We report herein a case of primary cutaneous diffuse large B-cell lymphoma with multiple skin lesions in a Korean woman. A 56-year-old woman presented with rapidly growing multiple sub-cutaneous nodules in her right flank and right upper arm. Microscopic examination of skin biopsy specimen showed diffuse infiltrates of large atypical lymphocytes with vesicular nuclei, prominent nucleoli and moderate degree of mitotic figures in deep dermis and subcutis. Immunophenotypic studies revealed the lymphoid infiltrates reacted with CD45, CD20 and bcl-2 protein, but none of the sections expressed CD3, bcl-6 protein and CD30. In physical examination and staging work-up, we could not find any other extracutaneous or systemic involvement. She was treated with 2 cycles of high-dose multiagent chemotherapy with the Vanderbilt and the BEAM regimen combined with the autologous peripheral blood stem cell transplantation. Until now, 10 months after termination of treatment, she has shown improvement of all skin lesions and no development of extracutaneous disease.
Arm ; B-Lymphocytes* ; Biopsy ; Dermis ; Drug Therapy ; Female ; Humans ; Lymphocytes ; Lymphoma, B-Cell* ; Middle Aged ; Peripheral Blood Stem Cell Transplantation ; Physical Examination ; Skin

STUDY DESIGN: Intertransverse lumbar fusion segments were evaluated in rabbits at 4, 8, 12, and 16 weeks after surgery. The calcium sulfate was used as a bone graft substitute and its fusion rate compared with the fusion rate of autogenous bone graft. OBJECTIVE: To investigate the efficacy of calcium sulfate as a bone graft substitute in achieving intertransverse fusion in rabbits. SUMMARY OF BACKGROUND: Calcium sulfate is a bone graft substitute made from medical grade calcium sulfate hemihydrate. Preclinical testing and clinical case studies demonstrate the excellent bone healing response and biocompatibility in long bone defect. MATERIALS AND METHODS: Forty adult New Zealand white rabbits were included in our study. In group I, the 0.8g of the calcium sulfate was grafted on the left inter transverse of L4-5 or L5-6 and the 0.8g of the autogenous iliac bone on the right side at the same level. In group II, the 0.4g of the calcium sulfate mixed with 0.4g of the autogenous graft on the left intertransverse of L4-5 or L5-6 and 0.8g of the autogenous iliac bone on the right side at the same level was grafted. At postoperative 4, 8, 12, 16 weeks, the plain roentgenogram was checked to evaluate the bony union. At 16 weeks, all rabbits were sacrificed and the histologic evidences of the bony union using H&E and trichrome stain were investigated. The molecular-biological study to detect the RNA of TNF-alpha was investigated in nonunion. RESULTS: Bone graft using calcium sulfate resulted in nonunion radiologically and histologically in all rabbits. 92.5% of calcium sulfate in group I and 80.0% in group II was resorbed within postoperative 12 weeks. There was statistical significance between group I and group II. In contrast, graft using autogenous cancellous bone showed complete bony union in 11 out of 20 rabbits. With molecular-biological study using PCR, the RNA of TNF-alpha was not detected from bony union site, but detected from nonunion site. CONCLUSION: The results of this study indicate that calcium sulfate is not an effective bone graft substitute for achieving stable intertransverse spinal fusion. TNF-alpha may have direct effects on autogenous graft bone with calcium sulfate resorption
Adult ; Calcium Sulfate* ; Calcium* ; Humans ; Polymerase Chain Reaction ; Rabbits* ; RNA ; Spinal Fusion ; Transplants* ; Tumor Necrosis Factor-alpha

