Anterior Release and Fusion followed by Posterior Correction in Scoliosis: A Comparison of Open Thoracotomy and the Thoracoscopic Approach / 대한정형외과학회잡지

PURPOSE: To compare the results of the thoracoscopic approach and open thoracotomy retrospectively for scoliosis requiring anterior release and fusion followed by posterior correction. MATERIALS AND METHODS: Of 22 rigid scoliosis patients, 10 open thoracotomy cases (group I) were compared with 12 thoracoscopic cases (group II) in terms of blood loss, operation time, and chest pain (visual analogue scale, VAS), as checked 1 week after operation and final follow-up, correction ratio of major curve and complications. Posterior correction was performed 2 weeks after anterior release. Statistical analysis of group differences was performed using the t-test or the Mann-Whitney. RESULTS: Blood loss was higher in group I, 268.0 mL (200-530) than in group II, 195.0 mL (100-280) (p=0.047). The operation time was shorter in group I, 108.0 minutes (90-180) than in group II, 175.0 minutes (120-240) (p=0.001), and chest pain (visual analogue scale, VAS) which was checked at 1 week after operation and at final follow-up was milder in group II, 3.9 (3-6), 1.6 (0-3) than in group I, 5.8 (4-8), 3.1 (1-5) (p=0.005, p=0.013, respectively). The correction ratios of the major curve between two groups were similar. The cosmetic aspects of the thoracoscopic approach were favorable. The postoperative complications were 1 pneumothorax in each group and 3 chronic chest pain in group I. CONCLUSIONS: The results of thoracoscopic approach for anterior release were compared favorably with standard open thoracotomy in terms of blood loss, chest pain both postoperatively and at final follow-up, and cosmetics, but unfavorably for operation time.

Simultaneous Endoscopic Sinus Surgery and Rhinoplasty: A Pilot Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Plastic surgeons have generally avoided performing rhinoplasty in the presence of rhinosinusitis due to potential infection. For the otolaryngologist, concurrent rhinoplasty can produce increased periorbital swelling and ecchymosis, which can obscure the parameters used to monitor complications of the sinus procedure. But recent advances of endoscopic sinus surgery have made the simultaneous procedures safe in appropriately selected patient. The purpose of this report is to identify the indications and limitations of the simultaneous procedures. MATERIALS AND METHOD: Seven patients were treated by this combined modality and all were available for follow-up. There were 3 women and 4 men with a mean age of 35 years who underwent the combined procedure by the otolaryngologist. RESULTS: Recurrence of sinusitis occurred in one patient, and another patient wanted revision rhinoplasty for cosmetic dissatisfaction. There were no other complications. CONCLUSION: Combined rhinoplasty and endoscopic sinus surgery can be performed safely and with good results in selected patients.

Result of Traction Thoracolumbosacral Orthosis in Idiopathic Scoliosis / 대한척추외과학회지

STUDY DESIGN: A retrospective study of the effectiveness of traction thoracolumbosacral orthosis (TLSO) in idiopathic scoliosis. OBJECTIVE: To compare the results of traction TLSO and conventional TLSO. SUMMARY OF LITERATURE REVIEW : No report has been published about longitudinal traction and lateral force before cast molding in the nonoperative treatment of idiopathic scoliosis. MATERIALS AND METHODS: Twenty-one cases of traction TLSO (group I) and 17 cases of conventional TLSO (group II) were studied. Traction TLSO was made as follows: 1. Cervical traction was applied to the patient standing under the frame with application of lateral force with compression pad. 2. Cast molding. 3. Fabrication of plastic jacket and application of pads. The mean age of group I was 12 years and of group II, 13 years. We evaluated the effectiveness of traction TLSO with Cobb`s angle reduction, trunk pain and dyspnea. Statistical analysis was made with SPSS. RESULTS: In group I, mean pre-brace Cobb`s angle was 31.1 degrees and in group II, 29.6 degrees. Flexibility of the curves was 78% and 75%, respectively. Mean reduction rate of Cobb`s angle after 3 days of brace application was 59.5% and 15.4%, respectively. One year later, reduction of Cobb`s angle was 15.4 degrees in group I and 2.7 degrees in group II. Reduction rate of Cobb`s angle after 1 year of brace application was 54.2% and 7.9%, respectively. Post-brace pain and dyspnea were similar in both groups. CONCLUSION: Traction TLSO was superior to conventional TLSO in terms of angle reduction, but was similar in subjective symptoms.

