OBJECTIVE: For the treatment of carotid cavernous fistula(CCF), transarterial detachable balloon occlusion(DBO) is the method of choice. When it has failed to occlude the fistula, various embolization methods are used to treat the fistula. Transvenous embolization through the superior ophthalmic vein(SOV) is another method of treatment. The venous approach through the SOV after surgical dissection and exposure of this vein has been recommended by some delete, but(here) delete delete(an) alternative treatment method by percutaneous puncture of the SOV without surgical dissection(is described). METHODS: A 19-year-old woman admitted to our hospital two months after accident, presented with proptosis, chemosis, occulomotor and abducens nerve palsies, and bruit of the right eye. The authors tried DBO via transarterial route in initial treatment and the fistula was occluded with subsequent disapearance of bruit. However, 2 weeks later, she complained of recurence of bruit. Transarterial approach was attempted again, but the fistula hole was too small for this approach. The venous approach via SOV by percutaneous puncture was then tried. Puncture was made at the medial one third of the superior orbital rim and the fistula was embolized with Guglielmi detachable coils (GDCs). RESULTS: The fistula was completely occluded and no early and late complications noted. The patient's clinical symptoms were improved within a few days. CONCLUSION: Treatment of CCF by percutaneous puncture of the SOV is an alternative and effective method when other approaches are not feasible.
Abducens Nerve Diseases ; Exophthalmos ; Female ; Fistula* ; Humans ; Orbit ; Punctures* ; Veins* ; Young Adult

For undercorrected esotropia after bilateral medial rectus(MR) recession, we performed unilateral or bilateral MR rerecession, unilateral rerecession or marginal myotomy of the recessed medial rectus muscle combined with lateral rectus(LR) resection, or unilateral LR resection. The correction of deviation was 15 delta in unilateral 2.0mm MR rerecession. Bilateral 2.0mm MR rerecession corrected 20 to 25 delta of esodeviation, but undercorrection was noted in one case. With unilateral 2.0mm rerecession or marginal myotomy of the recessed medial rectus muscle combined with 5.5mm or 8.0mm LR resection, the correction of deviation was 26 to 29 delta, and there was no under- or overcorrection. The corrective effect of this procedure was therefore greater and more stable than that of bilateral 2.0mm MR rerecession. Unilateral 8.0mm LR resection performed 3 months after bilateral MR recession showed correction of 15 delta, whereas the same procedure performed 3 weeks after bilateral MR rerecession showed correction of 24 delta. Unilateral LR resection procedure seems to be more efficacious for residual esotropia if performed as soos as possible within 3 months after sufficient bilateral MR recession or rerecession.
Esotropia* ; Methods ; Reoperation

Endoscopic dacryocystorhinostomy appears to have a lower success rate than of conventional external dacryocystorhinostomy. However, recently this procedure has been widely performed due to its several advantages. The most frequent cause of failure in endoscopic dacryocystorhinostomy is the obstruction of mucosal or bony openings; thus various techniques were introduced to minimize this obstruction of the opening site. Between November 1995 and February 1997, we performed 60 endoscopic dacryocystorhinostomy procedures on 46 patients diagnosed with mitomycin-C, an antimetabolic agent, was performed on the osteotomy site, intraoperatively. The postoperative follow-up interval ranged from 4 to 20 months(mean, 10.3 months). The success rate of the primary operation ws 66.7%(40 of 60 eyes), and with revision of failed cased the final success rate reached 90.0%(54 do 60 eyes). No complication associated with use of mitomycin-C was observed. Thus it suggests that the endoscopic dacryocystorhinostomy with the application of mitomycin-C is a useful technique in the management of obstruction of the nasolacrimal duct.
Dacryocystorhinostomy* ; Follow-Up Studies ; Humans ; Mitomycin* ; Nasolacrimal Duct ; Osteotomy

