Rapid Spontaneous Resolution of Contralateral Lentiform Acute Subdural Hematoma After Burr Hole Trephination for Chronic Subdural Hematoma / 대한신경손상학회지

Although rare, acute subdural hematoma (ASDH) may occur after burr hole trephination (BHT) for chronic subdural hematoma (CSDH). It usually occurs in the hemisphere ipsilateral to the burr hole site and rarely in the hemisphere contralateral to the burr hole site. On computed tomography (CT), SDH is usually crescent-shaped and occasionally lentiform or biconvex, which can be misdiagnosed as epidural hematoma (EDH). In rare cases, ASDH may resolve spontaneously and rapidly. Here, we report a case of rapid spontaneous resolution of contralateral lentiform ASDH after BHT for CSDH in a patient with brain atrophy. A 55-year-old man developed left CSDH 2 months after traumatic brain injury. Left BHT was performed, and a lentiform hematoma, presumed to be EDH, was found in the right frontal region on the CT scan acquired immediately after BHT. On the CT scan acquired 12 hours later, the lentiform hematoma disappeared and spread along the hemisphere. It was presumed to be ASDH. To prevent contralateral ASDH after BHT, slow decompression and minimal gentle or no irrigation should be performed during BHT, particularly in patients with brain atrophy.

A comparison of 0.075% and 0.15% of ropivacaine with fentanyl for postoperative patient controlled epidural analgesia after laparoscopic gynecologic surgery / 영남의대학술지

BACKGROUND: A motor blockade of lower limbs interferes with early ambulation and limits the usefulness of patient-controlled epidural analgesia (PCEA). The concentration of local anesthetic solution is a major determinant for motor block with PCEA. We compared the effects of epidural infusion of 0.075% ropivacaine with 0.15% epidural ropivacaine on postoperative analgesia, motor block of lower limbs, and other side effects.METHODS: A total of 70 patients undergoing laparoscopic gynecologic surgery received epidural infusions (group R1, 0.15% ropivacaine with fentanyl; group R2, 0.075% ropivacaine with fentanyl). Pain score, motor block, and side effects (hypotension, nausea, vomiting, pruritus, urinary retention, dizziness, and numbness) were measured.RESULTS: There were no significant differences in the demographic profiles between the groups. Pain scores of the group R1 and the group R2 were not significantly different. Motor block was more frequent in the group R1 (0.15% ropivacaine with fentanyl) than in the group R2 (0.075% ropivacaine with fentanyl).CONCLUSION: Lower concentration of ropivacaine (0.075%), when compared with higher concentration of ropivacaine (0.15%), seemed to provide similar analgesia with less motor blockade of the lower limbs for the purpose of PCEA.

A comparison of 0.075% and 0.15% of ropivacaine with fentanyl for postoperative patient controlled epidural analgesia after laparoscopic gynecologic surgery / 영남의대학술지

BACKGROUND: A motor blockade of lower limbs interferes with early ambulation and limits the usefulness of patient-controlled epidural analgesia (PCEA). The concentration of local anesthetic solution is a major determinant for motor block with PCEA. We compared the effects of epidural infusion of 0.075% ropivacaine with 0.15% epidural ropivacaine on postoperative analgesia, motor block of lower limbs, and other side effects. METHODS: A total of 70 patients undergoing laparoscopic gynecologic surgery received epidural infusions (group R1, 0.15% ropivacaine with fentanyl; group R2, 0.075% ropivacaine with fentanyl). Pain score, motor block, and side effects (hypotension, nausea, vomiting, pruritus, urinary retention, dizziness, and numbness) were measured. RESULTS: There were no significant differences in the demographic profiles between the groups. Pain scores of the group R1 and the group R2 were not significantly different. Motor block was more frequent in the group R1 (0.15% ropivacaine with fentanyl) than in the group R2 (0.075% ropivacaine with fentanyl). CONCLUSION: Lower concentration of ropivacaine (0.075%), when compared with higher concentration of ropivacaine (0.15%), seemed to provide similar analgesia with less motor blockade of the lower limbs for the purpose of PCEA.

