PURPOSE: We performed dynamic MR imaging using GdDTPA to find characteristic enhancement pattern of hepatic hemangioma distinguishing from hepatocellular carcinoma. METHODS AND MATERIALS: 28 hepatic hemangiomas and 10 hepatocellular carcinomas were evaluated. Serial dynamic scans after Gd-DTPA(0.1mmol/kg) intravenous injection were obtained by using 0.5T machine and analyzed contrast-to-noise ratio(CNR) of the lesion and enhancement pattern on each scan. RESULTS: Hepatic hemangiomas had positive CNR from 1-2 minute images, and revealed typical "fill-in phenomenon" on early phase with prolonged enhancement in 26 cases(92.8%), and early homogeneous enhancement with isointensity on delayed phase in 2 cases(7.2%) of small hemangiome~ Hepatocellular carcinomas revealed inhomogeneous enhancement with hypointensity on delayed phase in 10 cases(100%) and 3 cases (30%) of capsular enhancement. CONCLUSION: Hepatic hemangioma can be easily distinguished from hepatocellular carcinoma by using Gd DTPA enhanced dynamic MR imaging according to its typical enhancement pattern of "fill-in phenomenon" and prolonged enhancement.
Carcinoma, Hepatocellular ; Diagnosis, Differential* ; Gadolinium DTPA ; Hemangioma* ; Injections, Intravenous ; Magnetic Resonance Imaging*

Subcutaneous granuloma pyogenicum (SGP) is a rare variant of granuloma pyogenicum. In general, it appears as a single subcutaneous nodule with a slight tenderness. We report herein an unusual case of SGP arising from the left palm of an 11-year-old girl. Two mild-tender bean-sized reddish or flesh colored subcutaneous nodules on the lateral border of the left palm, and medial side of 5th left finger, respectively, were noted on physical examination. Histopathologic examination revealed the findings of lobular capillary hemangioma, characterized by localized proliferation of capillary lined by a single endothelial cell layer. Intralesional injection of triamcinolone acetonide (TA) were performed for the treatment. However two new erythematous nodules developed at another area of the left palm, which disappeared without any treatment.
Capillaries ; Child ; Endothelial Cells ; Female ; Fingers ; Granuloma* ; Granuloma, Pyogenic* ; Humans ; Injections, Intralesional ; Physical Examination ; Recurrence* ; Triamcinolone Acetonide

OBJECTIVE: Adult onset Still s disease is an acute systemic inflammatory disorder. There are no pathognomonic symptoms or specific laboratory abnormalities. In recent reports, serum ferritin concentration is increased in active disease phase and decreased after defervescence. Our purpose was to determine the clinical significance of serum ferritin as an indicator for disease activity. METHODS: Seven patients who were diagnosed as adult onset Still s disease at Samsung Medical Center between October 1994 and March 1997, were reviewed. In these patients we checked leukocyte count, ESR, CRP and serum ferritin concentrations at the time of diagnosis and during follow-up periods and recorded febrile events during follow-up periods. RESULTS: At the time of diagnosis and during febrile periods, the concentrations of ferritin were extremely high(927ng/ml to 96,650ng/ml normal 10-290.8 ng/ml). The values were unrelated to other manifestations of the disease or laboratory findings. The ferritin concentrations decreased rapidly after adequate treatment. Eleven febrile reattacks happened in 7 patients. Serum ferritin concentrations were increased in 8 febrile attacks, while leukocyte count, ESR, and CRP were increased in 5, 5, 6 febrile attacks respectively, There were 10 events of increased serum ferritin concentrations in 7 patients during follow-up periods and 8 events were related with fever. The increases of other laboratory tests were similar. CONCLUSIONS: In all patients, serum ferritin concentrations were increased at the time of diagnosis and closely related to fever. During follow-up periods, serum ferritin concentrations are helpful in monitoring disease activity and guiding decisions about treatment.
Adult* ; Diagnosis ; Ferritins* ; Fever ; Follow-Up Studies ; Humans ; Leukocyte Count ; Still's Disease, Adult-Onset*

