A case of znelanotic whitlow is presented which resembles clinically as chronic paronichia. Patient was 71 years old man and he has had a single brownish pigmented spot on left mid. finger since 3 years ago which was progressively grow and skin biopsy could be established the pathological diagnosis of superficial malignant melanoma.
Aged ; Biopsy ; Diagnosis ; Fingers ; Humans ; Melanoma ; Skin

With the recent introduction and development of the detachable balloon system, it has become the treatment of choice in the management of carotid cavernous fistulas(CCFs). But, since most delivery systems for embolization of CCF mainly depend on flow guidance for balloon delivery, in cases of small fistula, pseudoaneurysm and arterialized venous collaterals, failure of balloon embolization can occur. To overcome these limitations, the authors designed and used a new versatile, steerable, and flow-guided detachable balloon system by using a Tracker catheter system with silicone or latex balloons. Using this maneuver, we could get successful fistula occlusion in 7 out of 8 patients(silicone balloon). But in one case, we had to occlude the internal carotid artery at the fistula site, proximal and distal cervical portions of the internal carotid artery. This balloon delivery system proved to provide high selectivity for fistula and relatively ease of handing.
Aneurysm, False ; Balloon Occlusion ; Carotid Artery, Internal ; Catheters* ; Fistula* ; Hand ; Latex ; Silicon* ; Silicones*

The fractures of the cervical spine are relatively uncommon, but they may cause serious neurologic deficits temporarily or permanently. So, it is very important to treat the patients early by way of exact evaluation for the sites and the mechanisms of the injuries. The authors reviewed retrospectively 188 cervical spinal fractures in 100 patients from Sep. 1984 to Aug. 1990. Commonly involed levels were C5 and C6 in lower cervical level and C2 in upper cervical level and the sites in each spine were body; lamina and odontoid process. The hyperflexion injury was the most common type of the cervical spinal fractures occupying 53% of all cervical fractures and cause more multipe fractures(2.26 fractures/patient) than in hyperextension (1. 68 fractures/patient). In hyperflexion injuries, body, transverse and spinous process were commonly involved but lamina fracture was relatively common in hyperextension injury. The dislocations associated with fractures were developed most commonly in hyperflexion injury and 70% of these were anterior dislocation and the most commonly involved levels were C5-6 and C6-7. In conclusion, hyperflexion injury needs more close examination for the entire spinal levels than injuries of other mechanisms because it results in more severe fractures with or without dislocation and relatively frequent multiple fractures in different levels.
Dislocations ; Humans ; Incidence* ; Neurologic Manifestations ; Odontoid Process ; Retrospective Studies ; Spinal Fractures* ; Spine

Between August 1994 and June 1995, seventeen patients diagnosed as having partial or complete ruptures of the anterior cruciate ligament on MRI were managed by non-operative methods. Among them four patients were excluded due to operation during follow-up and the results were evaluated at a one year follow-up. We selected the patients prospectively for non-operative care using the selection criteria of age, degree of instability, activity level and patient compliance. The average age of them was 37.7 years. Initially knee stress test and MRI were checked, and Cybex study and Lysholm knee scoring were done at post-trauma one year follow-up. They were managed conservatively by ROM and muscle strengthening exercises and a brace fitting schedule for three months. Among them, six cases had partial tears and seven had a complete tear initially. At the one year follow-up, five of six cases who had shown partial ruptures, and two of seven cases with complete tears, recovered continuity of the ruptured ACL on MRI. Their Lysholm knee score was 84.4, and the Cybex test showed no difference in muscle power between the injured and uninjuried side. Those patients who had loss of continuity on follow-up MRI showed Lysholm score of 57.4 and decreased muscle power on Cybex study. Although there are still controversies about the adequate management of ACL injuries, our study suggests that conservative management is a viable alternative to surgery as long as the patients are selected prudently. For more concrete results, however, careful analysis based on a longer follow up period is necessary.
Anterior Cruciate Ligament* ; Appointments and Schedules ; Braces ; Exercise ; Exercise Test ; Follow-Up Studies ; Humans ; Knee ; Magnetic Resonance Imaging ; Patient Compliance ; Patient Selection ; Prospective Studies ; Rupture*

