BACKGROUND/AIM: Serial measurement of serum carcinoembryonic antigen was assessed to define its significance and to determine the adequacy in detecting recurrence after curative resection for colorectal cancer. METHODS: Six hundred forty-five patients with colorectal cancer underwent curative resection were included. The median follow-up period was 49 months (range, 24~94 months). Serum CEA was analyzed in accordance with location, histologic differentiation, stage of the tumor, recurrence and survival. RESULTS: The incidence of elevated preoperative serum CEA (> 6 ng/ml) was correlated with tumor stage (stage I vs. II, P=0.01; stage II vs. III, P=0.0001). Fifty five patients among 87 patients with recurrence (63.2%) had concomitant elevation of serum CEA, whereas 32 of 558 patients (5.7%) without recurrence showed a false-positive result. Measurement of serum CEA was more sensitive in patients with elevated preoperative serum CEA and liver metastases than in patients without elevated preoperative serum CEA and local recurrence (P=0.0397). The leading time of serum CEA between the first elevated serum CEA and the identification of recurrence was 3.5 months (range, 1~12 month). Tumor stage and preoperative serum CEA level were found to be significant prognostic variables by multivariate analysis. The overall 5-year survival rate in the normal preoperative serum CEA and the elevated group were 76% and 64% respectively (P=0.00019). CONCLUSION: Serum CEA seemed to be closely correlated with survival and to be an useful tool to detect recurrence after curative resection for colorectal cancer. The appropriate measurement of serum CEA might be suggested in stage II and III postoperatively: every three month for two years, every 6 month for succeeding 2 years, and annually thereafter. Monitoring of serum CEA in stage I could be individualized by preoperative serum CEA and clinical course.
Carcinoembryonic Antigen* ; Colorectal Neoplasms* ; Follow-Up Studies ; Humans ; Incidence ; Liver ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence ; Survival Rate

The rupture of the patellar tendon after total knee arthroplasty (TKA) is rare but serious complication resulting in a severe dysfunction in the extension mechanism. There are a few reports on the treatment of this condition. However, there is still some controversy regarding the choice of proper management. There is no report of the patellar tendon augmentation or reconstruction in this condition in the Korean literature. We report a case of an old patellar tendon rupture in 70-year old patient that occurred at 5 months after a two stage revision for an infected TKA and was treated satisfactorily by delayed repair with augmentation using an Achilles allograft.
Aged ; Allografts* ; Arthroplasty* ; Humans ; Knee* ; Patellar Ligament* ; Rupture

PURPOSE: This study is to evaluate the results of arthroscopic treatment for an acutely infected total knee arthroplasty (TKA) and to determine the protocol for a successful arthroscopic treatment. MATERIALS AND METHODS: Of 16 cases of acutely infected TKA treated at this institution, 7 cases treated with arthroscopic debridement were retrospectively reviewed. The indication for arthroscopic debridement was patients with a radiographically stable prosthesis and within 72 hours of the onset of symptoms. The necessity and method of the secondary procedures were determined using a follow up of the C-reactve protein (CRP) test and physical examination after the primary arthroscopic debridment. Successful treatment was defined as no recurrence or no re-operation by the final follow-up. RESULTS: All 7 cases were treated with a retention of the prosthesis. 3 cases were treated successfully with primary arthroscopic debridement only. Three cases were treated with open debridement after primary arthroscopic debridement. One case was treated with repeated arthroscopic debridement after primary arthroscopic debridement. CONCLUSION: Arthroscopic debridement is an effective treatment option for an acutely infected TKA within 72 hours of the onset of symptoms. A careful CRP follow up is suggested as the critical index to determine the secondary procedure for successful treatment of an acutely infected TKA by arthroscopic debridement.

PURPOSE: The purpose of this study was to compare the clinical results of a high-flex design (Scorpioflex(R), Stryker) in total knee arthroplasty with those of a non-high-flex design (Scorpio(R) PS type, Stryker). MATERIALS AND METHODS: Fifty-two knees with at least 120 degrees of further flexion preoperatively underwent total knee arthroplasty. Of the 52 knees, there were 35 knees in the high-flex design (HF group) and 17 knees in the non high-flex design (non-HF group). The clinical results were evaluated by postoperative further flexion at 3 months, 6 months, 1 year, 2 years and 3 years, as well as by Delta flexion, which means postoperative flexion improvement. The Knee Society Score and X-rays were evaluated preoperatively and at the 3-year follow-up. RESULTS: The HF group showed significantly greater flexion than the non-HF group at 3 months postoperatively (p=0.000). The delta flexion was also greater in the HF group at 3 months postoperatively (p=0.000). The Knee Society Score and X-rays were similar in the two groups at the final follow-up (p>0.05). CONCLUSION: High-flex total knee arthroplasty appears to facilitate greater flexion in the first 3 months postoperatively, but there is no significant difference between both groups with regard to the range of motion, clinical and radiographic variables after 3 months.
Arthroplasty* ; Follow-Up Studies ; Knee ; Range of Motion, Articular

