Outcomes of arthroscopic capsulolabral reconstruction for anterior instability with greater than 20% glenoid bone defects: are Latarjet procedures absolutely indicated for these patients?

Background@#Recent studies have reported high rates of recurrence of shoulder instability in patients with glenoid bone defects greater than 20% after capsulolabral reconstruction. The purpose of the present study was to evaluate the failure rate of arthroscopic capsulolabral reconstruction for the treatment of anterior instability in the presence of glenoid bone deficits >20%. @*Methods@#Retrospective analyses were conducted among cases with anterior shoulder instability and glenoid bone defects of >20% that were treated by arthroscopic capsulolabral reconstruction with a minimum 2-year follow-up (30 cases). We included the following variables: age, bone defect size, instability severity index score (ISIS), on-/off-track assessment, incidence recurrent instability, and return to sports. @*Results@#The mean glenoid bone defect size was 25.8% ± 4.2% (range, 20.4%–37.2%), and 18 cases (60%) had defects of >25%. Bony Bankart lesions were identified in 11 cases (36.7%). Eleven cases (36.7%) had ISIS scores >6 points and 21 cases (70%) had off-track lesions. No cases of recurrent instability were identified over a mean follow-up of 39.9 months (range, 24–86 months), but a sense of subluxation was reported by three patients. Return to sports at the preinjury level was possible in 24 cases (80%), and the average satisfaction rating was 92%. @*Conclusions@#Arthroscopic soft tissue reconstruction was successful for treating anterior shoulder instability among patients with glenoid bone defects >20%, even enabling return to sports. Future studies should focus on determining the range of bone defect sizes that can be successfully managed by soft tissue repair.

Free Vascularized Fibular Graft for Femoral Head Collapse Combined with Ununited Pathologic Intertrochanteric Fracture / 대한정형외과학회잡지

Surgery for pathologic hip fracture poses significant challenges regarding the fixation of fracture and management of the original tumor lesion. An extensive destruction of the femoral neck and intertrochanteric region by benign or malignant lesions complicated by a pathological fracture generally necessitates total hip arthroplasty; however, in adolescents and young adults, preservation of the hip is preferable. We present a 14-year-old female patient, who sustained a pathological intertrochanteric fracture through a pre-existing aneurysmal bone cyst. Several operative interventions with internal fixation and bone graft were unsuccessful, and combined nonunion and progression of osteolysis around the compression hip screw eventually caused femoral head collapse, mimicking osteonecrosis. Hip preservation and resolution of the original tumor were achieved by free vascularized fibular graft.

Ulnar Collateral Ligament Tear Combined with Medial Epicondylitis of the Elbow / 대한스포츠의학회지

Medial epicondylitis, also known as “golfer's elbow,” is a common overuse syndrome of the elbow and predominantly affects the origin of the common flexor tendon. We report two unique cases of medial epicondylitis complicated by chronic complete tear of the ulnar collateral ligament and common flexor tendon origin. Physical examination showed a focal huge swelling of medial epicondylar region of the dominant elbow and magnetic resonance imaging revealed complete tear of the ulnar collateral ligament and common flexor tendon and extravasation of intra-articular effusion. Satisfactory results were achieved with ulnar collateral ligament reconstruction and simultaneous repair of the common flexor tendon origin.

Posterior Glenoid Lesions on Magnetic Resonance Imaging in Adolescent Baseball Players / 대한스포츠의학회지

