Mycobacterium Tuberculosis in Spinal Tuberculosis

문명상,김성심,문한림,김동현 대한척추외과학회 2017 Asian Spine Journal Vol.11 No.1

Even in an era of remarkable medical advances, there is an issue of why tuberculosis remains in the list of disastrous diseases, afflicting humans and causing suffering. There has not been a plausible answer to this, and it has been suggested that clinicians and medical scientists could presently not win the war against the tubercle bacilli. With regards to this issue, based on the authors’ own clinical and research experiences, in this review, the available literature was revisited in order to address the raised questions and to provide recent information on characteristics of tubercle bacilli and possible ways to more effectively treat tuberculosis.

Surgery-Related Complications and Sequelae in Management of Tuberculosis of Spine

문명상,김성수,문영완,문한림,김성심 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.4

Study Design: Medical record-based survey. Purpose: To survey the overall incidence of the intra- and postoperative complications and sequelae, and to propose the preventive measures to reduce complications in the spinal tuberculosis surgery. Overview of Literature: There is no study focused on the surgery-related complications and sequelae, with some touching lightly on the clinical problems. Methods: There were 901 patients in this study, including 92 paraplegics. One hundred eighty-six patients had no visible deformity, while those of 715 patients were visible. Six hundred fifty-nine patients had slight to moderate non-rigid kyphosis, and 56 had severe rigid kyphosis. Sixty-seven out of 92 paraplegics had slight to moderate non-rigid kyphosis, and 25 had severe kyphosis. There were 134 cervical and cervicodorsal lesions, 518 thoracic and thoracolumbar lesions, and 249 lumbar and lumbosacral lesions. Seven hundred sixty-four patients had primarily anterior surgeries, and 137 had posterior surgeries. Instrumentation surgery was combined in 174 patients. Results: There were intra- and postoperative complications: direct large vessel and neurological injuries (cord, roots, nerves), late thrombophlebitis, various thoracic cavity problems, esophagus and ureter injuries, peritoneum perforation, ileus, wound infections, stabilization failure, increase of deformity and late adjacent joint and bone problems. Thrombophlebitis and sympatheticolysis symptoms and signs in the lower limbs were the most common complications related with anterior lumbar and lumbosacral surgeries. Kyphosis increased in 31.5% of the non-instrumented anterior surgery cases (42% in children and 21% in adults). Conclusions: The safe, effective and most familiar surgical procedure should be adopted to minimize complications and sequelae. Cosmetic spinal surgery should be withheld if functional improvement could not be expected.

Traumatic Absence of the Shaft of the Radius in a Child: A 15-Year Follow-up after Reconstruction by a Modified Define’s One Bone Forearm Procedure

문명상,김동현,문영완,김성수,문한림,김성심 대한정형외과학회 2018 Clinics in Orthopedic Surgery Vol.10 No.2

Traumatic absence of the entire radial shaft in children has not been reported though there are a few reports of adult cases. We report a 5-year-old boy with traumatic absence of the entire right radial shaft. The Define’s reconstruction procedure was chosen to localize the surgery only to the distal forearm and avoid further additional damage to the forearm muscles. The child’s forearm was successfully reconstructed by the authors’ modified Define’s procedure, which was followed until his maturity. Hand function was well maintained.

Radiographic Assessment of Effect of Congenital Monosegment Synostosis of Lower Cervical Spine between C2–C6 on Adjacent Mobile Segments

문명상,김성수,윤민근,서영훈,이봉진,문한림,김성심 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.5

Study Design: A prospective radiographic study of cervical spine with congenital monosegment fusion. Purpose: To evaluate the effect of cervical synostosis on adjacent segments and the vertebral morphology. Overview of Literature: There are numerous clinical studies of adjacent segment disease (ASD) after monosegment surgical fusion. However, there was no report on ASD in the cervical spine with congenital monosegment synostosis. Methods: Radiograms of 52 patients, aged 5 to 90 years, with congenital monosegment synostosis (CMS) between C2 and C6, who complained of neck/shoulder discomfort or pain were studied. 51 were normally aligned and one was kyphotically aligned. Results: Spondylosis was not found in the patients below 35 years of age. Only 12 out of 24 patients with normally aligned C2–3 synostosis had spondylosis in 19 more caudal segments, and only one at C3–4. A patient with kyphotic C2–3 had spondylolysis at C3–4. In 8 patients with C3–4 synostosis, spondylosis was found in only 9 caudal segments (4 at C4–5, 4 at C5–6, and 1 at C6–7). The caudate C4–5 disc was the most liable to degenerate in comparison with other caudate segments. Caudal corporal flaring and inwaisting of the synostotic vertebra were the features that were the most evident. In 2 of 9 C4–5 and 7 out of 10 C5–6 synostosis patients, spondylosis was found at the two adjacent cephalad and caudate segments, respectively. Only corporal inwaisting without flaring was found. In all cases, spondylosis was confined to the adjacent segments. More advanced spondylosis was found in the immediate caudal segment than the cephalad one. Conclusions: It is concluded that spondylosis at the mobile segments in a synostotic spine is thought to be a fusion-related pathology rather than solely age-related disc degeneration. Those data suggested that CMS definitely precipitated the disc degeneration in the adjacent segments.

