Diagnosis and treatment of adult spinal deformity

The diagnosis rate of adult spinal deformity (ASD) is increasing with increased life expectancy and the prevalence of degenerative spinal diseases. The prevalence of ASD in adults aged >60 years has been reported to be up to 68%. ASD has significant impact on the pain, disability, and mental health. Therefore, it is necessary to establish an effective surgical plan by accumulating modern knowledge on ASD, developing surgical techniques, and improving pre- and post-operative care so as to achieve optimal surgical outcomes.Current Concepts: ASD results from coronal and sagittal malalignments caused by degenerative diseases or iatrogenic factors. Recently, the significance of sagittal alignment correction has been emphasized, and the SRSSchwab classification of ASD is generally accepted. Individualized correction goals can be set through sufficient preoperative evaluations and imaging studies, and appropriate coronal and sagittal alignment correction can be achieved through intraoperative positioning of patient, anterior and posterior approach spine surgery, screw fixation, and osteotomies.Discussion and Conclusion: It is necessary to establish an optimal correction target and select the appropriate surgical approach for each patient with ASD, so as to improve patients’ quality of life. Surgical interventions for ASD can be safely completed by adequately comprehending and anticipating perioperative complications.

Reciprocal Changes in the Whole-Body Following Realignment Surgery in Adult Spinal Deformity

The idea of the global balance of spine stems from Jean Dubousset, who first introduced the concept of cone of economy. Through the compensatory mechanisms, the human body maintains an upright posture and horizontal gaze in the setting of the spinal malalignment. Compensation takes place not only in the mobile spine segments, but also in the pelvis and lower extremities. Patients with a malalignment exhibit compensatory changes in the cervical hyper-lordosis, posterior pelvic shift, knee/ankle flexion, hip extension, and the pelvic retroversion. The advent of whole-body stereo radiography has yielded an improved understanding of global changes among the patients. Deformity-induced compensatory changes in the sagittal alignment could be resolved reciprocally after the surgical correction of the malalignment. Thoracolumbar realignment surgery restores the pathologic compensatory changes in the unfused spinal segments, pelvis, and the lower extremities. Similarly, reciprocal changes in the thoracolumbar spine may harmonize global sagittal alignment after the cervical reconstruction. This study reviews the compensatory mechanisms and reciprocal changes in global sagittal alignment caused by the surgical correction and highlights, the factors that should be considered while assessing a patient’s compensatory status.

Diagnostic Clue of Meningeal Melanocytoma: Case Report and Review of Literature

In this report, the patient was pre-diagnosed as meningioma before surgery, which turned out to be meningeal melanocytoma. Hence, we will discuss the interpretation of imaging and neurological statuses that may help avoid this problem. A 45-year-old man had increasing pain around the neck 14 months prior to admission. His cervical spine MR imaging revealed a space-occupying, contrast-enhancing mass within the dura at the level of C1. The neurologic examination revealed that the patient had left-sided lower extremity weakness of 4+, decreased sensation on the right side, and hyperreflexia in both legs. Department of Neuroradiology interpreted CT and MR imaging as meningiom. The patient underwent decompression and removal of the mass. We confirmed diagnosis as meningeal melanocytoma through pathologic findings. Afterwards, we reviewed the patient's imaging work-up, which showed typical findings of meningeal melanocytoma. However, it was mistaken as meningioma, since the disease is rare.

