Purpose: To analyze the causes and to prevent dislocations of the hip joint that occur in patients who underwent revisions of total hip arthroplasties by changing only the polyethylene liners and femoral heads, subsequent to primary total hip arthroplasties. Materials and Methods: We evaluated 28 patients who underwent acetabular component revisions of total hip arthroplasties subsequent to primary total hip arthroplasties. The average age of the patients was 55 years old and all 28 patients had operations through the posterolateral approach. In 17 of the cases, the acetabular cups, polyethylene liners, and femoral heads were changed; in 10 cases, just the polyethylene liners and femoral heads were changed; and in 1 case, only the polyethylene liner was changed. Results: We observed 7 cases of hip dislocations that occurred among a total of 28 cases after revisions of total hip arthroplasties. In all 7 cases, the polyethylene liners and femoral heads were changed, but not the acetabular cups. In additional, in all 7 cases of dislocation, the patients were non-compliant and started weight-bearing prematurely after revisions of the total hip arthroplasties Conclusion: We observed new dislocations in the 7 cases in which the polyethylene liners and femoral heads were changed. The main reasons were inadequate soft tissue tension and hip joint laxity. Therefore, it is necessary to increase the neck length, use elevated rim polyethylene liners, readjust the acetabular cups to their optimal positions, and apply hip abduction braces to patients early after revision of total hip arthroplasties in order to lessen the danger of dislocations.
Acetabulum* ; Arthroplasty ; Braces ; Dislocations* ; Head ; Hip ; Hip Dislocation ; Hip Joint ; Humans ; Neck ; Polyethylene ; Risk Factors* ; Weight-Bearing

PURPOSE: Laparoscopic colectomy has clinical benefits such as short hospital stay, less postoperative pain, and early return of bowel function. However, objective evidence of its immunologic and oncologic benefits is scarce. We compared functional recovery after open versus laparoscopic sigmoidectomy and investigated the effect of open versus laparoscopic surgery on acute inflammation as well as tumor stimulation. MATERIALS AND METHODS: A total of 57 patients who were diagnosed with sigmoid colon cancer were randomized for elective conventional or laparoscopically assisted sigmoidectomy. Serum samples were obtained preoperatively and on postoperative day 1. C-reactive protein (CRP) and interleukin-6 (IL-6) were measured as inflammation markers, and vascular endothelial growth factor (VEGF) and insulin-like growth factor binding protein-3 (IGFBP-3) were used as tumor stimulation factors. Clinical parameters and serum markers were compared. RESULTS: Postoperative hospital stay (p=0.031), the first day of gas out (p=0.016), and the first day of soft diet (p<0.001) were significantly shorter for the laparoscopic surgery group than the open surgery group. The levels of CRP, IL-6, and VEGF rose significantly, and the concentration of IGFBP-3 fell significantly after both open and laparoscopic surgery. However, there were no significant differences in the preoperative and postoperative levels of CRP, IL-6, VEGF, and IGFBP-3 between the two groups. CONCLUSION: Our data suggest that both open and laparoscopic surgeries are accompanied by significant changes in IL-6, CRP, IGFBP-3, and VEGF levels. Acute inflammation markers and tumor stimulating factors may not reflect clinical benefits of laparoscopic surgery.
Aged ; Biological Markers/blood ; C-Reactive Protein/metabolism ; Colectomy/*adverse effects/methods ; Female ; Humans ; Inflammation/etiology/metabolism ; Insulin-Like Growth Factor Binding Protein 3/blood ; Interleukin-6/blood ; Laparoscopy/adverse effects ; Male ; Middle Aged ; Postoperative Period ; Sigmoid Neoplasms/*surgery ; Treatment Outcome ; Vascular Endothelial Growth Factor A/blood

The authors diagnosed a 54-year-old male as central mucoepidermoid carcinoma after undegoing clinical, radiologica l and histopathological examinations. The charateristics were as followed : 1. Clinically, the patient complained of the painless unilateral swelling of the left mandibular molar region and had a pus discharge through the fistula. Painful nodule was palpated on the scalp of the left frontal area and it was regarde d as a metastatic lesion. 2. Plain radiographs showed the ill-defined permeative radiolucent lesion. The osteolytic lesions were also detected in the cranial bone, number 9 and 11 ribs, scapula, and vertebral bodies. 3. The mandibular CT and PNS MRI showed the swelling of the left mandible and the enlargement of the several lymph node s of 1.5 cm in size. 4. Histopathologically, many solid epidermoid type cells were mixed with mucus-secreting cells and they were arranged i n duct-like structure. Most of them were epidermoid type, which indicates a high grade tumor. Mucins could be found in mucicarmine staining.
Carcinoma, Mucoepidermoid* ; Fistula ; Humans ; Lymph Nodes ; Magnetic Resonance Imaging ; Male ; Mandible* ; Middle Aged ; Molar ; Mucins ; Neoplasm Metastasis* ; Ribs ; Scalp ; Scapula ; Suppuration

