PURPOSE: We introduce a new surgical procedure for punctal stenosis, which is to insert a soft and thin cut-down tube, commonly used in general surgery. METHODS: After two snip operation, we inserted cut-down tube into canaliculus through incised punctum. We cut the tube for not touching to the cornea and buried in incision site. At postoperative 1 day, we asked patients their uncomfortness and examined ocular state with slit lamp. And then we removed the tube 4 days later. At postoperative 2 month, we evaluated whether epiphora improved or not and estimated the size of dialted punctum with caliper. Dye disappearance test and lacrimal irrigation test were also performed. RESULTS: Of 11 patients, 8 patients had no epiphora. Average diameter of dilated punctum was 1.77 +/- 0.20mm. In all patients, we found dilated punctum more than 1mm and confirmed patency by lacrimal irrigation test. 8 patients did not feel uncomfortness, and 3 patients felt a little uncomfortness. But no one felt severe discomfort. Although we found corneal erosion and conjunctival injection in 2 patients, they recovered in a few days. CONCLUSIONS: By this procedure, we reduced patient's hospital visit and pain resulting from postoperative care. And we observed well dilated punctum after the procedure. Therefore, punctoplasty using cut down tube is useful procedure for punctal stenosis, especially for recurrent stenosis after snip operation.
Constriction, Pathologic ; Cornea ; Humans ; Lacrimal Apparatus Diseases ; Postoperative Care

PURPOSE: To determine the different of enhancement patterns of hepatic hemangioma according to the lesionsize, using dual-phase spiral CT. MATERIALS AND METHODS: Fify-nine lesions in 45 patients with hepatichemangiomas were subjected to spiral Ct. According to size, the lesions were divided into two groups(< 2.5cm :n=34 ; >_2.5cm : n=25). The enhancement patterns of the lesions were classified as one of four types (homogeneoushyperdense, peripheral hyperdense, central hyperdense, or hypodense) during the early phase, and as one of fivetypes homogeneous hyperdense, peripheral hyperdense, central hyperdense, hypodense or isodense) during the delayedphase. We evaluated differences in enhancement patterns during the early and delayed phase according to lesionsize. RESULTS: During the early phase, the enhancement patterns of lesions large than 2.5cm were peripheralhyperdense(96%) or homogeneous hyperdense (4%);those of less than 2.5cm were peripheral hyperdense (53%),homogeneous hyperdense(26%), hypodense(18%), or central hyperdense(3%). Thus, hemangiomas in these two groupsusually showed a peripheral enhancement pattern during the early phase, but in those which were smaller than2.5cm, atypical enhancement patterns were more common. During the delayed phase, the enhancement patterns oflesions larger than 2.5cm were peripheral hyperdense (60%) or homogenous hyperdense (40%), while the patterns ofthose smaller than 2.5cm were homogeneous hyperdense (67%), peripheral hyperdense (24%), central hyperdense (3%),hypodense (3%), or isodense (3%). Thus, the enhancement patterns of lesions larger than 2.5cm were usuallyperipherally hyperdense during the delayed phase, while those smaller than 2.5cm showed a homogeneous enhancementpattern. CONCLUSION: The enhancement patterns of hepatic hemangiomas differ according to lesion size. A knowledgeof these differences is helpful in the diagnosis of hepatic hemangioma.
Diagnosis ; Hemangioma* ; Humans ; Tomography, Spiral Computed*

PURPOSE: There have been few reports about the endoscopic carpal tunnel release (ECTR) in elderly patients and its efficacy and safety are not well-known. We evaluated the clinical outcomes of ECTR using Agee technique in patients older than 65 years. MATERIALS AND METHODS: From October 2000 to January 2007, thirty-five patients (42 hands) who underwent ECTR using Agee technique were enrolled. The average age of the patients was 67.2 years (range, 65-71 years). The duration of symptoms averaged 10 months (range, 6-33 months). For evaluation of the clinical outcomes, physical examination and subjective assessment of the hand function using the Boston carpal tunnel questionnaire were performed at postoperative 1-year follow-up and compared with those obtained at preoperative evaluation. The mean follow-up period was 18 months (range, 12-24 months). RESULTS: There were no neurovascular injury and scar tenderness. At postoperative 1-year follow-up, paresthesia, numbness, Phalen's sign, tinel sign, two point discrimation, and grip power were significantly improved compared with those obtained at preoperation. According to the Boston questionnaire, symptom severity score improved from 3.43 preoperatively to 1.89 postoperatively, and functional status score improved from 3.18 preoperatively to 2.21 postoperatively (p<0.05). Thenar atrophy still remained in 32 hands (76.2%). CONCLUSION: Although thenar atrophy did not improve in many cases, symptom severity and functional status scores improved in most patients treated with ECTR. The single portal ECTR is a safe and efficacious treatment option in elderly patients with carpal tunnel syndrome.
Aged ; Atrophy ; Boston ; Carpal Tunnel Syndrome ; Cicatrix ; Follow-Up Studies ; Hand ; Hand Strength ; Humans ; Hypesthesia ; Paresthesia ; Physical Examination ; Surveys and Questionnaires

