Livedo vasculitis or vasculitis of atrophie blanche is a clinical entity which can be distinguished from cutaneous vasculitis by distinctive pathology and immunopathologic study. A 18-year-old female with erythematous, telangiectatic, purpuric or hyperpigmented patches, intermingled with white atrophic ivory patches on her legs of 3 years duration was seen in June 3, 1982. The histologic examination of an atrophic patch showed proliferation and occlusion of blood vessels in the upper dermis with patchy atrophy of the epidermis. The immunopatbologic features of an atrophic patch revealed deposits of IgM, Ca and fibrin as a definitive immunofluorescence vessel pattern. This suggests that the livedo va.sculitis or vasculitis of atrophie blanche may he considered one of the immune vasculitides. This patient had received aspirin and persantine for 4 months, and moderate therapeutic effects could be noticed.
Adolescent ; Aspirin ; Atrophy ; Blood Vessels ; Dermis ; Dipyridamole ; Epidermis ; Female ; Fibrin ; Fluorescent Antibody Technique ; Humans ; Immunoglobulin M ; Leg ; Pathology ; Vasculitis*

Most insects including the honeybee cause erythema and edema at the site of a sting in non-allergic individuals. This reaction usually resolves within a few days. However, in certain cases, the persistence of inciting materials in the cutaneous tissue may promote a local inflammatory foreign body reaction. Localized nodular lesions were seen in our two patients and erythemstous patches were present in one patient due to rarely encountered complications induced by retained sting materials. In these cases histopathology showed multiple foci of foreign body granuloma containing yellow refraetile material in the center surrounded by histiocytes and foreign body giant cells. The granulomatous skin lesions in these patients were treated with intralesional injections of triamcinolone acetonide and partial excisions of the nodular masses were performed.
Bites and Stings ; Edema ; Erythema ; Foreign-Body Reaction ; Giant Cells, Foreign-Body ; Granuloma* ; Granuloma, Foreign-Body ; Histiocytes ; Humans ; Injections, Intralesional ; Insects ; Skin ; Triamcinolone Acetonide

Lateral osteotomy has been chosen as a part of rhinoplasty for modification of the nasal bony vault, alteration of the base width of the lateral walls, establishment of a new profile line of the nasal dorsum and lateral profile line, and closure of the open roof. Various methods of lateral osteotomy may be employed, however Orientals have characteristically broad and flat noses Compared to caucasians and for an esthetically satisfactory result, it is important to correct both in rhinoplasty. In this study, the authors performed their devised method of lateral osteotomy in 12 patients for the correction of broad, flat nasal dorsum and deviated noses. The operations could be broadly categorized into two groups: 1) short lateral osteotomy in which the lateral osteotomy line was incomplete and short, extending to the infraorbital rim; and 2) green-stick transverse osteotomy which was induced by in-siturotation fracture by osteotomy and, if considered necessary, augmentation rhinoplasty and nasal tip plasty were also performed simultaneously. Our nasal osteotomy has limited mobilization, where as the previous method has total mobilization, and it has the advantages of repositioning the broad and deviated nose in a preferable direction and shape, as well as the capability of narrowing the preferable area selectively. Especially if there is a necessity to correct both broad and flat noses such as in Orientals, our osteotomy methods have a synergistic effect in esthetic outcome when performed with augmentation rhinoplasty with a silastic implant. There were no complications such as relapse or air-way obstruction during the 4.5-month follow-up period. However, a long-term follow-up period is needed to evaluate the complications considering the physiologic aspect of the nose.
Follow-Up Studies ; Humans ; Nose ; Osteotomy* ; Recurrence ; Rhinoplasty*

Lymphangioma circumscriptum is a rare disease and the lesions are indistinguishable, clinically and histologically, from lymphangiectasis. The only difference is that lymphangiectasis is usually bilateral and develops in adult or late life, ie, condary to irradiation, surgical interruption, or some malignancies, but lymphangioma circumscriptum is congenital disease or develops soon after birth.
Adult ; Humans ; Lymphangiectasis ; Lymphangioma* ; Parturition ; Rare Diseases

We describe the case of a 45-year-old woman who had self-regressing livedo reticularis on the lower extremities. Examination of a biopsy specimen from the mottled area revealed myxomatous emboli in the deep dermal arterioles. Echocardiography showed a myxoma in the left atrium. After the tumor was surgically excised, the patient had no further evidence of the disorders during the 3-year period of follow-up. Livedo reticularis caused by an peripheral arterial embolism, which in turn was caused by the tumor fragments in our patient with left atrial myxoma, is considered to be unusual.
Arterioles ; Biopsy ; Echocardiography ; Embolism ; Female ; Follow-Up Studies ; Heart Atria ; Humans ; Livedo Reticularis* ; Lower Extremity ; Middle Aged ; Myxoma*

