PURPOSE: To analyze the variable MRI features and clinical significance of intracranial cavernous realformation. MATERIALS AND METHODS: Forty patients(mean age 35.4) with cavernous malformation were evaluated by MRI. Eleven patients were surgically confirmed. Cavernous malformations were divided into four categories on the basis of the MR imaging characteristics, especially on T2-weighted image. Type I lesion was defined as an extralesional subacute hemorrhage outside the low signal rim, type II as an intralesional hemorrhage surrounded by low signal rim, type III lesion as an intralesional thrombosis with variegated central core surrounded by low signal rim, and type IV lesion as a focal old hemorrhagic core with small low signal intensity. Type IV was further divided into IVa and IVb, whether the lesion has small iso- or hypersignal central core (IVa) or not (IVb). Follow-up MRI was evaluated in 12 patients who were managed conservatively. Follow-up intervals ranged from 2 weeks to 29 months (mean 6months). RESULTS: Total 80 lesions were detected in 40 patients. Multiple lesions were noted in 10 patients. The topography of the cavernous malformations was supratentorial in 75% and infratentorial in 23%. There were 10 lesions in type I, 15 in type 11, 21 in type III, 14 in type IVa, and 20 in type IVb. Type I lesions mainly showed mass effect and edema. Type III lesions showed minimal contrast enhancements in 7 lesions on delayed images. Type II lesions showed the characteristics of both type I and type III lesions. On follow up images, decrease in size in 5, change of type in 7, rebleeding in 2 and no change in 12 lesions were demonstrated. Hemorrhage, edema and mass effect were combined in the cases of rebleeding. On follow-up study, the estimated risk of bleeding was 32.3%/person-year and 13.7%/lesion-year. CONCLUSION: Cavernous realformations show as variable appearance, on MR imaging suggesting variable stages of evolution. The MR morphologic classification and evaluation of secondary findings are helpful to predict natural course and possibility of rebleeding of the lesion.
Classification ; Edema ; Follow-Up Studies ; Hemorrhage ; Humans ; Magnetic Resonance Imaging* ; Thrombosis

The clinical resemblance of carcinoma of the Meibomian gland to the relatively frequent chaiazion should be kept in mind by anyone performing eye lid surgery. A 46-year-oId Korean house wife was first visited here in May 2nd '69 with complaints of localized swelling, ulceration and dull pain on the left upper lid. She had been taken the operation for chaiazion on the same side of the left upper eye lid a year ago. Examination revealed a reddened hard, tender lesion elevating the skin on the medial one third of the left upper lid with ulceration at its center. The tarsal conjunctiva was noted yellowish patches with ulceraion extended to its margin. Local resection with full thickness containing normal tissue around he lesion of upper lid was performed and graft was made in lower lid and rotatory transplantation was given, and pathologic examination revealed adeno-carcinoma of Meibimian gland. There was no evidence of recurrence and metastasis to remote site a year after surgery.
Adenocarcinoma* ; Conjunctiva ; Humans ; Meibomian Glands* ; Neoplasm Metastasis ; Recurrence ; Skin ; Spouses ; Transplants ; Ulcer

No abstract available.
Arthritis* ; Knee*

BACKGROUND: Scuba diving has become increasingly popular in Korea. Medical problems are common with dives, especially decompression sickness(DCS). This study was performed to obtain an useful information of hyperbaric oxygen therapy in DCS in Korea. METHOD: We reviewed the 62 cases of Korean divers, who were diagnosed as DCS and received recompression therapy according to U.S. Navy Standard Recompression Treatment Table at Ocean and Underwater Medical Research and Training Center of ROK Navy, for 6 years from Jan. 1993 to Nov. 1998. RESULT: 1) the mean no-decompression limit excess time between type I DCS group(72.7 min.) and type II DCS group(92.8min.) showed significant difference. 2) The rate of symptoms appeared on surfacing and within 10min. after surfacing of type I and type II DCS were 41.4%and 72.7% respectively. 3) The cure late of type I and type II were 75.9%and 42.4% respectively. In type II DCS group, the cure rate of the group within 12 hour-delayed recompression treatment and the group above 12 hour-delayed treatment were 64.3%and time 26.3% respectively, and in type I DCS group, 100% and 66.7% respectively. CONCLUSION: These findings suggest that the education of safety, the strict observance of the standard decompression table, and the avoidance of excessive repeated diving are important for reducing the risk of diving related disease. And to offer proper management of DCS, there should be more multiplace hyperbaric oxygen chambers, the suitable transport system, and the specialist of diving medicine or hyperbaric medicine in Korea.
Decompression Sickness* ; Decompression* ; Diving ; Education ; Hyperbaric Oxygenation* ; Korea ; Oxygen ; Specialization

Multiple primary tumors are defined as cases involving primary malignant tumors of different histologic origins in one person. The absolute number of reported cases of double primary malignant tumors has increased in recent years diagnostic procedures. Primary adenocarcinoma of duodenum is a rare disease and represents less than 0.5% of all gastrointestinal malignancies. Therefore, synchronous multiple primary cancers of the stomach and duodenum are very rare. Recently, we experienced a case of triple primary malignant tumors of different site originating from the stomach, duodenum and cervix in 71- year-old woman. She had had radiation therapy and chemotherapy for squamous cell carcinoma of the uterine cervix 8 years previously. We performed subtotal gastrectomy and pancreaticoduodenectomy with radical lymph node dissection. She remained healthy without any evidence of recurrence 12 months after the operation.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Cervix Uteri ; Drug Therapy ; Duodenal Neoplasms* ; Duodenum ; Female ; Gastrectomy ; Humans ; Lymph Node Excision ; Pancreaticoduodenectomy ; Rare Diseases ; Recurrence ; Stomach ; Stomach Neoplasms* ; Uterine Cervical Neoplasms*

