Risk factors of chronic subscapularis tendon tear

Background@#Chronic subscapularis tendon tear (SBT) is a degenerative disease and a common pathologic cause of shoulder pain. Several potential risk factors for chronic SBT have been reported. Although metabolic abnormalities are common risk factors for degenerative disease, their potential etiological roles in chronic SBT remains unclear. The purpose of this study was to investigate potential risk factors for chronic SBT, with particular attention to metabolic factors. @*Methods@#This study evaluated single shoulders of 939 rural residents. Each subject undertook a questionnaire, physical examinations, blood tests, and simple radiographs and magnetic resonance imaging (MRI) evaluations of bilateral shoulders. Subscapularis tendon integrity was determined by MRI findings based on the thickness of the involved tendons. The association strengths of demographic, physical, social, and radiologic factors, comorbidities, severity of rotator cuff tear (RCT), and serologic parameters for SBT were evaluated using logistic regression analyses. The significance of those analyses was set at p<0.05. @*Results@#The prevalence of SBT was 32.2% (302/939). The prevalence of partial- and full-thickness tears was 23.5% (221/939) and 8.6% (81/939), respectively. The prevalence of isolated SBT was 20.2% (190/939), SBT combined with supraspinatus or infraspinatus tendon tear was 11.9% (112/939). In multivariable logistic regression analysis, dominant side involvement (p<0.001), manual labor (p=0.002), diabetes (p<0.001), metabolic syndrome (p<0.001), retraction degree of Patte tendon (p<0.001), posterosuperior RCT (p=0.010), and biceps tendon injury (p<0.001) were significantly associated with SBT. @*Conclusions@#Metabolic syndrome is a potential risk factor for SBT, as are these factors: overuse activity, diabetes, posterosuperior RCT, increased retraction of posterosuperior rotator cuff tendon, and biceps tendon injury.

Successful Transcatheter Arterial Embolization following Diverticular Bleeding in the Third Portion of the Duodenum:A Case Report

This is a rare case of a 73-year-old male patient who presented with hematochezia and was treated using transcatheter arterial embolization following upper gastrointestinal bleeding in the third portion of the duodenum. The cause of the bleeding was not found on gastrointestinal endoscopy and CT. On the third day of hospitalization, the hemoglobin level continued to decrease. A technetium-99m-labeled red blood cell scan revealed suspicious bleeding in the diverticulum of the third portion of the duodenum. Superior mesenteric artery angiography showed active bleeding from the posteroinferior pancreaticoduodenal artery, which was embolized with N-butyl cyanoacrylate. The patient was discharged on the seventh day after embolization without re-bleeding or complication. We report a rare case of a patient with active bleeding from a duodenal diverticulum that was difficult to diagnose using routine modalities. Herein, we report a rare case of a patient with active bleeding from a duodenal diverticulum that was difficult to diagnose using routine modalities. We also conducted a relavant literature review.

Prevalence of Upper Extremity Musculoskeletal Diseases and Disability among Fruit Tree Farmers in Korea: Cross-Sectional Study

PURPOSE: The aim of this study was to examine the prevalence of upper extremity musculoskeletal (MSK) diseases and to identify factors influencing disability among fruit tree farmers in Korea. MATERIALS AND METHODS: Of the 1150 subjects of the Namgaram study, 460 fruit tree farmers completed a questionnaire and underwent clinical evaluations, including physical assessments, laboratory tests, simple radiographic examinations, and magnetic resonance imaging studies of the upper extremities. Disability was assessed using the Disabilities of the Arm, Shoulder, and Hand outcome measure. Data were analyzed with descriptive statistics and regression analyses using SPSS Win 24.0. RESULTS: The prevalences of upper extremity MSK diseases were 60.4% for rotator cuff tear, 20.9% for golf elbow, 40.9% for tennis elbow, and 58.0% for hand osteoarthritis. Disability in fruit farmers was associated with female sex (B=−4.47, p<0.001), smoking (B=−4.00, p=0.026), depression (B=2.83, p<0.001), working hours (B=0.96, p=0.001), injuries of the arms (B=10.78, p<0.001) and shoulders (B=6.75, p<0.001), and numbers of upper extremity MSK diseases (B=2.02, p=0.001), with 26.5% of the variance explained (R2=0.265, Durbin-Watson test=1.81, p<0.001). CONCLUSION: Fruit tree farmers remain at risk for MSK diseases of the upper extremities. Disability tended to worsen with more MSK diseases. It is necessary to not only educate farmers about prevention strategies, but also to develop an effective management system for agricultural work-related MSK diseases and a surveillance system at the government level for the health problems of farmers.

