Long-Term Survival and Tumor Recurrence in Patients with Superficial Esophageal Cancer after Complete Non-Curative Endoscopic Resection: A Single-Center Case Series

BACKGROUND/AIMS: To report the long-term survival and tumor recurrence outcomes in patients with superficial esophageal cancer (SEC) after complete non-curative endoscopic resection (ER). METHODS: We retrieved ER data for 24 patients with non-curatively resected SEC. Non-curative resection was defined as the presence of submucosal and/or lymphovascular invasion on ER pathology. Relevant clinical and tumor-specific parameters were reviewed. RESULTS: The mean age of the 24 study patients was 66.3±8.3 years. Ten patients were closely followed up without treatment, while 14 received additional treatment. During a mean follow-up of 59.0±33.2 months, the 3- and 5-year survival rates of all cases were 90.7% and 77.6%, respectively. The 5-year overall survival rates were 72.9% in the close observation group and 82.1% in the additional treatment group (p=0.958). The 5-year cumulative incidences of all cases of recurrence (25.0% vs. 43.3%, p=0.388), primary EC recurrence (10.0% vs. 16.4%, p=0.558), and metachronous EC recurrence (16.7% vs. 26.7%, p=0.667) were similar between the two groups. CONCLUSIONS: Patients with non-curatively resected SEC showed good long-term survival outcomes. Given the similar oncologic outcomes, close observation may be an option with appropriate caution taken for patients who are medically unfit to receive additional therapy.

The Efficacy of a Newly Designed, Easy-to-Manufacture Training Simulator for Endoscopic Biopsy of the Stomach

BACKGROUND/AIMS: We developed a new endoscopic biopsy training simulator and determined its efficacy for improving the endoscopic biopsy skills of beginners. METHODS: This biopsy simulator, which presents seven biopsy sites, was constructed using readily available materials. We enrolled 40 participants: 14 residents, 11 first-year clinical fellows, 10 second-year clinical fellows, and five staff members. We recorded the simulation completion time for all participants, and then simulator performance was assessed via a questionnaire using the 7-point Likert scale. RESULTS: The mean times for completing the five trials were 417.7±138.8, 145.2±31.5, 112.7±21.9, and 90.5±20.0 seconds for the residents, first-year clinical fellows, second-year clinical fellows, and staff members, respectively. Endoscopists with less experience reported that they found this simulator more useful for improving their biopsy technique (6.8±0.4 in the resident group and 5.7±1.0 in the first-year clinical fellow group). The realism score of the simulator for endoscopic handling was 6.4±0.5 in the staff group. CONCLUSIONS: This new, easy-to-manufacture endoscopic biopsy simulator is useful for biopsy training for beginner endoscopists and shows good efficacy and realism.

Rapid-onset of severe tigecycline-induced coagulopathy in drug reaction with eosinophilia and systemic symptom syndrome

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome-also known as drug-induced hypersensitivity syndrome-is an uncommon disease entity that manifests as fever, skin rash, blood cell abnormalities, lymphadenopathy, and often coagulopathy. Tigecycline is an antibiotic that is selectively used to treat complicated intra-abdominal and soft-tissue infections. Recently, a few cases of tigecycline-induced coagulopathy have been reported. Herein, we report a case of tigecycline-induced coagulopathy in a patient with DRESS syndrome. Both prothrombin time and activated partial thromboplastin time were abruptly exceeded beyond 180 seconds on day 6 of tigecycline treatment and normalized after discontinuation of tigecycline.

Staphylococcus-associated Glomerulonephritis / 대한내과학회지

A 64-year-old woman was admitted with vertebral osteomyelitis and polyarthritis (both knees and the right shoulder). She had had no health problems before these conditions developed. Joint culture grew methicillin-resistant Staphylococcus aureus. During hospitalization, hematuria, proteinuria, azotemia, and decreased C3 were reported. The renal biopsy showed mesangial proliferative glomerulonephritis with C3 and IgA co-dominant deposits on immunofluorescence staining. Following incision and drainage of the right shoulder and right knee, and intravenous vancomycin for 15 weeks, the C-reactive protein, proteinuria, hematuria, and C3 level all normalized. Here, we report a case of Staphylococcus-associated glomerulonephritis with a brief review of the literature.

