Long-term Results of Modified Salter Innominate Osteotomy for Legg-Calvé-Perthes Disease

BACKGROUND: In a previous study, we reported clinical and radiographic results of our modified Salter innominate osteotomy technique in 16 hips affected by Legg-Calvé-Perthes disease (LCPD) with an average follow-up of 31.8 months. In this study, we present the long-term results of the osteotomy in LCPD patients followed until physeal closure. METHODS: Thirty hips of 29 patients were followed until skeletal maturation after modified Salter innominate osteotomy. The mean follow-up duration was 12.9 years (range, 9.1 to 16.0 years). Eleven hips (36.7%) were classified as Catterall group III and 19 (63.3%) as Catterall group VI. Stable interposition of a bone block was achieved using one biodegradable screw in nine hips and without any fixation device in 21 hips by simply changing the direction of osteotomy. The Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and hip function were evaluated at the last follow-up. Radiological outcomes were evaluated using Wiberg's center-edge angle, the Mose method, and Stulberg classification, and osteoarthritic changes were evaluated using the Tonnis classification. RESULTS: Mean HHS and WOMAC score were 80.2 points and 54 points, respectively, preoperatively and these were improved to 96.2 points and 28 points, respectively, at the last follow-up. Clinical results, according to Robinson's criteria, were good in 18, fair in seven, and poor in five hips. Radiological results assessed using the Mose method were good in 18, fair in six, and poor in six hips, and according to the Stulberg classification, nine hips were class I, nine were class II, eight were class III, and four were class IV. The mean center-edge angle improved from 19.7° preoperatively to 29.6° at the final follow-up. According the Tonnis classification, three hips were grade 2, five were grade 1, and 22 were grade 0. Of the three grade 2 hips, two underwent Chiari osteotomy 12.1 and 8.8 years postoperatively, and the other underwent total hip arthroplasty 12.9 years postoperatively. CONCLUSIONS: The modified Salter innominate osteotomy produced relatively satisfactory long-term clinical and radiological results.

Long-Term Results of Intermittent Exotropia Surgery: Comparison between Motor and Functional Success

PURPOSE: To evaluate the long-term surgical success rate (>3 years) and contributing success factors considering motor and sensory criteria for patients with intermittent exotropia. METHODS: Fifty-four patients who received surgery for intermittent exotropia and were followed-up for a minimum of 3 years, including reoperation, were retrospectively evaluated. The first procedure was unilateral recession and resection in 50 patients and bilateral lateral rectus recession in 4 patients. Patients were classified as achieving a good, fair or poor outcome based on motor and sensory criteria. Success rate and associated factors such as postoperative alignment, exotropia type, first surgical procedure, and proportion of patients receiving reoperations were analyzed. RESULTS: The mean follow-up period after the first surgery was 4.81 +/- 1.30 years. The good outcome was achieved in 32 patients (59.3%), fair in 14 patients (25.9%), and poor in 8 patients (14.8%) considering motor criteria only. The good outcome was achieved in 29 patients (51.9%), fair in 12 patients (22.2%), and poor in 14 patients (25.9%) when considering combined motor/sensory (functional) criteria. No patient who received bilateral lateral rectus recession as the first procedure belonged to the good outcome group (p = 0.03 by motor criteria and p = 0.044 by functional criteria). Patients who received reoperation were significantly more likely to be in the good and fair groups (p = 0.009 by motor criteria and p = 0.02 by functional criteria). CONCLUSIONS: Long-term surgical results of intermittent exotropia in this Korean population revealed 85.2% motor success rate and 74.1% functional success rate. Early postoperative overcorrection was not associated with long-term success. Recession and resection procedure and reoperations were significantly associated with better outcome based on motor and functional criteria. Diligent reoperations after the first surgery could possibly contribute to good long-term functional outcome in intermittent exotropia patients.

Long Term Results of Congenital Pseudarthrosis of the Clavicle: A Case Report of 22 Years Follow-up

Congenital pseudarthrosis of the clavicle is a rare condition, which rarely produces functional disabilities except for cosmetic problems. Surgical treatment involves autogenous iliac bone grafts and internal fixation. Few studies have reported long-term results of surgical treatment or morphological changes of the clavicle. We report a patient with a congenital pseudarthrosis of the clavicle, who demonstrated a near normal radiographic appearance of the clavicle and an excellent result 22 years after the operation performed at 4 years of age.

