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

Wolf’s isotopic response refers to the occurrence of a novel skin disease at the site of a preceding treated or untreated skin disease. Although the most common preceding skin disease was found to be herpes zoster (HZ), HZ-related dermatological phenomena are not well known in the literature. We report a case of HZ granulomatous dermatitis in a 77-year-old female with a previous history of hypertension, diabetes mellitus, chronic kidney disease, and HZ. She presented with a 3-month history of a pruritic skin lesion on her right thigh. The location of the lesion was consistent with a previous HZ site. Histopathological examination revealed lympho-histiocytic infiltration in the superficial dermis, forming a granulomatous structure. Based on clinical and histopathological findings, we made a diagnosis of granulomatous dermatitis at a previous HZ site. We assumed that the lesion arose from an isotopic response of Wolf. The patient was treated with topical steroids for 3 months and showed clearance of the lesion and symptom. We suggest that treatment should be based on the individual disease, which in our case was topical steroid.

Friction melanosis (FM) is an acquired pigmented disease that is caused by recurrent mechanical stress. There is no previous report explaining the presence of tiny brown-colored particles confined to the corneal layer. We describe a case of a rare form of FM of the finger that showed a relatively transient clinical course. A 17-year-old Korean female presented with a 5-month history of an asymptomatic localized hyperpigmented patch on the tip of the right index finger. The dermoscopic examination revealed homogenous globular pattern, which favored pigmentation over hemorrhage. Histopathologically, hyperkeratosis and acanthosis with lymphohistiocytic infiltration of the superficial dermis were noted on hematoxylin and eosin staining; however, there was neither a definite increase in melanophages in the upper dermis nor melanocytic proliferation in the basal layer. Per high-power field, multiple brown-colored tiny particles were scattered in the corneal layer. The particles were not dyed by Fontana-Masson stain, iron stain, and S-100. We questioned the patient about the presence of irritation and found that she had bought new shoes at the time of the onset. She was habituated to placing her fingers in her shoes while wearing them because they were slightly tight. The lesion disappeared spontaneously a week after the cause of friction was eliminated.Altogether, we encountered a rare form of FM that occurred in a rare location with a transient clinical course. Further cases on pigmentation restricted to finger tips might reveal the origin of the particles.

Background and Objectives: Surgery for bilateral chronic otitis media (COM) is usually performed sequentially, not simultaneously. The main reason is to prevent iatrogenic bilateral conductive hearing loss during recovery period. However, with asymmetric hearing loss, the difference in patient inconvenience between sequential and simultaneous surgery may be the same. This study evaluates the efficacy of simultaneous COM surgery in patients with asymmetric hearing.Subjects Materials and Method From 2012 to 2018, 9 patients underwent simultaneous bilateral COM surgery. The period of patients’ hospital stay, the success rate of tympanoplasty, tolerability for operation, and hearing thresholds were analyzed statistically. Results: For the 8 same-day surgery patients, the mean hospital period was 4.4±0.7 days, which was much shorter than that of sequential surgery (8 days). Tympanoplasty was successful in all patients without complications. In the better side, the preoperative/postoperative mean air conduction thresholds (AC) were 62.97±12.89 dB/47.81±19.07 dB (p=0.017), the bone conduction thresholds (BC) were 46.72±10.31 dB/37.66±16.99 dB (p=0.161) and the air-bone gaps (ABG) were 16.25±8.81 dB/10.16±7.78 dB (p=0.176). In the worse side, the preoperative/ postoperative mean AC were 86.56±18.22 dB/72.18±29.43 dB (p=0.035), BC were 53.28± 11.10 dB/48.13±18.41 dB (p=0.173), and ABG were 33.28±11.22 dB/24.06±14.80 dB (p=0.500). In both ear, the postoperative AC and BC were better than or equivocal to those of the preoperative value, and the result was similar with each of the unilateral ear audiological results. Conclusion Despite the fact that there is no complete consensus to date, simultaneous bilateral COM surgery can be an option when patients have asymmetric hearing loss. Simultaneous bilateral COM surgery could save time, cost, and lead to similar results with sequential surgery, so it could be a considerable surgical option for patients with bilateral COM.

