Partial Stapled Hemorrhoidopexy Versus Circular Stapled Hemorrhoidopexy

No abstract available.

A case of Larsen syndrome / 대한산부인과학회지

Larsen syndrome is a rare congenital skeletal malformation (1 in 100,000 births) caused by a generalized mesenchymal connective tissue disorder. This disorder leads to a broad spectrum of anomalies. Major diagnostic criteria are multiple dislocations of large joints (especially knees), short metacarpals with cylindrical nontapering fingers and craniofacial abnormalities. Clinical variations range from mild clinical expression to lethal forms. Sporadic occurrence as well as autosomal dorminant and recessive inheritance are described.

Asynchronous bilateral adnexal torsion in a 16 year old female: A successful conservative treatment by laparoscopic surgery / 대한산부인과학회지

Adnexal torsion is a disease occurring mostly in young fertile women that causes severe pain with necrosis of the adnexa requiring an emergency surgery. Because the symptoms and physical findings are similar to emergency diseases of adjacent organs such as appendicitis, diagnosis of adnexal torsion could be confused. Delayed diagnosis leads to delayed operation and for that reason adnexectomy is done more often than conservative management. Since prompt diagnosis is the sole way for preservation of the ovary and the salpinx, early diagnosis of adnexal torsion is essential. We experienced a case of a 16 year old female with torsion of the right adnexa who had the left adnexa previously removed due to torsion of the left adnexa. The case is presented with review of the literature.

Circular Stapled Hemorrhoidectomies in the Treatment of Hemorrhoids

The circular stapled hemorrhoidectomy is a new treatment modality for hemorrhoids requiring surgical management. This study reviews the available information concerning the present results of this procedure. A medline search and a review of the literature wene conducted to identify available information on the procedure, with a special attention being given to on-going or published randomized clinical trials. The advantages of circular stapled hemorrhoidectomy were analyzed based on different areas of concern, including postoperative pain, operating time, duration of hospital stay and recovery of normal activity, postoperative wound care, and types and rates of complications. Continence status and patient satisfaction following a circular stapled hemorrhoidectomy are also reported. The circular stapled hemorrhoidectomy is safe, easy to perform, and effective in the treatment of advanced hemorrhoids with an external mucosal prolapse. Other advantages include minimal postoperative complications, easier postoperative management, and a shorter time to return to work congenial to a conventional hemorrhoidectomy. Despite the higher cost and difficult access, this study confirms the feasibility of using a circular stapled hemorrhoidectomy in the treatment of hemorrhoids. The circular stapled hemorrhoidectomy is a promising new option in the treatment of all patients eligible for a surgical approach. A longer follow-up is required to confirm the true efficacy of this surgical method.

The Effect of Subacromial Bursa Injection of Hyaluronate in Patients with Adhesive Capsulitis of Shoulder Joint: Multicenter, Prospective Study

OBJECTIVE: The goal of this study is to investigate the effect of subacromial bursa injection of hyaluronate in patients with adhesive capsulitis of shoulder. METHOD: Fifty nine patients with adhesive capsulitis of shoulder were injected with hyaluronate (Hyruan , LG chemical) 2.5 ml to subacromial bursa once a week for 5 weeks and randomly selected twenty eight patients among them were injected with Depomedrol 20 mg only at first week. The effect of hyaluronate injection was evaluated by pain (Visaul analogue scale), night pain, range of motion of shoulder, functional activities of daily living and patient's self satisfaction at preinjection, every week after first injection until 5th week, 8th and 12th week. RESULTS: Visual analogue scale and night pain were significantly decreased at 5th and 12th week compared with preinjection status. The range of motion of shoulder and functional activities of daily living significantly improved at 5th week and 12th week. Eighty eight percent (N=52) of patients reported as a little improved, improved or much improved at 5th week. No significant serious side effect of injection was found until 12th week. CONCLUSION: Hyaluronate injection into subacromial bursa decreased pain and improved shoulder range of motion. It also improved functional activities of daily living of patients with adhesive capsulitis. So it is effective and safe for those patients, especially who cannot receive corticosteroid intra articular injection.

