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Purpose: The purpose of this study was to evaluate the clinical and radiographic results of cementless total hip arthroplasty (THA) with subtrochanteric transverse shortening osteotomy in patients with high hip dislocation. Materials and Methods: Eighteen patients with high hip dislocation who underwent cementless THA combined with a subtrochanteric transverse shortening osteotomy, plate or cable fixation and bone graft on the osteotomy site between 2001 and 2012 were evaluated in this study. The mean duration of follow-up was 5.2 (2- 8.3) years. We evaluated Harris hip score, limping, limb length discrepancy as a clinical parameter and osteolysis, loosening and union of the osteotomy site as a radiographic parameter. Results: Harris hip scores at the final follow-up showed improvement of limping and limb length discrepancy in all cases. And, with the exception of two cases of infection, there were no loosening and osteolysis. All cases showed union of the osteotomy site. There were two cases of infection and one case of dislocation as a complication. Infection occurred in two patients who underwent reoperation and one patient developed sciatic nerve palsy. Conclusion: Cementless THA with subtrochanteric transverse shortening osteotomy showed relatively satisfactory clinical and radiologic results. However, the incidence of complications, such as infection, is relatively high, therefore, careful attention is needed. [ABSTRACT FROM AUTHOR]

Abstract  Many surgeons treat progressive femoral osteolysis in association with a well-fixed stem with bone grafting but in uncontained proximal defects the graft could get into the joint, raising a question regarding whether the osteolysis can be treated by simple débridement without bone grafting. We investigated whether the curetted proximal osteolysis around an unrevised femoral component progressed in size and whether this lesion would have a deleterious effect on fixation of the femoral component in patients with isolated acetabular revision. We prospectively followed 21 patients (24 hips) who underwent acetabular revision and curetting of femoral osteolysis. The minimum followup was 3 years (mean, 4.3 years; range, 3–7.4 years). By the latest followup, no hips had major progression of the osteolytic defect through the followup period and none had any new osteolytic lesions. All hips were judged stable and to have well-fixed acetabular cups and femoral stems. Provided a femoral component is bone ingrown with osseointegration sufficient to provide long-term stability, the osteolytic defect is in the proximal aspect of the femur, and the defect is uncontained, simple curettage may preserve femoral implant stability and may prevent progression of osteolysis to another Gruen zone for at least 3 to 7 years. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

A fracture of the affected extremity in patients with Klippel-Trenaunay-Weber syndrome can be fatal due to massive bleeding and show poor results. A 42-year-old male presented with an old fracture of the right femoral shaft with metal failure. We planned an operation to remove the previously fixed plate and to perform re-fixation using an intra-medullary nail. Preoperative angiography was performed and the arteriovenous malformations were embolized in order to reduce the risk of bleeding. After angiography, the previously fixed plate was removed. After the operation, a second angiography was performed immediately and the venous malformation was embolized. One week after the first operation, a second operation was performed in order to reduce the fracture and to perform re-fixation using an intramedullary nail. The patient is being followed without major complication over a period of seven years after surgery. We recommend careful planning of preoperative and postoperative angiography and embolization in order to reduce the risk of bleeding in patients with Klippel-Trenaunay-Weber syndrome. [ABSTRACT FROM AUTHOR]

Osteochondromas are one of the most common benign bone tumors. They usually arise from the metaphyses of long bones. Involvement of the bicipital tuberosity is rare. To date, no reports have described avulsed rupture of the distal biceps tendon caused by an osteochondroma of the bicipital tuberosity. This article presents a case of avulsion of the distal biceps tendon secondary to sessile osteochondroma of the bicipital tuberosity in a 65-year-old right-handed sedentary worker who presented with insidious pain and limited motion in his left elbow for 2 months. Intraoperative findings showed a bony mass of 25235 mm with osteocartilaginous nodules on the bicipital tuberosity. The distal biceps tendon with an avulsed bony fragment was displaced proximally, with a 20-mm gap between the tendon and the bicipital tuberosity. After complete excision of the mass, footprint preparation at the bicipital tuberosity was performed using a 4.0-mm burr and anatomic reattachment of the distal biceps tendon with a 5.0-mm suture anchor. The pathologic diagnosis of osteochondroma was confirmed microscopically. We suggest that osteochondroma of the bicipital tuberositybe considered as a cause of painful limitation of forearm rotation or avulsed rupture of the distal biceps tendon. [ABSTRACT FROM AUTHOR]