The authors diagnosed a 54-year-old male as central mucoepidermoid carcinoma after undegoing clinical, radiologica l and histopathological examinations. The charateristics were as followed : 1. Clinically, the patient complained of the painless unilateral swelling of the left mandibular molar region and had a pus discharge through the fistula. Painful nodule was palpated on the scalp of the left frontal area and it was regarde d as a metastatic lesion. 2. Plain radiographs showed the ill-defined permeative radiolucent lesion. The osteolytic lesions were also detected in the cranial bone, number 9 and 11 ribs, scapula, and vertebral bodies. 3. The mandibular CT and PNS MRI showed the swelling of the left mandible and the enlargement of the several lymph node s of 1.5 cm in size. 4. Histopathologically, many solid epidermoid type cells were mixed with mucus-secreting cells and they were arranged i n duct-like structure. Most of them were epidermoid type, which indicates a high grade tumor. Mucins could be found in mucicarmine staining.
Carcinoma, Mucoepidermoid* ; Fistula ; Humans ; Lymph Nodes ; Magnetic Resonance Imaging ; Male ; Mandible* ; Middle Aged ; Molar ; Mucins ; Neoplasm Metastasis* ; Ribs ; Scalp ; Scapula ; Suppuration

Duplicated inferior vena cava (IVC) is a congenital anomaly seen rarely in the general population. Patients with IVC variants usually do not present any symptoms and are found incidentally in many cases. However, physicians are urged to recognize the presence of such anomalies during diagnostic or invasive procedures as these variants of blood vessel systems can impose substantial implications in certain clinical situations. Subsequently, information about IVC variants may become critical if surgical injuries or predisposing conditions act as life-threatening risks to patients during medical procedures. We present a case of duplicated IVC in a 68-year-old female patient with rectal cancer where an IVC anomaly was found during surgical resection of her tumor. From our experience, we emphasize the importance of having the knowledge of IVC variations in patients undergoing invasive surgical procedures which may involve large vessels.
Aged ; Blood Vessels ; Female ; Glycosaminoglycans ; Humans ; Intraoperative Complications ; Laparotomy ; Rectal Neoplasms ; Vena Cava, Inferior

Spatio-temporal changes on c-Fos protein expression were investigated in vestibular compensation following unilateral labyrinthectomy (UL) induced by injection of arsanilate into the middle ear cavity, chemical labyrinthectomy, or surgical labyrinthectomy in medial vestibular nuclei (MVN), prepositus hypoglossal nuclei (PrH), and inferior olivary nuclei (ION) of Sprague-Dawley rats. Number of spontaneous nystagmus in surgical labyrinthectomy group was 28.2+/-.2 beats/10 sec at post-op 2 hs and the nystagmus disappeared 76 hs after UL. In chemical labyrinthectomy group, spontaneous nystagmus occurred 6 hs after UL and increased up to maximum at 12 hs and disappeared 96 hs. Head deviation in surgical labyrinthectomy group reached a peak at post-op 2 hs and recovered to control level at 144 hs, but chemical labyrinthectomy produced head deviation 24 hs after UL and increased degree of the deviation over time till 144 hs. Expression of c-Fos protein in surgical labyrinthectomy group at post-op 2 hs was 81+/-9.4 cells in ipsilateral MVN to the lesion side and 212+/-0 cells in contralateral MVN, which showed severe asymmetry between bilateral MVN, and decrease of c-Fos protein expression was more in contralateral MVN than in ipsilateral MVN at 6 hs. Chemical labyrinthectomy expressed more c-Fos protein in contralateral MVN 6 hs after UL and in ipsilateral MVN 12 hs after UL, which showed asymmetry of c-Fos protein expression between bilateral MVN. And the expression in ipsilateral MVN of chemical labyrinthectomy group was increased gradually 48 hs after UL and reached a peak at 72 hs. In chemical labyrinthectomy group, expression of c-Fos protein in PrH was increased more in ipsilateral than in contralateral 6 hs after UL and more in contralateral 12 hs after UL, and ION showed more expression of c-Fos protein in contralateral than in ipsilateral 6 hs after UL through 72 hs. These results suggest that the course of vestibular compensation and the temporal expression of c-Fos protein in the brain stem nuclei following UL differed between surgical and chemical labyrinthectomy.
Animals ; Arsanilic Acid ; Brain Stem* ; Brain* ; Compensation and Redress ; Ear, Middle ; Head ; Rats* ; Rats, Sprague-Dawley ; Vestibular Nuclei

