Hip Arthrodesis to Treat Severe Hip Osteoarthritis in an Adolescent with Down Syndrome / 대한정형외과학회잡지

Down syndrome is the most common chromosomal disorder and is accompanied by hip osteoarthritis in approximately 28% of patients.This paper reports a case of hip arthrodesis as a treatment for severe hip osteoarthritis in adolescent Down syndrome patients. When performing surgical treatment of patients with Down syndrome, it is necessary to take a comprehensive approach that considers not only the medical point of view, but also the psychological and economic requirements of the patient and their social environment.

Paralabral Cyst of the Hip Compressing Common Femoral Vein Treated with Sono-guided Cyst Aspiration Followed by Arthroscopic Labral Debridement: A Case Report / 대한고관절학회지

Paralabral cyst around hip is reported to be a cause of compression of the major neurovascular structures. Although, arthroscopic cyst and labral debridement is generally accepted as the effective treatment, there is limited literature available regarding treatment options for paralabral cysts in the hip. We present a case of paralabral cyst compressing left common femoral vein in the hip that was treated with sono-guided cyst aspiration followed by arthroscopic labral debridement.

Paralabral Cyst of the Hip Compressing Common Femoral Vein Treated with Sono-guided Cyst Aspiration Followed by Arthroscopic Labral Debridement: A Case Report / 대한고관절학회지

Paralabral cyst around hip is reported to be a cause of compression of the major neurovascular structures. Although, arthroscopic cyst and labral debridement is generally accepted as the effective treatment, there is limited literature available regarding treatment options for paralabral cysts in the hip. We present a case of paralabral cyst compressing left common femoral vein in the hip that was treated with sono-guided cyst aspiration followed by arthroscopic labral debridement.

The Results of Long-term Follow-up of Total Hip Arthroplasty Using Hydroxyapatite-coated Cups / 대한고관절학회지

PURPOSE: The aim of this study was to report the long-term outcome and the failure mechanism of cementless total hip arthroplasty (THA) using hydroxyapatite (HA)-coated acetabular cup. MATERIALS AND METHODS: From January 1992 to May 1994, a total of 123 consecutive cementless primary THAs were performed using a HA-coated acetabular cup with metal-on-polyethylene articulation. We retrospectively evaluated 66 hips available for follow-up at a mean 18.3 years (range, 10.4-23.6 years). The survival analysis was performed by the Kaplan-Meier method. We defined end point as any failure that required a reoperation of acetabular component. RESULTS: Thirty-nine of 66 hips (59.1%) were defined as a failure for progressive acetabular osteolysis or aseptic loosening of the cup. Acetabular osteolysis was observed in 47 hips (71.2%) and 33 hips (50.0%) were revised because of cup loosening. The Kaplan-Meier method showed the survival rate of the acetabular cup to be 46.3% at 15 years and 34.8% at 20 years for any failure that required a reoperation of acetabular component. CONCLUSION: The long-term survival rate of THA using HA-coated acetabular cup was unsatisfactory, and it was attributed to vulnerable property of HA coating and progressive osteolysis.

Clinical Outcomes of the Endoscopic Submucosal Dissection of Early Gastric Cancer Are Comparable between Absolute and New Expanded Criteria

BACKGROUND/AIMS: Advances in endoscopic submucosal dissection (ESD) techniques have led to the development of expanded criteria for endoscopic resection of early gastric cancer (EGC). The aim of this study was to evaluate the short- and long-term outcomes for ESD using indication criteria. METHODS: A total of 1,105 patients underwent ESD for EGC at six medical centers. The patients were classified into the following two groups based on the lesion size, presence of ulceration and pathological review: an absolute criteria group (n=517) and an expanded criteria group (n=588). RESULTS: The curative resection rates (91.1% vs 91.3%, p=0.896) were similar in the absolute criteria group and the expanded criteria group. The en bloc resection rates (93.4% and 92.3%, respectively; p=0.488) and complete resection rates (98.3% and 97.4%, respectively; p=0.357) did not differ between the groups. The cumulative disease-free survival rates and the overall survival rates were similar between the groups (p=0.778 and p=0.654, respectively). Independent factors for the curative resection of EGC included tumor location (upper vs middle and lower, 2.632 [1.128-6.144] vs 3.497 [1.560-7.842], respectively) and en bloc resection rate 12.576 [7.442-21.250]. CONCLUSIONS: The expanded criteria for ESD in cases of EGC is comparable with the widely accepted pre-existing criteria.

