In general, the long head of the biceps brachii originates from the superior glenoid labrum and the supraglenoid tubercle, crosses the rotator cuff interval, and extends into the bicipital groove. However, rare anatomic variations of the origins of the long head have been reported in the past. In this report, we review the clinical history, radiologic findings, and arthroscopic identifications of 3 anatomic variants of the biceps tendon long head. As the detection of long head of biceps tendon pathology during preoperative radiologic assessment can be difficult without prior knowledge, surgeons should be aware of such possible anatomic variations.
Anatomic Variation ; Head* ; Pathology ; Rotator Cuff ; Shoulder ; Tendons

No abstract available.
Otitis Media* ; Otitis*

Eosinophilic cholecystitis is a rare disease characterized by transmural leukocyte infiltration composed of more than 90% eosinophils. Eosinophilic cholecystitis is clinically indistinguishable from ordinary cholecystitis, and as a rule it leads to cholecystectomy. We report a case of idiopathic eosinophilic cholecystitis treated with steroids. A 75-year-old woman presented with a classic history of acute cholecystitis and a peripheral eosinophilia of 41.8%. There was no evidence of allergy or parasitic infestation. An abdominal ultrasonography and computed tomography (CT) scan showed an edematous, thickened gallbladder wall, but no gallstones. There was no evidence of eosinophilic infiltration in other organs. Cholecystectomy was not performed because the patient refused surgical management. However, fever, abdominal pain, and peripheral eosinophilia persisted despite antibiotic and conservative therapy. Therefore, we attempted treatment with prednisolone. A week later, the symptoms disappeared and the peripheral eosinophilia normalized.
Abdominal Pain ; Aged ; Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute ; Eosinophilia ; Eosinophils ; Female ; Fever ; Gallbladder ; Gallstones ; Humans ; Hypersensitivity ; Leukocytes ; Prednisolone ; Rare Diseases ; Steroids

Clostridium difficile is the most common nosocomial pathogen of the gastrointestinal tract. Pseudomembranous colitis occurs as a result of a severe inflammatory response to Clostridium difficile toxins. Pseudomembranous colitis is an increasingly frequent cause of morbidity and mortality among elderly hospitalized patients. Diarrhea is the most common manifestation. According to the literature, stools are almost never grossly bloody, and range from soft and unformed to watery or mucoid in consistency. We now report the cases of three patients with pseudomembranous colitis whose main clinical manifestation was hematochezia.
Aged ; Clostridium difficile ; Diarrhea ; Enterocolitis, Pseudomembranous ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Humans

This case involved a pulmonary thromboembolism, which originated from the lower extremity. A 68-year-old female, with a femur neck fracture, underwent spinal anesthesia with 0.5% heavy bupivacaine 11 mg for total hip arthroplasty. Ten minutes after the induction of spinal anesthesia, dyspnea, tachycardia and hypotension appeared. Under the impression of a pulmonary embolism, intubation was done and dopamine and epinephrine were infused. The operation stopped and she was sent to the intensive care unit. On the spiral CT chest angiogram, a pulmonary embolism was found. Deep venous thrombosis was detected in the left lower extremity on the venogram. Heparin therapy was started at a rate of 800 U/hour with a bolus of 5000 U. A consultative operation for the removal of deep vein thrombosis was performed by a chest surgeon, and total hip arthroplasty was performed successfully under spinal anesthesia.
Aged ; Anesthesia, Spinal* ; Arthroplasty, Replacement, Hip ; Bupivacaine ; Dopamine ; Dyspnea ; Epinephrine ; Female ; Femoral Neck Fractures* ; Femur Neck* ; Femur* ; Heparin ; Humans ; Hypotension ; Intensive Care Units ; Intubation ; Lower Extremity ; Pulmonary Embolism* ; Tachycardia ; Thorax ; Tomography, Spiral Computed ; Venous Thrombosis

