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How to Overcome Complications of Allograft Transplantation? (골종양 절제 후 동종골을 이용한 재건술의 합병증 및 해결방법)

  • Cho, Yool;Choi, Young;Kwon, Young-Ho;Chung, So-Hak;Kim, Jae-Do
    • The Journal of the Korean bone and joint tumor society
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    • v.17 no.2
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    • pp.65-72
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    • 2011
  • Purpose: We evaluated the complications of allograft reconstruction after a bone tumor resection, and reviewed literatures to overcome such complications. Materials and Methods: We retrospectively reviewed clinical records and radiographs of fifteen patients in whom reconstruction with allograft after bone tumor resection. Results: Eight patients were men and seven were women with a mean age of 27.1 years (1-56 years) and a mean follow-up period of 89.5 months (33-165 months). All postoperative complications related to the allograft were recorded. Twenty patients (80.0%) obtained a radiologic bony union at a mean of 8.35 months (4-12 months). The mean Musculoskeletal Tumor Society score was 73.5% (46.6-93.0%). Nine patients (60.0%) experienced one event and 3 (20.0%) patients experienced multiple events during the follow-up period. Recorded events were infection (3), fracture (2), nonunion (2), limb length discrepancy (2) and varus deformity (2). The mean event free survival period was 60.8 months (6-144 months). The mean allograft survival period was 80.2 months and the 5 year survival rate of the allografts was 83.0%. Conclusion: In order to overcome complications, the combination of an allograft and vascularized fibular graft is highly recommended. In the near future, the tissue engineering technique, the application of the stem cell and PRP, could reduce the complication of allograft such as resorption and nonunion.

Surgical Treatment of Pulmonary Tuberculosis (폐결핵의 절제술에 대한 임상적 고찰)

  • Kim, Ae-Jung;Gu, Ja-Hong;Kim, Gong-Su
    • Journal of Chest Surgery
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    • v.29 no.4
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    • pp.397-402
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    • 1996
  • A clinical study of 36 cases of pulmonary tuberculosis that had had a surgical resection during the period of 13 years from January 1979 to December 1992 was performed in the Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Hospital The ratio between male and female was 3.5 1 and the age of peak incidence was in the 2nd and 3rd decades. The common prodromal symptoms were chest pain (38.9 %) and hemoptysis or blood tinged sputum (36.1 %). Preoperative diagnostic examination of sputum positivity for AFB stain despite antituberculosis chemotherapy was noticed in 22.8 oyo . Surgical indications were destroyed lobe or segment with or without cavity (58.3 oyo), mass unable to differentiate from lung cancer (16.7 %), total destroyed lung (13.9 %), bronchostenosis with atelectasis and distal bronchiectasis (11.1 %). Types of resection were pneumonectomy in 16.7%, lobec omy and segmentectomy 2.7%, lobectomy 50 %, segmentectomy 27.8%, and wedge resection 2.7%. Postoperatively, pulmonary function Improved compared to the preoperative examination, although these changes were not statistically significant. One patient died of ulcerative colitis due to drug hypersensitivity, and the postoperative complications were remnant dead space in 11.1 %, spreading of tuberculosis in 5.5%, and empyema with BPF in 5.5%.

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Metallic Radial Head Prosthesis in Korea (요골두 금속 치환물의 국내 사용)

