The Treatment for Hallux Valgus with Scarf Osteotomy in Elderly Patients with Osteoporosis / 대한족부족관절학회지

PURPOSE: The aim of this study was to evaluate the radiological and clinical outcomes of scarf osteotomy for hallux valgus (HV) deformity in elderly patient with osteoporosis. MATERIALS AND METHODS: A total of 58 elderly patients (mean age, 72.6 years) underwent scarf osteotomy for HV deformity between 2008 and 2015. The mean follow-up period was 24.4 months. Of the 58 patients, 42 were diagnosed with osteoporosis and 16 were diagnosed as normal. The radiological and clinical outcomes were assessed preoperatively, postoperatively, and at final follow-up, including HV angle, intermetatarsal (IM) angle, American Orthopaedic Foot and Ankle Society (AOFAS) score, patient satisfaction, visual analogue scale (VAS), and complication. RESULTS: There was no significant difference in HV angle and IM angle between the osteoporosis group and normal bone mineral densitometry group at all time points, preoperative, postoperative, and final follow-up. Moreover, there was no statistically significant difference between the two groups with respect to the AOFAS score and VAS evaluations. In the osteoporosis group, the mean HV angle improved from 36.7° preoperatively to 11.3° at the time of final follow-up, and the mean IM angle improved from 13.2° to 5.7°. The mean AOFAS score improved from 52.6 preoperatively to 89.1 at the time of final follow-up. With respect to satisfaction, 83.4% of patients were very satisfied or satisfied. There were no serious complications, and all cases showed complete union at the osteotomy site. CONCLUSION: We believed that scarf osteotomy is a safe, effective procedure for the correction of elderly patients with osteoporosis.

Achromobacter xylosoxidans Infection Following Total Knee Arthroplasty / 대한정형외과학회잡지

Achromobacter xylosoxidans is an opportunistic organism, mainly causing infection in immune compromised hosts, such as patients on dialysis. However, review of the medical literature showed that few cases of A. xylosoxidans infections following total knee arthroplasty have been reported. This organism has not been reported in prosthetic joint infections of patients who are not immune compromised. Here, a case of periprosthetic infection with A. xylosoxidans following total knee arthroplasty in a man with no medical history of immune suppression is reported.

Patterns and Biologic Features of p53 Mutation Types in Korean Breast Cancer Patients / 한국유방암학회지

PURPOSE: The p53 gene is one of the most frequently mutated genes in breast cancer. We investigated the patterns and biologic features of p53 gene mutation and evaluated their clinical significance in Korean breast cancer patients. METHODS: Patients who underwent p53 gene sequencing were included. Mutational analysis of exon 5 to exon 9 of the p53 gene was carried out using polymerase chain reaction-denaturing high performance liquid chromatography and direct sequencing. RESULTS: A total of 497 patients were eligible for the present study and p53 gene mutations were detected in 71 cases (14.3%). Mutation of p53 was significantly associated with histologic grading (p<0.001), estrogen receptor and progesterone receptor status (p<0.001), HER2 status (p<0.001), Ki-67 (p=0.028), and tumor size (p=0.004). The most frequent location of p53 mutations was exon 7 and missense mutation was the most common type of mutation. Compared with patients without mutation, there was a statistically significant difference in relapse-free survival of patients with p53 gene mutation and missense mutation (p=0.020, p=0.006, respectively). Only p53 missense mutation was an independent prognostic factor for relapse-free survival in multivariate analysis, with an adjusted hazard ratio of 2.29 (95% confidence interval, 1.08-4.89, p=0.031). CONCLUSION: Mutation of the p53 gene was associated with more aggressive clinicopathologic characteristics and p53 missense mutation was an independent negative prognostic factor in Korean breast cancer patients.

Prognostic Factors for Patients with Bone-Only Metastasis in Breast Cancer

PURPOSE: Bone is the most frequent site of metastasis among breast cancer patients. We investigated prognostic factors affecting survival following bone-only metastasis in breast cancer patients. MATERIALS AND METHODS: The medical records of breast cancer patients who were treated and followed at Gangnam Severance Hospital retrospectively reviewed to identify patients with bone-only metastasis. RESULTS: The median time from the diagnosis of bone-only metastasis to the last follow-up or death was 55.2 [95% confidence interval (CI), 38.6-71.9] months. The Kaplan-Meier overall survival estimate at 10 years for all patients was 34.9%. In the multivariate Cox regression model, bisphosphonate treatment [hazard ratio=0.18; 95% CI, 0.07-0.43], estrogen receptor positivity (hazard ratio=0.51; 95% CI, 0.28-0.94), and solitary bone metastasis (hazard ratio=0.32; 95% CI, 0.14-0.72) were significantly associated with longer overall survival in the bone-only recurrence group. Among the treatment modalities, only bisphosphonate treatment was identified as a significant prognostic factor. CONCLUSION: Identifying the factors influencing breast cancer mortality after bone-only metastasis will help clarify the clinical course and improve the treatment outcome for patients with breast cancer and bone-only metastasis. Bisphosphonates, as a significant prognostic factor, warrant further investigation.

