Obstruction of the inferior vena cava(IVC) is an uncommon condition, and the collateral pathway variesaccording to the level, extent, duration and the cause of obstruction. Membranous obstruction of IVC in itshepatic portion might be one of the principal cause among Korean, though not reported till now. Analytical studywas perfomred in 26 cases of IVC obstruction with various cause. 1. The level of the obstruction showed relativelyeven distribution as follows, upper caval in 11 cases, middle caval in 6 cases and infrarenal in 9 cases. 2. Themain cause of upper caval obstruction was membranous obstruction . 3. As a whole, the main collateral pathway wasthe central route(22 case:85%). 4. Characteristic collateral pathway unique to upper caval obstruction wastranshepatic vanous collateral, developed between the obstructed segment and unobstructed segment of IVC. 5.Scalloping of left cardiac border produced by pericardiophrenic venous collateral was characteristic simple chestX-ray finding in IVC obstruction.
Collateral Circulation ; Vena Cava, Inferior

Cerebrovascular accident (CVA) is the most common cause of neurologic disorder accompanying grave prognosisand its mortality above 50%. Prior to introduction of the CT, the diagnosis have been depended on clinicalfindings and spinal puncture. Radiologic diagnostic methods, such as angiography, ventriculography andradioisotope scanning are invasive and less sentitive in diagnosis of CVA than CT. The size, location andextension of the intracranial pathology and ventricular penetration are accureately and rapidly portrayed by CT.Consequently, CT plays impotant role in effective tratement and evaluation of prognosis in CVA. Authors analyzed63 cases of diagnosed CVA who were performed CT scan in Korea General Hospital from November 1981 to April 1982.The results were as follows. 1. The most prevalent age group of CVA was 6th decade, and then 7th and 5th decadesin decreasing order. The sex ration between male and female was 1.2:1. 2. The causes of CVA were hypertensivehemorrhage (50.8%), vascular occlusive disease(22.2%), anurysm ruture (4.8%), arteriovenous malformation (3.2%)and hemorrhage of unknown etiology (19.0%). 3. The most common site of hemorrhage was basal ganglia (34.6%) andthen thalamus(21.8%) and cerebral lobes(20.5%). In infarction, the common sites were the lobes(64.7%) and thebasal ganglia (35.3%) 4. Round or oval shaped hematomas of high density (85.9%) were frequent findings ofhemorrhage and mass effect occured in 75.6%. 5. All infarctions were low in density ; Most of the lesion wasinhomogeneous(70.6%) and the rests were homogeneous. Mass effects were seen in 29.4%.
Angiography ; Arteriovenous Malformations ; Basal Ganglia ; Diagnosis ; Female ; Ganglia ; Hematoma ; Hemorrhage ; Hospitals, General ; Humans ; Infarction ; Korea ; Male ; Mortality ; Nervous System Diseases ; Pathology ; Prognosis ; Spinal Puncture ; Stroke ; Tomography, X-Ray Computed

Diagnostic ultrasound has become one of the most useful tools in the practice of obstetics. It has been ofparticular utility in the placental localization. We analyzed 34 patients of placenta previa scanned byultrasound. The reults were as follows; 1. The age of patient ranged from 22 to 39 years, showing the highestincidence in 26 to 30 years. 2. The accuracy of correct localization was 70.6%. 3. Among 13 cases diagnosed byultrasound as total placenta previa, 2 cases were partial placenta previa and 1 was low-lying placenta at the timeof delivery. 4. Among 9 cases diagnosed by ultrasound as partial placenta previa, 1 case was total palcenta previaand 1 case was low-lying placenta and 1 case was upper segment placenta. 5. Among 10 cases diagnosed by utrasoundas low-lying placenta, 2 cases were partial placenta previa. 6. Among 2 cases diagnosed by utlrasound as uppersegment placenta, 1 case was total placental previa and 1 case was partial placenta previa. 7. Among 9 cases doneserial ultrasoud, 3 cases revealed that the placenta migrates toward fundus in the course of pregnancy, Therefore,the palcental scanning should be repeated in the last month before term to decide the mode of delivery.conclusively, ultrasonography is the imaging modality of choice in the evaluation of placental localization becuseit provides speedy and repeatable way without any known risk to both mother and fetus itself. Careful performanceand accurate interpretation shold be needed for more correct palcental localization.
Fetus ; Humans ; Mothers ; Placenta Previa ; Placenta ; Pregnancy ; Ultrasonography

