Pull-in Suture Technique for the Disinsertion of the Phalangeal Tendon Distal Insertion

PURPOSE: The disinsertion of the phalangeal tendon distal insertion has difficulties in ordinary tenorrhaphy operation for the anatomical features, and still has controversy between non-surgical and surgical management. The purpose of this study is to select treatment for the injury of the phalangeal tendon distal insertion, as we've had a good results from operation treatment with Pull-in suture technique. METHODS: We reviewed the hospital records of 12 patients treated with Pull-in suture technique with disinsertion of the phalangeal extensor or flexor tendon distal insertion from June 2006 to June 2007. Eight patients were involved with the tendon disinsertion without bone fracture, and 4 patients were involved with the fracture of the phalangeal tendon distal insertion site. After removal of the K-wire in week 6, active physical exercises were commenced immediately. The mean follow-up period was 12.4 months. RESULTS: All the patients who had tendon disinsertion with bone fracture had IIB, by Wehbe and Schneider's classification 2, and we evaluated the results comparing the same finger of the other hand according to Crawford's evaluation criteria 5. The nine excellent and three good results were obtained and there were no limitation of motor for the patient who had operation for the rupture of flexor tendon as well. There were no particular complications during the follow-up period. CONCLUSION: The most important thing for the disinsertion of the phalangeal tendon distal insertion is to maintain an accurate and durable reduction state keeping the tension of tendon. At this point, after removal of the K-wire, the Pull-in suture technique allows accurate realignment of the tendon-bone unit without any specific instrumentation under the more stable state. The Pull-in suture technique seems to be a strong alternative for the treatment of disinsertion of the phalangeal tendon distal insertion, with successful treatment outcome(rapid functional recovery and high patient satisfaction).

Clinical analysis of Pediatric Blow out Fracture

PURPOSE: Because of traffic accidents and many criminal violences, the incidence of facial trauma has been increasing not only in adults but also in children. We planed this study to introduce our experience about pediatric blow out fracture and provide more information. METHODS: We made retrospective study in 76 children with blow out fracture from January 2001 to September 2005 by retrospective chart review including detailed preoperative and postoperative evaluations, age, sex, cause, symptom and sign, and their post-operative complications. RESULTS: Among our patients, 69 were male and 7 were female. The ages ranged from 7 to 18 years, which shows the greatest incidence of blow out fracture. Physical violence(46%) was the most common cause in this group and was followed by vehicle accident(28%), and fall down accident(17%). Left side(64%) showed slightly more incidence than right side(36%), but there were no statistical importance. Ecchymosis(88%) was the most common symptom and followed by periorbital swelling(68%) and diplopia(30%). 30 patients was diagnosed with another facial bone fracture and nasal bone(51%) was the most common associated facial bone fracture. Fourty four Patients(60%) got an orbital wall reconstruction in 7 days after trauma. After the operation, only 3 patients(4%) suffered from diplopia postoperative 3 month, and resolved in 4 years. CONCLUSION: The incidence of blow out fracture in children has been increasing every year, and violence has become more important etiology of pediatric blow out fracture and public and private education institutions were the most common place that blow out fracture originated. Accurate diagnosis and careful treatment plans are important in pediatric blow out fracture.

Clinical Analysis of Dog Bite Injuries

PURPOSE: The dog bite injury is expected to increase as westernizing lifestyle and the number of pet raisers increase. The bite injuries may cause serious sequelae. The purpose of this study is to contributes to establish a suitable management and treatment principle for domestic situation with a clinical analysis data of the dog bite injuries. METHODS: We reviewed the hospital records of 76 patients with dog bite injuries who were treated in the emergency unit or out patient department of our hospital from January 2000 to May 2006. RESULTS: The majority of patients were children less than 10 years of age, 21 case(27.6%). Injuries occurred most often in May and 14 patients(18.4%) were bitten by the kinds of Cockerspaniel. By Lackmann's classification, 36 patients(47.4%) had Stage I injuries, 27 patients (35.5%) Stage II, 11 patients(14.5%) Stage III and 2 patients(2.6%) Stage IVa. The most frequent injury site was the head and neck area with 55 cases(72.4%). Also, 58 cases(76.3%) were received the initial treatment within 30 minutes after being bitten and the most of case except emergency operation repaired within 3 days. CONCLUSION: The dog bite injuries increased by more than 20% every year over the study period and it says that it may continue to increase more in the future. However, There are little report or literature for suitable management and treatment principle for domestic situation. The authors think this clinical analysis data and treatment experience can be useful for establishing a suitable treatment principle for domestic situation.

Facial Scar Treatment Using 585nm Pulsed Dye Laser

To determine the efficacy of the 585nm pulsed dye laser in the treatment of traumatic or surgical scar. We made retrospective study with 26 patients and used 585nm pulsed dye laser (V-Star(R), 7mm spot size, mean 9.3J/cm2)in the treatment of traumatic or surgical scar. Scar were evaluated before and after the laser therapy by photo graph and Vancouver Scar Scale and Color Chart Manual and Visual Analogue Scale. Three month later after the last laser therapy, final scar analysis by the blinded examiner revealed a improved patient's satisfaction by visual analogue scale and much improvement on VSS parameter(vascularity and pigmentation) and Color Chart Manual. 585nm pulsed dye laser is effective and safe in improving the quality and cosmetic appearance of erythematous and hypertrophic scar.

