Efficacy and Safety of Letibotulinum Toxin A for the Treatment of Essential Blepharospasm

PURPOSE: To evaluate the efficacy and safety of BOTULAX® in subjects with essential blepharospasm.METHODS: In this study, a total of 250 subjects with essential blepharospasm were enrolled at 15 investigational sites and a total of 220 subjects completed the study. The efficacy and safety were evaluated at weeks 4 and 16 after treatment compared with baseline. In total, 240 subjects were enrolled, treated with the investigational product, and evaluable for the primary efficacy assessment at week 4 after treatment; these subjects were included in the intention-to-treat (ITT) population. With the ITT set as the main efficacy set, efficacy assessment included Jankovic rating scale (JRS), functional disability score, investigator evaluation of global response and quality of life. Safety assessment including the incidence of adverse events was also performed.RESULTS: In terms of the primary efficacy endpoint (i.e., change in JRS total score at week 4 after treatment from baseline [ITT set]), mean change indicated a statistically significant reduction (p < 0.0001) and demonstrated the non-inferiority of the test drug to similar drugs. In terms of the secondary efficacy endpoints, mean change in JRS total score at week 16 after treatment and mean change in functional disability score at weeks 4 and 16 after treatment both exhibited a statistically significant reduction compared with baseline (p < 0.0001 for all). Among the 249 subjects treated with the investigational product in this study, 44 (17.67%) experienced 76 treatment emergent adverse events but no serious adverse events were observed.CONCLUSIONS: Based on the study results, BOTULAX® is considered to be an effective and safe treatment for essential blepharospasm.

Bicanalicular Intubation to Repair Canalicular Laceration Guided by 6-0 Prolene with Pigtail Probe

No abstract available.

Delayed-Onset Interface Fluid Syndrome after LASIK Surgery in Traumatic Hyphema

A 50-year-old female was referred to our clinic with visual disturbance, hyphema and increased intraocular pressure (IOP) in her right eye 7 days after experiencing blunt trauma in that eye. She had undergone uncomplicated laser in situ keratomileusis (LASIK) on both eyes 10 years earlier. At initial examination, the best corrected visual acuity (BCVA) in her right eye was counting fingers at 2 feet with no correction. Central Goldmann applanation tonometry (GAT) showed an IOP of 7 mm Hg. Peripheral digital tonometry showed the IOPs in her right eye superiorly, nasally, temporally, and inferiorly were 36 mm Hg, 35 mm Hg, 34.5 mm Hg and 36.5 mm Hg, respectively. Slit-lamp examination showed diffuse epithelial and stromal edema and a blood clot 1 mm in height in the anterior chamber. Spectral domain scanning laser ophthalmoscope/optical coherence tomography (SD-SLO/OCT) images showed a pocket of fluid between the LASIK flap and the underlying stroma. The patient was started on anti-inflammatory agent and IOP lowering agents. After 15 days of treatment, IOP measured with GAT was 10 mm Hg, slit-lamp examination showed that epithelial and stromal edema had disappeared, and OCT showed no fluid between the corneal flap and stroma.

Unique features of bovine lymphocytes exposed to a staphylococcal enterotoxin

We previously demonstrated that stimulation of bovine peripheral blood mononuclear cells (PBMCs) with staphylococcal enterotoxin C (SEC), led to an inversion of the CD4(+):CD8(+) T cell ratio and generation of an atypical CD8(+) T cell subpopulation expressing CD26. In the present study, we examined T cell apoptosis and proliferation profiles of PBMC subpopulations in cultures stimulated with SEC. Unlike when stimulated with concanavalin A, nucleic acid synthesis in bovine PBMC cultures stimulated with SEC was low during the first four days but increased greatly on day 5. In contrast, nucleic acid synthesis in human PBMC cultures stimulated with SEC increased continuously. To investigate the mechanism of delayed bovine T cell proliferation, various cell phenotypes were monitored. The inversion of the bovine CD4(+):CD8(+) T cell ratio in PBMC cultures stimulated by SEC was associated with higher proliferation and lower apoptosis of CD8(+) T cells compared to CD4(+) T cells. The mRNA levels for interleukin (IL)-4 and IL-13 were sustained over 4 days but IL-12 mRNA levels dropped to background on day 2. These data suggest that SEC induces a prolonged Th-2- biased microenvironment, and together with the inversion of the bovine CD4(+):CD8(+) T cell ratios in bovine PBMC cultures with SEC, may in part explain the inability of the mammary immune system to establish an effective response to Staphylococcus aureus infections.

