We performed 70 proceudres of transarterial chemoembolization (TAE) through extrahepatic collateral vessels (n=27) or parasitic feeders (n=18) in 45 hepatocellular carcinoma patients. The collaterals developed after interruption of the hapatic artery due to repeated TAE(n=17), surgical ligation(n=7) and primary celiac occlusion (n=3). Radiologic findings suggesting the existence of parasitic or collateral supply for hepatocellular carcinoma were 1) a focal defect of Lipiodol retention on CT or plain film after TAE via the hepatic artery, 2) dilated and tortuous vessels around the mass on angiography, 3) persistent elevation of the level of serum alpha fetoprotein or continuous clinical symptoms in spite of sufficient devascularization of the tumor via the hepatic artery, and 4) radiological findings of direct invasion into adjacent organ. The sites of the catheter placement were the inferior phrenic artery (n=19), omental branches (n=16), periportal collaterals (n=6), pancreaticodenal arcade (n=3), gastroduodenal artery (n=3), internal mammary artery (n=2), intercostal artery (n=2), lateral thoracic artery (n=1), bronchial artery(n=1), and colic branches(n=1). Masses feeded by the inferior phrenic and chest wall collaterals were usually located at the dome area of the liver, and the omental and gastroduodenal collaterals developed in the masses located at the inferior tip of the liver. After TAE via collateral vessels, 37 patients underwent follow-up study. In 18 cases(48%), the tumor favorably responded to TAE. Specific complications of collateral TAE were epigastric soreness (n=10), severe shoulder pain (n=4), and embolization of the spinal artery during embolization through the intercostal artey (n=1). In conclusion, various extrahepatic collaterals are important alternative or additional routes for effective chemoembolization in patients with advanced hepatoma, and early recognition of the parasitic supply and the effort to perform TAE via collaterals is very important for effective management of the patients with the hepatoma.
alpha-Fetoproteins ; Angiography ; Arteries ; Carcinoma, Hepatocellular* ; Catheters ; Colic ; Ethiodized Oil ; Follow-Up Studies ; Hepatic Artery ; Humans ; Liver ; Mammary Arteries ; Shoulder Pain ; Thoracic Arteries ; Thoracic Wall

No abstract available.
Pulmonary Artery* ; Takayasu Arteritis*

PURPOSE: To evaluate the frequently of low ahetenuation area in enhanced CT scans of non-Hodgkin lymphoma(NHL) and to find out if there is any pertinent relationship between this and the histopathologic classification. MATERIALS & METHODS: The authors reviewed CT scans in the newly diagnosed 53 patients with NHL. We defined the-low attenuation area as the one with CT attenuation value lower than that of the muscle, surrounding lesion, or other lymph nodes after contrast enhancement. NHL with the low attenuation areas were correlated with the histopathologic findings according to the classification based on the Working Formulation and the frequency of the lesion was evaluated. RESULT: Of the 53 patients, the low attenuation area was found in 13 patients (25%) at CT. The histopathologic classification could be made in 12 patients, among whom one patient was classified as low grade, six as intermediate grade, and five as high-grade. Concerning the specific cell typing, the diffuse large cell type was most common in intermediate-grade NHL seen in five patients and the large cell, immunoblastic type was most common in high-grade NHL seen ih three patients. CONCLUSION: The authors concluded that the low attenution area within lymphoma is not an infrequent finding at CT, and there was no stastistically significant correlation between this finding and the prognostic grading of the Working Formulation.
Classification ; Humans ; Lymph Nodes ; Lymphoma ; Lymphoma, Non-Hodgkin* ; Tomography, X-Ray Computed

Acral persistent papular mucinosis is a subtype of the localized papular mucinosis. Clinically, ivory to flesh-colored papules develop exclusively on the back of the hands, the extensor surface of the wrists, and occasionally the distal forearms. Histologically, mucin accumulates in the upper reticular dermis, typically sparing a subepidermal zone and fibroblasts are not increased in number. On experiencing a case of numerous papules on both hands and forearms of a fifty year-old woman, we present it as acral persistent papular mucinosis.
Dermis ; Female ; Fibroblasts ; Forearm ; Hand ; Humans ; Mucins ; Scleromyxedema* ; Wrist

We herein report a case of occupational contact urticaria syndrome induced by cefotiam di-hydrochloride in a nurse. She had generalized pruritic wheals accompanied by palpitations and tachypnea during the preparation of cefotiam solution. A scratch patch test with cefotiam di-hydrochloride, a major component of cefotiam ingredient showed multiple erythema and wheals within 5 minutes, accompanied by palpitations and tachypnea. No delayed type reaction was observed. Based on her clinical history and scratch test result, we diagnosed her condition as contact urticaria syndrome caused by cefotiam.
Cefotiam* ; Erythema ; Patch Tests ; Tachypnea ; Urticaria*

