Uncalcified Synovial Chondromatosis in the Pisotriquetral Joint

Synovial chondromatosis is a rare lesion in the wrist, but some cases in the distal radioulnar joint have been reported and previous case reports emphasize joint calcifications, shown on preoperative plain radiographs. We report an extremely uncommon case of synovial chondromatosis in the pisotriquetral joint, in which radiographs and magnetic resonance imaging did not demonstrate apparent calcified bodies. In our case, for the accurate diagnosis and treatment, surgical exploration of the joint and synovectomy with removal of loose bodies was performed.

Characteristics of Severe Hallux Valgus Deformity with Moderate Intermetatarsal Angle / 대한족부족관절학회지

PURPOSE: The purpose of this study is to evaluate the characteristics of hallux valgus with severe hallux valgus angle (HVA) and moderate intermetatarsal angle (IMA) after proximal chevron osteotomy. MATERIALS AND METHODS: Between January 2008 and December 2010, 41 patients (48 feet) were treated with proximal chevron osteotomy and distal soft tissue procedure for symptomatic severe hallux valgus deformity (HVA > or =40degrees). Patients were divided into two groups, group M (IMA or =18degrees). Mean age of patients was 55.7 years (34~70 years) in group M and 60.0 years (44~78 years) in group S. Mean duration of follow-up was 20.4 months (12~41 months) in group M and 18.5 months (12~35 months) in group S. Radiographic parameters, including HVA, IMA, sesamoid position, metatarsus adductus angle (MAA), and distal metatarsal articular angle (DMAA), were compared between groups. Clinical results were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS). Recurrence rate at the last follow-up was compared between group M and group S. RESULTS: Preoperative HVA and grade of sesamoid position did not differ between the groups. However, immediate postoperative HVA and grade of sesamoid position were significantly larger in group M. Preoperative MAA and DMAA were significantly larger in group M. No significant difference in AOFAS score and VAS was observed between the groups at the last follow-up. Ten of the 27 feet (37.0%) in group M and two of the 21 feet (9.5%) in group S showed hallux valgus recurrence at the last follow-up. Group M showed a significantly higher recurrence rate than group S. CONCLUSION: Recurrence rate for severe hallux valgus with moderate IMA is higher than that of severe hallux valgus with severe IMA.

Treatment of Bilateral Hawkins Type II Talar Neck Fractures / 영남의대학술지

Talus fracture is less common than most fractures, and bilateral talar neck fracture is extremely rare. Complications associated with talus fractures are generally deemed common because of the anatomical characteristics of the talus, but few reports have described the methods of treating such complications and the results of bilateral talar neck fracture. We report here a case of bilateral Hawkins type II talar neck fracture that had good clinical results without complications after early surgical treatment.

Radiological Analysis of Osteoarthritis of the Second Metatarsophlangeal and Tarsometatarsal Joint / 대한족부족관절학회지

PURPOSE: The aim of this study was to investigate the radiological characteristics of the osteoarthritis of the second metatarsophalangeal (MTP) and tarsometatarsal (TMT) joint. MATERIALS AND METHODS: Between January 2002 and August 2010, 27 patients (33 feet) who had second metatarsal osteoarthritis (OA) were reviewed retrospectively. Group 1 was 14 patients (17 feet) with second MTP joint OA. Group 2 was 13 patients (16 feet) with second TMT joint OA. Group 3 was 24 patients (25 feet) had hallux valgus without second metatarsal (MT) OA as control. Weight bearing foot anteroposterior (AP) and lateral view were checked, and measured hallux valgus angle, metatarsus adductus angle (MAA), second MT functional length, first and second MT length by Hardy & Clapham method on AP view, angle of second MT with horizontal plane, calcaneal pitch, talo-first MT on lateral view. RESULTS: On weight bearing foot AP view, second MT functional length of group 1, 2, 3 was 2.4 mm, -0.1 mm, 0.7 mm and MAA of group 1, 2, 3 was 17.7degrees, 17.7degrees, 14.5degrees. Second MT functional length of group 1 was longer than control group and it was statistically significant. MAA was significant different between group 1-3 and group 2-3. Angle of second MT with horizontal plane of group 2 was smaller than control group and it was statistically significant. Other radiographic parameters have no statistical significance. CONCLUSION: Group 1 has long functional length of second MT and group 2 has small angle of second MT with horizontal plane.

