The main goals of treatment of malignant bone tumor are the prolongation of life survival and the improvement of quality of life. In growing children, however, leg length discrepancy (LLD) is one of major problem in the treatment of malignant bone tumors. Therefore, the precise understanding of growth in children is essential, and the prediction of LLD is critical in deciding the time and options of surgery. In addition, to use the adequate method of growth expectation, periodic follow-up and collaboration with patient's parents are needed.
Child ; Cooperative Behavior ; Humans ; Leg ; Life Support Care ; Parents ; Quality of Life

Primary bone tumors in pediatric age group are uncommon, and even when they do occur, they are usually benign. The primary malignant tumors that occur predominantly in children are two bone tumors, namely, osteosarcoma and Ewing's sarcoma. An adequate history and physical examination are the first and most important steps in evaluating a patient with a bone tumor. All suspected bone tumors should be evaluated initially with plain roentgenograms. Then the additional diagnostic studies, such as computed tomography(CT), magnetic resonance imaging(MRI) and technetium bone scan can be used, if necessary. Biopsy should be the last step in evaluation. Most of benign bone tumors usually do not require treatment other than a periodic follow-up evaluation. The optimal treatment of the malignant bone tumor often requires a combination of radiation therapy, chemotherapy, and wide surgical excision or amputation. Early detection of a malignant bone tumor not only may make the difference between life and death but also may allow successful salvage surgery rather than amputation of the limb.
Amputation ; Biopsy ; Child* ; Drug Therapy ; Extremities ; Follow-Up Studies ; Humans ; Osteosarcoma ; Physical Examination ; Sarcoma, Ewing ; Technetium

BACKGROUND: We investigated the expression of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) in malignant fibrous histiocytoma (MFH), and determined whether these could be useful as prognostic factors. METHODS: Among patients treated from 1993 to 2007, 30 cases of MFH were evaluated. Immunohistochemical staining was performed for MMP-2, MMP-9, TIMP-1, and TIMP-2 using paraffin wax-embedded blocks of MFH tissues. Reverse transcriptase polymerase chain reaction (RT-PCR) and Western blot and zymography were performed using fresh tissues obtained from 17 of the 30 cases. The levels of MMP and TIMP expression were compared between the MFH and normal control groups, and between non-metastatic and metastatic MFH groups. RESULTS: Expression levels of MMP-2, MMP-9, TIMP-1, and TIMP-2 were higher in the MFH group than the control group by RT-PCR, Western blotting, and zymography. Immunohistochemical staining revealed that MMP-2 and MMP-9 protein expression was higher in the metastatic than in the non-metastatic group. The expression levels of MMP-2 and TIMP-1 were significantly higher in the metastatic than in the non-metastatic group (p < 0.05) by RT-PCR. By Western blot analysis, the expression levels of MMP-2, TIMP-1, and TIMP-2 were higher in the metastatic group (p < 0.05), but MMP-9 showed only a slight increase in the metastatic group compared with the non-metastatic group (p > 0.05). Finally, gelatin zymography analysis showed that the expression levels of the pro- and active forms of MMP-2 were significantly higher in the metastatic group (p < 0.05), but the expression of the pro- and active forms of MMP-9 showed a slight decrease in the metastatic group (p > 0.05). CONCLUSIONS: These results suggest that MMP-2, MMP-9, TIMP-1, and TIMP-2 may have important roles in the development and progression of MFH, and that the degree of expression of these metalloproteinases and their inhibitors, especially MMP-2, could be useful as prognostic factors related to metastasis in MFH.
Adult ; Aged ; Aged, 80 and over ; Female ; Histiocytoma, Malignant Fibrous/*metabolism ; Humans ; Immunohistochemistry ; Male ; Matrix Metalloproteinase 2/*biosynthesis ; Matrix Metalloproteinase 9/*biosynthesis ; Middle Aged ; Neoplasm Metastasis ; Prognosis ; Tissue Inhibitor of Metalloproteinase-1/*biosynthesis ; Tissue Inhibitor of Metalloproteinase-2/*biosynthesis

PURPOSE: To evaluate the results of operative treatment for metaphyseal pathologic fracture of long bone in children using Locking Compression Plate (LCP). MATERIALS AND METHODS: Six children were enrolled in this study. The locations of fracture were proximal femur in five children and distal femur in one child. Pathologic diagnosis was aneurysmal bone cyst, in three children and simple bone cyst, enchondroma, and nonossifying fibroma, in other three children. All six children were underwent curettage of bone lesion and bone grafting, then the fractures were internally fixed using LCP. RESULTS: All fractures were united at six to ten weeks after operation. Healing of bone lesions except one case was observed. There were no mechanical complications, no loss of reduction and malunion. Also, we couldn't find any complication associated with physeal injury, such as leg length discrepancy of lower extremities. CONCLUSION: Internal fixation of metaphyseal pathologic fracture of long bone using LCP in children is technically easy and offers secure fixation despite anatomic and biologic characteristics of this type of fracture due to biologic and biomechanical advantages of LCP.
Aneurysm ; Bone Cysts ; Bone Transplantation ; Child ; Chondroma ; Curettage ; Femur ; Fibroma ; Fractures, Spontaneous ; Humans ; Leg ; Population Characteristics

