Extracorporeal Shock Wave Therapy versus Platelet-rich Plasma Injection for the Treatment of Lateral Epicondylitis: A Prospective Randomized Clinical Trial

PURPOSE: To compare clinical outcomes of extracorporeal shockwave therapy and platelet-rich plasma injection for the treatment of lateral epicondylitis of the elbow. MATERIALS AND METHODS: Consecutive patients with a lateral epicondylitis who had refractory elbow pain more than 6 months and no response to treatment more than 3 months were recruited for this study. Diagnosis was made on the basis of physical examination and ultrasound imaging study. Prospective randomized trial was performed between two treatment groups; extracorporeal shockwave therapy versus platelet-rich plasma injection. Fifty patients for each group were allocated based on the results of power analysis. Disabilities of arm, shoulder and hand (DASH) scores obtained before treatment and at 1 year after the last treatment were compared between two groups. RESULTS: Both groups showed significant improvement of DASH scores after treatment. The patients who had platelet-rich plasma injection showed significantly greater improvement of DASH scores (from 37.0 to 11.1) than the patients who had extracorporeal shockwave therapy (from 41.9 to 29.9). CONCLUSION: Better subjective outcomes can be expected after platelet-rich plasma injection compared with extracorporeal shockwave therapy in patients with a refractory lateral epicondylitis.

Treatment of Severe Hallux Valgus Deformity with Proximal Reverse Chevron Metatarsal Osteotomy and Akin Osteotomy / 대한족부족관절학회지

PURPOSE: This study analyzed the clinical and radiographic outcome of the severe hallux valgus corrected with proximal reverse chevron metatarsal osteotomy and Akin osteotomy. MATERIALS AND METHODS: The study was based on 18 feet (15 patients) of severe hallux valgus (hallux valgus angle> or =40degrees or intermetatarsal angle> or =18degrees) treated with proximal reverse chevron metatarsal osteotomy and followed for more than 1 year. Akin osteotmy was added in 72% of the patients. Clinically preoperative and postoperative AOFAS Hallux Metatarsophalangeal - interphalangeal score, VAS pain score and satisfaction after the surgery were analyzed. Radiologically hallux valgus angle, hallux valgus interphalangeal angle, the intermetatarsal angle and sesamoid position before and after the operation were analyzed. RESULTS: AOFAS Hallux Metatarsophalangeal - interphalangeal score improved from 54.5 (25-78) to 87.7 (70-100) and VAS pain score decreased from 6.0 (3-8) to postoperative 1.2 (0-5). Ninety-six percents of the patients were satisfied with results. Radiologically hallux valgus angle was decreased from 43.3degrees(31-58degrees) preoperatively to 6.8degrees (-8-27degrees) postoperatively. The intermetatarsal angle was decreased from 18.4degrees(11-24degrees) preoperatively to 5.3degrees (1-12degrees) postoperatively. The sesamoid subluxation was improved from 2.8+/-0.4 preoperatively to 0.4+/-0.6 postoperatively. CONCLUSION: Proximal reverse chevron metatarsal osteotomy and lateral soft tissue release with additional Akin osteotomy is good treatment option for severe hallux valgus.

Treatment of Severe Hallux Valgus Deformity with Proximal Reverse Chevron Metatarsal Osteotomy and Akin Osteotomy / 대한족부족관절학회지

PURPOSE: This study analyzed the clinical and radiographic outcome of the severe hallux valgus corrected with proximal reverse chevron metatarsal osteotomy and Akin osteotomy. MATERIALS AND METHODS: The study was based on 18 feet (15 patients) of severe hallux valgus (hallux valgus angle> or =40degrees or intermetatarsal angle> or =18degrees) treated with proximal reverse chevron metatarsal osteotomy and followed for more than 1 year. Akin osteotmy was added in 72% of the patients. Clinically preoperative and postoperative AOFAS Hallux Metatarsophalangeal - interphalangeal score, VAS pain score and satisfaction after the surgery were analyzed. Radiologically hallux valgus angle, hallux valgus interphalangeal angle, the intermetatarsal angle and sesamoid position before and after the operation were analyzed. RESULTS: AOFAS Hallux Metatarsophalangeal - interphalangeal score improved from 54.5 (25-78) to 87.7 (70-100) and VAS pain score decreased from 6.0 (3-8) to postoperative 1.2 (0-5). Ninety-six percents of the patients were satisfied with results. Radiologically hallux valgus angle was decreased from 43.3degrees(31-58degrees) preoperatively to 6.8degrees (-8-27degrees) postoperatively. The intermetatarsal angle was decreased from 18.4degrees(11-24degrees) preoperatively to 5.3degrees (1-12degrees) postoperatively. The sesamoid subluxation was improved from 2.8+/-0.4 preoperatively to 0.4+/-0.6 postoperatively. CONCLUSION: Proximal reverse chevron metatarsal osteotomy and lateral soft tissue release with additional Akin osteotomy is good treatment option for severe hallux valgus.