A Comprehensive Review of Percutaneous Nephrostomy and Suprapubic Cystostomy

Percutaneous nephrostomy is widely used for the diagnosis and treatment of various urinary tract diseases, such as ureteral fistula, stenosis, and percutaneous nephrolithotomy, and the relief of urinary obstruction. Suprapubic cystostomy is also known as a good method for bladder drainage in patients with lower urinary tract obstruction or injury and neurogenic bladder. Despite the frequent use of these procedures, reports in the literature are insufficient for an interventional radiologist to understand the procedures easily and thoroughly. In this article, the indication, anatomy, placement, and postoperative management of percutaneous nephrostomy and suprapubic cystostomy have been described, explaining that the procedures are safe and effective.

Common Upper Extremity Disorders and Function Affect Upper Extremity-Related Quality of Life: A Community-Based Sample from Rural Areas

PURPOSE: Upper extremity musculoskeletal disorders (UEMDs), such as rotator cuff tear, epicondylitis, and hand osteoarthritis, have a negative impact on quality of life (QOL). In this study, we evaluated the prevalence of rotator cuff tear, lateral and medial epicondylitis, and hand osteoarthritis in the dominant side and the impact of these UEMDs on the disabilities of the arm, shoulder, and hand (DASH) outcome measure, which assesses upper extremity-related QOL. MATERIALS AND METHODS: In 2013–2015, 987 participants from rural areas completed a questionnaire and underwent physical examinations, laboratory tests, simple radiographic evaluations of bilateral upper extremities, and magnetic resonance imaging studies of bilateral shoulders. Based on data from these participants, researchers evaluated DASH and performed a functional assessment of each region of the dominant side and related UEMDs. RESULTS: The prevalences of epicondylitis, rotator cuff tear, and hand osteoarthritis were 33.7%, 53.4%, and 44.6%, respectively. Univariate regression analysis results revealed that epicondylitis, epicondylitis+rotator cuff tear, epicondylitis+hand osteoarthritis, and epicondylitis+rotator cuff tear+hand osteoarthritis were significantly associated with DASH score. Multiple regression analysis, including DASH, UEMD, and regional functional assessments, showed that only epicondylitis and epicondylitis+rotator cuff tear were associated with DASH score. CONCLUSION: Epicondylitis significantly affected QOL, while other UEMDs, such as hand osteoarthritis and rotator cuff tear, had no significant impact. When a patient's QOL is affected by a UEMD, there is an increased possibility of the simultaneous presence of other UEMDs.

Traumatic Lumbosacral Spinal Subdural Hematoma Mimicking Subdural Lipoma: Value of Computed Tomography / 대한정형외과학회잡지

Traumatic lumbosacral spinal subdural hematoma due to anatomical and pathological causes is rare, compared to epidural hematoma. If the time of trauma cannot be determined, intracranial and intraspinal signal intensity according to lapse of time are not coincident, resulting in confusion in terms of differentiation. Fat suppression magnetic resonance image (MRI) and computed tomography (CT) are utilized for differentiation. The intention of this study is to report on a case where spinal subdural hematoma of unknown time of occurrence is differentiated from subdural lipoma by taking advantage of fat suppression MRI and CT in order to perform an early surgical decompression with auxiliary review of literature demonstrating good prognosis of the procedure.

