Treatment of Calcaneal Fracture Malunion Using Lateral Exostectomy and Corrective Osteotomy: A Report of Three Cases / 대한족부족관절학회지

Inappropriate treatment for calcaneus fracture may result in malunion causing long-lasting pain and functional deficits. When such complications occur, the ideal principle of management is preserving congruence and motion of adjacent joints. For three patients with calcaneus fracture malunion, subtalar joint-preserving surgery using exostectomy and corrective osteotomy was performed, and satisfactory outcomes were achieved postoperatively.

Effectiveness of Selective Nerve Root Block for the Patient with a Single Level Lumbar Spinal Stenosis who is on the Operation Schedule

STUDY DESIGN: Retrospective study. OBJECTIVES: We reported the therapeutic usefulness of a selective nerve root block (SNRB) for patients with a single level spinal stenosis. SUMMARY OF LITERATURE REVIEW: Selective nerve root block for the radiculopathy due to lumbar disc herniation, spinal stenosis, and spondylolisthesis have been reported frequently. MATERIALS AND METHODS: We retrospectively examined 44 patients with single-level spinal stenosis, for whom surgical treatment was considered due to the failure of other conservative treatments from January 2005 to January 2010. All 44 patients were admitted for surgical decompression. Selective nerve root block was done just before a final decision of surgical procedure; patients with his or her 50% or more pain reduction could avoid surgery. RESULTS: In fourty-four cases, twenty-seven pateints underwent a surgical operation. Seventeen patients avoided surgical procedures by successful SNRB. As a result of a 3 year follow-up, the VAS score was significantly and continuously low on the operation group (p=0.02~0.03). K-ODI and Roland-Morris Disability scores were low in both groups until 1 year after the operation and SNRB procedure (p=0.026~0.042, p=0.03), but there was no statistically significant difference beteween the two groups after 2 years upon follow-up (p=0.072~0.14, p=0.06). Generally, the operation group had good results until 1 year after operation and had better tendency for improvement. The data displayed a high probability of surgical treatment among the patients with foraminal stenosis (p=0.039) highlight - this sentence says there is no difference after 1 year and there is still no difference after 2 years. If this is true, the sentence needs to be rewritten so that it says both times show no difference. If there is a difference between 1 year and 2 year then the sentence needs to be rewritten to make this more clear. The next sentence seems to say they are different. CONCLUSIONS: Selective nerve root block avoided the surgical intervention in 39% of the patients with the spinal stenosis refractory to the conservative treatment. Thus it is one of options for the refractory spinal stenosis.

Usefulness of Anterior Cervical Interbody Fusion Using Locally Harvested Bone: Locally Harvested Bone Versus Autogenous Iliac Bone / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the usefulness of locally harvested bone in anterior cervical interbody fusion. MATERIALS AND METHODS: A retrospective review was conducted, including 31 patients who underwent anterior cervical interbody fusion using a polyetheretherketone (PEEK) cage and anterior plate fixation. We randomly divided the patients into two groups, local bone group and iliac bone group. In 15 patients of the local bone group, the cage was filled with locally harvested bone, and in another 16 patients of the iliac bone group, the cage was filled with autogenous iliac bone. RESULTS: Improvements in mean visual analogue scale (VAS) scores, from 5.8 and 7.7 to 1.6 and 2.3 for neck pain and arm pain, respectively, were observed in cases using locally harvested bone, while the improvements were from 5.7 and 7.2 to 1.4 and 2.2, respectively, in those using autogenous iliac bone grafts. However, no significant differences in mean VAS and neck disability index were observed between the two groups at the last follow up (p>0.05). Radiologic union was achieved at 14.0+/-2.50 weeks in the local bone group, and at 12.62+/-1.58 weeks in the iliac bone group. However, no significant difference was observed between the two groups (p=0.076). CONCLUSION: Utilization of locally harvested bone for packing in a PEEK cage for anterior cervical interbody fusion is considered a useful method because it gives satisfactory clinical results for retention of bone union and lordosis angles.

Effect of supportive periodontal therapy on the prevention of tooth loss in Korean adults

PURPOSE: The purpose of this retrospective study was to evaluate the effect of patient compliance with supportive periodontal therapy (SPT) on tooth loss in Korean adults. METHODS: The periodontal records of 134 patients were reviewed for this study. They completed active periodontal treatment from 1999 to 2001 and were placed on a schedule of periodic follow-up visits for SPT. Patient compliance was classified into complete compliance (CC), erratic compliance (EC), and noncompliance (NC) groups. Re-examinations were carried out 11.0+/-0.8 years after the active periodontal treatment. The prognosis for each tooth was determined as good, questionable, or hopeless according to the bone loss observed in pretreatment radiographs. RESULTS: The rate of tooth loss of the CC group was significantly lower than that of the NC group. The tooth loss/patient and the tooth loss/patient/year were not significantly different between the three groups. The rates of tooth loss in the good, questionable, and hopeless prognosis groups were 6.7%, 9.5%, and 13.2%, respectively. For the teeth with a good prognosis, the rate of tooth loss of the CC group was significantly lower than that of the NC group (0.4% vs. 5.1%). For the teeth with a questionable prognosis, the CC group showed a significantly lower rate of tooth loss than did the EC group (4.1% vs. 30.7%) or the NC group (4.1% vs. 25.6%). For the teeth with a hopeless prognosis, the rates of tooth loss were not significantly different among the three groups. CONCLUSIONS: Within the limits of this study, the patients who showed a poor compliance with SPT were more likely to lose teeth than were the regularly compliant patients. However, the risk of tooth loss with a hopeless prognosis was high irrespective of the compliance.

