Comparison of Clinical and Structural Outcomes of Open and Arthroscopic Repair for Massive Rotator Cuff Tear

BACKGROUND: Management of massive rotator cuff tears can be challenging because of the less satisfactory results and a higher retear rate regardless of the use of open or arthroscopic repair technique. METHODS: We retrospectively analyzed 102 cases of massive rotator cuff tear treated with either open or arthroscopic repair. Open repair was performed in 38 patients; and arthroscopic repair, in 64 patients. The mean age at the time of surgery was 59.7 years in the open group and 57.6 years in the arthroscopic group. RESULTS: The Constant score increased from the preoperative mean of 55.9 to 73.2 at the last follow-up in the open repair group and from 53.8 to 67.6 in the arthroscopic repair group (p<0.001 and <0.001, respectively). The University of California at Los Angeles (UCLA) score increased from a preoperative mean of 17.7 to 30.8 at the last follow-up in the open group and from 17.5 to 28.7 in the arthroscopic group (p<0.001 and <0.001, respectively). No statistically significant difference in the Constant and UCLA scores was observed between the two groups at the last follow-up (p=0.128 and 0.087, respectively). Retear was found in 14 patients (36.8%) in the open group and 39 patients (60.9%) in the arthroscopic group (p=0.024). CONCLUSIONS: Open and arthroscopic repairs of massive rotator cuff tears may provide satisfactory clinical results with no significant difference. However, a significantly lower retear rate was observed for the open repair group compared with the arthroscopic repair group.

Comparison of Clinical and Structural Outcomes of Open and Arthroscopic Repair for Massive Rotator Cuff Tear

BACKGROUND: Management of massive rotator cuff tears can be challenging because of the less satisfactory results and a higher retear rate regardless of the use of open or arthroscopic repair technique. METHODS: We retrospectively analyzed 102 cases of massive rotator cuff tear treated with either open or arthroscopic repair. Open repair was performed in 38 patients; and arthroscopic repair, in 64 patients. The mean age at the time of surgery was 59.7 years in the open group and 57.6 years in the arthroscopic group. RESULTS: The Constant score increased from the preoperative mean of 55.9 to 73.2 at the last follow-up in the open repair group and from 53.8 to 67.6 in the arthroscopic repair group (p<0.001 and <0.001, respectively). The University of California at Los Angeles (UCLA) score increased from a preoperative mean of 17.7 to 30.8 at the last follow-up in the open group and from 17.5 to 28.7 in the arthroscopic group (p<0.001 and <0.001, respectively). No statistically significant difference in the Constant and UCLA scores was observed between the two groups at the last follow-up (p=0.128 and 0.087, respectively). Retear was found in 14 patients (36.8%) in the open group and 39 patients (60.9%) in the arthroscopic group (p=0.024). CONCLUSIONS: Open and arthroscopic repairs of massive rotator cuff tears may provide satisfactory clinical results with no significant difference. However, a significantly lower retear rate was observed for the open repair group compared with the arthroscopic repair group.

Anti-TNF-alpha Therapy for Ankylosing Spondylitis

BACKGROUND: This review evaluated the safety and efficacy of etanercept in patients with ankylosing spondylitis (AS). METHODS: Of 59 patients with AS, this study reviewed 11 patients who were refractory to conventional therapy and treated with etanercept from September 2005 to January 2008. The mean follow-up duration was 13.6 months. The general improvement was evaluated by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and adverse effects, complications and inflammatory markers were also assessed. RESULTS: The mean BASDAI decreased from 7.1 +/- 1.6 before treatment to 4.2 +/- 1.8 at 3 months after the etanercept treatment (p = 0.001). The mean erythrocyte sedimentation rate and C-reactive protein were decreased significantly by the etanercept treatment. The greatest improvement in symptoms was enthesitis, followed by skin involvement and morning stiffness. There was a significant difference in the improvement in BASDAI along with the follow up duration (p = 0.04). A serious infection was observed as a complication in 1 case. CONCLUSIONS: These results suggest that etanercept can induce significant improvement in most patients with less damage. A trial of tumor necrosis factor inhibition is indicated in all AS patients who do not achieve adequate disease control with disease-modifying antirheumatic drugs, such as methotrexate, leflunomide etc. The patients treated with etanercept should be educated about the possibility of infection and monitored closely.

