No abstract available.

Purpose: To present the first case of severe upper and lower tarsal ectropion associated with immunoglobulin G4 (IgG4)-relatedophthalmic disease.Case summary: A 37-year-old male presented with relapsed eyelid swelling and periocular inflammation in the left eye for7 years. He had severe upper and lower tarsal ectropion and a thickened upper eyelid with prolapsed conjunctival fornix. Orbitalcomputed tomography showed a poorly defined anterior orbital mass involving the lacrimal gland and upper and lower eyelids onthe left eye. The severe upper and lower eyelid ectropion was corrected by a modified spindle procedure and lateral tarsal strip.Hard, ill-defined fibrotic tissue and a mass around the lateral upper tarsal plate were discovered that required excision of themass and a biopsy. Hematologic and histopathologic findings of the orbital mass indicated IgG4-related ophthalmic disease withsevere upper and lower ectropion caused by the disease. Conclusions In cases of severe upper and lower eyelid ectropion caused by chronic inflammation, as seen in this case, not onlyeyelid tightening with excision of the causative mass but also a modified spindle procedure is required to prevent rotation of theeyelid.

OBJECTIVE: The purpose of this study was to determine differential findings between Type I degenerative endplate changes and diskitis on MR images. MATERIALS AND METHODS: MR images(T1, T2 weighted or Gradient echo) of L-spine in twelve patients with a Type I degenerative endplate change and nine patients with diskitis were reviewed for the morphologic and signal intensity changes of intervertebral disc, vertebral endplate and vertebral body. RESULTS: involvement of the marrow of one side of intervertebral disk was noted in 33%(4/12) of Type I endplate changes, and 11%(1/9) of diskitis. Decreased signal intensity of intervertebral disc was seen in 92% (11/12) of Type I endplate changes, and 11%(1/9) of diskitis on T2 weighted or Gradient echo image. Loss of intranuclear cleft signal was noted in 17%(2/12) of Type I endplate changes, and 78%(7/9) of diskitis. Even disc space narrowing was seen in all cases of Type I endplate changes, but uneven narrowing was seen in 44%(4/9) of diskitis. Only partial cortical disruption was noted in 42%(5/12) of Type I endplate changes, while partial or total cortical disruption was noted in 89%(8/9) of diskitis. The extent of marrow involvement more than 2/3 was noted in 8%(1/12) of Type I endplate changes, but 56%(5/9) of diskitis. The margin of signal intensity change was well defined in 33%(4/12) of Type I endplate changes, but that of diskitis was ill defined in all cases(9/9). Gadolinium enhancement was homogeneous in all cases(5/5) of Type I endplate changes, and 63%(5/8) of diskiris. CONCLUSION: We conclude that involvement of one side of endplate, decreased signal intensity of intervertebral disc on T2 weighted or gradient echo image, even narrowing of disc space, lesser extent of marrow involvement, well defined margin and homogeneous enhancement pattern are the findings of Type I degenerative endplate changes on MR images.
Bone Marrow ; Diagnosis, Differential* ; Discitis* ; Gadolinium ; Humans ; Intervertebral Disc ; Magnetic Resonance Imaging*

No abstract available.

PURPOSE: To assess the accuracy of estimating postoperative deviation in large-angle exotropia over 40 prism diopters (PD). METHODS: A retrospective analysis was performed on 61 exotropia patients with over 40 PD exotropia who had undergone 2-muscle surgery by two surgeons and with at least 6 months follow-up. The accuracy was assessed by analyzing the discrepancy between preoperatively predicted residual deviation and deviation at postoperative 6weeks. Successful surgery was defined as deviation within +/- 10 PD at the last postoperative visit. RESULTS: More accurate residual deviation was predicted in exotropia with prism diopters between 40 and 59 (97.8%) than in exotropia with 60 PD or more (62.5%). And there was no significant difference between two surgeons. Surgical success rates at six months and one year after surgery were 96.8%, 94.7% in exotropia with 40 to 49 PD, 71.4%, 60.0%, 50 to 59 PD, 50.0%, 45.5%, 60 PD or more, respectively. There were four patients of whom the postoperative deviation angle exceeded more than 10 PD of the estimated deviation. CONCLUSIONS: The accuracy of estimating residual deviation prior to surgery was higher and more successful surgery was achieved in exotropia ranging in 40 to 59 PD than in exotropia with 60 PD or more. Therefore, 2- muscle surgery will be suitable for large-angle exotropia with less than 60 PD.
Exotropia ; Follow-Up Studies ; Humans ; Muscles ; Retrospective Studies

