Conversion Total Knee Arthroplasty after Failed High Tibial Osteotomy

Clinical results of high tibial osteotomy (HTO) deteriorate over time despite the initial satisfactory results. Several knees may require a conversion to total knee arthroplasty (TKA) because of failure such as the progression of degenerative osteoarthritis and the loss of the correction angle. It is important to know the long-term survival rate and common reason of failure in HTO to inform patients of postoperative expectations before surgery and to prevent surgical errors during surgery. In addition, it has been reported that clinical and radiological results, revision rate, and complication rate were poorer than those in patients without a previous HTO. There are few review articles that describe why conversion TKA after HTO is surgically difficult and the results are poor. Surgeons have to avoid the various complications and surgical errors in this specific situation. We would like to present the considering factors and technical difficulties during conversion TKA after HTO with a review of the literature. We could conclude through the review that the correction of deformity, lower amount of tibial bone resection, and sufficient polyethylene insert thickness, restoration of the joint line height, and adequate ligament balancing can be helpful in overcoming the technical challenges encountered during TKA following HTO.

Limb Salvage Surgery with Tumor Prosthesis for the Malignant Bone Tumors Involving the Proximal Femur / 대한골관절종양학회지

PURPOSE: As well as patient survival, the restoration of postoperative function such as ambulation is important in limb salvage operations for treatment of malignant bone tumors involving the proximal femur. The authors analyzed clinical outcomes of limb salvage operations using tumor prostheses for metastatic or primary malignant bone tumors in the proximal femur. MATERIALS AND METHODS: From February 2005 to January 2014, 20 cases (19 patients) with malignant bone tumor involving the proximal femur with pain or complicated pathologic fracture were treated with segmental resection and limb salvage operations with tumor prostheses. Mean age was 63.1 years (range 35-86). Fourteen patients were male and six ones were female. The mean follow-up period was 20 months (1-94 months). There were 15 cases of metastatic bone tumor, 4 cases of osteosarcoma, and 1 case of multiple myeloma. The primary tumors of the metastatic bone tumors included 4 lung cancers, 3 hepatocellular carcinomas, and 3 renal cell carcinomas. Other primary tumors were breast cancer, thyroid cancer, colon cancer, prostate cancer, and malignant spindle cell tumor, each in 1 case. Modular tumor prostheses were used in all cases; (Kotz's(R) Modular Tumor prosthesis (Howmedica, Rutherford, New Jersey) in 3 cases, MUTARS(R) proximal femur system (Implantcast, Munster, Germany) in 17 cases). Perioperative pain was assessed with Visual Analogue Scales (VAS). Postoperative functional outcome was assessed with Musculoskeletal Tumor Society (MSTS) grading system. RESULTS: Out of 20 cases (19 patients), 11 cases (10 patients) survived at the last follow-up. Average postoperative survival of the 9 deceased patients was 10.1 months (1-38 months). VAS score improved from pre-operative average of 8.40 (5-10) to 1.35 (0-3) after operation. Average postoperative MSTS function score was 19.65 (65.50%, 7-28). The associated complications were 2 local recurrences, 3 hematomas, 3 infections, 2 scrotal swellings, and 1 dislocation. There was no case of periprosthetic fracture or loosening. CONCLUSION: Limb salvage operation with tumor prosthesis is an appropriate treatment for early pain reduction and functional restoration in malignant bone tumors in the proximal femur with pain an/or complicated pathologic fractures.

A Case of Multiple endocrine neoplasia type 2a / 대한내분비학회지

Multiple endocrine neoplasia type2a (MEN type2a) is a dominantly inherited cancer syndrome which is characterized by medullary thyroid carcinoma, pheochromocytoma and parathyroid hyperplasia or adenoma. Recent reports show that DNA analysis will be introduced into screening of MEN type2a families. Regular prospective screening and appropriate surgical intervention can reduce the morbidity and mortality due to MEN type2a. We experienced a case of MEN type 2a in a 46-year-old female patient. She had undergone bilateral adrenalectomy due to pheochromocytoma, followed by a total radical thyroidectomy, which revealed medullary thyroid carcinoma of the both thyroid gland and parathyroid hyperplasia.

