No abstract available.

Many conditions may weaken bone and predispose to insufficiency fractures, including corticosteroids, radiation therapy, and rheumatoid arthritis, but osteoporosis is the main risk factor. Sacral insufficiency fractures (SIF) that usually present as nonspecific pelvic pain or low back pain are often overlooked in the elderly women with osteoporosis who have sustained minimal or no trauma. Diagnosis of SIF is difficult since the onset is mild, and usually discomfort is attributed to degenerative lumbar spine disease, spinal stenosis, vertebral compression fracture, or neoplasm. So a high index of clinical suspicion of SIF is required to avoid unnecessary diagnostic procedures. In most patients with SIF, bed rest, non-weight bearing ambulation, symptomatic treatment, and therapy for osteoporosis resulted in rapid improvement, and long-term follow-up of this fractures shows usually benign outcome. We are reporting a case of delayed detection of sacral fractures in osteoporotic woman.
Adrenal Cortex Hormones ; Aged ; Arthritis, Rheumatoid ; Back Pain ; Bed Rest ; Constriction, Pathologic ; Diagnosis ; Female ; Fractures, Compression ; Fractures, Stress* ; Humans ; Low Back Pain ; Osteoporosis ; Pelvic Pain ; Risk Factors ; Spinal Diseases ; Spine ; Walking

Despite current practice there is no evidence to demonstrate the efficacy of intraurethral 2% lidocaine gel as an anesthetic for rigid cystoscopy. To evaluate the usefulness of lidocaine on decreasing pain associated with cystoscopy, we performed a randomized controlled study comparing 2% lidocaine gel with a plain water based lubricant. Pain was recorded on a visual analogue scale by the patient and by the physician. Physician perception of pain experienced by the patient was compared with the actual pain experienced. We found decrease in pain perception in men following lidocaine gel instillation with a 5 or 10 minute dwell time compared to instillation of the plain lubricant.
Anesthetics ; Cystoscopy* ; Humans ; Lidocaine* ; Male ; Pain Perception ; Water

The outcomes of treatment of 31 patients who were managed by single visual internal urethrotomy were compared with those of 25 patients managed by perineal urethroplasty to asses whether the replacement of almost urethroplasty by the simpler urethrotomy was justified. The overall successful results were achieved in 51.6% of visual internal urethrotomy and 76%, of urethroplasty. Patients with anterior urethral strictures more than 1 cm long or completely obliterated strictures had higher failure rates in the visual internal urethrotomy than urethroplasty (p<0.05). The morbidity rates were 9.6% in the visual internal urethrotomy and 24% in the urethroplasty. We recommend that visual internal urethrotomy be reserved for patients with urethral strictures 1 cm or less in length and posterior urethral stricture which is supposed to have a high recurrence rate since the procedure is simple and it does not compromise asecondary urethroplasty.
Constriction, Pathologic ; Equidae ; Humans ; Recurrence ; Urethral Stricture*

PURPOSE: To report cases of late-onset endophthalmitis associated with glaucoma surgery. METHODS: We retrospectively reviewed the medical records of 4905 consecutive patients who underwent glaucoma surgery (trabeculectomy or valve implant surgery) from January 1, 1988 to March 31, 2013. RESULTS: There were a total of 14 late-onset endophthalmitis (0.29%) cases associated with glaucoma surgery occurring at 1 year to 21 years postoperatively. Six cases (6/993, 0.60%) occurred after valve implantation and the other 8 cases (8/3912, 0.20%) occurred after trabeculectomy (p = 0.046). All but one patient were injected with fortified vancomycin and ceftazidim. Four patients also received a vitrectomy with the injection. The implanted valve was removed in 2 cases. In four cases, organisms were found in the culture (staphylococcus.aureus, streptococcus viridians, propionibacterium acnes and candida parapsilosis). After 1 year, only 4 patients achieved a visual acuity above 4/200 compared with other patients who had a final visual acuity of hand motion or worse. Three patients (33%) who developed endophthalmitis underwent other intraocular procedures. CONCLUSIONS: Late-onset endophthalmitis associated with glaucoma surgery can often occur with fulminant sight-threatening complications. Due to devastating sequelae, the surgeon should carefully check the surgery site in the patients who underwent glaucoma surgery at every follow-up visit. Delayed endophthalmitis after glaucoma surgery still carries a poor visual prognosis and its onset is difficult to predict. Therefore, patients who undergo glaucoma surgery should be educated and carefully evaluated during regular follow-ups.
Candida ; Endophthalmitis* ; Follow-Up Studies ; Glaucoma* ; Hand ; Humans ; Medical Records ; Prognosis ; Propionibacterium acnes ; Retrospective Studies ; Streptococcus ; Trabeculectomy ; Vancomycin ; Visual Acuity ; Vitrectomy