Estimation Regression of Thigh Muscle Volume by Anthropometry / 체질인류학회지

The purpose in this study is to make a regression model for the prediction of skeletal muscle volume in thigh. For this purpose, men,14 and women,6 were included in this study. They were measured 22 independent variables by CT and anthropometry methods. CT Image analysis were performed with INFINITT, Rapidia 2.8, Korea. The results in this study are as following. There were not significant (P=.000) between CT-measured variables and predicted variables by anthropometry, excepting the difference (P=0.01) at thigh top muscle circumference. Therefore, many of variables could be applied with parameters for estimation equation by anthropometry. The estimation equation, obtained for thigh muscle volume using the predicted mid-thigh muscle circumference corrected by skinfold thickness and predicted total femur bone volume, was Y(Mtot)=127.4134x(X1)+18.7767x(X2)-5998.62. Where, X1 is predicted mid-thigh muscle circumference and X2 is predicted total femur bone volume. R2 in this model is .97, and SEE is 123 mL, CV 3.6%. In conclusion, the determination of skeletal muscle volume in thigh can be highly validated with estimaton model in this study. Therefore it also be apply to predicting thigh muscle volume in korean adults.

The Distribution of I/D Polymorphism in the ACE Gene between Korean Young Controls and Athletes / 체질인류학회지

A number of genetic and environmental factors influence athletic performance. Cardiovascular fitness is an important factor of athletic success, and ACE gene is a good candidate for regulating cardiac and vascular function. Because younger subjects have less chance of being exposed to environmental factors than older ones, genetic factors have a relatively greater influence on younger subjects. The aim of this study was to investigate the distribution of I/D polymorphism in the ACE gene between Korean young controls and athletes. By association study, there were no significant differences in genotype and allele distributions between two groups, respectively (P> 0.05). When stratified by sporting disciplines, the significant difference in distribution was not also detected in our study (P> 0.05). These results do not support the hypothesis that the I/D polymorphism in the ACE gene is associated with endurance performance in Korean young subjects.

Effects of Soy Isoflavone Supplementation and Exercise on Bone Mineral Density and Urinary Deoxypyridinoline in Postmenopausal Women

We studied the effects of soy isoflavones supplementation with exercise on bone mineral density and the urinary excretion of deoxypyridinoline as an index of bone resorption rates in postmenopausal women. A total of 67 postmenopausal women were assigned to Isoflavone (90 mg/day) or placebo groups. These groups were further divided into groups that undergone a regular exercise or a rather sedentary state performing daily activity only. Four groups were Placebo-control group (n = 16), Placebo-exercise group (n = 16), Isoflavone-sedentary group (n = 19) and Isoflavone-exercise group (n = 16). After the intervention, we compared anthropometric mesurement, dietary recall, bone mineral density (femoral neck, lumbar spine), urinary deoxypyridinoline between the groups and between the pre and post studies. There were no significant differences between the four groups in terms of average age, height, weight, period after menopause at the baseline. The average age of the subjects were 55.2 yrs, average height, weight, period after menopause were 154.7 cm, 59.3 kg, 5.58 yrs, respectively. After eight week intervention period, there were no significant differences between the four groups in bone mineral density, but urinary deoxypyridinoline excretion was significantly decreased both in Isoflavone-sedentary and Isoflavone-Exercise groups. These results suggest that Isoflavone supplementation alone or with exercise may be preventive measures through the decrease of bone reabsorption rate in post-menopausal subjects. Whereas exercise alone did not appear to be an effective measure in bone loss with these subjects.

Restriction Analyses of PCR Amplified Partial SSU Ribosomal DNA to Distinguish Arbuscular Mycorrhizal Fungi from Other Fungi Colonizing Plant Roots

Roots of Glycine max and Miscanthus sinensis and soil samples were collected from various field sites at Goesan, Chungbuk in Korea. Microscopic observations of the roots indicated high colonization rates of both arbuscular mycorrhizal fungi (AMF) and other fungi. The partial small subunit of ribosomal DNA genes were amplified with the genomic DNA extracted from their roots by nested polymerase chain reaction (PCR) with universal primer NS1 and fungal specific primers AM1. Restriction fragment length polymorphism (RFLP) was analyzed using the combinations of three restriction enzymes, HinfI, AluI and AsuC21. Nucleotides sequence analysis revealed that ten sequences from Miscanthus sinensis and one sequence from Glycine max were close to those of arbuscular mycorrhizal fungi. Also, 33% of total clones amplified with NS31-AM1 primers from M. sinensis and 97% from G. max were close to Fusarium oxysporum or other pathogenic fungi, and they were successfully distinguished from AMF. Results suggested that these techniques could help to distinguish arbuscular mycorrhizal fungi from root pathogenic fungi in the plant roots. Especially, DNA amplified by these primers showed distinct polymorphisms between AMF and plant pathogenic species of Fusarium when digested with AsuC21.

