PURPOSE: We report a case of a scleral perforation during inferior rectus recession in congenital fibrosis of extraocular muscles and the management of this perforation with a scleral patch graft. CASE SUMMARY: A 20-month-old female with bilateral ptosis, absence of elevation and a chin-up position was diagnosed with congenital fibrosis of extraocular muscles. Because severe esotropia in the downward gaze was observed, we first performed esotropia surgery. After 1 year, she underwent a bilateral ptosis correction. We decided to perform bilateral inferior rectus recession due to an abnormal head posture and the absence of elevation. Because the inferior rectus muscles were extremely tight and adhered to the sclera, hooking and isolating these muscles during surgery was difficult. After muscle suture placement, a portion of the sclera that contacted the left inferior rectus was chipped off as this muscle was disinserted with blunt Westcott scissors. A scleral perforation was observed, thus, we placed a scleral patch graft using the donor sclera and finished the bilateral inferior rectus recession. No abnormal findings for the vitreous or retina were detected. At 8 months after surgery, the patient exhibited exotropia of 12 prism diopters in her primary gaze. Her abnormal head posture nearly disappeared. CONCLUSIONS: Careful isolation and disinsertion of the muscle from the globe is necessary in the treatment of patients who are expected to exhibit severe adhesions between the muscle and sclera, such as patients with congenital fibrosis of extraocular muscles.
Esotropia ; Exotropia ; Female ; Fibrosis* ; Head ; Humans ; Infant ; Muscles* ; Posture ; Retina ; Sclera ; Sutures ; Tissue Donors ; Transplants

Axis, Cervical Vertebra ; Follow-Up Studies ; Humans ; Mandible ; Osteotomy, Sagittal Split Ramus ; Prognathism ; Recurrence

PURPOSE: Gastrointestinal stromal tumors (GISTs) represent a distinct and the most important subset of, mesenchymal tumors of the GI tract. Stromal tumors of the gastrointestinal tract have long been a source of confusion and controversy, with regard to their classification, differentiation, criteria of malignancy and prognostic features. METHODS: The 26 case studies of patients treated for a Gastrointestinal mesenchymal tumor, including leiomyomas, leiomyosarcomas and GISTs, between 1994 and 2002 at Keimyung University Hospital, were evaluated retrospectively. The cases were confirmed as leiomyomas, schwannomas, or GISTs by pathological re-examination. 20 of the cases were diagnosed as GISTs, from the pathological examination, and were chosen for the evaluation of their clinicopathological and immunohistochemical characteristics, using CD34, CD117, alpha-SMA and S-100 done. RESULTS: The new diagnoses of the mesenchymal tumors were a leiomyoma in 3 cases, a schwannoma in 3 and gastric stromal tumors in all 20. The immunohistochemical studies were positive for CD117 and CD34 in 95 and 75% of the gastric stromal tumors, respectively. The histopathological findings showed 5 benign tumors, 3 borderline tumors, and 12 malignant tumors in the 20 patients. CONCLUSION: The immunohistochemical marker (CD117) for KIT is a specific marker for GISTs among the tumors occurring in the stomach, and can be used to distinguish GISTs from true leiomyomas and gastric schwannomas. We also found that severe cellularity, atypism, intratumoral hemorrhage and necrosis, large size and a high mitotic count correlate with malignant behaviour and a poor prognosis.
Actins* ; Classification* ; Diagnosis ; Gastrointestinal Stromal Tumors* ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Leiomyoma ; Leiomyosarcoma ; Muscle, Smooth* ; Necrosis ; Neurilemmoma ; Prognosis ; Retrospective Studies ; Stomach

Vascular malformations in extremities are difficult to detect in cases of minor trauma. The authors report a case of an arteriovenous malformation (AVM) incidentally found by ultrasonography in a contusion. After a slip down, a 52-year-old man who had undergone total arthroplasty in both hips 10 years earlier complained of an ovoid right hip swelling that had gradually increased in size. Suspecting a simple cyst or hematoma, the swelling was examined by ultrasonography, which revealed a subcutaneous hematoma with arterial flow connected to muscle. Arteriography revealed an AVM around the right hip joint. Due to the presence of multiple arteriovenous shunts, a conservative treatment course was adopted and after 3 weeks of treatment the swelling almost completely resolved. It appears that the small AVM may have existed congenitally before hip surgery and the contusion over the AVM had led to hematoma rather than an arteriovenous fistula. The authors emphasize the usefulness of ultrasonography for the diagnosis of posttraumatic swelling.
Angiography ; Arteriovenous Fistula ; Arteriovenous Malformations ; Arthroplasty ; Contusions ; Extremities ; Hematoma ; Hip ; Hip Joint ; Humans ; Middle Aged ; Muscles ; Thigh ; Vascular Malformations

