Anomalous Origin of the Left Circumflex Coronary Artery From the First Diagonal Branch Presented as Acute Myocardial Infarction

Coronary artery anomalies are diagnosed in 0.6 to 1.5% of patients who undergo coronary angiography (CAG). They may present with life threatening conditions but are generally asymptomatic. Recognition and adequate visualization of the anomaly is essential for correct management of the condition. However, in some cases the exact orifice and course of an anomalous coronary vessel cannot be selectively identified by CAG. In this report, a 54-year-old man was admitted to the hospital with acute inferior myocardial infarction and had an anomalous origin of the left circumflex coronary artery (LCX) from the first diagonal branch (D1). In CAG, the right CAG showed no significant stenosis and fortunately we found an anomalous origin of the LCX from the D1. The course of LCX was precisely established by 64-slice multi-detector computed tomography.

Treatment of Spontaneous Psoas Hematoma in a Hemiplegic Patient Undergoing Anticoagulation Therapy: case report

Spontaneous psoas hematoma in patients receiving anticoagulation therapy is a rare condition, but sometimes very serious even fatal, if not properly treated on time. One of our patients developed large spontaneous psoas hematoma while intensive rehabilitation therapy due to recent stroke with global aphasia and right hemiplegia. He had undergone anticoagulation therapy with warfarin and prothrombin time was within therapeutic range. Patient revealed sudden cold sweating with change of vital sign. Because of global aphasia, he could not explain subjective symptoms, but revealed rebound tenderness in right lower quadrant on physical examination. Emergency abdominal & pelvic CT scan showed large hematoma on right iliopsoas area with retroperitoneal extension. Because of unstable hemodynamics and high risks for surgery, transcatheter arterial emboilzation was recommended. Bleeding was controlled successfully after transcatheter arterial embolization, and vital sign was stabilized without other neurologic change.

Echocardiographic Parameters for Predicting the Outcome of Patients Undergoing Surgery for Severe Tricuspid Regurgitation

BACKGROUND AND OBJECTIVES: This study was performed to identify echocardiographic parameters related to postoperative clinical outcome (PCO) in patients undergoing surgery for severe tricuspid regurgitation (TR) following mitral valve surgery. The indications for surgery due to severe TR following mitral valve surgery are not well defined largely because of a lack of knowledge of the prognostic factors of PCO in these patients. SUBJECTS AND METHODS: Eighteen patients (male/female; 2/16, mean age 58 years) with severe TR associated with prior mitral valve surgery were prospectively enrolled. Comprehensive echocardiographic examinations were performed before and 15+/-7 months after surgery. Favorable PCO was defined as an improvement of > or =1 in New York Heart Association (NYHA) functional class or a >25% increase in respiratory variation of IVC diameter. Non-survivors and survivors without a favorable PCO were defined as having an unfavorable PCO. RESULTS: The operative mortality was 11% (2/18). Of the 16 survivors, nine (9/16, 56%) achieved a favorable PCO. NYHA functional class, age, left ventricular ejection fraction, right ventricular fractional area change, severity of TR and pulmonary artery pressure were not related to PCO. Only systolic tricuspid annulus velocity (ST') was found to be associated with PCO (favorable vs unfavorable PCO; 12.9+/-2.1cm/s vs 9.7+/-1.7cm/s, p<0.05). For ST' value (9.5 cm/s, the sensitivity, specificity, positive and negative predictive values for predicting an unfavorable PCO were 67%, 100%, 100% and 75%, respectively. CONCLUSION: This study shows that ST' can predict PCO in patients undergoing surgery for severe TR following mitral valve surgery.

