Relationship of Posterior Decentering of the Humeral Head with Tear Size and Fatty Degeneration in Rotator Cuff Tear

BACKGROUND: Posterior decentering is not an uncommon finding on rotator cuff tear patients' shoulder magnetic resonance imaging. No previous study has reported on the relationship between posterior decentering and rotator cuff tear. METHODS: We assessed patients' rotator cuff tear humeral head positions based on humeral–scapular alignment (HSA). Subjects were classified into centering and decentering groups based on a 2 mm HSA value, respectively. Differences in rotator cuff tear size, degree of tear, and fatty degeneration between the two groups were evaluated. RESULTS: One hundred seventy-five patients (80 males, 95 females; mean age: 59.7 ± 6.5 years old) were selected as subjects (case-control study; level of evidence: 3). Tear size, degree of subscapularis tendon tear, and fatty degeneration of the supraspinatus, infraspinatus, and subscapularis muscles were significantly different between the two groups (p<0.001, p<0.001, p<0.001). CONCLUSIONS: The occurrence of decentering was related to rotator cuff tear size, degree of subscapularis tendon tear, and fatty degeneration of the rotator cuff muscles.

Relationship of Posterior Decentering of the Humeral Head with Tear Size and Fatty Degeneration in Rotator Cuff Tear

BACKGROUND@#Posterior decentering is not an uncommon finding on rotator cuff tear patients' shoulder magnetic resonance imaging. No previous study has reported on the relationship between posterior decentering and rotator cuff tear.@*METHODS@#We assessed patients' rotator cuff tear humeral head positions based on humeral–scapular alignment (HSA). Subjects were classified into centering and decentering groups based on a 2 mm HSA value, respectively. Differences in rotator cuff tear size, degree of tear, and fatty degeneration between the two groups were evaluated.@*RESULTS@#One hundred seventy-five patients (80 males, 95 females; mean age: 59.7 ± 6.5 years old) were selected as subjects (case-control study; level of evidence: 3). Tear size, degree of subscapularis tendon tear, and fatty degeneration of the supraspinatus, infraspinatus, and subscapularis muscles were significantly different between the two groups (p<0.001, p<0.001, p<0.001).@*CONCLUSIONS@#The occurrence of decentering was related to rotator cuff tear size, degree of subscapularis tendon tear, and fatty degeneration of the rotator cuff muscles.

Difference of Critical Shoulder Angle (CSA) According to Minimal Rotation: Can Minimal Rotation of the Scapula Be Allowed in the Evaluation of CSA?

BACKGROUND: Minimal rotation of the scapula may affect the measurement of critical shoulder angle (CSA). We investigated the difference in the CSA measured in minimal rotation between the patients with rotator cuff tear and those without non-rotator cuff tear and the CSA measurement error by comparing with computed tomography (CT). METHODS: We retrospectively reviewed patients with full-thickness rotator cuff tear and whose X-ray views correspond to Suter-Henninger classification type A1 and C1. The CSA values between the normal control group (without rotator cuff tear) and the rotator cuff tear group were compared according to A1 type and C1 type. In the rotator cuff tear group, we compared the CSA values measured by using X-ray and CT. RESULTS: A total of 238 patients (rotator cuff tear group, 139 patients; normal cuff group, 99 patients) were included in this study. The mean CSA of the rotator cuff tear group was 33.4° ± 3.5°, and that of the normal cuff group was 32.6° ± 3.9° (p = 0.085). On comparison of the CSA according to the Suter-Henninger classification type, the CSA values on the A1 type view and C1 type view were 32.7° ± 3.5° and 33.7° ± 3.5°, respectively, in the rotator cuff tear group and 30.5° ± 3.1° and 33.1 ± 3.9°, respectively, in the normal cuff group (p = 0.024 and p = 0.216, respectively). The mean CSA was 32.5° ± 3.1° in CT and 33.3° ± 3.2° in X-ray (p = 0.184). On comparison of the CSA according to the Suter-Henninger classification type, the CSA values on the A1 type view and C1 type view were 32.6° ± 3.6° and 32.5° ± 2.4°, respectively, in CT and 32.5° ± 3.5° and 34.2° ± 2.6°, respectively, in X-ray (p = 0.905 and p = 0.017, respectively). CONCLUSIONS: The X-ray view corresponding to Suter-Henninger classification type A1 or CT-reconstructed image can be used to reduce the measurement error and obtain reliable CSA values. The CSA measured on the X-ray view corresponding to Suter-Henninger classification type A1 may be related with rotator cuff tear.

Review of Sarcoidosis in a Province of South Korea from 1996 to 2014 / 결핵및호흡기질환

BACKGROUND: Since the introduction of endobronchial ultrasound (EBUS)–guided transbronchial needle aspiration (TBNA) of mediastinal lymph nodes, the incidence of histopathologically-confirmed sarcoidosis has increased. METHODS: The electronic medical records of Chonnam National University (CNU) Hospital and CNU Hwasun Hospital (CNUHH) were searched for confirmed cases of sarcoidosis diagnosed between 1996 and 2014. Cases were selected using a combination of clinical, radiological, and pathological evidence. Of 115 cases with the relevant disease codes, 16 cases were excluded, as they had not been confirmed pathologically or had no definitive clinical features of sarcoidosis. RESULTS: Among 99 cases of confirmed sarcoidosis, only nine patients were diagnosed with sarcoidosis before 2008; the rest were diagnosed from 2008 onward, after the introduction of EBUS-TBNA. EBUS-TBNA was used in 75.8% of patients, open surgical biopsy in 13.2%, and mediastinoscopic biopsy in 5.1%. At the time of diagnosis, 42.4% of sarcoidosis cases were at stage I, 55.6% at stage II, and 2% at stage III. Spontaneous remission of sarcoidosis was observed in 33.3% of cases, and stable disease in 37.4%; systemic steroid treatment was initiated in 23.2% of cases. Of the patients treated with systemic steroids, 69.6% showed improvement. The median duration of steroid treatment was 5 months. CONCLUSION: Following the introduction of EBUS-TBNA, the number of newly diagnosed sarcoidosis patients has increased. Clinical features of sarcoidosis were similar to those previously reported. Spontaneous remission occurred in about one-third of patients, while one-fourth of patients required systemic steroid treatment.

