Proptosis after a subgaleal hematoma (SGH) is a rare condition that may require immediate intervention to prevent visual loss. A 12-year-old boy presented with localized SGH in the left parietal area after hair-pulling. The SGH was massively expanded on the entire scalp on the 3rd day of the trauma. On the next day after the massive expansion, proptosis of the right eye occurred suddenly. Emergent needle aspiration of the SGH was performed, and the proptosis improved slightly. Fortunately, his vision did not deteriorate. After all, he was diagnosed with coagulation factor IX deficiency (hemophilia B). The supraorbital notch could be a passage of the SGH to extend into the subperiosteal space of the orbit.

OBJECTIVE: Using the standardization of disease diagnosis of disease, and surgical procedures, the authors have made a clinical application for the analysis of inpatient data with the ability to search for information pertinent for writing of clinical articles. METHODS: A client-server system and database software was developed for networking. For clinical application, a computerized daily report has been developed. Data from Neurosurgical patients admitted at Soonchunyang University Hospital from January to December 1998 were analyzed with this system. Data for clinical articles was obtained using the search mode, information such as orbital infarction syndrome following intracranial aneurysm surgery and epidemiological analysis or geriatric neurosurgical patients. RESULTS: For the daily report it takes approximately 10 minutes to input the patients demographic information, name of disease, diagnosis and surgical procedure. The daily report also numbers and sorts the inpatients according to large categories of diagnosis, reports the ratio between inpatients and operative patients. The annual report that was obtained was very accurate and gave rapid statistics for the one year. By retrospective study for the past 18 years, we calculated the incidence of orbital infarction syndrome following intracranial aneurysm surgery as 1.4%, and also estimated the population of geriatric inpatients as 18.3% by retrospective study. CONCLUSIONS: It has been found to be most useful to make a daily and annual report for tracking and research purposes. For use in clinical articles, it can be possible to do a search of the patients using the standardized disease, diagnosis and neurosurgical procedures application and obtain pertinent information in a timely manner.
Diagnosis ; Epidemiology* ; Humans ; Incidence ; Infarction ; Inpatients ; Intracranial Aneurysm ; Neurosurgical Procedures* ; Orbit ; Retrospective Studies ; Writing

OBJECTIVE: The the international classification of disease and surgical procedure has been found to be a lengthy and time-consuming text for use by neurosurgeons. A more subject matter related classification system is needed for use by this specialty. The author has developed a more comprehensive and standardized classification system specified for diagnosis of neurological disease and neurosurgical procedures. METHODS: Standardization of disease was completed by modifying the name of disease according to that which was used for daily report past 10 years, and from textbook of neurosurgery. The fields of international coding are continued in each. Neurosurgical procedures were designated and modified according to Current Procedure Terminology 96. Client-server system will be used for networking and database software applications have been developed. RESULTS: Disease was classified in 14 large categories and 379 subcategories. Diagnosis was classified in 12 large categories and 43 subcategories. Neurosurgical procedure has 20 large and 202 subcategories. The international coding system such as ICD-10 and ICD-9CM is maintained for the diagnosis and procedures to each category. CONCLUSIONS: It could be possible to make and use a standardized database model of disease, diagnosis and neurosurgical procedures to be used by physician.
Classification ; Clinical Coding ; Diagnosis ; Epidemiology* ; International Classification of Diseases ; Neurosurgery ; Neurosurgical Procedures*

