Subarachnoid hemorrhage (SAH) due to ruptured posterior cerebral artery (PCA) intracranial arterial dolichoectasia (IADE) is very rare. As these lesions are difficult to treat microsurgically, neurointervention is preferred because the dolichoectatic artery does not have a clear neck, and the surgical field of view was deep seated with the SAH. However, in some cases, neurointervention is difficult due to anatomical variation of the blood vessel to access the lesion. In this case, a 30-year-old male patient presented with a ruptured PCA IADE and an aortic arch anomaly. Aortic arch anomalies render it difficult to reach the ruptured PCA IADE via endovascular treatment. The orifice of the vertebral artery (VA) was different from the usual cases, so it was difficult to find the entrance. After only finding the VA and arriving at the lesion along the VA, trapping was performed. Herein, we report the PCA IADE with aortic arch anomaly endovascular treatment methods and results.

PURPOSE: To evaluate the clinical feature and the results of the treatment of Lisfranc joint fracture/dislocation with limited open reduction, pin fixation and Ilizarov external fixation. MATERIALS AND METHODS: From June 2001 to May 2003, six patients with Lisfranc fracture/dislocation were treated. The average periods of follow-up was 23 months. After limited open reduction on the second tarso-metatarsal joint, we performed pin fixation of the above joint. On the other Lisfranc joint fracture/dislocation, closed reduction and the application of Ilizarov external fixator was done. This rigid system produced the early partial weight bearing and joint motion of the injured foot and ankle joint. The parameters used were radiographic evaluation, patient's clinical assesment and the AOFAS midfoot score. RESULTS: We used the Myerson's criterier to evaluate the radiographic result. All cases could be achieved more than nearly anatomical reduction. Three cases of excellent and 3 cases of good result could be obtained in the evaluation of the patient's clinical assesment. The average AOFAS midfoot score was 87.2 (76~95) points. CONCLUSION: The treatment using Ilizarov external fixation on Lisfranc joint fracture/dislocation can be another useful method.
Ankle Joint ; Dislocations* ; Equidae ; External Fixators ; Follow-Up Studies ; Foot ; Humans ; Joints* ; Weight-Bearing

PURPOSE: Scarf osteotomy can provide the simultaneous correction of the hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA1-2), DMAA and the plantar displacement of the fragment. The study was conducted to understand the multi-dimensional correction of the hallux valgus. MATERIALS AND METHODS: Fourty eight patients who had undergone Scarf osteotomy with hallux valgus at more than 30 degrees of HVA and more than 15 degrees of IMA1-2 were studied. Before an osteotomy, a reference K-wire was inserted to the 1st metatarsal head. After the osteotomy, the plantar fragment was moved laterally and the proximal end of the fragment was forced beyond the distal end which resulted in an internal rotation of the head fragment to correct the DMAA. RESULTS: The HVA improved an average of 33.3 degrees to 7.7 degrees with the IMA1-2 respectively from 15.4 degrees to 6.5 degrees. The DMAA improved an average of 19.5 degrees (5.2-30.9 degrees) to 4.5 degrees (0.4-13.8 degrees). By checking the angle, which was at an average of 25 degrees between the plantar surface of the foot and the osteotomy plane, the average distance of 1.9 mm (1.18-3.1 mm) of plantar displacement was measured using the value of sine (sin 25 = 0.422). CONCLUSIONS: It is possible to correct the HVA, IMA1-2 and DMAA simultaneously with one osteotomy making the lateral shift, the internal rotation and the plantar displacement of the plantar head fragment as desired. Despite the technicality and difficulty of the Scarf osteotomy, once familiarized through myriad procedures, all disadvantages are outweighed by the success and satisfaction of both patient and surgeon.
Foot ; Hallux Valgus* ; Hallux* ; Head ; Humans ; Metatarsal Bones ; Osteotomy*

Granulomatosis with polyangiitis (GPA) is a disease characterized by a granulomatous necrotizing vasculitis of the small vessels, along with the presence of antineutrophil cytoplasmic antibody (ANCA), serologically. GPA is a multisystem disease, in which the diagnosis is frequently based on respiratory and renal manifestations, with rare breast invasion. To date, several cases of breast invasion by GPA have been published, and most cases have been positive for ANCA. However, ANCA-negative forms of breast invasion by GPA are extremely rare and have not been reported in Korea thus far. Therefore, we report a case of ANCA-negative GPA in a 70-year-old woman, who was initially presented with a localized palpable mass in the left breast.
Aged ; Antibodies ; Antibodies, Antineutrophil Cytoplasmic ; Breast* ; Cytoplasm* ; Diagnosis ; Female ; Humans ; Korea ; Vasculitis

A 19 year old female patient presented with diffuse alopecia as her chief medical complaint. A clinical examination revealed hirsutism limited only to the on midline lower abdomen with elevated DHEA-S(dehydroepiandrosterone sulfate) and total testosterone levels. Polycystic ovarian disease (PCOD) was diagnosed during the treatment with dexamethasone and spironolactone, which was effective to improve her alopecia. We believe that, with increasing, concerns about hair conditions of teen-age girls there should be increasing chances for dermatologists to care for patients of PCOD first before other specialities in medicine.
Abdomen ; Alopecia* ; Dexamethasone ; Female* ; Hair ; Hirsutism ; Humans ; Ovarian Diseases* ; Spironolactone ; Testosterone ; Young Adult

Reports of bowing and pseudarthrosis of the humerus and clavicle are rare. Most patients with congenital pseudoarthrosis of the clavicle involving the right side and midportion of clavicle tended to heal better than congenital pseudoarthrosis of the tibia. We experienced a patient who had special features in terms of location, pseudoarthrosis pattern, and neurofibromatosis, and report on this case here.
Clavicle* ; Humans ; Humerus ; Neurofibromatoses* ; Pseudarthrosis* ; Tibia