PURPOSE: This study evaluated the results of the curettage and grafting of calcium sulfate for the treatment of a benign bone tumor to determine its efficacy as a bone graft substitute. MATERIALS AND METHODS: Thirty six cases of calcium sulfate(Osteoset(R)) grafting for bone defect after curettage of benign bone tumor were evaluated. There were 21 males and 15 females with a mean age of 23 years (6-64). There were 23, 10 and 3 cases grafted with the Osteoset only, the Osteoset with allografts and the Osteoset with autografts, respectively. The average follow up duration was 19 months (12-49). The process of bone formation was observed and the times for graft absorption and complete bone formation were assessed. In addition, the time of bone formation was compared according to the patients' age, size of lesion, and grafting method, and the development of complications was observed. RESULTS: Complete bone formation was observed in 34 (94.4%) out of 36 cases. The groups of younger patients, smaller size of lesion and grafting of Osteoset(R) only showed more rapid bone formation. However, there was no statistical significance. There was one case of soft tissue calcification observed. CONCLUSION: Calcium sulfate is an effective substitute for an autogenous bone graft in the case of the treatment of a benign bone tumor, particularly in the case of an insufficient graft, such as in children and in those with a large bone defect. This method is a safe method that prevents complications in the donor site.
Absorption ; Allografts ; Autografts ; Calcium Sulfate* ; Calcium* ; Child ; Curettage ; Female ; Follow-Up Studies ; Humans ; Male ; Osteogenesis ; Tissue Donors ; Transplants

PURPOSE: The purpose of this study was to evaluate whether the medial joint space could be restored by HTO in osteoarthritic knee associated with varus deformity and to evaluate its clinical results. MATERIALS AND METHODS: HTO for medial gonarthrosis was performed in 65 knee joints of 59 patient. The median follow-up period was 36 months. The femoro-tibial angle(FTA) and joint space distance of medial and lateral compartment of the knee was measured on the weight-bearing antero-posterior plain radiogram. And the clinical results were evaluated by HSS knee score composed of pain, function, range of motion, muscle strength, flexion deformity and instability. RESULTS: Medial joint space distance was restored to 2.9 mm in average at postoperative 3 years from 1.8 mm in average preoperatively. Also the lateral joint space distance was maintained without decrease. FTA was corrected from varus 6.3 degree in average preoperatively to valgus 7.3 degree in average at three years postoperatively. HSS score was improved from 69.1 point in average preoperatively to 95 points in average at three years postoperatively. The group of increased joint space distance showed more improved HSS score and more corrected FTA than the unchanged group(p<0.05). When the change of HSS score was compared according to the postoperative FTA, the group, FTA was corrected 7 degree or more had more improved clinical results and more increased joint space distance(p<0.05). Complications were pain or tenderness on the fibular osteotomy site in seven knees, nonunion of fibular osteotomy in seven knee, transient peroneal paresis in four knees and delayed union of tibial osteotomy in one knee. CONCLUSION: At three years follow up after HTO, there was restoration of joint space of the medial compartment of the knee. Also we found the fact that the joint space widening was correlated with clinical improvement. These results suggest that the correction angle of valgus 7 degree or more may have better clinical outcomes.
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Joints* ; Knee Joint ; Knee* ; Muscle Strength ; Osteotomy* ; Paresis ; Range of Motion, Articular ; Weight-Bearing

