Isolated aneurysm of the common iliac artery that is secondary to medial degeneration (MD) is a very rare clinical entity. MD is an important histological abnormality that is commonly seen in the annuloaortic ectasia with Marfan syndrome. This abnormality is also observed in congenital aortic disease, atherosclerosis, and aging. This aortic disease develops as the consequences of disruption of the medial elastic layers in association with loss of vascular smooth muscle cells and the accumulation of proteoglycans. An iliac aneurysm greater than 3 cm in diameter should be treated. The treatment options include open surgical replacement with prosthetic graft or endovascular stent grafting. We experienced one case of the isolated common iliac artery aneurysm in a 60 year-old female patient. Her chief complaint was a pulsatile painful mass in the left lower quadrant of the abdomen that she had suffered with for 5 days. She was treated by performing aorto-left external iliac artery bypass with a Dacron graft (10 mm in diameter). The result was excellent. We report here on a case of a isolated common iliac artery aneurysm that was caused by MD, and we include a review of the relevant literature.
Abdomen ; Aging ; Aneurysm* ; Aortic Diseases ; Atherosclerosis ; Blood Vessel Prosthesis ; Dilatation, Pathologic ; Female ; Humans ; Iliac Aneurysm ; Iliac Artery* ; Marfan Syndrome ; Middle Aged ; Muscle, Smooth, Vascular ; Polyethylene Terephthalates ; Proteoglycans ; Transplants

PURPOSE: To demonstrate a CT technique by which carcinoma of the ampulla of Vater can be more accurately diagnosed, and to describe the radiologic findings this carcinoma. MATERIALS AND METHODS: We retrospectively reviewed CT findings in 26 patients with pathologically proven carcinoma of the ampulla of Vater. One additional cup of diluted oral contrast medium was ingested immediately before the scan. We analysed the difference in detection rate of the mass in the duodenal lumen with and without duodenal luminal opacification of gastrografin.We also evaluated the size and shape of the mass, dilatation of CBD and the pancreatic duct, and lymph node metastasis. In addition, we analyzed multimodality imaging findings ultrasonogram (US) : 13; hypotonic duodenogram (HTDG): 7; ERCP : 17) of carcinoma of the ampulla of Vater. RESULTS: Nodular soft tissue masses protruding into the duodenal lumen were identified in 21 of 26 cases. In 95% of cases (21/22) with favorable opacification and distension of the duodenum, masses were clearly identified on CT imaging. However, in four caseswith poor opacification and distension of the duodenum, masses could not be observed(P=0.000). The mass on CT scanshowed a well-defined margin, round or lobulated contour, and contrast enhancement similar to that of thepancreas. CBD dilatation was identified in 20 cases and pancreatic duct dilatation in 12. On US, protruding massesin the distal CBD were observed in nine of 13 cases(60%) and on HTDG, in six of seven cases(86%). as well-definedfilling defects. Conclusion : Since the accuracy of CT diagnosis of intestinal lesions is directly proportional tothe degree of intestinal distension and opacification with oral contrast, we believe that adequate ct techniquefor distending and opacitying the duodeual lumen are necessary for early diagnosis of carcinoma of the ampulla ofVater.
Ampulla of Vater* ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Dilatation ; Duodenum ; Early Diagnosis ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Pancreatic Ducts ; Phenobarbital ; Retrospective Studies ; Ultrasonography

PURPOSE: The purpose of this study was to determine whether it is possible to differentiate benign from malignant thyroid nodules according to the proportion of sponge-like appearance within the nodules. METHODS: A total of 201 thyroid nodules containing sponge-like appearance from 195 patients (157 women and 38 men) were included this study. Each thyroid nodule was classified into one of three grades by real-time ultrasonography (US) based on the areas with a sponge-like appearance within nodule: grade I had sponge-like areas occupying <50%; grade II, between 50% and 75%; and grade III, >75%. We evaluated whether a correlation existed between these grades and cytopathologic diagnoses. RESULTS: Of the 201 nodules, 196 were benign and five were malignant, and according to the US classification, 101 nodules were grade I, 45 were grade II, and 55 were grade III. Of the five malignant nodules, four were grade I, and one was grade II. No statistically significant difference was found in the rate of malignancy between grade III and grades I and II, due to insufficient statistical power. A sponge-like appearance was correlated with follicles filled with colloid and cholesterol granules in benign nodules and with papillary fronds around the dilated cystic spaces in malignant nodules. CONCLUSION: No malignancies were found in thyroid nodules with >75% sponge-like appearance. Due to the overall low incidence of malignancy and the limited number of patients, a statistically significant difference could not be found in the prevalence of malignancy depending on the proportion of sponge-like areas within the nodule.
Cholesterol ; Classification ; Colloids ; Diagnosis ; Diagnosis, Differential ; Female ; Humans ; Incidence ; Prevalence ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography*

