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The aim of this study was to review our cases of lower limb lengthening to treat Turner dwarfism, and to speculate whether or not effective limb lengthening can be achieved in this rare condition. Twelve tibiae and 2 femora were lengthened in 6 patients using the Ilizarov method for the tibia and a gradual elongation nail for the femur. The mean age at the time of surgery was 19 years, and the patients were followed up for a minimum of 2 years. The average gain in the tibial and femoral length was 6.2 cm and 6.0 cm, respectively. The average healing index of tibia and femur was 1.9 and 1.7 months. The average tibia-to-femur ratio improved from 0.68 preoperatively to 0.81 postoperatively, and leg-trunk ratios improved from 0.88 to 0.99. Seven segments (50.0 percent) had completed the lengthening protocol without complications. Two segments (14.3 percent) had an intractable pin site infection requiring a pin exchange, and four segments (35.7 percent) had twelve complications (a nonunion at the distraction site, premature consolidation, Achilles tendon contractures and planovalgus). The overall rate of complications was 100 percent for each bone lengthened. All the patients showing a nonunion at the distraction site had a reduced bone mass, which was less than 65 percent of those of the age-matched normal population. Despite the complications, all patients were satisfied with the results, and lower limb lengthening in Turner Dwarfism believed to be a valid option. However, it may require careful management in a specialist unit in order to prevent complications during the lengthening procedure. In addition, the osteopenia associated with an estrogen deficiency leading to problems in consolidation is a difficult issue to address.

Twenty-one pyridine-2-carboxylate derivatives were prepared by the coupling of 6-formyl-2-carboxylic acid with the corresponding phenol, thiophenol, and aniline, substituted with various functional groups. Among them, the 3,4-dichlorothiophenol ester (9p) showed the highest in vitro telomerase inhibitory activity and quite significant in vivo tumor suppression activity.

Primary malignant bone tumors of the proximal humerus have traditionally been treated by forequarter amputation. However, with the increased interest in limb salvage operations, efforts have been made to improve reconstructive surgery and some methods have become available for tumor control and preservation of a useful distal limb. This report describes three reconstructive techniques used for reconstruction of the humerus following primary tumor excision. We followed 11 patients treated by reconstructive surgery following tumor excision for primary malignant and aggressive benign bone tumors in the proximal humerus. The average follow-up period was 35.6 months. The histologic diagnosis included osteosarcoma (9), chondrosarcoma (1) and giant cell tumor (1). The options for reconstructive surgery following tumor excision were six prosthetic arthroplasties with low heat treated autobone, four arthroplasties with Ender nail and bone cement, and one arthroplasty with custom-made tumor prosthesis. We performed a retrospective analysis regarding functional status, as well as local recurrence, distant metastasis and complication. The functional status at final follow-up averaged 16 points (53.3%) overall: 17 points (56.7%) in the six prosthetic arthroplasties with low heat treated autobone; 15 points (50.0%) in two of four arthroplasties with Ender nail and bone cement (the two others died); and 16 points (53.3%) in the one arthroplasty with custom-made tumor prosthesis. Local recurrence was not observed in any of the cases. The complications noted were one nonunion between reimplanted, low heat treated autobone and the normal distal humerus and two metal failures. Each of these techniques for reconstructive surgery resulted in a relatively good outcome, although somewhat better results were found in the case of prosthetic arthroplasty with low heat treated autobone.

To evaluate the clinical characteristics of nonvariceal upper gastrointestinal hemorrhage (NGIH) in patients with chronic kidney disease (CKD).From 2003 to 2010, a total of 72 CKD patients (male n = 52, 72.2%; female n = 20, 27.8%) who had undergone endoscopic treatments for NGIH were retrospectively identified. Clinical findings, endoscopic features, prognosis, rebleeding risk factors, and mortality-related factors were evaluated. The characteristics of the patients and rebleeding-related data were recorded for the following variables: gender, age, alcohol use and smoking history, past hemorrhage history, endoscopic findings (the cause, location, and size of the hemorrhage and the hemorrhagic state), therapeutic options for endoscopy, endoscopist experience, clinical outcomes, and mortality.The average size of the hemorrhagic site was 13.7 ± 10.2 mm, and the most common hemorrhagic site in the stomach was the antrum (n = 21, 43.8%). The most frequent method of hemostasis was combination therapy (n = 32, 44.4%). The incidence of rebleeding was 37.5% (n = 27), and 16.7% (n = 12) of patients expired due to hemorrhage. In a multivariate analysis of the risk factors for rebleeding, alcoholism (OR = 11.19, P = 0.02), the experience of endoscopists (OR = 0.56, P = 0.03), and combination endoscopic therapy (OR = 0.06, P = 0.01) compared with monotherapy were significantly related to rebleeding after endoscopic therapy. In a risk analysis of mortality after endoscopic therapy, only rebleeding was related to mortality (OR = 7.1, P = 0.02).Intensive combined endoscopic treatments by experienced endoscopists are necessary for the treatment of NGIH in patients with CKD, especially when a patient is an alcoholic.

