BACKGROUNDS: The high mortality and morbidity rates associated with traumatic rupture of the hollow viscera have been attributed to the clinical difficulty in establishing an early diagnosis. The accuracy of CT in the detection of injuries of the solid visceral organ is well established, but the value of CT in diagnosing small bowel perforation artier blunt abdominal trauma is controversal. This study was conducted to ascertain CT findings of small bowel perforation result from blunt abdominal trauma. METHODS: A retrospective analysis of preoperative abdominal CT findings in 40 patients was performed. Small bowel perforation was confirmed by surgery. Precontrast and postcontrast enhanced CT images were obtained in all patients. RESULTS: Diagnostic findings of small bowel perforation including intraperitoneal or retroperitoneal free air, discontinuity of the bowel wall and extravasation of oral or IV contrast materials were observed in 34 cases(85%). The most common fading of small bowel perforation was intraperitoneal or retroperitoneal free fluid collection(90%), followed by segmental bowel wall thickening(83%), intraperitoneal or retroperitoneal free air(80%) and focal mesenteric fat infiltration(70%). CONCLUSIONS : The CT scan is sensitive and effective modality for evaluation of small bowel perforation after blunt abdominal truauma, because of high detectability of diagnostic antral suggestive CT findings.
Contrast Media ; Diagnosis* ; Early Diagnosis ; Humans ; Mortality ; Retrospective Studies ; Rupture ; Tomography, X-Ray Computed ; Viscera

PURPOSE: To evaluate the diagnostic usefulness of ultrasound-guided cutting-needle biopsy(CNB) with an automated biopsy device in head and neck masses. MATERIALS AND METHODS: A series of 153 consecutive head and neck masses in 133 patients, biopsied with an 18G cutting-needle and automated biopsy device under ultrasound guidance, was analysed for diagnostic yield and complications. Fine-needle aspiration biopsy(FNAB) was also performed on 88 masses and compared with the findings of CNB. RESULTS: Diagnostic specimens were obtained in 135 (88.2 %) of 153 masses. Eighty-four (90.3 %) of 93 lymph node CNBs provided a diagnostic histological specimen. Tuberculous lymphadenitis or chronic reactive hyper-palsia was diagnosed by CNB in 22 cases, but only six case were diagnosed by FNAB. Ten metastatic lymph nodes and two malignant lymphomas diagnosed by CNB were concordant with the findings of FNAB ; the exception was one case in which metastasis involved lymph nodes. Twenty-seven (77%) of 35 CNBs of thyroid nodule provided a diagnostic specimen. Seven of 28 FNAB cases in which CNB failed to provide a diagnostic specimen, revealed two papillary cancers and three benign nodular lesions. Twenty-five CNBs of soft tissue and salivary gland tumors provided diagnostic specimens; the exception was one probable hemangioma (96 %). In six of 11 FNABs of soft tissue and salivary gland masses, a diagnostic specimen was not obtained. There were four cases of hematoma (2.6%) without clinical significance. CONCLUSION: CNB of head and neck masses using an automated biopsy device is a useful and safe method. In the case of thyroid masses, however, FNAB is more useful and safe than CNB.
Biopsy* ; Biopsy, Fine-Needle* ; Diagnosis* ; Head* ; Hemangioma ; Hematoma ; Humans ; Lymph Nodes ; Lymphoma ; Neck* ; Neoplasm Metastasis ; Salivary Glands ; Thyroid Gland ; Thyroid Nodule ; Tuberculosis, Lymph Node ; Ultrasonography

