No abstract available.
Animals ; Muscle, Skeletal* ; Rats* ; Reperfusion Injury* ; Reperfusion*

PURPOSE: To obtain normative data on bone mineral density of each region of interest (ROI) measured by Hologic model dual-energy x-ray absorptiometry (DXA) of children and adolescents. METHODS: Cross sectional results from 723 healthy Korean children and adolescents (10-20 years of age) in the Korean National Health and Nutrition Examination Surveys were analyzed. We used age- and sex-specific reference data for bone mineral density (BMD) of the lumbar spine, femur neck, and total body except head from Hologic DXA device as recommended by the International Society for Clinical Densitometry. RESULTS: The bone mineral density of each ROI increased with age in both boys and girls. Maximal increase in the lumbar BMD occurred between ages 11 and 12 in girls and between ages 12 and 14 in boys. However, the increases of BMD in each ROI were different. The plateaus of the lumbar spine and whole body except head BMD in girls occurred at ages 15 and 17, respectively. The plateaus of BMD in each ROI occurred at age 17 in boys. CONCLUSION: Most of the skeletal mass, including lumbar spine and total body except head, is reached before the end of the second decade. This study provides reference values for bone density of each ROI measured with DXA for children and adolescents.
Absorptiometry, Photon ; Adolescent ; Bone Density ; Child ; Femur Neck ; Head ; Humans ; Korea ; Reference Values ; Sex Characteristics ; Spine

The 12th rib syndrome is a disease that causes pain between the upper abdomen and the lower chest. It is assumed that the impinging on the nerves between the ribs causes pain in the lower chest, upper abdomen, and flank. A 74-year-old female patient visited a pain clinic complaining of pain in her back, and left chest wall at a 7 on the 0-10 Numeric Rating scale (NRS). She had a lateral fixation at T12-L2, 6 years earlier. After the operation, she had multiple osteoporotic compression fractures. When the spine was bent, the patient complained about a sharp pain in the left mid-axillary line and radiating pain toward the abdomen. On physical examination, the 10th rib was not felt, and an image of the rib-cage confirmed that the left 10th rib was severed. When applying pressure from the legs to the 9th rib of the patient, pain was reproduced. Therefore, the patient was diagnosed with 9th rib syndrome, and ultrasound-guided 9th and 10th intercostal nerve blocks were performed around the tips of the severed 10th rib. In addition, local anesthetics with triamcinolone were administered into the muscles beneath the 9th rib at the point of the greatest tenderness. The patient's pain was reduced to NRS 2 point. In this case, it is suspected that the patient had a partial resection of the left 10th rib in the past, and subsequent compression fractures at T8 and T9 led to the deformation of the rib cage, causing the tip of the remaining 10th rib to impinge on the 9th intercostal nerves, causing pain.
Abdomen ; Abdominal Pain ; Aged ; Anesthetics, Local ; Female ; Fractures, Compression ; Humans ; Intercostal Nerves ; Leg ; Muscles ; Neuralgia ; Pain Clinics ; Physical Examination ; Ribs* ; Spine ; Thoracic Wall ; Thorax ; Triamcinolone

Knotting of a pulmonary artery catheter (PAC) is a rare, but well-known complication of pulmonary artery (PA) catheterization. We report a case of a double-knotted PAC with a large loop in a patient with hepatocellular carcinoma (HCC) undergoing liver transplantation, which has been rarely reported in the literature. A PAC was advanced under pressure wave form guidance. PAC insertion was repeatedly attempted and the PAC was inserted 80 cm deep even though PAC should be normally inserted 45 to 55 cm deep. However, since no wave change was observed, we began deflating and pulling the balloon. At the 30-cm mark, the PAC could no longer be pulled. Fluoroscopy confirmed knotting of the PAC after surgery (The loop-formed PAC was shown in right internal jugular vein); thus, it was removed. For safe PA catheterization, deep insertion or repeated attempts should be avoided when the catheter cannot be easily inserted into the pulmonary artery. If possible, the insertion of PACs can be performed more safely by monitoring the movement of the catheter under fluoroscopy or transesophageal echocardiography.
Carcinoma, Hepatocellular ; Catheterization ; Catheterization, Swan-Ganz ; Catheters* ; Echocardiography, Transesophageal ; Fluoroscopy ; Humans ; Jugular Veins* ; Liver Transplantation ; Pulmonary Artery*

