Outcomes of the Modified-Brostrom Procedure Using Suture Anchor for Chronic Lateral Ankle Instability: a Prospective, Randomized Comparison with the Bone Tunnel Technique / 대한정형외과학회잡지

PURPOSE: This study was performed prospectively and randomly to compare the clinical outcomes of modified-Brostrom procedures using the suture anchor and the bone tunnel for chronic lateral ankle instability. MATERIALS AND METHODS: Thirty patients were followed up for more than 1 year after the modified-Brostrom procedures. Fifteen procedures treated with a suture anchor and 15 procedures treated with a bone tunnel technique assigned randomly were performed by a single surgeon. The clinical evaluation was performed according to the VAS for pain, the Karlsson scale and Sefton grading system. Measurements of the talar tilt and anterior talar translation was performed using anterior and varus stress radiographs. RESULTS: There were no significant differences in the pain VAS between the 2 techniques postoperatively. However, the pain VAS at postoperative 4th day was significantly higher in the bone tunnel group. The Karlsson scale had improved significantly from a preoperative average of 45.2 points to 90.1 points in the suture anchor group, and from 44.6 points to 88.3 points in the bone tunnel group. According to the Sefton grading system, 13 cases (86.7%) in the suture anchor group and 12 cases (80%) in the bone tunnel group achieved satisfactory results. The talar tilt angle and anterior talar translation had improved significantly from preoperative average of 14.2degrees and 6.2 mm to 6.4degrees and 4.5 mm in the suture anchor group, from 13.8degrees and 6.4 mm to 6.1degrees and 4.2 mm in the bone tunnel group. There were no significant differences between 2 techniques. CONCLUSION: The techniques for ligament reattachment produced similar clinical and functional outcomes except for early-stage postoperative pain. Both modified-Brostrom procedures using the suture anchor and bone tunnel appear to be effective treatment methods for chronic lateral ankle instability. However, the suture anchor technique has an advantage of less early-stage postoperative pain.

Stenosing Peroneus Brevis Tendinitis Caused by Peroneus Quartus Tendon / 대한정형외과학회잡지

Peroneus quartus tendon is one of a group of accessory peroneal tendons present in humans. Associated pathologies include an attritional tear in the peroneus tendon, stenosing tendinitis, and peroneal tendon subluxation or dislocation. A 22-year old female patient, who presented suffering with lateral ankle pain and instability after ankle sprain, visited this hospital. The physical examination and MRI indicated a longitudinal tear of peroneus brevis tendon or chronic stenosing tendinitis caused by peroneus quartus tendon. Tenosynovectomy and an excision of the peroneus quartus tendon were performed. Satisfactory results were obtained at the 1 year follow-up after surgery. Orthopedic surgeons should consider the possible presence of the peroneus quartus tendon in a differential diagnosis of chronic lateral ankle pain.

Clinical and Colonoscopic Characteristics of Primary Signet Ring Cell Carcinoma in Colorectum / 대한소화기내시경학회지

BACKGROUND/AIMS: A primary signet ring cell carcinoma (SRCC) in the colorectum is unusual. This study evaluated the clinical and colonoscopic characteristics of primary colorectal SRCC. METHODS: Twenty-eight patients diagnosed with a primary colorectal SRCC and 100 patients diagnosed with a primary colorectal nonmucinous adenocarcinoma were enrolled in this study. The medical records and colonoscopic findings were reviewed. RESULTS: The mean age was younger in the SRCC patients than in the nonmucinous adenocarcinoma patients (47.3+/-15.5 years vs. 60.3+/-10.4 years, p<0.001). In SRCC, hematochezia was less frequent while abdominal pain was more common (p<0.001). Duke stages A or B was rare in SRCC (4/28, 14.3% vs. 58/100, 58.0%, p<0.001). The colonoscopic features of Borrmann type 4 was more common in SRCC (10/28, 35.7% vs. 3/100, 3.0%, p<0.001). The occurrence of a tumor in the right colon was more frequent in SRCC (17/28, 60.7% vs. 20/100, 20.0%, p<0.001). The diagnostic yield of the first colonoscopic biopsy was lower in the SRCC patients (85.7% vs. 98.0%, p=0.021). CONCLUSIONS: Primary colorectal SRCC appears to occur in younger patients compared with nonmucinous adenocarcinoma. A more advanced stage and an infiltrative lesion such as Borrmann type 4 appears to be common and the diagnostic yield of a colonoscopic biopsy tends to be low in primary colorectal SRCC.

Bilateral coronary arteriovenous fistula coexistent with atrial septal defect and pulmonary stenosis

A coronary arteriovenous fistula consists of a communication between a coronary artery and a cardiac chamber, a great artery or the vena cava. It is the most common anomaly that can affect coronary perfusion. Bilateral involvement of coronary fistula, however, constitutes an uncommon subgroup of coronary arteriovenous fistulas. We report a case which shows a rare occurrence of bilateral coronary arteriovenous fistula coexistent with atrial septal defect and pulmonic stenosis.