A Case of Gallbladder Perforation Complicated by Acalculous Cholecystitis due to Non-Typhoidal Salmonella / 대한내과학회지

Salmonella infections can cause a variety of diseases, but acute acalculous cholecystitis complicated by gallbladder perforation occurs very rarely in adults. Here, we report a case of acute acalculous cholecystitis with gallbladder perforation after non-typhoidal group D Salmonella infection. A 71-year-old man was admitted with fever, chills, and watery diarrhea. Blood cultures taken on admission were positive for non-typhoidal group D Salmonella. The patient subsequently developed acute acalculous cholecystitis, and abdominal ultrasound and computed tomography revealed gallbladder perforation. Because of other medical problems, cholecystectomy could not be performed. The patient's symptoms and signs were not resolved, even after parenteral antibiotic injection and percutaneous cholecystostomy. Despite meticulous supportive care, the patient died after progression to multiple organ dysfunction.

Case of Synchronous Primary Gastric Diffuse Large B-Cell Lymphoma and Hepatocellular Carcinoma / 대한내과학회지

Primary gastric lymphoma is relatively rare in the context of gastric malignancies. Synchronous primary gastric lymphoma and hepatocellular carcinoma (HCC) are even rarer. We report a case of synchronous primary gastric lymphoma and HCC in a 46-year-old man that appeared to be associated with hepatitis B virus infection. Pathologic examination and immunohistochemical analysis of gastric and liver specimens showed diffuse large B-cell lymphoma and HCC, respectively. The patient was initially treated for primary gastric lymphoma with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone) chemotherapy. During the chemotherapy interval, he was treated for HCC by transarterial chemoembolization (TACE) and laparoscopy-assisted left hemihepatectomy.

Prediction of compensated liver cirrhosis by ultrasonography and routine blood tests in patients with chronic viral hepatitis / 대한간학회지

BACKGROUND/AIMS: Liver biopsy is a standard method for diagnosis of liver cirrhosis in patients with chronic hepatitis. Because liver biopsy is an invasive method, non-invasive methods have been used for diagnosis of compensated liver cirrhosis in patients with chronic hepatitis. The current study was designed to evaluate the usefulness of ultrasonography and routine blood tests for diagnosis of compensated liver cirrhosis in patients with chronic viral hepatitis. METHODS: Two hundred three patients with chronic viral hepatitis who underwent liver biopsy were included in this study and ultrasonography and routine blood tests were analyzed retrospectively. Ultrasonographic findings, including surface nodularity, parenchyma echogenecity, and spleen size, were evaluated. The diagnostic accuracy of ultrasonography and routine blood tests were examined. RESULTS: Discriminant analysis with forward stepwise selection of variables showed that liver surface nodularity, platelet count, and albumin level were independently associated with compensated liver cirrhosis (p95% specificity: platelet count 1.3; and surface nodularity. If at least one of the four variables exists in a patient with chronic viral hepatitis, we can predict liver cirrhosis with 90% specificity and 61% sensitivity. CONCLUSIONS: These results suggest that four variables (platelet count 1.3, and surface nodularity) can be used for identification of liver cirrhosis in patients with chronic viral hepatitis with high specificity.

Ulnar Neuropathy Combined with Post-Traumatic Conditions of the Elbow / 대한정형외과학회잡지

PURPOSE: We evaluated surgical cases of ulnar neuropathy combined with post-traumatic conditions of the elbow. MATERIALS AND METHODS: Fourteen patients who received ulnar nerve decompression at the cubital tunnel combined with elbow injury were assessed retrospectively. Ulnar nerve showed McGowan grade I in eight patients, grade II-A in one, grade II-B in four and grade III in one. The decompression procedures included nine anterior transpositions, four epicondylectomy, and one in situ decompression. Pain, sensory and motor status were evaluated after a mean follow up of 17.9 months. RESULTS: Symptoms were completely resolved in ten patients and markedly improved in four. Decreased motor function was improved by at least one grade in all patients. Ulnar neuropathy did not compromise flexion exercise in postoperative rehabilitation. CONCLUSION: Development of ulnar neuropathy has close relationships with elbow trauma and its symptoms tend to be underestimated because elbow flexion is frequently limited due to post-traumatic contracture. Proper evaluation and decompression of the ulnar nerve should be considered as one of the factors influencing the clinical result in the management of post-traumatic problems of the elbow.

Component Size Matched Extension Gap Osteotomy for TKRA: A New Concept in Knee Osteotomy for TKRA / 대한정형외과학회잡지

PURPOSE: We designed a new osteotomy technique in order to get a consistent extension gap along with a tibial polyethelene insert in TKRA. The results were compared to the independent osteotomy technique. MATERIAL AND METHODS: Forty two patients were divided into an independent osteotomy group and a linked osteotomy group according to the technique adopted. In the linked osteotomy group, the extension gap was made by using a linker which was designed to provide a consistent gap between the distal femur and the proximal tibia during knee extension. The widths of the extension gap and the polyethylene thickness was compared between the two groups. RESULTS: The extension gap of the independent osteotomy group was 18.1 +/- 4.2 mm (2SD) and that of the linked femorotibial osteotomy group was 20.3 +/- 1.3 mm (2SD). The polyethylene thickness was 8.1 +/- 2.6 mm (2SD) in the independent group and 9.4 +/- 0.9 mm (2SD) in the linked group. CONCLUSION: This linked femorotibial osteotomy technique provided an improved method for obtaining a tibial insert matched extension gap in TKRA. This technique might also increase the longevity of the polyethylene insert.

Arthroscopic Revision ACL Reconstruction

PURPOSE: We analyzed the 11 knees in 11 patients who had arthroscopic revision anterior cruciate liga-ment(ACL) reconstruction and demonstrate the causes of failure of ACL reconstruction and report the clinical result of arthroscopic revision ACL reconstruction. MATERIALS AND METHODS: From March 1997 to April 1999, 11 patients who underwent ACL reconstruction at other hospital had been treated by revision ACL reconstruction. Their mean age at revision was 26.4 years, average time from primary to revision surgery was 26.8 months and average length of follow up was 22 months. We evaluated the results of revision surgery by symptom, Lysholm knee score, physical examination and KT-100 arthrometer. RESULTS: The causes of failure of ACL reconstruction were 8 improper tunnel placements(6 femoral tunnels, 2 tibial tunnels), 2 graft incorporation failure and 1 multiple ligament injury(N=l 1). After revi- sion all patients had improved symptom. There was improvement of average Lysholm knee score from 70 to 87( 2 excellents, 7 goods, 1 fair, 1 poor) with success rate of 82%( 9/11). The data showed decrease of the mean side to side difference from 10.9 mm to 1.7 mm by KT-1000 arthrometer. CONCLUSION: The most common causes of failure of ACL reconstruction were surgical techniques and anatomical tunnel placement was the most important among them.