Alloplastic implants are known to be inert for many years, though complications are infrequently reported many years after their insertion. We report the case of a patient who had undergone a blow-out fracture repair five years before the discovery of a hematic cyst. He had been free of symptoms for the first five years after his orbital floor repair but then developed pain on eyeball movement and persistent vertical diplopia, which finally led to surgical intervention. At surgery, a hematic cyst was found to have formed around the implanted silastic plate. When alloplastic material is used in orbital fracture repair, we should be alert for late complications which may occur many years after surgery.
Adult ; Biocompatible Materials ; *Blood ; Bone Cysts/diagnosis/*etiology ; Humans ; Male ; Orbital Diseases/diagnosis/*etiology ; Orbital Fractures/diagnosis/*surgery ; Postoperative Complications ; Prostheses and Implants/*adverse effects ; Reoperation ; Silicone Elastomers/*adverse effects ; Tomography, X-Ray Computed

BACKGROUND: "Closing-in" phenomenon is defined as a tendency to close in the model while copying tasks. This unique phenomenon is one of the constructional apraxia often observed in dementia, especially in Alzheimer's disease (AD). The aim of this study is to investigate the usefulness of "closing-in" in the differential diagnosis of AD and subcortical vascular dementia, and to clarify what the associated factors to this phenomenon are. METHODS: Based on copying data of alternating square and triangle in younger control, we operationally defined "closing-in". "Closing-in" in copied figure was classified into three types: overlap, adherent and near types. With this criteria, we analyzed the incidence of "closing-in" in younger control (N=30), elderly control (N=22), AD (N=64), and subcortical vascular dementia (N=31). RESULTS: Compared with subcortical vascular dementia, AD patients had a significantly higher occurrence of "closing-in" phenomenon. Among "closing-in" type, overlap and adherent type was exclusively occurred in AD. A discriminant analysis, calculated by combining results obtained by AD, showed that symptom onsets with age. Korean Mini-Mental State Examination, Clinical Dementia Rating Scale, Rey-Osterrieth Complex Figure Test were significantly correlated with "closing-in". In EEG mapping, though AD patients with apraxia had significantly lower alpha spectra power in all fields, there is no statistical difference between patients with closing-in and those without. CONCLUSIONS: This study suggests that "closing-in" phenomenon was a phase- and AD-specific useful tool for differential diagnosis with subcortical vascular dementia. Moreover, overlap and adherent subtypes of "closing-in" was highly specific in AD, so further clinical study may be promising.
Aged ; Alzheimer Disease ; Apraxias ; Dementia* ; Dementia, Vascular ; Diagnosis, Differential ; Electroencephalography ; Humans ; Incidence

PURPOSE: Primary pulmonary lymphoma(PPL) arising in the lung as the initial site is very rare. Authors experienced two cases of PPL and report the radiologic findings and clinical characteristics with a brief reviewof the literature. METHODS AND MATERIALS: Plain chest radiograph and enhanced axial CT scan of the chest were taken. We analyzed radiologic findings of the two cases and correlated with broncoscopic and pathologic findings. RESULTS: Plain chest radiograph showed a mass like consolidative lesion on RML without peripheral atelectasis. Chest CT scan revealed a mass like consolidation with airbronchogram and the absence of a hilar mass or thoracic adenopathy. Percutaneous needle aspiration and biopsy(PCNA and PCNB) of the RML mass confirmed B-cell lymphoma, in both cases. CONCLUSION: PPL must be included in the differential diagnosis of chronic alveolar consolidation such as bronchioloalveolar cell carcinoma.
Diagnosis, Differential ; Lung ; Lymphoma* ; Lymphoma, B-Cell ; Needles ; Pulmonary Atelectasis ; Radiography, Thoracic ; Thorax ; Tomography, X-Ray Computed

