Outcomes of Minimally Invasive Surgery in Intra-Articular Calcaneal Fractures:Sanders Type III, Joint Depressive Type Calcaneal Fracture

Purpose@#To evaluate the radiologic and clinical outcomes of a minimally invasive technique using the tarsal sinus approach in the management of Sanders type III, joint depressive type calcaneal fractures. @*Materials and Methods@#Between July 2011 and September 2019, data of 29 patients who underwent a minimally invasive procedure with the sinus tarsi approach for Sanders type III joint depressive intra-articular calcaneal fractures, and were followed up for more than 1 year were analyzed. We evaluated the radiologic outcomes by assessing the radiologic parameters (Böhler angle, Gissane angle, calca-neal length, calcaneal height, calcaneal width). We also evaluated the clinical outcomes based on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the complications associated with the technique. @*Results@#The radiological results showed an improvement in the Böhler angle from 2.5° to 18.6° and the Gissane angle from 132.4° to 119.1° after the operation. The mean AOFAS score during the clini-cal evaluation was 79.5. We observed 13 cases of posttraumatic arthritis, 1 case of subtalar arthrodesis, and no case of wound complication. @*Conclusion@#Minimally invasive technique for Sanders type III joint depressive calcaneal fractures resulted in relatively satisfactory radiologic and clinical outcomes. Open reduction and internal fixation through the sinus tarsi approach reduce complications including wound problems. This approach offers satisfactory results without long-term complications.

Pre- and Post-Angioplasty Perfusion CT with Acetazolamide Challenge in Patients with Unilateral Cerebrovascular Stenotic Disease

OBJECTIVE: Perfusion computed tomography (PCT) has the ability to measure quantitative value and produce maps of mean transit time (MTT), cerebral blood flow (CBF), and cerebral blood volume (CBV). We assessed cerebral hemodynamics by using these parameters and acetazolamide (ACZ) challenge for pre- and post-procedural evaluation in patients with unilateral cerebrovascular stenotic disease. METHODS: Thirty patients underwent pre-procedural PCT with ACZ challenge, and 24 patients (80%) was conducted follow up PCT after angioplasty with same protocol. The mean MTT, CBF, and CBV were measured and compared in both middle cerebral arterial (MCA) territories before and after ACZ challenge. Hemispheric ratio and percent change after ACZ challenge were calculated before and after angioplasty. RESULTS: The mean stenosis rate was 76.6%. Significant increases in MTT (32.6%, p=0.000) and significant decreases in CBF (-14.2%, p=0.000) were found in stenotic side MCA territories. After ACZ challenge, there were significant changes in MTT (37.4%, p=0.000), CBF (-13.1%, p=0.000), and CBV (-10.5%, p=0.001) in pre-procedural perfusion study. However, no significant increases were found in MTT, or decreases in CBF and CBV in post-procedural study. There were no significant changes after ACZ challenge also. In addition, the degrees of these changes (before and after ACZ challenge) were highly correlated with the stenotic degrees in pre-procedural perfusion study. CONCLUSION: PCT with ACZ challenge appears to be a useful tool to assess the cerebral perfusion status especially in patients with unilateral symptomatic stenotic disease.

Comparison of Drug-eluting Coronary Stents, Bare Coronary Stents and Self-expanding Stents in Angioplasty of Middle Cerebral Artery Stenoses

OBJECTIVE: The purpose of this study is to investigate the results of treatment using stent-angioplasty for symptomatic middle cerebral arterial (MCA) stenosis and comparison of in-stent restenosis between drug-eluting stents (DES), bare metal coronary stents (BMS) and self-expanding stents (SES). MATERIALS AND METHODS: From Jan. 2007 to June. 2012, 34 patients (mean age +/- standard deviation: 62.9 +/- 13.6 years) with MCA stenosis were treated. Inclusion criteria were acute infarction or transient ischemic attacks (TIAs) and angiographically proven symptom related severe stenosis. Stents used for treatment were DES (n = 8), BMS (n = 13) and SES (n = 13). National Institutes of Health Stroke Scale (NIHSS) at admission was 2.5 +/- 3.1 and mean stenosis rate was 79.0 +/- 8.2%. Assessment of clinical and angiographic results was performed retrospectively. RESULTS: Among 34 patients, periprocedural complications occurred in four cases (11.8%), however, only two cases (6.0%) were symptomatic. All patients were followed clinically (mean follow-up period; 40.7 +/- 17.7 months) and 31 were followed angiographically (91.2%. 13.4 +/- 8.5 months). There was no occurrence of repeat stroke in all patients; however, mild TIAs related to restenosis occurred in three of 34 patients (8.8%). The mean NIHSS after stent-angioplasty was 1.7 +/- 2.9 and 0.8 +/- 1.1 at discharge. The modified Rankin score (mRS) at discharge was 0.5 +/- 0.9 and 0.3 +/- 0.8 at the last clinical follow-up. In-stent restenosis over 50% occurred in five of 31 angiographically followed cases (16.1%), however, all of these events occurred only in patients who were treated with BMS or SES. Restenosis rate was 0.0% in the DES group and 20.8% in the other group (p = 0.562); it did not differ between BMS and SES (2/11 18.2%, 3/13 23.1%, p = 1.000). CONCLUSION: Stent-angioplasty appears to be effective for symptomatic MCA stenosis. As for restenosis, in our study, DES was presumed to be more effective than BMS and SES; meanwhile, the results did not differ between the BMS and SES groups.

