Cluster headache is a unique primary headache disorder characterized by unilateral severe orbital pain with ipsilateral autonomic symptoms. Symptomatic cluster headache can be caused by variable diseases, such as cerebral aneurysm, arteriovenous malformation, cerebral venous thrombosis, carotid dissection, pituitary tumor, and meningioma. We report a 33-year-old woman with parasellar meningioma mimicking cluster headache. After Novalis stereotactic radiosurgery, pain attacks disappeared.
Adult ; Cluster Headache* ; Female ; Headache Disorders, Primary ; Humans ; Intracranial Aneurysm ; Intracranial Arteriovenous Malformations ; Meningioma* ; Orbit ; Pituitary Neoplasms ; Radiosurgery* ; Venous Thrombosis

PURPOSE: This study was carried out to investigate the correlation among tumor angiogenetic activity, epithelial membrane antigen (EMA) reactivity and various clinicopathologic parameters. We also evaluated the validity of both as an independent prognostic factor in patients with papillary thyroid carcinoma. MATERIALS & METHODS: We studied 120 patients out of 727 patients with papillary thyroid casrcinoma who underwent thyroidectomy at our institute from January 1986 to December 1994. The age of the patients ranged from 14 to 80 years with a mean of 48.2 years. There were 24 males and 96 females (M:F=1:4). The paraffin embedded tissues of these patients were stained with the monoclonal antibodies against factor VIII related antigen, antigen CD34 to highlight microvessels and against EMA to show immunoreactivity. We measured microvessel density (MVD) in the area of highest vascular density at 200 times of magnification (0.785 mm2 per field). The positive cells for EMA were counted as percentages of the whole cell population and the degree of reaction was rated on a five-point scale. RESULTS: Mean MVDs and EMA reactivities by location of tissue per field were 64.8+/-18.9, 1.97+/-0.74, in the center of the tumor; 41.3+/-15.3, 1.55+/-0.68 in the periphery of tumor; and 22.1+/-14.4, 1.09+/-0.75 in normal thyroid tissue, respectively. In relation to TNM stage, only the MVDs of patients with stage IV disease were higher than those of other disease stages with statistical significance (p<.05). In relation to DeGroot stage, the MVDs of patients with stage IV disease was also higher than others with statistical significance (p<.005). There were no significant differences in MVD and EMA reactivity between the two groups of low risk (n=77) and high risk (n=43) by AMES scale. The MVDs and EMA reactivities of patients with local recurrence (n=23) and death (n=7) during the follow-up period had no statistical significance against those patients without recurrence and living patients. CONCLUSION: Tumor angiogenic activity and EMA reactivity in papillary thyroid carcinoma did not correlate with TNM stage, DeGroot stage, AMES score, local recurrence, and patient death. However, MVD was significantly higher in patients with distant metastasis and may be useful in predicting the distant metastasis in papillary thyroid carcinoma.
Antibodies, Monoclonal ; Female ; Follow-Up Studies ; Humans ; Male ; Microvessels ; Mucin-1 ; Neoplasm Metastasis ; Paraffin ; Recurrence ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; von Willebrand Factor

Bony mallet finger is treated by from conservative management to various operative options. A lot of internal fixations except hook plate lead to cartilage damage and limitation of motion of distal interphalangeal joint. Thus we introduce Delta(Delta)-wire technique which can permit early joint motion and give strong compression force on the fracture fragment continuously.
Cartilage ; Fingers* ; Fracture Fixation ; Joints

Reversible airway obstruction and wheezing are typical features of bronchial asthma, but these features may also be observed in other conditions. However, the inclusion of these conditions in the differential diagnosis of asthma-like symptoms in adults is often neglected, resulting in a correct diagnosis being made after months of unsuccessful treatment for asthma. We report two cases of an upper airway obstruction masquerading as asthma. In case one, adenoid cystic carcinoma was identified in the trachea of a patient showing asthma-like symptoms, positive response to allergic skin test and methacholine inhalation challenge. In the other case, aspirated foreign body was misdiagnosed and treated as asthma for more than one year. A high degree of suspicion and a thorough medical evaluation censisting of history, physical examination and pulmonary function test including shapes of spirogram are essential to the differential diagnosis of asthma-like symptoms
Adenoids* ; Adult ; Airway Obstruction* ; Asthma* ; Carcinoma, Adenoid Cystic* ; Diagnosis ; Diagnosis, Differential ; Foreign Bodies* ; Humans ; Inhalation ; Methacholine Chloride ; Physical Examination ; Respiratory Function Tests ; Respiratory Sounds ; Skin Tests ; Trachea

PURPOSE: The purpose of this study is to report clinical and radiographic results over a period of two 2 years after cementless total hip arthroplasty (THA) with fourth generation ceramic-on-ceramic articulation. MATERIALS AND METHODS: We studied 22 patients, 23 cases which were followed up for two years among 25 patients, 26 patients who underwent cementless THA with the fourth generation ceramic between April 2009 and December 2009. The average age of the patients was 55.9 years old(22 to 72 years old), and the average follow-up duration was 28 months(24 to 32 months). A clinical evaluation was performed using the Harris hip score (HHS), and radiologic evaluation was based on acetabular cups and osteolysis of the femoral stems, instability, distance, angle, and so on. RESULTS: HHS showed an increase, from 54 for before-surgical treatment, to 91 at the last follow-up. Inguinal pain was observed in one case, and femoral pain was observed in two cases. Stable fixation was achieved in all cases, and no instability, osteolysis, or movement of acetabular cups and femoral stems was observed. CONCLUSION: Clinical and radiological short-term results for use ofthe fourth generation ceramic-on-ceramic cementless THA have favorable so far. Further follow-up study should be performed for evaluation of the long-term results.
Arthroplasty ; Ceramics ; Follow-Up Studies ; Hip ; Humans ; Osteolysis ; Tacrine

