Late aortic rupture following successful endovascular repair of abdominal aortic aneurysm still does occur. It represents the ultimate failure of endovascular aortic repair of abdominal aortic aneurysm (EVAR) and subjects patients to equivalent risk of death as de novo rupture. Unfortunately, it is difficult to identify patients at risk for post-EVAR rupture as many present with aortic rupture in the absence of any endograft-related complications. Continued surveillance and timely intervention are of paramount importance to assure rupture-free survival, the ultimate goal of any aneurysm treatment modality. The vascular surgeon needs to be prepared to provide the optimal therapy, whether open or endovascular, for this challenging cohort of patients.
Aneurysm ; Aortic Aneurysm, Abdominal* ; Aortic Rupture ; Blood Vessel Prosthesis Implantation ; Cohort Studies ; Humans ; Rupture

One of the most important prognostic factors in LCP disease is the extent of epiphyseal involvement. Magnetic resonance imaging is considered to be the technique of choice for early diagnosis of Legg-Calve-Perthes disease. Gadolinium-enhanced spin-echo MR images were obtained after nonenhanced Tl-weighted(spin-echo) and T2-weighted(gradient-echo) images. Four different areas were identified in the femoral epiphysis(necrosis, regenerative, cartilaginous and normal fatty bone tissue). The histological evolution of LCP is well described by Catterall and others. Comparing their description with our MRI finding, we suggest classification of LCP into three phases: (I) necrosis, (II) regeneration(IIa-early and IIb-late) and (III) reossification and sequale. T2 weighted image was useful in the early stage and Tl weighted image was useful in the later stage for evaluation of involved extent of the disease. With MRI, we think that we can find out the stage of LCP more early and rationally, pathological factors more easily and appropriate time for operation exactly. we believe that MRI is more adequate method to decide the stage of LCP disease.
Classification ; Early Diagnosis ; Legg-Calve-Perthes Disease ; Magnetic Resonance Imaging* ; Necrosis

Serous cystadenomas of the pancreas are generally considered to be microcystic adenomas. Typical serous cystadenomas of the pancreas are encapsulated tumors composed of tiny cysts less than 2 cm in size showing sponge-like appearance with a central stellate scar or calcification on the cross-section. It has been recently reported, however, that serous cystadenomas may have macrocystic variants (major cysts more than 2 cm in size) that are radiologically indistinguishable from mucinous cystadenomas of the pancreas. We report the CT and MR imaging findings in a patient with mixed microcystic and macrocystic serous cystadenoma of the pancreas, indicating the histopathologic correlation. The mass was composed of two different types of cyst: multiple, small (<2 cm) with central calcification; and large (>2 cm) with peripheral calcification.
Adenoma ; Cicatrix ; Cystadenoma, Mucinous ; Cystadenoma, Serous* ; Humans ; Magnetic Resonance Imaging ; Pancreas*

Primary malignant lesions of the vagina are uncommon and represent approximately 1 -2% of all gynecologic malignancies. About 2% of all malignant vaginal lesions are primary sarcomas, the most common of these being leiomyosarcoma. We report the CT and MR imaging findings in a 41-year-old woman with vaginal leiomyosarcoma presenting as a bulky solid mass which caused expansion of the vaginal canal.
Adult ; Female ; Humans ; Leiomyosarcoma* ; Magnetic Resonance Imaging* ; Sarcoma ; Vagina*

