Nonfunctioning carcinoma of adrenal cortex is a rare disease and approximately 120 patients with nonfunctional adrenal cortical carcinoma have been reported in the world literature since first description of Rolienston and Marks in 1898. We report a case of nonfunctioning adrenal cortical carcinoma in a 47-year-old female patient, which was suspected by clinical investigation and confirmed by exploration and microscopic examination.
Adrenal Cortex* ; Adrenocortical Carcinoma ; Female ; Humans ; Middle Aged ; Rare Diseases

Nonfunctioning carcinoma of adrenal cortex is a rare disease and approximately 120 patients with nonfunctional adrenal cortical carcinoma have been reported in the world literature since first description of Rolienston and Marks in 1898. We report a case of nonfunctioning adrenal cortical carcinoma in a 47-year-old female patient, which was suspected by clinical investigation and confirmed by exploration and microscopic examination.
Adrenal Cortex* ; Adrenocortical Carcinoma ; Female ; Humans ; Middle Aged ; Rare Diseases

PURPOSE: To evaluate the value of dacryoscintigraphy in the assessment of patients with a clinical diagnosis of functional nasolacrimal duct obstruction. MATERIALS AND METHODS: Dacryoscintigraphy was performed in symptomatic 35 lacrimal drainage systems in 18 patients (age range: 37~76, 8 males, 10 females) that were patent on syringing. RESULTS: Abnormalities were detected with dacryoscintigraphy in 75.8% of systems. The positive scintigrams were subdivided into those demonstrating prelacrimal sac delay (31.8%), delay at the lacrimal sac/junction (40.9%), or delay within the duct (27%). CONCLUSION: Dacryoscintigraphy is noninvasive useful technique in the assessment of the functional nasolacrimal duct obstruction and very sensitive at detecting abnormalities in patients with lid laxity caused by senile change and facial nerve palsy.
Diagnosis* ; Drainage ; Facial Nerve ; Humans ; Male ; Nasolacrimal Duct* ; Paralysis

Traumatic injury to the lower legs has been increasing in Korea and often leads to skin and soft tissue loss, exposing blood vessels, nerves, tendons or bones. Salvaging these legs often requires free flaps. Over the past two decades, the use of free tissue transfer has produced an increasing salvage rate for severely injured lower leg. Between April. 1988 to July, 1997, 47 cases of lower soft tissue defects were reconstructed with free flaps, and retrospective analysis was performed to determine more about the factors associated with free flap failure or immediate vascular complications. We evaluated wound status before operation, operation time after injury, vascular status of recipient site, use of vein graft, use of reverse flow, salvage protocol in compromised anastomosis, survival rate and complications. There were 9 cases of venous thrombosis and 2 cases of arterial insufficiency while 7 out of 9 cases of venous thrombosis were reexplorated. However, 2 cases of partial flap necrosis and 1 case of total necrosis. Two cases of arterial insufficiency were necrotized, so the overall free flap failure rate was 9.6%. The results were analyzed to determine the factors promoting either failure or vascular complication, Many factors which are often blamed for failure (trauma cause, preoperative general condition, preoperative infection status, intraoperative ischemic time) were not significant in this study, but prolonged time after injury correlated with free flap failure, We concluded the adequate debridement and infection control, adequate selection of recipient vessel, accurate vascular anastomosis and most of all, early free flap transfer after injury, will improve the success rate.
Blood Vessels ; Debridement ; Free Tissue Flaps* ; Infection Control ; Korea ; Leg* ; Necrosis ; Retrospective Studies ; Skin ; Survival Rate ; Tendons ; Transplants ; Vascular System Injuries ; Veins ; Venous Thrombosis ; Wounds and Injuries

