Clinical Significance of Uptake Difference on DMSA Scintigraphy in Pediatric Urinary Tract Infection

PURPOSE: Disruption of normal renal development can lead to congenital anomalies of the kidney and urinary tract, including renal hypodysplasia. We aimed to clarify whether small kidney size affects clinical manifestations in children with urinary tract infection (UTI). METHODS: One hundred fifty-four patients who had their first symptomatic UTI between January 2014 and June 2015 were enrolled in this study. Differences in kidney size were estimated based on percent uptake of (99m)Tc-dimercaptosuccinic acid (DMSA) in scintigraphy. The patients who showed more than 10% difference in kidney size on DMSA scintigraphy with none or minimal cortical defects were included in group A. (group A, n=17). Laboratory, clinical, and imaging results were compared with those of the other patients (group B, n=137). RESULTS: Group A had a relatively higher incidence of vesicoureteral reflux than group B (44% vs 20%, P<0.05). The levels of plasma neutrophil gelatinase-associated lipocalin (NGAL) and serum C-reactive protein were significantly higher in group A (193 [64-337] vs 91 [59-211] ng/mL and 4.1 [0.5-11.9] vs 2.1 [0.7-5.3] ng/mL, respectively; all P<0.05). Linear regression analysis revealed that plasma NGAL level strongly correlated with the difference in renal uptake in DMSA scintigraphy in group A (R²=0.505). CONCLUSION: The difference in kidney size could influence the clinical course and severity of pediatric UTI.

A Case of Secondary FSGS due to Chronic Chloride Diarrhea

Congenital chloride diarrhea (CLD) is a rare autosomal recessive disease that is difficult to diagnose. CLD requires early treatment to correct electrolyte imbalance and alkalosis and to prevent severe dehydration. Renal injury is clearly associated with defective electrolyte balance induced by CLD, particularly during the first months or years of life. A 7-year-old boy was diagnosed with CLD following detection of a homozygous mutation (c.2063-1G>T) in SLC26A3 at 6 months of age. During treatment with electrolyte supplements, mild proteinuria was detected at 8 months of age, and is still present. Renal biopsy showed the presence of focal renal dysplasia, with metaplastic cartilage and mononuclear cell infiltration, calcification, and fibrosis in the interstitium. Up to two-thirds of the glomeruli exhibited global obsolescence, mostly aggregated in the dysplastic area. In nondysplastic areas, the glomeruli were markedly increased in size and severely hypercellular, with increased mesangial matrix, and displayed segmental sclerosis. The marked glomerular hypertrophy with focal segmental glomerulosclerosis suggested a compensatory reaction to the severe nephron loss or glomerular obsolescence associated with renal dysplasia, with superimposed by CLD aggravating the tubulointerstitial damage.

Foreign body granuloma after bone cement augmentation of pedicle screws for osteoporotic spinal surgery: A case report

Osteoporosis causes a decrease in bone mineral density. To overcome the decrease in fixation strength, a variety of techniques and devices have been developed, including cement augmentation of pedicle screws. Polymethyl methacrylate (PMMA), is commonly known as bone cement, and is widely used for implant fixation in various orthopaedic and spine surgery. In general, PMMA augmentation of pedicle screws is simple and safe if performed with technical precautions. PMMA is a safe agent, but it may rarely lead to significant foreign body reactions. In this report, we present a patient who developed bone cement-related epidural space foreign body granuloma

A Case of Primary Pneumatosis Cystoides Intestinalis in a Patient with Chronic Abdominal Pain

Pneumatosis cystoides intestinalis is a rare phenomenon presenting with multiple gas-filled cysts in the submucosal or subserosal layer of the gastrointestinal tract. Pneumatosis cystoides intestinalis can occur as a primary or secondary disease with an underlying etiology. We recently managed a case of primary pneumatosis cystoides intestinalis in a 42-year-old man with chronic abdominal pain. The case is presented with a review of the literature.

A Case of Primary Pneumatosis Cystoides Intestinalis in a Patient with Chronic Abdominal Pain

Pneumatosis cystoides intestinalis is a rare phenomenon presenting with multiple gas-filled cysts in the submucosal or subserosal layer of the gastrointestinal tract. Pneumatosis cystoides intestinalis can occur as a primary or secondary disease with an underlying etiology. We recently managed a case of primary pneumatosis cystoides intestinalis in a 42-year-old man with chronic abdominal pain. The case is presented with a review of the literature.

