Carriage of Staphylococcus schleiferi from canine otitis externa: antimicrobial resistance profiles and virulence factors associated with skin infection

The recent emergence of Staphylococcus schleiferi in dogs with otitis externa or skin and soft tissue infections has become a significant zoonotic issues. In the current study, we investigated 1) the carriage rates of S. schleiferi among major staphylococci in healthy dogs and dogs with otitis externa, 2) antibiotic susceptibility profiles of S. schleiferi, particularly methicillin resistance (MR), and 3) virulence factors associated with skin and soft tissue infections such as ability to form biofilm, resistance to cationic antimicrobial peptides (CAMPs), and carriage of staphylococcal enterotoxin genes. Among the 21 S. schleiferi isolates, 5 isolates (24%) were determined to be methicillin-resistant (MRSS). Staphylococcal cassette chromosome mec (SCCmec) typing revealed the presence of SCCmec type V in 4 MRSS isolates and type VII in one MRSS. Higher levels of antibiotic resistance, especially multidrug resistance, were observed in MRSS isolates compared to the methicillin-susceptible S. schleiferi (MSSS) isolates. In addition, MRSS isolates exhibited enhanced ability to form biofilm under static condition and all the 5 MRSS isolates carried three or more enterotoxin genes. However, there were no significant differences in resistance to CAMPs between MRSS and MSSS isolates. These findings suggest that coagulase-negative S. schleiferi is becoming more prevalent in canine otitis externa cases. Our results also highlight the presence of multidrug-resistant MRSS isolates with enhanced biofilm production and carriage of multiple enterotoxins.

Changes in the Gastrocnemius and Soleus Muscle Length during Gait in CP Patients with an Equinus Deformity / 대한정형외과학회잡지

PURPOSE: To measure the muscle length of the gastrocnemius and soleus during gait in CP patients with an equinus deformity before and after surgery. MATERIALS AND METHODS: Twelve CP patients with an equinus deformity (17 limbs) were examined by gait analysis preoperatively and postoperatively. The patient group was further classified into the TAL and Strayer group according to the surgical technique. The mean age and mean follow-up periods were 14.3 years (5-25 years) and 15.3 months (12.5-18.5 months), respectively. The muscle length of the Gastrocnemius and Soleus was measured during gait using the SIMM program linked to a gait analysis system. RESULTS: The ankle ROM, knee ROM, maximal muscle length and peak-to-peak excursion during gait improved after surgery. There was a significant difference between the preoperative and postoperative measurements (p0.05). The muscle length of the soleus was elongated during gait after the Strayer procedure. CONCLUSION: Patients with an equinus deformity had a contracted triceps muscle, which was elongated after surgery. These changes were quantified by a comparison of the preoperative and postoperative measurements.

Reversed Osteocutaneous Radial Forearm Island Flap for Crushing Injury and Open Fracture of the Thumb in Hand / 대한정형외과학회잡지

PURPOSE: To report the outcome of a reversed osteocutaneous radial forearm flap for a thumb reconstruction. MATERIALS AND METHODS: Five patients who underwent a reversed osteocutaneous radial forearm island flap for a thumb reconstruction between 2001 and 2005 were reviewed retrospectively. They were all males with a mean age at the time of surgery of 45 years. The types of thumb defects, size of the flap, length of the radius harvested, time to union, the range of motion of the thumb, grip and pinch strengths, and complications were analyzed. RESULTS: The mean size of the transferred radial forearm flap was 58.4 cm2. The mean length of the harvested radius was 4.4 cm. All flaps survived completely. The mean interval required to obtain bone union was 2.8 months. The mean ROM of the thumb was 47degrees. The postoperative mean grip strength was 94 lbs and the mean pinch power was 14.6 lbs. Mean moving two-point discrimination on the flap was 13 mm. There were no complications. All 5 patients were satisfied with the reconstructed new thumb. CONCLUSION: A reversed osteocutaneous radial forearm island flap is a useful procedure for reconstructing of a combined defect of the thumb.

