Tuberculosis Infection of the Ischial Tuberosity and That Recurred after 8 Years: A Case Report

Tuberculous infection of the ischium is a rare condition. It is recommended that antituberculosis chemotherapy is combined with surgical intervention. The patient in this case had an abscess on his right gluteal region and he had undergone an operation without antituberculosis chemotherapy. After eight years, an abscess recurred in the same area and he was treated with surgical resection. Antituberculosis chemotherapy was administered following histopathological confirmation of tuberculosis. At 1 year postoperatively, the patient had no pain and there was no evidence of recurrence.

Pregabalin as a Neuroprotector after Spinal Cord Injury in Rats: Biochemical Analysis and Effect on Glial Cells

As one of trials on neuroprotection after spinal cord injury, we used pregabalin. After spinal cord injury (SCI) in rats using contusion model, we observed the effect of pregabalin compared to that of the control and the methylprednisolone treated rats. We observed locomotor improvement of paralyzed hindlimb and body weight changes for clinical evaluation and caspase-3, bcl-2, and p38 MAPK expressions using western blotting. On histopathological analysis, we also evaluated reactive proliferation of glial cells. We were able to observe pregabalin's effectiveness as a neuroprotector after SCI in terms of the clinical indicators and the laboratory findings. The caspase-3 and phosphorylated p38 MAPK expressions of the pregabalin group were lower than those of the control group (statistically significant with caspase-3). Bcl-2 showed no significant difference between the control group and the treated groups. On the histopathological analysis, pregabalin treatment demonstrated less proliferation of the microglia and astrocytes. With this animal study, we were able to demonstrate reproducible results of pregabalin's neuroprotection effect. Diminished production of caspase-3 and phosphorylated p38 MAPK and as well as decreased proliferation of astrocytes were seen with the administration of pregabalin. This influence on spinal cord injury might be a possible approach for achieving neuroprotection following central nervous system trauma including spinal cord injury.

Open Synovectomy in Diffuse Pigmented Villonodular Synovitis of Ankle Joint: A Case Report / 대한족부족관절학회지

Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder that affects synovium, tendon sheath and bursa. Although the condition can present in any joint, knee joint is the most commonly affected site and only 2.5% of cases occur in foot and ankle joint. PVNS occurs in two types: localized and diffuse. Localized type is characterized by focal involvement of the synovium with either nodular or pedunculated masses, Diffuse type affects virtually the entire synovium. Diffuse type has reported more recurrence rate. We have experienced a patient who has diffuse type PVNS of ankle joint and report an optimal method of surgical treatment.

Kyphotic Angle Progression of Thoracic and Thoracolumbar Tuberculous Spondylitis after Surgical Treatment: Comparison with Predicted Kyphosis Outcome after Conservative Treatment

STUDY DESIGN: Retrospective comparative study. PURPOSE: To compare the progression of the kyphotic angle (KA) in a surgically treated group with the predicted outcome of a conservatively treated group. OVERVIEW OF LITERATURE: Late onset kyphosis is a complication of tuberculous spondylitis making its prevention a major goal of surgery. METHODS: Twenty six consecutive patients underwent an anterior reconstruction and posterior instrumented fusion in conjunction with antituberculous chemotherapy. The mean follow up was 56 months (range, 28 to 112 months). The patients were divided into subgroups based on the involved region of the thoracic and the thoracolumbar spine, initial KA, and the initial vertebral body loss (VBL(x)). The predicted KA (KA(Pd)) was calculated using the formula, KA(Pd)=5.5+30.5 VBL(x), to predict the final gibbus deformity. Kyphotic angle progression (DeltaKA) based on the radiographic measurements after surgery (DeltaKA(R)), and the predicted outcome of conservative treatment (DeltaKA(P)) with chemotherapy were compared. RESULTS: Among the subgroups of the regions involved and initial KA, the DeltaKA was radiographically superior with a reduced amount of kyphogenesis in the surgery group than the predicted outcome of the conservatively treated patients (p0.05) with VBL(x)< or =0.5 in the VBL(x) subgroup. CONCLUSIONS: These results showed that in the VBL(x) subgroup, an initial VBL(x)< or =0.5 is an indication of conservative antituberculous chemotherapy without surgery.

