Management of Osteoporotic Vertebral Fracture: Review Update 2022

A vertebral fracture is the most common type of osteoporotic fracture. Osteoporotic vertebral fractures (OVFs) cause a variety of morbidities and deaths. There are currently few “gold standard treatments” outlined for the management of OVFs in terms of quantity and quality. Conservative treatment is the primary treatment option for OVFs. The treatment of pain includes short-term bed rest, analgesic medication, anti-osteoporotic medications, exercise, and a brace. Numerous reports have been made on studies for vertebral augmentation (VA), including vertebroplasty and kyphoplasty. There is still debate and controversy about the effectiveness of VA in comparison with conservative treatment. Until more robust data are available, current evidence does not support the routine use of VA for OVF. Despite the fact that the majority of OVFs heal without surgery, 15%–35% of patients with an unstable fracture, persistent intractable back pain, or severely collapsed vertebra that causes a neurologic deficit, kyphosis, or chronic pseudarthrosis frequently require surgery. Because no single approach can guarantee the best surgical outcomes, customized surgical techniques are required. Surgeons must stay current on developments in the osteoporotic spine field and be open to new treatment options. Osteoporosis management and prevention are critical to lowering the risk of future OVFs. Clinical studies on bisphosphonate’s effects on fracture healing are lacking. Teriparatide was intermittently administered, which dramatically improved spinal fusion and fracture healing while lowering mortality risk. According to the available literature, there are no standard management methods for OVFs. More multimodal approaches, including conservative and surgical treatment, VA, and medications that treat osteoporosis and promote fracture healing, are required to improve the quality of the majority of guidelines.

A Case of Sweet’s Syndrome with Acute Kidney Injury in a Patient with Myelodysplastic Syndrome / 대한내과학회지

Sweet’s syndrome (SS) is an autoimmune-mediated acute febrile neutrophilic dermatosis with a number of possible etiologies, including infection, malignancy, and drug reactions. In contrast to its original description, it can rarely involve extracutaneous organs, including the central nervous system, cardiovascular system, lung, liver, gastrointestinal tract, spleen, and bone. To our knowledge, there have been only three cases of SS accompanied by acute kidney injury worldwide, and this is the first report in which the patient recovered completely from acute kidney injury as well as cutaneous lesions with early steroid administration. Here, we report a case of SS with acute kidney injury in a patient with myelodysplastic syndrome (MDS) whose skin lesions and renal function recovered fully with early diagnosis and steroid therapy along with a review of the relevant literature.

Clinical features and outcomes in kidney transplant recipients with renal cell carcinoma: a single-center study

BACKGROUND: Previous studies have recommended a 2- to 5-year waiting time prior to kidney transplantation (KT) in patients with end-stage renal disease (ESRD) and symptomatic renal cell carcinoma (RCC) and no delay for incidental early-stage RCC. Data on Asian KT recipients are unavailable.METHODS: This is a Korean single-center retrospective study on 35 KT recipients with ESRD and RCC. Patients were classified into two groups: early KT (KT performed within 1 year after nephrectomy for RCC, including KT with simultaneous nephrectomy) and delayed KT (KT performed over than 1 year after nephrectomy for RCC). Patient survival, graft survival, and cancer recurrence were compared between both groups.RESULTS: There were no statistically significant differences in patient survival (P = 0.388), graft survival (P = 0.317), or graft rejection rate (P = 0.207) between the early and delayed KT groups. Additionally, there were no differences in pathological characteristics or RCC stage other than cancer histology: acquired cystic disease-associated RCC (47.4%) was the most common RCC type in the early KT group, whereas clear cell type (62.5%) was the most common RCC type in the delayed KT group. No RCC recurrence was observed.CONCLUSION: Patients with early-stage and asymptomatic RCC do not require a mandatory observational period prior to KT after curative nephrectomy

Wide Excision Using Indigo-Carmine to Minimize the Recurrence of a Pilonidal Cyst: Technical Note / 대한정형외과학회잡지

The cause of a pilonidal cyst is unclear, and treatment is still under debate. In Korea, the incidence of this disease is lower than that of Western countries, and it has often been misdiagnosed as a simple abscess. When pilonidal cysts are diagnosed, the principle of treatment is not to leave a residue, and a wide excision is needed to reduce the recurrence rate. This paper introduces a wide excision technique using Indigo-carmine dye to minimize the recurrence of a pilonidal cyst.

