Pediatric Hip Disease (II): Developmental Dysplasia of the Hip – Treatment of Residual Dysplasia / 대한정형외과학회잡지

Residual dysplasia is common in spite of early treatment of developmental dysplasia of the hip and often requires a harness or femoral/ acetabular surgery. Operative treatment is roughly divided into two categories: reconstructive and salvage; but the reconstruction such as re-directional osteotomy of the acetabulum should always be considered first. Operative treatment consists of osteotomy on femur or acetabulum, or both. Before the surgery, thorough evaluation of the patient is necessary to select appropriate operation. Avascular necrosis is one of the most catastrophic complications, which is often seen in delayed diagnosis or surgically treated patients.

Corrigendum: Long-Term Results of Surgical Treatment for the Idiopathic Clubfoot / 대한정형외과학회잡지

In the article, the name of one of the authors was incorrectly presented: Yoon Je Cho should read Yoon Jae Cho.

Major Limb Replantation of Lower Leg Amputation with Ipsilateral Distal Femoral Comminuted Fracture in Old Age: A Case Report

The development of microsurgical techniques has also increased the success rate of replantation surgery. This paper reports the results of limb replantation performed on a lower extremity amputation that was associated with crush amputation and an ipsilateral comminuted fracture in and elderly patient. A 68-year-old female presented with a right distal tibia amputation due to a traffic accident. At that time, with a comminuted fracture in the distal femoral condyle, simple wound repair was recommended, but the caregivers strongly wanted replantation. Three years after surgery, normal walking was possible without a cane and the patient was satisfied with the function and aesthetics. What used to be contraindicated in limb replantation in the past are now indications due to the development of microsurgical techniques, surgical experience, and postoperative rehabilitation treatment. If the patient is willing to be treated, good results in contraindications can be obtained.

A Randomized, Placebo-Controlled, Double-Blind, Multi-Center Therapeutic Confirmatory Study to Evaluate the Safety and Efficacy of Avanafil in Korean Patients with Erectile Dysfunction

A multi-center, randomized, double-blind, placebo-controlled study was conducted with 158 subjects who were randomized to placebo or avanafil 50, 100, and 200 mg on demand for 8 weeks to evaluate the safety, tolerability, and efficacy of avanafil in the treatment of erectile dysfunction (ED) in Korean men. The primary outcome was the erectile function (EF) domain score of the International Index of Erectile Function (IIEF) questionnaire. Secondary outcomes included changes in the scores of IIEF questions 3 and 4 (IIEF Q3, Q4) from baseline, changes in all domain scores in the IIEF from baseline, Sexual Encounter Profile questions 2–5 (SEP2–5), the Global Efficacy Assessment Question (GEAQ), and the number of subjects whose EF domain score at the 8th week visit was ≥ 26. After 8 weeks of treatment, the dose groups except avanafil 50 mg scored significantly higher on the IIEF-EF domain from baseline than the placebo group. The changes from baseline in the avanafil group in IIEF Q3 (all doses) and Q4 (200 mg alone) were higher than the placebo group. The differences between avanafil and placebo groups were significant in SEP2 (100 and 200 mg) and SEP3–5 (200 mg). The differences in the GEAQ “Yes” response were also significant in the avanafil 100 and 200 mg groups. Regarding the ratio of normal EF at the end of the study, avanafil 200 mg differed significantly from the placebo. Most treatment-associated adverse events were mild and resolved spontaneously. This is a clinical trial study and was registered at www.ClinicalTrials.gov (Identifier: NCT02477436).

Differences between the Upper Extremity and the Lower Extremity in Reconstruction Using an Anterolateral Thigh Perforator Flap

BACKGROUND: While reconstruction of soft tissue defects is the common purpose, surgical reconstructions of upper extremities and lower extremities have different goals in terms of functional and aesthetic outcomes. The purpose of the current study was to compare and analyze differences between reconstructions of upper extremities and lower extremities using an anterolateral thigh (ALT) flap. METHODS: We analyzed 74 patients who underwent reconstructions of upper extremities and lower extremities using an ALT flap from October 2006 to August 2012 (upper extremities, 45 cases; lower extremities, 29 cases). The study focused on the statistical analysis of patient satisfaction according to the donor site of the ALT flap and the timing of a debulking procedure. RESULTS: On the choice of donor site, in the upper extremity reconstruction, flap elevation from the opposite side of the recipient limb was preferred (p = 0.019) because it causes less inconvenience while walking. In the lower extremity reconstruction, flap elevation from the same side of the recipient limb (p = 0.002) was preferred. The debulking procedure performed on the upper extremities at 4 weeks after reconstruction led to better functional results and enhanced patient satisfaction (p = 0.022). In the case of lower extremities, enhanced satisfaction was noted in patients who underwent the procedure at 6 months after reconstruction (p < 0.001). CONCLUSIONS: Elevation of the flap in reconstruction reduced inconvenience when performed on the same side of the recipient limb for lower extremities and on the opposite side for upper extremities. In addition, debulking resulted in better satisfaction when performed 4 weeks postoperatively in the upper extremities and 6 months postoperatively in the lower extremities.

