Isolated A1 Pulley Rupture of Left Fourth Finger in Kendo Players: Two Case Reports

Annular pulley injury of fingers is usually observed in rock climbers who support their entire body weight with flexed fingers during climbing. But these lesions can also follow trivial trauma, such as lifting heavy objects with the fingertips, or during sports and recreational activities. The A2 and A4 pulleys are most usually involved and reported most frequently. However, traumatic A1 pulley rupture has not been reported yet, to the best of our knowledge. Kendo is a very vigorous martial art with frequent physical contact. Therefore, we reported two cases of repetitive microtraumatic left fourth finger A1 pulley rupture in Kendo players with results from physical examination and imaging studies, such as ultrasonography and magnetic resonance imaging, together with related literature.

Sonography of Affected and Unaffected Shoulders in Hemiplegic Patients: Analysis of the Relationship Between Sonographic Imaging Data and Clinical Variables

OBJECTIVE: To explore the relationship between a number of clinically relevant variables and sonographic imaging data in respect to the level of impairment experienced in the affected and unaffected shoulders of hemiplegic stroke patients. METHOD: Fifty-one hemiplegic stroke patients (32 males, 19 females; 29 right-sided hemiplegics, 22 left-sided hemiplegics) participated in this study. A musculoskeletal radiologist conducted a sonographic exam on both the affected and unaffected shoulders of all patients and two physicians classified the severity of the injury on a six-point rating scale. Clinical variables including age, sex, duration of injury, spasticity and muscle power of the hemiplegic side, and level of functional activity of the shoulder were assessed. RESULTS: The sonographic rating scores of hemiplegic shoulders were positively correlated with age (p<0.01) and negatively correlated with level of muscle spasticity (p<0.05). The sonographic rating scores of unaffected shoulders were positively correlated with duration of injury (p<0.01). Affected shoulders received sonographic rating scores that reflected significantly more impairment than those of unaffected shoulders (p<0.001), and pre-morbid handedness did not affect the relationship between impairment rating and shoulder injury status. CONCLUSION: Hemiplegic stroke influences not only affected shoulders, but also unaffected sides. Proper management of spasticity, enhancement of motor recovery, and avoidance of unaffected shoulder overuse should be considered to prevent shoulder problems following strokes which result in hemiplegia.

"Trigger Finger at the Wrist" due to Anomalous Flexor Digitorum Superficialis Muscle Belly with Carpal Tunnel Syndrome: A Case Report

"Trigger finger at the wrist" is a rare phenomenon. The main symptom consists in a triggering at the wrist produced by finger motion. Its etiology and presentation may vary. One of etiology, some anomalies of muscle can cause this disease. Triggering finger at the wrist with carpal tunnel syndrome by abnormal the belly of the flexor digitorum superficialis has been reported. But most cases of it have been reported by orthopedic surgeons. We are presenting the case of 28 year old male patient who had abnormal flexor digitorum superficialis in carpal tunnel which was diagnosed by using ultrasonography.

Pure Motor Function Loss of Bilateral Upper Extremities after Anterior Spinal Cord Infarction: A case report

Anterior spinal artery syndrome refers to the paralysis of the bilateral upper extremities, bladder dysfunction and the sensory deficit of pain and temperature below the level of injury. A 64 year-old female got a cardiac arrest event after stent insertion into the coronary artery. After CPR, she underwent the motor deficit (Z-T) of the bilateral upper extremities without any sensory deficit; proprioception, vibration and pain. The brain MRI showed no abnormality, but high signal intensity was detected in C3-C7 level by T2 sagittal plane and at the anterior horn area of gray matter by axial view of spine MRI. The ventilator has been applied after CPR. By the fluoroscopy, the movement of the diaphragm was decreased, and the nerve conduction study of both phrenic nerves showed no responses.

Treatment of Synovial Proliferative Subdeltoid Bursitis through Alcohol Installation: A case report

For patients with bursitis, the treatment modality of choice was conservative treatment, and those who did not experience symptom relief usually received surgery. However, we have been able to treat a patient with chronic proliferative subdeltoid bursitis through alcohol instillation. The patient complained of aggravating right shoulder area pain particularly on abduction or flexion of his arm. Ultrasonographic examination revealed that there was notable synovial thickening, fluid collection and proliferative pannus in the subdeltoid bursa. Steroid was injected for treatment but after 9 days, synovial proliferation and synovial fluid collection remained unchanged. After additional 7 days, 70% isopropyl alcohol 5 ml was injected into the subdeltoid bursa via ultrasonograph-guided injection, followed by normal saline 10 ml injection to dilute the previously injected alcohol in order to re-aspirate. On the following check-up 3 weeks after, decrease in synovial proliferation along with normal ultrasonographic results other than slightly thickened bursa wall was noted.

