Analysis of Mechanical Loading after Anatomic Anterior Cruciate Ligament Reconstruction Using Combined Single-Photon Emission Computerized Tomography and Conventional Computerized Tomography

PURPOSE: This study was to evaluate changes of the mechanical loading pattern after anatomic anterior cruciate ligament (ACL) reconstruction by analyzing uptake patterns using combined single-photon emission computerized tomography and conventional computerized tomography (SPECT/CT). MATERIALS AND METHODS: On SPECT/CT, high signal intensity of the articular surface which shows biological activity and mean increase of mechanical loading was compared with that of the tibiofemoral shaft as a comparative signal. The proportion of positive signals was evaluated in all compartments of the operated knee. Analysis was performed according to combined injury. RESULTS: A relatively high proportion of positive signals was detected in the posterior zone of the lateral tibial plateau (23.5%) and trochlear groove (23.5%) although increased signal intensity was detected in all compartments. There was no statistical difference depending on the presence of combined injury and between single-bundle and double-bundle ACL reconstruction. CONCLUSIONS: Following anatomic ACL reconstruction, higher signal intensity was detected, particularly in the posterior part of the lateral tibial plateau and trochlear groove. Close observation for further signal changes or osteoarthritic changes would be required even if there was no combined injury and anatomic reconstruction was performed.

The Learning Curve for Biplane Medial Open Wedge High Tibial Osteotomy in 100 Consecutive Cases Assessed Using the Cumulative Summation Method

PURPOSE: The purpose of this study was to investigate whether surgical experience could improve surgical competency in medial open wedge high tibial osteotomy (MOWHTO). MATERIALS AND METHODS: One hundred consecutive cases of MOWHTO were performed with preoperative planning using the Miniaci method. Surgical errors were defined as under- or overcorrection, excessive posterior slope change, or the presence of a lateral hinge fracture. Each of these treatment failures was separately evaluated using the cumulative summation test for learning curve (LC-CUSUM). RESULTS: The LC-CUSUM showed competency in prevention of undercorrection, excessive posterior slope change, and lateral hinge fracture after 27, 47, and 42 procedures, respectively. However, the LC-CUSUM did not signal achievement of competency in prevention of overcorrection after 100 procedures. Furthermore, the failure rate for overcorrection showed an increasing tendency as surgical experience increased. CONCLUSIONS: Surgical experience may improve the surgeon’s competency in prevention of undercorrection, excessive posterior slope change, and lateral hinge fracture. However, it may not help reduce the incidence of overcorrection even after performance of 100 cases of MOWHTO over a period of 6 years.

Comparison of Clinical and Radiological Results between Posteromedial Portal Technique and Posterior Transseptal Portal Technique in Making a Tibial Tunnel in Single Bundle Posterior Cruciate Ligament Reconstruction with Remnant Preservation / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to compare the clinical and radiological results between posteromedial portal technique and posterior transseptal portal technique in making a tibial tunnel in single bundle posterior cruciate ligament (PCL) reconstruction with remnant preservation. MATERIALS AND METHODS: Thirty-three cases of posteromedial portal technique and 35 cases of posterior transseptal portal technique in making a tibial tunnel in single bundle PCL reconstruction with remnant preservation were evaluated retrospectively. The clinical evaluation, including function and stability, was assessed. The tibial tunnel placement was measured using computed tomography. RESULTS: At final follow-up, the clinical results showed significant improvement compared to preoperation in both groups. There were no significant differences in clinical results including function and stability in both groups. The centers of tibial tunnels by posteromedial portal technique were placed more medially and proximally than those of the posterior transseptal portal technique. CONCLUSION: Remnant preserved single bundle PCL reconstructions by posteromedial portal technique and posterior transseptal portal technique were good methods for restoring function and stability compared to preoperation. There were no significant differences in clinical results in both groups. However, the tibial tunnels by posteromedial portal technique tended to be more medial and proximal placements than those of the posterior transseptal portal technique.

