Association of Estrogen Receptor 2(ESR 2) Gene Polymorphisms with Ossification of the Posterior Longitudinal Ligament of the Spine

STUDY DESIGN: Genetic screening of the estrogen receptor 2 (ESR2) genes in patients with ossification of the posterior longitudinal ligament (OPLL). OBJECTIVE: We studied the relationships between ESR2 gene polymorphisms and OPLL to understand the pathophysiology of OPLL. SUMMARY OF LITERATURE REVIEW: The OPLL has a strong genetic component. Several familial surveys and human leukocyte antigen (HLA) haplotype studies reveal that genetic background is an important component in the occurrence of OPLL and a large number of gene analysis studies were utilized to clarify the susceptible gene for OPLL, including COL11A2, BMP-2, TNF-alpha, NPPS, leptin receptor, transforming growth factor (TGF)-beta, Retinoic X receptor, ER, IL-1, PTH, and VDR have been performed. MATERIALS AND METHOD: Genomic deoxyribonucleic acid (DNA) samples obtained from 164 patients (93 men and 71 women) with OPLL and 219 control subjects, without the disease (105 men and 114 women) were amplified by polymerase chain reaction, and polymorphism genotypes were determined by the restriction endonuclease digestion. The distribution of genotypes was compared between the patients with the disease and the control subjects. RESULTS: The polymorphism of ESR2 [rs1256049, exon6, Val328Val, p=0.018, odd ratio (OR)=2.41, 95 confidence interval (CI)=1.15-5.02 in the recessive model] only showed statistically significant association between the control and the OPLL groups. The rest SNPs of ESR2 did not show any significant differences between the control and the OPLL groups. CONCLUSIONS: Estrogen receptor 2 (ESR2) gene polymorphisms (rs 1256049) was associated with OPLL. In future studies, we will perform target SNP chip between OPLL and candidate gene.

Comparative Study of the Clinical Outcomes of Unilateral Transforaminal Lumbar Interbody Fusion(TLIF) with Bilateral TLIF using Wiltse Approach and Conventional Approach

STUDY DESIGN: Comparative study. OBJECTIVES: To compare the outcomes of unilateral TLIF, bilateral TLIF using Wiltse approach and bilateral TLIF using conventional midline approach. SUMMARY OF LITERATURE REVIEW: There are many studies about outcomes of Unilateral TLIF, but few have compared the 3 different fusion procedures. MATERIALS AND METHODS: 60 patients were divided into 3 groups. Each group has enrolled 20 patients (Study group: unilateral TLIF, Control group 1: bilateral TLIF using Wiltse approach, Control group 2: bilateral TLIF using conventional midline approach). For clinical outcomes, we compared operative time, blood loss, time for ambulation and discharge, VAS for back pain and leg pain and ODI among three groups. For radiologic evaluation, disc height and segmental lordosis were examined. RESULTS: The mean operative time was 147 minutes in study group(SG), 172 minutes in control group 1(CG1), 167 minutes in control group 2(CG2). The mean total blood loss was 466ml in SG, 569ml in CG1, 1140ml in CG2 respectively. VAS for back pain at the third postoperative day significantly decreased in SG and CG1 compared with CG2. There was no significant difference in ODI, disc height and segmental lordosis among the groups. CONCLUSION: Using Wiltse approach, there were several advantages in decreasing blood loss, immediate postoperative back pain, hospital stay and early ambulation. Clinical and radiological results of unilateral TLIF were comparable with bilateral TLIF.

Simultaneous Fractures of the Ipsilateral Distal and Proximal Clavicle: Double Clavicle Fracture: A Case Report

Clavicular fracture is common injury in the upper extremity, but ipsilateral proximal, distal or middle-third clavicular fractures which occur simultaneously are an extremely rare. Seven cases have been reported in the English and Japanese literatures, but it has never been reported in Korea. We report a case of ipsilateral proximal and distal clavicular fracture caused by fall from height and describe its presumed mechanism, diagnosis, treatment with a review of literatures.

