Solitary Congenital Erosion in a Newborn: Report of a Solitary Congenital Self-Healing Reticulohistiocytosis

Congenital self-healing reticulohistiocytosis (CSHRH) is a rare, cutaneous, self-limited form of Langerhans cell histiocytosis. Whereas multiple lesions are common, a solitary lesion is rare. A 14-day-old neonate presented with a solitary, 5-mm, oval, reddish, and eroded papule with crust on the left thigh that had existed since birth. No systemic involvement was found. Histopathology revealed dense infiltration of large histiocytes with scattered eosinophils and lymphocytes in the dermis. Immunohistochemistry showed S-100 and CD1a positivity. Two months later, the skin lesion involuted spontaneously, without evidence of recurrence and extracutaneous involvement. On the basis of the characteristic clinical course and typical histopathological findings, a diagnosis of solitary CSHRH was made.

A Recurrent Angiosarcoma Isolated to the Eyelid without the Recurrence on the Primary Lesion of the Forehead

Angiosarcoma is a highly malignant vascular tumor of endothelial origin. Initially, a cutaneous manifestation presents as a singular or multifocal bruise-like patches on the skin, most frequently on the face, the scalp or the neck regions. On progression, the lesions become violaceous, and ill-defined spongy nodular tumors appear. Our patient was a 71-year-old man with a previous history of angiosarcoma on the right forehead and was treated with an excision and local radiation 3 years ago. Several months after the treatment, a dark brownish to violaceous patch with edema arose from the right upper eyelid and spread out to the lower eyelid. Clinically, an ecchymosis caused by trauma or other hemangioma was suspected more than a recurrent angiosarcoma. Histopathologic examinations including immunohistochemical studies were consistent with cutaneous angiosarcoma. Herein, we report a rare case of a recurrent isolated angiosarcoma without the recurrence of a primary lesion.

A Case of Multiple SCCs in situ and BCC Induced Probably by Chronic Exposure to Arsenic-containing Pills (Hwan-Yak) / 대한피부과학회지

Not legally, arsenic has been used for various medical purposes. Chronic exposure to arsenic can induce different kinds of cutaneous diseases, including arsenic keratosis, Bowen's disease, squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and other pigment disorders. Also, arsenic induces internal malignancies, including tumors of the pulmonary and urogenital systems. To prevent these malignancies, the use of arsenics should be strictly prohibited. We describe a 72-year-old man who developed SCC in situ and BCC after chronic exposure to arsenics.

Adult Onset Still's Disesae: A Case Report / 대한피부과학회지

Adult-onset Still's disease (AOSD) is a systemic inflammatory disease of an unknown etiology, and AOSD is characterized by high fever, skin rash, arthritis, lymphadenopathy, hepatomegaly, sore throat and serositis. The typical skin rash of AOSD patients is an evanescent, erythematous maculopapular lesion. There is no single diagnostic test; therefore, the diagnosis is based upon the clinical criteria. Treatment consists of anti-inflammatory medications such as aspirin, NSAIDs, corticosteroids, anti-rheumatics and immunosuppressants. We report here on a case of AOSD in which a 53 year-old female patient presented with a high fever, a typical rash, arthritis, a sore thoat and mild splenomegaly.

Comparison of Monosegment Instrumented Posterior Lumbar Interbody Fusion with and without a Metal Cage in Degenerative Spine / 대한정형외과학회잡지

PURPOSE: To compare the radiological and clinical results of a local bone graft with those of a single cage in monosegement instrumented posterior lumbar interbody fusion (PLIF) for a spinal stenosis or low-grade spondylolisthesis at the L4-5 level. MATERIALS AND METHODS: Eighteen patients underwent PLIF using a local bone block and a chip bone without a cage (no-cage group) and 24 patients underwent PLIF using a local bone graft with a single non-threaded metal cage (cage group). All the patients were followed up for a minimum of 2 years. The disc space height, disc lordosis, bone union and clinical results according to Lin's criteria of both groups were reviewed and compared retrospectively. RESULTS: The disc space heights of the no-cage and cage groups increased by 27% and 44% at the immediate postoperative and 12% and 27% at the latest follow-up, respectively. The cage group showed significantly better restoration of the disc space height (p0.05). Clinical satisfactory results were obtained in 72% of the no-cage group and 84% of the cage group without a significant difference (p>0.05). CONCLUSION: Both groups had a significant loss of restored disc space height 3 months after surgery. PLIF using a cage showed better restoration of the disc space height but there was significant loss of disc lordosis during the follow-up. A cage with sufficient height is recommended for restoring the disc space as well as preventing a loss of disc lordosis.