PURPOSE: The proportion of sphincter-saving operations for lower rectal cancer is increasing with improved surgical techniques and additional concurrent preoperative chemo-radiation therapy. A defunctioning ileostomy or colostomy is performed after a sphincter-saving operation in the belief that diverting the fecal stream will prevent anastomotic leakage. This study was undertaken to assess all morbidity and combined problems associated with a temporary loop ileostomy. METHODS: A total of 167 patients who had undergone an ileostomy after a proctectomy between July 1997 and May 2007 were enrolled in this study. All patients were analyzed retrospectively, and the enrolled patients were registered in the Colorectal Cancer Database and were followed prospectively. Three patients did not receive an ileostomy take-down operation because of tumor recurrence. RESULTS: Complications of ileostomy formation developed in 20 (11.9%) cases. There were no significant relevant factors influencing the complications of ileostomy formation. Complications related with ileostomy take-down developed in 33 (17.9%) cases. Longer operation time, perioperative transfusion, and postoperative radiotherapy were statistically significant factors related to the complications of ileostomy take-down (P=0.047, P=0.019, P=0.042). After ileostomy take-down, six patients were identified with complications, such as a rectovaginal fistula or an anastomotic stenosis, related with rectal cancer surgery. CONCLUSIONS: The useful ileostomy sometimes carries certain morbidity; therefore, an ileostomy should be performed selectively, and the decision should be made with care. Also, a careful evaluation of the distal part of an ileostomy is necessary before and after an ileostomy take-down.
Anastomotic Leak ; Colorectal Neoplasms ; Colostomy ; Constriction, Pathologic ; Humans ; Ileostomy ; Prospective Studies ; Rectal Neoplasms ; Rectovaginal Fistula ; Recurrence ; Retrospective Studies ; Rivers

A rectal carcinoma, including primary an adenosquamous and a squamous cell carcinoma (SCC), is a very rare disease, accounting for 0.025% to 0.20% of all large-bowel malignant tumors. Because SCCs have a higher mortality than adenosquamous carcinomas, determining whether the primary rectal cancer exhibits an adenomatous component or a squamous component is important. While differentiating between these 2 components, especially in poorly differentiated rectal cancer, is difficult, specific immunohistochemical stains enable accurate diagnoses. Here, we report the use of immunohistochemical stains to distinguish between the adenomatous and the squamous components in 2 patients with low rectal cancer, a 58-year-old man and a 73-year-old woman, who were initially diagnosed using the histopathologic results for a poorly differentiated carcinoma. These data suggest that using these immunohistochemical stains will help to accurately diagnose the type of rectal cancer, especially for poorly differentiated carcinomas, and will provide important information to determine the proper treatment for the patient.
Aged ; Carcinoma, Adenosquamous ; Carcinoma, Squamous Cell* ; Coloring Agents ; Diagnosis ; Epithelial Cells* ; Female ; Humans ; Immunohistochemistry ; Middle Aged ; Mortality ; Rare Diseases ; Rectal Neoplasms*

Among women with intestinal endometriosis, the sigmoid colon and rectum are the most commonly involved areas. Sometimes, the differential diagnosis of colorectal endometriosis from carcinoma of the colon and rectum is difficult due to similar colonoscopic and radiologic findings. From October 2002 to September 2007, we performed five operations with curative intent for rectal and sigmoid colon cancer that revealed intestinal endometriosis. Colonoscopic and radiologic findings were suggestive of carcinoma of rectum and sigmoid colon, such as rectal cancer, sigmoid colon cancer and gastrointestinal stromal tumor (GIST). Anterior resection was performed in two patients, low anterior resection was performed in one patient and laparoscopic low anterior resection was done in two patients. We suggest to consider also intestinal endometriosis in reproductive women presenting with gastrointestinal symptoms and an intestinal mass of unknown origin.
Adult ; Carcinoma/*diagnosis ; Diagnosis, Differential ; Endometriosis/*diagnosis/pathology/surgery ; Female ; Humans ; Middle Aged ; Rectal Neoplasms/*diagnosis ; Sigmoid Neoplasms/*diagnosis

The incidence of extramammary Paget's disease (EMPD) is very low. An 84-year-old Korean man was treated with topical and oral medications at a local dermatologic clinic for a year, but the symptoms did not improve. He visited Severance Hospital and underwent a perianal skin biopsy and was finally diagnosed with EMPD. The authors performed a wide local excision according to a 1-cm margin around the lesion. For the skin and the soft tissue defects, bilateral inferior gluteal artery perforator flap transpositions were performed. The size of the lesion was 14 cm2 x 9 cm2, and the lateral and the basal margins were all disease free.
Aged, 80 and over ; Arteries ; Biopsy ; Humans ; Incidence ; Paget Disease, Extramammary ; Perforator Flap ; Skin