Increased Prevalence of Ossification of Posterior Longitudinal Ligament and Increased Bone Mineral Density in Patients with Ossification of Nuchal Ligament

OBJECTIVE: There are also few studies demonstrating the relationship between ossification of nuchal ligament (ONL) and ossification of posterior longitudinal ligament (OPLL). We compared the prevalence, location, and type of OPLL between patients with ONL and matched patients without ONL.We also compared the bone mineral densities (BMDs) between the 2 groups. METHODS: total of 124 cervical ONL patients were enrolled in this study. The control group of 124 patients was matched with 124 patients with ONL by age and sex on a 1:1 basis to minimize confounding factors. We reviewed the prevalence, location, and type of OPLL in both groups. RESULTS: The prevalence of OPLL was almost 2.5 times greater in patients with ONL than those without ONL. The mean value of BMD in patients with ONL was greater at the lumbar spine (L1-L4) than in patients without ONL. The mean T score of the lumbar spine was 0.25±1.68 in the patients with ONL and -0.73±1.64 in the patients without ONL. CONCLUSION: The prevalence of OPLL in patients with ONL was significantly higher than in patients without ONL. Because ONL is innocuous and may be seen more readily than OPLL on simple cervical radiographs, clinicians should consider the possibility of coexisting OPLL when ONL, especially extensive ONL, is detected in patients with neck pain, radiculopathy, or myelopathy, to facilitate proper treatment.

Cerebral Infarction Presenting with Unilateral Isolated Foot Drop

Weakness of the dorsiflexor muscles of the ankle or toe, referred to as foot drop, is a relatively common presentation. In most cases, foot drop is caused by a lower motor neuron disease such as peroneal peripheral neuropathy, L4-5 radiculopathic sciatic neuropathy, or polyneuropathy. Although upper motor neuron lesions can present as foot drop, the incidence is very rare. Here, we report an extremely rare case in which foot drop was the only presenting symptom of cerebral infarction.

Anterolateral Thigh Flap for 1st Web Contracture Release

PURPOSE: First web space contracture of the hand has been treated with various surgical techniques such as Z-plasty, local flap, pedicled flap, distant free flap, and anterolateral thigh free flap. Among those surgical techniques, anterolateral thigh free flap provide a thin and pliable flap, which is a useful method for correction of first web space contracture. METHODS: From August 2003 to September 2007, the authors selected 9 patients who had first web space contracture with limitation of thumb abduction within 30 degrees. All of patients had received first web contracture release with anterolateral thigh free flap. Age ranged from 24 to 51, and all the patients were male. Average follow up period was 12 months and the authors performed photographic analysis of the thumb abduction angle of postoperative increase. RESULTS: All the flaps were survived. Donor site was closed with primary closure in 8 cases and covered with split-thickness skin graft in 1 case. Average flap size was 8x9cm and average thickness was 0.6cm in suprafascial flap. The procedure resulted in increased thumb abduction angle of 34.7degrees in average and showed concave shape of first web space in suprafascial flap. Additional operations were performed with Z-plasty in 3 cases, local flap in 5 cases, and opponensplasty in 3 cases. CONCLUSION: In suprafascial flap, we obtained relatively thin flap thickness and were able to make natural concave shape of first web space. In releasing severe contracture of the first web space, anterolateral thigh free flap provided a good coverage of appropriate thickness and pliable soft tissue and allowed limited donor site morbidity.

Reconstruction of Hand using Anterolateral Thigh Fascial Free Flap

PURPOSE: The provision of thin and pliable tissue and the adequate coverage of tendon-gliding surface is necessary for a soft tissue defect of the hand with exposure of bone, tendon and muscle. This report discusses our experience with anterolateral thigh fascial free flap for the reconstruction of the soft tissue defect of the hand. METHODS: From February 2004 to August 2008, seven patients with full-thickness soft tissue defects in the hand were reconstructed by means of a composite anterolateral thigh fascial free flap. There were soft tissue defects associated with trauma(n=5), scar contracture(n=1) and necrosis due to ischemia(n=1). The flaps were harvested from the anterolateral thigh as adipofascial flaps with only a small sheet of fascia and fatty tissue above it. The fascia and the skin of the donor site was closed directly and delayed split-thickness skin graft was performed. RESULTS: All flaps survived completely. The size of the transferred flap ranged from 2x4cm to 5x8cm. Thin flap coverage was possible without secondary debulking operations. It left minimal donor site morbidity with a linear scar. In one case, the thigh muscle herniation in the donor site was developed. CONCLUSION: The anterolateral thigh fascial free flap provided thin and pliable tissue which can establish a tendon-gliding mechanism, minimal bulk and minimal donor site morbidity. The disadvantages of this technique were the needs for a skin graft and the muscle herniation in donor site.

