The SPECT/CT Evaluation of Compartmental Changes after Open Wedge High Tibial Osteotomy

PURPOSE: The purpose of this study was to evaluate compartmental changes using combined single-photon emission computerized tomography and conventional computerized tomography (SPECT/CT) after open wedge high tibial osteotomy (OWHTO) for providing clinical guidance for proper correction. MATERIALS AND METHODS: Analysis was performed using SPECT/CT from around 1 year after surgery on 22 patients who underwent OWHTO. Postoperative mechanical axis was measured and classified into 3 groups: group I (varus), group II (0°–3° valgus), and group III (>3° valgus). Patella location was evaluated using Blackburne-Peel (BP) ratio. On SPECT/CT, the knee joint was divided into medial, lateral, and patellofemoral compartments and the brighter signal was marked as a positive signal. RESULTS: Increased signal activity in the medial compartment was observed in 12 cases. No correlation was observed between postoperative mechanical axis and medial signal increase. Lateral increased signal activity was observed in 3 cases, and as valgus degree increased, lateral compartment’s signal activity increased. Increased signal activity of the patellofemoral joint was observed in 7 cases, and significant correlation was observed between changes in BP ratio and increased signal activity. CONCLUSIONS: For the treatment of medial osteoarthritis, OWHTO requires overcorrection that does not exceed 3 valgus. In addition, the possibility of a patellofemoral joint problem after OWHTO should be kept in mind.

Ceramic on Ceramic Total Hip Arthroplasty: The Results of a Minimum 10-Years Follow up

PURPOSE: We wanted to evaluate the clinical and radiographic results of ceramic on ceramic bearing cementless total hip arthroplasty with a minimum of 10-years follow up. MATERIALS AND METHODS: This study was performed on 44 patients and 51 hips, and the patients were recruited among the patients who underwent ceramic-ceramic type cementless total hip arthroplasty from August 1998 to February 2000 and they were available for 10-years or longer follow up. The gender ratio was 28 males and 16 females, and the mean age at the time of surgery was 49 years (range: 26~77 years). Regarding the causality of disease, osteonecrosis was noted in 36 cases, degenerative arthritis was noted in 4 cases, acetabular dysplasia was noted in 4 cases and septic or tuberculous hip sequelae was noted in 7 cases. The clinical evaluation was performed according to the Harris hip score, and for the radiological evaluation of the femoral component, we assessed the degree of subsidence and the presence of periprosthetic osteolysis, endosteal new bone formation and cortical hypertrophy, and the final fixation state of the implant. In the cases with an acetabular cup osteoscleostic line in the vicinity of the acetabular cup, endosteal new bone formation, acetabular osteolysis and the vertical migration as well as the horizontal migration of the acetubular cup were assessed. RESULTS: Regarding the clinical outcomes, the Harris hip score was improved from an average 59 points to 93 points at the final follow up. For the radiological results, osteolysis was not detected in the acetabular and femoral components, the subsidence of femoral stem was not beyond 2 mm on average and significant subsidence was not detected. In regard to complications, linear fracture during surgery was noted in 6 cases and postoperative hip dislocation was noted in 1 case. A ceramic head fracture occurred in one case and a ceramic liner fracture occurred in 2 cases. CONCLUSION: This type of articulation is a promising option at a minimum of 10-years follow up of 51 hips that underwent ceramic-ceramic bearing cementless total hip arthroplasty. However, our results demonstrated that surgeons should be aware of the potential risks of ceramic fracture when using ceramic-on-ceramic bearing surfaces. Additional longer-term follow-up is necessary.