Deep Infection following Instrumented Posterior Fusion / 대한정형외과학회잡지

PURPOSE: This study evaluated the diagnosis, treatment and related results for cases with a deep infection after instrumented posterior fusion. MATERIALS AND METHODS: Among the 306 cases of posterior instrumented spinal fusion, Seventeen cases who developed deep infection were reviewed retrospectively. RESULTS: The incidence of deep infections was 5.6% and the mean age of the cases with a deep infection was 55 years old. Nine out of 17 cases had the preoperative risk factors such as old age, diabetes, malnutrition, obesity, etc. The mean duration to diagnosis of a postoperative infection was 12.9 days (4-8 days). The clinical manifestations were fever, night pain and abscess drainage. In all cases, the value of the WBC, ESR and CRP were elevated. All cases were treated surgically as soon as possible with abscess drainage, debridement and the insertion of antibiotics-mixed cement beads without the removal of the instrument. The most common bacterial organisms were Coagulase negative Staphylococcus aureus in 11 cases. Vancomycin was used as the antibiotic. During the follow-up period, 2 cases were treated with the removal of the instruments due to metal failure and a delayed deep infection with loosening. The average follow-up was 32 months (12-56 months). 15 cases were controlled successfully without needing to remove the instruments and without complications. CONCLUSION: The meticulous care for a deep infection after posterior instrumented spinal fusion is essential. Favorable results can be achieved by surgery with drainage, debridement, and the insertion of antibiotics-mixed cement beads along with systemic antibiotics as soon as possible without removing the instruments.

Flexible Intramedullary Nail Fixation of Pediatric Femoral Shaft Fracture

PURPOSE: To traditional treatment of pediatric femoral shaft fracture has been a traction and spica cast application. But flexible intramedullary nail fixation has been introduced as an alternative to other treatment modalities. With this in mind, we analyzed the clinical and radiologic results of flexible intramedullary nail fixation of pediatric femoral shaft fractures. MATERIALS AND METHODS: We analyzed 12 patients (13 cases) who were treated with flexible intramedullary nail and followed up for at least 6 months at the department of Orthopedic Surgery, Inje University Ilsan Paik Hospital since May, 2002. RESULTS: In all 12 patients (13 cases) involving 1 case with reoperation because of reduction failure, average duration of bone union was 12.6 weeks. There were no considerable complications except mild post-op knee pain and limitation of motion. CONCLUSION: In spite of relatively short term study, a flexible intramedullary nail fixation seems to be a useful method without serious complications on pediatric femoral shaft fracture. However, in big or older pediatric patients, interlocking intramedullary nail fixation may be a better choice rather than a flexible nail fixation because of it's insufficient stability.

Comparison of the Results of Percutaneous Vertebroplasty for Treating Osteoporotic Vertebral Compression Fracture and Posttraumatic Vertebral Collapse (Kummell's disease) / 대한척추외과학회지

STUDY DESIGN: The comparison was based on the radiographc and clinically differences of 96 vertebroplasty cases. PURPOSE: This study evaluated the clinical and radiological results of performing percutaneous vertebroplasty for acute or subacute osteoporotic vertebral compression fracture (group A) and for posttraumatic vertebral collapse (Kummell's disease) (group B). SUMMARY OF LITERATURE REVIEW: Percutaneous vertebroplasty is a minimal invasive procedure for the treatment of a painful collapsed vertebral body MATERIALS AND METHODS: We experienced 67 cases of group A and 29 cases of group B, and we followed these patients for 2 years or more. We evaluated the clinical results by using the serial visual analogue scale (VAS) and the radiological results were evaluated by measuring the restoration of the anterior vertebral height and the change of the kyphotic angle. We also compared both groups for their bone mineral density (BMD) and new fracture rate. RESULTS: Statistically significant pain relief was obtained by both groups in the perioperative period. The average VAS change was 6.5 (from 8.7 preoperatively to 2.2 postoperatively) in group A, and 7.1 (from 9.1 preoperatively to 2.0 postoperatively) in group B on a 10 point pain scale. The anterior vertebral height increased an average of 4.9mm (16.5%), (from 16.8mm preoperatively to 21.7 mm postoperatively) in group A, and 6.5 mm (21%) (from 12.8 mm preoperatively to 19.3 mm postoperatively) in group B on the perioperative period. But the height was minimally decreased more that it was measured at the immediate postoperative period: 18.7 mm in group A, and 16.2 mm in group B on the last follow up. The kyphotic angle was restored an average of 5.2 degrees (from 32.4 degrees preoperatively to 27.2 degrees postoperatively) in group A, and 4.9 degrees (from 39.5 degrees preoperatively to 34.6 degrees postoperatively) in group B on the perioperative period. But the angle was increased more than that measured preoperatively: about 1.7 degree in group A and group B on the last follow up. There's no significant difference in the BMD between the groups. New fracture developed in 17.9% (12) of group A, and 20.7% (6) of group B. We did this procedure for 15 cases of new fracture, and then the VAS change was an average 5.0 immediately after the operation. CONCLUSIONS: Percutaneous vertebroplasty was an effective treatment method for both groups and there were no statistically significant differences in the clinical and radiological results. Care must be taken due to the relatively high rate of new fracture and this can be resolved by repeat vertebroplasty

