Diagnosis of Spinal Metastasis: Usefulness of Additional Diffusion-Weighted Imaging

PURPOSE@#To determine the usefulness of diffusion weighted-MRI (DW-MRI) in the evaluation of spinal metastasis.@*MATERIALS AND METHODS@#From July to August 2017, 48 whole-spine DW-MRI to detect metastasis in patients with extra-spinal tumors were retrospectively evaluated by three radiologists. The usefulness of DW-MRI was evaluated in four groups based on the change in confidence rating between two sessions: 1 (T1- and T2-weighted and contrast-enhanced images) and 2 (additional DW-MRI). The associations of the usefulness with age, sex, primary cancer, bone type with metastasis, number of probable metastatic segments in session 1, and anatomic locations were assessed in vertebral body and posterior element cases.@*RESULTS@#According to the readers 1, 2, and 3, there were 18, 19, and 16 vertebral body cases, respectively, and 12, 13, and 9 posterior element cases, respectively. In the group with no excepted metastasis, DW-MRI was useful in 52–59% of vertebral body cases and 39–67% of posterior element cases. There were no significant differences in the usefulness with respect to the number of probable metastatic segments in session 1, age, sex, primary cancer, bone type with metastasis, or anatomic location.@*CONCLUSION@#DW-MRI could be used to evaluate spinal metastasis. However, there were no differences in the usefulness with respect to the anatomic location.

Treatment of 5th Metacarpal Neck Fracture Using Percutaneous Transverse Fixation with K-Wires

PURPOSE: To evaluate the radiologic and clinical results of percutaneous transverse fixation with K-wires for 5th metacarpal neck fracture. MATERIALS AND METHODS: Between January 2007 and September 2010, 18 patients with a 5th metacarpal neck fracture, who underwent operative treatment, were included in this study. The surgical method was percutaneous transverse fixation using K-wires. We evaluated fracture angulation in oblique radiographs preoperatively, postoperatively, and at final follow-up, and used SPSS to perform statistical analysis. We also performed clinical evaluation using the Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS: All of the 18 cases were completely united, and in the oblique radiographs, the angulation was corrected from 50.69degrees to 11.68degrees. The average difference between postoperative and final follow-up angulations was 0.14degrees, which was statistically insignificant. Clinically, the DASH score was 1.030 and no complications were observed. CONCLUSION: Percutaneous transverse fixation using K-wires could be one of the best ways to treat a 5th metacarpal neck fracture because of its simple method and low rate of complications.

Interfering Factors of Breastfeeding in the Postpartum Care Centers / 대한주산의학회잡지

PURPOSE: Recently, mothers stay in postpartum care centers (PPCCs) instead of their home for a few weeks after child birth in Korea. The policies of breastfeeding in those facilities can affect the success of breastfeeding. We studied the breastfeeding practice of mothers who stayed in PPCCs and the policies of these facilities. METHODS: We conducted a survey using questionnaires about breastfeeding practice on mothers who visited the Departments of Pediatrics of Cheil General Hospital, Yeungnam University Hospital, Dongsan Medical Center and Chonnam University Hospital, from February 2010 to July 2010. We also conducted another survey on the PPCCs. RESULTS: We collected 349 replies from mothers and 151 responses from PPCCs. 97.4% of mothers had been encouraged breastfeeding, but only 60.3% of mothers practiced rooming-in care, and only 15.2% of them performed it for 24 hours. Milk bottle was used in 92.6% to supply formula instead of cup or spoon. 54.8% of mothers used breast pump unnecessarily to collect breast milk to feed their babies using bottle. 77.3% of mothers withheld breastfeeding in case of cracked nipples, mild jaundice or loose stool. Only 18% of personnels in PPCCs was educated about breastfeeding. Educational materials were provided in only 67.1% of PPCCs. Regional difference was noted in rooming-in care, lecture, feeding device for supplementation and breastfeeding in case of mild jaundice, loose stool or cracked nipples. CONCLUSION: Insufficiently trained people in PPCC may make mothers difficult to breastfeed. It is necessary for the people in PPCCs to be educated for breastfeeding appropriately.

