• Journal of Korea Association of Health Promotion
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• v.4 no.1
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• pp.75-84
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• 2006

Background : Osteoporosis and atrophic cell pattern in Pap smear are frequent findings In postmenopausal women due to loss of ovarian function, The present study attempted to find out possible correlation between morphologic characteristics of Pap smear and osteoporosis. Material & methods: The subjects were 825 women(age from 35 to 80) who had undergone Pap smear and bone mineral density(BMD) at The Korea Association of Health Promotion, Seoul Branch, from March 8 to May 10, 2005. Pap smears from 825 women were reviewed and classified either mature cell pattern or atrophic cell pattern by their cytologic patterns, BMD were measured using LUNAR DPX MdIQ(Minster, Ohio, USA). BMD value of lumbar spine(Ll, L2,L3 and L4) were measured from 825 women and BMD value of proximal region off emur(neck NK, Wards triangle WT, and trochanter TR) were measured from 818 women and their bone status were classified as normal( T-sore:>-1.0), osteopenia (T-score: -l~<-2,5) and osteoporosis(T-score: ≤ -2.5). And age distribution of Pap smear, average T-value andfrequency ofsteoporo-sis of each region of the bone, percentage of osteoporosis of each boneregion by age group and changing pattern of percentage of osteopenia and osteoporosis in certain postmenopausal period were compared between mature and atrophic cell pattern. Results: Pap smears revealed total mature cell pattern 53,9%(445/825) and total atrophic cell pattern 46.1%(380/825), Percentage of mature cell pattern decreased from 98.2%(168/171)under 44 age group to 13,3%(17/128) over 65 age group and mature cell pattern increased from 1.8%(3/171) under 44 age group to 86.7%(111/128) oyer 65 age group. Mean T-value of each region of lumbar spine and femur of mature cell pattern were lower than that of atrophic cell pattern about -1,5. And osteoporosis has noted in atrophic cell pattern showing odds ratio Ll 13.9, L2 15.3, L3 12.0, L4 10,4, UK 6.7, WT 10.9 and TR 4.1.Atrophic cell pattern started to increase after 45 years of age and osteoporosis of a trophic cell pattern started after 55 years of age. During 50 to 64 years of age period, L3, L4 and WT revealed parallel increased of osteopenia and osteoporosis and Ll, L2 revealed decreased of osteopenia and increased of osteoporosis. nia Conclusion: Above findings suggest that atrophic cell pattern of Pap smear precedes osteoporosis about 10 years and one of predictor of osteoporosis.

• The Journal of the Korean bone and joint tumor society
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• v.11 no.2
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• pp.160-167
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• 2005

Purpose : Distal femur and proximal tibia are the common sites affected by giant cell tumor of bone. There are a variety of treatment modality including wide excision and intralesional curettage. We evaluated the local recurrence rates and the post-operative functional scores of giant cell tumors around knee joint and investigated the identification of possible prognostic factors for recurrence. Materials and Methods: We reviewed 41 patients pathologically confirmed as giant cell tumors around knee joint that have undergone intralesional curettage using high-speed burr and methylmethacrylate. We evaluated the recurrence rate and post-surgical functional score and possible prognostic factors for recurrence, such as, gender, age, tumor location, size, subchondral invasion, intra-articular invasion and the Campanacci Grades. Mean follow up period was 50 (12-122) months. Results: The recurrence rate was 17% and mean recurrence onset was 10 months postoperatively. According to Musculoskeletal Tumor Society (MSTS) functional evaluation system, the average score was 27.8(93%) and 78% had excellent function. According to our study, suspected prognostic factors revealed not significant for recurrence. Conclusion: We found no significant recurrence related factors. Intralesional excision with high-sped burring and PMMA provides a low recurrence rate, similar to others in the literature, and good functional scores.

