Generalized Joint Laxity is Associated with Primary Occurrence and Treatment Outcome of Lumbar Disc Herniation / 가정의학회지

BACKGROUND: We investigated relationships between generalized joint laxity and primary lumbar disc herniation occurrence and compared clinical outcomes after conservative treatment in lumbar disc herniation patients with and without generalized joint laxity. METHODS: The study group included 128 men, and the control group included 276 men matched for age and body mass index with the study group. The primary outcome measure was the presence or absence of generalized joint laxity using the Beighton scale. Clinical outcomes measured by the visual analog scale and the Oswestry disability index 2 years after conservative treatment were the secondary outcome measure. RESULTS: Generalized joint laxity prevalence was 13.2% in the study group and 5.1% in the control group, a significant difference (P=0.01). Spearman correlation analysis revealed that weight (r=0.162, P=0.03), body mass index (r=0.131, P=0.03), and generalized joint laxity (r=0.372, P<0.01) significantly correlated with lumbar disc herniation occurrence. In multivariate regression analysis, generalized joint laxity was the only significant lumbar disc herniation predictor (P=0.002; 95% confidence interval, 1.08 to 5.26). Generalized joint laxity in lumbar disc herniation patients was associated with worse clinical outcomes after conservative treatment measured by visual analog scale scores for lower extremity pain (P=0.02), lower back pain (P=0.03), and Oswestry disability index scores (P=0.03). CONCLUSION: Generalized joint laxity might be associated with lumbar disc herniation occurrence and might also be a negative predictor of worse clinical outcomes after conservative treatment.

A Case of Esophageal Tuberculosis Diagnosed Using Endosonography / 대한내과학회지

Esophageal tuberculosis is rare, and may result from the direct extension of tuberculosis infection from adjacent mediastinal lymph nodes. Endosonography can be used to evaluate heterogeneous or homogeneous hypoechoic masses in the esophageal wall, interruption of the esophageal adventitia, and mediastinal lymphadenitis. We admitted a 19-year-old woman to our hospital because of weight loss and chest pain. Endoscopic observation revealed an esophageal submucosal mass and central ulceration with exudates. Endosonography showed a homogeneous hypoechoic mass with a destroyed esophageal wall layer, spot-like hyperechoic foci, and multiple enlarged lymph nodes in the mediastinum. A biopsy showed acute inflammation, while the results of the polymerase chain reaction (PCR) and interferon-gamma tests were positive for tuberculosis. The patient was diagnosed with esophageal tuberculosis using endosonography and she responded well to anti-tuberculosis therapy. Endosonography may be useful in the diagnosis of esophageal tuberculosis when an accurate histologic diagnosis is not established.

Risk Factors for Delayed Bleeding after Colonoscopic Polypectomy / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of this study was to identify risk factors for delayed bleeding after colonoscopic polypectomy. METHODS: 3,530 polypectomies in 1,542 patients were evaluated. Risk factors were identified among patient-related factors (age, sex, comorbidity, anticoagulants, antiplatelets), polyp-related factors (size, shape, location, histology), and procedure-related factors (experience of the endoscopist, sedation, resection method). RESULTS: Delayed bleeding occurred in 26 lesions (0.7%) of 24 patients (1.6%). Polyp-based multivariate analysis revealed that polyp size greater than 15 mm (OR, 2.882; 95% CI, 1.106 to 7.506; p=0.030) and sedation-free colonoscopy (OR, 2.606; 95% CI, 1.116 to 6.084; p=0.027) were significant risk factors for delayed bleeding after polypectomy. In colonoscopy-based analysis, hypertension increased the risk of delayed bleeding after polypectomy (OR, 2.938; 95% CI, 1.009 to 8.557; p=0.048). CONCLUSIONS: Large polyp size, sedation-free colonoscopy, and hypertension are associated with delayed bleeding after colonoscopic polypectomy.

A perinephric abscess caused by Streptococcus agalactiae / 대한내과학회지

Group B streptococcus (GBS, Streptococcus agalactiae) has recently been recognized as an important, increasingly common cause of invasive disease in non-pregnant adults with underlying medical conditions. Diabetes mellitus, malignancies, liver cirrhosis, and previous trauma history increase the risk for invasive GBS disease. We report a rare case of perinephric abscess caused by GBS in a non-pregnant diabetic woman. A 24-year-old woman with diabetes and a history of urinary tract infection presented with a 4-week history of intermittent febrile sensation, chills, right flank pain, and anorexia. Computed tomography revealed an 8-cm right perinephric abscess. She was treated with percutaneous drainage of the abscess and intravenous antibiotics directed at the GBS, which had grown from the abscess drainage. She had a satisfactory clinical course.

