Different Pattern of T-Score Discordance between Patients with Atypical Femoral Fracture and Femur Neck Fracture

Background@#Our study evaluated the prevalence and pattern of T-score discordance between the spine and hip in Korean patients with atypical femoral fracture (AFF) and femur neck fracture (FNF). @*Methods@#A total of 49 patients (all women) who were treated for AFF and 1:3 matched 147 female patients with FNF were included from January 2012 to August 2022. A discordance of more than 1.5 between lumbar spine and femur neck bone mineral density (BMD) was defined as a difference and divided into 3 groups: lumbar low (LL; lumbar BMD is less than femur neck BMD), no discordance (ND), and femur neck low (FL; femur neck BMD is less than lumbar BMD). We compared the prevalence and pattern of discordance between 2 groups, and the associated risk factors of T-score discordance among the subjects were evaluated using regression analysis. @*Results@#The prevalence of discordance was significantly higher in patients with AFF (51%) than in those with FNF (25.2%; p<0.001). LL discordance was found in 46.9% of the patients with AFF but only 4.8% in those with FNF. Conversely, FL discordance was found in 4.1% of the patients with AFF and 20.4% in those with FNF, respectively. No specific risk factor was found as T-score discordance in the 2 groups. @*Conclusions@#Clinicians should be aware that the pattern of T-score discordance can vary depending on the location of osteoporotic fractures. In addition, a longitudinal study would be necessary to verify the pattern of T-score discordance related to the osteoporotic fracture location.

Effects of preanesthetic dexmedetomidine on hemodynamic responses to endotracheal intubation in elderly patients undergoing treatment for hypertension: a randomized, double-blinded trial / 대한마취과학회지

BACKGROUND: Dexmedetomidine is an alpha-2 adrenergic agonist with sedative, anxiolytic, and analgesic properties. This study was designed to evaluate the inhibitory effects of preoperative administration of 0.5 µg/kg dexmedetomidine on hemodynamic responses caused by endotracheal intubation in elderly patients undergoing treatment for hypertension. METHODS: Forty elderly (≥ 65 years old) patients who had been receiving hypertension treatment, had American Society of Anesthesiologists physical status II, and were scheduled to undergo elective noncardiac surgery were randomly selected and assigned to 2 groups. Group C received normal saline and group D received 0.5 µg/kg dexmedetomidine intravenously over 10 min just before endotracheal intubation. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded preoperatively in the ward, immediately after study drug administration, and at 1, 3, and 5 min after endotracheal intubation. RESULTS: Compared to group C, group D showed significantly lower SBP and MAP at 1, 3, and 5 min as well as significantly lower DBP and HR at 3 and 5 min after endotracheal intubation. CONCLUSIONS: In elderly patients receiving hypertension treatment, a single preanesthetic dose of dexmedetomidine (0.5 µg/kg) effectively suppressed the hemodynamic responses to endotracheal intubation.

Treatment of Late-Onset Legg-Calve-Perthes Disease by Arthrodiastasis

BACKGROUND: To evaluate the efficacy of arthrodiastasis for Legg-Calve-Perthes disease. METHODS: Arthrodiastasis was conducted using external fixator devices (Orthofix) in 7 patients at least 8 years of age with a diagnosis of Legg-Calve-Perthes disease. The average follow-up was 80 months (range, 32 to 149 months), and their average age was 9.1 years (range, 8 to 12 years). The results of treatment were evaluated by measuring the degree of hip pain and the range of motion of the hip at 6 months after the operation and comparing the values with preoperative measurements. Radiological recovery was evaluated by the epiphyseal index and compared with the preoperative values. At the final follow-up, clinical and radiological results were evaluated using the Iowa hip score and the Stulberg classification. RESULTS: On the clinical evaluation performed at 6 months after arthrodiastasis, the degree of pain decreased by 1.8 points on average, and the average flexion, internal rotation, and abduction increased by 35°, 16°, and 11°, respectively. Based on radiological findings, the epiphyseal index showed a remarkable increase of 6.6 on average (from 19 preoperatively to 26 postoperatively). At the final follow-up, the average Iowa hip score improved from 65 points preoperatively to 84 points. There were 1 Stulberg class I hip, 2 Stulberg class II hips, 3 Stulberg class III hips, 1 Stulberg class IV hip, and no Stulberg class V hip. CONCLUSIONS: We conclude that arthrodiastasis using an external fixator can be a relatively promising surgical procedure for the treatment of late-onset Legg-Calve-Perthes disease.

