Clinical Outcomes of Neoadjuvant Chemotherapy in Colorectal Cancer Patients With Synchronous Resectable Liver Metastasis: A Propensity Score Matching Analysis

Purpose@#The survival benefit of neoadjuvant chemotherapy (NAC) prior to surgical resection in colorectal cancer with liver metastases (CRCLM) patients remains controversial. The aim of this study was to compare overall outcome of CRCLM patients who underwent NAC followed by surgical resection versus surgical treatment first. @*Methods@#We retrospectively analyzed 429 patients with stage IV colorectal cancer with synchronous liver metastases who underwent simultaneous liver resection between January 2008 and December 2016. Using propensity score matching, overall outcome between 60 patients who underwent NAC before surgical treatment and 60 patients who underwent surgical treatment first was compared. @*Results@#Before propensity score matching, metastatic cancer tended to involve a larger number of liver segments and the primary tumor size was bigger in the NAC group than in the primary resection group, so that a larger percentage of patients in the NAC group underwent major hepatectomy (P<0.001). After propensity score matching, demographic features and pathologic outcomes showed no significant differences between the 2 groups. In addition, there was no significant difference in short-term recovery outcomes such as postoperative morbidity (P=0.603) and oncologic outcome, including 3-year overall survival rate (P=0.285) and disease-free survival rate (P=0.730), between the 2 groups. @*Conclusion@#NAC prior to surgical treatment in CRCLM is considered a safe treatment that does not increase postoperative morbidity, and its impact on oncologic outcome was not inferior.

Clinical Outcomes of Neoadjuvant Chemotherapy in Colorectal Cancer Patients With Synchronous Resectable Liver Metastasis: A Propensity Score Matching Analysis

Purpose@#The survival benefit of neoadjuvant chemotherapy (NAC) prior to surgical resection in colorectal cancer with liver metastases (CRCLM) patients remains controversial. The aim of this study was to compare overall outcome of CRCLM patients who underwent NAC followed by surgical resection versus surgical treatment first. @*Methods@#We retrospectively analyzed 429 patients with stage IV colorectal cancer with synchronous liver metastases who underwent simultaneous liver resection between January 2008 and December 2016. Using propensity score matching, overall outcome between 60 patients who underwent NAC before surgical treatment and 60 patients who underwent surgical treatment first was compared. @*Results@#Before propensity score matching, metastatic cancer tended to involve a larger number of liver segments and the primary tumor size was bigger in the NAC group than in the primary resection group, so that a larger percentage of patients in the NAC group underwent major hepatectomy (P<0.001). After propensity score matching, demographic features and pathologic outcomes showed no significant differences between the 2 groups. In addition, there was no significant difference in short-term recovery outcomes such as postoperative morbidity (P=0.603) and oncologic outcome, including 3-year overall survival rate (P=0.285) and disease-free survival rate (P=0.730), between the 2 groups. @*Conclusion@#NAC prior to surgical treatment in CRCLM is considered a safe treatment that does not increase postoperative morbidity, and its impact on oncologic outcome was not inferior.

Results of Exchange Nailing in Hypertrophic Nonunion of Femoral Shaft Fracture Treated with Nailing

PURPOSE: This study examined the outcomes of exchange nailing for the hypertrophic nonunion of femoral shaft fractures treated with intramedullary nailing as well as the factors affecting the treatment outcomes. MATERIALS AND METHODS: From January 1999 to March 2015, 35 patients, who had undergone intramedullary nailing with a femoral shaft fracture and underwent exchange nailing due to hypertrophic nonunion, were reviewed. This study investigated the time of union and complications, such as nonunion after exchange nailing, and analyzed the factors affecting the results. RESULTS: Bone union was achieved in 31 cases (88.6%) after exchange nailing and the average bone union period was 22 weeks (14–44 weeks). Complications included persistent nonunion in four cases, delayed union in one case, and superficial wound infection in one case. All four cases with nonunion were related to smoking, three of them were distal shaft fractures, and one was a midshaft fracture with underlying disease. CONCLUSION: Exchange nailing produced satisfactory results as the treatment of hypertrophic nonunion after intramedullary nailing. Smoking is considered a factor for continuing nonunion even after exchange nailing. In the case of a distal shaft, where the intramedullary fixation is relatively weak, additional efforts are needed for stability.