Scapular Dyskinesis

PURPOSE: Scapular dyskinesis is an alteration in the normal position or motion of the scapula during coupled scapulohumeral movements. Vast majority of shoulder pathologies are known to be related with scapular motion abnormalities. Because there being enthusiasm about scapular pathology in recent literatures, understanding scapular dyskinesis seems to be an important subject. The authors describe the importance of scapular abnormality in terms of shoulder pathology. MATERIALS AND METHODS: Usually the inhibition or disorganization of activation patterns in scapular stabilizing muscles lead to scapular dyskinesis. This motion abnormality has more important values in Elite Athletes because it might be the sign of future shoulder pathology; for example, SLAP and internal impingement. Treatment of scapular dyskinesis is directed at managing underlying causes and restoring normal scapular muscle activation patterns by kinetic chain-based rehabilitation protocols. Treatment is also important to prevent secondary shoulder injuries. RESULTS AND CONCLUSION: Understanding scapular pathology may be the main key to approach to the shoulder pathology. Also treating scapular pathology might be important in preventing secondary shoulder injuries.

A treatment of atreiovenous malformation on mandible

The treatment of intraosseous ateriovenous malformation in the jaw is difficult because of life threatening frequent bleeding tendency. The surgical resection of AVM may be mortal due to massive blood loss .In the growing pediatric patient, surgery may cause facial deformity and growth disturbance. So currently, the treatment of AVM is only embolization using various material through endovascular access, direct-puncture or embolization in conjunction with surgical resection. We report a case of combined techniques.

Effects of Transforming Growth Factor-beta on Proliferation, Collagen synthesis, Migration and Metalloproteinase Secretion of Human Retinal Pigment Epithelial Cells

PURPOSE: This study was performed to evaluate the effect of TGF-beta on proliferation, collagen synthesis, migration, and matrix metalloproteinase (MMP) secretion of human RPE cells in vitro. METHODS: The cultured human RPE cells were treated with either TGF-beta1 or TGF-beta2 in concentrations of 0, 0.1, 1, 10 ng/ml respectively. The cell number was measured in 3, 6, 9 days, and the collagen synthesis and cell migration was measured. [3H]-thimidine uptake assay was done to evaluate the change of DNA synthesis. And the secretions of MMP1, MMP2, MMP3, MMP9, TIMP1 (tissue inhibitor of metalloproteinase), and TIMP2 were measured by electrophoresis and Western blot analysis. RESULTS: TGF-beta1 and TGF-beta2 significantly inhibited the proliferation of RPE cells in a concentration -and time-dependent manner (p<0.05). [3H]-thymidine uptake was decreased by TGF-beta1 and TGF-beta2 in a concentration-dependant manner. The collagen synthesis of RPE cells was significantly increased by high concentration of TGF-beta1 and TGF-beta 2. However, the migration of RPE cells was not affected by TGF-beta. As the concentration of TGF-beta1 and TGF-beta2 increased, the secretions of MMP1, MMP2, MMP3 and MMP9 decreased, while the secretion of TIMP1 and TIMP2 increased after 72 hours. CONCLUSIONS: These results suggest that the TGF-beta1 and TGF-beta2 may have critical effect on the development of PVR and provide clues to possible therapeutic solutions for controlling PVR process.

Expression of Vascular Endothelial Growth Factor after Laser Induced Retinal Vein Occlusion in the Rat Eye

PURPOSE: To examine the effects of retinal vein occlusion (RVO) on VEGF expression and the ultrastructural change of the various ocular tissues in the rat. METHODS: Sprauge Dawley rats were grouped into RVO group induced with argon laser (n=30) and control (n=10). The ocular tissues of the rats were collected on the first, third and seventh day after RVO. VEGF expression was evaluated with immunohistochemical stain, and the ultrastructural changes were observed with electron microscopy. RESULTS: In control group, VEGF stain was positive in various ocular tissues except outer nuclear cells. In RVO group, VEGF expression had gradual increase in the inner nuclear layer, the retinal pigment epithelia and the ciliary body epithelia after RVO. Especially, in the retinal pigment epithelia, VEGF was significantly increased on the seventh day. In electron microscopic examination, degenerative changes had gradual increase in the inner and middle retinal layers after RVO. The degenerative changes in the retinal pigment epithelia were noted on the third day, and in the retinal photoreceptor cells on the seventh day. CONCLUSIONS: These results showed that VEGF expressions in the inner nuclear layer, retinal pigment epithelia and ciliary body epithelia had a gradual increase, and the ischemic damages of the retina and the optic nerve progressed from the inner layer to the outer layer after RVO.

