• Title/Summary/Keyword: Musculoskeletal disorder surgery

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A Case of Cauda Equina Syndrome in Early-Onset Chronic Inflammatory Demyelinating Polyneuropathy Clinically Similar to Charcot-Marie-Tooth Disease Type 1

  • Lee, Seung Eun;Park, Seung Won;Ha, Sam Yeol;Nam, Taek Kyun
    • Journal of Korean Neurosurgical Society
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    • v.55 no.6
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    • pp.370-374
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    • 2014
  • To present a case of cauda equina syndrome (CES) caused by chronic inflammatory demyelinating polyneuropathy (CIDP) which seemed clinically similar to Charcot-Marie-Tooth disease type1 (CMT1). CIDP is an immune-mediated polyneuropathy, either progressive or relapsing-remitting. It is a non-hereditary disorder characterized by symmetrical motor and sensory deficits. Rarely, spinal nerve roots can be involved, leading to CES by hypertrophic cauda equina. A 34-year-old man presented with low back pain, radicular pain, bilateral lower-extremity weakness, urinary incontinence, and constipation. He had had musculoskeletal deformities, such as hammertoes and pes cavus, since age 10. Lumbar spine magnetic resonance imaging showed diffuse thickening of the cauda equina. Electrophysiological testing showed increased distal latency, conduction blocks, temporal dispersion, and severe nerve conduction velocity slowing (3 m/s). We were not able to find genetic mutations at the PMP 22, MPZ, PRX, and EGR2 genes. The pathologic findings of the sural nerve biopsy revealed thinly myelinated nerve fibers with Schwann cells proliferation. We performed a decompressive laminectomy, intravenous IgG (IV-IgG) and oral steroid. At 1 week after surgery, most of his symptoms showed marked improvements except foot deformities. There was no relapse or aggravation of disease for 3 years. We diagnosed the case as an early-onset CIDP with cauda equine syndrome, whose initial clinical findings were similar to those of CMT1, and successfully managed with decompressive laminectomy, IV-IgG and oral steroid.

Role of MRI and Plain Radiograph to Diagnose Fibrous Dysplasia Mimicking Metastasis on PET/CT in a Patient with Breast Cancer (유방암환자의 양전자방출단층촬영술에서 암 전이로 오인된 섬유형성이상 진단의 자기공명영상과 단순촬영의 역할)

  • Cho, Song-Mee;Jee, Won-Hee;Yoo, Ie-Ryung;Lee, Ah-Won;Chung, Yang-Guk
    • The Journal of the Korean bone and joint tumor society
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    • v.16 no.1
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    • pp.47-50
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    • 2010
  • Fibrous dysplasia is a common benign disorder of bone in which normal bone marrow is replaced with fibro-osseous tissue. As PET/CT is increasingly used for the staging of different malignant disease, incidentally found fibrous dysplasia with increased FDG uptake may mimic metastasis. We report on a 46-year-old woman with fibrous dysplasia who underwent PET/CT because of suspected recurrence of breast cancer and was misdiagnosed as a bony metastasis with a focal FDG uptake on left proximal femur. This lesion was interpreted as fibrous dysplasia based on MRI in addition to the plain radiographs. We conclude that MRI in addition to radiography may help to differentiate fibrous dysplasia mimicking metastasis on PET/CT in the patients with malignancy.

Bibliographic Study on the Tongue-Acupunccture Therapy (설침요법(舌鍼療法)에 대한 문헌적(文獻的) 고찰(考察))

