RESUMEN
Chondromyxoid fibroma is an uncommon benign cartilaginous tumor of the bone. It occurs most frequently in the metaphysis of long tubular bones, and an epiphyseal location is exceedingly rare. We present here an unusual case of a chondromyxoid fibroma that occurred in the epiphysis of the proximal tibia with an open growth plate. MR imaging findings of this tumor, which has, to the best of our knowledge, never been described in an epiphyseal location, makes the present case unique.
Asunto(s)
Adolescente , Humanos , Masculino , Neoplasias Óseas/diagnóstico , Condroma/diagnóstico , Epífisis , Fibroma/diagnóstico , Imagen por Resonancia Magnética , TibiaRESUMEN
Tissue bank with profer personnels (medical director, tissue bank speciality, and so on), facilities, equipments, standard of procedures (SOP) and quality control (QC) programs should get the permission from Korea Food and Drug Administration (KFDA). All kinds of tissues are donated from live donors, cadavers or brain deaths without any rewards. Permission to acquire tissues shall be obtained through the granting of informed consent by a consenting person in accordance with applicable Korean law and regulations for anatomical gifts. One or two more tissue banks participate in recovery, preservation, quarantine, processing, packaging, storage, and/or distribution. The relationship and responsibilities of each shall be delineated in writing and that documentation shall be maintained at each participating bank or facility. Each tissue bank should keep the safety for all tissues under the strict SOP and QC programs, including donor screening, donor testing and donor exclusion criteria. And also, the final human tissue products should keep in sterile package and transfer to medical facilities for reconstruction of patients' defects under profer temperature within transportation containers. Potential adverse reactions, suspected transmission of disease or complications, directly or indirectly related the allograft, shall be reported to KFDA for the further safety
Asunto(s)
Humanos , Muerte Encefálica , Cadáver , Selección de Donante , Organización de la Financiación , Donaciones , Consentimiento Informado , Jurisprudencia , Corea (Geográfico) , Embalaje de Productos , Control de Calidad , Cuarentena , Recompensa , Control Social Formal , Bancos de Tejidos , Donantes de Tejidos , Trasplante Homólogo , Transportes , United States Food and Drug Administration , EscrituraRESUMEN
STUDY DESIGN: Radiological investigation to study the morphologic difference of posterior facet joint in spondylolysis and isthmic spondylolisthesis. OBJECTIVES: To study the correlation of the clinical differences between the one with spondylolysis and another with isthmic spondylolisthesis with morphological analysis of posterior facets of lumbar spine in low back pain, anterior displacement and segmental instability. SUMMARY OF LITERATURE REVEIW: There are many studies for the lumbar facet in back pain, disc degeneration, degenerative spondylolisthesis. However, little is known about the correlation of facet joint between the spondylolysis and isthmic spondylolisthesis. METHODS: This study is done with 27 specimens which contain posterior facet and lamina from 25 patients due to spondylolysis or isthmic spondylolisthesis. We took the computed tomograms in each specimen and obtained the areas and angles of posterior facets of lumbar spine. RESULTS: The group with spondylolysis has mean area(Rt/Lt) of 158.4/159.3mnfand angle(Rt/Lt) of 49.8u/54.0u. The group with isthmic spondylolisthesis has mean area(Rt/Lt) of 172.3/189.6mnfand angle(Rt/Lt) of 44.3u/44.8u. The group with segmental instability has mean(Rt/Lt) area of 155.9/161.8mnfand angle of 48.1u/50.4u. The group without instability has mean area(Rt/Lt) of 173.4/185.2mnfand angle(Rt/Lt) of 46.2u/48.5u. CONCLUSION: There are no significant differences between the morphologic difference of facets with back pain and without back pain. The group with isthmic spondylolisthesis has greater mean area and less mean angle of facet than the group with spondylolysis, but, there are no statistical significant differences(p>0.05). There are no significant morphologic differences of facet between the group with segmental instability and without segmental instability.