STUDY DESIGN: A Retrospective study OBJECTIVE: To evaluate the results after an anterior decompression and fusion, with anterior instrumentation, using a Z-plate in osteoporotic vertebral fractures. SUMMARY OF LITERATURE REVIEW: Despite conservative treatment, continuous severe pain, progressive neurological impairments and deformity may need surgical treatment in osteoporotic vertebral fractures accompanied with neurological deficit. MATERIALS AND METHODS: Fourteen patients that had undergone anterior decompression and an autogenous iliac bone graft, with anterior internal fixation, between 1997 and 2001, under the diagnosis of an osteoporotic vertebral fracture, were reviewed. The chief complaints, severity of pain measured, using the Denis pain scale, fracture patterns, fracture level, changes of kyphotic angle (revised with sagittal index) and complications were analyzed. RESULTS: Symptoms subsided completely in 5 patients, one case showed no definite improvement and 8 showed improved symptoms. The fracture levels included: 1 and 2 cases at the 11th and 12th thoracic spine, and 8, 1 and 2 in the 1st, 2nd and 3rd lumbar spine, respectively. 10 patients showed wedge type fractures, three a compression type and one a biconcave type. The average kyphotic deformity decreased 49.0% (50.9% when revised with sagittal index) after surgery, but the average loss of correction angle was 28.8% (26.0% when revised with sagittal index), compared with the immediate postoperative correction angle. THE COMPLICATIONS INCLUDED: screw loosening and adjacent vertebral fractures in 3 and 4 patients, respectively. Two patients had the combined problem of screw loosening and an adjacent vertebral fracture. CONCLUSION: In anterior decompression and fusion, with instrumentation, for osteoporotic vertebral fracture treatment, the complications were primarily related, directly or indirectly, to the underlying osteoporosis. Complete neurological recovery occurred 9 of the 11 patients, but residual pain was common.
Congenital Abnormalities ; Decompression* ; Diagnosis ; Humans ; Osteoporosis ; Retrospective Studies ; Spine ; Transplants

Purpose: Considering the risk of coronavirus disease (COVID-19) transmission through infected droplets, emergency department (ED) operations in response to febrile patients should be planned. We investigated the general and clinical characteristics of febrile patients visiting the ED and changes in admission rates via the ED during the COVID-19 outbreak. Materials and Methods: We performed a retrospective analysis of prospectively collected patients who visited 402 EDs in the Republic of Korea with febrile symptoms between January 27 and May 31, 2020 and compared them to those enrolled before the COVID-19 outbreak. The primary outcome was admission rate; the secondary outcome was length of stay (LOS) in the ED. Results: In total, 266519 patients had febrile symptoms at ED presentation after the COVID-19 outbreak. In 2019, before the outbreak, there were 437762 patients. The rate of ED visits among pediatric patients (aged <15 years) decreased to 21.4% after the COVID-19 outbreak, compared with 41.8% in 2019. The proportion of patients admitted after ED management was higher after the outbreak (31.3%) than before (25.2%). The adjusted odds ratio for admission was 1.04 (95% confidence interval: 1.02–1.05) after the outbreak. Compared to before the COVID-19 outbreak, the median ED LOS increased by 16 min after the outbreak. Conclusion This study confirmed that admission rates and ED LOS increased for febrile patients visiting the ED after the COVID-19 outbreak. This could provide evidence for developing ED-related strategies in response to the ongoing COVID-19 outbreak and other infectious disease pandemics.

Few cases of intradural metastasis of a non-neurogenic origin, without antecedent cerebral metastasis, have been reported. To the best of our knowledge; however, this is the first reported case of distant tumor metastasis via seeding to the intradural space through a dural opening, which formed a tumor mass without antecedent brain metastasis at a different spine level. The medical records and imaging studies of a 67-year-old woman suffering from lower back pain and paresis of the lower extremities, were reviewed. She had previously had rectal cancer. A decompressive laminectomy and excision of the intradural mass were performed. The histopathology study confirmed her original diagnosis.
Aged ; Brain ; Diagnosis ; Female ; Humans ; Laminectomy ; Low Back Pain ; Lower Extremity ; Medical Records ; Neoplasm Metastasis* ; Paresis ; Rectal Neoplasms* ; Spine