BACKGROUND/AIM: Recent advances in both diagnosis and treatment have markedly improved the prognosis in patients with hepatocellular carcinoma (HCC). Bone metastasis has become a clinical problem in the treatment of HCC patients. The purpose of this study was to evaluate the palliative effect of radiotherapy for painful bone metastasis from HCC. METHODS: From January 1991 to June 2000, 51 patients (77 sites) with painful bone metastasis from HCC were retrospectively analyzed. Ages ranged from 21 to 80 years (median 55 years). The male:female ratio was 7.5:1. Synchronous or metachronous bone metastasis was seen in 20 (39%) and 31 patients (61%), respectively. The most common symptom of bone metastasis was pain (45 patients, 88%). Twenty-one patients (41%) had a solitary bone metastasis while 30 (59%) had multiple ones. The sites of bone metastasis, in order of frequency, were the vertebra (38), rib (20), and pelvis (19). The total radiation dose ranged from 12.5 to 50 Gy (median 30 Gy). The Wisconsin Brief Pain Questionnaire was used to evaluate pain response. RESULTS: The overall 1 and 2 year survival rates from the time of bone metastasis were 15% and 4%, respectively. The median survival time was 5 months. Intrahepatic stage(p=0.014), and metastasis to other organs(p=0.019) were significant prognostic factor for survival by univariate analysis. There was, however, no independent prognostic factor on multivariate analysis. Pain relief after radiotherapy was achieved for 56 sites (73%). CONCLUSION: The expected life span (median 5 months) in this group of patients suggests a strong necessity for effective treatment for symptomatic palliation. Radiation therapy was effective in pain palliation for bone metastasis from HCC, and this could improve patients' quality of life.
Adult ; Aged ; Aged, 80 and over ; Bone Neoplasms/*radiotherapy/*secondary ; Carcinoma, Hepatocellular/mortality/*radiotherapy/*secondary ; English Abstract ; Female ; Human ; Liver Neoplasms/mortality/*pathology ; Male ; Middle Aged ; Palliative Care ; Retrospective Studies ; Survival Rate

BACKGROUND: Most patients with malignant esophageal stricture are surgically incurable at the time of presentation. The aim of this study was to determine the safety and efficacy of endoscopic expandable metal stent for palliation of dysphagia caused by malignant stricture. METHODS: From January 2000 to December 2001, thirty-two expandable metal stents (Nitis(R) Taewoong Med. Co. Korea, 6 uncovered, 12 covered, 14 double stents for antimigration, 18 mm diameter) were placed in 28 consecutive patients with dysphagia caused by malignancy. Dysphagia score, complications, reintervention, survival length after stent placement were evaluated. RESULTS: This study consisted of 23 men and 5 women. The patients were composed of 13 esophageal carcinomas, 11 gastro-esophageal junction cancers or cardiac cancers, 3 lung cancers, 1 breast cancer. Immediate improvement of dysphagia symptom was seen after initial stent placement in 27 patients (96%). Dysphagia score decreased from 3.0 (+/-0.51) to 1.06 (+/-0.77) after stent placement. There was one death due to hemorrhage after the procedure. There was no stent migration. Restenting was required in 4 cases due to tumor ingrowth (1/4) and overgrowth (3/4) and average interval to restenting was 95 days. Mean survival length was 109 days. CONCLUSION: Expandable metal stents offer excellent rapid palliation of malignant dysphagia. In a small subset of patients who received chemoradiation before stent placement, major complications such as bleeding, perforation, were observed.
Breast Neoplasms ; Constriction, Pathologic ; Deglutition Disorders ; Esophageal Stenosis ; Female ; Heart Neoplasms ; Hemorrhage ; Humans ; Korea ; Lung Neoplasms ; Male ; Stents*

Nonvisualization of left circumflex coronary artery from the left coronary artery is commonly due to anomalous origin of circumflex artery from the right coronary artery or right sinus of Valsalva. However, complete ostial obstruction of circumflex artery, circumflex artery extended from the right coronary artery, anomalous origin of circumflex artery from the pulmonary artery may be the cause. We report two cases of absent left circumflex artery from the left coronary artery, in which the circumflex artery arose as a terminal extension of the right coronary artery. Angiographic features of absent left circumflex artery from the left coronary artery were described.
Arteries* ; Coronary Vessels* ; Pulmonary Artery ; Sinus of Valsalva

We descrive a 23-year-old female of 46, XXqi Turner's syndrome associated with large atrial sepatal defect(secundum type) and mitral valve prolapse who was admitted due to amenorrhea, sexual infantilism and exertional dyspnea. This patient had only one spontaneous menstrual period at the age of 15 and had a short stature without webbed neck. Chromosomal aberrations cause primarily structural defects of cardiovasculaqr system, and a variety of structural aberrations involving the X chromosome and cause partial or complete Turner's syndrome. In Turner's syndrome, bicuspid aortic valve or coarctaton of aorta is frequently combined, also aortic root dilatation, partial anomalous venous drainage, hypoplastic left heart and ventricular septal defect, atrial septal defect has been reported. However, this patient had not abnormalities in aortic valve and whole aorta. Atrial septal defect simultaneously with mitral valve prolapse in 46 XXqi Turner's syndrome have not been reported in Korea. We report this case with a brief review of the literature.
Amenorrhea ; Aorta ; Aortic Valve ; Bicuspid ; Chromosome Aberrations ; Dilatation ; Drainage ; Dyspnea ; Female ; Heart ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Korea ; Mitral Valve Prolapse ; Mitral Valve ; Neck ; Sexual Infantilism ; Turner Syndrome ; X Chromosome ; Young Adult