We describe a patient with an unusual cause of the occlusions of both femoral arteries by myxomas. A 41-year-old man presented with sudden onset of both leg pain and paresthesia. His hematological and cardiological status was normal. Lower peripheral angiography was performed and demonstrated thrombotic occlusion, both common femoral artery and superficial femoral and proximal portion of deep femoral artery. He was successfully treated with surgical and forgaty catheter extraction. Histologic finding was myxoma probably from cardiac origin. Cardiac investigations to determine the source of the myxoma, including 2-D echocardiography and Transesophageal echocardiogram (TEE) of the heart, failed to demonstrate residual myxoma in heart. No residual tumor or potential source of the tumor was found. The cause of both leg pain was the occlusions of the both common femoral arteries by myxomas. An entire cardiac tumor might have embolized with no detectable residual tumor in the heart; alternatively a myxoma might have originated as a primary tumor in the femoral artery.
Adult ; Angiography ; Catheters ; Echocardiography ; Femoral Artery* ; Heart ; Heart Neoplasms ; Humans ; Leg ; Myxoma* ; Neoplasm, Residual ; Paresthesia

BACKGROUND: Ropivacaine and levobupivacaine, both single S-enantiomers, show less toxicity on the central nervous and cardiovascular system than racemic bupivacaine. Earlier studies have shown that levobupivacaine and bupivacaine are almost equipotent while ropivaciane was 60% less potent than bupivacaine. The aim of this prospective, double blinded study was to compare the clinical efficacy and safety of epidural anesthesia produced by 0.5% levobupivacaine and 0.5% ropivacaine for a cesarean section. METHODS: Sixty-two parturients undergoing an elective cesarean section were randomized to receive either epidural levobupivacaine 0.5% 20 ml (n = 31) or epidural ropivacaine 0.5% 20 ml (n = 31). Surgery was commenced when the sensory block had reached the dermatome level, T6. The onset, duration, quality of the sensory and motor block and abdominal muscle relaxation were evaluated. The blood pressure and heart rate of the mother and neonatal outcome, as assessed by the Apgar score and umbilical pH, were also recorded. RESULTS: There was no difference in the onset time, the segmental spread of sensory block and analgesic supplement between the two groups. However, levobupivacaine produced a longer duration of sensory block than ropivacaine (levobupivacaine 224.1 +/- 66.6 min, ropivacaine 176.5 +/- 32.8 min, P < 0.05). The onset time (except Bromage scale 2), intensity and duration of the motor block and muscle relaxation were similar in both groups. There was no difference in the maternal and neonatal outcomes between the two groups. CONCLUSIONS: 0.5% levobupivacaine and 0.5% ropivacaine produced equivalent efficacy and safety in epidural anesthesia for a cesarean section, but levobupivacaine resulted in a longer duration of sensory block.
Abdominal Muscles ; Anesthesia, Epidural* ; Apgar Score ; Blood Pressure ; Bupivacaine ; Cardiovascular System ; Cesarean Section* ; Female ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Mothers ; Muscle Relaxation ; Pregnancy ; Prospective Studies ; Relaxation

