- Langerhans Cell Histiocytosis with Central Diabetes Insipidus: A Case Report.
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Jin Ho Kim, Jun Sung Moon, Sun Jung Mun, Ji Eun Lee, Jae Won Choi, Mi Jung Eun, Kyung A Chun, Ihn Ho Cho, Ji Sung Yoon, Kyu Chang Won, Kyung Hee Lee, Duk Seop Shin, Hyoung Woo Lee
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Yeungnam Univ J Med. 2005;22(2):259-265. Published online December 31, 2005
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DOI: https://doi.org/10.12701/yujm.2005.22.2.259
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- Central diabetes insipidus (DI) is a syndrome characterized by thirst, polydipsia and polyuria. Langerhans cell histiocytosis is one of the etiologies of DI. Recently we experienced a central DI associated with Langerhans cell histiocytosis. The 44 years old female patient complained right hip pain, polydipsia and polyuria. We carried out water deprivation test. After vasopressin injection, urine osmotic pressure was increased from 109 mOsmol/kg to 327 mOsmol/kg (300%). Brain MRI showed a thickened pituitary stalk and air bubble like lesions sized with 5cm, 7cm was shown on fifth L-spine and right hip bone at hip bone CT. CT guided biopsy revealed abnormal histiocytes proliferation and abundant lymphocytes. The final diagnosis was central DI associated with systemic Langerhans cell histiocytosis invading hip bone, L-spine and pituitary stalk. Desmopressin and etoposide chemotherapy were performed to the patient.
- The Analysis of the Cytokine Expression in Musculoskeletal Tumors.
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Joon Han Lee, Eun Seok Kwak, Oog Jin Shon, Hee Sun Kim, Duk Seop Shin
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Yeungnam Univ J Med. 2003;20(2):187-196. Published online December 31, 2003
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DOI: https://doi.org/10.12701/yujm.2003.20.2.187
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- The cytokines are the hormone-like proteins, which are produced in the mononuclear cells. They have many roles, such as immune mediators, cell differentiations, angiogenesis. The chemokines have chemotactic effects which control the host immune response. There were few reports about the cytokines associated with musculoskeletal tumors. From late 1980s, the cytokine studies of bone tumors such as osteosarcoma were started, but most studies for benign and malignant musculoskeletal tumors were left to be explored. To evaluate the characteristics of the cytokines in variable musculoskeletal tumors, tissues were obtained from the seven patients who visited the Yeungnam University hospital from February to July 2000. They were lipoma (1 case), parosteal osteoma (1 case), enchondroma (2 cases), pigmented villonodular synovitis (1 case), ganglion (1 case), and metastaic squamous cell carcinoma (1 case). The gene experession of the cytokines were analyzed by RNase protection assay (RPA) and reverse transcription-polymerase chain reaction (RT-PCR). The lipoma and parosteal osteoma expressed MIP-1beta, and IP-10 genes. The two enchondromas showed different results, one expressed all of MIP-1alpha, MIP-1beta and IP-10 genes but the other expressed none of above. The pigmented villonodular synovitis strongly expressed MIP-1alpha and IP-10 when compared with the other cases. The ganglion did not express all of the chemokines mentioned above. And the metastatic squamous cell carcinoma expressed all of the chemokines and especially IP-10 was highly expressed. Even though this study has only a few cases, these results provide a basis for the cytokine mediating network study in musculoskeletal tumors.
- The Role of Thallium-201 Scintigraphy in Bone and Soft Tissue Tumor.
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Duk Seop Shin
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Yeungnam Univ J Med. 2003;20(2):117-128. Published online December 31, 2003
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DOI: https://doi.org/10.12701/yujm.2003.20.2.117
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- Thallium-201 scintigraphy is used to discriminate the malignant bone tumor from the benign by qualitatively and quantitatively, and to predict the response of preoperative chemotherapy in osteosarcoma, by comparing the changes of thallium uptake ratio after chemotherapy to the tumor necrosis ratio. Thallium-201 scintigraphy scan should be done prior to surgical biopsy. PICKER Prism 2000 gamma camera with high resolution parallel hole collimator is usually used for scanning. The patient is injected with 2-3mCi of Tl-201 and the early phase is checked in 30 minutes and delayed phase in 3 hours. The scan images are visually evaluated by a blinded nuclear medicine physician. We could evaluate true positive, true negative, false positive and false negative by the comparison of results with those of biopsy, and calculate positive and negative predictive value(%), sensitivity(%), specificity(%) and diagnostic accuracy(%). For the quantitative analysis of thallium uptake, we drew the region of interest on the tumor side and contralateral normal side as mirror image, and calculated the uptake ratio with dividing the amount of gamma count in tumor side by normal side. We could calculate the percent changes of thallium uptake ratio in early and delayed phase, and compare them to the ratio of tumor necrosis. Thallium-201 scintigraphy proved as useful imaging study to discriminate malignant bone tumor from benign, but had exception in giant cell tumor and low grade malignant bone tumors. We can use T1-201 scan to differentiate the benign from the malignant tumor, and to evaluate the response of preoperative chemotherapy or radiotherapy, and to determine the residual tumor or local recurrence. For the better result, we need to have a more detail information about false positive cases and a more objective and quantitative reading technique.
