Pregnancy- and lactation associated osteoporosis is a rare condition. However, it may cause fragility fracture with severe pain. A 29-year-old woman had first delivery without any complications and she was breast-feeding her baby. In a postpartum one month, she had a severe back pain and it has gotten worse. She was diagnosed with multiple recent compression fractures in thoracic spines and treated with brace immobilization and bisphosphonate therapy. We report this rare case of pregnancy- and lactation associated osteoporosis with multiple vertebral compression fractures.
Adult ; Back Pain ; Braces ; Female ; Fractures, Compression ; Humans ; Immobilization ; Lactation ; Osteoporosis ; Postpartum Period ; Pregnancy ; Spine

PURPOSE: This study analyzed the treatment effects of drain insertion in the posteromedial portal after an arthroscopic synovectomy and posterior septum resection for pyogenic arthritis. MATERIALS AND METHODS: From June 2005 to December 2016, 56 cases (55 patients, 1 case of bilateral knee) were diagnosed with pyogenic arthritis and arthroscopic treatment was performed. Fourteen patients (25.0%) were identified with causative organisms. The average follow-up period was 12.3 months, and the mean age was 67.8 years old. Twenty-four cases were males and 31 cases were females. Kellgrene–Lawrence grade (K–L grade) I was 6 patients, II was 20 patients, III was 11 patients, and IV was 18 patients. Surgery was performed through six portal. The posterior septum was removed and a drainage tube was inserted from the posterior medial side to the posterior side of the joint. The Lysholm score was used after surgery for a functional evaluation. The K–L grade at the time of admission and at the last follow-up were compared for a radiological evaluation. RESULTS: The mean normalization period of the C-reactive protein was 59.8 days (6–164 days). Intravenous antibiotics were used for an average of 37.1 days. The results of the functional evaluation revealed a mean Lysholm score of 64.5 (30–98) in a total of 56 cases. Two reoperations was performed, but the treatment was completed with same method in all patients. The K–L grade was similar at the time of surgery and at the last follow-up (p>0.05). CONCLUSION: The method of drain insertion in the posteromedial portal after arthroscopic synovectomy and posterior septum resection for pyogenic arthritis is an effective technique that can obtain satisfactory results by inducing proper exudate discharge.
Anti-Bacterial Agents ; Arthritis ; Arthritis, Infectious ; Arthroscopy ; C-Reactive Protein ; Drainage ; Exudates and Transudates ; Female ; Follow-Up Studies ; Humans ; Joints ; Knee ; Male ; Methods

STUDY DESIGN: This is a retrospective clinical study. OBJECTIVES: To know how the associated foot or ankle fracture influences the fracture pattern in the thoracolumbar burst fractures caused by falls from height. SUMMARY OF LITERATURE REVIEW: There were few studies on how the foot or ankle fracture influences the thoracolumbar fracture caused by falls from height. MATERIALS AND METHODS: We reviewed 46 subjects, who underwent surgery due to burst fracture of the thoracic or lumbar region, caused by fall accidents, from May 2004 to October 2008. Among them, we defined 19 cases that had associated foot or ankle fractures as group A, and the other 27 cases as group B. We analyzed the differences of radiological and clinical findings, and functional outcomes between the two groups. RESULTS: The falling heights were higher in group A than in group B (P<0.01). Thoracolumbar junction (T11-L2) was the most common location involved in both groups, but group A had more fractures on the lower lumbar region (L3-5), relatively (p=0.03). Kyphotic deformity was more severe in group B (p=0.01) but there were no significant differences in the wedge angle, amount of canal compromise, compression rate of anterior column between both groups (p=0.08, 0.46, 0.76). More segments were fused in group B (P=0.04). Neurologic deficit was more common in group B (p=0.03), but there were many complications related with foot or ankle fractures in group A (38%).There was no significant difference in the final clinical outcome between both groups (Pain scale p= 0.48, Work scale p=1.00). CONCLUSIONS: In patients who had burst fractures in the thoracic or lumbar region associated with foot or ankle fractures, there was a tendency to increase the incidence of lower lumbar fracture, relatively. The neurologic deficits were less common in this group of patients, but there was no difference in the functional outcome.
Animals ; Ankle ; Congenital Abnormalities ; Foot ; Humans ; Incidence ; Lumbosacral Region ; Neurologic Manifestations ; Retrospective Studies

