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The Clinical Outcome of Dedifferentiated Chondrosarcoma (역분화 연골육종의 임상 결과)

  • Kong, Chang-Bae;Lee, Seung Yong;Song, Won-Seok;Cho, Wan-Hyeong;Koh, Jae-Soo;Jeon, Dae-Geun
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.2
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    • pp.164-171
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    • 2019
  • Purpose: A dedifferentiated chondrosarcoma is a rare lethal tumor characterized by a low grade chondrosarcoma juxtaposed with a high grade dedifferentiated sarcoma, such as osteosarcoma, fibrosarcoma. The aim of our study was to document the clinical manifestation and oncologic outcomes of a dedifferentiated chondrosarcoma. Materials and Methods: This study identified 11 patients who were diagnosed and treated for dedifferentiated chondrosarcoma between January 2007 and December 2016. The identified cohort was then reviewed regarding age, sex, symptom onset, tumor location, magnetic resonance imagings (MRIs), surgical margin, and pathologic diagnosis. The time to local recurrence and/or metastasis, follow-up duration, and the patients' final status were analyzed. Results: The patients were comprised of 7 males and 4 females with a mean age of 54 years (range, 33-80 years). The location of the tumor was in the femur in 6 cases, pelvis in 4 cases, and metatarsal in 1 case. The average tumor diameter was 12.7 cm (range, 6.0-26.1 cm). At the time of diagnosis, 2 patients showed pathologic fracture; 1 patient was Enecking stage IIA, 9 patients were stage IIB, and 1 patient was stage III. Eight patients were classified as a primary dedifferentiated chondrosarcoma and 3 patients were secondary. One of the primary lesions was misinterpreted initially as a low grade chondroid lesion by MRI and underwent curettage. Local recurrence occurred in 8 cases and distant metastasis occurred in 10 cases with a mean duration of 8 months (range, 2-23 months) and 7 months (range, 1-32 months), respectively. The three-year overall survival of patients with dedifferentiated chondrosarcoma was 18%, and 10 patients died due to disease progression. Conclusion: Dedifferentiated chondrosarcoma developed lung metastases in the early period of the clinical courses and the prognosis was dismal.

Treatment of Pyogenic Arthritis of the Knee Using Drainage Tube Insertion in the Posterior Compartment through the Posterior Transeptal Portal after an Arthroscopic Synovectomy (관절경적 활액막 절제술 후 후격막 삽입구를 통한 배액관의 후방 거치를 이용한 무릎의 화농성 관절염 치료)

  • Kim, Tae Ho;Yu, Chang Eon;Shin, Chung Shik
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.3
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    • pp.269-275
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    • 2019
  • Purpose: This study analyzed the treatment effects of drain insertion in the posteromedial portal after an arthroscopic synovectomy and posterior septum resection for pyogenic arthritis. Materials and Methods: From June 2005 to December 2016, 56 cases (55 patients, 1 case of bilateral knee) were diagnosed with pyogenic arthritis and arthroscopic treatment was performed. Fourteen patients (25.0%) were identified with causative organisms. The average follow-up period was 12.3 months, and the mean age was 67.8 years old. Twenty-four cases were males and 31 cases were females. Kellgrene-Lawrence grade (K-L grade) I was 6 patients, II was 20 patients, III was 11 patients, and IV was 18 patients. Surgery was performed through six portal. The posterior septum was removed and a drainage tube was inserted from the posterior medial side to the posterior side of the joint. The Lysholm score was used after surgery for a functional evaluation. The K-L grade at the time of admission and at the last follow-up were compared for a radiological evaluation. Results: The mean normalization period of the C-reactive protein was 59.8 days (6-164 days). Intravenous antibiotics were used for an average of 37.1 days. The results of the functional evaluation revealed a mean Lysholm score of 64.5 (30-98) in a total of 56 cases. Two reoperations was performed, but the treatment was completed with same method in all patients. The K-L grade was similar at the time of surgery and at the last follow-up (p>0.05). Conclusion: The method of drain insertion in the posteromedial portal after arthroscopic synovectomy and posterior septum resection for pyogenic arthritis is an effective technique that can obtain satisfactory results by inducing proper exudate discharge.

