STUDY DESIGN: We report two cases of symptomatic spinal epidural lipomatosis (SEL) associated with long-term use of steroid medication OBJECTIVES: The purpose of this study was to assess the clinical characteristics, diagnosis and treatment of symptomatic spinal epidural lipomatosis. SUMMARY OF LITERATURE REVIEW: Spinal epidural lipomatosis is a condition in which excess adipose tissue is deposited circumferentially about the spinal cord in the epidural space. It can present neurologic symptoms including back pain, radiculopathy or cauda equina. Magnetic resonance imaging is the most helpful dignostic means and should be used initially if suspected. Treatment is decompressive laminectomy and debulking of fat. MATERIALS AND METHODS: Two cases of lumbar epidural lipomatosis with neurologic symptoms were discussed and evaluated by physical examination, postmyelography CT and MRI. RESULTS: Two cases were treated with decompressive laminectomy and debulking of fat. Increased accumulation of the fatty tissue was seen predominently in posterior and posterolateral epidural space of the spinal canal, displacing and compressing the lumbar spinal cord anteriorly. Both gross and histologic evaluation revealed overgrowth of unencapsulated normal appearing fat consistent with spinal epidural lipomatosis. One case was demonstrated gradual improvement in symtoms after operation but the other was died due to medical problems. CONCLUSION: The authors reviewed the literature and reported the results of operative treatment of patients with lumbago, radicular pain and intermitent claudication caused by epidural lipomatosis of lumbar spine and degenerative spinal stenosis.
Adipose Tissue ; Back Pain ; Cauda Equina ; Diagnosis ; Epidural Space ; Humans ; Laminectomy ; Lipomatosis* ; Low Back Pain ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Physical Examination ; Radiculopathy ; Spinal Canal ; Spinal Cord ; Spinal Stenosis ; Spine

No abstract available in English.
Clinical Study ; Spondylolisthesis

We have experienced a case of 13 ring chromosome in a 40-month-old girl who demonstrated psychomotor retardation with delayed speech, growth retardation, hearing loss(left), microcephaly, trigonocephaly with flat occiput, hypertelorism, epicanthal folds, microophthalmia, broad prominamt nasal bridge, high arched palate, micrognathia, large auricles and other anomalies. Cytogenetic studies of peripheral blood lymphocytes with differential staining of chromosomes revealed 46, XX, r13. Her parents' karyotypes were normal. We reported the case with the review of the associated literatures.
Child, Preschool ; Craniosynostoses ; Cytogenetics ; Female ; Hearing ; Humans ; Hypertelorism ; Karyotype ; Lymphocytes ; Microcephaly ; Palate ; Ring Chromosomes*

No abstract available.
Acetylcholinesterase* ; Aluminum* ; Animals ; Brain* ; Choline O-Acetyltransferase* ; Choline* ; Rats*

PURPOSE: To evaluate the necessity for repair of associated deltoid ligament rupture in lateral malleolar fracture. MATERIALS AND METHODS: Twenty of twenty-five patients were evaluated. Each received surgical treatment without repair of the ruptured deltoid ligament. We found that the medial clear space was widened more than 5 mm in intraoperative stress tests which had been done between May 2003 and June 2008. We did follow-up on these patients for more than 1 year after surgery. At the final follow-up, radiologic and clinical assessment were evaluated on plain X-ray and according to Olerud Molander ankle scores. RESULTS: Open reduction and internal fixation of the lateral malleolar was done in all cases and an additional transfixation screw was needed in 17 patients who had concurrent syndesmotic disruption. Average medial clear space widening before surgery was 9.28 mm (7.0-17.14 mm), at final follow-up time it was 3.43 mm (2.9-5.28 mm). And there were 8 (40%) good, 10 (50%) fair and 2 (10%) poor ratings on radiologic evaluation, but the mean clinical score was 93.75, with 17 (85%) being excellent, 2 (10%) good and 1 (5%) fair on clinical evaluation. CONCLUSION: In the treatment of lateral malleolus fracture associated with disruption of the deltoid ligament, satisfactory clinical results could be obtained including lateral joint stability, with accurate anatomical reduction and internal fixation of the lateral malleolus and distal tibio-fibular joints. Medial joint stability could be obtained without deltoid ligament repair.
Animals ; Ankle ; Exercise Test ; Follow-Up Studies ; Humans ; Joints ; Ligaments ; Rupture

BACKGROUND: Mushroom poisonings are infrequent but potentially fatal. Most fatalities are due to the amatoxin containing species, particularly Amanita phalloides, Amanita virosa, Amanita verna which cause fulminant hepatic failure often with encephalopathy. METHODS: We experienced twenty two patients with acute mushroom poisoning admitted to Dong San hospital, Keimyung University through emergency department between January 1990 and September 1997. RESULTS: Mean age of the patients was 40.0 years and the ratio of male to female was 1 : 0.83. Seasonal distribution is 10 patients in July, 3 in August and 9 in September. The mean interval between ingestion and early symptom onset was 9.7 hours. Most of the patients had early gastrointestinal symptoms; abdominal pain, nausea, vomiting and diarrhea. except for a patient with associated mental change. The subsequent symptoms and signs follow up admission were fulminant hepatic failure(72.7%), renal failure(31.8%), mental change(27.3%), acute pancreatitis(9.1%), pericardial effusion(4.5%) and erythematous rash(4.5%). The outcomes of the patients were recovery(72.7%), death(18.2%) and hopeless discharge(9.1%). CONCLUSION: The patients who have mushroom poisoning are misdiagnosed as having viral gastroenteritis and are discharged frequently. The doctors and people should be educated not to overlook the severity of mushroom poisoning.
Abdominal Pain ; Agaricales* ; Amanita ; Diarrhea ; Eating ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Gastroenteritis ; Humans ; Liver Failure, Acute ; Male ; Mushroom Poisoning* ; Nausea ; Seasons ; Vomiting

