Associations of Illness Symptoms, Perception of Illness, and Coping with Quality of Life of Thyroid Cancer Patients after Thyroidectomy

Purpose@#To determine associations of illness symptoms, perception of illness, coping with quality of life (QOL) of thyroid cancer patients and identify factors affecting their QOL. @*Methods@#A cross-sectional study was performed using a self-administered questionnaire for 111 thyroid cancer patients after thyroidectomy. They were recruited from the outpatient clinic of one university hospital.Data collection was conducted from August 2018 to November 2018. @*Results@#The QOL was significantly associated with interpersonal coping (β= 0.31, p< .001), monthly household income (β= 0.30, p< .001), illness symptoms (β= -0.22, p= .017), perception of illness (β= -0.20, p= .031), and education (β= 0.18, p= .037) in stepwise multiple regression. These factors explained 33.1% of QOL of thyroid cancer patients. @*Conclusion@#Interpersonal coping is a major contributing factor to QOL. Therefore, thyroid cancer patients need good interpersonal coping for better quality of life.

Surgical treatment of rhinophyma using an ordinary bur

Rhinophyma is a painless benign tumor of the skin of the nose. It is the most severe form of rosacea. Rhinophyma is particularly rare among Asians. It can be treated with surgical resection using various methods, including scalpel excision, dermabrasion, cryosurgery, argon laser, carbon dioxide laser, and electrocautery. However, the gold standard treatment of rhinophyma remains unknown. In the present case, we debulked a giant rhinophyma with a scalpel and contoured it using a bur. Along with a relevant literature review, we present a case of rhinophyma in an Asian patient who was treated at no additional cost using a bur widely used in general plastic surgery.

The role of adjuvant external beam radiation therapy for papillary thyroid carcinoma invading the trachea

PURPOSE: To evaluate the effect of adjuvant external beam radiation therapy (EBRT) on local failure-free survival rate (LFFS) for papillary thyroid cancer (PTC) invading the trachea. MATERIALS AND METHODS: Fifty-six patients with locally advanced PTC invading the trachea were treated with surgical resection. After surgery, 21 patients received adjuvant EBRT and radioactive iodine therapy (EBRT group) and 35 patients were treated with radioactive iodine therapy (control group). RESULTS: The age range was 26–87 years (median, 56 years). The median follow-up period was 43 months (range, 4 to 145 months). EBRT doses ranged from 50.4 to 66 Gy (median, 60 Gy). Esophagus invasion and gross residual disease was more frequent in the EBRT group. In the control group, local recurrence developed in 9 (9/35, 26%) and new distant metastasis in 2 (2/35, 6%) patients, occurring 4 to 68 months (median, 37 months) and 53 to 68 months (median, 60 months) after surgery, respectively. Two patients had simultaneous local recurrence and new distant metastasis. There was one local failure in the EBRT group at 18 months after surgery (1/21, 5%). The 5-year LFFS was 95% in the EBRT group and 63% in the control group (p = 0.103). In the EBRT group, one late grade 2 xerostomia was developed. CONCLUSION: Although, EBRT group had a higher incidence of esophagus invasion and gross residual disease, EBRT group showed a better 5-year LFFS. Adjuvant EBRT may have contributed to the better LFFS in these patients.

Endoscopy versus Open Bursectomy of Lateral Malleolar Bursitis; Comparative Study / 대한족부족관절학회지

PURPOSE: To compare the result of endoscopic versus open bursectomy in lateral malleolar bursitis, which was not treated conservatively. MATERIALS AND METHODS: Between January 2008 and October 2009, We divided to two groups, endoscopy (group A) 11 cases, open bursectomy (group B) 11 cases. The average follow up period was 15 months (range, 12 to 18), the mean age was 66 (range, 38 to 79). We compared patients satisfaction, complete healing time, operation time, complications and recurrence. RESULTS: Group A had significant difference in terms of the clinical satisfactions, complete healing time. operation time, complications. Group A showed satisfaction (excellent 9, good 2), mean complete healing time 11.9 (8~14) days, operation time 37 (25~45) minutes, 1 case recur. Group B showed satisfaction (excellent 4, good 3, fair 1, poor 3), complete healing time 32.7 (14~98) days, operation time 22 (18~26) minutes. complication were one case of skin necrosis, one case of wound dehiscence, two cases of superficial peroneal nerve injury, no recurrence. Significant advantages of endoscopic method include lower morbidity and rapid wound healing period (p<0.05). CONCLUSION: Endoscopic resection of the lateral malleolar bursitis is a promising technique and shows favourable results compared to the open resection. Significant advantages of this method include lower morbidiy and rapid wound healing.

