Peripheral Facial Palsy after Dental Procedure / 대한신경근육질환학회지

Peripheral facial palsy is often reported after surgery for head or neck tumors and otolaryngologic surgery, but the occurrence of facial nerve palsy after dental procedures is very rare. A 29-year-old man visited our clinic with right-side facial asymmetry and right facial weakness 7 days before. The patient underwent dental treatment 8 days ago. He exhibited weakness of the right side of his face and was unable to close his right eye. He was diagnosed with right-sided peripheral type facial nerve paralysis and treated with an antiviral agent and prednisolone, and the symptoms gradually improved. Facial nerve palsies after dental procedures have been reported in foreign countries, but these cases have been very rarely reported in Korea. We also reported on the efficacy of the conventional treatment of facial nerve palsy after a dental procedure.

Erratum to: Complications and Survival Rate of Patients Over 80 Years Old Who Underwent Laparoscopic Gastrectomy for Gastric Cancer

Authors requested to change the name of the hospital to proper name.

Analysis of Postoperative Complications Following Laparoscopic Gastrectomy in 1332 Gastric Cancer Patients

PURPOSE: To analyze postoperative complications for gastric cancer patients undergoing laparoscopic gastrectomy in single institution over long period of time. METHODS: The data of 1332 consecutive patients undergoing laparoscopic gastrectomy for gastric cancer at a single institution from January 2007 to December 2015 were reviewed. The patients were classified into the early or late surgery group; the initial 100 cases were classified as the initial group. We compared between the two groups and analyzed risk factors for postoperative complications. RESULTS: A total of 265 postoperative complications occurred in 223 patients (16.7%). Major complications occurred in 38 patients (2.9%) including 1 death (0.1%). Operative time and hospital stay were significantly shorter in the late group. Blood loss was greater in the initial group. Sex, comorbidity, tumor location, D2 LND, operative method, non B-I anastomosis, co-resection, long operative time, and blood loss were significant risk factors for overall postoperative complication. In the multivariate analysis, male sex, comorbidity, D2 lymph node dissection, total or proximal gastrectomy, non B-I anastomosis, co-resection, operative time and blood loss were associated with postoperative overall complications. CONCLUSION: Sex, co-morbidity, D2 LND, operative method, co-resection, operative time and blood loss revealed as the risk factor of overall postoperative complication. And there was no significant differences of risk factor related to postoperative complication between initial and maturation surgical period. This suggests that beginners also can safely perform laparoscopic gastrectomy through the appropriate patient selection.

Complications and Survival Rate of Patients Over 80 Years Old Who Underwent Laparoscopic Gastrectomy for Gastric Cancer

PURPOSE: As the life expectancy increases, the population of elderly patients increases. We evaluated the complications and survival rate of patients over 80 years old, who underwent laparoscopic gastrectomy. METHODS: A retrospective analysis was conducted for a total of 1,912 patients, who underwent surgery with stomach cancer from 2008 to 2016. We analyzed postoperative complications and the survival rate between the middle old (70~79, n=255) group and the very old (≥80, n=37) group. RESULTS: Among 1,912 patients, 255 people in the middle old group and 37 people within the very old group underwent laparoscopic gastrectomy. We confirmed that there was no significant difference except for the age (p<0.001) between the two groups. Overall complications were not statistically significantly different between the Middle old (70~79) group and the very old (≥80) group, 11.8% and 16.2%, respectively. There were also no statistically significant differences in severe complications beyond Clavien-Dindo classification Grade III. Risk factors for overall complications were higher in males than in females (p=0.002). Overall survival was statistically significantly lower with very old group (p<0.001). CONCLUSION: Laparoscopic gastrectomy in gastric cancer patients over 80 years of age is feasible and safe in terms of complications. However, considering the life expectancy, it seems necessary to pay attention to the patients who apply surgery.

