Postoperative Intravenous Ferric Carboxymaltose Reduces Transfusion Amounts after Orthopedic Hip Surgery

BACKGROUND: This retrospective study was performed to determine whether postoperative intravenous ferric carboxymaltose reduces transfusion amounts without influencing clinical outcomes in patients that have undergone hip surgery. METHODS: Between May 2014 and April 2016, the authors adopted a new perioperative blood management protocol involving the administration of intravenous ferric carboxymaltose after hip surgeries. One-to-one matching between the 150 patients treated during this period with 150 patients treated before initiation of the new protocol was performed by propensity scoring for age, sex, diagnosis, and type of hip surgery. Hematologic results and clinical outcomes in these two groups were compared. RESULTS: Average amounts of perioperative blood loss were not different in the two groups. Ninety-two patients (61%) were transfused in the control group and 70 patients (47%) were transfused in the intravenous ferric carboxymaltose group. The average number of transfused blood units was significantly lower in the intravenous ferric carboxymaltose group (1.7 ± 2.7 units vs. 1.0 ± 1.2 units, p = 0.002). At 6 weeks after surgery, the average hemoglobin concentration recovered to baseline in both groups, but the amount of recovered hemoglobin concentration at 6 weeks was significantly greater in the intravenous ferric carboxymaltose group than in the control group. Clinical outcomes including incidences of postsurgical complications were similar between the two groups. CONCLUSIONS: This study suggests that postoperative intravenous ferric carboxymaltose injection is associated with reduced transfusion amounts and that intravenous ferric carboxymaltose does not influence clinical outcomes after hip surgery.

Displaced Double-Layered Lateral Meniscus That Mimicked the Bucket-Handle Tear: a Case Report

Among the various types of congenital meniscal anomalies, the double-layered lateral meniscus is extremely rare. The double-layered meniscus consists of both the upper additional and the lower normal meniscus. As the upper additional meniscus is mobile, it can be easily displaced, while the lower lateral meniscus is usually normal in shape and volume. A 42-year-old woman suffering from pain and locking of her left knee underwent Magnetic resonance imaging (MRI) examination and an arthroscopic surgery. A rare meniscal abnormality was seen in her left knee, which presented as a double-layered lateral meniscus with displacement. It was remarkable that the upper additional meniscus was displaced over the intercondylar eminence of the tibia and it mimicked a bucket-handle tear. Even though it is rare, it is necessary to consider the possibility of displaced double-layered meniscus in the differential diagnosis of a bucket-handle tear. Here, we report the MRI and arthroscopic findings of a displaced double-layered lateral meniscus, which was similar to the bucket-handle tear.

Preliminary Experience Using Dynamic MRI at 3.0 Tesla for Evaluation of Soft Tissue Tumors

OBJECTIVE: We aimed to evaluate the use of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) at 3.0 T for differentiating the benign from malignant soft tissue tumors. Also we aimed to assess whether the shorter length of DCE-MRI protocols are adequate, and to evaluate the effect of temporal resolution. MATERIALS AND METHODS: Dynamic contrast-enhanced magnetic resonance imaging, at 3.0 T with a 1 second temporal resolution in 13 patients with pathologically confirmed soft tissue tumors, was analyzed. Visual assessment of time-signal curves, subtraction images, maximal relative enhancement at the first (maximal peak enhancement [Emax]/1) and second (Emax/2) minutes, Emax, steepest slope calculated by using various time intervals (5, 30, 60 seconds), and the start of dynamic enhancement were analyzed. RESULTS: The 13 tumors were comprised of seven benign and six malignant soft tissue neoplasms. Washout on time-signal curves was seen on three (50%) malignant tumors and one (14%) benign one. The most discriminating DCE-MRI parameter was the steepest slope calculated, by using at 5-second intervals, followed by Emax/1 and Emax/2. All of the steepest slope values occurred within 2 minutes of the dynamic study. Start of dynamic enhancement did not show a significant difference, but no malignant tumor rendered a value greater than 14 seconds. CONCLUSION: The steepest slope and early relative enhancement have the potential for differentiating benign from malignant soft tissue tumors. Short-length rather than long-length DCE-MRI protocol may be adequate for our purpose. The steepest slope parameters require a short temporal resolution, while maximal peak enhancement parameter may be more optimal for a longer temporal resolution.

