Alternating hemiplegia of childhood(AHC) is a rare but clinically distinct syndrome characterized by onset before 18 months of age, frequent attacks of alternating paralysis, nystagmus transient ocular palsies, other autonomic dysfunction, and the development of cognitive impairment and a choreoathetotic movement disorder. The case is a 13 month-old boy who has presented repeated episodes of alternating hemiplegia from the age of 6 months at a frequency of several times per month, which was lasting for two or three days. Ths diagnosis was based on clinical features. Frequently such hemiplegic attacks were accompanied by irratability. He had mental retardation, neurodevelopmental delay, and seizure attacks. EEG, brain MRI, brain MR angiography, and Tc-99m HMPAO-brain single photon emission computed tomography(SPECT) failed to reveal any significant abnormal finding during the hemiplegic attacks. We tried calcium-entry block and flunarizine to relieve the hemiplegic attacks, but the frequency and severity of the hemiplegic attacks were not decreased by flunarizine therapy.
Angiography ; Brain ; Diagnosis ; Electroencephalography ; Flunarizine ; Hemiplegia* ; Humans ; Infant ; Intellectual Disability ; Magnetic Resonance Imaging ; Male ; Movement Disorders ; Paralysis ; Seizures

PURPOSE: This study was intended to evaluate the positional relationship between the hyoid bone and the mandible in patients with mandibular protrusion after mandibular set-back surgery by means of 3D-CT. MATERIALS AND METHODS: Preoperative(3 weeks before) and postoperative (6 weeks after) 3D-CT and cephalogram were taken on 32 patients(12 male, 20 female, mean age of 23.2) treated by bilateral sagittal split osteotomy with rigid fixation. The angular measurement on 3D-CT basilar view were deviation of Me and H, long axis angle of left and right cornu majus. The lineal measurement on 3D-CT basilar view were composed of intercondylar line and coordinates(x,y) of Me and H. The angular and lineal measurement of lateral cephalogram were composed of mandibular plane angle, SNA, SNB, ANB, FH-NA and FH-NB, and coordinates(x,y) of B, Pog, Me and H, PAS, Lpw, MPH and IAS. On the frontal cephalogram, deviation of Me were evaluated. RESULTS: The mean mandibular set-back was 8.0mm horizontally and mandibular plane angle was slightly increased. The hyoid bone was displaced postero-inferiorly, the distance between MP(mandibular plane) and H(hyoid bone) was increased and the posterior airway space values (PAS, Lpw, IAS) were decreased. The coordinates Me(x,y), H(x,y) and deviation angle Me' and H'were revealed the strong positive correlation. CONCLUSION: The results revealed that the horizontal, vertical and transverse relationship of the mandibular and the hyoid bone movements were significantly correlated in patients performed mandibular set-back surgery.
Axis, Cervical Vertebra ; Female ; Humans ; Hyoid Bone* ; Male ; Mandible* ; Orthognathic Surgery* ; Osteotomy

A 43-year-old woman presented with numerous cutaneous neurofibromas, limited to the left anterior chest(T2-3) and the right lower back(L1-2). These had been present for 10 years. Neither cafe-au-lait spot, intertriginous freckle, nor Lisch nodule was found. The family history was negative for neurofibromatosis. Biopsy specimens showed circumscribed, nonencapsulated neurofibromas. The present case was a rare form of bilateral segmental neurofibromatosis in that while most of the reported cases involved the same dermatome bilaterally, she had bilaterally different dermatomal neurofibromas.
Adult ; Biopsy ; Cafe-au-Lait Spots ; Female ; Humans ; Melanosis ; Neurofibroma ; Neurofibromatoses*

Juvenile xanthogranuloma is a congenital or perinatal tumor, 1 to 2 cm in diameter, usually located on the head. The extracutaneous lesions can occur on the eye, the lung, the epicardium, the oral cavity or the testicles. Subcutaneous form of juvenile xanthogranuloma has been reported very rarely in the literature. We report a unique case of a subcutaneous juvenile xanthogranuloma that showed 4 × 4 cm sized plaque and located on the extremity of 9-year-old girl.
Child ; Extremities ; Female ; Head ; Humans ; Lung ; Mouth ; Pericardium ; Testis ; Xanthogranuloma, Juvenile*

