Subcapsular Hepatic Hematoma after Endoscopic Retrograde Cholangiopancreatography / 대한내과학회지

Endoscopic retrograde cholangiopancreatography (ERCP) is a useful tool for the diagnosis and management of diseases of the pancreas and biliary tract. However, ERCP has a high risk of procedure-related complications compared with other endoscopic procedures performed in the upper gastrointestinal tract. The most common complications are pancreatitis, cholangitis, hemorrhage, and perforation. Extraluminal hemorrhagic complications after ERCP are relatively rare but potentially life threatening and should be identified and treated immediately. We report a case of subcapsular hepatic hematoma after guidewire injury during ERCP in a 64-year-old woman with choledocholithiasis who had undergone ERCP with guidewire-assisted papillotomy for stone extraction. Although subcapsular hepatic hematoma is a very rare complication after ERCP, it should be considered in the differential diagnosis of patients complaining of abdominal pain after ERCP.

Changes in Patient Pattern and Operation Methods for Intertrochanteric Fractures / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to analyze characteristics of femur intertrochanteric fractures concerning age, fracture pattern, and change in operation method, retrospectively. MATERIALS AND METHODS: Of the patients over 65 years of age that had been treated between June 1999 and June 2007, two hundred forty patients, who were available for follow-up for at least 1 year were selected. Patients were divided into 2 groups, A or B, based on their time of operation during a 4-year period. Age, bone marrow density (BMD), causes of fracture, fracture patterns, and treatment trends were analyzed. RESULTS: The number of patients in group A was 108 and in group B was 132; the mean age was 75.38 years and 77.58 years, retrospectively with the mean age increased by 2.2 years. In group A, 44 cases (40%) were comminuted fractures over AO type A2-2, 77 cases (71%) were unstable fracture using Evans classification; in group B, there were 65 cases (49%) and 100 cases (76%), respectively. Based on the BMD analysis, an average -0.29 decreased in group B. In group A, 61 cases (56%) were treated with compressive hip screw, 41 cases (38%) with proximal femoral nail , 6 cases (6%) with bipolar hemiarthroplasty. In group B, 48 cases (36%) were treated with compressive hip screw, 73cases (55%) with proximal femoral nail, and 11 cases (9%) with bipolar hemiarthroplasty. CONCLUSION: There were increases in patient age, percentages of unstable fractures, fracture comminution and decrease in bone marrow density. The use of proximal femoral nail or primary arthroplasty increased.

Spontaneous Dissolution of Isolated Superior Mesenteric Vein Thrombosis in Acute Pancreatitis / 대한소화기학회지

Acute pancreatitis can result in many vascular complications in both artery and vein. Venous complication usually occurs as a form of splenic or portal vein thrombosis, and also can simultaneously occur in superior mesenteric vein as well. Rarely, isolated superior mesenteric vein thrombosis occurs as a venous complication. Although it is uncommon, mesenteric vein thrombosis is an important clinical entity because of the possibility of mesenteric ischemia and infarction of small bowel. The treatments of mesenteric venous thrombosis include anticoagulation therapy, transcatheter therapy and surgical intervention. We report a case of 45-year-old man who had acute pancreatitis with isolated superior mesenteric vein thrombosis, which was spontaneously dissolved with the resolution of underlying inflammation without anticoagulation or surgical intervention.

Cementless Total Hip Arthroplasty with Alumina Ceramic-on-Ceramic Articulation

PURPOSE: We wanted to evaluate the clinical and radiological results of total hip arthroplasty using a ceramic-on-ceramic articulation. MATERIALS AND METHODS: From March 2004 to February 2006, total hip arthroplasty was performed in 21 patients and 31 hips. The mean follow up period was 56 months (range: 48~72 months). The causes for the AVN were alcohol in 12 cases, idiopathic in 10 cases, steroid in 6 cases and post-traumatic in 3 cases. The clinical results were evaluated using the Harris hip score and according to the pain on the inguinal area or thigh. The radiographic evaluation was performed to determine the level of osteolysis and instability around the acetabular cup and femoral stem, the position of the femoral stem and the wear of the articular surface. RESULTS: At the most recent follow-up, the mean Harris hip score was 93 points with no inguinal or thigh pain. The complications included one case of peroneal nerve palsy, one case of ceramic head fracture, two cases of noise in the joint, two cases of posterior dislocation and two patients died because of complication related to liver cirrhosis. Radiologically, bone ingrowth was noted in all the cases with no migration of the acetabular component and femoral stem, changing of the position or osteolysis. CONCLUSION: Total hip arthroplasty with ceramic on ceramic articulation shows satisfactory results at an average of 56 months follow up. There was bone ingrowth in all cases except for one ceramic head fracture. Further follow-up study should be performed to evaluate the long-term results.