Multiple Hepatic Metastasis and Lymphatic Metastasis of Solid Pseudopapillary Neoplasm of Pancreas

Solid pseudo-papillary neoplasm (SPN) of pancreas is a rare epithelial neoplasm of pancreas with a low malignant potential, occurs most commonly in young females. Here, we report a rare case of woman who has severe hepatomegaly due to multiple hepatic metastases of SPN of pancreas. At the time of diagnosis, a SPN was detected at only pancreas and there was no evidence of metastasis. So, she received subtotal pancreatectomy and total splenectomy. After 2 years of follow up, multiple small hepatic metastases were presented. In spite of three times of radiofrequency ablation, the burden of hepatic metastasis has increased continuously and multiple intra-abdominal lymph nodes metastases were detected, and ascites and peripheral edema occurred. However, because of benign feature of SPN and extremely rare incidence of recurrence and metastasis, there is no specific treatment guideline for metastatic SPN. Through multidisciplinary care service, we planned to do radiotherapy followed by a transarterial chemoembolization (TACE). But the patient could not have a scheduled radiation therapy due to deterioration of liver function. So changing the strategy of treatment, followed by TACEs were done alone. Although the size of SPN is not reduced, the extent of SPN and complication of SPN (ascites, peripheral edema, abdominal pain and so on) are being controlled.

Cardiovascular Risk in Patients with Non-alcoholic Fatty Liver Disease / 대한소화기학회지

Non-alcoholic fatty liver disease (NAFLD) includes a wide spectrum of diseases that range from simple steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis. In addition, the burden of NAFLD is rapidly growing. Previously, NAFLD was regarded as a hepatic manifestation of metabolic syndrome, which is a traditional cardiovascular disease (CVD) risk factor. However, there has been an increasing evidence that suggest NAFLD to be an independent risk factor of CVD. Therefore, currently, NAFLD should be reconsidered as not only a simple manifestation of metabolic syndrome, but also a systemic disease that contribute to CVD. There are some reasonable hypotheses about the relationship between NAFLD and CVD. Moreover, many studies have been performed to better understand this relationship. Nonetheless, the underlying mechanisms and pathogenesis of NAFLD that contribute to CVD have not yet been fully elucidated to date. This review focuses on the underlying mechanisms and relationship between NAFLD and CVD.

Bladder Malakoplakia Mimicking Bladder Cancer / 대한내과학회지

Malakoplakia is an extremely rare granulomatous disease caused by infection and known to occur mostly in immune-compromised hosts. The most common site of involvement is the bladder. Patients with malakoplakia of the bladder present with multiple intravesical masses and are often misdiagnosed with bladder cancer. As a result, appropriate treatment is delayed. Here we report a case of a patient with malakoplakia of the bladder that was misdiagnosed as bladder cancer.

Use of Botulinum Toxin Type A Injection Under Ultrasonographic Guidance for Management of Parotid Sialocele: A Case Report and Literature Review

Sialocele formation is a recognised complication of parotid surgery. Most cases resolve after conservative therapy consisting of pressure dressing, fasting, and repeated aspiration. However, some cases are resistent to such treatment and require further intervention. In this report, we present the method of botulinum toxin (BTX) injection into the parotid gland under ultrasonographic guidance along with atropine injection. A 63-year-old female underwent excision of a pleomorphic adenoma abutting an accessory parotid gland. Sialocele formation persisted after almost 3 weeks of conservative therapy. BTX A was given under ultrasonographic guidance and the sialocele disappeared after two doses of treatment. BTX injection under ultrasonographic guidance was thus a safe and effective method for treating persistent sialocele.

Spontaneous Regression of Hyperplastic Gastric Polyps

Although gastric hyperplastic polyps are recognized as benign lesions, there is concern regarding carcinomatous changes in the polyps, depending on their size. If the polyp size is larger than 1.0~2.0 cm, endoscopic resection is usually recommended. Gastric hyperplastic polyps easily undergo changes in their shape and size over time. However, spontaneous regression of hyperplastic polyps is very rare. We present a recent case wherein gastric hyperplastic polyps disappeared spontaneously. We present the case along with a literature review.

