Balloon Dilatation for an Esophageal Stricture by Long-Term Use of a Nasogastric Tube: A Case Report

In the present report, we describe a case of long-term follow-up esophageal stricture occurring in a patient with nasogastric tube use. A 63-year-old man who had experienced dislocation of the 6th and 7th cervical vertebrae as the result of an external injury received treatment at another hospital and was admitted to the rehabilitation department of our hospital. After he exhibited normal swallowing in a videofluoroscopic swallowing test, the nasogastric tube was removed and oral feeding with a dysphagia diet was initiated. However, during oral feeding, the patient complained of swallowing difficulties in his lower throat. An esophagogastroduodenoscopy was performed to examine the lesions below the pharynx and a 2-mm stricture was observed. A balloon dilatation was performed for a total of 9 times to extend the stricture. After the procedure, the patient was able to easily swallow a normal diet through the esophagus and the vomiting symptoms disappeared. An esophagography showed that the diameter of the esophageal stricture was 11 mm.

Which Emphasizing Factors Are Most Predictive of Hematoma Expansion in Spot Sign Positive Intracerebral Hemorrhage?

OBJECTIVE: The spot sign is related with the risk of hematoma expansion in spontaneous intracerebral hemorrhage (ICH). However, not all spot sign positive patients undergo hematoma expansion. Thus, the present study investigates the specific factors enhancing the spot sign positivity in predicting hematoma expansion. METHODS: We retrospectively studied 316 consecutive patients who presented between March 2009 to March 2011 with primary ICH and whose initial computed tomography brain angiography (CTA) was performed at our Emergency Department. Of these patients, 47 primary ICH patients presented spot signs in their CTA. We classified these 47 patients into two groups based on the presence of hematoma expansion then analyzed them with the following factors : gender, age, initial systolic blood pressure, history of anti-platelet therapy, volume and location of hematoma, time interval from symptom onset to initial CTA, spot sign number, axial dimension, and Hounsfield Unit (HU) of spot signs. RESULTS: Of the 47 spot sign positive patients, hematoma expansion occurred in 26 patients (55.3%) while the remaining 21 (44.7%) showed no expansion. The time intervals from symptom onset to initial CTA were 2.42+/-1.24 hours and 3.69+/-2.57 hours for expansion and no expansion, respectively (p=0.031). The HU of spot signs were 192.12+/-45.97 and 151.10+/-25.14 for expansion and no expansion, respectively (p=0.001). CONCLUSIONS: The conditions of shorter time from symptom onset to initial CTA and higher HU of spot signs are the emphasizing factors for predicting hematoma expansion in spot sign positive patients.

The Clinical Outcomes and Assessment of Quality of Life in Arthroscopic Repair of Isolated Type II Superior Labral Anterior and Posterior Lesion Caused by Sports Injuries from Public / 대한스포츠의학회지

The purpose of this study was to morphologically classify the superior labral anterior and posterior (SLAP) lesion in people with athletic injuries and further research into the clinical result of arthroscopic repair of type II SLAP lesions. January 2005 to June 2012 occurred after sports activity in patients with shoulder pain diagnosed with isolated SLAP lesion by magnetic resonance imaging and arthroscopy were classified according to the tear type. Of these patients, 40 cases of type II SLAP patients were evaluated using American Shoulder and Elbow Surgeons (ASES) questionnaire and range of motion. Also satisfaction of surgery was evaluated by following up through phone calls using translated short form-36 (SF-36). At average of 35 months postoperatively, external rotation decreased slightly from 60.4 degrees to 56.2 degrees, forward elevation and internal rotation were both recovered to a range of pre-surgery but no significant changes were noticed statistically (p>0.05). Visual analogue scale, ASES scores, physical component summary, and mental component summary of SF-36 improved from 5, 1 to 1.2 (p=0.01), from 65.4 to 91.5 (p=0.017), 42.6 to 52.5 (p=0.047), and from 48.5 52.6 to (p=0.036), respectively. In comparison of a group of patients over forty years and less than forty, both groups showed good results, but group of patients less than forty years showed more improvement in pain relief, functional test, and postoperational satisfaction (p=0.004). Arthroscopic repair showed good results in patients with type II SLAP lesion due to athletic injuries especially when they were less than 40 years and it can be regarded as a good treatment with high satisfaction.

