There have been various surgical methods to treat the carotid cavernous fistula such as the carotid ligation, trapping procedure, embolization with muscle, gelfoam and polyurethane foam, balloon technique and direct transcavernous approach. Each method has its own merits and disadvantages. The ideal treatment of the illness would be the selective closure of the fistula with preservation of carotid patency. The authors are reporting a case of C-C fistula in which selective muscle embolism preserving carotid flow was attempted at first, but the closure was incomplete that polyurethane foam embolization was done in addition with success.
Carotid-Cavernous Sinus Fistula ; Embolism ; Fistula* ; Gelatin Sponge, Absorbable ; Ligation ; Polyurethanes*

Round cell sarcomas involving spinal epidural space such as Hodgkin's disease, plasma cali sarcoma reticulum cell sarcoma and lymphosarcoma are well known diseases. Of those, primary lymphosarcoma arising at spinal epidural space has been reported as the very rare disease by Bucy and other authors. The clinical pictures of the disease were presented by the compression of the spinal cord or cauda equina. If the condition treated promptly and properly with surgery and radiation therapy, the outlook would be good both for recovery and life in most instances. We have experienced a case of primary lymphosarcoma involving lumbar spinal epidural space in a 13 year-old male and obtained a good result after surgery and radiation therapy.
Adolescent ; Cauda Equina ; Epidural Space ; Hodgkin Disease ; Humans ; Lymphoma, Non-Hodgkin* ; Male ; Plasma ; Rare Diseases ; Sarcoma ; Spinal Cord

Lipofibromatous hamartoma of median nerve is an extremely rare tumor that involves the palmar aspect of the hand, wrist and distal forearm. Other terms to describe this condition include macrodystopia lipomatosa of median nerve and median nerve territory-oriented macrodactyly. Lipofibromatous hamartoma is the most common condition associated with macrodactyly in the hand Also it most commonly involves the median nerve and is one of the causes of carpal tunnel syndrome. We present a review of our experience with this unusual neoplasm and give a detailed follow-up on patient treated by surgical exploration with carpal tunnel release.
Carpal Tunnel Syndrome* ; Follow-Up Studies ; Forearm ; Hamartoma* ; Hand ; Humans ; Median Nerve* ; Wrist

Background: The nipple is a potential source of pathogens because its lactiferous ducts act as direct conduits from the nipple–areolar complex to the breast parenchyma. Our previous studies identified breast microbiota as a factor in postoperative complications following immediate breast reconstruction using silicone implants and acellular dermal matrix. This study aimed to investigate the correlation between preoperative nipple swab microbiota and the incidence of surgical site infections (SSIs) after autologous breast reconstruction. Methods: We conducted a retrospective chart review of patients who underwent autologous breast reconstruction following total mastectomy. Preoperative nipple swab cultures were obtained. Patient demographics, surgical characteristics, and complication rates were compared between culture-positive and culture-negative groups. Microbiological data, including antibiotic‑resistance profiles, were collected. Results: Among 39 reconstructed breasts, 18 (46.9%) had positive preoperative nipple cultures. The mean duration of drain placement was significantly longer in the culture‑positive group (14.39±3.96 days) than in the culture‑negative group (12.14±2.76 days, P=0.045). Methicillin‑susceptible Staphylococcus epidermidis accounted for 55.0% of isolates. Of the four SSIs observed, three occurred in patients with positive preoperative cultures. Conclusions Although pathogen strains differed between preoperative and postoperative settings, obtaining preoperative nipple microflora cultures and determining antibiotic‑resistance profiles can guide immediate antibiotic selection for SSIs and enhance postoperative management.