Analysis of Radiographic Parameters of the Forearm in Traumatic Radial Head Dislocation

BACKGROUND: Various deformities can occur in the forearm bones when the traumatically dislocated radial head is untreated for a long period. Without correction of all deformities, reduction of the dislocated radial head is difficult to maintain, and forearm and elbow motion will deteriorate after reduction. We evaluated radiographic parameters of forearms with traumatically dislocated radial heads (and of the normal sides) to understand the resulting deformities and the effectiveness of surgical treatment. METHODS: We analyzed pre- and postoperative anteroposterior and lateral radiographs of 22 forearms (22 patients) with traumatic radial head dislocation. We divided the forearm into three equal parts and measured various morphological parameters. All patients underwent surgical treatment and evaluation of radial head reduction and range of motion pre- and postoperatively. RESULTS: Before treatment, the middle of the ulna was significantly different from the unaffected side in both anteroposterior and lateral views. After surgery, the proximal ulna was significantly different from the unaffected side and the abnormal proximal radial neck angle persisted. The radial head was successfully reduced in 20 of 22 cases. Overall, the mean range of motion decreased after surgery, except for increased flexion-extension. CONCLUSIONS: Complicated deformities developing during long-term remodeling after injury indicate that stable reduction is difficult to achieve with conventional one-bone osteotomy. Even after successful reduction, secondary deformity in the proximal ulna and/or remaining deformity in the proximal radius can hinder forearm rotation.

The Effect of 1-Propanol on the Rotational Mobility of n-(9-Anthroyloxy) stearic acid in Outer Monolayers of Neuronal and Model Membranes

The aim of this study was to provide a basis for the molecular mechanism underlying the pharmacological action of ethanol. We studied the effects of 1-propanol on the location of n-(9-anthroyloxy)palmitic acid or stearic acid (n-AS) within the phospholipids of synaptosomal plasma membrane vesicles (SPMV). The SPMV were isolated from the bovine cerebral cortex and liposomes of total lipids (SPMVTL) and phospholipids (SPMVPL). 1-Propanol increased the rotational mobility of inner hydrocarbons, while decreasing the mobility of membrane interface, in native and model membranes. The degree of rotational mobility varied with the number of carbon atoms at positions 16, 12, 9, 6 and 2 in the aliphatic chain of phospholipids in the neuronal and model membranes. The sensitivity of increasing or decreasing rotational mobility of hydrocarbon interior or surface by 1-propanol varied with the neuronal and model membranes in the following order: SPMV, SPMVPL and SPMVTL.

Conservative Treatment for Juvenile Osteochondritis Dissecans of the Talus / 대한정형외과학회잡지

PURPOSE: We compared the results between conservative and surgical treatment methods in a group of children and adolescents with osteochondritis dissecans of the talus. MATERIALS AND METHODS: A total of 24 patients (31 ankles), who were younger than 18 years old, were included in this study. Group 1 consisted of 14 ankles (mean age at the time of treatment was 13.0 years) treated conservatively. Group 2 consisted 17 ankles (mean age at the time of treatment was 15.1 years) treated surgically. According to the Berndt and Harty classification, there were 6 ankles in class I, 4 in class II, 3 in class III, and 1 in class IV in group 1; 1 ankle in class I, 9 in class II, and 7 in class III in group 2. In group 1, there were 13 medial lesions and 1 lateral lesion; and in group 2, there were 14 medial lesions and 3 lateral lesions. The mean follow-up period was 31.9 months for group 1 and 28.9 months for group 2. Clinical and radiologic results were analyzed using the American Orthopaedic Foot and Ankle Society (AOFAS) score and the classification by Higuera et al. RESULTS: The mean AOFAS clinical score was 91.4 in group 1 and 87.5 in group 2. According to the classification by Higuera et al., regarding clinical results, there were 6 excellent, 7 good, and 1 fair in group 1, and 5 excellent, 2 good, and 10 fair in group 2. As for radiological results, there were 13 good and 1 fair in group 1, and 10 good and 7 fair in group 2. There was no statistical difference between the two groups. CONCLUSION: Conservative treatment provided satisfactory results for osteochondritis dissecans of the talus in children and adolescents.

