Ultrasound-guided Intra-Articular Injections / 대한내과학회지

Ultrasonography (US) is being used increasingly to guide diagnostic and therapeutic musculoskeletal injections. Intra-articular injection is an important mainstay in the treatment of joint diseases, including rheumatoid arthritis (RA) and osteoarthritis (OA). However, blind or palpation-based injection can result in inaccurate needle placement and can be challenging for small joints or difficult-to-access joints such as the hip joint. The correct position of the needle with guidance in the target area would improve the efficacy of the procedure and greatly improve the outcome. Compared to conventional fluoroscopic guidance, the advantages of US are that it avoids radiation exposure and the equipment is readily available and less expensive. Knowledge of anatomy and probe positioning, as well as the ability to coordinate the probe and needle are necessary when injecting patients under US guidance. This review describes the general considerations for intra-articular injections under US guidance and includes practical suggestions for the injection of individual joints.

Factors Influencing Corneal Flap Thickness in Laser In Situ Keratomileusis with a Femtosecond Laser

PURPOSE: To evaluate factors responsible for the variability between intended and achieved corneal-flap thickness during femtosecond laser-assisted laser in situ keratomileusis (LASIK). METHODS: A prospective, nonrandomized, case study was performed on 35 eyes of 18 consecutive patients who underwent LASIK surgery using the 60 kHz femtosecond laser microkeratome. Eyes were assigned to three different thickness groups, with 110-, 120-, or 130-microm cut depths. Anterior segment optical coherence tomography was used to assess the morphology of 35 LASIK flaps at postoperative one week postoperatively. The flap thickness was assessed at seven measuring points across each flap. Patient age, preoperative spherical equivalent, manual keratometry, preoperative central pachymetry, and regional variability of the cornea were evaluated to determine where they influenced the achieved corneal flap thickness. RESULTS: Cuttings of all flaps were easily performed without any intraoperative complications. Flap-thickness measurements had a mean of 115.21 +/- 4.98 microm (intended thickness, 110 microm), 121.90 +/- 5.79 microm (intended, 120 microm), and 134.38 +/- 5.04 microm (intended, 130 microm), respectively. There was no significant difference between the 110-microm and 120-microm groups when compared with the 130-microm group (one-way analysis of variance test, p > 0.05). Patients' age, preoperative spherical equivalent, manual keratometry, and preoperative central pachymetry did not affect the achieved flap thickness (Pearson correlations test, p > 0.05). The reproducibility of flap thickness in the central 1.5-mm radius area was more accurate than that in the peripheral 3.0 to 4.0-mm radius area (paired samples t-test, p < 0.05). CONCLUSIONS: Femtosecond laser-assisted LASIK is likely to reproduce a reliable thickness of the corneal flap, which is independent of corneal shape factors or refractive status. Future studies should focus on variations in corneal biomechanical factors, which may also play an important role in determining flap thickness.

A Case of Osteoid Osteoma Presenting with Hip Joint Pain / 대한류마티스학회지

No abstract available.

The First Survey Report on the Current Trends in Prescription of Orthokeratologic Lenses in Korea

PURPOSE: To investigate the current trends in the prescription of orthokeratologic lenses in Korea. METHODS: We sent out an online survey to the members of the Korean ophthalmological Society in December 2007 and March 2008. We received responses from 139 ophthalmologists and analyzed the results of each question. RESULTS: Easy fitting (34.5%) was selected as a major factor in the selection of orthokeratologic lenses. Children between the ages of 10 and 15 years with myopia less than 5 diopter, astigmatism less than 1.5 diopter, and 42 to 45-diopter keratometric value were preferred by most respondents. Decentration (n=74, 59%), corneal erosion (n=35, 25.2%), undercorrection (n=18, 12.9%), and allergy (n=11, 7.9%) were the most frequently encountered problems. 54.7% (n=76) of respondents needed to be fitted twice for trial lenses. The time required for the lens prescription in one patient was more than 30 minutes in 83.5% (n=116) of respondents. 59.7% of the respondents agreed that the lenses had an inhibitory potential on myopic progression, and 81.3% of the respondents said that orthokeratology could substitute for refractive surgery. CONCLUSIONS: There is a possibility of future growth in the use of orthokeratology. It is necessary to provide guidelines and teaching programs for the safe and effective fitting of orthokeratologic lenses.

Interaction between Th1 Cytokine and Th2 Cytokine on the Expression of Chemokine and Adhesion Molecule in Human Mesangial Cells / 대한류마티스학회지

