Femoral head and neck fractures during the course of avascular necrosis are rare with only few reports in the English literature. Moreover, there are very few reports on an analysis of the patterns of these fractures. Four cases of femoral head fracture caused by minor trauma, which were quite different from the crescent fractures during the course of avascular necrosis were analyzed in regard to the underlying disease, causes, sites, types, directions, pattern of fractures and the injury mechanism of the fractures. The results are reported with special regard to the pattern of the stress fracture of the femoral head and neck during the course of avascular necrosis.
Fractures, Stress ; Head* ; Neck* ; Necrosis*

Intracranial arterial stenosis usually occurs due to atherosclerosis and is considered the most common cause of stroke worldwide. Although the effectiveness of bypass surgery for ischemic stroke is controversial, the superficial temporal artery to the middle cerebral artery bypass for ischemic stroke is a common procedure. In our report, a 50-year-old man presented with sudden-onset left side weakness and dysarthria. An angiogram showed significant stenosis in the junction of the right cavernous-supraclinoid internal carotid artery and right pericallosal artery. Symptoms altered between improvement and deterioration. Magnetic resonance imaging showed a repeated progression of anterior cerebral artery (ACA) infarction despite maximal medical therapy. We performed a STA-ACA bypass with contralateral STA interposition. Postoperative course was uneventful with no further progression of symptoms. Thus, bypass surgery may be considered in patients with symptomatic stenosis or occlusion of the ACA, especially when patients present progressive symptoms despite maximal medical therapy.
Anterior Cerebral Artery ; Arteries ; Atherosclerosis ; Carotid Artery, Internal ; Cerebral Revascularization ; Constriction, Pathologic* ; Dysarthria ; Humans ; Infarction ; Magnetic Resonance Imaging ; Middle Aged ; Middle Cerebral Artery ; Stroke ; Temporal Arteries ; Transplants*

Despite the frequent occurrence of peritonitis in patients with continuous ambulatory peritoneal dialysis (CAPD), fungal peritonitis is uncommon and usually associated with antibiotics and immunodeficiency. Most of the fungal isolates are usually Candida albicans, Candida parapsilosis, Candida guilliermondii or Candida torulopsis. The authors report a case of fungal CAPD related peritonitis due to Candida zeylanoides that occurred in a patient with the absence of the usual risk factors for fungal peritonitis. Treatment with intravenous fluconazole was successful.
Anti-Bacterial Agents ; Candida ; Candida albicans ; Candida glabrata ; Candidiasis ; Fluconazole ; Humans ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Risk Factors

Situs inversus totalis (SIT) is a rare congenital condition in which the viscera are transposed as a mirror of normal physiologic arrangement. We describe a rare case of lingual thyroid associated with SIT. A 64-year-old female who was diagnosed with SIT, visited our clinic due to pharyngeal foreign body sensation. Physical examination revealed a 2.5x2.5x2.0 cm sized, pinkish, round mass in the base of the tongue. Computed tomography suggested the diagnosis of lingual thyroid. She has been on regular follow up with levothyroxine therapy. To our best knowledge, this is the first case of lingual thyroid (LT) associated with SIT. The literature is reviewed and clinical features about LT and SIT are presented.
Diagnosis ; Female ; Follow-Up Studies ; Foreign Bodies ; Humans ; Lingual Thyroid* ; Middle Aged ; Physical Examination ; Sensation ; Situs Inversus* ; Thyroxine ; Tongue ; Viscera

The appearance of a tumor in the chest wall is rare compared to that in any other part of the body. It can be classified into benign and malignant types and can be located in the rib, clavicle, sternum, cartilage and soft tissues. Tumors that are metastatic are commonly located in the lung, breast, bone and pleura. But, the soft tissue mass of anterior chest wall is rarely metastasized from a distant organ that is not confined to the thoracic cavity. This and thus has rarely been described. A 68-year-old man was admitted to our hospital with a chief complaint of resting dyspnea. A huge non-tender mass of about 10*15 cm in size was visible on his left lower anterior chest wall. We pathologically confirmed that the mass was a metastatic renal cell carcinoma of clear cell type by incision biopsy. Through an incision biopsy, the mass was pathologically confirmed as a metastatic renal cell carcinoma of the clear cell type.
Aged ; Biopsy ; Breast ; Carcinoma, Renal Cell* ; Cartilage ; Clavicle ; Dyspnea ; Humans ; Lung ; Neoplasm Metastasis* ; Pleura ; Ribs ; Sternum ; Thoracic Cavity ; Thoracic Wall* ; Thorax*

This paper reports a rare case of a left sided thyroid hemiagenesis associated with papillary carcinoma. Thyroid hemiagenesis is a rare congenital anomaly resulted from failure of development on one of the thyroid lobes. Among several thyroid developmental anomalies, hemiagenesis is considered to be the rarest anomaly. In world literature to date, only about 310 cases have been reported. We present a case of thyroid hemiagenesis of the left lobe and isthmus in a 51-year-old female, along with radiological and operative findings. Our report can give the idea that the thyroid hemiagenesis may not influence the development of parathyroid glands.
Carcinoma, Papillary* ; Female ; Humans ; Middle Aged ; Parathyroid Glands ; Thyroid Gland*

