Anatomical reconstruction of lateral ligament complex with singletunnel pullout stutrue fixation for chronic lateral ankle instability / 中国骨伤

OBJECTIVE@#To explore clinical effects of single-tunnel pullout structure fixation and anatomical reconstruction of lateral ligament complex in treating chronic lateral ankle instability.@*METHODS@#From January 2016 to December 2018, clinical data of 23 patients with chronic lateral malleolus instability who underwent anatomical reconstruction of lateral malleolus ligament complex with single-tunnel pullout structure fixation, were retrospectively studied. Among them, including 7 males and 16 females, aged from 17 to 33 years old with an avergae of (26.0±4.3) years old;16 patients classified to grage 0, and 7 patients classified to gradeⅠaccording to Kellgren-Lawrence(K-L) grading;the time of sprain ranged form 2 to 15 with an average of (5.7±2.9) times;the time from injury to operation ranged to 4 to 18 months with an average of (9.0±3.3) months. The range of movement of operative and uninjured ankle joints were measured at 24 months after opertaion, visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) were used to evaluate ankle joint function and improvement of pain, K-L grading and MRI scoring of osteoarthritis of ankle (MSOA) were used to evaluate degree of cartilage degeneration of ankle joint.@*RESULTS@#All patients were followed up from 24 to 48 months with an average of (33.4±6.7) months. All the anterior talofibular ligaments and calcaneofibular ligaments were dissected and reconstructed by single-tunnel pullout structure fixation. The range of motion of dorsiflexion, plantarflexion, varus, and valgus on the operative side of ankle joint were smaller than those on the healthy side. There were no statistically differences in dorsiflexion and eversion between operative side and healthy side of ankle joint (@*CONCLUSION@#Treatment of chronic lateral ankle instability with reconstruction of lateral ligament complex with single-tunnel pullout structure fixation could provide better tendon and bone healing conditions, improve surgical safety and could achieve satisfactory clinical outcomes.

Study of quantitative flow ratio-guided surgical coronary revascularization / 上海交通大学学报（医学版）

Objective: To analyze the feasibility, safety and preliminary clinical results of quantitative flow ratio (QFR)-guided surgical coronary revascularization. Methods: From Jan 2018 to June 2019 at the Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, patients undergoing elective cardiac surgery with any coronary stenosis ≥ 50%, evaluated by preoperative coronary angiography visualization, were enrolled consecutively. There were 82 patients with 174 coronary artery vessels. Coronary artery bypass grafting (CABG) was recommended with a QFR value ≤ 0.8. The data of baseline characteristics, surgical procedure and perioperative outcomes were collected and analyzed. Results: QFR analysis was successfully carried out in 82 patients and 174 coronary artery vessels. QFR was detected positive ( ≤ 0.8) in 53 vessels (30.5%) and negative (>0.8) in the remaining 121 vessels (69.5%). As guided with QFR, 39 patients (47.6%) with 62 vessels (35.6%) proceeded to surgery for primary heart disease with concomitant CABG as planned, while the remaining 43 patients (52.4%) with 112 vessels (64.4%) changed revascularization strategy or spared CABG. Fifteen patients with simple coronary artery disease avoided CABG and discharged. Among the remaining 67 patients operated on, there were 2 deaths, 4 hemodialysis for new renal failure, 1 perioperative myocardial infarction and 1 stroke within 30 d. No unplanned revascularization was observed. The composite adverse events occurred in 6 cases (9.0%). Conclusion: QFR-guided surgical coronary revascularization is feasible and safe. This strategy could reduce the unnecessary bypass grafting. Further follow-up and prospective clinical trials are warranted to evaluate the effectiveness.