Asunto(s)
Humanos , Dolor de Espalda , Degeneración del Disco Intervertebral , Dolor de la Región Lumbar , Columna Vertebral , Espondilolistesis , Espondilólisis , Articulación CigapofisariaRESUMEN
Thyroid acropachy is a rare complication of Graves' disease, manifested by clubbing of the terminal phalanges, periosteal new bone formation and overlying soft tissue swelling, It may occur when the patient is hypothyroid, euthyroid or hyperthyroid. In most cases, it is a part of the syndrome, including exophthalmos and/or pretibial myxedema. The authors have experienced one case of thyroid acropachy and report with a review of the literature review. The patient a 56-year-old female with a characteristic feathery new bone formation on the medial side of the shaft of the left first metatarsal bone and overlying soft tissue swelling. However, there was no pretibial myxedema and clubbing of fingers. She was hypothyroid and treated with systemic corticosteroid for mild pain and persistent swelling. The treatment had temporarily improved the patient's condition.
Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Exoftalmia , Dedos , Enfermedad de Graves , Huesos Metatarsianos , Mixedema , Osteogénesis , Glándula TiroidesRESUMEN
To investigate changes in the radiographic appearance during weight-bearing in hallux valgus and examine the significance of the weight-bearing view, a comparative study was performed. Both normal and hallux valgus patients, who were all women over forty years old were studied. We reviewed radiographs of 100 normal feet in 50 patients and 70 symptomatic hallux valgus feet in 40 patients. Dorsoplantar radiographs were taken during weight-bearing and nonweight-bearing. Quantifiable angles were identified on dorsoplantar films in both the weight-bearing and nonweight-bearing positions. The measured angles were the hallux valgus angle, intermetatarsal angles between the first and second metatarsals, the second and third metatarsals, the third and fourth metatarsals, the fourth and fifth metatarsals, the first and fifth metatarsals, and the second and fifth metatarsals, and the interphalangeal angle. The hallux valgus angles in both groups were not constant on weight-bearing, whereas the intermetatarsals angle between the first and second metatarsals in both groups increased significantly on weight-bearing. The results show that most of the changes thought to occur with weight-bearing cannot be consistently demonstrated. Obtaining a weight-bearing view may not be routinely indicated in all patients.
Asunto(s)
Femenino , Humanos , Pie , Hallux Valgus , Hallux , Huesos Metatarsianos , Soporte de PesoRESUMEN
PURPOSE: To document the radiologic characteristics of Korean Gaucher disease. MATERIALS AND METHODS: Fifteen bone marrow biopsy and laboratory data confirmed Gaucher disease patients (age 1 -21, mean 10.9 yr) wereundertaken plain X ray and MRI. Number of type I were 10, type II, 2, type III, 3. Seven were splenectomized oninitial evaluation or during follow up. Five enzyme treated patient were undertaken follow-up MR examinationduring 6 -40 month with 6 month interval. Conventional T1 and T2WI of spine and femur was performed and FMPSPGR inand out of phase image was also done. Volume of liver and spleen were measured, and bone marrow infiltration andpresence of infarction were scored according to 6 scale scoring system. Clinical data were also reviewed andcorrelated with the MR findings. RESULTS: Marrow infiltration was noted in 71.4% of all patients in MRI, while itwas in 45.7% with plain radiography. Type I group showed marrow infiltration in all but one cases, which wasparallel with ages, SGPT, and presence of osteopenia, reversely correlated with spleen size. Severe bonecomplications (infarction or fracture) were noted in 7 of 10 type I group, and 6 patients showed severe growthretardation (below 3rd percentile). Follow up MR examination of 5 patient showed decrease in liver and spleen sizefirst without bone change until 6 months. There showed bone regeneration in 2 patient 1 year after, and increasedfat signal in one patient 3.5 years after. In and out of phase images couldn't help in quantifying fatcomposition in bone marrow. CONCLUSION: Korean Gaucher patients revealed as more severe skeletal complicationsthan others reported from Western groups. MR examination is a effective modality to evaluate and monitor ofGaucher patients.
