Suspected abdominal compartment syndrome during endoscopic diskectomy: A case report

Abdominal compartment syndrome can produce a critical situation if not diagnosed early and managed properly. We report a case of abdominal compartment syndrome that was caused by massive irrigation of surgical fluid during endoscopic lumbar diskectomy at the L4–L5 level. There was a sudden increase in peak inspiratory pressure during the operation, and the patient's tidal volume and blood pressure decreased. When the patient's position was changed from prone to supine, abdominal distension and cyanosis of both lower extremities were discovered. Ultrasonic findings showed fluid collection in both the chest and intra-abdominal cavity. Thoracentesis and abdominal decompression surgery were performed, and the patient's overall state improved. We concluded that irrigation fluid used during the endoscopic operation leaked into the retroperitoneal space and caused abdominal compartment syndrome.

Hemodynamic response to tracheal intubation and postoperative pharyngeal morbidity using GlideScope®, Lightwand and Macintosh laryngoscopes during remifentanil infusion

BACKGROUND: Use of GlideScope® laryngoscopes and lightwands for tracheal intubation does not require much force. Theoretically, less stimulation can reduce hemodynamic changes during intubation. We investigated the hemodynamic response to tracheal intubation using different laryngoscope types during remifentanil infusion. METHODS: Sixty American Society of Anesthesiologists class I-II patients were compared in terms of tracheal intubation time, hemodynamic changes, and postoperative pharyngeal complications when using a GlideScope®, lightwand, or Macintosh laryngoscope. Propofol and rocuronium were injected and remifentanil was infused for three minutes. Blood pressure and heart rate were measured before and 1, 3, and 5 minutes after tracheal intubation. Patients were assessed for postoperative oral and tracheal bleeding as well as hoarseness, dysphagia, and sore throat. RESULTS: Intubation time was prolonged in the GlideScope® group. All three groups showed a significant decrease in systolic and diastolic blood pressure 1, 3, and 5 minutesafter tracheal intubation. Heart rates increased significantly in all three groups immediately after intubation as well as 1 minute later in the GlideScope® group. However, there were no differences in blood pressure, heart rate, or the occurrence of hoarseness, dysphagia, and sore throat among the three groups. CONCLUSIONS: No differences in hemodynamic change were found among the three different techniques.

Hemodynamic response to tracheal intubation and postoperative pharyngeal morbidity using GlideScope®, Lightwand and Macintosh laryngoscopes during remifentanil infusion

BACKGROUND: Use of GlideScope® laryngoscopes and lightwands for tracheal intubation does not require much force. Theoretically, less stimulation can reduce hemodynamic changes during intubation. We investigated the hemodynamic response to tracheal intubation using different laryngoscope types during remifentanil infusion. METHODS: Sixty American Society of Anesthesiologists class I-II patients were compared in terms of tracheal intubation time, hemodynamic changes, and postoperative pharyngeal complications when using a GlideScope®, lightwand, or Macintosh laryngoscope. Propofol and rocuronium were injected and remifentanil was infused for three minutes. Blood pressure and heart rate were measured before and 1, 3, and 5 minutes after tracheal intubation. Patients were assessed for postoperative oral and tracheal bleeding as well as hoarseness, dysphagia, and sore throat. RESULTS: Intubation time was prolonged in the GlideScope® group. All three groups showed a significant decrease in systolic and diastolic blood pressure 1, 3, and 5 minutesafter tracheal intubation. Heart rates increased significantly in all three groups immediately after intubation as well as 1 minute later in the GlideScope® group. However, there were no differences in blood pressure, heart rate, or the occurrence of hoarseness, dysphagia, and sore throat among the three groups. CONCLUSIONS: No differences in hemodynamic change were found among the three different techniques.

Diagnosis and Treatment of Cavus Foot / 대한족부족관절학회지

The cavus foot is a deformity characterized by an elevated medial longitudinal arch and a hindfoot varus with plantarflexed 1st ray. The etiology of cavus foot is usually related to neuromuscular disease or idiopathic cause. Thorough clinical and radiographic evaluation is required for differentiating etiology of the cavus. Most cases of cavus foot are stable and slowly progressive deformities which can initially be managed with conservative treatment including orthoses and physical therapies. Determining whether the deformity is flexible or rigid, the apex of the deformity and any muscle imbalances in foot and ankle is important for achievement of an adequately balanced plantigrade foot. Treatment should include systematic preoperative planning for selection of appropriate procedures for maintaining a functional and flexible foot with combinations of soft-tissue release, osteotomy, tendon transfer, and arthrodesis.