Gastrointestinal stromal tumors (GISTs) are rare tumers of the alimentary tract, and these tumors arise from primitive mesenchymal cells. Duodenal GISTs comprise 4-5% of all GISTs. In this article, we report on a case of duodenal GIST in 35-year-old male who presented with a fistulo in ano and anal bleeding. Abdominal computed tomography and magnetic resonance imaging revealed a huge tumor, about 11x7 cm in size, of the duodenum. Duodenoscopy revealed a protruded mass with central deep ulceration on the third portion of the duodenum. Endoscopic biopsies showed subepithelial spindle cell proliferation of the tumor, and this was consistent with GIST. Pylorus-preserving pancreaticoduodenectomy was then performed. He subsequently underwent the sphincter-preserving modified loose Seton surgical technique. The patient did not have any problems postoperatively and he remained symptom-free at 6 months after surgery.
Adult ; Biopsy ; Cell Proliferation ; Duodenoscopy ; Duodenum ; Gastrointestinal Stromal Tumors ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Male ; Pancreaticoduodenectomy ; Ulcer

PURPOSE: Thallim-201 (201Tl) brain SPECT and proton (1H) magnetic resonance spectroscopy (MRS) have been used to evaluate tumor grade and viability of glioma. We assessed the correlations between 201Tl brain index or spectrum of metabolites of 1H MRS and grade of glioma or histopathologic findings. MATERIALS AND METHODS: We studied 17 patients (4 astrocytoma, 7 anaplastic astrocytoma and 6 glioblastoma). On 201Tl Brain SPECT, 201Tl index was measured as the ratio of average counts for region of interest to those for the contralateral normal brain. On 1H MRS, we calculated choline (Cho) /creatine (Cr) ratio and N-acetylaspartate (NAA)/Cr ratio in ROI defined as tumor center. Histopathologic findings were graded by Ki-67 index, cellularity, mitosis, pleomorphism, necrosis and endothelial proliferation. An unpaired t test and statistical correlations were performed to evaluate these data. RESULTS: Tl-index showed the best correlation with Ki-67 index (p<0.01), less correlations with cellularity, mitosis, and endothelial proliferation, but no correlation with results of MRS, pleomorphism, or necrosis. The findings of MRS did not correlate with all of the above. The cases of glioblastoma demonstrated a higher Tl-index, Cho/Cr ratio, Ki-67 index and lower NAA/Cr ratio, albeit without statistical significance. CONCLUSION: Even though 201Tl brain SPECT did not correlate directly with grade of malignancy, it may still be useful in determining biological aggressiveness of tumor and prognosis of patients because it correlated well with Ki-67 index, a growth fraction of glioma, cellularity, mitosis and endothelial proliferation.
Astrocytoma ; Brain* ; Choline ; Glioblastoma ; Glioma* ; Humans ; Magnetic Resonance Spectroscopy* ; Mitosis ; Necrosis ; Pathology* ; Prognosis ; Protons ; Tomography, Emission-Computed, Single-Photon*

Hobnail hemangioma, also known as "targetoid hemosiderotic hemangioma", represents a distinctive benign vascular tumor, characterized histologically by a biphasic growth pattern of dilated vascular structures lined by prominent hobnail endothelial cells in the superficial dermis, and collagen dissection by angulated vessels in deeper parts of the lesion. It is important to distinguish this tumor from patch stage Kaposi's sarcoma, retiform hemangioendothelioma and progressive lymphangioma. We report a 26-year-old man showing typical clinical and histological features of hobnail hemangioma.
Adult ; Collagen ; Dermis ; Endothelial Cells ; Hemangioendothelioma ; Hemangioma* ; Humans ; Lymphangioma ; Sarcoma, Kaposi