Clinical Outcomes of the Endoscopic Submucosal Dissection of Early Gastric Cancer Are Comparable between Absolute and New Expanded Criteria

BACKGROUND/AIMS: Advances in endoscopic submucosal dissection (ESD) techniques have led to the development of expanded criteria for endoscopic resection of early gastric cancer (EGC). The aim of this study was to evaluate the short- and long-term outcomes for ESD using indication criteria. METHODS: A total of 1,105 patients underwent ESD for EGC at six medical centers. The patients were classified into the following two groups based on the lesion size, presence of ulceration and pathological review: an absolute criteria group (n=517) and an expanded criteria group (n=588). RESULTS: The curative resection rates (91.1% vs 91.3%, p=0.896) were similar in the absolute criteria group and the expanded criteria group. The en bloc resection rates (93.4% and 92.3%, respectively; p=0.488) and complete resection rates (98.3% and 97.4%, respectively; p=0.357) did not differ between the groups. The cumulative disease-free survival rates and the overall survival rates were similar between the groups (p=0.778 and p=0.654, respectively). Independent factors for the curative resection of EGC included tumor location (upper vs middle and lower, 2.632 [1.128-6.144] vs 3.497 [1.560-7.842], respectively) and en bloc resection rate 12.576 [7.442-21.250]. CONCLUSIONS: The expanded criteria for ESD in cases of EGC is comparable with the widely accepted pre-existing criteria.

Post-Marketing Surveillance for the Safety and Effectiveness of Adefovir in Patients with Chronic Hepatitis B

BACKGROUND: To investigate the safety and effectiveness of adefovir in Korean patients with chronic hepatitis B, an observational study was carried out. METHODS: A total of 4,393 patients with chronic hepatitis B were enrolled from February 2004 to February 2010. For the safety assessment, investigators recorded the occurrence of observed and patient-reported adverse events (AEs) throughout the course of treatment. Antiviral effectiveness was assessed by measuring the degree of symptom improvement and the reduction of HBV DNA after 12 weeks of treatment. RESULTS: Of the 4,393 patients, 4,158 patients were evaluated for safety and 3,867 patients for effectiveness assessment. A total of 118 AEs were reported in 4,158 patients (1.8 %). The most frequent AE was hepatic failure (0.2 %) followed by coughing (0.2 %), hepatic neoplasm (0.2 %), abdominal pain (0.1 %), dyspepsia (0.1 %), nausea (0.1 %), flatulence (0.1 %), hepatic cirrhosis (0.1 %), asthenia (0.1 %), increase in sputum production (0.1 %), and varicose vein (0.1 %). The incidence of unexpected AEs was 0.9 %. Forty-nine cases of serious AE were reported in 32 patients but all of those were thought to be unrelated to adefovir according to physician's evaluations. The rate of subjects with well effectiveness was 96.2 %. CONCLUSION: Adefovir was clinically well tolerated and effective in treatment of chronic hepatitis B patients.

Influence of Obesity on the Severity and Clinical Outcome of Acute Pancreatitis

BACKGROUND/AIMS: Obesity tends to be associated with increased mortality and morbidity in acute pancreatitis. However, in Asian populations, higher morbidity and mortality have been reported in patients with low body mass indexes (BMIs). This study was undertaken to evaluate the relation between obesity and outcome, and to investigate the occurrence of complications by overweightedness in acute pancreatitis. METHODS: The medical records of 403 patients with acute pancreatitis were reviewed retrospectively, and Ranson's scores, modified Glasgow scores, Acute Physiology and Chronic Health Evaluation (APACHE) II scores and computed tomography severity indexes were calculated. Patients were categorized by BMI for the analysis. RESULTS: When compared with normal patients (BMI 18.5 to 22.9), all categories with a BMI > or =23 had an increased risk of developing a severe form of acute pancreatitis (p=0.003) and all categories with a BMI > or =25 significantly predicted severity (p<0.001). Patients with class 1 obesity (BMI 25 to 29.9) developed significantly more systemic and metabolic complications. CONCLUSIONS: Overweightedness and obesity were found to be associated with a higher risk of developing severe pancreatitis. Further studies are needed to establish the precise prognostic value of obesity in members of the population with low BMIs.

Gastrointestinal Risk Assessment in the Patients Taking Nonsteroidal Anti-inflammarory Drugs for Lumbar Spinal Disease