  • Han, Sang-Hwan;Moon, Jun-Gyu;Park, Jong-Wong;Jang, Ki-Mo
    • Clinics in Shoulder and Elbow
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    • v.10 no.1
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    • pp.84-91
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    • 2007
  • Purpose: The aim of this study was to report seven cases of metallic radial head prosthesis and present the limit of use in Korea. Materials and Methods: Metallic radial head arthroplasty was performed on 7 patients between April 2006 and December 2006, who had complex elbow injury including comminuted radial head fracture. Indication, operative findings and outcome were assessed. Availability and payment of implant were investigated. Results: All of the patients had more than one associated injury including coronoid fracture, olecranoan fracture, and ligament ruptures. According to Mason classification, there were three type III and four type IV fractures. All radial head fractures were too comminuted to reconstruct. There were two excellent results, four good, and one poor, as graded by Mayo score. There were no patient with instability and implant related complications. Insufficient supply of implant did not enable to do scheduled surgery in 2 cases. Current medical insurance did not cover charge for radial prosthesis, five patients could not help paying for that by themselves. Conclusion: Metallic radial head implants are useful when the radial head cannot be repaired reliably. Preoperative preparing and coverage by medical insurance based on appropriate indication are helpful for decision for a treatment option.

Clinical evaluation on 5 cases of lead poisoning (연 중독의 임상적 고찰)

  • Lee, Jung-Mi;Lee, Hyung-Woo;Hyun, Myung-Soo;Chung, Moon-Kwan;Shim, Bong-Sup;Lee, Hyun-Woo
    • Journal of Yeungnam Medical Science
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    • v.6 no.2
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    • pp.29-38
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    • 1989
  • 5 cases of lead poisoning were investigated clinically. Of the 5 patients, 4 were male and 1 was female. The causes of lead poisoning in 3 cases were ingestion of herb drug pills and in 2 cases were occupational poisoning. Chief complain at admission in 4 cases were in defined colicky abdominal pain and constipation. Only 1 case complained of dizziness and palpitation without gastrointestinal symptom. On peripheral blood, normocytic normochromic anemia (mean Hgb 9.2gm/dl), reticulocytosis (mean 4.7%) and basophilic stippling were found in 100% of patients. Bone marrow aspiration was done in 4 cases. Erythroid hyperplasia and basophilic stippling were found in all 4 cases. Mean M : E ratio was 0.7 : 1. The lead concentration in serum was in creased in 4 cases (80%) of patients. Lead concentration, deltaaminolevulinic acid concentration in 24 hours collected urine were in creased in 5 patients (100%). Qualitative test of coproporphyrin of urine was positive in all 5 cases. 3 patients treated with Ca-EDTA, abdominal pain was improved rapidly and hemoglobin level was in creased slowly.

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Usefulness of Ultrasound in Treatment of Patella Fracture (슬개골 골절 치료에서 초음파의 유용성)

  • Kim, Jung-Man;Nam, Ho-Jin;Ra, Ki-Hang;Park, Se-Wook
    • The Journal of Korean Orthopaedic Ultrasound Society
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    • v.3 no.1
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    • pp.26-31
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    • 2010
  • Purpose: The purpose of this study is to evaluate the clinical usefulness of ultrasound in treatment of patella fracture. Material and Methods: Twenty cases of twenty patients with patella fracture radiographically from March, 2006 to September, 2009 were involved in this study, there were 8 males and 12 females, there were 13 right knees, 7 left knees, the average age was 43 years (range, 14~72 years). We decided the methods of treatment by using the ultrasound in conjunction with Drayer's test that examining the intactness of patella retinaculum. There were 10 transverse, 8 vertical and 2 comminuted fractures, we examined the patella retinaculum by using the ultrasound and performed Drayer's test. Results: In 12 cases of intact retinaculum, Drayer's test was negative and we allowed patients ambulation without surgical fixation especially. In 4 cases of completely ruptured retinaculum, Drayer's test was positive and we treated the patella fractures by the use of ORIF (open reduction and internal fixation) method, in 2 cases of partially ruptured retinaculum, Drayer's test was negative but displacement of fractures were more than 2 mm, we treated the patella fractures by the use of CRIF (closed reduction and internal fixation) method and obtained clinically satisfactory results. Conclusion: In conjunction with radiographs and Drayer's test, an ultrasound would be one of the useful diagnostic modality for determining treatment method of the patella fracture.

