In osteoarthritis of the knee with varus deformity, abnormal stress is concentrated in the medial compartment of the knee joint. A logical treatment must decrease and recenter the force acting on the knee in order to distribute the compressive stresses evenly over the largest possible weight-bearing articular surfaces. This can be attained by an overcorrection of the deformity. The technique of a Barrel-Vault osteotomy is the correction of severe angular deformity of the knee and the reduction of the patellofemoral joint pressure simultaneously by an anterior displacement of the distal fragment. From 1986 to 1989, the authors studied the preoperative clinical status and lpostoperative results in twelve knees(nine patients) who had had a Barrel-Vault osteotomy for combined medial and patellofemoral disease. The total Insall Knee Rating Score improved from a preoperative mean 54.1 to 85.4 Points at the last assessment. The pain component score improved from a preoperative mean 6.6 to 26.2 points at the last assessment. Eleven kness had either no pain or occasional mild pain. The tibiofemoral angle was corrected from a preoperative mean of 4.4 degrees of varus to a mean of 11.2 degrees of valgus at the last assessment.
Congenital Abnormalities ; Knee Joint ; Knee ; Logic ; Osteoarthritis ; Osteotomy ; Patellofemoral Joint ; Weight-Bearing

No abstract available.
Child* ; Humans ; Humerus*

In this report, we introduce a case of surgical treatment for Stensen's duct stone with ultrasonography. A 49-year-old female patient presented with postprandial swelling in the right infraauricular lesion. Upon confirming the swelling as the Stensen's duct stone on the computed tomography scan, the sialolith was surgically removed using the transcutaneous procedure. Using ultrasonography, we found the exact location of the stone and removed it without any facial nerve injury. The case clearly demonstrated that the Stensen's duct stone canbe removed more easily and safely with ultrasonography.
Facial Nerve Injuries ; Female ; Humans ; Middle Aged ; Salivary Ducts ; Salivary Gland Calculi

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the treatment outcomes of medullary thyroid carcinoma (MTC) by retrospective data analysis. SUBJECTS AND METHOD: We conducted a retrospective chart review of 17 cases of pathologically proven MTC patients who were treated from 1998 to 2010 at the department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine. RESULTS: The mean tumor size was 2.32 cm (0.5-3.4 cm). Seventy-one percent of patients were diagnosed with advanced stage (III or IV) of MTC. We performed RET genetic screening in 8 of 17 patients. Hereditary MTC was found in 3 of 17 patients (18%) and sporadic MTC was found in 14 of 17 (82%). The preoperative assessment of basal serum calcitonin (CT) level was performed in 15 of 17 patents. Eleven patients had elevated basal calcitonin levels (>13 pg/mL). After the operation for MTC, the serum CT levels were elevated in 7 patients. Overall 5-year survival rate was 94%. Normalization of serum calcitonin level was accomplished more frequently in the absence of extra thyroidal invasion (p=0.034), multifocal tumor (p=0.02). CONCLUSION: The initial treatment of MTC is total thyroidectomy with central compartment neck dissection with or without lateral neck dissection. To detect recurrence or metastasis, regular checking of serum calcitonin is necessary. A better knowledge of prognostic factors could improve the management of MTC patients.
Calcitonin ; Genetic Testing ; Humans ; Neck ; Neck Dissection ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Survival Rate ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

Considering the relatively good prognosis of papillary thyroid carcinoma, surgical treatment should be conducted with an adequate method and extent of surgery with minimal complications. The optimal indications and extent of central neck dissection in papillary thyroid carcinoma has been introduced by variable guidelines. However, there have been controversies in several aspects regarding central neck dissection (i.e., prophylactic versus therapeutic, unilateral versus bilateral), which will remain until a large prospective study is completed. Successful management of cervical lymph node metastasis in papillary thyroid carcinoma requires thorough preoperative evaluation, knowledge on adequate indications and extent of surgery and considerations on surgical anatomy. In this article, we reviewed the rationales for optimal central neck dissection in papillary thyroid carcinoma based on recent studies and presented the surgical strategy and skills based on personal experience of a single surgeon.
Humans ; Lymph Nodes ; Neck Dissection* ; Neoplasm Metastasis ; Prognosis ; Thyroid Neoplasms*

