Mid-term results of titanium-titanium modular neck femoral stem in primary total hip arthroplasty.

BACKGROUND: Modular neck femoral stems are advantageous because they can accurately restore the ideal hip geometry using various options in terms of offset, length, and version. However, there are concerns regarding junctional problems. Despite several reports on such issues, there is a lack of study on mid- to long-term results of these stems. The current study evaluated the mid-term results of patients who underwent primary total hip arthroplasty using a titanium-titanium (Ti-Ti) modular neck femoral stem. METHODS: In total, data on 47 hips (42 patients) that could be followed-up for ≥ 5 years after primary total hip arthroplasty using the Ti-Ti modular neck femoral stem from 2011 to 2015 were reviewed. There were 22 male and 20 female patients, and their mean age was 56.3 (range: 31-76) years. The mean follow-up period was 8 (range: 5-12) years. Functional and radiological outcomes, complications, and reoperations were investigated. In addition, we conducted a comparative analysis of the outcomes between those who underwent surgery using the Ti-Ti modular neck femoral stem and 41 hips (35 patients, 19 males and 16 females) that underwent primary total hip arthroplasty using nonmodular femoral stems as a control. RESULTS: In all Ti-Ti cases, the mean Harris Hip Scores were 50.6 (range: 6-59) preoperatively and 92.7 (range: 78-99) at the last follow-up (P < 0.001). Regarding the neck component's modularity, straight neck components were used in all Ti-Ti cases, and an anteverted or a retroverted neck was not used in any case. Stem revision was performed in one hip due to aseptic loosening. One hip underwent open reduction and internal fixation due to periprosthetic fracture without stem loosening. There were no cases of osteolysis and periprosthetic joint infection and clinically detectable junctional problems. The stem survival rate, with any stem revision as the endpoint, at 12 years was 96.6%. No significant difference was observed in the functional and radiological outcomes beween the Ti-Ti and nonmodular groups. CONCLUSIONS: The Ti-Ti modular neck femoral stem had comparable results with broadly used nonmodular femoral stems; hence, it can be a reliable option in primary total hip arthroplasty. However, in terms of the modularity itself of the modular neck femoral stem, whether the modular neck femoral stem is useful in uncomplicated primary total hip arthroplasty is unclear.

Optimization of Acetabular Cup Abduction by Adjusting Pelvic Pitch.

Background: The purposes of this study were to determine the accuracy of our cup positioning method and to evaluate the dislocation rate after total hip arthroplasty (THA). Methods: After positioning the patient in the lateral decubitus position on the operation table, an anteroposterior view of the hip was taken. The pelvic pitch was measured on the X-ray. A positive pitch was defined as the caudal rotation of the upper hemipelvis. Our target abduction of the cup was 43°. We used the cup holder to guesstimate the cup abduction. In a preliminary study, we found that the weight of the cup holder increased the pelvic pitch by 5°. Thus, the target abduction of the cup holder was calculated by a formula: 43° - pelvic pitch - 5°. During the cup insertion, the cup holder was anteverted to the calculated target according to the concept of combined anteversion. We evaluated 478 THAs (429 patients), which were done with the use of the method. Results: The mean cup abduction was 43.9° (range, 32.0°-53.0°) and the mean error of cup abduction was 2.4° (standard deviation [SD], 2.0°; range, 0.0°-11.0°). The mean cup anteversion was 28.5° (range, 10.0°-42.0°) and the mean error of cup anteversion was 6.7° (SD, 5.2°; range, 0.0°-27.6°). Of all, 82.4% of the cups (394 / 478) were within the safe zone: 30°-50° abduction and 10°-35° anteversion. During 2- to 5-year follow-up, no hip dislocated. Conclusions: Our adjusting method according to the pelvic pitch can be a reliable option for optimizing the cup abduction in THA.

Local Postoperative Complications after Surgery for Intertrochanteric Fractures Using Cephalomedullary Nails.

