Thrombotic Occlusion during Intravascular Ultrasonography-Guided Percutaneous Coronary Intervention of Stumpless Chronic Total Occlusion / 전남의대학술지

Percutaneous coronary intervention (PCI) of stumpless chronic total occlusion (CTO) lesions with a side branch stemming from the occlusion have a significantly lower treatment success rate because physicians cannot identify an accurate entry point with only conventional angiographic images. An intravascular ultrasonography (IVUS)-guided wiring technique might be useful for the penetration of stumpless CTO. We recently experienced thrombotic occlusion during an IVUS-guided stumpless CTO procedure. The cause of the thrombosis is not completely understood; the thrombosis may have been associated with the long use of the IVUS catheter. Special precautions should be taken to prevent thrombus in such cases.

Peroneus Tendon Dislocation Associated with Fracture of Lateral Process of Talus: A Case Report

Traumatic peroneal tendon dislocation in association with fracture of the lateral process of the talus is a rare injury, which is difficult to diagnose. As a result, early detection is often delayed, which in turn leads to ankle pain and dysfunction. We treated a patient by open reduction and screw fixation in fracture of the lateral process of talus and primary repair of the superior peroneal retinaculum. We report this case with a brief review of the literature.

Thrombotic Occlusion during Intravascular Ultrasonography-Guided Percutaneous Coronary Intervention of Stumpless Chronic Total Occlusion / 전남의대학술지

Percutaneous coronary intervention (PCI) of stumpless chronic total occlusion (CTO) lesions with a side branch stemming from the occlusion have a significantly lower treatment success rate because physicians cannot identify an accurate entry point with only conventional angiographic images. An intravascular ultrasonography (IVUS)-guided wiring technique might be useful for the penetration of stumpless CTO. We recently experienced thrombotic occlusion during an IVUS-guided stumpless CTO procedure. The cause of the thrombosis is not completely understood; the thrombosis may have been associated with the long use of the IVUS catheter. Special precautions should be taken to prevent thrombus in such cases.

A Case of Myotonic Dystrophy with Electrolyte Imbalance

Type 1 myotonic dystrophy (DM1) is an autosomal-dominant inherited disorder with a multisystem involvement, caused by an abnormal expansion of the CTG sequence of the dystrophic myotonia protein kinase (DMPK) gene. DM1 is a variable multisystem disorder with muscular and nonmuscular abnormalities. Increasingly, endocrine abnormalities, such as gonadal, pancreatic, and adrenal dysfunction are being reported. But, Electrolytes imbalance is a very rare condition in patients with DM1 yet. Herein we present a 42-yr-old Korean male of DM1 with abnormally elevated serum sodium and potassium. The patient had minimum volume of maximally concentrated urine without water loss. It was only cured by normal saline hydration. The cause of hypernatremia was considered by primary hypodipsia. Hyperkalemic conditions such as renal failure, pseudohyperkalemia, cortisol deficiency and hyperkalemic periodic paralysis were excluded. Further endocrine evaluation suggested selective hyperreninemic hypoaldosteronism as a cause of hyperkalemia.

Polarus Intramedullary Nail for Proximal Humeral and Humeral Shaft Fractures in Elderly Patients with Osteoporosis

PURPOSE: To assess the effectiveness of optimal treatment of proximal humeral fractures and humeral shaft fractures in elderly patients with osteoporosis using the Polarus nail. MATERIALS AND METHODS: Twenty-three patients with proximal humeral and humeral shaft fractures in elderly osteoporosis patients were treated using the Polarus intramedullary nail. Nine patients had proximal humeral fracture, 10 had humeral shaft fracture and 4 had the proximal humeral frac-ture extended diaphyseally. Radiological outcomes included the bone-union and the degree of re-sidual deformity. The residual deformities of the proximal humerus were assessed by the neck-shaft angle and the shaft angulation. Clinical outcome was assessed with the American Shoulder and Elbow Surgeons (ASES) score. RESULTS: All cases had bony union and the mean union period was 16.5 weeks. The average neck/shaft alignment at the time of bone union was 135degrees and varus deformities of neck-shaft angle was not seen in all patients. Varus shaft angulation was seen in 5 patients. The mean ASES score after surgery was 86.7 points. CONCLUSION: The Polarus intramedullary nail is effective for the treatment of proximal humeral and humeral shaft fractures in elderly patients with osteoporosis because it not only enables early postoperative mobilization, but also obtains bone-union without avascular necrosis and nonunion.

