Does a Lower Limb Balance Test after Anterior Cruciate Ligament Reconstruction Have a Significant Correlation with Postoperative Clinical Score, Stability, and Functional Performance Test?

Background@#Lower limb balance ability is reduced after anterior cruciate ligament reconstruction (ACLR). However, the recovery of balance based on functional test scores after ACLR is not known because the correlation between balance and clinical scores remains unclear. We aimed to analyze the correlation between lower limb balance assessed by functional test and clinical knee test scores after ACLR. @*Methods@#We evaluated lower limb balance using the anterior-posterior stability index (APSI) of the Biodex Balance System (BBS).Patients underwent clinical tests to evaluate the knee, including the Tegner activity score, International Knee Documentation Committee (IKDC) subjective score, Lysholm score, and KT-2000 arthrometer measurement, hamstring per quadriceps muscle strength ratio at 60°/sec (HQ ratio), and functional performance tests (single-leg hop and single-leg vertical jump tests) 1 year after ACLR.We used a paired t-test to compare continuous preoperative and postoperative variables and Pearson’s correlation coefficient to determine the relationship between BBS-APSI and clinical scores. @*Results@#Forty-eight patients (35 men and 13 women; mean age, 28.9 ± 8.3 years) were included. The follow-up period and BBSAPSI were 12.4 ± 2.0 months and 0.9 ± 0.4, respectively. Tegner activity score, IKDC subjective score, Lysholm score, and KT-2000 arthrometer measurement improved significantly postoperatively (p < 0.001). BBS-APSI was correlated with the Tegner activity score (r = –0.335, p = 0.020), IKDC subjective score (r = –0.301, p = 0.037), Lysholm score (r = –0.323, p = 0.025), single-leg hop test results (r = –0.300, p = 0.038), and single-leg vertical jump test results (r = –0.336, p = 0.019). There was no correlation between KT-2000 arthrometer measurement and HQ ratio. @*Conclusions@#BBS-APSI was correlated with functional performance test scores after ACLR, rendering the BBS-APSI as a useful assessment tool to evaluate postoperative functional recovery. Continuously improving balance after ACLR could be useful for functional recovery after surgery.

Rehabilitation after Repair of Medial Meniscus Posterior Root Tears: A Systematic Review of the Literature

Background@#There is no consensus established on postoperative rehabilitation after medial meniscus posterior root tear (MMPRT) repair, including when and how physicians can apply range of motion (ROM) exercise, weight-bearing (WB), brace use, and return to sports (RTS). The purpose of this study was to systematically review the literature on postoperative rehabilitation characteristics of MMPRT repair regarding ROM, WB, brace use, and RTS. @*Methods@#A literature search was performed using the Medline/PubMed, Cochrane Central Register of Controlled Trials, and Embase databases. The inclusion criteria were English language, human clinical studies, and studies describing rehabilitation protocols after MMPRT repair such as ROM, WB, brace use, and RTS. Abstracts, case reports, cohort studies, controlled laboratory studies, human cadaveric or animal studies, systematic reviews, and meta-analyses were excluded. @*Results@#Thirteen studies were included. Of the 12 ROM studies, ROM was started immediately within 1 or 2 days after operation in 6 studies and after 2 to 3 weeks of knee immobilization in the rest. Of the 13 WB studies, partial weight-bearing was initiated 1 to 4 weeks after operation in 8 studies and 6 weeks in the rest. Of the 9 brace studies, patients were immobilized by a splint for 2 weeks in 3 studies, and in the rest, a brace with full extension was applied for 3 to 6 weeks after several days of splint application.Of the 7 RTS studies, RTS was allowed at 6 months in 6 studies and 5 to 7 months in 1 study. @*Conclusions@#This systematic review revealed conservative rehabilitation protocols were more widely adapted as ROM and WB were restricted at certain degrees during postoperative periods in most protocols analyzed. However, it is impossible to identify a consensus on rehabilitation protocols as the protocols analyzed in this review were distinct each other and heterogeneous. In the future, a well-designed comparative study among different rehabilitation protocols is essential to establish a consensus.

