Leiomyosarcoma arising in the skin is rare tumor, and diagnosis usually is made microscopically. After local excision, these lesions recur in large proportion of pat ients. The authors herein report a 53-year-old male with leiomyosarcoma appeared in the skin of the right forearm and presenting as a dark reddish colored, 5*6cm in diameter, superficial ulcerated single firm nodule with intermittent pain. Histopathological examination showed poorly circumscribed tumor consisting of interlacing bundles of spindle shaped smooth muscle cells in the middle and lower parts of the dermis. The nuclei were hyperchromatic, large, vacuolated, and irregular in shape. Electron microscopic findings revealed cytoplasmic organelles such as rough endoplasmic reticulum and mitochondria of malignant smooth muscle cells in the paranuclear area, Characteristic subsarcoelmmal caveolae and dense plaque were noted and myofilaments were distributed in the peripheral cytoplasm. The tumor did not recur in 10 months' follow-up.
Caveolae ; Cytoplasm ; Dermis ; Diagnosis ; Endoplasmic Reticulum, Rough ; Follow-Up Studies ; Forearm ; Humans ; Leiomyosarcoma* ; Male ; Middle Aged ; Mitochondria ; Myocytes, Smooth Muscle ; Myofibrils ; Organelles ; Skin* ; Ulcer

OBJECTIVE: The purpose of this study was to compare the right and left differences of frontal ramal inclination in chin-deviated individuals. METHODS: Thirty adult patients with clinically apparent chin deviation were selected as the chin-deviated group, and 30 adult patients with symmetric faces were selected as the control group. On the posteroanterior cephalograms, the frontal ramal inclination was measured, and the right and left differences were compared and analyzed. RESULTS: While the control group did not show right and left differences of frontal ramal inclinations, the chin-deviated individuals showed right and left differences of frontal ramal inclination. In chin-deviated individuals, the frontal ramal inclinations of the non-deviated side were statistically greater than those of the deviated side. The right and left differences of frontal ramal inclinations, with menton deviation and the right and left differences of maxillary heights showed statistically significant correlation. CONCLUSION: We conclude that the frontal ramal inclinations should be considered in the diagnosis of facial asymmetry.
Adult ; Chin ; Diagnosis ; Facial Asymmetry ; Humans

This is a case report of the congenital ileal atresia with disuse microcolon. The patient was a 3 day-old male newborn infant who was admitted in department of pediatrics Soon Chun Hyang Hospital with complaints of persistant vomitings, no meconium passage, and jaundice from a few hours after birth. The diagnosis was established by characteristic clinical features and barium enuma and finally confirmed by operationl. The operative findings showed that entire colon showed very narrow lumen and was associated with malrotation of the cecum, volvulus of midgut, multiple bands formation, and atresia of ileum with marked dilated proximal small bowel. It is considered that this microcolon was originated from non-use of the colon due to atreisa of the ileum. Resection of the obstructed ileum with multiple bandlysis and finally ileo-ileal end to end anastomosis were done. Microscopic findings showed that sections of cord like mass revealed marked narrowing of mucosal lumen with collections of mucus and necrotic cell debris and lack of mucosa. He was discharged 50 days after operation with favorable condition and normal finding of follow-up barium enema. A brief review of related literature was also presented.
Barium ; Cecum ; Colon ; Diagnosis ; Enema ; Follow-Up Studies ; Humans ; Ileum ; Infant, Newborn ; Intestinal Volvulus ; Jaundice ; Male ; Meconium ; Mucous Membrane ; Mucus ; Parturition ; Pediatrics

Enlargement is an inherent property of X-rays which occurs when straight lines diverge from small a focal spot. The purpose of the present study was to evaluate the validity of the correction of gonial angle width enlarged on frontal cephalogram, using frontal and lateral cephalograms taken orthogonally from each other. In 40 adult individuals, frontal and lateral cephalograms were taken at a 90 degrees angle using the Head Posture Aligner. The angle width was measured on the frontal cephalogram and subsequently, the corrected angle width was calculated using the magnification rate of two cephalograms. Measured and corrected angle widths were compared with the measurement from the 3D CT image. The measurement on the frontal cephalogram showed a 9.10 mm of enlargement on average, ranging from 7.92 to 11.31 mm. Corrected angle width measurement showed a 0.14 mm difference with the 3D CT image measurement, which was not statistically significant. The results of the study indicate that actual angle width can be approached through calculation using frontal and lateral cephalograms taken orthogonally with the help of the Head Posture Aligner. The study also showed that the magnitude of correction error did not show a significant correlation with the amount of menton deviation, and it suggests that the present correction method is valid even in individuals with severe facial asymmetry.
Adult ; Facial Asymmetry ; Head ; Humans ; Posture

