Refractory Achilles Tendinopathy and Multiple Pain on the Tendon and Tendon Attachment Site of the Foot Related to Intermittent Levofloxacin Usage: A Case Report / 대한족부족관절학회지

Quinolone antibiotics are frequently prescribed for suspected respiratory or urinary tract infections because of their effectiveness and generally perceived safety profile. On the other hand, some studies have raised concerns regarding the potential association between quinolone use and Achilles tendinopathy or tendon rupture. There is a lack of reports on the link between quinolone use and multiple tendon and tendon attachment site pain in the foot and ankle joints; hence, this study examined this issue further. This paper presents a case report of a patient with persistent Achilles tendinopathy and multiple tendon and tendon attachment site pain in the foot who did not respond adequately to conservative treatments. In particular, the discontinuation of quinolone use resulted in favorable clinical outcomes. This report offers valuable insights into the potential risks associated with quinolone antibiotics and highlights the importance of vigilance when managing patients with tendon-related complaints. A comprehensive review of the relevant literature is also presented to contextualize these findings.

Clinical analysis of non-blood transfusion treatment in patients who refused a blood transfusion for obstetrical part / 대한산부인과학회지

OBJECTIVE: The goal of this study is to analyze the clinical manifestation of obstetrical patients who refused transfusion of any blood component. Through this analysis, we could define the guideline of non-blood transfusion treatment during the obstetrical procedure. METHODS: 127 patients who visited our non-blood transfusion treatment center and had obstetrical procedures from 1 Jan. 2000 to 31 March 2006 participated in this study. They were retrospectively analyzed according to the following indexes; the reason of refusing blood transfusion, age, ratio of vaginal delivery to Cesarean section, comparison of hemoglobin level, volume of blood loss, presence of bloodless treatment, days of hospitalization, presence of blood transfusion, consequence of patient (including complications and deaths). Bloodless treatment at the hospital are medical method (recombinant human erythropoietin, Aprotinin, Hemocoagulase, Tranexamine acid, Venoferrum), Autotransfusion and Electrocauterization. RESULTS: Among 126 patients (except for 1 patient who was delivered at the other hospital), the vaginal delivery group consisted of 57, and the Cesarean operation group was 69. The most common cause of primary caesarean section was arrest disorder of cephalo-pelvic disproportion. Among 26 patients qualified for indication of transfusion, uterine atony had the highest number of patients at 16. Among the indication of transfusion, low hemoglobin level (< or =8.0 g/dL) after operation had the highest number of patients at 20. Patients qualified indication of transfusion had twice more blood loss (464.6+/-34.2 ml vs 920.5+/-214.2 ml) and two more days of hospitalization (7.6+/-0.5 day vs 9.7+/-0.6 day) compared with those of non-qualified for indication of transfusion. Nobody received direct transfusion of blood component. There were no death but acute renal failure in one patient, and DIC (disseminated intravascular coagulation) in another patient as complications. CONCLUSIONS: This study analyzed the clinical manifestations of patients who refused a blood transfusion in obstetrics. Especially, when the non-blood transfusion treatment was performed, which had been an issue in recent times, more active treatment showed less reduction of hemoglobin level than no treatment. This study also confirmed that bleeding patients can be treated by selective non-blood transfusion treatment.

The effects of cervical conization on sexual function / 대한산부인과학회지

OBJECTIVE: This study is aimed to evaluate the effects of cervical conization on sexual function in patients with non-malignant conditions. METHODS: We choose thirthy-one patients who were operated by cervical conization. They were interviewed retrospectically that effects on sexual desire or interest, sexual activity or frequency, pleasure, communication and satisfaction with sexual relationship. RESULTS: After cervical conization, there was no statistically significant change (p>.05) in sexual desire or interest, sexual activity or frequency, pleasure, communication and satisfaction with sexual relationship. CONCLUSION: Cervical conization was not found to have any adverse effects on sexual function in our study. In this respects, conization is a suitable conservative method when treating patients with non-malignant conditions.

