Journal of Yeungnam Medical Science

Case reports

Transient osteoporosis of the hip with a femoral neck fracture during follow-up: a case report: Yusuke Tabata, Shuhei Matsui, Masabumi Miyamoto, Koichiro Omori, Yoichiro Tabata, Tokifumi Majima; J Yeungnam Med Sci. 2023;40(2):212-217. Published online September 26, 2022; DOI: https://doi.org/10.12701/jyms.2022.00479

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We report a case of transient osteoporosis of the hip with a femoral neck fracture found during follow-up. A 53-year-old man presented with left hip pain without trauma. The pain did not improve after 2 weeks and he was brought to our hospital by ambulance. Magnetic resonance imaging (MRI) of the left hip joint showed diffuse edema in the bone marrow, which was identified by low signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and increased signal intensity on short tau inversion recovery. This edema extended from the femoral head and neck to the intertrochanteric area. He was diagnosed with transient osteoporosis of the left hip. Rest gradually improved his pain; however, 3 weeks later, his left hip pain worsened without trauma. X-ray, computed tomography, and MRI results of the hip joint demonstrated a left femoral neck fracture, and osteosynthesis was performed. Differential diagnoses included avascular necrosis of the femoral head, infection, complex regional pain syndrome, rheumatoid arthritis, leukemia, and other cancers. Transient osteoporosis of the hip generally has a good prognosis with spontaneous remission within a few months to 1 year. However, a sufficient length of follow-up from condition onset to full recovery is necessary to avoid all probable complications such as fractures.

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Hip effusion/synovitis influences results after multiple drilling core decompression for bone marrow edema syndrome of hip
Hua-zhang Xiong, Yan-li Peng, Yu-hong Deng, Ying Jin, Ming-hong Tu, Shu-hong Wu
BMC Surgery.2023;[Epub] CrossRef

Septic arthritis of the hip joint caused by Klebsiella pneumoniae: a case report: Jeong-Bo Moon, Jun-Hwan Lee, Byung-Ju Ryu; J Yeungnam Med Sci. 2023;40(2):193-197. Published online January 13, 2022; DOI: https://doi.org/10.12701/yujm.2021.01613

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Abstract PDF: Klebsiella pneumoniae is an uncommon cause of septic arthritis in adults. However, late detection can cause serious complications, including joint destruction and immobility. The purpose of this study was to report a case of successfully treated septic arthritis of the hip joint (SAHJ) caused by K. pneumoniae. A 49-year-old female patient presented to our hospital with fever and progressive severe pain in the right hip area. Although there was no abnormality on plain radiographs, ultrasonography revealed diffuse swelling of the right hip joint. Under ultrasonography guidance, the hip joint fluid was aspirated, and Gram staining and culturing were performed. The patient’s pain was significantly reduced after the joint aspiration. The Gram staining and culturing revealed gram-negative bacilli, which were subsequently identified as K. pneumoniae. According to the results, systemic intravenous antibiotic (ceftriaxone) was administered without complications, and the patient was discharged on oral antibiotic (ciprofloxacin). Clinical cases of septic arthritis of the knee or sacroiliac joint have been occasionally reported in adults, but cases of SAHJ are rare. Moreover, K. pneumonia-induced SAHJ has not been reported to date. Therefore, we report this very rare case and its successful treatment.

Original article

Correlation between anterior thigh pain and morphometric mismatch of femoral stem: Haksun Chung, So Hak Chung; Yeungnam Univ J Med. 2020;37(1):40-46. Published online September 16, 2019; DOI: https://doi.org/10.12701/yujm.2019.00325

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Abstract PDF

Background
Postoperative pain occurring after hip arthroplasty has become common since the expanded use of cementless femoral stems. The characteristic pain develop in the anterolateral thigh area. This study aimed to predict anterior thigh pain based on the measurements of postoperative anteroposterior (AP) and lateral (Lat) radiographs of the hip joint.
Methods
The present study included 26 patients (29 hips) who underwent total hip replacement or bipolar hemiarthroplasty between March 2010 and May 2016, whose complete clinical information was available. AP and Lat radiographs of the affected hip were taken on the day of surgery and 1 and 6 months postoperatively. Patients with improper radiographs were excluded. The distance from the femoral stem to the nearest cortical bone in the distal region of the stem was measured. The patient group with a visual analog scale (VAS) score of ≥6 points was designated as patients with anterior thigh pain.
Results
Sex, age, weight, height, body mass index, and bone mineral density in the lumbar spine and femur did not have a significant effect on postoperative VAS scores (p>0.05). Presence of contact between the femoral stem and cortical bone was associated with postoperative anterior thigh pain.
Conclusion
Hip AP and Lat radiographs are usually taken to confirm fixation and alignment of the femoral stem after hip arthroplasty. The measurement method introduced in this study can be utilized for predicting anterior thigh pain after hip arthroplasty.