PURPOSE: Cephalomedullary nails (CMN) are commonly used for the surgical treatment of intertrochanteric fractures. This study aimed to evaluate overall postoperative local complications by reviewing patients who received surgical treatment using three different types of implants. MATERIALS AND METHODS: The study sample included 353 patients (107 males, 246 females) who underwent surgery using CMN for intertrochanteric fractures. Three different types of implants were used: i) the Gamma3® (Stryker) in 80 cases, ii) the Targon® PF (Aesculap) in 225 cases, and iii) the Compression Hip Nail® (Trademedics) in 48 cases. The mean age was 82.6 (range, 60-109) years and the average follow-up period was 15 (range, 6-80) months. Postoperative local complications and risk factors of cut-out were assessed. RESULTS: The most common complication was cut-out (n=26). Other complications included non-union (n=3), periprosthetic fracture (n=2), avascular necrosis (n=1), heterotopic ossification (n=1), and sleeve pull out (n=1). Multivariate analysis revealed that the cut-out group had a higher rate of poor reduction compared to the non-complicated group (P<0.001). Although the mean tip-apex distance (TAD) was 18.4 mm in the non-complicated group, lower than that of the cut-out group (P=0.001), multivariate analysis revealed that TAD was not a significant risk factor for cut-out (P=0.065). CONCLUSION: Cut-out is the most common local complication associated with surgical treatment of intertrochanteric fractures using CMN. Proper reduction appears to be important in lowering the risk of cut-out. Maintaining low TAD is another critical factor in achieving sufficient fixation of lag screw to the subchondral bone of the femoral head.

Full Cementation in Revision Total Knee Arthroplasty Using a Constrained Condylar Knee Prosthesis with an Average 7-Year Follow-up.

Purpose: To evaluate clinical and radiological outcome of the full cementation technique in revision total knee arthroplasty (TKA) using a constrained condylar knee (CCK) prosthesis. Materials and Methods: Between January 2008 and March 2012, 18 cases (16 patients) of fully cemented revision TKA were performed using a CCK prosthesis. Fifteen cases of aseptic loosening (13 patients) and 3 cases of infection were included. There were 2 males and 14 females with a mean age of 76.7 years at the time of surgery, and the average follow-up was 81 months. Clinically, the pain score, function score and Hospital for Special Surgery (HSS) score were evaluated. Radiologically, loosening, radiolucent lines and migration of implant were evaluated. Results: Preoperatively, the pain score, function score and HSS score were 50.3, 24.4 and 61.8 points, respectively. At the latest follow-up, the scores were improved to 84.8, 63.6 and 85.6 points, respectively (p<0.05). Loosening or migration of implant was not observed in any cases. Radiolucent lines were observed in 5 cases underneath the tibial component without progression during the follow-up. Conclusions: The full cementation technique in revision TKA using a CCK showed excellent clinical results. Although radiolucent lines were observed in 27.8% underneath the tibial component, there was no progression to loosening or instability.

Result of Modular Necks in Primary Total Hip Arthroplasty with a Average Follow-up of Four Years.

PURPOSE: This study aimed to investigate the outcomes of modular neck-utilization in primary total hip arthroplasty (THA). MATERIALS AND METHODS: Thirty patients (34 hips) who had modular stem THA between April 2011 and January 2013 were evaluated. There were 19 men and 11 women with a mean age of 61.2 years at the time of surgery. There were 20 cases of osteonecrosis of femoral head, 7 cases of osteoarthritis, 6 cases of femur neck fracture, and 1 case of rheumatoid arthritis. No patients presented with anatomical deformity of hip. Patients were operated on using a modified Watson-Jones anterolateral approach. All patients underwent clinical and radiological follow-up at 6 weeks, 3, 6, and 12 months, and every year postoperatively. The mean duration of follow-up was 48.2 months (range, 39 to 59 months). RESULTS: The average Harris hip score improved from 63.7 to 88.1 at the final follow-up. Radiographically, mean acetabular cup inclination was 45.3°(range, 36°-61°) and anteversion was 21.7°(range, 11°-29°). All were neutral-positioned stems except 5 which were varus-positioned stems. In only 3 cases (8.8%), varus or valgus necks were required. A case of linear femoral fracture occurred intraoperatively and 1 case of dislocation occurred at postoperative 2 weeks. No complications at modular junction were occurred. CONCLUSION: Our study shows that the use of modular necks had favorable clinical and radiographic results. This suggests that the use of modular neck in primary THA without anatomical deformity is safe at a follow-up of 39 months.

A Prospective Randomized Clinical Trial Comparing Bone Union Rate Following Anterior Cervical Discectomy and Fusion Using a Polyetheretherketone Cage: Hydroxyapatite/B-Tricalcium Phosphate Mixture versus Hydroxyapatite/Demineralized Bone Matrix Mixture.