Limb Salvage Using a Combined Distal Femur and Proximal Tibia Replacement in the Sequelae of an Infected Reconstruction on Either Side of the Knee Joint (슬관절 주위 재건물 감염 후유증 시 슬관절 상하부 종양인공관절을 이용한 사지 구제술)

  • Jeon, Dae-Geun;Cho, Wan Hyeong;Park, Hwanseong;Nam, Heeseung
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.1
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    • pp.37-44
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    • 2019
  • Purpose: Tumor infiltration around the knee joint or skip metastasis, repeated infection sequelae after tumor prosthesis implantation, regional recurrence, and mechanical failure of the megaprosthesis might require combined distal femur and proximal tibia replacement (CFTR). Among the aforementioned situations, there are few reports on the indication, complications, and implant survival of CFTR in temporarily arthrodesed patients who had a massive bony defect on either side of the knee joint to control infection. Materials and Methods: Thirty-four CFTR patients were reviewed retrospectively and 13 temporary arthrodesed cases switched to CFTR were extracted. All 13 cases had undergone a massive bony resection on either side of the knee joint and temporary arthrodesis state to control the repeated infection. This paper describes the diagnosis, tumor location, number of operations until CFTR, duration from the index operation to CFTR, survival of CFTR, complications, and Musculoskeletal Tumor Society (MSTS) score. Results: According to Kaplan-Meier plot, the 5- and 10-year survival of CFTR was 69.0%±12.8%, 46.0%±20.7%, respectively. Six (46.2%) of the 13 cases had major complications. Three cases underwent removal of the prosthesis and were converted to arthrodesis due to infection. Two cases underwent partial change of the implant due to loosening and periprosthetic fracture. The remaining case with a deep infection was resolved after extensive debridement. At the final follow-up, the average MSTS score of 10 cases with CFTR was 24.6 (21-27). In contrast, the MSTS score of 3 arthrodesis cases with failed CFTR was 12.3 (12-13). The average range of motion of the 10 CFTR cases was 67° (0°-100°). The mean extension lag of 10 cases was 48° (20°-80°). Conclusion: Although the complication rates is substantial, conversion of an arthrodesed knee to a mobile joint using CFTR in a patient who had a massive bony defect on either side of the knee joint to control infection should be considered. The patient's functional outcome was different from the arthrodesed one. For successful conversion to a mobile joint, thorough the eradication of scar tissue and creating sufficient space for the tumor prosthesis to flex the knee joint up to 60° to 70° without soft tissue tension.

A Comparison between Minimally Invasive Percutaneous Plate Osteosynthesis and Plate Fixation in the Treatment of Clavicle Midshaft Fracture (쇄골 간부 골절의 최소 침습적 경피적 금속판 고정술과 관혈적 수술 비교)

  • Yoo, Seong-Ho;Kang, Suk-Woong;Kim, Bu-Hwan;Song, Moo-Ho;Kim, Yeong-Joon;Park, Gyu-Taek;Kwack, Chang-Hun
    • Journal of the Korean Orthopaedic Association
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    • v.52 no.1
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    • pp.1-6
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    • 2017
  • Purpose: To retrospectively compare minimally invasive percutaneous plate osteosynthesis (MIPPO) with open plate fixation for the treatment of clavicle midshaft fracture. Materials and Methods: Between November 2011 to May 2014, 40 cases that were followed for more than 1 year-among all cases of MIPPO and open plate fixation-were analyzed. The study population was divided into two groups: group A included 20 cases of MIPPO and group B included 20 open plate fixation cases. The comparative analysis between the two groups was based on the operative time, bone union, functional evaluation (American Shoulder and Elbow Society score), incision length, pain relief (visual analogue scale, VAS), and complication. Results: The bone union was successful for all the cases, and the functional evaluation scores of the shoulder joint were satisfactory for both groups (p>0.05). The operative time was 47.5 minutes and 58.7 minutes for group A and B, respectively (p<0.05). The incision length for group A was 6.2 cm and that for group B was 10.7 cm with statistical significance (p<0.05). Pain relief (VAS) after surgery for group A showed a quick recuperation in the early stages. For complications, there were 2 cases of dysesthesia and 1 case of malunion due to metal fixation failure in group A. There were 6 cases of dysesthesia and 2 cases of cosmetic problem due to hypertrophic scar in group B. Conclusion: Surgical results of clavicle shaft fracture were satisfactory for both groups, but group A had advantages of shorter operative time, minimal incision length, and better pain relief in the early stages compared with group B. However, we need further evaluations with long-term follow-up results and complications, such as malunion and exposure on radiation.

