The Effect of a Lumbar Spinal Lesion on the Clinical Results of Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: Patients with osteoarthritis of knee joint often concomitantly suffer from degenerative disease of the spine. Furthermore, resulting spinal problems could influence function and pain after total knee arthroplasty (TKA), and hence, cause the results of TKA to be misinterpreted. The purpose of this prospective study was to evaluate the effect of spinal disorders, as assessed by Swiss Spinal Stenosis score (SSS scores), on knee function as assessed by knee scores, the Hospital for Special Surgery scale (HSS scale) and Western Ontario & McMaster Osteoarthritis Index scores (WOMAC scores) in patients that after TKA. MATERIALS AND METHODS: One hundred and forty nine osteoarthritic knees of 87 patients were enrolled in this study. All patients received TKA by single surgeon (W-S Cho) from August 2009 to May 2010. Preoperative and postoperative 1- and 2-years HSS scale, Knee, WOMAC, and SSS scores were recorded and analyzed. RESULTS: Postoperative HSS scale, Knee, and WOMAC scores showed marked improvements versus preoperative scores, and scores at 2 years postoperatively were better than at 1 year postoperatively. No significant correlation was found between postoperative Knee scores and SSS scores. On the other hand, statistically significant correlations were found between HSS and SSS scores and between WOMAC and SSS scores. Interestingly, differences between Knee scores and HSS scores were found to be significantly correlated with SSS scores. CONCLUSION: When evaluating outcome after TKA, spinal problems should be investigated concomitantly. SSS scores appear to provide a suitable means of assessing spinal problems.

Perinatal Complications of Mothers and Neonates Resulting from Inadequate Prenatal Care / 대한주산의학회잡지

OBJECTIVE: With improvement in the social and economic states of Korea, most of the pregnancies have been appropriately examined but there are a few mothers and newborns who have not received proper prenatal care. The aim of this study was to investigate obstetrical and neonatal complications resulting from inadequate prenatal care. METHODS: The medical records of 107 neonates who had received prenatal care lesser than 3 visits and admitted to the neonatal intensive care units of Korea University Ansan Hospital from January 2004 to December 2009 were retrospectively reviewed. Obstetrical complications, neonatal gestational age, birth weight, neonatal complications were analyzed. We compared neonatal complications of the inadequate prenatal care group and those of the adequate prenatal care group lesser than 34 weeks' gestational age neonates. RESULTS: In obstetrical complications, there were twenty women with anemia, fifteen cases with premature rupture of membranes, and fourteen chorioamnionitis. In neonatal complications, there were forth-four premature infants, and forty-four low birth weight infants. Respiratory distress syndrome, small for gestational age, severe intraventricular hemorrhage were more common in the inadequate prenatal care group than the adequate prenatal care group. Thirty-seven infants (34.5%) were sent to the adoption agency. Fifty infants (46.6%) received medical expense support by the social service. CONCLUSIONS: Obstetrical and neonatal complications and social burden were increasing when the pregnancies had not received adequate prenatal care. To reduce perinatal complications of mothers and neonates in low socioeconomic classes, practical nation's policies and social supports for adequate prenatal care should be provided.

Obstetric and Neonatal Outcomes of the Teenage Pregnancy

PURPOSE: In recent years, Korea has showed a steady increase in the frequency of teenage births, while the overall birth rate has declined. As the teenage birth is known as a high risk pregnancy itself, we examined perinatal complications of teenage mothers and whose neonates in aspects of medical problem, and social status and support. METHODS: We examined the perinatal characteristics of teenage mothers and whose babies, who were hospitalized at Korea University Ansan Hospital from January 2004 to July 2009 using medical records retrospectively. Twenty-seven teenage mothers and their 28 babies were enrolled in this study. RESULTS: Teenage mothers were all unmarried and showed high rates of preterm labor, maternal anemia, and unexpected delivery. Among them, 11 (40.7%) were from families that were separated. Eleven mothers (40.7%) did not have any antenatal care. There were high rates of prematurity and low birth weight (60.7% and 64.3%, respectively). The complication included: respiratory distress syndrome, patent ductus arteriosus and necrotizing enterocolitis. Fourteen babies (51.9%) were not going to be brought up by their biological parents. CONCLUSION: Teenage pregnancy had high rates of preterm labor and associated complications, often caused by the lack of proper antenatal care. Babies from unmarried mothers were likely to be adopted and this could be a social burden. Therefore, to reduce unplanned teenage pregnancy and births, sex education and social supports should be provided to all teenagers.

