No abstract available.

The authors present 12 cases of far lateral disc herniation(FLDH) diagnosed and treated in our institution from march, 1992 to February, 1994. In the author's series the incidence of far lateral disc herniation was 5% of all lumbar disc herniations. The average age of the patients was 4 years and there were 7 men and 5 women. The L4-5 intervertebral disc level was the most commonly involved level. All patients initially presented with symptoms of radiculopathy. Cases with double herniations at the same level and on the same side seemed to have the most potential source of misdiagnosis and mismanagement, and a careful surgical consideration was needed for such cases. In 4 cases, a combined intraspinal and extraforaminal approach was performed with preservation of facet joints and in 2 cases, paramedian muscle splitting approach was performed. Chemonucleolysis and the usual partial hemilaminectomy were undertaken in 5 cases and in 1 case, respectively. The combined approaches proved to be an effective means of treatment for cases with double herniations, but misdiagnosis of such lesion can lead to an inappropriate and an ineffective treatment and poor surgical results. Furthermore, in the diagnosis of far lateral disc herniation, differentiation must be made from symptoms of conjoined nerve root and congested epidural vein.
Diagnosis ; Diagnostic Errors ; Estrogens, Conjugated (USP) ; Female ; Humans ; Incidence ; Intervertebral Disc ; Intervertebral Disc Chemolysis ; Male ; Radiculopathy ; Veins ; Zygapophyseal Joint

Adrenocortical tumors in children are rare and show various clinical symptoms. We present an 8-year-old boy with peripheral precocious puberty caused by adrenocortical tumor. He showed elevated serum DHEA-S and 17-hydroxyprogesterone, and computed tomography revealed an abdominal mass. After surgical resection, he developed central precocious puberty. We report a rare case that showed progression from peripheral precocious puberty to central precocious puberty.
17-alpha-Hydroxyprogesterone ; Adrenal Cortex Neoplasms ; Child ; Humans ; Puberty, Precocious

There is an increasing tendency to use three dimentional computed tomographic angiography(CTA) in diagnosis of intracranial aneurysm. The authors have planned to get a better CTA image through comparing of the maximum intensity projection(MIP) and shaded surface display(SSD) techniques. Eighteen patients were evaluated who had been studied with conventional cerebral angiography(CCA), CTA and received aneurysmal surgery, all together. Original spiral CT images were studied with helical CT scanner with 120ml of non-ionic contrast material, 3ml/sec injection rate, 1mm collimation and 1mm reconstruction interval. MIP and SSD images of CTA were reconstructed with diting by using a standard processing algorithm of volume rendering technique and three dimensional technique. There were 3 cases(12%) of false negatives in both MIP and SSD images among the ottal 25 cases of saccular aneurysms. There were 2 cases(8%) of false positives in SSD images that were actually negative for aneurysm in MIP and CCA. Our results have demonstrated that CTA is a quick, reliable and relatively simple diagnostic tool or screening of intracranial aneurysms, and superior to CCA in evaluating configuration, direction and its associated vascular anatomy. The MIP image was better to reveal vasospasm, calcification, neck shape and adjacent vascular anatomy. On the other hand, the SSD image showed higher false positive rate due to pseudo-saccular fusion and superior to glance over the external configuration and for planning of surgery.
Aneurysm ; Diagnosis* ; Hand ; Humans ; Intracranial Aneurysm* ; Mass Screening ; Neck ; Silver Sulfadiazine* ; Tomography, Spiral Computed