Prótesis de pivote medial y ultra-congruente: satisfacción y resultados clínicos. Serie de casos / Medial and ultra-congruent pivot designed prosthesis: satisfaction and clinical results. case series

Introducción La artroplastia total de rodilla es un procedimiento exitoso que mejora significativamente la calidad de vida de los pacientes disminuyendo el dolor e incrementando su capacidad funcional. Sin embargo, la literatura reporta hasta 25% de pacientes insatisfechos. El objetivo de este estudio es presentar los resultados clínicos y la satisfacción de un grupo de pacientes operados con implantes de tipo pivote medial y ultra-congruente. Materiales y métodos Se realizó un estudio observacional retrospectivo. Se revisaron las historias clínicas de todos los pacientes operados con los sistemas mencionados con mínimo 12 meses post-operatorios. Se analizaron resultados de 100 rodillas (96 pacientes) que completaron los cuestionarios, con una media de seguimiento de 33.5 meses. Se aplicaron los cuestionarios KSS, KOOS y WOMAC. Se estudiaron diferencias en dolor y función entre la etapa pre-operatoria y el último seguimiento. Se analizó la satisfacción de los pacientes con respecto al dolor y la capacidad funcional. Se evaluaron complicaciones presentadas. Resultados Todos los criterios presentaron una mejora estadísticamente significativa entre la etapa pre-operatoria y el último seguimiento. 97% de los pacientes reportaron estar satisfechos con los resultados. Las medias de los cuestionarios fueron entre 83.97 y 95.3. Se presentó 1 caso de revisión por infección peri-protésica. Discusión Las prótesis de pivote medial y ultra-congruente constituyen opciones eficaces y seguras para el tratamiento de artrosis de rodilla. Es necesario realizar estudios prospectivos y comparativos que generen evidencia de más alto nivel para confirmar los beneficios de estos diseños.

Background Total knee arthroplasty is a successful procedure that improves patient quality of life by reducing pain and increasing their functional capacity. However, literature reports up to 25% dissatisfaction in patients. The objective of the study is to present the clinical results and satisfaction of a group of patients operated on using ultra-congruent medial pivot-type implants. Methods A retrospective observational study was carried out. The medical records of all the patients who underwent knee arthroplasty surgery with a specific system were reviewed, including patients with a minimum of 12 months follow up. An analysis was performed on the results of 100 knees (96 patients) that had completed questionnaires. There was a mean follow-up of 33.5 months. The KSS, KOOS, and WOMAC questionnaires were used. Differences in pain and function between the pre-surgical stage and the last follow-up were studied. An analysis was made on patient satisfaction with regard to pain and functional capacity. Specific complications were evaluated. Results All evaluation criteria showed a statistically significant improvement between the pre-surgical stage and the last follow-up. Almost all (97%) of patients reported being satisfied with the results. The means of the questionnaires were between 83.97 and 95.3. One case of revision due to peri-prosthetic infection was presented. Discussion Medial pivot and ultra-congruent prostheses designs are effective and safe options for the treatment of osteoarthritis of the knee. Prospective and comparative studies that generate higher level evidence are necessary to confirm the benefits of these designs.

Revision Anterior Cruciate Ligament Reconstruction: Analysis of the Causes of Failure, Associated Injuries and Clinical Results / 대한정형외과학회잡지

PURPOSE: The aim of this study was to analyze the causes of failure after a primary anterior cruciate ligament reconstruction (ACLR), associated injuries, and the clinical results of revision ACLR. MATERIALS AND METHODS: This study evaluated 46 patients (46 knees), who were followed at least two years after revision ACLR. The evaluations included the causes of failure after primary ACLR, associated injuries, 2000 International Knee Documentation Committee (IKDC) subjective knee scores, Lachman test, Pivot shift test, and KT-1000 arthrometer measurement. RESULTS: The most common cause of failure was trauma (27 patients, 58.7%) and 19 failures (19 patients, 41.3%) were caused using an inappropriate surgical technique. The associated injuries were meniscus tears in 29 cases (63.0%) and articular cartilage injuries of Outerbridge grade II to IV in 19 cases (41.3%). The IKDC scores, Lachman test, Pivot shift test, and KT-1000 arthrometer measurements were improved significantly at the final follow-up. CONCLUSION: The most common cause of failure after primary ACLR was trauma. One stage revision ACLR resulted in relatively satisfactory stability but less satisfactory clinical function than the primary reconstruction, as reported previously, which is believed to be due to the more associated injuries.