End Stage Ankle Arthritis with Ankle Instability Patients Treatment Results Using Autograft Ligament Reconstruction with Total Ankle Arthroplasty / 대한족부족관절학회지

PURPOSE: We report the clinical and radiographic result of ligament reconstruction using plantaris and total ankle replacement in end-stage ankle arthritis with ankle instability. MATERIALS AND METHODS: The study is based on the 9 cases among total 48 patients of end-stage ankle arthritis that were treated with total ankle prosthesis and ligament reconstruction from 2007 to 2009 at least 12 months follow-up. We evaluated the VAS (Visual analogue scale) pain score, AOFAS (American orthopedic foot and ankle society) score and radiographic measurements. RESULTS: Average age was 59.4 years (53~67 years) old. VAS pain score improved from preoperative average 8.2+/-0.9 (range, 7~10) to 2.7+/-1.7 (range, 0~6) and the AOFAS score improved from 46.4+/-14.6 points (range, 23~69) to 80.1+/-9.3 points (range, 65~95) at final follow-up. Anterior draw test improved 15.2+/-3.4 mm (range, 12~23 mm) to 8.8+/-2.6 mm (range, 6~13mm),varus stress test improved from 13.9+/-4.6degrees (range,10-18degrees) to 6.2+/-4.7degrees (range,2-18degrees) at final follow up. CONCLUSION: Plantaris ligament reconstruction is good option as part of the management of ankle instability with end-stage ankle arthritis. We achieved good clinical and radiographic results.

The Preoperative Role of Breast-specific Gamma Imaging for the Breast Cancer Patients: In Comparison with Conventional Imaging Modality / 한국유방암학회지

PURPOSE: We wanted to assess the clinical efficacy of breast-specific gamma imaging (BSGI) as compared with that of conventional imaging modalities (mammography, ultrasonography and magnetic resonance imaging) as a preoperative examination for patients with breast cancer. METHODS: From April to May 2009, a retrospective review was performed for the prospectively collected 143 patients who were diagnosed with breast cancer. All the patients received a conventional imaging examination and BSGI before definitive surgery. The patients underwent BSGI with intravenous injection of 30 mCi of (99m)Tc-sestamibi through the contralateral antecubital vein. After 10 minutes, the craniocaudal and mediolateral oblique images were obtained. All the imaging findings were correlated with the final pathologic examination. RESULTS: The mean age of the patients was 49.7+/-9.4 years (range, 27-77). In 143 patients, 166 malignant lesions were identified by pathologic examination (invasive cancer: 96 (67.1%), ductal carcinoma in situ 14 (9.8%) and invasive cancer with carcinoma in situ 33 (23.1%). The conventional imaging modalities found 166 malignant lesions and BSGI found 156 malignant lesions. The rate of correspondence was 94.0% between the conventional imaging modalities and BSGI for malignant lesions. For BSGI, there were 4 false positive findings and 10 false negative findings. BSGI found no occult cancers that were missed by conventional imaging modality. For making the diagnosis of axillary lymph node metastasis, the sensitivity, specificity and accuracy were 33.3%, 92.1%, and 69.9% for BSGI, and 55.6%, 77.5%, and 69.2%, for ultrasonography, respectively. CONCLUSION: BSGI may have the potentiality to make a correct diagnosis in breast cancer patients. However, in this study, it seems that BSGI is not superior to conventional imaging modalities. BSGI is not a standard method to evaluate breast cancer lesions before surgery.