Asymptomatic Pulmonary Embolus Following Percutaneous Kyphoplasty: A Case Report / 대한골다공증학회지

Percutaneous vertebroplasty is a relatively recent procedure in the treatment of osteoporotic vertebral compression fractures. Bone cement embolism is a severe and potentially life-threatening complication of percutaneous vertebroplasty with cement. The risk for cement pulmonary embolism ranges between 3.5 and 23% for osteoporotic fractures. Bone cement leakage may be usually more frequent with vertebroplasty than with kyphoplasty. We experienced a 69-year-old female patient of an asymptomatic pulmonary embolus (length 8 cm) after kyphoplasty for an osteoporotic vertebral compression fracture

Intramuscular Ganglion of the Quadriceps Femoris

Ganglion cysts are common lesions that are most often found around the joints of the hands and feet. Ganglia around the distal femur usually occur within the synovial membrane or tendon sheath, but rarely within muscles. Several cases of intramuscular ganglions in the hand and wrist have been reported, but a ganglion cyst in the quadriceps muscle has rarely been addressed in studies. In this report, we present a 17-year-old patient with a painful movable mass in the intramuscular area of the quadriceps femoris that was diagnosed by ultrasound and treated by excision and biopsy.

Changes of Paraspinal Muscles in Postmenopausal Osteoporotic Spinal Compression Fractures: Magnetic Resonance Imaging Study

BACKGROUND: To investigate the changes of cross sectional area (CSA) in paraspinal muscles upon magnetic resonance imaging (MRI) and bone mineral density (BMD) in postmenopausal osteoporotic spinal compression fractures. METHODS: We reviewed 81 postmenopausal women with osteoporosis, who had underwent MRI examination. The patients were divided into 51 patients who had osteoporotic spinal compression fractures (group I), and 30 patients who without fractures (group II). Group I were subdivided into IA and IB, based on whether they were younger (IA) of older (IB) than 70 years of age. We additionally measured body mass index and BMD. The CSA of multifidus, erector spinae, paraspinal muscles, psoas major (PT), and intervertebral (IV) discs were measured. The degree of fatty atrophy was estimated using three grades. RESULTS: The BMD and T-score of group I were significantly lower than those of group II. The CSA of erector spinae, paraspinal muscles, and PT in the group I was significantly smaller than that of group II. The CSA of paraspinal muscles in group IB were significantly smaller than those of group IA. The CSA of erector spinae, mutifidus, and PT in group IB were smaller than those of group IA, but the difference was not statistically significant. Group 1 exhibited greater fat infiltration in the paraspinal muscle than group II. CONCLUSIONS: Postmenopausal osteoporotic spinal compression fracture is associated with profound changes of the lumbar paraspinal muscle, reduction of CSA, increased CSA of IV disc, and increased intramuscular fat infiltration.

Intractable Plantar Keratoses due to Interphalangeal Sesamoid Bone of the Hallux (A Case Report) / 대한족부족관절학회지

A sesamoid bone can occasionally be found under the interphalangeal joint of the hallux. These had anatomical variants and usually remain asymptomatic, it is uncommon for symptomatic cases of painful plantar keratoses or irreducible dislocation of interphalangeal joint of the hallux with incarcerated sesamoid. While the latter has a few cases, the former has not reported in Korea. We experienced a rare case of intractable plantar keratoses due to interphalangeal sesamoid bone of the hallux which may reqire excision.

Nodular Hidradenoma on the Fourth Finger

Nodular hidadenoma is known as an eccrine sweat gland origin that arises in the skin and occurs as a solitary tumor in most cases. Although it is not uncommon, it is rarely occurs in the hand. We report a case of nodular hidadenoma of the fourth finger with a brief review of the literatures.

Two Stage Procedure with a Temporary Antibiotic-impregnated Cement Spacer of Infected Hallux Interphalangeal Joint (A Case Report) / 대한족부족관절학회지

The interphalangeal joint (IPJ) of the hallux has received little attention compared with the first metatarsophalangeal joint. But, the hallucal IPJ has several disorders such intra-articular fractures, dorsal dislocation, alignment disorder, and inflammatory or degenerative arthritis. Among these disorders septic arthritis of the IPJ of the hallux is rare. We report a case of sepsis of the hallucal IPJ and adjacent underlying osteomyelitis without neuropathic problem and was performed through infected soft tissue and osseous debridement, temporary antibiotic-impregnated cement spacer, and delayed intercalary allogenic fibular bone graft with K-wire fixation.

Pseudoaneurysm of the Lateral Inferior Genicular Artery after Arthroscopic Partial Meniscectomy of Lateral Meniscus: A Case Report / 대한스포츠의학회지

Arthroscopic meniscectomy of the knee is generally a safe and effective procedure with a low rate of vascular complications. The authors encountered a case of a pseudoaneurysm of the lateral inferior genicular artery after arthroscopic partial meniscectomy of lateral meniscus. The pseudoaneurysm was treated successfully using transcatheter embolization. No recurrence of the hemarthrosis was observed in the patient after a follow-up of 2 years.

