ABSTRACT
The rate of malignant transformation in porokeratosis (PK) lesions is approximately 7.5%, and linear PK demonstrates the highest rate of malignancy. An 83-year-old woman presented with a rapidly enlarging mass on her left arm. Variably sized erythematous scaly patches were scattered across the left half of her trunk and arm. Additionally, generalized variably sized brownish annular patches with a hyperkeratotic outer ring were observed on her face, trunk and bilateral arms. A skin biopsy was performed on 3 lesions-a yellowish to erythematous appearing mass, an erythematous scaly patch, and a brownish annular patch. Histopathological evaluation of these 3 lesions revealed squamous cell carcinoma, actinic keratosis, and PK, respectively. The final diagnosis was disseminated superficial PK with linear PK on the left side of the body, and actinic keratosis and squamous cell carcinoma confined to the linear PK lesions. We report a case which represents the progressive and stepwise malignant transformation of PK into squamous cell carcinoma.
Subject(s)
Aged, 80 and over , Female , Humans , Arm , Biopsy , Carcinoma, Squamous Cell , Diagnosis , Keratosis, Actinic , Porokeratosis , SkinABSTRACT
No abstract available.
Subject(s)
Lupus Erythematosus, Systemic , Sarcoidosis , Thyroiditis, AutoimmuneABSTRACT
BACKGROUND: The aim of study was to confirm the clinical effectiveness and results of wide and single anterior approach for fractures occurring along length of humerus. METHODS: A total of 23 patients with humeral fracture were enrolled into our study who were able to participate in at least one year of follow-up. Seven patients had segmental comminuted humeral fractures and 16 patients had distal humeral fractures. We made various tractions of the muscles to expose the proximal and the middle third humerus between the biceps and brachialis and the distal humerus by partial splitting of lateral side of biceps through a single incision. Postoperatively, we measured the Mayo elbow performance index (MEPI). RESULTS: we achieved bone union in all 23 patients. Solid union of the bone was achieved at an average 13.9 weeks. Postoperatively, two complications were observed screw loosening and nonunion. Revision surgery was performed in both patients. The patient with bone nonunion was treated using bone grafts. No postoperative infections or peripheral neuropathies were observed. At the final follow-up (average 20 months), we found that the average MEPI functional score of the patients was 91.7 points regardless of the fracture site. CONCLUSIONS: Our whole humerus with a single incision was effective for the treatment of segmental comminuted and distal fractures. we believe it is a useful alternative to preexisting methods of fracture fixation.
Subject(s)
Humans , Elbow , Follow-Up Studies , Fracture Fixation , Humeral Fractures , Humerus , Muscles , Peripheral Nervous System Diseases , Traction , Transplants , Treatment OutcomeABSTRACT
Acute generalized exanthematous pustulosis (AGEP) is a rare disorder characterized by acute onset of erythematous and edematous eruptions with sterile pustules, accompanied by fever, and a self-limiting condition thought to be caused by drugs, in particular, antibiotics. Drug-related rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe adverse drug-induced reaction, characterized by a generalized skin rash associated with hypereosinophilia, lymphocytosis, and internal organ involvement. These reactions differ in causative agents, as well as clinical presentation, prognosis, and treatment. Therefore, appropriate diagnostic measures should be rapidly undertaken. Herein, we described a patient who developed overlapping features of hypersensitivity syndromes, AGEP and DRESS, with the use of piperacillin and the beta-lactamase inhibitor sodium tazobactam. Coexistence of AGEP and DRESS in the same patient is quite rare. To the best of our knowledge, there have been no previous reports on the coexistence of AGEP and DRESS associated with piperacillin/tazobactam.