Radiographic Progression of Degenerative Lumbar Scoliosis after Short Segment Decompression and Fusion

STUDY DESIGN: A retrospective study. PURPOSE: To assess the radiographic progression of degenerative lumbar scoliosis after short segment decompression and fusion without deformity correction. OVERVIEW OF LITERATURE: The aims of surgery in degenerative lumbar scoliosis are the relief of low back and leg pain along with a correction of the deformity. Short segment decompression and fusion can be performed to decrease the level of low back and leg pain provided the patient is not indicated for a deformity correction due to medical problems. In such circumstance, the patients and surgeon should be concerned with whether the scoliotic angle increases postoperatively. METHODS: Forty-seven patients who had undergone short segment decompression and fusion were evaluated. The average follow-up period was more than 3 years. The preoperative scoliotic angle and number of fusion segments was 13.6+/-3.9degrees and 2.3+/-0.5, respectively. The preoperative, postoperative and last follow-up scoliotic angles were compared and the time of progression of scoliotic angle was determined. RESULTS: The postoperative and last follow-up scoliotic angle was 10.4+/-2.3degrees and 12.1+/-3.6degrees, respectively. In eight patients, conversion to long segment fusion was required due to the rapid progression of the scoliotic angle that accelerated from 6 to 9 months after the primary surgery. The postoperative scoliosis aggravated rapidly when the preoperative scoliotic angle was larger and the fusion was extended to the apical vertebra. CONCLUSIONS: The scoliotic angle after short segment decompression and fusion was not deteriorated seriously in degenerative lumbar scoliosis. A larger scoliotic angle and fusion to the apical vertebra are significant risk factors for the acceleration of degenerative lumbar scoliosis.

Osteotomy of the Spine to Correct the Spinal Deformity

There are a number of reports on Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR). However, there are few systematic reviews of all three kinds of osteotomies. Literature review and author's experience of SPO, PSO and VCR osteotomy will be described. Various surgical techniques can be applied according to the disease entity and magnitude of the deformity. The most appropriate methods for deformity correction should be chosen and the potential complications should be considered. Before attempting an osteotomy of the spine for a spinal deformity, sufficient surgical experience and a thorough understanding of the anatomy of the spine and adjacent structures are needed. In addition, a well-organized team with the other departments is essential.

Cruciate Retaining Medial Pivot Knee / 대한정형외과학회잡지

Purpose: To analyze the clinical and radiographic results of patients who underwent total knee arthroplasty with a posterior cruciate retaining medial pivot knee, and to identify the technical aspects in preserving the posterior cruciate ligament. Materials and Methods: From March 2002 to Dec 2003, 40 total knee arthroplasties with a cruciate retaining medial pivot knee were implanted in 28 cases. The average follow-up period was 2.8 years (range, 2 to 3.7 years). The clinical and radiographic results were evaluated using the clinical and roentgenographic evaluation and scoring system of the American Knee Society. Results: The average flexion contracture before surgery was 5.4degrees, which improved to 0.6degrees at the last follow-up. The average preoperative knee flexion was 126.1degrees and 126.6degrees at the last follow-up. The average knee score improved from 60 points preoperatively to 94.8 points postoperatively, and the average functional score improved from 55.3 points to 87.0 points at the final evaluation. The average post operative alpha, beta, gamma and delta angles were 95.1degrees, 91.1degrees, 3.6degrees and 84.0degrees, respectively. There were no postoperative complications. Conclusion: The short term clinical results in patients who had undergone total knee arthroplasty with a cruciate retaining medial pivot knee was acceptable.

Efficacy of Computer Assisted Surgery in Revision Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to analyze the accuracy of the mechanical axis and implant positions postoperatively and to evaluate the radiology results of computer assisted navigation surgery for bone cutting and ligament balancing in revision TKA. MATERIALS AND METHODS: 13 consecutive revision TKAs were performed by a single surgeon with use of computer assisted surgery (CAS) from July 2004 to August 2005. At the revision, the mean age was 64.7 years. The mean interval from the index arthroplasty was 9.8 years. The cause of the revision included 11 cases of polyethylene wear and 2 cases of loosening. Two observers measured the mechanical axis, position of the implants, and level of joint lines. RESULTS: By observer I, the mechanical axis improved from varus 11.9degrees to valgus 1.5degrees, and the mean alpha, bets, gamma and delta angles were 95.3, 90.8, 3.9 and 87.6degrees respectively. From observer II, the mechanical axis improved from varus 11.6degrees to valgus 1.6degrees, and mean alpha, beta, gamma and delta angles were 95.5, 90.5, 4.1 and 87.9degrees respectively. The measured angles from observers I and II showed a good correlation. CONCLUSION: Accurate bone cutting and verification in each step are possible using real time information provided by the CAS. The mechanical axis, component positions, joint line could be checked and adjusted with feedback of navigation system. Information about flexion and extension gap and ligament balancing could be verified during revision surgery.