PURPOSE: This study is to establish a detailed anthropometric data of Korean female knee and to compare the data with current total knee prostheses. MATERIALS AND METHODS: 476 consecutive osteoarthritic knees were measured intraoperatively about anteroposterior (AP) dimension of medial and lateral condyle, and mediolateral (ML) dimension of distal femur as well as proximal tibia. Dimensions of 5 total knee arthroplasty (TKA) systems were compared with these measurements. RESULTS: The AP dimension of medial and lateral condyle, and ML dimension of distal femur were 60.3+/-3.5 mm, 60.9+/-3.2 mm and 68.4+/-3.9 mm, respectively. Those of proximal tibia were 47.4+/-2.8 mm, 39.5+/-3.1 mm and 67.4+/-2.9 mm, respectively. Korean femurs below -1 standard deviation (SD) in lateral AP dimension had narrower ML dimension than femoral prostheses. And most femurs above -1 SD in lateral AP dimension had wider ML dimension than femoral prostheses. Korean tibias had wider ML dimension than tibial prostheses. CONCLUSION: Current total knee prostheses had tendency to ML overhang in small femurs and ML undercoverage in other femurs, and tendency to ML undercoverage or posterolateral overhang in tibias. Thus, Korean anthropometric data should be considered in Korean-friendly prostheses.
Arthroplasty ; Female* ; Femur ; Humans ; Knee Prosthesis ; Knee* ; Prostheses and Implants ; Tibia

PURPOSE: This study is to compare the size distribution of current total knee prostheses with a measurements of Korean knees. MATERIALS AND METHODS: 566 consecutive osteoarthritic knees were measured, intraoperatively, for anteroposterior(AP) dimension of medial and lateral condyle, and mediolateral(ML) dimension of distal femur and proximal tibia. The size distribution of 5 total knee arthroplasty(TKA) systems were compared with these measurements. RESULTS: Regarding femoral component, the numbers of available lateral AP sizes within +/-1SD of Korean knees were two in Genesis II, PFC-RPF, Scorpio and one in Advance MPK, LPS-Flex. Those of available ML sizes for +/-1SD range were two in all systems. Regarding tibial component, the numbers of available lateral AP sizes for +/-1SD range were four in Scorpio, three in LPS-Flex, PFC-RPF and two in Advance MPK, Genesis II. Those of available ML sizes for +/-1SD range were two in Advance MPK, Scorpio and one in the others. CONCLUSION: Korean-friendly total knee prostheses should incorporate the size distribution as well as the dimension of the Korean knees.
Femur ; Knee Prosthesis* ; Knee* ; Tibia

Schwannoma or neurilemmoma is a benign peripheral nerve sheath tumor that arises from Schwann cells. Approximately 25–45% of all schwannomas occur in the head and neck regions, and the intraoral presentation of these is only 1%. We report a rare case of a patient presenting tongue base schwannoma with characteristic imaging features on computed tomography and magnetic resonance imaging.
Diagnosis, Differential ; Head ; Humans ; Magnetic Resonance Imaging ; Neck ; Nerve Sheath Neoplasms ; Neurilemmoma ; Peripheral Nerves ; Schwann Cells ; Tongue

