TMJ internal derangement has been treated by the conservative methods and the surgical methods according to the clinical state. There are several surgical methods for treatment of TMJ internal derangement, such as disk repositioning and repair, diskectomy with and without grafts, articular surface contouring, high condylectomy, condylotomy, and arthroscopic surgery etc. Especially, it has been reported that the condylotomy produced the increase of the joint space, the pain relief, the elimination of the joint dysfunction due to the antero-inferiorly movement of the condyle, and the condylar morphologic change resulted from the progressive remodeling in TMJ without the surgical intervention within the TMJ. We have performed EVRO(extraoral vertical ramus osteotomy) to the 5 patients diagnosed as ADDWR(Anterior disk displacement with reduction) from June 1997 to December 1997 in the Chin-Hae military hospital. We diagnosed them with MRI and clinical examination. And we compared the preoperative symptoms with postoperative 2 months symptoms. They were compared by Helkimo index, mandibular mobility index, and pain scale. Anamnestic Index(Ai) was changed from 2.0 preoperatively to 1.2 postoperatively, clinical dysfunction score from 11.8 to 2.8, and Clinical Dysfunction Index(Di) from 2.8 to 1.2. The pain scale of the affected side was changed from 4.4 to 2.6 and that of the non-affeted side from 2.2 to 2.6. The maximal mouth opening was changed from 35.2mm to 40.9mm, right lateral excursion from 7.8mm to 8.0mm, left from 8.8mm to 7.0mm, and protrusion from 6.2mm to 6.2mm. In these results, we could not expect any excellent improvement of the clinical symptoms during the immediate postoperative periods. But we could observe the disappearance of the joint noise and the improvement of the clinical dysfunction score. On the basis of the results of the previous investigations about condylotomy effect which presented the condyle position were changed antero-inferiorly in the articular fossa during the immediate postoperative period, the displaced condyles may prevent wide mouth opening. Therefore it is elucidated that the improvement of the maximal mouth opening and other functions were restricted during the immediate postoperative periods. After long term follow-up period, the symptomatic and functional improvement will be expected by the passive repositioning of the proximal segment. We report the preliminary results with the related references.
Arthroscopy ; Diskectomy ; Follow-Up Studies ; Hospitals, Military ; Humans ; Joints ; Magnetic Resonance Imaging ; Mouth ; Noise ; Postoperative Period ; Temporomandibular Joint* ; Transplants

Neurilemmomas of the extremities are nerve sheath tumors involving peripheral nerves of the extremities. We analyzed MR images of 16 surgically proved tumors in 12 patients and compared the MR images with gross pathologic specimens in two tumors (2/16). Spin echo T1-weighted images were obtained in all the patients but T2-weighted images were obtained in six patients with a gradient echo technique. Gadolinium dimeglumine enhanced T1-weighted images were obtained in 11 patients (15/16). Signal on T1-weighted images was iso or slightly higher than that of the adjacent muscles. Signal on T2-weighted images ranged from homogeneous high to heterogeneous. After Gadolinium injection, all the 15 tumors showed enhancement. Small sized tumors were enhanced homogeneously but there was a tendency tobe enhanced heterogeneously to the central portion with peripheral rim enhancement as the size of the tumors increased. Pathologically, the enhanced portion was correlated the with solid protion was correlated the with solid portion of the tumors. Also encapsulation of the mass (12/16), suspended nerve strings (9/16) and bony erosion (1/16) were detected. MR characteristics of neurilemmoma include heterogeniety on enhanced T1 and T2 weighted images, encapsulation, and suspended nerve strings. Signal heterogeneity on enhanced T1 and T2 weignted images may be attributed to the variable cellularity, cystic changes, vascularity and focal hemorrhage of the tumors.
Extremities ; Gadolinium ; Hemorrhage ; Humans ; Magnetic Resonance Imaging* ; Muscles ; Nerve Sheath Neoplasms ; Neurilemmoma* ; Peripheral Nerves ; Population Characteristics

Neurilemmomas of the extremities are nerve sheath tumors involving peripheral nerves of the extremities. We analyzed MR images of 16 surgically proved tumors in 12 patients and compared the MR images with gross pathologic specimens in two tumors (2/16). Spin echo T1-weighted images were obtained in all the patients but T2-weighted images were obtained in six patients with a gradient echo technique. Gadolinium dimeglumine enhanced T1-weighted images were obtained in 11 patients (15/16). Signal on T1-weighted images was iso or slightly higher than that of the adjacent muscles. Signal on T2-weighted images ranged from homogeneous high to heterogeneous. After Gadolinium injection, all the 15 tumors showed enhancement. Small sized tumors were enhanced homogeneously but there was a tendency tobe enhanced heterogeneously to the central portion with peripheral rim enhancement as the size of the tumors increased. Pathologically, the enhanced portion was correlated the with solid protion was correlated the with solid portion of the tumors. Also encapsulation of the mass (12/16), suspended nerve strings (9/16) and bony erosion (1/16) were detected. MR characteristics of neurilemmoma include heterogeniety on enhanced T1 and T2 weighted images, encapsulation, and suspended nerve strings. Signal heterogeneity on enhanced T1 and T2 weignted images may be attributed to the variable cellularity, cystic changes, vascularity and focal hemorrhage of the tumors.
Extremities ; Gadolinium ; Hemorrhage ; Humans ; Magnetic Resonance Imaging* ; Muscles ; Nerve Sheath Neoplasms ; Neurilemmoma* ; Peripheral Nerves ; Population Characteristics

