The Comparison of Punctoplasty and Silicone Tube Intubation in Patients with Punctal Obstruction

PURPOSE: To compare surgical results of two patient groups with punctal obstruction. One group underwent punctoplasty while the other group underwent silicone tube intubation. METHODS: We compared postoperatively 48 eyes of 37 patients with punctal obstruction within and after one year of the procedure. 24 eyes of 17 patients had punctoplasty and 24 eyes of 20 patients had silicone tube intubation by the same surgeon. RESULTS: Upon follow-up within one year after the punctoplasty, 13 eyes (54%) showed no epiphora, nine eyes (38%) showed intermittent epiphora, and two eyes (8%) showed persistent epiphora. However, after silicone tube intubation, 20 eyes (83%) showed no epiphora, three eyes (13%) showed intermittent epiphora, and one eye (4%) showed persistent epiphora. Over one year after the punctoplasty, one eye (4%) showed no epiphora, 19 eyes (78%) showed intermittent epiphora, and four eyes (17%) showed persistent epiphora. However, after the silicone tube intubation, 17 eyes (71%) showed no epiphora, six eyes (25%) showed intermittent epiphora, and one eye (4%) showed persistent epiphora. CONCLUSIONS: Silicone tube intubation is more effective than punctoplasty in the long term treatment of punctal obstruction.

Different Effect of IVTA in the Management of Macular Edema Secondary to Perfusion and Ischemic Type BRVO

PURPOSE: To investigate the improvement of visual acuity with the different effects of ischemic and perfusion type branched retinal vein occlusion (BRVO), and explore the relationship between defects of the macular capillary network and intravitreal injection of triamcinolone acetonide (IVTA) for treatment of BRVO secondary to macular edema. METHODS: We compared macular capillary network condition, improvement of visual acuity due to ischemic range, and decrease of macular edema between 23 perfusion type BRVO patients and 21 ischemic type BRVO patients who were treated with IVTA for BRVO secondary to macular edema. RESULTS: Both ischemic and perfusion type BRVO exhibited decreased macular edema and showed meaningful improvements in visual acuity (P<0.01), but did not show a relationship between the defects in the macular capillary network and improvement of visual acuity. No differences were seen in macular capillary network defects between ischemic and perfusion type BRVO. CONCLUSIONS: IVTA had an effect on the decrease in macular edema and improvement of visual acuity for both ischemic and perfusion type BRVO. However, defects in the macular capillary network do not seem to have any effect on the improvement of visual acuity.

Effects of Heme Oxygenase-1 Inducer and Inhibitor on Experimental Autoimmune Uveoretinitis

PURPOSE: Experimental autoimmune uveoretinitis (EAU) is an animal model of posterior uveitis and heme oxygenase-1 (HO-1) is a well-known anti-oxidant factor. However, there is no report a protective role of HO-1 on EAU in vivo. To verify that HO-1 is induced in EAU by interphotoreceptor retinoid-binding protein (IRBP), that an HO-1 inducers ameliorates the associated inflammation, and that an HO-1 inhibitor exacerbates this inflammation. METHODS: Forty four Lewis rats were given either 40 mol/kg hemin or 40 mol/kg SnPP (tin protoporphyrin IX) by intraperitoneal injection and twenty two uveitis control rats were injected with 0.5 mL of saline once daily 5-20 days after IRBP immunization inducing EAU. Three normal control rats were used for Western blotting and ELISA assay of HO-1. The clinical uveitis signs of inflammation were scored in the three groups from 0 to 4 on alternate three days. To confirm the clinical results, histological and immunohistochemical stain of HO-1 were performed on the day of peak inflammation and Western blotting and ELISA assay of HO-1 were performed on 6th, 12th and 18th day after IRBP immunization. RESULTS: Hemin, an inducer of HO-1, ameliorated the clinical signs of EAU. In contrast, SnPP-treated rats show that the severity of the clinical sign were exacerbated at the peak period of the disease. These results are roughly compatible with histological, immunoblotting, and immunohistochemical evaluations and an ELISA assay of HO-1. CONCLUSIONS: We suggest that HO-1 plays an important protective role in EAU.