Clinical significance of postoperative gastrointestinal decompression with enteral feeding tube in elderly patients with gastric cancer / 中华老年医学杂志

Objective To investigate the clinical effects of gastrointestinal decompression with enteral feeding tube in elderly patients with gastric cancer.Methods 78 cases of gastric cancer patients undergoing postoperative gastric decompression with enteral feeding tube were selected as the treatment group,and 66 patients with gastric cancer undergoing postoperative intravenous nutrition and gastric decompression with routine nasogastric tube as the control group in our hospital from January 2015 to December 2015.The incidence rate of gastric tube patency,faster postoperative recovery,nutritional immune improvement,adverse reaction and complication were compared between the two groups.Results The incidence rate of adverse reactions and complications in treatment group were significant lower than in control group (3.0 ％ vs.12.8 ％,x2 =4.4857,P =0.0342;1.5 ％ vs.10.2％,x2 =4.6620,P =0.0308,respectively).Following parameters were significant better in treatment group versus in control group:the time of evacuating [(3.1 ± 0.3) d vs.(4.0 ± 0.1) d,t =24.9227,P =0.0000],defecation[(4.3 ± 0.6) d vs.(5.5 ± 1.1) d,t =7.9189,P =0.0000],extubation [(5.3±1.3)d vs.(10.1±2.2)d,t=15.5690,P=0.0000],hospitalization[(12.3±2.5)d vs.(18.6± 3.2)d,t=12.9864,P=0.0000],postoperative body weight[(57.2±4.9)kg vs(49.0±7.2)kg,t=-7.8408,P=0.0000],plasma protein[(133.2± 11.2)g/L vs(104.5± 10.3)g/L,t=-16.0055,P=0.0000],hemoglobin[(4.7 ± 1.0) g/L vs (3.2 ± 0.6) g/L,t =-11.0991,P =0.0000] and peripheral blood lymphocyte count[(3.5 ± 0.7) × 109/L vs (2.1 ± 0.4) × 109/L,t =-15.0088,P =0.0000].Conclusions Effects of postoperative gastrointestinal decompression in elderly patients with gastric cancer are similar between with routine gastric tube and with enteral feeding tube.However,the enteral feeding tube-induced enteral nutrition shows fewer side effects and complications,better nutritional and immune effects,and faster postoperative recovery,which is worthy of a generalization and application.

Immunotherapy of acute leukemia:clinical experience and prospect / 中国肿瘤临床

Breakthroughs in the immunotherapy of acute leukemia have been achieved in recent years. The paper summarizes the clinical results, experience, and prospect in this area. One of the most significant advancements is the finding that anti-CD19 chimeric anti-gen receptor T cells (CAR-T) or CD3/CD19 bispecific antibody increases the rate of complete remission in patients with refractory re-lapse acute B lymphocytic leukemia. The disease-free survival of patients with low or intermediate risk was dramatically improved by combining chemotherapy and adoptive cytokine-induced killer or natural killer cells. Many immunotherapy methods, such as those fo-cusing on other targets of CAR-T, T-cell antigen receptor-modified T cell, and other targets of bispecific antibodies, are currently being examined. Combined methods can further increase cure rate and improve patients' quality of life, decreasing application of allogeneic hematopoietic cell transplantation which increases risks and reduces the quality of life.

Application of 3D-CRT for cervical cancer stage of ⅠA-ⅡA after radical operation / 局解手术学杂志

Objective To investigate the clinical effect and safety of three dimensional conformal radiotherapy (3D-CRT)for patients with cervical cancer after radical operation in stage ⅠA to ⅡA.Methods The data of 119 patients of cervical cancer in ⅠA-ⅡA with postoperative radiotherapy in our hospital were analyzed retrospectively.Of which 56 patients were treated with 3D-CRT radiotherapy (3D-CRT group),63 patients were treated with conventional radiotherapy (conventional group).The differences radiation reactions and quality of life between two groups were compared.Results The local control rate of 3D-CRT group in the first 12 and 18 months after surgery were 87.50% and 82.14%,respectively,which were significantly higher than those of conventional group(71.43%,65.08%),the difference was statistical significance(P 0.05). Patients of 3D-CRT group were followed up for 3 years,the median survival time was 34.29 months,which was longer than the 31.08-month of conventional group,the difference was statistically significant(χ2 =4.116,P =0.042).Quality of life of 3D-CRT group (60.81 ±4.28) point was lower than that of conventional group (63.75 ±5.03)point,and the difference was statistically significant(P <0.05).The rate of early radiation reaction(rectal reaction,vaginitis)and late radiation reaction (mild or moderate radiation proctitis)in 3D-CRT group were lower than those in the conventional group,the difference was statistically significant(P <0.05 ).Conclusion The 3D-CRT has effect on the long-term prognosis of patients with cervical cancer in stage ⅠA-ⅡA,which can significantly reduce the radiation reaction and improve the quality of life of patients.

