Case report: electrical automated massage chair use can induce osteoporotic vertebral compression fracture.

This case report describes a case of an elderly woman diagnosed with acute osteoporotic vertebral compression fracture (OVCF) at thoracic spine after using an electrical automated massage chair (EAMC). Care should be taken when using an EAMC, especially by those with or at risk of developing osteoporosis. Osteoporotic vertebral compression fracture (OVCF) is a common problem among elderly population and presents a high burden to society. Osteoporotic fractures may occur after a minimal trauma of the vertebrae. Electrical automated massage chair (EAMC) is a device that uses a programmed algorithm to perform automated massage. The massage chair, a popular device among elderly with back pain, relies on friction and rhythmic tapping created by a motorized roller. However, research regarding the safety of this device is lacking, especially in the perspective of OVCF. We present a case of an elderly woman diagnosed with acute OVCF of the thoracic spine after using an EAMC. The patient had no risk factor for fragility fracture and experienced an abrupt onset of severe upper back pain while using EAMC. Imaging studies revealed an isolated acute compression fracture at T8 vertebra (AO classification type A1) while dual-energy X-Ray absorptiometry scan confirmed osteoporosis. The patient was treated with a plastic orthosis and oral medications for osteoporosis. After 6-months follow-up, the patient showed union of the fractured T8 vertebra and no remaining symptoms. This case highlights that OVCF can be induced by EAMC. Therefore, patients with or at risk for osteoporosis should be cautious while opting for deep tissue massage using EAMC.

Degenerative retrolisthesis: is it a compensatory mechanism for sagittal imbalance?

We investigated the spinopelvic morphology and global sagittal balance of patients with a degenerative retrolisthesis or anterolisthesis. A total of 269 consecutive patients with a degenerative spondylolisthesis were included in this study. There were 95 men and 174 women with a mean age of 64.3 years (sd 10.5; 40 to 88). A total of 106 patients had a pure retrolisthesis (R group), 130 had a pure anterolisthesis (A group), and 33 had both (R+A group). A backward slip was found in the upper lumbar levels (mostly L2 or L3) with an almost equal gender distribution in both the R and R+A groups. The pelvic incidence and sacral slope of the R group were significantly lower than those of the A (both p < 0.001) and R+A groups (both p < 0.001). The lumbar lordosis of the R+A group was significantly greater than that of the R (p = 0.025) and A groups (p = 0.014). The C7 plumb line of the R group was located more posteriorly than that of the A group (p = 0.023), but was no different from than that of the R+A group (p = 0.422). The location of C7 plumb line did not differ between the three groups (p = 0.068). The spinosacral angle of the R group was significantly smaller than that of the A group (p < 0.001) and R+A group (p < 0.001). Our findings imply that there are two types of degenerative retrolisthesis: one occurs primarily as a result of degeneration in patients with low pelvic incidence, and the other occurs secondarily as a compensatory mechanism in patients with an anterolisthesis and high pelvic incidence.

Trabecular microstructure of the human lunate in Kienbock's disease.

The trabecular microstructure of normal lunates and lunates with Kienböck's disease was investigated using micro-computed tomography (micro-CT). Five lunates with advanced Kienböck's disease were obtained during lunate excision and scaphocapitate fusion, and five control lunates were from embalmed cadavers. Microstructural morphometric parameters were measured using micro-CT images. Trabeculations of lunates with Kienböck's disease were 2.67 times denser and 1.84 times thicker than those of normal lunates. Furthermore, bone surface areas were 1.43 times greater and bone volume 2.67 times greater, and structural model indices were significantly lower in lunates with Kienböck's disease. The study estimated that high mechanical stress would be applied to lunates with Kienböck's disease, and suggests that new bone formation and collapse may play important roles in the microstructural changes in the lunate with advanced Kienböck's disease.

Clinical characteristics and outcomes of Takayasu's arteritis: analysis of 108 patients using standardized criteria for diagnosis, activity assessment, and angiographic classification.

