More Effective Way to Perform Complete Percutaneous Vertebroplasty for Patients in Kummell’s Disease: A Case Report / 이화의대지

An 84-year-old woman visited our pain clinic with complaints of low back pain and severe radiating pain in the right lower extremity during walking. The patient demonstrated subacute compression fracture of L3 with vacuum change in lumbar spine plain radiographs and MRI which suggest Kummell’s disease. Despite our conservative treatments, she had little back pain relief. Therefore, we planned a percutaneous vertebroplasty. Manual compression could help perform percutaneous vertebroplasty more effectively by expanding the vertebral body. In addition, the spontaneous recovery of vacuum cleft width using negative pressure could help perform the technique more effectively. We successfully performed percutaneous vertebroplasty using these combination therapies for our patient.

More Effective Way to Perform Complete Percutaneous Vertebroplasty for Patients in Kummell’s Disease: A Case Report / 이화의대지

An 84-year-old woman visited our pain clinic with complaints of low back pain and severe radiating pain in the right lower extremity during walking. The patient demonstrated subacute compression fracture of L3 with vacuum change in lumbar spine plain radiographs and MRI which suggest Kummell’s disease. Despite our conservative treatments, she had little back pain relief. Therefore, we planned a percutaneous vertebroplasty. Manual compression could help perform percutaneous vertebroplasty more effectively by expanding the vertebral body. In addition, the spontaneous recovery of vacuum cleft width using negative pressure could help perform the technique more effectively. We successfully performed percutaneous vertebroplasty using these combination therapies for our patient.

The Effect of Stellate Ganglion Block on Breast Cancer-Related Infectious Lymphedema / 한국호스피스완화의료학회지

Breast cancer related lymphedema (BCRL) is one of the most intractable complications after surgery. Patients suffer from physical impairment, as well as psychological depression. Moreover, a recent study revealed that cellulitis significantly increased the risk of BCRL, and cellulitis has been suggested as a risk factor of BCRL development. We describe a patient treated with stellate ganglion blocks (SGBs) without steroid for relief of symptoms and reduction of the arm circumference of breast cancer-related infectious lymphedema in a month. We measured the arm circumference at four locations; 10 cm and 5 cm above and below the elbow crease, numeric rating scale (NRS) score, lymphedema and breast cancer questionnaire (LBCQ) score on every visit to the pain clinic. A serial decrease of the arm circumference and pain score were observed after second injection. In the middle of the process, cellulitis recurred, we performed successive SGBs to treat infectious lymphedema. The patient was satisfied with the relieved pain and swelling, especially with improved shoulder range of motion as it contributes to better quality of life. This case describes the effects of SGB for infectious BCRL patients. SGB could be an alternative or ancillary treatment for infectious BCRL patients.

Halimeter ppb Levels as the Predictor of Erosive Gastroesophageal Reflux Disease

BACKGROUND/AIMS: In a previous issue published in Gut and Liver, we found that erosive changes in the esophagogastroduodenal mucosa were strongly correlated with increased levels of volatile sulfur-containing compounds (VSC), suggesting that halitosis could be a symptom reflecting the erosive status of the upper gut mucosa. Together with other studies showing a possible association between halitosis and gastroesophageal reflux disease (GERD), under the premise that halitosis could be one of extraesophageal manifestations of erosive GERD (ERD), we investigated the significance of Halimeter ppb levels on ERD compared to non-erosive gastroesophageal reflux disease (NERD). METHODS: Subjects were assigned to the NERD group if there was no evidence of esophageal erosive changes on endoscopy, despite reflux symptoms, and to the ERD group if they had GERD A, B, C, or D (according to the Los Angeles classification). The VSC levels were measured in all patients with either a Halimeter (before endoscopy) or by gas chromatography of the gastric juices aspirated during endoscopy. RESULTS: The VSC level differed significantly between the NERD and ERD groups (p24 kg/m2 was significantly associated with ERD, there was no correlation with Halimeter ppb levels. Minimal-change lesions exhibited the highest VSC levels, signifying that minimal change lesions can be classified as ERD based on our finding that halimeter ppb levels were descrimitive of erosive change. CONCLUSIONS: Erosive changes in the esophageal mucosa were strongly associated with VSC levels, supporting the hypothesis that halitosis can be a potential biomarker for the discrimination between ERD and NERD, reflecting the presence of erosive change in the lower esophagogastric junction.

