without any complication. Herein, we report a successful case.
Deglutition Disorders ; Enteral Nutrition ; Gastrectomy* ; Gastroenterology ; Gastroenterostomy ; Humans ; Jejunostomy* ; Male ; Meals ; Middle Aged ; Mortality ; Nutritional Support ; Peptic Ulcer Hemorrhage ; Stomach

PURPOSE: We analyzed the oncological outcome and prognostic factor of the chondrosarcoma arising from benign bone tumor due to malignant transformation. MATERIALS AND METHODS: From April 1986 to April 2009, 18 cases were considered eligible. We analyzed retrospectively the patient's characteristics and prognostic factors that affect to the local recurrence and distant metastasis. RESULTS: As classified by primary benign bone tumor, 4 cases were solitary osteochondroma, 11 cases were multiple osteochondromatosis and 3 cases were multiple enchondromatosis. The mean follow-up period was 85 months. The 5-year disease free survival rate of 18 patients was 85.9%. Their overall MSTS score was 25.2 (84%). There were local recurrence in 3 cases and no distant metastasis. We found that tumor location and surgical margin affected to the prognosis significantly. CONCLUSION: In secondary chondrosarcoma patients, the prognosis was good relatively and tumor location and surgical margin are important prognosis factor.
Chondrosarcoma ; Disease-Free Survival ; Enchondromatosis ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Osteochondroma ; Osteochondromatosis ; Prognosis ; Recurrence ; Retrospective Studies

We report a non-obese patient suffering from spastic gait and right leg paresis caused by thoracic spinal cord compression secondary to spinal epidural lipomatosis. Although spinal epidural lipomatosis is most often associated with the administration of exogenous steroid or endogenous Cushing syndrome, obesity also has been reported as a possible cause. However, idiopathic(non-glucocorticoid induced) spinal epidural lipomatosis in non-obese healthy man is an extremely rare disease and dose not have any good explanation for the abnormal fat deposition in spinal epidural space. We recently experienced a patient with idiopathic thoracic epidural lipomatosis in whom MRI and histopathology established the specific diagnosis. With a case report, brief review of the disease including clinical feature, diagnostic procedure and therapeutic considerations is described.
Cushing Syndrome ; Diagnosis ; Epidural Space ; Gait Disorders, Neurologic ; Humans ; Leg ; Lipomatosis* ; Magnetic Resonance Imaging ; Obesity ; Paresis ; Rare Diseases ; Spinal Cord Compression

OBJECTIVES: The causes of benign esophageal stricture were postoperative, corrosive, peptic and after esophageal sclerotheraphy, etc. The patients mainly suffered from dysphagia and insufficient nutrition. Recently, balloon and bougie dilatation were introduced to these patients. This study was performed to evaluate the effectiveness and safety of both procedures in different types of strictures METHODS: 32 patients who presented dysphagia enrolled from March 1996 to August 1997 who visited Pusan National University Hospital. Balloon dilatation was performed on 22 patients and bougie on 10 patients. RESULTS: 1) The causes of stricture were postoperative (18 cases), corrosive (10 cases), hypertensive LES (2 cases), peptic (1 case) and web (1 case). 2) Overall cure rate was 59% in bougie dilatation and 40% in balloon dilatation 3) The cure rate of postopertive stricture was 59% which is significantly higher than that of corrosive stricture (27%), and cure rate of hypertensive LES, peptic stricture and web was 100%. 4) The cure rate of corrosive stricture was significantly higher on bougie dilatation than balloon dilatation. 5) The cure rate of postoperative stricture was similiar between balloon and bougie dilatation 6) The length of stricture was inversly affected on cure rate of both dilatation procedures. 7) Overall complication was 5.6% and similiar between balloon and bougie dilatation. CONCLUSIONS: These results suggested that bougie dilatation was recommended on corrosive stricture and balloon dilatation on postopertive stricture
Busan ; Constriction, Pathologic ; Deglutition Disorders ; Dilatation* ; Esophageal Stenosis* ; Humans

