Diagnosis and Treatment of Brown Tumor (Brown 종양의 진단 및 치료)
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- Journal of the Korean Orthopaedic Association
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- v.55 no.1
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- pp.54-61
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- 2020
Purpose: Brown tumor is a tumor-like disease that can occur as a linked disease of hyperparathyroidism which can causes osteoporosis, osteitis fibrosa cystica, pathologic fractures. Brown tumor has been reported as a case report, but there is no comprehensive report on the exact diagnosis and principle of management for osseous lesion. The purpose of this study is to report the treatment and results of osseous lesions through 5 cases. Materials and Methods: From February 2004 to May 2015, five cases of Brown tumor were diagnosed in Chosun University Hospital and Chonnam National University Hospital orthopedic department. Medical records and radiographs were reviewed retrospectively. Parathyroid tumors were surgically removed, and surgical treatment and observation were performed for orthopedic osseous lesions. Results: The mean length of the long axis of the symptomatic osseous lesion was 6.2 cm (4.5-9.0 cm). An average of 7.6 (range, 3 to 14) of high uptake osseous lesion showed in whole body bone scan. The absolute value, T-score and Z-score of the vertebrae and proximal femur were adequate for diagnosis of osteoporosis using dual energy X-ray absorptiometry bone mineral density at diagnosis and recovered to normal at the last follow-up. In laboratory tests, serum concentrations of total calcium, ionized calcium, inorganic phosphorus, serum alkaline phosphatase, and parathyroid hormone were helpful to diagnosis and normalized upon successful removal of parathyroid adenoma or cancer. Conclusion: For accurate diagnosis of Brown tumor, it should be accompanied by systemic examination as well as clinical symptoms, laboratory tests and radiologic examination for osseous lesions. And a good prognosis can be expected if the hyperparathyroidism is treated together with the comprehensive treatment of osseous lesions.
Purpose: This study examined the degree of cartilage regeneration by performing second-look arthroscopy in a group of patients who underwent high tibial osteotomy and microfractures for unicompartmental osteoarthritis of the medial knee joint and to determine the factors affecting cartilage regeneration. In addition, this study analyzed whether there is a relationship between the degree of cartilage regeneration and functional results. Materials and Methods: From 2007 to 2015, this study evaluated 81 cases who underwent second-look arthroscopy at the time of plate removal after a microfracture and high tibial osteotomy with a minimum two-year follow-up. The degree of femoral cartilage injury before surgery was classified by ICRS (International Cartilage Research Society), and all were grade III and IV. After second-look arthroscopy, cartilage regeneration was classified into a well-regenerated group (grade I, II) and a poorly regenerated group (grade III, IV). The independent factors influencing cartilage regeneration were identified through multivariate logistic regression analysis. In addition, the functional results were compared before and after surgery between the two groups using the Knee Society score (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index score (WOMAC). Results: Age, sex, body mass index, postoperative radiologic factors, and preoperative joint condition did not affect the degree of cartilage regeneration significantly. The large cartilage defect (≥2.0 cm2) (p=0.011) and the presence of kissing lesions (p=0.027) were associated with poor cartilage regeneration. No significant difference in the KSS and WOMAC scores was observed between the group with good and poor cartilage regeneration. Conclusion: The presence of a large cartilage defect and kissing lesions is associated with poor cartilage regeneration after high tibial osteotomy and microfracture. On the other hand, the degree of the regenerated cartilage did not show any correlation with the functional outcome.
Sulfur-oxidizing, ammonium-oxidizing, and nitrogen-oxidizing media were used to isolate bacteria to degrade malodor gas effectively in piggery manure or soil. Twelve different strains were isolated: Paenibacillus amylolyticus, Rhodococcus jostii, Rhodococcus qingshengii, Rhodococcus opacus, Alcaligenes faecalis, Alcaligenes faecalis, Kastia adipate, Kastia adipata, Microbacterium oxydans, Halomonas campisalis, Acinetobacter oleivorans, and Micrococcus luteus. By inoculating each strain in the piggery liquid manure by 1%, the pH in most strain treatments was maintained at 8.0. Total bacterial counts were maintained at 7.3~7.9 log CFU/ml until 15 days, and then they dropped dramatically down to 5.1~5.5 log CFU/ml. On the 30th day, the treatment group inoculated with Rhodococcus opacus SK2659 showed a relatively high level of ammonium nitrogen removal, which was 39% of that of the control group. When Rhodococcus opacus SK2659 was inoculated, H2S concentration after 100 days was 3.23% compared with the control (no inoculation), suggesting that Rhodococcus opacus SK2659 is an excellent strain for removing malodor gas. The gas production of the treatments was lower than that of the control. The total accumulated amount of gas production in most strain treatments was a quarter of the gas production compared to the control throughout the experimental periods. Acinetobacter oleivorans SK2675 showed the lowest level at 12.39% compared to the control in gas production. In conclusion, the use of mixture strains, such as Rhodococcus opacus SK2659 and Acinetobacter oleivorans SK2675 isolated in this study could increase the efficacy of malodor gas reduction in the biological treatment of piggery manure.