Internal Fixation for Isolated Posterolateral Fracture of the Acromion: A Case Report

Isolated acromial fracture is not common and it frequently accompanies fractures to the coracoid process and glenoid bone and also injuries to the acromioclavicular joint. Furthermore, most of these combined acromial fractures have minimal displacement, which needs no additional treatment other than protection for a certain period of time. We have experienced a case of isolated fracture of the posterolateral angle of the acromion, which we reduced and fixated using K-wire and cannulated screws. We report on the technical aspects and clinical results of this reduction and fixation, along with a review of the literature.

Minimally Invasive Microscopic Decompression with Tubular Retractor System in Lumbar Spinal Stenosis: Results Comparing with Open Microscopic Decompression / 대한척추외과학회지

PURPOSE: To compare the two methods of decompression using a microscope with a tubular retractor system and open microscopic decompression in lumbar spinal stenosis. MATERIALS AND METHODS: The records of patients that had undergone decompression from May 2000 to April 2005 were reviewed. The average follow-up period was 29 months (4~60 months). The duration of hospital stay, estimated blood loss, relief of pain, and operating time were reviewed retrospectively. Analysis was conducted by telephone interview and chart review (McNab's criteria). Pre- and post-operative Visual Analogue Scale (VAS) scores and JOA scores were also evaluated. RESULTS: Of the total 53 patients, open microscopic decompression was performed on 27 patients, and 26 patients received surgery using microscopic decompression with tubular retractors. There were no patients who had serious complications such as infection or nerve root injury in either of the groups. The average estimated blood loss was 205 cc for the open microscopic decompression group versus 120 cc in the minimally invasive microscopic decompression (MIMD) group (p=0.019). The mean operating time was 2.5 hours in the open microscopic decompression group and 2.2 hours in the MIMD group (p=0.048). As shown by the clinical results, good or excellent results were shown by the McNab's criteria after operation, 85.1% for the open microscopic decompression group and 94.7% for the MIMD group, respectively. The JOA score improved after surgery, with average scores of 14.5 to 24.5 in the open microscopic decompression group, and 15.9 to 25.6 in the MIMD group. The VAS score was reduced after surgery, with an average score of 8.0 to 3.7 in the open microscopic decompression group, and 8.3 to 2.6 in the MIMD group. CONCLUSION: In terms of blood loss, the MIMD group showed significantly better results than the open microscopic decompression group. The clinical results showed no statistically significant difference between the two groups.

A Case of Common Variable Immunodeficiency with Autoimmune Hemolytic Anemia

Common variable immunodeficiency (CVID) is a heterogeneous collection of disorders with hypogammaglobulinemia with recurrent bacterial infections and high incidence of autoimmune disorders as its hallmark. We report a 7-year-old girl suffering from CVID with Coombs' test positive hemolytic anemia. She had been relatively well until 23-months old when she was admitted to Taejon St. Mary's Hospital with pneumonia 5 years ago. Afterwards, she had suffered from recurrent otitis media, paranasal sinusitis, bronchitis and pneumonia, experiencing 13 admissions. She was diagnosed as autoimmune hemolytic anemia at 4-years old and had been treated with prednisolone. Laboratory finidings showed hypogammaglobulinemia(gamma-globulin in immunoelectrophoresis 0.04g/dL, IgG 170mg/dL, IgA 31mg/dL, IgM 27.5mg/dL) which was previously within normal limits checked at the age of 3- and 5-years old. Isohemmagglutinins (Anti-A,-B IgM and IgG) and anti-measles IgG, anti-mumps IgG, anti-rubella IgG and anti-HBs antibody along with PPD skin test were all negative. Peripheral lymphocyte subsets revealed as follows : pan T cells (CD3+) 48.6% (normal values : 60-85%), pan B cells (CD19+) 36.7% (8-20%), CD4+ T cells 24.4% (28+/-8%), CD8+ T cells 15.3% (5+/-10%), and CD4/CD8 ratio of 1.6 (0.6-2.8). Proliferations of peripheral blood mononuclear cells induced by various T cell stimulants were all markedly depressed. Chronic paranasal sinusitis and lung parenchymal damages were revealed on computerized tomography and lung scan, and a monthly intravenous immunoglobulin therapy was started.

