Steroid mvopathy is a skeletal muscle disease that develops in condition both endogenous and exogenous glucocorticoid excess and is characterized by muscle weakness. Myalgia, and wasting. The onset is usually insidious and the distribution of weakness is primarily proximal uith the legs more severely involved than the arms; cranial-nerve-in nervated muscles and sphin ers are usually spared. We report a 60-year-old man with rheumatoid arthritis uho was managed by prednisone and dexamethasone over 20 years and showed progressive lower limb weakness afterwards.
Arm ; Arthritis, Rheumatoid ; Dexamethasone ; Humans ; Leg ; Lower Extremity ; Middle Aged ; Muscle Weakness ; Muscle, Skeletal ; Muscles ; Muscular Diseases* ; Myalgia ; Prednisone

Spinal fixation using pedicle screws has recently been the focus of increased attention, but the adequate size of pedicle screw and maximum percentage fill as related to the pedicle diameter and are not well known. The objects of this study were to determine the ideal ratio among pedicle, drill and screw diameter, and to determine the maximum percentage fill of the screw without significant decrease of pull-out strength. The materials used for the experiments were 376 thoracic pedicles obtained from the 38 young pigs, and the diameters of pedicles ranged from 3.0 to 8.5mm. After 40% to 100% drilling as compared to pedicle diameter, screws were inserted carefully, and measurements were taken of the outer pedicle changes and pull-out strengths, and adequate drill and screw sizes as related to the diameters of given pedicles were determined. It was found that pull-out strength was the strongest after 60% drill, and the larger the drill diameter, the smaller the holding power, and the larger the screw diameter, the greater the holding power. Maximum pull-out strength was seen at 80-90% fill with 60% drill. After sequentially drilling each pedicle with increasingly larger drill bits, larger screws could be inserted with pedicle changes such as expansion, cutout, split fracture, and comminuted fracture. after larger drilling up to 100%, pedicle screws with diameters smaller than 115% of measured pedicle diameters could be safly inserted without fracture and significant decrease of pull-out strength. It is concluded that effective percentages of drill and screw diameters to the pedicle diameter are 60% and 80-90% respectively, and pedicle screw up to 115% of measured pedicle diameter can be safely inserted into pedicle without significant decrease of pull-out strength. It is thought that fresh pedicle has elasticity and larger screw can be inserted to the pedicle with strong holding after larger drilling.
Elasticity ; Fractures, Comminuted ; Pedicle Screws ; Swine

OBJECTIVE: It was to analyze two failed arterial embolization cases in the treatment for pseudoaneurysm followed by D&C. METHODS: Two failure cases out of eight cases were gained in the transarterial embolization treatment for eight years.(1. 1. 1992 - 12. 31. 1999) To search for the factors of failure, we went through obstetrical history and biopsy. RESULTS: Eight cases of transarterial embolization were performed to the treatment for pseudoaneurysm appeared after undergoing D&C. Six cases were successfully treated without complications. However, laparotomy was done due to the continuous bleeding in the other two cases. According to tissue biopsy, they showed the cervical pregnancy in one case and placenta accreta in the other. CONCLUSION: Transarterial embolization is proved to be more preferable to operate in the treatment of pseudoaneurysm than laparotomy, and transarterial embolization therapy failure rate is higher in case of existing remnant villi than not.
Aneurysm, False* ; Biopsy ; Dilatation and Curettage* ; Female ; Hemorrhage ; Hysterectomy ; Laparotomy ; Placenta Accreta ; Pregnancy

BACKGROUND: Venous thromboembolism (VTE) is a relatively common and potentially life threatening complication after major hip surgery. There are two main types of prophylaxis: chemical and mechanical. Chemical prophylaxis is very effective but causes bleeding complications in surgical wounds and remote organs. On the other hand, mechanical methods are free of hemorrhagic complications but are less effective. We hypothesized that mechanical prophylaxis is effective enough for Asians in whom VTE occurs less frequently. This study evaluated the effect of intermittent pneumatic compression (IPC) in the prevention of VTE after major hip surgery. METHODS: Incidences of symptomatic VTE after primary total hip arthroplasty with and without application of IPC were compared. A total of 379 patients were included in the final analysis. The IPC group included 233 patients (106 men and 127 women) with a mean age of 54 years. The control group included 146 patients (80 men and 66 women) with a mean age of 53 years. All patients took low-dose aspirin for 6 weeks after surgery. IPC was applied to both legs just after surgery and maintained all day until discharge. When a symptom or a sign suspicious of VTE, such as swelling or redness of the foot and ankle, Homans' sign, and dyspnea was detected, computed tomography (CT) angiogram or duplex ultrasonogram was performed. RESULTS: Until 3 months after surgery, symptomatic VTE occurred in three patients in the IPC group and in 6 patients in the control group. The incidence of VTE was much lower in the IPC group (1.3%) than in the control group (4.1%), but the difference was not statistically significant. Complications associated with the application of IPC were not detected in any patient. Patients affected by VTE were older and hospitalized longer than the unaffected patients. CONCLUSIONS: The results of this study suggest that IPC might be an effective and safe method for the prevention of postoperative VTE.
Ankle ; Arthroplasty, Replacement, Hip* ; Asian Continental Ancestry Group ; Aspirin ; Dyspnea ; Foot ; Hand ; Hemorrhage ; Hip ; Humans ; Incidence ; Leg ; Male ; Methods ; Ultrasonography ; Venous Thromboembolism* ; Wounds and Injuries

