In this report, we describe a rare case of pudendal neuropathy caused by deep-layer penetration of the sacrotuberous ligament (STL), accompanied by perineural venous engorgement, and emphasize its diagnostic and surgical implications. The patient was a 65-year-old man who presented with a 15-year history of left-sided perineal and testicular pain that was markedly exacerbated by sitting and partially relieved by standing or lying down. Pelvic magnetic resonance imaging (MRI) demonstrated asymmetry of the left pudendal nerve, with prominent perineural venous engorgement adjacent to the STL. Conservative treatment failed to provide adequate symptom relief; therefore, transgluteal pudendal nerve decompression was performed. Intraoperatively, the pudendal nerve was found to penetrate the deep layer of the STL and was tightly constricted at the penetration site, with marked venous engorgement. Layer-by-layer release of the deep STL achieved complete neural decompression, followed by gradual collapse of the engorged veins. Postoperatively, the patient experienced immediate and sustained pain relief, with improved tolerance for sitting. Follow-up MRI demonstrated resolution of the venous engorgement and normalization of the perineural soft-tissue signal. In summary, deep-layer penetration of the pudendal nerve through the STL, with associated venous congestion, is rare but clinically significant in pudendal neuropathy. Recognition of this anatomical variant and careful assessment of perineural venous engorgement on MRI may improve diagnostic accuracy and inform layer-by-layer surgical decompression in patients with refractory pudendal neuralgia.

Objective: Posterior interosseous nerve (PIN) syndrome (PINS) is a compressive neuropathy of the deep branch of the radial nerve that primarily presents with motor weakness of finger and thumb extension. Although some patients respond to conservative management, others develop persistent motor deficits requiring surgical decompression. This study aimed to evaluate the clinical outcomes of external neurolysis in patients with PINS presenting with refractory motor weakness. Methods: Seven patients with clinically diagnosed PINS who exhibited persistent motor weakness despite conservative treatment and subsequently underwent surgical decompression were retrospectively reviewed. Clinical characteristics, magnetic resonance imaging (MRI) findings, intraoperative compression sites, and postoperative motor recovery were analyzed. Motor strength was evaluated using the Medical Research Council grading system. Preoperative and postoperative motor strength grades were compared using the Wilcoxon signed-rank test. Results: The patients presented with progressive weakness of finger extension, resulting in impaired hand opening. MRI demonstrated denervation-related signal changes and atrophy in the affected muscles innervated by the PIN. Surgical exploration revealed compressive structures within the radial tunnel, most commonly at the arcade of Frohse. Significant improvement in motor strength was observed within 2 months postoperatively (thumb extension, p = 0.018; second digit extension, p = 0.011; third to fifth digit extension, p = 0.009). One patient experienced symptom recurrence approximately 6 months after the initial surgery and subsequently underwent revision decompression. Conclusion External neurolysis provides meaningful recovery of finger extension in patients with PINS presenting with refractory motor weakness. MRI may support the diagnosis by demonstrating denervation-related morphological changes in the affected muscles. Recurrence of PINS may occur even after initial recovery, highlighting the importance of careful postoperative follow-up.

Background: Laugier-Hunziker syndrome (LHS) is a rare, benign, acquired disorder that is usually characterized by hyperpigmentation of the oral cavity and lips, along with longitudinal melanonychia. Till date, its characteristics have not been investigated in a large number of patients in a single-center study. Objective: This study aimed to investigate the clinical, dermoscopic, and histological characteristics of LHS. Methods: We retrospectively reviewed the medical records, biopsy specimens, and clinical and dermoscopic photographs of 21 patients diagnosed with LHS at Pusan National University Hospital (Busan and Yangsan) over a period of 15 years (2008∼2022). Results: Among the 21 patients, 20 patients (95.2%) were female and one patient (4.8%) was male, and the mean age was 56.0 years (range: 18∼75 years). The lower lip (95.2%) was the most frequently affected oral mucosa, followed by the upper lip (81.0%), buccal mucosa (66.7%), tongue (57.1%), gingiva (42.9%), and palate (14.3%). The nails were the most commonly affected extraoral site, and in our study, eight of 21 patients (38.1%) presented with periungual lesions. Based on the dermoscopic findings, a globular pattern was the most common. Histologically, the lesions showed epithelial acanthosis and increased basal keratinocyte melanin without an increase in the number of melanocytes. Conclusion This is the first study to investigate the clinical, dermoscopic, and histological characteristics of patients with LHS. The results of this study could be helpful in understanding LHS.

PURPOSE: Challenging iliac anatomy remains an important issue during endovascular aneurysm repair (EVAR), and it is known that the length of the common iliac artery (CIA) is shorter in Asians than in Western groups. We analyzed both the iliac anatomy and the incidence of adjunctive maneuvers to overcome iliac artery-related difficulties during EVAR. METHODS: Seventy-four EVARs were performed for abdominal aortic aneurysm between January 2010 and March 2013. Patient demographic data, iliac anatomical characteristics (presence of iliac artery aneurysm, iliac artery diameter and length, and iliac tortuosity), and adjunctive iliac artery maneuvers were reviewed retrospectively. RESULTS: Mean CIA length was 52.8 mm (range, 6.6-98.0 mm) on the right and 56.3 mm (range, 0-94.8 mm) on the left. CIA length was > or =20 mm, except in one patient with bilateral short CIAs. Forty patients (54%) had a CIA aneurysm, and 18 had aneurysms on both sides. Iliac adjunctive procedures were performed in 38 patients (51%) as follows: 23 internal iliac artery (IIA) embolizations or ligations, seven IIA revascularizations, 16 external iliac artery (EIA) balloon angioplasties or stenting, one EIA patch angioplasty, one EIA interposition, two femoral endarterectomies with patch angioplasty, and nine femoro-femoral bypasses after EVAR with an aorto-uni-iliac device. Technical success for the adjunctive iliac procedures was achieved in all patients. CONCLUSION: Short CIA length was uncommon. Although many patients had access-related difficulties, most were overcome by an endovascular or hybrid technique. Liberal use of iliac adjunctive procedures can facilitate EVAR.
Aneurysm ; Angioplasty ; Aortic Aneurysm, Abdominal* ; Arteries ; Asian Continental Ancestry Group ; Endarterectomy ; Endovascular Procedures ; Humans ; Iliac Aneurysm ; Iliac Artery ; Incidence* ; Ligation ; Retrospective Studies ; Stents

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