A cases is reported of congenital atlanto-occipital fusion in a 12-years-old girl. The lesion was treated by occipito-cervical arthrodesis by iliac bone grafting with wiring. The congenital atlanto-occipital fusion has not progressed in this 2 years of observation. This is presented with a review of literature.
Arthrodesis ; Bone Transplantation ; Female ; Humans

PURPOSE: The aim of this study is to compare the shock wave lithotripsy (SWL) with the rigid ureteroscopic stone removal (URS) in order to establish the efficacy in treating upper ureteral stones according to the stone size. MATERIALS AND METHODS: We reviewed 328 patients who have been treated for upper ureteral stones between January 1999 and December 2002. 227 patients were treated with SWL, and 101 patients were treated with URS. We analyzed the success rates of the stone removal, reasons for failure, and complication rates of each procedure. RESULTS: The overall success rate of the URS was 93.1%. In terms of stone size, the success rates were 94.5% (<10mm) and 91.3% (>10mm), respectively. With the SWL treatments, the overall success rates after the first, second, and third sessions were 59%, 78%, and 92.5%, respectively. According to the stone size, the success rates were 96.5% (<10mm) and 85.7% (>10mm) after third sessions, respectively. The success rate was significantly affected by the size of the stone in the SWL group, but this was not the case with the URS group. The associated complication rates of URS and SWL were 11% and 7%, respectively. CONCLUSIONS: In this study, URS was relatively more efficacious than SWL when the stone was larger than 10 mm. The proper selection of patients for in situ SWL or URS would improve the results of the initial treatment.
Humans ; Lithotripsy* ; Shock* ; Ureter* ; Ureteral Calculi ; Ureteroscopy

PURPOSE: Bilateral high signal intensity in basal ganglia on Tl-weighted images is unusual. the purpose of this study is to describe the pattern of high signal intensity and underlying disease. METHODS AND MATERIALS: During the last three years, 8 patients showed bilateral high signal intensity in basal ganglia on Tl-weighted image, as compared with cerebral white matter. Authors analized the images and underlying causes retrospectively. Of 8 patients, 5 were male and 3 were female. The age ranged from 15 days to 79 years. All patient were examined by a 0.5T superconductive MRI. Images were obtained by spin echo multislice technique. RESULTS: Underlying causes were 4 cases of hepatopathy, 2 cases of calcium metabolism disorder, and one case each of neurofibromatosis and hypoxic brain injury. These process were bilateral in all cases and usually symmetric. In all cases the hyperintense areas were generally homogenous without mass effect or edema, although somewhat nodular appearence was seen in neurofibromatosis. Lesions were located in the globus pallidus and internal capsule in hepatopathy and neurofibromatosis, head of the caudate nucleus in disorder of calcum metabolism, and the globus pallidus in hypoxic brain injury. CONCLUSION: Although this study is limited by its patient population, bilateral hyperintense basal ganglia is associated with various disease entities. On analysis of hyperintense basal ganglia lesion, the knowledge of clinical information improved diagnostic accuracy.
Basal Ganglia* ; Brain ; Brain Injuries ; Calcium Metabolism Disorders ; Caudate Nucleus ; Edema ; Female ; Ganglia ; Globus Pallidus ; Head ; Humans ; Internal Capsule ; Magnetic Resonance Imaging ; Male ; Metabolism ; Neurofibromatoses ; Retrospective Studies

The safety and efficacy of the CO2laser as a replacement for the steel scalpel is well documented in plastic surgery, but the use of the laser blepharoplasty has been controversy. This study compares and contrasts the use of the CO2 laser with conventional method in cosmetic upper eyelid blepharoplasty. Thirteen Patients underwent blepharoplasty in a paired comparison study. Four patients(Group A) underwent blepharoplasty by laser, another four patients (Group B) underwent blepharoplasty by conventional method, and the other five patients(Group C) underwent upper eyelid blepharoplasty using the laser on one eye and a conventional method on the other side. Preoperative factor(set up time, equipment), intraoperative factor(actual operation time, bleeding, visibility), postoperative factor(swelling, ecchymosis, immediate & short term result) were evaluated. The advantage of using the CO2 laser rather than the steel scalpel in blepharoplasty are less bleeding and superior intraoperative visibility. The disadvantage of using the laser compared with steel scalpel include the cost of purchasing and maintaining the laser equipment, the need for additional and extensive laser training for surgeons and assistants, and the need for two assistants rather than the one needed for scalpel surgery There were no complications with either the scalpel or the laser.
Bleeding Time ; Blepharoplasty* ; Carbon Dioxide* ; Carbon* ; Ecchymosis ; Eyelids* ; Hemorrhage ; Humans ; Lasers, Gas* ; Matched-Pair Analysis ; Steel ; Surgery, Plastic

For many years the standard surgical treatment for carpal tunnel syndrome has been division of the transverse carpal ligament under direct vision through a palm incision. Although the effectiveness and Patient acceptability of the conventional open carpal tunnel release are good, disability from a painful palm cutaneous neuroma, and prolonged swelling are reported Endoscopic carpal tunnel release seems to result in less postoperative morbidity, and minimal serious complications. Because endoscopic carpal tunnel release leaves the overlying skin, the subcutaneous fat and the palmer fascia and its attachments to the thenar and hypothenar musculature intact its proponents maintain that their patient have less scar tenderness, quicker recovery of grip strength, and earlier to return activities of daily living and work The endoscopic approach(Agee single portal technique), which includes specific localization of the hook of hamate, flexor retinaculum and the superficial palmar arch utilizing topographical landmarks, avoids entry into Guyon's canal and common digital nerves. We experienced four cases of carpal tunnel syndrome. In four cases, patients with carpal tunnel syndrome have been performed endoscopic carpal tunnel release with minor complication.
Activities of Daily Living ; Carpal Tunnel Syndrome ; Cicatrix ; Fascia ; Hand Strength ; Humans ; Ligaments ; Neuroma ; Skin ; Subcutaneous Fat