Needs and Satisfaction of Cancer Patients on the Medical Services in Jeju Special Self-Governing Province / 한국호스피스완화의료학회지

PURPOSE: The purpose of the present study was to investigate needs and satisfaction on the medical services of cancer patients in Jeju Special Self-Governing Province. METHODS: Total 174 cancer patients, who visited at the clinic of Jeju National University Hospital, submitted informed consent and participated in this study from July 13 to July 30, 2009. Self questionnaire was used and data were analyzed with Kolmogorov-Smirnov test, Mann-Whitney U test, ANOVA, and Kruskal-Wallis test. RESULTS: Participants expressed the needs of most economical support (3.38 out of 4), followed by counseling of treatment plan (3.22), information of disease (3.07), and disease management except cancer (2.97). Participants were satisfied most with religious counseling (3.41), followed by nursing service support (3.39), employment counseling (3.26), and counseling for family or interpersonal relationships (3.26). The satisfaction of economical support was the lowest (1.98). Satisfaction of men was higher than women, and needs in patients who were living with children was the highest. Patients who were living alone or with children showed the lowest satisfaction about the medical services. There were no significant differences in the general characteristics, however, participants who were older than 60 years of age or had higher income showed lower needs and higher satisfaction. There were no significant differences in the medical characteristics, however, thyroid cancer patients and patients who were treated with radiation therapy or transarterial embolization showed low satisfaction. CONCLUSION: Cancer patients seemed to need more economical support, information of treatment or disease, and symptom management. Furthermore, there were various needs about the services, depending on family formation or economical support of patients. Therefore, it is certain that patients who were suffering from other cancers, except the 5 major cancers, needed more services. In conclusion, continuous and systemic policy to consider patient's characteristics and needs are needed in community as well as health care system.

Clinical Usefulness of Sentinel Lymph Node Biopsy in the Surgical Treatment of Malignant Melanoma

PURPOSE: The aim of this study was to evaluate the usefulness of sentinel lymph node (SLN) biopsy in the treatment of primary melanoma. METHODS: Fifty-one cases that were diagnosed as malignant melanoma of the skin without clinical evidence of regional lymph node metastasis and underwent SLN biopsy at Samsung Medical Center were analyzed retrospectively. A lymphoscintigraphy with peritumoral injection of radionuclide was performed preoperatively. SLNs were identified using a hand-held gamma probe and by methylene blue dye injection intraoperatively. RESULTS: Twenty patients (39%) had metastasis in the SLN and they underwent immediate complete radical dissection of the nodal basin. Among the 20 patients who had SLN metastasis, additional metastatic lymph nodes were detected in 5 patients after the complete lymph node dissection. When several clinico-pathologic parameters such as gender, age, primary tumor location, draining nodal basin, tumor depth and size of tumor were compared between SLN positive group and negative group, there was a significant difference in the mean thickness of melanoma between SLN (+) group (5+/-2.9 mm) and SLN (-) group (4.5+/-5.0 mm) (P<0.05). In the same way, as the thickness of melanoma increased, positive SLN were detected more frequently (P<0.05). Recurrences occurred in 18 patients (35.3%) during the follow-up period, but only one case in 31 patients with negative SLN recurred at the SLN basin without evidence of distant or loco-regional recurrence (false negative rate 4.8%). Lymphedema of extremity developed in 9 patients who underwent complete radical lymph node dissection and 2 patients who underwent only SLN biopsy had a very mild-form lymphedema. CONCLUSION: SLN biopsy in the treatment of cutaneous melanoma is a safe, useful and feasible method to identify status of regional lymph node with low false negative rates and low complications.

