Metaphyseal Chondrodysplasia is a disease characterized by metaphyseal ossification leading to shortening of stature. The extremities, especially lower, and mainly affected, resulting in a disproportionate drarfing which spares the trunk. The first case was reported in a patient with irregular metaphysis of lower extremities and hands, and severe shorteness of stature by Murk Jansen in 1934. A milder form of Metaphyseal Chondrodysplasia was noted in 1949 by Schmid, which is more common and transmitted in autosomal dominant. Mckusick recently reported another form of Metaphseal Chondrodysplasia, and other types were reported, but they are extremly rare, and of little clinical significance. In the Schmid type, patient is normal at birth, but characteristically shortness of stature, bowed leg, and waddling gait developed at biginning of walking. Ali labratory findings including serum calcium level, phosphorous, alkaline phosphatase, renal function test is normal in Metaphyseal Chondrodysplasia. The most difficult differential diagnosis is Vitamin D-resistant rickets in clinical and x-ray findings. The only treatment is careful observation and properly timed corrective surgery. Authors experienced on case of Schmid type of Metaphyseal Chondrodysplasia which had been treated with Vitamin D under impression of rickets for 1 year before the case was consulted to Orthopedic Department. Proximal tibial osteotomy and subtrochanteric valgus osteotomy were performed for the correction of genu varum and coxa vara deformity with satisfactory results for one year follow up.
Alkaline Phosphatase ; Calcium ; Congenital Abnormalities ; Coxa Vara ; Diagnosis, Differential ; Extremities ; Follow-Up Studies ; Gait ; Genu Varum ; Hand ; Humans ; Leg ; Lower Extremity ; Orthopedics ; Osteotomy ; Parturition ; Rickets ; Rickets, Hypophosphatemic ; Vitamin D ; Walking

Recently, continuous epidural catheter insertion is common practice not only in anesthesia but also in pain clinic. Meningitis is rare but serious complication of epidural analgesia. Acute bacterial meningitis occurred in a 82-year-old female patient with thoracic herpes zoster after continuous thoracic epidural analgeia. An MRI of thoracic region did not show an epidural abscess or granulation tissue. Gram stain and culture of the epidural catheter tip and the CSF yielded Staphylococcus aureus. Immediate treatment with antibiotics and supportive therapy was instituted and then the patient discharged without neurologic sequalae.
Aged, 80 and over ; Analgesia, Epidural* ; Anesthesia ; Anti-Bacterial Agents ; Catheters ; Epidural Abscess ; Female ; Granulation Tissue ; Herpes Zoster ; Humans ; Magnetic Resonance Imaging ; Meningitis ; Meningitis, Bacterial* ; Pain Clinics ; Staphylococcus aureus

It has been Known that silicone intubation may be an effective procedure for total or partial obstruction in infants of age one year or less, and the older the patient, the lower the success rate. We had performed silicone intubation on 40 eyes of 39 patients from january 1995 to May 1996, and they were divided into 3 groups according to age: group 1, 6 months to 6 years: group 2,6 to 16.: group 3, one 16 years. The success rate was 92.4% in groups 1 and 2, respectively: 83.3% ingroup 3. The success rate in patients with partial obstruction in group 3 was 100% In view of the results of the present study, silicone intubation may be in primary procedure for partial obstruction of lacrimal drainage system.
Drainage ; Humans ; Infant ; Intubation* ; Silicones*

A rare case of microgliomatosis(reticulum cell sarcoma) of the brain is reported. The tumor was located in the left parietal lobe and the right cerebellar hemisphere and the vermis. V-P Shunt was performed and left parietal craniotomy was done for removal of tumor. The patient received radiation therapy and chemotherapy for brain tumor with a good result Histogenesis and therapy of the microgliomatosis are briefly discussed.
Brain Neoplasms ; Brain* ; Craniotomy ; Drug Therapy ; Humans ; Parietal Lobe ; Rabeprazole