In Vivo Cartilage Formation Using Human Bone Marrow-Derived Mesenchymal Stem Cells Mixed with Fibrin Glue / 대한정형외과연구학회지

PURPOSE: To investigate the feasibility of in vivo cartilage formation by direct injection the chondrogenic undifferentiated human bone marrow-derived mesenchymal stem cells (hBMSCs) mixed with fibrin glue including TGF-beta3. MATERIALS AND METHODS: Chondrogenic differentiation induced hBMSCs for 14 days (control group-2) and undifferentiated hBMSCs combined with TGF-beta3 mixed (experimental group-3) with fibrin glue and fibrin glue only (control group-1) were injected subcutanteously into the back of nude mouse. For evaluation of the cartilage-like tissue formed after 8 weeks after injection, real time PCR, histological analysis and immunohistochemical analysis were used. RESULTS: Control group-1 did not form any visible mass. Control group-2 as well as experimental group-3 could form new cartilage-like tissue which were demonstrated expression of type II collagen by real-time PCR, histology analysis such as H&E staining, MT staining and type II collagen specific immunohistologic analysis. As results, expression of type II collagen was shown in the both groups. CONCLUSION: Our study confirmed that cartilage-like tissues could be formed in subcutaneous layer of nude mouse by direct injection mixed with fibrin glue including TGF-beta3 without chondrogenic-induction of hBMSCs, suggesting that these model could be suitable for preliminary studies or optimizing experiments to evaluate reconstruction of cartilage.

Redomicrofracture as a Treatment for Osteochondral Lesion of Talus after the Failure of Arthroscopic Microfracture / 대한족부족관절학회지

Arthroscopic treatment has been reported to provide effective improvement of ankle function when used in treatment of small osteochondral lesion of talus; however, favorable long-term results have been less predictable for large osteochondral lesion of talus. In cases in which primary arthroscopic treatment fails, the decision regarding which subsequent technique to choose has become increasingly difficult, as good clinical outcomes may be unlikely for such patients irrespective of the surgical technique used. Redomicrofracture should be used judiciously for treatment of osteochondral lesion of talus in which arthroscopic treatment has failed.

Anti-inflammatory, Antioxidant and Antimicrobial Effects of Artemisinin Extracts from Artemisia annua L

The anti-inflammatory, antioxidant, and antimicrobial properties of artemisinin derived from water, methanol, ethanol, or acetone extracts of Artemisia annua L. were evaluated. All 4 artemisinin-containing extracts had anti-inflammatory effects. Of these, the acetone extract had the greatest inhibitory effect on lipopolysaccharide-induced nitric oxide (NO), prostaglandin E2 (PGE2), and proinflammatory cytokine (IL-1beta , IL-6, and IL-10) production. Antioxidant activity evaluations revealed that the ethanol extract had the highest free radical scavenging activity, (91.0+/-3.2%), similar to alpha-tocopherol (99.9%). The extracts had antimicrobial activity against the periodontopathic microorganisms Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum subsp. animalis, Fusobacterium nucleatum subsp. polymorphum, and Prevotella intermedia. This study shows that Artemisia annua L. extracts contain anti-inflammatory, antioxidant, and antimicrobial substances and should be considered for use in pharmaceutical products for the treatment of dental diseases.

