BACKGROUND: This study examined the clinical and radiologic mid-term results of patients treated by Oxford minimally invasive unicompartmental knee arthroplasty. METHODS: One hundred and eighty-eight knees of unicompartmental knee arthroplasties with Oxford Uni(R) in 166 patients (16 males and 150 females), which were performed between 2002 and 2005, were reviewed. The mean age was 65.3 years (range, 44 to 82 years) and the mean follow-up period was 79.8 months (range, 56 to 103 months). The preoperative diagnosis was osteoarthritis in 166 patients, osteonecrosis of the medial femoral condyle in 20 and chondrocalcinosis in 2. RESULTS: The mean Hospital for Special Surgery (HSS) knee score was 67.5 (range, 52 to 75) preoperatively and 89.9 (range, 85 to 100) at the final follow-up. The mean preoperative flexion contracture was 6.5degrees (range, 0 to 15degrees) and 0.8degrees (range, 0 to 5degrees) at the final follow-up. The mean full flexion increased from 135degrees (range, 90 to 150degrees) preoperatively to 150degrees (range, 140 to 165degrees) at the final follow-up. Active full flexion was possible within 2 postoperative months. The squatting and cross-leg postures were possible in 133 patients (80.1%) and 152 patients (91.6%) at the final follow-up. The mean tibiofemoral angle was improved from varus 1.5degrees to valgus 4.8degrees. Complications were encountered in 18 cases (9.5%). A bearing dislocation occurred in 10 cases (5.3%), tibial component loosening in 4 cases (2.1%), femoral loosening in 3 cases (1.6%) and lateral translation in 1 case (0.5%). The mean time for a bearing dislocation was 22.6 months (range, 3 to 70 months) postoperatively. Seven cases returned to the predislocation level of activity with the insertion of a thicker bearing and 3 cases converted to total knee arthroplasty. CONCLUSIONS: Minimally invasive unicompartmental knee arthroplasty with Oxford Uni(R) provided rapid recovery, good pain relief and excellent function suitable for the Korean lifestyle. In contrast, the high complication rates of Oxford Uni(R) encountered in the mid-term results suggested less reliability than total knee arthroplasty.
Adult ; Aged ; Aged, 80 and over ; *Arthroplasty, Replacement, Knee/adverse effects ; Female ; Humans ; Knee Joint/physiopathology/radiography ; *Knee Prosthesis ; Male ; Middle Aged ; Prosthesis Failure ; Range of Motion, Articular

Developmental venous anomalies (DVAs) are hemodynamically low flow, low resistance vascular malformations without clinical significance. Although most DVAs are asymptomatic and are found incidentally, sometimes they can be symptomatic with intracerebral hemorrhage, many of which are usually caused by associated cavernous malformations (CMs) rather than the DVAs themselves. Only a few cases have been reported in the literature where an intracerebral hemorrhage has been caused by a DVA alone. This report describes a case of an intracerebral hemorrhage due to DVA alone with review of the literature.
Caves ; Cerebral Hemorrhage ; Vascular Malformations

Duplications of the gastrointestinal tract are rare congenital malformations that are usually present during the first decade of life. However, a smaller number of cases may remain occult until adulthood. Overall, the colon is the least common site of congenital gastrointestinal duplications. Colonic duplications can present with symptoms of diverticulitis and can be confused with acquired giant cysts or masses. We present a rare case of a duplication cyst of the colon in a female adult. Although the preoperative evaluations, including an abdominal CT scan and colonoscopy, were suggestive of a gastrointestinal tumor of the colon, the final diagnosis was a colonic duplication cyst based on the histopathologic examination of the resected specimen. Even if intestinal duplication cysts are uncommon, they should be considered in the differential diagnosis of intestinal masses.
Adult ; Colon ; Colonoscopy ; Diagnosis, Differential ; Digestive System Abnormalities ; Diverticulitis ; Female ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans

A case of a patient diagnosed as the chronic spinal epidural hematoma in the lumbar region is reported. There was no history of trauma except the repeated epidural block for controlling the lower back pain at the pain clinic. The symptoms were occurred after epidural block and were exaggerated by repeated injections. Magnetic resonance imaging showed a spinal epidural mass located dorsolaterally at the level of L3-L4. After removal of the hematoma, the symptoms were completely relieved. The diagnosis of a chronic spinal epidural hematoma was confirmed with both operative and histological findings.
Hematoma ; Hematoma, Epidural, Spinal ; Humans ; Low Back Pain ; Lumbosacral Region ; Magnetic Resonance Imaging ; Pain Clinics

