Although gout often initially affects the peripheral joints, gout may also involve the axial joints. The radiologic changes of axial gout are more common than are clinically recognized. According to a recent report, when the spine CT images of peripheral gout were reviewed for features of axial gout, there was about a 14% frequency of suspected axial gout. The vertebral level and the finding with the most common spinal gouty changes were L4 and lumbar facet joint erosions. We describe here the case of a 36-year-old gout patient with low back and right buttock pain and his lesions were unexpectedly diagnostic of lumbar facet joint arthritis and right sacroiliitis.
Adult ; Arthritis ; Buttocks ; Gout ; Humans ; Joints ; Magnetic Resonance Imaging ; Sacroiliac Joint ; Sacroiliitis ; Spine ; Zygapophyseal Joint

OBJECTIVE: There have been no clinical studies regarding the epidemiology and treatment outcome for unruptured intracranial aneurysm (UIA) in South Korea yet. Thus, The Korean Society of Cerebrovascular Surgery (KSCVS) decided to evaluate the clinical and epidemiological characteristics, and outcome of the treatment of UIA in 2006, using the nationwide multicenter survey in South Korea. METHODS: A total of 1,696 cases were enrolled retrospectively over one year at 48 hospitals. The following data were obtained from all patients : age, sex, presence of symptoms, location and size of the aneurysm, treatment modality, presence of risk factors for stroke, and the postoperative 30-day morbidity and mortality. RESULTS: The demographic data showed female predominance and peak age of seventh and sixth decades. Supraclinoid internal carotid artery was the most common site of aneurysms with a mean size of 5.6 mm. Eight-hundred-forty-six patients (49.9%) were treated with clipping, 824 (48.6%) with coiling, and 26 with combined method. The choice of the treatment modalities was related to hospital (p = 0.000), age (p = 0.000), presence of symptom (p = 0.003), and location of aneurysm (p = 0.000). The overall 30-day morbidity and mortality were 7.4% and 0.3%, respectively. The 30-day mortality was 0.4% for clipping and 0.2% for coiling, and morbidity was 8.4% for clipping and 6.3% for coiling. Age (p = 0.010), presence of symptoms (p = 0.034), size (p = 0.000) of aneurysm, and diabetes mellitus (p = 0.000) were significant prognostic factors, while treatment modality was not. CONCLUSION: This first nation-wide multicenter survey on UIAs demonstrates the epidemiological and clinical characteristics, outcome and the prognostic factors of the treatment of UIAs in South Korea. The 30-day postoperative outcome for UIAs seems to be reasonable morbidity and mortality in South Korea.
Aneurysm ; Carotid Artery, Internal ; Diabetes Mellitus ; Female ; Humans ; Intracranial Aneurysm ; Korea ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Stroke ; Treatment Outcome

Rectus sheath hematoma is an uncommon cause of acute abdomen, caused by a tear in deep epigastric vessels or its branches. It occurs spontaneously, after trauma or surgery. Rectus abdominus myonecrosis is a life threatening complication of rectus sheath hematoma. We report a case with fatal rectus sheath hematoma complicated by rectus abdominus myonecrosis caused by ischial fracture in a chronic active rheumatoid arthritis patient.
Abdomen, Acute ; Arthritis, Rheumatoid* ; Hematoma* ; Humans

Cardiovascular involvement in cases of Behcet's disease is a rare but life-threatening condition, and prosthetic valve detachment is a frequent and serious complication attributable to Behcet's disease following the surgical repair of aortic regurgitation. We report the case of a patient with Behcet's disease presenting with contained aortic rupture around the aortic root. The patient had previously undergone aortic valve surgery three times due to recurrent prosthetic valve detachment. An emergency operation was performed, consisting of aortic root replacement (ARR) using a composite valved conduit and the replacement of the hemiarch. ARR may be an appropriate surgical option for patients with Behcet's disease in order to prevent recurrence of the disease.
Aortic Rupture* ; Aortic Valve ; Aortic Valve Insufficiency ; Behcet Syndrome ; Emergencies* ; Extracorporeal Circulation ; Humans ; Recurrence

