No abstract available.
Humans ; Twins*

Basilar migraine is a rare type of migraine with complex symptoms including aura such as dysarthria, vertigo, tinnitus, and decreased level of consciousness. A 13-year-old male patient was presented with severe headache and immobility of whole body for 20 minutes after vomiting, dizziness, and dysarthria. Similar episode of headache and unconsciousness after vomiting happened 2 weeks ago prior to the visit. Vital signs were stable and pupils showed positive light reflex. Brain MRI and MRA, EEG, and electrocardiography revealed no abnormality. One day after discharge from hospital, patient revisited emergency room because of similar episode of headache. Preventive medication was started with flunarizine 5 mg per day. However, similar episodes of headache and loss of consciousness repeated three times over the next four months. Topiramate was then added with dose of 100 mg divided into two doses. Since then, the patient has been symptom free over 1 year.
Adolescent ; Brain ; Consciousness ; Dizziness ; Dysarthria ; Electrocardiography ; Electroencephalography ; Emergencies ; Epilepsy ; Flunarizine ; Fructose ; Headache ; Humans ; Light ; Male ; Migraine Disorders ; Migraine with Aura ; Paralysis ; Pupil ; Reflex ; Tinnitus ; Unconsciousness ; Vertigo ; Vital Signs ; Vomiting

PURPOSE: To compare MRI appearance between plicae syndrome and normal plicae. MATERIALS AND METHODS: MR images of 60 cases of arthroscopically-confirmed plicae syndrome and 18 of arthroscopically-proven normal plicae were retrospectively analyzed. Sagittal T2-weighted MR images in all cases and MPGR(200) in 37 cases of plicae syndrome were obtained. Statistical analysis was performed using the chi-square test. RESULTS: On the basis of operatingresults, we observed 55 medial plicae, eight combined medial and suprapatellar plicae, four suprapatellar plicae,and one lateral plica. T2-weighted sagittal MR scans of the 60 cases demonstrated 37 medial plicae, 8 suprapatellar and one lateral plica. Joint effusion was found in 26 cases of 55 medial plicae. In T2-weighted sagittal MR scans, the identification of medial plicae was superior in the presence of joint effusion than its absence(plicae syndrome, p < 0.001 ; normal plicae group, p < 0.05). Medial plicae were well demonstrated onMPGR(200) axial images; on T2-weighted sagittal MR scans, they could be more frequently identified in the plicae syndrome group than in the normal control group(p < 0.001). Plicae syndrome-associated pathology included degenerative change of the articular cartilage of the medial femoral condyle in eight cases(14.5%), discoidmeniscus in nine(16.4%), lateral meniscus tear in 12(21.8%), medial meniscus tear in 21(38.1%), anterior cruciate ligament tear in three(5.5%), medial collateral ligament tear and osteochondritis dissecans in one case. CONCLUSION: The present study revealed that synovial plicae were well demonstrated in T2-weighted sagittal images, particularly on the presence of joint effusion. Medial plicae could be more frequently identified in the plicae syndrome group than in the normal control group, especially on T2-weighted sagittal MR scans.
Cartilage, Articular ; Collateral Ligaments ; Humans ; Joints ; Magnetic Resonance Imaging ; Menisci, Tibial ; Osteochondritis Dissecans ; Pathology

A case of histiocytic medullary reticulosis in 14-years-old girl was presented, who had characteristic clinical and histiopathologic findings. The patient manifested intermitten fever, general weakness, weight loss, multiple skin lesion and pancytopenia with terminal massive bleeding. The clinical finding with fatal course and hematologic features were basically identical to those of previously documented histiocytic medullary reticulosis and verified with autopsy. On autopsy, systemic proliferation of the actively phagocytic atypical histiocytes was found. The authors report the case with review of pertinent literature.
Autopsy ; Female ; Fever ; Hemorrhage ; Histiocytes ; Humans ; Pancytopenia ; Skin ; Weight Loss