Conservative Management of Condensing Osteitis of the Medial End of the Clavicle / 대한정형외과학회잡지

PURPOSE: To assess the clinical features and the outcomes of conservative treatment of condensing osteitis of the medial end of the clavicle. MATERIALS AND METHODS: We reviewed 24 patients among 44 patients with pain and protrusion on the medial clavicle, who were diagnosed as condensing osteitis and followed over one year between April 2003 and August 2008. Plain radiograph and laboratory examination (24 cases), bone scan (12 cases), computed tomography (3 cases), MRI (1 case) and biopsy (1 case) were performed. Patients were followed with UCLA score, VAS (Visual Analogue Scale) and change of protrusion. RESULTS: In all cases, mild sclerosis and expansion were seen at the medial clavicle and sternoclavicular joint was preserved. Laboratory examination showed nonspecific results but various abnormal findings. Protrusion was not changed in 20 cases (83%) and decreased in 4 cases (17%). VAS for pain was improved from 3.4 to 1.2 and VAS for function was improved from 25.5 to 29.1. UCLA score was improved from 28.8 points to 33.7 points. CONCLUSION: Physical and radiologic examination was important for diagnosis of condensing osteitis and laboratory exmination was useful to differentiate it from other diseases. Conservative treatment with rest and nonsteroidal anti-inflammatory drugs showed satisfactory result.

Pulmonary tuberculosis misdiagnosed as lung Metastasis in childhood cancer patients / 소아과

PURPOSE: The differential diagnosis for a pulmonary nodule is intriguing in cancer patients. Metastasis might be a preferential diagnosis, and yet possibilities of other medical conditions still exist. Pulmonary tuberculosis should be enlisted in the differential diagnosis for a pulmonary nodule in cancer patients in Korea. This study was aimed at analyzing the incidence and clinical features of pulmonary tuberculosis that were misdiagnosed as pulmonary metastasis during radiologic follow-up in pediatric cancer patients. METHODS: We retrospectively studied 422 cancer patients less than 18 years old in the Korea Cancer Center Hospital from January 2001 to June 2007. We collected episodes of lung metastasis of primary tumor and tuberculosis during treatment or follow-up, and analyzed medical records. RESULTS: There were 5 cases of tuberculosis confirmed after surgery which were initially regarded as cancer. Two patients had respiratory symptoms such as cough and sputum but the other 3 patients did not. One patient had a family history of tuberculosis. Acid-fast M. tuberculosis was found in one case upon tissue specimen analysis. Two cases were Mantoux positive and the sputum examination was negative in all cases. The polymerase chain reaction for tuberculosis on a pathologic specimen was used to differentiate M. tuberculosis from non-tuberculosis mycobacterium (NTM). It was positive in one case. Lung lesions in one case showed a concurrence of tuberculosis along with lung metastasis. One of these patients died after cancer recurrence. CONCLUSION: It is necessary to consider the possibility of tuberculosis when a lung mass is newly detected during treatment or follow-up in patients with childhood cancer.

A Case of Usher Syndrome / 대한이비인후과학회지

The usher syndrome (US) is an autosomal recessive disorder characterized by congenital bilateral sensorineural hearing loss and progressive visual loss secondary to retinitis pigmentosa. It is the most common cause of the hereditary combined deafness-blindness in the western world. Three different types of US are recognized by clinical criteria. The US type I has severe to profound hearing loss, vestibular dysfunction, and prepubertally diagnosed retinitis pigmentosa, while the US type II has moderate to severe hearing loss, normal vestibular function, and later onset of retinitis pigmentosa. The US type III has a progressive hearing loss and retinitis pigmentosa with variable vestibular involvement. The diagnosis is confirmed by medical history and thorough otoscopical, audiologic, vestibular, and ophthalmological examinations. We have recently experienced a case of the US type I and report this with a brief review of the related literature.

