Radiological Results and Assessment of Navigation-Guided Total Knee Arthroplasty

PURPOSE: To assess the accuracy of implantation by radiologic results of navigation-guided total knee arthroplasty and compare radiologic results with navigation data. MATERIALS AND METHODS: Between September 2004 and May 2007, total knee arthroplasties were performed in 105 knees using navigation system and radiological results(group A) were compared with navigation data(group B). All patients had standing long anteroposterior radiographs of the lower extremities and supine lateral views of the knees at 6 weeks postoperatively. Mechanical axis deviation, alpha, theta, beta, gamma and delta angles were measured. Excepting alpha and gamma angles since there were no corresponding results among navigation data, reliability analysis was done for 4 angles. RESULTS: Radiological alignment on coronal plane relating to long-term prognosis were satisfactory in 97%. In analysis for reliability, mechanical axis deviation, theta, beta and delta angles showed moderate agreement. CONCLUSION: Radiological results of navigation-guided total knee arthroplasty allowed proper alignment and showed moderate agreement with navigation data, and thus navigation system will help to predict the postoperative radiological results.

A Case Report of Synchronous Double Primary Liver Cancers Combined with Early Gastric Cancer

Combined hepatocellular carcinoma and cholangiocarcinoma is found at a frequency of 1.0~6.3% in resected primary hepatic tumors. However, the case of double cancers of hepatocellular carcinoma and cholangiocarcinoma that are discovered synchronously in different lobes of a liver is very rare. We experienced a case of a 74-year-old man who was found to have hepatocellular carcinoma and cholangiocarcinoma in different lobes of the liver, which were accompanied by early gastric cancer. To our knowledge, this is the first case report of double primary hepatic cancers accompanied with early gastric cancer. The pathogenesis and previous related reports of these lesions are discussed.

The Study of Sexual Dysfunction in Patients with End Stage Renal Disease / 대한신장학회잡지

Sexual dysfunction is a common problem in patients with end stage renal disease. The pathogenesis of this problem is complex, and includes psychological factors, vascular, and neurological disorders, drug therapy, uremic intoxication and hormonal disturbances. However, we don't have any valid report because pathogenesis and physiologic significance is not proved clearly. With the questionnaire that we provided to our patients, we evaluated the sexual dysfunction in patients with end stage renal disease, and we treated our patient with antidepressants for males and estrogen for females. The results are as follows: 1) Sixty patients among 70 answered the sexual question. Among these, 46 patients (76%) complained of sexual dysfunction, 75% of male patients and 58% of female patients complained of impotence and mensturation disturbance, respectively. Especially, female patients complained of loss of libido as a whole. Also they said that they never tried to do anything to recover their sexual dysfunction. 2) After starting dialysis, 57% of patients showed decrease in coital frequency than before. 58% of patients showed no significant change in subjective sezual symptoms after dialysis. 18% of patients showed significant change in sexual function after anemia treatment. 3) Eighty-eight percents of males and one hundred percents of females treated with antidepressants and estrogen, respectively showed no effect. Finally, we found that sexual dysfunction is a common problem in chronic renal failure, but they never try to recover their conditions. Our therapeutic approach was not effective, but dialysis in CRF patient must be used for lifting the value of life, not by way of life extension. In addition we can make more effective treatment through objective study and psychological examination.

Hemostatic Effect of Endoscopic Hemoclip Method, Hypertonic Saline Epinephrine Injection Method and Their Combined Method for Bleeding Peptic Ulcer / 대한소화기내시경학회지

