A 45-year-old woman was admitted due to severe headache and neck stiffness. She had visited a local clinic for back pain and received a lumbar nerve root steroid injection 10 days before admission. Computed tomography and magnetic resonance imaging showed psoas abscess, pneumocephalus, and subdural hygroma. She was diagnosed with psoas abscess and meningitis. The abscess and external ventricle were drained, and antibiotics were administered. Unfortunately, the patient died on hospital day 19 due to diffuse leptomeningitis. Lumbar nerve root steroid injections are commonly used to control back pain. Vigilance to "red flag signs" and a rapid diagnosis can prevent lethal outcomes produced by rare and unexpected complications related to infection. Here, we report a case of fatal meningitis after infection of the cerebrospinal fluid following a lumbar nerve root steroid injection.
Abscess ; Anti-Bacterial Agents ; Back Pain ; Cerebrospinal Fluid* ; Diagnosis ; Female ; Headache ; Humans ; Magnetic Resonance Imaging ; Meningitis ; Middle Aged ; Neck ; Pneumocephalus ; Psoas Abscess ; Subdural Effusion

PURPOSE: This study was conducted to determine how a manual therapy (joint mobilization and flexion-distraction technique) would affect pain and function with the chronic low back pain. METHODS: Thirty patients were assigned to either the experimental group (n=15) or the control group (n=15). Patients in the experimental group performed joint mobilization and flexion-distraction technique. Patients in the control group performed spinal decompression therapy. Both exercises were performed for three days per week, for a period of six weeks. Pain was measured by the visual analogue scale (VAS) and functional disability was measured using the Oswestry disability index (ODI). A paired t-test was used for identify differences before and after treatment, and an independent t-test was used to identify differences between treatment groups. RESULTS: In the within group comparison, the experimental group and control group differed significantly for all variables (p<0.05). However, no significant differences were observed in any variables between groups (p>0.05). CONCLUSION: The above results confirmed that it is necessary to confirm the various benefits of therapy with the joint mobilization and the flexion-distraction technique. The findings of the concerned study will be useful to doctors applying therapy to treat patients with the chronic low back pain.
Decompression ; Exercise ; Humans ; Joints ; Low Back Pain* ; Musculoskeletal Manipulations*

BACKGROUND: In this era of donor shortage, use of organs from living donors has increased significantly. Nonetheless, less than 1% of pancreas transplantations involve living donors, despite the immunological benefits, reduced cold ischemic time, and decreased waiting time. One reason for the paucity of donors is the high morbidity after open surgery. Using hand-assisted laparoscopic donor surgery (HALDS) can be a favorable technique for living donors. METHODS: Using HALDS, we performed three Simultaneous pancreas-kidney transplantations (SPKs) involving living donors. Two donors were women; one was a man. RESULTS: Their mean age was 34.3±4.7 years, and their body mass index was 23.2±2.36 kg/m². The mean operation time was 241±19.0 minutes and the mean cold-ischemic time of the kidney was 42.7±9.8 minutes, while that of the pancreas was 64.3±5.2 minutes. One donor developed a pancreatic fistula, which was controlled using conservative management. The donors' pancreatic and renal functions were well preserved postoperatively. CONCLUSIONS: HALDS for SPKs can be performed without significant complications if the surgeon has sufficient skill.
Body Mass Index ; Cold Ischemia ; Female ; Hand-Assisted Laparoscopy ; Humans ; Kidney Transplantation* ; Kidney* ; Living Donors* ; Pancreas Transplantation ; Pancreas* ; Pancreatic Fistula ; Tissue Donors*