Treatment of Reverse Oblique Trochanteric Fracture with Compression Hip Screw

PURPOSE: To investigate the results of treatment of reverse oblique trochanteric fractures with compression hip screw. METHODS: We reviewed the results of 12 cases of reverse oblique trochanteric fracture treated with compression hip screw from January 2000 to December 2006 which could be followed up for more than 1 year. The mean follow up period was 26 months (15~40). The mean age was 48 years old. Injury mechanism was composed of 6 cases of traffic accident and 6 cases of fall down. 8 persons were man. We investigated the union time, degree of neck-shaft angle change, amount of sliding of compression hip screw, complications, functional and clinical results. RESULTS: 10 cases were united and the mean union time were 5 months (3~8). The mean neck-shaft angle change was 3.5 degrees (0~12). The amount of sliding of compression hip screw was 8.9 mm (2~24). There were six coxa vara, six leg due to coxa vara shortening, two nonunion, and one superficial infection. Unsatisfactory results of Jensen's social function score and Parker and Palmer's mobility score were studied. CONCLUSION: The results of treatment of reverse oblique trochanteric fractures with compression hip screw were relatively unsatisfied.

Treatment of Proximal Tibia Fractures Using LCP by MIPO Technique

PURPOSE: We wanted to evaluate the efficacy of MIPO (minimal invasive plate osteosynthesis) technique by LCP (locking compression plate) for treating proximal tibia fractures. MATERIALS AND METHODS: Twenty-three patients, who had operation due to proximal tibia fracture and available for follow up for more than 1 year were included in this study. Cause of injury and accompanied injuries were checked. Operation time, period to bone union, range of joint motion and alignment were evaluated with complications. RESULTS: Mean bone union time was 13.7 weeks (10~20). Twenty-one cases of the patients showed angulation of less than 5 degrees and 17 cases had normal range of motion. Five cases showed skin irritation by the plate and 2 cases had superficial infection. CONCLUSION: LCP by MIPO technique for treating proximal tibia fracture showed excellent results. Delicate technique is required for the proper adjustment of LCP and the alignment of the lower leg.

Ape1/Ref-1 Stimulates GDNF/GFR alpha1-mediated Downstream Signaling and Neuroblastoma Proliferation

We previously reported that glial cell line-derived neurotropic factor (GDNF) receptor alpha1 (GFR alpha1) is a direct target of apurinic/apyrimidinic endonuclease 1 (Ape1/Ref-1). In the present study, we further analyzed the physiological roles of Ape1/Ref-1-induced GFRalpha1 expression in Neuro2a mouse neuroblastoma cells. Ape1/Ref-1 expression caused the clustering of GFR alpha1 immunoreactivity in lipid rafts in response to GDNF. We also found that Ret, a downstream target of GFRalpha1, was functionally activated by GDNF in Ape1/Ref-1-expressing cells. Moreover, GDNF promoted the proliferation of Ape1/Ref-1-expressing Neuro2a cells. Furthermore, GFR alpha1-specific RNA experiments demonstrated that the downregulation of GFR alpha1 by siRNA in Ape1/Ref-1-expressing cells impaired the ability of GDNF to phosphorylate Akt and PLC gamma-1 and to stimulate cellular proliferation. These results show an association between Ape1/Ref-1 and GDNF/GFR alpha signaling, and suggest a potential molecular mechanism for the involvement of Ape1/Ref-1 in neuronal proliferation.

Management of Cyst on Anterior Tibia following Cementless Total Knee Arthroplasty: Case Report / 대한정형외과학회잡지

There are no reports of the occurrence of a cyst in the anteromedial side of the proximal tibia after cementless total knee arthroplasty in the Korean literature. The authors encountered 2 cases with a cyst, in whom the pain improved after cemented total knee revision arthroplasty. We report these cases with a review of the relevant literature.