Roentgenogram based assessment of pedicular screw placement / 대한정형외과학회잡지

No abstract available.

Pudendal Nerve Neurapraxia Associated with Traction on the Fracture Table: A Case Report / 대한정형외과학회잡지

Sexual impotence from positioning on the fracture table is rare complication. We are reporting a case of pudendal nerve neurapraxia associated with pressure from the perineal post of the fracture table in 42 years old male with hip fracture. Historical reviews and suggestion for prophylactic measures are also reported in this paper.

Effects of Low Intensity Ultrasound on the Co-Culture of Human Osteoblastic Cells (SaOS-2) with Endothelial Cells (HUVEC) / 대한정형외과연구학회지

PURPOSE: We investigated the effects of low intensity ultrasound on the co-culture of human osteoblastic cells with endothelial cells and analysed cell proliferation and growth factors that might be involved in bone formation. METHODS: Cell culture system was established with human osteoblastic cells (SaOS-2) and primary isolated human umbilical vein endothelial cells (HUVEC). Low intensity ultrasound (1 MHz) treatment was administered for 20 minutes per day to each well for 4 consecutive days and its effects were determined by analysing cell proliferation activity, alkaline phosphatse and amount of growth factors such as basic fibroblast growth factor, transforming growth factor beta and transforming growth factor beta in the conditioned medium. RESULTS: Low intensity ultrasound treatment increased cell proliferation activity, level of the basic fibroblast growth factor and transforming growth factor beta in the co-culture system. The levels of alkaline phosphatase and transforming growth factor beta in the conditioned medium were not changed. We could not observe the change of cell proliferation or amount of various growth factors in a culture system of SaOS-2 or HUVEC. CONCLUSION: The low intensity ultrasound treatment can increase osteogenesis by certain interaction between the two cells and increase in bFGF and TGF beta participate in the process.

The Effects of Droxieam(Precam)on the Patients with Active Rheumatoid Arthifis / 대한류마티스학회지

OBJECTIVE: For the past quarter of a century, the medical treatment of rheumatoid arthritis has been both illustrated and influenced by the therapeutic pyramid. In this plan of sequential drug administration, the initial choice, the base of pyramid, is aspirin or one of the many other NSAIDs. Droxicam, a new NSAID, is a pro-drug of piroxicam and acts by inhibition of PGE2~. Although it belongs to oxicam family, it is characterized by being a pro-drug of piroxicam, the molecule undergoing conversion by hydrolysis once dissolved in the digestive tract. So, its analgesic and anti-inflammatory potentials are the same as those of piroxicam, but G-I trouble, its major adverse effect, is less troublesome. This study was aimed to evaluate the clinical efficacy and safety of Droxicam. METHODS: Thirty three cases of active RA had been selected, 20mg of Droxicam was administrated to them per oral daily for 4 weeks and changes in pain score, numbers of tender/swollen joints, severity of their tenderness/swelling, duration of morning stiffness, grip strength, ESR and side effects of the drug were estimated. RESULTS: l. Pain rated by the patients with visual analogue scale was improved. the average pain score decreased gradually as follows: 7.0 in preadministration, 5.0 in the second weeks of post-treatment and 3.7 in the fourth weeks. 2. The numbers of tender/swollen joints and severity of their tenderness/swelling were gradually decreased after treatment. 3. Average durations of morning stiffness were 70.6 minutes in pre-administration, 67.3 in 2weeks and 59.7 in 4weeks after treatment, and average grip strengths were 45.5, 45.8, and 47,5mmHg in orders. 4. Average ESR decreased after administration : 41.3mm/hour in pre-treatment and 32.3mm/hour in 4weeks after administration. 5. Untoward effects were G-I trouble, edema, dizziness and weight gain. CONCLUSIONS: In summary, Droxicam seems to be useful drug in the treatment of active PA. However, further longterm follow-up is necessary.

