OBJECTIVE: We report here on analyzing 3,128 subjects with stroke and who were discharged from the Departments of Rehabilitation Medicine of secondary or tertiary hospitals, and all the hospitals subscribed to the Online Database System developed by the Korean Society of Neurorehabilitation. METHOD: This is a retrospective analysis of the brain rehabilitation registry database for outcome of stroke outcome in the year 2006 to 2008. RESULTS: The male stroke subjects and cerebral infarction were 58.4% and 66.3%, respectively. Cerebral infarction in the middle cerebral artery territory was the most common, and the basal ganglia and cerebral cortex were the common areas for the cases of intracranial hemorrhage. The mean age of the patients was 61.7 years, and the most common ages were 45~64 years for all the stroke subjects. The subjects with cerebral hemorrhage (56.1 years) were younger than those with cerebral infarction (63.9 years). Seasonal variation was observed in the occurrence of stroke; spring (34.1%), winter (27.4%), summer (21.6%) and autumn (16.8%) in this order. There was no significant difference of the changes on the Korean version of the modified Barthel index between the patients with cerebral infarction and cerebral hemorrhage after rehabilitation. On analyzing the two groups of stroke subjects admitted before and after 100 days from stroke onset, the changes on the Korean version of the modified Barthel index and the Brunnstrom stage scores of the early admission group were higher that those of the late rehabilitation group. CONCLUSION: The above findings suggest that 1) the incidence, lesion sites and seasonality of stroke in this database system are similar to those of the worldwide data, 2) the length of hospital stay for the subjects with stroke is about 46 days and 3) early rehabilitation is more effective in improving the outcome of stroke subjects.

Spinal dural arteriovenous fistulas are rare abnormal connections of arteries and veins on the surface of the dura. A male presenting with myelopathy, which had a slowly progressive course for about 28 months, was diagnosed by magnetic resonance imaging and selective angiography. After surgical coagulation and excision, his symptoms were mildly improved. We report here on a man who underwent a surgical procedure for his myelopathy that was due to spinal arteriovenous fistula. Although it is unusual, spinal arteriovenous fistula should be considered when making a differential diagnosis of myelopathy.
Angiography ; Arteries ; Arteriovenous Fistula ; Central Nervous System Vascular Malformations* ; Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; Male ; Spinal Cord Diseases* ; Veins

BACKGROUND/AIMS: To evaluate the clinical outcomes of the percutaneous cholangioscopic ethanol injection in the hepatocellular carcinoma (HCC) invading the bile duct, we conducted a retrospective study. METHODS: Ten patients who received the percutaneous cholangioscopic ethanol injection were selected patients were diagnosed as HCC invading the bile duct between January 1998 and February 2004. Treatment response, complications, survival or death and survival time were analyzed. RESULTS: Ten patients received mean of 5.3 sessions (range 2~19) of cholangioscopic ethanol injection. Eight patients had decreased tumor mass, and the rest 2 patients had no response. Complications were pain (n=10), hemobilia (n=6: bleeding was minimal), cholangitis (n=2), bile duct rupture (n=1), and bile duct stricture (n=1). Nine patients died from severe hepatic failure and sepsis, one patient has survived for 19 months as of now. Median survival time was 5 months (range 2~19 months). Percutaneous transhepatic biliary drainage (PTBD) could be removed in two patients. CONCLUSIONS: Percutaneous cholangioscopic ethanol injection in HCC invading the bile duct showed size reduction of mass. PTBD could be no longer needed in some patients. However, supportive cares such as PTBD may be appropriate considering their short survival period and risk of procedure.
Bile Ducts* ; Bile* ; Carcinoma, Hepatocellular* ; Cholangitis ; Constriction, Pathologic ; Drainage ; Ethanol* ; Hemobilia ; Hemorrhage ; Humans ; Liver Failure ; Retrospective Studies ; Rupture ; Sepsis

