Coxa Vara with Spondylometaphyseal Dysplasia / 대한정형외과학회잡지

Developmental coxa vara is a rare disease and the symptoms do not appear at birth, but rather, they appear at the age of walking. Clinically, the symptoms include a waddling gait, limb length discrepancy and frequent weariness. Developmental coxa vara is sometimes associated with skeletal dysplasia. Especially, it is associated with spondylometaphyseal dysplsia and the vertebral bodies and long bones are affected. The authors report here on diagnosing and treating this rare disease and we review the relevant literatures.

Correlation between the Likert Scale and the Numeric Rating Scale for Evaluating Knee Pain

PURPOSE: The Likert scale and the numeric rating scale (NRS) have been widely used to evaluate knee pain. The purpose of the present study is to compare the Likert scale and the NRS. MATERIALS AND METHODS: The records of 350 patients who had painful knees were investigated from June 2008 to June 2009. The patients were divided into three groups. Group 1 included 98 patients who were admitted for total knee replacement, while group 2 consisted of 141 patients who underwent total knee replacement within a minimum of 1 year (range: 1 to 5 year), and group 3 included 111 patients who were treated with conservative methods. We simultaneously evaluated the Likert scale and the NRS and we analyzed the relationships between them using Pearson's correlation test. RESULTS: The correlation coefficients between the Likert scale and the NRS was -0.91. The correlation coefficients for each group was -0.75 (group 1), -0.78 (group 2), and -0.68 (group 3), respectively. CONCLUSION: The Likert scale was correlated with the NRS and there were no significant differences between these two scales for evaluating knee pain. It is believed that the Likert scale is another useful tool for expressing knee pain.

Ankle Lesions, Associated with Anterior Soft Tissue Impingement / 대한족부족관절학회지

PURPOSE: To evaluate clinical features of ankle lesions, associated with anterior soft tissue impingement. MATERIALS AND METHODS: We retrospectively reviewed 21 patients who had chronic anterior ankle pain as initial symptom and associated ankle lesions with anterior soft tissue impingement. Based on preoperative radiologic findings, physical examination intra-operative findings, appropriate procedures were done for lesions by either arthroscopic or minimal open procedure or combined. Clinical evaluation was done using American Orthopedic Foot and Ankle Society, ankle-hind foot score (AOFAS score) and visual analog scale (VAS) on last follow up. RESULTS: Associated lesion(s) to anterior soft tissue impingement of the ankle were 16 cases of osteochondral lesion of talus, 14 cases of bony impingement, 6 cases of ankle lateral instability, 5 cases of loose body, 4 cases of os subfibulare. AOFAS score was 58.9 +/- 5.1 preoperatively and 74 +/- 9.1 on last follow up. Clinical satisfaction score using VAS showed excellent in 3 cases, good in 11, fair in 3, poor in 4. CONCLUSION: The patients who had anterior soft tissue impingement would have various associated lesions on their ankle. In such cases, preoperative counseling for variety of postoperative results would be needed.

A Case of Cerebellar Dysfunction After Acute Organotin Poisoning / 대한산업의학회지

BACKGROUND: We performed a follow-up study of an acute organotin poisoning case on the neurological sequelae that remained after 3 years since diagnosis. CASE: In the previous study, a 43-year-old male was reported for acute organotin poisoning. After 3 years, the neurological sequelae were studied using neurological examination, cognitive tests, neurobehavioral tests (by CAYSYS 2000(TM)), brain magnetic resonance imaging (MRI), and 18F-fluorodeoxyglucose (18F-FDG) PET/CT. Upon neurological examination and other tests, orientation was improved compared to that 3 years before, but cerebellar ataxia, dysmetria and dysdiadochokinesia remained the same, with little change. Brain MRI showed cerebellar atrophy. 18F-FDG PET/CT revealed mildly decreased metabolic activity in the pons and in both cerebellar hemispheres. DISCUSSION: This is the first brain MRI study on cerebellar atrophy caused by organotin poisoning. Cerebellar ataxia was confirmed by decreased metabolic activity in 18F-FDG PET/CT.

A Case of Chemical Pneumonitis After Ingestion of Hydrocarbon / 대한산업의학회지

BACKGROUND: Hydrocarbon is used frequently in the home in places such as the kitchen, garage, and basement. Accidental ingestion of hydrocarbons occurs generally in infants and children in the home. In cases of accidental ingestion, the amount is usually too small to cause medical problems, but can bring about diseases such as chemical pneumonitis. CASE REPORT: After ingesting organic solvent mistaken for mineral water, a 53-year-old male complained of cough, fever, and pain in the right upper abdomen, back, and right chest. Simple chest x-ray revealed focal chemical pneumonitis mainly involving the right middle lobe. The resulting lung abscess did not resolve until after treatment with drainage accompanied with antibiotics therapy. The ingested solution was analyzed and found to be a C11~C13 hydrocarbon mixture which has low viscosity. CONCLUSION: Chemical pneumonitis occurred after ingestion of hydrocarbon solution, and there is evidence of aspiratory mechanism.

