Frequency of Radiographic Knee Osteoarthritis in Women Having Knee Joint Pain / 대한류마티스학회지

OBJECTIVE: This study was done to evaluate the frequency and to examine the difference of radiographic findings between patellofemoral joint (PFJ) and tibiofemoral joint (TFJ) in radiographic change of knee osteoarthritis (OA). METHODS: 347 Korean women (694 knees) who visited our clinic with knee joint pain took anteroposterior (AP) weight bearing view of TFJ, lateral and skyline view of PFJ of the knees from Jan. to Dec. in 1999. Radiographs were read for features of OA using Kellgren-Lawrence. The difference of frequency in two joint's radiographic changes of OA was examined using chi-square and Wilcoxon signed rank test. RESULTS: Radiographic knee OA was correlated with patient's age (r=0.482, P<0.001) and with body mass index (r=0.123, p<0.001). Frequency of radiographic OA using lateral view of PFJ was 38.8%, using AP view of TFJ was 28% and skyline view of PFJ was 23.1% (p<0.05). CONCLUSION: These results show that lateral view of PFJ with AP view of TFJ increase the frequency of radiographic knee OA, but skyline view of PFJ doesn't contribute to increase the frequency of radiographic knee OA.

Correlation between Bone Mineral Density and Knee Osteoarthritis / 대한정형외과학회잡지

PURPOSE: To examine the correlation between bone mineral density (BMD) and radiographic changes in knee osteoarthritis (OA). MATERIALS AND METHODS: BMD of the lumbar spine and hip was measured, using dual x-ray energy absorptiometry, in 297 Korean women who visited our clinic with knee joint pain; anteroposterior weight bearing X-ray of the knees was also taken. Radiographic OA was defined as a Kellgren-Lawrence score of >or=2. The relationship between BMD and the radiographic changes of OA was examined using correlation and multiple regression analysis. RESULTS: Mean BMD was lower in subjects with knee OA (n=136) than in non OA subjects (n=161): Mean BMD in the lumbar spine, OA group was 0.863 +/-0.154 g/cm2 and in the non OA group 0.896 +/-0.131 g/cm2, and there was no significant correlation between the BMD of the spine and radiographic knee OA (r=-0.087, p=0.134). Mean BMD in the hip, OA group was 0.610 +/-0.135 g/cm2 and in the non OA group was 0.662+/-0.105 g/cm2, and the difference between the two groups was significant (r=-0.227, p<0.001). CONCLUSION: Hip BMD and radiographic knee OA were found to be negatively correlated, although the mechanism remains unclear. This result differs from that of a western study and further study is needed.

A case of small cell carcinoma of the rectum manifesting as pathologic femur neck fracture / 대한내과학회지

Small cell carcinoma of the colon and rectum is a rare primary epithelial malignancy at this location. Histologically, this tumor represents a spectrum of neuroendocrine differentiation. The neuroendocrine cancers of the colon manifest a highly aggressive behavior, even more than their adenocarcinoma counterpart of the same stage. Small cell carcinoma in the colon has early metastasis and the prognosis is extremely poor. We report a case of small cell carcinoma of the rectum manifesting as femur neck fracture during sleep.

Myoblast Transfer Therapy on mdxMouse / 대한정형외과학회잡지

PURPOSE: To observe dystrophin formation and histological improvement in dystrophic muscle of mdx mouse after normal myoblast injection. MATERIALS AND METHODS: Cultured myoblasts from genetically normal rats were injected into the right quadriceps femoris of a 6-week-old mdx mouse (n=9). dPBS was injected into the left quadriceps femoris as a control. One, 2, and 3 months after injection, The control and experimental group were compared histologically and by dystrophin immunostaining. RESULTS: When compared with controls 3 months postoperatively, quadriceps femoris in the experimental group exhibited greater cross-sectional area and total fiber number, and the experimental animals contained more normal-appearing and less abnormalappearing fibers than the control group. Most of the fibers in the experimental group showed positive results in dystrophin immunostaining, whereas immunostaining of mdx muscle fibers in the control group was completely negative. CONCLUSION: This study shows that normal myoblast injection improved the muscle architecture histologically and produced dystrophin protein in dystrophic muscle.

