Mucormycosis is a fatal opportunistic fungal infection that typically occurs in immunocompromised patients. The classical manifestation of mucormycosis is a rhinocerebral infection, and although primary gastrointestinal infection is uncommon, it has an extremely high mortality rate in immunocompromised patients. Furthermore, cases of gastrointestinal mucormycosis in an immunocompetent host are rarely reported. Here, we describe our experience of a male patient, with no underlying disease, who succumbed to a bowel infarction caused by intestinal mucormycosis during mechanical ventilatory care for severe pneumonia and septic shock.
Humans ; Immunocompetence ; Immunocompromised Host ; Infarction ; Male ; Mucormycosis ; Pneumonia ; Shock, Septic

PURPOSE: The purpose of this study was to evaluate the accuracy and the usefulness of MRI in patients with shoulder injuries. MATERIALS AND METHODS: The sensitivity and the accuracy of MRI in the diagnosis of various lesion were evaluated in 20 patients with shoulder injuries. RESULTS: MRI enabled Bankart lesions and SLAP lesions to be accurately predicted with 100% sensitivity and 90% accuracy in both. However, for types of SLAP lesions, the sensitivity and the accuracy were 60% and 70%, respectively, and for full-thickness or partial-thickness tear of rotator cuff, the sensitivity and the accuracy were 75% in both. MRI was also effective at predicting rotator cuff tear with 100% sensitivity and 95% accuracy. Sensitivity and accuracy for the diagnosis of Hill-Sachs lesion were 91.7% and 90%, respectively. For all lesions except Hill-Sachs lesion, the negative prediction value was higher than the positive prediction value, which means MRI overestimated the lesions. CONCLUSION: MRI was accurate and useful in the prediction of prediction of rotator cuff tear, labral tear and Hill-Sachs lesions. However, for the identification of full-thickness or partial-thickness tear of rotator cuff, and types of SLAP lesions, it was less accurate and less useful.
Diagnosis ; Humans ; Magnetic Resonance Imaging* ; Rotator Cuff ; Shoulder*

PURPOSE: To assess the clinical results of surgical treatment for established nonunion of the lateral humeral condyle and to determine the factors necessary for successful outcome. MATERIALS AND METHODS: 12 patients with nonunion of the lateral humeral condyle underwent open reduction, autogenous iliac bone graft and internal fixation with two smooth or treated K-wires between 1994 and 1999. Mean age was 16 years and the mean follow-up period was 2 years and 8 months. RESULTS: All of the patients achieved solid union at the nonunion site and were free of pain in the elbow upon strenuous activities. Average union time was 7.2 weeks after the surgery. Aggressive anatomical reduction of the fragment must not be undertaken because it may disturb a well adapted joint congruity in adults. Rigid internal fixation with iliac bone graft and preservation of the blood supply of the distal fragment are important factors for a successful outcome. The range of motion of the elbow joint decreased 10.5 degrees on average after surgery. Valgus deformity improved in four of six patients. CONCLUSION: The patients with symptomatic established nonunion are good candidates for surgery, even adults.
Adult ; Congenital Abnormalities ; Elbow ; Elbow Joint ; Follow-Up Studies ; Humans ; Joints ; Range of Motion, Articular ; Transplants

PURPOSE: To investigate the role of VEGF (vascular endothelial growth factor) and macrophage cells in the pathogenesis of diabetic frozen shoulders. MATERIALS AND METHODS: Five diabetic frozen shoulders which were resistant to conservative treatment were involved in this study. Synovial tissue was obtained during arthroscopic adhesiolysis. The synovial tissue of the shoulders from cadava dominators who had no history of shoulder joint disease was used for the control study. Immunohistochemical staining was performed with polyclonal antibodies against VEGF and CD68 macrophage/synovial antigen. RESULTS: Injection and hypertrophy of the synovium and thickening of the capsule were noted in all diabetic frozen shoulders. Strong immunostaining to VEGF and CD68 was observed in all diabetic frozen shoulders, whereas the control specimens showed little staining. CONCLUSION: From these results it would be postulated that the VEGF, synthesized and secreted by macrophage/synovial cells of the diabetic frozen shoulders stimulate regional angiogenesis which leads to synovitis and fibrosis could be one of the leading factors in the pathogenesis of frozen shoulders in diabetic patients.
Antibodies ; Bursitis* ; Fibrosis ; Humans ; Hypertrophy ; Macrophages ; Shoulder ; Shoulder Joint ; Synovial Membrane ; Synovitis ; Vascular Endothelial Growth Factor A*