Multiple Flexor Tendon Injuries after Volar Plate Fixation for Distal Radius Fracture: Two Cases Report

As the, injury of flexor tendons has been rarely reported rarely after volar plate fixation in the distal radius fractures. Author experienced one case with delayed rupture of flexor pollicis longus and flexor digitorum profundus of index finger caused by anterior protrusion of volar plate. We also experienced another case with delayed rupture of flexor pollicis longus and wear on flexor digitorum profundus of index finger caused by volar plate placed distally to watershed line. Proper placement of volar plate and distal shape of the plate are important to prevent multiple tendon injury.

Development and Application of a Newly Designed Massage Instrument for Deep Cross-Friction Massage in Chronic Non-Specific Low Back Pain

OBJECTIVE: To introduce a newly designed massage instrument, the Hand Grip T-bar (HT-bar) and use it to relieve chronic non-specific low back pain (nLBP) through deep cross-friction massage (roptrotherapy). METHOD: 22 subjects (9 males and 13 females, aged 51.6+/-6.7) with chronic nLBP were allocated randomly to a Roptrotherapy group (n=12) and a Transcutaneous Electrical Nerve Stimulation (TENS) group (n=10). The Roptrotherapy group received deep cross-friction massage with the HT-bar, which was made of metal and had a cylinder for increasing weight and grooves for an easy grip. It was applied across the middle and lower back for 20 minutes a day, 3 days a week for 2 weeks. The TENS group received TENS for 20 minutes a day, 5 days a week for 2 weeks. The outcome was measured on the pain numeric rating scale (PNRS), by the Oswestry disability index (ODI), and by the Roland & Morris Disability Questionnaire (RMDQ) at pre-treatment, at immediate post-treatment and 2 weeks later. The application of the HT-bar was assessed by a questionnaire to 19 therapists. RESULTS: At post-treatment, immediately and 2 weeks later, both groups showed significant improvement in PNRS, ODI and RMDQ. During the two weeks after post-treatment, however, the Roptrotherapy group improved in PNRS, ODI and RMDQ, but the TENS group did not. Over 80% of the therapists responded that the HT-bar was useful and comfortable. CONCLUSION: This study suggests that deep cross-friction massage can be a beneficial therapeutic technique and that the HT-bar can be a useful instrument in deep cross-friction massage for chronic nLBP patients.

The Daily Life Functions of Elderly Peritrochanteric Fracture Patients after Surgical Treatment

PURPOSE: Although most peritrochanteric fractures in old age necessitates surgical treatment, daily life functions are still impaired after discharge. We assessed the types of peritrochanteric fracture, risk factors, and functional recovery in elderly patients who were over 65 years old. We also tried to determine factors for recovery to daily life. MATERIALS AND METHODS: From January 2006 to December 2007, among 61 patients who were over 65 years old with the possibility of 1 year follow-up, 50 patients were selected through interviews. After verifying age, sex, mode, types of fracture, and method, we analyzed daily living activities with a functional recovery index and estimated recovery of daily life functions after surgery, assuming a score increase if functional recovery was good. RESULTS: The mean age was 75.8 years, and females (31 patients, 62%) exceeded males. Slipping (27 patients, 54%) was the most common cause of fracture, and the intertrochanteric femur fracture was the most common fracture type (34, 68%). The average functional recovery index decreased 16.24% compared with the pre-operation value, having a tendency to decrease more in old age and female patients. Subtrochanteric femur fracture showed a 17.6% decrease in functional recovery index among the fracture types. CONCLUSION: In elderly patients over 65 years, the functional recovery index after peritrochanteric fracture decreased 16.24% on average compared with the preoperation state. The largest decrease was in basic life ability. The functional recovery index decreased more in old age, females, and subtrochanteric femur fracture, which indicates these factors influence functional recovery.

MANDIBULAR OSTEOBLASTOMA: REPORT OF 3 CASES

OPEN REDUCTION AND TRANSORAL FIXATION USING TROCHAR FOR MANDIBULAR SUBCONDYLE FRACTURE

Diabetic Muscle Infarction in a Chronic Stroke Patient: A Case Report

Diabetic muscle infarction is a rare complication of diabetes and is characterized by acute or subacute onset of painful and non-pitting swelling of the thigh or the calf, and rarely in the upper limbs. Diabetic muscle infarction and cerebral vascular accidents ocurr in patients with advanced diabetic complications. Painful swelling of the extremities is very common manifestation in patients with hemiplegia. Thus, early correct diagnosis and differential diagnosis of the underlying causes of painful swelling of the extremities are very important in these patients. We report a case of diabetic muscle infarction in a patient with hemiplegia, and suggest that diabetic muscle infarction should be considered as a disease of differential diagnosis for acute pain and swelling on the extremity.

