A 31-year-old woman was referred to our pain clinic department under the diagnosis of an adult onset Still's disease. She had been suffering from high fever, skin rash, multiple arthralgia, morning stiffness and lymph node enlargement for 16 months. She had taken conventional medication with steroid and NSAIDs, but the symptoms were a remittent nature. And also, she complained of systemic side effects of corticosteroids. Stellate ganglion block with 0.25% bupivacaine was performed 67 times for the treatment of adult onset Still's disease and then, her symptoms were improved eventually. We could discontinue steroid and NSAIDs, laboratory data were satisfactory. As we experienced an adult onset still's disease improved with stellate ganglion block, we report this case with a review of the literature.
Adrenal Cortex Hormones ; Adult* ; Anti-Inflammatory Agents, Non-Steroidal ; Arthralgia ; Bupivacaine ; Diagnosis ; Exanthema ; Female ; Fever ; Humans ; Lymph Nodes ; Pain Clinics ; Stellate Ganglion* ; Still's Disease, Adult-Onset*

OBJECTIVES: We have analyzed relationship between pedicle screw loosening and bone mineral densitiy (BMD) after spinal arthrodesis with pedicle screw. MATERIALS AND METHODS: We have chosen 31 cases that had screw loosening radiologically on the follow up X-ray among the patients who underwent spinal arthrodesis with pedicle screws, and compared Saville's index that was measured by lateral view of preoperative X-ray with Dual energy X-ray absortiometry (DEXA) score.
Arthrodesis ; Bone Density ; Follow-Up Studies ; Humans ; Osteoporosis ; Risk Factors ; Spine

Numerous foreign bodies in the rectum have been reported in the literature. Their removal can be challenging depending on the size and shape of the objects and their anatomical location in the rectum. A 64-year-old man presented to the emergency department after inserting a sausage into his rectum. He had some rectal discomfort and lower abdominal pain. There were no signs of bowel perforation. We attempted to extract the sausage impacted in the recto-sigmoid junction by colonoscopy using a snare and grasping forceps but failed to extract the foreign body. Unfortunately, a colon perforation had occurred, and the sausage was eventually extracted by performing a colostomy at the recto-sigmoid junction with primary repair. We report this case of a soft rectal foreign body impacted in the recto-sigmoid colon complicated by a colon perforation with a literature review.
Abdominal Pain ; Colon ; Colonoscopy ; Colostomy ; Emergencies ; Foreign Bodies ; Hand Strength ; Humans ; Middle Aged ; Rectum ; SNARE Proteins ; Surgical Instruments

Background: Topical medications play a crucial role in the treatment of atopic dermatitis (AD). Topical corticosteroids (TCSs) remain the main treatment of choice and topical antibiotics have also been used. However, with the new topical calcineurin inhibitors (TCIs), the prescription patterns of topical agents have changed over time. Objective: To characterize the prescription patterns of topical medications in Korean patients with AD. Methods: We investigated topical medications prescribed to Korean patients with AD using the National Health Insurance Sharing System (NHISS) database over a 14-year period (2002~2015). Additionally, the potency of prescribed TCSs was compared with AD and psoriasis patients. Results: The annual prescription of TCSs showed a slightly decreasing trend without significant change. In particular, in terms of steroid class, prescription of moderate-to-low potency TCSs were increased and the use of high potency TCSs were decreased. TCSs were the most commonly prescribed topical medications for AD. Tertiary hospitals had a higher prescription rate for TCIs than secondary or primary hospitals (16.2%, 3.1%, and 1.9%, respectively). Additionally, dermatologists prescribed TCIs more frequently than pediatricians and internists (4.3%, 1.2%, and 0.6%, respectively). Among TCSs, Class 5 was prescribed the most (40.6%) followed by Class 7, 6, 4, 3, 1, and 2. When we compared the potency of TCSs prescribed for AD with psoriasis patients, moderate-to-low-potency TCSs were more commonly prescribed in AD. Conclusion Prescription patterns of topical medications had changed from 2002 to 2015 and differed according to the type of institution and specialty of the physician.

Rudimentary polydactyly is a congenital anomaly of the hand clinically ranging from a small wart-like tumor to a pedunculated structure near the thumb or little finger. The histology reveals a marked neural proliferation, dilated blood vessels, and some Meissner corpuscles in the dermis. The etiology is unknown and there are a few theories. First, Hare believed that it represented a vestigial form of supernumerary finger, and termed it rudimentary polydactyly. Since then, Shapiro et al. has argued that rudimentary polydactyly is an amputation neuroma after finding histological similarity between acquired traumatic neuroma and rudimentary polydactyly. Recently Brehmer- Andersson et al. asserted that rudimentary polydactyly is a neuroma that can arise in any area containing Meissner corpuscles after observing a penile lesion with similar histology as rudimentary polydactyly. We report a case of rudimentary polydactyly characteristically not showing any prominent Meissner corpuscles. With this case, we provide support for the theory of Shapiro et al.
Amputation ; Blood Vessels ; Dermis ; Fingers ; Hand ; Hares ; Neuroma ; Polydactyly* ; Thumb