Treatment of Traumatic Posterior Fracture and Dislocation of the Hip

Purpose: To evaluate outcomes and complications after traumatic posterior hip fractures and dislocations classified according to the Thompson-Epstein system. Materials and Methods: Thirty-five cases were selected from among the patients we treated between January 2000 and December 2005. According to Thompson-Epstein classification, 5 cases were type I, 7 cases were type II, 5 cases were type III, 8 cases were type IV, and 10 cases were type V. The mean age at the time of injury was 41 years (range: 19~72 years). Twenty-six patients were men, and 9 patients were women. The mechanisms of injury included traffic accidents in 30 cases and falls in 5 cases. The mean follow-up period was 31 months (range: 13~86 months). Fracture reduction was achieved within 6 hours in 32 cases. Thirty-four patients underwent closed reduction, and 22 of these patients were treated using Allis'method. Results: All Thompson-Epstein type I fractures were managed with closed reduction. Two type II fractures were treated conservatively, and 4 were treated with open reduction and internal fixation. All 13 type III and IV fractures were treated using open reduction and internal fixation. Six type V fractures were treated conservatively, 4 were treated with open reduction and internal fixation, and 1 was treated using total hip arthroplasty. Posttraumatic arthritis was observed in 9 cases, 7 of which were Thompson-Epstein type IV. Avascular necrosis (AVN) of the femoral head and deep vein thrombosis were observed in 1 case. Sciatic nerve injury was seen in 5 cases. Conclusion: Complications often occur in Thompson-Epstein type IV fractures. We believe that early, appropriate anatomical reduction helps to improve outcomes.

Bursoscopic Finding in Primary Adhesive Capsulitis of the Shoulder

PURPOSE: To evaluate the bursoscopic findings of refractory primary adhesive capsulitis of the shoulder and to determine the clinical correlation. MATERIALS AND METHODS: Arthroscopic capsular release was performed in 21 refractory adhesive capsulitis patients who had not responded to conservative treatment. The VAS for pain, range of motion, UCLA score was checked before and after surgery, and at the last follow up. RESULTS: Bursitis, mild friction and impingement on coracoacromial ligament, as well as adhesion were observed. The function and pain improved earlier than after simple acromiohumeral joint capsular release. CONCLUSION: Subacromial bursoscopy helps rule out a hidden secondary frozen shoulder or secondary changes with primary adhesion. In addition, it has the advantage of being both a treatment and procedure for making a prognosis.

Treatment of Femoral Head Fracture with Traumatic Posterior Dislocation of the Hip

PUEPOSE: To evaluate the treatment results and complication of a femoral head fracture with posterior dislocation of the hip according to the Pipkin classification. MATERIALS AND METHODS: Ten cases of Thompson-Epstein type V femoral head fracture with a posterior dislocation of the hip were evaluated. According to the Pipkin classification, 5 cases were type I, 1 case was type III, and 4 cases were type IV. The average age at time of trauma was 38 (19~72) years, and the causes were traffic accidents in 9 cases and falls in 1 case. The average follow-up period was 33 (13~79) months. A reduction of the fracture was performed within 6 hours in 9 cases and 12 hours in 1 case. When the stability was achieved after the reduction, the choice of further treatment was made from either conservative treatment while maintaining skeletal traction, or surgical treatment according to the fracture type and instability. The complications were evaluated by a physical examination, simple radiography, computed tomography (CT) and magnetic resonance imaging (MRI). RESULTS: In Pipkin type I fractures, 4 cases were treated with conservative treatment and 1 case was treated with surgical treatment. One case of Pipkin type III fracture was treated with primary total hip arthroplasty. In Pipkin type IV fractures, 2 cases were treated surgically using a plate and 2 cases were treated with conservative treatment with skeletal traction. Bone union was achieved in all cases. One case of mild posttraumatic arthritis and 1 case of avascular necrosis was found, respectively in Pipkin type IV. CONCLUSION: The extent of the initial injury has an effect on the prognosis of a hip fracture and dislocation.