PURPOSE: Vocal symptoms have been reported after thyroidectomy and even in the absence of injury to the recurrent laryngeal nerve or the external branch of the superior laryngeal nerve. The aim of this prospective study was to evaluate the subjective and objective voice changes in patients without laryngeal nerve injury after thyroidectomy. METHODS: The subjects had undergone total thyroidectomy for differentiated thyroid carcinoma from November 2007 to December 2008. Twenty-eight subjects (males: 8, females: 20) were selected for this study. Voice analysis was prospectively evaluated in the subjects at the time of preoperation and postoperation (10.8 months for the males and 11.7 months for the females). A subjective analysis was done using the visual analogue scale (VAS, 0: no symptom, 10: severe symptoms) and objective analyses were determined by several parameters such as the fundamental frequency (Fo), jitter, shimmer and the noise to harmonic ratio (NHR) using the multi-dimensional voice program. Maximum phonation time (MPT)was performed as an aerodynamic test. RESULTS: 3 patients (37.5%) among the males and 14 patients (70%) among the females had subjective postoperative voice change. The VAS showed a significant difference for the females (0 to 1.25±0.97, P<0.001), whereas no changes were shown for the males (0 to 0.88±1.25, P>0.05). The vocal parameters (Fo, jitter, shimmer, NHR) and MPT showed no significant changes for both the males and females (P>0.05). CONCLUSION: Subjective voice changes may occur after thyroidectomy without laryngeal nerve injury. Surgeons should take possible voice changes into consideration when informing patients before thyroidectomy.
Female ; Humans ; Laryngeal Nerve Injuries ; Laryngeal Nerves ; Male ; Noise ; Phonation ; Prospective Studies ; Recurrent Laryngeal Nerve ; Surgeons ; Thyroid Neoplasms ; Thyroidectomy* ; Voice

Aldosterone-producing adrenal adenoma can induce various clinical manifestations as a result of chronic exposure to aldosterone. We report a rare case of a 37-year-old man who complained of general weakness and polyuria. He was diagnosed with aldosterone-producing adrenal adenoma and nephrogenic diabetes insipidus. Aldosterone enhances the secretion of potassium in the collecting duct, which can lead to hypokalemia. By contrast, nephrogenic diabetes insipidus, which manifests as polyuria and polydipsia, can occur in several clinical conditions such as acquired tubular disease and those attributed to toxins and congenital causes. Among them, hypokalemia can also damage tubular structures in response to vasopressin. The patient's urine output was > 3 L/d and was diluted. Owing to the ineffectiveness of vasopressin, we eventually made a diagnosis of nephrogenic diabetes insipidus. Laparoscopic adrenalectomy and intraoperative kidney biopsy were subsequently performed. The pathologic finding of kidney biopsy revealed a decrease in aquaporin-2 on immunohistochemical stain.
Adenoma ; Adrenalectomy ; Adult ; Aldosterone ; Aquaporin 2 ; Biopsy ; Diabetes Insipidus ; Diabetes Insipidus, Nephrogenic* ; Diagnosis ; Humans ; Hyperaldosteronism* ; Hypokalemia ; Kidney ; Polydipsia ; Polyuria ; Potassium ; Vasopressins

BACKGROUND: Aldosterone induces renal fibrosis and administration of spironolactone showed beneficial effect in various animal models of renal injury such as unilateral ureteral obstruction model and hypertensive renal injury models. The aim of this study is to demonstrate that inhibition of aldosterone may have additional beneficial effect independent of angiotensin blockade in diabetic nephropathy. METHODS: We investigated the effect of aldosterone blockade on renal function in animal model of type II diabetic nephropathy. Diabetic rats were treated with spironolactone (20 mg/kg/day), starting at 20 weeks of age. RESULTS: In diabetic rats, proteinuria was increased since 24 weeks, and presented five-fold increment at 52 weeks comparing to that at 24 weeks. Aldosterone blockade significantly reduced proteinuria without affecting blood glucose concentration and blood pressure. In the diabetic kidney, profibrogenic molecules such as CTGF and type I collagen expression was enhanced and spironolactone treatment decreased their expression. It is of interest that plasma aldosterone level showed a weak but significant relationship with blood glucose levels. CONCLUSION: Aldosterone blockade prevents fibrotic process in the kidney associated with decrement in profibrotic molecule such as CTGF and type I collagen. Furthermore, aldosterone blockade resulted in decrease in urinary protein excretion and glomerulosclerosis. These results suggest that aldosterone blockade may be a new therapeutic target for retarding the progression of diabetic nephropathy.
Aldosterone ; Angiotensins ; Animals ; Blood Glucose ; Blood Pressure ; Collagen Type I ; Diabetic Nephropathies ; Fibrosis ; Kidney ; Models, Animal* ; Plasma ; Proteinuria ; Rats* ; Spironolactone* ; Ureteral Obstruction