BACKGROUNDS: In the absence of distant metastasis, small cell lung cancer (SCLC) patients presenting with supraclavicular lymph node (SCLN) involvement and pleural effusion can benefit from thoracic radiotherapy. But there are some debate as to the prognostic significance of both SCLN involvement and pleural effusion. The purpose of this study was to determine the prognostic significance of SCLN involvement and pleural effusion in SCLC. METHODS: Two Hundred and fifteen patients with histologically confirmed small cell lung cancer, who were treated either at the Keimyung university Dongsan hospital and Kyungpook national university hospital from January 1994 to June 1998, were evaluated retrospectively. The patients were classified as having either limited or extensive stage using the Veterans Administration staging system. RESULTS: SCLN was presented in 10.5% of patients(n=21). The median survival was 247 days for patients with SCLN(n=21) and 264 days for patients without(n=194) (p=0.52). After treatment, the median survival was 298 days for patients with SCLN(n=13) and 348 days for patients without(n=115) (p=0.52). SCLN involvement was not correlated with the presence of distant metastases. Medican survival was 459 days for patients with a limited stage without SCLN(n=66), 650 days for those with a limited stage with SCLN (n=7) (p=0.96). Pleural effusion was presented in 24.7% of patients(n=52). The median survival was 198 days for patients with pleural effusion(n=52) and 275 days for patients without(n=163) (p<0.05). After treatment, the median survival was 294 days for patients with a pleural effusion(n=25) and 286 days for patients without(n=103) (p=0.39). The presence of pleural effusion was not correlated with that of distant metastases. The median survival was 395 days for patients with a limited stage without a pleural effusion(n=63), 451 days for those with a limited stage with pleural effusion(n=10) (p=0.92). CONCLUSIONS: In this study, SCLN involvement does not explain the poor survival rate and the relevance to extensive staged disease. Furthermore, the existence of a pleural effusion did not correlated with the presence of distant metastases. However, the presence of a pleural effusion appears to be a minor prognostic factor in our study. Therefore supraclavicular lymph node justify any amendment to the staging system currently used.
Gyeongsangbuk-do ; Humans ; Lymph Nodes* ; Neoplasm Metastasis ; Pleural Effusion* ; Radiotherapy ; Retrospective Studies ; Small Cell Lung Carcinoma* ; Survival Rate ; United States Department of Veterans Affairs

PURPOSE: To evaluate the lung changes in healthy smokers, as seen on inspiratory and expiratoryhigh-resolution computed tomography (HRCT). MATERIAL AND METHODS: Twenty-seven healthy smokers (light smokers,below 20 pack-years, n=16; heavy smokers, above 20 pack-years, n=11) and 25 nonsmokers underwent inspiratory andexpiratory HRCT. All healthy smokers had normal pulmonary function and chest radiography. Parenchymal andsubpleural micronodules, ground-glass attenuation, centrilobular and paraseptal emphysema, bronchial wallthickening, bronchiectasis and septal line were evalvated on inspiratory scan and by air-trapping on expiratoryscan. RESULTS: On inspiratory scan, parenchymal micronodules were observed in one of 25 nonsmokers(4%), two of 16light smokers(13%) and five of 11 heavy smokers(45%); subpleural micronodules in two(8%), four(25%), two(18%);ground-glass attenuation in 0(0%), one(6%), three(27%); centrilobular emphysema in 0(0%), one(6%), three(27%);paraseptal emphysema in three(12%), 0(0%), five(45%); bronchial wall thickening in 0(0%), two(13%), one(9%),bronchiectasis in 0(0%), one(6%) two(18%) and septal line in one(4%), four(25%), two(18%). On expiratory scan,air-trapping was detected in 0 of 15 nonsmokers(0%), two of 17 light smokers(12%), and five of 11 heavysmokers(45%). Statistically significant differences between these three groups were found in parenchymalmicronodules(P=0.006), ground-glass attenuation(P=0.008), centrilobular emphysema(P=0.018), paraseptal emphysema(P=0.005) and air-trapping(P=0.013) between these three groups. CONCLUSION: According to the findings of HRCT,heavy smokers had higher frequency of parenchymal micronodules, ground-glass attenuation, centrilobular andparaseptal emphysema, and air-trapping than nonsmokers and light smokers.
Bronchiectasis ; Bronchiolitis ; Emphysema ; Lung* ; Pulmonary Emphysema ; Radiography ; Thorax

Sacral schwannoma is a rare lesion with a tendency to reach large proportions. The benign schwannoma rarely involves the vertebral bodies extensively. The authors report a case of giant intrasacral schwannoma in 30-year-old woman who had intermittent lower back pain during 3 years period. CT and MRI showed a destructive mass lesion within the upper part of sacrum with a large mass extending into the presacral space. The patient underwent combined surgery consisted of anterior transabdominal approach and posterior sacral laminectomy and total removal of tumor. The characteristics of the lesion were discussed with a review of literatures.
Adult ; Female ; Humans ; Laminectomy ; Low Back Pain ; Magnetic Resonance Imaging ; Neurilemmoma* ; Sacrum

The pathogenesis of the exfoliation syndrome is still unknown. To clarify the etiology of the exfoliation syndrome, we examined the iris taken from a patient with exfoliative glaucoma during cataract surgery using light microscope, polarization microscopy and electron microscopy. The amorphous substance around the iris pigment epithelium and stroma were stained purplish red in PAS staining and showed purplish red metachromasia in toluidine blue staining. In electromicroscopic examination, we observed that many fibrillar materials were deposited at basement membrane and partially detached basement membrane around the pigment epithelium of the iris. Therefore we concluded that the exfoliative materials in this syndrome is a sort of glycoprotein and originated from the abnormal synthesis and metabolism of the basement membrane in the eye.
Basement Membrane ; Cataract ; Epithelium ; Exfoliation Syndrome* ; Glaucoma ; Glycoproteins ; Humans ; Iris* ; Metabolism ; Microscopy, Electron ; Microscopy, Polarization ; Tolonium Chloride

