Distal Femoral Varus Osteotomy for Valgus Arthritis of the Knees: Systematic Review of Open versus Closed Wedge Osteotomy

PURPOSE: The purpose of this review is to compare the clinical and radiological outcomes between open and closed wedge distal femoral varus osteotomy (DFO). METHODS: A literature search of online databases (MEDLINE, EMBASE, and Cochrane Library database) was made in addition to manual search of major orthopedic journals. Data were searched from the time period of January 1990 to October 2016. A modified Coleman Methodology Score system was used to assess the methodologic quality of the included studies. A total of 20 studies were included in the review. All studies were level IV evidence. RESULTS: Comparative analysis of open and closed wedge DFO did not demonstrate clinical and radiological differences. The survival rates were also similar. Five studies (56%) on open wedge DFO mentioned the need for either bone grafting or substitute for osteotomy gap filling and reported higher incidences of reoperation for plate removal than the closed wedge DFO studies. CONCLUSIONS: The present systematic review showed similar performance between open and closed wedge DFO. Outcomes including survival rates were not statistically significantly different. However, additional bone grafting or substitutes were often needed to prevent delayed union or nonunion for open wedge techniques. Additional operations for plate removal were commonly required due to plate irritation in both techniques.

A Combined Closing Wedge Distal Femoral Osteotomy and Medial Reefing Procedure for Recurrent Patellar Dislocation with Genu Valgum

PURPOSE: Recurrent patellar dislocation is often associated with genu valgum. The purpose of this study was to analyze the short-term results of single-incision, closing-wedge distal femoral osteotomy (CWDFO) combined with medial reefing and lateral release for recurrent patellar instability with genu valgum. MATERIALS AND METHODS: Combined CWDFO/medial reefing/lateral release was performed on 10 knees. Clinical evaluation was based on pre- and postoperative Knee Society Score (KSS) and Kujala patellofemoral score. Radiographic evaluation was performed with reference to the weight-bearing line (WBL), the femorotibial angle (FTA), and the mechanical lateral distal femoral angles in the knee-standing view. RESULTS: At a mean follow-up of 20±11.7 months (range, 12–42 months), KSS scores improved significantly, from 46.7±5.2 preoperatively to 87±4.4 postoperatively (p<0.001), as did the Kujala score, from 44±8 preoperatively to 86.6±6.8 postoperatively (p<0.001). The WBL decreased significantly, from 76±7% preoperatively to 41±11% postoperatively (p<0.001). The FTA was improved significantly, from 12.7±1.7° preoperatively to 4±4° postoperatively (p<0.001), as was the mLDFA, from 83±4° preoperatively to 91±1.3° postoperatively (p<0.001). CONCLUSION: Use of single-incision CWDFO combined with medial reefing and lateral release prevents patellar dislocation, corrects deformity, and improves clinical outcomes.

Percutaneous Transhepatic Biliary Drainage and Percutaneous Balloon Dilatation for Patients with Biliary Duct Stones and Biliary Obstruction in Whom an Endoscopic Approach Is Difficult to Use: Case Series of 21 Patients at a Single Institution / 대한췌담도학회지

BACKGROUND/AIM: The aim of this study was to evaluate the stability and simplicity of papillary balloon dilatation by retrospectively analyzing the results of performing concurrent papillary balloon dilatation in conjunction with percutaneous transhepatic biliary drainage (PTBD) in the patients with biliary obstruction due to common bile duct stones or a tumor who were difficult to treat with an endoscopic approach. METHODS: We retrospectively analyzed a total of 21 patients who were treated through a percutaneous transhepatic biliary approach after they were diagnosed with biliary obstruction due to a tumor and biliary stones in a single medical institution for four years from 2012 to 2015. RESULTS: Sixteen out of 21 patients (76.2%) underwent percutaneous transhepatic biliary drainage and papillary balloon dilatation. For 5 patients (23.8%) in whom it was difficult to perform the procedure simultaneously due to the patient's poor overall condition such as pancreatitis and septic shock, papillary balloon dilatation was performed 5-8 days after biliary drainage. Nineteen of 21 patients (90.5%) were successfully treated by a single procedure without residual stones or restenosis, but in two patients, stones were removed two times and three times. CONCLUSIONS: The use of a percutaneous transhepatic biliary approach to patients in whom endoscopy cannot be performed is considered safe and effective. In addition, unless the procedure is specifically contraindicated, the use of papillary balloon dilatation performed simultaneously with PTBD can reduce patient inconvenience and procedure frequency.