Lateral Positioning for Proximal Femoral Nailing of the Intertrochanteric Fracture: Surgical Technique

In the treatment of intertrochanteric fractures, most of intramedullary nailings are performed on a fracture table in supine position. In supine position, however, soft tissue mass of the patients and drapes make it difficult to access to the piriformis fossa and to straighten the trajectory of reamer and nail insertion. To resolve these problems, we have treated twenty intertrochanteric fractures in lateral position on the general operation table with IM nail. Adjustment of the position of lag screw in femoral head was done with the technique that overlaps the shadows of the femoral head, nail and targeting guide in the lateral view. Because the entire injured limb can be moved readily, it was easy to reduce fracture and to convert to open procedure. In cases likely that the fracture table is unavailable in which patients are obese, have short stature or are amputated, and that open procedure is strongly likelihood, lateral position will be helpful technique in the treatment of intertrochanteric fractures with IM nail.

Annular Lupus Vulgaris Mimicking Tinea Cruris

Cutaneous tuberculosis is an infrequent form of extrapulmonary tuberculosis. It is often clinically and histopathologically confused with various cutaneous disorders. A 36-year-old man attended our clinic with slowly progressive, asymptomatic, annular skin lesions on both the thighs and buttocks for 10 years. He consulted with many physicians and was improperly treated with an oral antifungal agent for several months under the diagnosis of tinea cruris, but no resolution of his condition was observed. A diagnosis of lupus vulgaris was made based on the histopathologic examination and the polymerase chain reaction assay. Anti-tuberculosis therapy was administered and the lesions started to regress.

Poststeroid Panniculitis in an Adult / 대한피부과학회지

Poststeroid panniculitis is a very rare complication of corticosteroid therapy, and this is characterized by firm subcutaneous nodules on the cheek, neck or upper trunk within days or weeks following rapid systemic steroid tapering or cessation in childhood. It can be identified by the clinical features and a history of using steroid, and if necessary, with a biopsy. There have been just 2 reported cases in adulthood, one was an autopsy case of a 28-year woman and another was a 60-year-old man after massive administration of corticosteroids for congestive heart failure. Herein, we report a case of panniculitis accompanied by Cushing's syndrome in an adult after long-term misuse of systemic steroid for rosacea.

Rare Normal Variation Between Biceps Anchor and Superior Labrum: A Case Report

PURPOSE: Labral lesions and its anatomic variants have been studied by several authors in the last decade. Buford complex and sublabral recess are most common variants. Their recognition is important in order to distinguish them from superior and anterior labral tear. MATERIALS AND METHODS: We report one case of a 19-year-old female who was mistaken SLAP lesion for normal variant and was treated with arthroscopic surgery. RESULTS: The arthroscopic finding shows rare normal variant of biceps anchor and superior labrum. The biceps long head tendon was inserted at superior labrum and supraspinatus tendon area. This finding was mistaken to SLAP lesion. CONCLUSION: We report rare normal variant of biceps anchor and superior labrum that was observed during arthroscopic surgery for SLAP lesion.

MRI Measurement of the Distal Femur for Determining the Rotational Alignment in TKA

PURPOSE: The purpose of the current study was to investigate the relationship between the angles made by the reference axes on the axial magnetic resonance (MR) images and to provide information for determining the rotational alignment of the femoral component in total knee arthroplasty. MATERIALS AND METHODS: We analyzed 194 magnetic resonance (MR) images to measure the posterior condylar angle, the condylar twist angle and the difference between the posterior condylar angle and the condylar twist angle. We then evaluated the relationship between these angular measurements. RESULTS: The condylar twist angle averaged 6.09degrees, the posterior condylar angle averaged 2.95degrees and the difference between the posterior condylar angle and the condylar twist angle was 3.14degrees. There were no differences in these angles based on gender and age. CONCLUSION: In the cases that the center of the medial epicondyle is difficult to clearly identify during TKA, the femoral rotational resection angle can be determined by subtracting 3degrees from the condylar twist angle.