In spite of vigorous efforts to enhance appropriateness of blood usage in surgery, it is recognized that there are still not a few overuse and misuse of blood products in Korean hospitals. To assure appropriate use of blood, continuous monitoring and controlfling blood orders, particularly for surgical operations, should be implemented. The indicator of 'ratio of crossmatching to transfusion' (C/T ratio) has been focalized on in this regard. The authors investigated C/T ratio for eight hospitals, evenly distributed in their geographical location as well as size. Only elective surgeries operated from March 1 to May 31, 1995 were included for analysis. Standardized survey format was distributed, and retrospective reviews of medical records were performed by volunteer surveyors from each hospital after two sessions of pre- survey education. The results were as follows. Average C/T ratio, for all hospitals and all surgeries, was 1.76. Differences in C/T ratio by sex, months, clinical departments, blood components were not significant. However, the ratio showed increasing tendency with ages. The C/T ratio on the average was not higher, compared with the recommended guideline. However, due to study' s limitations ini standardization of survey method and verification of data, we could not conclude that current status of appropriateness of blood use is satisfactory. In addition, to pervasively use the C/T ratio as a quality indicator for blood use management, supplementary measures, such as standardization of data, should be adopted.
Surveys and Questionnaires ; Education ; Medical Records ; Quality Indicators, Health Care* ; Retrospective Studies ; Volunteers

No abstract available.
Diagnosis* ; Hemoglobinuria*

Wiskott-Aldrich Syndrome is an X-linked disorder characterized by recurrent infection, thrombocypenia and eczema. Various defects in cell-mediated immunity and deficient antibody reponse to carbohydrate antigens have been described. We experienced a case of Wiskott-Aldrich Syndrome of 28 months old male patient. He has been suffered from multiple petechiae with bleeding, recurrent pyogenic infections and generalized eczema since 3 months of age. Immunological abnormalities are as follows: 1) Serum IgM was gradually decreased, while IgA and IgE were increased. 2) Antibody response against polysaccharide antigen (PRP) was not observed after 3 times of PRPT immunization. 3) CD4/CD8 ratio was reversed (0.6). 4) Proliferative response of mononuclear cells was significantly reduced, and CMI skin test also showed negative results. A brief review of literature was made.
Antibody Formation ; Child, Preschool ; Eczema ; Hemorrhage ; Humans ; Immunity, Cellular ; Immunization ; Immunoglobulin A ; Immunoglobulin E ; Immunoglobulin M ; Male ; Purpura ; Skin Tests ; Wiskott-Aldrich Syndrome*

PURPOSE: Laparoscopic appendectomy is one of the most commonly performed minimally invasive surgeries worldwide. In recent years, successful attempts to reduce the number of conventionally-used three ports have been reported. Specifically, two-port techniques, hybrid approaches and single-port assisted techniques have been described. In this article, we report on the feasibility, safety and cosmesis of trans-umbilical single port laparoscopic appendectomy. METHODS: The procedure was performed using a single 15-mm-diameter umbilical incision. Under general anesthesia, an Alexis O wound retractor (Applied medical resources Co., Ltd., rancho Santa Margarita) was inserted through the umbilicus. After the appendix and meso-appendix were dissected with a Harmonic scalpel (Ethicon Endo-Surgery, Inc., USA), the base of the appendix was ligated with two Endo-loops (SEOJONG medical Co., Ltd., Korea). The appendix was withdrawn into the wound protector and removed from the abdominal cavity. RESULTS: This retrospective study enrolled 70 patients (36 females and 34 males with a mean age of 29.0+/-15.0 years). The mean operative time was 49.0+/-13.9 min. There was no mortality. There were five complications in five patients (7.1%) and the median hospital stay was 3.5+/-1.4 days. CONCLUSION: This is a safe, minimally invasive procedure with excellent cosmetic results. Compared with other trans-umbilical appendectomy techniques, single port laparoscopic appendectomy has the advantages of feasibility without extensive endoscopic skills and an acceptable operative time. Technical refinements and accumulated experience probably will enable its wider use for more patients with acute appendicitis.
Anesthesia, General ; Appendectomy ; Appendicitis ; Appendix ; Chimera ; Cosmetics ; Female ; Humans ; Length of Stay ; Male ; Operative Time ; Retrospective Studies ; Umbilicus

PURPOSE: To evaluate the CT appearance of renal cell carcinoma and to correlate it with nuclear grading andcell type. MATERIALS AND METHODS: The size, outer margin and heterogeneity of inner texture of renal cell carcinomas in 86 patients were evaluated on CT scan and were correlated with nuclear grade and cell type. RESULTS: Tumors less than 5cm were of low grade in 28 of 31 patients, while those larger than 5cm were of low grade in 28 of 55 patients. The lesions which showed no or round protrusion with a sharp margin were of low grade in 26 of 28 patients, while those which showed an undulated or indistinct margin were of low grade in 30 of 58 patients. Lesions which showed a homogeneous solid appearance, focal low densities, or mostly cystic changes were of low grade in 23 of 26 patients, while those which showed multiple or confluent low densites were low grade in 33 of 60 patients. There was a significant difference in the distribution of nuclear grading between the groups. Differences in CT apperance according to cell type were not found. CONCLUSION: Differences in less than 5cm showing no or round protrusion with a sharp margin, homogeneous inner texture with solid appearance, and heterogeneous inner texture with cystic appearance or focal low densities on CT scan were thought to be the findings suggesting low nuclear grading.
Carcinoma, Renal Cell* ; Humans ; Population Characteristics ; Tomography, X-Ray Computed