The New Phytoformula Containing Morus alba, Schizandra sinensis and Asparagus cochinchinensis Inhibits Lung Inflammation in vitro and in vivo

A phytoformula containing the root barks of Morus alba, the fructus of Schizandra sinensis and the roots of Asparagus cochinchinensis (MSA) was prepared as a potential new herbal remedy, and its therapeutic potential for alleviating inflammatory lung conditions was examined. For in vivo evaluation, an animal model of lipopolysaccharide (LPS)-induced acute lung injury (ALI) in mice was used. With oral administration of 6 - 60 mg/kg, MSA potently and dose-dependently inhibited bronchitis-like symptoms in acute lung injury induced by intranasal treatment of LPS as judged by the number of cells in the bronchoalveolar lavage fluid (BALF) and histological observation. The inhibitory potency was comparable with that of dexamethasone. For in vitro assay, the effects on the production of proinflammatory molecules in lung epithelial cells and alveolar macrophages were examined. Although MSA inhibited IL-6 production in IL-1β-treated lung epithelial cells (A549) only at a high concentration (300 µg/ml), the formula strongly and concentration-dependently inhibited NO production in LPS-treated alveolar macrophages (MH-S) at 20 - 300 µg/ml. Based on all of these findings, the new phytoformula MSA is suggested to have the potential to control inflammatory lung diseases including bronchitis, at least in part, by inhibiting inducible nitric oxide synthase-catalyzed NO production.

Effectiveness of Initial Extracorporeal Shock Wave Therapy on the Newly Diagnosed Lateral or Medial Epicondylitis

OBJECTIVE: To evaluate the effectiveness of initial extracorporeal shock wave therapy (ESWT) for patients newly diagnosed with lateral or medial epicondylitis, compared to local steroid injection. METHOD: An analysis was conducted of twenty-two patients who were newly confirmed as lateral or medial epicondylitis through medical history and physical examination. The ESWT group (n=12) was treated once a week for 3 weeks using low energy (0.06-0.12 mJ/mm2, 2,000 shocks), while the local steroid injection group (n=10) was treated once with triamcinolone 10 mg mixed with 1% lidocaine solution. Nirschl score and 100 point score were assessed before and after the treatments of 1st, 2nd, 4th and 8th week. And Roles and Maudsley score was assessed one and eight weeks after the treatments. RESULTS: Both groups showed significant improvement in Nirschl score and 100 point score during the entire period. The local steroid injection group improved more in Nirschl score at the first week and in 100 point score at the first 2 weeks, compared to those of the ESWT group. But the proportion of excellent and good grades of Roles and Maudsley score in the ESWT group increased more than that of local steroid injection group by the final 8th week. CONCLUSION: The ESWT group improved as much as the local steroid injection group as treatment for medial and lateral epicondylitis. Therefore, ESWT can be a useful treatment option in patients for whom local steroid injection is difficult.

Predictive Risk Factors for Refracture after Percutaneous Vertebroplasty

OBJECTIVE: To identify risk factors for developing a vertebral refracture after percutaneous vertebroplasty. METHOD: A retrospective analysis of 60 patients who had undergone percutaneous vertebroplasty between January 2008 and April 2010 was conducted. All patients were observed for a 1 year follow-up period, and fracture was defined when it was both clinically reported and radiographically confirmed. Twenty-seven patients with a refractured vertebra and 33 patients without a refracture were included. Of the 60 patients, 20 presented with a refracture from a cemented vertebra, whereas the remaining 40 patients did not. Clinical, imaging and procedure-related factors for each group were analyzed by the Fisher's exact, chi-square, and the Mann-Whitney U-tests. RESULTS: Local kyphotic angle and sagittal index were significant as a result of researching various risk factors related to vertebral refracture (p<0.001, p<0.001, respectively) and refracture from a cemented vertebra itself (p=0.004, p<0.001, respectively). Other factors were not significant. CONCLUSION: Patients who had a high preoperative local kyphotic angle and a high sagittal index required a close follow-up and attention.

