Osteochondrosis dissecans in glenoid cavity of Korean War casualty’s scapula / 대한해부학회지

Since the first description of this disease in 1887, there are rare reports on osteochondrosis dissecans (OCD) found in the glenoid cavity by way of anthropological studies. During an excavation project for recovery of the remains of Korean War casualties, a skeletonized soldier was found inside a cave fort at the Arrowhead Ridge of the demilitarized zone (DMZ), South Korea. In our recovery and examination of a Korean War casualty in DMZ, we identified a possible OCD in the individual’s glenoid cavity of a right-sided scapula by radiological analysis and computed tomography reconstruction. This is a rare case of scapular OCD discovered in an archaeologically investigated skeleton.

Osteochondrosis dissecans in glenoid cavity of Korean War casualty’s scapula / 대한해부학회지

Since the first description of this disease in 1887, there are rare reports on osteochondrosis dissecans (OCD) found in the glenoid cavity by way of anthropological studies. During an excavation project for recovery of the remains of Korean War casualties, a skeletonized soldier was found inside a cave fort at the Arrowhead Ridge of the demilitarized zone (DMZ), South Korea. In our recovery and examination of a Korean War casualty in DMZ, we identified a possible OCD in the individual’s glenoid cavity of a right-sided scapula by radiological analysis and computed tomography reconstruction. This is a rare case of scapular OCD discovered in an archaeologically investigated skeleton.

A Study on the Size of TMD Patient's Condyle Head

OBJECTIVE: In many TMD cases, deformed and reduced condyle heads were frequently observed. This study was prepared to compare the dimensions between normal and symptomatic condyles, using MR images. MATERIALS: One hundred and twenty one patients with clinical signs and MRI-confirmed diagnosis of disc displacement were selected for this study. Thirty eight TMJs from nineteen asymptomatic volunteers who had no clinical symptoms and no disc displacement on sagittal and coronal view of MRI, were served as normal. METHODS: Symptomatic condyles were classified according to the severity of the anterior disc displacement. The amount of anterior disc displacement was evaluated at sagittal section, and they were classified into 4 groups as normal(N), little(G0), mild(G1), moderate(G2) and severe displacement(G3). The dimentions of condyle were measured at the 200% magnified view, by digitizing program. All dimensions were compared among each groups on the central section of sagittal and coronal views, and the statistical analysis was performed. RESULTS: The mean value of anteroposterior length of normal condyle was 0.79+/-0.13cm at sagittal section and mediolateral length was 2.12+/-0.22cm on coronal section. The mean value of anteroposterior length of symptomatic condyle was 0.67+/-0.16cm at sagittal section and mediolateral length was 1.97+/-0.28cm on coronal section. CONCLUSIONS: The size of symptomatic condyle was smaller than normal TMJ. The size of condyle was decreased as the amount of the disc displacement was increased. The dimensional change was found on the anterior articular surface of condyle at the mild or moderate disc displacement. And at the case of severe disc displacement, dimensional change was found on the superior articular surface.

A Study On The Morphology Of Mandibular Condyle

OBJECTIVE: This study was prepared to figure out a certain dimension and morphology of the condyle at the central, medial and lateral aspects on MR images of asymptomatic volunteers, which could be comparable with those of the TMD patient's condyle. MATERIALS: Sixty TMJs from 30 asymptomatic volunteers(15 male, 15 female) who had no clinical symptoms and no disc displacement on sagital and coronal view of MRI were served as normal. METHOD: MR images were taken from the asymptomatic volunteers and the dimension of the anteroposterior length, mediolateral width, height, convexities were measured through the images on the sagittal and coronal sections of mandibular condyle. Then, these data were collected and analyzed. RESULT: The mean value of anteroposterior length was 8.00+/-1.21mm at central section and mediolateral length was 21.40+/-2.32mm on coronal view. The anterior condylar length at medial side was the shortest and the convexity of anterior slop at the lateral side was roved to be the flattest among 3 sections. There were little dimensional and morphological differences at sagittal sections, but the ediolateral width of condyle at coronal section was significantly different between male and female. CONCLUSION: In sagittal sections, the anterior condyle length was shortest at medial side and the convexity of anterior slop was flattest at lateral side, and there were little dimensional and morphologic differences between male and female. In coronal section, male's condyle was more wider and flatter than female's.