OBJECTIVES: To investigate the clinical characteristics and outcomes of Takayasu's arteritis (TA) using standardized criteria for diagnosis, disease activity, and angiographic classification, and to identify the predictive factors for remission, angiographic progression, and mortality in patients with TA. METHODS: One hundred and eight patients who fulfilled the 1990 American College of Rheumatology (ACR) classification criteria for TA were studied. Their clinical features, laboratory findings, angiographic findings, and clinical outcomes were evaluated retrospectively. The disease activities were assessed using the National Institutes of Health (NIH) criteria for active disease, and the angiographic types were classified using the International TA Conference in Tokyo 1994 angiographic classification. RESULTS: Angiographic classification showed that type I was the most common, followed by types V and IV. Ninety-one patients had active disease at diagnosis, and remission was achieved in 81.3% of them. Among those who experienced remission and those who had stable disease at diagnosis, 28.6% experienced a relapse. A low erythrocyte sedimentation rate (ESR) at diagnosis and treatment with glucocorticoid were found to be independent predictors for remission, and the stable disease activity at diagnosis was an independent predictor for the quiescence of vascular lesions on follow-up angiography. Survival rates were 92.9% at the fifth year and 87.2% at the tenth year, and the presence of two or more complications was a risk factor for mortality. CONCLUSIONS: These findings could provide useful information on the clinical features, angiographic findings, and outcomes in TA, particularly on the assessment of patients at risk of a poor outcome.

Differences in body fat distribution and antioxidant status in Korean men with cardiovascular disease with or without diabetes.

BACKGROUND: Abnormal body fat distribution and reduced antioxidant status have been shown to be effective markers of risk of cardiovascular disease (CVD). OBJECTIVE: The objective of this study was to determine the differences in body fat distribution and antioxidant status in healthy men (control subjects) and in men with CVD with or without diabetes. DESIGN: An oral-glucose-tolerance test was performed and CVD patients were subdivided into groups according to the presence or absence of diabetes. Adipose tissue areas were calculated from computed tomography scans made at the L1 and L4 vertebrae. Fasting serum concentrations of lipids, testosterone, insulin-like growth factor I, antioxidants, and plasma homocysteine were determined. RESULTS: There were no significant differences in mean age, body mass index (in kg/m(2)), or blood pressure between the groups. The visceral fat area at the L1 vertebra was nonsignificantly greater in CVD patients without diabetes than in control subjects, whereas it was significantly greater in CVD patients with diabetes than in control subjects at both the L1 and L4 vertebrae. Both groups of CVD patients had higher plasma concentrations of homocysteine and lower serum insulin-like growth factor I concentrations and superoxide dismutase activities than did control subjects. Serum ss-carotene and lycopene concentrations were lowest in the CVD patients with diabetes. CONCLUSION: The concurrent presence of CVD and diabetes is associated with a greater negative effect on the risk factors typically associated with significant declines in health status.

The use of high-resolution computed tomography in the evaluation of pulmonary hemodynamics in patients with congenital heart disease: in pulmonary vessels larger than 1 mm in diameter.

High-resolution computed tomography (HRCT) was carried out in 36 patients with congenital left-to-right shunt disease and 10 normal control subjects to assess the feasibility of CT in the evaluation of pulmonary hemodynamics. The patients had a left-to-right or a bidirectional shunt and the hemodynamic data obtained by cardiac catheterization in these patients were compared to the information obtained by CT imaging. The pulmonary/systemic blood flow (Q(p)/Q(s)) ratio and pulmonic/systemic resistance (R(p)/R(s)) ratio had a significant correlation with the pulmonary artery/bronchus (PA/Br) ratio (r = 0.54 and r = -0.37, respectively) and pulmonary vein/bronchus (PV/Br) ratio (r = 0.66 and r = -0.66, respectively), and the R(p)/R(s) and mean PA pressure also showed a significant correlation with the PA/PV ratio (r = 0.53 and r = -0.61, respectively) in the mid-lung field when accompanying bronchi were 4. 0-5.9 mm in diameter. There was no correlation between the hemodynamic data and the size of the central and hilar PA or with the rate of PA tapering. With HRCT, it is possible to evaluate pulmonary hemodynamics in patients with congenital heart disease with a left-to-right or bidirectional shunt, particularly R(p)/R(s) and mean PA pressure, which have been very difficult to obtain noninvasively. The small-sized pulmonary vessel/Br ratio or the small-sized PA/PV ratio could offer very useful information, but the dimension of the central PA provided the least useful information.

Progression of hypertrophic cardiomyopathy to dilated cardiomyopathy--a case reports and review of the literatures.

Left ventricular systolic function in hypertrophic cardiomyopathy (HCMP) does not usually deteriorate even in the end stage of the disease. However, occasionally cases of HCMP progress to a similar form of dilated cardiomyopathy (DCMP) with a decreased systolic function and dilated left ventricle. We report two cases of HCMP which progressed to DCMP during follow-up. Our cases have been documented by serial M-mode echocardiography which shows a prominent decrease in the left ventricular systolic function and a chamber enlargement of the left ventricle. There are various explanations of the pathogenesis of the functional and morphological myocardial deterioration of HCMP progressing to DCMP, and more cases should be studied to determine the pathogenesis and prevention of this end-stage feature of HCMP.

Acute myocardial infarction in the young adults.

