• Journal of the Korean Orthopaedic Association
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• v.55 no.3
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• pp.244-252
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• 2020

Purpose: Total femoral replacement (TFR) is an extreme form of limb salvage. Considering the rarity of this procedure, reports have focused on the complications and a proper indication is unclear. This study analyzed 36 patients with TFR who were asked the following: 1) prognostic factors related to survival in patients who underwent TFR with a tumoral cause; 2) overall implant and limb survival; 3) complications, functional outcome, and limb status for patients surviving for more than 3 years. Materials and Methods: According to the causes for TFR, 36 patients were categorized into three groups: extensive primary tumoral involvement (group 1, 15 cases), tumoral contamination by an inadvertent procedure or local recurrence (group 2, 16 cases), and salvage of a failed reconstruction (group 3, 5 cases). The factors that may affect the survival of patients included age, sex, cause of TFR, and tumor volume change after chemotherapy. Results: The overall five-year survival of the 36 patients was 31.5%±16.2%. The five-year survival of 31 patients with tumoral causes was 21.1%±15.6%. The five-year survival of 50.0%±31.0% in patients with a decreased tumor volume after chemotherapy was higher than that of increased tumor volume (p=0.02). The five-year survival of 12 cases with a wide margin was 41.7%±27.9%, whereas that of the marginal margin was 0.0%±0.0% (p=0.03). The ten-year overall implant survival of 36 patients was 85.9%±14.1%. The five-year revision-free survival was 16.6%±18.2%. At the final follow-up, 12 maintained tumor prosthesis, three underwent amputation (rotationplasty, 2; above knee amputation, 1), and the remaining one had knee fusion. Among 16 patients with a follow-up of more than three years, 14 patients underwent surgical intervention and two patients had conservative management. Complications included infection in 10 cases, local recurrences in two cases, and one case each of hip dislocation, bushing fracture, and femoral artery occlusion. Conclusion: Patients showing an increased tumor volume after chemotherapy and having an inadequate surgical margin showed a high chance of early death. In the long-term follow-up, TFR showed a high infection rate and the functional outcome was unsatisfactory. Nevertheless, this procedure is an inevitable option of limb preservation in selected patients.

• Journal of Chest Surgery
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• v.42 no.3
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• pp.404-407
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• 2009

A 43-yr-old patient visited our department with intermittent chest pain he had suffered with for the past 2 months. Chest CT showed an egg shaped mass in the left chest wall. Local resection was performed for distinguishing the mass from a neurogenic tumor. The diagnosis was periosteal Ewing sarcoma of the rib. Since there was no evidence of metastasis based on the PET-CT, a 2nd operation was done with wide resection and thoracoplasty. The patient was then treated with combined chemotherapy. There has been no local recurrence for the fast 1 year. The patient's age and tumor origin were distinct from the usual characteristics of Ewing's sarcoma. Periosteal Ewing's sarcoma of the rib has rarely been reported. We report here on a case of periosteal Ewing's sarcoma of the rib along with a review of the relevant medical literature.

• The Journal of the Korean bone and joint tumor society
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• v.14 no.2
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• pp.131-139
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• 2008

Purpose: Lipomatous tumor occurred in hand is very rare. There is a broad spectrum of lipomatous tumors including lipomas, variants of lipomas, lipomatosis, liposarcomas and so on. We report the clinical features of 11 cases of lipomatous tumor which occurred in hand. Materials and Methods: Between 1992 and 2008, 11 cases were histologically diagnosed as lipomatous tumor in hand. We reviewed all medical records and clinical photographs retrospectively and ascertained recurrence by telephone interview. Results: Eight cases were ordinary lipomas. Three cases were angiolipoma, fibrolipoma and atypical lipoma respectively. Four cases occurred in finger, two cases in thenar area, two cases in hypothenar area, one case in palm, two cases in wrist. All cases were situated on volar surface. All patients complained of palpable masses. One patient with subungal angiolipoma felt pain. There was no neurologic sign or vascular symptom preoperatively. In one case, postoperative complication (hypoesthesia in $5^{th}$ finger) was developed. There was no local recurrence. Conclusion: In our study, lipomatous tumors occurred in hand did not recur. Patients mainly complained of feeling of lump. Pain was uncommon symptom. Postoperative complication was rare if operation was performed carefully.