Unexpected Delayed Colon Perforation after the Endoscopic Submucosal Dissection with Snaring of a Laterally Spreading Tumor

Colonic perforation may occur as a complication of diagnostic and therapeutic colonoscopy. The risk factors for perforation after colorectal endoscopic submucosal dissection (ESD) include an inexperienced endoscopist, a large tumor size, and submucosal fibrosis. The mechanisms of perforation include unintended endoscopic resection/dissection and severe thermal injury. Here, we report a case of colon perforation that occurred after ESD with snaring of a laterally spreading tumor. The perforation was completely unexpected because there were no colorectal ESD-associated risk factors for perforation, deep dissection, or severe coagulation injury in our patient.

A Case of Duodenal Metastasis from Squamous Cell Carcinoma of the Uterine Cervix / 대한췌담도학회지

We report a case of duodenal metastasis from squamous cell carcinoma of the cervix confirmed by histopathological diagnosis. A 48-year-old woman was diagnosed with uterine cervix cancer stage IVB and underwent chemotherapy. During follow-up after chemotherapy, a mass suspicious of malignancy was found at the 3rd portion of the duodenum on the magnetic resonance imaging of the abdomen. Esophagogastroduodenoscopy with biopsy was done for an ulcerofungating mass at the 3rd portion of the duodenum. Squamous cell carcinoma was confirmed on the biopsy which was same as the histopathological diagnosis confirmed by cervix biopsy and right supraclavicular lymph node biopsy resulting from metastasis of cervix. Since 1981, only ten cases of small bowel metastasis from squamous cell carcinoma of cervix have been reported. It is exceedingly rare to find metastasis to the duodenum from uterine cervix cancer.

Pseudoxanthoma Elasticum-Like Disorder with Multiple Coagulation Factor Deficiency in a Patient with Crohn's Disease / 대한내과학회지

Pseudoxanthoma elasticum (PXE)-like disorder with multiple coagulation factor deficiency is a genetic disease characterized by dystrophic mineralization of the connective tissue in multiple organs such as the skin, arteries, and retina. Patients with this disorder have excessive folding and sagging of the skin with loss of recoil, as well as coagulopathy. Crohn's disease is a chronic inflammatory condition of the gastrointestinal tract, which primary affects the small intestine, often leading to malnutrition. Here, we describe the case of a 25-year-old woman who presented with these diseases. We found that nutrient deficiency due to long-term Crohn's disease aggravated the coagulopathy associated with PXE-like disorder.

A Case of Peroneal Nerve Palsy Secondary to Fibular Head Osteochondroma

Osteochondroma of the proximal fibula is relatively common, but there are only rare reports of this lesion in conjunction with peroneal nerve palsy. We report here on a case of the peroneal nerve palsy secondary to fibular head osteochondroma, and the patient experienced complete recovery of function following the excision of the tumor and neurolysis of the peroneal nerve.

Usefulness of Kyphoplasty in Sacral Insufficiency Fracture: A Case Report

Kyphoplasty has recently attended as a potential treatment for sacral insufficiency fracture. We report a 85-years-old female patient with osteoporotic S1 insufficiency fracture with absence of trauma history treated with kyphoplasty which has no symptom improve with conservative treatment. Kyphoplasty is an effective and useful procedure in the treatment of the sacral insufficiency fracture, additionally reviewed of the literatures.

Multiple Non-contiguous Spine Fractures with Concomitant Injuries: A Case Report

Multiple non-contiguous spinal fracture is a special type of multi-level spinal injury, which is rare but most frequently occur in motor vehicle accident or a falling from a height. We report five patients of multiple non-contiguous spinal fractures. All patients underwent segmental pedicle screws fixation without fusion for preserving facet joints and minimizing blood loss and operation time. We performed necessary operation for any concomitant injuries at the same day.