Comparison between Aflibercept, Ranibizumab Intravitreal Injection on Neovascular Age-related Macular Degeneration Patients

PURPOSE: To investigate the difference of optical coherence tomography (OCT) findings between the aflibercept treatment group and the ranibizumab treatment group. METHODS: This study includes patients diagnosed with treatment-naïve neovascular age-related macular degeneration (AMD), and they were treated with aflibercept (n = 23, 23 eyes) or ranibizumab (n = 26, 26 eyes) monthly for 3 months. In this study, the aflibercept treatment group patients were treated from March 2014 to April 2015, and the ranibizumab treatment group patients were treated from December 2008 to April 2015. After three initial injections, they were followed up monthly for an additional 3 months, and additional treatments were performed if necessary. We compared the changes of the two groups before the treatment and after 6 months of treatment, beginning with the OCT findings, such as serous pigment epithelium detachment, fibrovascular pigment epithelium detachment, subretinal fluid, intraretinal fluid, dense zone of outer retina, classic neovascularization, and hyper- reflective dots. We also compared the changes of best corrected visual acuity (BCVA) and inner segment/outer segment (IS/OS) length, external limiting membrane length, and central foveal thickness with optical OCT between the two groups. RESULTS: In the aflibercept group, 46% of serous epithelial detachments disappeared, while 33% disappeared in the ranibizumab group, and there was significant difference between the two groups (p = 0.01). There was no significant difference in BCVA change or OCT findings between the two groups, but there was a significant difference in serous pigment epithelium detachment. CONCLUSIONS: For treatment of neovascular AMD patients, aflibercept might be more effective in serous pigment epithelium detachment than ranibizumab. Because there was no significant difference in visual acuity improvement in serous pigment detachment for both treatments, it might be necessary to further study the relationship between visual acuity and serous pigment detachment improvement.

Multiple Cranial Neuropathy with and Polyradiculoneuropathy as a Delayed Sequelae after of Ethylene Glycol Intoxication / 대한임상신경생리학회지

Multiple cranial and peripheral neuropathies as a delayed sequellae of ethylene glycol poisoning is a less well known clinical entity and its information about long-term electrophysiological and clinical outcomes is limited. We report a 45-year-old male who presented with acute renal failure and subsequently developed multiple cranial neuropathy, respiratory failure, and flaccid tetraparesis. Through sequential electrophysiological studies, we would like suggest that the main pathophysiology of ethylene glycol-related neuropathy is a demyelinating polyradiculoneuropathy with secondary axonal degeneration.

Development and Evaluation of a Scenario for Simulation Learning of Care for Children with Respiratory Distress Syndrome in Neonatal Intensive Care Units

PURPOSE: This study was done to develop a scenario and evaluate student performance in simulation learning of care for children with respiratory distress syndrome in neonatal intensive care units. METHODS: To test the application effect, a one group pre-test design was applied. The scenario based on actual patients and textbook material was developed through several meetings of experts. The scenario was used with 17 groups of 55 senior nursing students who participated voluntarily. RESULTS: Contents were organized focusing on the nursing process for simulation learning. In the application of knowledge and skills, nursing students had high scores in the contents of observation of oxygen saturation, and care to relieve dyspnea. Participants' ability, especially in suction and oxygen supply in the evaluation of objective structured clinical examination was not adequate. There was a significant positive correlation between problem-solving ability and satisfaction in learning. CONCLUSION: The respiratory distress syndrome simulation scenario developed in this study was an effective tool to give students experience in problem solving and critical thinking ability under conditions similar to reality. The development of various scenarios for child nursing care is needed.

Extensive Enteritis with Rapid Onset of Massive Ascites as the Initial Presentation of Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disorder with protean manifestations. However, compared with articular, cutaneous, or renal involvement, gastrointestinal symptoms are far less common and are particularly unusual for the initial presentation of SLE. Gastrointestinal manifestations range from mild nonspecific symptoms to serious life-threatening complications, such as mesenteric vasculitis, intestinal pseudoobstruction, acute pancreatitis, and protein-losing enteropathy. Therefore, in order to improve the prognosis, early diagnosis and timely treatment are important. We describe a 45-year-old female patient who presented with extensive enteritis and peritonitis as the initial manifestation of SLE. Symptoms at presentation included severe abdominal pain and rapid development of massive ascites. After administration of high-dose corticosteroid therapy, her symptoms showed prompt improvement.

