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Yonsei Med J [journal]
- Extensive tuberculous lymphadenitis mimicking distant lymph node metastasis on F-18FDG PET/CT in a patient with a history of malignant melanoma. [Journal Article]
- Yonsei Med J 2013 Nov; 54(6):1554-6.
18-Fluoredeoxyglucose position emission tomography and computed tomography (F-18FDG PET/CT) scanning has been useful in the evaluation of malignant disorders and has been extensively used in cancer screening. However, F-18FDG uptake was not found to be specific for cancer diagnosis. Here, we describe increased F-18FDG uptake on PET/CT caused by extensive tuberculous lymphadenitis in a 62-year-old woman with malignant melanoma.
- Ceramic head fracture in ceramic-on-polyethylene total hip arthroplasty. [Journal Article]
- Yonsei Med J 2013 Nov; 54(6):1550-3.
Revision rates of total hip arthroplasty have decreased after introducing total hip arthroplasty (THA) using ceramic component, since ceramic components could reduce components wear and osteolysis. The fracture of a ceramic component is a rare but potentially serious event. Thus, ceramic on polyethylene articulation is gradually spotlighted to reduce ceramic component fracture. There are a few recent reports of ceramic head fracture with polyethylene liner. Herein, we describe a case of a ceramic head component fracture with polyethylene liner. The fractured ceramic head was 28 mm short neck with conventional polyethylene liner. We treated the patient by total revision arthroplasty using 4th generation ceramic on ceramic components.
- Successful azathioprine treatment with metabolite monitoring in a pediatric inflammatory bowel disease patient homozygous for TPMT*3C. [Journal Article, Research Support, Non-U.S. Gov't]
- Yonsei Med J 2013 Nov; 54(6):1545-9.
Thiopurine S-methyltransferase (TPMT) methylates purine analogues, showing TPMT activity in inverse relation to concentrations of active metabolites such as 6-thioguanine nucleotide (6-TGN). With conventional dosing of thiopurines, patients with homozygous variant TPMT alleles consistently suffer from severe myelosuppression. Here, we report a patient with TPMT*3C/*3C who managed successfully with monitoring of thiopurine metabolites. The patient was an 18-year-old male diagnosed with Crohn's disease. The standard dose of azathioprine (AZA) (1.8 mg/kg/day) with mesalazine (55.6 mg/kg/day) was prescribed. Two weeks after starting AZA treatment, the patient developed leukopenia. The DNA sequence analysis of TPMT identified a homozygous missense variation (NM_000367.2: c.719A>G; p.Tyr240Cys), TPMT*3C/*3C. He was treated with adjusted doses of azathioprine (0.1-0.2 mg/kg/day) and his metabolites were closely monitored. Leukopenia did not reoccur during the follow-up period of 24 months. To our knowledge, this is the first case of a patient homozygous for TPMT*3C successfully treated with azathioprine in Korea. While a TPMT genotyping test may be helpful to determine a safe starting dose, it may not completely prevent myelosuppression. Monitoring metabolites as well as routine laboratory tests can contribute to assessing drug metabolism and optimizing drug dosing with minimized drug-induced toxicity.
- A proposal to prevent the "Mephisto sign" side effect of botulinum toxin type A injection in chronic migraine. [Journal Article]
- Yonsei Med J 2013 Nov; 54(6):1542-4.
Botulinum toxin type A (BoNT-A) has been reported as an effective treatment for chronic migraine. When BoNT-A is injected on the frontalis muscle for chronic migraine, an unexpected clinical side effect called the "Mephisto sign" may occur. The aim of this article is to propose a method to eliminate or prevent the Mephisto sign side effect. A 25-year-old female patient visited the hospital and was diagnosed with chronic migraine. A total of 155 U of BoNT-A was injected into 31 sites. 2-weeks later, and the patient developed the Mephisto sign. An additional 2-U dose was administered bilaterally to the lateral-most point of the frontalis muscles, and the eyebrow morphology returned to normal within 2-3 weeks. We propose that the development of the Mephisto sign may be prevented with an additional BoNT-A injection of 2-4 U bilaterally to the lateral most point of the frontalis muscles during the primary injection process.