Thyroidectomy Using Ultrasonically Activated Shears; Prospective Randomized Study / 대한내분비외과학회지

PURPOSE: Adequate hemostasis in thyroidectomy is important to reduce postoperative complications including bleeding and hematoma. The object of this study was to evaluate the utility of thyroidectomy using ultrasonically activated shears. METHODS: This was a prospective randomized controlled study. It was conducted on 95 patients who underwent total thyroidectomy between January and March 2009. Patients were divided into two groups according to operation method used: group A (n=49) underwent total thyroidectomy using ultrasonically activated shears, group B (n=46) involved the conventional clamp and tie maneuver. Comparisons included operation time, drain amount, hospitalization, postoperative complications and off-thyroglobulin. RESULTS: The two groups had no significant differences regarding drain amount, hospitalization, postoperative complications and off-thyroglobulin. Operation time was statistically shorter in group A than group B (96.6±22.7 min vs 114.6±24.3 min) (P=.00). CONCLUSION: Thyroidectomy using ultrasonically activated shears reduces operation time significantly, and enables a complete and safe operation without postoperative complications. We recommend the use of ultrasonically activated shears in thyroidectomy.

Implications of Isolated Tumor Cells in Sentinel Lymph Nodes of Breast Cancer Patients

PURPOSE: Sentinel lymph node (SLN) biopsy has replaced unnecessary axillary dissection in breast cancer surgery except when the nodes are positive for macrometastasis. But guidelines for isolated tumor cells (ITCs) found in SLNs has not yet been established and further study is ongoing. The goal of this study was to consider the implication of the isolated tumor cells found in the SLNs of Korean breast cancer patients. METHODS: Between September 2003 and March 2008, 985 primary breast cancer patients underwent SLN biopsy. On reviewing the medical records, 81 patients were found to have ITCs in SLNs without macrometastasis or micrometastasis. ITCs were detected by serial sectioning and immunohistochemistry. RESULTS: The mean number of detected SLNs was 3.5+/-1.7. Thirty three patients had multifocally distributed ITCs and 9 had ITCs in multiple SLNs whose N stage was N0 (i+). Completion axillary dissection has been performed in 9 patients and 3 of them (33.3%) finally were found to be N1 or N1mi. CONCLUSION: The characteristics of ITCs are not clear yet and their prognostic value is still under investigation. Until the significance of ITCs found in SLNs become definite, axillary dissection should be more aggressively considered.

Left Ventricular Sphericity Index in Asymptomatic Population

BACKGROUND: Left ventricular (LV) remodeling manifests as an increase in LV end-diastolic and end-systolic volumes, an increase in myocardial mass, and a change in chamber geometry to a more spherical shape, and has been considered to be a consequence of heart failure, myocardial infarction or mitral regurgitation. However, less is known about change of LV geometry, especially LV sphericity, in asymptomatic population according to aging. METHODS:We investigated 261 asymptomatic subjects who volunteered for health screening and underwent transthoracic echocardiography. Those with poor echo image, significant coronary artery disease, LV dysfunction, hypertension, and diabetes mellitus were excluded. LV sphericity index is defined as the ratio of the long-axis length divided by LV short-axis length, both during systole and diastole. LV mass was calculated from septal and posterior wall thickness and LV internal dimension at end-diastole and then divided by body surface area to calculate LV mass index RESULTS: The mean age of subjects was 49.6+/-6.7 years and the percentage of male was 81%. LV sphericity index at diastole showed significant correlation with age (r=-0.17, p value<0.01), but LV sphericity index at systole did not. Both indices did not showed significant association with aerobic fitness, blood pressure, glucose, insulin resistance and LV function. LV mass index showed significant correlation with age (r=0.14, p value<0.05). CONCLUSION: Among the parameters of LV geometry, sphericity index showed decrease with aging in healthy population, meaning LV becoming more spherical with aging. Longitudinal follow-up study is needed to determine its usefulness as a predictor of future LV dysfunction in asymptomatic population.

Sensory Loss of Upper Inner Arm and Nipple after Transaxillary and Periareolar Augmentation Mammaplasty - MDbP204

