Management of Infections with Rapidly Growing Mycobacteria after Unexpected Complications of Skin and Subcutaneous Surgical Procedures

BACKGROUND: Infection caused by rapidly growing mycobacteria (RGM) is not uncommon, and the prevalence of RGM infection has been increasing. Clinical diagnosis is difficult because there are no characteristic clinical features. There is also no standard antibiotic regimen for treating RGM infection. A small series of patients with RGM infections was studied to examine their treatments and outcomes. METHODS: A total of 5 patients who had developed postoperative infections from January 2009 to December 2010 were retrospectively reviewed. Patients were initially screened using a mycobacteria rapid screening test (polymerase chain reaction [PCR]-reverse blot hybridization assay). To confirm mycobacterial infection, specimens were cultured for nontuberculous mycobacteria and analyzed by 16 S ribosomal RNA and rpoB gene PCR. RESULTS: The patients were treated with intravenous antibiotics during hospitalization, and oral antibiotics were administered after discharge. The mean duration of follow-up was 9 months, and all patients were completely cured of infection with a regimen of a combination of antibiotics plus surgical treatment. Although none of the patients developed recurrence, there were complications at the site of infection, including hypertrophic scarring, pigmentation, and disfigurement. CONCLUSIONS: Combination antibiotic therapy plus drainage of surgical abscesses appeared to be effective for the RGM infections seen in our patients. Although neither the exact dosage nor a standardized regimen has been firmly established, we propose that our treatment can provide an option for the management of rapidly growing mycobacterial infection.

Apocrine Hidrocystoma of the Cheek

No abstract available.

Thoracolumbar Intradural Schwannoma in a Patient with Osteopetrosis / 대한정형외과학회잡지

Schwannoma is a benign tumor derived from Schwann cells which are usually found in the head, neck, trunk, upper and lower extremities, and rarely in the thoracolumbar junction. Also, osteopetrosis is an idiopathic genetic skeletal disease that rarely occurs. Most reports of osteopetrosis are about long bone fractures, but spinal tumor in osteopetrosis has been rarely reported. Furthermore, there is no report about thoracolumbar intradural Schwannoma and its treatment in patient with osteopetrosis. Thus, we report the clinical results of a thoracolumbar Schwannoma in a 36 year-old female osteopetrotic patient who had progressive weakness, and dysesthesia of the left lower limb. The patient underwent laminectomy and total excision of tumor through a posterior approach, and a favorable clinical outcome was achieved.

Posterior Decompression and Fusion in Patients with Multilevel Lumbar Foraminal Stenosis: A Comparison of Segmental Decompression and Wide Decompression

STUDY DESIGN: This is a prospective study. PURPOSE: We compared the outcomes of segmental decompression and wide decompression in patients who had multilevel lumbar foraminal stenosis with back pain. OVERVIEW OF LITERATURE: Wide decompression and fusion in patients with multilevel lumbar foraminal stenosis may increase the risk of perioperative complications. METHODS: From March 2005 to December 2007, this study prospectively examined 87 patients with multilevel lumbar foraminal stenosis and who were treated by segmental or wide decompression along with posterior fusion using pedicle screw fixation, and these patients could be followed-up for a minimum of 2 years. Of the 87 patients, 45 and 42 patients were assigned to the segmental decompression group (group 1) and the wide decompression group (group 2), respectively. We compared the clinical and radiological outcomes of the patients in these two groups. RESULTS: There were no significant differences between groups 1 and 2 in terms of the levels of postoperative pain based on the visual analogue scale, the Oswestry Disability Score, the clinical results based on the Kirkaldy-Willis Criteria, the complication rate or the posterior fusion rate. On the other hand, the mean operating times in groups 1 and 2 were 153 +/- 32 minutes and 187 +/- 36 minutes, respectively (p < 0.05). The amount of blood loss during surgery and on the first postoperative day was 840 +/- 236 ml and 1,040 +/- 301 ml in groups 1 and 2, respectively (p < 0.05). CONCLUSIONS: These results suggest that segmental decompression offers promising and reproducible clinical and radiological results for patients suffering from multilevel lumbar foraminal stenosis.

