Thyroid Volume Measured by (99m)Tc-Pertechnetate Scintigraphy and Its Relationship with Clinical Parameters in Korean Patients with Autoimmune Thyroiditis

BACKGROUND AND OBJECTIVES: Autoimmune thyroiditis (AIT) is a form of thyroiditis associated with autoimmune antibodies. Few studies have measured thyroid volume in Asians. This study was undertaken to determine the distribution of thyroid volume and to explore possible correlations between thyroid volume and other factors in a Korean cohort. MATERIALS AND METHODS: Two hundred eleven patients who underwent (99m)Tc-pertechnetate thyroid scintigraphy between 2009 and 2011 were recruited and their thyroid volume was measured. AIT was defined as having thyroperoxidase antibody (TPOAb) and/or thyroglobulin antibody (TgAb) positivity and TRAb negativity, regardless of thyroid function. RESULTS: The mean thyroid volume was 32.1 mL in AIT patients. The distribution of thyroid volume was normal after log transformation. Thyroid volume was larger in patients with both autoantibodies than in patients with only one antibody (p<0.001). The first quartile of patients grouped according to thyroid volume were older (52.1 years, p=0.037) than the patients in other quartile groups. Thyroid volume correlated independently with TPOAb titer, and TgAb titer adjusted for other factors in a multivariate analysis. CONCLUSION: Thyroid volume in Korean AIT patients had an unimodal distribution and correlated with autoantibody titer.

Thyroid Volume Measured by (99m)Tc-Pertechnetate Scintigraphy and Its Relationship with Clinical Parameters in Korean Patients with Autoimmune Thyroiditis

BACKGROUND AND OBJECTIVES: Autoimmune thyroiditis (AIT) is a form of thyroiditis associated with autoimmune antibodies. Few studies have measured thyroid volume in Asians. This study was undertaken to determine the distribution of thyroid volume and to explore possible correlations between thyroid volume and other factors in a Korean cohort. MATERIALS AND METHODS: Two hundred eleven patients who underwent (99m)Tc-pertechnetate thyroid scintigraphy between 2009 and 2011 were recruited and their thyroid volume was measured. AIT was defined as having thyroperoxidase antibody (TPOAb) and/or thyroglobulin antibody (TgAb) positivity and TRAb negativity, regardless of thyroid function. RESULTS: The mean thyroid volume was 32.1 mL in AIT patients. The distribution of thyroid volume was normal after log transformation. Thyroid volume was larger in patients with both autoantibodies than in patients with only one antibody (p<0.001). The first quartile of patients grouped according to thyroid volume were older (52.1 years, p=0.037) than the patients in other quartile groups. Thyroid volume correlated independently with TPOAb titer, and TgAb titer adjusted for other factors in a multivariate analysis. CONCLUSION: Thyroid volume in Korean AIT patients had an unimodal distribution and correlated with autoantibody titer.

Clinical Results of Open Reduction and Internal Fixation in the Coronal Plane Articular Fracture of the Distal Humerus / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the surgical outcomes according to the Ring's classification system in patients with the distal humeral coronal plane articular fracture after treatment with open reduction and internal fixation (OR/IF). MATERIALS AND METHODS: Patients with the distal humeral coronal plane articular fracture treated with OR/IF in the three hospitals were reviewed retrospectively. The patients were evaluated clinically and radiographically according to the Ring's classification system. RESULTS: Eleven patients, including three males and eight female patients, with a mean age of 55 years (15–88 years) were enrolled in this study. Average Mayo elbow performance score was 85 (60–100), four patients had excellent, four had good, and three had fair results. Fracture union was achieved in ten of 11 patients who underwent open reduction and internal fixation. In the analysis of the results according to Ring's classification, patients presenting fracture of the posterior aspect of the lateral column showed worse clinical results than those who did not. It was the same for the patient presenting fracture of the posterior aspect of the trochlea. CONCLUSION: The open reduction and internal fixation provides good clinical and radiologic outcomes for the distal humeral coronal plane articular fracture. Our results suggest that the type of fracture involvement with posterior aspect of trochlear or capitellum can result in poor clinical outcomes.

