ABSTRACT
Background@#Limited information is available about the proportion of patients with degenerative lumbar spinal disease (DLSD) who have gastrointestinal (GI) and cardiovascular (CV) risk factors. Many DLSD patients are prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) that are known to carry risks to the GI and CV systems by increasing GI bleeding and thromboembolic events.This study aimed to measure the prevalence of GI and CV risk in patients with DLSD and to ascertain whether the prescription of NSAIDs is in line with current guidelines. @*Methods@#This study included 153 patients with symptomatic DLSD who were planning to undergo lumbar spinal surgery. The GI profile was checked using the GI Standardized Calculator of Risk for Event system and CV risk was evaluated using the presence of metabolic syndrome. The conformity of the prescription of NSAIDs was investigated according to the recommendations in current guidelines. @*Results@#More than half of the patients (59.5%) had high or very high GI risk, and 66% of the patients were diagnosed with metabolic syndrome, which corresponds with CV risk. The rate of simultaneous GI and CV risk was 40.5% (n = 62 / 153; gastrointestinal Standardized Calculator of Risk for Event, > high and metabolic syndrome, yes). The actual prescription of NSAIDs was not in accordance with current guidelines. @*Conclusions@#Two out of 3 patients had GI or CV risk factors, and approximately 40% of patients had both. Detailed assessment of GI and CV risk in patients with DLSD by using effective evaluation tools is mandatory for optimal medical treatment.
ABSTRACT
The synovium is lined by a layer of intimal cells which have been classified on ultrastructural criteria into type A and B synoviocytes. The functionally important lining cells of the synovium(type A and B synoviocytes) are the subjects of many study but have presented problems with their characterization and microscopical identification. Synovial sarcoma is a distinct and generally recognized soft tissue tumor that its origin still raises controversy. In this study, 12 cases of nonspecifically proliferative and resting human synoviocytes have been obtained from the synovium of knee and hip joints, and 3 cases of synovial sarcoma which have arisen in the left thigh, left buttock and right inguinal region were examined with light microscopy, immunohistochemical observation, and electron microscopy. In light microscopic level, it was difficult to differentiate the type A synoviocytes from type B synoviocytes morphologically. The reactive type B synoviocytes were positive for the protein of cytoskeleton such as pancytokeratin, CK1, CK8, CEA, and vimentin. The resting type B synoviocytes showed positive reactions for pancytokeratin, CK1, and CK8. The markers for the monocytes/histiocytes(CD15, CD68, lysozyme, Al-AT, Al-ACT) were reactive in resting and reactive type A synoviocytes. Also, MHC class II antigen was reactive in type A synoviocytes. Three cases of primary synovial sarcoma were 2 fibrous monophasic and 1 biphasic. Spindle-shaped cell in fibrous monophasic synovial sarcoma showed reactivity for CK7 and pancytokeratin, and epithelial cells (lining the glands) in biphasic synovial sarcoma were reactive for CK 7, pancytokeratin, EMA, and focally CEA, but only spindle cells reactive for vimentin, By electron microscopy, fibrous monophasic synovial sarcoma showed pseudogland formation with intercellular junctions of paired subplasmalemmal density and discontinuous basal lamina. These results suggest that the reactive type B synoviocytes and synovial sarcoma show an aberrant expression of the vimentin and CEA. The expression of CK on the resting and reactive type B synoviocytes and fibrous monophasic and biphasic synovial sarcomas are different. Type A synoviocytes expressing the MHC class II molecule and monocyte/histiocyte markers suggest a member of the mononuclear phagocytic system. The reasons of the aberrant expression of the intermediate filament, vimentin and oncofetal antigen, and CEA in reactively proliferative type B synoviocytes and synovial sarcoma and the different expression of cytokeratin on the resting, reactive type B synoviocyte and synovial sarcoma should be further evaluated.