Angiographic diagnosis of lesions of the posterior fossa requires detailed knowledge of the normal anatomy of both arteries and veins of the brainstem and cerebellum. For this perfuse we measured normal distribution of the vertebrobasilar vessels from three base lines namely clival line, Twining line and foramen magnum line. In the measurement are also included some of the methods which were published in the past. This paper is based on the results of the measurements on 18 cases of normal vertebral angiogram among 77 cases of serial vertebral angiography performed at Catholic Medical center from October 1972 to August 1975. The result obtained were as follows: 1) Distance from the most posterior portion of the pericallosal artery to the clival line is 6.55+/-0.68 cm. 2) Distance from the most posterior portion of the arcuate portion of the lateral posterior choroidal artery to the clival line is 5.16+/-0.61 cm. 3) Distance from the posterior portion of the quadrigeminal portion of the medial posterior choroidal artery to the clival line is 4.87+/-0.67 cm. 4) Distance from the most posterior portion of the distal segment of the medial posterior choroidal artery to the clival line is 4.47+/-0.49 cm. 5) Distance from the bifurcation portion of the basilar artery to the clival line is 1.22+/-0.26 cm. 6) Distance from the forward convexity of the basilar artery to the clival line is 0.15+/-0.11 cm. 7) Distance from the choroidal point to the clival line is 2.99+/-0.51 cm. 8) Distance from the posterior medullary portion of the PICA to the clival line is 2.58+/-0.45 cm. 9) Distance from the tuberculum sellae to the Torcular Herophilli(Twining line) is 10.96+/-0.52 cm. 10) Distance between the tuberculum sellae to the point on the Twining line crossed by a perpendicular line drawn from the choroidal point is 6.61+/-0.40 cm. 11) Distance from the superior portion of the anterior culminate segment of the superior cerebellar artery to the Twining line is 3.28+/-0.48 cm. 12) Distance from the supratonsilar portion of the PICA to the Twining line is 0.97+/-0.42 cm. 13) Distance from the colliculocentral point to the clival line is 3.74+/-0.37 cm. 14) Distance from the crural portion of the anterior pontomesencephalic vein to the clival line is 1.65+/-0.33 cm. 15) Distance from the crural portion of the anterior pontomesencephalic vein to the colliculocentral point is 2.51+/-0.35 cm. 16) Distance from the copular point to the clival line is 3.99+/-0.51 cm. 17) Distance from the copular point to the line drawn from the anterior margin of the foramen magnum is 1.63+/-0.38 cm. 18) Distance from the highest point of the lateral posterior choroidal artery to the Twining line is 4.74+/-0.37 cm. 19) Distance from the highest point of the medial posterior choroidal artery to the Twining line is 4.35+/-0.34 cm. 20) Distance between two bisected points of the anterior culminate segment of the superior cerebellar artery by a line drawn parallel to the Twining line at 1cm from the top of the anterior culminate segment is 2.86+/-0.29 cm.
Angiography ; Arteries ; Basilar Artery ; Brain Stem ; Cerebellum ; Choroid ; Diagnosis ; Foramen Magnum ; Normal Distribution* ; Pica ; Veins