PURPOSE: To evaluate patterns of recurrence and factors which influence them in radiofreqency (RF) ablation for the treatment of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Between May 1999 and March 2000, 69 patients with 82 HCCs underwent RF ablation for complete necrosis. They were diagnosed by tissue biopsy or tumor marker, and the results of triphasic spiral CT. The indications were that nodular lesions were clearly visualized at sonography, less than 5 cm in size and less than four in number, and that patients had no history of previous treatment. Local therapeutic efficacy such as complete necrosis and marginal recurrence, and new lesions were evaluated by means of triphasic spiral CT performed at least six months after the completion of ablation. We then analyzed the correlation between local therapeutic efficacy and various influential factors such as tumor size, whether the tumor was attached to the portal vein, gross morphology, Child-Pugh classification, and alpha- fetoprotein level before the procedure, as well as the correlation between new lesions and influential factors which included the alpha-fetoprotein level before the procedure, Child-Pugh classification, and multiplicity per person. RESULTS: During a mean follow-up period of 8.95 (range, 6-14) months after RF ablation, the rate of complete necrosis and of marginal recurrence was 91% and 12%, respectively. When a tumor was larger and was attached to a large branch of the portal vien, the incidence of incomplete necrosis and marginal recurrence was greater. The occurrence rate of new lesion was 19.4%. When the alpha-fetoprotien level before the procedure was higher and a tumor was multiple in number, new lesions occurred more frequently. CONCLUSION: Sufficient knowledge of patterns of recurrence and the factors which influence them might improve the therapeutic effects of RF ablation in patients with HCC.
alpha-Fetoproteins ; Biopsy ; Carcinoma, Hepatocellular* ; Catheter Ablation* ; Classification ; Fetal Proteins ; Follow-Up Studies ; Humans ; Incidence ; Necrosis ; Portal Vein ; Recurrence ; Tomography, Spiral Computed

To evaluate MR findings of soft tissue masses in extremities and to find the helpful findings of distinguish benignity from malignancy, 28 soft tissue masses (22 benign and 6 malignant) in extremities were reviewed. T1-weighted, proton density, T2-weighted and Gd-DTPA enhanced images were obtained. MR images allowed a specific diagnosis in a large number of benign masses, such as hemangioma(8/9), lipoma(2/2), angiolipoma(1/1), epidermoid cyst(2/2), myositis ossificans(1/1), synovial chondromatosis(1/1) and pigmented villonodular synovitis (1/2). Specific diagnosis was difficult in the rest of the masses including malignancy. However, inhomogenous signal intensities with necrosis and inhomogenous enhancement may suggest malignant masses.
Diagnosis ; Extremities ; Gadolinium DTPA ; Myositis ; Necrosis ; Protons ; Synovitis, Pigmented Villonodular

Charcot-Marie-Tooth disease (CMTD) is a hereditary neuropathy with slow progression, whereas Guillain-Barre syndrome is an acute acquired neuropathy of immunopathogenesis. A 17 year-old girl with hammertoes and pes cavus developed an acute quadriparesis. The duplication of PMP-22 exons in 17p12-p11.2 was confirmed by genetic study. After Intravenous ingection of immunoglobulin, she recovered to normal activity within one month with improvement of nerve conduction study. We should be concerned with the possibility of Guillain-Barre syndrome if there is rapidly progressive exacerbation on CMTD.
Adolescent ; Charcot-Marie-Tooth Disease* ; Exons ; Female ; Foot Deformities ; Guillain-Barre Syndrome* ; Humans ; Immunoglobulins ; Neural Conduction ; Quadriplegia

Background: Palmoplantar pustulosis is a specific form of localized pustular psoriasis occurring on the palm and sole. Multiple therapeutic options, including topical and systemic agents as well as phototherapies, are available for palmoplantar pustulosis; however, treatment outcomes are not satisfactory in most cases. Recently, a gain-switched 311-nm Ti:Sapphire Laser was developed and showed good treatment response in vitiligo and atopic dermatitis. Objective: To investigate the efficacy and safety of the 311-nm Ti:Sapphire Laser in the treatment of palmoplantar pustulosis. Methods: A total of 24 patients with palmoplantar pustulosis were treated with a 311-nm Ti:Sapphire Laser twice a week for up to 32 sessions and had a 3-month follow-up visit. The treatment dose started at 300 mJ/cm 2 and was increased by 50 mJ/cm 2 at each subsequent session. The Palmoplantar Pustular Psoriasis Area and Severity Index score, 5-grade patient satisfaction score, and adverse events were evaluated. Results: The mean Palmoplantar Pustular Psoriasis Area and Severity Index score decreased from 8.31±3.31 at baseline to 4.75±2.70 at 16 sessions, 3.26±2.18 at 32 sessions, and 4.05±2.19 at follow-up visit. In the subgroup analysis, non-smokers and emollients user groups showed better responses in Palmoplantar Pustular Psoriasis Area and Severity Index (p=0.033 and p=0.027, respectively). Adverse effects, including burning sensation and transient erythema, were limited and well-tolerated. Conclusion The 311-nm Ti:Sapphire Laser can be considered as a treatment option for palmoplantar pustulosis.Moreover, habitual risk factor modifications, such as smoking cessation and steady use of emollients, can impact treatment outcomes in patients with palmoplantar pustulosis.

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by severe thunderclap headache with multifocal segmental vasoconstriction of the cerebral arteries. RCVS can be diagnosed if the cerebral angiogram shows segmental stenosis and spontaneously resolves within weeks to months. RCVS is reversible, but might cause brain lesions such as subarachnoid hemorrhage or cerebral infarction. We report a 45-year-old woman with severe sudden onset frontal headache who was identified with reversible cerebral vasoconstriction syndrome.
Angiography ; Brain ; Cerebral Arteries ; Cerebral Infarction ; Constriction, Pathologic ; Female ; Headache ; Headache Disorders, Primary ; Humans ; Middle Aged ; Subarachnoid Hemorrhage ; Swimming ; Vasoconstriction