Three-Dimensional Fast Spin-Echo Imaging without Fat Suppression of the Knee: Diagnostic Accuracy Comparison to Fat-Suppressed Imaging on 1.5T MRI

PURPOSE: To evaluate the diagnostic performance of three-dimensional fast spin-echo (3D FSE-Cube) without fat suppression (NFS) for detecting knee lesions, using comparison to 3D FSE-Cube with fat suppression (FS). MATERIALS AND METHODS: One hundred twenty-four patients who underwent 1.5T knee magnetic resonance imaging (MRI) scans and 25 subsequent arthroscopic surgeries were retrospectively reviewed. Using arthroscopic results and two-dimensional images as reference standards, diagnostic performances of 3D FSE-Cube-NFS and FS imaging about lesions of ligament, meniscus, subchondral bone marrow edema (BME), and cartilage were compared. Scan parameters of 3D FSE-Cube imaging were previously optimized by a porcine knee phantom. RESULTS: No significant differences were observed between detection rates of NFS and FS imaging for detecting lesions of meniscus and cartilage (p>0.05). However, NFS imaging had lower sensitivity for detection of medial collateral ligament (MCL) tears, and lower sensitivity and specificity for detection of BME lesions, compared to FS imaging (p<0.05). CONCLUSION: 3D FSE-Cube-NFS imaging showed similar diagnostic performance for detecting lesions of meniscus or cartilage compared to FS imaging, unlike MCL or BME lesions.

Fixation of Olecranon Fractures Using Plating System

PURPOSE: To evaluate the clinical and radiological outcomes of plate fixation for olecranon fractures which was difficult to be fixed firmly with tension band wiring alone. MATERIALS AND METHODS: From 1995 through 2008, 20 patients who underwent plate fixation of an olecranon fracture were included in this retrospective study. According to the Mayo classification, there were 3 type IIA fracture, 7 type IIB, and 10 type IIIB fractures. Clinical evaluation was done based on radiographic union of olecranon and measurements of range of motion at last follow-up. Disability of the arm, shoulder and hand (DASH) score and Mayo Elbow Performance score was used for evaluation of functional recovery. RESULTS: Union was achieved in 18 (90%) at an average of 5.6 months. The mean arc of elbow motion was 123degrees and the mean rotation arc was 81degrees. According to the MEPS, sixteen of twenty patients had a good or excellent outcome. The mean DASH score was 16.3. Most common complication was hardware irritation in 3 patients. CONCLUSION: Plate fixation is an effective treatment option for severe olecranon fracture pattern like comminuted fractures, Monteggia equivalent with unstable elbows and nonunions.

Study of Priority between Prognostic Factors of Status Epilepticus in Childhood

PURPOSE: Poor prognostic factors of status epilepticus(SE) in children have been known as less than 1 year of age, generalized tonic clonic type of convulsion, symptomatic etiology, and duration of longer than 12 hours. Through statistical analysis of morbidity and mortality between these poor prognostic factors, we intended to inquire out the priority of every prognostic factor. METHODS: We selected patients admitted at the Department of Pediatrics of Masan Samsung Hospital because of SE from January to December 2001. We investigated the statistical significance and the priority in morbidity and mortality of each prognostic factor:age, etiology, type of seizure and response to treatment. RESULTS: There were 38 patients with SE. Age distribution showed that the number of patients less than 3 years old is 29(76.3%). The patients more than 3 years old showed increasing morbidity but there is no statistical significance. In the type of seizure, one patient with a mixed type died. The morbidity in partial seizure was 100% and in mixed type of seizure it was 83.3%(P<0.05). In etiology, one patient with non-febrile SE died. The morbidity in non-febrile SE was 60.9%(P<0.05). In the response of treatment, one patient whose seizure activity was controlled after pentothal infusion died. The morbidities of the groups with in phenytoin or phenobarbital, midazolam, and pentothal were 60.0%, 100%, and 75.0%(P<0.05) respectively. In a multivariate statistical analysis, the etiology factor showed the highest priority between the prognostic factors. CONCLUSION: Among the prognostic factors of SE, the etiology factor is the most important and has the higher priority than the other prognostic factors.

