Four Cases of Polyarteritis Nodosa Presenting Initially as Pain and Pitting Edema in Both Lower Extremities

Polyarteritis nodosa (PAN) has a broad spectrum of clinical presentation, since it affects small and medium-sized muscular arteries with microaneurysm formation, aneurysmal rupture with hemorrhage, thrombosis, and, consequently, organ ischemia or infarction. Although skeletal muscle involvement is well documented in patients with PAN, it can mimic more common diseases, and cause confusion and delays in diagnosis. PAN muscular involvement may have limited or early systemic forms with a benign course and excellent clinical response to corticosteroid therapy. Herein, we describe the clinical course and outcome of four unusual cases of PAN manifested by acute onset of pain and pitting edema in both lower extremities; in addition, we reviewed the relevant literature.

Lupus-like Glomerulonephritis Associated with Extranodal Marginal Zone B-cell Lymphoma of MALT / 대한내과학회지

Lupus-like glomerulonephritis is an immune complex disease with features of lupus nephritis in the absence of systemic lupus erythematosus (SLE). We report a 49-year-old man diagnosed with lupus-like glomerulonephritis associated with extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT). He was admitted to the hospital for edema. At admission, the serum creatinine was 2.2 mg/dL and the urine protein level was 3.9 mg/day. A renal biopsy showed features of lupus nephritis with no clinical or serological evidence of SLE. Extranodal marginal zone B-cell lymphoma of MALT was discovered concurrently. After successful chemotherapy, the lupus-like glomerulonephritis and lymphoma entered complete remission.

Spontaneous Thymic Cyst Hemorrhage Manifesting as a Mediastinal Mass / 대한내과학회지

Thymic cysts are uncommon benign lesions in the anterior mediastinum. We here describe a 55-year-old male with spontaneous thymic cyst hemorrhage manifesting as a rapidly enlarging mediastinal mass that was resected completely with video-assisted thoracoscopic surgery. To the best of our knowledge, this is the first report of a spontaneous thymic cyst hemorrhage in Korea. In cases of rapidly enlarging mediastinal masses, spontaneous thymic cyst hemorrhage should be considered as a differential diagnosis.

Ligamentum Teres Injuries of the Hip / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to identify functions of ligamentum teres during multi-planar movement of the hip joint and to evaluate the correlation between arthroscopic findings and preoperative magnetic resonance imaging (MRI) of ligamentum teres rupture. MATERIALS AND METHODS: With four fresh-frozen cadavers that were dissected for removal of all soft tissue from around the hip, leaving only the ligamentum teres intact, tension of ligamentum teres at each position of the hip during multiplanar movement of the hip joint was identified. Among patients who underwent arthroscopic treatment for hip joint lesion from June 2006 to December 2012, arthroscopic findings of 26 patients who showed ligamentum teres rupture on arthroscopy were compared retrospectively with finding of preoperative MRI and visual analogue scale pain score and modified Harris hip score preoperatively and at final follow-up were evaluated. RESULTS: The ligamentum teres was maximal taut at flexion with external rotation. Ligamentum teres rupture was suspected according to preoperative MRI in 20 cases (76.9%). All cases underwent arthroscopic debridement and thermal shrinkage for the ruptured ligamentum teres. At final follow-up, visual analogue scale pain score and modified Harris hip score had improved from 6.1 (4-9) and 63.7 (36.3-86.9) to 2.0 (0-5) and 88.4 (72.6-100), respectively (all p<0.001). CONCLUSION: The ligamentum teres is maximal taut at flexion with external rotation and contributes to internal stability. Ruptured ligamentum teres should be treated by arthroscopic debridement and thermal shrinkage.

Recovery of Limitation of Motion in Secondary Osteoarthritis of the Hip Using Arthroscopy / 대한고관절학회지

PURPOSE: To analyze the arthroscopic findings and treatment results of patients with a limitation of hip motion caused by early degenerative osteoarthritis. MATERIALS AND METHODS: Retrospective analysis was performed on 13 patients who underwent arthroscopic treatment from May 2009 to March 2010, among patients with a limitation of hip motion and femoroacetabular impingement symptoms by early degenerative osteoarthritis. Head-neck offset, anteversion, and a change in the alpha angle was compared. At the final follow up, the VAS (Visual analogue scale), modified Harris hip score, and range of motion were compared. RESULTS: The arthroscopic findings showed diffused synovitis in all 13 cases. Among them, 9 cases were accompanied with a labral tear, and 2 cases showed a labral deformity. The VAS decreased from 7.5 preoperatively to 1.8 postoperatively and the modified Harris hip score improved from 49.3(35-60) before surgery to 90.1(85-95) after surgery. Each flexion and internal rotation improved significantly (P<0.05) from 95.2degrees (60-120degrees) to 127.7degrees (110-140degrees) and 4.6degrees (-5-25degrees) to 25.4degrees (15-30degrees), respectively. CONCLUSION: This study shows that the arthroscopic treatment of femoroacetabular impingement with a limitation of the range of motion by early degenerative arthritis can be expected with an improvement in flexion and internal rotation of the hip.

Periprosthetic Mass after Total Hip Replacement / 대한고관절학회지

PURPOSE: To analyze the characteristics and causes of periprosthetic huge mass which occur after treatment by total hip arthroplasty. MATERIALS AND METHODS: Of the patients who had undergone total hip arthroplasty from January 2000 to October 2007, we retrospectively evaluated the 10 patients who suffered huge soft tissue mass. Five of these patients had received metal-on-metal bearing (group 1) prostheses, and the other 5 had received metal-on-polyethylene bearings (group 2). We evaluated the size and location of the mass, the extent of osteolysis, and the hematologic and pathologic examination results. RESULTS: Roentgenographically, the location of the masses varied from the acetabular area to the distal femoral stem. The mean mass diameter of all 10 patients was 14.6 cm(7-21 cm)x6.2 cm(3-9 cm)x7.2 cm(4-12 cm). Osteolytic lesions were found in 3 group 1 patients and 3 patients in group 2. High counts of lymphocytes and eosinophils were present in group 1. High counts of macrophages were present in group 2. CONCLUSION: The occurrence of osteolysis and huge soft mass after total hip arthroplasty is thought to be related to foreign body reaction by polyethylene wear particles and metal hypersensitivity. Outside-in patterned cortical thinning was considered to be indicative of a long standing periprosthetic soft tissue mass effect.

Pathologic Fracture of Femoral Neck due to Mass suspicious of Gossypiboma in Proximal Thigh: Case Report

Gossypiboma is the foreign body granuloma that's due to retained surgical gauze after an operation. The reports of gossypiboma are not infrequent after thoracic, abdominal and pelvic operation, but they are rare after operation on the extremities. Some patients with gossypiboma may remain asymptomatic for several months or several years, but others experience complications such as abscess formation, chronically infectious fistulae formation, neighboring bone erosion and vessel occlusion and sepsis; physicians may suffer some serious legal problems if they are responsible for this condition. We experienced the gossypiboma that developed in the proximal thigh; a 60 year-old patient experienced pathologic fracture of the femoral neck due to this gossypiboma.