Background: The nipple is a potential source of pathogens because its lactiferous ducts act as direct conduits from the nipple–areolar complex to the breast parenchyma. Our previous studies identified breast microbiota as a factor in postoperative complications following immediate breast reconstruction using silicone implants and acellular dermal matrix. This study aimed to investigate the correlation between preoperative nipple swab microbiota and the incidence of surgical site infections (SSIs) after autologous breast reconstruction. Methods: We conducted a retrospective chart review of patients who underwent autologous breast reconstruction following total mastectomy. Preoperative nipple swab cultures were obtained. Patient demographics, surgical characteristics, and complication rates were compared between culture-positive and culture-negative groups. Microbiological data, including antibiotic‑resistance profiles, were collected. Results: Among 39 reconstructed breasts, 18 (46.9%) had positive preoperative nipple cultures. The mean duration of drain placement was significantly longer in the culture‑positive group (14.39±3.96 days) than in the culture‑negative group (12.14±2.76 days, P=0.045). Methicillin‑susceptible Staphylococcus epidermidis accounted for 55.0% of isolates. Of the four SSIs observed, three occurred in patients with positive preoperative cultures. Conclusions Although pathogen strains differed between preoperative and postoperative settings, obtaining preoperative nipple microflora cultures and determining antibiotic‑resistance profiles can guide immediate antibiotic selection for SSIs and enhance postoperative management.

Background: The nipple is a potential source of pathogens because its lactiferous ducts act as direct conduits from the nipple–areolar complex to the breast parenchyma. Our previous studies identified breast microbiota as a factor in postoperative complications following immediate breast reconstruction using silicone implants and acellular dermal matrix. This study aimed to investigate the correlation between preoperative nipple swab microbiota and the incidence of surgical site infections (SSIs) after autologous breast reconstruction. Methods: We conducted a retrospective chart review of patients who underwent autologous breast reconstruction following total mastectomy. Preoperative nipple swab cultures were obtained. Patient demographics, surgical characteristics, and complication rates were compared between culture-positive and culture-negative groups. Microbiological data, including antibiotic‑resistance profiles, were collected. Results: Among 39 reconstructed breasts, 18 (46.9%) had positive preoperative nipple cultures. The mean duration of drain placement was significantly longer in the culture‑positive group (14.39±3.96 days) than in the culture‑negative group (12.14±2.76 days, P=0.045). Methicillin‑susceptible Staphylococcus epidermidis accounted for 55.0% of isolates. Of the four SSIs observed, three occurred in patients with positive preoperative cultures. Conclusions Although pathogen strains differed between preoperative and postoperative settings, obtaining preoperative nipple microflora cultures and determining antibiotic‑resistance profiles can guide immediate antibiotic selection for SSIs and enhance postoperative management.

Peutz-Jeghers Syndrome, characterized by autosomal inheritance, skin pigmentation, and hamartomatous polyps, had long been considered a benign polyposis until recent studies suggested an association with increased risk of malignant neoplasia in patients who had been followed-up for long periods. The authors present a case of Peutz-Jeghers syndrome in a 44 year old man with an adenomatous malignant change in his small bowel. The patient underwent surgery following a diagnosis of intestinal intussuception. Observing the polyps resected, all the polyps had characteristics of hamartoma, excluding one which showed a malignant transformation. Although it has not been fully determined with certainty whether the adenocarcinoma developed from hamartoma, histologic examination of an excised specimen suggested, thht potency of hamartoma to undergo malignant transformation. All the members of the family were confirmed to have no evidence of Peutz-Jeghers syndrome. Our clinical experience determines the malignant potency in Peutz-Jeghers and recommends that intensive follow-up of gastrointestinal and extragastrointestinal sites is needed in patients with this syndrome.
Adenocarcinoma ; Adult* ; Diagnosis ; Follow-Up Studies ; Hamartoma ; Humans ; Male* ; Peutz-Jeghers Syndrome ; Polyps ; Skin Pigmentation ; Wills