A Study of Changes of Inversion Time Effect on Brain Volume of Normal Volunteers

PURPOSE: The objective of this study was to analyze the brain volume according to the brain image of healthy adults in the 20s taken with different inversion time (TI). MATERIALS AND METHODS: Brain images of healthy adults in the 20 s were acquired using magnetization prepared rapid acquisition gradient echo (MPRAGE) pulse sequence with 1.5 mm thickness of pieces and four inversion times (1100 ms, 1000 ms, 900 ms, 800 ms). The acquired brain images were analyzed to measure the volume of white matter (WM), gray matter (GM), intracranial volume (ICV). The statistical difference according to brain volume and gender was analyzed for each TI. RESULTS: The brain volume calculated using Freesurfer was WM=486.52+/-48.64 cm3 and GM=646.86+/-57.12 cm3 in mean when adjusted by mean ICV=1278.94+/-154.92 cm3. Men's brain volume(WM, GM, ICV) was larger than women's brain volume. In the intrarater reliability test, all of the intraclass correlation coefficients were high (0.992 for WM, 0.988 for GM, and 0.997 for ICV). In the repeated measures analysis of variance, GM and ICV did not show a significant difference at each TI (GM p=0.143, ICV p=0.052), but WM showed a significant (p=0.001). In the linear structure relation analysis, all of the Pearson correlation coefficients were high. CONCLUSION: WM, GM, and ICV indicated high reliability and solid linear structure relations, but WM showed significant differences at each TI. The brain volume of healthy adults in the 20s could be used in comparison with that of patients for reference purposes and to predict the structural change of brain. It would be needed to conduct additional studies to examine the contract, SNR, and lesion detection ability according to variable TI.

Ossifying Lipoma in the Groin / 대한정형외과학회잡지

It is extremely rare to observe ossifying lipoma that developes separately from bone tissues in the groin. A patient with an adult fist-sized, firm, non-movable and painless mass in the left groin area, had been treated with marginal excision, which turned out to be ossifying lipoma. Although many different variants of lipoma with bone tissue have been reported, a case like this has never previously been reported. It is important to distinguish ossifying lipoma, from tumors with calcific lesions. We report its uniqueness in radiologic and pathologic ways, with specific findings of ossifying lipoma.

Nodular Fasciitis with Cortical Erosion of the Hand

Nodular fasciitis is a benign, reactive myofibroblastic tumor that is often mistaken for a sarcoma because of its histological appearance and rapid growth. Involvement of a finger is extremely rare. We report a case of nodular fasciitis of the thumb, accompanied by bone erosion. Magnetic resonance findings suggested the possibility of a malignancy, which could have led to misdiagnosis as a malignant soft tissue sarcoma. Instead, the lesion was treated by excisional biopsy, which confirmed nodular fasciitis. There has been no evidence of local recurrence at recent follow-up, 1 year after surgery. This case illustrates that, to avoid unnecessarily aggressive surgery, nodular fasciitis must be included in the differential diagnosis for any finger lesion that resembles a sarcoma, even if bone erosion is present.

Nodular Fasciitis with Cortical Erosion of the Hand

Nodular fasciitis is a benign, reactive myofibroblastic tumor that is often mistaken for a sarcoma because of its histological appearance and rapid growth. Involvement of a finger is extremely rare. We report a case of nodular fasciitis of the thumb, accompanied by bone erosion. Magnetic resonance findings suggested the possibility of a malignancy, which could have led to misdiagnosis as a malignant soft tissue sarcoma. Instead, the lesion was treated by excisional biopsy, which confirmed nodular fasciitis. There has been no evidence of local recurrence at recent follow-up, 1 year after surgery. This case illustrates that, to avoid unnecessarily aggressive surgery, nodular fasciitis must be included in the differential diagnosis for any finger lesion that resembles a sarcoma, even if bone erosion is present.

