Abdominal aortic calcification in patients newly diagnosed with essential thrombocythemia

Background@#Although atherosclerosis is likely to be involved in the development of arterial thrombotic events in patients with essential thrombocythemia (ET), abdominal aortic calcification (AAC) has rarely been investigated. We evaluated the prevalence and clinical relevance of AAC at the time of ET diagnosis. @*Methods@#This retrospective study included patients newly diagnosed with ET who underwent abdominal computed tomography (CT) at the time of diagnosis between January 2002 and December 2021 at Chungnam National University Hospital, Daejeon, Korea. CT images were reviewed and an aortic calcification score was assigned. @*Results@#Of the 94 patients (median age, 62 yr; range, 18‒90 yr), AAC was detected in 62 (66.0%).AAC was most commonly mild (33.0%), followed by moderate (22.7%) and severe (5.3%).Old age [odds ratio (OR), 34.37; 95% confidence interval (CI), 12.32‒95.91; P ＜0.001] was an independent risk factor for AAC. The patients with AAC had a higher WBC count (11.8±4.7 vs. 9.7±2.9×109 /L, P =0.017), higher neutrophil-to-lymphocyte ratio (4.3±2.7 vs. 3.1±1.5, P=0.039), and higher JAK2V617F positivity (81.5% vs. 58.8%, P=0.020) compared to those without AAC. AAC was an independent risk factor for arterial thrombotic vascular events that occurred before or at diagnosis of ET (OR, 4.12; 95% CI, 1.11‒15.85; P=0.034). @*Conclusion@#AAC is common in patients with ET and is associated with arterial thrombotic events.

Increased interleukin-6 and TP53 levels in rotator cuff tendon repair patients with hypercholesterolemia

Background@#A previous study reported that hyperlipidemia increases the incidence of tears in the rotator cuff tendon and affects healing after repair. The aim of our study was to compare the gene and protein expression of torn rotator cuff tendons in patients both with and without hypercholesterolemia. @*Methods@#Thirty patients who provided rotator cuff tendon samples were classified into either a non-hypercholesterolemia group (n=19, serum total cholesterol [TC] <200 mg/dL) and hypercholesterolemia group (n=11, serum TC ≥240 mg/dL) based on their concentrations of serum TC. The expression of various genes of interest, including COL1A1, IGF1, IL-6, MMP2, MMP3, MMP9, MMP13, TNMD, and TP53, was analyzed by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR). In addition, Western blot analysis was performed on the proteins encoded by interleukin (IL)-6 and TP53 that showed significantly different expression levels in real-time qRT-PCR. @*Results@#Except for IGF1, the gene expression levels of IL-6, MMP2, MMP9, and TP53 were significantly higher in the hypercholesterolemic group than in the non-hypercholesterolemia group. Western blot analysis confirmed significantly higher protein levels of IL-6 and TP53 in the hypercholesterolemic group (p<0.05). @*Conclusions@#We observed an increase in inflammatory cytokine and matrix metalloproteinase (MMP) levels in hypercholesterolemic patients with rotator cuff tears. Increased levels of IL-6 and TP53 were observed at both the mRNA and protein levels. We suggest that the overexpression of IL-6 and TP53 may be a specific feature in rotator cuff disease patients with hypercholesterolemia.