Background/Objectives: Extra-nodal extension (ENE) is one of the strongest prognosticators in oral cancers. Here we tried to evaluate clinicopathological factors associated with the presence of ENE.Materials & Methods: We retrospectively analyzed clinical information of 120 patients who diagnosed with oral cancer and received curative surgery at our hospital from Mar 2012 to Apr 2020. We comparatively analyzed clinicopathological factors associated with the presence of lymph node (LN) metastasis and ENE, respectively. Results: Variable factors of primary tumor characteristics such as lymphovascular invasion, perineural invasion, largest diameter of tumor, depth of invasion and maximum standardized uptake value were significantly associated with the presence of cervical LN metastasis. The largest diameter of tumor was statistically significant also in multivariate analysis for predicting the LN metastasis. Meanwhile, the association between primary tumor characteristics and the presence of ENE were not statistically significant except the primary tumor size. Importantly, factors associated with LN characteristics including the maximum diameter and number of metastatic LNs were significantly associated with ENE. Conclusion In this study, several factors affecting cervical LN metastasis and ENE in oral cancer patients were identified. The ENE seems to be influenced by the status of the metastatic LNs, such as the number of metastatic LNs, rather than the characteristics of the primary tumor itself.

Background: This study investigated whether concomitant facial bone (FB) fractures reduce temporal bone (TB) injuries, such as posttraumatic facial palsy and vertigo, through an impact absorbing effect, so-called “cushion effect,” in severe trauma patients. Methods: A total of 134 patients with a TB fracture were included. They were divided into two groups according to their concomitant facial fractures: group I (no FB fracture) and group II (FB fracture). We compared clinical characteristics, such as brain injury, trauma severity, and complications of TB fracture, between the two groups. Results: In group II, immediate facial palsy was more frequent (11.6% vs. 1.5% in group I), and the Injury Severity Score was higher (19.0 ± 5.9 vs. 16.7 ± 7.3, P = 0.020). Delayed facial palsy (12.3% in group I vs. 4.3% in group II) and posttraumatic vertigo (24.6% vs.7.2%) occurred more often in group I. FB fractures significantly decreased the incidence of posttraumatic vertigo (odds ratio [OR], 0.276; 95% confidence interval [CI], 0.083–0.914). Intraventricular hemorrhage (OR, 20.958; 95% CI, 2.075–211.677), facial nerve canal injury (OR, 12.229; 95% CI, 2.465–60.670), and FB fractures (OR, 16.420; 95% CI, 1.298–207.738) increased the risk of immediate facial palsy. Conclusion Concomitant FB fractures reduced the risk of the occurrence of delayed facial palsy and posttraumatic vertigo in injured patients with TB fracture. Particularly, an anterior force may be reduced by the cushion effect of the bony fracture.

Although rapid diagnosis of human babesiosis usually can be made by microscopic examination of thin and thick blood smears, differentiation between Babesia microti and Plasmodium falciparum can be quite difficult. The parasite is often not visualized in the early course of infection or in a partially treated case and the young trophozoites of these two organisms are similar. Recently, we experienced a case, which was thought as human babesiosis initially by microscopic examination of the Giemsa-stained thin blood smears, but was finally diagno-sed as P. falcifarum infection by indirect immunofluorescent antibody assay and polymerase chain reaction. The patient was treated successfully with quinine and clindamycin, which are effective in both infections. When differential diagnosis is difficult, we suggest combination therapy of quinine and clindamycin as an empirical regimen.
Animals ; Babesia microti ; Babesiosis ; Clindamycin* ; Diagnosis ; Diagnosis, Differential ; Humans ; Parasites ; Plasmodium falciparum ; Polymerase Chain Reaction ; Quinine* ; Trophozoites

OBJECTIVE: To compare the plantar peak pressure of diabetic patients without neuropathic and ischemic symptoms to normal subject wearing diabetic shoes and to compare the plantar peak pressures of P.W. minor (B) shoes to Apex (A) shoes. METHOD: Thirty three normal subjects and fourteen diabetic patients were participated. Plantar peak pressures in shoes were measured by pedar(r)during a comfortable gait wearing two types of diabetic shoes, respectively. A shoes and B shoes were used in this study. Plantar pressure was analyzed by pedar C-expert program at T0 (whole foot), M1 (heel), M2 (midfoot), M3 (1st, 2nd metatarsal area), M4 (3rd, 4th, 5th metatarsal area), M5 (great toe), M6 (2nd, 3rd toe area) and M7 (4th, 5th toe area) zones respectively. RESULTS: Plantar peak pressures of diabetic patients without neuropathic and ischemic symptom were not different from normal subjects. In normal subjects, plantar peak pressure of B shoes were lower than A shoes at both T0, M3 and M5 zones and left M6 and M7 zones. Plantar peak pressures of A shoes was lower than B shoes at both M2 zones. In diabetic patients plantar peak pressures of B shoes was lower than A shoes at right M4 and left M5 zones. CONCLUSION: There was no sgnificant difference between plantar peak pressures of normal subjects and diabetic patients without neuproathic and ischemic symptom. B shoes were better than A shoes to reduce plantar peak pressure.
Diabetes Mellitus ; Gait ; Humans ; Metatarsal Bones ; Shoes* ; Toes

