Pelvic Insufficiency Fracture in Severe Osteoporosis Patient

( Woong Chae Na ),( Sang Hong Lee ),( Sung Jung ),( Hyun Woong Jang ),( Suenghwan Jo ) 대한고관절학회 2017 Hip and Pelvis Vol.29 No.2

Purpose: To evaluate clinical features and the effect of parathyroid hormone (PTH) on treatment outcomes of patients with pelvic insufficiency fractures. Materials and Methods: Fifteen patients diagnosed with pelvic insufficiency fractures were evaluated retrospectively. All patients had osteoporosis with mean lumbar T score of -3.9 (range, -3.1 to -6.4) and the mean age was 76.5 years. In all cases, simple radiography and computed tomography was used for final diagnosis; additional magnetic resonance imaging and technetium bone scans were used to confirm the diagnosis in 2 and 6 patients, respectively. Initial conservative treatment was used in all cases; treatment with PTH was applied in 5 cases. Radiological follow-up was done every 4 weeks up to 6 months and every 3 months thereafter. Symptom improvement was measured using visual analogue scale (VAS) score. Results: Fractures were located: i) sacrum and pubis (9 cases), ii) isolated sacrum (4 cases) and iii) isolated pubis (2 cases). One case showed fracture displacement and pain aggravation at 4 week follow-up which was treated with percutaneous sacro-iliac fixation using cannulated screws. Duration of bone union was significantly shorter in the patients who used PTH (P<0.05). VAS scores were also lower in the group treated with PTH; however, statistical significance was not reached. Conclusion: In patients with osteoporosis, a pelvic insufficiency fracture should be considered if pain is experienced in the pelvic area in the absence of major trauma. While nonoperatic has been shown to be sufficient for treatment, our study shows that PTH therapy shortens treatment period and could be a favorable treatment option.

Comparison of osteoporotic intertrochanteric fracture fixation using a proximal femoral nail with a helical blade and lag screw type proximal femoral nail

Woong Chae Na,Chae Won Lim,Sang Hong Lee 조선대학교 의학연구원 2018 Medical Bilogical Science and Engineering Vol.1 No.2

The aim of the study was to compare clinical and radiological results between the helical blade lag screw (proximal femoral nail antirotation II [PFNA II]) and the traditional lag screw (Zimmer Natural Nail [ZNN]) in the operative treatment of osteoporotic femur intertrochanteric fractures. We selected 182 patients who could be observed for at least 1 year from among 352 patients who received surgical treatment for osteoporotic isolated femur intertrochanteric fractures between January 2013 and December 2016. The PFNA II was applied in 110 cases, and the ZNN in 72 cases. We evaluated operation time, bleeding amount, quality of reduction, tip apex distance, bone union time, sliding distance, and lag screw position. The mean operation times and bleeding volumes were respectively 38 minutes and 224 mL for PFNA II, and 42 minutes and 234 mL for ZNN. The quality of reduction was good, acceptable, and poor in 71%, 25%, and 4% for PFNA II, and 68%, 31%, and 1% for ZNN, respectively. The mean tip apex distances, bone union times, and sliding distances were respectively 21.1 and 20.7 mm, 12.4 and 12.9 weeks, and 4.2 and 3.9 mm. The lag screw position was acceptable and poor in 95% and 5% for PFNA II, and 97% and 3% for ZNN, respectively. The design of the lag screw did not influence the surgical outcome in the osteoporotic isolated femur intertrochanteric fractures. Therefore, choice of the proximal femoral nail can safely be made according to surgeon preference.

Fate of sciatic nerve palsy following hip arthroplasty

Woong Chae Na,Jeong Hoon Kang,Jung Woo Lee,Suenghwan Jo 조선대학교 의학연구원 2019 Medical Bilogical Science and Engineering Vol.2 No.1

Sciatic nerve palsy is a rare complication that occur after total hip arthroplasty but clinically this can result in significant functional deficit. The previous literature suggests most of the sciatic nerve palsy symptom to improve after a few weeks to a few months but in the real clinical setting, the result may vary and the symptom maybe significantly prolonged and some may not fully recover to the original state. Therefore, the current study aims assessed the fate of the patients who developed sciatic nerve palsy from hip arthroplasty operation. The authors have also looked at potential risk factors for poor outcome. This is the first case series in the Korean literature and we are reporting the result with the literature review.

