To obtain wider versatility and greater reach in microsurgical lumbar discectomy, modified procedure has been performed on 263 patients in 1979-1983. It consisted of a smaller midline incision, removal of lateral half of the spinous process, partial but sufficient microdrilling of the lamina, use of a modified slender Taylor retractor, flavotomy, preservation of epidural adipose-areolar tissue etc. Particularly a slender Taylor-Chung retractor offered yielding surgical opening and therefore secured free of pituitary forceps to every direction. The microsurgical results including 72 bisegmental and 8 trisegmental discectomies were compared with those of standard operations of same number performed by same surgeon in 1972-1979, for the good contrast. Mean blood loss per operation was 94 ml with the standard discectomy and 46 ml with microsurgery. Dural tear occured in 17 cases undergoing standard operation and in 3 undergoing microsugery. The mean time until return to duty was 8.6 weeks with standard, compared with 4.2 weeks. In the microsurgical group, 3 patients had postoperative discitis while 2 had in the standard. In this series, the results of microsurgery surpasses the standard in the convalescent phase. Major advantages of this modified microsurgical technique were its ability to secure the greater reach to remove disc material as much as possible and to preserve the integrity of normal tissue better.
Discitis ; Diskectomy* ; Humans ; Microsurgery ; Surgical Instruments

PURPOSE: To evaluate the early clinical results of lumbar microdiscectomy using minimally invasive tubular retractor (METRx-MD system, Medtronic Sofamor Danek, Memphis, TN), and to validate the merits of minimally invasive spinal surgery. MATERIALS AND METHODS: From April, 2003 to April 2004 we retrospectively studied a consecutive series of 45 patients who underwent lumbar microdiscectomy using minimally invasive tubular retractor. In all cases, minimally invasive approach using the tubular retractor were performed with a 2 cm sized paramedian incision. The following data were collected: clinical outcomes, operative time, intraoperative blood loss, need for blood replacement, time needed before ambulation, length of hospital stay, and complications. The clinical outcomes were assessed by the modified MacNab criteria. RESULTS: Minimally invasive tubular microdiscectomy was performed in 45 patients over a 12-month period with an average follow-up of approximately 8 months. The clinical outcomes assessed by MacNab criteria were excellent in 33 patients (73%), good in 10 patients (22%). The average operative time was 63 minutes (range, 35 to 95 minutes). The average blood loss was 62 mL (range, 50 to 110 mL). None of the patients needed blood replacement. With the exception of 2 patients, all patients could walk at the day of surgery. The average hospital stay was 2.3 days. None of the patients had dural tear, wound problem, or other complications. CONCLUSION: Lumbar microdiscectomy using tubular retractor can offer a useful modality for the treatment of lumbar herniated disc with the merits of minimally invasive spinal surgery. Further long-term, randomized, prospective investigations are needed to fully evaluate the impact of this technique.
Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; Length of Stay ; Operative Time ; Wounds and Injuries

There are many complications after traumatic shoulder dislocation including redislocation, dislocation capsulitis especially in the older age and dislocation arthropathy. Redislocation rates have been primarily related to age at the time of initial dislocation, to lesser degree, athletic participation, length of immobilization, rehabilitative exercises, and time hefore return to sports or full activity. So we wanted to confirm the difference of the lesion between the young and the old at the initial dislocation. Arthroscopic evaluation of the twelve patients with an acute traumatic anterior dislocation of the shoulder was done to identify the intraarticular pathology within 10 days of the initial injury. All patients were taken MRI and evaluated under anesthesia. We classified these shoulders into two groups based on the age of patient. Young agegroup under 30 were seven patients and old age-group over 40 were five patients. And the following results were ohtained; 1. The detachment of the anterior labrum with the inferior glenohumeral ligament from the glenoid rim was primary finding and might cause the shoulder unstable under anesthesia in the young age-group under 30. 2. In the age-group over 40, there were the capsular tears with no labral lesion and these shoulders were stable under anesthesia 3. In acute traumatic anterior dislocation, examination under anesthesia was more closely related to the prediction of the extent of labro-ligamental detachment than MRI examination. 4. We believe that arthroscopic surgical intervention after the initial shoulder dislocation should be considered as a treatment option
Anesthesia ; Arthroscopy ; Dislocations* ; Exercise ; Humans ; Immobilization ; Ligaments ; Magnetic Resonance Imaging ; Pathology ; Shoulder Dislocation ; Shoulder* ; Sports