PURPOSE: Transaxillary and periareolar incision in augmentation mammaplasty has risks of injury to branches of intercostal nerves that lead to sensory loss of upper inner arm and nipple. The aim of study was to compare the incidence of sensory loss between two groups according to incision method. METHODS: One hundred seventy one cases that received transaxillary or periareolar subpectoral breast augmentation at the M.D. Clinic from Jan. 2006 to Jul. 2007 were evaluated for sensory loss of upper inner arm and nipple. The cases were divided into transaxillary (118 cases, 69%) and periareolar group (53 cases, 31%). The type of sensory loss was divided into temporary and permanent. The postoperative follow-up periods were from 7 to 22 months (mean: 8.5 months). RESULTS: In cases of upper inner arm, results were as follows; temporary sensory loss in 9 cases (7.6%) and permanent in 2 cases (1.7%) in the transaxillary incision group and, temporary sensory loss in 1 case (1.9%) and no permanent sensory loss in the periareolar incision group. There is no statistical difference between the two groups for permanent sensory loss (P=0.340). In cases of nipples, results were as follows; temporary sensory loss in 26 cases (22%) and permanent sensory loss in 12 cases (10.2%) in the transaxillary incision group, and temporary sensory loss in 12 cases (10.2%) and permanent sensory loss in 3 cases (5.7%) in the periareolar incision group. There was no statistical difference between two groups (P=0.335). CONCLUSION: There was no statistical difference in sensory loss of upper arm and nipple between transaxillary and periareolar approach after subpectoral augmentation mammaplasty.

Arm Sentinel Lymph Node Detection for Preserving the Arm Lymphatic System / 한국유방암학회지

PURPOSE: The objective of arm sentinel lymph node (SLN) detection were to identify the presence of different drainage tracts of the breast and arm lymphatics and eventually to prevent lymphedema after an axillary procedure. METHODS: Twenty one patients underwent surgery for breast cancer, with arm SLN detection, from March to July 2008 at Samsung Medical Center. We used the (99)Tc-tin colloid isotope in two patients, blue dye in 18 and green dye in one for the arm SLN detection. RESULTS: Stained and/or hot nodes from the arm lymphatics were identified in 15 of the 21 patients (71.4 %). Among the 15 patients who had the arm SLN identified, one patient had a metastasis at the arm SLN, and another patient had common breast and arm lymphatic drainage. CONCLUSION: Identification of the arm lymphatic drainage was possible. Since there were cases of common pathway of the arm and breast lymphatics and metastasis of the arm SLN, we cannot conclude that the arm SLN detection was safe and effective. A subsequent study for identifying the presence of two different drainage systems of the breast and arm lymphatics and confirmation of no metastasis at the arm SLN is needed.

Experience with Intracystic Papillary Carcinoma of the Breast at a Single Institute in Korea / 한국유방암학회지

Intracystic papillary carcinoma (IPC) of the breast is a rare entity, which can be associated with ductal carcinoma in situ (DCIS) or an invasive carcinoma. There have been only limited reports describing IPC in Korea and the incidence among breast cancer cases in Korea has not yet been reported. From a database of 7,109 breast cancer cases treated surgically at Samsung Medical Center, we could only identify four IPC cases (0.056%). We also found that there are some differences between the clinicopathological characteristics of our cases and the alleged characteristics of IPC as reported from Western countries, such as a relatively young age of onset, small tumor size and various expression levels of hormonal receptors. We suspect this very low incidence may be caused by a true rarity of IPC in women in Korea or may be due to a lack of clinical interest for IPC. Upon presentation of our experience with IPC, we suggest the diagnosis for this rare disease entity needs to be reappraised.

The Impact of the Ratio of Positive Nodes to Removed Nodes on Recurrence and Overall Survival in Node Positive Breast Cancer Patients / 한국유방암학회지

PURPOSE: The status of axillary lymph node (LN) metastasis is the most important prognostic factor in breast cancer. Postoperative regional nodal radiotherapy is recommended usually based on the number of metastatic LNs, which is associated with the total number of removed LNs during the axillary dissection. We evaluated the prognostic impact of the ratio of metastatic LNs to removed LNs on disease free survival and overall survival in breast cancer patients. METHODS: The medical records of 743 breast cancer patients with metastatic axillary LNs and treated at Samsung Medical Center between 1994 and 2003 were retrospectively analyzed. The ratio of metastatic/removed LNs as well as the other prognostic factors were analyzed. RESULTS: Both disease-free survival and overall survival rates were significantly worse in patients with a ratio of metastatic/removed LNs greater than 20% compared to those patients with a ratio of less than 20% (p=0.028, p<0.001, respectively). In patients with T1-2 and N1 breast cancer, the ratio of metastatic/removed LNs greater than 20% was significantly associated with poorer disease-free survival (p=0.027). CONCLUSION: A ratio of metastatic/removed LNs greater than 20% in the axilla can be an adverse prognostic factor in breast cancer patients with axillary node metastasis. In T1-2 N1 breast cancer patients, adjuvant radiotherapy as well as more aggressive chemotherapy therapy may be indicated.

