The Difference between Short and Long Intramedullary Nailing as the Treatment for Unstable Intertrochanteric Femoral Fracture (AO/OTA 31-A2) in Elderly Patients / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to analyze the radiological and clinical outcomes in elderly patients with unstable intertrochanteric femur fractures in accordance with the length of intramedullary nail. MATERIALS AND METHODS: Between August 2009 and December 2014, a total of 139 patients–older than 65 years of age with AO/OTA classification of 31-A2 unstable intertrochanteric femur fracture–who has been followed-up for at least 1 year after the treatment with internal fixation by using an intramedullary nail were enrolled for this retrospective control study. The subjects were classified into two groups according to the length of intramedullary nail: 106 patients in the short group (group I) and 33 patients in the long group (group II). For radiological assessments, the reduction state, time to union, and implant related complications were examined. The clinical outcomes were assessed by preoperative hemoglobin, operating time, intraoperative bleeding amount, blood transfusion rate, hospitalization period, and Charnley hip pain scoring system at the final follow-up. RESULTS: The postoperative radiographs showed good or acceptable reduction in all cases. The mean time of radiologic bone union was 4.8 months, and there was no difference between the two groups. With respect to surgical time, the group II was found to take longer (57.87 minutes) than the group I (45.65 minutes) (p=0.003). The bleeding amount during surgery of the group II was greater (288.78 ml) than that of the group I (209.90 ml) (p=0.046). The clinical results at the final follow-up were found to be satisfactory in both groups. CONCLUSION: In cases of good reduction of the fracture from the treatment of unstable intertrochanteric femur fracture accompanying the posteromedial fragment in elderly patients, both groups–long and short intramedullary nails–showed satisfactory radiological and clinical outcomes.

Placental expression of D6 decoy receptor in preeclampsia

OBJECTIVE: The purpose of this study was to investigate the expression of the D6 decoy receptor that can bind chemokines and target them for degradation, resulting in inhibition of inflammation in placentas from preeclamptic and normal pregnancies. METHODS: The current study was carried out in 35 pregnant women (23 patients with preeclampsia and 12 healthy, normotensive pregnant women) during the third trimester of pregnancy. The expressions of D6 decoy receptor in the placenta were determined with real time reverse transcriptase polymerase chain reaction and western blotting. RESULTS: The mRNA and protein of D6 decoy receptor were detected in all of placentas from preeclamptic and normal pregnancies. Placental D6 decoy receptor mRNA expression was significantly lower in patients with preeclampsia than in patients with normal pregnancies. Western blot analyses revealed decreased protein expression in cases of preeclampsia. CONCLUSION: The expression of the D6 decoy receptor in preeclamptic placentas was significantly lower than in normal placentas. Further studies are needed to clarify the underlying mechanisms that link decreased expression of placental D6 decoy receptor and preeclampsia.

A case of chronic myeloid leukemia with features of essential thrombocythemia in peripheral blood and bone marrow

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm characterized by overproduction of myeloid white blood cells. Philadelphia chromosome is an essential finding for CML diagnosis. Generally, a clinical diagnosis of essential thrombocythemia (ET) can be established from isolated marked thrombocytosis in peripheral blood. However, Philadelphia chromosome-positivity or bcr/abl rearrangement with isolated thrombocytosis should be diagnosed as CML, not ET, according to World Health Organization diagnostic criteria. Therefore, CML should not be excluded before confirming the presence of the Philadelphia chromosome or bcr/abl rearrangement in cases of isolated thrombocytosis in peripheral blood. We report a case of CML with clinical features of ET in a patient successfully treated with imatinib.

Endoscopic Treatment of a Symptomatic Ileal Lipoma with Recurrent Ileocolic Intussusceptions by Using Cap-Assisted Colonoscopy

A 73-year-old woman presented with intermittent abdominal pain and weight loss of 15 kg for 2 years. Colonoscopy revealed an erythematous polypoid tumor with a long and wide stalk in the cecum, but with air inflation, it abruptly went away through the ileocecal valve (ICV). An abdominal computed tomography showed a well-demarcated pedunculated subepithelial mass of 2.6x2.7 cm size with fat attenuation in the terminal ileum. It was an intussusceptum of the ileal lipoma through the ICV. This ileal lipoma was causing her symptoms because repeated ileocolic intussusceptions resulted in intermittent intestinal obstructions. In order to avoid surgical sequelae of ileal resection, snare polypectomy using cap-assisted colonoscopy technique was performed within the ileum without complications. The histopathology report confirmed it as a subepithelial lipoma. After endoscopic resection of the ileal lipoma, the patient has been free of symptoms and was restored to the original weight.

A Case of Peritoneal Tuberculosis Developed after Infliximab Therapy for Refractory RA / 결핵및호흡기질환

Recently, interferon gamma releasing assay has been recommended to compensate the tuberculin skin test (TST) for screening for latent tuberculosis infection (LTBI). Although it improved the detection of LTBI before treatment with tumor necrosis factor blocker, its application to immune suppressed patients is limited. We report a case of peritoneal tuberculosis (TB) developed in a patient who tested positive for TST and QuantiFERON-TB Gold (QFT-G) before infliximab therapy, to emphasize the importance of monitoring during treatment. A 52-year-old woman presented with abdominal distension. She had been diagnosed with seropositive rheumatoid arthritis six years ago. She had started taking infliximab six months ago. All screening tests for TB were performed and the results of all were negative. At admission, the results of repeated TST and QFT-G tests were positive. Histopathological examination confirmed peritoneal TB. The patient started anti-TB therapy and the symptoms were relieved.

