A Case of POEMS Syndrome that Presented with a Moderate Pericardial Effusion / 대한내과학회지

Pericardial effusions can be caused by a wide variety of infectious or noninfectious diseases. After a conventional diagnostic work-up, the etiology of pericardial effusion often remains idiopathic. We report a patient with POEMS syndrome whose main clinical problem was recurrent pericardial effusions. Patients with POEMS syndrome often have generalized edema and a pleural effusion, while a pericardial effusion is a very rare complication. A 44-year-old man visited our hospital because of a recurrent pericardial effusion. He was initially diagnosed with idiopathic pericarditis five months prior. We reassessed the patient meticulously and found IgG lambda type monoclonal gammopathy, polyneuropathy, lymphadenopathy, peripheral edema, pleural effusion, hypothyroidism, pulmonary hypertension, hyperpigmentation, hypertrichosis, and papilledema, which we diagnosed as POEMS syndrome.

Percutaneous Cardiopulmonary Support-Supported Percutaneous Coronary Intervention: A Single Center Experience

BACKGROUND AND OBJECTIVES: Percutaneous cardiopulmonary support (PCPS) has proven to be a valuable technique in high-risk coronary patients undergoing percutaneous coronary intervention (PCI). However, there have been few studies on PCI associated with PCPS in Korea. We summarized our experience with PCPS-supported PCI. SUBJECTS AND METHODS: We retrospectively reviewed 19 patients with PCPS-supported PCI between August 2005 and June 2009. PCPS was used as an elective procedure for 10 patients with at least two of the following conditions: left-ventricular ejection fraction <35%, target vessel(s) supplying more than 50% of the viable myocardium, high risk surgical patients, and patients who refused coronary bypass surgery. In the remaining 9 patients PCPS was used as an emergency procedure, to stabilize and even resuscitate patients with acute myocardial infarction and cardiogenic shock, in order to attempt urgent PCI. RESULTS: Among the 19 patients who were treated with PCPS-supported PCI, 11 (57.9%) survived and 8 (42.1%) patients did not. ST elevation myocardial infarction with cardiogenic shock was more prevalent in the non-survivors than in the survivors (75% vs. 27.3%, p=0.04). The elective PCPS-supported PCI was practiced more frequently in the survivors than in the non-survivors (72.7% vs. 25%, p=0.04). In the analysis of the event-free survival curve between elective and emergency procedures, there was a significant difference in the survival rate (p=0.025). Among the survivors there were more patients with multi-vessel disease, but a lower Thrombolysis in Myocardial Infarction grade in the culprit lesions was detected in the non-survivors, before PCI. Although we studied high-risk patients, there was no procedure-related mortality. CONCLUSION: Our experience suggests that PCPS may be helpful in high risk patients treated with PCI, especially in elective cases. More aggressive and larger scale studies of PCPS should follow.

Gender-Based Differences in the Management and Prognosis of Acute Coronary Syndrome in Korea

PURPOSE: Gender-based differences exist in the characteristics, management, and prognosis of acute coronary syndrome (ACS). However, their impact on prognosis remains unclear. We aimed to identify factors causing these differences in Koreans. MATERIALS AND METHODS: We examined 6,636 ACS patients (66.2% males) visiting 72 Korean hospitals between April-2007 and December-2008. Gender-based differences in clinical demographics, therapy, and outcomes were analyzed over 6 months. RESULTS: Women were older than men [mean (standard deviation, SD) age, 67.6 (9.8) vs. 60.6 (11.2) years; p<0.001]; had higher rates of hypertension, diabetes mellitus, and lack of exercise (p<0.001 for all); and lower rates of obesity, familial history of cardiovascular disease (CVD), and smoking (p<0.05 for all). Atypical symptoms were more common in women (20.5% vs. 15.1% in men, p<0.001), whereas myocardial infarction with ST-segment elevation was less common (17.1% vs. 27.8%, p<0.001). Mean (SD) time lapse from symptom onset to arrival at hospital was longer in women [11.44 (18.19) vs. 8.26 (14.89) hours in men, p<0.001], as was the duration of hospitalization [7.58 (7.61) vs. 7.04 (7.72) days, p=0.007]. Fewer women underwent revascularization procedures, including thrombolytic therapy, balloon angioplasty, stent implantation, and coronary artery bypass grafting (79.4% vs. 83.3% men, p<0.001). No significant differences were observed in CVD-related death, recurrent ACS, stroke, refractory angina, or rehospitalization for angina. CONCLUSION: Female ACS patients were older than male subjects and had more atypical presentation. They arrived at the hospital later than men and had longer hospital stays, but less often required revascularization therapy. However, no gender-based differences were noted in ACS-related mortality and morbidity.