Post-operative Changes of Cerebral Glucose Metabolism in Patients with Lumbar Spinal Stenosis with Pre-operative Anxiety: Statistical Parametric Mapping Analysis of F-18 FDG Brain PET

STUDY DESIGN: A prospective study. PURPOSE: To assess postoperative changes in cerebral glucose metabolism in anxiety patients with lumbar spinal stenosis (SS). OVERVIEW OF LITERATURE: Although an association between preoperative anxiety and abnormal cerebral glucose metabolism may exist, only a limited number of studies using F-18 fluorodeoxyglucose positron emission tomography (FDG PET) have evaluated preoperative to postoperative changes in cerebral glucose metabolism in SS patients in detail. METHODS: The present study was designed to assess preoperative to postoperative changes in cerebral glucose metabolism in anxiety patients with SS. F-18 FDG PET with statistical parametric mapping analyses was used to compare preoperative and postoperative regional brain glucose metabolism in 18 SS patients. RESULTS: F-18 FDG PET scans showed postoperative activation of several brain clusters in gray matter. These included left parahippocampus, left cerebellar tonsil, left inferior semi-lunar lobule, and right cerebellar tonsil. Areas that were deactivated postoperatively were the right insula, left fusiform gyrus, left orbitofrontal cortex, left inferior frontal gyrus, left middle frontal gyrus, left precuneus, and left inferior frontal gyrus. CONCLUSIONS: SS patients with preoperative anxiety showed altered cerebral glucose metabolism at postoperative follow-up.

Association of Estrogen Receptor Gene Polymorphism in Patients with Degenerative Lumbar Spondylolisthesise

OBJECTIVE: The purpose of this study was to investigate the possible association of estrogen receptor alpha (ERalpha) gene polymorphisms in a cohort of degenerative spondylolisthesis (DS) patients. METHODS: Accordingly, the authors examined the association between DS and ERalpha gene polymorphisms in 174 patients diagnosed with DS. The Pvu II and Xba I polymorphisms, bone mineral density at the lumbar spine and femoral neck, and biochemical markers were analyzed and compared in the 174 patients with DS and 214 patients with spinal stenosis (SS). RESULTS: A comparison of genotype frequencies in DS and SS patients revealed a significant difference for the Pvu II polymorphism only (p=0.0452). No significant difference was found between these two groups with respect to the Xba I polymorphism, BMD or biochemical markers. No significant association was found between the Pvu II polymorphism of ERalpha and BMD, vertebral slip or biochemical markers in patients with DS. CONCLUSION: These results suggest that the ERalpha gene polymorphism using Pvu II restriction enzyme influences the prevalence of DS.

Long-Term Changes of the Clinical and Nerve Electrophysiological Findings after Endoscopic Carpal Tunnel Release / 대한정형외과학회잡지

PURPOSE: The aim of this study was to analyze the clinical symptoms and function and the nerve electrophysiological changes between the pre-operative and long-term post-operative states of patients who underwent surgical treatment with endoscopic release of the carpal tunnel for idiopathic carpal tunnel syndrome. MATERIALS AND METHODS: This study was performed in 48 patients and 88 wrists with idiopathic carpal tunnel syndrome. All patients were treated with endoscopic carpal tunnel release using a single portal. The preoperative and the 3 years 5 months long-term postoperative clinical symptoms and function were evaluated using the Boston carpal tunnel questionnaire. The nerve electrophysiological status was evaluated using the Bland grade system. RESULTS: When the preoperative Bland grade was 2, 3, 4, 5, and 6, the range of the change of the symptom severity score was 1.38, 1.68, 2.40, 1.61 and 1.28, respectively, and the range of the change of the functional status score was 0.60, 1.34, 1.58, 0.93 and 0.88, respectively, at the long-term follow-up. The clinical symptoms were signifi cantly improved at the fi nal follow-up when the preoperative Bland grade was 2, 3, 4 and 5. The function was signifi cantly improved for all the preoperative Bland grades. On the nerve electrophysiological study, there was statistical improvement of the distal motor latency of the motor nerve and the nerve conduction velocity and amplitude of the sensory nerve. When the preoperative Bland grade was 2, 3, 4, 5 and 6, the extent of improved grade was 0.60, 0.75, 2.17, 2.87 and 4.25, respectively, at the long-term follow-up, and the Bland grade was signifi cantly improved when the preoperative Bland grade was 3, 4, 5 and 6. However, there was no statistical signifi cance between the Bland grade and the clinical state at the long-term follow-up. CONCLUSION: The clinical and nerve electrophysiological states were significantly improved at the long-term follow-up after endoscopic carpal tunnel release. When the preoperative Bland grade was 3, 4 and 5, the clinical symptoms, function and the nerve electrophysiological states were signifi cantly improved at the long-term follow-up.