Painful Os Peroneum Syndrome Presenting as Lateral Plantar Foot Pain

Lateral plantar foot pain can be caused by various entities, and the painful os peroneum syndrome should be considered in the differential diagnosis. Recent developments in musculoskeletal ultrasonography are very useful for initial diagnosis. We discuss a 69-year-old female who experienced lateral plantar foot pain for over one month. Through physical examination, radiography, ultrasound and magnetic resonance imaging, she was diagnosed with the painful os peroneum syndrome with a chronic fatigue fracture of multipartite os peroneum and peroneus longus tenosynovitis, for which she underwent surgery. We herein report this rare condition and reviewed the relevant literature.

Ultrasound and MR Findings of Aleukemic Leukemia Cutis in a Patient with Complete Remission of Acute Lymphoblastic Leukemia: A Case Report

Aleukemic leukemia cutis is an extremely rare condition characterized by the infiltration of leukemic cells in skin without blasts in the peripheral blood. Leukemia cutis is considered a grave prognostic sign, thus early diagnosis is important. Leukemia cutis usually occurs in patients with myeloid leukemia. To the best of our knowledge, there has been no report regarding the radiological findings of aleukemic leukemia cutis, which is probably due to the presence of the skin changes in most patients. We report the ultrasound and MR findings of aleukemic leukemia cutis, even without the skin manifestation in patients with a history of complete remission of the acute lymphoblastic leukemia following an allogeneic peripheral blood stem cell transplantation.

Hearing Abilities at Ultra-High Frequency in Patients with Tinnitus

OBJECTIVES: To compare tinnitus patients who have normal hearing between 250 Hz and 8 kHz with normal controls with regard to the ability of each group to hear extended high-frequency pure tone thresholds. METHODS: We enrolled 18 tinnitus patients, each of whom had a threshold of HL <25 dB and threshold differences of <10 dB between ears at frequencies of 250 and 500 Hz and 1, 2, 4, and 8 kHz. We also enrolled age- and gender-matched normal volunteers (10 ears), for each patient. Extended high frequency pure tone audiometry was performed, and the mean hearing thresholds at 10, 12, 14, and 16 kHz of each tinnitus ear were compared with those of the 10 age- and sex-matched normal ears. RESULTS: Of the 18 patients with tinnitus, 12 had significantly increased hearing thresholds at more than one of the four high frequencies, compared with the normal group. When we assessed results according to frequency, we found that 8 patients had decreased hearing ability at 10 kHz, 10 at 12 kHz, 8 at 14 kHz, and 4 at 16 kHz. CONCLUSION: Some patients with tinnitus who have normal hearing below 8 kHz have decreased hearing ability at extended high-frequencies. Thus, the proportion of patients with tinnitus who have normal hearing over the entire audible range is smaller than in previous reports.

Thoracic Intramedullary Schwannoma Aggravated on Follow-up MRI: Case Report and Review of the Literature

Schwannoma is a rare intramedullary tumor. There has been no reported case about interval aggravation on follow-up MR imaging. We report initial and follow-up MR findings of a thoracic intramedullary schwannoma with syringomyelia and edema in a patient without neurofibromatosis. Intramedullary schwannoma should be included for differential diagnosis of intramedullary tumor even though followup MR imaging shows interval increase in size of the tumor and extent of associated edema to mimic malignancy.