Concurrent Coronary Thromboembolism and Pulmonary Thromboembolism without Right-to-Left Shunt / 대한내과학회지

A 65-year-old woman was referred for management of chest pain and ST segment elevation on electrocardiography. Emergency coronary angiography revealed a well demarcated thrombus that near totally occluded the mid portion of the left anterior descending artery, with a Thrombolysis In Myocardial Infarction (TIMI) flow grade 1, and a fusiform aneurysm on the left main coronary artery. No significant stenosis was observed after aspiration of the thrombus; however, complete coronary reperfusion by urgent aspiration did not improve her dyspnea and tachypnea. Echocardiography revealed a D-shaped left ventricle; thus, we performed a chest computed tomography scan and diagnosed a pulmonary embolism. The patient's coagulation studies were normal. She was prescribed chronic anticoagulation, and we carried out transthoracic echocardiography using second harmonic imaging with agitated saline. Second harmonic imaging with the Valsalva maneuver revealed no right-to-left shunt. We report here a case of concurrent coronary embolism and pulmonary embolism without right-to-left shunt.

Synovial Biopsy Findings among Patients with Monoarthritis

OBJECTIVE: Any joint disorders can present as monoarthritis initially, which makes the range of differential diagnosis of monoarthritis extensive. Synovial biopsy may play a role in the diagnosis of monoarthritis. We reviewed the synovial biopsy findings of monoarthritis patients in order to assess its diagnostic value. METHODS: Synovial pathologic findings of 39 patients who visited the rheumatology or orthopedic surgery clinic for acute or chronic monoarthritis from Feb., 2006 to Jul., 2010 were reviewed retrospectively. RESULT: Four (10.3%) of 39 patients could be diagnosed with specific arthritis after synovial biopsy (rheumatoid arthritis, tuberculous arthritis, giant cell tumor, and osteochondroma, each). CONCLUSION: The result showed that the synovial biopsy is useful for differential diagnosis of monoarthritis in a limited number of cases.

A Case of Paraplegia Following Endovascular Stent Repair of Descending Thoracic Aortic Aneurysm

Paraplegia secondary to spinal cord infarction is a recognized complication of open thoracic and thoracoabdominal aortic aneurysm (TAA) repair. TAA is serious and unpredictable condition. Therefore, aortic repair requires thorough information on managing the potential complications will facilitate improve control the problem. We report the symptoms and management of paraplegia in a patient who underwent stent insertion as TAA.

Myopericarditis in a Korean Young Male With Systemic Lupus Erythematosus

Myocardial involvement with clinical symptoms is a rare manifestation of systemic lupus erythematosus (SLE), despite the relatively high prevalence of myocarditis at autopsies of SLE patients. In this review, we report the case of a 19-year-old male SLE patient who initially presented with myopericarditis and was successfully treated with high dose of glucocorticoids.

The prevalence of significant fibrosis in chronic hepatitis B patients with ALT <80 IU/L / 대한내과학회지

BACKGROUND/AIMS: The aims of this study were to investigate the prevalence of significant fibrosis in patients with chronic hepatitis B (CHB) virus infections and alanine aminotransferase (ALT) <80 IU/L, and to develop a noninvasive predictive model for significant fibrosis. METHODS: The 136 patients with CHB who underwent liver biopsy were recruited from six tertiary hospitals. The diagnostic value of predictors was judged using multivariate logistic modeling and the area under the receiver operating characteristic (AUROC) curve. RESULTS: Significant fibrosis was diagnosed in 97 patients (71.3%, 95% CI, 63.7~78.9%). In the training set (n = 85), the most important clinical data for predicting significant fibrosis were age and aspartate aminotransferase (AST). The AUROC of this model was 0.86 (95% CI, 0.78~0.94). The validation set (n=51), obtained from another institute, yielded similar results [AUROC: 0.90 (95% CI, 0.78~0.99)]. CONCLUSIONS: A high prevalence of significant fibrosis in CHB patients with ALT <80 IU/L was observed. A simple model that includes age and AST provides an easily applicable tool for physicians to guide the decision-making process regarding the need to perform a liver biopsy in individual patients. However, additional studies are needed to explore the model's performance in larger, independent patient populations.