3 cases of transitional cell carcinoma were subjected to detailed cytogenetic analysis. All three were superficial (T1G I , T1G III, T1G I). Case 1 and case 3 (all T1G I) had diploidy modal chromosomal number but case 2 (TtGIII) had partly triploidy and tetraploidy chromosome. Case 3 showed marker chromosomes and in case 2 and 3, breakage of long arm of the second chromosome was seen.
Arm ; Carcinoma, Transitional Cell* ; Cytogenetic Analysis ; Diploidy ; Tetraploidy ; Triploidy ; Urinary Bladder*

PURPOSE: To evaluate the clinical usefulness of ultrasonography (US) - guided automated gun biopsy of nonpalpable breast lesions. MATERIALS AND METHODS: In 30 nonpalpable breast lesions over 0.6cm and detected on US, we performed US-guided biopsy using an 18-gauge automated biopsy gun. Two to four specimens were obtained from each lesion. We analyzed the site, size and depth of the lesions, and the length and histopathologic results of the specimens. In four lesions, surgical biopsy and gun biopsy results were compared. RESULTS: In 29 of 30 lesions (96.7%), specimens were adequate for histopathologic diagnosis, and this was as follows: one case of infiltrating ductal carcinoma, 13 of fibrocystic disease, 10 of fibrocystic disease versus fibroadenoma and one of fibroadenoma. There was also one reactive hyperplasia of LN, and one fatty one and two normal tissues, and inthese four lesions, agreement between gun and surgical biopsy results was 100%. The only complication was minor bleeding, which was controlled by compression. CONCLUSION: US-guided automated gun biopsy is a clinically useful and safe procedure for evaluating nonpalpable breast lesions detected on US.
Biopsy* ; Breast* ; Carcinoma, Ductal ; Diagnosis ; Fibroadenoma ; Hemorrhage ; Hyperplasia ; Ultrasonography

PURPOSE: The purpose of this study was to evaluate the frequency, location, and appearance of increasedattenuation of the liver adjacent to a mass during arterial-phase spiral CT in patients with hemangioma. Thecharacteristics of the mass associated with these findings were also evaluated. MATERIALS AND METHODS: Usingspiral CT, 153 lesions in 114 hepatic hemangioma patients were retrospectively reviewed. We evaluated thefrequency, location, and appearance of increased hepatic attenuation adjacent to the hemangioma, and determinedwhether lesion size varied according to whether or not there was increased hepatic attenuation. RESULTS: Areas ofincreased hepatic attenuation adjacent to the hemangioma were identified in 10.5% of cas-es(16/153) and seen inmasses which showed a homogeneously hyperdense (11/16, 69%) or peripherally hy-perdense pattern (5/16, 31%). Thelocation of increased hepatic attenuation was commonly the peripheral por-tion (9/16, 56%), and increased hepaticattenuation was frequently wedge shaped of the mass (11/16, 69%). Lesion size did not vary according to whether ornot there was increased hepatic attenuation. CONCLUSION: Increased hepatic attenuation adjacent to a hemangiomais not rare, and is usually located periph-eral to the mass. It is common in a mass showing a homogeneouslyhyperdense pattern.
Hemangioma* ; Humans ; Liver* ; Retrospective Studies ; Tomography, Spiral Computed

PURPOSE:The aim of this study was to compare the early postoperative results and the long-term outcome of restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) in familial adenomatous polyposis (FAP) and ulcerative colitis (UC). METHODS:Thirty patients that underwent IPAA for either FAP (14 patients) or UC (16 patients) at Kyung-Hee University Hospital between January 1987 and December 1999 were studied retrospectively. Either handsewn or stapled anastomosis technique was used in IPAA. Most patients (12 patients in FAP, 16 patients in UC) had a two-stage operation with temporary diverting loop ileostomy and two patients with FAP had a one-stage operation without temporary ileostomy. RESULTS:One patient in the UC group died from sepsis after operation (n=16, 6.25%), but no patients in the FAP group died. Overall operative complications appeared in two patients (14.3%) and four patients (25%) with FAP and UC, respectively. At follow-up (mean, 47.3 months), pouchitis was developed in four patients with UC, but no patients with FAP. The mean daytime stool frequency was 4.5 stools per day in FAP patients and 5.8 stools per day in UC patients (P=0.031), but night-time stool frequency was similar between two groups (1.2 and 1.4 in FAP and UC, respectively; P>0.05). Daytime fecal incontinence was noticed in two patients (14.3%) with FAP and four patients (26.7%) with UC. Night-time fecal incontinence was noticed in three patients (21.4%) with FAP and six patients (40.0%) with UC. CONCLUSIONS:FAP patients tolerated the operation better and had less long-term disability than did UC patients. This suggested that the long-term outcome of IPAA procedure may depend on the primary disease rather than the procedure itself.
Adenomatous Polyposis Coli* ; Colitis, Ulcerative* ; Fecal Incontinence ; Follow-Up Studies ; Humans ; Ileostomy ; Pouchitis ; Proctocolectomy, Restorative* ; Retrospective Studies ; Sepsis ; Ulcer*