A case of Intrapartum Subcutaneous Emphysema After Spontaneous Vaginal Delivery with Vacuum Extraction / 대한주산의학회잡지

A 30-year-old primipara at 41 weeks gestation was admitted with regular labor pain and delivered a healthy male infant without complications except for a 4th degree tear of perineum. Two hours after delivery, she complained of sore throat and developed mild swelling of left side face, neck and upper chest. A chest radiography showed mild subcutaneous emphysema of neck. There was no pneumomediastinum and pneumothorax. She was managed conservatively and discharged without any complication at the 6th postpartum day. We report a rare case of subcutaneous emphysema with a brief review of literatures that presented shortly after vaginal delivery without complications except for a 4th degree perineal tear and resolved without special treatment.

A Case of Fibroepithelial Polyp of Vulva / 대한산부인과학회잡지

Fibroepithelial polyp is a very rare tumor mostly arising at the urogenitalia. Norris and Taylor firstly reported 12 cases of fibroepithelial polyp in 19661 and until recently under 100 cases were reported in literature. A 11-year-old girl complainted the painless bulging mass at the left labium major. The bulging tumor was measured 5x3 cm in diameter. The margin of the mass was not demarcated ever from the skin and underlying dermis and the mass was not clearly differentiated from surrounding tissues grossly but could be delineated by palpation. The mass was excised by palpation under the general anesthesia. In microscopic finding it was primarily composed of stromal portion containing fibroblast-like stromal cells, with bundles of collagen, skin appendages, and small numbers of blood vessels. We report a case of fibroepithelial polyp of the vulva in a 11-year-old female with a brief review of the literature.

Transverse Vaginal Septum: Difficult Management Concerning Postoperative Stricture: Report of 2 Cases / 대한산부인과학회잡지

Two cases of incomplete transverse vaginal septum with a small opening in the upper third of vagina were presented. One case was a patient presenting at 31 years of age for evaluation of primary infertility and oligomenorrhea. Diagnosis was made by hysterosalpingography, tranvaginal ultrasonography, MRI, and diagnostic pelviscopy for evaluation of abnormality of endopelvic organs. The patient was treated with surgical resection of septum (simple septectomy). Examination 3 months later demonstrated narrowing of the vaginal lumen. Another case was a patient presenting intrauterine pregnancy at 8 weeks and 2 days accompanying transverse vaginal septum with small opening. She had previous septotomy history and presented postoperative scarring. She had septectomy and anastomosis of the mucosa, and presented postoperative narrowing again about a month postoperatively. In this report we describe the two cases of transverse vaginal septum. We also reviewed the literature including diagnostic and treatment guidelines. Prevention of postoperative scarring is the most important factor in management of transverse vaginal septum. For that, first of all, initial septectomy should be done with approximation of the mucosa and postoperative dilatation is necessary. Importance of the initial accurate septectomy is too important to be over-emphasized.

The Changes of Skin Temperature and Sympathetic Skin Response after Thoracic Sympathectomy in Patients with Palmar Hyperhidrosis

OBJECTIVE: The purposes of these study were to evaluate the changes of temperature and sympathetic skin response (SSR) before and after sympathectomy in patients with palmar hyperhidrosis and to quantify long standing effect of sympathectomy. METHOD: The SSR and skin temperature were measured before, one day and 30 days after thoracoscopic sympathectomy. SSR was recorded from palm and sole bilaterally. Temperature was recorded on 9 sites of each hand and 11 site of each sole. Patient's satisfaction with operation was assessed by 10-point scale. RESULTS: One day after sympathectomy, the amplitude of SSR was significantly decreased and latency of SSR was delayed in all cases on bilateral palm and sole. However, after sympathectomy 30 days, the amplitude of SSR was normalized in all cases on bilateral sole. All patients who had undergone sympathectomy showed significant clinical improvement. The temperature increased dramatically over 3degrees C on postoperation 1 day and maintained 1.72degrees C higher in post-operation 30 days than pre-operation on both hands. There was no significant difference of temperature among pre-operation and post-operation 1 day and post-operation 30 days on sole. CONCLUSION: Our study proved effect of thoracoscopic sympathectomy to the patients with palmar hyperhidrosis objectively and quantified the decrement of sympathetic tone. Further study is needed for long term follow up over 2 months or more.

