Shallow trochlear groove and narrow medial trochlear width at the proximal trochlea in patients with trochlear dysplasia: A three-dimensional computed tomography analysis.

PURPOSE: Although the Dejour classification is the primary classification system for evaluating trochlear dysplasia, concerns have been raised about its reliability owing to its qualitative criteria and challenges associated with obtaining accurate radiographs. This study aimed to quantify trochlear dysplasia using three-dimensional (3D) computed tomography (CT) reconstruction with novel parameters related to the transepicondylar axis (TEA). METHODS: Sixty patients were enrolled, including 20 with trochlear dysplasia and 40 healthy controls. The 3D CT model was generated using the Materialise Interactive Medical Image Control System software. The following six parameters were measured in eight consecutive planes at 15° intervals (planes 0-105): the distance from the TEA to the most cortical point of the lateral condyle ('LP-TEA', where LP stands for lateral peak), medial condyle ('MP-TEA', MP for medial peak) and deepest point of the trochlea ('TG-TEA', TG for trochlear groove). The distances from the medial epicondyle (MEC) to the corresponding TEA points were measured ('LP-MEC', 'MP-MEC' and 'TG-MEC'). RESULTS: In the dysplasia group, TG-TEA (planes 0, 15 and 30) and MP-MEC (planes 0, 15 and 30) were significantly greater than those in the control group (all p < 0.05 for planes of TG-TEA and MP-MEC). For type A dysplasia, LP-MEC (plane 0) was greater than that in the control group. For type B dysplasia, the MP-MEC (planes 0 and 15) and TG-TEA (planes 0 and 15) were greater than those of the control group. For type D dysplasia, MP-MEC (planes 0, 15 and 30) and TG-TEA (planes 0 and 15) were elevated. CONCLUSION: The 3D CT reconstruction analysis established a reproducible method for quantifying osseous trochlear morphology. Patients with trochlear dysplasia had a shallow TG and narrow medial trochlear width at tracking angles of 0°-30°. This finding corroborates the clinical manifestations of recurrent patellar instability that occur during early flexion. LEVEL OF EVIDENCE: Level III.

Tumor enucleation for the treatment of T1 renal tumors: A systematic review and meta-analysis.

PURPOSE: To evaluate the clinical efficacy and safety of tumor enucleation (TE) compared with partial nephrectomy (PN) for T1 renal cell carcinoma. MATERIALS AND METHODS: According to protocol, we searched multiple data sources for published and unpublished randomized controlled trials and nonrandomized studies (NRSs) in any language. We performed systematic review and meta-analysis according to the Cochrane Handbook for Systematic Reviews of Interventions and rated the certainty of the evidence (CoE) using the GRADE framework. RESULTS: We are uncertain about the effects of TE on perioperative (mean difference [MD] 3.38, 95% CI 1.52 to 5.23; I²=68%; 4 NRSs; 942 participants; very low CoE) and long-term (MD 2.31, 95% CI -1.40 to 6.01; I²=57%; 4 NRSs; 542 participants; very low CoE) residual renal function. TE may result in little to no difference in short-term residual renal function (MD 1.04, 95% CI 0.25 to 1.83; I²=0%; 2 NRSs; 256 participants; low CoE). We are uncertain about the effects of TE on cancer-specific mortality (risk ratio [RR] 0.90, 95% CI: 0.11 to 7.28; I²=0%; 2 NRSs; 551 participants; very low CoE) and major adverse events (RR 0.48, 95% CI: 0.30 to 0.79; I²=0%; 10 NRS; 2,360 participants; very low CoE). CONCLUSIONS: While TE appears to have similar effects on short term postoperative residual renal function, there were uncertainties on mortality and major adverse events. However, we need rigorous RCTs to elucidate the effects of TE as the evidence stems mostly from NRSs.

Effect of Fibular Height and Lateral Tibial Condylar Geometry on Lateral Cortical Hinge Fracture in Open Wedge High Tibial Osteotomy.

PURPOSE: To evaluate whether the fibular position and lateral proximal tibial geometry affect the osteotomy configuration and lateral hinge fracture (LHF) during open wedge high tibial osteotomy (OWHTO). METHODS: From March 2014 to January 2016, patients who underwent OWHTO for isolated medial compartment osteoarthritis of the knee were retrospectively reviewed. To identify whether the fibular position and lateral proximal tibial geometry affect the osteotomy configuration, the fibular height, fibular anteroposterior position, lateral tibial condylar width, and lateral tibial condylar slope were evaluated on plain radiograph or computed tomography (CT). Thereafter, the correlation of these parameters with the thickness of the proximal fragment around the osteotomy end and LHFs was determined. RESULTS: A total of 123 OWHTOs including 30 LHFs (24.3%) were evaluated. High fibular head and small tibial condylar width and slope were related to thin thickness of the proximal tibial fragment, particularly on the posterior side (fibular height, P = .005; condylar width, P = .002; condylar slope, P = .01). The fibular height was shorter in the LHF group than in the non-LHF group on both plain radiography and CT (fibular height [plain radiography], 18.3 ± 1.6 vs 20.2 ± 2.1 mm; P < .001; fibular height [CT], 17.4 ± 1.1 vs 19.6 ± 2.0 mm; P < .001). The lateral tibial condylar width and slope were also smaller in the LHF group compared with the non-LHF group (tibial condylar width, 21.2 ± 4.9 vs 23.4 ± 4.5 mm; P = .023; tibial condylar slope, 37.7 ± 6.6 vs 41.3 ± 7.6 mm; P = .027). CONCLUSIONS: The fibular position and lateral proximal tibial geometry affect the osteotomy configuration and LHFs. A highly positioned fibula was related to a small lateral tibial condyle, which induced a thin proximal fragment. This finding was related to a higher risk of LHFs. Therefore, understanding the fibular height and lateral proximal tibial geometry may be helpful for the prediction of the osteotomy configuration and development of LHFs. LEVEL OF EVIDENCE: Level III, case-control study.