OBJECTIVE: Esophageal/hypopharyngeal injury can be a disastrous complication of anterior cervical surgery. The amount of hypopharyngeal wall exposure within the surgical field has not been studied. The objective of this study is to evaluate the chance of hypopharyngeal wall exposure by measuring the amount of axial rotation of the thyroid cartilage (ARTC) and posterior projection of the hypopharynx (PPH). METHODS: The study was prospectively designed using intraoperative ultrasonography. We measured the amount of ARTC in 27 cases. The amount of posterior projection of the hypopharynx (PPH) also was measured on pre-operative CT and compared at three different levels; the superior border of the thyroid cartilage (SBTC), cricoarytenoid joint and tip of inferior horn of the thyroid cartilage (TIHTC). The presence of air density was also checked on the same levels. RESULTS: The angle of ARTC ranged from -6.9degrees to 29.7degrees, with no statistical difference between the upper and lower cervical group. The amount of PPH was increased caudally. Air densities were observed in 26 cases at the SBTC, but none at the TIHTC. CONCLUSION: Within the confines of the thyroid cartilage, surgeons are required to pay more attention to the status of hypopharynx/esophagus near the inferior horn of the thyroid cartilage. The hypopharynx/esophagus at the TIHTC is more likely to be exposed than at the upper and middle part of the thyroid cartilage, which may increase the risk of injury by pressure. Surgeons should be aware of the fact that the visceral component at C6-T1 surgeries also rotates as much as when the thyroid cartilage is engaged with a retractor. The esophagus at lower cervical levels warrants more careful retraction because it is not protected by the thyroid cartilage.
Animals ; Esophagus ; Horns ; Hypopharynx ; Joints ; Prospective Studies ; Thyroid Cartilage ; Thyroid Gland

High tibial osteotomy is one of established methods in the treatment for medial knee osteoarthritis with varus deformity in younger patients. Infections after high tibial osteotomy are rare. Infection management is difficult, but there is no definitely standardized treatment. We report the case of infection after high tibial osteotomy that was treated clinically and radio-graphically with literature reviews.
Congenital Abnormalities ; Humans ; Knee* ; Osteoarthritis, Knee ; Osteotomy*

Lipofibromatous hamartoma is a rare, benign neoplasm of peripheral nerves that usually involved the median nerve. Clinical symptoms are mass, neuropathy, tenderness, muscle atrophy and limitation of range of motion. If the tumor is occurred on the median nerve, secondary carpal tunnel syndrome may be happened. We report a patient with a lipofibromatous hamartoma in the median nerve focusing on clinical symtoms and treatment.
Carpal Tunnel Syndrome ; Hamartoma* ; Humans ; Median Nerve* ; Muscular Atrophy ; Peripheral Nerves ; Range of Motion, Articular

PURPOSE: A The purpose of this retrospective study was to evaluate the results of compression plating and autogenous iliac bone graft in the management of humeral diaphyseal nonunion. MATERIALS AND METHODS: Twenty patients who underwent the surgical treatments between May. 1998 and May. 2002 were included in this study. Nine of them are males and the others are females. The average age of them, when they was on operation, was 45 years. The symptoms lasted 23 months on average. They have been followed up for 33 months at an average. Treatment of nonunion consisted of resecting the atrophic nonunion, shortening the bone, apposing bleeding diaphyseal surface. Rigid fixation was then achieved using a compression plate and autogenous bone graft. RESULTS: Solid bony union was achieved in all patients. In one patient, the bone was not healed at the first operation of plating and autogenous bone graft, but achieved union after the use of intramedullary nailing. In another patient, because of infected nonunion, we achieved union after several surgical debridement and stabilization by internal fixation. CONCLUSION: This study documents that compression plate fixation with autogenous cancellous bone graft is a viable option with predictable and satisfactory results for humerus diaphyseal nonunion.
Debridement ; Female ; Fracture Fixation, Intramedullary ; Hemorrhage ; Humans ; Humerus* ; Male ; Retrospective Studies ; Transplants*

PURPOSE: We analyzed the causative factors of femoral component radiologic abnormality after total knee arthroplasty (TKA) using a Legacy Posterior Stabilized (LPS)-Flex prosthesis. MATERIALS AND METHODS: 140 cases of TKA using LPS-Flex and 140 cases of Vanguard from Jan 2008 to June 2010 were analyzed and radiographic abnormalities around the femoral stems were compared. Secondly, TKA using LPS-Flex was divided into two groups according to the posterior femoral cutting technique, which were single cutting method and additional cutting method. Accuracy of the femoral posterior resection was compared. RESULTS: Radiographically, anterior radiolucent line was found in eight cases with LPS-Flex but no case with Vanguard. Posterior overhang more than 30% was found in ten cases in both groups. Posterior bone defect more than 50% was found in 23 and seven cases respectively. Anterior radiolucent line and posterior bone defect were observed significantly more in LPS-Flex. In the second study, we found femoral posterior bone defect in 20 cases with additional cutting method which was caused by flexion of the femoral box-cutting guide. CONCLUSION: Posterior bone defect from LPS-Flex was caused by inappropriate resection due to flexion of the box cutting guide. Single cutting method should be adopted for more accurate posterior femoral cutting.
Arthroplasty ; Knee ; Osteoarthritis ; Prostheses and Implants