A Comparision of Functional Outcomes after Successful Replantation versus Thenar Flap for Single Fingertip Amputations

PURPOSE: This retrospective study was to determine the functional results of patients who were amputated of their fingertip between patients who were treated with replantation and patients who were treated with thenar flap. MATERIALS AND METHODS: From 2004 to 2007, we identified and operated 159 patients who were diagnosed with fingertip amputations. Of 159 patients, Eighty-two patients were treated by replantation (67 in men and 14 in women) and the mean age at the operation was 41 years (range, 15-68 years). Seventy-nine patients was treated with thenar flap(54 in men and 25 in women) and the mean age at the operation was 43 years(range, 21-70 years). We compared variables between two groups including, age, gender, diagnosis, duration of hospital admission, grip strength, two-point discrimination, Semmes Weinstein monofilament test, active range of motion (ROM) of the proximal and distal interphalangeal (PIP and DIP) joint, pain (or tenderness), paresthesia, cold intolerance, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and finger for activities of daily living (ADLs). RESULTS: The duration of admission was longer in Replantation group than in Thenar flap group(p=0.001). However, the grip strength (p=0.003) and Semmes Weinstein monofilament test (p=0.029) in the Replanation group were statistically superior to the Thenar flap group. The average DASH disability (p=0.003)/symptom score (p=0.007) and ADLs (p<0.001) in the Replantation group was statistically better. In addition, cold intoleranace test of Thenar flap group is worse than the Replantation group. CONCLUSION: This study demonstrate that fingertip replantation have demonstrated not only to obtain the best appearance but also to gain better functional outcome. However, it is impossible to perform replatation, the thenar flap can be limited alternative method for fingertip amputation in aspect of preservation of range of motion and hospitalization time.

Nerve Palsy and Delayed Arterial Occlusion after Total Knee Arthroplasty: A Case Report

Nerve palsy after total knee arthroplasty is a rare complication and this is usually associated with local nerve compression or severe deformity of the knee. In many cases, the cause of nerve palsy was unknown and this is rarely associated with vascular complication. We report here on a case of the patient who had nerve palsy and delayed arterial occlusion after total knee arthroplasty.

Microsurgical Distal Thumb Reconstruction Using a Mini Wrap-around Free Flap

PURPOSE: Free flaps from the great toe are an established method for reconstruction of absent or partially amputated thumbs. However, options differ as to which technique represents the ideal solution for each level of amputation. Various methods of distal thumb reconstruction have been proposed. We prefer to transplant the entire great toe nail complex with the almost all of the pulp rather than a portion of the nail. This paper reflects our experience in using the great toe mini wrap-around flap for distal thumb reconstruction. MATERIALS AND METHODS: In the period from October of 2005 to July of 2007, 9 patients were treated for traumatic thumb defects localized at the distal phalanx of the thumb. The patients included seven men and two women. The mean age was 44 years (range, 21~60) and the dominant right hand was involved in seven of nine patients. RESULTS: The transferred flaps have survived completely in all cases. The mean range of motion in the interphalangeal joints was 51o, with 73% of the normal uninjured opposite hands. The two-point discrimination was 10.5 mm (range, 5~13 mm). In Semmes-Weinstein monofilament test, the sensibility was 4.31 in 4 cases, 3.61 in 3 cases and 2.83 in 2 cases. The pinch power was 64% (range, 55~95%) of the opposite hand. All patients were satisfied with the appearance of the reconstructed thumb and felt comfortable at final follow-up. CONCLUSION: We have successfully reconstructed 9 cases of traumatic distal thumb defects using the mini wrap-around free flap. The mini wrap-around free flap in great toe is an excellent alternative method for distal thumb reconstruction in selected patients.

Study of Exchange Phenomenon of Mycoplasma pneumoniae in Children from 1997-2002 / 소아과

PURPOSE: Mycoplasma pneumoniae(M. pneumoniae) is classified into two groups(I and II) by difference of DNA sequences in P1 protein. Between these two groups, there are some different immune responses and disease severity. M. pneumoniae pneumonia have epidemic outbreaks occurring every three to seven years and these outbreaks are related with rising of either group I or II. We studied cases of M. pneumoniae pneumonia during the past six years(November 1996-October 2002), to evaluate the prevalence and yearly distribution of each group. METHODS: We enrolled 504 patients out of 547 patients, who were admitted to the Department of Pediatrics, Sung-Ae and Kwangmyung Sung-Ae General Hospital from November 1996 to October 2002. They were diagnosed as M. pneumoniae pneumonia by clinical characteristics and indirect particle agglutination test of M. pneumoniae. To classify into two groups, the group specific polymerase chain reaction amplification were performed using specific oligonucleotide primers designed for P1 gene genotyping. RESULTS: Group I(91.7%) occured more frequently than group II(8.3%) during the study period. There were outbreaks of M. pneumoniae pneumonia in 1997 and 2000, which showed epidemics of M. pneumoniae pneumonia were occuring every three or four years, but there was no exchange phenomenon between the two groups. CONCLUSION: Group I was more prevalent than group II with a three years cycle of epidemic outbreak from 1997 to 2002 in Korea. But, six years of research is a relatively short time to compare immune responses, disease severity and exchange phenomenon between the two groups. Further follow-up study will be needed for the epidemiologic and clinical studies of M. pneumoniae in Korea.