Therapeutic Approach to Humeral Pathologic Fracture Caused by Benign Bone Tumor / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to suggest an appropriate therapeutic approach by making a comparison between conservative therapy and surgical therapy for a pathologic fractures of the humerus caused by benign bone tumor. MATERIALS AND METHODS: We selected 15 cases with a pathologic fracture of the humerus caused by benign bone tumor from January 2000 to April 2014 to evaluate the fracture union period and remission of primary bone tumor. Eight cases were treated with conservative therapy, and 7 cases by surgical therapy. The mean age was 13.1 years, and the age range was between 1 year and 19 years; there were 8 male cases and 7 female cases. The mean follow-up period was 24.9 months, with a range from 4 months to 72 months. We evaluated the remission of primary benign tumor in accordance with the ‘Modified Neer classification’ system. RESULTS: There was no statistically significant difference in age, sex, and mean follow-up period between the two groups. The pathologic fracture was united in all cases without secondary displacement. There was no statistically significant difference in the fracture union period (p=0.164) and remission of primary benign tumor (p=0.931) between the two groups. CONCLUSION: We suggest that both conservative and surgical therapies can be a treatment for pathologic fracture of the humerus caused by benign bone tumor.

The Change in Distribution of Red Blood Cell Antigens in Korean Youth: In an Era of Multicultural Society / 대한수혈학회지

BACKGROUND: It is important to check the blood group antigens to ensure the safety of blood transfusions. Recently, the number of multicultural families and foreigners has increased in Korea; therefore, a survey for red blood cell antigens for multicultural families is need. We performed a phenotyping of their red blood cell antigens and found the characteristics in providing basic data. METHODS: We recruited young people under the age of 26 years from multicultural family between September 2015 and March 2016. The participants were divided into two groups: the multicultural youth group (MCY) and the non-multicultural youth group (non-MCY). Subjects underwent phenotyping of ABO, Rh, Kell, Kidd, Duffy, MNS, and Diego blood group, and the results were compared and characterized between the two groups. RESULTS: A total of 226 subjects (89 MCY, 137 non-MCY) were recruited. The blood groups with differences between MCY and non-MCY were E, e in Rh and S in MNS. In MCY, the frequency of CDe expression in the Rh blood group was higher and the cDE expression was lower. There were 3.4% and 2.2% of MCY with no expression of Fy(a) and s, respectively, which were rare blood types in Koreans. CONCLUSION: The difference in frequency of red blood cell antigens between MCY and non-MCY have been identified. These results suggest that the national blood policy reflects an increasing number of multicultural families and Korea needs to be prepared for a population change.

Results of Surgical Treatment for Congenital Vertical Talus / 대한정형외과학회잡지

PURPOSE: We performed clinical and radiological evaluation of surgical outcomes of congenital vertical talus. MATERIALS AND METHODS: Fifteen surgically treated feet in 9 patients (6 bilateral and 3 unilateral) which were followed-up for at least 2 years were included. Mean patient age at the time of surgery was 10.9 months. The surgical technique was a one-stage correction using the Kumar technique with a Cincinnati skin incision. In 7 feet we also transferred half of the tibialis anterior to the talar neck (the Grice technique). Radiologic parameters (talo-calcaneal angle, talo-first metatarsal angle, tibio-talar angle, tibio-calcaneal angle) were analyzed pre- and postoperatively and at the last follow-up, and clinical outcomes by the Laaveg-Ponseti score. RESULTS: Talus orientation was improved in all patients. All radiologic parameters showed statistically significant improvement by the last follow-up. The mean Laaveg-Ponseti score at the last follow-up was 16 for patient satisfaction, 16 for function, and 24 for pain. There was no recurrence, however one case of talar neck fracture occurred during the tibialis anterior transfer. CONCLUSION: One-stage surgical correction for congenital vertical talus at an early age provides satisfactory functional and cosmetic results.

Development and Verification of Nested PCR Assay for Detection of Tobacco rattle virus in Plant Quarantine

Tobacco rattle virus (TRV) is a plant pathogen belonging to the Group IV positive-sense single-stranded RNA viruses. TRV causes disease in various plants (e.g., potato, tomato and tobacco), for which it was classified as a controlled quarantine virus in Korea. This study aimed to develop specific primer sets for the rapid detection of TRV. Two RT-PCR primer sets were developed for specific detection of TRV. Furthermore, nested primer sets were also developed, which is required for high sensitivity detection in plant quarantine. The RT-PCR and nested PCR products had the following sizes: set 5 (1,096-->540 bp), and set 7 (878-->756 bp), respectively. In addition, a modified positive-control plasmid was also developed for use as a positive control in TRV quarantine. The diagnostic system for TRV detection was verified using samples from Korean quarantine sites for the last five years (2009-2014). A total of 83 cases were detected among various import crops. This system for detection of TRV will continuously contribute to plant quarantine in the future.

