Treatment of Enchondromas of the Hand with Curettage, Autoiliac Bone Graft and Contact Cryotherapy

PURPOSE: The purpose of this study was to evaluate the effectiveness of contact cryotherapy as an adjuvant therapy after intralesional curettage and autoiliac bone graft of enchondromas of the hand. MATERIALS AND METHODS: Thirty seven cases in 30 patients (17 males, 13 females) with enchondromas of the hand who underwent curettage, contact cryotherapy and autoiliac bone graft between July 2004 and March 2010 were reviewed with a minimum follow-up of 1 year. Radiologic evaluations were done periodically. Mean follow-up period was 26 months (range: 12-54 months). The radiologic results were evaluated according to the degree of new bone formation based on the Tordai's criteria. RESULTS: According to the Tordai's criteria, 33 cases (89%) were group I, and 4 cases (11%) were group II. There was no case of group III, which meant recurrence. Bone healing was achieved at average 4.8 months (range: 4-5.3 months) after the operation. There was no cryotherapy-related complication such as pathologic fracture, bone necrosis and skin necrosis during the follow-up periods. CONCLUSION: We suggest that the contact cryotherapy can be used as an effective adjuvant therapy for treatment of enchondroma of the hand without complications.

Ebstein's Anomaly in a 74-year-old Man

Ebstein's anomaly of the tricuspid valve is a rare cardiac malformation, which constitutes>0.5% of all congenital heart disease. The basic malformation of Ebstein's anomaly is displacement of septal and posterior leaflets of the tricuspid valve from the normal atrio-ventricular annulus into the body of right ventricle. Recently, an old man complained cough, dyspnea and sputum production at our hospital. His chest X-ray showed left lower lung atelectasis and cardiomegaly. Bronchoscopic study revealed nonspecific inflammatory change in the left lower lung bronchus. In echocardiographic study, there are dilated right atrium, downward displacement of the tricuspid valve into the right ventricle and moderate degree of tricuspid valve regurgitation. These echocardiographic findings were suitable for diagnostic criteria of Ebstein's anomaly. The atelectasis was resolved by antibiotic therapy, and he has been managed by ACE inhibitor and diuretics through our outpatient department. The clinical manifestation and prognosis of Ebstein's anomaly are quite variable, and considerable proportions of the patients are able to survive through their adult life, but extremely rare cases exist until old age. Recently, I experienced a case of Ebstein's anomaly in a 74-year-old man, such old case is very rare, thus report this case with review of literature.

The change of gastric antral mucin expression after Helicobacter pylori eradication / 대한내과학회지

BACKGROUND: Helicobacter pylori colonizes the gastric surface epithelium and the mucus gel layer. It has been known that H. pylori infection decreased the gastric mucin expression. The aim of this study was to determine the effect of H. pylori eradication on mucin expression (MUC5AC, MUC6 and MUC1) in the gastric epithelium. METHODS: This study included 20 patients positive for H. pylori whom successful eradication was performed between March 1998 and December 1999. H. pylori status was determined by histology, rapid urase test and urea breath test. Gastric antral biopsy specimens were examined by immunohistochemistry for mucin (MUC5AC, MUC6 and MUC1) expression. The distribution of epithelial cells expressing MUC5AC was calculated at two sites (surface mucous cells, pyloric glands). Two scores system (weak-strong) was used to assess staining intensity. RESULTS: There was a gradient of MUC5AC expression, higher to lower from the surface to the glands. Increased MUC5AC expression in the surface mucous cell (p=0.013) and in the glands (p=0.008) was found after H. pylori eradication. MUC6 and MUC1 distribution was not changed after H. pylori eradication. CONCLUSION: MUC5AC expression was increased after H. pylori eradication. These results suggest that MUC5AC may relate in the pathogenesis of H. pylori.

A Case of Acute Mediastinitis Associated with Fish Bone with Successful Conservative Treatment / 결핵

Acute mediastinitis is a life threatening disorder that causes severe morbidity in affected patient. We experienced a case of acute mediastinitis in a 56 year-old man as a result of swallowing a fish bone (Order Perciformes, Family Pomacentridae). Conservative treatment, including starvation therapy and the injection of antibiotic drugs, were successful in treating this patient. Although the optimal treatment for acute mediastinitis remains controversial, it is important to choose the appropriate strategies when encountering cases of acute mediastinitis.