Clinical Results of Anterolateral Thigh Perforator Flap for Soft Tissue Reconstruction of the Foot and Ankle (족부 및 족관절부 연부조직 재건을 위한 전외측 대퇴 천공지 피판술의 임상결과)

  • Han, Soo-Hong;Hong, In Tae;Lee, Yohan;Jo, Yong-Gil;Kwon, Young Woo
    • Journal of the Korean Orthopaedic Association
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    • v.52 no.1
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    • pp.40-48
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    • 2017
  • Purpose: Soft tissue reconstruction of a defect around the foot and ankle is a particularly challenging procedure due to the anatomical and functional characteristics of this area. Hence, only a limited number of treatment options are available. Moreover, if patients wish to avoid additional scars on the ipsilateral lower leg for cosmetic reasons, even fewer options are available for treatment. The authors used an anterolateral thigh perforator flap for soft tissue defects in this area, when other surgical options were inadequate. The aim of this study was to report the clinical results and the efficacy of this procedure. Materials and Methods: Sixteen cases of soft tissue defects around the foot and ankle were included. Participants included 12 male and 4 female subjects, and the mean age was 34 years. The most common cause of defect was acute trauma, and the average follow-up period was 33 months. Flap survival time, surgical complications, and ambulation status at the final follow-up stage were evaluated. Results: All 16 flaps successfully survived, except for one case with partial flap necrosis that was thought to be due to weight bearing earlier than scheduled. All patients were able to walk independently without any aid at the final follow-up stage. No patients showed other significant surgical complications. Conclusion: The anterolateral thigh perforator flap is a good alternative for soft tissue defects of the foot and ankle, when other options are not applicable. This study also demonstrated that surgery using an anterolateral thigh perforator flap is safe and highly reliable.

The Effectiveness of Arthroscopic Debridement with Mini-Open Ulnar Nerve Decompression in Primary Osteoarthritis of the Elbow with Ulnar Neuropathy (척골 신경 병증을 동반한 주관절 퇴행성 관절염에서 최소 절개 척골 신경 감압술과 동시에 시행한 관절경적 변연 절제술의 효과)

  • Jegal, Midum;Yu, Kun-Woong;Park, Sung-Bae;Kim, Jong-Pil
    • Journal of the Korean Orthopaedic Association
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    • v.52 no.1
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    • pp.15-24
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    • 2017
  • Purpose: The aim of this study was to determine the effectiveness of arthroscopic debridement with mini-open ulnar nerve decompression in primary osteoarthritis of the elbow with ulnar neuropathy. Materials and Methods: Between May of 2006 and July of 2014, a total of 43 patients who had undergone surgery for primary osteoarthritis of the elbow with ulnar neuropathy were included in this study. We divided the subjects into two groups according to the method of surgery: group 1 (n=18) received mini-open ulnar nerve decompression only, and group 2 (n=25) received arthroscopic debridement with mini-open ulnar nerve decompression. Patients were assessed for the following clinical outcomes: visual analogue scales (VAS) score, range of motion of the elbow joint, Mayo elbow performance score (MEPS), and disabilities of the arm, shoulder and hand (DASH) at the time before surgery and 6 months after surgery. We analyzed the recovery of the ulnar nerve by the McGowan grade and Bishop rating score preoperatively and at 6 months after the surgery. Results: The VAS score, range of motion of the elbow joint, MEPS, and DASH showed significant statistical difference after the surgery (p<0.05). However, between the 2 groups, there was no significant difference. For the McGowan grade, all cases of both groups-except one case each group-showed at least one grade improvement. Moreover, group 2 showed a greater significant difference than group 1 (p=0.001). At the final follow-up, according to the Bishop rating score, group 2 had a greater significant difference than group 1 (p=0.036). Conclusion: Arthroscopic debridement with mini-open ulnar nerve decompression in primary osteoarthritis of the elbow with ulnar neuropathy is a useful technique, which has several advantages, including the benefits associated with a minimally invasive surgery and also the improvement of elbow joint function and excellent recovery of the ulnar nerve.

