Purpose: We evaluated, retrospectively, twenty hips that had undergone revision surgeries because of massive pelvic osteolysis in order to determine the retention rate of acetabular metal shells and polyethylene liner exchanges.. Materials and Methods: We performed liner exchanges for massive osteolysis around stable HG acetabular cups with severe polyethylene wear in twenty-three hips, between June 1996 and May 2003. Clinical and radiological follow-up was available for 20 hips for more than 2 years. In 18 hips, we performed curettage of the granulomatous tissue and tightly packed morselized cancellous allografts into the screw holes or the peripheral rims for the acetabular osteolytic lesions. The mean follow-up period was 3.8 years (range, 2.4 to 9.3 years) and the mean of time from the primary total hip arthroplasties to the component exchanges, was 8.2 years (range, 5.6 to 12.4 years). Results: During the follow-up period, all of the hips were functioning well, and none required any subsequent repeat surgeries. Dislocations occurred three times after the repeat operations in one hip, which was treated successfully with an abduction brace. None of the hips demonstrated a progression of the pre-existing osteolytic lesions or the development of any new osteolytic lesions. At the final follow-up, none of the acetabular components demonstrated any evidence of loosening. Conclusion: Our results demonstrated that isolated liner exchanges and debridement of the granulomatous tissue, with or without bone grafting, can be an effective alternative solution to revision of the cup for massive osteolysis around well-fixed, cementless, acetabular cups in selected patients. Retention of the pre-existing cementless acetabular cup provides less intra-operative and post-operative morbidity. However, in order to determine the longevity of the retained cementless acetabular cups, further long-term studies are necessary.
Acetabulum* ; Allografts ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Bone Transplantation ; Braces ; Curettage ; Debridement ; Dislocations ; Follow-Up Studies ; Hip ; Humans ; Longevity ; Osteolysis* ; Osteolysis, Essential ; Polyethylene ; Retrospective Studies ; Transplants*

Popliteal artery entrapment syndrome (PAES) occurs when an abnormal anatomic relationship between the popliteal artery and the surrounding musculotendinous structures causes repeated arterial compression with exercise. The most commonly reported causes of this syndrome have been anomalies of the medial head of the gastrocnemius muscle as it relates to the course of the popliteal artery. PAES can result in calf claudication, aneurysm formation, distal arterial emboli, or popliteal vessel thrombosis. This syndrome is a rare but potentially limb threatening anatomical anomaly occurring predominently in young adults. We experienced two cases who have suffered from a coldness and pain of lower leg. Angiogram and MRI were performed and we diagnosed as a popliteal artery entrapment syndrome. We report two cases of rare anomalous origin of the gastrocnemius muscle in intraoperative findings.
Aneurysm ; Extremities ; Head ; Humans ; Leg ; Magnetic Resonance Imaging ; Muscle, Skeletal* ; Popliteal Artery* ; Thrombosis ; Young Adult

Intravenous leiomyomatosis is an uncommon uterine tumor characterized by the growth of histologically benign smooth muscle initially into venous channels within the broad ligament, intrauterine, and iliac vein, and can extend to inferior vena cava, and right side of the heart. Intravenous leiomyomatosis is always grossly visible as worm-like plugs within the involved vessels. A 41-year-old woman presented with lower abdominal mass, and she had undergone total abdominal hysterectomy and left salpingoophorectomy for leiomyoma of uterus. On pathological examination it was diagnosed as intravenous leiomyomatosis. 16 month later, She was admitted with lower abdominal mass on retroperitoneal cavity. The patient was successfully treated by resection of recurred mass and right salpingoophorectomy. A case of recurrent intravenous leiomyomatosis is presented with a brief review of literatures.
Adult ; Broad Ligament ; Female ; Heart ; Humans ; Hysterectomy ; Iliac Vein ; Leiomyoma ; Leiomyomatosis* ; Muscle, Smooth ; Uterus ; Vena Cava, Inferior

