Rotating Arm Internally Can Change the Arthroscopic Diagnosis of a Partial-thickness Tear of the Subscapularis

BACKGROUND@#The aims of this study were (1) to examine the footprint of the subscapularis tendon using the traditional posterior portal and 30° arthroscope by simple internal rotation of the arm during surgery, and (2) to classify the pattern of a subscapularis partial-thickness tear.@*METHODS@#This study analyzed a total of 231 patients with a partial-thickness subscapularis tear from 550 consecutive patients undergoing an arthroscopic operation who had a visualization of the subscapularis tendon footprint by internal rotation of the arm. First, the patients were classified into four categories according to the tear pattern: (1) stable lamination, (2) unstable lamination, (3) avulsion, and (4) laminated avulsion. Randomized arthroscopic videos were reviewed blindly by two independent orthopedic surgeons. The pattern of the tear of the subscapularis at the neutral position and after internal rotating the arm were assessed and compared with the treatment decision (level IV case series).@*RESULTS@#Stable lamination, unstable lamination, avulsion, and laminated avulsion were observed in 9.1% (n=21), 20.8% (n=48), 41.1% (n=95), and 29.0% (n=67) of cases, respectively. In 145 out of 231 cases (62.8%), the decision was changed after inspecting the footprint after internal rotation of the arm, and the treatment method was changed in 116 (50.2%) cases.@*CONCLUSIONS@#In a subscapularis tendon partial-thickness tear, inspecting the footprint of the subscapularis tendon is essential to diagnosing and deciding on the appropriate treatment. In addition, simply internal rotating the arm during surgery when using the traditional posterior portal and 30° arthroscope can be a valuable method.

Arthroscopic Capsular Repair without Relaying Sutures: ‘Simple Sewing Technique’

We report a simple technique for repairing capsular tear, using only a hook-like, cannulated instrument and braided sutures without relaying steps. A No. 2 braided suture is passed through the lumen of the instrument. Under direct arthroscopic view, the tip of the instrument is passed through the side of the capsule that has previously been separated with the probe. One end of the suture is retrieved with a grasper through a separate portal. The tip is moved back without withdrawing through the skin, and reinserted into the other side of the capsule. Holding the end retrieved earlier, the other end of the suture is retrieved with a suture retriever. After complete removal of the instrument, the suture is tied through a cannula using the standard knot tying techniques. The same procedures are repeated for other required knots.

Rotating Arm Internally Can Change the Arthroscopic Diagnosis of a Partial-thickness Tear of the Subscapularis

BACKGROUND: The aims of this study were (1) to examine the footprint of the subscapularis tendon using the traditional posterior portal and 30° arthroscope by simple internal rotation of the arm during surgery, and (2) to classify the pattern of a subscapularis partial-thickness tear. METHODS: This study analyzed a total of 231 patients with a partial-thickness subscapularis tear from 550 consecutive patients undergoing an arthroscopic operation who had a visualization of the subscapularis tendon footprint by internal rotation of the arm. First, the patients were classified into four categories according to the tear pattern: (1) stable lamination, (2) unstable lamination, (3) avulsion, and (4) laminated avulsion. Randomized arthroscopic videos were reviewed blindly by two independent orthopedic surgeons. The pattern of the tear of the subscapularis at the neutral position and after internal rotating the arm were assessed and compared with the treatment decision (level IV case series). RESULTS: Stable lamination, unstable lamination, avulsion, and laminated avulsion were observed in 9.1% (n=21), 20.8% (n=48), 41.1% (n=95), and 29.0% (n=67) of cases, respectively. In 145 out of 231 cases (62.8%), the decision was changed after inspecting the footprint after internal rotation of the arm, and the treatment method was changed in 116 (50.2%) cases. CONCLUSIONS: In a subscapularis tendon partial-thickness tear, inspecting the footprint of the subscapularis tendon is essential to diagnosing and deciding on the appropriate treatment. In addition, simply internal rotating the arm during surgery when using the traditional posterior portal and 30° arthroscope can be a valuable method.

Arthroscopic Capsular Repair without Relaying Sutures: ‘Simple Sewing Technique’

We report a simple technique for repairing capsular tear, using only a hook-like, cannulated instrument and braided sutures without relaying steps. A No. 2 braided suture is passed through the lumen of the instrument. Under direct arthroscopic view, the tip of the instrument is passed through the side of the capsule that has previously been separated with the probe. One end of the suture is retrieved with a grasper through a separate portal. The tip is moved back without withdrawing through the skin, and reinserted into the other side of the capsule. Holding the end retrieved earlier, the other end of the suture is retrieved with a suture retriever. After complete removal of the instrument, the suture is tied through a cannula using the standard knot tying techniques. The same procedures are repeated for other required knots.

