PURPOSE: To evaluate the usefulness, patterns and appearances of false positive lesions, and technical problems of CTAP(CT Arterioportography). MATERIALS AND METHODS: CTAP was done in 45 patients in whom hepatic lesions were suggested on other radiologic studies. CTAP findings were compared with the informations obtained by operations, biopsies, and follow-up imagings. Additional findings, which were not detected in other radiologic studies, false positive manifestations, and technical errors were analyzed. RESULTS: CTAP detected 51 additional hepatic lesions which are not detected in other imaging studies. Of the 51 lesions, ten were true positive hepatic tumors, 2 were inflammatory lesions and 39 were false positive .lesions. False positive lesions included perfusion defects of periportal and perifissural areas, subcapsular perfusion defects and nonlobar, nonsegmental geographic perfusion defects. In 2 cases, CTAP aided in deciding the surgical strategy. On the other hand, there were 4 cases causing interpretational confusion and 6 cases of improper imaging due to technical errors. CONCLUSION: CTAP was valuable in detection of additional hepatic cancer lesion as well as in making the treatment plan. However, since many false positive lesions and improper imaging due to technical error occur during the examination, the understanding of such problems is essential for correct interpretation of CTAP.
Biopsy ; Follow-Up Studies ; Hand ; Humans ; Liver Neoplasms ; Perfusion

The incidence of severe hepatitis A virus (HAV) infection has been increasing. However, clinicopathologic features of severe HAV infection that lead to liver transplantation (LT) have not been reported in Korea. We retrieved 16 LT cases with HAV infection during the last 3 years at Asan Medical Center, Seoul, Korea. Fifteen cases progressed to hepatic encephalopathy. Thirteen cases survived with or without complications, and three patients died of sepsis. The explanted liver showed massive or zonal necrosis with moderate to severe cholestasis. The zonal distribution of necrosis was frequently associated with endothelialitis of portal and/or central veins. Degenerative changes of hepatocytes were various in degree and distribution. Viral inclusions were suspected in two cases. Although HAV infection is usually confirmed by serological tests, significant venulitis of central and/or portal veins and viral inclusions, which are rarely observed, can suggest an HAV infection as a cause of massive hepatic necrosis of unknown mechanism.
Cholestasis ; Fluconazole ; Hepatic Encephalopathy ; Hepatitis ; Hepatitis A ; Hepatitis A virus ; Hepatocytes ; Humans ; Incidence ; Korea ; Liver ; Liver Transplantation ; Massive Hepatic Necrosis ; Necrosis ; Portal Vein ; Sepsis ; Serologic Tests ; Veins

In the case of crown-root fracture due to traumatic injury in anterior tooth and the fracture margin is located subgingivally,forced eruption has been proposed for the reconstruction of deficient bone and soft tissue. Forced eruption is one of the easiestorthodontic approaches that can have an acceptable outcome and prognosis, and has a low incidence of relapse. However, using heavy forces or very fast movements can also cause tissue damage or ankylosis. The following case reports present forced eruption as treatment option of crown fracture in maxillary anterior teeth.

Disseminated Fusarium infection has rarely been encountered in neutropenic cancer patients. The clinical features include fever, positive blood cultures, severe myalgias, disseminated ecthyma gangrenosum-like skin lesions, ocular symptoms and multi-organ-system involvement. The mortality rate reported so far exceeded 70% despite antifungal treatments. We report here the first two cases of disseminated fusarial infections in Korea. The first patient contracted pneumonia during severe neutropenic period following consolidation chemotherapy for acute myelogenous leukemia(AML). Fusarium oxyshrum was cultured from bronchoalveolar lavage fluid. The patient remains free of fungemia after successful antifungal treatment of high-dose amphotericin B and terbinafine. The second patient had relapsed AML and suffered from disseminated fusarial infection involving lungs with characteristic skin lesions. The patient succumbed to refractory leukemia and the fungal infection. A brief review of the literature ensues with the case report.
Amphotericin B ; Bronchoalveolar Lavage Fluid ; Child* ; Consolidation Chemotherapy ; Ecthyma ; Fever ; Fungemia ; Fusariosis ; Fusarium ; Humans ; Korea ; Leukemia* ; Lung ; Mortality ; Myalgia ; Pneumonia ; Skin

Coronary stent embolization is a rare event but may result in clinically relevant cardiac ischemia or peripheral embolization during the procedure. We report a case of systemic embolizations of two coil stents during the primary PTCA in acute myocardial infarction, who were treated successfully with a double wire helix technique and a gooseneck snare. Although in our experience this rare complication did not produce any clinical complications, care should be taken to prevent this possibility, especially in patients with significant vessel tortuosity, calcification, total occlusion, or mild stenosis proximal to the target lesion.
Constriction, Pathologic ; Humans ; Iliac Artery* ; Ischemia ; Myocardial Infarction ; SNARE Proteins ; Stents*

Schwannomatosis or neurilemmomatosis has been used to describe patients with multiple nonvestibular schwannomas with no other stigmata of neurofibromatosis type-2 (NF-2). In our case, schwannomatosis, multiple schwannomas were present in a 21-yr-old woman with no stigmata or family history of NF-1 or NF-2. She had no evidence of vestibular schwannoma or other intracranial tumors. Multiple peripheral tumors were found in the carotid space of the neck, and soft tissue of posterior shoulder, lower back, ankle and middle mediastinum. All of those tumors were completely limited to the right side of the body. All surgically removed tumor specimens in this patient proved to be schwannomas.
Treatment Outcome ; Peripheral Nervous System Neoplasms/*diagnosis/*surgery ; Neurilemmoma/*diagnosis/*surgery ; Humans ; Female ; Adult