Influence of Application Methods on Results of Contact Transscleral Nd:YAG Laser Cyclophotocoagulation

PURPOSE: To examine the influence of irradiation methods on the long-term results of contact transscleral Nd:YAG laser cyclophotocoagulation and to evaluate the factors that affect changes in intraocular pressure (IOP) and occurrence of ocular hypotony after cyclophotocoagulation. METHODS: In this retrospective study, 36 refractory glaucomatous eyes of 36 patients were observed for at least one year after a cyclophotocoagulation procedure. Contact transscleral Nd:YAG laser cyclophotocoagulation was performed with 7 to 10 Watts of power, a duration of 0.7 seconds, with one or two rows, and ranges of either greater or less than 180 degrees. The change in IOP, the success rate of the procedure, and the occurrence rate of hypotony were analyzed with regard to the methods of cyclophotocoagulation. RESULTS: In this series of patients with refractory glaucoma, the final IOP and success rate were not significantly influenced by the laser application method or by the total energy used. The eyes with ocular hypotony showed significantly decreased IOP one year after cyclophotocoagulation when compared with eyes without ocular hypotony. The IOP percent reduction in the patients with ocular hypotony tended to decrease more rapidly than did that of the patients without hypotony, beginning three months after the operation. CONCLUSIONS: The application methods of cyclophotocoagulation appear to have no significant influence on success rate, IOP or ocular hypotony rate. The percent reduction in IOP was higher in the hypotony group, including during the early postoperative periods.

Long-term Outcome of Treatment of Mycobacterium Abscessus Pulmonary Disease / 결핵및호흡기질환

BACKGROUND: Although there is an increasing incidence of Mycobacterium abscessus pulmonary disease in Korea, the optimal therapeutic regimen has not yet been established and there are no reports of the long-term treatment outcomes. This study examined the long-term treatment outcomes of M. abscessus pulmonary disease. METHODS: Twenty-nine patients diagnosed with M. abscessus pulmonary according to the American Thoracic Society criteria and treated from January 1996 to December 2003 were enrolled in ghis study. The clinical characteristics, radiological findings, treatment outcome, and follow up data were analyzed retrospectively. RESULTS: The mean age of the 29 patients was 56.1 (+/- 13.6) years and there was a female (22/29) dominance. The chest radiography revealed the nodular bronchiectatic type to be dominant (69%, 20/29). Twenty-seven (93.1%) were prescribed clarithromycin-containing regimens, and injectable drugs, mainly aminoglycosides, were included in the regimen of nineteen patients. The most predominant regimen (48.3%) consisted of clarithromycin and amikacin. The treatment success, failure, and default were achieved in 19(65.5%), 9(31.0%), and 1(3.4%), respectively. The median duration to culture conversion was 42 days (range 15-362) and the median duration of treatment in the success group was 543 days (range 176-1,160). An adjunctive surgical resection was performed in five patients, which resulted in treatment success in two patients. After the completion of treatment, nineteen patients were followed up for a median duration of 931 days (range 230-2,294). Only one (5.3%) patient relapsed 45 days after completing treatment. CONCLUSION: Treatment with clarithromycin-containing regimens resulted in a successful treatment in approximately two thirds of patients with M. abscessus pulmonary disease. The long-term relapse rate was also quite low.

Long-term Experience with the Bjork-Shiley Monostrut Tilting Disc Valve

The Bjork-Shiley Monostrut valve is tilting disc mechanical valve prosthesis. This study was designed to present the long-term outcome of our experience. One hundred and thirty-seven Bjork-Shiley Monostrut valves were implanted in 101 consecutive patients from November 1983 to February 1990. There were 60 male and 41 female with mean age of 34.5 yr at the time of operation. Fifty-nine patients underwent single valve replacement, 38 had double valve, and 4 had triple valve replacement. There were six in-hospital deaths (5.9%): three from cardiopulmonary bypass weaning failure and one each from septic shock, sudden cardiac arrest, and uncontrollable bleeding. Mean duration of follow-up was 181.2+/-76.2 months. Overall survival was 86.2% at 15 yr and 83.1% at 20 yr. Patients with mitral valve replacement had 93.5% and 90.2% cumulative survival at 10 and 15 yr, respectively, while patients with aortic valve replacement had 91.1% and 86.5% cumulative survival at 10 and 15 yr. Two groups had no significant difference in survival. Double valve replacement patients had 92.2% and 84.0% survival at 10 and 15 yr, respectively. There were no significant differences in survival between the single and double valve replacement groups. Freedom from thromboembolism was noted in: 97.8%, 97.8%, 96.4% and 87.8% at 5, 10, 15 and 20 yr, respectively. Absence of endocarditis was noted in 98.6% and 94.8% at 15 and 20 yr. Absence of reoperation was 92.5% at 20 yr. In conclusion, the Bjork-Shiley Monostrut valve is reliable, with a similar incidence of valve-related morbidity as in other mechanical valves.