BACKGROUND/AIMS: Although endoscopic resection is widely used for the treatment of early colorectal cancer, the risk factors for lymph node metastasis are not clear. This study was designed to determine the risk factors for lymph node metastasis in patients with colorectal cancer who are treated by endoscopic resection. METHODS: The medical records of patients with histologically-proven early colorectal cancers who were treated by endoscopic resection between January 2002 and September 2008 were retrospectively reviewed. Information regarding the demographic data of patients and the clinicopathologic characteristics were recorded and analyzed. RESULTS: Twenty-nine patients who underwent subsequent surgical treatment after endoscopic resection for early colorectal cancer were enrolled in this study. Six patients (20.7%) had lymph node metastases on surgical pathologic examination. The predictive factors for lymph node metastasis were tumor morphology (non-polypoid flat tumors [p=0.019]), absence of background adenomas (p=0.033), and deep submucosal invasion > or = 2,000 um (p=0.012). Unexpectedly, the presence of vascular invasion was not associated with lymph node metastasis. CONCLUSIONS: The presence of vascular invasion might not be an absolute indication for additional surgical treatment of early colorectal cancer; however, deep submucosal invasion, accompanied by a gross tumor with a non-polypoid flat morphology, and the absence of background adenomas are potential risk factors for lymph node metastasis.
Adenoma ; Colorectal Neoplasms ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Medical Records ; Neoplasm Metastasis ; Retrospective Studies ; Risk Factors

Familial adenomatous polyposis (FAP) arises from germline mutations of the adenomatous polyposis coli (APC) gene. FAP is characterized by the occurrence of hundreds to thousands of adenomas throughout the colorectum, and there is nearly a 100% risk of colorectal cancer. In addition to polyposis coli, patients with FAP can develop a variety of extracolonic manifestations. Recent advances in screening and surgery have reduced the colon cancer occurrence and death in FAP patients, leaving desmoid tumors as a leading cause of their morbidity and mortality. Treatment of desmoid tumors is generally considered to be challenging for both the doctor and the patient. We report here on an 18 year old man with resectable intra-abdominal desmoid tumor that developed after total colectomy due to FAP and we include a review of the relevant literature.
Adenoma ; Adenomatous Polyposis Coli* ; Adolescent ; Colectomy* ; Colonic Neoplasms ; Colorectal Neoplasms ; Fibromatosis, Aggressive* ; Germ-Line Mutation ; Humans ; Mass Screening ; Mortality

BACKGROUND/AIMS: Impacted papillary stone (IPS) may lead to complete biliary obstruction and acute cholangitis. We evaluated clinical characteristics and endoscopic findings of IPS. METHODS: Data were obtained from patient recordings, radiologic and endoscopic reports in 14 patients. RESULTS: All patients had severe epigastric pain, but only 3 patients showed typical presentation of acute cholangitis. Radiologically, IPS was not found in 6 patients, but subsequently found as be a single IPS (n=5) and sandy stones filled in the bile duct and gallbladder (n=1). All patients showed a bulging and swollen papilla. Patients (n=9) without peripapillary diverticulum, or with extradiverticular papilla showed more posteriorly displaced papillary orifice and more frequent mucosal changes compared with patients (n=5) with intradiverticular papilla or juxtapapillary diverticulum. The stones were completely removed in 11 patients endoscopically, and the remainders, who had intradiverticular papilla, underwent surgical treatment. CONCLUSIONS: To predict IPS, clinical assessment is very important because the only characteristic manifestation is severe epigastric pain and radiological studies seem to be occasionally insufficient for detecting IPS. The characteristic endoscopic findings of IPS are bulging and swollen papillae with posterioriy displaced orifice and frequent mucosal changes, which may be influenced by presence or absence, and types of peripapillary diverticulum.
Bile Ducts ; Cholangitis ; Diverticulum ; Gallbladder ; Humans