PURPOSE: Tuberculosis (TB) is mainly caused by Mycobacterium tuberculosis, which is a pathogenic mycobacterial species grouped under Mycobacterium tuberculosis complex (MTBC) with four other pathogenic mycobacterial species. The mycobacteria not included in MTBC are known as nontuberculous mycobacteria (NTM), and cause several pulmonary diseases including pneumonia. Currently, NTM occurrences in TB-suspected respiratory specimens have increased, due to which, precise detection of MTBC and NTM is considered critical for the diagnosis and vaccination of TB. Among the various methods available, real-time PCR is frequently adopted for MTBC/NTM detection due to its rapidness, accuracy, and ease of handling. In this study, we evaluated a new real-time PCR kit for analytical and clinical performance on sputum, bronchial washing, and culture specimens. MATERIALS AND METHODS: For assessing its analytical performance, limit of detection (LOD), reactivity, and repeatability test were performed using DNA samples. To evaluate clinical performance, 612 samples were collected and clinically tested at a tertiary hospital. RESULTS: LOD was confirmed as 0.584 copies/µL for MTBC and 47.836 copies/µL for NTM by probit analysis (95% positive). For the reactivity test, all intended strains were detected and, in the repeatability test, stable and steady results were confirmed with coefficient of variation ranging from 0.36 to 1.59. For the clinical test, sensitivity and specificity were 98.6%–100% and 98.8%–100% for MTBC and NTM, respectively. CONCLUSION: The results proved the usefulness of the kit in TB diagnosis. Furthermore, it could be adopted for the assessment of vaccine efficacy.
BCG Vaccine ; Diagnosis ; DNA ; Limit of Detection ; Lung Diseases ; Mycobacterium tuberculosis ; Nontuberculous Mycobacteria ; Pneumonia ; Real-Time Polymerase Chain Reaction* ; Sensitivity and Specificity ; Sputum ; Tertiary Care Centers ; Tuberculosis ; Vaccination*

Various candidate biomarkers have been investigated for the early and accurate diagnosis of Kawasaki disease (KD). We aimed to evaluate platelet activity using platelet indices (PI) in patients with KD or simple febrile illness to determine whether these indices might support a diagnosis of KD. Another objective of the study was to delineate the changes in PI from the acute to convalescent phases of KD. A total of 225 patients with complete KD (cKD), 110 with incomplete KD (iKD), and 71 with simple febrile illness (control) were enrolled. PI included mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT). We serially measured the serum PI four times for each patient with KD from the acute to convalescent phases: on D0 (day of intravenous immunoglobulin (IVIG) treatment) and repeated on days 2 (D2), 14 (D14), and 56 (D56) after IVIG therapy. Data from the control group were collected during the acute stage of the disease (D0). The platelet counts in the cKD (341±103×10 3 /mm 3 ) and iKD (374±135×10 3 /mm 3 ) at diagnosis were higher than the control group (290± 128×10 3 /mm 3 ). The PCT in the cKD (0.284±0.085%) and iKD (0.313±0.109%) groups at diagnosis were also higher than the control group (0.246±0.108%). However, the MPV and PDW levels in the KD group were not statistically significant. Therefore, platelet count and PCT are adjuvant parameters for the differential diagnosis of KD from a simple febrile illness.

We report the case of a polyethylene tibial post fracture in a 72-year-old woman 14 months after a Scorpio posterior-stabilized (PS) total knee arthroplasty. The polyethylene wear was found around the fracture site of the post, especially over the anterior aspect of the post base. The failure mechanism of the post fracture in the present case was anterior impingement with excessive wear over the base of the anterior aspect of the tibial post, which became a stress-riser of post and cam articulation. This is the first report of a polyethylene tibial post fracture of a Scorpio PS prosthesis.
Aged ; *Arthroplasty, Replacement, Knee ; Female ; Humans ; Knee Joint/radiography ; Knee Prosthesis/*adverse effects ; Osteoarthritis, Knee/surgery ; *Polyethylenes ; *Prosthesis Failure ; Reoperation

PURPOSE: To provide a case report of 1 patient (1 eye) who experienced recurrences of conjunctival papilloma and was treated with complete resection, electrocauterization, cryotherapy, intraoperative application of mitomycin C and postoperative topical mitomycin C. CASE SUMMARY: We evaluated the clinical course of a 42-year-old male with recurrent conjunctival papillomas on the left upper and lower tarsal conjunctiva who was treated 10 times with a simple resection over the past 8 years. The patient was treated with complete resection, electrocauterization, intraoperative application of mitomycin C and cryotherapy. Topical mitomycin C was applied for 1 month. There was no recurrence or complications for 12 months postoperatively. CONCLUSIONS: Complete resection, electrocauterization, intraoperative application of mitomycin C, cryotherapy and topical mitomycin C in patients with recurrent conjunctival papilloma was shown to be an effective treatment without recurrence and complications.
Adult ; Conjunctiva ; Cryotherapy ; Humans ; Male ; Mitomycin ; Papilloma ; Recurrence