Acute necrotizing encephalopathy is a recently established disease entity, proposed by Mizuguchi et al in 1995, that shows a characteristic symmetric and multifocal involvement of both thalamus, brainstem tegmentum, cerebral periventricular white matter, and cerebellar medulla. It is known to be prevalent in Japan and other Far Ease countries. The etiology of the acute necrotizing encephalopathy remains unknown. The typical course of acute necrotizing encephalopathy is the development of the irreversible neurologic symptoms related to brain lesions. The diagnosis can be made on the basis of the combination of a typical clinical profile and characteristic radiologic findings. We experienced a first case of acute necrotizing encephalopathy in a 9 month old boy in Korea. We report this case with the brief review of related literatures.
Brain ; Brain Stem ; Diagnosis ; Humans ; Infant ; Japan ; Korea ; Male ; Neurologic Manifestations ; Thalamus

Deglutition ; Dislocations ; Ligaments ; Mastication ; Recurrence ; Temporomandibular Joint ; Transplants ; Zygoma

In the diagnosis of acute spinal trauma, meticulous physical examination and history taking is the most important tool and auxilliary support support can be given by plain X-ray, CT or myelography, etc. But these cannot show the state of cord injury directly. On the contrary, MRI shows the cord directly as well as the soft and bony tissues. We analysed retrospectively 39 patients who suffered from acute spinal trauma at the level of cervical and thoracic spine and had their spine MRI taken. We verified the meaningful correlation between the signal change in the spinal cord on MRI and the degree of neurologic deficit and prognosis, using Frankel classification and trauma motor index at the time of admission and the final follow-up.
Classification ; Diagnosis ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Myelography ; Neurologic Manifestations ; Physical Examination ; Prognosis ; Retrospective Studies ; Spinal Cord ; Spine

Potassium citrate therapy caused a sustained increase in urinary pH and potassium, and restored urinary citrate to normal levels. No significant changes occurred in urinary uric acid, oxalate, sodium or phosphorus levels. Owing to these physiological changes, uric acid solubility increased, urinary saturation of calcium oxalate decreased and the propensity for spontaneous nucleation of calcium oxalate was reduced to normal. Therefore, the Physicochemical environment of urine following treatment become less conductive to the crystallization of calcium oxalate or uric acid. Twenty six patients with uric acid nephrolithiasis with or without calcium nephrolithiasis underwent treatment and long-term preventive management (mean of 20.8 months) with potassium citrate. Urinary pH increased from acid (5.0-5.5) to normal (6.5-7.0) during treatment. During the period of preventive management, stones were not developed.
Calcium ; Calcium Oxalate ; Citric Acid ; Crystallization ; Humans ; Hydrogen-Ion Concentration ; Nephrolithiasis ; Oxalic Acid ; Phosphorus ; Potassium Citrate* ; Potassium* ; Solubility ; Uric Acid ; Urinary Calculi*

A 61-year-old woman with a left cavernous sinus dural arteriovenous fistula presented with left 6th nerve palsy. Initial brain MRI showed findings consistent with left-sided pontine infarction. Follow-up MRIs revealed an enlarged pontine lesion, and additional lesions in the right hippocampus, both basal ganglia and centrum semiovale mimicking a brain tumor or a demyelinating disease. We suggest that the MRI lesions are venous congestions caused by the shunting of blood flow from the left carotid artery into the venous system. (J Korean Neurol Assoc 19(5):520~525, 2001)
Abducens Nerve Diseases ; Basal Ganglia ; Brain ; Brain Neoplasms ; Carotid Arteries ; Cavernous Sinus* ; Central Nervous System Vascular Malformations* ; Cerebrum* ; Demyelinating Diseases ; Estrogens, Conjugated (USP) ; Female ; Follow-Up Studies ; Hippocampus ; Humans ; Hyperemia* ; Infarction ; Magnetic Resonance Imaging ; Middle Aged ; Pons*

We report a case of spontaneous right carotid-cavernous fistula (CCF) in a proximal segment of persistent primitive trigeminal artery (PPTA) and combined vascular anomalies such as left duplicated hypoplastic proximal posterior cerebral arteries and a variation of anterior choroidal artery supplying temporal and occipital lobe. A 45-year-old male presented with progressive right exophthalmos, diplopia, and ocular pain. With manual compression of the internal carotid artery, a cerebral angiography revealed a right CCF from a PPTA. Treatment involved the placement of detachable non-fibered and fibered coils, and use of a hyperglide balloon to protect against coil herniation into the internal carotid artery. A final angiograph revealed complete occlusion of PPTA resulted in no contrast filling of CCF.
Arteries ; Carotid Artery, Internal ; Caves ; Cerebral Angiography ; Choroid ; Diplopia ; Exophthalmos ; Fistula ; Humans ; Male ; Middle Aged ; Occipital Lobe ; Posterior Cerebral Artery

We report two cases of supratentorial gangliocytomas mimicking an extra-axial tumor. MR imaging indicated that the tumors were extra-axial, and meningiomas were thus initially diagnosed. Relative to gray matter, the tumors were hypointense on T1-weighted images and hyperintense on T2-weighted images. On contrast-enhanced T1-weighted images, homogeneous enhancement was observed, while CT scanning revealed calcification in one of the two cases.
Adult ; Brain Neoplasms/*diagnosis/pathology ; Case Report ; Female ; Ganglioneuroma/*diagnosis/pathology ; Human ; *Magnetic Resonance Imaging ; Middle Age