No abstract available.
Dilatation* ; Esophageal Perforation*

Thirty consecutive patient seen in a pediatric out patient and emergency department, in whom the diagnosis of intussusception was considered, had an ultrasound examination of the abdomen before the barium enema. The peak age was 5~12 month (range 4~34 month). Intussusception was detected by ultrasonography in all 25 cases proved by barium enema (sensitivity 100%). Normal findings on ultrasonography correlated with a negative barium enema results in 5 of 5 cases (negative predictive value=100%). No intussusception was missed by ultrasonography. To determine which patient would most benefit from ultrasonography, we divided patients into either a high risk group (100% intussusception) or a low risk group (37.5% intussusception) on the basis of clinical symptoms. We conclude that ultrasonography can be used as a rapid sensitive screening procedure in the diagnosis or exclusion of childhood intussusception. Probability of surgical reduction was associated with size of of total thickness and external rim thickness.
Abdomen ; Barium ; Child* ; Diagnosis* ; Emergency Service, Hospital ; Enema ; Humans ; Infant* ; Intussusception* ; Mass Screening ; Ultrasonography*

PURPOSE: Tethered cord syndrome(TCS) is defined as low position of the conus medullaris by the abnormally fixed spinal cord with progressive neurologic deficit MATERIALS AND METHODS: To evaluate the findings of TCS at MRI and its diagnostic value, we performed a retrospective analysis of MRI of 30 patients with emphasis on clinical manifestation, level of conus medullaris, cause of tethering, and associated findings. RESULTS: Clinical presentation included back mass(26 cases), neurogenic bladder(5 cases), urinary incontinence(5 cases), progressive constipation(2 cases), skin dimpling(1 case), gait disturbance(1 case) and club foot (1 case). Neurologic deficit was developed in 11 cases(40% and mean age of these patients at the time of diagnosis was 8.6 years. The most common cause of tethering was lipoma(63%). The tips of conus medullaris were below the level of the second lumbar spine in all patients. The causes of tethering were lipomatous component(spinal lipoma and lipomyelomenigocele) in 67% myelomeningocele in 20%, presacral mass in 7%, thickened filum terminale in 3% and postoperative change in 3%. Associated anomalies included syringomyelia(20%) and hydrocephalus was associated in 3 out of 5 patients who underwent brain MRI. CONCLUSION: MRI clearly delineated the location of conus, tethering of the filum terminale with their causes and associated abnormalities. MRI examination is a very useful diagnostic tool for the early evaluation of TCS and the postoperative follow up.
Brain ; Cauda Equina ; Conus Snail ; Diagnosis ; Follow-Up Studies ; Foot ; Gait ; Humans ; Hydrocephalus ; Lipoma ; Magnetic Resonance Imaging ; Meningomyelocele ; Neural Tube Defects* ; Neurologic Manifestations ; Retrospective Studies ; Skin ; Spinal Cord ; Spine

Cerebral fat embolism (CFE) is a rare, albeit potentially lethal complication of long-bone fractures. All trauma patients who are initially lucid and subsequently experience mental status deterioration should undergo immediate evaluation of possible CFE. In the present case, magnetic resonance imaging (MRI) was the most sensitive technique for the diagnosis of CFE, particularly the use of diffusion-weighted images (DWI). The authors present this case to report a pathophysiology-based interpretation of the MR characteristics and treatment of CFE.
Embolism ; Embolism, Fat ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets

Cerebral fat embolism (CFE) is a rare, albeit potentially lethal complication of long-bone fractures. All trauma patients who are initially lucid and subsequently experience mental status deterioration should undergo immediate evaluation of possible CFE. In the present case, magnetic resonance imaging (MRI) was the most sensitive technique for the diagnosis of CFE, particularly the use of diffusion-weighted images (DWI). The authors present this case to report a pathophysiology-based interpretation of the MR characteristics and treatment of CFE.
Embolism ; Embolism, Fat ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets

PURPOSE: To evaluate the efficacy of intravitreal bevacizumab and subsequent trabeculectomy with mitomycin C (MMC) for neovascular glaucoma (NVG) in eyes that underwent previous 23-gauge transconjunctival sutureless vitrectomy (TSV). METHODS: This was a retrospective, comparative, and consecutive case series study. We reviewed the medical records of patients with NVG who underwent trabeculectomy with MMC after intravitreal bevacizumab (1.25 mg/0.05 mL) injection and compared the surgical outcomes according to 23-gauge TSV history. Surgical success was defined as an intraocular pressure (IOP) of ≥6 mm Hg and ≤21 mm Hg without additional glaucoma surgery or loss of light perception. The main outcome measures were postoperative IOP control, visual acuity, and complications. RESULTS: A total of 27 patients (27 eyes) were included; 12 patients with 23-gauge TSV history (TSV group) and 15 patients without vitrectomy history (nonvitrectomized group). The cumulative probability of success after trabeculectomy with MMC was 82.5% and 73.3% after one year for the TSV group and the nonvitrectomized group, respectively (p = 0.523). Mean IOP decreased from 37.3 ± 9.0 mm Hg preoperatively to 12.8 ± 6.2 mmHg at the final visit in the TSV group (p = 0.002). Mean IOP decreased from 40.3 ± 9.7 mm Hg preoperatively to 17.8 ± 11.7 mm Hg at the final visit in the nonvitrectomized group (p = 0.001). Preoperative and final IOP were not significantly different between the two groups. Complications were comparable between the groups. CONCLUSIONS: Intravitreal bevacizumab injection and subsequent trabeculectomy with MMC is an effective method for controlling IOP in patients with NVG associated with sutureless vitrectomy.
Glaucoma ; Glaucoma, Neovascular* ; Humans ; Intraocular Pressure ; Medical Records ; Mitomycin* ; Outcome Assessment (Health Care) ; Retrospective Studies ; Trabeculectomy* ; Visual Acuity ; Vitrectomy*

PURPOSE: To evaluate the efficacy of intravitreal bevacizumab and subsequent trabeculectomy with mitomycin C (MMC) for neovascular glaucoma (NVG) in eyes that underwent previous 23-gauge transconjunctival sutureless vitrectomy (TSV). METHODS: This was a retrospective, comparative, and consecutive case series study. We reviewed the medical records of patients with NVG who underwent trabeculectomy with MMC after intravitreal bevacizumab (1.25 mg/0.05 mL) injection and compared the surgical outcomes according to 23-gauge TSV history. Surgical success was defined as an intraocular pressure (IOP) of ≥6 mm Hg and ≤21 mm Hg without additional glaucoma surgery or loss of light perception. The main outcome measures were postoperative IOP control, visual acuity, and complications. RESULTS: A total of 27 patients (27 eyes) were included; 12 patients with 23-gauge TSV history (TSV group) and 15 patients without vitrectomy history (nonvitrectomized group). The cumulative probability of success after trabeculectomy with MMC was 82.5% and 73.3% after one year for the TSV group and the nonvitrectomized group, respectively (p = 0.523). Mean IOP decreased from 37.3 ± 9.0 mm Hg preoperatively to 12.8 ± 6.2 mmHg at the final visit in the TSV group (p = 0.002). Mean IOP decreased from 40.3 ± 9.7 mm Hg preoperatively to 17.8 ± 11.7 mm Hg at the final visit in the nonvitrectomized group (p = 0.001). Preoperative and final IOP were not significantly different between the two groups. Complications were comparable between the groups. CONCLUSIONS: Intravitreal bevacizumab injection and subsequent trabeculectomy with MMC is an effective method for controlling IOP in patients with NVG associated with sutureless vitrectomy.
Glaucoma ; Glaucoma, Neovascular* ; Humans ; Intraocular Pressure ; Medical Records ; Mitomycin* ; Outcome Assessment (Health Care) ; Retrospective Studies ; Trabeculectomy* ; Visual Acuity ; Vitrectomy*

Popliteal artery entrapment syndrome (PAES) occurs when an abnormal anatomic relationship between the popliteal artery and the surrounding musculotendinous structures causes repeated arterial compression with exercise. The most commonly reported causes of this syndrome have been anomalies of the medial head of the gastrocnemius muscle as it relates to the course of the popliteal artery. PAES can result in calf claudication, aneurysm formation, distal arterial emboli, or popliteal vessel thrombosis. This syndrome is a rare but potentially limb threatening anatomical anomaly occurring predominently in young adults. We experienced two cases who have suffered from a coldness and pain of lower leg. Angiogram and MRI were performed and we diagnosed as a popliteal artery entrapment syndrome. We report two cases of rare anomalous origin of the gastrocnemius muscle in intraoperative findings.
Aneurysm ; Extremities ; Head ; Humans ; Leg ; Magnetic Resonance Imaging ; Muscle, Skeletal* ; Popliteal Artery* ; Thrombosis ; Young Adult

