Purpose: An adequate minimal surgical margin for partial nephrectomy (PN) has not yet been conclusively established. Therefore, we aimed to compare PN recurrence rates according to surgical margin status and to establish an adequate minimal surgical margin. Materials and Methods: We retrospectively studied patients with clinically localized renal cell carcinoma who underwent PN between 2005 and 2014. Surgical margin width (SMW) was assessed for all surgical tissues and divided into three groups: SMW <1 mm, SMW ≥1 mm, and positive surgical margin (PSM). The data were analyzed using the Kaplan-Meier method with log-rank tests and multivariate Cox regression models. Results: Of 748 patients (median age, 55 years; interquartile range, 46–64 years; 220 female), 704 (94.2%) and 44 (5.8%) patients had negative and PSMs, respectively. Recurrence-free survival was significantly lower in patients with PSMs (p<0.001) and was not significantly different between SMW ≥1 mm and <1 mm groups (p=0.604). PSM was a significant predictor of recurrence (hazard ratio: 8.03, 95% confidence interval: 2.74–23.56, p<0.001), in contrast to SMW <1 mm (p=0.680). Conclusion A PSM after PN significantly increases the risk of recurrence. We discovered that even a submillimeter safety surgical margin may be enough to prevent recurrence. To maximize normal renal parenchyma preservation and to avoid cancer recurrence in renal parenchymal tumor patients, PN may be a safe treatment, except for those with a PSM in the final pathology.

PURPOSE: To investigate and distinguish the computed tomography (CT) characteristics of chromophobe renal cell carcinoma (chRCC) and renal oncocytoma. MATERIALS AND METHODS: Fifty-one patients with renal oncocytoma and 120 patients with chRCC, diagnosed by surgery between November 2005 and June 2015, were studied retrospectively. Two observers, who were urologists and unaware of the pathological results, reviewed the preoperative CT images. The tumors were evaluated for size, laterality, tumor type (ball or bean pattern), central stellate scar, segmental enhancement inversion, and angular interface pattern and tumor complexity. To accurately analyze the mass-enhancing pattern of renal mass, we measured Hounsfield units (HUs) in each phase and analyzed the mean, maximum, and minimum HU values and standard deviations. RESULTS: There were 51 renal oncocytomas and 120 chRCCs in the study cohort. No differences in clinical and demographic characteristics were observed between the two groups. A central stellate scar and segmental enhancement inversion were more likely in oncocytomas. However, there were no differences in ball-/bean-type categorization, enhancement pattern, and the shape of the interface between the groups. Higher HU values tended to be present in the corticomedullary and nephrogenic phases in oncocytomas than in chRCC. Receiver-operating characteristic curve analysis showed that the presence of a central stellate scar and higher mean HU values in the nephrogenic phase were highly predictive of renal oncocytoma (area under the curve=0.817, p<0.001). CONCLUSIONS: The appearance of a central stellate scar and higher mean HU values in the nephrogenic phase could be useful to distinguish renal oncocytomas from chRCCs.
Adenoma, Oxyphilic/pathology/*radiography ; Carcinoma, Renal Cell/pathology/*radiography ; Diagnosis, Differential ; Female ; Humans ; Kidney Neoplasms/pathology/*radiography ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed

PURPOSE: There are numerous opinions about the methods and usefulness of minimizing leg length discrepancies after hip arthroplasty. In this study, we tried to evaluate the usefulness of an intraoperative x-ray in addition to preoperative templating for minimizing leg length discrepancy. MATERIALS AND METHODS: We reviewed pre- and post-operative pelvis AP x-rays of 46 patients who underwent hip arthroplasty due to a traumatic femoral neck fracture or intertrochanteric fracture between May 2008 and February 2009. A leg length discrepancy is the difference in vertical distance between a horizontal line drawn along the bottom of the ischial tuberosities and the most inferior points of the lesser trochanter. It was measured in a pelvis AP x-ray. In each case, pre-operative templating was performed and an intraoperative pelvis AP x-ray was taken again to assess the accuracy of preoperative planning. Implant positions were readjusted when necessary. RESULTS: The mean post-operative leg-length discrepancy was 0.3 mm (SD, 3.1 mm). The range was from -5.8 mm to +5.9 mm. CONCLUSION: Combining preoperative templating and intraoperative x-rays is a useful method of minimizing leg length discrepancy during hip arthroplasty.
Arthroplasty ; Femoral Neck Fractures ; Femur ; Hip ; Humans ; Leg ; Pelvis

Multiple drilling of the femoral head is a commonly-used surgical technique for the treatment of osteonecrosis. Several holes are drilled into the femoral head using a small-diameter Steinmann pin. This decompression technique promotes revascularization and regeneration of necrotic tissue in the femoral head. Known complications are heterotopic ossification and femoral subtrochanteric fractures, although these have only been rarely reported. Our case study focuses on a subtrochanteric fracture 6 weeks after a multiple drilling operation.
Decompression ; Femur ; Head ; Hip Fractures ; Mandrillus ; Ossification, Heterotopic ; Osteonecrosis ; Regeneration

