Heterotopic calcification following head and neck irradiation has rarely been reported. It usually develops as a late complication of radiotherapy in patients with malignancies, including breast cancer, lymphoma, and genitourinary malignancies. The occurrence of heterotopic calcification in the prevertebral space of the cervical spine has not been described as a late complication of irradiation. Here, we report a case of prevertebral heterotopic calcification in a patient with history of chemotherapy and radiotherapy for tonsil cancer 21 years ago.
Aged ; Calcinosis/*etiology/pathology/radiography ; *Cervical Vertebrae/radiography ; Female ; Humans ; Ossification, Heterotopic/*etiology/radiography ; Radiation Injuries/complications ; Tomography, X-Ray Computed ; Tonsillar Neoplasms/*radiotherapy

PURPOSE: To assess the incidence of aspiration pneumonia in infants with cleft palate and to compare the incidence between complete and incomplete types of cleft palate. MATERIALS AND METHODS: A review of medical records revealed 100 infants who had undergone initial surgery to repair cleft palate in our hospital during a recent three-year period. Aspiration pneumonia was defined as the coexistence of pneumonia at chest radiography with a history of frequent choking during feeding. The anatomic distribution of aspiration pneumonia was analyzed, and the incidences of aspiration pneumonia in infants with complete and incomplete cleft palate were compared. RESULTS: Among 100 children, aspiration pneumonia was found in 35 (35%). Those with complete and incomplete cleft palate showed similar incidences of the condition (27 of 70 [39%] vs 8 of 30 [27%], p=0.36). Pneumonia was most commonly seen in the left lower lobe (11 of 35), followed by the right upper and lower lobes. CONCLUSION: Aspiration pneumonia is frequently associated with infants with cleft palate. There is no statistical difference in the incidence of aspiration pneumonia between the complete and the incomplete cleft palate group.
Airway Obstruction ; Child ; Cleft Palate* ; Humans ; Incidence ; Infant ; Medical Records ; Pneumonia ; Pneumonia, Aspiration* ; Radiography ; Thorax

On MRI, abnormal signals of the intervertebral disc, destruction of the upper and lower vertebral body endplate around the disc, and bone marrow edema around the endplate are considered typical findings of infectious spondylitis. These findings can also appear in various non-infectious spinal diseases, such as degenerative changes, acute Schmorl’s node, spondyloarthropathy, synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO), chronic recurrent multifocal osteomyelitis, and calcium pyrophosphate dihydrate crystal deposition disease. The imaging findings of infectious spondylitis that can be differentiated from these non-infectious spinal diseases on MRI are high signal intensity and abscess of the disc space, an abscess in the paraspinal soft tissue, and the loss of the linear low signal intensity on T1-weighted images of the bony endplate. However, these differentiation points do not always apply since there are many similarities in the imaging findings of infectious and non-infectious diseases. Therefore, for an accurate diagnosis, it is important to know the imaging characteristics related to the pathophysiology of not only infectious spondylitis but also non-infectious spinal diseases, which requires differentiation from infection.

OBJECTIVE: To assess the clinical efficacy and safety of intra-articular injection of hyaluronic acid (HA) combined with polydeoxyribonucleotide (PDRN) in patients with knee osteoarthritis in comparison with that of HA alone. METHODS: The current single-center, prospective, randomized, double-blind, controlled study was conducted in 36 patients with knee osteoarthritis at our medical institution. All the eligible patients (n=30) were equally assigned to two treatment arms (trial group ‘HA+PDRN’ and control group ‘HA’). For efficacy assessment, the patients were evaluated for the visual analogue scale (VAS) scores, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Knee Society Scores (KSS), all of which served as efficacy outcome measures. We monitored time-dependent changes in efficacy outcome measures at baseline and 1, 3 and 6 months. Subsequently, we compared differences in changes in efficacy outcome measures at 6 months from baseline between the two groups. Moreover, we assessed the safety based on the treatment-emergent adverse events (TEAEs), adverse drug reactions (ADRs) and any other complications serving as safety outcome measures. RESULTS: There were significant differences in changes in the VAS scores, the WOMAC scores in all domains, except ‘Stiffness’, the total WOMAC scores, and the KSS scores in all the domains at 6 months from baseline between the two groups (p<0.05). In our series, there were no TEAEs, ADRs, and any other complications. CONCLUSION: Intra-articular injections of HA combined with PDRN can also be considered in the treatment of knee osteoarthritis. However, further large-scale and multi-center studies are required to demonstrate the potential of the proposed combination.
Arm ; Drug-Related Side Effects and Adverse Reactions ; Humans ; Hyaluronic Acid ; Injections, Intra-Articular ; Knee ; Ontario ; Osteoarthritis ; Osteoarthritis, Knee ; Outcome Assessment (Health Care) ; Polydeoxyribonucleotides ; Prospective Studies ; Treatment Outcome

