We have experienced three cases of extrarnsmmary Pagets disease. The first case was a 77-year-old female who showed 8x10cm sized, erythematous plaque on the suprspubic area of one year's duration. The second case was a 60-year-old male who showed erythematous, oozing, crusted, well circumscribed patches on the right scrotum and the pubic area of 8 years' duration. Third case was a 79-year-old male who showed erythernstous to gray, eczemstoid plaques with marginal elevation on the right side of the scrotum, penile root and pubic area of 3 years duration. On histologic exarnination, the third case showed swest gland adenocarcinoma in the dermis.
Adenocarcinoma ; Aged ; Dermis ; Female ; Humans ; Male ; Middle Aged ; Paget Disease, Extramammary* ; Scrotum

OBJECTIVE: It is mandatory to optimaze clip placement in situ for complete clipping of cerebral aneurysm. Intraoperative microvascular doppler sonography (MDS) provides a functional and non-invasive intraoperative examination of the aneurysm proper. The present study was performed to investigate the reliability of MDS for assessing the complete aneurysm closure. METHODS: Blood flow velocities in the aneurysm sac were determined by MDS with a 20-MHz probe before and after aneurysm clipping, to confirm the obliteration of aneurysm since 1997. Complete aneurysm obliteration was confirmed by absent flow patterns in the domes of all aneurysms after clipping. RESULTS: The 1 mm microprobe was able to insonate all vessels and their major branches. The immediate adjustment of aneurysm clip placement or another clipping was done because hemorrhage after puncturing of completely clipped aneurysms on MDS developed in five patients including 3 middle cerebral artery aneurysms, 1 posterior communicating artery aneurysm, and 1 anterior communicating artery aneurysm. CONCLUSIONS: MDS is safe and cost-efficient for evaluation of aneurysm obliteration. In many cases, it can preclude the need of postoperative angiogram. However, although an intra-aneurysmal flow velocity is absent on MDS, it is necessary to puncture or cut the aneurysm sac if that is not shrunken after clipping, especially in cases of a complex aneurysm with a broad irregular base and atherosclerotic or thrombotic sac.
Aneurysm* ; Blood Flow Velocity ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Punctures

OBJECTIVE: The ideal treatment of intracranial aneurysms is an occlusion of the neck with a clip, which preserves the parent vessels. Upward projecting anterior communicating artery(Acom) aneurysms appear to be directed both above and below the plane formed by the two A2 segments, which usually conceal the contralateral A2 takeoff. It is difficult to perform complete clipping when these lesions are tightly adherent to the A2 segment. Neurosurgeons need to focus on the safe treatment of these lesions. A variety of clipping techniques can be used depending on the aneurysm anatomy, size, and morphology. The authors recommend a safe method of clipping these lesions safely. METHODS: The authors operated on 109 patients with upward projecting Acom aneurysms over the last 16 years. Among them, 34 aneurysms were clipped using fenestrated clips through the side of the dominant A1 segment, which were closely adhered to the A2 segment. RESULT: In each case, the aneurysm and both A2 segments formed a straight line in the narrow surgical field and were not easily separated, and consequently it was difficult to handle the aneurysm behind the ipsilateral A2. After partial identification of the Acom complex, careful dissection of the posterior aspect of the ipsilateral A2 and the aneurysm dome was continued to allow mobilization of both A2 segments and the aneurysm. All aneurysms were secured successfully without any surgery related complications. CONCLUSION: The authors recommend that fenestrated clip incorporating the ipsilateral A2 segment after complete mobilization of both A2 segments and the aneurysm may be useful for definitive clipping of upward projecting Acom aneurysm which is densely adherent to the A2 segment.
Aneurysm ; Humans ; Intracranial Aneurysm* ; Neck ; Parents

PURPOSE: To report a case of infectious crystalline keratopathy caused by Alternaria in the corneal center. CASE SUMMARY: A 66-year-old male visited our clinic with right ocular pain and visual loss after corneal trauma caused by a foreign body hitting his right eye while performing farm work 1 month prior to his visit. The patient had no history of corneal surgery and long-term use of topical corticosteroid. A corneal epithelial defect and whitish snowflake margin infiltration around the corneal stroma were observed in the corneal center, but there was an absence of conjunctival injection and anterior segment inflammation. Cultures and a biopsy of the corneal scrapings revealed Alternaria species fungus. The patient was treated with 1% topical voriconazole and 0.5% moxifloxacin, together with oral voriconazole (400 mg/day). After 2 months of treatment, the disease was completely cured, with a minute corneal opacity. CONCLUSIONS: We successfully treated a rare case of infectious crystalline keratopathy caused by Alternaria, which has not been previously reported in the Republic of Korea.
Aged ; Agriculture ; Alternaria ; Biopsy ; Corneal Injuries ; Corneal Opacity ; Corneal Stroma ; Crystallins ; Foreign Bodies ; Fungi ; Humans ; Inflammation ; Male ; Republic of Korea ; Voriconazole