Change of Joint Space according to Sideways Disc Displacement of TMJ

OBJECTIVE: Disc displacement may affect the joint space narrowing between condyle head and glenoid fossa. This study was designed to evaluate the correlation between the joint space change and the directions of disc displacement. STUDY DESIGN: Two hundreds temporomandibular joints MR images of TMD patients (170 joints) and asymptomatic volunteers (30 joints) were evaluated for this purpose. Anterior disc displacement was divided into 3 stages (normal, little to mild, and moderate to severe displacement) based on sagittal images. And sideways displacement was classified as 3 categories (center, medial and lateral displacement) based on coronal images, then joint spaces were measured at medial, central and lateral parts of condyle head on coronal MR images, respectively. The joint spaces of 7 groups divided according to the severity and the direction of disc displacement were compared. RESULTS: The reduction of the joint space was affected by sideways disc displacement at the opposite side of the condyle head, except the cases accompanied with severe anteriorly and laterally displaced disc. CONCLUSION: The sideways disc displacement affected on the opposite side temporomandibular joint space width.

Unusual peripheral osteomas: Report of 2 cases

Osteoma is defined as a benign neoplasm of bony tissue. Osteomas are divided into two groups: central and peripheral by origin, compact and cancellous by histopathologic findings. Solitary osteoma of jaw bone, not related with Gardner syndrom, is relatively uncommon. We present two cases of huge solitary peripheral osteomas: compact type exophyting osteoma on the inferolingual side of mandibular angle and cancellous type on the residual ridge of posterior maxilla, which is extremely rare.

Magnetic Resonance Imaging of Acute Cervical Cord Injuries (Clinical Correlation and Prognosis) / 대한척추외과학회지

STUDY DESIGN: Retrospective evaluation of MRI and clinical examinations in 60 acute cervical spine cord injury. OBJECTIVES: To determine whether initial MRI appearances of the spinal cord in acute trauma correlate with clinical presentation and prognosis. SUMMARY OF LITERATURE REVIEW: Magnetic resonance imaging was known to be the best imaging modality to evaluate spinal cord injury. However, there was no sufficient report to correlate between clinical presentation, prognosis and findings of mag-netic resonance imaging. METHODS: Sixty patients with cervical SCI were evaluated their clinical manifestations, prognosis and MRI findings. MRI was taken with 10 days after trauma in all patients. The patients initial and final neurologic status and functional outcome were evaluated and correlation with initial MRI findings. RESULTS: Edema 37%, swelling 33%, contusion 20%, normal 10% was found at initial magnetic resonance imaging. The group of edema and swelling was more neurological deficit than other groups and low functional and neurological recovery was found at last follow up. The average length of the edema and swelling was each other 19.8, 20.4 mm. There was more neurological deficit, lower functional recovery in longer length of the edema and swelling. CONCLUSION: There is a close correlation between initial magnetic resonance imaging and final neurological, functional recovery in acute spinal cord injury. Magnetic resonance imaging is useful in predicting the clinical outcome and prognosis.