A Case of Hamartomatous Polyp without Peutz-Jeghers Syndrome Arising from Appendix / 대한소화기내시경학회지

Peutz-Jeghers syndrome is a familial syndrome consisting of mucocutaneous pigmentation and gastrointestinal polyposis and appears to be inherited as a single pleiotropic autosomal dominant gene with variable and incomplete penetrance. Cases of hamartomatous polyps of the Peutz-Jeghers type without Peutz-Jeghers syndrome have only rarely been reported. Moreover, only one case of a Peutz-Jeghers polyp at the appendix has been reported; it was resected by appendectomy. We report here on a case of a 45 year old man who had a hamartomatous polyp of the Peutz-Jeghers type arising from the appendix. The polyp was successfully removed by endoscopic polypectomy. To our knowledge, this is the first case of a hamartomatous polyp of the Peutz-Jeghers type that originated from the appendix and that was resected endoscopically.

Concurrent Malignant Carcinoid Tumor and Benign Carcinoid Tumor of the Rectum / 대한소화기내시경학회지

Neuroendocrine cells are distributed throughout the body and they are found in the gastrointestinal tract, pancreas, lung, thyroid, adrenal gland and many other organs, and especially the gastrointestinal tract. As a consequence, neuroendocrine tumors of the colon and rectum are common neoplasm. Several cases of the benign carcinoid tumor and a few cases of the malignant carcinoid tumor of the colon and rectum have been reported. Yet there have been no reports on concurrent malignant carcinoid tumor and benign carcinoid tumor at the same site of the colon. A 60-year-old man presented with an asymptomatic rectal mass. After the mass was evaluated and operated on, it was confirmed to be a concurrent malignant carcinoid tumor and benign carcinoid tumor of the rectum, and metastasis to the liver was also found.

Volatile Sulfur Compounds as a Predictor for Esophagogastroduodenal Mucosal Injury

BACKGROUND/AIMS: Halitosis is a symptom that bothers patients more socially than medically and its pathogenic mechanisms are unclear and treatment armamenterium is limited. Clinicians generally ignored active interventions. Since halitosis is closely associated with volatile sulfur compounds (VSCs), we used a Halimeter and gas chromatography to measure VSCs in patients with Helicobacter-pylori (H. pylori)-associated gastric diseases. METHODS: We categorized 72 patients with H. pylori infection into two groups based on their endoscopic findings: a non-erosive mucosal group (NE, n=24) and an erosive mucosal group (E, n=48). Halitosis was objectively assessed by applying either a Halimeter to breath air or gas chromatography to gastric juice. Simultaneously, the expression of VSC-generating enzyme was measured with reverse-transcriptase PCR using mRNA isolated from biopsy tissues. RESULTS: The levels of VSCs in exhaled breaths or aspirated gastric juices differed significantly between the NE and E groups (p<0.00001), suggesting that VSCs might reflect eroded epithelial damage induced by H. pylori infection. The expressions of cystathionine beta-synthase (CBS) and cystathionine gamma-lyase (CSE) were broadly consistent with the degree of mucosal injury. CONCLUSIONS: Erosive changes in esophagogastroduodenal mucosa were strongly correlated with increased VSC levels, suggesting that halitosis might result from H. pylori-associated erosive lesions.

A Case of Central Vein Stenosis in a Hemodialysis Patient with History of Humerus Osteomyelitis Ipsilateral to Arteriovenous Fistula / 대한신장학회잡지

Central vein stenosis (CVS) is a serious complication in hemodialysis patients mostly related to central vein catheterization. Although rare, CVS may also develop without any previous history of central venous catheterization. Here we report a case of central vein stenosis in a hemodialysis patient with the history of humerus osteomyelitis ipsilateral to arteriovenous fistula. The patient did not have any previous history of central vein catheterization. She received radial artery-cephalic vein fistula operation for maintenance hemodialysis. Venography was performed because of inadequate vein maturation 2 months after the operation. Venography shows complete occlusion of left innominate vein, multiple collateral veins and backflow of left internal jugular vein. After percutaneous transluminal angioplasty with stent insertion, the innominate vein was fully dilated and the collateral vessels completely disappeared.