BACKGROUND AND PURPOSE: For the diagnosis of amyotrophic lateral sclerosis(ALS), symptoms and signs of upper motor neuron(UMN) and lower motor neuron(LMN) involvement should be confirmed. The electromyography(EMG) studies are known to be essential for the demonstration of LMN involvement. The authors assessed the value of the EMG in the diagnosis of ALS. METHODS: The authors collected 51 patients (M:F=31:20, age:51.9?12.0 years) who were diagnosed and followed up at Seoul National University Hospital from 1994 to 1996. Diagnosis of ALS was based on the El Escorial diagnostic criteria. They were classified to be definite in 5, probable in 23, and possible in 23. On view of the affected area of onset, they consisted of 12 bulbar and 39 spinal form of ALS. The needle EMG studies were performed in limb, thoracic paraspinal and tongue muscles. RESULTS: Of 51 cases, it was possible to demonstrate widespread denervations at the initial needle EMG tests in 46(90.2%); 5 of 5 definite, 21 of 23 probable, and 20 of 23 possible ALS. Among 30 spinal form ALS without bulbar symptoms, the initial EMG evaluation showed the widespread denervation processes in three limbs in 13(43.3%) and in two limbs in 17(56.7%). Of 17 patients with denervation in only two limbs, the thoracic paraspinal and tongue muscles were found to be involved in 7 and 5 cases, respectively. The other 5, who initially showed abnormal EMG in limited muscles without abnormal EMG finding in thoracic paraspinal and tongue muscles, were confirmed to have ALS by the clinical and EMG follow-up. Nine patients of spinal onset ALS with bulbar symptoms and 12 patients of bulbar onset showed widespread denervation features at the tongue and limb muscles. In 6 ALS cases, difficult to be differentiated from spondylotic myeloradiculopathy, the abnormal EMG features in thoracic paraspinal and bulbar muscle were helpful to diagnose ALS. CONCLUSION: The authors could diagnose ALS in most cases(90.2%) at the time of initial EMG evaluation. The needle EMG study with the regular follow-up is useful to diagnose ALS. Moreover, the needle EMG study on thoracic paraspinal and tongue muscle is much helpful to differentiate ALS from spondylotic myeloradiculpathy.
Amyotrophic Lateral Sclerosis* ; Denervation ; Diagnosis* ; Electromyography* ; Extremities ; Follow-Up Studies ; Humans ; Muscles ; Needles* ; Seoul ; Tongue

Objective: This study aimed to evaluate the diagnostic value of combining the quantitative parameters of shear waveelastography (SWE) and superb microvascular imaging (SMI) to breast ultrasound (US) to differentiate between benign andmalignant breast masses. Materials and Methods: A total of 200 pathologically confirmed breast lesions in 192 patients were retrospectively reviewedusing breast US with B-mode imaging, SWE, and SMI. Breast masses were assessed based on the breast imaging reporting anddata system (BI-RADS) and quantitative parameters using the maximum elasticity (Emax) and ratio (Eratio) in SWE and thevascular index in SMI (SMIVI). The area under the receiver operating characteristic curve (AUC) value, sensitivity, specificity,accuracy, negative predictive value, and positive predictive value of B-mode alone versus the combination of B-mode US withSWE or SMI of both parameters in differentiating between benign and malignant breast masses was compared, respectively.Hypothetical performances of selective downgrading of BI-RADS category 4a (set 1) and both upgrading of category 3 anddowngrading of category 4a (set 2) were calculated. Results: Emax with a cutoff value of 86.45 kPa had the highest AUC value compared to Eratio of 3.57 or SMIVI of 3.35%. Inset 1, the combination of B-mode with Emax or SMIVI had a significantly higher AUC value (0.829 and 0.778, respectively)than B-mode alone (0.719) (p< 0.001 and p= 0.047, respectively). B-mode US with the addition of Emax, Eratio, and SMIVIhad the best diagnostic performance of AUC value (0.849). The accuracy and specificity increased significantly from 68.0%to 84.0% (p< 0.001) and from 46.1% to 79.1% (p< 0.001), respectively, and the sensitivity decreased from 97.6% to 90.6%without statistical loss (p= 0.199). Conclusion Combining all quantitative values of SWE and SMI with B-mode US improved the diagnostic performance indifferentiating between benign and malignant breast lesions.

In a retrospective study of 21 patients, in whom the acetabular fractures were suspected on initialradiographs, we compared and analysed the CT findings and plain radiographic findings and plain radiographicfindings. The results were as follow: 1. In patients with multiple trauma, no further change in position wasrequeired during CT examinations. 2. CT showed intraarticular loose bodies, which were invisible on plainradiographs. 3. CT was useful in detecting the fractures of acetabular rims, medial wall of acetabulum, andfemoral head. 4. CT permitted better evaluation of shape, extent, and degree of separation of fracture fragments.5. CT was helpful indetecting the associated fractures and soft tissue injuries. 6. CT also demonstrated theadequacy of reduction, the position of metallic fixation devices, and the presence or absence of remainingintraarticular osseous fragments after surgery.
Acetabulum ; Head ; Humans ; Multiple Trauma ; Retrospective Studies ; Soft Tissue Injuries

Rapid eye movement (REM) sleep behavior disorder (RBD) is a prodromal stage for major neurodegenerative diseases, particularly α-synucleinopathies. Recently, the spectrum of RBD is expanding and its prodromal state has been recognized and categorized into isolated REM sleep without atonia and isolated dream-enacting behavior. Although unclear, prodromal RBD frequently occurs in the aged population, with a significantly high phenoconversion rate to RBD and an increased risk of developing neurodegenerative disorders. More active and structured general surveillance of this condition may contribute to the effective modulation of major neurodegenerative diseases. However, the clinical and polysomnographic profiles of prodromal RBD, methods for effective screening and diagnosis of prodromal RBD, and biomarkers for disease progression and phenoconversion must be investigated.

Rapid eye movement (REM) sleep behavior disorder (RBD) is a prodromal stage for major neurodegenerative diseases, particularly α-synucleinopathies. Recently, the spectrum of RBD is expanding and its prodromal state has been recognized and categorized into isolated REM sleep without atonia and isolated dream-enacting behavior. Although unclear, prodromal RBD frequently occurs in the aged population, with a significantly high phenoconversion rate to RBD and an increased risk of developing neurodegenerative disorders. More active and structured general surveillance of this condition may contribute to the effective modulation of major neurodegenerative diseases. However, the clinical and polysomnographic profiles of prodromal RBD, methods for effective screening and diagnosis of prodromal RBD, and biomarkers for disease progression and phenoconversion must be investigated.