Modified Iliac Crest Reconstruction with Bone Cement for Reduction of Donor Site Pain and Morbidity after Open Wedge High Tibial Osteotomy: A Prospective Study

PURPOSE: This study was to determine the efficacy of iliac crest reconstruction using bone cement in reducing pain and morbidity at the donor site in patients undergoing open wedge high tibial osteotomy (OWHTO) with tricortical iliac crest autologous graft. MATERIALS AND METHODS: Thirty-three patients who underwent iliac crest reconstruction using polymethyl methacrylate (PMMA) bone cement (group A) and thirty patients who had no iliac crest reconstruction (group B) were enrolled in this study. All patients were evaluated for pain and functional disability related to graft harvesting using the pain and functional visual analogue scale (VAS) score during hospital stay and at 6 weeks, 3 months, and 6 months postoperatively. RESULTS: There was significant difference between the two groups in terms of pain and function. The pain VAS score was significantly lower in group A than group B during the first 2 weeks postoperatively (p=0.04) and the functional VAS score was also significantly lower in group A during the first 2 weeks postoperatively (p<0.001) in terms of breathing, sitting up from the supine position, and standing up with crutches from the sitting position. CONCLUSIONS: Iliac crest donor site reconstruction using PMMA bone cement in patients undergoing OWHTO significantly decreased pain and improved function during the first 2 weeks postoperatively when compared to patients who underwent OWHTO without iliac crest reconstruction.

High Tibia Osteotomy for a Posterior Root Tear of the Medial Meniscus / 대한정형외과학회잡지

Posterior root tear of the medial meniscus which is frequently unrecognized is a common injury of meniscus that often results in serious consequences in a knee joint. After medial meniscus posterior root tear (MMPR), there is a significant increase in tibio-femoral contact pressure concomitant with altered knee joint kinematics. This injury frequently leads to meniscal extrusion, and thus the transmission of circumferential hoop stresses would be impaired, which condition is biomechanically similar to that of total meniscectomy. For these reasons, several methods (conservative treatment, meniscectomy, repair, or unicompartmental knee arthroplasty) have been developed for treatment of MMPR, many of which have shown good clinical results. However, the methods of MMPR treatment are still debatable. This article presents a review of the current strategies for treatment of common injuries to these MMPR and clinical results of high tibia osteotomy for MMPR after failed conservative treatment.

Serum Levels of IL-8 and ICAM-1 as Biomarkers for Progressive Massive Fibrosis in Coal Workers' Pneumoconiosis

Coal workers' pneumoconiosis (CWP) is characterized as a chronic inflammation of the lung associated with activation of macrophages and endothelial cells in the lung. The aim of the present study was to compare the levels of serum interleukin-8 (IL-8), macrophage inflammatory protein-1alpha (MIP-alpha), and intercellular adhesion molecule-1 (ICAM-1) as biomarkers for progressive massive fibrosis (PMF) in 106 subjects (27 non-CWP and 79 CWP patients). The levels of serum IL-8 (P<0.001) and ICAM-1 (P=0.001) of subjects with PMF were higher than those of non-CWP subjects. The IL-8 levels of PMF subjects were also higher than those of simple CWP subjects (P=0.003). Among the subjects without PMF, IL-8 levels in the subjects with International Labour Organization (ILO) category II or III were higher than those in the subjects with ILO category 0 (P=0.006) and with category I (P=0.026). These results suggest that high serum levels of IL-8 and ICAM-1, which are important as neutrophil attractants and adhesion molecules, are associated with PMF.