OBJECTIVE: The purpose of this study was to present the MRI and CT findings of solitary spinal bone lesions (SSBLs) with the aims of aiding the differential diagnoses of malignant tumors and benign lesions, and proposing a diagnostic strategy for obscure SSBLs. METHODS: The authors retrospectively reviewed the imaging findings of 19 patients with an obscure SSBL on MRI at our hospital from January 1994 to April 2011. The 19 patients were divided to benign groups and malignant groups according to final diagnosis. MRI and CT findings were evaluated and the results of additional work-up studies were conducted to achieve a differential diagnosis. RESULTS: At final diagnoses, 10 (52.6%) of the 19 SSBLs were malignant tumors and 9 (47.4%) were benign lesions. The malignant tumors included 6 metastatic cancers, 3 multiple myelomas, and 1 chordoma, and the benign lesions included 4 osteomyelitis, 2 hemangiomas, 2 nonspecific chronic inflammations, and 1 giant cell tumor. No MRI characteristics examined was found to be significantly different in the benign and malignant groups. Reactive sclerotic change was observed by CT in 1 (10.0%) of the 10 malignant lesions and in 7 (77.8%) of the 9 benign lesions (p=0.005). CONCLUSION: Approximately half of the obscure SSBLs were malignant tumors. CT and MRI findings in combination may aid the differential diagnosis of obscure SSBLs. In particular, sclerotic change on CT images was an important finding implying benign lesion. Finally, we suggest a possible diagnostic strategy for obscure SSBLs on MRI.
Chordoma ; Diagnosis, Differential ; Giant Cell Tumors ; Hemangioma ; Humans ; Inflammation ; Multiple Myeloma ; Osteomyelitis ; Retrospective Studies

Larsen syndrome is a rare congenital skeletal malformation (1 in 100,000 births) caused by a generalized mesenchymal connective tissue disorder. This disorder leads to a broad spectrum of anomalies. Major diagnostic criteria are multiple dislocations of large joints (especially knees), short metacarpals with cylindrical nontapering fingers and craniofacial abnormalities. Clinical variations range from mild clinical expression to lethal forms. Sporadic occurrence as well as autosomal dorminant and recessive inheritance are described.
Connective Tissue ; Craniofacial Abnormalities ; Dislocations ; Fingers ; Joints ; Metacarpal Bones ; Methapyrilene ; Wills

OBJECTIVE: This study is to evaluate the efficacy of dorsal short-segment fixation in unstable thoracolumbar junction fractures. METHODS: The cases of 20 patients who underwent dorsal short-segment fixation were reviewed retrospectively. Clinical outcomes were analysed using Sonntag's pain level, work status, and neurological scale according to the modified Frankel classification. Radiological outcomes were analysed using Mumford's anterior body compression(%), canal compromise ratio, and Cobb's kyphotic angle. RESULTS: At the latest clinical follow-up (average=14.6 months), there were 19 (95.0%) in group I and 1 patient (5.0%) in II in pain level35). The postoperative work status were 17 (85.0%) in group I, 2 patients (10.0%) in II, and 1 patient (5.0%) in V. Surgery brought to improve the neurologic status. In success group (19 cases, 95%), the average canal compromise ratio was reduced from 0.57 (+/-0.07) to 0.05 (+/-0.08) (P<0.05), the average anterior body compression (%) was reduced from 41% (+/-17) to 18% (+/-14) (P<0.05), and the average preoperative kyphotic angle was 20.0 degrees (+/-9.0), and corrected to 5.7 degrees (+/-7.1) postoperatively, and progressed to 7.8 degrees (+/-6.2) at the latest follow-up. There was a case of implantation failure in an elderly osteoporotic patient. CONCLUSION: Although there are limitations in the patient number and follow-up period, the present study favors dorsal short-segment fixation for selective cases in unstable thoracolumbar junction fractures.
Aged ; Classification ; Follow-Up Studies ; Humans ; Retrospective Studies

PURPOSE: To evaluate the usefulness of a 2 holes side plate dynamic hip screw for the treatment of stable intertrochanteric fracture of the femur. MATERIALS AND METHODS: Between January 2000 and September 2004, 46 patients with intertrochanteric fracture of the femur were treated with 2 hole side plate dynamic hip screw (Group 1, 25 cases) or 4 hole side plate dynamic hip screw (Group 2, 21 cases). The mean age of the patient was 70 years, with a mean follow-up duration of 13 months. The time for operation, surgical incision length, blood loss, time for union, the sliding distance, change in the femoral neck-shaft angle and patient's walking ability were evaluated. RESULTS: The mean operation time and mean incision length were shortened, and mean blood loss was decreased in Group 1 (p<0.01). There was no statistical difference in the union time, the mean change in the femoral neck-shaft angle and the mean sliding distance of the lag screw at the last follow-up. The mean mobility score of the Parker and Palmer was 8.0 points before the fracture and 7.2 points at the last follow-up. CONCLUSION: Two-hole side plate dynamic hip screw is a useful device, in terms of the operation time, morbidity of operation site, satisfactory union rate and functional recovery of the patient in treatment of elderly patients with stable intertrochanteric fractures of the femur.
Aged ; Femur ; Follow-Up Studies ; Hip Fractures* ; Hip* ; Humans ; Walking