The purpose of this study is to evaluate the characteristics of posterior glenoid lesion (PGL) on magnetic resonance imaging (MRI) in adolescent baseball players. Seventy-two adolescent baseball players (mean age, 15.1 years) who underwent MRI scan for dominant shoulder pain were enrolled and the location and morphologic features of PGLs were assessed on MRI. All players were divided into three groups based on the physeal status of proximal humerus: group I, open; group II, partial closure; and group III, complete closure. Of the 72 players, posterior glenoid rim rounding (69%) and periosteal thickening (88%) were the main PGL on axial imaging. Osteochondritis dissecans (OCD) of glenoid (10%), Bennett lesion (6%), and posterior labral tear (21%) were also identified. On oblique sagittal imaging, bony PGL including OCD involves mid-portion of posterior glenoid consistent with the level of the infraspinatus muscle, but Bennett lesion was located relatively lower than PGL. Posterior glenoid rim rounding was more prevalent in younger players (group I, 86%; group II, 78%; group III, 43%; p=0.015), and posterior labral tears were in older players (group I, 0%; group II, 19%; group III, 38%, p=0.027). Factors related with prevalence of posterior glenoid rim rounding were increased body mass index (p=0.016), pitchers (p=0.024), and players with posterior shoulder tightness (p=0.023), but career length was not statistically significant (p=0.089). Decreasing the rate of posterior glenoid rim rounding with skeletal growth implies that it may be recovered through the remodeling process, and labral tears are increasing internal impingement lesion after physeal closure.

A Case of Imperforate Hymen with Hematocolpometra / 대한산부인과학회지

Imperforate hymen is a rare congenital malformation, but it can make hematocolpometra and complications. In most cases definite finding is noticed after menarche as retention of menstrual flow results in abdominal pain, distension of the lower abdomen and often in acute urinary retention. A case of imperforate hymen associated with hematocolpometra at age of 12 was treated satisfactorily by simple crucial incision of hymen and drained of about 450 cc of tarry blood. We present a case of imperforate hymen with a brief review of literatures concerned.

Cytogenetic and clinical analysis of midtrimester amniocentesis / 대한산부인과학회지

OBJECTIVE: To analyze the clinical features and cytogenetic results of midtrimester amniocentesis. METHODS: We reviewed retrospectively medical records of 1,622 women who received amniocentesis from 1998 to 2003. The maternal age and gestational age at amniocentesis, indications, cytogenetic results and complications of amniocentesis were analyzed. RESULTS: A total of 1,653 cases of amniocentesis were performed in 1,590 singleton pregnancies and 32 twin pregnancies. The mean age at amniocentesis of singleton pregnancies was 33.5 +/- 4.3 years, and the most common age group was from 35 to 39 (38.6%) and those of twin pregnancies were 33.1 +/- 3.6 years and from 30 to 34 (50.0%), respectively. Majority of the cases (78.9%) were performed between 16th and 19th weeks of gestation. Advanced maternal age was the most common indication of amniocentesis (46.2%), followed by abnormal serum screening test (32.9%) and abnormal ultrasonographic findings (10.0%). Abnormal fetal karyotype results were identified in 34 cases (2.1%). 24 cases were numerical aberration and the other 10 cases were structural aberration. Trisomy 21 was the most common abnormal karyotype (23.5%). There was no abnormal karyotype results from 63 amniocentesis performed in twin pregnancies. Positive predictive value of abnormal ultrasonographic finding, advanced maternal age and abnormal serum screening test were 3.0%, 2.5%, 1.5% respectively. The procedure-related fetal death occurred in 7/1,353 (0.51%). CONCLUSION: Among the several indications of midtrimester amniocentesis, advanced maternal age was the most common indication, whereas abnormal ultrasonographic finding had the most powerful predictive value for abnormal fetal karyotype.

Perinatal Outcome in Relation to the Latency of Delivery in Severe Preeclampsia before 32 Weeks of Gestation / 대한주산의학회잡지