Surgical Treatment of Congenital Hypoplasia of the Thumb / 대한정형외과학회잡지

PURPOSE: We evaluated the results and complications of surgical treatment for congenital thumb abnormalities. MATERIALS AND METHODS: Between 2002 and 2011, nine thumbs were surgically treated (Pusan National University Hospital, Busan, Korea). There were five males and four females. The mean age of patients at the time of operation was 4.7 years (seven patients were under five years old and two patients were over 10). Five cases of Blauth type V hypoplasia (aplasia) were treated by pollicization (using the Buck-Gramcko technique). Four cases of type I or II hypoplasia were treated by opponensplasty and tendon transfer (for extensor and abductor augmentation). The Mehta scoring system was used for analysis of outcomes. RESULTS: Among nine cases, outcomes were good in five cases, fair in three cases, and poor in one case. Second operations were required due to muscle weakness and metacarpo-phalangeal joint subluxation in three cases of aplasia and one case of hypoplasia. In all cases, the range of active abduction of the thumb was more than 40degrees and pinch power was at least 40% of that on the normal side at the latest follow up. CONCLUSION: Surgical reconstruction using pollicization and opponensplasty for congenital thumb aplasia and hypoplasia, with additional surgery for muscle weakness, provided good results both functionally and cosmetically.

Phylogeny of Flavobacteria Group Isolated from Freshwater Using Multilocus Sequencing Analysis

Sequence analysis of the 16S rRNA gene has been widely used for the classification of microorganisms. However, we have been unable to clearly identify five Flavobacterium species isolated from a freshwater by using the gene as a single marker, because the evolutionary history is incomplete and the pace of DNA substitutions is relatively rapid in the bacteria. In this study, we tried to classify Flavobacterium species through multilocus sequence analysis (MLSA), which is a practical and reliable technique for the identification or classification of bacteria. The five Flavobacterium species isolated from freshwater and 37 other strains were classified based on six housekeeping genes: gyrB, dnaK, tuf, murG, atpA, and glyA. The genes were amplified by PCR and subjected to DNA sequencing. Based on the combined DNA sequence (4,412 bp) of the six housekeeping genes, we analyzed the phylogenetic relationship among the Flavobacterium species. The results indicated that MLSA, based on the six housekeeping genes, is a trustworthy method for the identification of closely related Flavobacterium species.

New Bone Formation Following Transplantation of Stem Cells and Nanoscale Hydroxyapatite Scaffold Materials into Rabbit Long Bone Defects / 대한정형외과학회잡지

PURPOSE: We observed new bone formation following the transplantation of allogenic periosteum-derived stem cells and different sizes of hydroxyapatite (HA) scaffold materials into rabbit long-bone defects. MATERIALS AND METHODS: Thirty-two white rabbits were grouped according to the material transplanted into their tibial bone defects: group 1 (microscale HA only); group 2 (nanoscale HA only); group 3 (microscale HA plus stem cells); and group 4 (nanoscale HA plus stem cells). Viscosity was controlled by the relative amounts of HA and agar. After surgery, radiologic, microscopic, and biochemical observations were performed weekly for 8 weeks. RESULTS: Nanoscale HA (groups 2 and 4) provided better bone formation than microscale HA (groups 1 and 3). The rabbits that had been transplanted with nanoscale HA plus stem cells (group 4) had more homogeneous bone formation during the natural repair process than the other groups. CONCLUSION: Further study is required using nanoscale HA plus organic substance and stem cells, which are more similar to human bone structure, for better bone formation.

