Limb salvage surgery using a tumor prosthesis for the treatment of malignant bone tumors in the proximal femur is an effective method for preserving hip joint function. On the other hand, maintaining hip joint stability can be challenging because of the extensive resection of the bone and surrounding soft tissue. This paper reports an unusual case of hip dislocation in a patient with a proximal femoral osteosarcoma who underwent limb salvage surgery. Over six years, the tumor prosthesis gradually migrated posterosuperiorly above the iliac crest, resulting in 14 cm of lower limb shortening. The acetabular reconstruction was performed using an allograft, and the middle segment of the tumor prosthesis was removed to allow for hip reduction. Concurrent reconstruction of the hip abductor muscles was also carried out. No recurrence of the dislocation was observed during follow-up, and the patient could walk independently with the aid of an orthopedic brace, despite an 8 cm leg length discrepancy.

Objective: Primary frozen shoulder causes significant pain and progressively restricts shoulder movements. Diagnosis is made clinically based on patient history and physical examination. Management is mainly non-invasive owing to its self-limiting clinical course. However, clinical practice guidelines for frozen shoulder have not yet been developed in Korea. The developed guidelines aim to provide evidence-based recommendations for the diagnosis and treatment of frozen shoulder. Methods: A guideline development committee reviewed the literature from four databases (PubMed, Embase, Cochrane Library, and KMbase). Using the Population, Intervention, Comparator, and Outcome (PICO) framework, the committee formulated two backgrounds and 16 key questions to address common clinical concerns. Recommendations were made using the Grading of Recommendations, Assessment, Development, and Evaluation framework. Results: Diabetes, thyroid disease, and dyslipidemia significantly increase the risk of developing a frozen shoulder. Although frozen shoulder is often self-limiting, some patients may experience long-term functional disabilities. Ultrasound and magnetic resonance imaging should be used as adjunctive tools alongside clinical diagnosis, and rather than as independent diagnostic methods. Noninvasive approaches, such as medications, physical modalities, exercises, electrical stimulation, and manual therapy, may reduce pain and improve shoulder function. Other noninvasive interventions have limited evidence, and their application should be based on clinical judgment. Intra-articular steroid injections are recommended for treatment, and physiotherapy or hydrodilation with steroid injections can also be beneficial. Conclusion These guidelines provide evidence-based recommendations for diagnosing and treating primary frozen shoulder.

STUDY DESIGN: Retrospective study. OBJECTIVES: To analyze the outcomes of degenerative lumbar spine surgery in patients undergoing hemodialysis due to chronic kidney disease (CKD). SUMMARY OF LITERATURE REVIEW: Patients who undergo hemodialysis due to chronic renal disease tend to exhibit accelerated changes in bone quality, deterioration of spinal stenosis, and accompanying neurological degeneration. The surgical treatment of chronic spinal diseases is also becoming more necessary with the increased lifespan of these patients. MATERIALS AND METHODS: We reviewed the medical records and radiographs of patients with CKD undergoing hemodialysis who were followed-up for more than 1 year after posterior lumbar spinal surgery. We evaluated clinical, laboratory, and radiologic variables. For a comparative analysis, patients were classified into subgroups according to age (65 years old), duration of hemodialysis (10 years), and type of surgery (simple decompression or fusion). RESULTS: We included 21 patients (5 men, 16 women) with a mean age of 66.2 years (range, 48-87 years). The mean duration of hemodialysis and follow-up was 18.9 years and 43 months, respectively. Decompressions with fusion were performed in 11 patients and simple decompressions in the other 10. The mean visual analog scale (VAS) of leg pain and the Oswestry Disability Index (ODI) significantly improved after surgery at time of the last follow-up; meanwhile, the mean VAS score for lower back pain did not show a statistically significant improvement. The postoperative ODI was correlated with age (correlation coefficient=0.71, p=0.006). In patients less than 65 years old, the ODI improvement was greater (p=0.035) than in those 65 years of age or older. There was no significant difference in the clinical outcomes according to the duration of hemodialysis. Complications were observed in 11 patients (52.4%, 7 in fusion and 4 in simple decompression), of which 2 cases were infections, and reoperations were performed in 5 patients. The union rate of the fusion cases at the 1-year follow-up was 81.8%. CONCLUSIONS: Appropriate spine surgery improved radicular pain and the ODI in patients with degenerative lumbar disease undergoing hemodialysis. However, postoperative complications were frequent and the improvement of clinical outcomes was minimal, especially in patients over 65 years of age and in those who underwent fusion. Therefore, the surgical treatment of patients with chronic renal disease undergoing hemodialysis requires adequate consideration of age and the duration of hemodialysis.
Decompression ; Follow-Up Studies ; Humans ; Kidney Failure, Chronic ; Leg ; Low Back Pain ; Male ; Medical Records ; Postoperative Complications ; Renal Dialysis* ; Renal Insufficiency, Chronic* ; Retrospective Studies ; Spinal Diseases ; Spinal Stenosis ; Spine* ; Visual Analog Scale