PURPOSE: We observed an association between obesity and UTI in infants and pediatric patients, which we aimed to validate in this study. METHODS: The medical records of 740 patients (≤24 months old) hospitalized with fever were retrospectively analyzed. The patients were subdivided into 2 groups, namely, the UTI and control (non UTI) groups. We analyzed the patient's height, weight. Obesity was defined as weight-for-length ≥95(th) percentile, and the association between obesity and UTI was evaluated. RESULTS: Out of 740 patients, 253 and 487 patients were in the UTI group and the control group, respectively. A comparative analysis, based on 3 age groups (0–5 months, 6–11 months, and 12–24 months) showed higher proportion of obesity in the UTI group (26.4%) than in the control group (13.0%) in the 0–5 months group. After adjusting for age and gender in the 0–5 month group, the obesity group was 3.76 times likely to have an UTI (95% CI 1.419–9.98). CONCLUSION: Obesity and UTI show strong association, especially in infants aged 0–5 months. Febrile obese infant patients (≤5 months old) visiting medical centers should be advised urine tests for potential UTI.
Child ; Fever ; Humans ; Infant ; Medical Records ; Obesity ; Pediatrics ; Retrospective Studies ; Urinary Tract Infections

PURPOSE: To establish a new therapeutic strategy for proliferative vitreoretinopathhy (PVR), we examined the effect of combined treatment with HDAC inhibitor SAHA and proteasome inhibitor lactacystin in human retinal pigment epithelial (RPE) cells, ARPE-19. METHODS: Viability was determined by trypan blue exclusion assay. Mitochondrial membrane potential (MMP) was measured by flow cytometry. Proteasome activity was measured by fluorophotometry. The expression and degradation of apoptosis-related proteins were assesssed by Western blotting. Subcellular location of apoptosis-related factors was monitored by confocal miscroscopy. RESULTS: A single treatment with 5 micro M SAHA or 10 micro M lactacystin did not reduce cell viability. However, combination treatment with 5 micro M SAHA and 10 micro M lactacystin substantially reduced the viability, because the mixture induced the reduction of MMP and nuclear condensation or fragmentation. Moreover, the combination treatment triggered the activation of caspase-3 and the production of PARP cleavage products. These data indicate that the combination treatment efficiently induces apoptosis in ARPE-19 cells. However, co-treatment of SAHA did not augment the proteasome inhibitory activity of lactacystin, nor did co-treatment of lactacystin augment acetylation of histones. It is notable that while p53 and CAD were observed in the mitochondria of cells treated with SAHA, they were translocated into the nucleus after the combination treatment. CONCLUSIONS: These results suggest that the combination treatment of SAHA and lactacystin effectively induced apoptosis in ARPE-19 cells. Further work is warranted to develop this combination therapy as a novel therapeutic strategy for PVR.
Acetylation ; Apoptosis* ; Blotting, Western ; Caspase 3 ; Cell Survival ; Flow Cytometry ; Fluorophotometry ; Histones ; Humans ; Membrane Potential, Mitochondrial ; Mitochondria ; Proteasome Endopeptidase Complex ; Proteasome Inhibitors ; Retinaldehyde ; Trypan Blue