Versatile Applications of Anterolateral Thigh Perforator Flap in the Reconstruction of Upper Extremity Defects: Retrospective Analysis of 119 Cases

PURPOSE: The perforator flaps have established their role in the reconstruction of various soft tissue defects. For the last five years, we have extensively used anterolateral thigh (ALT) flap for the reconstruction of the complex tissue defects of the hand and upper extremity and report the clinical results and our experiences with the versatile applications of this flap. MATERIALS AND METHODS: From March 2003 through May 2008, 119 free ALT perforator flaps were transferred for reconstruction of the complex tissue defects of the elbow, forearm, wrist and hand after crushing or degloving injuries as well as severe scar contractures. There were 95 females and 24 males. The mean age of the patients was 37 years and mean size of the flap was 170 cm(2). In 20 cases, the flap was vascularized by septocutaneous and in 99 cases by musculocutaneous perforators. Intra-muscular dissection length averaged 3.4 cm. The total length of pedicle averaged 8.4 cm and the average arterial diameter was 0.84 mm. End-to-end arterial anastomosis was performed in 103 cases and end-to-side in 16 cases. RESULTS: Flap survival rate was 98.3%(117/119) and there were 6 cases of partial necrosis. Donor site was closed primarily in 41 cases and skin grafts were applied in 78 cases. CONCLUSION: The reliability and versatility of ALT flap makes it one of the foremost choices for the reconstruction of complex tissue defects of the upper extremity.

Current Trends of Reconstructive Surgery for the 173 Cases of Korean Duplicated Thumbs Based on the Iowa System

PURPOSE: To report the current trends of Korean duplicated thumbs and their reconstructive surgery based on Iowa system performed during the last five years. MATERIALS AND METHODS: We performed retrospective review of all (164) patients who had performed operations between 2003 and 2007. Out of all, 109 were male and 55 were female. The age at the time of surgery ranged from six months to 46 years. Data analysis was done by using information from preoperative radiographs and patients'chart including operative records, etc. RESULTS: Wassel type IV was the most common one, and type II was the next. The thumbs were involved as follows: bilateral in nine patients; right, 100; left, 55. In right duplicated thumb, males had about 2.45 more times than females. Eighty five percent of all were 24 months or less: their average body weight was 2.72 kg; average body weight at surgery, 9.07 kg (7.7~10.3 kg); average age at surgery, 9.98months (6~19months). In age distribution of their parents, each average age of fathers and mothers was 34.3 and 32.5 years old. And 10.1 percent of all had combined anomalies. Though there could be some discrimination between radiological types and intraoperative findings on cartilaginous epiphyseal portions, surgical procedures were simple ablation, central resection followed by reconstruction, and combination with radial remnant tissue portions after resection of radial extradigital bone through preoperative findings including radiographs based on Iowa system. CONCLUSIONS: Surgical procedures for duplicated thumb are not ablation but reconstruction. At the appropriate time and optimal procedures are needed for satisfactory postoperative results.

Early Results of Mobile Bearing Unicompartmental Knee Arthroplasty in Korean Patients / 대한정형외과학회잡지

PURPOSE: The results of unicompartmental knee arthroplasty are controversial. We report our first year's experience of unicompartmental knee arthroplasty using minimally invasive Oxford Uni(R). MATERIALS AND METHODS: 57 knees from 49 patients who had undergone operation from January 2002 to December 2002 were reviewed. The mean age was 65 years (46-77). There were 5 males and 44 females. The mean follow-up period was 28 months (24-31). The preoperative diagnosis was 50 cases of osteoarthritis, 5 cases of avascular necrosis of the medial femoral condyle and 2 cases of chondrocalcinosis. The clinical results were evaluated preoperatively and at the final follow up using the HSS knee score and the range of motion of knee. At the final follow up, ability of the patient to assume the squatting position was checked. The tibiofemoral angle was measured preoperatively and postoperatively. RESULTS: The tibiofemoral angle was improved varus 1.3o preoperatively to valgus 4.8degrees postoperatively. The HSS knee score was 67.7 (52-80) preoperatively and 94.6 (88-100) at the final follow up. The mean preoperative flexion contracture was 6.3degrees (0-15) and 1.7degrees (0-5) at the final follow up. The active full flexion of the knee was possible in all patients within 2 months after surgery. The squatting position was possible in forty patients within 6 months after surgery. Complications were encountered in four cases with a meniscal bearing dislocation. One case was converted to a total knee arthroplasty and three cases were changed with thicker bearings. CONCLUSION: Minimally invasive unicompartmental knee arthroplasty using Oxford Uni(R) is suitable surgical method for a unicompartmental knee lesion. It provides a short recovery period, excellent pain relief, and is compatible with the Korean life style. However, a meniscal bearing dislocation during the follow-up period is an important complication.