The Rosai-Dorfman Disease of the Nasal Cavity and Salivary Gland: A Case Report / 대한이비인후과학회지

Rosai-Dorfman disease (RDD), or sinus histiocytosis with massive lymphadenopathy, is a rare idiopathic histiocytosis that most commonly involves the cervical lymph nodes, Extranodal involvement occurs in 30- 40% of cases, most often in the head and neck. Characteristic histological findings include emperiopolesis (intracellular engulfment) of lymphocytes and S-100 protein positivity. Treatment of Rosai-Dorfman disease is unnecessary unless the disorder becomes life-threatening, since the disease will resolve spontaneously in most patients. We experienced a case of extranodal RDD at the nasal cavity as the initial lesion prior its nodal involvement. The patient was a 18-year-old woman who complained of nasal obstruction for 4 years and had a submandibular mass that persisted during the last 3 months. Histologically, all specimens taken from the left nasal cavity, the left submandibular mass and the left upper jugular lymph node showed heavy infiltration of plasma cells, lymphocytes and sheets of macrophages with abundant pale cytoplasm which replaced the existing organ architecture.

Cellular Toxicity of Local Anesthetics by Change of Glucose Consumption Rate and Lactic Dehydrogenase Activity in Cultured Media after 3 Dimensional Cultured Cell were Treated with Lidocaine and Bupivacaine / 대한마취과학회지

BACKGROUND: Even though careful techniques is utilized and proper concentration of local anesthetics are used, tissue toxicity is common. METHOD: The fibroblast cell lines (NUGM) was exposed with each concentration of 10(-6), 10(-5), 10(-4) M lidocaine and bupivacaine in culture media for 24 hours. Glucose consumption rate and LDH activity in cultured media were measured for using as indicator of cellular damage on 0. 24, 48, 72 hours. By using that, we calculated the trend lines of the change of glucose consumption rate and LDH (lactic dehydrogenase) activity. On the trend lines, we searched out for decreasing time to 1/2 of glucose concentration and increasing time to 2 times of LDH activity compared to control. RESULTS: 1) In control group, Decreasing time to 1/2 of glucose concentration was 236.0 hours (p<0.05) and increasing time to 2 times of LDH activity was 1168.6 hours (p<0.05). 2) At each concentration of 10 6, 10 5, 10 4 M lidocaine, decreasing time to 1/2 of glucose concentration was 873.7 (370%), 938.7 (398%), 1101.6 (467%) hours compared with 236.0 (100%) hours of control (p<0.05) and then increasing time to 2 times of LDH activity was 135.1 (12%), 85.6 (7%), 93.9 (8%) hours when compared with 1168.6 (100%) hours of control (p<0.05). 3) At each concentration of 10(-6), 10(-5), 10(-4) M bupivacaine, decreasing time to 1/2 of glucose concentration was 706.7 (299%), 948.1 (402%), 1018.2 (431%) hours when compared with 236.0 (100%) hours of control (p<0.05) and then increasing time to 2 times of LDH activity was 111.6 (10%), 69.5 (6%), 59.1 (5%) hours when compared with 1168.6 (100%) hours of control (p<0.05). 4) On light microscopy, cells are showed destruction in each concentration of 10(-6), 10(-5), 10(-4) M lidocaine and bupivacaine with dose dependent fashion. CONCLUSIONS: 1) Glucose consumption rate and LDH activity in cultured media could be used as a useful index of cellular destruction by toxic effect on cultured cell. 2) Even at any concentration of lidocaine and bupivacaine could be toxic on cell. With all of above results, cell-line on 3 demensional cultured method could be use as another method for determining of cellular toxicity of local anesthetics.

Primary Endobronchial Actinomycosis / 결핵

We report a case of a 20-year-old woman who presented with fever, dry cough and pulmonary consolidation at the left upper lobe on chest radiograph. Fiberoptic bronchoscopy revealed obstruction of the left upper lobar bronchus with exophytic mass and multiple nodular protruding lesions at the left main bronchus. Endobronchial actinomycosis was confirmed by demonstration of sulfur granule through the bronchoscopic biopsy of nodular lesion. Intravenous administration of penicillin G followed by oral tetracycline therapy for 5 months resulted in complete recovery of symptoms which had been present for 3 months prior to therapy. Infiltrative consolidation on the chest X-ray disappeared and all the lesions shown by bronchoscopy were nearly normalized after 6 months only to remain small nodular remnants at the left main bronchus. Endobronchial actinomycosis should be included in the differential diagnosis of endobronchial mass.

