Purpose: The purpose of this study was to retrospectively evaluate the effect of ‘Blocking Kirschner Wire (K-Wire) Technique’, which has been developed to reduce protrusion of the lateral wall, in maintaining the level of reduction through clinical and radiological outcomes. Materials and Methods: Twenty-two patients with displaced intra-articular calcaneal fractures who used the blocking K-wire to maintain reduction (group A) and 44 patients that did not use blocking K-wire and were paired in 1:2 ratio with those Group A patients (group B), between January 2015 and December 2017 were enrolled in the study. All surgical procedures were performed via the extended sinus tarsi approach, and internal fixation using cannulated screws, Steinmann pins and K-wires was performed. American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale and postoperative recovery of exercise ability were compared for postoperative clinical outcomes.The radiological results were compared the Böhler angle, Gissane angle, calcaneal height and width, step off of posterior calcaneal joint, and the degree of protrusion of the lateral wall. Moreover, postoperative complications in both groups were compared. Results: There were no significant differences in the clinical outcomes of the two groups (p=0.924, p=0.961). The amount of Böhler angle, Gissane angle, calcaneal height and width, and step off of posterior calcaneal joint from the radiological results was not significantly different between the two groups (p=0.170, p=0.441, p=0.230, p=0.266, and p=0.400). However, the degree of protrusion of the lateral wall was 1.78 mm and 4.95 mm in group A and group B, respectively, and the difference between the two groups was significant (p=0.017). Although sural nerve entrapment and painful exostosis were more frequent in group B, they were occurred in a non-significant manner (p=0.293, p=0.655). Conclusion Most of the clinical and radiological results as well as the complications were not significantly different between the two groups. However, the degree of protrusion of the calcaneus lateral wall in group A was promising. The ‘Blocking K-Wires Technique’ established by the authors may be an effective surgical option for maintaining the reduction of the lateral wall protrusion in displaced intraarticular calcaneal fractures.

Stiff-person syndrome is a rare disorder, and the natural history of the syndrome has not been completely ascertained. The symptoms range from mild to severe and can progress over time: the final result can be significant disability. However, this syndrome is often misdiagnosed due to a lack of understanding of the clinical manifestations. We report the case of a patient who presented with slowly progressing gait disturbance and lower extremity pain and was later diagnosed as suffering from stiff-person syndrome. The patient experienced symptomatic improvement after the administration of benzodiazepines. No recurrence of symptoms has been reported. If the characteristic clinical features and electromyography findings of the syndrome are accurately interpreted, diagnosis of patients with abnormal muscle tension can be effectively done.
Autoantibodies ; Autoimmune Diseases ; Benzodiazepines ; Diagnosis ; Electromyography ; Gait ; Humans ; Leg ; Lower Extremity ; Muscle Tonus ; Natural History ; Recurrence ; Spasm ; Stiff-Person Syndrome

This article was published with a misspelled the date of acceptance. The date of acceptance should be corrected as “March 7, 2013”.
Breast Neoplasms* ; Breast* ; Humans ; Recurrence*

PURPOSE: Neoadjuvant chemotherapy (NAC) has been recently used to downstage breast cancer. However, in patients with initial axillary lymph node (ALN) metastasis, ALN dissection regardless of the NAC response remains the standard treatment. The purpose of this study was to identify the feasibility and accuracy of sentinel lymph node biopsy (SLNB) after NAC in patients with ALN metastasis at diagnosis. METHODS: From January 2007 to August 2013, data of patients who were diagnosed with invasive breast cancer and ALN metastasis and treated with NAC followed by definitive surgery in two centers were collected retrospectively. A total of 386 patients were enrolled and classified into five groups according to surgical procedure for the ALNs and pathologic results. RESULTS: At SLNB after NAC, sentinel lymph nodes (SLNs) that stained blue or were hot, including suspicious nodes, were identified; the SLN identification and false-negative rates was 96% and 10%, respectively. There was no difference in the overall survival among the groups. For patients who revealed a pathologic complete node response, there was a significant difference in the disease-free survival rate between the SLNB only and complete ALN dissection groups (p=0.031). However, the rate of axillary recurrence demonstrated no significant differences among the groups (p>0.050). CONCLUSION: SLNB after NAC in breast cancer patients with initial ALN metastasis may help identify downstaging to negative nodal status and thereby reduce the surgical morbidity by avoiding standard ALN dissection.
Axilla ; Breast Neoplasms ; Diagnosis ; Disease-Free Survival ; Drug Therapy* ; Humans ; Lymph Nodes ; Neoadjuvant Therapy ; Neoplasm Metastasis* ; Recurrence ; Retrospective Studies ; Sentinel Lymph Node Biopsy*

PURPOSE: Arthralgia is the most common side effect in breast cancer patients receiving aromatase inhibitor (AI) therapy. Few studies have evaluated the risk factors, onset, and incidence of musculoskeletal pain in these patients. This study identifies the risk factors of AI-related severe arthralgia and their prevalence. METHODS: All the clinical and pathological records of postmenopausal patients diagnosed with invasive breast cancer using AI at Samsung Medical Center from January 2005 to November 2007 were reviewed. Multivariate logistic regression analyses were performed to evaluate the risk factors of AI-associated musculoskeletal symptoms (AIMSS) and factors associated with AI discontinuance. RESULTS: Among 299 patients, 69 patients (23%) experienced musculoskeletal symptoms attributed to AI use. In multivariate logistic regression analysis, no statistically significant outcome was found to confirm the risk factors for the development of AIMSS. Among the 69 patients who experienced AI-associated musculoskeletal symptoms, 29 (39.7%) discontinued AI use. Multivariate logistic regression analyses revealed an association of prior tamoxifen use with discontinuance of AI (P < 0.01; odds ratio, 4.27; 95% confidence interval, 1.74 to 10.50). CONCLUSION: Prior use of tamoxifen is related to discontinuation of AI due to AI-associated severe arthralgia. Special monitoring and proper pain control for these patients should be considered during the treatment period.
Aromatase Inhibitors ; Aromatase* ; Arthralgia ; Breast Neoplasms ; Humans ; Incidence* ; Logistic Models ; Musculoskeletal Pain ; Odds Ratio ; Risk Factors ; Tamoxifen

PURPOSE: IBTR! 2.0 is a web-based nomogram that predicts the 10-year ipsilateral breast tumor recurrence (IBTR) rate after breast-conserving therapy. We validated this nomogram in Korean patients. METHODS: The nomogram was tested for 520 Korean patients, who underwent breast-conserving surgery followed by radiation therapy. Predicted and observed 10-year outcomes were compared for the entire cohort and for each group, predefined by nomogram-predicted risks: group 1, <3%; group 2, 3% to 5%; group 3, 5% to 10%; group 4, >10%. RESULTS: In overall patients, the overall 10 year predicted and observed estimates of IBTR were 5.22% and 5.70% (p=0.68). In group 1, (n=124), the predicted and observed estimates were 2.25% and 1.80% (p=0.73), in group 2 (n=177), 3.95% and 3.90% (p=0.97), in group 3 (n=181), 7.14% and 8.80% (p=0.42), and in group 4 (n=38), 11.66% and 14.90% (p=0.73), respectively. CONCLUSION: In a previous validation of this nomogram based on American patients, nomogram-predicted IBTR rates were overestimated in the high-risk subgroup. However, our results based on Korean patients showed that the observed IBTR was higher than the predicted estimates in groups 3 and 4. This difference may arise from ethnic differences, as well as from the methods used to detect IBTR and the healthcare environment. IBTR! 2.0 may be considered as an acceptable nomogram in Korean patients with low- to moderate-risk of in-breast recurrence. Before widespread use of this nomogram, the IBTR! 2.0 needs a larger validation study and continuous modification.
Breast ; Breast Neoplasms ; Cohort Studies ; Delivery of Health Care ; Humans ; Mastectomy, Segmental ; Nomograms ; Recurrence

Takayasu's arteritis (TA) is a nonspecific, chronic and stenotic panarteritis which usually involves the aorta and its major branches. Corticosteroid and immunosuppressants are recommended to manage the acute inflammatory phase, but their long term benefits are uncertain. Blood pressure (BP) control during the chronic phase of TA is essential to preserve renal function, which is associated with the patient's long-term prognosis and survival. Revascularization in organ damaging arterial stenosis with percutaneous angioplasty (PTA)/stenting or bypass surgery have been accepted as established treatment options in chronic complicated phase of TA. We present a case of a 31-year-old female patient with a two-day history of sudden onset oliguria and generalized edema whose acute oliguric renal failure was successfully reversed following PTA and stenting in a solitary functioning kidney with critical renal artery stenosis (RAS) caused by TA.
Acute Kidney Injury ; Adult ; Angioplasty ; Aorta ; Blood Pressure ; Constriction, Pathologic ; Edema ; Female ; Humans ; Immunosuppressive Agents ; Kidney ; Oliguria ; Prognosis ; Renal Artery ; Renal Artery Obstruction ; Renal Insufficiency ; Stents ; Takayasu Arteritis