STUDY DESIGN: Prospective randomized noninferiority trial. PURPOSE: To evaluate whether the union rate of anterior cervical discectomy and fusion (ACDF) using a polyetheretherketone (PEEK) cage filled with a mixture of hydroxyapatite (HA) and demineralized bone matrix (DBM) is inferior to that of a mixture of ß-tricalcium phosphate (ß-TCP) and HA. OVERVIEW OF LITERATURE: There have been no clinical trials investigating the outcomes of a mixture of HA and DBM in a PEEK cage in ACDF. METHODS: Eighty-five eligible patients were randomly assigned to group B (n=43), in which a PEEK cage with a mixture of HA and DBM was used, or group C (n=42), in which a PEEK cage with a mixture of HA and ß-TCP was used. The primary study endpoint was the fusion rate, which was assessed with dynamic radiographs and computed tomography (CT) scans. Secondary endpoints included pain intensity using a visual analogue scale, functional outcome using a neck disability index score, laboratory tests of inflammatory profiles, and the infection rate. RESULTS: Seventy-seven patients (38 in group B and 39 in group C) were included in the final analysis. One year postoperatively, bone fusion was achieved in 87% of group B patients and 87% of group C patients on dynamic radiographs, and 87% of group B patients and 72% of group C patients on CT scans (p=1.00 and 0.16, respectively). There were also no between-groups differences with respect to the secondary endpoints. CONCLUSIONS: A HA/DBM mixture inside a PEEK cage can provide noninferior outcomes compared to a HA/TCP mixture in ACDF.

Proximal tibial resection in varus-deformed tibiae during total knee arthroplasty: an in vitro study using sawbone model.

PURPOSE: This study was designed to investigate accuracy of the tibial component in the coronal plane when the lateral condylar eminence was determined as the proximal reference of proximal tibial cutting in varus-deformed knees. METHODS: Varus-deformed tibiae were designed using the entire tibia sawbone models of four categories (varus 0°, 5°, 10° and 15°). Each of ten sawbones was allocated into four in each group. All sawbones were osteotomised with the proximal reference of proximal tibial cutting as the lateral intercondylar eminence. The thickness of the cut tibial medial and lateral condyles were measured. After implantation of the tibial component, anteroposterior (AP) radiographs were obtained. An independent examiner evaluated angles between the perpendicular line to the tibial tray and the shaft/mechanical axes of the tibia. RESULTS: The mean angular difference between the axis perpendicular to the prosthesis and the mechanical/shaft axes of the tibia were not significant in any group. When the tibial component coronal alignment was measured based on the tibial mechanical axis, no significant difference was observed in any group, but when based on the shaft axis of the tibia, it was significantly different between Group A and Group D. CONCLUSIONS: Accuracy of the tibial component alignment was acceptable in varus-deformed knees when the lateral intercondylar eminence was used as a reference for tibial osteotomy, although any prolonged clinical benefits will require long-term in vivo study.

Primary total knee arthroplasty in infection sequelae about the native knee.

The aim of this study is to assess the results of primary total knee arthroplasty (TKA) after bone or joint sepsis about the native knee and to analyze the risk factors of periprosthetic infection. Sixty-two patients (62 knees), considered to have prior sepsis history to be resolved, underwent primary TKA and were followed during a mean of 6.1years (range, 2-10.4years). Of the 62 patients, periprosthetic infection occurred in 6 after primary TKA (9.7%). Five of 6 patients grew the same organism as prior infection. The number of prior surgeries undertaken for deep infection was found to be an independent risk factor of periprosthetic infection.

Treatment of Intertrochanteric Fractures Using the Compression Hip Nail.