PURPOSE: To determine changes in the square index of the liver segments of liver cirrhosis(LC) patients, as seen on CT, and the value of this indicator during follow-up. MATERIALS AND METHODS: Twenty-three patients with LC were included in this study. Abdominal CT scans were performed twice in each patient and the mean follow-up period was 15 (6-36) months. We measured the square index of the right lobe, the caudate lobe, and the medial and lateral segment of the left lobe of the liver, as seen on initial and follow-up CT images, and compared the results. The square index was obtained by deter-mining the product of the transverse and longitudinal diameters. According to the Child-Pugh classification, the condition was classified as either progressive or non-progressive, and the square index was compared between the two groups. RESULTS: The square index of the left lobe medial segment showed a significant decrease in both the progression group(n=13) and non-progression group(n=10), while that of the right lobe was significantly lower only in the progression group. There was no significant change in the square index of the caudate lobe or the lateral segment of the left lobe. CONCLUSION: For predicting the progression of LC, the square index of the medial segment of the left lobe is a more sensitive index than the Child-Pugh classification. For ascertaining the progression of the condition, the square index of the right lobe is a valuable deferminant.
Classification ; Follow-Up Studies ; Humans ; Liver ; Tomography, X-Ray Computed

PURPOSE: Atypical femoral fracture (AFF), periprosthetic femoral fracture (PPFF) and femoral nonunion (FNU) are recalcitrant challenges for orthopedic surgeons. Teriparatide (TPTD) had been demonstrated to have anabolic effects on bone in various studies. We postulated that adjuvant TPTD after operation would enhance biologic stimulation for bone formation. We investigated (1) whether the adjuvant TPTD could achieve satisfactory union rate of surgically challenging cases such as displaced AFF, PPFF and FNU; (2) whether the adjuvant TPTD could promote development of abundant callus after surgical fixation; (3) whether the adjuvant TPTD had medically serious adverse effects. MATERIALS AND METHODS: Thirteen patients who agreed to off label use of TPTD in combination of operation were included in this retrospective case series. Median patients' age was 68.7 years, and there were three male and ten female patients. Their diagnoses were nonunion in six patients and acute fracture in seven. Medical records and radiographic images were reviewed. RESULTS: Twelve of thirteen fractures were united both clinically and radiologically within a year after adjuvant TPTD. Union completed radiologically median 5.4 months and clinically 5.7 months after the medication, respectively. Callus appeared abundantly showing median 1.4 of fracture healing response postoperatively. There was no serious adverse reaction of medication other than itching, muscle cramp, or nausea. CONCLUSION: Even appropriate surgical treatment is a mainstay of treatment for AFF, PPFF, and FNU, the current report suggested that adjuvant TPTD combined with stable fixation results in satisfactory outcome for the challenging fractures of femur.
Anabolic Agents ; Bony Callus ; Diagnosis ; Female ; Femoral Fractures* ; Femur ; Fracture Healing ; Humans ; Male ; Medical Records ; Muscle Cramp ; Nausea ; Off-Label Use ; Orthopedics ; Osteogenesis ; Periprosthetic Fractures ; Pruritus ; Retrospective Studies ; Surgeons ; Teriparatide*

In order to examine the neurotoxic mechanism of oxygen radicals on cultured bovine oligodendrocytes, cytoxic effect of oxygen radicals was examined when cultures were treated with various concentrations of xanthine oxidase (XO) and hypoxanthine (HX) in culture medium. In addition, the neuroprotective effect of iron-chelators against the neurotoxicity induced by oxygen radicals was evaluated by MTT assay. Cell viability was remarkably decreased in a time-dependent manner after exposure of cultured bovine oligodendrocytes to 20mU/ml XO and 0.1mM HX for 4 hours. In the neuroprotective effect of iron-chelators on oxidant-induced neurotoxicity, tetrakis (2-pyridylmethyl)ethylenediamine (TPEN) blocked the neurotoxicity induced by oxygen radicals, while DFX was not effective in blocking oxidant-induced neurotoxicity in these cultures. These results suggest that oxygen radicals are toxic in cultured bovine oligodendrocytes, and also selective iron-chelators such as TPEN are effective in blocking the neurotoxicity induced by oxygen radicals.
Allopurinol* ; Cell Survival ; Hypoxanthine ; Neuroprotective Agents ; Oligodendroglia ; Reactive Oxygen Species ; Xanthine Oxidase

