PURPOSE: We expected the motion fraction could be checked, with simple radiographic examination, according to the guide-line of fluoroscopic technique, and recovery of the function also could be correlated with the improvement of the motion fraction. MATERIALS AND METHODS: We measured the motion fraction of the glenohumeral and scapulothoracic movement using fluoroscope in 30-degree intervals of arm elevation in the scapular plane. The ratio of glenohumeral to scapulothoracic movement (thetaGH/thetaST) was 1.6 for the full range of motion in scapular plane. During arm elevation, scapular tilting from the coronal plane was decreased from 42 degrees to 20 degrees tilting as well as internal rotation (scapular extension). We also measured the motion fraction (thetaGH/thetaST) and functional recovery of the shoulder in 11 patients after operative treatment of the shoulder instability in 15 patients from December 1996 to August 1997. RESULTS: We could find out a significant correlation between the recovery of motion fraction and shoulder function. These results would be applied in planing rehabilitation program after treatment of the shoulder instability. CONCLUSIONS: The measuring technique of glenohumeral to scapulothoracic movement (thetaGH/thetaST) with fluoroscopy could be applied to the simple radiographic measurement at the out-patient clinic in order to identify the pathology and recovery of shoulder motion after treatment
Arm ; Fluoroscopy ; Humans ; Outpatients ; Pathology ; Range of Motion, Articular ; Rehabilitation ; Shoulder*

Basal cell carcinoma (BCC) may exhibit diverse differentiation. In BCC with matrical differentiation, islands of shadow cells, which are characteristic of a pilomatricoma, are located within the tumor. This is an extremely rare variant and to our knowledge, only two review articles and one case report have been published. We recently experienced a case of BCC with matrical differentiation in a 45-year-old Caucasian male. This tumor should be differentially diagnosed from other tumors, particularly a pilomatricoma and pilomatrix carcinoma.
*Arm ; Carcinoma, Basal Cell/*pathology ; Diagnosis, Differential ; Human ; Male ; Middle Aged ; Skin Neoplasms/*pathology

PURPOSE: This study was conducted to validate the survival benefit of metastasectomy plus chemotherapy over chemotherapy alone for treatment of Krukenberg tumors from gastric cancer and to identify prognostic factors for survival. MATERIALS AND METHODS: Clinical data from 216 patients with Krukenberg tumors from gastric cancer were collected. Patients were divided into two arms according to treatment modality: arm A, metastasectomy plus chemotherapy and arm B, chemotherapy alone. RESULTS: Overall survival (OS) was significantly increased in arm A relative to arm B for patients initially diagnosed with stage IV gastric cancer (18.0 months vs. 8.0 months; p < 0.001) and those with recurrent Krukenberg tumors (19.0 months vs. 9.0 months; p=0.002), respectively. Metastasectomy (hazard ratio [HR], 0.458; 95% confidence interval [CI], 0.287 to 0.732; p=0.001), signet-ring cell pathology (HR, 1.583; 95% CI, 1.057 to 2.371; p=0.026), and peritoneal carcinomatosis (HR, 3.081; 95% CI, 1.610 to 5.895; p=0.001) were significant prognostic factors for survival. CONCLUSION: Metastasectomy plus chemotherapy offers superior OS when compared to palliative chemotherapy alone in gastric cancer with Krukenberg tumor. Prolonged survival applies to all patients, regardless of gastric cancer stage. Metastasectomy, signet-ring cell pathology, and peritoneal carcinomatosis were prognostic factors for survival. Future prospective randomized trials are needed to confirm the optimal treatment strategy for Krukenberg tumors from gastric cancer.
Arm ; Carcinoma ; Drug Therapy* ; Humans ; Krukenberg Tumor* ; Metastasectomy ; Pathology ; Prognosis ; Prospective Studies ; Stomach Neoplasms*