Spinal infection due to Serratia marcescens is very rare. A 78-year-old male patient withoutany risk factor was admitted to our hospital with chief complaints of severe back pain, fever, weakness in both legs, and bowel dysfunction, following caudal epidural injection. Magnetic resonance imaging revealed spondylodiscitis with epidural abscess. Surgical decompression was performed and the epidural abscess was removed. The cultures isolated S. marcescens, which can cause nosocomial infection in immunocompromised patient. However, to the best of our knowledge, we report the first case of S. marcescens spinal epidural abscess following epidural injection, with literature review.
Aged ; Back Pain ; Cross Infection ; Decompression, Surgical ; Discitis ; Epidural Abscess* ; Fever ; Humans ; Immunocompromised Host ; Injections, Epidural* ; Leg ; Magnetic Resonance Imaging ; Male ; Risk Factors ; Serratia marcescens* ; Serratia*

BACKGROUND: The educational assessment of residents is very important in order to check their knowledge and to improve their ability. In case of family practice, the residents spend most of their training time in outside rotations with other specialities. Therefore, they are requested to be evaluated by each specialist after each rotation. To give more accurate assessment, we surveyed directly our family practice residents and family practice faculties. METHODS: A questionnaire was sent to family practice residents and family practice faculties in 116 hospitals from May to June 2006. The response rate was 29% and 78%, respectively. RESULTS: Among the total, 70.2% of family practice residents thought an assessment is necessary, but only 51.7% were evaluated. Overall, 90.4% of family practice faculties knew about the assessment of residents made by other specialists, and only 56.7% of faculties requested other specialists to assess their family practice residents. CONCLUSION: Most of the family practice residents and their faculties knew the need for assessment, but they complained there were no objectivity and the assessment tool was lacking. In order to solve this problem, it is urgent to develop a unified form and guidelines of assesment.
Educational Measurement* ; Equidae ; Family Practice* ; Humans ; Specialization ; Surveys and Questionnaires

BACKGROUND: Isoflavones are biologically active compounds that occur naturally in a variety of plants, with relatively high levels in soybean. Tectorigenin, an isoflavone, protects against hydrogen peroxide (H2O2)-induced cell damage. However, the underlying mechanism is unknown. METHODS: The MTT assay was performed to determine cell viability. Catalase activity was assessed by determining the amount of enzyme required to degrade 1 μM H2O2. Protein expression of catalase, phospho-extracellular signal-regulated kinase (ERK), IκB-α, and NF-κB were evaluated by Western blot analysis. A mobility shift assay was performed to assess the DNA-binding ability of NF-κB. Transient transfection and a NF-κB luciferase assay were performed to assess transcriptional activity. RESULTS: Tectorigenin reduced H2O2-induced death of Chinese hamster lung fibroblasts (V79-4). In addition, tectorigenin increased the activity and protein expression of catalase. Blockade of catalase activity attenuated the protective effect of tectorigenin against oxidative stress. Furthermore, tectorigenin enhanced phosphorylation of ERK and nuclear expression of NF-κB, while inhibition of ERK and NF-κB attenuated the protective effect of tectorigenin against oxidative stress. CONCLUSIONS: Tectorigenin protects cells against oxidative damage by activating catalase and modulating the ERK and NF-κB signaling pathway.
Animals ; Blotting, Western ; Catalase* ; Cell Death* ; Cell Survival ; Cricetinae ; Cricetulus ; Electrophoretic Mobility Shift Assay ; Extracellular Signal-Regulated MAP Kinases ; Fibroblasts ; Hydrogen Peroxide ; Isoflavones ; Luciferases ; Lung ; NF-kappa B ; Oxidative Stress ; Phosphorylation ; Phosphotransferases ; Soybeans ; Transfection