Bilateral Uterine Arterial Embolization for Treatment for Uterine Myoma / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to evaluate the effectiveness and safety of uterine artery embolization for the treatment of symptomatic leiomyomas in the patients who want to preserve uterus, want fertility or feel fear for operation. METHODS: From January 2003 to June 2005, among the patients with symptomatic uterine leiomyoma, fifteen women who wanted to preserve uterus or wanted fertility or had fear for operation were included in this retrospective study. Bilateral Uterine artery embolization (UAE) was performed. At the preprocedure and at 2, 6, and 12 weeks of postprocedure, transvaginal ultrasonography was performed for all patients. Clinical symptoms and follow-up information for each patient were evaluated. RESULTS: 15 leimyomas were treated with UAE. The initial mean volume of leiomyomas was 55.4 (46.3-67.4) cm3. The mean volume decrease was 58.6+/-9.7%, 77.5+/-12.3%, 86.8+/-23.5% at 2, 6, 12 weeks. The outcome of clinical symptoms were as followed; 'much improved' 20% (3/15), 'somewhat improved' 60% (6/15), 'no improvement' 20% (3/15), 'somewhat worsen's 0% (0/15), and 'much worsen' was 0% (0/15). There was no case of hysterectomy or myomectomy after UAE. And also no case of increasement of volume nor worsening of clinical symptoms were found. Lower abdominal pain was the most common symptoms after UAE, but complications were not detected. CONCLUSION: In this study, UAE to treat patients with uterine leiomyoma is proved to be effective not only in volume reduction, but also in symptom improvement. And it is a relatively less-invasive procedure which decreases the risk of side effects of operation. Above all things, it preserves fecundity in young women. Therefore, UAE is very effective and safe procedure in the treatment of symptomatic uterine leiomyoma.

A Case of Transvaginal Expulsion of Intramural Leiomyoma after Uterine Artery Embolization / 대한산부인과학회지

Uterine artery embolization for the treatment of uterine leiomyomas is gaining acceptance as an effective alternative to surgical treatment in preserving uterus and reducing symptoms. Vaginal expulsion of leiomyomas after UAE is uncommon, and has been regarded as a side effect of the procedure, as well as a natural phenomenon of treatment response. A-28-year-old unmarried woman who has been suffered from menorrhagia underwent UAE. MRI revealed the remnant leiomyomas were reduced in size and volume and also symptoms of leiomyomas were much improved. After 6 month, We've made sure about non-visualization of leiomyoma on follow-up pelvic dynamic MRI. We report this rare case of vaginal expusion of intramural leoimyoma with a brief literature.

Joint Contracture and Radiologic Features in Mucopolysaccharidosis / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical manifestations of contracted joints and the radiological features in mucopolysaccharidosis(MPS). MATERIALS AND METHODS: From January 1996 to March 2002, 15 children from a pool of children diagnosed with MPS through a fibroblast culture and an enzyme assay, who could tolerate a large umber of examinations, underwent orthopedic physical and radiological examinations. RESULTS: There were limitations in the abduction and internal rotation of the shoulder, extension limitation of the wrist, and internal rotation of the hip joint and flexion contractures of the elbow and DIP joints. Scoliotic deformities were all within the physiological curve. There were only three cases of a dorsolumbar kyphotic change and there were no neurological deficits due to the spinal deformities. The mean bone age was delayed compared with the mean chronological age. As the chronological age increased, the gap between the chronological age and the bone age increased. CONCLUSION: Joint contracture, which is the most severe symptom in orthopedic aspect, was more severe in the upper extremities than in the lower extremities. The spinal deformity was relatively mild and there were no neurological problems. The bone age tended to be delayed as the chronological age increased.

Treatment of Brachymetatarsia by Distraction Osteogenesis: Operative Technique and Results / 대한정형외과학회잡지

PURPOSE: To report on a new operative technique of distraction osteogenesis and it's results in brachymetatarsia. MATERIALS AND METHODS: 17 patients (39 metatarsal bones) formed the basis of this study (male: female-2: 15). To prevent varus deformity of the hindfoot after lengthening, all screws were inserted at the same level from the medial aspect of the first metatarsal bone for horizontal distraction in the anterior direction, rather than distraction in the direction of the anatomical axis. Also, care was taken to ensure that the screw for the fourth metatarsal bone did not interpose with the fifth extensor tendon. RESULTS: All cases achieved satisfactory lengthening and bony union, except 1 case. The healing index increased with patient's age. Plantar capsular release was performed in seven cases, six of which had been previously operated on bilaterally. There was no hindfoot varus deformity or entrapment of the fifth extensor tendon on final follow up. CONCLUSION: Varus deformity of the hindfoot can be prevented by horizontal distraction of the first metatarsal bone. Also, entrapment of the fifth extensor tendon can be prevented by careful handling of the fifth extensor tendon during operation on the 4th metatarsal bone. Complications of stiffness or of an increase in treatment period were mainly found in bilaterally operated or relatively old (over 20 year-old) patients.