Arthroscopic Meniscus Repairs

PURPOSE: The clinical outcomes of the arthroscopic meniscus repairs were reviewed retrospectively. MATERIALS AND METHODS: Forty six cases of arthroscopic meniscus repairs which had been performed from September 1993 to December 1998 on the basis of day surgery and followed up for a minimum of one year were analyzed retrospectively about the clinical outcomes, including age, sex, involved meniscus, duration of symptom, tear site, and the associated injuries. We arthroscopically repaired the meniscus which was detached peripherally or vertically over 1 cm in length where the inner portion is found to be salvageable at the outer one-third of the meniscus and where there is a rich blood supply that promotes healing of the torn edges, Inside-out techniques were used for the tears in the middle and posterior one- third of the mensicus and outside-in techniques for the tears in the anterior one-third of the meniscus. Repairs after partial excisions were tried for the tears of the discoid lateral meniscus if possible and the mean follow-up periods was 34 months(ranged, 12~65 months). RESULTS: At the final follow-up evaluation, we obtained 34 cases(76.1 k) of good or excellent clinical results according to the Ikeuchi criteria among 46 arthroscopic meniscus repairs and 9 cases(19.6%) of poor results due to recurrent tears. The best clinical results(80.6%) after repairs according to the comparison of tear patterns is obtained in the longitudinal tears, and the results after repairs for the medial mensicus tears were better than that of the lateral meniscus, but poor results in the tears of the discoid lateral meniscus(64.3%) and tears with associated ligamentous injuries(73.6%), CONCLUSION: Arthroscopic meniscus repair is thought to be a reliable procedure and recommended if possible as the repaired meniscus gives better function than that of meniscectomy.

Repair of scleromalacia with Preserved Scleral and Amniotic Membrane Transplantation

PURPOSE: This study was performed to evaluate the use of preserved scleral and amniotic membrane transplantation in the treatment of scleromalacia. METHODS: This surgical treatment were used to reconstruct scleromalacia in 8 eyes of 8 patients who had painful, non-infectious scleromalacia with impending perforation. Although a variety of graft material such as cartilage, fascia lata, and tibial periosteum on sclera has been used in the surgical treatment of scleromalacia, these tissues must be covered by conjunctiva to prevent necrosis of the grafted material. But in this study, the glycerin preserved sclera had been grafted and then covered by amniotic membrane with thick basement membrane instead of conjunctival flap. RESULTS: Postoperatively, all the patients showed loss of ocular pain and inflammation, fast reepitheliza-tion of ocular surface, and marked improvement in visual acuity. CONCLUSION: This surgical method seemed to be simple, fast and effective. Especially, it was more advantageous in case of large scleral defect or conjunctival scarring. Therefore, amniotic membrane transplantation with preserved scleral graft may be utilized as a new treatment modality for scleromalacia.

Current Trends in Cataract and Refractive Surgery in Korea: 1999 Survey for KSCRS Members

PURPOSE: Cataract and refractive surgical procedures are now among the most common and successful surgeries in medicine. Since 1995, we have annually surveyed the members of the Korean Society of Cataract and Refractive Surgery(KSCRS) on cataract surgery technique, anesthesia, intraocular lens and refractive surgery to understand the current situation and future trends in these fields. METHODS: Fifth annual survey forms consisted of 80 multiple-choice questions mailed in January 2000 to 234 ophthalmologists of the KSCRS. Approximately 47% of the questionnaires mailed were returned by the February cutoff date. Current data were compared with previous annual survey and data from Japan and USA. RESULTS: Hospitalized period is decreased annually and use of topical anesthesia(38%) increased steady. Self sealing wound construction was the main wound closure technique in phacoemulsification accounted for 41%. Most preferred intraocular lenses for small incision cataract surgery are silicone(60%), acrylic (33%), and PMMA(7%). Especially, acrylic intraocular lens had been used highly. Viscoelastics(38%) produced by Korean medical company becomes widely used compared with previous year. 61% of the respondents were performing excimer laser keratomy for refractive surgery. Its complications are the regression of visual acuity(39%), halo or glare(36%), and irregular astigmatism(15%). 52% of the respon-dents performing LASIK had the experience of thin or perforated flap formation, and 48% had free cap formation. Also, legal problems on excimer laser and LASIK have been increased highly. CONCLUSION: From this survey, we found current trend and change in cataract and refractive surgery in Korea are similar to those of Japan and USA.