We studied the ultrastructural features of four consecutive subfoveal neovascularmembranes (SFNM) associated with age-related macular degeneration. Cellular components of the membranes included retinal pigment epithelial (RPE) cells, endothelium-lined vascular channels, macrophages, myofibroblasts, fibrocytes, glial cells, erythrocytes, and lymphocytes. Extracellular interstitial constituents included collagen fibrils, basal laminar deposits, fibrin and young elastic fibrils. These findings show that SFNMs consist of various cells originating from surrounding tissues and vessels. Among these RPE cells and macrophages are the main cellular components and in conjunction with various extracellular matrix, especially collagen, may play an important role in the formation and maintenance of the membranes.
Basement Membrane/surgery/ultrastructure ; Humans ; Macular Degeneration/complications ; Microscopy, Electron ; Retina/*ultrastructure ; Retinal Neovascularization/etiology/*pathology/surgery

Metastasis of signet ring cell gastric carcinoma to the breast is extremely rare. The common clinical findings are redness, edematous skin and pain, and these findings are similar to those of inflammatory breast cancer. We describe here a case of metastatic signet ring cell gastric carcinoma to the bilateral breasts, and this presented as bilateral palpable breast lumps after the patient had undergone radical total gastrectomy two years previously.
Breast ; Carcinoma, Signet Ring Cell ; Gastrectomy ; Humans ; Inflammatory Breast Neoplasms ; Neoplasm Metastasis ; Skin ; Stomach

Pulmonary lymphangioleiomyomatosis is a disease involving the proliferation of atypical smooth muscle cells trom the perilymphatics, peribronchial and perivascular region of the lung and the retroperitneum. The disease usually affects women of child-bearing age. We recently experienced a case of pulmonary lymphangioleiomyomatosis in a 31-year-old women who had suffered from a chylous pleural effusion. Histologic confirmation of lymphangioleiomyomatosis was made upon a video-associated thoracoscopic lung biopsy. Here we report this case with a brief review of the literature.
Adult ; Biopsy ; Female ; Humans ; Lung ; Lymphangioleiomyomatosis* ; Myocytes, Smooth Muscle ; Pleural Effusion*

PURPOSE: To evaluate differences in regional density of normal lung, as seen on CT, according to respiration and gravity. MATERIALS AND METHODS: The subjects were 15 healthy volunteers, all non-smokers and without previous pulmonary disease. CT scans were obtained at three selected levels through the apex, middle and basal lung at the aortic arch, carina and just above the diaphragm, respectively at both full inspiration (FVC) and full expiration (RV). Within these regions of interest and at the three scanning levels, lung density was measured in the anterior, lateral, and posterior portions of the peripheral lung field. RESULTS: Attenuation of the anterior portion of the lung was lower than that of the posterior portion(p<0.005); average lung attenuation increase from the anterior to the posterior portion was significantly greater during full expiration than full inspiration (p<0.005), and was significantly greater at the base of the lung than at the apex (p<0.005 on expiration, p=0.006 on inspiration). Lung density during inspiration was lower than during expiration (p<0.005); average lung density increase from full inspiration to full expiration was significantly greater in the posterior portion than in the anterior (p<0.005). In the former, the average increase at the base of the lung was greater than at the apex (p=0.007), but in the latter, the average increase at the apex was greater than at thebase (p<0.005). CONCLUSION: In normal lung, respiration and gravity cause regional density changes, as seen on CT, and result in difference of lung attenuation between dependent and nondependent portions and between the apex, middle and base of the lung, according to inspiration and expiration.
Aorta, Thoracic ; Diaphragm ; Gravitation ; Healthy Volunteers ; Lung Diseases ; Lung* ; Respiration ; Tomography, X-Ray Computed