전위된 거골 경부 골절의 소형 금속판을 이용한 고정

나웅채 ( Woong Chae Na ),이상홍 ( Sang Hong Lee ),이준영 ( Jun Young Lee ),이상준 ( Sang Jun Lee ),김보선 ( Boseon Kim ) 대한골절학회 2015 대한골절학회지 Vol.28 No.4

목 적: 전위된 거골 경부 골절 환자를 대상으로 소형 금속판을 이용한 고정을 시행한 후 방사선 및 임상적 결과를 분석하고자 하였다. 대상 및 방법: 2006년 5월부터 2011년 12월까지 수술을 시행한 20예 중 소형 금속판을 이용하고 2년 이상 추시 가능하였던 15예를 대상으로 후향적 분석을 시행하였다. Hawkin’s 분류상 2형은 7예, 3형은 8예였다. 자기공명영상 검사는 술 후 12-16주 사이에 시행하였으며 임상적 평가는 American Orthopaedic Foot and Ankle Society (AOFAS) 발목-후족부 점수를 이용하였다. 결 과: 유합 기간은 평균 11.6주(10-15주)였다. 불유합 및 부정유합은 발생하지 않았다. AOFAS 점수는 평균 88.2점(80-97점)이었다. 거골의 무혈성 괴사는 5예가 발생하였고, 그 중 체부의 붕괴는 3예, 외상 후 관절염은 4예에서 나타났다. 통계적분석 결과 나이, 성별, Hawkin’s 분류와 유합 기간이나 임상적 결과는 유의한 상관성을 보이지 않았다. 결 론: 전위된 거골 경부 골절 환자에서 관혈적 정복술 후 소형 금속판을 이용하여 내고정을 시행한 결과 부정유합 발생률이 낮고 방사선 및 임상적 평가에서 만족스러운 결과를 보여 좋은 치료 방법이 될 것으로 생각된다. Purpose: We evaluated the complications, radiological and clinical results after operative treatment using a mini-plate for fixation of displaced talar neck fractures. Materials and Methods: There were 20 cases of displaced talar neck fractures from May 2006 to December 2011; we performed a retrospective chart review of 15 patients treated by open reduction and internal fixation using a mini-plate who had more than 2 years of follow-up. According to Hawkin’s classification, there were 7 cases of type II fractures and 8 cases of type III fractures. During postoperative 12-16 weeks we checked magnetic resonance imaging. The assessment of clinical results was based on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale. Results: Mean union period was 11.6 weeks (10-15 weeks). Nonunion and malunion did not occur in all cases. The mean AOFAS score was 88.2 points (80-97 points). There were 5 cases of avascular necrosis. Of these, there were 3 cases of body collapse and 4 cases of post-traumatic arthritis. In the statistical analysis, there was no correlation between the elements including gender, Hawkin’s classification and union rates and clinical results. Conclusion: Mini-plate fixation of a displaced talar neck fracture is thought to be a good technique, with a low rate of malunion and also showed satisfactory results in radiological and clinical assessment.

Letter to the Editor : Leukemia Cutis in an Infant Presenting as Benign-appearing Exanthema

( Woong Suk Chae ),( Jun Young Seong ),( Sook Hyun Kong ),( Ha Na Jung ),( Ho Seok Suh ),( Yu Sung Choi ) 대한피부과학회 2015 大韓皮膚科學會誌 Vol.53 No.2

Leukemia cutis (LC) refers to the specific infiltration of the skin by neoplastic leukemia cells that occurs mainly in conjunction with systemic leukemia1. The prevalence of thisdisease is 2∼3% in systemic acute leukemia and 10∼15% in acute myeloid leukemia (AML)2. While the mechanisms underlying the migration of the leukemic cells to the skinare not clear, it has been proposed that integrin and other adhesion molecules may play roles in the skin-specific homing behavior of leukemic cells3. We report a case of LC in a 5-month-old infant who presented with asymptomatic erythematous patches on his right lower leg and right cheek that developed 4 weeks after birth. A 5-month-old male patient was referred to the Dermatology Department for the evaluation of coin-sized erythematous patches on the right lower leg and right cheek (Fig. 1). A coin-sized erythematous patch was first detected on the right lower leg 4 weeks after birth. This skin lesionwas persistent and showed no changes in its size and color. Similar lesions developed on the right cheek 4 months after birth. Laboratory tests, which included a complete blood cell count showed no abnormalities, except for a high lactate dehydrogenase level. A histopathological examination showed a diffuse infiltration of leukemic cells into the dermis (Fig. 2A, B). A definitive diagnosis and classification of the leukemia required the immunohistochemical analysis of the skin lesion and correlations with the cytogenetic information. A skin biopsy showed a diffuse infiltration of leukemic cells that were positive for cluster of differentiation(CD) 34, Ki-67, and leukocyte common antigen, and negative for CD3, CD20, myeloperoxidase, and terminal deoxynucleotidyl transferase (Fig. 2C∼I). The bone marrow cytology was consistent with AML of the French-American- British M7 type. The patient had no congenital abnormalities or underlying diseases. The patient was transferred to the Pediatric Department for further evaluation and chemotherapy. Aleukemic LC is a rare condition that is characterized by the infiltration of the skin by leukemic cells before they appear in the peripheral blood or bone marrow4. LC is strongly associated with the leukemic involvement of the bone marrow, peripheral blood, and other extramedullary sites2,3. The diagnosis of aleukemic LC or LC is made with suspicion and is verified by skin biopsies. To make the final diagnosis, hematologic studies are needed as well as the complete analyses of bone marrow aspirates and peripheral blood smears3. Clinically, LC usually presents as single or multiple violaceous, red-brown papules, nodules, and plaques of varying sizes. The legs are most commonly involved, followed by the arms, trunk, and scalp5. The prognosis of LC is directly related to the prognosis of the systemic disease, and myeloid LC has a relatively poor prognosis compared with other types of leukemia2. An atypical clinical presentation makes it difficult for dermatologists to anticipate and diagnose LC in newborns or infants without suspicion. In general, LC with AML has a poor prognosis; hence, early suspicion and confirmation withbiopsies are important.

