Plasma Cell Myeloma Initially Presenting as Lung Cancer

No abstract available.

Transglutaminase 2 Expression Predicts Progression Free Survival in Non-Small Cell Lung Cancer Patients Treated with Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor

Transglutaminase 2 (TG2), a cross-linking enzyme, is involved in drug resistance and in the constitutive activation of nuclear factor kappa B (NF-kappaB). We investigated the association of non-small cell lung cancer (NSCLC) treatment efficacy with TG2 and NF-kappaB expression in 120 patients: 102 with adenocarcinoma and 18 with other histologic types. All patients underwent surgery; 88 received adjuvant chemotherapy, with 28 receiving platinum-based doublet chemotherapy as first-line treatment and 29 receiving epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) therapy. Patients' TG2 and NF-kappaB expression values were calculated semiquantitatively. The median TG2 value was 50 (range, 0-300) and the median NF-kappaB value was 20 (range, 0-240). Disease-free survival did not differ between the low- and high-TG2 groups. Among patients who received palliative platinum-based doublet chemotherapy, progression free survival (PFS) was longer in the low-TG2 group than in the high-TG2 group (11.0 vs. 7.0 months; P=0.330). Among those who received EGFR-TKI therapy, PFS was also longer in the low-TG2 group than in the high-TG 2 group (11.0 vs. 2.0 months; P=0.013). Similarly, in EGFR wild-type patients treated with EGFR-TKI, PFS was longer in patients with low TG2 expression (9.0 vs. 2.0 months; P=0.013). TG2 expression levels can predict PFS in patients with NSCLC treated with EGFR-TKI.

Comparison of the Clinical Outcomes after Total Knee Arthroplasty with the LCS Rotating Platform Mobile Bearing Knee System and the PFC Sigma RP-F Mobile Bearing Knee System

BACKGROUND: We compared clinical outcomes after total knee arthroplasty with the Low Contact Stress (LCS) rotating platform mobile bearing knee system and the Press Fit Condylar Sigma rotating platform high flexion (PFC Sigma RP-F) mobile bearing knee system. METHODS: Fifty cases of total knee arthroplasty were performed with the PFC Sigma RP-F mobile bearing knee system and sixty-one cases were performed with the LCS mobile bearing total knee arthroplasty. The average duration of follow-up was 2.9 years. RESULTS: The mean Hospital for Special Surgery (HSS) knee score was 62.1 (range, 52 to 75) in the LCS group and 61.9 (range, 50 to 74) in the Sigma RP-F group preoperatively, and 90.1 (range, 84 to 100) in the LCS group and 89.8 (range, 83 to 100) in the Sigma RP-F group at the final follow-up. The mean preoperative flexion contracture was 6.7degrees (range, 0degrees to 10degrees) in the LCS group and 9.3degrees (range, 0degrees to 15degrees) in the Sigma RP-F group preoperatively. The mean range of motion was 124.6degrees (range, 105degrees to 150degrees) in the LCS group and 126.1degrees (range, 104degrees to 145degrees) in the Sigma RP-F group at the final follow-up. CONCLUSIONS: After a minimum duration of follow-up of two years, we found no significant differences between the two groups with regard to the range of knee motion or the clinical or radiographic results.

Letter to the Editor: Detection of EML4-ALK and Other ALK Fusion Genes in Lung Cancer: A Lesson from the Leukemia Fusion Gene Analysis and Future Application

No abstract available.

