Clinical problems of computer-guided implant surgery / 대한악안면성형재건외과학회지

BACKGROUND: The utilization of a cone-beam computed tomography (CT)-assisted surgical template allows for predictable results because implant placement plans can be performed in the actual surgery. In order to assess the accuracy of the CT-guided surgery, angular errors and shoulder/apex distance errors were evaluated by data fusion from before and after the placement. METHODS: Computer-guided implant surgery was performed in five patients with 19 implants. In order to analyze differences of the implant fixture body between preoperative planned implant and postoperative placed implant, angular error and distance errors were evaluated. RESULTS: The mean angular errors between the preoperative planned and postoperative placed implant was 3.84°± 1.49°; the mean distance errors between the planned and placed implants were 0.45 ± 0.48 mm horizontally and 0.63 ± 0.51 mm vertically at the implant neck and 0.70 ± 0.63 mm horizontally and 0.64 ± 0.57 mm vertically at the implant apex for all 19 implants. CONCLUSIONS: It is important to be able to utilize these methods in actual clinical settings by improving the various problems, including the considerations of patient mouth opening limitations, surgical guide preparation, and fixation.

A Case of Peutz-Jeghers Syndrome with Nasal Polyposis / 대한내과학회지

Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant disease characterized by typical mucocutaneous pigmentation and multiple hamartomatous polyps in the gastrointestinal tract. The clinical manifestations of PJS include polyp-induced bowel obstruction, abdominal pain, and gastrointestinal bleeding. The risk of gastrointestinal and extragastrointestinal cancers is also significantly increased in patients with PJS. Nasal polyposis associated with PJS has been described, and is considered an extragastrointestinal manifestation of PJS. We present an unusual case of a patient with PJS and nasal polyposis causing complete unilateral nasal obstructio.

Autoamputation of a Giant Colonic Lipoma

Most colonic lipomas are asymptomatic and need no treatment, whereas lesions larger than 2 cm can cause acute abdominal pain, changes in bowel habits, gastrointestinal bleeding, intussusception or bowel obstruction. Autoamputation of polypoid lesions in the gastrointestinal tract is indeed a rare phenomenon, and its precise mechanism remains unknown. It presumably occurs due to ischemic necrosis of the polyp by peristalsis-induced torsion or tension. Here, we report a case of autoamputation of a giant colonic lipoma in a 48-year-old man. In our case, colonoscopic examination showed a huge autoamputated mass in the rectum and a remnant long stalk in the transverse colon. The autoamputated mass in the rectum was completely removed after fragmentation using an electrosurgical snare, and the remnant long stalk located in the transverse colon was also resected safely by endoscopic snare polypectomy. To our knowledge, these endoscopic treatments for removal of an autoamputated mass and a remnant long stalk of colonic lipoma have not been reported previously.

Gastric Lymphoepithelioma-like Carcinoma Diagnosed and Treated by Endoscopic Submucosal Dissection: Review of the Literature / 대한소화기내시경학회지

Gastric lymphoepithelioma-like carcinoma (LELC) is a rare neoplasm of the stomach that features undifferentiated carcinoma mixed with lymphoid stroma, and it invariably has a good prognosis. Most gastric LELCs have been linked to Epstein-Barr virus (EBV) infection. We experienced a case of a patient with gastric LELC. A 57 years old female patient was found to have shallow irregular ulcerative lesion on the gastric antrum. Although repetitive endoscopic biopsy didn't yield any cancer, early gastric cancer (EGC) was strongly suspected. Endoscopic submucosal dissection (ESD) was performed for establishing the correct diagnosis and curatively resecting the lesion. The pathology revealed gastric LELC with vertical invasion to the submucosa. No remnant cancer and no lymph node metastasis were noted after surgery following ESD. Here, we are reporting on a case of gastric ELEC along with reviewing the relevant literature. We believe this is the first case of gastric ELEC that was successfully diagnosed and managed by ESD.

Gastric Candidiasis in an Immunocompromised Host: A Case Report and Review of the Literature / 대한소화기내시경학회지

Candida albicans frequently inhabits the gastrointestinal tract of humans and this can lead to gastrointestinal candidiasis. Candida albicans infection of the gastrointestinal tract in normal or immunocompromised patients invariably involves the esophagus, with the typical finding of mucosal plaques. In contrast, gastric candidiasis is an uncommon phenomenon that usually occurs in immunocompromised hosts, andonly such eight cases have currently been documented in Korea. We report here on an additional case of gastric candidiasis in a 39-year old woman who had undergone craniotomy and chemotherapy for glioblastoma, and we review the medical literature related to this condition.

A Case of Large Retroperitoneal Lipoma Mimicking Liposarcoma / 대한소화기학회지

Lipomas are the most common benign tumors of adipose tissue among adults. Lipomas can occur almost anywhere in the trunk, extremities, mediastinum, and pelvis, but retroperitoneal lipomas are extremely rare. It should be distinguished from well differentiated liposarcoma in order to provide the appropriate treatment and follow up. We experienced a case of 60-year-old patient with large retroperitoneal lipoma mimicking liposarcoma causing palpable abdominal mass and pain. Abdominal computerized tomography (CT) showed 33x22 cm sized bulky fat-containing mass with contrast enhanced solid portion in right retroperitoneum. Positron emission tomograpgy (PET) revealed increased 18F-FDG uptake at solid portion shown in abdominal CT. Imaging studies confirmed a high index of suspicion on liposarcoma. Laparotomy showed a large encapsulating tumor arising from retroperitoneum with fat necrosis. Pathologic examination of resected specimen revealed normal mature adipocytes without atypical cells, compatible with lipoma.

