Nerve injury associated with cardiac surgery and anesthesia is a well-recognized complication with a predilection for the upper half of the body. We report four cases of common peroneal nerve palsy following cardiac surgery that were not subject to external compression to fibular head. The diagnosis of nerve palsy was delayed because of a complicated postoperative course and intensive care, which prevented our determining the causes. The mechanisms of nerve injury are reviewed. We postulate that the etiology is multifactorial, including, old age, subnormal body habitus, prolonged knee flexion and rotation, coexisting disease, postoperative cardiovascular complications, and cardiopulmonary bypass.
Anesthesia ; Cardiopulmonary Bypass ; Diagnosis ; Head ; Critical Care ; Knee ; Paralysis* ; Peroneal Nerve* ; Thoracic Surgery*

Squamous cell carcinoma of the nail bed is a low grade, slowly progressive, malignant neoplasm. A 66-year-old man had nail lesion on his right thumbnail for two years. After partial nail avulsion, an incisional biopsy was done. The histologic diagnosis was a squamous cell carcinoma. A radiological examination of digit was normal and no lymphadenopathy was palpable. The lesion was totally excised and surgical defect of nail bed was reconstructed by dermal graft. There was no recurrence of tumor till one year after surgery and out-look of nail recovered almost normal. When the underlying malignancy is suspected, it is necessary to examine the nail bed after partial nail avulsion. And application of dermal graft may be useful procedure for regeneration of nail plate when there is a large nail bed defect after excision.
Aged ; Biopsy ; Carcinoma, Squamous Cell* ; Diagnosis ; Humans ; Lymphatic Diseases ; Recurrence ; Regeneration ; Transplants*

Squamous cell carcinoma of the nail bed is a low grade, slowly progressive, malignant neoplasm. A 66-year-old man had nail lesion on his right thumbnail for two years. After partial nail avulsion, an incisional biopsy was done. The histologic diagnosis was a squamous cell carcinoma. A radiological examination of digit was normal and no lymphadenopathy was palpable. The lesion was totally excised and surgical defect of nail bed was reconstructed by dermal graft. There was no recurrence of tumor till one year after surgery and out-look of nail recovered almost normal. When the underlying malignancy is suspected, it is necessary to examine the nail bed after partial nail avulsion. And application of dermal graft may be useful procedure for regeneration of nail plate when there is a large nail bed defect after excision.
Aged ; Biopsy ; Carcinoma, Squamous Cell* ; Diagnosis ; Humans ; Lymphatic Diseases ; Recurrence ; Regeneration ; Transplants*

PURPOSE: The purpose of this study is to analyze and compare the CT findings of gastric adenocarcmoma and gastric lymphoma. MATERIALS AND METHODS: We retrospectively analyzed and compared the CT findings in 46 cases of adenocarcinoma and 12 cases of lymphoma, which were pathologically confirmed by operation and endoscopic biopsy. RESULTS: Antral involvement was more common in adenocarcinoma(71.7%) than in lymphoma(41.7%). Localized involvement was more common in adenocarcinoma(83.7%), while diffuse involvement was more common in lymphoma(55.6%). Adenocarcinoma tended to have smooth inner margin(83.8%), while lymphoma had nodular or irregular inner margin(36.4%). Mean gastric wall thickness of adenocarcinoma was 1.7cm, while mean thickeness of lymphoma was 2.7cm. The involved wall of adenocarcinoma tended to be highly enhanced (59.5%), while lymphoma was moderately enhanced(90.1%). Perigastric lymphadenopathy was present in 40% (group I) and 42%(group II) of adenocarcinoma and 33% of lymphoma(group I and II). Three cases of lymphoma had lymphadenopathy below renal vascular pedicles with no or minimal perigastric lymphadenopathy. When only the distal portion of the stomach was involved, disturbance in passage developed in six adenocarcinoma (12%), while none developed in the lymphoma. CONCLUSION: CT features help to differentiate between gastric adenocarcinoma and gastric lymphoma
Adenocarcinoma* ; Biopsy ; Lymphatic Diseases ; Lymphoma* ; Retrospective Studies ; Stomach

