Syndesmotic Injury / 대한족부족관절학회지

Syndesmotic injuries are found frequently in clinical practice, and they remain controversial because of the variety of diagnostic techniques and management options. Bony avulsions or malleolar fractures are commonly associated with syndesmotic disruptions. Even unstable isolated syndesmosis injuries are associated with a latent or frank tibiofibular diastasis and should not be ignored in the early phase. A relevant instability of the syndesmosis with diastasis results from collateral ligaments tears and requires operative stabilization.The treatment involves an anatomic reduction of the distal tibiofibular articulations followed by stable fixation. Syndesmotic transfixation screws or suture button implants are being proposed as a means of fixation. Recently, suture button fixation has shown more favorable outcomes, but the outcomes can still be controversial. Syndesmotic malreduction can lead to hardware failure, adhesions, heterotopic ossification, tibiofibular synostosis, chronic instability, and posttraumatic arthritis. In particular, the correct diagnosis and evidencebased treatment options for unstable syndesmotic injury should be considered.

Degeneration of the Cruciate Ligaments in Osteoarthritic Knee

PURPOSE: To assess the histological degeneration of the cruciate ligaments and it's correlation with gross appearance of the cruciate ligaments and functional status of the knee. MATERIALS AND METHODS: Macroscopic and microscopic evaluations of cruciate ligaments were made in 80 osteoarthritic knees undergoing cruciate-substituting total knee arthroplasty (TKA). Gross appearance was classified into "normal", "abnormal" and "tear". A scoring system was made to represent the degree of histological degeneration, and correlation with the gross appearance and functional status by knee society score (KSS) was statistically analysed. RESULT: Gross appearance of the anterior cruciate ligament (ACL) was "normal" in 24 cases, "abnormal" in 50 and "tear" in 6 with average histological score 3.7, 4.5 and 8.0 respectively. Gross appearance of the posterior cruciate ligament (PCL) was "normal" in 70, "abnormal" in 10 with average histological score 3.8 and 6.4 respectively. There was no "tear" of the PCL. Gross appearance of the ACL was correlated with histological score of ACL and PCL (p<0.05) and KSS (p<0.05). CONCLUSION: Gross appearance of the ACL was related to the degree of histological degeneration of the PCL as well as the ACL and functional loss of the knee. Therefore intraoperative gross appearance of the ACL can be one of the factors to decide if the PCL would be sacrificed or not during TKA.

Treatment of Femoral Intertrochanteric Fracture with Proximal Femoral Nail

PURPOSE: To evaluate the usefulness of proximal femoral nail in the treatment of intertrochanteric fracture. MATERIALS AND METHODS: The authors investigated the classificaton of fracture, operation time, the amount of intraoperative and postoperative bleeding, the amount of transfusion, postoperative ambulation status, bone union time and the complication among 45 cases who were treated with proximal femoral nail from Jan. 2001 to June 2002. RESULTS: The mean operation time was 116 minutes, and the amount of bleeding was 524 ml in average. The amount of intraoperative transfusion was 1.4 pints and that of postoperative transfusion was 1.1 pints. The complications were the intraoperative penetration of antirotational screw through the femoral neck in 2 cases, separation of the fracture fragment while inserting the nail in 4 cases, irritation of skin by retropulsion of antirotation screw in 2 cases, and penetration of antirotation screw through femoral head in 1 case. CONCLUSION: Proximal femoral nail was effective for the treatment of intertrochanteric fracture, however the surgeon should be carful about collision of the insertion handle against pelvis when the fracture line coincides with the insertion point of nail, especially in obese patients.

A Multi-center Study to Evaluate the Efficacy and Safety of Balofloxacin and Ofloxacin for Patients with Uncomplicated Urinary Tract Infection / 대한비뇨기과학회지

PURPOSE: Balofloxacin is a new fluoroquinolone antibiotic that has potent, broad-spectrum, antimicrobial activity and a good safety profile during preclinical study. The aim of this study was to evaluate the efficacy and safety of balofloxacin in comparison with those of ofloxacin for uncomplicated urinary tract infections. MATERIALS AND METHODS: Patients randomly received oral balofloxacin at 100mg twice a day or oral ofloxacin at 200mg twice a day for 5 days at a ratio of 2:1. Efficacy was assessed by the eradication rate of baseline pathogens and clinical outcome of the objective disease. Safety was assessed by adverse events, changes in laboratory tests and vital signs. RESULTS: The bacteriological efficacy rate was 83.9%(99/118) in the balofloxacin group and 88.4%(61/69) in the ofloxacin group. In the equivalence test using 15% as the standard, clinically acceptable difference value of efficacy, balofloxacin was equivalent to ofloxacin [95% CI: -14.6% to 5.5%]. The bacteriological evaluation of the case whose baseline pathogen was susceptible to the study drug was 96.6%(84/87) for the balofloxacin group and 92.6%(50/54) for the ofloxacin group [95% CI: -4.0% to 11.9%], thereby demonstrating equivalence; as did the relatively high clinical success rates of 99.2% and 95.7%, respectively. The adverse event rate and the drug-related adverse event rate for the balofloxacin group was significantly lower than that of the ofloxacin group(p=0.036, 0.031). Neither unusual laboratory findings nor abnormal vital signs were reported for either group and there were no significant differences between the treatment groups. CONCLUSIONS: Twice daily administration of 100mg balofloxacin is as effective as twice daily administration of 200mg ofloxacin for the treatment of uncomplicated urinary tract infections. With regard to safety, balofloxacin was confirmed to be safer than ofloxacin.

Hemolytic-Uremic Syndrome Associated with Bloody Diarrhea

The authors analysed 2,653 cases of transthoracic fine needle aspiration cytology of the lung to evaluate the diagnostic accuracy and its limitation. A comparison was made between the original cytologic and the final histologic diagnoses on 1,149 cases from 1,074 patients. A diagnosis of malignancy was established in 38.3% benign in 48.1%, atypical lesion in 2.3%, and inadequate one in 11.9% of the cases. Statistical data on cytologic diagnoses were as follows; specificity 98.9%: sensitivity of procedure, 76.8%: sensitivity of diagnosis, 95.5%: false positive 5 cases: false negative 18 cases: predictive value for malignancy, 98.8%: predictive value for benign lesion, 79.5%: overall diagnostic efficiency, 87.5%: typing accuracy in malignant tumor, 80%.