2014–2017 Nationwide Bariatric and Metabolic Surgery Report in Korea

PURPOSE: The information committee of the Korean Society for Metabolic and Bariatric Surgery (KSMBS) performed the nationwide survey of bariatric and metabolic operations to report IFSO (International Federation for the Surgery of Obesity and Metabolic Disorders) worldwide survey annually. This study aimed to report the trends of bariatric and metabolic surgery in Korea in 2014–2017. MATERIALS AND METHODS: We analyzed the accumulated nationwide survey data conducted for annual ISFO survey from 2014 to 2017. Trends such as the number of operations by hospital type and the number of operations by surgical method were analyzed. RESULTS: The number of operations has decreased sharply in 2015 comparing to 2014 (913⇒550). The number of operations performed in private hospitals dropped sharply from 529 to 250, 198, and 103 cases. The number of revisional surgeries increased to 223 in 2015. The primary surgery number fell from 757 in 2014 to 327 in 2015. In primary surgery, sleeve gastrectomy was gradually increased from 2014 to 143 (18.9%), 105 (32.1%), 167 (47.2%) and 200 (56.3%) and became the most frequently performed surgery. On the other hand, the incidence of adjustable gastric band decreased gradually from 439 (58.0%) to 117 (35.8%), 112 (31.6%) and 59 (16.6%). CONCLUSION: The overall number of obesity metabolic operations has decreased since 2014, especially the number of adjustable gastric band, and the number of operations in private hospitals declined sharply. On the other hand, the number of operations in university hospitals did not change much, and the number of sleeve gastrectomy increased.

Intra-abdominal necrotic lipoma diagnosed by computed tomography as a paraprostatic cyst

A dog with a history of diarrhea and dyschezia exhibited an oval-shaped, soft-tissue opacity mass in the abdomen on radiographs. CT examination revealed a large fluid-filled structure displacing the urinary bladder, prostate, and colon. The mass had continuity with the prostate; therefore, it was tentatively diagnosed as a paraprostatic cyst. Cytologic examination was performed and the mass was considered a non-inflammatory cyst. However, after surgery, histopathologic examination revealed a necrotic, inflamed cystic lipoma. This case shows that unusual intra-abdominal lipomas may have a cystic appearance.

Personal Factors Affecting Therapeutic Responses to BCG Vaccination in Asthmatics

PURPOSE: Bacille Calmette-Guerin (BCG) vaccination has been reported to be an effective treatment for asthma in several animal models. This study investigated whether the response to BCG treatment in asthma depends on subject clinical characteristics. METHODS: Stable asthma patients were vaccinated with BCG. One month later, alterations in pulmonary function after vaccination and their relationships with subject clinical characteristics were determined. RESULTS: Of 149 patients with asthma, 54 (36.2%) showed a good or fair response to BCG. The DeltaFEV1 after vaccination was significantly related to age (r=-0.348, P0.05). A good/fair response was highly prevalent in atopic females compared with atopic males, especially among those aged < or =50 years (90.9% vs. 40.0%, P=0.024). Age (P<0.001, odds ratios (OR)=0.92, confidence interval (CI)=0.88-0.96) and atopy (P<0.01, OR=4.95, CI=1.70-14.44) were significant predictors for a good/fair response in females. However, blood eosinophil counts (P<0.05, OR=1.18, CI=1.01-1.39) and FEV1 % best (P<0.001, OR=0.86, CI=0.79-0.94), but not age or atopy, were significant predictors in males. Approximately three-quarters of the males were smokers. CONCLUSIONS: The therapeutic effect of BCG in asthma may differ according to patient clinical characteristics. The greatest benefit occurred in young atopic females. Asthma activity indices, such as eosinophilia and FEV1 % best, were more predictive of a good/fair response in males; this may have been related to cigarette smoking.

Quality of Life and Anxiety in Patients with Acute and Chronic Pain

OBJECTIVE: To compare the factors such as quality of life (QOL), anxiety and pain intensity in patients with acute and chronic pain. METHOD: Twenty patients with acute (pain duration 3 months) musculoskeletal pain were recruited. Pain intensity was assessed using 3 measures: ratings of average pain on a visual analogue scale (VAS), ratings of average pain on the short form McGill pain questionnaire (SF-MPQ), and ratings of pain on the present pain intensity (PPI) verbal rating scale. Quality of life and anxiety were assessed using 2 measures: the SF-36 (medical outcomes study 36-item short-form health survey) and the STAI (state-trait anxiety inventory). RESULTS: The SF-36 scale was lower and state anxiety scale was higher in chronic pain group. The SF-36 and the state anxiety scale revealed significant difference between the acute and chronic groups (p<0.05), but there was no significant difference between the the groups regarding pain intensity and the trait anxiety scale. CONCLUSION: Patients with chronic pain showed low well-being status and increased anxiety level compared to acute pain patients. According to the above results, proper management of chronic pain might be helpful for enhancing their psychosocial function.

