Biportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis

Biportal endoscopic spinal surgery (BESS) is a minimally invasive spinal surgery, which is basically similar to microscopic spinal surgery in terms of the use of floating technique and technically similar to conventional percutaneous endoscopic spinal surgery in terms of the use of endoscopic or arthroscopic instruments. Using two independent portals (viewing and working) and maintaining a certain distance from the bony and neural structures allow closer access to the target lesion through a panoramic view by free handling of the scope and instruments rather than through a fixed view by docking into the Kambin's triangle. Minimally invasive surgery allows for reduced dissection and inevitable muscle injury, preserving stability and reducing risks of restabilization. The purpose of fusion surgery is the same as that of the three surgical techniques stated above. Its wider range of view helps to overcome limitations of conventional endoscopic spinal surgery and to supplement the weak points of microscopic spinal surgery, such as limited working space in a tubular retractor and difficulty in accessing the contralateral area. This technique provides an alternative to unilateral or bilateral decompression of lumbar central spinal stenosis, foraminal stenosis, low-grade spondylolisthesis, and adjacent segment degeneration. Early clinical outcomes are promising despite potential for complications, such as dural tearing and postoperative epidural hematoma, similar to other procedures. Merits of BESS include decreased postoperative infection rate due to continuous irrigation throughout the procedure and decreased need for fusion surgery for one- or two-level lumbar stenosis by wide sublaminar and foraminal decompression with minimal sacrifice of stabilizing structures.

Changes in Oral Vowel Sounds and Hyoid Bone Movement After Thyroidectomy

OBJECTIVES: Voice and speech alterations after total thyroidectomy may be associated with other extralaryngeal factors, such as neck muscle dysfunction and neck scar contracture. We evaluated the acoustic characteristics of oral vowel sounds and changes in hyoid bone movement before and after thyroidectomy. METHODS: Twenty-nine female patients undergoing total thyroidectomy were included. Fundamental frequencies (Fo), formants and vowel space areas were evaluated before surgery and 7 days and 3 months after surgery to acoustically analyze the oral vowel sounds. Videofluoroscopic images were taken at the same times to evaluate hyoid bone movement. RESULTS: The Fo levels of seven vowels decreased significantly after surgery. The vowel formant changes the F1 of vowel /[e]/ decreased significantly from baseline at 3 months postoperatively, and the F3 of vowel /[i]/ decreased significantly from baseline 7 days postoperatively. The change in the vowel space area was not observed. The Y coordinate of the vowels /[i]/ and /[e]/ decreased significantly from baseline 7 days postoperatively due to changes in hyoid movement. CONCLUSION: The damage to the neck muscles after thyroidectomy changes in Fo, formant and hyoid bone position. These quantitative results could be used as basic data for voice management in patients who undergo thyroidectomy.

Thyroid Hemiagenesis Associated with Papillary Carcinoma

This paper reports a rare case of a left sided thyroid hemiagenesis associated with papillary carcinoma. Thyroid hemiagenesis is a rare congenital anomaly resulted from failure of development on one of the thyroid lobes. Among several thyroid developmental anomalies, hemiagenesis is considered to be the rarest anomaly. In world literature to date, only about 310 cases have been reported. We present a case of thyroid hemiagenesis of the left lobe and isthmus in a 51-year-old female, along with radiological and operative findings. Our report can give the idea that the thyroid hemiagenesis may not influence the development of parathyroid glands.

Z-lengthening of the Achilles Tendon with Transverse Skin Incision

BACKGROUND: The risk of various complications after Achilles tendon lengthening is mainly related to the length of surgical exposure and the lengthening method. A comprehensive technique to minimize the complications is required. METHODS: The treatment of Achilles tendon tightness in 57 patients (95 ankles) were performed by using a short transverse incision on a skin crease of the heel and by Z-lengthening of the tendon. In the severe cases, two or three transverse incisions were required for greater lengthening of the tendon, and a serial cast or Ilizarov apparatus was applied for the gradual correction. The results of these 95 ankles were compared to those of 18 ankles, which underwent percutaneous sliding lengthening, and to the 19 ankles, which received Z-lengthening with a medial longitudinal incision. RESULTS: The functional and cosmetic satisfaction was achieved among those who underwent the tendon lengthening with the new technique. The mean American Orthopaedic Foot & Ankle Society (AOFAS) score improved from 56.1 to 81.8. The second operations to correct recurrence were performed in the two cerebral palsy patients. CONCLUSIONS: The new technique has a low rate of complications such as scarring, adhesion, total transection, excessive lengthening, and recurrence of shortening. The excellent cosmesis and the short operation time are the additional advantages.

