Ultrasound-guided core needle biopsy (US-CNB) is an important step in the diagnosis of musculoskeletal soft-tissue lesions. To maximize efficacy and minimize the complications of US-CNB, it is critical to collaborate with a multidisciplinary team and to understand the particular considerations of US-CNB for these lesions. The purpose of this article is to provide a systematic review and step-by-step tips for using US-CNB to diagnose musculoskeletal soft-tissue lesions.
Biopsy, Large-Core Needle* ; Diagnosis ; Image-Guided Biopsy ; Soft Tissue Neoplasms ; Specialization* ; Ultrasonography

The computational fluid dynamics methods for the limited flow rate and the small dimensions of an intracranial artery stenosis may help demonstrate the stroke mechanism in intracranial atherosclerosis. We have modeled the high wall shear stress (WSS) in a severe M1 stenosis. The high WSS in the systolic phase of the cardiac cycle was well-correlated with a thick fibrous cap atheroma with enhancement, as was determined using high-resolution plaque imaging techniques in a severe stenosis of the middle cerebral artery.
Blood Flow Velocity ; *Cerebral Angiography ; Cerebrovascular Circulation ; Computational Biology ; Humans ; Image Interpretation, Computer-Assisted ; Imaging, Three-Dimensional ; Intracranial Arteriosclerosis/*diagnosis ; *Magnetic Resonance Angiography ; Shear Strength ; Software ; Systole

Intestinal malrotation with volvulus is generally presented as a bilious vomiting and acute intestinal obstruction in the newborn period. It could compromise vascular supply of the small bowel secondary to torsion of superior mesenteric artery (SMA) and without urgent surgical management, it could lead to detrimental outcomes such as transmural bowel infarction and sepsis. However, in chronic cases, it is rarely obstructs the vascular supply and propagates to an acute bowel infarction. Rarely, chronic malrotation with midgut volvulus may not reduce the mesenteric blood supply because of collateral vessels, and the chronically stagnated blood flow of the superior mesenteric vein (SMV) favors thrombus formation within the lumen. The recommended treatment is Ladd's procedure and anticoagulation therapy. The authors present an unusual case of intestinal malrotation with chronic volvulus resulting in superior mesenteric vein and portal vein thrombosis in a 28-year-old patient.
Adult ; Humans ; Infant, Newborn ; Infarction ; Intestinal Obstruction ; Intestinal Volvulus ; Mesenteric Artery, Superior ; Mesenteric Veins ; Portal Vein ; Sepsis ; Thrombosis ; Vomiting

PURPOSE: Computational fluid dynamics (CFD) applications for atherosclerotic carotid stenosis have not been widely used due to limited resolution in the severely stenotic lumen as well as small flow dimension in the stenotic channel. MATERIALS AND METHODS: CT data in DICOM format was transformed into 3 dimensional (3D) CFD model of carotid bifurcation. For computational analysis of blood flow in stenosis, commercial finite element software (ADINA Ver. 8.5) was used. The blood flow was assumed to be laminar, viscous, Newtonian, and incompressible. The distribution of wall shear stress (WSS), peak velocity and pressure across the average systolic and diastolic blood pressures permitted construction of a contour map of the velocity in each cardiac cycle. RESULTS: Computer simulation of WSS, flow velocity and wall pressure could be demonstrated three dimensionally according to flow vs. time dimension. Such flow model was correlated with angiographic finding related to maximum degree of stenosis associated with ulceration. Combination of WSS map and catheter angiogram indicated that the highest WSS corresponded to the most severely stenotic segment at systolic phase, whereas ulceration, which is the weakest point of the plaque, appeared at the downstream side of the carotid bulb stenosis. CONCLUSION: Our preliminary study revealed that 3D CFD analysis in carotid stenosis was feasible from CT angiography source image and could reveal WSS, flow velocity and wall pressure in the severe carotid bulb stenosis with ulceration. Further CFD analysis is warranted to apply such hemodynamic information to the atherosclerotic lesion in the more practical way.
Angiography ; Carotid Arteries ; Carotid Stenosis ; Catheters ; Computer Simulation ; Constriction, Pathologic ; Hemodynamics ; Hydrodynamics ; Ulcer