Serum Levels of IL-8 and ICAM-1 as Biomarkers for Progressive Massive Fibrosis in Coal Workers' Pneumoconiosis

Coal workers' pneumoconiosis (CWP) is characterized as a chronic inflammation of the lung associated with activation of macrophages and endothelial cells in the lung. The aim of the present study was to compare the levels of serum interleukin-8 (IL-8), macrophage inflammatory protein-1alpha (MIP-alpha), and intercellular adhesion molecule-1 (ICAM-1) as biomarkers for progressive massive fibrosis (PMF) in 106 subjects (27 non-CWP and 79 CWP patients). The levels of serum IL-8 (P<0.001) and ICAM-1 (P=0.001) of subjects with PMF were higher than those of non-CWP subjects. The IL-8 levels of PMF subjects were also higher than those of simple CWP subjects (P=0.003). Among the subjects without PMF, IL-8 levels in the subjects with International Labour Organization (ILO) category II or III were higher than those in the subjects with ILO category 0 (P=0.006) and with category I (P=0.026). These results suggest that high serum levels of IL-8 and ICAM-1, which are important as neutrophil attractants and adhesion molecules, are associated with PMF.

Malondialdehyde and 3-Nitrotyrosine in Exhaled Breath Condensate in Retired Elderly Coal Miners with Chronic Obstructive Pulmonary Disease

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an important cause of occupational mortality in miners exposed to coal mine dust. Although the inflammatory mediators involved in COPD have not been defined, many studies have shown that inflammatory mediators such as reactive oxygen and nitrogen species are involved in orchestrating the complex inflammatory process in COPD. METHODS: To investigate the relevance of exhaled biomarkers of oxidative and nitrosative stress in participants with COPD, we determined the levels of hydrogen peroxide, malondialdehyde (MDA), and 3-nitrotyrosine (3-NT) in exhaled breath condensate (EBC) in 90 retired elderly coal miners (53 non-COPD and 37 COPD participants). RESULTS: Mean levels of MDA (4.64 nM vs. 6.46 nM, p = 0.005) and 3-NT (3.51 nM vs. 5.50 nM, p = 0.039) in EBC were significantly higher in participants with COPD. The median level of MDA did show statistical difference among the COPD severities (p = 0.017), and the area under the receiver operating characteristic curve for MDA (0.67) for the diagnostic discrimination of COPD indicated the biomarker. The optimal cutoff values were 5.34 nM (64.9% sensitivity and 64.2% specificity) and 5.58 nM (62.2% sensitivity and 62.3% specificity) for MDA and 3-NT, respectively. The results suggest that high levels of MDA and 3-NT in EBC are associated with COPD in retired elderly miners. CONCLUSION: These results showed that the elevated levels of EBC MDA and EBC 3-NT in individuals with COPD are biomarkers of oxidative or nitrosative stress.

Comparative Study of Intertrochanteric Fracture Treated with the Proximal Femoral Nail Anti-Rotation and the Third Generation of Gamma Nail

PURPOSE: To compare the result between the third generation gamma nail (gamma 3 nail) and proximal femoral nail anti-rotation (PFNA) in the treatment of unstable intertrochanteric fractures. MATERIALS AND METHODS: Between March 2009 and June 2011, 47 consecutive patients with unstable intertrochanteric femoral fractures were treated with gamma 3 nail or PFNA. We reviewed 24 cases of gamma 3 nail and 23 cases of PFNA. Retrospectively, we evaluated the mean operation time, amount of bleeding, average union period, reduction status, change of neck shaft angle, Tip-apex distance, Cleveland index, sliding of lag screw and complication on set of telephone interview and outpatient. We also evaluated the postoperative capability of function and mobility, using 'Modified Koval index'. RESULTS: There were no significant differences between the groups, which were treated with gamma 3 nail and PFNA. In addition, they did not show statistical difference. We experienced 2 cases of complication (gamma 3 nail 1 case, PFNA 1 case), which were cut-out of the femoral head. CONCLUSION: The gamma 3 nail and PFNA were seen with good results in the treatment of unstable intertrochanteric fracture.

Surgical Techniques for Percutaneous Reduction by Towel Clips and Percutaneous Intramedullary Fixation with Steinmann Pins for Clavicle Shaft Fractures

PURPOSE: To report the clinical results of surgical treatment of clavicle shaft fracture by percutaneous reduction with towel clips and percutaneous intramedullary pin fixation. MATERIALS AND METHODS: This study reviewed the results of 80 cases of clavicle shaft fracture treated by percutaneous reduction with towel clips and percutaneous intramedullary pin fixation with Steinmann pins from January 2002 to August 2010, after follow-up for 12 months or more. We evaluated the clinical results, such as union time and complications. RESULTS: Bone union was evident in all cases and the mean time for bone union to appear on radiological findings was 10.3 weeks. Using Kang's criteria, 78 of the 80 patients (97.5%) showed good results and there were no severe complications. CONCLUSION: Percutaneous reduction with towel clips and the percutaneous intramedullary pin fixation method showed good results for treating clavicle shaft fracture.