Comparison of the Compression Hip Screw (CHS) and the Proximal Femoral Nail Antirotation (PFNA) for Intertrochanteric Femoral Fracture

PURPOSE: To evaluate the radiologic, clinical results between who had intertrochanteric fracture, treated with Compression Hip Screw (CHS) and Proximal Femoral Nail Antirotation (PFNA). MATERIALS AND METHODS: We retrospectively reviewed each 36 and 48 patients of intertrochanteric fracture which were treated with CHS or PFNA by one surgeon from January 2005 to June 2009. We evaluated mean operation time, amount of bleeding, radiologic results, and the clinical outcomes with the mobility score of Parker and Palmer, social function scoring system. RESULTS: The mean operation time, amount of bleeding were less in the PFNA group, there were 116.7 min, 486.1 ml for the CHS group versus 87.7 min, 289.6 ml for the PFNA group. The radiologic results were not significantly different. Decrease of mobility score of Parker and Palmer, social function score were similar. Proximal migration of leg screw and perforation of femoral head was 2 case and deep infection was 1 cases in CHS group. CONCLUSION: There were no significant differences that are clinical and radiological results in treatment of intertrochanteric fracture using the CHS and PFNA. But PFNA is less invasive device than CHS, therefore it may be useful device in elderly patients.

Treatment of Kienbock's Disease Using the 4+5 Extensor Compartmental Vascularized Bone Grafting Procedure: Early Experience / 대한정형외과학회잡지

PURPOSE: Kienbock's disease can be treated with a vascularized bone graft to provide relief of wrist joint symptoms and prevent collapse of the lunate. We evaluated the functional outcome and subjective satisfaction in patients with Kienbock's disease treated with the 4+5 extensor compartmental vascularized bone graft. MATERIALS AND METHODS: We included 6 patients in the study. 3 males and 3 females with an average age of 37.5 years (range 21-49). Kienbock's disease was staged by Lichtman classifi cation based on plain radiography. Three patients were in stage II and three in stage IIIA. Cooney's wrist function score was used to evaluate changes in severity of pain, functional status, range of motion, and grip strength. We also assessed subjective patient satisfaction, carpal height ratio and bone union on the radiographs, and the occurence of complications. The mean follow-up period was 30 months. RESULTS: Four patients had excellent and two had good outcomes of wrist function. Three patients showed excellent subjective satisfaction, and three were good. All patients showed radiographic bone union and no further progression of lunate necrosis. The presurgical carpal height ratio was similar to the value at last follow-up, and there was no radiographic carpal bone collapse. For two cases of Lichtman stage IIIA, the slight degenerative arthritis at the lunocapitate joint observed preoperatively did not change. Skin necrosis and pin track infection were not observed. CONCLUSION: The 4+5 extensor compartmental vascularized bone graft is a reliable procedure for Lichtman stage II and IIIA patients with Kienbock's disease, as it achieved not only pain relief and improvement of range of motion but also maintenance of the intercarpal bone relationship on radiographs, with relatively few complications.