A case of superior mediastinal parathyroid adenoma / 대한이비인후과학회지

No abstract available.

The clinical evaluation of selective neck dissection on tuberculouscervical lymphadenitis / 대한이비인후과학회지

No abstract available.

Analysis of Interdepartmental Consultation / 대한마취과학회지

The purpose of a conculation is to seek the opinions and advice of those whom we recognize to be more expert in a particular field of medicine than we are. Most surgeons regard the anesthesiolgist as a conculatant. Thus we analyzed 308 cases of interdepartmental consulatation submitted to our department from June 1991 to Novermber 1991. All case were elective ones and emergent cases were excluded. The analysis were as follow. 1) The overall conculation rate were 11.5%. 2) The highest rate of consultation were requested from orthopedic surgery department(29.9%) followed by ophthalmology department(25.0%), neurosurgery department(24.6%) and urology department(13.4%). 3) Male was 42.8% and female was 57.2%. 4) Most requestered problem was hepatic diseases including elevated transaminase, hepatitis and liver cirrhosis(35.1%) and then cardiovascular problem was 20.5%. 5) Because of our opinion, 22 cases were postponed. 6) Consultation rate increased according to advancing of age.

Comparative Study of Vecurnium and Domestic Product of Vecaron in Human / 대한마취과학회지

The introduction of musele relaxants was an epoch-making event in the development of clinical anesthesia and their use has hecome essential to anesthesia practice. Vecuronium, one of the newest muscle relaxant, has many advantages; it is rapid and short-acting, noncumulative, has minimal side reactions and is promptly antagonized by anticholinesterases was introduced recently our clinical anesthesia practice. Fortunately, domestic product of vecuronium as vecaron was introduced lately. Therefore, this study was performed to evaluate the effects of vecaron and as compare with vecuronium. The results were as follows: 1) Similar effects of muscle relaxation was observed in both group except the onset time of twitch depression was shorter in vecuronium group than vecaron group. 2) Blood pressure and heart rate was increased during intubation in groups. 3) Recovery index was slightly prolonged in vecuronium group than vecaron group but no significance was observed. However, this recovery index of vecuronium was slightly shorter than previous observations.

Changes of Circuratory Response during Intubation by Small Dose Fentanyl / 대한마취과학회지

Induction of general anesthesia with tracheal intubation is routine procedure but causes significant tarchycardia and hypertension. Many approaches have been tried to attenuate these circulatory response. The effects of small dose fentanyl on arterial pressure and heart rate increase during intubation were studied in 40 normotensive patients, who were randomly allocated to two groups, receiving saline (Control group) or fentanyl 2ug/kg (Fentanyl group), in a double blind fashion during anesthetic induction with thiopental 5mg/kg. Systolic, diastolic, mean arterial pressure and heart rate were measured and rate pressure product was calculated. All parameters were significantly different between two groups (p<0,05) and control group was significant increase in blood pressure and heart rate compared with pre-induction value but fentanyl group was relatively small changes of blood pressure and heart rate (p<0.01). After tracheal intubation, incresed blood pressure was returned to pre-induction value within two to three minutes in fentanyl group but heart rate was not returned pre-induction value within 5 minutes. Dose of fentanyl that are low enough to cause any side effects of drug itself, no notable side effects were observed during study and recovery.