A Case of Aortic Arch Thrombus Associated with Acute Pyelonephritis in a Patient with Thrombocythemia / 대한신장학회잡지

Aortic thrombus is a rare but life threatening disorder. The usual causes of aortic thrombus are primary or secondary thrombocythemia, malignancy, atherosclerosis, trauma, and acute infectious disease. Here, we report a case of aortic arch thrombus associated with acute pyelonephritis in a patient with thrombocythemia. A 78-year-old woman was admitted with acute pyelonephritis. A complete blood cell count showed severe thrombocythemia with platelet count of 1, 340, 000/mm3. Chest CT scan demonstrated floating thrombus in the aortic arch. After antibiotic treatement, platelet count decreased to 770, 000/mm3 and aortic thrombus disappeared without thrombolytic therapy.

A Case of Allopurinol Hypersensitivity Syndrome in a Patient with Chronic Renal Failure / 대한신장학회잡지

Allopurinol hypersensitivity syndrome is a rare but life-threatening complication. We here report a case of allopurinol hypersensitivity syndrome manifested with irreVersible change of renal function and severe toxic epidermal necrolysis in a patient with chronic renal faiure. A 29-year-old male patient with chronic renal failure due to chronic glomerulonephritis presented with high fever and skin rash. He had been taking allopurinol for 6 weeks due to asymptomatic hyperuricemia. Blood chemistry showed severe hepatic dysfunction and aggrevated renal function. Skin biopsy revealed consistent findings with allopurinol hypersenstivity syndorme. Allopurinol was discontinued and steroid was instituted. His cutaneous lesion and high fever, and hepatic dysfunction improved but renal function irreversibly progressed in end stage renal failure requiring maintenance hemodialysis treatment.

Relationship Between Skeletal Maturity and Body Composition in Boys Aged 9 ~12 Years / 체질인류학회지

The aims of this study were to investigate the present status of skeletal maturation and to compare body composition parameters on the basis of the levels of skeletal maturity in boys aged 9 ~12 years. The subjects participated consisted of 258 elementary school boys. Anthropometric characteristics included body weight, height, sitting height, bone widths, circumferences, and skinfold thicknesses. Skeletal maturation was assessed by the Tanner -Whitehouse II method. Skeletal age was determined by RUS scores (radius, ulna, and short bones). Body composition variables were evaluated by bioelectrical impedance analysis (BIA Model 310). Means and standard deviations were calculated by descriptive statistics. To compare body composition variables among skeletal maturity groups one -way analysis of variance (ANOVA) was applied and Duncan's a posteriori tests. The results showed that RUS scores varied from 298.2 for 9 years to 482.6 for 12 years. TW2 -20 scores were 569.2 for 9 years, 628.8 for 10 years, 701.8 for 11 years, and 814.5 for 12 years. Skeletal ages were 9.7 for 9 years, 10.5 for 10 years, 11.7 for 11 years, and 13.6 for 12 years. It indicates that chronological age was lower than skeletal age in all age groups. Although no significant difference was found in 12 years for body composition according to the levels of skeletal maturity, in general advanced boys had higher body composition variables than retarded boys. In 9 years there were significant differences (p 0.05) among skeletal maturity groups for body mass index, WHR, and WTR. Also, differences were found in 10 years for percent body fat, fat -free mass, and body mass index. In 11 years advanced children (40.4 kg) have statistically significant (p 0.05) higher fat -free mass than retarded children (32.2 kg).

Interaction of HIV-1 core p24 antigen with human monocytic cell line THP1 results in TNF-alpha dependent secretion of matrix metalloproteinase-9

Immunological mechanisms involving the release of inflammatory factors by HIV-1 infected microglia in the brain have been implicated in the pathogenesis of HIV dementia (HIVD). Since the regulation of matrix metalloproteinases (MMPs) activity can be influenced by variety of inflammatory mediators, this study was undertaken to look for a correlation between the MMP-9 release and the production of TNF-alpha in response to HIV-1 p24 in the human monocyte cell line THP-1 as a model for microglia. First, it was shown that HIV-1 core p24 antigen induced THP-1 to secrete MMP-9 in a dose response manner while it elicited a little effect on MMP-2 release in human astroglial cell line T98G. Next, it was found that p24 induced THP-1 to secrete TNF-alpha without prior differentiation into macrophages by phorbol myristate acetate (PMA) treatment. Furthermore, anti-TNF-alpha neutralizing antibodies significantly blocked p24-induced MMP-9 release in a dose dependent manner. Our data indicate that p24 antigen induces monocytic MMP-9 release by triggering up-regulation of TNF-alpha secretion.