A Case of Pachydermodactyly

Pachydermodactyly is a form of digital dermal fibromatosis of unknown etiology, characterized by asymptomatic soft tissue swelling on the lateral aspects of the proximal interphalangeal joints of the hands. It usually affects young men and often associated with repetitive mechanical trauma. As a rule, it is a benign condition and a specific therapy or extensive investigation is not necessary in most cases. However, pachydermodactyly is not well recognized by physician. So it can be confused with other rheumatic conditions, such as rheumatoid arthritis or juvenile idiopathic arthritis. A prompt diagnosis is crucial for preventing inappropriate or possible toxic treatment. We describe a case of pachydermodactyly in a 20-year-old military man, who had painless swellings of the hand joints.

Perineural Involvement in Benign Mixed Tumor

No abstract available.

A Case of Candida Parapsilosis Infectious Arthritis in a Patient with Enteropathic Arthritis and Ulcerative Colitis / 대한내과학회지

Infectious arthritis is an important medical emergency with high morbidity. The most frequent causative organism of infectious arthritis is Staphylococcus aureus, and Candida is an uncommon pathogen. Candida arthritis has been reported to occur in seriously ill or immunocompromised patients and neonates. We report the first case of C. parapsilosis arthritis in a patient with ulcerative colitis. A 52-year-old woman was diagnosed with ulcerative colitis 1 year previously and took balsalazide. Pain and swelling in the right knee joint developed 6 months after diagnosis. She was diagnosed with enteropathic arthritis associated with ulcerative colitis and took methotrexate, sulfasalazine, and prednisolone for 3 months, but the symptoms did not improve. We finally diagnosed her with infectious C. parapsilosis arthritis by culturing the synovial fluid. The patient received amphotericin B for 6 weeks and underwent arthroscopic synovectomy. She finally experienced improvement of inflammation in the right knee joint.

Retroperitoneal Fibrosis in 27 Korean Patients: Single Center Experience

Retroperitoneal fibrosis (RPF) is a rare disease with unclear etiology, which is characterized by chronic non-specific inflammation of the retroperitoneum. This study was performed to investigate the clinical characteristics, laboratory findings, radiologic findings, treatment and outcome in Korean patients with RPF. We retrospectively reviewed medical records of 27 RPF patients who were admitted to Yonsei University Medical Center between 1998 and 2009. Twenty-two patients (81%) were male. The mean age at diagnosis was 56 yr. Nine patients had identifiable risk factors of RPF and three patients had combined autoimmune diseases. Acute phase reactants were elevated in most patients. Rheumatoid factor was positive in 3 of 16 patients (19%) and antinuclear antibody in 4 of 17 (24%). Five of 6 patients who were taken positron-emission tomography showed positive uptake. Glucocorticoids were used in 16 patients (59%) and four of them received combination therapy with azathioprine. After immunosuppressive treatment, the levels of acute phase reactants dropped, and the size of mass also decreased in most patients. In conclusion, the clinical characteristics of RPF in Korean patients are similar with other series except for higher proportion of male. Some patients with RPF have autoimmune features. The effect of immunosuppressive treatment on RPF is good.

Giant Thoracic Spinal Arteriovenous Fistula with Cord Compression: A Case Report / 대한정형외과학회잡지

A spinal arteriovenous fistula is a rare vascular disease that is characterized by abnormal connections between the vertebral artery or its branches and the neighboring veins. Bruit and back pain are common symptoms related to the fistula. Spinal cord dysfunction can also occur as a result of blood flow steal, venous hypertension, or mechanical compression of the nerve roots and spinal cord. We report a huge arteriovenous fistula in the spinal canal at the thoracic vertebra, which was characterized by a large azygous vein connected to the epidural vein causing osteolysis on the vertebral body and spinal cord compression symptoms. Staged embolization was performed using 80 coils.

