PURPOSE: The purpose of this study was to investigate the feasibility of shear wave ultrasound elastography for differentiating superficial benign soft tissue masses through a comparison of their shear moduli. METHODS: We retrospectively analyzed 48 masses from 46 patients from February 2014 to May 2016. Surgical excision, fine-needle aspiration, and clinical findings were used for the differential diagnosis. The ultrasonographic examinations were conducted by a single musculoskeletal radiologist, and the ultrasonographic findings were reviewed by two other radiologists who were blinded to the final diagnosis. Conventional ultrasonographic features and the median shear modulus were evaluated. We compared the median shear moduli of epidermoid cysts, ganglion cysts, and lipomatous tumors using the Kruskal-Wallis test. Additionally, the Mann-Whitney U test was used to compare two distinct groups. RESULTS: Significant differences were found in the median shear moduli of epidermoid cysts, ganglion cysts, and lipomatous tumors (23.7, 5.8, and 9.2 kPa, respectively; P=0.019). Epidermoid cysts showed a greater median shear modulus than ganglion cysts (P=0.014) and lipomatous tumors (P=0.049). CONCLUSION: Shear wave elastography may contribute to the differential diagnosis of superficial benign soft tissue masses through a direct quantitative analysis.
Biopsy, Fine-Needle ; Diagnosis ; Diagnosis, Differential ; Elastic Modulus ; Elasticity Imaging Techniques* ; Epidermal Cyst ; Ganglion Cysts ; Humans ; Lipoma ; Retrospective Studies ; Shear Strength ; Ultrasonography

Nasal osteotomy for aesthetic results is required in patients who have broad nasal bone. Since the procedure is difficult, many operators hesitate the surgery. From January 2007 to July 2009, we performed 77 cases of nasal osteotomy, consisting of paramedian oblique medial osteotomy or median oblique-medial osteotomy and percutaneous lateral osteotomy. Most of the patients had satisfying results, however three patients had asymmetric shape and inappropriate inward movement of nasal bone which required revision with percutaneous lateral osteotomy. Osteotomy procedure varies, depending on surgeon's preference and experience, however, each surgeon should be aware of good and weak points of those procedures and use the most suitable method. In order to achieve maximal satisfying results, preoperative analysis of patients and minimal invasive handling should be done. Based on these efforts, this method could broadly be used in the aesthetic field.
Handling (Psychology) ; Humans ; Nasal Bone ; Nose ; Osteotomy ; Rhinoplasty

Purpose: This study aimed to apply MR elastography (MRE) to achieve in vivo evaluation of the elastic properties of thigh muscles and validate the feasibility of quantifying the elasticity of normal thigh muscles using MRE. Materials and Methods: This prospective study included 10 volunteer subjects [mean age, 32.5 years, (range, 23–45 years)] who reported normal activities of daily living and underwent both T2-weighted axial images and MRE of thigh muscles on the same day. A sequence with a motion-encoding gradient was used in the MRE to map the propagating shear waves in the muscle. Elastic properties were quantified as the shear modulus of the following four thigh muscles at rest; the vastus medialis, vastus lateralis, adductor magnus, and biceps femoris. Results: The mean shear modulus was 0.98 ± 0.32 kPa and 1.00 ± 0.33 kPa for the vastus medialis, 1.10 ± 0.46 kPa and 1.07 ± 0.43 kPa for the vastus lateralis, 0.91 ± 0.41 kPa and 0.93 ± 0.47 kPa for the adductor magnus, and 0.99 ± 0.37 kPa and 0.94 ± 0.32 kPa for the biceps femoris, with reader 1 and 2, respectively. No significant difference was observed in the shear modulus based on sex (p < 0.05). Aging consistently showed a statistically significant negative correlation (p < 0.05) with the shear modulus of the thigh muscles, except for the vastus medialis (p = 0.194 for reader 1 and p = 0.355 for reader 2). Conclusion MRE is a quantitative technique used to measure the elastic properties of individual muscles with excellent inter-observer agreement. Age was consistently significantly negatively correlated with the shear stiffness of muscles, except for the vastus medialis.