Manejo quirúrgico del pie cavo anterior en pacientes con Charcot-Marie-Tooth; evolución a 5 años / Surgical management of anterior cavus foot in Charcot-Marie-Tooth patients. Five-year follow-up

La neuropatía hereditaria motora y sensitiva presenta deformidad en los pies, como varo, cavo y dedos en garra. La enfermedad de Charcot-Marie-Tooth tiene descrita diversas técnicas quirúrgicas. Objetivo: Evaluar el resultado clínico y funcional de la osteotomía basal en "V" de los metatarsianos centrales con elevación del primer metatarsiano, osteotomía dorsal más osteotomía de cierre y elevación del quinto metatarsiano en los pacientes de Charcot-Marie-Tooth en un período de cinco años. Material y métodos: Es un estudio prospectivo, aleatorio, longitudinal, observacional y descriptivo en un período comprendido de cinco años. El total de pacientes que cumplieron los criterios de inclusión fueron 24, 16 del sexo masculino y 8 del sexo femenino. Con un total de 34 pies, a siete se les realizó el procedimiento quirúrgico en el pie derecho, a siete en el pie izquierdo y a 10 de manera bilateral, quedando un total de 34 pies tratados. Resultados: Se encontró un coeficiente de correlación de Pearson de -0.1 y una T de 1.71. Con ello se observó una diferencia estadística significativa entre las variables con lo que a los seis meses encontramos que el tratamiento quirúrgico tiene beneficios representativos. Conclusiones: El estudio realizado mostró un valor estadístico significativo tanto en la función, dolor y alineación en pacientes que se sometieron al tratamiento quirúrgico, comparado con el grado previo al evento quirúrgico, por lo que se recomienda continuar con esta técnica en todos los pacientes que sean portadores de pie cavo anterior.

Hereditary sensorimotor neuropathy involves foot deformities such as varus and cavus foot and claw toes. Several surgical techniques have been described to treat Charcot-Marie-Tooth disease. Objective: To assess the clinical and functional result of "V" basal osteotomy of the central metatarsals with elevation of the first metatarsal, dorsal osteotomy plus closing osteotomy, and elevation of the fifth metatarsal in Charcot-Marie-Tooth patients during a five-year period. Material and methods: Prospective, randomized, longitudinal, observational and descriptive study conducted during a five-year period. Twenty-four patients met the inclusion criteria: 16 males and 8 females. Seven underwent the surgical procedure in the right foot, seven in the left, and 10 in both feet, for a total of 34 feet treated. Results: The Pearson correlation coefficient was -0.1 and T = 1.71. A statistically significant difference was seen between the variables, which meant that, in the six-month follow-up, surgical treatment had representative benefits. Conclusions: The study found a statistically significant value for function, pain and alignment in patients who underwent surgical treatment, compared with their status prior to surgery. It is therefore recommended to continue using this technique in all patients presenting with anterior cavus foot.