Total Hip Arthroplasty in the Fused Hip

PURPOSE: The purpose of this study is to analyze the clinical and radiological results of performing primary total hip arthroplasty (THA) in patients with a fused hip and to compare the results with that of patients with avascular necrosis of the femur head (AVNF). MATERIALS AND METHODS: 19 patients (21 hips) with a fused hip(s) were retrospectively reviewed. We analyzed them clinically with using the Harris hip score (HHS), and radiologically with performing serial radiograms and we then compared them with the results of the patients in the AVNF group. RESULTS: The mean HHS was improved from 59.2 to 85.8. The VAS improved from 6.5 to 2.2 and the leg length discrepancy (LLD) improved from 27.5 mm to 12.5 mm. As complications, wound infection occurred in 3 hips, heterotopic ossification occurred in 8 hips and recurrent dislocation occurred in one hip. Although a radiolucent line was found in 4 acetabular cups and 6 femoral stems, there was no progression. Osteolysis was found in 1 acetabular cup. CONCLUSION: The results of THA in patients with a fused hip were excellent. Comparing with the AVNF group, improvement of the hip motion and LLD were much better. The improvement of the VAS and HHS showed similar results between the groups. However, the final results of the HHS, VAS, LLD and the range of motion of the hip were worse, and the complication rate was higher.

Clinical Manifestations of Febrile Neutropenic Patients with Solid Tumor and Risk Factors for Gram Positive Bacteremia

BACKGROUNDS: Recently, there has been a rise of prevalence of gram positive infection among cancer patients with febrile neutropenia. The proportion of antibiotic-resistant gram positive infection has been growing lately, especially in Korea, where the rate of MRSA infection was over 70%. It brings to careful consideration of early glycopeptide treatment in febrile neutropenic patients if gram positive infection is suspected. Also until now, most studies concerning febrile neutropenic patients were mainly related to hematologic malignancy rather than solid tumor. MATERIALS AND METHODS: We evaluated clinical manifestations and risk factors for gram positive bacteremia in a cohort of 288 solid tumor patients who were more than 18 years old and had neutropenic fever after chemotherapy from January 2002 to December 2004 at the Department of Oncology, Yonsei Cancer Center, Seoul. RESULTS: We identified the cause of fever in 130 (45.1%) cases, of which 53 (18.4%) cases were blood stream infection. Gram positive organism was isolated in 27 cases which comprises 50.9% of blood stream infections, followed by gram negative organism (47.2%) and fungus (1.9%). A logistic regression analysis revealed that gram positive bacteremia was associated independently with central venous catheter (CVC) infection, oropharyngeal mucositis, skin and soft tissue infection in febrile neutropenic patients with solid tumor. CONCLUSIONS: Gram positive bacteremia was common among febrile neutropenic patients in solid tumor and was associated with CVC infection, oropharyngeal mucositis, skin and soft tissue infection. The early use of glycopeptide must be taken into account in such conditions.

A Case of Human Babesiosis Confirmed by Polymerase Chain Reaction and Treated with Atovaquone and Azithromycin

Human babesiosis is a tick-borne infectious disease caused by Babesia species. The clinical diagnosis is difficult because of nonspecific symptoms like flu. Rapid diagnosis of human babesiosis is microscopic examination in peripheral blood smear (Giemsa-stain) which reveals characteristic forms of an intracellular quadruplet parasite. But differentiation between Babesia microti and Plasmodium species can be quite difficult because of the morphologic similarity. We experienced a case of human babesiosis. The patient was a 62-year old Korean male who had been in New Jersey, U.S.A for 2 months. We initially diagnosed as malaria infection because the peripheral blood smear revealed intracellular single ring form organism. But the patient was not improved significantly by the treatment with chloroquine regimen. Finally we confirmed human babesiosis by polymerase chain reaction for Babesia microti. We treated the patient successfully with a regimen of atovaquone and azithromycin which has fewer adverse reactions than a regimen of clindamycin and quinine.

