OBJECTIVE: To correlate the acromiohumeral distance (AHD) using tomosynthesis and rotator cuff (RC) pathology and various anatomical indices and to assess the diagnostic reproducibility of tomosynthesis for the evaluation of subacromial impingement. MATERIALS AND METHODS: A retrospective review of 63 patients with clinically suspected subacromial impingement was conducted. Two musculoskeletal radiologists independently measured the following quantitative data: the AHD on plain radiographs and the AHD at three compartments (anterior, middle, and posterior) using tomosynthesis, computed tomography (CT) arthrography, or magnetic resonance (MR) arthrography. To investigate the association between the AHD and RC pathology and various anatomical indices, we reviewed the arthroscopic operation record as the referenced standard. RESULTS: The size of rotator cuff tear (RCT) in full-thickness tears displayed a significant inverse correlation with the middle and the posterior tomosynthetic AHDs (p < 0.05). The results of an ANOVA revealed that the middle tomosynthetic AHD retained a significant association with the type of RCT (p = 0.042), and the posterior tomosynthetic AHD retained significance for the size of RCT in a full-thickness tear (p = 0.024). The inter-modality correlation exhibited significant agreement especially among the plain radiography, tomosynthesis, and CT or MR arthrography (p < 0.05). The intraobserver and interobserver correlation coefficients (ICCs) displayed excellent agreement (ICC = 0.896–0.983). The humeral head diameter and glenoid height were significantly correlated with patient height and weight. CONCLUSION: Acromiohumeral distance measurement using tomosynthesis is reproducible compared with other modalities.
Arthrography ; Humans ; Humeral Head ; Pathology ; Radiography ; Retrospective Studies ; Rotator Cuff* ; Shoulder ; Tears

No abstract available.
Tendinopathy

PURPOSE: To evaluate the 3 year results of the tension-free vaginal tape (TVT) procedure for the treatment of female stress urinary incontinence. MATERIALS AND METHODS: Of 41 women that underwent the TVT procedure, between March 1999 and December 1999, for stress urinary incontinence, 30 were followed up for at least 3 years following surgery. The preoperative evaluations included a comprehensive medical history, a through physical examination, urinalysis, urine culture, voiding diary, 1-hour pad test and a complete multichannel urodynamic study, including valsalva leak point pressure (VLPP) and maximal urethral closing pressure (MUCP). Long-term evaluations were performed by questionnaires on the durability of surgical outcome and the patients' satisfaction of the procedure. RESULTS: Of the 30 patients followed-up, the tension-free vaginal tape procedure remained successful in 93.3% (cured 80%, improved 13.3%) 3 years after the procedure. Two patients, with a VLPP lower than 60cmH2O and a MUCP lower than 40cmH2O, failed to gain continence after the procedure. There were no serious or long-term complications related to the procedure. The satisfaction rates 1 and 3 years after the surgery were 90 and 86.6%, respectively. CONCLUSIONS: We consider the TVT procedure to be an effective treatment for stress urinary incontinence, with long-term durability of continence and minimal complications related to the surgery.
Female* ; Humans ; Physical Examination ; Surveys and Questionnaires ; Suburethral Slings* ; Urinalysis ; Urinary Incontinence* ; Urodynamics

Systemic sclerosis (SSc) is a chronic autoimmune disorder characterized by endothelial and fibroblast dysfunction, resulting in progressive fibrosis of the skin and internal organs. Ankylosing spondylitis (AS) is an arthritic condition affecting the axial skeleton and peripheral joints. An association between SSc and AS is relatively rare, as the two diseases share few characteristics. Here, we present a case of limited SSc in a 44-year-old man who exhibited low-grade AS, and discuss several cases of coexisting SSc and AS in the literature. Patients with both diseases showed several common features, including male predominance, middle age, and combined interstitial lung disease. However, unlike our case, the patients reported in the literature had advanced ankylosis and diffuse SSc.
Adult ; Ankylosis ; Fibroblasts ; Fibrosis ; Humans ; Joints ; Lung Diseases, Interstitial ; Male ; Middle Aged ; Pleural Effusion* ; Scleroderma, Systemic* ; Skeleton ; Skin ; Spondylitis, Ankylosing*