Gender Differences Associated with Pain Patterns and Psychological Variables in Chronic Musculoskeletal Pain Patients

OBJECTIVE: To investigate gender differences in pain patterns and psychological variables among patients with chronic musculoskeletal pain. METHOD: Thirty-five male and thirty-eight female patients who visited our outpatient clinic due to chronic musculoskeletal pain were evaluated using a questionnaire survey. Chronic musculoskeletal pain was defined as pain lasting longer than 6 months. Patients were evaluated with visual analogue scale (VAS), pain site, pain duration and frequency. Beck depression inventory, state-trait anxiety index, somatization scale of symptom checklist-revised, symptom interpretation questionnaire, and pain catastrophizing scale were checked for psychological variables. Correlations among each variable were evaluated statistically. RESULTS: Female patients with chronic musculoskeletal pain recorded higher scores on number of pain site, pain catastrophizing scale, rumination, magnification and catastrophic attribution than male patients (p<0.05). In female patients, VAS was correlated significantly with depression, static anxiety, somatization, catastrophizing thought. rumination, magnification, helpless, and catastrophic attribution. Pain frequency was correlated significantly with somatization, catastrophizing thought, rumination, and helpless. Number of pain site was correlated with somatization, catastrophizing thought, magnification, and helpless. The correlation between pain patterns and psychological variables was also observed in male patients, but statistically less significant than female patients. CONCLUSION: We found gender difference associated with pain patterns and psychological variables in chronic musculoskeletal pain patients. Consideration of psychological factors may be important for management in female patients with chronic musculoskeletal pain.

Buttock Pain Secondary to Segmental Neurofibromatosis: A case report

Neurofibromatosis (NF) is a dysplastic disease which consists of multiple cafe-au-lait spots and neurofibromas from neural sheath. The 61-year-old male patient complained of sudden severe pain on the left buttock started one month ago. On physical examination, multiple "lentigines" were seen on his left buttock which spreaded to the thigh and small soft protruding nodules were observed on the right side of the back and left shoulder. Histopathologic finding of a specimen obtained from a nodule was consistent with neurofibroma. Magnetic resonance imaging (MRI) and ultrasonography revealed asymmetrical hypertrophy of neurovascular bundle located in the left greater sciatic foramen. On diagnosing as NF, he was treated with medication, physical modalities and therapeutic intervention (caudal block). Visual analogue scale (VAS) went down to 3/10 with these treatments and he was discharged. We report successful treatment of buttock pain rarely associated with segmental neurofibromatosis.

Predictive Factors for Female Bladder Outlet Obstruction Defined by Pressure-Flow Study

PURPOSE: We investigated pre-urodynamic study parameters of bladder outlet obstruction (BOO) defined by pressure-flow study (PFS) in female patients without anatomical obstruction. MATERIALS AND METHODS: The cohort of this study consisted of 320 women who did not have anatomical BOO in whom urodynamic study was conducted for lower urinary tract symptoms (LUTS). BOO was defined when the PFS maximal flow rate (Qmax) was or =25 cmH2O. The main outcomes were the incidence of BOO and its predictive factors in our cohort. RESULTS: Of the total patients, 39 (12.2%) were diagnosed with BOO in the PFS. Free Qmax and maximal voided volume (MVV) were significant predictors of BOO (p15 ml/sec or MVV is >350 ml, PFS may be not essential. On the contrary, if free Qmax and MVV are below these levels, PFS may be indicated to evaluate the presence of BOO.

Are Risk Factors for Failure after Mid-Urethral Sling Operation Different between Patients with Pure Stress and Those with Mixed Urinary Incontinence in the Short-Term Follow-Up?

