PURPOSE: Anal problems due to ingested foreign bodies are rare and usually present as acute anal pain. However, various clinical presentations are possible. This study was performed to identify the diverse manifestations of and the outcomes of treatments for anal diseases caused by ingested foreign bodies. METHODS: Between September 1995 and June 2003, seven patients were treated for anal diseases due to the impaction of ingested foreign bodies in Seoul National University Hospital and Daehang Hospital. We retrospectively reviewed the medical records of those unusual patients. RESULTS: All patients were males, and their mean age was 49.4 yr (range, 37 to 74 yr). The detected foreign bodies were fish bones (n=3), fish fins (n=2), a chicken bone (n=1), and a toothpick (n=1). Four patients had acute anal pain as the primary symptom while two patients presented anal pus discharge, and one patient presented anal bleeding. In the four patients with acute anal pain, the foreign bodies were easily found on digital rectal examination and inspection with anoscopy. Those patients underwent simple removal of the foreign body at the outpatient clinic. In three patients, the foreign bodies were found during surgery for hemorrhoids or fistulas. The two fistulas detected were complex types and needed seton placement. CONCLUSION: Anal problems caused by ingested foreign bodies usually involve acute anal pain, but our results indicate that, in some cases, the anal foreign bodies are also the cause or an aggravating factor in chronic anal disease.
Ambulatory Care Facilities ; Chickens ; Digital Rectal Examination ; Eating ; Fistula ; Foreign Bodies ; Hemorrhage ; Hemorrhoids ; Humans ; Male ; Medical Records ; Retrospective Studies ; Suppuration

PURPOSE: To evaluate the effect of adjunctive subtenon injection of triamcinolone acetonide (TA) in gas-filled eyes after vitrectomy for complicated proliferative diabetic retinopathy (PDR). METHODS: This nonrandomized comparative study included 27 patients (27 eyes) who underwent pars plana vitrectomy and gas tamponade for treatment of PDR with tractional or combined tractional-rhegmatogenous retinal detachment and who received subtenon injection of TA (40 mg) at the end of surgery. The study group was compared with the control group (29 eyes), which was matched with the study group for preoperative and intraoperative parameters, but underwent pars plana vitrectomy and gas tamponade without a subtenon injection of TA. RESULTS: Retinal reattachments without reoperation were achieved in 25 eyes (92.6%) and 26 eyes (89.7%) at 6 months (p = 1.000) in the study and control groups, respectively. The study group and the control group did not differ significantly in the frequency of postoperative proliferative vitreoretinopathy, retinal redetachment rate, reoperation rate, macular pucker formation, postoperative vitreous hemorrhage, gain in visual acuity, intraocular pressure, and intraocular inflammation (p > 0.05). CONCLUSIONS: The clinical results of pars plana vitrectomy for complicated PDR are not improved significantly by an adjunctive subtenon TA injection in gas-filled eyes.
Diabetic Retinopathy/complications/*therapy ; Female ; Gases ; Glucocorticoids/administration & dosage ; Humans ; Injections ; Male ; Middle Aged ; Tenon Capsule ; Treatment Outcome ; Triamcinolone Acetonide/*administration & dosage ; Visual Acuity ; Vitrectomy/*methods ; Vitreoretinopathy, Proliferative/etiology/*therapy

BACKGROUND: Although pedobarographic measurement is increasingly used for clinical and research purposes, relatively few published studies have investigated normative data. This study examined pedobarographic findings in young healthy adults with regard to sex-related differences and correlations among measurement indices. METHODS: Twenty young healthy adults (mean age, 22.4 years; standard deviation, 1.2 years; and 10 males and 10 females) were included. Weight bearing anteroposterior (AP) and lateral foot radiographs were taken, and dynamic pedobarographic data during treadmill walking and maximum ankle dorsiflexion were obtained. AP talo-first metatarsal angle, naviculocuboid overlap, lateral talo-first metatarsal angle, and plantar soft tissue thickness were measured on foot radiographs. Pedobarographic data including peak pressure and pressure-time integral were measured on five plantar segments: medial forefoot (MFF), lateral forefoot (LFF), medial midfoot (MMF), lateral midfoot (LMF), and heel. RESULTS: Male and female subjects significantly differed in body mass index (BMI, p < 0.001), AP talo-first metatarsal angle (p = 0.018), soft tissue thickness under the metatarsal head (p = 0.040) and calcaneal tuberosity (p < 0.001), maximum dorsiflexion during stance phase (p = 0.041), peak pressure on the MFF (p = 0.005) and LFF (p = 0.004), and pressure-time integral on the MFF (p = 0.018) and heel (p = 0.001). BMI was significantly correlated with soft tissue thickness under the metatarsal head (r = 0.521, p = 0.018) and calcaneal tuberosity (r = 0.585, p = 0.007), peak pressure on the MFF (r = 0.601, p = 0.005) and LFF (r = 0.487, p = 0.029), pressure-time integral on the heel (r = 0.552, p = 0.012), and total pressure-time integral (r = 0.755, p < 0.001). Maximum dorsiflexion demonstrated significant negative correlations with pressure-time integral on the MFF (r = −0.595, p = 0.007) and total pressure-time integral (r = −0.492, p = 0.032). Pressure-time integral varus/valgus index was significantly correlated with pressuretime integral forefoot/heel index (r = 0.472, p = 0.036). CONCLUSIONS: Sex-related differences in pedobarographic examination were observed, which could provide useful information in setting appropriate treatment goals and obtaining appropriate control data. The effects of subtalar motion in distributing plantar pressure should be investigated in a future study.
Adult* ; Ankle ; Body Mass Index ; Female ; Foot ; Head ; Heel ; Humans ; Male ; Metatarsal Bones ; Sex Characteristics* ; Walking ; Weight-Bearing