Risk Factors for Predicting New-Onset Atrial Fibrillation in Persons Who Received Health Screening Tests

BACKGROUND AND OBJECTIVES: Atrial fibrillation (AF) is the most common significant arrhythmia in the general population, and it is associated with increased cardiovascular morbidity and mortality. The incidence of and the risk factors for new-onset AF have not been well evaluated in Koreans. SUBJECTS AND METHODS: We retrospectively analyzed 16,568 adults (median age 49 years, 10,685 males and 5,883 females) who had repeatedly received screening tests for general health at the Health Promotion Center, Samsung Medical Center in Korea between March, 2001 and June, 2006 (mean follow up duration: 44 months). RESULTS: Sixty one cases had new-onset AF noted on the electrocardiogram (ECG). On the univariate analysis, age, male gender, a history of coronary artery disease and taking hypertension medication, the waist circumference, body mass index, fasting glucose, hemoglobin A1c, fibrinogen, and left atrium enlargement seen on ECG at baseline were significantly associated with new-onset AF. After multivariable adjustment, the independent risk factors for predicting new-onset AF were male gender [odds ratio (OR): 3.356, 95% confidence interval (CI): 1.168-9.643, p=0.025] and a history of coronary artery disease (OR: 4.657, 95% CI: 1.703-12.737, p=0.003). CONCLUSION: The risk factors for predicting new-onset AF in persons who received general health screening tests were male gender and a history of coronary artery disease.

Proximal Metatarsal Chevron Osteotomy for Moderate to Severe Hallux Valgus: A Mean Eight Year Follow up / 대한족부족관절학회지

PURPOSE: The purpose of the present study is to evaluate the proximal metatarsal chevron osteotomy outcomes for moderate to severe hallux valgus more than seven year follow up. MATERIALS AND METHODS: Between 1996 and 1998, hallux valgus 61 cases were evaluated. The follow up period was more than seven years. The clinical review analyzed by the hallux metatarsophalangeal-interphalangeal scale of the American Orthopedic Foot and Ankle Society, radiologic review by the hallux valgus angle, first and second intermetatarsal angle. Complication also evaluated. RESULTS: Clinically, preoperative AOFAS score was average 43 points (range; 16~60 points) which significantly improved to 88 points (range; 61~100 points) at last follow up periods. Radiologically, the mean preoperative, postoperative, last follow up hallux valgus angle was 34 degrees, 5.2 degrees, 10.9 degrees. The mean preoperative, postoperative, last follow up intermetatarsal angle was 15.3 degrees, 3.3 degrees, 5.3 degrees. Postoperative angle change were no statistical significance (p>0.05). Complication were hallux varus 6 cases, metatarsophalangeal joint arthritis 2 cases, recurrence 1 case. CONCLUSION: Proximal metatarsal chevron osteotomy shows satisfactory outcome for moderate to severe hallux valgus more than seven year follow up.

Mid to Long Term Follow-up Results of Reconstruction in Rheumatoid Arthritic Forefoot Deformities / 대한족부족관절학회지