Outcome of Type 3 Talar Neck Fractures by Means of Medial Malleolar Osteotomy and Large Distractor / 대한정형외과학회잡지

PURPOSE: The clinical and radiological results of patients with type 3 talar neck fractures treated with the anteromedial approach using medial malleolar osteotomy and large distractor were analyzed retrospectively. MATERIALS AND METHODS: From March 2009 to August 2016, 12 patients with a type 3 talar neck fracture, who underwent the anteromedial approach using a medial malleolar osteotomy and large distractor and who could be followed-up for more than 12 months after the operation, were examined. The patients were examined for the presence of Hawkins signs by anteroposterior and lateral radiographs and osteonecrosis by magnetic resonance imaging (MRI) on the postoperative 3 months. Subsequently, every 3 months, radiographic union was assessed by a simple radiograph and clinical symptoms. Twelve months postoperatively, posttraumatic arthritis was assessed and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was analyzed. RESULTS: In 7 cases, osteonecrosis was found on MRI performed 3 months after surgery. On the other hand, at the 12 months follow-up, all of them obtained AOFAS scores of 83.86±4.53 without surgical treatment. Radiographic union was achieved in all cases. The mean union period was 5.3 months. In 10 cases, traumatic arthritis was found after the radiographical and clinical evaluation. In addition, all of them could carry on everyday life by conservative treatment. The AOFAS ankle-hindfoot score was measured to be 85.17 on average. Other complications included superficial wound infection in 2 cases. CONCLUSION: An anteromedial approach using a medial malleolar osteotomy and a large distractor in the surgical treatment of patients with type 3 talar neck fractures can achieve anatomical reduction of the displaced fragment without a lateral dissection. This is considered to be another good surgical option.

Procarbazine and CCNU Chemotherapy for Recurrent Glioblastoma with MGMT Promoter Methylation

BACKGROUND: While procarbazine, CCNU (lomustine), and vincristine (PCV) has been an alternative chemotherapy option for malignant gliomas, it is worth investigating whether the combination of only procarbazine and CCNU is comparable because vincristine adds toxicity with uncertain benefit. The purpose of this study was to evaluate the feasibility of procarbazine and CCNU chemotherapy for recurrent glioblastoma multiforme (GBM) with O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation. METHODS: Eight patients with recurrent GBM following concurrent chemoradiotherapy and temozolomide (TMZ) adjuvant therapy were enrolled in this trial; they received no other chemotherapeutic agents or target therapy. They received CCNU (75 mg/m²) on day 1 and procarbazine (60 mg/m²) through days 11 and 24 every 4 weeks. The median cycle of CCNU and procarbazine was 3.5 (range: 2–6). RESULTS: One patient achieved stable disease. The median progression-free survival (PFS) with procarbazine and CCNU chemotherapy was eight weeks (range: 5–73), and the PFS rates were 25% and 12.5% at 16 and 30 weeks, respectively. The median overall survival (OS) from the initial diagnosis to death was 40 months, and the median OS from the administration of procarbazine and CCNU chemotherapy to death was 9.7 months (95% confidence interval: 6.7–12.7). Serious adverse events were found at six visits, and two cases were considered to be grade 3 toxicities. CONCLUSION: The efficacy of procarbazine and CCNU chemotherapy is not satisfactory. This study suggests the need to develop other treatment strategies for recurrent and TMZ-refractory GBM. Trial registry at ClinicalTrials.gov, NCT017337346.