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Hydroxyapatite ceramic-coated femoral components in younger patients followed up for 27 to 32 years
Piyush K. Upadhyay, Nirav Shah, Vishal Kumar, Saqeb B. Mirza
Bone & Joint Open.2024; 5(4): 286. CrossRef

Original Article

Antiepileptic and anti-neuroinflammatory effects of red ginseng in an intrahippocampal kainic acid model of temporal lobe epilepsy demonstrated by electroencephalography: Ju Young Kim, Jin Hyeon Kim, Hee Jin Lee, Sang Hoon Kim, Young Jin Jung, Hee-Young Lee, Hee Jaung Kim, Sae Yoon Kim; Yeungnam Univ J Med. 2018;35(2):192-198. Published online December 31, 2018; DOI: https://doi.org/10.12701/yujm.2018.35.2.192

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Abstract PDF

Background
Chronic inflammation can lower the seizure threshold and have influence on epileptogenesis. The components of red ginseng (RG) have anti-inflammatory effects. The abundance of peripherally derived immune cells in resected epileptic tissue suggests that the immune system is a potential target for anti-epileptogenic therapies. The present study used continuous electroencephalography (EEG) to evaluate the therapeutic efficacy of RG in intrahippocampal kainic acid (IHKA) animal model of temporal lobe epilepsy.
Methods
Prolonged status epilepticus (SE) was induced in 7-week-old C57BL/6J mice via stereotaxic injection of kainic acid (KA, 150 nL; 1 mg/mL) into the right CA3/dorsal hippocampus. The animals were implanted electrodes and monitored for spontaneous seizures. Following the IHKA injections, one group received treatments of RG (250 mg/kg/day) for 4 weeks (RG group, n=7) while another group received valproic acid (VPA, 30 mg/kg/day) (VPA group, n=7). Laboratory findings and pathological results were assessed at D29 and continuous (24 h/week) EEG monitoring was used to evaluate high-voltage sharp waves on D7, D14, D21, and D28.
Results
At D29, there were no differences between the groups in liver function test but RG group had higher blood urea nitrogen levels. Immunohistochemistry analyses revealed that RG reduced the infiltration of immune cells into the brain and EEG analyses showed that it had anticonvulsant effects.
Conclusion
Repeated treatments with RG after IHKA-induced SE decreased immune cell infiltration into the brain and resulted in a marked decrease in electrographic seizures. RG had anticonvulsant effects that were similar to those of VPA without serious side effects.

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Comparative analysis of physicochemical properties, ginsenosides content and α-amylase inhibitory effects in white ginseng and red ginseng
Huairui Wang, Yao Cheng, Xue Zhang, Yingping Wang, Hui Zhao
Food Science and Human Wellness.2023; 12(1): 14. CrossRef
Robust chronic convulsive seizures, high frequency oscillations, and human seizure onset patterns in an intrahippocampal kainic acid model in mice
Christos Panagiotis Lisgaras, Helen E. Scharfman
Neurobiology of Disease.2022; 166: 105637. CrossRef
The interplay of epilepsy with impaired mitophagy and autophagy linked dementia (MAD): A review of therapeutic approaches
Siva Prasad Panda, Yogita Dhurandhar, Mehak Agrawal
Mitochondrion.2022; 66: 27. CrossRef

Case Reports

Preoperative arterial embolization of heterotopic ossification around the hip joint: Jin Hyeok Kim, Chankue Park, Seung Min Son, Won Chul Shin, Joo Yeon Jang, Hee Seok Jeong, In Sook Lee, Tae Young Moon; Yeungnam Univ J Med. 2018;35(1):130-134. Published online June 30, 2018; DOI: https://doi.org/10.12701/yujm.2018.35.1.130

