서 론 최근 전 세계적으로 비만인구의 수와 비율은 매우 빠른 속도로 증가하고 있다.미국의 경우 이상체중(ideal body weight)을 20% 이상 초과하는 인구의 비율이 50%를 넘었으 며, 1) 우리나라에서도 서구화된 식습관, 운동부족 등의 원인으 로 비만인구의 비율이 25%에 이른다. 2)아시아-태평양 비만진 단기준에 의하면 체질량 지수(body mass index, BMI [kg/m 2 ]) 가 18.5 미만을 저체중으로 정의하고 있으며, 18.5-22.9를정 상, 23-24.9이면과체중, 25-29.9이면비만, 30 이상이면 고 도비만이라 정의하고 있다. 2) 비만과 연관된 병태생리학적 변화는 모든 주요 장기에서 일어나며, 대사, 호르몬 및 생리학적인 변화가 비만과 연관 되어 발생할
Hydranencephaly is a rare congenital disease defined as an absence of cerebral hemispheres with an intact thalamus, brain stem, and cerebellum. Generally, patients with hydranencephaly require cerebro-spinal fluid diversion due to progressive hydrocephalus. An excellent view of the choroid plexus and advancement of the neurosurgical endoscope were possible, leading to easy coagulation of the choroid plexus to balance cerebro-spinal fluid production without the use of a shunt device. We present this rare case and good treatment outcome from endoscopic coagulation of the choroid plexus.
Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a chronic progressive and diffuse inflammatory fibrosis of the spinal dura mater. Though treatment of IHSP is surgical decompression with steroid therapy, treatment for recurrent IHSP is controversial. Our patient was diagnosed with IHSP based on magnetic resonance imaging (MRI) and underwent laminectomy for decompression following steroid pulse therapy. Despite maintenance of steroid therapy, the patient experienced 3 recurrences. As an alternative immunosuppressant medication, methotrexate was introduced with low-dose steroid. Fortunately, the symptom was resolved, and a decrease of dura thickening was revealed on MRI. We present the case and suggest that methotrexate might be an effective treatment modality for recurrent IHSP.
Occult papillary adenocarcinoma of the thyroid is known to be indolent, slow metastatic, and has a good prognosis. Occult thyroid carcinoma presenting as a blood-borne metastasis without obvious cervical lymph node involvement is extremely rare. A 65-year-old male patient was visited for hoarseness, dysphagia, and shortness of breath. Bronchoscopy with biopsy revealed a papillary carcinoma of thyroid by immunohistochemical staining. Head & neck CT revealed that involving both the upper esophagus and the posterior tracheal wall, extending into the mediastinum along the upper thoracic spine at T1-T2. We have experienced a rare case of occult papillary carcinoma which invaded the trachea, esophagus and fascia of thoracic spine. Treatment was initiated with radioactive iodine and external bean therapy.
Distal phalanx fractures are the most common injuries of the hand, and K-wire fixation is commonly performed for unstable fractures. However, there is no consensus regarding the number of K-wires to use in bone fixation. We aimed to compare the results between single and dual K-wire pinning. This retrospective study enrolled patients who underwent K-wire pinning for unstable distal phalanx fractures, including the shaft and tuft, from June 2016 through April 2020. We divided patients into two groups based on the number of K-wires used for bone fixation (single vs. dual). Clinical and radiographic data were measured and compared between the two groups. Additionally, multivariable logistic analysis was performed to identify the risk factors for nonunion. A total of 80 patients were enrolled. Among them, 27 were managed with a single K-wire and 53 with a dual K-wire. There was no significant difference in the union rate between the single and dual K-wire groups (77.7% vs. 84.9%, respectively), but time to union was significantly longer in the single K-wire group (11.3 vs. 8.4 weeks; p = .003). The presence of a bone gap after fixation was a risk factor for nonunion. Our study showed that the union rate was comparable between single and dual K-wire pinning in distal phalanx fractures. However, dual K-wire pinning shortened the union time.