OBJECTIVE: To study the differences in the pregnancy outcomes of severe preeclampsia before 32 weeks of gestation in relation to the latency between admission and delivery. METHODS: We reviewed medical records of 89 pregnant women who were managed in Samsung Medical Center because of severe preeclampsia before 32 weeks of gestation between January 1996 and February 2004. We studied the differences in the management and the neonatal outcomes between the immediate delivery group (admission to delivery 2 days). We excluded maternal renal disease, chronic hypertension, multiple pregnancies, diabetes and placenta previa from this study. RESULTS: 40 women were included in the immediate delivery group and 49 women in the expectant management group. Antenatal corticosteroid was given pregnant women in the expectant management group (89.8% vs. 52.5%, p<0.0001). There was no significant difference in the occurrence of small for gestational age- and prematurity-related complications including neonatal mortality. There was significantly less respiratory distress syndrome in the expectant management group (46.9% vs. 62.5%, p=0.0315). However this difference disappeared when the adjustment was made to the gestational age at delivery (p=0.223). CONCLUSION: The latency period does not seem to alter the neonatal prognosis in severe preeclampsia before 32 weeks of gestation but the gestational age at the delivery, a reflection of the severity of the preeclampsia, seems to be the single most important factor for the occurrence of neonatal respiratory distress syndrome.

Maternal and Fetal Outcomes according to the Latency Period in Preterm Premature Rupture of Membrane / 대한주산의학회잡지

OBJECTIVE: To evaluate the clinical characteristics and perinatal outcomes in relation to the latency period after preterm premature rupture of membrane (PPROM). METHODS: We analyzed retrospectively the 223 pregnant women with PPROM who delivered before 34 weeks of gestation in Samsung Seoul Hospital from January 1996 to October 2003. The study population was divided into six groups according to the larency from membrane rupture and delivery (group I: shorter than 6 hours, group II: 6~48 hours, group III: 2~4 days, group IV: 4~7 days, group V: 7~12 days, group VI: beyond 12 days). RESULTS: The mean gestational age (GA) at rupture was 29.6+/-2.6 weeks and the mean GA at delivery was 30.6+/-2.4 weeks. The median latency was 102 hours and 67% of patients delivered within 7 days. The latency was prolonged with GA at rupture before 30 weeks and used of tocolytics. After adjustment of GA at delivery, pathologic chorioamnionitis occurred more frequently in group V than group I. Respiratory distress syndrome occurred less frequently in group II and group IV than group I. Neonatal mortality rate was highest in group I, but the other neonatal morbidities were not significant differences. CONCLUSION: In PPROM with delivery before 34 weeks, prolongation of the latency longer than 6 hours seems to be beneficial for reducing neonatal RDS and mortality, but infectious morbidity seems to increase when the latency was prolonged longer than 7 days without any benefits for perinatal outcomes.

The Prognostic Significance of Serum CA 125 Levels in Patients with Advanced Serous Epithelial Ovarian Cancer / 대한산부인과학회잡지

OBJECTIVE: In this retrospective study, we analyzed the clinicopathologic characteristics of advanced serous epithelial ovarian cancer and evaluated the prognostic factors which have an impact on survival of patients with epithelial ovarian cancer. We also compared several analyzing methods of CA 125 for predicting prognosis of advanced serous epithelial ovarian cancer. METHODS: A total of 57 patients with advanced serous epithelial ovarian cancer who were treated at Samsung Medical Center between Aug. 1995 and Jul. 2000 were included. Medical records including pathologic reports were reviewed to identify clinicopathologic characteristics and serum levels of CA 125. Five different methods of analyzing serum CA 125 were compared for predicting the prognosis of advanced serous epithelial ovarian cancer. Survival curves were analyzed by Kaplan-Meier method and Cox proportional hazards model. RESULTS: The median age of all patients was 54.2 years. In univariate analysis, age, FIGO stage, grade, residual tumor and ascites showed no significant correlation with prognosis. Among five different analyzing methods of serum CA 125 levels, normalization after 3rd chemotherapy was correlated with improved 5-year survival rate (p=0.026). CONCLUSION: This study showed that normalization of serum levels of CA 125 after 3rd chemotherapy is useful for predicting prognosis of advanced serous epithelial ovarian cancer patients.