Early Dislocation Rate with Large Femoral Heads in Primary Total Hip Arthroplasty

PURPOSE: To compare the incidence of early dislocation in a series of a small femoral heads with a series of larger femoral heads. MATERIALS AND METHODS: This study analyzed 84 primary total hip arthroplasties, which were performed between January 2002 and January 2006 and were followed more than 6 months. The cases were divided into two groups, a smaller head group (28 & 32 mm) and a larger head group (36 mm). The incidence of dislocation was recorded for both groups during the first 3 months after surgery. The probability that the incidence of dislocation between both groups was significantly different from the expected dislocation rate was assessed based on the assumed risk of an early dislocation of 2%. The two groups were compared with regard to the size of the acetabular cup. RESULTS: There were 6 early dislocations in the smaller head group, while no dislocations occurred in the larger head group. The incidence of expected dislocation, assuming a 2% dislocation rate, was similar for the smaller head group but different for the larger head group. The size of the acetabular cup was similar in both groups. CONCLUSION: These results highlight the advantage of a larger femoral head in reducing the early dislocation rates.

Clinical features and prognostic factors in Korean patients hospitalized for coronary artery disease (Catholic Heart Care Network Study) / 대한내과학회지

BACKGROUND: Coronary artery disease (CAD) has recently become one of the major causes of mortality and morbidity in Korea. However, not much epidemiologic and demographic data has yet been reported. The purpose of this study was to investigate the clinical features as well as the prognostic factors of patients with CAD. METHODS: We prospectively enrolled 1,665 consecutive patients with CAD who had been admitted to the Catholic University Hospitals from December 1999 to April 2003. RESULTS: Acute myocardial infarction (AMI) was the most common cause of admission (n=715, 42.9%). Dyslipidemia, hypertension and smoking were the most common risk factors. More than 70% of the patients who underwent percutaneous coronary intervention (PCI) received stent implantation. A total of 965 (612 males) patients were followed at least for 6 months (the mean follow-up duration was 23.8+/-12.2 months). The incidence rates of major adverse cardiac events (MACE: cardiac death, acute myocardial infarction, target vessel revascularization) and cardiac death were 15.1% (n=146) and 2.2% (n=21), respectively. There was no difference in overall survival between the patients treated with medical therapy and those treated with PCI. By Cox regression analysis, the independent prognostic factors for MACE were PCI (95% CI: 1.75-4.85; p<0.01) and multivessel disease (95% CI: 1.03-2.04; p<0.05), and the independent prognostic factors for cardiac death were medical therapy (95% CI: 1.08-14.41; p<0.05) and old age (95% CI: 1.13-16.13; p<0.05). CONCLUSIONS: There was no difference in overall survival between the patients treated with medical therapy and those treated with PCI. However, PCI was superior to medical therapy for preventing death of the patients with acute coronary syndrome.

A Case of Multiple Dermatofibromas in a Patient with Systemic Lupus Erythematosus / 대한피부과학회지

Dermatofibroma is a common fibrohistiocytic tumor of the skin. It generally occurs as a solitary lesion. However, some cases of multiple dermatofibromas in immune-compromised patients or patients with abnormal immune status have been reported, hence this phenomenon has been thought to be associated with altered immunity. We present a case of multiple dermatofibromas which developed in a patient with systemic lupus erythematosus, plus a review of the literature.

