Immunoglobulin G (IgG)4-related sclerosing disease is an emerging clinicopathologic entity. It is defined as a systemic disease characterized histopathologically by extensive IgG4-positive plasma cell infiltration of various organs together with T-lymphocyte infiltration.1 Pancreas is the most frequently affected organ. This disease was included within the category of autoimmune pancreatitis before the concept of IgG4-related sclerosing disease was introduced.2 There have been several reports of patients with IgG4-related sclerosing disease involving a wide range of extrapancreatic tissues.3 However, involvement of the CNS is still exceptional. To date, only 1 case of IgG4-related sclerosing pachymeningitis has been reported in the published literature. We describe IgG4-related sclerosing disease manifesting as an inflammatory epidural mass with spinal cord compression.
### Case report.
A healthy, 46-year-old, Korean woman presented to the emergency department with a 2-week history of progressive bilateral weakness of the lower limbs. On the day she visited the emergency department, she could not stand by herself. Neurologic examination showed symmetric paresis of the lower limbs with motor power of Medical Research Council grade 4. Touch and pain sensations were impaired. MRI of the thoracic spine (figure, A–C) revealed a mass …
Purpose: This study retrospectively analyzed the prosthetic survival and functional results after a prosthetic reconstruction for malignant bone tumors of the proximal tibia. Materials and Methods: Thirty-five patients (32 osteosarcomas and 3 chondrosarcomas) were followedup for an average 72 months (24-167 months). A gastrocnemius flap was transferred in 12 patients and cement fixation of the stem was performed in 10. More than 40% of the bone length was resected in 12 patients. Results: Three patients had died of the disease at the time of the final follow-up. There were one local recurrence and five distant metastases. The major complications were infection (5), aseptic loosening (5) and periprosthetic fractures (1). Gastrocnemius flap affected the incidence of a deep infection in the proximal tibia (17.4% vs. 8.3%) but there were no statistical correlation. A resection of >40% of the involved tibia increased the incidence of aseptic loosening (p=0.002). The rate of prosthetic survival was 72% at 5 years and 58% at 10 years. The functional score at the final follow-up was 81% (43-93%). Conclusion: A prosthetic reconstruction in the proximal tibia showed acceptable oncologic and functional outcomes in patients at an intermediate term follow-up. Infection and loosening were the main factors threatening the survival of the prosthesis.
Background Melanoma in dark‐skinned individuals often develops in an acral lentiginous fashion on the foot and wide excision usually results in a substantial defect. Various repair methods, including free flap, full‐thickness skin graft and secondary intention healing (SIH), are used to repair these defects. Recently, use of negative pressure wound treatment (NPWT) has been shown to accelerate wound healing in different types of wound. Objectives To compare the functional and cosmetic results of NPWT and SIH in patients who underwent wide excision of melanomas on the foot. Methods The wound defects of 22 patients after wide excision of melanoma on the foot were treated using SIH (n =13) or NPWT (n =9). Results There was no significant difference in time to complete wound healing between the two groups. However, evaluation using the Vancouver Burn Scar Assessment Scale at the time of complete healing showed that the mean score of the NPWT group was significantly lower than that of the SIH group. The NPWT group also had significantly better results than the SIH group in terms of total score, vascularity and height of the scars. As for complications, no wound infection was encountered in the NPWT group, whereas eight of the 13 patients in SIH group had wound infections during the course of treatment despite frequent and meticulous aseptic dressing changes. Conclusions These results show that, despite the drawback of rather prolonged healing time, NPWT is an excellent therapeutic option for wounds after wide excision of melanoma on the foot, with acceptable functional and cosmetic outcomes.
Epidemic outbreaks of multi-drug resistant (MDR) Acinetobacter baumannii (AB) in intensive care units (ICUs) are increasing. The incidence of MDR AB bacteremia, which develops as a result of colonization, is increasing through widespread dissemination of the pathogen, and further colonization. We sought to determine risk factors for MDR AB bacteremia in patients colonized with MDR AB in the ICU.We conducted a retrospective, observational study of 200 patients colonized with MDR AB in the ICU at Severance Hospital, South Korea during the outbreak period between January 2008 and December 2009.Of the 200 patients colonized with MDR AB, 108 developed MDR AB bacteremia, and 92 did not. APACHE II scores were higher in bacteremic than non-bacteremic patients at the time of ICU admission and colonization (24.0 vs. 21.6; P = 0.035, 22.9 vs. 16.8; P < 0.001, respectively). There was no difference between the two groups in the duration of time from ICU admission to colonization (7.1 vs. 7.2 days; P = 0.923), but the duration of time at risk was shorter in bacteremic patients (12.1 vs. 6.0 days; P = 0.016). A recent invasive procedure was a significant risk factor for development of bacteremia (odds ratio = 3.85; 95% CI 1.45-10.24; P = 0.007). Multivariate analysis indicated infection and respiratory failure at the time of ICU admission, maintenance of mechanical ventilation, maintenance of endotracheal tube instead of switching to a tracheostomy, recent central venous catheter insertion, bacteremia caused by other microorganism after colonization by MDR AB, and prior antimicrobial therapy, were significant risk factors for MDR AB bacteremia.Patients in the ICU, colonized with MDR AB, should be considered for minimizing invasive procedures and early removal of the invasive devices to prevent development of MDR AB bacteremia.
Reliable diagnosis of liposarcoma by magnetic resonance imaging (MRI) is essential for surgical planning. The purpose of this study was to correlate radiologists' certainty of the diagnosis of liposarcoma on musculoskeletal MRI with pathology results.Between January 2001 and February 2009, 105 patients who radiologically suggested liposarcoma on their MRI reports were retrospectively reviewed. Among them, pathologically confirmed 64 patients (benign, 42; malignant, 22) were included. Two musculoskeletal radiologists reviewed MR reports and classified these into 3 groups according to the degree of certainty of liposarcoma (CL) by consensus: C1, high; C2, undetermined; and C3, low. Classified data were compared with pathology results.The number of cases in each group was C1, 32; C2, 12; and C3, 20. Group C1 included 17 liposarcomas (53%), 7 lipomas, 4 other sarcomas, 2 hibernomas, 1 abscess, and 1 epidermal cyst. There were 11 lipomas (92%) and one liposarcoma in C2. In C3, all patients had lipomas. Fifteen (47%) of 32 variable benign or malignant tumors were incorrectly diagnosed as liposarcomas.On the diagnosis of liposarcoma, the radiologists' high degree of CL showed high agreement. However, nonadipose tumors were sometimes misdiagnosed as liposarcomas with a high CL. Therefore, we should consider other soft tissue tumors and benign lipomas for the differential diagnosis of liposarcoma.
The treatment success rate for tuberculosis (TB) has stagnated at 80-81% in South Korea, indicating unsatisfactory outcomes. Enhancing treatment success rate necessitates the development of individualized treatment approaches for each patient. This study aimed to identify the risk factors associated with unfavorable treatment outcomes to facilitate tailored TB care.
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