A Case of Surgical Repair For Convergent Strabismus Fixus with Bilateral Abducens Nerve Palsy

PURPOSE: We report a case in which a convergent strabismus fixus due to head trauma-induced bilateral abducens nerve palsy was successfully corrected. METHODS: A 45-year-old male patient who had bilateral,convergent strabismus fixus and limited eye movement because of bilateral abducens nerve palsy. A year previously, the patient had experienced a skull fracture and right facial nerve palsy caused by a traffic accident. At that time, the forced duction test revealed severe restriction of both eyes. The forced duction test still showed resistance after the right medial rectus muscle was disinserted. We made a conjunctival incision on the lateral canthal area and resected the right lateral rectus muscle. Then we performed lateral canthotomy, and fixed the lateral rectus muscle to the periosteum of the lateral orbital rim. When the left medial rectus muscle was disinserted, there was no resistance on the forced duction test. We then addressed the medial rectus muscle recession, superior and inferior rectus muscle transposition to the lateral rectus. RESULTS: Two years after the procedure, bilateral convergent strabismus fixus did not recur, even though right eyeball movement was impossible. Patient appeared an orthophoria at the primary position, and the cosmetic rersult was satisfactory.

Removal of Benign Tumors at the Eyelid Margin Using the Radiofrequency Surgical Unit

PURPOSE: To evaluate the efficacy of the radiofrequency surgical unit for the removal of benign tumors at the eyelid margin. METHODS: Twenty-five benign tumors at the eyelid margin were removed with the Ellman Surgitron F.F.P.F(R). Histologic examination of the excised tumors was performed in 18 of the 25 cases. RESULTS: There were 15 eyes of 15 females and 10 eyes of 10 males with age ranging from 20.9 to 73.5 years (mean, 41.8 years). Over a mean follow-up of 21.1 months, there was no instance of recurrence in any of the patients. In addition, there were no serious complications except temporary foreign body sensation and eye discharges. CONCLUSIONS: Using the radiofrequency surgical unit for benign tumors at the eyelid margin may simplify the surgery, avoid recurrence, and produce a satisfactory cosmetic effect.

Arthroscopic Treatment of Displaced tibial Intercondylar Eminence Fractures: A Comparison of K-wires vs. Screw Fixation / 대한정형외과학회잡지

OBJECTIVES: To assess and compare the degree of reduction and clinical results following arthroscopic cannulated screw and K-wire fixation for type III displaced tibial intercondylar eminence fractures. METHODS: From 1991 to 1997, 20 patients with type III of intercondylar eminence fractures were arthroscopically treated (K-wire in 12 and screw in 8) and followed up 31 mo. in average. Degrees of reduction, extension loss and residual joint laxity were checked. And statistical analysis was done (Mann Whitney U-test) . Functional results were recorded by Meyers & McKeever's criteria. RESULTS: Degrees of reduction showed +2.1mm in K-wire group, and -1.3mm in screw group (avg., p<0.05) . Anterior displacements were 2.2mm and 1.7mm in stress x-rays and 3.5mm and 1.2mm in KT-1000 arthrometer, respectively (avg.,p<0.05) . Average loss of extension was 7 in K-wire group and 3 in screw group. There were excellent 9, good 3 in K-wire group and excellent 7, good 1 in screw group. CONCLUSION: Because of arthroscopic screw fixation able to compress and sink the fragment, it may showed less extension loss and residual laxity than K-wire fixtion. It is recommendable for the first choice to the treatment of type III tibial intercondylar eminence fractures with relatively large fragment.

Lumbar Intradural Lipomatosis: A case Report / 대한정형외과학회잡지

Intradural lipomatosis is a rare clinical entity characterized by excessive fat deposition in the intradural space. And they occur slightly more frequently in males. It may lead compression of the spinl cord or lumbargo, radiating pain, paresthesia, intermittent claudication and if they involve the cervical and thoracic region, the patients with tumours in these regions most frequently present with a slow ascending monoparesis or paraparesis, cutaneous sensory loss and defective deep sensation. Only 3% of tumours have been reported in the thoraco-lumbar region. The diagnosis should be based on a combination of clinical, imaging, surgical, and histological findings, and especially the diagnostic procedure of choice in patients with progressive myelopathy is MRI scan as it produces accurate imaging without exposure to ionizing radiation. He was treated surgically-removal of excessive fat tissue and decompressive laminectomy. We report a case of intradural lipomatosis that we had removed by surgically.