Annular atrophic lichen planus(AALP) is the most unusual variant of lichen planus that results from elastolytic activity of inflammatory cells. We report a case of AALP in 22-year-old man who had two annular pruritic plaques on the axilla. He had a two year history of skin lesions. Each lesion had elevated erythematous annular border with hyperpigmented atrophic macular center. Histopathologically, it showed typical features of lichen planus in the border of the lesion while a pattern of resolved lichen planus in its center. Elastic fibers was not found in the papillary dermis either at the border or at the center of the lesion.
Axilla ; Dermis ; Elastic Tissue ; Humans ; Lichen Planus* ; Lichens* ; Skin ; Young Adult

No abstract available.
Nipples*

The management of fractures of the intercondylar eminence of the tibia is uncomplicated when the fracture has minimal displacement(type I) or when only anterior one-third or half of the eminence is elevated(type II)(Meyers and Mckeever 1959, 1970). The treatment of complete separation(type III) has been controversial. Many authors however recommended conservative treatment even for the completely separated fracture if the fracture fragment is not rotated. Two cases of non-union of the tibial spine fracture we experienced were; one in type IIl, and the other type II. They were treated conservatively by cast immobilization. One patient had severe anterolateral rotatory.instability and had lateral meniscal tear, and the other had transverse ligament impingement at the fracture gap which interfered the reduction of the fragment and also bony union. Through the clinical experience and the two listed non-union cases, we drafted a therapeutic plan for the avulsed tibial spine fractures. The authors recommend open reduction and internal fixation of the avulsion fracture of the tibial spine in following circumstance; 1) all of the type K complete separation injuries 2) tibial spine fracture with positive Lachman test and soft end point 3) fracture with associated ligament injury. We applied the above surgical indications for 13 cases. The authors reviewed 25 cases of the anterior tibial spine fracture patients treated at the Department of Orthopaedic Surgery, Catholic Unviersity Medical College during the period from October 1982 to August 1986 and the following results were obtained. 1. The cases were classified into 3 different categories according to the Meyers and Mckeever classification; Type I(7 cases, 29%), Type II(10 cases, 40%), Type III(8 cases, 31%). 2. Associated ligament injuries on the same knee were rupture of LCL for 7 cases(28%) and MCL for 6 cases(24%). 3. Twelve out of thirteen open reduction and internal fixation cases had excellentresult in minimum 6 months follow-up period.
Classification ; Follow-Up Studies ; Humans ; Immobilization ; Knee ; Ligaments ; Rupture ; Spine ; Tears ; Tibia

Total 7,446 pedicle measurements were made from T1 to L6. Direct dimensional measurements were obtained from dried adult human spinal columns. Parsmeters considered were the pedicle isthmus diameter in the coronal and sagittal planes, pedicle angles in the transverse and sagittal planes, and the depth to the anterior cortex in a line parallel to the midline of the vertetral body and along the pedicle axis. The results were as follows. 1. The widest pedicle transverse diameters were seen at L6, the narrowest at T4. 2. The widest pedicle superoinferior diameters were seen at T12, the narrowes at T1. 3. In the transverse plane, the posterolateral to anteromedial pedicle axis orientations were seen at all levels except at T12 and T12. 4. In the sagittal plane, the pedicles angled caudally at L5 and cephaladly from L3 to T1. 5. In the thoracolumbar junction, the percentage less than 6mm in the transverse diameters of pedicles is most high at L1(27%) and followed by at the level L2, T11 and T12. 6. The use of 6mm transpedicular screws can be expected to violate the cortex of the pedicles in a significant number in the upper lumbar spine. 7. The 5mm transpedicular screws can be used safely below the T11 level. 8. It is advisable to use roentgen image intensifier during insertion of the transpedicular screws.
Adult ; Humans ; Lumbar Vertebrae ; Spine