- Mesenchymal Chondrosarcoma: 3 Cases Report.
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Mi Jin Gu, Young Kyong Bae, Joon Hyuk Choi, Mi Jin Kim, Won Hee Choi, Duk Seop Shin, Jang Soo Suh
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Yeungnam Univ J Med. 2000;17(1):87-92. Published online June 30, 2000
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DOI: https://doi.org/10.12701/yujm.2000.17.1.87
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- Mesenchymal chondrosarcoma is a rare malignant tumor of skeletal and extraskeletal origin, and which shows aggressive local behavior as well as a high metastatic potential. We report 3 cases of mesenchymal chondrosarcoma. Two cases were male and one was female. The ages ranged from 25 to 32 years(mean: 28 years). Tissue was obtained by wide excision in two patients, and incisional biopsy in one. The mass locaterd in the rib(case 1), orbital floor(case 2), and abdominal wall(case 3). Roentgenographically, the tumor resembles ordinary chondrosarcoma, showing osteolytic and obstructive appearance with stippled calcification. Grossly, the tumor was lobulating, solid fish-fleshy like mass with calcification and ossification. Histologically, the tumor shows characteristic bimorphic pattern composed of islands of well differentiated hyaline cartilage admixed with a cellular area of undifferentiated small cells. The small cells usually displayed a hemangiopericytoid or an alveolar pattern.
- Chordoma: A Clinicopathologic Review of 4 Cases.
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Joon Hyuk Choi, Young Kyung Bae, Mi Jin Kim, Duk Seop Shin, Kil Ho Cho
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Yeungnam Univ J Med. 1999;16(2):369-375. Published online December 31, 1999
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DOI: https://doi.org/10.12701/yujm.1999.16.2.369
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- Chordoma is a slow-growing malignant neoplasm arising from the remnants of the primitive notochord. It accounts for 1 to 4% of all malignant bone tumors. It occurs exclusively along the spinal axis. Authors experienced four cases of chordoma occurred in the sacrococcygeal region. There were two male and two female patients, with a mean age of 63.5 years(range. 57~75 years). Tissue was obtained by wide excision in two patients, by incisional biopsy in one patient and by needle biopsy in the other. Adjuvant radiation theraphy was performed on all the patients after their biopsy. The mean diameter of the tumors was 7.6cm(range, 5.5 to 13.0cm). Grossly, tumor was multilobulated, soft and myxoid gelatinous mass. Microscopically, the tumor showed lobulated feature divided by fibrous septa within it. There were physaliphorous cells with vacuolated bubbly cytoplasm. And small uniform, round, and non-vacuolated tumor cells were also present. On immunohistochemical stain, all the cases were immunoreactive for cytokeratin, epithelial membrane antigen(EMA) and vimentin, respectively. One of the 4 cases was positive for S-100 protein. All the cases were negative for CEA.
- Clear cell sarcoma: 1 case report.
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Joon Hyuk Choi, Hae Jeong Choi, Mi Jin Kim, Duk Seop Shin, Kil Ho Cho
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Yeungnam Univ J Med. 1999;16(1):108-113. Published online June 30, 1999
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DOI: https://doi.org/10.12701/yujm.1999.16.1.108
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- Clear cell sarcoma is a rare soft tissue sarcoma that occurs tendons and aponeuroses, usually of the lower extremities in young adult. The exact histogenesis is not definitely established, We experienced a case of 58 year-old female who presented with a 3.2x2.2cm sized mass located in the subcutaneous tissue on the left lower thigh. The mass was well circumscribed and grayish firm. Two small satellite nodules were also seen. Histologically the tumor was composed of round to fusiform cells with clear or pale eosinophilic cytoplasm and separated into compact nests or short fascicles by delicated fibrous septa. The melanin pigments and hemosiderin were seen. Tumor cells showed positive reaction for S-100 protein and HMB-45. The ultrastructural examination showed abundant mitochondria and melanosomes.
- A Clinicopathologic Review of Eight Cases of Chondroblastoma.
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Joon Hyuk Choi, Hae Jeong Choi, Mi Jin Ku, Dae Hong Suh, Duk Seop Shin, Kil Ho Cho
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Yeungnam Univ J Med. 1998;15(2):359-370. Published online December 31, 1998
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DOI: https://doi.org/10.12701/yujm.1998.15.2.359
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- Eight cases of chondroblastoma were studied by analyzing the clinical and pathologic findings. The age of eight cases ranged from 17 to 38 years old(median age, 22.7 years old). The tumors developed in the femur (3 cases), patella (2 cases), tibia( 1 case), fibula (1 case), and ulna (1 case). The mean diameter of tumors was 4.0 cm (range, 1.5 to 8.0 cm). Grossly, tumors showed grayish brown solid area with foci of secondary aneurysmal bone cyst. Histologically, the tumor cells were round or polygonal in shape with nuclear groove. And there were chondroid differentiation(7 cases), mitosis(3 cases), calcific deposits(3 cases), secondary aneurysmal bone cyst(4 cases), hemosiderin deposits(4 cases), necrosis(3 cases), vascular invasion(1 caes) and foamy histiocytes and cholesterol cleft(1 cases). All cases showed no metastasis to lymph node and distant organ. Seven cases (87.5 %) were immunoreactive for S-100 protein. None were immunoreactive for cytokeratin.
- Treatment of Developmental Dislocation of the Hip in Walking Age.
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Se Dong Kim, Jae Hyuk Jang, Dong Chul Lee, Duk Seop Shin
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Yeungnam Univ J Med. 1996;13(2):211-224. Published online December 31, 1996
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DOI: https://doi.org/10.12701/yujm.1996.13.2.211
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- The patients of developmental dislocation of the hip(DDH) are almost found after walking age because of early diagnosis of DDH in younger children is not easy. A controversy still exists as to the relative value of closed and operative management in the treatment of a child who has reached walking age. This study is a report of the results of 16 patients(17 cases) in developmental dislocation of the hip who have visited our hospital at the age of 9 months to 3 years old, and have been followed more than 12 months (12-112 months) on review of plain radiographs and arthrograms. The results were as follows 1. The age at diagnosis was 16.4 months(9-31 months) in average. The methods of treatment were conservative for 8 cases, and operation for 4 cases and secondary operation for 5 cases who were failed with conservative therapy. 2. By Severin's radiologic grade, the result was good in 4 cases, fair in 3 cases and poor in 1 case in conservative treatment. In operative treatment, fair was in 2 cases and poor in 2 cases. In secondary operative -patients who were failed with conservative therapy, good was in 2 cases, fair in 2 cases and poor in 1 case. 3. Avascular necrosis of femoral head was developed in 3 cases. 4. In the good reduction as determined by arthrogram according to Race and Herring, we can get a favorable result in conservative treatment, and in the poor reduction as determined by arthrogram, the better
- The Early Result of Anterior Rotational Osteotomy in the Treatment of Osteonecrosis of the Femoral Head.
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Sae Dong Kim, Duk Seop Shin, Woo Seok Jang
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Yeungnam Univ J Med. 1994;11(2):284-292. Published online December 31, 1994
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DOI: https://doi.org/10.12701/yujm.1994.11.2.284
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- In transtrochanteric rotational osteotomy to treat osteonecrosis of the femoral head, the necrotic superior anterior femoral head is rotated anteriorly around the longitudinal neck axis so that the weight bearing force is transferred to the intact posterior surface. The ratio of transposed intact articular surface of the femoral head to the weight-bearing surface of the acetabulum on postoperative anteroposterior view of the hip roentgenograph is the most important indicator of the prognosis. During the period from December 1992 to June 1994, we treated 31 hips in 28 patients who were indicated for the anterior rotational osteotomy among the patients of osteoncrosis of the femoral head. Among the patients, male were 27 and female was one. Age distribution was from 13 to 62 years old and mean age was 44.3. According to the Ficat and Arlet classification, II A was most in number as 16 II B was 7 and III was 8. As their etiolgic factors, alcohol was most in number as 18, steroid was 3, idiopathic was 5 and trauma was 2. The mean rate of the intact area of the posterior part of the femoral head to the total articular surface on the preoperative lateral view of the hip roentgenograph was 41.8%. The mean ratio of transposed intact articular surface of the femoral head to the weight bearing surface of the acetabulum was 53.8% Fixation devices were screws or dynamic hip screw.
- Percutaneous K-wire fixation of supracondylar fracture of humerus in children.
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Duk Seop Shin, Jong Chul Ahn, Se Dong Kim, Dong Woo Lee
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Yeungnam Univ J Med. 1993;10(2):400-408. Published online December 31, 1993
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DOI: https://doi.org/10.12701/yujm.1993.10.2.400
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- During the period from March 1990 to November 1993, 22 children with diplaced supracondylar fracture of humerus were treated by closed reduction and percutaneous K-wire fixation at department of Orthopaedic surgery in Yeungnam University. All fracture were treated with closed reduction under the general anesthesia and percutaneous pinning. After the fracture was internally fixed, intraoperative anteroposterior reontgenograms of each distal humerus were compared. Only anatomical reduction ensured good result,, because the main cause of late cubitus varus was medial tilting of distal fragment. We could follow up 10 patients more than one year. By Flynn's criteria, satisfactory result were obtained in 9 of the 10. Unsatisfactory one had a limitation in flexion of elbow joint, but had no problem in cosmetic feature. In short term follow up of 7 patients, 5 patients had a satisfactory result, too. There were no neurovascular complication and hospitalization was shortened to 11.4 days. Closed reduction and percutaneous pinning provided stabillity, vascular safty, simplified management, reduced hospital stay. This is safe and reliable technique for obtaining and maintaining an exellent reduction.
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