Effects of Medpor(R) Sheet as Substitute for Tarsus in Eyelid Reconstruction

PURPOSE: To report a simple surgical technique for rebuilding the palpebral tarsal plate using a Medpor(R) sheet. The formation of a palpebral tarsal plate is very important in the reconstruction of the eyelid. Transplantation of cartilaginous tissue is often necessary to create the palpebral tarsal plate. However obtaining enough cartilaginous tissue is difficult. CASE SUMMARY: Eyelid reconstruction and surgical resection of each lesion was attempted on two patients clinically diagnosed with basal cell carcinoma and sebaceous gland carcinoma between August, 2006 and November, 2007. Reconstruction was performed using a modified Cutler-Beard method or the sebaceous gland carcinoma that occurred in the upper eyelid, and a modified Tenzel semicircular rotational flap procedure was used or the basal cell carcinoma that occurred in the lower eyelid. For the reconstruction of tarsus, 0.45 mm Medpor(R) sheet was used. Complications, such as shortage of eyelid movement, dragging of eyelid or unstable eyelid margin, did not occur after the operations in either subject. In the case of the upper eyelid reconstruction, the eyelid became stiff at the early stage, but the condition improved after 6 months. CONCLUSIONS: The reconstruction of the palpebral tarsal plate using a Medpor(R) sheet is considered an effective and safe technique for the reconstruction of an eyelid.

A case of Mullerian cyst of the uterine cervix / 대한산부인과학회지

Uterine Mullerian cyst is extremely rare and the diagnosis is made by histological analysis. We report a case of a huge cyst which was initially regarded as ovary cyst or cystic degeneration of uterine myoma in 46-year-old woman. She was admitted due to tender palpable lower abdominal mass and total abdominal hysterectomy was performed. Histologically, the cyst was lined by unilayer (unilocular) ciliated columnar epithelial cells. Immunostains for PAS and mucicarmine showed negative results.

Isolation and characterization of mesenchymal stem cells from human amnion and decidua / 대한산부인과학회지

OBJECTIVES: The purpose of this study is to isolate a population of multipotent cells from human amnion and decidua, respectively. METHODS: Human placentas (gestational age, 30~42 weeks) were obtained after vaginal or cesarean deliveries. Amnions and deciduas were divided mechanically. The collected cells from the amnion and decidua were cultured. Cultured cells were immunophenotypically characterized. The adipogenic, osteogenic and neurogenic differentiation capacities were tested, and their growth kinetics were analyzed. RESULTS: We successfully isolated MSCs from both the amnion and decidua. The phenotype of MSCs cultured from different fetal and maternal parts of the placenta was comparable. The growth kinetics of MSCs derived from amnions and deciduas were similar. Isolated MSCs were differentiated into various cell lines such as adipogenic, osteogenic, myogenic and neurogenic cells. CONCLUSIONS: The human amnion and decidua could be an excellent source of MSC because they are easily obtainable after delivery and showed a higher expansion capacity than that of MSCs from adult bone marrow.

Results of Total Knee Arthroplasty using NexGen(R) System / 대한정형외과학회잡지

Purpose: To prospectively evaluate the survival rate, follow-up rate, clinical and radiographic results of NexGen(R) total knee replacement arthroplasty (TKRA). Materials and Methods: Between June 1998 and March 2002, 434 knees in 278 patients after TKRA performed by a single-surgeon using the same implant were evaluated prospectively. The preoperative diagnosis was primary osteoarthritis in 399 knees, osteonecrosis in 17 knees, rheumatoid arthritis in 12 knees and post-traumatic arthritis in 6 knees. Data collection, physical examination and radiographic evaluation were carried out at postoperative 1, 2, 3 and 5 years. A telephone survey was carried out for the patients who could not visit the outpatient clinic, and the mean follow-up duration was 4.3 years (3-7 years). The follow-up rate and survival rate was analyzed using the Kaplan-Meier method with the reimplantation cases being counted as a failure. The clinical results were evaluated by the Knee Society Score, and the range of motion and status of the implants were assessed by a radiographic evaluation. Results: The total follow up rate was 91.0% (395/434). The survival rate was 98.3% at 5 years after surgery and the survival rate excluding the infection cases was 99.0% 5 years after surgery. The Knee Society Total Score improved to 96.8 in the cruciate retaining (CR) type and to 95.2 in the Legacy posterior stabilized (LPS) type. The Knee Society Function Score improved to 82.6 in the CR type and to 73.8 in the LPS type on the final follow up. The average preoperative further flexion was 122.6, which improved to 125.4. The radiographic evaluation revealed 6 cases (1.5%) of osteolysis with reimplantation being performed in 2 cases. Conclusion: In this prospective study, with a high follow-up rate (91.0%), the survival rate of TKRA using the NexGen(R) implant was relatively high and satisfactory in terms of the functional improvement. However, a long-term follow-up evaluation will be needed.

