Magnetic resonance imaging (MRI) is an essential modality for the diagnosis of musculoskeletal system defects because of its higher soft-tissue contrast and spatial resolution. With the recent development of MRI-related technology, faster imaging and various image plane reconstructions are possible, enabling better assessment of three-dimensional musculoskeletal anatomy and lesions. Furthermore, the image quality, diagnostic accuracy, and acquisition time depend on the MRI protocol used. Moreover, the protocol affects the efficiency of the MRI scanner. Therefore, it is important for a radiologist to optimize the MRI protocol. In this review, we will provide guidance on patient positioning; selection of the radiofrequency coil, pulse sequences, and imaging planes; and control of MRI parameters to help optimize the MRI protocol for the six major joints of the musculoskeletal system.

Tinea incognito (TI) is a dermatophytic infection which has lost its typical clinical appearance because of improper use of steroids or calcineurin inhibitors. The incidence of TI is increasing nowadays. We conducted retrospective review on 283 patients with TI from 25 dermatology training hospitals in Korea from 2002-2010 to investigate the demographical, clinical, and mycological characteristics of TI, and to determine the associated risk factors. More than half (59.3%) patients were previously treated by non-dermatologists or self-treated. The mean duration of TI was 15.0 +/- 25.3 months. The most common clinical manifestations were eczema-like lesion, psoriasis-like, and lupus erythematosus-like lesion. The trunk and face were frequently involved, and 91 patients (32.2%) also had coexisting fungal infections. Among 67 isolated strains, Trichophyton rubrum was the most frequently detected (73.1%). This is the largest study of TI reported to date and the first investigational report concerning TI in Korea. We suggest that doctors should consider TI when a patient has intractable eczema-like lesions accompanied by tinea pedis/unguium. Furthermore, there should be a policy change, which would make over-the-counter high-potency topical steroids less accessible in some countries, including Korea.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Demography ; Eczema/pathology ; Face/pathology ; Female ; Humans ; Lupus Erythematosus, Cutaneous/pathology ; Male ; Middle Aged ; Psoriasis/pathology ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Tinea/*diagnosis/microbiology ; Trichophyton/isolation & purification ; Young Adult

PURPOSE: In some girls with central precocious puberty (CPP), growth velocity (GV) decreases below the age-appropriate normal range during gonadotropin-releasing hormone agonist (GnRHa) treatment. The purpose of this study was to investigate clinical and laboratory factors related to changes in GV during GnRHa treatment in girls with CPP. METHODS: We analyzed clinical and laboratory data of 49 girls (aged 7.8+/-0.5 years) with idiopathic CPP who were treated with GnRHa. GV, height standard deviation score (SDS), hormonal parameters, pubertal stage, chronological age and bone age (BA) were evaluated. RESULTS: GV during the first year of GnRHa treatment was 5.9+/-1.0 cm/yr and decreased significantly to 5.4+/-1.1 cm/yr during the second year of treatment (P = 0.005). GV during the third year (5.0+/-1.0 cm/yr) was not different from GV during the second year. During the second year of treatment, 8.2% and 36.7% of the girls had a GV < 4 cm/yr and < 5 cm/yr, respectively. Girls with relatively low GV during the second year of treatment (< 5 cm/yr) showed higher risk of advanced BA (> or = 11 yr) at 1 year (55.6% vs. 19.4%; odds ratio [OR], 5.2; P = 0.022). In multivariate logistic regression analysis, more advanced BA at 1 year (OR, 6.1; 95% confidence interval [CI], 1.57-23.87) and lower height SDS for BA at 1 year (OR, 0.24; 95% CI, 0.06-0.94) were associated with relatively decreased GV (< 5 cm/yr) during the second year of GnRHa treatment. CONCLUSION: GV during and after the second year of GnRHa treatment in girls with idiopathic CPP remains within the normal prepubertal range, and relatively low GV during GnRHa treatment is associated with more advanced BA and lower height SDS for BA.
Gonadotropin-Releasing Hormone ; Logistic Models ; Odds Ratio ; Piperazines ; Puberty, Precocious ; Reference Values