BACKGROUND: This study was conducted to survey the current status of family medicine residency programs and to evaluate the difficulties in training of the curriculums. METHODS: Questionnaires on residency programs were sent to all the centers of residency programs by mail in April 2006. The questionnaire included detailed characteristics of residency programs, curriculum schedule, reasons for failed specific curriculum, and review and measures by the program center and the Korean Academy of Family Medicine to resolve problematic curriculums. RESULTS: A total of 113 residency programs responded. Among the 93 residency programs except for the 20 subsidiary hospitals, inadeguate subjects were mainly dermatology (12 programs, 12.3%), psychiatry (6 programs, 7.5%), ophthalmology (5 programs, 7.1%), and otolaryngology (5 programs, 7.1%). Training rejection rate was higher in dermatology (13 programs, 14.4%), radiology (11 programs, 13.1%), gastrofibroscopy (8 programs, 9.5%), and psychiatry (5 programs, 6.2%). Emergency me-dicine in 4 programs and general surgery in 3 programs had a longer duration of training than initially planned. Difficulties in training some subjects were due to failed establishment of specific curriculums in non-university hospital. Commonly established clinics were health promotion center, obesity clinic, smoking cessation clinic, geriatric clinic, stress clinic, and clinical nutrition clinic. Family medicine center programs included gastrofibroscopy, obesity, smoking cessation, geriatrics, hospice care, and evidence-based medicine. CONCLUSION: There is repeated demand for taking measures to promote better curriculum in the nation-wide view of family medicine. Dermatology, radiology, psychiatry, and otolaryngology were the subjects difficult to receive training. Measures to strengthen the weak subjects are urgently needed.
Appointments and Schedules ; Curriculum* ; Dermatology ; Emergencies ; Evidence-Based Medicine ; Geriatrics ; Health Promotion ; Hospice Care ; Humans ; Internship and Residency* ; Korea* ; Obesity ; Ophthalmology ; Otolaryngology ; Postal Service ; Smoking Cessation ; Surveys and Questionnaires

BACKGROUND: This study was conducted to survey the current status of family medicine residency programs and to evaluate the difficulties in training of the curriculums. METHODS: Questionnaires on residency programs were sent to all the centers of residency programs by mail in April 2006. The questionnaire included detailed characteristics of residency programs, curriculum schedule, reasons for failed specific curriculum, and review and measures by the program center and the Korean Academy of Family Medicine to resolve problematic curriculums. RESULTS: A total of 113 residency programs responded. Among the 93 residency programs except for the 20 subsidiary hospitals, inadeguate subjects were mainly dermatology (12 programs, 12.3%), psychiatry (6 programs, 7.5%), ophthalmology (5 programs, 7.1%), and otolaryngology (5 programs, 7.1%). Training rejection rate was higher in dermatology (13 programs, 14.4%), radiology (11 programs, 13.1%), gastrofibroscopy (8 programs, 9.5%), and psychiatry (5 programs, 6.2%). Emergency me-dicine in 4 programs and general surgery in 3 programs had a longer duration of training than initially planned. Difficulties in training some subjects were due to failed establishment of specific curriculums in non-university hospital. Commonly established clinics were health promotion center, obesity clinic, smoking cessation clinic, geriatric clinic, stress clinic, and clinical nutrition clinic. Family medicine center programs included gastrofibroscopy, obesity, smoking cessation, geriatrics, hospice care, and evidence-based medicine. CONCLUSION: There is repeated demand for taking measures to promote better curriculum in the nation-wide view of family medicine. Dermatology, radiology, psychiatry, and otolaryngology were the subjects difficult to receive training. Measures to strengthen the weak subjects are urgently needed.
Appointments and Schedules ; Curriculum* ; Dermatology ; Emergencies ; Evidence-Based Medicine ; Geriatrics ; Health Promotion ; Hospice Care ; Humans ; Internship and Residency* ; Korea* ; Obesity ; Ophthalmology ; Otolaryngology ; Postal Service ; Smoking Cessation ; Surveys and Questionnaires

Previously, we demonstrated that galangin (3,5,7-trihydroxyflavone) protects human keratinocytes against ultraviolet B (UVB)-induced oxidative damage. In this study, we investigated the effect of galangin on induction of antioxidant enzymes involved in synthesis of reduced glutathione (GSH), and investigated the associated upstream signaling cascades. By activating nuclear factor-erythroid 2-related factor (Nrf2), galangin treatment significantly increased expression of glutamate-cysteine ligase catalytic subunit (GCLC) and glutathione synthetase (GSS). This activation of Nrf2 depended on extracellular signal-regulated kinases (ERKs) and protein kinase B (AKT) signaling. Inhibition of GSH in galangin-treated cells attenuated the protective effect of galangin against the deleterious effects of UVB. Our results reveal that galangin protects human keratinocytes by activating ERK/AKT-Nrf2, leading to elevated expression of GSH-synthesizing enzymes.
Catalytic Domain ; Extracellular Signal-Regulated MAP Kinases ; Glutamate-Cysteine Ligase ; Glutathione Synthase ; Glutathione* ; Humans* ; Keratinocytes* ; Proto-Oncogene Proteins c-akt