PURPOSE: To investigate the clinical and radiologic outcomes following treatment of intertrochanteric fractures using the Compression Hip Nail® (CHN), which has a sliding lag screw. MATERIALS AND METHODS: Twenty-eight cases of intertrochanteric fractures treated with CHN from November 2012 to October 2013 and followed-up for >6 months were included. The patient population consisted of 11 men and 17 women with a mean age of 75.2 years at the time of surgery. For the initial 11 cases, 10 mm sliding lag screws were used; the remaining 17 cases used 20 mm sliding lag screws. Clinical variables including operation time, amount of transfusion, weight-bearing start time, postoperative physical activity, and complications were investigated. The average sliding of lag screws and the average union were investigated radiologically at 3 and 6 months after surgery. RESULTS: In an analysis of 23 cases (exclusion of 3 cases of lag screw cutout and 2 cases of nonunion), 11 (48%) recovered their pre-injury activity level. In an analysis of 25 cases (exclusion of 3 cases of cutout), 17 (68%) and 23 (92%) showed radiological union at postoperative months 3 and 6, respectively. Seven complications were noted. Cutout of the lag screw and the lateral protrusion of barrels were significantly greater in the group with 10 mm sliding lag screws as compared to the group using 20 mm sliding lag screws. CONCLUSION: The use of CHN for the treatment of intertrochanteric fracture yielded poor results. However, results from patients in the 20 mm sliding lag screw group were better than for the 10 mm sliding lag screw group. Therefore, use of the 20 mm sliding lag screw is advisable.

Simultaneous multiple anterior cruciate ligament reconstructions using a single Achilles tendon allograft.

This study aimed to evaluate simultaneous multiple anterior cruciate ligament (ACL) reconstructions performed with a single Achilles allograft. After selection of an Achilles allograft with suitable length, the circumference of the isthmus and length of the tendinous portion were measured. The Achilles tendon was divided along its fibers into two or three strips and each strip was looped into a two-strand construct. Fifteen Achilles allografts were used for 31 ACL reconstructions in 30 subjects. The median circumference at the isthmus was 29 mm and the median length of the Achilles tendon 185 mm before and 206 mm after removal of the insertional bone block. The median difference in length before and after removal of the bone block was 19 mm. Achilles allografts with proper length consistently yielded two free tendon grafts suitable for simultaneous multiple ACL reconstruction with good short-term results.

Arthroscopic treatment for tibial "Peel off" tears in anterior cruciate ligament-case report.

Anterior cruciate ligament (ACL) injury was very common, and its reconstruction is one of the most commonly performed orthopaedic surgeries. A standard treatment option for ACL complete rupture in active young patients is debridement of remnant tissue and reconstruction with various types of tendon graft. However, "A tibial peel off tear" of ACL without bony avulsion can be treated using preservation of original ACL and trans-osseous pullout suture repair. The IKDC subjective score was 90, the objective score was A, and the Lysholm score was 95 at 24 months after surgery. KT-2000 arthrometer showed 2 mm side-to-side difference. Pivot shift test and Lachman test were negative, and there was no limitation in range of motion. Patient returned to full activities including sports and satisfied with the surgical results. In the postoperative MRI at 6 months after the surgery, the continuity of ACL was well maintained without any Cyclops lesion. We believe that trans-osseous pullout suture repair could be included as an alternative method in this "tibial peel off" type ACL injury instead of the usual removal of remnant tissue and reconstruction with a graft.

True anteroposterior (Grashey) view as a screening radiograph for further imaging study in rotator cuff tear.

BACKGROUND: Although findings of conventional radiography seem nonspecific, it is still the first imaging modality used to evaluate patients with rotator cuff tears. The purpose of this study is to determine whether the true anteroposterior (AP) view of the glenohumeral (GH) joint (the thorax is rotated to the affected shoulder for 35°-45°) is more sensitive than the conventional shoulder AP view (the beam and cassette are perpendicular to the torso but oblique to the glenohumeral joint) in terms of detecting rotator cuff tears. MATERIALS AND METHODS: Intermixed GH AP and conventional AP views of 160 consecutive shoulders, which were repaired by arthroscopic surgery, were reviewed in a blinded fashion. The detection rate of 5 pathognomonic signs for rotator cuff tear were determined by use of both radiographs: greater tuberosity (GT) sclerosis, GT osteophyte, subacromial (SA) osteophyte, GT cyst, and humeral head osteophyte. An additional comparison according to the tear size was performed. RESULTS: The detection of all radiographic findings was significantly greater on the GH AP view than on the conventional AP view (P < .001 for GT sclerosis, P = .003 for GT osteophyte, P = .013 for GT cyst, P < .001 for SA osteophyte, and P = .002 for humeral head osteophyte). In subgroup analysis by tear size, GT sclerosis was identified significantly more on the GH AP view for all tear sizes, GT osteophytes showed a higher detection rate, especially in medium-sized tears, and SA osteophytes showed a higher detection rate in medium and large to massive tears. CONCLUSION: The GH view is more sensitive than the conventional AP view for detecting pathognomonic findings of rotator cuff tear. In particular, the superiority of the GH AP view in detecting abnormal radiographic findings seemed prominent in medium-sized tears.