A Case Report of Bilateral Squamous Cell Carcinoma Arising in Endometriosis of the Ovary / 대한부인종양콜포스코피학회잡지

Primary ovarian squamous cell carcinoma is the one of the rarest of all ovarian malignancies. Most of them arise in mature cystic teratoma and a minority of them associated with endometriosis, arising in a Brenner tumor, or appearing in pure form. Due to its rarity, there is no agreement concerning the efficacy of postoperative treatment of primary squamous cell carcinoma of the ovary, although the prognosis of this type of tumor is much worse than that of other epithelial ovarian cancers. We describe a patient with squamous cell carcinoma of the ovary in association with ovarian endometriosis, who has undergone postoperative systemic chemotherapy.

Effects of Bone Density in Femur and Lumber and the Cross-sectional Area of Thigh by Resistance Strength Training in Elderly Women / 체질인류학회지

No abstract available.

An Assessment of a Regional and Whole Body Composition Using Magnetic Resonance Image / 체질인류학회지

This study aims at analyzing the articulator of human body and its composition using the Magnetic Resonance Image (MRI, 0.5 Telsa). The MRI images were photographed for 1cm per every cm of human body using TR 600ms and TE 20ms spin-echo sequence. For this test, 6 healthy male subjects were sampled. The subject's heights and weights were measured before photographing and then their entire bodies were photographed in the MRI whole body scanner which has a 56cm diameter. It took 90~120 minutes to scan every subject's body during scanning the subjects were allowed to put their both hand beside their femurs. According to his height, each subject were photographed for 180~200 MR slices and every image was analyzed on the tracing paper via X-ray reading View Box. Then, the traced images were all volumized through computer scanner and CAD program, and thereupon, each volume was multiplied by its density coefficient. The results of study can be summarized as follows ; The mass of the bones occupied 8.41±0.62kg, which accounted for 11% of the body mass. The femurs accounted for 19.73±2.73% of the bone mass in terms of bodily articulation. The muscle occupied 39.70±5.28kg which accounted for 51.28±8.98% of the body mass. The part which has the richest muscle mass was femur which accounted for 33.93±5.58% of entire muscle mass. The fat accounted for 24.61±11.6% of the body mass, among which the back waist including inside intestinal fat occupied 30.66±3.64%. It was suggested through this study that MRI analysis is the most suitable method to evaluate the composition of human body and that the data acquired through MRI analysis may apply as references to other indirect or estimated evaluation of human body.

Swimming-induced Influences on Bone Density in Middle-aged Women / 체질인류학회지

The purpose of this study was to investigate whether the Bone Mineral Density (BMD) in a postmenopausal women has affected by a long-term swimming exercise. Swimming exercised 9 female and non-exercised 13 female were involved in this study. All of them were accepted by selection criteria through a questionnaire and personal interviews. Experimental group performed regularly swimming exercise while over a 8 year, but control group never taken part in any activities periodically. Bone densities were measured at Lumbar 2-4 and Femur's 3 sites (neck, ward's triangle, and trochanter) with DEXA method (Lunar DPX). There are no significant differences between two groups on the ages, body weights, heights, % fats, and menopausal durations. Bone densities on the neck and ward's triangle of Femur were 1.7% and 2.7% higher in the control group than in the swimming group, not significant between two groups. In the case of Femur trochanter and Lumbar 2-4 sites, swimming group however were nonsignificantly higher 2% and 5.3% than control group, respectively. In conclusion, it was recognized that a long-term swimming exercise may be ineffective to intensify local density, stiffly lowering in a postmenopausal women.