Complications of Hook-Plate Fixation for Distal Clavicle Fractures

PURPOSE: To report on the complications of hook-plate fixation for distal clavicle fractures. MATERIALS AND METHODS: Eighteen patients who underwent surgery for distal clavicle fracture with a hook-plate from April 2008 to April 2011 were enrolled with a minimum of 4 months follow-up. The reduction was qualified and evaluated according to the radiologic findings. We analyzed the results by UCLA score, Kona's functional evaluation, and VAS pain score. RESULTS: By radiologic evaluation, 17 of 18 cases showed anatomical reduction and solid unions. Although satisfactory results were found in the clinical study as shown by the UCLA score, Kona's functional evaluation, and VAS pain score, complications arose in 7 cases, including osteolysis of the acromion in 2 cases, nonunion in 1 case, periprosthetic fracture in 2 cases, subacromial pain in 1 case, and skin irritation in 1 case. 2 cases of all required reoperation. CONCLUSION: To reduce the complications of the hook-plate, a precise surgical technique and the choice of an appropriate size for the hook-plate are needed. We suggest that early removal of the plate is necessary to decrease the risk of subacromial impingement and erosion in hook-plate fixation.

Treatment of Distal Clavicle Fracture Using Hook Plate

PURPOSE: To evaluate the result of distal clavicle fracture treated by Hook plate (LCP clavicle hook plate, Synthes(R), Paoli, Switzerland). MATERIALS AND METHODS: 10 patients with distal clavicle fracture treated by Hook plate from April 2008 to March 2010 were analyzed. The average follow-up period was 10 (range 4 to 26) months. The reduction was qualified and evaluated according to the immediate post-operative, final radiographs. We analyze the result by UCLA score and Kona's functional evaluation. RESULTS: By radiologic evaluation, all cases showed anatomical reduction and solid union. By Kona's functional evaluation, there are 7 cases with excellent results, 3 cases with good results. The UCLA score was average 33.3 (range 29 to 35) points followed by 6 excellent cases, 4 good cases. As complication, 1 case showed post-operative clavicle shaft fracture and 1 case showed acromial osteolysis on X-rays. We found no complications such as skin irritation, infection, loosening of screws, and plate failure. CONCLUSION: The Hook plate fixation for distal clavicle fracture is considered effective method for satisfactory reduction and rigid fixation, a lower incidence of nonunion and excellent clinical result.

Avulsion Fracture of Medial Cuneiform by Tibialis Anterior Tendon (A Case Report) / 대한족부족관절학회지

Avulsion fracture of medial cuneiform by tibialis anterior tendon is quite rare. It has been reported about the avulsion fracture and surgical repair of tibialis anterior tendon rupture at distal insertion site of medial cuneiform in Korea. We report a case of right foot medial cuneiform avulsion fracture by tibialis anterior tendon after autobike accident and describe this case with a review of literature.

Surgical Treatment of Using Acutrak Screw for Ankle Medial Malleolar Fracture / 대한족부족관절학회지

PURPOSE: The purpose of this study is to evaluate the clinical and radiologic results of using Acutrak screws for treating ankle medial malleolar fracture. MATERIALS AND METHODS: We reviewed 38 cases of ankle medial malleolar fracture treated with Acutrak screws from February 2005 to May 2008. RESULTS: In clinical result, there were 30 exellent cases, 7 good cases, 1 fair case. In radiologic result, there is no case with reduction loss. Average union time is 10.5 weeks. CONCLUSION: We conclude that Acutrak screw fixation is a useful method for ankle medial malleolar fracture, there are many advantages in accurate anatomical reduction, small incision, short operative time.