The Effectiveness of Transpedicular Bone Graft in Burst Fracture / 대한척추외과학회지

PURPOSE: To assess the effectiveness of transpedicular bone graft after short segmental fixation in the treatment of thora-columbar burst fracture. MATERIALS AND METHODS: Patients who were admitted to our hospital from January 1994 to December 1998 for thoracolumbar burst fracture and treated with open reduction and internal fixation were reviewed. Seventy-five cases who were followed up for more than 1 year were selected. Among of these, 45 cases were treated with internal fixation and posterior fusion only, and in 30 cases transpedicular bone graft was done additionally. Denis classification was used and preop., postop., final follow up wedge angle, Cobb's angle, the height of disc space, and anterior body height were compared and analized respectively. RESULTS: The preop, postop and final follow-up of wedge angle, cobb's angle, disc height and anterior body height were mea-sured. The preop, postop. and final follow up wedge angle of patients who underwent transpedicular bone graft and patients who were treated with posterior fusion only were 20.4 +/-8.4 degrees, 9.8+/-4.6 degrees, 11.5+/-5.3 degrees and 21.4+/-5.9 degrees, 6.7+/-3.1 degrees , 6.8+/-3.1 degrees respec-tively. The Cobb's angle were 19.2+/-7.3 degrees, 8.9 +/-4.4 degrees, 9.2+/-4.6 degrees and 20.2+/-9.9 degrees, 11+/-5.9 degrees, 15+/-6.9 degrees respectively. Anterior body height were 51+/-15.3%, 93 +/-8.8%, 91+/-8.9% and 53+/-11.3%, 88+/-12.8% and 84+/-15.3%. These values were statistically signifi-cant(p<0.05). CONCLUSION: Transpedicular bone graft reduced the loss of the Cobb's angle, wedge angle and anterior body height at postop. and last follow-up. The transpedicular bone graft was a valuable method to prevent reduction loss in the treatment of thoracolumbar burst fracture

Comparison of Adolescents with Adults in Lumbar HNP / 대한척추외과학회지

PURPOSE: To evaluate the difference of clinical and radiological findings for patients who underwent surgery for lumbar HNP in adolescents and adults MATERIALS AND METHODS: We studied 70 patients ; 35 adolescents(below 20 years of age), 35 adults(21 to 40 years of age) retro-spectively from May 1992 through July 1999, whom we were able to follow up for more than one year after surgery. Patients with spinal instability and stenosis were excluded. RESULTS: By the JOA score, preoperative radiating pain of the lower leg was 1.0 point in adolescents, 0.6 point in adults, showing a statistically significant difference(p<0.05). Mean value was excellent as 9.5 points in adolescents and 9.3 points in adults at last follow-up of the JOA score, and there was no significant difference. Degree of disc degeneration was of higher grade in adults, but disc degeneration was not related to lower back pain in either group. In adolescents, severity of preoperative sensory or motor dysfunction affected duration of postoperative sensory or motor recovery respectively, while in adults, severity of either preoperative sensory or motor dysfunction affected that of both sensory and motor postoperative neurologic recovery(p<0.05). The longer the time of suffering from radiating pain, the lower the points of last follow-up JOA score in adolescents. The longer the time of lower back pain, the lower the points in adults(p<0.05). CONCLUSION: Preoperative radiating pain was more severe in adults, and no other clinical difference was seen between the two groups. In adolescents, severity of preoperative sensory or motor dysfunction affected duration of postoperative sensory or motor recovery respectively, while in adults, severity of either preoperative sensory or motor dysfunction affected that of both sensory and motor postoperative neurologic recovery. Duration of radiating pain in adolescents, and lower back pain in adults, can be used to predict prognosis.

Minimum Five Year Follow-Up Study of Porous-Coated Versus Hydroxyapatite Porous-Coated Cementless Total Hip Replacement / 대한정형외과학회잡지

PURPOSE: To compare the results of hydroxyapatite (HA) -coated with porous coated prosthesis for a minimum of five years. MATERIALS AND METHODS: We reviewed radiographs of 43 patients in HA group (48 cases) and 44 patient in porous group (48 cases) that followed for a minimum of five years after primary cementless total hip arthroplasty. Average follow up period was 6.2 years in HA group and 6.8 years in porous group. RESULTS: Harris hip score was improved to 78.1 point in porous group, 90.9 point in HA group at 6 months after surgery, but at last follwo up, 94 point in HA group, 96 point in porous group, there was no significancy. Thigh pain was noted 22.9% in porous group and 6.3% in HA group at 6 months after surgery (P=0.047) . At last follow up, thigh pain was noted 6.3% and 2.1% respectively. The mean wear of polyethylene liner was 1.36 mm in porous group and 1.72 mm in HA group (P=0.067) . Endosteal bone formation of femoral stem was noted 56.3% of porous group and 91.7% of HA group at one year after surgery, but there was 97% of endosteal bone formation was noted in both group at last follow up. Osteolysis around acetabular cup was noted 8.3% in porous group and 10.4% in HA group, and osteolysis around femoral stem was noted in 20.8%, 37.5% respectively. CONCLUSION: The results of HA coated implant was better than that of porous group at initial, but there was no significant differency at last follow up. The difference in rate of osteolysis and polyethylene wear between both groups were not significant at the last follow up. Final acceptance must await follow-up at least of 10 to 15 years in comparison with current hip prostheses.