Preoperative Nutritional Status of the Surgical Patients in Jeju

문명상,김성수,이상엽,전달재,윤민근,김성심,문한림 대한정형외과학회 2014 Clinics in Orthopedic Surgery Vol.6 No.3

postBackground:To assess the preoperative nutritional status of patients with various disorders and to provide data for pre- and postoperative patient management plans, particularly in the elderly. There is no published information on age-matched and disease-matched preoperative nutritional/immunologic status for orthopedic patients, especially in the elderly, in Jeju. Methods: In total, 331 patients with four categories of orthopedic conditions were assessed: 92 elective surgery patients, 59 arthroplasty patients, 145 patients with fractures, and 35 infection patients. Malnutrition was defined as body mass index (BMI) below 18 kg/m2 of expected body weight (below 20% of normal), serum albumin/globulin ratio below 1.5 (normal range, 1.5 to 2.3), albumin level below 3.5 g/dL, total lymphocyte count below 1,500 cells/mm3, and lymphocyte/monocyte ratio below 5 versus 1. Results: In 92 elective surgery patients, the average BMI was 23 kg/m2, hemoglobin was 15 g/dL, lymphocytes (2,486 cells)/monocytes (465 cells) ratio was 6.1, and the albumin (4.4 g/dL)/globulin (2.5 g/dL) ratio as a protein quotient was 1.7. Among the 59 hip and knee arthroplasty patients, the average BMI was 25 kg/m2, hemoglobin was 12 g/dL, lymphocytes (2,038 cells)/monocytes (391 cells) ratio was 6.6, and albumin (4.1 g/dL)/globulin (2.4 g/dL) ratio was 1.6. No subject showed malnutrition. Among the 145 fracture patients, the average BMI was 23 kg/m2. The hemoglobin level was 13 g/dL, monocytes (495 cells)/lymphocytes (1,905 cells) ratio was 1 versus 4.6, and albumin (4.1 d/gL)/globulin (2.5 d/gL) ratio was 1.6. However, both ratios decreased after 70 years of age. Among the 17 of 35 infection patients, albumin levels were below 3.5 g/dL, the average BMI was 22 kg/m2, lymphocytes (1,532 cells)/monocytes (545 cells) ratio was 2.4 versus 1, and albumin (3.0 g/dL)/globulin (3.3 g/dL) ratio was 0.9, while in 18 patients albumin levels were over 3.5 g/dL, the average BMI was 22 kg/m2, hemoglobin was 12 g/dL, lymphocytes (1,998 cells)/monocytes (583 cells) ratio was 3 versus 1, and albumin/globulin ratio was 1.4. Thus, in the infection group, approximately 50% of the patients showed poor nutrition and immunosuppression. Conclusions: It was found that nutritional and immune condition deteriorated gradually to some degree in elderly patients over 60 years of age.

소아 척추 결핵 : 투약 후의 병의 정지와 치유점, 그리고 후만 변형

문명상(Myung-Sang Moon),김동현(Dong-Hyeon Kim),김상재 (Sang-Jae Kim),문한림(Hanlim Moon),김성수(Sung-Soo Kim),김성심(Sung-Sim Kim) 대한정형외과학회 2017 대한정형외과학회지 Vol.52 No.1