PURPOSE: Cervical epidural analgesia is used for pain control in head and neck or upper arm. But it is not commonly used for the purpose of pure regional anesthesia for upper arm surgery. Therefore, we investigated the usefulness of cervical epidural anesthesia (CEA) as a method of regional anesthesia for arteriovenous bridge graft (AVBG) for hemodialysis at upper arm and evaluated the effects of CEA on hemodynamics and respiration. METHODS: One hundred-fifty chronic renal failure patients scheduled for AVBG were randomly assigned. In the sitting position, an epidural catheter was inserted at C6-7 or C7-T1 and 15 ml of 0.375% ropivacaine with fentanyl 20microg was injected. Analgesic level, blood pressure and heart rate were measured at 5-minute intervals after injection of the drug. Arterial blood sampling was taken for aBGA before and twenty minutes after CEA. RESULTS: Average anesthetic dermatomalsensory levels were C3.4+/-1.2~T5.7+/-2.8. During surgery, hypotension was noted in 49% of patients. It was treated with ephedrine or phenylephrine i.v. Baseline PaCO2 changed from 42.4+/-2.9 mmHg to 44.6+/-3.6 mmHg. CONCLUSION: The above results suggest that CEA is suitable for AVBG at upper arm as a regional anesthesia.
Amides ; Analgesia, Epidural ; Anesthesia, Conduction ; Anesthesia, Epidural ; Arm ; Arteriovenous Shunt, Surgical ; Blood Gas Analysis ; Blood Pressure ; Catheters ; Ephedrine ; Fentanyl ; Head ; Heart Rate ; Hemodynamics ; Humans ; Hypotension ; Kidney Failure, Chronic ; Neck ; Phenylephrine ; Renal Dialysis ; Transplants

Among many kinds of internal fixation techniques for the transverse fracture of the patella, AO modified tension band wiring technique and Pyrford technique have been widely used. However, it seems that those techniques are not strong enough to withstand immediate full weight bearing and full range of motion exercise postoperatively. Instead, a load sharing wiring technique seems to be more effective fixation technique. A comparative study was performed to evaluate the load sharing wiring technique using porcine patellae. Transverse fractures of thirty knees were made and were fixed with 3 different fixation technique. 1) AO modified tension band wiring technique, 2) Pyrford technique, and 3) Load sharing wiring technique. Then, those knees were mounted on the material testing system (Instron 4204(R)) and longitudinal traction was applied. The result showed that the separation of the fracture fragments was much less with the load sharing wiring technique than with the AO modified tension band wiring technique and the Pyrford tehchnique when 5 kg to 25 kg of traction was applied(P<0.05). The load sharing wiring technique showed less than 0.4mm of separation at 25~50kg of traction, where other techniques led specimen to failure. From this study, it was suggested that the load sharing wiring technique was proved to be more effective fixation technique compared to other techniques.
Knee ; Patella* ; Range of Motion, Articular ; Traction ; Weight-Bearing

