Spontaneous Intracranial Hypotension(SIH) is a rare syndrome of spontaneous postural cephalalgia associated with low CSF pressure and usually without evidence of CSF leakage from meningeal defect due to dural puncture. The postural headache may appear suddenly or gradually and disappear within several weeks spontaneously. MRI findings maybe include diffuse symmetric pachymeningeal gadolinium-enhancement, also subdural effusion and downward brain displacement. We report two cases of SIH in which MRI of the brain reveals diffuse symmetric pachyme-ningeal enhancement.
Brain ; Headache ; Intracranial Hypotension* ; Magnetic Resonance Imaging* ; Punctures ; Subdural Effusion

Free dorsalis pedis flap transfers were performed in twelve cases at the Department of Orthopaedic Surgery of Hanyang University Hospital from January, 1980 to December, 1983. The result were summerized as followings; 1. Among twelve cases of the free dorsalis pedis flap transfer, neurovascular flap transfers were performed in nine cases and tendocutaneous flap transfers in five cases. 2. In all cases the textures of flaps were improved and the bulky subcutaneous fat tissues were shrunk gradually, so cosmetically good results were obtained. 3. Temperature, pain, protective and touch sensations were retained or restored by preservation of sensory nerve. 4. Free dorsalis pedis flap transfer has many advantages compared to conventional skin grafts, such as shorter therapeutic time, lesser physical or economic demands and primary covering to vital organ. 5. In injured hands, the application of free dorsalis pedis flap transfer including long extensor tendons of foot has been shown the excellent clinical result in the point of functional and cosmetic effect in dorsum of hand, as transferring simultaneously free tendon and skin flap. 6. Free dolis pedis flap transfer needs abundant experiences, meticulous microvascular technique and anatomic knowledge.
Clinical Study ; Foot ; Hand ; Microsurgery ; Sensation ; Skin ; Subcutaneous Fat ; Tendons ; Transplants

It is well known that the computed tomography(CT) is very useful i the evalutaion of obstructive jaundice. Wehave studied 55 cases of obstructive jaundice with whole body scanner from Jun. 1980 to Jun. 1981. The resultswere as follows; 1. The sex distribution was 36 males and 19 females, and 40 cases of obstructive jaundice wereseen in fifth, sixth, and seventh decades. 2. Causes of obstructive jaundice were 25 cases of pancreas cancer, 8cases of common duct cancer, 4 cases of gall bladder cancer, 4 cases of ampulla vater cancer, 12 cases of commonduct stone, and 2 cases of common duct stricture. 3. Levels of obstruction were 8 cases of hepatic portion, 15cases of suprapancreatic portion, 28 cases of pancreatic portion, and 4 cases of ampullary portion. 4. In tumorouscondition, CT demonstrated metastasis of other organs, 9 cases of the liver, 1 case of the lung, 3 cases of thepancreas, 3 cases of the common bile duct, 1 case of the stomach,and 12 cases of adjacent lymph nodes. 5.Associated diseases were 12 cases of intrahepatic stone. 4 cases of clonorchiasis, 2 cases of pancreas pseudocyst,1 cases of hydronephrosis, and 1 case of renal cyst.
Clonorchiasis ; Common Bile Duct ; Constriction, Pathologic ; Female ; Gallbladder Neoplasms ; Humans ; Hydronephrosis ; Jaundice, Obstructive ; Liver ; Lung ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Pancreas ; Pancreatic Neoplasms ; Sex Distribution

Cerebral dural sinus thro-bosis(DST) has been described as a rare and severe disease, clinically characterized by headache, papiliedema, seizures, focal deficits,progressive coma and even to death With the, advances ih diagnostic tools particularly MRI, DST is more commonly detected and index of suspicion is being increased. In order to characterize clinical features of DST that has been rarely reported in this country, we investigate a series of 14 patients with radiologically cerebral dural sinus thrombosis. It showed a highly variable mode of onset, diverse causes and unpredictable clinical courses. DST consists of heterogenous disease entities, with more broad spectrum of clinical presentation. Outcome was felt to be rather favorable than previously thought. Therefore, early consideration of the possibility, proper neuroimaging diagnosis and appropriate therapeutic trial on individual basis is recommended in the management of DST.
Coma ; Diagnosis ; Headache ; Humans ; Magnetic Resonance Imaging ; Neuroimaging ; Seizures ; Sinus Thrombosis, Intracranial*

