Clinical Outcome of IM-Guided Total Knee Arthroplasty with Inappropriate Femoral Resection in Coronal Plane

PURPOSE: The purpose of this study was to evaluate clinical results and accuracy of femoral cutting in the coronal plane in total knee arthroplasty (TKA) using a fixed length intramedullary guide. MATERIALS AND METHODS: From 2005 to 2008, 101 patients (154 knees) underwent TKA (NexGen LPS implant). The minimal follow-up period was 3 years (mean, 4.4 years). The patients were divided into two groups (group 1, 94alpha, 98 or =2degrees MAD was 65 in group 1 and 24 in group 2. The mean PTA, KSKS, and KSFS were 10.17degrees, 96.0, and 96.6, respectively, in group 1 and 11.58degrees, 84.5, and 85.5, respectively, in group 2. CONCLUSIONS: The percentage of coronal alignment outliers was relatively high (34 in 154 cases, 22%) after TKA using a fixed length intramedullary guide. However, there was no statistically significant intergroup difference in clinical results (KSKS, p=0.67; KSFS, p=0.56).

Protective Effect of ECQ on Rat Reflux Esophagitis Model

This study was designed to determine the protective effect of Rumex Aquaticus Herba extracts containing quercetin-3-beta-D-glucuronopyranoside (ECQ) on experimental reflux esophagitis. Reflux esophagitis was induced by surgical procedure. The rats were divided into seven groups, namely normal group, control group, ECQ (1, 3, 10, 30 mg/kg) group and omeprazole (30 mg/kg) group. ECQ and omeprazole groups received intraduodenal administration. The Rats were starved for 24 hours before the experiments, but were freely allowed to drink water. ECQ group attenuated the gross esophagitis significantly compared to that treated with omeprazole in a dose-dependent manner. ECQ decreased the volume of gastric juice and increased the gastric pH, which are similar to those of omeprazole group. In addition, ECQ inhibited the acid output effectively in reflux esophagitis. Significantly increased amounts of malondialdehyde (MDA), myeloperoxidase (MPO) activity and the mucosal depletion of reduced glutathione (GSH) were observed in the reflux esophagitis. ECQ administration attenuated the decrement of the GSH levels and affected the MDA levels and MPO activity. These results suggest that the ECQ has a protective effect which may be attributed to its multiple effects including anti-secretory, anti-oxidative and anti-inflammatory actions on reflux esophagitis in rats.

Short-term Follow-up of Posterior Cruciate Ligament-sacrificed Total Knee Arthroplasty Using a Mobile Polyethylene Insert: Navigation-aided Technique

PURPOSE: Recently, a mobile ultracongruent polyethylene insert was used to increase joint stability in the posterior cruciate ligament sacrificed total knee arthroplasty with non-posted mobile bearing. However, as yet there have been no reports about this implant. In this study, the clinical and radiological results of surgery using the implant were analyzed through a navigation system. MATERIALS AND METHODS: The subjects included 95 cases of 70 patients to whom the rotating tibial implant was applied after posterior cruciate ligament resection among the patients who underwent total knee arthroplasty from September 2006 to December 2008. The follow-up duration was at least 24 months, and 40 months on average. For clinical evaluation, the knee score and functional scores were measured preoperatively and at the time of final follow-up. With reference to a 5 mm joint line change measurement recorded by the navigation system, which can affect the clinical result, the comparison and evaluation were performed by dividing the subjects into group I (5 mm). Radiological evaluation was performed by measuring the angle of the mechanical axis of the lower extremities and the patella tilting angle preoperatively and at the time of final follow-up using plain radiographs. RESULTS: Seventy subjects (95 cases) were followed up for at least 24 months. According to the clinical results, the mean KSS knee score improved from a preoperative score of 43.4 to a final follow-up score of 90.6 (p<0.0001). In addition, the mean functional score improved from a preoperative score of 51 to a final follow-up score of 88.4 (p<0.0001). Finally, the mean joint line change, which can affect the clinical result, was 5.82 mm, ranging from -1 to 12 mm. The clinical and radiological evaluations were performed by dividing the subjects into two groups in relation to the reference value of 5 mm, but no significant difference was found. The mechanical axis angles of the lower extremities improved from the preoperative value of varus 10.01degrees to the final follow-up value of varus 1.89degrees, and the difference was significant (p<0.0001). The mean patella tilting angles were 8.8degrees and 9.3degrees, respectively, at the time before the operation and after the final follow-up; this difference was not significant (p=0.89). CONCLUSION: Good clinical and radiological results were observed after at least two years of follow-up subsequent to total knee arthroplasty, in which a rotating ultracongruent polyethylene insert was applied after posterior cruciate ligament resection using a navigation system.