PURPOSE: Electrophysiologically assess conduction pathways of the pyramidal and extrapyramidal systems in rats and predict the pathways involved in spinal cord injuries. METHOD: The motor area of the cerebral cortex, medullary reticular nucleus, lateral vestibular nucleus, and red nucleus of adult Sprague-Dawley rats were stimulated with microelectrodes. Laminectomies were performed at the C6, T10 and L2 cord level. Field potentials evoked by stimulation of the cerebral cortex and the three motor nuclei were recorded with a glass microelectrode of 1.5~2.5 Mohm filled with 0.2M NaCl. To construct a cross-sectional map of field potentials, recording was made in 7 tracks equally spaced across the spinal cord. In each track, field potentials were recorded at seven equally spaced points from the ventral to dorsal cord. RESULT: Stimulation of the cerebral motor cortex evoked 5 wanes, such as P1, P2, P3, P4, P5. P1 was monitored mainly in the bilateral dorsal half of the spinal cord and other wades mainly in the ventral half of the spinal cord. With lateral vestibular nucleus stimulation, 1 or 2 short duration biphasic waves followed by a longer duration positive wave were monitored mainly in the ipsilateral ventrolateral funiculus of the cord. Field potentials produced by stimulating the medullary reticular nucleus were shown mainly in the ventromedial funiculus, and their latencies were longer than those from the vestibular nucleus stimulation. Field potentials generated by the stimulation of the red nucleus were monitored mainly in the dorsolateral funiculus. CONCLUSION: motor evoked potential is clinically useful to evaluate the descending pathways of the spinal cord.
Adult ; Animals ; Cerebral Cortex ; Evoked Potentials, Motor* ; Glass ; Humans ; Laminectomy ; Microelectrodes ; Motor Cortex ; Rats* ; Rats, Sprague-Dawley ; Red Nucleus ; Spinal Cord ; Spinal Cord Injuries ; Vestibular Nucleus, Lateral

BACKGROUND: Vertebroplasty is not free from cement related complications. If an allograft is used as a filler, most of them can be averted. METHODS: Forty consecutive cases of osteoporotic vertebral fracture were divided into two groups by self-selection. The study and the control groups underwent vertebroplasty with fresh frozen allogeneic bone chips and bone cement, respectively. Clinical results were assessed at preoperation, postoperative day 1 and months 3, 6, and 12 by 10-grade visual analog scale (VAS), and radiological results were assessed at the same time by vertebral kyphotic angle (VKA) and local kyphotic angle (LKA). The results were compared within and between the groups. Survival function was analyzed. The criteria of an event were clinical or radiological deterioration versus pre-index surgery state. RESULTS: VAS was improved in the study group from 8.4 +/- 0.8 to 5.2 +/- 1.4, 6.4 +/- 1.2, 5.5 +/- 2.7, and 3.7 +/- 1.4 at postoperative day 1 and months 3, 6, and 12, respectively, and in the control group from 8.4 +/- 1.2 to 3.2 +/- 1.1, 3.2 +/- 1.7, 3.2 +/- 2.7, and 2.5 +/- 1.7, respectively (within group, p < 0.001; between groups, p < 0.001). VKA was improved in the study group from 18.9degrees +/- 8.0degrees to 15.2degrees +/- 6.1degrees (p = 0.046) and in the control group from 14.7degrees +/- 5.2degrees to 10.3degrees +/- 4.7degrees (p < 0.001) at postoperative day 1. LKA was not improved in the study group but was improved in the control group from 16.8degrees +/- 11.7degrees to 14.3degrees +/- 9.6degrees (p = 0.015). Correction angle was 2.7degrees +/- 4.6degrees, -7.9degrees +/- 5.3degrees, -7.2degrees +/- 5.2degrees, and -7.4degrees +/- 6.3degrees at postoperative day 1 and months 3, 6, and 12, respectively, in the study group and 4.3degrees +/- 3.7degrees, 0.7degrees +/- 3.6degrees, 0.7degrees +/- 4.2degrees, and 0.1degrees +/- 4.4degrees, respectively, in the control group. Correction loss was significant in both groups (p < 0.001) and more serious in the study group (p < 0.001). The 6-month survival rate was 16.7% in the study group and 64.3% in the control group (p = 0.003; odds ratio, 5.250). CONCLUSIONS: In treatment of osteoporotic vertebral fracture, fresh frozen allogeneic bone chips are not recommendable as a filler for its worse results than bone cement.
Aged ; Bone Cements/adverse effects ; Bone Substitutes/adverse effects ; Case-Control Studies ; Female ; Humans ; Male ; Osteoporotic Fractures/epidemiology/*surgery ; Pain Measurement ; Transplantation, Homologous/adverse effects/instrumentation/*methods ; Vertebroplasty/adverse effects/instrumentation/*methods

