BACKGROUND: Common and effective treatments for calcific tendinitis involve needling procedures. However, it has been widespread practice to refer patients with calcific tendinitis, which is a predominantly orthopedic condition, to radiology department. The purpose of this study was to compare clinical and radiological outcomes after ultrasound-guided needling for calcific tendinitis between the orthopedics and radiology department. METHODS: Seventy-seven shoulders (Group 1) and 38 shoulders (Group 2) treated in the radiology and orthopedic department, respectively. A fellowship-trained orthopedic surgeon and a musculoskeletal radiologist each performed the procedure of ultrasound-guided needle decompression with subacromial steroid injection. Clinical outcomes was evaluated using the visual analogue scale for pain (pVAS) and the American Shoulder and Elbow Surgeons (ASES) shoulder score before treatment and at each follow-up. The pre- and post-needling size and shape of the calcific deposits were compared between the two groups. RESULTS: We analyzed a total of 56 shoulders for Group 1 and 32 shoulders for Group 2. The mean age and sex ratio of the patients no significantly different. We found that the mean decrease in the diameter of calcification between pre- and post-needling was 9.0 mm for Group 1 and 13.1 mm for Group 2; the difference was significantly larger in Group 2 than in Group 1. Both groups showed improved pVAS and ASES scores after needling but the extent of these improvements did not differ with the type of operator. CONCLUSIONS: Needling decompression performed by orthopedic surgeons could a viable option for the treatment of calcific tendinitis.

BACKGROUND: An effective control of postoperative pain may contribute to success of day-case surgery. After knee arthroscopy, local anesthetics was injected into the knee joint to reduce postoperative pain, but results were variable and the duration of action may be short. The recent reports have suggested that intraarticular morphine would provide more effective and longer acting analgesia than expected from the same dose given systemically. METHODS: A randomized, controlled study was conducted in patients undergoing elective knee arthroscopy under general anesthesia to assess the analgesic effect of intraarticular bupivacaine and morphine, either alone or in combination. Patients in group I(n=20) received 20 ml of normal saline as a control; patients in group II(n=20) received 20 ml of 0.25% bupivacaine; patients in group III(n=20) received 5 mg of morphine in 20ml of normal saline; patients in IV(n=20) received a combination of 5 mg of morphine and 50 mg of bupivacaine in 20 ml of normal saline. All the drugs were injected intraarticularly. Postoperative pain was assessed using the VAS at 1, 2, 4, 8, 12, and 24h after the intraarticular injection. Whenever patients want supplemental analgesia, 90 mg of diclofenac(dicknol ) was injected intramuscularly and then the need for supplemental analgesia was recorded. RESULTS: Patients in groups III and IV had significantly lower pain scores than those in groups I and II. There was no significant difference in the pain scores or analgesics requirements between groups III and IV. CONCLUSIONS: We conclude that intraarticular morphine(5 mg) significantly reduces postoperative pain following knee arthroscopy and there is no significant advantage of combining bupivacaine with morphine.
Analgesia ; Analgesics ; Anesthesia, General ; Anesthetics ; Anesthetics, Local ; Arthroscopy* ; Bupivacaine* ; Humans ; Injections, Intra-Articular ; Knee Joint ; Knee* ; Morphine* ; Pain, Postoperative*

Leukemia cutis (LC) is a nonspecific term that is used for the cutaneous manifestations of any type of leukemia, but LC is especially common in the acute myelogenous leukemia M4 and M5 variants. LC has a wide range of cutaneous manifestations, which can make it difficult to clinically distinguish LC from other skin lesions. We herein report on a case of LC that was misdiagnosed as abscess. A cutaneous biopsy demonstrated diffuse infiltrations of neutrophils in the dermis. The patient was diagnosed as having abscess and he received antibiotic therapy with disappointing results. Additional laboratory examination of the peripheral blood revealed a leukemic figure and the review of the histologic finding revealed infiltrations of atypical cells. Bone marrow biopsy demonstrated a high proportion of leukemic blasts. With these results, a new diagnosis of monocytic leukemia cutis was made. In conclusion, we believe that accurate management is important for the patients with leukemia, and particularly in a situation where skin lesions are the first clinical sign.
Abscess ; Biopsy ; Bone Marrow ; Dermis ; Humans ; Leukemia ; Leukemia, Myeloid, Acute ; Neutrophils ; Skin