Gastrointestinal amyloidosis secondary to chronic tophaceous gout / 대한내과학회지

Secondary amyloidosis is associated with infectious, inflammatory, or neoplastic disorders. Gouty arthritis, unlike other forms of chronic inflammatory arthritis, is not usually associated with amyloidosis. A 70.year.old man was admitted because of generalized edema, anorexia, and diarrhea. He had been diagnosed with gouty arthritis 12 years earlier and took over-the-counter medication during acute attacks. The physical examination revealed multiple tophi on his ears, right hand, and right foot. No evidence of amyloidosis involving the heart or bone marrow was detected. Biopsy of the antrum, duodenum, ileum, and descending colon showed green birefringence with Congo red stain. Immunohistochemistry was strongly positive for amyloid A. We diagnosed him as having secondary gastrointestinal amyloidosis AA with chronic tophaceous gouty arthritis. Allopurinol was administered and oral rednisolone was increased. However, he died from septic shock 25 days after admission.

The Prevalence and Clinical Features of Musculoskeletal Diseases in Incheon: Results from Chronic Disease Management Surveys / 대한류마티스학회지

OBJECTIVE: To estimate the prevalence of musculoskeletal diseases in Incheon. METHODS: This study was based on data from chronic disease management surveys of Incheon. The surveys were conducted from 12 Sept 2005 to 7 Oct 2005 on 5,144 households using proportional stratified sampling methods. Three questionnaires were performed on all study subjects. All analyses were done using SPSS version 11.5. RESULTS: Out of 16,623 subjects, the mean age was 34.5+/-20.2 (years, +/-SD). The crude prevalence rate of musculoskeletal diseases were as follows: osteoarthritis 3.2%, rheumatoid arthritis 1.1%, spondyloarthropathy 0.3%, gouty arthritis 0.1%, Behcet's disease 0.04%, herniated disc 1.1%, and osteoporosis 0.8%. Age-standardized prevalence of rheumatoid arthritis was 1.6%, and osteoarthritis 5.2%. The prevalence of rheumatoid arthritis and osteoarthritis tended to be higher among older age groups, low socioeconomic/education state, and homemakers. The age-standardized prevalence of arthritis was higher in rural than in urban area. There were more concurrent chronic diseases such as hypertension or diabetes mellitus in the arthritis group than in the whole population. Questionnaires were performed on subjects with musculoskeletal disease. It revealed chronic arthralgia at 3%, spine arthralgia 2.5%, and chronic myalgia 2.8%. CONCLUSION: The crude prevalence of rheumatoid arthritis and osteoarthritis were 1.1% and 3.2% (age-standardized, 1.6% and 5.2%), respectively. The prevalence of musculoskeletal diseases in Incheon is much lower than previously-reported data indicate. These differences should be confirmed by further epidemiological survey. The prevalence of arthritis is higher in populations of old age, low socioeconomic state, and rural areas.

A case of spontaneous ureteral rupture in a patient on hemodialysis / 대한내과학회지

Spontaneous ureteral rupture is rare, and refers to leakage in the absence of prior ureteral manipulation, external trauma, previous surgery, or any destructive kidney disease. It presents a major diagnostic challenge due to the diversity at presentation. Here, we present a rare case of spontaneous ureteral rupture in a 62-year-old man with a history of fungal pyonephrosis (Candida) on maintenance hemodialysis, causing a large infected urinoma and abscess and a review the literature.

A Case of Humeral Osteomyelitis and Soft Tissue Abscess Accompanied with Streptococcus anginosus Bacteremia

Streptococcus anginosus is a normal flora found in multiple body sites and belongs to the Streptococcus milleri group. It has often been associated with pyogenic infection, such as perio-dontitis, endocarditis, pulmonary abscess and abdominal or cerebral abscess. Also uncommonly, it can cause osteomyelitis. A 42-year-old man was admitted due to gastric ulcer perforation. At 12th hospital day, left humeral osteomyelitis and soft tissue abscess developed. Streptococcus anginosus grew in blood culture. He was treated with intravenous penicillin and surgical debridement of the necrotic tissue which lead to a satisfactory result. We report a rare case of Streptococcus anginosus-induced humeral osteomyelitis and soft tissue abscess.