Diastasis of the Symphysis Pubis after Delivery / 대한정형외과학회잡지

PURPOSE: The objectives of this study are to observe the clinical characteristics, outcome of treatment and incidence of diastasis of the symphysis pubis after delivery and to evaluate the risk factors of the lesion. MATERIALS AND METHODS: Seventy-six patients diagnosed with diastasis of the symphysis pubis were reviewed. The diagnostic criteria of diastasis were; 1) positive signs and symptoms of pelvic instability, 2) radiological evidence of widening of the symphysis pubis by more than 6 mm and/or vertical mobility of more than 3 mm, or widening of the sacroiliac joint by more than 4 mm. Several factors that increase the risk of this lesion during delivery were reviewed and analyzed using the chi-square test, t-test, and by logistic regression. RESULTS: Seventy-six diastasis of the symphysis pubis were diagnosed in 24,089 deliveries during the study period. Joint widening ranged from 3 mm to 34 mm. Twenty-three cases had accompanying vertical mobility. Pain in the pelvic joint and walking difficulty were most common clinical characteristics. History of pelvic girdle relaxation during pregnancy was found to increase the risk of the lesion (P=0.0028). CONCLUSION: We found that a history of pelvic girdle relaxation during pregnancy was a risk factor of diastasis of the symphysis pubis after delivery. Early detection and satisfying results by optimal treatment are associated with recognizing the lesion's characteristic clinical findings.

Symptoms and Physical Examinations of Symptom-Giving Pelvic Girdle Relaxation in Pregnant Women / 대한산부인과학회잡지

OBJECTIVE: This prospective study was done to find out common symptoms and beneficial physical examinations, and to evaluate relations among symptom, pain severity, physical examination method and width of symphysis pubis of symptom-giving pelvic girdle relaxation (PGR) in pregnant women. METHODS: Four hundreds sixty-five pregnant women who complained pelvic pain were asked to fill out a questionnaire. Ninety-six pregnant women were diagnosed as PGR and were examined physically and took the sonogram. Statistical correlation was evaluated among symptoms, pain severity (visual analog scale: VAS), physical examination method and sonogram. RESULTS: The most common complain was difficulty of rolling in bed (100%). The most frequent positive diagnostic physical method was posterior pelvic pain provocative test (PPPT) (85.4%). There was correlation between VAS and symptoms (r= 0.340, P=0.001) but no correlations between VAS or symptoms and numbers of positive physical examination (P>0.05). CONCLUSION: It is suggested that PPPT was most beneficial diagnostic methods of PGR in pregnancy.

Asymmetric Exercise and Scoliosis: A Study of Volleyball Athletes / 대한정형외과학회잡지

PURPOSE: To determine the prevalence of scoliosis in volleyball athletes and compare this with the prevalence in the general population. MATERIALS AND METHODS: One hundred and sixteen volleyball athletes who had been enrolled in the activity for more than one year were examined for prevalence of scoliosis. The Adams forward bending test was performed with a measurement of the truncal asymmetry using a scoliometer (Orthopaedic System, Inc, USA). Those atheletes who showed more than 5degreesof measurement were selected for an X-ray evaluation. Data from a randomized point prevalence survey of Korean Middle school students (46,428) in Seoul City, which had been performed by our department, was adopted for the control group. RESULTS: Among the 116 volleyball players, 60 (51.7%) showed more than a 5degreesof angle of trunk rotation, whereas controls of middle school students showed 2.5%. Cobb's angle more than 10degrees was 6 (5.17%) in athletes and the control group was 465 (1.0%). Despite higher frequency of prevalence, the Cobb' angle was below 15degrees whereas the control group showed a severe scoliosis which of Cobb's angle reaching to 45degrees. CONCLUSION: Volleyball athletes showed a higher incidence of truncal asymmetry and scoliotic spinal columns than the control group. However, we were able to conclude that asymmetrical muscle development can produce a mild scoliosis. However this doesn't have the potential for a severe progression as found in some cases of idiopathic scoliosis.

Prevalence and Risk Factors of Symptom-Giving Pelvic Girdle Relaxation in Pregnant Women / 대한산부인과학회잡지

OBJECTIVE: This study was done to evaluate the risk factors and prevalence of symptom-giving pelvic girdle relaxation in pregnant women. METHODS: Three hundreds thirty-two postpartum women were asked to fill out a questionnaire within one week after their parturition. The diagnostic criteria of this lesion were adopted from the Norwegian Medical Association's and Larsen's criteria. The questionnaire were included age, parity, BMI(kg/cm2), weight gain during the pregnancy, history of symptom giving pelvic girdle relaxation in previous pregnancy, level of exercise and vocational status during and before the pregnancy and baby's birth weight. The answers were evaluated to determine the risk factors. The correlation was tested by student t-test and logistic regression. RESULTS: The prevalence of symptom-giving pelvic girdle relaxation during pregnancy was 18.9%. The history of symptom-giving pelvic girdle relaxation in previous pregnancy, multiparity and the absence of regular exercise before and during pregnancy showed correlation with symptom-giving pelvic girdle relaxation in pregnancy (p<0.05). CONCLUSION: It is suggested that women who experienced symptom-giving pelvic girdle relaxation in previous pregnancy should be checked for this lesion before pregnancy. Regular exercise is required to lower the incidence and lessen the severity of this lesion in pregnancy.