Esthetics ; Facial Asymmetry ; Genioplasty ; Humans ; Jaw ; Orthognathic Surgery ; Osteotomy ; Rhinoplasty ; Seoul ; Surgery, Oral ; Surgery, Plastic

Langerhans cell histiocytosis is a rare disease entity in which various tissue are infiltrated by proliferating histiocytes. Involvement of alimentary tract is rare (<5%), especially in the stomach. Only seven cases of gastric Langerhans cell histiocytosis have been reported in Enlglish literature. Diabetes insipidus is the most common endocrinologic complication. We report a case of Langerhans cell histiocytosis involving stomach and pituitary stalk. The diagnosis of gastric Langerhans cell histiocytosis and diabetes insipidus was based on gastric mucosal biopsy specimen from a Korean man with suspicious hypertrophic gastric folds of gastric body, water deprivation test and sella MRI.
Biopsy ; Diabetes Insipidus ; Diagnosis ; Histiocytes ; Histiocytosis, Langerhans-Cell* ; Magnetic Resonance Imaging ; Pituitary Gland ; Rare Diseases ; Stomach ; Water Deprivation

Myxoma, a rare primary tumor occurring in cardiac chamber, has been shown to cause various neurologic complications such as embolic infarction, neoplastic aneurysm and metastasis. Recently we experienced a patient with cardiac myxoma who presented with behavioral changes. Brain MRI showed lesions suggestive of metastasls and embolic infarctions. Aneurysm was also documented in cerebral angiogram. The case illustrates diverse spectrum of neurologic complications of cardiac myxoma.
Aneurysm ; Brain ; Humans ; Infarction ; Magnetic Resonance Imaging ; Myxoma* ; Neoplasm Metastasis

The syndrome of inappropriate ADH secretion is a disorder characterized by hyponatremia which results from water retention attributable to ADH release. The hallmark of SIADH is hyponatremia due to water retention, in the presence of urinary osmolality above plasma osmolality. The SIADH was initially described by Schwartz et al (1957). This syndrome, first recognized in patients with bronchogenic carcinoma, has now been observed in a variety of other illnesses. Recently, we encountered a 59 year-old female with small cell lung cancer, also she had SIADH. Thus, we present a case and review the literature on the subject.
Carcinoma, Bronchogenic ; Female ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome* ; Osmolar Concentration ; Plasma ; Small Cell Lung Carcinoma* ; Water

A 56 year old female was admitted because of the right upper quadrant mass for 4 days. She complained of intermittent colicky RUQ pain, fever and chills. So diagnostic procedures was performed: Blood chemistry testings. Ultrasonography. Barium enema, Liver scan, Hepatobiliary scan, ERCP and Abdomen CT, which diagnosed as gall bladder carcinoma. So explolaparotomy was performed and gross operative finding was gall bladder carcinoma with metastatic lymph node and cystic duct stone. So cholecystectomy, hemigastrectomy and anterior segmentectomy of right liver was done. But the biopsy result was cystic duct stone, cholecystitis and gall bladder empyema.
Abdomen ; Barium ; Biopsy ; Chemistry ; Chills ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cholecystitis* ; Cystic Duct* ; Enema ; Female ; Fever ; Humans ; Liver ; Lymph Nodes ; Mastectomy, Segmental ; Middle Aged ; Ultrasonography ; Urinary Bladder

We have experienced a rare case of progressive supranuclear palsy with hallucination and delusion. The common manifestations of progressive supranuclear palsy are gait disturbance, mental change and sign of vertical ophthamoplegia but no efficacious therapy has been known. Neuropsychiatric symptom clusters include cognitive impairment, affective and behavioral changes, sleep disturbance, and psychotic symptoms. Though schizophrenia-like psychosis has been reported but this is certainly rare. Addressing a case of progressive supranuclear palsy, in whom parkisonian symptoms appeared with concurrent psychotic symptoms, we emphasize accurate diagnosis.
Delusions ; Diagnosis ; Gait ; Hallucinations ; Psychotic Disorders ; Supranuclear Palsy, Progressive*