The Position of Proximal Reference Point of Tibia Plateau for Correct Tibial Osteotomy in Total Knee Replacement: Prospective Randomized and 6 Years Follow-up Study.

PURPOSE: When there is a varus deformity in proximal tibia, the extension of a tibial shaft axis tends to pass through the lateral intercondylar eminence. A prospective randomized study was conducted to find out whether the lateral eminence of tibia could serve as a reference point for proximal tibial osteotomy during total knee arthroplasty and results from 6-years follow up period were reported. MATERIALS AND METHODS: Forty-six patients (50 knees) who received total knee replacement arthroplasty from April to December 2004, were randomly divided into two groups. For a proximal tibial osteotomy, the proximal tibial reference point was located at the center of intercondylar eminence for group I and at the lateral eminence for group II and subsequently, the results were evaluated. Radiologic indices were the angles between the axis of the prosthesis and the mechanical/shaft axes of tibia and angle of the prosthesis in sagittal plane. Clinical indices were pain and function score of American knee society, functional score of Hospital for Special Surgery and range of knee joint motion. RESULTS: The angles between the axis of the prostheses and the mechanical/shaft axes of tibia were varus 1.64°/2.12° in group I and valgus 0.57°/0.38° in group II (p=0.589/p=0.558). There were 6 cases of outliers (27.2%) in group 1 and 3 cases (15.0%) in group 2. There was a significant difference in the pain score between group I (82.9) and II (91.4) (p=0.032), respectively. CONCLUSIONS: By moving the reference point of proximal tibial osteotomy laterally, lower incidence of outlier and residual varus deformity could be achieved.

Seven-year results of a tapered, titanium, hydroxyapatite-coated cementless femoral stem in primary total hip arthroplasty.

BACKGROUND: Aseptic loosening of cemented hip prostheses is recognized as a long-term problem, and especially in males and younger patients. Much energy has been focused on developing new prostheses that are designed for cementless fixation. We evaluated the performance of and periprosthetic bone response to a tapered, titanium, hydroxyapatite (HA)-coated femoral hip prosthesis at a minimum of 7 years of follow-up after treatment with primary total hip arthroplasty. METHODS: Seventy-eight patients and 86 hips were included in the study. There were 35 men and 43 women; the mean age at the time of the operation was 59 years (range, 41 to 81 years). We used a tapered, titanium (Ti6Al4V), HA-coated femoral implant. We evaluated the patients at a minimum of 7 years of follow-up after treatment with primary total hip arthroplasty. Clinical evaluation was performed using the scoring system and the hip scores were assigned according to the level of pain, the functional status and the range of motion. The patients who refused to return, but who did forward X-rays for review after being contacted were questioned by phone about the functional status of their hip. Radiographic follow-up was performed at six weeks, at three, six and twelve months and yearly thereafter. All the available radiographs were collected and assessed for implant stability, subsidence, osseointegration, osteolysis, stress shielding and evidence of periprosthetic lucency. RESULTS: Eighty-six hips (78 patients) were available for review at follow-up of greater than 7 years. In 11 of the 86 cases, acetabular failure required revision of the acetabular component, but the femoral stem survived and it was available for long-term evaluation. The radiographs were obtained at 7-year follow-up for another 20 hips, but the patients would not come in for the 7-year clinical evaluation. Therefore, a phone interview was conducted to assess any change in the functional status at a minimum of 7 years. CONCLUSIONS: The mechanical fixation of a tapered, titanium, HA-coated femoral implant was excellent in this study. This femoral design provided reliable osseointegration that was durable at a mean of 7 years follow-up.

Gains and losses of small incision lateral total hip arthroplasty: what the patients want and its index case result.