A Case of Rhabdomyolysis in a Patient with Plasmidium vivax Malaria Treated with Hydroxychloroquine

Rhabdomyolysis is a potentially life-threatening syndrome resulting form the breakdown of skeletal muscle fibers with leakage of muscle contents into the circulation. Rhabdomyolysis may complicate many disease states. In some cases, patients with malaria may be complicated with rhabdomyolysis. Also hydroxychloroquine may induce myopathy and rhabdomyolysis. But there is no case report of rhabdomyolysis after use of hydroxychloroquine in a Korean patient with Plasmodium vivax malaria. Recently we experienced a patient who developed rhabdomyolysis 20 days after starting therapy with hydroxychloroquine for the treatment of P. vivax malaria. We report the case with the review of the literature.

Clinical Manifestations of Febrile Neutropenic Patients with Solid Tumor and Risk Factors for Gram Positive Bacteremia

BACKGROUNDS: Recently, there has been a rise of prevalence of gram positive infection among cancer patients with febrile neutropenia. The proportion of antibiotic-resistant gram positive infection has been growing lately, especially in Korea, where the rate of MRSA infection was over 70%. It brings to careful consideration of early glycopeptide treatment in febrile neutropenic patients if gram positive infection is suspected. Also until now, most studies concerning febrile neutropenic patients were mainly related to hematologic malignancy rather than solid tumor. MATERIALS AND METHODS: We evaluated clinical manifestations and risk factors for gram positive bacteremia in a cohort of 288 solid tumor patients who were more than 18 years old and had neutropenic fever after chemotherapy from January 2002 to December 2004 at the Department of Oncology, Yonsei Cancer Center, Seoul. RESULTS: We identified the cause of fever in 130 (45.1%) cases, of which 53 (18.4%) cases were blood stream infection. Gram positive organism was isolated in 27 cases which comprises 50.9% of blood stream infections, followed by gram negative organism (47.2%) and fungus (1.9%). A logistic regression analysis revealed that gram positive bacteremia was associated independently with central venous catheter (CVC) infection, oropharyngeal mucositis, skin and soft tissue infection in febrile neutropenic patients with solid tumor. CONCLUSIONS: Gram positive bacteremia was common among febrile neutropenic patients in solid tumor and was associated with CVC infection, oropharyngeal mucositis, skin and soft tissue infection. The early use of glycopeptide must be taken into account in such conditions.

A Case of Human Babesiosis Confirmed by Polymerase Chain Reaction and Treated with Atovaquone and Azithromycin

Human babesiosis is a tick-borne infectious disease caused by Babesia species. The clinical diagnosis is difficult because of nonspecific symptoms like flu. Rapid diagnosis of human babesiosis is microscopic examination in peripheral blood smear (Giemsa-stain) which reveals characteristic forms of an intracellular quadruplet parasite. But differentiation between Babesia microti and Plasmodium species can be quite difficult because of the morphologic similarity. We experienced a case of human babesiosis. The patient was a 62-year old Korean male who had been in New Jersey, U.S.A for 2 months. We initially diagnosed as malaria infection because the peripheral blood smear revealed intracellular single ring form organism. But the patient was not improved significantly by the treatment with chloroquine regimen. Finally we confirmed human babesiosis by polymerase chain reaction for Babesia microti. We treated the patient successfully with a regimen of atovaquone and azithromycin which has fewer adverse reactions than a regimen of clindamycin and quinine.

A Case of Rhabdomyolysis in a Patient with Plasmidium vivax Malaria Treated with Hydroxychloroquine

Rhabdomyolysis is a potentially life-threatening syndrome resulting form the breakdown of skeletal muscle fibers with leakage of muscle contents into the circulation. Rhabdomyolysis may complicate many disease states. In some cases, patients with malaria may be complicated with rhabdomyolysis. Also hydroxychloroquine may induce myopathy and rhabdomyolysis. But there is no case report of rhabdomyolysis after use of hydroxychloroquine in a Korean patient with Plasmodium vivax malaria. Recently we experienced a patient who developed rhabdomyolysis 20 days after starting therapy with hydroxychloroquine for the treatment of P. vivax malaria. We report the case with the review of the literature.