Children with abnormal sex development may present with ambiguous genitalia in the newborn period or lacking of secondary sexual characteristics in puberty. Clinicians should make a prompt and accurate diagnosis and counsel parents on therapeutic options to minimize or avoid medical and psychological complications. 5alpha-reductase deficiency is a rare autosomal recessive disorder of sex development caused by a mutation of the 5alpha-reductase type 2 gene. As a result, there is an abnormality in conversion of testosterone (T) to dihydrotestosterone (DHT) and children with 5alpha-reductase deficiency are born with ambiguous genitalia. Here, we report identical twins who presented with ambiguous genitalia with a 46,XY karyotype and were diagnosed as 5alpha-reductase deficiency.
Child ; Dihydrotestosterone ; Disorders of Sex Development ; Humans ; Infant, Newborn ; Karyotype ; Parents ; Puberty ; Sexual Development ; Testosterone ; Twins, Monozygotic

PURPOSE: To report a case of Charles Bonnet syndrome in a patient who developed phantom vision of an enucleated eye. The patient had lost her vision because of a chemical burn 10 years previously. CASE SUMMARY: A 37-year-old woman received enucleation of one eye because ocular pain and phthisis had developed due to a chemical burn that occurred 10 years previously. On the first postoperative day, she complained of phantom vision in the enucleated eye. The image she described was like sparkling bubbles. She had recognized the image was not real, and no psychological problems were found during pre- and postoperative periods. Her wound state was good, so she is currently wearing an artificial eye, though her phantom vision intermittently returns. She has adapted to her phantom vision such that she now rarely feels discomfort. RESULTS: Charles Bonnet syndrome is a visual hallucination that occurs among the blind or those who are visually impaired. Besides ophthalmologic care, sociological and psychological care should be considered.
Adult ; Burns, Chemical ; Eye ; Eye, Artificial ; Female ; Hallucinations ; Humans ; Postoperative Period ; Vision, Ocular

PURPOSE: Recently, legal disputes resulting from medical accidents have been increasing annually. The purpose of this study is to determine the causes and characteristics of medical disputes brought as a result of neonatal accidents and to suggest measures to reduce the number of medical malpractice suits. METHODS: Twenty-eight medical malpractice lawsuits brought as a result of neonatal accidents between 2005 and 2009 were analyzed. RESULTS: The average time taken to resolve these lawsuits was approximately 4.4 years. The average gestational age and birth weight of the newborns in these cases were 35.3+/-4.2 weeks and 2,668+/-931 g, respectively. Twelve cases (42.9%) were concluded partially in favor of the plaintiffs, while in 10 (35.7%) cases the plaintiffs lost. In 11 of the 12 cases that were concluded partially in favor of the plaintiffs, the defendants were found guilty of violating their duty of care. Medical accidents resulted in death in 10 cases and physical disability in 18 cases, and cerebral palsy and blindness were the most common physical disabilities. The average compensation amount ordered as damages was KRW 161,389,291+/-12,636,454. CONCLUSION: In medical litigation, the standard of judgment is whether appropriate medical practices were performed based on the patient's symptoms. Thus, to comply with the medical treatment rules is paramount in securing patients' safety and protecting doctors themselves. Individual effort is necessary, but not sufficient to prevent medical accidents; multilateral, systemic reform is also required if the number of neonatal medical accidents is to be reduced.
Birth Weight ; Blindness ; Cerebral Palsy ; Compensation and Redress ; Dissent and Disputes ; Gestational Age ; Humans ; Infant, Newborn* ; Judgment ; Jurisprudence* ; Malpractice ; Patient Safety

BACKGROUND: It has been known that a patient head in sniffing position for lightwand facilitated tracheal intubation is not an anatomically appropriate method. However, there is no evidence nor study whether it is true or not. In this study, we compared success rates of lightwand facilitated tracheal intubation in neutral position versus sniffing position. METHODS: With informed consent, sixty adult patients of ASA physical status I or II were randomly allocated into two groups: neutral position (N) or sniffing position (S) group. A lightwand and tube were bent at approximately a 90degrees degree angle for N group and a 60 degree angle for S group on the basis of mouth axis and pharyngeal axis. The time to intubation, success rates of 1st trial of intubation, overall intubation success rates, hemodynamic changes and complications during the procedure were recorded. RESULTS: There was no significant difference in the time to intubation, success rates of 1st trial of intubation, overall intubation success rates, hemodynamic changes and complications between neutral position and sniffing position groups. CONCLUSIONS: Success rates of lightwand facilitated tracheal intubation in neutral position versus sniffing position showed no significant difference. Therefore, both positions are suitable for lightwand assisted intubation.
Adult ; Axis, Cervical Vertebra ; Head* ; Hemodynamics ; Humans ; Informed Consent ; Intubation* ; Mouth