Tissue tear hemorrhages(TTHs) have been thought to be visible manifestation of more severe forms of diffuse axonal injury and thus portend a poor prognsis. Computed tomographic scans and magnetic resonance images from 1076 patients with closed head injuries were reviewed;30(3.5%) cases were found to have TTHs. The authors investigated the clinical spectrum of TTHs. No direct relationship could e established between presence of TTHs and the severity and/or outcome from the head injury in this group. Magnetic resonance imaging provided more sensitive information than computed tomography in evaluating TTHs.
Brain* ; Craniocerebral Trauma ; Diffuse Axonal Injury ; Head Injuries, Closed ; Humans ; Magnetic Resonance Imaging

The authors present a case of central neurocytoma in right lateral ventricle. Central neurocytoma is a rare clinicopathological entity that has been recently recognized and is characterized by 1) intraventricular location, 2) predominant occurance in young adults, 3) oligodendroglioma-like histology, 4) benign course, 5) immunohistochemical and ultrastructual evidence of neuronal differentiation. Twenty one year old female patient was admitted to the Department of neurosurgery of Chung Ang Gil hospital because of diplopia and headache which developed and progressed gradually 2 months prior to admission. The neurological examination showed paresis of right lateral rectus muscle, bilateral optic papilledema, nystagmus and mild left hemiparesis. MRI scan showd an intraventricular tumor of lateral ventricle that had isosignal and high signal intensity with cortex on T1-and T2-weighted and proton density images, respectively. Serpiginous flow voids representing blood vessels in the tumor were seen an all pulse sequences.
Blood Vessels ; Diplopia ; Female ; Headache ; Humans ; Lateral Ventricles* ; Magnetic Resonance Imaging ; Microscopy, Electron ; Neurocytoma* ; Neurologic Examination ; Neurons ; Neurosurgery ; Papilledema ; Paresis ; Protons ; Young Adult

Bednar tumor was described by Bednar in 1957. The histologic pattern of this tumor shows similar to dermatofibrosarcoma protuberans (DFSP) but melanin pigments are scattered within the tumor, It's rare neoplasm accounting for approximately 1-5% of all case of DFSP. Clinically, this tumor is considered to be intermediated malignancy, because of slow growth and frequent local recurrence and lack of distant metastasis. The majority are located on the trunk and the upper and lower extremities, but extremely rate in the head and neck area. Microscopically, this tumor is characterized by tight storiform spindle cells and long slender cells that admixed with a small population of melanin containing dendritic cells. This dendritic cells are the primary features distinguising this lesion from conventional DFSP. Complete surgical excision and close follow-up case are necessany for this neoplasm because of probable intermediate malignancy. A patient was admitted to Our Department of Oral and Maxillofacial Surgery due to swelling on right parotid area and numbness of the right lower lip on September, 1994, By clinical examinations and C-T finding, we dignosed tentatively as myxoma or pleomorphic adenoma. Surgical excision of this tumor was performed with parotidectomy and mandibular osteotomy under the frozen biopsy. By final microscopic and electromicroscopic examination and immunohistochemical study, this tumor was diagnosed as Bednar tumor. So, we report a case of pigmented DFSP with review of literatures.
Adenoma, Pleomorphic ; Biopsy ; Dendritic Cells ; Dermatofibrosarcoma* ; Follow-Up Studies ; Head ; Humans ; Hypesthesia ; Lip ; Lower Extremity ; Mandibular Osteotomy ; Melanins ; Myxoma ; Neck ; Neoplasm Metastasis ; Recurrence ; Surgery, Oral

