The incidence of distal anterior cerebral artery(ACA) aneurysm is relatively rare, and only a few cases of bilateral symmetrical distal ACA aneurysms which were adhered together have been reported. They are also called kissing aneurysms. We treated bilateral symmetrical distal ACA kissing aneurysms in a 44-year-old woman. We successfully clipped the double aneurysmal sacs individually by interhemispheric approach in spite of intraoperative aneurysmal rupture. The patient was discharged without any neurological deficits two weeks after the operation.
Adult ; Aneurysm* ; Anterior Cerebral Artery* ; Female ; Humans ; Incidence ; Rupture

PURPOSE: The purpose of the present study was to examine the changes in bladder compliance of a spinal cord injured population, and analyze the effects of several factors, related to the clinical and urodynamic findings, on bladder compliance. MATERIALS AND METHODS: The charts, videourodynamic and upper tract radiographic studies of 114 patients with a spinal cord injury were retrospectively reviewed. The patients were categorized according to their bladder and urethral activities from the videourodynamic study, the interval since the time of the injury and the bladder emptying method, including intermittent catheterization (IC), self voiding and Foley catheterization. The association of bladder compliance with upper/lower tract complications was also identified in the population. A bladder compliance threshold values of 12.5ml/cm H2O was selected for the comparison between a normal and decreased compliance. RESULTS: No significant differences in compliance were noted in relation to sex, age or level of injury. Of the 114 patients, 43 (37.4%), by definition, had a low bladder compliance. The patients whose interval since the time of injury was more than one year had a significantly higher incidence of low compliance than those of less than one year. Low compliance was more common in patients using an indwelling catheter than in those using the other methods. A low compliance was statistically associated with more deformity of the bladder shape (p<0.05) and upper tract complications (p<0.05). CONCLUSIONS: In a spinal cord injured population, compliance may be one of the most important factors resulting in upper/lower urinary tract complications. With time, or due to the wrong treatment, there is a great possibility of a low compliance. Therefore, regular observation of the compliance, and other factors, using urodynamic studies, is warranted.
Catheterization ; Catheters ; Catheters, Indwelling ; Compliance* ; Congenital Abnormalities ; Humans ; Incidence ; Retrospective Studies ; Spinal Cord Injuries ; Spinal Cord* ; Urinary Bladder* ; Urinary Catheterization ; Urinary Tract ; Urodynamics

A 46-year-old female presented a mass on her right lower leg where she had a burn injury due to moxibustion 10 years ago. Physical examination revealed a 3 cm sized firm nodule with tenderness. Plain radiograph was performed and it revealed well-defined calcifications. According to the history of moxibustion burn injury and the result of plain radiograph, dystrophic calcinosis cutis caused by burn injury was suspected. The patient underwent excisional biopsy using pre-,intra-, and postoperative ultrasonography (USG). There was no sign of recurrence. Herein, we report a case of a 46-year-old healthy woman who presented with single hard nodule on the right lower leg. Our case is worthwhile in two respects. First, It is first case report of dystrophic calcinosis cutis due to moxibustion burn injury. In east asian culture, moxibustion is a commonly conducted procedure and it often induces burn injury. Second, USG was used pre-, intra-, and post-operatively to assess the shape, location, and depth of the calcinosis cutis and to determine the surgical margin.

Isolated head and neck metastasis of renal cell carcinoma (RCC) is relatively rare and metastasis to the temple area is very rare. Here, we present the case of a 51-year-old man who was diagnosed with RCC 2 years earlier and had a contralateral metastatic temple area lesion. The patient who was diagnosed with renal cell cancer and underwent a nephrectomy 2 years ago was referred to the plastic surgery department for a temple mass on the contralateral side. In the operative field, the mass was located in the temporalis muscle with a red-to-purple protruding shape. Biopsy of the mass revealed a metastatic RCC lesion. Computed tomography imaging showed a lobulated, contoured enhancing lesion. Positron emission tomography/computed tomography imaging showed high-fluorodeoxyglucose uptake in the right temporalis muscle. The patient underwent wide excision of the metastatic RCC including the temporalis muscle at the plastic surgery department. Skeletal muscle metastasis of head and neck lesions is extremely rare in RCC. Isolated contralateral temporalis muscle metastasis in RCC has not been previously reported in the literature. If a patient has a history of malignant cancer, plastic surgeons should always consider metastatic lesions of head and neck tumors. Because of its high metastatic ability and poor prognosis, it is very important to keep this case in mind.