A Case of Toluene-induced Renal Tubular Acidosis Presented with Hypokalemic Paralysis

Toluene is known to cause a moderate degree of hypokalemia, myalgia, and even muscular weakness. We encountered the patient with acute hypokalemic paralysis in a chronic glue sniffer. A 32-year-old Korean male was taken to the emergency room with muscle weakness and somnolence. His serum chemistries showed severe hypokalemia and hyperchloremic metabolic acidosis. The urine toxicology screening showed excess levels of hippuric acid. His serum potassium level and metabolic acidosis were corrected after interruption of the offending agents and KCl & bicarbonate replacement. We report a case of severe hypokalemic muscular paralysis with renal tubular acidosis resulting from toluene inhalation.

A Case of Focal Myositis Associated with Rheumatoid Arthritis / 대한류마티스학회지

Focal myositis is an uncommon benign inflammatory myopathy of unknown cause affecting skeletal muscle, and presenting as a localized painful swelling within the soft tissue of an extremity. According to some reports, focal myositis may occur in patients with rheumatoid arthritis, sarcoidosis, and other connective tissue diseases. To our knowledge, there has been no case report of focal myositis associated with rheumatoid arthritis. We report first case of focal myositis in a patient with rheumatoid arthritis.

The Effect of Early Diagnosis and Treatment on the Disease Activity and Joint Damages in Korean Patients with Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: We investigated the effect of the early diagnosis and treatment on the disease activity and joint damage in patients with rheumatoid arthritis (RA). METHODS: We enrolled 242 RA patients (male 50 patients, female 192 patients, mean age 49.7+/-13.5 years old) in this study. They were divided into two groups according to lag-time to diagnose RA from the onset of symptoms. 136 RA patients whose lag-time did not exceed 12 months were classified into early diagnosed RA group and 106 RA patients whose lag-time over 12 months were classified into delayed diagnosed RA group. Baseline date were assessed at the time of diagnosis. Disease activity was assessed by sums of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) during first year after diagnosis. Radiological joint damages were evaluated using modified Sharp score. RESULTS: At the time of diagnosis, the age of patients, ESR and platelet counts were significantly decreased, and hemoglobin level was significantly increased in early diagnosed RA group. Early diagnosed RA group showed lower sums of ESR and CRP than delayed diagnosed RA group significantly. Modified sharp score at the time of diagnosis and after treatment were significantly lower in early diagnosed RA group than delayed diagnosed RA group. The difference of modified sharp score between at the time of diagnosis and after treatment were lower in early diagnosed RA group than delayed diagnosed RA group too. CONCLUSION: The early diagnosis and treatment of RA reduced extent of joint damage and provoked better response to treatment significantly.

Clinical Characteristics of Late-onset Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: Late-onset rheumatoid arthritis (LORA) refereed as the subset of rheumatoid arthritis with age of onset over 60 years old, seems to differ from younger onset disease (YORA) by more equal sex distribution, a higher frequency of abrupt disease onset, more large joints involvement, more extraarticular manifestation, erythrocyte sedimentation test (ESR), and less rheumatoid factor (RF) positivity. We need data of LORA in Korea because of lack of data. METHODS: Two hundred and forty-two patients were studied retrospectively. We compared the difference with clinical manifestation, disease activity markers, RF, ANA, and radiologic changes between LORA and YORA. Sums of ESR and C-reactive protein (CRP) during first year after diagnosis were calculated through area under curve. Radiologic joint damages were evaluated using modified Sharp score. RESULTS: The gender ratio (female/male) was 1.54 in LORA and 6.43 in YORA (p<0.001). The duration of the diagnosis was longer in LORA than in YORA (25.2+/-27.0 months, 18.5+/-22.2 months, p=0.048). Tender and swollen joint, and involvement of joints were not different in the groups. ESR, CRP, platelet, and RF were higher with LORA. Sums of ESR and CRP were higher in LORA than in YORA (403.7+/-252.2 mm/hr, 25.6+/-41.1 mg/dL vs 281.4+/-201.3, 12.0+/-15.0). There was no difference of modified Sharp score in both groups. CONCLUSION: The LORA has an equal gender ratio, longer morning stiffness and disease duration, and higher levels of RF, platelet, ESR, CRP, and summation of ESR and CRP, which suggests that LORA may have poorer prognosis than YORA.