PURPOSE: Although application of the mid-urethral sling (MUS) operation has expanded to more complicated cases such as patients with mixed urinary incontinence (MUI), the success rates in patients with MUI have been reported to be lower than those in patients with pure stress urinary incontinence (SUI). We evaluated and compared the risk factors for failure after MUS surgery in patients with pure SUI and in those with MUI. MATERIALS AND METHODS: Two hundred twenty-eight women were categorized as having pure SUI (Group A, 163 patients) or MUI (Group B, 65 patients). Preoperative evaluations including a symptom questionnaire, physical examination, and urodynamic study were performed. Patients underwent retropubic (17.5%) or trans-obturator (82.5%) MUS surgery. RESULTS: The demographic characteristics that differed between the 2 groups were body mass index, presence of cystocele, and severity of incontinence. The success rate in Group A (95.7%) was higher than that in Group B (84.6%) (p=0.015, chi-square test). In Group A, VLPP, PdetQmax, and weight of the 1-hour pad test were identified as risk factors for failure of the operation in the univariate analysis, but only weight of the 1-hour pad test was an independent risk factor in the multivariate analysis (adjusted odds ratio [OR]=3.5; 95% confidence interval [CI]=1.204-8.895, p=0.045). In Group B, menopause without hormone replacement, AUA Symptom Index-QoL score, maximal cystometric capacity (MCC), and involuntary detrusor contraction (IDC) were the risk factors in the univariate analysis, but only MCC (adjusted OR=0.9; 95% CI=0.645-0.984, p=0.032) and IDC (adjusted OR=2.3; 95% CI=1.014-3.309, p=0.044) were independent risk factors in the multivariate analysis. CONCLUSIONS: Unlike in pure SUI, weight of the 1-hour pad test was not a significant predictor of failure of surgery in MUI. Meanwhile, MCC and IDC, which indicate the pathophysiologic status of the detrusor muscle itself, were important predictors of failure of surgery in MUI.

Single Symptom of 'Pure' Mechano-allodynia Secondary to Acute Herniated Cervical Disc: A case report

Allodynia is pain following a non-noxious stimuli which does not provoke pain normally and develops after incomplete spinal cord injury more commonly in cervical rather than thoracic level, and central cord syndrome. This article presents an unusual patient who presented with the single symptom of an intense allodynia after cervical intervertebral disc herniation. This 36-year-old male patient developed acute lancinating and burning pain aggravated by skimming light touch on both thenar area. Cervical magnetic resonance imaging (MRI) revealed central disc herniation and spinal cord compression. The allodynia secondary to acute herniated cervical disk has been successfully disappeared through pharmacotherapy with pulsed-use of steroid, gabapentin and comprehensive rehabilitation.

A study on the correlations between facial biotype, submentovertex cephalometric measurements and surface EMG activity in patients with facial asymmetry / 대한치과교정학회지

Although the submentovertex radiograph and surface EMG are not often used due to the difficulty of interpretation, they are accepted as useful diagnostic and analytic aids for skeletal asymmetry. There have been reports which state that they were also useful for the evaluation of vertical skeletal relations. The purpose of this study was to evaluate the correlations between EMG data, measurements from submentovertex radiographs, facial types and facial asymmetry following examination of 60 asymmetric patients. The radiographic corpus length were greater in the nonaffected sides (p < 0.001), gonion to interspinosum axis were greater in the affected sides and the mandibular condyle and gonion were located more anteriorly in the non-affected sides than in the affected sides but not significant (p=0.07). The activity of the anterior temporal muscle in rest position was higher in the affected sides than in the non-affected sides (p < 0.01). The activity of the masseter muscle at maximum clenching was found to be nonsignificant but it was higher in the affected sides than in the non-affected sides (p=0.09). There was positive correlation between facial index and the intercondylar axes angle (p < 0.01). There was positive correlation between masseter muscle activity in maximum occlusion and facial index in the affected and non-affected sides (p < 0.05). The results demonstrate that the submentovertex radiograph and EMG can provide useful information for the evaluation of horizontal and vertical skeletal relations.

