Cerebral aneurysms associated with arteriovenous malformation (AVM) have been reported with a variable incidence, averaged 10% of total AVM cases. It has been AVM. We report four cases of the intracranial aneurysm associated with AVM. Three cases of aneurysm were located in distal portion of feeding artery, and one case was proximal on major feeding artery. And bleeding resulted from rupture of aneurysm. Three of them located in the posterior circulation. Removal of aneurysm and AVM was successfully accomplished in 3 cases.
Aneurysm ; Arteries ; Arteriovenous Malformations* ; Hemorrhage ; Incidence ; Intracranial Aneurysm ; Rupture

The increased use of magnetic resonance imaging (MRI) has increased the frequency of diagnosis of cavernous hemangioma, but its presentation of an epidural lesion with foraminal extension without intramedullary involvement is very rare. We describe a 31-year-old woman admitted to our department with pain in the left side of her neck and shoulder. Gadolinium enhanced cervical MRI revealed a brightly enhanced, extradural mass (112 cm sized) with widened neural foramen; after surgical excision, it was histologically confirmed as a cavernous hemangioma. Postoperatively, the patient has no neurological deficit or specific complication. Although this lesion mimicked an epidural- neurogenic tumor, its enhancement pattern indicated a cavernous hemangioma. Accurate preoperative diagnosis is necessary for treatment planning. Cavernous hemangioma must be included in the differential diagnosis of a brightly enhanced, extradural tumors.
Adult ; Caves ; Diagnosis, Differential ; Female ; Gadolinium ; Hemangioma, Cavernous ; Humans ; Magnetic Resonance Imaging ; Neck ; Shoulder

PURPOSE: To search cause of recurrence of varus deformity and to correlate the mechanical angle of the knee joint at the third postoperative month following high tibial osteotomy to the final mechanical angle and to the clinical results. MATERIALS AND METHODS: Study of thirty knee joints with lateral closed wedge osteotomy and fixation with 90-degree angle blade plate. Plateau-Blade angle was measured to evaluate the loss of correction at the osteotomy site. At the third postoperative month, the knees were divided into two groups according to the mechanical angle. Group I included the patients with valgus angle (16 knees) and group II included the patients with varus angle (14 knees) . The final mechanical angle was measured and the clinical results were evaluated with the knee score and the function score of Knee Society. RESULTS: Plateau-Blade angle decreased 2.5 in group I and 4.8 in group II at postoperative three month. At the final follow-up, the loss of correction angle was 0.8 in group I and 2.3 in Group II (p>0.05) . The final knee score was 86 in group I and 80 in group II (p>0.05) . The final function score was 90 in Group I and 80 in Group II. CONCLUSIONS: Because the final function score of valgus angle group is superior to that of varus angle group and recurrence of varus was mainly occur within postoperative three months, meticulous postoperative management needed to maintain valgus mechanical angle.
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Knee ; Knee Joint ; Osteotomy* ; Recurrence

Objective: : High precision and accuracy are expected in gamma knife radiosurgery treatment. Because of the requirement of clinically applying complex radiation and dose gradients together with a rapid radiation decline, a dedicated quality assurance program is required to maintain the radiation dosimetry and geometric accuracy and to reduce all associated risk factors. This study investigates the validity of Leksell Gamma plan (LGP)10.1.1 system of 5th generation Gamma Knife Perfexion as modified variable ellipsoid modeling technique (VEMT) method. Methods: : To verify LGP10.1.1 system, we compare the treatment plan program system of the Gamma Knife Perfexion, that is, the LGP, with the calculated value of the proposed modified VEMT program. To verify a modified VEMT method, we compare the distributions of the dose of Gamma Knife Perfexion measured by Gafchromic EBT3 and EBT-XD films. For verification, the center of an 80 mm radius solid water phantom is placed in the center of all sectors positioned at 16 mm, 4 mm and 8 mm; that is, the dose distribution is similar to the method used in the x, y, and z directions by the VEMT. The dose distribution in the axial direction is compared and analyzed based on Full-Width-of-Half-Maximum (FWHM) evaluation. Results: : The dose profile distribution was evaluated by FWHM, and it showed an average difference of 0.104 mm for the LGP value and 0.130 mm for the EBT-XD film. Conclusion : The modified VEMT yielded consistent results in the two processes. The use of the modified VEMT as a verification tool can enable the system to stably test and operate the Gamma Knife Perfexion treatment planning system.