Intermittent, subtle change of ST segment in narrow QRS regular tachycardia

No abstract available.

The Impacts of Living Alone in in-Hospital and One-Year Clinical Outcomes after Acute Myocardial Infarction in Korean Patients

OBJECTIVE: The aim of this study is to evaluate the impact of living alone for in-hospital and one-year clinical outcome after acute myocardial infarction (AMI) in Korean patients. METHODS: A total of 1,700 patients who admitted at the Chonnam National University Hospital were analyzed. We divided the patients into two groups by the existence of a spouse or family member that lived together with the patient at the first time of hospital visit due to AMI. The primary endpoint was composed of in-hospital death and cardiac death during one-year clinical follow-up. Secondary end point was other major adverse cardio-cerebral events (MACCE) including non-fatal MI, repeat revascularization, ischemic or hemorrhagic stroke during one-year clinical follow-up. RESULTS: Living alone patient group had higher proportion of Killip class II-IV (34.3% vs. 26.6%, p=0.006) and higher value of high sensitivity C-reactive protein (2.2+/-4.0 vs. 1.5+/-3.4 ng/mL, p=0.019) than not living alone group. In-hospital death (8.9 % vs. 5.1%, p=0.010) and one-year cardiac death (7.7% vs. 4.6%, p=0.031) developed more in living alone groups. However, living alone was not an independent prognostic factor for in-hospital death (HR 1.51, 95% CI 0.91-2.52, p=0.113) and one-year cardiac death (HR 1.18, 95% CI 0.59-2.34, p=0.64) after multivariate analysis. CONCLUSION: Living alone was not an independent prognostic factor for in-hospital and one-year clinical outcome after AMI.

A Case of Successful Percutaneous Coronary Intervention by Fractional Flow Reserve and 13N-Ammonia Positron Emission Tomography

A 43-year-old male presented with effort angina. Ammonia positron emission tomography (PET) revealed reversible perfusion defect in left anterior descending artery (LAD) and left circumflex artery (LCX) territories with decreased coronary flow reserve. Coronary angiogram showed significant stenosis in proximal LAD and intermediate diffuse stenosis in LCX and right coronary artery (RCA). Fractional flow reserve (FFR) showed similar results with ammonia PET. After percutaneous coronary intervention for LAD and LCX, flow and pressure checked by PET and FFR showed improvement. Simultaneously use of ammonia PET and FFR could be useful for determining ischemia-inducible lesion especially in diffuse intermediate lesion with discrepancy between functional studies.

A Case of Toxocariasis in a Patient with Cecal Cancer Mimicking Hepatic Metastasis / 대한내과학회지

Toxocariasis is a common helminth infection and the most common cause of peripheral blood eosinophilia. The clinical presentation of liver toxocariasis is often confused with primary or metastatic hepatic tumors. Here, we report on a 52-year-old man admitted with cecal cancer and eosinophilia. Computerized tomography (CT) scans revealed multiple lesions with peripheral enhancement in the liver, and T1- and T2-weighted images revealed isointensity. The patient underwent right hemicolectomy and an exploratory laparotomy with a liver biopsy. Resection of the cecal specimen revealed an adenocarcinoma, while the liver biopsy revealed an eosinophilic abscess with no evidence of malignancy. A serologic test showed a marked increase in specific immunoglobulin G antibody concentrations against Toxocara canis and daily antiparasitic treatment with albendazole (800 mg per day for 7 days) was initiated. Follow-up CT scans indicated that all liver masses and eosinophilia were resolved.

Sudden Hemiplegia by Epidural Hematoma in a Patient Treated with Warfarin and Therapeutic Range International Normalized Ratio

Spontaneous spinal epidural hematoma is extremely rare. It can cause fatal complication such as permanent neurologic deficit. Even though the exact cause of epidural hematoma is not known in most cases, anticoagulation treatment is associated in some cases. In this situation, prompt reversal of anticoagulation and immediate decompression surgery is required. Seventy-year-old woman presesnted with sudden hemiplegia. She had history of hypertension, dyslipidemia, and paroxysmal atrial fibrillation and had taken antihypertensive agent, statin, and warfarin. She did not have any history of trauma and her international normalized ratio was within therapeutic range during follow-up and at the time of event. Physical examination revealed decreased right extremities' motor and sensory function but cognitive function was normal. Detailed neurologic examination and spinal magnetic resonance imaging identified extensive, spontaneous spinal epidural hematoma. After the reversal of anticoagulation with vitamin K injection, the patient underwent emergent hematoma removal surgery and recovered completely. Our case suggests epidural hematoma should be considered in sudden hemiplegia patients with anticoagulation therapy. Immediate reversal of anticoagulation and decompression surgery can avoid neurologic deficit.