Immunosuppression by T regulatory cells in cows infected with Staphylococcal superantigen

Our recent study has provided that the in vitro SEC-induced proliferation of bovine T cells is preceded by a period of a non-proliferative immunoregulation of T cells that may be associated with cytokine production regulated by type 1 or type 2 T cells. Inversion of CD4+:CD8+ T cell ratio and induction of CD8+T cells with immunoregulatory activity could increase the probability of intracellular survival of Staphylococcus aureus (S. aureus). The increase of activated CD8+(ACT2+ BoCD8+) T cells in cows with mastitis caused by S. aureus may be associated with immune-regulatory function in the bovine mammary gland. The difference and similarity between bovine activated CD8+ T cells (CD8+ CD26+)and well-established human CD4+ CD25+ T regulatory (Tr)cells may help to reveal their unique immune regulatory system in the host infected with S. aureus.

Sciatic Pain Caused by Piriformis Syndrome / 대한정형외과학회잡지

PURPOSE: Sciatic pain rarely develops from piriformis syndrome; thus, its differential diagnosis from other diseases associated with sciatic pain is essential. We analysed the clinical symptoms and radiological findings for the differential diagnosis of piriformis syndrome, and assessed the results of its treatment. MATERIALS AND METHODS: We analysed five patients diagnosed with piriformis syndrome. Four patients were treated with a tenotomy. Of these, three had a history of misdiagnosis. The hypertrophied piriformis muscle was revealed with a compressed sciatic nerve in the operative field. We performed a tenotomy of the piriformis at the site of the tendinous insertion to decompress the sciatic nerve. RESULTS: At the average follow up was 23.5 months, at which time no patients had any problems relating to tenderness and sciatic pain, and were able to return to normal activity one month postoperatively. All patients evaluated their postoperative clinical state as being better. CONCLUSION: Multiple approaches are essential for the diagnosis of piriformis syndrome. We can obtain the satisfactory results through a tenotomy of the piriformis for the decompression of the sciatic nerve in intractable cases as a conservative treatment.

The Relationship between the Duration of IOP Elevation during LASIK and Nerve Fiber Layer Thickness Measured by GDx(R)

PURPOSE: To determine the effect of temporary intraocular pressure (IOP) elevation during laser in situ keratomileusis (LASIK) on retinal nerve fiber layer measurement by scanning laser polarimetry in a clinical trial. METHODS: The duration of IOP elevation was recorded during LASIK and scanning laser polarimetry (GDx(R) Retinal Nerve Fiber Analyzer. Laser Diagnostic Technologies, Inc, San Diego, California) measurements were performed in 60 eyes of 30 consecutive patients before and after the LASIK procedure. RESULTS: The mean duration of IOP elevation during LASIK was 27.2+/-4.5 seconds. The mean retinal nerve fiber layer (RNFL) thickness measured by scanning laser polarimetry were 73.2+/-12.8 micro meter preoperatively, 65.6+/-12.7 at postoperative 1 month and 66.0+/-9.8 micro meter at postopertive 3 months. The mean postoperative 1 month and 3 months values showed significantly reduced RNFL thickness. But, there was no relationship between the duration of IOP elevation and the amount of nerve fiber layer thickness reduction. (R2=0.064, p=0.627) Furthermore, there were no interval change between the retardation values of postoperative 1 month and 3 months (p=0.706). CONCLUSIONS: There was no relationship between the duration of IOP elevation during LASIK and the postoperative reduction of RNFL thickness measured by scanning laser polarimetry. When using scanning laser polarimetry as a helpful diagnostic and follow-up tool for glaucoma, care should be taken in the interpretation of the result after LASIK procedure. If a comparison is likely to be needed in the future, this image should be obtained after the LASIK procedure to set the postoperative baseline.