Open Reduction of Intra-Articular Fractures of the Calaneus through the Lateral Approach / 대한정형외과학회잡지

Displaced intra-articular fractures of the calcaneus result in serious and prolonged disability. These injuries continue to pose a therapeutic challange and there remains a great deal of controversy regarding treatment, operative versus nonperative. The lateral approach for open reduction, popularized by Palmer, has been used by many authors, with high percentage of excellent results. We treated 21 displaced intra-articular fractures of the calvaneus in 18 patients by open reduction and internal fixation through the lateral approach from July 1990 to May 1992 and the patients have been followed from 12 to 36 months from the time of their injury. The clinical and radiographic analyses were as follows; 1. The most common cause of injury was falls from a height: 19 fractures in 16 patients(88.8%), Spine fracture was most commonly associated injury : 5 patients (27.8%). 2. Fracture was classified according to classification of Paley and Hall. Eight fractures were tongue type(no comminution 4, with comminution 4), 12 joint depression type(no comminution 8, with comminution 4), and a comminuted type. 3. The average bohler tuber-joint angle was

An assessment on the human body composition of Korean adult males with magnetic resonance image(I) / 체질인류학회지

No abstract available.

A Clinical Experience of Fractures in Rickets / 대한정형외과학회잡지

Vitamin D deficient ricket is now a rare disease in the developed countries because of the generally improved nutrition and medical awareness but occasional cases are found in the special susceptible populations. The ricket is characterized pathophysiologically by a failure of the normal mineralization of bones and epiphyseal cartilages and is susceptible to the fractures because of the weakness and increased plasticity of bones. The fractures occurred in rickets are known to be delayed in union but it should be normal if the ricket is effectively treated. Authors reviewed 7 cases of fractures occurred in the vitamin D deficient rickets which were managed at Daegu Fatima Hospital during the years from 1980 to 1986 and the following results were obtained. 1. The cases were 4 boys and 3 girls having ages from 6 to 11 years who were all in the same group of restricted population of poor nutrition. 2. 10 fractures noted in 7 cases including two cases of multiple fractures and a case of refracture and most of the fractures occurred in femurs except for a humerus and a forearm bones. 3. The causes of fractures were uncertain because the definite histories were unable to obtain but any violent trauma was not suggested. 4. The fractures were treated by the usual methods of skin tractions or cast immobilizations and daily doses of 2,000 U. or 5,000 U. of vitamin Dwere given as soon as the rickets are recognized. 5. The normal healing of the fractures and rickets occurred in the cases who were given vitamin D initially when the diagnosis of rickets were made. 6. The healing of fractures were very delayed in 2 cases who were missed to recognize the rickets initially and vitamin D was not given.

The Late Complications of Prosthetic Replacement for the Femoral Neck Fractures / 대한정형외과학회잡지

The displaced femoral neck fractures remain a major challenge to orthopaedic surgeons as the elderly population is increasing. Successful union by internal fixation after adequate reduction without avascular necrosis is primary goal since the functional results having own femoral head are much superior to those having prosthetic femoral head, but prosthetic replacement is indicated for some patients with fresh fractures who need early ambulation as well as neglected fractures and failed internal fixations. The early result after prosthetic replacement was known to be very satisfactory but the late complications are becomming the major problem. Authors reviewed 21 cases of the prosthetic replacements for the femoral neck fractures which were followed for more than one year and managed at Fatima Hospital during the years between 1975-1984 and the following results were obtained. 1. The cases were 8 males and 13 females having ages from 42 to 87 years with average 69 years old. 2. The cases were 11 elderly fresh fractures, 6 neglected fractures, 2 failed osteosynthesis and 2 others. 3. Moore and Thompson prosthesis were used and 13 of them were fixed with bone cement. 4. The early result evaluated at 3 months after surgery revealed satisfactory in 90% but the final result at average 3 years and 5 months ranging from 1 year to 6 years and 2 months revealed satisfactory results in 58% 5. There was no significant early post-operative complications. 6. The late complications were 8 cases of acetabular erosions and these were combined with stem loosening in 2, subsidence in 2 and deep infection in 1 case. 7. The late complications started to reveal at about 3 years after surgery and occurred in younger and active patient. 8. The prosthetic replacement for femoral neck fracture is recommended for the inactive patient or the patient with expected activity less than 3 years.