Subject(s)
Humans , Acute Generalized Exanthematous Pustulosis , Anti-Bacterial Agents , beta-Lactamases , Drug Hypersensitivity Syndrome , Eosinophilia , Exanthema , Fever , Hypersensitivity , Lymphocytosis , Piperacillin , Prognosis , SodiumABSTRACT
BACKGROUND: The aim of study was to confirm the clinical effectiveness and results of wide and single anterior approach for fractures occurring along length of humerus. METHODS: A total of 23 patients with humeral fracture were enrolled into our study who were able to participate in at least one year of follow-up. Seven patients had segmental comminuted humeral fractures and 16 patients had distal humeral fractures. We made various tractions of the muscles to expose the proximal and the middle third humerus between the biceps and brachialis and the distal humerus by partial splitting of lateral side of biceps through a single incision. Postoperatively, we measured the Mayo elbow performance index (MEPI). RESULTS: we achieved bone union in all 23 patients. Solid union of the bone was achieved at an average 13.9 weeks. Postoperatively, two complications were observed screw loosening and nonunion. Revision surgery was performed in both patients. The patient with bone nonunion was treated using bone grafts. No postoperative infections or peripheral neuropathies were observed. At the final follow-up (average 20 months), we found that the average MEPI functional score of the patients was 91.7 points regardless of the fracture site. CONCLUSIONS: Our whole humerus with a single incision was effective for the treatment of segmental comminuted and distal fractures. we believe it is a useful alternative to preexisting methods of fracture fixation.
Subject(s)
Humans , Elbow , Follow-Up Studies , Fracture Fixation , Humeral Fractures , Humerus , Muscles , Peripheral Nervous System Diseases , Traction , Transplants , Treatment OutcomeABSTRACT
BACKGROUND: The purpose of this study was to evaluate whether physicians' practice was adequate for the diagnosis and treatment of osteoporosis in patients with proximal humeral fracture over the age of 50 years, which is one of major osteoporotic fractures. METHODS: A retrospective nation-wide cohort study was performed using data collected in 2010 by the Korean Health Insurance Review Agency. The incidences of fractures around the hip, spine, and proximal humerus in patients more than 50 years of age, the frequencies of diagnostic bone density scan for osteoporosis, and the prescription for the osteoporosis medication were analyzed and compared. RESULTS: A search of database identified 48,351 hip fractures, 141,208 spine fractures, and 11,609 proximal humeral fractures in patients more than 50 years of age in 2010. Among these patients, 12,097 (25.0%) of hip fractures, 41,962 (29.7%) of spine fractures, and 1,458 (12.6%) of proximal humeral fractures underwent diagnostic bone density scan (p < 0.001); 4,773 (9.9%) of hip fractures, 27,261 (19.3%) of spine fractures, and 639 (5.5%) of proximal humeral fractures were managed with at least one medication approved for the treatment of osteoporosis (p < 0.001). Furthermore, 1,217 (2.5%) of hip fractures, 7,271 (5.2%) of spine fractures, and 188 (1.6%) of proximal humeral fractures received diagnostic bone density scans as well as osteoporosis medications (p < 0.001). Younger patients (50–69 years of age) were less likely to be evaluated and managed for osteoporosis relative to older patients (≥ 70 years of age) (p < 0.001); and men were less likely to be evaluated and managed for osteoporosis relative to women (p < 0.001). CONCLUSIONS: Current physicians' practice pattern may be inadequate for the diagnosis and treatment of osteoporosis in patients of proximal humeral fractures over the age of 50 years. Additional study and educational programs are necessary to improve this care gap, beginning with physicians who are responsible for the fracture treatment and shoulder diseases.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Bone Density , Bone Density Conservation Agents/therapeutic use , Osteoporosis/complications , Retrospective Studies , Shoulder Fractures/complicationsABSTRACT
Pigmented villonodular synovitis (PVNS) is a slowly, progressive, proliferative disorder of synovial tissue characterized by villous or nodular changes of synovial-lined joints, bursae, and tendon sheaths and most frequently affects the large joints, with the knee and hip. A few studies have been reported that occurred PVNS in small joint, but mainly in hands. It is a very rare condition that occurs in the small joints of the forefoot. We have experienced the case, which developed in small joint of the forefoot, and performed total synovectomy. After the operation, there was no recurrence. We report a case of PVNS in forefoot with a review of the literature.