Accuracy of Inter Femoral Head Center Distance Measurement and Evaluation for Coronal Alignment of Femoral Component during Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: Alignment is an important factor in the long-term success of total knee arthroplasty. In the total knee arthroplasty, the conventional extramedullary femoral alignment system has significant error in femoral coronal alignment, since it is difficult to find the femoral head center and it is time consuming to determine during the operation. The purpose of our study was to evaluate the accuracy of the newly-designed marker system for extramedullary femoral alignment that uses radiologic distance between the 2 femoral head centers. MATERIALS AND METHODS: Between July 2008 and July 2009, 90 patients (100 knees) with knee osteoarthritis underwent total knee arthroplasty using the femoral extramedullary femoral guide system. We measured the distance between the femoral head centers using the radiologic picture archiving and communication system (PACS, General Electric, Milwaukee, WI) system preoperatively, then plastic rods and metal pegs were used to simulate the inter femoral head center distance. By placing the center of the plastic rod after marking the inter femoral head center distance on the central body line, we could trace the coronal mechanical axis. We measured the angle between the femoral mechanical axis and the femoral component in standing long leg antero-posterior radiograph to assess radiologically the accuracy of coronal alignment postoperatively. RESULTS: The average femoral length in the study group was 402.5+/-16.2 mm. The mean distance between the femoral head and the center of the marker was 49.6+/-17.9 mm. The average error in estimation of the distance between the femoral head center and the metal peg of the marker was 3.78+/-3.14 mm. The positional error in alignment was 1degrees or less in 90% and 2degrees or less in 100% of knees. The average angle of femoral component to femoral mechanical axis was 89.9+/-1.5degrees (range 84.4-93.6degrees). The coronal alignment of the femoral components was within 90degrees+/-3degrees in -96% of cases. CONCLUSION: Our results suggest that the clinical method reported here is a simple and reliable method to localize the center of the femoral head during total knee arthroplasty.

Comparison of the Naranjo and WHO-Uppsala Monitoring Centre criteria for causality assessment of adverse drug reactions / 대한내과학회지

BACKGROUND/AIMS: Several criteria have been proposed to increase the objectivity, reliability and validity of causality assessment of adverse drug reactions (ADR). We compared the Naranjo probability scale and the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) causality categories to evaluate the validity and clinical usefulness of these criteria. METHODS: We evaluated 100 ADR cases with the Naranjo probability scale and the WHO-UMC causality categories. The Spearman rank coefficient was used to determine the correlation of these criteria. The evaluation of the ADR was categorized into four groups for the Naranjo system: definite, probable, possible, and doubtful, and six groups for the WHO UMC: certain, probable, possible, unlikely, conditional/unclassified, and unassessable. RESULTS: The criteria used form these two systems showed some differences when compared with the same ADR cases. The Spearman rank coefficient was 0.519 (p<0.001) and the agreement was 55% between the Naranjo probability scale and the WHO-UMC causality categories. The Naranjo probability scale includes measurements for drug concentration, objective evidence of ADR, ADR to previous exposures, responses to placebo, and the dose adjustment of drugs. However, few cases were evaluated for all of these measures. CONCLUSIONS: The Naranjo probability scale may be helpful for assessing unexpected ADRs and useful for evaluators with little experience. However, some of the items are not utilized and there are discrepancies when compared with the WHO-UMC causality criteria.

Huckstep Nail in theTreatment of a Femur Fracture / 대한정형외과학회잡지

Purpose: To analyze the clinical and radiological results of Huckstep nailing in the treatment of acute femoral fractures and femoral nonunion, and to report the easy and non-fluoroscopic technique of targeting the locking screw holes by making double cortical windows. Materials and Methods: This study examined a total of fifteen femoral fractures treated with Huckstep nailing between January 1999 and January 2004. The fractures included six acute fractures (five closed and one open) and nine nonunions (four infective and five aseptic). The reoperative status, number of interventions, time to union and complications were analyzed. Ten male and 5 female patients with an average age of 42 years (range, 18-70) were followed up for a mean of 26 months (range, 16 months to 6.4 years). A new method of double cortical windows for targeting the screw holes were performed in seven cases without fluoroscopic aid. Results: Radiographic union was achieved after a mean of 15.3 weeks in those with an acute fracture and after a mean of 24.6 weeks in those with nonunion. One open fracture was fixed initially using a monofixator followed by Huckstep nail 4 weeks later when the open wound had healed. A bone graft was performed in two cases of nonunion, and Hydroxyapatite/Tricalcium phosphate granules were grafted in three cases of nonunion. Partial knee ankylosis resulted in 6 cases of nonunion at the final follow-up because the nonunion cases had undergone an average of 4.3 surgical procedures at other hospitals over an average of 11.8 months before performing Huckstep nailing. One acute case without proximal screw fixation resulted in dynamization and femoral shortening of 2 cm. Conclusion: Huckstep nailing provides stable fixation sufficient to enable early knee motion and weight bearing until the fracture heals in both acute fracture and nonunion. The new method of double cortical windows allows the easy targeting of screw holes without fluoroscopic aid.