OBJECTIVE: The point-of-care ultrasound of the airway (POCUS-A) is a useful examination method but there are currently no educational programs for medical students regarding it. We designed a POCUS-A training curriculum for medical students to improve three cognitive and psychomotor learning domains: knowledge of POCUS-A, image acquisition, and image interpretation.METHODS: Two hours of training were provided to 52 medical students in their emergency medicine (EM) rotation. Students were evaluated for cognitive and psychomotor skills before and immediately after the training. The validity measures were established with the help of six specialists and eight EM residents. A survey was administered following the curriculum.RESULTS: Cognitive skill significantly improved after the training (38.7±12.4 vs. 91.2±7.7) and there was no significant difference between medical students and EM residents in posttest scores (91.2±7.7 vs. 90.8±4.6). The success rate of overall POCUS-A performance was 95.8%. The students were confident to perform POCUS-A on an actual patient and strongly agreed to incorporate POCUS-A training in their medical school curriculum.CONCLUSION: Cognitive and psychomotor skills of POCUS-A among medical students can be improved via a limited curriculum on EM rotation.
Airway Management ; Curriculum ; Education ; Education, Medical ; Emergency Medicine ; Humans ; Learning ; Methods ; Pilot Projects ; Point-of-Care Systems ; Schools, Medical ; Specialization ; Students, Medical ; Ultrasonography

The major purpose of this study is to construct a retrospective exposure assessment for benzene through a review of literature on Korea. Airborne benzene measurements reported in 34 articles were reviewed. A total of 15,729 individual measurements were compiled. Weighted arithmetic means [AM(w)] and their variance calculated across studies were summarized according to 5-year period intervals (prior to the 1970s through the 2010s) and industry type. Industries were classified according to Korea Standard Industrial Classification (KSIC) using information provided in the literature. We estimated quantitative retrospective exposure to benzene for each cell in the matrix through a combination of time and KSIC. Analysis of the AM(w) indicated reductions in exposure levels over time, regardless of industry, with mean levels prior to the 1980e1984 period of 50.4 ppm (n = 2,289), which dropped to 2.8 ppm (n = 305) in the 1990e1994 period, and to 0.1 ppm (n = 294) in the 1995e1999 period. There has been no improvement since the 2000s, when the AM(w) of 4.3 ppm (n = 6,211) for the 2005e2009 period and 4.5 ppm (n = 3,358) for the 2010e2013 period were estimated. A comparison by industry found no consistent patterns in the measurement results. Our estimated benzene measurements can be used to determine not only the possibility of retrospective exposure to benzene, but also to estimate the level of quantitative or semiquantitative retrospective exposure to benzene.
Benzene* ; Classification ; Korea* ; Retrospective Studies

The triad of rash, arthritis, and uveitis seems to be characteristic for early-onset childhood sarcoidosis. We describe an interesting case of early-onset childhood sarcoidosis coexisting enchondromatosis, which clinically masquerade as Langerhans cell histiocytosis. A 33 months old girl presented with skin rash, subcutaneous nodules with polyarthritis, and revealed the involvement of lymph nodes as well as spleen during work-up. She also presented with multiple osteolytic lesions which pathologically proven enchondromatosis. Oral prednisone was prescribed at 2 mg/kg/day for 2 months until when subcutaneous nodules and joint swellings almost disappeared, and then slowly tapered over a period of 5 months. We report an unusual case of early-onset childhood sarcoidosis presented with osteolytic bone lesions which were irrelevant to sarcoidosis.
Administration, Oral ; Anti-Inflammatory Agents/therapeutic use ; Arthritis/complications ; Child, Preschool ; Diagnosis, Differential ; Enchondromatosis/*complications/*diagnosis/drug therapy/radiography ; Exanthema/etiology ; Female ; Humans ; Positron-Emission Tomography and Computed Tomography ; Prednisone/therapeutic use ; Sarcoidosis/*complications/*diagnosis/drug therapy/radiography ; Whole Body Imaging