There are approximately 20 known species of the genus Cryptosporidium, and among these, 8 infect immunocompetent or immunocompromised humans. C. hominis and C. parvum most commonly infect humans. Differentiating between them is important for evaluating potential sources of infection. We report here the development of a simple and accurate real-time PCR-based restriction fragment length polymorphism (RFLP) method to distinguish between C. parvum and C. hominis. Using the CP2 gene as the target, we found that both Cryptosporidium species yielded 224 bp products. In the subsequent RFLP method using TaqI, 2 bands (99 and 125 bp) specific to C. hominis were detected. Using this method, we detected C. hominis infection in 1 of 21 patients with diarrhea, suggesting that this method could facilitate the detection of C. hominis infections.
Child ; Cryptosporidiosis/*diagnosis/*parasitology ; Cryptosporidium/*classification/*genetics ; Female ; Genotype ; Humans ; Polymerase Chain Reaction/methods ; Polymorphism, Restriction Fragment Length ; Sensitivity and Specificity

Amebiasis is a protozoan disease caused by Entamoeba histolytica and a potential health threat in areas where sanitation and hygiene are inappropriate. Highly sensitive PCR methods for detection of E. histolytica in clinical and environmental samples are extremely useful to control amebiasis and to promote public health. The present study compared several primer sets for small subunit (SSU) rDNA and histone genes of E. histolytica cysts. A 246 bp of the SSU rDNA gene of pure cysts contained in phosphate-buffered saline (PBS) and in stool samples was successfully amplified by nested PCR, using the 1,147-246 bp primer set, of the primary PCR products which were pre-amplified using the 1,147 bp primer as the template. The detection limit of the nested PCR using the 1,147-246 primer set was 10 cysts in both groups (PBS and stool samples). The PCR to detect histone gene showed negative results. We propose that the nested PCR technique to detect SSU rDNA can be used as a highly sensitive genetic method to detect E. histolytica cysts in stool samples.
DNA Primers/genetics ; DNA, Protozoan/genetics ; DNA, Ribosomal/genetics ; Entamoeba histolytica/genetics/*isolation & purification ; Entamoebiasis/*diagnosis ; Histones/genetics ; Humans ; Molecular Diagnostic Techniques/*methods ; Parasitology/*methods ; Polymerase Chain Reaction/*methods ; Protozoan Proteins/genetics ; Sensitivity and Specificity

To understand protozoan, viral, and bacterial infections in diarrheal patients, we analyzed positivity and mixed-infection status with 3 protozoans, 4 viruses, and 10 bacteria in hospitalized diarrheal patients during 2004-2006 in the Republic of Korea. A total of 76,652 stool samples were collected from 96 hospitals across the nation. The positivity for protozoa, viruses, and bacteria was 129, 1,759, and 1,797 per 10,000 persons, respectively. Especially, Cryptosporidium parvum was highly mixed-infected with rotavirus among pediatric diarrheal patients (29.5 per 100 C. parvum positive cases), and Entamoeba histolytica was mixed-infected with Clostridium perfringens (10.3 per 100 E. histolytica positive cases) in protozoan-diarrheal patients. Those infected with rotavirus and C. perfringens constituted relatively high proportions among mixed infection cases from January to April. The positivity for rotavirus among viral infection for those aged < or = 5 years was significantly higher, while C. perfringens among bacterial infection was higher for > or = 50 years. The information for association of viral and bacterial infections with enteropathogenic protozoa in diarrheal patients may contribute to improvement of care for diarrhea as well as development of control strategies for diarrheal diseases in Korea.