Identification of Functionally Different Rat IgE in RBL-2H3 Exocytosis

BACKGROUND: IgE is closely related to the development of allergies. However, the poor relationship between the specific IgE level and the severity of allergic diseases suggests the possibility of functionally different IgE isoforms. With this in mind, rat basophilic leukemia (RBL)-2H3 activation was analyzed with each type of rat IgE for two parameters, exocytosis and IL-4 mRNA production. RBL-2H3 has been well documented in the rat mucosal mast cell line. METHODS: RBL-2H3 cells sensitized with each kind of rat IgE was activated by cross-linking FcRI with B5 (monoclonal anti-rat IgE mouse IgG antibodies). The RBL-2H3 exocytosis was measured by analyzing the beta-hexosaminidase level, and the level of IL-4 mRNA synthesis was analyzed using semi- quantitative RT-PCR. Rat IgE, which was produced by a parasite infection (REP), was prepared using either Paragonimus westermani metacercariae (REP-PW) or Anisakis simplex third stage larvae (REP-AS). A rat IgE prototype of IR162 was prepared by a peritoneal injection of immunocytoma. RESULTS: The level of exocytosis showed a linear relationship with the rat IgE concentration when REP-PW or REP-AS was applied. However, it exhibited a biphasic response with IR162. In addition, the time course of heating at 56oC illustrated the similarity between REP-PW and REP-AS, which differed from that of IR162. In contrast, the level of IL-4 mRNA synthesis in the RBL-2H3 cells with IR162 was comparable to that of either REP-PW or REP-AS. CONCLUSION: These results suggest that functionally different rat IgE isoforms exists in RBL-2H3 exocytosis.

Rifabutin susceptibility and rpoB gene mutations in multi-drug resistant mycobacterium tuberculosis / 결핵

BACKGROUND: Following several decades of decline, the incidence of tuberculosis has recently begun to increase in many countries and the control of this disease has been impeded by the emergence of multi-drug resistant tuberculosis (MDR-TB). The development of rapid diagnostic methods and effective new drugs are needed to control MDR-TB. One of the new drugs for MDR-TB is rifabutin (RBU) which has been known to be effective in some patients with MDR-TB. A few reports showed that some types of mutaitions of the rpoB gene, which were known to be present in 96-98% of rifampicin-resistant M. tuberculosis, were associated with the rifampicin-resistant but RBU-susceptible phenotype. This study was performed to investigate the correlation between RBU susceptibility and the patterns of rpoB gene mutations in Korean MDR-TB. METHODS: Sixty-five clinical isolates of multi-drug resistant Mycobacterium tuberculosis, gathered from patients two visited the Asan Medical Center from July 1997 to June 1999, were investigated. Clinical responses to rifabutin-containing regimen were evaluated. An RBU susceptibility test and sequencing analysis of rpoB gene were performed, and the result were analyzed to confirm which mutations correlated with RBU-susceptible MDR-TB. RESULTS: Fifty-three of 56 (95%) clinical isolates of MDR-TB had 60 mutations of the rpoB gene. The most frequent mutations were found at codon 531 (43%), and two mutations were combined in seven clinical isolates. Five of 53 (10%) clinical isolates showed the RBU-susceptible phenotype, and in them the characteristic patterns of point mutations were found at codon 509, 516, and 526. CONCLUSION: The frequency and pattern of mutations of the rpoB gene of Korean MDR-Tb isolates were similar to those in western countries, where the prevalence of tuberculosis is low, but some show RBU-susceptible phenotypes. RBU-susceptible MDR-TB isolates showed the characteristic pattern of mutations of the rpoB gene which could be used to rapidly diagnose RBU susceptibility.

Arthroscopic Evaluation for Acute Traumatic Anterior Dislocation of the Shoulder / 대한정형외과학회잡지

There are many complications after traumatic shoulder dislocation including redislocation, dislocation capsulitis especially in the older age and dislocation arthropathy. Redislocation rates have been primarily related to age at the time of initial dislocation, to lesser degree, athletic participation, length of immobilization, rehabilitative exercises, and time hefore return to sports or full activity. So we wanted to confirm the difference of the lesion between the young and the old at the initial dislocation. Arthroscopic evaluation of the twelve patients with an acute traumatic anterior dislocation of the shoulder was done to identify the intraarticular pathology within 10 days of the initial injury. All patients were taken MRI and evaluated under anesthesia. We classified these shoulders into two groups based on the age of patient. Young agegroup under 30 were seven patients and old age-group over 40 were five patients. And the following results were ohtained; 1. The detachment of the anterior labrum with the inferior glenohumeral ligament from the glenoid rim was primary finding and might cause the shoulder unstable under anesthesia in the young age-group under 30. 2. In the age-group over 40, there were the capsular tears with no labral lesion and these shoulders were stable under anesthesia 3. In acute traumatic anterior dislocation, examination under anesthesia was more closely related to the prediction of the extent of labro-ligamental detachment than MRI examination. 4. We believe that arthroscopic surgical intervention after the initial shoulder dislocation should be considered as a treatment option

Magnetic Resonance Arthrography in the evaluation of Anterior Glenohumeral Instability / 대한정형외과학회잡지