The Effect of Polyphenols Isolated from Cynanchi wilfordii Radix with Anti-inflammatory, Antioxidant, and Anti-bacterial Activity

Recently, Cynanchi wilfordii Radix has gained wide use in Asian countries as a functional food effective for relieving fatigue, osteoporosis, and constipation, particularly in menopausal disorders. However, its anti-inflammatory and anti-microbial activities have not been explored in detail to date. The anti-inflammatory, antioxidant, and anti-bacterial properties of the Cynanchi wilfordii Radix extracts obtained with water, methanol, ethanol, and acetone were compared. All 4 polyphenol-containing extracts exhibited anti-inflammatory and antioxidant effects. The ethanol extract was found to elicit the most potent reduction of nitric oxide (NO), prostaglandin E2 (PGE2), and cytokine (IL-1beta, IL-6, IL-10, and TNF-alpha) levels, as well as inhibit the expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) in a concentration-dependent manner. The evaluation of antioxidant activity also revealed the ethanol extract to have the highest free radical scavenging activity, measured as 85.3+/-0.4%, which is equivalent to 99.9% of the activity of alpha -tocopherol. In the assessment of anti-bacterial activity, only ethanol extract was found to inhibit the growth of the Bacillus species Bacillus cereus and Bacillus anthracis. These results show that polyphenols of Cynanchi wilfordii Radix have anti-inflammatory, antioxidant, and anti-bacterial properties that can be exploited and further improved for use as a supplementary functional food, in cosmetics, and for pharmaceutical purposes.

First Metatarsal Proximal Opening Wedge Osteotomy for Correction of Hallux Valgus Deformity: Comparison of Straight versus Oblique Osteotomy

PURPOSE: The aim of this study was to compare clinical and radiographic outcomes of proximal opening wedge osteotomy using a straight versus oblique osteotomy. MATERIALS AND METHODS: We retrospectively reviewed 104 consecutive first metatarsal proximal opening wedge osteotomies performed in 95 patients with hallux valgus deformity. Twenty-six feet were treated using straight metatarsal osteotomy (group A), whereas 78 feet were treated using oblique metatarsal osteotomy (group B). The hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle, and distance from the first to the second metatarsal (distance) were measured for radiographic evaluation, whereas the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was used for clinical evaluation. RESULTS: Significant corrections in the HVA, IMA, and distance from the first to the second metatarsal were obtained in both groups at the last follow-up (p<0.001). There was no difference in the mean IMA correction between the 2 groups (6.1+/-2.7degrees in group A and 6.0+/-2.1degrees in group B). However, a greater correction in the HVA and distance from the first to the second metatarsal were found in group B (HVA, 13.2+/-8.2degrees; distance, 25.1+/-0.2 mm) compared to group A (HVA, 20.9+/-7.7degrees; distance, 28.1+/-0.3 mm; p<0.001). AOFAS scores were improved in both groups. However, group B demonstrated a greater improvement relative to group A (p=0.005). CONCLUSION: Compared with a straight first metatarsal osteotomy, an oblique first metatarsal osteotomy yielded better clinical and radiological outcomes.

Comparison of Efficiency of Self-renewal and Differentiation Potential in Tendon-derived Mesenchymal Stem Cells Isolated by Magnetic-activated Cell Sorting Method or Colony Picking Method / 대한족부족관절학회지

PURPOSE: The purpose of this study is to evaluate the efficacy of mesenchymal stem cell (MSC) isolation by the magnetic-activated cell sorting (MACS) method in tendon tissue-derived cells compared to the colony picking method for isolation of MSCs by picking colonyforming cells. MATERIALS AND METHODS: Human tendon-derived cells were isolated by enzyme digestion using normal tendon tissues from three donors. We used the magnetic kit and well-known MSC markers (CD90 or CD105) to isolate MSCs in tendon-derived cells using MACS. Cloning cylinders were used to isolate colony-forming cells having MSC characteristics in tendon-derived cells. Colony-forming unitfibroblast (CFU-F) assay was used to evaluate the self-renewal capacity of cells isolated using the colony picking method or MACS. For comparison of differentiation potentials into osteogenic or adipogenic lineage between two groups, alizarin red S and oil red O staining were performed at 14 days after induction of differentiation in vitro. RESULTS: Flow cytometry results showed that early passage tendon-derived cells expressed CD44 in 99.13%, CD90 in 56.51%, and CD105 in 86.19%. In the CFU-F assay, CD90+ or CD105+ cells isolated with MACS showed larger colony formation in size than cells isolated using the colony picking method. We also observed that CD90+ or CD105+ cells were constantly differentiated into both osteogenic and adipogenic lineages in cells from all donors, whereas cells isolated using the colony picking method were heterogeneous in differentiation potentials to the osteogenic and adipogenic lineages. CONCLUSION: CD90+ or CD105+ cells isolated using MACS showed superior MSC characteristics in the self-renewal and multi-differentiation capacities compared with cells isolated using the colony picking method.

