Factors Related to Preoperative Shoulder Pain in Patients with Atraumatic Painful Rotator Cuff Tears

BACKGROUND@#Patients with rotator cuff tears are usually afflicted with shoulder pain and disability. However, it is unclear which factors are related to shoulder pain in patients with rotator cuff tears. This study was therefore undertaken to determine the factors correlated with shoulder pain in patients with painful rotator cuff tears, but without any history of trauma.@*METHODS@#We evaluated a cohort of 745 patients with painful rotator cuff tears having no trauma history, and analyzed the relationship between pain and multiple factors including demographic data, tear characteristics, and passive range of motion. Pain was analyzed with a questionnaire concerning the visual analogue scale (VAS) for pain. Tear characteristics were determined by evaluating tear size, muscle atrophy, number of torn tendons, and presence of arthritis. Multivariate linear regression analysis and chi-squared test were applied to evaluate the relationship between the VAS for pain and variable factors.@*RESULTS@#Shoulder pain was associated with young age (p=0.01), male sex (p=0.01) and the presence of diabetes mellitus (p0.05) also showed no correlation with VAS for pain.@*CONCLUSIONS@#Young age, male sex and the presence of diabetes mellitus correlated positively with preoperative shoulder pain in patients with painful rotator cuff tears without a trauma history. Combined treatment of pain management and risk factor correction could be helpful to control preoperative shoulder pain.

Factors Related to Preoperative Shoulder Pain in Patients with Atraumatic Painful Rotator Cuff Tears

BACKGROUND: Patients with rotator cuff tears are usually afflicted with shoulder pain and disability. However, it is unclear which factors are related to shoulder pain in patients with rotator cuff tears. This study was therefore undertaken to determine the factors correlated with shoulder pain in patients with painful rotator cuff tears, but without any history of trauma. METHODS: We evaluated a cohort of 745 patients with painful rotator cuff tears having no trauma history, and analyzed the relationship between pain and multiple factors including demographic data, tear characteristics, and passive range of motion. Pain was analyzed with a questionnaire concerning the visual analogue scale (VAS) for pain. Tear characteristics were determined by evaluating tear size, muscle atrophy, number of torn tendons, and presence of arthritis. Multivariate linear regression analysis and chi-squared test were applied to evaluate the relationship between the VAS for pain and variable factors. RESULTS: Shoulder pain was associated with young age (p=0.01), male sex (p=0.01) and the presence of diabetes mellitus (p0.05) also showed no correlation with VAS for pain. CONCLUSIONS: Young age, male sex and the presence of diabetes mellitus correlated positively with preoperative shoulder pain in patients with painful rotator cuff tears without a trauma history. Combined treatment of pain management and risk factor correction could be helpful to control preoperative shoulder pain.

Comparison of Fixation Stability and Incidence of Extensor Tendon Injury according to the Screw Insertion Method in Volar Plate Fixation for Distal Radius Fractures / 대한정형외과학회잡지

PURPOSE: This retrospective study was aimed to analyze the differences in stability and extensor impairment after two different volar plating procedures to manage unstable distal radius fracture, which were the penetration of only near-cortex followed by screw fixation (Group 1) and perforation of dorsal cortex by drill-bit followed by fixation with the screws downsized after gauging (Group 2). MATERIALS AND METHODS: We reviewed the medical records of 491 patients with distal radius fracture treated with standard-sized, targeted distal radius plate in two institutions between April 2009 and May 2014. Finally, 341 patients with complete demographic data, records of AO classification of fractures, data on the lengths of inserted distal screws, radiologic parameters immediately and at 3 months after operation, as well as extensor impairments, were included in this study. There were 112 patients (98 women and 14 men) in Group 1, and 229 patients (171 women and 58 men) in Group 2. The mean age was 59.8 years for all the patients; 60.3 years in Group 1 and 59.5 years in Group 2. RESULTS: The mean length of the longest screws used in Group 2 was longer than that in Group 1; however, the mean length of the shortest screws used in Group 2 was shorter than that in Group 1. While the differences in changes for radial inclination measured immediately and at 3 months after the operation were statistically significant (p=0.019), the change of radial inclination in Group 2, which showed a greater change, was only 0.5 mm. There were two cases with extensor pollicis longus rupture in Group 1 and 2 respectively, and the difference in frequency according to each Group was not statistically significant (p=0.6). CONCLUSION: The superiority of one surgical procedure in terms of fracture stability on measured radiological parameters was not fully proven compared with the other one in this study. Therefore, it would be better to selectively use the surgical method of dorsal cortex perforation viadrill-bit followed by fixation only in limited circumstances.