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Effects of Bronchoscopic Nd-YAG Laser Therapy in Tuberclous Tracheobronchial Fibrostenosis (기관 및 기관지결핵에 의한 반흔성 기도협착에 대한 기관지경적 Nd-YAG 레이저 치료의 효과)

  • Park, Jae-Yong;Jung, Tae-Hoon
    • Tuberculosis and Respiratory Diseases
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    • v.41 no.5
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    • pp.494-503
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    • 1994
  • Background: Fibrostenosis of large airway due to tuberculosis is one of the most perplexing clinical problems not only because it can lead to respiratory failure but also because of difficulty in the management. No one technique, such as balloon dilatation or insertion of self expandable metallic stent, has proved totally satisfactory in the management of fibrostenosis. We evaluated the effect of laser therapy in patient with severe fibrostenosis due to tuberculosis. Method: We classified the fibrostenosis to three types by bronchoscopic finding - the diaphragm type: stenosed by fibrous diaphragm, sparing the tracheobronchial wall, the collapse type: stenosed by collapse of the wall due to destruction of the cartilage, and the combined type: stenosed by nonspecific inflammatory scar tissue within internal lumen with collapse of the wall. We have treated 10 patients complaining dyspnea due to with severe fibrostenosis of the diaphargm or the combined type using a neodymiumyttrium aluminum garnet(Nd-Y AG) laser through a flexible bronchoscopy. Results: Eight of the 10 cases improved after laser therapy and maintained during a follow up period of average 31.9 months. All of the cases undergoing laser therapy showed no serious complication to need the therapy. Conclusion: The results of our present study indicate that the Nd-YAG laser therapy is an effective and safe method for the management of selective tuberculous fibrostenosis.

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Giant Cell Tumor of the Proximal Fibula Treated by En Bloc Resection (전 절제술로 치료한 근위 비골의 거대 세포종)

  • Suh, Jeung-Tak;Choi, Sung-Jong;Kim, Young-Goun;Kim, Jeung-Il;Kim, Hui-Taek;Yoo, Chong-Il
    • The Journal of the Korean bone and joint tumor society
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    • v.9 no.2
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    • pp.200-205
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    • 2003
  • Purpose: To report our experiences of clinical features, treatment method and results of giant cell tumor of 5 patients in proximal fibula. Materials and Methods: Five patients managed with an en bloc resection preserving common peroneal nerve and lateral collateral ligament reconstruction with biceps femoris tendon followed up between January 1997 and July 2001. Preoperative plain radiograph and MRI and bone scan were checked. The recurrence of the tumor was judged by plain radiograph and clinical signs. Lateral instability of knee joint was checked during the outpatient follow-up. Results: The mean age of the patients at the time of operation was twenty- three (21-29). There were one male and four female patients. Dull pain was main symptom and palpable mass was seen in two patients. Peroneal nerve palsy and local recurrence were not observed except one case of temporary peroneal nerve palsy. During the outpatient follow up, one among 5 patients showed slight lateral instability and the other 4 patients showed no instabililty. Conclusion: Giant cell tumor in proximal fibula managed with an en bloc resection preserving common peroneal nerve and lateral collateral ligament reconstruction with biceps femoris tendon showed favorable results.

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Long Term Clinical Results of Duromedics Valve (Duromedics 판막의 장기 임상 성적 고찰)