Effect of Benfotiamine on the Expression of Phosphodiesterase Type 5 and Its Isoforms in Type 2 Diabetic Rat Kidneys / 대한남성과학회지

PURPOSE: The phosphodiesterases (PDEs) are critical components in the cyclic AMP/protein kinase A and the cyclic GMP/phosphokinase G signaling pathways. The cAMP and cGMP pathways are regulated by activation and dissolution of PDEs. Benfotiamine, a lipophilic derivation of thiamine is known an activator of transketolase, is reported to prevent diabetic nephropathy by decreasing proteinuria and reducing oxidative stress. We did this study to investigate the effect of benfotiamine in type 2 diabetic rat kidneys. MATERIALS AND METHODS: We prepared 10 male Long-Evans Tokushima Fatty (LETO: control) and 20 male Otsuka Long-Evans Tokushima Fatty (OLETF) rats, which developed non-insulin-dependent diabetes mellitus (NIDDM) naturally. An oral glucose tolerance test confirmed diabetic development in the OLETF rats at 26 weeks. We classified 10 of the OLETF rats into Group I, the no treatment group and the other 10 into Group II, the treatment group. Group II received 100 mg/kg benfotiamine after developing DM. At 44 weeks, we checked kidney weight, serum glucose, free testosterone, insulin, total cholesterol, and triglyceride before sacrifice. We designed the primers for rat PDE5, PDE5A1, and PDE5A2 genes were carried out semiquantitive multiplex RT-PCR. Immunohistochemical staining was performed for monoclonal mouse anti-cGB-PDE5 and mouse monoclonal anti-smooth muscle alpha-actin. RESULTS: For the Control Group, Group I, and Group II, kidney weight was 2.13+/-0.23, 2.08+/-0.22, and 1.94+/-0.44 g; serum glucose was 279.50+/-56.79, 338.00+/-55.00, and 314.71+/-139.1 mg/dl; free testosterone was 1.46+/-1.08, 1.05+/- 0.42, and 0.72+/-0.56 pg/dl; insulin was 1.03+/-0.43, 1.09+/-0.83, and 1.15+/-1.08 ng/ml; total cholesterol was 86.83+/-4.79, 132.00+/-7.69, and 118.14+/-30.93 mg/dl; and triglyceride was 78.83+/-16.47, 177.83+/-75.62, and 194.57+/-92.57 mg/dl, respectively. All three groups expressed PDE5, PDE5A1, PDE5A2 mRNA, but Group I PDE5 mRNA expression was lower than that of Group C, II. However, the expression of PDE5A1 and PDE5A2 mRNA was not significantly different among the three groups. CONCLUSIONS: Serum cholesterol, triglyceride, and glucose were significantly higher in OLETF than in LETO rats. The PDEs were lower in diabetic rat (OLETF) kidneys and PDEs may play a significant role in the development of diabetic renal complications. Benfotiamine is suggested to increase expression of PDE5 mRNA in the type 2 diabetes rat kidney, but the difference in expression levels between PDE5A1 and PDE5A2 was not significant. These findings suggest that benfotiamine may play a specific role in diabetic changes of the rat kidney via a PDE5-related pathway, but it is not clear whether subtype PDE5A1 and PDE5A2 genes play a specific role.

Clinical Analysis of Sinonasal Inverted Papilloma according to the Staging System / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this work is to evaluate our results in the treatment of the nasal inverted papillomas according to staging system using a retrospective case series. SUBJECTS AND METHOD: Between March, 1997 and July, 2007,we treated 157 patients with nasal inverted papillomas. A retrospective assessment was performed to evaluate the demographic data, clinical presentations, and involved site of tumor. Inclusion criteria for the study required a histologically proven case of inverted papillomas and a minimum of 12 months follow-up period. All patients were staged according to the Krouse's staging system and a new staging system by Citardi et al. We compared the recurrence rate according to the tumor stage. RESULTS: The median age was 53.7 years (range 21 to 81 years) with males comprising 71%. The most frequent presenting complaint was nasal obstruction. The most common site of involvement was the lateral nasal wall. According to the Krouse's staging system, T1, T2, T3 and T4 were 29 (19.3%), 69 (46%), 51 (34%) and 1 (0.7%). According to the staging system by Citardi et. al., groups A, B and C were 98 (65.3%), 51 (34%) and 1 (0.7%). The recurrence rates of T1, T2, T3 and T4 were 3 (10.3%), 8 (11.6%), 8 (15.7%) and 1 (100%). The recurrence rates of group A, B and C were 11 (11.2%), 8 (15.7%) and 1 (100%). CONCLUSION: The Krouse's staging system, based on the involvement of IP, is a simple tool for grading IP. The new staging system by Citardi et. al. provides information about recurrence rates after surgery. Both staging system could provide important objective data for preoperative planning and prognosis.

