Syringomyelia Presenting as Lower Cervical Radiculopathy: A case report

Syringomyelia may present with confusing, unilateral patterns of segmental muscle involvement and dissociated sensory loss. The objective of this study was to report a patient with syringomyelia and Chiari malformation type 1 (CM 1) who had an unusual presentation suggesting lower cervical radiculopathy. A 50-year-old woman presented with clinical evidence of left lower cervical radiculopathy. Nerve conduction studies revealed normal in both motor and sensory nerves of the left upper extremity. Electromyography showed abnormal spontaneous activities in the paracervical muscles at C7-T1 levels and in some examined muscles of the left upper extremity such as abductor pollicis brevis and abductor digiti minimi muscles. Magnetic resonance imaging of cervical spine demonstrated syringomyelia at C4- T4 levels. Syringomyelia may clinically mimic lower cervical radiculopathy.

Non-union of Golf Related Fracture of the Hook of Hamate: A case report

We presented a 64-year-old man who complained sudden onset of ulnar sided wrist pain, paresthesia in ulnar aspect of left hand after swinging a golf club. The intermittent pain was not relieved by physical therapy, local injection and medication on local clinics. Physical examination revealed tenderness on the area of the hook of hamate and weakness on flexion of 5th finger in the left side. Plane X-ray and electrodiagnostic study did not show abnormal findings. Bone scan revealed increased uptake localized on left ulnar site of wrist joint. For proper diagnosis, MRI and carpal tunnel view of left wrist were performed and fracture of the hook of hamate was found. We reported a case of non-union of golf related fracture of the hook of hamate by delayed diagnosis with the review of literatures.

The Changes of Markers of Bone Metabolism and Bone Mineral Densities in Patients with Spinal Cord Injury

OBJECTIVE: In patients with spinal cord injury, it is more susceptible to osteoporosis because bone resorption is more prominent than bone formation. Thus we evaluated the change of biochemical markers and bone mineral densities (BMDs) according to the duration of injury, the spinal cord injury level, and the injury severity. METHOD: The subjects were included 26 patients with spinal cord injury and 22 healthy men. We measured serum osteocalcin and urine deoxypyridinoline (DPYD) in 2 hours after awakening and measured BMDs in lumbar vertebrae, femur, and distal forearm in patients and control group. The patients were 21 men, 5 women, mean age 43.2+/-14.3 years, and mean duration 28.3+/-45.0 months, who were divided by injury level and injury severity respectively. RESULTS: The biochemical markers of bone metabolism in patients group had significant differences comparing to control group (p<0.05). The urine DPYD and BMDs in femur showed significantly negative correlation with the duration of spinal cord injury (p<0.05). CONCLUSION: In patients with spinal cord injury, urine DPYD and BMDs in femur had significant correlation with the duration of injury. But, the injury level and injury severity had no significant correlation with the markers of bone metabolism and BMDs.

Clinical Implication of Magnetic Resonance Imaging in the Idiopathic Inflammatory Myopathies / 대한류마티스학회지

OBJECTIVE: The purpose of the study is to describe the magnetic resonance imaging (MRI) findings and to investigate useful sequences of MRI in inflammatory myopathies. A third goal is to correlate MRI findings with the grade of histopathologic severity. METHODS: Sixteen patients (13 women, 3 men), aged 21-74 years (median age of 49) with inflammatory myositis (examined with both MRI and muscle biopsy) were studied. Ten patients were diagnosed with polymyositis and 6 with dermatomyositis. Conventional T1-weighted (SE 366/12) and T2-weighted (SE 4766/90) fast spin-echo and fat-suppressed T1-weighted MR images with contrast enhancement (FSAT T1 CE) were obtained. Ratios between the signal intensities of a muscle and the signal intensities of subcutaneous fat in the same tomographic sections were calculated to objectively represent the degree of signal intensities. Semi-quantitative grading of severities in muscle biopsy specimen was examined based on invasion of inflammatory cells and necrosis, degeneration and regeneration of muscle fiber by a neuromuscular pathologist. RESULTS: FSAT T1 CE could objectively describe the severity of involvement in inflammatory myopathies. The quadriceps muscle group, especially the vastus muscle tended to be most severely and frequently involved in inflammatory myositis with FSAT T1 CE (statistically insignificant). The vastus intermedius muscle was more severely involved in dermatomyositis than polymyositis. The signal intensity of abnormal muscle sampled by biopsy correlated positively with the grade of muscle biopsy. CONCLUSION: MRI shows promise in identifying pathologic muscle in patients suspected of having one of the inflammatory myopathies. The degree of signal intensity on MRI may reflect the severity of grade in muscle biopsy.

