Treatment of an Unstable Intertrochanteric Fracture of The Femur Using a PMMA Augmented Compression Hip Screw / 대한정형외과학회잡지

PURPOSE: The aim of this study was to evaluate the clinical and radiological results of a PMMA augmented compression hip screw for the management of unstable intertrochanteric fractures of the femur in senile patients. MATERIALS AND METHODS: From May 1996 to May 2002, 30 patients (mean age 74.8 years, ranging from 51 to 89) with an unstable intertrochanteric fracture of the femur, were treated with a PMMA augmented compression hip screw. The average follow-up period was 16.8 months (12 to 36). Radiologically, the degrees of osteoporosis, the neck-shaft angle after the reduction, the position of lag screw in the femoral head, the degrees of sliding of the lag screw and the shortening of the limb when union had been achieved, the extent of the insertion of the PMMA cement, and the timing of bone union were analyzed. In addition, the changes in the ambulatory capacity were evaluated by the functional class of Koval. RESULTS: Radiologically, 5 cases of a varus deformity over 10degrees and 7 cases of lag screw sliding more than 15 mm were found in the 30 cases. However, there was no cutting out of the screw in femoral head nor was there fixation failure of the plate. In addition, union was finally achieved in all cases, although there were two cases of a delayed union. Clinically, satisfactory results were obtained in most of the cases according to the functional class of Koval. CONCLUSION: For senile patients with an unstable intertrochanteric fracture of the femur, PMMA augmented compression hip screw appears to be one of the more useful methods allowing the early ambulation and reducing the number of complications by the long immobilization.

Effects of Intra-Epiphyseal Vascularized Muscle Flap and Platelet Derived Growth Factor in Regeneration of Articular Cartilage of Lyophilized Humeral Head in Rabbits / 대한정형외과연구학회지

PURPOSE: The regeneration of injured articular cartilage is one of the most interesting things in orthopedic field. The aim of this study is to assess whether the degree of regeneration of a lyophilized autografted articular cartilage and the union capacity on osteotomized site could be improved by implanting a vascularized muscle flap into the epiphysis of autografted proximal humerus and applying platelet derived growth factor (PDGF) that stimulates the growth of chondrocytes in vitro into the reconstructed joint. MATERIALS AND METHODS: Nine rabbits were used in the experiment. A hemijoint reconstruction using a lyophilized autografted proximal humerus was done in 3 rabbits for control, and combined with a vascularized muscle flap using lateral thoracic artery into the epiphysis of proximal humerus and PDGF injection (0.25 mg/ml/kg) into the reconstructed joint for another 6 rabbits in experimental group. One rabbit in control group and two rabbits in experimental group on each the 3rd, 6th and 9th week after experiments were sacrificed. In both group, articular cartilage regeneration and union process of implanted autograft were followed by serial plain radiographs at the 3rd, 6th and 9th week and MRI at the 9th week after implantation. The histological investigations were followed at the same time. RESULTS: Radiologically, the control group showed delayed union in osteotomized site and sclerosis and collapse on articular surface as time goes, but the experimental group showed solid union by huge callus formation in osteotomized site and smooth articular surface. Histologically, the cartilage surface was irregular and the chondrocytes are completely destroyed with empty lacunae and revealed with severe osteoarthritic changes in whole layers in control groups, but the cartilagenous erosions and their arthritic changes are also noted with somewhat regeneration of chondrocytes in deep layer more prominently in experimental groups. CONCLUSIONS: These results suggest that an intra-epiphyseal vascularized muscle flap and injection of PDGF into the reconstucted joint can improve the functional results of lyophilized autograft by providing stimulation for bony union on osteotomized site and partial regeneration of injured articular cartilge.

The Effect of the Epidermal Growth Factor(EGF) on the Healing of the Injured Anterior Cruciate Ligament of the Knee in Dog: in Vivo Study / 대한정형외과연구학회지

PURPOSE: The purpose of this study is to find out the possibilities of the new treatment via continuous stimulation by photo-immobilization of growth factor in the anterior cruciate ligament(ACL) injury. MATERIALS AND METHODS: Photo-reactive epidermal growth factor(EGF-Az) synthesized by conjugating EGF with N-(4-azidobenzoyloxy)succinimide was immobilized onto biodegradable tissue-regenerative mesh(Bio-Mesh(R)) using UV irradiation. We sutured the BioMesh containing photo-reactive EGF on the artificial defect area of ACL in the left knee of beagle dogs and sutured the BioMesh that was not treated with EGF-Az on the defect area of ACL in the right knee. Four weeks later, we obtained the tissues from the defect area of both ACLs and compared the results of HE stain, immunohistochemistry and RT-PCR in both tissues. RESULTS: In results of HE stain and immunohistochemistry, we observed better cellular proliferation and more definite spindle shape of cells in EGF-immobilized area than in non-EGF defect area. Also cellular density was higher in EGF-immobilized area. On the other hand, cells had shaped more round and cellular density was lower in non-EGF defect area. In results of RT-PCR of GAPDH(Glyceraldehyde-3-phosphate dehydrogenase), COL I(Collagen type I), COL III and EGF, except for TGF-beta1(Transforming growth factor-beta 1), we also observed more definite expressions in EGF-immobilized area than in non-EGF defect area. CONCLUSION: We were able to confirm rapid cellular proliferation via artificial stimulation effect induced by photo-immobilized EGF. If EGF is immobilized onto biodegradable materials for clinical application, it will contribute to the treatment of ACL injury.