PURPOSE: CSF (Cerebrospinal fluid) leakage is the most common complication of neurosurgery. Early management with conservative care or surgery must be followed appropriately due to the increased risk of lethal complications, such as meningitis. We report a case of intractable CSF leakage that occurred after a cerebellar tumor resection, which was treated successfully. METHODS: A 53-year old male consulted our department for continuous CSF leakage for 3 months after having received conservative care and lumbar drainage. CSF collection was observed in the dead space of the posterior fossa after a cerebellar tumor resection and postoperative radiotherapy. Using a free latissimus dorsi muscle flap, the dead space within the skull was filled and the defects were covered successfully. RESULTS: At 6 weeks after surgery, the follow-up MRI and CT revealed proper coverage and filling in the area where cerebellar tumor had been removed. No CSF leakage was observed at the postoperative 3 month follow-up. CONCLUSION: Recurrent CSF leakage was treated after cerebellar tumor resection with a relatively satisfactory result. In terms of the patient's treatment, much better results can be achieved by performing dead space filling using a flap with a sufficient size, in addition to coverage of the defects of the dura.
Cerebellar Neoplasms ; Drainage ; Follow-Up Studies ; Humans ; Male ; Meningitis ; Muscles ; Neurosurgery ; Skull

PURPOSE: Lipobean(R)s, widely used in lipodissolving techniques, contain phosphatidylcholine and sodium deoxycholate as its main substances. They have been approved only as medication for liver disease by the FDA. However, they have been used under various clinical settings without exact knowledge of its action mechanism. The authors designed an in vitro study to analyze the effects of different concentrations of phosphatidylcholine and sodium deoxycholate on adipocytes and other types of cells. METHODS: Human adipose-derived stem cell were cultured and induced to differentiate into adipocytes. Fibroblasts extracted from human inferior turbinate tissue, and MC3T3-E1 osteoblast lines were cultured. Phosphatidylcholine solution dissolved with ethanol was applied to the culture medium at differing concentrations (1, 4, 7, 10 mg/mL). The sodium deoxycholate solution dissolved in DMSO applied to the medium at differing concentrations (0.07, 0.1. 0.4. 0.7 mg/mL). Cells were dispersed at a concentration of 5 x 10(3) cells/well in 24 well plates, and surviving cells were calculated 1 day after the application using a CCK-8 kit. RESULTS: The number of surviving cells of adipocytes, fibroblasts and osteoblasts decreased as the concentration of sodium deoxycholate increased. However, all types of cells that had been processed in a phosphatidylcholine showed a cell survival rate of over 70% at all concentrations. CONCLUSION: This study shows that sodium deoxycholate is the more major factor in destroying adipocytes, and it is also toxic to the other cells. Therefore, we conclude that care must be taken when using Lipobean(R)s as a method of reducing adipose tissue, for its toxicity may destroy other nontarget cells existing in the subcutaneous tissue layer.
Adipocytes ; Adipose Tissue ; Cell Survival ; Deoxycholic Acid ; Dimethyl Sulfoxide ; Ethanol ; Fibroblasts ; Humans ; Liver Diseases ; Osteoblasts ; Phosphatidylcholines ; Sincalide ; Sodium ; Stem Cells ; Subcutaneous Tissue ; Turbinates

Spinal perineural cyst rarely appears in the upper lumbar spinal region as compared it occurrence at other spinal region. These cysts seldom cause radiating pain and neurologic symptoms because the majority of these cysts involve the sacral portion of the spine. Spinal perineural cyst can be recognized incidentally on magnetic resonance imaging while differentiating other diseases that cause back pain. The differential diagnosis of symptoms is needed to rule out whether or not the intraspinal cystic mass is the actual cause of radiculopathy. We report here on a case of perineural cyst at a left neural foramen of L2-3 and the patient displayed neurologic manifestations. The patient had progressively aggravated low back pain and sciatica of two years duration. MRI well demonstrated neural compression of the left 2nd lumbar neural root. Relief of symptoms were achieved by performing posterior decompression (hemilaminectomy, fascectomy & decompression of the ligamentum flavum), excision of the cyst and posterolateral fusion of L2-3.
Back Pain ; Decompression ; Diagnosis, Differential ; Humans ; Low Back Pain ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Radiculopathy ; Sciatica ; Spine ; Tarlov Cysts

PURPOSE: This study was performed to evaluate the risk factors affecting the failure of fixation and to analyze the clinical and radiologic results after operation with using a sliding hip screw for treating OTA type A2 intertrochanteric fractures of the femur. MATERIALS AND METHODS: From January 2001 to June 2005, we reviewed the clinical records and the serial radiographs of 53 patients (OTA type A2 intertrochanteric fractures of the femur) who were treated with a 135-degree angled sliding hip screw. We analyzed the change in the neck-shaft angle, the sliding distance and failure of the sliding screw, according to the reduction of the lesser trochanteric fragment and the stability of the lateral buttress. RESULTS: Among 53 patients, there were 15 cases (28.3%) of failures to reduce the lesser trochanteric fragment. Losses of the lateral buttress were observed in 35 cases (66.0%). There were 8 cases (15.1%, 8/15) that failed radiologically, including cutting out of the sliding hip screw from a femoral head (3 cases), metal failure (1 case) and excessive sliding (4 cases). There were significantly differences for the changes of the angle of the neck-shaft, the distance of sliding and the length of penetration of the sliding hip screw, according to the reduction of the lesser trochanteric fragment and the stability of the lateral buttress. CONCLUSION: It is important to consider the reduction of the lesser trochanteric fragment and the stability of lateral buttress when treating OTA type A2 intertrochanteric fractures with using a sliding hip screw.
Femur* ; Head ; Hip Fractures* ; Hip* ; Humans ; Risk Factors*

Ganglion cyst and synovial cyst are rarely found in the lumbar spinal canal. Synovial cysts usually arise from degenerative apophyseal joints, and ganglion cysts arise from articular facet joints. We present here two cases: one ganglion cyst that arose from the posterior longitudinal ligament at the L2-3 intervertebral space level, and a synovial cyst that also arose from the posterior longitudinal ligament at the level of the L4 body. Both patients progressively developed low back pain with radiating pain. The lesions were detected by magnetic resonance imaging in both cases. The dural sac was displaced by the cysts in both cases. Relief of symptoms was achieved by decompressive laminectomy and excision of the ganglion cyst, and excision of the synovial cyst and PLIF at L3-4. Because these lesions have not been reported on before, we report here on 2 cases with synovial and ganglion cyst from the posterior longitudinal ligament at lumbar spinal level.
Ganglion Cysts* ; Humans ; Joints ; Laminectomy ; Longitudinal Ligaments* ; Low Back Pain ; Magnetic Resonance Imaging ; Spinal Canal ; Synovial Cyst* ; Zygapophyseal Joint

PURPOSE: We made a radiological comparison between 60 degrees distal Chevron osteotomy with short armed two parts and 40 degrees distal Chevron osteotomy with long armed one part performing operation in cases of hallux valgus angle of less than 40 degrees, intermetatarsal angle of less than 15 degrees. MATERIALS AND METHODS: 12 cases with 60 degrees distal Chevron osteotomy and 12 cases with 40 degrees distal Chevron osteotomy were selected from October 2000 to March 2005. We have analysed the hallux valgus angle, 1-2 intermetatarsal angle, metatarsal length, distal metartarsal articular angle and angulation at osteotomy site on lateral view in each radiological films taken at preoperative, postoperative and 3 months after operation presuming bone union. All cases were women, both sides were 9 cases and average age was 52.3 years old. RESULTS: Data taken at preoperative, postoperative and 3 months follow up films in 60 degrees distal Chevron osteotomy were as follows; the hallux valgus angles were 32.1 degrees, 10.9 degrees, 13.8 degrees, the 1-2 intermetatarsal angles were 13.6 degrees, 8.5 degrees, 8.4 degrees, the metatarsal length were 60.6 mm, 58.8 mm, 58 mm, the distal metartarsal articular angles were 13 degrees, 6 degrees, 6.6 degrees and 3 cases were over 3 degrees angulation at lateral view. In 40 degrees distal Chevron osteotomy, the hallux valgus angles were 34.5 degrees, 11.6 degrees, 15.3 degrees, the 1-2 intermetatarsal angles were 12.7 degrees, 8.2 degrees, 7.8 degrees, the metatarsal length were 59.2 mm, 56.9 mm, 55.9 mm, the distal metartarsal articular angles were 12 degrees, 7.3 degrees, 7.3 degrees and there were no case with angulation over 3 degrees at lateral view. CONCLUSION: In comparison between 60 degrees distal Chevron osteotomy and 40 degrees distal Chevron osteotomy measuring at postoperative and follow up, most of all data were similar, but 3 cases over 3 degrees angulation at lateral view happened in 60 degrees Chevron osteotomy. This result showed that 40 degrees distal Chevron osteotomy fixing with screws through long armed one part may have benefit than 60 degrees distal Chevron osteotomy fixing with K-wires through short armed two parts in making rigid fixation, even though there is a personal difference of technigue.
Arm ; Female ; Follow-Up Studies ; Hallux Valgus* ; Hallux* ; Humans ; Metatarsal Bones ; Osteotomy*