Phenotypic and genotypic characterization of Bifidobacterium isolates from healthy adult Koreans

A total of twenty-two strict anaerobic and Gram-positive Bifidobacteria, identified as B. adolescentis, B. pseudocatenulatum, or B. longum, were isolated from healthy adult Koreans. We here investigated the cell morphology, antimicrobial resistance patterns to novel antibiotics and genotypic differentiation of Bifidobacteria assessing repetitive DNA element PCR [rep-PCR] fingerprinting using the BOXA1R primer at the species level. All Bifidobacterium spp., except B. adolescentis SPM1005 and B. longum SPM1205, formed round and convex colonies. All B. adolescentis, B. pseudocatenulatum, and B. longum were opaque white glossy in colony color, and short, long, and irregular rods in morphological shape. In addition, all B. adolescentis, B. pseudocatenulatum, and B. longum formed a variety of shapes ranging from rods to Vshaped, Y-shaped, clubbed rods, or irregular. All Bifidobacterium spp., except B. adolescentis SPM0214, were sensitive to daptomycin [DAP], linezolid [LIN], and tigecycline [TIG]. B. adolescentis SPM0214 was resistant to DAP. Genomic fingerprinting patterns of B. adolescentis, B. pseudocatenulatum, and B. longum were diverse and different from those of the KCTC strain. The band size of B. adolescentis, B. pseududocatenulatum, and B. longum varied from 3.0 kb to 300 bp, 2.0 kb to 200 bp, and 2.0 kb to 500 bp, respectively. In conclusion, twenty-two strains of B. adolescentis, B. pseudocatenulatum, and B. longum isolated from healthy adult Koreans were very diverse in both phenotype and genotype. Moreover, this diversity of phenotype and genotype may support that health promoting effects of individual strain of Bifidobacterium spp. human isolates could be different and specific even within same species

Supramalleolar Osteotomy in Patients with Varus Ankle Osteoarthritis / 대한족부족관절학회지

This article has reviewed the alignment of the ankle and hindfoot in varus ankle osteoarthritis. The indication and surgical technique of the supramalleolar osteotomy has been reviewed. Alignment of tibial plafond and hindfoot is variable in early stages of ankle osteoarthritis. Supramalleolar osteotomy is indicated for the treatment of ankle osteoarthritis in patients with minimal talar tilt and neutral or varus heel alignment.

Vascular Malformation of Flexor Hallucis Longus Muscle Associated with a Flexion Deformities of Toes: A Case Report / 대한골관절종양학회지

Vascular malformations may typically present with palpable mass that can be either asymptomatic or can present with symptoms including swelling and pain. On rare occasions, vascular malformation of muscle may produce joint deformities caused by contracture of the involved muscle. When vascular malformation involves the flexor muscle of the leg, ankle equinus deformity may occur. However, there are no reports of toe deformities secondary to intermuscular or intramuscular vascular malformations of flexor muscles of toe. Thus, we report a case of vascular malformation of flexor hallucis longus muscle with flexion contracture of toes in a 40-years-old woman who was treated with surgical excision.

Intraneural Hemangioma of the Median Nerve: A Case Report

Hemangioma of the median nerve is very rare and a few cases of intraneural hemangioma of this nerve have been reported in the literature. We present a case of 33-year-old man who had an intraneural hemangioma of the median nerve. He complained of symptoms of carpal tunnel syndrome for a month. On preoperative ultrasonography, a mass of the median nerve was observed in the region of the right wrist. At surgery, a mass of the median nerve was removed totally and histopathologic examination confirmed an intraneural hemangioma of the median nerve. The symptoms were relieved completely without any neurologic deficit after the operation.