  • Jeong, Dong-Seop;Lim, Chung;Kim, Kyung-Hwan;Kim, Ki-Bong;Aun, Hyuk
    • Journal of Chest Surgery
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    • v.34 no.9
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    • pp.686-691
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    • 2001
  • Background: The Duromedics valve has been used in Korea since 1982, however, but there were no long term clinical results that have been reported. This paper presents the long term clinical results of Duromedics valve implanted in Seoul National University Hospital. Material and method: Between 1987, 23 patients underwnet cardiac valve replacement with Duromedics mechanical valve. There were 8 mitral valve replacements, 5 aortic valve replacements, one tricuspid valve replacement, 6 aortic and mitral valve replacements, and one mitral and tricuspid valve replacement. There were 12 men and 11 women. The mean age was 35$\pm$10(15~52) years. We evaluated the clinical performance of Duromedics cardiac prosthesis. Result: The early operative mortality was 4.3%(1/23) and the late morlatity was 4.3%(1/23). Causes of death were low cardiac output syndrome and structural valvular failure. The mean follow-up duration was 133$\pm$43(8~157) months. There were 3 reoperations. The causes of reoperations were thrombosis and structural failure and nonstructural valvular failure. The actuarial survival rate at 10 years was 90.9%. Conclusion: Although the number of patients was not sufficient for effective clinical study, the long term clinical results of Duromedics valve was relatively good and there was no structural defect in this mechanical valve. However, more research is needed in the future.

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Histopathological Study of Gastric Adenoma (위선종에 관한 병리조직학적 연구)

  • Kim, Dong-Sug;Nam, Hae-Joo;Choi, Won-Hee;Lee, Tae-Sook;Chung, Moon-Kwan
    • Journal of Yeungnam Medical Science
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    • v.8 no.2
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    • pp.76-83
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    • 1991
  • A total of 53 gastric adenomas from endoscopically biopsied gastric mucosa were examined histopathologically. The average age at the time of endoscopic biopsy was 59 years, and gastric adenomas were found to be more frequent in the aged, particularly above the age of 50. The majority of adenomas occurred at the antrum. Concerning the shape of the adenomas, Yamada type II was more frequent(55%). All adenomas were accompanied by varying degree of intestinal metaplasia, and this findings suggest that gastric adenoma develops from intestinal metaplasia. In adenomas with severe atypia(grade III), endocrine cells(argyrophil and argentaffin cells)were markedly decreased or absent. Gastric adenocarcinomas coexistent with adenoma were seen in 5(9.4%) out of 53 cases, and were more frequent in male than female patients(sex ratio, 4 : 1) and the average age was 61.4 years. It is suggested that there is a necessity of thorough follow-up study for definitive correlation between gastric adenoma and adenocarcinoma.

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Two to Four Year Follow-Up Results after Anterior Cruciate Ligament Reconstruction Using Transtibial Femoral Tunnel at 10 or 2 O'clock Position (10시 혹은 2시 방향의 경경골 대퇴 터널을 이용한 전방 십자 인대 재건술 후 2~4년 추시 결과)

  • Cho, Sung-Do;Youm, Yoon-Seok;Jeong, Ji-Young;Park, Han-Chang
    • Journal of the Korean Arthroscopy Society
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    • v.13 no.1
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    • pp.1-7
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    • 2009
  • Purpose: To evaluate the 2 to 4-year follow-up results after arthroscopic anterior cruciate ligament (ACL) reconstruction using transtibial femoral tunnel at 10 or 2 O'clock position. Materials and Methods: Eighty-six ACL reconstructions could be evaluated. Evaluations included 2000 International Knee Documentation Committee (IKDC) subjective knee score, Lachman test, Pivot-shift test, KT-1000 arthrometer measurement, 2000 IKDC knee examination and second-look arthroscopy. Results: Seventy-five patients (87.2%) had over 80 in 2000 IKDC subjective knee score. Eighty-three patients (96.5%) had 1+firm end or negative Lachmann test. Seventy-eight patients (90.7%) had a negative Pivot-shift test. Eighty-three patients (96.5%) had less than 5 mm difference by KT-1000 arthrometer. Eighty patients (93.0%) were normal or nearly normal by 2000 IKDC knee examination. Second-look arthroscopy was done in fifteen cases. Nine cases showed good synovialization, four cases showed partial synovialization, two cases showed poor synovialization and graft failure was noted in one case. Conclusion: ACL reconstruction using transtibial femoral tunnel at 10 or 2 O'clock position resulted in a good outcome in terms of rotatory stability as well as antero-posterior stability.

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