Anti-Inflammatory and Anti-Superbacterial Properties of Sulforaphane from Shepherd's Purse

Shepherd's purse, Capsella bursa-pastoris (L.) Medik., has been considered a health food for centuries in Asia and is known to contain the isothiocyanate compound sulforaphane. In this study, we evaluated the anti-inflammatory and antibacterial properties of a sulforaphane-containing solution (SCS) isolated from shepherd's purse. SCS had significant anti-inflammatory activity indicated by the decreased levels of nitric oxide (NO), cytokines (interleukin 1beta [IL-1beta], IL-6, and IL-10), and prostaglandin E2 (PGE2) in lipopolysaccharide-stimulated RAW 264.7 murine macrophages. In addition, SCS decreased the inducible NO synthase (iNOS) and cyclooxygenase 2 (COX-2) levels, which confirmed the anti-inflammatory activity of SCS. Further, SCS inhibited vancomycin-resistant enterococci (VRE) and Bacillus anthracis. The minimal inhibitory concentration was 250 microg/ml for VRE and 1,000 microg/ml for B. anthracis. Taken together, these data indicate that SCS has potential anti-inflammatory and anti-superbacterial properties, and thus it can be used as a functional food or pharmaceutical.

Effects of Beraprost Sodium on Subjective Symptoms in Diabetic Patients with Peripheral Arterial Disease

BACKGROUND: This study evaluated the effects of Beraprost sodium (Berasil) on subjective leg symptoms in patients with peripheral arterial disease caused by diabetes mellitus. METHODS: Ninety-four diabetic patients with peripheral arterial disease were treated with Beraprost in a fixed-dose, prospective, multicenter, cohort study. Beraprost (40 microg) was administered orally 3 times daily (120 microg/day) for 12 weeks. We developed a new disease-specific symptom questionnaire, which evaluated the effect of peripheral arterial disease on leg discomfort in daily life and assessed therapeutic responses to treatment. Patients were asked for their subjective assessment of symptoms on a written questionnaire before treatment and after 12 weeks of therapy. RESULTS: There was significant improvement in all estimated subjective symptoms (burning, coldness, edema, exertional pain, stabbing, and paresthesias) in the lower extremities at 12 weeks (p < 0.001). There were 18 patients with neuropathy in whom significant improvement was noted for 6 subjective symptoms at 12 weeks (p < 0.05). Adverse events considered to be drug-related were observed in 4 patients (4.3%), all of which were mild and resolved with discontinuation of the medication. CONCLUSIONS: Beraprost is effective as a treatment for improving various subjective symptoms in the lower extremities, such as burning, coldness, edema, exertional pain, stabbing, and paresthesias, in diabetic patients with peripheral arterial disease.

Implant-supported fixed restoration of post-traumatic mandibular defect accompanied with skin grafting: A clinical report

Traumatic defects are mostly accompanied by hard and soft tissue loss. This report describes the surgical and prosthetic treatment of a patient with post-traumatic mandibular defect. A split-thickness skin graft was performed prior to implant placement and prefabricated acrylic stent was placed to hold the graft in place. The esthetic and functional demands of the patient were fulfilled by implant-supported screw-retained fixed prosthesis using CAD-CAM technology.