The SPECT/CT Evaluation of Compartmental Changes after Open Wedge High Tibial Osteotomy

PURPOSE: The purpose of this study was to evaluate compartmental changes using combined single-photon emission computerized tomography and conventional computerized tomography (SPECT/CT) after open wedge high tibial osteotomy (OWHTO) for providing clinical guidance for proper correction. MATERIALS AND METHODS: Analysis was performed using SPECT/CT from around 1 year after surgery on 22 patients who underwent OWHTO. Postoperative mechanical axis was measured and classified into 3 groups: group I (varus), group II (0°–3° valgus), and group III (>3° valgus). Patella location was evaluated using Blackburne-Peel (BP) ratio. On SPECT/CT, the knee joint was divided into medial, lateral, and patellofemoral compartments and the brighter signal was marked as a positive signal. RESULTS: Increased signal activity in the medial compartment was observed in 12 cases. No correlation was observed between postoperative mechanical axis and medial signal increase. Lateral increased signal activity was observed in 3 cases, and as valgus degree increased, lateral compartment’s signal activity increased. Increased signal activity of the patellofemoral joint was observed in 7 cases, and significant correlation was observed between changes in BP ratio and increased signal activity. CONCLUSIONS: For the treatment of medial osteoarthritis, OWHTO requires overcorrection that does not exceed 3 valgus. In addition, the possibility of a patellofemoral joint problem after OWHTO should be kept in mind.

Expression of Aquaporin-2 in the Inner Ear of Water-Deprived Guinea Pigs / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although the role of aquaporin-2 (AQP2) in the kidney has been well defined, its role in the inner ear remains to be determined. The present study was to investigate the effect of water deprivation on the expression of AQP2 in the inner ear. MATERIALS AND METHOD: Healthy male guinea pigs weighing 250 g were used. The experimental group underwent water restriction and the control underwent water loading with sucrose-containing water for 3 days. Concentrations of plasma arginine-vasopressin (AVP) were determined and electrocochleography (ECoG) recordings were made. An RT-PCR, real-time PCR and Westernblotting analysis were used for quantitative analysis of AQP2 mRNA and AQP2 protein expression. Immunohistochemistry was also used to evaluate the distribution of AQP2 water channel proteins in the inner ear. RESULTS: AQP2 was mainly expressed in the epithelium of endolymphatic sac, spiral limbus, spiral ligament and stria vascularis of scala media. The concentrations of plasma AVP were 9.2+/- 0.8 pg/mL in the experimental group and 0.78+/-0.3 pg/mL in the control. The summation potential/ action potential (SP/AP) ratio in ECoG was markedly increased in the experimental group (0.55 in the experimental and 0.29 in the control). RT-PCR and real time PCR as well as Western blot analysis showed that the level of AQP2 mRNA and protein in the cochlea and endolymphactic sac of the water-deprived group was significantly higher than those in the control group. CONCLUSION: These data suggest that AQP2 is one of the important water channels in fluid homeostasis in the inner ear. Moreover, the volume of endolymphatic space can be increased via AVP-AQP2 system in response to water deprivation.

A Clinical Review of 1,060 Dizziness Cases Who Visited Patients in Emergency Room / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Dizziness is an illusion of environmental movement due to various causes. It is difficult to confirm the diagnosis of dizziness according to history and physical examination in restricted situation such as emergency room. The aim of this study is to find another clue for diagnosis in patients of dizziness who visited emergency room. SUBJECTS AND METHOD: Author retrospectively reviewed the charts of 1,060 patients of dizziness who visited emergency room at Chonnam University Hospital from July 2004 to June 2005 and accumulated the various information such as final diagnosis, clinical feature, physical examination, present illness and past history etc. RESULTS: Average age of patients was 57. The most frequently consulted department for evaluation of dizziness was the department of otolaryngology, head and neck surgery (> 29.8%). Benign paroxysmal positional vertigo (BPPV) was the most frequent final diagnosis (14.4%) in all patients. But, cerebrovascular disease was the more frequent cause for dizziness in male and old age group. Whirling type dizziness was frequent in BPPV (36.8%) and spontaneous nystagmus was detected frequently in peripheral type vertigo such as vestibular neuritis (65.1%). Average age of central vertigo patients was 61.4 and other vertigo patients was 55. Patients of central vertigo visited the emergency room more frequently in the months of Dec, Jan, Feb and patient of other vertigo visited more frequently in June, July, Aug. CONCLUSION: Various specialized departments should be involved in effective and exact diagnosis of dizziness. The organized questionnaire in addition to prevalence, incidence and characteristics of dizziness may be used in finding another clue for diagnosis and managing dizzy patients helpfully.

