Next-generation sequencing of BRCA1/2 in breast cancer patients: potential effects on clinical decision-making using rapid, high-accuracy genetic results

PURPOSE: We evaluated the clinical role of rapid next-generation sequencing (NGS) for identifying BRCA1/2 mutations compared to traditional Sanger sequencing. METHODS: Twenty-four paired samples from 12 patients were analyzed in this prospective study to compare the performance of NGS to the Sanger method. Both NGS and Sanger sequencing were performed in 2 different laboratories using blood samples from patients with breast cancer. We then analyzed the accuracy of NGS in terms of variant calling and determining concordance rates of BRCA1/2 mutation detection. RESULTS: The overall concordance rate of BRCA1/2 mutation identification was 100%. Variants of unknown significance (VUS) were reported in two cases of BRCA1 and 3 cases of BRCA2 after Sanger sequencing, whereas NGS reported only 1 case of BRCA1 VUS, likely due to differences in reference databases used for mutation identification. The median turnaround time of Sanger sequencing was 22 days (range, 14–26 days), while the median time of NGS was only 6 days (range, 3–21 days). CONCLUSION: NGS yielded comparably accurate results to Sanger sequencing and in a much shorter time with respect to BRCA1/2 mutation identification. The shorter turnaround time and higher accuracy of NGS may help clinicians make more timely and informed decisions regarding surgery or neoadjuvant chemotherapy in patients with breast cancer.

Detection of Immunoglobulin Heavy Chain Gene Clonality by Next-Generation Sequencing for Minimal Residual Disease Monitoring in B-Lymphoblastic Leukemia

Minimal residual disease (MRD) following B-lymphoblastic leukemia (B-ALL) treatment has gained prognostic importance. Clonal immunoglobulin heavy chain (IGH) gene rearrangement is a useful follow-up marker in B-ALL owing to its high positivity rate. We evaluated the performance and clinical applicability of a next-generation sequencing (NGS) assay for IGH rearrangement in B-ALL MRD monitoring. IGH rearrangement was tested by using fluorescence PCR-fragment analysis and the NGS assay in eight B-ALL patients. The NGS assay was run on two platforms: the Ion Torrent PGM (Thermo Fisher Scientific, USA) (18 samples from 1st to 7th patients) and the MiSeq system (Illumina, USA) (four samples from 8th patient). All initial diagnostic samples and four follow-up samples were positive for clonal IGH rearrangement with fluorescence PCR-fragment analysis and the NGS assay, and six follow-up samples were positive only with NGS. In one case with BCR-ABL1 translocation, BCR-ABL1 quantitative PCR was negative but the NGS IGH assay was positive just prior to full-blown relapse, suggesting the high sensitivity and clinical utility of the NGS assay. The NGS assay is proposed for MRD monitoring in B-ALL Additional studies are needed to confirm the clinical implications of cases showing positive results only in NGS.

Effects of Neutralization by Soluble ABH Antigens Produced by Transplanted Kidneys From ABO-Incompatible Secretor Donors

BACKGROUND: Grafts survive despite blood group antigens on the transplant being continuously exposed to antibodies in the blood of recipients in ABO-incompatible kidney transplantation (ABOi KT), owing to the mechanism of accommodation. We analyzed the immunodynamics of soluble ABH antigens in allografts from secretor donors and the influence of such immunodynamics on accommodation and subsequent graft survival in ABOi KT. METHODS: The genotype of a known human β-galactoside α-1,2-fucosyltransferase gene (FUT2), which determines soluble ABH antigen secretor status, was established in 32 donors for ABOi KT at the Severance Hospital, from June 2010 to July 2015. Clinical outcomes of recipients, such as anti-A/B antibody titer change, renal function, and graft survival, were evaluated. RESULTS: Twenty-five donors were secretors (78.1%), and seven were nonsecretors (21.9%). The frequency of anti-A/B IgG or IgM antibody titer elevation or reduction post-transplantation was not significantly related to donor secretor status. However, IgM titer was rapidly reduced in recipients transplanted from nonsecretor donors (P=0.01), which could be explained by the lack of absorption effect of soluble antigens, enhancing the binding of antibodies to antigens in the allografts. Interestingly, soluble ABH antigens did not affect rejection-free graft survival, which may be due to the nature of β-galactoside α-1,2-fucosyltransferase. CONCLUSIONS: Soluble ABH antigens produced by transplanted kidneys from secretor donors played a role in inducing accommodation within three months of KT through neutralization; however, major graft outcomes were not affected.

