• Title/Summary/Keyword: 골수 전이

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Value of Tibiotalocalcaneal Arthrodesis Using Retrograde Intramedullary Nailing in Severe Hindfoot Deformity and Arthritis (심한 후족부 변형 및 경거종골간 관절염에서 골수강내 금속정을 이용한 경거종골 관절 유합술의 가치)

  • Park, Jae-Gu;Chung, Hyung-Jin;Bae, Su-Young;Lee, Jung-Hwan;Kim, Hwi-Young;Lee, Jun Seok
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.2
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    • pp.133-140
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    • 2019
  • Purpose: This study examined the radiological and clinical outcomes of tibiotalocacalcaneal arthrodesis using retrograde intramedullary nailing in a severe hindfoot deformity and ankle/subtalar arthritis. Materials and Methods: A total of 22 patients (22 cases) with a severe hindfoot deformity and arthritis underwent tibiotalocalcaneal arthrodesis with retrograde intramedullary nails. The average age was 57.4 years (22-82 years) and the mean follow-up was 29.6 months (12-74 months). The radiological outcomes included an assessment of the preoperative and postoperative coronal ankle alignment, hindfoot alignment, sagittal alignment, and postoperative union time. The clinical outcomes were evaluated using the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, and postoperative complications. The results were analyzed statistically by dividing the patients into two groups based on a 10° angle of deformity. Results: Regarding the preoperative coronal ankle alignment, 14 patients had a mean varus deformity of 17.8°±14.5° and six had a mean valgus deformity of 8.1°±6.6°. Postoperatively, a satisfactory postoperative coronal ankle alignment of less than 5° was obtained in all patients. Regarding the preoperative hindfoot alignment, 12 patients showed a mean varus deformity of 15.2°±10.5° and six had a mean valgus deformity of 8.1°±4.2°. In total, 94.4% (17 patients) had satisfactory postoperative hindfoot alignment of less than 5°. Radiological union was achieved in 90.9% at an average of 19.2 weeks (12-32 weeks) and there were 2 cases of nonunion. The clinical outcomes showed improvement in the mean VAS and AOFAS scores (p<0.001, p<0.001, respectively). Even a preoperative severe deformity more than 10° showed a significant deformity correction of coronal ankle alignment and hindfoot alignment, postoperatively (p<0.001, p<0.001, respectively). No significant differences were found between the patients with a preoperative coronal ankle deformity more than 10° and those less than 10° regarding the mean postoperative coronal ankle alignment (p=0.162). Conclusion: Tibiotalocalcaneal arthrodesis using retrograde intramedullary nailing is an acceptable technique for achieving satisfactory deformity correction, high union rate with minimal complications, and improvement of the clinical outcomes. In addition, tibiotalocalcaneal arthrodesis using retrograde intramedullary nailing is considered an effective treatment option, particularly in severe ankle and hindfoot deformities.

Treatment of Benign Bone Lesions with Autologous Bone Marrow Stromal Cell Transplantation (자가 골수 기질 세포 이식을 이용한 장관골 양성 골 병변의 치료)

  • Rhee, Seung-Koo;Kang, Yong-Koo;Kim, Yong-Sik;Bahk, Won-Jong;Chung, Yang-Guk;Kim, Hyoung-Jun;Ok, Ji-Hoon
    • The Journal of the Korean bone and joint tumor society
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    • v.10 no.1
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    • pp.13-21
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    • 2004
  • Purpose: We analyzed the result of autologous bone marrow stromal cell transplantation with or without cancellous chip bone allograft for benign long bone lesions. Materials and methods: Since July 1996, eight benign bone lesions treated by curettage, cancellous chip bone allograft and bone marrow or marrow stromal cell transplantation were observed for resolution of clinical symptoms, new bone formation and consolidation. There were 6 males and 2 females. Average age was 24 (range 8 to 47) years old. Histologic diagnoses were 5 fibrous dysplasia, 2 simple bone cysts and one chondroblastoma and fibrous cortical defect each. Mean follow-up period was 16.3 (range 3 to 84) months. Results: In all four symptomatic patients, the pain was subsided in two weeks after surgery. New bone formation in the lesion was observed at 4 weeks, which incorporated into surrounding normal bone around 8 weeks. There were one pathologic fracture through the lesion at 3 weeks and one recurrence of simple bone cyst at 5 months postoperatively. Conclusion: Bone marrow or marrow stromal cell transplantation for bone defects from curettage of benign bone lesions, with or without cancellous chip bone allograft revealed rapid healing. Though it was the result of short-term follow up, it supports that bone marrow stromal cell transplantation will be very useful for the treatment of benign long bone cysts or other lesions. The complete curettage of inner cystic wall is important to prevent later recurrence, and the rigid internal fixation is also needed in selected high risk lesions of fracture.