Pulsed-Field Gel Electrophoresis Analysis of a Salmonella london Outbreak in Neontes

PURPOSE: Salmonella species is one of the most common causative organisms of acute gastroenteritis in neonates. There have been some reports of outbreaks of Salmonella species in neonates, but none was caused by Salmonella london. Pulsed-Filed Gel Electrophoresis (PFGE) was used to compare and analyze 6 isolates of S. london from the formula-fed neonates in Chunan city from late June through early July in the year of 2000. METHODS: In June and July 2000, we performed culture from blood and stool of 5 patients who admitted in Soonchunhyang Chunan Hospital. We performed a molecular analysis based on plasmid profile and pulsed-filed gel electrophoresis (PFGE). We reviewed their hospital records retrospectively. The affected babies were isolated during hospitalization and discharged home as soon as possible. In addition, hand washing, cleaning, and disinfection were intensified to prevent the spread to other babies. RESULTS: We isolated 6 strains of S. london from stool or blood samples of five patients, who were 9 to 14 days old and had fever, diarrhea, poor feeding or weight loss. The specimens for culture of Salmonella species were obtained on the admission day of every patient. All Salmonella species showed the same biochemical reactions as slant/ butt on KIA -/+, H2S +, gas +, motility +, indole -, ornitine decarboxylase +, lysine decarboxylase +, and citrate utilization +. They also showed agglutinations by Salmonella serogroup E antisera. They were susceptible to all antimicrobial agents tested by NCCLS disk diffusion method. The clonality of isolates was confirmed by PFGE after digestion with Xba I and revealed the similar band patterns of S. london. CONCLUSION: We have reported the outbreak of S. london of the formula-fed neonates in Chunan city from late June through early July in the year of 2000. Pulsed-Filed Gel Electrophoresis (PFGE) would be essential for the molecular and epidemiologic studies for the outbreaks caused by Salmonella species.

Two cases of Creosote Induced Gastric Ulcer / 대한소아소화기영양학회지

Secondary peptic ulceration and gastritis have been known to be associated with stress, exogenous agents, drugs or infection. Salicylate (aspirin) ingestion has been known to be associated with increased incidence of gastric ulcer and more frequently as the cause of hemorrhagic gastric erosions and gastritis. Some medications such as tetracyclines and iron preparations have been associated with ulceration of the gastrointestinal tract. Chemotherapeutic agents including cytoxan and methotrexate also have been implicated in the development of mucosal and gastrointestinal ulcers. We have experienced two cases of hemorrhagic gastric ulcers due to creosote ingestion in a 13 month and a 45 year old boys. Creosote is a main component of one of the popular digestives, Jungrohwan in Japan and Korea.

A Case of Acrodermatitis Enteropathica Associated with CMV Hepatitis / 대한소아소화기영양학회지

Acrodermatitis enteropethica (AE) is a rare autosomal recessive disorder of zinc absorption leading to chronic diarrhea and characteristic skin lesion. The term is also applied to any acquired zinc deficiency state resulting in the same clinical pictures. We experienced one case of AE in 1 month old male infant who had bacterial enterocolitis. The skin around mouth, anus, eyes, ears, hands and legs became reddish, vesicular and eczematoid. Serum zinc level was decreased to 51.4 microgram/dL (N=70~150). Endoscopic finding revealed pale gastric mucosa and villous atrophy of small intestine. Biopsy finding of small intestine showed no villi due to mucosal atrophy. On 13 day of admission jaundice with DIC were noted and AST & ALT were elevated to 110 & 36.8 IU/L, respectively. Diarrhea was improved but jaundice and liver function were not recovered until discharge from hospital. After discharge when the patient was 4 months of age serum bilirubin and AST/ALT had not been normalized. CMV shell vial culture of urine and CMV Ig G antibody were positive. So intravenous ganciclovir injection of 7.5 mg/kg, two times a day for 2 weeks and then 10 mg/kg/day for 3 months was done from 4 to 6 months of age. No virus was found in the urine and AST & ALT were normalized at 2 months after stopping ganciclovir treatment.