Emphysematous Gastritis with Concomitant Portal Venous Air and Acute Necrotizing Esophagitis in Type 1 Diabetes with Diabetic Ketoacidosis: A Case Report and Literature Review of a Rare Complication in Diabetes / 임상당뇨병

Emphysematous gastritis is a rare disorder characterized by emphysematous change of the gastric wall due to infection with a gas-forming organism. Acute necrotizing esophagitis is a rare disorder with an unknown pathogenesis. Above two disorders rarely occur together, only three global cases have been reported to date. Such a case has never been reported in Korea, we report a novel case of severe emphysematous gastritis with concomitant portal venous air and acute necrotizing esophagitis in type 1 diabetes presenting with diabetic ketoacidosis. A 24-year-old man known to have type 1 diabetes and pulmonary tuberculosis was brought to the emergency room for epigastric pain with vomiting. His body mass index was 14.7, and the laboratory findings demonstrated leukocytosis and acidosis, as well as elevated serum glucose, ketone, and C-reactive protein levels. Enhanced computed tomography showed portal vein gas and edematous wall thickening without enhancement in the stomach wall, with air density along the stomach and esophageal wall. The patient required surgical intervention of total gastrectomy and cervical esophagostomy followed by esophagocolostomy and esophageal reconstruction. Early radiologic diagnosis and clinical suspicion of this disease and prompt intervention including antibiotics, decompression, and surgery are important for a good prognosis.

Partial Androgen Insensitivity Syndrome Presenting with Gynecomastia

Gynecomastia is a benign enlargement of the male breast caused by the proliferation of glandular breast tissue. Determining the various causes of gynecomastia such as physiological causes, drugs, systemic diseases, and endocrine disorders is important. Androgen insensitivity syndrome (AIS) is a rare endocrine disorder presenting with gynecomastia and is a disorder of male sexual differentiation caused by mutations within the androgen receptor gene. All individuals with AIS have the 46 XY karyotype, although AIS phenotypes can be classified as mild, partial or complete and can differ among both males and females including ambiguous genitalia or infertility in males. We experienced a case of partial AIS presenting with gynecomastia and identified the androgen receptor gene mutation.

A Case of Acute Suppurative Thyroiditis with Thyrotoxicosis in an Elderly Patient

Acute suppurative thyroiditis (AST) is a rare condition, as the thyroid gland is relatively resistant to infection. Thyroid function tests are usually normal in AST. A few cases of AST associated with thyrotoxicosis have been reported in adults. We report a case of AST that was associated with thyrotoxicosis in a 70-year-old woman. We diagnosed AST with thyroid ultrasonography and fine needle aspiration of pus. The patient improved after surgical intervention and had no anatomical abnormality. Fine needle aspiration is the best method for the difficult task of differentiating malignancy and subacute thyroiditis from AST with thyrotoxicosis. Earlier diagnosis and proper treatment for AST might improve the outcome.

A Case of Demyelinating Peripheral Neuropathy Associated with Hashimoto's Thyroiditis

Peripheral neuropathy is somewhat common in hypothyroidism. But, demyelinating peripheral neuropathy in Hashimoto's thyroiditis is extremely rare. The pathophysiology of demyelinating peripheral neuropathy associated with Hashimoto's thyroiditis is unclear and complex and various mechanisms including the cell mediated and antibody mediated responses may be operative. We report a 68-year-old woman who presented with paresthesia and gait disturbance. She was diagnosed with hypothyroidism 7 years prior and has been on thyroid hormone. Serum antithyroglobulin antibody was significantly elevated. Nerve conduction studies revealed sensory-motor demyelinating polyneuropathy with prolonged distal latencies and reduced conduction velocities. She was under the suspicion of the lymphoma of thyroid. Surgery was performed which turned up to be Hashimoto's thyroiditis. With the impression of rare demyelinating peripheral neuropathy associated with Hashimoto's thyroiditis after other causes were excluded, she was treated with steroid which ameliorated rapidly her neurological symptoms.

Multiple Bilateral Thoracic Perineural Cysts: A Case Report

STUDY DESIGN: Case report OBJECTIVES: We report a case of relatively rare multiple bilateral perineural cysts. SUMMARY OF LITERATURE REVIEW: Tarlov cysts, also known as perineural cysts are most often found in the sacral region, but there are a few cases reported in the thoracic region. In particular, there are very few cases of multiple bilateral thoracic perineural cysts. MATERIALS AND METHODS: A woman aged 65 years with perineural cysts in the bilateral T10-T11 and T11-12 neural foramens, underwent a T10-11-12 decompressive laminectomy and resection of the cyst. RESULTS: Satisfactory results were obtained for the patient after surgery. CONCLUSIONS: For more detailed and definitive treatment of thoracic perineural cysts, additional cases are required.