BACKGROUND/AIMS: The management of small-bowel perforations associated with endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic sphincterotomy (EST) is still controversial. The purpose of this study was to analyze the treatment and outcome of patients with ERCP-related perforations in a single tertiary medical center. METHODS: Of 18,379 cases of ERCPs performed between January 1990 and December 2003, twenty-six patients (0.14%) with perforation were identified and medical chart were reviewed retrospectively. RESULT: EST were performed in 10,231 patients and perforation occurred in 18 patients. Four out of 18 patients with small-bowel perforation related to EST underwent surgical operation and the rest 14 patients recovered with conservative treatment alone. Of the rest 8 perforation patients unrelated to EST, perforation occurred during the insertion of endoscope in 7 patients and catheter manipulation in 1 patient. All but one perforations associated with mechanical injury by endoscope itself were managed with an emergent laparotomy, and the one patient with perforation related to catheter manipulation recovered with conservative treatment. CONCLUSIONS: A small-bowel perforation related to endoscope per se usually required a surgery, but sphincterotomy related perforations rarely did so. The prevalence and mortality rate of small-bowel perforations associated with ERCP and/or EST were 0.14% and 0%, respectively, in a single tertiary medical center.
Catheters ; Cholangiopancreatography, Endoscopic Retrograde ; Endoscopes ; Humans ; Laparotomy ; Mortality ; Prevalence ; Retrospective Studies ; Sphincterotomy, Endoscopic

Lipoma is the most common soft tissue tumor, but among the rarest tumors of the bone. The first case, reported by Cornil and Renvier in 1868 was a lipoma in the diaphysis of the femur. In Korea, 12 cases of intraosseous lipoma have been reported. A 42-year-old woman presented with a radiolucent lesion that was well marginated, lobulated, and had a sclerotic border by radiographic findings of the proximal humerus taken after a traffic accident. Magnetic resonance imaging and biopsy were performed for diagnosis. Histologically, the lesion was compatible with intraosseous lipoma. Intralesional curettage with a bone graft was performed. No recurrence was evident at the 1 year follow-up. We report a case of intraosseous lipoma that arose in the proximal humerus and include a review of the literature.
Accidents, Traffic ; Adult ; Biopsy ; Curettage ; Diagnosis ; Diaphyses ; Female ; Femur ; Follow-Up Studies ; Humans ; Humerus* ; Korea ; Lipoma* ; Magnetic Resonance Imaging ; Recurrence ; Transplants

Castleman's disease is a rare lymphoproliferative disorder of uncertain etiology which most commonly occurs in the mediastinum. We describe a case of a benign Castleman 's disease of the hyaline vascular type affecting the upper extremity, an extremely rare site of the disease.
Giant Lymph Node Hyperplasia* ; Hamartoma ; Hyalin ; Lymphoproliferative Disorders ; Mediastinum ; Upper Extremity*

Lithium has been established as a drug useful for the treatment of manic depressive disorder. It is now well recognized that long-term administration of this drug is associated with various antithyroid effects such as goiter, and subclinical and overt hypothyroidism. However, it has been associated less commonly with thyrotoxicosis. Recently we experienced a case of thyroitoxicosis during lithium therapy. A 24-year-old man treated with lithium carbonate 900 mg-1,200 mg/day for manic-depressive illness for four weeks. He then complained of nervousness, palpitation, tremor, heat intolerance, and sweating. Neck pain was not noted. At that time the results of thyroid function test were consistent with hyperthyroidism: T3 568.8 ng/dL, TSH 0.01 mU/mL, FT4 6.0 ng/dL, but 24 hr radioiodine uptake was 0.3%. We suspected this case as lithium induced thyrotoxicosis and discontinued lithium administration. After discontinuation of lithium thyrotoxic symptoms were subsided. One month later, thyroid hormon levels became normalized: T 100.2 ng/dL, TSH 0.06 mU/mL, FT4 0.97 ng/dL and 24hr radioiodine uptake was 16%. We report this case with review of literatures.
Antithyroid Agents ; Anxiety ; Depressive Disorder ; Goiter ; Hot Temperature ; Humans ; Hyperthyroidism ; Hypothyroidism ; Lithium Carbonate ; Lithium* ; Neck Pain ; Sweat ; Sweating ; Thyroid Function Tests ; Thyroid Gland ; Thyrotoxicosis* ; Tremor ; Young Adult