OBJECTIVE: A poll was initially attempted to elucidate what type of skin incision would be preferred by the patients. The retrospective analysis of index cases was preformed to reveal the gains and losses of small incision transgluteal THA. MATERIALS AND METHODS: We performed a poll on the preferred type of skin incision to the patients, their families and the medical personnel in orthopedic department in a face-to-face manner. According to the result of the poll, we changed approaches from a standard transgluteal to a small incision transgluteal approach. Each 20 consecutive index patients that underwent standard or small-incision transgluteal THA were followed and compared for more than 2 years. RESULTS: The small incision THA group showed more rapid mobilization, shorter hospital stay, and better early satisfaction. However, no clinical benefits of small incision were observed after 6-weeks postoperatively. There were significant variations in implant alignments. More early major complications such as dislocation, intraoperative femoral fracture or leg length inequalities occurred in the small incision group. CONCLUSIONS: The use of a small incision in THA resulted in subtle and temporary gains, at the cost of several major early complications. Now we perform THA with definitely smaller incision than before but we do believe that performing a stable and well-aligned THA is far more important than the length or amount of surgical dissection.

Antigenic properties of cystatin-binding cysteine proteinases from Neodiplostomum seoulense.

The antigenic properties of cysteine proteinases binding to cystatin were analyzed in Neodiplostomum seoulense, an intestinal trematode that infects humans and rodents in the Republic of Korea. Cystatin was found to effectively capture cysteine proteinases present in the crude extract of N. seoulense. The IgG levels against cystatin-binding cysteine proteinases in sera of mice infected with N. seoulense were higher than those in sera of mice immunized with the crude extract of N. seoulense. The production of IgG antibodies against cystatin-binding cysteine proteinases increased according to the length of infection period. In immunoblots of purified cystatin-binding proteinases, 2 molecules, approximately 50 kDa and 60 kDa, reacted with N. seoulense-infected mouse sera. Of the sera from patients infected with various helminths, those of sparganum-infected patients showed the strongest affinities for cystatin-binding cysteine proteinases of N. seoulense. Cystatin-binding cysteine proteinases of N. seoulense are suggested to be putative antigens for serodiagnosis of human N. seoulense infection.

Tegumental ultrastructure of the juvenile and adult Himasthla alincia (Digenea: Echinostomatidae).

The tegumental ultrastructure of juvenile and adult Himasthla alincia (Digenea: Echinostomatidae) was observed by scanning electron microscopy. One-, 5- (juveniles) and 20-day-old worms (adults) were harvested from chicks experimentally fed metacercariae from a bivalve, Mactra veneriformis. The juvenile worms were elongated and curved ventrally. The head crown bore 31 collar spines, arranged in a single row. The lip of the oral sucker had 12 paired, and 3 single type I sensory papillae, and the ventral sucker had about 25 type II sensory papillae. The anterolateral surface between the two suckers was densely packed with tegumental spines with 4-7 pointed tips. The adult worms were more elongated and filamentous, and had severe transverse folds over the whole body surface. On the head crown and two suckers, type I and II sensory papillae were more densely distributed than in the juvenile worms. Retractile brush-like spines, with 8-10 digits, were seen on the anterolateral surface, whereas claw-shaped spines, with 2-5 digits, were sparsely distributed posteriorly to the ventral sucker. The cirrus characteristically protruded out, and was armed with small spines distally. The surface ultrastructure of H. alincia was shown to be unique among echinostomes, especially in the digitation of its tegumental spines, the distribution of sensory papillae and by severe folds of the tegument.

No Association between Catalase Gene Polymorphism and Gastric Carcinoma and Hepatocellular Carcinoma in Koreans.

PURPOSE: Oxidative stress has been implicated in the pathogenesis of various diseases. Catalase is one of the main defense mechanisms against oxidative stress. To examine the possible relationship between oxidative stress, and gastric and hepatocellular carcinomas, HinfI restriction length polymorphism (RFLP) in the human catalase gene was assessed. MATERIALS AND METHODS: The genotype and allele frequencies in the promoter region of the catalase gene were studied by PCR-RFLP in 108 Korean controls, 80 Korean gastric carcinoma (GC) and 106 Korean hepatocellular carcinoma (HCC) patients. RESULTS: No statistically significant differences were found in the genotypic distribution and allelic frequencies between the controls and both types of carcinoma patient. CONCLUSION: To address the possible contribution of oxidative stresses to the pathogenesis of gastric and hepatocellular carcinomas, the associations between the catalase gene polymorphism and GC and HCC susceptibilities were studied. As a result, the catalase gene polymorphism was found not to be determinant of GC and HCC susceptibilities. Further studies are required on various other oxidative stress related genes to elucidate the mechanisms of GC and HCC.