Ischiofemoral impingement (IFI) syndrome is an uncommon cause of gluteal and hip pain. We report on a case of a 20-year-old man who presented with chronic gluteal and hip pain with low back pain without a history of trauma or surgery. He was misdiagnosed with ankylosing spondylitis (AS) at another clinic. The patient was finally diagnosed with IFI syndrome according to pelvic magnetic resonance imaging findings at our hospital. After two weeks of medical and physical treatment, his pain showed gradual improvement. Because IFI syndrome is rarely reported in male patients, it might be misdiagnosed as AS. Therefore, IFI syndrome should be considered as a differential diagnosis of AS, particularly in young male patients with atypical pain characteristics.
Diagnosis, Differential* ; Hip ; Humans ; Low Back Pain ; Magnetic Resonance Imaging ; Male ; Spondylitis, Ankylosing* ; Young Adult

Dengue fever is an acute febrile disease caused by the dengue virus, which belongs to the family Flaviviridae. The increasing number of people traveling abroad has increased the number of cases of imported dengue fever in Korea. The most common symptoms in patients with dengue fever are malaise, fever, musculoskeletal pain, headache, nausea, vomiting, and abdominal pain. Neurological manifestations such as myelitis, encephalitis, and cranial nerve palsies have been recognized as clinical consequences of dengue infection, but meningitis is a rare complication. We report the case of a 38-year-old man who presented with fever, headache, and nuchal rigidity while traveling in Vietnam. The etiology of meningitis was confirmed by the presence of dengue IgM antibody in his serum. This case report highlights the potential of dengue infection as a cause of meningitis.
Abdominal Pain ; Adult ; Cranial Nerve Diseases ; Dengue ; Dengue Virus ; Encephalitis ; Fever ; Flaviviridae ; Headache ; Humans ; Immunoglobulin M ; Korea ; Meningitis ; Muscle Rigidity ; Musculoskeletal Pain ; Myelitis ; Nausea ; Neurologic Manifestations ; Vietnam ; Vomiting

Purpose: Computed tomography (CT) is commonly used for the clinical staging of bladder cancer. However, a previous transurethral resection (TUR) often results in an overestimation of a proper muscle and perivesical fat invasion in the CT. The purpose of this study was to evaluate the effects of a TUR on CT staging in patients with bladder cancer. MATERIALS AND METHODS: A total of 67 patients who underwent a radical cystectomy for primary bladder cancer were included in this study. CT was performed before a TUR in 38 patients (group 1) and after a TUR in 29 (group 2). In each patient, CT evaluated the presence or absence of a proper muscle and perivesical fat invasion and the findings were then compared with the histopathologic findings following the radical cystectomy. RESULTS: CT had an overall staging accuracy of 79.1% for a proper muscle invasion and 67.2% for a perivesical fat invasion. For a proper muscle invasion, there was a significant difference between both groups in the CT specificity (76.9% vs. 30.0%, p=0.024) while no difference in the sensitivity (92.0% vs. 89.5%) was noted. For a perivesical fat invasion, there was also a significant difference between the two groups in terms of the CT specificity (75.0% vs. 35.7%, p=0.022) while there was no difference in the sensitivity (72.2% vs. 80.0%). CONCLUSIONS: A TUR before a CT may cause a false positive result in the clinical staging of bladder cancer using CT. Therefore, to minimize the confounding effect of a TUR on CT staging, it is strongly recommended that a CT be performed before a TUR in the case of a highly suspicious invasive bladder cancer.
Cystectomy ; Humans ; Neoplasm Staging ; Sensitivity and Specificity ; Urinary Bladder Neoplasms* ; Urinary Bladder*

OBJECTIVES: The purpose of this study was to determine the current status of presenteeism and absenteeism among railroad workers as well as to investigate whether or not job stress level and psychosocial well-being status are associated with presenteeism and absenteeism. METHODS: As the cross-sectional design, a self-reported questionnaire using the Korean Occupational Stress Scale(KOSS), Psychosocial Well-being Index(PWI), and Work Productivity and Impairment-General Health(WPAI-GH) was administered to railroad workers. Univariate and multivariate logistic regressions were used to analyze the association between job stress, psychosocial well-being status and presenteeism, absenteeism in 1,099 subjects. RESULTS: Among the study subjects, 52.0% and 22.0% experiened presenteeism and absenteeism, respectively. Job stress level in railroad workers was higher than that in general workers. Multivariate logistic regression with presenteeism as the dependent variable showed an elevated odds ratio of 3.56(95% CI 1.48-8.54) in the highest job stress group, and an odds ratio of 3.20(95% CI 1.94-5.26) in the high-risk psychosocial stress group. There was no significant association between job stress level and absenteeism, whereas weak association between psychosocial stress and absenteeism was found. CONCLUSIONS: Since railroad workers have a high level of job stress and elevated experience of presenteeism, a management strategy is required to control presenteeism and absenteeism in order to promote railroad workers' health and safety.
Absenteeism ; Efficiency ; Logistic Models ; Odds Ratio ; Questionnaires ; Railroads ; Sick Leave