PURPOSE: Predominance of IFN-gamma over Th2 cytokines is evident in proliferative lupus nephritis. Th2 cytokines such as IL-10, or IL-4 have been known to suppress Th1 cytokine driven pro-inflammatory responses. However a combination of cytokines can exert variable effects during the evolution of autoimmune diseases depending on the various factors, such as the stage of diseases or local versus systemic expression. To determine whether Th2 cytokines play a pro- or anti-inflammatory role in the local glomerular inflammation induced by IFN-gamma, we studied the effect of IL-10 and IL-4 on the expression of chemokines and adhesion molecules in human mesangial cells stimulated with IFN-gamma. MEHTODS: Human mesangial cells were obtained from 3 patients undergoing nephrectomy. MCP-1, RANTES, ICAM-1, and CD40 expressions were examined in response to various cytokine stimulation; IFN-gamma, IL-10, IL-4, IFN-gamma+IL-10, IFN-gamma+IL-4, and IFN-gamma+IL-10+IL-4, respectively. Expression of MCP-1 mRNA was analyzed by RT-PCR and the levels of MCP-1 and RANTES in the culture supernatants were measured using an enzyme immunoassay. ICAM-1 and CD40 surface expressions were analyzed by flow cytometry. RESULTS: IFN-gamma increased basal mRNA expression of MCP-1, and IL-10 strongly enhanced the level of MCP-1 mRNA and protein expressions induced by IFN-gamma. IL-4 did not affect significantly on the MCP-1 expression induced by IFN-gamma. Although IFN-gamma increased the concentration of RANTES, IL-10 and IL-4 did not affect IFN-gamma induced RNTES expression. Increased expression of ICAM-1 and CD40 induced by IFN-gamma were not down-regulated by IL-10 or IL-4. CONCLUSION: Taken together, IL-10 appears to augment local inflammatory reaction though the up-regulation of MCP-1 from mesangial cells in the presence of IFN-gamma rather than inhibit inflammatory response in the pathogenesis of proliferative glomerulonephritis.

Autologous Hematopoietic Stem Cell Transplantation in Patients with Refractory Systemic Lupus Erythematosus / 대한류마티스학회지

OBJECTIVE: To determine the safety and efficacy of immune ablation followed by autologous hematopoietic stem cell transplantation (HSCT) in refractory systemic lupus erythematosus (SLE). METHODS: Three patients who had been refractory to steroid and one or more immunosuppressive drug were included. Peripheral blood stem cells were mobilized with cyclophosphamide (CTX, 3 g/m(2)), followed by granulocyte-colony stimulating factor (5mug/kg/day). T lymphocytes were depleted from the graft by selection of CD34 positive cells. Conditioning regimens composed of high dose CTX (total dose 200 mg/kg) and anti-thymocyte globulin (total dose 90 mg/kg) in 2 patients and BEAM (BCNU 300 mg/m(2), etoposide 200 mg/m(2), cytarabine 200 mg/m(2), melphalan 200 mg/m(2)) in 1 patient. Stored stem cells were reinfused 48 hours after conditioning. RESULTS: Among 3 patients, first patient had lupus nephritis, second patient had overlap syndrome combined with rheumatoid arthritis (rhupus) and the last patient had severe thromobocytopenia and intractable polyserositis. No life threatening complications were observed during the treatment. All patients demonstrated rapid and marked improvement in organ function and quality of life just after HSCT. Previous massive proteinuria in first patient was decreased to less than 500 mg/day with 6 months follow up. Rhupus patient satisfied American college of rheumatology 70% response criteria with 3 months follow up. But third patient improved polyserositis dramatically 1 month after HSCT and relapsed at 9 weeks. CONCLUSION: In refractory SLE patients, HSCT can be performed safely with marked improvement and sustained withdrawal of all immunosuppressive medication. A further randomized trial is needed to confirm the efficacy and durability of remission.

Acute Acalculous Cholecystitis Associated with Systemic Lupus Erythematosus with Sjogren's Syndrome

Both systemic lupus erythematosus and Sjogren's syndrome are autoimmune diseases. Almost all organs can be involved but the gall bladder is an unusual site. We report a 39-year-old woman with systemic lupus erythematosus and Sjogren's syndrome presenting with acute acalculous cholecystitis. It is a very rare complication and, in the literature review, surgical interventions are mostly applied for treatment. In our case, high dose corticosteroid was tried and clinical manifestations and radiologic findings were improved.

A Case of Wilson's Disease Presenting and Flare-up as Acute Hemolytic Anemia and Fulminant Hepatitis Features / 대한혈액학회지

Wilson's Disease is a rare familial disorder of abnomalities in hepatic copper metabolism usually presenting with neuropsychiatric or hepatic manifestation. Hemolytic anemia is known as one of its initial clinical manifestation, but that with fulminant hepatitis is a rare presentation of Wilson's disease and so fatal leading always to death, to our best knowledge. This 16-year-old woman was transferred to our hospital with problems of acute Coombs' negative hemolytic anemia and unknown fulminant hepatitis features. She was early diagnosed as complications of Wilson's disease by slit-lamp examination of characteristic Kayser-Fleischer ring and later confirmed by raised serum free copper (55.9microgram/dL, control;< 15 microgram/dL) and 24h urine copper (1,546 microgram/dL, control; 38~70 microgram/dL). She was soon treated with D-penicillamine and pyridoxine with the plan of early liver transplantation. She was fortunately recovered with conservative treatment alone but did have active cirrhosis on consequent liver biopsy. She has been followed up for 7months. Wilson's disease should always be thought in childhood or adolescent patient with Coombs' negative hemolytic anemia and unknown fulminant hepatitis.

A Case of Pseudomembranous Colitis Associated with Neutrocytic Ascites / 대한소화기내시경학회지

Antibiotic associated colitis due to Clostridium difficile is a common infection associated with significant morbidity. In severe cases, Pseudomembranous colitis (PMC) may be associated with intraperitoneal fluid accumulation. Howwver, the characteristics of the liquid are seldom described. This case report describes PMC patients who were presented with low serum-ascites albumin gradients (SAAG)and neutrocytic ascites, without evidence of infectious, malignant, or inflammatory peritoneal disease. The characteristics of their fluid specimens and the possible pathogenic mechanisms are discussed. These findings suggest that PMC without bowel perforation or spontaneous bacterial peritonitis.