Prognosis of Breast Cancer Patients with Ten or More Positive Lymph Nodes

PURPOSE: The most important prognostic factor in patients with operable breast cancer is lymph node involvement. The 6th edition of AJCC categorizes metastasis to more than 10 nodes as N3, or stage IIIc. Such patients have a high risk of recurrence and death. The purpose of this study was to evaluate the prognosis of these N3 patients. METHODS: Between 1991 and 2004, 141 patients with 10 or more positive lymph nodes were treated at our institution, and we retrospectively reviewed their medical records. We analyzed patient age, tumor size, number of metastatic lymph nodes, hormone receptor status, C-erb-B2 status, and treatment modality. Survival was calculated using the Kaplan-Meier method on SPSS 12.0 software. RESULTS: The median follow-up duration was 55.0 months (range 3~182 months); 78 patients had recurrence, and 44 patients died. The 5-year disease-free survival and 5-year overall survival rates were 49.4% and 64.6%, respectively. The only prognostic factor for disease-free survival was tumor size. In patients with tumors less than 2 cm in size, the 5-year disease-free survival was 68.9%, while the 5-year disease-free survival was 27.7% in patients with tumors larger than 5 cm. Hormonal receptor status, C-erb-B2 status, number of metastatic lymph nodes, and treatment modality were statistically insignificant in predicting disease-free survival. None of these factors was significant for predicting overall survival, either. CONCLUSION: The 5-year disease-free survival rate was 49.4%, and it was influenced only by tumor size. Adjuvant chemotherapy and adjuvant radiotherapy were not independent factors predicting survival. Early breast tumor detection is important in N3 breast cancer patients.

A Comparative Study of Trochanteric Fractures Treated with the Intertrochanteric/subtrochanteric Fixation or the Proximal Femoral Nail

PURPOSE: To evaluate the radiographic, clinical results and the complications between who had intertrochanteric fracture, treated with the ITST or the PFN. MATERIALS AND METHODS: We selected each 30 patients of intertrochanteric fracture which were treated with ITST or PFN from July 2002 to November 2005. We evaluated the radiographic results by follow-up radiography and the clinical results with the mobility score of Parker and Palmer, Salvati and Wilson hip function scoring system and Jensen index. RESULTS: The mean distance of lag screw sliding was 4.1 mm at the ITST group and 6.6 mm at the PFN group. Decrease of mobility score of Parker and Palmer, Salvati and Wilson hip function score were similar. Patients complaint pain over lateral thigh area in 5 cases (ITST group) and 8 cases (PFN group). CONCLUSION: The ITST nail and PFN were seen good results in treatment of stable and unstable intertrochanteric fracture.

Osteoprotegerin and Osteoprotegerin Ligand Expression in the Periprosthetic Tissue of Failed Hip Prosthesis / 대한정형외과학회잡지

PURPOSE: To investigate the pathogenesis of articular prosthesis osteolysis, and to clarify the role of OPG, RANKL and RANK on osteolysis in aseptic loosening of hip prostheses. MATERIALS AND METHODS: We examined the mRNAs of OPG, RANKL and RANK from cultured peripheral mononuclear cells and the tissue surrounding failed hip prostheses by RT-PCR and gel electrophoresis and performed immunohistochemistry for RANKL and RANK in the periprosthetic tissue of revised hip replacement therapy. RESULTS: RANKL was detected in 32% and RANK was detected in 20% of the periprosthetic tissues of failed hip prostheses. Proliferative responses of cultured PBMCs occurred in cells with the titanium, cobalt and LPS, and highest response was observed in cells with cobalt particles. The mRNAs of RANKL and OPG were expressed in the periprosthetic tissues of loosened hip prostheses, but RANK mRNA was not detected. OPG mRNA was not detected in cultured PBMCs with any particles, RANKL mRNA was detected in cultured PBMCs with titanium and cobalt particles by RT-PCR, and RANK mRNA was detected in PBMCs with cobalt particles, but not with titanium. CONCLUSION: Osteolysis around the failed hip prosthesis may be related to activation of the OPG-ANKLRANK system. It is suggested that OPG, RANKL and RANK are major mediators of osteolysis in failed hip prosthesis.

