OBJECTIVE: To correlate the acromiohumeral distance (AHD) using tomosynthesis and rotator cuff (RC) pathology and various anatomical indices and to assess the diagnostic reproducibility of tomosynthesis for the evaluation of subacromial impingement. MATERIALS AND METHODS: A retrospective review of 63 patients with clinically suspected subacromial impingement was conducted. Two musculoskeletal radiologists independently measured the following quantitative data: the AHD on plain radiographs and the AHD at three compartments (anterior, middle, and posterior) using tomosynthesis, computed tomography (CT) arthrography, or magnetic resonance (MR) arthrography. To investigate the association between the AHD and RC pathology and various anatomical indices, we reviewed the arthroscopic operation record as the referenced standard. RESULTS: The size of rotator cuff tear (RCT) in full-thickness tears displayed a significant inverse correlation with the middle and the posterior tomosynthetic AHDs (p < 0.05). The results of an ANOVA revealed that the middle tomosynthetic AHD retained a significant association with the type of RCT (p = 0.042), and the posterior tomosynthetic AHD retained significance for the size of RCT in a full-thickness tear (p = 0.024). The inter-modality correlation exhibited significant agreement especially among the plain radiography, tomosynthesis, and CT or MR arthrography (p < 0.05). The intraobserver and interobserver correlation coefficients (ICCs) displayed excellent agreement (ICC = 0.896–0.983). The humeral head diameter and glenoid height were significantly correlated with patient height and weight. CONCLUSION: Acromiohumeral distance measurement using tomosynthesis is reproducible compared with other modalities.
Arthrography ; Humans ; Humeral Head ; Pathology ; Radiography ; Retrospective Studies ; Rotator Cuff* ; Shoulder ; Tears

BACKGROUND AND OBJECTIVES: Ten to twenty percent of children with Kawasaki disease (KD) do not respond to initial intravenous immunoglobulin (IVIG) treatment. If untreated, approximately 15% to 25% of KD patients have complications. The aim of this study was to find useful predictors of responsiveness to initial IVIG treatment in KD. SUBJECTS AND METHODS: We retrospectively reviewed medical records of 91 children diagnosed with KD at Myong Ji Hospital from March 2012 to April 2014. Before and after (24 hours to 36 hours) IVIG treatment, the following laboratory data were obtained: hemoglobin (Hb) level, white blood cell count, proportion of neutrophil, lymphocyte and eosinophil, platelet count, erythrocyte sedimentation rate (ERS), C-reactive protein (CRP), creatine kinase (CK), creatine kinase MB (CK-MB), and N-terminal pro-brain natriuretic peptide (NT-proBNP). Subjects were then divided into two groups: IVIG-responsive or IVIG-resistant. RESULTS: Of 91 patients, 11 (12%) required retreatment. By univariate analysis, before-IVIG laboratory parameters of white blood cell count, % neutrophil, ERS, CRP, sodium, CK, CK-MB, and NT-proBNP were significantly different between IVIG-responsive and IVIG-resistant patient groups. In the after-IVIG laboratory parameters, Hb level, white blood cell count, % neutrophil, % lymphocyte, CRP, CK, CK-MB, and NT-pro-BNP were significantly different between the two groups. While the mean-differences were not statistically significant, fractional change (FC)-CRP and FC-% neutrophil showed significant difference. By multivariate analysis, FC-CRP was confirmed to be an independent predictor for initial IVIG resistance. CONCLUSION: Fractional change-C-reactive protein might be a useful and important value for predicting initial IVIG resistance in KD patients.
Blood Sedimentation ; C-Reactive Protein ; Child ; Creatine Kinase ; Eosinophils ; Humans ; Immunization, Passive* ; Immunoglobulins ; Immunoglobulins, Intravenous ; Leukocyte Count ; Lymphocytes ; Medical Records ; Mucocutaneous Lymph Node Syndrome* ; Multivariate Analysis ; Neutrophils ; Platelet Count ; Retreatment ; Retrospective Studies ; Risk Factors ; Sodium

Renal cell carcinoma is an uncommon source of bladder metastases. Here we report a case of renal cell carcinoma that metastasized to the bladder. A 73-year-old woman complained of gross hematuria. Abdominopelvic computerized tomography showed a bladder mass and a heterogenous enhancing mass in the lower pole of the left kidney with left vein thrombosis. The pathological analysis of the resected bladder specimen revealed metastatic renal cell carcinoma of the clear cell type.
Carcinoma, Renal Cell ; Female ; Hematuria ; Humans ; Kidney ; Neoplasm Metastasis ; Thrombosis ; Urinary Bladder ; Veins