The Florence Charter, established in 1981 by the ICOMOS-IFLA International Commission on Historic Gardens, considered the historic garden as a plant-dominated architectural composition, a perpetual balance between the artist and the artisan's desire to remain unaltered in perpetuity. Trees, the main component of the garden, require continuous management as they repeat their creation and calling according to the cycle of the seasons and accordingly, it is suggested that management to maintain the appearance of trees in Korean palaces was an indispensable element. Although it is an important matter to historically verify the tree management techniques of the palaces of the past, research has been difficult due to the absence of historical records and the disconnection of life due to the Japanese colonial period. In addition, according to the view that trees were not generally managed in the palace, research on palace tree management techniques has not been conducted so far. Therefore, this study aimed to examine whether or not the tree management of the palaces was performed in the past through expert interviews based on photographs taken in modern times. With the identification of tree species and pruning through in-depth interviews with experts using photographs taken in the modern period, the results are as follows. First, it was found that the shapes of trees and leaves could be identified through photographs and by observing the phenomena caused by planting and pruning, it was possible to estimate whether or not the tree management was implemented in the modern palace. Second, as a result of in-depth interviews with 8 experts in 4 fields, it was possible to determine the tree species and pruning status, purpose, and method. There was no significant difference in opinions between groups, and the evidence was clearly presented. Third, the type of management of trees in the palace was mainly found to be determination of the types of tree, removal of hazardous factors of trees, and management of lower vegetation and through the photographs of Jondeokjeong and Gwanwanjeong, it was confirmed that the trees were managed even before the Japanese colonial era, considering the time of filming. Based on the photographs taken, it was possible to estimate whether the trees were managed before the Japanese colonial period through expert interviews. However, it could not be clarified due to lack of historical materials as to whether it was carried out on its own according to the circumstances of the times or by the Japanese Empire. Still, in this study, evidence was obtained to refute the view that trees of the palace were not managed in the past through the collected data. Expert opinions supporting this view were collected to make the conclusion. In addition, based on the general theory of pruning, an empirical review of expert opinions was conducted to secure the reliability of the research results.
Urban is an area where small-scale changes to individual buildings occur frequently. An existing urban building database requires periodic updating to increase its usability. However, there are limitations in data collection for building changes over a wide urban. In this study, we check the possibility of detecting building changes and updating a building database by using satellite images that can capture a wide urban region by a single image. For this purpose, building areas in a satellite image are first extracted by projecting 3D coordinates of building corners available in a building database onto the image. Building areas are then divided into roof and facade areas. By comparing textures of the roof areas projected, building changes such as height change or building removal can be detected. New height values are estimated by adjusting building heights until projected roofs align to actual roofs observed in the image. If the projected image appeared in the image while no building is observed, it corresponds to a demolished building. By checking buildings in the original image whose roofs and facades areas are not projected, new buildings are identified. Based on these results, the building database is updated by the three categories of height update, building deletion, or new building creation. This method was tested with a KOMPSAT-3A image over Incheon Metropolitan City and Incheon building database available in public. Building change detection and building database update was carried out. Updated building corners were then projected to another KOMPSAT-3 image. It was confirmed that building areas projected by updated building information agreed with actual buildings in the image very well. Through this study, the possibility of semi-automatic building change detection and building database update based on single satellite image was confirmed. In the future, follow-up research is needed on technology to enhance computational automation of the proposed method.