OBJECTIVE: To assess inter-modality variability when evaluating cervical intervertebral disc herniation using 64-slice multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI). MATERIALS AND METHODS: Three musculoskeletal radiologists independently reviewed cervical spine 1.5-T MRI and 64-slice MDCT data on C2-3 though C6-7 of 51 patients in the context of intervertebral disc herniation. Interobserver and inter-modality agreements were expressed as unweighted kappa values. Weighted kappa statistics were used to assess the extents of agreement in terms of the number of involved segments (NIS) in disc herniation and epicenter measurements collected using MDCT and MRI. RESULTS: The interobserver agreement rates upon evaluation of disc morphology by the three radiologists were in fair to moderate agreement (k = 0.39-0.53 for MDCT images; k = 0.45-0.56 for MRIs). When the disc morphology was categorized into two and four grades, the inter-modality agreement rates were moderate (k-value, 0.59) and substantial (k-value, 0.66), respectively. The inter-modality agreements for evaluations of the NIS (k-value, 0.78) and the epicenter (k-value, 0.79) were substantial. Also, the interobserver agreements for the NIS (CT; k-value, 0.85 and MRI; k-value, 0.88) and epicenter (CT; k-value, 0.74 and MRI; k-value, 0.70) evaluations by two readers were substantial. MDCT tended to underestimate the extent of herniated disc lesions compared with MRI. CONCLUSION: Multidetector-row computed tomography and MRI showed a moderate-to-substantial degree of inter-modality agreement for the assessment of herniated cervical discs. MDCT images have a tendency to underestimate the anterior/posterior extent of the herniated disc compared with MRI.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cervical Vertebrae/pathology/*radiography ; Female ; Humans ; Intervertebral Disc Displacement/*radiography/therapy ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Multidetector Computed Tomography/*methods ; Observer Variation ; Young Adult

It has been thought for many years that gastric adenocarcinoma almost never crosses the pylorus. Although this theory was generally accepted, several studies have refuted it. We report three cases of gastric adenocarcinoma direct spreading into the duodenum that was diagnosed by endoscopic duodenal biopsy and review the literature.
Adenocarcinoma ; Biopsy ; Duodenum* ; Endoscopy ; Pylorus

Primary rectal lymphoma is a rare disease among the gastrointestinal (GI) lymphoma. In particular, diffuse large B-cell lymphoma (DLBCL) transformed from mucosa-associated lymphoid tissue (MALT) lymphoma is often the primary type of GI lymphoma, mostly in stomach or duodenum, but has never been reported in rectum. Here we report an unusual case in which a 75-year-old male patient diagnosed with DLBCL transformed from MALT lymphoma in the rectum. The patient was diagnosed as rectal DLBCL transformed from MALT lymphoma as Lugano stage II2 and was treated with chemotherapy (R-CHOP) with CD-20 monoclonal antibody (rituxaimb). Complete remission of multiple lymphadenopathy and mass forming ulcer of the rectum was achieved after 6 cycles of R-CHOP. He has been free from disease for 12 months.
Aged ; B-Lymphocytes* ; Drug Therapy ; Duodenum ; Humans ; Lymphatic Diseases ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell* ; Lymphoma, B-Cell, Marginal Zone* ; Male ; Rare Diseases ; Rectum ; Stomach ; Ulcer