Subject(s)
Humans , Basement Membrane , Buttocks , Cytoskeleton , Epithelial Cells , Hip Joint , Histocompatibility Antigens Class II , Immunohistochemistry , Intercellular Junctions , Intermediate Filaments , Keratins , Knee , Microscopy , Microscopy, Electron , Muramidase , Sarcoma, Synovial , Synovial Membrane , Thigh , VimentinABSTRACT
Distal radial fractures are recognized as very complex injuries with a variable prognosis that depends upon the fracture type and the treatment method. The purpose of this study is to compare radiological and clinical result between external fixation and external fixation with primary bone graft in intraarticular comminuted fracture of distal radius. From January 1993 to December 1995, 32 patients with comminuted intraarticular fractures of the distal radius were treated using a external fixation. 15 cases were treated with ligamentotaxis without bone graft and 17 cases were treated with additional primary bone graft. In last follow-up examination, the mean loss of radial length, radial inclination and volar tilt were less in with bone graft group than without bone graft group. According to Demerit point system Excellent to good results were obtained in 88.2% in cases of external fixation and bone graft group, 66.6% in cases of only extemal fixation group. External fixation combined with primary bone graft is more useful method for the reconstruction and treatment of comminuted intraarticular fractures of the distal radius than closed reduction and external fixation because cancellous bone graft not only provides early mechanical stability but also helps to reduce and supports the depressed intraarticular fragments. Furthermore, this method not only prevents late collapse of fracture but also enhance fracture healing.
Subject(s)
Humans , External Fixators , Follow-Up Studies , Fracture Healing , Fractures, Comminuted , Intra-Articular Fractures , Prognosis , Radius , TransplantsABSTRACT
Nontuberculous mycobacteria usually cause systemic disease and often appear as a primary pulmonary infection. However, a cutaneous lesion may be the first or only sign of infection. The most frequent human diseases caused by Mycobacterium fortuitum are cutaneous or soft tissue infections, usually preceded by injection, trauma or surgery. We report a case of a cutaneous lesion due to Mycobacterium(M.) fortuitum occuring in a 50-year-old man with a subcutaneous flat nodule on his left anterior tibia. He had received a small injury to his left shin in a swimming pool. The culture from the skin biopsy specimen on Lowenstein-Jensen medium yielded clolnies after 5 days. The microorganism was subsequently identified as M. fortuitum by selected biochemical reactions. Therapy was instituted with minocycline for 5 months.
Subject(s)
Humans , Middle Aged , Biopsy , Minocycline , Mycobacterium fortuitum , Mycobacterium , Nontuberculous Mycobacteria , Skin , Soft Tissue Infections , Swimming Pools , TibiaABSTRACT
PURPOSE: To evaluate further the right minor and major fissure on thin-section narrow-interval CT scans with particular emphases on orientation, degree of completeness. MATERIALS AND METHODS: Thin section CT scans from 10 mm distal to carina to the proximal basal segmental bronchus were obtained at 5 mm invervals in 50 consectutive subjects. Orientation, degree of completeness, and the relationship of the minor and major fissure on thin-section CTscans were analyzed. RESULTS: Four principal types of the minor fissure could be identified according to the highest point of the upper surface of the middle lobe. At bronchus intermedius level, the major fissure appeared with its medial end anterior to lateral end in 45 subjects. The minor fissure was complete in only 10 subjects (20%). Completely absent minor fissure was noted in four subjects (8%). The major fissure was incomplete in 17 subjects (34%) at bronchus intermedius level. the minor and major fissure intersected each other in only 27 subjects (54%). The hig best point of intersection was variable. CONCLUSION: There are much more variations in the fissural complex in our study than in previous reports and these variations can be visualized well on thin-section CTscans.
Subject(s)
Bronchi , Lung , Tomography, X-Ray ComputedABSTRACT
PURPOSE: To assess the prognostic value of computed tomography (CT) in acute pancreatitis, initial CT examinations were classified into 5 grades in terms of the degree of disease severity and CT findings were correlated with clinical course, objective prognostic signs, and complications. MATERIALS AND METHODS: In 29 consecutive patients with acute pancreatitis, the CT examination and clinical course were reviewed without knowledge of each other finding. Both Ranson's prognostic signs and modified Glascow prognostic signs were used for evaluation of acute pancreatitis. RESULTS: Of the 29 patients, 25 patients recovered with medical treatment while 4 patients (14%) developed pseudocysts and the other 4 patients (14%) developed abscesses. CT findings of the acute pancreatitis are as follows; 10 patients (35%) in grade A with normal pancreas, 2 patients (7%) in grade B with pancreatic enlargement, 2 patients (7%) in grade C with intrinsic pancreatic abnormalities associated with haziness, 3 patients (10%) in grade D with single, ill-defined fluid collection, and 12 patients (41%) in grade E with extensive and two or multiple fluid collections or presence of gas in or adjacent to the pancreas. Correlation coefficient is 0.46 (p=0.012) between CT findings and Ranson's prognostic signs, 462 (p=0.0115) between CT findings and modified Glascow prognostic signs. CONCLUSION: CT gradings of acute pancreatitis may be useful in predicting clinical course.