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Abstract PDF

Heterotopic ossification (HO) around the hip joint is not uncommon following neurological injury. Often, surgical treatment is performed in patients with restricted motion and/or refractory pain due to grade III or IV HO according to Brooker classification. The major complication that occurs as a result of surgical HO removal is perioperative bleeding due to hyper-vascularization of the lesion. Here, we report a case of preoperative embolization in a 51-year-old male patient presenting with restricted bilateral hip range of motion (ROM) due to HO following a spinal cord injury. In the right hip without preoperative arterial embolization, massive bleeding occurred during surgical removal of HO. Thus, the patient received a transfusion postoperatively due to decreased serum hemoglobin levels. For surgery of the left hip, preoperative embolization of the arteries supplying HO was performed. Surgical treatment was completed without bleeding complications, and the patient recovered without a postoperative transfusion. This case highlights that, while completing surgical removal for ROM improvements, orthopedic surgeons should consider preoperative arterial embolization in patients with hip HO.

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Embolization followed by resection of the heterotopic hip joint ossification with spinal cord injury
Takahiro Igei, Satoshi Nakasone, Masato Ishihara, Masamichi Onaga, Kotaro Nishida
Journal of Orthopaedic Science.2024; 29(1): 454. CrossRef
Preoperative Arterial Embolization for Heterotopic Ossification of the Hip
Nicolas Papalexis, Giuliano Peta, Costantino Errani, Marco Miceli, Giancarlo Facchini
Journal of Vascular and Interventional Radiology.2023; 34(4): 608. CrossRef
Neurogenic heterotopic ossification: A review. Part 2
Vladimir A. Novikov, Alina M. Khodorovskaya, Valery V. Umnov, Evgenii V. Melchenko, Dmitry V. Umnov
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery.2023; 11(4): 557. CrossRef

A Case of von Hippel-Lindau Disease with Aortic Valve Insufficiency.: Sang Hyeon Kang, In Chul Park, Duk Song Cho, Hye Jung Lee, Ho Jin Lee, Dong Hyun Lee; Yeungnam Univ J Med. 2013;30(2):101-104. Published online December 31, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.2.101

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Abstract PDF: Von Hippel-Lindau (VHL) disease is an autosomal dominant hereditary disorder caused by a germline mutation of the VHL gene. It is a multi-systemic disorder that is predisposed to benign or malignant tumors of visceral organs such as hemangioblastoma of the central nervous system, renal cell carcinoma, retinal angioma and pheochromocytoma. We report herein a case of VHL disease that initially manifested with aortic valve insufficiency.

Original Articles

Two Year Experiences of the International Elective Clerkship for Medical Students.: Sam Beom Lee, Jae Beum Bang, Young Hwan Lee; Yeungnam Univ J Med. 2009;26(1):24-29. Published online June 30, 2009; DOI: https://doi.org/10.12701/yujm.2009.26.1.24

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Abstract PDF: BACKGROUND
The aims of medical education have recently been changing in Korea, which has been accompanied by efforts to modify the rotating clerkship courses, improve the quality of clinical education, and make global doctors. We report the experiences of medical students going through an international elective clerkship for during past two years. MATERIALS AND METHODS: Third year medical students could apply to the international elective clerkship course during a 4 week period after their third-year rotating clerkship at a university hospital. This was done twice-in 2008 and in 2009. Applicant students were allowed to select hospitals anywhere in the world. We analyzed their choices including data on nation, state or city, hospital or institute, contacted hospitals by medical college, differences of two years, etc. RESULTS: Twelve students (10.9%) of a total of 75 third-year students applied to 3 nations and 4 hospitals in 2008. Nine students applied to the Tampa General Hospital at the University of South Florida (USF) in the USA, which was arranged by their medical college. In 2009, a total of five (4.2%) of 77 students applied to 2 nations and 3 hospitals, including three at the University of South Florida, one in another city in the USA, and one in another nation because of the increased financial burden due to a higher exchange rate. CONCLUSION: Medical students started their first international elective clerkship courses during the past two years. Experiences were interesting and meaningful to the students and the medical college. Greater effort and support to developing a new paradigm and to enlarge the scope of the program for making global doctors are required in the future.

