Actinomycosis is a chronic suppurative and granulomatous disease characterized by peripheral spread and extension to contagious tissue, rare hematogenous spread, and the formation of multiple draining sinus tracts. In the rare case of hematogenous disseminated Actinomycosis; lesions appear in all parts of the body. Bone involvement, however, is very rare except the jaw and there has been only some reports about the ribs and vertebral columns. To our knowledge, this case represents the first report of documented distal femoral involvement.
Actinomycosis ; Femur ; Fractures, Spontaneous ; Jaw ; Osteomyelitis ; Ribs ; Spine

Endoscopic nasobiliary drainage(ENBD) has been developed as a safe and effective noninvasive biliary drainage method for initial decompression in the benign or malignant biliary obstruction, dissolution of biliary stones by injection of litholytic agents through the tube, and proper causative diagnosis of biliary obstruction by cytologic, bacteriologic and parasite investigation of drained bile. Generally, endoscopic sphicterotomy (EST) is performed before the insertion of an ENBD tube in order to make the procedure easy and to prevent acute pancreatitis that may develop by compression of the pancreatic orifice of the inserted tube. Nevertheless, in some cases EST is difficult to perform or should not be performed due to their coagulopathy. In such cases, ENBD without EST may be necessary. To evaluate the safety, successfullness and effectiveness of ENBD without EST, ENBD without EST using 5, 6 or 7 Fr pigtail tubes were performed in 81 cases(49 malignant, 32 benign). ENBD without EST was successfully performed in 78 out of 81 cases(96.3%). This effectiveness for decompression of bile duct, evaluated by decreasing total bilirubin values, was good in 66 out of 73 casee (90. 2%). The complications of this procedure were noted in 6 out of 78 cases(7. 7%). e. g. cholangitis in 3, migration of ENBD tube in 2, acute pancreatitis in 1 case. Particularly, regardless of our concern that ENBD without EST may develop acute pancreatitis acute panereatitis was noted in only one case. In conclusion, ENBD without EST is a safe and effective method which can be applied to the cases who have benign or malignant obstructive jaundice.
Bile ; Bile Ducts ; Bilirubin ; Cholangitis ; Decompression ; Diagnosis ; Drainage* ; Jaundice, Obstructive ; Pancreatitis ; Parasites

No abstract available.
Female* ; Humans ; Urinary Incontinence*

We present a case of nevus flammeus associated with angiokeratoma of Fordyce and lymphangioma circumscriptum in a 26 year-old Korean man. We have known that the congenital hemangiomas may be associated with many syndromes such as Kasabacb-Merritt syndrome, Sturge-Weber syndrome and etc. Recently the congenital hemangiomas associated with angiokeratoma or lymphangioma were reported in several literatures, Watson and McCarthy reported that it seemed to be established that three types of benign vascular tumors had a common origin and grew in an identical fashion by projecting buds of endothelial tissue. So the congenital hemangiomas may have a close association with angiokeratoma or lymphangioma.
Adult ; Angiokeratoma* ; Hemangioma ; Humans ; Lymphangioma* ; Nevus* ; Port-Wine Stain* ; Sturge-Weber Syndrome

No abstract available.
Thyroid Diseases* ; Thyroid Gland*

Primary tumors of the heart are rare, and one-third of them are malignant. The most common malignant intracardiac tumor is angiosarcoma, which usually involves right atrium. MR features in one patients with right atrial angiosarcoma is presented and the literature briefly reviewed. Angiosarcoma demonstrated slightly heterogeneous intermediate signal intensity on T1-weighted images, high signal intensity on T2-weighted images and higher signal intensity on Gd-DTPA enhanced images. MRI provided more information regarding the extent of the tumor than 2D echocardiography or CT.
Echocardiography ; Gadolinium DTPA ; Heart ; Heart Atria ; Hemangiosarcoma* ; Humans ; Magnetic Resonance Imaging*

Three cases of congenital coxa vara were treated by subtroch-anterie abduction osteotomy with percutaneous pin fixation of both fragments. The indications of the corrective subtrochanteric osteotomy for coxa vara deformity were the neck-shaft angle of 100 degress or less, the presence of marked gluteus medius limp and the vertical neck defect with progression of the varus deformity. Through a lateral approach, the lateral aspect of the proximal end to the femoral shaft was exposed and 2 Steinmann pins were inserted through the upper and lower levels to the proposed osteotomy. The distal pin was inserted perpendicular to the long axis of the femur and the proximal pin at an algle of desired correction to the distal pin and a subtrochanteric transverse osteotomy was completed. Two Steinmann pins were paralell to each other by adducting the proximal fragment and abducting the distal fragment. and the lateral cortex of the proximal fragment was impacted into the marrow cavity of the distal fragment. The Steinmann pins were then incorporated in the hip spica cast. The object of the operation was to correct the coxa vara, to change the stress on the vertical fissure in the neck from shear to compression and to overcome shortening of leg. With this technically simple method, the authors achieved adequate correction of the deformity. The ostetomies healed rapidly and the medullary canal was re-established in all cases, The gait of each patient was markedly improved and the Trendelenburg test become negative in all of them. One of these patients showed a mild recurrence of varus deformity and limp 2 years following surgery.
Bone Marrow ; Congenital Abnormalities ; Coxa Vara ; Femur ; Gait ; Hip ; Humans ; Leg ; Methods ; Neck ; Osteotomy ; Recurrence