Change in the Synthesis of Brain-Derived Neurotrophic Factor in the Dorsal Root Ganglion Following Peripheral Inflammation / 대한해부학회지

It is well known that nerve growth factor (NGF) may serve as a link between inflammation and hyperalgesia. However, there is little information whether brain-derived neurotrophic factor (BDNF), another family of neurotrophin, may related with nociception. In the present study, in situ hybridization was used to evaluate i) the change in the level of BDNF mRNA, ii) colocalization of the trkA mRNA and BDNFmRNA and iii) colocalization of the preprotachykinin (PTT)mRNA and BDNFmRNA following peripheral inflammation produced by an intraplantar injection of Freund's adjuvant into the rat paws. The results obtained were as follows: 1. Peripheral tissue inflammation significantly increased BDNFmRNA levels in the DRG. 2. Many neurons expressing trkAmRNA showed increased expression of BDNFmRNA following peripheral inflammation. 3. Many neurons expressing PTT mRNA showed increased expression of BDNFmRNA following peripheral inflammation. 4. Intraplantar injection of antibody to NGF together with Freund's adjuvant prevent the increase in BDNFmRNA. The present results indicate that the peripheral inflammation induces an increased synthesis of BDNF which is mediated by NGF and BDNF coexist with substance P in the DRG and that BDNF may play an important role related with nociception.

Dumbbell-Shaped Hypoglossal Neurinoma: Case Report and One-stage Operation

A case of dumbbell-shaped hypoglossal neurinoma is reported. Neurinomas of the hypoglossal nerve are very rare, only 35 cases reported. Of these cases, most are intracranial and only 7 were dumbbell-shaped with both intracranial and extracranial components. The clinical feature of the patient was marked ipsilateral atrophy of the tongue. Magnetic resonance imaging should be included in the examination of tumors, and great aids in planning the radical removal of the tumor. In this one-stage operation which was modified lateral inferior suboccipital craniectomy, the most important aspect was removal of the posterior wall of anterior condylar canal and lateral mass of C1. This approach requires a thorough understanding of microsurgical anatomy of the region of foramen magnum. Patient's postoperative course was uneventful. The literatures concerning this lesion were reviewed.

High Dose Urokinase Irrigation in the Management of Hypertensive Intracerebral Hematoma

It is well known that stereotaxic urokinase(UK) irrigation through a catheter is one of surgical methods in the management of hypertensive intracerebral hematoma(ICH) patients. Several authors recommended irrigation with 6000 IU UK, 4 times per a day. Based on authors' experience some patients who were managed with above protocol suffered from complications such as meningitis and/or pneumonia. It might be partially caused by prolonged duration of irrigation and immobilization of the patients. In order to reduce complications and to improve the final outcome of hypertensive ICH patients, we tried high dose UK irrigation(group II:irrigation with 50ml of normal saline mixed with 200,000 IU UK at immediate postoperative period, followed by two times of 20,000 IU UK irrigation per a day) to remove the ICH rapidly in those patients since Oct. 1991. We compared the rate of decreasing volume of hematoma, Glasgow coma scale(GCS) score change according to postoperative period, final outcome, and the rate of complications between this group(group II) and group I(4 times irrigation with 6,000 IU UK per a day). The results shows that the rate of decreasing volume of hematoma is slightly more rapid in group II than group I. The rate of poor outcome(vegetative and death) is lower in group II than I(group I vs. II:34% vs. 20% respectively). The rate of complication is lower in group II than I(group I vs. II:38.5% vs. 0.0%, respectively). One case(5%) of postoperative rebleeding was noted in group II. From this study, we concluded that, even if the beneficial effects are small, the high dose UK irrigation is one of protocols in the management of hypertensive ICH patients.

Trigeminal Neuralgia Caused by Epidermoid Tumor in the Cerebellopontine Angle

The authors report two cases of trigeminal neuralgia caused by epidermoid tumor in the cerebellopontine angle. The one case showed that trigeminal nerve was displaced superiorly by the tumor and was adhesed to the superior cerebellar artery. The other case showed that tumor mass encircled the facial, acoustic nerves as well as trigeminal nerve entirely and after removal of the tumor petrosal vein was found at the root entry zone of the trigeminal nerve. Interestingly these two cases were devoid of neurologic deficit. We tried microvascular decompression as well as removal of tumor and were satisfied with its result. We reviewed the literature and discussed these cases in point of mechanisms of trigeminal neuralgia.