Intra-articular Benign Fibrous Histiocytoma of the Knee: A Case Report / 대한골관절종양학회지

Benign fibrous hitiocytoma of the infrapatella fat pad is very rare. It has usually do not induced a pain or a symptom because it was located deep tissue. So it was very difficult to be diagnosed. We experienced a case of deep benign fibrous histiocytoma in a 53-year-old woman. It was diagnosed by MRI. Diagnostic arthroscopic procedure was performed and the lesion was completely resected by open excision. We report a rare case of benign fibrous hitiocytoma presenting as an intra-articular tumor in the joint causing pain and limitation of movement.

Annual Changes of Lung Function in Retired Workers Exposed to Inorganic Dusts / 결핵및호흡기질환

BACKGROUND: The aim of this study was to investigate annual changes in pulmonary function in workers who were exposed to inorganic dust. METHODS: The subjects were 2,922 male patients who had been diagnosed with pneumoconiosis more than twice during 6 years from 2005 to 2010. RESULTS: Of the 2,922 cases, forced vital capacity (FVC) decreased by 54 mL in 1 year. In contrast, the annual change of forced expiratory volume in one second (FEV1) decreased by 56 mL. CONCLUSION: This is the first study that has investigated the annual change in pulmonary function in workers exposed to inorganic dust. The results will help estimate the pulmonary condition of patients who are unable to perform a pulmonary function test due to age or a disorder.

Hebei Spirit Oil Spill Exposure and Subjective Symptoms in Residents Participating in Clean-Up Activities

OBJECTIVES: This study was conducted to examine the relationship between crude oil exposure and physical symptoms among residents participating in clean-up work associated with the Hebei Spirit oil spill, 2007 in Korea. METHODS: A total of 288 residents responded to a questionnaire regarding subjective physical symptoms, sociodemographic characteristics and clean-up activities that occurred between two and eight weeks after the accident. Additionally, the urine of 154 of the respondents was analyzed for metabolites of volatile organic compounds (VOCs) and polycyclic aromatic hydrocarbons (PAHs) and heavy metals. To compare the urinary levels of exposure biomarkers, the urine of 39 inland residents who were not directly exposed to the oil spill were analyzed. RESULTS: Residents exposed to oil remnants through clean-up work showed associations between physical symptoms and the exposure levels defined in various ways, including days of work, degree of skin contamination, and levels of some urinary exposure biomarkers of VOCs, metabolites and metals, although no major abnormalities in urinary exposure biomarkers were observed. CONCLUSIONS: This study provides evidence of a relationship between crude oil exposure and acute human health effects and suggests the need for follow-up to evaluate the exposure status and long-term health effects of clean-up participants.

Serum Levels of Interleukin-8 and Tumor Necrosis Factor-alpha in Coal Workers' Pneumoconiosis: One-year Follow-up Study

OBJECTIVES: Various cytokines induced by inhalation of coal dust may mediate inflammation and lead to tissue damage or fibrosis, such as coal workers' pneumoconiosis (CWP). METHODS: To investigate the relevance of serum cytokines in CWP, the levels of serum interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-alpha) as CWP biomarkers in 110 retired coal miners (22 controls and 88 CWP subjects) were related to cross sectional findings and 1-year progressive changes of the pneumoconiosis. Progressive changes of CWP were evaluated by paired comparison of chest radiographs. Analysis by a receiver operating characteristic curve assessed the biomarker potential of each cytokine. RESULTS: The mean serum IL-8 level was significantly higher in CWP compared to controls and IL-8 levels correlated with the degree of CWP. The median serum TNF-alpha level was significantly higher in subjects with progressive CWP compared to subjects without CWP progression. The area under the ROC curve for IL-8 (0.70) and TNF-alpha (0.72) for CWP identification and progression, respectively, indicated the biomarker potential of the two cytokines. Serum cutoff values of IL-8 and TNF-alpha were 11.63 pg/mL (sensitivity, 69%; specificity, 64%) and 4.52 pg/mL (sensitivity, 67%; specificity, 79%), respectively. CONCLUSION: The results suggest that high levels of serum IL-8 are associated with the presence of CWP and those of serum TNF-alpha are associated with the progression of CWP.

