Severe recurrent attacks of acute febrile neutrophilic dermatosis shortly followed multiple keratoacanthoma in a 43-year-old man with myelodysplastic syndrome. Besides the typical clinicopathological findings of the syndrome(fever, leukocytosis and neutrophilic erythematous plaques of the skin), the patient showed orolingual and conjunctival ulceration and severe cutaneous pathergic reactions. Moreover, to the best of our knowledge, multiple keratoacanthoma has not yet been reported with relation to the acute febrile neutrophilic dermatosis.
Adult ; Humans ; Keratoacanthoma* ; Leukocytosis ; Myelodysplastic Syndromes ; Neutrophils ; Sweet Syndrome* ; Ulcer

Supernumerary derivative (22) syndrome is a rare genomic syndrome. It is characterized by severe mental retardation, microcephaly, failure to thrive, preauricular tag or sinus, ear abnormalities, cleft and/or high-arched palate, micrognathia, kidney abnormalities, congenital heart defects, and genital abnormalities in males. In 99% of the cases, one of the parents is a balanced carrier of a translocation between chromosome 11 and chromosome 22. To date, there have been about 100 case reports of supernumerary derivative (22) syndrome. In most of the cases, supernumerary derivative (22) syndrome was the result of 3:1 meiotic segregation in the maternal 11;22 translocation carrier. We now report a case of 47,XX, + der(22)t(11;22)(q23;q11.2) resulting from 3:1 meiotic segregation of the paternal translocation carrier.
Chromosomes, Human, Pair 11 ; Chromosomes, Human, Pair 22 ; Congenital Abnormalities ; Ear ; Failure to Thrive ; Heart ; Humans ; Intellectual Disability ; Kidney ; Male ; Microcephaly ; Palate ; Parents ; Trisomy

PURPOSE: When medial protrusion in the base of proximal phalanx is severe from removing metatarsal bunion during the hallux valgus surgery, it could lead to skin irritation and medial pain after the surgery. The purpose of this paper was to report our clinical and radiographic results with transarticular fixation of Akin osteotomy for the treatment of patients with hallux valgus after resection of the medial protrusion of base of the proximal phalanx. MATERIALS AND METHODS: Our study is subject to 34 cases of 30 patients who went through proximal phalanx medial corticectomy among patients undergone both hallux valgus surgery and Akin osteotomy at our institution from March 2006 to March 2012. In all cases, we used absorbable suture material through the articular surface for Akin osteotomy after resection of the medial protrusion in proximal phalanx. Radiographs were reviewed to assess the union and displacement of osteotomy site at the time of postoperative 6 months. The clinical results were assessed by using AOFAS score and complication such as skin irritation and pain. RESULTS: AOFAS score was improved from average 44 points(36-58), before operation and average 87 points(74-96), 12 months after operation. In two cases, partial union was suspected in radiological perspective, however, complete union on the osteotomy site was observed in all cases, 12 months after the operation. No patients was dissatisfied with pain, joint discomfort, skin irritation and inflammation from the knot. CONCLUSION: When medial protrusion in the base of proximal phalanx is severe from removing metatarsal bunion during the hallux valgus surgery, We have good results by transarticular fixation of Akin osteotomy using absorbable suture material.
Arthralgia ; Displacement (Psychology) ; Hallux ; Hallux Valgus ; Humans ; Inflammation ; Metatarsal Bones ; Osteotomy ; Skin ; Sutures

PURPOSE: To evaluate the efficacy of surgical treatment through retrospective comparison of minimally invasive percutaneous plate osteosynthesis (MIPPO) vs open plate fixation in the treatment of the distal femur fractures. MATERIALS AND METHODS: Thirty-one patients with distal femur fractures from January 2002 to December 2010 were divided into two groups depending on the surgical method. Minimum follow up was 12 months. Group A consisted of 17 patients treated with MIPPO, and group B was comprised of 14 patients treated with open plate fixation. Clinical outcomes including operation time, transfusion rate, rehabilitation, range of motion, and interval change of postoperative C-reactive protein (CRP) were evaluated to assess postoperative inflammatory reaction, postoperative complications and clinical results with the use of Sanders criteria. RESULTS: The operative time was 86/135 min and transfusion volume was 0.8/1.9 unit respectively. The postoperative 3-day and 7-day CRP were 7.4/1.5 mg% in group A and 10.3/2.4 mg% in group B, showing more minimal tissue injury and early recovery in group A. There were no significant differences in clinical results by Sanders criteria in both groups. CONCLUSION: Both MIPPO and open plate fixation for the treatment of distal femur fractures showed comparably good results. However, the MIPPO technique is superior to group B in view of minimal tissue injury and operation time and was proven to lessen the transfusion rate.
C-Reactive Protein ; Femur* ; Follow-Up Studies ; Humans ; Operative Time ; Postoperative Complications ; Range of Motion, Articular ; Retrospective Studies