An osteoclast-like giant cell tumor of the pancreas is a very rare neoplasm, with only three cases reported in Korea. Due to the rarity of this tumor type, few clinical data are available. We present a case of undifferentiated carcinoma with osteoclast-like giant cell tumor arising in the tail of the pancreas in a 72-year-old woman hospitalized to evaluate epigastric pain and a palpable abdominal mass. Magnetic resonance imaging revealed the presence of a large enhancing mass with septation arising from the tail of the pancreas. A distal pancreatectomy with splenectomy was performed. The pathological diagnosis was undifferentiated carcinoma with osteoclast-like giant cell tumor. Here, we describe the histopathological and immunohistochemical findings and review the clinical features of the cases reported in the Korean literature.
Aged ; Carcinoma ; Female ; Giant Cell Tumors ; Giant Cells ; Humans ; Korea ; Magnetic Resonance Imaging ; Pancreas ; Pancreatectomy ; Pancreatic Neoplasms ; Splenectomy

BACKGROUND AND OBJECTIVES: A treatment gap for dyslipidemia can occur during the early phase of acute myocardial infarction (AMI) because the baseline low density lipoprotein-cholesterol (LDL-C) level during this period rapidly decreases physiologically. SUBJECTS AND METHODS: We retrospectively reviewed the medical records of the patients who were admitted with AMI from December 2004 to July 2007 and their baseline LDL-C levels were less than 100 mg/dL. We analyzed the baseline lipid profiles and its serial changes in these patients. The initial LDL-C value, which can be expected to increase to over 100 mg/dL of LDL-C after discharge, was estimated statistically. RESULTS: Among the 298 AMI patients, 94 (31.5%) patients showed a LDL-C level below 100 mg/dL. The LDL-C level increases between baseline and within 2 weeks, 2-6 weeks and 6 weeks after discharge were 11.8+/-22.5, 24.4+/-23.8 and 26.6+/-16.6 mg/dL, respectively. We made a receiver operating characteristics (ROC) curve of the LDL-C level at baseline and within 2 weeks after discharge for predicting the increment of the LDL-C level. Using the cutoff value 74 mg/dL for the initial LDL-C level, the sensitivity and specificity were 83% and 50%, respectively. With using an 81 mg/dL cutoff value at 2 weeks, the sensitivity and specificity were 83% and 62%, respectively. CONCLUSION: A significant portion of AMI patients with an LDL-C level less than 100 mg/dL and who were not prescribed statin in the early phase of infarction showed an elevated LDL-C level over 100 mg/dL at 2 weeks after the infarction. The early administration of statin should be considered for treating an LDL-C=74 mg/dL during the initial period of AMI or an LDL-C=81 mg/dL at 2 weeks after AMI because their LDL-C level will increase to over 100 mg/dL during the subsequent follow-up period.
Dyslipidemias ; Follow-Up Studies ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Infarction ; Medical Records ; Myocardial Infarction ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity

Obstructive jaundice is most commonly attributed to a malignancy or stones affecting the common bile duct. Biliary tuberculosis and lymphadenitis around the periportal area have also been implicated but cases are quite rare. A 24 year old man presented with jaundice and abdominal pain for 3 days. Abdominal CT and ERCP revealed a stricture of the extrahepatic bile duct with multiple enlarged lymph nodes showing necrotic foci located at the periportal area. The colonoscopic biopsy showed evidence of M. tuberculosis. The patient was treated with ERBD insertion and oral anti-tuberculosis therapy. However, the abdominal pain recurred and there was progressive stenosis of the common bile duct. A bile duct resection with choledochojejunostomy was subsequently performed. Frozen sections revealed granulomatous inflammation with caseation necrosis, which was consistent with tuberculosis. We report a case of tuberculous cholangitis and lymphadenitis with obstructive jaundice that was managed surgically due to the progressive stricture of the bile duct.
Abdominal Pain ; Bile Ducts* ; Bile Ducts, Extrahepatic ; Bile* ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis* ; Choledochostomy ; Common Bile Duct ; Constriction, Pathologic* ; Frozen Sections ; Humans ; Inflammation ; Jaundice ; Jaundice, Obstructive* ; Lymph Nodes ; Lymphadenitis* ; Necrosis ; Tomography, X-Ray Computed ; Tuberculosis ; Tuberculosis, Lymph Node ; Young Adult