Anterior glenohumeral instability is mainly due to the Bankart lesion and capsular stretch. The differentiation between the Bankart lesion and capsular laxity may not be readily apparent on clinical examination. So, increasing attention has been directed toward preoperative evaluation of the labral lesion and capsular laxity. MRI and MR Arthrogram of 55 shoulders, 40 stable shoulders and 15 unstable shoulders that were confirmed by arthroscopic surgery, were reviewed to evaluate the labral and capsular shapes, especially the lesions of labroligamentous complex. To evaluate and compare the capsular laxity, we measured the anterior capsular insertion type, capsular ballooning, capsular insertion angle and anterior band of inferior glenohumeral ligament. And the following results were obtained; 1) The shape of anterior labrum was varied in the superior, middle and inferior potions in 40 stable shoulders. The anterior labral lesions were shown as torn(eight cases), displaced(six cases) and no detectable labrum(one case), in 15 unstable shoulders. Also, there were a significant di fference in the evaluation of the anteior labrum shape between MRI and MR arthrography. 2) There were not a significant difference in the type III capsular insertion type, capsular ballooning and capsular insertion angle between the stable and unstable shoulders. However, it was found that the shape of the anterior band of the inferior glenohumeral ligament had definite difference between the two groups. And so, more experience and attention should be given for the accurate preoperative evaluation of the anterior labroligamentous complex in shoulder instability.

Treatment of Fracture of the Tibial Intercondylar Eminence with Arthroscopic Pull-Out Suture

The purpose of this study is to demonstrate the effectiveness of arthrocopic treatment for the avulsion fracture of intercondylar eminence of the tibia and of the technique of arthroscopically assisted reduction and fixation through pull-out suture method. Between January 1995 and May 1997, three patients were underwent arthroscopic reduction and suture fixation for type 0 of avulsion fracture of intercondylar eminence of tibia and were followed up. The result of two patients were graded as normal and one as nearly normal by the criteria of the International Knee Documentation Committee(IKDC) rating scale. The advantages of this technique include no retained hardware and ability to treat comminuted fracture(type g ). We describe technique of arthroscopic reduction and suture fixasion for displaced avulsion fractures, including those with comminution of intercondylar eminence of tibia.

Press-Fit Condylar Total Knee Arthroplasty / 대한정형외과학회잡지

The goal of total knee replacement is to relieve pain, to stabilize joint movement and to correct deformity. It is indicated for patients with rheumatoid arthritis, osteoarthritis and severe post-traumatic arthritis. The author analyzed 71 patients(106 cases), who received the PFC type of total knee replacement from August 1992 and the results were as follows; 1. Among the 71 patients, male was 8 patients and female was 63 patients whose average age was 56 years and average follow up period was 24 months, ranged from 8 months to 3 years 8 months. 2. Rheumatoid arthritis was the most common cause with 31 patients(56 cases) followed by osteoarthritis with 39 patients(49 cases). There was also one patient(1 case) that showed bony union of the knee due to old tuberculosis. The average duration of the illness was 12 years and the average weight of the patients was 57.7kg. 3. Flexion contracture decreased from an average of 21 degrees to 5 degrees after the operation. The range of motion increased from an average of 92 degrees before the operation to 117 degrees afterwards in cases of rheumatoid arthritis and decreased slightly from 108 degrees to 106 degrees in cases of osteoarthritis. 4. The tibiofemoral angle was corrected from an average 1.5 degrees varus before the operation to an average 6.7 degrees valgus after operation. Eighty seven percent of patients with rheumatoid arthritis showed valgus deformity and seventy eight percent of degenerative osteoarthritis patients showed varus deformity preoperatively. 5. Radiographically, the joint line position shifted an average 2.3mm in rheumatoid arthritis and an average 0.3mm in osteoarthritis. The component position, the femoral flexion was an average 89.6 degrees in the anteroposterior view, an average 87 degrees in the lateral view. 6. The thickness of the patella measured in the operating room of 61 cases was an average 21mm and after resection of patella, the remaining bone measured an average of 13.6mm. 7. To achieve soft tissue balance, 29 patients(33 cases) underwent medial stripping and 23 patients(30 cases) had patella lateral release. 8. The Insall Knee Rating Score was used to evaluate the results. The results were 69 cases excellent, 33 cases good, 3 fair and 1 poor. Ninety two percent of the patients had good or excellent results in average 24 months follow-up. 9. The complications consisted of one case of delayed deep infection, one case of patellar subluxation and one case of supracondylar fracture of the femur.

Liposarcoma which occured in the extremities / 대한정형외과학회잡지

No abstract available.