Radiologic Characteristics of Vertebral Artery Injury in the Cervical Spine Fracture

STUDY DESIGN: A retrospective study. OBJECTIVES: This study was performed by probing vertebral artery injuries and their radiologic characteristics in cervical spine fractures, and analyzing MRI findings of vascular injuries. SUMMARY OF LITERATURE REVIEW: Vertebral artery injuries are found relatively often in cervical spine fractures. MATERIALS AND METHODS: We evaluated 57 cases of cervical spine fractures that occurred beginning in June 2011 and ending in February 2003. The characteristics of each fracture were evaluated using conventional radiographs, CT, and MRI. The presence of a vertebral artery injury was based on the absence of signal void in multilevel transverse foramens. RESULTS: Twelve out of the 57 cases (21.1%) were found to have unilateral vertebral artery injuries. Clinically, impairment in cerebral circulation was not found. We found no statistical correlation between the signal change in the spinal cord and in the vertebral artery injury (P=0.424). We noted fractures of transverse processes in 7 cases, 6 of which showed vertebral artery injuries. Thus, the transverse process facture was associated with t vertebral artery injury (P=0.000). There seemed to be no relationship between the vertebral artery injury and each of following: fracture level (P=0.416), fracture type (P=0.723) and severity of soft tissue injury (P=0.195). CONCLUSIONS: Unilateral vertebral artery injuries were frequently found in the cervical spine fractures. And of all radiographic factors associated with vertebral artery injury, only the presence of transverse process fracture was statistically significant. Absence of signal void at multi-section MR images is considered to be a useful guide to commence additional vascular evaluation.

Comparison of Radiologic Parameters between Weight Bearing Affected Single Ankle Anteroposterior View and both Ankle Anteroposterior View in Ankle Osteoarthritis / 대한족부족관절학회지

PURPOSE: This study was performed to analyze the results of radiologic parameters between weight bearing affected single ankle anteroposterior (AP) view and both ankle AP view in ankle osteoarthritis (OA). MATERIALS AND METHODS: Between January 2009 and August 2010, 41 patients (50 ankles) who visited our institution to treat ankle OA were reviewed retrospectively. In radiographic assessment, weight bearing affected single ankle AP view and both ankle AP view were checked, and measured tibial anterior surface angle (TAS), tibial medial malleolar angle (TMM), talar tilting angle (TT), maximum and minimun joint space width (JSW) of ankle, width between articular surface of medial malleolar and medial articular surface of talus as radiologic parameters. RESULTS: On weight bearing both ankle AP view, TAS was 85.4+/-4.1degrees, TMM was 33.1+/-9degrees, TT was 5.4+/-6.1degrees, maximum JSW was 3.2+/-2.7 mm, minimum JSW was 1.1+/-1.3 mm, width between articular surface of medial malleolar and medial articular surface of talus was 1.8+/-1.8 mm and on weight bearing affected ankle AP view, TAS was 85.3+/-3.9degrees, TMM was 34.3+/-10.9degrees, TT was 5.4 +/- 6.5degrees, maximum JSW was 3.2+/-2.7 mm, minimum JSW was 1.1+/-1.3 mm, width between articular surface of medial malleolar and medial articular surface of talus was 1.6+/-1.7 mm. CONCLUSION: There is no statistical significance in radiologic parameters between weight-bearing affected single ankle AP view and both ankle AP view in ankle OA.

Split Transfer of Extensor Digitorum Longus of the Second Toe for Elongation of EHB after Modified Jones' Procedure / 대한족부족관절학회지

Extensor hallucis brevis (EHB) is only extensor of the first metatarsophalangeal (MTP) joint after modified Jones procedure. Therefore preserving the normal insertion of the EHB has been emphasized during that procedure. We experienced a case of EHB rupture after modified Jones procedure and had satisfied surgical outcome by partial transfer of extensor digitorum longus (EDL) of second toe.

