Degeneration of Leiomyoma in Patients Referred for Uterine Fibroid Embolization: Incidence, Imaging Features and Clinical Characteristics

PURPOSE: Imaging features and clinical characteristics of degenerated leiomyoma in patients referred for uterine fibroid embolization (UFE) were analyzed to assess the incidence of degenerated leiomyoma. MATERIALS AND METHODS: Patients referred for UFE between 2008 and 2009 were retrospectively analyzed (n=276). Patients ranged in age from 27 to 51 years (mean 38.0 years). All patients underwent screening MRI with contrast enhancement. Medical histories and clinical symptoms were evaluated. RESULTS: Among the 276 patients who underwent MRI, 14 (5.1%) showed degenerated leiomyomas. Symptoms were abdominal pain (n=4, 26.7%), menorrhagia (n=5, 35.7%) and bulk-related symptoms (n=5, 35.7%) and no symptoms (n=5, 35.7%). Of the 14 patients with degenerated leiomyomas, 5 (42.9%) had a history of pregnancy in the past two years. For T1-weighted imaging (T1WI), a high signal intensity (SI) of the leiomyoma was the most common finding (n=9, 64.3%) and a hyperintense rim (n=4, 28.6%) was the second most common. On T2-weighted imaging (T2WI), a low SI of the leiomyoma was found in six patients (42.9%), a high SI in four (28.6%) and a heterogeneous SI in four (28.6%) patients. Conservative management was performed in 11 (78.6%) patients, surgery in 3 (21.4%) and uterine artery embolization in one (7.1%) patient. CONCLUSION: The incidence of degeneration of leiomyoma in patients referred for UFE was 5.1%. Patients presented with variable clinical symptoms with or without a history of pregnancy. MR imaging showed a high SI on T1WI and various SIs on T2WI without contrast enhancement. An understanding of the degeneration of leiomyomata is essential when considering UFE.

Screw Fixation Techniques for Talar Neck Fractures (Anterior versus Posterior insertion) / 대한족부족관절학회지

PURPOSE: To compare the clinical and radiological results between the anterior and posterior screw fixation for the treatment of talar neck fracture. MATERIALS AND METHODS: Among 30 patients who received surgical treatment for talar neck fracture from 2001 to 2008. Twenty-seven patients with a follow-up period of more than 1 year were divided into two groups. Twelve patients were treated with anterior screw fixation and 15 patients with posterior approaches. We analyzed preoperative, postoperative and follow-up radiographs. Clinical results were evaluated by Hawkins criteria. RESULTS: The posteriorly inserted screws were placed across the more central portion of the talar neck and perpendicular to the plane of fracture (p<0.05). There were no difference in clinical results, the duration of union, and complications including avascular necrosis between two groups. However, 2 patients complained of pain around the talonavicular joint in the anterior insertion group. CONCLUSION: Although the clinical results were good irrespective of insertion methods, the posterior approach of screw fixation for talar neck fractures allows for a better mechanical advantage than anterioly placed screws. This may allow early motion with a reduced risk of failure of fixation or of displacement of the fracture.

Percutaneous Retrograde Intramedullary Pin Fixation for Isolated Metacarpal Shaft Fracture of the Little Finger

PURPOSE: To evaluate the anatomic and functional outcome of retrograde intramedullary single wire fixation for metacarpal shaft fractures of the little finger. MATERIALS AND METHODS: hirty one consecutive patients with closed metacarpal shaft fractures of the little finger who have been treated with retrograde intramedullary single wire fixation were evaluated. Fracture union and angulation were analyzed radiologically, and clinical evaluations were performed including range of motion, DASH score and complications. RESULTS: Fracture union was achieved in all cases and callus formation was obvious at postoperative 41 days. Average angulation of fracture site was 3degrees in the coronal plane and 1.2degrees in the sagittal plane at the last follow up and no measurable metacarpal shortening was observed. Mean TAM was 253degrees and DASH score was 2.6. There were two cases of pin migration as intermediate complications. CONCLUSION: Closed reduction with subsequent percutaneous retrograde K-wire fixation produced good radiological and functional results. We recommend this minimally invasive technique which provides adequate fixation of displaced little finger metacarpal shaft fractures with good functional results and low morbidity.