OBJECTIVE: We evaluated the clinical characteristics and prognoses of patients with septic shock who transferred to the emergency department (ED) in a tertiary referral center. METHODS: This study was performed using a prospective, multi-center registry of septic shock, with the participation of 11 tertiary referral centers in the Korean Shock Society between October 2015 and February 2017. We classified the patients as a transferred group who transferred from other hospitals after meeting the inclusion criteria upon ED arrival and a non-transferred group who presented directly to the ED. Primary outcome was hospital mortality. We conducted multiple logistic regression analysis to assess variables related to in-hospital mortality. RESULTS: A total of 2,098 patients were included, and we assigned 717 patients to the transferred group and 1,381 patients to the non-transferred group. The initial Sequential Organ Failure Assessment score was higher in the transferred group than the non-transferred group (6; interquartile range [IQR], 4–9 vs. 6; IQR, 4–8; P < 0.001). Mechanical ventilator (29% vs. 21%, P < 0.001) and renal replacement therapy (12% vs. 9%, P=0.034) within 24 hours after ED arrival were more frequently applied in the transferred group than the non-transferred group. Overall hospital mortality was 22% and there was no significant difference between transferred and non-transferred groups (23% vs. 22%, P=0.820). Multivariable analysis showed an odds ratio for in-hospital mortality of 1.00 (95% confidence interval, 0.78–1.28; P=0.999) for the transferred group compared with the non-transferred group. CONCLUSION: The transferred group showed higher severity and needed more organ support procedures than the nontransferred group. However, inter-hospital transfer did not affect in-hospital mortality.
Emergencies* ; Emergency Service, Hospital* ; Hospital Mortality ; Humans ; Logistic Models ; Mortality ; Observational Study* ; Odds Ratio ; Prognosis ; Prospective Studies ; Renal Replacement Therapy ; Retrospective Studies* ; Sepsis ; Shock ; Shock, Septic* ; Tertiary Care Centers* ; Ventilators, Mechanical

Small cell lung cancer (SCLC) is one of the most fatal cancers in humans and many factors are known to be related to its poor prognosis. Immunohistochemical (IHC) stainings were done on SCLC specimens in order to investigate the prognostic value of the apoptosis-related gene expression and the tumor proliferative maker, and the relationships among these IHC results and patients clinical characteristics, chemoresponsiveness, and survival were analyzed. The medical records of 107 patients were reviewed retrospectively. IHC stainings for p53, bcl-2 and Ki-67 expressions were performed in the 66 paraffin-embedded biopsy samples. Sixty-six out of the 107 patients were evaluable for response rate and survival. The overall response rate was 75% (95% Confidence Interval=74-76%) and the median survival time was 14 months. The median survival time of limited stage was 16 months and that of extensive stage was 10 months. The prevalence of p53, bcl-2 and Ki-67 expression was 62%, 70%, and 49%, respectively. There were no correlations among the immunoreactivities of p53, bcl-2 and Ki-67 with clinical stage, chemoresponsiveness or overall survival. The clinical stage was the only prognostic factor influencing survival. The expression rates of p53, bcl-2, and Ki-67 were relatively high in SCLC without any prognostic significance. The exact clinical role of these markers should be defined through further investigations.
Adult ; Aged ; Carcinoma, Small Cell/metabolism/*pathology ; Female ; Humans ; Immunohistochemistry ; Ki-67 Antigen/analysis ; Lung Neoplasms/metabolism/*pathology ; Male ; Middle Aged ; Multivariate Analysis ; Prognosis ; Proto-Oncogene Proteins c-bcl-2/analysis ; Survival Analysis ; Tumor Markers, Biological/*analysis ; Tumor Suppressor Protein p53/analysis

PURPOSE: Accurate assessment of the lesion after treatment of patients with bone lymphoma is difficult. In this patient who demonstrated complete remission after chemotherapy, the regions of fluorine-18 fluorodeoxyglucose ( (18) FFDG) PET uptake diminished more rapidly following therapy, indicating a complete response at much earlier stage than did Magnetic Resonance Imaging (MRI) or CT based findings. With the conventional methods, such as MRI and CT, it was difficult to assess whether the residual tumor tissue was viable or not. Decision to complete response is very important in patients with lymphoma to plan the further treatment. We experienced a patient with primary lymphoma of bone who revealed complete response to chemotherapy on (18) FFDGPET while CT showed persistent destructive bone lesion. Thus, (18) FFDGPET study after therapy may be superior to CT in the evaluation of response to treatment in primary lymphoma of bone.
Drug Therapy ; Electrons* ; Fluorodeoxyglucose F18* ; Humans ; Lymphoma* ; Magnetic Resonance Imaging ; Neoplasm, Residual ; Positron-Emission Tomography*