Objective: Cerebral white matter changes (WMCs) and silent brain infarcts (SBIs) are common radiological findings in neurologically asymptomatic elderly people. Their presence is associated with an increased risk of stroke or dementia. Homocysteine (Hcy) can cause atherosclerosis and may thus act as a useful marker of stroke prior to symptom onset. This study aimed to evaluate the utility of Hcy as a surrogate marker for early intervention for stroke in community-dwelling healthy elderly persons with cerebrovascular lesions such as WMCs and SBIs. Methods: We assessed the relationship between the Hcy level and presence of WMCs/SBIs on brain computed tomography (CT) in 554 elderly individuals aged ≥65 years with no history of stroke or dementia. Results: The mean age of the participants was 74.43±7.32 years. Of the 554 patients, 106 (19.1%) had WMCs and/or SBI findings on brain CT. The mean Hcy level was higher in participants with WMCs/SBIs (P=0.001). The WMCs/SBIs group had a significantly greater number of participants with high Hcy levels than the non-WMCs/SBIs group (P<0.001). High Hcy levels (≥12.3 μmol/L) was significantly associated with WMCs and SBIs even after adjusting for age, Korean Mini Mental Status Examination score, education level, and vascular risk factors such as hypertension, diabetes, hyperlipidemia and smoking status. Conclusion: The result of our study suggests that regular monitoring of homocysteine level as a modifiable risk factor may be helpful for predicting the association of cerebrovascular lesions such as WMCs and SBIs for the prevention of future ischemic stroke and cognitive impairment.

Twenty cases of hepatocelluar carcinoma were examined by selective celiac and superior mesentericarteriography. Obstruction of the main portal vein due to tumor thrombus was revealed in 7 cases and 3 of thesecases had carvenous transformation of the protal vein(CTPV). The authors intended in this study to evaluate CTPVgroup and non-CTPV group clinically and radiologically. The results obtained are as follows; 1. The duration ofillness was shorter in CTPV group than non-CTPV group. 2. There was no significant difference in tumor sizebetween two groups, and main portion of tumor was located in the right lobe in both groups. 3. Arterioportal shuntwas present in 2 of 4 cases in non-CTPV group, but was no present at all in CTPV group. 4. Hepatofugal collateralsof portal vein were developed in all but one in both groups. 5. There was no significant difference in bloodchemistry between two groups. 6. CTPV may play an important role maintain the hepatic blood flow.
Carcinoma, Hepatocellular ; Portal Vein ; Thrombosis

High output heart failure due to congenital arteriovenous fistula is a rare disease and is difficult to treat. A 27 year old man, suffering from dyspnea, palpitation, lower extremity edema, and abdominal distension admitted May, 1987. At admission there were continuous thrill and bruit at left supraclavicular and infraclavicular area. The heart sound was irregular and rapid, and grade IV/VI pansystolic murmur was audible at the apex. Chest PA showed marked cardiomegaly with pleural effusion and notching at superior aspect of left 2nd rib. Selective left subclavian artery angiogram showed extensive congenital arteriovenous fistula at the area of left subclavian artery and its branches. After setrial feeding artery embolization and palliative operation, the fistula size decreased much with clinical improvement.
Adult ; Arteries ; Arteriovenous Fistula* ; Cardiomegaly ; Dyspnea ; Edema ; Fistula ; Heart Failure ; Heart Sounds ; Humans ; Lower Extremity ; Pleural Effusion ; Rare Diseases ; Ribs* ; Subclavian Artery* ; Thorax

Xanthoma is a relatively rare soft tissue lesion on the Achilles tendon and is usually associated with hyperlipidemia (lipid metabolism abnormality), mental retardation, cataract and atherosclerotic disease. We report on a case of normolipidemic bilateral Achilles tendon xanthoma without any notable cause. We herein describe the case where we achieved a satisfactory result by subtotal resection.
Achilles Tendon* ; Cataract ; Humans ; Hyperlipidemias ; Intellectual Disability ; Metabolism ; Xanthomatosis*

[Background] Over the last thirty years, majority of researches on clinical effectiveness of acupuncture have been explanatory (or experimental) randomized controlled trial. The benefits of acupuncture in clinical trials are stillcontroversial and most studies concluded that further control studies were required. Standardized combinations of acupuncture points for all the experimental subjects in various past studies have been criticized because such treatments do not reflect current routine clinical treatment.
[Objective] This paper aims to review pragmatic clinical trials on the effect of acupuncture treatment and to develop the ideal clinical research methodology of acupuncture study.
[Method] Clinical studies of acupuncture relevant with pragmatic or individualized trials were searched mainly in Pubmed and Science direct databases. All articles were fully reviewed by researchers, and data were evaluated by usage of a standardized form.
[Results & Suggestion] Pragmatic acupuncture researches were tried for various symptoms (eg. low back pain, hypertension, depression during pregnancy, sleep quality in HIV disease, chronic poststroke leg spasticity, headache, etc). Individualized acupuncture treatments based on oriental disease pattern diagnosis reflexes practical treatments which is more effective than unified and fixed acupuncture treatments without any theoretical basis of oriental medical philosophy.
[Conclusion] To overcome the controversies and limitations of past explanatory acupuncture trials, more individualized and tailored acupuncture trials with the theoretical basis of oriental medical diagnosis is highly recommended. Also clear definition and categorization of pattern identification should be established for further active clinical researches and applications of acupuncture.