The Relationship between Limb-Length Discrepancy on Function, Dislocation, Pain and Acetabular Wear after Bipolar Hemiarthroplasty for Femoral Neck Fracture

PURPOSE: To evaluate the relationship between a limb-length discrepancy and the clinical and radiological outcomes after bipolar hemiarthroplasty for femur neck fractures in elderly patients. MATERIALS AND METHODS: Between August 2004 and January 2007, 60 out of 80 cases over 65 years who underwent cemented bipolar hemiarthroplasty for femur neck fractures with a more than 2 years follow-up were evaluated retrospectively by dividing the patients into two groups, > 5 mm (group 1) and 0.05). CONCLUSION: Limb-lengthening by hemiarthroplasty may be a cause of pain but with little effect on the overall functional outcome.

Short Term Results of Cementless Total Hip Arthroplasty with Using a Accolade TMZF Femoral Stem

PURPOSE: We wanted to evaluate the short term clinical and radiological results and the complications of primary total hip arthroplasty with using a Accolade TMZF femoral stem. MATERIALS AND METHODS: 66 cases among 80 cases underwent total hip arthroplasty by one surgeon with using an Accolade TMZF femur stem from January 2002 to August 2006. The minimum follow-up was 30 months and we retrospectively analyzed these 66 patients. RESULTS: The mean Harris Hip Score improved from 54 to 92 at the last follow up. On the last follow-up X-ray, all the femoral stems (100%) showed stable fixation and there was no osteolysis or loosening, but there were 34 cases of stress shields and 20 cases of cortical hypertrophy. The acetabular component revealed stable fixation in 65 cases (98.5%) and loosening in one case (1.5%). There was no acetabular osteolysis, but 22 cases of radiolucency were observed in the Dee Lee and Charnley zone II. As complications, there were 5 cases of heterotrophic ossification, 1 case of greater trochanteric bursitis, 2 cases of thigh pain and 1 case with a squeaking sound. CONCLUSION: Primary total hip arthroplasty using a cementless Accolade TMZF femoral stem showed good results in the short term, but long term follow up is needed.

The Analysis of the Clinical Characteristics and Prognosis of Vibrio Vulnificus Septicemia

PURPOSE: Vibrio vulnificus, one of the most invasive and rapidly fatal human pathogens known is a free-living inhabitant of estuarine and marine environments throughout the world. Vibrio septicemia usually present with a sudden onset of fever, chills, vomiting, diarrhea, abdominal pain, pain in the extremities, and cutaneous lesions. There are many microbiologic studies of V. vulnificus, but few clinical and prognostic studies are reported. We performed a study in 81 clinically suspected V. vulnificus cases to analyze the clinical characteristics of and the prognosis for V. vulnificus septicemia. METHODS: The study included 81 clinically suspected cases V. vulnificus septicemia at the emergency department from 1997 to 2003. We retrospectively analyzed the clinical features and the laboratory data, and measured the simplified acute physiologic score (SAPS II). RESULTS: The overall fatality was 39.5%. The monthly incidence was high in July and August. Almost all cases were primary septicemia (92.6%). Many patients had underlying disease; such as liver disease (66.6%), and diabetes mellitus (18.5%). Alcohol drinking habits were observed in 61.7% of the cases. There were significant difference between non-survivors and survivors in the extent of skin manifestations, respiration rate, leukocyte count, platelet count, albumin, PT, PTT, creatinine, pH, HCO(3-), and SAPS II. CONCLUSION: The platelet count, PT, PTT, creatinine, pH, H CO3-, the leukocyte count, albumin, SAPS II, and the extent of skin manifestations can be used as severity indicators in V. vulnificus septicemia. Especially, the SAPS II on hospital day 2 and the extent of skin manifestations can be used as prognostic factors.

A Case of an Aortic Arch Aneurysm in which a Fistula Formed Between the Pulmonary Parenchyma

Massive hemoptysis represents a major medical emergency that is associated with high mortality. The causes of hemoptysis are various and include pulmonary and cardiovascular disorders and trauma. The causes of pulmonary disorder are tuberculosis, bronchiectasis, abscess, malignancy, bronchitis, and fungal infection. The causes of cardiovascular disorder are mitral stenosis, pulmonary embolism, and congestive heart failure. A fistula between an aortic aneurysm and the pulmonary parenchyma is one of the causes of hemoptysis, but it is a rare. However, if undiagnosed, it is a uniformly fatal cause of massive hemoptysis. This is a case of bleeding from a fistula between an aortic arch aneurysm and a lung parenchyma in a patient with an aortic arch aneurysm who presented with massive hemoptysis. He had suffered intermittent hemoptysis since he was diagnosed with an aortic arch aneurysm three years before. A high clinical suspicion must be maintained when a history of intermittent hemoptysis is obtained in patients with an aortic aneurysm or prior aortic graft surgery.