No abstract available.
Lung Neoplasms* ; Lung* ; Neoplasm Metastasis* ; Toes*

BACKGROUND: Venous thromboembolism (VTE) is a relatively common and potentially life threatening complication after major hip surgery. There are two main types of prophylaxis: chemical and mechanical. Chemical prophylaxis is very effective but causes bleeding complications in surgical wounds and remote organs. On the other hand, mechanical methods are free of hemorrhagic complications but are less effective. We hypothesized that mechanical prophylaxis is effective enough for Asians in whom VTE occurs less frequently. This study evaluated the effect of intermittent pneumatic compression (IPC) in the prevention of VTE after major hip surgery. METHODS: Incidences of symptomatic VTE after primary total hip arthroplasty with and without application of IPC were compared. A total of 379 patients were included in the final analysis. The IPC group included 233 patients (106 men and 127 women) with a mean age of 54 years. The control group included 146 patients (80 men and 66 women) with a mean age of 53 years. All patients took low-dose aspirin for 6 weeks after surgery. IPC was applied to both legs just after surgery and maintained all day until discharge. When a symptom or a sign suspicious of VTE, such as swelling or redness of the foot and ankle, Homans' sign, and dyspnea was detected, computed tomography (CT) angiogram or duplex ultrasonogram was performed. RESULTS: Until 3 months after surgery, symptomatic VTE occurred in three patients in the IPC group and in 6 patients in the control group. The incidence of VTE was much lower in the IPC group (1.3%) than in the control group (4.1%), but the difference was not statistically significant. Complications associated with the application of IPC were not detected in any patient. Patients affected by VTE were older and hospitalized longer than the unaffected patients. CONCLUSIONS: The results of this study suggest that IPC might be an effective and safe method for the prevention of postoperative VTE.
Ankle ; Arthroplasty, Replacement, Hip* ; Asian Continental Ancestry Group ; Aspirin ; Dyspnea ; Foot ; Hand ; Hemorrhage ; Hip ; Humans ; Incidence ; Leg ; Male ; Methods ; Ultrasonography ; Venous Thromboembolism* ; Wounds and Injuries

PURPOSE: To evaluate the changes and normal ranges of the artery-bronchus ratio (ABR) during respiration MATERIALS AND METHODS: We analyzed HRCT of 10 healthy adults. The HRCT findings of ten healthy adults were analysed. CT scanning was performed with 1 mm collimation at 3 mm intervals during full inspiration and full expiration, with a range during inspiration from 2 cm to 4 cm above the carina and from 4 cm above to 2 cm below the right hemidiaphragm. The range during expiration was from 1 cm to 3 cm above the carina and from 4 cm above to 2 cm below the right hemidiaphragm. ABiR (defined as the diameter of pulmonary artery divided by the inner diameter of the bronchus), ABoR (defined as the diameter of pulmonary artery divided by the outer diameter of the bronchus) and BLR (defined as the inner diameter of the bronchus divided by the outer diameter of the bronchus) were measured on the display console. RESULTS: The mean inner diameter of the bronchi was 2.04+/-0.73 mm during inspiration and 1.68+/-0.51 mm during expiration, while the mean diameter of the arteries was 3.95+/-1.03 mm during inspiration and 4.37+/-1.09 mm during expiration. The diameters of the bronchi were thus seen to increase during inspiration, and the diameters of the pulmonary arteries, to decrease. The mean thickness of the bronchial wall was 1.07+/-0.19 mm during inspiration and 1.06+/-0.24mm during expiration; thus, no change in thickness was seen during respiration (p<0.05). Mean ABiR was 2.01+/-0.60 (range 1.15-4.58) during inspiration and 2.59+/-0.74(range 1.16-4.9) during expiration, and in all cases the inner diameter of the bronchus was less than that of the accompanying pulmonary artery. Mean ABoR was 0.91+/-0.19 during inspiration and 1.09+/-0.22 during expiration. while for BLR, the corresponding fingures were 0.46+/-0.06, and 0.44+/-0.09. CONCLUSION: HRCT is a useful tool for evaluating changes in the pulmonary arteries and bronchi during respiration.
Adult ; Arteries ; Bronchi ; Humans ; Pulmonary Artery ; Reference Values ; Respiration* ; Tomography, X-Ray Computed