Tumor Recurrence in Hepatocellular Carcinoma Patients after Radiofrequency Ablation: Portal Hypertension as an Indicator of Recurrence of Hepatocellular Carcinoma

PURPOSE@#To evaluate the effect of portal hypertension on the tumor recurrence in patients with hepatocellular carcinoma (HCC) and without hepatic decompression following radiofrequency ablation (RFA).@*MATERIALS AND METHODS@#Treatment-naïve HCC patients within the Milan criteria and with Child-Pugh class A were included in this study, who had performed RFA in our hospital between January 2010 and March 2017. Univariate and multivariate analyses using the Cox proportional hazard model were performed to find the predictors of local or distant tumor recurrence.@*RESULTS@#Overall, 178 patients were included in this study. Median follow-up period was 40.2 months. The difference in the local tumor progression rates depending on the absence or presence of portal hypertension was not statistically significant (p = 0.195). The 1-, 3-, and 5-year distant intrahepatic tumor spread rates were 6.6%, 29.5%, and 537% in patients without portal hypertension, and 23.4%, 51.9%, and 63.6% in patients with portal hypertension, respectively. The difference was statistically significant (p = 0.011). Univariate and multivariate analysis showed that portal hypertension was an independent predictor for distant intrahepatic tumor spread (p = 0.008).@*CONCLUSION@#For HCC patients with Child-Pugh class A, portal hypertension adversely affected distant intrahepatic tumor progression.

Fixation of Greater Trochanteric Fracture Using Double Strands and Double Loops with Figure of 8 Wiring in Non-cement Total Hip Arthroplasty for Unstable Intertrochanteric Fracture / 대한고관절학회지

PURPOSE: Non-cement total hip arthroplasty for unstable intertrochanteric fracture in elderly patients is regarded as another surgical technique preventing complications such as non-union, long term limitation of weight bearing, pressure sore, pulmonary thromboembolism after open reduction or closed reduction with intramedullary nailing, or plate fixation. We would like to announce the short-term results of primary non-cement total hip arthroplasty with double strands and double loops figure of 8 wiring for unstable intertrochanteric fracture in elderly patients. MATERIALS AND METHODS: All of the 20 patients admitted to the hospital between April 2010 and February 2012 who underwent non-cement total hip arthroplasty with double strands and double loops figure of 8 wiring for unstable intertrochanteric fractures were evaluated. The mean age was 71.1(57-86), there were nine males, and 11 females, with an average follow up period of six months. The post-operative state was evaluated by Harris hip score. RESULTS: The mean operation time was 95 min, and the average blood loss was 800 cc. Mean Harris hip score at the last available follow-up was 92.7, and, among the patients, 15 had all functions of daily life without limitation of walking distance, one had hip dislocation, one had breakage of strands. Pressure sore, deep vein thrombosis, and pulmonary thromboembolism were absent. Radiography at the last available follow-up showed no loosening of the femoral stem in any of the patients, and 13 patients had osteogenesis around the fracture site, and there was no osteolysis. CONCLUSION: Primary non-cement total hip arthroplasty with double strands and double loops figure of 8 wiring in elderly patients with unstable intertrochanteric fractures showed satisfactory results. These results are expected to be useful for further studies with a long-term follow-up and in development of a reduction method.

Rotational Alignment of Femoral Component for Minimal Medial Collateral Ligament Release in Total Knee Arthroplasty