A Case of Bilateral Congenital Middle Ear Cholesteatoma / 대한이비인후과학회지

The incidence of congenital middle ear cholesteatoma in children has increased recently for the following reasons: developed diagnostic instruments and increased awareness of congenital middle ear cholesteatoma. But bilateral congenital middle ear cholesteatoma is still a rare disease entity. The patient was a 3-year-old male with delayed language development. A whitish bulging mass was presented behind the anterior superior quadrant of right tympanic membrane and the left side lesion was detected on CT scan. Bilateral explotympanotomy were performed simultaneously and cholesteatomas were removed from both middle ear cavities. In the left side case, the cholesteatoma matrix was spreading diffusely and the ossiculoplasty with total ossicular replacement prosthesis was needed. There has been no evidence of recurrence up to 6 months following the surgery. We report this case with a review of literature.

A Case of Primary Hyperparathyroidism in Child Presented with Acute Abdominal Pain / 대한소아내분비학회지

Primary Hyperparathyroidism is the metabolism abnormality of calcium, phosphate, and bone due to the high synthesis of parathyroid hormone, a rare endocrine disease in children. It scarcely occurs in children so that till now it was reported only 4 cases in Korea, especially with abdominal symptoms. We report this case of primary hyperparathyroidism with brief review of literatures.

A Case of Ameloblastic Fibrodentinoma in Nasal Floor / 대한이비인후과학회지

Ameloblastic fibrodentinoma is an extremely rare benign tumor composed of odontogenic epithelium and stroma with dentin. It usually arises in the posterior mandible (maxilla-mandible ratio 1:3) and is commonly associated with the unerupted molar teeth of young adults, adolescents and children. It mainly affects people younger than 4th decades of age and is found more commonly in males than in females. Ameloblastic fibrodentinoma usually grows slowly without any symptoms, but sometimes it may grow rapidly. Radiographically, it shows well-delineated radiolucency, but it may be seen as a radiopaque mass in its mature stage. Ameloblastic fibrodentinoma of nasal floor is an extremely rare entity and no document in the literature was found. Recently, we experienced a case of ameloblastic fibrodentinoma of nasal floor which was confirmed by excisional biopsy. Thus, for the first time in Korea, we report a case of ameloblastic fibrodentinoma of the nasal floor with a review of literature.

Efficacy of Benzodiazepines to Laryngopharyngeal Reflux: A Double-Blind, Randomized Controlled Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Anti-anxiety drugs such as benzodiazepines are often given to globus patients in practice, based on the notion that globus is a kind of somatization disorder. However, many of globus are caused by laryngopharyngeal reflux (LPR) and the effects of anti-anxiety drugs to LPR are unknown. The study goal was to assess the efficacy of benzodiazepines to LPR. SUBJECTS AND METHOD: We selected 51 LPR patients, who were confirmed by 24-hour double-probe ambulatory pH monitoring. Patients were allocated into case and control groups at random and entered into a double-blind trial. Patients in the control group received proton pump inhibitors and prokinetics. Diazepam was added to patients in the case group. Assessments were made after 4 weeks of treatment using reflux symptom index (RSI) and reflux finding score (RFS). RESULTS: In both groups, RSI and RFS were improved significantly at the end of the study. However, there was no significant difference between the two groups. CONCLUSION: Diazepam seems to have little efficacy in the treatment of LPR.

Mammographic and Sonographic Findings of Metaplastic Carcinoma of the Breast

PURPOSE: To demonstrate the mammographic and sonographic appearances of metaplastic carcinoma of the breast. MATERIALS AND METHODS: The mammographic and sonographic findings in eight female patients (aged: 28-78 years, mean: 50.3 years) with pathologically proven metaplastic cancer were analyzed retrospectively by three radiologists. We analyzed the size, density, shape, margin, associated architectural distortion, calcification in the mass and enlarged lymph node at the axilla, on the mammograms. We also analyzed the shape, margin and echogenicity of the lesions on the sonograms. RESULTS: On mammography, irregular (n=4), lobular (n=2) or oval (n=2) shaped high density masses were found. The margins of the masses were indistinct (n=4) or obscured (n=3). There were architectural distortions in three cases and pleomorphic calcifications in two cases. On sonography, irregular (n=5) or oval (n=3) shaped masses with microlobulated margins were found. The echopatterns of the masses were complex (n=5) or hypoechoic (n=3). CONCLUSION: The mammographic and sonographic findings of metaplastic carcinoma of the breast are nonspecific and similar to those of other forms of breast cancer. However, this type of tumor should be included in the differential diagnosis for breast masses which appear as an irregular or oval shape with a microlobulated margin and a complex or hypoechoic echopattern on sonography.