A Randomized Comparison of Cilostazol and Ticlopidine after Coronary-artery

BACKGROUND AND OBJECTIVES: Combination of ticlopidine and aspirin has been accepted as a standard antiplatelet regimen after coronary stenting because it reduced the rate of cardiac events and hemorrhagic-vascular compli-cations compared with intensive anticoagulation. Ticlopidine use, however, may accompany serious side effects such as neutropenia or liver dysfunction. Cilostazol, a c-AMP phosphodiesterase inhibitor, is a novel antiplatelet agent which is known to have less side effects. MATERIALS AND METHODS: We compared the efficacy and safety of ci lostazol plus aspirin (CA) with ticlopidine plus asprin (TA) after elective coronary stenting. Patients were randomly assigned to receive either CA or TA two days before stenting. The primary end point was a composite of angiographic stent thrombosis, death, myocardial infarction (Q or Non-Q), repeat intervention or bypass su rgery at 30 days. The secondary end points were hemorrhagic-vascular complications, or drug side effects such as neutropenia, thrombocytopenia, or any side effects requiring cessation of drugs at 30 days. RESULTS: After randomization of 300 patients equally to each group, 4 patients were excluded from the analysis: 1 failure of stenting, 3 follow-up loss. The primary end point was reached in 2 patients (1.4% ) in CA group and 3 patients (2.0% ) in TA group (p=1.0). The rate of hemorrhagic-vascular complications was not different between the gr oups (1.4% vs 2.0%, p=1.0). The incidence of significant drug-related side effects was not statistically different between CA group and TA group (0.7% vs 2.7%, p=0.37). However, serious side effect such as neutropenia was seen only in TA group. CONCLUSION: Compared with TA, CA has comparable effect for the prevention of stent thrombosis and major cardiac events with similar rate of hemorrhagic-complications and drug-related side effects after elective coronary-artery stenting. Thus CA regimen can be a safe alternative to TA in elective implantation of coronary artery stent.

The role of radiotherapy in the treatment of aggressive fibromatosis

Aggressive fibromatosis is a rare benign soft tissue tumor that is difficult to cure because of its infiltrative nature and high tendency to recur locally. The authors retrospectively analyzed 20 patients with histologically-confirmed fibromatosis. All patients underwent surgery with a wide or marginal margin. Five (25%) cases with histologically-negative margins had recurred. External beam radiotherapy was administered to patients whose margins were positive or who had local recurrence. However, out of concern for safety, radiotherapy was not given to two babies and a reproductive-aged woman. The average dose was 5,020 cGy. During the follow-up (mean 32.6 months), all the patients undergoing radiotherapy showed no evidence of local recurrence. A wide local excision has traditionally been the treatment of choice. However, postoperative radiotherapy could be an effective measure for preventing local recurrence in patients with a histologically-positive surgical margin and recurrence independent of any signs of relapse.

Mechanism of Hypercallus Formation in Patients with Concomitant Fracture and Head injury / 대한정형외과연구학회지

We built the hypothesis that the hypertrophic callus formation is mediated by beta-endorphin that stimulates secretion of GH and increase circulation growth factor activity in head injury patient. We classified 4 groups such as 5 normal person(control), group I;5 patients with only fracture, group II;5 patients with fracture and head injury, group III; 5 patients with only head injury, group IV. We obtained the samples of serum from each group at 0, 2, 4, 6, 8 weeks after trauma and assessed the serum level of GH, GHRH, somatostatin. The serum level of GH was statisticallyu higher in group III, IV than group I, II. There was not significant difference in serum level of GHRH. The serum level of somatostatin was higher in group II, III, IV than group I, but there was no statistical significance in each group. GH has a important role in hypertrophic callus formation in severe head injury patients, but there was no evidence that the mechanism is mediated by beta-EndorphinGHRH & somatostatin-GH-GF-1, beta-FGF axis. There may be a another mechanism in increasing GH that was stimulated by beta-endorphin in thalamus and lateral ventricle, and it should be necessary for further evaluation of it.

