Background: It is well known that a large number of patients with diabetes also have dyslipidemia, which significantly increases the risk of cardiovascular disease (CVD). This study aimed to evaluate the efficacy and safety of combination drugs consisting of metformin and atorvastatin, widely used as therapeutic agents for diabetes and dyslipidemia. Methods: This randomized, double-blind, placebo-controlled, parallel-group and phase III multicenter study included adults with glycosylated hemoglobin (HbA1c) levels >7.0% and <10.0%, low-density lipoprotein cholesterol (LDL-C) >100 and <250 mg/dL. One hundred eighty-five eligible subjects were randomized to the combination group (metformin+atorvastatin), metformin group (metformin+atorvastatin placebo), and atorvastatin group (atorvastatin+metformin placebo). The primary efficacy endpoints were the percent changes in HbA1c and LDL-C levels from baseline at the end of the treatment. Results: After 16 weeks of treatment compared to baseline, HbA1c showed a significant difference of 0.94% compared to the atorvastatin group in the combination group (0.35% vs. −0.58%, respectively; P<0.0001), whereas the proportion of patients with increased HbA1c was also 62% and 15%, respectively, showing a significant difference (P<0.001). The combination group also showed a significant decrease in LDL-C levels compared to the metformin group (−55.20% vs. −7.69%, P<0.001) without previously unknown adverse drug events. Conclusion The addition of atorvastatin to metformin improved HbA1c and LDL-C levels to a significant extent compared to metformin or atorvastatin alone in diabetes and dyslipidemia patients. This study also suggested metformin’s preventive effect on the glucose-elevating potential of atorvastatin in patients with type 2 diabetes mellitus and dyslipidemia, insufficiently controlled with exercise and diet. Metformin and atorvastatin combination might be an effective treatment in reducing the CVD risk in patients with both diabetes and dyslipidemia because of its lowering effect on LDL-C and glucose.

PURPOSE: To assess the efficacy of open debridement and polyethylene exchange (ODPE) combined with proper antibiotic therapy in strictly selected patients with infection after total knee arthroplasty (TKA) and analyze factors associated with treatment failure. MATERIALS AND METHODS: From January 2010 to January 2014, 25 cases that underwent ODPE under the diagnosis of infection within four weeks after TKA or acute hematogenous infection within five days of symptom onset were reviewed in this study. RESULTS: Treatment was successful in 22 out of 25 cases (88.0%). Factors associated with failure were accompanying infection (periprosthetic infection in the ipsilateral foot, cervical parotid abscess, and masticator space abscess) and diagnosis of rheumatoid arthritis (RA) before TKA. Resistant bacteria did not entail a risk. On clinical results, the mean postoperative Lysholm score and Korean Knee score were 81.4 and 79.4, respectively, the knee range of motion was 115.4°±12.9°, and duration of hospitalization was 32.3±8.4 days. On radiographic results, 3.47±1.56 mm joint line elevation and a valgus change of 0.61°±2.35° in knee alignment were observed. CONCLUSIONS: ODPE combined with appropriate antibiotics therapy could be a useful treatment method for infection after TKA if the procedure is performed within a symptom duration of five days or less in the absence of accompanying infection in patients whose indication for TKA was not RA.
Abscess ; Anti-Bacterial Agents ; Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Bacteria ; Debridement ; Diagnosis ; Foot ; Hospitalization ; Humans ; Joints ; Knee ; Methods ; Polyethylene ; Range of Motion, Articular ; Treatment Failure

PURPOSE: Bowel preparation with sodium phosphate was recently prohibited by the U.S. Food and Drug Administration. Polyethylene glycol (PEG) is safe and effective; however, it is difficult to drink. To identify an easy bowel preparation method for colonoscopy, we evaluated three different bowel preparation regimens regarding their efficacy and patient satisfaction. METHODS: In this randomized, comparative study, 892 patients who visited a secondary referral hospital for a colonoscopy between November 2012 and February 2013 were enrolled. Three regimens were evaluated: three packets of sodium picosulfate/magnesium citrate (PICO, group A), two packets of PICO with 1 L of PEG (PICO + PEG 1 L, group B), and two packets of PICO with 2 L of PEG (PICO + PEG 2 L, group C). A questionnaire survey regarding the patients' preference for the bowel preparation regimen and satisfaction was conducted before the colonoscopies. The quality of bowel cleansing was scored by the colonoscopists who used the Aronchick scoring scale and the Ottawa scale. RESULTS: The patients' satisfaction rate regarding the regimens were 72% in group A, 64% in group B, and 45.9% in group C. Nausea and abdominal bloating caused by the regimens were more frequent in group C than in group A or group B (P < 0.01). Group C showed the lowest preference rate compared to the other groups (P < 0.01). Group C showed better right colon cleansing efficacy than group A or group B. CONCLUSION: Group A exhibited a better result than group B or group C in patient satisfaction and preference. In the cleansing quality, no difference was noted between groups A and C.
Citric Acid* ; Colon ; Colonoscopy* ; Humans ; Nausea ; Patient Satisfaction ; Polyethylene Glycols ; Secondary Care Centers ; Sodium* ; United States Food and Drug Administration ; Surveys and Questionnaires