Intraosseous hemangiolymphangioma of the mandible: a case report

Hemangiolymphangioma is a malformation of both lymphatic and blood vessels. While a hemangiolymphangioma is a benign lesion, its propensity to invade underlying tissues and to recur locally distinguishes it from the simple lymphangioma or hemangioma. Hemangiolymphangiomas are uncommon developmental anomalies and intraosseous hemangiolymphangioma of the mandible is a relatively rare condition: when it occurs, the clinical and radiographic presentation are often nonspecific. The author presents a case of hemangiolymphangioma in mandible.

Tendon transfers in traumatic foot

A clinical review was performed of 11 cases of traumatic foot treated by tendon transfer. Among 11 patients, there were eight males and three females, ranging from four to 36 years of age. The anterior tibial tendon was used in six cases for tendon transfer and among these, split anterior tibial tendon was used in three cases in children. The posterior tibial tenodn was used in two cases and the extensor digitorum longus tendon of the foot was in three cases. In six cases of soft tissue injury where tendon transfer was impossible, microvascular free cutaneous flap transplantation was combined with the tendon transfer. Follow-up results were obtained from 25 months to nine years. Excellent results were obtained in eight cases and satisfactory results in three cases. For the correction of function loss in traumatic foot, tendon transfere were a useful method for the recovery of active motion of the foot. For the restoration of function loss in the traumatic foot, there are several methods of treatment such as tendon transfer, arthrodesis and tenodesis, but for recovery of the active motion of the foot, tendon transer is the only useful method.

A Comparison of Biomechanical Characteristics and Morphologise between Operative and Nonoperative Treatments fo Tenotomized Rabbit Achilles Tendon over Lapse of Time / 대한정형외과학회잡지

The treatment of Achilles tendon rupture is controversial between surgical repair and conservative cast treatment. This study was attempted to compare the biomechanical and morphological results between operative and nonoperative treatments of experimentally tenotomized rabbit Achilles tendon with the lapse of time. A total of 72 adult rabbits were used. After tenotomizing the Achilles tendons, the subjects were divided into 3 groups according to the time of the initiation of the treatment and each group was subdivided into 2 further subgroups according to the method of treatment; immediate operation and nonoperation, 1 week delayed operation and nonoperation, and 2 weeks delayed operation and nonoperation subgroups. Ten animals from each subgroup were sacrificed after four weeks of cast immobilization and the Achilles tendons were prepared for the gross, biomechanical and histological examinations. At the same time, two animals from each subgroup were examined by Microfil perfusion for microvascular changes in the healed tendons. On biomechanical examination, maximal loads were decreased with the lapse of time in each treatment method, and there were statistical significances between the immediate and 2 weeks delayed operation subgroups, 1 week and 2 weeks delayed operation subgroups, and immediate and 2 weeks delayed nonoperation subgroups. A maximal loads were higher in the operative treatment of each group but there was no statistical significances between operative and nonoperative treatment of each group. The results of absorption energy and stiffness were similar to those of maximal load. In conclusion, these results suggest that a rupture of the Achilles tendon should be treated as early as possible preferably within 1 week, in order to achieve a high tensile strength irrespective of the treatment method. In terms of rerupture, nonoperative treatment is comparable with surgical treatment if a rupture of Achilles tendon is managed within 2 weeks of injury.

Changes of kyphotic angle in children and adults after anterior intervertebral fusion in spinal tuberculosis / 대한정형외과학회잡지

No abstract available.

Bilateral optic neuritis as first manifestation of systemic lupus erythematosus

A 21-year-old woman presented with bilateral optic neuritis, combined with central retinal vein occlusion. General physical examination and neurologic consultation revealed no other findings. Laboratory investigation yielded an elevated erythrocyte sedimentation rate, positive LE preparation, elevated ANA titer, and elevated blood urea nitrogen and creatinine levels. Diagnosis of systemic lupus erythematosus (SLE) was made. Renal failure developed quickly and she was treated with hemodialysis, transfusion and subsequently systemic corticosteroid. Anti-phospholipid antibody was positive to lupus anti-coagulant and the titer was normalized after 2-month steroid therapy at which time the visual outcome differed between the eyes. The right eye showed improvement in visual acuity and visual field, but the left eye was not improved and retained a central scotoma. SLE needs to be considered in young women with optic neuritis when other causes of optic neuritis have been excluded, and serologic tests including anti-phospholipid antibody should be conducted.