Bone Marrow Chimerism Detection Using Next Generation Sequencing Based on Single Nucleotide Polymorphisms Following Liver Transplantation: Comparison With Short Tandem Repeat-PCR

No abstract available.

A Comparative Study of the Diagnostic Performance of the GENEDIA Avellino Corneal Dystrophy Mutation Detection Kit and Screening Master Mix and a Direct Sequencing Method to Detect Mutations in the TGFB1 Gene / 임상검사와정도관리

BACKGROUND: Mutations in the gene encoding transforming growth factor-beta induced (TGFBI) are associated with corneal dystrophies. We evaluated the diagnostic performance of the GENEDIA Avellino corneal dystrophy (ACD) mutation detection kit and GENEDIA corneal dystrophy screening master mix (Green Cross Medical Science Co., Korea) by comparing it with an in-house sequencing method. METHODS: The study group consisted of 40 patients with Avellino corneal dystrophy (ACD) and 40 patients suspected to suffer from ACD; 40 healthy individuals were used as the control. All samples used for this study were previously obtained. All results obtained using the kit were evaluated for sensitivity, specificity, and detection limit. RESULTS: The sensitivity of the GENEDIA ACD kit was 100.0% with a positive mean+/-2SD Ct (cycle threshold) value of 25.87+/-1.24 and an excellent coefficient of variation value of 0.02 in ACD group. All normal control samples were negative, indicating a specificity of 100% for the GENEDIA kit. The detection limit was set at a DNA concentration of >0.2 ng/microL. Direct sequencing results obtained using the GENEDIA master mix and the in-house method agreed for all 20 ACD samples. Additional R555W mutation detected in four ACD-suspected samples were suggestive of the diagnosis of granular corneal dystrophy type I. CONCLUSIONS: The GENEDIA ACD detection kit and master mix showed acceptable results, demonstrating high sensitivity and specificity, and may be considered for clinical application. Furthermore, the GENEDIA master mix was useful for the detection of mutations in exons 4 and 12 of the TGFBI gene.

Altered expression of gamma-secretase components in animal model of major depressive disorder induced by reserpine administration / 한국실험동물학회지

Altered expression of neurotrophic factors as well as neuroinflammation is commonly associated with Major depressive disorder (MDD) and Alzheimer's disease (AD). To investigate whether or not reserpine-induced MDD affects the expression of AD-related proteins, the expression of gamma-secretase components and substrate were measured in brains of ICR mice following reserpine treatment for 15 days. In active avoidance test, total response time and peak slightly increased in the 2 mg/kg reserpine (RSP2)-treated group compared to vehicle-treated group (P<0.05). Expression and phosphorylation of MKP-1, which is a key factor in MDD pathology, were both higher in the RSP2-treated group than the vehicle- and 1 mg/kg reserpine (RSP1)-treated groups (P<0.02). Furthermore, full-length expression of amyloid precursor protein (APP) was enhanced in the RSP1 and RSP2-treated groups compared to the vehicle-treated group, whereas expression of gamma-secretase components decreased (P<0.03). Among the three components of the gamma-secretase complex, nicastrin protein underwent the largest decrease in expression, as detected by Western blotting (P<0.03). Therefore, the data presented here provide additional evidence about the pathological correlation between MDD and AD.

Monitoring of antibiotic resistance in bacteria isolated from laboratory animals / 한국실험동물학회지