Surgical Strategies in Patients with the Supplementary Sensorimotor Area Seizure

OBJECTIVE: This study was designed to analyze surgical strategies for patients with intractable supplementary sensorimotor area(SSMA) seizures. METHODS: Seventeen patients who had surgical treatment were reviewed retrospectively. Preoperatively, phase I (non-invasive) and phase II (invasive) evaluation methods for epilepsy surgery were done. Seizure outcome was assessed with Engel's classification. The mean follow-up period was 27.2 months (from 12 months to 54 months). RESULTS: An MRI identified structural abnormality in eight patients and 3D-surface rendering revealed abnormal gyration in three. PET, SPECT, and surface EEG could not delineate the epileptogenic zone. Video-EEG monitoring with a subdural grid or depth electrodes verified the epileptogenic zone in all patients. Surgical procedures consisted of a resection of the SSMA and simultaneous callosotomy in two patients, a resection of the SSMA extending to the adjacent area in seven, a resection of a different area without a SSMA resection in seven, and a callosotomy in one. Seizure outcomes were class I in 11 (65%), class II in five (29%), class III in one (6%). CONCLUSION: In patients with intractable SSMA seizure, surgery was an excellent treatment modality. Precise delineation of the epileptogenic zone based on multimodal diagnostic methods can provide good surgical outcomes without neurological complications.

A case of Intravascular Hemolytic Transfusion Reaction due to Anti-Jkb / 대한수혈학회지

We report a hemolytic transfusion reaction with acute intravascular hemolysis due to anti-Jkb in a 49-year-old woman with uterine myoma. A patient experienced chills, fever, and red color urine following the transfusion of 1.25 units of packed red cells, shown to be compatible by the conventional cross-matching tube method. She had been received two units transfusion 3 weeks ago and there was no transfusion reaction at that time. One day after transfusion, her laboratory data showed total bilirubin 2.7 mg/dL, LDH 2,310 IU/L, and a trace positive direct antiglobulin test. Irregular antibody screening test was negative by the conventional tube methods but anti-Jkb was identified by column agglutination method. The presence of anti-Jkb provided an explanation for the acute hemolytic reaction. The hemolytic transfusion reaction was secondary responses following the previous transfusion. She showed severe hemoglobinuria, but renal failure did not develop and she was fully recovered with maintaining adequate renal output with IV diuretics.

Solitary Plasmacytoma of the Skull: A Case Report

No abstract available.

Sonographic Prediction of Fetal Weight of the Macrosomia and Its Outcome / 대한주산의학회잡지

OBJECTIVE: Our purpose was to assess the efficacy of routine ultrasonographic prediction of macrosomic fetal weight, to determine its influences on subsequent delivery type and to assess perinatal outcome by delivery type. METHODS: The hospital records of 177 patients delivered infants weighing > or =4000gm between January 1997 and December 1998 were reviewed. Statistical comparisons were made between patients in whom fetal macrosomia was predicted before delivery(n=71) and those in whom it was not(n=106) and between the perinatal outcomes for macrosomic fetuses delivered vaginally and by cesarean section. The statistical analysis was performed by student-t test, and Chi-square test and Fisher's exact test. RESULTS: The fetuses were consecutive singleton fetuses in vertex presentation delivered at a single institute. The sensitivity for identifying macrosomic fetus(birth weight >4000gm) with an estimated weight of > or =4000gm was 40%, Overall 60% of the infants had birth weights within 10% of the ultrasonographic estimates and 29% had birth weights within 5% of the ultrasonographic estimates. Cesarean sections were performed in 69% of the 'predicted' group and in 35% of the 'not predicted' group(69% vs 35%, p or =4cm cervical dilatation was similar in the predicted and not predicted groups(19% vs 12%, NS). There was no significant difference in the incidences of the occurrence of birth trauma. CONCLUSION: There appears to be a limitation to obtain estimation of fetal weight by ultrasonography. The antenatal prediction of fetal macrosomia is associated with a marked increase in cesarean deliveries without a significant reduction in the incidence of fetal injury

The Effect of Epidural Anesthesia on Labor Course / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to evaluate the effect of epidural anesthesia on labor course. METHODS: Between January 1998 and December 1998, we evaluated pregnant women at term with singleton fetus in vertex presentation and with spontaneous onset of labor at our hospital. Comparison of 120 women (100 cases of primiparous women, 20 cases of multiparous women) who received epidural anesthesia in labor with 120 women (100 cases of primiparous women, 20 cases of multiparous women) who did not receive epidural anesthesia was performed. Adverse pregnancy outcomes were obtained from hospital delivery records and neonatal records. Statistical analysis were performed by Student's t-test and Chi square test. RESULTS: The results of this study were as followings; 1. There was no significant difference in mean age, body weight, height, and gestational age between epidural anesthesia group and control group (P>0.05). 2. The frequency of oxytocin augmentation was significantly greater in the primiparous epidural anesthetic group than in primiparous control group (p<0.05). 3. The effect of epidural anesthesia on the first stage of labor revealed no significant difference in both group. 4. Prolongation of second stage of labor was noticed in nullipara of epidural anesthesia group compared to control group (p<0.05). 5. The incidence of instrumental delivery was significantly increased in the primiparous epidural group than in the primiparous control group(p<0.05). 6. The meconium-stained amnionic fluid, Apgar score and birth weight were similar in both groups. 7. The maternal blood loss was similar in both groups. CONCLUSION: Epidural anesthesia, significantly prolongs second stage of labor in induced patients. While instrumental delivery was more prevalent in these parturients, C-section rate and intra-partum complications were not increased in these patients.