Thrombotic thrombocytopenic purpura (TTP) is a rare medical condition characterized by thrombocytopenia, microangiopathic hemolytic anemia, neurologic manifestations, and infrequently, renal involvement. In many cases, TTP is associated with deficiency of the von Willebrand factor-cleaving protease, ADAMTS13, and treatment with plasma exchange is effective in the majority of patients. We report a patient with acute TTP in whom remission was not achieved by initial treatment consisting of plasma exchange and corticosteroids. In view of the severe autoantibody-mediated ADAMTS-13 deficiency, treatment was initiated with rituximab, a chimeric monoclonal antibody directed against the CD 20 antigen present on B lymphocytes. The patient received 4 weekly infusions of rituximab (375 mg/m2). Four weeks after the last infusion of rituximab, a complete clinical and laboratory remission was documented. We conclude that rituximab should be considered in patients with TTP with acquired ADAMTS-13 deficiency, who fail to respond to standard treatment with plasma exchange and corticosteroids. Rituximab may result in a lowered requirement for plasmapheresis and avoid the complications of salvage immunosuppressive therapy.
Adrenal Cortex Hormones ; Anemia, Hemolytic ; Antibodies, Monoclonal, Murine-Derived ; B-Lymphocytes ; Humans ; Neurologic Manifestations ; Plasma Exchange ; Plasmapheresis ; Purpura ; Purpura, Thrombotic Thrombocytopenic ; Thrombocytopenia ; Thymine Nucleotides ; Rituximab

A 28-year-old man was admitted due to abdominal pain and nausea. The patient had been diagnosed with peritoneal tuberculosis and was being treated with anti-tuberculous drugs. After 7 months of therapy, he developed abdominal pain, nausea, and melena. Gastrofiberscopy showed a duodenal ulcer and fistular opening. Abdominal CT revealed an aneurysm of the replaced hepatic artery due to abdominal tuberculous lymphadenopathy. After embolization of the aneurysm, his symptoms improved. Although mycotic aneurysm occurs rarely as a complication of tuberculous lymphadenopathy, it should be diagnosed as early as possible because of the high rate of rupture and associated high mortality.
Abdominal Pain ; Adult ; Aneurysm ; Aneurysm, Infected ; Duodenal Ulcer ; Hepatic Artery ; Humans ; Lymphatic Diseases ; Melena ; Nausea ; Peritonitis, Tuberculous ; Rupture ; Tuberculosis

PURPOSE: We performed this study to share experiences in the management of obturator hernia, which is a very rare disease among elderly women, because rarity of this disease will not approve an expert institute or surgeon and because the aging society, Korea, can increase the incidence. METHODS: Patient characteristics, clinical manifestations and treatment results were retrospectively collected from the 12 obturator hernia patients since 2000 in the three hospitals of the authors. Twenty-one obturator hernia cases reported in the Korean literatures were reviewed. In addition, we analyzed clinical features and treatment results of the total 33 patients, collectively. RESULTS: Most of the patients were elderly women except one young, poorly nourished, male patient with pulmonary tuberculosis. Their mean age was 79.6 years. Sixty-four percent (21/33) of the patients had preoperative morbidity. Symptoms from the compression of the obturator nerve, which is an important clue to the diagnosis, were observed in 67% (22/33). Interestingly, spontaneous or suspicious-spontaneous reductions were reported in 7 (21%) patients. Abdominal CT scan was the major tool for diagnosis. Abdominal approach alone could successfully manage most cases, though 84% (27/32) needed anastomosis of the bowel. Operative mortality was 2 of the 32 cases but morbidity was 44% of the 32 patients and the mean hospital period after operation was 21 days. CONCLUSION: Management of patients with obturator hernJd surgical management and proper peri-operative care as well as appropriate managing the families is essential for improved results.
Aged ; Aging ; Female ; Hernia, Obturator ; Humans ; Incidence ; Korea ; Male ; Obturator Nerve ; Rare Diseases ; Retrospective Studies ; Tuberculosis, Pulmonary