Arthroscopy in acute post-traumatic hemarthrosis / 대한정형외과학회잡지

No abstract available.

The supracondylar osteotomy for the correction of angular deformity of the distal humerus / 대한정형외과학회잡지

No abstract available.

Change of Pillar Pain after Endoscopic Carpal Tunnel Release / 대한정형외과학회잡지

PURPOSE: Endoscopic carpal tunnel release has been reported to offer the advantages of reduced pain and complications, and to allow a rapid return to work. It was, therefore, introduced as an alternative to open carpal tunnel release. With this in mind, we analyzed changing pillar pain after endoscopic carpal tunnel release. MATERIALS AND METHODS: We analyzed 22 patients (35 cases) who were treated by endoscopic carpal tunnel release, and followed for over l year, from November 1999. RESULTS: According to Cseuz's criteria, 27 cases were excellent and 5 were good. Levine's Symptom Severity Scale improved from 35 preoperatively to 14 postoperatively. CONCLUSION: While endoscopic carpal tunnel release was confirmed to offer the advantages of reduced pain and palmar scarring, there seemed to be no difference in the clinical results compared with the open method. Therefore, endoscopic carpal tunnel release may be a useful method if it is done skillfully and carefully. However, even in the case of endoscopic release, pillar pain remains a problem. Long term results need to be examined to evaluate recurrence.

Clinical study on the posterior decompression and posterolateral fusion with instrumentation in lumbar spinal stenosis / 대한정형외과학회잡지

No abstract available.

Treatment of unstable fracture and fracture-dislocation of the thoracolumbar spine using Kaneda instrument / 대한정형외과학회잡지

No abstract available.

Postirradiation Fibrosarcoma of Bone: Report of 2 Cases / 대한정형외과학회잡지

Ionizing radiation has brought powerful aids to medical practitioners, but it has also brought new and bewildering problems. Radiation in the form of systemically administered radionuclides or external radiation may produce such abnormal reactions in the musculoskeletal system as growth disturbances, myelofibrosis, radiation osteitis, necrosis of bone, exostosis, pathologic fracture, and on rare occasion malignant tumors. The incidence of postirradiation sarcoma was quite rare and there were some histologic hypes of postirradition sarcoma. Of them, incidence of osteosarcoma and fibrosarcoma is most common, although there is some difference between each reports. The authors have experienced recently two cases of postirradiation fibrosarcoma developed in sacrum. In one case, the patient was 55 years old female and the latent period was about 12 years. In another case, the patient was 67 years old female and the latent period was about 15 years. In these cases, they received radiation therapy due to cervical cancer of uterus. They had nerve roots compression symptoms and recieved operation of nerve roots decompression. The diagnosis was confirmed by core bone biopsy. A clinical analysis of these cases is to be reported with review of references.

An Unusual Cause of Carpal Tunnel Syndrome: A Case of Tuberculosis of the Median Nerve / 대한정형외과학회잡지

Numerous cause of the carpal-tunnel syndrome have been reported, but we could not find a reference for tuberculosis of the median nerve causing this syndrome. Therefore, we are presenting the case report of this rare condition as another cause of the carpaltunnel syndrome.

A Clinical study of the High Tibial Osteotomy in Osteoarthritic Knees with Varus Deformity / 대한정형외과학회잡지

During the period of 5 years and 5 months, from January 1979 to May 1984, we treated 27 cases(17 patients) of osteoarthritis with genu varum deformity by high tibial osteotomy. The results were as follows: l. In the 27 cases of the high tibial osteotomy, 24 cases were female and 3 cases were male. 2. Of the etiology of the osteoarthritis with genu varum, 14 female patients had primary one and 3 male patient knees were related with infection(2 patients) and trauma (1 patient). 3. Preoperative varus angles, ranging from 0° to 20°, 6.4° in an average and postoperative valgus angles, ranging from 5° to 15°, 8° in an averge. 4. In a review of the high tibial osteotomy, good and fair results were noted in 26 cases (96.3%) of the knees after average 2 years of follow-up. 5. The high tibial osteotomy is found to be useful method in the treatrnent of the osteoarthritic knee with varus deformity.