Recurrent lumbar disc herniation after discectomy alone:long-term results / 中国矫形外科杂志

[Objective]To evaluate the long-term results of recurrent lumbar disc herniation between different kinds of reoperation.[Method]Seventy-four patients of recurrent lumbar disc herniation after discectomy alone were treated surgically from May 2001 to Augest 2005.They were divided into three groups:nonfusion,posterolateral fusion and intervertebral fusion.After a long term follow-up(≥2y),their clinical data were reviewed to compared their improvement rate of lower back pain,JOA score,subside rate of disc height and chang rate of superior intervertebral space angle.[Result]The long-term results revealed that the improvement rates of lower back pain JOA score in the three groups were increased in sequence.The differences in subside rate of disc height and change rate of superior intervertebral space angle between discectomy and posterolateral fusion groups were insignificant,but much higher than those of posterior lumbar interbody fusion group.[Conclusion]Posterior lumbar interbody fusion is effective in increasing the improvement rates of lower back pain JOA score and maintaining the disc height and the superior intervertebral space angle.

The Compliance and Long-term Follow up of Onychomycosis Treatment / 대한의진균학회지

BACKGROUND: Modern antifungal drugs achieve high cure rates in onychomycosis of the toes, but little is known about the long-term evolution of the treated patients. OBJECTIVE: We evaluated the compliance and long-term follow up of onychomycosis after treating the 438 patients with one of the 3 drugs including itraconazole, terbinafine and fluconazole. METHODS: On the basis of the patients' charts, photographs and telephone visiting, we investigated the positivity of the diagnostic methods, compliance and long-term follow up results of the onychomycosis treated with one of the three drugs including itraconazole, terbinafine and fluconazole from January 1999 to August 2002 in the Department of Dermatology, St. Mary's hospital, the Catholic University of Korea, Seoul. RESULTS: 1. The positivity rates of the KOH smear, fungus culture and KONCPA test were 68% (283/418), 18% (65/354) and 89% (178/200), respectively. 2. The percentage of the patients who had completely finished the course of the treatment were 61% (191/315) in the itraconazole-treated, 43% (30/69) in the terbinafine-treated and 21% (3/14) in the fluconazole-treated. 3. Cure rates after 1 year of the treatment were 34% (56/167) in the itraconazole-treated, 29% (10/35) in the terbinafine-treated and 86% (6/7) in the fluconazole-treated. Cure rate after 2 years of the treatment were 33% (17/51) in the itraconazole-treated, 8% (1/12) in the terbinafine-treated. Cure rates after 3 years of the treatment were 29% (9/31) in the itraconazole-treated, 10% (1/10) in the terbinafine-treated. 4. Cure rates after more than 1 year of the treatment were 33% (82/249) in the itraconazole-treated, 21% (12/57) in the terbinafine-treated. 5. Cure rates of the completely treated groups were 36%, 37% and 40% after 1 year, 2 years and 3 years in the itraconazole-treated and 44%, 20% and 20% after 1 year, 2 years and 3 years in the terbinafine-treated. CONCLUSION: In the treatment of onychomycosis, compliance rate varied very much according to the duration or method of medication, but the cure rates are different after more than 2 years of follow up between the itraconazole-treated and the terbinafine-treated.

High Tibial Osteotomy / 대한정형외과학회잡지

High tibial osteotomy is a useful procedure in the treatment of early stage osteoarthritis of the knee which is confined to the medial compartment. But long term follow-up study of high tibial osteotomy has not been provided yet and its prerequisite for a successful result still remains unrevealed. Since the osteoarthritis can progress after the osteotomy, it may result in the loss of correction and recurrence of pain and require conversion to total knee replacement arthroplasty. We studied clinically and radiologically the long term result of high tibial osteotomy in 11 patients(16 knees) who had been treated at the Department of Orthopaedic surgery of Seoul Paik Hospital during the period from January, 1978 to May, 1989, and follow-up for longer than 4 years. Preoperative mean varus angle was 6.4 degrees and immediate postoperative mean valgus angle was 8.6 degrees and final mean valgus angle was 4.7 degrees. The average loss of correction angle was 3.9 degrees. At 2-year follow-up, the results of 16 knees were as follows; excellent in six knees, good in seven knees. The final results at average 7.2-year follow-up were excellent in four knees, good in six knees and one knee was converted to total knee replacement arthroplasty. The results showed deterioration of clinical results and loss of correction with time after osteotomy. However, in more than half of the cases the results were good or excellent at the final follow-up, We, therefore, conclude that high tibial osteotomy is still a useful procedure in osteoarthritis of the knee if performed with a precise surgical technique and an adequate overcorrection more than 10 degrees.