Successful Treatment of Hypercalcemia During Continuous Renal Replacement Therapy in Patient with Rhabdomyolysis Following Cardioversion and Cardiopulmonary Resuscitation / 대한신장학회지

Rhabdomyolysis is a common clinical and laboratory syndrome resulting from reversible skeletal muscle injury, with release of muscle cell contents into the plasma. Cardioversion, and cardiopulmonary resuscitation may produce rhabdomyolysis and myoglobinuria. We report a 5-year-old boy surviving after cardiopulmonary resuscitation and repeated 5 times of cardioversion. He showed elevated serum BUN and creatinine levels, requiring hemodialysis treatment. We had tried 5 times of intermittent hemodialysis, but oliguria was continued and there was no change of serum BUN and creatinine. His urine output was less than 100 cc per day and he showed severe edema and weight gain of 7 kg, and so we started the continuous renal replacement therapy (Prismaflex(R), gambro). After 12 days of continuous venovenous hemodiafiltration (CVVHDF), his urine output recovered and his BUN, creatinine, liver enzyme, creatine kinase, and lactate dehydrogenase levels returned to normal. During the treatment of CVVHDF, he had shown persistent hypercalcemia, and so we changed dialysate and replacement solution from hemosol B0 to calcium free solution. The hypercalcemia was controlled successfully using this calcium free pharmacy-made bicarbonate solution.

Varus Positined Femoral Stem in Cementless Total Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: This study examined the effect of a varus positioned femoral stem after cementless proximal fitting total hip arthroplasty. MATERIALS AND METHODS: A total of 144 hips in 136 patients who underwent cementless total hip arthroplasty, were followed-up. Twenty-one varus positioned hips were compared with 123 neutral positioned hips. The clinical results were analyzed according to the level of thigh pain and the Harris Hip score. The radiological outcome was assessed according to osteolysis, loosening and stem failure. RESULTS: In the varus positioned hips, thigh pain was present in 1 hip, and the average Harris Hip Score was 96 points. None of the implants showed radiological evidence of loosening or impending failure. Localized osteolysis was identified in 1 hip, non-progressive radiolucencies in 2 hips, and cortical hypertrophy in 1 hip. In the neutral positioned hips, thigh pain was present in 6 hips, and the average Harris Hip Score was 97 points. Localized osteolysis was identified in 8 hips, non-progressive radiolucencies in 7 hips, cortical hypertrophy in 9 hips. CONCLUSION: Patients with varus alignment of the stem did not present poorer clinical outcomes than those with neutral alignment of the stem.

The Morphometric Changes of the Enteric Nervous System in the Intestinal Transection-reanastomosis Model / 체질인류학회지

This study was performed to investigate the morphometric changes of myenteric plexus and type 1 interstitial cells of Cajal (ICC-I) in regeneration process of small intestine transection. Sprague Dawley rats (200~250 g) were anesthetized with ether; then the full thickness of ileal wall were semitransected; and subsequent end-to-end anastomosis were performed by using 6-0 silk suture thread. Sham-operated rats, which only underwent the laparotomy, were used for control group. Experimental animals were sacrificed at 3 days, 7 days, 15 days, and 30 days after the operation. In each group myenteric plexus and ICC-Is were prepared by histochemical method (NADH-TR stain for myenteric plexus, ZIO stain for ICC-Is) and cell numbers were counted by image analyzer (Image plus pro-5.0, Media Cybermedics, USA). Degeneration of myenteric neurons and ICC-Is occurred simultaneously and it was similar in oral and anal to the site of transection. Degeneration effects were most prominent at 3 days and 7 days after intestinal transection. In myenteric plexus, many neurons had degenerated appearances and about 40% of them were lost. Most of ICC-Is had cytoplasmic vacuoles and 20~37% of the cells were lost. At 15 days after transection, there were no more degeneration in myenteric neurons (20~25% cell loss) and ICC-Is (20~13% cell loss). At 30 days after transection, numbers of myenteric neurons were not recovered as that of the control group. However numbers of ICC-Is were as similar as that of the control group. In conclusion, we confirmed that degeneration effects of intestinal transection are more severe in myenteric plexus than in ICC-Is, and recovery of cell loss occurs more slowly in myenteric plexus.

