Successful Treatment of Rectus Femoris Calcification with Ultrasound-guided Injection: A Case Report

Painful periarticular calcification most commonly occurs within the rotator cuff of the shoulder and rarely around the elbow, hip, foot, and neck. As acute inflammatory reaction develops, severe pain, exquisite tenderness, local swelling, and limitation of motion with pain occur. In case of calcific tendinitis of the shoulder, it can be easily diagnosed according to the symptoms and with x-ray. However, in lesions of the hip, as it is a rare location and usually involves pain in the posterolateral aspect of the thigh, which can simulate radicular pain from a lumbar intervertebral disc, it could be difficult to diagnose. Hence, physicians usually focus on lumbar lesions; therefore, misdiagnosis is common and leads to a delayed management. Here, we report the case of a 30-year-old female patient with calcific tendinitis of the rectus femoris that was successfully managed with ultrasound-guided steroid injection. This study offers knowledge about the rectus femoris calcification.

Morphological Study for Osteoinduction by Human Fibroblasts Transduced with rhBMP-7 Adenovirus / 대한해부학회지

To evaluate availability of the BMP-7 adenovirus (AdBMP-7) as a gene therapy for osteoinduction, we investigated in morphological aspect at 1, 2, 4, 6 weeks after cells injection. Primary cultured human dermal fibroblasts, transduced with AdBMP-7, were injected into gastrocnemius muscle of the nude mice. One week after fibroblasts transplantation new tissue was observed in the muscle. Majority of new tissue was evaluated as cartilage and calcification in the matrix was confirmed by Von Kossa stain as well as electron microscopy. Two weeks after transplantation, spongy bone was built up and adipocytes were observed in intertrabecular spaces. Osteoblasts and osteoclasts were observed in the bony tissue surface. In the result of Von Kossa-Van Gieson stain, osteolysis was dominant in bony trabeculae. Bone marrow was established in 4th weeks with intertrabecular space filled up by hematopoietic cells. At the 6th weeks, the number of trabeculae decreased and thickness of the cortical bone was increased. A great part of bone matrix has laminar structure which run paralleled to surface and which included osteocytes and canaliculi. These data demonstrate that cell mediated AdBMP-7 for gene therapy initiate development of cartilage and calcification of matrix within 1 week and complete bone and bone marrow formation within 4 weeks, so then, could be made practical application for promotion of osteoinduction.

A Case of Rhabdomyolysis and Acute Renal Insufficiency Associated with Gastroenteritis Caused by Salmonella Group C / 대한신장학회잡지

Rhabdomyolysis is a syndrome characterized by muscle necrosis and release of intracellular muscle constituents into the circulation. Rhabdomylosis can be precipitated by different causes, such as trauma, extraordinary physical exer- tion, metabolic disorder, drugs, toxins, infection, or endocrinopathy. Salmonellosis is another rare cause of rhabdomyolysis. We report a 62-year-old male who developed severe diarrhea and vomitting, one day after boiled pork & raw octopus ingestion. The diagnosis of rhabdomyolysis was established primarily by the elevated serum CPK and myoglobin level. There were no other traumatic, metabolic, toxic, or enzymatic causes for the rhabdomyolysis. Stool cultures received at the first day of hospitalization yielded Salmonella Group C. Salmonella sp. is suggested to cause muscle damage by direct bacterial invasion as well as by decreasing the oxidative and glycolytic enzyme activity of skeletal muscles and by activating lysosomal enzymes. We wish to draw attention to these serious complication of salmonella gastroenteritis, and to institute of prompt measures for preventing the development of ATN. We report a case of acute renal failure associated with rhabdomyolysis and gastroenteritis caused by salmonella Group C with review of literatures.

A Case of Myocardial Injury after Phenylpropanolamine Ingestion

Phenylpropanolamine is a sympathomimetic amine used widely as a decongestant or appetite suppressant. Reports of the myocardial injury from the use of phenylpropanolamine are rare and the mechanism of the myocardial injury is not known clearly. We experienced a case of myocardial injury after ingestion of phenyl-propanolamine. A 46-year-old woman was admitted because of chest pain and dyspnea after ingestion of 5 tablets of anorectic pill containing phenylpropanolamine 75 mg per tablet. The serum creatine kinase MB isoenzyme levels were elevated and electrocardiographic abnormalities suggesting myocardial infarction were seen in the precordial lead. In echocardiograpy, left ventricular anteroseptal wall motion was nearly akinetic but coronary angiography showed normal coronary arteries except sluggish blood flow in left anterior descending artery.