  • Lee, Jun Ho;Kim, Kee Hyun
    • Journal of Haehwa Medicine
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    • v.1 no.1
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    • pp.255-278
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    • 1992
  • Based on recent 27 document, reported in Huang Ti Nei Ching, the following results concering the tongue and Tongue-acupuncture were obtained: 1. It was observed that the tongue has direct or indirect connection with the Heart meridian, the Liver meridian, the Spleen meridian, the Kidney meridian, the Triple energizer meridian and the Stomach meridian. 2. The Tongue-acupunccture, needlingon tongue, is one of new acupunctures treating general disorder and 31 acu-points have been found; 17 points on the upper part and 14 points on the lower part of the tongue. 3. The Tongue-acupuncture is employed by dividing the tongue into threeregions; Sangcho area(下焦穴), Jungcho area(中焦穴) and Hacho area(下焦穴). Each region cures its own corresponding symptoms. 4. The upper part of the tongue is divided into 4 regions by the sidelines along with Chuy Cheon(聚泉), So Jang Hyul(小腸穴) and Dae Jang Hyul(大腸穴). Sangcho area(上焦穴) includes Sim Hyul(心穴), Pye Hyul(肺穴), Sang Gi Hyul(上肢穴) and Jungcho area(中焦穴) includes Ui Hyul(胃穴), Bi Hyul(脾穴), Dam Hyul(膽穴) and Hacho area(下焦穴) includes Gan Hyul(肝穴), Bang Kwang Hyul(膀胱), Sin Hyul(腎穴) and the inner region includes Yim Hyul(陰穴), Ha Gi Hyul(下肢穴), on The lower part of the tongue, there are aec Hyul(額穴), Mok Hyul(目穴), Bi Hyul(鼻穴), I Hyul(耳穴), In Hu Hyul(咽喉穴) in contrast with the face above the center of the tongue as well as Gi Maek Hyul(支脈穴), Hae Chun Hyul(海泉), Gyum Gin Ok Aek(金津玉液), Seol Ha Hyul(舌下穴), Seol Gu(舌柱), Joa Chun Hyul(佐泉穴), Sin Gyun Hyul(神根穴), Jung Gu(中矩), Aek Bang Hyul(液旁穴). 5. The Tongue-acupuncture can be applied to the disease internal medicine, surgery, ophthalmology, otorhinolaryngology, gynecology, musculoskeletal system, symptomatology.

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General Anesthesia for Dental Treatment of a Pediatric Patient with Marfan Syndrome (마판 증후군 소아 환자의 전신마취 하 치과치료)

  • Kim, Kyung Jin;Bak, Soyeon;Hyun, Hong-Keun;Shin, Teo-Jeon;Kim, Jung-Wook
    • Journal of The Korean Dental Society of Anesthesiology
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    • v.13 no.4
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    • pp.209-214
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    • 2013
  • Multiple caries in a pediatric patient often requires dental treatment under general anesthesia, especially when the patient is suffering from a systemic disease. The patient was a 6-year-old boy with Marfan syndrome and needed extensive dental treatment. Marfan syndrome is an inherited disorder resulting from mutations in Fibrillin-1 gene. Patients are known to have mainly cardiovascular, ocular, and musculoskeletal problems. Although clinical symptoms of the syndrome are age-realted, thus hindering early diagnosis of the disease in young children, our patient had been confirmed by a gene study at a younger age. Medical history of the patient revealed moderate to severe mitral regurgitation and aortic root dilatation, which required mitral valve replacement surgery with a mechanical valve. As a result, the patient was taking warfarin post-operatively and changes in medication had to be made before the dental treatment. Also, prophyalctic antibiotics had to be given before the treatment for prevention of (to prevent the) infective endocarditis. With careful control of the medications and bleeding tendency, general anesthesia and the treatment were done successfully without any complications.

Multiple Xanthomatosis in Familiar Hypercholesterolemia Patient - A case report - (가족성 고콜레스테롤혈증 환자에서의 다발성 황색종 - 1례 보고 -)