Effectiveness of High Physical Activity after Rotator Cuff Repair / 대한스포츠의학회지

Purpose@#This study aims to determine the effectiveness of high physical activity (PA) on shoulder pain, functional recovery, and structural outcome in the early healing phase after arthroscopic rotator cuff repair (ARCR). @*Methods@#Forty-two patients were included in this study according to inclusion criteria. Subjects were classified into high PA (HPA) group (n=22) and low PA (LPA) group (n=20) according to the classification criteria. Differences between groups according to the PA level were analyzed by comparing visual analogue scale (VAS), range of motion (ROM), American Shoulder and Elbow Surgeons Shoulder Score (ASES), and isokinetic strength before and 6 weeks, 3, and 6 months after surgery. Structural outcome was analyzed by evaluating magnetic resonance imaging performed 6 months after ARCR. @*Results@#VAS, ROM, and ASES were significantly higher in the HPA group at 6 weeks and 3 months after ARCR with a significant interaction effect between time and group (p＜ 0.05). The isokinetic muscle strength was significantly higher in the HPA group at 3 months after surgery with a significant interaction effect on forward flexion and external rotation strength (p＜ 0.05). There was no significant difference in extension and internal rotation strength. In the structural outcome of 6 months after surgery, the retear rate was lower in the HPA group with a significant trend (p＜ 0.05). @*Conclusion@#In this study, higher PA levels in the early healing phase after ARCR were found to result in faster pain relief and restoration of shoulder function. In addition, higher PA level was associated with lower retear rates in structural outcomes related to tendon healing.

Antioxidant and hepatoprotective effects of Korean ginseng extract GS-KG9 in a D-galactosamine-induced liver damage animal model

BACKGROUND/OBJECTIVES@#This study was designed to investigate the improvement effect of white ginseng extract (GS-KG9) on D-galactosamine (Ga1N)-induced oxidative stress and liver injury. @*SUBJECTS/METHODS@#Sixty Sprague-Dawley rats were divided into 6 groups. Rats were orally administrated with GS-KG9 (300, 500, or 700 mg/kg) or silymarin (25 mg/kg) for 2 weeks. The rats of the GS-KG9- and silymarin-treated groups and a control group were then intraperitoneally injected Ga1N at a concentration of 650 mg/kg for 4 days. To investigate the protective effect of GS-KG9 against GalN-induced liver injury, blood liver function indicators, anti-oxidative stress indicators, and histopathological features were analyzed. @*RESULTS@#Serum biochemical analysis indicated that GS-KG9 ameliorated the elevation of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH) in GalN-treated rats. The hepatoprotective effects of GS-KG9 involved enhancing components of the hepatic antioxidant defense system, including glutathione, glutathione peroxidase (GPx), superoxide dismutase (SOD), and catalase (CAT). In addition, GS-KG9 treatment inhibited reactive oxygen species (ROS) production induced by GalN treatment in hepatocytes and significantly increased the expression levels of nuclear factor erythroid-2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1) proteins, which are antioxidant proteins. In particular, by histological analyses bases on hematoxylin and eosin, Masson's trichrome, α-smooth muscle actin, and transforming growth factor-β1 staining, we determined that the administration of 500 mg/kg GS-KG9 inhibited hepatic inflammation and fibrosis due to the excessive accumulation of collagen. @*CONCLUSIONS@#These findings demonstrate that GS-KG9 improves GalN-induced liver inflammation, necrosis, and fibrosis by attenuating oxidative stress. Therefore, GS-KG9 may be considered a useful candidate in the development of a natural preventive agent against liver injury.

Incomplete Clipping Resulting from Scissoring of the Clip Blades during Treatment of a Large Atheromatous Aneurysm

The cerebral aneurysm 'clip scissoring' phenomenon resulting from clip blade twisting is an unpredictable surgical complication. Additionally, incomplete clipping resulting from the presence of an atherosclerotic wall in the neck of the aneurysm can also cause unforeseen problems. Here, the authors present an unusual case of incomplete clipping of a large, atheromatous aneurysm resulting from clip scissoring, which was treated with additional endovascular coiling.