Incidence and Risk Factors of Pelvic Pain in Pregnancy / 대한척추외과학회지

STUDY DESIGN: An analysis was made of the questionnaire answers and pain drawings of postpartum women. OBJECTIVES: This study was done to evaluate the risk factors of pelvic pain in pregnancy and its incidence. SUMMARY OF LITERATURE REVIEW: Pelvic pain accounts for the major complaints among pregnancy women. The incidence and risk factors of pelvic pain during pregnancy in Korean women have not been defined fully. MATERIALS AND METHODS: Three hundreds thirty-two postpartum women were asked to fill out a questionnaire within one week after their parturition. Age, parity, body mass index(BMI; kg/cm(2)), weight gain during pregnancy, history of pelvic pain in previous pregnancy, level of exercise and vocational status during and before the pregnancy and baby's birth weight were asked and evaluated to determine risk factors. The correlation was tested by student t-test and logistic regression. RESULTS: The incidence of pelvic pain during pregnancy was 53.3%. The history of pelvic pain in previous pregnancy showed correlation with pelvic pain in pregnancy(p<0.05). CONCLUSION: It is suggested that women who experienced pelvic pain in previous pregnancies should be checked for pelvic pain before pregnancy. Effective intervention of pelvic pain will be needed in further studies.

Effects of obesity on bone mineral density in aged Korean women

BACKGROUND: In general, increased body weight may be a risk factor for hypertension, diabetes, hyperlipidemia, and coronary heart disease. It is very difficult to lose weight especially in aged people. Osteoporosis is commonly developed in aged. Many reports revealed that obesity may prevent bone loss. The protective effect of obesity on bone has been ascribed to a high body fat content. Obese aged people can be very confused whether to decide to lose weight or not. METHODS: We evaluated 137 women aged over 60 who visited a health care center of a university hospital in Seoul from Jan. 1999 to Oct. 1999 to determine the effects of obesity on bone mineral density in aged Korean women. We measured anthropometrical characteristics, BMD of lumbar spine, markers of bone turnover, and FSH of the subjects. RESULTS: The results revealed that obese group had a greater BMD at lumbar spine, but the levels of FSH were noted to be lower than the non obese group. But, none of the markers of bone turnover showed significant differences between the two groups. BMI was positively correlated with BMD (r=0.455, P<0.001) by Pearson's correlation matrix. Also, the level of total alkaline phosphatase significantly had negative association with BMD. The level of FSH revealed that it had a negative correlation (r= 0.290, P<0.01) with BMI. CONCLUSION: We concluded that obesity might have a protective effect related with FSH. Prospective studies on endocrinologic association with BMD, bone markers, FSH and estradiol will be needed.

3\Month follow up results after alendronate therapy in postmenopausal osteoporosis

BACKGROUND: Increased bone turnover results in bone loss after menopause. After menopause, the major cause of bone loss is estrogen deficiency. Rate of bone loss seems to increase after menopause and then formation coupled with resorption is also increased. Antiresorptive drugs are known to be helpful in preventing bone loss. Alendronate is one of antiresorptive drugs for the treatment of osteoporosis which results in a decrease in bone turnover. Some papers report about nonresponders to antiresorptive drugs, and screening people early is very important to optimal management. There are no available data of Korean people. Therefore, this study evaluated the effects of alendronate in Korean postmenopausal osteoporosis patients after 3 months of treatment. METHODS: We studied 96 women with postmenopausal osteoporosis (bone mineral density{BMD} T score<2.5) who visited Climacteric Clinic in Samsung Cheil Hospital from Jan. 1999 to Jul. 1999. Subjects were stratified in to 3 groups: Group 1 treated with alendronate (Fosamax ; MSD, Rahway, NJ, USA) 10mg/day and estrogen, Group 2 treated with calcitonin nasal spray 100 IU every other day and estrogen, and Group 3 treated with estrogen alone for 3 months. We measured serum marker of bone formation (osteocalcin [BGP]), and marker of bone resorption (deoxypyridinoline [DPYD]) from urine at baseline and 3 months after treatment. RESULTS: The mean difference in change of markers among the three groups at the end of study that were significant were BGP 25.7 4.8% and DPYD 23.3 2.3%. DPYD known as bone resorption marker showed a significant response in alendronate and estrogen therapy group than estrogen alone group (P<0.05). Also, BGP showed response to estrogen alone, and calcitonin and estrogen group, but its responsiveness was lesser than alendronate therapy. CONCLUSION: Our data showed that using alendronate with estrogen in patients of osteoporosis further prevents bone resorption. Therefore, we conclude that alendronate therapy with estrogen is helpful in managing osteoporosis patients.