Bonding Strength between Cement and an Implant according to the Cementing Time / 대한정형외과학회잡지

PURPOSE: The objective of this study was to compare the bonding strength between cement and an implant according to the cementing time. MATERIALS AND METHODS: The two types of cement used were CMW(R) 1 and 3 (Depuy Ltd., Blackpool, UK). Plastic molds containing CMW(R) 1 were pressed onto metal blocks at 2, 4, 5 or 6 minutes after mixing the cement, while molds containing CMW(R) 3 were pressed onto blocks at 3, 5, 6 or 7 minutes after mixing the cement. Tensile strength was tested with using an Instron Model 8874 (Instron Corp., Canton, MA, USA). Tensile strengths were compared using the Kruskal-Wallis test and the Mann-Whitney U test. RESULTS: The strongest bonding strengths for the tensile load were at 2 minutes post-mixing for CMW(R) 1, and at 3 minutes post-mixing for CMW(R) 3. The strength rapidly decreased after 5 minutes for CMW(R) 1 and after 6 minutes for CMW(R) 3. CONCLUSION: This study suggests that the risk of loosening between cement and an implant is likely to be minimized by the surgical technique that considers the bonding strength according to time.

The Differential Diagnosis and Prognosis of an Ampulla of Vater Cancer with a Grossly Normal Appearance / 대한소화기내시경학회지

BACKGROUND/AIMS: The purpose of this study was to determine the clinical parameters for a differential diagnosis between a malignant and benign stricture of the ampulla of Vater with a grossly normal appearance and to evaluate the diagnostic accuracy of the use of an endoscopic biopsy for the prognosis of ampulla of Vater cancers. METHODS: Medical records and cholangiograms were retrospectively reviewed. In order to determine the clinical parameters useful for a differential diagnosis, clinical manifestations, laboratory findings and the common bile duct diameter were compared between malignant and benign strictures. The diagnostic accuracy of the use of an endoscopic biopsy and the clinical features of patients with an ampulla of Vater cancer were analyzed. The survival rate after management was also evaluated. RESULTS: Nine patients with a benign stricture and 15 patients with a malignant stricture were included in this study. The levels of serum bilirubin, alkaline phosphatase and alanine aminotransferase were significantly higher in patients with a malignant stricture than in patients with a benign stricture (p<0.05). Of the patients who underwent surgical management, 93% had stage I or II disease. All of the patients were alive up to a mean follow-up period of 50 months. CONCLUSIONS: Liver function tests and the use of an endoscopic biopsy are useful in the differential diagnosis of a stricture of the ampulla of vater with a grossly normal appearance. Cancer patients typically present with an early stage and the prognosis is relatively good.

The Expression of the Adhesion Molecules on Interfacial Membrane fromthe Aseptically Loosened Failed Femoral Stems in Revisional Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: To clarify the relationship between aseptic loosening of hip arthroplasty and adhesion molecules on interfacial membrane from revisional hip arthroplasty. MATERIALS AND METHODS: We studied 26 revisional total hip arthroplasties between May 2004 and July 2006, and 15 synovial tissues from hip fractures were selected as the control group. We analyzed the degree of femoral osteolysis by Paprosky's classification. We examined the expression of soluble endothelial leukocyte adhesion molecule-1 (E-selectin), vascular adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1) by immunohistochemical staining technique. We compared and analyzed radiologic evaluation and expression of adhesion molecules. RESULTS: Expression of E-selectin was observed in 100%, VCAM-1 in 42.3% and ICAM-1 in 34.6%. Expression of adhesion molecules were increased compared to the control group (p<0.05). The higher the expression of E-selectin, the higher the degree of osteolysis (p=0.023). CONCLUSION: These results showed that adhesion molecules are involved in aseptic loosening of hip arthroplasties, and we proposed that E-selectin may strongly engage in the cascade of aseptic loosening in hip arthroplasty.