Surgical Outcomes of Post-Fusion Lumbar Flatback Deformity with Sagittal Imbalance

OBJECTIVES: To review surgical results of post-fusion lumbar flatback treated with pedicle subtraction osteotomy (PSO) or Smith-Petersen osteotomies (SPOs). METHODS: Twenty-eight patients underwent osteotomies. Radiological outcomes by sagittal vertical axis (SVA), and pelvic tilt (PT), T1 pelvic angle (T1PA), and pelvic incidence (PI)-lumbar lordosis (LL) at preoperative, postoperative 1 month, and final were evaluated. Oswestry Disability Index (ODI), visual analog scale (VAS) score of back pain/leg pain, and Scoliosis Research Society-22 score (SRS-22r) were analyzed and compared. Patients were divided into 2 groups (SVA ≤5 cm : normal, SVA >5 cm : positive) at final and compared outcomes. RESULTS: Nineteen patients (68%) had PSO and the other 9 patients had SPOs with anterior lumbar interbody fusions (ALIFs) (Mean age : 65 years, follow-up : 31 months). The PT, PI-LL, SVA, T1PA were significantly improved at 1 month and at final (p0.05). Common reoperations were early 4 proximal junctional failures (14%) and late four rod fractures. CONCLUSION: Our results demonstrate that PSO and SPOs with ALIFs at the lower lumbar are significantly improves sagittal balance. For maintenance of normal SVA, PI-LL might be made negative value and T1PA might be less than 11° even though positive SVA group was also significantly improved clinical outcomes.

Analysis of the Risk Factors Affecting the Surgical Site Infection after Cranioplasty Following Decompressive Craniectomy / 대한신경손상학회지

OBJECTIVE: The risk factors for surgical site infections (SSIs) after cranioplasty following decompressive craniectomy remain unclear. The goal of this study was to analyze the risk factors related to developing SSIs after cranioplasty and to suggest valuable predictors. METHODS: A retrospective review was conducted of patients who underwent cranioplasty following decompressive craniectomy at our institution from January 2011 to December 2014, a total of 78 patients who underwent 78 cranioplasties. Univariate and multivariate logistic regression analyses were carried out to determine possible risk factors related to developing SSIs. We analyzed both patient-specific and surgery-specific factors. RESULTS: The overall rate of SSIs was 9.0% (7/78). SSIs after cranioplasty were significantly related to being female, having the primary etiology of traumatic brain injury (TBI) and having had a bilateral cranioplasty in the univariate analysis. Multivariate logistic regression analysis showed that being female [odds ratio (OR) 5.98, p=0.000] and having had a bilateral cranioplasty (OR 4.00, p=0.001) significantly increased the risk of SSIs. CONCLUSION: Based on our data, cranioplasty following decompressive craniectomy is associated with a high incidence of SSI. Being female, having a primary etiology of TBI and having had a bilateral cranioplasty may be risk factors for surgical site infections after cranioplasty.

An Unruptured Cerebral Aneurysm at the Origin of the Duplicated Middle Cerebral Artery

A variety of cerebral vascular anomalies are widely applied, however anomalies of the middle cerebral artery (MCA) are relatively infrequent. The duplicated MCA (DMCA) is a MCA anomaly. Aneurysm arising from the origin of the DMCA is rare. Cerebral angiography in a 61-year-old female demonstrated a small (about 3 mm) saccular aneurysm located at the origin of the DMCA in the anterior direction. Considering the unusual location, the lesion was treated, regardless of the size. Aneurysmal characteristics of a broad neck and small size limited the endovascular approach, necessitating open surgery. Her postoperative course was uneventful and postoperative angiography showed complete obliteration of the aneurysm. The patient was discharged without neurologic deficit.

Absence Expression of Heat Shock Protein 25 in the Cerebellum of Ataxic Mutant Pogo Mouse / 대한해부학회지

