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*

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

Arytenoid edema following radiation therapy of laryngeal cancer may persist and make careful inspection and evaluation of the larynx difficult. Moreover, it may have serious impacts on functions such as breathing, swallowing, speech and voice. Conservative management such as antibiotics and steroid may be attempted but may be ineffective in progressive and severe cases of edema. We present four cases of persistent postradiation arytenoid edema successfully treated with partial resection of the arytenoid mucosa using transoral CO2 laser.
Anti-Bacterial Agents ; Arytenoid Cartilage ; Deglutition ; Edema ; Laryngeal Edema ; Laryngeal Neoplasms ; Larynx ; Lasers, Gas ; Mucous Membrane ; Respiration ; Voice

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

PURPOSE: This study was performed to assess the clinical and epidemiological changes after the introduction of the rotavirus vaccine in Korea, as well as to determine the efficacy of the rotavirus vaccine among hospitalized rotaviral gastroenteritis patients over the past two years. METHODS: We analyzed yearly and seasonal patterns of 1,165 inpatients who were hospitalized for rotaviral gastroenteritis under the age of 5 years between 2006 and 2013. We also conducted a survey among 460 gastroenteritis patients who were hospitalized between 2012 and 2013 regarding the rotavirus vaccination and the symptoms of gastroenteritis. Among those individuals surveyed, clinical indices were analyzed for 124 patients who were tested positive for the rotavirus antigen. RESULTS: The incidence of Rotaviral gastroenteritis have decreased significantly by year 2010. After the introduction and widespread dissemination of the rotavirus vaccine, the onset of the disease and the seasonal peak have been delayed. Overall, the vaccinated group showed a lower rate of positivity than the unvaccinated group. Among the hospitalized rotaviral gastroenteritis patients, the vaccinated group had a shorter hospitalization period, less severe clinical symptoms of gastroenteritis, and better laboratory test results. CONCLUSIONS: After introduction of the rotavirus vaccine in Korea, there were two main trends observed: 1) the overall level of disease incidence was reduced; 2) the severity of rotaviral gastroenteritis cases also decreased. Based on this data, more children should receive vaccination in order to prevent the rotavirus infection and decrease the severity of rotaviral gastroenteritis.
Child ; Epidemiologic Studies* ; Epidemiology ; Gastroenteritis* ; Hospitalization ; Humans ; Incidence ; Inpatients ; Korea ; Rotavirus Infections ; Rotavirus* ; Seasons ; Vaccination

BACKGROUND AND OBJECTIVES: Blood neutrophil-to-lymphocyte ratio (NLR) has been reported to have poor prognostic impact in variable malignancies. However, studies evaluating the clinical significance of blood NLR in patient with papillary thyroid carcinoma (PTC) has been relatively rare, and the outcomes were inconsistent. In this study, we sought to analyze the clinical value of NLR in patients with PTC who had cervical lymph node metastasis. MATERIALS AND METHODS: Retrospective chart review was conducted with 174 patients with confirmed neck metastasis of PTC after initial thyroidectomy. Blood NLR was estimated by dividing the absolute number of blood neutrophil with that of lymphocyte. Statistical analysis was conducted to evaluate correlation between NLR and clinicopathologic factors, patterns of metastatic lymph nodes, and recurrence. RESULTS: Higher NLR (>1.74) was correlated to younger age of patients ( < 45 years, p=0.045) and smaller size of tumor ( < 1 cm, p=0.017). Blood NLR had no impact on patterns of lymph node metastasis or recurrence. CONCLUSION: Blood NLR may not be considered as a predictive factor for clinical aggressiveness or prognosis in patients with PTC with lymph node metastasis.
Humans ; Lymph Nodes* ; Lymphocytes* ; Neck* ; Neoplasm Metastasis* ; Neutrophils* ; Prognosis ; Recurrence ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy