PURPOSE: To prevent excessive sliding and subsequent fixation failures in unstable intertrochanteric fractures with posteromedial comminution, extramedullary reduction through overlapping of the anteromedial cortices of both proximal and distal fragments as a buttress has been introduced. The purpose of this study was to compare the biomechanical properties between two reduction methods-intramedullary reduction and extramedullary reduction-in treating unstable intertrochanteric fractures with posteromedial comminution (AO/OTA classification 31-A2.2). MATERIALS AND METHODS: Eight pairs of frozen human cadaveric femora were used. The femora of each pair were randomly assigned to one of two groups: the intramedullary reduction group or the extramedullary reduction group. A single axial load-destruction test was conducted after cephalomedullary nailing. Axial stiffness, maximum load to failure, and energy absorbed to failure were compared between the two groups. Moreover, the pattern of mechanical failure was identified. RESULTS: The mean axial stiffness in the extramedullary reduction group was 27.3% higher than that in the intramedullary reduction group (422.7 N/mm vs. 332.0 N/mm, p=0.017). Additionally, compared with the intramedullary reduction group, the mean maximum load to failure and mean energy absorbed to failure in the extramedullary group were 44.9% and 89.6% higher, respectively (2,848.7 N vs. 1,966.5 N, p=0.012 and 27,969.9 N·mm vs. 14,751.0 N·mm, p=0.012, respectively). In the intramedullary reduction group, the mechanical failure patterns were all sliding and varus deformities. In the extramedullary reduction group, sliding and varus deformities after external rotation were noted in 3 specimens, sliding and varus deformities after internal rotation were noted in 3 specimens, and medial slippage was noted in 2 specimens. CONCLUSION: In unstable intertrochanteric fractures with posteromedial comminution, the biomechanical properties of extramedullary reduction are superior to those of intramedullary reduction. Anteromedial cortex could be the proper buttress, despite a comminuted posteromedial cortex. It could help enhance the stability of the bone-nail construct.
Cadaver ; Classification ; Congenital Abnormalities ; Hip Fractures ; Humans

BACKGROUND: To elucidate the effect of anterolateral bowing on the fracture height of atypical femoral fractures (AFFs), we separated the AFFs into 2 groups according to the presence of anterolateral femoral bowing (straight group and bowing group) and analyzed the fracture height. The aims of this study were to evaluate the clinical and radiological features of AFFs in the straight group and bowing group, and to determine which factors were associated with the fracture height of AFFs in the total cohort and each subgroup. METHODS: Ninety-nine patients with AFFs were included in this study (43 patients in the bowing group and 56 patients in the straight group). Clinical and radiological characteristics were compared between the groups. Multivariable linear regression analysis was performed to determine the effect of factors on fracture height. RESULTS: Patients in the straight group were younger, heavier, and taller, and had a higher bone mineral density, smaller anterior and lateral bowing angles, and more proximal fracture height than those in the bowing group. Multivariable analysis showed that the presence of anterolateral bowing itself and height were associated with fracture height in the total cohort. In the subgroup analysis, the lateral bowing angle in the straight group and the estimated apex height in the bowing group were associated with fracture height. The lateral bowing angle was not significantly associated with fracture height in the total cohort and the bowing group. CONCLUSIONS: The presence of anterolateral bowing and the level of the apex of the bowed femur were important factors for the fracture height of AFFs.
Bone Density ; Cohort Studies ; Femoral Fractures ; Femur ; Humans ; Linear Models ; Osteoporosis ; Stress, Mechanical

BACKGROUND/AIMS: This prospective study was conducted to assess the effect of walking-exercise on the bowel cleansing before colonoscopy and to define subgroup of patients to whom walking-exercise was beneficial. METHODS: Before taking 2.5 L of polyethylene glycol, 393 out-patients were randomized into two groups (G1; walking-exercise, G2; non-exercise) and the amount of walking-exercise was estimated by the step counter. A single colonoscopist performed the procedure with a single-blinded manner and estimated the bowel cleansing. RESULTS: A total of 366 patients were included by per protocol analysis. The number of step count was significantly different between two groups (p<0.000). However, the groups were similar in other data collected. The degree of bowel cleansing between two groups was significantly different (p<0.01). Age, history of abdominal surgery, constipation, obesity and walking- exercise were related to the degree of bowel cleansing. Interestingly, walking-exercise was especially beneficial to patients with age less than 65 years, without history of abdominal surgery, and non-obesity. Multivariate analysis demonstrated that absence of constipation (OR=4.74), walking- exercise (OR=2.04), and younger age (OR=1.97) were independent factors associated with better bowel cleansing. Most of walking patients (97.4%) answered that walking-exercise is more comfortable than taking the solution. CONCLUSIONS: The walking-exercise was of an additional benefit to improve colonoscopic bowel cleansing without significant patients discomfort.
Colonoscopy* ; Constipation ; Humans ; Multivariate Analysis ; Obesity ; Outpatients ; Polyethylene Glycols ; Prospective Studies ; Walking