PURPOSE: We assess the mid to long term follow up results of arthrodesis of the first metatarso-phalangeal (MTP) joint and resection arthroplasty of the lesser toes in rheumatoid arthritic forefoot deformity. MATERIALS AND METHODS: Between 1998 to 2001 year, 25 cases (18 patients) rheumatoid forefoot deformities were surgically corrected. Follow up period was 83 months (range, 63 to 90 months). The clinical outcome was evaluated using subjective satisfaction and AOFAS score. The radiological measurements were hallux valgus angle, first and second intermetatarsal angle, second metatarso-phalangeal angle (MTP-2nd angle). RESULTS: Subjective satisfaction was 76%. AOFAS score improved from 37 to 73. The hallux valgus angle improved from preoperative 39 degrees (27~64 degrees) to 14 degrees (4~34) at the last follow up. The intermetatarsal angle were preoperative 13 degrees (6~22 degrees) to 11 degrees (3~13 degrees) at the last follow up, The MTP-2nd angle were preoperative 24 degrees (9~47) to last follow up 15 degrees (2~39 degrees) respectively (p>0.05). Complication was intractable callus 10 cases, Interphalangeal arthritis 5 cases. CONCLUSION: Mid to long term outcomes rheumatoid forefoot reconstruction by first MTP arthrodesis and resection arthroplasty of lesser toes results a satisfaction and pain relief.

Total Ankle Arthroplasty : Short Term follow up Results of Semiconstrained Type and Unconstrained Type / 대한족부족관절학회지

PURPOSE: The purpose of this study is to compare the two prosthesis that used for total ankle arthroplasty. MATERIALS AND METHODS: From Sept. 2003 to Jun 2006, 13 patients and 14 ankles that could be follow up more than 1 months. Semiconstrained type (Group I, 7 cases) and Unconstrained type (Group II, 7 cases) were used for total ankle arthroplasty. Mean age was 63.2 year-old, 12 ankles are men and 2 ankles were women. Mean follow up periods were 29 months. The criteria to compare the clinical result were postoperative range of motion, AOFAS score and residual bone stock of medial malleolus. RESULTS: Postoperative range of motion of group I was 43.6+/-9.4 degrees and of group II was 50.7+/-7.3 degrees (p=0.115). Postoperative AOFAS score of group I was 77.1+/-13.0 points and of group II was 86.0+/-5.7 points (p=0.094). Resected bone stock in medial malleolus of group I was 10.7+/-2.5 mm and of group II was 5.1+/-1.2 mm (p=0.003). Total number of complication in our study was 9 cases. 3 cases were a malleolar fracture, two occurred at intra-operation, the other at follow-up period. Re-operation was done in 6 cases, 3 cases were calcaneal corrective osteotomy, 2 cases were resection of a heterotopic bone and one case was pedicular flap operation for skin problem. CONCLUSION: In our hospital, mobile bearing type prosthesis shows good result than a semiconstrained type in respect of residual bone stock in medial malleolus. Postoperative range of motion and AOFAS score between two groups shows no significant difference. But small number of patients and short term follow up period is a defect in our study, afterward more population and long term follow up period are needed.

Anatomical Study of Interdigital Neuroma Occurring Site and the Deep Transverse Metatarsal Ligament (DTML) / 대한족부족관절학회지

PURPOSE: We examined the relationship of interdigital neuroma occurring site and the surrounding structures, including the deep transverse metatarsal ligament (DTML) by cadaver study and clinical results. MATERIALS AND METHODS: Seventeen fresh frozen cadavers study were done to evaluate the relationship of interdigital neuroma occuring site and the DTML at two phase of the gait cycle with 60 degree of metatarsophalangeal dorsiflexion and with 15 degrees of ankle dorsiflexion. We measured the distance from interdigital nerve bifurcation of the common digital nerve to anterior margin of the DTML and longitudinal length of DTML itself. Clinically, we checked the location of interdigital neuroma and DTML length during surgery in 32 feet. RESULTS: In the second and third web space, the mean distance from bifurcation of the common digital nerve of foot to the anterior margin of DTML was 16.7 mm, 15.1 mm in the mid-stance position, and 15.9 mm. 14.6 mm in heel-off position. Second, Third web space ligament itself length were average 12.8 mm, 10.6 mm. Clinically, all of the cases of interdigital neuroma started at the bifurcation area of the common digital nerve and interdigital neuroma was average 7.5 mm (range; 6-11 mm). CONCLUSION: Interdigital neuroma were located more distally than DTML in both the mid-stance and heel off stage. The main lesion was located between metatarsal head and metatarsophalangeal joint and more distal than the DTML anterior margin.