Evaluation of Foot Deformity according to the Occupational Condition in the Labor of the Industry

OBJECTIVE: The purpose of this study was to evaluate the correlation between each variable on occupational condition and foot deformity by Harris mat footprint. METHOD: Subjects were 227 labors having no neurologic or musculoskeletal problems. They were evaluated by clinical history and Harris mat footprint. Three optional parameters of footprints were medial arch angle, metatatarsal arch grade, and hallux valgus angle. RESULTS: 1) Hallux valgus angles were significantly increased in group of female, above 39 years old, labor, and duration of duty more than 6 years. 2) Medial arch angles were significantly decreased in female, above 39 years old, obese person, and labor. 3) Metatarsal arch grades were significantly increased in group of female, above 39 years old, and more than 20 numbers of conveyance, less than 6 years of duration of duty. Foot pain was not related to medial arch angle, metatatarsal arch grade, and hallux valgus angle, respectively. CONCLUSION: These results suggest that deformity of foot were related to female, above 39 years old, obese person, position of duty, duration of duty, and standing time. So these peoples maybe helpful for weaning proper modified shoes.

Evaluation of Peripheral Polyneuropathy in Patients with Diabetes Mellitus Using Quantitative Sensory Test

OBJECTIVE: The purpose of this study was to determine whether quantitative sensory test can be used as a screening test of peripheral polyneuropathy in patients with diabetes mellitus, and to evaluate the severity of peripheral polyneuropathy in patients with diabetes mellitus using quantitative sensory test. METHOD: We performed nerve conduction study to right upper and left lower extremity of the patients. Quantitative sensory test was performed using TSA-2001 thermal sensory analyser on right thenar and left foot dorsum in both diabetic and control groups. RESULTS: 1) The warm sense and heat pain threshold were higher, the cold sense and cold pain threshold were lower in diabetic group than age-matched control group (p<0.05). 2) The warm sense and heat pain threshold were higher, the cold sense and cold pain threshold were lower in diabetic group than young-aged control group (p<0.05). 3) As nerve conduction study results were severe, the cold sense threshold in right thenar were decreased (p<0.05). CONCLUSION: Quantitative sensory study in patients with diabetes mellitus are sensitive to identify neuropathic change; thus, they would be used as the screening method of diabetic peripheral polyneuropathy.

Vaginal removal of mature cystic teratoma in postmenopausal woman / 영남의대학술지

Mature cystic teratomas, commonly called dermoid cysts, are the most common benign germ cell tumors of ovary in women of reproductive age. Mature cystic teratoma that constitutes 10-25% of ovarian tumors and 95% of teratoma, is germ cell tumor of the ovary. This occurs frequently in women less than 20 years old, but it can be found upto 10-20% in postmenopausal women. And in women over the age of 50, a mature cystic teratoma is likely to change into malignant form. Traditional surgical methods of mature cystic teratoma treatment include transabdominal cystectomy, oophorectomy, hysterectomy and(or) bilateral salphingooophorectomy. Recently laparoscopic approach replaces transabdominal surgeries in many cases. Vaginal removal of mature cystic teratoma is unique and rare. Compared with laparotomy, transvaginal approach is characterized by shorter hospital stay and lower morbidity rate. Compared with laparoscopic operation, transvaginal approach has advantages of no visible operative scar and lower intra-operative tumor spillage. The decision for surgical methods is related with patients' situations and surgeon's preference. We report 1 case of vaginal removal of mature cystic teratoma as a part of vaginal hysterectomy in old age patient.

Diagnosis of Osteoporosis of the Foot in Patients with Diabetes Mellitus Using Bone Densitometry

OBJECTIVE: The purpose of this study was to evaluate the severity and frequency of osteoporosis of the foot in patients with diabetes mellitus using bone densitometry, and to determine whether plain radiologic evaluation can be used as a cheap and reliable screening of osteoporosis. METHOD: We studied plain X-ray including AP and lateral views of the feet of the patients. Bone densitometry studies were performed on the feet of both diabetic and age-matched control groups. RESULTS: Forefoot bone densitometry scores were significantly lower in the male diabetic group compared to the control group (p<0.05). Furthermore, the female diabetics had significantly lower bone densitometry scores for forefoot and hindfoot than the control group (p<0.05). Bone densitometric evaluation of the diabetic patients' feet revealed scores significantly lower than those of the controls in cases which the radiologist interpreted as normal finding in plain roentgenogram alone (p<0.05). CONCLUSION: Plain radiologic studies of the feet in patients with diabetes mellitus are not effective in identifying osteoporotic change; thus, they should not be used as the screening method of diabetic foot lesions.