STUDY DESIGN: This retrospective study was designed to investigate the effectiveness of surgical procedure for degenerative lumbar scoliosis. OBJECTIVES: To evaluate surgical outcome on symptomatic degenerative lumbar scoliosis and to analyze the cause of decompensation of the curve at the above segment adjacent to fused vertebra. SUMMARY OF LITERATURE REVIEW: Few studies evaluated the surgical outcome of patients with symptomatic degenerative lumbar scoliosis, and observed the postoperative deompensation of the curve at adjacent segment. MATERIALS AND METHODS: Thirty patients were retrospectively reviewed. All patients underwent decompressive laminectomy, transpedicular screw fixation, and intertransverse fusion by autogenous bone graft. Scoliotic angle within curves and within fused segments were measured by Cobb's method. Changes of the adjacent segment were analyzed. RESULTS: The overall satisfactory clinical results was noted in 25(83%) of 30 patients. The curve preoperative averaged 13.3 degrees +/- 4.0 degrees, 5.5 degrees +/-3.2 degrees after surgery and curves at final follow-up 8.6 degrees +/-6.2 degrees. In six patients(20%) decompensation of the curve with more than 5degrees occurred at the adjacent segment above to the fused segments. This decompensation of the curve closely correlated to the lateral translation at adjacent segments and postoperative pain. Sagittal profile was not significantly improved following surgery. CONCLUSIONS: Uncorrected lateral translation at the unfused adjacent segment resulted in progression of the coronal deformity at upper adjacent segment to fused vertebrae. Therefore, in fusion operation upper end vertebra with lateral instability should be included to prevent the postoperative decompensation.
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Laminectomy ; Pain, Postoperative ; Retrospective Studies ; Scoliosis* ; Spine ; Transplants

Primary leptomeningeal melanomas(PLMs) are rare aggressive central nervous system(CNS) tumors without systemic foci. It can be very difficult, however, to clearly distinguish PLMs from those that have metastasized. We report a case of malignant leptomenigeal melanoma occurring in the right temporal convexity of a 77-yearold woman. Almost all malignant CNS melanomas in the old are secondary to the cutaneous melanoma and can cause diverse neurological manifestations; certain clinical findings of the presented case-namely, the patient's age, vague neurologic findings and absence of cutaneous lesions -are therefore interesting. Thorough clinical checkups, including whole-body bone scan, whole spine MRI, abdominal ultrasound, and tumor marker studies to find extracranial lesions revealed no abnormalities. Based on these clinical findings, we suppose-though are not certain-that the tumor of the presented case is a PLM.
Female ; Humans ; Magnetic Resonance Imaging ; Melanoma* ; Neurologic Manifestations ; Spine ; Ultrasonography

Henoch-Shonlein(H-S) purpura, or anaphylactoid purpura is a hypersensitivity vasculitis characterized by palpable purpura usually on buttock and low extremities; arthralgia mostly polyarhtralgia in the absence of frank arthritis; gastraintestinal involvement with colicky abdominal pain, nausea, vomiting, diarrhea, constipation and bleeding; and renal involvement, manifested chiefly by hematuria and proteinuria. Gastrointestinal involvement is seen in 70 percent of pediatric patients and one third of adult patients. Any portion of the gastrointestinal tract distal to the esophagus maybe involved, but most frequently affected sites are jejunum and ileum. We report one case of H-S purpura with duodenal involvement observed in 16, male patient.
Abdominal Pain ; Adult ; Arthralgia ; Arthritis ; Buttocks ; Constipation ; Diarrhea ; Esophagus ; Extremities ; Gastrointestinal Tract ; Hematuria ; Hemorrhage ; Humans ; Ileum ; Jejunum ; Male ; Nausea ; Proteinuria ; Purpura* ; Purpura, Schoenlein-Henoch ; Vasculitis, Leukocytoclastic, Cutaneous ; Vomiting