Relationships of Bone Mineral Density, Blood Pressure, and Physical Characteristics of Third and Fourth Decade College Students / 대한정형외과연구학회지

The purpose of this study was to analyze the relationship of body mass index (BMI), bone mineral density (BMD) and blood pressure (BP) in third and fourth decade college students. Total of 114 (67 male and 47 female) students who received health examination in April 2010 participated in this research. Bone status was measured by a peripheral dual energy X-ray absorptiometry method and T-score was calculated via WHO guideline. For body composition measurements, body fat, height and weight were measured and BMI was calculated. Among male students, 3.6% belong to the UW (under weight) group, 49.1% to the NW (normal weight) group, 18.2% to the OW (over weight) group and 29.1% belong to the obese group, while 2.1% of female students belong to the UW group, and 68.1% to the NW group, 14.9% to the OW group and 14.9% belong to the obese group. Differences of body weight among male and female students were statistically significant (p<0.001). Above overweight groups showed higher systolic and diastolic BP than normal group. Differences among two groups were statistically significant (systolic BP: p=0.041, diastolic BP: p=0.021). The mean BMI of normal BP group is 22.6+/-2.87, hypertension group is 24.1+/-2.95. Differences among two groups were statistically significant (p=0.045). The mean T-score of male students is -0.1+/-1.17, female is -0.6+/-0.88(total -0.5+/-0.91). Differences of T-score among male and female students were statistically significant (p=0.007). In conclusion, our results showed that many college students had the problems in the BMI, BMD and BP, and BP increased according to the increase of BMI. Therefore, nutritional education and weight control is required for normal blood pressure and bone health.

Comparison of Adjacent Spinal Compression Fracture after Old Osteoporotic Spinal Compression Fracture and Percutaneous Vertebroplasty / 대한골다공증학회지

OBJECTIVES: New adjacent spinal compression fractures occur not only in patients with osteoporotic spinal compression fractures after vertebroplasty but also in untreated old spinal compression fractures. The objective was to analyze and compare the characteristics in a group who had untreated old osteoporotic spinal compression fractures with those who had adjacent spinal compression fractures, which occurred after a vertebroplasty. MATERIALS & METHODS: From April 2006 to April 2009, 103 patients who had undergone vertebroplasty were evaluated. Eighteen patients (22 cases) who had untreated old osteoporotic spinal compression fractures were in group I, and 12 patients (13 cases) who had adjacent spinal compression fractures, which occurred after a vertebroplasty were in group II. In each group, we measured age and gender, body mass index (BMI), lumbar bone marrow density (BMD), sagittal index, and compression rate at the initial fracture site.

Popliteal Artery Pseudoaneurysm after Arthroscopic Posterior Cruciate Ligament Reconstruction: A Case Report / 대한스포츠의학회지

The pseudoaneurysm of the popliteal artery following an arthroscopic posterior cruciate ligament reconstruction is rare. We present a case of the delayed pseudoaneurysm of the popliteal artery after arthroscopic posterior cruciate ligament reconstruction. Open excision of the pseudoaneurysm and pin-point repair were done. Retrospectively reviewing the case, we found that the relation of the popliteal artery and posterior cruciate ligament on preoperative magnetic resonance images can predict the complication of pseudoaneurysm of the popliteal artery.

The Use of Fresh Frozen Allogenic Bone Graft in the Impacted Tibial Plateau Fractures

PURPOSE: To assess the behaviour of fresh frozen cancellous allograft used for supporting the reconstructed articular surface in impacted tibial plateau fractures. MATERIALS AND METHODS: Between May 2004 and May 2008, 13 cases of impacted tibial plateau fracture were evaluated retrospectively. All fractures were treated with open reduction-internal fixation after restoration of the tibial plateau surface and insertion of fresh frozen cancellous allograft chips for subchondral support. Mean age was 46.6 (31~65) years. Average follow-up period was 36 (13~58) months. The radiological and clinical result for every patient was assessed according to the modified Rasmussen's system and Lysholm's knee score. RESULTS: According to last follow-up weight bearing A-P X-ray, the fresh frozen cancellous allograft incorporated soundly in all cases and no complications such as joint depression, fracture reduction loss, angular deformity, and malunion were found. The mean time to complete bone union was postoperative 10+/-0.7 weeks. The mean range of motion was 135 (115~145) degrees. The mean Rasmussen's radiological score at last follow up was 15.3 (10 cases: excellent, 3 cases: good). The mean Lysholm's knee score at last follow up was 88.2+/-4.3. CONCLUSION: We concluded that fresh frozen cancellous allograft in impacted tibial plateau fractures showed good results in terms of bone union and functional improvement and was considered to be a good structural supporter.