PURPOSE: The laparoscopic cholecystectomy has become a common procedure for treating gallbladder disease. The objectives of this study was to evaluate the learning curve by reviewing 145 patients treated with laparoscopic cholecystectomy, between Group A (From January 1991 to December 1995) and Group B (From January 1996 to December 2000). METHODS: We retrospectively analyzed 145 laparoscopic cholecystectomies performed at the Department of General Surgery, National Medical Center, from January 1991 to December 2000. The sex, age, operation time, associated disease, previous operation history, hospital stay, and pathology were reviewed. RESULTS: The ratio of Females to males was 1.9:1, and their age ranged from 18 to 80 years with the majority in their fifties and sixties. Most of the operative indications were cholelithiasis. The mean operative time was 89 minutes, which varied between 40 and 180 minutes, and the average admission time was five days. The operation times of Group A and Group B were statistically significant with respect to learning curve (p value<0.000). A linear regression test of the operation time and operation cases was also significant. The postoperative analgesic injection and hospital stay were improved in Group B, but had no statistical significance. A conversion to open cholecystectomy was done in four cases due to bleeding, severe adhesion, or clip migration of the cystic duct during surgery. CONCLUSION: The laparoscopic cholecystectomy was a safe and effective treatment for gallbladder disease, and wepredict that the operation time will become shorter with more experience.
Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholelithiasis ; Cystic Duct ; Female ; Gallbladder Diseases ; Hemorrhage ; Humans ; Learning Curve ; Length of Stay ; Linear Models ; Male ; Operative Time ; Pathology ; Retrospective Studies

It is well recognized that there is an association between hyperlipidemia and pancreatitis. However, it is not so easy to define clearly whether lipid abnormalities are the cause or the result of pancreatitis. Generally, a serum level of more than 1,000 mg/dL of triglyceride is an identifiable risk factor of hyperlipidemic pancreatitis in patients with type I, IV, or V hyperlipidemia classified by Fredrick's criteria. The clinical course as well as the management of hyperlipidemic pancreatitis is not different from that of pancreatitis of other causes. A thorough family history of lipid abnormalities should be obtained and an attempt to identify secondary causes should be made. The mainstay of treatment includes dietary restriction of fat and lipid-lowering medications. In Korea, there have been reported several cases of hyperlipidemic pancreatitis but familial history of hyperlipidemia has never been identified. We experienced a case of acute type IV hyperlipidemic pancreatitis in a patient suspected of familial combined hyperlipidemia. So, we report this case with the review of related literature.
Humans ; Hyperlipidemia, Familial Combined* ; Hyperlipidemias ; Korea ; Pancreatitis* ; Risk Factors ; Triglycerides

Diabetic patients have an increased risk of burn injuries on foot. Because of their diabetic neuropathy, they could contact with hot water or warming device without being aware of it. Split-thickness skin graft (STSG) is successful in treatment of various wound types; however, donor site wounds are sometimes problematic, and complications such as pain and impaired healing often occur. Although, donor site wounds in healthy young individuals can rapidly heal without complications, the wound-healing capacity of elderly patients or those with a comorbidity has been reported to be low. The dermatome is the most commonly used tool because it can harvest a large skin graft in one attempt. However, it is difficult to harvest tissues if the area is not flat. Furthermore, because the harvested skin is usually rectangular, additional skin usually remains after skin grafting. Therefore, use of razor blade and fragmented STSG on a large defect area is advantageous for harvesting a graft with a desired size, shape, and thickness. From January 2018 to July 2018, fragmented STSG was used in 9 patients who suffered from burn induced open wound on foot with diabetic neuropathy. With this approach, healing process was relatively rapid. The mean age of patients was 70 (57∼86 years) and all of 9 patients had diabetes mellitus type 2. In all patients, the skin graft on the defect site healed well and did not result in complications such as hematoma or seroma.