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Clinical Study of Acute Pyogenic Osteomyelitis in Children (소아 급성 화농성 골수염의 임상적 고찰)

  • Park, Ji Sook;Yeom, Jeong Suk;Hwang, Sun Chul;Park, Eun Sil;Seo, Ji Hyun;Lim, Jae Young;Park, Chan Hoo;Woo, Hyang Ok;Youn, Hee Shang
    • Clinical and Experimental Pediatrics
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    • v.48 no.7
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    • pp.731-736
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    • 2005
  • Purpose : Acute pyogenic osteomyelitis is uncommon in children. Delayed diagnosis and inappropriate treatment are leading to growth failure and deformation. We review the clinical manifestations and treatment of acute osteomyelitis in children according to age. Methods : A retrospective analysis was made of 32 patients who underwent antibiotic management or operation between Aug 1989 and Dec 2003 for acute pyogenic osteomyelitis in age from 0 to 15 years old. Results : The study group was composed of 21 boys and 11 girls. The subjects were divided into four groups according to age : 0-1 yr(n=6), 1-5 yr(n=11), 6-10 yr(n=8), and 11-15 yr(n=7). Nineteen cases were diagnosed in Winter. Femur was the most common infected site(37.5%). There were no predisposing factor in 17 patients, and 7 of 15 patients had trauma history. Sepsis was important predisposing factor in neonates. The chief complaints were pain, swelling and fever. S. aureus(61%) is the most common organism. Twenty-nine patients were treated with operation and concomitant antibiotics. Two cases had sequelae in follow-up period : One is avascular necrosis of femur and the other is discrepancy of leg length. Conclusion : In our review, because of poor prognosis in septic neonates, we recommend to treat actively neonatal sepsis and prevent or detect osteomyelitis early. Because most of patients were diagnosed and treated in orthopedic surgery, the rate of operation was too high. So, protocol for further evaluation and management of acute osteomyelitis in pediatric patients were needed.

Beyond the Molecular Facilitator, CD82: Roles in Metastasis Suppressor, Stem Cell Niche, Muscle Regeneration, and Angiogenesis (분자 촉진제를 넘어, CD82: 전이억제자, 줄기세포 니쉬, 근육 재생 및 혈관신생에서의 역할)

  • Lee, Hyun-Chae;Han, Jung-Hwa;Hur, Jin
    • Journal of Life Science
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    • v.31 no.9
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    • pp.856-861
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    • 2021
  • CD82/KAI1, identified as a metastasis suppressor, was initially known only as a molecular facilitator, but its various functions have recently been revealed. CD82 plays an important role in the stem-progenitor cell, angiogenesis, and muscle. We would like to introduce the recently reported functions and roles of CD82 in this review. CD82 is a member of the tetraspanin family, which consists of four transmembrane domains. The interaction between CD82 and cell adhesion molecules suppresses the metastasis of cancer. CD82 regulates the cell cycle of stem-progenitor cells in the stem cell niche. In the bone marrow, CD82 is expressed on long-term repopulating hematopoietic stem cells (LT-HSCs), which show multipotent differentiation potential. The interaction between CD82 and Duffy antigen receptor for chemokines (DARC) induces quiescence in LT-HSCs. CD82 also regulates Rac1 activity, resulting in the homing and engraftment of HSCs into the bone marrow niche. Besides, CD82 maintains the differentiation potential of muscle stem cells and prevents angiogenesis by inhibiting the expression of cytokines, such as IL-6 and VEGF and adhesion molecules in endothelial cells. CD82 is a key membrane protein that distinguishes the hierarchy of stem-progenitor cells, and is also important for amplification and verification of cellular resources. Further studies on the function of CD82 in various organs and cells are expected to advance cell biology and cell therapy.