Popliteal artery compression rarely occurs after posterior cruciate ligament (PCL) reconstruction using the tibial inlay technique that allows for direct visualization of the surgical field. However, we experienced a popliteal artery compression after PCL reconstruction performed using the technique, which eventually required re-operation. Here, we report this rare case and discuss reasons of popliteal artery compression.
Inlays ; Popliteal Artery ; Posterior Cruciate Ligament

Total knee arthroplasty is a surgical treatment for end-stage osteoarthritis of the knee. Postoperative lower limb alignment is one of the factors determining the long-term prognosis after total knee arthroplasty. Navigation-assisted surgery can be used to achieve an accurate lower limb alignment. Particular situations, such as severe extra-articular deformity in the femur or tibia and retained hardware, are a good indication for navigation-assisted surgery. On the other hand, thorough preoperative planning and an understanding of each steps of surgery are necessary to perform total knee arthroplasty successfully in these special cases. In this review article, preoperative radiological measurements and surgical planning for extra-articular deformity correction will be elucidated. The surgical steps and necessary instruments for navigation-assisted total knee arthroplasty will be described in cases of extra-articular deformity or retained hardware. A literature review showed that the radiological and clinical results after total knee arthroplasty using navigation in osteoarthritis with extraarticular deformity were good. Therefore, it is essential to use navigation when performing total knee arthroplasty in patients with extraarticular deformity or retained hardware.

To evaluate the efficacy of anthelmintic treatment of Enterobius vermicularis in highly endemic population, total 82 children in two orphanage institutes were divided into 4 groups and treated with placebo, 5 mg/kg of pyrvinium pamoate, 100 mg of mebendazole and 10 mg/kg of pyrantel pamoate respectively. Total 4 anal swabs were taken from each child before treatment and the even distributions of positive rate and consecutive results between groups were considered. Follow-up swabs were taken 8 times up to the 40th day after treatment. After remarkable and significant reduction of positive rates up to 19-27th day after treatment in respective groups, the remarkable egg positive conversions were observed 3-4 weeks after treatment. The positive conversion was the earliest and the most remarkable in pyrantel-treated children and the slowest and the least remarkable in mebendazole-treated cases. Also found was that the figures of negative conversion were different with statistical significance between two categories of cases, consecutively positive and alternately positive cases of pre-treatment swabs. This means that the conventional indices of cure rate in E. vermicularis infection may be variable by the selection of subjected cases. Above results mean that the spectrum of susceptible pinworms according to the developmental stages are different between currently available drugs, and the ability to remove pinworms completely in certain developmental stage are also different between chemotherapeutics. These results suggest the need of interval chemotherapy of Enterobius vermicularis infection in heavily infected cases of in highly endemic population to achieve the complete eradication of whole range of pinworms in intestine.
parasitology-helminth-nematoda ; Enterobius vermicularis ; chemotherapy- mebendazole ; pyrantel pamoate ; enterobiasis

PURPOSE: The ictal perfusion patterns of cerebellum and basal ganglia have not been systematically investigated in patients with temporal lobe epilepsy (TLE). Their ictal perfusion patterns were analyzed in relation with temporal lobe and frontal lobe hyperperfusion during TLE seizures using SPECT subtraction. MATERIALS AND METHODS: Thirty-three TLE patients had interictal and ictal SPECT, video-EEG monitoring, SPGR MRI, and SPECT subtraction with MRI co-registration. RESULTS: The vermian cerebellar hyperperfusion (CH) was observed in 26 patients (78.8%) and hemispheric CH in 25 (75.8%). Compared to the side of epileptogenic temporal lobe, there were seven ipsilateral hemispheric CH (28.0%), fifteen contralateral hemispheric CH (60.0%) and three bilateral hemispheric CH (12.0%). CH was more frequently observed in patients with additional frontal hyperperfusion (14/15, 93.3%) than in patients without frontal hyperperfusion (11/18, 61.1%). The basal ganglia hyperperfusion (BGH) was seen in 11 of the 15 patients with frontotemporal hyperperfusion (73.3%) and 11 of the 18 with temporal hyperperfusion only (61.1%). In 17 patients with unilateral BGH, contralateral CH to the BGH was observed in 14 (82.5%) and ipsilateral CH to BGH in 2 (11.8%) and bilateral CH in 1 (5.9%). CONCLUSION: The cerebellar hyperperfusion and basal ganglia hyperperfusion during seizures of TLE can be contralateral, ipsilateral or bilateral to the seizure focus. The presence of additional frontal or basal ganglia hyperperfusion was more frequently associated with contralateral hemispheric CH to their sides. However, temporal lobe hyperperfusion appears to be related with both ipsilateral and contralateral hemispheric CH.
Basal Ganglia* ; Cerebellum* ; Epilepsy, Temporal Lobe* ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging ; Perfusion ; Seizures ; Temporal Lobe* ; Tomography, Emission-Computed, Single-Photon

Intraoperative fracture in total knee arthroplasty (TKA) is a rare complication. However, when it happens, additional surgery to fix the fracture site is needed. Therefore, it is important to diagnose intraoperative fractures in TKA exactly. The authors experienced two cases of cortical perforation of medial femoral condyle misidentified as the fracture in TKA. Cortical perforation could be misdiagnosed as the fracture, which could lead to unnecessary surgery. This is the first report about cortical perforation in TKA. We report two cases of intraoperative cortical perforations and describe the radiological characteristics.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Femur ; Knee ; Unnecessary Procedures