BACKGROUND: Lipoprotein(a)[Lp(a)], an independent risk factor for athrosclerosis, consist of low density lipoprotein like particle and specific glycoprotein, apolipoprotein(a). The levels of Lp(a) are mainly determined by the genetic pleomorphism of apolipoprotein(a) and has been though not to be influenced by age, sex and other biochemical parameters. Recent reports have shown that the concentrations of Lp(a) are correlated with age in women. The purpose of this study was to invastigate the association of Lp(a) concentration with sex and age. METHODS: The concentrations of Lp(a) were measured in 3,707 women and 389 men, free of diseases and medications known to affect the lipid levels. Plasma Lp(a) concentration were measured by commercial radioimmunoassay kit and other lipid profiles by conventional method. RESULTS: In female, median Lp(a) concentration increased with age till the early sixth decade (P=.0000) and then decreased. If peri- and postmenopausal women were excluded in the fifth decades, the relation between age and Lp(a) disappeared. In male, Lp(a) concentration were not associated with age. Median Lp(a) concentrations were higher in females than in males in the fifth(p=.0039) and the sixth decades(p=.0007), The difference became negligible after the exclusion of peri- and postmenopausal woman in the fifth decade. CONCLUSION: The concentrations of Lp(a) were corrected with age only in female. Females had higher levels than males in the fifth and the sixth decades. The relations are thought to be nither due to aging process nor sex but due to postmenopausal increase of Lp(a).
Aging ; Apoprotein(a) ; Female ; Glycoproteins ; Humans ; Lipoprotein(a)* ; Lipoproteins ; Male ; Menopause ; Plasma ; Radioimmunoassay ; Risk Factors

BACKGROUND: Lipoprotein(a)[Lp(a)], an independent risk factor for athrosclerosis, consist of low density lipoprotein like particle and specific glycoprotein, apolipoprotein(a). The levels of Lp(a) are mainly determined by the genetic pleomorphism of apolipoprotein(a) and has been though not to be influenced by age, sex and other biochemical parameters. Recent reports have shown that the concentrations of Lp(a) are correlated with age in women. The purpose of this study was to invastigate the association of Lp(a) concentration with sex and age. METHODS: The concentrations of Lp(a) were measured in 3,707 women and 389 men, free of diseases and medications known to affect the lipid levels. Plasma Lp(a) concentration were measured by commercial radioimmunoassay kit and other lipid profiles by conventional method. RESULTS: In female, median Lp(a) concentration increased with age till the early sixth decade (P=.0000) and then decreased. If peri- and postmenopausal women were excluded in the fifth decades, the relation between age and Lp(a) disappeared. In male, Lp(a) concentration were not associated with age. Median Lp(a) concentrations were higher in females than in males in the fifth(p=.0039) and the sixth decades(p=.0007), The difference became negligible after the exclusion of peri- and postmenopausal woman in the fifth decade. CONCLUSION: The concentrations of Lp(a) were corrected with age only in female. Females had higher levels than males in the fifth and the sixth decades. The relations are thought to be nither due to aging process nor sex but due to postmenopausal increase of Lp(a).
Aging ; Apoprotein(a) ; Female ; Glycoproteins ; Humans ; Lipoprotein(a)* ; Lipoproteins ; Male ; Menopause ; Plasma ; Radioimmunoassay ; Risk Factors

Pheochromocytoma with pregnancy is very uncommon but it is associated with very high maternal and fetal morbidity and mortality. Antepartum diagnosis and proper management can prevent mother and fetus from potentially lethal outcome. Since pheochromocytoma produces and secretes catecholamines, hemodynamic instability can be brought. The aim of anesthetic management is the avoidance of drugs and episodes that will result in hypertensive crisis, and the selection of safe anesthetic measures and anesthetics to mother and fetus. We report a case of pheochromocytoma with pregnancy managed with combined anesthetic technique-epidural anesthesia for cesarean section and general anesthesia for resection of pheochromocytoma 3 weeks after cesarean section. ?
Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Anesthetics ; Catecholamines ; Cesarean Section ; Diagnosis ; Female ; Fetus ; Hemodynamics ; Humans ; Mortality ; Mothers ; Pheochromocytoma* ; Pregnancy*