STUDY DESIGN: A cross-section observational study. OBJECTIVES: To evaluate the current prescription patterns of non-steroidal anti-inflammatory drugs (NSAIDs) and gastrointestinal (GI) risk assessment in patients with lumbar spine disease. SUMMARY OF LITERATURE REVIEW: NSAIDs are commonly prescribed medications for lumbar spine disease patients. Since the rate of GI complication varies for each patient, identification of individual GI risks is a prerequisite to prevent such a complication. There are few reports about the GI risks in patients with lumbar spine disease who take NSAIDs. MATERIALS AND METHODS: 2264 patients with lumbar degenerative spondylopathy who were taking NSAIDs were enrolled from May 2010 to September 2010. The Standardized Calculator of Risk for Event (SCORE) was used to measure patients' GI risk factors. NSAID prescription patterns and GI protective agents were also investigated. RESULTS: Being aged over 65 (1098 patients; 48.5%) and the presence of GI side-effects from NSAIDs (896 patients; 39.6%) were the most common risk factors. 31.9% and 5.8% percent of patients belonged to each of the high risk and the very high risk groups in GI risk factor analysis. The total prescription rate of gastroprotectants was 91.7% for all patients. However, the prescription rate of selective COX-2 inhibitors in the high risk group was low, and in 54.8% of patients who took COX-2 inhibitors there was GI discomfort. CONCLUSIONS: The prescription pattern of GI protective agents was not correlated with GI symptoms. Therefore, physicians should consider NSAID prescription based on the GI risk factors of individual patients.

A case of hemocholecyst associated with hemobilia following radiofrequency ablation therapy for hepatocellular carcinoma / 대한간학회지

Radiofrequency ablation (RFA) is performed as an alternative to surgical resection for primary or secondary liver malignancies. Although RFA can be performed safely in most patients, early and late complications related to mechanical or thermal damage occur in 8-9.5% cases. Hemocholecyst, which refers to hemorrhage of the gallbladder, has been reported with primary gallbladder disease or as a secondary event associated with hemobilia. Hemobilia, defined as hemorrhage in the biliary tract and most commonly associated with accidental or iatrogenic trauma, is a rare complication of RFA. Here we report a case of hemocholecyst associated with hemobilia after RFA for hepatocellular carcinoma that was successfully managed by laparoscopic cholecystectomy.

A Case of Portal Hypertension after the Treatment of Oxaliplatin Based Adjuvant-Chemotherapy for Rectal Cancer / 대한소화기학회지

We report herein a case of 35-years-old woman in whom portal hypertension (esophageal varix and splenomegaly) developed after 12 cycles of oxaliplatin based adjuvant chemotherapy for rectal cancer. She was transferred for the evaluation of etiology of new-onset portal hypertension. The esophageal varix and splenomegaly were absent before the oxaliplatin based adjuvant chemotherapy. Thorough history taking and serological exam revealed no evidence of chronic liver disease. Liver biopsy was done and there was no cirrhotic nodule formation. Instead, perivenular fibrosis was noted. Considering new development of esophageal varices and splenomegaly after 12 cycles of oxaliplatin-based adjuvant chemotherapy, we could conclude that portal hypertension in this patient were due to sinusoidal injury by oxaliplatin. Finally, we recommend regular follow-up with endoscopy and radiologic examination for checking the development of varices and for screening of varices and splenomegaly in patients with colo-rectal cancer who receive oxaliplatin-based chemotherapy.

A Case of Portal Hypertension after the Treatment of Oxaliplatin Based Adjuvant-Chemotherapy for Rectal Cancer / 대한소화기학회지

We report herein a case of 35-years-old woman in whom portal hypertension (esophageal varix and splenomegaly) developed after 12 cycles of oxaliplatin based adjuvant chemotherapy for rectal cancer. She was transferred for the evaluation of etiology of new-onset portal hypertension. The esophageal varix and splenomegaly were absent before the oxaliplatin based adjuvant chemotherapy. Thorough history taking and serological exam revealed no evidence of chronic liver disease. Liver biopsy was done and there was no cirrhotic nodule formation. Instead, perivenular fibrosis was noted. Considering new development of esophageal varices and splenomegaly after 12 cycles of oxaliplatin-based adjuvant chemotherapy, we could conclude that portal hypertension in this patient were due to sinusoidal injury by oxaliplatin. Finally, we recommend regular follow-up with endoscopy and radiologic examination for checking the development of varices and for screening of varices and splenomegaly in patients with colo-rectal cancer who receive oxaliplatin-based chemotherapy.

Medial Meniscal Tears in Anterior Cruciate Ligament-Deficient Knees: Effects of Posterior Tibial Slope on Medial Meniscal Tear

PURPOSE: To evaluate the incidence of meniscal tears in patients with chronic anterior cruciate ligament (ACL)-deficient knees, and to determine the influence of posterior tibial slope (PTS) on medial meniscal tears in ACL-deficient knees. MATERIALS AND METHODS: We reviewed 174 patients (174 knees) with a mean age of 30.7 years who underwent ACL reconstruction for chronic ACL tears. We divided the patients into two groups: low group (135 knees with a PTS or =13degrees). RESULTS: The incidence of medial meniscus tears was 44% (77/174), and that of lateral meniscus tears was 35% (61/174). The mean PTS in patients with medial meniscal tears was 11.4degrees+/-3.0degrees, whereas that in patients without medial meniscal tears was 9.8degrees+/-2.4degrees. The incidence of meniscal tears was 57.8% (78/135) in the low group and 89.7% (35/39) in the high group (p or =13degrees is a risk factor for secondary medial meniscal tears in ACL-deficient knees. So, we suggest that PTS is one of the considerations for determining early ACL reconstruction to prevent secondary meniscal tears.