Multiple symmetric lipomatosis (MSL), or Madelung's disease, is a rare disease of unknown etiology. It is characterized by the presence of loose adipose tissue deposits localized in the cervical region and upper body. MSL presenting as bilateral huge gynecomastia is an extremely rare phenomenon. The present report describes a case of MSL in a 66-year-old man. The patients presented with bilateral breast bulging. He had a history of cigarette and alcohol use. His condition was treated with a bilateral nipple-sparing mastectomy. MSL can present as a form of gynecomastia, for its accurate diagnosis and proper treatment of MSL, increasing awareness of the clinical characteristics of the disease is required, especially amongst breast surgeons. Herein, we review the literature and discuss the clinical characteristics, pathology, and surgical treatment of MSL.
Adipose Tissue ; Aged ; Breast ; Diagnosis ; Gynecomastia* ; Humans ; Lipomatosis ; Lipomatosis, Multiple Symmetrical* ; Male ; Mastectomy ; Pathology ; Rare Diseases ; Tobacco Products

BACKGROUND: Few studies have explored the effects of bisphosphonates on bony healing in patients undergoing spinal fusion surgery. Most previous studies used animal models and found that bisphosphonate shows negative effects on spinal fusion consolidation. We intended to evaluate the effect of a single-dose of zoledronic acid on the volume of the fusion-mass in lumbar spinal fusion. METHODS: A retrospective review was carried out on 44 patients with symptomatic degenerative lumbar spinal stenosis who underwent one or two-level posterolateral fusion from January 2008 and January 2011. They were divided into 4 groups: group 1, autograft and zoledronic acid; group 2, allograft and zoledronic acid; group 3, autograft alone; and group 4, allograft alone. Functional radiography and three-dimensional computed tomography scans were used to evaluate and quantify the volume of the fusion-mass. The visual analog scale (VAS), the Oswestry disability index (ODI), and the short form 36 (SF-36) were used to evaluate the clinical outcomes. RESULTS: The mean volume of the fusion-mass per level was 8,814 mm3, 8,035 mm3, 8,383 mm3, and 7,550 mm3 in groups 1, 2, 3, and 4, respectively, but there were no significant differences between the groups (p = 0.829). There were no significant decreases in the volume of the fusion-mass (p = 0.533) in the zoledronic acid groups (groups 1 and 2). The VAS, the ODI, and the SF-36 at the 6-month follow-up after surgery were not significantly different (p > 0.05) among the 4 groups. The VAS, the ODI, and the SF-36 were not correlated with the volume of the fusion-mass (p = 0.120, 0.609, 0.642). CONCLUSIONS: A single dose of zoledronic acid does not decrease the volume of the fusion-mass in patients undergoing spinal fusion with osteoporosis. Therefore, we recommend that zoledronic acid may be used after spinal fusion in osteoporotic patients.
Aged ; Aged, 80 and over ; Bone Density Conservation Agents/*therapeutic use ; Diphosphonates/*therapeutic use ; Female ; Humans ; Imidazoles/*therapeutic use ; Lumbar Vertebrae/drug effects/pathology/radiography/surgery ; Male ; Middle Aged ; Osteoporosis/drug therapy ; Pain Measurement ; Pain, Postoperative ; Quality of Life ; Retrospective Studies ; Spinal Fusion/adverse effects/*methods ; Spinal Stenosis/pathology/radiography/*surgery ; Treatment Outcome

OBJECTIVE: To assess the utility of hysterosonography (HS) as a screening method in patients with abnormal uterine bleeding. MATERIALS AND METHODS: We retrospectively reviewed transvaginal ultrasonography (TVS) and HS for 105 patients whose diagnosis was confirmed pathologically. All 105 patients were initially evaluated on the same day with both TVS and HS. On TVS and HS examination, endometrial cavitary lesions were classified as diffuse hyperplasia, endometrial polyp, endometrial cancer, uterine synechia and submucosal leiomyoma. Hysteroscopy with biopsy (n=35), curettage (n=60) or hysterectomy (n=10) was performed, and the results of TVS and HS examination were correlated with the pathological findings. RESULTS: The sensitivity and specificity were 79.0% and 45.8% for TVS, and 95.1% and 83.3% for HS, respectively. The positive and negative predictive values were 83.0% and 39.3% for TVS, and 95.1% and 83.3% for HS, respectively. Twenty-seven showed a discrepancy between the TVS and HS, and eight cases showed a discrepancy between HS and the pathologic diagnosis. CONCLUSION: TVS is a sensitive method to evaluate the endometrial cavitary lesions, but it often does not provide the physician with sufficient diagnostic information. With its higher sensitivities, specificities and positive and negative predictive values, HS can be better used than TVS in evaluating those patients with abnormal uterine bleeding.
Adult ; Aged ; Comparative Study ; *Endosonography/methods ; Female ; Human ; Middle Aged ; Retrospective Studies ; Sensitivity and Specificity ; Uterine Hemorrhage/etiology/*ultrasonography