Asunto(s)
Humanos , Alanina Transaminasa , Biopsia , Enfermedades Óseas Metabólicas , Médula Ósea , Regeneración Ósea , Fémur , Estudios de Seguimiento , Enfermedad de Gaucher , Infarto , Hígado , Imagen por Resonancia Magnética , Metabolismo , Radiografía , Columna Vertebral , BazoRESUMEN
PURPOSE: To discuss the technical aspect of interstitial brachytherapy including method of implant, insertion time of radioactive source, total radiation dose, and complication, we reviewed patients who had diagnoses of soft tissue sarcoma and were treated by conservative surgery, interstitial implant and external beam radiation therapy. MATERIALS AND METHODS: Between May 1995 and Dec. 1997, ten patients with primary or recurrent soft tissue sarcoma underwent surgical resection (wide margin excision) and received radiotherapy including interstitial brachytherapy. Catheters were placed with regular intervals of 1~1.5 cm immediately after tumor removal and covering the critical structures, such as neurovascular bundle or bone, with gelform, muscle, or tissue expander in the cases where the tumors were close to those structures. Brachytherapy consisted of high dose rate, iridium-192 implant which delivered 12~15 Gy to 1 cm distance from the center of source axis with 2~2.5 Gy/fraction, twice a day, starting on 6th day after the surgery. Within one month after the surgery, total dose of 50~55 Gy was delivered to the tumor bed with wide margin by the external beam radiotherapy. RESULTS: All patients completed planned interstitial brachytherapy without acute side effects directly related with catheter implantation such as infection or bleeding. With median follow up duration of 25 months (range 12~41 months), no local recurrences were observed. And there was no severe form of chronic complication (RTOG/EORTC grade 3 or 4). CONCLUSION: The high dose rate interstitial brachytherapy is easy and safe way to minimize the radiation dose delivered to the adjacent normal tissue and to decrease radiation induced chronic morbidity such as fibrosis by reducing the total dose of external radiotherapy in the management of soft tissue sarcoma with conservative surgery.
Asunto(s)
Humanos , Vértebra Cervical Axis , Braquiterapia , Catéteres , Diagnóstico , Fibrosis , Estudios de Seguimiento , Hemorragia , Radioterapia , Recurrencia , Sarcoma , Dispositivos de Expansión TisularRESUMEN
In the literature, the scapular neck fracture with ipsilateral acromioclavicluar dislocation(type I), mid-clavicular fracture(type II) or sternoclavicular dislocation(type III) is defined as floating shoulder. Authors managed 4 cases of type II floating shoulder, 3 cases by open reduction and internal fixation for the clavicular fracture only and 1 case by conservative therapy. The final results were excellent in 3 cases of the operative group and good in 1 case of the conservative group, by UCLA shoulder rating scale. There were no complications, including drooping or limited motion in the operative treatment group. However, there was shoulder pain in the case of the conservative treatment. It is thought that internal fixation for the clavicular fracture only may be the simple and sufficient treatment method for type lI floating shoulder.
Asunto(s)
Cuello , Dolor de Hombro , HombroRESUMEN
Osteosarcoma is one of the most common malignant bone tumors except for multiple myeloma. The current managements of the osteosarcoma patients include preoperative chemotherapy, definitive operation and postoperative chemotherapy with tremendous improved oncologic results by lots of Orthopedic Oncologists. The definitive operations are either limb-salvage operations or amputation. Limb-salvage operations include autograft, allograft, tumor prosthesis, or its combination. However, we have a difficulty to use allograft due to Korean traditonal customs. Authors managed the 6 year-old female patient with the osteosarcoma on the proximal metaphysis of the right humerus by wide-margin resection and reconstruction with a clavicula pro humero procedure with an excellent result, which technique was devised and developed by W. Winkelmann in Germany.
