PURPOSE: To compare clinical outcomes of the tumor prosthetic replacement and osteosynthetic fixation for pathologic fracture of skeletal metastatic lesion of the proximal femur. MATERIALS AND METHODS: From 1994 May to 2009 May, medical records of 22 patients who underwent tumor prosthetic replacement with tumor resection (group 1) and 15 others (16 hips) who underwent osteosynthetic fixation without tumor resection (group 2) were reviewed. The mean age of overall patients were 59 (group 1) and 60 (group 2). Mean follow up periods were 23 and 11 months. The oncological and functional results were evaluated with Kaplan-Meier methods and Musculoskeletal Tumor Society (MSTS) scoring system, 1993. The statistical evaluation was assessed with Log rank test and t-test. RESULTS: The mean survival periods were 24 months in group 1 and 11months in group 2. The 1 year survival rates were 86% in group 1 and 50 % in group 2, and 2 year survival rates were 29.7% in group 1 and 9.4% in group 2. The mean MSTS functional score were 26.4 (19-30), 87.9% in group 1 and 15.3 (10-23), 51.0% in group 2. CONCLUSION: The results of tumor resection and prosthetic replacement in selected cases was better than osteosynthetic fixation without tumor resection for metastatic bone tumors around proximal femur in oncological and functional aspects.
Femur ; Follow-Up Studies ; Fractures, Spontaneous ; Humans ; Joints ; Medical Records ; Survival Rate

OBJECTIVES: As suicide among the elderly population has been a critical issue in Korea, this study aimed to evaluate correlations of suicidal ideation with protective and risk factors among elderly who reside in a rural community. METHODS: A total of 157 elders from Gyeongju city, who had attended senior centers in, were enrolled to answer questionnaires including the Geriatric Depression Scale Short Form-Korea and the Scale for Suicidal Ideation. Data were analyzed using SPSS 18.0K for Windows, and included t-test, Pearson correlation, and a three-step hierarchical multiple regression analyses. RESULTS: Using the hierarchical regression analyses for predicting the elderly's suicidal ideation, male gender and social group variables were entered as predictors in the first step(adjusted R2=0.107, P<0.05). Pain, ADLs, family support variables were not entered in the second step. Depression variable was the only predictor in the third step(adjusted R2=0.384, P<0.001). CONCLUSIONS: Although this study confirmed the impact of depression on the suicidal ideation, elderly with risk factors including male gender and social isolation should receive a special attention from community health care professionals.
Activities of Daily Living ; Aged ; Community Health Services ; Depression ; Humans ; Korea ; Male ; Risk Factors ; Social Isolation ; Suicidal Ideation ; Suicide ; Surveys and Questionnaires

To evaluate the effectiveness of centralizing device, three groups of patients on whom cemented total hip arthroplasty with three types of implant was performed respectively were analyzed and compared; SL stems without centralizing device were used in Group I, Interlok stems with central sleeve in Group II, and MS-30 stems with distal centralizer in Group III .The size of each group was 20. Cement mantle thickness, the amount of displacement of stem tip, and axis alignment of femoral stem on A-P radiograph checked at 2 weeks after operation were assessed. More optimal cement mantle thickness (3~6mm) was achieved in Group II (P=0.046) and Group III (P=0.01) than in Group I. Centralizing effect of the distal femoral stem in the intramedullary canal was significantly better (P<0.05) in Group III ( 4.55% ) than in Group I (11.60%) and Group II (12.35%). Neutral alignment of femoral stem was achieved in 15% of Group I, in 90% of Group II, and in 95% of Group III. Compared to stem without centralizing device, cemented femoral stem with distal centralizer resulted in 1) significantly more centralized distal femoral stem, 2) significantly more neutrally aligned femoral stem,and 3) significantly more optimal cement mantle thickness at zone V. Compared to stem without centralizing device, cemented femoral stem with central sleeve resulted in 1) significantly more neutrally aligned femoral stem, and 2) significantly more optimal cement mantle thickness at zone VI.
Arthroplasty, Replacement, Hip ; Axis, Cervical Vertebra ; Humans

Thrombotic thrombocytopenic purpura (TTP) in the acute postoperative setting is a syndrome that presents with various symptoms such as microangiopathic hemolytic anemia, thrombocytopenia, fever, renal failure, and change of the patient's mental status. Though most of the previous reports of postoperative TTP have been in conjunction with cardiac or vascular surgery, it has also been reported following orthopedic and abdominal surgeries. We present here a case of a 78 year-old female who was diagnosed with rectal cancer and who developed TTP the 2nd day following her cancer surgery. Because the presentation can be confused with other early postoperative complications, TTP should be considered in the differential diagnosis of the patient who develops unexplained anemia and thrombocytopenia following an abdominal surgery. Awareness of this syndrome is essential because starting plasmapheresis early can be life-saving.
Anemia ; Anemia, Hemolytic ; Diagnosis, Differential ; Female ; Fever ; Humans ; Orthopedics ; Plasmapheresis ; Postoperative Complications ; Purpura, Thrombocytopenic ; Purpura, Thrombotic Thrombocytopenic ; Rectal Neoplasms ; Renal Insufficiency ; Thrombocytopenia ; Thymine Nucleotides