Pull - out Strength of Different Multiple Suturing Method of the Cruciate Ligament / 대한정형외과학회잡지

The aim of this study was to measure the immediate pull-out strengths by increasing the number of suture loops and to compare the immediate pull-out strengths of three different suturing techniques. In one group, the number of suture loops increased from 2 to 9 and the suturing technique of multiple loops through the proximal ligament stumps was used. The other group, the three different techniques were transverse, vertical, and criss-cross suture. The ultimate strength for the 2 loops was 16.62 (+/-6.7)N, for the 3 loops was 34.45 (+/-12.5)N, for the 4 loops was 54.80 (+/-17.7)N, for the 5 loops was 74.30 (+/-21.4)N, for the 6 loops was 102.49 (+/-13.5)N, for the 7 loops was 105.05 (+/-24.8)N, for the 8 loops was 129.50 (+/-76.1)N, for the 9 loops was 229.50 (+/-48.7)N. The transverse suture had a mean ultimate strength of 47.38 (+/-14.8)N, where-as the vertical suture failed at 76.94 (+/-26.4)N and the criss-cross suture at 101.82 (+/-25.7)N. Consequently, their strength can be improved by increasing the number of loops and we suggest that the criss-cross suture technique is reliable method for clinical use, because of high failure strength and wider apposition area of bone to ligament.

Clinical Recovery after Surgical Treatment of Lumbar HIVD / 대한척추외과학회지

STUDY DESIGN: The authors retrospectively analysed the recovery of clinical symptoms after surgical treatment of lumbar HIVD. OBJECTIVES: To investigate the incidence of clinical symptoms, the recovery rate and time after surgical treatment and the difference between L4-5 and L5-S1 lesion. SUMMARY OF LITERATURE REVIEW: There are many reports concerning the clinical result of surgical treatment for the HIVD. They usually describe the result as excellent, good, fair and poor. We can't get any information about the recovery rate and recovery time of each clinical symptom from the reports . MATERIALS AND METHODS: Thirty-eight patients were treated by one level open discectomy from march 1991 to december 1995, The clinical symptoms and signs including SLR, motor deficit, sensory deficit, change of DTR and severity of radiating pain were periodically followed up on the predesigned protocol. RESULTS: In preoperative examination, SLR was positive in 82%, motor deficit in 76%, sensory deficit in 74%, DTR change in 50%, and radiating pain in 100%. The recovery rate of SLR was 96.8%, motor deficit ; 93.6%, sensory deficit ,78.6%, DTR change ; 21% and radiating pain ,84.2%. The average recovery time of SLR was 3.4 months, motor deficit ; 1.9 months, sensory deficit ; 5.3 months, DTR change ; 4.1 months and radiating pain ; 3.2 months. Motor and sensory deficit was more frequent in L4-5 lesion but DTR change was usually noted in L5-S1 lesion. The recovery rate and time showed no great difference between the two level. CONCLUSIONS: The recovery rate was higher in SLR, motor deficit and radiating pain rather than sensory deficit and DTR change. The recovery time was fastest in radiating pain but variable nature was noted in sensory deficit. Above results may be helpful to explain the prognosis of the lumbar HIVD.

Posterior Column Injuries in Thoracolumbar and Lumbar burst Fractures / 대한척추외과학회지

No abstract available.

Dural Tear and Root Entrapment in Lumbar Burst Fractures / 대한척추외과학회지

No abstract available.

Giant Epidermal Cyst / 대한정형외과학회잡지

Epidermal cysts slowly growing, intradermal or subcutaneous tumors that usually cease growing after having reached 1 to 5 cm in diameter. We report a case of giant epidermal cyst on the scapular region with the appearance of well delineated huge mass measured 19×17×14cm in size. Its clinical and surgical management are illustrated.