Asunto(s)
Niño , Femenino , Humanos , Aloinjertos , Amputación Quirúrgica , Autoinjertos , Quimioterapia , Alemania , Húmero , Mieloma Múltiple , Ortopedia , Osteosarcoma , Prótesis e ImplantesRESUMEN
Subacute hematogenous ostemyelitis is mostly likely due to an altered relationship between host and pathogen, associated with increase host resistance, decreased virulence of the causative organism and/or antibiotics modification. In a retrospective study of the hematogenous ostemyelitis in 156 cases, 19 cases of them were the subacute form of the ostemyelitis. Pain is the most consistent symptom and most of the constitutional symptoms were usually mild. However, the ESR was often elevated. From our data, the following results were obtained. 1. The most common skeletal involvement was the distal part of the tibia(8 out of 19 patients). 2. The causative organism was staphylococcus aureus by the bacterial culture of the specimens. 3. In the literature, acute hematogenous ostemyelitis rarely cross the physis in patients older than 18 months of its age. However, subacute ostemyelitis frequently does cross the physis(5 out of 19 patients). 4. Cross physeal lesions were healed without any permanant damage to the growth plate in our cases(5 out of 19 patients). 5. All patients except for one case were treated by curettage and antibiotics. 6. The mush higher incidence of the cross physeal lesions may be expected by MRI in identifying the lesion. 7. Seven out of 19 patients had radiographic findings similar to eosinophilic granjuloma, Ewing's sarcoma or osteosarcoma.
Asunto(s)
Niño , Humanos , Antibacterianos , Legrado , Eosinófilos , Placa de Crecimiento , Incidencia , Imagen por Resonancia Magnética , Osteosarcoma , Estudios Retrospectivos , Sarcoma de Ewing , Staphylococcus aureus , VirulenciaRESUMEN
The osteopoikilosis is commonly known as harmatoma in which metaphyseal and epiphyseal area of long bones and the bone of pelvis, hands, feet and et al, contain islands of dense cortical bone with normal Harversian system without any symptoms. The radiologic findings of the osteopoikilosis is multitude of oval or well-circumscribed areas of increased density, 2 to 10 mm in size, in symmetrical distribution and normal uptake in bone scan. Buschke-Ollendorff syndrome, which is transmitted by autosomal dominant, is characterized by the association of osteopoikilosis and connective tissue nevi which are popular and symmetrically distributed lesions on chest, back, buttock, thigh or arm. Authors report three Buschke-Ollendorff syndrome, studied by CT scan, MRI, bone scan and bone and skin biopsy, among five patients associated with osteopoikilosis found by simple radiologic study from ten members in one family with their pedigree.
Asunto(s)
Humanos , Brazo , Biopsia , Nalgas , Tejido Conectivo , Pie , Mano , Islas , Imagen por Resonancia Magnética , Nevo , Osteopoiquilosis , Linaje , Pelvis , Piel , Muslo , Tórax , Tomografía Computarizada por Rayos XRESUMEN
Freeman-Sheldon Syndrome is one of the very rare genetic diseases which primarily affects face, hands and feet. At first, Freeman and Sheldon described this syndrome as cranio-carpo-tarsal dystrophy in 1938 and later Burian, as "whistling face" syndrome in 1963. There were 60 cases of reports in the world up to now, and only one paper with 5 cases in a family was reported in Korea. The authors report 2 cases of Freeman-Sheldon Syndrome associated with bilateral inguinal hernias and undescended tests in a family, briefly review the literature and alert orthopaedic surgeons to this condition.