PURPOSE: This current study examined the clinicopathologic characteristics of patients with splenic flexure (SF) colon cancer and the association with the surgical outcomes to find the optimal procedure to treat this malady. MATERIALS AND METHODS: A total of 167 operated patients with SF colon cancer were consecutively recruited between 1993 and 2003. The clinicopathological, operative and survival data was reviewed and analyzed. RESULTS: For the SF colon cancer patients, the proportion of males was higher than that for the right-sided colon patients or the sigmoid-descending junction & sigmoid (SD & S) colon patients (p< or =0.05, respectively) and the age at the time of diagnosis was younger (p< or =0.05). Obstruction was more frequent in the patients with SF colon cancer than that for the patients with colon cancer at other sites (p< or =0.001). The incidence of mucinous adenocarcinoma for the SF patients was similar to that for the patients with right-sided colon cancer, but it was higher than that for the patients with SD & S colon cancer (11.4% vs. 6.5%, p=0.248 or 2.5%, respectively, p=0.001). Disease-free and overall survival did not differ between the patients who underwent a left hemicolectomy and extended surgery such as combined splenectomy or subtotal colectomy. Multivariate analysis showed that old age (> or =60 years) and a N1-2 and M1 status were the independent risk factors for overall survival. CONCLUSION: The SF colon cancers exhibited exclusively different characteristics as compared to colon cancers at other site colon cancers. It appears that left hemicolectomy was generally sufficient for a satisfactory oncological outcome, obviating concurrent splenectomy.
Adenocarcinoma, Mucinous ; Colectomy ; Colon ; Colon, Sigmoid ; Colon, Transverse ; Colonic Neoplasms ; Humans ; Incidence ; Male ; Multivariate Analysis ; Risk Factors ; Splenectomy

BACKGROUND/AIMS: The eradication rates of Helicobacter pylori has been decreasing over the years and it is different among the regions. The aim of this study was to investigate the rates of first-line and the second-line eradication of H. pylori over the last 5 years in a single institute of Changwon and Gyeongsangnam-do, Korea. MATERIALS AND METHODS: Eradication rates of first-line triple regimen in 1,164 patients and second-line quadruple regimen in 223 patients who received H. pylori eradication treatment from January 2008 to December 2012 at Changwon Fatima Hospital were evaluated retrospectively. The patients for second-line quadruple therapy were divided into three groups according to the dosage of medications. RESULTS: The overall eradication rates of first-line and second-line therapy were 70.5% and 81.2%, respectively. There was no decreasing tendency in the eradication rate of first-line therapy for 5 years (P=0.573). However, annul eradication rates of second-line therapy significantly decreased (P=0.001, linear by linear association). In second-line therapy, patients treated with high dose bismuth and metronidazole had higher eradication rates than those treated with low dose bismuth and metronidazole (P=0.039). CONCLUSIONS: The effectiveness of the first-line and second-line therapy for H. pylori was suboptimal. In addition, there was a decreasing tendency in the eradication rates of second-line therapy over the past 5 years in Changwon and Gyeongsangnam-do province. Alternative regimens or high dose therapy should be considered for first-line and second-line therapy.
Bismuth ; Gyeongsangnam-do ; Helicobacter pylori* ; Helicobacter* ; Humans ; Korea ; Metronidazole ; Retrospective Studies

PURPOSE: We aimed to compare the prognosis and the recurrence patterns of sporadic primary colon cancers according to the location of the cancer. METHODS: One thousand four-hundred eighty-three (1,483) stage II, III colon cancer patients who had undergone a consecutive curative resection between January 1989 and December 2003 were analyzed. Hereditary, synchronous, metachronous, and recurrent colon cancers were excluded. The right colon was defined as being from the cecum to the transverse colon, and the left colon was defined as being from the splenic flexure colon to the rectosigmoid colon. The median follow-up time was 63 (3-228) mo. RESULTS: Poorly differentiated and mucinous cell type tumors were more frequent in the right colon. T3 tumors were more frequent in the right colon. Lymph-node-positive tumors were more frequent in the left colon. The recurrence rate was higher in the left colon, but the patterns of recurrence were not different according to the tumor's location. By univariate analysis, age, preoperative serum CEA level, T-stage, N-stage, lymphovascular invasion, postoperative chemotherapy, and tumor location were significant prognostic factors associated with recurrence. By multivariate analysis, sex, preoperative serum CEA level, T-stage, N-stage, postoperative chemotherapy, and tumor location were significant prognostic factors associated with recurrence. The 5-yr disease-free survival rates were 84.0% for right colon cancer and 77.1% for left colon cancer (P=0.005). The recurrence rates for cancers in the sigmoid colon and the rectosigmoid colon were higher than those for cancers in the cecum and the ascending colon. CONCLUSION: The tumor's location was an independent prognostic factor for recurrence, but the pattern of recurrence did not vary with the tumor's location.
Cecum ; Colon ; Colon, Ascending ; Colon, Sigmoid ; Colon, Transverse ; Colonic Neoplasms ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Mucins ; Multivariate Analysis ; Prognosis ; Recurrence