Hand-foot syndrome is also known as palmar-plantar erythrodysesthesia, and it is a side effect that mostly occurs with chemotherapy or biologic therapy. It is characterized by a painful erythema and edema, which may be followed by dry or moist desquamation of the palms and soles. Mizoribine (MZR) is an imidazole nucleoside that blocks purine biosynthesis. It was found to inhibit both humoral and cellular immunity by selectively inhibiting proliferation of lymphocytes. MZR has been used for preventing renal transplant rejection and treating rheumatoid arthritis, nephritic syndrome and lupus nephritis. The principal adverse reactions are leukopenia, abnormal hepatic function and hyperuricemia. The cutaneous side effects are skin rash, prurigo and epilation, with an incidence of about 1.32%, 0.77% and 0.55%, respectively. To the best of our knowledge, no case of hand-foot syndrome associated with MZR has ever been published. Herein, we report that MZR, which has been widely used, may induce drug-induced hand-foot syndrome.
Arthritis, Rheumatoid ; Biological Therapy ; Edema ; Erythema ; Exanthema ; Graft Rejection ; Hair Removal ; Hand-Foot Syndrome ; Hyperuricemia ; Imidazoles ; Immunity, Cellular ; Incidence ; Leukopenia ; Lupus Nephritis ; Lymphocytes ; Prurigo ; Purines ; Ribonucleosides

Drug hypersensitivity syndrome is defined by various combinations of severe skin eruption and systemic signs. The symptoms of this syndrome usually begin in two to six weeks after the exposure to the offending drug, but if a patient is re-challenged with the drug, then the symptoms occur within a day. Midazolam is a short-acting benzodiazepine that,s commonly used for conscious sedation for a variety of procedures and also for premedication. Midazolam is capable of causing adverse effects such as nausea, vomiting, difficulty of breathing, cardiac arrest and signs of an allergic reaction. A 56-year-old man was prescribed Midazolam to prepare him for colonoscopy. Shortly after, he developed diffuse erythematous macules and patches with an itching sensation on all the skin of his body. The laboratory studies showed leukocytosis with eosinophilia and abnormal liver transaminase values. The skin biopsy showed vacuolar degeneration in the basal layer and a perivascular lymphocytic infiltration with eosinophils in the upper dermis. He was diagnosed as suffering with Midazolam-induced drug hypersensitivity syndrome and he was treated with systemic steroid and antihistamines for 2 weeks. This resulted in an improvement of the skin lesions and normalization of the liver transaminase values. To the best of our knowledge, no case of drug hypersensitivity syndrome associated with Midazolam has ever been published. Herein, we report that Midazolam, which is a widely used drug, may induce drug hypersensitivity syndrome.
Benzodiazepines ; Biopsy ; Colonoscopy ; Conscious Sedation ; Dermis ; Drug Hypersensitivity ; Eosinophilia ; Eosinophils ; Heart Arrest ; Histamine Antagonists ; Humans ; Hypersensitivity ; Leukocytosis ; Liver ; Midazolam ; Middle Aged ; Nausea ; Premedication ; Pruritus ; Respiration ; Sensation ; Skin ; Stress, Psychological ; Vomiting

Lymphangioma circumscriptum is a rare, benign disorder of no specific etiology involving the lymphatic channels in the deep dermal and subcutaneous layers. Lymphangioma circumscriptum can occur as either a congenital abnormality or as acquired damage to previously normal lymphatic channels. It can occur at any site in the body, especially the thigh, buttock, upper arm, axilla, and tongue, but rarely the vulva. Surgical management and laser therapy are usually performed, but other management strategies have been suggested because of frequent recurrence and cosmetic problems. We report a 64-year-old female patient who had lymphangioma circumscriptum of the vulva and who was successfully treated with an UltraPulse CO2 laser.
Arm ; Axilla ; Buttocks ; Carbon ; Carbon Dioxide ; Congenital Abnormalities ; Cosmetics ; Female ; Humans ; Laser Therapy ; Lasers, Gas ; Lymphangioma ; Middle Aged ; Recurrence ; Thigh ; Tongue ; Vulva

Pityriasis rotunda is an uncommon dermatosis characterized by asymptomatic, multiple, widely distributed, round or oval-shaped, hyperpigmented or hypopigmented, fine, scaly patches. They typically involve the abdomen, the trunk and extremities. Histopathologic findings are consistent with ichthyosis vulgaris, such as hyperkeratosis, hypogranulosis or agranulosis, hyperpigmentation of the basal layer in epidermis, and perivascular lymphohistiocytic infiltration in the dermis. Although the etiology of the disease remains unknown, it has been associated with a variety of underlying systemic diseases including infectious diseases, hormonal disorders, malignancies, and chronic disorders. One clinical case has been reported about the occurrence of the disease during pregnancy of a 24-year-old african woman, but there is only one reported case of exacerbation of the disease during pregnancy in Korea. Herein, we report a case of pityriasis rotunda occurring during pregnancy.
Abdomen ; Communicable Diseases ; Dermis ; Epidermis ; Extremities ; Female ; Humans ; Hyperpigmentation ; Ichthyosis Vulgaris ; Korea ; Pityriasis ; Pregnancy ; Skin Diseases ; Young Adult