The Carrier Detection and Genetic Counseling of Duchenne and Becker Muscular Dystrophy Using Linkage Analysis / 대한정형외과학회잡지

PURPOSE: Restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR) is a widely accepted method for carrier detection of Duchenne and Becker muscular dystrophy (DMD and BMD) . This study was done to evaluate the clinical value of linkage analysis of RFLP-PCR using five polymorphic markers selected and the heterozygote frequency of those markers in DMD/BMD patients and their family members. MATERIALS AND METHODS: RFLP-PCR test was performed in twenty clinically diagnosed male DMD/BMD patients from 13 families who have been confirmed to have dystrophin gene defect from 1994 to 1997 and their 47 female family members and the results were evaluated by linkage analysis to detect carriers. RESULTS: The heterozygote frequency of pERT 87-15/XmnI, pERT87-15/BamHI, pERT87-8/TaqI, 5'-dysIII (CA) and 3'-dys (CA) markers were 55%, 49%, 45%, 32% and 26% respectively. Fourty-four (91%) out of 47 female family members had heterozygosity to at least one of those five markers. Since the obligate carriers from two families showed homozygocity to all five markers, carrier detection was possible in eleven families (85%) by the linkage analysis. CONCLUSION: RFLP-PCR using markers with high heterozygote frequency could be the first line modality of carrier detection that is crucial in genetic counseling of DMD/BMD patients and their families.

Diastasis of the Symphysis Pubis After Cesarean Section / 대한산부인과학회잡지

No abstract available.

Differences in Bone Mineral Density by Using Different Densitometers or by Measuring Different Sites of Spine in Osteoporotic Vertebral Fractures / 대한정형외과학회잡지

PURPOSE: To see whether different types of DEXA and levels of lumbar vertebrae show any differences in making standard values of lumbar bone mineral density (BMD) in osteoporotic vertebral fracture. MATERIALS AND METHODS: Four hundred and sixty-two postmenopausal women who visited our center due to back pain were screened. Sixty osteoporotic vertebral fracture out of 462 patients were subdivided into QDR group and DPX group, according to densitometers (QDR 39 patients, DPX 21 patients). The BMD was compared between the two groups. The difference between BMD measured in L3 and that measured in L2-4 was analyzed by student t-test. Fracture threshold was defined. RESULTS: There was no difference between BMD of L3 and L2-4 standard level (P>0.05). The mean BMD measured by QDR and DPX, using L2-4 standard, were 0.667+/-0.127 g/cm2 and 0.756+/-0.123 g/cm2, respectively, and showed statistically significant difference (P=0.012). Fracture threshold was 0.831 g/cm2 in QDR and 0.896 g/cm2 in DPX. CONCLUSION: The type of bone mineral densitometer should be taken into consideration in follow-up of osteoprosis patients, and the L3 standard level might not be superior over the conventional L2-4 standard level in measuring BMD in osteoporotic vertebral fracture patients.

Hemangioma of the Scapula Associated with High Scapular Deformity: Case Report / 대한정형외과학회잡지

A hemangioma doesn't often involve the scapula and concurrent high scapular deformity is also too. We present a case of capillary left scapula hemangioma at its superior angle with Cavendish grade 2 high scapular deformity treated by surgical intervention. Excision of the hemangioma and resection of the fibrous band attached to the superior angle of the scapula resulted in symptomatic and cosmetic improvement. Even though the causality between the two lesions is not clear, we cannot exclude the possibility that the hemangioma contributed to the development of high scapular deformity.

The Diagnosis of Duchenne and Becker Muscular Dystrophy: Multiplex-PCR methods / 대한정형외과학회잡지

PURPOSE: The objective of this study is to evaluate the value of multiple-PCR as a diagnostic modality in detection of dystrophin gene deletion by observing its detection rate and concordance rate with clinical diagnosis. MATERIALS AND METHODS: Fifty-two male patients who were clinically diagnosed as DMD or BMD (Duchenne or Becker muscular dystrophy) and received multiple-PCR from 1994 to 1997 at our center were included in this study. The relationship between clinical phenotype and the location of gene deletion were studied using reading-frame rule. Dystrophin protein analysis by immunocyto-chemical technique was done in 7 cases with negative multiplex-PCR. RESULTS: Out of fifty-two patients, thirty-four were DMD and eighteen as BMD clinically. Multiplex-PCR revealed dystrophin gene deletion in 19 patients (36%) consisting of twelve DMD and seven BMD cases. The locations of the gene deletion coincide with the clinical phenotype in 17 cases (89%). Among the 7 cases that underwent dystrophin protein analysis, 3 DMD and 2 BMD were confirmed. CONCLUSIONS: Though no substantial gene deletion detection rate was observed in this study, multiple-PCR could be used as a first-line diagnostic tool in detecting dystrophin gene deletion in DMD/BMD patients based on its high concordance rate with phenotype and favorable patient compliance and convenience.