Clinical Outcomes of Ductal Carcinoma In Situ of the Breast Treated with Partial Mastectomy without Adjuvant Radiotherapy

PURPOSE: Some recent trials suggest that postoperative adjuvant radiotherapy (RT) may be safely omitted after breast-conserving surgery (BCS) for some patients with ductal carcinoma in situ (DCIS). In this study, we reviewed clinical outcomes of patients with DCIS treated with partial mastectomy (PM) without adjuvant RT. MATERIALS AND METHODS: Medical records of 28 patients (29 breasts) with DCIS who were treated with PM, but without RT, between April 1991 and December 2010 were retrospectively analyzed. Based on established criteria (2.0 cm or less in size and no comedonecrosis), 18 patients were treated without RT after PM. Seven patients (8 breasts) who did not receive RT due to refusal were also included in this study. Three other patients were excluded because data concerning comedonecrosis were not available. RESULTS: For the 25 patients included in this study, the mean age of the 18 patients who met the criteria was 47.9+/-6.2 years, and 47.6+/-12.7 years for the 7 patients who did not. The mean sizes of the primary tumors were 0.6+/-0.4 cm and 0.9+/-0.3 cm, respectively, in these two groups. Among these 25 patients (26 breasts) treated without RT, we observed no ipsilateral breast tumor recurrence or mortality within a mean follow-up of 84 months. CONCLUSION: Based on this small number of cases, patients with DCIS, who were selected for tumor size less than 2 cm and absence of comedonecrosis, may be treated successfully with BCS; adjuvant RT may be omitted.

Correlation of Early Systemic Recurrence with In Vitro Adenosine Triphosphate-Based Chemotherapy Response Assay in Stage II and III Breast Cancer Patients Treated with Doxorubicin-Based Chemotherapy / 한국유방암학회지

PURPOSE: An in vitro adenosine triphosphate-based chemotherapy response assay (ATP-CRA) was designed to require only a limited number of cells and shorten test turnaround time with a high success rate. This study investigated the correlation between in vitro doxorubicin sensitivity of tumor cells and early systemic recurrence, defined as recurrence within 2 years after surgery. METHODS: From January 2004 to March 2007, the ATP-CRA for doxorubicin was tested in 128 patients among breast cancer patients treated at Gangnam Severance Hospital, Seoul, Korea. The American Joint Committee on Cancer stages for all patients were II and III. All patients received doxorubicin-based chemotherapy. Selected patients were divided into a chemosensitive group and a non-chemosensitive group, according to a 40% cell death rate as a cut-off value. We analyzed the relationship between chemosensitivity and early systemic recurrence in patients with breast cancer. RESULTS: The mean age of the patients investigated was 44.6-years-old, the mean follow-up period was 39.9 months, and recurrence free survival was 38.6 months. Thirteen recurrences were observed during follow-up. Among 13 patients with a recurrence, eight had a recurrence within 2 years (early recurrence). All of the early recurring patients belonged to the non-sensitive group. Doxorubicin sensitivity results measured by ATP-CRA were related with early recurrence free survival in patients with breast cancer (p=0.030). The mean cell death rate derived from the ATP-CRA for the early recurrence group tended to be lower than that of the non-early recurrence group, but the difference was not statistically significant (p=0.05). CONCLUSION: Doxorubicin sensitivity measured by ATP-CRA was well correlated with in vivo drug responsibility to predict early recurrence against doxorubicin-based adjuvant chemotherapy in patients with breast cancer.

The Short-term Follow-up Results of Open Wedge High Tibial Osteotomy with Using an Aescula Open Wedge Plate and an Allogenic Bone Graft: The Minimum 1-Year Follow-up Results

BACKGROUND: This study examined the results of open wedge high tibial osteotomy with using an Aescula open wedge plate and an allogenic bone graft as a surgical technique for the patients who suffer from osteoarthritis of the knee with a genu varum deformity. METHODS: From March 2007 to August 2007, 33 patients (37 cases) with osteoarthritis of the knee and a genu varum deformity underwent a high tibial osteotomy with using an Aescula open wedge plate and an allogenic bone graft. The patients were followed up for more than 1 year. Before and after surgery, the correction angle of the genu varum was measured by the lower extremity scannogram and the posterior tibial slope, the joint space distance and the time to bone union were evaluated. The functional factors were evaluated using the Knee Society Score. RESULTS: The average knee score and function score improved from 52.19 +/- 11.82 to 92.49 +/- 5.10 and 52.84 +/- 6.23 to 89.05 +/- 5.53, respectively (p < 0.001). According to the lower extremity scannogram, the mean preoperative varus angle was -1.86 +/- 2.76degrees, and the average correction angle at the last follow-up was 10.93 +/- 2.50degrees (p < 0.001). The tibial posterior slope before surgery and at the last follow-up were 8.20 +/- 1.80degrees and 8.04 +/- 1.30degrees, respectively (p = 0.437). The joint space distance increased from 4.05 +/- 1.30 mm to 4.83 +/- 1.33 mm (p < 0.001). The average time to complete bone union was 12.69 +/- 1.5 weeks. CONCLUSIONS: An open wedge high tibial osteotomy using an Aescula open wedge plate and an allogeneic bone graft to treat osteoarthritis of the knee with a genu varum deformity showed good results for the precision of the correction angle, the time to bone union and the functional improvement.

