Prospective Randomized Study of Six Months' Chemotherapy and Nine Months' Chemotherapy for Cervical Lymph Node Tuberculosis / 결핵

BACKGROUND: Tuberculous lymphadenitis is one of the most common forms of extrapulmonary tuberculosis. It was recently reported that the treatment for tuberculous lymphadenitis could be shortened to 6 months without increasing the risk of a relapse. However, there is no report of a prospective randomized study on the use of 6-month chemotherapy with HERZ for cervical lymphadenitis, which is regimen recommended in the areas concerned with the initial drug resistance. The aim of this study is to evaluate the efficacy of the 6-month regimen with HERZ for cervical lymphadenitis in areas where there is a high prevalence of drug resistance in Korea. METHOD: From January 1997 to February 2002, 92 patients with cervical tuberculous lymphadenitis were recruited from Kyungpook national university hospital. Forty-six patients were given the 6-month regimen (2HERZ/4HER) and the other forty-six patients were given the 9-month regimen(2HERZ/ 7HER). RESULT: Of the 46 patients given the 6-month regimen, 5 had residual lymph nodes greater than 5mm after the completion of treatment and 3 had new lymph nodes or an increased lymph node size during the follow-up period. Of the 46 patients in the 9-month regimen, 9 had residual lymph nodes and 8 had new events during the follow-up period. There were no significant differences between thetwo groups. CONCLUSION: These results suggest that the 6-month HERZ regimen can be used safely as the initial treatment for tuberculous lymphadenitis in areas with a similar prevalence of drug resistance.

Loss of Heterozygosity on the Long Arm of Chromosome 21 in Non-Small Cell Lung Cancer / 결핵

BACKGROUND: Non-small lung cancer(NSCLC) develops as a result of the accumulation of multiple genetic abnormalities. Loss of heterozygosity(LOH) is one of the most frequent genetic alterations that is found in NSCLC, and the chromosomal regions that display a high rate of LOH are though to harbor tumor suppressor genes(TSGs). This study was done to determine the frequency of LOH in 21q with the aim of identifying potential TSG loci. METHOD: Thirty-nine surgically resected NSCLCs were analysed. Patietns peripheral lymphocytes were used as the source of the normal DNA. Five microsatellite markers of 21q were used to study LOH : 21q21.1(D21S1432, and D21S1994) ; 21q21.2-21.3(D21S1442) ; 21q22.1(21S1445) ; and 21q22.2-22.3(D21S266). The fractional allelic loss(FAL) in a tumor was calculated as the ratio of the number of markers showing LOH to the number of informative markers. RESULT: LOH for at least one locus was detected in 21 of 39 tumors(53.8%). Among the 21 tumors with LOH, 5(21.8%) showed LOH at almost all informative loci. Although statistically not significant, LOH was found more frequently in squamous cell carcinomas(15 of 23, 65.2%) than in adenocarcinomas(6 of 16, 37.5%). In the squamous cell carcinomas the frequency of LOH was higher in stage II-III (80.0%) than in stage I (53.8%). The FAL value in squamous cell carcinomas(0.431±0.375) was significantly higher than that found in adenocarcinomas(0.192±0.276). CONCLUSION: These results suggest that LOH on 21q may be involved in the development of NSCLC, and that TSG(s) that contribute to the pathogenesis of NSCLC may exist on 21q.

A study on changes of the Vertebral Pedicles and Mechanical Strengths after Screw Insertion / 대한정형외과학회잡지

