Achromobacter xylosoxidans Infection Following Total Knee Arthroplasty / 대한정형외과학회잡지

Achromobacter xylosoxidans is an opportunistic organism, mainly causing infection in immune compromised hosts, such as patients on dialysis. However, review of the medical literature showed that few cases of A. xylosoxidans infections following total knee arthroplasty have been reported. This organism has not been reported in prosthetic joint infections of patients who are not immune compromised. Here, a case of periprosthetic infection with A. xylosoxidans following total knee arthroplasty in a man with no medical history of immune suppression is reported.

Comparative Study of Osteoporosis Treatment of Elderly Patients with Degenerative Osteoarthritis of the Knee Joints, according to the Korean Health Insurance Review & Assessment Service Criteria versus the FRAX(R) Criteria / 대한정형외과학회잡지

PURPOSE: To compare and evaluate any differences in the osteoporosis treatments of elderly patients with degenerative osteoarthritis of the knee joints, in accordance with the Korean Health Insurance Review & Assessment Service (HIRA) criteria versus the World Health Organization (WHO) fracture risk assessment tool (FRAX(R), http://www.shef.ac.uk/FRAX/) criteria, which is a fracture risk assessment tool developed by the WHO. MATERIALS AND METHODS: From June 2010 to March 2011, we investigated and screened the target populations of osteoporosis treatments among 65-year-old or older patients with degenerative osteoarthritis of the knee joints who scheduled to undergo elective total knee arthroplasty. They were classified in the treatment group only if they met either the HIRA criterion, defined as having a T score of or =20% or > or =3%, respectively. RESULTS: Of a total of 929 patients, the number of patients included in the treatment group as screened according to the HIRA or FRAX(R) criteria was 562 (60.5%) and 372 (40.0%), respectively. The number of patients who met both criteria was 339 (36.5%), and including 334 non-treated patients (36.0%), a total of 673 patients (72.4%) showed low diagnostic concordance (k=0.471). Of 319 patients diagnosing osteopenia, 33 (10.3%) patients were included in the treatment group according to the FRAX(R) criteria. CONCLUSION: A combination of the HIRA and FRAX(R) criteria is required to improve the current guidelines for osteoporosis treatment.

Fracture of a Polyethylene Tibial Post in a Scorpio Posterior-Stabilized Knee Prosthesis

We report the case of a polyethylene tibial post fracture in a 72-year-old woman 14 months after a Scorpio posterior-stabilized (PS) total knee arthroplasty. The polyethylene wear was found around the fracture site of the post, especially over the anterior aspect of the post base. The failure mechanism of the post fracture in the present case was anterior impingement with excessive wear over the base of the anterior aspect of the tibial post, which became a stress-riser of post and cam articulation. This is the first report of a polyethylene tibial post fracture of a Scorpio PS prosthesis.

Measurements of Socket Osteolysis with using 3D CT and their Correlation with the Clinical Outcome

PURPOSE: We wanted to measure the size of the osteolysis of the pelvis and to quantify its location and we wanted to assess the correlation of these measurements with the clinical result. MATERIALS AND METHODS: We evaluated 40 hips (31 patients) that showed definitive osteolysis among 116 hips (97 patients) that underwent 3 dimensional CT scanning post-operatively after total hip arthroplasties with using cementless acetabular cups. The inclusion criteria were a follow up duration of more than 18 months and no history of infection. The radiographs were obtained at the 6th to 12th week postoperatively. The size of pelvic osteolysis was divided into 4 groups (less than 1 cm3 (A), between 1 cm3 to 2 cm3 (B), between 2 cm3 to 3 cm3 (C), more than 3 cm3 (D)), and the location of osteolysis was divided into 5 groups (anterior, posterior, superior, inferior and central) The size and location of osteolysis and the wear of the polyethylene were analysed in relation to the clinical outcome, which was assessed using the Harris Hip Score). RESULTS: The average size of the osteolysis was 3.2 cm3 (A 14 cases in group A, B 11 cases in group B, C 4 cases in group C, and D 11 cases in group D). There was significant correlation between the size of the osteolysis and the clinical outcome (Rs=-0569). However, there was no significant correlation between the osteolysis location (Anterior: 18 cases, Superior: 5 cases, Posterior: 10 cases, Inferior: 33 cases and Central: 32 cases) and the clinical outcome (P=0.35). CONCLUSION: There is a significant correlation between the size of the osteolysis and the Harris Hip Score (Rs=- 0569). Especially, a pelvic osteolysis of more than 3 cm3 was found to be correlated with a decreased postoperative HHS (P=0.022). We hope that these results may be useful to help guide the treatment of osteolysis.