Arthroscopic Findings of Dysplastic Hip & Usefulness of Preoperative Labral Test / 대한정형외과학회잡지

PURPOSE: To report the arthroscopic findings in symptomatic dysplastic hips and to clarify the efficacy of a labral test. MATERIALS AND METHODS: Between July 2001 and Nov 2004, arthroscopy was performed on 37 dysplastic hips. There were 7 males and 30 females and the average age was 38.8 years. The average center-edge angle was 6.54o. Radiographically, 28 hips were prearthritic and 9 hips showed arthritic changes. The arthroscopic findings of the labrum and cartilage and the efficacy of labral test were compared. RESULTS: Labral lesions were found in 25 cases, and cartilage lesions were found in 16 cases of 28 prearthritic hips. All patients with radiographic evidence of osteoarthritis had both labral and cartilage lesions. Labral lesions were found in 30 out of 33 cases with a positive labral test. CONCLUSION: This study identified the pathologic processes of acetabular labrum and cartilage in most cases, even though there was no radiographic evidence of osteoarthritis. Preoperative labral test is a useful physical examination in those suspected of having labral lesions.

Changes in BMD in the Proximal Femur after Cementless Total Hip Arthroplasty and Resurfacing Arthroplasty: Prospective, Longitudinal, ComparativeStudy / 대한정형외과학회잡지

PURPOSE: This study analyzed the differences in bone remodeling and stress shielding between cementless total hip arthroplasty and resurfacing arthroplasty by examining the serial bone mineral density around the prosthesis. MATERIALS AND METHODS: Fifty total hip arthroplasty procedures and 50 resurfacing arthroplasty procedures, which were performed between July 2002 and June 2003, were examined to this comparative study. The mean age at surgery was 44 years in the THA group and 36 years in the resurfacing arthroplasty group. The bone mineral density was measured by the DEXA at preoperation and 3 months, 6 months, 12 months after surgery in zone I-III of the acetabulum (classified by DeLee & Charnley) and zone I-VII of the femur (classified by Gruen), and the medial and lateral side of the femoral neck in the resurfacing arthroplasty group. RESULTS: In the acetabulum, zones I and II of both groups showed a significant decrease in the BMD 12 months after surgery but the level of bone loss in the resurfacing arthroplasty group was relatively small compared with those in the THA group. In the proximal femur, the overall amount of bone loss at 3, 6 and 12 months postoperatively were 0.7%, 5%, and 2.6% respectively, and those in zones I and VII at 12 months postoperatively in the THA group were 7.8% and 7.7%, respectively. In the BHR group, the overall bone loss in the proximal femur at 3, 6 and 12 months postoperatively were 5.8%, 4.4%, and 2.9%, respectively. However, those Gruen zones I and VII at 12 months postoperatively were 2.6% and 0.6%, respectively. CONCLUSION: The level of bone loss in Gruen zones I and VII of the resurfacing arthroplaty group was much lower, which suggests that resurfacing arthroplasty can prevent stress shielding and preserve the proximal bone stock around the femoral stem.

Clinical Outcome of Shoulder Replacement in Non-Traumatic Arthritis: A Comparison of Hemiarthroplasty and Total Shoulder Arthroplasty / 대한정형외과학회잡지

PURPOSE: To compare the clinical outcomes and complications of hemiarthroplasty (HHR) and total shoulder arthroplasty (TSR) in non-traumatic arthritis patients. MATERIALS AND METHODS: Thirty-two patients (34 shoulders) underwent shoulder arthroplasty for nontraumatic shoulder arthropathy. There were sixteen patients with rheumatoid arthritis, nine with osteoarthritis, four with avascular necrosis and etc. HHR was performed in eleven shoulders and TSR in twentythree shoulders. RESULTS: In HHR, the pain score decreased from preoperatively 7.09 to 0.91 postoperatively. The mean forward elevation was 137degrees and the mean external rotation at the side and abduction were 55degrees and 131degrees, respectively. The mean ASES score was 82.4. In TSR, the pain score decreased from 7.04 preoperatively to 1.17 postoperatively. The mean forward elevation, external rotation at the side and abduction were 132degrees, 44degrees, and 132degrees, respectively. The mean ASES score was 81.2. In rheumatoid arthritis, the mean ASES score of the HHR and TSR were 77.8 and 78.1, respectively. In osteoarthritis, the mean ASES score was 84.7 and 90.8, respectively. During the follow up, glenoid erosion was observed in three HHR cases, and glenoid loosening in two TSR case. CONCLUSION: HHR and TSR produced similar results in terms of the functional improvement. The clinical results were much better in patients with osteoarthritis than in those with rheumatoid arthritis, and TSR was performed on most cases of rheumatoid arthritis.