Incidence and Risk Factors of Ipsilateral Foot and Lower Limb Reamputation in Diabetic Foot Patients / 대한족부족관절학회지

PURPOSE: To evaluate the incidence and risk factors of ipsilateral reamputation after lower limb amputation in the patient with diabetic foot lesions. MATERIALS AND METHODS: Between May 2005 and June 2009, 88 patients who underwent lower limb amputation were analyzed. Group 1 consisted of 73 patients who didn't have a ipsilateral reamputation after lower limb amputation and group 2 consisted of 15 patients who underwent reamputation. We compared several factors between two groups, such as age, gender, BMI, ABI, Wagner classification, wound culture, site of amputation, vascular surgery, the period of diabetes mellitus, chronic renal failure. RESULTS: Fifteen (17%) of 88 patients had a ipsilateral limb reamputation and 13 patients (87%) of them underwent reamputation within 6 months. When we compared the two groups, average age was 59.3 (range, 48-74 years); 62.9 (range, 44-78 years). Age was significantly associated with reamputation rate (p=0.02) and no reamputation after initial amputation above ankle joint was found. Other factors did not show statistically difference between both groups. CONCLUSION: There were no significant difference between diabetic limb amputation and reamputation group in our concerned risk factors except age and amputation level. There should be careful consideration when determine level of amputation in diabetic foot lesions especially in elder patients.

Treatment for the Lumbosacral Soft Tissue Defect after Spine Surgery

The lumbosacral area is one of the most frequently operated spine regions because of the prevalence of disease in that area. Although a lumbosacral soft tissue defect after surgery due to inflammation and other causes is rare, such soft tissue defects are difficult to treat. Therefore, suitable methods for treating lumbosacral soft tissue defects are necessary. Therefore, this study introduces a case-treated with a transverse lumbosacral rotational flap.

Multiple Noncontiguous Fractures in Cervical Spine: Cases Report

STUDY DESIGN: Cases report OBJECTIVES: We report 2 cases of relatively rare cervical fracture. SUMMARY OF LITERATURE REVIEW: Although numerous studies in the literature have investigated cervical spine injuries, patients with multiple-level cervical fractures have not been commonly described. Multiple non-contiguous cervical fractures are distinctively unusual. MATERIALS AND METHODS: First case was a girl aged 8 years and 4 months who had multifocal compression fracture of C3, 5, 6 & T7, 8 without spinal cord injury. Second case was a thirty nine-year-old female who had Type I Hangman's fracture and compression fractures of C3, 7. RESULTS: We had satisfactory results of them treated nonsurgically. CONCLUSIONS: We should remind that cervical spinal column can incur multiple injuries in variant patterns.

Total Ankle Replacement in Pigmented Villonodular Synovitis of Ankle Joint (A Case Report) / 대한족부족관절학회지

Pigmented villonodular synovitis (PVNS) is a rare proliferative disease affecting joint synovium, tendon sheaths, bursae. The usual treatment for PVNS is a surgical excision. If destructive joint lesions have occurred, complete resections must be performed followed by arthrodesis or arthroplasty. We report a case of a pigmented villonodular synovitis involving an ankle joint which was treated by total ankle replacement for recurrence after simple synovectomy.

Comparison of Bone Formation between Allogenic Periosteum-Derived Mesenchymal Stem Cells and Cultured Osteoblasts Transplanted into Long-Bone Defects of Rabbits / 대한정형외과연구학회지

PURPOSE: To analyze the bone formation between allogenic periosteum-derived mesenchymal stem cells and cultured osteoblasts transplanted into rabbit long-bone defects. MATERIALS AND METHODS: Forty white rabbits were grouped according to the material transplanted into their tibial bone defects: stem cells plus agar (group 1); osteoblasts plus agar (group 2); osteoblasts plus gelfoam (group 3). Bone formation was evaluated radiologically, histologically, and using serum osteoblastic markers during 8 weeks following transplantation. RESULTS: Group 1 and 2 both showed satisfactory bone formation, with group 2 showing thicker and more abundant bone trabeculae than group 1. Rabbits in group 3 showed worse bone formation than group 1 and 2. CONCLUSION: These results demonstrate that rabbits implanted with osteoblasts (with agar) showed more satisfactory bone formation than those inserted with stem cells; thus osteoblasts may be useful in the treatment of bone defects.

Pyogenic Spondylitis after Vertebroplasty: A Report of Two Cases

Vertebroplasty is now extensively used worldwide for thoracic and lumbar osteoporotic compression fractures. Although percutaneous vertebroplasty is considered a minimally invasive procedure, it may result in several complications. In this report, we present two patients where pyogenic spondylitis developed after vertebroplasty surgery was required. The serious nature of these infections, surgical management and complication avoidance are discussed.

