Cementless Zweymuller Stem for the Treatment of the Hip Fracture in Patients Older than 80 with Severe Osteoporosis: Case Control Study with Cemented Stem

PURPOSE: We tried to evaluate the usefulness of the cementless Zweymuller stem for treating hip fracture in those patients older than 80 years with severe osteoporosis. MATERIALS AND METHODS: Thirty cases were treated with bipolar hemiarthroplasty with a cementless Zweymuller stem and they served as group I (the study group), and 30 cases treated with a cemented stem served as group II (the control group). We performed a comparative study between the two groups. RESULTS: The admission period (days) was 24.6+/-10.7 and 32.8+/-16.8 (p=0.047) for the 2 groups, respectively, and the average operation time (minutes) was 75.8+/-17.6 and 89.2+/-28.1 (p=0.024), respectively; the total blood loss (ml) was 457.2 and 548.3 (p=0.035) in group I and II, respectively. The incidence of staying in the intensive care unit (ICU) and the average time to start postoperative ambulation showed no significant differences between the two groups. Pulmonary embolism occurred in 1 case in group I and in 4 cases in group II, and intraoperative fracture of calcar occurred in 2 cases of group I. There was no case of position change of the femoral stem at 1 year postoperatively in both groups. CONCLUSION: The cementless Zweymuller stem, inserted by press fit in the patients who are older than 80 years and who have hip fracture with severe osteoporosis showed clinically better results as compared with the cemented stem.

The Trend for Diagnosis and Treatment of Childhood Asthma in Korean Pediatricians / 소아알레르기및호흡기학회지

PURPOSE: Korean Academy of Pediatric Allergy and Respiratory Disease suggested Korea Guideline for Diagnosis and Management of Childhood Asthma(KGDMCA) in 1994 and updated it in 1999. This survey was performed to evaluate the practical efficacy of KGDMCA and to develop appropriate educational interventions of childhood asthma for the Korean Pediatricians. METHODS: One thousand and two hundreds pediatricians were chosen randomly from the address book of Korean Pediatric Society. A questionnaire consisted of 22 multiple choices about childhood asthma and personal data was mailed to each pediatrician. RESULTS: Two hundred and thirty-eight pediatricians(19.8%) completed and returned the questionnaires. History of recurrent wheezing(24.9%) and improvement of wheezing after using bronchodilator(13.1%) were considered as the most important factors for the asthma diagnosis. 65.1% of the respondents used inhaled bronchodilator for the treatment, and 64.0% of users thought it efficient. 46.3% of the respondents used the inhaled corticosteroid. The younger the respondents are, the more they use the inhaled corticosteroid and inhaled bronchodilator(P<0.01). 66.4% of the respondents was already aware of the KGDMCA. 20% of them followed KGDMCA and 72.0% of them used personal guidelines modified from KGDMCA. KGDMCA was significantly preferred in younger pediatricians(4-5th decades, P<0.01). CONCLUSION: Many Korean pediatricians used KGDMCA-modified personal guidelines, but older pediatricians were less familiar with KGDMCA. It is necessary to identify specific areas of misunderstanding about the diagnosis and treatment of asthma, and the continuous, eager education about KGDMCA must be emphasized.

A Case of Cerebral Abscess with Pulmonary Arteriovenous Fistula / 대한소아신경학회지

Pulmonary arteriovenous fistula is an uncommon capillary abnormality. It may be accompanied by neurological complications such as cerebral abscess and be associated with or without hemorrhagic telangiectasia. We recently experienced a case of cerebral abscess with pulmonary arteriovenous fistula(PAVF), which was not associated with hereditary hemorrhagic telangiectasia. We report this case with review of the related literature.

A Case of Melkersson-Rosenthal Syndrome

Melkersson-Rosenthal syndrome(MRS) is a rare disorder, having a symptom triad of recurrent facial palsy, orofacial swelling and fissured tongue(lingua plicata). This disorder is usually recurrent or progressive, and monosymptomatic or oligosymptomatic forms have been reported to be more common than classic forms. Generally, MRS occurs in young adults at the end of the second decade of life and incidence of the disease in childhood is known to be very low. Although the clinical manifestation of MRS in children is similar to that in adults, early diagnosis and management is essential to avoid long-lasting functional disorders and psychological problems. We experienced MRS in a 13 year old boy with a history of recurrent facial palsy. We report this case with review of related literature.