This experiment was performed to define the paricipation of a discrete hypothalamic neural structure in the genesis of pulmonary edema and the effect of alpha adrenergic blockade. Fifty adult cats weighing 2.5 to 4.0 Kg, were used in this study. The components of the pathophysiological systemic changes, lung weight, and histopathological changes of lung and hypothalamus were studied in groups of animals when intracranial pressure(ICP) was raised to 200 mmH2O of 300 mmH2O for 2 hours by intraventricular infusion with normal saline. The animals were divided into 5 groups : The normal control group was comprised in 10 normal cats. Control and phentolamine treated animal groups which had an elevated ICP of up 200 mmH2O consisted of 10 cats each. Control and phentolamine treated animal groups which had an elevated ICP of up to 300 mmH2O consisted of 10 cats each. The results obtained were as follows : 1) In the animal groups of elevated ICP to 200 mmH2O or 300 mmH2O, there were hemodynamic systemic changes which were neurogenically mediated and caused an immediate elevation in blood pressure of 30 mmHg to 60 mmHg. The hemodynamic data of the animals that had an elevated ICP of up to 300 mmH2O were significantly more deviated from normal control values than the 200 mmH2O ICP groups. The hemodynamic responses of the phentolamine treated animal with elevated ICP of up to 200 and 300 mmH2O were less deviated from normal control values. 2) The lung weights of the animals with an elevated ICP of up to 200 and 300 mmH2O were significantly heavier than the normal control value(p<0.05) and the lung weights of the animals with an elevated ICP of 300 mmH2O were significantly heavier than those with an ICP of 200 mmH2O(p<0.01). The lung weights of the phentolamine treated animal groups were significantly lighter than the control group but showed little increase in the lung weight when compared to the normal value. 3) By controlling the elevated ICP above 200 mmH2O in the experimental animals we have confirmed gross and microscopic appearances of hemorrhagic pulmonary edema. Histopathological changes of the phentolamine treated animals were significantly less sever than in the control groups. 4) By elevating ICP above 200 mmH2O in the experimental animals, we have confirmed discrete bilateral hemorrhagic spots of the anterior hypothalamus, preoptic region induced by increased intracranial pressure. Histopathological changes of the phentolamine treated animals with the elevated ICP were significantly less severe than of the control groups. 5) This experimental model may define the specific particification of the hypothalamus in the pathophysiological pathogenesis of neurogenic pulmonary edema. These results suggest that the lungs are directly affected by the intense sympathetic discharge evoked by release phenomenon from the sympathoinhibitory influence of the hypothalamus, and pulmonary edema was effectively eliminated by alpha adrenergic blockade.
Adult ; Animals ; Blood Pressure ; Cats* ; Edema* ; Hemodynamics ; Humans ; Hypothalamus ; Hypothalamus, Anterior ; Infusions, Intraventricular ; Intracranial Pressure ; Lung* ; Models, Theoretical ; Phentolamine* ; Pulmonary Edema ; Reference Values ; Weights and Measures

Some individuals may demonstrate a secondary phase nystagmus (SPN) following the caloric irrigation. It has been stated that if a SPN begins prior to 140 seconds after the onset of caloric stimulation and if the magnitude of the slow phase velocity is greater than 6 degrees/sec, then a premature reversal caloric nystagmus (PRCN) is said to exit. Thus far, there have been no reports describing PRCN in Korea. We described a typical PRCN in a patient with medulloblastoma within the 4th ventricle. The patient had a gaze-evoked horizontal and upbeating nystagmus. However, there was no indication of spontaneous nystagmus. A monothermal caloric test was administered. The initial left beating primary phase nystagmus was subsided at 60 seconds after right cold water stimulation and at 110 seconds, a right beating SPN with 14 degrees/sec of slow phase velocity was appeared and was continuous for 240 seconds. Although the precise mechanism of PRCN is unknown, vestibular nuclei damage may be related.
Caloric Tests ; Humans ; Korea ; Medulloblastoma ; Nystagmus, Physiologic* ; Vestibular Nuclei ; Water