Evaluation of Accessory Navicular Bone Using a Bone Scan and Its Clinical Significance for the Prognosis and Treatment / 대한족부족관절학회지

PURPOSE: To evaluate the clinical significance and usefulness of a bone scan in accessory navicular bone. MATERIALS AND METHODS: Eighty-five patients with foot pain and accessory navicular bone on radiography, who underwent bone scan from 2012 to 2015, were analyzed retrospectively. The subjects was divided into a symptomatic and asymptomatic group according to the presence of navicular bone tenderness. The grade of bone scan uptake was divided into 3 grades. Age, gender, grade of bone scan and size of the accessory navicular bone were analyzed. The symptomatic group were divided into a low (grade 0, 1) and high uptake (grade 2) group to determine the appropriate treatment. The low uptake group was treated conservatively for 3 months. The high uptake group was initially treated conservatively for 3 months and surgery was performed if pain persisted. For the clinical evaluation, the visual analogue scale, American Orthopaedic Foot and Ankle Society midfoot scale were evaluated in the first examination and last follow-up date. The patient's satisfaction grade was also evaluated at the last follow-up. RESULTS: The asymptomatic group mostly showed no uptake in the bone scan. On the other hand, some patients in the asymptomatic group showed an increase in uptake. In these patients, the size of accessory navicular bone was related to the grade of bone scan uptake, showing that the bone scan uptake grade can be predicted when applying different cut off values for the bone size. The symptomatic group mostly showed uptake in the bone scan and the grade of uptake had a positive correlation with the size of the accessory navicular bone (p<0.05). Age and gender were not related to the bone scan uptake. In the clinical evaluation, conservative and surgical treatment showed a good outcome. CONCLUSION: The bone scan uptake grade alone cannot be used to completely predict the symptoms. On the other hand, the size of the accessory bone can increase the bone scan uptake. Therefore, the size of the accessory bone, and patient symptoms should be considered in patients with a high uptake when deciding treatment.

High expression of epidermal growth factor-like domain 7 is correlated with poor differentiation and poor prognosis in patients with epithelial ovarian cancer / 부인종양

OBJECTIVE: The purpose of this study was to evaluate the expression of epidermal growth factor-like domain 7 (EGFL7) in epithelial ovarian cancer, and to assess its relevance to clinicopathological characteristics and patients' survival. METHODS: A total of 177 patients with epithelial ovarian cancer were enrolled in the current study. For each patient, a retrospective review of medical records was conducted. Immunohistochemical staining for EGFL7 was performed using tissue microarrays made with paraffin-embedded tissue block. EGFL7 expression levels were graded on a grade of 0 to 3 based on the percentage of positive cancer cells. We analyzed the correlations between the expression of EGFL7 and various clinical parameters, and also analyzed the survival outcome according to the EGFL7 expression. RESULTS: The expression of EGFL7 in ovarian cancer tissues was observed in 98 patients (55.4%). High expression of EGFL7 (grade 2 or 3) was significantly correlated with pathologic type, differentiation, stage, residual tumor after debulking surgery, lymphovascular space involvement, lymph node metastasis, high cancer antigen 125, peritoneal cytology, and ascites. Among these clinicopathologic factors, differentiation was significantly correlated with EGFL7 expression in multivariate analysis (p<0.05). Survival analysis showed that the patients with high EGFL7 expression had a poorer disease free survival than those with low EGFL7 expression (p=0.002). CONCLUSION: Our data suggest that EGFL7 expression is a novel predictive factor for the clinical progression of epithelial ovarian cancer, and may constitute a therapeutic target for antiangiogenesis therapy in patients with epithelial ovarian cancer.

Popliteal Artery Pseudoaneurysm after Anterior Cruciate Ligament Re-Revision Using a Rigidfix Cross Pin

Popliteal artery injury is a very rare complication of anterior cruciate ligament (ACL) reconstruction. The authors experienced a case of popliteal arterial pseudoaneurysm after re-revision of ACL reconstruction using Rigidfix for femoral tunnel fixation. Pseudoaneurysm was detected in knee magnetic resonance imaging, which caused pain, limit of motion, common peroneal nerve palsy, leg swelling and symptoms similar to compartment syndrome. After excision and re-anastomosis of the popliteal artery using a greater saphenous vein graft, all symptoms were resolved within 3 months except for common peroneal nerve palsy. So we report on this case with a review of the literature.