BACKGROUND: A pharyngocutaneous fistula is a common and difficult-to-manage complication after head and neck reconstruction. It can lead to serious complications such as flap failure, carotid artery rupture, and pharyngeal stricture, and may require additional surgery. Previous radiotherapy, a low serum albumin level, and a higher T stage have been proposed as contributing factors. We aimed to clarify the risk factors for pharyngocutaneous fistula in patients who underwent flap reconstruction and to describe our experiences in treating pharyngocutaneous fistula. METHODS: Squamous cell carcinoma cases that underwent flap reconstruction after cancer resection from 1995 to 2013 were analyzed retrospectively. We investigated several significant clinical risk factors. The treatment modality was selected according to the size of the fistula and the state of the surrounding tissue, with options including conservative management, direct closure, flap surgery, and pharyngostoma formation. RESULTS: A total of 127 cases (18 with fistulae) were analyzed. A higher T stage (P=0.048) and tube-type reconstruction (P=0.007) increased fistula incidence; other factors did not show statistical significance (P>0.05). Two cases were treated with conservative management, 1 case with direct closure, 4 cases with immediate reconstruction using a pectoralis major musculocutaneous flap, and 11 cases with direct closure (4 cases) or additional flap surgery (7 cases) after pharyngostoma formation. CONCLUSIONS: Pharyngocutaneous fistula requires global management from prevention to treatment. In cases of advanced-stage cancer and tube-type reconstruction, a more cautious approach should be employed. Once it occurs, an accurate diagnosis of the fistula and a thorough assessment of the surrounding tissue are necessary, and aggressive treatment should be implemented in order to ensure satisfactory long-term results.
Carcinoma, Squamous Cell ; Carotid Arteries ; Constriction, Pathologic ; Cutaneous Fistula ; Diagnosis ; Fistula* ; Free Tissue Flaps ; Head ; Humans ; Hypopharynx* ; Incidence ; Myocutaneous Flap ; Neck ; Oropharynx* ; Postoperative Complications ; Radiotherapy ; Retrospective Studies ; Risk Factors* ; Rupture ; Serum Albumin

Endometriosis is defined as the presence of endometrial tissue (gland and stroma) outside the uterus. The most frequent sites of implantation are the pelvic viscera and the peritoneum. About 1% of woman with endometriosis have urinary tract lesions, of which 85% involve the bladder. We report one case of vesical endometriosis that have been treated by partial cystectomy.
Cystectomy ; Endometriosis* ; Female ; Humans ; Peritoneum ; Urinary Bladder ; Urinary Tract ; Uterus ; Viscera

BACKGROUND: In Korea, the separation of prescribing and dispensing medicine was finally accepted as a medical policy in July, 2000, after a long period of discussion and study which was started in 1963. Now a year after the policy started, we investigated the knowledge, attitude, and practice of separation of prescribing and dispensing medicine. METHODS: Information, concerning whether the policy was effectively carried out and well understood, were gathered from 383 patients, who visited an university hospital from August 20 to September 1, 2001. RESULTS: The results revealed that 73.1% of the subjects knew the policy precisely. However, only 1.6% of them could answer all four questions on the purpose of the policy. The old-aged, the low educated, the low socioeconomic groups and the residents in agricultural area revealed poor understanding of the policy (P<0.05). Among the total, 74.9% showed negative response toward the policy. Time and cost increment were 75.7% and 75.2%, respectively. Among them 61.1% revealed negative attitude towards continuance the policy and 93.2% revealed dissatisfaction of the policy. CONCLUSION: The knowledge of the policy was relatively high. However, negative attitudes prevailed on the continuance of the policy. Therefore, more solutions and better strategies for the problems of prescribing and dispensing medicine would be needed.
Humans ; Korea