Intravascular Papillary Endothelial Hyperplasia (Masson's Tumor) of the Chest Wall: A Case Report

Intravascular papillary endothelial hyperplasia is a rare tumor-like lesion caused by hyperplastic proliferation of endothlial cells that is usually an incidental findings within thrombosed dilated blood vessels or vascular tumor. We report the sonographic appearance and pathological correlation of intravascular papillary endothelial hyperplasia that presented as an intramuscular solitary mass in chest wall.

Sonographic Appearance of a Solitary Intramuscular Cysticercosis: A Case Report

The development of antiparasitic drugs and public health strategies has reduced the prevalence of cysticercosis in South Korea. In contrast, the disease is still endemic in Southeast Asia. The influx of immigrants from endemic areas has been on the increase. We report the sonographic and pathological findings of cysticercosis that presented as an intramuscular solitary mass in a 27-year-old Philippine woman.

Intradural Extramedullary Metastasis to Lumbar Spinal Nerve of Cholangiocarcinoma : A Case Report / 대한척추외과학회지

An intradural extramedullary metastasis to the spinal nerve root across dura mater is extremely rare. The authors encountered a case 39-year-old man who suffered radiculopathy arising from a soft mass around nerve root mimicking a nerve sheath tumor compressing the 4th lumbar nerve root in the right intervertebral foramen between the 4th and 5th lumbar spine. After an excisional biopsy, the metastatic infiltration of adenocarcinoma was confirmed pathologically. The primary lesion was found to be an intrahepatic cholangiocarcinoma with multiple metastases. This report suggests that an intradural metastatic tumor can show similar clinical and radiographic findings to other disease,s such as a nerve sheath tumor. The results also suggest that proper diagnosis and further treatment are possible only by pathological confirmation after and excisional biopsy.

US Features of Angioleiomyoma Arising from Superficial Soft Tissue

PURPOSE: To describe the sonographic features of angioleiomyoma arising from superficial soft tissue. MATERIALS AND METHODS: A retrospective study of the sonographic findings of 11 pathologically proven angioleiomyomas was performed. We evaluated the location, layer, size, shape, margin, echotexture, echogenicity, internal content, presence of calcification, and relationship to adjacent structures on gray scale sonography. We evaluated the presence, degree, and distribution pattern of vascularity within the mass on color Doppler sonography. RESULTS: All tumors were located in the subcutaneous layers of the extremities (5 in hand, 2 in elbow, 2 in knee, 1 in foot, 1 in calf). The sizes ranged from 8 to 30 mm, with an average size of 15.5 mm. All lesions were relatively homogeneous and hypoechoic, with well-defined margins and oval to round shape. There were no intratumoral calcifications or cystic portions in any of the masses. Vascularity was not detected in any patient (type 1), but was easily detected in 10 other patients. The degree of vascularity was mild (type 2) in 1 patient, moderate (type 3) in 4, and abundant (type 4) in 5. CONCLUSION: Although angioleiomyoma is an uncommon entity, our study suggests that it must be included in the differential diagnosis of well-defined, hypoechoic, vascular subcutaneous tumors in the extremities.

CT Diagnosis of Fitz-Hugh and Curtis Syndrome: Value of the Arterial Phase Scan

OBJECTIVE: We wanted to evaluate the role of the arterial phase (AP) together with the portal venous phase (PP) scans in the diagnosis of Fitz-Hugh-Curtis syndrome (FHCS) with using computed tomography (CT). MATERIALS AND METHODS: Twenty-five patients with FHCS and 25 women presenting with non-specifically diagnosed acute abdominal pain and who underwent biphasic CT examinations were evaluated. The AP scan included the upper abdomen, and the PP scan included the whole abdomen. Two radiologists blindly and retrospectively reviewed the PP scans first and then they reviewed the AP plus PP scans. The diagnostic accuracy of FHCS on each image set was compared for each reader by analyzing the area under the receiver operating characteristic curve (Az). Weighted kappa (wk) statistics were used to measure the interobserver agreement for the presence of CT signs of the pelvic inflammatory disease (PID) on the PP images and FHCS as the diagnosis based on the increased perihepatic enhancement on both sets of images. RESULTS: The individual diagnostic accuracy of FHCS was higher on the biphasic images (Az = 0.905 and 0.942 for reader 1 and 2, respectively) than on the PP images alone (Az = 0.806 and 0.706, respectively). The interobserver agreement for the presence of PID on the PP images was moderate (wk = 0.530). The interobserver agreement for FHCS as the diagnosis was moderate on only the PP images (wk = 0.413), but it was substantial on the biphasic images (wk = 0.719). CONCLUSION: Inclusion of the AP scan is helpful to depict the increased perihepatic enhancement, and it improves the diagnostic accuracy of FHCS on CT.