The drug resistance of microorganisms isolated from laboratory animals never treated with antibiotics is being reported consistently, while the number of laboratory animals used in medicine, pharmacy, veterinary medicine, agriculture, nutrition, and environmental and health science has increased rapidly in Korea. Therefore, this study examined the development of antimicrobial resistance in bacteria isolated from laboratory animals bred in Korea. A total of 443 isolates (7 species) containing 5 Sphingomonas paucimobilis, 206 Escherichia coli, 60 Staphylococcus aureus, 15 Staphylococcus epidermidis, 77 Enterococcus faecalis, 27 Citrobacter freundii, 35 Acinetobacter baumannii were collected from the nose, intestine, bronchus and reproductive organs of ICR mice and SD rats. Of these species, Acinetobacter baumannii and Enterococcus faecalis showed significant antimicrobial resistance according to the minimum inhibition concentration (MIC) in E-test. In case of Acinetobacter baumannii, several isolates showed MIC values 16-128 microg/mL for cefazolin and cefoxitin, and higher resistance (128-512 microg/mL) to nitrofurantoin than that of standard type. Resistance to cefazolin, cefoxitin and nitrofurantoin was detected in 17.14, 20.00, and 8.57% of the Acinetobacter baumannii isolates, respectively. In addition, 44.1% of the Enterococcus faecalis isolates collected from the laboratory animals were resistant to oxacillin concentration of 16-32 microg/mL range, while MIC value of standard type was below oxacillin concentration of 6 microg/mL. These results suggest that in rodent species of laboratory animals, Acinetobacter baumannii are resistance to cefazolin, cefoxitin and nitrofurantoin, whereas those of Enterococcus faecalis were resistance to oxacillin.

Effects of Red Liriope platyphylla on NGF secretion ability, NGF receptor signaling pathway and gamma-secretase components in NSE/hAPPsw transgenic mice expressing Alzheimer's Disease / 한국실험동물학회지

Liriope platyphylla (LP) has long been regarded as a curative herb for the treatment of diabetes, asthma, and neurodegenerative disorders. To examine the therapeutic effects of Red LP (RLP) manufactured by steaming process on neurodegenerative disorders, significant alteration of the key factors influencing Alzheimer's Disease (AD) was detected in NSE/hAPPsw transgenic (Tg) mice after RLP treatment. The concentration of nerve growth factor (NGF) in serum increased in RLP-treated NSE/hAPPsw Tg mice compared with vehicle-treated Tg mice. However, downstream effectors of the NGF receptor signaling pathway, including TrkA and p75NTR proteins, were suppressed in RLP-treated NSE/hAPPsw Tg mice. Especially, Tg mice showed decreased levels of TrkA, p75NTR, and RhoA expression. Production of Abeta-42 peptides was lower in RLP-treated NSE/hAPPsw Tg mice than in vehicle-treated Tg mice. Further, analysis of gamma-secretase components showed that Abeta-42 peptide expression was downregulated. Of the four components, the expression of APH-1 and Nicastrin (NCT) decreased in RLP-treated NSE/hAPPsw Tg mice, whereas expression of PS-2 and Pen-2 was maintained or increased within the same group. Overall, these results suggest that RLP can help relieve neurodegenerative diseases, especially AD, through upregulation of NGF secretion ability, activation of NGF signaling pathway, downregulation of Abeta-42 peptide deposition, and alteration of gamma-secretase components.

Aqueous extract of Liriope platyphylla, a traditional Chinese medicine, significantly inhibits abdominal fat accumulation and improves glucose regulation in OLETF type II diabetes model rats / 한국실험동물학회지

Liriope platyphylla is a medical herb that has long been used in Korea and China to treat cough, sputum, neurodegenerative disorders, obesity, and diabetes. The aims of this study were to determine the antidiabetic and antiobesity effects of aqueous extract of L. platyphylla (AEtLP) through glucose and lipid regulation in both pre-diabetes and obesity stage of type II diabetes model. Two concentrations of AEtLP were orally administrated to OLETF (Otsuka Long-Evans Tokushima Fatty) rats once a day for 2 weeks, after which changes in glucose metabolism and fat accumulation were measured. Abdominal fat mass dramatically decreased in AEtLP-treated OLETF rats, whereas glucose concentration slightly decreased in all AEtLP-treated rats. However, compared to vehicle-treated OLETF rats, only AEtLP10 (10% concentration)-treated OLETF rats displayed significant induction of insulin production, whereas AEtLP5 (5% concentration)-treated OLETF rats showed a lower level of insulin. Although serum adiponectin level increased in only AEtLP5-treated rats, significant alteration of lipid concentration was detected in AEtLP5-treated OLETF rats. Expression of Glut-1 decreased in all AEtLP-treated rats, whereas Akt phosphorylation increased only in AEtLP10-treated OLETF rats. Furthermore, the pattern of Glut-3 expression was very similar with that of Glut-1 expression, which roughly corresponded with the phosphorylation of c-Jun N-teminal kinase (JNK) and p38 in the mitogen-activated protein kinase pathway. Therefore, these findings suggest that AEtLP should be considered as a therapeutic candidate during pre-diabetes and obesity stage capable of inducing insulin secretion from pancreatic beta-cells, glucose uptake in liver cells, as well as a decrease in fat and lipid accumulation.