A Case of Pelvic Actinomycosis / 대한산부인과학회잡지

Actinomycosis is an oppoturnistic infection of actinomyces, which are relatively avirulent endogenous oral commensals. After trauma or infection, they breach the normally protective mucosal barriers to invade adjacent soft tissue structures. Lesions routinely contain other bacteria, the normal resident flora at the site of primary infection, which act synergistically with actinomyces species to provoke this unique infection, which range from an acute suppurative process to a chronic fibrotic process. According to epidemic studies about pelvic actinomycosis, it should be significantly related to IUD(intrauterine device). It is accounted that IUD cause chronic intrauterine infection, tissue injury and act as nucleus for parasitic infestation. Here we present a case of pelvic actinomycosis related to IUD with brief review of the concerned literature.

Tuberculosis of the Sacrococcygeal Junction / 대한척추외과학회지

In the tuberculosis of bone and joint, the spine is the most prevalent site and its treatment was improved with operative procedure, but still tuberculous spondylitis has remained as a serious and chronic infectious disease in developing areas including Korea. Tuberculous spinal lesions were thoracic, lumbar and thoracolumbar in order, and sacrococcygeal junction was very rare in the published literature, and none reported in Korea. This case was combined with pulmonary tuberculosis and confirmative diagnosis could be made by smear and pathologic findings. Satisfactory result was obtained by abscess drainage and radical curettage with antituberculous medication.

Pyogenic Sacroiliac Joint Infection / 대한정형외과학회잡지

Sacroiliac joint infection is relatively rare and difficult in differential diagnosis with other spinal disorders. Delay in diagnosis is frequent which causes an increased morbidity. The authors reviewed clinical courses of the patients who were treated for pyogenic sacroiliac joint infection from January 1985 to April 1997. Investigation included physical examination, bone scan, biopsy, ESR, plain radiography, CT scan, and MRI. The diagnosis was made on clinical findings and a positive results of the above investigation. There were 17 pyogenic arthritis. Six patients had all symptoms of triad(fever, unilateral buttock pain, limping gait) and fifteen patients had typical buttock pain. Increased ESR(>20mm/hr) was noticed in fourteen patients. In all seventeen cases, skeletal scintigraphy and Gaenslen test were positive. Also CT scan and MRI study were helpful in diagnosis of the sacroiliac joint infection. Pus culture could be done in twelve cases and staphylococcus aureus was found in seven cases. Conservative treatment was performed in eleven cases, and operation in six cases. Fifteen cases were recovered and two cases relieved.

A Biomechanical Study of Screw Designs of Transpedicular Screw on the Fixation Strength / 대한정형외과학회잡지