Kasabach-Merritt syndrome is rare disorder which consists of hemangioma and thromobocytopenia occurring in infatns. Two cases of giant hemanioma with thrombocytopenia and anemia are reported with review of literures. It is postulated that the abnormalities resulted from intravascular coagulation within the hemangioma. Those patients were managed with prednisolone administration, blood transfusion and compression with the elastic bandage over the hemangioma. Following the conservative therapy the hemangioma regressed and the platelet and the erythrocyte returned to normal.
Anemia ; Blood Platelets ; Blood Transfusion ; Compression Bandages ; Erythrocytes ; Hemangioma ; Humans ; Kasabach-Merritt Syndrome* ; Prednisolone ; Thrombocytopenia

PURPOSE: To assess the effectiveness of optimal treatment of proximal humeral fractures and humeral shaft fractures in elderly patients with osteoporosis using the Polarus nail. MATERIALS AND METHODS: Twenty-three patients with proximal humeral and humeral shaft fractures in elderly osteoporosis patients were treated using the Polarus intramedullary nail. Nine patients had proximal humeral fracture, 10 had humeral shaft fracture and 4 had the proximal humeral frac-ture extended diaphyseally. Radiological outcomes included the bone-union and the degree of re-sidual deformity. The residual deformities of the proximal humerus were assessed by the neck-shaft angle and the shaft angulation. Clinical outcome was assessed with the American Shoulder and Elbow Surgeons (ASES) score. RESULTS: All cases had bony union and the mean union period was 16.5 weeks. The average neck/shaft alignment at the time of bone union was 135degrees and varus deformities of neck-shaft angle was not seen in all patients. Varus shaft angulation was seen in 5 patients. The mean ASES score after surgery was 86.7 points. CONCLUSION: The Polarus intramedullary nail is effective for the treatment of proximal humeral and humeral shaft fractures in elderly patients with osteoporosis because it not only enables early postoperative mobilization, but also obtains bone-union without avascular necrosis and nonunion.
Aged ; Congenital Abnormalities ; Elbow ; Humans ; Humerus ; Nails ; Necrosis ; Osteoporosis ; Shoulder ; Shoulder Fractures

STUDY DESIGN: A retrospective study OBJECTIVES: Contralateral undercutting laminoplasty via a unilateral laminotomy has been performed instead of bilateral partial laminectomy in lumbar spinal stenosis. This study compared the radiographic and clinical results of undercutting laminoplasty with bilateral partial laminectomy. SUMMARY OF LITERATURE REVIEW: Less invasive surgery has become attractive for minimizing soft tissue injury and reducing the recovery time. MATERIALS AND METHODS: Twenty five patients, who underwent decompressive surgery for lumbar spinal stenosis and were followed-up more than one year, were enrolled in this study. Unilateral undercutting laminoplasty and bilateral partial laminectomy was performed in 13 and 12 cases, respectively. The blood loss was compared and the presence of instability was observed. The increase in dural cross sectional area was measured in the preoperative and postoperative CT scans. In the clinical assessment, the Oswestry disability index (ODI) and visual analogue scale (VAS) to pain was used. RESULTS: The average blood loss per segment was 273 ml and 436 ml in the laminoplasty and laminectomy group. There was no case of instability after surgery but there was a significant difference in the increase in dural cross sectional area between the two groups: 109.7 mm2 and 78.6 mm2 in the laminoplasty and laminectomy group, respectively. The preoperative and final change in the ODI and VAS scores was similar between the two groups. CONCLUSIONS: Unilateral undercutting laminoplasty is a minimally invasive procedure with less blood loss than the conventional technique and is equally effective.
Humans ; Laminectomy ; Retrospective Studies ; Soft Tissue Injuries ; Spinal Stenosis