Spinal fixation using pedicle screws has recently been the focus of increased attention, but the adequate size of pedicle screw and maximum percentage fill as related to the pedicle diameter and are not well known. The objects of this study were to determine the ideal ratio among pedicle, drill and screw diameter, and to determine the maximum percentage fill of the screw without significant decrease of pull-out strength. The materials used for the experiments were 376 thoracic pedicles obtained from the 38 young pigs, and the diameters of pedicles ranged from 3.0 to 8.5mm. After 40% to 100% drilling as compared to pedicle diameter, screws were inserted carefully, and measurements were taken of the outer pedicle changes and pull-out strengths, and adequate drill and screw sizes as related to the diameters of given pedicles were determined. It was found that pull-out strength was the strongest after 60% drill, and the larger the drill diameter, the smaller the holding power, and the larger the screw diameter, the greater the holding power. Maximum pull-out strength was seen at 80-90% fill with 60% drill. After sequentially drilling each pedicle with increasingly larger drill bits, larger screws could be inserted with pedicle changes such as expansion, cutout, split fracture, and comminuted fracture. after larger drilling up to 100%, pedicle screws with diameters smaller than 115% of measured pedicle diameters could be safly inserted without fracture and significant decrease of pull-out strength. It is concluded that effective percentages of drill and screw diameters to the pedicle diameter are 60% and 80-90% respectively, and pedicle screw up to 115% of measured pedicle diameter can be safely inserted into pedicle without significant decrease of pull-out strength. It is thought that fresh pedicle has elasticity and larger screw can be inserted to the pedicle with strong holding after larger drilling.

Tuberculous Lesion after Local Steroid Injections / 대한정형외과학회잡지

Local steroid injection is applied for the various problems in orthopaedic fields. Its not well known whether local steroid injection can induce or aggrevate the tuberculous lesion of the injection site. Tuberculous lesion of the shoulder and posterior compartment of the lumbar spine is rare, but rather commonly noted in the steroid injection group. Fifteen patients of tuberculous lesion(8 in shoulder and 7 in posterior compartment of the lumbar spine) after local steroid injection were treated surgically at the Department of the Orthopaedic Surgery, College of Medicine, Seoul National University, from Jan. 1980 to Agu. 1986, and following results were obtained; 1. The highest incidence was in the 6th decade and male to female ratio was 2: 13. 2. The average number of the injection was 16 times and the average duration was 6 months. 3. The duration from the last steroid injection to the first sign of the tuberculous lesion was from 2 weeks to 3 months and average 2.4 months. 4. Of the 15 cases, active tuberculous lesion at other sites were associated in 6 patients. 5. All cases were treated by complete curettage. It took 5.2 months for the primary wound healing. 6. Local steroid injection could induce or aggrevate the local tuberculous lesion. Radical extirpation of the lesion is the treatment of choice, but with high recurrence rate.

A Radiological Study of Normal Wrist in Korean People / 대한정형외과학회잡지

The carpal injury is difficult to diagnose due to anatomical complexity and the like. So, in order to get radiological knowledge of normal wrist, the authors measured the values which will be described on the wrist PA and lateral roengenogram obtained from 440 normal wrists(male : 188 cases, female : 252 cases) in randomly selected patients. The following results were obtained. l. Ulnar variance(mm±standard deviation): Total 1.1±1.2 : negative variance : 9.3%, positive variance : 56.1%, 2. Scapholunate Gap(mm±standard deviation): Total 0.4±0.7, 3. Ulnar Tilt(degrees±standard deviation): Total 23.6±5.3, 4. Volar Tilt, 5. Carpal height rstio : Total 0.52±0.05 male 0.53±0.04 female 0.51±0.05 : Total 13.1±5.9, 6. Carpal ulnsr distance ratio Total 0.05±0.05, 7. Scapholunate Angle : Total 49.9'±10.1', 8. Capitatolunate Angle Total 17.5'±10.0', 9. Radiolunate Angle Total 8.8'±6.7', 10. Carpal width ratio Total 0.72±0.08 11. Carpal thickness ratio Total 0.49±0.07.