Yonsei University College of Medicine, Seoul, Korea Maffucci's syndrome is characterized by dysccondroplasia with hemangiomata. Since Angelo Maffucci (1881) first described this entity, 105 cases and some more were reported in the literature till 1976. We recently observed a patient suffering from this disorder. The patient is 21 year-old girl, who has multiple hemangiomes on her right foot, right buttock, left wrist and enchondromas on both proximal phalanx, distal phalanx of both great toes and proximal, middle phalanx of right second toe. The disease started at age of 11 and these lesions grew rapidly last 3 years. The diagnosis was based on clinical, radiological and histological findings. Because of its rarity, we report it with brief review of literature.
Buttocks ; Chondroma ; Diagnosis ; Female ; Foot ; Humans ; Korea ; Osteochondrodysplasias ; Seoul ; Toes ; Wrist

PURPOSE: To evaluate characteristic MR findings of primary cardiac and pericardiac tumors. MATERIALS AND METHODS: There were myxomas (n=7), malignant lymphoma (n=l), lipoma (n=l), and pericardiac mesotheliomas (n=2). We analyzed location, size, shape, signal intensity, contrast enhancement, and associated findings of adjacent structures such as pericardiac and pleural effusion, and mediastinal lymph node enlargement. RESULTS: Locations of the myxomas were left atrium in four cases, left ventricle in one, right atrium in one, and right ventricle in one. Mean diameter was 3.5cm (range, 2-7cm). They were polypoid or Iobulated in shape, and attached to interatrial or interventricular septurn in all cases except in right atrial myxoma which was attached to lateral wall. Their peduncles were demonstrated in three left atrial myxomas. The signal intensities were iso or slightly high on T1-weighted images and high on T2-weighted images. Pleural and pericardial effusions were shown in the three cases. Malignant lymphoma was manifested as large mass in right ventricle infiltrating to right atrium, interventricular septum, right paratracheal and retrocardiac area. It had slightly high intensity in both T1- and T2-weighted images with a strong contrast enhancement and associated with both pericardiac and pleural effusion. Lipoma was polypoid in shape and attached to lateral wall of left ventricle with bright T1 and high T2 signal intensity. Pericardiac mesothelioma was manifested as a pericardiac and atrial mass with diffuse irregular uneven thickening of pericardium which had iso signal on T1- and high T2-weighted images with moderate contrast enhancement. Conculsion: MR imaging is a very useful method in demonstration of the location, extent, tissue characteristics of the mass, and relationship with its adjacent structu res in evaluation of cardiac and pericardiac tumors.
Heart Atria ; Heart Ventricles ; Lipoma ; Lymph Nodes ; Lymphoma ; Magnetic Resonance Imaging* ; Mesothelioma ; Myxoma ; Pericardial Effusion ; Pericardium ; Pleural Effusion

PURPOSE: To analyze the outcome of distal tibia fracture treated with the Distal Tibia LCP with combination of interfragmentary screw. MATERIALS AND METHODS: Between January 2008 and March 2012, data of 34 patients with fracture of distal tibia treated with the Distal Tibia LCP with or without combination of interfragmentary screws were reviewed. There were 17 males and 17 females with an average age of 51.8 years (range, 18~77 years). Radiographic union time and time from surgery until ability to full weight bearing were measured and compared. Callus index was measured as quotient of callus thickness and diameter of corticalis both in AP and sagittal direction. RESULTS: 12 fractures were treated with interfragmentary screws and 22 fractures were treated with bridging plate alone. In interfragmentary fixation group, time to full weight bearing was 14 weeks versus 15.75 weeks without screw. Callus index at bearing was not significantly lesser in patients with screw compated with those without, but callus index difference at posterative 4weeks was sigficant. Radiologic union time was 11.3 weeks in interfragmentary fixation group and 12.58 weeks without screw. CONCLUSION: The osteosynthesis with the Distal tibia LCP with combination of interfragmentary screw seems to be more stable in postoperative 4weeks than Distal tibia LCP alone, expecting to earlier ROM exercise and rehabilitation.
Bony Callus ; Female ; Humans ; Male ; Tibia ; Ursidae ; Weight-Bearing

There have been various surgical methods to treat the carotid cavernous fistula such as the carotid ligation, trapping procedure, embolization with muscle, gelfoam and polyurethane foam, balloon technique and direct transcavernous approach. Each method has its own merits and disadvantages. The ideal treatment of the illness would be the selective closure of the fistula with preservation of carotid patency. The authors are reporting a case of C-C fistula in which selective muscle embolism preserving carotid flow was attempted at first, but the closure was incomplete that polyurethane foam embolization was done in addition with success.
Carotid-Cavernous Sinus Fistula ; Embolism ; Fistula* ; Gelatin Sponge, Absorbable ; Ligation ; Polyurethanes*

We report a case of a 55-year-old male renal transplant patient, who showed 1 cm sized six round brownish macules on both arms and legs for 8 months. These lesions were stable without change in size or number and histopathologically were consistent with the finding of porokeratosis. We think that this lesion is the mixed type which shares the character of Mibelli's porokeratosis and disseminated superficial actinic porokeratosis.
Arm ; Humans ; Immunosuppression* ; Leg ; Male ; Middle Aged ; Porokeratosis*