A Case of Intestinal Pseudo-Obstruction in a Patient with Systemic Lupus Erythematosus / 대한류마티스학회지

Intestinal pseudo-obstruction is an uncommon and poorly understood complication of systemic lupus erythematosus. It is characterized by acute or chronic symptoms suggestive of the obstruction of small or large intestine without any radiologic, surgical or endoscopic evidence of mechanical obstruction. Although the exact pathogenesis of intestinal pseudo-obstruction in SLE remains unknown, it can be caused by derangement of the visceral smooth muscle, enteric nerves or visceral autonomic nervous system. Concomitant involvement with dilatation of gastrointestinal and genitourinary tract highly suggests of intestinal pseudo-obstruction in systemic lupus erythematosus. There is an apparent association between lupus-related intestinal pseudo-obstruction and ureterohydronephrosis. The management of intestinal pseudo-obstruction consists of high dose corticosteroid, adequate nutrition, hydration and prokinetics. Early recognition of intestinal pseudo-obstruction in systemic lupus erythematosus and the use of adequate dose of corticosteroid are important. We report a case of systemic lupus erythematosus presenting as intestinal pseudo-obstruction.

A case of primary antiphospholipid syndrome with renal microangiopathy / 대한내과학회지

Antiphospholipid syndrome is a disease that has continuous high titer of antibodies directed against either phospholipids or plasma proteins bound to anionic phospholipids in serum and shows a variety of clinical manifestations including recurrent venous and arterial thrombosis, recurrent fetal losses, livedo reticularis and thrombocytopenia. Because thrombosis may develop in any vessel, clinical manifestations are variable. Renal microangiopathy has been reported in antiphospholipid syndrome associated with systemic lupus erythematosus and rarely reported in primary antiophospholipid syndrome. But there was no case report of antiphospholipid syndrome accompanied by renal microangiopathy in Korea. Recently, we experienced a 25 years old male patient who had primary antiphospholipid syndrome with intrarenal thrombotic microangiopathy and IgA nephropathy. So, we report this case with review of relevant literature.

The Comparison of Clinical Efficacy and Safety of Meloxicam versus Diclofenac in Korean Patients with Osteoarthritis of the Knee ; Open Multicenter Comparative Randomized Trial / 대한류마티스학회지

OBJECTIVE: To assess the clinical efficacy and safety of meloxicam 7.5mg versus diclofenac 100mg slow release (SR) in the Korean patients with osteoarthritis of the knee. METHODS: Ninety-one patients of four university hospitals in 1999 were randomized to receive once daily oral meloxicam 7.5mg (N=45) or diclofenac 100mg SR (N=46) for 8 weeks. Clinical efficacy was evaluated using 100mm Visual Analogue Scale (VAS) for pain, Lequesne index after 4, 8 weeks of treatment as well as the physician? and patient? global assessment at the end of treatment. Evaluations for clinical safety were performed using the incidence of adverse events, physical examinations, laboratory finding and total ingestion of antacid during the treatment. RESULTS: After 8 weeks of therapy, both groups had significant improvement in 100mm VAS and Lequesne index than baseline although the difference between two groups did not reach statistical significance. The physician? and patient's global assessment were similar in two groups. The incidence of gastrointestinal adverse events was significantly lower in meloxicam group (24.4%) than diclofenac group (50.0%)(p<0.05). CONCLUSION: Meloxicam 7.5mg is comparable to diclofenac 100mg SR in the treatment of Korean patients with osteoarthritis of the knee. Furthermore meloxicam 7.5mg was well tolerated for 8 weeks and has safe advantage of a significantly lower incidence of gastrointestinal adverse events.