PURPOSE: To demonstrate a CT technique by which carcinoma of the ampulla of Vater can be more accurately diagnosed, and to describe the radiologic findings this carcinoma. MATERIALS AND METHODS: We retrospectively reviewed CT findings in 26 patients with pathologically proven carcinoma of the ampulla of Vater. One additional cup of diluted oral contrast medium was ingested immediately before the scan. We analysed the difference in detection rate of the mass in the duodenal lumen with and without duodenal luminal opacification of gastrografin.We also evaluated the size and shape of the mass, dilatation of CBD and the pancreatic duct, and lymph node metastasis. In addition, we analyzed multimodality imaging findings ultrasonogram (US) : 13; hypotonic duodenogram (HTDG): 7; ERCP : 17) of carcinoma of the ampulla of Vater. RESULTS: Nodular soft tissue masses protruding into the duodenal lumen were identified in 21 of 26 cases. In 95% of cases (21/22) with favorable opacification and distension of the duodenum, masses were clearly identified on CT imaging. However, in four caseswith poor opacification and distension of the duodenum, masses could not be observed(P=0.000). The mass on CT scanshowed a well-defined margin, round or lobulated contour, and contrast enhancement similar to that of thepancreas. CBD dilatation was identified in 20 cases and pancreatic duct dilatation in 12. On US, protruding massesin the distal CBD were observed in nine of 13 cases(60%) and on HTDG, in six of seven cases(86%). as well-definedfilling defects. Conclusion : Since the accuracy of CT diagnosis of intestinal lesions is directly proportional tothe degree of intestinal distension and opacification with oral contrast, we believe that adequate ct techniquefor distending and opacitying the duodeual lumen are necessary for early diagnosis of carcinoma of the ampulla ofVater.
Ampulla of Vater* ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Dilatation ; Duodenum ; Early Diagnosis ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Pancreatic Ducts ; Phenobarbital ; Retrospective Studies ; Ultrasonography

Pseudo-Meigs syndrome is accompanied with pleural effusion, ascites and a benign or malignant tumor of ovary, tubes, uterus, round ligament or colon. We reported a case of hypoxia in an ovarian cancer patient with moderate ascites after head-down tilt position for central venous catheterization under general anesthesia. Massive pleural effusion was detected on portable chest X-ray, which was not observed in a preoperative radiologic test. The patient had no respiratory symptoms and breath sound was normal in both lungs prior to surgery. The pleural effusion was resolved by a chest tube insertion.
Anesthesia, General ; Anoxia ; Ascites* ; Catheterization, Central Venous ; Central Venous Catheters ; Chest Tubes ; Colon ; Female ; Head-Down Tilt* ; Humans ; Lung ; Ovarian Neoplasms* ; Ovary ; Pleural Effusion* ; Round Ligament of Uterus ; Thorax ; Uterus

OBJECTIVE: To assess the short-term clinical effect of a new spinal decompression device (DRX-3000) combined with transforaminal steroid injection (TFI) in comparison with TFI only in patients with lumbar herniated intervertebral disc (HIVD) METHOD: Fourty-one patients diagnosed as lumbar intervertebral disc herniation were recruited and divided into two therapeutic groups. Eighteen patients were treated with DRX-3000 combined with TFI. Twenty-three patients were treated with only TFI. The visual analogue scale (VAS), straight leg rasing test (SLR), radiating pain, Oswestry Disability Index (ODI), sitting tolerance, standing tolerance and sleeping tolerance were measured before treatment and 4 weeks after treatment. RESULTS: VAS, radiating pain, sitting tolerance and ODI were significantly improved after treatment in all patients (p<0.05). SLR and sleeping tolerance were significantly improved in combined treatment group and standing tolerance were significantly improved in TFI group after treatment (p<0.05). After treatment, degree of VAS decrease was larger in combined treatment group than TFI group(p<0.05). CONCLUSION: Spinal decompression with TFI was more effective than only TFI in patients with lumbar HIVD in a short period.
Decompression ; Humans ; Injections, Epidural ; Intervertebral Disc ; Intervertebral Disc Displacement ; Leg ; Low Back Pain