Perioperative Changes in C-Reactive Protein Levels after Unilateral and Simultaneous Bilateral Total Knee Replacement / 대한정형외과학회잡지

PURPOSE: The objective of this study was to determine the patterns of C-reactive protein (CRP) changes during the postoperative period after total knee replacement (TKR), and to determine the CRP changes associated with infection after TKR. MATERIALS AND METHODS: A retrospective analysis of the pattern of CRP changes during the first 6 postoperative months was conducted on 2,315 patients who underwent unilateral or simultaneous bilateral TKR. This data was also compared with the pattern of CRP changes which occurred in 19 patients with a deep prosthesis infection who were not enrolled in the main study. RESULTS: The CRP levels peaked 3 days postoperatively, and then decreased to baseline levels at 15-28 days postoperatively. Within 14 days postoperatively, the CRP levels were significantly higher in the simultaneous bilateral TKA group than in the unilateral group (p<0.01). Thereafter, no significant difference in CRP levels existed between two groups. After the 8th postoperative day, a significant difference in CRP level existed between patients with and without deep prosthesis infections. CONCLUSION: CRP changes post-TKR provide an effective means of monitoring of infections. In cases of non-inflammatory arthritis in which the CRP levels are significantly difference after the 8th postoperative day or are elevated after the 4th postoperative week, an infection should be suspected.

Endoscopic Retrograde Cholangiopancreatography in Thirty-four Children / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is being used with increasing frequency as a diagnostic and therapeutic tool in children with suspected disorders of the pancreaticobiliary tract. We reviewed ERCPs performed in children and investigated clinical indications and usefulness of ERCP. METHODS: A total of 80 ERCPs were performed in 34 patients (age: 17 months~15 yrs) at Asan Medical Center from 1994 to 2001. Adult side-viewing duodenoscope, Olympus JF or TJF, was used for all procedures. General anesthesia was used in 73% of the patients, whereas intravenous sedation was employed in the remainder. RESULTS: Cannulation was successful in 77 attempts (96%). ERCP was commonly indicated for the evaluation of pancreatic disease (18 cases) such as acute pancreatitis (4), recurrent pancreatitis (4), chronic pancreatitis (9), and non-resolving acute pancreatitis (1). Biliary tract diseases (15 cases) were common bile duct stones (4), choledochal cyst (8), and traumatic or nontraumatic common bile duct stricture (3). Therapeutic ERCP (n=20) included sphincterotomy (55.9%), insertion of stents (12%), and removal of common bile duct stones or pancreatic duct stones with balloon or basket (32%). The complications were developed in 12 out of 80 attempts (15%) and resolved with medical management. CONCLUSIONS: ERCP seems to be a useful and relatively safe procedure in the evaluation of pancreaticobiliary disorders in children and also can be used for nonoperative treatment of these diseordrs.