Diagnostic Accuracy of Spiral CT in Detecting Hepatic Tumors: Evaluation Using Portogenously Implanted Hepatic VX-2 Carcinoma in Rabbit

PURPOSE: To assess, by means of CT-pathologic correlation, the ability of CT to detect hepatic VX-2 carcinomas in rabbits, and to determine the factors influencing the sensitivity of tumor detection. MATERIALS AND METHODS: By means of direct portal inoculation, VX-2 carcinomas were implanted in the liver of eight rabbits after laparotomy. Two weeks later, dual-phase spiral CT scanning was performed using scan parameters of 3-mm collimation and reconstruction intervals of 1 mm and 3 mm. Radiologic-pathologic correlation involved the comparison of CT images and pathologic slices. The sensitivity and positive predictive value with which each technique detected the presence of tumors were calculated. RESULTS: Using pathologic slices, 2-40 (mean, 9.1) mm in size, 65 tumor nodules were detected. Overall sensitivity and the positive predictive value were 63% and 73%, respectively. Sensitivities for tumors of 2-5 mm and 6-10 mm were 28% and 79%, respectively. For images reconstructed with a 1-mm interval, sensitivity was significantly higher than that where a 3-mm interval was used (79% vs. 46%), but sensitivities for arterial and portal-phase imaging were not significantly different. Among small tumors (< or = 10 mm), 63% (12/19) showed strong enhancement at arterial-phase imaging. Regarding tumor detection, inter-observer concordance between the three radiologists was excellent for portal-phase images (k=0.86 and 0.83 for 1 mm and 3 mm reconstruction intervals, respectively), and good for arterial-phase images (k=0.77 and 0.73 for 1 mm and 3 mm reconstruction intervals, respectively. CONCLUSION: Even where dual-phase scanning with 3-mm collimation is used, spiral CT is limited in its ability to detect tumors 5 mm or less in diameter, though overlapping reconstruction improves the sensitivity with which those of 6-10 mm are detected. In the evaluation of arterial-phase images obtained at contrast-enhanced dual-phase imaging, special attention should be given to small hyper-attenuating nodules.

Influence of Anatomical, Scanning, and Reconstructing Parameters on Image Quality of CT Angiography: Vascular Phantom Study

PURPOSE: To investigate the image quality of CT angiograms obtained with various anatomical, scanning, and reconstruction parameters using a phantom with small vessels, and to determine the technique appropriate to a specific vascular anatomy. MATERIALS AND METHODS: The vascular phantom consisted of three pairs of parallel tubes with a luminal size of 1, 2, and 3 mm. Using the phantom, CT scans were obtained at three inter-tubal distances (1, 2, and 3 mm), three angles of inclination relative to the z-axis (0 degree, 45 degree, and 90 degree), three collimation widths (1, 3, and 5 mm) and two pitch factors (1 and 2). Using axial images obtained at 1-, 2-, and 3-mm reconstruction intervals, two types of three-dimensional images were rendered, and the quality of 972 such images was subjectively graded in terms of edge definition and artifact by three radiologists. RESULTS: All vessels parallel to the z-axis showed good image quality irrespective of other factors. A pair of vessels separated by 1 mm appeared to be stuck to each other. As collimation width and reconstruction interval increased, image quality decreased significantly and artifact increased. The quality of images obtained at 3 mm collimation and with a 6 mm increment was significantly better where collimation and increment were both 5 mm (p=0.001). Vessels 1 mm in size suffered artifactual degradation, especially in the case of SSD images. Most obliquely oriented vessels showed stair-step artifact, which tended to be severe when the reconstruction interval was large. CONCLUSION: In small vessels perpendicular to or inclined relative to the z-axis, a smaller collimation width and reconstruction interval lessens image degradation. When wider scan coverage is intended, a larger pitch rather than a larger collimation width is recommended. To lessen the artifacts occurring where vessels are obliquely oriented, the reconstruction interval should be reduced.