PURPOSE: The vertebral artery dissection is rare and increasingly recognized as a source of stroke. The purpose of this study is to describe causes, clinical manifestations, MRI and anglographic findings. MATERIALS AND METHODS: Conventional anglograms(n=7) and magnetic resonance imaging(n=6) were retrospectively analyzed in seven patients of vertebral artery dissection. The classification of the Krayenbuhl and Yasargil for vertebral artery segmentation was used for localization of vertebral artery dissection. Additionally, etiology and clinical manifestations were also retrospectively reviewed. RESULTS: Six cases were spontaneous type and one case was traumatic type. The clinical diagnoses of 6 spontaneous arterial dissection cases were wallenberg syndrome(4 cases), subarachnoid hemorrhage(1 case), and infarction of the cerebellum corresponding to PICA territory(1 case). A linear bright signal caused by thrombus was well visualized at the dissection area on sagittal T1 weighted spin echo MR images in all 6 cases. The characteristic anglographic findings were profound narrowing in 4 cases, pearl and string sign(including dissecting aneurysm) in 3 cases, complete obstruction in 3 cases, and a double density lumen(true and false lumen) extending to proximal basilar artery in one case. Spontaneous dissections were located at the V4 segment in all 6 cases. One traumatic dissection was located at the V2 segment. CONCLUSION: The most common site of the spontaneous dissection of the vertebral artery was V4 portion and a linear bright signal caused by thrombus was well visualized on sagittal T1 weighted spin echo MR images.
Basilar Artery ; Cerebellum ; Classification ; Diagnosis ; Humans ; Infarction ; Magnetic Resonance Imaging ; Pica ; Retrospective Studies ; Stroke ; Thrombosis ; Vertebral Artery Dissection* ; Vertebral Artery*

PURPOSE: To describe plain radiographic and thin-section CT findings of hematogenous candida pneumonia in major burn patients. MATERIAL AND METHOD: We reviewed nine cases of hematogenous candida pneumonia in major burn patients who had positive blood culture for candida and findings of pneumonia on plain chest radiograph. On five of nine cases, thin-section CT was done. We evaluated retrospectively nine cases for onset, the pattern, distribution, and size of lesions on plain chest radiograph and thin-section CT. RESULTS: On plain chest radiograph, randomly distributed 2-10mm nodules were seen in six cases(66%) and randomly distributed 10-15mm consolidations in remaining three cases{33% ). Lesion occured in 11th to 75th post-burn day{average, 34th post-burn day). Other findings were cardiomegaly in three cases, atelectasis in three cases, and pulmonary edema in one case. Thin-section CT showed variable shaped subpleural nodules in all five cases. The size of nodules were 1-5mm in two cases(40%) and 5-10mm(60% ) in three cases. Feeding vessel signs were seen in two cases. Other findings were atelectasis in three cases, cardiomegaly in three cases, ground-glass opacity and interlobular septal thickenings by pulmonary edema in two cases. CONCLUSION: Plain chest radiographic findings of hematogenous candida pneumonia in major burn patients are randomly distributed nodules or consolidations of variable size. Thin-section CT findings are variable shaped subpleural nodules less than 1 cm.
Burns* ; Candida* ; Cardiomegaly ; Humans ; Pneumonia* ; Pulmonary Atelectasis ; Pulmonary Edema ; Radiography, Thoracic* ; Retrospective Studies ; Thorax*