There is an increasing tendency to use three dimentional computed tomographic angiography(CTA) in diagnosis of intracranial aneurysm. The authors have planned to get a better CTA image through comparing of the maximum intensity projection(MIP) and shaded surface display(SSD) techniques. Eighteen patients were evaluated who had been studied with conventional cerebral angiography(CCA), CTA and received aneurysmal surgery, all together. Original spiral CT images were studied with helical CT scanner with 120ml of non-ionic contrast material, 3ml/sec injection rate, 1mm collimation and 1mm reconstruction interval. MIP and SSD images of CTA were reconstructed with diting by using a standard processing algorithm of volume rendering technique and three dimensional technique. There were 3 cases(12%) of false negatives in both MIP and SSD images among the ottal 25 cases of saccular aneurysms. There were 2 cases(8%) of false positives in SSD images that were actually negative for aneurysm in MIP and CCA. Our results have demonstrated that CTA is a quick, reliable and relatively simple diagnostic tool or screening of intracranial aneurysms, and superior to CCA in evaluating configuration, direction and its associated vascular anatomy. The MIP image was better to reveal vasospasm, calcification, neck shape and adjacent vascular anatomy. On the other hand, the SSD image showed higher false positive rate due to pseudo-saccular fusion and superior to glance over the external configuration and for planning of surgery.
Aneurysm ; Diagnosis* ; Hand ; Humans ; Intracranial Aneurysm* ; Mass Screening ; Neck ; Silver Sulfadiazine* ; Tomography, Spiral Computed

Choledochocele is a rare abnormality that's defined as cystic or diverticular dilatation of the common bile duct, and this protrudes into the duodenal lumen. It may cause abdominal pain, recurrent pancreatitis, obstructive jaundice etc. Although its anatomic form does not meet the criteria of pancreaticobiliary malunion, malignant changes of the choledochocele in relation to pancreaticobiliary reflux may occur. It still is regarded as having a lower malignant potential than any other type of choledochal cyst. Only one case has been currently been reported in Korea. We experienced a case of a 71 year-old woman with upper abdominal pain that was caused by a choledochocele with duodenal ampullary adenocarcinoma. She was successfully treated by surgical excison without severe complications. We report here on this case along with a review of the literature.
Abdominal Pain ; Adenocarcinoma ; Adenocarcinoma, Papillary* ; Aged ; Choledochal Cyst* ; Common Bile Duct ; Dilatation ; Female ; Humans ; Jaundice, Obstructive ; Korea ; Pancreatitis

BACKGROUND: Inflammatory factors and beta-cell dysfunction due to high-fat diets aggravate chronic diseases and their complications. However, omega-3 dietary fats have anti-inflammatory effects, and the involvement of autophagy in the etiology of diabetes has been reported. Therefore, we examined the protective effects of autophagy on diabetes using fat-1 transgenic mice with omega-3 self-synthesis capability. METHODS: Streptozotocin (STZ) administration induced beta-cell dysfunction in mice; blood glucose levels and water consumption were subsequently measured. Using hematoxylin and eosin (H&E) and Masson's trichrome staining, we quantitatively assessed STZ-induced changes in the number, mass, and fibrosis of pancreatic islets in fat-1 and control mice. We identified the microtubule-associated protein 1A/1B light chain 3-immunoreactive puncta in beta-cells and quantified p62 levels in the pancreas of fat-1 and control mice. RESULTS: STZ-induced diabetic phenotypes, including hyperglycemia and polydipsia, were attenuated in fat-1 mice. Histological determination using H&E and Masson's trichrome staining revealed the protective effects of the fat-1 expression on cell death and the scarring of pancreatic islets after STZ injection. In the beta-cells of control mice, autophagy was abruptly activated after STZ treatment. Basal autophagy levels were elevated in fat-1 mice beta-cells, and this persisted after STZ treatment. Together with autophagosome detection, these results revealed that n-3 polyunsaturated fatty acid (PUFA) enrichment might partly prevent the STZ-related pancreatic islet damage by upregulating the basal activity of autophagy and improving autophagic flux disturbance. CONCLUSION: Fat-1 transgenic mice with a n-3 PUFA self-synthesis capability exert protective effects against STZ-induced beta-cell death by activating autophagy in beta-cells.
Animals ; Autophagy* ; Blood Glucose ; Cell Death ; Chronic Disease ; Cicatrix ; Diet, High-Fat ; Dietary Fats ; Drinking ; Eosine Yellowish-(YS) ; Fatty Acids, Omega-3 ; Fatty Acids, Unsaturated* ; Fibrosis ; Hematoxylin ; Hyperglycemia ; Islets of Langerhans ; Mice ; Mice, Transgenic* ; Pancreas ; Phenotype ; Polydipsia ; Streptozocin

