Purpose: This study assessed the effects of bilateral inferior oblique myectomy for hypertropia on the preoperative vertical deviation angle in patients with asymmetric primary inferior oblique overaction (IOOA). Methods: This study included patients who underwent bilateral inferior oblique myectomy and lateral rectus recession due to asymmetric primary IOOA and intermittent exotropia, and were followed up for at least 6 months postoperatively. Pre- and post-operative vertical deviation angles were compared. The correlation between the extent of correction of vertical deviation after surgery and residual hypertropia, according to the preoperative degree of vertical deviation and difference between bilateral IOOA, was evaluated. Results: This study included 178 eyes from 89 patients. The angle of hypertropia in the primary position was reduced from 3.2 ± 2.2 prism diopters (PD) preoperatively to 0.5 ± 2.5 PD postoperatively (Wilcoxon signed-rank test, p < 0.001). No significant correlation was observed between the preoperative interocular difference in IOOA and postoperative extent of correction of the vertical deviation (r = 0.044, p = 0.684), or between the preoperative difference in bilateral IOOA and residual hypertropia (Spearman's rank-order correlation, r = -0.084, p = 0.432). Increased preoperative hypertropia correlated with a greater extent of surgical correction of the vertical deviation (r = 0.733, p < 0.001). Preoperative hypertropia had no significant correlation with residual hypertropia (Spearman's rank-order correlation, r = 0.182, p = 0.087). Conclusions In symmetric bilateral inferior oblique myectomy with bilateral lateral rectus recession for asymmetric bilateral primary IOOA with V-type intermittent exotropia, a positive correlation between the degree of preoperative vertical deviation and extent of correction of the vertical deviation was observed. Additionally, IOOA and hypertropia were significantly improved postoperatively.

Purpose: We report a case of phakomatous choristoma presenting as an orbital tumor with involvement of the inferior oblique muscle. Case summary: A 2-month-old male infant presented to our clinic with a right orbital mass that had been present since birth. Magnetic resonance imaging demonstrated a homogenous enhanced well-defined mass located in the inferomedial portion of the right orbit without bone erosion. By transconjunctival orbitotomy, the orbital tumor invading the inferior oblique muscle was identified and resected. Histopathology showed a thick basement membrane surrounding pseudoglandular structures embedded in a collagenous stroma, psammomatous calcific foci in the stroma, and eosinophilic material in the lumen. Immunohistochemical analysis showed positive staining for S-100 and cytokeratin. On histopathological evaluation, the tumor was diagnosed as phakomatous choristoma. Conclusions To our knowledge, this is the first report in South Korea of phakomatous choristoma of the orbit with involvement of the inferior oblique muscle. Although rare, phakomatous choristoma should be included in the differential diagnosis of tumors occurring on the inferomedial side of the orbit.

No abstract available.
Adult* ; Humans ; Neck*

Purpose: We report a case of phakomatous choristoma presenting as an orbital tumor with involvement of the inferior oblique muscle. Case summary: A 2-month-old male infant presented to our clinic with a right orbital mass that had been present since birth. Magnetic resonance imaging demonstrated a homogenous enhanced well-defined mass located in the inferomedial portion of the right orbit without bone erosion. By transconjunctival orbitotomy, the orbital tumor invading the inferior oblique muscle was identified and resected. Histopathology showed a thick basement membrane surrounding pseudoglandular structures embedded in a collagenous stroma, psammomatous calcific foci in the stroma, and eosinophilic material in the lumen. Immunohistochemical analysis showed positive staining for S-100 and cytokeratin. On histopathological evaluation, the tumor was diagnosed as phakomatous choristoma. Conclusions To our knowledge, this is the first report in South Korea of phakomatous choristoma of the orbit with involvement of the inferior oblique muscle. Although rare, phakomatous choristoma should be included in the differential diagnosis of tumors occurring on the inferomedial side of the orbit.