Biomechanical Analysis of Operative Methods in the Treatment of Extra-Articular Fracture of the Proximal Tibia

BACKGROUND: To determine relative fixation strengths of a single lateral locking plate, a double construct of a locking plate, and a tibial nail used in treatment of proximal tibial extra-articular fractures. METHODS: Three groups of composite tibial synthetic bones consisting of 5 specimens per group were included: lateral plating (LP) using a locking compression plate-proximal lateral tibia (LCP-PLT), double plating (DP) using a LCP-PLT and a locking compression plate-medial proximal tibia, and intramedullary nailing (IN) using an expert tibial nail. To simulate a comminuted fracture model, a gap osteotomy measuring 1 cm was created 8 cm below the knee joint. For each tibia, a minimal preload of 100 N was applied before loading to failure. A vertical load was applied at 25 mm/min until tibial failure. RESULTS: Under axial loading, fixation strength of DP (14,387.3 N; standard deviation [SD], 1,852.1) was 17.5% greater than that of LP (12,249.3 N; SD, 1,371.6), and 60% less than that of IN (22,879.6 N; SD, 1,578.8; p < 0.001, Kruskal-Wallis test). For ultimate displacement under axial loading, similar results were observed for LP (5.74 mm; SD, 1.01) and DP (4.45 mm; SD, 0.96), with a larger displacement for IN (5.84 mm; SD, 0.99). The median stiffness values were 2,308.7 N/mm (range, 2,147.5 to 2,521.4 N/mm; SD, 165.42) for the LP group, 4,128.2 N/mm (range, 3,028.1 to 4,831.0 N/mm; SD, 832.88) for the DP group, and 5,517.5 N/mm (range, 3,933.1 to 7,078.2 N/mm; SD, 1,296.19) for the IN group. CONCLUSIONS: During biomechanical testing of a simulated comminuted proximal tibial fracture model, the DP proved to be stronger than the LP in terms of ultimate strength. IN proved to be the strongest; however, for minimally invasive osteosynthesis, which may be technically difficult to perform using a nail, the performance of the DP construct may lend credence to the additional use of a medial locking plate.

Reconstruction of the Glenoid Using Iliac Bone Graft for Recurrent Anterior Shoulder Instability with Severe Glenoid Bone Defect: A Report of Two Cases

PURPOSE: The purpose of this report was to assess a surgical technique-using an autogenous tricortical iliac crest bone graft in patients with epilepsy-for anatomical glenoid reconstruction for recurrent anterior glenohumeral instability with severe glenoid deficiency. MATERIALS AND METHODS: We studied two cases of recurrent anterior dislocation of the shoulder due to epilepsy. These cases were treated with anatomical glenoid reconstruction using an autogenous tricortical iliac crest bone graft. RESULTS: Both cases achieved bone union in 5 months. There was no recurrence of instability and pain. Both cases had normal range of motion. CONCLUSION: Anatomical glenoid reconstruction for recurrent anterior glenohumeral instability with severe glenoid deficiency using an autogenous tricortical iliac crest bone graft is a successful surgical technique for achieving shoulder stability.

Dynamic Morphologic Study of the Ulnar Nerve Around the Elbow Using Ultrasonography