Erratum: Author's Name Correction / 한국유방암학회지

One of the authors' names was misprinted. The author list should be corrected as follows. Seok Kyoung Choi, Joon Jeong, Seung Ah Lee, Seung Hyun Hwang, Sung Gwe Ahn, Woo Hee Jung1, Hy-De Lee

Heterogeneous Chemosensitivity of Breast Cancer Determined by Adeonsine Triphosphate Based Chemotherapy Response Assay / 한국유방암학회지

PURPOSE: Breast cancer is heterogeneous disease and the response to chemotherapeutic agents is also heterogeneous from patient to patient. Chemotherapy response assay is in vitro test that is performed to evaluate the degree of tumor growth inhibition by chemotherapy drugs. In this study, we performed the chemotherapy response assay using adenosine triphosphate (ATP-CRA) in breast cancer patients and assessed the clinical availability. METHODS: Sixty five breast cancer patients were enrolled in this study. Cancer cells were evenly divided and treated with commonly used chemotherapeutic drugs in breast cancer (doxorubicin, epirubicin, 5-fluorouracil, paclitaxel, docetaxel, vinorelbine, and gemcitabine). To verify in vitro ATP-CRA indirectly, we analyzed the correlation between cell death rate (CDR) of doxorubicin and epirubicin, and between doxorubicin and paclitaxel. We also analyzed the mean CDR of doxorubicin, epirubicin and paclitaxel by HER2 status. RESULTS: We could successfully perform the ATP-CRA in 60 patients (95.2%). In all cases, we can get the results within 7 days. The range of CDR was very wide, from 0 to more than 50%, except gemcitabine. Epirubicin showed the highest mean CDR (39.9%) and doxorubicin, paclitaxel in order. According to the chemosensitivity index, paclitaxel is the most frequently first-ranked and doxorubicin, epirubicin in order. Correlation coefficient between the cell death rate of doxorubicin and epirubicin is 0.4210 and 0.1299 between paclitaxel and doxorubicin. In HER2 positive group, mean CDR of paclitaxel, epirubicin and doxorubicin was higher than in HER2 negative group, even though epirubicin and doxorubicin were not statistically significant (p=0.018, p=0.114, p=0.311, respectively). CONCLUSION: ATP-CRA showed heterogeneous results in individual patients. ATP-CRA was successful and can be performed within short time period. According to our in vitro study, it showed similar results with in vivo study but for the clinical use, the prospective randomized controlled trial should be preceded.

Treatment of the Perinatally Diagnosed Asymptomatic Adrenal Gland Mass

Recently, the incidence of perinatally detected asymptomatic adrenal gland masses has increased because of widespread use of radiological diagnostic tools. However, optimal treatment of these masses has not been determined. The aim of this study is to elucidate the treatment guideline of perinatally diagnosed adrenal gland masses. The authors retrospectively reviewed the medical records of the 11 patients with asymptomatic adrenal gland mass, detected perinatally, between 1999 and 2004. Six cases were detected by prenatal ultrasound and 5 cases were incidentally detected by postnatal ultrasound. Six patients (surgery group) underwent mass excision. The pathologic diagnoses were neuroblastoma (n=4), adrenocortical adenoma (n=1) and adrenal pseudocyst (n=1). The indications for operation were suspicion of neuroblastoma (n=5) or absence of size decrease during observation (n=1). Three of the 5 suspicious cases of neuroblastoma and one case under observation were proven to be neuroblastoma. There was no surgical complication in the urgery group. All neuroblastoma patients have been well during the follow up period (24.4+/-14.4 month) without evidence of recurrence. Five cases (observation group) were closely observed because of the benign possibility or size decrease in follow up ultrasound. During the observation period (39+/-21 week), 4 cases showed complete spontaneous resolution and 1 case showed markedly decreased size of the mass but could not be followed up completely. Surgical resection of the perinatally diagnosed asymptomatic adrenal gland mass is a safe treatment method especially in case of suspicion of neuroblastoma, but closed observation can be applied.