Background: Laryngoscopy and tracheal intubation often induced an undesirable increase in blood pressure and heart rate.We evaluated the preventing effect of nicardipine infusion on the increase of the blood pressure (BP) and heart rate (HR) following a direct laryngoscopy and tracheal intubation.Methods: Sixty, ASA physical status 1-2, adult patients were selected with informed consent, and randomly allocated into two groups; control group (n = 30) and nicardipine group (n = 30).In the control group, 1.8 ml/kg/h of normal saline was infused, and in the nicardipine group, 5μg/kg/min of nicardipine was infused continuously from 2 minutes before intubation to 3 minutes after intubation.BP and HR were measured by non-invasive method after arrival at the operating room, before tracheal intubation, shortly after tracheal intubation, and 1, 3, 5, and 10 minutes following intubation.Data were analyzed by repeated measure of ANOVA and t-test.Results: Systolic and diastolic BP were significantly lower in the nicardipine group than in the control group (P ＜ 0.05).HR showed significantly higher value in the nicardipine group (P ＜ 0.05).Conclusions: The continuous infusion of nicardipine (5μg/kg/min) was effectively attenuating an increase of BP during tracheal intubation.But the increase in HR is not blunted by nicardipine infusion and there is a significant increase in HR.Although rate-pressure product (RPP) does not increase, the use of nicardipine for blunting hemodynamic responses should be considered carefully in patients with ischemic heart disease.(
fore, the ankle and hindfoot joints could be damaged simultaneously, as another study mentioned that 90% of patients had obvious radiological arthritic changes in the hindfoot, and 30% had spontaneous fusion of the subtalar joint. 2,3) Standard treatment for an ankle with rheumatoid arthritis is arthrodesis with acceptable outcomes and fewer complications. 4)However, arthrodesis makes climbing steps and walking on uneven surfaces difficult. 3)For the present case, we planned total ankle arthroplasty to preserve ankle motion as other peritalar joints were all spontaneously fused.However, irreducible spacer subluxation occurred after the operation, even after revision with additional soft tissue release and spacer change.Our report focuses on the reduction of subluxation with buttress plating after total ankle arthroplasty in a patient with rheumatoid arthritis.Rheumatoid arthritis is a systemic disease that commonly involves multiple joints and has numerous complications.Ankle joint arthritis occurs in 15% to 52% of adult-onset rheumatoid arthritis patients. 1)Patients usually have osteoporosis, fragile skin, and poor soft tissue around the ankle. 2) The difference between rheumatoid and osteoarthritic arthritis is that the coexistence of severe degenerative changes in the ankle and hindfoot can occur in the former. 3)There-
We wanted to evaluate the mural changes by CT on the follow-up examination of patients with active Takayasu arteritis.The study included 18 patients, (4 males and 14 females), with active Takayasu arteritis. A total of 44 CT examinations were done during the follow-up period (mean: 55.6 months). At the time of the last follow-up CT, the disease, on the basis of the erythrocyte sedimentation rate (ESR), was found to be inactive in five patients and the disease was active and persistent in 13 patients. The thickness and CT attenuation of the aortic wall on the precontrast, arterial and venous phases were measured on the initial and the follow-up CT examinations. The ratio of the mural attenuation over that of the back muscle on the initial CT was compared with the ratio found on the follow-up CT.The initial CT findings included high density and calcifications of the aortic wall in the precontrast images and a thickened wall with enhancements in the arterial and the venous phases. A low-attenuation ring was demonstrated in the venous phase in 15 patients (83%). On the follow-up evaluation, the mean mural thickness decreased significantly from 4.1 mm to 2.4 mm. The mean mural attenuation ratio in the venous phase decreased significantly from 1.9 to 1.3 (p = 0.001). The low attenuation ring was identified in seven patients (39%) who had only with active, persistent Takayasu arteritis.The mural changes demonstrated by the follow-up CT evaluations for the patients with active Takayasu arteritis included a decrease of the mural thickness and enhancement, disappearance of the low-attenuation ring on the venous phase, and an increase of the mural attenuation and calcification on the precontrast phase.
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