Scaphoid Nonunion: Herbert Screw Fixation through Dorsal Approach

PURPOSE: To evaluate the clinical and radiographic outcomes of scaphoid nonunion patients who had treated by open reduction and internal fixation with Herbert screw through dorsal approach. METHODS: We reviewed prospectively a series of 102 consecutive patients with scaphoid nonunion (Mack-Lichtman stage I, II, III). All patients were managed with open reduction with dorsal approach and internal fixation with a Herbert screw and additional K-wires. Exclusion criteria included conservative treatment, percutaneous fixation, scaphoid nonunion advanced collapse wrist. There were 94 male and 8 female with an average age of 28 years (range, 13-65 years). The mean follow period was 35 months (range, 12-96 months). Postoperative radiographs were reviewed to assess the fracture union, carpal alignment, and screw position. Functional results were evaluated by modified Mayo wrist score. RESULTS: Ninety-eight of 102 patients (96.1%) showed radiographic union at an average time of 12.7 weeks. Modified Mayo wrist score was 87.5 points in an average. Ninety-two of 102 patinets (91.3%) showed more than good results. There was no major complications. There was no statistically significant difference between the preoperative and postoperative radiolunate angle, scapholunate angle, or height to length scaphoid ratio. CONCLUSION: Herbert screw fixation through dorsal approach was a reliable method for patients of scaphoid nonuinion to achieve bony union with high functional scores and without major complications.

Management of Meniscal Injury: Repair, Meniscectomy, and Transplantation / 대한정형외과학회잡지

Although total meniscectomy had been performed as a treatment of meniscal tear, many published articles reported progression of the degeneration process and development of the osteoarthritis after meniscectomy. Meniscal repair has been performed increasingly, with the increased knowledge of the biomechanical properties of the meniscus. However, resection of the meniscus is still needed for irreparable tear and should be performed as minimally as possible to maintain the important functions of the meniscus. When substantial meniscal tissue is resected, meniscal allograft transplantation is considered to be a therapeutic option for young active patients to prevent the progress of degenerative change of the cartilage. In this review, indications and outcomes after meniscectomy, meniscal repair, and meniscal transplantation for the treatment of the meniscal injury are discussed.

Malnutrition-Related Fulminant Type 1 Diabetes in a Patient with Sturge-Weber Syndrome

Fulminant type 1 diabetes is a subtype of idiopathic type 1 diabetes and is characterized by a short duration of symptom onset and an absence of anti-islet autoantibodies. It has not been common since first reported in Japan, and only two childhood cases are reported in Korea. Malnutrition-related diabetes is associated with malnutrition and characterized by low body weight and hyperglycemia without ketoacidosis. Here we report a case of malnutrition-related fulminant diabetes in a 15-year-old girl with Sturge-Weber syndrome.

Malnutrition-Related Fulminant Type 1 Diabetes in a Patient with Sturge-Weber Syndrome

Fulminant type 1 diabetes is a subtype of idiopathic type 1 diabetes and is characterized by a short duration of symptom onset and an absence of anti-islet autoantibodies. It has not been common since first reported in Japan, and only two childhood cases are reported in Korea. Malnutrition-related diabetes is associated with malnutrition and characterized by low body weight and hyperglycemia without ketoacidosis. Here we report a case of malnutrition-related fulminant diabetes in a 15-year-old girl with Sturge-Weber syndrome.

Neurodevelopmental Outcomes of VLBW Infants with Diffuse Excessive High Signal Intensity (DEHSI) in the White Matter of the Brain MR Imaging around a Near Term-equivalent Age