Acquired tumors of the nonpigmented ciliary epithelium are rare diseases. They are difficult to diagnose and present as pseudoadenomatous hyperplasia, adenoma or adenocarcinoma. They exhibit slowly progressive enlargement leading to a subluxated lens, cataract, and secondary glaucoma. And some of the more malignant tumors may extend extrasclerally. We report a case of adenoma of nonpigmented ciliary epithelium which produced a cataract.
Adenocarcinoma ; Adenoma* ; Cataract ; Epithelium* ; Glaucoma ; Hyperplasia ; Rare Diseases

BACKGROUND: Paradoxical puborectalis syndrome (PPS) is a complex and poorly understood entity characterized by contraction rather than relaxation of the pelvic floor muscles during attempted evacuation. Anal electromyography (EMG) and cinedefecography (CD) are the most commonly used tests for the diagnosis of PPS. Therefore, the aim of this study was to prospectively assess the correlation of EMG and CD in the diagnosis of PPS. METHODS: All patients with symptoms of obstructed evacuation who underwent EMG and CD between September 1998 and February 1999, were evaluated. The clinical criteria for PPS included incomplete or difficult evacuation, straining, tenesmus, and the need for an enema or digitation. The EMG criteria included failure to achieve a significant decrease in the electrical activity of the puborectalis during attempted evacuation. The CD criteria included either paradoxical contraction or failure of the puborectalis to relax along with incomplete evacuation. RESULTS: Twenty-nine (29) patients had clinical evidence of PPS, 8 males and 21 females with a mean age of 42.6 years (range, 19-75 years), and underwent CD and EMG. The mean duration of symptoms was 7.2 years (range, 3 months-30 years). Nineteen patients (65.5%) had evidence as having PPS on CD and/or EMG. Of these patients, six patients (20.7%) were diagnosed as having PPS on both tests, five patients (17.2%) were only diagnosed on CD, and eight patients (27.6%) were only diagnosed on EMG. The remaining ten patients had normal puborectalis muscle relaxation on CD and EMG. Therefore, the correlation rate between the two tests was 55.2%. If EMG was considered as the ideal test for the diagnosis of PPS, CD had a sensitivity of 42.9% and a specificity of 66.7%. Conversely, if CD was considered as the ideal test, EMG had a sensitivity of 54.5% and a specificity of 55.6%. CONCLUSIONS: The sensitivity and the specificity values of EMG and CD for the diagnosis of PPS are suboptimal, and a low correlation existed between the two tests. This result suggests that the diagnosis of PPS should not be based upon only one test.
Constipation ; Diagnosis* ; Electromyography* ; Enema ; Female ; Humans ; Male ; Muscle Relaxation ; Muscles ; Pelvic Floor ; Prospective Studies ; Relaxation ; Sensitivity and Specificity

Consequences of an untreated sleep related breathing disorder include failure to thrive, enuresis, attention deficit disorder, behavior problems, poor academic performance, and cardiopulmonary disease. The most common etiology of sleep related breathing disorder in children is adenotonsillar hypertrophy. Other upper airway lesion should be evaluated. We experienced a case of a child whose etiology of sleep related breathing disorder was suspected to have been caused by a tubal tonsil hypertrophy. Therefore, in this paper, we present a case of a sleep related breathing disorder in a child which was successfully treated by removing the tubal tonsil hypertrophy.
Attention Deficit Disorder with Hyperactivity ; Child* ; Enuresis ; Failure to Thrive ; Humans ; Hypertrophy* ; Palatine Tonsil ; Respiration ; Sleep Apnea, Obstructive*