Free Functioning Muscle Transfer in Brachial Plexus Injury

The free functional muscle transfer (FFMT) is the surgical procedure aimed at reconstructing defective or deteriorated muscle function by grafting free muscles including blood vessels and nerves. Since the free gracilis transfer in the facial paralysis was introduced in 1976, there have been many studies and clinical applications of the FFMT in various donor and recipient sites in brachial plexus injury, muscle ischemic contracture, muscle defect after tumor resection, congenital muscular deficit, multiple trauma. When the reconstruction of the nerve is delayed for 9 months to 1 year after the brachial plexus injury, voluntary muscle contracture is impossible even after the nerve regeneration by the irreversible degeneration of the muscles. And it is difficult to obtain adequate function even if nerve transfer or nerve transplantation is performed because the distance to be regenerated is too long. In these cases, the FFMT has been improved the functions of the upper limb in flexion or extension of the elbow, fingers. Many good clinical results of the FFMT have been reported, so the FFMT gets much interests and attentions. The essential things for the successful outcome of the surgery are the anatomical knowledge, the skilled surgical technique and the choice of patients who can meet the indications and receive long-term rehabilitation. Recent advances in surgical techniques will result in improved results of the FFMT.

Spontaneous Aortic Dissection in a Patient with Neurofibromatosis

Neurofibromatosis type 1 (NF-1), or von Recklinhausen's disease, is an autosomal dominant disorder that primarily affects the skin, the central and peripheral nervous systems, and the skeleton. Vasculopathy, such as, aneurysm or stenosis of large vessels is a less common manifestation of NF-1, but spontaneous aortic dissection in NF-1 is very rare. We report a case of acute aortic dissection with incidental aneurysm of the right femoral artery in NF-1.

A case of adult extrarenal Wilms' tumor originated from retroperitoneum / 대한내과학회지

Wilms' tumor is the most common malignant abdominal tumor in the adolescent and pediatric period, whereas adult Wilms' tumor is uncommon. Wilms' tumor often originates in the kidney. Extrarenal Wilms' tumor is rare and has been considered "unstageable". Therefore, treatment and long-term survival have not been uniformly reported. We report a 24 year-old female who developed extrarenal Wilms' tumor, in the retroperitoneal space. She was misdiagnosed for ovarian neoplasm and underwent debulking operation, by which Wilms' tumor was confirmed. Palliative chemotherapy and radiotherapy were performed.

Appendiceal Intussusception Induced by Appendiceal Adenoma / 대한소화기내시경학회지

Colonic polyp is one of the most common lesions during colonoscopy, but appendiceal polyp is very rare. Moreover appendiceal intussusception associated with appendiceal polyp is extremly rare. Most appendiceal polyp is rarely diagnosed preoperatively, and diagnosed by postoperative pathologic specimen. We report a case of a 52-year old woman with appendiceal intussusception induced by appendiceal adenoma. She experienced sustained right lower quadrant pain for one month. Double contrast barium enema showed a mass in the cecal base without normal appendiceal filling and colonoscopy showed intussuscepted appendix with polyp on the tip. Endoscopic polypectomy with endoloop and snare was performed successfully without any complication.

A Case of Medullary Cystic Disease which Progressed to End Stage Renal Disease during Pregnancy / 대한신장학회잡지

Medullary cystic disease (MCD) and familial juvenile nephronophthisis are inherited diseases characterized by development of small cysts at the cortico- medullary borders of the kidneys. Both diseases consist of microscopic or gross cysts of the renal medullae associated with atrophy of nephrons, anemia, renal insufficiency, polyuria, and salt-wasting. We report a 27-year-old pregnant female patient with MCD which caused acute renal failure progressing to end stage renal disease during the second trimester. Hypertension, oliguria, preeclampsia, placenta abruptio, and disseminated intravascular coagulation were also accompanied. Radiologically, abdominal ultrasonography and computed tomogram showed many cysts confined only to the renal medullae, which are typical findings consistent with MCD. In spite of conservative therapy, her renal function deteriorated rapidly and uremic symptoms including pulmonary edema were aggravated. She was started on hemodialysis and she has received regular hemodialysis without recovery of renal function.