BACKGROUND: De novo methylation and transcriptional silencing of p16 gene is one of the main pathways in inactivation of p16 gene in colon neoplasm. But there has been no study about that in Korea yet. The aims of this study were to determine p16 methylation status and its association with clinicopathologic parameters and stage of colon cancers and adenomas in patients of Korea. METHODS: We examined p16 methylation of sixty primary colon cancer tissues and thirty colon adenoma tissues using methylation specific PCR after bisulfite modification of the DNA samples. RESULTS: In colon cancer group, 30 patients were male and the others were female, and the average age was 59.7+/-12.5 years. Three cases were in Dukes' stage A, 24 in B, 26 in C, and 7 in D respectively. p16 gene was methylated in 20% (12 of 60) of colon cancers. There was no significant correlation between methylation status of p16 gene and clinicopathologic variables of colon cancers including patient's age, sex, tumor location, size, and differentiation. In Dukes' stage C and D, methylation was positive in 24.2% (8/33 cases) comparing 14.8% (4/27 cases) in Dukes' A and B, but there was no significant difference statistically (p=0.52). In colon adenoma group, there were 15 simple adenomas, and 15 advanced adenomas (>or=1cm, including villous component, or high grade dysplasia). The p16 gene was methylated in 16.7% (5 of 30) of colon adenomas; in 3 cases of simple adenoma and in 2 cases of advanced adenoma. There was no significant correlation between p16 methylation status and clinicopathological variables in colon adenoma. CONCLUSION: The p16 gene was methylated in 20% of colon cancers and 16.7% of colon adenomas in the present series, suggesting that the methylation of p16 tumor suppressor gene might be expressed in similar rate in colon cancer/adenoma in Korea, and play a role in colorectal tumorigenesis in its early stage.
Adenoma* ; Carcinogenesis ; Colon* ; Colonic Neoplasms* ; Colorectal Neoplasms ; DNA ; Female ; Genes, p16 ; Genes, Tumor Suppressor* ; Humans ; Korea ; Male ; Methylation* ; Polymerase Chain Reaction

BACKGROUND/AIMS: The post-treatment relapse patterns and efficacy of lamivudine re-treatment for relapsed patients have not been clarified. The aims of this study were to evaluate the relapse patterns after discontinuing therapy and the effects of lamivudine re-treatment for relapsed patients after HBeAg seroconversion. METHODS: Therapy was discontinued after HBeAg seroconversion in 121 patients. Sixty-six patients were relapsed and included in this study. The duration of lamivudine re-treatment therapy was from 6-35 (mean: 16) months. Post-retreatment monitoring continued for 1-40 (mean: 8.9) months. RESULTS: Among the relapsed 66 patients, 50 (75.8%) had HBeAg reappearance while 16 (24.2%) remained HBeAg negative and anti-HBe positive. The cumulative relapse rates at 3, 6, 12 and 24 months were 27%, 47%, 60% and 66%, respectively. Forty-two relapsers received lamivudine re-treatment. Among them, 33 were HBeAg positive and 9 were HBeAg negative and anti-HBe positive, Response was achieved in 31 of the 42 patients (73.8%). The cumulative response rates at 6, 9 and 12 months were 62%, 69% and 72%, respectively. Six patients (14.3%) developed viral breakthrough. All patients were HBeAg positive chronic hepatitis B. The duration of lamivudine re-treatment was the only predictable factor for response of lamivudine re-treatment. Therapy was discontinued after response in 21 patients. Eleven patients were relapsed, including 6 who were HBeAg positive and 5 who were HBeAg negative. Predictive factors for post-retreatment relapse were age and the duration of additional lamivudine therapy after response. CONCLUSIONS: The response rate of lamivudine re-treatment was significantly higher than in initial lamivudine treatments. The breakthrough and relapse rates, however, were similar in both initial and retreated lamivudine therapy.
Adult ; Antiviral Agents/*therapeutic use ; Female ; Hepatitis B e Antigens/blood ; Hepatitis B, Chronic/diagnosis/*drug therapy/virology ; Humans ; Lamivudine/*therapeutic use ; Male ; Recurrence ; Retreatment

BACKGROUND/AIMS: The diagnosis of clonorchiasis is based on demonstrating eggs in stool or bile. It is believed that bile examination is the most precise method for detecting eggs. We evaluated diagnostic usefulness of intradermal test (IDT) by comparing it with the result of bile examination. METHODS: For 88 patients with pancreatobiliary diseases, we examined Clonorchis sinensis eggs in bile and performed IDT for clonorchiasis. The bile was obtained from endoscopic nasobiliary or percutaneous transhepatic biliary drainage tubes. RESULTS: We calculated ROC curve to decide the cut-off value of IDT in determining diagnostic accuracy on the basis of bile examination. We chose a value of 40 mm2, which significantly improved the sensitivity, without reducing the specificity. With a cut-off value of 40 mm2, the sensitivity, specificity, positive and negative predictive values of IDT were 81.5%, 67.2%, 52.4%, and 89.1%, respectively. The value of IDT was not affected by age and showed no difference between benign and malignant diseases. However, in egg-positive patients, the mean value was lower in malignant diseases than in benign diseases. CONCLUSIONS: In patients with pancreatobiliary diseases, IDT with a cut-off value of 40 mm2 seems to be a valuable supplementary diagnostic test for clonorchiasis in view of its high sensitivity.
Aged ; Bile/parasitology ; Biliary Tract Diseases/*diagnosis ; Clonorchiasis/*diagnosis ; Female ; Humans ; *Intradermal Tests ; Male ; Middle Aged ; Pancreatic Diseases/*diagnosis ; Predictive Value of Tests ; Sensitivity and Specificity