We describe the use of gold-coating expandable urethral stents implanted into 3 patients with urinary obstruction due to recurrent urethral stricture(one case) and inoperable benign prostatic hypertrophy(two cases) respectively. The stent formed from stainless steel in the form of a cylindrical zigzag pattern and coated with 24 carat gold was inserted via delivering device using fluoroscopy control under heal anesthesia. During 6 months follow-up. the stents remained in situ and there were no urinary incontinence or other complication. The maximum flow rate were 24ml/sec in case of urethral stricture and 20ml/sec in BPH. These patients were satisfied with the procedure which provided a quiet safe and effective alternative to conventional surgical treatment.
Anesthesia ; Fluoroscopy ; Follow-Up Studies ; Humans ; Stainless Steel ; Stents* ; Urethral Obstruction* ; Urethral Stricture ; Urinary Incontinence

Herpes simplex virus type I (HSV-I) causes an acute necrotizing encephalitis that selectively affects tempioral and frontal lobes. The sequelae and mortality of herpes simplex encephalitis(HSE) may be reduced by available antiviral therapy and therefore early diagnosis of HSE is essential. We have assessed the potential of brain perfusion scintigraphy using Tc-99m-HMPAO single photon emission computed tomoglaphy(SPECT) in HSE. Nine Tc-99m-HMPAO SPECTs were performed in eight patients with clinically suspected herpes simplex encephalitis. The examinations were made between 18 days and 10 months after onset of encephalitic symptoms The SPECT images in seven patients revealed decreased accumulation ol radioactivity in the affected temporal, frontal or parietal lobes. In a 30 yr-old female patient, two SPECT images were obtained on 18th day after the onset of symptoms and 3 months later. Her initial SPECT showed increased accumulation of radioactivity in the affected temporal and inferior frontal lobes. 3 month later follow-up SPECT image revealed the decreased radioactivity in the affected temporal, inferior frontal, and inferior parietal lobes. We found that the SPECT done at early stage of HSE may show increased cerebral perfusion due to inflammatory or other pathologic mechanism and the later stage SPECT may show decreased cerebral perfusion due to decreased cerebral metabolism caused by neuronal death We suggest that Tc-99m-HMPAO SPECT may support the clinical diagnosis of HSE.
Brain ; Diagnosis ; Early Diagnosis ; Encephalitis, Herpes Simplex ; Female ; Follow-Up Studies ; Frontal Lobe ; Herpes Simplex ; Humans ; Leukoencephalitis, Acute Hemorrhagic ; Metabolism ; Mortality ; Neurons ; Parietal Lobe ; Perfusion ; Perfusion Imaging ; Radioactivity ; Simplexvirus ; Tomography, Emission-Computed, Single-Photon*

A 63-year-old woman presented to the hospital with gross hematuria and acute renal failure. Kidney function deteriorated rapidly and progressively. A renal biopsy revealed segmental or circumferential crescents associated with linear deposits of immunoglobulin G, typical of anti-glomerular basement membrane disease. Both c-ANCA and anti-GBM antibody were detected in serum. She was treated with hemodialysis, plasmapheresis, high dose steroid and cyclophosphamide. However, she died 7 weeks after treatment because of pneumonia, without recovery of renal function. Serologic positivity of both ANCA and anti-GBM antibody are becoming more frequently recognized in rapidly progressive glomerulonephritis. The influence of c-ANCA on the clinical course of anti-GBM glomerulonephritis remains to be determined.
Acute Kidney Injury ; Anti-Glomerular Basement Membrane Disease ; Antibodies, Antineutrophil Cytoplasmic ; Basement Membrane* ; Biopsy ; Cyclophosphamide ; Cytoplasm* ; Female ; Glomerulonephritis* ; Hematuria ; Humans ; Immunoglobulin G ; Kidney ; Middle Aged ; Plasmapheresis ; Pneumonia ; Renal Dialysis