Duodenal stump fistula after gastrectomy for gastric cancer: risk factors, prevention, and management

PURPOSE: A duodenal stump fistula is one of the most severe complications after gastrectomy for gastric cancer. We aimed to analyze the risk factors for this problem, and to identify the methods used for its prevention and management. METHODS: We retrospectively reviewed the clinical data of 716 consecutive patients who underwent curative gastrectomy with a duodenal stump for gastric cancer between 2008 and 2013. RESULTS: A duodenal stump fistula occurred in 16 patients (2.2%) and there were 2 deaths in this group. Univariate analysis revealed age >60 years (odds ratio [OR], 3.09; 95% confidence interval [CI], 0.99-9.66), multiple comorbidities (OR, 4.23; 95% CI, 1.50-11.92), clinical T stage (OR, 2.91; 95% CI, 1.045-8.10), and gastric outlet obstruction (OR, 8.64; 95% CI, 2.61-28.61) to be significant factors for developing a duodenal stump fistula. Multivariate analysis identified multiple comorbidities (OR, 3.92; 95% CI, 1.30-11.80) and gastric outlet obstruction (OR, 5.62; 95% CI, 1.45-21.71) as predictors of this complication. CONCLUSION: Multiple comorbidities and gastric outlet obstruction were the main risk factors for a duodenal stump fistula. Therefore, preventive methods and aggressive management should be applied for patients at high risk.

Evaluation of P-POSSUM as a Risk Prediction Model in Laparoscopic Gastrectomy of Elderly Patients with Gastric Cancer

PURPOSE: The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) is a validated scoring system for auditing surgical outcomes. However, evaluation of this system has primarily been applied to open surgical techniques. The present study demonstrates the validity of P-POSSUM in predicting morbidity and mortality in the treatment of elderly patients with gastric cancer who underwent curative laparoscopic gastrectomy. METHODS: All patients aged 70 years or over, who underwent curative laparoscopic gastrectomy between January 2014 and January 2015, were collected from our hospital database. A case-note review was used to collate data in terms of clinical and operative factors as described in P-POSSUM. Observed/Estimated ratio of morbidity and 30-day mortality were calculated. RESULTS: Laparoscopic gastrectomy was performed in 101 patients. The mean age was 74.9 years (70~83 years). A significant postoperative morbidity was observed in 20 (19.8%) of 101 patients. There was no 30-day mortality. Using exponential analysis, P-POSSUM predicted morbidity in 22 patients. Thus, O/E ratios for morbidity and mortality were 0.9 and 0, respectively. CONCLUSION: P-POSSUM scoring slightly overestimated predictions of morbidity and mortality. An assessment of its application to laparoscopic gastrectomy of elderly patients with gastric cancer merits further evaluation. Also, laparoscopic gastrectomy was a feasible and safe treatment for elderly patients in terms of P-POSSUM.

Risk factors for lymph node metastasis in mucosal gastric cancer and re-evaluation of endoscopic submucosal dissection

PURPOSE: The selection of the appropriate treatment strategy for patients with mucosal gastric cancer (MGC) remains controversial. In the present study, we aimed to determine the risk factors for lymph node (LN) metastasis in MGC and reassess the role of endoscopic submucosal dissection (ESD). METHODS: We examined 1,191 MGC patients who underwent curative gastrectomy between January 2005 and December 2014. We determined the clinicopathologic risk factors for LN metastasis among the MGC patients. RESULTS: Among 1,191 patients with MGC, 42 patients (3.5%) had LN metastasis. Univariate analysis indicated that age ≤ 50 years (P = 0.045), tumor invasion to the muscularis mucosa (P 2 cm (P = 0.014), presence of ulceration (P = 0.01), diffuse type as per Lauren classification (P = 0.005), and undifferentiated-type histology (P = 0.001) were associated with LN metastasis. Moreover, multivariate analysis indicated that tumor invasion to the muscularis mucosa (P = 0.001; odds ratio [OR], 4.909), presence of ulceration (P = 0.036; OR, 1.982), and undifferentiated-type histology (P = 0.025; OR, 4.233) were independent risk factors for LN metastasis. In particular, LN metastasis was observed in some MGC cases with indications for ESD, including absolute indications (1 of 179, 0.6%) and expanded indications (9 of 493, 1.8%). CONCLUSION: Although MGC patients can be treated via ESD, we recommend that they undergo a more aggressive treatment strategy if they have tumor invasion to the muscularis mucosa, ulceration, or undifferentiated-type histology in the final pathology report.