Cutaneous metastases from follicular thyroid carcinoma are extremely rare. A 59-year-old woman presented with a 1 month history of a slowly enlarging scalp nodule. Ten years earlier, the patient had been received total thyroidectomy for anterior neck mass, and diagnosed as poorly differentiated follicular thyroid carcinoma. The patient had developed pulmonary metastases 4 years after the initial surgery and concurrent chemotherapy. A biopsy from the scalp nodule showed an intradermal tumor composed of mostly thyroid follicular structures with colloid material. The tumor cells were monomorphic with scant pale cytoplasm and uniform nuclei, and stained positive for thyroid transcription factor-1 and thyroglobulin. We report a cutaneous metastasis from the follicular thyroid carcinoma as a rare case.
Adenocarcinoma, Follicular ; Biopsy ; Colloids ; Cytoplasm ; Female ; Humans ; Middle Aged ; Neck ; Neoplasm Metastasis ; Scalp ; Thyroglobulin ; Thyroid Gland ; Thyroidectomy

PURPOSE:The purpose of this study was to assess the effect of long-term and differing frequency of on-line hemodiafiltration (OL-HDF) on changes in degree of hemoglobin, albumin level, serum small and middle molecules concentration in stable patients with undergoing high-flux hemodialysis (HF-HD). METHODS:Twenty five patients with more than 3 months of HF-HD were divided into two groups and followed for more than 36 months. Group 1 was treated once with OL-HDF and twice with HF-HD per week. Group 2 was treated three times with OL-HDF per week. Analysis was performed to compare hemoglobin, biochemical parameters, serum beta-microglobulin, leptin, alpha-microglobulin levels in both groups. RESULTS:There were significant improvements in hemoglobin and albumin level in group 2 compared to group 1. After receiving OL-HDF for a mean of 24 months, patients on both groups had the significantly reduced predialysis level of beta-microglobulin compared to baseline level. However, there is no significant difference in beta-microglobulin level between both groups. The predialysis level of leptin and alpha-microglobulin with relatively large molecular weight was not significantly reduced during observational period and was not significantly different between both groups. CONCLUSION:There were improvements in hemoglobin and albumin level according to the frequency of OL-HDF. The predialysis level of beta-microglobulin was significantly reduced after receiving even once with OL-HDF per week for long-term. Therefore, our study can suggest that there is no correlation between the frequency of OL-HDF and the predialysis level of beta-microglobulin.
Hemodiafiltration ; Hemoglobins ; Humans ; Leptin ; Molecular Weight ; Renal Dialysis

OBJECTIVE: The purpose of this study was to evaluate the complications of Transobturator tape (TOT) in the surgical treatment for stress urinary incontinence and their management. METHODS: From March 2005 to October 2007, 206 patients diagnosed with stress urinary incontinence were operated using TOT at Chonnam National University Hospital. We reviewed medical records and analyzed the data according to age, parity, menopausal state, concomitant operations and complications. RESULTS: Mean age of the patients was 52.6+/-10.5 years and mean parity was 2.9+/-1.4. 91 patients (44.2%) were in postmenopausal state and 201 patients (97.6%) had other concomitant gynecologic operations. There were no intraoperative complications such as vaginal injury or bladder perforation. Postoperatively, there were 2 cases (1.0%) of vulva hematoma, 6 cases (2.9%) of urinary retention, 4 cases (1.9%) of de novo urgency and 4 cases (1.9%) of vaginal erosion. CONCLUSION: The surgical treatment using TOT is thought to be safe and effective means for the management of stress urinary incontinence. Although rare, complications may occur, therefore surgeons must be aware of the management of each complications.
Female ; Hematoma ; Humans ; Intraoperative Complications ; Medical Records ; Parity ; Suburethral Slings ; Urinary Bladder ; Urinary Incontinence ; Urinary Retention ; Vulva