Treatment for Intractable Infected Nonunion of Lower Extremity in Elderly People using External Fixator

PURPOSE: To introduce and report the results of treatment of old patients' infected nonunion using external fixator. MATERIALS AND METHODS: Nine patients more than 60 years old were included in the study. Four cases had combined medical problems of diabetes, hypertension, and vascular disorder. We used Ilizarov fixator in eight cases and uni-lateral external fixator in one. All patients were treated with debridement, broad sequestrectomy, segmental resection, bone graft and compression of fracture site about 1~1.5 cm. We evaluated the final results by functional result and complication according to the criteria of Paley. RESULTS: Average length discrepancy was 1.7 cm before operation by initial bone loss and final follow-up shortening was average 2.6 cm. Mean duration of fixtor removal was 5.2 months. We acquired bony union lastly in 8 cases. Final functional result was 3 excellent, 2 good, 2 fair and 2 poor. Among them, 2 good, 1 fair and 1 poor cases had medical problem. CONCLUSION: In old patients, compression of nonunion site and early joint motion using external fixator seemed to be very useful in the treatment of intractable infected nonunion of lower extremity and in minimizing duration of treatment.

Variability of Radiographic Measurements of Bowleg deformity in Children: A new method for Metaphyseal Diaphyseal Angle (MDA) / 대한정형외과학회잡지

PURPOSE: We investigate a new measurement method for bowleg deformity in children to reduce intra-observer and inter-observer error and to assess change in the angles measured with respect to the rotation of the lower leg. MATERIALS AND METHOD: Fifty-one children younger than 3 years old with bow leg were analyzed. To assess the intra-observer and inter-observer error of the Metaphyseal-Diaphyseal Angle, Intermetaphyseal-metaphyseal angle and Tibio-Femoral angle measurements, supine view antero-posterior radiographs of the lower legs were taken at the neutral rotation, at 10 degrees and at 20 degrees internal rotation positions. Also, the effect of the rotation of lower legs upon the measured angle was assessed by comparing and analyzing the angle values with respect to rotations of the lower leg. RESULTS: TInter-observer error showed statistically significant difference (p<0.05). All measured angles showed statistically significant differences with respect to the rotation of the lower legs. The measurement variability introduced by rotation was significantly greater than the intra-observer and inter-observer errors. The Intermetaphyseal-metaphyseal angle measurement had the lowest standard error and the highest correlation coefficient. CONCLUSION: The Intermetaphyseal-metaphyseal angle measurement seems a highly reliable method, which could be clinically utilized. Also, since the rotation of the lower legs influences the metaphyseal-diaphyseal angle, the clinician should consider this effect when studying a simple radiograph for bowleg deformity.

Mechanism of Tissue Injury in Experimental Retinal Artery Occlusion: Morphological Study I

We used an animal model of laser-induced retinal artery occlusion to study the temporal and spatial patterns of tissue injury and to identify apoptosis-like morphologic changes.We performed fundus exam and fluorescein angiography for 2 weeks.Rats were sacrificed at 6 hours, 12 hours, 1 day, 2 days, 3 days, 7 days, and 14 days after arterial occlusion.The arterial reperfusion was seen from 6 hours to 4 days.We could observe vascular tortuosity and retinal hemorrhage in the fundus.Six hours after retinal arterial occlusion, there were a lot of cells which had chromatin condensation.One to three days membrane budding and apoptotic body were identifed after occlusion.Most of inner retinal layers were destroyed following 7days.These data demonstrated that retinal artery occlusion induces apoptotic cell death in the retinal ganglion cell and inner nuclear layer.