Cutaneous fistula of dental origin is the most common type of cutaneous fistula that is formed on the face and neck. This lesion can be a diagnostic challenge to clinicians who are not familiar with cutaneous fistula since many patients with cutaneous fistula of dental origin do not have any complaints such as toothache. Diagnostic errors may result in multiple excisions, biopsies, and ineffective long-term antibiotic therapy. However, if the lesion could be suspected of being of dental origin, the diagnosis can be easily confirmed by radiologic examinations. We report four cases of cutaneous fistula of dental origin. All four patients had a characteristic cutaneous findings with chronically draining, fixed, erythematous papule on their nasolabial fold or submental region. Ultrasonography, fistulography or plain roentgenography were needed to confirm the diagnosis of cutaneous fistula originating from dental problems.
Biopsy ; Cutaneous Fistula* ; Diagnosis ; Diagnostic Errors ; Humans ; Nasolabial Fold ; Neck ; Radiography ; Toothache ; Ultrasonography

Bell's palsy is a relatively common, unilateral facial paralysis of unknown etiology. The purpose of this study was to evaluate the prognostic value of several electrophysiologic tests in Bell's palsy. Blink reflex (BR), side-to-side compound muscle action potential (CMAP) amplitude comparison, and side-to-side nerve excitability test (NET) threshold differ once have been studied during the first 2 weeks in 66 patients with Bell's palsy. According to the early response of BR(Rl), the patients were divided into 3 groups: Rl< or = 13ms(17cases) ; Rl>13ms(22cases), and absent BR(27cases). There was a remarkable tendency towards a satisfactory recovery from paralysis if BR occurred during the first 2 weeks from onset(p<0.001). In patients with normal BR, 88.2% had a satisfactory recovery, when the reflex was absent a bad prognosis was given in 59.3% of the patients. According to side-to-side CMAP amplitude comparison, the patients were divided into 2 groups; CMAP amplitude comparison > or = 25% (35cases), and CMAP amplitude comparison <25% (31cases). There was a tendency towards a satisfactory recovery from paralysis if side-to-side CMAP amplitude comparison was more than 25% (p < 0,003). In patients with more than 25% of CMAP amplitude comparison, 82.9% of the patients had a satisfactory recovery, but in patients with less than 25% of CMAP amplitude comparison, 51.6% of the patients had a bad prognosis. According to side-to-side NET threshold difference, the patients were divided into 2 groups, NET threshold difference < or = 3.5mA(43cases), and NET threshold difference >3.5mA (23cases). When the threshold of electrical excitability on both sides differs 3.5mA or more an unsatisfactory recovery has strongly to expected(p<0.001). In patients with less than 3.5mA of NET threshold, 81.4% had a satisfactory recovery, but in patients with more than 3.5mA of NET threshold, 60.9% had a bad prognosis. BR, side-to-side CMAP amplitude comparison, and side-to-side NET threshold difference seem to be useful independent indices for predicting the prognosis an early stage of the paralysis.
Action Potentials ; Bell Palsy* ; Blinking ; Facial Paralysis ; Humans ; Paralysis ; Prognosis ; Reflex

The spontaneous hematomyelia is an uncommon event and its predisposing conditions are vascular malformation, syringomyelia, pregnancy and delivery, angioma, hemophilia, anticoagulant therapy, etc. We have recently experienced the patient with spontaneous onset and resolving hematomyelia in the cervical spinal cord. A 30-year-old male patient with non-traumatic spinal shock was evaluated. On MRI, a hematomyelia along cervical spi-nal cord was revealed. A suspicious AV malformation was noticed at C3-4 level. Fol-low-up MRIs showed spontaneous resolution of the hematoma.
Adult ; Hemangioma ; Hematoma ; Hemophilia A ; Humans ; Magnetic Resonance Imaging ; Male ; Pregnancy ; Shock ; Spinal Cord ; Spinal Cord Vascular Diseases* ; Syringomyelia ; Vascular Malformations

