Do Magnets Have the Potential to Serve as a Stabilizer for the Shoulder Joint in Massive Rotator Cuff Tears?: A Biomechanical Cadaveric Study

Background@#Disruption of the rotator cuff muscles compromises concavity compression force, which leads to superior migration of the humeral head and loss of stability. A novel idea of using the magnetic force to achieve shoulder stabilization in massive rotator cuff tears (MRCTs) was considered because the magnets can stabilize two separate entities with an attraction force. This study aimed to investigate the biomechanical effect of the magnetic force on shoulder stabilization in MRCTs. @*Methods@#Seven fresh frozen cadaveric specimens were used with a customized shoulder testing system. Three testing conditions were set up: condition 1, intact rotator cuff without magnets; condition 2, an MRCT without magnets; condition 3, an MRCT with magnets. For each condition, anterior-posterior translation, superior translation, superior migration, and subacromial contact pressure were measured at 0°, 30°, and 60° of abduction. The abduction capability of condition 2 was compared with that of condition 3. @*Results@#The anterior-posterior and superior translations increased in condition 2; however, they decreased compared to condition 2 when the magnets were applied (condition 3) in multiple test positions and loadings (p <0.05). Abduction capability improved significantly in condition 3 compared with that in condition 2, even for less deltoid loading (p < 0.05). @*Conclusions@#The magnet biomechanically played a positive role in stabilizing the shoulder joint and enabled abduction with less deltoid force in MRCTs. However, to ensure that the magnet is clinically applicable as a stabilizer for the shoulder joint, it is necessary to thoroughly verify its safety in the human body and to conduct further research on technical challenges.

Clinical and Radiological Outcomes of Rectangular Tapered Cementless Stem According to Proximal Femoral Geometry in Elderly Asian Patients / 대한고관절학회지

PURPOSE: A retrospective analysis of mid- to long-term clinical and radiological outcomes of Korean patients over 60 years of age who underwent hip arthroplasty using a cementless rectangular tapered stem according to Dorr proximal femur geography. MATERIALS AND METHODS: From January 2007 to December 2013, 107 patients (112 hips) underwent hip arthroplasty using the C2 stem. The mean age of patients was 77.4 years (range, 60–91 years) and the mean follow-up duration was 91.1 months (range, 60–116 months). All patients were evaluated clinically and radiologically with special attention to Dorr femoral bone classification, implant fixation, radiolucent line (RLL), and thigh pain. RESULTS: All implants demonstrated radiographic evidence of stable fixation by bone ingrowth without any change in position. The mean Harris hip score improved from 65.5±16.0 (preoperative) to 90.5±15.9 (final follow-up) (P<0.001). Incidence of RLLs, stress shielding, and thigh pain was highest in patients with Dorr type A (RLL, P=0.021; stress shielding, P=0.030; thigh pain, P<0.001). One stem revision was performed due to deep infection. The Kaplan–Meier survival rate of the femoral stem was 97.6%. CONCLUSION: The overall survival rate of the C2 stems was greater than 97%; there were no significant differences in survival of the C2 stem according to the Dorr classification. The incidences of RLL of thigh pain and RLL were significantly different among Dorr classifications and (highest in patients with Dorr type A).

Middle Turbinate Stabilization after Endoscopic Sinus Surgery: The Suture Technique / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Middle turbinate lateralization is a common complication of endoscopic sinus surgery, and many methods are employed to avoid it. We tried to suture middle turbinate-septum-opposite middle turbinate for middle turbinate stabilization. MATERIALS AND METHOD: A prospective study was done for 32 patients who had floppy or paradoxically curved middle turbinate at the time of endoscopic sinus surgery. A 3-0 Vicryl suture on 20 mm 1/2 curved round bodied needle was used for suture. The needle was passed through the left middle turbinate from lateral to medial, transversing the nasal septum to the right side and continued through the middle turbinate from medial to lateral. It is then passed again in the opposite direction through the same structures and tied. All cases were followed up until complete healing was confirmed by endoscopic visualization at the final office examination. RESULTS: OMUs (Ostiomeatal Units) were patent in 93.7% (30/32) of patients. Middle turbinates of 2 cases were lateralized due to parted suture. In 4 cases (12.5%), patients complained temporary hyposmia during the immediate postoperative period. In 2 cases, patients continued to have hyposmia at 3 postoperative months, but recovered at 6 postoperative months. Crust was observed about 6 weeks. Granulation tissue was presented in 3 cases (9.4%). CONCLUSION: Suture technique is an effective method to stabilize middle turbinate and it can be performed in selected cases of paradoxical middle turbinate or floppy middle turbinate.