PURPOSE: Laparoscopic approaches to the anterior abdominal wall are difficult because of the inherent limitations of laparoscopic surgery. METHODS: A 25-year-old young female visited to our hospital with an incidentally-found palpable abdominal mass. Computed tomography revealed a 7-cm round enhancing mass arising from the left posterior rectus sheath. The patient underwent laparoscopic excision of the inner mass arising from the anterior abdominal wall. RESULTS: The operation lasted for 45 minutes and there was no measurable bleeding during the procedure. Pathological assessment revealed that the tumor was a DTF 7.0 cm in size. The patient was discharged on the second postoperative day in good condition, and is currently being followed on a routine basis for surveillance without adjuvant therapy. CONCLUSION: Laparoscopic approach for the anterior abdominal wall tumor could be feasible in select patients. This minimally-invasive approach helps to ensure good cosmetic outcomes and quality of life.
Abdominal Wall* ; Adult ; Female ; Fibroma* ; Fibromatosis, Abdominal ; Hemorrhage ; Humans ; Laparoscopy ; Quality of Life

No abstract available.
Tibia*

PUPOSE: Through a survey on an Internet homepage, we conducted research concerning the need of patients and their families for information on gastric cancer. We also assessed their interest in gastric cancer. MATERIALS AND METHODS: We analyzed 619 inquiries presented from June 2002 to September 2003 and 524 replies submitted to a questionnaire survey delivered by the Internet homepage (www.gastriccancer.co.kr) from August to October 2003 to gastric cancer patients and their families. RESULTS: Analysis of Inquiries: The classified inquiries listed in order of frequency are as follows: treatment, prognosis, stages, symptoms, pathophysiology, diagnostic modalities, favorable food, etiology, follow-up, etc. Among the inquiries about treatment, the most frequent subgroup was about the scope of surgery or perioperative implications. Next came questions concerning chemotherapy. Among the questions from patients yet to be operated, on those about operability and the prognosis were most frequent. Among the patients who had undergone a resection, questions on complications and the corresponding prognosis were most frequent. The concern from patients with inoperable or recurrent cancers was related to terminal care and/or chemotherapy. Analysis of Questionnaires: The respondents acquired information on gastric cancer from the Internet (40%), doctors (32%), the mass media (15%) and acquaintances (13%). Only 6% of the respondents were sufficiently satisfied with the information provided by doctors. Among the respondents, 89.9% were interested in complementing treatment with folk remedies while only 5% were not. CONCLUSION: Patients and their families were eager to get information about gastric cancer. However, many of them found the doctors' information to be insufficient. Our suggestion is that the public health, academic societies, medical institutions, and public organizations should endeavor to provide through an activated Internet network correct information on gastric cancer.
Complement System Proteins ; Surveys and Questionnaires ; Drug Therapy ; Follow-Up Studies ; Friends ; Humans ; Internet* ; Mass Media ; Medicine, Traditional ; Prognosis ; Public Health ; Surveys and Questionnaires* ; Societies, Medical ; Stomach Neoplasms ; Terminal Care

PURPOSE: Minimally invasive central pancreatectomy has rarely performed because of its technical difficulty. Robot system enhances surgical dexterity to perform such complex procedures. METHODS: A 29-year-old woman was admitted with acute cholecystitis and an 1.4 cm enhancing mass was incidentally found at the pancreatic proximal body on computed tomography. Preoperative image studies suggested a neuroendocrine tumor or solid pseudopapillary neoplasm. The patient underwent robotic cholecystectomy and central pancreatectomy with pancreaticojejunostomy. RESULTS: The total operation time was 280 minutes and the estimated amount of intraoperative bleeding was 100 ml. The postoperative recovery was uneventful and she was discharged on the 7(th) postoperative day. Pathologic examination reported a solid pseudopapillary neoplasm. CONCLUSION: The technical difficulties associated with the procedure can be overcome with the help of the wrist-like movement of the robotic instruments, especially for the preservation of splenic vessels and for creating precise anastomoses in narrow spaces.
Adult ; Cholecystectomy ; Cholecystitis, Acute ; Female ; Hemorrhage ; Humans ; Neuroendocrine Tumors ; Pancreatectomy* ; Pancreatic Neoplasms ; Pancreaticojejunostomy* ; Robotic Surgical Procedures

