The blue rubber bleb nevus syndrome(CRBNS) is a rare disorder characterized by distinctive vascular malformations of the skin and gastrointestinal tract. The syndrome is associated commonly with iron deficiency anemia due to gastrointestinal bleeding. Most cases are sporadic, although a few have been reported with autosomal dominant inheritance. We report a case with clinical characteristics of the blue rubber bleb nevus syndrome. The patient had typical skin manifestations of the BRBNS and chronic iron deficiency anemia. However, we could not find any gastrointestinal vascular malformations radiologically.
Anemia, Iron-Deficiency ; Blister* ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Nevus* ; Rubber* ; Skin ; Skin Manifestations ; Vascular Malformations ; Wills

Forty five cases of adult tibial shaft fractures were treated with flexible intramedullary nails under image intensifier at the department of orthopaedic surgery, Capital Armed Forces General Hospital during between April 1986 to July 1988. The results were summarized as follows: 1. 45 cases were all male, the average age was 24.3 years and the most common cause of fractures was sports injury(20 cases) and the second most common cause was traffic accident(18 cases). 2. 11 cases out of 45 cases were open fracture and 34 cases were closed fracture. Eight cases of open fraeture were grade I and three cases were grade II. Twenty eight cases were comminuted fracture. The most common level of the fracture was middle third of the tibial shaft. 3. Average interval from injury to Ender nailing was 13.5 days and the mean duration of permission to full weight bearing was 9.2 weeks. 4. Out of 2 cases of delayed union, the average time of clinical bone union was 9.7 weeks and that of roentgenological bone union was 14 weeks. 5. 11 cases of complication were noted among the 45 cases of tibial shaft fracture which were treated by PGP nailing such as angulation, rotation, ankle joint stiffness, delayed union, shortening, and soft tissue infection. 6. PGP nailing is considered to be a valuable method in treating tibial shaft fracture because of their relative ease of nailing, allowing early weight bearing and decreased complication.
Adult ; Ankle Joint ; Arm ; Fractures, Closed ; Fractures, Comminuted ; Fractures, Open ; Hospitals, General ; Humans ; Male ; Methods ; Soft Tissue Infections ; Sports ; Tibial Fractures ; Weight-Bearing

A case of carotico-cavernous fistula was managed by intravascular occlusion using a Fogarty catheter and ligation of the carotid artery. The fistula was obliterated by the procedure and neurologic deficits improved progressively without further recurrence. The radiological feature, symptomatology and surgical management were discussed.
Carotid Arteries ; Catheters ; Fistula* ; Ligation ; Neurologic Manifestations ; Recurrence

BACKGROUND: Vitiligo is an acquired depigmentary disorder characterized by loss of melanocytes from the epidermis. Autografting using the suction blistered epidermis technique is one of the surgical modalities of vitiligo treatment, and has been successfully used by several authots. OBJECTIVE: The purpose of this study was to evaluate the effect of the autografting using the suction blistered epidermis technique for the treatment of vitiligo. METHODS: 142 sites from 39 patients with vitiligo were treated with autografting using the suction blistered epidermis technique. The recipient sites were prepared by freezing with liquid nitrogen of the sites 48 hours prior to grafting. RESULTS: Better results were seen in cases with the following Factors: a) cases where the disease had been present for more than 3 years b) the post-operative period had been Longer than a year c) the Lesional sites of the vitiligo were on the trunk and neck rather than the neck and extremities d) the vitiligo had affected the grabous rather than the hairy areas on the face. However, there were no differences between the clinical types(such as generalized, localized, and segmental) in the success rate of treatment. Preopera'tive PUVA or post operative PUVA also did not affect the statistical results. CONCLUSION: On autografting using the suction blistered epidermis, it is better to select the patients who have had the disease for more than 3 years, and graft the epidermis which has increased melanocytes by preoperative PUVA for good treatment results and even pigmentation.
Autografts* ; Blister* ; Epidermis* ; Extremities ; Freezing ; Humans ; Melanocytes ; Neck ; Nitrogen ; Pigmentation ; Suction* ; Transplantation, Autologous* ; Transplants ; Vitiligo*

PURPOSE: The purpose of this study was to evaluate the impact of the use of external radiation therapy (ERT) in terms of survival and compliance in patients with anaplastic thyroid carcinoma. MATERIALS AND METHODS: The medical records of 17 patients with anaplastic thyroid carcinoma treated with ERT between 1993 and 2002 were retrospectively reviewed. ERT was administered after surgery in 14 patients and after a biopsy in three patients. Among the 14 patients who had undergone surgery, nine underwent a curative resection and five underwent a palliative resection. Six patients had associated well-differentiated thyroid carcinomas and 14 patients were diagnosed with a tumor size exceeding 5 cm. The radiation dose ranged from 6~70 Gy (median dose, 37.5 Gy). Eleven patients completed the planned course of ERT, whereas six patients did not. The follow-up period ranged from 1~104 months (median, 5 months; mean, 20 months). RESULTS: Five patients started the ERT without the presence of a gross mass and all of the patients completed ERT without a re-growth of tumor. Twelve patients (four patients after a curative resection, five patients after a palliative resection and three patients after a biopsy) started ERT with a gross mass present and only six patients were able to complete the planned course of ERT. Among the six patients who completed ERT, two patients showed a marked regression of the tumor mass, whereas two patients showed slight regression and two patients showed no response. The median survival was five months (range, 1~104 months) and the mean survival was 21 months. The overall survival was 41% at 1-year, 24% at 2-years and 12% at 5-years. Significant prognostic factors included the number of primary tumors present, tumor size, whether surgery was performed and completion of ERT as planned. Long-term survivors showed a tendency of having smaller sized initial tumors and smaller sized pre-ERT tumors than the short-term survivors. CONCLUSION: This study suggests that patients with a small initial tumor (< or =5 cm), which was treated by surgery (curative resection or palliative resection) before ERT, and without rapid re-growth of the mass seen at the surgical site at the beginning of the ERT course, would be the best candidates for postoperative ERT. In contrast, patients with a large initial tumor (>5 cm) and did not undergo surgery before ERT or that rapid re-growth of the mass was observed at the surgical site are likely to have a short survival time, along with the interruption of ERT. In these cases, the role of ERT is very limited and the omission of ERT could be considered.
Biopsy