• The Journal of the Korean bone and joint tumor society
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• v.17 no.1
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• pp.30-35
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• 2011

Purpose: This study was designed to evaluate the treatment results of malignant melanoma and to analyze the factors influencing prognosis. Materials and Methods: Thirty one cases of malignant melanoma were included in this study. They were treated in our hospital surgically, medically and immunologically from January 1996 to December 2005, and were followed more than 5 years. We compared 5 year survival rate (5YSR) according to the age, gender, anatomical site, depth of tumor, TNM stage, involvement of lymph node and immuno-chemotherapy. Results: Overall 5YSR was 80.6%. 5YSR of the age group below 65 years was 89.7% and 66.7% for the age group over 65 (p=0.033). 5YSR for men was 75% and 90.9% for women. 5YSR according to the site of occurrence showed 66.7% in upper extremities, 89.5% in lower extremities, and 66.7% in other site. 5YSR was 100% for the Clark level below III and 62.5% for the level above IV (p=0.032). 5YSR was 53.8% for lymph node metastasis group and 100% for non-lymph node metastasis group (p=0.021). Conclusion: We concluded that early diagnosis and wide excision was the most important in treatment of malignant melanoma. The prognostic fractors of malignant melanoma were age, depth of tumor (Clark's stage) and metastasis of lymph node.

• Korean Journal of Head & Neck Oncology
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• v.16 no.2
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• pp.177-181
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• 2000

배경 및 목적: Theodor Kocker에 의해 일반화된 전통적인 갑상선 수술방법은 갑상선 질환의 종류 및 정도, 수술범위와 상관없이 광범위한 수술범위로 인한 조직 손상으로 인해 수술후 환자들의 여러가지 불편감은 물론 경부의 넓은 부위의 통증과 경부 피부부종, 장액종, 혈종 등과 같은 후유증을 동반할 수 있다. 최근 본 저자들은 이같은 전통적 갑상선 수술의 부작용을 최소화하기 위해 작은 피부절개($3{\sim}4.5cm$) 후 피하 피판(subplatysmal skin flap) 없이 직접 갑상선으로 접근하는 새로운 수술기법으로서 최소침습 갑상선 수술기법을 개발하였기에 그 술식을 소개하고 전통적인 갑상선 절제술에 대한 우월성을 확인하고자 본 연구를 시행하였다. 대상 및 방법: 1999년 1월 15일 부터 2000년 1월 14일까지 573예의 갑상선 수술 예 중 최소침습 갑상선절제술이 시행되었던 466예와 1998년 1월 15일부터 1999년 1월 14일까지 전통적 갑상선 수술을 시행한 549예 중 거대 종양(양성>6cm, 악성>5cm), 흉골하 선종, 국소진행암, 재발암, 측경부의 다발성 림프절 전이가 있었던 112예를 제외한 437예의 임상병리적 특성과 피부절개 길이, 수술 시간, 수술중 출혈양, 수술후 진통제 요구빈도 및 재윈기간, 수술 후 합병증 발생빈도를 비교 분석하였다. 결 과: 두 군간의 임상병리적 특성상의 유의한 차이는 없었다. 피부절개 길이($3.7{\pm}0.7cm,\;vs\;9.6{\pm}3.3cm$), 수술 시간($57.6{\pm}11.7$분 vs $85.2{\pm}32.3$분) 수술 중 출혈양($18.4{\pm}15.3ml\;vs\;43.1{\pm}21.8ml$), 수술후 재원기간($1.6{\pm}0.5$일 vs $4.3{\pm}1.6$일), 및 수술후 진통제 요구빈도가 전통적 수술군에 비해 최소침습 수술군에서 통계적으로 유의하게 감소되었으나(p<0.05), 수술후 장액종 및 혈종 형성, 일시적인 음색변화, 일시적인 저칼슘혈증과 같은 합병증의 발생빈도는 각각 4.3%(n=20)와 4.8%(n=21)로 두 군간에 유의한 차이가 없었다. 결 론: 최소침습 갑상선 수술법은 새로운 수술기구의 도입 없이도 갑상선 수술의 충분한 시야를 확보할 수 있고 안전하고 간단하게 시행할 수 있으며, 기존 수술법으로 인한 부작용을 최소화할 수 있어 전통적 인 수술법을 대치할 수 있는 새로운 방법으로 사료된다.