Actinomycosis is difficult to diagnose preoperatively because of non-specific clinical feature. We usually have excessively invasive treatment for actinomycosis. So, we must rule out actinomycosis in the case of patients with a complaint of lower abdominal pain with a long time IUD inserted state and laboratory findings suggestive of inflammation. We experienced two cases of pelvic actinomycosis associated with IUD and report these cases with a brief review of literatures.
Abdominal Pain ; Actinomycosis* ; Humans ; Inflammation ; Intrauterine Devices*

BACKGROUND/AIMS: Important lesions related to gastroesophageal reflux disease (GERD) are located around the gastroesophageal junction (GEJ). This study examined the distribution of endoscopic findings around the GEJ and elucidated their relationship to each other and esophageal manometric features. METHODS: Endoscopic data were collected prospectively from 2,450 consecutive diagnostic upper gastrointestinal endoscopies. The presence and degree of hiatal hernia (HH), columnar-lined esophagus (CLE), and reflux esophagitis (RE) were recorded. Esophageal manometric data were collected from 181 patients. RESULTS: The prevalence of HH, CLE, and RE was 9.8, 18.8, and 9.9%, respectively. Of all HH and CLE cases, 62.8 and 98.9%, respectively, were of the short-segment variety. Of all RE cases, 95.0% were mild. Younger age, male gender, the presence of HH, and a higher gastroesophageal flap valve (GEFV) grades were associated with the presence of RE. Increased ZAP grades were associated with increased prevalence and grades of HH, CLE, and RE. Higher GEFV grades were associated with increased prevalence and grades of HH, CLE, and RE. Lower esophageal sphincter pressure (LESP) decreased in patients with HH or RE compared to those without HH or RE. CONCLUSIONS: Endoscopic findings around the GEJ revealed that a substantial proportion of our patients showed features potentially related to GERD. In combination with other recent reports, our study implies that Korea is no longer a very-low-prevalence area of GERD, although it may predominate in silent or milder forms.
*Endoscopy, Gastrointestinal ; Esophageal Sphincter, Lower ; Esophagogastric Junction/*pathology ; Female ; Gastroesophageal Reflux/epidemiology/*pathology ; Hernia, Hiatal ; Humans ; Korea/epidemiology ; Male ; Manometry/instrumentation ; Middle Aged ; Prevalence ; Prospective Studies

OBJECTIVE: Recently, the definition of occult osteoporotic vertebral fracture has been established, and its clinical significance has come to our interest. We report the effect of early percutaneous vertebroplasty in occult osteoporotic vertebral fracture. METHODS: From January 2006 to January 2008, we performed percutaneous vertebroplasty for 50 levels in 47 patients. 21 levels (21 patients) of them were classified into occult osteoporotic vertebral fracture group, 29 levels (26 patients) were categorized into control group (not occult osteoporotic vertebral fracture) by the Pham T..s criteria. We obtained VAS score and measured the compression ratio at first hospital day and 1 day, 1 month, 3 months after procedure. RESULTS: There are noticeable improvements in VAS score. The mean VAS score at admission was 6.44 in occult group and 6.15 in control group, which changed 2.23 in occult group and 2.68 in control group after procedure. The compression rate was 1.008, 1.018, 1.016 in occult group and 0.862, 0.891, 0.881 in control group at admission and 1 month, 3 months after procedure. The conservative effect for vertebral height was higher than control group (p=0.011). CONCLUSION: Percutaneous vertebroplasty in occult osteoporotic compression fracture provided significant pain relief and conservative effect for vertebral height. It is probable that it can lower the rate of secondary adjacent vertebral compression fracture.
Fractures, Compression ; Humans ; Vertebroplasty