Patients presenting with green nail syndrome often show coinfection with fungus. A delay in the accurate diagnosis of coinfection may warrant longer treatment duration. Four patients with green nail syndrome coinfected with fungus were reviewed retrospectively. Fungal culture, cultivating Candida parapsilosis and Candida albicans, was performed in two patients' samples. The mean time of the initiation of treatment for onychomycosis after the first visit was 5.75 weeks. If green nail syndrome is suspected, screening for fungal coinfections and precise management are necessary.

No abstract available.
Sarcoma

PURPOSE: To evaluate the effect of gadoxetic acid on the measurement of the stiffness value of MR elastography (MRE) used to evaluate hepatic fibrosis (HF). MATERIALS AND METHODS: MRE was obtained in 32 patients with clinically suspected chronic liver disease, both before and after injection of gadoxetic acid. Two independent reviewers measured the stiffness values of the liver parenchyma on elastograms. The mean liver stiffness values were compared in the pre- and post-contrast MREs using the paired t-test. Intra-rater and inter-rater correlation was assessed using the intraclass correlation coefficient (ICC). The accuracy, sensitivity, and specificity of both pre- and post-contrast MREs was evaluated for the diagnosis of significant HF (> or = F2) using cut off value of 3.1 kPa. RESULTS: There were no significant differences in the stiffness values of the liver parenchyma on pre- and post-contrast MREs (p = 0.15 and 0.38 for each reader, respectively). Regarding intra-rater correlation, excellent agreement was noted on rater 1(ICC = 0.998) and rater 2 (ICC = 0.996). Excellent correlation regarding the measured stiffness values was noted on both pre- and post-contrast MREs (ICC = 0.988 for pre-contrast, ICC = 0.993 for post-contrast). The accuracy, sensitivity, and specificity of the pre- and post-contrast MREs for differentiating significant HF (> or = F2) from < or = F1 were same as 71%, 60%, and 100%, respectively. CONCLUSION: As there was no significant difference in the stiffness measurements seen on MREs before and after administration of gadoxetic acids, it is therefore acceptable to perform MRE after contrast injection in order to evaluate HF.
Elasticity Imaging Techniques ; Fibrosis ; Gadolinium DTPA ; Humans ; Liver ; Liver Diseases ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Sensitivity and Specificity

BACKGROUND: The purpose of this retrospective study was to determine the prevalence of sarcopenia and sarcopenic obesity among patients who underwent orthopedic surgery (OS). METHODS: A total of 222 patients were reviewed immediately after or prior to OS. In the control group, 364 patients from outpatient departments (OPDs) who did not have any OS were enrolled. Whole-body dual-energy X-ray absorptiometry was used to analyze body composition. Skeletal muscle mass was adjusted for height squared, total body weight, and height and fat mass (residuals). Obesity was defined as body mass index (BMI) > 25.0 kg/m2. RESULTS: The prevalence of sarcopenia in the OS group was 25.7%, 44.1%, and 26.6%, respectively, according to the 3 different criteria. The prevalence was significantly lower in the OPD group (6.0%, 33.1%, and 14.8%, respectively). The highest rates of sarcopenia with height-adjusted definition were seen in patients with a femoral neck fracture. In the multivariate analysis, factors associated with sarcopenia were male gender, older age, and lower BMI (odds ratio [OR]: 28.38, 1.03, and 1.83, respectively) when muscle mass was adjusted for height, whereas male gender, older age, and higher BMI were associated with sarcopenia (OR: 1.04, 2.57, and 1.83, respectively) when adjusted for weight. When residuals were used as a cutoff, decreased BMI and total hip bone mineral density (0.1 g/cm2) were independent risk factors associated with sarcopenia (OR: 1.09 and 1.05). The prevalence of sarcopenic obesity ranged from 1.8% to 21.2%. CONCLUSIONS: Our study demonstrated a high prevalence of sarcopenia among OS patients.
Absorptiometry, Photon ; Body Composition ; Body Mass Index ; Body Weight ; Bone Density ; Femoral Neck Fractures ; Hip ; Humans ; Male ; Multivariate Analysis ; Muscle, Skeletal ; Obesity* ; Orthopedics* ; Outpatients ; Prevalence ; Retrospective Studies ; Risk Factors ; Sarcopenia*