OBJECTIVE: To evaluate the clinical importance of effusion in bicipital tendon sheath and the change of ultrasonographic findings according to the treatment. METHOD: Thirty patients with hemiplegia, clinically diagnosed as adhesive capsulitis in hemiplegic shoulder, were investigated. To confirm the location and existence of effusion and to measure the largest diameter and cross sectional area (CSA) of bicipital tendon sheath, the longitudinal and transverse scan of the shoulder were used. Each patient was treated with a series of three intraarticular injections with triamcinolone under ultrasonographic guidance. After each intraarticular injection, the diameter and CSA of bicipital tendon sheath, and passive range of motion of the affected shoulder were measured and compared to the unaffected side. RESULTS: The initial ultrasonographic examination showed increased amount of effusion in the affected bicipital tendon sheath compared to the unaffected side (p<0.01). After intraarticular injection, the amount of effusion was decreased (p<0.01) and passive range of motion of the shoulder was increased (p<0.05). CONCLUSION: The ultrasonographic evaluation of effusion in the bicipital tendon sheath, and interval change of effusion according to the treatment, can be useful tool for diagnosis and follow-up of adhesive capsulitis in hemiplegic shoulder.
Adhesives* ; Bursitis* ; Diagnosis ; Follow-Up Studies ; Hemiplegia ; Humans ; Injections, Intra-Articular ; Range of Motion, Articular ; Shoulder* ; Tendons ; Triamcinolone ; Ultrasonography

PURPOSE: To evaluate the results of the medial gastrocnemius muscle flap to cover the wound necrosis and dehiscence caused by repeated surgery in the reconstruction of infected total knee arthroplasty (TKA). MATERIALS AND METHODS: Out of forty three reconstructions of infected TKA performed between 1995 and 2002, eleven cases (25.6%)underwent medial gastrocnemius flap to cover the anterior skin defects at the time of reimplantation in two cases and in an average 3.3 weeks after reimplantation in seven cases. Two cases which refused reimplantation were treated by arthrodesis and delayed flap coverage and by flap surgery only resulting in pseudarthrosis respectively. They were five male and six female patients of 61 years (range, 56-77 years)of age in average. Clinical and radiological assessments were done for minimum two years of follow-up. RESULTS: Nine cases (81.8%)maintained TK prostheses with less range of motion (77 degrees in average)than ordinary TKAs of primary healing. Two patients refused TKA which resulted in one arthrodesis and one pseudarthrosis. There was no case of recurrence of wound dehiscence or infection. CONCLUSION: Medial gastrocnemius flap can salvage the prostheses by providing good soft tissue coverage for compromised operative wounds caused by infected TKA and repeated surgical interventions.
Arthrodesis ; Arthroplasty* ; Female ; Follow-Up Studies ; Humans ; Knee* ; Male ; Muscle, Skeletal ; Necrosis ; Prostheses and Implants ; Pseudarthrosis ; Range of Motion, Articular ; Recurrence ; Replantation ; Skin ; Wounds and Injuries

OBJECTIVE: To evaluate the accuracy of ultrasonography (US) guided intraarticular injection technique comparing to blind technique of the shoulder joint. METHOD: Thirty patients with hemiplegia clinically diagnosed as adhesive capsulitis of the shoulder joint were included. Each patient was treated with serial intraarticular injections with both blind and US guided technique, and then was confirmed by X-ray. We analyzed possible factor including range of motion of the shoulder joint, degree of shoulder subluxation, and clinical stage by Cyriax contributing to failure of intraarticular injection with blind technique. RESULTS: The accuracy of intraarticular injection using blind technique were 46.7% and 33.3% in each physician without significant interpersonal difference. However, US guided intraarticular injection showed the accuracy of 93.3%, significantly higher than blind technique (p<0.05). We could not find significant differences in clinical stage by Cyriax, degree of subluxation between success and failure group by blind technique. However, the range of external and internal rotation of the shoulder joint was more limited in failure group by blind technique (p<0.05). CONCLUSION: Ultrasonography guided injection into the shoulder joint improved the accuracy of injection without exposure to radiation and could be used as one of the promising treatment for patients with adhesive capsulitis of the shoulder.
Bursitis ; Hemiplegia ; Humans ; Injections, Intra-Articular* ; Range of Motion, Articular ; Shoulder Joint ; Shoulder* ; Ultrasonography*