Clinical characteristics and outcome of invasive Prevotella infection / 대한내과학회지

BACKGROUND: Prevotella species is one of the major microoranism responsible for invasive anaerobic bacterial infection. This study was performed to investigate the clinical characteristics and outcome of invasive Prevotella infection in a University affiliated, tertiary care Hospital. METHODS: We obtained the information from the computerized data base of the clinical microbiology laboratory from January 1997 to December 2000, and identified patients whose sterile clinical specimen culture had yielded Prevotella species. We then reviewed the patients' medical records, and studied demographic, clinical, and microbiologic data. RESULTS: The total of 34 patients with invasive Prevotella infection were enrolled for the analysis. Seventeen strains were isolated from blood, 13 from the pleural fluid, 5 from the ascites, and 1 from both the ascites and blood. Half of the cases of Prevotella infection were mixed-infection and 22 cases (64.7%) were of community origin. Twenty-six patients (76%) were men and the mean age was 59 years. Most common underlying disease was malignant neoplasms (19/34, 55.9%). A portal of entry could be determined in 29 patients (85.3%) with the most common being the respiratory tract (12/34, 35.3%), followed by the gastrointestinal tract (6/34, 14.4%), and the wound site (6/34, 14.4%). Surgical procedure was necessary for 21 cases (63.5%). One-month mortality was 32.3%. The mortality was significantly associated with the underlying chronic renal failure (p=0.028) and ICU care (p=0.002). Surgical therapy had a protective effect (54% vs 14%, p=0.022) CONCLUSION: Invasive Prevotella Infections were more prevalent among old age patients with underlying malignancy than younger people and frequently necessitated surgical procedure. Early surgical treatment would decrease mortality.

Murine Typhus as a Cause of Acute Respiratory Distress Syndrome in Endemic Area / 결핵

BACKGROUND: Murine typhus is a fea-borne, worldwide Rickettsial disease caused by Rickettsia typhi. Its symptoms are typically mild byt sometimes can be fatal. The major clinical features include fever, rash, and headache. Recently, we experienced 6 cases of ARDS associated with a Rickettsia typhi infection. This study was aimed to analyze the attributing factors for fatal murine typhus and to review the characteristics of the pateints who showed acute respiratory distress syndrome as the initial presentation. METHODS: The medical records of 15 patients diagnosed as murine typhus were reviewed. The diagnosis was made by single titers of 1:512 or higher, or a 4-fold rise with compatible clinical features. Acute Respiratory Distress syndrome (ARDS) was define according to the American-European Consensus Conference. The characteristics between the ARDS group and the non-ARDS group of murine typhus were compared. RESULTS: Six patients developed ARDS as their initial presentation. Two of them were women and three of them had lived urban area. None of them a showed skin rash. One of them expired during treatment. The time lapse until the commencement of the specific treatment, the lower serum albumin level, the higher serum total bilirubin level, the higher APACHE III score and the higher MOD score were significantly associated with the ARDS group compared to the non-ARDS group. CONCLUSIONS: Murine typhus should be considered as one of the etiologies for the ARDS of unknown cause, particularly in an endemic regions. ARDS caused by Murine typhus generally has a good prognosis.

Santorinicele Associated with Pancreas Divisum / 대한소화기내시경학회지

Santorinicele denotes a focal cystic dilatation of the terminal dorsal pancreatic duct at the minor papilla. Santorinicele results from a combination of obstruction and weakness of the distal dorsal ductal wall. This anomaly has been found in patients with pancreas divisum and recurrent acute pancreatitis. We recently experienced a typical case of santorinicele associated with pancreas divisum incidentally found in a 71-year-old woman presented with acute cholecystitis. At duodenoscopy, the minor papilla was plumped out and bulged into the duodenal lumen after contrast injection. Dorsal pancreatography showed a cystic dilatation at the terminal portion of the dorsal duct and upstream dilatation. In this patient, previous pancreatic-type pain and pancreatitis are thought to be related to this anomaly.

A case of gout with glycogen storage disease type Ia / 대한내과학회지

Glycogen storage disease type Ia (GSD-Ia) is an autosomal recessive disorder that has defects in glucose-6-phosphatase (G6Pase) in liver, kidney and intestinal mucosa. The defect leads to inadequate conversion of glucose-6-phospate to glucose in the liver and thus makes affected individuals susceptible to fasting hypoglycemia, hyperuricemia, lactic acidemia and hyperlipidemia. Hyperuricemia has been observed in a considerable number of patients and in some of those, clinical gout has occurred. Inhibited tubular secretion of uric acid due to hyperlacticacidemia and ketonemia, and overproduction of uric acid have been postulated as a mechanism for hyperuricemia in patients with GSD-Ia. A 30-year-old male was admitted with fatigue, foot pain and multiple gouty tophi on knee, ankle, and elbow. GSD-Ia and gout were confirmed by analysis of the G6Pase gene and tophi aspiration respectively. He was treated with allopurinol and uncooked cornstarch. After treatment, foot pain improved and the number and size of tophi were decreased.