The Efficacy of Transverse Fixation and Early Exercise in the Treatment of Fourth Metacarpal Bone Fractures

BACKGROUND: Several techniques have been designed to treat fifth metacarpal fractures reported to be effective. However, these methods cannot be easily applied to the fourth metacarpal due to its central anatomical position. In this study, we sought to analyze the functional outcomes of patients who underwent transverse pinning for a fourth metacarpal bone fracture. METHODS: A total of 21 patients were selected and their charts were retrospectively reviewed. After fracture reduction, two transverse Kirchner wires were first inserted from the fifth metacarpal to the third metacarpal transversely at the distal part of the fractured bone, and then another two wires were inserted at the proximal part of the fractured bone. The splint was removed approximately one week postoperatively and the Kirchner wires were removed four to five weeks postoperatively. Patients started active and passive exercise one week after the operation. Pain visual analog scores, total active and passive motion, and the active and passive range of motion of the metacarpophalangeal joint and grip strength were evaluated. RESULTS: Dorsal angulation improved from a preoperative value of 44.2° to a postoperative value of 5.9°. Six weeks after surgery, functional recovery parameters, such as range of motion and grip strength, had improved to 98% of the function of the normal side. No major complication was observed. CONCLUSIONS: We suggest that the transverse pinning of fourth metacarpal bone fractures is an effective treatment option that is less invasive than other procedures, easy to perform, requires no secondary surgery, minimizes joint and soft tissue injury, and allows early mobilization.

Embryonal rhabdomyosarcoma in the abdominal cavity of an aged Sprague-Dawley rat / 대한수의학회지

We report a spontaneous embryonal rhabdomyosarcoma in the abdominal cavity of an aged (88-week-old) Sprague-Dawley rat. The animal had a firm lobulated 5 x 5 x 4.5 cm mass in the abdominal cavity that was whitish to tan with necrotic and hemorrhagic plaques. Microscopically, the mass contained nodules with spindle or globoid shaped neoplastic cells with abundant eosinophilic cytoplasm and round or elongated nuclei mixed with other spindle cells with a filamentous appearance and scanty cytoplasm. Multinucleated cells and cross-striations were also observed. The neoplastic cells were positive for vimentin, desmin, and alpha-smooth muscle actin, especially the small spindle cells.

Immediate Distal Digit Reconstruction with Short Vascular Pedicled Partial Toe Transfer

We studied the results of the immediate microsurgical reconstruction of the distal digit injury with short vascular pedicled partial toe transfer. Thirteen patients with amputation or crush injury of the distal digit who underwent partial toe transfer at the authors' institute over 8-year period were reviewed. Delay between initial injury and reconstruction ranged from 1 to 9 days. All flaps were harvested on a short vascular pedicle, with anastomoses performed at a proximal interphalangeal joint level on the fingers and metacarpophalangeal joint level on the thumbs. Good to excellent cosmetic and functional results were obtained in all cases, with nearly normal-looking fingertip. The mean static two point discrimination was 10 mm. Immediate reconstruction with short vascular pedicled partial toe transfer is an excellent option for the reconstruction of the compostie defect of the distal digit.

A 6-Week Oral Toxicity Study of Oral Cholera Vaccine in Sprague-Dawley Rats

The present study was carried out to examine the toxicity and target organs of oral cholera vaccine (OCV) after repeated oral administration in Sprague-Dawley rats for 6 weeks (3 administrations, once every 2 weeks). OCV is an inactivated oral cholera vaccine that contains Vibrio cholerae and confers protection against cholera caused by V. cholera serogroups O1 (Inaba and Ogawa serotypes) and O139 (strain 4260B). The animals were orally administered either OCV placebo (negative control) or OCV at a dose equivalent to 240 times the anticipated human dose. Throughout the administration period, no significant change was detected in clinical signs, body weight, food or water consumption, urinalysis results, hematological and clinical biochemistry test results, organ weights, necropsy, or histopathological examination results. Minor changes were found in hematological and clinical biochemistry tests; however, these changes were within normal ranges. The above results suggest that oral administration of OCV in rats did not induce any toxicologically meaningful changes, and the target organs could not be determined. This study was conducted in accordance with the guidelines established by Good Laboratory Practice (2009-183, KFDA, December 22, 2009) and the OECD Principles of Good Laboratory Practice (1997).