BACKGROUND/AIMS: Laparoscopic cholecystectomy has become popular. Occasionally, unsuspected gallbladder carcinoma is diagnosed after the operation by pathologic examination, incidentally. And even when the gallbladder carcinoma is suspected preoperatively, it is determined whether or not the additional radical operation will proceed, according to the pathologic diagnosis after laparoscopic cholecystectomy. Multiple staging systems have been described, including the modified Nevin classification (Donohue et al 1990, Nevin et al 1976), the AJCC TNM staging system, and there are controversies in the surgical management of gallbladder carcinoma for each stage. The purpose of this study was to evaluate the role and the meaning of the laparoscopic cholecystectomy in the surgical management of the gallbladder carcinoma. METHODS: A retrospective analysis was made of 24 patients with gallbladder carcinoma that was confirmed by pathologic diagnosis after laparoscopic cholecystectomy in Severance Hospital between January 1993 and Feburary 2002. RESULTS: Gallbladder carcinoma was found in 1.1% of the 2141 cholecystectomy specimens. Gallbladder carcinoma was suspected preoperatively in 11 patients (45.8%). The location of the lesions was the serosal side in 16 patients (66.7%), the liver bed side in 1 patient, and undetermined in 7 patients. The histologic type was adenocarcinoma in all patient, and well differentiated in 16 patients (66.7%), moderate and poorly differentiated in 8 patients (33.3%). According to the AJCC TNM staging system, there were 13 stage I (54%), 5 stage II (20.8%), 2 stage III (8.3%), 4 stage IV (16.7%). The lymph node metastasis was observed in 4 patients (16.7%). In 18 patients (75%), only laparoscopic cholecystectomies were performed, and additional radical cholecystectomies were performed in 4 patients (16.7%). The patients with stage I and II tumor were alive without recurrence except 1 follow-up loss, and there was not any port site recurrence. CONCLUSION: Laparoscopic cholecystectomy is sufficient with stage I gallbladder carcinoma. It may be considered that the patient with stage II gallbladder carcinoma is closely followed without additional radical cholecystectomy after laparoscopic cholecystectomy, if properly selected. The use of vinyl bag for retrieval of specimen is recommended to avoid the port site recurrence. For advanced gallbladder carcinoma (stage III and IV), the additional radical cholecystectomy is recommended. When gallbladder cancer is suspected, an open operation should be performed with sufficient preoperative staging work-up.
Adenocarcinoma ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Classification ; Diagnosis ; Follow-Up Studies ; Gallbladder Neoplasms ; Gallbladder* ; Humans ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm Staging ; Recurrence ; Retrospective Studies

PURPOSE: We investigated the clinical difference between single infection and coinfection with respiratory virus in hospitalized children with acute respiratory tract infections. METHODS: We reviewed 727 patients who were admitted with the diagnosis of acute respiratory infection at the Department of Pediatrics, Bundang Jesaeng Hospital between January and December of 2014. Diagnoses were made using the multiplex reverse transcriptase polymerase chain reaction (RT-PCR) assay targeting 16 viruses in nasopharyngeal swabs. Subjects were classified as the single virus infection and coinfection groups. RESULTS: A total of 439 patients were enrolled; 359 (77.2%) under 24 months. Single virus was detected in 279 (63.6%). Coinfection with multiple virus was detected in 160 (36.4%): 126 (28.7%) with 2 viruses, 30 (6.8%), and 4 (0.9%) with 3 to 4 viruses. Viral coinfection was detected in 28 samples (17.5%), with respiratory syncytial virus (RSV) A and rhinovirus being the most dominating combination. There were no clinical differences between the single infection and coinfection groups, except sputum and the frequency of high RSV load. Sputum was significantly more frequent in the coinfection group (P=0.043), and the frequency of high RSV load was significantly higher in the single infection group (P=0.029). Disease severity (high fever, the duration of fever [≥5 days], and the length of hospital stay [≥5 days], O₂ therapy) did not differ significantly between both groups. RSV was a frequent virus of single infection during winter. Coinfection was most common in winter. CONCLUSION: There were no clinical differences between single infection and coinfection, except sputum and the frequency of high RSV load.
Child ; Child, Hospitalized ; Coinfection* ; Diagnosis ; Fever ; Humans ; Length of Stay ; Multiplex Polymerase Chain Reaction ; Pediatrics ; Respiratory Syncytial Viruses ; Respiratory Tract Infections ; Reverse Transcriptase Polymerase Chain Reaction ; Rhinovirus ; Sputum