PURPOSE: To evaluate the usefulness and diagnostic accuracy of turbo spin-echo(TSE) proton-density andT2-weighted images of meniscal tears of the knee. MATERIALS AND METHODS: We retrospectively evaluated thesensitivity, specificity, and accuracy of TSE proton density and T2-weighted images of meniscal tears confirmedarthroscopically or surgically in 47 patients(98 menisci). The routine TSE parameters used in all patients werethe dual echo sequence with sagittal proton density and T2-weighed images(4000/16, 90/5/2 [TR/effectiveTE/ETL/NEX]), and fat-suppressed coronal proton density and T2-weighted images. The chi-square test was used forstatistical analysis. RESULTS: The sensitivity, specificity, and accuracy of TSE proton density images for thedetection of meniscal tears were 93.9%, 93.8%, and 93.9%, respectively, in the medial meniscus, and 92.9%, 91.4%,and 91.8% in the lateral. On T2-weighted images the corresponding figures were 87.9%, 93.8%, and 89.8%,respectively, in the medial meniscus, and 64.3%, 91.4%, and 83.7 % in the lateral. CONCLUSION: With regard tosensitivity and accuracy, TSE proton density images of meniscal tears were superior to TSE T2-weighted images.
Humans ; Knee* ; Magnetic Resonance Imaging* ; Menisci, Tibial ; Protons ; Retrospective Studies ; Sensitivity and Specificity

BACKGROUND: CATCH-22 syndrome is a common genetic disorder with features of cardiac defect, abnormal face, thymic hypoplasia, cleft palate, and hypocalcemia, along with microdeletion at chromosome 22. This study is to report twelve Korean patients with CATCH-22 syndrome diagnosed by the fluorescent in situ hybridization (FISH) method. METHOD: Clinical features were analyzed according to the FISH result and the Southern blot analysis using new probes DGCR680 and pDH-1 was performed to correlate with the clinical findings and FISH results. Twelve patients were studied by FISH method and eight of them were studied by Southern blot analysis. RESULTS: Seven patients had typical facial features for CATCH-22 syndrome, but five patients had equivocal face, although they were originally suspected to have the conotruncal face. The main cardiac lesion of eight patients were tetralogy of Fallot (TOF) and seven of them had pulmonary atresia. Two cases had other anomalies in the ventricular outflow tract, being common arterial trunk or pulmonary stenosis. Two cases had a patent arterial duct or atrial septal defect (ASD). All of twelve patients had positive result on FISH study. Among eight patients with positive FISH study, six cases were positive for Southern blot analysis. CONCLUSION: We conclude that CATCH-22 syndrome has variable facial, cardiac and genetic features, and the combined use of probes is recommended for a more accurate diagnosis.
Blotting, Southern ; Chromosomes, Human, Pair 22 ; Cleft Palate ; Diagnosis* ; DiGeorge Syndrome ; Heart Defects, Congenital ; Heart Septal Defects, Atrial ; Humans ; Hypocalcemia ; In Situ Hybridization, Fluorescence ; Pulmonary Atresia ; Pulmonary Valve Stenosis ; Tetralogy of Fallot

BACKGROUND: LV chamber obliteration(COB) during dobutamine stress echocardiography indicates a vigorous inotropic response to dobutamine stress. This may suggest the absence of coronary artery disease, but a small LV cavity may also preclude recognition of wall motion abnormalities. METHODS: Chamber obliteration was defined by contact of the opposite walls in the apical 4 chamber views during dobutamine stress echocardiography. To detect of chamber obliteration and coronary artery disease, dobutamine stress echocardiography was performed in 132 patients with chest pain. To confirm of coronary artery disease, coronary angiography was performed in 64 patients among 132 patients. RESULTS: 1) Chamber obliteration during dobutamine stress echocardiography occurred in 37 patients(28%) among 132 patients. 2) Chamber obliteration during dobutamine stress echocardiography was more common in patients with hypertension(p<0.05) and left ventricular hypertrophy during baseline echocardiography(p<0.005). 3) Coronary angiography was performed in 64 patients(48 patients without chamber obliteration, 16 patients with chamber obliteration). The sensitivity of dobutamine stress echocardiography in the diagnosis of coronary artery disease was 88% in patients without chamber obliteration, 71% in patients with chamber obliteration. But, the difference of sensitivity of both groups was not significant. CONCLUSION: These results suggest that chamber obliteration during dobutamine stress echocardiography will not affect results of the sensitivity of dobutamine stress echocardiography in the diagnosis of coronary artery disease.
Chest Pain ; Coronary Angiography ; Coronary Artery Disease ; Diagnosis ; Dobutamine* ; Echocardiography, Stress* ; Heart Ventricles* ; Humans ; Hypertrophy, Left Ventricular