Differentiation between benign and malignant hepatic lesions was attempted according to the shape of the lesion, internal architecture and characteristics of signal intensity on MR images. MR images. We retrospectively analyzed 20 cases of hemangiomas, 12 cases of hepatomas and 5 cases of cysts which were diagnosed by clinical, radiological and surgical methods (33 patients). On T1-weighted, proton weighted, and T2-weighted images, most hemangiomas (70%) and cysts (100%) had smooth margin and were round or oval in shape, while hepatocellular carcinomas had irregular (67%) or lobulated (33%) borders. Ninety percent of hemangiomas and 100% of cysts had homogeneous signal intensity, but 67% of hepatocellular carcinomas were inhomogeneous. Signal intensities of hepatocellular carcinomas were more variable. However, hemangionmas were isointense or hyperintense on proton weighted images, and markedly hyperintense on T2-weighted images . In conclusion, inhomogenous, irregular border, and variable signal intensity lesions had high likelihood of malignancy, while homogenous and markedly hyperintense lesions were more likely benign.
Carcinoma, Hepatocellular ; Diagnosis* ; Hemangioma ; Magnetic Resonance Imaging* ; Protons ; Retrospective Studies

Differentiation between benign and malignant hepatic lesions was attempted according to the shape of the lesion, internal architecture and characteristics of signal intensity on MR images. MR images. We retrospectively analyzed 20 cases of hemangiomas, 12 cases of hepatomas and 5 cases of cysts which were diagnosed by clinical, radiological and surgical methods (33 patients). On T1-weighted, proton weighted, and T2-weighted images, most hemangiomas (70%) and cysts (100%) had smooth margin and were round or oval in shape, while hepatocellular carcinomas had irregular (67%) or lobulated (33%) borders. Ninety percent of hemangiomas and 100% of cysts had homogeneous signal intensity, but 67% of hepatocellular carcinomas were inhomogeneous. Signal intensities of hepatocellular carcinomas were more variable. However, hemangionmas were isointense or hyperintense on proton weighted images, and markedly hyperintense on T2-weighted images . In conclusion, inhomogenous, irregular border, and variable signal intensity lesions had high likelihood of malignancy, while homogenous and markedly hyperintense lesions were more likely benign.
Carcinoma, Hepatocellular ; Diagnosis* ; Hemangioma ; Magnetic Resonance Imaging* ; Protons ; Retrospective Studies

Extraskeletal Neoplasm Resembling Ewings Sarcoma was firstly reported with comprehensive review of 39 cases by L. Angervall and F.M. Enzinger in 1975. The tumors chiefly affected young adults and most commonly involved the soft tissue of lower extremity. Microscopically, they were consisted of solidly packed small, round or ovoid cells arranged in sheets or lobules, which were indistinguishable from those of the Ewings sarcoma of bone. The authors recently experienced a soft tissue sarcoma occurring in deltoid area of young male patient, which was diagnosed extraskeletal neoplasm resembling Ewings sarcoma. The case review is presented.
Humans ; Lower Extremity ; Male ; Sarcoma ; Sarcoma, Ewing ; Young Adult

The author reviewed eighteen congenitally dislocated hips in Kyung Hee University Hospital during the three and a half year period (rom September, 1973 to March, 1977. The following observations were made. 1. The average age of the patients at the first visit was 17.9 months. 2. All 16 patients were female. 3. There were 2 bilateral dislocations and 14 unilateral dislocations. 4. Left side was dislocated in 12 hips snd right side in 6 hips. 5. Limping was the chief complaint in 12(75%) of the patients. 6. Arthrogram gave valuable information as to make correct diagnosis and treatment. 7. Twelve hips were successfully treated by closed methods and 6 hips required operative treatment. 8. Following reduction, cast immobilization was continued for an average of 5 months in the conservative series. 9. In the conservative series, the acetabular index decreased from 33.4 degree before treatment to 28.1 degree immediately after removal of cast. 10. The results were good or excellent in all except for 2 cases of avascular necrosis and 1 case of redislocation.
Acetabulum ; Diagnosis ; Dislocations ; Female ; Hip ; Humans ; Immobilization ; Necrosis

Insulinoma is a rare tumor, occurring more often in women and in the older age range. Eighty percent of patients have a single benign tumor, usually 2 cm in diameter, located with about equal frequency in body, head or tail of pancreas and amenable to surgical cure. About 10% have multiple tumors. The remaining 10% of patients have metastatic malignant insulinoma. The symptom of insulinoma is characterized by the periodic attack of hypoglycemia of blood sugar level below 50mg%, by fasting or exertion, and rapid relief of symptom by oral or intravenous administration of glucose. Symptom often lead to misdiagnosis as a neurologic or psychiatric disorder. A case described by authors was 44-year old female with the chief complaints of the loss of consciousness, epileptic seizure although she has been treated by anticonvulsants. Serum blood sugar and insulin level during fasting suggested insulinoma but abdominal computed tomography shows no definitive mass in pancreas. Celiac angiography revealed insulinoma. She transferred to the department of General Surgery and was performed enucleation. Microscopic findings shows the islet cell tumor of pancreas. A brief review of the literature was made.
Adenoma, Islet Cell ; Administration, Intravenous ; Angiography ; Anticonvulsants ; Blood Glucose ; Diagnostic Errors ; Epilepsy ; Fasting ; Female ; Glucose ; Head ; Humans ; Hypoglycemia ; Insulin ; Insulinoma* ; Pancreas ; Tail ; Unconsciousness