The Comparison of Clinical Efficacy and Safety of Meloxicam versus Diclofenac in Korean Patients with Osteoarthritis of the Knee ; Open Multicenter Comparative Randomized Trial / 대한류마티스학회지

OBJECTIVE: To assess the clinical efficacy and safety of meloxicam 7.5mg versus diclofenac 100mg slow release (SR) in the Korean patients with osteoarthritis of the knee. METHODS: Ninety-one patients of four university hospitals in 1999 were randomized to receive once daily oral meloxicam 7.5mg (N=45) or diclofenac 100mg SR (N=46) for 8 weeks. Clinical efficacy was evaluated using 100mm Visual Analogue Scale (VAS) for pain, Lequesne index after 4, 8 weeks of treatment as well as the physician? and patient? global assessment at the end of treatment. Evaluations for clinical safety were performed using the incidence of adverse events, physical examinations, laboratory finding and total ingestion of antacid during the treatment. RESULTS: After 8 weeks of therapy, both groups had significant improvement in 100mm VAS and Lequesne index than baseline although the difference between two groups did not reach statistical significance. The physician? and patient's global assessment were similar in two groups. The incidence of gastrointestinal adverse events was significantly lower in meloxicam group (24.4%) than diclofenac group (50.0%)(p<0.05). CONCLUSION: Meloxicam 7.5mg is comparable to diclofenac 100mg SR in the treatment of Korean patients with osteoarthritis of the knee. Furthermore meloxicam 7.5mg was well tolerated for 8 weeks and has safe advantage of a significantly lower incidence of gastrointestinal adverse events.

The effectiveness of spiral computed tomography as a diagnostic tool in pulmonary embolism: Comparison of spiral CT with Ventilation-perfusion scan / 결핵

BACKGROUND: With variable symptoms and nonspecific radiographic appearances, pulmonary embolism (PE) is a frequent and often undiagnosed cause of mortality and morbidity. The Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study suggested that the majority of patients undergoing ventilation-perfusion (V-Q) scan would require additional studies to establish or to exclude the diagnosis of PE. Pulmonary angiography has been regarded as gold standard for diagnosis of PE. However, it is an invasive procedure that may be associated with significant notable mo rbidity and mortality. Thus, availability of an accurate, noninvasive screening examination is highly desirable. METHOD: From October 1994 to February 1997, twenty patients (male 13, female 7, range 23-91 years, median 58 years) who were suspected as pulmonary embolism on the basis of clinical evidence and underwent the spiral volumetric computed tomography (spiral CT), were studied retrospectively to evaluate the effectiveness of spiral CT as a diagnostic tool in PE. RESULTS: PE could be excluded with spiral CT in 4 patients; diagnoses of these patients were lung cancer, pneumonia with lung abscess, bilateral pleural effusion due to congestive heart failure, nonspecific pulmonary abnormality retrospectively. One patient who disclosed high probability in V/Q scan, could be diagnosed as pneumonia with lung abscess and underlying emphysema with spiral CT. Among 4 patients who showed intermediate and low probability in V/Q scan, 3 patients could be confirmed as PE with spiral CT. Spiral CT were helpful in 3 patients, in whom V/Q scan could not be performed due to other reasons (e.g. night time, mechanical ventilation) to confirm the diagnosis of PE. Spiral CT could demonstrate embolus above lobar artery level in 11 patients, and up to segmental artery level in 5 patients. CONCLUSION: This study demonstrated that spiral CT could allow accurate demonstration of thrombotic clots in centrally localized embolism. Spiral CT could be effective, specific, noninvasive and useful diagnostic screening modality for the diagnosis of pulmonary embolism.

The effectiveness of spiral computed tomography as a diagnostic tool in pulmonary embolism: Comparison of spiral CT with Ventilation-perfusion scan / 결핵

