We report a case of Becker's nevus associated with smooth muscle hamartoma, in a 21-year-old male patient, which shows clinically match-head sized, flat topped, round to oval, grouped papules with hairs on the outer surface of the right arm, and microscopically reveals numerous bundles of smooth muscle fiber in the dermis.
Arm ; Dermis ; Hair ; Hamartoma* ; Humans ; Male ; Muscle, Smooth* ; Nevus* ; Young Adult

Dizziness is a common symptom in patients with diabetes mellitus; it can lead to or may be confused with presyncope or syncope. The causes of these three symptoms include various drugs, metabolic decompensation, cerebrovascular diseases, vestibular diseases, and diabetic autonomic neuropathy. Although cardiac autonomic neuropathy (CAN) in patients with diabetes is associated with increased cardiovascular morbidity and mortality, CAN might exist in a subclinical state before patients develop resting tachycardia, exercise intolerance, postural hypotension, cardiac dysfunction, and diabetic cardiomyopathy. Thus, it is important to detect CAN in the early phase. This article aimed to review the pathogenesis, manifestations, diagnosis, and treatment of diabetic CAN related to dizziness, presyncope, and syncope.
Cerebrovascular Disorders ; Diabetes Mellitus ; Diabetic Cardiomyopathies ; Diabetic Neuropathies* ; Diagnosis ; Dizziness* ; Humans ; Hypotension, Orthostatic ; Mortality ; Syncope* ; Tachycardia ; Vestibular Diseases

The authors report seven cases of carotid-ophthalmic artery aneurysms who were surgically treated using the combined extradural-intradural or intradural approach from March, 1991, to December, 1993. Carotid-ophthalmic artery aneurysms are of considerably surgical interest because some of these were considered to have technical difficulties of clipping and disastrous surgical results. Removal of the anterior clinoid process and unroofing of the optic canal are the key points to exposure the operative field adequately. On the basis of these experiences, authors concluded that this approach is very useful, because of adequate surgical field and better mobilization of the internal carotid artery and optic nerve for direct clipping of carotid-ophthalmic artery aneurysm and basilar tip aneurysm.
Aneurysm* ; Arteries* ; Carotid Artery, Internal ; Optic Nerve

No abstract available.
Zygapophyseal Joint*

Acute infarcts of the anterior inferior cerebellar artery (AICA) territory are unusual. Furthermore incomplete AICA infarcts are perplexing because of its variations of vascular anatomy and inconsistent clinical features. We present a case with clinical features of AICA infarction, which consist of ipsilateral peripheral-type facial palsy, vertigo, and contralateral facial and upper limb sensory changes without motor weakness. The patient had hypertension and was a current smoker. The high signal intensity on inferior pontine tegmental area was found on MRI and the R2 interneuronal dysfunction was note on Blink reflex. The angiographic findings didn't show any focal vascular lesions, which is contrary to the pathogenesis of AICA infarction published previously. On the clinical ground, the present case reserves to attention in that patients with peripheral-type facial palsy should be properly evaluated and with thorough neurological examination and we could differentiate between the incomplete AICA infarcts such as Gasperini syndrome and Bell's palsy.
Arteries ; Bell Palsy ; Blinking ; Facial Paralysis* ; Humans ; Hypertension ; Infarction ; Interneurons ; Magnetic Resonance Imaging ; Neurologic Examination ; Upper Extremity ; Vertigo

Gastric dilatation is a rare life-threatening condition and consists of massive distention of the stomach by gas and fluid. Its etiology is unclear but predisposing factors include recent surgery, diabetic gastroparesis, fundoplication and gastric outlet obstruction. As the distended stomach grows larger, it hangs down across the duodenum, producing a mechanical gastric outlet obstruction, venous obstruction of the mucosa, ischemic necrosis and perforation. The distended stomach pushes the diaphragm upward, causing collapse of the left lung, rotation of the heart, and obstruction of the inferior vena cava. Hypochloremia, hypokalemia, and alkalosis may result from fluid and electrolyte losses and may precipitate cardiac arrhythmias. If acute gastric dilatation is not treated promptly, cardiovascular and pulmonary compromise may compound an increasing intravascular volume deficit leading to hypotension, which may be a cause of death.
Alkalosis ; Arrhythmias, Cardiac ; Causality ; Cause of Death ; Diaphragm ; Duodenum ; Fundoplication ; Gastric Dilatation* ; Gastric Outlet Obstruction ; Gastroparesis ; Heart ; Hypokalemia ; Hypotension ; Lung ; Mucous Membrane ; Necrosis ; Stomach ; Vena Cava, Inferior