A Case of Crescentric Glomerulonephritis Superimposed on Preexisting Membranous Nephropathy / 대한신장학회잡지

Membranous nephropathy (MGN) is a common cause for nephrotic syndrome in adults. Renal failure usually develops gradually in patients with MGN and rapid deterioration of renal function is a rare complication. Moreover, the development of crescentric glomerulonephritis (CGN) as a cause of acute renal failure (ARF) in patients with preexisting MGN is very rare. We report 20-year-old male patient with MGN who presented with ARF due to superimposed CGN. He had been diagnosed as idiopathic MGN and his renal function was maintained within normal range. After 13 months of conservative treatment, ARF was developed and renal biopsy was performed to differentiate the possible causes of ARF. Renal biopsy revealed diffuse crescents formation on preexisting MGN. Anti-GBM antibody and ANCA were not detected. This patient was treated with combination therapy including methylprednisolone pulse therapy followed by high dose steroid and cyclophosphamide. His renal function was improved significantly 2 weeks after treatment. In conclusion, when unexplained ARF in patient with MGN develops, prompt investigation for superimposed conditions including CGN is necessary and repeat renal biopsy should be considered.

A Case of Pulmonary Alveolar Proteinosis Associated with Pulmonary Tuberculosis / 결핵

Pulmonary alveolar proteinosis(PAP) is a disorder in which an insoluble, proteinaceous material, rich in phospholipids, is deposited in the alveoli and bronchioles. The deficiency in the clearance and degradation of the i ntra-alveolar phospholipoproteinaceous material in PAP most likely represents a dysfunction of the type II pneumocytes. Although the pathogenesis and causative treatment of PAP is unclear a whole lung bronchopulmonary lavage is a relatively safe and effective treatment. Here we experienced a case of pulmonary alveolar proteinosis in a 62 year old female patient who had pulmonary tuberculosis approximately 20 years ago. She complained of aggravated dyspnea and chronic cough, and presented fine inspiratory crackles at both lung fields. diffuse ground glass opacity with some area of consolidation and smooth interlobular septal thickenings in both upper, right middle lobes, and a portion of right lower lobe. Optical microscopy of the lung tissue obtained by an open lung biopsy many granulomas containing acid-fast smear positive bacilli and diffuse homogeneous PAS-positive fluid in the alveolar space. Immunohistochemical stain showed surfactant A in the alveolar space. Antituberculosis drugs with bronchoalveolar lavage were used to treat the disease. There after she showed improvement in her symptoms and a partial improvement in the chest X-ray and HRCT findings. We present a case of PAT associated with pulmonary tuberculosis.

A Case of Pulmonary Alveolar Proteinosis Associated with Pulmonary Tuberculosis / 결핵

Pulmonary alveolar proteinosis(PAP) is a disorder in which an insoluble, proteinaceous material, rich in phospholipids, is deposited in the alveoli and bronchioles. The deficiency in the clearance and degradation of the i ntra-alveolar phospholipoproteinaceous material in PAP most likely represents a dysfunction of the type II pneumocytes. Although the pathogenesis and causative treatment of PAP is unclear a whole lung bronchopulmonary lavage is a relatively safe and effective treatment. Here we experienced a case of pulmonary alveolar proteinosis in a 62 year old female patient who had pulmonary tuberculosis approximately 20 years ago. She complained of aggravated dyspnea and chronic cough, and presented fine inspiratory crackles at both lung fields. diffuse ground glass opacity with some area of consolidation and smooth interlobular septal thickenings in both upper, right middle lobes, and a portion of right lower lobe. Optical microscopy of the lung tissue obtained by an open lung biopsy many granulomas containing acid-fast smear positive bacilli and diffuse homogeneous PAS-positive fluid in the alveolar space. Immunohistochemical stain showed surfactant A in the alveolar space. Antituberculosis drugs with bronchoalveolar lavage were used to treat the disease. There after she showed improvement in her symptoms and a partial improvement in the chest X-ray and HRCT findings. We present a case of PAT associated with pulmonary tuberculosis.