Tendon Transfers in Traumatic Foot / 대한정형외과학회잡지

A clinical review was performed of 11 cases of traumatic foot treated by tendon transfer at Severance Hospital during the period from April 1979 to March 1988 and the results are summarized as follows: l. Among 11 patient, there were 8 males and 3 females, ranging from 4 to 36 years of age. 2. Anterior tibial tendon was used in 6 cases, among these, split anterior tibial tendon was used in 3 cases. Posterior tibial tendon was used in 2 cases and extensor digitorum longus tendon of the foot in 3 cases. 3. In cases of soft tissue injury where tendon transfer was impossible, microvascular free cutaneous flap transplantation was combined with the tendon transfer in 6 cases. 4. Follow-up results of the 11 cases were obtained from 5 months to 9 years. Excellent results were obtained in 8 cases and satisfactory in 3 cases. For the correction of function loss in traumatic foot, tendon transfers were useful method for the recovery of active motion of the foot.

The Significance of Liquid Crystal Thermography in Patents with Low Back Pain / 대한정형외과학회잡지

Liquid crystal thermography is a new diagnostic imaging method detecting the temperature change by the physiologic disturbance as compared with the radilogic method detecting the anatomical distortion. We have used liquid crystal thermography in 54 patients with complaining low back pain during the period form 2nd. March 1989 to 30th. April 1989. Of these 54 patients, 35 had myelography and C-T scan, 23 had EMG, and 13 were operated upon. 1. There were 35 clinically positive patients on whom concomitant myelography and C-T scan was performed; 32 patients(91%) had a positive myelography and C-T scan, and 30 patients (86%) had a positive thermography. Of these 35 patients, 23 had EMG concomitantly; 17 patients(74%) had a positive EMG and 18 patients(78%) had a positive thermography. 2. Liquid crystal thermography correlated with myelography and C-T scan in 31 patients(89%), EMG in 18 patients(78%). 3. Concomitant thermography, myelography and C-T scan, and surgery were performed on 13 patients among them EMG was added on 5 patients; Myelography and C-T scan had 100% accuracy, thermography had 92% accuracy, and EMG had 80 % accuracy. 4. Liquid crystal thermography is non-invasive method, dose not involve the use of ionizing radiation, and correlates well with clinical and surgical findings and other diagnostic methods, and costs relatively low. So, liquid crystal thermography is useful and reliable diagnostic method in patients with low back pain.

Arthroscopic Surgery for the Acute Anterior Cruciate Ligament Injury / 대한정형외과학회잡지

The treatment of acutely torn anterior cruciate ligament(A.C.L) remains a controversial subject. The purpose of this paper is to show the arthroscopic technique of A.C.L. primary repair with or without augmentation with semitendinosus tendon. Twenty-one patients with acute A.C.L. tear were treated with repair or augmented repair under arthroscopic control from April 1989 to August 1993. Five A.C.L. torn at femoral attachment with intact distal stump were treated with arthoscopic repair alone & 16 A.C.L. torn at substance near the femoral attachment with arthroscopic repair & augmentation with semitendinosus tendon. The patient population included of 16 males and 5 females with an average age 28.3 years. Fifteen patients injuried during sports activity. Postoperative results were evaluated by Lysholm knee score & Hospital for Special Surgery knee scale in average 26 months (range from 12 months to 64 months). All patients were rated as good or excellent result except one patient who had fair result. At follow-up study, testing with KT1000 arthrometer revealed 17 patients had less than 3mm of side to side difference. Second look arthroscopy was performed in 15 patients from 4 to 29 months after repair or augmented repair. Eleven out of these 15 A.C.L. were well healed with good tension 8r. revascularization of graft. Remaining 4 A.C.L. were healed with scar tissue. On the based of this study, arthroscopic repair or augmented repair is very effective treatment for acutely torn A.C.L. near the femoral attachment.