PURPOSE: To characterize the MR findings for a differential diagnosis and to make a plan for treatment by interventional technique of the vascular masses with/without hypertrophic feeding vessels of the head and neck. SUBJCETS AND METHODS: Seven patients with vascular masses of the head and neck proved by pathology, angiography, clinical findings were included. Vascular masses included 4 venous malformations, a capillary hemangioma, and a hemangiopericytoma, a hemangioma combined with arteriovenous malformation. 7 patients had MR studies with 1.0T and 1.5T using routine TI-, T2- weighted spin echo sequences, and contrast enhancement. 4 MR angiography, 3 inversion recovery, and 6 contrast angiography were studied from 7 patients RESULTS: All vascular masses demonstrated higher than muscle signal intensity on Tl-weighted images, bright signal intensity on T2-weighted images, and prominent enhancement, except AV hemangioma combined with prominent arteriovenous malformation on postcontrast scan. Three hemangiomas demonstrated distinct serpiginous signal voids. Venous malformations demonstrated venous lakes seen as homogenous regions of high signal intensity and phleboliths seen as low signal foci on images. Inversion recovery was the best pulse sequence for evaluation of the extent of lesion. CONCLUSION: MR findings of the vascular masses of the head and neck are useful in delineating the extent of the disease, differentiating venous malformation or cavernous hemangioma from other hemangiomatous lesions including hypertrophic feeding vessels, and making a plan for treatment by interventional technique also.
Angiography ; Arteriovenous Malformations ; Diagnosis, Differential* ; Head* ; Hemangioma ; Hemangioma, Capillary ; Hemangioma, Cavernous ; Hemangiopericytoma ; Humans ; Lakes ; Neck* ; Pathology

PURPOSE: To characterize the magnetic resonance (MR) imaging features of cervical tuberculous lymphadenitis. MATERIALS AND METHODS: The cervical MR images of 14 patients with pathologically or clinically proven cervical tuberculous lymphadenitis were retrospectively analyzed. T1- and T2-weighted or proton density images and contrast enhanced MR images were obtained in all patients. RESULTS: Most patient had multiple (n=12), unilateral lesions (n=l0), 8 mm to 45 mm in size, round (n=46) or ovoid (n=46) in shape and all with smooth and well-defined margins mostly at internal jugular chain(N2: 41, N3: 2, N4: 21 ). The signal intensities of the most lymph nodes were isointense or slightly hyperintense on T1 -weighted images, and hyperintense (all) with variable homogeneity on T2-weighted and/or proton density images. After contrast enhancement most showed characteristic thin peripheral rim enhancement (n=71). CONCLUSION: The characteristic MR features of cervical tuberculous lymphadenitis would be multiple, unilateral enlarged lymph nodes which show iso or slightly increased signal intensity on T1 -weighted image, high signal intensity on T2-weighted and/or proton density image and peripheral rim enhancement.
Humans ; Lymph Nodes ; Protons ; Retrospective Studies ; Tuberculosis, Lymph Node*

The authors experience 3 cases of angiographically occult vascular malformation(AVOM) of the brain during the last 3 months in 1990. All cases were diagnosis of either operative or pathological finding and were associated with intracerebral hemorrhage. The authors recommend that surgery should be considered even to those angiographically negative intracerebral hemorrhage cases, once clinical features are highly suggestive of AOVM. Surgery can be an effective and define therapy for these entities, which are prone to cause recurrent hemorrhage and persistent neural deficits.
Brain* ; Cerebral Hemorrhage ; Diagnosis ; Hemorrhage ; Magnetic Resonance Imaging ; Vascular Malformations*

Forty-two cases of brain abscess operated at the Department of Neurosurgery, Seoul National University Hospital during the past 10 years from Jan. 1971 to June 1981 were studied clinically. The incidence of this disease did not decline throughout the period and preponderance of males under the age of 20 was found. The abscesses of ear and nose origin constituted the largest group(35.7%) and cyanotic heart disease was followed(19.0%). In 33%, the primary site of infection could not be established. Headache was by far the most common symptom and frequent locations were temporal, frontal, parietal and cerebellum in order of frequency. On bacteriological study, G(-) rods, streptococcus, staphylococcus and anaerobic bacteroides were cultured and about 30% was sterile. Mixed infection was about 20%. CT scan made it possible to detect the brain abscess easily and accurately, especially in cerebellar abscess and multiple abscess. Factors influencing the surgical outcome were preoperative status and surgical procedure. Excision was superior to simple aspiration in respect of recurrence and surgical outcome.
Abscess ; Bacteroides ; Brain Abscess* ; Brain* ; Cerebellum ; Coinfection ; Ear ; Headache ; Heart Diseases ; Humans ; Incidence ; Male ; Neurosurgery ; Nose ; Rabeprazole ; Recurrence ; Seoul ; Staphylococcus ; Streptococcus ; Tomography, X-Ray Computed