Clinical Characteristics of Extended-spectrum beta-lactamase Producing Shigella sonnei Infection Outbreaked in Chungju Area / 대한진단검사의학회지

BACKGROUND: An outbreak of extended-spectrum-lactamase (ESBL)-producing Shigella sonnei enteritis, especially in pediatric populations, was unprecedented not only in Korea, but also throughout the world in the past. This study was intended to devise a management guideline for shigellosis caused by an ESBL-producing strain based on analysis of the clinical manifestations and response to therapy. METHODS: We examined 24 strains of S. sonnei isolated from stool cultures of patients with acute enteritis, between November 2004 and February 2005, for antimicrobial susceptibility and ESBL production, and we also performed DNA sequencing with PCR for the typing of ESBL genes. In addition, we retrospectively analyzed the clinical characteristics, laboratory results, and therapeutic responses to antibiotics of the 103 patients who grew S. sonnei on stool cultures. RESULTS: All 24 isolates showed a very similar antibiotic sensitivity pattern and were ESBL gene type of CTX-M-14. The most frequent clinical symptom in the 103 patients was a fever, followed by diarrhea, abdominal pain, headache, vomiting, and nausea. Leukocytosis and CRP were positive in 53.4% and 78.6% of the patients, respectively. On stool direct smears, 11.7% showed more than 50 WBCs per HPF and 71% were positive on stool occult blood. Microbiological eradication rates were as follows: azithromycin and ciprofloxacin, 100%; imipenem-cilastatin, 68.8%; ampicillin-sulbactam, 42.9%; amoxicillin-clavulanic acid, 20%; ceftizoxime, 12.5%; cefdinir, 6.9%; and ceftriaxone and trimethoprim-sulfamethoxazole, 0%. CONCLUSIONS: We presumed that, given its cost-effectiveness and safety, azithromycin can be an attractive option for the treatment of ESBL-producing S. sonnei enteritis in pediatric populations. Although ciprofloxacin is another cost-effective agent, its use in pediatric populations is not recommended.

The Incidence of Infection in Interlocking Intramedullary Nailing after Skeletal Traction of Distal Femur

PURPOSE: The insertion site of K-wire for skeletal traction is proximal part of tibia or distal part of femur. However, people prefer proximal tibia over distal femur due to lower risk of infection rate when change to interlocking IM nailing is needed. We evaluated the infection rate of interlocking IM nailing. MATERIALS AND METHODS: Fourty-seven patients were included in this study who underwent interlocking IM nailing due to femur shaft fracture. Traction was applied at the distal femur in 19 cases and proximal tibia in 10 cases before interlocking IM nailing. No skeletal traction was applied to the remaining 18 cases. Thirty-eight patients were male and 9 were female. The average age at the time of surgery was 36.7 years old (range, 15~17 years). The average traction period was 9.5 days (range, 3~33 days) and the average followed-up period was 17.2 months. RESULTS: In the distal femoral traction group, 8 cases of superficial pin tract infection developed, but no case of deep infection such as osteomyelitis occurred. In the proximal tibia traction group, 2 cases of superficial pin tract infection developed, but no case of deep infection occurred. In the group that received no skeletal traction before interlocking IM nailing, no case of infection developed. CONCLUSION: In femur shaft fracture, the distal femoral skeletal traction followed by interlocking IM nailing of femur, compared to proximal tibia skeletal traction, did not increase the risk of deep infection such as osteomyelitis.

A Case of Iatrogenic Bronchobiliary Fistula / 대한소화기내시경학회지

Bronchobiliary fistula is a rare condition. It is defined by the presence of a passage between the biliary tract and the bronchial tree. Many conditions can give rise to the developement of such a communication. The patient was a 71-year-old man who had obstructive jaundice due to liver mass. At first, we inserted an uncovered metallic stent for biliary drainage. However, the bile duct was perforated due to the trapping of a catheter in the distal end of the deployed stent. The operation was performed immediately, but only the sump draingage was placed in the retroperitoneum because the perforation site could not be found. After 20 days from the procedure, the patient complained of bilioptysis because of a bronchobiliary fistula. We inserted a covered stent into the previous uncovered metallic stent. Bilioptysis rapidly resolved after the successful procedure. We report a case of iatrogenic bronchobiliary fistula which was managed by endoscopic biliary stenting.

A Case of Jejunal Infarction and Perforation due to Acute Pancreatitis / 대한소화기학회지

Jejunal infarction as a complication of acute pancreatitis is not common and can not be well recognized. This jejunal infarction usually arises from the venous thrombosis rather than arterial thrombosis. Jejunal infarction results in bowel perforation or stenosis according to its extension of injury and progression rate. Pathologic findings of the involved jejunum show a segmental transmural infarction and mesenteric venous thrombotic occlusions. Early diagnosis should be made for better prognosis. We report a patient with jejunal infarction resulting perforation due to acute pancreatitis, in which the initial presenting symptoms were hematemesis and abdominal distention.

Idiopathic Scoliosis in Korean Middle School Students: Prevalence study / 대한정형외과학회잡지

PURPOSE: To update and reevaluate the scoliosis prevalence in middle school students in Korea, and correlate those data with past references and other countries general prevalence. MATERIALS AND METHODS: Among the middle schools in Seoul city, forty-five middle schools were randomly selected for screening. Total number of students were 46,428 who were screened for the prevalence of adolescent idiopathic scoliosis. There were 24,892 boys and 21,536 girls. Their age ranged from 12 to 15 years. Adams forward bending test and "Scoliometer" (Orthopaedic Systems, Inc, USA) were used to detect and measure the degree of rotation of trunk. Students more than 5 (ATR were assessed subsequently by standardized clinical and radiological examinations. RESULTS: Using 10 degrees as cut-off points, 465 students were found to have structural idiopathic scoliosis, representing a prevalence of 0.9% overall. CONCLUSION: The prevalence of the scoliosis has not changed from previously estimated rates in Korea, which was about 20 years ago. It nearly approximates with the prevalence of the world wide reported. We also confirmed that it is not necessary to issue a mass screening, considering the cost and effectiveness aspect, due to its low prevalence.