Toxicity of red Liriope platyphylla manufactured by steaming process on liver and kidney organs of ICR mice / 한국실험동물학회지

Red Liriope platyphylla (RLP) produced by steaming process has been reported to enhance the secretion of insulin and nerve growth factor (NGF). However, there has been no report on the toxicity of RLP in the specific organs of mice. To investigate the toxic effect of RLP, we tried to observe a significant alteration on body weight, food/water intake, organ weight, liver pathology and kidney pathology in female ICR mice received 12.5, 25.0 and 50.0 mg/kg body weight/day of RLP via gavage for 10 days. Out of seven organs including brain, heart, lung, liver, kidney, spleen and ovary, two organs (heart and lung) showed significantly decreased weights in the medium dosage RLP-treated group, whereas weights of other organs were maintained at constant levels in all dosage groups. In the liver toxicity analysis, no significant increase of alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate amino-transferase (AST) were detected in any RLP-treated group compared to vehicle-treated group. The specific pathological changes induced by most of toxic compounds were not observed in the liver in microscopic examination. Furthermore, in the kidney toxicological analysis, a significant enhancement of the blood urea nitrogen (BUN) concentration was detected in the high dosage RLP-treated group compared to the vehicle-treated group. However, the serum creatinine (CA) concentration on the serum biochemistry as well as the pathological changes in microscopic examination were not significantly different between the vehicle- and RLP-treated groups. Therefore, these results suggest that RLP does not induce any specific toxicity in liver or kidney tissues of mice, although the BUN level slightly increased in 50.0 mg/kg of RLP-treated group.

Peroxiredoxin I regulates the component expression of gamma-secretase complex causing the Alzheimer's disease / 한국실험동물학회지

Peroxiredoxin I (Prx I) is a member of the peroxiredoxins (Prxs) family, which are antioxidant enzymes that regulate various cellular process via intracellular oxidative signal pathways. In order to investigate the correlation between Prx I and the gamma-secretase complex, which causes Alzheimer's disease (AD), the expression level of Prx I was firstly evaluated in an animal model for AD. NSE/hPen-2 transgenic (Tg) mice, which were used as animal model in this study, showed a high level of Pen-2 expression and accumulation of Abeta-42 peptides in the hippocampus of brain. The expression level of Prx I was significantly higher on the mRNA and protein level in the brain of this model, while not change in Prx VI expression was observed. Furthermore, to verify the effect of Prx I on the gamma-secretase components in vitro, the expression level of these components was analyzed in the Prx I transfectants. Of the components of the gamma-secretase complex, the expression of PS-2 and Pen-2 was lower in the transfectants overexpressing Prx I compared to the vector transfectants. However, the expression of APP, NCT and APH-1 did not change in Prx I transfectants. Therefore, these results suggested that the expression of Prx I may be induced by the accumulation of Abeta-42 peptides and the overexpression of Prx I in neuroblastoma cells may regulate the expression of gamma-secretase components.

Overexpression of Insulin Degrading Enzyme could Greatly Contribute to Insulin Down-regulation Induced by Short-Term Swimming Exercise / 한국실험동물학회지

Exercise training is highly correlated with the reduced glucose-stimulated insulin secretion (GSIS), although it enhanced insulin sensitivity, glucose uptake and glucose transporter expression to reduce severity of diabetic symptoms. This study investigated the impact of short-term swimming exercise on insulin regulation in the Goto-Kakizaki (GK) rat as a non-obese model of non-insulin-dependent diabetes mellitus. Wistar (W/S) and GK rats were trained 2 hours daily with the swimming exercise for 4 weeks, and then the changes in the metabolism of insulin and glucose were assessed. Body weight was markedly decreased in the exercised GK rats compare to their non-exercised counterpart, while W/S rats did not show any exercise-related changes. Glucose concentration was not changed by exercise, although impaired glucose tolerance was improved in GK rats 120 min after glucose injection. However, insulin concentration was decreased by swimming exercise as in the decrease of GSIS after running exercise. To identify the other cause for exercise-induced insulin down-regulation, the changes in the levels of key factors involved in insulin production (C-peptide) and clearance (insulin-degrading enzyme; IDE) were measured in W/S and GK rats. The C-peptide level was maintained while IDE expression increased markedly. Therefore, these results showed that insulin down-regulation induced by short-term swimming exercise likely attributes to enhanced insulin clearance via IDE over-expression than by altered insulin production.