case of retroperitoneal leiomyosarcoma with scalp metastasis

( Woong Suk Chae ),( Dan Bi Lee ),( Ha Na Jung ),( Ho Seok Suh ),( Yu Sung Choi ) 대한피부과학회 2012 대한피부과학회 학술발표대회집 Vol.64 No.1

얼굴에 국한되어 발생한 국소성 후천물집표피박리증

( Woong Suk Chae ),( Ha Na Jung ),( Dan Bi Lee ),( Ho Seok Suh ),( Yu Sung Choi ) 대한피부과학회 2013 대한피부과학회지 Vol.51 No.12

후천물집표피박리증(epidermolysis bullosa acquisita)은 드문 자가면역 수포성 질환으로서 진피표피경계의 고정세섬유를 구성하는 제7형 교원섬유 성분에 대한 자가항체를 특징으로 한다. 후천물집표피박리증의 임상양상은 다양하게 발현되는데 전형적으로 외상을 많이 받는 사지에 주로발생하지만 비전형적으로 머리와 목에 국한된 수포성 병변을 보일 수도 있다. 환자는 38세 여자로 10개월 전부터 좌측 뺨에 국소적으로 발생한 소양감을 동반한 홍반성 반과 미란을 주소로 내원하였다. 상기 병변으로 개인 의원에서 스테로이드제 또는 항진균제로 치료하였으나 증상이 지속되었다고 하였다. 내원 당시 병변은 좌측 뺨에 국한된 홍반성 반, 미란과 함께 미립종, 모세혈관 확장 및 위축이 관찰되었다(Fig. 1A). 다른 신체 부위에서 이러한 피부병변은 관찰되지 않았으며, 구강점막 및 결막에도 이상소견은 없었다. 과거력과 가족력에서 특이사항은 없었으며, 내원 당시 시행한 일반혈액검사, 일반화학검사, 소변검사에서 정상 소견 보였으며 항핵항체는 음성소견을 보였다. 병변부에서 시행한 조직생검에서 표피하 수포를 관찰할 수 있었고, 상부 진피에서 림프구 및 호중구의 침윤이 관찰되었다(Fig. 2A). 병소 주위 조직으로 시행한 직접면역형광검사에서 기저막대를 따라 IgG, C3의 선상 침착이 관찰되었다. 환자의 혈청을 이용한 간접면역형광검사를 시행하였으나 음성을 나타내어 환자의 피부조직을 1M 식염수를 이용하여 진피와 표피를 분리한 조직에서 직접면역형광검사를 시행하였으며, 이 검사에서 진피쪽에만 IgG와 C3의 침착됨이 관찰되었다(Fig.2B). 국소성 후천물집표피박리증으로 진단하고, 1일 prednisolone10 mg과 dapsone 50 mg의 경구 투여와 함께 tacrolimus 연고를 하루 1∼2회 병변에 도포하였다. 치료 2일만에 수포성 병변의 발생이 소실되었다고 하며, 그후 3개월이 지난 현재까지 새로운 물집 병변의 발생 없이 외래추적 관찰 중에 있다(Fig. 1B). 후천물집표피박리증의 전형적인 임상양상은 외상을 받기 쉬운 부위, 즉 손, 팔꿈치, 무릎, 엉치뼈 부위, 발가락에 비염증성의 긴장성 수포가 발생하고 흉터와 미립종을 남기며 치유되는 것이다. 그러나, 그 밖에도 다양한 임상양상을 나타낼 수 있어 물집유사천포창, 흉터유사천포창 등과 비슷하게 나타나기도 하며, 또한 본 증례처럼 Brunsting-Perry 흉터유사천포창과 유사하게 나타날 수도 있다1. Brunsting-Perry 유형의 후천물집표피박리증은 후천물집표피박리증의 국소성 유형으로 머리와 목에 국한하여 만성적으로 재발성의 수포가 발생하여 위축성 흉터를 남기고 치유된다. 그리고 조직학적 검사에서 표피하 수포를 보이고, 직접면역형광검사에서 기저막대를 따라 면역글로불린의 침착을 보이며, 1M 식염수를 이용하여 표피와 진피를 분리한 조직으로 시행한 직접면역형광검사에서는 진피쪽에 면역글로불린의 침착이 관찰된다. 그러나 전신적인 침범을 보이는 후천물집표피박리증과 달리 혈청의 항체를 검출하기 어려워 본 증례와 같이 간접면역형광검사에서는 음성 소견을 나타내는 경우가 많고, 면역전사검사로 항원성분의 분자량을 동정 확인하기가 어렵다1,2. 본 증례와 유사하게 얼굴에 국한하여 만성적인 수포를 보일 수 있는 질환으로 수포성 전신성 홍반성 루푸스, 국소성 유사천포창 등이 있으므로 이들 질환과의 감별이 필요하다. 본 증례에서 환자는 광선노출부위인 뺨에 병변이 발생하였지만, 검사실 검사에서 항핵항체검사 음성 소견을 보였으며 나머지 전신성 홍반성 루푸스의 진단기준을 만족하지 못하였다. 