Asunto(s)
Humanos , Masculino , Criptorquidismo , Pie , Mano , Hernia Inguinal , Corea (Geográfico) , CirujanosRESUMEN
From September 1992 to April 1994, we reviewed 7 patients after arthroscopic surgery for anterior impingement in the ankle, who complained ankle pain and limitation of motion. All patients were mem and main symptoms were severe pain at full dorsiflexion of ankle and limitation of motion. Bony spur was located on the anterior aspect of tibia, and it was possible to resect the tibial bony spur arthroscopically without distraction devices. Mean operation time was 55 minutes. Pain, swelling and limitation of motion were much improved. There was no postoperative complication. Arthroscopic resection of the anterior tibial bony spur is an effective treatment for anterior impingement in the ankle.
Asunto(s)
Humanos , Tobillo , Artroscopía , Complicaciones Posoperatorias , TibiaRESUMEN
As a variety of the industrial accidents, we have experienced the paint-gun injuries at ship yard. Authors have experienced 17 patients (18 cases) of the paint-gun injuries at Okpo Daewoo Hospital, Daewoo Medical Foundation, Kyungnam from January, 1986 to September, 1992. After clinical and roentgenographical analysis, the clinical results were summarized as follows: The hand was the most common site (83.3%) among the upper extremity injuries, espicially right hand and we have had good results from the extensive debridement, curettage, prophylactic antibiotics and the penrose drain insertion in extensive injury cases, compared with minimal injury cases. However, we concluded that most of the cases in Paint-injures were preventalbe.
Asunto(s)
Humanos , Accidentes de Trabajo , Antibacterianos , Legrado , Desbridamiento , Mano , Navíos , Extremidad SuperiorRESUMEN
Between 1987 and 1992, 86 tibial fractures were treated with the Ilizarov external fixator at Gyeong-Sang National University Hospital and Okpo Hospital. The mean follow-up period was 31.4 months. Sixty-six were open fractures and twenty were closed fractures with severe comminution. In 66 open fractures, there were 9 Gustilo type I, 10 type II, and 47 type III fractures. Of 66 open fractures, 22 had bone defects ranged from 2cm to 17cm and 16 had extensive loss of soft tissue. Twenty-two bone defects were treated with cancellous bone grafts in 8 cases, bifocal osteosynthesis with bone graft in 12 cases, and trifocal osteosynthesis with bone graft in 2 cases. Thirty-four extensive soft tissue defects were treated with split-thickness skin graft, musculocutaneous flap, soft tissue transportation with ring used in bifocal, trifocal osteosynthesis, and acute shortening of fracture site. Of 20 closed fractures, 14 were treated with cancellous bone graft for decreasing union time and 6 were treated with monofocal compression without bone graft. The mean time to union was 20.5 weeks in closed fractures, and 35.4 weeks in open fractures. Of 40 complications, 12 were knee and ankle joint contractures, 12 were soft tissue and bone infections of pin tract, 5 were refracture, 5 were angular deformities of 10 degree or more, 5 were delayed union, and 2 were nonunion. According to Tucker's classification, the results were graded as excellent in 31, good in 38, fair in 12, and poor in 5 cases. Primary or secondary bone graft is necessary for early bony union and anatomical reduction combined with bone graft could prevent the complications of delayed union and nonunion.
Asunto(s)
Articulación del Tobillo , Clasificación , Anomalías Congénitas , Contractura , Fijadores Externos , Estudios de Seguimiento , Fracturas Cerradas , Fracturas Abiertas , Técnica de Ilizarov , Rodilla , Colgajo Miocutáneo , Piel , Tibia , Fracturas de la Tibia , Trasplantes , TransportesRESUMEN
The human hand is a highly sophisticated tool of sensibility and prehension, and the reconstruction of injured hands are essential to not only reconstruct of hand function but also reconstruct of body. Seven cases of tendocutaneous flap, a case of osteocutaneous flap, nine cases of thumb reconstruction with a free neurovascular wrap-around flap from the big toe, two cases of second toe-to-index trander, and a case of left ring finger to right index finger transfer were performed at the Department of Orthopedic Surgery of Hanyang University Hospital, and satisfactory results were obtained both comsmetically and functionally.