Hatchet-type Gluteus Maximus Musculocutaneous Flap for Reconstruction of Sacral Pressure Sore

One of the most frequently used flaps for coverage of sacral skin and soft-tissue defects is the gluteus maximus musculocutaneous flap. These authors encountered two cases of sacral pressure sore, for which reconstructive surgery was performed, using the hatchet-shaped gluteus maximus musculocutaneous flap - a modified flap type. We report on our experience in treatment of these two cases, with an excellent outcome.

Acute Traumatic Irreducible Anterior Dislocation and Fracture of the Radial Head in an Adult

Traumatic dislocation of the radial head without fracture of the olecranon is very rare, especially in adults. We experienced a case of irreducible radial head dislocation with fracture without involvement of ulna. Open reduction and internal fixation was performed. During surgery, brachialis was interposed between capitellum and radial head, and also interposed between the fragments at the fracture site of the radial head. At 12 months after operation, the radial head was well reduced with normal rotation.

Osteoid Osteoma of the Capitate with Extensor Tenosynovitis

An osteoid osteoma is a benign bone tumor. It is most commonly found in the femur and tibia but only 5% to 15% occurs in hand. Osteoid osteoma of carpal bone has vague nature of symptoms including spontaneous dull aching causing delayed diagnosis and the late treatment. We had a patient with an osteoid osteoma of the capitate bone presenting with tenosynovitis. We present clinical and radiological findings including magnetic resonance imaging, surgical result, and a review of the current literature.

Diabetic Muscle Infarction in Thigh / 대한정형외과학회잡지

Although ischemia in the distal areas of the limbs due to vascular occlusion is a well recognized systemic condition in patients who have diabetes, infarction of skeletal muscle, not associated with gangrene, is exceedingly rare and the paucity of published cases focused on this condition makes it difficult to determine the most appropriate methods of diagnosis and treatment. The authors encountered a case of diabetic muscle infarction with exquisitely tender swelling on the anteromedial aspect of thigh and herein report the diagnostic work-up and treatment performed on the patient.

Early Surgical Repair of Acute Complete Rupture of the Proximal Hamstring Tendons

Hamstring injuries are common forms of muscle strains in athletes but a complete rupture of a proximal hamstring origin is rare. Often there is a considerable delay in diagnosis and stringent treatment because of its rarity, difficulty in clinical diagnosis, and initial attempts of conservative care. We report two cases of acute complete rupture of the proximal hamstring tendons treated with early surgical repair. The diagnosis and treatment of this unusual injury are discussed.

Lumbar Posterolateral Fusion Using Demineralized Bone Matrix / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To compare the efficacy of demineralized bone matrix as a bone graft extender in lumbar posterolateral fusion with cases using an autogenous iliac bone graft. SUMMARY OF LITERATURE REVIEW: Since demineralized bone grafts were introduced for bone graft extension in 1995, many types of demineralized bone matrices have been used with improved fusion rates. MATERIALS AND METHODS: From October 2004 to December 2005, demineralized bone matrices were used as iliac bone graft extenders in 49 cases (Group I) of lumbar posterolateral fusion, compared with 50 cases receiving autogenous grafts (Group II) similar in age, bone marrow density, and number of fusion levels. Fusion status was graded by the Lenke classification and data was analyzed using a chi-square test through SPSS v.10.0. RESULTS: Group I had Lenke A in 7 cases (14.3%), B in 21 cases (42.9%), C in 15 cases (30.6%), and D in 6 cases (12.2%). Group II had Lenke A in 9 cases (18.0%), B in 26 cases (52.0%), C in 12 cases (24.0%), and D in 3 cases (6.0%). There was no statistical difference in fusion rate. CONCLUSION: Demineralized bone matrix could be used as a bone graft extender in lumbar posterolateral fusion.

Mesenchymal Chondrosarcoma Involving Posterior Bone of C7, T1, T2 and Adjacent Muscles / 대한척추외과학회지

A mesenchymal chondrosarcoma is a rare malignant tumor occurring in both the bone and soft tissues, and has the characteristics of a malignant nature. Since its original description in 1959, several reports of this tumor occurring in the maxilla, mandible, rib and spine have been published. We report a case of a mesenchymal chondrosarcoma that occurred in the posterior part of C7, T1 and T2 and adjacent muscles in a 31-year-old man who was treated with a wide marginal excision.