Infectious arteritis is a rare complication of liver abscess, and infectious arteritis involving multiple arterial sites with pseudoaneurysm formation has not been described previously. A 74-year-old man treated for liver abscess complained of abdominal and neck pain. Abdominal computed tomographic angiography (CTA) revealed a decrease in the size of the liver abscess, but also disclosed a pseudoaneurysm in the distal descending thoracic aorta was newly noted. Neck CTA revealed arteritis with abscess formation in the left internal carotid artery (ICA). Follow-up CTA after antibiotic therapy showed a decrease in the size of the left ICA abscess and a significant increase in the size of the aortic pseudoaneurysm. To prevent the rupture of the pseudoaneurysm, an endovascular stent graft was used. The final CTA revealed the disappearance of the aortic pseudoaneurysm with good apposition of the grafted stent. The patient has been monitored for 3 years with no new clinical events.
Abscess ; Aged ; Aneurysm, False* ; Angiography ; Aorta, Thoracic ; Arteritis* ; Blood Vessel Prosthesis ; Carotid Artery, Internal ; Endovascular Procedures ; Follow-Up Studies ; Humans ; Liver Abscess* ; Neck ; Neck Pain ; Rupture ; Stents ; Transplants

PURPOSE: This study was designed to compare the effectiveness of intrarectal lidocaine gel versus periprostatic lidocaine injection during TRUS-guided biopsies. MATERIALS AND METHODS: From April 2003 to September 2003, 90 men undergoing a transrectal prostate biopsy were randomized into three groups. In group 1, 30 patients intrarectally received 20ml of 2% lidocaine gel; and group 2, 30 patients received 5ml(2.5ml per side) of 2% lidocaine solution injected along each side of the prostate, near the junction of the seminal vesicle and the base of the prostate(along the neurovascular bundles); in group 3, 30 patients received 5ml(2.5ml per side) of normal saline injected along the neurovascular bundles. The pain level after the biopsy was assessed using a 10-point linear visual analog pain scale(VAS). A statistical analysis was performed using the Wilcoxon Rank Sum test, and the results compared. RESULTS: Patient who received lidocaine solution injections along the neurovascular bundles (Group 2) had significantly lower VAS scores compared to the control group(mean score 3.56+/-2.13 versus 5.83+/-1.94, p<0.0001), but patients who received intrarectal lidocaine gel did not (mean score 5.46+/-2.70 versus 5.83+/-1.94, p=0.671). Gross hematuria, rectal bleeding and hemospermia occurred in 36(40.0%), 6(6.7%) and 5(5.6%) subjects, respectively. One patient had a vasovagal syncope. No patient reported febrile UTI or urinary retention. CONCLUSIONS: Bilateral nerve blockade with local anesthetic is a safe technique that significantly reduces pain during a prostate biopsy. However, in this study, intrarectal lidocaine injection did not reduce the pain compared to the control group during the prostate biopsy.
Anesthesia, Local* ; Anesthetics, Local ; Biopsy* ; Hematuria ; Hemorrhage ; Hemospermia ; Humans ; Lidocaine ; Male ; Nerve Block ; Prospective Studies* ; Prostate* ; Seminal Vesicles ; Syncope, Vasovagal ; Urinary Retention

Gitelman's syndrome (GS), a hereditary disease characterized by hypokalemia, hypomagnesemia, and hypocalciuria, is a salt-losing renal tubulopathy. Herein, we describe a case of a 28-year-old woman diagnosed with atypical GS accompanying chondrocalcinosis. One year ago, she presented with vomiting, hypokalemic metabolic alkalosis, and hypocalciuria, and was tested by diuretic challenge test. As a result, she was diagnosed with atypical GS with normomagnesemia and treated with spironolactone and potassium supplementation. Meanwhile, acute arthritis of the right 1st metatarsophalangeal joint occurred. On the radiographies of the knees, chondrocalcinosis was observed. To the best of our knowledge, this is the first report in Korea of GS with chondrocalcinosis. Antialdosterone therapy or magnesium supplementation is effective in preventing the progression of chondrocalcinosis; thus, early diagnosis and treatment of GS are important.
Adult ; Alkalosis ; Arthritis ; Chondrocalcinosis* ; Early Diagnosis ; Female ; Genetic Diseases, Inborn ; Gitelman Syndrome* ; Humans ; Hypokalemia ; Knee ; Korea ; Magnesium ; Metatarsophalangeal Joint ; Potassium ; Spironolactone ; Vomiting