The Effect of Hemodialysis on the Olfactory Function in Chronic Renal Failure Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The sense of smell plays an important role in the quality of life. Loss of smell is common in the elderly and it results from respiratory diseases, certain disease states (Alzheimer disease, chronic renal failure (CRF), multiple sclerosis), medications, and surgical interventions. Many studies have shown a declining odor perception in the CRF patients. The objectives of the present study were to test odor identification ability in patients with CRF and the effect of hemodialysis on olfactory recognition, and to examine the possible correlations between smell identification test score and various clinical parameters. MATERIALS AND METHOD: We performed a case-control study comparing the Cross- Cultural Smell Identification Test (CC-SIT) scores of CRF patients with hemodialysis, and those without hemodialysis, and age-sex matched healthy controls. RESULTS: Healthy controls had significantly high CC-SIT scores compared to those of CRF patients without hemodialysis. No significant differences were observed in the CC-SIT scores between CRF patients with hemodialysis and healthy controls and in CRF patients before and after the hemodialysis session. No significant positive correlation was found between CC-SIT score and creatinine clearance in the dialysis group. CONCLUSION: Acute removal of uremic toxins by hemodialysis does not correct olfactory disturbances. Odor perception is severly impaired in patients with CRF and is related to the degree of renal impairment.

Particle Image Velocimetry Measurements for the Study of Nasal Airflow / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Several studies have utilized physical models or casts of the nasal cavity in an effort to understand the relationship between nasal anatomy and the distribution of inspired or expired airflow. This paper deals with the evaluation of nasal airflow characteristics during physiologic breathing in normal conditions. MATERIALS AND METHOD: The choana of a nasal model casting by a combination of rapid prototyping and solidification of clear silicone was connected to a pump that simulated physiological pressure in the upper airway system. Glycerin-water mixture was used as medium. The airstream was marked with polyvinyl spherical particles, and was observed through an solidificated clear silicone and analyzed with particle image velocimetry. RESULTS: Turbulence is clearly visible at the level of the head of the middle turbinate. The maximal velocity was recorded at the superior meatus. The flow rate was highest at the middle meatus. CONCLUSION: This model allows the investigation of airflow distribution and velocity under physiologic conditions. The main flow stream passes through the middle meatus.

An analysis of adolescent idiopathic scoliosis according to Coonrad classification / 대한정형외과학회잡지

PURPOSE: To establish the interobserver and intraobserver reliability of the Coonrad classification for an idiopathic coronal curve pattern. MATERIALS AND METHODS: Radiographs of 257 idiopathic scoliosis patients that had a rib humping of more than 1 cm and a Cobb angle of more than 10 were reviewed. The interobserver and intraobserver reliability was assessed by a comparison of the classification of the curves between four observers. RESULTS: In the Coonrad classification, a 1A type-curve occurred in 37 cases, the 1B type-curve occurred in 27 cases, the 2A type-curve occurred in 70 cases, a 2B type-curve occurred in 22 cases, a 3 type-curve occurred in 44 cases, a 4 type-curve occurred in 6 cases, a 5 type-curve occurred in 15 cases, a 6 type-curve occurred in 22 cases, a 7 type-curve occurred in 13 cases and a 8 type curve occurre in 1 case. The interobserver reliability for the Coonrad classification was 0.60 and the intraobserver reliability was 0.71. CONCLUSION: The Coonrad classification proved to be relatively reliable, but revealed some confusion, particularly between type 2A and type 3. Also, there seemed to be no advantage in using this method of determining the treatment modality compared with the conventional scoliosis classification system.