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70
The mechanism of the contractile response of longitudial muscle of rabbit ileum to substance P (SP) has been investigated. The contractions in rabbit ileum under various conditions were recorded isometrically The following results were obtained. 1) The contractions by SP increased according to concentrations. SP·induced contraction was not sustained but faded rapidly at
Purpose: Firstly, to analyze facto in terms of radiation treatment that might potentially cause subfrontal relapse in two patients who had been treated by craniospinal irradiation (CSI) for medulloblastoma, Secondly, to explore an effective salvage treatment for these relapses. Materials and Methods: Two patients who had high-risk disease (T3bMl, T3bM3) were treated with combined chemoradiotherapy CT-simulation based radiation-treatment planning (RTP) was peformed. One patient who experienced relapse at 16 months after CSI was treated with salvage surgery followed by a 30.6 Gy IMRT (intensity modulated radiotherapy). The other patient whose tumor relapsed at 12 months after CSI was treated by surgery alone for the recurrence. To investigate factors that might potentially cause subfrontal relapse, we evaluated thoroughly the charts and treatment planning process including portal films, and tried to find out a method to give help for placing blocks appropriately between subfrotal-cribrifrom plate region and both eyes. To salvage subfrontal relapse in a patient, re-irradiation was planned after subtotal tumor removal. We have decided to treat this patient with IMRT because of the proximity of critical normal tissues and large burden of re-irradiation. With seven beam directions, the prescribed mean dose to PTV was 30.6 Gy (1.8 Gy fraction) and the doses to the optic nerves and eyes were limited to 25 Gy and 10 Gy, respectively. Results: Review of radiotherapy Portals clearly indicated that the subfrontal-cribriform plate region was excluded from the therapy beam by eye blocks in both cases, resulting in cold spot within the target volume, When the whole brain was rendered in 3-D after organ drawing in each slice, it was easier to judge appropriateness of the blocks in port film. IMRT planning showed excellent dose distributions (Mean doses to PTV, right and left optic nerves, right and left eyes: 31.1 Gy, 14.7 Gy, 13.9 Gy, 6.9 Gy, and 5.5 Gy, respectively. Maximum dose to PTV: 36 Gy). The patient who received IMRT is still alive with no evidence of recurrence and any neurologic complications for 1 year. Conclusion: To prevent recurrence of medulloblastoma in subfrontal-cribriform plate region, we need to pay close attention to the placement of eye blocks during the treatment. Once subfrontal recurrence has happened, IMRT may be a good choice for re-irradiation as a salvage treatment to maximize the differences of dose distributions between the normal tissues and target volume.
In analyzing the operational characteristics of a rice whitening machine, the internal radial pressure of the machine was measured using strain gage equipment. Changes in cylinder and feed screw configurations, screen type, cylinder speed and counter-pressure levels were examined to determine their impact on the quality and quantity of milled rice and the performance of the machine. The results are summarized as follows: 1. The internal radial pressure in the whitening chamber varied with the surface condition of the grain being processed. During the first or second pass through the machine, pressure was relatively low, reached a maximum after two to three passes with combinations I and II, three to six with combination III and then began to fall. 2. The pitch of the feed screw and the size of the feed gate opening which determine the rate of entry of grain into the whitening chamber, appeared to be the most important factor aff-::cting the degree of radial pressure, quality and quantity of milled rice and the efficiency of the machine. Using a feed screw with a wide pitch (4.8cm), radial pressure was relatively high and head rice recovery ratio \vere quite low. In this case capacity and machine effic?iency were much higher than obtained when using a feed screw with a narrow pitch (2.3cm). Very significant responses in radial pressure, head rice recovery rates and machine capacity were observed with changes in cylinder speed and counter-pressure levels when using the wide pitch feed screw. 3. The characteristics of the screen which surrounds the whitening chamber had an important effect on whitening efficiency. The existence of small protuberances on the original screen resulted in significant increases in both machine capacity and efficiency but without a significant decrease in head rice recovery or development of excessive radial pressure. Further work is required to determine the effects of screen surface conditions and the shape of the cylinderical steel roller on the rate of bran removal, machine efficiency and recovery rates. The size of the slotted perforations 0:1 the screen affects total milled rice recovery. The opening size on the original screen was fabricated to accommodate the round shape of Japonica rice varieties but was not suitable for the more slender Indica type. Milling Indica varieties with this screen resulted in a reduction in total milled rice recovery. 4. An increase in cylinder speed from 380 to 820 rpm produced a positive effect on head rice recovery for all machine combinations at every level of counter-pressure used in the tests. Head rice recovery was considerably lower at 380rpm using a wide screw pitch when compared to the results obtained at speeds from 600 to 820 r.p.m. The effects of cylinder speed On radial pressure, capacity and machine efficiency showed contrasting results, depending on the width of the feed screw pitch. With a narrow feed screw pitch (2.3cm), a direct proportional relationship was observed bet?ween cylinder speed and both radial pressure and machine efficiency. In contrast, using a 4.8 centimeter pitch feed roller produced a series of inverse relationships between the above variables. Based on the results of this study it is recommended when milling Indica type long grain rice varieties that the cylinder speed of the original machine be increased from 500-600 rmp up to a minimum of 800 rpm to obtain a greater abrasive effect between the grain and the screen. The pitch of the feed screw should be also reduced to decr?ease the level of internal radial pressure and to obtain higher machine efficiency and increased quality of milled rice with increased cylinder speeds. Further study on the interaction between cylinder speed and feed screw pitch is recommended. 5. An increase in the counter pressure level produced a negative effect On the head rice recovery with an increase in radial pressure, capacity, and machine efficiency over all combinations and at every level of cylinder speed. 6. Head rice recovery rates were conditioned primarily by the pressure inside the whitening chamber. According to the empirical cha racteristics curve developed in this study, the relationships of head rice recovery (