Risk factors for lymph node metastasis in mucosal gastric cancer and re-evaluation of endoscopic submucosal dissection

PURPOSE: The selection of the appropriate treatment strategy for patients with mucosal gastric cancer (MGC) remains controversial. In the present study, we aimed to determine the risk factors for lymph node (LN) metastasis in MGC and reassess the role of endoscopic submucosal dissection (ESD). METHODS: We examined 1,191 MGC patients who underwent curative gastrectomy between January 2005 and December 2014. We determined the clinicopathologic risk factors for LN metastasis among the MGC patients. RESULTS: Among 1,191 patients with MGC, 42 patients (3.5%) had LN metastasis. Univariate analysis indicated that age ≤ 50 years (P = 0.045), tumor invasion to the muscularis mucosa (P 2 cm (P = 0.014), presence of ulceration (P = 0.01), diffuse type as per Lauren classification (P = 0.005), and undifferentiated-type histology (P = 0.001) were associated with LN metastasis. Moreover, multivariate analysis indicated that tumor invasion to the muscularis mucosa (P = 0.001; odds ratio [OR], 4.909), presence of ulceration (P = 0.036; OR, 1.982), and undifferentiated-type histology (P = 0.025; OR, 4.233) were independent risk factors for LN metastasis. In particular, LN metastasis was observed in some MGC cases with indications for ESD, including absolute indications (1 of 179, 0.6%) and expanded indications (9 of 493, 1.8%). CONCLUSION: Although MGC patients can be treated via ESD, we recommend that they undergo a more aggressive treatment strategy if they have tumor invasion to the muscularis mucosa, ulceration, or undifferentiated-type histology in the final pathology report.

Necrotizing soft tissue infection: analysis of the factors related to mortality in 30 cases of a single institution for 5 years

PURPOSE: Necrotizing soft tissue infection is the infection of the soft tissue with necrotic changes. It is rare, but results in high mortality. We analyzed the characteristics of patients, prognosis, and mortality factors after reviewing 30 cases of a single hospital for 5 years. METHODS: From January 2009 to December 2013, 30 patients diagnosed with necrotizing fasciitis or Fournier's gangrene in Pusan National University Hospital were enrolled for this study. The following parameters were analyzed retrospectively: demographics, infection site, initial laboratory finding, initial antibiotics, isolated microorganisms, number of surgeries, time to first operation, length of intensive care unit, and total hospital stays. RESULTS: The overall mortality rate was 23.3%. Mean body mass index (BMI) of the survival group (24.7 ± 5.0 kg/m2) was significantly higher than the nonsurvival group (22.0 ± 1.4 kg/m2, P = 0.029). When BMI was less than 23 kg/m2, the mortality rate was significantly higher (P = 0.025). Two patients (6.7%) with chronic kidney disease requiring hemodialysis died (P = 0.048). Initial WBC count (>13×103/µL), CRP (>26.5 mg/dL), and platelet (PLT) count (27.6 mg/dL), serum creatinine (>1.2 mg/dL) that reflected kidney function were significant mortality factors. CONCLUSION: Patients with low BMI or abnormal values of WBC count, CRP, and PLT count reflecting the degree of infection or abnormal renal function will need more intensive care.

Necrotizing soft tissue infection: analysis of the factors related to mortality in 30 cases of a single institution for 5 years

PURPOSE: Necrotizing soft tissue infection is the infection of the soft tissue with necrotic changes. It is rare, but results in high mortality. We analyzed the characteristics of patients, prognosis, and mortality factors after reviewing 30 cases of a single hospital for 5 years. METHODS: From January 2009 to December 2013, 30 patients diagnosed with necrotizing fasciitis or Fournier's gangrene in Pusan National University Hospital were enrolled for this study. The following parameters were analyzed retrospectively: demographics, infection site, initial laboratory finding, initial antibiotics, isolated microorganisms, number of surgeries, time to first operation, length of intensive care unit, and total hospital stays. RESULTS: The overall mortality rate was 23.3%. Mean body mass index (BMI) of the survival group (24.7 ± 5.0 kg/m2) was significantly higher than the nonsurvival group (22.0 ± 1.4 kg/m2, P = 0.029). When BMI was less than 23 kg/m2, the mortality rate was significantly higher (P = 0.025). Two patients (6.7%) with chronic kidney disease requiring hemodialysis died (P = 0.048). Initial WBC count (>13×103/µL), CRP (>26.5 mg/dL), and platelet (PLT) count (27.6 mg/dL), serum creatinine (>1.2 mg/dL) that reflected kidney function were significant mortality factors. CONCLUSION: Patients with low BMI or abnormal values of WBC count, CRP, and PLT count reflecting the degree of infection or abnormal renal function will need more intensive care.