We have experienced 19 patients of the cerebral arteriovenous malformation with subarachnoid hemorrhage, who were admitted to the Presbyterian Hospital, Daegu from January 1966 to July 1968, and to the Catholic Medical Center, Seoul from August 1968 to August 1971. All of the patients, who have the cerebral arteriovenous malformation, were proved by cerebral angiography. Since the site of lesions were considered to have close relation to the neurologic deficit and the result of surgery, various analysis of the clinical manifestations and the cerebral angiographic findings were attempted. Of the 19 patients, surgery was performed on 12 patients and its results were analyzed correlating to various types of surgical procedure. Following are the results. 1. From January 1966 to August 1971, there were 100 cases of cerebral vascular anomalies which were proved by cerebral angiography. Among the 100 cases, there were 71 intracranial aneurysms, 19 cerebral arteriovenous malformations, one cavernous angioma, 2 telangiectasis, 5 cerebral rete mirabile, and s Sturge Weber-Dimitris disease. The ratio of arteriovenous malformatons to aneurysms was 1: 3.7. 2. Age distribution of the bleeding arteriovenous malformations was ranged from 8 to 54, and 42 per cent of them were in the third decade. 73 percent of the group had bleeding from the cerebral arteriovenous malformation before the age of 40. The ratio of male to female was 1.9:1. 3. The parietal region was most commonly involved by the malformations. There were 8 parietal lesion, 4 temoroparietal lesions, one temporal lesion, one occipital lesion, and one tela chorioidea lesion. Simultaneous involvement of the both hemispheres occurred in one case. In lesions involving the cerebral hemisphere, there was a predominance of the left side. 4. In the past history, convulsive seizure was recorded in two cases and recurrent hemorrhages were reported in two. One patient was recorded to have suffered fourth hemorrhage and the other have sufferd third hemorrhge. 5. Meningeal irritation signs were most frequently observed in bleeding arteriovenous malformations. The incidence of weakness of extremities was higher in lesions involving the parietal area. Unconsciousness was occurred in 6 patients at the onset of symptom, of which transient loss of consciousness was seen in 3 patients. Transient hypertension at the onset was observed in two patients. 6. The feeding arteries of the malformations were most frequently seen from the middle cerebral artery and the draining veins from the malformations were into the superior sagittal sinus and internal cerebral vein in many cases. It was evident that the carotid artery of the sites of arteriovenous malformations was markedly dilated in 5 patients. 7. Ligation of the vessels feeding the arteriovenous malformations was carried out in 8 patients. One patient had neurologic deficit after the operation. Evacuation of intracerebral hematoma, resection of the anomaly or carotid ligation were carried out in 4 patients. Of the 12 patients who underwent various types of surgery, there was one death after evacuation of a large intracereral hematoma. 8. In our opinion, the ligation of feeding artery a choice of procedure to reduce the incidence of rebleeding, if the resection of the lesion was considered to have operative risk by the location of malformations.
Age Distribution ; Aneurysm ; Arteries ; Arteriovenous Malformations ; Carotid Arteries ; Cerebral Angiography ; Cerebral Veins ; Cerebrum ; Daegu ; Extremities ; Female ; Hemangioma, Cavernous ; Hematoma ; Hemorrhage ; Humans ; Hypertension ; Incidence ; Intracranial Aneurysm ; Intracranial Arteriovenous Malformations ; Ligation ; Male ; Middle Cerebral Artery ; Neurologic Manifestations ; Protestantism ; Rabeprazole ; Seizures ; Seoul ; Subarachnoid Hemorrhage ; Superior Sagittal Sinus ; Telangiectasis ; Unconsciousness ; Veins

A case of carotico-cavernous fistula was managed by intravascular occlusion using a Fogarty catheter and ligation of the carotid artery. The fistula was obliterated by the procedure and neurologic deficits improved progressively without further recurrence. The radiological feature, symptomatology and surgical management were discussed.
Carotid Arteries ; Catheters ; Fistula* ; Ligation ; Neurologic Manifestations ; Recurrence

To evaluate the effect of steroid and alpha adrenergic blockade in experimental spinal cord trauma, pathological change was observed after 500 gm-cm force was impacted on the exposed cord of the 30 Mongoreal adult dogs. The progression of the pathological changes was compared in time lag with the groups of steroid adminstered and phenoxybenzamine treatment. In the group of the spinal cord trauma without treatment, histopathological findings were classical evolution namely from the central hemorrhage and necrosis to peripheral involvement up to amorphous necrotic pattern of entire cord at 24 hours preparation. In the steroid therapy group after the trauma, the pathological changes were confined in the gray matter around and posterior portion of the central canal in all intervals. Moreover the edematous changes and hemorrhagic necrosis were far less severe than the group without treatment. Although the pathologic change was somewhat less severe in the group which received phenoxybenzamine prior to the trauma than the group administered phenoxybenzamine afterward, these group revealed much severe edema and hemorrhagic necrosis than steroid therapy group. The pathologic change, however, in the groups which received phenoxybenzamine was less severe than the group of the spinal cord trauma without treatment.
Adult ; Animals ; Dogs ; Edema ; Hemorrhage ; Humans ; Necrosis ; Phenoxybenzamine ; Spinal Cord Injuries* ; Spinal Cord*