Hematogenous metastasis to skeletal muscle from urothelial carcinoma is extremely rare and metastatic disease to skeletal muscle tends to be found in people with advanced-stage neoplasm. We report in this paper a case of left sartorius muscle metastasis from urothelial cell carcinoma. A left nephroureterectomy with bladder cuff excision was performed and revealed a high-grade papillary transitional cell carcinoma (TCC) of the pelvis. And 6 month later, recurrent bladder cancer was found regular cystoscopy and then treated with transurethral resection of the bladder. After 6 times resection of bladder, an invasion into the bladder muscle layer was found. We recommended additional radical cystectomy to prevent the disease from advancing. However, the patient refused additional surgery. 6 month later, the patient complained of left thigh pain, so ultrasonography-guided biopsy of the nodular mass lesion in the left sartorius muscle was performed. The pathological analysis of the biopsy specimen revealed poorly differentiated metastatic urothelial carcinoma.
Biopsy ; Carcinoma, Transitional Cell ; Cystectomy ; Cystoscopy ; Humans ; Muscle, Skeletal ; Muscles ; Neoplasm Metastasis ; Pelvis ; Thigh ; Urinary Bladder ; Urinary Bladder Neoplasms

To determine the recovery time from noise-induced temporary threshold shift (TTS), a prospective field study was conducted at three worksites where workers are known to be exposed high level of noise. Subjects were selected according to answers on a questionnaire which inquired about otological history and previous noise exposure, including avocational, military and occupational exposures. After excluding employees with past otologic problems, recent exposure to high level noise, and under medications, total 92 employees participated in the study. Among 92 participants, complete consecutive audiometric examinations were carried out at 0~2 hours, 5~7 hours, 14~16 hours after worktime noise exposure on 26 participants wearing hearing protectors and 22 participants wearing no protective devices. The difference between the hearing level 0~2 hours after noise exposure and 5~7 hours is statistically significant by paired t-test(p<0.01). The median recovery times calculated from the data of 22 participants wearing no protective hearing devices are 15.6 hours at 4000 Hz, and 7.7 hours, 10.3 hours, 8.4 hours at 1000 Hz, 2000 Hz and 8000 Hz respectively. These data suggest that when measuring the pure tone audiometry for noise exposed workers, at least 16 hours noise-free interval is required.
Audiometry ; Hearing ; Hearing Loss, Noise-Induced ; Humans ; Military Personnel ; Noise ; Occupational Exposure ; Prospective Studies ; Protective Devices ; Questionnaires ; Workplace

To determine the recovery time from noise-induced temporary threshold shift (TTS), a prospective field study was conducted at three worksites where workers are known to be exposed high level of noise. Subjects were selected according to answers on a questionnaire which inquired about otological history and previous noise exposure, including avocational, military and occupational exposures. After excluding employees with past otologic problems, recent exposure to high level noise, and under medications, total 92 employees participated in the study. Among 92 participants, complete consecutive audiometric examinations were carried out at 0~2 hours, 5~7 hours, 14~16 hours after worktime noise exposure on 26 participants wearing hearing protectors and 22 participants wearing no protective devices. The difference between the hearing level 0~2 hours after noise exposure and 5~7 hours is statistically significant by paired t-test(p<0.01). The median recovery times calculated from the data of 22 participants wearing no protective hearing devices are 15.6 hours at 4000 Hz, and 7.7 hours, 10.3 hours, 8.4 hours at 1000 Hz, 2000 Hz and 8000 Hz respectively. These data suggest that when measuring the pure tone audiometry for noise exposed workers, at least 16 hours noise-free interval is required.
Audiometry ; Hearing ; Hearing Loss, Noise-Induced ; Humans ; Military Personnel ; Noise ; Occupational Exposure ; Prospective Studies ; Protective Devices ; Questionnaires ; Workplace

BACKGROUND/AIMS: Gastric hepatoid adenocarcinoma (GHA), a rare type of primary gastric cancer, is characterized by a histology resembling hepatocellular carcinoma. Previous case studies reported that patients with GHA have a poor prognosis due to early lymph node or liver metastasis, but information concerning GHA is still limited. Therefore, we aimed to evaluate the clinicopathological features of GHA. MATERIALS AND METHODS: We reviewed the medical records of 9 patients who were diagnosed as having GHA between January 2011 and December 2016. The clinicopathological characteristics of these patients were retrospectively analyzed. RESULTS: The median age of the patients at diagnosis was 68.9 years. Seven of the 9 patients were male. Serum AFP levels were elevated in 3 of 4 patients. All the tumors were >4 cm (range, 4~12 cm), and 7 tumors were located at the lower third of the stomach. Five tumors were classified as Borrmann's type 3, with a purple, berry-like surface. Of the 6 patients without distant metastasis, 5 received curative-intent surgery and 3 received adjuvant chemotherapy. Three patients with distant metastasis received either palliative operation and/or chemotherapy. Their median survival time was 11.8 months (range, 1~36 months). Two patients with elevated serum CEA levels had poor outcomes. CONCLUSIONS: GHA is a rare subtype of gastric cancer that is prone to liver metastasis. All GHAs are advanced gastric cancer with a purple, berry-like surface at diagnosis. Although the prognosis of advanced-stage GHA is poor, active multimodality treatment might provide some benefit.
Adenocarcinoma* ; Carcinoma, Hepatocellular ; Chemotherapy, Adjuvant ; Diagnosis ; Drug Therapy ; Endoscopy ; Humans ; Liver ; Lymph Nodes ; Male ; Medical Records ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Stomach ; Stomach Neoplasms