Entry Point of Pedicle Screw in the Lower Lumbar Spine / 대한척추외과학회지

STUDY DESIGN: We analysed retrospectively the entry point of pedicle screw in the lower lumbar spine using computed tomoscan. OBJECTIVES: The purpose of this study is to find the ideal entry point of pedicle screw in the lower lumbar spine. MATERIALS AND METHODS: We evaluated 98 patients with each second, third, fourth, fifth lumbar spine, and divide three group into normal group(NP), osteoarthritis group(OA), degenerative spondylolisthesis group(DS). We collected the two axial images of lower lumbar spine from CT at the same level. One image is parallel to upper end plate and again, the facet joint is well visuable, another image is the pedicle which cross the center, and the size of the both sides of pedicle is same and largest. And then we were superimposed mathematically above two images with computer. With the use of these three images, facet joint and pedicle axis orientation, pedicle isthmus width, distance between facet joint and pedicle axis, distance between lateral surface of facet and pedicle axis are measured. RESULT: The ideal entry point of pedicle screw is 3mm lateral from lateral end of facet joint in NP group, in OA 0.5~1mm medial and in DS 0.3mm medial from lateral end of facet joint. CONCLUSION: The selected anatomical landmark using the pedicle screw insertion is not advisable because of the variations of pedicle width and orientation depend on pathologic state of the lower lumbar spine, especially facet joint. We suggest that the sugeon should selected well the ideal entry point of the pedicle screw, knowing the shape and any anatomical variations of the pedicle in details before screw insertion with peroperative computed tomoscan.

A Case of Septic Arthritis Caused by Salmonella Group D in a Patient with Systemic Lupus Erythematosus / 대한류마티스학회지

Patients with systemic lupus erythematosus(SLE) are at increased risk for infection. Insufficiency of the reticuloendothelial system caused by either immunosuppressive therapy or inadequate opsonization is the mechanism that Salmonella infections in particular appear in these patients. Salmonella infections can provoke a polyarticular reactive arthritis while septic arthritis caused by Salmonella is monoarticular. We report a rare case of septic arthritis caused by Salmonella Group D in a patient with systemic lupus erythematosus. A 20-year-old female patient with systemic lupus erythematosus admitted with a painful swelling of right knee joint. The culture of synovial fluid obtained by aspiration yielded growth of Salmonella Group D. With trimethoprimsulfamethoxazole, the patient was recovered completely.

Amyopathic Dermatomyositis with Interstitial Lung Disease: A Case Report / 대한류마티스학회지

Amyopathic dermatomyositis is defined by characteristic cutaneous manifestation of dermatomyositis without evidence of muscle involvement. There is no clinical difference between dermatomyositis and amyopathic dermatomyositis. Pulmonary involvement of dermatomyositis is so frequent than aggressive dianostic and therapeutic approach is needed. Early steroid or immunosuppresive treatment in pulmonary involvement of dermatomyositis gets better prognosis. Intravenous immunoglobulin treatment is an effective and safe alternative when the steroid or immunosuppresive treatment is ineffective or intolerable. We are reporting a case of amyopathic dermatomyositis with interstitial lung disease. This patient was improved with intravenous immunoglobulin treatment.

A Case of Toxoplasma Lymphadenitis / 감염

Toxoplasma lymphadenitis is the most common clinical manifestation of toxoplasmosis in an immunocompetent host. In foreign countries, it is a relatively common etiology of reactive hyperplasia of lymph nodes, but it is still rare in Korea. The cervical lymph nodes are the most commonly involved, whereas systemic manifestations are rare. We are reporting a case of toxoplasma lymphadenitis in an immunocompetent host. A 31-year-old man was admitted to the hospital because of submandibular lymph node enlargement for 3 months. Toxoplasma lymphadenitis was diagnosed by positive IgG and IgM toxoplasma antibody titer and specific pathologic findings of submandibular lymph node, such as reactive follicular hyperplasia, epitheioid histiocytes in the interfollicular area, and infiltrations of subcapsular monocytoid B lymphocytes. In Korea, travels to and from other countries and contacts with foreigners are increasing, possibly increasing the incidence of toxoplasma lymphadenitis, which should be considered in the differential diagnosis of lymphadenitis.