Early Objectified Detection Method of Sensorineural Component in Hand Arm Vibration Syndrome / 대한산업의학회지

OBJECTIVES: In order to determine find out the best methods for a more objective detection of neurologic abnormality in early hand arm vibration syndrome(HAVS), early with analyzing the validity of each of the detection methods was analyzed. We evaluated the relationships between the sensorineural stage of Stockholm-revised vibration syndrome classification and the results of several tests. METHODS: 497 workers were investigated for symptom, exposure duration, the types of tools used, and medical history from January 2000 to December 2007. Pain sense threshold, vibrotactile threshold, hand grasp force, finger grasp force, and a finger tapping frequency test were performed by the workers. RESULTS: The grinder(67.3%) was the most commonly used tool and the mean exposure duration was 14.8 years. Although the pain sense and vibrotactile threshold level tended to increase according to sensorineural stage of the Stockholm classification, there was statistically significant difference in the vibrotactile threshold of 125, 250 Hz (p=0.006~0.038) but not in the pain sense threshold. Hand and finger grasp force tended to decrease according to the sensorineural stage of Stockholm classification and there was statistically significant difference(p=0.041,<0.001, 0.034) only on the right hand side. The tapping frequency also generally decreased according to the sensorineural stage of the Stockholm classification and there was statistically significant difference (p=0.002~0.019) only on the left hand side. CONCLUSIONS: Although there is no single standardized method that can objectively diagnose the sensorineural component of early HAVS early, the combination of subjective symptoms, the sensorineural stage of Stockholm classification, the pain and vibrotactile threshold test, the hand and finger grasp force, and the finger agility (tapping) test can objectively detect sensorineural component of HAVS early.

Early Objectified Detection Method of Sensorineural Component in Hand Arm Vibration Syndrome / 대한산업의학회지

OBJECTIVES: In order to determine find out the best methods for a more objective detection of neurologic abnormality in early hand arm vibration syndrome(HAVS), early with analyzing the validity of each of the detection methods was analyzed. We evaluated the relationships between the sensorineural stage of Stockholm-revised vibration syndrome classification and the results of several tests. METHODS: 497 workers were investigated for symptom, exposure duration, the types of tools used, and medical history from January 2000 to December 2007. Pain sense threshold, vibrotactile threshold, hand grasp force, finger grasp force, and a finger tapping frequency test were performed by the workers. RESULTS: The grinder(67.3%) was the most commonly used tool and the mean exposure duration was 14.8 years. Although the pain sense and vibrotactile threshold level tended to increase according to sensorineural stage of the Stockholm classification, there was statistically significant difference in the vibrotactile threshold of 125, 250 Hz (p=0.006~0.038) but not in the pain sense threshold. Hand and finger grasp force tended to decrease according to the sensorineural stage of Stockholm classification and there was statistically significant difference(p=0.041,<0.001, 0.034) only on the right hand side. The tapping frequency also generally decreased according to the sensorineural stage of the Stockholm classification and there was statistically significant difference (p=0.002~0.019) only on the left hand side. CONCLUSIONS: Although there is no single standardized method that can objectively diagnose the sensorineural component of early HAVS early, the combination of subjective symptoms, the sensorineural stage of Stockholm classification, the pain and vibrotactile threshold test, the hand and finger grasp force, and the finger agility (tapping) test can objectively detect sensorineural component of HAVS early.

A Case of Raynaud's Phenomenon of both Feet in a Rock Drill Operator with Hand-arm Vibration Syndrome / 대한산업의학회지

BACKGROUND: There have been many studies on hand-arm vibration syndrome (HAVS) for almost a century. The Stockholm Workshop scale has been accepted as a useful tool in diagnosing HAVS. Although they are not standard tests for diagnosis, cold provocation test and plethysmography of the fingers are commonly used as objective measurements to confirm the vascular component of HAVS. However, there are only a handful of case reports and studies worldwide on Raynaud's phenomenon in the toes. We report the case of a patient with HAVS who developed Raynaud's phenomenon in the toes after the vibration exposure had ceased. To our knowledge, this is the first report of this entity in Korea. CASE REPORT: A 58-year-old male, who had been diagnosed with HAVS in 2003, first noticed white toes in the summer of 2006 after immersing his feet in cold water. He had been working as a rock drill operator since 1976 for almost 30 years and had symptoms on his fingers since 1992. He underwent the cold provocation test, photoplethysmography, Nerve conduction velocity, and basic laboratory tests to rule out other causes of secondary Raynaud's phenomenon. To describe the severity of his feet, it could be classified as vascular stage 2 and sensorineural stage 1 if we were to apply the Stockholm Workshop scale. CONCLUSIONS: The patient showed vibration-induced white toes, and we would like to share the results of objective findings related to his condition. When diagnosing HAVS, symptoms of the feet should be assessed by the occupational and environmental medicine physicians. Further studies are needed to standardize test methods to diagnose "vibration-induced white toes."