Effect of extramucin pools in gastric cancer patients

PURPOSE: Mucinous gastric adenocarcinoma (MGC) is defined by the World Health Organization as a gastric adenocarcinoma with >50% extracellular mucin pools within the tumors. In this study, we attempted to analyze the clinicopathologic features of patients pathologically diagnosed as gastric cancer with lower than 50% tumor volume of extracellular mucin pool adenocarcinoma (LEMPC). We compared MGC versus nonmucinous gastric adenocarcinoma (NMGC). We were used in abbreviations LEMPC for NMGC including extracellular mucin pool. METHODS: Files of 995 patients with gastric cancer NMGC (n = 935), MGC (n = 20), LEMPC (n = 40) who underwent curative resection at Pusan National University Yangsan Hospital from December 2008 to December 2013 were retrospectively analyzed. All pathologic reports after curative resection and evaluated clinicopathologic features were reviewed to identify the effect of extracellular mucin pools in gastric cancer. RESULTS: Compared with the NMGC patients, the clinicopathological features of MGC patients were as follows: more frequent open surgery, larger tumor size, more advanced T stage and N stage, more positive lymph node metastasis, and perineural invasion. LEMPC patients showed similar features compared with NMGC patients. MGC and LEMPC patients showed similar clinicopathological features, except T stage and lymph node metastasis. CONCLUSION: LEMPC can be thought of as a previous step of MGC. It is reasonable to consider LEMPC patients in the diagnostic criteria of MGC, and to adequately treat.

Ultimate Determination of P.F.C Femoral Prosthetic size in TKR for the Elderly Patients / 대한정형외과연구학회지

PURPOSE: To analyze the clinical and radiologic results after total knee arthroplasties using down-sizing femoral prosthesis for tight fitting in patients over 75 years old. SUBJECTS AND METHODS: The study tracked the histories of 99 elderly patients aged 75 and over who underwent total knee arthroplasties with at least five years of follow-up from January 1st, 2005 to December 31st, 2007. The average age of the 99 patients was 78.58 years, and 17 women an 82 men patients underwent 78 cases of total knee arthroplasties on the right and 77 cases of total knee arthroplasties on the left. The HSS score and VAS scoring systems were introduced for clinical analysis. We compared the results of the width of the radiolucent line in 7 sections around the femoral component, 7 sections around the tibia component and 5 sections in the patella component using the American Knee Society Radiographic Evaluation and Scoring system respectively. RESULT: The average period of postoperative follow-up study was 6.2 years. The average femoral prosthesis size in preoperative measurement was 2.41 while the size selected in surgery was 1.89. The average VAS score decreased from 8.15 in preoperative measurement to 2.85 in postoperative measurement. Clinical significant loosening or dislocation of femoral prosthesis was not observed. Although the radiolucent line was observed in 5 cases, the score was less than 4. CONCLUSION: Total knee arthroplasties using down-sizing femoral prosthesis does not increase osteolysis and dislocation of femoral prosthesis but does reduce pain and help patients return to normal activities. Therefore this study showed that total knee arthroplasties using down-sizing femoral prosthesis helped elderly patients aged 75 and over.

Single-incision intragastric resection for upper and mid gastric submucosal tumors: a case-series study

PURPOSE: Laparoscopic gastric wedge resection is a standard treatment for removing gastric submucosal tumors (SMTs). So far, however, there have been few reports of single-incision laparoscopic intragastric wedge resection. Our aim was to describe this procedure and our experience with it. METHODS: From January 2010 to December 2013, a total of 21 consecutive patients with gastric SMTs underwent single-incision intragastric resection at our institution. Their clinicopathologic data were analyzed retrospectively. RESULTS: The patients consisted of nine men and 12 women with a mean age of 51.9 +/- 12.9 years (22-69 years). Their mean body mass index was 22.6 +/- 2.0 kg/m2. Mean tumor size was 2.4 +/- 0.7 cm, with the following anatomic distribution: esophagogastric junction in three patients, fundus in twelve, upper body in three, and lower body in two. Mean operating time was 68.6 +/- 12.0 minutes. There were no conversions to open surgery and no major intraoperative complications. Time to resumption of water intake was 1.4 +/- 0.5 days. Mean hospital stay was 4.9 +/- 1.7 days. There were no recurrences or deaths during the mean 19-month follow-up. CONCLUSION: Single-incision intragastric wedge resection is a feasible and safe procedure. It is especially efficient for treating small endophytic gastric SMTs located on the upper and mid portion of the stomach.