A light and electron microscopic study of changes in intermaxillary suture during the rapid maxillary expansion of young adult dogs / 대한치과교정학회지

Rapid maxillary expansion is widely used for the correction of anteroposterior discrepancies, constriction of the maxillary arch, etc. This experiment was undertaken to examine the serial changes in the osteogenesis as well as the collagen fiber bundles in the intermaxillary suture during the rapid maxillary expansion treatment. Four young female dogs aged 6 to 8 months old and not showing menarche yet were used for the experiment. The maxillary impression of dogs were taken, expansion device cast and Hyrax screw soldered at the midline in the 1st premolar area. RME device was delivered to the dogs and the activation of 0.25mm per quarter-tum was done 2 times per day for 10 days until 5mm separation was made. Separation of the maxilla was confirmed by X ?ray. The animals were sacrificed on 0, 15, 30, 60 days from the finish of maxillary separation and preparations for light microscopy and surface electron microscopy were made. The sutures were cut into frontal serial sections for examination of the histological reactions. The following results were obtained and the conclusions made. 1. The edges of the two palatal plates bordering the midpalatal suture which at the beginning of the retention period were mainly composed of compact bone, underwent extensive resorption followed by new bone formation and gradually became spongy bone rich in bone marrow which in the 60 day retention animal became the compact bone with short intermaxillary suture space. During this transformation, newly formed trabecular bone tissues were added to the original margin. 2. Throughout the expansion period, the collagen fibers underwent successive changes such as stretching, loss of polarity, and finally fibrillogenesis. Towards the end of the expansion procedure, sharpey's fiber formation in newly formed bones were observed. 3. Bony spicules were found in the initial stage of retention on occlusal topographic X -rays, which later were confirmed to have ossified. 4. Judging from the histological changes occuring during the experimental expansion, excessive expansion will cause an excessive bleeding, and retard the remodeling of intermaxillary suture. According to the above results, the bone remodeling after rapid maxillary expansion was preceded by the migration of migratory cells into the intermaxillary suture area. The bone remodeling phenomena were on-going during the 2 months retention sample.

A study on the correlations between mesiodistal crown diameters of the deciduous and successional permanent teeth / 대한치과교정학회지

The primary objective of this study is to estimate of the mesiodistal crown diameters of the unerupted permanent successors derived from the mesiodistal crown diameters of the deciduous teeth in Korean population. The subjects were 54 indiciduals (twenty nine boys and twenty five girls) with normal occlusion aged 6 to 13 years. The mesiodistal crown diameters of the deciduous and the successional permanent teeth were measured from the longitudinal dental cast models using the shding calipers (Mitutoyo Co.) From the study, the results are as follows, 1. Sex differences of mesiodistal crown diameters were less in the deciduous teeth, but male were more than that of female in the successional permanent teeth. 2. The mesiodistal crown diameters of the deciduous central incisors, lateral incisors, canines were smaller than that of the successional permanent teeth and the deciduous 1st molars, and 2nd molars were more larger than that of the successional permanent teeth. 3. Size differences between sum of the mesiodistal crown diameters of central meisors and lateral meisors in the decidous teeth and the successional permanrnt teeth were 7.20 +/- 1.79 mm in upper, 5.38 +/- 1.64 mm in lower and that of canine, 1st molar and 2nd molar in the deciduous teeth and the successional permanent teeth were 0.56 +/- 1.19 mm in upper, 2.22 +/- 1.19 mm in lower. 4. In male, the correlation coefficients between the upper deciduous central incisor and the successional permanent tooth (r=0.57) and in female, the correlation coefficients between the upper deciduous 1st molar and the successional permanent tooth (r=0.67) appeared the highest. 5. The regression constants were determined to estimate the mesiodistal crown diameters of the unerupted successional permanent teeth.