• The Journal of the Korean bone and joint tumor society
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• v.3 no.1
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• pp.9-17
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• 1997

Resistance to combination chemotherapy remains challenge in the treatment of osteosarcoma. One of the mechanisms of multiple drug resistance is an increased expression of the multidrug resistance gene(mdr1). Expression of the P-glycoprotein(mdr-1 gene product) was studied immunohistochemically and the mdr-1 gene by in situ hybridization in 33 osteosarcomas relating to various prognostic factors. Thirty cases out of 33 osteosarcomas(90.9%) showed positive cytoplasmic reactions with P-glycoprotein and nineteen instances(57.6%) were strong positive(2+). The older(>20 years) and female patients revealed more intense immunohistochemical reactions rather than those of the younger and male patients. Osteoblastic and chondroblastic osteosarcomas revealed more strong immunohistochemical reactions compared to fibroblastic types. There were no significant staining differences between the type of bony involvement, Broder's grade and the presence of necrosis. On follow-up, the mean survival rate was decreased in the strong positive group, however, this was not statistically significant. In situ hybridization for mdr-1 gene revealed positive signals in 22 cases out of 29 osteosarcomas(75.9%). Chemotherapy was done in 15 cases out of 28 patients(53.6%). The results of immunohistochemistry and in situ hybridization were not correlated with the protocols for chemotherapy. However, this result should be confirmed by a larger scale study about mdr1 mRNA expression.

• Archives of Craniofacial Surgery
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• v.20 no.4
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• pp.274-278
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• 2019

Orbital tuberculosis is a rare form of extrapulmonary tuberculosis, even in endemic areas. It may involve the soft tissue, lacrimal gland, periosteum, or bones of the orbital wall. We present a case of orbital tuberculosis on the lower eyelid. An 18-year-old woman with no underlying disease visited our clinic for evaluation of an oval nodule ($1.5{\times}1.2cm$) on the right lower eyelid. Incision and drainage without biopsy was performed 2 months ago in ophthalmology department, but the periorbital mass had deteriorated, as the patient had erythematous swelling, tenderness, and cervical lymphadenopathy. Visual acuity was normal; there were no signs of proptosis, diplopia, or ophthalmoplegia. Computed tomography revealed a small abscess cavity without bony involvement. We performed an excision and biopsy through a percutaneous incision under local anesthesia. Histological examination revealed a granuloma and was diagnosed as orbital tuberculosis. The patient was additionally treated with anti-tuberculosis therapy for 6 months and recovered without complication or recurrence by 7 months. Orbital tuberculosis occurs in patients with or without associated pulmonary tuberculosis, and should be considered as a differential diagnosis in patients with inflammatory orbital disease and an orbital mass. If recurrence occurs despite adequate initial treatment, we recommend an additional examination and excisional biopsy.

• Journal of Periodontal and Implant Science
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• v.29 no.3
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• pp.553-560
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• 1999

The aim of the present study was to evaluate the effect of the expanded polytetrafluoroethylene (e-PTFE) membrane exposure on the initial healing of the periodontal tissue in guided tissue regeneration (GTR) procedure. 90 sites selected from 90 patients were treated with gingival flap surgery supported by an e-PTFE membrane. The material included angular bony defects with probing attachment loss of > 5mm or degree II furcation involvement. Treated sites were classified with membrane exposure group and non-exposure group at membrane removal and evaluated healing type. The results were obtained as follows. 1. e-PTFE membrane was exposed at 61 sites (67.8%) among 90 sites. 2. Thirteen sites (14.4%) depicted rapid healing type, 65 sites (72.2%) depicted typical healing type, 9 sites (10%) showed delayed healing type and 3 sites (3.3%) were categorized as adversed healing type. 3. In e-PTFE membrane exposure group, 1 site (1.6%), 51 sites (83.6%), 6 sites (9.8%) and 3 sites (4.9%) showed rapid healing type, typical healing type, delayed healing type and adverse healing type respectively. 4. In e-PTFE membrane non-exposure group, 12 sites (41.3%), 14 sites (48.3%) and 3 sites (10.3%) showed rapid healing type, typical healing type and delayed healing type respectively. Adverse healing type was not observed. 5. The rate of favourable healing between e-PTFE membrane exposure group and non-exposure group was not statistically significant(p=0.56). These results suggest that the prevention of membrane exposure may be important to obtain rapid healing type. However favourable healing could be obtained with stringent infection control program even if membrane was exposed.