Bilateral Fractured of the Fabella / 대한정형외과학회잡지

The fabella is the seasmoid bone occurring in about 10–30% of individuals and is located in the head of the lateral tendon of the Gastrocnemius muscle. Fracture of the fabella is a very rare condition. Since first reported by Jacob Sagel in 1932, only 5 cases of fabella fracture had been reported. However, there has been no bilateral case. We report a first case of bilateral fracture of the fabella with review of literature. This case was combined with rupture of anterior cruciate ligament and lateral collateral ligament on the right knee.

Tendon Transfer for Radial Nerve Paralysis and Multiple Extensors Rupture / 대한정형외과학회잡지

Loss of radial nerve function in the hand results in a significant disability and so cannot extend the wrist, thumb & fingers according to the injury levels. Therefore the patient has great difficulty in grasping objects, especially power grip. Tendon transfers to restore function of extension of wrist and fingers are among the the best − most predictable transfers in the upper extremity. We performed 13 cases of tendon transfers for radial nerve palsy and extensive extensor ruptures from 1987 to 1993. The results were evaluated according to Arbitrary Value Method. Among 13 cases 30% of excellent, 46% of good, 24% of fair and no poor result were obtained and the better results were obtatined in low radial nerve lesion.

Biomechanical Study of the Pull-Out Strength of Interference Screw Fixation in Anterior Cruciate Ligament Reconstruction: Comparison Between Endoscopic and Arthroscopic Assisted Technique / 대한정형외과학회잡지

Surgical reconstruction of the anterior cruciate ligament is undergoing constant evolution. The variable success of these procedures can be attributed to many factors including graft selection, graft placement, graft tensioning, graft remodelling and rehabilitation program. Rigid fixation is probably the most important factor in the success of these procedures during the initial stages of healing. Arthroscopically assisted reconstruction of the ACL-deficient knee using a bone-patellar tendon-bone graft(two-incision technique) is a reliable and evolving technique. Rosenberg et al, described a one-incision technique that allows endosteal fixation of bone plugs within their femoral tunnels intraarticularly via the intercondylar notch. These two techniques are different from their femoral tunnel direction and bone plug placement. The present study was designed to develop a swine model for in vitro biomechanical testing of the bone-patellar tendon-bone ACL autograft to compare the pull-out strength of Outside-In technique and Inside-Out technique. The result were as follows: 1. Normal ACL(N=10 knees) pull-out tensile strength tests showed a maximum tensile strength of 1295.34(N), a stiffness of 120.95(N/mm), and a linear load of 1104.26(N). The failure sites were all tibial attachments. 2. Femoral and Tibial interference fit pull-out tensile strength tests(N=10 knees) showed a maximum tensile strength of 463.23±42.27(N), a stiffness of 33.62±3.18(N/mm), and a linear load of 392.51±95.42(N). The failure sites were all in the tibial tunnel area(N=9 knees), except for one which femoral tunnel area. 3. Inside-Out technique(N=15 knees) showed a maximum tensile strength of 1250.64±75.67(N), a stiffness of 94.31±26.44(N/mm), and a linear load of 1046.92±367.55(N), but the Outside-In tech-nique(N=15 knees) showed a maximum tensile strength of 805.35±54.61(N), a stiffness of 83.33±10.98(N/mm), and a linear load of 685.99±86.32(N)(p < 0.0001). The failure sites were all in the femoral tunnel area. 4. Tensile testing demonstrated that the Inside-Out technique was significantlly stronger than Outside-In technique for maximum tensile strength, stiffness and a linear load.

Clinical comparative Study Between Uncemented Anatomic Stem with and Without Lateral Porous Pad / 대한정형외과학회잡지

Authors performed a retrospective clinical and radiologic comparative study for 43 uncemented primary total hip arthroplasty which include 20 hips without lateral porous pad and 23 hips with lateral porous pad in same kinds of implant(Zimmer Anatomic") to investigate the role and significance of the lateral porous pad. The average follow up was 35 months and 38 months for without and with lateral porous pad respectively. The results were as followings: 1. Clinical and radiological results of group with and without lateral pad were similar together except incidence of radiolucency at zone 1 on anteroposterior radiograph in group without lateral pad was markedly higher compare to that in group with lateral pad. 2. The extent of lateral porous pad was not sufficiently enough to make better clinical and radiological results in stem with lateral pad compare to stem without lateral pad. 3. Stems without lateral porous pad had no evidence of bone ingrowth on lateral pad while stems with lateral pad had bone ingrowth on lateral pad with more than 50% in incidence. So, we think that presence and increase of extent of porous pad would have better clinical and radiological results.