Results of Primary Total Knee Replacement According to Tibial Bone Defect : At Least 5 Years of Evaluation

PURPOSE: This study was performed to find out whether tibial bone defect preceeding the surgery has an effect on the outcome of patients who have undergone total knee replacement therapy with an evaluation period of more than five years. MATERIAL AND METHOD: Osteoarthritis patients who were treated with total knee replacement and evaluated for more than 5 years were selected, of which 42 patients were with tibial bone defects, and 21 without. Clinical evaluation were made on the basis of pre- and post-operative Knee Society Knee Score and Functional Score, radiological evaluation using the American Knee Society Score. and range of motion, tibio-femoral angle, subjective satisfaction, complication were evaluated. RESULTS: Knee fuction score and subjective satisfaction of the two groups showed significant improvement after the surgery, but comparison between the two was statistically insignificant. Radiological evaluation showed radiolucency in zone 1 and 2 of tibia in the majority of both groups, but dissociation of the inserted device was not shown. CONCLUSION: In the cases of tibial bone defect, bone cement, screw fixation enforced with autograft, and wedge metal insertions can be considered to be effective in treating patients by total knee replacement surgery.

The Use of Vancomycin-impregnated Polymethylmetactylate Beads for the Treatment of Chronic Osteomyelitis

One of the current treatment methods for chronic osteomyelitis is removal of the infected and necrotic tissue to reduce the bacterial concentration as much as possible. This is performed concomitantly with antibiotic therapy. Chronic osteomyelitis (C.O.) implies chronic ischemia of the diseased bone. Thus, the treatment for C.O. requires high systemic level of antibiotics. In some cases, however, inherent undesirable adverse effects (for example, nephrotoxicity, ototoxicity, and others) may render this course of treatment difficult. Knowing that residual monomers are released from hardened bone cement, installation of antibiotic-impregnated PMMA (polymethylmethacrylate) beads in situ have been one of treatment methods of C.O. When introduced into the wound, they established an exceedingly high level of local antibiotics for prolonged period without high systemic level of antibiotics. We experienced favorable results with vancomycin-impregnated PMMA beads for the treatment of C.O. of the mandible. So, we report it with literature reviews.

Overexpression of cyclin D1 and cyclin E in 1,2-dimethylhydrazine dihydrochloride-induced rat colon carcinogenesis

Deregulation of G1 cyclins has been reported in several human and rodent tumors including colon cancer. To investigate the expression pattern of G1 cyclins in 1,2- dimethyl-hydrazine dihydrochloride (DMH)-induced rat colon carcinogenesis, we studied the expression of cyclin D1 and cyclin E by quantitative reverse transcription-polymerase chain reaction (RT-PCR) analysis and immunohistochemistry (IHC). The mRNA level of cyclin D1 was increased 1.2-fold in adenocarcinomas but not significantly in adenomas, when compared with normal rat colonic mucosa (p<0.05). The cyclin E mRNA level was increased 2.7-fold in adenomas and 3.3-fold in adenocarcinomas (p<0.05). The PCNA mRNA level was also increased 1.9-fold in adenomas and 1.8-fold in adenocarcinomas (p<0.05). Immunohistochemical staining revealed exclusive nuclear staining of the neoplastic cells for cyclin D1, cyclin E and PCNA. Cyclin D1 expression was detected in 56.3% of the adenomas and in 61.5% of the adenocarcinomas examined, whereas cyclin E expression was detected in 87.5% of the adenomas and in 92.3% of the adenocarcinomas. Overall, cyclin D1, cyclin E and PCNA expression was significantly increased at both the mRNA and protein levels in normal colonic mucosa, adenomas and adenocarcinomas, but there was no significant difference in the degree of expression of these genes in adenomas and adenocarcinomas. Our results indicate that the overexpression of cyclin D1 and cyclin E may play an important role during the multistage process of rat colon carcinogenesis, at a relatively early stage, and may disturb cell-cycle control in benign adenomas, and thereafter, participate in tumor progression.