PURPOSE: Blow-out fractures can be reduced using various methods. The orbital reconstruction technique using a balloon under endoscopic control has advantages over other methods. However, this method has some problems too, such as postoperative follow-up, management of the balloon catheter, and reduction of the posterior orbital floor. Thus, we developed a simple, effective method for orbital floor reduction that involves molding and shaping the antral balloon catheter. METHODS: A 0, 30, or 70degrees, 4-mm endoscope was placed though a two-point, 5-mm maxillary antrostomy. The balloon catheter is placed directly at the orbital apex to reconstruct the anterior shelf(spherical shape), while it is turned in a U-shape towards the anterior maxilla for the posterior shelf(elliptical shape). Orbital floor defects, compound or comminuted fractures are reconstructed with alloplastic materials through an open lid incision under the endoscopic control. RESULTS: This technique was applied to ten patients with orbital floor fractures: five anterior shelf and five posterior shelf fracture, respectively. Four of the patients had zygomatico-orbital fractures, while the rest had isolated orbital floor fractures. Two patients were given porous polyethylene implants(Synpor(R)) and three underwent reconstruction with a resorbable mesh plate. No complication associated with this technique was identified. CONCLUSION: The freestyle placement and selection of a urinary balloon catheter under endoscopic control and the preoperative estimation of the volume enhanced the stabilization of the orbital contour. This method improves the adaptation of the orbital floor without the risk of injuring the surrounding orbital contents, dissecting blindly, or using sharp traction. One drawback of this method is the patient's discomfort from the catheter during treatment.
Carbamates ; Catheters ; Endoscopes ; Floors and Floorcoverings ; Follow-Up Studies ; Fractures, Comminuted ; Fungi ; Humans ; Maxilla ; Orbit ; Orbital Fractures ; Organometallic Compounds ; Polyethylene ; Traction

PURPOSE: The purpose of this study was to evaluate the clinical and radiographic results of cementless total hip arthroplasty (THA) with subtrochanteric transverse shortening osteotomy in patients with high hip dislocation. MATERIALS AND METHODS: Eighteen patients with high hip dislocation who underwent cementless THA combined with a subtrochanteric transverse shortening osteotomy, plate or cable fixation and bone graft on the osteotomy site between 2001 and 2012 were evaluated in this study. The mean duration of follow-up was 5.2 (2-8.3) years. We evaluated Harris hip score, limping, limb length discrepancy as a clinical parameter and osteolysis, loosening and union of the osteotomy site as a radiographic parameter. RESULTS: Harris hip scores at the final follow-up showed improvement of limping and limb length discrepancy in all cases. And, with the exception of two cases of infection, there were no loosening and osteolysis. All cases showed union of the osteotomy site. There were two cases of infection and one case of dislocation as a complication. Infection occurred in two patients who underwent reoperation and one patient developed sciatic nerve palsy. CONCLUSION: Cementless THA with subtrochanteric transverse shortening osteotomy showed relatively satisfactory clinical and radiologic results. However, the incidence of complications, such as infection, is relatively high, therefore, careful attention is needed.
Arthroplasty, Replacement, Hip* ; Dislocations ; Extremities ; Follow-Up Studies ; Hip ; Hip Dislocation* ; Hip Dislocation, Congenital ; Humans ; Incidence ; Osteolysis ; Osteotomy* ; Reoperation ; Sciatic Neuropathy ; Transplants

Osteomas in the head and neck regions are benign bone neplasms usually found in the frontoethmoid area. Osteomas are usually produce symptoms secondary to pressure on adjacent structures. Although commonly discovered in the external auditory canal of the temporal bone, few cases have been reported in the mastoid or squamous portion of the temporal bone. When located in the mastoid and squamous parts of the temporal bone osteomas can cause cosmetic deformity such as external mass or an auricular protrusion. Other neoplasms of the mastoid region such as osteosarcoma and osteoblastic metastasis should be considered for the differential diagnosis. The authors experienced a case of osteoma that originated from mastoid of temporal bone. We report this rare case and its successful management with a review of the literatures.
Congenital Abnormalities ; Diagnosis, Differential ; Ear Canal ; Head ; Mastoid* ; Neck ; Neoplasm Metastasis ; Osteoblasts ; Osteoma* ; Osteosarcoma ; Temporal Bone