A Case of Pulmonary Metastasis of a Dermatofibrosarcoma Protuberans / 결핵및호흡기질환

Dermatofibrosarcoma protuberans (DFPS) is a locally aggressive skin tumor with a very low incidence in the general population. This tumor has a remarkable tendency to recur, However, a metastasis is rare. We report a case of DFPS with a pulmonary metastasis in 28-year-old man. The pulmonary metastasis developed 5 years after a complete resection of the primary skin tumor. We reviewed the clinical manifestations and treatment of DFPS, and highlight the need for a long-term follow-up examination for metastases after a wide excision of these lesions.

A Case of Cardiac Arrest due to Drug Interaction between Halothane and Aminophylline: A case report / 대한마취과학회지

Although halothane is generally anesthetic of choice for asthmatics due to its bronchodilatory action, its combined use with aminophylline should be discouraged. This report is a 43-year-old male who had primary closure and open reduction internal fixation (ORIF) for facial avulsion injury and zygomatic tripod fracture under N2O-O2-halothane anesthesia. About 90 minutes after the procedure, the patient who had aminophylline infusion for an acute bronchospasm developed a sudden cardiac arrest. The immediate cardiopulmonary resuscitation was applied and the patient was recovered without any neurological deficit. At the time, the serum theophylline concentration of the patient was 16 microgram/ml which was in the range of normal therapeutic dose. The cause for this cardiac arrest by halothane is unknown, but possibly a drug interaction between halothane and aminophylline might have contributed, since halothane sensitizes the heart to exogenous catecholamines.

Postoperative Sore Throat and Hoarseness : Influence of the Method of Anesthesia Induction and Time for Extubation / 대한마취과학회지

BACKGROUND: Tracheal intubation for general anesthesia often leads to trauma of the airway mucosa, resulting in postoperative sore throat and hoarseness. Numerous studies have investigated the factors as contributing causes, but the influence of method of anesthesia induction and time for extubation of the endotracheal tube has not been systematically examined. The aim of this study was to establish the effects of the methods of anesthesia induction and timing of extubation on postoperative sore throat and hoarseness. METHODS: Eighty patients with ASA physical status 1 or 2 were randomly divided into four groups. Group 1 patients (n=20) recieved succinylcholine 1.0 mg/kg for intubation and early extubated ; group 2 patients (n=20) recieved succinylcholine 1.0 mg/kg for intubation and lately extubated ; group 3 patients (n=20) recieved pancuronium 0.1 mg/kg for intubation and early extubated ; group 4 patients (n=20) recieved pancuronium 0.1 mg/kg for intubation and lately extubated. All patients were interviewed 6, 24, 48, and 72 hrs after operation by an anesthesiologist in a double-blind manner. RESULTS: The incidence of sore throat at postoperative 6 and 24 hrs were decreased in group 3 compaired with group 1, 2, and 4 (p<0.05), respectively. The severity of sore throat at postoperative 6 hrs were decreased in group 3 compared with group 1, 2 and 4 (p<0.05), and that of postoperative 24 hrs were decreased in group 3 compared with group 1 and 2 (p<0.05), respectively. The severity of hoarseness at postoperative 6 hrs were decreased in group 3 compared with group 2 (p<0.05). CONCLUSIONS: We suggest that postoperative sore throat and hoarseness may be developed more when extubation was perfomed lately than early. Therefore, early extubation provide advantage in terms of reducing sore throat and hoarseness in limited cases of anesthesia.