A Clinical Study on Staphylococcus Aureus Bacteremia / 대한내과학회지

OBJECTIVE: Staphylococcus aureus has persisted and is now resurging as an important hospital and community pathogen. Nosocomial infection caused by methicillin-resistant S.aureus(MRSA) is a major problem which may be connected with heavy or prolonged use of antibiotics S.aureus bacteremia caused acute complications, which occasionally resulted in death, and infectious/suppurative complications, which necessitated prolonged antibiotic therapy, sometimes in conjunction with surgery. Therefore, S.aureus bacteremia is a serious medical problem in association with high morbidity and mortality. METHODS: 130 patients with S.aureus bacteremia who were admitted in the Kyung Hee University Hospital from January, 1991 to December, 1994 were analyzed retrospectively. We compared the clinical and laboratory characteristics, and antibiotics resistances between MRSA and MSSA bacteremia and also we evaluated risk factors that contribute to fatal outcome in patients with S.aureus bacteremia. RESULTS: 1) of 130cases, 80 were male and 50 were female. The mean age was 44.5+/-25.1 years. 2) 84(65%) of S.aureus bacteremia were nosocomial and 46(35%) were community-acpuired. The percentage of MRSA stains studied was 55%(71/130) and The percentage of MRSA bacteremia in hospital-acpuired and community-accquired S. aureus bacteremia were 64% (54/84) and 36%(17/46), respectively. Sources of bacteremia were uncertain in 85(65%) with intravascular catheter(20%) and skin wound sites (8%) being the most common sources in remainder(35%) 3) 110(85%) of 130 patients had one or more underlying diseases. Common underlying dieases were cerebrovascular disease(33%), malignancy(17%), Diabetes mellitus(15%), chronic renal failure(8%) and liver cirrhosis(6%). 4) Acute complications occurred in 35 patients and were fatal in 21 5) The risk factors associated with MRSA bacteremia were various severe underlying diseases, vairous invasive procedures, IV catheter-associated infection, hypoalbuminemia, previous use of antibiotics, male sex and old age. 6) The Case fatality rate for patients with S. aureus bacteremia was 18% and those for patients with MRSA and MSSA bactermia were 20% and 12%, respectively. The risk factors that contribute to the increment of mortality rate in patients with S. aureus bacteremia were acute complication, low serum level of total protein, hypoalbuminemia, various invasive procedures and IV catheter-associated infection, 7) In the antibiotic sensitivity test S. aureus was resistant to penicillin in 98.5%, ofloxacin in 73%, cefotaxime in 67%, erythromycin in 58%, aztreonam in 56%, clindamycin in 52%, vancomycin in 0%. 8) In the multiple antibiotic resistance of S. aureus, 43(68%) of MRSA was resistant to more than 10 antibotics, revealing multiply resistant nature of strains, While all but one MSSA was resistant to 1 to 4 antibiotics, one revealing resistance to 8 antibiotics. CONCLUSION: S. aureus bacteremia is a cause of considerable morbidity and mortality in hospitalized patients who especially, exposed to various risk factors. MRSA revealed higher resistance rate to most antibiotics tested and more marked multiply resistant nature than MSSA. But there was no significant difference in case fatality rate between patients with MRSA and MSSA bacteremia.

A Case of Infected Aortic Aneurysm Caused by Salmonella Group B / 대한내과학회지

We experienced a case of the rupture of infected aortic aneurysm caused by Salmonella group B. A 75-year-old diabetic female patient was admitted with lower back pain and fever. Abdominal CT scan showed the abdominal aneurysm and the abscess of retroperitoneal space. We confirmed the ruptured aortic anecrysm with retroperitoneal abscess by obermter. The blood culture, and the pus obrained by operan yielded growth of Salmonella group B. After oration the patient was recovered completely by anrotics. We report this case with literature

Ileocolovesical Fistula Caused by Crohn's Disease: Report of a Case / 대한비뇨기과학회지

Enterovesical fistula is a relatively rare disease and usually caused by primary intestinal disease (diverticulitis, colon cancer and inflammatory bowel disease including Crohn's disease etc.). We experienced a rare case of ileocolovesical fistula caused by Crohn's disease. The 34 year old man had had chronic dysuria, lower abdominal pain and turbid urine for 3 years. Contrast studies including cystography, small bowel series, barium enema and abdominal Of showed ileocolovesical fistula. Small bowel segmental resection, Hartmann's colostomy and suprapubic cystostomy were performed. Histological examination of operative specimen showed a granulomatous inflammation caused by Crohn's disease. Our case suggests that Crohn's disease may be a rare cause of enterovesicalfistula in Korean.