PURPOSE: With advances in various treatment modalities, limb salvage surgery has been commonly used in osteosarcoma of extremities. An alternative method for skeletal reconstruction is reimplantation of the tumor bearing bone following extracorporeal irradiation (ECI). We report the long-term results of ECI autograft in aspect of the oncological and functional outcomes, and complications. MATERIALS AND METHODS: We retrospectively reviewed 31 osteosarcoma patients who underwent reconstruction with ECI between July 1995 and January 2006. There were 24 males and 7 females with a mean age of 24 (7-74 years) and a mean follow-up of 117 months (17-177 months). Twenty-five cases were reconstructed with ECI autograft, 6 cases with ECI autograft-prosthesis composite. The pathologic subtypes were conventional in 29 cases, periosteal in 1 case, and parosteal in 1 case. The most common location of tumor was distal femur (15 cases) followed by humerus (3), proximal fibula (3) and proximal tibia (3). Musculoskeletal Tumor Society (MSTS) score was used for functional evaluation. The overall survival rate, local recurrence, complications were analyzed. RESULTS: The overall survival rate was 80.6% and the disease-free survival rate was 64.5%. Five patients died of distant metastasis. One patient required above-knee amputation due to local recurrence. All of them, twenty-three complications occurred, which included nonunion in 7 cases, deep infection in 5 cases, joint instability in 4 cases, metal failure in 2 cases, Limb-length discrepancy (LLD) in 2 cases, periprosthetic fracture in 1 case, epiphyseal collapse in 1, local recurrence in 1 case. The mean MSTS functional score was 62.5%. CONCLUSION: Extracorporeal irradiated autograft can be achieved relatively good result in aspect of oncological and functional aspect, but is needed to be additional research about occurring many complications. The reconstruction with ECI after intercalary or fragmentary resection is effective reconstruction in aspect of oncological and functional result, complications.
Amputation ; Disease-Free Survival ; Extremities ; Female ; Femur ; Fibula ; Follow-Up Studies ; Humans ; Humerus ; Joint Instability ; Limb Salvage ; Male ; Neoplasm Metastasis ; Osteosarcoma ; Periprosthetic Fractures ; Recurrence ; Replantation ; Retrospective Studies ; Survival Rate ; Tibia ; Ursidae

No abstract available.
Dermatitis, Atopic ; Pyroglyphidae

OBJECTIVE: Under the definition of macrosomia where the birth weight of the fetus being 4,000 grams or more, we analyzed and studied the obstetrical problems, complications of both mother and the fetus and the predisposing factors of macrosomia in this report. METHODS: A study was done on 231 cases of macrosomia infants weighing 4,000 grams or more out of 5220 full-term delivered cases in Dongguk University, Kyung-ju hospital from January, 1998 to December, 2002. RESULTS: The frequency of macrosomia ranged from 4.18% in 4,000 g or more to 0.42% in 4,500 g or more. In macrosomia frequency correlations to parity showed 41.13% (95 cases) in primiparous women, 58.87% (134 cases) in multiparous women. According to the type of delivery, normal vaginal delivery has proven to be the most, consuming 52.38% (121 cases), where Cesarean section was 47.61% (110 cases). Indications for Cesarean section ranged from cephalopelvic disproportion (27.3%) to previous Cesarean section (25.4%), in the order of frequency. Maternal complications due to delivery showed highest incidence in postpartum hemorrhage (13.63%), followed by birth canal laceration (12.12%). As of fetal complications, 3 cases (2.72%) of cephalhematoma existed, and 1 brachial plexus palsy and clavicle fracture were reported and 1 case of fetal death was reported. CONCLUSION: It would be appropriate to have definite diagnostic schemes and adequate choice of delivery method for macrosomia. Therefore, the complications of macrosomia could be decreased by a well-trained delivery coming in forehand.
Birth Weight ; Brachial Plexus ; Causality ; Cephalopelvic Disproportion ; Cesarean Section ; Clavicle ; Female ; Fetal Death ; Fetal Macrosomia* ; Fetus ; Gyeongsangbuk-do ; Humans ; Incidence ; Infant ; Lacerations ; Mothers ; Paralysis ; Parity ; Parturition ; Postpartum Hemorrhage ; Pregnancy