Clinical Analysis of Angioedema of the Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Angioedema is a localized, nonpitting edema resulting from extravasation of fluid into the interstitial space. It usually develops suddenly and fades during the course of 24 to 48 hours. However, angioedema of the upper respiratory tract can result in serious acute respiratory distress, airway obstruction, and death. The purpose of this study was to analyze clinical characteristics of angioedema in the head and neck. SUBJECTS AND METHOD: A review of 144 patients with angioedema of the head and neck over 3-year period was conducted. RESULTS: The presumptive causes were 115 allergic reactions to food, drug, or environmental exposure, 3 losses of C1 esterase inhibitor, 1 angiotensin-converting enzyme inhibitor use, and 25 idiopathic conditions. The main locations of the edema were 100 face/lips, 4 oral cavity/oropharynx, 5 larynx/hypopharynx, and 35 multiple sites of the head and neck. Most of patients were treated with steroids and H1 and H2 blockers. All of 7 patients with low oxygen saturation and 14 out of 18 patients with hypotension on arrival were improved within 24 hours. There were 4 patients with airway distress treated with urgent airway intervention, three of them were completely recovered within 110-240 hours but one of them died of the disease. Patients with the cause of idiopathic and loss of C1 esterase inhibitor were found to stay longer in the hospital over 48 hours (p<0.05). CONCLUSION: Angioedema of the head and neck usually responds well to the treatment. However, there might be cases with life-threatening airway obstruction.

Image-Guided Surgery in the Paranasal Sinus and Skull Base Lesion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Endoscopic paranasal sinus surgery is effective for the treatment of paranasal sinus lesion and reduction of invasiveness enabling the surgeon to perform precise procedures with minimal tissue traumatization. But, some studies showed that there was a risk of invasive management and major complications occurring in 0.5% to 1% of all procedures. The aim of this study was to assess the usefulness and effectiveness of image-guided endoscopic surgery in reducing the complication and treating the disease suitably. SUBJECTS AND METHOD: The image-guided paranasal sinus surgery was performed in 12 patients from 2000 to 2005 who had difficulty in endoscopic surgery for the diagnosis and treatment of the inaccessible location such as skull base, sphenoid and clivus, infratemporal fossa etc. and the uncertain lesion such as severe distorted lesion due to previous sinus operation, congenitally underdeveloped anatomic lesion, nearby vital organ-lesion and submucosal lesion in our experiences. We retrospectively reviewed radiologic evaluations and medical records in our patients. RESULTS: We included 6 oncogenic lesions such as craniopharyngioma, chordoma in clivus and sphenoid sinus, 5 infectious lesions such as invasive aspergillosis and 1 cystic lesion. The accuracy we could achieve varied between 0.9 and 2.0 mm. CSF rhinorrhea occurred in 2 cases after management. But, only one case was not only related to image-guided surgery but also resolved spontaneously. CONCLUSION: Image-guided endoscopic surgery is a safe and effective tool in paranasal sinus and skull base lesion for maximizing surgical results and limiting complications.

A Clinical Review on Four Cases of the Retropharyngeal Hematoma / 대한이비인후과학회지

Retropharyngeal hematomas are relatively rare. But, they are clinically important because of the close proximity of the retropharyngeal space to the upper airway. The authors experienced four cases of the retropharyngeal hematoma following cervical trauma, esophageal foreign body, stellate ganglion block, and discuss the diagnosis and treatment of individual condition.

