Comet tail artifact on ultrasonography: is it a reliable finding of benign gallbladder diseases?

PURPOSE: The aim of this study was to evaluate whether the comet tail artifact on ultrasonography can be used to reliably diagnose benign gallbladder diseases. METHODS: This retrospective study reviewed the clinical findings, imaging findings, preoperative ultrasonographic diagnoses, and pathological diagnoses of 150 patients with comet tail artifacts who underwent laparoscopic cholecystectomy with pathologic confirmation. The extent of the involved lesion was classified as localized or diffuse, depending on the degree of involvement and the anatomical section of the gallbladder that was involved. This study evaluated the differences in clinical and imaging findings among pathologic diagnoses. RESULTS: All gallbladder lesions exhibiting the comet tail artifact on ultrasound examination were confirmed as benign gallbladder diseases after cholecystectomy, including 71 cases of adenomyomatosis (47.3%), 74 cases of chronic cholecystitis (49.3%), two cases of xanthogranulomatous cholecystitis (1.3%), and three cases of cholesterolosis (2.0%); there were two cases of coexistent chronic cholecystitis and low-grade dysplasia. There were no statistically significant differences in any of the clinical and ultrasonographic findings, with the exception of gallstones (P=0.007), among the four diseases. There were no significant differences in the average length, thickness, or number of comet tail artifacts among the four diagnoses. No malignancies were detected in any of the 150 thickened gallbladder lesions. CONCLUSION: The ultrasonographic finding of the comet tail artifact in patients with thickened gallbladder lesions is associated with the presence of benign gallbladder diseases, and can be considered a reliable sign of benign gallbladder disease.

Recurrent Meningitis due to Growing Basal Skull Fracture of Orbital Roof: A Case Report

A 6-year old boy was admitted with high fever and redness of the right eyelids and the surrounding area. He had previously suffered cerebral contusion, basal skull fracture and pneumocephalus following a traffic accident which required six months' hospitalization. Since then, and prior to admission, he had twice suffered probable bacterial meningitis and had been treated at an outstanding hospital. At the time of this admission, the patient again developed high fever, with redness of the right eyelid and surrounding area. His symptomatology suggested bacterial meningitis and cerebrospinal fluid culture revealed Streptococcus pneumoniae sensitive to penicillin. In accordance with the clinical course of meningitis and accompanying sinusitis, the appropriate antibiotic and its duration of usage were determined. Recurrent episodes of bacterial meningitis in this child raised the possibility of anatomical defect as an a contributory factor. Computerized tomographic(CT) cisternography suggested leakage of cerebrospinal fluid and revealed herniated frontal brain tissue protruding through a gap in the right frontal skull base, three dimensional CT(3-D CT) confirmed this defect, which was 3X4cm in size. After recovery from meningitis, surery to prevent recurrent meningitis, was performed. To locate pathologic areas, the subfrontal approach,involving bicoronal skin incision and bifrontal bone flap was used. Multiple fracture lines and a large bony defect on the orbital roof were observed, together with a dural defect, through which cerebromalatic tissue was herniated as encephalocele. Using lyophilized dura, the dural defect was made watertight; the bony defect was packed with autologous fats and covered with titanium mesh. The patient improved after surgery. Recurrent meningitis with anatomical pathologic focus after head trauma requires surgical intervention.

Trichloroacetic Acid Peeling in Koreans

BACKGROUND: There have been many articles about the chemical peeling of Caucasian skin, but there have been few reports about postpeel results among Oriental people. OBJECTIVE: The purpose of this report is to evaluate the effects of chemical skin peeling on the facial skin of Korean individuals over a two year period and compare these results with those relating to Caucasian skin. METHOD: Using 15 to 50 per cent trichloroacetic acid (TCA), we have peeled 121 pationts with fine wrinking, irregular pigmentary deposits, superficial acne scars, and melasma, and observed them for 2 years. RESULTS: In contrast to melasma, fine wrinkling and irregular pigmentary deposits responded efficiently to TCA peeling. About 70 per cent of the patients showed satisfactory clinical results one year after treatment while 50 per cent of them did so two years after treatment. Postpeel hyperpigmentation and erythema lasted for 3.15 months and 6 weeks, respectively, on average. CONCLUSION: If we select a fair-skinned woman in her fifties, even though she is an Oriental. TCA peeling can treat the fine wrinkling or irregular pigmentary deposits to a satisfactory degree.