Clinical Study of Recurrent Parotitis in Children

PURPOSE: Recurrent parotitis is defined as a recurrent parotid inflammation, generally associated with sialectasis of the parotid gland. It can often be misdiagnosed as recurrent mumps. We studied the clinical and laboratory features of recurrent parotitis. METHODS: Outpatient clinical records of 23 cases were analyzed retrospectively between April 1993 and March 1999. Follow-up after the last outpatient clinic visit was carried out by telephone interview. RESULTS: Mean age of onset was 3.7+/-2.1 yr with 16 cases (69.6%) of 2-4 yr being predominant. Males (56.5%) were affected more than females. Mean number of recurrence per year for patients who recurred more than 3 times was 1.8/yr. Most parotid swellings subsided within 3-7 days. Laboratory findings at first visits were as follows:WBC 14,100+/-7,660/mm3 (neutrophil 56.6+/-18.9%, lymphocyte 35.5+/-17.6%), ESR 19.3+/-7.6mm/hr in males and 24.7+/-6.8 mm/hr in females and amylase 407.4+/-391.8IU/L. An eosinophil count over 250/mm3 was found in 6 out of 23 cases and IgE levels over 150IU/ml was found in 3 out of 14 cases. Anti-mumps IgG was positive in 10 out of 16 cases but anti-mumps IgM was all negative. CONCLUSION: Recurrent parotitis is not uncommon in childhood. Careful history taking and follow-up observation are important for the diagnosis of recurrent parotitis. The clinicians should reassure patients and their parents of the benign disease process.

A Case of Acute Renal Failure Following Intravenous Immunoglobulin Therapy in a Child

Intravenous immunoglobulin (IVIG) therapy is associated with a number of complications, including rare acute renal failure (ARF). Although the cause of IVIG-associated ARF is unknown, it may be related to the stabilizing agent used in IVIG preparations. ARF following IVIG infusion has not been previously described in children. We report a 4-year-old girl with Kawasaki disease who suffered from ARF following IVIG containing maltose. The previously healthy child had no underlying renal disease. She was given a 2g/kg body weight of IVIG (I.V.-Globulin S, Green Cross, IgG:maltose=1:2) for 10 hours. From the second day of IVIG administration, a gradual reduction of daily urine output was observed with an increase of BUN and creatinine levels, which by the fourth day of treatment reached 43.8mg/dL and 4.7mg/dL, respectively. A conservative ARF treatment resulted in a gradual increase in urine output, together with a decrease in BUN and creatinine levels, which after 7 days returned to normal levels. In view of the increasing use of IVIG in medicine, it is imperative that clinicians be aware of this unusual form of renal injury.

Clinical Analysis and Comparison of Kawasaki Disease between Patients Younger than One Year of Age and Those over One Year of Age

PURPOSE: To identify the risk factors for coronary sequelae in Kawasaki disease, we analyzed and compared the clinical features and laboratory findings of Kawasaki disease in patients younger than one year of age with those over one year of age. METHODS: A retrospective chart review was conducted of all children with Kawasaki disease who were admitted to the Catholic University Taejon St. Mary's hospital between March 1992 and December 1997. RESULTS: Of 162 patients with Kawasaki disease, 36 patients(22.2%) were less than one year of age and four(11.1%) of them had coronary artery aneurysms. On the other hand, 126 patients (77.8%) were above 12 months and 15(11.9%) of them developed coronary artery aneurysms. The Kawasaki criteria signs were not significantly prominent(P<0.05) and maximal platelet count was higher in the infant group(P<0.05) but other clinical and laboratory findings were not different between the two groups. Comparative studies revealed that maximal platelet count was higher (P<0.05), and total duration of fever was significantly longer in the patients with coronary aneurysms(19 cases, P<0.001) than those without coronary aneurysms(143 cases). CONCLUSION: We cannot find any significant clinical and laboratory differences including coronary artery involvement in Kawasaki disease between less than one year of age and over one year. The age of onset seems not to be a predictor for the risk of coronary aneurysm. The principal signs of Kawasaki disease can be less prominent in infant. For this reason, early diagnosis utilizing laboratory findings are important, especially in the course of illness with prolonged fever.