Heat shock proteins (Hsps) are generally known to be induced in response to a range of stressful stimuli such as hyperthermia, immobilization, UV radiation, arsenite, various chemicals, and drugs. In addition, these proteins have been suggested to have roles in protecting cells against apoptotic cell death. The ataxic mutant Pogo (pogo/pogo) mouse is a novel neurological ataxic mutant, which is derived from Korean wild type mouse (KJR/Mskist) strain. Pogo mutation is considered as an alleles of alpha subunit of P/Q-type calcium channel mutants such as rolling mouse Nagoya (RMN), tottering, and leaner. We investigated the topographical Hsp25 expression using immunohistochemistry and western blot analysis in several ataxic mutant mice: RMN, tottering, leaner, Pogo and Korean wild mouse. In the cerebellum of the RMN, tottering, leaner, and normal mouse including Balb/C, C57BL/6 and ICR mouse, Hsp25 was expressed in a subset of Purkinje cells that form parasagittal stripes. The Hsp25 expression is largely restricted to specific cerebellar lobules: VI /VII (the central zone: CZ), and IX/X (the nodular zone: NZ). Surprisingly, no Hsp25-immunoreactive Purkinje cells were seen in CZ and NZ of the cerebellum of Pogo (pogo/pogo), heterozygotes Pogo (pogo/+), and Korean wild mouse. Moreover, in western blot analysis, there was no cerebellar Hsp25 expression in ataxic Pogo mouse including Korean wild mouse. These data suggest that cerebellar Hsp25 expression was irrelevant with the development of ataxia in Pogo mouse.

Decreased Calbindin-immunoreactive Renshaw Cells (RCs) in the Lumbar Spinal Cord of the Ataxic Pogo Mice / 대한해부학회지

Calbindin D-28K (CALB) is one of the calcium-binding proteins which is assumed to be buffering, transport of Ca2+, and regulation of various enzyme systems. In the spinal cord, a subpopulation of calbindin-immunoreactive neurons located in the ventral portion of lamina VII, medial to the motoneuron column, has recently been proposed to be Renshaw cells (RCs), that mediate recurrent inhibition of spinal alpha-motoneurons, based on the anatomical location. In this study, we have performed to investigate the correlation between RCs containing high levels of CALB and motoneurons in the ventral horn of lumbar spinal cord of the ataxic pogo mice, that characterized by a failures of interlimb coordination, and prolonged excessive tone of hindlimb extensor muscles. We have shown that CALB immunoreactive RCs was significantly decreased in the ventral horn of lumbar spinal cord of the ataxic pogo mice (p.0.05), when compared with the control mice. Whereas, CALB immunoreactivity expression levels were no difference in the dorsal horn. Furthermore, CALB protein was significantly decreased in the lumbar spinal cord of the ataxic pogo mice (p.0.01). However, there were no difference in the cervical and thoracic spinal cord of the between control and pogo mice. These results suggest that motoneurons of ventral horn of the lumbar spinal cord might be more excited state, results in the decreased CALB immunoreactive RCs have not mediated a motoneuron excitability, in the atxic mice, pogo.

Voltage-dependent Calcium Channel (VDCC) alpha(1A) Subunit Expression in the Ataxic Mutant, Pogo Mice Cerebellum / 대한해부학회지

The pogo mouse is a new ataxic mutant derived from a Korean wild mouse. The pogo mutation is inherited as an autosomal recessive trait on chromosome 8. Mutations in gene coding for the alpha(1A)subunit of voltagegated P/Q-type Ca(2+) channel have been shown to cause phenotypes in humans and mice, i.e., tottering, leaner, rolling mouse mouse Nagoya. Using immunohistochemistry, the expression of the alpha(1A)subunit of voltage-gated P/Q-type Ca(2+) channel was examined in pogo mice cerebellum including deep cerebellar nuclei (DCN). We observed alpha(1A)immunoreactivity in the cerebellar cortex (Purkinje cell and granule cell) and DCN of ataxic pogo mice and heterozygote control mice. There was no difference in cerebellar cortical alpha(1A)immunoreactivity between ataxic pogo mice and heterozygous littermate controls (pogo/+). However, we observed alpha(1A)immunoreactivity in the Purkinje cells of control and ataxic pogo mice cerebellum and DCN. We found a significant difference between pogo and heterozygous controls in terms of alpha(1A)immunoreactivities in the DCN. alpha(1A)immunoreactivity in this nucleus in pogo was much higher than in heterozygous littermate controls. No significant differences were observed in the interposed nucleus between pogo and heterozygous controls, but we found that the alpha(1A)subunits were clearer and more abundant in the lateral and medial regions of pogo than in control mice in these regions, where only weak immunoreactivity was observed. This elevated expression of the alpha(1A)subunit in deep cerebellar neurons of pogo might be a compensation for the altered function of P/Q type calcium channel and be related with the induction of the ataxic phenotype in pogo mice.