Kimura's Disease Involving The Eyelid and Orbit

PURPOSE: Kimura's disease is a benign slow-growing subcutaneous tumor, which is manifested clinically by one or more inflammatory nodules invading mainly the head and neck. Orbital, eyelid and lacrimal involvement by Kimura disease is rare. We report two cases of Kimura's disease involving the orbit and eyelid , which has not been reported in korea. METHODS: A 16-year-old male patient presented with the chief complaint of upper eyelid swelling and ptosis that was first noticed 15 years ago. Another 16-year-old male patient visited our clinic with multiple nodules involving the head, neck, left upper arm, and the both upper eyelids . Ocular examination of case.1 revealed upper eyelid swelling and redness, painless nodule, and ptosis. In case 1. patient, Orbital MRI scan showed thickening of the superior, inferior, medial rectus muscle, levator palpebrae muscle, and a well-demarcated homogenous mass in the superonasal portion of the left orbit. RESULTS: Histopathologically, the lesions were characterized by lymphoid follicles, infiltration of many eosinophils, lymphocytes, abnormal capillary proliferation and fibrosis. Laboratory findings definitely revealed peripheral blood eosinophilia in both patients. CONCLUSIONS: Kimura's disease should be suspected and considered in the differential diagnosis for the patients with the eyelid swelling and mass.

The Biocompatibility of Human Osteoblasts to Porous Coated Nickel-Titanium Alloy (porous NiTi alloy) with Thermal Shape Memory / 대한정형외과연구학회지

PURPOSE: This research is to clarify utilization and efficiency of porous coated NiTi alloy by observing its affinity on human osteoblast. In this study, the biocompatibility of porous NiTi alloy was analyzed by investigating the biological activity and growth patterns of osteoblasts on NiTi alloy in vitro, followed by comparative analysis of their activity on commercial titanium based alloy (TBA) and tissue culture polystyrene (TCP), as a control. MATERIALS AND METHODS: The human osteoblasts were obtained from the iliac crest of a normal adult and cultured with routine maneuver. A seeding of cultured human osteoblasts to each group (NiTi alloy : experimental 1 group, TBA: experimental 2 group, TCP: control group) was done at the 15th day of primary culture. At the 4th, 7th and 10th seeding day, we observed the morphology of cultured cells on the surface of materials using scanning electron microscope and measured the amount of biosynthesis of cell protein and activity of alkaline phosphatase. RESULTS: In the scanning electron microscope study, the osteoblasts in experimental 1 and 2 groups were proliferated well in similar levels. However in control group, growth of osteoblasts were significantly retarded than experimental 1 and 2 groups. And the biosynthesis of proteins and activity of alkaline phosphatase were significantly increased in experimental 1 and 2 groups time dependently but decreased apparently in control group. CONCLUSION: The porous NiTi alloy which was proved to have good affinity and biocompatibility on human osteoblasts could be used as one of press-fit implants in orthopaedic fields.

The Effect of LASIK on the Retina in Patients with High Myopia

PURPOSE: To investigate the effect of LASIK on the peripheral retina in patients with high myopia. SUBJECT AND METHOD: The difference between preoperative and postoperative retinal findings was investigated in 454 high myopic eyes underwent LASIK. RESULT: At postoperative 6 month, we did not observe any change in the preoperative retinal findings. CONCLUSION: From the above results, it is concluded that there is no significant effect of LASIK on the retina in patients with high myopia, at postoperative 6 month.

The Relation between Idiopathic Macular Hole and Perifoveal Vitreous Detachment

PURPOSE: To determine the relation between the pathogenesis of idiopathic macular hole and perifoveal vitreous detachment using OCT scan. METHODS: On 28 eyes with idiopathic macular hole stage 1,2,3 which was graded according to using the classification described by Gass and on 123 eyes from the normal contrast group, OCT scan were performed to obtain axial views of the vitreoretinal interface in the posterior pole. The incidence of perifoveal vitreous detachment was assessed. RESULTS: 18 of the 28 eyes (64.2%) from the macular hole group and 15 of the 123 eyes (12.1%) from the normal contrast group had perifoveal vitreous detachment on OCT scan. The difference was statistically significant (p<0.05).There was no statistically significant difference on the incidence of perifoveal vitreous detachment according to stage of macular hole. CONCLUSIONS: These results led to the conclusion that there is a significant relation between the pathogenesis of macular hole and the papillofoveal traction.