Inguinal hernia is the most common disease treated by the pediatric surgeon. There are several controversial aspects of management 1)the optimal timing of surgical repair, especially for preterm babies, 2)contralateral groin exploration during repair of a clinically unilateral hernia, 3)use of laparoscope in contralateral groin exploration, 4)timing of surgical repair of cord hydrocele, 5)perioperative pain control, 6)perioperative management of anemia. In this survey, we attempted to determine the approach of members of KAPS to these aspects of hernia treatment. A questionnaire by e-mail or FAX was sent to all members. The content of the questionnaire were adapted from the "American Academy of Pediatrics (AAP) Section on Surgery hernia survey revisited (J Pediatr Surg 40, 1009-1014, 2005)". For full-term male baby, most surgeons (85.7 %) perform an elective operation as soon as diagnosis was made. For reducible hernia found in ex-preterm infants already discharged from the neonatal intensive care unit (NICU), 76.2 % of surgeons performed an elective repair under general anesthesia (85.8 %). 42.9 % of the surgeons performed the repair just before discharge. For same-day surgery for the ex-premature baby, the opinion was evenly divided. For an inguinal hernia with a contralateral undescended testis in a preterm baby, 61.9 % of surgeons choose to 'wait and see' until 12 month of age. The most important consideration in deciding the timing of surgery of inguinal hernia in preterm baby was the existence of bronchopulmonary dysplasia (82.4 %), episode of apnea/bradycardia on home monitoring (70.6 %). Most surgeons do not explore the contralateral groin during unilateral hernia repair. Laparoscope has not been tried. Most surgeons do not give perioperative analgesics or blood transfusion.
Analgesics ; Anemia ; Anesthesia, General ; Blood Transfusion ; Bronchopulmonary Dysplasia ; Child* ; Cryptorchidism ; Diagnosis ; Electronic Mail ; Groin ; Hernia ; Hernia, Inguinal* ; Herniorrhaphy ; Humans ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Korea* ; Laparoscopes ; Male ; Pediatrics ; Surveys and Questionnaires

Primary malignant melanoma of tbe esophagus is extremely rare and its incidence is below 0.1%. The tumor is polypoid and tend to be large, which is covered with false membrane, friable, hemorrhagic, and necrotic. Hematogenous and lymphogenic metastasis are common. Resection of the tumor with an anastomotic procedure seems to be the treatment of choice, and postoperative irradiation may be useful. But, despite these measures, prognosis is poor, with a 5-year survival of 4.2%. We report a case of 58-year-old man with primary malig- nant melanoma of the epophagus, and review of the literature in presented related studies.
Esophagus* ; Humans ; Incidence ; Intestines* ; Melanoma* ; Membranes ; Middle Aged ; Neoplasm Metastasis ; Prognosis ; Stomach*

BACKGROUND: Despite numerous investigations, the pathogenesis of Meniere's disease is uncertain. Endolymphatic hydrops (ELH) has been the main histologic finding of Meniere's disease. Experimentally induced ELH in animal model has been developed in order to understand better the consequences of this morphopathology on inner ear structure and function. OBJECTIVES: The aim of this study is to develope the animal model of ELH. MATERIAL AND METHODS: We made an animal endolymphatic hydrops model on giunea pigs by mechanically obliterating the right endolympatic sac and duct. The left ears were used as a controls. RESULTS: After twelve weeks, the temporal bones were prepared for light and electron microscopic examination. The light microscopic study showed the distension and folding of Reissner's membrane, however other pathologic changes were uncertain in hydropic aminal. Under scanning electron microscopic examination, the cellular population of Reissner membrane remained normal but the microvilli of Reissner membrane were significantly decreased in hydrops group. The damage pattern of stereocilia were most severe in the apical turns, followed by the middle and the basal turns, in the order of severeity. The outer hair cell third row was most severely damaged in the entire cochlea, whereas the outer hair cell first row was relatively spared. On the single hair cell examination, abnormal distensions of the tip of stereocilia started from longer stereocilia. The number of microvilli on marginal cell was reduced in stria vascularis, but atrophic change was not observed.
Animals ; Cochlea ; Ear ; Ear, Inner ; Edema ; Endolymphatic Hydrops* ; Guinea Pigs* ; Guinea* ; Hair ; Membranes ; Meniere Disease ; Microvilli ; Models, Animal ; Stereocilia ; Stria Vascularis ; Swine ; Temporal Bone