PURPOSE: Sentinel lymph node (SLNB) is the first confronted lymph node from primary lesion of tumor through lymphatic drainage, which is important for determining early metastasis and setting guidelines for treatment. We reported significant of sentinel lymph node biopsy in malignant melanoma (MM) and squamous cell carcinoma (SCC) of lower extremities. MATERIALS AND METHODS: Twenty-five cases of surgically treatment and being possible for follow up more than 1 year among the patients who were diagnosed as MM and SCC in this institution from Sep. 2005 to Jan. 2009, and 10 cases of them were performed SLNB. Average age was 64 years old, and 15 cases of male and 10 cases of female were in this group. RESULTS: 3 years overall survival rate was 100% and 3 years disease-free survival rate was 76%. Metastasis occurred in total 6 patients, 4 cases of inguinal lymph nodes, 1 case of soft tissue around knee, 1 case of left achilles tendon. In 15 cases of not performing SLNB, overall survival rate was 93.3% and disease-free survival rate was 73.3%. In 10 cases of performing SLNB, overall survival rate was 100% and disease-free survival rate was 90%. And only 1 case showed positive finding in the biopsy, and none of the 10 cases showed metastasis in follow-up. CONCLUSION: SLNB leads simpler and less complications compared to prior elective lymph node dissection, and shows high degree of accuracy. Throughout the SLNB, setting guidelines for treatment by accurate staging is thought to be helpful for increasing the survival rate in the patient with MM and SCC.
Achilles Tendon ; Biopsy ; Carcinoma, Squamous Cell ; Disease-Free Survival ; Drainage ; Female ; Follow-Up Studies ; Humans ; Knee ; Lower Extremity ; Lymph Node Excision ; Lymph Nodes ; Male ; Melanoma ; Neoplasm Metastasis ; Nitriles ; Pyrethrins ; Sentinel Lymph Node Biopsy ; Survival Rate

OBJECTIVE: The aim of this study was to assess the relationship between disease progression and expression of c-erbB-2 and S-100 protein positive dendritic cells in Cervical cancer. STUDY DESIGN: Tissues were analyzed from 100 patients. Each of them had invasive carcinoma(44), microinvasive(12), CIS(33), CIN(II) before treatment, c-erbB-2 oncoprotein expression and S-100 protein positive dendritic cell were confirmed by immunohistochemical staining. (Avidin-biotin complex method) RESULTS: C-erbB-2 immunostaining was significantly associated with disease progression (p<0.05). In case of CIN I, there was not noted stained specimen but in case of invasive carcinoma, 24 cases of stained specimen were noted. S-100 protein positive dendritic cell was not associated with disease progression of cervical carcinoma.(p>0.05) CONCLUSIONS: According to our results, c-erbB-2 is possible factor in Carcinogenesis of cervical carcinoma with progression of it. and S-100 protein positive dendritic cell was not associated with disease progression of cervical carcinoma.
Carcinogenesis ; Carcinoma, Squamous Cell* ; Cervix Uteri* ; Dendritic Cells* ; Disease Progression ; Female ; Humans ; S100 Proteins* ; Uterine Cervical Neoplasms

In double eyelid operation, if the eyes have too little fat and soft tissue, or if the orbital fat were removed too much in the operation, the double eyelid crease is too high. And the supra-tarsal recess becomes hollow and the adhesion of eyelid crease occurs even in orbital septum and levator muscle. Secondary double eyelid operation in response to these problem needs to correct the height of eyelid crease or the supra-tarsal depression by releasing the inadequately high eyelid fold and preventing re-adhesion. Moreover, in case the muscle and scar tissue are bulged below the incision line, the height of double eyelid should be appropriately lowered, the adhesion should be released, and the bulky lower flap should be flattened. In case the adjacent tissue (e.g., preaponeurotic fat) was excessively removed during the primary double eyelid operation, free-fat graft or dermis-fat graft has been done to correct supra-tarsal depression and re-adhesion. These graft materials are extracted from a distant donor site. Even if the adjacent tissue was not sufficient, we made the superiorly based local flap or graft of pre-tarsal scar-muscle tissue obtained after thinning the bulky lower flap. In these cases, the fibrous muscle flap or graft compensated tissue depletion with a proper mass around the double eyelid crease and help prevent re-adhesion. Of the 1225 patients with high placement of supra-tarsal fold with bulky lower skin flap, we used pretarsal fibro-muscular flap in 914 patients and pretarsal fibro-muscular graft in treating 311 patients from November 1997 to October 2005. And we eventually found that the operation was successful in making a natural eye shape and preventing re-adhesion with no requirement of a distant donor site. We found that the pretarsal fibro-muscular flap or graft were effective in reducing the operative time and lowering the risk of post-operative infection, preventing the re-adhesion, correcting the supratarsal depression and making a natural eye shape with a slender eyelid line.
Cicatrix ; Depression ; Eyelids ; Humans ; Operative Time ; Orbit ; Skin ; Tissue Donors ; Transplants

