Thirty-one distal femoral and nine proximal tibial primary bone tumor patients who had prosthetic replacements were reviewed retrospectively. Average follow-up was thirty-eight months(range: 12- 109 months). There were thirty-two(osteosarcoma: 29, chondrosarcoma: 3) stage IIB lesions and eight 1B lesions(giant cell tumor). Twenty-nine patients were surviving at final follow-up. Overall prosthetic survival was 81%, 27% at 2 and 5 year respectively. Eleven prostheses were revised. The causes of revisions were infection(7), metal failure(2), fracture of host bone(1), and loosening(1). Eight revisions were successful, one was fair, and two patients needed an amputation. Prognostic factors which were analyzed for survival of prostheses were age, sex, location of primary lesion, percent of bone resected, and stage. Only the location of primary lesion showed statistical significance and diabolic pattern of survival curve was noted between two groups in resection length(<40% versus >40%). Average functional score was 26. The tibial side had worse prosthetic survival and a major threat to this procedure was due to infection.
Amputation ; Chondrosarcoma ; Follow-Up Studies ; Humans ; Knee Joint* ; Knee* ; Prostheses and Implants ; Prosthesis Failure ; Retrospective Studies ; Sarcoma

PURPOSE: The increased expression of cyclooxygenase (COX)-2 has been implicated in the development and progression of human cancer. This study investigated the COX-2 expression in colorectal cancer, and its relationships with tumor angiogenesis and the clinicopathological factors. MATERIALS AND METHODS: The expression of the COX-2 protein and microvessel density were evaluated, using immunohistochemical methods, in 21 normal colonic mucosa and 190 human colorectal carcinomas. Correlations between COX-2 expression and microvessel density, as well as various clinicopathological factors, were studied in colorectal carcinomas. RESULTS: The COX-2 protein expression in epithelial cells was increased in 169 of the 190 adenocarcinoma cases (88.9%), but in only 1 of the 21 (4.8%) normal mucosa cases. The COX-2 expression was significantly increased in the differentiated compared with the undifferentiated colorectal carcinomas (p<0.05), and significantly correlated with the depth of invasion and microvessel density (p<0.05). Rectal cancers had more COX-2 positive cases than the colon cancers (p<0.05). However, there were no significant differences in the tumor size and the presence of lymphatic or vascular invasion. CONCLUSION: The overexpression of cyclooxygenase-2 in colorectal carcinomas seems to play a role in the invasion and angiogenesis of the tumors, so may be a useful marker of the prognosis. The prominent expression was also demonstrated in differentiated colorectal cancers.
Adenocarcinoma ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms* ; Cyclooxygenase 2* ; Epithelial Cells ; Humans ; Microvessels* ; Mucous Membrane ; Prognosis ; Prostaglandin-Endoperoxide Synthases ; Rectal Neoplasms

Traumatic diaphragmatic hernia may show a delayed presentation and it rarely simulates pleural effusion. We report here on two asymptomatic cases that were diagnosed by performing chest CT.
Hernia, Diaphragmatic ; Hernia, Diaphragmatic, Traumatic* ; Omentum ; Pleural Effusion* ; Tomography, X-Ray Computed

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) strategy is proposed to reduce the ventilator-induced lung injury in acute respiratory distress syndrome (ARDS). As ECMO use has increased, a number of studies on prognostic factors have been published. Age is estimated to be an important prognostic factor. However, clinical evidences about ECMO use in elderly patients are limited. Therefore, we investigated clinical courses and outcomes of ECMO in elderly patients with ARDS. METHODS: We reviewed medical records of patients with severe ARDS who required ECMO support. Study patients were classified into an elderly group (> or = 65 years) and a non-elderly group (< 65 years). Baseline characteristics, ECMO related outcomes and associated factors were retrospectively analyzed according to group. RESULTS: From February 2011 to June 2013, a total of 31 patients with severe ARDS were treated with ECMO. Overall, 14 (45.2%) were weaned from ECMO, 9 (29.0%) survived to the general ward and 7 (22.6%) survived to discharge. Among the 18 elderly group patients, 7 (38.9%) were weaned from ECMO, 4 (22.2%) were survived to the general ward and 2 (11.1%) were survived to discharge. Overall intensive care unit survival was inversely correlated with concomitant acute kidney injury or septic shock. CONCLUSIONS: In this study, ECMO outcome was poor in severe ARDS patients aged over 65 years. Therefore, the routine use of ECMO in elderly patients with severe ARDS is not warranted except in highly selective cases.
Acute Kidney Injury ; Aged* ; Extracorporeal Membrane Oxygenation ; Humans ; Intensive Care Units ; Medical Records ; Patients' Rooms ; Respiratory Distress Syndrome, Adult* ; Retrospective Studies ; Shock, Septic ; Ventilator-Induced Lung Injury