PURPOSE: The purpose of this study was to assess the utility of total prostate-specific antigen(PSA) as a predictor of the prostatic volume in men with symptomatic benign prostate hyperplasia(BPH). MATERIALS AND METHODS: From 1999 to 2003, data were collected from 942 patients complaining of lower urinary tract symptoms(LUTS). Baseline prostatic volume(PV) and serum PSA were measured using transrectal sonography and ELSA-PSA2 kit. Patients with a history of prostate surgery, prostatic cancer and conditions other than BPH at baseline were excluded. Transrectal prostatic biopsy was performed in 162 of patients with a serum PSA >4.0 ng/ml to exclude prostatic cancer. A log-transformed linear regression model was used to estimate threshold PVs in men with BPH, and to select the optimal serum PSA cut-off values. RESULTS: The analyses included 942 patients with a mean age of 63.8 years, mean baseline PV 29.59 ml, and mean baseline PSA value 2.37 ng/ml. PV as well as serum PSA increased with age. Linear regression analyses showed that PV and serum PSA have an age-dependent log-linear relationship. Optimal serum PSA cut-off values for the overall study population irrespective of age was 1.7 ng/ml (AUC: 0.800+/-0.053) to detect PV >30 ml and 2.2 ng/ml (AUC: 0.805+/-0.027) to detect PV >40 ml. The age-specific criteria for detecting men with prostate glands exceeding 40 ml are PSA >1.9 ng/ml (AUC: 0.800+/-0.053), >2.2 ng/ml (AUC: 0.805+/-0.027), and >3.4 ng/ml (AUC: 0.763+/-0.039) for men with BPH in their 50 s, 60 s, and 70 s, respectively. CONCLUSION: This study suggests that PV is strongly related to serum PSA in men with BPH and the relationship depends on age. The age-specific criteria for detecting men with prostate glands exceeding 40 ml are PSA >1.9 ng/ml, >2.2 ng/ml, and >3.4 ng/ml for men with BPH in their 50 s, 60 s, and 70 s, respectively. And in the absence of reliable direct measurement of PV, serum PSA can estimate the degree of prostate enlargement accurately to be useful for therapeutics, especially medical management.
Biopsy ; Humans ; Linear Models ; Male ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Hyperplasia* ; Prostatic Neoplasms ; Urinary Tract

Cutaneous larva migrans (CLM) is a rare serpiginous cutaneous eruption caused by accidental penetration and migration in the skin with infective larvae of nematode that normally do not have the human as their host. Although CLM has a worldwide distribution, the infection is most frequent in warmer climates. More recently, they have been increasingly imported from the tropics or subtropics by travelers. We experienced two patients who had pruritic serpiginous linear eruption in their skin for a few weeks after traveling to the endemic areas (Brazil and Thailand, respectively). After the treatment with albendazole, the skin lesions resolved with post-inflammatory hyperpigmentation. We report herein two cases of cutaneous larva migrans successfully treated with albendazole.
Adult ; Albendazole/therapeutic use ; Anthelmintics/therapeutic use ; Child, Preschool ; Female ; Human ; Larva Migrans/*drug therapy/pathology ; Male ; *Travel ; Treatment Outcome

Hypoglossal nerve palsy after general anesthesia is an exceptionally rare complication, which has varied etiology. We present a case of unilateral hypoglossal nerve palsy resulting from repeated airway intervention for general anesthesia. A 57-year-old woman was scheduled to undergo modified radical mastectomy. During endotracheal intubation, the patient had Cormack's grade III-a severe airway condition. After the first intubation attempt failed, the intubation was attempted a second time using a stylet inside the endotracheal tube with cricoid pressure; this attempt was successful. In the evening of the operation day, the patient complained of dysarthria and dysphagia. Physical examination revealed deviation of the tongue to the right, which may have been caused by traumatic hypoglossal nerve injury. This case reviews the pathophysiology, prevention, and management of hypoglossal nerve palsy.
Anesthesia, General* ; Deglutition Disorders ; Dysarthria ; Female ; Humans ; Hypoglossal Nerve Diseases* ; Hypoglossal Nerve Injuries ; Hypoglossal Nerve* ; Intubation ; Intubation, Intratracheal* ; Mastectomy, Modified Radical ; Middle Aged ; Paralysis ; Physical Examination ; Tongue

Most adenocarcinomas of the colorectum arise in a visible benign precursor lesion, the adenoma, which is a monoclonal proliferation of dysplastic nonmalignant epithelial cells. Adenoma-adenocarcinoma sequence has been represented as the predominat pathogenetic pathway. But a small flat depressed colon cancer is characterized by non-polypoid growth pattem with no association of adenomatous tissues, which has tendency to early submucosal invasion and lymph node metastasis even in very small lesion (<10 mm). It supports de novo carcinogenesis of colorectal cancer, although most colorectal cancerarise in pre-existing adenoma. We report a case of small float colon adenocarcinoma arising in normal colonic epithelium rather than adenomatous polyp in familial adenomatous polyposis syndrome.
Adenocarcinoma* ; Adenoma ; Adenomatous Polyposis Coli* ; Adenomatous Polyps ; Carcinogenesis ; Colon* ; Colonic Neoplasms ; Colorectal Neoplasms ; Epithelial Cells ; Epithelium ; Humans ; Lymph Nodes ; Neoplasm Metastasis