Pulmonary Hypertension Associated with Use of Phentermine

Weight-control drugs (known as anorexigens) such as fenfluramine have been linked with pulmonary hypertension in previous reports. In our case, a 29 year old woman was admitted for shortness of breath and was diagnosed with pulmonary hypertension. Three months ago, she had been taking phentermine for five weeks. Other factors that might have contributed to the development of pulmonary hypertension were excluded. With treatment, her symptoms improved. This is the first case that can suggest a possible connection between phenermine single medication with pulmonary hypertension. Phentermine has been considered a relatively safe drug to treat obesity, and further investigation is needed to decide the safety and dosage of phentermine.

Constrictive Pericarditis Accompanied by Swine-Origin Influenza A (H1N1) Infection

Swine-origin influenza A (H1N1) is caused by a new strain of the influenza virus. The disease has spread rapidly and was declared a pandemic in April, 2009. So far, however, there is a scarcity of information regarding the complications of swine influenza. A report of the disease in the winter of 2009 in the Southern Hemisphere found that the most common manifestations of influenza A virus infection are upper respiratory tract infection and pneumonia. Although there may be an association between fulminant myocarditis and Swine influenza, cardiovascular complications resulting from swine Influenza A infection are exceedingly rare. We report a case of acute constrictive pericarditis in a healthy subject infected by the swine-origin influenza A (H1N1) virus.

Two cases of acute fibrinous and organizing pneumonia / 대한내과학회지

Acute fibrinous and organizing pneumonia (AFOP) is a histological pattern consisting of intra-alveolar fibrin in the form of fibrin "balls" and organizing pneumonia, without hyaline membranes or prominent eosinophil infiltration. Some reports suggest that the clinical course and pathological findings of AFOP are different from typical findings of bronchiolitis obliterans organizing pneumonia (BOOP) or eosinophilic pneumonia (EP), and its prognosis can be better or similar to that of diffuse alveolar damage (DAD). We report two cases of pathologically demonstrated AFOP experienced recently at our institute. One fatal case revealed a rapid development of respiratory failure and the need for mechanical ventilation. Another nonfatal case revealed subacute diffuse bilateral lung infiltration without the need for mechanical ventilation. Judging from our experience, the patient who required a mechanical ventilator had a poorer prognosis than the one who did not need a mechanical ventilator.

Two cases of acute fibrinous and organizing pneumonia / 대한내과학회지

Acute fibrinous and organizing pneumonia (AFOP) is a histological pattern consisting of intra-alveolar fibrin in the form of fibrin "balls" and organizing pneumonia, without hyaline membranes or prominent eosinophil infiltration. Some reports suggest that the clinical course and pathological findings of AFOP are different from typical findings of bronchiolitis obliterans organizing pneumonia (BOOP) or eosinophilic pneumonia (EP), and its prognosis can be better or similar to that of diffuse alveolar damage (DAD). We report two cases of pathologically demonstrated AFOP experienced recently at our institute. One fatal case revealed a rapid development of respiratory failure and the need for mechanical ventilation. Another nonfatal case revealed subacute diffuse bilateral lung infiltration without the need for mechanical ventilation. Judging from our experience, the patient who required a mechanical ventilator had a poorer prognosis than the one who did not need a mechanical ventilator.

The relationship between depressive tendency, somatic symptoms and drug use in housewives

BACKGROUND: In women, the prevalence of depression is known to be more than twice as high as in men. Because many depressive women complain of their somatic symptoms instead of neurovegetative ones, many cases of depression have been misdiagnosed. Women also tend to use medicine more frequently than men do to manage depression. So we investigated the relationship between somatic symptoms and drug use in housewives for better management. METHODS: From 1st. March to 31st. March in 1996, the prepared questionnaires were presented to housewives living in the area of Kyung-ju city, who responded the questionnaires under direct interview. The questionnaire was composed of two parts. One part included demographic data, somatic complaints, drug use, places of drug purchase, current diseases that had been diagnosed by doctors. The other included Korean standard Beck Depression Inventory-questionnaire. The subjects were divided into two groups by BDI score(21 point), which was the cut-off point for depression in Korea. The relationships of somatic symptoms and drug use between the two groups were analyzed. RESULTS: There were 110 housewives who had depressive trends among 569 respondents. In general characteristics, there was significant difference between the two groups except the item of religion. In the items of somatic symptoms, there were more somatic symptoms in the group of high BDI score(>_21) except fatigue(P_21) (P_21), there was definite correlation between the items of somatic symptoms and drug use. There was no difference between the two groups in the item of drug purchase site. The most common site of drug purchase was the drug store in both groups. CONCLUSIONS: Depressive housewives complained of more somatic symptoms and more often used drugs as well.

A Case of Vulva Syrigoma Clinically Suggesting Milia in a Pregnant Woman

We report a case of vulvar syringoma suggesting milia. A 20-year-old pregnant woman visited the obstetrical department of our hospital for labor pain. On physical examination, the skin lesions were revealed accidently and showed symmetrically distributed, numerous, 2-4mm sized, yellow to skin colored papules on the vulva. The lesions developed in the fifth gestational month and were aggravated thereafter. After delivery, we performed a skin biopsy of the lesion. Histopathologic findings of the biopsy specimen showed the typical findings of syringoma and milia.