Clinical use of Ender Flexible Intramedullary Nail for the Proximal or Distal third Fracture of Tibia / 대한정형외과학회잡지

Authors reviewed 39 cases of proximal or distal fracture which had been managed with Ender flexible intramedullary nails to identify the proper region of tibial fracture for the nail and acceptable indication of retrograde nailing relevant to our clinical experiences. The results were as followings; l. Incidence of malunion with more than 10° of angulation was higher in the fracture of proximal 1/3 tibia than that of distal 1/3. Especially this phenomenon was more significant in case of combination with segmental fracture. 2. As all segmental fractures combined with proximal tibial fracture within 9cm from the plateau were malunited with angulation of 10° or more, another method of internal fixation should be considered. 3. Although degree of angulation was relatively larger in distal tibial fracture within 10cm from the plafond than that beyond 10cm and 2 cases of malunion with angulation of 10° or more were also found within 10cm from tibial plafond, there was no statistically significant difference. 4. Retrograde nailings were performed for 5 cases of proximal 1/3 fractures and 1 case of poor skin condition on the proximal entry. Clinical relevance: Suitable region of tivial fracture managed with Ender-flexible intreamedullary nail was fracture which occurred from 9cm distal to tibial plateau to 10cm proximal to tibial plafond.

Comparative Analysis of Medial Collateral Ligament Grade III injury of the Knee / 대한정형외과학회잡지

The medial collateral ligament is the most commonly injured ligamentous structure of the knee and it has been demonstrated that this ligament is the prime static stabilizer of the medial side of the knee joint. The management of the medial collateral ligament injuries were divided into surgical and conservative treatment. Many investigators reported consistently good to excellent results following surgical treatment. More recently, other investigators reported that isolated medial collateral ligament injuries did equally well under non-operative as operative treatment. For accurate diagnosis, arthroscopic examination of the knee to rule out other intraarticular pathologic conditions such as cruciate ligament injuries, maniscal tears and bony injuries is essential. From October 1988 to January 1991, we treated 76 cases of isolated medial collateral ligament injuries which was confirmed by diagnostic arthroscopy. Among them, we analyzed 31 cases that minimum follow-up was over 1 year and could be re-examed, 20 cases were treated with surgery and 11 cases were not. With comparision between initial and final follow-up stress X-ray, 5.45 ± 3.17mm in non-operative group had improved in medial laxity(P 0.05). In conclusion, medial stability was improved in operative than in non-operative group, however functional score was equally well under non-operative as operative treatment.

Ganglion Cysts of the Anterior Cruciate Ligament: Three cases report / 대한정형외과학회잡지

Ganglion cysts of the cruciate ligament are quite rare. Ganglion cysts on the anterior cruciate ligament(ACL) should be suspected in any patient having pain and clicking sensation during terminal knee extension. A few cases have been reported concerning ganglion cysts present on the surface of the anterior cruciate ligament. We report three cases of a ganglion cysts on the ACL that was treated with arthroscopic excision.

Disassembly of Polyethylene Liner in Cementless Metal-Backed Cup: A case report / 대한정형외과학회잡지

In 1971, for purpose of reduction of peak stress occuring in cement and trabecular bone of the acetabulum, Harris reported a series of metal-backed acetabular components with removable polyethylene liners that could be replaced if excessive wear occured. Modular designs of hip prostheses have become popular recently, but they introduce the risk of disassembly of the components postoperatively. And introduce of loosening and infection of femoral or acetabular components by debris of polyethylene liner. We report a case of mechanical disassembly of polyethylene liner in cementless metal backed cup, and review previously reported articles.