Fibroepithelial polyp (FEP) and lymphangioma circumscriptum (LC) of the vulva are rare diseases that occur generally in young to middle-aged women. The pathogenesis of FEP is not clearly understood. Several previous cases have suggested that a hormonal influence may be a predisposing condition for developing FEP with or without chronic inflammation. A 68-year-old postmenopausal woman presented with a history of multiple raised lesions on the vulva with a 1-year duration. Additionally, a pedunculated mass had appeared 6 months earlier in the left lower labia minora. The patient underwent simple excision by electrocautery. The final pathological diagnosis was FEP with LC. In this case, the development of FEP was associated only with chronic inflammation induced by LC. Therefore, the case supports the hypothesis that a chronic inflammatory process may be related to the development of FEP even without hormonal influence.
Aged ; Diagnosis ; Electrocoagulation ; Female ; Humans ; Inflammation ; Lymphangioma* ; Neoplasms, Fibroepithelial ; Polyps* ; Polytetrafluoroethylene ; Postmenopause ; Rare Diseases ; Vulva*

PURPOSE: To evaluate the clinical and radiologic outcomes of the perilunate dislocation and the lunate dislocation which were managed surgically through a dorsal approach. MATERIALS AND METHODS: Retrospective reviews of the 13 patients who had minimum 1-year follow-up after surgical treatment through isolated dorsal approach for their perilunate dislocations or the lunate dislocations were performed. The case that dislocated lunate migrated proximally through the wrist was excluded in this series. We evaluated the DASH score in questionnaire method and Mayo wrist score to analyze the clinical outcomes. Radiologic results were investigated by measurement of the scapho-lunate angle, and fracture union was also evaluated in the case of trans-scaphoid dislocation. RESULTS: The mean DASH Score was 16.3 points (range, 10.8~26.7 points) and the mean Mayo wrist score was 79 points (range, 65~90 points) at the final follow-up. There were 2 cases of excellent, 7 cases of good and 4 cases of fair in the Mayo wrist score. On the radiologic analysis, the mean scapho-lunate angle was 49.0degrees (range, 35~55degrees) and all cases were within the normal range. All cases of the trans-scaphoid perilunate dislocation achieved bone union. CONCLUSION: Author's cases showed satisfactory outcomes in clinically and radiologically. Isolated dorsal approach could give anatomical reduction and appropriate internal fixation in treatment of the perilunate dislocations and the lunate dislocations except the rare case of proximal migration of the lunate through the wrist.
Dislocations ; Follow-Up Studies ; Humans ; Surveys and Questionnaires ; Reference Values ; Retrospective Studies ; Wrist

PURPOSE: To compare and analyze length change of patella tendon after intramedullary nailing of tibial shaft fracture using transtendinous approach. MATERIALS AND METHODS: Thirty-two cases were analyzed from December, 1999 to December, 2005. Insall Salvati ratios were estimated. Severity of initial trauma, duration of nail retension, knee function and pain on change of length of patellar tendon was evaluated. RESULTS: Mean duration of nail retention was twenty-two months. The shortening of patella tendon was observed in 25 cases (p<0.001). The effect of AO type and the duration of nail retension on the decrease of Insall Salvati ratio was not significant (p>0.05, p=0.778). Lysholom score decrease to 89.5. There was no significant difference between the shortening of patellar tendon length and knee pain (p=0.058). CONCLUSION: After intramedullary nailing for closed tibia fracture, shortening of patellar tendon length is observed. That is irrelevant to the fracture type and the duration of nail retension. The shortening of patella tendon length may contribute to decreasing of knee function, but it was no significance of knee pain after intramedullary nailing.
Fracture Fixation, Intramedullary ; Knee ; Nails ; Patella ; Patellar Ligament ; Retention (Psychology) ; Tibia ; Tibial Fractures