Ligament Reconstruction in Congenital Absence of the Anterior Cruciate Ligament: A Case Report

Congenital absence of the cruciate ligament is an extremely rare condition that was first reported in Giorgi's radiographic study in 1956. The authors report on a case of anterior cruciate ligament reconstruction performed on a 21-year-old female patient with congenital anterior cruciate ligament absence. We also discuss radiographic evidence that could provide clues to the congenital absence and possible difficulties that may be encountered during surgery with a review of the relevant literature.

Clinical factors influencing liver stiffness as measured by transient elastography (Fibroscan(R)) in patients with chronic liver disease / 대한간학회지

BACKGROUND/AIMS: Transient elastography as performed using the Fibroscan(R) is a useful noninvasive method for evaluating hepatic fibrosis. However, recent studies have found that liver stiffness measurement (LSM) values are inappropriately elevated in acute hepatitis or in the acute flare state of chronic hepatitis, suggesting that the LSM value obtained by the Fibroscan(R) is not a reliable marker for fibrosis. We retrospectively evaluated the clinical factors influencing the LSM value obtained using transient elastography as performed using the Fibroscan(R) in patients with chronic liver disease. METHODS: A total of 298 patients who were followed in Kungpook National University Hospital from November 2007 to May 2008 due to previously established liver cirrhosis or chronic liver disease were investigated using the Fibroscan(R), laboratory test, ultrasound, and/or abdominal computed tomography. RESULTS: The 298 patients were aged 47.8+/-12.9 years (mean+/-SD). The cut-off value for a diagnosis of liver cirrhosis was 12.5 kPa (as used in previous studies). Thirty-six patients (15%) and 202 patients (85%) with chronic liver disease without clinical manifestation of cirrhosis had LSMs of >12.5 kPa and <12.5 kPa, respectively. Multivariate analysis revealed that LSM values were unusually increased in patients with chronic liver disease who were older (P=0.007) or who had increased gamma gultamyltranspetidase (GGT) (P=0.022), decreased albumin (P=0.015), or increased total bilirubin (P=0.009). CONCLUSIONS: This study reveals that age, GGT, and albumin are clinical factors influencing LSM values. This reinforces the need to interpret LSM values in the context of a defined diagnosis, biochemical data, radiologic examination, and other clinical findings.

A Pityrosporum Fungal Infection Following Infliximab Therapy in a Crohn's Disease Patient

Crohn's disease (CD) is a chronic immune-mediated inflammatory disorder. Treatment strategies for CD are targeted toward various components of the proinflammatory mediators and subsequent immune response. Recently, the anti-tumor necrosis factor (TNF) monoclonal antibody, infliximab has been used in patients with CD. However, uncommon and unusual infections have been reported during anti-TNF-alpha therapy and immunomodulator. Here, we report a case of pityriasis versicolor occurring in a patient with CD receiving infliximab treatment. The patient was successfully treated with topical ketoconazole.

The trend in the eradication rates of first- and second-line therapy for Helicobacter pylori infection in Daegu and Kyungpook provinces: a single center experience for the most recent 9 years / 대한내과학회지

BACKGROUND/AIMS: The reported prevalence of antibiotic resistance in Helicobacter pylori infection has been increasing. However, recent trends in the eradication rates of H. pylori using first-line triple regimens are rarely reported. Therefore, we determined the trend in the H. pylori eradication rates in a single center for the most recent 9 years in Daegu and Kyungpook provinces, Korea. METHODS: From January 1999 through December 2007, the eradication rates in 615 H. pylori-positive patients who received one-week triple regimens were evaluated retrospectively according to year and ulcer location. RESULTS: The overall H. pylori eradication rate was 81.6%. The eradication rate from the years 1999 to 2007 was 76.3, 78.3, 82.8, 88.5, 77.8, 91.7, 84.8, 75.4, and 83.7%, respectively, based on the per-protocol analysis. No definite evidence of a decreasing tendency of the eradication rate was seen over the 9 years (p=0.760). Furthermore, there was no significant difference in the eradication rate according to ulcer location. CONCLUSIONS: There is no decreasing trend in the H. pylori eradication rate over the past 9 years in Daegu and Kyungpook provinces. However, the eradication rates are not satisfactory, and further investigation is needed to develop more effective regimens.