BACKGROUND: With variable symptoms and nonspecific radiographic appearances, pulmonary embolism (PE) is a frequent and often undiagnosed cause of mortality and morbidity. The Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study suggested that the majority of patients undergoing ventilation-perfusion (V-Q) scan would require additional studies to establish or to exclude the diagnosis of PE. Pulmonary angiography has been regarded as gold standard for diagnosis of PE. However, it is an invasive procedure that may be associated with significant notable mo rbidity and mortality. Thus, availability of an accurate, noninvasive screening examination is highly desirable. METHOD: From October 1994 to February 1997, twenty patients (male 13, female 7, range 23-91 years, median 58 years) who were suspected as pulmonary embolism on the basis of clinical evidence and underwent the spiral volumetric computed tomography (spiral CT), were studied retrospectively to evaluate the effectiveness of spiral CT as a diagnostic tool in PE. RESULTS: PE could be excluded with spiral CT in 4 patients; diagnoses of these patients were lung cancer, pneumonia with lung abscess, bilateral pleural effusion due to congestive heart failure, nonspecific pulmonary abnormality retrospectively. One patient who disclosed high probability in V/Q scan, could be diagnosed as pneumonia with lung abscess and underlying emphysema with spiral CT. Among 4 patients who showed intermediate and low probability in V/Q scan, 3 patients could be confirmed as PE with spiral CT. Spiral CT were helpful in 3 patients, in whom V/Q scan could not be performed due to other reasons (e.g. night time, mechanical ventilation) to confirm the diagnosis of PE. Spiral CT could demonstrate embolus above lobar artery level in 11 patients, and up to segmental artery level in 5 patients. CONCLUSION: This study demonstrated that spiral CT could allow accurate demonstration of thrombotic clots in centrally localized embolism. Spiral CT could be effective, specific, noninvasive and useful diagnostic screening modality for the diagnosis of pulmonary embolism.

Clinical Manifestations and Significance of Mononeuritis Multiplex in Systemic Necrotizing Vasculitis / 대한류마티스학회지

No abstract available.

Invasive Aspergillosis after Solid Organ Transplantation / 감염

Solid organ transplantation has been established as an accepted treatment modality for end-stage diseases. Although the prognosis for organ recipients has improved with the development of surgical technical skills and the application of newly developed immunosuppressive agents, opportunistic infections remain the major cause of death in these patients. Invasive aspergillosis is one of the most common fungal infections in solid organ transplantation, and it carries a high mortality rate. In Korea, eight sporadic cases of invasive aspergillosis after kidney or heart transplantation have been reported. Recently, we experienced five cases of invasive aspergillosis after liver or heart transplantation over a four year period. Among these five patients, three died of uncontrollable aspergillosis and one died of heart failure and graft rejection. Early diagnosis and treatment are essential for the improvement of the prognosis for invasive aspergillosis after solid organ transplantation.

Rheumatoid vasculitis manifesting as ischemic colitis / 대한내과학회지

Rheumatoid vasculitis is a necrotizing arteritis of unknown causes that affect a subset of patients with rheumatoid arthritis. Vasculitis associated with rheumatoid arthritis was first recognized in 1898. It was described frequently in the 1940s through 1960s but is now rarely diagnosed. Typical clinical features include constitutional symptoms, mononeuritis multiplex, skin infarction, ulceration, peripheral gangrene and visceral infarction. Gastrointestinal involvement occurs in 10 to 38% of cases of rheumatoid vasculitis and may include bowel infarction, ulceration, perforation, colitis, stricture, or bleeding. Ischemia of the intestine is the end result of interruption or reduction of its blood supply. However, the clinical manifestations of intestinal ischemia range from mild chronic symptoms to a catastrophic acute episode, depending on the vascular supply involved, the extent of the occlusion or ischemia, and the rapidity of the process. Physicians caring for patients with rheumatoid arthritis should be aware that intestinal ischemia or infarction may occur without overt clinical evidence of systemic rheumatoid vasculitis. Herein we describe a case of rheumatoid vasculitis manifesting as ischemic colitis which was intractable to medical therapy and led to subtotal colectomy.

A Histological Comparative Analysis of Thermal Side Effects of Excimer Laser Versus Holmium : YAG Laser in the Human Articular Cartilage / 대한정형외과학회잡지