PURPOSE: The aim of this study was to investigate the relationship between diffuse excessive high signal intensity (DEHSI) in the white matter of the brain MRI and neurodevelopmental abnormalities in VLBW infants. METHODS: The T1- and T2-weighted MR images of the brain around a near term-equivalent age in 167 VLBW infants were evaluated for the white matter lesions. The presence of DEHSI was determined and classified into four grades on the extent of DEHSI. The relationship between the grade of DEHSI and neurodevelopmental abnormalities was investigated in 94 infants who were assessed for neurodevelopmental outcomes by using a neurologic examination and neurodevelopmental assessment (BSID-II) at 18-24 months of corrected age. RESULTS: DEHSI was the most commonly observed white matter lesion (68.3%) in the MR imaging of the brain around a near term-equivalent age. Gestational age and birth weight tended to increase with increasing grade of DEHSI (P=0.060, P=0.001, respectively). There was no significant relationship between the grade of DEHSI and neurodevelopmental outcomes at 18??4 months of corrected age (P>0.05). Periventricular cysts and ventriculomegaly in the brain MRI were significant risk factors for neurodevelopmental abnormalities (P<0.05). CONCLUSION: DEHSI, most commonly seen in the white matter of the brain MRI around a near term-equivalent age in VLBW infants, did not seem to be related to the neurodevelopmental abnormalities at 18-24 months of corrected age.

Functional and Radiological Results of Intermediate-term Follow Up in MUTARS(R) Tumor Endoprostheses / 대한골관절종양학회지

PURPOSE: This study was designed to verify intermediate-term functional and radiological results of limb salvage operation using endoprosthetic replacement system (MUTARS(R)) used in patients with a malignant bone tumor. MATERIALS AND METHODS: Thirty one cases which used MUTARS(R) tumor prosthesis were reviewed. The mean age of the patients was 49.2 years and the mean follow up was 39.8 months. We retrospectively reviewed complications, and evaluated functionally and radiologically by Enneking functional score, ISOLS radiological implants evaluation system at last follow-up. RESULTS: 3 patients had died of disease, distant metastasis was seen in 4 patients and local recurrence was seen in 1 patients. Complications were developed in 12 patients. (infection 6, leg length discrepancy 2, aseptic loosening 2, periprosthetic femoral fracture 1, screw loosening 1) Mean value of total functional scores were 81.2% in proximal femur, 77.4% in distal femur, 78.1% in proximal tibia, and 80.2% in proximal humerus. The overall radiological result was relatively satisfactory. CONCLUSION: Our results suggest limb salvage with the MUTARS(R) endoprosthesis is successful with good functional and radiological results. But we should be careful with complications such as infection.

The Value of 18-FDG PET CT in Soft Tissue Sarcoma / 대한정형외과학회잡지

PURPOSE: Recently, there have been many attempts to use PET-CT for the diagnosis of metastasis of soft tissue tumors and for differentiating benign tumors from malignant tumors. In this study, we wanted to evaluate the efficacy of 18-FDG PET CT in soft tissue tumors. MATERIALS AND METHODS: Patients (n=64) with suspected malignant soft tissue tumor had 18-FDG PET CT scans. This included 15 cases of benign soft tissue tumor, 34 cases of malignant soft tissue tumor and 15 cases of inflammatory lesions. All patients went through surgical treatment after PET-CT imaging was done, and all dissected tissues were biopsied. For semiquantitive analysis, SUVmax(Maximal standard uptake value) was measured, and SUVmax was determined using ROC analysis, the Kruskal-Wallis test and the Mann-Whitney test. RESULTS: Using 18-FDG PET CT it was possible to differentiate benign from malignant tumor using SUVmax values. But, discrimination between different grades of tumor was not possible. Also discrimination between malignant tumors and inflammatory lesions was not possible. CONCLUSION: PET-CT can be considered as a useful nuclear imaging method that can detect local recurrence and distant metastasis of soft tissue sarcoma and can differentiate benign from malignant tumors. But PET-CT results must be interpreted carefully in diagnoses when there is inflammatory disease or a suspected lesion present.

Staged Revision of Infected Hip Arthroplasty Using an Antibiotics-Loaded Intra-Articular Cement Spacer with Retention of the Stem

PURPOSE: When the femoral stem was well fixed in patients with a deep prosthetic hip infection, the authors performed a two-stage revision procedure using antibiotic-loaded cement spacers (ALCS) without removal of the stem, and the efficacy of this treatment was assessed. MATERIALS AND METHODS: For 12 cases of infected hip arthroplasties, a two-stage procedure was performed, and the patients were followed up for over 2 years. After the acetabular component and head was removed, debridement was done. The molded ALCS was inserted. Revision was then performed after eradication of the infection. The results were analyzed, including the changes in the clinical manifestation, the radiologic findings, the laboratory results, the functional score and the complications. RESULTS: Of all 12 cases, the two-stage revision arthroplasty using an ALCS with retention of the stem was performed in 11 cases (92%), on an average of 66 days (range: 40~152 days). In the 11 revised cases, there was no evidence of recurrence of infection. In the 11 cases, the mean Harris hip score improved from 40.1 points preoperatively to 91.8 points at last the follow-up. The mean WOMAC score improved from 41.8 points preoperatively to 81 points at the last follow-up. The mean Harris hip score was 85.3 points and the WOMAC score was 72.4 points during the ALCS insertion-period. CONCLUSION: For the case of a perioprosthetic hip infection with a well-fixed femoral stem, two-staged revision using an ALCS without stem removal could be an alternative method in terms of effective infection control and preservation of the joint function.