There has been considerable controversies in the method of the treatment of dislocation of the acromioclavicular joint, especially in grade III injury. It is hard to give a direct firm repair having a short ruptured coracoclavicular ligament. Thats why there are lots of difficulties in the treatment. Therefore, in operative treatment, the authors make use of cotton tape on coracoid process and clavicle as a reconstructive technique, because we have thought a simple fixation of acromioclavicular joint adding to a firm fixation of clavicle and coracoid process is inevitable. From January 1991 to December 1995, twenty-nine cases of grade III acromio-clavicular dislocation were treated by the modified Phemister method with using the cotton tape. Twenty-four patients were followed for an average of fifteen months and the following results were obtained. 1. The clinical results were evaluated by Weitzman criteria after average fifteen months follow up. An excellent result was obtained in 19 cases (79.2%), a good result in 3 cases (12.5%) and a fair result in 2 cases (8.3%), consecutively. 2. Clinical result in patients over 60-year old were bad. 3. The comparison of the coracoclavicular interval ratio before surgery with that after surgery facilitated the evaluation of effectiveness of the coracoclavicular ligament reconstruction. 4. The operative technique is through temporary fixation using K-wires which endows horizontal stability, and it fixes clavicle and coracoid process using cotton tape which endows vertical stability.
Acromioclavicular Joint ; Clavicle ; Dislocations* ; Follow-Up Studies ; Humans ; Ligaments ; Middle Aged

PURPOSE: The purpose of this study is to illustrate MR patterns of signal intensity of proximal femur in normal subjects according to the age distribution. METHOD AND MATERIAL: Tl-weighted MR images of the proximal femur in 125 subjects, aged 13 days to 25 years, were retrospectively analyzed. Age distribution was classified to 4 groups;below 4 months, 5 months to 4 years, 5 years to 14 years, and 15 years to 25 years. RESULTS: By the age of 4 months, the non-ossified femoral epiphysis was seen as intermediate-signal-intensity cartilage. At 5 months-4 years, the ossified fernoral capital epiphysis was seen within intermediate-signal-intensity cartilage and appeared as decreased or increased signal-intensity red or yellow marrow surrounded by a rim of low-signal-intensity cortical bone. At 5-14 years, the ossified femoral capital and greater trochanteric epiphysis were seen within the intermediate-signal-intensity cartilage and appeared as decreased or increased signal-intensity red or yellow marrow. At 15-25 years, the proximal metaphyseal marrow showed increased signal intensity. Four patterns of the metaphyseal marrow were recognized by Ricci et al. The frequency of pattern la progressively decreased with age. Pattern 2 and 3 were visible in the 15-25 years age group. CONCLUSION: An understanding of the spectrum of normal age-related change of the proximal femoral cartilage and marrow patterns serves as the foundation for interpretation of proximal femur pathologies.
Age Distribution ; Bone Marrow ; Cartilage ; Epiphyses ; Femur* ; Humans ; Magnetic Resonance Imaging* ; Pathology ; Retrospective Studies

False aneurysm has been recognized for many years. Incomplete severance of an artery as the result of trauma is thought to be the precipitating factors in the formation of false aneurysm. False aneurysm of the peripheral artery is presented with pulsating mass and may show extrinsic indentations of the adjacent bone with or without neurovascular symptoms, mimicking a malignant tumor. But careful history taking can reveal a proceeding deep penetrating injury variable period prior to development of symptoms. We are reporting two cases of false aneurysm of the superior gluteal artery and superficial femoral artery in each after trauma.
Aneurysm, False ; Arteries ; Femoral Artery ; Precipitating Factors