Availability of Patella Resurfacing in Primary Total Knee Arthroplasty Through Evaluation and Analysis of the Patella in Revision Total Knee Arthroplasty / 대한정형외과연구학회지

PURPOSE: The aim of this study was to discuss about availability of patella resurfacing in primary total knee arthroplasty through evaluation and analysis of the patella in revision total knee arthroplasty. MATERIALS AND METHODS: The study was performed for 27 patients who could be followed up more than 12 months after having the revision TKA from March, 2004 to July 2008 among 105 patients (145 knees) who could be followed up more than 5 years after having primary TKA due to degenerative arthritis from 1989 to 1997. There were Group A (15 knees) which had patella resurfacing in revision TKA without patella resurfacing in primary TKA, Group B (12 knees) which had patella resurfacing in primary TKA, but didn't have patella resurfacing in revision TKA. There was difference of mean 11.2 years (6~15 years) between the time that the patients had primary TKA and the time that the patients had revision TKA. The patients consisted of 3 males and 24 females. The average age of the patients who had revision TKA was 76.2 years old (68~87). The Feller's patella score was used as clinical evaluation system after primary TKA, before and after revision TKA, and last follow-up. Ahlback's score was used by for the radiological evaluation of preoperative and postoperative outcome. And Outerbridge classification was used for the evaluation of group A which about wear of articular surface of patellofemoral joint in primary TKA and revision TKA, and positions of wear were classified. RESULTS: The Feller's patella score of group A, The outcome before revision TKA, 14.5 points, after 3 months TKA, 22.6 points, and 12 months follow-up, 24.2 points. The Feller's patella score of group B, The outcome before revision TKA, 24.2 points, after 3 months TKA, 24.3 points, and 12 months 24.8 points. The Ahlback score of group A decreased from 3.4 to 1.7 points, group B decreased from 1.6 to 1.5 points and group C decreased from 3.8 to 1.7 points. The Outerbridge classification of group A was mean 1.9 grade in primary TKA, and mean 3.6 grade in revision TKA. The wear of patella mainly occurred at medial facet. CONCLUSION: The patella resurfacing in primary TKA is considered as a useful treatment on the basis of these clinic and radiologic evaluation.

The Adequate Amount Irrigation After Cemented Total Knee Arthroplasty / 대한정형외과연구학회지

PURPOSE: We studied the adequate amount of pulse lavage irrigation for removal of polymethyl methacrylate (PMMA) and bone particles after cemented total knee arthroplasty. MATERIALS AND METHODS: A prospective study of 8 patients who received cemented total knee arthroplasty between March 2011 and November 2011, was done. The mean age of patients was 74.0 (range 65~84). After component implantation, the knees were lavaged with 10L of normal saline using pulsatile lavage; all fluid was collected in 1 liter using standard wall suction canisters. PMMA and bone particles within the irrigation fluids were quantitated by weight. RESULTS: The average of 413 mg/L (range, 71~999 mg/L) of particle debris was removed after cemented total knee arthroplasty with 1L of irrigation. Average of 230 mg/L (range, 51~432 mg/L), 112 mg/L (range, 32~185 mg/L), 48 mg/L (range, 21~125 mg/L), 47 mg/L (range, 10~120 mg/L), 45 mg/L (range, 5~140 mg/L), 49 mg/L (range, 0~110 mg/L), 46 mg/L (range, 0~107 mg/L), 50 mg/L (range, 5~85 mg/L), 41 mg/L (range, 3~68 mg/L) of debris was removed after the second, third ,fourth, fifth, sixth, seventh, eighth, ninth and tenth liter of pulse lavage irrigation respectively. Using analysis of variance testing, there was a statistically significant difference between the debris removed with 1L and until 4L irrigation (p=0.03). CONCLUSION: The bone debris and PMMA decreased as the amount of irrigation increased, especially most of remnants within more than 5L solution for irrigation were bone particles. 4L of irrigation through pulse lavage is appropriate for removing PMMA and bone particles after cemented total knee arthroplasty because a supplementary irrigation can cause a secondary bone loss.