The Use of Microdebrider in Reduction Rhinoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Surgeons commonly employ osteotome and rasp to remove the bony hump of the nasal dorsum in reduction rhinoplasty. The thickness of skin-soft tissue envelope and nasal bone is not consistent in nasal dorsum. Therefore, the tendency is to over-resect at the rhinion and under-resect at the nasofrontal angle, thereby leaving an excessive amount of thicker superior nasal bone. Manual rasps can cause avulsion injury of upper lateral cartilage and soft tissue trauma. So we introduced a powered instrument (microdebrider) in reduction rhinoplasty to improve precision and technical ease while minimizing tissue trauma. SUBJECTS AND METHOD: We operated on eleven patients either with hump nose only (N=6) or deviated nose with hump (N=5). Endonasal approach was used in 3 cases and external approach in 8 cases. We used the microdebrider only for 5 cases and microdebrider after osteotome for 6 cases to smoothen the dorsal edges of open roof after osteotome. We used the powered instrument XPS 2000 Microresector system for rhinoplsty (XOMED(R)). RESULTS: Ten patients were satisfied with the results subjectively. Bony irregularity of the nasal dorsum was not observed and we found less eccyhmosis and edema compaired with the usage of rasp. CONCLUSION: A microdebrider offers a precise alternative to the rasp and can be used in a more precise and limited fashion in reduction rhinoplasty with reduced complication than rasp.

The Effect of Mitomycin C in Middle Meatal Antrostomy Site / 대한이비인후과학회지

BACKGROUND AND OBJECTIVE: Adhesion and stenosis are important in causing poor results of sinus surgery. Mitomycin C (MMC) is an antibiotic-antineoplastic agent that decreases fibroblast proliferation and scar formation. This study was designed to observe the effect of intraoperative application of mitomycin C on the size of the antrostomy site and mucociliary clearance rate after an endoscopic sinus surgery. MATERIALS AND METHODS: A total 20 patients diagnosed with chronic sinusitis with nasal polyp were used. After middle meatal antrostomy, a piece of merocel soaked with 0.04 mg/mL MMC 1.5 mL was applied on right antrostomy site for 5 minutes. Left antrostomy site was used as control without applying MMC. The antrostomy size was measured by using gauze instrument under endoscopy at operation, 1, 3 and 6 months after surgery. Mucocilliary clearance rate was assessed by saccharine time test after 2 weeks, 1, 3 and 6 month. RESULTS: The MMC group has showed lower incidence of stenosis, granulation and adhesion than the control group. At 1 month, the percentage of remaining antrostomy size was 61.6+/-31.6% in MMC group, whereas that of the control group was 46.9+/-23.3%. There was a significant difference in the antrostomy size between the two groups at 1 month, but there was no significant difference at 3 and 6 month. The saccharine time test between the two groups showed no significant difference after operation. CONCLUSION: The use of MMC will improve the success rate of sinus surgery if it is used as adjuvant therapy after antrostomy. Further study will be needed on the duration of application time, concentration of MMC and method.

A Case of Leopard Syndrome Associated with Pure Gonadal Dysgenesis / 대한산부인과학회잡지

Leopard syndrome, a feature of a syndrome, is a acronym of Lentiginosis, Electrocardiographic conduction abnormalities, Ocular hypertelorism, Pulmonic stenosis, Abnormal genitalia, Retardation of growth, and Deafness. It is one of the autosomal dominant neurocutaneous traits accompanied by neurologic abnormality. We have experienced a case of Leopoard syndrome associated with 46,XX pure gonadal dysgenesis, which was diagnosed by laparoscopic biopsy, karyotyping, and dermatologic consultation. So we report this case with a brief review of literatures. In our knowledge, this very rare case is presented for the first time in Korea.