Lumbar Spinal Stenosis Accompanied by Severe Osteoarthritis of Knee: Comparison between Staged Operations and Same-day Operations / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVE: To compare the peri-operative morbidity of patients who undergo same-day operations for lumbar spinal stenosis accompanied by severe osteoarthritis of knee with those who undergo staged operations . SUMMARY AND LITERATURE REVIEW: There is no report on the peri-operative morbidity of same-day operations for patients who have a concurrent lumbar spinal stenosis and severe osteoarthritis of the knee, even though elective surgery for lumbar spinal stenosis or total knee arthroplasty are safe procedures. MATERIALS AND METHODS: From January 1996 to December 2005, 11 patients who underwent staged operations for lumbar spinal stenosis and concomitant osteoarthritis of the knee (Group I) and 14 patients who underwent total knee arthroplasty and lumbar spinal decompression and fusion on the same-day (Group II) were compared in terms of the operative time, blood loss, perioperative complications and admission days. The data was analyzed statistically using a chi-square test through SPSS v.10.0. RESULTS: The mean surgery time in groups I and II was 266+/-34.4 minutes and 258+/-54.2 minutes, respectively. The estimated blood loss during operation of groups I and II was 1055+/-229.6 and 925+/-174.0. There was no statistical differences between the two groups. There were no life-threatening complications in any group. The admission period for group I and group II were 41.0+/-6.05 days and 30.1+/-5.10 days respectively, but there was no statistical significance. CONCLUSION: There was no difference in the surgical time, estimated blood loss, and complications between the group that underwent the staged operations and the group that underwent same-day operations. A possible surgical option is to perform both procedures on the same day.

Radiolucent Zones Surrounding Transpedicular Screws After Lumbar Spinal Instrumented Fusion / 대한척추외과학회지

STUDY DESIGNS: A retrospective study for radiographic and clinical assessment. OBJECTIVES: To clarify the clinical significance of the radiolucent zones surrounding transpedicular screws that occasionally appears following lumbar spinal instrumented fusion. SUMMARY OF LITERATURE REVIEW: that the formation of radiolucent zones surrounding pedicular screws are significantly frequent after transpedicular fixation. MATERIALS AND METHOD: 88 cases, age 50 or older, which underwent lumbar spinal fusion with transpedicular screws, between January 1999 and December 2002, were included in this investigation. The postoperative radiographs of all patients were analyzed for radiolucent zones around the transpedicular screws. These radiolucent zones were evaluated in relation the number of fusion levels, the existence of osteoporosis, and the fusion status and satisfaction rates. RESULTS: Radiolucent zones were observed in 30 cases (34%, 30/88), 13 (43%, 13/30) of which disappeared during the follow-up period. The average number of fixation levels in the cases with and without radiolucent zones were 2.33 (range 1-4, SD 0.94) and 1.74 (range 1-4, SD 0.82), respectively. Osteoporosis was found to accompany 43.3 and 20.7% of the cases with and without radiolucent zones, with the latter cases showing a statistically significant higher fusion rate and greater patient satisfaction. CONCLUSION: Radiolucent zones, a frequent finding following pedicle screw fixation, resulted in less favorable outcomes. Surgeons should be alert to radiolucent zones and their transformation during follow-up. Methods for improving the stability of the interface between the pedicle screw and vertebral bone will require further research.

External Fixator and External Fixator Supplemented with K-wire in the Treatment of Distal Radius Fractures

PURPOSE: To evaluate the differences of the outcome between external fixator and external fixator supplemented with K-wire in the treatment of distal radius fractures. MATERIALS AND METHODS: Twenty-one cases which underwent external fixation (external fixation group) and 28 cases, external fixation supplemented with K-wire (external fixation with K-wire group), were analyzed. Radial length, radial inclination and volar tilt were compared in preoperative, immediate postoperative radiographs, and radiographs after removal of external fixator between two groups. And functional outcome including flexion, extension, pronation and supination of wrist were compared between two groups and wrist pain, as well. RESULT: Radial length and radial inclination in the postoperative radiographs and radiographs after removal of external fixator showed no difference between two groups, but volar tilt of external fixation group measured 2.1+/-4.2 degrees, 1.3+/-3.8 degrees and external fixation with K-wire group, 8.8+/-2.3 degrees, 8.5+/-2.4 degrees respectively, so that external fixation with K-wire group showed better reduction and maintenance. Wrist flexion and extension about postoperative 6 months measured 25.6+/-8.2 degrees, 25.1+/-10.2 degrees, respectively, in external fixation group and 42.5+/-15.2 degrees, 33.6+/-9.5 degrees in external fixation with K-wire group, so that external fixation with K-wire group showed better functional results. CONCLUSION: In the treatment of distal radius fractures, to obtain better reduction and function result, external fixations supplemented with K-wire need to be taken into consideration.