PURPOSE: To evaluate the efficacy of fat-suppressed gadolinium-enhanced MR imaging in differentiating acutefrom chronic ligament tears of anterior cruciate ligament. MATERIALS AND METHODS: MR images of 22 patients witharthroscopically proven complete tear of the anterior cruciate ligament were retrospectively reviewed. Theinterval between injury and MR examination was one day to seven years. When ligament tear was detected on MR imagewithe three months of injury, the case was considered acute;if detected after three months had elapsed, it wasjudged to be chronic. The extent of contrast enhancement was graded as 1, 2 or 3; grade 1, enhancement wasconfined to the expected ligament region; grade 2, enhancement extended to the joint capsule; grade 3, enhancementextended beyond the joint capsule. The grades of contrast enhancement correlated with the acute and chronic stagesof ligament tears. Associated bone bruise and/or adjacent soft tissue edema were also evaluated. RESULT: Among15 patients with acute ligament tear, nine (60%) showed grade 3 enhancement; among seven in whom tearing waschronic, four (57%) showed grade 1 enhancement. Bone bruising was present in 100% of acute tears (15/15) and 29%of chronic tears (2/7). Soft tissue edema was associated in 87% of acute tears (13/15) and 29% of chronic tears(2/7). CONCLUSION: Fat-suppressed gadolinium-enhanced MR imaging could help differentiate acute from chronictears of anterior cruciate ligament, as well as bone bruising and tissue edema.
Anterior Cruciate Ligament* ; Cartilage ; Contusions ; Edema ; Humans ; Joint Capsule ; Ligaments ; Magnetic Resonance Imaging* ; Retrospective Studies

PURPOSE: We aimed to determine the sensitivity of computer-aided detection (CAD) applied to digital mammography in asymptomatic and symptomatic breast cancer patients. METHODS: We retrospectively analyzed digital mammography and CAD images from 210 patients diagnosed with breast cancer. The patients were divided into symptomatic and asymptomatic groups. The sensitivity of CAD in both groups was assessed in relation to breast tissue density, histopathological type of breast cancer, and tumor size. RESULTS: The detection rate of the CAD system was 87.8% in the asymptomatic group. The sensitivity in different tissue densities was 100% in fatty breasts (P1), 88.9% with scattered fibroglandular densities (P2), 94.4% in heterogeneously dense breasts (P3), and 66.7% in extremely dense breasts (P4). The detection rate of the CAD system in the symptomatic group was 87.2%, and the sensitivity was 90.5%, 90%, 86.6%, and 75% in P1-P4 breasts, respectively. In the asymptomatic group, the CAD system detected 90.3% of invasive ductal carcinomas, not otherwise specified (IDC-NOS) and 88.9% of ductal carcinomas in situ (DCIS), but did not detect other types of malignancy. In the symptomatic group, the CAD system detected 88.2% of IDC-NOS, 88.9% of DCIS and 75% of other types of malignancy. When analyzed according to tumor size, the sensitivity of CAD in the asymptomatic and symptomatic groups was 82.6% and 83.3% for tumors <1 cm, 76.5% and 82.4% for tumors between 1 and 2 cm, and 91.7% and 89% in tumors >2 cm. CONCLUSION: The sensitivity of CAD was low in P4 breasts and high for tumors larger than 2 cm, with no statistically significant differences between the asymptomatic and symptomatic groups for IDC-NOS and DCIS. CAD showed greater sensitivity for other neoplasms in symptomatic patients.
Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Diagnosis, Computer-Assisted ; Humans ; Mammography ; Retrospective Studies

The I-gel(TM) is a single-use supraglottic airway device introduced in 2007 which features a non-inflatable cuff and allows passage of a tracheal tube owing to its large diameter and short length of the airway tube. In this case, the authors experienced a difficult airway management on a 4-year-old boy with underlying Goldenhar syndrome who underwent a tonsillectomy. Intubation using a laryngoscope was unsuccessful at the first attempt. In the following attempt, we used the I-gel(TM) supraglottic airway for ventilation and were able to achieve successful intubation with a cuffed tube by using fiberoptic bronchoscope through the I-gel(TM) supraglottic airway. The authors suggest that I-gel(TM) is a useful device for ventilation and it has many advantages for tracheal intubation in pediatric patients with difficult airway.
Airway Management ; Bronchoscopes ; Goldenhar Syndrome ; Humans ; Intubation ; Laryngeal Masks ; Laryngoscopes ; Tonsillectomy ; Ventilation