PURPOSE: We investigated whether free testosterone measured by direct immunoassay(aFT) reflects aging as well as bioavailable testosterone(free testosterone index; cBT) calculated from serum testosterone(T) and sex hormone-binding globulin(SHBG). MATERIALS AND METHODS: Serum T, SHBG, and aFT were measured in sera of 414 patients who presented with erectile dysfunction and partial androgen deficiency symptoms but no serious medical comorbidities. Their mean age was 52.5 years(<50: 152, >or=50: 262). The cBT was obtained by calculation from T and SHBG. The mean values of T, aFT, SHBG, and cBT were compared according to the age range. We analyzed the correlation between cBT and aFT and calculated the correlation coefficient. RESULTS: The mean values of T(ng/mL), aFT(pg/mL), SHBG(nmol/L), and cBT(nmol/L) were 3.39, 13.08, 24.3, and 6.04, respectively, in the 3rd and 4th decades; 4.34, 14.72, 23.36, and 7.74 in the 5th and 6th decades; and 4.05, 13.83, 27.32, and 5.96 in the 7th and 8th decades. The SHBG increased and T/aFT/cBT declined as age increased from the 5th and 6th to the 7th and 8th decades. The change was statistically insignificant only for aFT. The correlation between cBT and aFT was weak, with a correlation coefficient of 0.391. CONCLUSIONS: Because free testosterone measured by direct immunoassay did not reflect the age-related changes of SHBG, a single measurement is not a reliable index of bioavailable testosterone.
Aging ; Comorbidity ; Erectile Dysfunction ; Humans ; Immunoassay* ; Male ; Testosterone*

Purpose: This study investigated whether shear wave elastography (SWE) could be used to estimate the chronicity of supraspinatus tendon (SST) tears. Methods: A retrospective study was performed. From November 2015 to July 2016, 113 patients (52 men, 61 women; age range, 21 to 79 years) with persistent shoulder pain underwent 119 rotator cuff tendon examinations by routine B-mode ultrasonography, while SST elasticity was measured using SWE. Following the exclusion of eight suboptimal examinations, four examinations with missing SST measurements, and 27 examinations of patients with other conditions, 80 examinations were analyzed. A torn SST was found in 54 examinations (27 with a partial-thickness tear and 27 with a full-thickness tear). Elasticity values were compared in multiple ways. The results were analyzed using the Mann-Whitney U test or Kruskal-Wallis test. Results: No statistically significant difference in elasticity values (in kPa) was found between normal (median, 94.65; interquartile range [IQR], 87.43 to 105.47) and torn SSTs (median, 96.79; IQR, 86.71 to 108.56) or between full-thickness tears (median, 93.80; IQR, 82.50 to 108.33) and partial-thickness tears (median, 96.83; IQR, 90.60 to 112.20). However, there was a statistically significant difference in elasticity according to whether the duration of symptoms was 1 year or less (median, 92.20; IQR, 84.01 to 104.38) or longer than 1 year (median, 105.10; IQR, 100.41 to 116.03; P=0.032). Conclusion Elasticity values were significantly higher in torn SSTs in patients with chronic shoulder pain that had persisted for more than 1 year. Further studies with larger samples seem warranted to determine whether elasticity values measured by SWE can be used preoperatively as a surrogate marker of the chronicity of a rotator cuff tendon tear.