No abstract available.
Rectal Neoplasms*

It is difficult to distinguish benign from malignant, pulmonary nodule by conventional roentgenologic examination. But CT makes it easier to evaluate adjacent parencymal invasion, pleural or mediastinal extenstion,or early metastasis to intra- or extrathoracic lymph node as well as distant organs, although only a solitaryperipheral pulmonary nodule is seen on plain radiograph. Authors reviewed CT of 22 cases of histopathologically confirmed primary lung cancer seen as a solitary peripheral pulmonary mass from May 1980 to Sep. 1984 at DongsanMedical Center, Keimyung University. The results are as follows: 1.The incidence was most common in the 6thdecade(36%). Male to female ratio was 10:1 and 2 females all had bronchioloalveolar cell carcinoma. 2. Thedistributions of histologic cell type were as follows: squamous cell carcinoma 40%, adenocarcinoma, small cellcarcinoma, bronchioloalveolar cell carcinoma and unclassified carcinoma 14% in each cases, and adenoid cysticcarcinoma 4% . 3. The CT findings were as follows: a) Superior and posterior basal segments of both lower lobeswere most frequently involved(68%). b) The mean diameter of the mass was 48mm, and most common in the range of30-49 mm in the greatest dimension(46%). c) The mean CT atttenuation value was 57 H.U., and most common in thegroup of 41-70 H.U. (64%). d) Lymph node metastasis was found in 13 (59%) of 22 cases, and the involved nodes wereas follows: hilar nodes 10 cases, paratracheal nodes 8 cases, subcarinal nodes 7 cases and extrathoracic nodes 3cases. In 2 of 3 cases with small cell carcinoma, diffuse multiple lymph nodes were involved. e) Distantmetastasis was seen relatively early in 3 cases; cerebral metastasis in 1 case of squamous cell carcinoma, rightaderenal metastasis without intrathoracic lymph node metastasis or invasion of adjacent structures in 1 case ofbronchioloalveolar cell carcinoma, and liver and bone metastases in 1 case of unclassified carcinoma. f) Adjacentpleural or mediastinal invasion was found in 7 cases(32%): pleural invasion along chest wall in 4 cases, andinvasion of adjacent mediastinal pleura in 3 cases of 2 squamous cell carcinoma and 1 unclassifed carcinoma. g)Calcifications witihin the mass were found in 5 cases (23%), and most common in squamous cell carcinoma(3 cases).In all cases, a few granular calcification were seen along the peripheral margin of the mass. h) Tumor necrosiswas seen in 4 cases(18%), and 3 cases were squamous cell carcinoma, and one of them showed irregular centralcavitation. i) The margins of tumor were irregularly lobulated with radiating spiculations in all except one ofadenoid cystic carcinoma, which revealed oval shaped, smooth clear margin. j) In 9(41%) of 22 cases, someenlargement of pulmonary vessels with perivascular linear infiltrations were found in the adjacent lungparenchymes of the mass, which were thought to be retrograde perivascular lymphangitic spread along pulmonaryvessels.
Adenocarcinoma ; Adenoids ; Carcinoma, Bronchogenic ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Epithelial Cells ; Female ; Humans ; Incidence ; Liver ; Lung Neoplasms ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Pleura ; Thoracic Wall

The intravenous administration of midazolam is widely used as sedative premedication for upper gastrointestinal endoscopy. We performed a study to evaluate the effectiveness and safety of midazoiam as premedication for upper gastrointestinal endoscopy. Between June 1995 and October 1995, 112 patients of diagnostic esophago-gastroduodenoseopy were enrolled in the study. The patients were recieved a bolus midazolam 0.~03mg/kg or placebo, followed by typical anesthesia. The blood pressure, pulse and oximeter values were monitored. The systolic blood pressure and heart rate were increased during endoscopy in compared with before premedication, and normalized immediately. There was no significant change of arterial oxygen saturation. Midazolam induced amnesia completely in 49.2% and partially in 27.2%, and all patients were recovered completely in 1 hour. The tolerance score is higher in the midazolam group as compared with the placebo group(p<0.05), and midazolam group would accept the same sedation for repeated endoscopies(p<0.01). We conclude that midazolam has beneficial effects as premedication for upper gastrointastinal endoscopy without significant altteration in cardiopulmonary parameters. This suggest that midazolam may be used more frequently as premedication, especially in the cases of repeated endoscopy.
Administration, Intravenous ; Amnesia ; Anesthesia ; Blood Pressure ; Endoscopy ; Endoscopy, Digestive System ; Endoscopy, Gastrointestinal* ; Heart Rate ; Humans ; Midazolam* ; Oxygen ; Premedication*