OBJECTIVE: Patients with severe spontaneous cerebellar hemorrhage typically undergo treatment with suboccipital craniectomy and hematoma evacuation. However, this is a stressful procedure for patients due to the long operating time and operation-induced tissue damage. In addition, the durotomy can result in pseudomeningocele. We investigated the efficacy of stereotactic or navigation-guided burr hole aspiration surgery as a treatment for spontaneous hypertensive cerebellar hemorrhage (SHCH). METHODS: Between January 2002 and December 2011, 26 patients with SHCH underwent surgery using the stereotactic or navigation-guided burr hole aspiration and catheter insertion technique in our institution. RESULTS: Mean hematoma volume was 21.8 +/- 5.8 cc at admission and 13.1 +/- 5.4 cc immediately following surgery. Preoperative Glasgow Coma Scale (GCS) score was 12.5 +/- 1.3 and postoperative GCS score was 13.1 +/- 1.2. Seven days after surgery, the mean hematoma volume was 4.3 +/- 5.6 cc, and there was no occurrence of surgery-related complications during the six-month follow-up period. The mean operation time for catheter insertion was 43.1 +/- 8.9 min, and a mean 31.3 +/- 6.0 min was also added for extra-ventricular drainage. The mean Glasgow Outcome Scale (GOS) score after six months was 4.6 +/- 1.0. CONCLUSION: Stereotactic burr hole aspiration surgery for treatment of SHCH is less time-consuming and invasive than other interventions, and resulted in no surgery-related complications. Therefore, we suggest that this surgical method could be a safe and effective treatment option for selected patients with SHCH.
Catheters ; Drainage ; Follow-Up Studies ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hematoma ; Hemorrhage ; Humans

OBJECTIVE: The limitations of medical management of symptomatic intracranial arterial stenosis (ICS) have prompted development of new strategies, including endovascular treatment. However, stenting of symptomatic ICS remains investigational. Here, we have reported and analyzed a series of 19 endovascular procedures involving placement of a Wingspan stent. METHODS: We conducted a retrospective review of a series of ICS in which patients were treated with percutaneous transarterial balloon angioplasty and stent placement (PTAS). Patients included in the study were diagnosed as symptomatic ICS between May 2010 and September 2011. RESULTS: Nineteen patients (median age, 65 years; 12 males, seven women) were treated with the Wingspan stent system for symptomatic ICS ranging from 50% to 99%. The technical success rate was 100%. The location of ICS included the internal carotid (n = 5; 1 petrous, 3 cavernous, and 1 clinoid segments), vertebral (n = 1; V4 segment), basilar (n = 1), and middle cerebral (n = 12; 9 M1, 3 M2) arteries. There was no occurrence of procedure-related mortality. Periprocedural morbidity occurred in two cases (10.5%), including carotid-cavernous fistula (n = 1) and subarachnoid hemorrhage (n = 1). No ipsilateral stroke was recorded beyond 30 days during a mean follow-up period of 13.2 months (range 9-19 months). Restenosis (> 50%) was observed in one patient (6.3%), who was asymptomatic, on follow-up imaging. CONCLUSION: Wingspan stent for symptomatic ICS can be performed with a high rate of technical success and acceptable periprocedural morbidity rates. Our initial experience indicates that this procedure represents a viable treatment option for this patient population.
Angioplasty ; Angioplasty, Balloon ; Arteries ; Caves ; Constriction, Pathologic ; Endovascular Procedures ; Fistula ; Follow-Up Studies ; Humans ; Male ; Retrospective Studies ; Stents ; Stroke ; Subarachnoid Hemorrhage