The Effect of Combined Aniviral Agent Therapy for Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The idiopathic sudden sensorineural hearing loss is a disease that develops within several hours to several days. Its etiology is not verified yet, but disturbance of blood circulation in the inner ear, intracochlear membrane break, inner ear hydrops and viral infection are considered as possible causes of disease. The herpes virus family is one of the possible viral pathogens that can cause a sudden hearing loss. The purpose of this study was to evaluate the effect of antiviral agent (Vacrovir, 200 mg/T, acyclovir) on sudden sensorineural hearing loss. MATERIALS AND METHOD: Fifty-eight ears were studied from 56 patients who were admitted to Konkuk University Medical Center Minjoong Hospital from December 1993 to August 1999. Fifty eight ears were divided into experimental (30 ears) and control (28 ears) groups. Acyclovir (3000 mg/ day) was added to the therapeutic regimen in the experimental group. The effect of antiviral agent therapy was analyzed according to the factors relating to the prognosis. RESULT: 1) Total recovery rate of the experimental group(76.7%) was significantly (p0.05). CONCLUSION: These results suggest that the antiviral agent therapy seems to be effective on the recovery of sudden sensorineural hearing loss. The factors which affect good prognosis in the antiviral agent therapy were age (less than fifty years), early initial treatment that began within 2 weeks, mild to severe hearing loss, accompanying symptom of tinnitus and no dizziness.

The Causative Factors of Dislocation after Total Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: We performed a clinical study and a matched-set radiographic analysis to determine the factors that contribute to dislocation after total hip arthroplasty. MATERIALS AND METHODS: We reviewed 346 total hip arthroplasties (46 were revision procedure) followed by more than 1 year from January, 1992 to June, 1998. A clinical study was performed for dislocated group (16 cases) and non-dislocated group as to disease and patient's factors and prosthesis type. A radiographic analysis was performed for dislocated group and matched control group (32 cases) to evaluate operative factors. RESULT: Dislocation occurred in sixteen cases (4.6%) of the 346 total hip arthroplasties. There was no statistical correlation between age, gender, preoperative diagnosis or prior hip surgery in disease and patient's factor and dislocation. The patients who had a history of alcoholism (more than 0.8 bottle of Soju a day) had the significant difference in dislocation rate in comparison with the patients who did not have such a history. Operative factors were studied by radiographic analysis for sixteen hips that had dislocated and thirty-two that had not. We detected no relationships between the angle of the anteversion and inclination of the cup, leg length difference or the rate of horizontal offset and the risk of dislocation. The prosthesis type and acetabular liner also had no relationships with the dislocation. CONCLUSION: Although the causative factors for dislocation after total hip arthroplasty were not related to operative factor and prosthesis type, alcoholism in patient related factors was important.

Osteonecrosis of the Both Knees in a Pediatric Patient following Combination Chemotherapy for Acute Lymphocytic Leukemia: A Preliminary Report

Osteonecrosis (Avascular necrosis) of the bone is a known complication of systemic corticosteroid therapy and may he dose related. It also has been associated less commonly with nonsteroida1 chemotherapy. Nonetheless, avascular necrosis of bone has heen reported infrequently in children who have received antileukemia regimens including prednisone. We report our experience with one adolescent girl with acute lymphocytic leukernia (ALL) who developed hoth femoral condylar osteonecrosis presenting bone pain after aggressive chemotherapy that including high cumulative dosage of corticosteroid as well as other antileukemia agents. We performed arthroscopic surgery with debridement, multiple drilling and screw fixation to the lesion sites. Eight months after operation, she was free of pain with full range of both knee movements. We got good resuit according to Hughston criteria.