Effect of Single-Rescuer Fatigue on the Quality of Cardiopulmonary Resuscitation with 30:2 and 15:2 Compression-toventilation Ratios

PURPOSE: Compression-to-ventilation (C:V) ratios of 30:2 are recommended in the 2005 guidelines for cardiopulmonary resuscitation (CPR). The aim of this study was to compare the quality of CPR performance with 30:2 and 15:2 C:V ratios and to evaluate the influence of single-rescuer fatigue on the quality of CPR performance. METHODS: Perceived fatigue and the quality of single-rescuer CPR performance were evaluated for fourth-year medical students randomized to perform CPR for 5 minutes at either a 30:2 or 15:2 ratio on a recording CPR manikin. RESULTS: Sixty students participated in this experimental study and were randomly assigned to two groups; group 30:2 (n=29, male=13, female=16) and group 15:2 (n=31, male=11, female=20). The mean percentage of correct compression (PCC) for 5 minutes was significantly different between two groups (group 30:2, 38.7+/-30.3% vs. group 15:2, 59.1+/-34.0%, p=0.017). A significant reduction in the PCC over the course of time was founded in group 30:2. In addition, the fatigue score in group 30:2 was significantly higher than in group 15:2 from the third minute (p<0.05). There was no significant correlation found between the body mass index of the rescuer and either PCC and fatigue score, but PCC decreased over the course of time for female students. Fatigue scores for female students in group 30:2 were also significantly higher than for men from the third minute (p<0.05). CONCLUSION: An increase in perceived fatigue and a decrease in quality of compression occurs with a 30:2 C:V ratio compared to a 15:2 C:V ratio from the third minute in single-rescuer CPR, and this effect is especially pronounced with female rescuers.

The Risk of Cervical Spine Injuries among Submersion Patients in River

PURPOSE: Recently, the American Heart Association recommended that routine cervical spine protection in submerged patients was not necessary, except in high-energy injury situations. However, until now, this recommendation has few supportive studies and literatures. This retrospective study was performed to demonstrate the risk of cervical spine injury in patients who had been submerged in a river. METHODS: Seventy-nine submerged patients who visited St. Mary's Hospital between January 2000 and December 2005 were included in this retrospective study. We investigated and analyzed the victim's age, sex, activity on submersion, mental status and level of severity at admission, prognosis at discharge, associated injuries, and risk group by using the medical records and cervical spine lateral images. According to the activity on submersion, victims were classified into three groups: high risk, low risk, and unknown risk. The reports of radiologic studies were classified into unstable fracture, stable fracture, sprain, degenerative change, and normal. RESULTS: The patients'mean age was 36.8 yrs, and 54% were males. Of the 79 patients, adult and adolescent populations (80%) were dominant. Jumping from a high bridge (48%) was the most common activity on submersion and accounted for 52% of the high-risk group. The Glasgow coma scale at admission and the cerebral performance scale at discharge showed bimodal patterns. The results of the radiologic studies showed one stable fracture, one suspicious stable fracture, and 18 sprains. The incidence of cervical spine fracture in submerged patients was 2.5% in our study. The incidence of cervical spine injury was higher in the high-risk group than it was in the low-risk group, especially in the jumping-from-high-bridge subgroup; however this observation was not statistically significant. No other factors had any significant effect on the incidence of cervical spine injury. CONCLUSION: Our study showed that even submerged patients in the high risk group had a low incidence of cervical spine fracture and that the prognosis of a patient did not seem to be influenced by the cervical spine fracture itself.

Effect of Posterior Lumbar Interbody Fusion for Maintaining the Reduction in Isthmic Spondylolisthesis / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study on the effect of posterior lumbar interbody fusion for maintaining the reduction in isthmic spondylolisthesis patients. OBJECTIVES: We evaluated the efficacy of performing posterior lumbar interbody fusion for maintaining the reduction in isthmic spondylolisthesis. SUMMARY OF THE LITERATURE REVIEW: There have been many reports regarding the surgical treatment of spondylolisthesis. Although there are many reports that the clinical results have nothing to do with the reduction, many surgeons have tried to maintain the reduction. However, the question about what kind of fusion modality is the most effective for maintaining the reduction is still controversial. MATERIAL AND METHOD: Between August 2002 and January 2004, 24 patients with isthmic spondylolisthesis were operated on. 14 underwent posterolateral fusion alone (group A) and 10 underwent additional posterior interbody fusion (group B). These two groups were compared in terms of the clinical results, the radiological changes and fusion rates. RESULTS: the reduction rate were 11.81% and 7.32% in the PLF and PLF+PLIF groups, respectively (p>0.05). The reduction losses were 0.19% and 0.35% in the PLF and PLF+PLIF groups, respectively (p>0.05). The changes after fusion were 0.11% and 0.10% in the PLF and PLF+PLIF groups, respectively (p>0.05). There was no case of nonunion. The satisfaction rates were 86% and 83% in the PLF and PLF+PLIF groups, respectively (p>0.05). CONCLUSIONS: In our study, the addition of posterior interbody fusion showed no benefit in maintaining correction. If solid fusion can be obtained, then posterolateral fusion seems to be sufficient enough to maintain correction in isthmic spondylolisthesis. The authors think that further studies are mandatory because of the small number subjects in our study.