Bilateral Traumatic Locked Posterior Dislocation of the Shoulder: A Case Report

PURPOSE: Bilateral traumatic locked posterior dislocations of the shoulder are very rare and there has been no report on the operative treatment for this injury in the Korean medical literature. MATERIALS AND METHODS: We present here a case of bilateral locked posterior dislocations of the shoulders after trauma and this was successfully treated with open reduction and lesser tuberosity transfer on the right shoulder and subscapularis tendon transfer on the left shoulder. RESULTS AND CONCLUSION: Twenty-four months later, the clinical and radiologic results were excellent.

Treatment of Ulnar Impaction Syndrome using Arthroscopy and Ulnar Shortening Osteotomy / 대한정형외과학회잡지

PURPOSE: To retrospectively analyze the follow-up results of patients with ulnar impaction syndrome, who were treated with arthroscopic debridement, thermal shrinkage and a simultaneous ulnar shortening osteotomy. MATERIALS AND METHODS: Eleven wrists from ten patients with ulnar impaction syndrome, which were diagnosed by the clinical history, physical examination, radiological evaluation and arthroscopic findings, and were treated by arthroscopic debridement, thermal shrinkage and ulnar shortening osteotomy were enrolled in this study. The minimum duration of the follow-up was one year. The ulnar variance was measured using Kreder's method, and the follow-up results were analyzed radiographically as well as clinically using the Chun and Palmer wrist score. RESULTS: According to the wrist scoring system, seven wrists were fair and four poor preoperatively. However, after surgery, eight wrists were excellent and three good. The average wrist score increased from 62 preoperatively to 93 at the last follow-up. The mean ulnar variance decreased from +3.3 mm (+0.4-+6.4 mm) preoperatively to +0.1 mm (-0.8-+1.3 mm) at the last follow-up. Radiological union of the osteotomy site was achieved after an average of 12 weeks. There were no cases of nonunion or malunion. CONCLUSION: When ulnar impaction syndrome is diagnosed by the clinical, radiological and arthroscopic findings, arthroscopic debridement, thermal shrinkage and simultaneous ulnar shortening osteotomy are useful treatments for relieving the patients symptoms.

Inhibitory Effect of Corni fructus on Compound 48/80-induced Mast Cell Activation and Vascular Permeability / 체질인류학회지

The fruit of Corni fructus (CF), a perennial herb, is believed to have anti-allergy effects, but its mechanism is unknown. The purpose of this study is to investigate the inhibitory effect of CF on compound 48/80-induced mast cell activation. For this, the effects of CF on the degranulation, the histamine release, the calcium influx and the change of the intracellular cAMP levels of rat peritoneal mast cells (RPMC) and influences of CF on the compound 48/80-induced cutaneous reaction were studied. The results were as follows; the compound 48/80-induced degranulation, intracelluar calcium influx and histamine release of RPMC was significantly inhibited by pretreatment with CF, the compound 48/80-induced cAMP level of RPMC were significantly increased by pretreatment with CF, CF significantly inhibited compound 48/80-induced vascular permeability of rat cutaneous tissue. From the above results, it is suggested that CF contains some substances which inhibit the compound 48/80-induced vascular permeability and mast cell activation.

Inhibitory Effect of Corni fructus on Compound 48/80-induced Mast Cell Activation and Vascular Permeability / 체질인류학회지

The fruit of Corni fructus (CF), a perennial herb, is believed to have anti-allergy effects, but its mechanism is unknown. The purpose of this study is to investigate the inhibitory effect of CF on compound 48/80-induced mast cell activation. For this, the effects of CF on the degranulation, the histamine release, the calcium influx and the change of the intracellular cAMP levels of rat peritoneal mast cells (RPMC) and influences of CF on the compound 48/80-induced cutaneous reaction were studied. The results were as follows; the compound 48/80-induced degranulation, intracelluar calcium influx and histamine release of RPMC was significantly inhibited by pretreatment with CF, the compound 48/80-induced cAMP level of RPMC were significantly increased by pretreatment with CF, CF significantly inhibited compound 48/80-induced vascular permeability of rat cutaneous tissue. From the above results, it is suggested that CF contains some substances which inhibit the compound 48/80-induced vascular permeability and mast cell activation.