BACKGROUND: Stellate ganglion block is usually performed at the transverse process of C6, because the vertebral artery is located anterior to the transverse process of C7. The purpose of this study is to estimate the location of the transverse process of C6 using the cricoid cartilage in the performance of stellate ganglion block. METHODS: We reviewed cervical lateral neutral-flexion-extension views of 48 patients who visited our pain clinic between January and June of 2010. We drew a horizontal line at the surface of the cricoid cartilage in the neutral and extension views of cervical lateral x-rays. We then measured the change in the shortest distance from this horizontal line to the lowest point of the transverse process of C6 between the neutral and extension views. RESULTS: There was a statistically significant difference in the shortest distance from the horizontal line at the surface of the cricoid cartilage to the lowest point of transverse process of C6 between neutral position and neck extension position in both males and females, and between males and females in both neutral position and neck extension position. The cricoid cartilage level was 4.8 mm lower in males and 14.4 mm higher in females than the lowest point of transverse process of C6 in neck extension position. CONCLUSIONS: Practitioners should recognize that the cricoid cartilage has cephalad movement in neck extension. In this way, the cricoid cartilage can be still useful as a landmark for stellate ganglion block.
Cricoid Cartilage ; Female ; Humans ; Male ; Neck ; Pain Clinics ; Stellate Ganglion ; Vertebral Artery

Six year-old female having TGA, VSD with severe PHT which was considered inoperable for anatomical correction, received palliative Senning procedure. During follow-up, she was given prostacyclin and at the age of 21, she received Senning takedown, arterial switch and VSD closure after a reevaluation of the hemodynamic status. Significant reduction in PHT was found and she is doing well without complication 3 months after the operation.
Epoprostenol ; Female ; Follow-Up Studies ; Hemodynamics ; Humans

Hemorrhagic cystitis is potentially life-threatening sequellae of chemotherapy using oxazaphosphorine alkylating agents (cyclophosphamide and ifosfamide). Mesna contains a sulfhydryl group that is believed to bind acrolein within the urinary collecting system and reduce the hemorrhagic cystitis without affecting the chemotherapeutic potential. To date, about thirty cases of hypersensitivity or allergic reactions of the delayed and urticarial type associated with mesna have been reported. We reported two patients with systemic lupus erythematosus who developed facial rash and flushing associated with mesna which imitate malar rash.
Acrolein ; Alkylating Agents ; Cyclophosphamide ; Cystitis ; Drug Therapy ; Exanthema* ; Flushing ; Humans ; Hypersensitivity* ; Lupus Erythematosus, Systemic ; Mesna*

We describe the case of a 58-year-old woman affected by Sjogren's syndrome characterized by dry eye, dry mouth, positive Schirmer test, and postitive ANA and anti-Ro antibody. After eight years, the patient presented muscle weakness and skin rash on upper eyelid, the dorsum of hands, upper chest, and neck diagnosed as dermatomyositis. Dermatomyositis is well controlled by a high-dose steroid, methotrexate, and hydroxychloroquine.
Dermatomyositis* ; Exanthema ; Eyelids ; Female ; Hand ; Humans ; Hydroxychloroquine ; Methotrexate ; Middle Aged ; Mouth ; Muscle Weakness ; Neck ; Sjogren's Syndrome* ; Thorax

The status of pulmonary circulation is regarded with utmost importance for the successful Fontan operation. The absence of unilateral pulmonary artery leads to decreased pulmonary vascular bed and elevated pulmonary vascular resistance which are the risk factors for Fontan operation. A 9-year-8-month-old female patient diagnosed as tricuspid atresia, pulmonary atresia with absent left pulmonary artery flow, received extracardiac conduit Fontan operation using 18 mm Gore-Tex graft. She was discharged on twenty sixth postoperative day with arterial O2 saturation of 70% on room air. On last follow up at 14 months after the operation, she was clinically well with O2 saturation of 91%.
Female ; Follow-Up Studies ; Fontan Procedure* ; Humans ; Polytetrafluoroethylene ; Pulmonary Artery* ; Pulmonary Atresia ; Pulmonary Circulation ; Risk Factors ; Transplants ; Tricuspid Atresia ; Vascular Resistance

Previously the patulous eustachian tube has been regarded as troublesome but benign condition. Recently some cases have been reported in conjunction with middle ear complications. In spite of its intractability, pathophysiology and specific therapy for this condition has not been fully investigated. We experienced two cases of abnormally patulous eustachian tube, the 23-year-old patient who complained autophonia and the 36-year-old female patient who complained autophonia with tinnitus, and they were treated with autologous free fat injection. We report these cases with a brief review of the literatures.
Adult ; Ear, Middle ; Eustachian Tube* ; Female ; Humans ; Tinnitus ; Transplants* ; Young Adult