BACKGROUND: Epidural adhesion can cause pain from compression and irritation of nerves. But a simple injection into the lumbar epidural space usually goes into the area of least resistance and cannot deliver the medication to the target area. Thus, the adhesiolysis of the affected area is sometimes mandatory. We performed an adhesiolysis, irrigating with normal saline, and targeted an injection of a local anesthetic and steroid mixture to the epidural space, using a flexible catheter-secured epiduroscopic unit in 15 patients with low back pain, and assessed the pain score changes. METHODS: With the patient in the prone position, the epidural space was entered with a 17-gauge Tuohy needle. A guide-wire was inserted through the needle and advanced under fluoroscopic guidance to the level of the suspected pathology. A catheter was then advanced over the guide-wire. After the removal of the guide-wire, an adapter was then attached to the proximal end of the catheter, and its side arm was connected to a syringe containing normal saline flush. The 0.9 mm diameter fiberoptic scope was introduced into the catheter via the adaptor, and a video camera was then attached. Gentle irrigation of normal saline less than 50 ml distended the epidural space. The catheter and fiberoptic scope were advanced to the adhesion area and adhesiolysis was done by moving the tip of the steering catheter. Assuming that original NRS (Numeric Rating Scale) before the procedure was 10, we asked the NRS at 1, 4, 8, 12, 16 weeks after the epiduroscope. RESULTS: NRS at 1, 4, 8, 12, 16 weeks after the epiduroscope showed significant decrease of both low back pain and radiating pain, compared with the original pain (P<0.05). CONCLUSIONS: The flexible catheter-secured epiduroscopic unit proved to be painless, safe, and more simple, than an operation, it is, thus, a practical method for pain relief using adhesiolysis and irrigation of epidural space under the direct visualization of the epidural space in patients with low back and lower extremity pain.
Arm ; Catheters ; Epidural Space ; Humans ; Low Back Pain ; Lower Extremity* ; Needles ; Pathology ; Prone Position ; Syringes

This clinical and histopathological study was performed with 147 cases of benign mielanocytic tumors and 19 cases of malignant melanomas, which were obtained as surgical specimens from 1974 to 1984 at Department of Clinical Pathology, Catholic Medical College. The results were as follows: 1, In 89 cases of acquired benign melanocytic nevi, the average age of intradermal type(64 cases) was 34. 7 years and that of compound type(24 cases) was 24. 6 years. 2. In 30 cases of congenital nevus, nevus cells were present in the lower two thirds of reticular layer of the dermis in 93. 3% and in the subcutis as well in 3.3%. A case of giant congenital nevus with balloon cell appearance was found. 3. Of the 147 benign melanocytic tumors, a pigmented spindle cell nevus and a desmoplastic nevus were observed. 4. Blue nevi were 11 in number and excised from the face in 7, buttock in 2, shoulder in 1, upper arm in 1, and all were common type histopathologically. 5. Twelve malignant melanornas which were possible to be re-examined histopathologically were composed of 5 nodular type, 3 acral lentiginous type, 1 superficial spreading type and 3 metastatic malignant melanoma.
Arm ; Buttocks ; Dermis ; Melanoma* ; Nevus ; Nevus, Blue ; Nevus, Pigmented ; Nevus, Spindle Cell ; Pathology, Clinical ; Shoulder

Fibrous hamartoma of infancy is an uncommon benign fibrous proliferation, usually presenting as a solitary nodule. A rare example of multiple fibrous hamartoma of infancy is described. Two masses which developed in the upper arm of a 10-month-old boy were successfully excised, and one month later three small nodules 2 cm below the previous operation field appeared. It will be further elucidated whether multiple forms and early recurrence are related or not as cases accumulate.
*Arm ; Hamartoma Syndrome, Multiple/pathology/*surgery ; Humans ; Infant, Newborn ; Male ; Neoplasm Recurrence, Local

Occlusion or stenosis of subclavian artery by atherosclerosis is uncommon pathology compare to atherosclerosis of lower extremity. Most of the cases involve left subclavian artery and show vertebral-basilic ischemia and/or arm ischemia. Surgical intervention including bypass or transposition are performed to relieve the symptoms of obstruction but percutaneous intraluminal angioplasty and insertion of stent also be done with comparable results. Here we report 4 cases of symptomatic subclavian artery occlusion which have been managed by authors, and summarize all the cases reported in korean literature.
Angioplasty ; Arm ; Arteries ; Atherosclerosis ; Constriction, Pathologic ; Extremities ; Ischemia ; Lower Extremity ; Pathology ; Stents ; Subclavian Artery*