Background Successful cecal intubation (SCI) is not only a quality indicator but also an important marker in a colonoscopy trainee’s progress. We conducted this study to determine factors predicting SCI in colonoscopy trainees, and to compare these factors before and after trainees achieve technical competence. Methods Design of this study was a cross-sectional studies of two time series design for one year at a single center. From March 2011 to February 2012, a total 2,050 subjects who underwent colonoscopy by four first-year gastrointestinal fellows were enrolled at Christian hospital, Wonju, Republic of Korea. Four gastrointestinal fellows have filled out the colonoscopic documentation. Main outcome measurement was predictive factors affecting cecal intubation failure and learning curves. Results Colonoscopy was successfully completed to the cecum in 1,720 patients (83.9%). Success rates gradually increased as trainees performed more colonoscopies: the rate of SCI was 62% in the first 50 cases, and grew to 93% by the 250th case. Logistic regression analysis of factors affecting cecal intubation failure showed that female gender, low BMI (BMI < 18.5 kg/m2), poor bowel preparation, and past history of stomach surgery were more often associated with cecal intubation failure, particularly before the trainees achieved technical competence. Conclusion Several patient characteristics were identified that may predict difficulty of cecal intubation in colonoscopy trainees. Particularly, low BMI, inadequate bowel cleansing, and previous stomach operation were predictors of cecal intubation failure before the trainees have reached technical competency. The results could be informative so that trainees enhance the success rate regarding better colonoscopy training programs.

Technological Assistance of Cap-Assisted Chromoendoscopy Enhances the Detection Rates of Both Colorectal Adenoma and Proximal Serrated Polyp in an Average-Risk Screening Population: Preliminary Results of a Multi-Center Randomized Controlled Trial Hyun-Soo Kim*, Hong Jun Park, Chan Sik Won, Hyo Keun Jeon, Dongil Park, Jae Myung Cha, Seun-Ja Park, Hwang Choi, Jeong Eun Shin, Chang Soo Eun, Jin-Oh Kim, Hyun Gun Kim, Seong-Eun Kim, Cheol Hee Park, Tae Il Kim, Sung Noh Hong, Dong-Hoon Yang, Byung Chang Kim, Byungho Nam Yonsei Univ. Wonju College of Medicine, Wonju, Republic of Korea; Sungkyunkwan University College of Medicine, Seoul, Republic of Korea; KyungHee University College of Medicine, Hanam, Republic of Korea; Kosin University College of Medicine, Busan, Republic of Korea; The Catholic University of Korea College of Medicine, Incheon, Republic of Korea; Dankook University College of Medicine, Cheonan, Republic of Korea; Hanyang University College of Medicine, Guri, Republic of Korea; Soonchunhyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University School of Medicine, Seoul, Republic of Korea; Hallym University College of Medicine, Anyang, Republic of Korea; Yonsei University College of Medicine, Seoul, Republic of Korea; Konkuk University School of Medicine, Seoul, Republic of Korea; University of Ulsan College of Medicine, Seoul, Republic of Korea; National Cancer Center, Goyang, Republic of Korea Background/Aim: There is growing evidence that a transparent cap or chromoendoscopy improve detection of colorectal polyps. However, the combined method of these two technologies has not been proven for colorectal polyp or adenoma detection rate. In this multicenter prospective randomized trial, we examined whether cap-assisted chromoendoscopy (CAP-ACE) enhances colorectal adenoma detection rate especially in the proximal colon. Methods: From March 2010 to October 2011, 1,202 asymptomatic average-risk subjects who underwent the first screening colonoscopy in an age of 45 to 75 were enrolled at 14 hospitals. Eighteen expert colonoscopists (more than 5,000 procedures) have performed procedures. Subjects were randomly allocated to CAP-ACE group and regular colonoscopy (RC) group. We prospectively compared insertion and withdrawal time, polyp detection rate (PDR), adenoma detection rate (ADR), and proximal serrated polyp detection rate (PSPDR) between the two groups. Results: A total of 1,202 subjects were enrolled; 598 CAP-ACEs and 604 RCs were performed. Overall PDR and ADR were 60.3% and 47.6%. A total of 52 advanced lesions were found including 16 tubulovillous adenomas, 2 villous adenomas, 13 high grade dysplasias, 11 intramucosal cancers and 10 invasive cancers. The time to cecal intubation (4.8 vs. 4.8 min, p 0.902) was not different between the groups but withdrawal time was prolonged in CAP-ACE group for indigocarmine solution spray and suction (10.5 vs. 8.7 min, p 0.001). Compared to RC, CAP-ACE did increase PDR (65.9% vs. 54.8%, p 0.001) and ADR (51.8% vs. 45.5%, p 0.033) significantly. In particular, this technological assistance of CAP-ACE even in experts significantly enhanced the proximal adenoma detection rate (34.8% vs. 28.8%, p 0.030) as well as PSPDR (10.5% vs. 6.1%, p 0.006). However, advanced lesions (CAPACE 26/598 (4.3%) vs. RC 26/604 (4.3%), p 0.99) including cancers were equally found between groups. Conclusion: Technological assistance of CAP-ACE enhances not only PDR but also ADR, especially in the proximal colon. These results suggest that CAP-ACE technology provide a potential solution for overcoming the limited effectiveness of colonoscopy in the proximal colon and should be considered as the preferred, high standard colorectal cancer screening method for the average-risk screening population.