Subject(s)
Humans , Abscess , Pancreas , PancreatitisABSTRACT
PURPOSE: To evaluate the extrahepatic spread of peripheral cholangiocarcinoma with CT. MATERIALS AND METHODS: We retrospectively reviewed CT findings of extrahepatic spread in thirty-six patients with peripheral cholangiocarcinoma confirmed adenocarcinoma at surgery(n=5) or percutaneous biopsy(n--31) without primary leion in other organs, and analysed the frequency and distribution of enlarged lymph nodes, direct invasion of adjacent solid organs, and thrombosis of major vessels. RESULTS: Among the 36 cases, enlarged metastatic lymph node was noted in twenty-four(66.7%), direct invasion into adjacent organs in six(16.7%), portal and inferior vena caval thrombosis in five(13.9%). Enlarged lymph nodes were seen in hepatic nodes(n=16, 44.4%), portocaval nodes(n=15, 41.7%), interaortocaval nodes (n=10, 27.8) and celiac nodes in two(5.6%). Direct invasion was detected in the greater omentum(n=6), gallbladder(n:3) and stomach(n=2). Portal vein thrombosis(n:5) and thrombosis of inferior vena cava(n=2) were noted. CONCLUSION: Lymph node metastasis was seen in 67% in patients with peripheral cholangiocarcinoma. Direct invasion to adjacent organs and thrombosis in portal vein or inferior vena cava were occasionally associated.
Subject(s)
Humans , Adenocarcinoma , Cholangiocarcinoma , Lymph Nodes , Neoplasm Metastasis , Portal Vein , Retrospective Studies , Thrombosis , Vena Cava, InferiorABSTRACT
Authors reviewed 42 fractures of distal tibia fixated with Ender nails(24 cases) or Interlocking nails(18 nails) at the Chosun university Hospital from 1986 to 1992. The purpose of this study is to compare the bony union, the complications and the functional results of two groups(Ender nailing group and Interlocking nailing group). The follow-up period was average 19 months(range, 12 to 36 months). The results were as follows 1. The most common causes of the injury were traffic accidents(36 cases). 2. In the Ender nailing group, 8 cases are closed fractures and 16 cases are open fractures. Among 24 cases, 14 cases are simple fractures and 10 cases comminuted fractures. In interlocking nailing group, 7 cases are closed fracture and 11 cases are open fractures. Among 18 cases, 8 cases are simple fractures and 10 cases are comminuted fractures. 3. The average radiologic union was obtained at 19.3 wks in Ender nailing group, and 18.1 wks in interlocking nailing group. 4. Major complication was a delayed union in both group(5 cases-Ender nailing group, 3 cases-Interlocking group). 5. According to the criteria of functional results by Klemm and Borner, we obtained a 87.5% of Excellent and good results in Ender nailing group(21 out of 24 cases) and 94.4% of Excellent and good results in Interlocking group(17 out of 18 cases). 6. There was no significant difference between the two groups in stable fractures of distal tibia, so we suppose that Ender nailing is a good technique in these cases due to its simplicity and the economic price. But in more unstable fractures such as long oblique, spiral and comminuted fractures, we think that intramedullary interlocking nailing is better due to its stability.
Subject(s)
Follow-Up Studies , Fracture Fixation, Intramedullary , Fractures, Closed , Fractures, Comminuted , Fractures, Open , TibiaABSTRACT
The CT findings were reviewed in two patients with injuries to the gallbladder following blunt trauma. In one patient high attenuation of intraluminal blood clot within the gallbladder and associated hemoperitoneum were identified. Another patient was represented hemoperitoneum and bile leakage into the peritoneal cavity due to laceration of the fundus of the gallbladder which appeared contrasted.
Subject(s)
Humans , Bile , Gallbladder , Hemoperitoneum , Lacerations , Peritoneal CavityABSTRACT
No abstract available.