Comparison of the Compression Hip Screw (CHS) and the Proximal Femoral Nail Antirotation (PFNA) for Intertrochanteric Femoral Fracture

PURPOSE: To evaluate the radiologic, clinical results between who had intertrochanteric fracture, treated with Compression Hip Screw (CHS) and Proximal Femoral Nail Antirotation (PFNA). MATERIALS AND METHODS: We retrospectively reviewed each 36 and 48 patients of intertrochanteric fracture which were treated with CHS or PFNA by one surgeon from January 2005 to June 2009. We evaluated mean operation time, amount of bleeding, radiologic results, and the clinical outcomes with the mobility score of Parker and Palmer, social function scoring system. RESULTS: The mean operation time, amount of bleeding were less in the PFNA group, there were 116.7 min, 486.1 ml for the CHS group versus 87.7 min, 289.6 ml for the PFNA group. The radiologic results were not significantly different. Decrease of mobility score of Parker and Palmer, social function score were similar. Proximal migration of leg screw and perforation of femoral head was 2 case and deep infection was 1 cases in CHS group. CONCLUSION: There were no significant differences that are clinical and radiological results in treatment of intertrochanteric fracture using the CHS and PFNA. But PFNA is less invasive device than CHS, therefore it may be useful device in elderly patients.

A Case of Intestinal Duplication Cyst Identified as Pathological Lead Point in a Child with Recurrent Intussusception / 대한소아소화기영양학회지

Intestinal duplication cysts are characterized by the attachment to some part of the gastrointestinal tract with which a blood supply is shared, and have an epithelial lining resembling some part of the alimentary tract. A 15-month-old female was admitted to our hospital with cyclic irritability, vomiting, and blood-tinged stool. The results of an ultrasound showed an ileocolic intussusception and a 1.3 cm cystic mass had double-wall sign and a Y-configuration with an adjacent ileal loop. She had a past history of two ileocolic intussusceptions. The cystic mass was considered to be a pathologic lead point, so resection and end-to-end anastomosis was performed. The gross and histologic evaluation of the specimen demonstrated a 2.4x2.4 cm cystic mass containing yellow mucoid fluid and the cyst wall was lined with intestinal and gastric mucosa and enclosed by a layer of muscle, which was shared with the adjacent ileum.

Congenital Insensitivity to Pain and Anhidrosis Masquerading as a Chronic Osteomyelitis of the Talus: A Case Report / 대한족부족관절학회지

We experienced a case of congenital insensitivity to pain with anhidrosis mimicking a chronic osteomyelitis of the talus, with recurrent ankle swelling and intermittent fever. He was misdiagnosed as low virulence osteomyelitis at other hospital in annual recurrence for 3 years. A Charcot joint in children is a very rare condition and diagnosis should be made in a careful approach.

Fracture of Os Peroneum with Rupture of the Peroneus Longus Tendon: A Case Report / 대한족부족관절학회지

We report a rare case of painful Os peroneum syndrome (POPS) of 54 year-old man who had suffered from chronic pain on lateral foot after varus ankle injury and been treated successfully with surgical excision of the fractured Os peroneum and repair of ruptured peroneus longus tendon at a same time.

The Internal Diameter of the Radius and Ulna in Korean Children / 대한정형외과학회잡지

PURPOSE: Flexible intramedullary nailing is a advanced method for treating forearm fractures with fewer complications. But sometimes these nails should not be used due to the narrower internal diameter of the forearm bones. We studied the inner diameter of the radius and ulna of children along with their age in relation to the width of the nail. MATERIALS AND METHODS: We reviewed the forearm AP radiographs of all the patients who visited our institute during a specific period, in which their age was between 6 and 19. We measured the inner diameters of the radius and ulna at their narrowest location, and we analyzed the diameter in relation to the patients' age groups, and we compared this data with the width for the nail. RESULTS: A total of 208 patients was included in this study. The inner diameter grew with their increasing age, and the younger the patients, the higher was the rate of inappropriate use of the nail. On linear regression analysis, the age plus or minus 1 SD for usage of the ready-made nail was 12.6 years-old for the male radius. CONCLUSION: The nail was sometimes too thick for the diameter of the forearm bones of Korean children. It is correct for the surgeon to select whatever material to fix the fracture, but appropriate thickness of the nail should be selected thoughtfully in preoperative planning.