Purpose: The morphological study and dynamic stability of the ulnar nerve around the elbow joint was investigated in asymptomatic normal population using ultrasonography. The purpose of this study is to provide fundamental data for ultrasonographic diagnosis of ulnar neuropathy in cubital tunnel syndrome. Materials and Methods: Fifty cases of 25 healthy male volunteers, aged between 20 to 30 years, included in this study. High resolution 7.5 MHz linear probe was used to examine the ulnar nerve in axial and longitudinal views. In a longitudinal view, the course, position and the thickness of nerve were monitored, the diameter of ulnar nerve and dynamic stability at elbow flexion and extension were measured in an axial view at four different points; 1cm proximal to medial epicondyle, behind the medial epicondyle, entrance to Osborne ligament, and 1cm distal to Osborne ligament. Results: The short diameters of ulnar nerve at elbow extension at four anatomic points were 2.66 mm, 2.97 mm, 2.64 mm, and 2.69 mm and the long diameters were 4.61 mm, 4.56 mm, 4.36 mm, and 4.37 mm, which showed no significant change at each point. However, at elbow flexion, the short diameters were changed to 2.72 mm, 2.34 mm, 2.65 mm, and 2.41 mm and the long diameters into 4.49 mm, 5.40 mm, 4.16 mm, and 4.66 mm. At elbow flexion, significant morphologic change was observed in the medial epicondyle area, and the diameter of the ulnar nerve was shortest at the entrance of Osborne ligament both at flexion and extension. In terms of dynamic stability, nine subluxations and seven dislocations were observed. Conclusion: This study shows dynamic instability and a morphological change of long and short diameters of ulnar nerve at flexion and extension in a normal person, which should be considered in the ultrasonographic diagnosis of ulnar neuropathy.

Early Failure of Total Hip Arthroplasty with Hydroxyapatite-Coated Smooth Surface Acetabular Component / 대한정형외과학회잡지

PURPOSE: To evaluate the early intermediate outcomes of total hip arthroplasty using hydroxyapatite (HA)-coated smooth surface hemispherical acetabular component. MATERIALS AND METHODS: Seventy total hip arthroplasties were performed, in 63 patients, using a HA-coated smooth surface hemispherical acetabular component consecutively between June 1993 and August 1996. Fifty-four cases were followed at an average of 71 months. The mean age at the time of arthroplasty was 49 years old. Clinical results were evaluated using the modified Harris hip score, and the radiologic results were evaluated in terms of stability, polyethylene wear rate, and osteolysis around the acetabular component. RESULTS: The mean preoperative Harris hip score of 50.9 was improved to 82.2 points at the most recent follow-up. Pelvic osteolysis was found at 18 cases (33%) and the mean polyethylene wear rate was 0.15 mm/year. Eight acetabular components (15%) were unstable radiologically and 7 acetabular components (13%) were revised. CONCLUSION: Total hip arthroplasty using HA-coated smooth surface hemispherical acetabular component showed accelerated polyethylene wear rate, which was accompanied by a high incidence of osteolysis, and a high loosening rate due to failure of bony ongrowth at early midterm.

Functional and Radiological Outcomes of Patella Retaining Total Knee Arthroplasty: Minimun 5-Year Follow-up Results / 대한정형외과학회잡지

PURPOSE: Conflicting results have been reported for patellar resurfacing in total knee arthroplasty. We reviewed the clinical and radiological results of patella retaining total knee arthroplasties retrospectively. MATERIALS AND METHODS: Patella retaining total knee arthroplasty using a press-fit condylar (PFC) model by the hybrid technique was reviewed retrospectively in 27 knees (22 patients). Clinical evaluation was done according to HSS knee and patella scores. Radiographic assessment was made by measuring the patellofemoral joint space (mild, moderate, and severe loss), patellar sclerosis, patellar tilt, and patellar subluxation. RESULTS: The mean HSS knee score improved from 58 to 87 and the patellar score was found to be good or excellent in 85% (23/27) of cases. Patellar sclerosis was found in 10 cases (9 lateral and 1 medial) and patellar tilting was found in 4 cases (15%). Correlation between the radiographic findings and the clinical scores was statistically indifferent (p>0.05). CONCLUSION: Patella retaining total knee arthroplasty may reduce patellofemoral complications but long term radiographic and clinical follow-up including patellar sclerosis, patellar tilting, and patellar subluxation is recommended.