Clinical Study of Rotavirus Gastroenteritis in the Last 2 Years / 소아과

PURPOSE: Although the rotavirus-related neonatal death occurred in western part of Kyeonggi Province recently, there were just a few reports about rotavirus gastroentertis in domestic since 2000. We proposed to investigate changes of epidemiology and clinical features of rotavirus gastroenteritis for the last 2 years. METHODS: We selected 166 patients diagnosed as gastroenteritis from January, 2002 to July, 2003 and reviewed the admission records retrospectively such as age distribution, sex ratio, seasonal distribution, admission period, laboratory data and dehydration type in the rotavirus group (RVG) and non-RVG. RESULTS: The percentage of patient under 3 years was 77% on RVG. The non-RVG showed even age distribution (P< 0.05). In RVG, patients occurred in March frequently and 52% occurred from January to March. In non-RVG, patients occurred highly in February and July (P< 0.05). The average of admission period was higher in RVG than non-RVG (P< 0.05). The percentage of patient admitted for over 10 days was 8% in the RVG. In dehydration severity, the RVG showed mild (51%), moderate (44%) and severe (5%) respectively, but non-RVG showed only mild dehydration (P< 0.05). The laboratory findings' did not have statistic significance between RVG and non-RVG. CONCLUSION: Compared to the previous studies, seasonal peak prevalence of rotavirus gastroenteritis changed from autumn to spring and patients over 3 years increased. Therefore, we suggest that there are variable serotypes of rotavirus domestically and there is a need for reinvestigation about clinical features and serotypes of rotavirus gastroenteritis.

Surgical Treatment of Malignant and Aggressive Bone Tumors Around the Knee by Segmental Resection and Rotationplasty

In patients having malignant or aggressive bone tumors around the knee joint and requiring amputation, segmental resection and rotationplasty was performed and the clinical results were analyzed. Twenty-six patients underwent segmental resection and rotationplasty between February 1988 and June 1994. The mean follow-up period was 57 (6 - 120) months and the average age of patients was 21.4 (5 - 37) years. Out of 26 patients, there were 18 osteosarcomas (> or = stage IIB), 2 synovial sarcomas, and 6 giant cell tumors. Clinical results were evaluated by the Shriner's rating system. Four patients were excluded due to death or amputation and the remaining twenty-two patients were included for assessment. Eighteen patients had excellent results, 3 good, and 1 fair. Range of motion of the ankle joint was -11 (dorsiflexion) - 80 (plantarflexion) degrees and daily walking activity was possible. Local recurrence developed in 2 patients and distant metastasis in 10. Early complications include 3 thromboses and 1 sepsis, and late complications were 6 nonunion, 2 malrotation and 1 stiffness of the ankle joint. Rotationplasty, which is functionally excellent, may serve as an effective partial limb salvage procedure, especially in patients younger than 10 years old who are expected to have leg length discrepancy or loosening of the tumor prosthesis due to the growth of the medullary cavity or when amputation is inevitable for a wide resection margin.

Evaluation of Patella Alignment using Computed Tomographic Image

PURPOSE: This study was evaluated to find out meaning of patellofemoral alignment related to anterior knee pain using computed tomographic image. MATERIALS AND METHODS: This study include 32 cases, 21 persons as a patient group which had been treated due to anterior knee pain related to tight lateral retinaculum from Jan. 1999 to Dec. 1999 and 36 cases, 18 persons as a control group which had no history of anterior knee pain and no abnormal finding malalignment by physical examination. Patellofemoral alignment was evaluated by measuring sulcus angle, congruence angle and lateral patellofemoral angle using computed tomographic images in 0 degrees and 20 degrees knee flexion patellofemoral alignment of the patient group was compared with that of the control group statistically. All 32 cases of the patient group had an arthroscopic lateral release and the patellofemoral alignment was rechecked on computed tomographic images. RESULTS: There was statistically difference between the average measurement of patient group and that of the control group on the computed tomographic images in 0degree and 20degree flexion of the knee. Also the average measurement after lateral release in patient group was corrected significantly. CONCLUSION: Laterally aligned patella during 0 degrees and 20 degrees knee flexion in computed tomographic should not be considered as normal variation but as pathologic condition related to anterior knee pain.

A Case of Similar Pattern of Hepatotoxicity after Propylthiouracil and Methimazole / 대한간학회지

A 46-year-old male patient developed jaundice after 23 days' treatment of propylthiouracil (PTU) for Graves' disease. Serum alkaline phosphatase was elevated markedly with moderate increase in serum aminotransferase, and the peak level of total bilirubin was 7.3 mg/dL. After withdrawal of PTU, serum aminotransferase and bilirubin began to decrease simultaneously, and completely normalized. One week after the discharge from hospital, he received radioiodine treatment for Graves' disease, but he showed aggravation of hyperthyroidism and ophthalmopathy. So we prescribed methimazole inevitably 16 days' after the radiodiodine treatment. He developed jaundice again after 69 days' treatment of methimazole, but the pattern of hepatotoxicity was slightly different from that of the previous PTU-nduced hepatotoxicity. Serum aminotransferase increased slightly and quickly normalized after discontinuance of methimazole, but serum total bilirubin increased continuously and reached to 24.6 mg/dL. Eosinophilia was prominent and the result of liver biopsy was compatible with cholestatic jaundice. The patient was treated with prednisolone and recovered from jaundice rapidly.