Hydrogen Peroxide Producing Lactobacilli in Women with Cervical Neoplasia / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: It is well known that human papillomavirus (HPV) is the main cause of cervical neoplasia, and hydrogen peroxide-producing lactobacilli are the most important microorganisms for maintaining the balance of the vaginal ecosystem. The purpose of our study was to investigate the relationship of hydrogen peroxide-producing lactobacilli, cervical neoplasia and high-risk HPV. MATERIALS AND METHODS: We enrolled 1138 women with abnormal cervical smears or cervicograms who were referred to the department of Obstetrics and Gynecology at Chonnam National University Medical School. In all of them, 1,138 vaginal swabs were collected for the qualitative assay of hydrogen peroxide producing lactobacilli and 150 cervical swabs were used for the HPV hybrid capture II test without regard to the subjects' pregnancy status. In the non-pregnant women, 880 cervical biopsies and/or loop electrosurgical excision procedures were performed for making the histological diagnosis. RESULTS: There was no significant difference not only between the distribution of H2O2 producing lactobacilli and the cervical histology, but also between the distribution of H2O2 producing lactobacilli and the positivity for high-risk HPV. CONCLUSIONS: Both cervical neoplasia and high-risk HPV may not be influenced by the existence of hydrogen peroxide producing lactobacilli in the vagina.

Study of Bacterial Distribution on the Skin of Psoriasis by Tape Method / 대한피부과학회지

BACKGROUND: Psoriasis is one of the relatively common chronic relapsing cutaneous disorders. The etiology and pathogenesis of the psoriatic skin lesion are still unknown. A colonization of microbacterial organisms especially Staphylococcus aureus (S. aureus) have been considered as a factor for development and exacerbation of psoriatic skin lesion. OBJECTIVES: The purpose of this study was to observe the bacteria on the skin of the patients with psoriasis and healthy normal persons, and evaluate the relations between bacterial density, S. aureus colonization, and severity of psoriatic skin lesions. MATERIALS & METHODS: Twenty two psoriasis patients and 25 healthy normal persons were involved for this study. Psoriasis patients were classified according to a severity estimated by PASI (Psoriasis Area and Severity Index) and activity of psoriatic skin lesions. Microbial sampling by tape method (3M, 5x5 cm) were performed on the psoriatic skin lesion and uninvolved skin in the patients of psoriasis, and on the inner forearm of the normal healthy person. Microbial sampling by a swab were also carried out from nasal mucosa. The tapes were gently contacted on the blood agar plate, and cultured in aerobic condition(30 degrees C) during 2-5 days and the numbers of colony forming unit (CFU) were estimated. RESULTS: The results were as follows; Total numbers of CFU in the lesion and uninvolved skin of psoriasis patients were significantly higher than those of the healthy controls (p0.05). The activity of psoriasis was relatively correlated with PASI score and total number of CFU (p0.05). There was a significant correlation between the numbers of S. aureus on the lesional and uninvolved skin and that on the nasal mucosa. (p<0.05). CONCLUSION: This study demonstrates that bacterial density is significantly higher on the psoriatic skin lesions, which suggests that bacterial colonization on the skin has a role in the development and exacerbation of the psoriatic lesion.

A Case of Schwannoma of the Trachea / 대한이비인후과학회지

Schwannoma is a distinct subset of peripheral nerve sheath tumor distinguished by unique histologic and immunohistochemical features. Tracheal schwannomas are among the rarest of tracheal tumors. The surgical approach to such tumors has been debated. We report a case of a primary tracheal schwannoma causing airway obstruction in a 52-year-old woman. Computerized tomography demonstrated an intraluminal growing mass in the trachea. Tracheofissure was performed to remove the mass. Histologic analysis revealed a benign neurogenic tumor of Schwann cell. We plan to follow up and examine the patient very carefully for the possibility of recurrence.