그리고 1M 식염수를 이용하여 표피-진피를 분리한 조직에서 시행한 직접면역형광검사에서는 진피쪽에 면역글로불린의 침착을 보였으므로, 표피쪽에 면역글로불린의 침착을 보이는 유사천포창과 감별이 가능하다. 국소적으로 발생하는 후천물집표피박리증은 전신적인 유형에 비해 좋은 예후를 가지지만 악화와 호전을 거듭하는 것으로 알려져 있다. 전신 스테로이드 및 dapsone의 병용투여와 함께 국소 스테로이드제 또는 tacrolimus제를 이용하여 좋은 치료효과를 보인 보고가 있으며, 본 증례에서도 이를 이용하여 좋은 효과를 보았다3-5. 저자들은 왼쪽 뺨에 국한되어 만성적으로 재발성의 수포가 발생하는 환자를 조직면역학적 검사로 국소성 후천물집표피박리증으로 진단하고 드물고 흥미로운 예로 생각되어 문헌 고찰과 함께 보고한다.

Analysis of Gene Expression Profile of AGS Cells Stimulated by Helicobacter pylori Adhesion

( Na Young Kim ),( Woong Yang Park ),( Jung Mogg Kim ),( Young Soo Park ),( Dong Ho Lee ),( Ji Hyun Park ),( Joo Sung Kim ),( Hyun Chae Jung ),( In Sung Song ) 대한소화기학회 2007 Gut and Liver Vol.1 No.1

Background/Aims: Interactions between H. pylori and gastric epithelial cells contribute to gastric inflammation and epithelial damage. This study was performed to evaluate the gene expression profile of AGS cells by adhesion of H. pylori. Methods: Changes in AGS cell gene expression induced by co-culturing with H. pylori (G69a strain) (4, 12, 24, 48 hours) were monitored using oligonucleotide microarray. Real-time reverse transcription-polymerase chain reaction (RT-PCR) was performed for data validation by the Assay-on-Demand Gene Expression product method. Results: A total of 270 (2.66%) and 19 genes (0.19%) were up-regulated in AGS cells by H. pylori adhesion. Gene ontology analysis showed that up-regulated genes were categorized into endolipidase activity (17 genes), receptor binding (17 genes), integrin binding (4 genes), and two down-regulated genes into GTP binding category. The expression levels of 20 up- and 5 down-regulated genes were quantified by real-time RT-PCR. Sixteen genes involving cytokine activity (IL8, IL1B, TNF), hydrolase activity (PTP4A1, ERCC1, CASP8, CASP7, ACIN1), VIP receptor activity (VIPR2), and neuropeptide Y receptor activity (GPR83) were confirmed to be up-regulated. Five genes, namely, ARF3, M17S2, DDB2, AWP1, and WTAP were confirmed to be down-regulated. Conclusions: Host genes are significantly changed by H. pylori adhesion, which might explain the gastroduodenal pathogenesis induced by H. pylori infection. (Gut and Liver 2007;1:40-48)