• Journal of Chest Surgery
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• v.37 no.4
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• pp.376-381
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• 2004

Primary cardiac lymphoma is an extranodal malignant lymphoma of any cell type involving only heart and pericardium without dissemination. Patients usually present symptoms of heart failure, arrhythmias, pericardial effusion and cardiac tamponade. Diagnosis of primary cardiac lymphoma can be performed by echocardiogram, CT and MRI and cytologic examination of pericardial effusion or transvenously biopsied cardiac tissue. Prognosis of primary cardiac lymphoma is poor. Because of poor prognosis, early diagnosis and complete surgical excision is essential and postoperative systemic chemotherapy or radiotherapy is useful. In this case extensive tumor infiltration on the right ventricle and atrioventricular groove preclude surgical excision. Tissue biopsy revealed primary cardiac lymphoma. After postoperative chemotherapy and radiotherapy, the size of intracardiac mass is decreased in follow up chest CT scan and echocardiogram and symptoms of patient are relieved. Therefore, we report a case of primary cardiac lymphoma with review of literatures.

• Journal of Chest Surgery
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• v.38 no.11 s.256
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• pp.799-802
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• 2005

Langerhans cell histiocytosis (LCH) involves disorders previously referred as 'histiocytosis X' (including eosinophilic granuloma, Letterer-Siwe, and Hand-Schuller syndrome). Its clinical patterns are various and it is a basically benign tumoral condition but with a strong tendency toward dissemination and destruction. Its natural history is unpredictable. But, in solitary bone lesion, wide resection with tumor-free margin is required in order to provide the best chance for a cure. In the majority of patients LCH is a osteolytic lesion with a predilection for calvarium and is rarely seen in the skull base and the femur. LCM of rib, especially if solitary, is relatively rare. We report two rare cases of solitary LCH developed in the rib, which were successfully treated by surgical resection.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1991.06a
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• pp.28-28
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• 1991

후두암의 수직절제 수술후의 후두 재건 목적은 기관절개를 통하지 않고 후두를 통한 호흡이 가능하도록 하면서 연하시 기도흡인을 피하기 위한 sphincter 능력의 보존, 그리고 발성이 가능하도록 성대진동 mechanism을 재건하는데 있다. 오늘날 수많은 후두학자들에 의해서 고안 개발된 다양한 재건 방법이 있다. 연자는 광범위한 후두절제에 따른 큰 결손을 메우기 위해 bulky하면서도 점막 상피의 재생이 용이한 재건 피판으로 흉유돌근골막 피판을 이용하여 후두 결손부를 재건하여 보았다. 방법은 성견 3마리를 대상으로하여 thiopental sodium 정맥주사로 전신마취를 시행한 후 설골에서부터 흉골상까지 경부 정중앙의 피부를 절개하고 후두를 노출시켜 후두 수직절제술을 시행하였다. 흉유돌근과 흉골에 부착된 골막을 박리하여 흥유돌근골막 피판을 제작한 후 골막이 후두강 안쪽으로 되도록하여 골막연과 후두점막을 봉합하였다. 그리고 3, 5, 9개월에 후두적출술을 시행하여 병리조직학적 및 수술후 경과를 관찰하였다. 3실험견 모두 기관절개술 없이 후두를 통한 호흡이 가능하였고 흡입성 폐렴이나 피하기종등의 합병증없이 창상이 치유되었으며 발성도 양호하였다. 이식된 골막위로 신생혈관의 출현과 함께 점막재생이 잘되 있었다. 단지 봉합사 주위에 소량의 육아종이 관찰되었다. 조직학적으로는 섬유조직위로 편평상피가 재생되었으며 성문하부에서는 일부 섬모가 있는 호흡기 점막도 관찰되고 골막하부에 신생골 형성은 관찰할 수 없었다. 골막 피판은 그 유연성 때문에 결손부위의 점막연에 맞춰도 tension이 없고 공기 누출이 되지 않게 봉합이 가능할 뿐 아니라 점막이 재생할 수 있는 frame-work의 역할을 하는 것으로 사료되었다. 이상과 같은 사실로 미루어 흉유돌근 자체가 견실하고 골막에 혈류공급이 잘되어 창상치유에 좋을 뿐 아니라 큰 후두결손부의 재건이 가능하리라고 사료되었다.로서 몇가지 앞으로의 치료지침에 도움이 되는 결과를 얻었기에 보고하는 바이다. 1) 성별 분포는 남자 16(39 %), 여자 25 (61%)이었으며 1 : 1.5의 빈도를 보였다. 2) 연령 분포는 20대와 30대에서 남녀 모두 25명으로 대부분을 차지하였다. 3) 부식제의 종류는 빙초산이 26명 (63.4 %)으로 대부분을 차지하였고 염산 7 (17.1 %) Lye 3 (0.7 %) 의 순이었다. 4) 음독후 12시간내에 식도경술을 받은 환자가 3명(0.7 %) 12-24시간에 받은 환자가 17명(41.5 %), 24 - 48시간에 받은 환자가 11명(26. 8%)으로 48시간 내에 시행받은 환자가 전체의 75.6%를 차지하였다. 5) 식도경 검사상 나타난 식도화상은 Grade I 11명 (26.8%) G.ade II 18(43.9%) Grade III 7명(17.1%) 이었으며 Grade II 인 경우가 18명(43.9%)로 가장 많았으며 Grade I 11명(26.8 %), Grade III 7명 (17.1 %) Normal 5명 (12.2 %) 순이었다. 6) 조기 식도경 검사에서 41명중 oral cavity burn이 없었던 경우가 15명(36. 1 %) 이었으며, oral cavity burn이 있었던 26명중 5명(19 .2 %)에서 Esophageal burn이 없었다 특히 Esophageal burn의 Grade II, III 25명 중 9명(29.6 %)에서 oral cavity burn이 없었다. 7) 식도 부식중 환자의 치료 원칙으로 Grade I, II, III에서 항생제 및 보존적 치료를 하였으며 Grade I에선 oral feeding을 시켰고 Steroid는 경우에 따라 투여하였으며 Grade III에선 원칙적으로 사용치 않았다. 식도조영술은 Grade I II III에서 3주 후에 모두 시행하였다. 8) 3주 후 식도조영술을 실