Clinical Assessment of Atlantoaxial Instability by Sharp-Purser Test in Rheumatoid Arthritis

OBJECTIVE: To evaluate the validity of Sharp-Purser test in the assessment of anterior atlantoaxial subluxation in rheumatoid arthritis patients. METHOD: We assessed the validity of the Sharp-Purser test in 38 rheumatoid arthritis patients who were subjected to stabilization surgery. All patients were evaluated using manual laxity test and re-evaluated radiologically. RESULTS: In 31 out of 38 patients (81.6%) Sharp-Purser test was positive in spite of anterior displacement of C1 over C2 on radiograms, while the tests were negative in 7. Among those 7 patients with negative test, 4 (10.5%) were acute cases and 3 (7.9%) were chronic cases with high grade hypomobile slip. Among the 31 patients with positive Sharp-Purser test, ADI (atlantodental interval) was 4 mm in 4 patients, 5 mm in 9, and greater than 5 mm in 18 patients. Among the 7 patients with negative Sharp-Purser test, ADI was 4 mm in 4 patients and greater than 5 mm in 3 patients. CONCLUSION: Our results show that the Sharp-Purser test is a useful clinical examination to diagnose atlantoaxial instability.

Comparison of the Model for End-stage Liver Disease and hepatic venous pressure gradient for predicting survival in patients with decompensated liver cirrhosis / 대한간학회지

BACKGROUND/AIMS: This study compared the prognostic values of the Model for End-stage Liver Disease (MELD) and the hepatic venous pressure gradient (HVPG) in the prediction of death within 3 and 12 months in patients with decompensated liver cirrhosis. METHODS: We used data from 136 consecutive patients with decompensated cirrhosis who underwent HVPG between January 2006 and June 2008. Cox regression analysis was used to investigate the independent relationships with death of MELD and HVPG. The prognostic accuracies of MELD and HVPG were analyzed by calculating the area under the receiver operating characteristic curve (AUROC) for the occurrence of death within 3 and 12 months. RESULTS: Both MELD and HVPG were independent predictors of death [hazard ratio (HR)=1.11 and 1.12, respectively; 95% confidence interval (CI)=1.04~1.20 and 1.08-1.16]. Analysis of the AUROC demonstrated that the prognostic power did not differ between MELD and HVPG for predicting the 3-month survival (HR=0.76 and 0.68, respectively; 95% CI=0.62~0.89 and 0.52~0.84; P=0.22) or the 12-month survival (HR=0.72 and 0.73, 95% CI=0.61~0.83 and CI=0.61~0.84). CONCLUSIONS: Both MELD and HVPG are independent prognostic factors of death within 3 and 12 months in patients with decompensated liver cirrhosis, and their accuracies are similar. However, HVPG has a limited role in the prediction of death in decompensated cirrhosis due to its invasiveness and limited use.

A Case of Cerebral Gumma Presenting as Brain Tumor in a Human Immunodeficiency Virus (HIV)-Negative Patient

Syphilis, along with the recent increase of human immunodeficiency virus (HIV) patients, has also been on the rise. It has a broad spectrum of clinical manifestations, among which cerebral gumma is, a kind of neurosyphilis, however, it is rare and can be cured by penicillin. Thus, cerebral gumma needs to be differentially diagnosed from other brain masses that may be present in syphilis patients. We have experienced a case where the patient was first suspected of brain tumor, but confirmed by surgery to be cerebral gumma due to neurosyphilis. This is the first such case encountered in Korea, therefore, we report it here in. A 40-year old woman complaining of headaches was found to have a brain mass on her CT scans and MRI. Suspecting a brain Tumor, a resection was performed on the patient, and histological results revealed that the central portion of the mass contained necrotic material and the peripheral region was infiltrated with plasma cells. Warthin-Starry staining of the region revealed spirochetes, and the patient was thus diagnosed as brain gumma. Venereal Disease Research Laboratory (VDRL) of cerebrospinal fluid (CSF) was reactive. After an operation, penicillin-G at a daily dose of 24x10(6) U was given for 10 days from post-operative day 10, and thereafter, the mass disappeared.

A case of fulminant hepatic failure due to cyproterone acetate in a patient with cryptogenic liver cirrhosis / 대한내과학회지

Cyproterone acetate is an antiandrogenic drug that has been used in prostatic cancer. The drug is thought to be well-tolerated but has hepatotoxic effects. An 89 year-old man treated with cyproterone acetate 300 mg/d for prostatic cancer presented with a hepatotoxic reaction. Toxic hepatitis was diagnosed and cyproterone acetate was stopped immediately. The patient was treated with supportive management and a corticosteroid, but he died 28 days after administration due to liver failure. A liver biopsy performed after his death revealed the presence of acute hepatitis with cirrhosis. Underlying cirrhosis was not suspected before his death. Ultimately, the case was diagnosed as fulminant hepatic failure due to cyproterone acetate with underlying cryptogenic liver cirrhosis. This case and current literature highlight the hepatotoxic potential of cyproterone acetate and illustrate the importance of clinical surveillance, especially in patients with unrecognized liver disease.