Spontaneous Regression of a Cystic Tumor in a Postpartum Woman; Is It A Cystic Lymphangioma?

Spontaneous regression of intra-abdominal cystic tumors in adults is unusual. Here, we present the case of an apparently spontaneous regression of a large intra-abdominal cystic mass found in the postpartum period of an 18-year-old woman. The regression was demonstrated using serial computed tomography (CT) examinations over a two-year period.

Spontaneous Regression of a Cystic Tumor in a Postpartum Woman; Is It A Cystic Lymphangioma?

Spontaneous regression of intra-abdominal cystic tumors in adults is unusual. Here, we present the case of an apparently spontaneous regression of a large intra-abdominal cystic mass found in the postpartum period of an 18-year-old woman. The regression was demonstrated using serial computed tomography (CT) examinations over a two-year period.

Noninvasive Follow-Up of Coronary Artery Bypass Graft Patency Using Multi-Slice Computed Tomography

PURPOSE: We wanted to evaluate the utility of multi-slice computerized tomography (MSCT) for assessing coronary artery bypass graft patency and/or occlusion. MATERIALS AND METHODS: For 24 patients, both conventional angiography and CT angiography with 4-MSCT were performed within seven days of one another in order to evaluate the accuracy of MSCT with regard to graft patency and/or occlusion. A follow-up CT angiogram was performed in patients with and without symptoms (n=11, n=34, respectively) with 4- or 16-MSCT. We retrospectively compared the results of MSCT to those of conventional coronary graft angiography. RESULTS: Sixty-five grafts were evaluated for the accuracy of MSCT. Six of those 65 were occluded. The sensitivity, specificity, positive predictive value and negative predictive values of MSCT for the diagnosis of graft occlusion were 100% (6/6), 98% (58/59), 86% (6/7) and 100% (58/58), respectively. Patency could not be determined by angiography in two grafts; however, the grafts proved to be patent on MSCT. On follow-up, new graft occlusions in the asymptomatic patients were detected by MSCT in 8.2% of the previously patent grafts at the two years post-op, and in 15.2% at the three years post-op. CONCLUSION: MSCT is a practical and accurate noninvasive diagnostic tool for following up coronary artery bypass grafts.

MR Findings of Fulminent Leukoencephalopathy in EBV-Associated Hemophagocytic Syndrome

Various manifestations of brain involvement for patients with virus-associated hemophagocytic syndrome have been reported. Here, we report on the sequential magnetic resonance (MR) findings of acute demyelination of the entire brain with subsequent brain atrophy in a follow-up study of a 25-month- old boy who was admitted with fever and then diagnosed with infectious mononucleosis and EBV-associated hemophagocytic syndrome. We also review other conditions that should be included in the differential diagnosis of this disease.

MR Findings of Fulminent Leukoencephalopathy in EBV-Associated Hemophagocytic Syndrome

Various manifestations of brain involvement for patients with virus-associated hemophagocytic syndrome have been reported. Here, we report on the sequential magnetic resonance (MR) findings of acute demyelination of the entire brain with subsequent brain atrophy in a follow-up study of a 25-month- old boy who was admitted with fever and then diagnosed with infectious mononucleosis and EBV-associated hemophagocytic syndrome. We also review other conditions that should be included in the differential diagnosis of this disease.

Lymphoepithelial Cyst of the Pancreas: A Case Report

We present a case of lymphoepithelial cyst of the pancreas. The cyst showed moderate echogenicity, mimicking a solid lesion on ultrasonography (US), and had a cystic appearance on computed tomography (CT). This ambivalent finding may be a distinctive feature of lymphoepithelial cysts of the pancreas.

The Comparison of Buccal SpO2 and Finger SpO2 Accuracy in Patients with Moderate Defect in Pulmonary Function Test / 대한구급학회지

BACKGROUND: The reliability of pulse oxymetry probes when applied to the finger or toes may be compromised in certain patients. Other sites less subject to mechanical interference or a pathophysiologic decrease in pulse amplitude have been sought. In the patients with moderate defect (N=20) in pulmonary function test, we examined the accuracy of buccal and digital SpO2 (oxygen saturation of pulse oxymetry) monitoring. METHODS: SpO2 probe was placed firmly in the corner of the patient's mouth. Buccal and finger SpO2 and radial SaO2 (arterial oxygen saturation) were measured before the induction of anesthesia. The agreement between SaO2 and each SpO2 were calculated with the method outlined by Bland and Altman. RESULTS: Buccal SpO2 was higher than finger SpO2, but finger SpO2 agreed more closely with SaO2 (buccal; 97.9+/-1.89, finger; 94.5+/-2.48, radial; 93.73+/-2.73%). CONCLUSIONS: We conclude that buccal SpO2 monitoring may offer alternative when other sites aren't available. But, we suggest that buccal SpO2 should be further evaluated for the accuracy.