When Do Clinical and Radiographic Results Stabilize after Proximal Chevron Osteotomy in Hallux Valgus? / 대한족부족관절학회지

PURPOSE: The purpose of this study is to evaluate the sequential changes of clinical and radiographic results after proximal chevron osteotomy in patients with moderate to severe hallux valgus. MATERIALS AND METHODS: Between January 2008 and December 2009, 93 patients (117 feet) were treated with proximal chevron osteotomy and distal soft tissue procedure for symptomatic moderate to severe hallux valgus deformity. The mean age of patients was 51 years (range, 19 to 71) and the mean duration of follow-up was 27.5 months (range, 24 to 35). Clinical results were evaluated using visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) score preoperatively, at 3, 6, and 12 months after surgery, and at the last follow-up. Radiographic parameters including hallux valgus angle, intermetatarsal angle, and sesamoid position were evaluated preoperatively, immediately postoperatively, at 6 weeks, at 3, 6, and 12 months after surgery, and at the last follow-up. RESULTS: VAS and AOFAS score showed significant improvement until 12 months after surgery. Hallux valgus angle and sesamoid position stabilized at 12 months after surgery and intermetatarsal angle stabilized at 6 months after surgery. CONCLUSION: Clinical and radiographic results were stabilized beyond 12 months after proximal chevron osteotomy in patients with moderate to severe hallux valgus.

Clinical effect of vitrectomy with intravitreal ranibizumab for diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AlM: To observe clinical effect of vitrectomy with intravitreal ranibizumab for the treatment of diabetic retinopathy ( DR) . METHODS:From February 2011 to February 2013, there were 90 cases in our hospital diabetic retinopathy patients withvitrectomy surgery. lt was randomly divided into observation group ( 45 cases ) and control group ( 45 cases ) . Two groups of patients were performed vitrectomy. Patients in observation group were injected intravitreal ranibizumab before surgery, then vitrectomy was underwent for diabetic retinopathy. Vitrectomy was only underwent in control group. RESULTS:The patients in observation group with good effect accounting for 71% (32/45) and good rate was 89%(40/45 ), which were significantly higher than that in control group 51% ( 23/45 ) , 71% ( 32/45 ) . Differences were statistically significant ( P CONCLUSlON: The vitrectomy with intravitreal ranibizumab treatment of diabetic retinopathy can not only reduce blood loss, but also reduce edema and improve effectiveness and safety. lt's worth recommending for clinical practice.

Clinical Results of Direct Arthroscopic Excision of Popliteal Cyst Using a Posteromedial Portal

PURPOSE: To evaluate the efficacy of the direct arthroscopic excision of a popliteal cyst without additional skin incision using a posteromedial portal based on minimum 2 year follow-up clinical results. MATERIALS AND METHODS: From January 2003 to January 2010, 105 patients (111 cases) with popliteal cyst have been treated by a direct arthroscopic excision. Direct arthroscopic excision using a 70 degree arthroscopy and posteromedial portal can correct the valvular mechanism of capsular fold and reduce the complications with no additional skin incision at the popliteal area. In all cases, preoperative magnetic resonance imaging (MRI) was performed to detect combined intraarticular pathology. At 2 years postoperatively, a follow-up ultrasonography or MRI was performed to detect the recurrence of cysts. We used Rauschning and Lindgren criteria for clinical evaluation. RESULTS: All cases had neither recurrence nor complaints of pain, swelling, or functional impairment more than 2 years after the surgery. At ultrasonography or MRI, no recurrence was found, and 5 complications were 1 skin lesion and 4 hematoma. Postoperatively, Rauschning and Lindgren criteria were more than grade 1. CONCLUSIONS: Direct arthroscopic excision using 70 degree arthroscope and posteromedial portal is an effective method for the treatment of popliteal cyst.

Fragmentectomy versus Conventional Microdiscectomy in Single-Level Lumbar Disc Herniations : Comparison of Clinical Results and Recurrence Rates

OBJECTIVE: This retrospective study aimed to compare clinical outcomes in terms of pain relief and recurrence rate between fragmentectomies and conventional microdiscectomies in patients with lumbar disc herniation (LDH). METHODS: Between January 2008 and May 2011, a total of 175 patients met the inclusion criteria of this study. The visual analogue scale (VAS) scores of back and radicular pains were recorded before surgery, 2 and 6 weeks after surgery. Recurrence was defined when a patient had the same pattern of preoperative symptoms and was confirmed with magnetic resonance imaging. RESULTS: Seventy-four patients (42.3%) were suitable for fragmentectomy, and 101 patients underwent conventional microdiscectomy. There were no significant differences in VAS scores between the fragmentectomy and conventional microdiscectomy groups 2 and 6 weeks after surgery. During the follow-up period, 3 patients (4.05%) in the fragmentectomy group and 7 patients (6.93%) in the conventional microdiscectomy group relapsed. CONCLUSION: If patients are selected according to well-defined criteria, fragmentectomy can be a good surgical option for LDH, in the physiological aspect of preserving healthy intervertebral disc materials.