BACKGROUND AND OBJECTIVES: The purpose of this study is to evaluate endothelium dependent vasodilation in the diabetic patients suffering with coronary artery disease (CAD). SUBJECTS AND METHODS: 43 patients who presented with typical chest pain and who underwent coronary angiography were enrolled in this study. They were classified into diabetic patients with CAD (n=13), non-diabetic patients with CAD (n=13), diabetic patients without CAD (n=7), and non-diabetic patients without CAD (n=10), according to the presence of CAD and diabetes mellitus. Endothelium-dependent vasodilation of the brachial artery was measured in all the subjects by performing 7.5 MHz high-resolution ultrasound sonography. RESULTS: The endothelium-dependent vasodilation in the diabetic patients with CAD was 1.30+/-2.13% and it was 5.72+/-3.70% in the non-diabetic patients with CAD. There was a significant difference between the two groups (p=0.001). The endothelium-dependent vasodilation in diabetic patients without CAD was 2.28+/-1.88% and it was 10.70+/-10.19% in the non-diabetic patients without CAD. There was a significant difference between the two groups (p=0.029). The endothelium-dependent vasodilations in the diabetic group was 2.28+/-1.88% and it was 10.70+/-10.19% in the non-diabetic group for all the patients. There was a significant difference between the two groups (p=0.029). There was correlation between the endothelium-dependent vasodilation and the fasting blood sugar. There was negative correlation between the endothelium-dependent vasodilation and the fasting blood sugar (FBS) in the patients with CAD (r=-0.59, p=0.002). However, there was no correlation between the endothelium-dependent vasodilation and the FBS in the patients without CAD (r=-0.327, p=0.201). There was negative correlation between the endothelium-dependent vasodilation and the FBS in all subjects (r=-0.352, p=0.021). CONCLUSION: The endothelium-dependent vasodilation was decreased in the diabetic patients with CAD as compared to the non-diabetic patients with CAD. There was also was negative correlation between the endothelium-dependent vasodilation and the FBS in the patients with CAD.
Blood Glucose ; Brachial Artery ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Diabetes Mellitus ; Endothelium ; Fasting ; Humans ; Ultrasonography ; Vasodilation*

Actinomycosis, rare in pelvic localization and a severe condition not well known to gynecologists, is an uncommon entity caused by anaerobic bacteria, Actinomycosis israelii. After trauma, surgery, or other infections that alter the host's mucosal barriers, these organisms advance to invade surrounding tissue and organs. The pelvic loculation of the disease generally presents as a pseudoneoplastic formation, so it is very difficult to make an accurate diagnosis initially. We experienced a pelvic and abdominal actinomycosis confirmed by pathology in a woman who had been wearing an IUD and complained fever, chill, headache for one month, and lower abdominal pain and palpable mass. This case illustrates the importance of considering the possibility of actinomycosis when we met a vague abdominal mass.
Abdominal Pain ; Actinomycosis* ; Bacteria, Anaerobic ; Diagnosis ; Female ; Fever ; Headache ; Humans ; Intrauterine Devices* ; Pathology

PURPOSE: To assess the clinico-pathologic characteristics associated with pathologic complete remission (pCR) after preoperative chemoradiotherapy (PCRT) for rectal cancer and evaluate predictive factors for pCR and prognostic impact of pCR. METHODS: We analyzed 325 patients who underwent PCRT and surgical resection between September 1999 and September 2006. We have treated 319 patients with PCRT for locally advanced rectal cancer and 6 patients for sphincter-saving procedure. Chemotherapy consisted of either of bolus 5-FU (325 mg/m2/d) or capecitabine (1,650 mg/m2/d) for the duration of radiation and after surgery. Radiation therapy was delivered and surgery was performed 4~6 weeks following the completion of PCRT. We compared pCR patients with non-pCR patients according to the clinico-pathologic characteristics and followed up with a median of 32 (range, 12~91) months. RESULTS: The pCR (n=41, 12.6%) and non-pCR (n=284) groups were comparable in age, sex, location of the tumor, chemotherapy regimen, pre-CRT CEA level except pre-CRT clinical stage (12.2% vs. 0.4% in stage I, P= 0.047). There was no significant difference in genetic characteristics between groups. There was no specific predictive factors for pCR except pre-CRT T category (pCR in T2 (5/8, 62.5%) vs. T3 (33/283, 11.7%) or T4 (3/33, 9.1%), P=0.001). The 3-year disease free survival (DFS) was 100% and 83.6% in the pCR and non-pCR group respectively (P=0.012). There were 5 local and 34 systemic recurrences only in non-pCR group. CONCLUSIONS: Rectal cancer patients with pCR after PCRT have an excellent prognosis and are unlikely to fail locally or systemically because of the effect of stage. However there was no specific predictive factor for pCR except preoperative T category.
Capecitabine ; Chemoradiotherapy ; Deoxycytidine ; Disease-Free Survival ; Fluorouracil ; Humans ; Polymerase Chain Reaction ; Prognosis ; Rectal Neoplasms ; Recurrence