• The Journal of the Korean bone and joint tumor society
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• v.1 no.2
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• pp.133-144
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• 1995

After resection of intraarticular, periacetabulum(P2) and pubic rami(P23) and extraarticular, proximal femur(P2-H12) by Enneking classification, reconstruction is very difficult. We experienced three cases of saddle prostheses for reconstruction after P2, P23, and P2-H12 resection in pelvic malignancies. Case 1 was a high grade chondrosarcoma in 36 year-old-man and P2 resection was done. But he died of disease 19 months after operation. Case 2 was a malignant giant cell tumor in 32 year-old-woman. P23 resection was given and she is disease-free 32 months after operation. Case 3 was an osteosarcoma of 27-year-old-man and P2-H12 resection was performed and he is disease-free postoperative 12 months now. According to MSTS functional evaluatin system, all three patients showed no pain(5), intermediate function(2), emotinally satisfied(3), one cane or crutch supported(1), limited walking(3), and minor cosmetic gait(3). There was no significant complication and no dislocation except intermittent inguinal hernia in case 2. All patients started crutch walking 3 weeks after operation. Around 6 months postoperatively, the preserved iliac wing(P1 component) was hypertrophied enough to endure the full weight bearing. All could have squating and kneeling positions. In conclusion, saddle prosthesis would be a very useful method of reconstruction after P2, P23, and/or H1-2 resection to shorten the operation time and to reduce the infection rate without significant loss of function.

• The KIPS Transactions:PartB
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• v.19B no.2
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• pp.99-106
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• 2012

The purpose of this study was to determine the evaluation parameters' osteoporosis predictability in accordance with measuring regions by analyzing the correlations between bone mineral density and trabecular patterns derived from different measuring regions. Experimental subjects were a total of 40 female patients after menopause aged over 40 years, and were classified into 20 control and 20 osteoporotic groups according to the T-score. Bone mineral density was measured on femoral neck, trochanter and ward's triangle by DEXA(Dual Energy X-ray Absorptiometry). We designated ROI(Region of Interest) with $50{\times}50$ pixel size on each measuring regions, and extracted trabecular patterns by using existing image processing method. We also selected a total of eight evaluation parameters that are categorized into structural(mean gray level, area, perimeter, thickness and terminal distance), skeletonized parameters(number, length) and fractal dimension. As a result, it was observed that area, perimeter, thickness, terminal distance, number, length and fractal dimension reflected the bone mineral density with high statistical validity(p<0.003). We also confirmed that the evaluation parameters could predict the osteoporosis more efficiently.

• Tuberculosis and Respiratory Diseases
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• v.64 no.3
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• pp.224-229
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• 2008

Erdheim-Chester disease (ECD) is a rare disease that is characterized by multi-organ involvement of foamy histiocytes. It causes systemic inflammation, and also demonstrates various clinical manifestations and has a poor prognosis. We encountered a case of ECD in a patient that had been treated for underlying polycythemia vera. As far as we know, this is the first reported case worldwide where ECD developed in association with polycythemia vera. A 59-year-old man visited our hospital due to pleuric pain at the right side of the chest. Pleural tissue that was obtained following a thoracoscopic biopsy showed non-Langerhan's cell histiocytosis, suggesting the presence of ECD. The histiocytes stained positively for CD68, but were negative for S-100 and CD1a. The patient also complained of pain at both hips and the right shoulder area. An X-ray and magnetic resonance image demonstrated that the lesion showed sclerosis and osteolysis in both the proximal femur and right humerus. Treatment was started with predinisolone, and subsequently cyclophosphamide was added. ECD is a very rare multi-systemic disease, and its cause and therapeutic options have not yet been defined. ECD has a poor prognosis. Therefore, we believe that additional case studies are needed prior to the determination of a novel therapy for ECD.