Subject(s)
Hand , Hip , Joints , Knee , Recurrence , Synovitis, Pigmented Villonodular , TendonsABSTRACT
PURPOSE: We attempted to determine the degree of rotation of the femoral component to achieve an ideal rectangular flexion gap with minimal medial collateral ligament (MCL) release using a modified measured technique. MATERIALS AND METHODS: Group I consisted of 60 osteoarthritis patients (72 cases) who underwent total knee arthroplasty (TKA) with minimal MCL release and Group II consisted of 48 patients without osteoarthritis (61 cases). We performed computed tomography (CT) scanning of the knee with 90 degree flexion in all of the patients and analyzed the angles between the distal femur landmarks and the tibial mechanical axis using a Picture Archiving Communication system. External rotation of the femoral component from the Whiteside line and posterior condylar line was measured in group I who underwent TKA with minimum MCL release. The variance in the mediolateral flexion gap according to the degree of rotation was also measured using an Auto-Computer Aided Design program. RESULTS: The CT scans showed that the Whiteside line, posterior condylar line, and transepicondylar line was more internally rotated on average from the longitudinal axis of tibia by 4.12degrees, 5.54degrees, and 4.64degrees, respectively, in group I compared to group II. In group I, the femoral component was inserted with an average external rotation of 5.6degrees from the posterior condylar line and with an average external rotation of 2.0degrees from the Whiteside line with minimal MCL release. From the measurements of the femoral component size and the variance in the degree of rotation using an Auto-CAD program, it was found that the change in the mediolateral flexion gap was greater when the rotation angle was greater and it was greater when the size of femoral component was larger at the same rotation angle. CONCLUSIONS: The average rotation angle of the femoral component to achieve an ideal rectangular flexion gap with minimal MCL release in TKA was an external rotation of 5.6degrees from the posterior condylar line and an external rotation of 2.0degrees from the Whiteside line. We concluded that when a femoral component is small in size, greater than average external rotation needs to be applied and when a femoral component is large in size, less than average external rotation needs to be applied.
Subject(s)
Humans , Arthroplasty , Axis, Cervical Vertebra , Collateral Ligaments , Femur , Knee , Osteoarthritis , TibiaABSTRACT
Research advances in dental implantology have led to the development of several different types of materials and it is anticipated that continued research will lead to advanced dental implant materials. Currently used pure titanium has relatively low hardness and strength which may limit its ability to resist functional loads as a dental implant. Ti-6Al-4V also has potential problems such as corrosion resistance, osseointegration properties and neurologic disorder due to aluminium and vanadium, known as highly toxic elements, contained in Ti-6Al-4V. Newly developed titanium based alloys (Ti-20Zr-3Nb-3Ta-0.2Pd-1In, Ti-20Zr-3Nb-3Ta-0.2Pd) which do not contain toxic metallic components were designed by the Korea Institute of Science and Technology(KIST) with alloy design techniques using Zr, Nb, Ta, Pd, and In which are known as non-toxic elements. Biocompatibility and osseointegration properties of these newly designed alloys were evaluated after implantation in rabbit femur for 3 months. The conclusions were as follows: 1. Mechanical properties of the new designed Ti based alloys(Ti-20Zr-3Nb -3Ta-0.2Pd-1In, Ti-20Zr-3Nb-3Ta-0.2Pd) demonstrated close hardness and tensile strength values to Ti-6Al-4V. 2. New desinged experimental alloys showed stable corrosion resistance similar to the pure Ti but better than Ti-6Al-4V. However, the corrosion rate was higher for the new alloys. 3. Cell culture test showed that the new alloys have similar cell response compared with pure Ti and Ti-6Al-4V with no cell adverse reaction. 4. New designed alloys showed similar bone-metal contact ratio and osseointegration properties compared to pure Ti and Ti-6Al-4V after 3 months implantation in rabbit femur. 5. Four different surface treatments of the metals did not show any statistical difference of the cell growth and bone-metal contact ratio.