Misdiagnosis of Talar Body or Neck Fractures as Ankle Sprains in Low Energy Traumas

BACKGROUND: The talus has a very complex anatomical morphology and is mainly fractured by a major force caused by a fall or a traffic accident. Therefore, a talus fracture is not common. However, many recent reports have shown that minor injuries, such as sprains and slips during sports activities, can induce a talar fracture especially in the lateral or posterior process. Still, fractures to the main parts of the talus (neck and body) after ankle sprains have not been reported as occult fractures. METHODS: Of the total 102 cases from January 2005 to December 2012, 7 patients had confirmed cases of missed/delayed diagnosis of a talus body or neck fracture and were included in the study population. If available, medical records, X-rays, computed tomography scans, and magnetic resonance imaging of the confirmed cases were retrospectively reviewed and analyzed. RESULTS: In the 7-patient population, there were 3 talar neck fractures and 4 talar body fractures (coronal shearing type). The mechanisms of injuries were all low energy trauma episodes. The causes of the injuries included twisting of the ankle during climbing (n = 2), jumping to the ground from a 1-m high wall (n = 2), and twisting of the ankle during daily activities (n = 3). CONCLUSIONS: A talar body fracture and a talar neck fracture should be considered in the differential diagnosis of patients with acute and chronic ankle pain after a minor ankle injury.

A Case with Severe Bone Disease Due to Primary Hyperparathyroidism Caused by Parathyroid Chief Cell Hyperplasia / 대한내과학회지

The routine screening of patients for hypercalcemia has increased the incidence of hyperpa-rathyroidism, But, Primary hyperparathyroidism is relatively rare disease in korea. Especially, primary hyperparathyroidism caused by parathyroid chief cell hyperplasia has not been reported. The numbers of patients with bone disease, renal stones, other severe complication has declined, but the numbers of patients with psychiatric and neuromuscular disturbance or with asymptomatic disease has increased. We experienced a case with severe bone diseases due to primary hyperparathyroidism caused by parathyroid chief cell hyprepiasia which was confirmed through the mearsurement of serum calcium and parathyroid hormone, neck CT scanning and surgical exploration and which was managed by total parathyroidectomy with autotransplantation.

A Case of Acute eosinophilic pneumonia / 대한내과학회지

Acute eosinophilic pneumonia is reported as a specific disease entity. But, it is different from chronic eosinophilic pneumonia in its onset, clinical course and recurrence. Badesh et al reported the following diagnostic criteria os acute eosinophilic pneumonia a less than one-month history of symptoms prior to diagnosis, no evidence of asthma, the absence of other organic disease, no obvious etiology and an evidence of recurrent disease. We experienced a case of acute eosinophilic pneumonia in 37 old male. Pathologically eosinophilic pneumonia is confirmed and other features meet Badesh's criteria.

One Case of Percutaneous Transluminal Angioplasty of Renal Artery Stenosis Caused by Takayasu's Arteritis

Takayasu's arteritis is one of the most important causes of the renovascular hypertension in orientals. Among the multiple treatment modalities, percutaneous transluminal renal angioplasty(PTRA) has become the treatment of the choice for major renal artery stenosis and is a safe, repeatable, effective procedure for the treatment of renovascular hypertension due to Takayasu's arteritis. We experienced a case of percutaneous transluminal balloon angioplasty of Takayasu's arteritis involving the proximal left renal artery. After PTRA, clinical and angiographical improvements were achieved.