Asymmetric Exercise and Scoliosis: A Study of Volleyball Athletes / 대한정형외과학회잡지

PURPOSE: To determine the prevalence of scoliosis in volleyball athletes and compare this with the prevalence in the general population. MATERIALS AND METHODS: One hundred and sixteen volleyball athletes who had been enrolled in the activity for more than one year were examined for prevalence of scoliosis. The Adams forward bending test was performed with a measurement of the truncal asymmetry using a scoliometer (Orthopaedic System, Inc, USA). Those atheletes who showed more than 5degreesof measurement were selected for an X-ray evaluation. Data from a randomized point prevalence survey of Korean Middle school students (46,428) in Seoul City, which had been performed by our department, was adopted for the control group. RESULTS: Among the 116 volleyball players, 60 (51.7%) showed more than a 5degreesof angle of trunk rotation, whereas controls of middle school students showed 2.5%. Cobb's angle more than 10degrees was 6 (5.17%) in athletes and the control group was 465 (1.0%). Despite higher frequency of prevalence, the Cobb' angle was below 15degrees whereas the control group showed a severe scoliosis which of Cobb's angle reaching to 45degrees. CONCLUSION: Volleyball athletes showed a higher incidence of truncal asymmetry and scoliotic spinal columns than the control group. However, we were able to conclude that asymmetrical muscle development can produce a mild scoliosis. However this doesn't have the potential for a severe progression as found in some cases of idiopathic scoliosis.

A Case of Cutaneous and Gastric Cavernous Hemangiomas / 대한소화기내시경학회지

A hemangioma is a common soft tissue tumor, usually affecting the cutaneous regions of the head and neck in infancy and childhood. A hemangioma in the gastrointestinal tract is rare occurrence which is usually found in the submucosa of the small and large intestine, but rarely in the stomach. Infrequently, multiple cavernous hemangiomas have been reported on skin and in the intestines. A 23-year-old man was admitted with hematemesis. An upper endoscopy revealed a purple colored sessile lesion at the posterior wall side of the fundus which had surface erosion and erythema. This lesion was easy to bleed when the patient retched. Another sessile lesion was detected at the greater curvature side of the upper body. The patient had two intradermal soft masses at the back and left forearm. An X-ray revealed a phebolith that suggested a cavernous hemangioma. An abdomen CT and angiography revealed that these lesions were highly suggestive of hemangioma. Gastric wedge resection was performed and the histological diagnosis was gastric cavernous hemangiomas.

The Clinical Spectrum of Gastroesophagel Reflux Disease in Korea / 대한소화관운동학회지

BACKGROUND/AIM: Heartburn, which was the most common symptom of reflux disease, was unreliably interpreted by Korean patients. Our aim was to evaluate the clinical spectrum of gastroesophageal reflux disease(GERD) in Korea. METHODS: Patients who were diagnosed by an endoscopy or ambulatory pH monitoring at a tertiary medical facility were given a validated questionnaire and the clinical spectrums were prospectively investigated. RESULTS: Seventy one patients were included. Heartburn was occurring in 39 patients and the frequency of heartburn on two or more days a week were found in only 12 patients. Negative impact of reflux symptoms on health related well being were found in 16 patients. The reflux related atypical symptoms were hoarseness(55%), globus sensation(45%), cough(25%), and chest pain(20%). Twenty two patients complained of epigastric pain or discomfort more than 6 times a year, with 13 patients listing abdominal pain as the most bothersome one. The clinical spectrums were not different between endoscopy negative patients and those with esophagitis. CONCLUSIONS: Typical reflux symptoms are absent in a substantial proportion of Korean patients with GERD. True dyspepsia could result from gastroesophageal reflux. GERD needs to be clarified in patients with chronic laryngeal symptoms, cough or chest pain.

A Case of Endobronchial Lipoma causing middle lobe syndrome / 결핵

Although lipomas are common benign tumors in humans, endobronchial lipomas are quitely rare. Up to date, about 60 cases have been reported in the English literature. But endobronchial lipomas causing middle lobe syndrome were only 4 cases. These benign slow-growing tumors generally occur in the proximal portion of the lobar or segmental bronchi and originate from fatty tissue that is normally present in the bronchial tree. Smoking or chronic inflammation may be important in the pathogenesis of these tumors. Bronchoscopy is the definite diagnostic tool but, in general, open thoracotomy is required for diagnosis and treatment. Here, we present a case of endobronchial lipoma, with a review of the literature.