The Harris-Galante-II Acetabular Componentin Cementless Total Hip Arthroplasty : Average Ten-year Follow-up Results / 대한정형외과학회잡지

PURPOSE: To evaluate the average ten-year follow-up results of 98 total hip arthroplasties using Harris-Galante-II porous-coated acetabular components. MATERIALS AND METHODS: Ninety-eight hips were evaluated. The mean age of the patients was 45 years, and the mean follow-up was 121 months. The clinical and radiographic findings including the wear of the polyethylene liner were evaluated. The endurance of the acetabular component was analyzed using the Kaplan-Meier method. RESULTS: Retroacetabular osteolysis, dissociation of the PE liner and aseptic loosening of the acetabular component was observed in 25 hips (25.5%), 9 hips (9.2%), and 1 hip (1.0%), respectively. The average rate of liner wear was 0.16 mm/year. Twenty acetabular components (20.4%) were revised, and the survival probability of the acetabular components at 10 years was 87% (95% confidence limits, 83-90%). CONCLUSION: In this long-term follow-up study, the revision rate of Harris-Galante-II acetabular component was relatively high, and was associated with locking mechanism failure and retroacetabular osteolysis. However, the rarity of aseptic loosening suggests that excellent long-term fixation could be achieved with the surface treatment of a fiber-metal porous coating.

Degenerative Change of Femoral Head Cartilage in the Elderly with Hip Fracture / 대한정형외과학회잡지

PURPOSE: To evaluate the incidence, grade and extent of the degenerative changes in the femoral head articular cartilage in the elderly with hip fracture through gross, histological and immunohistochemical studies. MATERIALS AND METHODS: The study examined 30 femoral heads obtained from patients over 65 years with no arthrosis by radiograph, who had undertaken bipolar hemiarthroplasty due to hip fracture. The mean age of patients was 79.7 years and the study examined three weight bearing zones (anterior, middle and posterior) and one non-weight bearing zone (inferior) of each femoral head. RESULTS: The gross findings showed significant correlation with the Mankin grade for each zone (p<0.05). Twenty four cases (80%) showed mild degeneration according to the Mankin grade and the others moderate. The mean Mankin score at each zone of all femoral heads was 5 points, which indicated mild degeneration. No significant difference was found between the weight bearing zone and the non-weight bearing zone (p=0.75). The distribution of type II collagen antibody stainabilities mainly showed normal or mild degeneration (93.3%). CONCLUSION: Degeneration of the articular cartilage of the femoral heads in the elderly with hip fracture and no arthrosis by radiograph was mostly mild, and showed generalized changes regardless of the zone.

Value of Preoperative Bone Scan in Evaluation of Femur Shaft Fracture

PURPOSE: To evaluate the availability of bone scan as a preoperative study by analyzing patients who developed ipsilateral femoral neck fractures during intramedullary nailing for femoral shaft fractures. MATERIALS AND METHODS: Among 28 patients who conducted preoperative bone scan before performing intramedullary nailing for femoral shaft fractures, three patients developed femoral neck fractures during the operation. We analyzed retrospectively the result of bone scan including clinical and radiological findings of three patients. RESULTS: Among 28 patients, 7 showed hot uptake in femoral neck area compared to the unaffected side in preoperative bone scan; All 3 patients who developed femoral neck fractures during the operaion showed hot uptakein the area. Among 7 patients who showed hot uptake, there were no abnormalities in plain radiograph and computerized tomography of femoral neck area. CONCLUSION: The risk of femoral neck fracture should be considered during the intramedullary nailing for femoral shaft fracture, if there was hot uptake in femoral neck area in preoperative bone scan.