- A case of cerebellar infarction caused by acute subclavian thrombus following minor trauma. [Journal Article, Research Support, Non-U.S. Gov't]
- Yonsei Med J 2013 Nov; 54(6):1538-41.
Subclavian steal syndrome caused by an acute thrombus is very rare. We present a case of cerebellar infarction with proximal subclavian artery thrombosis. A 56-year-old woman was admitted for sudden vertigo. One day prior to admission, she received a shoulder massage comprised of chiropractic manipulation. On examination, her left hand was pale and radial pulses were absent. Blood pressure was weak in the left arm. Downbeat nystagmus and a right falling tendency were observed. Brain MRI showed multiple acute infarctions in the left cerebellum. The findings of Doppler ultrasonography in the left vertebral artery were compatible with a partial subclavian artery steal phenomenon. Digital subtraction angiography demonstrated a large thrombus in the left subclavian artery. After heparin infusion, thrombus size markedly decreased. Cerebellar infarction caused by acute subclavian thrombosis following minor trauma is rare, but the thrombus can be successfully resolved with anticoagulation.
- Use of animated cartoons with children's songs to increase compliance with ultrasonography in young children. [Journal Article]
- Yonsei Med J 2013 Nov; 54(6):1533-7.
To evaluate the effect of animated cartoons with children's songs to increase compliance with ultrasonography (US) examination in young children.Animated cartoons with children's songs viewed on a cell phone were played just before the start of US examination when pediatric patients were agitated or irritable. The effect of this method was evaluated for initial responses and sustained responses (grade 0, no response; 1, partial response; and 2, good response). Site of US examination, scan duration, and the helpfulness of this method (0, useless; 1, partially helpful; and 2, very helpful) were also recorded.Among 464 pediatric patients who underwent US during the study period, 88 children (19%) needed to be calmed (67 abdominal and 21 other parts of the body). All subjects were less than five years of age (mean 1.5 years), except for four patients with mental retardation. Scan duration was less than 5 minutes in almost all examinations. Five children refused to watch the cartoon. Initial responses were good in 75 and partial in eight children. Sustained responses were good in 70 and partial in 12 children. The cartoons were very helpful in 73 (83%) and partially helpful in nine (10%) children. The effect of watching the cartoon did not change with sex, age (less or more than one year), or site of examination.Animated cartoons with children's songs viewed on a cell phone were helpful (93%) in increasing compliance with US examination in young children of both the abdomen and other parts.
- Lipid emulsions enhance the norepinephrine-mediated reversal of local anesthetic-induced vasodilation at toxic doses. [Journal Article, Research Support, Non-U.S. Gov't]
- Yonsei Med J 2013 Nov; 54(6):1524-32.
Intravenous lipid emulsions have been used to treat the systemic toxicity of local anesthetics. The goal of this in vitro study was to examine the effects of lipid emulsions on the norepinephrine-mediated reversal of vasodilation induced by high doses of levobupivacaine, ropivacaine, and mepivacaine in isolated endothelium-denuded rat aorta, and to determine whether such effects are associated with the lipid solubility of local anesthetics.The effects of lipid emulsions (0.30, 0.49, 1.40, and 2.61%) on norepinephrine concentration-responses in high-dose local anesthetic (6×10(-4) M levobupivacaine, 2×10(-3) M ropivacaine, and 7×10(-3) M mepivacaine)-induced vasodilation of isolated aorta precontracted with 60 mM KCl were assessed. The effects of lipid emulsions on local anesthetic- and diltiazem-induced vasodilation in isolated aorta precontracted with phenylephrine were also assessed.Lipid emulsions (0.30%) enhanced norepinephrine-induced contraction in levobupivacaine-induced vasodilation, whereas 1.40 and 2.61% lipid emulsions enhanced norepinephrine-induced contraction in both ropivacaine- and mepivacaine-induced vasodilation, respectively. Lipid emulsions (0.20, 0.49 and 1.40%) inhibited vasodilation induced by levobupivacaine and ropivacaine, whereas 1.40 and 2.61% lipid emulsions slightly attenuated mepivacaine (3×10(-3) M)-induced vasodilation. In addition, lipid emulsions attenuated diltiazem-induced vasodilation. Lipid emulsions enhanced norepinephrine-induced contraction in endothelium-denuded aorta without pretreatment with local anesthetics.Taken together, these results suggest that lipid emulsions enhance the norepinephrine-mediated reversal of local anesthetic-induced vasodilation at toxic anesthetic doses and inhibit local anesthetic-induced vasodilation in a manner correlated with the lipid solubility of a particular local anesthetic.