Measurement of Normal Size of Styloid Process with 3D Reconstruction CT

PURPOSE: To measure the normal size of the styloid process using 3D (three-dimensional) reconstruction CT. MATERIALS AND METHODS: We retrospectively analyzed 3D reconstruction images obtained after coronal and axial CT scanning of the temporal bone or neck of 115 patients. The length and shape of both sides of the styloid process, the location of its tip, and calcification of the stylohyoid ligament were retrospectively analysed. RESULTS: The mean length of the styloid process was 26.6 (+/-7.9)mm on the right side, and 26.4(+/-8.3)mm on the left, a statistically insignificant difference (p=0.694). Its mean length was 26.2 (+/-8.5)mm in men and 26.7 (+/-7.2)mm in women, a statically in significant difference (p=0.733). As for variation with age, mean length tended to increase until the third decade, but not beyond. Segmental type (104/230, 45.2%) and fragmental type (73/230, 31.7%) were more commonly seen in shape of styloid process, and tapering tip of styloid process (156/230, 67.9%) is more commonly seen than clubbing tip of it (74/230, 32.1%). The process was angulated in six cases (2.6%); its tip was more frequently located between the internal and external carotid artery (211 cases, 91.7%) than more medially (19 cases, 8.3%). In the former location, the length of the process was 26.2(+/- 7.2)mm, and in the latter, 37.0(+/-6.0)mm. The difference was statistically significant (p=0.000). Calcification had occurred in 33 cases (14.3%). CONCLUSION: The length of a normal styloid process was 18-32 mm. There were no statistically significant differences between its two sides, or between the sexes. Length tended to increase until the third decade, but not beyond. Predominantly the tip was located between the internal and external carotid artery, though the process was longer when its tip was located medially.

Sonographic Findings after Total Hip Arthroplasty: Normal and Complications

PURPOSE: The purpose of this study was to determine the efficacy of sonography in the evaluation of normal pseudocapsular morphology and the detection of complications after total hip arthroplasty. MATERIALS AND METHODS: Between Janvary 1997 and June 2000, 47 patients [35 men and 12 women aged 24 to 84 (mean, 61) years] using real-time linear-array, convex US units with 3.5-MHz and 10-MHz transducers. Normal capsular morphology in 30 with total hip replacements, who had been asymptomatic for at least one year, was studied, and the prosthetic joint infection demonstrated in six of 17 who had experienced was confirmed at surgery or by US-guided aspiration. RESULTS: Sonograms indicated that a normal pseudocapsule lay straight over the neck of the prosthesis or was slightly convex toward the neck, and that the mean bone-to-pseudocapsule distance was 2.9 mm. However, in the 11 symptomatic patients in whom no evidence of infection was revealed by cultures, th mean distance was 4.7 mm; in the remaining six patients, whose joints were infected (a condition strongly suggested by the presence of extracapsular fluid), the mean distance was 5.5 mm, with no significant difference between the two groups. CONCLUSION: Sonography can be used to evaluate normal caspular morphology after total hip replacement and to diagnose infection around hip prostheses. In all patients in whom sonography revealed the presence of extra-articular fiuid, infection had occurred.

Central Lung Tumors with Obstructive Pneumonitis:Ultrasonographic Findings and Usefulness of Ultrasound-guided Biopsy

PURPOSE: To determine the ultrasonographic findings and assess the usefulness of ultrasound (US)-guided biopsy of central lung tumors in patients with obstructive pneumonitis. MATERIALS AND METHODS: Fourteen patients with central lung tumors causing obstructive pneumonitis, as seen on chest radiographs and chest CT scans, were examined between January 1997 and January 2000. In no patient conclusive histologic diagnosis obtained by means of bronchoscopic biopsy or sputum cytology. Eleven patients were men and three were women, and their ages ranged from 45 to 83 (mean, 64) years. For all examinations, real-time, linear-array, convex US units with a 3.75- and a 5.0-MHz transducer were used. The images obtained were analyzed for evidence of consolidation or atelectasis in the lung, demonstrable tumors, and tumor size and echogenicity. For US-guided percutaneous transthoracic biopsy, 19.5G automatic biopsy devices, were employed. RESULTS: Lung consolidation due to a wedge-shaped, homogeneous, hypoechoic lesion was revealed by sonographic fluid bronchograms, air bronchograms, air alveolograms, and visualization of intraparenchymal pulmonary vessels, which showed appropriate motion with respiration. The tumor presumed to be causing obstruction was seen as a hypoechoic nodule near the hilum or as a well-defined hyperechoic mass inside the partially consolidated lung. Pleural effusion was observed in one case. The cytologic findings indicated the presence of squamous cell carcinoma (n=4), adenocarcinoma (n=4), small cell carcinoma (n=3), non-small cell carcinoma (n=2) and large cell carcinoma (n=1). The success rate was 100%, and there were no complications. CONCLUSION: In patients with central lung tumors causing obstructive pneumonitis, chest ultrasonography and US-guided biopsy are useful adjunctive diagnostic modalities and techniques.