PURPOSE: Many articles have proposed that osteonecrosis of the femoral head (ONFH) is caused by fat embolism or intravascular coagulation linked to hyperlipidemia. To determine whether hyperlipidemia is an associated factor for ONFH, serum lipid levels were measured. MATERIALS AND METHODS: Nighty-eight patients presenting with ONFH and 110 controls were investigated. We compared the average value of serum lipid levels and the incidence of hyperlipidemia of the two groups. RESULTS: ONFH group showed generalized increase in lipid level and statistically significant difference in the average value of total cholesterol (P=0.0001), HDL-cholesterol (P=0.0261) and phospholipid (P=0.0465) compared with the control. The incidence of hyperlipidemia of the two groups showed statistically significant difference in HDL-cholesterol (P=0.019) and triglyceride (P=0.024). CONCLUSION: Hyperlipidemia seems to be associated with pathogenesis of ONFH. We speculated that hyperlipidemia might be a contributing factor of ONFH. Hyperlipidemia may play a role as a triggering factor in the pathogenetic process that results in osteonecrosis. However, it can not be ruled out that secondary hyperlipidemia might be a finding following ONFH.
Cholesterol ; Embolism, Fat ; Head* ; Humans ; Hyperlipidemias ; Incidence ; Osteonecrosis* ; Triglycerides

Malacoplakia is an uncommon granulomatous inflammatory disease, which predomina- ntly affected the urinary tract, particularly the urinary bladder. The prostatic involve- ment of malacoplakia is extremely rare and may clinically mimic prostate cancer. A correct diagnosis of malacoplakia can be made by histopathologic findings characterized by accumulations of macrophages containing typical intracytoplasmic inclusions(Michael is-Gutmann bodies). We report a case of prostatic malacoplakia, which was incidentally found in prostate biopsy performed to confirm clinically suspected prostate cancer.
Biopsy ; Diagnosis ; Macrophages ; Malacoplakia* ; Prostate* ; Prostatic Neoplasms ; Urinary Bladder ; Urinary Tract

Sacral insufficiency fractures are unexpected causes of inguinal, lower back and buttock pain in elderly women with osteoporosis who have sustained unknown or only minimal trauma. Differential and radiological diagnoses of these fractures are often difficult. Bone scan remains the standard diagnostic tool, but computed tomography or magnetic resonance image may be required to differentiate insufficiency fracture from other diseases such as malignant bone lesion. The fracture usually extends vertically in the sacral ala, parallel to the sacroiliac joints. This distribution suggests that such fractures could be partially caused by weight-bearing transmitted through the spine. We report the treatment of insufficiency sacral fracture in one osteopenic patient who has been confirmed by computed tomography and treated with conservative method that convinced by follow up computed tomography.
Aged ; Buttocks ; Diagnosis ; Female ; Follow-Up Studies ; Fractures, Stress* ; Humans ; Osteoporosis ; Sacroiliac Joint ; Sacrum* ; Spine ; Weight-Bearing

Cytomegalovirus(CMV) infections are common in immune compromised situations such as human immunodeficiency virus infection and organ transplantation. However CMV colitis had been rarely found in immunocompetent individuals. We experienced a case of an 83-year-old female patient, initially immune competent, who developed a massive lower gastrointestinal bleeding caused by CMV colitis. Previously, multiple antibiotics were used for nontuberculous Myco- bacterium and other bacterial infections after total knee arthroplasty. Colonoscopy revealed multiple ulcerations and mucosal congestion with hemorrhage. In spite of ganciclovir therapy, our patient did not recover.
Aged, 80 and over ; Anti-Bacterial Agents ; Arthroplasty ; Bacterial Infections ; Colitis ; Colonoscopy ; Cytomegalovirus ; Estrogens, Conjugated (USP) ; Female ; Ganciclovir ; Hemorrhage ; HIV ; Humans ; Knee ; Mycobacterium Infections, Nontuberculous ; Nontuberculous Mycobacteria ; Organ Transplantation ; Transplants ; Ulcer

Acute maxillary sinusitis is a common disorder affecting children. Untreated acute sinusitis can develop into chronic sinusitis, and complications, such as orbital cellulitis or abscess, can occur. Maxillary sinusitis of odontogenic origin is not a well-recognized condition and is frequently missed in children. As an odontogenic source of sinusitis, the dentigerous cyst is one of the most prevalent types of odontogenic cysts, and it is associated with the crown of an unerupted or developing tooth. This report concerns a nine-year-old boy who was diagnosed with maxillary sinusitis originating from a dentigerous cyst with supernumerary teeth. The boy visited our pediatric clinic presenting with rhinorrhea and nasal obstruction and was initially diagnosed with maxillary sinusitis only. With antibiotic treatment, his symptoms seemed to improve, but after 2 months, he came to our clinic with left facial swelling with persistent rhinorrhea and nasal obstruction. Radiographic examinations of the sinuses were performed, and he was diagnosed with maxillary sinusitis originating from a dentigerous cyst with supernumerary teeth. After a surgical procedure involving the removal of the dentigerous cyst with supernumerary teeth, the symptoms of sinusitis gradually diminished. There are only very few cases in the pediatric medical literature that remind us that odontogenic origin can cause maxillary sinusitis in children. Our patient can act as a reminder to general pediatricians to include dentigerous cysts in the differential diagnosis of maxillary sinusitis.
Abscess ; Child* ; Crowns ; Dentigerous Cyst* ; Diagnosis, Differential ; Humans ; Male ; Maxillary Sinus* ; Maxillary Sinusitis* ; Nasal Obstruction ; Odontogenic Cysts ; Orbital Cellulitis ; Sinusitis ; Tooth ; Tooth, Supernumerary*