Clinicopathologic and Epidemiologic Study of Childhood Nephrotic Syndrome in Daejeon

Cytologic findings from five cases with variable types of Hodgkin's disease were reviewed with special emphasis on the Reed-Sternberg (R-S) cells and their variants, Typical R-S and Hodgkin's cells were mono- or binucleated, and nuclei had rounded smooth con- tour. Acidophilic prominent nucleoli with perinucleolar halo were conspicuous. In comparison to typical Reed-Sternberg cells, L & H (lymphocytic and histiocytic) cells in the lymphocyte predominant type tended to show pop-corn like irregular nuclear contour and to lack the prominent nucleoli. Lacunar cells in the nodular sclerosis type had multilobated nuclei with prominent acidophilic nucleoli. There was no prominent perinucleolar halo in L & H and lacunar cells. In conjuction with the number of Reed-Sternberg cells and back ground findings observed on the smears, the characteristic features of R-S cells and their variants allowed to make typing of Hodgkin's disease.

A Case of Kawasaki Disease Diagnosed with the Assistance of Ophthalmologic Examination

Kawasaki disease is a systemic vasculitis in which bilateral nonexudative conjunctivitis and anterior uveitis are common early findings in the course of illness. We report an eleven-year-old boy with atypical Kawasaki disease who was diagnosed with the help of an ophthalmologic examination. The patient presented with fever, epigastric pain with vomiting, erythematous rash, and severe bilateral conjunctival injection, a red throat without strawberry tongue and scarletiniform rash on the chest and back. Cervical lymphadenopathy and changes in the extremities were not shown. Slit lamp biomicroscopic examination three days after admission revealed bilateral bulbar conjuctival injection, superficial punctate erosions, and aquous humor inflammatory reaction(3+/4+ cells and 2+/4+ flare), a manifestation of anterior uveitis. After receiving two consecutive doses of intravenous immunoglobulin(IVIG, total 2.4g/kg) the boy showed no response. He was subsequently treated with high dose methylprednisolone(14mg/kg) intravenously. Two-dimensional echocardiography 2 weeks after admission showed aneurysmal changes on the proximal parts of the left main coronary artery(4.5mm) and right coronary artery(4.0mm). Slit lamp examination early in the course of the illness can help in the diagnosis of Kawasaki disease.

A Case of Acute Drug-Induced Agranulocytosis Treated with Recombinant Granulocyte Colony-Stimulating Factor(G-CSF)

Drug-induced agranulocytosis is a potentially lethal disorder characterized by selective neutropenia. G-CSF has been utilized for its treatment. We report a case of acute agranulocytosis probably associated with injection of sulpyrine(dipyrone). A three-year old girl was admitted to Taejon St. Mary's Hospital following five days of fever and two days of chills and prostration. During this period, she had been treated at local clinics with oral acetaminophen, ibuprofen, and miokamycin. Two days before admission, she was administered an intramuscular injection of dipyrone as antipyretics. She had a past history of previous sensitization of dipyrone. CBC revealed profound netropenia(total WBC 900/mm3, with 1% neutrophils, 88% lymphocytes, 10% atypical lymphocytes, 1% monocytes), but normal RBC and platelet count. Bone marrow examination showed hypocellularity(20%), decreased myeloid precusors, and M:E ratio of 1 : 2.5. The girl received subcutaneous G-CSF once daily for 3 days. G-CSF therapy resulted in a steep increase of neutrophil count, which was faster than the spontaneous recovery reported in the literature. G-CSF may be considered useful in the management of drug-induced agranulocytosis.