It has been well known that Nitrogen Oxide (NO)plays an important role in endotoxin-induced uveitis (EIU)model,but there has been few researches on development of corneal toxicity in this model. This study was planned to elucidate ultrastructural changes of corneal opacities and edema in EIU model. Lewis rats were separated into 3 groups:A,B and ontrol. Lipopolysaccharide(LPS)was administered subcutaneously into footpads in group A and B for induction of uveitis, while balanced salt solution was injected into those in control rats. NG-nitro-L-arginine methyl ester (L-NAME), known as inhibitor of NO synthase, was applied topically into eyes in group B before and after injection of LPS, respectively. 24 hours after injection of LPS, all of these eyes were observed with light microscope and electron microscope to assess severity of uveitis and corneal status. More severe corneal edema and opacity,along with more intense uveitis were noted in group A than in group B. Corneal thickness was 93.21 +/-8 .9 4 micrometerin control group,161.97+/-11.93micrometerin A group,and 121.67+/-11.35micrometerin B group.The rats treated with L-NAME showed less corneal edema,which was statistically significant(p<0.05). Ultrastructural alterations observed were as folloews: vacuolated necrosis in epithelium;increased perikeratocyte space, derangement of collagen fibrils due to stromal edema;and condensed chromatin,mitochondrial swelling, increased intercellular space in endothelium. Atypical pyknotic pattern of cellular necrosis due to intranuclear and perinuclear vacuoles was charactreristic. However, ultrastructures were relatively well preserved in group B except for intracytoplasmic vacuoles.These results suggest that L-NAME inhibits corneal toxicity caused by endotoxin. In conclusion,this study support the hypothesis that NO plays an important role in corneal toxicity.
Animals ; Collagen ; Corneal Edema* ; Corneal Opacity ; Edema ; Endothelium ; Extracellular Space ; Necrosis ; NG-Nitroarginine Methyl Ester ; Nitric Oxide ; Nitric Oxide Synthase ; Nitrogen ; Rats ; Uveitis* ; Vacuoles

OBJECTIVE: To compare the characteristics between geriatric depression scale (GDS), Hamilton depression rating scale (HDRS) and post-stroke depression scale (PSDS) in the aspect of diagnosis and severity assessment for post-stroke depression. METHOD: 45 post-stroke patients were included for this study. Subjects were classified through DSM-IV criteria into three different groups; depression-free, minor depression and major depression. GDS, HDRS, PSDS were also assessed in all subjects simultaneously. Three depression assessment scales were compared between groups based on DSM-IV criteria, and the sensitivity and specificity using cut-off value were analyzed. RESULTS: All scales showed the significant differences between depression group and depression-free group. GDS showed higher sensitivity and specificity than HDRS and PSDS and GDS showed the significant difference between minor depression and no depression group, but other scales did not. HDRS and PSDS in major depression group showed the significant differences compared with minor depression group (p<0.05), but GDS did not. CONCLUSION: GDS may be more useful to identify the presence of depression compared to GDRS and PSDS. However, to measure the severity of depression, HDRS and PSDS may be more useful than GDS.
Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Sensitivity and Specificity ; Stroke ; Weights and Measures

PURPOSE: To understand the relationship between tibial bone defect and extent of medial release in total knee arthroplasty. MATERIALS AND METHODS: We evaluated 32 knees in 22 patients with variable degrees of tibial bone defect on medial plateau has undergone total knee arthroplasty. In this study, 31 cases had been diagnosed as degenerative osteoarthritis and 1 case was osteonecrosis. We excluded cases with infection, traumatic arthritis, or neuropathic joints. With regard to gender, 29 cases were female and 3 cases were male. The following relationships were analyzed: preoperative degrees of tibial bone defect and varus deformity; the femorotibial angle of both weight-bearing whole extremity radiogram, distractive stress radiogram, and the extent of medial release. RESULTS: Average tibial bone defect was 9.8+/-4.1 mm. Average femorotibial angle on weight-bearing whole extremity radiograph was varus 10.0degrees+/-6.2degrees. Average femorotibial angle on distractive stress radiograph was varus 0.7degrees+/-4.6degrees. Statistically the extent of medial release showed no significant relationship with the degree of tibial bone defect and femoro-tibial angle of whole extremity radiogram. However, it revealed a statistically significant relationship with the femorotibial angle on distractive radiogram (r=0.465, p=0.007). CONCLUSIONS: Preoperative distractive stress radiograph might be a useful method to predict the extent of intraoperative medial release during total knee arthroplasty.
Arthritis ; Arthroplasty ; Extremities ; Female ; Humans ; Joints ; Knee ; Male ; Osteoarthritis ; Osteonecrosis ; Weight-Bearing