Effects of Recombinant Human Growth Hormone Treatment in Elderly Patients Undergoing Surgery for Hip Fracture / 대한정형외과연구학회지

PURPOSE: To investigate whether early recombinant human growth hormone (hGH) treatment in elderly patients undergoing surgery for hip fracture improves biochemical and functional recovery. MATERIALS AND METHODS: From September 2007 to December 2008, a total of 25 patients older than 60 years who underwent a gamma nailing surgery for an accidental hip fracture were randomized to be treated with either hGH (Declage(R), 3mg/week) (Group I: 15 patients) or placebo (Group II: 10 patients) at a postoperative 1, 2, 3 weeks, starting within 24 hour after the hip fracture. Mean age was 73.5 years. 6 cases were male and 19 cases were female. Serum IGF-I was measured by radioimmunoassay. Subjective and objective parameters were analyzed such as the mean mid-thigh circumference, change of weight, hand grip strength, functional recovery by Modified Barthel Index of activities of daily living (ADL). RESULTS: There were significant differences in the mean serum IGF-I, mid-thigh circumference, hand grip strength, Modified Barthel Index of activities of daily living between two groups. There were no significant differences in the change of weight. There were three nausea symptom after hGH injection, but no any general adverse effect. CONCLUSION: Early recombinant human growth hormone (hGH) treatment in elderly patients undergoing surgery for hip fracture showed clinical safety and good biochemical and functional recovery.

Immunohistochemical Demonstration of Nerve Fibers of the Human Knee Synovium / 대한정형외과연구학회지

PURPOSE: To demonstrate the presence of nerve fibers including nociceptive fibers in synovium of human knee joint using immunohistochemistry. MATERIALS AND METHODS: 10 Synovial membrane tissues of knee joint obtained from 5 cadavers were analyzed immunohistochemically using antibodies to protein gene product 9.5, betaIII-tubulin, substance P and calcitonin gene-related peptide (CGRP). RESULTS: Many nerve fibers immunoreactive for protein gene product 9.5 and betaIII-tubulin were demonstrated in synovial folds of human knee joints. Also, immunostaining showed the presence of free nerve ending fibers immunoreactive for substance P and calcitonin gene-related peptide in synovium. CONCLUSION: The presence of putative nerve fibers including nociceptive fibers in synovial folds supports a possible role for theses structures as source of knee joint pain.

Effects of the Peroxisome Proliferator-Activated Receptor Ligand Troglitazone in Osteosarcoma Cell Lines / 대한정형외과학회잡지

PURPOSE: We wanted to investigate the effects of Troglitazone (TRO) on the cellular growth in two human osteosarcoma cell lines (U2OS and HOS). MATERIALS AND METHODS: Cell viability was assessed by performing trypan blue exclusion assay. FACScan analysis was performed to study the cell cycle and apoptosis. Antibodies against PTEN, tAkt, pAKt, Bcl-2, Bax, pRB, p21(Cip1), and beta-actin were used in the Western blot analysis. RESULTS: TRO inhibited the growth of both the osteosarcoma cell lines. TRO induced G0/G1 arrest in the cell cycle progression for both osteosarcoma cell lines. TRO induced the apoptosis of HOS cells, but it decreased apoptosis of the U2OS cells. TRO induced Rb dephosphorylation and the increased expression of p21(Cip1). TRO increased the PTEN and Bcl-2 expressions and it decreased the level of pAkt, pRb and Bax. CONCLUSION: The present study suggested that TRO may be used as a chemotherapeutic agent for the treatment of human OS. Yet further study is required for uncovering the precise the mechanism of TRO.

Functional Evaluation of the r-nailing Treatment of Intertrochanteric Fracture Older than 60 years Old Patient

PURPOSE: To evaluate the functional status after Gamma nailing in inter-trochanteric fractures in elderly with functional recovery score (FRS). MATERIALS AND METHODS: We reviewed 285 patients of intertrochanteric fracture treated by gamma nailing from January 1993 to May 2002 with follow up more than 3 years. We analized recovery of functional status concerned with sex, age, fracture pattern, functional recovery index. RESULTS: The intertrochanteric fractures in elderly resulted in 15.8% loss of function after 3 years. The more functional loss was observed in female, the older age, and Boyd-Graffin type II fracture but, were not signifily related with functional loss except age. CONCLUSION: We concluded that the age is the important factor to functional recovery to pre-injury status in elderly patients.