A Case of Vocal Cord Candidiasis / 대한이비인후과학회지

Candidal infection is recently reported to increase in certain predisposing condition, although isolated candidiasis from larynx is infrequently recognized and reported. Iisolated whitish lesions of vocal cord may be confused with precancerous lesions, squamous cell carcinoma, or verrucous carcinoma. A 62-year-old male visited our department for continuous hoarseness. Flexible laryngoscopy disclosed a whitish irregular exophytic mucosal lesion in right true vocal cord, which extended to anterior commissure and subglottis. Laryngeal microscopic surgery was done because of a concern regarding the possibility of glottic cancer. A pathologic biopsy revealed distorted and septated hypae and yeasts, scattered in moderate dysplasia. The patient was treated with itraconazole for 4 weeks, and followed up without any recurrence of candidiasis or dysplasia.

Recurrent Pseudotumor Cerebri in Systemic Lupus Erythematosus: A Case Report

Pseudotumor cerebri is an uncommon manifestation of neuropsychiatric systemic lupus erythematosus (SLE), and is characterized by an elevated intracranial pressure, papilledema with occasional abducens nerve paresis, absence of a space-occupying Iesion or ventricular enlargement, and normal cerebrospinal fluid chemical and hematological constituents. Pseudotumor cerebri has been reported in a few sporadic cases in patients with systemic lupus erythematosus. However, the recurrent pseudotumor cerebri in patients with systemic lupus erythematosus which has been rarely reported, has not been reported in Korea. We experienced a 30-yr-old female patient with SLE who was presented with second attack of severe intractable headache. She was diagnosed pseudotumor cerebri twice and successfully treated with corticosteroid. Headache is the common symptom in patients with neuropsychiatric SLE and attributable to various causes. We suggest that it is important to define the cause of headache in patients with SLE and pseudotumor cerebri should be included in the spectrum of clinical manifestations during the course of SLE as a cause of headache.

A case of juvenile rheumatoid arthritis with myelodysplastic features / 대한내과학회지

Juvenile rheumatoid arthritis (JRA), an autoimmune disease, was characterized by chronic synovitis and associated with various extra-articular manifestations. Abnormal hematologic findings have been reported in all form of JRA, especially anemia due to chronic disease or iron deficiency. Dysplastic changes were rarely noted in the peripheral blood and bone marrow. We experienced a 15-year-old female patient with pauciarticular JRA who have pancytopenia in peripheral blood and a number of dysplastic changes in bone marrow, and present the case here with brief review of literatures.

Double Bronchial Lesions Detected by Bronchoscopic Examination / 결핵

OBJECTIVES: Multiple lung cancers and/or precancerous lesions can be developed because many bronchi are exposed to carcinogens simultaneously according to the concept of 'Field Cancerization'. We had performed a careful bronchoscopic examination and analysed the patients of double bronchial lesions who received the separate pathologic evaluation. METHODS: We studied 21 patients of double bronchial lesions among 1855 patients of bronchoscopic examination from April 1990 to December 1993 in Korea Cancer Center Hospital. We classified the patients into three groups(double malignancies of different histology, double malignancies of same histology, and combination of malignant and benign lesions) and analysed the histologic type, location, radiologic findings, and clinical parameters. RESULTS: Among 21 patients, six patients had double malignancies of different histology, eight had double malignancies of same histology, and seven had combination of malignant and benign lesions. Out of 14 double malignant cases, 11 cases are considered as synchronous multiple primary lung cancers. Combination of squamous cell carcinomas was found in 5 cases, combination of small cell carcinoma and squamous cell carcinoma was found in 4 cases. Combination of adenocarcinoma and squamous cell carcinoma and combination of squamous cell carcinoma and poorly differentiated carcinoma were found in 1 case respectively. All patients of synchronous multiple primary lung cancers were male and had long smoking history(average 40 pack years). Among 21 cases of double bronchial lesions, only one lesion could be detected by prebronchoscopic radiologic examination including chest CT in 15 cases. CONCLUSIONS: The presence of double bronchial lesions including multiple primary lung cancers and the limitation of radiologic examination to detect early bronchial lesions encourage us to examine the whole bronchi carefully and to perform pathologic evaluations.