A Case of Cyclic Hematopoiesis / 대한혈액학회지

Classical cyclic neutropenia is the most frequent of the cyclic hematopoietic disorders and a rare condition characterized by regular and predictable oscillations in the peripheral neutophil counts with the cycle length varying from 14 to 28 days and in many cases simultaneous fluctuation in the other blood cell line. The etiology of cyclic neutropenia is unknown, but has usually been considered as stem-cell disorder. We have observed a 17-year-old boy with a cyclic pancytopenia with a constant and predictable oscillation period of about 120 days. Serial bone marrow biopsies showed a similar fluctuating pattern and myelodysplatic change. We report this case and review the literature regarding this unusal long period cyclic neutropenia.

Effect of Short Term Treatment with Different Dosage of Inhaled Flucatisone Propionate on Basal Cortisol Concentration / 결핵

BACKGROUND: The efficacy of oral corticosteroids in the treatment of chronic asthma is undisputed, but their long-term use is associated with adverse side-effects, including supression of the hypothalamic-pituitary adrenal axis function, osteoporosis, weight gain, hypertension and impaired glucose tolerance. The introduction of inhaled corticosteroids in the early 1970's represented a significant therapeutic advance in the management of asthma, since these compounds combined high topical potency with low systemic activity. Fluticasone propionate is a new topically active synthetic glucocorticosteroid that combinds a high degree of efficacy with negligible systemic bioavailability. This study was perfomed to determine the effect of inhaled fluticasone propionate on the adreocortical supression in patients with bronchial asthma or chronic obstructive pulmonary disease. METHODS: The adrenocortical function was assessed by measurement of plasma cortisol concentration at 8 o'clock in morning and free cortisol in 24 hour urine collection at intervaL Absolutely, no steroid was taken during pretreatment period of l0days. There after each subject inhaled fluticasone aerosol, in daily doses of 500 or l000 mierograms for l2days. The dose was delivered by metered dose inhaler(MDI). RESULTS: The serum cortisol and 24hour urinary free cortisol were not decreased during the treatment period in patients with inhaled fluticasone propionate in daily doses of 500 micrograms. In contrast, serum cortisol was significantly decreased on 9th and 12th day(p less than 0.05). And, 24hour urinary free cortisol was also significantly decreased on 3rd and 12th day of treatement period(p less than 0.05) in patients with inhaled fluticasone in daily doses of 1000 micrograms. CONCLUSION: These results suggested that endogenous cortisol secretion was not supressed after short-term inhalation of fluticasone in daily dose of 500 micrograms, but in daily dose of 1000 micrograms, the endogenous cortisol secretion was supressed.

A Study on the Efficacy and Safety of Dipheny-dimethyl-dicarboxylate in Patients with Chronic Liver disease / 대한간학회지

BACKGROUND/AIMS: The spectrum of clinical features of chronic liver disease bas wide range from asymptomatic cases to hepatic failure, The natural course and long-term prognosis of chronic liver disease also varies greately, and this diversity makes it diflicult to predict the clinical course of individual patient. The two majar approaches to the treatment of chronic liver disease are 1) directed toward the eradication of the virus and 2)designed to modulate cellular and humeral immunity. Progress has been made in the development of antiviral chernotherapeutic agents for hepatitis. But as yet no safe and reliably effective treatment or combination of treatrnents is available. In tkis study, we performed trial of diphenyl-dimethyl-dicarboxylate to evaluate the therapeutic effect and safety of it. METHODS: The ciinical trials of DDB(complex capsule of diphenyl dimethyl dicarboxylate 7.5mg and polysorbate 80 1,5mg and polyethylene glycol 6000 66mg) were carried out in 30 patients with chronic liver disease for 6 months. All patients had abnormal liver function test ouer a period of 6 months. RESULTS: In selected groups mean serum aspartate aminotransferase and alanine aminotrans- ferase dropped from pretreatment level of' 115.9+/-74.1 IU/L and 201.6+/-173.0 1U/L to posttreatment level of46.6+/-21.6 UU/L and 28.7+/-15.4IU/L, respectively(p<0.01). There was no significant hernatological and biochemical change after administration of DDB. Untoward side effects were easily controlled by discontinuing the drugs. CONCLUSIONS: Administration of DDB(for 6 months) appears to be effective for decrement of transaminase level and safe for the treatment of patients with chronic liver disease.