PURPOSE: We evaluated the factors that affect the improvement of the initial peak flow rate after transurethral resection of the prostate (TURP) or photoselective vaporization of the prostate (PVP) for benign prostatic hyperplasia (BPH) patients by using noninvasive tools. METHODS: One hundred and twenty seven BPH patients who had undergone TURP or PVP between January 2005 and May 2009 were evaluated. They were divided into 2 groups: the postoperative initial peak urinary flow rate (Qmax) was less than 10 mL/sec (Group 1; n=37, TURP=11, PVP=26) and more than 10 mL/sec (Group 2; n=90, TURP=41, PVP=49). We confirmed the patients' preoperative check lists. The check list were the international prostate symptom score (IPSS), the quality of life score, a past history of acute urinary retention (AUR), body mass index and/or pyuria, the serum prostate-specific antigen (PSA) level and the prostate volume, the prostate transitional zone volume and prostatic calcification. The initial Qmax was measured at the outpatient clinic one week after discharge. RESULTS: The improvement rate was not significant difference between the TURP group (78.8%) and the PVP group (65.3%). The efficacy parameters were the IPSS-storage symptom score, the prostate volume, the PSA level and a past history of AUR. The IPSS-storage symptom scores of Group 1 (12.3+/-3.3) was higher than those of Group 2 (10.5+/-1.7). The prostate volume of Group 2 (42.3+/-16.6 g) was bigger than that of Group 1 (36.6+/-7.8 g). The PSA level of Group 2 (3.8+/-2.6 ng/mL) was higher than that of Group 1 (2.6+/-2.6 ng/mL). A past history of AUR in Group 1 (35.1%) was more prevalent than that of Group 2 (15.6%). CONCLUSIONS: The non-invasive factors affecting the initial Qmax after TURP or PVP were the IPSS-storage symptom score, the prostate volume and a past history of AUR. Accordingly, in patients who have a higher IPSS-storage symptom score, a smaller prostate volume and a history of AUR, there might be a detrimental effect on the initial Qmax after TURP or PVP. These factors might also be used as long-term prognostic factors.
Ambulatory Care Facilities ; Body Mass Index ; Humans ; Laser Therapy ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Pyuria ; Quality of Life ; Transurethral Resection of Prostate ; Urinary Retention ; Volatilization

Cytomegalovirus (CMV) infection is associated with an exacerbations of systemic lupus erythematosus (SLE), but the role of CMV in disease pathogenesis remains unclear. CMV infection is often severe and difficult to diagnose in patients with SLE. Only a few cases of opportunistic CMV interstitial pneumonitis infection occurring in patients with SLE after intensive immunosuppressive therapy have been described. We report a case of CMV infection presenting with massive pericarditis and aggravating lupus nephritis in a patient who did not undergo any kind of immunosuppressive therapy except for low dose steroids to treat concomitant pulmonary tuberculosis. After diagnosis, the patient was successfully treated with immunoglobulin and ganciclovir. This case may support the theory that CMV infection is a potential trigger for SLE.
Cytomegalovirus ; Cytomegalovirus Infections ; Ganciclovir ; Humans ; Immunoglobulins ; Lung Diseases, Interstitial ; Lupus Erythematosus, Systemic ; Lupus Nephritis ; Pericarditis ; Steroids ; Tuberculosis, Pulmonary

PURPOSE: To describe the radiographic and MR characteristics of subacute diaphyseal osteomyelitis of the long bone. MATERIALS AND METHODS: We retrospectively analyzed plain radiographs and MR images in nine children and two young adults with surgically-proven diaphyseal osteomyelitis of the long bones. MR imaging was carried out before and after Gd-DPTA administration. Patients charts were reviewed for clinical and laboratory data and histologic correlation was available in all cases. RESULTS: All patients had a history of a minimum of 2 weeks' duration. All presented with an insidious onset of mild pain; they showed apyrexia and normal erythrocyte sedimentation rate. In all patients, plain radiographs showed single or multiple linear periosteal reaction with cortical irregularity. Medullary abnormality was not found except in one case which showed an abscess cavity. MR images revealed thickening or irregularity of the cortex, periosteal reaction, bone marrow signal alteration, and perilesional edema. CONCLUSION: Subacute diaphyseal osteomyelitis of the long bone is broadly based on the cortex, and elicits more sclerosis and periosteal reaction. Familarity with plain radiographs and MR features may be useful in the diagnosis of subacute diaphyseal osteomyelitis.
Abscess ; Blood Sedimentation ; Bone Marrow ; Child ; Diagnosis ; Edema ; Humans ; Magnetic Resonance Imaging* ; Osteomyelitis* ; Periostitis ; Retrospective Studies ; Sclerosis ; Young Adult