Phorbol 12-Myristate 13-Acetate Induces MUC16 Expression via PKCdelta and p38 in Human Airway Epithelial Cells

OBJECTIVES: Phorbol 12-myristate 13-acetate (PMA) is widely used as a protein kinase C (PKC) activator, PKC is involved in the secretion of mucins. MUC16, one of the membrane-bound mucins, is produced in human airway epithelial cells. However, the effect and signaling pathway of PMA on MUC16 expression in human airway epithelial cells has not been reported. Therefore, the effect and brief signaling pathway of PMA on MUC16 expression were investigated in human airway epithelial cells in this study. METHODS: In the mucin-producing human NCI-H292 airway epithelial cells and the primary cultures of normal nasal epithelial cells, the effect and signaling pathway of PMA on MUC16 expression were investigated using reverse transcriptase-polymerase chain reaction (RT-PCR), real-time PCR, enzyme immunoassay, and immunoblot analysis with several specific inhibitors and small interfering RNA (siRNA) for p38 mitogen-activated protein kinase (MAPK). RESULTS: PMA increased MUC16 expression, and activated phosphorylation of p38 MAPK. However, it did not activate phosphorylation of extracellular signal-regulated kinase 1/2 (ERK1/2). SB203580 (p38 MAPK inhibitor) inhibited PMA-induced MUC16 expression, while U0126 (ERK1/2 inhibitor) did not. In addition, the knockdown of p38 MAPK by p38 MAPK siRNA significantly blocked PMA-induced MUC16 mRNA expression. Rottlerin (PKCdelta inhibitor) inhibited PMA-induced MUC16 expression, and also inhibited the phosphorylation of activated p38 MAPK by PMA. CONCLUSION: These results show for the first time that PMA-induced MUC16 expression is regulated by activation of the PKCdelta and p38 MAPK signaling pathway in human airway epithelial cells.

Reconstruction of the Digit Using Anterolateral Thigh Perforator Flap

PURPOSE: We reported the results of the digit reconstruction using anterolateral thigh perforator flap followed by delayed debulking operation. METHODS: We retrospectively reviewed all patients with digital injury who underwent anterolateral thigh perforator flap and delayed debulking operation. Ten digits in 8 patients were included. Three months after the last operation, the circumferences of the reconstructed digits were measured. RESULTS: There were no partial or complete flap necrosis. Average circumferences of the reconstructed digits were 111 percent (range: 104-120 percent) of those of the normal digits. CONCLUSION: Anterolateral thigh perforater flap and delayed debulking operation is a good option for the reconstruction of the large soft tissue defect of the digit.

Sex Differences in a Cross Sectional Study of Age-related Hearing Loss in Korean

OBJECTIVES: The purpose of this study was to obtain sex- and age-specific reference level for hearing threshold of normal aging in Korean and to determine if the rate of change in pure-tone hearing thresholds differed by sex. METHODS: Subjects were clients who visited the Health Promotion Center, Daegu Fatima Hospital, Daegu, Korea, from January 2004 to September 2005. Pure-tone audiometric measures were obtained from 3,470 subjects who also completed a hearing questionnaire. The slope of a linear regression was used to estimate the rate of change in pure-tone thresholds at 0.25 to 8 kHz for each ear in 214 men and 902 women without past history of otorrhea, usage of ototoxic drugs, head injury, job in noisy environment, and military service. RESULTS: Hearing thresholds were elevated with age in all test frequencies. Significant sex differences were found in pure-tone thresholds at 4 and 8 kHz after adjusting for age using analysis of covariance. In those high frequencies, hearing was worse in men than in women. The average rate of change in threshold was 0.28 and 0.24 dB per year at 0.25 kHz, increasing gradually to 1.27 and 1.05 dB per year at 8 kHz for men and women, respectively. Men had significantly faster rates of threshold increase at 4 and 8 kHz than women. CONCLUSION: These cross-sectional measures of hearing levels and rate of threshold increases at 4 and 8 kHz showed significant sex differences in Korean men and women with little evidence of noise-induced hearing loss.