Background/Aims Endoscopic procedures are important for diagnosis and treatment of gastrointestinal disease even in children. As indications are different and cases are not common, pediatric endoscopic procedures might be trickier than those of adults. The aim of the study is to comprehend and analyze the current status of pediatric endoscopy practice pattern in South Korea. Methods A questionnaire was developed by 12 members of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition. The questionnaires were sent to pediatric gastroenterologists by e-mails who are working in general and tertiary hospitals in South Korea. Results The response rate was 80% (50/60). Three of them (6%) were not performing endoscopy currently. Among the 47 responders who were performing endoscopy, all of them were doing esophagogastroduodenoscopy and 42 (89%) were doing colonoscopy. Other therapeutic procedures such as endoscopic foreign body removal (98%), colonoscopic polypectomy (66%) were performed by pediatric gastroenterologist in many centers. However, some procedures such as endoscopic retrograde cholangiopancreatography (ERCP; 2%), double-balloon enteroscopy (2%) were performed by pediatrician only in limited centers and adult endoscopists were doing such procedures for pediatric endoscopy cases in most of the centers. Thirty-four of the responders (72.3%) were conducting endoscopic biopsies depending on the patient's clinical conditions even from grossly normal mucosa. Eight (17%) responded that they are performing routine biopsies for all patients who are undergoing diagnostic endoscopy. Majority of the endoscopies were done under sedation in most centers and the most frequently used sedatives were midazolam and ketamine. Conclusions Most of the pediatric endoscopy specialists were performing esophagogastroduodenoscopy, colonoscopy and endoscopic foreign body removal by themselves. However, relatively rare procedures such as ERCP or double balloon enteroscopy were dependent on adult endoscopy specialist. These results should be considered for pediatric endoscopic training. Furthermore, close communications with endoscopy specialist of internal medicine are required. [ABSTRACT FROM AUTHOR]

Background/Aims: A full colonoscopy is currently required in children and adolescents with colorectal polyps, because of their potential of neoplastic transformation and complications such as intussusception. We aimed to analyze the associations of polyp characteristics in children and adolescents with colorectal polyps. Based on these findings, we also aimed to reevaluate the necessity of conducting a full colonoscopy. Methods: Pediatric patients <18 years of age who had undergone a colonoscopic polypectomy and those with <5 colorectal polyps were included in this multicenter, retrospective study. Baseline clinicodemographics, colonoscopic and histologic findings were investigated. Results: A total of 91 patients were included. Multivariate logistic regression analysis showed that polyp size was the only factor associated with the presence of any polyps located proximal to the splenic flexure (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.28 to 4.28; p=0.007). Furthermore, polyp location proximal to the splenic flexure and sessile morphology were associated with the presence of any adenomatous polyp (OR, 8.51; 95% CI, 1.43 to 68.65; p=0.023; OR, 18.41; 95% CI, 3.45 to 173.81; p=0.002, respectively). Conclusions: In children and adolescents presenting with <5 colorectal polyps, polyp size and the presence of any adenomatous polyp were positively associated with polyp location proximal to the splenic flexure. This finding supports the necessity of a full colonoscopic exam in pediatric patients with colorectal polyps for the detection of polyps before the occurrence of complications such as intussusception or neoplastic transformation. [ABSTRACT FROM AUTHOR]