Diagnostic Value of (99m)Tc-DMSA Pinhole Imaging in Childhood Urinary Tract Infection with Renal Cortical Defect

PURPOSE: The aim of this study was to assess the diagnostic value of the (99m)Tc-DMSA pinhole imaging by comparing the detection rate of cortical defects identified from planar and pinhole imaging. METHODS: (99m)Tc-DMSA planar and pinhole imaging, voiding cystoureth-rogram(VCUG), renal ultrasonography were performed in 67 patients diagnosed with urinary tract infection at the Department of Pediatrics, Sung-Ae General Hospital, from September, 1999 to Feburary, 2001. The follow-up of (99m)Tc-DMSA pinhole imaging was performed on 25 patients. RESULTS: Overall detection rate of (99m)Tc-DMSA planar imaging was 41.8%(28 patients/67 patients), but (99m)Tc-DMSA pinhole imaging showed cortical defects in 62.7%(42 patients/67 patients) and the patients with renal cortical defects in planar imaging showed all definite or more additional cortical defects in pinhole imaging. The detection rate of cortical defect by (99m)Tc- DMSA pinhole imaging in patients with vesicoureteral reflux(VUR) was 80%(24 kidneys/30 kidneys). Those without VUR, however, also presented high detection rate as 25.9%(27 kidneys/ 104 kidneys). Out of 25 patients, improvement of cortical defect was presented in 19, no change in 4, and aggravation in 2 from the follow-up studies by (99m)Tc-DMSA pinhole imaging. CONCLUSION: This study indicates that (99m)Tc-DMSA pinhole imaging is superior to planar imaging and, hence, that pinhole imaging is a useful initial diagnostic tool for children suspected of urinary tract infection, irrespective of VUR, and to identify patients who need more extensive radiological studies and early treatment.

A Case of Split Hand Split Foot Anomaly

We experienced a case of split hand split foot(SHSF) anomaly in a male neonate who had a deficiency of the middle finger, syndactyly of the 1st and 2nd finger and a deep median cleft in both hands. He also had a deep median cleft between 2nd and 3rd toe, syndactyly of the 1st and 2nd, 3rd and 4th toe without deficiency of the middle toe in both feet. SHSF anomaly may occur either isolated or associated with other anomalies. In this case, it occurd sporadically without family history and showed an isolated type without any other specific anomalies except both posterior iris synechiae. The karyotype of patient showed 46,XY,t(7p:14q) which has not been reported yet. We reported the case with the review of the associated literatures.

The Diagnostic Value of Polymerase Chain Reaction in Mycoplasma pneumoniae Pneumonia

PURPOSE: This study was performed to evaluate the polymerase chain reaction (PCR) in the diagnosis of Mycoplasma pneumoniae pneumonia in comparison with the specific antibody test. METHODS: Five hundred and ten patients with pneumonia, ranging from the ages of 8 months to 15 years who were admitted in Sung-Ae and Kwangmyung Sung-Ae general hospitals from Nov. 1996 to Oct. 1997, were enrolled in this study. Specific antibody test of the serum using Serodia Myco II kit and PCR of the sputum or throat swab were performed on admission simultaneously, and follow-up antibody test was done during the convalescent stage if they showed sero-negative at first. Among the PCR positive patients, 40 were treated with erythromycin initially, and were followed with PCR on the 7th day of treatment. RESULTS: The sensitivity of PCR to the specific antibody test was 82.5%, and the specificity, 98.4%. The false positive and negative rates of PCR to the specific antibody test were 1.6% and 17.5%, respectively. Fifty-six (91.8%) of the 61 patients who showed sero-negative and PCR positive on admission were determined as sero-positive at the convalescent stage. Negative conversion of PCR at the convalescent stage was noted for 32 (80%) of 40 patients who were treated with erythromycin. CONCLUSION: The PCR was considered to be valuable due to its high sensitivity and specificity as a diagnostic method of Mycoplasma pneumoniae pneumonia. The effect of the method was more apparent than the specific antibody test in early diagnosis which is clinically important. In addition, it seems to be more useful in the appreciation of treatment and epidemiologic study than the culture method that shows low sensitivity and takes too much time.