A Case of Dengue Fever with Maculopathy / 감염과화학요법

Dengue fever is transmitted principally by Aedes aegypti, which is not infested in Korea. Therefore, all Korean patients with dengue fever are imported cases from endemic areas such as Southeast Asia. Although disease manifestation and complication of dengue fever are various, ocular involvement is rare. We encountered a patient infected with dengue virus, imported from the Philippines. After defervescence from dengue fever, he complained of blurred vision. Blot hemorrhage with retinal infiltration in the macular area was observed in both eyes. Maculopathy by dengue fever was treated with systemic and intraocular glucocorticoid for two weeks; his ocular condition then showed improvement.

The Levels of Circulating Vascular Endothelial Growth Factor and Soluble Flt-1 in Pregnancies Complicated by Preeclampsia

To evaluate the role of vascular endothelial growth factor (VEGF) in the pathogenesis of preeclampsia, we measured total VEGF, free VEGF and soluble Flt-1 (sFlt-1) concentrations and determined their relationships. Maternal serum samples were collected from 20 patients with preeclampsia and 20 normotensive women with uncomplicated pregnancies matched with the patients with preeclampsia for gestational age and parity. The serum concentrations of total VEGF (2.39+/-0.75 vs. 0.28+/-0.14) and sFlt-1 (934.5+/-235.5 vs. 298.0+/-161.2) were significantly increased in the patients with preeclampsia compared to the women with uncomplicated pregnancies. However the serum concentration of free VEGF (21.5+/-6.3 vs. 134.0+/-16.3) was lower in patients with preeclampsia. There was a positive correlation between the serum concentrations of total VEGF and sFlt-1 with systolic and diastolic blood pressure, respectively. There was a negative correlation between the serum concentration of free VEGF and systolic and diastolic blood pressure. There was a strong negative correlation between free VEGF and sFlt-1 concentrations. In conclusion, we found VEGF and sFlt-1 were related to the pathogenesis of preeclampsia. Although reduced concentrations of free VEGF might interfere with endothelial cell function and survival, further studies are required to clarify its specific role in the pathogenesis of preeclampsia.

Prenatal Diagnosis of Cystic Hygroma at Axillar / 대한주산의학회잡지

Fetal cystic hygroma is a congenital malformation of the lymphatic system resulting from the jugular-lymphatic obstruction sequence. This is characterized by single or multiple cysts within the soft tissues, usually involving the neck and is easily diagnosed by prenatal ultrasonography. We report a case of axillary cystic hygroma which was diagnosed by ultrasonography at 25 weeks of gestation with a brief review of related literatures.

A Fetus with Persistent Hyperextended Neck Complicated with Ventriculomegaly and Pulmonary Immaturity in Third Trimester / 대한주산의학회잡지

Hyperextended neck of the fetal head is among the various fetal attitudes detected by prenatal sonography. Various etiologies may lead to hyperextension of the fetal head, including fetal anomalies such as structural abnormalities, conjoined twins and fetal neck masses, nuchal cord and uterine factors such as leiomyoma and uterine malformations. The importance of the precise prenatal diagnosis of this condition relates not only to the delivery mode, but also to the detection of associated conditions, as noted above. We report a case of a fetus whose persistent hyperextended neck was detected by midtrimester sonography, and who later demonstrated ventriculomegaly and lung immaturity in the 3rd trimester.

A case of Listeriosis in early third trimester pregnant woman / 대한산부인과학회지

Although listeria monocytogenes is widely distributed in nature, it rarely causes clinical infection in previously healthy people. However, this microorganism may cause severe infectious disease in pregnant women and newborns due to impaired cell-mediated immunity. Various clinical symptoms have been described such as sepsis, central nervous system infections, endocarditis, gastroenteritis and localized infections. A clinical presentation of listeriosis in an early third trimester pregnant woman and in a preterm infant is emphasized in addition to taking a careful patient history, early empirical administration of antibiotics, aggressive ventilation therapy and also pharmacological support.

Positive Margins after Cervical Conization and the Predictive Factors of Residual Disease / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the predictive factors of residual disease for positive conization margins. METHODS: Retrospective study was performed in 735 patients treated with bovie electroknife conization at the University Hospital of Kuro between January, 1988 and December, 2003. Of the 735 patients, 81 patients (11.0%) had positive margins after conization. 58 of these 81 patients underwent either immediate reoperation or monitoring with a Pap smear, HPV test, endocervical curettage and colposcopy. Fisher exact test, Trend test were used for statistical analysis. RESULTS: The mean age of the patients was 44.5 years. 27 of 58 patients (46.6%) undergoing conization followed by reoperation had residual lesion in the specimen obtained by reoperation. Severity of lesion was associated with the predictive factors of residual disease (p<0.05). Age of patients, site of resection margins were not associated with the predictive factors of residual disease. But more sufficient number of cases of Pap smear, HPV test, endocervical curettage and colposcopy directed biopsy are thought to be needed for stastistical analysis. CONCLUSION: Severity of lesion is useful in predicting residual disease for positive conization margins.