The 2010 Emergency Physician (EP) Survey of the Korean Society of Emergency Medicine (KSEM) was the first comprehensive survey of its members on their working conditions, working environment, and compensation. The survey was conducted using a questionnaire on the web interface and e-mail from March to December of 2010. The subjects were currently active EPs working in an emergency department (ED). Additional e-mails, telephone calls, and visits were necessary in order to encourage the participation of members. Out of 841 members, 394 members completed the questionnaire. Excluding members who are currently not working in an ED, retired, opened a private practice as a primary physician, or unknown status, 635 (75.5%) EPs were working in 203 EDs out of a total of 465 EDs in Korea. There was a wide range of variations in ED employing EP. EP employing practices by the hospitals depended on the size and level of ED and the region of the country. ED employed 4.52+/-2.97 Eps, and 4.80+/-5.69 emergency residents, 4.21+/-3.05 interns, and 26.02+/-16.99 nurses. On average, EPs worked 17.51+/-5.84 days, and 7.87+/-3.17 night shifts in a month, 228.11+/-57.46 hours in a month. The average pay for the hour was 33,300 KRW. Satisfaction of the EPs with their compensation was below average. Important factors in selection of a workplace depended on night-shifts, time for the family, pay, and the relationship with other specialties. On a 10 point scale, satisfaction with their training was 6.38; the answer to selection of the same specialty was 5.53; satisfaction with the current emergency medical services (EMS) system was 3.85; emergency medicine in 10 years was 5.75. The adult APGAR score was 5.05. As in the survey, members of KSEM as a whole are working a large number of heavy duty hours, with insufficient pay. Most of them feel over burdened and unsatisfied with their current state. They also share a dim outlook on the future. In order to increase job satisfaction of EPs, there must be an improvement in the welfare and working conditions. This survey was conducted in order to obtain a clear view of the current status of EPs in Korea, and in hopes of contributing to improvement of the EP status. This survey will lay a cornerstone for development of an EMS system in Korea.
Adult ; Apgar Score ; Compensation and Redress ; Electronic Mail ; Emergencies* ; Emergency Medical Services ; Emergency Medicine ; Emergency Service, Hospital ; Hope ; Humans ; Job Satisfaction ; Korea ; Private Practice ; Surveys and Questionnaires ; Telephone

STUDY DESIGN: This retrograde study was designed to compare the clinical features and postoperative clinical results between diabetic and non-diabetic patients who had been performed decompression and arthrodesis with instrumentation. SUMMARY OF LITERATURE REVIEW: There are controversies in the treatment results of diabetic patients. OBJECTIVE: To identify poor results in the patients of lumbar spinal stenosis accompanied diabetes mellitus and to find out variables influencing postoperative results among diabetics. MATERIALS AND METHODS: We analyzed 27 diabetic patients and sex, age-matched 27 non-diabetic patients who were diagnosed as lumbar spinal stenosis and operated from April, 1995 to December, 1998. In all patients, duration of symtoms, sensory and motor deficits, comorbidity, level of operations were investigated and in diabetics, duration of diabetes, amount of insulin administered before operation and presence of diabetic neuropathy were included. Clinical results, postoperative complications were compared between diabetics and non-diabetics. RESULTS: Considerable improvement was reported by 19(71%) in diabetic group and 21(78%) in non-diabetic group. Complication rate such as of infection and delayed wound healing was not higher in diabetic group than non-diabetic group. Duration of diabetes and amount of insulin before operation did not affected the result of operations. CONCLUSION: The outcome of surgery was similary successful in the two groups.
Arthrodesis ; Comorbidity ; Decompression ; Diabetes Mellitus* ; Diabetic Neuropathies ; Humans ; Insulin ; Postoperative Complications ; Spinal Stenosis* ; Wound Healing