PURPOSE: We evaluated the diagnostic performance of a noninvasive bladder cancer test, the urinary bladder cancer (UBC) antigen test, on voided urine samples from patients with active transitional cell carcinomas, on follow-up and controls. MATERIALS AND METHODS: We measured the UBC antigen in the urine from 136 patients with active transitional cell carcinomas of the bladder (group 1), 56 patients with no evidence of tumor recurrence, confirmed by cystoscopy at follow-up (group 2), 60 patients with urinary tract infections (group 3), 52 patients with other genitourinary tract malignancies (group 4) and 74 healthy subjects, free from urological diseases (group 5). RESULTS: The mean UBC antigen concentrations were 75.79, 28.95, 52.90, 16.90 and 7.56micro gram/L, in groups 1 to 5, respectively. Group 2, 4 and 5 showed statistically significant differences in the UBC concentrations compared to group 1 (p=0.03, <0.001 and <0.001, respectively). Sensitivity and specificity were 61.8 and 68.2%, at a threshold value of 9.7micro gram/L, from group 1, compared to groups 2 to 5. As for the tumor grade in group 1, there were significant differences between grade I and II (p<0.001) or between grade I and III (p<0.001), but there were no significant differences according to the T stage. CONCLUSIONS: The UBC test might have a role as a potential tumor marker for the diagnosis of transitional cell carcinomas of the bladder adjunct to cystoscopy.
Carcinoma, Transitional Cell* ; Cystoscopy ; Diagnosis ; Follow-Up Studies ; Humans ; Keratins ; Recurrence ; Sensitivity and Specificity ; Biomarkers, Tumor ; Urinary Bladder Neoplasms ; Urinary Bladder* ; Urinary Tract Infections ; Urologic Diseases

PURPOSE: We evaluated the diagnostic performance of a noninvasive bladder cancer test, the urinary bladder cancer (UBC) antigen test, on voided urine samples from patients with active transitional cell carcinomas, on follow-up and controls. MATERIALS AND METHODS: We measured the UBC antigen in the urine from 136 patients with active transitional cell carcinomas of the bladder (group 1), 56 patients with no evidence of tumor recurrence, confirmed by cystoscopy at follow-up (group 2), 60 patients with urinary tract infections (group 3), 52 patients with other genitourinary tract malignancies (group 4) and 74 healthy subjects, free from urological diseases (group 5). RESULTS: The mean UBC antigen concentrations were 75.79, 28.95, 52.90, 16.90 and 7.56micro gram/L, in groups 1 to 5, respectively. Group 2, 4 and 5 showed statistically significant differences in the UBC concentrations compared to group 1 (p=0.03, <0.001 and <0.001, respectively). Sensitivity and specificity were 61.8 and 68.2%, at a threshold value of 9.7micro gram/L, from group 1, compared to groups 2 to 5. As for the tumor grade in group 1, there were significant differences between grade I and II (p<0.001) or between grade I and III (p<0.001), but there were no significant differences according to the T stage. CONCLUSIONS: The UBC test might have a role as a potential tumor marker for the diagnosis of transitional cell carcinomas of the bladder adjunct to cystoscopy.
Carcinoma, Transitional Cell* ; Cystoscopy ; Diagnosis ; Follow-Up Studies ; Humans ; Keratins ; Recurrence ; Sensitivity and Specificity ; Biomarkers, Tumor ; Urinary Bladder Neoplasms ; Urinary Bladder* ; Urinary Tract Infections ; Urologic Diseases

PURPOSE: The aim of this study was to evaluate the operative feasibility and safety of endoscopic thyroidectomy via bilateral axillo breast approach (BABA) compared to conventional thyroidectomy in papillary thyroid carcinoma (PTC) patients. METHODS: From July 2009 to November 2010, patients underwent BABA endoscopic thyroidectomy (ET group; n=41) or conventional open thyroidectomy (OT group; n=61) for PTC. Clinical and pathologic characteristics of patients, operation time, post-operative complications, cosmetic satisfaction and thyroglobulin (TG) level were analyzed retrospectively. RESULTS: The mean age of the patients was 40.05±9.58 years (range 25~61 years) and 46.21±13.68 years (range 19~79 years) for the ET and OT group, respectively. The operative extent in the ET group did not include advanced thyroid cancer or lateral neck dissection. The size of the tumor was 0.78±0.59 cm (range 0.1~3.00 cm) and 1.54±1.05 cm (range 0.3~6.00 cm) for the ET and OT group, respectively. Extrathyroidal extension and number of retrieved lymph nodes were significantly higher in the OT group. Postoperative radioactive iodine ablation was performed on 25 patients (72.43%) in the ET group and 48 patients (78.69%) in the OT group. There was no abnormal uptake on radioactive iodine scans in the iodine-treated patients and no significant differences in postoperative off-T4 TG levels between the two groups. There were no significant differences in operative time, amount of drainage, postoperative hospitalization period, hypocalcemia, and vocal cord palsy between the two groups. Cosmetic results of ET group were rated as excellent in a 3-month postoperative questionnaire by 25 (72.43%) of 35 patients. CONCLUSION: Endoscopic thyroidectomy via the bilateral axillo breast approach can be a feasible and effective option for PTC in selected cases.
Breast* ; Drainage ; Hospitalization ; Humans ; Hypocalcemia ; Iodine ; Lymph Nodes ; Neck Dissection ; Operative Time ; Retrospective Studies ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy* ; Vocal Cord Paralysis