Modified Weil Osteotomy for the Treatment of Freiberg's Disease

BACKGROUND: Numerous metatarsal osteotomies have been developed for the treatment of Freiberg's disease. The purpose of this study was to evaluate the clinical outcomes of modified Weil osteotomy in the treatment of Freiberg's disease. METHODS: From November 2001 to July 2008, nineteen patients (twenty feet), treated surgically for Freiberg's disease, were included in this study. The average age of the patients was 33.6 years (range, 17 to 62 years), the mean follow-up period was 71.6 months (range, 41 to 121 months). Clinical outcomes were evaluated according to visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal-interphalangeal scale, the patients' subjective satisfaction and range of motion (ROM) of metatarsophalangeal (MTP) joint. In the radiologic evaluation, initial metatarsal shortening by Freiberg's disease compared to opposite site, metatarsal shortening after modified Weil osteotomy compared with preoperative radiography and term for radiologic union were observed. RESULTS: VAS showed improvement from 6.2 +/- 1.4 to 1.4 +/- 1.5 at last follow-up (p < 0.0001). Points of AOFAS score increased from 63.3 +/- 14.9 to 80.4 +/- 5.6 (p < 0.0001). ROM of MTP joints also improved from 31.3 +/- 10.1 to 48.3 +/- 13.0 degrees at last follow-up (p < 0.0001). According to Smillie's classification system, there was no significant improvement of VAS, AOFAS score and ROM between early stages (stage I, II, and III) and late stages (stage IV and V). Out of twenty cases, nineteen (95%) were satisfied, reporting excellent or good results. CONCLUSIONS: Modified Weil osteotomy is believed to be a useful method for the treatment of Freiberg's disease, not only in the early stages but also in the late stages. It relieves pain and improves function via shortening of metatarsals and restoration of MTP joint congruency.

Ankle Impingement Syndrome / 대한족부족관절학회지

The ankle impingement syndrome is an established cause of ankle dysfunction. In most cases with suspected ankle impingement, the diagnosis can be possible on the basis of mechanism of injury involved and the clinical examination. An appropriate imaging study should be selected where clinical doubt about the exact diagnosis exists. Radiography plays an important role in the initial assessment of these conditions, especially in anterior and posterior impingement. Magnetic resonance arthrography seems to be the most accurate means of assessing the capsular abnormalities present in anterolateral and anteromedial impingement and for confirmation of possible concomitant injury. Surgical treatment can be considered for the patients who did not respond to conservative treatment for more than 6 months, and has a low complication rate and a high level of success.

Percutaneous Disc Coagulation Therapy (PDCT) comparing with Automated Percutaneous Lumbar Discectomy (APLD) in Patients of Herniated Lumbar Disc Disease: Preliminary Report

OBJECTIVE: Percutaneous techniques are rapidly replacing traditional open surgery. This is a randomized controlled trial study of clinical outcomes of Percutaneous Plasma Disc Coagulation Therapy (PDCT) in patients with HLD(herniated lumbar disc) as a new percutaneous access in comparison with Automated Percutaneous Lumbar Discectomy (APLD) in its clinical application and usefulness as a reliable alternative method. METHODS: The authors analyzed 25 patients who underwent PDCT randomized 1:1 to 25 who underwent APLD between June, 2010 and October, 2011. All patients had herniated lumbar disc diseases. The clinical outcomes were evaluated using Visual Analog Scales (VAS) score and MacNab's criteria. RESULTS: The age of the patients who underwent PDCT ranged from 29 to 88 years with a mean age of 51.8 years. The age of the APLD undergone patients' population ranged from 30 to 66 with a mean age of 46.0 years. The average preoperative VAS score in PDCT was 7.60 and 1.94 at 7months post-operatively, and in APLD was 7.32, and 3.53 at 7 months post-operatively (p<0.001). In Macnab's criteria, 20 patients (80%) had achieved favorable improvement (excellent and good) in PDCT group. In Macnab's criteria, 16 patients (64%) had achieved favorable improvement in APLD group (p<0.001). CONCLUSION: PDCT can be considered a viable option as a new percutaneous access to herniated lumbar disc. PDCT showed to be more effective than APLD in this study, allowing stable decompression and safe minimally invasive operation to an area desired by the operator in lumbar disc herniation patients, although further long term clinical evaluations are still necessary.

