• The Journal of the Korean bone and joint tumor society
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• v.14 no.2
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• pp.95-105
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• 2008

Purpose: To identify which is the best procedure in recycling autograft according to the resection & reconstruction type and recycling methods, and so when the recycling autograft is used in limb salvage surgery. Materials and Methods: We have treated fifty-eight patients (34 male, 24 female; age range 5 to 74 years, mean age 36.5 years), who had the malignant musculoskeletal tumors, with recycling autograft (47 patients with extracoporeal irradiation, 11 patients with pasteurization) from December 1995 to February 2006. The resection and reconstruction type was 3 cases with fragmentary, 8 intercalary, 23 rAPC (recycling-Autograft-Prosthesis composite), 18 osteoarticular, 5 total joint and 1 soft tissue (achilles tendon). The result was evaluated by the radiologic union at junctional site, the functional score by musculoskeletal tumor society score and complications according to the resection & reconstruction type and recycling methods. Results: The junctional union was obtained at 15.0 months in extracoporeal irradiation and 12.6 months in pasteurization. Also the mean radiologic union was shown at 6.0 months in fragmentary, 12.8 months in intercalary, 10 months in rAPC, 23.3 months in osteoarticular and 15.6 months in total joint. The functional score was 65.5% in fragmentary, 60.8% in intercalary, 62.8% in APC (except pelvis), 66.0% in osteoarticular and 66.6% in total joint. We have experienced 1 infection, 1 prutrusio acetabuli in pasteurization (18.1%) and other 22 complications (3 deep infections, 8 nonunions, 2 fractures, 2 epiphyseal problems, 5 joint instabilities, 2 local recurrence) in extracoporeal irradiation (46.8%). Also we have experienced 3 complications (3 nonunions) in intercalary (37.5%), 9 complications (4 nonunions, 1 deep infection, 1 periprosthetic fracture, 1 epiphyseal problem, 1 local recurrence, 1 protrusio acetabuli) in rAPC (50.0%), 6 complications (2 deep infections, 2 nonunions, 1 epiphyseal problem, 1 pathologic fracture) in osteoarticular (33.3%), 5 complications (5 joint instabilities) in total joint (100%) and 1 complication(1 local recurrence) in soft tissue (100%). Conclusion: In our experience, according to the resection & reconstruction type fragmentary and intercalary may have several advantages such as good radiologic and functional result and low rate of complication. And it seems that rAPC was available in case which have no sufficient residual bone stock. Also the pasteurization may have more advantages than that of the extracorporeal irradiation.

• Tuberculosis and Respiratory Diseases
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• v.44 no.3
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• pp.534-546
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• 1997

Background : The p53 and retinoblastoma(Rb) tumor suppressor genes are associated with the pathogenesis of several types of human cancer. Substantial proportion of the primary lung cancers or cell lines have been reported to have the p53 and/or the Rb gene mutations. But, so far there is no report on the analysis of the Rb gene polymorphism as one of the genetic susceptibility marker. This study was undertaken to establish the gene frequencies of the polymorphic genotypes of the p53 and Rb genes in Koreans to evaluate the possible involvement of these genotypes as a risk factor of lung cancer. Methods : In this study 145 controls without previous and present tumor history and 128 lung cancer patients were subjected to analysis. The two intragenic polymorphisms of the p53 gene(exon 4/ AccII, intron 6/MspI) and one intron 17/XbaI polymorphism of the Rb gene were analysed by the method of polymersae chain reaction- restriction fragment length polymorphisms(PCR-RFLPs). The genotype of the intron 3/16 bp repeat polymorphism of p53 was determined by PCR and direct gel electrophoresis. Results : There were no significant differences in the genotype distributions of the p53 gene between lung cancer patients and controls. But heterozygotes(Arg/Pro) of the exon 4/AccII polymorphisms were slightly over-represented than controls, especially in the Kreyberg type I cancer, which was known to be associated with smoking. The intron 3/16 bp duplication and the intron 6/MspI polymorphisms were in complete linkage disequilibrium. About 95% of the individuals were homozygotes of the common alleles both in the 16 duplication and MspI polymorphisms, and no differences were deteced in the genotype distributions between lung cancer patients and controls. Overall genotype distributions of the Rb gene polymorphisms between lung cancer patients and controls were not significantly different However, the genotype distributions in the Kreyberg type I cancer were significantly different from those of controls(p = 0.0297) or adenocarcinomas(p = 0.0008). It was noticeable that 73.4% of the patients with adenocarcinomas were heterozygotes(r1/r2) whereas 39.2% of the Kreyberg type I cancer were heterozygous at this polymorphisms. In the lung cancer patients, significant differences were also noted between the high dose smokers and low dose smokers including non-smokers(p = 0.0258). The relative risk to Kreyberg type I cancer was significantly reduced in the individuals with the genotype of r1/r2(odds ratio = 0.46, 95% C.I. = 0.25-0.86, p = 0.0124). The combined genotype distribution of the exon 4 AccII of the p53 and the intron 17 Rb gene polymorphisms in Kreyberg type I cancers were significantly different from dose of controls or adenocarcinomas. The highest odds ratio were observed in the individuals with the genotypes of Arg/Pro and r2/r2(odds ratio = 1.97,95% C.I. = 0.84-4.59) and lowest one was in the patients with Arg/Arg, r1/r2 genotype(odds ratio = 0.54, 95% C.I. = 0.25-1.14). Conclusion : The p53 and the Rb gene polymorphisms modulate the risk of smoking induced lung cancer development in Koeans. However, the exact mechanism of risk modulation by these polymorphism remains to be determined. For more discrete clarification of associations between specific genotypes and lung cancer risk, the evaluations of these polymorphisms in other ethnics and more number of patients will be needed.