A Case of Congenital Biliary Atresia associated with Ectopic Pancreatic Tissue

Congenital biliary atresia is the commonest cause of prolonged obstructive jaundice in the neonatal period, and is due to the pathologic closure of a major portion or segment of the biliary tree. The neonate with prolonged obstructive jaundice poses a diagnostic dilemma that may be insoluble by routine clinical and laboratory studies. This applies particularly to the most common entities, neonatal hepatitis and biliary atresia. We esperienced one case of congenital biliary atresia associated with ectopic pancreatic tissue in 23 day-old female which was confirmed by autospy. Literature about congenital biliary atresia were reviewed.

Studies on Time to Normal Return of C.S.F. Findings in Childhood T.B. meningitis

The following results were obtained through the clinical review of 71 cases among 256 cases of tuberculous meningitis treated at the Mokpo children's T.B. hospital during the seven-year period, January 1970 through December 1976. 1. The distribution by age was 83.1% of the patients less than 6 years of age and 25.4% were between 1 and 2 year old. Male to female ratio was similar. 2. Seasonal incidence was in the order of summer, spring, winter and autumn. 3. Family history of tuberculosis was found in 29.5% of cases. 4. The most common symptoms on admission were in the order of vomiting, fever, generalized convulsion, cough and headache. 5. Tuberculin test revealed positive reaction in 65.1% of cases. 6. Chest x-ray revealed tuberculous lesions in 70.4% and miliary tuberculosis were found in 8.4% of all cases. 7. Leukocytes count in the C.S.F. on admission were between 200 and 500/mm3 in 43.7% of the patients and mean count was 330/mm3 Sugar in C.S.F. was definitely reduced less than 40mg% in 77.4% of the patients and mean level was 27mg%. Protein content was elevated between 40 and 300mg% in 78.9% of the patients. 8. Time to normal return of C.S.F. findings ; Sugar returned to normal in 80.4% of the patients less than 7 months and average was 5 months. Protein returned to normal in 81.8% of the patients less than 5 months after therapy was started and average was 3.2 months Leukocytes count returned to normal in 22.5% of the patients between 4 and 5 months after therapy was started and returned to normal in 80.4% of the patients less than 7 months and average was 5 months.

Clinical Observation of Congenital Aganglionic Megacolon in Infancy and Childhood

This clinical observation was carried out 24 cases of the congenital aganglionic megacolon in infancy and childhood admitted to Chonnam University Hospital during 10 years from 1965 to June 1976. The following results were obtained: 1) The frequency was 1 to 500 admission patients. 2) Male to female ratio was 5 to 1 3) The familial ccurrence was not observed in this study and all infants were normal fullterm delivery. 4) The associated congenitalanomalies were mental retardation 2, inguinal hernia 1 and mongolism 1. 5) In majority of the cases, the symptoms occured oon after birth. 6) The clinical symptoms were abdominal distension(87.5%), vomiting(62.5%), constipation(62.5%), malnutrition(41.6%) and diarrhea(41.6%) in order of frequency. 7) The meconium was evacuated after digitalexamination or enema in 61.1%, and it passed spontaneously in remainder. 8) Positive findings of barium enema was noted as 26.7% in the group under the age of 2 months and 100% in the group over the age of 2 months. 9) The mortalityrate was 28.5% in the cases who had Swenson's pull-h-rough operation at the time of admission, and 20% in the case who had Swenson's pperation 6 or 12 months later after colostomy.