• The Journal of the Korean bone and joint tumor society
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• v.9 no.1
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• pp.84-92
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• 2003

Purpose: To report two cases of bone tumors other than osteoid osteoma in the proximal femur and treated with percutaneous high frequency radioablation method. Cases: We reviewed two cases with intracortical chondroma and enchondroma in the femoral head retrospectively. The patient with intracortical chondroma was a thirty one year old woman and had suffered right hip pain of 1 year duration. The lesion was located in the head of right femur and treated with CT guided percutaneous high frequency radioablation after needle biopsy under general anesthesia. The symptom was gone immediately after the procedure and was discharged postop. 1 day. 15 months has passed without symptom recurrence. Second case having enchondroma, was 56 year old woman complaining of gluteal area pain for 3 months. Radiologic evaluation showed osteolytic lesion with sclerotic rim on the inferior portion of the left femoral head. She received a same therapy with CT guided radiofrequency ablation following needle biopsy. She reported dramatic pain relief after the procedure and was discharged postop. 1 day. No symptom has occurred for 3 months until now. Conclusion: We present 2 cases of bone tumor occurred in the hip joint area other than osteoid osteoma which were treated with CT guided radiofrequency ablation.

• Journal of the Korean Orthopaedic Association
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• v.55 no.6
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• pp.503-510
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• 2020

Purpose: Bipolar hemiarthroplasty is used as an alternative to open reduction and internal fixation for unstable intertrochanteric fractures in elderly patients. Recent advances in medical systems and technologies have resulted in increased survival rates after intertrochanteric fractures of the femur, requiring selection of the appropriate femoral stems considering the mid- to long-term duration of survival. Hemiarthroplasty was performed for unstable intertrochanteric fractures using a double tapered quadrilateral femoral stem (C2 stem), and the clinical and radiological results were evaluated as a five-year follow-up post-surgery. Materials and Methods: From January 2004 to December 2013, 43 patients (43 hips) who underwent hemiarthroplasty with a C2 stem were enrolled in this study. Their mean age was 78.6 years (range, 70-84 years), and the mean follow-up period was 85.4 months (range, 60-96 months). During the follow-up period, clinical parameters, such as the changes in pain, walking ability, and functional status, were examined. Radiologically, changes in the proximal femur, such as osteoporosis and bone resorption of cortical bone, were noted. Complications that occurred during the follow-up period, such as dislocation and prosthetic features, were also reviewed. Results: Initially, the pain was relieved postoperatively, but it increased four years after surgery. The walking ability was reduced by two steps in nine patients after 60 months, and the Harris hip score was reduced significantly postoperatively after two to three years. Radiologically, cortical osteoporosis occurred in 14 patients. Five patients developed cortical bone resorption. Four of them showed nonunion of the trochanteric fracture fragments, and three of them suffered reverse oblique fractures. Conclusion: Careful selection considering the general health condition and remaining lifespan of the patient would be necessary for primary hip hemiarthroplasty using a 3C type cementless femoral stem for unstable intertrochanteric fractures in elderly patients with osteoporosis.

• The Journal of the Korean bone and joint tumor society
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• v.9 no.1
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• pp.24-30
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• 2003

Purpose: To clarify the results of simple bone cyst (SBC) treatment in children by percutaneous autologous bone marrow grafting and xenografting. Materials and Methods: We studied seven cases (4 males, 3 females) of SBC, which were treated by percutaneous autologous marrow and heterograft bone grafting from January 1996 to February 1999. Their mean age at surgery was 10 years (6 to 15), and the mean follow-up period was 35.6 months (20 to 52). Three cases were located in the proximal and middle humerus; three cases were in the proximal femur; and one case occurred in the ilium. Mean volume was 14.7 $cm^2$ (10 to 23). Six cases were active, and one was inactive. Five patients had a history of receiving a mean of 3.2 steroid injections. The mean quantity of bone marrow used in treatment was 14.3 ml (10 to 20), and the mean amount of $Lubboc^{(R)}$ heterograft bone (Transphyto S.A. Clermont Ferrand, France) used was 6.4 blocks (5 to 10). Results were analyzed using the modified Neer classification. Results: Five cases completely healed with obliteration of the cyst cavity (Grade IV). Two cases demonstrated sclerosis around a partially visible cyst (Grade III). All treatment results were satisfactory and without intraoperative or postoperative complications. Conclusione: Percutaneous autologous marrow and heterograft bone grafting is recommended as an effective treatment method for simple bone cyst. It offers ease of operative technique, a high rate of healing, a low recurrence rate, low morbidity, a low incidence of postoperative complications, and free from bone graft donor site problems.