Conservatively Treated Isolated Medial Collateral Ligament Injury of the Knee Joint / 대한정형외과학회잡지

PURPOSE: To determine the clinical results and healing potential of nonoperatively treated isolated medial collateral ligament injuries of the knee. MATERIALS AND METHODS: Fifty-four cases of isolated medial collateral ligament injuries of the knee, which were treated conservatively from Sept. 1993 to Aug. 1998 and followed up for at least one year at Konkuk University Medical Center MinJoong Hospital, were evaluated. Patients with previous knee injuries, knee operations, or general illness as well as with simultaneous knee fractures or other ligament injuries were excluded from the study. Immediate weight-bearing along with knee ROM and muscle strengthening excercise were allowed after the patient became accustomed to H-bar brace fitting. Thirty-three Grade II and 21 Grade I patients were given questionnaires and analyzed radiologically at an average of 44 months (range, 21-70 months) after injury. The methods used included three standardized knee scoring scales for subjective, functional, and objective or roentgenographic evaluations by Indelicato (1990) . RESULTS: Overall, 85.2 % good or excellent clinical results were obtained according to Indelicato's criteria at a short-term followup of a mean 44 months. Some residual medial laxity was common, and poor results were associated with underlying degenerative changes due to old age or from traffic accident. CONCLUSION: The outcome of the conservatively treated Grade I and II isolated medial collateral ligament injuries of the knee joint was generally good or excellent in 85.2 % of the patients. Advantages of the treatment included more rapid rehabilitation with less postoperative surgical complications, even though some residual medial laxity was common. Arthroscopy could also be useful in identifying other associated lesions such as mensicus or ACL tears.

Arthroscopic Management for the Symptomatic Discoid Lateral Meniscus

PURPOSE: Retrospective study was performed about the incidence, type and pattern of tears, and clini-cal results after arthroscopic management for the symptomatic discoid lateral meniscus. MATERIALS AND METHODS: 54 cases in 49 patients who were managed arthroscopically and followed up for minimum one year for the symptomatic discoid lateral meniscus from Sept. 1993 to Aug. 1998 were included. Mean age at the time of surgery was 30.9 years(ranged, 12-63), most commonly in the second decade(42.5%) and mean duration of symptoms was 22.2 months. Females were more commonly affected than males(25 males and 29 females), and right knees were involved in 25 cases, left knees in 19 cases and bilateral in 5 cases. Most common symptoms was pain in 83.3% and snapping sound in 43.3%. The cause of symptoms was mostly related to previous trauma or sports injury in 66.7%, but none in 18 cases(33.3%). Discoid meniscus was classified according to the Watanabe's classification system and tears were classified as a transverse, longitudinal, horizontal with cystic degeneration, peripheral, wear in the inferior surface and complex. All the partial meniscectomies were done by a piecemeal fashion and the menisci were sutured in a vertical and horizontal way by inside-out or outside-in technique on the basis of day surgery. Postoperative regimens of the immediate passive and active ROM and quadriceps setting exercises were prescribed, and mean follow-up was 31.7 months(ranged, 12-62). RESULTS: According to the Ikeuchi's scale(1969), overall 83.4% of good or excellent clinical results were obtained and poor in 2 cases. Among 5 cases of retear, 3 cases showed excellent clinical results after the second arthroscopic treatment, and 1 case was fair, but 1 case progressed to arthrofibrosis which was rated poor result, and in another one case of poor result without retear, persistent pain was complained due to preexisting osteoarthrosis. CONCLUSIONS: Arthroscopic partial meniscectomy or reshaping is recommmended for the symptomatic discoid lateral meniscus tears in children and adults, but more long-term follow-up and its clinical results about the treatment method in children and adults will be needed.