Short Term Results of Cementless Total Hip Arthroplasty with Subtrochanteric Shortening Osteotomy in Severe Dysplasia of Hip

PURPOSE: This study examined the clinical, functional and radiological results of total hip arthroplasty with subtrochanteric shortening osteotomy in severe dysplasia of hip. MATERIALS AND METHODS: Seventeen cases of severe dysplasia of the hip, which were treated with total hip arthroplasty with subtrochanteric shortening osteotomy from August 1997 to September 2004, were evaluated. The mean follow-up duration was 52.9 months (range: 26~106). Harris hip score (HHS), leg length discrepancy (LLD) and complication were assessed clinically. Gait analysis (7 cases) and Cybex study (8 cases) for the abductor muscle power were assessed functionally. Bony union and stability around the osteotomy site of the femoral and acetabular components was assessed radiologically. RESULTS: The mean HHS improved from 65.1 (range: 23~87) points preoperatively to 88.2 (range: 72~100) points at the last follow-up. The mean LLD improved from 3.7 (range: 1~7) cm preoperatively to 1.6 (range: 0.5~3.3) cm postoperatively. All cases showed complete bony union of the allograft in the acetabulum and osteotomy site at a mean time of 6 months postoperatively. Gait analysis improved in all cases but there was some limping gait remaining. On the Cybex study, 6 out of 8 cases showed improved abductor muscle peak toque, postoperatively. CONCLUSION: A cementless total hip arthroplasty with subtrochanteric shortening osteotomy is believed to be a useful treatment for severe dysplasia of hip. Despite the improving HHS, the abductor power can be decreased. In these points, gait analysis and the Cybex study are helpful on the follow-up.

A Case of Esophageal Obstruction Caused by an Ingested Canine Gallbladder / 대한소화기내시경학회지

Endoscopic intervention is a very important and effective tool for evaluating and treating an esophageal foreign body. The size of a cystic foreign body filled with liquid can be reduced by needle puncture and fluid spillage. We report a rare case of an acute total obstruction of the esophagus by an ingested canine gallbladder that was removed by endoscopic intervention.

Extensor Hallucis Longus Tendon Rupture in TaeKwonDo Players: Two Case Report / 대한족부족관절학회지

Occasionally, extensor hallucis longus tendon (EHL) ruptures becames open by laceration and spontaneous rupture of EHL that has previous story of diabetes mellitus, steroid injection, systemic steroid administration, operation and rheumatoid arthritis. But, closed traumatic EHL ruptures are reported rarely. Especially, we diagnosed the closed EHL ruptures in TaeKwonDo players. We reported the 2 patients, differently treated end to end anastomosis and EHL transfer, had the course and treatment methods. Be care the prognosis can be altered according to the treatment time and method.

Usefulness of NCI-N87 Cell Lines in Helicobacter pylori Infected Gastric Mucosa Model / 대한소화기학회지

BACKGROUND/AIMS: The unavailability of human gastric cell lines representative of the normal gastric epithelial function such as polarized monolayer restricts the application of cell culture system in approaching the field of Helicobacter pylori (H. pylori) infected gastric mucosa models. The present investigation aimed at assessing the usefulness of NCI-N87 cell line as an adequate cellular model to study the pathophysiology of human H. pylori infection. METHODS: For the identification of epithelial phenotypes at low magnification, cells were observed on a phase-contrast microscope and confocal microscope. Transepithelial resistance (TER) was measured on NCI-N87 cells seeded on Transwell(R) to identify monolayer polarity two or three times a week after confluency. The IL-8 level was determined by ELISA at 24 hours after the administration of HP60190 and IL-1alpha on NCI-N87 cells. IL-8 level was compared in both upper and lower well with the control. RESULTS: A monolayer phenotype was observed in NCI-N87 cell lines by using confocal microscope. TER was measured as 400-500 (omega x cm2) at two or three weeks after cell culture. In NCI-N87 cell lines, IL-8 level was significantly increased after 24 hour compared to control, and was prominent in the lower well. CONCLUSIONS: These results suggest that NCI-N87 cell line may be useful in H. pylori infected gastric mucosa model.

Prediction of the Clinical Course According to the Macroscopic Type by Colonoscopy in Behcet's Colitis / 대한소화기내시경학회지

The intestinal lesion of Behcet's colitis shows aphthoid or punched-out ulceration. But these morphological characteristics are variable and the clinical course of Behcet's colitis is also diverse. There have been many case reports since 1962, but there is few study for clinical course or for morphological characteristics of intestinal lesion of Behcet's colitis. So we retrospectively investigated the clinical course of Behcet's colitis according to colonoscopic findings. Thirty-two patients with Behcet's colitis were investigated retrospectively from January 1984 to July l994. The patients who had at least two major stigmata of Behcet's syndrome with intestinal lesions were included, and whose colonoscopic films were available and whose follow-up studies were done. The studies used at their follow-up were colonoscopy and/or barium enema. In our study the patients ranged in age from 15 to 64 years old, with mean age of 37 years old; 28% were in 3rd decade. The mean follow-up period was 33 months.