INTRODUCTION: The fixation strength of transpedicular screw system in the vertebral hody relied on bone quality and anatomical characteristics of vertebral pedicle, designs of screw and types of connection(rod or plate) with screw. The purpose of this study is to verify the biomechanical nature of the transpedicular fixation in spine under various conditions with porcine vertebrae. MATERIAL AND METHOD: Fresh porcine vertebrae and the custom-made screws were used in this experiment. To reduce the errors caused by vertebral bodies of different size and quality, vertebral bodies having regular range of pedicular width(10.0 to 11.5mm) and hone density(more than 1.0 gm/cm2) were used. The pedicle screws were inserted in the same procedure and axial pull out test was performed with using the Material Testing System(lntron8511, Canton, USA). The experiments were performed in four types to assess the difference of strength accroding to designs of the screw hy using two group of screws. The first group of screw was designed according to the outer and inner diameter and the second group was designed according to the shape, pitch, and thread profile of screw. Experiment I was perfomed to evaluate the effect of screw diameters on the biomechanical pull-out strength hy using the first group of custom-made pedicle screw which fixed all other factors except the diameter of screw. Experiment I was to verify the effect of screw shape, experiment III to verify the effect of pitch and experiment IV to verify the effect of thread profile. RESULTS: The results of experiments were summarized as follows: Experiment I showed that the screw of larger outer diameter had greater holding strength. Experiment II showed that the holding strength of cylindrical shaped screw is superior to that of conical shaped screw. Experiment III showed that there is no statistical significance between different modes of pitch. Experiment IV showed that the holding strength of buttress shape of thread profile is superior to that of V-shape. CONCLUSION: It seemed that the fixation strength of the screw was more powerful with 1 mm increment of outer diameter in 4-7mm of outer diameter, 3mm of pitch and buttress shape of thread of the screw with the same operation technique.

Posterolateral Fusion in Spondylolisthesis / 대한정형외과학회잡지

After Kilian first described apondylolisthesis in 1854, there has been diverse opinions over the surgical treatment of the spondylolisthesis: in situ fusion vs. reduction and fusion, PLIF vs. PLF, and instrumentation vs. non-instrumentation. The advantages of the instrumentation are rigid fixation, better union rate of grafted bone and early rehabilitation after surgery. The disadvantages are long operation time and increased chance of the wound infection. The purpose of this retrospective study is to review the clinical results and fusion rate of 41 patients who were treated with decompression and posterolateral fusion in situ with autograft with or without instrumentation from January 1986 to June 1992. 1. Among 41 patients, 20 patients were degenerative type and 21 were isthmic type, and most commonly involved level was L4-5(46.4%). 2. Fusion was obtained in all patients. 3. Clinically 11 of 15 patients(73.4%) showed excellent or good results in instrumentation group, and 19 of 26 patients(73.0%) showed excellent or good results in non-instrumentation group. 4. Postoperative complications developed in two cases(13.3%) with instrumentation and five cases(19.2%) without instrumentation. Comparing with the non-instrumentation, we could not find great advantage of the instrumentation on the clinical results or union rate, although instrumentation showed a little better result.

CT Evaluation of Sacroiliitis' Differentiation of Infectious Sacroiliitis versus Ankylosing Spondylitis

PURPOSE: To determine the characteristic CT findings of infectious sacroiliitis and ankylosing spondylitis. MATERIAL AND METHOD: We retrospectively reviewd CT findings in 10 patients with infectious sacroiliitis confirmed by culture and clinical follow ups and in 5 patients with ankylosing spondylitis by HLA-B27 typing. Mean ages were 30 years in ankylosing spondylitis and 29 years in infectious sacroiliits. CT scans were obtained with GE 9800 or Toshiba 900-S scanner. We analyzed CT findings in regard to the morphology and the degree of bone erosion, and the adjacent soft tissue change. RESULT: All cases of ankylosing spondylitis had bilateral and asymmetic bone erosion, predominantly in ilium, showing subchondral sclerosis on ilium. Infectious sacroiliitis showed unilateral involvement and soft tissue swelling in 10 cases and abscess in 5 cases. CONCLUSION: We concluded that CT was useful in the differentiation between infectious sacroiliitis and ankylosing spondylitis.

MR Imaging of the Dural Ligaments' Cadaveric and Clinical Study

OBJECTIVE: The purpose of this study was to describe the MR imaging appearance of the dural ligaments which is connected between the anterior dura mater and the posterior longitudinal ligament. MATERIALS AND METHODS: In 10 cadavers with formalin fixation, the dural ligaments were evaluated and photographed after removal of the posterior element of the spinal canal. MR studies of 12 patients who had distinct dural ligaments were evaluated. Spin-echo MR images were obtained on a 1. 5T unit. RESULTS: In seven of the ten cadavers, the midline dural ligament was observed; the lateral dural ligament was observed in 3 cadavers. On MR, the dural ligaments were imaged as thin lines of low signal intensity between the anterior dural margin and the posterior longitudinal ligament. Dural ligaments were well-visualized at the level of the lower lumbar spine which had a more prominent anterior epidural space than that of the upper level of the spine. Eight of 12 cases had well developed midline dural ligaments. Two cases showed distinct lateral dural ligaments and the remaining 2 cases had distinct midline and lateral dural ligaments. CONCLUSION: MR images of the dural ligament demonstrate a thin low signal line at the anterior epidural space.