PURPOSE: Metastasis of a colorectal carcinoma to regional lymph nodes indicates poor prognosis. The detection of lymph node metastasis is routinely performed by his topathological analysis of hematoxylin-eosin (H&E) stained sections. However the routine histological technique may fail to detect isolated tumor cells in lymph nodes. The aims of this study are to elucidate the prognostic significance of the presence of isolated tumor cells in the regional lymph nodes in colorectal cancer, and to elucidate the correlation between the presence of isolated tumor cells and p53 protein expression in the primary colorectal cancer tissue. METHODS: We used immunohistochemical staining with anti-cytokeratin antibody to examine 452 lymph nodes in 24 patients (11 recurrent and 13 nonrecurrent) who were histologically determined Astler-Coller B. And we used immunohistochemical staining with p53 protein to examine primary colorectal cancer tissues of the patients. RESULTS: Immunohistochemical staining of cytokeratin revealed the presence of isolated tumor cells in 5/13 patients (38.5%), 5/214 lymph nodes (2.34%) in the nonrecurrent group and 6/11 patients (54.6%), 11/244 lymph nodes (4.51%) in the recurrent group, respectively. The detection rate of isolated tumor cells in the recurrent group was slightly higher than nonrecurrent group, but the difference was not significant statistically. The expression rate of p53 protein was 23.1% (3/13) in the nonrecurrent group and 36.4% (4/11) in the recurrent group, respectively. The expression rate of the p53 protein was not significantly correlated with the presence of isolated tumor cells in regional lymph nodes and the rate of tumor recurrence. CONCLUSIONS: The presence of isolated tumor cells in regional lymph nodes was not a prognostic indicator in predicting recurrence in histologically determined Astler- Collar B colorectal cancer patients.
Colorectal Neoplasms* ; Histological Techniques ; Humans ; Keratins ; Lymph Nodes* ; Neoplasm Metastasis ; Prognosis ; Recurrence

Pseudomyxoma peritonei is a relatively rare and poorly understood condition in which mucus accumulate within the peritoneal cavity. The presence of cells in the mucin, either inflammatory or neoplastic, distinguishes it from simple acellular mucus ascites caused by mucinous spillage. There are widespread seedings on the peritoneal and omental surfaces with a heavy cancerous glaze. This is principally a complication of borderline or malignant neoplasm of the ovary and/or appendix. We report one female case with pseudomyxoma peritonei from mucinous adenocarcinoma of appendix which was diagnosed incidentally during laparoscopic cholecystectomy.
Adenocarcinoma, Mucinous* ; Appendix ; Ascites ; Cholecystectomy, Laparoscopic ; Female ; Humans ; Mucins* ; Mucus ; Ovary ; Peritoneal Cavity ; Pseudomyxoma Peritonei*

Desmoid tumor is a subtype of fibromatosis arising from deep fascial or soft tissue structure. It is characterized by locally aggressive behavior with a tendency to local recurrence, but is generally accepted the lack of ability for distant metastasis. Although excision is the best initial therapy, surgery is not always amenable in cases of lesions lying in difficult anatomical area. Two female patients with recurrent desmoid tumor in abdomen and pelvis after excision were treated with tamoxifen, goserelin, and sulindac. This therapy led to a progressive decrease of tumor size within 13 months in one patient. However, in the other patient, this combined therapy failed to reduce the size of the tumor. Despite the success of combined therapy with hormone and nonsteroidal anti-inflammatory drug is anecdotal, this treatment may improve the survival and reduce the recurrence in certain sub-group of desmoid tumor.
Abdomen* ; Deception ; Female ; Fibroma ; Fibromatosis, Aggressive* ; Goserelin* ; Humans ; Neoplasm Metastasis ; Pelvis ; Recurrence ; Sulindac* ; Tamoxifen*