No abstract available.
Trichotillomania*

BACKGROUND: The differentiation between hemorrhagic(HS) and norhemorrhagic(NHS) stroke is the most important first step in the management of acute stroke because clinical management of the two disorders differs substantially. Neuroimaging studies are useful in diagnosing and distinctioning between HS and NHS. The use of clinical variables, such as Siriraj stroke scores(SSS), has led to good sensitivity, specificity and predictive values. The aim of our study was to evaluate the use of the SSS in the Korean population and assess whether it could aid to expedite treatment decisions. METHODS: We reviewed 111 cases of stroke patients admitted to our hospital via the emergency department over a 6 months period from July to December 1998. Levels of consciousness, vomiting, headache, and atheroma markers used in the SSS were applied to these patients who met the criteria for a stroke. RESULTS: Of the 111 patients, the SSS classified 83 with sensitivities of 81.1%(NHS) and 73.3%(HS) and positive predictive values of 84.3% and 68.8%, respectively. The overall accuracy rate was 78.3%. CONCLUSION: Our results suggest that the SSS is not reliable in distinguishing stroke types in the Korean population. Definite neuroimaging studies are needed prior to thrombolytic therapy.
Consciousness ; Emergency Service, Hospital ; Headache ; Humans ; Neuroimaging ; Plaque, Atherosclerotic ; Sensitivity and Specificity ; Stroke* ; Thrombolytic Therapy ; Vomiting

To evaluate the effectiveness of computed tomography for the differential diagnosis of cervical lymphadenopathy, we reviewed CT scans of 26 patients with cervical lymphadenopathy retrospectively. These included 10 patients with tuberculous lymphadenitis, 11 patients with metastasis and 5 patients with lymphoma, We evaluated the CT scans with a special attention to internal nodal density, feature of contrast enhancement and location of lymphadenopathy. Tuberculous lymphadenitis involved multiple nodes unilaterally and showed central low density with even or uneven rim enhancement, usually occurring in young patients (mean: 31.6 years). Two cases with tuberculous lymphadenitis showed calcifications within the lymph nodes. Lymphoma involved unilateral or bilateral nodes and appeared as conglomerated isodense mass with even rim enhancement. Metastasis involved multiple nodes unilaterally and showed focal, diffuse of mixed pattern of central low density with variable rim enhancement, usually occurring in old patients (mean: 59.4 years). Locations of most frequent lymph node involvements were internal jugular group (76%), spinal accessory group (54%) and retropharyngeal group(12%).
Diagnosis, Differential ; Humans ; Lymph Nodes ; Lymphatic Diseases* ; Lymphoma ; Neoplasm Metastasis ; Retrospective Studies ; Tomography, X-Ray Computed ; Tuberculosis, Lymph Node

OBJECTIVES: The purpose of this study is to examine whether the neurocognitive deficits of schizophrenia may be associated with certain features of symptomatology or a stable vulnerability of disease itself. METHOD: The 42 schizophrenic patients and 35 matched normal controls with sex, age, and education level were examined for their sustained attention, sensory register, executive function, concentration and attention, and verbal memory and learning in the acute and remitted stages of schizophrenia using Degraded Stimulus Continuous Performance Test, Span Apprehension Task, Wisconsin Card Sorting Test, Digit Span, and Rey Auditory Verbal Learning Test, respectively. RESULTS: The schizophrenic patients showed significant deficits in the sustained attention, sensory register, executive function, and verbal memory and learning compared with the normal controls in both acute and remitted stages of schizophrenia. Regarding the concentration and attention, the schizophrenic patients showed significant deficits in the backward digit span compared with the normal controls during acute stages, but there was no difference between two groups in the forward and backward digit span during remitted stages. No difference was evident in the sustained attention, sensory register, executive function, and verbal memory and learning between acute and remitted stages of schizophrenia. But the forward and backward digit span of schizophrenic patients showed significant improvement in the remitted stages compared with acute stages. CONCLUSIONS: The sustained attention and sensory register deficits in the visual information processing associated with schizophrenia, detected by high-processing-load version of the Degraded Stimulus Continuous Performance Test and Span Apprehension Task, are highly possible to be stable vulnerability indicators. Executive functioning deficit in the schizophrenic patients detected by Wisconsin Card Sorting Test is not likely to be dependent on symptoms, so it is difficult to conclude that it is a stable vulnerability indicators of schizophrenia. In the digit span task, the forward digit span is more likely to be a episodic indicator but the backward digit span is likely to be a mediating vulnerability indicator. And the forward and backward digit span tasks seem to be tap different cognitive abilities that are differentially associated with the diathesis for schizophrenia. Some forms of the verbal memory and learning deficits associated with schizophrenia appear to be a stable vulnerability indicators.
Automatic Data Processing ; Disease Susceptibility ; Education ; Executive Function ; Humans ; Learning ; Memory ; Negotiating ; Schizophrenia* ; Verbal Learning ; Wisconsin