The methods available for arthroscopic debridement vary widely in cost and efficiency. The use of laser treatment is growing rapidly with advantages of production of smooth surface and avoidance of direct contact. Nevertheless, growing attention is directed to the negative side effects of laser-controlled cartilage ablation, especially to the depth effects of the various lasers on which various scientific studies have focused. The purpose of this study is to evaluate the thermal side effects of Ho: YAG laser and Excimer laser on human articular cartilage hy histological analysis. Sixteen human articular cartilages were obtained during total knee arthroplasty for patients with advanced degenerative arthritis. Three craters, 1cm in diameter, were created on each articular cartilage by shaver, Holmium: YAG laser and Excimer laser in the saline medium. These total 48 craters were prepared to tissue specimen by paraffin blocks and stained with Hematoxylin-Eosin(HE) and Massons trichrome. Under the light microscope, we analysed extents of thermal necrosis and thermal change in craters. Also some specimens were fixed by 2.5% glutaraldehyde and ohserved in changes of three different methods under scanning electron microscope. We report the results as follow: 1. The average times to making one crater were 25 seconds in shaver, 33 seconds in Holmium: YAG laser, and 65 seconds in Excimer laser respecti vely. 2. In gross inspection, the most smoothing surface of crater was seen on the specimens of Excimer laser. 3. In histological findings, thermal necrosis on hematoxylin and eosin sections was not noted after shaver use, whereas seen average of 243.8+/-159.6micrometer in Molmium: YAC laser and 36.6+/-17.1micrometer in Excimer laser(p=0.000). Thermal change on trichrome-stained sections was not noted after shaver use, hut showed average of 372.1 +/-203.1micrometer in Holmium: YAG laser and 76.0+/-47. Imicrometer in Excimer laser(p=0.000). 4. In scanning electron micrograph, coagulation of collagen fiher in the matrix was ohserved, with less extents in Excimer than Holmium: YAG laser. In conclusion, Excimer laser was superior to Holmium: YAG laser in terms of thermal necrosis and precision, whereas Holmium: YAG laser was more effective due to rapid time for procedure. To minimize the thermal necrosis during laser chondroplasty, we suggest it is desirable to less energy and reduce exposure time to laser beam on the articular surface.

A Case of Cyclosporine Induced Reversible Cortical Blindness / 대한혈액학회지

The immunosuppressive agent, cyclosporine (CSA), has improved the success rate of organ transplantation due to its effectiveness in treating graft versus host diseases. However, as its use has increased, so has the variety of toxicities associated with it, including in the kidney, liver, and central nervous system. The spectrum of neurotoxcity ranges from mild tremor and blurred vision to seizures, ataxia, mental status changes, peripheral neuropathy, and paraparesis. Cortical blindness, an extremely rare form of CSA neurotoxicity, has previously been described in only 15 patients after a bone marrow transplant (BMT). We have experienced a rare case of CSA induced cortical blindness in a 15 year-old girl receiving a bone marrow transplantation for aplastic anemia. Tests showed a high cyclosporine level, a low serum magnesium level, and a low cholesterol. In a brain MRI, we found a diffuse high signal intensity in the parieto-occipital lobe on T2-weighted images. In an awake EEG, there were diffuse slowing waves. A visual evoked potential, performed at the time of initial evaluation, when patient was cortical blind, showed no wave formation in the left occipital recording. After discontinuation of CSA, there was significant improvement of cortical blindness, much improvement in the brain MRI, the brain EEG, and the visual evoked potential.

A Case of Endocarditis Caused by Pasteurella multocida Complicated with Cerebral Infarction / 감염

In recent years, an increasing number of infections with Pasteurella multocida in human have been reported, causing a wide range of systemic illness. Infective endocarditis with P. multocida, however, is still quite rare. Recently we experienced a case of P. multocida endocarditis in a 26-year old man who was admitted because of fever and headache. He denied any recent contact with animals. P. multocida was identified from blood cultures and echocardiography showed mitral regurgitation and vegetation on mitral valve area. He became stuporous on the fourth hospital day and the brain MRI showed acute cerebral infarction. He was treated with penicillin intravenously for six weeks, which successfully controlled clinical features of infections. To our knowledge, this is the first case of P. multocida endocarditis complicated with cerebral infarction in Korea.