Association of Neutrophil Adhesion Molecules Expression and Change of sICAM-1 Concentration after Coronary Artery Stenting with Later Restenosis

BACKGROUND: Neointimal hyperplasia, as the most important mechanism of restenosis after intracoronary artery stenting, its severity is closely correlated with the degree of local inflammatory reaction initiated by vasular injury during stenting procedure. So, we proceeded this study to determine whether inflammatory markers such as CD11b/CD18 (Mac-1) adehsion molecules of neutrophils, sICAM-1 (soluble intercellular adhesion molecule-1), ESR, and CRP increase or not in the peripheral circulation after coronary artery stenting, and whether there is any association between these findings and the degree of later restenosis. METHOD: 32 patients (chronic stable angina 4, unstable angina 17, acute myocardial infarction 11) underwent single vessel coronary artery stenting were enrolled in our study. Blood samples were obtained from peripheral vein just before coronary artery stenting and 48 hours thereafter. The degrees of CD11b/CD18 expression on the surface of neutrophils were analyzed by flow cytometry with monoclonal antibodies, and sICAM-1 by ELISA method. At each times, ESR and CRP were also measured. Follow-up coronary artery angiography was performed with QCA analysis at least 6 months later. We compared the each 48 hours values with the baseline (just before procedure) values. Percentage increments (as a ratio 48 hours values to baseline) of CD11b/CD18 expression, sICAM-1, ESR, and CRP levels were also compared with the results of follow-up QCA analysis. RESULTS: Restenosis (diameter stenosis > or = 50%) occurred in 6 patients (19%) at follow up angiography. 48 hours values of CD11b/CD18 expression, sICAM-1, ESR, and CRP were significantly elevated from the baseline values (each p values, CD11b : < 0.0001, CD18 : 0.01, sICAM-1 : < 0.0001, ESR : 0.005, and CRP : 0.001). The percentage increments of CD11b/CD18 expression were more elevated in restenosis group than nonrestenosis group (CD11b : 341+/-215%/74+/-95%, CD18 : 84+/-60%/17+/-37%, each p < 0.001, 0.001). There was some positive correlation between the percentage increments in the expression of CD11b and the late loss index at the follow up angiography (r=.43, p<0.05). CONCLUSIONS: Through this study, we found that the activation of neutrophils was occurred, and that sICAM-1 level was increased after coronary artery stenting in the peripheral blood. There was some correlations between the degree of CD11b expression on the surface of neutrophils and the severity of late lumen loss of inserted stents. The measurements of increased neutrophil adhesion molecules of CD11b/CD18 levels at 48hrs after coronary stenting may have a value as the predictor of subsequent late restenosis.

A Case of Relapsing Polychondritis Presenting As a Diffuse Tracheobronchial Tree Involvement / 결핵

Relapsing polychondritis (RP) is a rare inflammatory disorder of unknown etiology, causing recurrent inflammatory and degenerative reactions involving the cartilaginous structures throughout the body. Generally, RP is known as multiorgan disease presented as auricular chondritis, arthritis, nasal chondritis, ocular inflammation, audiovestibular damage and respiratory tract inflammation. Major airway involvement occurs in more than 50% of the patient and has been reported to be the primary cause of death. Rarely, it may be presented with only respiratory symptoms without typical clinical manifestation of RP. We experienced a 64-year-old male patient with RP involving diffuse airway tract without other characteristic clinical manifestation and present here with a review of literatures.

A case of Esophageal Cancer with Pneumopericardium / 결핵

A diabetic 73-year-old man had admitted and examined gastrofiberoscopy due to dyspagia and weight loss of 6 kg during two months. He was confirmed diagnosis of esophageal squamous cell carcinoma. During the esophagography, we found the dye spillage into pericardial space from the esophagus with air collection. A following chest roentgenogram revealed a typical pneumopericardium with pericardial air filling. Although intensive care was done, he expired 4 days later. We report a case of typical pnemopericardium caused secondary to esophageal cancer.