A Case of Mycoplasma Pneumonia Complicated with Status Epilepticus and Encephalopathy / 소아알레르기및호흡기학회지

Mycoplasma pneumoniae is known to be a common respiratory pathogen in children and adolescents. It rarely causes neurologic complications, such as meningitis, encephalitis and cerebellar ataxia, in some patients as extrapulmonary manifestations. Neurologic symptoms, such as impairment of consciousness, seizure and paralysis, in the early stage. We report a case of lobar pneumoia caused by M. pneumoniae which was complicated with status epilepticus and encephalopathy.

Two Cases of Familial Hypokalemic Periodic Paralysis Caused by Salty Foods / 대한소아신경학회지

Hypokalemic periodic paralysis is an autosomal dominant disorder characterized by episodic weakness of skeletal muscle associated with hypokalemia. It may be presented as familial or sporadic. Familial hypokalemic periodic paralysis is caused by mutations in the muscle membrane dihydropyridine sensitive calcium channel alpha-1 subunit. The abnormal genes in most cases are located in the chromosome 1q31-32. We experienced 2 cases(a 14-year-old male, a 12-year old male) of familial hypokalemic periodic paralysis. Two cases presented with quadriplegia after eating salty foods. The diagnosis was made by demonstrating decreased plasma level of potassium. The patient responded dramatically to potassium replacement therapy. We report two cases of familial hypokalemic periodic paralysis caused by salty foods with a brief review of related literatures.

Effect of Encircling Silicone Sponge for Retinal Detachment

120 eyes of 119 patients with retinal detachment were treated with an encircling silicone sponge scleral buckling in the department of Ophthalmolgy, Severance Hospital, Yonsei University Medical Center from September 1, 1988, to January 31, 1991. Results were as follow 107 eyes among 120 eyes (89.2%) showed anatomical success, and 54 eyes of them (45%) showed functional success. As the preoperative factors, the case of over 20/70 vision (100%, p>0.05, 100%, p0.05, 57%, p0.05,61%, p0.05, 54%, p<0.05) showed favorable anatomical and functional success rate. The presence and degree of the proliferative vitreoretinaopathy affected the anatomical and functional success rate, but the age of patients did not affect the success of surgery.

A Standard Method of Measuring Tear Film Break-Up Time in Normal Subjects

The tear film break-up time test is a useful diagnostic test for dry eye syndrome,but it shows a wide range of results in normal subjects according to many factors, especially the methods of measuring it. We studied the factors having some influences on B.U.T. and tried to find out a standard method of measuring B.U.T. in normal subjects. The results were as follows: 1. The subjects were healthy without any ocular disease or symptoms. Total subjects were 200 persons, 400 eyes. 2. The standard method of measuring B.U.T. was as follows: a drop of 0.125% sodium fluorescein was applied into the conjunctival sac and the patient was allowed to blink for at least 1-2 minutes. The tear film was then scanned without holding the lids, using the slit lamp beam, 4-5mm in width. 3. The mean B.U.T. measured by the standard method was 20.35 +/- 6.45 sec in normal subjects. 4. The mean B.U.T. was 18.17 +/- 8.02'sec in the group using fluorescein paper, 9.68 +/- 6.19 sec in the group blinking just 4-5 times,16.54 +/- 8.32 sec in the group measured holding the lids with the fingers, and 18.36 +/- 7.95 sec in the group using a broad beam. 5. There were statistically significant decreases of B.U.T. in the group blinking just 4-5 times and in the group measured holding the lids with the fingers.