Airway obstruction by congenital cardiovascular anomaly / 소아알레르기및호흡기학회지

PURPOSE: This study was performed to review the clinical presentation, diagnostic methods, treatments and prognosis of children with vascular rings. METHOD: We reviewed the medical records of 7 patients with vascular ring who were admitted in Samsung medical center between 1996 and 2000 retrospectively. RESULT: Pulmonary artery sling was noted in 4 cases. Two cases had double aortic arch, and 1 case had right aortic arch with left ligamentum arteriosus and aberrant left subclavian artery. The mean age at onset of symptoms was 3.2 months(from birth to 11 months). The mean age at diagnosis was 7.0 months(from 6 weeks to 15 months). Presenting symptoms and signs were respiratory difficulty, stridor, chest retraction, coughing, grunting, wheezing, sputum, cyanosis, choking, dysphagia, and poor feeding. All patients with pulmonary artery sling had tacheobronchial and/or pulmonary anomalies and cardiac defects were associated in two of them. Surgical repair was done successfully for the patients with double aortic arch or right aortic arch, but three deaths occurred to the patients with pulmonary artery sling combined with bronchial anomaly. CONCLUSION: Vascular ring should be considered especially for infants with respiratory distress or chronic respiratory symptoms. Associated anomalies are likely to affect the prognosis in these patients.

The Influences of Obesity on Bone Mineral Density in Children / 대한소아내분비학회지

PURPOSE: Nutritional as well as genetic and hormonal factors play an important role in the bone mineralization during childhood and adolescence. There are several physical and metabolic changes in obese children, and these changes may influence on the mineralization of the skeleton. The studies about bone mineralization of obese children are rare and contradictory. This study was performed to evaluate the influence of childhood obesity on bone mineral density(BMD). METHODS: The BMD of 49 obese and 41 non-obese children were measured at lumbar spines(L2-L4) using dual energy X-ray bone absorptiometry. Then, the results were assessed and compared according to the degree of obesity and pubertal sex maturation. RESULTS: There were no significant differences in BMD between obese children and non-obese children(0.87+/-.19 g/cm2 vs 0.81+/-.13 g/cm2). BMD increased according to the Tanner' pubertal staging, and the most marked increment was observed at overt puberty. No sex difference in BMD was seen in both obese and non-obese children. BMD was highly correlated with age, height, weight and body mass index(BMI), but there was no significant correlation between BMD and osteocalcin. CONCLUSION: BMD of obese children was not significantly different from that of non-obese children, and BMD also was not changed according to the degree of obesity. These findings suggest that BMD is not influenced by obesity in children.

Crush-Cleavage Fracture in Thoracolumbar and Lumbar Spine: Comparative Study with Type B Burst Fracture / 대한정형외과학회잡지

We noticed a group of thoracolumbar and lumbar spine fractures showing a unique fracture pattern that consisted of 1) superior disc injury, 2) crush fracture of the upper half of the vertebral body, 3) sagittal fracture of the lower half of the vertebral body, 4) bone fragments in the spinal canal, and 5) lamina fracture. Some of these fracture patterns were present in type B burst fracture of Denis classification. The purpose of this study was to compare the difference between crush-cleavage fracture and type B burst fracture in the viewpoint of neural canal involvement and neurologic status, and functional outcome with surgical treatment. Ten cases were identified as crush-cleavage fractures in 22 type B burst fractures during a 5 year period from Mar. 1989 to Jun. 1993 at the Department of Orthopedic Surgery of Chonbuk National University Hospital. Four out of 10 crush-cleavage fractures and 4 out of 12 type B burst fractures were paraparetic. Crush-cleavage fracture must be an unstable thoracolumbar comminuted fracture, but there were no significant differences in the neural canal involvement, incidence of neurologic deficit, and in the functional outcome, compared with type B burst fracture (P>0.05). It could be classified as a progressed form of type B burst fracture in Denis classification, or as a burst-split fracture in Magerl classification in the anatomical viewpoint. In conclusion, crush-cleavage fracture must be a variant of burst fracture.