Análise de resultados clínicos de pacientes tratados com trombólise venosa no acidente vascular cerebral isquêmico agudo, com início dos sintomas há menos de três horas estendido até 4,5 horas / Analysis of clinical results of patients treated with intravenous thrombolysis inacute ischemic stroke administered within 3 hours after the onset of a stroke and extended until 4.5 hours

O Acidente Vascular cerebral Isquêmico corresponde a 80 - 88% de todos os AVEs. Entre esses eventos 8 a 12% resultam em óbito em até30 dias. É casuisticamente líder em seqüelas nos adultos. A trombólise venosa com rt-PA até 4,5h do início dos sintomas clínicos, é consenso atual para tratamento da fase hiper-aguda. Foram analisados os resultados clínicos dos pacientes com diagnóstico de Acidente Vascular Cerebral Isquêmico, tratados através da trombólise venosa cerebral, na Santa Cassa de Misericórdia de Fernandópolis/SP, no período de 01/06/07 à 30/09/08. Nossos resultados chamam a atenção porque nos encontramos em um Hospital filantrópico, no Interior do Noroeste Paulista, e estamos podendo mudar a história de nossos pacientes, com protocolo instalado, união de uma equipe e coragem. É possível diminuição gradual na NIHSS, encurtamento de tempo hospitalizado, assim, minimizar as complicações, vencendo seqüelas, restituindo o retorno aos lares e ao trabalho pelos nossos pacientes.

Among all strokes, 80 ? 88% are Ischemic, and 8 to 12% of these events result in death within 30 days. It is casuistically the leader in sequels in the adults. The thrombolytic therapy with rt-PA within 4.5h of stroke onset is current consensus for treatment of the hyperacute phase.The clinical results of the patients with diagnosis of Ischemic stroke treated with intravenous tPA, in Santa Casa de Misericórdia deFernandópolis/SP from 01/06/07 until 30/09/08, were analyzed. Our results stand out considering that we work in a philanthropic Hospital in the periphery of northwestern São Paulo, and that we can change the history of our patients, with installed protocol, teamwork and courage. It is possible a gradual reduction in the NIHSS, shortening of hospitalization time, and thus minimizing the complications, overcoming sequels, restituting the return of our patients to their homes andto their works.

The Comparison of Radiographic Parameters and Clinical Results after Operative Treatment of Displaced Intraarticular Calcaneal Fractures

PURPOSE: To evaluate the relationship between radiographic parameters and clinical results after operative treatment of the displaced intra-articular calcaneal fractures. MATERIALS AND METHODS: We analyzed 35 patients of unilateral displaced intraarticular calcaneal fractures who had operative treatment with minimum follow up of 1 year. At the last follow up, we measured the radiographic parameters including Bohler angle, Gissane angle, heel height, calcaneal length, talocalcaneal angle, talar declination angle, subtalar incongruity between normal and affected site. Clinical results were measured by Creighton-Nebraska Health Foundation Assessment Score (CNH). The correlation between the radiographic parameters and the clinical results were analysed by Pearson correlation method. RESULTS: Among the all radiographic parameters we analyzed, only subtalar incongruity shows strong negative linear correlation with clinical results. The average difference of subtalar incongruity between normal and affected site was 0.54 mm (0~2.5) and the correlation coefficients with CNH score was -0.784 (p=0.002). CONCLUSION: We suggest that the subtalar incongruity is significantly correlated with the clinical results after operative treatment of the displaced intraarticular calcaneal fractures.