Open Reduction of Coxofemoral Luxation with a Toggle Pin & Synthetic Capsule Technique in a Rottweiler (Rottweiler에서 발생한 고관절 탈구의 개방적 정복)

  • 장광호;채형규;권영삼;임재현;김영홍;장인호
    • Journal of Veterinary Clinics
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    • v.17 no.1
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    • pp.134-137
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    • 2000
  • 체중 43kg의 10개월령 암컷 로토와일러가 약 2개월전부터 점진적으로 진행된 좌측후지의 심한 파행 병력으로내원하였다. 신체검사와 고관절 탈구를 진단하였으며 골반의 외측 및 복배측 방사선 사진 촬영으로 확진할 수 있었다. 전배측 접근 후 골수내정으로 제작한 한 개의 toggle pin 및 두 개의 bone screw를 병용 적용하여 대퇴골두를 고정하였다. 일차교정은 술후 7일의 재탈구로 실패하였으며 동일 방법으로 이차 시술한 후 Ehner sling을 적용하고 운동을 제한하였다. 술후 20일에 환축은 거의 정상보행을 회복하였다.

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Correlation Between Vertebral Marrow Fat Fraction Measured Using Dixon Quantitative Chemical Shift MRI and BMD Value on Dual-energy X-ray Absorptiometry (Dixon 정량 화학적 변위 자기공명영상을 이용한 척추 골수 지방함량과 이중에너지 방사선 흡수법의 BMD 값의 비교)

  • Youn, In-Young;Lee, Hwa-Yeon;Kim, Jae-Kyun
    • Investigative Magnetic Resonance Imaging
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    • v.16 no.1
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    • pp.16-24
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    • 2012
  • Purpose : The purpose of this study was to determine whether there is a significant correlation between vertebral marrow fat fraction measured using Dixon quantitative chemical shift MRI (QCSI) and BMD on dual-energy X-ray absorptiometry (DXA). Materials and Methods: This retrospective study included 68 healthy individuals [mean age, 50.7 years; range, 25-76; male/female (M/F) = 36/32] who underwent DXA of the L-spine and whole body MRI including QCSI of the L-spine and chemical shift MRI of the liver. The enrolled individuals were divided into subgroups according to sex and T-score [i.e., normal bone density (M/F=27/23) and osteopenia (M/F=9/9)]. Vertebral marrow (Dixon QCSI, TR/TE 10.2/4.8 ms) and hepatic fat fractions (chemical shift technique, TR/TE 110/4.9 and 2.2 ms) were calculated on MRI. We evaluated whether there were significant differences in age, body mass index (BMI), vertebral marrow fat fraction, or hepatic fat fraction among the subgroups. Whether or not the participant had reached menopause was also evaluated in females. The correlations among variables (i.e., age, BMI, vertebral marrow and hepatic fat fractions, BMD) were evaluated using Spearman's correlation method. Results: There were no significant differences in age, BMI, or vertebral marrow and hepatic fat fractions between the two male subgroups (normal bone density vs. osteopenia). In female subjects, mean age in the osteopenic subgroup was greater than that in the normal subgroup (p=0.01). Presence of menopause was more common in the osteopenic subgroup [77.8% (7/9)] than the normal subgroup [26.1% (6/23), p<0.05]. The other variables showed no significant difference between female subgroups. The only significant correlation with marrow fat fraction after partial correlation analysis was that with age in the female subjects (r=0.43, p<0.05). Conclusion: The vertebral marrow fat fraction calculated using the Dixon QCSI does not precisely reflect the mild decrease in BMD for either sex.

Short-term Results of Hematopoietic Stem Cell Transplantation for Children with Myelodysplastic Syndrome (소아 골수이형성 증후군에서 조혈모세포이식의 단기간 결과 분석)

  • Lee, Jin;Kim, Soh Yeon;Cho, Bin;Jang, Pil Sang;Chung, Nak Gyun;Kim, Hack Ki
    • Clinical and Experimental Pediatrics
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    • v.45 no.3
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    • pp.370-375
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    • 2002
  • Purpose : In most cases, myelodysplastic syndrome(MDS) transforms into a more aggressive state or acute myelogenous leukemia; it's prognosis is very poor. It is believed that hematopoietic stem cell transplantation(HSCT) is the only curative treatment of MDS, but available data in children are very sparse. In this report, the short term outcome of HSCT in childhood MDS was analyzed. Methods : Ten children with MDS(CMMoL 5, RAEB 3, RAEBt 2) underwent HSCT(HLA-matched sibling transplantation 4, HLA-matched unrelated transplantation 4, cord blood transplantation 1, HLA-mismatched familial transplantation 1) between November 1995 and January 2001 at St. Mary's Hospital. Median follow-up duration was 11 months. Results : Engraftment was successful in all cases and 8 patients are alive without disease. Three cases of VOD were observed and improved without complication. Four cases of grade II and 1 case of grade III acute GVHD were observed and well controlled with treatment. Three patients relapsed after transplantation. One patient is alive without disease after cytoreduction with allogenic stem cell rescue and 2 patients died of relapse. Conclusion : HSCT is a curative strategy of MDS and the survival rate is relatively higher than that of adults. But there is an obvious need for more studies because of the small number of patients and the short duration of the follow-up.