A Case of Primary Pulmonary Sarcoma with Morphologic Features of Biphasic Synovial Sarcoma / 결핵

Synovial sarcoma is a malignant soft tissue neoplasm that occurs frequently in the extremities of young adults, near large joints. The lung is a common site of metastasis but an extremely unusual primary site for synovial sarcoma. We report an unusual case of primary synovial sarcoma that arose in the lung of a 59-year-old woman. The tumor had histologic and immunophenotypic features consistent with biphasic synovial sarcoma. These features included of an intimate admixture of cytokeratin and epithelial membrane antigen(EMA)-positive neoplastic epithelial cells and vimentin-positive fibroblast-like spindle cells. The patient had a closed thoracomy drainage and doxycycline pleurodesis for malignant loculated effusion and showed tumor extension in the left whole lung 4 months after pleurodesis. This case is an usual addition to the small number of published reports on primary pulmonary synovial sarcoma. The distinctive features of this neoplasm allow it to be distinguished from a variety of primary and metastatic malignancies in the lung.

Operative Treatment for Cubital Tunnel Syndrome / 대한정형외과학회잡지

Thirteen patients were operated for cubital tunnel syndrome and followed for an average of 26 months postoperatively. Ten patients had a history of relevant trauma and three patients had degenerative osteoarthritis of the elbow. The average duration of symptoms was 18 months (range, 2 to 96 months). Diagnosis was made by physical examination, electromyography and nerve conduction study. Among these, nerve conduction study was found to be the most valuable diagnostic method for the patients with atypical clinical findings. Most of the operations were performed by anterior transposition of the ulnar nerve. At the most recent follow-up, the result was excellent in two patients, good in eight, and fair in three; thus ten patients(77%) showed satisfactory results. The rating system for ulnar neuropathy based on sensory, motor dysfunction and pain was useful for evaluating the operative results. The postoperative gain of score for pain and sensory function were larger than that of motor function. Factors known to influence the result of the operation (age, duration of symptom, history of trauma, method of operation) did not effect the outcome in this study. For successful operation, the ulnar nerve must be thoroughly examined, all possible levels of compression must be released and new foci of compression must be created.

Ender nailing for tibial shaft fractures / 대한정형외과학회잡지

No abstract available.

Ipsilateral radial head dislocation and radial shaft fracture / 대한정형외과학회잡지

No abstract available.

Acute renal failure from tourniquet-induced rhabdomyolysis: a case report / 대한정형외과학회잡지

No abstract available.

Traumatic medial dislocation of the patella with rotational malignment along its longitudinal axis: a case report / 대한정형외과학회잡지

No abstract available.

Shortening of the Femoral Neck During Healing Period of the Femoral Neck Fracture / 대한정형외과학회잡지

Since osseous healing in the fracture of the femoral neck is carried out by endosteal bone formation, the size of contact area of the fracture fragments and impaction are of prime importance. It is not uncommon to be faced with the problem of back out of the internal fixation devices during healing period. It seems unnecessary to emphasize the benefit of sliding to close the gap between the fracture fragments. We report a retrospective study of 25 cases of the femoral neck fractures treated by closed reduction and fixation with multiple Knowles pins, paying particular attention to the amount and duration of sliding back out of the fixation devices and relating these to the final results of fracture union. Our clinical study led us to the following conclusions; 1. The shortoning of the femoral neck over 3mm occurred in 16 cases(64%) out of 25 cases. The average amount of back out of Knowles pin is 6mm. 2. Most of the shortening occurred during the first 8 weeks after surgery and extrusion of the nail is frequent findings in unstable fractures and osteoporoses. 3. Backing out over 12 weeks after surgery was associated frequently with delayed union and non-union. 4. Collapse or shortening is nceessary to promote a bone to bone contact and bone healing.

Segmental Resection and Reimplantation with an Autoclaved Bone for Treatment of Malignant Disease / 대한정형외과학회잡지

Wide resection is an acceptable alternative to amputation for the management of primary sarcomas of the long bones or pelvis. The resected bone can be debrided of gross tumor tissue, autoclaved, and than replaced to reconstruct the limb anatomically. The procedure can be combined with prosthetic reconstruction of adjacent joints with sufficient strength to allow early unprotected weight-bearing. We had an experience of a large segmental defect in the shaft of the humerus after wide resection due to.a low grade malignant chondrosarcoma without extension to the surrounding soft tissues and this case had been managed by reimplantation after autoclaving the locally resected segment and autogenous iliac bone graft with a sound union and the favorable functional outcomes. So we are reporting this case with bibliographic reviews as a possible method of reconstruction for the management of the segmental defect which was produced by a local resection for a low grade malignancy.