A Case of Gossypiboma in the Peritonsillar Space / 대한이비인후과학회지

Gossypiboma is the term used to describe mass lesion caused by retained surgical sponges with reactive tissue after a surgical intervention. This condition has been mostly reported after abdominal or thoracic surgery. We recently experienced a case of gossypiboma of the peritonsillar space in a 31-year old male patient, who previously undergone incision and drainage for treatment of peritonsillar abscess but had persistent symptom of sore throat, myalgia and febrile sensation for 6 months. The gauze was accidently left in the peritonsillar space after a surgical intervention and resulted in mass like lesion in the ipsilateral peritonsillar space. To our knowledge, this is the first case of oropharyngeal gossypiboma in the literature. Although it is rare in adults, foreign body of peritonsillar space should be considered in the differential diagnosis of unilateral recurrent tonsillitis.

Coblation Tonsillectomy versus Conventional Dissection Tonsillectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A variety of tonsillectomy has been performed to treat chronic tonsillitis or tonsillar enlargement. Coblation, one of the radiofrequency electrosurgeries, has been introduced as another modality of tonsillectomy to minimizing the heat-induced tissue damage accompanied by electrocautery. The aim of this study is to find the advantages and disadvantages of coblation tonsillectomy compared with conventional tonsillectomy using cold dissection. SUBJECTS AND METHOD: Eighteen patients who underwent tonsillectomy in St. Paul's hospital between January and June in 2006 were included in this study. Conventional tonsillectomy was performed on one side, and coblation tonsillectomy on the other side in one subject. The operation time, postoperative pain, otalgia, bleeding rate and mucosal healing of the tonsillar fossa were evaluated on both sides in every patient. RESULTS: The operation time, postoperative otalgia, and bleeding rate were not significantly different for either sides. The postoperative pain was less severe on the coblation side only on the third day. But the mucosal healing of the tonsillar fossa was more rapid on the coblation side than cold dissection side. CONCLUSION: Coblation tonsillectomy can be a new method that will ensure rapid tissue healing but gives almost the same postoperative outcome in pain and hemorrhage as the conventional dissection tonsillectomy.

Spinal Cord Infarction following Spine Surgery in the Patient with Vertebral Bursting Fracture : A case report / 대한마취과학회지

Spinal cord infarction as a complication of spine surgery occurs rarely. Herein, a case of spinal cord infarction, which developed in a 69 year old woman following posterior decompression and internal fixation for a T11 bursting fracture, is descirbed. The anesthetic induction and intraoperative course were uneventful, except at the end of the procedure, where her blood pressure suddenly dropped from 130/90 to 90/60 mmHg. The patient was aggressively treated with a transfusion and vasopressor, the blood pressure then returned to its usual value within 10 minutes. However, during a physical examination in the recovery room, the patient was found to have flaccid lower limbs, with impaired sensory function below the T8 level. Her cord diameter had increased, and a high signal lesion was observed within the thoracic spinal cord, from T9 to T12 level on T2-weighted MR images, which was diagnosing as a spinal cord infarction, was and showed no improvement despite the immediate and aggressive treatment.