Lumbar Spinal Stenosis and Diabetes Mellitus: Comparison of Surgical Outcome / 대한척추외과학회지

STUDY DESIGN: This retrograde study was designed to compare the clinical features and postoperative clinical results of diabetic and non-diabetic patients who had undergone decompression and postero-lateral fusion with instrumentation. OBJECTIVE: To determine whether diabetes affected the outcome of surgery and to identify the clinical features associated with a poor outcome. SUMMARY OF BACKGROUND DATA: Symptoms of peripheral angiopathy and neuropathy as long-term complications of diabetes closely mimic those of lumbar stenosis and there may be a risk of inappropriate surgical intervention in patients with both diabetes and spinal stenosis. In the presence of diabetes, a poor surgical outcome might be expected. But only a few literatures have been documented. MATERIALS AND METHODS: We reviewed 21 diabetic(mean age 58.2 years) and 21 non-diabetic patients(mean age 61.3 years) who had undergone decompression and postero-lateral fusion with instrumentation for lumbar spinal stenosis at a mean of 32 months after operation by reviewing the medical records such as clinical symptoms and results of objective examination(including electrophysiologic study). RESULTS: The preoperative symptoms were similar in the two groups except that abrupt onset of symptoms, the presence of night pain and the absence of any posture-related pain relief were recorded only by diabetic patients. The level of decompression, co-morbidity rate, and intra-operative blood loss were similar in two groups, too. Nerve-conduction velocity was lowered in 66.7% of the diabetic and in 25% of the non-diabetic patients. Polyneuropathy, which are highly suspicious of diabetic neuropathy was detected 46.7% in only diabetic group. The long-term result was excellent or good for thirteen(61.9%) of the twenty-one diabetic patients and for nineteen(90.5%) of the twenty-one non-diabetic patients. CONCLUSIONS: Thus diabetic patients who haute spinal stenosis cannot be expected to have same clinical outcome as non-diabetic patients, which is consistent with the general belief of impression. Therefore, the selection of patient according to clinical and electrophysiologic findings would be the most important factor in determining the rate of success of surgical treatment.

Result of Pedicle Screw Fixation in Lumbar Stenosis with: A Comparison of Degenerative Type Lumbar Stenosis with Spondylolisthetic type Lumbar Stenosis / 대한정형외과학회잡지

Concurrent use of instrumentation has been shown to increase fusion rates and satisfactory results for surgical treatment of the lumbar stenosis. The objectives of the present study were to evaluate clinically and radiologically two groups of lumbar stenosis who were surgically treated with pedicular screw fixation system and posterior lumbar interbody or posterolateral autogenous bone graft following complete posterior decompression. One group was degenerative type and the other group was spondylolisthetic type spinal stenosis. We analyzed the results of 39 cases of lumbar stenosis who underwent pedicular screw and rod fixation system and posterior lumbar interbody or posterolateral autogenous iliac bone fusion following complete posterior decompressive operation during the period from May 1988 to December 1992. There were 27cases of degenerative type and 12 cases of spondylolisthetic type lumbar stenosis. The were 25 women and 14 men. Their age was ranged 20 to 76 years old with an average of 51.7 years old. The follow up period was the interval from 18 months to 6 years with an average of 3.2 years. The radiologic union rate was average 94.9% and 96.3%(26cases) in degenerative spinal stenosis and 91.7%(11 cases) in spondylolisthetic spinal stenosis. The clinical success rate was average 92.3%(36 cases), 88.9%(24 cases) in degenerative spinal stenosis and 100%(12 cases) in spondylolisthetic spinal stenosis. The patients with spondylolytic spinal stenosis showed better result in their life than the patient with degenerative spinal stenosis.

Change of Carrying Angle in Fracture of the Lateral Humeral Condyle in Children / 대한정형외과학회잡지

From June 1980 to May 1986, 24 fractures of the lateral condyle of humerus in children ranging in age from 1 to 11 years were treated at the Department of Orthopedic Surgery, Kyungpook National University Hospital. Authors have been analized all cases of fractures clinically, especially the change of carryin angle by radiographic examination in follow-up periods. The results were as follows : 1. Fractures are more common in male than female. Mean age at time of fracture was 5.4 years. Fractures were predominated in the left side by 66.7%. 2. By the classification of epiphyseal injury, all cases were Salter-Harris type IV. By the classification of fragment displacement, Wadsworth type II fracture was most comrnon in 66.7%. They were treated with open reduction and internal fixation in 20 and with conservative treatment in 4. 3. The range of change in carrying angle was distributed from 9 degree decrease to 8 degree increase with a mean of 4.1 degrees. The range of change in carrying angle was influenced by degree of fragment displacement at the time of initial injury and longer period of follow-up. 4. The complications were lateral condylar voergrowth(20.8%), premature epiphyseal fusion(8.4%), snd nonunion(4.1%). By the criteria of Hardacre et al, 8 cases(33.3%) showed excellent result, 15 cases (6. 2%) showed good result, and 1 case (4.2%) showed poor result.