Anisakiasis of the gastrointestinal tract is caused by the ingestion of raw fish or uncooked foods infested with Anisakis larvae belonging to the subfamily Anisakidae. With the increasing popularity of Japanese cuisine such as sashimi in Korea, the incidence of anisakiasis is expected to increase. The entire gastrointestinal tract from the esophagus to the rectum can be involved. Colonic anisakiasis is rare in comparison with gastric involvement. We report the anisakiasis concurrently invading the stomach, ileocecal valve and transverse colon treated by endoscopy with a brief review of the relevant literature.
Anisakiasis* ; Anisakis ; Asian Continental Ancestry Group ; Colon ; Colon, Transverse* ; Eating ; Endoscopy ; Esophagus ; Gastrointestinal Tract ; Humans ; Ileocecal Valve* ; Incidence ; Korea ; Larva ; Rectum ; Stomach*

OBJECTIVES: This study was performed to investigate the effects of shift-work, in terms of general health concepts, insomnia, stress, quality of life and psychological health, at several manufacturing plants. METHODS: Questionnaires were distributed to 850 shift-workers (study group), and to 550 non-shift workers (as a control group). The questionnaires included questions on ; general health concepts, insomnia, stress, quality of life and psychological health. 455 shift-workers and 372 non-shift workers completed the questionnaires, and the factors influencing the health status and quality of life in workers estimated by multiple iogistic regression analysis. RESULTS: From the general health questionnaires, the mental health and health perception were significantly different between the shift and non-shift workers, with the better being former than the latter (p<0.05). Shift-workers complained of more insomnia when adjusted for age, working period, education and job satisfaction. Greater job satisfaction, was coupled with less complaints of insomnia (p<0.05). There were 200(43.96 %) shift workers classified as insomniac, whereas with the non-shift workers this figure was 84 (25.15 %), showing a significant difference between the two groups (p<0.05). Shift-workers were more stressed than the non-shift workers in their daily lives, which also showed significant difference (p<0.05). Less job satisfaction, was coupled with more complaints of stress (p<0.05). The quality of life of the shift-workers was lower than that of the nonshift workers (p<0.05). With the shift-workers complaining of more anxiety than the nonshift workers (p<0.05). CONCLUSIONS: Our results suggest that shift-workers suffer from physical and psychological distresses, sleep problems and stress than non-shift workers. Furthermore, it is presumed that these factors might negatively affect the quality of life of shift-workers. Accordingly, interventional methods for shift-worker's health and quality of life as a result of adverse effects of shift-work are needed.
Anxiety ; Education ; Job Satisfaction ; Mental Health ; Quality of Life* ; Questionnaires ; Sleep Initiation and Maintenance Disorders

BACKGROUND AND OBJECTIVES: The combination of platelet glycoprotein IIb/IIIa inhibitors and a low dose thrombolytic agent may produce early Thrombolysis In Myocardial Infarction (TIMI) 3 flow and a high rate of ST elevation resolution in an ST elevation acute myocardial infarction (STEMI). The clinical effect of tirofiban combined with low dose alteplase, prior to primary percutaneous coronary intervention (PCI) in STEMI, were evaluated on the ST elevation resolution, TIMI flow and 30-day clinical outcomes. SUBJECTS AND METHODS: Following aspirin, clopidogrel and standard heparin, 45 patients with STEMI were randomized into 2 groups; tirofiban administration (Group I; n=23, 64+/-10 years; 15 male) or combined administration of tirofiban with 40 mg alteplase prior to primary PCI (Group II; n=22, 59+/-11 years; 19 male). The pre- and post-interventional TIMI flow grades, ST elevation resolution and bleeding complications were compared between the two groups. The major adverse cardiac events (MACE) were compared between the two groups during 30-days of clinical follow-up. RESULTS: Group II had a higher pre-interventional TIMI flow (TIMI flow> or =2: 34.8% vs. 90.9%, p<0.0001) and rate of ST elevation resolution (49.0+/-27.8% vs. 66.6+/-27.2%, p=0.045) than Group I. A major bleeding complication developed in 1 (5.0%) Group II patient, and minor bleeding complications developed 1 patient from each group (Group I; 9.5% vs. Group II; 10%, p=0.959). CONCLUSION: Combined administration of tirofiban with alteplase prior to primary PCI leads to a higher TIMI flow and more frequent ST elevation resolution, without bleeding complications, compared to a single administration of tirofiban.
Angioplasty ; Aspirin ; Blood Platelets ; Electrocardiography ; Follow-Up Studies ; Glycoproteins ; Hemorrhage ; Heparin ; Humans ; Myocardial Infarction* ; Percutaneous Coronary Intervention* ; Thrombolytic Therapy ; Tissue Plasminogen Activator*