Expression of Estrogen Receptors in Retrodiscal Tissue of the Temporomandibular Joint Disorder Patients

Those composing temporomandibular joint (TMJ) complex such as the temporal bone, the disc and the mandibular condyle perform their own functions with organic relation. The retrodiscal tissue is the main area of pain induction and contributes to compositional change of synovial fluid. If displacement of the disc lasts long time, not only adaptive changes, but also destructive or degenerative changes may happen. It was reported that these changes and symptoms appear mostly to female rather than male and especially, in the case of patients suffering from TMJ disorder, a large quantity of female sex hormone is found in the joint synovium. And that may play a role in bone resorption and inflammation. Also, the frequency and the intensity of pain perception for female is reported to be much more than for male. In this study, we investigated the expression extents of estrogen receptors (ER) and progesteron receptors (PR) in retrodiscal tissue with immunohistochemistry among the patients received TMJ surgery and compared with MRI findings and surgical findings. We report the relations between the expression of ER in retrodiscal tissue and the pathological change in TMJ, such as inflammation, internal derangement and osteoarthritis.

Surgical Treatments of Spinal Intradural Tumor / 대한정형외과학회잡지

PURPOSE: This article aims at evaluating the results of treatment which excise the intradural extramedullary tumor using surgical microscope, mainly concerned by the field of orthopaedic surgery. MATERIALS AND METHODS: A retrospective review was carried out on 11 cases who were operated on for the excision of intradural extramedulary tumor in two hospitals from June 2001 to May 2007. Of the 11 cases, there were 3 males, and 8 females with an average age of 62.4 (33-78) years. Average follow-up period is 18.8 (1-78) months. Patients were diagnosed by MRI and pathological diagnosis was analyzed. The clinical evaluation was made by the index of VAS (visual analogue scale) and Cooper- Epstein grade. RESULTS: 7 cases were Schwannoma and 4 cases were meningioma. The VAS take a favorable turn from average 9.4 before practice to final follow-up 2.4, and the Cooper-Epstein grade take a favorable turn from average 2.4 to final follow-up 0.7 CONCLUSION: A fine result of excision of the intradural extramedullary tumor with using surgical microscope could be acquired even in the field of orthopedic surgery.

Operation Fee and Insurance Charge of Hallux Valgus Surgery / 대한족부족관절학회지

PURPOSE: The purpose of this study was to figure out the appropriate and systemic insurance charge for the hallux valgus operations. MATERIALS AND METHODS: 5 Hospitals for hallux valgus operations were analyzed how they have been charging the national health insurance corporation for their operation fees and how to use the estimated guide and authoritive interpretation through the guide book of health insurance medical treatment grant expense and the guide book of Health insurance medical treatment. RESULTS: There are nothing for guiding principle of hallux valgus operations in both books but a guide of Mcbride operation which is approved 'JA-93-KA and JA-31' for operation fee. So majority of hospitals have charged operation fee depending on their own interpretations they like. According to the guide books, there was a authoritive interpretation that simultaneous operation of osteotomy and tendon transfer for cerebral palsy and flat foot can be eatimated as 'osteotomy +JA-93-NA'. CONCLUSION: Distal soft tissue procedure should be approved as 'JA-93-NAx100%+JA-31x50%' according to the the estimated guide and authoritive interpretation if transected adductor hllucis is transfered to first metatarsal head. So distal chevron osteotomy could be 'JA-30-1-RAx100%+JA-31x50%', proximal metatarsal osteotomy could be 'JA-93-NAx100%+JA-31-50%+JA-30-1-RAx50%', first metatarsocuneiform joint arthrodesis could be 'JA-93-NAx100%+ JA-31x50%+JA-73-RAx50%'.

Total Knee Arthroplasty in Diabetic Patients

PURPOSE: We investigated clinical and radiologic results and complications on diabetic patients with degenerative arthritis treated by total knee arthroplasty. MATERIALS AND METHODS: From March 1995 to July 2002, 56 diabetic patients among 594 TKR patients was ananlysed. Compared group was 124 patients of no medical disease. There were 52 women and 4 men, with mean age of 65.3 years (49.6~78.2) at operation. Insulin-dependent (type I) was 8 cases and noninsulin-dependent (type II) was 48 cases. We compared preoperative and postoperative knee function score, HSS score, radiologic results and complications. Mean follow up period of 38 months (21~108 months). RESULTS: HSS score improved preoperative mean 42 points to 86 postoperative and clinical knee function score estimated significant improvement (p<0.05) that 44 preop. to 82 postop. in DM TKR patients. There were 3 cases of infection (5.3%) including superficial wound infection 2 cases, deep joint infection 1 case. Deep vein thrombosis occured 2 cases (3.6%), wound problem 3 cases (5.3%), urinary infection 1 case (1.8%), cardiopulmonary complication 1 case (1.8%) and also high infection rate including wound problem (p<0.05). CONCLUSION: Total knee arthroplasty improves knee function and pain relieve in diabetic patients. But owing to high postoperative risk of infection and complication, meticulous hemostasis and careful wound closure is mandatory.