Correlations between MRI and Histopathologic Findings in Intracranial Meningioma

The histopathologic findings of the intracranial meningima are variegated and those of magnetic resonance imaging (MRI) which has been used for preoperative evaluation are also varied in signal characteristics. In order to aid the preoperative diagnosis, authors analyzed MRI and microscopic findings in twenty eight meningioma cases which underwent surgery. The results were summarized as follows : 1) Meningothelial, fibrous and transitional subtypes showed isointense signal on T1-weighted image and iso and/or hyperintense signal T2-weighted and proton density images compared to the signal intensity of the gray matter. 2) Microcystic subtype was isointense signal on T1-weighted image and hyperintense signal on T2-weighted and proton density images. 3) Variation of signal intensity might be correlated to the ratio of the stroma in the tumor. 4) Peritumoral edema was not closely related to the pathologic subtypes or location of meningioma, but it seemed to be correlated with the size of tumor.

A Case of Generalized Dermal Melanocytosis / 대한피부과학회지

Dermal melanocytosis includes Mongolian spot, nevi of Ota and Ito, dermal melanocytic harnartoma, and blue nevus. Nevi of Ota may be respectively associated with Mongolian spot, blue nevi and unilateral or bilateral nevi of Ito. We present a case, a 24 year-old female, who had bilaterally brownish or slatebluish pigmented patches on the face, sclera, neck, anterior chest, deltoid, supraclavicular, scapular, back and sacrococcygeal area. And also she had a bluish, bean-sized nodule on her left mid-back. It is likely that this case may be considered as an extremely extensive case of pig:m.entary anomaly, associating aberrant and persistent mongolian spots, extensive nevus of Ito, bilateral nevus of Ota and blue nevus. To our knowledges it seems that such case has not previously been reported in Korean literature.

Quantitative Comparison of Dopa - Positve Cells in the Skin of Normal Person and Pigmentary Disorders / 대한피부과학회지

Melanocytes were identified by the dopa reaction, and counted in vertical sections of 183 specimens of normal skin and 218 specimens of patients with pigmentary disorders. The incidence of dopa-positive cells in the basal layer was determined. One cell in 9 in the basal layer was dopa-positive in normal specimens. There was no significant difference in the incidence of dopa-positive cells between male and female and between adult and children. Specimens from face, neck and prepuce revealed comparatively high incidence of dopa-positive cells. Among pigmentary disorders, vitiligo and halo area of halo nevus were characterized by an abscence or marked reduction in the number of dopa-positive cells, but lentigo and cafe-au-lait spot were characterized by an increase in their number In tuberous sclerosis, tinea versicolor and idiopathic guttate hypomelanosis, there wasn't any change of the melanocyte population between lesional skin and normal skin. The significance of these findings in vertical skin sections was discussed.

Nevus Lipomatosus Cutaneus Superficialis: Report of a Case / 대한피부과학회지

Nevus lipomatosus cutaneous superficialis(NLCB) is a rare condition consisting of ectopic fat tissue in the dermis and having the predilection for the pelvic girdle, especially gluteal region. The patient was a 20 year-old female. About 8 years prior to the first visit she had noticed the rice-sized papules on her lower back, which had been gradually increased in size and coalesced to become two, cerebriform, skin colored to yellowish tumor masses of soft consistency, distributed on both sides of the midline of lower back, and measuring respectively 3.5X7.Qcm and 7.0x11.5cm in size. Jihe biopsy specimen taken from the tumor mass revealed the ectopic presence of fat lobules occupying half of the reticular dermis. The fat lobules consisted of almost mature fat cells with the presence of dilated capillaries in their centers.