Intraoperative versus Postoperative Measurement in Total Knee Arthroplasty using Computer-Assisted Orthopaedic Surgery (CAOS): Accuracy of CAOS / 대한정형외과학회잡지

PURPOSE: The purpose of this research was to compare the intra-operative and post-operative measured angle in total knee arthroplasty (TKA) and to evaluate the postoperative improvement in the mechanical axis. MATERIALS AND METHODS: Forty TKAs were performed using CAOS between February and May 2004. We measured the mechanical axis in the preoperative orthograms. After inserting the implant, we measured the femoral component angle (FCA), tibial component angle (TCA) and tibial component slope (TCS) using the verification tool in CAOS, on the post-operative orthogram and X-ray of the lateral tibial view, 2 observers measured the FCA, TCA, TCS and mechanical axis. RESULTS: The mean FCA, TCA and TCS using the verification tool in CAOS, were valgus 0.03+/-0.85degrees, valgus 0.49+/-1.02degrees, nd 4.26+/-1.64degrees. The mean FCA, TCA and TCS by observer 1 were valgus 0.67+/-1.24degrees, varus 0.54+/-1.54degrees, and 4.57+/-1.74degrees and those by observer 2 were valgus 0.48+/-1.17degrees, varus 0.52+/-1.44degrees, and 4.24+/-2.83degrees. There was a positive correlation between the measured angle by respective observers and the angle measured by the CAOS (p<0.05). The mechanical axis by observers 1 and 2 improved from varus 13.96degrees to valgus 0.04degrees and from varus 14.12degrees to valgus 0.08degrees respectively. CONCLUSION: CAOS affords the possibility of precisely placing the femoral and tibial components. The angles measured by the respective observers and in the CAOS were significantly correlated.

A case of pheripheral T-cell lymphoma in nasal cavity / 대한이비인후과학회지

No abstract available.

A clinical observation on hearing disturbance in patients with diabetes mellitus / 대한이비인후과학회지

No abstract available.

The significance of nucleolar organizer regions in bladder epithelial lesions induced by N-butyl-N-(4-hydroxybutyl)nitrosamine in rat / 대한비뇨기과학회지

It is known that the activity of tumor cells correlates with the malignant potential of tumors. Nucleolar organizer regions(NORs) are loops of DNA which occur in nucleoli and which possess ribosomal DNA genes. Ribosomal DNA genes transcribe to ribosomal RNA by RNA polymerase I and are of vital significance in the ultimate synthesis of protein. Proteins associated with the NORs are stained with silver nitrate(Ag-NORs). Ag-NORs were studied in various tumors and might reflect the activity of cells and might be and indicator of the degree of malignancy in tumors. 0.05 % N-Butyl-N(4-hydroxybutyl) nitrosamine(BBN) in drinking water was given for 8 and 14 weeks to induce pre-neoplastic and neoplastic vesical epithelial lesions in female Wister rats. Ag-NORs were stained by the simple one-step silver colloid staining in routine processed, formalin-fixed paraffin sections of bladder lesions induced by N-butyl-N(4-hydroxybutyl) nitrosamine(BBN) in rat. The mean number of silver stained NORs(Ag-NORs) was as follows : normal transitional epithelium was 1.64+/-0.25(mean+/-SD; n=10), simple hyperplasia was 2.24+/-0.24(n=7). nodular hyperplasia was 2.63+/-0.12 (n=6), transitional cell papilloma was 3.24+/-0.28(n=6) and transitional cell carcinoma was 4.52+/-0.32(n=10). Based on the above results, we concluded that the mean number of Ag-NORs showed a stepwise increase from normal transitional epithelium through simple hyperplasia and nodular hyperplasia to papilloma and carcinoma of bladder epithelium induced by BBN in rat and may reflect proliferative activity of cells. Further investigations may be needed to confirm whether the number or quantification of Ag-NORs is a useful method for evaluating proliferative activity of neoplastic lesions or another indicator of prognosis in human bladder cancer.

A case of ureteral stump metastasis from renal adenocarcinoma / 대한비뇨기과학회지

The metastasis of renal cell carcinoma to the ureteral stump is very rare and only a Few cases were reported. In most cases ureteral metastasis appeared after nephrectomy. We are presenting a case of metastatic renal cell carcinoma to the ureteral stump after radical nephrectomy in a 14 years old male with brief review and literature.