Giant basal cell carcinoma (BCC), defined as a lesion greater than 5 cm at its largest diameter, is a rare variant of BCC. In contrast to small BCC, giant BCC develops on skin that is not exposed to sunlight, including the back, shoulder, groin and thigh. Most of the histopathologic subtypes of giant BCC are micronodular, morpheaform and nodular, but the superficial subtype is rare. Giant superficial BCC arising on the scalp is extremely rare. We report the case of giant superficial BCC with four satellite lesions on the scalp in a 53-year-old male without predisposing factors.
Carcinoma, Basal Cell ; Groin ; Humans ; Male ; Middle Aged ; Scalp ; Shoulder ; Skin ; Sunlight ; Thigh

Rare cases of a congenital absence of the long head of the biceps tendon (LHBT) have been reported, and its incidence is unknown. In a literature review of the congenital absence of the LHBT, only 1 case was associated with posterior shoulder instability and severe posterior glenoid dysplasia. This paper reports the first case of a patient with a bilateral congenital absence of the LHBT with posterior shoulder instability without glenoid dysplasia or posterior glenoid tilt. The patient experienced a traffic accident while holding the gear stick with his right hand. After the accident, a posteroinferior labral tear with paralabral cysts was detected on the magnetic resonance images. The congenital absence of the LHBT was assumed to have affected the posterior instability that possibly increased the susceptibility to a subsequent traumatic posterior inferior labral tear. This case was identified as a posterior inferior tear caused by a traumatic ‘gear stick injury’.
Accidents, Traffic ; Hand ; Head ; Humans ; Incidence ; Shoulder ; Tears ; Tendons

BACKGROUND AND PURPOSE: To analyze 18F-THK5351 positron emission tomography (PET) scans of patients with clinically diagnosed nonfluent/agrammatic variant primary progressive aphasia (navPPA). METHODS: Thirty-one participants, including those with Alzheimer's disease (AD, n=13), navPPA (n=3), and those with normal control (NC, n=15) who completed 3 Tesla magnetic resonance imaging, 18F-THK5351 PET scans, and detailed neuropsychological tests, were included. Voxel-based and region of interest (ROI)-based analyses were performed to evaluate retention of 18F-THK5351 in navPPA patients. RESULTS: In ROI-based analysis, patients with navPPA had higher levels of THK retention in the Broca's area, bilateral inferior frontal lobes, bilateral precentral gyri, and bilateral basal ganglia. Patients with navPPA showed higher levels of THK retention in bilateral frontal lobes (mainly left side) compared than NC in voxel-wise analysis. CONCLUSIONS: In our study, THK retention in navPPA patients was mainly distributed at the frontal region which was well correlated with functional-radiological distribution of navPPA. Our results suggest that tau PET imaging could be a supportive tool for diagnosis of navPPA in combination with a clinical history.
Alzheimer Disease ; Aphasia, Primary Progressive* ; Basal Ganglia ; Broca Area ; Diagnosis ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging ; Neurofibrillary Tangles ; Neuropsychological Tests ; Positron-Emission Tomography ; Primary Progressive Nonfluent Aphasia ; tau Proteins

PURPOSE: To evaluate the clinical outcome and other relevant factors in cases where local intra-aterial thrombolysis (LIT) is used for the threatment of hyperacute ischemic stroke. MATERIALS AND METHODS: Forty-eight hyperacute ischemic stroke patients were treated by LIT, using urokinase, within six hours of ictus, and for evaluation of their neurological status, the National Institutes of Health Stroke Scale (NIHSS) score was used. Angiographic recanalization was classified according to Mori recanalization grades. Three months after LIT, the outcome was assessed by clinical examination using the modified Rankin scale (good outcome: RS=0-3; poor outcome: RS=4-6). In all patients, the findings of pre- and post- LIT CT, and angiography, as well as neurological status and hemorrhagic complications, were also analysed. RESULTS: Thirty-three patients had occlusions of the middle cerebral artery (MCA), and 15, of the internal carotid artery (ICA). The NIHSS score averaged 16.9 at the onset of therapy and 13.5 at 24 hours later. Successful recanalization (Mori grade 3,4) was achieved in 28 (58.3%) of 48 patients, but in 20 (41.7%) the attempt failed. Twenty-two (45.8%) of the 48 patients had a good outcome, but in (54.2%) the outcome was poor. Thirteen (40.6%) of 32 patients with MCA occlusions and 13 (81.2%) of 16 with ICA occlusions had a poor outcome. Eight patients (16.7%) died. Overall, hemorrhages occured in 20 (41.7%) of 48 patients, with symptomatic hemorrhage in ten. Five (50%) of these ten died. CONCLUSION: LIT using urokinase for hyperacute ischemic stroke is feasible; patients with MCA occlusions had better outcomes than those with ICA occlusions. Hemorrhagic complications of LIT were frequent, and in cases of symptomatic hemorrhage a fatal outcome may be expected.
Angiography ; Carotid Artery, Internal ; Fatal Outcome ; Hemorrhage ; Humans ; Middle Cerebral Artery ; National Institutes of Health (U.S.) ; Stroke* ; Urokinase-Type Plasminogen Activator*