MR imaging of spondylolisthesis

We evaluated MR imaging of spondylolytic spondylolisthesis degenerative spondylolisthesis and retrolisthesis in 14, 9 and 20 patients respectively. Sagittal and axial spin echo and gradient echo images were obtained with 25-30cm FOV and 5mm/0.5mm thickness/gap by using spine surface coil. Sagittal images showed defects of pars interarticularis just inside of the pedicles of spines in all the cases of spondylolytic spondylolisthesis with relatively variable signal intensity. Displaced vertebrae were commonly observed at L5 (8/14) in spondylolytic spondylolisthesis, at L4 (5/9) in degenerative spondylolisthesis and at variable locations in retrolisthesis. The mean length of displacement of vertebrae in spondylolytic spondylolisthesis was about 7mm and less displacement was onserved in degenerative spondylolisthesis and retrolisthesis. Seven, four and six cases of pseudobulging of disk at displaced level were observed in cases of spondylolytic spondylolisthesis, degenerative spondylolisthesis and retrolisthesis respectively. Seven, five and 14 cases of true disk lesions were onserved in cases of spondylolytic spondylolisthesis, degenertive spondylolisthesis and retrolisthesis respectively. Grade II neural foraminal stenoses (obliteration of one half epidural fat of neural foramen) were commonly (8/14) seen in spondylolytic spondylolisthesis, however the other two types showed less severe neural foraminal stenosis. In conclusion, MR imaging is a highly accurate method for the diagnosis and evaluation of spondylolisthesis and associated lesions of spine and disks.

A clinical analysis about VSP plate fixation combined with posterior lumbar interbody fusion / 대한정형외과학회잡지

No abstract available.

Excision of intrapelvic tumor(myxoma) after sacral amputation and anterior approach / 대한정형외과학회잡지

No abstract available.

Radiological analysis of parellar ligament length and patellar height after proximal tibial osteotomy / 대한정형외과학회잡지

No abstract available.

A Clinical Study of the Myelography with Metrizamide / 대한정형외과학회잡지

The authors have studied 60 cases of back pain with respect to diagnostic accuracy of myelography with metrizamide from January, 1983 to Decembar, 1984 at the Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University. The results were as followes; 1. Of the 60 cases, 57 cases (95%) showed excellent and good findings of myelography. 2. In case of the marginal clearance of the nerve-sleeve in myelography, the excellent finding was 93.3%.3. The side effect of myelography was slight and 44% of all patients complained of headache, which disappeared within 24 hours after onset in 92% of them. 4. The accuracy rate of myelography with metrizamide was 89. 2%.

Arthroscopic Total Meniscectomy of the Lateral Discoid Meniscus / 대한정형외과학회잡지

The technique of the arthroscopic total meniscectomy of discoid meniscus is very difficult. Ikeuchi(1982) reported a technique of arthroscopic total meniscectomy of the lateral discoid meniscus by removal of 2/3 of the anterior part of the meniscus first and then by morselization. The purpose of this paper is to report a technique of arthroscopic total meniscectomy of the lateral discoid meniscus as a whole. During the period from October 1982 to October 1984, we had 12 experiences of arthroscopic total meniscectomy of the discoid meniscus and found good results, that is, little postoperative pain, short period of hospitalization and early restoration of joint motion without physical therapy. Complications are 3 cases of symptomless slight lateral instability and 4 cases of hemarthrosis.