• Clinical and Experimental Pediatrics
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• v.48 no.1
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• pp.93-96
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• 2005

Neurofibromatosis type I is an autosomal dominant disorder with varied manifestations in bone, soft tissue, the nervous system and skin. This is characterized by cafe-au-lait spots, neurofibromas, Lisch nodules, optic glioma, bony displasia, and intertriginous freckling. One of the more serious aspect of the disease relates to the arterial involvement. Vascular changes in neurofibromatosis may occur in any arterial tree from the proximal aorta to the small arteries but these changes are most common in the renal arteries, aorta, celiac arteries and mesenteric arteries. Of the many complications observed in neurofibromatosis type I, cerebrovascular lesions may be the least appreciated. About 40 cases of neurofibromatosis type I associated with occlusive cerebrovascular disorders have been reported in the literature, but MRI and angiographic findings typical of moyamoya disease are rarely described. We experienced a case of moyamoya disease associated with neurofibromatosis type I in a 3-year-old girl who of complained gait disturbance and paraparesis and showed findings typical of moyamoya disease on MRI and carotid angiogram.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.4
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• pp.399-406
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• 2000

With the increase of industrialization, leisures, sports activities and traffic, the risk of trauma has increased markedly. Midfacial bones are relatively common sites of trauma, and are difficult sites of correct reduction and reconstruction, because midface is composed of mostly thin cortical bone surrounding cavities filled with either air or fat with discrete areas of bony condensation. A clinical study on 208 patients with midfacial bone fracture who visited Sanggye Paik Hospital during 5 years($1990{\sim}1995$) was done by analyzing sex, age, cause, fracture site, treatment method, complication and involvement of other body part, etc. The results obtained were as follows : 1. The occurrence was more frequent in male than in female with ratio of 2.7 : 1 and most frequently in twenties. 2. Traffic accident was the most common cause of midface fractures. 3. Zygoma was the most frequently occurred site(50%) of midface fractures. 4. Simple fracture(75%) was more frequently occurred than compound fracture(25%). 5. As treatment method, open reduction(76.4%) was used more frequently than closed reduction(23.6%) 6. Generally, operations are done in 5 days after admission(59.1%), and intermaxillary fixation was done in 78.4% of cases. 7. Teeth and alveolar bone damages were occurred in 32.2% of cases. 8. Other injuries that were related to midface fracture occurred in 63.3% of cases. 9. Post-operative complications occurred in 9% of cases.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.18 no.4
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• pp.626-635
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• 1996

Odontogenic infections are usually locally confined, self-limiting processes. However, under certain circumstances, they may break through the bony, muscular, and mucosal barriers and spread into contiguous fascial spaces or planes far from the initial site of involvement, resulting in severe life-threatening complications, such as retropharyngeal spread, suppurative mediastinal extension, airway obstruction, pleuropulmonary suppuration, and hematogenous dissemination to distant organs. The mortality arte for mediastinitis from odontogenic infection ranges from 40% to 60%. Therefore rapid evalution and treatment is essential with a combination of life support, antibiotic therapy, and surgical intervention. Recently, we experienced three cases of retropharyngeal and mediastinal abscesses secondary to odonogenic infections. In all patients, early diagnosis was possible by CT scanning and physical examination. The prognosis was good in all patients by using urgent aggressive surgical and antibiotic therapy.

• Archives of Plastic Surgery
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• v.37 no.4
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• pp.335-339
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• 2010

Purpose: Diabetic foot ulcer with osteomyelitis is notorious with its complexity and healing difficulties. Bone biopsy is considered to be the gold standard method of guidance for antibiotic therapy. However, it is often replaced by cultures of ulcer swabs or by superficial samples because of the technical difficulties and possible adverse events. In this study, we compared microbiologic results of bone biopsy with those of superficial tissue biopsy or swab culture to investigate concordance and diagnostic value in bone involved diabetic foot ulcers. Methods: This study involved 106 patients with diabetic foot ulcers who showed positive results in bone probing test. Tissue samples for microbiologic tests were collected from all the patients by using superficial cotton swab, superficial tissue biopsy, and bone biopsy. The microbiologic results of bone biopsy were compared with swab culture and superficial tissue biopsy statistically. Results: The positive predictive value of bone probing test for underlying osteomyelitis was 82.1%. Microbiology of the bone biopsy showed same results with those of the swab culture and superficial tissue in 64% and 63%, respectively. Statistical analysis demonstrated that the microbiology of the swab culture or superficial tissue did not coincide with that of the bone biopsy. Conclusion: These results suggest that the microbiologic results of superficial tissue or swab culture do not coincide with those of bony tissue. To select appropriate antibiotic regimen for diabetic ulcer with bone involvement, the specimen for the microbiologic test should be obtained from involved bone.