Risk Factors for Early Rebleeding after Initial Endoscopic Hemostasis in Patients with Bleeding Peptic Ulcers / 대한소화기내시경학회지

BACKGROUND/AIMS: Rebleeding rate after initial endoscopic hemostasis in patients with ulcer hemorrhage has been reported in 20-30%. Identification of patients who are at high risk for rebleeding would be expected to improve the outcome of endoscopic hemostasis. The purpose of this study was to evaluate risk factors for early rebleeding after initial hemostasis in the view of clinical and endoscopic characteristics. METHODS: We reviewed 99 patients who presented with bleeding peptic ulcers and were treated with endoscopic hemostasis including hypertonic saline injection, electrocautery and clipping. We compared the clinical variables (age, pulse rate, hemoglobin), endoscopic characteristics of ulcer (size, number, and location of ulcer, clots on the base, bleeding stigmata, size and color of exposed vessel) between the patients who bled early (n=22) and who didn't bleed (n=77) within 5 days. RESULTS: The statistically significant correlates with early rebleeding after hemostasis were number of comorbid illness (> or =2) (p=0.031), volume of transfusion (> or5 units) (p=0.001), size of ulcer (>1 cm) (p=0.038), multiple ulcers (p=0.020), presence of blood clots on ulcer base (p=0.012), stigmata (active bleeding and visible vessels) (p=0.010), size of exposed vessel (>1 mm) (p<0.0001). In multivariate analysis, volume of transfusion (odds ratio[OR] 14.4), size of ulcer (OR 11.7), multiple ulcers (OR 5.5) and size of exposed vessel (OR 13.2) were significant risk factors. CONCLUSIONS: The risk factors for early rebleeding after hemostasis in bleeding peptic ulcer can be predicted by clinical variables and endoscopic findings. Early identification of risk factors such as transfusion over 5 units, large-sized ulcer, multiple ulcers, bleeding stigmata and size of exposed vessel over 1 mm can predict the prognosis of peptic ulcer bleeding.

Clinical Significance of Total Fibronectin in Patients with Rheumatoid Arthritis / 대한류마티스학회지

A study on fibronectin, which is synthesized in response to inflammatory process of joint destruction, can be of great value in identifying the mechanism of inflammation or disease activity of rheumatoid arthritis (RA). This study attempts to measure the concentrations of total fibronectin in synovial fluid of patients with RA and osteoarthritis (OA), and compare it with the clinical disease activity parameters of RA available. A total 68 patients suffering from knee pain and joint effusion was examined. Synovial fluids of thirty-eight RA patients and thirty OA patients were measured by using monoclonal fibronectin antibody. Cross-sectional analysis was undertaken to correlate the fibronectin levels of the RA patients with the clinical disease activity parameters available. RESULTS: 1. Mean synovial fibronectin level of RA (148.4+/-72.6 microgram/ml) was significantly higher than that of OA (39.5+/-16.9 microgram/ml)(p<0.001). 2. The fibronectin levels in RA do not seem to have significant relationship with the parameters such as disease duration, the duration of morning stiffness, Ritchie index, ESR, CRP, and rheumatoid factor. CONCLUSION: In conclusion, the synovial total fibronectin concentration can clearly distinguish RA from OA. However, it would be unlikely to be used as a parameter of disease activity.

A Case of Rhabdomyolysis, Acute Renal Failure, and Acute Hepatitis Due to Carp Bile Ingestion / 대한신장학회잡지

Sevral cases of acute renal failure and acute hepatitis after ingestion of raw carp gall bladder have been reported. We experienced for the first time 1 case of acute renal failure and acute hepatitis associated with rhabdomyolysis, which has not been seen in previous studies, after ingestion of the raw carp gall bladder. Serum creatine phosphokinase, myoglobin and urine myoglobin were increased and 99mTc-MDP bone scan showed diffusely increased uptake of isotope in soft tissue of whole body. The other laboratory data corresponded to acute tubular necrosis and acute toxic hepatitis. The kidney pathology showed the recovery phase of acute tubular necrosis. Etiologic factor for rhabdomyolysis was not found except carp gall bladder. We considered that carp gall bladder was etiologic factor for rhabdomyolysis and that rhabdomyolysis acted as agravatting factor for developing acute tubular necrosis due to carp bile toxicity in this case.

Two Cases of Rhabdomyolysis Complicated with Doxylamine Overdose / 대한신장학회잡지

Doxylamine succinate is common over-the-counter sleep medication that is frequently involved in accidental poisonings and suicide attempts. Doxylamine overdose is generally directed at the anticholinergic effect including autonomic,and central nervous system effect and direct cardiac toxicity. Rarely, rhabdomyolysis has been reported with doxylamine overdose. We experienced two cases of rhabdomyolysis with overdose of doxylamine in 17-year-old and 31-year-old male. They were diagnosed with high levels of creatine phosphokinase in serum, myoglobin in serum and urine, and increased radionuclide uptake of muscles in (99m)Tc-MDP bone scan. Patients recovered without any complications with hydration and diuresis. Clinicians should be aware of the possibility of rhabdomyolysis in patients with doxylamine overdose.