Acute hypokalemic paralysis is characterized by acute systemic weakness and low serum potassium. Trigger point injection (TPI) is frequently performed for myofacial pain relief with rare complications. 34-year-old male was admitted with quadriparesis after TPI with dexamethasone and lidocaine before 24 hours. Hypokalemia was found with compatible findings on nerve conduction studies and electromyography. Hypokalemia and weakness were fully recovered after potassium replacement. Steroid and lidocaine can provoke iatrogenic hypokalemic paralysis, therefore, TPI with these medications should be cautiously performed.
Adult ; Dexamethasone* ; Electromyography ; Facial Pain ; Humans ; Hypokalemia ; Lidocaine* ; Male ; Neural Conduction ; Paralysis* ; Potassium ; Quadriplegia ; Trigger Points*

Malignant growth of the small bowel accounts for approximately 1 to 3 percent of malignant tumors of the gastrointestinal tract. Leiomyosarcomas are the second most common primary tumor of the small bowel, their frequency being one-third to one-half of adenocarcinoma. The common clinical symptoms of leiomyosarcoma of the small intestine are hemorrhage and abdominal pain. Accurate diagnosis cannot be based on solely on the roentgenographic finding, although in certain situations the dignosis of leiomyosarcoma may be suggested strongly. We report a case of bleeding leiomyosarcoma located in the second portion of the duodenum which was first recognized by endoscopic examination and confirmed by explolaparotomy.
Abdominal Pain ; Adenocarcinoma ; Diagnosis ; Duodenum* ; Gastrointestinal Tract ; Hemorrhage ; Intestine, Small ; Leiomyosarcoma*

Osteoporosis represents reduced amount of bone mass per unit volume as compared with controls of the same age and sex. The purpose of this study was to show how bone mineral densities of spine and intertrochanteric area decrease with aging, to investigate the relationship between the bone mineral densities (BMD) of the two areas, and to obtain fracture threshold values. We measured BMD of lumbar vertebrae and intertrochanteric areas by Dual Energy X-ray Absorptiometry (DEXA) from 241 postmenopausal women. 190 normal postmenopausal women comprised non-fracture group and there were 50 fresh thoracolumbar fracture patient and 31 intertrochanteric fracture patients in whom the fractures were not caused by high energy trauma. The mean bone mineral density values of non-fracture group were significantly higher than those of fracture groups and significant correlation held between bone density of spine and that of intertrochanteric area in non-fracture group and fracture groups. The fracture threshold was 0.837 g/cm3 in spine fracture group and 0.792 g/cm3 in the intertrochanteric fracture group.
Absorptiometry, Photon* ; Aging ; Bone Density* ; Female ; Humans ; Lumbar Vertebrae ; Osteoporosis ; Spine

PURPOSE: The authors investigated the process of endochondral ossification quantitatively and objectively in respect to proliferation and apoptosis. MATERIALS AND METHODS: Fractures were made on the left tibiae of 72 male Sprague-Dawley rats. The fracture callus was harvested at the 5th, 7th, 9th, 11th, 14th, and the 21st day after fracture. Cellular DNA content was analyzed with image cytometry, and proliferative index was determined from the data. The Ki-67 antigen expression was semiquantitatively measured by the immunohisto-chemical method. TUNEL was used for in situ localization of apoptotic cells. The expression of cell cycle inhibitors, P21 and P27, was investigated with Northern blotting. RESULTS: The proliferation index was highest on the 5th day, then gradually decreased until the 11th day. The expression of Ki-67 antigen gradually decreased with time. Apoptotic cells increased in accordance with enhanced bone formation within chondroid callus. The expression of p21 and p27 was highest on the 11th and the 14th day. CONCLUSIONS: These findings show that proliferative activity decreased with the reduction of mesenchymal tissue and the appearance of mature chondroid tissue. The apoptosis of hypertrophic chondrocytes occurred in accordance with enhanced bone formation. P21 and P27 had a certain role in the differentiation of chondrocytes.
Apoptosis* ; Blotting, Northern ; Bony Callus ; Cell Cycle ; Cell Proliferation* ; Chondrocytes ; DNA ; Fracture Healing* ; Humans ; Image Cytometry ; In Situ Nick-End Labeling ; Ki-67 Antigen ; Male ; Osteogenesis ; Rats, Sprague-Dawley ; Tibia