Clinical Analysis of the Conservative Treatment for Diabetic Foot Osteomyelitis / 대한족부족관절학회지

PURPOSE: The question of surgical versus non-surgical treatment for diabetic foot osteomyelitis remains subject to debate. The aims of this study were to analyse the outcome of conservative treatment (antibiotic treatment and conservative surgery) for diabetic foot osteomyelitis and identify the predictive factors of remission in conservative treatment of diabetic foot osteomyelitis. MATERIALS AND METHODS: Seventy-seven patients with diabetic foot osteomyelitis who initially received conservative treatment from January 2004 to July 2013 were identified, and their medical records were reviewed. Diabetic foot osteomyelitis was defined by imaging studies or histological evidence. Remission was defined as the absence of any sign of infection at the initial or contiguous site assessed at least 12 months after the end of treatment. The demographic, clinical, and therapeutic factors were analysed. RESULTS: The mean age of the patients was 62.7+/-12.2 years, and 47 patients (61.0%) were male. The median diabetes duration was 15.7+/-11.2 years and mean HbA1c was 8.7%+/-2.4%. Forty-eight patients (62.3%) healed with conservative treatment (antibiotic treatment and conservative surgery). Twenty-five patients (32.5%) underwent amputation. In the multivariate analysis, concomitant peripheral artery disease and inadequate antibiotic therapy were associated with failure of conservative treatment. CONCLUSION: Antibiotics alone, or with conservative surgery, were successful in treatment of diabetic foot osteomyelitis in 62.3% of the patients. Concomitant peripheral artery disease and inadequate antimicrobial therapy were risk factors for remission in conservatively treated diabetic foot osteomyelitis.

The effects of electrical current from a micro-electrical device on tooth movement / 대한치과교정학회지

OBJECTIVE: The purpose of this study was to determine whether an exogenous electric current to the alveolar bone surrounding a tooth being orthodontically treated can enhance tooth movement in human and to verify the effect of electric currents on tooth movement in a clinical aspect. METHODS: This study was performed on 7 female orthodontic patients. The electric appliance was set in the maxilla to provide a direct electric current of 20 micronA. The maxillary canine on one side was assigned as the experimental side, and the other as control. The experimental canine was provided with orthodontic force and electric current. The control side was given orthodontic force only. Electrical current was applied to experimental canines for 5 hours a day. The amount of canine movement was measured with an electronic caliper every week. RESULTS: The amount of orthodontic tooth movement in the experimental side during 4 weeks was greater by 30% compared to that of the control side. The amount of increase in tooth movement in the experimental side was statistically significant. The amount of tooth movement in the experimental side during the first two weeks was greater than that in the following two weeks. The amount of weekly tooth movement in the control side was decreased gradually. CONCLUSIONS: These results suggested that the exogenous electric current from the miniature electric device might accelerate orthodontic tooth movement by one third and have the potential to reduce orthodontic treatment duration.

Transepidermal Elimination of Nevus Cells in Acral Lentiginous Nevus / 대한피부과학회지

Pigmented lesions of palmar and plantar skin may cause diagnostic problems, because some features of benign lesions in these sites may raise the suspicion of melanoma if considered alone. Transepidermal elimlnation is a mechanism by which a substance is eliminated through the epidermis, and it is apt to be confused with a feature of melanoma that tumor cells are located at all layers of the epidermis. We report a case of transepidermal elimination of nevus cells in acral letiginous nevus which needs a differential dignosis of melanoma.

Expression of NMDA Receptor Subunit mRNAs in the Developing Circadian Pacemaker of the Rat / 대한해부학회지

Hypothalamic suprachiasmatic nucleus (SCN) is a circadian pacemaker which controls diurnal behavioral and hormonal rhythms in mammals. The SCN receives environmental light signals through the retinohypothalamic tract, and glutamate is the major excitatory neurotransmitter in the retinohypothalamic tract. In the present study, we investigated the developmental expression of the mRNAs for N-methyl-D-aspartate type glutamate receptor (NR)1, NR2A, NR2B and NR2C subunits in the rat SCN using in situ hybridization with specific riboprobes. At postnatal day 2 (P2), P8, Pl5 and P45, the high level of NRI transcripts was observed in both ventrolateral and dorsomedial subdivisions of the SCN, and the distinct expression of NR2C mRNA was principally found in the dorsomedial SCN. The weak NR2B mRNA expression was clearly found in both subdivisions of the SCN at P2 and P8, whereas specific NR2B hybridization signals were not found at Pl5 and P45. There was no specific hybridization signal of NR2A in the SCN throughout the postnatal life. These findings implicate that NR may play an important role in the neonatal SCN. In addition, this study suggests that NR1, NR2B and NR2C might be the major NR subunits in the developing SCN, whereas NRI and NR2C could be the subunit components of NR in the adult SCN.

The Use of Hydroxychloroquine in Patients with Pemphigus Erythematosus / 대한피부과학회지

Pemphigus erythematosus (PE) is a superficial type of pemphigus, which can be aggravated by sunlight (espicially UV light). Because of the known side effects of corticosteroids, we evaluated the efficacy of hydroxychloroquine as a corticosteroid-sparing agent and/or the effect of a single-drug regimen in two patients with PE with photosensitivity. We obtained a good therapeutic response with hydroxychloroquine in these two patients with PE. This drug could be used in selected patients with pemphigus who are prednisolone/ immunosuppressive-resistant or who have certain degrees of photosensitivity.