Significance of HPV viral load for prediction of recurrence after treatment in patients with carcinoma in situ of cervix / 부인종양

OBJECTIVE: The purpose of this study is to verify association between HPV viral load and recurrence after conization and analyse clinicopathological characteristics in patients with carcinoma in situ of cervix. METHODS: We reviewed the chart of 154 women with carcinoma in situ who underwent conization from January 2003 to December 2005. Pap smear and high risk HPV test was performed before treatment and colposcopic examniation with biopsy was performed in necessary. After operation, repeated Pap smear and quantitative high risk HPV test (Hybrid capture II test, HC II) were performed in three month after conization for recurrence of disease. We studied the medical records of the patients, analyzed demographic characteristics and conducted the correlation between the prognostic factors of the age, parity, presence of high risk HPV infection before and after the operation, existence of invasion of resection margin after conization and remaining or recurrent lesions. RESULTS: Positive of cone margin showed significantly high recurrence rate than negative cone margin (p<0.05). And posttreatment HPV viral load was significantly higher in recurrent patients (p<0.05). But initial Pap smear, age and parity has not shown in difference. CONCLUSION: We can conclude that a clear association between positive cone margin, high HPV viral load and recurrence of disease after conization. A patient with positive resection margin after or high viral load after conization should be evaluated and treated aggressively.

Clinical Results of Endoscopic Dacryocystorhinostomy using a Microdebrider

PURPOSE: The success rate of endoscopic dacryocystorhinostomy has been increasing with the development of better instruments and techniques. We conducted this study to evaluate the clinical results of endoscopic dacryocystorhinostomy using a Microdebrider, which has also been used for functional endoscopic sinus surgery. METHODS: We selected 76 patients (with a total of 84 affected eyes) who had been diagnosed with a nasolacrimal duct obstruction. These patients underwent an endoscopic dacryocystorhinostomy using a Microdebrider, which removed both nasal mucosa and lacrimal sac mucosa and also trimmed the margins of the ostotomy site. We assessed patients' outcomes on an anatomical basis using a dye test and endoscopy, which were used to define the anatomical success. We also arbitrarily defined functional success as whether the subjective epiphora was absent. At a four to 18 month follow-up, we monitored the clinical course to examine any recurrent episodes. RESULTS: The symptoms were alleviated in 72 eyes, with a primary success rate of 85.7%. On nasal endoscopy, a functional failure was seen in four eyes. In these four eyes, the orifice was narrowed by the presence of either granulation tissue or conjunctivochalasis. By contrast, surgical outcomes were the anatomical failure in eight eyes. In these eight eyes, the orifice was obstructed by the presence of granulation tissue as well as the adhesion of nasal mucosa. CONCLUSIONS: Endoscopic dacryocystorhinostomy using a Microdebrider enabled us to make the large fistula while minimizing the damage of adjacent tissue. It might be the recommended surgery that reduces the complications and enhances the success rate.

The Effect of Intraoperative Regional Analgesic Injection in Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: This study was performed to evaluate the effect and complications of an intraoperative regional analgesic injection in primary total knee replacement arthroplasty (TKRA). MATERIALS AND METHODS: As a prospective study, 50 patients who underwent bilateral TKRA were injected with 50 cc of mixed analgesics (morphine, norepinephrine and epinephrine) into the joint capsule, muscles around the knee joint on one side (study side) and the same amount of the normal saline on the other side (control side) before closure. The level of postoperative pain was evaluated in the visual analogue scale (VAS) at postoperative 4 hours, 12 hours, 1, 2, 4, 7, 14 days. The range of motion at postoperative 4, 7, and 14 days, the amount of hemovac drainage and the patients preference were also evaluated. RESULTS: There was a significant decrease in the VAS on the study side at postoperative 4 hours, 12 hours and 1 day (p0.05). CONCLUSION: An intraoperative regional analgesic injection in primary TKRA is effective in reducing the level of acute postoperative knee pain with minimal complications with the majority of patients preferring it.

A Case of Paradoxical Vocal Fold Motion with Dyspnea and Stridor / 대한이비인후과학회지

Paradoxical vocal fold motion (PVFM) is a rare disorder, characterized by episodic glottic obstruction in which the vocal folds are adducted on respiration. The disorder may aggravate airway obstruction and result in respiratory failure; therefore, a proper diagnosis by the otolaryngologist is critical to subsequent treatment. A review of literature shows that the effective treatment is psychotherapy, breathing education, biofeedback, anti-reflux medications, and most importantly, botulinum toxin injection to both vocal folds. We report a case with PVFM, effectively treated with above modalities.