Slide Tracheoplasty for Congenital Tracheal Stenosis: Case Report / 대한흉부외과학회지

Congenital tracheal stenosis is very rare, but it leads to life threatening obstruction in infancy and childhood. Recently, we experienced two cases of congenital tracheal stenosis, involving half of the distal trachea. We adopted slide tracheoplasty procedure proposed by Peter Goldstraw. Tracheoplasty was performed by dividing the stenosis at midpoint, incising the proximal and distal narrow segments vertically on opposite anterior and posterior surfaces, and sliding these together. On case 1, the patient is now doing well. On case 2, the patient succumbed due to anastomotic disruption at postoperative day 4.

Pulmonary Aspergillosis in Cardiac Transplant Patients: The Report of Two Cases / 대한흉부외과학회지

Aspergillus Infection is a major cause of mortality in individuals with depressed cell-mediated immunity. Despite therapy with intravenous amphotericin B and oral antifungal agents, high mortality has been reported among heart transplant recipients. We experienced two cases of pulmonary aspergillosis among 15 cases of heart transplantation cases. Both cases were similiar in terms of age, time of diagnosis, diagnosis, and medication. Percutaneous needle aspiration biopsy revealed Aspergillus fumigatus in both cases. The first case showed multiple aspergilloma on both lung fields and were treated by IV Amphotericin B and oral itraconazole. After completion of treatment, the lesion completely disappeared and he has been followed up for more than one year in his good condition. The second case showed a single nodule on his right lower lung field and were treated by both medication and surgery. The patient recovered well and had been doing well until 4th postoperative month when he developed humoral rejection and expired.

Bivenrticular Repair of Double Outlet Right Ventricle with Remote Ventricular Septal Defect / 대한흉부외과학회지

Understanding of the surgical anatomy of patients with double outlet right ventricle (DORV) is important in the planning of biventricular repair. From May 1995 to September 1996, 7 patients underwent biventricular repair for DORV with remote ventricular septal defect. There were 5 males and 2 females. Age at operation varied from 2 to 9 years(mean 3.4+/-2.7years). Preoperative diagnostic assessment was made by two-dimensional echocardiography and cardiac catheterization. Ventricular septal defect was perimembranous inlet type in all patients. Associated cardiac anomalies were pulmonary atresia in two, pulmonary stenosis in five and tricuspid chordae attachment to conal septum in five. The operations were performed intraventricular repair and pulmonary enlargement in two, REV operation in two, and Rastelli operation in three. There was no early postoperative deaths and complications. The follow-up period was from 1 month to 18months, averaging 10+/-6.1 months. In the past,we considered the Fontan operation indicative as primary choice when DORV was associated with abnormal tricuspid chordal attachment to the conal septum,but now we believe that biventricular repair is feasible for those cases by making conal flap or reattachment method. Biventricular repair has theoretic advantages because it estabilishes normal anatomy and physiology,and it was concluded that the precise preoperative evaluation using both echocardiography and cardiac catheterization was essential to the successful surgery.

Aneurysm of the Sinus of Valsalva Dissecting into the Ventricular Septum Associated with Paravalvular Leakage After Double Valve Replacement / 대한흉부외과학회지

We experienced a case of aneurysm of the sinus of Valsalva dissecting into the ventricular dseptum. This dissection was induced by paravalvular leakage after aortic and mitral valve replacement. This 37-year-old male was admitted via emergency room due to progressive dyspnea. He had undergone aortic valve replacement(carbomedic(R) 23 mm) and mitral valve replacement(carbomedic(R) 31 mm) due to aortic regurgitation and mitral regurgitation about 6 years prior to admission and followed up regularly. The diagnosis was made by transthoracic and transesophageal echocardiography and reconfirmed by root aortography. The inlet of the ventricular septal aneurysmal sac was repaired by one layer suture with 3-0 prolene of the endocardium, epicardium and homograft muscle shoulder altogether. Postoperative course was uneventful and the patient was discharged on the 11th postoperative day.

Midline One-Stage Complete Unifocalization and Repair for Pulmonary Atresia, Ventricular Septal Defect associated with Major Aortopulmonary Collaterals: 1 case report / 대한흉부외과학회지

Pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals is a rare and complex lesion in which great morphologic variability exists regarding the sources of pulmonary blood flow. We report a case of this disease with no true central pulmonary arteries in a 9-month-old-boy successfully treated by one-stage complete unifocalization and repair from a midline sternotomy approach.

Surgical Treatment of Tennis Elbow / 대한정형외과학회잡지

Five cases of tennis elbow seen during the time period from Jaunary 1983 to January 1985 had operative treatment. Of the five clinical cases, four elbows in three patients were treated with Nirschl and Pettrone operation. This operative technique included exposure of the extensor carpi radialis brevis, excision of the identified lesion, and repair. The following results were obtained. 1. Correct analysis of the patient's emotional stability was essential prior to undertaking surgical procedure for tennis elbow. 2. The results of Nirschl and Pettrone operation were graded as excellent in three elbows and fair in one.