Head and neck cutaneous metastasis of advanced gastric cancer is uncommon, and scalp metastasis is particularly rare. We present the case of a 60-year-old man who was diagnosed with cutaneous metastasis on the scalp originating from advanced gastric cancer. The patient was referred to the plastic surgery department for a scalp mass near the hairline. He had been diagnosed with advanced gastric cancer and undergone total gastrectomy and Roux esophagojejunostomy 3 years previously. The differential diagnosis for a single flesh-colored nodule on the scalp included benign tumors such as epidermal cyst or lipoma; therefore, the patient underwent excision and biopsy. In the operative field, the mass was found to be located in the frontalis muscle. The biopsy result showed that the mass was a metastatic lesion of advanced gastric cancer. Whole-body computed tomography revealed a gastric tumor with blood vessel infiltration, peritoneal carcinomatosis, liver metastasis, and multiple disseminated subcutaneous metastases. Although scalp metastasis originating from an internal organ is extremely rare, plastic surgeons should always consider a metastatic lesion in the differential diagnosis if a patient with a scalp lesion has a history of malignant cancer.

Head and neck cutaneous metastasis of advanced gastric cancer is uncommon, and scalp metastasis is particularly rare. We present the case of a 60-year-old man who was diagnosed with cutaneous metastasis on the scalp originating from advanced gastric cancer. The patient was referred to the plastic surgery department for a scalp mass near the hairline. He had been diagnosed with advanced gastric cancer and undergone total gastrectomy and Roux esophagojejunostomy 3 years previously. The differential diagnosis for a single flesh-colored nodule on the scalp included benign tumors such as epidermal cyst or lipoma; therefore, the patient underwent excision and biopsy. In the operative field, the mass was found to be located in the frontalis muscle. The biopsy result showed that the mass was a metastatic lesion of advanced gastric cancer. Whole-body computed tomography revealed a gastric tumor with blood vessel infiltration, peritoneal carcinomatosis, liver metastasis, and multiple disseminated subcutaneous metastases. Although scalp metastasis originating from an internal organ is extremely rare, plastic surgeons should always consider a metastatic lesion in the differential diagnosis if a patient with a scalp lesion has a history of malignant cancer.

BACKGROUND: Atopic dermatitis will persist into adult life and chronic severe atopic dermatitis may cause significant interference in social interaction. Despite the controversy concerning the existence of specific personality exhibited by patients with atopic dermatitis, psychological and social factors have long been considered important factors that have influence on the course of the disease. OBJECTIVE: The purpose of this study was to investigate the charateristics of the personalities of adult patients with atopic dermatitis and their relationship to psychological factors and clinical characteristics. METHODS: Eysenck Personahty Questionnaire(EPQ) was carried out on 54 adult patients with atopic dermatitis. Using the EPQ scores, a cluster analysis was done to identify the subgroup of psychologically disabled patients. The psychological and social aspects of the identified patients were then investigated using a designed questionnaire. RESULTS: 1. A cluster analysis identified two patient subgroups. Psychoticism(P), extroversion-introversion(E), and neuroticism(N) scores were significantly different between the subgroups. The neuroticism scores were above the upper limit of the normal range in the higher EPQ scored subgroups. However, the total clinical severity score which was evaluated in 25 patients showed no significant difference between these subgroups. 2. The higher psychoticism, extroversion-introversion, and neuroticism scored patients tended to express severe disability due to atopic dermatitis and a high level of stress which was evaluated by the designed questionnaire. CONCLUSION: Eysenck personality questionnaire can be helpful in identifying a subgroup of patients who may need psychiatric intervention.
Adult* ; Dermatitis, Atopic* ; Humans ; Interpersonal Relations ; Psychology ; Reference Values ; Surveys and Questionnaires