Estrogenic effects of phytoestrogens derived from Flemingia strobilifera in MCF-7 cells and immature rats.

Phytoestrogen (PE) has received considerable attention due to the physiological significance of its estrogenicity. Flemingia strobilifera (FS) has been used as a folk medicine in Asia for the treatment of inflammation, cancer, and infection; however, the estrogenic effects and chemical components of FS have not yet been reported. We aimed to uncover the estrogenic properties and PEs derived from FS using phytochemical and pharmacological evaluation. PEs from FS extract (FSE) were analyzed by NMR, HPLC, and MS. To evaluate estrogenic activity, FSE and its compounds were evaluated by in vitro and in vivo assays, including human estrogen receptor alpha (hERα) binding, estrogen response element (ERE)-luciferase reporter assays, and uterotrophic assays. FSE and its compounds 1-5 showed binding affinities for hERα and activated ERE transcription in MCF-7 cells. Additionally, FSE and compounds 1-5 induced MCF-7 cell proliferation and trefoil factor 1 (pS2) expression. In immature female rats, significant increases in uterine weight and pS2 gene were observed in FSE-treated groups. We identified estrogenic activities of FSE and its bioactive compounds, suggesting their possible roles as PEs via ERs. PEs derived from FSE are promising candidates for ER-targeted therapy for post-menopausal symptoms.

Synchronous mucosal Schwann-cell hamartomas in a young adult suggestive of mucosal Schwann-cell harmatomatosis: a case report.

BACKGROUND: Mucosal Schwann-cell hamartoma is a rare mesenchymal polyp that presents in the intestine. Despite lacking ganglion cells, it resembles a gastrointestinal ganglioneuroma. CASE PRESENTATION: We report a case of synchronous mucosal Schwann-cell hamartomas in a young male patient, who presented with a single discrete polyp in the mid-rectum and multiple polypoid mucosal lesions in the distal rectum. CONCLUSION: To the best of our knowledge, this is the first report of a case of multiple mucosal Schwann-cell hamartomas.

Incidence of Cholangiocarcinoma with or without Previous Resection of Liver for Hepatolithiasis.

BACKGROUND/AIMS: To investigate the incidence of cholangiocarcinoma in patients with hepatolithiasis with or without previous resection of liver. METHODS: From 2002 to 2009, we retrospectively reviewed 117 patients who were diagnosed and treated for hepatolithiasis in Korea University Guro Hospital. Among the 117 patients, 55 patients who were lost during follow-up were excluded, and 62 patients were eligible for analysis. The hepatic resection group (n=25) included patients who underwent left hemihepatectomy (n=2); left lateral segmentectomy (n=10); left lobectomy (n=9); right lobectomy (n=3); or wedge resection (n=1). The nonhepatic resection group (n=37) included transhepatic cholangiographic lithotomy and endoscopic retrograde cholangiopancreatography-treated patients. The mean follow-up period was 47 months. RESULTS: The incidence of cholangiocarcinoma while patients were followed for hepatolithiasis was 12.9% (8/62) (hepatic resection group, three cases [12%] vs nonhepatic resection group, five cases [13.5%]; p=1.000). The mean follow-up period was 53 months (47±11 months) until the diagnosis of cholangiocarcinoma. CONCLUSIONS: There was no difference in the incidence of cholangiocarcinoma according to previous liver resections. Patients with hepatolithiasis should be carefully followed up for detection of cholangiocarcinoma even after a previous liver resection.

[A case of hypopharyngeal cancer treated by endoscopic submucosal dissection].

Recent advances in endoscopic instruments, including narrow-band imaging (NBI) and magnification endoscopy, allowed dramatic increase in the early diagnosis of hypopharyngeal cancers. In addition, endoscopic mucosal resection or endoscopic submucosal dissection has recently been used for the treatment of hypopharyngeal cancer at an early stage, especially in Japan. However, to date, there is no published report in Korea. A 68-year-old man was admitted for preoperative evaluation and treatment for known esophageal cancer initially diagnosed at a local clinic. During the evaluation, magnifying endoscopy combined with the NBI system revealed a concurrent hypopharyngeal cancer not detected by initial conventional endoscopy. In this case report, we describe for the first time in Korea a case of early stage hypopharyngeal carcinoma that was successfully treated by endoscopic submucosal dissection with a review of literature.