OBJECTIVE: To investigate the clinical characteristics of Korean JRA and the possible profiles related to prognosis and to compare these data to pre-existing occidental reports. METHODS: 140 cases of JRA patients were randomly selected from 1986 through 1995. Juvenile ankylosing spondylitis was excluded with the aid of modified New York criteria for ankylosing spondylitis. We used the classification of progression of rheumatoid arthritis (radiological stage III+IV / I+II+III+IV) as a index of prognosis. The study factors were sex, age, type, affected joints, degree of destruction of joint, anti-nuclear antibody (ANA), rheumatoid factor (RF), HLA-B27 and extra-articular manifestations. Chi-square test, One-way ANOVA test, and Pearson' s correlation coefficient were used as statistical methods. RESULTS: Our study show results as follows : (1) Systemic onset type (ll%) { polyarthritis subset (66%), oligoarthritis subset (34%) }, oligoarthritis onset type (62%) { sero (-) -HLA-B27 (+) subset (66%) , RF (+) subset (20%), not otherwise classified subset (14%) ANA(+)-chronic uveitis subset(O%) }, polyarthritis onset type (27%) { RF(+) subset (66%), not otherwise classified subset (34%) }, (2) Sex ratio was M:F=1.8:l. (3) Age of onset was 11+3.6 years. (4) Affected joints were knee, ankle, hand in decreasing order of frequency. (5) Patients show seropositivity of RF in 31%, HLA-B27 in 54%, ANA in 8%. (6) Chronic uveitis was observed in 7 cases (5%) (all oligoarthritis onset type, M:F=6:1, age of onset 11+4.3 years, ANA (0%), HLA-B27 (86%) , 2 cases leading to blindness. (7) Destructive bone change was significantly more prominent in female (p<0.01) , RF(+) (p<0.01), HLA-B27(-) (p<0.01) , polyarthritis onset type (p=0.02). CONCLUSIONS: In this study, we obtained interesting results that are somewhat different from Occidental data in sex ratio (male dominance), age of onset (older age) , profiles of HLA-B27 (high positivity in spite of low HLA-B27 positivity in Korean (about 2. 3%) , low rate of destructive change) , ANA (low positivity, older age of onset) , chronic uveitis (low incidence, male dominance, older age of onset, high association with HLA-B27, not associated with ANA) . This study suggests possible racial difference in clinical features of JRA. But for prove of racial difference, further multi-center trial and large scale epidemiological study should be done.
Age of Onset ; Ankle ; Antibodies, Antinuclear ; Arthritis ; Arthritis, Juvenile* ; Arthritis, Rheumatoid ; Blindness ; Classification ; Epidemiologic Studies ; Female ; Hand ; HLA-B27 Antigen ; Humans ; Incidence ; Joints ; Knee ; Male ; Prognosis ; Rheumatoid Factor ; Sex Ratio ; Spondylitis, Ankylosing ; Uveitis

Lead aVR ST segment elevation in patients with clinically suspected acute coronary syndrome strongly suggests the possibility of occlusion of the left main coronary artery (LMCA), and stenosis or occlusion in this area can cause severe life-threatening left ventricular dysfunction or malignant arrhythmias. Thus, it could be a sign suggestive of a poor prognosis for patients. In this study, we report on the case of a 67-year-old male who presented to the emergency department with total occlusion of LMCA with ST-segment elevation in only lead aVR, and without ST-segment elevation in other leads.
Acute Coronary Syndrome ; Aged ; Arrhythmias, Cardiac ; Constriction, Pathologic ; Coronary Vessels ; Electrocardiography ; Emergency Service, Hospital ; Humans ; Male ; Myocardial Infarction* ; Prognosis ; Ventricular Dysfunction, Left

BACKGROUND: The present work was designed to examine the altered expression of peritoneal AQP-1 and water transport of peritoneal membrane during the long-term peritoneal dialysis with hypertonic glucose solution in rats. METHODS: Eighteen Sprague-Dawley male rats were randomly divided into 2 groups: control rats (n=6) with peritoneal catheter but not dialyzed; rats with peritoneal dialysis (PD) (n=12) were dialyzed with 4.25% glucose dialysate for all exchanges. Before completion of the study, 4 animals in PD group were euthanized owing to nonfunctional catheters or peritonitis, leaving 14 animals for the analysis. Dialysis exchanges were performed 3 times a day with 25 mL/each exchange for 12 weeks. Immunoperoxidase staining was performed using monoclonal anti-AGE antibody and polyclonal anti-AQP-1 antibody. The slides were read by 5 different examiners in a blind fashion. The staining intensity was graded semiquantitively from 0 to 3. The peritoneal membrane function was assessed by performing one-hour peritoneal equilibration tests every 6 week for comparing transport characteristics. Peritoneal membrane transport rate was assessed by D/P of urea nitrogen and D/Do of glucose. Water transport of peritoneal membrane was assessed by D/P of sodium at 12 week. RESULTS: The expression of peritoneal AQP-1 was increased in rats with PD, compared to control rats. Consistent with this, D/P of sodium in rats with PD was significantly decreased compared to control rats (0.58+/-0.04 vs 0.86+/-0.07, p<0.05), indicating high peritoneal water permeability in response to long-term peritoneal dialysis. Moreover, rats with PD were associated with significantly lower D/Do of glucose and higher D/P of urea nitrogen, suggesting high peritoneal membrane transport. CONCLUSION: High expression of peritoneal AQP-1 was associated with an increased peritoneal water permeability in response to long-term peritoneal dialysis with 4.25% glucose for 12 weeks. The underlying mechanisms for the increased AQP-1 expression need to be examined whether it is due to the continuous exposure to the dialysis solution containing high glucose concentration itself or compensatory effects of slowly developed concomitant ultrafiltration failure in chronic peritoneal dialysis.
Animals ; Catheters ; Dialysis ; Glucose ; Glucose Solution, Hypertonic ; Humans ; Male ; Membranes ; Nitrogen ; Peritoneal Dialysis* ; Peritonitis ; Permeability ; Rats* ; Rats, Sprague-Dawley ; Sodium ; Ultrafiltration ; Urea ; Water*