Synovectomy of the Knee in Rheumatoid Arthritis / 대한정형외과학회잡지

Rheumatoid arthritis is a chronic inflammatory systemic disease of young or middle aged adults, characterized by destructive and proliferative changes in the synovial membrane, periarticular structures, skeletal muscle and perineural sheath. Eventually joints are destroyed, ankylosed and deformed. Therefore the aim of treatment is to keep the inflammatory process at a minimum, thereby preserving joint motion, maintaining health of muscles supplying motor power about the joint, and preventing secondary joint stiffness and deformity. Much of the increasing enthusiasm for surgical treatment of rheumatoid arthritis revolves around preventing the destruction of cartilage and tendon simply by excising as much as possible of the tissue that produces the destruction, namely the inflamed synovial membrane. Synovectomy probably is the earlient and most rewarding procedure that can be done in the treatment of rheumatoid arthritis. For the period of 11 yesrs from March 1966 to December 1977, 16 cases of rheumatoid knees were treated by synovectomy and the results of clinical observation was as follows. 1. Synovectomy was performed in 16 knees of 13 patients and 11 patients were followed up. 2. Of 13 patients, 10 patients were female and 3 patients were male. 3. Peak age incidence was in the third decade (38.4%) and the postoperative results were more satisfactory in younger patients than in older patients. 4. Post operative range of motion was not specifically correlated to the duration of symptom. 5. Postoperative results were not specifically correlated to the laboratory findings. 6. Postoperative range of motion was satisfactory in 6 cases and was unsatisfactory in 5 cases.

Clinical Observation on Giant Cell Tumor: Treatment and prognosis / 대한정형외과학회잡지

Giant cell tumor is an uncommon neoplasm, arising from the mesenchymal cells of bone marrow. The lesion was first described by Sir Astley Cooper in 1818. Levert in 1845 gave a detailed delineation of this tumorous condition. Paget in 1853 provided an excellent description of what remains a guiding treatise. In 1940, Jaffe, Lichtenstein, and Portis identified it as an entity with distinctive roentgenographic, hiatological, and clinical characteristics. Since then, frequent detailed reports analyzing the treatment and prognosis were published by many authors. The classic grading system is that of Jaffe, Lichtenstein, and Portis. Grade I,II, and III correspond respectively to insignificant, moderate, and marked atypism of the nuclei of the stromal cells. Tumors of Grade III are considered to be frankly malignant. While Dahlin and associates and Goldenberg and his co-workers found the grading of no prognostic value, Lichtenstein, in 1972, still claimed that in his experience the grading of giant cell tumor is of practical value. Twenty seven cases of giant cell tumor were seen and treated at Severance Hoepital during the 18 years from July 1960 to June 1978. The tumors were mostly diatributed 55% in the 21 to 40 years group and mostly located around the knee (52%). According to the pathologlcal grading, these casosbelonged to Grade I and Grade III in 19% each and to Grade Il in 62%. The treatment consisted of curettage and bone graft in 14 cases, amputation in 4 cases, en bloc excision in 3 cases, partial resection and fusion, curettage and bone graft with radiotherapy in 2 cases each, curettage and bone cement, and en bloc excision and endoprosthsis in one case each. On following up the end results, the over all recurrence rate was 18.5% (5 cases) and the malignant change rate was 3.7% (1 case). In this study one case was changed into malignant degeneration in Grade II and a pulmonary metastasis was found. Among our cases, 5 were of recurrences, primarily treated by curettage and bone graft in to cases, partial excision with fusion in one case, and curettage, and bone graft with radiotherapy in one case. The recurrence rate seems not to be correlated with the grade. In the treatment of this tumor, surgical treatment if pcssible is recommended. The definitive procedures for removal of the tumors in this series were curettage-and bone graft, excision or resection with or without bone graft, and amputation. Resection and prosthesis replacement was employed in our cases for one lesion in the proximal end of humerus. A new alternative in the choice of surgery has been tried in many authors. This alternative is a thorough curettage of the tumor and filling with bone or acylic bone cement. In our series bone cement filled up the lesion of the distal end of tibia. Tumors located around the knee and distal radius showed higher recurrence than other sites. The results obtained from this study led us to conclude that: 1) The highest incidence was in the age group from 21 to 40 years in 15 cases (55%) and sex distribution was almost equal 2) The most frequent sites of this tumor are the lower end of the femur, upper end of tibia, and lower end of the radius (18 cases, 67%). 3) The pathological grading in this series showed 5 cases in Grade I, 17 cases in Grade II, and 5 cases in Grade III. 4) Recurrence rate was 18.5% and all cases recurred within 2 years after first surgery. 5) A case who is in Grade II in pathological finding was changed into malignant degeneration and pulmonary metastasis. 6) Tumors located around the knee and distal radius were higher in recurrence than at other sites.