Clinical analysis of unstable thoracolumbar fractures and fracture-dislocation using transpedicular screws / 대한정형외과학회잡지

No abstract available.

Improvement of titration methods for porcine rotavirus, its serum neutralizing antibody and of virus isolation from feces

No abstract available.

A Clinical Study of Subtrochanteric Fractures of the Femur / 대한정형외과학회잡지

Subtrochanteric fractures of the femur are difficult to manage successfully. Two factors, involvement of cortical bone tissue and concentration of stress, frequently have been mentioned as reasons for the high incidence of failure in the treatment of these fractures. We studied 37 patients with 38 subtrochanteric fractures treated at the Seoul Red Cross Hospital from Feb. 1978 to Nov. 1983. The results were obtained as follows: 1. Of the 37 patients studied, 29 were male and 8 female. The majority of male patients (representing 62.1%) were between 21 and 50 years of age, while 7 of 8 female patients were after 50years of age. 2. In 27 (73.0%) of our patients, the fracture resulted from high-energy trauma, traffic accident or fall from height. 3. Many fractures in the present series could not be classified in the manners described by Fielding, Zickel or Seinsheimer. So, we could not find any correlation between fracture type and used fixation device or its prognosis. 4. The associated injuries, which were relatively common in lower limb (10 cases) and pelvis (8 cases), made the fractures more difficult to treat. 5. Of the 38 fractures, 35 (92.1%) were treated by operative means. The Jewett nail was the device most commonly used, with a total of 11(31.4%) fractures being so treated. 6. The average time from operation to partial weight bearing was 12.9 weeks. 7. The average time untill clinical union was about 14 weeks and radiographic union about 24 weeks. 8. From these series, it was considered that, although early weight bearing is frequently impossihle, Jewett nail, plate and screw, compression hip screw, Judet plate or blade plate can be applied successfully to the treatment of subtrochanteric fractures of the femur if the most proper one which can stabilize the lesion effectively is selected and weight bearing is delayed for a sufficient period.

The Significance of Bone Scan in Fatigue Fractures / 대한정형외과학회잡지

No abstract available in English.

Multiple Fatigue Fractures: Report of 3 Cases / 대한정형외과학회잡지

No abstract available in English.

A Clinical Study of the Unstable Thoracolumbar Vertebral Fractures or Fracture-dislocations: 10 Cases Report / 대한정형외과학회잡지

In accidents, the spines are generally subjected to one of five types of violence; pure flexion, flexion and rotation, extention, vertical compression, or direct shearing force by Holdsworth's report. Flexion and rotational violence, so-called, unstable rotational fracture-dislocation results in paraplegia commonly. The treatment of the fracture-dislocations of the thoracic and lumbar spine had varied widely during the past 100 years, including conservative and operative treatment, but there is no definitive study that convincingly show the superiority of either operative or nonoperative treatment till now. Ten cases of the unstable thoracolumbar vertebral fracture or fracture-dislocations during the past two years were reported in this paper. In unstable types on the thoracolumbar vertebral fracture or fracture-dislocations, direct blow was the most common cause of injury and the thoracolumbar junction extending from T10 to L1 was the most common location of injury in this report. Three among four paraplegic patients were received flexion and rotational violence and the remaining one, direct shearing force. All four paraplegic parients were operated. Among them two cases, the one who was performed open reduction and simple wire fixation and the other open reduction and Harrington instrumentation, recovered almost completely except mild motor weakness of lower extremities. All cases complained of remaining back pain more or less without relation to the method of treatment.

Pathological Fracture of The Distal Femur, Caused by Chronic Actinomycotic Osteomyelitis: A case report / 대한정형외과학회잡지

Actinomycosis is a chronic suppurative and granulomatous disease characterized by peripheral spread and extension to contagious tissue, rare hematogenous spread, and the formation of multiple draining sinus tracts. In the rare case of hematogenous disseminated Actinomycosis; lesions appear in all parts of the body. Bone involvement, however, is very rare except the jaw and there has been only some reports about the ribs and vertebral columns. To our knowledge, this case represents the first report of documented distal femoral involvement.

A case of Equinus Deformity due to Mesenchymoma of Calf Muscle: A case Report / 대한정형외과학회잡지

Joint deformity secondary to neoplastic involvement of the soft tissue has been well described and is easy to diagnose. Mesenchymema is a rare neoplasm which can arise at anyplace of the body and called as angiomyolipoma, lipomyohemangioma, fibromyxolipoma and etc. according to the composition of the various tissues. We experienoed a case of equinus deformity due to mesenchymoma of calf muscle. The patient was treated by excision and tendo calcaneus lengthening with satisfactory result.