PURPOSE: To assess the characteristic features of MR imaging in the diagnosis of spinal tuberculosis. MATERIALS AND METHODS: We retrospectively reviewed MR imaging of 27 cases with pathologically-proven spinal tuberculosis and analyzed the MR findings including the extent of the lesions on non-contrast T1, proton density, and T2*VI, and the specific contrast enhancement patterns of the lesion on Gd-DTPA enhnced TIWI. RESULTS: The inflammatory lesions showed low signal intensity on T1WI in 25 patients(93%) and high signal intensity on T2*gradient echo image in 25 patients(93%). Bone destruction was noted in 15 patients(55%), disc-space narrowing in 21 patients(77%), paravertebral abscess in 16 patients(59%), subligamentous extension in 23 patients(85%), kyphosis in 8 patients(29%), and spinal canal narrowing in 19 patients(70%). After Gd-DTPA was administrated, rim-enhancement was noted in all patients(100%). CONCLUSION: We conclude that MR imaging is an excellent imaging modality for establishing the diagnosis of spinal tuberculosis as well as delineating the extent of soft tissue involvement. Characteristic peripheral rim enhancement after injection of Gd-DTPA may provide rather specific diagnosis in spinal tuberculosis.
Abscess ; Diagnosis ; Gadolinium DTPA ; Kyphosis ; Magnetic Resonance Imaging* ; Protons ; Retrospective Studies ; Spinal Canal ; Tuberculosis, Spinal*

PURPOSE: To assess the MR findings of Tolosa-Hunt syndrome and to evaluat differential point of cavernous sinus lesions. MATERIALS AND METHODS: Eleven cases of Tolosa-Hunt syndrome were evaluated by MRI with specific regard to the shape of cavernous sinus, signal intensity, and pattern of enhancement. Other associated findings were also anlaysed. RESULTS: Two patients had normal MR features of the cavernous sinus. When compared with the contralateral normal cavernous sinus, the involved cavernous sinus was enlarged in six of the nine patients. The outer dural margin was convex and bulged laterally in 6 cases, flat in 2 cases, and concave in 1 case. Of the nine patients, five had iso-signal intensity and four had low signal intensity relative to gray matter on short TR/short TE. Three had isosignal intensity and 6 were not detectale on long TR/short and long TE pulse sequence. Contrast enhancement was seen in 8 cases ;7 cases showed homogeneous enhancement, 1 case heterogeneous enhancement. CONCLUSION: In the appropriate clinical setting of painful ophthalmoplegia, MR findings of cavernous sinus abnormality that consist of iso to low signal intensity on short TR/short TE images and isointense or undetectale mass on long TR/short TE or long TR/Iong TE images may suggest the dignosis of Tolosa-Hunt syndrome.
Cavernous Sinus ; Humans ; Magnetic Resonance Imaging ; Ophthalmoplegia ; Tolosa-Hunt Syndrome*

PURPOSE: The medial meniscus is injured much more than the lateral meniscus. Because the medial meniscus is much larger in diameter, is thinner in its periphery and narrower in body than the lateral meniscus, and does not attach to either cruciate ligament. We evaluated correlations with sites of tear and history of trauma. METHODS AND MATERIALS: We reviewed retrospectively in 43 patients with meniscal tears on MRI(51 cases) and correlated them with history of trauma. RESULTS: The most common site of injury was the posterior horn of the medial meniscus(32/51), but high incidence of lateral meniscal tear compared with previous reports was seen. In the cases which had history of trauma, the posterior horn of medial meniscus was most commonly injured(26/34) and 5 meniscal tears were combined with meniscal tear in the other site. The tear in the anterior horn of the medial meniscus was seen only in a patient which had history of trauma and combined with meniscal tear in the other site. But in the meniscal tears without definite history of trauma, the incidence of meniscal tear was different from the meniscal tear with history of trauma. The incidence of lateral meniscal tear(11/17) was highter than medial meniscal tear and the posterior horn of lateral meniscus was commonly injured. CONCLUSION: We concluded that the medial meniscus was commonly injured, especially posterior horn, but in the cases which had no definite history of trauma, the lateral meniscus was commonly ipjured. An awareness of prevalent site of meniscal injuries may be helpful in the diagnostic interpretation of MR imaging of knee.
Animals ; Horns ; Humans ; Incidence ; Knee ; Ligaments ; Magnetic Resonance Imaging* ; Menisci, Tibial ; Retrospective Studies