Background/Aim: Gastric cancer is divided into differentiated intestinal type and undifferentiated diffuse type by the most widely used Lauren's classification, which appear clearly as dissimilar clinical and epidemiological entities. Undifferentiated diffuse type gastric cancer is also classified into poorly differentiated carcinoma and signet-ring cell carcinoma (SRCC). However, recent evidences suggest early SRCC is an initial, differentiated form of diffuse gastric cancer that may evolve into poorly differentiated carcinoma (PDC). To test the hypothesis that molecular epigenetic signature of SRCC is different from that of PDC in early gastric carcinogenesis, we compared epigenetic methylation profile between SRCC and PDC and found unique epigenetic signature of SRCC. Methods: Six genes (GDNF, ROR-a, KLF7, MINT25, E-cadherin (CDH1), and LINE-1) were identified as sensitive molecular markers of early gastric cancer at a previous study. We evaluated the DNA methylation patterns of 4 gene promoters (GDNF, ROR-a, KLF7 and LINE-1(long interpersed nuclear element-1)) by bisulfite-PCR and pyrosequencing in primary tissues from 33 PDCs and 20 SRCCs as a test group. Then, the methylation status of the 6 genes including MINT25 and E-cadherin (CDH1) was next evaluated in endoscopically biopsied gastric cancer tissues from prospectively collected 21 PDCs and 22 SRCCs as a validation group. Results: In the test group, quantitative methylation levels of 3 genes (GDNF, ROR-a, and LINE-1) of SRCCs were significantly different from those of PDCs. MINT25, E-cadherin including the above 4 genes were next evaluated in the validation group. We confirmed the significant different levels of methylations of prospectively collected SRCCs from PDCs. Compared to PDCs, SRCCs showed the lower level of methylations for GDNF (17.7% vs. 31.0%, p = 0.001) and ROR-a (14.4% vs. 28.0%, p = 0.001) genes. Interestingly, however, the methylation level of E-cadherin was higher in SRCCs than that of PDCs (26.8% vs. 20.5%, p = 0.009). Methylaion levels of LINE-1 (63.0% vs. 60.5%), MINT25 (31.1% vs. 34.3%) and KLF7 (10.2% vs. 18.1%) in SRCCs were not significantly different from those of PDCs. Conclusion: Our results identified unique methylation patterns of SRCCs distinguished from PDCs, suggesting different molecular epigenetic signature of SRCC in gastric carcinogenesis. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3814. doi:10.1158/1538-7445.AM2011-3814