PURPOSE: This study was performed to evaluate the usefulness of volar plate fixation of dorsally displaced unstable distal radius fracture. MATERIALS AND METHODS: 48 patients with dorsally displaced unstable distal radius fracture were treated by volar plate fixation, between August 1993 and February 2003. Radial inclination, radial length and volar tilting were analyzed by radiographic evaluation. For clinical evaluation, the clinical ratings of Green and O'Brien were used. RESULTS: Radiographic analysis of extra-articular or non-comminuted intra-articular fractures (AO type A2, A3, and C1) demonstrated no significant differences in radial inclination, radial height and volar tilting between the immediate postoperative period and the last follow-up evaluation. However, in cases of comminuted intra-articular fractures (AO type C2), there were statistically significant differences. In clinical evaluation, 40 (83%) patients demonstrated excellent or good results based on the clinical ratings of Green and O'Brien. 32 (94%) of patients demonstrated excellent or good results in extra-articular (AO type A2 and A3) or non-comminuted intra-articular fractures (AO type C1) and 8 (57%) patients demonstrated excellent or good results in comminuted intra-articular fractures (AO type C2). The number of patients with complications was 4 (8%). Median nerve neuropathy developed in 2 patients, and hand and wrist stiffness in 2 patients. All cases achieved bony union. There was no implant failure or irritation. CONCLUSION: Volar plate fixation of extra-articular or non-comminuted intra-articular fractures (AO type A2, A3, and C1) was an effective treatment method for dorsally displaced unstable distal radius fractures. It provided stable fixation and allowed early postoperative rehabilitation.
Follow-Up Studies ; Hand ; Humans ; Intra-Articular Fractures ; Median Nerve ; Postoperative Period ; Radius Fractures* ; Radius* ; Rehabilitation ; Palmar Plate* ; Wrist

Redislocation of bipolar hemiarthroplasty is not a simple complication. When redislocation of bipolar hemiarthroplasty occurs, open reduction must be considered. Displacement of the polished tapered femoral stem could occur through the unwanted traction force during the reduction of the dislocated cemented hip arthroplasty as a complication. We experienced displacement of the polished tapered femoral stem during closed reduction of a redislocated cemented bipolar hemiarthroplasty. We suggest that preoperative analysis for the cause and status of the dislocation is essential and open reduction should be considered if closed reduction is not thought to be suitable for a polished femoral stem.
Arthroplasty ; Dislocations ; Displacement (Psychology) ; Hemiarthroplasty ; Hip ; Traction

Background: This study was performed to identify acute tinnitus and evaluate the efficacy of steroids for noise-induced acute tinnitus by measuring the gap-prepulse inhibition of the acoustic startle (GPIAS) value in an animal model. Methods: Nineteen rats (the noise group [n = 7] and the noise + dexamethasone [DEX] group [n = 12]) were exposed to narrow-band noise centered at 16 kHz from a sound generator for 4 hours. The noise + DEX group received intraperitoneal steroid administration daily for 5 days (1.5 mg/kg/day) after completing noise exposure. Auditory brainstem response and GPIAS value were measured just prior to, and 1 day after noise exposure and on days 1 and 10 days after completing steroid administration. The changes in cochlear structure were evaluated by histological analysis. Results: The threshold shift was checked 1 and 10 days after intraperitoneal steroid injection, and no differences in threshold shift were observed between the two groups in each frequency except for 32 kHz 1 day after steroid injection. The mean GPIAS value in the noise + DEX group (36.4% ± 14.1%) was significantly higher than that in the noise group (16.4% ± 18.8%) 10 days after intraperitoneal steroid administration (P = 0.017). There were no pathological changes associated with noise trauma in the two groups as determined on hematoxylin and eosin and immunohistochemical staining. Conclusion An acute tinnitus model with minimal structural changes by noise exposure was set up, and used to verify tinnitus objectively by measuring the GPIAS value. Steroid therapy for control of tinnitus was validated in this animal model.

BACKGROUND: Numerous cell surface proteins of leukemia cells such as CD33 and CD52 have been identified as diagnostic and therapeutic targets. Thus the profiling of the cell surface proteome and proteins restricted to specific leukemia(s) can provide a way to identify novel targets for leukemia diagnosis and therapy. However, there is a lack of data pertaining to the comprehensive analysis of surface membrane proteins because there are few effective strategies for profiling surface membrane proteomes. METHODS: We report on the application of quantitative proteomic techniques that incorporate affinity-capture and purification on monomeric avidin columns to identify all biotinylated cell surface proteins from leukemia cell lines. RESULTS: An analysis of a subset of biotinylated proteins among the different human leukemia cell lines using matrix-assisted laser desorption ionization and tandem mass spectrometry identified, among others, some widely expressed proteins in leukemia cells, such as CD11a, CD11c, CD18, CD31, CD44, and CD147, as well as a set of proteins identified as chaperone proteins, including HSP90, GRP78, GRP75, HSP70, HSP60 and protein disulfide isomerases. On the basis of their known functional roles, several of these proteins may participate in the progression of leukemogenesis and should be considered as potential markers of leukemia. CONCLUSION: Comprehensive profiling of the leukemia cell surface proteome provides an effective approach for the identification of commonly occurring proteins as well as proteins with restricted expression patterns to a specific cell line.
Avidin ; Cell Line ; Diagnosis ; Humans ; Leukemia* ; Membrane Proteins* ; Membranes ; Protein Disulfide-Isomerases ; Proteome ; Tandem Mass Spectrometry