Localized Fibrosing Mediastinitis with Superior Vena Caval(SVC) Syndrome / 결핵및호흡기질환

Fibrosing mediastinitis is a rare disease that is characterized by the proliferation of dense fibrous tissue of the mediastinum. The pathogenesis of fibrosing mediastinitis is unknown in most cases. However, histoplasmosis, tuberculosis, autoimmune disease, radiation therapy, and other idiopathic fibroinflammatory diseases have been implicated in some cases. Most clinical features are related to an obstruction or compression of the mediastinal structure. Fibrosing mediastinitis is often progressive and occurs diffusely throughout the mediastinum. We encountered a case of fibrosing mediastinitis of a very focal lesion without evidence of mediastinal involvement. The condition was confirmed by biopsy and graft bypass surgery was performed because of SVC syndrome.

Total Hip Arthroplasty using Sandwich type Ceramic-Ceramic Articulation: Minimal 2 years follow-up / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical and radiological results of total hip replacement arthroplasty using a cementless, sandwich (alumina-polyethylene-titanium) acetabular component and the cause of three ceramic liner fracture. MATERIALS AND METHODS: From June 1999 to December 2001, one hundred and twenty eight (110 patients) among 146 cases (129 patients) who were underwent total hip replacement arthroplasty using a sandwich type acetabular component, were followed up for minimum 24 months (range, 54-24 months). Among 110 patients, 85 patients (101 cases) were men and 25 patients (27 cases) were women. Their mean age was 48.8 years (range, 17-78 years) old. The patients were examined clinically and radiologically at postoperative 1 month, 3 months, 6 months, 1 year and every year, thereafter. RESULTS: At the median followup of 32 months, the average Merle d'Aubigne and Postel score had improved from 8.4 to 16.7. Results were graded as excellent in 110 hips (86%), and very good in 18 hips (14%). At the last followup, all component including acetabular cup and femoral stem acquired firm bony union. Neither component migration nor acetabular osteolysis was detected. Finally three fracture and dislocation of ceramic liner developed and the fractured liners were changed other sandwich type or polyethylene liner. CONCLUSION: Even though short-term clinical result of total hip replacement arthroplasty using sandwich type acetabular component is excellent, two percent of the ceramic liner fracture incidence is unexpected high. So we have to caution with using sandwich acetabular cup. In addition, ceramic acetabular cup need more precising surgical technique.

Biofeedback Therapy in Patients with Nonrelaxing Puborectalis Syndrome: Are there differences of therapeutic effect according to methods of diagnosis?

PURPOSE: To evaluate therapeutic effect of biofeedback therapy according to methods of diagnosis in patients with norelaxing puborectalis syndrome. METHODS: From September, 1, 1998 to February, 30, 1999, the patients who were diagnosed with norelaxing puborectalis syndrome on anal electromyography (EMG) and/or cinedefecography (CD) underwent biofeedback therapy. The patients were divided into 3 groups according to the diagnostic method; CD group - only diagnosed on cinedefecography, EMG group - only diagnosed on anal electromyography, CD EMG group - diagnosed on both tests. RESULTS: Nineteen patients were diagnosed nonrelaxing puborectalis syndrome on CD and/or EMG. There were 14 females and 5 males with a mean age of 40.8+/-18.4 years. The patients were classified into CD group; five patients (26.3%); EMG group, eight patients (42.1%); CD EMG group, six patients (31.6%). The patients had 5.4 3.7 sessions of outpatient EMG-based biofeedback sessions. Subjective symptoms after biofeedback therapy improved in 4 (80.0%), 6 (75%), 5 (83%) patients in CD, EMG, CD EMG groups, respectively. There was a statistically significant increase in spontaneous bowel movements, and a reduction in assisted bowel movements after biofeedback therapy in patients in all three groups (p<0.05). However, no significant difference was found among the three groups. CONCLUSION: This study demonstrated that biofeedback therapy had a high therapeutic effect regardless to the diagnostic method. Therefore, biofeedbck therapy can be performed if one test results in the diagnosis of norelaxing puborectalis syndrome in patients with constipation.