Desmoplastic fibromas are rare intraosseous bone tumors. They are benign but locally aggressive and frequently found in the long bones and mandible. We report radiographic and histopathologic finding of a case desmoplastic fibroma involving right temporal skull bone. A 53-year-old woman presented at our hospital complaining of continuous right side headaches for a year. Simple skull X-ray film showed 3 x 2.5 cm lytic lesion with mild sclerotic margin on right temporal area. A large craniectomy 1cm lateral to margin was fashioned. The resected mass showed encapsulated mass colored white gray. Histologic diagnosis was compatible with that of a the desmoplastic fibroma. There was no evidence of recurrence during the 15months of follow-up period.
Diagnosis ; Female ; Fibroma, Desmoplastic* ; Follow-Up Studies ; Headache ; Humans ; Mandible ; Middle Aged ; Recurrence ; Skull* ; Temporal Bone ; X-Ray Film

The aorto-enteric fistula is rarely occurred in patients, however it is clinically important since it is a life threatening condition in association with a massive gastrointestinal bleeding. It is classified as the primary type associated with aortic aneurysm and the secondary type which is complicated with vascular surgery. The fistula is mainly found between the aorta and the third portion of duodenum, and rarely occurred on the other part of gastrointestinal tract. In particular, to our knowledge the fistula between the aorta and transverse colon has not been reported. We report the aorto-transverse colon fistula in a 37 years old man who presented a massive lower gastrointestinal bleeding. Past history revealed that he had been stabbed in the abdomen 18 years ago, suggesting the pseudoaneurysm of aorta with fistula formation could be related. The aorto-transverse colon fistula was diagnosed by abdominal angiography and the fistula was repaired by operation.
Abdomen ; Adult ; Aneurysm, False* ; Angiography ; Aorta ; Aortic Aneurysm ; Colon ; Colon, Transverse ; Duodenum ; Fistula* ; Gastrointestinal Tract ; Hemorrhage* ; Humans

PURPOSE: This study was performed to present out experience of neonatal adrenal hemorrhage (NAH) and to help diagnosis and management of NAH. METHODS: We conducted a retrospective study on 14 neonates diagnosed as NAH from January 1993 to August 2002 at Hallym Medical Center. Their clinical manifestations, risk factors, sonographic findings and progression of NAH were evaluated using medical records. RESULTS: There were 12 male cases and two female cases. All cases were full-term babies. In terms of method of delivery, there were 13 cases of vaginal delivery and one case of cesarean section. The most common symptom was jaundice(10 cases). Poor feeding, vomiting, anemia, scrotal swelling with bluish discoloration, abdominal distension and cyanosis were also noted. The risk factors included perinatal asphyxia(five cases), large baby(three cases), sepsis(one case) and birth trauma(one case). Twelve cases(85.7%) involved the right adrenal gland, one case(7.1%) the left side and one case(7.1%) bilateral. In abdominal sonography, hemorrhage was seen as an isoechoic mass with central anechoic portion(35.7%), a central hypoechoic mass with peripheral hyperechoic portion(28.6%), an anechoic cystic mass(28.6%) and a heterogeneous hyperechoic mass(7.1%). Only a conservative treatment was sufficient in all cases. In the 12 cases(85.7%) followed up, size of hemorrhage was reduced in repetitive sonography without any complications. CONCLUSION: The review of these patients emphasizes the subtle and diverse clinical presentation of adrenal hemorrhage in neonates and stresses the importance of repetitive abdominal sonography in establishing the diagnosis.
Adrenal Glands ; Anemia ; Cesarean Section ; Cyanosis ; Diagnosis ; Female ; Hemorrhage* ; Humans ; Infant, Newborn ; Male ; Medical Records ; Parturition ; Pregnancy ; Retrospective Studies ; Risk Factors ; Ultrasonography* ; Vomiting