The Adequate Amount Irrigation After Cemented Total Knee Arthroplasty / 대한정형외과연구학회지

PURPOSE: We studied the adequate amount of pulse lavage irrigation for removal of polymethyl methacrylate (PMMA) and bone particles after cemented total knee arthroplasty. MATERIALS AND METHODS: A prospective study of 8 patients who received cemented total knee arthroplasty between March 2011 and November 2011, was done. The mean age of patients was 74.0 (range 65~84). After component implantation, the knees were lavaged with 10L of normal saline using pulsatile lavage; all fluid was collected in 1 liter using standard wall suction canisters. PMMA and bone particles within the irrigation fluids were quantitated by weight. RESULTS: The average of 413 mg/L (range, 71~999 mg/L) of particle debris was removed after cemented total knee arthroplasty with 1L of irrigation. Average of 230 mg/L (range, 51~432 mg/L), 112 mg/L (range, 32~185 mg/L), 48 mg/L (range, 21~125 mg/L), 47 mg/L (range, 10~120 mg/L), 45 mg/L (range, 5~140 mg/L), 49 mg/L (range, 0~110 mg/L), 46 mg/L (range, 0~107 mg/L), 50 mg/L (range, 5~85 mg/L), 41 mg/L (range, 3~68 mg/L) of debris was removed after the second, third ,fourth, fifth, sixth, seventh, eighth, ninth and tenth liter of pulse lavage irrigation respectively. Using analysis of variance testing, there was a statistically significant difference between the debris removed with 1L and until 4L irrigation (p=0.03). CONCLUSION: The bone debris and PMMA decreased as the amount of irrigation increased, especially most of remnants within more than 5L solution for irrigation were bone particles. 4L of irrigation through pulse lavage is appropriate for removing PMMA and bone particles after cemented total knee arthroplasty because a supplementary irrigation can cause a secondary bone loss.

Risk Factors of Periprosthetic Fracture after Total Knee Arthroplasty

PURPOSE: To evaluate the incidence rate and risk factors for periprosthetic fracture after total knee replacement (TKR). MATERIALS AND METHODS: We carried out a retrospective case-control study of 596 patients (951 knees) who underwent TKR between 1999 and 2006 and who were followed up over 36 months. We classified patients into group I (study group) and group II (control group). We subdivided risk factors as pre-operative, intra-operative, and post-operative factors. Age, osteoporosis, revision arthroplasty, CVA, and alcohol dependence were categorized as pre-operative factors; anterior femoral notching and prosthetic types (mobile, fixed, and load-bearing) were considered intra-operative factors; and post-operative activity level was classified as a post-operative factor. We obtained information from the patients' charts, X-ray film, and telephone interviews. RESULTS: The overall incidence rate was 2.25%; 3 patients were male, and 18 were female (14.28% and 85.72%, respectively). Old age (p<0.01, odds ratio=1.14), osteoporosis (p=0.01, odds ratio=4.74), revision arthroplasty (p=0.01, odds ratio=7.46), CVA (p=0.02, odds ratio=8.55), and alcohol dependence (p=0.03, odds ratio=44.54) were statistically significant among the pre-operative factors. Among the intra-operative factors, anterior femoral notching (p<0.01, odds ratio=11.74) was significant, and continued heavy labor (p<0.01, odds ratio=8.14) was significant among the post-operative factors. CONCLUSION: We concluded that old age, osteoporosis, revision arthroplasty, comorbidity related with falling down, anterior femoral notching, and continued heavy labor were associated with periprosthetic fracture after TKR.