BACKGROUND: Arthroscopic rotator cuff repair generally has a good clinical outcome but shoulder stiffness after surgery due to subacromial adhesion is one of the most common and clinically important complications. Sodium hyaluronate (HA) has been reported to be an anti-adhesive agent in a range of surgical procedures. However, there are few reports of the outcomes of arthroscopic rotator cuff repair of the shoulder. This study examined whether a subacromial injection of HA/carboxymethylated cellulose (CMC) affected the postoperative shoulder stiffness and healing of rotator cuff repair, as well as the safety of an injection. METHODS: Between January 2008 and May 2008, 80 consecutive patients with arthroscopic rotator cuff repair were enrolled. The patients were assigned randomly to the HA/CMC injection group (n = 40) or control group (n = 40). All patients were evaluated using the visual analog scale (VAS) for pain, passive range of motion at 2, 6 weeks, 3, 6, 12 months after surgery, and the functional scores at 6, 12 months postoperatively. Cuff healing was also evaluated using CT arthrography or ultrasonography at 6 or 12 months after surgery. RESULTS: The HA/CMC injection group showed faster recovery of forward flexion at 2 weeks postoperatively than the control group but the difference was not statistically significant (p = 0.09). There were no significant difference in pain VAS, internal rotation, external rotation and functional scores between two groups at each follow-up period. The functional scores improved 6 months after surgery in both groups but there were no differences between the two groups. The incidence of unhealed rotator cuff was similar in the two groups. There were no complications related to an injection of anti-adhesive agents including wound problems or infections. CONCLUSIONS: A subacromial injection of an anti-adhesive agent after arthroscopic rotator cuff repair tended to produce faster recovery in forward flexion with no adverse effects on cuff healing. However, its anti-adhesive effects after rotator cuff repair should be considered carefully with further studies.
Adult ; Aged ; Arthroscopy/*adverse effects/*methods ; Carboxymethylcellulose Sodium ; Drug Carriers ; Female ; Humans ; Hyaluronic Acid/adverse effects/*therapeutic use ; Male ; Middle Aged ; Pain ; Prospective Studies ; Range of Motion, Articular ; Recovery of Function ; Rotator Cuff/injuries/*surgery ; Shoulder Joint/physiology ; Tissue Adhesions/*prevention & control ; Treatment Outcome ; Viscosupplements/adverse effects/*therapeutic use

Botulinum toxin type A (BoNT-A) has been reported as an effective treatment for chronic migraine. When BoNT-A is injected on the frontalis muscle for chronic migraine, an unexpected clinical side effect called the "Mephisto sign" may occur. The aim of this article is to propose a method to eliminate or prevent the Mephisto sign side effect. A 25-year-old female patient visited the hospital and was diagnosed with chronic migraine. A total of 155 U of BoNT-A was injected into 31 sites. 2-weeks later, and the patient developed the Mephisto sign. An additional 2-U dose was administered bilaterally to the lateral-most point of the frontalis muscles, and the eyebrow morphology returned to normal within 2-3 weeks. We propose that the development of the Mephisto sign may be prevented with an additional BoNT-A injection of 2-4 U bilaterally to the lateral most point of the frontalis muscles during the primary injection process.
Adult ; Botulinum Toxins, Type A/administration & dosage/*adverse effects ; Female ; Humans ; Injections ; Migraine Disorders/*drug therapy

Objectives: To survey daily doses of dopaminergic medications and to draw a posteriori equation of the dose in relation to the various clinical variables in Korean patients with Parkinson disease. Methods: A multi-center cross-sectional survey was conducted over a defi ned period. Information on patient demographics and clinical features including age at Parkinson disease onset, disease duration, treatment duration and Hoehn and Yahr stage, and daily doses of anti-parkinsonian drugs was obtained from the patients’ medical records. Results: A total of 1,762 patients with Parkinson disease were recruited from 6 referral centers. The mean L-dopa equivalent daily dose (LEDD) in the whole population was 608.9 mg/day, which tended to increase linearly depending on the duration of disease and Hoehn and Yahr stage. LEDD was also signifi cantly affected by age and gender. We performed multiple linear regression analyses and devised a posteriori equation of LEDD with clinical variables. Conclusions: This survey provides systematic data for mean LEDD in Korean Parkinson disease patients. In spite of profound individual variations in LEDD, our linear regression model provides an insight about the relationship between daily doses of dopaminergic medications and various clinical features of Parkinson disease.

Spinal cord ischemia after open repair of abdominal aortic aneurysm (AAA) is an unpredictable and devastating complication. We present a case report of a patient who developed paraplegia 6 hours after open repair of suprarenal AAA. A 74-yearold man presented with asymptomatic 5.5-cm suprarenal AAA, for which he underwent open repair under general anesthesia. The paraplegia was identified 6 hours after the operation. Postoperative magnetic resonance imaging showed T2 signal hyperintensity and swelling of the spinal cord, which were consistent findings with subacute spinal cord infarction. Although intravenous steroid was administered and lumbar cerebral spinal fluid drainage was instituted, his neurological outcome did not improve. He was discharged after vigorous rehabilitation but still has paraplegia and requires wheelchair for ambulation.