PURPOSE: The purpose of this study is to examine the frequency of posterior element injury in patients with traumatic thoraco-lumbar burst fractures and to evaluate the correlation between the MR imaging and CT findings. MATERIALS AND METHODS: The MR images of 38 patients with 39 thoraco-lumbar burst fractures and the results of the CT examinations of 28 patients with 29 fractures were retrospectively analyzed. Both procedures were performed within two weeks of injury. Twenty-one males and 17 females were included ; their average age was 51.3 (range, 11-75) years. MR images were evaluated for injury to the posterior ligamentous complex, comprising the supraspinous ligament(SSL), the interspinous ligament(ISL), the flaval ligament(FL), and the capsule of facets. Analysis of the CT findings focused on the posterior bony elements of the lamina, pedicle, spinous process, and facet joint. RESULTS: MR imaging revealed posterior ligamentous injuries in 18(46.2%) of 39 burst fractures ; there was tearing of the ISL in 15 cases(38.5%), of the SSL in 11(28.2%), of the capsule of facets in 11(28.2%), and of the FL in nine(23.1%). Among the 29 burst fracture cases examined by CT, posterior bony injuries were detected in 13(44.8%). Lamina and facet joint fractures were detected in six cases(20.7%), facet separation or dislocation in six(20.7%), and spinous process and pedicle fracture in one(3.4%). In 29 burst fracture cases, both MRI and CT were performed. Among the 18 cases in which MR imaging revealed posterior ligamentous injuries, CT failed to demonstrate posterior element fractures in seven. On the other hand, among the 13 cases in which CT indicated posterior bony fractures, MR failed to reveal posterior ligamentous injuries in two. CONCLUSION: Posterior element injury is frequently found in patients with traumatic thoraco-lumbar burst fractures demonstrated by MR imaging(46.2%) and CT(44.8%). Both MRI and CT are useful tools for the evaluation of posterior element injury, which determines the degree of instability of traumatic burst fracture.
Dislocations ; Female ; Hand ; Humans ; Ligaments ; Magnetic Resonance Imaging ; Male ; Retrospective Studies ; Zygapophyseal Joint

PURPOSE: We evaluated the usefulness of the nuclear matrix protein 22 BladderChek (NMP22BC) test for the screening and follow-up of bladder cancer. MATERIALS AND METHODS: From February 2006 to September 2009, we enrolled 1,070 patients who had hematuria or who were being followed up for bladder cancer. We compared the sensitivity and specificity of the NMP22BC test with those of urine cytology. RESULTS: The sensitivity of the NMP22BC test (77.5%) was significantly higher than that of urine cytology (46.3%). The specificity of the NMP22BC test was 88.8%, compared with 97.9% for urine cytology. The sensitivity of the NMP22BC test (81.8%) in non-muscle-invasive bladder cancer was higher than that of cytology (36.4%). However, the sensitivity of the NMP22BC test and of urine cytology in invasive bladder cancer were 57.1% and 92.9%, respectively. The sensitivity of the NMP22BC test was higher for low-grade bladder cancer (83.9%) than for high-grade (62.5%), and the sensitivity of cytology was higher for high-grade bladder cancer (66.7%) than for low-grade (37.5%). Follow-up bladder cancer was detected in 262 patients. The sensitivity of the NMP22BC test in that group (72.7%) was decreased and the specificity (91.7%) was increased. The sensitivity of cytology (54.5%) in the follow-up group was increased and the specificity (95.6%) was decreased. The presence of pyuria was significantly associated with the lower specificity of the NMP22BC test. CONCLUSIONS: The greater sensitivity of the NMP22BC test may be more useful for the diagnosis of non-muscle-invasive bladder cancer and low-grade bladder cancer than for the diagnosis of invasive or high-grade bladder cancer. If the NMP22BC test is performed in the absence of pyuria, it may play a compensatory role for urine cytology.
Follow-Up Studies ; Hematuria ; Humans ; Mass Screening ; Nuclear Matrix ; Nuclear Proteins ; Pyuria ; Sensitivity and Specificity ; Urinary Bladder ; Urinary Bladder Neoplasms

PURPOSE: Serum alkaline phosphatase (sALP) levels show great variation with age and sex in children and adolescents. We aimed to study pediatric age- and sex-specific reference ranges for sALP and how the pattern changed according to age . METHODS: Cross-sectional results from 1366 healthy Korean children and adolescents (10-19.9 years) from the Korean National Health and Nutrition Examination Survey were analyzed. We constructed age- and sex-specific reference data for sALP with a Hitachi Automatic Analyzer 7600 using Pureauto S ALP. We assessed its peak both in relation to age. RESULTS: Reference values for sALP according to age were constructed. Peak sALP levels were found at 12-13 years in boys (P < 0.001). Total sALP levels decreased to the adult level at the age of 17 in boys and 15 in girls, respectively. CONCLUSION: This study provides reference values for sALP by age for Korean children and adolescents. This normative data that includes upper and lower limits will provide a basis from which to better evaluate sALP levels, especially for bone disorders such as rickets and vitamin D deficiency. However, caution should be made in interpreting sALP levels because different buffers might lead to different values in the same serum.
Adolescent ; Adult ; Alkaline Phosphatase ; Buffers ; Child ; Humans ; Nutrition Surveys ; Reference Values ; Rickets ; Sex Characteristics ; Vitamin D Deficiency