Muscle Relaxation and Cardiovascular Response in Rabbits by Pancuronium and Verapamil / 대한마취과학회지

Pancuronium is one of the most available nondepolarizing muscle relaxant. It is primarily eliminat-ed unchanged by the kidney, although a small fraction is metabolized by the liver. On the other hand, calcium channel blocking agents are a chemically heterogeneous group of drugs that inhibit the ionic current carried through the calcium slow channel in cardiac and vascular smooth muscle. This action is the basis of their usefulness in the treatment of cardiovascular disorders. Although the role of calcium in skeletal muscle differs from that in cardiac and vascular smooth muscle, various recent studies have shown that verapamil is able to inhibit neuromuscular function in skeletal muscle preparations. However, it is not well known, yet. Increasing number of patients who are taking calcium channel blockers were reported recently. The present study was undertaken to determine if verapamil could potentiate the effects on pancuronium and how does it affect the cardiovacular response. The results were as follows; 1. Verapamil (1.41 mg) significantly enhanced the recovery index of pancuronium as 226.7 sec compared with control recovery index as 162.5 sec (p<0.025). But tetanic stimulation (50Hz, 5 sec) was sustained in the both group. 2. Hypotensive effect was appeared when 1.41 mg of verapamil was given and it was taken 7.7 min. 3. Signs of cardiovascular response was decreasing the blood pressure especially diastolic first then heart rate was decreased.

Muscle Relaxation and Cardiovascular Response in Rabbits by Pancuronium and Verapamil / 대한마취과학회지

Pancuronium is one of the most available nondepolarizing muscle relaxant. It is primarily eliminat-ed unchanged by the kidney, although a small fraction is metabolized by the liver. On the other hand, calcium channel blocking agents are a chemically heterogeneous group of drugs that inhibit the ionic current carried through the calcium slow channel in cardiac and vascular smooth muscle. This action is the basis of their usefulness in the treatment of cardiovascular disorders. Although the role of calcium in skeletal muscle differs from that in cardiac and vascular smooth muscle, various recent studies have shown that verapamil is able to inhibit neuromuscular function in skeletal muscle preparations. However, it is not well known, yet. Increasing number of patients who are taking calcium channel blockers were reported recently. The present study was undertaken to determine if verapamil could potentiate the effects on pancuronium and how does it affect the cardiovacular response. The results were as follows; 1. Verapamil (1.41 mg) significantly enhanced the recovery index of pancuronium as 226.7 sec compared with control recovery index as 162.5 sec (p<0.025). But tetanic stimulation (50Hz, 5 sec) was sustained in the both group. 2. Hypotensive effect was appeared when 1.41 mg of verapamil was given and it was taken 7.7 min. 3. Signs of cardiovascular response was decreasing the blood pressure especially diastolic first then heart rate was decreased.

Comparative Study on Neostigmine and Pyridostigmine during Vecuronium Reversal in Rabbits / 대한마취과학회지

Anesthesiologists may have close relationship with muscle relaxants in clinical practice. Fourtunately, a few of the new muscle relaxants were discovered and used in clinic recently. Newly introduced non-depolarizing muscle relaxant: vecuronium has been clinically in use recently. The most suitable method for reversing the neurom uscular blockade caused by vecuronium continues to provoke discussion and differences of opinion. Simultaneous administration of neostigmine and atropine has been considered safe by some authors and dangerous by others. Both slow and rapid administration have been recommended. The general acceptance of the slow administration of neostigmine and atropine has been confirmed. In view of the various data on vecuronium reversal, neostigmine was compared with pyridostigmine and heart rate changes were studied. The results were as follows: 1) Recovery index after i.v. neostigmine 40 ug/kg and atropine 20 ug/kg when first twitch of the "train of four" was appeared during vecuronium 0.1mg/kg relaxation, was 129.9 sec. Heart rate change was decreased to 46.9/min(15%) after i.v. neostigmine during 16 to 20 minutes period(p<0.05). 2) Recovery index after i.v. pyridostigmine 160 ug/kg and atropine 20ug/kg when first twitch of the "train of four" was appeared during vecuronium 0.1mg/kg relaxation, was 134.0sec. Heart rate change was not statistically significant compared with neostigmine.