Human Umbilical Cord Blood Infusion in Paralyzed Rats: Histologic and Behavioral Alterations / 대한척추외과학회지

STUDY DESIGN: Experimental animal study OBJECTIVES: To examine the ability of human umbilical cord blood (hUCB) stem cells to target a zone of injury and to determine the efficacy of hUCB cells to ameliorate the behavioral deficits after a hUCB cell infusion in paralyzed rats. SUMMARY OF LITERTURE: Many groups have investigated the use of stem cells as potential treatments for a CNS injury. hUCB cells have recently been reported to alleviate the behavioral consequences of a stroke injury. MATERIALS AND METHODS: Thirty Sprague Dawley rats were divided into 6 groups (Gr) (Gr 1. SCI (spinal cord injury) + hUCB delivered at one day postinjury, Gr 2. SCI + hUCB delivered at 3 days postinjury, Gr 3. SCI + hUCB delivered at 5 days postinjury, Gr 4. laminectomy + hUCB, Gr 5. SCI only, Gr 6. Laminectomy only). SCI was produced by compressing the spinal cord to the level of the 8-9th thoracic spine for 1 minute with an aneurysm clip that was calibrated to a closing pressure of 50 gms. The hUCB cells (0.5 ml, 1.5x106) were administered intravenously to the rats. The rat was assessed behaviorally at one, two and three weeks using the BBB behavioral scale. Four weeks after the injury, the animals were sacrificed and the hUCB positiveresponse neural cells (mouse anti-human mitochondria monoclonal antibody=MAB 1273) at the injury level observed using optical and fluorescent microscopy. RESULTS: MAB 1273 positive cells were observed in groups 1, 2 and 3 but not in groups 4, 5 and 6. In particular, there were 870 cells distributed over an area of 1.2 mm(2) in group 3. Group 3 showed the most significant recovery over time in the open field exam, and the most improvement in another tests of incline, leg extension, and toe spread compared with group 1 (p<0.01). CONCLUSION: After infusing the hUCB stem cells to SCI rats, it was confirmed that hUCB cells migrate to an injured area and ameliorate the behavioral deficits. A hUCB infusion 5 days after the injury produced best results in terms of the number of cells and motor recovery.

Treatment of Senile Osteoporotic Intertrochanteric Fracture using Proximal Femoral Nail

PURPOSE: Clinical and radiologic results of femur intertrochanteric fractures treated with ITST nail in elderly patients with osteoporosis were analysized to evaluate the efficacy and complication of ITST nailing. MATERIALS AND METHODS: 32 patients who were treated with ITST nail due to femur intertrochanteric fracture and were followed up for more than 1 year were analysed. According to Evans classification, 11 cases were stable fractures and 21 cases were unstable fractures. Clinically, ambulatory function was compared and radiologically, BMD of healthy leg was checked with analysis of postoperative bone union and complication. RESULTS: In ambulatory function comparison before and after the operation, there were 9 cases of good, 17 cases of moderate and 6 cases of poor. Considering social activity after the operation, 7 cases showed normal ambulation, 9 cases showed ambulatory with one cane, 5 cases showed two cane ambulation and 11 cases showed dependent ambulation. In radiologic evaluation, T-score of ward triangle in healthy femoral neck showed BMD of -3.12. In 20 cases, bone union was observed within 3 months. The patients with low BMD result had poor outcome. There were 2 cases of intraoperative proximal femur fracture, 3 cases of nonunion and 4 cases of death within 1 year. CONCLUSION: In elderly patients with intertrochanteric fracture, ITST nailing is relatively efficient treatment. However, in pateint with severe osteoporosis (T-score<-3.0) and unstable fracture pattern, arthroplasty should be considered due to relatively high complicaton rate.

Fat-suppressed 3D SPGR MR Imaging of Articular Cartilage Lesion of Medial Femoral Condyle in Osteoarthritic Knee / 대한정형외과학회잡지