A Case of Acute Drug-Induced Agranulocytosis Treated with Recombinant Granulocyte Colony-Stimulating Factor(G-CSF)

Drug-induced agranulocytosis is a potentially lethal disorder characterized by selective neutropenia. G-CSF has been utilized for its treatment. We report a case of acute agranulocytosis probably associated with injection of sulpyrine(dipyrone). A three-year old girl was admitted to Taejon St. Mary's Hospital following five days of fever and two days of chills and prostration. During this period, she had been treated at local clinics with oral acetaminophen, ibuprofen, and miokamycin. Two days before admission, she was administered an intramuscular injection of dipyrone as antipyretics. She had a past history of previous sensitization of dipyrone. CBC revealed profound netropenia(total WBC 900/mm3, with 1% neutrophils, 88% lymphocytes, 10% atypical lymphocytes, 1% monocytes), but normal RBC and platelet count. Bone marrow examination showed hypocellularity(20%), decreased myeloid precusors, and M:E ratio of 1 : 2.5. The girl received subcutaneous G-CSF once daily for 3 days. G-CSF therapy resulted in a steep increase of neutrophil count, which was faster than the spontaneous recovery reported in the literature. G-CSF may be considered useful in the management of drug-induced agranulocytosis.

A Case of Guillain-Barr Syndrome Coinciding with Bronchial Asthma associated with Mycoplasma Pneumonia

Mycoplasma pneumoniae is the most common etiologic agent of pneumonia in school-aged children and young adults. It involves not only the respiratory system but includes extrapulmonary complications such as exanthem, hemolysis, arthritis, hepatic dysfuction, cardiac disease, and central nervous system disease. The pathogenesis of extrapulmonary involvements may be an autoimmune phenomena. Recent studies suggest that bronchial asthma can be initiated by Mycoplasma pneumoniae infection. We experienced a five-year-old girl suffering simultaneously from Guillain-Barr syndrome and initial bronchial asthmatic attack after mycoplasma pneumonia. She was admitted with lower-leg pain and weakness for three days. Ten days before admission, she was coughing and showed on a chest X-ray, pneumonic infitrations of both subhilar peribronchial areas. The titers of anti-mycoplasma antibody and cold hemagglutinin were 1:80 and 1:32, respectively. With a progression of paralysis to the upper extremities, she showed dyspnea, dysphagia and right facial palsy on the second hospital day. We performed a tracheostomy and started artificial ventilation. Unexpectedly, she showed continuous dyspnea, poor lung aeration and revealed severe hypoxemia in serial arterial gas analysis. Intravenous theophylline, high-dose corticosteroid and intravenous immunoglobulin therapy resulted in a progressive improvement of lung condition. She recovered completely from neurologic and pulmonic complications after five weeks.

A Case of Bronchial Foreign Body in a Premature Neonate Removed by Non-bronchoscopic Method

We report a premature neonate who suffered from bronchial foreign body. The neonate was delivered at 34 weeks of gestational age, 1,850 g of birth weight, through Cesarean section. After birth the baby showed respiratory distress and received surfactant therapy on the first hospital day. After extubation on the 10th hospital day, the baby experienced 2 episodes of pneumonia in the right upper lung field. On the 27th day after birth, a chest X-ray revealed a feeding tube-shaped foreign body which was located from right main bronchus to trachea, about 4.5 cm long and 2.0 mm wide. The patient was too small to remove the foreign body by even the smallest-diametered fibroptic bronchoscopy. We rotated the baby to a nearly 90 degree head-down position and percussed on the back. After confirming the movement of foreign body in to the trachea, we intubated 3.0 Fr. endotracheal tube under fluoroscopic observation. We found that a tip of foreign body was inserted into the ET tube innerside. We sucked out the foreign body by mechanical suction with central-holed rubber suction tip. Forced expiration with cough reflex and intubation with mechanical suction allowed for the successful removal of the foreign body.

A Study on the Serum Triglyceride Values in Children

The concentration of serum triglyceride values were studied at department of pediatrics, Chungnam National University Hospital. With the total 742 cases, among them 462 boys and 280 girls who were at the age of 2 months through 15 years old. Serum triglycerde values were measured to determine the distribution of values and evaluated on the basis of sex, age, height and weight percentile. The following results were obtained: 1) The mean value of the serum triglycerides were 88.11+/-35.76 mg/dl in boys and 94.82+/-34.56 mg/dl in girls. 2) In distribution of trglyceride level by percentile, the value of 90th percentile was 136 mg/dl. 3) The values of the serum triglyceride from 6 to 11 year old age group were significant low values in boys and girls.

Prognostic significance of initial blood glucose level in near-drowning / 대한소아신경학회지

No abstract available.