• Radiation Oncology Journal
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• v.16 no.4
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• pp.497-504
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• 1998

Purpose : To evaluate the usefulness of electronic portal imaging device through objective compare of the images acquired using an EPID and a conventional port film Materials and Methods : From Apr. to Oct. 1997, a total of 150 sets of images from 20 patients who received radiation therapy in the pelvis area were evaluated in the Inha University Hospital and Severance Hospital. A dual image recording technique was devised to obtain both electronic portal images and port film images simultaneously with one treatment course. We did not perform double exposure five to ten images were acquired from each patient. All images were acquired from posteroanterior (PA) view except images from two patients. A dose rate of 100-300 Mu/min and a 10-MV X-ray beam were used and 2-10 MUs were required to produce a verification image during treatment. Kodak diagnostic film with metal/film imaging cassette which was located on the top of the EPID detector was used for the port film. The source to detector distance was 140 cm. Eight anatomical landmarks (pelvic brim, sacrum, acetabulum. iliopectineal line, symphysis, ischium, obturator foramen, sacroiliac joint) were assessed. Four radiation oncologist joined to evaluate each image. The individual landmarks in the port film or in the EPID were rated - very clear (1), clear (2), visible (3), not clear (4), not visible (5). Results : Using an video camera based EPID system. there was no difference of image quality between no enhanced EPID images and port film images. However, when we provided some change with window level for the portal image, the visibility of the sacrum and obturator foramen was improved in the portal images than in the port film images. All anatomical landmarks were more visible in the portal images than in the port film when we applied the CLAHE mode enhancement. The images acquired using an matrix ion chamber type EPID were also improved image qualify after window level adjustment. Conclusion : The quality of image acquired using an electronic portal imaging device was comparable to that of the port film. When we used the enhance mode or window level adjustment. the image quality of the EPID was superior to that of the port film. EPID may replace the port film.

• The Journal of the Korean bone and joint tumor society
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• v.1 no.1
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• pp.1-6
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• 1995

Giant cell tumors are primary bone tumors originating from non-osteoblastic connective tissue. The sites of involvement were commonly distal femur, proximal tibia, proximal humerus, distal radius and others (including os calcis, ilium and sacrum). Giant cell tumor located around knee joint has been difficult to treat because of local recurrence following curettage with or without bone graft. Although primary resections reduce recurrence of the lesion, the joint function will be markedly impaired. Marginal excision was very often complicated by a loss of joint integrity since all the giant cell tumors occupy juxtaarticular positions. Techniques involving physical adjuncts(high speed burr and electric cauterization) have been used in the hope of decreasing the rate of local recurrence and avoiding the morbidity of primary resection. A meticulous clinical, radiological and histological evaluation is needed to choose the correct treatment, keeping in mind the possibility of recurrence after each treatment modality.

• Archives of Reconstructive Microsurgery
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• v.15 no.2
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• pp.107-110
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• 2006

Malignancy in a chronic pressure sore is rare among Marjolin's ulcers. Carcinomas arising in pressure sores are highly aggressive and usually fatal. Although carcinomas in pressure sores are generally well-differentiated squamous carcinomas, they can show quite an aggressive course and do not respond either to chemotherapy or radiotherapy. The mortality rate is high despite wide surgical resection. Extensive surgical excisions with wide surgical margins are necessary and elective lymph node dissection should be considered for optimal therapy. We report a squamous carcinoma arising in a pressure sore. The related literature was reviewed.

• Journal of Korean Neurosurgical Society
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• v.54 no.6
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• pp.537-539
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• 2013

Charcot spinal arthropathy is a rare, progressive type of vertebral joint degeneration that occurs in the setting of any preexisting condition characterized by decreased afferent innervation to the extent that normal protective joint sensation in the vertebral column is impaired. The authors report on a case of Charcot arthropathy of the lower lumbar spine mimicking a spinal tumor following cervical cord injury.

• The Korean Journal of Pain
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• v.11 no.1
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• pp.134-137
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• 1998

The presence of an enlarged transverse process on one or both sides of the last lumbar vertebra is a common congenital anomaly of the lumbar vertebra. It is thought to be a genetic or developmental anatomical variant. The first reported assimilation of the fifth lumbar vertebra into the sacrum associated with low back pain was in 1917 by Bertolotti. However, clinical significance of lumbosacral transitional vertebra has not been fully considered due to lack of scientific investigations dealing with it. We experienced a case of symptomatic lumbosacral transitional vertebra during management of low back pain. Low back pain was relieved after infiltration of local anesthetics and steroid into the false joint of lumbosacral transitional vertebra. This result may possibly indicate a significant correlation between low back pain and lumbosacral transitional vertebra.

• Journal of Korean Neurosurgical Society
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• v.51 no.2
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• pp.105-108
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• 2012

Giant spinal schwannoma of the cauda equine involving many nerve roots is rare, and ossification is usually not observed in the schwannoma. A 21-year-old man presented with a 12-month history of urinary dysfunction and numbness below the buttocks. Plain radiography showed scalloping of the posterior surface of the vertebral bodies from L4 to the sacrum, and magnetic resonance imaging and computed tomography revealed a giant cauda equina tumor with dystrophic calcification. The tumor was completely removed, with intraoperative neurophysiologic monitoring. Histopathologic examination showed that the tumor was a schwannoma. The patient's postoperative course was uneventful, with urinary function and numbness gradually improving. Although a giant schwannoma accompanied by dystrophic calcification is extremely rare, such a tumor can be removed safely and completely by meticulous dissection and careful neuromonitoring of the cauda equina spinal nerves involved in the tumor.

• Radiation Oncology Journal
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• v.17 no.1
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• pp.52-56
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• 1999

Chordomas are rare tumors arising from the primitive notochord. The commonest affected segment is the sacrum and these chordomas frequently follow a progressive course with multiple recurrences and metastases and eventual death due to tumor. This report describes two cases of sacrococcygeal chordomas with widespread metastases treated by surgery and adjuvant radiation therapy.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.15 no.1
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• pp.115-119
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• 2020

Objectives : This study aimed to introduce a new sacral lumbar joint distraction technique in the prone position in Chuna manual therapy for effective lumbar distraction. Methods : The patient was placed in the prone position. Next, clinicians contacted the sacrum and L1, L2, L3, L4 and L5 spinal processes. Then they were pulled in the direction of the head and leg respectively while pressing down with 30% force to maintain the lumbar lordosis. This is a more effective and safer lumbar distraction technique according to the latest knowledge. Conclusions : This technique can be used for lumbar disc herniation in addition to relaxing the existing lumbar muscles, and is suggested to be used as a safe and effective Chuna manual therapy.

• Archives of Reconstructive Microsurgery
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• v.23 no.1
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• pp.25-28
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• 2014

One of the most frequently used flaps for coverage of sacral skin and soft-tissue defects is the gluteus maximus musculocutaneous flap. These authors encountered two cases of sacral pressure sore, for which reconstructive surgery was performed, using the hatchet-shaped gluteus maximus musculocutaneous flap - a modified flap type. We report on our experience in treatment of these two cases, with an excellent outcome.

• Journal of Korean Neurosurgical Society
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• v.44 no.3
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• pp.166-169
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• 2008

Sacral insufficiency fractures are usually known to develop in elderly patients with osteoporosis without definite trauma history. It is difficult to diagnose the sacral insufficiency fracture at an early stage because lower lumbar diseases. concurrently or not, may also be presented with similar symptoms and signs. We report a rare case of sacral insufficiency fracture who was not diagnosed initially but, instead, showed progressively worsening of clinical symptoms and radiological findings after decompression surgery for upper level lumbar stenosis.