Surveillance Strategy After Endoscopic Submucosal Dissection for Early Gastric Cancer: A Multicenter Study by Osaka University ESD Study Group Motohiko Kato, Tsutomu Nishida, Katsumi Yamamoto, Shinji Kitamura, Takeshi Nakamura, Akihiro Nishihara, Naoki Kawai, Shinichiro Zushi, Masato Komori, Kazuo Kinoshita, Tomoki Michida, Takuya Yamada, Shusaku Tsutsui, Masahiko Tsujii, Norio Hayashi Graduate School of Medicine, Department of Gastroenterology and Hepatology, Osaka University, Suita, Japan; Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan; Department of Gastroenterology, Sakai Municipal Hospital, Sakai, Japan; Department of Gastroenterology, Kansai Rosai Hospital, Amagasaki, Japan; Department of Gastroenterology, Minoh City Hospital, Minoh, Japan; Department of Gastroenterology, Osaka Police Hospital, Osaka, Japan; Department of Gastroenterology, Ikeda Municipal Hospital, Ikeda, Japan; Department of Gastroenterology, Osaka Rosai Hospital, Sakai, Japan; Department of Gastroenterology, Sumitomo Hospital, Osaka, Japan; Endoscopy Center, Osaka Koseinenkin Hospital, Osaka, Japan Background and Aim: Endoscopic submucosal dissection (ESD) has been accepted as a treatment for early gastric cancer (EGC). However, it is known that the patient after endoscopic treatment of EGC is at risk of synchronous and metachronous multiple cancers, even though initial lesion is completely resected, and there is not enough evidence concerning surveillance strategy after ESD for EGC. The aim of this multicenter study is to clarify the surveillance strategy after ESD by assessing the incidence of multiple cancers during follow-up. Methods: This is a multicenter retrospective study from 6 institutes. From March 2003 to November 2010, of total 1567 consecutive cases with gastric neoplasm performed ESD at these 6 institute, 1041 cases were diagnosed as EGC after ESD and were included in this study. Cumulative incident rates of gastric cancer after initial ESD were calculated using the Kaplan-Meier methods. Results: In 1041 cases, multiple cancers were detected in 101 cases and incident rate was 9.7% in the median follow-up period of 28.3 months. The cumulative incident rates of gastric cancer were 7.4% at 1 year, 9.5% at 2 years, and 11.5% at 3 years, respectively. The cumulative incident rates curve showed an inflection point at 1.7 months, after that those increased constantly about 2% per year. Median and 90 percentile of duration between initial ESD and cancer incidence were 22.9 and 36.0 months, respectively. There were no significant differences in institute, patients’ background, and characteristics of initial lesion between cases with and without multiple cancers. All lesions detected during follow-up were successfully treated by re-ESD except 2 cases of mucosal cancers where ESD was not applicable because of undifferentiated histological type. Conclusion: These results suggested multiple cancers detected within 3 months after initial ESD for EGC were overlooked synchronous cancers in the pre-ESD survey. Metachronous lesions were detected with low but constant frequency during follow up. Our recommendation is that initial endoscopic surveillance should be performed within 3-6 months after ESD to check up synchronous lesions and scheduled endoscopic surveillance should be performed annually for at least 3 years. 1174 Randomized Controlled Trial of Conventional vs. Jumbo Forceps Biopsy for the Diagnostic Accuracy of Gastric Neoplasia Before Endoscopic Submucosal Dissection Hyun-Soo Kim, Hyo Keun Jeon, Jae Woo Kim, Hong Jun Park, so Yeon Park, Bo RA Kim, Chan Sik Won, Mee-Yon Cho Internal medicine, Yonsei Univ. Wonju College of Medicine, Wonju, Republic of Korea; Pathology, Yonsei Univ. Wonju College of Medicine, Wonju, Republic of Korea Aim: An endoscopic forceps biopsy carries the risk of missing the neoplastic foci within a gastric neoplastic lesion and underestimating the grade of neoplasia because only a small portion of the lesion is sampled using this technique. The aim of this prospective study was to compare the diagnostic accuracy of gastric neoplasia before endoscopic submucosal dissection (ESD) between conventional forceps and jumbo forceps. Patients and Methods: Between May 2009 and November 2010, 162 gastric neoplastic lesions (adenomas or early gastric cancers without ulcer) from 148 patients were randomized to two groups, conventional forceps (7 mm) and jumbo forceps (8 mm), and four specimens were obtained from each lesion. Each pathologic result of the four endoscopic biopsied specimens between the two groups was compared with that of ESD specimens. Results: Of the 148 patients, 123 (76.9%) were, men; median age was 64.66 10 years. Twenty-nine gastric neoplastic lesions in 26 patients were excluded because ESD was not performed or because pathologic result was inappropriate. Finally, 66 gastric neoplastic lesions in 60 patients and 65 gastric neoplastic lesions in 62 patients were allocated to conventional group and jumbo group. A total of 131 ESD specimens in 122 patients were analyzed. The pathological diagnoses of ESD specimens were as follows: 47 (35.9%) adenomas with low grade dysplasia, 20 (15.3%) adenomas with high grade dysplasia, and 63 (48.1%) adenocarcinomas. The mean diameter of the biopsy specimens were 2.48 0.53mm with conventional group, 2.89 0.60mm with jumbo group. Thus, significantly larger biopsy specimens were obtained by jumbo forceps than conventional forceps(p 0.001). The rates of concordance from the first to all four endoscopic forceps biopsy specimens and the ESD specimens were 66.7%, 72.7%, 74.2% and 80.3% in conventional forceps group and 72.3%, 76.9%, 81.5% and 84.6% in jumbo forceps group (p 0.483, p 0.580, p 0.315, p 0.517), respectively. The concordance rate was not associated with location of gastric neoplastic lesions or with experience of endoscopists (p 0.05). There were no variables found to be significantly associated with rates of concordance in multivariate analysis. Conclusions: Obtaining 4 endoscopic biopsy specimens rather than only one before ESD improved diagnostic accuracy by about 15%. Despite of bigger specimen size, however, jumbo forceps was not proven to be superior to the conventional forceps for better diagnostic accuracy of gastric neoplasia.

