Diagnosis of Infectious Spondylitis Using Non-Contrast Enhanced MRI With Axial Diffusion-Weighted Images: Comparison With Gadolinium-Enhanced MRI

Purpose@#To assess the diagnostic performances of diffusion-weighted imaging (DWI)-included non-contrast magnetic resonance imaging (MRI) compared to standard contrastenhanced MRI for infectious spondylitis. @*Materials and Methods@#This study involved 154 participants: a spondylitis group (n = 76) and a control group (n = 78) with Modic type 1 degeneration or recent compression fractures. Two readers independently reviewed paraspinal soft tissue signal change and abscess with 5-scale confidence scores based on two image sets: one featuring both non-contrast-enhanced MRI (NCEI) and DWI and the other consisting of NCEI and contrast-enhanced fat-suppressed T1-weighted imaging (CEFST1). The diagnostic performance of the two image sets was compared using McNemar tests for sensitivity, specificity, and area under the receiver operating characteristics (AUROC) analysis. Interobserver agreements (κ) for each images sets were also calculated. @*Results@#The sensitivity and specificity for infectious spondylitis were 90.8% and 69.2% for NCEI + DWI, 96.1% and 60.3% for NCEI + CEFST1 in reader 1, whereas it was 92.1% and 66.7% for NCEI + DWI, and 96.1% and 68.0% for NCEI + CEFST1 in reader 2. Sensitivities and specificities were not significantly different between NCEI + DWI and NCEI + CEFST1 (reader 1: p = 0.289, 0.065; reader 2: p = 0.250, > 0.999, respectively). However, the AUROC was not considerably different between the two modalities in only one reader (p = 0.306 in reader 1, p = 0.031 in reader 2). Interobserver agreement for infectious spondylitis was moderate (κ = 0.55) in NCEI + DWI and substantial (κ = 0.66) in NCEI + CEFST1. @*Conclusion@#Non-contrast enhanced MRI with additional DWI is as effective for diagnosing infectious spondylitis as a contrast-enhanced MRI.

The relationships among birth season, sunlight exposure during infancy, and allergic disease / 소아과

PURPOSE: The recent increase in the prevalence of allergic diseases is hypothetically attributed to immune dysregulation in turn caused by a reduction in exposure to sunlight. We explored relationships between birth season, sunlight exposure, exercise duration, and an allergic disease. METHODS: We performed a questionnaire-based survey on allergic diseases among elementary school students. Birth time was categorized according to the season (summer and winter). RESULTS: The prevalence of atopic dermatitis (AD) "symptoms ever" was higher in the children born in winter than in those born in summer (adjusted odds ratio [aOR], 1.24; 95% confidence interval [CI], 1.03-1.49; P=0.024). Birth in winter was associated with an increase in the "symptoms in the past 12 months" prevalence of food allergy (FA) (aOR, 1.56; 95% CI, 1.09-2.24; P=0.015). The lifetime prevalence of allergic diseases except FA was higher in the children whose parents considered their sunlight exposure prior to 24 months of ageas inadequate than those who considered their exposure as adequate ("diagnosis ever" asthma: aOR, 1.4; 95% CI, 1.17-1.67; P<0.001; allergic rhinitis [AR]: aOR, 1.4; 95% CI, 1.17-1.67; P<0.001; AD: aOR, 1.26; 95% CI, 1.06-1.51; P=0.01). Neither recent sunlight exposure nor exercise duration was associated with the prevalence of an allergic disease. CONCLUSION: Birth in winter may be associated with development of AD and FA. Inadequate sunlight exposure before the age of 24 months might possibly increase the risks of development of asthma, AR, and AD.

Food Protein-Induced Enterocolitis Syndrome in a Neonate with Peripheral Epimerase Deficiency Galactosemia

Food protein-induced enterocolitis syndrome (FPIES) is a severe infantile form of non-immunoglobulin E-mediated gastrointestinal food hypersensitivity that manifests as profuse, repetitive vomiting, often with diarrhea, which leads to acute dehydration and lethargy and failure to thrive if chronic. Symptoms such as dehydration and lethargy are also observed in sepsis, viral infection, and food poisoning. It is difficult to differentiate FPIES from sepsis-like illness. The diagnosis is based on clinical criteria and/or an oral food challenge. FPIES developed in the patient with peripheral epimerase deficiency galactosemia after the use of soy formula. The change in feeding to soy formula is not required of a patient with peripheral epimerase deficiency galactosemia. Early intake of soy formula in our patient was harmful. Therefore, we think the changing the formula should be taken carefully. Another important point is the diagnosis. Late diagnosis and misdiagnosis are common, and inappropriate treatment or invasive treatment can occur.