A Case of Warthin's Tumor Associated with Primary Tuberculosis of the Parotid Gland / 대한이비인후과학회지

Warthin's tumor is a common neoplasm of the major salivary glands. Tuberculosis of the parotid gland is rare. It may result from the involvement of intraparotid lymph nodes or the infection of parenchyma, either primary or secondary to nodal disease. Clinically, tuberculosis of the parotid may not be distinguishable from a neoplasm. This report presents a patient with a parotid mass that was thought to be a malignancy but, after surgery, was diagnosed to be Warthin's tumor associated with tuberculosis.

A Clinical Study of the Cervical Necrotizing Fasciitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To clarify the presenting signs and symptoms, clinical course, pathologic organisms, and management of cervical necrotizing fasciitis. SUBJECTS AND METHOD: We retrospectively reviewed the inpatient charts treated at our ENT department for cervical necrotizing fasciitis. Seven such patients were identified as having been treated from January 2002 to December 2004. RESULTS: During the 36-months period, 7 adults consisting of 5 males and 2 females with cervical necrotizing fasciitis were diagnosed and treated. The mean age was 45 years ranging from 25 to 59 years. All patients had infections in more than five fascial spaces. The most commonly involved sites of infection were the superficial neck space (100%), followed by submandibular (85.7%), and parapharyngeal and submental space (57.1%). The most commonly known associated preceding illness were tonsillitis and dental abscess (28.5%). Painful neck swelling and difficulty in moving the neck were the most frequent symptoms and signs. The most common pathogen was Streptococcus species (4/7), followed by Staphylococcus epidermidis and Klebsiella pneumoniae (1/6). The mean duration of hospitalization was 17.2 days (range, 8-24). Leukocytosis (WBC>10000/mm3) was found in all patients. All patients received parenteral antibiotics and surgical drainage after admission. Six patients recovered and one patient died after surgical drainage. Tacheotomy was performed on five patients. CONCLUSION: Cervical necrotizing facilitis is an uncommon but often fatal bacterial infection of the skin, subcutaneous fat, superficial fascia, and deep fascia. It is characterized by marked tissue edema, rapid spread of inflammation, and signs of systemic toxicity. High index of suspicion, prompt aggressive surgery, appropriate antibiotics, and supportive care are the mainstays of management.

Traumatic Pseudoaneurysm of the Superficial Temporal Artery / 대한이비인후과학회지

Pseudoaneurysm of the superficial temporal artery is very rare and can potentially be a critical cause of facial masses. Most pseudoaneurysms form as a result of blunt trauma and present as painless, pulsatile tumors that may be associated with neuropathic findings and enlarged size. They can be accurately diagnosed through physical examination alone. The treatment of choice is surgical ligation and resection. We present a case of traumatic pseudoaneurysm of the superficial temporal artery caused by blunt injury and discuss pertinent diagnosis and treatment option.

The Results of Transsphenoidal Microsurgery for Pituitary Microadenama in Cushing's Disease / 대한내과학회지

BACKGROUND: Cushing's disease is a hypercortisolic state attributable to hypersecretion of ACTH at pituitary gland Most of these diseases are due to pituitary microadenoma. Selective removal of adenoma by transsphenoidal microsurgery is the treatment of choice for Cushing's disease. We evaluated 25 cases to analyze results of transsphenoidal microsurgery and to identify prognostic factors that may predict successful outcome. METHODS: From 1989 to 1995, 25 patients were diagnosed as having Cushing's disease in Seoul National University Hospital. They were underwent pituitary microsurgery and confirmed to have pituitary microadenoma radiologically and pathologically. About these patients. retrospective evaluation was done. RESULTS: The patients consist of 21 females and 4 males and the age was ranged from 23 to 49 years. 19 patients (76%) were judged as immediate remission. The preoperative clinical, hormonal, and radiological characteristics of the remission and failure groups were similiar The patients who were immediate remission were followed from 3 months to 72 months. 3 patients had recurrences(15.8%) at 4, 8, 49 months after operation. The pre and postoperative clinical, hormonal, and radiological characteristics of the long-term remission and recurrence groups were similiar. We could not find any predictable factors of surgical outcome. CONCLUSION: The first line trearment of Cushing's disease is transsphenoidal microsurgery. However considering relative late and high rate of recurrence of Cushing's disease following curative surgery, careful longterm follow up is mandatory.