The Usefulness of Serum Transferrin Receptor in Anemia with Rheumatoid Arthritis: Comparison with Bone Marrow Iron Store / 대한류마티스학회지

OBJECTIVE: This study was aimed at investigating the usefulness of serum transferrin receptor (sTfR) in anemic patients with rheumatoid arthritis (RA) compared with bone marrow storage iron and other tests for anemia. METHODS: Fifty-five anemic RA patients were undergone anemia study including hematologic indices, iron panel, and sTfR. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were also measured. Eighteen patients performed marrow iron stain. The sTfR and serum ferritin levels were compared with bone marrow iron store, hematologic values, iron batteries, and markers of the disease activity. RESULTS: 1) Mean sTfR concentration was 2.68+/-1.29mg/L in all patients. 2) sTfR correlated significantly with hemoglobin concentration (r=-0.491; p<0.001), hematocrit (r=-0.348; p=0.009), MCV (r=-0.597; p<0.001), RDW (r=0.696; p<0.001), serum iron (r=-0.389; p=0.003), and transferrin saturation (r=-0.451; p=0.001) 3) Ferritin did not correlated significantly with hemoglobin, hematocrit, serum iron/TIBC, MCV and RDW, except reticulocyte count (r=0.295; p=0.032) and total iron binding capacity (TIBC) (r=-0.503; p<0.001). 4) sTfR showed no significant correlation with ESR and CRP, whereas ferritin correlated with CRP (r=0.342; p=0.019). 5) Among the patients who performed iron staining from bone marrow, sTfR was higher in ?ron-depleted? group compared with ?ron replete? group (p=0.040). CONCLUSION: This study suggests that measurement of sTfR may be useful assay for anemia and the possible substitute for invasive bone marrow study in differentiating iron deficiency anemia from anemia of chronic diseases in patients with RA.

The Usefulness of Serum Transferrin Receptor in Anemia with Rheumatoid Arthritis: Comparison with Bone Marrow Iron Store / 대한류마티스학회지

OBJECTIVE: This study was aimed at investigating the usefulness of serum transferrin receptor (sTfR) in anemic patients with rheumatoid arthritis (RA) compared with bone marrow storage iron and other tests for anemia. METHODS: Fifty-five anemic RA patients were undergone anemia study including hematologic indices, iron panel, and sTfR. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were also measured. Eighteen patients performed marrow iron stain. The sTfR and serum ferritin levels were compared with bone marrow iron store, hematologic values, iron batteries, and markers of the disease activity. RESULTS: 1) Mean sTfR concentration was 2.68+/-1.29mg/L in all patients. 2) sTfR correlated significantly with hemoglobin concentration (r=-0.491; p<0.001), hematocrit (r=-0.348; p=0.009), MCV (r=-0.597; p<0.001), RDW (r=0.696; p<0.001), serum iron (r=-0.389; p=0.003), and transferrin saturation (r=-0.451; p=0.001) 3) Ferritin did not correlated significantly with hemoglobin, hematocrit, serum iron/TIBC, MCV and RDW, except reticulocyte count (r=0.295; p=0.032) and total iron binding capacity (TIBC) (r=-0.503; p<0.001). 4) sTfR showed no significant correlation with ESR and CRP, whereas ferritin correlated with CRP (r=0.342; p=0.019). 5) Among the patients who performed iron staining from bone marrow, sTfR was higher in ?ron-depleted? group compared with ?ron replete? group (p=0.040). CONCLUSION: This study suggests that measurement of sTfR may be useful assay for anemia and the possible substitute for invasive bone marrow study in differentiating iron deficiency anemia from anemia of chronic diseases in patients with RA.