PURPOSE: To evaluate the efficacy of sagittal fat-suppressed 3D SPGR MR imaging of the osteoarthritic medial femoral condyle in terms of extent and degree of a focal articular cartilage defect of the knee. MATERIALS AND METHODS: The MRI findings (Disler scale) of normal and osteoarthritic medial femoral condyles from 112 knees were prospectively compared with the arthroscopic findings (Jackson staging). The arthroscopic findings were normal in 10 cases, stage I in 26 cases, stage II in 36 cases, stage III in 21 cases and stage IV in 19 cases on arthroscopy. RESULTS: All 10 cases arthroscopy findings were grade 0 in MRI. Among the 26 knees in arthroscopic stage I, only 11 knees (42.3%) showed surface irregularities on MRI that were consistent with grade 1, otherwise grade 2. All cases of arthroscopic stage II showed grade 2 or grade 3. Stage III was grade 3 in all cases on MRI. Among the 19 knees in arthroscopic stage IV, 16 knees (84.2%) with a large defect showed grade 4 on MRI. The sensitivity, specificity and accuracy of the MRI compared with the arthroscopic findings was 97%, 100% and 97.3%, respectively. The weighted kappa index was 0.7194 and the SE (standard error) was 0.053, suggesting significant consistency. CONCLUSION: The sagittal fat-suppressed 3D SPGR MR imaging is valuable for determining the extent and degree of the articular cartilage lesion of the medial femoral condyle in an osteoarthritic knee.

Treatment of Nonunion of Proximal Scaphoid Fractures Using Vascularized Bone Graft / 대한정형외과학회잡지

PURPOSE: To evaluate the radiographic and clinical results of the treatment of nonunion of scaphoid proximal fractures using vascularized bone graft and internal fixation, and to present the surgical procedures in detail. MATERIALS AND METHODS: Six patients with established nonunion of scaphoid proximal fractures who had been treated by vascularized bone graft and internal fixation from the year of 2000 to 2003 were analyzed retrospectively. The mean ages were 27.8 years old (18-45) and all the patients were male. The average follow up period was 13 months (8-18), and the causes of injuries were fall down in 4 cases, and motor vehicle accident in 2 cases. The 1, 2-intercomparmental supraretinacular artery was used as a vascular pedicle for the bone graft and fixed with a Herbert screw. RESULTS: All the non-unions had united at a mean period of 8.7 weeks (7-11). According to the Maudsley and Chen's criteria, 4 and 2 cases showed excellent and good results, respectively. There was one case of dysesthesia on the superficial branch of the radial nerve after surgery, which was resolved in 2 months. CONCLUSION: A vascularized bone graft is an useful method for treating a nonunion of scaphoid proximal fractures without severe arthritic changes, and can achieve a shorter immobilization and improved bone healing.

Percutaneous Carpal Tunnel Release Using Curved Hemostat and Meniscectomy Hook Knife / 대한정형외과학회잡지

PURPOSE: The aims of this study were to introduce a method of percutaneous carpal tunnel release and report the results of our experience. MATERIALS AND METHODS: A percutaneous carpal tunnel release was performed using a curved hemostat and a meniscectomy hook knife through a small transverse incision at the proximal wrist crease. Among 125 cases from 81 patients, 91 wrists from 58 patients were evaluated retrospectively in terms of the symptomatic resolution and complications. The mean follow up period was 38.9 months ranging from 12 to 118 months. RESULTS: All but one cases (99%) showed a complete symptomatic resolution or a marked improvement postoperatively, and 94.5% of cases were satisfied with the final result. Two patients had a second operation, one chronic renal failure patient showed recurrent symptoms after an initial improvement and the other showed persistent symptoms. There were two superficial palmar arch injuries and one digital nerve injury. However two of them were the earliest cases of an inexperienced surgeons. CONCLUSION: When an experienced surgeon performs a percutaneous carpal tunnel release meticulously, it is a safe and reliable method with the benefits of less postoperative pain and an early recovery.

Operative Treatment of Patellar Fractures

PURPOSE: To establish a general guide line in the treatment of the patellar fracture MATERIALS AND METHODS: Twenty three patellar fractures followed for 2.2 years in average, treated with internal fixation were evaluated retrospectively. The primary fixations were the metal screw fixation in 7, the Dall-Miles' cable circumferential fixation in 14 and combination of both methods in 2 cases. The additional fixations were the tension band wiring in 9, the load sharing cable fixation in 3 and combination of both methods in 5 cases. The initial postoperative immobilazation of the knee joint in flexion, preferably 90degrees, for 7 days was effective to gain full range of motion RESULTS: Complete union without displacement was achieved in all cases. Full ROM was achieved in all cases except one. CONCLUSION: The choice of internal fixation need to be individualized according to the level of comminution, bone strength, fracture site and soft tissue damage. A strong internal fixation, initial immobilization in flexion followed by early ROM exercise were important factors to gain good result.