PURPOSE: In some girls with central precocious puberty (CPP), growth velocity (GV) decreases below the age-appropriate normal range during gonadotropin-releasing hormone agonist (GnRHa) treatment. The purpose of this study was to investigate clinical and laboratory factors related to changes in GV during GnRHa treatment in girls with CPP. METHODS: We analyzed clinical and laboratory data of 49 girls (aged 7.8+/-0.5 years) with idiopathic CPP who were treated with GnRHa. GV, height standard deviation score (SDS), hormonal parameters, pubertal stage, chronological age and bone age (BA) were evaluated. RESULTS: GV during the first year of GnRHa treatment was 5.9+/-1.0 cm/yr and decreased significantly to 5.4+/-1.1 cm/yr during the second year of treatment (P = 0.005). GV during the third year (5.0+/-1.0 cm/yr) was not different from GV during the second year. During the second year of treatment, 8.2% and 36.7% of the girls had a GV < 4 cm/yr and < 5 cm/yr, respectively. Girls with relatively low GV during the second year of treatment (< 5 cm/yr) showed higher risk of advanced BA (> or = 11 yr) at 1 year (55.6% vs. 19.4%; odds ratio [OR], 5.2; P = 0.022). In multivariate logistic regression analysis, more advanced BA at 1 year (OR, 6.1; 95% confidence interval [CI], 1.57-23.87) and lower height SDS for BA at 1 year (OR, 0.24; 95% CI, 0.06-0.94) were associated with relatively decreased GV (< 5 cm/yr) during the second year of GnRHa treatment. CONCLUSION: GV during and after the second year of GnRHa treatment in girls with idiopathic CPP remains within the normal prepubertal range, and relatively low GV during GnRHa treatment is associated with more advanced BA and lower height SDS for BA.
Gonadotropin-Releasing Hormone ; Logistic Models ; Odds Ratio ; Piperazines ; Puberty, Precocious ; Reference Values

PURPOSE: Many patients have fear for surgery owing to the injection of lidocaine and the possible pain in the course of the operation. To resolve such a problem the cases to do plastic surgery with monitored anesthetic care are increasing, in which something like sedatives is injected into vein without endotracheal intubation and under voluntary respiration, but the usage is now under the controversy. METHODS: There were 25 patients who had surgery with local anesthesia, and another 25 patients who had surgery with monitored anesthetic care which belongs to ASA class 1 and 2 from January to April, 2009. Their anesthesia records were collected and surveys were given before and after the surgery and the surgery staff recorded OAA/S during the surgery. The postoperative surveys included the awakening during the surgery, pain, anxiety, and the degree of patient's satisfaction through visual analogue scale to identify the difference between the two methods. RESULTS: The OAA/S results according to time lapse show that it is possible to lead a fast effective sedation and recovery with monitored anesthetic care, and monitored anesthetic care enhances both surgeon's convenience level and patient's satisfaction level, and reduces awakening, pain, and anxiety, compared to local anesthesia. CONCLUSION: The current paper shows about the plastic surgery, particularly the outpatient surgery, when monitored anesthetic care method is applied, it could gain a fast sedation and recovery or an effective sedation of patients. The method also has some affirmative effects in regard with surgeon's convenience and the patients' satisfaction degree and the reduction of their awakening, pain, and anxiety. With careful and adequate watch on the measures about vital signs like electrocardiogram, the degree of oxygen saturation, and blood pressure, it could clinically be very useful.
Ambulatory Surgical Procedures ; Anesthesia ; Anesthesia, Local ; Anxiety ; Blood Pressure ; Electrocardiography ; Humans ; Hypnotics and Sedatives ; Intubation, Intratracheal ; Ketamine ; Lidocaine ; Oxygen ; Propofol ; Respiration ; Surgery, Plastic ; Veins ; Vital Signs