A new radiopharmaceutical, technetium-99m hexamethylpropyleneamine oxime(99mTc-HMPAO), has been reported to cross the blood-brain-barrier and to distribute in brain in proportion to regional blood flow. Measurement of cerebral blood flow with single photon emixxion computed tomography(SPECT) was performed using 99mTc-HMPO in 46 patients and clinical analysis was done. Decreased regional cerebral perfusion was observed in 41 cases. Moreover eight cases of them who had normal X-ray C-T scan revealed positive finding on SPECT. We porpose that 99mTc-HMPAO SPECT seems to be a useful diagnostic method for evaluation of ischemic cerebral lesions.
Brain ; Diagnosis* ; Humans ; Perfusion ; Regional Blood Flow ; Technetium Tc 99m Exametazime* ; Tomography, Emission-Computed, Single-Photon*

Spinal arachnoid cysts are relatively uncommon lesions that may be either intradural or extradural, while intradural spinal arachnoid cysts are even less common. The cysts are filled with clear, and colorless fluid nearly identical to cerebrospinal fluid. The origin of these cysts remains unclear although congenital, traumatic, and inflammatory causes have been postulated. These cysts are usually asymptomatic but may produce symptoms by compressing the spinal cord or nerve roots suddenly or progressively. The treatment of choice is surgical excision or fenestration, which is indicated when there are features of cord compression. We report a case of a thoracic spinal intradural arachnoid cyst in 13-year-old girl with chest pain.
Adolescent ; Arachnoid Cysts ; Arachnoid* ; Cerebrospinal Fluid ; Chest Pain* ; Female ; Humans ; Spinal Cord ; Thorax*

PURPOSE: The purpose of this study was to assess the usefulness of CT angiography(CTA) with spiral CT in evaluation of intracranial vascular lesions. MATERIALS AND METHODS: CTA and conventional angiography(CA) were performed in 22 patients with suspected intracranial vascular lesion. Nine patients had 10 aneurysms and 2 patients had arteriovenous malformation(AVM)s, while the remaining 11 patients had no vascular lesion. Twenty seconds after beginning injection of contrast media(100 mL with use of a power injector at the rate of 3 mL/sec), CT scanning(30-second continuous exposure and 60-mm length) was performed with a table speed of 2mm/sec and a section thickness of 2mm. The starting point was selected at the floor of the sella turcica. The resulting data were reformatted by MIP and SSD after reconstruction of 1 mm interval. For aneurysm, its size, shape, direction, neck and the relationship to adjacent vessels were compared to CA. RESULTS: The aneurysm diameter was ranged between 3mm and 20mm and all aneurysms were clearly visualized with CTA. CTA findings of the size, shape, direction, and neck of aneurysms and the relationship between aneurysm and adjacent vessels were well correlated with CA. In one case of aneurysm, calcification of the aneurysm wall was demonstrated on CTA. In one case of AVM, the nidus and its arterial supply and venous drainage were well visualized. In the other case of AVM, however, the feeding artery of AVM was not demonstrated on CTA(it was also unclear on CA). CONCLUSION: CTA with spiral CT may be useful in the evaluation of intracranial vascular lesion and valuable as a screening test for intracranial aneurysm.
Aneurysm ; Angiography* ; Arteries ; Drainage ; Humans ; Intracranial Aneurysm ; Mass Screening ; Neck ; Sella Turcica ; Silver Sulfadiazine ; Tomography, Spiral Computed*

PURPOSE: During crossover femoro-femoro-popliteal sequential bypass (CFFPB) surgery in ilio-femoral occlusive disease, proximal anastomosis of the femoro-popliteal bypass is usually performed distal to the distal anastomosis of the crossover femoro-femoral bypass. If not, it is done with a piggyback configuration. Another method is a side-to-side anastomosis. Its benefit is that this is the only anastomosis made. And it is less bulky compared with the piggyback configuration. This study was aimed to investigate the long-term outcome of CFFPB using side-to-side anastomosis. METHODS: From Sep 2006 to Aug 2012, 21 patients who underwent CFFPB using side-to-side anastomosis were enrolled. Externally supported polytetrafluoroethylene graft was used as a conduit in all patients. Patient demographic data and procedure details were investigated. Primary graft patency was calculated using the Kaplan-Meier method. RESULTS: The mean age of patients was 79 years (range, 62-81 years) and males were 17 (81%). Fifteen patients (71%) had critical limb ischemia. Inflow arteries comprised of 16 common femoral artery (CFA), 4 superficial femoral artery (SFA), and 1 deep femoral artery (DFA). Side-to-side anastomosis was performed on the CFA in 11, SFA in 2, and DFA in 8 patients. During the mean follow-up period of 21 months (1-60 months), 8 patients died. The 1-, 3-, and 5-year primary patency rates were 76%, 63%, and 63%. CONCLUSION: Long-term patency of CFFPB using side-to-side anastomosis was acceptable. It can be one of the treatment options for patients with ilio-femoral occlusive disease.
Arteries ; Extremities ; Femoral Artery ; Follow-Up Studies ; Humans ; Ischemia ; Male ; Polytetrafluoroethylene ; Transplants