BACKGROUND: The purpose of this study was to examine histological changes of testes induced by hindlimb unloading & position change of testis in mature adult male rats. METHOD: Eight month old (390~410g) 36 male Sprague-Dawley rats were weight-matched assigned to Ground Control (GC), Hindlimb Unloading (HU), Hindlimb Unloading & Testis Tie(HUT), Intra-abdominal Testis(IAT) for 24 days. Daily body weight was watched for status of animal. Testis weight, Seminiferous Tubule Diameter(STD), Seminiferous Tubule Perimeter(STP), Serminiferous Tubule Area(STA), Sertori Cell Height(SCH) were examined in each group. RESULTS: The 24-day hindlimb unloading of HU, HUT and IAT showed no significant change of body weight compared to GC. HUT maintained the weights, STD, STP, STA, SCH of their testes as GC while HU, IAT had significantly decreased the weights, STD, STP, STA of their testes. CONCLUSION: These results support that hindlimb unloading experiment induces serious morphological changes of testes. Therefore, on the hindlimb unloading experiment, IAT should be avoid or the effect of IAT should be correct. It will be necessary to study the pure effect of hindlimb unloading without IAT on the musculoskeltal system and so on which are associated with testosterone.
Adult ; Animals ; Body Weight ; Hindlimb Suspension* ; Hindlimb* ; Humans ; Male ; Rats* ; Rats, Sprague-Dawley ; Seminiferous Tubules ; Testis* ; Testosterone ; Weightlessness ; Weights and Measures

Although hypertrophic cardiomyopathy is uncommon in infant and children, we have experienced a case of dexamethasone induced hypertrophic cardiomyopathy in preterm baby who had bronchopulmonary dysplasia. This patient had hyaline membrane disease. Therefore, he received prolonged mechanical ventilation that resulted in bronchopulmonary dysplasia. After we carried out dexamethasone therapy for 7 days, hypertrophic cardiomyopathy appeared in his echocardiographic finding. We discontinued dexamethasone and then, hypertrophic cardiomyopathy improved. We report this case with the review of the associated literatures.
Bronchopulmonary Dysplasia* ; Cardiomyopathy, Hypertrophic* ; Child ; Dexamethasone* ; Echocardiography ; Humans ; Hyaline Membrane Disease ; Infant ; Infant, Newborn* ; Respiration, Artificial

To investigate diagnostic value of Thallium 201(T1-201) thymid scan in differentiating malignant nodule from benign, 135 patients with thyroid nodule were evaluated with Tl-201 thyroid scan, fine needle aspiration(FNA), clinical characteristics and laboratory data. Each had histological diagnosis after thyroidectomy. Tl-201 scan had a sensitivity of 67.3% and a specificity of 66.3% and FNA had sermitivity of 46.9% and specificity of 100% in predicting malignancy. As the size of thyroid nodule and age of patient incteases, diagnostic value of 11-201 thyroid scan was improved. In the thyroid nodules larger then 3cm, sensitivity, specificity and negative predictive value were 100%, 70% and 100%, reqectively. By cornbining Tl-201 throid scan and FNA, sensitivity had 91.8%. From the data we conclude that Tl-201 thyroid scan is valuable with adjuvant diagnostic method in differentiating malignant fmm benign thyroid nodule and treatment planning.
Diagnosis ; Humans ; Methods ; Needles ; Sensitivity and Specificity ; Thallium ; Thyroid Gland ; Thyroid Nodule ; Thyroidectomy

BACKGROUND: Transient myocardial ischemia that is recorded on Holter monitoring after a myocardial infarction is known to be a risk factor of myocardial reinfarction or death. However, it is still uncertain whether transient myocardial ischemia is a cause of ventricular arrhythmias or is simply an indicator of severe coronary artery disease. Therefore, we have studied the relation of ventricular arrhythmias to transient myocardial ischemia detected on Holter monitoring after a myocardial infarction. METHOD: We studied 40 patients with acute myocardial infarction who were performed Holter monitoring, 7 to 14 days after an attack. On Holter monitoring, we analyzed the prevalence, characteristics of transient myocardial ischemia and its relation to ventricular arrhythmias. RESULTS: 1) Among 40 patients(32 men, 8 women, mean age 53+/-13), transient myocardial ischemia was recorded in 13 patients(33%). ST elevation was observed in 2 patients, and ST depression, in 11 patients. Total episodes of transient myocardial ischemia were 65, of which only one episode was accompanied by chest pain, and total daily episodes were 4.8+/-1.4. Total daily duration of transient myocardial ischemia was 61.4+/-15.5 minutes and the duration of each transient myocardial ischemia was 15.8+/-2.1 minutes. 2) There were no significant differences in frequencies of single ventricular premature beast, bigeminy, trigeminy, ventricular couplets, and ventricular tachycardias between two groups with and without transient myocardial ischemia. CONCLUSION: It is concluded that transient myocardial ischemia on Holter monitoring after myocardial infarction is not a cause of ventricular arrhythmias.
Arrhythmias, Cardiac* ; Chest Pain ; Coronary Artery Disease ; Depression ; Electrocardiography, Ambulatory* ; Female ; Humans ; Male ; Myocardial Infarction* ; Myocardial Ischemia* ; Prevalence ; Risk Factors ; Tachycardia, Ventricular