Candida is a rare cause of infectious arthritis, and it can be found in infants and immunocompromised patients. Patients with maintenance hemodialysis are prone to opportunistic infections because of altered immunity, and frequent exposures to health-care associated infections. Herein, we report a case of candida arthritis of right shoulder with preceding fungemia in patients with maintenance hemodialysis. The diagnosis is based on the isolation of Candida Tropicalis from blood and synovial fluids of the shoulder joint. The patient has received intravenous fluconazole and arthroscopic surgical debridement. We then changed the fluconazole into amphotericin B due to the abnormal signs in the liver function tests, although the fluconazole successfully controlled fungemia and arthritis. To the best of our knowledge, this is the first case of candida arthritis in patients with maintenance hemodialysis in South Korea.
Amphotericin B ; Arthritis* ; Arthritis, Infectious ; Candida tropicalis ; Candida* ; Debridement ; Diagnosis ; Fluconazole ; Fungemia ; Humans ; Immunocompromised Host ; Infant ; Korea ; Liver Function Tests ; Opportunistic Infections ; Renal Dialysis* ; Shoulder ; Shoulder Joint ; Synovial Fluid

Talocalcaneal coalition known as the most common tarsal coalition is a congenital failure of segmentation. Talocalcaneal coalition with complete bone bridge is very rare, and there are few references in the literature about the clinical results and the operative method for this type of tarsal coalition. We report a case of 15 years old female with complete talocalcaneal coalition, who showed good clinical results by lateral sliding calcaneal osteotomy.
Female ; Humans ; Osteotomy

PURPOSE: We aimed to obtain a reference for the optimal rotational alignment of femoral component in Koreans through an analysis of grand piano sign observed during total knee arthroplasty (TKA) and the angle between the clinical transepicondylar axis and the posterior condylar axis (TEA-PCA angle), by computed tomography. MATERIALS AND METHODS: The study subjects included 24 patients (30 cases), who underwent the anterior femoral resection, which was applied at an external rotation 3degrees relative to the posterior condylar axis during TKA. The relationship between anterior femoral resection with external rotation of 3degrees and the morphological pattern of Grand piano sign was evaluated. On postoperative computed tomography images, we evaluated the relationship between the clinical transepicondylar axis, posterior condylar axis of femoral component and grand piano sign. Moreover, a total of 28 Korean patients with 41 arthritic knees scheduled for a TKA had a preoperative computed tomography. We measured the TEA-PCA angle to evaluate the normal range in Korean subjects. RESULTS: The morphological pattern of grand piano sign observed after the anterior femoral resection, which was applied at an external rotation 3degrees, showed statistically significant correlation with TEA-PCA angle. On preoperative computed tomography images, the TEA-PCA angle was 6.01 degrees (range from 3.90 to 7.86). CONCLUSION: The TEA-PCA angle of Koreans was different from that of the westerners. More external rotation was needed for the optimal femoral rotational alignment theoretically, and we could confirm the correlation between Grand piano sign and rotational alignment of femoral component by measurement of grand piano sign and computed tomography.
Arthroplasty ; Axis, Cervical Vertebra ; Humans ; Knee ; Reference Values

No abstract available.
Osteomyelitis

PURPOSE: The purpose of the study is to evaluate the usefulness of CT arthrography (CTA) by conducting a comparative study of CTA and MR arthrography (MRA) with the arthroscopic findings in the same patients. MATERIALS AND METHODS: Forty nine patients who suffered from shoulder disease underwent MRA and CTA concurrently. The sensitivity and specificity of CTA was evaluated, as compared to MRA, in the case of four types of shoulder pathological lesions. The accuracy of CTA was evaluated by analyzing the arthroscopic findings of thirty four patients. RESULTS: Compared to MRA, CTA showed a sensitivity of 90% and a specificity of 100% for diagnosing supraspinatus tendon (SST) full thickness tear, and CTA showed a sensitivity of 100% and a specificity of 97.5% for making the diagnosis of superior labrum anterior to posterior (SLAP) lesion. For diagnosing partial articular side supraspinatus avulsion (PASTA) lesion, some studies have shown the usefulness of CTA with a sensitivity of 71.4% and a specificity of 97.7%. However, for diagnosing SST bursal side partial tear, the sensitivity of CTA was as low as 10%. CTA has been shown to be relatively accurate when the diagnoses were verified with the arthroscopic findings; diagnosing SST full thickness tear and SLAP lesion with CTA has shown an accuracy of 100% and87.5% respectively, and CTA showed 71.4% diagnostic accuracy for PASTA lesion. CONCLUSION: CTA was a useful tool and it was equivalent to MRA for the assessment of SST full thickness tear, SLAP lesion and PASTA lesion, but not bursal side partial tear. Thus, it may be used preferably to diagnose shoulder pathology and for follow up as an inexpensive tool after operation.
Arthrography ; Arthroscopy ; Humans ; Sensitivity and Specificity ; Shoulder ; Tendons

The incidence of primary bone tumor of the acetabulum is 1-2% of all the bone tumors. Degenerative cystic change can occur in patients with hip dysplasia and this can be misdiagnosed as primary bone tumor. We have experienced 2 patients with painful dysplastic hips that were treated with curettage and autogenous bone graft for a cystic lesion that was originally misdiagnosed as primary bone tumor. The patients'hip pain and limitation of motion recurred, and so Bernese periacetabular osteotomy was performed for the dysplastic hips. At over one year follow-up, the corrected hips showed a painless and good range of motion.
Acetabulum ; Curettage ; Follow-Up Studies ; Hip ; Humans ; Incidence ; Osteotomy ; Range of Motion, Articular ; Transplants

Calcific amyloidoma of the soft tissue is quite rare and it is difficult to make a differential diagnosis from other lesions such as osteomyelitis or bone tumor. We encountered a case of a calcified amyloidoma found in the anterior tibial muscle that occurred more than 20 years after a proximal tibial fracture adjacent to the origin of the muscle. The features of the lesion resembled osteomyelitis. Satisfactory result was obtained by a thorough mass excision. We report this case with review of the relevant literature.
Diagnosis, Differential ; Muscle, Skeletal ; Muscles ; Osteomyelitis ; Tibial Fractures