ABSTRACT
The authors evaluated high resolution computed tomographic (HRCT) findings of the isolated rabbit lungs with paraquat poisoning, and the findings were correlated with pathologic specimens. The purposes of this study are 1) to obtain the HRCT findings of the normal rabbit lung, 2) to find out if pulmonary pathology can be induced in rabbits by paraquat, and 3) to correlate the HRCT findings to those of pathology. Thirty rabbits were divided into three groups: group I included four control rabbits; group II included 16 rabbits given paraquat intraperitoneally(IP group); and group III included 10 rabbits given paraquat intravenously(IV group). The rabbits were sacrificed seven, 10 and 14 days after injection of various amount of paraquat, and then the lungs were isolated for HRCT and pathologic studies. Gross and microscopic findings of the three groups of control and paraquat-injected rabbit lungs were correlated with HRCT findings. Pulmonary congestion, mild thickening of alveolar walls and septae, and multifocal micro-atelectasis were the main pathologic findings of the lungs in both groups of the rabbits. Pulmonary hemorrhage was noted in five (31%) of 16 rabbits of IP group and three (30%) of 10 IV group. Pulmonary edema was seen in one rabbit (6%) of IP and four (40%) of IV group. Typical pulmonary fibrosis was seen in one rabbit of IP (6%) and IV (10%) group, respectively. There was no correlation between the amount of paraquat and frequency of the pulmonary pathology. Pulmonary fibrosis was seen at least one week after the paraquat injection. On HRCT, pulmonary hemorrhage and edema appeared as diffuse air-space consolidation and pulmonary fibrosis as linear or band-like opacities. However, minimal changes such as mild congestion.
Subject(s)
Rabbits , Edema , Estrogens, Conjugated (USP) , Hemorrhage , Lung , Paraquat , Pathology , Poisoning , Pulmonary Edema , Pulmonary FibrosisABSTRACT
We obtained sixty normal chest postero-anterior(PA) radiographs with high kilovoltage technique(90-110kVp), 10 radiographs from the consecutive normal persons in each decade from twenties to seventies to analyze normal course and appearance of azygoesophageal recess (AER) line. (AER) line. CT scans from sixty consecutive normal persons were correlated with the radiographs to see how the line is formed and what structure the line abuts. In 20 patients with a lesion in AER area(10 with subcarinal lymphadenopathy of various size, five with left atrial enlargement, three with lesions in the esophagus, and two with dilated azygos vein), radiographic and CT correlation was done with main attention to the pattern of displacement of the azygoesophageal line. In normal chest PA radiographs, AER was shown as a straight line in young adults. As age increased, it was seen as a smooth are with convexity to the left. Sigmoid shape with midline cross was noted in an aged person. At the level of the right main bronchus on CT, AER was noted along the right lateral aspect to the vertebral margin in young adults. It extended medially as age increased. Caudally the recess extended more medially. The azygos vein usually bordered the recess. The esophagus or mediastinal fat sometimes bordered the recess in caudal level. In normal persons, the recess appeared deeper on plain radiographs than on CT. On plain radiographs, there were no changes in contour of AER with subcarinal lymphadenopathy of less than 2.5cm in diameter. However right sided and downward displacement of AER line just below the carina was noted with lymphadenopathy of more than 2.5cm in diameter. With left atrial enlargement, obliteration of the line was noted at T8-10 level. Focal right sided bulging of the line was noted with esophageal cancer Dilatation of azygos vein caused the line to appear with right sided displacement. In conclusion, AER line can be delineated with various features on radiographs with high KVP technique, depending on the age of normal persons and the formation of the line can be explained with CT. Displacement and change in the contour of the line can be seen with various mediastinal diseases.
Subject(s)
Humans , Young Adult , Azygos Vein , Bronchi , Colon, Sigmoid , Dilatation , Esophageal Neoplasms , Esophagus , Lymphatic Diseases , Mediastinal Diseases , Thorax , Tomography, X-Ray ComputedABSTRACT
Lymphomatoid granulomatosis usually presents as a primary lung affliction with secondary metastatic spread to the central nervous system(CNS), and its initial manifestation purely as a CNS disease is rare. A 57-year-old man with histologically proven lymphomatoid granulomatosis of the brain as the sole manifestation of the disease is presented.
Subject(s)
Humans , Male , Middle Aged , Brain Neoplasms/pathology , Frontal Lobe , Lymphomatoid Granulomatosis/pathologyABSTRACT
No abstract available.
ABSTRACT
Confluent and reticulate papillomatosis is a rare but clinically distinct dermatosis first described by Gougerot and Carteaud in 1927. It consists of dark brown pigmented papules which coalesce to reticulate and confluent patches. It usually begins shortly after puberty mainly in females and is most often localized to the intermammary and interscapular regions. Histological examination shows hyperkeratosis and papillomatosis, and there may be decreased granular cell layer, focal acanthosis, or hypermelanosis of the basal cell layer. We recently observed a 20-year-old male patient who showed typical clinical and histopathological findings of confluent and reticuIate papillomatosis. Treatment with an aromatic analog of vitamin A acid(Ro 10-9359) resulted in dramatic effectivenese.