Distribution of Hair on the Phalanges of the Hand in Koreans / 체질인류학회지

The distribution of hair on the phalanges was investigated in the hands of 652 Koreans (402 males and 250 females). The fingers of both hands were examined in eye, using a hand lens. The proximal phalanx of the middle finger was the most frequently haired (98.2%). The middle phalanx of the index finger was mostly hairless (0.6%). The frequency order of occurrence of proximal phalangeal hair was middle finger >ring finger >little finger >index finger >thumb finger (P3 >P4 >P5 >P2 >P1). The frequency order of occurrence of middle phalangeal hair was ring finger >middle finger >little finger >index finger (M4 >M3 >M5 >M2). The score of digital hair in Korean was 5.05. The most co mmon type of digital hair in Korean was type VII which had digital hair in all proximal phalangeal segments and no hair in midphalangeal segments. Sex differences appeared in the digital hairs of midphalangeal segment of ring finger (M4), middle finger (M3) and little finger (M5), and also appeared in the digital hairs of proximal phalangeal segment of thumb (P1).

Cauda Equina Syndrome in the Lumbar Disc Herniation / 대한척추외과학회지

STUDY DESIGN: A retrospective analysis of the patients who had cauda equina syndrome caused by a herniated lumbar disc. OBJECTIVES: To assess the clinical debates concerning the diagnosis, treatment, and results of treatment. SUMMARY OF LITERATURE REVIEW: This syndrome has been considered as an absolute indication of surgical treatment in the herniated lumbar disc and poor prognosis after surgery were reported. Although there are debates on the timing of surgery, early recognition early surgical treatment are recommended for a better results of treatment. MATERIALS AND METHODS: 23 consecutive patients having a cauda equina syndrome caused by herniated lumbar disc were reviewed retrospectively. They were 14 males and 9 females having ages of 41.6 in average. The incidence of this syndrome was 3.8% of the patients who had surgical treatment of herniated lumbar disc. RESULTS: All patients had bladder dysfunction in addition to the low back pain and radicular pain in the leg, but five patient did not recognize their urinary retention which were shaded by severe leg pain. A surgical treatment were performed for all patients at 6.8 days in average after onset of the bladder dysfunction. At follow-up of 3 years and 3 months in average after surgery, 20 patients(86.9%) had satisfactory resolution of the low back pain and leg pain, and all patients had complete recovery of motor weakness except one patients who had residual foot drop. Bladder function recovered satisfactorily in 18 patients (78.3%), but 4 patients had some difficulty of urination and one patient needed a sphinterotomy for urination. CONCLUSIONS: The cauda equine syndrome in herniated lumbar disc was often not recognized early and a poor result of treatment was not rare, particularly in the patients who had acute onset and severe bladder dysfunction. So, early diagnosis and active surgical treatment are recommended for a better results of treatment.

Combined Iliac Balloon Angioplasty and Distal Surgical Revascularization

Patients with multilevel atherosclerotic disease represent a difficult surgical challenge. In the 5 decades that have relapsed since the introduction of initial methods of revascularization, a wide variety of the therapeutic options have been developed and advocated for management of aortoiliac disease. With the aid of dramatic advance of endovasular technique, various nonoperative catheter based endoluminal therapies have been accentuated in recent years by the explosive growth in vascular surgical procedures. A combination of iliac PTA and distal surgical revascularization would appeal to be a logical and potentially advantageous methods of revascularization in selected patients. This report is a retrospective review of 20 patients who were treated using a combination of lilac transluminal angioplasty and/or stent and infrainguinal reconstruction. They were 19 males and 1 female with an average of 69 years (range : 48 to 74 years). Follow-up period ranged from 1 month to 92 months( median : 28 months). These patients had cormorbid disease including heart disease (35%), hypertension(35%), diabetes mellitus(15%), hyperlipidemia(15%); 90% of the patients were smokers. Ten patients were treated for rest pain or tissue loss, while ten were treated for moderate or severe claudication. Distal operation included 7 femorofemoral bypass, 11 femoropopliteal(AK) bypass, 4 femoropopliteal(BK) bypass, 1 pop-tibial bypass. A mean resting iliac artery pressure gradient of 27.6+/-22.8 mmHg pre-PTA was reduced to 3.1+/-4.3 post PTA. Mean pretreatment ankle/brachial index of 0.36+/-0.28 increased to 0.80+/-0.16 after operation(P<.001). By Kaplan-Meier method, the 5-year primary patency rate of the distal surgical procedures was 72%. The procedures were well tolerated with no mortality and two complication occurred, but all were sucessfully corrected by stent insertion for intimal dissection and Urokinase infusion for thrombosis. Two patients underwent amputation due to preoperative wide skin ulcer and knee joint infection. We conclude that in selected patients, combined use of iliac PTA or stent insertion and distal surgical reconstructions is safe and effective modality for managing the patients with severe multilevel occlusive disease.