Chordomas are maligaant tumors which arise in the remnants of the embryonic notochord, and exhibit a definite predilection for the extremes of the spinal axis, the great majority arising either in the basioccipital or in the sacrococcy geal regions. Particularly, complete surgical removal is almost impossible, therefore, local recurrence after the surgical removal of this tumor is common or rule. This report describes a csse of chordoma arising sacrococcygeal region treated with block resection.
Chordoma ; Notochord ; Recurrence ; Sacrococcygeal Region

In evaluation of head trauma, simple skull examinations have been almost routinely requested in emergency room, regardless of historical, physical or neurologic findings, for fear of an unexpected fracture and medicolegal problem. Considering the low yield rate of positive radiologic findings for skull fracture and poor correlation of skull fracture with intracranial sequelae, simple skull examinations in head trauma patients, especially in those with minor trauma, is overutilized without reasonable clinical criteria of application. A retrospective review of 1,101 patients was performed to evaluate the efficacy of simple skull examination at the point of diagnosis and treatment, and to predict the risk for skull fracture and significant intracranial sequelae by clinical findings. Eighty-six patients(7.8%) had skull fractures including two basilar fractures and 12 depressed fractures. 116 patients(10.5%) had significant intracranial sequelae and 62 of these had skull fractures. Of 1,101 patients, 237 had the clinical findings of "high-yield" features and 70 of these had skull fractures and 99 had intracranial sequelae, so high-yield fractures are very indicative for the skull fracture and intracramal sequelae. Only in nine patients(0.08%0 the managements were altered after simple skull examination in that two with basilar fractures were treated with antibiotics and seven with depressed fractures were undergone neurosurgical precedures. Patients who were not admitted nor required further study or treatment because of minor head traumadidn't have any skull fractures or intracranial sequelae in our series, and 62 of 116 patients with intracranial sequelae showed normal skull findings indicating that normal findings can create false sense of security.
Anti-Bacterial Agents ; Craniocerebral Trauma* ; Diagnosis ; Emergency Service, Hospital ; Head* ; Humans ; Neurologic Manifestations ; Retrospective Studies ; Skull Fractures ; Skull*

PURPOSE: To evaluate the effectiveness of pelvic arterial embolization (PAE) for intractable postpartum hemorrhage (PPH) after hysterectomy. MATERIALS AND METHODS: From March 2011 to December 2017, 14 patients who received PAE for PPH that persisted after total abdominal hysterectomy were included (mean age, 33.6 years; range, 26–37 years). The delivery type, cause of PPH, and angiographic findings were investigated. The technical and clinical success rates and clinical outcomes were evaluated. RESULTS: Of 14 patients, 8 patients (57%) had positive angiographic findings for bleeding; contrast extravasation (n = 6), and pseudoaneurysm (n = 2). Remnant uterine artery (UA) was the most common bleeding focus (n = 4), followed by vaginal artery (n = 2), left lateral sacral artery (n = 1), and left internal pudendal artery (n = 1). Technical and clinical success rates were 100% and 93% (13/14), respectively. In 1 patient, bleeding was not controlled after initial selective embolization and the entire anterior divisions of both internal iliac arteries were embolized with gelfoam. CONCLUSION PAE for persistent PPH after hysterectomy is a safe and effective treatment. Remnant UA was the most common bleeding site and all patients recovered without any significant sequelae after embolization.

The neurofibromatoses are a rare group of hereditary diseases of autosomal dominant fashion with the overall incidence of one in 3,000~4,000 and with two distinct forms, type I (Von Recklinghausen's neurofibromatosis) characterized by skin lesions including multiple cutaneous neurofibromas, axillary and groin freckling, and cafe-au-lait spots and type II by the presence of bilateral vestibular schwannomas. The neurofibromatosis type I is associated with the mutation of NF-I gene on chromosome 17q 11.2, which has a tumor suppressive role and with resultant development of the wide variety of tumors with the malignant incidence of about 2~16 %. Although the cases of malignant tumors in the neurofibromatosis type I have been reported in various tumors with the neural origin, lymphoma, pheochromocytoma and some cases of gastrointestinal tumors, the gastrointestinal tumors were found in only hepatobiliary system and large and small bowels and the cases of the malignant tumors of upper GI origin in duodenum and stomach have not been reported yet in Korea. We report a case of a 64-year-old man admitted with epigastric pain and diagnosed to adenocarcinoma, signet ring cell type, in 2nd portion of duodenum associated with neurofibromatosis type I.
Adenocarcinoma* ; Cafe-au-Lait Spots ; Duodenum* ; Genetic Diseases, Inborn ; Groin ; Humans ; Incidence ; Korea ; Lymphoma ; Middle Aged ; Neurofibroma ; Neurofibromatoses* ; Neurofibromatosis 1* ; Neuroma, Acoustic ; Pheochromocytoma ; Skin ; Stomach