Background: This study aimed to compare the biomechanical strength of 360° scapholunate interosseous ligament (SLIL) reconstruction only using an artificial material (AM), double dorsal limb (DDL) SLIL reconstruction only using AM, and the modified Brunelli technique (MBT) with ligament. Methods: Eight cadaver wrists were used for this study. The SL interval, SL angle, and radiolunate (RL) angle were recorded with MicroScribe. The SL distance was measured after dividing the volar and dorsal aspects. We utilized four different wrist postures (neutral, flexion, extension, and clenched fist) to compare five conditions: intact wrist, SLIL resection, 360° SLIL reconstruction using AM, DDL SLIL reconstruction using AM, and MBT SLIL reconstruction with ligament. Results: The dorsal SL distance in the SLIL resection was widened in all wrist positions. The dorsal SL distance was restored with all three techniques and in all wrist positions. The volar SL distance in the wrist extension position was widened in the SLIL resection condition. The volar SL distance was restored in the extension position after 360° SLIL reconstruction using AM condition. There were no statistically significant differences in SL and RL angles among the conditions. Conclusions All three reconstruction techniques could restore the dorsal SL distance. However, only the 360° SLIL reconstruction using AM restored the volar SL distance in the wrist extension position. DDL SLIL reconstruction using AM tended to overcorrect, whereas 360° SLIL reconstruction using AM effectively stopped volar SL interval widening.

BACKGROUND AND OBJECTIVES: Recent studies have examined the structure-function relationship of high-density lipoprotein (HDL). This study aimed to identify and rank HDL-associated proteins involved in several biological function of HDL. METHODS: HDLs isolated from 48 participants were analyzed. Cholesterol efflux capacity, effect of HDL on nitric oxide production, and vascular cell adhesion molecule-1 expression were assessed. The relative abundance of identified proteins in the highest vs. lowest quartile was expressed using the normalized spectral abundance factor ratio. RESULTS: After adjustment by multiple testing, six proteins, thyroxine-binding globulin, alpha-1B-glycoprotein, plasma serine protease inhibitor, vitronectin, angiotensinogen, and serum amyloid A-4, were more abundant (relative abundance ratio ≥2) in HDLs with the highest cholesterol efflux capacity. In contrast, three proteins, complement C4-A, alpha-2-macroglobulin, and immunoglobulin mu chain C region, were less abundant (relative abundance ratio <0.5). In terms of nitric oxide production and vascular cell adhesion molecule-1 expression, no proteins showed abundance ratios ≥2 or <0.5 after adjustment. Proteins correlated with the functional parameters of HDL belonged to diverse biological categories. CONCLUSIONS In summary, this study ranked proteins showing higher or lower abundance in HDLs with high functional capacities and newly identified multiple proteins linked to cholesterol efflux capacity.

BACKGROUND AND OBJECTIVES: Recent studies have examined the structure-function relationship of high-density lipoprotein (HDL). This study aimed to identify and rank HDL-associated proteins involved in several biological function of HDL.METHODS: HDLs isolated from 48 participants were analyzed. Cholesterol efflux capacity, effect of HDL on nitric oxide production, and vascular cell adhesion molecule-1 expression were assessed. The relative abundance of identified proteins in the highest vs. lowest quartile was expressed using the normalized spectral abundance factor ratio.RESULTS: After adjustment by multiple testing, six proteins, thyroxine-binding globulin, alpha-1B-glycoprotein, plasma serine protease inhibitor, vitronectin, angiotensinogen, and serum amyloid A-4, were more abundant (relative abundance ratio ≥2) in HDLs with the highest cholesterol efflux capacity. In contrast, three proteins, complement C4-A, alpha-2-macroglobulin, and immunoglobulin mu chain C region, were less abundant (relative abundance ratio <0.5). In terms of nitric oxide production and vascular cell adhesion molecule-1 expression, no proteins showed abundance ratios ≥2 or <0.5 after adjustment. Proteins correlated with the functional parameters of HDL belonged to diverse biological categories.CONCLUSIONS: In summary, this study ranked proteins showing higher or lower abundance in HDLs with high functional capacities and newly identified multiple proteins linked to cholesterol efflux capacity.
Amyloid ; Angiotensinogen ; Atherosclerosis ; Cardiovascular Diseases ; Cholesterol ; Complement System Proteins ; Immunoglobulin mu-Chains ; Lipoproteins ; Nitric Oxide ; Plasma ; Proteomics ; Serine Proteases ; Thyroxine-Binding Globulin ; Vascular Cell Adhesion Molecule-1 ; Vitronectin