Revision Total Knee Arthroplasty Using the PFC Sigma Knee System

PURPOSE: We wanted to analyze the causes of revision and the clinical and radiographic results after revision total knee arthroplasty. MATERIALS AND METHODS: Thirty-eight knees in 34 patients underwent revision total knee arthroplasty using the PFC(R) Sigma revision system between March 1999 and May 2005. The average patient age was 71.2 years, and the average follow-up period was 6 years 7 months (range: 4 years~10 years 2 months). We evaluated the time interval between the primary and revision arthroplasty and the causes of revision. The clinical outcomes were assessed using the knee score and the functional score of the Knee Society Scoring system (KSS system), and the radiographic measurements were assessed using the roentgenographic method of the American Knee Society. RESULTS: The mean interval between primary and revision arthroplasty was 6 years 3 months. The causes of revision included 25 cases of aseptic loosening and osteolysis, 7 cases of infection, 3 cases of joint stiffness and 3 cases of polyethylene problems. At the follow up, the mean preoperative knee and functional scores improved from 45.1 points to 84.5 and 37.2 to 78.2, respectively. Radiographycally, the average femorotibial angle was corrected from 2.2degrees in valgus to 6.5degrees. The radiolucency score was below 4 in all the cases. The complications after revision arthroplasty were 2 cases of superficial infection and 1 case of wound dehiscence with a skin defect. CONCLUSION: The main causes of revision arthroplasty were aseptic loosening and osteolysis. Satisfactory results were obtained using the posterior cruciate ligament and substituting the PFC(R) Sigma knee system with appropriately selected metal augmentation and an allograft. This study showed favorable results on long term follow-up.

Bilateral Total Knee Arthroplasty using the Fixed Bearing Platform and the Rotating Platform in the Same Patient

PURPOSE: We wanted to evaluate the clinical and radiological results after total knee arthoplasty using the Press Fit Condylar (PFC) Sigma fixed bearing platform knee and the rotating platform knee in the same patient. MATERIALS AND METHODS: We enrolled 44 patients who had undergone bilateral total knee arthroplasties due to osteoarthritis of both knees from November 2001 to December 2004, using the fixed bearing platform and the rotating platform, respectively. The mean age of the study group was 71.5 years (range: 65~85 years). The mean follow up period was 74.3 months (range: 62~86 months). The clinical results were evaluated according to the knee score, the functional score, the presence of flexion contracture, the range of motion and the complications, and the visual analog scale system was used for the patients' satisfaction. The radiological results using the American Knee Society criteria and the tibiofemoral angle were also evaluated. RESULTS: The average knee score improved from 36.5 to 87.3 in the fixed bearing group and from 38.8 to 87.9 in the rotating platform group, respectively. The average functional score improved from 28.4 to 83.5 in the fixed bearing group and from 32.6 to 85.8 in the rotating platform group, respectively. The average range of knee motion improved from 85.5degrees to 115.5degrees in the fixed bearing group and from 86.6degrees to 116.8degrees in the rotating platform group. The average tibiofemoral angle improved from varus 8.2degrees to valgus 5.5degrees in the fixed bearing group and from varus 7.1degrees to valgus 5.3degrees in the rotating platform group. We did not observe any clinically significant osteolysis or wear. However, there were 3 cases of instability out of the 13 cases in rotating platform group, and this was accompanied by varus deformities of over 15 degree and 6 cases of friction sound during walking. CONCLUSION: We could find no clinical and radiological differences between the fixed bearing platform and the rotating platform in this study. However, we should regard the fixed bearing prosthesis as a good option for the patients with severe varus deformities, with considering performing bulky soft tissue release for obtaining a balanced gap, for preventing spin-out and to correct deformity.

Is Surgical Treatment Necessary after Non-curative Endoscopic Resection for Early Gastric Cancer?

PURPOSE: Additional surgery is commonly recommended in gastric cancer patients who have a high risk of lymph node metastasis or a positive resection margin after endoscopic resection. We conducted this study to determine factors related to residual cancer and to determine the appropriate treatment strategy. MATERIALS AND METHODS: A total of 28 patients who underwent curative gastrectomy due to non-curative endoscopic resection for early gastric cancer between January 2006 and June 2009 were enrolled in this study. Their clinicopathological findings were reviewed retrospectively and analyzed for residual cancer. RESULTS: Of the 28 patients, surgical specimens showed residual cancers in eight cases (28.6%) and lymph node metastasis in one case (3.8%). Based on results of the endoscopic resection method, the rate of residual cancer was significantly different between the en-bloc resection group (17.4%) and the piecemeal resection group (80.0%). The rate of residual cancer was significantly different between the diffuse type group (100%) and the intestinal type group (20%). The rate of residual cancer in the positive lateral margin group (25.0%) was significantly lower than that in the positive vertical margin group (33.3%) or in the positive lateral and vertical margin group (66.7%). CONCLUSIONS: We recommended that patients who were lateral and vertical margin positive, had a diffuse type, or underwent piecemeal endoscopic resection, should be treated by surgery. Minimal invasive procedures can be considered for patients who were lateral margin positive and intestinal type through histopathological examination after en-bloc endoscopic resection.