Three-dimensional gestational sac volumetry with automatic tracing mode of the VOCAL-imaging program as the new biometric parameter in determining gestational age: Preliminary study / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to verify the correlation between gestational sac volume (GSV) from automatic tracing mode the VOCAL-imaging program and gestational age and to construct the nomogram of gestational sac volume as the new biometric parameter in early pregnancy. METHODS: The cross-sectional study has been conducted in 242 uncomplicated singleton pregnancies. 47 cases were excluded due to early pregnancy failure, fetal malformations, elective abortion, age discrepancy, etc. In 195 uncomplicated singleton pregnancies from 5 to 12 weeks' menstrual age, gestational sac volume, mean sac diameter and crown-lump length were measured for the assessment of gestational age. Gestational sac volumetry was carried out with automatic method and manual method of the VOCALTM (Virtual Organ Computer- aided AnaLysis) for the comparison between two methods. The collected data were analyzed for mean, standard deviation, 90% reference interval, 5th, 50th and 95th percentiles of gestational sac volume, mean sac diameter and CRL, and the nomogram were constructed. RESULTS: Polynomial regression analysis demonstrated the statistically significant positive correlation between gestational age and gestational sac volume by automatic tracing mode (R2 0.826, p<0.001), gestational sac volume by manual tracing mode (R2 0.844, p<0.0001), mean sac diameter (R2 0.763, p<0.0001) and crown-lump length (R2 0.950, p<0.0001). The 5th, 50th and 95th percentiles of the gestational sac volume were calculated and the nomogram was tabulated. In determining gestational age, the standard deviation (SD) of gestational sac volume by automatic tracing mode is 5.6 days, the SD of gestational sac volume by manual tracing mode is 5.2 days and the SD of MSD is 6.6 days. CONCLUSION: we can conclude that three-dimensional GSV with automatic tracing mode of the VOCAL-imaging program can be used as the new biometric measurement in determining gestational age. Gestational sac volumetry with automatic tracing mode of the VOCAL-imaging program have been proven available and convenient method and it can be recommended in 5-7 weeks' of gestation, when CRL is not clearly visualized.

A Case of Primary Sjogren's Syndrome Associated with Acute Transverse Myelitis / 대한류마티스학회지

Sjogren's syndrome is a chronic autoimmune inflammatory disorder characterized by dryness of the eyes, mouth, and other mucous membranes with multiple abnormalities of cellular and humoral immunity. There are numerous neurologic symptoms in Sjogren's syndrome involving the central, peripheral and autonomic nervous system. Transverse myelitis is an uncommon and serious complication of Sjogren's syndrome. It is an inflammatory process affecting one or more segments of the spinal cord that interrupts most of the large tracts across the greater part of the horizontal extent of the cord at the level of the lesion. The dramatic presentation with rapidly progressive symptoms involving motor, sensory, and autonomic functions makes transverse myelitis a medical emergency. We describe a patient of Sjogren's syndrome associated with transverse myelitis, manifest as paraparesis and urinary retention. MRI showed involvement of the spinal cord from C3 to T3. The patients symptoms improved to the therapy with corticosteroid and cyclophosphamide.

Cutaneous Polyarteritis Nodosa Presented with Digital Gangrene: A Case Report

Cutaneous polyarteritis nodosa (CPAN) is an uncommon form of vasculitis involving small and medium sized arteries of unknown etiology. The disease can be differentiated from polyarteritis nodosa by its limitation to the skin and lack of progression to visceral involvement. The characteristic manifestations are subcutaneous nodule, livedo reticularis, and ulceration, mostly localized on the lower extremity. Arthralgia, myalgia, peripheral neuropathy, and constitutional symptoms such as fever and malaise may also be present. We describe a 34-yr-old woman presented with severe ischemic change of the fingertip and subcutaneous nodules without systemic manifestations as an unusual initial manifestation of CPAN. Therapy with corticosteroid and alprostadil induce a moderate improvement of skin lesions. However, necrosis of the finger got worse and the finger was amputated.

Dural Puncture by Introducer when Performing Spinal Anesthesia -A case report- / 대한마취과학회지

To reduce the possibility of a postdural puncture headache and subarachnoid infection, an introducer is commonly used during spinal anesthesia. Because an introducer has a larger diameter than a spinal needle, a dural puncture by made using an introducer may increase postdural puncture headache. Actually, dura mater is hard to perforate using an introducer, because mean depth to the subarachnoid space is 5.44 +/- 0.47 cm in koreans but the required introducer length is only 3.2 cm. However, we experienced dural puncture by an introducer when performing spinal anesthesia and therefore report the case.

A Case of Henoch-Schonlein Purpura Complicated by Hemorrhagic Ascites / 대한류마티스학회지

Henoch-Schonlein purpura (HSP) is a systemic vasculitis with IgA dominant immune complex deposits affecting small vessels in the skin, joint, gastrointestinal tract, and kidneys. Gastrointestinal symptoms are common and may precede the appearance of characteristic skin rash. These manifestations include abdominal pain, bleeding, bowel infarction, intussusception, or even, perforation. However, hemorrhagic ascites has been rarely described in patients with HSP. The pathophysiologic mechanism is presumably a vasculitis of the small vessels within the serosa. We report a 37-year-old man with HSP complicated by hemorrhagic ascites. Contrast CT of the abdomen showed extensive bowel wall thickening and ascites. A paracentesis yielded hemorrhagic fluid. These abdominal manifestations were improved after methylprednisolone pulse therapy.