Acute Simultaneous Ruptures of the Anterior Cruciate Ligament and Patellar Tendon

Acute simultaneous rupture of the anterior cruciate ligament (ACL) and patellar tendon is a rare injury. We present a case report of a 32-year-old male patient with ruptured ACL and ipsilateral patellar tendon rupture sustained while playing baseball. Surgery was performed on the patellar tendon and the ACL simultaneously. The clinical and radiological outcomes of the treatment were successful. We present this case with a review of the literatures.

Analysis of the Result Treated with Locking Compression Plate-Distal Tibia and Zimmer Periarticular Locking Plate in Distal Tibia Fracture

PURPOSE: To evaluate the clinical and radiological results of minimally invasive plate, osteosynthesis, using either a locking compression plate-distal tibia (LCP-DT) or Zimmer periarticular locking plate (ZPLP) for distal tibia fractures. MATERIALS AND METHODS: Fifty one patients (51 cases), who underwent minimally invasive osteosynthesis using locking compression plate for distal tibia fractures between October 2008 and August 2011, were followed for more than six months. Eighteen patients were treated with LCP-DT and 33 patients with ZPLP. Time to bony union and anatomic alignment were evaluated radiologically. Clinically, American Orthopedic Foot & Ankle Society ankle-hindfoot scales (AOFAS score) and range of ankle motion were assessed and compared between two groups. RESULTS: All patients achieved bony union at an average of 18 weeks on LCP-DT group and 16weeks on ZPLP group. The average American Orthopedic Foot & Ankle Society ankle-hindfoot scales was 83.3 points on the LCP-DT group, 84.6 points on the ZPLP group, and range of ankle motion averaged at 45 degrees, 48 degrees, respectively. CONCLUSION: Both types of locking compression plates were effective when performing minimally invasive osteosynthesis for distal tibia fractures.

Outcomes and Analysis of Factors Affecting Bone Union after Interlocking Intramedullary Nailing in Segmental Tibia Fractures

PURPOSE: To evaluate the radiological results and complications of interlocking intramedullary nailing for segmental tibia fractures. MATERIALS AND METHODS: Twenty-six patients (26 cases) who underwent interlocking intramedullary nailing for segmental tibia fractures between January 2003 and May 2011 were followed for more than one year. We evaluated the complications and statistically analyzed the factors influencing bone union, including open fracture, fracture site, reaming, postoperative angulation, and postoperative fracture gap. RESULTS: Nineteen cases (73%) achieved bone union with one operation at an average of 7 months (range, 5 to 11). Seven cases had secondary procedures before achieving union. Complications included 7 cases of nonunion, 3 cases of incomplete peroneal nerve injury, 2 cases of superficial infection, 1 case of compartment syndrome. Factors showing statistically significant differences were open fracture, postoperative angulation, and postoperative fracture gap. Factors showing no statistically significant difference were fracture site and reaming. CONCLUSION: Nonunion is the most common complication in interlocking intramedullary nailing for segmental tibia fractures. To minimize this complication, comprehension of surgical techniques to reduce anatomically and careful evaluation of the fracture are required.

Overexpression of CD73 in epithelial ovarian carcinoma is associated with better prognosis, lower stage, better differentiation and lower regulatory T cell infiltration / 부인종양