Ganglion Cyst of the Posterior Cruciate Ligament: A Case Report

This case report draws attention to the possibility of symptomatic and asymptomatic intraarticular ganglion cyst which was situated adjacent to the insertion sites of the anterior or posterior cruciate ligament. In many reports and our case, MR imaging is recommended as the modality of choice in diagnosing method and the cyst, if encountered, is successfully treated with arthroscopie technique. We report one case of symptematic ganglion cyst of the posterior cruciate ligament with review of literatures.

Fixation Failure of Instrumentation for the Spinal Fusion in Lumbar Region / 대한척추외과학회지

STUDY DESIGN: A retrospective review of the patients who have a fixation failure of instrumentalion for the spinal fusion in lumbar region. OBJECTIVES: To assess the incidence and different types of the mechanical failure of fixation and to evaluate their managements and their influences on the progression of a spinal fusion and to the clinical outcomes. SUMMARY OF LITERATURE REVIEW: Most of the spine surgeons have been experiencing the mechanical failures after instrumentations for a spinal fusion, eden though the incidence is decreasing with a modification of the implants. Reports on this problem are sporadic in conjunction with the other topics, rarely focusing on their management and their influences on the final outcomes. MATERIALS AND METHODS: 338 consecutive patients who had a lateral fusion in the lumbar region with an instrumentation of pedicle screws and rods, mostly with decompression, were reviewed to analyse the fixation failures of instrumentation after surgery. RESULTS: There were 26 patients (7.7%) who had the fixation failures of instrumentation, in terms of loosening around the pedicle screws in 18 patients (5.3%), the breakage of the pedicle screws in fide patients (1.5%), and the migration of a rod in three patients (0.9%). They were managed by prolonged use of brace and ergonomic back cares. Even with the fixation failures, 19 patients (73.1%) disclosed solid union uneventfully, but one patient had re-operation to obtain solid fusion. The final outcomes were satisfactory in 22 patients (84.6%), including four of six patients who had pseudoarthrosis. CONCLUSIONS: The fixation failure of instrumentation after a spinal fusion in lumbar region was not rare, but the progression of a spinal fusion usually quite well achieved and the final outcomes were not so bad, even with the implant failures and pseudoarthrosi s. Except for the persistently symptomatic pseudoarthrosis, only a prolonged use of brace and the ergonomic back cares are recommended for symptomatic patients.

A Case of Squamous Cell Carcinoma of the Clitoris / 대한피부과학회지

Primary carcinoma of the vulva is predominantly a disease of elderly women, a somewhat infrequent entity, accounting for approximately 3-4% of all female genital cancer and less than 1% of all malignant disease. Many studies have pointed out the long delay in the diagnosis of the cancer. This is due not only to the reluctance of the older patient to seek attention for this "personal problem", but to the delay of the physician in taking a biopsy. Therefore physicians should carry out a biopsy in every patient when the diagnosis is uncertain or the lesion fails to resolve with topical therapy. We experienced a case of squamous cell carcinoma arising from the clitoris in 65 years old woman. She had had a pruritic erythematous patch on the external genitals for 20 years but never visited a clinic. One month before, she found a reddish papule on the clitoris which enlarged rapidly and reached a exophytic hard 1.5 * 2.1 cm sized mass. The patient was treated with a radical vulvectomy and bilateral lymph nodes dissection of the groin with oophorectomy. She had been followed for 20 months without any evidence of recurrence.