The Beau's Line Secondary to Acute Hand Injury

Beau first described transverse depressions of the fingernails after an acute febrile illness in 1846. It was the result of the temporary arrest of nail matrix formation. The transient interference of nail growth rate is usually induced by disability caused by severe systemic disease. Such as Raynaud disease, myocardial infarction, pulmonary embolism, acute renal failure, psoriasis and dysmenorrhea were reported to be the cause of Beau's line. The trauma caused either in a hand or in a forearm was also reported to be the cause of Beau's line. We experienced patients with Beau's line, two cases secondary to fingertip injury and one case due to fracture in radius. They had Beau's lines in all fingers of traumatized hand and nails of opposite hand were normal. During the follow-up, the growth rate of traumatized fingernails were normal and there was no complication.

Doxorubicin-induced reactive oxygen species generation and intracellular Ca2+increase are reciprocally modulated in rat cardiomyocytes

Doxorubicin (DOX) is one of the most potent anticancer drugs and induces acute cardiac arrhythmias and chronic cumulative cardiomyopathy. Though DOX-induced cardiotoxicity is known to be caused mainly by ROS generation, a disturbance of Ca2+ homeostasis is also implicated one of the cardiotoxic mechanisms. In this study, a molecular basis of DOX-induced modulation of intracellular Ca2+ concentration ([Ca2+]i) was investigated. Treatment of adult rat cardiomyocytes with DOX increased [Ca2+]i irrespectively of extracellular Ca2+, indicating DOX-mediated Ca2+ release from intracellular Ca2+ stores. The DOX-induced Ca2+ increase was slowly processed and sustained. The Ca2+ increase was inhibited by pretreatment with a sarcoplasmic reticulum (SR) Ca2+ channel blocker, ryanodine or dantrolene, and an antioxidant, alpha-lipoic acid or alpha-tocopherol. DOX-induced ROS generation was observed immediately after DOX treatment and increased in a time-dependent manner. The ROS production was significantly reduced by the pretreatment of the SR Ca2+ channel blockers and the antioxidants. Moreover, DOX-mediated activation of caspase-3 was significantly inhibited by the Ca2+ channel blockers and a-lipoic acid but not a-tocopherol. In addition, cotreatment of ryanodine with alpha-lipoic acid resulted in further inhibition of the casapse-3 activity. These results demonstrate that DOX-mediated ROS opens ryanodine receptor, resulting in an increase in [Ca2+]i and that the increased [Ca2+]i induces ROS production. These observations also suggest that DOX/ROS-induced increase of [Ca2+]i plays a critical role in damage of cardiomyocytes.

595nm Pulsed Dye Laser (Vbeam(R)) Treatment of Hypertrophic Scar

Hypertrophic scars are relatively common, but they remain very difficult to treat and induce functional and psychologic morbidity. Many treatment modalities have been advocated in the past. But none of these are satisfactory with unpredictable result, long treatment interval and sometimes unacceptable side effects. Recent use of the flashlamp-pumped pulsed-dye laser(585nm) has been shown to be effective in the treatment of various traumatic and surgical scars with improvement in scar texture, color and pliability with minimal side effects. 80 patients with 95 hypertrophic scars which had little response to usual conservative treatment and resulted from trauma, operation, skin graft donor sites, and burns were treated with Vbeam(R)(595nm) pulsed dye laser(Candela Laser Corporation, Wayland, Mass). The mean number of treatment was 2.2. Period of follow-up vary from 2 month to 16 months. The 595nm Pulsed Dye Laser can effectively improve scar pliability and texture and decrease erythema and associated symptoms yielding cosmetically and functionally acceptabel clinical results. Complications such as hypopigmentation, ulcer and infection were not seen.

The Comparison of the Efficacy and Adverse Drug Reaction ofCelecoxib and Diclofenac in the Treatment of Osteoarthritis in Korean Multicenter Trial / 대한류마티스학회지

OBJECTIVE: Long-term use of the analgesic acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of osteoarthritis is limited due to the lack of effectiveness and presence of side effects. Celecoxib is a selective inhibitor of cyclo-oxygenase (COX)-2 and expected to help NSAIDs in expressing the effective anti-inflammatory effect by not inhibiting COX-1. Thus, 200 mg of celecoxib and 100 mg of slow releasing diclofenac were compared for their effectiveness and safety in Korean patients with knee osteoarthritis. METHODS: We administered 200 mg of celecoxib or 100 mg of slow releasing diclofenac in 223 randomly selected patients with knee osteoarthritis for 4 weeks. The effectiveness of these drugs on osteoarthritis was assessed by evaluating pain in each patient, making overall evaluation on osteoarthritis by the patient and his/her attending physician, and measuring the severity indices on osteoarthritis before treatment, and 2 weeks and 4 weeks after treatment. Moreover, safety and drug resistance were evaluated by assessing the rate of adverse effects, rate of withdrawal, laboratory tests, and vital signs. RESULTS: The clinical symptoms of osteoarthritis were improved significantly by 4 weeks after treatment with celecoxib and diclofenac. According to the results of overall evaluation made by attending physicians 2 weeks after treatment, the rate of improvement was 49.5% in celecoxib group and 35.7% in diclofenac group, showing a statistically significant difference (p=0.023). Other than this difference, no other significant difference was present between the two groups with other variables used for the evaluation of effectiveness. The rate of adverse effects was significantly lower in celecoxib group compared with diclofenac group. According to laboratory findings, no abnormal figure was found in both groups but total bilirubin, SGOT, and SGPT were consistently higher in patients in diclofenac group. Thirteen patients dropped out of the study due to side effects (10 patients) and treatment failure (3 patients). CONCLUSION: Our findings from the clinical comparison of celecoxib and diclofenac in Korean patients with knee osteoarthritis were similar to those results found in previous studies. Although celecoxib showed similar effectiveness as diclofenac on knee osteoarthritis in the treatment of symptoms, it showed a lower rate of adverse effects; thus, we concluded that celecoxib is safer compared with diclofenac.