OBJECTIVE: To determine possible similarities and differences in clinical and laboratory features and prognosis between patients with inflammatory myopathies diagnosed at Kangnam St. Mary's hospital and other reported series. METHODS: Medical records of 52 patients diagnosed as inflammatory myopathies by Bohan and Peter criteria who were admitted to Kangnam St. Mary's hospital between January 1989 and August 1994, were reviewed. The patients were further classified into 5 groups proposed by Bohan and Peter ; group I primary polymyositis(PM), group II primary dermatomyositis(DM), group III polymyositis/dermatomyositis(PM/DM) with neoplasia, group IV juvenile PM/DM, group V PM/DM associated with connective tissue disease. RESULTS: 1) There were 52 PM/DM cases with mean age at diagnosis of 34. 4 ranging from 6 to 67 years, and significantly more females(male:female = 9:43). 2) Of 52 patients, group II was the most frequent group(36.5%), and the next were as follows ; group I 28.8%, group V 25%, group IV 5.7%, group 3.8%. Systemic lupus erythematosus(SLE) was the commonest connective tissue disease, and malignancy was associated in 2 cases including breast cancer and small cell carcinoma of lung. 3) At presentation, 86.5% had proximal muscle weakness, 61.5% had arthralgia/arthritis and 44. 2% had Raynaud phenomenon. 4) The elevated serum LDH, aldolase and creatine kinase were found in 84. 6%, 84. 1%o, 71.2% of the patients respectively. Positive electromyography and muscle biopsy consistent with inflammatory myopathy were also found in 91.4%, 88.8% respectively. 5) Positive antinuclear antibody, rheumatoid factor, anti-Ro, anti-nRNP were found in 59.6%, 17.3%, 16.7%, 8.3% of patients respectively, mainly in group V. Anti-Jo-1 antibody was present in 25.8% of patients tested(8/31), including group II 4 cases, group V 3 cases and group I I case. 6) All 8 patients with anti-Jo-1 antibody had interstitial lung disease(ILD) and Raynaud phenomenon with statistical significance, compared with those without anti-Jo-1 antibody(P<0.01). 7) Among the 43 patients in whom follow up was available, 10 patients died(mortality rate 23.2%). The main cause of death were infection(4 cases), and respiratory muscle weakness, respiratory failure due to ILD, malignancy 2 cases respectively. CONCLUSION: The results of the study demonstrated that clinical expression of PM/DM were similar to previously reported series except relatively high frequency of primary dermatomyositis in this study. Anti-Jo-1 antibody was main autoantibody in inflammatory myopathies, which was associated with extramuscular manifestations, such as ILD and Raynaud's phnomenon.
Antibodies, Antinuclear ; Biopsy ; Breast Neoplasms ; Carcinoma, Small Cell ; Cause of Death ; Connective Tissue Diseases ; Creatine Kinase ; Dermatomyositis ; Diagnosis ; Electromyography ; Follow-Up Studies ; Fructose-Bisphosphate Aldolase ; Humans ; Lung ; Medical Records ; Muscle Weakness ; Myositis* ; Prognosis ; Raynaud Disease ; Respiratory Insufficiency ; Respiratory Muscles ; Rheumatoid Factor

Esophageal strictures may result from common conditions such as gastroesophageal reflux disease. Dysphagia is by far the most common presenting complaint in patients with esophageal peptic stricture. Symptomatic peptic strictures are treated by dilatation via ballooning or bougienation. Vascular ring is a term given to a combination of vascular and often ligamentous structures that encircle the trachea and esophagus. Symptomatic vascular ring, also known as dysphagia lusoria, is generally treated by conservative management. However, surgery should be considered when symptoms persist regardless of the treatment. We experienced a case involving a 41-year-old man with dysphagia diagnosed with peptic stricture on upper endoscopy and concomitant vascular ring on chest CT, which proved asymptomatic.
Adult ; Constriction, Pathologic ; Deglutition Disorders ; Dilatation ; Endoscopy ; Esophagus ; Gastroesophageal Reflux ; Humans ; Ligaments ; Thorax ; Trachea