For securing large, giant, and wide-neck aneurysms, conventional coil embolization has substantial limitations, such as incomplete occlusion, recanalization, and a high recurrence rate. To overcome these limitations, a novel paradigm was suggested and, as a result, flow-diverting device was developed. The flow-diverting device is an innovative and effective technique to allow securing of large, giant, and wide-neck aneurysms. In numerous studies, the flow-diverting device has shown better outcomes than coil embolization. However, the flow-diverting device has also some risks, including rupture of aneurysm, intracerebral hemorrhage, and ischemic stroke. In addition, with more experience, unexpected complications are also reported.5) 7) In the present case, we experienced a delayed ischemic stroke at 27 days after endovascular treatment. The patient had multiple aneurysms and, among them, we treated a large posterior communicating artery aneurysm using Pipeline™ Embolization Device. The patient was tolerable for 25 days, but then suddenly presented intermittent right hemiparesis. In the initial diffusion magnetic resonance imaging (MRI), there was no acute lesion; however, in the follow-up MRI, an acute ischemic stroke was found in the territory of anterior choroidal artery which was covered by Pipeline Embolization Device. We suspect that neo-intimal overgrowth or a tiny thrombus have led to this delayed complication. Through our case, we learned that the neurosurgeon should be aware of the possibility of delayed ischemic stroke after flow diversion, as well as, long-term close observation and follow-up angiography are necessary even in the event of no acute complications.
Aneurysm ; Angiography ; Arteries ; Cerebral Hemorrhage ; Choroid ; Diffusion Magnetic Resonance Imaging ; Embolization, Therapeutic ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Magnetic Resonance Imaging ; Paresis ; Recurrence ; Rupture ; Stroke* ; Thrombosis

It is well-known that multiple sclerosis (MS) has a higher prevalence rate in occidental countries than in Asia and Africa. In addition to their lower prevalence rate of MS, oriental countries may have different clinical characteristics. It has been shown in the previous studies performed in Japan that there is more frequent involvement of optic nerve and spinal cord during the course of disease. These results were also confirmed by the study of MS in Hawaii which compared orientals with caucasians in their clinical features. In Korea, there has been no estimate for clinical features and prevalence rate of MS except two studies. We performed this study to evaluate the clinical features and estimated prevalence rate based on a series of 50 consecutive cases of MS seen over 8 and a half year-period in the Seoul National University Hospital.
Africa ; Asia ; Hawaii ; Japan ; Korea* ; Multiple Sclerosis* ; Optic Nerve ; Prevalence* ; Seoul ; Spinal Cord

No abstract available.
Intracranial Arteriovenous Malformations* ; Microsurgery*

No abstract available.
Wernicke Encephalopathy*

PURPOSE: To evaluate the usefulness of spiral CT in predicting the depth of tumor invasion in patients with gastric cancer by comparing with histopathological finding. MATERIALS AND METHODS: We studied spiral CT scans of forty-eight patients, in whom gastric cancer was proven by gastrofibroscopic biopsy and surgery. After distending the stomach with 400ml tap water or effervescent granules, 100ml of contrast media was given intravenously at a rate of 3ml/sec. CT scanning was started at 45 sec after administration of the contrast material. Gastric tumors were subdivided into five types according to enhancing pattern from the inner layer of gastric wall to the outer layer. These pattern were correlated with histopathologic results. RESULT: The tumor masses were detected on CT scan in 10(77%) of 13 patients with early gastric cancer, while, the tumor masses were seen on CT scan in all patients with advanced gastric cancer. Of 9 patients with type 1 or type 2 enhancing pattern, early gastric cancer(T1) were proven in 7 patients(78%), serosal invasion (T3) in 2 patients(22%). In contrast, among 29 patients with type 4 and type 5, 22 patients(76%) were proven as serosal invasion(T3). Of 7 patients with type 3, 3 patients(43%) were proven as serosal invasion(T3), three(43%) as subserosal invasion(T2), one as early gastric cancer(T1). CONCLUSION: Analysis of morphological enhancing pattern on spiral CT is useful in predicting the depth of tumor invasion in patients with gastric cancer.
Biopsy ; Contrast Media ; Humans ; Stomach ; Stomach Neoplasms ; Tomography, Spiral Computed* ; Tomography, X-Ray Computed ; Water