Gastric dilatation is a rare life-threatening condition and consists of massive distention of the stomach by gas and fluid. Its etiology is unclear but predisposing factors include recent surgery, diabetic gastroparesis, fundoplication and gastric outlet obstruction. As the distended stomach grows larger, it hangs down across the duodenum, producing a mechanical gastric outlet obstruction, venous obstruction of the mucosa, ischemic necrosis and perforation. The distended stomach pushes the diaphragm upward, causing collapse of the left lung, rotation of the heart, and obstruction of the inferior vena cava. Hypochloremia, hypokalemia, and alkalosis may result from fluid and electrolyte losses and may precipitate cardiac arrhythmias. If acute gastric dilatation is not treated promptly, cardiovascular and pulmonary compromise may compound an increasing intravascular volume deficit leading to hypotension, which may be a cause of death.
Alkalosis ; Arrhythmias, Cardiac ; Causality ; Cause of Death ; Diaphragm ; Duodenum ; Fundoplication ; Gastric Dilatation* ; Gastric Outlet Obstruction ; Gastroparesis ; Heart ; Hypokalemia ; Hypotension ; Lung ; Mucous Membrane ; Necrosis ; Stomach ; Vena Cava, Inferior

A 21-year-old woman with a 4 cm enhancing cystic renal mass in the left moiety of a horseshoe kidney was treated through a retroperitoneal laparoscopic approach. The tumor was excised completely with cold scissors, and renal parenchyma suturing with a surgical bolster was done with Vicryl 2-0 sutures. Choosing the proper approach according to the location of the lesion and the surgeon's experience with both approaches are of importance in laparoscopic surgery in horseshoe kidney cases. A preoperative kidney computed tomography angiography was helpful for understanding the complex renal vasculature.
Angiography ; Cold Temperature ; Female ; Humans ; Kidney ; Laparoscopy ; Nephrectomy ; Polyglactin 910 ; Sutures ; Young Adult

The presence of pneumocephalus associated with insertion, maintenance, and removal of intravenous catheters is a rare radiographic finding, but may be clinically relevant. Various pathways have been proposed to explain the development of pneumocephalus, but none are well understood. We present a patient with hemicranial pneumocephalus secondary to removal of a central venous catheter as determined by computed tomography, and we propose a possible mechanism of the pneumocephalus.
Catheterization ; Catheters ; Central Venous Catheters ; Humans ; Pneumocephalus

STUDY DESIGN: Retrospective study. PURPOSE: Facet joint block is performed for diagnostic or therapeutic purposes and generally carried out under computerd tomography (CT) or radiologic fluoroscopy guidance. Ultrasonography-guided facet block has recently been attempted. So, we compared the results of ultrasonography-guided facet joint block with the results of fluoroscopy-guided facet joint block. OVERVIEW OF LITERATURE: Because fluoroscopic or CT guided facet joint block has been reported side effects, we performed spinal facet block using a fluoroscopy-guided method. METHODS: We selected 133 patients who had lumbar pain or referred pain. They were diagnosed as having spinal stenosis and hospitalized from January 2008 to June 2008. As the subjects, we selected 105 patients who had been follow-up for more than 6 months and carried out a prospective study. RESULTS: The procedure in group 2 averaged 4 minutes and 25 seconds, and in group 1, 4 minutes and 7 seconds. The coast was an average of 38,000 won in group 2 and 25,000 won in group 1. The VAS score was improved from an average of 7.5 (range, 5 to 9) to 2.8 (range, 2 to 6) in group 2 and from 7.8 (range, 4 to 10) to 2.7 (range, 2 to 5) in group 1. The Oswestry disability index was improved from an average of 32.3 (range, 28 to 41) to 23.5 (range, 17 to 26) in group 2 and from 34.2 (range, 29 to 43) to 24.8 (range, 18 to 28) in group 1. As for complications, worsening of lumbar pain, paresthesia, headache and allergic reaction were detected in 5 cases of group 2 and in 3 of group 1. Those symptoms were improved within several hours. One case of superficial infection that developed in group 2 was improved within several days. CONCLUSIONS: We should consider that ultrasonography-guided facet joint block is a minimal invasive procedure that is easily carried out without radiation exposure.
Fluoroscopy ; Follow-Up Studies ; Headache ; Humans ; Hypersensitivity ; Pain, Referred ; Paresthesia ; Prospective Studies ; Retrospective Studies ; Spinal Stenosis ; Spine ; Zygapophyseal Joint