Correlation between P300 Latency and Cognitive Capacity Screening Examination in Patients with Brain Lesion

OBJECTIVE: To verify the correlation between auditory event-related potential and Cognitive Capacity Screening Examination (CCSE) in patients with brain lesion. METHOD: P300 study using an auditory paradigm was performed in thirty patients with brain lesion, age ranged from thirteen to seventy-three years-old, and then was compared with the score of CCSE. RESULTS: The mean latency of P300 was 383.07+/-50.63 msec. The mean score of CCSE was 17.10+/-8.62. There was no significant difference in P300 latency and score of CCSE between male and female, and among the types of brain lesion. There was significant negative correlation between P300 latency and score of CCSE (p<0.05, r= 0.686), between score of CCSE and age (p<0.05, r= 0.364). There was significantly high intra-rater reliability in P300 latency study (alpha=0.9771). CONCLUSION: We conclude that P300 electrodiagnostic study is useful for reflection of cognitive function in patients with brain lesion.

Factors Influencing Activities of Daily Living in the Patients with Spinal Cord Injury

OBJECTIVE: The purpose of this study was to obtain and access baseline data and factors influencing activities of daily living(ADL) in the patients with spinal cord injury(SCI). METHOD: 65 complete SCI patients who were admitted to the Wonju Christian and Severance hospital from January 1990 to february 1998 were studied. A questionnaire contained 15 items of ADL and factors such as cause, level, age and sex distribution, duration, employment status, religious status, medical payment, income source and complications. We compared each level of SCI according to each variables. RESULTS: The income source and employment status were associated with adjustment of ADL in patients with SCI. CONCLUSION: Financial independence was the most important factor to improve adjustment of ADL in patients with SCI.

A Diagnostic Significance of Simple X-ray Examination for Children's Flatfoot in Footprint

OBJECTIVE: The purpose of this study was to evaluate the difference for each variable on plain radiologic study of the foot between weighted and non-weighted routine plain anterior-posterior and lateral views in flatfoot children diagnosed by Harris mat footprint. METHOD: Both feet of thirty-four children over two-year old, who had been diagnosed as flatfooted by modified Rose' classification using Harris mat footprint were included. We studied plain roentgenogram images, including anterior-posterior and lateral views, in both standing (weighted) and sitting (non weighted) position of the feet of the patients. We measured the following variables; arch height (AH), calcaneal pitch (CP), talocalcaneal angles from lateral view (TCALA) and anterior-posterior view (TCAAP), talo-first metatarsal angles from the lateral (TFML) and anterior-posterior view (TFMA). RESULTS: Each variable revealed no significant difference between boys and girls (p>0.05); neither was there any significant difference noted in each parameter between the right and left feet (p>0.05). All the variables of plain foot roentgenogram on weighted state were significantly different from the data of non-weighted state, except TCAAP (p<0.05). CP was the only parameter which showed significant difference according to severity of flatfoot by modified Rose'classification. CONCLUSION: Because most of the flatfoot in childhood is hypermobile type, it is necessary to take plain radiologic studies of the feet both in weighted and non weighted state and to compare both data of each variable. In addition, it is prefer to use plain radiologic study of foot both in weighted and non weighted state with footprint as the screening method of pediatric flatfoot lesions.

A Method of Analyzing Footprint Using the Harris Mat for Diabetic Foot Lesion

Deformity due to the diabetic foot causes repetitive and excessive pressure to the certain areas of a foot, which may result in ulcers and pains. Therefore, it is necessary to measure the pressure of the sole for the prevention and management of the diabetic foot lesions. The computerized foot scan system is one of the direct methods to measure the excessive pressure from the deformity of a foot. However, it is not usually affordable in a developing country due to its high cost, space occupancy, and lack of trained personnel. Manual counting using Harris mat is another rather affordable method, however it has problem of the time consumption for a quantitative measure and poor in reproducibility. The purposes of this study were to obtain the objective and quantitative data from Harris mat footprints of diabetic patients by using Paint Shop Pro and to apply the same method to the patients with other foot lesions. Fifty three cases(twenty four males and, twenty nine females) who were referred due to the diabetic foot lesions were evaluated. The average age was 56.62+/-8.03 years and the duration of diabetes mellitus was 104.93+/-79.53 months. By the Paint Shop Pro , the highest pressure was recorded at the first toe(thirteen cases), followed by the calcaneal area (also thirteen cases) and the first metatarsal head area (seven cases) in order of the right foot. Of the left foot, the highest pressure was recorded at the first toe (fourteen cases), followed by the calcaneal area(twelve cases) and the third metatarsal head area(nine cases). By the manual analysis, the highest pressure was recorded at the calcaneal area (thirteen cases), followed by the first toe(ten cases) and the fifth metatarsal head area (six cases) in order of the right foot. Of the left foot, the highest pressure site was the first toe(fourteen cases), followed by the calcaneal area(fifteen cases) and the third matatarsal head area(seven cases) in order of pressure level. Based on these results, we have concluded that the Paint Shop Pro analysis method is an easy and inexpensive foot pressure measurement system which is clinically applicable. However further researches for the test-retest reliability and a comparison with the computerized foot scan system would be required for the standardization of this method.