We reviewed clinicoradiologic findings of twenty-one patients with lateral medullary(Wallenberg) syndrome who admitted at Seoul National University Hospital from March, 1983 to February, 1989. The results are as follows: 1. Lateral medullary syndrome was 14.6% of ischemic stroke in vertebrobasilar territory during the same period. The ages ranged from 35 to 69 years and most of them were in 6th or 7th decades. Z. Detected risk factors were hypertension in 17, previous stroke in 8, hyperlipidemia in 7, and diabetes mellitus in 4. 3. The interval which developed maximal characteristic symptoms after onset were within 5 days in all patients and 2 days in 13 patients. 4. Frequent complaints were dizziness in 21, vertigo in 17, nausea or vomiting in 18, swallowrng difficulty in 14, dysarthria in 12, headache in 11, hoarseness in 7, hiccup in 7, and facial pain in 3, 5. Frequent signs were Horner's syndrome in 21, ataxia in 21, crossed sensory change in 19, soft palate sagging in 15, ipsilateral facial weakness in 9, DTR increase in the same side in 7, tongue deviation in 6, transient diplopia in 5, and transient altered consciousness in 4, 6. Disease courses were considerable improvement in 18, recurrence in 1, and discharge against medical advice in 1. Frequent disturbing complaints during the follow-up period were paresthesia or sensory loss in 16 and ataxia in 11. 7 Among the radiologic studies, MRI could define the lesion at corresponding site in 8 of 9, CT in 3 of 21, and TFCA in 3 of 6. These results suggest that MRI is the best rdiologic study to yeild the lesion in lateral medullary syndrome.
Ataxia ; Consciousness ; Diabetes Mellitus ; Diplopia ; Dizziness ; Dysarthria ; Facial Pain ; Follow-Up Studies ; Headache ; Hiccup ; Hoarseness ; Horner Syndrome ; Humans ; Hyperlipidemias ; Hypertension ; Lateral Medullary Syndrome* ; Magnetic Resonance Imaging ; Nausea ; Palate, Soft ; Paresthesia ; Recurrence ; Risk Factors ; Seoul ; Stroke ; Tongue ; Vertigo ; Vomiting

This is a case report and review of literature that deals with hemifacial microsomia corrected by costochondral graft, Lefort I osteotomy and bilateral intraoral sagittal split ramus osteotomy. Patient, 23 years old female, had visited to treat the esthetic problem due to a deviation of jaw. On the basis of clinical and radiographic examinations, she was diagnosed as hemifacial microsomia. First, costochondral graft was performed to bridge the defect between glenoid fossa and body of mandible. After 11 months,. Patient was performed a Lefort I osteotomy and bilateral intraoral sagittal split ramus osteotomy to create a symmetric jaw. Patient was satiesfied with final esthetics and there have been no evidence of infection ill now.
Esthetics ; Female ; Goldenhar Syndrome* ; Humans ; Jaw ; Mandible ; Osteotomy ; Osteotomy, Sagittal Split Ramus ; Transplants

PURPOSE: To evaluate the efficacy of OK-432 solution for sclerotheraphy of cystic lesions of the head and neck. MATERIALS AND METHODS: Nineteen cystic lesions comprising ten plunging ranulas, three simple ranulas, three cystic lymphangiomas, one first branchial cleft cyst and two unknown supraclavicular cysts considered to be lymphangiomas were treated by sucking out as much liquid content as possible and then injecting the same volume of OK-432 solution under ultrasound guidance. Patients were followed up clinically and radiologically. RESULTS: Follow-up sonography or CT performed after a mean interval of nine months showed total or near-total shrinkage of four plunging ranulas. However, six such lesions recurred in spite of more than one (mean, two) sclerotherapy sessions. In cases involving two simple ranulas at the floor of the mouth, failure resulted from extracystic leakage of OK-432 solution via the puncture site. Two unilocular cystic lymphangiomas completely regressed during the follow-up period (mean, seven months), but the multilocular type showed a 65% volume reduction after 12 months. A first branchial cleft cyst was markedly reduced in size, with only a small cystic portion remaining after eight months, follow-up. Two supraclavicular cysts with straw-color fluid did not respond to sclerotherapy. CONCLUSION: OK-432 sclerotherapy of macrocystic lymphangiomas is an effective and promising alternative to surgery. For other cysts, however, including plunging ranula, efficacy varied, and 64% of such lesions recurred.
Branchioma ; Follow-Up Studies ; Head* ; Humans ; Lymphangioma ; Lymphangioma, Cystic ; Mouth ; Neck* ; Picibanil* ; Punctures ; Ranula ; Sclerotherapy* ; Ultrasonography