Extension of Platforms and Return of High-Teen Romance Drama (플랫폼의 확장과 하이틴 로맨스 드라마의 귀환)

  • Moon, Sun-Young
    • Journal of Popular Narrative
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    • v.25 no.4
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    • pp.45-71
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    • 2019
  • Through the expansion of platforms in the media era, this paper notes the phenomenon in which 'high-teen romance drama,' a genre which had been marginalized in the past, began to re-emerge. It analyzes the 'high-teen romance drama,' which is moving from TV to the Web and being produced in various ways, while successfully returning to the TV drama format. This study sums up the latest trends in TV and web-based high-teen romance dramas, and as a case study, this paper examines the characteristics of the 'high-teen romance drama' in relation to the platform's environment through the web drama A-Teen, TV drama 18 Moment. Due to the restriction of ratings, high-teen romance dramas have been one of the largely marginalized genres on television. But in the web space, high-teen romance dramas are no longer non-mainstream. The high-teen romance drama has been solidifying its position through the Web, with absolute support from young viewers. Web dramas are gradually expanding their influence on the genre and subject of TV dramas. The high-teen romance drama is one of the most prominent examples of this trend. The popular interest and success of the high-teen romance web drama has brought the forgotten high-teen romance drama back to TV. The web drama A-Teen is a high-teen romance drama about everyday life and love of high school students, and became one of the most popular and popular web dramas, leading to a Season 2. A-Teen actively utilizes teenage culture and expression, and a strategy that leads to empathy among teenage viewers. In A-Teen, love is recreated in a way that relieves the depth of overconsumption emotions. Instead of dealing in depth with the inner conflict over love, it takes an approach ofpresenting the emotional change of love in real time and forming a consensus with the acceptor. The TV drama 18 Moment is one of the programs that has helped refocus attention to TV-hitting romance dramas. 18 Moment underlines the growth of the characters, with the main characters reaching maturity through love as fresh and innocent teenagers. The TV drama 18 Moment is a high-teen romance drama that has been transformed into a way to apply the web-fadding high-times grammar while retaining the typicality of existing TV hagwons to suit the TV broadcasting environment. As the Internet becomes more ubiquitous, video content is changing based on the newly emerging platforms. Dramas no longer mean just traditional television media. While considering the limitations of TV, this paper analyzed the background of the rebirth of the high-teen romance drama, which had been marginalized, through the web platform. This is meaningful in that it identifies and considers the increasing popularity of this genre of drama.

An Oral History Study of Overseas Korean Astronomer: John D. R. Bahng's Case (한국천문연구원 원외 원로 구술사연구 - 방득룡 전임 노스웨스턴 대학교 천문학 교수 사례 -)