Spinal cord ischemia after open repair of abdominal aortic aneurysm (AAA) is an unpredictable and devastating complication. We present a case report of a patient who developed paraplegia 6 hours after open repair of suprarenal AAA. A 74-yearold man presented with asymptomatic 5.5-cm suprarenal AAA, for which he underwent open repair under general anesthesia. The paraplegia was identified 6 hours after the operation. Postoperative magnetic resonance imaging showed T2 signal hyperintensity and swelling of the spinal cord, which were consistent findings with subacute spinal cord infarction. Although intravenous steroid was administered and lumbar cerebral spinal fluid drainage was instituted, his neurological outcome did not improve. He was discharged after vigorous rehabilitation but still has paraplegia and requires wheelchair for ambulation.

BACKGROUND: The incidence of malignant melanoma in oriental countries is lower than that in western countries. But recently the incidence of malignant melanoma and related death rate are increasing in the world. Malignant melanoma on the palm and sole is known to have worse prognosis and sometimes radical surgery such as amputation is necessary. It is important to exclude malignant melanoma when pigmented patch is encountered, and biopsy is necessary in most cases. But histopathological features of benign melanocytic neoplasms occurring at palm or sole are known to be confusing, because they can resemble the features of malignant melanoma. But there has been no report on this item in Korean dermatological literature, to our knowledge. OBJECTIVE: We investigated the histopathological features of benign melanocytic neoplasms on the palm and sole with their clinical features. MATERIALS AND METHODS: A total of 23 benign melanocytic neoplasms that had been excised from the palm and sole at Inje University Sanggye Paik Hospital and Seoul National University Hospital between July 1991 and April 1998 were evaluated. The retrospective analysis of the clinical manifestation was performed. Histologically, hematoxylin and eosin stained tissue sections were reviewed with the following criteria: symmetry, circumscription, lentiginous hyperplasia, anastomosing rete ridges, pagetoid spread, papillary dermal fibroplasia, lymphocytic infiltrate, pigment in the dermis and the stratum corneum, cytologic atypia, and mitotic activity. RESULTS: Five patients were male and eighteen were female; the mean age was 27.6 years with a peak incidence in the fourth decades. Six lesions had asymmetric, irregular and geographic borders. The diameter of the lesions varied; 3 cases were larger than 9 mm in maximum diameter. Clinically, we suspected 7 cases to be malignant melanoma before biopsy. Histological diagnoses of 23 benign melanocytic neoplasms were as follows: 12 junctional nevi, 3 compound nevi, 1 intradermal nevus, 2 lentigines, 3 benign melanocytic hyperplasias, and 2 congenital melanocytic nevi. Microscopic findings showed single melanocytic proliferation at the dermo-epidermal junction in 17 cases(73.9%), lentiginous hyperplasia in 8 cases, upward migration of melanocytes in 8 cases(34.7%), and ill-defined lateral circumscription in 6 cases(26.0%). Mitotic figures and cytologic atypia were not present. Pigments were variously seen in the stratum corneum in all cases and conspicuous amounts of melanin where the melanocytes upwardly migrated were found in 8 cases. CONCLUSION: There has been a report that the diameter of lesions is very important in differential diagnosis of malignant melanoma when a pigmented lesion is present on the palm and sole and 9mm is the critical maximum diameter. But we encountered 3 cases of benign melanocytic neoplasm which were larger than 9mm in their diameters. We think 9mm is not a reliable critical diameter in the differential diagnosis of malignant melanoma. Histological analysis showed some features resembling malignant melanoma, such as single melanocytic hyperplasia, upward migration of melanocytes in epidermis, ill-defined lateral margin, abundant pigments in the stratum corneum, and lymphocytic infiltration in dermis. There was no case with cytological atypia or mitoses and we think this is an important feature to be studied in the future in the differentiation of malignant melanoma.
Amputation ; Biopsy ; Dermis ; Diagnosis ; Diagnosis, Differential ; Eosine Yellowish-(YS) ; Epidermis ; Female ; Hematoxylin ; Humans ; Hyperplasia ; Incidence ; Lentigo ; Male ; Melanins ; Melanocytes ; Melanoma ; Mitosis ; Mortality ; Nevus ; Nevus, Intradermal ; Nevus, Pigmented ; Prognosis ; Retrospective Studies ; Seoul