PURPOSE: A distal pancreatectomy was often simultaneously performed with splenectomy and total gastrectomy in the treatment of gastric carcinoma for complete removal of lymph nodes around the splenic artery. However, pancreatic juice leakage, subphrenic abscess, and postoperative diabetes were common complications in patients treated by pancreas resection. We performed a retrospective analysis to evaluate the role of distal pancreatectomy on the prognosis of gastric cancer patients. MATERIALS AND METHODS: The effect of distal pancreatectomy on survival was studied by examination of the records of 120 patients who underwent splenectomy and total gastrectomy for gastric carcinoma with serosal invasion. Of these, 75 underwent pancreas preserving splenectomy and 45 underwent pancreaticosplenectomy. Prognostic factors and postoperative complications were evaluated according to the operation types. RESULTS: The addition of distal pancreatectomy to splenectomy with total gastrectomy for patients with gastric cancer was not associated with severe complications. And patients underwent pancreaticosplenectomy showed similar survival as those underwent pancreas preserving splenectomy. CONCLUSION: Distal pancreatectomy for the gastric cancer patients with suspected metastatic lymph nodes around the splenic artery could be recommended for the purpose of radical lymph node dissection.
Gastrectomy* ; Humans ; Lymph Node Excision ; Lymph Nodes ; Pancreas ; Pancreatectomy* ; Pancreatic Juice ; Postoperative Complications ; Prognosis* ; Retrospective Studies ; Splenectomy ; Splenic Artery ; Stomach Neoplasms* ; Subphrenic Abscess

PURPOSE: The exact role of postoperative radiotherapy following curative surgery of rectal carcinoma has been debated. In this retrospective study, we examined the effect of radiotherapy on the survival and recurrence rate of rectal cancer patients who underwent total mesorectal excision (TME). METHODS: Since June of 1994, we have recommended postoperative chemoradiation (6 cycles of 5-FU with folinic acid plus 5040 cGy external irradiation) for stage II and III rectal cancer patients. Among 134 stage II and III rectal cancer patients who underwent TME, 100 patients received postoperative chemoradiation (group A) and 34 patients decided not to receive radiation therapy (group B). For these two groups, survival and recurrence rates were compared. Follow-up times were 6 to 60 months (mean 24.7). There was no difference between two groups with regard to sex, stage of the disease, mean tumor location from dentate line, status of lateral margins, type of operation and mean follow-up duration. However, mean age was higher in group B (65.6 vs 53.9, P<0.05). RESULTS: The overall recurrence rate showed no difference between two groups (28.0% in group A vs 21.0% in group B, P>0.05). Local recurrence rate was also similar (11.0% vs 3.0%). There was no significant difference in duration between surgery and initial recurrence (14.0 months vs 11.0 months, P=0.18). The 5-year-disease-free survival rate was 57.0% in group A and 63.0% in group B (P=0.33). CONCLUSION: In this study, we found no beneficial effect of postoperative radiation therapy following TME for the rectal cancer.
Fluorouracil ; Follow-Up Studies ; Humans ; Leucovorin ; Radiotherapy* ; Rectal Neoplasms* ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: Soft tissue sarcomas have a wide variety of manifestation and its course is still unpredictable in many cases. This study altlempts to analyze the meaningful prognostic factors and to find optimal treatment strategies for each clinical stage. MATERIALS AND METHODS: From May 1985 to Mar. 1997, 432 soft tissue sarcomas were enlisted and 319 cases were eligible for this retrospective study. Staging followed AJCC classification and there were 34 stage I, 69 stage II, 151 stage III and 64 cases of stage IV. For stage I and II, operation was a major tool. Radiotherapy and chemotherapy were added for each situation. Intensive chemotherapy and surgery were done for stage III and IV. Metastasectomy was added in feasible cases. RESULTS: Actual survival rate for the 319 cases was 50% at 152 months. Disease free survival for stage I, II, III was 84%, 41%, and 38%, respectively. The stage itself had a statistical significance (P<0.00001). In univariate analysis, surgical margin in stage II and local recurrence in stage III had statistical significance. Multivariate study revealed the local recurrence as the only meaningful factor in stage I, II, III. An aggressive treatment for stage IV and I, II, III with late metastasis group had significant gain on survival. CONCLUSIONS: The stage itself predicts the course of soft tissue sarcomas. Evaluation of sound surgical margin to prevent the local recurrence is necessary.
Classification ; Disease-Free Survival ; Drug Therapy ; Metastasectomy ; Neoplasm Metastasis ; Radiotherapy ; Recurrence ; Retrospective Studies ; Sarcoma* ; Survival Rate