  • Choi, Youngsil;Seo, Yoon Kyung;Lee, Hyung Mok
    • The Bulletin of The Korean Astronomical Society
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    • v.46 no.2
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    • pp.73.4-74
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    • 2021
  • 한국천문연구원은 2017년 제1차 구술채록사업에 이어 2020년 제2차 사업을 진행하면서 최초로 원외 원로에 대한 구술채록을 시도하였다. 국가 대표 천문연구의 산실로서 연구원 존재 의의를 확립하기 위하여 원내 원로에 국한되었던 구술자 대상을 확장한 것이다. 그 첫 외부 구술 대상자로 방득룡 전임 노스웨스턴 천문학과 교수를 선정하여 2020년 7월부터 준비단계에 들어갔다. 방득룡 전(前)교수가 첫 번째 한국천문연구원 원외 인사 구술자로 선정된 이유는, 그가 우리나라 천문대1호 망원경 구매 선정에 개입한 서신(1972년)이 자료로 남아있었기 때문이다. 한국천문연구원에서 2017년에 수행한 제1차 구술채록사업에서 구술자로 참여한 오병렬 한국천문연구원 원로가 기증한 사료들은 대부분 연구원 태동기 국립천문대 구축과 망원경 구매 관련 자료였으며 이 가운데 1972년 당시 과학기술처 김선길 진흥국장에게 Boller and Chivesns(사(社))의 반사경을 추천한 방득룡 전(前)교수의 서신은 한국 천문학 발전사에서 중요한 사료였다. 연구진은 이 자료를 시작으로, 방득룡 전(前)교수의 생존 여부와 문서고의 공기록물들에서 그의 흔적을 찾아가기 시작했다. 놀랍게도 그는 실제 세계와 한국천문연구원 문서고 깊숙이 기록물들 모두에서 상존하고 있었다. 1927년생인 방득룡 전(前)교수, Dr. John D. R.은 미국 플로리다 한 실버타운에서 건강한 정신으로 생존하여 있었고 연구진의 인터뷰에 흔쾌히 응했다. 2020년 9월 16일에 한국천문연구원 본원 세종홀 2층 회의실에서 영상통신회의로 그와의 구술인터뷰가 진행되었다. 이 구술인터뷰는 원외 인사가 대상이란 점 외에도 방법적으로는 전형적인 대면 방식이 아닌 영상 인터뷰였다는 점에서 코로나 시대의 대안이 되는 실험적 시도였다. 현대 한국천문학 발전사의 재조명 측면에서도 의미가 있었다. 1960년대 초반부터 1992년 정년퇴임까지 30년을 미국 유수 대학교 천문학과 교수로 재직하며 활발한 활동을 해 온 한국계 천문학자가 우리나라 최초 반사망원경 구매 선정에 적극 개입하였던 역사는, 공문서 자료들과 서신 사료들에 이어 그의 육성으로 나머지 의구심의 간극이 채워졌다. 또 구술자 개인이 주관적으로 중요하다고 여기는 '기억'이 중요한 아카이빙 콘텐츠 확장의 단초가 될 수 있다는 것을 보여줌으로써 구술사 연구에 있어서도 중요한 관점을 주었다. 애초 연구진이 방득룡 전(前)교수의 공식 기록에서 아카이빙의 큰 줄기로 잡았던 것은 1948년 도미, 1957년 위스콘신 대학교 천문학 박사학위 취득, 1962년부터 노스웨스턴 대학(일리노이주 에반스턴)의 천문학 교수진, 1992년 은퇴로 이어진 생애였다. 그러나 그와의 구술 준비 서신 왕래와 구술을 통하여 알게 된 그가 인생에서 중요시 여겼던 지점은, 1948년 도미 무렵 한국의 전쟁 전 상황과 당시 비슷한 시기에 유학한 한국 천문학자들의 동태, 그리고 1957년부터 1962년까지 프린스턴 대학교에서 M. Schwarzschild 교수와 L. Spitzer 교수를 보조하며 Stratoscope Project를 연구하였던 경험이었다. 기록학적 의미에서도, 전자를 통해서 그와 함께 동시대 한국 천문학을 이끌었던 인재들의 맥락정보를 얻을 수 있었으며, 후자를 통해서는 세계 천문학사에 큰 영향을 미친 석학에 대한 아카이브 정보와의 연계 지점과 방득룡 전(前)교수의 연구 근원을 찾을 수 있었다. 이들은 추후 방득룡 콘텐츠 서비스 시에 AIP, NASM, Lyman Spitzer 콘텐츠, 평양천문대, 화천조경천문대, 서울대와 연세대, 그리고 한국천문연구원까지 연계되어 전 세계 폭넓은 이용자들의 유입을 유도할 수 있는 검색 도구가 될 수 있다. 이번 방득룡 구술사 연구에서 구술자 개인의 주관적인 소회가 공식 기록이 다가갈 수 없는 역사적 실체에 일정 부분 가까울 수 있다는 것, 그리고 이를 통하여 개인의 역사는 공동체의 역사로 확장될 수 있다는 사실을 발견할 수 있었다. 또 연구진은 방득룡 전(前)교수의 회상을 통하여 구술자 개인의 시각으로 한국과 미국 천문학계의 공동체 역사를 재조명할 수 있었고, 이것을 아카이브 콘텐츠 확장 서비스에 반영할 수 있다는 기대를 가지게 되었다. 무엇보다 이 연구를 통하여 다양한 주제의 아카이브로 연동될 수 있는 주제어와 검색도구를 구술자 개인의 회상으로부터 유효하게 도출할 수 있다는 것을 확인하였다. 그리고 향후 한국천문 구술아카이브의 확장을 통하여 보다 다양한 활용과 연구 재활용의 선순환이 가능하다는 것도 알 수 있었다. 이는 최근 기록학계에서 대두되고 있는 LOD(Linked Open Data)의 방향성과도 흡사하여 한국천문학 구술사연구의 차세대 통합형 기록관리의 미래모형을 기대케 하는 대목이다.