  • Rhee, Seung-Koo;Lee, Hwa-Sung;Moon, Chan-Woong
    • The Journal of the Korean bone and joint tumor society
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    • v.6 no.1
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    • pp.41-46
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    • 2000
  • We experienced the case of familiar hypercholesterolemia with multiple xanthomas which was treated by combined surgical and medical therapy. He was 26-year-old male patient of familiar hypercholesterolemia with multiple xanthomas in 22 sites on whole body, and was treated by 17 surgical excisions of the xanthomas and by medical therapy of the hypercholesterolemia. There was a normal healing process of the surgical wounds. Continual postoperative medical therapy of the hypercholesterolemia was done. There was no recurrence of the symptoms during more than 13 months of follow-up. But the serum level of the cholesterol was not lowered significantly, so we are treating him with drug therapy. Familial hypercholesterolemia is caused by a specific disorder of lipid metabolism, and is characterized by increased LDL cholesterol, tendon xanthomas, coronary disease associated with autosomal dominant transmission. Xanthomas usually appear in the second decade of life with familiar hypercholesterolemia which may have high risk for premature coronary atherosclerosis, which might be prevented with early diagnosis and medical treatment. So, orthopedic surgeons do not only excise the xanthomatosis surgically but also can diagnose the underlying hypercholesterolemia.

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The Result of Bone Grafting for Fibrous Dysplasia (섬유성 골 이형성증에서 시행한 골 이식술의 결과 분석)

  • Jeong, Won-Ju;Kim, Tae-Seong;Cho, Hwan-Seong;Yoon, Jong-Pil;Park, Il-Hyung
    • The Journal of the Korean bone and joint tumor society
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    • v.20 no.2
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    • pp.74-79
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    • 2014
  • Purpose: Fibrous dysplasia is related to the mutation of gene encoding the alpha-subunit of a signal-transducing G-protein and has variable clinical course. Operation can be performed to prevent functional disorder or structural deformity. After curettage, autologous bone graft were used to fill the defects after curettage. The aim of this study is to compare the result of autogenous cancellous bone grafting and allogenic bone grafting for fibrous dysplasia. Materials and Methods: Among the patients who visit our hospital during the period of April, 1997 to October, 2013, we selected 34 patients who diagnosed fibrous dysplasia and visited our clinic over 1 year. There were 13 males and 21 females. Average age was 26.4 (range 2 to 57) years old. Autogenous bone graft (group I) in 5 cases, Non-autogenous bone graft (group II) in 30 cases. Iliac bone is used in all cases of autogenous bone graft. There were no significant difference in age, follow-up period, preoperational laboratory finding between two groups. Radiographic image was done to evaluate the recurrence of fibrous dysplasia or secondary degeneration. Results: There were four cases in recurrence (group I: 1 case, group II: 3 cases, p=0.554). In all recurrent cases, reoperations were done using curettage and autogenous iliac bone graft. There was no re-recurrence after reoperation. One case of secondary aneurysmal bone cyst was confirmed (group II) and 1 cases of pathologic fractures had developed (group I: 0 case, group II: 1 cases, p=0.559). No malignant change occurred. Conclusion: There were no significant difference between autogenous bone graft group and non-autogenous bone graft group. Our result suggested that autogenous bone graft seems to be good method to treat fibrous dysplasia, in the case of small volume of tumor lesion or non-weight bearing portion.

Chronic Recurrent Multifocal Osteomyelitis Associated With Inflammatory Bowel Disease Successfully Treated With Infliximab

  • Kwak, Shinhyeung;Kim, Dongsub;Choi, Joon-sik;Yoon, Yoonsun;Kim, Eun Sil;Kim, Mi Jin;Yoo, So-Young;Shim, Jong Sup;Choe, Yon Ho;Kim, Yae-Jean
    • Pediatric Infection and Vaccine
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    • v.29 no.2
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    • pp.96-104
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    • 2022
  • Chronic recurrent multifocal osteomyelitis (CRMO) is an inflammatory bone disorder presenting with sterile osteomyelitis, most often presenting in childhood. Although the etiology is understood incompletely, its association with other auto-inflammatory diseases including inflammatory bowel disease (IBD); psoriasis; Wegener's disease; arthritis; and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome suggests that dysregulated innate immunity may play an important role in the pathogenesis. We report a case of a 13-year-old boy with CRMO associated with Crohn's disease (CD) successfully treated with infliximab after failure of non-steroidal anti-inflammatory drug (NSAID) treatment. He initially was diagnosed with CRMO based on symmetric and aseptic bone lesions with no fever, lack of response to antibiotic treatment, vertebral involvement, and normal blood cell counts. Despite five months of NSAID treatment, his musculoskeletal symptoms were aggravated, and he developed gastrointestinal symptoms. Finally, he was diagnosed with CRMO associated with CD. Due to the severity of symptoms, infliximab was initiated and produced symptom improvement. This case supports infliximab as another choice for treatment of bowel symptoms in addition to the bone and joint symptoms of CRMO when other first-line treatments are ineffective.