Dermatofibroma: Unusual Lesion with Underlying Cutaneous Horn / 대한피부과학회지

Cutaneous horn is a nonspecific clinical description and may arise from a variety of benign and malignant lesions. A 46-year-old Korean man presented with a 1-year history of an extensively hyperkeratotic nodule on his left foot. Following an initial diagnosis of dermatofibroma with underlying cutaneous horn by wedge biopsy, the tumor was completely removed by excision with 5 mm margin. When excisional surgery was performed, the size of the dermal tumor mass was found to be 1.3 cm in length on the axis and 0.6 cm in depth on section. On histopathologic examination, the tumor was characterized by spindle-shaped cells arranged in storiform pattern, epidermal hyperplasia, and an overlying compact hyperkeratotic mass. The tumor cells did not express CD34. Cutaneous horn of dermatofibroma may be the product of epidermis-dermal tumor interaction. Although we performed a wide excision for complete removal of the tumor, Mohs micrographic surgery could have been another option.

Erythema Ab Igne Associated with Frequent Bathing of Feet in Hot Water / 대한피부과학회지

Erythema ab igne is a relatively uncommon skin lesion caused by chronic exposure to low levels of infrared heat from open fires or stoves, and is characterized by reticulated hyperpigmentation on the exposed skin. Recently, exposure to various 'new' heat sources, such as heated furniture, car heaters, or even laptop computers, has been reported to cause this condition. We present a case of 31-year-old Korean woman with reticulated hyperpigmentation on her feet, which had occurred due to bathing her feet in hot water on a daily basis.

Reconstruction of Defect on the Nasal Dorsum with Modified Bilateral Rhombic Flap / 대한피부과학회지

The skin over the nose is less mobile for primary closure of defects. In addition to skin graft and secondary intention healing, there are various local flap techniques and their modifications for the reconstruction of nasal defects. Imprecise engineering of wound repair methods and contracture can lead to twisting of the nose and distortion of surrounding anatomic structures such as the nasal ala and paranasal sulcus. The skin defects on the nasal dorsum were reconstructed with a modified bilateral rombic flap. In our case, there were no significant complications and the final result was satisfactory in both functional and cosmetic aspects. Through our experience, we can confirm that the modified bilateral rhombic flap can reconstruct defects on the center area of the nasal dorsum effectively and in a single stage.

A Case of Dariers Disease Treated with Adapalene / 대한피부과학회지

Dariers disease is inherited as an autosomal dominant trait and characterized by follicular pruritic hyperkeratotic papules. The onset is usually in late childhood and the course of the disease is chronic and slowly progressive in most cases. Dariers disease is refractory to treatment with most conventional keratolytics and anti-inflammatory agents. To date, oral and topical retinoid products have been the mainstay therapy for this population, but local as well as systemic side effects often limit their effectiveness. We present a case of localized Dariers disease which responded promptly to the topical application of adapalene 0.1% gel without side effects. A review of treatment for Dariers disease also is presented.

Effect of Transjugular Intrahepatic Portosystemic Shunt for Variceal bleeding in Hepatocellular Carcinoma Patients with Portal Vein Thrombosis / 대한간학회지

BACKGROUND/AIMS: Transjugular Intrahepatic Portosystemic Shunt (TIPS) is commonly used in patients with variceal bleeding. However, this procedure is contraindicated in hepatocellular carcinoma patients with portal vein thrombosis. This study was done to evaluate the effect of TIPS in those patients with variceal bleeding. METHODS: Between 1997 and 2004, six hepatocellular carcinoma (HCC) patients with portal vein thrombosis were enrolled in this study due to their variceal bleeding. All the patients underwent TIPS placement to treat the variceal bleeding that had not responded to endoscopic treatment. Effective shunt creation was assessed by the decrease of the portal pressure gradient (less than 12 mmHg) or if good patency and flow were seen on a doppler examination. RESULTS: Shunts were successfully created in all the patients and the bleeding was immediately controlled in the active bleeding cases. The bleeding was caused by esophageal varices in one patient and, by gastric varices in five patients. The HCC types were diffuse or massive in five patients, and a single nodule was present in one patient. All the patients had portal vein thrombosis. Rebleeding was noted in two patients at 10 days and 3 months, respectively, due to the shunt occlusion. Hepatic encephalopathy was noted in two patients. The causes of death were hepatorenal syndrome after 2 weeks in one patient, bleeding due to portal hypertensive gastropathy after 3 weeks in another, and cancer progression after 4 months in third patient. CONCLUSIONS: For HCC patients with portal vein thrombosis, TIPS can be an effective treatment modality if uncontrolled variceal bleeding presents when using endoscopic hemostasis or pharmacologic therapy. However, further studies are needed.