The Study of K Channels in Smooth Muscle Cells of Rabbit Seminal Vesicle / 대한남성과학회지

PURPOSE: Ionic currents in smooth muscle have fundamental roles in initiation and maintenance of excitability and contractile status. So we studied and characterized potassium ion channels in smooth muscle cells of rabbit seminal vesicle. MATERIALS AND METHODS: Single smooth muscle cells of New Zealand White rabbit seminal vesicle were obtained using proteolytic enzymes (collagenase and papain). Using single cell and channel recording methods of patch clamp, potassium channels in smooth muscle of seminal vesicle were recorded. RESULTS: Potassium currents recorded whole-cell patch clamp method were divided into maxi-K channel dominant cells (n=11) and the cells with mixture of maxi-K and delayed rectifier K channels (n=7). Inside-out mode of patch clamp technique was used to characterize the maxi-K channel. The channel showed outward rectification and Ca-dependency. The single channel conductance of this channel estimated from slope conductance was 188 pS in physiological condition. These characters were typical properties of maxi-K channel. CONCLUSIONS: From these results it is suggested that maxi-K channel was predominantly distributed in rabbit seminal vesicle cell. The physiological roles of this channel in modulating seminal vesicle smooth muscle tone need further studies.

A Case of Reactive Airways Dysfunction Syndrome in a Synthetic Resin Manufacture Factory / 대한산업의학회지

BACKGROUND: Reactive airways dysfunction syndrome (RADS), which represents between 5% and 18% of new-onset, work-related asthma, remains underreported in spite of increasing reports of occupational asthma cases through occupational asthma surveillance in Korea. We report a 61-year-old male who developed RADS after exposure to a high level of toxic gases from a workplace accident. CASE: The patient who had worked for 21 years at a PVC manufacture factory and had retained good health until Aug 22, 2007, when he was exposed to PVC (polyvinyl chloride), DEHP (Di (2-Ethylhexyl) Phthalate), dibutyl tin maleate and epoxidized soybean oil gases from a heated mixer. Within several minutes of exposure, he developed coughing, rhinorrhea, dyspnea and wheezing. Pulmonary function tests (PFTs) showed an FVC of 3.81 L(82% of predicted), FEV1 of 1.63 L/s (50% of predicted), FEV1/FVC% of 43 %, and FEV1 of 1.80 L/s that increased by 170 ml and 10.4% in response to bronchodilator. After 7 months of treatment with inhaled steroids and bronchodilators, repeat PFTs showed an FVC of 6.56 L(143.5% of predicted), FEV1 of 3.21 L(99.3% of predicted), and FEV1/FVC% of 48.9%. A methacholine challenge test was negative at a concentration of 25 mg/ml. CONCLUSION: RADS occurred due to exposure to raw material vapors or their thermal decomposition products.

A Case of Polyneuropathy Associated with Methyl Bromide Intoxication / 대한산업의학회지

BACKGROUND: The diagnosis and treatment of intoxication induced by methyl bromide depends on the patient's exposure history. In the present case, the patient showed various neurologic symptoms which were helpful to confirm the diagnosis and to determine the concentration of bromide ion in his body. The reduction rate of bromide ion concentration was another important clue to estimate the patient's health state in treatment. CASE REPORT: Some neurologic disorders were manifested in a 35-year-old man who had been engaged in a fumigation company for 12 years. Although he had been complaining of abnormal symptoms for 10 days, he had left his work only 3 days before being admitted to our hospital in serious state via the emergency department. Comprehensive clinical evaluations confirmed he was suffering from polyneuropathy, optic neuropathy and cerebellar signs. We diagnosed his condition as methyl bromide intoxication, and ruled out other possible diseases, after taking his occupational history and evaluating the elevation of bromide ion concentration in the sampled blood, urine and cerebrospinal fluid. With decreasing bromide ion concentration, his abnormal symptoms improved and he was discharged 22 days after admission without any neurologic sequela. CONCLUSION: This case report confirmed the usefulness of measuring the concentrations of bromide ion in the diagnosis of methyl bromide intoxication. We therefore suggest that the regular measuring of bromide ion concentration be included in the occupation specified health examination.