A 58-year-old man with uncontrolled type 2 diabetes mellitus developed rhinocerebral mucormycosis. The infection progressed to intracranial extension despite more than 5 weeks of treatment with amphotericin B. The patient then received oral posaconazole, 800 mg/d, in divided doses for 6 months. Salvage treatment with the new azole antifungal posaconazole resulted in dramatic clinical improvement as early as 1 week after the initiation of therapy. Oral posaconazole continued through 24 weeks of treatment, with marked clinical, mycological, and radiological improvements and no adverse events. Here we review the medical literature on rhinocerebral mucormycosis, which is a rapidly progressive and often fatal infection. The treatment of choice is amphotericin B, which failed in our patient. Our case report suggests that posaconazole appears to be a well tolerated and effective salvage treatment option for rhinocerebral mucormycosis, including disseminated disease.
Amphotericin B ; Danazol ; Diabetes Mellitus, Type 2 ; Humans ; Middle Aged ; Mucormycosis ; Salvage Therapy ; Triazoles

Animal ; Ascorbic Acid/metabolism ; Helicobacter Infections/*prevention & control ; Helicobacter pylori/*physiology ; Human ; Nitroso Compounds/metabolism ; Stomach Neoplasms/*microbiology ; Support, Non-U.S. Gov't

PURPOSE: We sought to elucidate the influence of acetazolamide on choroidal structure changes during the treatment of central serous chorioretinopathy (CSC).METHODS: This was a retrospective study of 45 eyes from 45 patients with acute CSC who were divided into an acetazolamide group (group 1, n = 20) and an observation group (group 2, n = 25). The main outcome measures were the changes in best-corrected visual acuity, subretinal fluid (SRF) height, subfoveal choroidal thickness (SFCT), and choroidal vascularity index (CVI) at one week, one month, two months, and three months, respectively.RESULTS: Although statistical significance was not reached, best-corrected visual acuity improved in both groups at month 3 (from 0.06 ± 0.07 to 0.01 ± 0.03 in group 1 and 0.17 ± 0.24 to 0.09 ± 0.18 in group 2; p = 0.083 and 0.183, respectively). Separately, SRF height and CVI showed a significant decrease at three months in both groups (all p < 0.05), while a significant SRF height decrease was also noted in group 1 at one month (p = 0.038). In group 1, a significant decrease in the SFCT and CVI started at one week and one month (p = 0.021 and 0.008), respectively. However, in group 2, a significant decrease in the SFCT and CVI started at one month and two months (p = 0.005 and 0.015), respectively.CONCLUSIONS: Acetazolamide has no effect on final functional or anatomical status at three months in eyes with CSC but does shorten the time for SRF absorption and accompanying choroidal structural changes.
Absorption ; Acetazolamide ; Central Serous Chorioretinopathy ; Choroid ; Humans ; Outcome Assessment (Health Care) ; Retrospective Studies ; Subretinal Fluid ; Visual Acuity

Therapeutic radiation therapy has developed new technologies that use a high dose of radiation with three- dimensional targeting for a few days instead of conventional radiation therapy that uses small doses of radiation for a longer period of time. A Cyberknife is an image- guided robotic system for stereotactic radiosurgery. The Cyberknife was first developed for the treatment of intracranial lesions, and recently has been used for tumors in the chest and abdomen. A Cyberknife can use a high dose of radiation for treatment of a hepatocellular carcinoma and can be employed to minimize radiation injury around the tumor. However, in a large tumor, the therapeutic efficacy is reduced and injury can occur around the organs. We report a case of acute injury in the stomach and duodenum after Cyberknife treatment of a hepatocellular carcinoma near the hepatic portal area.
Abdomen ; Carcinoma, Hepatocellular ; Constriction, Pathologic ; Duodenal Ulcer ; Duodenum* ; Radiation Injuries ; Radiosurgery ; Stomach Ulcer ; Stomach* ; Thorax

BACKGROUND/AIMS: The serum Helicobacter pylori IgG antibody test has been widely used by primary care physicians for over two decades. We assessed its usefulness as a screening strategy for organic gastrointestinal disease in routine check-up. METHODS: We retrospectively reviewed the medical records of 10,080 subjects who received a routine check up at the Kangnam St. Mary's Hospital from January 2004 to April 2005. All subjects underwent the H. pylori IgG antibody test and upper gastrointestinal endoscopy or a barium contrast study. RESULTS: The overall seropositive rate for H. pylori detection was 61.0% (6,150/10,180). The 13C-urea breath test (UBT) was performed in 340 subjects. The H. pylori antibody test showed 55% accuracy in comparison to the standard 13C-UBT. The number of patients with peptic ulcer in the seropositive group was 475 (7.7%) compared to only 168 patients (4.3%) in the seronegative group (p<0.001). Stomach cancer was observed in eight (0.1%) and two (0.1%) patients in the seropositive and seronegative groups, respectively. The positive and negative likelihood ratios for the H. pylori IgG antibody test for peptic ulcer were 1.22 and 0.66, respectively, compared to 1.31 and 0.26 for stomach cancer. CONCLUSIONS: In view of its low accuracy and likelihood ratios, we do not recommend the H. pylori antibody test as a diagnostic tool for H. pylori infection or as a screening strategy for organic gastrointestinal disease during routine check-ups.
Barium ; Breath Tests ; Endoscopy, Gastrointestinal ; Gastrointestinal Diseases ; Helicobacter ; Helicobacter pylori ; Humans ; Immunoglobulin G ; Mass Screening ; Medical Records ; Peptic Ulcer ; Physicians, Primary Care ; Retrospective Studies ; Serologic Tests ; Stomach Neoplasms