A Case of Steroid and Methotrexate-Resistant Eosinophilic Fasciitis Treated with Adalimumab

Eosinophilic fasciitis (EF) is a rare fibrosing disorder characterized by painful swelling and induration of the limbs and trunk, characteristic histology with sclerosis and lymphocytic inflammation affecting the fascia. The cause and pathogenesis of EF are still unknown and current therapies include glucocorticoids with or without use of immunosuppressive agents. Recently, there have been several case reports documenting the efficacy of a TNF alpha inEosinophilic fasciitis (EF) is a rare fibrosing disorder characterized by painful swelling and induration of the limbs and trunk, characteristic histology with sclerosis and lymphocytic inflammation affecting the fascia. The cause and pathogenesis of EF are still unknown and current therapies include glucocorticoids with or without use of immunosuppressive agents. Recently, there have been several case reports documenting the efficacy of a TNF alpha inhibitor in EF following a steroid-resistant disease course. However, there has been no report on the experience in treatment of EF with a TNF alpha inhibitor in Korea. Hence, we report a case of steroid and methotrexate-resistant EF which was successfully treated with adalimumab, along with a review of the relevant articles.

A Case of Diffuse Subcutaneous Sarcoidosis Presenting as Thickened Extremities / 대한류마티스학회지

Sarcoidosis is multi-systemic disorder of an unknown etiology, and this is histologically characterized by noncaseating granulomatous inflammation. Sarcoidosis may affect the lung, skin, lymph nodes and eyes, but it rarely affects the subcutaneous tissue. There has been no report of diffuse subcutaneous sarcoidosis in Korea. We experienced a 57-year-old female with diffuse subcutaneous sarcoidosis that presented as thickened extremities. The patient complained of edema and skin thickening on both upper extremities. Magnetic resonance imaging revealed the reticular form of sarcoidosis on the forearm and the biopsy showed noncaseating granuloma. She was finally diagnosed as diffuse subcutaneous sarcoidosis and she improved after treatment with corticosteroid. We report here on this unusual case along with a review of the relevant literature.

A Case of Polyarthritis Caused by Mycobacterium Marinum Infection Mistaken for Rheumatoid Arthritis / 대한류마티스학회지

Mycobacterium marinum (M. marinum) is a nontuberculosis mycobacterium that is normally associated with cutaneous lesions. Most cases occur after an individual has suffered minor trauma in association with contaminated fresh or salt water. In immunocompromised patients, M. marinum can cause osteomyelitis, synovitis and/or disseminated infection, which can be mistaken for rheumatoid arthritis (RA) or remitting seronegative symmetrical synovitis with pitting edema (RS3PE). Therefore, precise history taking and specimen culture are very important for early diagnosis and appropriate treatment. We report an unusual case of septic polyarthritis due to M. marinum that was diagnosed by culture and improved with antibiotic therapy.

Comparison of Subchondral Fracture on Radiographs with MR Images in Evaluation of Osteonecrosis in LCP Patients

PURPOSE: To compare the subchondral fracture on plain radiography and MR image as a method for assessing osteonecrosis in Legg-Calve-Perthes(LCP) pateients. MATERIALS AND METHODS: We retrospetively reviewed 15 hip joint MR images and plain radiography which visualized subchondral fracture. With basis of the Salter-Thompson classification, extent of necrosis was graded group A to B, as follows; Group A= 50%. On PACS workstation, necrotic area of each MR image was measured to calculate the volume of necrotic portion: volume = necrotic area x slice thickness. Necrotic areas on MR images were graded group A to B and results were compared with that measured in Salter-Thompson classification. On follow up, bone resorption was measured and the extent was compared with subchondral fracture representing necrotic area and that on MR volume method respectively. RESULTS: In 9 joints of 15 hip joints (60%), the degree of necrosis in Salter-Thompson classification on plain radiographs was different from that on MR volume method. Based on plain radiographs by Salter-Thompson classification, the degree of necrosis was overestimated in 6 (67%) joints, and underestimated in 3(33%) joints compared with MR volume method. On follow up study, bone resorption was not correlated with necrotic extent of subchondral fracture and MR volume method. CONCLUSION: The extent of femoral head necrosis measured by subchondral fracture was different from that measured by MR and was not correlated with bone resorption on follow up. Therefore, usefulness of subchondral fracture as a prognostic factor may be limited.