The Usefulness of 0.5 %-Methylcellulous as Oral Contrast Agent: In Subtotal Gastrectomy Patients

PURPOSE: To assess the usefulness of 0.5 %-methylcellulose as oral contrast agent in spiral CT examinationsfor the evaluation of anastomotic site and remnant stomach in patients who have undergone subtotal gastrectomy dueto stomach cancer. MATERIALS AND METHODS: Twenty-seven patients who underwent subtotal gastrectomy for stomachcancer and were referred for the evaluation of anastomosis recurrence and lymph node metastasis wereprosepectively analyzed by spiral CT. They were divided into two groups: before scanning, group A patients drank0.5 %-methylcellulous 500ml as oral contrast agent, while those in group B drank diluted gastrografin 500ml. Threepatients were examined twice. Anatomic delineation of the anastomosis site was graded by two radiologists asexcellent (3), good (2), fair (1), or poor (0). To evaluate the degree of distension, maximal transverse andanterior-posterior diameter of remnant stomach and anastomotic sites were measured. RESULTS: In Group A, anatomicdelineation of the anastomotic site was very much better than in group B (mean score: 2.93 vs 1.80, p<0.05). Inaddition, the maximum diameters of remnant stomach and anastomotic site were significantly larger in group A thanin group B (transverse A-P remnant stomach and anastomosis site: 87.5 +/-14.7mm, 103.3 +/-20.1mm, 17.6 +/-2.9mm vs57.6 +/-20.1mm, 69.9 +/-3 5 . 0 m m , 10.7 +/-7 . 2 m m ) CONCLUSION: In patients who had undergone subtotalgastrectomy, the use of 0.5 %-methylcellulose as oral contrast agent for spiral CT showed excellent anatomicdelineation of the anastomotic site and distension of remnant stomach.

Magnetic Resonance Imaging of Radiographically Negative Avascular Necrosis of the Femoral Head / 대한정형외과학회잡지

Magnetic resonance imaging has been recognized as more suitable method than radiography and bone scan for the early detection of avascular necrosis of the femoral head. Segmental collapse is the most important factor in the prognosis of patient with avascular necrosis. The authors studied the appearance of avascular necrosis with both radiography and magnetic resonance imaging and then determined which lesions remained unchanged, progressed or led to collapse, as determined wih follow-up radiography in the 61 radiographically negative avascular necrosis of the femoral heads. 1. The necrosis-progression rates according to the extent were 36% in Extent A, 83% in Extent B, and 93% in Extent C. The necrosis-progression rate was significantly correlated with the extent of necrosis initially involved. 2. The necrosis-progression rates according to the location were 37% in Type I, 70% in Type II, and 95% in Type III. The necrosis-progression rate was significantly correlated with the weight bearing area of necrosis initially involved. 3. There was no correlation between necrosis-progression rate and signal intensity. 4.All of the cases which had combinations of the Extent C, and Type III location showed progression. 5. None of the femoral heads that had been treated at the radiographically negative stage was collapsed, but 35% of the femoral heads those had been treated at the radiographically positive stage were collapsed. 6. In the cases which were treated early, all of the Extent C, Type III were collapsed, but none of the Extent A, Type I were collapsed. In conclusion, magnetic resonance imaging is useful for evaluation of the risk of collapse or for anticipation of the prognosis of the affected hip joint as well as for the early diagnosis of radiographically negative avasular necrosis of the femoral head.

Problems in the Treatment of Patients with Ankylosing Spondylitis

The characteristic pathological lesions in ankylosing spondylitis are vertebral body osteoporosis, ankylosis of the apophyseal joints, intervertebral disc calcification, and ligamentous ossification. Calcification of the annulus fibrosis reduces the movement and elasticity of the intervertebral disc, causing this point to be the site of least resistance when the spine is subjected to trauma. The rigid spine may secondarily develop osteoporosis, further increasing the risk of spinal fracture. The ligamentous fragility and multiple fused vertebral segments cause the fractured ankylosing spondylitic spine to resemble a long-bone fracture. In ankylosing spondylitis patient who have sustained minor trauma, a complete radiological study of the entire spine and not just the symptomatic region must be performed for an accurate diagnosis, so that any fracture possible along the spine can be detected and thus prevent any medicolegal problems. The authors report 4 cases of ankylosing spondylitis including 2 cases with severe neurological abnormalities that had occurred after minor trauma.

Bone mineral density and fracture threshold in the patients with femoral neck & intertrochanteric fractures due to osteoporosis / 대한정형외과학회잡지

No abstract available.

Effect of natibiotic-impregnated bone cement in total knee arthroplasty / 대한정형외과학회잡지

No abstract available.

A clinical analysis about VSP plate fixation combined with posterior lumbar interbody fusion / 대한정형외과학회잡지

No abstract available.

The Development of the Ruminal Ulcer in the Albino Rats Fed with Low Protein Diet associated with Rocking Stress

The pathological changes of the gastric rumen produced by rocking stress in 38 young male albino rats fed on low protein diet for a short period and in 20 young male albino rats fed on low protein diet only as the control rats, were investigated macroscopically and histologically. The ulcerative lesions of the gastric rumen were observed in 17 out of 38 experimental rats accompanied with hyperplasia and cornification of the ruminal epithelial layer and more or less edematous changes of the tunica propria near the ulcer site. The authors, finding of the ruminal ulcer in albino rats produced by rocking stress associated with feeding on a low protein diet for a short period were compared with the results of others. The authors discussed other opinions concerning of the gastric ruminal ulcer of the albino rats produced in various ways.