Radiographic Appearance of the Symphysis Pubis: Criteria of Diastasis of Symphysis Pubis after Normal Delivery / 대한정형외과학회잡지

PURPOSE: This study was performed to evaluate the width of symphysis pubis and its radiographic appearance in different age and sex, and it was aimed to establish a radiographic diagnosis criteria for diastasis of the joint. MATERIALS AND METHODS: The width and the appearance of symphysis pubis were observed by pelvic X-ray in 92 males and 169 females who had no history of any joint disease. The mean width of symphysis pubis was calculated and data were analyzed by age, sex and parity using student t-test. RESULTS: The mean width of symphysis pubis was 2.88+/-0.71 mm in male group and was 3.24+/-0.68 mm in female group. It was 3.34+/-0.84 mm in parturient and 2.82+/-0.55 mm in nullipara and the difference between these two groups was significant (P<0.05). Osteoarthritic changes were noted in most cases over 60 irrespective of sex. CONCLUSIONS: Based on the results from this study and reported value of physiological relaxation of symphysis pubis through pregnancy and labor, a separation over 6 mm and/or a vertical migration over 3mm can be diagnosed as diastasis of symphysis pubis. This criteria would facilitate the earlier diagnosis of relaxation and separation of this joint by labor or trauma.

A Clinical Analysis of the Ankle Fractures / 대한정형외과학회잡지

The ankle is a complex, weight bearing joint and its injury result in a severe functional disturbance of complex anatomical characteristics. It is very important to understand the mechanism of trauma in order to make definite diagnosis and proper treatment. The authors analysed 52 cases(52 patients) of the ankle fractures which were admitted and treated in Orthopaedic department, Korea University Hospital from Sept. 1980 to Dec. 1986. The results obtained were as follows : l. Of the 52 cases, male was 32 cases(61.5%), female was 20 cases(38.5%) and average age of the patients was 32.9 years. 2. The causes of the injury were slipping down, traffie accident, falling down and sports injuries, in orders. 3. Open fractures were 8 cases(15.4%) and closed fractures were 44 cases(84.6%). The most common type of the ankle fracture was supination-extenal rotation type(18 cases, 34.1%) and next was pronation-external rotation type(15 cases, 30%), according to the classification of Lauge-Hansen. 4. 38 cases(73.1%) were treated by open reduction and 14 cases(26.9%) by closed reduction, and average duration of immobilization was 7.7 weeks in open reduction and 10.4 weeks in closed reduction. 5. The associated fractures other than ankle was 15 cases(28.8%). 6. The better results were obtained from open reduction and the worst results obtained from pronation-dorsiflexion type, according to the criteria of Meyer. 7. The complication was 7 cases(13.5%), traumatic arthritis 4 cases, malunion 2 cases and nonunion 1 case. 8. Accurate reduction and rigid internal fixation of the fractured lateral malleolus, distal fibular and distal tibiofibular diastasis was important in treatment of the ankle fracture.

An Experimental Study of Silastic Cuff Wrapping Around the Severed Peripheral Nerve / 대한정형외과학회잡지

The authors conducted an in-Vivo experimental study using sciatic nerve of 200-300 grammed rats to verify clinical applicability of Silicone cuffing method, by which scar adhesion of repaired nerve in crushed limb is assumed hopefully to be reduced. The following observations were obtainable. 1. Nerve conduction velocity was noted faster in Silicone cuff group than in control group significantly after 6 weeks postoperatively. 2. Adhesion of repaired nerve with surrounding scar tissue was far less present in Silicone cuff group than in control group when observed grossly. 3. The amount of scar formation and axonal degeneration were noted reduced remarkably in Silicone cuff group than in control group after 3 weeks postoperatively. 4. The intraneural vascularity was noted reduced either in Silicone cuff group and in control group, but definitely less reduced in the former than in the latter. Clinical relevance: Above results may be taken as an experimental basis supporting clinical applicability of Silicone cuff wrapping method for neurorraphy in crushed limb.