PURPOSE: The purpose of this study is to demonstrate the usefulness of the high resolutional ultrasonographic features in patients with foreign body. METHODS: From September 2007 to August 2009, we retrospectively reviewed high resolutional ultrasonogram using 5~12MHz linear transducer of 13 patients presenting with inflammation after foreign body injection. They were referred for complications after foreign body injection. Injected foreign bodies were 4 silicone, 4 paraffin, 2 artecoll, and 3 unknown. We treated them with foreign body removal(7), foreign body removal and corrective plastic surgery(4), and conservative treatment with antibiotics and steroid injection(2). RESULTS: High resolutional ultrasonography well demonstrated the existence of foreign body and it's overall size, location within the tissue layer, and vascularity. Comparison between preoperative and postoperative ultrasonographic findings was useful not only to evaluate the prognosis but also to plan the treatment. These ultrasonographic findings aided in precise assessment of the contour and location of the foreign body and led to an accurate surgery. We were able to acquire various information in order to set a detailed plan for the operation which in turn, led to a precise, successful surgery. After the treatment, complication did not occur in 12 patients, except 1 patient. But this patient was also treated after reoperation. Postoperative high resolutional ultrasonography shows almost foreign body removed and inflammation disappeared. CONCLUSION: Considering the usefulness of high-resolution ultrasonography in foreign body injection, high-resolution ultrasonography would be necessary for both the patient and the doctor. Preoperative and postoperative high resolutional ultrasonography is highly accurate, safe, inexpensive and easy. It can be a useful modality in foreign body after plastic surgery.
Anti-Bacterial Agents ; Collagen ; Foreign Bodies ; Humans ; Inflammation ; Paraffin ; Polymethyl Methacrylate ; Prognosis ; Reoperation ; Retrospective Studies ; Silicones ; Surgery, Plastic ; Transducers

PURPOSE: Primary malignant lymphomas of the salivary glands are uncommon, representing only 1.7% to 3.1% of all salivary neoplasms and 0.6% to 5% of all tumors and tumor-like lesions of the parotid gland. Lymphomas of the parotid glands are usually manifestations of a systemic disease process but primary lymphomas of the parotid glands are rare. Most of these lesions are classified as extranodal non-Hodgkin's lymphoma. We report the clinicopathological features of primary malignant lymphoma of the parotid gland based on an analysis of our cases. METHODS: The subject was a 48-year-old male patient with a malignant lymphoma originating in the parotid gland, which had been slowly increasing in size over previous 6 months. The diagnosis was established by MRI and a superficial lobectomy. After diagnosis, the patient was referred to an oncologist for staging and medical treatment. RESULTS: The stage was IIIA. The patient was treated with chemotherapy following surgery with rituximab and CHOP (Cyclophosphamide, Adriamycin, Vincristine, Prednisolone). The tumor was controlled successfully by chemotherapy. The patient was followed up for 1 year with no relapse. CONCLUSION: A case of primary non-Hodgkin's lymphoma of the parotid gland was treated with a superficial parotidectomy and chemotherapy. The disease was well controlled after a 1 year follow-up.
Antibodies, Monoclonal, Murine-Derived ; Doxorubicin ; Follow-Up Studies ; Humans ; Lymphoma ; Lymphoma, Non-Hodgkin ; Male ; Middle Aged ; Parotid Gland ; Recurrence ; Salivary Glands ; Vincristine

A 81-year-old female patient was experiencing a second degree burn. The vesicobullous lesion and skin necrosis was accompanied by erythema with a size of 8x11 cm and severe pain. Three days earlier, the patient had bumped her forehead against the wall, her forehead was swelled and hurted. The patient spread ground indomethacin cream (Vigel cream(R)) on her forehead constantly. She was treated with potadine soaked gauze every day. As soon as the erythema had worn out, she was treated by foam dressing using Episurge(R) (Erweis). Epithelialization of the injured area began from the 7th day since the burn. Complete epithelialization took 14th days, and the outpatient's progress is currently being observed.
Aged, 80 and over ; Bandages ; Burns ; Burns, Chemical ; Erythema ; Female ; Forehead ; Humans ; Indomethacin ; Necrosis ; Skin