Comparison of the Mobile-bearing and Fixed-bearing Designs for High Flexion Total Knee Arthroplasty

PURPOSE: We compared and analyzed the follow-up results of high flexion total knee arthroplasty (TKA) with using the mobile-bearing and fixed-bearing designs. MATERIALS AND METHODS: We studied 130 patients who had undergone high-flexion TKA from December 2003 to December 2007 and who were followed up for at least 2 years. Of all the 130 patients, 65 patients had undergone TKA using a mobile-bearing design, and the other 65 patients had undergone TKA using the fixed-bearing design. RESULTS: The post-operative Knee Society Knee Score (KSKS) and Knee Society Functional Score (KSFS) of the mobile-bearing group were 95.6 and 96.1 points, which were 53.2 and 49.7 points, respectively, preoperatively, and the post-operative KSKS and KSFS of the fixed-bearing group were 94.5 and 95.1 points, which were 54.1 and 50.9 points, respectively, preoperatively. The range of motion (ROM) and maximal flexion angle (MFA) of the knee joints of the mobile-bearing group were 129.1degrees and 131.4degrees, which were 122.3degrees and 125.8degrees, respectively, preoperatively, and those of the fixed-bearing group were 128.3degrees and 129.3degrees, which were 122.2degrees and 123.9degrees, respectively, preoperatively. There were no significant differences between the two groups. Crossed-legged sitting and attaining a kneeling position also showed no significant differences between the two groups, but the mobile-bearing group could easily take a crossed-legged sitting position. CONCLUSION: The clinical parameters and the ROM and MFA of the knee joint showed no significant differences between both groups, but the mobile-bearing group felt more comfortable in the crossed-legged sitting position.

The Efficacy and Safety of Tamsulosin 0.2mg/day on Sexual Function in BPH: A Multicenter Open-label, Non-comparative, 3 Months Observational, Phase IV Prospective Study / 대한남성과학회지

PURPOSE: The aim of this study was to assess the efficacy and safety of tamsulosin, 0.2mg/day on sexual function in Korean BPH patients. Patients and Methods: 116 patients (mean age: 60 yrs) with BPH were enrolled in this study and 0.2mg of tamsulosin was administrated every night for 3 months. Primary efficacy was evaluated with changes of IIEF and GEQ. Secondary efficacy parameters were changes of IPSS and QoL, uroflowmetry, changes of total IIEF and IIEF domain score according to the severity of IPSS, and retrograde ejaculation. RESULTS: Before treatment, patients of moderate IPSS (8-19) and severe IPSS (20-35) were 56% and 44% and QoL3 were 33.6% and 66.4%. In primary efficacy evaluation, total IIEF score was significantly increased from 37.0+/- 18.2 to 40.5+/- 18.9 (p<0.01). All domains of IIEF except orgasmic function were significantly improved. GEQ showed improvement of erection in 34.4% and intercourse ability in 30.1%. In secondary efficacy evaluation, IPSS was significantly decreased from 18.4+/- 6.9 to 12.9+/- 6.7 (p<0.01) and QoL was significantly improved from 3.8+/- 1.1 to 2.7+/- 1.4 (p<0.01). Qmax significantly increased from 14.2+/- 8.3 to 16.5+/- 11.3 ml/sec (p<0.01). Total IIEF score and EF domain score were significantly improved from 36.8+/- 18.5 to 41.8+/- 19.1 (p<0.01) and from 13.0+/- 7.1 to 14.7+/- 7.9 (p<0.01) in patients of moderate IPSS but no improvement in severe patients. Retrograde ejaculation occurred in 2 patients (2%). No serious adverse reactions were observed. CONCLUSIONS: Tamsulosin, 0.2mg/day was effective and safe dose for the improvement of LUTS and sexual function for Korean BPH/LUTS patients.

Epidemiology of Erectile Dysfunction in one Korean Rural Community / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate the prevalence of erectile dysfunction (ED) in a rural area of Korea and to examine the relationship between the prevalence and correlates of subjects. METHOD: This study was done as a part of the chronic disease survey of rural area by the Asan Foundation. Among 30 years or older population from Jung Eup, a rural area of Korea, 711 male subjects were sampled using a cluster probability sampling method. Trained interviewers visited and interviewed subjects aged 30 years or older with a structured interview. ED was categorized as 'none', 'mild', 'moderate', or 'severe' according to the ability to 'attain and/or maintain an erection satisfactory for sexual intercourse'. Response rate was 54.3% (N=386). RESULTS: The age weighted prevalence of ED was 27.2% (minimal 14.1%, moderate 7.6%, severe 5.5%). Prevalence and severity increased with age. Liver disease and underweight were significantly (p<0.05) associated with ED. Smoking seemed to be correlated with ED, but did not reach statistically significant level. CONCLUSION: ED was highly prevalent in the rural community of Korea. Medical, sociodemographic, and lifestyle variables associated with ED may alert physicians to patients at risk for ED and offer insight to its etiology.

New Definition and Classification of Female Sexual Dysfunction / 대한남성과학회지

No abstract available.

Role of Heat Shock Protein, P70 in Spermatogenic Arrest / 대한비뇨기과학회지

No abstract available.