Health-Related Quality of Life in Korean Patients with Chronic Diseases / 대한류마티스학회지

OBJECTIVE: Few studies have examined the impact of chronic diseases on populations using a comprehensive health-related quality of life (HRQOL) in Korea. We assessed HRQOL of patients with 16 common chronic diseases. METHODS: We interviewed patients with chronic diseases (n=980) and healthy control (n=288) using two HRQOL measurements: Korean Medical Outcome Study Short Form-36 (KSF-36) and Korena EuroQol-5 Dimensions (KEQ-5D), and questions on sociodemographic and clinical characteristics. RESULTS: Each illness had a distinctive profile. Among disease groups, the KSF-36 global health score was highest in DM and lowest in fibromyalgia. The KSF-36 physical component summary score was highest in DM and lowest in osteoarthritis . The KSF-36 mental component summary score was highest in hypertension and lowest in fibromyalgia. The KEQ-5D utility score was highest in DM and lowest in fibromyalgia. The KEQ-5D visual analog score was highest in DM and lowest in liver cirrhosis. In correlation analysis, the KSF-36 physical component summary, mental component summary and five domains in KEQ-5D were well correlated with each others. CONCLUSION: Health related quality of life in Korean patients with chronic disease is lower than healthy control. Patients with hypertension and DM registered the two highest scores in global health but patients with fibromyalgia reported the worst health experience in global health.We can compare the profiles of the groups and determine the relative impact on the patients of the various diseases and these data will provide a baseline of the current health related quality of life of individuals suffering from a variety of conditions.

Effect of Life-Style Factors on Bone Mineral Density in the Community: Based Survey

OBJECTIVE: This study is designed to evaluate the relationship between bone mineral density (BMD) and life-style factors such as physical activity, smoking, and alcohol consumption and to offer the information for the modification of life-style. METHOD: Eight hundred and sixty nine inhabitants (354 males and 515 females whose age was 55.0+/-13.9 years- old) were participated in this study. BMD was measured in the right calcaneus by quantitative ultrasound (Mark 6000(R), Medison). Amount of physical activity, smoking, and alcohol consumption were got through the closely designed interview. Independent sample T-test and simple regression were used for data analysis. RESULTS: Amount of physical activities were 2656.8+/-732.3 cal/day, smokers were 329 persons (37.9% of inhabitants), and amount of alcohol consumption were 26.2+/-53.3 g/day. Increasing the amount of physical activity, BMD showed significantly higher T-score (p<0.01). Increasing the amount of alcohol consumption, BMD showed significantly lower T-score (p<0.01). BMD in smokers appeared significantly lower T-score than non-smokers (p<0.01). CONCLUSION: Life-style factors significantly effect on bone mineral density. Therefore prevention of osteoporosis through maintenance or augmentation of BMD needs proper physical activity, cessation of smoking, and no heavy drinking.

Study for the Lack of Mental Changes to Severe Hyperglycemia in Diabetic Patients with Renal Failure / 대한신장학회잡지

In diabetic patients who were being treated with hemodialysis, coma and other neurological deficits did not occur in spite of extremely elevated serum glucose levels. In this report, we compared diabetic patients with renal failure in severe hyperglycemia with nonketotic hyperosmolar coma patients with normal renal function to know what affect mental changes. Mental changes were not present in diabetic patients with renal failure. These patients with renal failure showed more severe hyperglycemia, but corrected serum sodium concentration and calculated effective serum osmolality were low. So it is suggested that corrected serum sodium concentration and effective serum osmolality are more important factor affecting mental changes than high blood glucose levels in diabetic patients with renal failure, due to absence of osmotic diuresis.

Alteration in Endothelin Receptor-Mediated Responses in Femoral Arteries from Hyperlipidemic Rabbits / 대한정형외과학회잡지