A Case of type IV Hyperlipoproteinemia with Xanthoma tuberosum and Xanthoma Eruptivum / 대한피부과학회지

We report a case of type IV hyperlipoproteinemia associated with xanthoma tuberosum and xanthoma eruptivum, which improved by treatment with gernfibrozil and procetofene. A 46-year-old male patient visited our clinic for evaluation of multiple orange-yellow colored nodules on the elbows and multiple papules on the knees, buttocks and back. Laboratory examination showed an abnormal elevation of serun cholesterol and triglyceride. Lipoprotein electrophoresis showed an increase of pre-b band and plasma standing test showed turbid plasma. Analysis of lipoprotein revealed increase of VLDL level in his plasma. The biopsy specimens from the nodule on the elbow and the papule on the back revealed characteristic findings of xanthoma. We diagnosed the patient as type IV hyperlipoproteinemia. After 5 months of treatment with diet restriction, gemfibrozil, and procetofene, the serum levels of cholesterol and triglyceride were reduced to normal level. The skin lesions of the both back and buttock showed marked improvement and the skin lesions on the elbows and knee were much improved.

A Subcutaneous Granuloma Pyogenicum with Multiple Lesions and Recurrence

Subcutaneous granuloma pyogenicum (SGP) is a rare variant of granuloma pyogenicum. In general, it appears as a single subcutaneous nodule with a slight tenderness. We report herein an unusual case of SGP arising from the left palm of an 11-year-old girl. Two mild-tender bean-sized reddish or flesh colored subcutaneous nodules on the lateral border of the left palm, and medial side of 5th left finger, respectively, were noted on physical examination. Histopathologic examination revealed the findings of lobular capillary hemangioma, characterized by localized proliferation of capillary lined by a single endothelial cell layer. Intralesional injection of triamcinolone acetonide (TA) were performed for the treatment. However two new erythematous nodules developed at another area of the left palm, which disappeared without any treatment.

A Clinical Study of 223 Cases of Keloid / 대한피부과학회지

BACKGROUND: Keloids may occur at any age, but tend tend velop between the ages of 10 and 30. The incidence and median age of onset are equal for both sexes. Keloids are common among the darker pigmented rices, but there have been a few clinia studies of keloids in Korea. OBJECTIVE: The purpcse of this study was to evaluate the variable clinical characteristics of keloids in Korea. METHODS: This clinical investigation was made with 223 of patients of keloid who had visited the Department of Derrnatology, Chonnam University Hosptal from January 1984 to December 1993. RESULTS: 1.The annual incidenie averaged over 10 years was 0.831 (361 cases of total 43,752 outpatients). 2.The ratio of male to female was 1: 0.94(Male. 115, Feila 108). 3.The mean age of the onset and at the first visit to our hospital were 24.5years and 29.2 years respectively. 4.In our series tte presternal area was the most commor saes, the shouder region next. Most keloids on the shoulder were related to BCG vaccination in ifoncy or chilhood. 5.The precipitating fa ctors associated with keloid were riaeeding dermatologic diseases(33.2 %), unknown(17.9%) rejection & vaccination(15.2%), operation(13.9%), burn(13.9%) and laceration(5.8%) in descending order. 6.Among preceeding as, iociated dermatologic diseases, acne w s the most common. 7. A positive family history is more likely in cases of mitile keloidal (p<0,001), and severe keloidal formation. 8.Most patients did not. complain of any symptorns(45.3%) nd a symptom of pain or tenderness(40.8%) was piesert rather than pruritus(13.9%). 9.The most prevaent tr eatment modality was intralesional injection with triamcinolone acetonide (84.3%). CONCLUSION: According, to this study, usually keloids occore in patients between 10 and 29 years of age, and most keloids were located on the antetio partion of the chest, shoulders, and face and scalp. A positive family history is more likely in as of multiple, severe keloidal for mation.

Thrombolytic therapy in peripheral arterial occlusion: selective intra-arterial thrombolysis with urokinase

No abstract available.