A Case of Stevens-Johnson Syndrome Associated with Mycoplasma pneumoniae Pneumonia in an Adult Patient

Stevens-Johnson syndrome is an acute mucocutaneous syndrome that is related to drugs and infections. Mycoplasma pneumoniae infection is known as one of the causes of Stevens-Johnson syndrome in children and young adults. In Korea, Mycoplasma pneumoniae infection is rarely reported as a cause of Stevens-Johnson syndrome in adults. We report a case of Stevens-Johnson syndrome associated with Mycoplasma pneumoniae pneumonia in an adult patient. A 34-years old woman was admitted to our hospital and was diagnosed with mycoplasma pneumonia. At the time of admission, she had hemorrhagic crusts on her lips. On the 2nd day of admission, target lesions also developed on her skin. We diagnosed her disease as Stevens-Johnson syndrome associated with Mycoplasma pneumoniae pneumonia. She completely recovered from pneumonia and Stevens-Johnson syndrome after treatment with antibiotics and conservative management.

A Case of Humeral Osteomyelitis and Soft Tissue Abscess Accompanied with Streptococcus anginosus Bacteremia

Streptococcus anginosus is a normal flora found in multiple body sites and belongs to the Streptococcus milleri group. It has often been associated with pyogenic infection, such as perio-dontitis, endocarditis, pulmonary abscess and abdominal or cerebral abscess. Also uncommonly, it can cause osteomyelitis. A 42-year-old man was admitted due to gastric ulcer perforation. At 12th hospital day, left humeral osteomyelitis and soft tissue abscess developed. Streptococcus anginosus grew in blood culture. He was treated with intravenous penicillin and surgical debridement of the necrotic tissue which lead to a satisfactory result. We report a rare case of Streptococcus anginosus-induced humeral osteomyelitis and soft tissue abscess.

A Case of Stevens-Johnson Syndrome Associated with Mycoplasma pneumoniae Pneumonia in an Adult Patient

Stevens-Johnson syndrome is an acute mucocutaneous syndrome that is related to drugs and infections. Mycoplasma pneumoniae infection is known as one of the causes of Stevens-Johnson syndrome in children and young adults. In Korea, Mycoplasma pneumoniae infection is rarely reported as a cause of Stevens-Johnson syndrome in adults. We report a case of Stevens-Johnson syndrome associated with Mycoplasma pneumoniae pneumonia in an adult patient. A 34-years old woman was admitted to our hospital and was diagnosed with mycoplasma pneumonia. At the time of admission, she had hemorrhagic crusts on her lips. On the 2nd day of admission, target lesions also developed on her skin. We diagnosed her disease as Stevens-Johnson syndrome associated with Mycoplasma pneumoniae pneumonia. She completely recovered from pneumonia and Stevens-Johnson syndrome after treatment with antibiotics and conservative management.

Etanercept-related Cutaneous Nodulosis in a Patient with Rheumatoid Arthritis / 대한류마티스학회지

Etanercept is a recombinant human tumor necrosis factor (TNF) receptor fusion protein, which inhibits the biological activity of TNF-alpha. The common side effects of TNF-alpha inhibitors are injection site reactions, infusion reactions and infection. Rheumatoid nodules are the most common extraarticular manifestation of rheumatoid arthritis. Drugs such as methotrexate were reported to be associated with rheumatoid nodules, but etanercept-related nodules were uncommonly observed. We report the new formation of cutaneous rheumatoid nodules in a 58-year-old man during anti-TNF alpha therapy with etanercept. He had 2-year history of seropositive rheumatoid arthritis, and been treated with methotrexate, hydroxychloroquine, sulfasalazine, prednisolone and nonsteroidal anti-inflammatory drugs before etanercept regimen. Rheumatoid nodules developed on the palmar surface of fingers 4 month after treatment of etanercept, although his disease activity was maintained low. One month later, we decided to stop etanercept because his nodulosis extended to elbow. Since then, he has been followed up without any progression of rheumatoid nodules or aggravation of arthritis.