The aim of this study was to assess the feasibility and efficacy of laparoscopic myomectomy (LM) for large myomas. A subpopulation of 51 patients with myomas 8 cm or larger in diameter was selected from 155 patients who underwent LM at Kangbuk Samsung Hospital from July 2003 to November 2006. The mean age of the patients was 34.9+/-5.6 yr, mean parity was 0.6+/-0.9, and 8 patients had a previous operative history. The most common operative indication was a palpable abdominal mass (24 patients, 47%). The mean operating time was 85.6+/-38.9 min, and the mean diameter of the largest myoma was 9.3+/-1.8 cm. The mean change in hemoglobin concentration was 2.1+/-1.2 g/dL. Histopathological diagnosis included 49 patients of leiomyoma (96.1%) and 2 patients of leiomyoma with adenomyosis (3.9%). Postoperatively, a transfusion was done in 7 patients, and a case of subcutaneous emphysema was noted. None of the operations was switched to laparotomy. With the newly-developed screw and the port placement system that was modified from the Choi's 4-trocar method to obtain better surgical vision, LM of large myomas proved to be one of the efficient and feasible methods.
Adult ; Feasibility Studies ; Female ; Humans ; Laparoscopy/adverse effects/*methods ; Leiomyoma/pathology/*surgery ; Length of Stay ; Postoperative Complications/etiology ; Reproducibility of Results ; Subcutaneous Emphysema/etiology ; Treatment Outcome ; Uterine Neoplasms/pathology/*surgery

PURPOSE: Recently, the incidence of refractory Mycoplasma pneumoniae (MP) pneumonia has increased in Korea. Given that its early diagnosis is helpful in selection of the treatment, this study aimed at investigating the value of the antimycoplasma antibody (IgM) for early diagnosis of MP pneumonia. METHODS: A total of 315 children admitted with MP pneumonia from September 2015 to May 2016 were investigated with the IgM and polymerase chain reaction (PCR) for the diagnosis of MP pneumonia. Specifically, patients were grouped into nonrefractory respiratory MP and refractory MP groups according to their response to macrolide therapy. RESULTS: In the 44 PCR-negative seroconversed children, seroconversed IgM was more frequent in the refractory MP group compared with the nonrefractory respiratory MP group with statistical significance (P<0.001). In the 264 IgM-positive children, the time of antibody reaction was more delayed in the refractory MP group compared to the nonrefractory respiratory MP group with statistical significance (P<0.001). CONCLUSION: This study showed that there was a higher incidence of seroconversed IgM and delayed antibody reaction in the refractory MP group. In children with suspect MP pneumonia, follow-up studies of antibody are necessary, even through initial antibody and PCR showed negative findings. In addition, this result may suggest that the diagnosis of refractory MP pneunomia will be helpful in establishing the strategy of the treatment.
Child ; Diagnosis ; Early Diagnosis ; Follow-Up Studies ; Humans ; Immunoglobulin M ; Incidence ; Korea ; Mycoplasma pneumoniae ; Mycoplasma ; Pneumonia ; Pneumonia, Mycoplasma ; Polymerase Chain Reaction