PURPOSE: We evaluated the indications of operation and radiologic findings in 12 operated DeBakey type III aortic dissections. MATERIAL AND METHODS: We retrospectively reviewed radiologic findings of 12 operated DeBakey type III aortic dissections, using CT, MRI, or aortography, and correlations were made with clinical course of the patients. RESULTS: Three cases were uncomplicated dissections. There were aneurysm rupture in 4 cases, impending rupture in 4 cases, occlusion of common lilac artery in 2 cases, occlusion of renal artery in 1 case, and compression of bronchus and esophagus by dilated aorta in 1 case. Associated clinical sign and symptoms were chest and back pain in 12 cases, claudication in 3 cases, dyspnea and dysphagia in 1 case, hoarseness in 1 case, and hemoptysis in 1 case. Post-operative complications were death from aneurysm rupture in 1 case, paraplegia in 2 cases, acute renal failure in 3 cases, and hemopericardium in 1 case. CONCLUSION: Although medical therapy is preferred in management of DeBakey type Ill aortic dissection, surgical treatment should be considered in patients with radiological findings of aortic rupture, impending rupture, occlusion of aortic major branches.
Acute Kidney Injury ; Aneurysm ; Aorta ; Aortic Aneurysm* ; Aortic Rupture ; Aortography ; Arteries ; Back Pain ; Bronchi ; Deglutition Disorders ; Dyspnea ; Esophagus ; Hemoptysis ; Hoarseness ; Humans ; Magnetic Resonance Imaging ; Paraplegia ; Pericardial Effusion ; Renal Artery ; Retrospective Studies ; Rupture ; Thorax

PURPOSE: To assess the postoperative CT findings of aortic aneurysms or dissections treared by resection- and-graft replacement or continuous-suture graft-inclusion technique MATERIALS AND METHODS: We reviewed postoperative follow-up CT findings of 14 patients, 19 cases. There were 8 patients(10 cases) of aortic aneurysm and 6 patients(9 cases) of aortic dissecton which involved the thoracic aorta in 9 patients(13 cases) and abdominal aorta in 5 patients(6 cases). The interval of follow-up after operation was from 9 days to 2 year 9 months. On CT scans, we analyzed the appearance of graft materials, differences of CT findings between two surgical techniques, and normal or abnormal postoperative CT findings. RESULTS: Most of grafts appeared as hyperdense ring on precontrast scan, and all of them were not seperated from aortic lumen on postcontrast scan. On CT findings of patients who were operated by continuous-suture graft-inclusion technique, perigraft thrombus was concentrically located with sharp demarcation by native aortic wall and its density was homogeneous, but in cases of those operated by resection-and-graft replacement, perigraft hematoma was eccentrically located with indistinct margin and its density was heterogeneous and native aortic wall could not be delineated. In patients without complication, perigraft thrombus or hematoma(15 cases), perigraft calcification(11 cases), residual intimal flap(6 cases), graft deformity(4 cases), perigraft air(2 cases) and reconstructed vessels(1 case) were noted. And in one patient with complication, perigraft flow was noted with more increased perigraft hemaroma. CONCLUSION: Precise knowledge of the differences of CT findings between two surgical techniques and nor- mal postoperative CT findings is crucial to evaluate the postoperative CT findings in aortic aneurysm and dissection.
Aorta, Abdominal ; Aorta, Thoracic ; Aortic Aneurysm* ; Follow-Up Studies ; Hematoma ; Humans ; Thrombosis ; Tomography, X-Ray Computed ; Transplants

BACKGROUND: Ceramides are the main lipid component of the stratum corneum and are a structurally heterogeneous and complex group of sphingolipids of which sphingoid bases are the basic structural constituents. Altered levels of sphingoid bases have been reported in skin conditions that involve dryness and barrier disruption, including atopic dermatitis. OBJECTIVE: The purpose of this study was to investigate the altered levels of sphingoid bases in psoriatic epidermis and their relationship with the clinical severity of the psoriasis. METHODS: Samples from the lesional and non-lesional epidermis were obtained from eight psoriasis patients. Levels of sphingosine and sphinganine were analyzed by high-performance liquid chromatography. The expression of ceramide synthase and ceramidase proteins, which are related to sphingosine and sphinganine metabolism, were measured using Western blot analysis. RESULTS: Levels of sphingosine and sphinganine in the lesional epidermis were significantly higher than those in the non-lesional epidermis. Although there was no altered ceramide synthase and ceramidase, there was a highly significant positive correlation between the % change of ceramidase, the degradative enzyme of ceramide into sphingosine, and the Psoriasis Area Severity Index (PASI) score. CONCLUSION: The levels of sphingosine and sphinganine were significantly increased in psoriatic epidermis and the % change of ceramidase was positively correlated with the clinical severity of psoriasis.
Blotting, Western ; Ceramidases ; Ceramides ; Chromatography, Liquid ; Epidermis ; Humans ; Oxidoreductases ; Proteins ; Psoriasis ; Skin ; Sphingolipids ; Sphingosine