PURPOSE: The purpose of this study was to investigate and define the factors affecting the success of quad-sparing (QS) minimally invasive total knee arthroplasty (TKA). MATERIALS AND METHODS: A total of 120 patients(150 knees) were tried consecutively to undergo QS minimally invasive TKA from July 2004 to February 2005. Seventy knees (Group 1) could be performed with this technique, but 80 knees (Group 2) were failed and required further incision. Two groups were compared for clinical, radiological and postoperative data. These cases were also divided into three groups according to the time undergone surgery. For these three groups, we analyzed the clinical data and surgical results. RESULTS: Age, height, weight, body mass index and pre-operative knee score were not significantly related to the success of QS minimally invasive TKA. Greater preoperative range of motion, low patella height, and smaller size of the tibial implant were of a significant correlation with the success of surgery. As the number of cases were cumulated, the success rate of this method increased and the operating time was shortened. CONCLUSION: QS minimally invasive TKA could not be successfully applied to every patients. For the success of this surgery, adequate preoperative assessment of the patient and sufficient experience on this surgical technique would be necessary.
Arthroplasty* ; Body Weight ; Humans ; Knee* ; Patella ; Range of Motion, Articular

PURPOSE: To compare the short-term clinical results of mini-midvatus minimally invasive total knee arthroplasty(TKA) with quadriceps-sparing minimally invasive TKA. MATERIALS AND METHODS: Between August 2005 and February 2006, 23 bilateral (46 knees) minimally invasive total knee arthroplasties were performed simultaneously using quadriceps-sparing surgical technique at one side and mini- midvastus minimally invasive technique at the contralateral side. The same surgeon performed all the operations with the same type of prosthesis(Nexgen LPS-flex Total Knee System) using MIS quadriceps-sparing instrument. The pos- toperative clinical and radiological results were analyzed in each group. RESULTS: There were no significant differences between the two groups in the operating time, total blood loss, length of skin incision, radiological results and postoperative HSS scores at 8 weeks and 1 year follow-up(p>0.05). Also, there were no differences in the postoperative range of motion and pain score assessed by visual analog scale at 1 day, 3 days, 7 days, 14 days, 8 weeks and 1 year follow-up(p>0.05). Conclusions: Compared to quadriceps-sparing TKA, mini-midvastus minimally invasive TKA revealed no significant differences in the short-term clinical and radiological results. Therefore, it can be considered as an effective, alternative minimally invasive technique.
Arthroplasty* ; Knee Joint ; Knee* ; Range of Motion, Articular ; Skin ; Visual Analog Scale

No abstract available.
Lymphadenitis*

No abstract available.
Humans

Sjogren's syndrome(SS) is a chronic inflammatory disorder characterized by lymphocytic infiltration of lacrimal and sailvary glands, which results in dry eyes and dry mouth. SS may exist as a secondary condition or as a secondary condition in association with connective tissue disease such as rheumatoid arthritis, systemic lupus erythematosus, or progressive systemic sclerosis. We experienced a patient with primary SS who developed multiple bullae, nodular type of pulmonary amyloidosis and lymphocytic interstitial peumonitis. We believe this to be the first reported case of SS acompanied by these three types pulmonary manifestations at the same time.
Amyloidosis* ; Arthritis, Rheumatoid ; Bronchioles* ; Connective Tissue Diseases ; Humans ; Lupus Erythematosus, Systemic ; Mouth ; Scleroderma, Diffuse ; Sjogren's Syndrome*

PURPOSE: To evaluate the efficacy of distraction osteogenesis for fourth brachymetatarsia. MATERIALS AND METHODS: Seven patients (10 cases) who were treated by distraction osteogenesis for fourth brachymetatarsia from March 2000 to December 2003 were reviewed retrospectively. RESULTS: The average length gain of fourth metatarsus was 16.6 mm (37%) and the average healing index was 50 days/cm. The final results according to AOFAS functional scale were excellent in 8 cases and good in 2 cases. CONCLUSION: Distraction osteogenesis is an effective treatment for fourth brachymetatarsia in spite of some minor complications.
Humans ; Metatarsus ; Osteogenesis, Distraction* ; Retrospective Studies

PURPOSE: To evaluate the efficacy of distraction osteogenesis for fourth brachymetatarsia. MATERIALS AND METHODS: Seven patients (10 cases) who were treated by distraction osteogenesis for fourth brachymetatarsia from March 2000 to December 2003 were reviewed retrospectively. RESULTS: The average length gain of fourth metatarsus was 16.6 mm (37%) and the average healing index was 50 days/cm. The final results according to AOFAS functional scale were excellent in 8 cases and good in 2 cases. CONCLUSION: Distraction osteogenesis is an effective treatment for fourth brachymetatarsia in spite of some minor complications.
Humans ; Metatarsus ; Osteogenesis, Distraction* ; Retrospective Studies