So Hak Chung

A reconstruction with extracorporeal irradiated autograft in osteosarcoma around the knee

An extracorporeal irradiated (ECI) autograft was first reported in Israel in 1968 for the treatment of primary malignant bone tumor. However, subsequent reports covered mostly short‐term follow up results, and the reported results of reconstruction vary from study to study. We analyze the long‐term follow up results of reconstruction using an extracorporeal irradiated (ECI) autograft in osteosarcoma around the knee.

Osteosarcoma of the Patella: Biologic Reconstruction With Allograft

Osteosarcoma rarely occurs in the patella. The majority of lesions located in the patella are usually benign. According to the literature, osteosarcoma of the patella has been reported in 32 cases. Surgical treatment (patellectomy, resection and arthrodesis with allograft, and total joint replacement) was attempted in several cases, but neither function of the knee joint nor prognosis of the patients were good. A 53-year-old woman reported pain and swelling in the left knee. Based on plain radiographs and magnetic resonance imaging (MRI), a bone tumor was suspected, and an open bone biopsy of the patella was performed. The pathologic diagnosis was osteoblastic osteosarcoma. A total patellectomy was performed because MRI showed a lesion that did not spread into the joint. A reconstruction was subsequently performed by allograft patella. The graft consisted of a quadriceps tendon, a patella with a patellar tendon, and the medial and lateral retinacula. Twenty-six months postoperatively, the function of the knee joint was almost similar to that before the procedure, and there was no evidence of recurrence or metastasis. After the procedure, the patient could walk without pain and the knee joint could flex to 140 degrees with extension lag of 10 degrees . To our knowledge, this is the first report of a biologic reconstruction with allograft patella after total patellectomy in osteosarcoma involving the patella.

The Analysis of Treatment of Aggressive Fibromatosis Using Oral Methotrexate Chemotherapy

Background Aggressive fibromatosis is a rare but invasive tumor infiltrating widely between fascia and muscle fibers. It has a high tendency to be locally recurrent despite complete resection. Effectiveness of adjuvant treatment for aggressive fibromatosis including radiotherapy, pharmacological agents, hormonal treatments, and chemotherapy have been previously reported. The purpose of this article was to collect and analyze all information regarding the effectiveness and side effects of oral methotrexate in aggressive fibromatosis. Methods From 2005 to 2011, eleven patients with aggressive fibromatosis treated with oral methotrexate at our institution were analyzed in this study. Oral methotrexate was administered once per week at 10 mg per week. Authors collected information about effectiveness concerning cases of local recurrence and metastasis. Results Eleven patients had remission, two patients had local recurrence. Fatal complications or toxicity were not observed. Conclusions Oral methotrexate given at this dose and schedule was considered as a useful treatment in primary inoperable fibromatosis and recurrent fibromatosis.

Temporary hemiarthroplasty with a synthetic device in children with osteosarcoma around the knee as a bridging procedure until skeletal maturity

We hypothesized that hemiarthroplasty with a synthetic device in skeletally immature patients with osteosarcoma around the knee would be functional due to high adaptability in the pediatric age group, and may decrease the number of surgeries until limb equalization by preserving the nearby physis.

Tumor Treated by Endoscopy

Background This study was conducted to examine the clinical usefulness and efficacy of endoscopic curettage on benign bone tumor. Methods Thirty-two patients (20 men and 12 women) with benign bone tumor were included in the study. The patients were aged between five and 76 years; the mean follow-up period was 27.05 months (range, 9.6 to 39.9 months). The primary sites include simple bone cyst (9 cases), fibrous dysplasia (6 cases), enchondroma (5 cases), non-ossifying fibroma (4 cases), bone infarct (3 cases), aneurysmal bone cyst (1 case), chondroblastoma (1 case), osteoblastoma (1 case), intraosseous lipoma (1 case), and Brodie abscess (1 case). A plain radiography was performed to assess the radiological recovery. Radiological outcomes, including local recurrence and bone union, were evaluated as excellent, good, poor, and recurred. Results In our series, there were 27 cases (84.4%) of good or better outcomes, six cases (18.8%) of complications (4 local recurrence, 1 wound infection, and 1 pathologic fracture). Conclusions Our results showed that endoscopic curettage and bone graft had a lower rate of recurrence and a higher cure rate in cases of benign bone tumor. It can, therefore, be concluded that endoscopic curettage and bone graft might be good treatment modalities for benign bone tumors.

Clinical Usefulness of Long-term Application of Fentanyl Matrix in Chronic Non-Cancer Pain: Improvement of Pain and Physical and Emotional Functions

Background Opioids are recently recommended for those who do not gain adequate pain relief from the use of acetaminophen or nonsteroidal anti-inflammatory drugs. Medical opioids are administered in various routes, and transdermal opioid products that can make up for the weaknesses of the oral or intravenous products have been developed. This study is to evaluate the clinical usefulness of fentanyl matrix in terms of the long-term improvement in pain and physical and mental functions. Methods This was a multicenter, open, prospective, observational study that was conducted in 54 institutions in Korea. Patients with non-cancerous chronic pain completed questionnaires, and investigators also completed questionnaires. A total of 1,355 subjects participated in this study, and 639 subjects completed the study. Subjects received transdermal fentanyl matrix (12 µg/hr, 25 µg/hr, or 50 µg/hr depending on the patients response and demand). Subjects visited at 29 ± 7 days, 85 ± 14 days, and 169 ± 14 days after administration, respectively, to receive drug titration and fill out the questionnaires. The results were analyzed using the intention-to-treat (ITT) analysis, full analysis set (FAS), and per-protocol (PP) analysis. The FAS analysis included only 451 participants; the PP analysis, 160 participants; and the ITT analysis, 1,355 participants. Results The intensity of pain measured by the Numeric Rating Scale decreased from 7.07 ± 1.78 to 4.93 ± 2.42. The physical assessment score and mental assessment score of the Short-Form Health Survey 12 improved from 28.94 ± 7.23 to 35.90 ± 10.25 and from 35.80 ± 11.76 to 42.52 ± 10.58, respectively. These differences were significant, and all the other indicators also showed improvement. Adverse events with an incidence of ≥ 1% were nausea, dizziness, vomiting, and pruritus. Conclusions The long-term administration of fentanyl matrix in patients with non-cancerous pain can reduce the intensity of pain and significantly improves activities of daily living and physical and mental capabilities.