Transmasseteric Approach for Open Reduction and Internal Fixation of Mandible Subcondylar Fracture

PURPOSE: Surgical approaches to the condylar neck and subcondyle area can cause some morbidity such as, facial nerve injury, time-consuming nature and external scar etc. So many surgeons hesitate using open reduction and internal fixation for the treatment of subcondylar fractures. We report open reduction and internal fixation of subcondylar fractures in 13 adult patients via transmasseteric approach. METHODS: From 2007 to 2009, 13 adults with subcondylar fracture of mandible were treated with open reduction and internal fixation via transmasseteric approach. A preauricular incision was extended downwards in a curvilinear fashion in the cervicomastoid skin crease. Skin flap was elevated above the SMAS layer. Masseter muscle was splitted at the anteroinferior edge of the parotid gland. After the fracture was reduced, fixed with appropriate plates and screws. All operation were performed under general anesthesia. RESULTS: Mean follow-up period was 13.3 months. There were no signs and symptoms of facial nerve injury, difficulty in mouth opening, or malocclusion. Dissection time was roughly within 30 minutes. CONCLUSION: Transmasseteric open reduction and internal fixation of mandible subcondylar fracture can be performed with excellent visualization, and inconspicuous scar. It also offers swift access to the subcondylar area while substatially reducing the risk to the facial nerve and eliminating the complications associated with transparotid approaches.

Fibro-osseous Pseudotumor of the Great Toe: A Case Report / 대한골관절종양학회지

Fibro-osseous pseudotumor is an extremely rare benign lesion which is fast-growing and painful. It is often misdiagnosed as a malignancy, but it is a noninvasive entity and can be cured by simple resection. We report a case of fibro-osseous pseudotumor of the distal phalanx of great toe in 20-year-old female patient who present with painful mass.

Uterine Adenomyosis in Beagle Dogs / 한국실험동물학회지

Adenomyosis is a nonneoplastic hyperplastic lesion, characterized by invagination of proliferating endometrial glands into myometrium. In dogs, uterine adenomyosis is relatively rare and it is important in Toxicologic Pathology to differentiate other non-neoplastic and neoplastic lesions in uterus. In the present study, we report two cases of adenomyosis in the female beagle dogs used for a chemical toxicity test. Clinically, one out of the two female beagle dogs, 15 months of age, had vaginal bleeding for 2 weeks and the other one, 11 months of age, showed swelling of vulva for a week. At necropsy, the weight of uterus was markedly increased to 27.9 g and 15.8 g, compared with the mean value (4.01+/-2.37, n=6) of that of other normal dogs, respectively. The parameters of hematology and serum chemistry were ranged normal in both of the dogs with enlarged uterus. For differentiation of connective tissue with muscle fibers, Van Gieson stain was also performed in the serial tissue sections. Histopathologically, the lesions of the enlarged uteruses were characterized by proliferating endometrial glands into myometrium, surrounded by connective tissue. The endometrial glands were proliferating downward to myometrium or embedded in multiple clustered glands in deeper myometrium without compressing the adjacent muscle fibers. The gland epithelial cells are uniformly cuboidal shape with a dense and bottom-located nucleus. These gross and histological findings were consistent with adenomyosis.

Ulna Nerve Compression Caused by a Tortuous Ulnar Artery

PURPOSE: This case report presents ulnar nerve compression which associated with variant distribution of ulnar artery at the proximal site of the wrist. MATERIALS AND METHODS: Based on the patient's symptoms, we could assume a neuropathy resulting from the compression of the ulnar nerve. The magnetic resonance imaging (MRI) was used to evaluate the anatomical abnormality of the ulnar artery at the site of compression, and the elecromyogram (EMG) and Nerve conduction velocity (NCV) were also performed to confirm the overall abnormality of the ulnar nerve. RESULTS: The tortuous ulnar artery of the lesion which was in the same course as that of ulnar nerve surrounded by sheath seemed to be compressed. Such finding was resolved 5 minutes after taking off tourniquet during adhesiolysis. Along with the improvement in the symptoms of paresthesia and the numbness of the patient a day after the surgery, the atrophy of the muscle and the weakness of the affected lesion were also slightly improved 6 months after the adhesiolysis. The decrease in abnormal spontaneous activity of the ulnar nerve was observed in both EMG and NCV, performed after the 6 month of the surgery. CONCLUSION: Among the patients manifesting significant symptoms of neuropathy arising from ulnar nerve compression, the tortuous ulnar artery as the source of entrapment of ulnar nerve was observed. Six months after the adhesiolysis of the sheath, the overall improvement of clinical symptoms was remarkable.