PURPOSE: Biofeedback treatment is thought to be appropriate for patients with nonrelaxing puborectalis syndrome (NRPR). The aim of this study is to analyze the physiologic characteristics and to assess the outcomes of biofeedback treatment for patients with NRPR. METHODS: Forty-six (46) patients with NRPR were evaluated with anorectal physiologic studies, including colonic transit time (n=26), anorectal manometry (n=41), defecography (n=46), anal sphincter EMG (n=28), and colonoscopy or barium enema (n=33). The treatment consisted of a training program with EMG-based biofeedback for 30 minutes once a week and routine supportive care, including Kegel practice. RESULTS: The mean age was 52.8 years, and the sex ratio was 1 male to 0.6 female. A delayed colonic transit time was noted in 5 patients (19.26%). In the NRPR group, the maximal voluntary contraction and the mean squeezing pressure were higher than they were for other patients with pelvic outlet obstructive disease. Also, the perineal descents and the dynamic change of anorectal angle were shorter. Polyps were observed in 6 patients (18.2%), melanosis coli in 4 patients (12.1%), and diverticula in 3 patients (9.1%). The rectoanal inhibitory reflex (RAIR) was negative in 3 patients (7.3%). The patients underwent a mean of 4.0 sessions, and the mean follow-up was 7.4 months. Twenty-three (23) patients (82.1%) experienced improved of symptoms or EMG findings. The patients (17.9%) who did not improve had several abnormal findings: neuro-psychologic disease with delayed colonic transit time in 2 cases, negative RAIR in 2 cases, and melanosis coli in one case. CONCLUSIONS: We think that biofeedback training is an effective treatment for patients with NRPR. In addition, several factors, such as neuro-psychologic diseases, delayed colonic transit time, negative RAIR, or melanosis coli may influence the prognosis for biofeedback treatment, so further large-scaled studies will be needed to confirm these findings.
Anal Canal ; Barium ; Biofeedback, Psychology* ; Colon ; Colonoscopy ; Defecography ; Diverticulum ; Education ; Enema ; Female ; Follow-Up Studies ; Humans ; Male ; Manometry ; Melanosis ; Polyps ; Prognosis ; Reflex ; Sex Ratio

PURPOSE: With recent anorectal physiologic studies, functional etiologies of pelvic outlet obstructive disease were evaluated in detail. The current study was designed to assess the clinical and the physiologic characteristics of patients with pelvic outlet obstructive disease. METHODS: one hundred two (102) patients with pelvic outlet obstructive disease were evaluated with anorectal physiologic studies, including the colonic transit time (n=66), anorectal manometry (n=88), defecography (n=102), anal sphincter EMG (n=50), and colonoscopy or barium enema (n=77). The patients were categorized as group I (nonrelaxing puborectalis syndrome), group II (rectocele), group III (sigmoidocele), and group IV (rectoanal intussusception). The clinical and the physiologic characteristics were compared between the groups. RESULTS: The mean age was 51.9 years, and the sex ratio was 1:1.9. the populations of the groups were group I 45.1% (n=46), group II 36.3% (n=37), group III 5.9% (n=6), and group IV 9.8% (n=10). In group II and group III, co-existing etiologies were more, and the incidences of female patients was higher (P<0.05). Delayed colonic transit time was noted in 11 patients (17%). Diverticula was observed in 6 patients (8%), polyps in 12 patients (16%), and melanosis coli in 14 patients (18%). On anorectal manometry, group I showed higher maximal voluntary contraction and mean squeezing pressure than the other groups (P<0.05). On defecography, group I had a shorter perineal descent at rest and a smaller anorectal angle at push (P<0.05). CONCLUSIONS: The current study showed the clinical and the physiologic characteristics of the each functional etiology in patients with pelvic outlet obstructive disease. These results provide fundamental data for diagnosis of and tailored therapy for pelvic outlet obstructive disease.
Anal Canal ; Barium ; Colon ; Colonoscopy ; Defecography ; Diagnosis ; Diverticulum ; Enema ; Female ; Humans ; Incidence ; Manometry ; Melanosis ; Polyps ; Rectocele ; Sex Ratio