BACKGROUND AND OBJECTIVES: Sleep related obstructive breathing disorders are frequently observed in adults. Despite extensive work of recent years, the essential pathophysiologic mechanism that mediates this process is still unclear. This study was conducted to determine whether distribution of connective tissue in the uvula is different among apneics, snorers and normal controls. MATERIALS & METHODS: Uvula was obtained by uvulopalatopharyngoplasty in 8 apneics, 6 snorers (mean apnea index: 17.1, 2.43 respectively) and by autopsy in 5 individuals not known to have snoring. The surgical specimen of uvula was fixed in 10% formalin and subsequently embedded in paraffin. Each specimen was cut into 5 micrometer-thick section and stained with hematoxylin-eosin for general appearance, Masson-Trichrome stain for collagen fiber, and Verhoeff stain for elastic fiber. Microscopic examination was performed by two pathologists who were blinded to the polysomnographic data. RESULTS: Infiltration of inflammatory cells and edema were significantly increased in the snorer and apneic groups compared with the control group (p<0.0001, p<0.05 respectively). Compared with the normal group, the density of elastic fibers and collagen fibers were significantly decreased in snorers and apneics (elastic fiber: p<0.0005, collagen fiber: <0.01). The distribution of elastic and collagen fiber showed significantly heterogeneous patterns in the snorer and apneic group compared to the control group (elastic fiber: p<0.001, collagen fiber: p<0.0005). CONCLUSION: Since connective tissue fibers have the supportive function in the body, this condition may result in increased collapsibility of upper airway and contributes to the development of obstructive sleep apnea.
Adult ; Apnea ; Autopsy ; Collagen* ; Connective Tissue ; Edema ; Elastic Tissue ; Elastin ; Formaldehyde ; Humans ; Paraffin ; Respiration ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Snoring ; Uvula

PURPOSE: To evaluate the results of the medial gastrocnemius muscle flap to cover the wound necrosis and dehiscence caused by repeated surgery in the reconstruction of infected total knee arthroplasty (TKA). MATERIALS AND METHODS: Out of forty three reconstructions of infected TKA performed between 1995 and 2002, eleven cases (25.6%)underwent medial gastrocnemius flap to cover the anterior skin defects at the time of reimplantation in two cases and in an average 3.3 weeks after reimplantation in seven cases. Two cases which refused reimplantation were treated by arthrodesis and delayed flap coverage and by flap surgery only resulting in pseudarthrosis respectively. They were five male and six female patients of 61 years (range, 56-77 years)of age in average. Clinical and radiological assessments were done for minimum two years of follow-up. RESULTS: Nine cases (81.8%)maintained TK prostheses with less range of motion (77 degrees in average)than ordinary TKAs of primary healing. Two patients refused TKA which resulted in one arthrodesis and one pseudarthrosis. There was no case of recurrence of wound dehiscence or infection. CONCLUSION: Medial gastrocnemius flap can salvage the prostheses by providing good soft tissue coverage for compromised operative wounds caused by infected TKA and repeated surgical interventions.
Arthrodesis ; Arthroplasty* ; Female ; Follow-Up Studies ; Humans ; Knee* ; Male ; Muscle, Skeletal ; Necrosis ; Prostheses and Implants ; Pseudarthrosis ; Range of Motion, Articular ; Recurrence ; Replantation ; Skin ; Wounds and Injuries

Background: The problem with current dental hygienist education is that it operates as an education system based on the national examination rather than on a practical basis; thus, graduates have difficulties in practice after obtaining their license. This study aimed to propose a job-oriented curriculum by analyzing the links between the task analysis of Korean dental hygienists and dental hygiene learning goals. Methods: This study performed a relationship analysis based on a second job analysis study of dental hygienists conducted by the Korea Health Personnel Licensing Examination Institute and the learning goals of the Korean Dental Hygiene Faculty Association. Results: Based on the links between the task and learning goals of the dental hygienist, they were classified into six types: 1) tasks listed in the license exam and learning goal, 2) tasks not listed in the license exam but listed in learning goals, 3) tasks not listed in learning goals, 4) learning goals not related to tasks, 5) learning goals listed in a few tasks, and 6) tasks related to several learning goals. The results showed that most of them correspond to the 5th classification, followed by the 3rd and 4th categories, which are mostly basic science learning goals. Tasks without learning goals are not included in the curriculum; thus, the curriculum needs to be supplemented. The overlapping learning goals of several subjects for one job skill must be reduced in job-oriented education. Conclusion We suggest that the dental hygiene curriculum be developed based on task analysis and reflected in the national dental hygienist exam. The clinical practice performance of dental hygienists will take further leap forward through task-oriented education.