Local Flaps for Reconstruction of Nasal Defects / 대한피부과학회지

BACKGROUND: The skin over the nose is not relatively less mobile for primary closure of nasal defects. In addition to skin grafts and secondary intention healing, there are various local flap techniques available for the reconstruction of nasal defects. OBJECTIVE: The aim of this study was to assess the effectiveness and the cosmetic consequences of various local flap techniques in reconstructing nasal defects. METHODS: Between December 2002 and April 2004, 18 patients were treated with a local flap technique for the reconstruction of a nasal skin defect following Mohs micrographic surgery. The post-operative result of each case was rated with serial clinical photographs and medical records by two independent physicians. RESULTS: The nasal skin defects were reconstructed with various local flaps, such as the nasolabial interpolation flap, bilobed flap, glabellar flap, median forehead flap, and subcutaneous island pedicle flap. The cosmetic and functional results of the nasal reconstructions were judged to be generally satisfactory, excluding a trapdoor deformity in one patient, and eyebrow distortion and cancer recurrence in another patient. The cosmetic results of the cases reconstructed with a subcutaneous island pedicle flap were favorable in color and texture of the flaps, and incision scar formation, compared to the other techniques used. CONCLUSION: There are various local flap techniques which can be used in the reconstruction of nasal defects, and each of them has its own merits and drawbacks. The reconstructive plan should be customized to the patient considering not only the size, depth and location of the defect but also the medical history of the patient, the patients expectations, and the surgeons experience. Reconstruction with a subcutaneous island pedicle flap has been found to be one of the most effective methods, and allows the surgeon to spend a relatively short time in reconstructing defects of the upper and lower part of the nose. Furthermore, it has many advantages over the skin graft and other local flap techniques, especially with the aesthetic result.

Disseminated Coccidioidomycosis with Cutaneous Manifestation / 대한피부과학회지

Coccidioidomycosis is a disease by airborne exposure of Coccidioides(C.) immitis, and endemic in the Southwest United States. Primary infection site is lung, and dissemination of the disease can occur depending on the host factors: race, immune status, pregnancy, etc. We report a Korean man with coccidioidomycosis disseminated to the skin, presenting the granulomatous papules on the face and trunk in addition to the pulmonary symptoms. Fungal spherules in the dermis were detected on the skin tissue section, and C. immitis were cultured from the skin tissue. The clinical symptoms were gradually improved with the systemic treatment of antifungal agents (amphotericin B and caspofungin). After more than 6 months of treatment, all of the pulmonary and cutaneous lesions were cleared, but fever persisted.

A Case of Acneiform Skin Eruption Associated with ZD1839(Iressa(R)) / 대한피부과학회지

Epidermal growth factor (EGF) has an important role in the regulation of the proliferation and differentiation of epidermal keratinocytes, as well as in the survival, angiogenesis and metastasis of various cancer cells. There have been some reports of acneiform skin lesions that occurred in the cancer patients treated with ZD1839(Iressa(R)), an inhibitor of EGF tyrosine kinase. We report a case of acneiform eruption related to the anticancer drug, ZD1839(Iressa(R)).

A Case of Cutaneous Focal Mucinosis / 대한피부과학회지

Cutaneous focal mucinosis is a rare condition characterized with asymptomatic, single, dermal mucin deposition anywhere on the body surface except on the joint surfaces of the hands, wrists and feet. Histopathologically, homogenous mucinous material is deposited in the dermis to replace dermal composition mucin. We herein report a case of cutaneous focal mucinosis with the review of the literature.