A review was done on 631 patients with acute myocardial infarction who underwent coronary angiography within 30 days after onset of myocardial infarction at Yonsei University Severance Hospital from January, 1985, to August, 1993. The incidence of acute myocardial infarction in patients under 40 years of age was 10.3% (65/631). Acute myocardial infarction below the fourth decades was the predominant disease of men. Risk factor analysis revealed a history of cigarette smoking and hypercholesterolemia were more frequently found in the young patients, but a history of hypertension and diabetes were more frequently found in the elderly patients. Angiographically, the incidence of one vessel disease and normal or minimal lesion coronary anatomy were more frequent in the young patients and incidence of multi-vessel disease were more frequent in the elderly patients. Of the 65 patients under 40 with acute myocardial infarction, the patients with multi-vessel disease tended to have a history of diabetes mellitus in comparison with those with normal coronary anatomy or one vessel disease.

[Second report on intestinal parasites among the patients of Seoul Paik Hospital (1984-1992)].

The results of fecal examination for helminth eggs and protozoan cysts in Seoul Paik Hospital during 1984-1992 are reported. Fecal specimens of a total of 52,552 out- or inpatients were examined by formalin-ether sedimentation and/or direct smear method. The overall egg positive rate of helminths was 6.5% and the cyst positive rate of protozoa 2.5%. The egg positive rate (number of positive cases) for each species of helminth was; Clonorchis sinensis 3.2% (1,667), Trichuris trichiura 2.0% (1,089), Metagonimus yokogawai 1.2% (613), Ascaris lumbricoides 0.2% (100), Trichostrongylus orientalis 0.1% (34), Taenia spp. 0.05% (28), Hymenolepis nana 0.03% (18), hookworms 0.03% (17), Paragonimus westermani 0.02% (12), Echinostoma spp. 0.03% (12), Enterobius vermicularis 0.02% (10), Strongyloides stercoralis (larvae) 0.01% (6), and Diphyllobothrium latum 0.004% (2). The cyst positive rate (number of positive cases) for each protozoan was; Entamoeba coli 1.1% (588), Endolimax nana 0.8% (402), Giardia lamblia 0.3% (173), Entamoeba histolytica 0.3% (164), and Trichomonas hominis (trophozoites) 0.004% (2). Viewing from the data of 9 years, it was evident that the prevalence of soil-transmitted helminths such as A. lumbricoides and T. trichiura has been decreasing remarkably, while that of snail-transmitted helminths such as C. sinensis and intestinal protozoans has not.

Cardiovascular findings of Hutchinson-Gilford syndrome--a Doppler and two-dimensional echocardiographic study.

Progeria, also known as Hutchinson-Gilford syndrome, is an extremely rare condition originally described by Hutchinson in 1886. Death results from cardiac complications in the majority of cases and usually occurs at an average age of fourteen years. We recently experienced a patient with progeria who died suddenly after symptomatic improvement with conservative treatment. A Doppler and two-dimensional echocardiographic study revealed an enlarged and hypertrophied left ventricle with reduced global systolic function and senile aortic calcific stenosis (peak systolic pressure gradient: 50 mmHg) with a moderate degree of aortic regurgitation. Doppler findings of restrictive hemodynamic suggest severe left ventricular dysfunction due to multiple influences from the aging process, coronary artery and valvular heart disease.

Percutaneous mitral balloon valvuloplasty in patients with restenosis after surgical commissurotomy: a comparative study.

We performed percutaneous mitral balloon valvuloplasty (PMV) in 367 patients to compare the effectiveness of PMV between patients with mitral restenosis after surgical commissurotomy (group 1) and patients with unoperated mitral stenosis (group 2). Twenty-two had undergone closed or open mitral commissurotomy 11.2 years before. There were no significant differences in clinical profiles between the two groups. The mitral valve area was increased from 1.0 +/- 0.8 to 1.8 +/- 0.6 cm2 in group 1 and 0.9 +/- 0.3 to 2.0 +/- 0.7 cm2 in group 2 (p > 0.05). The mitral gradient was decreased from 14 +/- 5.9 to 6 +/- 2.6 mmHg in group 1 and 18 +/- 7.0 to 7 +/- 5.3 mmHg in group 2 (p > 0.05). The increment of mitral regurgitation and significant left to right shunt after PMV were not significantly different (10% versus 14.7%, 5% versus 10.4% respectively). Optimal results were attained in 75% of the patients in group 1 and in 84.3% of the patients in group 2 (p > 0.05). These results suggest PMV in mitral restenosis after surgical commissurotomy may be safe in selected patients and may be equally effective as in unoperated mitral stenosis.