CD34 Analysis according to ISHAGE Guideline / 대한혈액학회지

BACKGROUND: Flow cytometric analysis for CD34 has been widely used for hematopoietic stem cell enumeration. The procedure is simple and rapid for clinical use but the lack of standardization resulted in great intralaboratory variations. In 1995, a guideline for CD34 analysis was established by International Society of Hematotherapy and Gene Engineering (ISHAGE) for reliable testing. We performed CD34 analysis using the ISHAGE guideline in umbilical cord blood (UCB), mobilized peripheral blood (MPB) and leukapheresis product (LP) and compared the results with those of in-house method. METHODS: CD34 analyses were performed in thirty units each of UCB, MPB and LP according to the ISHAGE guideline and in-house method and the results were analyzed by the t-test. Both methods used CD45FITC/CD34PE and its isotype controls. In ISHAGE guideline, among CD34+/ CD45+ cells, only those with low forward scattering, low to intermediate side scattering and low to intermediate CD45 fluorescent intensity were identified as stem cells, and the percentage of those cells among CD45+ cells was calculated. In in-house method, cells expressing both CD34 and CD45 antigens were selected by isotype control and the percentage of CD34+/CD45+ cells among CD45+ cells were calculated. RESULTS: Significant differences were observed in the percentages of CD34+ cells in UCB, MPB and LP between ISHAGE guideline (0.25%, 0.42%, 0.80%) and in-house method (0.40%, 0.55%, 1.20%) (P<0.001). So were the CD34+ cell counts : mean values of CD34+ cells in microliter of UCB, MPB and LP were 20, 40, 1,392 by ISHAGE guideline, and 35, 62, 2,079 by in-house method (P<0.001). CONCLUSION: ISHAGE guideline for CD34 enumaration was considered as a simple, rapid and reliable method for clinical setting and to have economic benefits because no additionalmonoclonal antibodies were required.

A Case of Pulmonary Blastoma

Pulmonary blastoma is a rare type of malignant lung tumor comprised of epithelial and mesenchymal elements reminiscent of fetal lung. Mesenchymal element may show various patterns of differentiation toward mature tissue, such as cartilage, smooth muscle, and bone. Rhabdomyoblastic differentiation in pulmonary blastoma is quite rare. Our case of pulmonary blastoma with rhabdomyoblastic differentiation documented by electron microscopy and immunohistochemistry. Usually it has been treated with surgery, but both chemotherapy and radiotherapy have been used against the metastatic disease, and as the adjuvant setting. A 28/12-year-old girl is described who was presented with pulmonary blastoma. She underwent surgical excision of the tumor, followed by the T2protocol, a 8 cycles of combination chemotherapy consisting of actinomycin-D, adriamycin, vincristine and cyclophosphamide with the radiation therapy to the left chest cage(180cGyx11 times). The patient has been off therapy without any evidence of relapse for 24 months. We report a case of pulmonary blastoma with brief review of related literatures.

Clinical Analysis on Various Fractures of the Axis

This retrospective analysis describes the clinical characteristics, treatment, and outcome of 15 patients with C2 fracture. The Age of the patients varied from 28 to 71. There were only two female patients whose mean age was 25.5 while the mean age of 13 male patients was 44.6. Five patients showed odontoid process fracture, three had C2 body fracture and the remainder were traumatic spondylolisthesis of the axis. The fractures were caused by falls in two patients(13.3%) while in 11 patients(73.3%) they were associated with motor-vehicle accidents. The other two patients were injured by falling objects. No patients suffered a neurological injury associated with the fracture. Three patients are still hospitalized, and follow-up was lost for 2 patients. In 10 patients mean follow-up period was 7 months. External immobilization with halovest was done on all patients. Additionally, anterior interbody fusion was done on 1 patient(Case No. 3). All patients showed the union radiologically, and resumed routine activity. Only 4 of them complained minor limited range of motion of the neck.