Fourth Brachymetatarsia Treated by Distraction Osteogenesis / 대한정형외과학회잡지

PURPOSE: We retrospectively reviewed outcomes, complications and their influencing factors after distraction osteogenesis for fourth brachymetatarsia. MATERIALS AND METHODS: We performed twenty-two cases of metatarsal lengthening with external fixator in sixteen patients for fourth brachymetatarsia from May 1998 to May 2000. At the final follow-up, AOFAS scores were awarded according to stiffness, pain, function, alignment and the satisfaction of patients. RESULTS: On average, the gain in length was 16.5 mm, the percentage of lengthening 38.9%, and the healing index 72.9 days/cm. There were some complications including subluxation of the metatarsophalangeal joint in 7 cases, stiffness in 5 cases, pin tract infection in 2 cases, and angular deformity in 3 cases. Those having a percentage of lengthening of less than 40% and those involving only the metatarsus had better results. Most patients were satisfied with the corrected result, though one unsatisfied patient underwent revision surgery. CONCLUSION: Even though distraction osteogenesis for fourth brachymetatarsia is effective, excessive lengthening in patients involving both metatarsus and phalange can produce minor complications.

Correction of Thoraco-Lumbar Kyphotic Deformity using a Posterior Interbody Fusion / 대한척추외과학회지

PURPOSE: This is a retrospective study evaluating the efficacy of posterior thoraco-lumbar interbody fusion for the treatment of thoraco-lumbar kyphotic deformity. MATERIALS AND METHODS: A posterior thoraco-lumbar interbody fusion was performed in 10 patients with thoracolumbar kyphotic deformity from April 1996 to April 1999. The mean age was 39.5 years (range 16 ~59 years), and five were male and five were female. The cause of deformity was tuberculous spondylitis in 7 cases, post-traumatic kyphosis in 2 cases, and ankylosing spondylitis in 1 case. Three cases involved thoracic spine alone, 3 cases involved thoracolumbar junction, and 4 cases involved lumbar spine alone. The chief complaint was lower back pain in 6 cases, progression of deformity in 2 cases, and both type in 2 cases. There was no patients with neurologic symptoms or signs. The average postoperative follow-up period was 19.5 months (range 12~33 months) RESULTS: By standard Cobb measurement, the mean preoperative kyphosis of 43.7 degrees was reduced to 19.3 degrees in the immediate postoperation and to 22.5 degrees in the last follow-up. Mean correction rate was 51.4% and average loss of correction was 3.2 degrees. Interbody fusion was achieved in 9 cases out of 10 by criteria of Lee et al. Clinical results such as back pain, fatigue pain, and tingling sensation were improved in 8 cases out of 10 by criteria of Lin et al. Nine patients were satisfied with the correction of the deformity. Mean operation time was 255 minutes and average amount of transfusion was 1400 ml(3.5 pints) of packed red cell. There was no serious complications like paraplegia or death. CONCLUSION: A posterior thoraco-lumbar interbody fusion is a relatively easy, safe and good-outcome technique for treatment of moderate thoraco-lumbar kyphotic deformity

The Correlation between CD34+ Cell and Nucleated RBC Counts in Human Cord Blood

PURPOSE: Human umbilical cord blood as a potential source of hematopoietic stem cell for stem cell transplantation in children has recently been advocated. Clinical application of cord blood transplantation, however, requires adequate blood volume and number of stem cells. Currently, the number of stem cells in the cord blood is usually measured by flowcytometry, which requires strict quality control and high costs. Here, we postulate that the number of nucleated red blood cells(NRBC) which are relatively immature erythroid cells may correlate well with that of CD34-expressing(CD34+) cells which are considered lymphohematopoietic precursors. If so, CD34+ cell-rich cord blood can be selected and such cells enumerated by a simple and cost-effective blood smears. METHODS: Correlation between CD34+ cell and nucleated RBC in human cord blood were checked. Sixty cord blood specimens(30 specimens for group A with NRBC>500/mul and 30 specimens for group B with NRBC500/ul; 55+/-61(SD))(p<0.005). 3.Regression relationship among CD34+ cell, WBC, and NRBC counts was as following. ln(CD34+ cell) = -12.21 + 1.46xln(WBC)+ 0.25xln(NRBC) gamma2=30.07 p=0.0001 4.There was a significant correlation between CD34+ cell counts and NRBC counts(gamma=0.4334, p<0.005) CONCLUSIONS: Our results suggest that there is a significant correlation between CD34+ cell counts and NRBC counts, and that CD34+ cell-rich cord blood specimens can be selected by a simple NRBC counting.