An Analysis of Clinicopathologic Factors Affecting Survival in Patients with Invasive Cervical Carcinoma / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to investigate the clinicopathologic characteristics of cervical carcinoma and to evaluate the prognostic factors which have an impact on 5-year survival. PATIENTS AND METHODS: 575 patients with invasive cervical carcinoma treated at Samsung Medical Center from November 1994 to January 2000, for whom the records were retrospectively analyzed, were included in this study. Of the 575 patients, 499 patients were primarily treated by surgery including conization or type I, II, III hysterectomy. Medical records including pathologic reports were reviewed to identify clinicopathologic characteristics. Survival was analyzed by Kaplan-Meier method and log-rank test was used for curve comparison. Cox proportional hazards model was used for multivariate analysis. RESULTS: The age distribution of patients was from 26 to 84 years old, and the peak incidence was in the 5th decade. The International Federation of Gynecology and Obstetrics (FIGO) stage distribution of invasive cervical cancer was 76.4%, 19.2%, 1.9%, 1.2% for stage I, II, III, IV respectively. Among 354 patients with FIGO stage Ib and II a, 325 patients were treated by type III hysterectomy. The overall 5-year survival of 575 patients was 91.9%, and the 5-year disease-free survival rate (DFSR) according to FIGO stage was as follows: Ia 97.5%, Ib 95.5%, II a 85%, IIb 66.8%, III/IV 42%. The frequency of lymph node metastasis was 10.2% in stage Ib and 25.4% in stage II a. In multivariate analysis, only FIGO stage and lymph node involvement remained independent prognostic factors. CONCLUSION: This study showed that clinical stage and lymph node involvement status are identified as independent prognostic factors in the patients with cervical cancer.

A Case of Primary Endometrial Squamous Cell Carcinoma / 대한산부인과학회잡지

Primary squamous cell carcinoma of the endometrium is very rare. In 1928 Flumann suggested three criteria for diagnosis: (1) no coexisting endometrial adenocarcinoma, (2) no connection between the endometrial squamous cell carcinoma and squamous epithelium of the cervix, and (3) no cervical squamous cell carcinoma. In 1975, the World Health Organization (WHO) updated Flumann's criteria by adding that the tumor must contain clear evidence of squamous differentiation, such as the presence of intercellular bridges and/or keratin. Most patients with endometrial squmamous cell carcinoma have had poor prognosis regardless of their stages of disease or treatment. In this report we present the clinical and pathological findings of a case of a primary squamous cell carcinoma that developed in the endometrial cavity of a 65-year-old patient with a review of the concerned literatures.

A Significance of Emergency Cerclage in Cervical Incompetence with Advanced Cervical Dilatation / 대한산부인과학회잡지

OBJECTIVE: To investigate the clinical significance of emergency cerclage on prologation of pregnancy and perinatal outcome in mid-trimester cervical incompetence with advanced cervical dilatation. METHODS: We analyzed the pregnancy outcome retrospectively by the medical record review for 16 patients who had emergency cervical cerclage placed from March 1995 to June 2001. And these data were compared with those of 48 patients who had elective cervical cerclage placed during the same period. RESULTS: The mean gestational age of the patients at emergency cerclage was 22.0+/-2.3 weeks. The mean cervical dilatation was 2.9+/-1.2 cm and mean effacement was 55.3+/-4.7%. The mean prolongation of pregnancy after cerclage was 63.1+/-54.7 days (median 61, range 2-152) and the mean duration of antepartum hospitalization was 10.1+/-12.6 days (2-52). After cerclage, preterm premature rupture of the membranes occurred in 5 cases (31%), clinical chorioamnionitis in 3 cases (19%), and preterm labor in 5 cases (31%). The mean gestational age at delivery was 31.1+/-7.1 weeks. Perinatal survival rate was 85% (17/20), and neonatal survival rate was 94% (17/18). CONCLUSION: It seems that emergency cerclage contribute to maintenance of pregnancy and improve perinatal outcome of fetuses in cervical incompetence with advanced cervical dilatation.