Comparative Study of Osteoporosis Treatment of Elderly Patients with Degenerative Osteoarthritis of the Knee Joints, according to the Korean Health Insurance Review & Assessment Service Criteria versus the FRAX(R) Criteria / 대한정형외과학회잡지

PURPOSE: To compare and evaluate any differences in the osteoporosis treatments of elderly patients with degenerative osteoarthritis of the knee joints, in accordance with the Korean Health Insurance Review & Assessment Service (HIRA) criteria versus the World Health Organization (WHO) fracture risk assessment tool (FRAX(R), http://www.shef.ac.uk/FRAX/) criteria, which is a fracture risk assessment tool developed by the WHO. MATERIALS AND METHODS: From June 2010 to March 2011, we investigated and screened the target populations of osteoporosis treatments among 65-year-old or older patients with degenerative osteoarthritis of the knee joints who scheduled to undergo elective total knee arthroplasty. They were classified in the treatment group only if they met either the HIRA criterion, defined as having a T score of or =20% or > or =3%, respectively. RESULTS: Of a total of 929 patients, the number of patients included in the treatment group as screened according to the HIRA or FRAX(R) criteria was 562 (60.5%) and 372 (40.0%), respectively. The number of patients who met both criteria was 339 (36.5%), and including 334 non-treated patients (36.0%), a total of 673 patients (72.4%) showed low diagnostic concordance (k=0.471). Of 319 patients diagnosing osteopenia, 33 (10.3%) patients were included in the treatment group according to the FRAX(R) criteria. CONCLUSION: A combination of the HIRA and FRAX(R) criteria is required to improve the current guidelines for osteoporosis treatment.

Extra-adrenal pheochromocytoma after operation of congenital heart disease: a case report of 18-year-old boy / 대한외과학회지

Extra-adrenal pheochromocytoma is rare and presents variable symptoms. Its difficulty to diagnosis delays appropriate treatment. We would like to report an unusual case of extra-adrenal pheochromocytoma. The patient came to the emergency room with dyspnea, palpitation, and cyanosis. He had a history of hospitalization for Fontan operation due to congenital heart disease. Despite medication, his blood pressure remained high. After additional laboratory and image exams, he was diagnosed with extra-adrenal pheochromocytoma and had surgical treatment. The final pathology report was extra-adrenal pheochromocytoma with high risk of malignancy. The postoperative course was uneventful and showed normal laboratory results even after 3 months of outpatient follow-up. Extra-adrenal pheochromocytoma presents variable symptoms. We should consider endocrinologic diseases like extra-adrenal pheochromocytoma in cases presenting with palpitation and high blood pressure, even with a past history of cardiac surgery.

Surgical Treatment for Planovalgus Foot in Children with Generalized Ligamentous Laxity / 대한정형외과학회잡지

PURPOSE: Planovalgus deformity in children with generalized ligamentous laxity is usually asymptomatic, but it sometimes causes severe deformity and functional problems. The aim of this study was to evaluate, post-operatively, functional outcomes, plantar pressure and radiographic results of symptomatic planovalgus with generalized ligamentous laxity. MATERIALS AND METHODS: This retrospective study included a total of 42 feet of 24 patients that had undergone a calcaneal lengthening osteotomy or an extra-articular subtalar arthrodesis. The mean age of the patients at the time of the index operation was 10.5 years (range, 6-15.6 years), and the mean duration of follow-up was 51 months (range, 18-92 months). Patients were evaluated clinically and radiographically using the Oxford Ankle Foot Questionnaire, AOFAS score, Mosca criteria, standard radiographs and dynamic pedobarographs. RESULTS: Functional outcomes at the latest available follow-up were excellent except for three feet. No foot had a significant limitation affecting the patient's daily activities. Both surgical treatments improved radiographic parameters. The parameters of dynamic pedobarographs, including the relative vertical impulse and the peak pressure, decreased for the medial aspect of the forefoot and midfoot, while they increased for the lateral aspect of the forefoot, midfoot and calcaneus after surgical treatment. The change in the center of pressure indicated a significant lateral shift in the weight-bearing surface of the foot. CONCLUSION: Calcaneal lengthening osteotomy and extra-articular subtalar arthrodesis appear to be effective means for pain relief and clinical improvement in children with symptomatic planovalgus deformity and generalized ligamentous laxity. Further follow-up evaluation is needed to obtain long-term clinical and radiographic results with regard to skeletal maturation and changes in generalized ligamentous laxity.

Hibernoma of Right Shoulder :A Case Report

PURPOSE: Hibernoma is a very rare benign soft tissue tumor of the hypervascularized brown fat tissue with no malignant potential. MATERIALS AND METHODS: However, it is difficult to differentiate a hibernoma from other malignant tumors, such as liposarcoma using computed tomography and magnetic resonance imaging, and a surgical resection with histological confirmation is the treatment of choice. RESULTS: Histopathologically, hibernoma is composed of brown adipose cells that are polygonal and multivacuolated with a centrally located nucleus and granular cytoplasm, unlike white adipose cells. CONCLUSION: This article describes a patient with a histologically-confirmed hibernoma of the right shoulder.