OBJECTIVE: The purpose of the current study was to evaluate survival outcome according to the expression status of CD73 in patients with epithelial ovarian cancer. METHODS: A total of 167 patients with epithelial ovarian cancer were enrolled in the current study. For each patient, a retrospective review of medical records was conducted. Immunohistochemical staining for CD73, CD8, FoxP3, and CD68 was performed using tissue microarray made with paraffin embedded tissue block. RESULTS: Among the enrolled patients, 29.9% of patients (n=50) showed negative expression for CD73, whereas 70.1% of patients (n=117) showed positive expression for CD73. The CD73 positive group showed better prognosis compared to the CD73 negative group (5-year overall survival of CD73 positive group, 73.0%; that of CD73 negative group, 50.1%; p=0.023). CD73 was more frequently expressed in mucinous adenocarcinoma and clear cell carcinoma compared to serous or endometrioid adenocarcinoma. In addition, CD73 overexpressions were more frequently detected in patients with known good prognostic factors, i.e., low stage, well/moderate differentiation, negative peritoneal cytology, no lymphovascular involvement, and no macroscopic residual tumor after debulking surgery. There was significantly more infiltration of regulatory T cells in the CD73 negative group compared to the CD73 positive group. CONCLUSION: Good prognosis in patients with overexpression of CD73 may be due to that overexpression of CD73 was more frequently observed in epithelial ovarian cancer patients with known good prognostic factors. Therefore, this result means that favorable differentiation and stage have more influence on survival outcome than adverse effect of CD73 per se.

Overexpression of CD73 in epithelial ovarian carcinoma is associated with better prognosis, lower stage, better differentiation and lower regulatory T cell infiltration / 부인종양

OBJECTIVE: The purpose of the current study was to evaluate survival outcome according to the expression status of CD73 in patients with epithelial ovarian cancer. METHODS: A total of 167 patients with epithelial ovarian cancer were enrolled in the current study. For each patient, a retrospective review of medical records was conducted. Immunohistochemical staining for CD73, CD8, FoxP3, and CD68 was performed using tissue microarray made with paraffin embedded tissue block. RESULTS: Among the enrolled patients, 29.9% of patients (n=50) showed negative expression for CD73, whereas 70.1% of patients (n=117) showed positive expression for CD73. The CD73 positive group showed better prognosis compared to the CD73 negative group (5-year overall survival of CD73 positive group, 73.0%; that of CD73 negative group, 50.1%; p=0.023). CD73 was more frequently expressed in mucinous adenocarcinoma and clear cell carcinoma compared to serous or endometrioid adenocarcinoma. In addition, CD73 overexpressions were more frequently detected in patients with known good prognostic factors, i.e., low stage, well/moderate differentiation, negative peritoneal cytology, no lymphovascular involvement, and no macroscopic residual tumor after debulking surgery. There was significantly more infiltration of regulatory T cells in the CD73 negative group compared to the CD73 positive group. CONCLUSION: Good prognosis in patients with overexpression of CD73 may be due to that overexpression of CD73 was more frequently observed in epithelial ovarian cancer patients with known good prognostic factors. Therefore, this result means that favorable differentiation and stage have more influence on survival outcome than adverse effect of CD73 per se.

A Case of Alagille Syndrome

Alagille syndrome is characterized by chronic cholestasis, posterior embryotoxon, skeletal abnormalities, cardiovascular abnormalities, and a typical face with prominent forehead and pointed chin. Its histological feature includes paucity of interlobular bile ducts. We experienced a 49-day-old female infant presenting with frequent upper respiratory tract infection and persistent jaundice. She had a typical face and chronic cholestasis. Echocardiograms revealed peripheral pulmonary stenosis. The histological examination of liver revealed paucity of interlobular bile ducts.

A case of intestinal lymphangiectasia

No abstract available.

Evolution of serum ferritin levels after renal transplantation / 대한신장학회잡지

No abstract available.

Rhabdomyosarcoma of the Lower Leg in Newborn / 대한정형외과학회잡지

Rhabdomyosarcoma which was first described by Weber has generally been considered an uncommon tumor of striated muscle. Recently it was classified as four types as embryonal, alveolar, pleomorphic, and botryoid type by Horn and Enterline. A fourth type, sarcoma botryoides was generally recognized as a variant of the embryonal type. Al1 of these tumors tend to have a short clinical course, but the survival time seems to be slightly improved by sugical excision followed by radiotherapy and chemotherapy. Authors report one case of rhabdomyosarcoma, which was seen in the right lower leg and showed a rapid growing nature to die, which experienced in Busan National University Hospital, February, 1983.