similar between the two groups, 22 days vs 30 days in patients without and with infection, respectively (p=ns). In conclusion, patients with HRS with bacterial infection have liver, renal, and circulatory dysfunction of similar intensity to that of patients with HRS without bacterial infection and a similarly low survival expectancy. These data suggest that vasoconstrictors and albumin should be evaluated for the management of patients with HRS and bacterial infection.

2. To assess whether the acute response to oral propranolol predicts the long-term response to these drugs. Methods: Thirty-eight patients with cirrhosis and HVPG ≥12mmHg were included. The HVPG was measured at baseline and 90 minutes after an oral dose of 80mg propranolol. Following randomisation, 17 patients received propranolol (mean dose 122.4mg/day) and 21 carvedilol (mean dose 14.0mg/day) titrated according to pulse and blood pressure response. After 12 weeks, HVPG-measurements were repeated. Results: Acute HVPG-response to propranolol was significant −19.3±12.8% (p < 0.01). Long-term treatment with propranolol and carvedilol decreased HVPG −12.5±16.7% (p < 0.01) and −18.7±16.7% (p < 0.01), respectively, with no significant difference between the two treatment-regimens (p = 0.26). The frequency of long-term responders (HVPG decrease ≥20% or to

Background/Aims: The blunted ventricular systolic and diastolic contractile responses to physical and pharmacological stress in cirrhosis are termed cirrhotic cardiomyopathy (CCM). CCM has been known to involve multiple defects in the β-adrenergic signaling pathway. The aim of this study was to determine whether cirrhotic patients have blunted cardiac responses to catecholamine stimulation through dobutamine stress echocardiography (DSE). Methods: Seventy-one cirrhotic patients with normal left ventricular (LV) chamber size and ejection fraction were enrolled. The LV systolic and diastolic functions were evaluated by two-dimensional and Doppler echocardiography at rest and during peak dobutamine infusion (40 μg/kg/min). An abnormal response was defined as a decrease of less than 10% in LV end-diastolic volume, a decrease of less than 20% in end-systolic volume, and an increase of less than 10% in LV ejection fraction (EF) at peak dobutamine infusion, based on previously used criteria. The early/late diastolic flow (E/A) ratio and diastolic parameters were also measured. Results: A blunted LV response to dobutamine was observed in 18 of 71 cirrhotic patients (25.4%). The baseline EF was significantly higher in 18 patients with a blunted DSE response than that of those with a normal DSE response (P

M. pneumoniae는 지역사회폐렴의 중요한 원인균으로 대개 경증의 임상상을 보이지만 급성호흡곤란증후군을 일으킬 정도로 중증의 폐렴을 보이는 경우가 드물게 보고 되고 있다. 저자들은 일반적인 임상적인 경과와 달리 심한 폐침윤과 호흡곤란을 호소한 M. pneumoniae 폐렴 2예를 보고한다. 이들은 M. pneumoniae 폐렴의 전형적인 임상양상을 보이지 않았으나 중증지역사회폐렴의 양상을 보여 처음부터 새로운 퀴놀론이나 마크로라이드가 포함된 경험적 항생제 투여를 시작하였다. 또한 처음부터 M. pneumoniae IgG또는 IgM의 의미있는 상승과 추적검사에서 더욱 상승된 항체가를 보이고 혈청 검사에서 다른 감염증의 가능성을 배제하여 M. pneumoniae 폐렴으로 진단하였으며 합병증을 남기지 않고 치료가 되었다. 두 증례를 통하여 저자들은 M. pneumoniae 감염이 중증의 지역사회폐렴의 원인의 하나로 고려되어야 하며, 중증 폐렴소견을 보이는 경우에도 마크로라이드나 퀴놀론을 포함한 경험적 항생제 치료가 필요할 수 있음을 경험하여 보고한다.