• The Journal of the Korean bone and joint tumor society
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• v.16 no.1
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• pp.1-7
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• 2010

Purpose: With advances in various treatment modalities, limb salvage surgery has been commonly used in osteosarcoma of extremities. An alternative method for skeletal reconstruction is reimplantation of the tumor bearing bone following extracorporeal irradiation (ECI). We report the long-term results of ECI autograft in aspect of the oncological and functional outcomes, and complications. Materials and Methods: We retrospectively reviewed 31 osteosarcoma patients who underwent reconstruction with ECI between July 1995 and January 2006. There were 24 males and 7 females with a mean age of 24 (7-74 years) and a mean follow-up of 117 months (17-177 months). Twenty-five cases were reconstructed with ECI autograft, 6 cases with ECI autograft-prosthesis composite. The pathologic subtypes were conventional in 29 cases, periosteal in 1 case, and parosteal in 1 case. The most common location of tumor was distal femur (15 cases) followed by humerus (3), proximal fibula (3) and proximal tibia (3). Musculoskeletal Tumor Society (MSTS) score was used for functional evaluation. The overall survival rate, local recurrence, complications were analyzed. Results: The overall survival rate was 80.6% and the disease-free survival rate was 64.5%. Five patients died of distant metastasis. One patient required above-knee amputation due to local recurrence. All of them, twenty-three complications occurred, which included nonunion in 7 cases, deep infection in 5 cases, joint instability in 4 cases, metal failure in 2 cases, Limb-length discrepancy (LLD) in 2 cases, periprosthetic fracture in 1 case, epiphyseal collapse in 1, local recurrence in 1 case. The mean MSTS functional score was 62.5%. Conclusion: Extracorporeal irradiated autograft can be achieved relatively good result in aspect of oncological and functional aspect, but is needed to be additional research about occurring many complications. The reconstruction with ECI after intercalary or fragmentary resection is effective reconstruction in aspect of oncological and functional result, complications.

• The Journal of the Korean bone and joint tumor society
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• v.11 no.2
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• pp.134-140
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• 2005

Purpose: We evaluated the effectiveness of temporary using the extendible external fixator (EF) for lengthening of soft tissue that contracture caused by tumor prosthesis removal in the treatment of complications after limb salvage surgery like deep infection and loosening. Materials and Methods: Five patients six cases were included who underwent extendible EF (Dyna-extor(r)). EF was applied after insertion of half pin to the proximal and distal bone of defect area. EF lengthening started at third day of post-operation, above 2-3 mm per day in the range of no neurological sign. Results: The treatment area was three in femur and two in tibia. Mean age when the time of EF apply was 22.2 years old (range 15-29), but its primary limb salvage operation had done in 13.4 years old (range 9-19), therefore mean times of interval between initial tumor prosthesis reconstruction and temporary EF apply was 8.8 years (range 3-14). One patient had EF for 150 days with 7.2 cm lengthening. Others 5 cases of 4 patients had EF for mean 37 days (range 25-50) and mean soft tissue lengthening was 5.8 cm. Three patients underwent re-insertion of tumor prosthesis and two patients underwent knee fusion as final operation and showed no evidence of infection through mean 22 months follow up period. Conclusion: Temporary using of extendible EF is an effective method for correction of leg shortening which occurred by soft tissue contracture in the complications of limb salvage operation or their treatment process, and it could be provide easily application of tumor prosthesis and knee fusion as final operation.