A male, 67 years old, visited the emergency room because of a foreign body impacted in his rectum. While he was being treated for grade-II hemorrhoids conservatively, he heard that massage of the peri-anal area could be helpful for preventing hemorrhoids. Thus, while using an electronic massager after placing the head of the machine into a short round bar, the head became separated from the machine, and this was inserted into the anus and impacted. The patient had anal discomfort without abdominal pain. His vital signs were stable, and no abnormal physical findings were found for the abdomen. On digital rectal examination, the rim of the foreign body was palpated about 8 cm from the anal verge. Anal bleeding, abnormal discharge, or foul odor was not found. On a simple abdominal X-ray, a radio-opaque foreign body was observed in the pelvic cavity, and mild leukocytosis was noted on the laboratory test. To avoid injury to the anal sphincter, we tried to remove the foreign body under the spinal anesthesia. After anesthesia had been administered, the foreign body was palpated more distally at 5-6 cm from the anal verge by digital examination, and the foreign body was found to have a hole in its center. This was held using a Kelly clamp, and with digital guiding, was removed through the anus. After removal, an anoscopic examination was performed to determine if mucosal injury had occurred in the rectum or anal canal. The patient was discharged without complication after 24 hours of close observation.
Abdomen ; Abdominal Pain ; Anal Canal ; Anesthesia ; Anesthesia, Spinal ; Digital Rectal Examination ; Electronics ; Electrons ; Emergencies ; Foreign Bodies ; Head ; Hemorrhage ; Hemorrhoids ; Humans ; Leukocytosis ; Male ; Massage ; Odors ; Rectum ; Vital Signs

A 62-year-old woman with two vessel coronary artery disease was scheduled for an off-pump coronary artery bypass graft. Under general anesthesia, a 7.5 Fr pulmonary artery (PA) catheter (AH-05050-H, Arrow, USA) was inserted via an 8.5 Fr introducer in the right internal jugular vein. After several attempts, it was successfully guided into the PA, and the systolic/diastolic/mean pressure was 28/10/16 mmHg at 45 cm insertion. Since the catheter migrated into an overwedged position during the operation, the catheter was withdrawn several centimeter. After a while, a sudden change of PA pressure waveform to plateau was noticed, and then PA pressure fell into 0/0/0 mmHg. The PA catheter tip was seen protruding through the normal-appearing anterior wall of the right ventricle. The catheter was withdrawn to a right atrial position, and the perforation was closed. The operation was finished uneventfully and the patient remained stable for the next 14 days and was discharged home. In this case, withdrawal of the PA catheter probably placed its tip in the origin of the PA, from which it then slipped into and perforated the right ventricle. After withdrawal of a PA catheter to avoid an overwedged position, the balloon of the catheter should be re-advanced into a proper position or be withdrawn to a right atrial position.
Anesthesia, General ; Catheters* ; Coronary Artery Bypass, Off-Pump ; Coronary Artery Disease ; Female ; Heart Ventricles ; Humans ; Jugular Veins ; Middle Aged ; Pulmonary Artery* ; Transplants

PURPOSE: This study clarified the bacterial pathogens currently causing acute infectious enterocolitis (AIE) in children and evaluated the clinical characteristics and ultrasonographic findings according to the different pathogens. METHODS: Medical records regarding age, sex, clinical symptoms, laboratory data, identified enteropathogens, ultrasonographic findings, treatment, and outcome of 34 patients who were diagnosed with AIE via stool examination using multiplex polymerase chain reaction (PCR) or culture, were retrospectively reviewed. RESULTS: Twenty-four patients (70.6%) were male. The mean age of the patients was 8.5±6.2 (range, 1.1–17.1) years. Six bacterial pathogens were isolated: Salmonella species (spp.) (32.4%), Campylobacter spp. (20.6%), verotoxin-producing Escherichia coli (14.7%), Staphylococcus aureus (11.8%), Clostridium difficile (8.8%), and Shigella spp. (2.9%). Abdominal pain occurred in all patients regardless of pathogen. The patients infected with Salmonella were older than those infected with verotoxin-producing E. coli (p<0.05). C-reactive protein levels were higher in patients with Salmonella and Campylobacter infections than in those with verotoxin-producing E. coli infection (p<0.05), the other clinical and laboratory data were indistinguishable between pathogens. Ultrasonography demonstrated diverse involvement of bowel segments according to pathogen. Wall thickening of both the ileum and the entire colon was the most common lesion site regardless of pathogen. CONCLUSION: Various bacterial agents cause AIE and the symptoms are diverse symptoms, however, all most children recovered spontaneously. Use of multiplex PCR on stool samples warrants improvement of its sensitivity for diagnosis of enteropathogenic bacteria. Ultrasonographic examination is useful for diagnosis of AIE; it can also detect the disease extent and severity.
Abdominal Pain ; Bacteria ; C-Reactive Protein ; Campylobacter ; Campylobacter Infections ; Child* ; Clostridium difficile ; Colon ; Diagnosis ; Enterocolitis* ; Humans ; Ileum ; Male ; Medical Records ; Multiplex Polymerase Chain Reaction ; Retrospective Studies ; Salmonella ; Shiga-Toxigenic Escherichia coli ; Shigella ; Staphylococcus aureus ; Ultrasonography