• The Journal of the Korean bone and joint tumor society
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• v.9 no.1
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• pp.52-60
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• 2003

Purpose: To analyse their end results and also to differentiate the single or multiple giant cell tumor(GCT) of tendon sheath in hand. Materials & Methods: Total 21 cases with GCT of tendon sheath in hand were treated surgically and analyzed their end results with clinically, radiologically and pathologically to allowed for average 16 months after surgical excision. Results: The finger flexor tendons, especially on index and ring finger, involving distal interphalangeal joint and mid-phalanges in fourth decades (average age of 47 years old) were frequently involved, and the mass was not exceed than 2 cm in size, fixed on tendon sheath with rubbery hard tenderness but rare bony involvements except 4 cases of bony erosion and cortical perforation. The three cases with multiple GCT of hand was also combined with familial hypercholesterolemia, and are commonly involved the extensor tendons as well as achilles tendons bilaterally, treated with partial excision because of multiplicity. Average 16 months after surgical excision for single GCT cases was followed and showed the recurrence in 3 cases(3/18,16.7%), treated with wide excision. The single and multifocal GCT are similar in pathologic changes but different soft tissue tumors in their pathogenesis, treatment and prognosis. Conclusion: Incomplete excision of GCT of tendon sheath in hand are thought to be the cause of recurrence, especially in cases with incomplete lesional excision, in multilobular and bony involvement etc. So careful wide excision is necessary to prevent the recurrence.

• The Journal of the Korean bone and joint tumor society
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• v.5 no.3
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• pp.169-177
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• 1999

Osteosarcoma in patients older than 40 years are rare, however they have different clinical, radiological and pathological features from those of younger patients. Sometimes accurate histologic diagnosis is not easy, which is important in determining the correct surgical treatment and appropriate chemotherapy. Since January 1995, 11 patients with osteosarcoma occurring in patients older than 40 years have been diagnosed, treated and followed up for more than 6 months. In contrast to osteosarcoma in children and adolescents, only 4 cases(36.4%) were conventional types, while the others included 2 malignant fibrous histiocytoma-like types, 2 small cell types, 2 periosteal osteosarcomas and 1 giant cell-rich type. Seven cases showed purely osteolytic or predominantly osteolytic bony lesions and 8 were in Enneking stage IIB. Performed surgical treatments included 2 amputations, 6 wide resections and reconstructions, and one curettage and autogenous bone graft. In the remaining 2 cases, definitive surgical treatments included not carried out because of old age, multifocal involvement or poor medical tolerance. Neoadjuvant and adjuvant chemotherapies were performed in 9 of 11 patients. At last follow-up, there were 6 continuously disease-free survivals, 3 alive with diseases and 2 died of diseases. The overall cumulative 4-year survival rate calculated using Kaplan-Meier's productlimit method was 59.3%. For improved oncologic outcomes and survivals, early and accurate diagnosis, surgical treatment with adequate margin and neoadjuvant and adjuvant chemotherapy will be necessary.

• Archives of Plastic Surgery
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• v.36 no.3
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• pp.356-360
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• 2009

Purpose: Lipofibromatous Hamartoma(LFH) of nerve is a tumor - like lipomatous process principally involving the young persons. This is rare disease characterized by a soft slowly growing mass surrounding and infiltrating major nerves and their branches of the palm and digits. LFH of nerve usually affects the median nerve, with the most common sites of presentation being the distal forearm and hand in the wrist or palm. It may cause symptoms of compression neuropathy and is associated with macrodactyly. Recently, MRI plays a major role in confirming the diagnosis of LFH. Therefore, we present two cases of LFH in the hand with MRI features and surgical management. Methods: One is 6 - years - old female who presented with macrodactyly involving both the soft tissue and bony parts of the second, third and forth digits of her right hand. The other one is 16 - years - old man who presented involving the soft tissue of the second and third digits of his right hand, with pain and numbness, along with motor and sensory deficits in the median nerve distribution. To evaluation about LFH, we enforced preoperative MRI and physical examination. After confirming the diagnosis of LFH, we proposed decompression of all compromised peripheral nerve to help alleviate pain and paresthesia to reduce the likelihood of permanent motor and sensory sequelae. Results: A characteristic feature on MRI is the appearance of serpentiform nerve fascicle surrounded by fibro - fatty tissue within the expended nerve sheet. Distribution of fat between fascicles is asymmetric. Two cases were treated by limited debulking of the redundant tumor tissue and excision of epineurial fatty tissue. These cases were performed with relief of symptom. Conclusion: MRI not only confirms the diagnosis, it also provides a detailed assessment of nerve involvement preoperatively. Especially, on coronal images, the nerve has a spagetti - like appearance that is pathognomonic of LFH. Recommendations for early treatment include decompression of the carpal tunnel, debulking of the fibro - fatty sheath, microsurgical dissection of the neural elements and excision of involve nerve with or without grafting.