BACKGROUND AND OBJECTIVES: Early glottic cancer can be effectively treated with conservation laryngeal surgery, radiation therapy, and endoscopic laser surgery. The aim of this study was to compare the clinical results between laser cordectomy and radiation therapy for early glottic cancer and to evaluate the role of laser cordectomy. MATERIALS AND METHOD: From 1988 to 1998, 89 patients with T1-T2/N0 glottic cancer were treated initially with radiation therapy or laser cordectomy. There were 67 T1 and 22 T2 tumors. Fifty-two patients were treated by radiation therapy (RT), and thirty-seven patients were treated by endoscopic laser cordectomy. The method of primary treatment, local control rate, survival rate and larynx preservation were retrospectively evaluated. RESULTS: With the median follow-up period of 48.2 months, the local control rates in laser cordectomy and radiation therapy were 88.9%, 89.7% for T1, and 90.0% and 61.5% for T2 tumors, respectively. The 3-year survival rate was 88.9% and 87.2% for T1 and 80.0% and 61.5% for T2. Larynx preservation rate was 83.4% in T1 and 70.0% in T2 patients. These results of laser cordectomy were superior to those treated by radiation therapy. CONCLUSION: In T1b glottic cancer, radiation therapy gave better results than laser cordectomy, whereas for T2 glottic cancer, laser cordectomy was superior to radiation therapy in initial control of tumor. Compared with radiation therapy, laser cordectomy afforded a greater likelihood of larynx preservation and more options for further treatment in case of failure. We conclude that the laser cordectomy is a good surgical alternative for properly selected early glottic cancer.
Follow-Up Studies ; Humans ; Larynx ; Laser Therapy ; Retrospective Studies ; Survival Rate

BACKGROUND AND OBJECTIVES: The aim of this study was to find risk factors for recurrence after curative radiotherapy in early glottic cancer and to analyze the result of treatment between salvage total laryngectomy and salvage conservation laryngectomy for recurrent glottic cancer. SUBJECTS AND METHOD: A retrospective analysis was performed for patients of 45 cases of early glottic cancer who were treated with curative radiotherapy from 1997 to 2004. The risk factors analyzed for recurrence in early glottic cancer were gender, age, anterior involvement, bilaterality, T stage and radiotherapy interruption. Fourteen patients who underwent salvage laryngectomy for recurrent glottic cancer were analyzed by Kaplan-Myer method to assess the results of salvage total laryngectomy and salvage conservation laryngectomy. RESULTS: Forty-two patients were male and only 3 patients were female, with the median age of 62.4 years. Radiotherapy interruption was found to be a risk factor significantly influencing recurrence in univariate and multivariate analyses. The 5-year overall survival rate in salvage total laryngectomy was 77% and that in salvage conservation laryngectomy was 75%. CONCLUSION: When a curative radiotherapy was interrupted in early glottic cancer before total dosage irradiation, the possibility of recurrence must be considered. In such cases, by choosing an adequate patient group combined with a proper surgical technique, optimal treatment results can be obtained by salvage conser-vation laryngectomy.
Female ; Humans ; Laryngeal Neoplasms ; Laryngectomy ; Male ; Multivariate Analysis ; Recurrence ; Retrospective Studies ; Risk Factors ; Salvage Therapy ; Survival Rate

McCune-Albright syndrome (MAS) is a sporadic disease classically including polyostotic fibrous dysplasia, cafe -au-lait spots, sexual precocity, and other hyperfunctional endocrinopathies. Recent investigations suggest an etiological role for activating embryonic somatic missense mutations in the gene for the a subunit of Gs (Gsa), the G protein that stimulates adenylyl cyclase. DNA from bone, ovary, and blood was analyzed by using polymerase chain reaction and sequenced. A embryological somatic mutation of Gsa gene encoding substitution of a Cys for Arg at amino acid 201 from cells of dysplastic bone and ovary was observed, and the distribution of mutant gene reveals mosaic pattern. We report a case of McCune-Albright syndrome with an activating mutation at codon 201 of Gsa subunit on ovary and bone tissue that was experienced recently.
Adenylyl Cyclases ; Bone and Bones ; Codon ; DNA ; Female ; Fibrous Dysplasia, Polyostotic* ; GTP-Binding Proteins* ; Mutation, Missense ; Ovary ; Polymerase Chain Reaction