PURPOSE: We prospectively evaluated the efficacy of administering tamsulosin with or without deflazacort, combined with furosemide, for treating distal ureteral stones. MATERIALS AND METHODS: A total of 241 patients with symptomatic distal ureteral stones were enrolled in this study between January 2004 and September 2007. They were divided into three treatment groups: group A(n=42) who received furosemide(40mg/day), group B(n=66) who received furosemide and tamsulosin(0.4mg/day) and group C(n=72) who received furosemide and tamsulosin plus deflazacort(24mg/day) for a maximum of 2 weeks. Follow-up visits were made at the 1st and the 2nd week after all the medication had been administered. The efficacy was evaluated in terms of the success rate and the time for achieving expulsion after administering the medication, according to the stone size. RESULTS: The three groups were comparable in terms of age, gender and stone size. The stone diameter was 4.90+/-0.47mm for group A, 5.08+/-0.30mm for group B and 5.04+/-0.36mm for group C. The overall success rate was 64.3%, 80.3% and 91.7%, respectively, and the differences were statistically significant(p=0.001). The mean expulsion time for the smaller stones (<5mm) was 9.13 days, 6.25 days and 5.43 days for each group, respectively, while that for the larger stones(>or=5mm) was 10.25 days, 8.93 days and 7.32 days, respectively, and the values for both sized stones showed statistically significant differences(p=0.027 for the smaller stones, 0.018 for the larger stones). There was no serious adverse event associated with the medication. CONCLUSIONS: Medical expulsive therapy with tamsulosin and deflazacort combined with furosemide is a time saving, safe and effective method for treating distal ureter stone.

Patients with hypertrophic cardiography often complain of chest pain and have electrocardioagrams suggesting myocardial damage or ischemia. Some of three patients have associated coronary arterial atherosclerosis. Transmural myocardial infarction may occur in patients with hypertrophic cardiomyopathy in the absence of significant atherosclerosis of the extramural coronary arteries, about which several pathophysiologic exlpanations were discussed. Presented here, a case of 49-year-old man with hypertrophic cardiomyopathy accompanied with myocardial infarction and angiographically normal coronary arteries is reported. Asymmetric septal hypertrophy, characteristic morphologic abnormality of hypertrophic cardiomyopathy, was progressed to dilated cardiomyopathy after the occurrence myocardial infarction.
Atherosclerosis ; Cardiomyopathy, Dilated ; Cardiomyopathy, Hypertrophic* ; Chest Pain ; Coronary Vessels ; Humans ; Ischemia ; Middle Aged ; Myocardial Infarction*

Dual left anterior descending artery (LAD) is a rare congenital coronary artery anomaly with a prevalence of approximately 1% in the general population. To date, 10 types of dual LAD artery anomalies have been reported. Among these, type 4 is one of the rarest. Knowledge and recognition of the dual LAD artery are important for correct diagnosis and planning of coronary bypass surgery and percutaneous coronary intervention. We report a case of a 59-year-old male with type 4 dual LAD artery who presented with dyspepsia and sweating for several months and had approximately 50%–70% stenosis in a major diagonal branch off the short LAD artery.

Dual left anterior descending artery (LAD) is a rare congenital coronary artery anomaly with a prevalence of approximately 1% in the general population. To date, 10 types of dual LAD artery anomalies have been reported. Among these, type 4 is one of the rarest. Knowledge and recognition of the dual LAD artery are important for correct diagnosis and planning of coronary bypass surgery and percutaneous coronary intervention. We report a case of a 59-year-old male with type 4 dual LAD artery who presented with dyspepsia and sweating for several months and had approximately 50%–70% stenosis in a major diagonal branch off the short LAD artery.

Dual left anterior descending artery (LAD) is a rare congenital coronary artery anomaly with a prevalence of approximately 1% in the general population. To date, 10 types of dual LAD artery anomalies have been reported. Among these, type 4 is one of the rarest. Knowledge and recognition of the dual LAD artery are important for correct diagnosis and planning of coronary bypass surgery and percutaneous coronary intervention. We report a case of a 59-year-old male with type 4 dual LAD artery who presented with dyspepsia and sweating for several months and had approximately 50%–70% stenosis in a major diagonal branch off the short LAD artery.