MR Findings of Flexor Hallucis Longus Dysfunction

PURPOSE: To find the MR findings and evaluate the usefulness of MR in flexor hallucis longus(FHL) dysfunction. MATERIALS AND METHODS: From 1992 to 2003, fourty patients were found to have surgically confirmed FHL dysfunction. 24 cases of 22 patients who had performed MR were included in this study. We analyzed the signal intensity of FHL tendon and muscle, tendon sheath, sheath effusion, and bone lesions, retrospectively. RESULTS: Non-specific, increased sheath effusion of FHL tendon was seen in 12 cases (50%). Large amount of sheath effusion(grade 3) was observed in 5 cases (21%). The signal intensity of FHL tendon was normal in all cases. High signal intensity at the FHL muscle, proximal to musculotendinous junction was seen in 1 case (4%). One case (4%) of marrow edema of the talus and another one case (4%) of osteochondritis dissecans of the talus was seen. CONCLUSION: Non-specific, increased sheath effusion of FHL tendon was observed on MR in FHL dysfunction patients. Therfore, MR has a limited role in diagnosis of FHL dysfunction and is useful to exclude other bone and tendon diseases causing medial ankle pain.

The Effect of Recombinant Human Epidermal Growth Factor on Cisplatin and Radiotherapy Induced Oral Mucositis in Mice / 대한방사선종양학회지

PURPOSE: To study the effect of recombinant human epidermal growth factor (rhEGF) on oral mucositis induced by cisplatin and radiotherapy in a mouse model. MATERIALS AND METHODS: Twenty-four ICR mice were divided into three groups? the normal control group, the no rhEGF group (treatment with cisplatin and radiation) and the rhEGF group (treatment with cisplatin, radiation and rhEGF). A model of mucositis induced by cisplatin and radiotherapy was established by injecting mice with cisplatin (10 mg/kg) on day 1 and with radiation exposure (5 Gy/day) to the head and neck on days 1~5. rhEGF was administered subcutaneously on days -1 to 0 (1 mg/kg/day) and on days 3 to 5 (1 mg/kg/day). Evaluation included body weight, oral intake, and histology. RESULTS: For the comparison of the change of body weight between the rhEGF group and the no rhEGF group, a statistically significant difference was observed in the rhEGF group for the 5 days after day 3 of the experiment. The rhEGF group and no rhEGF group had reduced food intake until day 5 of the experiment, and then the mice demonstrated increased food intake after day 13 of the of experiment. When the histological examination was conducted on day 7 after treatment with cisplatin and radiation, the rhEGF group showed a focal cellular reaction in the epidermal layer of the mucosa, while the no rhEGF group did not show inflammation of the oral mucosa. CONCLUSION: These findings suggest that rhEGF has a potential to reduce the oral mucositis burden in mice after treatment with cisplatin and radiation. The optimal dose, number and timing of the administration of rhEGF require further investigation.