Effects of Steaming Time and Frequency for Manufactured Red Liriope platyphylla on the Insulin Secretion Ability and Insulin Receptor Signaling Pathway / 한국실험동물학회지

In oriental medicine, Liriope platyphylla (LP) has long been regarded as a curative herb useful for the treatment of diabetes, asthma, and neurodegenerative disorders. The principal objective of this study was to assess the effects of steaming time and frequency for manufactured Red LP (RLP) on insulin secretion ability and insulin receptor signaling pathway. To achieve our goal, several types of LPs manufactured under different conditions were applied to INS cells and streptozotocin (STZ)-induced diabetic ICR mice, after which alterations in insulin concentrations were detected in the culture supernatants and sera. The optimal concentration for the investigation of insulin secretion ability was found to be 50 ug/mL of LP. At this concentration, maximum insulin secretion was observed in the INS cells treated with LP extract steamed for 3 h (3-SLP) with two repeated steps (3 h steaming and 24 h air-dried) carried out 9 times (9-SALP); no significant changes in viability were detected in any of the treated cells. Additionally, the expression and phosphorylation levels of most components in the insulin receptor signaling pathway were increased significantly in the majority of cells treated with steaming-processed LP as compared to the cells treated with LP prepared without steaming. With regard to glucose transporter (GLUT) expression, alterations of steaming time induced similar responses on the expression levels of GLUT-2 and GLUT-3. However, differences in steaming frequency were also shown to induce dose-dependent responses in the expression level of GLUT-2 only; no significant differences in GLUT-3 expression were detected under these conditions. Furthermore, these responses observed in vitro were similarly detected in STZ-induced diabetic mice. 24-SLP and 9-SALP treatment applied for 14 days induced the down-regulation of glucose concentration and upregulation of insulin concentration. Therefore, these results indicated that the steaming processed LP may contribute to the relief of diabetes symptoms and should be regarded as an excellent candidate for a diabetes treatment.

Are Risk Factors for Failure after Mid-Urethral Sling Operation Different between Patients with Pure Stress and Those with Mixed Urinary Incontinence in the Short-Term Follow-Up?

PURPOSE: Although application of the mid-urethral sling (MUS) operation has expanded to more complicated cases such as patients with mixed urinary incontinence (MUI), the success rates in patients with MUI have been reported to be lower than those in patients with pure stress urinary incontinence (SUI). We evaluated and compared the risk factors for failure after MUS surgery in patients with pure SUI and in those with MUI. MATERIALS AND METHODS: Two hundred twenty-eight women were categorized as having pure SUI (Group A, 163 patients) or MUI (Group B, 65 patients). Preoperative evaluations including a symptom questionnaire, physical examination, and urodynamic study were performed. Patients underwent retropubic (17.5%) or trans-obturator (82.5%) MUS surgery. RESULTS: The demographic characteristics that differed between the 2 groups were body mass index, presence of cystocele, and severity of incontinence. The success rate in Group A (95.7%) was higher than that in Group B (84.6%) (p=0.015, chi-square test). In Group A, VLPP, PdetQmax, and weight of the 1-hour pad test were identified as risk factors for failure of the operation in the univariate analysis, but only weight of the 1-hour pad test was an independent risk factor in the multivariate analysis (adjusted odds ratio [OR]=3.5; 95% confidence interval [CI]=1.204-8.895, p=0.045). In Group B, menopause without hormone replacement, AUA Symptom Index-QoL score, maximal cystometric capacity (MCC), and involuntary detrusor contraction (IDC) were the risk factors in the univariate analysis, but only MCC (adjusted OR=0.9; 95% CI=0.645-0.984, p=0.032) and IDC (adjusted OR=2.3; 95% CI=1.014-3.309, p=0.044) were independent risk factors in the multivariate analysis. CONCLUSIONS: Unlike in pure SUI, weight of the 1-hour pad test was not a significant predictor of failure of surgery in MUI. Meanwhile, MCC and IDC, which indicate the pathophysiologic status of the detrusor muscle itself, were important predictors of failure of surgery in MUI.