OBJECTIVE: To analyze radiologic findings of cervical involvement in ankylosing spondylitis (AS) patients, determine its association with structural severity and clinical variables, and to divide radiologic findings of atlantoaxial ankylosis (AAA) in AS patients into three anatomical components. METHODS: The study includes 150 AS patients with either AAA (62 patients) or atlantoaxial subluxation (AAS, 88 patients) who underwent plain radiography of the cervical spine on flexion at our tertiary center for rheumatic diseases. The study subjects' medical records were reviewed. Lateral plain radiographs of the cervical spine were analyzed by a musculoskeletal radiologist. We compared the results of the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) between AAS and AAA patients to determine if mSASSS was related to severity or duration of AS. RESULTS: The mean duration of illness in AS patients with AAA was 19.3 years, and in AAS patients 13.7 years (p<0.01). The mean total mSASSS of AS patients with AAA was 40.1, and of AAS patients 16.5 (p<0.001), and was positively associated with the development of AAA and AAS. The odds ratio (OR) of AAA development by cervical spine mSASSS change was higher (OR, 1.079) than the OR (1.049) of lumbar spine mSASSS even after adjusting for age, sex, and disease duration. CONCLUSION: Although AAA is described infrequently, we found from our data that it is another manifestation of cervical spine involvement in longstanding AS and is related to severity of AS reflected by higher cervical mSASSS.
Ankylosis* ; Atlanto-Axial Joint ; Humans ; Medical Records ; Odds Ratio ; Radiography ; Rheumatic Diseases ; Spine* ; Spondylitis, Ankylosing*

BACKGROUND AND OBJECTIVES: Despite the sporadic case reports on the cardiac involvement of Behcet's disease, any systemic investigation has not been reported on. We sought to investigate the frequency and clinical characteristics of the patients with the cardiac manifestations of Behcet's disease. SUBJECTS AND METHODS: We retrospectively analyzed the clinical data of 217 patients (mean age: 39+/-11 years) with Behcet's disease who were diagnosed in Asan Medical Center from January 1990 to September 2000. The patients were subgrouped into the mucocutaneous, cardiac, vascular, central nervous system, gastrointestinal and ocular group according to the involved organ. RESULTS: Among 217 patients, nineteen (8.8%) were found to have cardiac involvement: aortic regurgitation was found in ten patients (53%), right ventricular thrombi in six (32%), acute myocardial infarction in two (11%), and myocarditis in one (5%). The incidence of initial oro-genital ulcers at the first clinical presentation was significantly lower in the cardiac Behcet's group than in the other subgroups (52% vs 90%, p=0.001). The event-free survival rate during a mean follow-up duration of 67+/-46 months was also significantly lower in the cardiac Behcet's group (63% vs 14%, p=0.0001). CONCLUSION: Aortic regurgitation and right ventricular thrombus are two common types of cardiac Behcet's disease. Although its incidence is low, cardiac Bechcet's disease has a characteristic pattern for the clinical presentation, and it has a worse prognosis compared with the other subgroups of Behcet's disease that have other solid organ involvement.
Aortic Valve Insufficiency ; Central Nervous System ; Chungcheongnam-do ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Incidence ; Myocardial Infarction ; Myocarditis ; Prognosis ; Retrospective Studies ; Thrombosis ; Ulcer

PURPOSE: Tibial internal torsion is prevalent in East Asian countries such as Korea and Japan, where sitting on the floor is common behavior. Tibial internal torsion or excessive lateral tibial torsion may cause esthetical, functional, or psychological problems and also may induce degenerative arthritis in older age. The aim of this study is to evaluate the therapeutic effect of Tibial Counter Rotator (TCR) in patients with tibial internal torsion. Method:One hundred forty nine children (274 limbs) with tibial internal torsion participated in this study. Transmalleolar angle were measured with gravity goniometer. When tibial internal torsion was detected, TCR was applied at least for 3 hours a day during sleep. The patient's progress was followed monthly and transmalleolar angle was reevaluated by the same examiner. RESULTS: Transmalleolar angle was significantly increased in patients with tibial internal torsion during TCR application (P<0.001). CONCLUSION: TCR can be one of the effective methods for correcting tibial internal torsion in children under 12 years old of age.
Asian Continental Ancestry Group ; Child* ; Gravitation ; Humans ; Japan ; Korea ; Osteoarthritis ; Tibia*