Expression of Estrogen Receptor Gene in Degenerative Spinal Stenosis / 대한정형외과학회잡지

PURPOSE: The purpose of this experiment was to investigate the relationship between sex hormones and degenerative spinal disorder. MATERIALS AND METHODS: 22 ligamentum flavum were obtained from 22 patients who had undergone spinal surgery. Patients' specimens were divided into three groups. The experimental group contatining 16 postmenopausal female patients, diagnosed as having degenerative spinal stenosis. As a control group, two groups were formed. The first control group was composed of 4 male patients diagnosed as having same disease and the second group was two premenopausal females, who were diagnosed as having disc herniation and fracture. The relative amount of estrogen receptor expression at gene level was measured by reverse transcription-polymerase chain reaction (RT-PCR). The amounts of expressed gene in each group were compared: receptor subtypes (ER-alpha, ER-beta), sex and age (pre, postmenopausal). The calculated amount of ER-alpha and ER-beta gene expression was standardizised with respect to the mRNA of GAPDH. RESULTS: The mean density of the estrogen receptor, signals were 55.0+/-12.3, 143.0+/-32.1 in the experimental group, 39.6+/-8.0, 89.7+/-20.1 in the first control group and 34.1+/-2.0, 102.5+/-2.7 in the second control group. The mean density of the estrogen receptor alpha, beta, signals were higher in the experimenal group than in the control group. A statistically significant difference was found between the experimental group and the control group (p<0.05) CONCLUSION: The expression of ER-alpha, beta, gene in the human ligamentum flavum was confirmed. It was inferred from this study that a high expression of estrogen receptor might affect ligamentum flavum hypertropy in postmenopausal women and that this is likely to be a pre-disposing factor for degenerative spinal disorder.

Expression of b-FGF in Different Type of Herniated Nucleus Pulposus / 대한정형외과학회잡지

PURPOSE: To clarify b-FGF expression in different types of herniated nucleus pulposus (HNP) as angiogenesis marker, and to identify the novel vasculature in avascular nucleus pulposus. MATERIALS AND METHODS: Twenty-seven disc specimens removed surgically from patients who underwent discectomy for L4-5 HNP. The control disc specimens were obtained from five patients who underwent surgery for spine fracture or idiopathic scoliosis. According to MRI and operative findings, HNP was classified into 3 groups; protruded, extruded and sequestrated. The study involved; 7 protruded cases, 10 extruded cases and 10 sequestrated cases. Specimens were analyzed by western quantitative comparisons were performed upon the different bands. H-E stain and immunohistochemistry of CD 34 were performed to identify vessels in the avascular nucleus pulposus. RESULTS: The expression of b-FGF was not significantly increased in the protruded disc (p>0.05), but was significantly increased in the extruded disc as compared with the protruded disc (p<0.05) and in the sequestrated disc in compared with the extruded disc (p<0.05). Immunohistochemical study revealed novel vasculature at the periphery of the sequestrated disc. CONCLUSION: It is possible to confirm that sequestrated HNP is exposed to more vigorous regression via new vessel infiltration into the avascular nucleus pulposus tissue.

Skeletal Manifestation of Paget's Disease in Korean / 대한정형외과학회잡지

PURPOSE: We reviewed the clinical characteristics of skeletal Paget's disease in Korean. MATERIALS AND METHODS: We retrospectively analyzed the clinical features, the responses to treatment and complications of 11 cases of Paget's disease occurred in Korean patients. Then we compared the result obtained with those previously reported. RESULTS: Previous studies have mainly involved the axial skeleton, such as skull, spine or pelvic bone, and the pelvis was the most commonly involved site. In 7 cases, more than one site were involved. Clinical symptoms were pain around the involved sites in 5 cases and claudica-tion associated with spinal stenosis in one case. Serum alkaline phosphatase, a biochemical marker of bone formation, was elevated two to five fold in all cases. Responding to bisphosphate, the clinical symptoms subsided and the levels of alkaline phosphatase were markedly diminished or normalized. No serious complications, such as, cranial neuropathy or a congestive heart failure occurred. CONCLUSION: Compared western reports, Paget's disease of skeletal bone in Koreans showed a much lower incidence rate, milder symp-toms and fewer complications.

Double-Layered Lateral Meniscus: A Case Report / 대한정형외과학회잡지

Many types of meniscal anomalies were reported. Authors found a double-layered lateral meniscus, with one meniscus overlying another. The 39-year old male patient had torn medial and lateral menisci. We performed partial medial and lateral meniscectomy, and incidentally found that lateral meniscus was double-layered. It was characteristic that the upper small accessory meniscus was firmly connected from the posterior horn to middle segments of the lower main meniscus along its peripheral edge. We left it alone. The symptoms were gone, So, it was thought that this anomaly was not related to the patient's symptoms.