Results of selective expansive open-door laminoplasty for the treatment of cervical spondylotic myelopathy / 中国矫形外科杂志

[Objective] To evaluate the efficacy and short-term results of selective expansive open-door laminoplasty(ELAP).[Method] From June 2005-June 2006,a total of 102 pataents with cervical spondylotic myelopathy(CSM)were enrolled in this study.Forty-four patients underwent ELAP.Fifty-eight patients undergoing conventional C3~7 ELAP served as controls.The clinical results and radiological examinations of both groups were evaluated at 12 month after surgery.[Result]There was no significant difference in recovery rate of Japanese Orthopaedic Association(JOA)scores.The incidence of axial symptoms in the selective ELAP group was significantly lower than those in the C3~7 ELAP group(P

Manifestation of clinical imageology and surgical treatment of the brucellosis spondylitis / 中国矫形外科杂志

[Objective] To improve the clinical diagnosis and therapic effect and to discuss the clinical and imageologic manifestations and treatment of the brucellosis spondylitis(BS).[Method]Sixteen patients with BS were all taken radiographs and CT scanning and seven cases were also taken MRI.The test of SAT,test of RBP and ELISA were used in accessing BS.Pathogenic bacteria were examined in 11 cases.All cases were treated with anti-brucellosis agents and other conservative measures.Seven cases were followed with a focal debridement and 2 cases withminimal invasive surgery.[Result]Fourteen cases were misdiagnosed as spine TB before they were hospitalized with rate of error diagnosis 87.5%,even careful clinic and radiographic examination,and CT scanning had been taken,and 5 cases were misdiagnosed by MRI with the misdiagnosis rate 71.4%.The BS occurred far more in the lumbar vertebrae than in the thoracic vertebrae with its highest morbidity at the L4.Among 16 cases,the titers of SAT test were all beyond 1.160,the test of RBP all showed positive and IgG,IgM showed positive by ELISA.Eleven cases was confirmed BS diagnosis by phthogenic bacteria examination.Only 12 cases were followed up for 1～2 years(including 8 surgical-treated cases).Ten cases were cured without recurrence,and 2 cases improved.[Conclusion]Brucellosis spondylitis commonly misdiagnose before hospitalization.Characteristic imageologic changes and clinical appearance,combined tests of SAT and RBP are useful for diagnosis.Long-term and enough amount sensitive antibiotics and other conservative measures is still the major and reliable measures in treatment of BS and prevent recurrence,additional minimal invasive surgery or focal debridement could shorten the course of therapy,increase the cure rate and decrease its complication.

Clinical Results after Corrective Osteotomy of the Kyphotic Deformity in Ankylosing Spondylitis / 대한척추외과학회지

STUDY DESIGN: A retrospective analysis of clinical results through questionnaire based instrument and radiologic changes after correction in ankylosing spondylitis. OBJECTIVES: To evaluate the radiographic changes and verify the clinical results of the extension osteotomy through pedicular subtraction and intracorporal decancellization in patients with ankylosing spondylitis who have severely fixed kyphotic deformity. MATERIALS AND METHODS: Total 45 patients were included in this study. In all cases, the deformity was corrected by a onestage pedicle subtraction extension osteotomy. Radiographic assessment for sagittal balance was performed on the criteria of thoracic kyphosis, lumbar lordosis, distance between the vertical line on anterosuperior point of T1 and that of S1 and sacrohorizontal angle. Finally clinical assessment for function, indoor activity, outdoor activity, psychosocial activity, pain and overall subjective satisfaction on the basis of patients' satisfaction(5 grade) were performed. RESULTS: The osteotomy was performed at single level in 43 cases, double levels in 2 cases. The mean follow-up was 36.2 months. The criteriae of radiographic assessment were changed on preoperative, postoperative 3 months and the last follow-up as follows; thoracic kyphosis: 50, 51 and 54 degrees, lumbar lordosis: 10, 46 and 44 degrees, distance between vertical lines of T1 and S1: 94, 15 and 8 mm, sacral inclination: 8, 28 and 24 degrees. At the last follow-up, clinical results were high as 3.2 in function, 2.8 in indoor activity, 3.3 in outdoor activity, 3.3 in psychosocial activity, 3.4 in pain and 3.2 in overall subjective satisfaction. There was no any serious complication, such as death or permanent neurologic deficit. CONCLUSIONS: Nearly all the patients have maintained good correction. Eighty five percent of patients have revealed self-satisfaction to corrective osteotomy. But in connection with the clinical results, the changes of parameters of radiographic assessment didn't revealed any significant correlation and so it should be traced much longer with care.