OBJECTIVE: To investigate the roles of ET in the regulation of peripheral vascular tone, we studied the effect of hyperlipidemia on vascular responsiveness in femoral arteries from rabbits with control groups of rabbits and test groups receiving a hyperlipidemic diet. MATERIALS AND METHODS: New Zealand Whites were anesthetized with pentobabital and killed by exsanguination from the femoral arteries. Arteries which were suspended on muscle chambers at their optimal length for contractile properties, were examined. RESULTS: 1. After 14-16 weeks of cholesterol-rich diet, plasma cholestrol and HDL levels were significantly higher in the hyperlipidemic rabbits than in the control rabbits. There was no significant difference in the triglyceride levels between the two groups. 2. The contractions caused by 60 mM KCI in the femoral arterial strips were significantly augmented (P<0.01). The contractile responses to phenylephrine or angiotensin II were also augmented, whereas 5-hydroxytryptamine or U46619- induced contraction was not affected by the hyperlipidemic diet. 3. In control rabbits, ET-1 and ET- 2 contracted femoral arteries in a concentraction-dependent manner, whereas sarafotoxin S6c and IRL 1620 had no effect. 4. Contractions caused by ET-1 and ET-2 were significantly diminished by hyperlipidemia. 5. ET-1-induced concentration-response curves were inhibited by BQ-610, but not affected by BQ-788 in the femoral arterial strips from control and hyperlipidemic rabbits. CONCLUSIONS: These results suggest that ET is involved in the regulation of vascular tone in peripheral arteries and ETA receptor subtypes are mainly present in rabbit femoral arteries. Further more, ET-induced contraction is attenuated in hyperlipidemic rabbit, and the attenuated responses might be caused at least in part by the alteration of ET receptors (e.g. desensitization).

Treatment of Ipsilateral Unstable Femoral Fracture after Total Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: To show the results of treatment of ipsilateral unstable femoral fracture during postoperative period of total hip arthroplasty. MATERIAL AND METHOD: We analyzed eight cases of ipsilateral unstable femoral fractures during the postoperative period of total hip arthroplasty, which were treated operatively from November 1992 to November 1995. The follow-up period ranged from 2 years to 3 years and 8 months (average, 2 years 8 months). There were seven cases of type B2 fractures and one case of type B3 fracture according to the Duncan's8) classification. All showed femoral stem loosening. One case was treated with revision of new femoral stem and internal fixation using wire. Six cases were treated with revision of long femoral stem and internal fixation using wire or Parham band. One case was treated with revision of long femoral stem and internal fixation using plate and wire. All cases had bone graft performed at the fracture site of femur. RESULTS: The results of treatment of periprosthetic fractures showed that seven cases were satisfactory and one case was unsatisfactory. The complications were as follows: nonunion in one, heterotopic ossification in two, and one case of limb shortening. CONCLUSION: The treatment of ipsilateral femoral fractures during postoperative period of total hip arthroplasty can be complex and difficult but revision arthroplasty with a new femoral stem prosthesis, combined with internal fixation and bone graft, may be satisfactory, if the femoral stem is displaced or loosened.

Intra-articular Osteoid Osteoma of the Hip / 대한정형외과학회잡지

Osteoid osteoma is a relatively common benign skeletal tumor that usually affects the cortex of the long bone. Despite its common incidence, the diagnosis is often delayed and confused with other entities such as stress fracture, tuberculosis, osteomyelitis and intracortical abscess. Moreover, the diagnosis becomes more difficult when the osteoid osteoma develops in the intra-articular region. Several factors contribute to the difficulty of the diagnosis: First, osteoid osteoma is relatively rare compared to other causes of articular pain. Second, it presents non-specific clinical manifestation in the hip joint much like other intraarticular disorders. Third, plain radiographs sometimes do not represent the characteristic findings. Fourth, MR imaging reveals inconsistent signal intensities, especially in the early stage. Bone scan also lacks specificity for diagnosis. Recently, we experienced four cases of intra-articular osteoid osteoma of the hip joint and presented them with a review of the literatures.

Bilateral Jumped Thoracic Facets Dislocation: A Case Report / 대한척추외과학회지

Bilateral jumped facets dislocation in upper thoracic spine is rare injury because the thoracic spine is relatively immobile structure. We experienced a case of T2-3 dislocation without fracture and successfully reduced the dislocation after partial resection of the superior articular process of the third thoracic spine and performed fixation and fusion from T1 to T4 with pedicle screw system.

Clinieal Values of Single Photon Emission Computed Tomography ( SPECT ) in Ankylosing Spondylitis / 대한정형외과학회잡지

Now that ankylosing spondylitis is known to be relatively common, it is important that mild cases should be diagnosed earlier to avoid inappropriate investigation and unhelpful non-specific therapy and to improve social rehabilitation. However, difficulties in the diagnosis of ankylosing spondylitis are often encountered. To establish the clinical values of SPECT in ankylosing spondylitis, a study of radiologic evaluation, quantitative bone scan and SPECT have been carried out in 34 patients who were firmly suspected as having ankylosing spondylitis by other tests. This study showed that SPECT could improve the applicability of the imaging modality in the diagnosis and the assessment of disease activity and the capacity of early diagnosis in patients with ankylosing spondylitis. We believe that improved three dimensional localization in and around the sacroiliac joints by SPECT might overcome several diagnostic difficulties. Especially when radiographic abnormalities are not present in the early period, the diagnostic values of SPECT may be more potential.