A Case of Acute Myocardial Infarction with the Anomalous Origin of the Right Coronary Artery from the Ascending Aorta above the Left Sinus of Valsalva and Left Coronary Artery from the Posterior Sinus of Valsalva

Coronary anomalies are rare angiographic findings. Moreover, there are few reports of cases of an anomalous origin of the right coronary artery from the left sinus of Valsalva and of the left coronary artery from the posterior sinus of Valsalva. Here, we report a case with an anomalous origin of the right coronary artery from the ascending aorta above the left sinus of Valsalva and the left coronary artery from the posterior sinus of Valsalva. This was observed in a patient who was treated for a myocardial infarction of the inferior wall caused by a thrombus in the proximal right coronary artery. The patient was treated successfully with the implantation of a stent in the anomalous origin of the right coronary artery using a 6Fr Amplatz left 1 catheter.

Two cases of infliximab treatment in Patients with Behcet's disease and intractable colon ulcers / 대한내과학회지

Behcet's disease is a chronic disease characterized by recurrent systemic vasculitis. The pathogenesis remains unclear. This disease involves various organs of the body and it can have a variety of symptoms with an unpredictable course. The diagnosis of Behcet's disease is made in patients with oral and genital ulcers and uveitis. In addition, gastrointestinal symptoms are frequently present; however, intestinal ulcers are infrequent. The most common extra-oral sites of gastrointestinal involvement are ileocecal and colon lesions. The lesions are typically resistant to medical treatment and frequently recur after surgical treatment. Here we present two cases treated with the monoclonal antibody anti-tumor necrosis factor (TNF) and regression of all symptoms.

A Case of Autoerythrocyte Sensitization Syndrome in an Adult Male / 대한혈액학회지

Autoerythrocyte sensitization syndrome (Gardner-Diamond syndrome), also known as painful bruising syndrome or psychogenic purpura, is characterized by sudden and spontaneous painful bruising and swelling on both extremities, and is a psychologically induced painful bruising condition. The exact etiology of the syndrome is an enigma, even today. It occurs primarily in young to middle-aged women who usually have psychogenic disorders. A diagnosis of this syndrome is made on the basis of the clinical history, dermatological examination complemented by a positive autoerythrocyte sensitization test, psychiatric evaluation and the absence of any organic cause. We present a 20-year-old man with characteristic features of this syndrome, who had a positive autoerythrocyte sensitization test. To our knowledge, this is the first case in an adult male reported in the Korean literature.

A Case Study of Meningococcal Vaccination At a University Hospital

Meningococcal infection is a life threatening disease that leaves serious sequelae in spite of appropriate treatment, thus vaccination for high risk groups are important for the prevention of meningococcal diseases. However, the vaccine for Neisseria meningitidis has not been available in Korea until we introduced bivalent (serogroup A and C) polysaccharide vaccine for the first time for relief works in our university hospital. The vaccine was administered from January 2005 to March 2007 to 317 persons. Of the groups administered, the largest group among them were 133 (133/317, 42%) students who planned to study abroad and needed the vaccination for secure entrance to school dormitories. This group was followed by health care workers, travellers to the regions of the world with high risks of meningococcal diseases, and splenectomised patients. To rationalize the domestic use of meningococcal vaccine, the availability of vaccines first needs to be simplified by introducing them to the domestic market; for this to be possible, the approval system for vaccines should be reformed and epidemiogical studies need to be carried out.

A Case Study of Meningococcal Vaccination At a University Hospital

Meningococcal infection is a life threatening disease that leaves serious sequelae in spite of appropriate treatment, thus vaccination for high risk groups are important for the prevention of meningococcal diseases. However, the vaccine for Neisseria meningitidis has not been available in Korea until we introduced bivalent (serogroup A and C) polysaccharide vaccine for the first time for relief works in our university hospital. The vaccine was administered from January 2005 to March 2007 to 317 persons. Of the groups administered, the largest group among them were 133 (133/317, 42%) students who planned to study abroad and needed the vaccination for secure entrance to school dormitories. This group was followed by health care workers, travellers to the regions of the world with high risks of meningococcal diseases, and splenectomised patients. To rationalize the domestic use of meningococcal vaccine, the availability of vaccines first needs to be simplified by introducing them to the domestic market; for this to be possible, the approval system for vaccines should be reformed and epidemiogical studies need to be carried out.