PURPOSE: To evaluate the efficacy of transvenous embolization in patients with dural arteriovenous fistula (DAVF). MATERIALS AND METHODS: From October 2002 to July 2004, eight patients with angiographically confirmed DAVF underwent transvenous embolization of the affected dural sinuses. Concomitant transarterial embolization was performed in four patients. Patients included five men and three women aged 45-78 years (mean age, 55.4 years). The patient's medical records and angiographic features were retrospectively reviewed. Patients had follow-up periods ranging from 5 to 24 months (mean, 16.5 months). RESULTS: The locations of DAVF were transverse - sigmoid sinus in six patients and cavernous sinus in two patients. According to Cognard's classification, four of the DAVFs were Type I, two were type IIa, and two were Type IIb. Embolic materials used for the transvenous embolization were platinum detachable coils and fibered microcoils. After the transvenous embolization, there was complete obliteration of the DAVF in seven patients and significant flow reduction in one patient. All cases were clinically successful. There were no transient or permanent complications as a result of the endovascular procedures in any of the patients. One patient who had symptom recurrence 2 months after the initial treatment was successfully treated with repeated transvenous embolization. The remaining seven patients had no symptom recurrence during the follow-up period. CONCLUSION: Transvenous embolization is an effective and safe method in the treatment of patients with DAVF.
Arteriovenous Fistula ; Cavernous Sinus ; Central Nervous System Vascular Malformations* ; Classification ; Colon, Sigmoid ; Endovascular Procedures ; Female ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Platinum ; Recurrence ; Retrospective Studies

PURPOSE: Parastomal hernia is a major complication of an intestinal stoma. This study was performed to compare the results of various operative methods to treat parastomal hernias. METHODS: Results of surgical treatment for parastomal hernias (postoperative recurrence, complications and postoperative hospital stays) were surveyed in 39 patients over an 11-year period. The patients enrolled in this study underwent surgery by a single surgeon to exclude surgeon bias. RESULTS: Seventeen patients were male, and twenty-two patients were female. The mean age was 65.9 years (range, 36 to 86 years). The stomas were 35 sigmoid-end-colostomies (90%), 2 loop-colostomies (5%), and 2 double-barrel-colostomies. Over half of the hernias developed within two years after initial formation. Stoma relocation was performed in 8 patients, suture repair in 14 patients and mesh repair in 17 patients. Seven patients had recurrence of the hernia, and ten patients suffered from complications. Postoperative complications and recurrence were more frequent in stoma relocation than in suture repair and mesh repair. Emergency operations were performed in four patients (10.3%) with higher incidence of complications but not with increased risk of recurrence. Excluding emergency operations, complications of relocations were not higher than those of mesh repairs. Postoperative hospital stays were shortest in mesh repair patients. CONCLUSION: In this study, mesh repair showed low recurrence and a low complication rate with shorter hospital stay than relocation methods, though these differences were not statistically significant. Further studies, including randomized trials, are necessary if more reliable data on the surgical treatment of parastomal hernias are to be obtained.
Emergencies ; Female ; Hernia ; Humans ; Incidence ; Length of Stay ; Male ; Postoperative Complications ; Recurrence ; Sutures