The Effect of Hip Fusion in Living Activity / 대한정형외과학회잡지

Hip fusion has provided disease eradication, stabilization, pain relief and strenuous activity, but the possible complication of pseudarthrosis as well as loss of all motion is a drawback. Total hip replacement arthroplasty has not been a good procedure for active young patients. This study was perforrned to clarify the indications, the best position, the functional results of hip fusion and the effect of hip fusion on the adjacent joint. The authors reviewed 32 cases of hip fusion performed at the Department of Orthopedic Sugery, Seoul National University Hospital during the period of 11 years from April 1973 to June 1984 and the following results were obtained. 1. The average age of the patients at the time of operation was 20.3 years. 2. Tuberculosis of the hip was the most common cause (56.2%). 3. The satisfactory fusion was obtained in 26 cases (81,2 %). 4. The average position of fusion was 20±9 degrees of flexion, 1±5 degrees of abduction and 10±4 degrees of external rotation. 5. Although there was a disability due to limitation of motion after hip fusion, leg length discrepancy was reduced from 3cm (preoperative) to 2.5cm (postoperative) and scoliosis was decreased from 18' of Cobbs angle (preoperative) to 12' of Cobbs angle (postoperative). 6. After hip fusion, walking capacity was increased and back pain was reduced. 7. Age was barely correlated with absolute clinical scores, but better functional results were obtained in younger patients than in older patients. 8. The results were excellent or good in 24 cases (75%).

Surgical Treatment of Spinal Stenosis / 대한정형외과학회잡지

Spinal stenosis was defined as any type of narrowing of the vertebral canal, nerve canals or intervertebral foramina. It is difficult to diagnose spinal stenosis due to obscure symptoms and signs, and there is not established theory on its surgical treatment. Two hundred and three patients who had been treated surgically for lumbar spinal stenosis between 1979 and 1985 at Department of Orthopedic Surgery, Seoul National University Hospital, were studied in an attempt to define the etiology and the diagnosis, and to assess the results of surgical treatment. They were followed up from 1 year to 8 years with average duration of 3.5 years. 1. Degenerative change in the lumbar spine was the principal etiologic factor in 142 patients (70.0%) Spondylolisthesis was found in 47 patients (23 1%). 2. Back pain(81.3%) and intermittent claudication(71.4%) were the predominant symptoms, and sensory (61.1%) and motor(59.6%) deficit were the leading signs. Limitation of straight leg raising was observed only in 12.3%. 3. The most common myelographic finding was hourglass defect(38.4%) and that of CT was facet joint hypertrophy(97.6%). Preoperative CT with myelographic findings were confirmed intraoperatively in 97.4%, revealing their diagnostic significance. 4. Total laminectomy combined with foraminotomy and posterolateral fusion was the most frequently employed procedure and performed in 153 patients(75.4%). 5. The results were classified as excellent or good in 88.2%. Whether or not Knodt rod was used for internal fixation, there was no statistically significant difference between the two groups in reation to the results(P>0.05). Factors for satisfactory results were adequate decompression and posterolateral fusion with sufficient bone graft.

Experimental Scoliosis Induced by Electrical Stimulation / 대한정형외과학회잡지

Animal experiment was carried out to measure the physiologic changes of thoracic or thoracolumbar spine that occurred as a result of electrical stimulation, and to evaluate the usefulness of electrical stimulation as a possible treatment for scoliosis. Unilateral electrical stimulations were applied to the back muscle of immature rabbits.They were subgrouped into medial, intermediate, and lateral muscle stimulated groups in order to observe the effects of various electrode placements. The radiograms were taken every other week to observe the changes of the spinal curvatures for the period of 12 weeks. The histological studies of the muscles, which were obtained from the stimulated(right) and the nonstimulated(left) sides at the same level, also were carried out to determine the response of the muscles to the electrical stimulation. The results were as follows. l. A significant scoliotic curvature was observed two weeks after electrical stimulation, and those curvatures did not change more for the next six weeks in spite of prolonged stimulation. 2. Scoliotic curvature induced by electrical stimulation for eight weeks remained unchanged for another four weeks after stopping stimulation. 3. There were no statistical differences in the induced scoliotic curvature among the three groups stimulated at different sites of the medial, intermediate, and lateral regions respectively. 4. A prolonged unilateral electrical stimulation could induce the scoliosis, and may be used as a method for treatment of scoliosis.