Targeted Therapy in Metastatic Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: To evaluate the efficacy and safety of targeted therapy in patients with metastatic renal cell carcinoma. MATERIALS AND METHODS: In this retrospective analysis, 43 consecutive patients with metastatic renal cell carcinoma received targeted therapy between December 2005 and December 2007. All patients underwent radical nephrectomy. Twenty-two patients received targeted therapy as a first-line treatment and 21 as a second-line treatment. RESULTS: The median follow-up duration after radical nephrectomy and after the initiation of targeted therapy was 87 and 14 months, respectively. The initial response rate was 74.4% (partial response 37.2%, stable disease 37.2%) and the last response rate was 34.9% (partial response 4.7%, stable disease 30.2%). The median survival was 17 months (95% confidence interval (CI), 11.6-22.4) and the median progression-free survival was 10 months (95% CI, 7.5-12.5). Eleven patients (50%) with synchronous metastasis and 3 (14.3%) with metachronous metastasis died from renal cell carcinoma (p=0.023), but there was no significant difference in terms of median survival (15 months vs. longer than 14 months, p=0.210). Also, there was a significant difference in the overall mortality of the MSKCC risk groups (13.3% vs. 44.4%, p=0.049), but no significant difference in median survival (longer than 14 months vs. 15 months, p=0.236). CONCLUSIONS: Targeted therapy shows promising clinical activity in patients with metastatic renal cell carcinoma. Time to metastasis and MSKCC risk group may be associated with overall survival, and the prognostic implications of those factors should be analyzed in further prospective studies.

Laparoscopic Radical Prostatectomy: Learning Curves for Surgical, Oncological, and Functional Outcome

PURPOSE: We report our experience with laparoscopic radical prostatectomy (LRP) and investigate the learning curves for various outcome variables for LRP. MATERIALS AND METHODS: From January 2005 to March 2008, 47 patients with prostate cancer with a clinical stage < or =T3a underwent LRP by a single surgeon. We retrospectively reviewed the medical records of the patients regarding to the surgical, oncological, and functional outcomes. RESULTS: The median follow-up for the entire group was 38 months (18-49). In surgical outcomes, the operative time was decreased to less than 300 minutes after 5 cases and the estimated blood loss was stabilized after 30 cases. The positive surgical margin rate was decreased within the first 30 cases, but not significantly so. For functional outcomes, the urinary continence rates at 1 month, 3 months, 6 months, and 1 year postoperatively were 17.0%, 53.2%, 72.3%, and 80.9%, respectively. Neurovascular bundle saving was performed in 11 cases (23.4%). In cases of neurovascular bundle saving, the potency rates at 3 months, 6 months, and 1 year postoperatively were 27.3%, 27.3%, and 54.5%, respectively. Analysis of the learning curve for functional outcome revealed no statistical differences in the continence rate or potency rate with time. CONCLUSIONS: In the present study, the learning curve for operative time was overcome within the first 5 cases, and estimated blood loss took 30 cases to reach a plateau. The longest learning curve was for functional outcomes such as continence and potency, which did not stabilize until 47 cases.

A Case of Buried Bumper Syndrome Replaced by Endoscopic Management / 대한소화기내시경학회지

Percutaneous endoscopic gastrostomy (PEG) is used for nutritional support to the patients who cannot maintain the adequate oral intake. Compared with operative gastrostomy, PEG is a safe, rapid, and less expensive technique. Among several complications, buried bumper syndrome is a late complication in which internal bumper erodes into the gastric wall or migrates into the abdominal wall due to improper compression to the gastric wall. We here report a patient with peritubular leakage, resistance of tube feeding, and abdominal pain which were developed 13 months after percutaneous endoscopic gastrostomy. On endoscopic examination, the gastrostomy lumen could not be found. The gastrostomy tube was replaced successfully to new one with single procedure endoscopic technique. No complication was occurred and the function of tube has been well preserved.