PURPOSE: To evaluate the usefulness of the helical CT in the differentiation of periampullary malignanttumors. MATERIALS AND METHODS: Fifty-five periampullary carcinoma patients (pancreatic head carcinoma (n=18);distal CBD carcinoma (n=17) ; carcinoma of the ampulla of Vater(n=16) ; periampullary duodenal cancers,(n=4), alldiagnosed by histopathologic study] underwent helical CT with 5mm scan thickness and 5mm/sec table speed. Afterscanning, retrospective reconstruction was performed at 2mm intervals, followed by multiplanar reformation. Inboth retrospective reconstructed axial and multiplanar reformation images, the authors analyzed the detection rateand size of the mass, and associated findings including invasion of peripancreatic fat, dilatation of CBD and itsnarrowing pattern, dilatation of the pancreatic duct and its degree of dilatation, wall thickening of CBD,extension of dilated bile duct into the ampulla, and of protruding mass into the duodenal lumen, and lymph nodemetastasis all according to the origin sites of tumors. Differential points were thus determined. RESULTS: Thedetection rate of the masses was 96% (53/55). Their size was 1-5cm, with a mean size of 2.4 +/-0.5cm in carcinomaof of ampulla of Vater and 3.5 +/-1.0cm in pancreatic head carcinoma. Invasion of peripancreatic fat was mostcommonly observed in pancreatic head carcinoma (100%, 18/18) (P >0 . 0 5 ), dilatation of CBD was observed in allcases except one of periampullary duodenal cancer (98%, 54/55), and abrupt termination of dilated bile duct wasnoted in all cases except one of the pancreatic head carcinoma (98%, 53/54). Dilatation of pancreatic duct wascommonly observed in pancreatic head carcinoma (94%, 17/18) and carcinoma of the ampulla of Vater (75%, 12/16).Its degree of dilatation was mostly moderate in pancreatic head carcinoma (56%, 10/18) and mostly mild incarcinoma of the ampulla of Vater (63%, 10/16) ( P >0.05). Wall thickening of the distal CBD was most commonlyobserved in distal CBD carcinoma (76%, 13/17). Extension of dilated bile duct into the ampulla was commonlyobserved in the carcinoma of the ampulla of Vater (81%, 13/16) and periampullary duodenal cancer (75%, 3/4) (P>0.05). A mass protruding into the duodenal lumen was commonly observed in periampullary duodenal cancer (100%,4/4) and carcinoma of the ampulla of Vater (94%, 15/16) (P >0.05). Lymph node meatastasis was observed inpancreatic head carcinoma (17%, 3/18) and distal CBD carcinoma (6%, 1/17). CONCLUSION: Because of improvement inthe rate at which the mass is detected, and a clear demonstration of associated findings, helical CT is useful inthe differentiation of periampullary carcinomas.
Ampulla of Vater ; Bile Ducts ; Diagnosis* ; Dilatation ; Duodenal Neoplasms ; Head ; Humans ; Lymph Nodes ; Pancreatic Ducts ; Retrospective Studies ; Tomography, Spiral Computed*

OBJECTIVE: Detection of focal non-hemorrhagic lesion (NHL) has become more efficient in diffuse axonal injury (DAI) patients using an MRI. The aims of this study are to find out the radiological distribution, progress of NHL and its clinical significance. METHODS: Between September 2005 and October 2011, 32 individuals with NHLs on brain MRI were enrolled. NHLs were classified by brain location into 4 major districts and 13 detailed locations including cortical and subcortical, corpus callosum, deep nuclei and adjacent area, and brainstem. The severity of NHL was scored from grades 1 to 4, according to the number of districts involved. Fourteen patients with NHL were available for MRI follow-up and an investigation of the changes was conducted. RESULTS: Thirty-two patients had 59 NHLs. The most common district of NHL was cortical and subcortical area; 15 patients had 20 NHSs. However the most common specific location was the splenium of the corpus callosum; 14 patients had 14 lesions. The more lesions patients had, the lower the GCS, however, this was not a statistically meaningful difference. On follow-up MRI in 14 patients, out of 24 lesions, 13 NHLs resolved, 5 showed cystic change, and 6 showed atrophic changes. CONCLUSION: NHLs were located most commonly in the splenium and occur frequently in the thalamus and the mesial temporal lobe. Because most NHS occur concomitantly with hemorrhagic lesions, it was difficult to determine their effects on prognosis. Since most NHLs resolve completely, they are probably less significant to prognosis than hemorrhagic lesions.
Brain ; Brain Injuries ; Brain Stem ; Corpus Callosum ; Diffuse Axonal Injury ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Temporal Lobe ; Thalamus