PURPOSE: Neuroblastoma is a malignant neoplasm which arises from primitive sympathetic neuroblasts, and occasionally can matured from a malignant neuroblastoma into a benign ganglioneuroma. It has the highest rate of spontaneous regression of any pediatric tumor. We performed a retrospective study of pathologic features after combination therapy in advanced neuroblastoma. Prognostic effects of the individual morphologic feature and prognostic groupings according to modified Shimada classification systems were analyzed. METHODS: The treatment results for six patients with neuroblastoma seen at Keimyung University from Jan. 1991 to June 2000 were analyzed. Patients were treated with a combination of chemotherapy, radiation therapy, and surgery, and classified by two major prognostic criteria based on morphological features of neuroblastoma, such as modified Shimada classification and histologic grading. RESULTS: Three cases were classified to a good histologic group; among them, two cases survived, but one case was lost in follow-up. There were three cases classified in a poor histologic group. All of these patients expired due to sepsis and hemorrhagic pancreatitis. CONCLUSION: Prognostic classification due to pathologic findings had significant value in evaluating the survival rate of neuroblastoma patients.
Classification ; Drug Therapy ; Follow-Up Studies ; Ganglioneuroma ; Humans ; Neuroblastoma* ; Pancreatitis ; Prognosis* ; Retrospective Studies ; Sepsis ; Survival Rate

The surgical stapling technique has been recognized as an indispensable tool in rectal cancer surgery. A personal experience in one-hundred patiens is presented for the purpose of appropriate use of the surgical staplers. Three anastomotic techniques used were end-to-end anastomosis in 75 cases, double-stapling in 11 cases, and side-to-end anastomosis in 14 cases. In 88 cases, level of anastomosis was below the peritoneal reflection. Eight cases of stapling errors were found during operation. Among them, 5 cases of instrumental failure were 2 cases of blade defect and each one of difficult extraction, misfiring or tearing over trocar. The other 3 cases of surgical errors come from uneven perirectal excision causing one incomplete doughnut and 2 deficient anastomosis. Distal resection margin was closely related to the location of tumor(p < 0.01), but local recurrence did not associated with it. Two cases of postoperative hematochezia showed self-limiting. Anastomotic leakage occurred in 3 female patients and they were converted into resection. Excluding one leakage from skipped proximal foci, 2 cases occurred in the ultra-low anastomosis. Postoperative stricture was found in 5 cases and they were not associated with internal diameter of circular stapler. They were treated by manual dilatation and bulk-forming laxatives without surgical intervention. Bowel frequency or inability of deferrment was found in 9 cases on 1 month and 5 cases on 6 months postoperatively. They were not related to anastomotic level or stapling method. In conclusion, the stapling technique in rectal cancer surgery is a safe as well as a comfortable technique whenever complication can be amenable to the surgeon.
Anastomotic Leak ; Constriction, Pathologic ; Dilatation ; Female ; Gastrointestinal Hemorrhage ; Humans ; Laxatives ; Medical Errors ; Rectal Neoplasms* ; Recurrence ; Surgical Instruments ; Surgical Staplers* ; Surgical Stapling

BACKGROUND: Although the incidence of colorectal cancer in young adults is low, they seem to show advanced tumors with a poor prognosis at their initial presentation due to diagnostic delay. We evaluated colorectal cancer in young patients with respect to clinical characteristics and prognosis. METHODS: Twelve hundred and seventy-three colorectal cancer patients were evaluated retrospectively. Familial adenomatous polyposis and ulcerative colitis related cases were excluded. We grouped these patients into younger (40 years old) and older (>40 years old) patients. These two groups were compared with respect to sex, tumor location, duration of symptoms and signs, patterns of DNA ploidy, histological differentiations, TNM stage, survival rate, and familial tendency of colorectal cancer. RESULTS: One hundred forty-nine patients (11.7%) were 40 years old or younger. There was no significant difference between the two groups with respect to sex, tumor location, patterns of DNA ploidy, and 5-year survival rate. Histological patterns revealed a higher incidence of mucinous and signet-ring cell tumors in the younger group than in the older group (12.7% vs. 2.7% and 4.0% vs. 0.7%, p<0.05). The duration of the symptoms was shorter in the younger group, being less than 3 months in 56.3% of the younger group and 36.3% of the older group. Colorectal cancer in the younger group seemed to present more advanced lesions, especially those in stage III. Familial clustering of cancers(younger group, 25.5%; older group, 9.3%) and hereditary nonpolyposis colorectal cancer(younger group, 7.4%; older group, 0.7%) were more prevalent in the younger group. CONCLUSION:For colorectal cancer in younger patients with histological shortcomings and familial clustering, every effort is needed to make an earlier diagnosis.
Adenomatous Polyposis Coli ; Adult* ; Colitis, Ulcerative ; Colorectal Neoplasms* ; Colorectal Neoplasms, Hereditary Nonpolyposis ; Diagnosis ; DNA ; Humans ; Incidence ; Mucins ; Ploidies ; Prognosis* ; Retrospective Studies ; Survival Rate ; Young Adult