Clinical Clerkship in the Yeungnam University Medical School － Through the Questionnaires －: Young Hwan Lee; Yeungnam Univ J Med. 2007;24(2 Suppl):S340-351. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S340

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Abstract PDF

Purpose：To evaluate the status and activities of the clinical clerkship in the Yeungnam University Medical School through the surveying of the clerkship directors and 4th grade medical students in 2003. Materials and Methods：A total 22 clerkship directors and 60 medical students who finished their clerkships were enrolled. For the faculties, the questionnaire was composed of appointment status of clinical instructors, clerkships' logbooks, main activities, type and scope of assessment, feedback mode and opinion to improve the clerkships with a 10 scaled score. For the students, selfassessment for learning the basic clinical skill, effectiveness of ambulatory care and ward round, attendance of the surgical procedures, experience of making the preliminary chart were included.
Results
：The clerkship directors have provided logbooks, activities in various fields and feedback. However, the satisfaction scores (10 scaled sore) of the students was followed; confidence of the basic clinical skills 4.7, acquaintance with the clerkship objectives 5.3, relevance the logbook contents 5.2, relevance the lecture contexts 5.6, respectively. In the ambulatory cares, ward round and the attendance of the operative procedures did not contribute to learning the etiology of disease, process of treatment and prognosis.
Conclusion
：The clerkship program of the Yeungnam University Medical School have some discrepancy in the satisfaction scores between the clerkship directors and students. To reinforce the educational effects of the clinical clerkships, each course will be composed of the main learning objectives based on the clinical situation. The teaching skill training programs should be operated for clerkship directors or instructors, including the residents. Appropriate educational environment will be established, also.

Citations

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Accreditation Standards for Designating Teaching Hospitals for Medical Students in Korea
Jonghoon Park, Youngchang Kim, Dongseok Moon, Kwihwa Park, Sujin Chae, Hyohyun Yoo, Ducksun Ahn
Korean Medical Education Review.2015; 17(1): 15. CrossRef

Arthrographic Evaluation in Developmental Dislocation of the Hip: Comparison Between Hip Arthrogram and Operative Findings.: Se Dong Kim, Yun Seok Lee; Yeungnam Univ J Med. 1998;15(2):263-274. Published online December 31, 1998; DOI: https://doi.org/10.12701/yujm.1998.15.2.263

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Abstract PDF: One of the main purposes in the treatment of developmental dislocation of the hip is to achieve and maintain concentric, congruent, and stable reduction. The arthrogram perform an important role in the diagnosis and treatment of developmental dislocation of the hip. The arthrogram provides much information about the soft tissue status of the hip joint. Limbus and ligamentum teres is exactly evaluated so we can plan the reduction and treatment before operation. 18 preoperative hip arthrograms of 17 children treated for developmental dislocation of the hip from 1992 to 1998 were reviewed. The limbus, ligamentum teres and transverse acetabular ligament were compared with the pathoanatomy seen at the time of open reduction. Arthrography proved reliable in identifying the limbus and ligamentum teres. So we recommend that arthrography must be performed before closed or open reduction. Also, we recorded the radiographic parameters: acetabular index, acetabular floor thickness, center edge(CE) angle of Wiberg, and Y-coordinate. The center edge(CE) angle of Wiberg obtained from arthrography was measured more accurately than from simple roentgenograms because the ossification of the femoral head was frequently located eccentrically in the developmental dislocation of the hip.

Erythrocyte sedimentation rate and C-reactive protein values in patients with hip arthroplasty.: Se Dong Kim, Dong Chul Lee, Dong Gu Park; Yeungnam Univ J Med. 1992;9(2):218-223. Published online December 31, 1992; DOI: https://doi.org/10.12701/yujm.1992.9.2.218

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Abstract PDF: Serum C-reactive protein (CRP) levels and erythrocyte sedimentation rates (ESR) were measured in 46 patients treated with uncomplicated primary hip replacements, 39 total tip replacements and 7 bipolar hip replacements. In uncomplicated primary hip replacements, ESR levels were slightly elevated preoperatively and were variable postoperatively. But CRP was normal before surgery and elevated in postoperative course, but back to normal within three weeks in most cases. Early success of hip arthroplasty is in indicated by normalization of CRP within three weeks, regardless of ESR. Since ESR seems to react somewhat differently from the CRP, both methods are useful in the monitoring of complications after hip arthroplasty.

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