Long-Term Effects of Complex Decongestive Therapy in Breast Cancer Patients With Arm Lymphedema After Axillary Dissection

OBJECTIVE: To investigate the long-term effects of complex decongestive therapy (CDT) on edema reduction in breast cancer-related lymphedema patients after axillary dissection, according to the initial volume of edema. METHODS: A retrospective review of 57 patients with unilateral arm after an axillary dissection for breast cancer was performed. The patients, treated with two weeks of CDT and self-administered home therapy, were followed for 24 months. Arm volume was serially measured by using an optoelectronic volumeter prior to and immediately after CDT; and there were follow-up visits at 3, 6, 12, and 24 months. Patients were divided into two groups according to the percent excess volume (PEV) prior to CDT: group 1, PEV or =20%. RESULTS: In group 1, mean PEV before CDT was 11.4+/-5.0% and 14.1+/-10.6% at 24 months after CDT with no significant difference. At the end of CDT, PEV was 28.8+/-15.7% in group 2, which was significantly lower than the baseline (41.9+/-19.6%). The reduction of PEV was maintained for 24 months in group 2. CONCLUSION: The long-term effects of CDT were well-maintained for 24 months, but there was a difference in progression of PEV between the two groups. The patients with more initial PEV showed significant volume-reducing effects of CDT. In patients with less initial PEV, the severity of lymphedema did not progress to higher grades.

Immediate Clinical and Biomechanical Effects of Low-dye Taping in Patients with Plantar Heel Pain / 대한스포츠의학회지

Plantar heel pain is common musculoskeletal disorder of the foot related to sports activity. Treatment of the plantar heel pain is usually conservative including low-dye (LD) taping. We evaluated the immediate clinical and biomechanical effect of LD taping. 19 patients who had plantar heel pain with fat pad tenderness or tenderness on plantar fascia insertion area participated in this study. We assessed plantar pressure change with foot pressure analysis system, fat pad depth changes with ultrasonography, pain improvement with visual analogue scale before and after LD taping. Patient treated with LD taping showed the decrease in maximum peak pressure and pressure time integral, and there was not a significant difference between pre and post maximal velocity, average velocity, distance of center of pressure. Fat pad depth increase (mean 1.67 mm, p<0.05) and pain improvement (mean 1.91 on visual analog scale, p<0.05). LD taping restrict midtarsal joint, correct hindfoot pronation, and provide fat pad depth increase and pain improvement, immediately.

Clinical, Electrophysiological Findings in Adult Patients with Non-traumatic Plexopathies

OBJECTIVE: To ascertain the etiology of non-traumatic plexopathy and clarify the clinical, electrophysiological characteristics according to its etiology. METHOD: We performed a retrospective analysis of 63 non-traumatic plexopathy patients that had been diagnosed by nerve conduction studies (NCS) and needle electromyography (EMG). Clinical, electrophysiological, imaging findings were obtained from medical records. RESULTS: We identified 36 cases with brachial plexopathy (BP) and 27 cases with lumbosacral plexopathy (LSP). The causes of plexopathy were neoplastic (36.1%), thoracic outlet syndrome (TOS) (25.0%), radiation induced (16.7%), neuralgic amyotrophy (8.3%), perioperative (5.6%), unknown (8.3%) in BP, while neoplastic (59.3%), radiation induced (22.2%), neuralgic amyotrophy (7.4%), psoas muscle abscess (3.7%), and unknown (7.4%) in LSP. In neoplastic plexopathy, pain presented as the first symptom in most patients (82.8%), with the lower trunk of the brachial plexus predominantly involved. In radiation induced plexopathy (RIP), pain was a common initial symptom, but the proportion was smaller (50%), and predominant involvements of bilateral lumbosacral plexus and whole trunk of brachial or lumbosacral plexus were characteristic. Myokymic discharges were noted in 41.7% patients with RIP. Abnormal NCS finding in the medial antebrachial cutaneous nerve was the most sensitive to diagnose TOS. Neuralgic amyotrophy of the brachial plexus showed upper trunk involvement in all cases. CONCLUSION: By integrating anatomic, pathophysiologic knowledge with detailed clinical assessment and the results of ancillary studies, physicians can make an accurate diagnosis and prognosis.