BACKGROUND: The purpose of this retrospective study was to determine the prevalence of sarcopenia and sarcopenic obesity among patients who underwent orthopedic surgery (OS). METHODS: A total of 222 patients were reviewed immediately after or prior to OS. In the control group, 364 patients from outpatient departments (OPDs) who did not have any OS were enrolled. Whole-body dual-energy X-ray absorptiometry was used to analyze body composition. Skeletal muscle mass was adjusted for height squared, total body weight, and height and fat mass (residuals). Obesity was defined as body mass index (BMI) > 25.0 kg/m2. RESULTS: The prevalence of sarcopenia in the OS group was 25.7%, 44.1%, and 26.6%, respectively, according to the 3 different criteria. The prevalence was significantly lower in the OPD group (6.0%, 33.1%, and 14.8%, respectively). The highest rates of sarcopenia with height-adjusted definition were seen in patients with a femoral neck fracture. In the multivariate analysis, factors associated with sarcopenia were male gender, older age, and lower BMI (odds ratio [OR]: 28.38, 1.03, and 1.83, respectively) when muscle mass was adjusted for height, whereas male gender, older age, and higher BMI were associated with sarcopenia (OR: 1.04, 2.57, and 1.83, respectively) when adjusted for weight. When residuals were used as a cutoff, decreased BMI and total hip bone mineral density (0.1 g/cm2) were independent risk factors associated with sarcopenia (OR: 1.09 and 1.05). The prevalence of sarcopenic obesity ranged from 1.8% to 21.2%. CONCLUSIONS: Our study demonstrated a high prevalence of sarcopenia among OS patients.
Absorptiometry, Photon ; Body Composition ; Body Mass Index ; Body Weight ; Bone Density ; Femoral Neck Fractures ; Hip ; Humans ; Male ; Multivariate Analysis ; Muscle, Skeletal ; Obesity* ; Orthopedics* ; Outpatients ; Prevalence ; Retrospective Studies ; Risk Factors ; Sarcopenia*

The V-Y advancement flap has been widely used for the reconstruction of cutaneous defects. However, direct closure is impossible without undue tension. To overcome this limitation, the present study introduces a modified design of V-Y advancement flap with two horns and assesses its clinical outcome for facial reconstruction. From June, 2009 through June, 2010, twelve cases of skin tumors were surgically excised and reconstructed with this modified V-Y flap. Defects were located in nasolabial, nasojugal fold, cheek and lower eyelid region. Modified V-Y advancement flap was designed with lateral limbs like horns of V-flap and two horns were extended to the end point of the defect. Design and movement of this flap was demonstrated with photographs and the clinical outcome was described. All flaps survived with primary healing. The follow-up period ranged from 1 month to 12 months with a mean of 5.5 months. Neither short-term nor long-term postoperative complications such as flap necrosis, hematoma, infection were noted. All twelve patients were pleased with their postoperative results and no recurrence of malignant skin tumor was observed. This modified V-Y advancement flap with two horns is a safe, easy, versatile and reliable method for functional and esthetic reconstruction of facial defects.
Animals ; Cheek ; Extremities ; Eyelids ; Facial Injuries ; Facial Neoplasms ; Follow-Up Studies ; Hematoma ; Horns ; Humans ; Necrosis ; Postoperative Complications ; Recurrence ; Skin ; Surgical Flaps