BACKGROUND: The recurrent temporal lobe epilepsy induces contralateral cell damage and secondary epileptogenesis in the contralateral hippocampus of rats. This phenomenon is fairly constant and has been used as a model of human temporal lobe epilepsy. It is necessary to understand this patho-mechanism in order to prevent this cell damage. METHODS: We have investigated the patho-mechanism of secondary epileptogenesis by using the rat model injected with kainic acid (KA) into the unilateral hippocampus. KA model shows initial complex partial seizures originating from the limbic structures and following convulsive status epilepticus. Immunohistochemical staining for c-fos expression, TUNEL stain for apoptosis, and hematoxylin-eosin (H-E) stain for morphologic changes were used. RESULTS: In the injected hippocampus, transient activation of c-fos was expressed in the dentate gyrus and CA3 hippocampal area, which were shaded out within 24 hours after the onset of limbic seizure. The stained cell with normal appearance was not observed in the H-E stain after 72 hours due to diffuse cell death. In the contralateral hippocampus, transient expression of c-fos was observed in the dentate gyrus, hilus, CA3, and CA1 area. But the expression of c-fos in the CA3 and CA1 area was sustained to 24 hours. Cell loss was mild in the CA3 and hilus, and mild cell degeneration and shrinkage were observed in the CA1 area. Apoptotic body was expressed in the CA1 area at 72 hours after the onset of seizure. CONCLUSION: These results mean that the area of prolonged expression of c-fos is vulnerable to apoptosis. Also it suggests that the patho-mechanism of ipsilateral hippocampus is an acute cytotoxic edema, whereas the contralateral damage is an apoptosis.
Animals ; Apoptosis ; Cell Death* ; Dentate Gyrus ; Edema ; Epilepsy, Temporal Lobe ; Hippocampus* ; Humans ; In Situ Nick-End Labeling ; Kainic Acid ; Models, Animal ; Neurons* ; Rats* ; Seizures* ; Status Epilepticus

Recently, Skeletal Anchorage System (SAS) has been focused clinically with the view point that it could provide the absolute intraoral anchorage. First, it began to be used for the patient of orthognathic surgery who had difficulty in taking intermaxillary fixation due to multiple loss of teeth. And then, its uses have been extended to many cases, the control of bone segments after orthognathic surgery, stable anchorage in orthodontic treatment, and anchorage for temporary prosthesis and so on. SAS has been developed as dental implants technique has been developed and also called in several names; mini-screw anchorage, micro-screw anchorage, mini-implant anchorage, micro-implant anchorage (MIA), and orthosystem implant etc. Now many clinicians use SAS, but the anatomical knowledges for the installed depth of intraosseous screws are totally dependent on general experiences. So we try to study for the cortical thickness of maxilla and mandible in Korean adults without any pathologic conditions with the use of Computed Tomography at the representative sites for the screw installation.
Adult ; Dental Implants ; Humans ; Mandible ; Maxilla ; Orthognathic Surgery ; Prostheses and Implants ; Tooth

PURPOSE: We studied to compare computed tomographic(CT) findings of liver injury with management methods in adults and, moreover, to present the CT basis for the management. MATERIALS AND METHODS: We retrospectively reviewed CT scans of 43 adults diagnosed as liver injury during a 66-month period. Thirty-eight patients were hemodynamically stable. Thirty-two of them were managed conservatively, whereas six managed operatively. Five unstable patients underwent emergency operation. We classified CT findings according to the severity of liver injuries(ie, hematoma, laceration, and periportal tracking) and hemperitoneum, ranging from grade 1 to 5 and from 0 to 3+, respectively. Thus, we compared the CT classificafions with their management(ie, operation rate), especially hemodynamically stable patients. RESULTS: Operation rates of all patients and hemodynamically stable patients were 26% and 16%, respectively. Operation rate at each grade of liver injury was low, especially in hemodynamically stable, despite relatively high operation rate in grade 4. Operation rate of 3+ hemoperitoneum was 100%, including hemodynamically stable patients, in contrast to otherwise low operation rate of others. CONCLUSION: Most liver injury in adults, including grade 4, were managed conservatively, especially hemodynamically stable. Though large amount of hemoperitoneum(ie, 3+) required operation, most hemoperitoeum were managed conservatively. Thus, CT findings of liver injury is helpful in the decision for the management method.
Adult* ; Classification* ; Emergencies ; Hematoma ; Hemoperitoneum ; Humans ; Lacerations ; Liver* ; Retrospective Studies ; Tomography, X-Ray Computed