BACKGROUND: Bleeding peptic ulcer is the most common cause of upper gastrointestinal bleeding. Various different endoscopic hemostatic methods were introduced to treat bleeding peptic ulcer. Many studies reported the efficacy and comparision of various methods. Endoscopic injection therapy is the most comman method among them because it is inexpensive and easy in use. Complications of injection therapy such as aggravation of bleeding, tissue neerosis and perforation were repoted rarely. Recently endoscopic hemoclipping method is considered to be safe and effective hemostatic method for upper gastrointestinal bleeding. METHODS: During the period between January 1993 and August 1996, we have conducted clinical trial and retrospective analysis among 100 patients in whom active bleeding or visible vessel was identified. RESULTS: 1) Three groups was divided, Hemoclip group 26 cases, Hypertonic Saline Epinephrine(HSE) group 59 cases, Combination group 15 cases. 2) The sources of bleeding in Hemoclip group were gastric ulcer in 23 Cases and duodenal ulcer in 3 cases, and in HSE group, gastric ulcer in 44 case, duodenal ulcer 14 cases and stomal ulcer in one case, and in combination group, gastric ulcer in 10 cases, duodenal ulcer in 3 cases and stomal ulcer in two cases. HSE and combination method were performed more than Hemoclip method in duodenal ulcer(23.7% and 20.0% versus 11.5%). 3) As the stigmata of bleeding in Hemoclip and HSE and Combination group, spurting were seen in 5 cases and 3 cases and 4 cases, and oozing in 10 cases and 17 cases and 3 cases, and nonbleeding visible vessel in 11 cases and 39 cases and 8 cases, respectively. Hemoclip method was performed more than HSE method in active bleeding state(57.6% versus 33.9%). 4) Initial hemostasis was achieved in 24 cases(92.3%) in Hemoclip group and 52 cases(88.1%) in HSE group, 13 cases(86.7%) in Combination group. 5) The rebleeding developed in 1 case(4.2%) in Hemoclip group and 8 cases(15.4%) in HSE group and 1 case(7.6%) in Combination group, the emergent operation was undewent 2 cases(7.7%) in Hemoclip group and 10 cases(17.0%) in HSE group and 1 case(6.7%) in Combination group, respectively. 6) The death was noticed in 1 cases(3.9%) in Hemoclip group and 2 cases(3.4%) in HSE group and 2 case(13.3%) in Combination group, repectively. 7) Permanent hemostasis by only endoscopic treatment was achieved in 24 cases(92.3%) in Hemoclip group and 48 cases(81.4%) in HSE group, 12 cases(80.0%) in Combination group. 8) Complication was noticed only in HSE group, aggravation of bleeding in one case and hematoma in two cases. CONCLUSION: Hemoclip method was effective hemostatic method same as HSE injection method, and safe method weth low complication in bleeding peptic ulcer. We suggest more detail selection of endoscopic hemostatic method in variously individualized endoscopic features.

Superficial Spreading Stomach Cancer: Report of One Case / 대한소화기내시경학회지

Superficial spreading stomach cancer, as first described by Stout in 1942, is superficially spreading cancer confined to mucosa and submucosa, and measuring up to 10 cm in diameter. Clinical manifestation is peptic ulcer like symptom with a long duration, and a gross appearance is characterized by reddening, irregular and slight nodular thickening of the involved mucosa. We should be careful to differentiate chronic atrophie gastritis or multiple superficial gastric erosions from superficial spreading stomach cancer. It is classified to a subtype of early gastric cancer type Ilc(IIc'') and the prognosis is as good as early gastric cancer. A 60-yearold woman was admitted to our hospital because of epigastric pain for 2 years. She was confirmed to have superficial spreading stomach cancer by gastroduodenoscopy, endoseopic ultrasonography, and operation. We report a case of superficial spreading stomach cancer with a review of relevant literatures.

A Case of Polypoid Gastric Metaplasia in Duodenal Bulb / 대한소화기내시경학회지

Gastric metaplasia of the duodenum, defined as the presence of groups of gastric mucosal cell within normal duodenal epithelium, is an almost constant feature of duodenal ulcer. The pathogenesis of gastric metaplasia is unclear, but acid and Helicobacter pylori infection are contributory factors to the development of gastric metaplasia. Generally, endoscopic finding of gastric metaplasia in duodenum is typically patchy distribution in duodenal bulb, but polypoid gastric metaplasia in duodenum is very rare. We report that the patient who complaints of abdominal pain has a villous, polypoid gastric metaplasia in duodenal bulb without duodenal ulcer.

The Changes of Coronary Artery Stenosis by Sequential Coronary Angiographies

BACKGROUND: Progression of coronary atherosclerosis is a unpredictable process. It follows a nonlinear course, and information derived from sequential coronary angiograms is of little value in predicting future progression. This study was designed to evaluate the changing patterns of coronary artery disease(CAD) and to determine possible factors for progression. METHOD: We analyzed progression and regression of CAD in 22 patients(group I : patients with progression of the coronary lesion, group II : patients with regression or no significant change of the coronary lesion) who underwent coronary arteriography two times. Progression was defined either as an increase in percent stenosis of preexisting stenoses by > or =20% including occlusions or as formation of new stenoses > or =20%. The results were compared with clinical findings to determine the nature of the progression of coronary atherosclerosis. RESULTS: Progression of the coronary artery lesion was found in 14 of 22 patients, regression in 4 and no significant changes in 4. New lesions occured in 22 of 156 segments in previously normal segments of arteries. The highest progression percentage was shown by the proximal right coronary artery. Progression occured most frequently in segments with stenosis of 50% to 74% at initial arteriogram. There were no significant differences in mean values for age, blood pressure, total serum cholesterol and blood sugar between two groups. CONCLUSION: The coronary arterial lesions are more frequently progressive rather than regressive of stationary. The progression follows nonlinear course. Many new lesions occurred in segments with previously normal segments of arteries.