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

The purpose of this study was to assess the incidence of spontaneous renal artery dissection (SRAD) as a cause of acute renal infarction, and to evaluate the clinical and multidetector computed tomography (MDCT) findings of SRAD. From November 2011 to January 2014, 35 patients who were diagnosed with acute renal infarction by MDCT were included. We analyzed the 35 MDCT data sets and medical records retrospectively, and compared clinical and imaging features of SRAD with an embolism, using Fisher's exact test and the Mann-Whitney test. The most common cause of acute renal infarction was an embolism, and SRAD was the second most common cause. SRAD patients had new-onset hypertension more frequently than embolic patients. Embolic patients were found to have increased C-reactive protein (CRP) more often than SRAD patients. Laboratory results, including tests for lactate dehydrogenase (LDH) and blood urea nitrogen (BUN), and the BUN/creatinine ratio (BCR) were significantly higher in embolic patients than SRAD patients. Bilateral renal involvement was detected in embolic patients more often than in SRAD patients. MDCT images of SRAD patients showed the stenosis of the true lumen, due to compression by a thrombosed false lumen. None of SRAD patients progressed to an estimated glomerular filtration rate < 60 mL/min/1.73 m2 or to end-stage renal disease during the follow-up period. SRAD is not a rare cause of acute renal infarction, and it has a benign clinical course. It should be considered in a differential diagnosis of acute renal infarction, particularly in patients with new-onset hypertension, unilateral renal involvement, and normal ranges of CRP, LDH, BUN, and BCR.

Calcium pyrophosphate dihydrate (CPPD) deposition disease is a heterogeneous group of diseases with CPPD crystal deposition. Aging is the most common risk factor for CPPD deposition, followed by osteoarthritis and previous injury. Occasionally, CPPD depositions are associated with familial predisposition and metabolic diseases, including hemochromatosis, primary hyperparathyroidism, hypophosphatasia, and hypomagnesemia. CPPD deposition diseases associated with primary hyperparathyroidism in Koreans have rarely been reported. Thus, we report a case of a relatively young female patient with CPPD deposition disease associated with primary hyperparathyroidism, which was diagnosed through a polarized microscopic examination of the synovial fluid and a subtotal parathyroidectomy.
Aging ; Calcium Pyrophosphate ; Chondrocalcinosis* ; Female ; Hemochromatosis ; Humans ; Hyperparathyroidism, Primary* ; Hypophosphatasia ; Metabolic Diseases ; Osteoarthritis ; Parathyroidectomy ; Risk Factors ; Synovial Fluid

OBJECTIVE: To analyze radiologic findings of cervical involvement in ankylosing spondylitis (AS) patients, determine its association with structural severity and clinical variables, and to divide radiologic findings of atlantoaxial ankylosis (AAA) in AS patients into three anatomical components. METHODS: The study includes 150 AS patients with either AAA (62 patients) or atlantoaxial subluxation (AAS, 88 patients) who underwent plain radiography of the cervical spine on flexion at our tertiary center for rheumatic diseases. The study subjects' medical records were reviewed. Lateral plain radiographs of the cervical spine were analyzed by a musculoskeletal radiologist. We compared the results of the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) between AAS and AAA patients to determine if mSASSS was related to severity or duration of AS. RESULTS: The mean duration of illness in AS patients with AAA was 19.3 years, and in AAS patients 13.7 years (p<0.01). The mean total mSASSS of AS patients with AAA was 40.1, and of AAS patients 16.5 (p<0.001), and was positively associated with the development of AAA and AAS. The odds ratio (OR) of AAA development by cervical spine mSASSS change was higher (OR, 1.079) than the OR (1.049) of lumbar spine mSASSS even after adjusting for age, sex, and disease duration. CONCLUSION: Although AAA is described infrequently, we found from our data that it is another manifestation of cervical spine involvement in longstanding AS and is related to severity of AS reflected by higher cervical mSASSS.
Ankylosis* ; Atlanto-Axial Joint ; Humans ; Medical Records ; Odds Ratio ; Radiography ; Rheumatic Diseases ; Spine* ; Spondylitis, Ankylosing*