Definitive Surgical Management for Deep-Seated Mediastinitis and Sternal Osteomyelitis Following Tracheal Reconstruction -Sternectomy, Free or In-Situ Omental Transfer, Myocutaneous Flap- (기관재건술 후 발생한 심부 종격염 -흉골 절제, 위망 이식, 근피성형을 병합한 근치술-)

  • Lee, Seo-Won;Kim, Jung-Taek;Kim, Kwang-Ho;Lee, Choong-Jae;Kim, Young-Mo;Lim, Hyun-Kyoung;Sun, Kyung
    • Journal of Chest Surgery
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    • v.32 no.2
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    • pp.206-210
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    • 1999
  • We report here 2 cases of deep-seated mediastinitis combined with sternal osteomyelitis after tracheal reconstruction which were successfully treated with sternectomy, in-situ or free omental transfer, and pectoralis major myocutaneous flap. In case I, an 8 year-old boy with deep seated mediastinitis and sternal osteomyelitis that developed after anterior tracheoplasty through a standard midline sternotomy. In case II, a 50 year-old female patient with mediastinal abcess and sternal osteomyelitis that developed after resection and end-to-end anastomosis of the trachea through an upper midline sternotomy. Treatments consisted of drainage and irrigation followed by wide resection of the infected sternum, placement of the viable omentum into the anterior mediastinal space, and chest wall reconstruction with a pectoralis major myocutaneous flap. The omentum was transferred as an in-situ pedicled graft in case I and a free graft in case II. Both patients have recovered smoothly wit out any events and have been doing well postoperatively.

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The Study of Dosimetry according to the Thickness of Beam Spoiler on Total Body Irradiation (전신방사선치료시 산란체의 두께에 따른 선량측정)

  • Kim, Youngjae;Jeon, Byeongkyou;Lee, Jaesik;Jung, Jaeeun
    • Journal of the Korean Society of Radiology
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    • v.8 no.5
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    • pp.265-269
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    • 2014
  • The therapy of total body irradiation on leukemia carries out to kill harmful bacteria or suppression of immune system by external beam therapy, which is a preparatory stage to reconstitute bone marrow before a pre-treatment of bone marrow transplantation to patients with health bone marrow cells. In case of this kind of radiation therapy, the spoiler use to increase surface dose of patient which varies depending on distance and thickness between patient and spoiler. In this study, the change was investigated the surface dose according to thickness of spoiler. The 0.5% increase of surface dose was observed with each 2.0 cm when the spioler in acrylic was prepared from 0.5 cm to 3.0 cm at intervals of 0.5 cm was evaluated. Based on this result, it suggests that this kind of application will be somewhat limited on clinical trials directly but proper surface dose can be useful method when is applied on patients of treatment prognosis who are required each different surface dose.

FDG-PET/CT Complements Bone Scan with Respect to the Detection of Skip Metastasis of Osteosarcoma: A Case Report (골육종의 도약전이 진단에서 골스캔의 보완검사로서의 FDG-PET/CT: 증례 보고)

  • Cheon, Gi-Jeong;Choe, Jae-Gol;Chae, In-Jung;Lee, Dae-Hee;Song, Sang-Heon;Kim, Myo-Jong;Park, Jong-Hoon
    • The Journal of the Korean bone and joint tumor society
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    • v.18 no.1
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    • pp.45-49
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    • 2012
  • Skip lesion is not uncommon feature in osteosarcoma and considered to be importantly associated with poor prognosis factor, and thus, should be excised with the main mass. The accurate pre-operative evaluation of the intramedullary extent of osteosarcoma is essential, because it determines the level of bone resection. Among the reliable detection methods, bone scan has a drawback of high rate of false negative results and regional MRI has a difficulty to cover the whole involved lesions without clinical suspicion. The authors report a case of osteosarcoma of the distal femur with a proximal skip lesion that was not detected by either regional MR imaging or by bone scan, but which was visualized by FDG-PET/CT.