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Examining the Influence of Science Museum Service Quality on Customer Satisfaction and Revisit Intention - A Case of Gwacheon National Science Museum - (과학관 서비스 품질이 고객만족도 및 재방문 의도에 미치는 영향 분석 - 국립과천과학관을 중심으로 -)

  • Choi, Jung won;Nam, Tae woo;Cho, Jae min
    • Korea Science and Art Forum
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    • v.27
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    • pp.277-288
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    • 2017
  • The number of science museums in Korea has expanded quantitatively from 72 in 2008 to 128 in 2016. This study started with the fact that the government puts a lot of budget into building a science museum, but there are more than one quarter of science museums with less than 50 spectators per day and many inefficient institutions. The number of visitors is an important factor in improving the efficiency of the science museum operation. The purpose of this study is to analyze the relation between the service quality of the science museum and the customer satisfaction and the intention to revisit and to find out what kind of effort should be concentrated in the science museum to attract more visitors. Questionnaires were written in the exhibition, education, and culture fields of the Gwacheon National Science Museum. The results were derived by frequency analysis, reliability analysis, factor analysis, and multiple regression analysis. The results and contents of the study are as follows. First, in the field of exhibition, the quality of exhibition facilities was expected to affect customer satisfaction and intention to return, but did not have a meaningful relationship. Second, the education sector has been found to affect customer satisfaction and return intention in all aspects of service quality (operation and contents, instructors, educational facilities and environment). Third, in the field of culture (event), the quality of the cultural program influences the visitor satisfaction, but it does not affect the intention to revisit. The science museum can provide satisfaction to visitors by combining activities such as science and arts. Despite the limitations, it is necessary to make efforts to improve the visitor satisfaction and revisit by proceeding with the convergence research on the entire National Science Museum in the future.

Analysis of Ruminal Dry Matter and Crude Protein Digestibility on Major Roughage, Wormwood and Green Tea (주요 조사료원과 쑥, 녹차의 반추위 건물 및 조단백질 소화율에 대한 분석)

  • Lee, Shin Ja;Lee, Su Kyoung;No, Jin Gu;Kim, Do Hyung;Lim, Jung Hwa;Moon, Yea Hwang;Lee, Sung Sill
    • Journal of agriculture & life science
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    • v.50 no.5
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    • pp.139-152
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    • 2016
  • The comparative in vitro and in situ analysis were conducted to evaluate the rumen degradability and physical structure of domestic roughage as rice straw, timothy, alfalfa, wormwood and green tea. The feedstuffs incubated with rumen fluid and was used to determine gas production, microbial growth rate and pH changes in an in vitro experiment. The gas production was increased during incubation times and was significantly(p<0.05) lower in green tea than other feedstuffs. The microbial growth rate in the feedstuffs was increased during incubation times. However, microbial growth rate was significantly(p<0.05) lower in wormwood and green tea than other feedstuffs. Ruminal pH was decreased during incubation times, and timothy was the lowest, and rice straw was the highest among feedstuffs. The disappearance rate of dry matter(DM) and crude protein(CP) in all feedstuffs were increased during incubation times and green tea was the highest(p<0.05) compared with other feedstuffs. In effective degradability, when rumen out-flow rate was assigned to 4%, wormwood showed the highest in DM, and alfalfa was the highest in CP. Whereas, green tea was the highest in both in situ DM and CP degradability. Many cilia on the surface and stoma of wormwood and stoma in green tea were observed by scanning electron microscopy. Microbes breaked down the cilia at the beginning and then degraded the surface in wormwood. In case of green tea, microbes attached to stoma. Therefore, wormwood and green tea have a potential value as ruminal feed stuffs.