MR Imaging Findings of Acute Gouty Arthritis

PURPOSE: The purpose of this study was to describe the clinical and MR imaging features of acute gouty arthritis and to define the characteristic findings that would be helpful for differentiating acute gouty arthritis from septic arthritis. MATERIALS AND METHODS: The authors retrospectively studied seven patients who suffered from acute gouty arthritis. The MR imaging findings were analyzed by two musculoskeletal radiologists who focused on joint effusion, subchondral bone erosion, bone marrow edema, synovial thickening (regular and even, or irregular and nodular), and the soft tissue changes (edema or abscess). The clinical records of the patients were reviewed with regard to age and gender, the clinical presentation and the laboratory findings (serum uric acid, WBC, erythrocyte sedimentation rate, C-reactive protein and synovial fluid culture). RESULTS: The patients consisted of six men and one woman whose mean age was 41 years (age range: 24-65 years). The joints involved were the knee (n=6), and ankle (n=1). Two patients had medical histories of gouty attacks that involved the first metatarsophalangeal joint. In six cases, the serum uric acid level during acute attacks was elevated. In all the patients, the affected joint became swollen, hot, erythematous and extremely tender, and this was accompanied by a high ESR and a high C-reactive protein level at the time of presentation. The results of Gram stain and culture of the synovial fluid were negative. In all patients, the MR images showed large amounts of joint effusion, thick irregular and nodular synovial thickening and soft tissue edema without subchondral bone erosions and soft tissue abscess. In one case, subchondral bone marrow edema of the medial femoral condyle was present. In five cases, there were multiple low signal foci in the joint on the spin-echo T2-weighted MR image. CONCLUSION: Even though the MR imaging findings of acute gouty arthritis are nonspecific, it should be considered as a possible diagnosis when a large amount of joint effusion, irregular and nodular synovial thickening and soft tissue edema without subchondral bone erosion, bone marrow edema or soft tissue abscess are seen in the knee or ankle joint, and especially if this is accompanied by the clinical and laboratory features of infection.

Effects of Recombinant Human Epidermal Growth Factor on the Proliferation and Radiation Survival of Human Fibroblast Cell Lines in Vitro / 대한방사선종양학회지

PURPOSE: To explore the effect of recombinant human EGF on the proliferation and survival of human fibroblast cell lines following irradiation. MATERIALS AND METHODS: Fibroblast was originated human skin and primary cultured. The trypan blue stain assay and MTT assay were used to study the proliferative effects of EGF on human fibroblast cell lines in vitro. An incubation of fibroblasts with rhEGF for 24 hours immediately after irradiation was counted everyday. Cell cycle distributions were analyzed by FACS analysis. RESULTS: Number of fibroblast was significantly more increased rhEGF (1.0 nM, 10 nM, 100 nM, 1,000 nM) treated cell than control after 8 Gy irradiation. Most effective dose of rhEGF was at 160 nM. These survival differences were maintained at 1 week later. Proportion of S phase was significantly increased on rhEGF treated cells. CONCLUSION: rhEGF cause increased fibroblast proliferation following irradiation. We expect that rhEGF was effective for radiation induced wound healing.

Myositis Ossificans in Rectus Abdominis Muscle: Case Report

Myositis ossificans is an ossifying inflammatory lesion occurring within skeletal muscle. Myositis ossificans usually arises in the large muscles of the extremities and this lesion is characterized by progression of mineralization from periphery to center. In the early phase, myositis ossificans simulates malignant soft tissue tumor without dense mineralization. Traumatic myositis ossificans in rectus abdominis muscle has been reported worldwide. The radiologic findings of early active myositis ossificans in rectus abdominis muscle are ill defined heterogenous hypoechoic mass on US, hemorrhage, early strong enhancement and early peripheral mineralization on CT and MR.

MR Findings of Infectious Myositis Caused by Vibrio vulnificus: Case Report

Vibrio vulnificus infection is a fatal disease occurring after the consumption of seafood in patients with underlying liver disease. Inflammation of the skin, subcutanous fat and fascia disseminates from the lower extremity to the trunk and upper extremity Infectious myositis caused by vibrio vulnificus is rare, and its MR imaging findings have not been reported. We report these in a case of infectious myositis caused by vibrio vulnificus involving both lower extremities.