Monitoring of Polycyclic Aromatic Hydrocarbons and the metabolites in Workers using Coal tar Paints / 대한산업의학회지

OBJECTIVE: In this study, the exposure levels of polycyclic aromatic hydrocarbons (PAHs) and urinary 1-hydroxypyrene(1-OHP) were surveyed among the workers using coal tar paint. METHOD: The study subjects for the exposed group were 107 male coal tar workers in 10 factories, and for the comparison group were 201 male clerk workers who had never been exposed to coal tar paint. Ambient PAHs, and pre-shift and end-shift urinary 1-OHP were sample and 16 PAHs were analysed. Smoking history was recorded during the survey day. RESULTS: The geometric mean of ambient concentration of total PAHs was 120.17 microgram/m3. Naphthalene had the highest level among the 16 PAHs. The pre-shift 1-OHP in the exposed group (8.89 micro mol/mol creatinine) was significantly higher than that in the control group (0.29 micro mol/mol creatinine). The end-shift 1-OHP in the exposed group (19.02 micro mol/mol creatinine) was significantly higher than that in the pre-shift (8.89 micro mol/mol creatinine) (Ed- confirm). 1-OHP of smokers was significantly higher than that of non-smokers in both groups. The difference between pre-shift and end-shift 1-OHP in smokers (12.40 micro mol/mol creatinine) was twice as high as that in non-smokers (6.06 micro mol/mol creatinine). The difference of 1-OHP between smokers and nonsmokers was 7.59 micro mol/mol creatinine in pre-shift and 13.96 micro mol/mol creatinine in end-shift. Thus, the effect of smoking and exposure to PAHs on 1-OHP may not be additive. In regression analysis for 1-OHP, the significant independent variables were pre-shift 1-OHP and PAHs. The direction of these variables was positive. When the analysis was performed in workers exposed to higher PAHs, smoking was significant independent variable. CONCLUSION: The above results suggest that not only ambient PAHs but also smoking, one of the most important non-occupational PAHs source, influenced the level of 1-OHP. Moreover, the effect of smoking to 1-OHP changed according to the exposure level of PAHs.

Influence of Hepatocyte Growth Factor on Matrix Metalloproteinase Expression in HT cell line / 대한산부인과학회잡지

OBJECTIVE: This study was performed to investigate the influence of hepatocyte growth factor (HGF) on matrix metalloproteinase (MMP), which are related in the lysis process of tissue during the invasion of trophoblasts. METHOD: HT cell line was treated with recombinant HGF (rHGF) of different concentration (0, 10, 50 and 100 ng/mL) and was cultured for 24 hours to check the changes in the expression of MMP-2 and MMP-9. Also, HT cell line was treated with recombinant HGF 50 ng/mL and was cultured for 24, 36, 48, and 72 hours to check the changes in the expression of MMPs according to the different time span. Total RNA were extracted from each cultured sample and RT-PCR and Western blotting were used to analyze the expression of MMP-2 and MMP-9. RESULTS: MMP-2 mRNA expression with treated rHGF showed increase of 2, 2.5 and 2.2 times with the increase of concentration level of 10, 50 and 100 ng/mL accordingly, while MMP-2 protein expression were increased 1.4 and 1.5 times in 50 ng/mL and 100 ng/mL of rHGF respectively compared with that of normal control. MMP-9 mRNA showed no significant changes in its expression with all different levels of concentration, while MMP-9 protein showed 1.5 times increase with 10 ng/mL rHGF but 0.4 times decrease with 100 ng/mL. MMP-2 mRNA expression treated with recombinat HGF were increased 1.6 times with 24 hour culture and 2.3 times with 36 hour culture. MMP-2 protein showed 1.9 times increase only for the case of 24 hour culture. MMP-9 mRNA expression of recombinant HGF-treated groups was decreased 0.7 times compared with that of control group in 36 hours. MMP-9 protein expression were increased by 1.2, 1.6 and 1.9 times as culture time increase to 36, 48, and 72 hours accordingly, compared with that of normal control. CONCLUSION: This result suggests that the HGF might partially regulate the invasion of trophoblasts through MMP-2 and MMP-9.