Severe hypokalemia in internal medicine hospitalized patients / 대한내과학회지

BACKGROUND: Serum potassium level assessment is one of the commonly requested laboratory tests. Hypokalemia is defined as a serum potassium level of less than 3.5 mEq/L. It can be potentially life-threatening when severe, due to its association with cardiac arrhythmia and sudden deaths. The aim of our study is to determine the prevalence and to define clinical characteristics of severe hypokalemia in internal medicine hospitalized patients. METHODS: From December 1999 to June 2000, the group with at least one recorded plasma potassium concentration of less than 3.0 mEq/L was selected in department of internal medicine, Pusan national university hospital. Routine records of age, sex and prevalence was collected. Severe hypokalemia is defined as a serum potassium concentration less than 2.6 mEq/L. This patients were retrospectively studied for discharge diagnosis, medications prescribed before and during hospital stay, hospital course and laboratory findings. RESULTS: There were 7.52% (235/3124) with at least one recorded potassium level of less than 3.0 mEq/L. Severe hypokalemia were 75 patients (2.4%). It were more likely to be female, but statically insignificant. Of the 75 patients, 59 patients (77.3%) had hypokalemia during hospitalization. Gastrointestinal loss of potassium was only 13.8% of the patients. The main causes were combination of iatrogenic factors, including the adminstration of intravenous fluids with insufficient or no potassium, malnutrition, and several drugs. The discharge diagnosis included infection 20 patients (26.6%), malignancy 19 patients (25.3%), gastointestinal disorders 8 patients (10.6%). And each of cardiovascular, respiratory and renal disorders have 7 patients (9.3%). In-hospital mortality was 34.6% (26/75) in severe hypokalemia. Compared to the alive group, death group showed statically significant decrease in serum albumin concentration (p<0.05). CONCLUSION: Severe hypokalemia is fatal electrolyte disorder. The most frequent cause of this lethal condition is drug therapy and intravenous fluids with insufficient or no potassium replacement. It can be prevented by regular potassium monitoring and appropriate potassium supplementation in risky hospitalized patients.

Two cases of SAPHO syndrome / 대한내과학회지

We describe two cases of SAPHO syndrome with history of palmoplantar pustulosis and pain on the anterior chest wall and lower back area. The acronym SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome includes a group of disorders characterized by bony lesions commonly involving the anterior chest wall and associated with skin manifestations. The skeletal manifestation is characterized by the association of inflammation and hyperostotic change, in the form of sternocostoclavicular hyperostosis, spondyloarthropathy and chronic recurrent multifocal osteomyelitis. Common cutaneous lesions include palmoplantar pustulosis, pustulotic psoriasis, and severe forms of acne. The pathogenesis remains elusive, but a link with seronegative spondyloarthropathy is probable. To date, the treatment is empirical. Nonsteroidal anti-inflammatory drugs are the first choice, and other drugs including corticosteroid, disease modifying antirheumatic drugs, pamidronate, and infliximab have been tried with some therapeutic benefit. SAPHO syndrome is a condition in the differential diagnosis of infectious or tumorous conditions of the bone. Early and proper diagnosis is important to avoid unnecessary investigations or treatments.

Two cases of SAPHO syndrome / 대한내과학회지

We describe two cases of SAPHO syndrome with history of palmoplantar pustulosis and pain on the anterior chest wall and lower back area. The acronym SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome includes a group of disorders characterized by bony lesions commonly involving the anterior chest wall and associated with skin manifestations. The skeletal manifestation is characterized by the association of inflammation and hyperostotic change, in the form of sternocostoclavicular hyperostosis, spondyloarthropathy and chronic recurrent multifocal osteomyelitis. Common cutaneous lesions include palmoplantar pustulosis, pustulotic psoriasis, and severe forms of acne. The pathogenesis remains elusive, but a link with seronegative spondyloarthropathy is probable. To date, the treatment is empirical. Nonsteroidal anti-inflammatory drugs are the first choice, and other drugs including corticosteroid, disease modifying antirheumatic drugs, pamidronate, and infliximab have been tried with some therapeutic benefit. SAPHO syndrome is a condition in the differential diagnosis of infectious or tumorous conditions of the bone. Early and proper diagnosis is important to avoid unnecessary investigations or treatments.