Laparoscopic Management of Early Primary Abdominal Pregnancy / 대한산부인과학회잡지

Abdominal pregnancy is a very rare case consisting 1% of ectopic pregnancy and occurring once in 372-9714 of normal pregnancies. However, the possibility of massive bleeding which is a main cause of maternal death can lead to the death rate of 5.1 in every 1000 cases and is certainly a difficult subject in proceeding laparoscopic procedures. Here we are reporting with a brief review, an experienced case where an abdominal pregnancy is successfully treated with laparoscopy without massive bleeding or any other complications.

Intraosseous Ganglia of Scaphoid in Hand: Report of 2 Cases / 대한정형외과학회잡지

Ganglia in the wirst are frequent, but intraosseous ganglia of the carpal bone are uncommon. We report upon two patients with intraosseous ganglia that involved the scaphoid bone, review the literature.

Operative Treatment of Diaphyseal Forearm Fracture in Children / 대한정형외과학회잡지

PURPOSE: This article presents a retrospective study of treatment modality for children's diaphyseal forearm fractures. MATERIALS AND METHODS: A total 148 forearm fractures (October. 1997-October. 2001) were examined, of which 19 required operation, a teenager whose growth plate had closed was excluded from the study. 17 patients required intramedullary K-wire fixation, 2 patients required open reduction and plate fixation. Time to radiologic union, complications at the last follow up were evaluated. RESULTS: In 17 intramedullary K-wire fixation patients, the average time to union was 6 weeks and complications including 1 ulnar shortening, 1 pin infection, 1 osteomyelitis, which developed due to a patient's mistake. In 2 plating patients, average union time was 6 weeks with no complications. CONCLUSION: We think that the treatment method of pediatric forearm fracture should be decided upon based on the fracture site and type of fracture. Intramedullary K-wiring for diaphyseal forearm fracture is an effective method and we recommend that the wire is inserted across the physis in cases of diaphyseal fractures of the forearm bone close to the metaphysis. If the diaphyseal forearm fracture is refracture or a bony gap is shown at the fracture site, open reduction and plate fixation is needed. If reduction and fixation of the bone alone in a diaphyseal fracture of both forearm bones restores the stability of other fracture, fixation of the other bone can be avoided.

Predictive Factors for Failure of Methotrexate Treatment of Cervical Pregnancy / 대한산부인과학회잡지

OBJECTIVE: The use of methotrexate for the treatment of cervical pregnancy is now common practice. Our study was performed to determine the risk factors when the primary methotrexate treatment of cervical pregnancy was failed. METHODS: From January 1985 to December 1999, we studied 32 women with cervical pregnancies who were treated with methotrexate intramuscularly according to a repeated intramuscular injections protocol. For evaluation of the efficacy of therapy, pretreatment serum concentrations of human chorionic gonadotropin, the size of the gestational mass, fetal cardiac activity, and the presence of fluid in the peritoneal cavity were measured. This findings were analyzed and compared by means of the chi-square test, Fisher exact test, and student's t-test between the success and failure. RESULTS: There was no relation between the women's age, parity, the size of the conceptus, or the presence of fluid in the peritoneal cavity and the efficacy of treatment. A cervical pregnancy that presented with a serum human chorionic gonadotropin concentration of >or= 10,000mIU/ml, fetal cardiac activity was considered to be associated with a higher failure rate of primary methotrexate treatment. CONCLUSION: Among cervical pregnancies, a high serum human chorionic gonadotropin concentration and fetal cardiac activity were the important factors associated with failure of treatment with methotrexate.

LH-Beta Gene Analysis in Infertility Patients / 대한산부인과학회잡지

No abstract available.

Comparison of Telomerase Activity in Human Chorionic Villi between Eutopic and Ectopic Pregnancies / 대한산부인과학회잡지

No abstract available.