OBJECTIVE: To determine whether annual screening reduces ovarian cancer mortality in women with a family history of breast or ovarian cancer. METHODS: Data was obtained from the Prostate, Lung, Colorectal, and Ovarian cancer trial, a randomized multi-center trial conducted to determine if screening could reduce mortality in these cancers. The trial enrolled 78,216 women, randomized into either a screening arm with annual serum cancer antigen 125 and pelvic ultrasounds, or usual care arm. This study identified a subgroup that reported a first degree relative with breast or ovarian cancer. Analysis was performed to compare overall mortality and disease specific mortality in the screening versus usual care arm. In patients diagnosed with ovarian cancer, stage distribution, and survival were analyzed as a secondary endpoint. RESULTS: There was no significant difference in overall mortality or disease specific mortality between the two arms. Ovarian cancer was diagnosed in 48 patients in the screening arm and 44 patients in the usual care arm. Screened patients were more likely to be diagnosed at an earlier stage than usual care patients. Patients in the screening arm diagnosed with ovarian cancer experienced a significantly improved survival compared to patients in the usual care arm; relative risk 0.66 (95% CI, 0.47 to 0.93). CONCLUSION: Screening did not appear to decrease ovarian cancer mortality in participants with a family history of breast or ovarian cancer. Secondary endpoints, however, showed notable differences. Significantly fewer patients were diagnosed with advanced stage disease in the screening arm; and survival was significantly improved. Further investigation is warranted to assess screening efficacy in women at increased risk.
Aged ; Breast Neoplasms/*genetics ; *Early Detection of Cancer ; Female ; Humans ; Menopause ; Middle Aged ; Ovarian Neoplasms/diagnosis/*genetics

OBJECTIVE: To determine whether annual screening reduces ovarian cancer mortality in women with a family history of breast or ovarian cancer. METHODS: Data was obtained from the Prostate, Lung, Colorectal, and Ovarian cancer trial, a randomized multi-center trial conducted to determine if screening could reduce mortality in these cancers. The trial enrolled 78,216 women, randomized into either a screening arm with annual serum cancer antigen 125 and pelvic ultrasounds, or usual care arm. This study identified a subgroup that reported a first degree relative with breast or ovarian cancer. Analysis was performed to compare overall mortality and disease specific mortality in the screening versus usual care arm. In patients diagnosed with ovarian cancer, stage distribution, and survival were analyzed as a secondary endpoint. RESULTS: There was no significant difference in overall mortality or disease specific mortality between the two arms. Ovarian cancer was diagnosed in 48 patients in the screening arm and 44 patients in the usual care arm. Screened patients were more likely to be diagnosed at an earlier stage than usual care patients. Patients in the screening arm diagnosed with ovarian cancer experienced a significantly improved survival compared to patients in the usual care arm; relative risk 0.66 (95% CI, 0.47 to 0.93). CONCLUSION: Screening did not appear to decrease ovarian cancer mortality in participants with a family history of breast or ovarian cancer. Secondary endpoints, however, showed notable differences. Significantly fewer patients were diagnosed with advanced stage disease in the screening arm; and survival was significantly improved. Further investigation is warranted to assess screening efficacy in women at increased risk.
Aged ; Breast Neoplasms/*genetics ; *Early Detection of Cancer ; Female ; Humans ; Menopause ; Middle Aged ; Ovarian Neoplasms/diagnosis/*genetics

PURPOSE: Delayed rupture of flexor pollicis longus as a sequelae of the plate inserted for distal radius fracture is a very rare. This is the first case reported and published in Korea. METHODS: A 48 years old female patient visited hospital, complaining flexor disturbance of interphalangeal joint of left thumb, which suddenly occurred without any external wound. We found that she had received operation of fixing plate for fracture of left distal radius 10 years ago. As operational opinion, we have checked that flexor pollicis longus tendon has been ruptured with oblique ways being stimulated by extended plate to palmar side over long period. RESULTS: Authors performed tenorrhaphy of flexor pollicis longus without tendon graft and presented a successful active flexion of the left thumb interphalangeal joint 1 year after the operation. CONCLUSION: If the extruded part of the end plate is observed during the operation or follow-up, it is considered to be necessary to get rid of the plate as early as possible after the fracture healing.
Drug Combinations ; Female ; Follow-Up Studies ; Humans ; Joints ; Piperonyl Butoxide ; Pyrethrins ; Radius ; Radius Fractures ; Rupture ; Tendons ; Thumb ; Transplants