Rapid Identification of Mycoplasma Pneumoniae, Mycobacterium Tuberculosis and Staphylococcus Aureus in Pleural Fluid by PCR

PURPOSE: Pleural effusions may develop during the course of bacterial pneumonia. The aim of this study was to evaluate the significance of the polymerase chain reaction (PCR) method for detection of Mycoplasma pneumoniae, Mycobaterium tuberculosis and Staphylococcus aureus from pleural fluid. METHODS: Total 12 samples were obtained from pleural fluid; 2 samples from children with Mycoplasma pneumonia, 5 samples from adults with tuberculous pleurisy, and 5 samples from sterile pleural fluid seeded artificially with staphylococcus aureus. The primers used for our PCR were prepared to amplify M. pneumonia-specific MP5 gene, M. tuberculosis-specific IS6110 gene, and S. aurus-specific femA and mecA gene. The amplified PCR products were detected by ethidium bromide-stained agarose gel electrophoresis. RESULTS: A total of 12 pleural fluid samples were tested by nested PCR using the specific primer set. We could amplify MP5 gene in 2 samples, IS6110 gene in 5 samples, mecA gene in 3 samples, and femA gene in 5 samples. These PCR data were correlated with serolological data, microbiological data and methicillin-sensitivity test result. There were no false-positive results due to cross-contaminating DNA between these 3 organisms. CONCLUSIONS: We conclude that enzymatic amplification of specific gene from pleural fluid might be useful to diagnose the infectious pleural effusion by Mycoplasma pneumoniae, Mycobacterum tuberculosis or Staphylococcus aureus.

Acute Renal Failure (ARF) Associated with Yersinia Pseudotuberculosis Infection Diagnosed by Polymerase Chain Reaction

The clinical significance of Yersinia pseudotuberculosis (Y. pseudotuberculosis) has recently recognized in various part of the world because it can cause a wide range of clinical problems such as mesenteric lymphadenitis, septicemia, reactive arthritis, terminal ileitis, erythema nodosum and acute renal failure. we experienced a case of acute renal failure associated with Y. pseudotuberculosis infection. We applied a nested polymerase chain reaction method for rapid diagnosis of Y. pseudotuberculosis infection. DNA was extracted from standard strains of Y. pseudotuberculosis, Y. enterocolitica, serial blood samples, urine, and mountain water by phenol-chloroform method. Using specific primers, we amplified inv and ail gene from extracted DNA samples by PCR method. The patient' serotype was Y. pseudotuberculosis 2a and it's titer was 1:40 initially, after 2 weeks the titer increased to 1:160. Stool culture was negative. Inv gene amplification was positive in patient's urine, febrile stage blood, and mountain water. The nested polymerase chain reaction method can be used clinically for rapid diagnosis of Y. pseudotuberculosis infection. So we report here the clinical findings and PCR method of this case with brief review of the literatures.

A Case of Synophthalmia with Chromosomal Anomaly: 46, XX, -15, t (15q, 21q)

A synophthalmia, another form of cyclopia, in which the element of the two eyes are partially fused to form an apparently single eye in the middle of the forehead. The synophthalmia is a result of complex, neural plate misdevelopment syndrome involving the eye, brain, skull and face. It is well known that synophthalmia is due to heterogenous causes, most of which chromosomal imbalances. We experienced a case of synophthalmia associated with proboscis, alobar holoprosencephaly and chromosomal anomaly 46, XX, -15,t (15 q, 21 q). Diagnosis was confirmed by brain MRI and autopsy, The patient died about 20 hours of age and autopsy was done. A brief review of the literatures was also presented.

Clinical Study of Arthrogram in Ankle Fracture / 대한정형외과학회잡지

The Ankle joint is a modified complex hinge joint which plays an importnat role in weight bearing, walking and standing. Injuries about the ankle joint cause destruction of not only bony architecture but also the ligament and soft tissue components. We performed arthrography in 52 cases of ankle fracture. The Result obtained from this study was as follow; The ligament & interosseous membrane injuries were more severe, when fracture of lateral malleolus was occured higher level than ankle joint.

Clinical Failures of Internal Fixation / 대한정형외과학회잡지

Since the first attemt of internal fixation not much more than a century ago, implants have come to play an important role in orthopaedic surgery. Yet little has been reported about complications which may result from implant surgery. During the period of May 1980 to April 1984, 32 cases of fixation failures were treated in the Department of Orthopaedic Surgery, Hallym College, Kang Nam Sacred Heart Hospital and results were obtained as follows: 1. The most common area involved femoral shaft, but the highest rate was distal femur. 2. The most common period of failure was between 2 to 4 months postoperatively. 3. The leading cause of failure was remaining defects at fracture site. 4. The authors recommend accurate reduction of fracture and bone graft, if necessary, adequate immobilization postoperatively and co-coperation of patient to avoid failure of implant.