Seven Year Results of Excimer Laser Photore fractive Keratecto my for Myopia

To evaluate the long term efficacy of excimer laser photorefractive kerate-ctomy (PRK)for myopia, 37 eyes of 20 patients were observed for 7 years after PRK.The patients were divided into three groups according to preop-erative myopia :group 1 with diopters between -2.00 and -5.75, group 2with diopters between -6.00 and -9.75, group 3 with myopia over -10.0 diopter.During the follow up period, 6 months, 1 year, 2 years and 7 years, refractive error, uncorrected and best corrected visual acuity and corneal opacity were examined. Mean refractive errors seven years after PRK were changed significantly. In group 1 and group 3, long-term regression occured between 2 and 7 years (paired t test:p=0.01, p=0.01, respectively).In group 2, long-term regression occured between 1 and 7 years (p=0.02).At 7 years, in group 1, 92%of eyes, in group 2, 69%of eyes, and in group 3, 20%of eyes achieved uncorrected visual acuity of 0.5 or better.The group 3 showed a trend toward greater regression. With these results we thought that excimer PRK was effective for mild-to-moderate myopia, while less effective for high myopia.Despite the effi-cacy, we believe that slow myopic regression can continue up to 7 years and further follow-up is essential to assess long-term effect.

Clinical Results of Subtotal Colectomy in Chronic Constipation Patients

PURPOSE: The aim of this study was to assess the outcome of subtotal colectomy on patients with a diagnosis of chronic constipation. METHODS: A retrospective review of 11 consecutive patients who underwent subtotal colectomy between January 1990 and July 1999 was undertaken. Preoperative testings included complete history and physical examination, anorectal manometry, videodefecography, and colonic transit studies. RESULTS: The 11 patients consisted of 5 men and 6 women, with a mean age of 44 (range, 25~62) years. The most common symptom was inability to defecation and mean duration of this symptom was 13.6 (range, 0.75~45) years. Ten patients had slow colon transit and one patient had normal colon transit with anismus. All patients were followed up for mean duration of 33 (range, 5~120) months. Mean bowel frequency was 4 times per day after colectomy. Nine patients were satisfied with the results of surgery and showed improvement in quality of life. One patient was less satisfied due to diarrhea even with several times bowel movement per day. One patient felt that the operation was not so effective due to incontinence for liquid stool and 7 bowel movement per day. Three patients frequently used antidiarrheal medication after surgery. Three patients had postoperative small bowel obstruction and were treated without surgery. CONCLUSION: Subtotal colectomy with ileorectal anastomosis produces a satisfactory functional outcome in the majority of patients with proven slow transit constipation.

Relationship between Union of Grafted Autologous Bone and Clinical Results of Operative Treatment of Degenerative Spondylolisthesis by Posterolateral Fusion / 대한정형외과학회잡지

PURPOSE: Bone graft is essential for successful spinal fusion. So, we clinically assessed the effect of uniting grafted autologous bone. MATERIALS AND METHODS: Retrospective analysis is performed on 46 patients who had grade I or II, one segmental, degenerative spondyloiisthesis according to Meyerding classification and treated operatively by posterolateral fusion with posterior decompression and autologous iliac bone graft from January 1991 to June 1996. We got the data from simple anteroposterior, lateral, flexion- extension X-ray film at preoperative, postoperative and last follow-up period, and from clinical results at last OPD follow-up according to Kirkaldy-Willis criteria. We compared the union of grafted autologous bone with clinical results using X2-test. We also compared preoperative spinal instability, with/without instrumentation and intraoperative reduction with the union of grafted autologous bane and clinical results. RESULTS: There was high significant correlation (P=0.000) between the union of grafted autologous bone and clinical results statistically, CONCLUSIONS: This results suggest that the union of grafted autologous bone was an important factor in determing clinical results.