Effect of Posterior Femoral Clearance on Knee Flexion in Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To analyze the effect of clearing the protruding posterior femoral condyle from the femoral component (PFC: Posterior femoral clearance) on knee flexion in patients who underwent LCS(R) rotating platform TKA. MATERIALS AND METHODS: Twelve patients were male and one hundred seventy-eight patients were female. The patients were divided into the following two groups: Group A (62 patients 84 knees), TKA without PFC; and Group B (128 patients 182 knees), TKA with PFC. The clinical and radiology follow-up were carried out using the HSS score and tibiofemoral angle, and the possibility of squatting was evaluated in each group, respectively. RESULTS: The mean flexion contracture improved 10.8degrees in group A, and 10.3degrees in group B. The mean further flexion improved 13degrees in group A, and 24degrees in group B. The improvement of knee flexion with PFC showed statistical significance. The mean HSS knee scores improved 30.5 points in group A, and 36.3 points in group B. The improvement in the HSS knee score with PFC showed statistical significance. Squatting was possible 50.0% of group A, and 67.4% of group B. CONCLUSION: PFC is effective in increasing the level of knee flexion and improving the HSS score. PFC can be a good solution for high demand patients, particularly those from Asian countries.

Short-term Results of Cementless Total Hip Arthroplasty Using Ceramic on Ceramic Articulation / 대한정형외과학회잡지

PURPOSE: The authors evaluated the clinical and radiological short-term results of ceramic on ceramic articulation of cementless total hip arthroplasty. MATERIALS AND METHODS: One hundred fourteen patients, with a total of 130 hips were followed for more than 2 years after cementless total hip arthroplasty using ceramic on ceramic articulation (Lima. SPH-C2). The mean age was 58 years, and the mean follow-up period was 3.0 years. The Harris hip score and postoperative hip pain were analyzed clinically. The radiological results were assessed using various radiological indices such as subsidence, cup inclination angle, radiolucent line, endosteal new bone formation and osteolysis. RESULTS: At last follow-up, the average Harris hip score improved from 57.5 points preoperatively to 93 points postoperatively. There were 4 cases (3.0%) of significant hip pain. Radiologically, all stems demonstrated stable fixation. The inclination of the acetabular cup was significantly changed in 4 cases (3%), and was diagnosed as loosened. A radiolucent line was observed around the stem in 5 cases (3.8%), and around the cup in 7 cases (5.4%). Endosteal new bone formation was observed around the stem in 47 cases (36.2%), and around the cup in 52 cases (40.0%). Osteolysis was not observed around the stem and the cup. CONCLUSION: With a minimum follow-up of 2 years, ceramic on ceramic articulation hip arthroplasty demonstrated excellent results on the stem side. However, 4 cases (3.0%) of cup loosening suggest that there is a fixation problem due to the design of the cup.

The Results of Pedicle Subtraction Osteotomy in Iatrogenic Flat Back Syndrome / 대한정형외과학회잡지

PURPOSE: To analyze the results of radiologic and clinical outcomes after pedicle subtraction osteotomy in iatrogenic flat back syndrome. MATERIALS AND METHODS: We reviewed 12 surgical cases of iatrogenic flat back syndrome from January 1998 to July 2001 with a follow-up of more than 12 months. All cases were females and an average age was 59.8 years (48-66 years). An average follow-up period was20.4 months (12-37 months). Initial diagnosis were as follows: lumbar degenerative kyphosis, in 5 cases; spinal stenosis, in 5 cases; spondylolisthesis, in 2 cases. For clinical evaluation, 10-point pain scale and 5-point scale for activity level, cosmesis and subjective satisfaction were used. Lumbar lordotic angles and sagittal vertical axis (SVA) were measured. RESULTS: In radiologic results, an average lumbar lordotic angle at preoperative, postoperative and the last follow-up were 5.13+/-21.69 degree, -31.33+/-16.32 degree, -27.50+/-16.73 degree respectively. And average SVA at preoperative, postoperative and the last follow-up were 8.46+/-6.04 cm, 0.62+/-2.24 cm, 2.82+/-2.81 cm respectively. In clinical results, preoperative pain (6), activity (2) and cosmesis (1.8) were improved to 3.2, 3 and 3.2respectively at the last follow-up. Subjective satisfaction was 3.9. CONCLUSION: Pedicle subtraction osteotomy seemed to be very useful surgical option for improvement of clinical results through recovering of lumbar lordotic angle and sagittal balance in cases of iatrogenic flat back syndrome.