• Korean Journal of Head & Neck Oncology
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• v.10 no.2
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• pp.152-156
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• 1994

Stomal recurrence after total laryngectomy presents serious therapeutic problems despite aggressive treatment methods. The purpose of this study is to evaluate the critical analysis of etiology and treatment results and to clarify the treatment plans and prevention of stomal recurrence. Among 159 cases who had undergone total laryngectomy for cancers of larynx(135 cases) and hypopharynx(24 cases) during recent 10 years, stomal recurrence occured in 12 cases(1 case with type I, 2 cases with type II, 2 cases with type III, 3 cases of type IV and unclassified 4 cases according to Sisson's classification) and the retrospective analysis of results were as follows: 1) Average duration of stomal recurrence was $8.2{\pm}4.35$ months after cessation of primary treatment. 2) The overall incidence of stomal recurrence was 7.6%. 3) The suggested etiology in the pathogenesis of stomal recurrence could be inadequate surgical margin, delayed laryngectomy after initial tracheostomy and improper management of metastatic nodes. 4) Mean survival time was $7.3{\pm}5.61$ months and one case with type I underwent surgical salvage is still alive out of 7 cases with chemotherapy and radiotherapy and 5 cases with surgical salvage and adjacent therapy. In summary, aggressive surgical resection should be recommended in cases with high risks of stomal recurrence.

• Journal of The Korean Ophthalmological Society
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• v.58 no.11
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• pp.1313-1316
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• 2017

Purpose: To report fundus photography using a smartphone in an infant with abusive head trauma. Case summary: An 8-month-old male infant presented to the emergency room with decreased consciousness and epileptic seizures that the parents attributed to a fall from a chair. He had no external wounds or fractures to the skull or elsewhere. However, computerized tomography of the brain revealed an acute subdural hematoma in the right cranial convexity and diffuse cerebral edema, leading to a midline shift to the left and effacement of the right lateral ventricle and basal cistern. The attending neurosurgeon promptly administered a decompressive craniectomy. Immediately after the emergency surgery, a fundus examination revealed numerous multi-layered retinal hemorrhages in the posterior pole extending to the periphery in each eye. He also had white retinal ridges with cherry hemorrhages in both eyes. We acquired retinal photographs using the native camera of a smartphone in video mode. The photographer held the smartphone with one hand, facing the patient's eye at 15-20 cm, and held a 20 diopter condensing lens at 5 cm from the eye in the other hand. Our documentation using a smartphone led to a diagnosis of abusive head trauma and to obtain the criminal's confession, because the findings were specific for repetitive acceleration-deceleration forces to an infant's eye with a strong vitreoretinal attachment. Conclusions: This ophthalmic finding had a key role in the diagnosis of abusive head trauma. This case presented the diagnostic use of a smartphone for fundus photography in this important medicolegal case.