Primary hyperparathyroidism is caused mainly by a parathyroid adenoma or hyperplasia, and is characterized by hypercalcemia and hypophosphatemia induced by an increased level of parathyroid hormone (PTH). Patients with primary hyperparathyroidism are usually as ymptomatic and the disease is most often detected incidentally. However, patients can present with symptoms of renal stones, peptic ulcer disease, muscle weakness, depression, constipation, and pancreatitis. In addition, it has been reported that choletithiasis can be combined with primary hyperparathyroidism. We report a case of a 49-year-old man with primary hyperparathyroidism accompanied with chronic cholecystitis caused by a gallbladder (GB) stone. The chief complaint was nausea, poor oral intake, abdominal pain, and weight loss. Abdominal sonography was performed and chronic cholecystitis with a GB stone was diagnosed. The serum calcium level was 18.5 mg/dL and the intact parathyroid hormone level was 1,777 pg/mL. A parathyroid mass was detected by neck-computed tomography, neck ultrasonography and a 99m Tc-Tetrofosmin parathyroid scan. The parathyroid mass was removed and the mass was confirmed as a parathyroid adenoma. Cholecystectomy was performed and the diagnosis of chronic cholecystitis was confirmed. After the surgical procedure, the symptoms improved and the calcium level was normalized. (J Kor Endocr Soc 22:470~474, 2007)

In patients having malignant or aggressive bone tumors around the knee joint and requiring amputation, segmental resection and rotationplasty was performed and the clinical results were analyzed. Twenty-six patients underwent segmental resection and rotationplasty between February 1988 and June 1994. The mean follow-up period was 57 (6 - 120) months and the average age of patients was 21.4 (5 - 37) years. Out of 26 patients, there were 18 osteosarcomas (>/= stage IIB), 2 synovial sarcomas, and 6 giant cell tumors. Clinical results were evaluated by the Shriner's rating system. Four patients were excluded due to death or amputation and the remaining twenty-two patients were included for assessment. Eighteen patients had excellent results, 3 good, and 1 fair. Range of motion of the ankle joint was -11 (dorsiflexion) - 80 (plantarflexion) degrees and daily walking activity was possible. Local recurrence developed in 2 patients and distant metastasis in 10. Early complications include 3 thromboses and 1 sepsis, and late complications were 6 nonunion, 2 malrotation and 1 stiffness of the ankle joint. Rotationplasty, which is functionally excellent, may serve as an effective partial limb salvage procedure, especially in patients younger than 10 years old who are expected to have leg length discrepancy or loosening of the tumor prosthesis due to the growth of the medullary cavity or when amputation is inevitable for a wide resection margin.

Purpose : This study was undertaken to determine the origins of dorsal root ganglion (DRG) cells containing calcitonin gene-related peptide (CGRP) which innervate the quadriceps femoris tendon in the rat. Materials and Methods : DRG cells containing CGRP, which innervate the quadriceps femoris tendon, from 25 rats (Sprague-Dawley, 200-250 g) were examined using the retrograde tracing technique (neural tracers: horseradish peroxidase and fluorogold) combined with immunohistochemistry. Results : Injection of horseradish peroxidase (HRP) or fluoro-gold (FG) into the quadriceps femoris tendon resulted in the ipsilaterally labelling of cells between L1 and L6 DRGs. However, a large number of the labelled cells innervating the quadriceps femoris tendon were found in the L3 and L4 DRGs. Many DRG cells were immunostained with CGRP antibody in the L1-6 DRGs. The number of CGRP immunoreactive cells in the lumbar DRGs was larger than in the sacral DRG. FG labelled cells containing CGRP immunoreactivity (FG+CGRP cells) were found in the lumbosacral DRGs. Many FG+CGRP cells innervating the quadriceps femoris tendon were located in the L3 and L4 DRGs. Conclusion : These results show that the main DRG origin for the sensory innervation of the quadriceps femoris tendon is L3 or L4. The neurogenic pain of the quadriceps femoris tendon may originate from this region, and suggests that this may be important for the release of neurogenic pain.