Ramsay Hunt syndrome associated with the Varicella zoster virus (VZV) infection is characterized by vesicles on the pinna, otalgia, facial nerve palsy and sensorineural hearing loss. Although significant complications from VZV infection are increasing, thrombosis associated with VZV infection is one of the rare complications in adults. The VZV itself could cause endothelial damage in the various organs. Subsequently, the thrombosis might be complicated. A previously healthy 84 year-old female patient was diagnosed with Ramsay Hunt syndrome. On the 7th day of antiviral treatment, she complained of sudden breathlessness. She was hypoxemic with an elevated alveolar-arterial oxygen difference and needed to be supported by mechanical ventilation. Massive pulmonary thrombosis was documented by computerized tomography and she successfully underwent thrombolytic therapy. We report a case of massive pulmonary thromboembolism associated with VZV infection, treated with thrombolytic therapy.
Adult ; Earache ; Facial Nerve ; Female ; Hearing Loss, Sensorineural ; Herpes Zoster ; Herpes Zoster Oticus ; Herpesvirus 3, Human ; Humans ; Oxygen ; Paralysis ; Parkinsonian Disorders ; Pulmonary Embolism ; Respiration, Artificial ; Thrombolytic Therapy ; Thrombosis

PURPOSE: Treatment modalities of acute limb ischemia have evolved over the last decades, but the morbidity and mortality of the disease still remains high. We performed a retrospective study to analyze the demographics, risk factors, and prognosis of this disease. METHOD: Our subjects included a total of 49 patients (55 limbs) with acute peripheral arterial occlusion who underwent operative procedures between September 1996 and August 2001 at Gil Medical Center. Cases with graft occlusion or blue toe syndrome were excluded. The SVS/ISCVS reporting standards was used. RESULT: Mean age was 64.2 years (range: 25~85) and male-to-female ratio was 1.7 : 1. Clinical categories of ischemia were classified as the following: Viable (I) in 10 cases, Marginally threatened (IIa) in 14, Immediately threatened (IIb) in 17, and Irreversible (III) in 8. There were 40 lower extremity and 8 upper extremity arterial occlusions, and 1 aortic occlusion. The causes of occlusion were thrombosis in 14 and embolism in 35. Thromboembolectomy was performed in 42 cases, bypass graft in 9, primary amputation in 7, thrombolysis in 1, and stent insertion in 1. The 30-day mortality rate was 8%, mainly due to reperfusion injury and underlying cardiopathy. The 30-day major amputation rate was 23.8%. CONCLUSION: An aggressive, prompt operative management is important in saving patients with acute arterial occlusion. Higher amputation rates were related to more severe categories of ischemia at initial presentation. Patient education along with early referral and intervention will possibly reduce the amputation rate.
Amputation ; Blue Toe Syndrome ; Demography ; Embolism ; Extremities ; Humans ; Ischemia ; Lower Extremity ; Mortality ; Patient Education as Topic ; Prognosis ; Referral and Consultation ; Reperfusion Injury ; Retrospective Studies ; Risk Factors ; Stents ; Surgical Procedures, Operative ; Thrombosis ; Transplants ; Upper Extremity

Because of repeated failures of clinical trials, the concept of Alzheimer's disease (AD) has been changing rapidly in recent years. As suggested by the National Institute on Aging and the Alzheimer's Association Research Framework, the diagnosis and classification of AD is now based on biomarkers rather than on symptoms, allowing more accurate identification of proper candidates for clinical trials by pathogenesis and disease stage. Recent development in neuroimaging has provided a way to reveal the complex dynamics of amyloid and tau in the brain in vivo, and studies of blood biomarkers are taking another leap forward in diagnosis and treatment of AD. In the field of basic and translational research, the development of animal models and a deeper understanding of the role of neuroinflammation are taking a step closer to clarifying the pathogenesis of AD. Development of big data and the Internet of Things is also incorporating dementia care and research into other aspects. Largescale genetic research has identified genetic abnormalities that can provide a foundation for precision medicine along with the aforementioned digital technologies. Through the first international conference of the Korean Dementia Association, experts from all over the world gathered to exchange opinions with association members on these topics. The Academic Committee of the Korean Dementia Association briefly summarizes the contents of the lectures to convey the depth of the conference and discussions. This will be an important milestone in understanding the latest trends in AD's pathogenesis, diagnostic and therapeutic research and in establishing a future direction.