- Autologous platelet-poor plasma gel for injection laryngoplasty. [Journal Article, Research Support, Non-U.S. Gov't]
- Yonsei Med J 2013 Nov; 54(6):1516-23.
To overcome the potential disadvantages of the use of foreign materials and autologous fat or collagen, we introduce here an autologous plasma gel for injection laryngoplasty. The purpose of this study was to present a new injection material, a plasma gel, and to discuss its clinical effectiveness.From 2 mL of blood, the platelet poor serum layer was collected and heated at 100°C for 12 min to form a plasma gel. The plasma gel was then injected into a targeted site; the safety and efficacy thereof were evaluated in 30 rats. We also conducted a phase I/II clinical study of plasma gel injection laryngoplasty in 11 unilateral vocal fold paralysis patients.The plasma gel was semi-solid and an easily injectable material. Of note, plasma gel maintains the same consistency for up to 1 year in a sealed bottle. However, exposure to room air causes the plasma gel to disappear within 1 month. In our animal study, the autologous plasma gel remained in situ for 6 months in animals with minimal inflammation. Clinical study showed that vocal cord palsy was well compensated for with the plasma gel in all patients at two months after injection with no significant complications. Jitter, shimmer, maximum, maximum phonation time (MPT) and mean voice handicap index (VHI) also improved significantly after plasma gel injection. However, because the injected plasma gel was gradually absorbed, 6 patients needed another injection, while the gel remained in place in 2 patients.Injection laryngoplasty with autologous plasma gel may be a useful and safe treatment option for temporary vocal cord palsy.
- Is there relationship between brain atrophy and higher incidence of hip fracture in old age?--A preliminary study. [Journal Article]
- Yonsei Med J 2013 Nov; 54(6):1511-5.
The studies on the correlation between incidence of fall and brain atrophy have been going on to find out the cause of fall and its prevention. The purpose of this study was to explore the relationship between incidence of hip fracture and brain volume, measured by magnetic resonance image.A total of 14 subjects with similar conditions (age, height, weight, and past history) were selected for this study. Fracture group (FG) was consisted of 5 subjects with intertrochanteric fracture. Control group (CG) had 9 subjects without intertrochanteric fracture. MRI-based brain volumetry was done in FG and CG with imaging software. Total brain (tBV), absolute cerebellar volumes (aCV) and relative cerebellar volumes (rCV) were compared between two groups. Student t-test was used to statistically analyze the results.In FG, average tBV, aCV and rCV were 1034.676±38.80, 108.648±76.80 and 10.50±0.72 cm³, respectively. In CG, average tBV, aCV and rCV were found to be 1106.459±89.15, 114.899±98.06 and 10.39±0.53 cm³, respectively, having no statistically significant difference (p>0.05).There was no significant difference between the fracture and control groups. Patients with neurologic disease such as cerebellar ataxia definitely have high incidence of fall that causes fractures and have brain changes as well. However, FG without neurologic disease did not have brain volume change. We consider that high risk of fall with hip fracture might decrease brain function which is not obvious to pickup on MRI.
- Easy identification of mechanical axis during total knee arthroplasty. [Journal Article]
- Yonsei Med J 2013 Nov; 54(6):1505-10.
We devised an intraoperatively identifiable mechanical axis (IIMA) as a reference of alignment in total knee arthroplasty (TKA).Between February 2010 and January 2011, primary TKAs were consecutively performed on 672 patients (1007 knees) using an IIMA as a reference in the coronal plane.The alignment of the lower extremity improved from a mean of 11.4±6.7° (-10.3-34.4°) of varus preop. to 0.7±3.5° (-5.2-8.6°) immediately after surgery. Mean alignment of the femoral component in the coronal plane was 89.3±2.3° (83.4-97.2°) postop. and mean alignment of the tibial component was 90.4±2.2° (85.1-94.2°) postop.This study showed that IIMA could be of considerable value as a new guider of alignment that is easily accessible and highly effective during total knee arthroplasty.