Finite element analysis of the effects of mouthguard produced by combination of layers of different materials on teeth and jaw / 대한치과보철학회지

PURPOSE: The purpose of this study was to compare the stress distribution of teeth and jaw on load by differentiating property of materials according to each layer of widely used mouthguard. MATERIALS AND METHODS: A Korean adult having normal cranium and mandible was selected to examine. A customized mouthguard was constructed by use of DRUFOMAT plate and DRUFOMAT-TE/-SQ of Dreve Co. according to Signature Mouthguard system. The cranium was scanned by means of computed tomography with 1mm interval. It was modeled with CANTIBio BIONIX/Body Builder program and simulated and interpreted using Alter HyperMesh program. The mouthguard was classified as follows according to the layers. (1) soft guard (Bioplast)(SG) (2) hard guard (Duran)(HG) (3) medium guard (Drufomat)(MG) (4) soft layer + hard layer (SG + HG) (5) hard layer + soft layer (HG + SG) (6) soft layer + hard layer + soft layer (SG + HG + SG) (7) hard layer + soft layer + hard layer (HG + SG + HG) The impact locations on mandible were gnathion, the center of inferior border, and the anterior edge of gonial angle. And the impact directions were oblique (45degrees). The impact load was 800 N for 0.1 sec. The stress distribution was measured at maxillary teeth, TMJ and maxilla. The statistics were conducted using Repeated ANOVA and in case of difference, Duncan test was used as post analysis. RESULTS: In teeth and maxilla, the mouthguard contacting soft layer of mandibular teeth presented lowest stress measure and, in contrast, in condyle, the mouthguard contacting hard layer of mandibular teeth presented lowest stress measure. CONCLUSION: For all impact directions, soft layer + hard layer + soft layer, the mouthguard with three layers which the hard layer is sandwiched between two soft layers, showed relatively even distribution of stress in impact.

Comparison of Clinical Outcome of Excision versus Osteosynthesis in Type II Accessory Navicular / 대한족부족관절학회지

PURPOSE: The purpose of this study is to compare the clinical outcome of excision versus osteosynthesis of type II accessory navicular performed by a single surgeon. MATERIALS AND METHODS: Cases of 14 feet treated with excision and 13 feet by osteosynthesis for type II accessory navicular of 25 patients from 2002 to 2009 were included in this study. Radiological measurements and American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scale was evaluated. RESULTS: AOFAS midfoot scale of both excision and osteosynthesis groups at last follow-up showed improvement from pre-operation. However, there was no statistical difference in AOFAS midfoot scale and subjective satisfaction between the two groups at last follow-up. In detail of AOFAS midfoot scale, pain and footwear requirements showed statistically favorable results for the excision group, while activity limitation and support showed statistically favorable results for the osteosynthesis group. Subjective recovery time returning to daily activities and starting rehabilitation exercise were 14.6 weeks in the excision group and 13.7 weeks in the osteosynthesis group (p=0.025, Mann-Whitney). Suture anchor loosening was observed in one case in the excision group and non-union in two cases in the osteosynthesis group. CONCLUSION: Both excision and osteosynthesis are favorable surgical methods, but each method has advantages and possible complications such as suture anchor loosening or non-union. Surgeon's preference, patient's chief complaint, specific needs of patient after the operation and consideration of the size of accessory navicular can be a criteria to consider when selecting a surgical method.

Total Ankle Replacement / 대한족부족관절학회지

Although first generation total ankle replacement (TAR) had high failure rates, recent investigations have reported good results of the newer generations of TAR due to advances in implant designs and techniques. Patient selection is critical to performing TAR to obtain promising outcomes and to decrease complication rate. As the current concepts of correcting the accompanying deformity have been established, TAR in moderate to severe varus deformity of the ankle result in favorable outcomes and indications for TAR are expanding. Correction of deformity and hindfoot fusion should be performed in conjunction with TAR if needed. If radiolucency around components or osteolysis is progressive during follow-up, CT should be carried out as a confirmative diagnostic method. TAR is an effective treatment modality alternative to ankle fusion. However, we should recognize that TAR is a demanding procedure, which requires accurate techniques, enough experience, and preoperative plan for a concomitant deformity.

A Case of Benign Cephalic Histiocytosis

Benign cephalic histiocytosis (BCH) is a rare non-Langerhans cell histiocytosis of unknown etiology. Clinically, lesions are characterized by small, red-to-yellow papules distributed mainly on the head, face, neck, and shoulders of infants and children. Histopathological specimens show massive histiocytic infiltration of the superficial dermis. Immunohistochemically, they are positive for CD68, but negative for CD1a and S-100. Two cases have been reported so far in the relevant work published in Korean literature. Herein, we report on an additional case of BCH.