PURPOSE: This study aimed to investigate the outcomes of gonadotropin-releasing hormone agonist (GnRHa) therapy with or without growth hormone (GH) therapy for girls with idiopathic central precocious puberty (CPP). METHODS: The medical records of 166 girls diagnosed with CPP from 2002 to 2017 were retrospectively reviewed. All included patients were treated with GnRHa for ≥36 months. Changes in height standard deviation score (SDS) for bone age, chronological age (CA), and predicted adult height (PAH) were assessed for the first three years of treatment. The final height gain SDS was calculated as the difference between the initial PAH SDS and adult height (AH) SDS; these were then compared between the GnRHa group (group A, n=135) and the combined GnRHa/GH group (group B, n=31).
Adolescent ; Adult ; Body Height ; Female ; Gonadotropin-Releasing Hormone ; Growth Hormone ; Humans ; Medical Records ; Puberty ; Puberty, Precocious ; Retrospective Studies

Primary gastric lymphoma is relatively rare in the context of gastric malignancies. Synchronous primary gastric lymphoma and hepatocellular carcinoma (HCC) are even rarer. We report a case of synchronous primary gastric lymphoma and HCC in a 46-year-old man that appeared to be associated with hepatitis B virus infection. Pathologic examination and immunohistochemical analysis of gastric and liver specimens showed diffuse large B-cell lymphoma and HCC, respectively. The patient was initially treated for primary gastric lymphoma with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone) chemotherapy. During the chemotherapy interval, he was treated for HCC by transarterial chemoembolization (TACE) and laparoscopy-assisted left hemihepatectomy.
B-Lymphocytes ; Carcinoma, Hepatocellular ; Cyclophosphamide ; Doxorubicin ; Hepatitis B virus ; Humans ; Liver ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, Non-Hodgkin ; Middle Aged ; Stomach Neoplasms ; Vincristine

OBJECTIVE: To evaluate the feasibility and effectiveness of laparoscopic adnexal surgery in posthysterectomy patients and review clinical characteristics including comparison of the adhesion score of left with that of right adnexal mass. METHODS: From February 2004 to January 2007, we reviewed the medical records of 23 post-hysterectomy patients who received laparoscopic adnexal surgery including age, parity, type of hysterectomy, operative indications, histopathological diagnosis, operating time, size of the adnexal mass, adhesion score, change in the hemoglobin level, hospital stay, and any complications. RESULTS: The median age of patients was 48 years (range 35-69 years), and median parity was 2 (0-3). The median operating time was 100 minutes (range 35-180 minutes), and the median size of the adnexal mass was 7.1 cm (range 4-12 cm). The median change in hemoglobin level was 1.8 g/dL (range 0.6-4.1 g/dL). The median hospital stay was 4 days (range 3-19 days). The adhesion score was significantly higher in the left adnexal mass than in the right adnexal mass. Histopathological diagnosis included 6 cases of mucinous cystadenoma, 6 cases of functional cyst, 4 cases of hydrosalpinx, 3 cases of serous cystadenoma, 1 case of fibrothecoma, 1 case of mucinous adenofibroma, 1 case of endometrioma, and 1 case of tubo-ovarian abscess. There were no intraoperative complications or conversion to laparotomy. One case of postoperative ileus was noted. CONCLUSION: The skilled laparoscopic surgeon is capable of achieving successful result by performing laparoscopic surgery primarily to patients with adnexal mass for posthysterectomy patients who are expected to suffer severe adhesion. In posthysterectomy patients, left adnexal mass has more extensive adhesion than right adnexal mass, and these finding was represented as a high adhesion score of left adnexal mass.
Abscess ; Adenofibroma ; Cystadenoma, Mucinous ; Cystadenoma, Serous ; Diagnosis ; Endometriosis ; Female ; Humans ; Hysterectomy ; Ileus ; Intraoperative Complications ; Laparoscopy ; Laparotomy ; Length of Stay ; Medical Records ; Mucins ; Parity