Advances in medical science have produced significant progress in the area of wound healing. Yet, despite proper administration of initial medical treatment, burns or radiation induced wounds often develop into chronic wounds or develop other complications such as scar contractures. In these type of patients, chronic wounds and the potential accompanied ulcers are difficult to heal as malignant changes may occur to the wounds especially in the absence of or in the delay in timely medical treatment. In our beauty oriented society today people have shown great interest in improving their image and many obese patients want to undergo suction-assisted lipectomies or abdominoplasties. Abdominoplasty is an effective procedure to remove locally accumulated fat and to reshape abdominal contours by tightening the muscles of the relaxed abdominal wall. Our medical research conducted on two patients, one with contact burn injuries accompanied by upper abdominal ulcers suffered for fifty years and another with radiation impaired wounds accompanied by lower abdominal ulcers due to cancer treatment for seven years, has shown that through the proper use of abdominoplasty. We have eliminated all possibilities that may trigger the re-occurrence of Marjolin's ulcers which may become malignant. Additionally, we have been able to heal chronic wounds and functionally improve our patient's restrictions of movement caused by the scar contractures by completely removing the lesions, erythemas and discharges from the ulcer areas by performing upper and lower abdominoplasties while still obtaining cosmetically satisfactory results.
Abdominal Wall ; Abdominoplasty ; Beauty ; Burns ; Cicatrix ; Contracture ; Erythema ; Humans ; Lipectomy ; Muscles ; Ulcer ; Wound Healing

PURPOSE: The purpose of this study was to describe the clinical and MR imaging features of acute gouty arthritis and to define the characteristic findings that would be helpful for differentiating acute gouty arthritis from septic arthritis. MATERIALS AND METHODS: The authors retrospectively studied seven patients who suffered from acute gouty arthritis. The MR imaging findings were analyzed by two musculoskeletal radiologists who focused on joint effusion, subchondral bone erosion, bone marrow edema, synovial thickening (regular and even, or irregular and nodular), and the soft tissue changes (edema or abscess). The clinical records of the patients were reviewed with regard to age and gender, the clinical presentation and the laboratory findings (serum uric acid, WBC, erythrocyte sedimentation rate, C-reactive protein and synovial fluid culture). RESULTS: The patients consisted of six men and one woman whose mean age was 41 years (age range: 24-65 years). The joints involved were the knee (n=6), and ankle (n=1). Two patients had medical histories of gouty attacks that involved the first metatarsophalangeal joint. In six cases, the serum uric acid level during acute attacks was elevated. In all the patients, the affected joint became swollen, hot, erythematous and extremely tender, and this was accompanied by a high ESR and a high C-reactive protein level at the time of presentation. The results of Gram stain and culture of the synovial fluid were negative. In all patients, the MR images showed large amounts of joint effusion, thick irregular and nodular synovial thickening and soft tissue edema without subchondral bone erosions and soft tissue abscess. In one case, subchondral bone marrow edema of the medial femoral condyle was present. In five cases, there were multiple low signal foci in the joint on the spin-echo T2-weighted MR image. CONCLUSION: Even though the MR imaging findings of acute gouty arthritis are nonspecific, it should be considered as a possible diagnosis when a large amount of joint effusion, irregular and nodular synovial thickening and soft tissue edema without subchondral bone erosion, bone marrow edema or soft tissue abscess are seen in the knee or ankle joint, and especially if this is accompanied by the clinical and laboratory features of infection.
Abscess ; Ankle ; Ankle Joint ; Arthritis ; Arthritis, Gouty* ; Arthritis, Infectious ; Blood Sedimentation ; Bone Marrow ; C-Reactive Protein ; Diagnosis ; Edema ; Female ; Gout ; Humans ; Joints ; Knee ; Magnetic Resonance Imaging* ; Male ; Metatarsophalangeal Joint ; Retrospective Studies ; Synovial Fluid ; Uric Acid