Background: Subdermal shaving is a surgical procedure for the treatment of axillary osmidrosis. In this procedure, a direct axillary incision is made, and the apocrine glands are removed. Insufficient subcutaneous tissue removal during subdermal shaving can lead to recurrence due to the presence of remaining apocrine glands, while excessive removal can injure the subdermal plexus and cause skin necrosis. We measured the depth of the apocrine glands from the basement membrane of the epidermis to develop a quantitative method of determining the thickness of the skin flap to be removed. Methods: A chart review of patients who underwent subcutaneous shaving to treat osmidrosis between 2012 and 2019 was performed. Axillary subcutaneous tissues were harvested from five randomly chosen patients with osmidrosis before and after surgery. The apocrine gland depth was then measured via immunofluorescence (IF) staining of the collected tissues. A questionnaire was administered to 10 of the patients to investigate postoperative outcomes. Results: Of the 47 total patients, six (12.8%) experienced recurrence, seven (14.9%) had complications, four (8.5%) had skin necrosis, two (4.3%) had hematomas, and one (2.1%) had an infection. One patient underwent reoperation due to hematoma. IF staining revealed the mean distance from the basal layer of the epidermis to the apocrine glands to be 1.4312±0.8064 mm. On the questionnaire, the mean patient rating of axillary odor was 8.6 pre-surgery and 4.4 post-surgery. Conclusions During subdermal shaving, the subcutaneous tissue must be preserved up to 14.312±8.064 mm from the epidermal basement membrane to remove the apocrine glands while preserving the subdermal plexus.

We report here on an extremely rare case of duplicated extrahepatic bile ducts that was associated with choledocholithiasis, and this malady was visualized by employing the minimum intensity projection images with using multi-detector row CT. The presence of duplicated extrahepatic bile ducts with a proximal communication, and the ducts were joined distally and they subsequently formed a single common bile duct, has not been previously reported.
Aged, 80 and over ; Bile Ducts, Extrahepatic/*abnormalities/pathology/radiography ; Choledocholithiasis/*complications/radiography ; Female ; Humans

Internal auditory canal (IAC) stenosis with hypoplasia of the facial and vestibulocochlear nerves is a rare cause of congenital facial palsy. In this case report, a 3-month-old female infant was referred for a neurological developmental assessment for developmental delay and congenital facial palsy. Upon evaluation of developmental delay, hearing loss was detected. Following a magnetic resonance imaging scan of the brain and a computed tomography scan of the temporal bone, IAC stenosis with hypoplasia of facial and vestibular nerves was diagnosed. This is a rare case of IAC stenosis in an infant with initial presentations of left facial palsy and developmental delay associated with hearing loss in the left ear. We strongly suggest that IAC stenosis be considered a cause of congenital facial palsy in infants, especially in patients with developmental delay. In infants with congenital facial palsy, a thorough physical examination and neurological developmental assessment should be performed.

BACKGROUND: The bone graft for the alveolar cleft has been accepted as one of the essential treatments for cleft lip patients. Precise preoperative measurement of the architecture and size of the bone defect in alveolar cleft has been considered helpful for increasing the success rate of bone grafting because those features may vary with the cleft type. Recently, some studies have reported on the usefulness of three-dimensional (3D) computed tomography (CT) assessment of alveolar bone defect; however, no study on the possible implication of the cleft type on the difference between the presumed and actual value has been conducted yet. We aimed to evaluate the clinical predictability of such measurement using 3D CT assessment according to the cleft type. METHODS: The study consisted of 47 pediatric patients. The subjects were divided according to the cleft type. CT was performed before the graft operation and assessed using image analysis software. The statistical significance of the difference between the preoperative estimation and intraoperative measurement was analyzed. RESULTS: The difference between the preoperative and intraoperative values were -0.1+/-0.3 cm3 (P=0.084). There was no significant intergroup difference, but the groups with a cleft palate showed a significant difference of -0.2+/-0.3 cm3 (P<0.05). CONCLUSIONS: Assessment of the alveolar cleft volume using 3D CT scan data and image analysis software can help in selecting the optimal graft procedure and extracting the correct volume of cancellous bone for grafting. Considering the cleft type, it would be helpful to extract an additional volume of 0.2 cm3 in the presence of a cleft palate.
Alveoloplasty ; Bone Transplantation ; Cleft Lip ; Cleft Palate ; Cone-Beam Computed Tomography ; Humans ; Transplants