목적: 화학요법만으로 치료한 소아 척추 결핵 환아들에서의 후만의 경시적 변화를 분석하였다. 대상 및 방법: 2세부터 15세 사이의 101명을 대상으로 하여 후향적으로 단순 방사선 영상과 소수에게서 자기공명영상을 이용하여 치료 시작 시와 치료 종결 시의 잔존 성장판에 의한 후만 변형의 변화를 살폈다. 결과: 영상상 초진 시 추간판의 완전 파괴로 판정한 예들은 경추의 경우 40명 중 2명(5.0%), 흉추 내에서는 30명 중 8예(26.7%), 그리고 요천추에서는 31명 중 6명(19.4%)이었다. 나머지 예들에서는 성장판이 완전하게 또는 부분적으로 잔존하는 것으로 판정하였다. 101명 중 후만 변형이 변치 않고 유지된 경우는 20명(19.8%), 후만각 감소 예는 14명(13.9%), 그리고 후만각의 증가 예는 67명(66.3%)에서 관찰되었다. 결론: 반수 이상의 환아에서 치료 시작 시점에서 이미 병이 심히 진행되었던 것을 알 수 있었다. 후만 변형의 진행 여부는 일차적으로 치료 시작 시점에서 예측 가능하나 그 정확도가 떨어지므로 후만 변형의 변화의 보다 정확한 증거를 확인할 수 있는 투약 종료 시점에서 실시할 것을 권한다. 진행형과 자연 교정군에서는 성장 종료 시까지의 추적 관찰이 필요하다. Purpose: To assess the chronological changes of disease-related kyphosis after chemotherapy alone. Materials and Methods: A total of 101 children aged 2 to 15 years with spinal tuberculosis, accompanied by various stages of disease processes were enrolled for analysis. By utilizing the images in them, the growth plate condition and chronological changes of kyphosis after chemotherapy were analyzed at two points in time; the first assessment was at post-chemotherapy one-year and second at the final discharge. Results: Complete disc destruction in the cervical, dorsal and lumbosacral spines was observed in 2 out of 40 children (5.0%), 8 out of 30 children (26.7%), and 6 out of 31 children (19.4%), respectively. In those cases, the residual kyphosis inevitably developed. In the remaining children, the discs were intact or partially damaged. Among the 101 children kyphotic deformity was maintained without change in 20 children (19.8%). Kyphosis decreased in 14 children (13.9%), while it increased in 67 children (66.3%) with non-recoverably damaged growth plate. Conclusion: Although it is tentatively possible to predict the deformity progress or non-progress and spontaneous correction at the time of the initial treatment, its predictive accuracy is low. Therefore, assessment of the chronological changes should be performed at the end of chemotherapy. In children with progressive curve change, assessment of deformity should be continued until maturity.

유해성분 분석에 관한 연구 : 주류중 urethane, 2-phenylethanol 및 methanol 함량 Urethane, 2-phenylethanol and methanol in some alcoholic beverages

윤태보,박혜경,이윤동,한상배,문춘선,정혜윤,박희라,유순영,이선옥,최용훈,김희선,이경진,전영배,문성심,정태영 식품의약품안전청 1997 식품의약품안전청 연보 Vol.1 No.-

줄룬의 식품위생적 안전성과 팎켠하여 주류중에 존재하는 urethane, 2-phenylethanol 밋 methanol 합량 분석을 하고, 돌연변이원성 시험을 통하여 유해 가능성을 화인하고자 하였파. Urethane 및 2-Phenylethanol은 GC-MSD로 분석하였고, methanol은 GC-FID로 분석하였으며, 이들 물질의 변이원성을 지헝하기 위하여 세균에 대한 505 chromotest 및 Ames test를 실시하였다. 실험 결과 urethane은 29중의 시료에서 모듯 불검출이었고, 3-phenylethanol은 6~103ppin으로 검출되었으며, methauol은 0~195ppm으로 모두 식품공전상 규제농도 이하of 었다. Urethane 및 2-phonyhano쎄 대한 돌떤변이원성 실험 결과 변이원으로 알려진 4-NqO와 MNNG에 비해서 각각 75,000배, 3,750해와 낮은 변이월성을 나타내었다. 따라서 상기 결과로 볼 매, 본 실험에서 분석한 주류중의 urethane, 2-phenylethanol 및 methanol에 대한 유괘성은 거의 문레시 되지 않을 것으로 관단되었다. In the present study. we investigated the content of urethane, 2-phenylethanol and methauol in some alcoholic beverages and conducted the mutagenic test to establish the food safety. The content of urethane and 2-phenylethanol was determined by GC-MSD and the methanol was analysed by GC-FID. The SOS chroxnotest and Ames test were also conducted to determine the mutagenicity of urethane and 2-phenylethanol. As results, the urethane was not detected in all of the 29 samples, and the levels of 2-phenylethanel were determined as 6~103ppm in this study. The methanol content of these samples was analyze4 as O~195ppm below the guideline of regulation. In the mutagenic test of urethane ana 2-phenylethanol, the mutagenicity of urethane and 2-phenylethanol was 75,000 times and 3,750 times lower than 4-NQO and MNNG, respectively. From these results, toxicity caused by these materials could to be disregared in some alcoholic beverages.