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to “surgical management of oral cancer” published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient's treatment goals.
Advisory Committees ; Bias (Epidemiology) ; Carcinoma, Squamous Cell ; Counseling ; Expert Testimony ; Humans ; Mouth Neoplasms ; Neck ; Republic of Korea

Objectives: . Head and neck squamous cell carcinomas (HNSCs) are frequently diagnosed at the locoregional advanced stage (stage IVa), but controversy remains regarding whether stage IVa HSNCs should be treated with upfront surgery or definitive chemoradiation therapy (CRT). The purpose of this study was to compare overall survival (OS) and disease-free survival (DFS) in patients with stage IVa HNSC treated primarily by surgery with curative intent with/without (neo)adjuvant treatment (surgery group) versus those treated primarily with CRT (CRT group). Methods: . We reviewed data of 1,033 patients with stage IVa HNSC treated with curative intent at 17 cancer centers between 2010 and 2016. Results: . Among 1,033 patients, 765 (74.1%) received upfront surgery and 268 (25.9%) received CRT. The 5-year OS and DFS rates were 64.4% and 62.0% in the surgery group and 49.5% and 45.4% in the CRT group, respectively. In multivariate analyses, OS and DFS were better in the surgery group than in the CRT group (odds ratio [OR] for death, 0.762; 95% confidence interval [CI], 0.592–0.981; OR for recurrence, 0.628; 95% CI, 0.492–0.802). In subgroup analyses, the OS and DFS of patients with oropharyngeal cancer were better in the surgery group (OR for death, 0.548; 95% CI, 0.341–0.879; OR for recurrence, 0.598; 95% CI, 0.377–0.948). In the surgery group, patients with laryngeal cancer showed better OS (OR for death, 0.432; 95% CI, 0.211–0.882), while those with hypopharyngeal cancer DFS was improved (OR for recurrence, 0.506; 95% CI, 0.328–0.780). Conclusion . A survival benefit from surgery may be achieved even in patients with stage IVa HNSC, particularly those with oropharyngeal and laryngeal cancer. Surgery led to a reduction in the recurrence rate in patients with hypopharyngeal cancer.

Objectives: . Head and neck squamous cell carcinomas (HNSCs) are frequently diagnosed at the locoregional advanced stage (stage IVa), but controversy remains regarding whether stage IVa HSNCs should be treated with upfront surgery or definitive chemoradiation therapy (CRT). The purpose of this study was to compare overall survival (OS) and disease-free survival (DFS) in patients with stage IVa HNSC treated primarily by surgery with curative intent with/without (neo)adjuvant treatment (surgery group) versus those treated primarily with CRT (CRT group). Methods: . We reviewed data of 1,033 patients with stage IVa HNSC treated with curative intent at 17 cancer centers between 2010 and 2016. Results: . Among 1,033 patients, 765 (74.1%) received upfront surgery and 268 (25.9%) received CRT. The 5-year OS and DFS rates were 64.4% and 62.0% in the surgery group and 49.5% and 45.4% in the CRT group, respectively. In multivariate analyses, OS and DFS were better in the surgery group than in the CRT group (odds ratio [OR] for death, 0.762; 95% confidence interval [CI], 0.592–0.981; OR for recurrence, 0.628; 95% CI, 0.492–0.802). In subgroup analyses, the OS and DFS of patients with oropharyngeal cancer were better in the surgery group (OR for death, 0.548; 95% CI, 0.341–0.879; OR for recurrence, 0.598; 95% CI, 0.377–0.948). In the surgery group, patients with laryngeal cancer showed better OS (OR for death, 0.432; 95% CI, 0.211–0.882), while those with hypopharyngeal cancer DFS was improved (OR for recurrence, 0.506; 95% CI, 0.328–0.780). Conclusion . A survival benefit from surgery may be achieved even in patients with stage IVa HNSC, particularly those with oropharyngeal and laryngeal cancer. Surgery led to a reduction in the recurrence rate in patients with hypopharyngeal cancer.