Fifty-two cases of neurilemmoma, which occurred in the skin and soft tissue and filed at the Department of Clinical Pathology, Catholic University Medical College from 1974 to 1984, were included for the clinical study. Forty four cases whose microscopic slides were available were reviewed for the histopathologic observation. The results were as follows : Clinical observations 1) The average age of the patients was 42.8% years old, and the average duration of tlie tumor was 3.9 years. 2) Eight cases were acompanied with tenderness and cases with tingling sensation. Clinica] signs described prior to biopsy were palpable mass(15), slow growing mass (8), palpable cystic mass(6) and hard mass(4). 3) The mean diameter was 2.6m (0.45cm-8cm), and the frequent sites were head and neck (32.7%), upper extremities(28.8%), lower extremities (23.11%) and trunk (15.4%) in decreasing orders. Histopathologic observations 1) 33 cases were composed of both Antoni A and type B with variable composition, but only Antoni type A was observed in 6 cases and Antoni type B in 5 Cases. 2) On the areas of Antoni type B, there were several degenerative changes including cystic change (52.3%), hemorrhage(50%), hyalinization(27.3%), necrosis(25%), and calcification(4.5%). 3) In 3 cases out of 44, the tumor was observed in the dermis and the tumors composed of Antoni A only occurred on the tongue, neck, and upper arm.
Arm ; Biopsy ; Dermis ; Head ; Humans ; Lower Extremity ; Neck ; Neurilemmoma* ; Pathology, Clinical ; Sensation ; Skin ; Tongue

Cervical radicular pain has been recognized as a common cause of neck, shoulder and arm pain. The initial recommended therapy is based on the medical treatment by anti-inflammatory, analgesic agents, rest, traction and physical therapy. In the case of failure with these therapies, the classical alternative is a surgical discectomy, but this is associated with numerous risks inherent to invasive procedures. As a result, a number of percutaneous intradiscal therapies have developed over the last 3 decades, which have specifically focused on the pathology of the disc. However, these treatments have considerable limitations and success rates, and none allow for the extraction of a quantifiable amount of nucleus pulposus via a 17 gauge introducer using fluoroscopic guidance alone. Herein, we describe our experience using a Dekompressor(R) on a 52 year-old female patient with a cervical disc herniation. Percutaneous decompression in the treatment of cervical disc herniation was successfully performed, with a good outcome.
Analgesics ; Arm ; Decompression ; Diskectomy* ; Female ; Humans ; Middle Aged ; Neck ; Pathology ; Shoulder ; Traction

A 34-year-old female was suffered from pain and numbness of right arm for 2 months after undergoing a thoracoscopic procedure for a posterior mediastinal mass that was diagnosed as neurilemmoma. The patient was diagnosed as a complex regional pain syndrome type 2 with brachial plexopathy developed during thoracoscopic excision of posterior mediastinal mass, and stellate ganglion block (SGB) with 0.2% ropivacaine 10 mL was performed every 3-4 days. The patient revealed slightly prolonged blepharoptosis as Horner syndrome accompanied after every SGB and recovered. However, following the 23rd SGB, the blepharoptosis persisted and patient was recovered spontaneously from blepharoptosis after about 12 months. The possibility that the persistent blepharoptosis might be caused by brachial plexopathy related to patient's pathology or surgical manipulation and/or repeated SGB. If Horner syndrome occurs, its etiology should be assessed, and it would be necessary to explain and to assure the patient the possibility of recovery spontaneously from the complication within a year, without any sequelae.
Adult ; Arm ; Blepharoptosis* ; Brachial Plexus Neuropathies* ; Female ; Horner Syndrome ; Humans ; Hypesthesia ; Neurilemmoma ; Pathology ; Stellate Ganglion* ; Thoracoscopy*