Hemophilia A in a Senior Patient: A Case Report of Spinal Epidural Hematoma as First Presentation

Hemophilia A is a hereditary coagulation disorder. Most cases are diagnosed at birth or at least during childhood. A spontaneous spinal epidural hematoma was developed in a 74-year-old male patient who hadn't had a family or past medical history of bleeding disorders. On magnetic resonance imaging, epidural hematoma at L1-2 was accompanied by spinal stenosis at L4-5 and spondylolytic spondylolisthesis at L5. Hematoma evacuation and surgery for distal lumbar lesions were performed at once. After transient improvement, complete paraplegia was developed due to redevelopment of large epidural hematomas at L1-2 and L4-S1 which blocked epidural canal completely. Emergency evacuation was performed and we got to know that he had a hemophilia A. Factor VIII was 28% of normal value. Mild type hemophilia A could have not been diagnosed until adulthood. Factor VIII should have been replaced before the surgical decompression.

The Survivorship and Clinical Results of Minimally Invasive Unicompartmental Knee Arthroplasty at 10-Year Follow-up

BACKGROUND: In this study, we investigated the long-term clinical results and survival rate of minimally invasive unicompartmental knee arthroplasty (UKA) by collecting cases that had been implanted more than 10 years ago. METHODS: One hundred and twenty-eight patients (166 cases) who underwent Oxford phase 3 medial UKA using the minimally invasive surgery from January 2002 to December 2002 were selected. The mean age of the patients at the time of surgery was 61 years, and the duration of the follow-up was minimum 10 years. Clinical and radiographic assessments were performed using the Knee Society clinical rating system, and the survival analysis was done by the Kaplan-Meier method with 95% confidence interval (CI). RESULTS: The mean Knee Society knee and function scores improved significantly from 53.8 points (range, 25 to 70 points) and 56.1 points (range, 35 to 80 points) preoperatively to 85.4 points (range, 58 to 100 points) and 80.5 points (range, 50 to 100 points) at 10-year follow-up, respectively (p < 0.001). Failures following the UKA occurred in 16 cases (9.6%), and the mean time of the occurrence of the failure was 6.2 years after the surgery. The 10-year survival rate was 90.5% (95% CI, 85.9 to 95.0) when failure was defined as all the reoperations, whereas the 10-year survival rate was 93.4% (95% CI, 89.6 to 97.1) when the cases in which only revision total knee arthroplasty was defined as failure. CONCLUSIONS: The results of this study show outstanding functions of the knee joint and satisfactory 10-year survival rate after minimally invasive UKA. Therefore, minimally invasive UKA could be a useful method in the treatment of osteoarthritis in one compartment of knee joint.

Causes of Failure after Total Knee Arthroplasty in Osteoarthritis Patients 55 Years of Age or Younger

PURPOSE: To identify the modes of failure after total knee arthroplasty (TKA) in patients >55 years of age and to compare with those >55 years of age in patients who underwent revision TKA. MATERIALS AND METHODS: We retrospectively reviewed 256 revision TKAs among patients who underwent TKA for knee osteoarthritis between January 1992 and December 2012. The causes of TKA failure were analyzed and compared between the groups. RESULTS: Thirty-one revision TKAs were performed in patients 55 years of age at primary TKA. In the < or =55 years of age group, the most common cause of TKA failure was polyethylene wear (45%) followed by infection (26%) and loosening (17%). The interval from primary TKA to revision was 8.6 years (range, 1 to 17 years). There were relatively lower infection rate and higher loosening rate in patients < or =55 years of age, but the difference was not statistically significant. CONCLUSIONS: The main causes of failure after TKA in patients < or =55 years of age were polyethylene wear, infection and loosening, and there was no significant difference in the modes of failure after TKA between the two groups.

Axillary Lymph-Node Metastases in Patients with T1 Breast Cancer

PURPOSE: In T1 tumors, the reported incidence of lymph-node metastases ranges from 21% to 35%. We analyzed the pathological parameters of T1 tumors for their association with the likelihood of axillary lymph-node metastases. Our objectives were to determine if standard pathologic factors can predict lymph-node metastases in T1 tumors and to provide a basis for patient selection for nonradical surgery. METHODS: Sixty-five patients with T1 unilateral invasive breast cancer were studied. All patients underwent axillary dissection from 1990 to 1999 at Masan Samsung Hospital, and the pathologic status of the nodes was reviewed. The associations between the incidence of axillary lymph-node metastases and pathologic factors, including age, size, histologic subtype, nuclear grade, hormone receptor status, and lymphatic/vascular invasion, were analyzed. RESULTS: Of the 65 patients, 21 (32.3%) had nodes that were positive for metastases. The independent predictor of lymph-node metastases in the multivariate logistic regression analyses was a tumor size larger than 1 cm (p<0.05). However, other predictors showed nonspecific findings. CONCLUSION: These results suggest that the characteristics of the primary tumor can help assess the risk for axillary lymph-node metastases. Axillary lymph-node dissection should be performed routinely for all patients with lesions with a tumor more than 1 cm in size. Although a routine axillary dissection or radiation therapy to the axilla might be spared in selected patients who are assessed to be at minimal risk, new prognostic factors for providing reliable assurance of the absences of axillary lymph-node metastases must be investigated.