Discharge Analysis of Chungcheongbuk-do Residents using National Hospital Discharge In-depth Injury Survey in the Recent 5 Years (퇴원손상심층조사 자료를 이용한 최근 5년간의 충청북도 거주민의 퇴원 분석)

  • Kim, Hae-Sook
    • Journal of Korea Entertainment Industry Association
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    • v.15 no.8
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    • pp.389-401
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    • 2021
  • This study was performed to generate basic data to establish a health promotion plan for residents of Chungcheongbuk-do by identifying characteristics of discharged patients residing in the Chungcheongbuk-do area from an In-Depth Post-Discharge Injury Survey reported by the Korea Centers for Disease Control and Prevention(KCDCP). The Report provided data on demographic characteristics, medical institution use characteristics, medical use characteristics, and disease characteristics of patients discharged from medical institutions with 100 or more beds from 2013 to 2017. The total number of Chungcheongbuk-do residents who were admitted and discharged from 2013 to 2017 was estimated to be 1,656,590, and the discharge rate was 21,089, which was higher than the national average of 13,882 in 2016. The regions where the discharge rate increased during this period include Goesan, Yeongdong, Boeun, Okcheon, Jeungpyeong, and Eumseong-gun, which are mainly rural areas. Among the patients hospitalized and discharged from hospitals outside the Chungcheongbuk-do area, the discharge rate of patients who used hospitals in Incheon/Gyeonggi areas and Daejeon/Chungnam areas increased slightly. Among the malignant tumor patients, the number of lung cancer(included trachea & bronchial cancer) patients was the highest. In addition, the discharge rate was highest for patients with respiratory diseases. This study suggests that efforts need to be made to lower the discharge rate for infection, circulatory disease, genitourinary disease, and musculoskeletal disorder patients

Mortality rate undergoing anesthesia in Thoroughbred racehorses at Busan Race Park (부산경남경마공원 Thoroughbred 경주마의 마취중 치사율)

  • Yang, Jaehyuk;Park, Yong-Soo
    • Journal of Practical Agriculture & Fisheries Research
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    • v.17 no.1
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    • pp.125-132
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    • 2015
  • The report about equine anesthesias in Korea are very rare. This paper aimed at the mortality rate during anesthesia in Thoroughbred horses at Equine Hospital of Busan Race Park, KRA in South Korea from 2005 to 2010. Drugs used in anesthesia was IV injection of detomidine hydrochloride (0.01 mg/kg) or xylazine(0.5mg/kg) for sedation and premedication, Guaifenesin(50-100 mg/kg) for muscle relaxation, ketamine hydrochloride(2 mg/kg) for induction of anaesthesia and Inhalational isoflurane(1.3-1.5 %) to maintain anesthesia. Total number of anesthetic cases was 190, 150 of inhalational anesthesia and 40 of general anesthesia, repectively. The purpose of anesthesia was highest in the disorder of musculoskeletal system, followed by urogenital system and respiratory system Mortality case due to anesthesia was one during arthroscopic surgery for removal of osteochondral chip fragments. The time of anesthesia was 150 min, fatal sign was hypoxemia and the reason was improper machine operation of the anesthetist. In conclusion, the perianesthetic mortality rate during anesthesia in Thoroughbred horses at Busan Race Park was 0.52%(1 death per 190 anesthetics).