Tranexamic Acid Versus a Placebo in Decreasing Blood Loss in Patients Undergoing Spine Surgery / 대한마취과학회지

BACKGROUND: Major spine surgery can be associated with dramatic blood loss, thereby requiring a high-volume transfusion. Tranexamic acid inhibits fibrinolysis and it has been used in general surgery. The effect of tranexamic acid on blood loss and transfusion requirements during spine surgery was prospectively studied. METHODS: Twenty-two patients scheduled for orthopaedic surgery for spinal stenosis under general anesthesia were randomly selected to receive, either tranexamic acid administered as a bolus of 15 mg/kg, or the equivalent volume of saline, during the operation and postoperatively. The anesthetic and perioperative management were standardized. The total blood loss of each patient and transfusion requirements were noted. Hematocrit, PT, PTT, and platelet count measure were performed before and after surgery. RESULTS: The tranexamic acid group demonstrated a significantly less amount of blood loss (859.5 +/- 280.0 ml) compared to the placebo group (1366.0 +/- 333.7 ml). In addition the fluid and homologous transfusion requirements in the placebo group were greater than in the tranexamic acid group. CONCLSIONS: Tranexamic acid during major spine surgery significantly reduces both blood loss and consequent blood transfusion requirements.

Patellar metastasis from Squamous Cell Carcinoma of the Larynx: A Case Report / 대한정형외과학회잡지

Metastatic tumors of the patella are rare, espicially metastasis of the head and neck carcinoma to the patella is exceedingly rarer still. We experienced a case of patellar metastatic cancer from laryngeal squamous cell carcinoma and report the clinical, radiographic and pathologic findings in detail.

Treatment of Lumbar Spinal Stenosis with Diabetes Mellitus / 대한척추외과학회지

STUDY DESIGN: This retrograde study was designed to compare the clinical features and postoperative clinical results between diabetic and non-diabetic patients who had been performed decompression and arthrodesis with instrumentation. SUMMARY OF LITERATURE REVIEW: There are controversies in the treatment results of diabetic patients. OBJECTIVE: To identify poor results in the patients of lumbar spinal stenosis accompanied diabetes mellitus and to find out variables influencing postoperative results among diabetics. MATERIALS AND METHODS: We analyzed 27 diabetic patients and sex, age-matched 27 non-diabetic patients who were diagnosed as lumbar spinal stenosis and operated from April, 1995 to December, 1998. In all patients, duration of symtoms, sensory and motor deficits, comorbidity, level of operations were investigated and in diabetics, duration of diabetes, amount of insulin administered before operation and presence of diabetic neuropathy were included. Clinical results, postoperative complications were compared between diabetics and non-diabetics. RESULTS: Considerable improvement was reported by 19(71%) in diabetic group and 21(78%) in non-diabetic group. Complication rate such as of infection and delayed wound healing was not higher in diabetic group than non-diabetic group. Duration of diabetes and amount of insulin before operation did not affected the result of operations. CONCLUSION: The outcome of surgery was similary successful in the two groups.

KAL Gene and GnRH Receptor Gene Analysis in Patients with Kallmann's Syndrome / 대한내분비학회지

BACKGROUND: Kallmann's syndrome is related to the defect in migration of olfactory neuron and GnRH neuron from the olfactory placode to the brain and it represents hypogonadism with anosmia or hyposmia. There are 3 modes of transmission in Kallmann's syndrome: X-linked, autosomal recessive and autosomal dominant. X-linked form is the most common. KAL gene is responsible for the X-linked form of Kallmann's syndrome and it had been localized to Xp22.3. The intron-exon organization had been determined and KAL gene mutation had also been identified in familial Kallmann's syndrome and it is very rare and shows heterogeneity. Furthermore, in the sporadic cases, KAL gene mutation is more rare. METHODS: In order to investigate the KAL gene mutation and the regulation of the gene expression in Kallmann's syndrome, we examined genomic DNA of 35 patients with sporadic Kallmann's syndrome. In the exon 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 of KAL gene and 1, 2, 3 of GnRH receptor gene, the mutations were analyzed by PCR-based DNA sequencing. RESULTS: In our study, the mutation of KAL gene and GnRH receptor gene was not identified in the studied exons that were known as preferable sites of the mutation. CONCLUSION: The mutation of KAL gene and GnRH receptor gene is rare, and it might be needed to investigate mutations in other genes or in other part of the KAL gene such as intron or promoter region.