No abstract available.
Animals ; Gonadotropin-Releasing Hormone* ; Rats* ; RNA, Messenger* ; Testis*

PURPOSE: Forearm lengths in cases of unilateral congenital radioulnar synostosis, were analysed radiographically to evaluate the amount of length discrepancy according to different types. MATERIALS AND METHODS: We measured the ulnar length ratio (length of affected forearm/length of unaffected forearm) in 15 cases of uni-lateral congenital radioulnar synostosis. We observed two distinct radiographic patterns. Type I (Lamda type) appeared to be of gamma character grossly, and showed severe radial bowing and a severely hypoplastic radial head. Type II (Chi type) seemed x like in character, showed mild radial bowing and a mildly hypoplastic, or normal radial head. RESULTS: Nine cases were type I and 6 were type II. The ulnar length ratio was 0.89 in type I and 0.98 in type II. Significant differences were formed in the ulnar length ratios between normal subject and type I, and between type I and type II (p<0.05). The equation determined by simple linear regression analysis in a patient of type I, who had been followed for 10 years, was'ulnar length ratio=0.959-0.013 X age (year)'. CONCLUSION: Unilateral congenital radioulnar synostosis can be classified into two types according to radiological morphology. This classification can be helpful in the prediction of forearm length discrepancy, and in the determination of surgical treatment type.
Classification ; Forearm* ; Head ; Humans ; Linear Models ; Synostosis*

PURPOSE: There have been few reports on the outcome of nerve grafts for radial nerve injury with a large gap. Furthermore, the results of reports are variable. It was the purpose of this study to report our results of nerve grafting for high radial nerve injury with a defect of more than 9 cm. MATERIALS AND METHODS: Five patients with high radial nerve injury were treated by sural nerve autograft. The gap of radial nerve, measured in the operative field, was 9 cm in one patient, 10 cm in three, and 11 cm in one. There were four men and one woman of average age was 35 years. The causes of the injuries were, fracture of the humerus in three patients and surgery-related complications in two. Average delay from injury to operation was 8 months, and average duration of follow up after surgery was 49 months. RESULTS: Overall motor recovery was M5 in two patients, M4 in two, and M2 in one. CONCLUSION: Good motor recovery can be expected in patients with a large gap radial nerve gap, when sural nerve autografts are sutured to areas which have motor fascicles dominantly.
Autografts* ; Female ; Follow-Up Studies ; Humans ; Humerus ; Male ; Outcome Assessment (Health Care)* ; Radial Nerve* ; Sural Nerve* ; Transplants