PURPOSE: The purpose of this study was to evaluate the oncologic outcomes of parosteal osteosarcoma (POS) and to ascertain the fates of patients after local recurrence (LR). MATERIALS AND METHODS: The authors retrospectively reviewed 22 POS patients with an average follow-up of 114 months (range: 36-235 months). Seven of the 22 patients were referred after LR. There were 17 Stage IB and 5 Stage IIB (G2, 2; dedifferentiation, 3). Tumors were located in the femur (11) and in other locations (11). Initial surgical margins were wide in 10, marginal in 5, and intralesional in 7. Correlations between clinico-pathologic variables and LR and clinical courses after LR were evaluated. RESULTS: The 10-year overall survival rate was 85.7%. Three (14%) patients developed distant metastasis and all of them succumbed to the disease. Nine (41%) patients developed LR. Tumor location, resection type, and surgical margin were found to be correlated with LR. At final follow-up, 7 of the 9 patients that experienced local failure achieved no evidence of disease. CONCLUSION: A substantial risk of misdiagnosis exists, especially for POS in other than a femoral location. Recurrent tumor re-excision is possible in most cases; however, patients with an aggressive recurrence pattern deserve special attention.
Diagnostic Errors ; Femur ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Osteosarcoma ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: We analyzed the oncologic characteristics and outcome of patients with inflammatory myofibroblastic tumor of extremities. MATERIALS AND METHODS: Among the soft tissue tumor patients who were treated between 1999 and 2012, 5 patients who were pathologically confirmed as the inflammatory myofibroblastic tumor of extremities were analyzed retrospectively. RESULTS: There were 1 man and 4 women with mean age of 44 years (37-55 years). The average follow up was 34.6 months (8-87 months). All patients underwent surgical treatment. Only 1 patient had wide resection margin and remaining 4 had marginal (3) or intralesional (1) resection margin. All of 4 patients without wide resection margin developed local recurrence at 10.3 months (8-19 months). Malignant transformation to fibrosarcoma was occurred in 2 patients who developed local recurrence, and 1 patient developed multiple metastases to lung, liver and lymph nodes and expired at 37 months. Three of 5 patients had tumor location abutted to or invasion to major arteries and 1 patient had tumor invading sciatic nerve. CONCLUSION: It is observed that inflammatory myofibroblastic tumor of extremities is usually located near the major neurovascular structure. Wide resection should be considered as the initial surgical treatment because this tumor showed a high local recurrence rate and possibility of malignant transformation.
Arteries ; Extremities ; Female ; Fibrosarcoma ; Follow-Up Studies ; Humans ; Liver ; Lung ; Lymph Nodes ; Myofibroblasts ; Neoplasm Metastasis ; Recurrence

BACKGROUND: The aim of this study was to estimate the minimum effective volume (MEV) of 1.5% mepivacaine for ultrasound-guided supraclavicular block by placing the needle near the lower trunk of brachial plexus and multiple injections. METHODS: Thirty patients undergoing forearm and hand surgery received ultrasound-guided supraclavicular block with 1.5% mepivacaine. The initial volume of local anesthetic injected was 24 ml, and local anesthetic volume for the next patient was determined by the response of the previous patient. The next patient received a 3 ml higher volume in the case of the failure of the previous case. If the previous block was successful, the next volume was 3 ml lower. MEV was estimated by the Dixon and Massey up and down method. MEV in 95, 90, and 50% of patients (MEV95, MEV90, and MEV50) were calculated using probit transformation and logistic regression. RESULTS: MEV95 of 1.5% mepivacaine was 17 ml (95% confidence interval [CI], 13-42 ml), MEV90 was 15 ml (95% CI, 12-34 ml), and MEV50 was 9 ml (95% CI, 4-12 ml). Twelve patients had a failed block. Three patients received general anesthesia. Nine patients could undergo surgery with sedation only. Only one patient showed hemi-diaphragmatic paresis. CONCLUSIONS: MEV95 was 17 ml, MEV90 was 15 ml, and MEV50 was 9 ml. However, needle location near the lower trunk of brachial plexus and multiple injections should be performed.
Anesthesia, General ; Brachial Plexus ; Forearm ; Hand ; Humans ; Mepivacaine ; Needles