OBJECTIVES: To determine which factors are changed in the thyroid cancer postoperative care and how quality of life compared between patients who had undergone modified radical neck dissection and selective neck dissection. METHODS: Prospectively, total 151 patients who diagnosed as thyroid cancer and underwent 16 modified radical neck dissection (mRND) or 135 selective neck dissection (SND) were evaluated for shoulder function, neck mobility, and quality of life and degree of depression at baseline, 2 days and 1 week postoperatively. All patients performed neck and shoulder stretching exercise three times a day beginning the morning following surgery. Shoulder function was assessed with the Constant's shoulder scale. Quality of life was assessed with the SF36v2 questionnaire. And depression was assessed with Beck depression inventory (BDI). RESULTS: The disability scores of patients were significantly worse for neck range of motion (ROM), shoulder pain, ADL, shoulder ROM, shoulder abduction power, total score of Constant's shoulder scale, physical function domain in SF-36v2 and BDI score & grade 2 days after the surgeries. SF36v2 domain score was no significantly difference between two groups. CONCLUSION: The mRND and SND are risk factors for neck ROM limitation, shoulder dysfunction, and onset of depression. In comparison between mRND and SND, more deterioration in ADL, shoulder abduction power, total score of Constant's shoulder scale are associated with modified radical neck dissection. More study is needed about usefulness of the stretching exercise in shoulder pain onset through comparison with control group.
Activities of Daily Living ; Depression ; Humans ; Neck ; Neck Dissection ; Postoperative Care ; Prospective Studies ; Quality of Life ; Surveys and Questionnaires ; Range of Motion, Articular ; Risk Factors ; Shoulder ; Shoulder Pain ; Thyroid Gland ; Thyroid Neoplasms

BACKGROUND/AIMS: Heart rate variability (HRV) is a method for evaluation of autonomic nervous system activity by expressing the balance of sympathetic and parasympathetic tones. Some studies of HRV in patients with end-stage renal disease (ESRD) have been performed in Korea. However, few have examined kidney transplantation (KT) patients. Therefore, we investigated autonomic nervous system activity by means of HRV in patients with KT due to ESRD. METHODS: We compared the pattern of cardiac sympathetic and parasympathetic activity by time- and frequency-domain analysis of HRV with 24-h Holter monitoring of 23 KT and 56 dialysis patients. Patients underwent KT between January, 2008 and June, 2011. RESULTS: The mean ages of KT and dialysis patients were 54.2 +/- 12.3 and 53.7 +/- 12.6 years, respectively. The KT group showed increased time- and frequency-domain HRV (including HRV index), very low frequency (VLF), means and standard deviations of all normal R-R intervals for all 5-min segments of the entire recording (SDNNi), low frequency (LF), LF in normalized units (LF norm), and LF to high-frequency power ratio, compared with the dialysis group. CONCLUSIONS: Autonomic tone in patients with KT is higher than that in patients with ESRD on dialysis.
Autonomic Nervous System ; Dialysis ; Electrocardiography ; Electrocardiography, Ambulatory ; Heart ; Heart Rate ; Humans ; Kidney ; Kidney Failure, Chronic ; Kidney Transplantation ; Korea

We report the case of a 63-year-old female with sigmoid colon cancer and isolated metastasis to the left kidney at the time of initial diagnosis. An anterior resection of the sigmoid colon and a left nephrectomy were performed. Three cycles of adjuvant chemotherapy consisting of oxaliplatin, 5-fluorouracil, and leucovorin were given, but two months after the surgery, multiple metastases of the liver were detected on a CT scan. The patient refused further treatment and died 5 months after the discovery of an isolated metastasis. An isolated metastasis to the kidney is very rare in clinical practice. A nephrectomy for kidney metastasis has no effect on survival and quality of life, and a nephrectomy may also compromise the choice of chemotherapy agents that require renal clearance; thus, a careful evaluation of renal function is necessary before a nephrectomy. At present, kidney metastasis should be regarded as an advanced metastatic disease, and aggressive chemotherapy, including target therapy, should prolong survival and improve the quality of life. However, when a synchronous or a metachronous renal tumor is suspected, a nephrectomy should be performed for accurate diagnosis and treatment.
Chemotherapy, Adjuvant ; Colon, Sigmoid* ; Diagnosis ; Drug Therapy ; Female ; Fluorouracil ; Humans ; Kidney* ; Leucovorin ; Liver ; Middle Aged ; Neoplasm Metastasis* ; Nephrectomy ; Quality of Life ; Sigmoid Neoplasms* ; Tomography, X-Ray Computed