Spatial architectures of somatic mutations in normal prostate, benign prostatic hyperplasia and coexisting prostate cancer

Chae Jeesoo,Jung Seung-Hyun,Choi Eun Ji,Kim Jae Woong,Kim Na Yung,Moon Sung Won,Lee Ji Youl,Chung Yeun-Jun,Lee Sug Hyung 생화학분자생물학회 2024 Experimental and molecular medicine Vol.56 No.-

This study aimed to identify somatic mutations in nontumor cells (NSMs) in normal prostate and benign prostatic hyperplasia (BPH) and to determine their relatedness to prostate cancer (PCA). From 22 PCA patients, two prostates were sampled for 3-dimensional mapping (50 normal, 46 BPH and 1 PCA samples), and 20 prostates were trio-sampled (two normal or BPH samples and one PCA sample) and analyzed by whole-genome sequencing. Normal and BPH tissues harbored several driver NSMs and copy number alterations (CNAs), including in FOXA1, but the variations exhibited low incidence, rare recurrence, and rare overlap with PCAs. CNAs, structural variants, and mutation signatures were similar between normal and BPH samples, while BPHs harbored a higher mutation burden, shorter telomere length, larger clone size, and more private NSMs than normal prostates. We identified peripheral-zonal dominance and right-side asymmetry in NSMs, but the asymmetry was heterogeneous between samples. In one normal prostate, private oncogenic RAS-signaling NSMs were detected, suggesting convergence in clonal maintenance. Early embryonic mutations exhibited two distinct distributions, characterized as layered and mixed patterns. Our study identified that the BPH genome differed from the normal prostate genome but was still closer to the normal genome than to the PCA genome, suggesting that BPH might be more related to aging or environmental stress than to tumorigenic processes.

Letter to the Editor : Cutaneous Horn Arising from Keratoacanthoma

( Woong Suk Chae ),( Jun Young Seong ),( Ha Na Jung ),( Ho Seok Suh ),( Yu Sung Choi ) 대한피부과학회 2014 大韓皮膚科學會誌 Vol.52 No.10

Cutaneous horn is an epidermal tumor, which appears as a protruding conical mass of keratin. The height of the keratotic mass should amount to at least half of its diameter to be defined as cutaneous horn1. The lesion can be derived from various underlying lesions, which may be benign, premalignant, or malignant. Therefore, it is important to accurately determine the base of the lesion by histopathologic confirmation2. We report a case of cutaneous horn on the anterior chest of a healthy 66-year-old man. A 1.1×1.2× 1.2 cm-sized, white-grayish hyperkeratotic horn-like tumor was observed for 6 months (Fig. 1A, B). It had been slowly growing without pain or pruritus. Additionally, the patient had no history of trauma or contact with irritants. The lesion was removed by surgical excision (Fig. 1C). Histopathologic study showed marked hyperkeratosis of the cutaneous horn and irregular epidermal proliferation, acanthosis, and a crater-shaped, keratin-filled structure, all of which are characteristic findings of keratoacanthoma (Fig. 2). Keratoacanthoma is a common but unique neoplasm, usually demonstrating rapid growth. Histopathologic patterns show marked hyperkeratosis and irregular epidermal proliferation, acanthosis, and crater-shaped, keratin-filled structures. Keratoacanthoma has unique clinical stages including proliferating, mature, and resolving. The process from origin to spontaneous resolution usually occurs within 4∼6 months. However, rapidly growing lesions can cause widespread tissue destruction. Additionally, it is sometimes difficult to differentiate keratoacanthoma from squamous cell carcinoma in very early lesions. Therefore, complete surgical excision is recommended3. Its clinical manifestation and the presence of a large crater filled with keratin were consistent with keratoacanthoma. A cutaneous horn is an epidermal tumor composed of compact keratin projecting above the surface of the skin. It differs from animal horn by the absence of a central bone1. Because the lesion can be derived from many primary underlying lesions, it is important to investigate the derivation of the lesion in order to guide further treatment and establish prognosis1,2. The patient is currently being monitored for recurrence and a regular check-up is recommended. Though cutaneous horn arising from keratoacanthoma is not actually rare, the frequency of these cases is underestimated. In the literature, descriptions of cutaneous horn originating from keratoacanthoma are sparse and only 2 such cases were previously reported in Korea (Table 1)4,5. We report a case of a cutaneous horn arising from keratoacanthoma in a 66-year-old male patient.