Radiological Analysis of the Tapered Femoral Stem after Cementless Hip Arthroplasty: Minimum 5 years follow-up / 대한정형외과학회잡지

PURPOSE: We reviewed radiological mid-term results of cementless hip replacement using Mallory-Head tapered titanium femoral stem. MATERIALS AND METHODS: Forty six patients, 50 hips were followed for more than 5 years. Mean age was 56 years, and mean follow-up period was 6.8 years. Radiologically changes in alignment, subsidence and wear rate were measured. Radiolucent line, endosteal spot weld and osteolysis were also assessed according to Gruen zones. RESULTS: All stems showed stable fixation, and radiolucent lines were observed in noncoated zones of 13 cases (26%) . Osteolysis was observed around the proximal stem in 16 cases (32%) , but it did not progress distally. CONCLUSION: With minimum follow-up of 5 years, the tapered titanium femoral stem showed good radiological results, however osteolysis needs more long-term follow-up.

Preliminary Results of Uncemented Metal on Metal Total Hip Replacement Arthroplasty / 대한정형외과학회잡지

Particulate wear debris(polyethylene, polymethylmethacrylate and metal particles, or combination of these) can initiate aseptic loosening. To eliminate polyethylene debris and reduce the total amount of wear, metal on metal bearings(Metasul) which were made of a wrought Co-28Cr-6Mo-0.2C alloy, were introduced. From May 1994 total hip replacements using a Metasul metal on metal articulation were performed by the authors. 34 patients with 40 hips with minimum follow-ups during 24 months were analysed in this study. The mean follow up period was 31 months(ranging from 24 to 47 months). We used Armor cups and standard cups as acetabular comporients and SL stems, CLS stems and cone stems as femoral components. Preoperative average Harris hip score of 48 points became postoperatively 93(from minimum 81 to maximum 100). And there were slight and occasional thigh pains in 2 cases(5%). There were no revisions for the early aseptic loosening of femoral stems or stem failures. Radiologic evaluation which revealed mild calcar atrophy was developed in 33 cases(82.5%), revealing cortical hypertrophy in 10 cases(25%). Osteolysis was not noted around the prosthetic stem nor around the cup. Radiolucent lines were found in 9 cases of femoral components(22.5%) and in 1 case of acetabular component(2.5%) and subsidence of more than 3mm in 1 case of femoral components(2.5%) were also found. There was 1 case of definitive loosening of acetabular component(2.5%). These also showed that endosteal bone formation adjacent to femoral prosthesis was developed in 22 cases(55%) but no distal pedestal and stem shift occurred. The short-term but satisfactory results of the contemporary metal on metal articulation investigated in this study were encouraging and warrant continued study.

Modular Hemiarthroplasty for the Treatment of Complex Fractures of the Proximal Humerus / 대한정형외과학회잡지

From 1993 to 1996, we have used a new modular shoulder prosthesis for the treatment of acute complex fracture of the proximal humerus. The purpose of this study is to evaluate function, pain relief, and patient satisfaction after moduiar hemiarthroplasty for proximal humerus fractures. The stucly included 12 patients (J2 shoulders) with an average age of 68.5 years (range, 60 to 84 years). According to the Neer classification system, there were 3 four-part fracture-dislocations, 5 four-part fractures, 3 three-part fractures, and #I head splitting fracture. 'fhe hemiarthroplasty was pert'ormed at an average of 4 days (range, 3 to 10 days) following injury. Deltopectoral approach was used in all patients, and the prostheses were implanted with cement in ten cases. Follow-up evaluation, at an average of 32 months post-surgery, included clinical and radio- graphic examination. Active forward elevation averaged 120 degrees; external rotation, 35 degrees; and internal rotation, to the first lumbar vertebra. All of patients, except two who had poor results, were graded as good or excellent according to UCLA shoulder rating scale. Complications consisted of one tuberosity dispiacement, one peri-operative death and one loosening of uncemented humeral prosthesis. We concluded that Modular hemiarthroplasty for acute complex fracture of the proximal humerus especially in severely osteoporotic elderly patients facilitated the restoration of humeral length, anatomic repositioning of tuberosities, and precise soft tissue balance, thereby allowing earliermotion to prevent the developement of painful shoulder stiffness.