A CASE REPORT ON THE SURGICAL TREATMENT FOR THE ECTROPION AS A COMPLICATION OF RECONSTRUCTION OF BLOW-OUT FRACTURE

Ectropion is a drooping or eversion of the lower eyelid as a result of lower lid laxity, canthal tendon laxity, or cicatrix formation from scarring. Ectropion can also be congenital or develop with aging. This complication can arise from primary trauma to the lower lid apparatus or as a result of unfavorable healing and scar contracture. To prevent development of ectropion, a careful attention in case of operation for orbital frature repair or blepharoplasty is necessary. Especially, excessive dissection or retraction of skin and orbicularis muscle should be avoided, and formation of edema and hematoma should be prevented by complete hemostasis. It might be helpful to massage on the eyelid frequently. In spite of endeavors mentioned above, lareral canthoplasty or skin graft must be performed when postoperative ectropion is occurred. With literature review the authors present a case report that good clinical result is achieved by lateral tarsal strip procedure on cicatricial ectropion caused by a complication of reconstruction of blow-out fracture.

The Effects of Glutathione and Prostaglandin E1 on Recovery of Hepatic Function during Hepatic Ischemia and Reperfusion in Rabbits / 대한마취과학회지

The interruption of hepatic blood flow has been adopted as a method of bleeding control in hepatectomy and liver transplantation. But this occlusion of hepatic inflow may result in significant hepatic injury by various kinds of oxygen radicals produced as a result of hepatic ischemia and following reperfusion. Arterial ketone body ratio(AKBR) is adequatc and convenient parameter by which both acute and prolonged changes of the hepatic function can be estimated. Pharmacological modulation of hepatic injury during warm ischemia and early reperfusion has shown some benefical effects. The authors conducted an experiment to evaluate the inhibitory effect of glutathione and prostaglandin E on hepatic injury due to acute hepatic ischemia and reperfusion. Thirty rabbits were divided into three groups, such as control(n=10), GSH(n=10) and PGE(n=10) groups. Acute hepatic ischemia was induced through the application of portal triad cross-clamping for 30 minutes, and thereafter hepatic reperfusion was induced with the removal of cross-clamping. A single bolus of 200 mg glutathione was injected 10 min before clamp in GSH group, and 200 ng/kg/min of PGE continuously from 10 min before clamp to 30 min after declamp in PGE group. AKBR and hepatic histological findings hefore clamp, 30 min after clamp, 5 min and 30 min after declamp, respectively were compared among 3 groups AKBR was markedly decreased during the clamping period in all groups (P<0.05). In control and PGE groups AKRR was significantly increased after reperfusion than before clamp (P<0.05), but was significantly lower than before clamp. Thirty minutes after reperfusion in GSH group AKBR returned to normal level and was significantly higher than in control group (P<0.05). On light tnicroscopic examination of liver biopsy, mild swollen hepatocytes in the centrilobular zone were seen at ischemia and reperfusion in control and GSH groups, but nearly normal hepatic architectures in PGE group. These results suggest that glutathione has some benefical effect on protection of hepatic dysfunction, and PGE1 on protection of hepatocellular injury during hepatic ischemia and reperfusion.

Effects of propofol and thiopental sodium on the intracranial pressure under halothane or isoflurane anesthesia in the rabbit

The effects of halothane or isoflurane, alone and in combination with propofol or thiopental were investigated for their effects on intracranial pressure (ICP) in the rabbit, with inducing artificially-increased ICP with an intracranial balloon. The higher the end-tidal concentrations of either halothane or isoflurane, the lower the mean arterial pressures (MAP) and cerebral perfusion pressures (CPP). However, the ICP was not influenced by the depth of anesthesia for either inhalation anesthetics. The mean ICPs at 1.5 MAC of halothane and isoflurane were 14 +/- 2 and 20 +/- 2 mmHg, respectively. With the increase of intracranial volume using a 0.7 ml-saline balloon, the ICPs were increased to 193 and 205% in halothane and isoflurane anesthesia, respectively. The ICPs were returned to the levels prior to balloon inflation by the injection of thiopental or propofol. The authors conclude that propofol could be used to reduce ICP under halothane or isoflurane anesthesia if it is ascertained to have the characteristics of a balanced coupling between cerebral metabolism and blood flow like barbiturates do and that either halothane or isoflurane with increased concentrations may decrease MAP without significant change of ICP.