PURPOSE: We attempted to determine the degree of rotation of the femoral component to achieve an ideal rectangular flexion gap with minimal medial collateral ligament (MCL) release using a modified measured technique. MATERIALS AND METHODS: Group I consisted of 60 osteoarthritis patients (72 cases) who underwent total knee arthroplasty (TKA) with minimal MCL release and Group II consisted of 48 patients without osteoarthritis (61 cases). We performed computed tomography (CT) scanning of the knee with 90 degree flexion in all of the patients and analyzed the angles between the distal femur landmarks and the tibial mechanical axis using a Picture Archiving Communication system. External rotation of the femoral component from the Whiteside line and posterior condylar line was measured in group I who underwent TKA with minimum MCL release. The variance in the mediolateral flexion gap according to the degree of rotation was also measured using an Auto-Computer Aided Design program. RESULTS: The CT scans showed that the Whiteside line, posterior condylar line, and transepicondylar line was more internally rotated on average from the longitudinal axis of tibia by 4.12degrees, 5.54degrees, and 4.64degrees, respectively, in group I compared to group II. In group I, the femoral component was inserted with an average external rotation of 5.6degrees from the posterior condylar line and with an average external rotation of 2.0degrees from the Whiteside line with minimal MCL release. From the measurements of the femoral component size and the variance in the degree of rotation using an Auto-CAD program, it was found that the change in the mediolateral flexion gap was greater when the rotation angle was greater and it was greater when the size of femoral component was larger at the same rotation angle. CONCLUSIONS: The average rotation angle of the femoral component to achieve an ideal rectangular flexion gap with minimal MCL release in TKA was an external rotation of 5.6degrees from the posterior condylar line and an external rotation of 2.0degrees from the Whiteside line. We concluded that when a femoral component is small in size, greater than average external rotation needs to be applied and when a femoral component is large in size, less than average external rotation needs to be applied.

Rapidly Progressive Cardiac Manifestation of Behcet's Disease Involving Conduction System and Aortic Valve

Cardiac conduction system impairment is a rare clinical manifestation of Behcet's disease. We report a patient who showed 1st degree atrioventricular block at first presentation, and showed aggravated finding of 3rd degree atrioventricular block on five months later. His cardiac manifestation finally developed to acute severe aortic regurgitation on six months later from his first cardiac manifestation. We observed this rapid progression during 6 months and successfully improved symptom and disease severity of the patient with treatment targeting Behcet's disease.

The Effect of High Sodium Dialysate(HSD) on Blood Pressure in Hemodilaysis / 대한신장학회잡지

Hypotensive episode is one of the serious complication during hemodialysis. HSD has used for relief of this problem, but sometimes increased interdialytic weight gain or exacerbation of hypotension are happened. To evaluate the effect of HSD, 7 non- diabetic normotensive uremic patients were hemodialyzed with different sodium level of dialysate (stage A : Na 138mEq/L for 4hrs, stage B : Na 148mEq/L for 4hrs, stage C : initially Na 148mEq/L for 3hrs and Na 138mEq/L for 1hrs), and each stages were continued for 2 weeks. Ultrafiltration was performed to maintain the patient's estimated dry weight constantly. Interdialytic weight gain(stage A : 2.9+/-1.2kg, stage B : 3.2+/-1.1kg, stage C : 3.1+/-0.8kg) and presystolic systolic and diastolic blood pressure were not different in each stage. The incidence of hypotension (systolic BP<90mmHg) during hemodialysis was significantly lower in stage B and stage C(24%, 21%) than stage A(54%)(P<0.01). During hemodialysis the incidence of thirst was higher in stage B(40%) than stage A and stage C(11%, 12%) (P<0.05) significantly but there are no difference in headache and itching during hemodialysis between the each stage. Pre-dialysis and post-dialysis serum sodium and osmolality were not different in each stage but at 2 hrs after initiation of hemodialysis serum sodium and osmolality were higher in stage B(145.6+/-2.1mEq/L, 306+/-6.7mOsm/kg) and stage C (146.1+/-2.1mEq/L, 306+/-13.1mOsm/kg) than stage A (140.1+/-2.5mEq/L, 292+/-8.7mOsm/kg)(P<0.05). The ANP levels of pre-dialysis and post-dialysis were not different in each stage. In conclusion, HSD improved hypotenive episode. In spite of sodium load, increased interdialytic weight gain and elevation of pre-dialysis blood pressure were not developed and sodium modeling during hemodialysis attenuate some adverse effect of HSD.