Purpose: Gastrointestinal (GI) endoscopy is an important tool for diagnosing and treating GI diseases in children. This study aimed to analyze the current GI endoscopy practice patterns among South Korean pediatric endoscopists. Methods: Twelve members of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition developed a questionnaire. The questionnaire was emailed to pediatric gastroenterologists attending general and tertiary hospitals in South Korea. Results: The response rate was 86.7% (52/60), and 49 of the respondents (94.2%) were currently performing endoscopy. All respondents were performing esophagogastroduodenoscopy, and 43 (87.8%) were performing colonoscopy. Relatively rare procedures for children, such as double-balloon enteroscopy (DBE) (4.1%), endoscopic retrograde cholangiopancreatography (ERCP) (2.0%), and endoscopic ultrasound (EUS) (2.0%), were only performed by pediatric gastroenterologists at very few centers, but were performed by adult endoscopists in most of the centers; of all the respondents, 83.7% (41/49) performed emergency endoscopy. In most centers, the majority of the endoscopies were performed under sedation, with midazolam (100.0%) and ketamine (67.3%) as the most frequently used sedatives. Conclusion: While most pediatric GI endoscopists perform common GI endoscopic procedures, rare procedures, such as DBE, ERCP, and EUS, are only performed by pediatric gastroenterologists at very few centers, and by adult GI endoscopists at most of the centers. For such rare procedures, close communication and cooperation with adult GI endoscopists are required. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to investigate factors that correlate with fecal calprotectin (FC) levels in children and adolescents with colorectal polyps. Methods: Pediatric patients aged <19 years who underwent colonoscopic polypectomy for a juvenile polyps (JPs) and FC tests were simultaneously conducted in a multicenter, retrospective study. Baseline demographics, colonoscopic and histological findings, and laboratory tests, including FC levels, were investigated. Correlations between the factors were investigated, and linear regression analysis revealed factors that correlated with FC levels. FC levels measured after polypectomies were investigated and the FC levels pre- and post-polypectomies were compared. Results: A total of 33 patients were included in the study. According to Pearson correlation analysis, the polyp size was the only factor that showed a statistically significant correlation with FC levels (r=0.75, p<0.001). Furthermore, according to the multivariate linear regression analysis, polyp size was the only factor that showed a statistically significant correlation with FC levels (adjusted R²=0.5718, β=73.62, p<0.001). The median FC level was 400 mg/ kg (interquartile range [IQR], 141.6–1,000 mg/kg), and the median polyp size was 14 mm (IQR, 9–20 mm). Nineteen patients underwent post-polypectomy FC tests. FC levels showed a significant decrease after polypectomy from a median of 445.2 mg/kg (IQR, 225–1,000) to 26.5 mg/kg (11.5–51) (p<0.001). [ABSTRACT FROM AUTHOR]

An inverse-opal poly(3,4-ethylene dioxythiophene) (PEDOT) electrode was fabricated by electrodeposition of EDOT onto a PEDOT:poly(styrene sulfonate) filler in a self-assembled polystyrene template. By this novel fabrication method, the inverse-opal electrode was directly assembled into a dye-sensitized solar cell (DSSC) as a Pt-free counter electrode without any additional processing. This inverse-opal PEDOT electrode exhibits superior electrocatalytic activity and easy electrolyte diffusion in the electrode, as the inverse-opal electrode provides a porous morphology. The improved reflectivity of the inverse-opal electrode was also observed in the incident-photon conversion-efficiency spectra at low wavelength, which was a characteristic of its well-ordered structure. Therefore, the inverse-opal PEDOT electrode could successfully act as an alternative counter electrode for DSSCs to replace Pt in the counter electrode. [ABSTRACT FROM AUTHOR]

Even though the surgical techniques and perioperative care have improved, blood transfusions are still often required for the patients undergoing pancreaticoduodenectomy (PD). But complications from blood transfusions, poor prognosis of blood transfused patients, cost, and availability of blood products demand transfusion free (TF) surgery in the PD patients. The purpose of this study is to compare clinical outcome of TF pancreaticoduodenectomy with transfusion-eligible (TE) PD. We had investigated the possibility of blood TF treatments for the patients who underwent PD from December 2005 to August 2007. There were 41 cases of PD performed by one surgeon with the same method: 14 patients of the TF group and 27 patients of the TE group. Most of the TF group patients received perioperative blood augmentation and intraoperative acute normovolemic hemodilution. The results of statistical analysis between TF and TE group showed that there were no statistical differences in intraoperative data and postoperative outcomes, except preoperative hemoglobin levels, type of operations, and transfusion amount. To our best knowledge, this is the first successful PD program in selected patients as a series of operations without blood trans- fusion. TF PD can be done successfully in selected patients without severe complications. [ABSTRACT FROM AUTHOR]