We report herein a case of tethered cord syndrome with recurrent ulcerations of the skin in a 17-year-old girl. The patient presented an asymptomatic punched-out deep ulcer on the right buttock and right heel. The lesions were noticed as bullae on the sites, which developed into ulceration. At birth, a reddish nodule was noted on the lower back, which was excised when she was 3 years old at a private clinic. Neurological examination revealed hypoesthesia below the LS dermatome. We suspected a simple neurotrophic ulcer which was treated with zinc oxide dressing and oral antibiotics. 1 month later, the ulcers had healed, but tense bullae had developed on the same right buttock. Spina bifida with intraspinal lipoma was revealed by plain X-ray film and magnetic resonance imgaing. Tethered cord syndrome was diagnosed, and treated with a surgical excision of the lipoma, and repair of the dura. This is a vary rare etiology of a neurotrophic ulcer due to a central nervous system disease, and is the first reported case in the Korean dermatologic literature.
Adolescent ; Anti-Bacterial Agents ; Bandages ; Buttocks ; Central Nervous System ; Female ; Heel ; Humans ; Hypesthesia ; Lipoma ; Neural Tube Defects* ; Neurologic Examination ; Parturition ; Skin ; Spinal Dysraphism ; Transcutaneous Electric Nerve Stimulation ; Ulcer* ; X-Ray Film ; Zinc Oxide

BACKGROUND: The purpose of carotid endarterectomy is to prevent stroke regardless of past neurologic events. Major concern in the carotid endarterectomy is the inadequate blood flow of ipsilateral hemisphere during clamping of the carotid artery. It is well known that internal carotid artery back pressure means collateral cerebral blood flow. Our study is intended to determine the guideline of shunt placement according to the carotid back pressure and electroencephalographic finding. MATERIAL AND METHOD: The study population comprised of 16 consecutive patients who underwent carotid endarterectomy for carotid stenosis in our institution between from February 1996 to March 1999. There were 14 men and 2 women between the ages of 56 and 78 years(mean age 66.25+/-6.53 years). The carotid stenosis in the operative site was ranged from 61% to 95%(mean 73.8+/-12.33%) and the mean carotid stenosis of the contralateral side was 60.99+/-25.03%. During the operation, electroencephalographic monitoring was taken in all cases. The internal carotid artery back pressure was measured to estimate the collateral cerebral blood flow, and in all patients with back pressure below 40 mmHg(11 patients) and patients with complete occulusion of contralateral carotid artery(2 patients), an internal shunt was installed. RESULT: One postoperative death occurred in a patient with large evolving cerebral infarction and severe ipsilateral carotid stenosis, who underwent emergent carotid endarterectomy. The cause of death was hemorrhagic infarction in the corresponding cerebral territory. We observed that immediate operation after a major stroke negatively influenced the postoperative outcome. No intraoperative ischemic neurologic complication developed. During the follow-up upto now(mean follow-up 21.5+/-11.85 months), there has been no early or late recurrence of stroke except one patient ,in whom cerebral infarction developed in the contralateral side on the first postoperative day. CONCLUSION: At least 4-6 weeks stabilization after a stroke is recommended for surgical management. The carotid endarterectomy is an effective surgical intervention for prevention of anticipated stroke and can be performed safely if an internal shunt is used in patients whose internal carotid arterial back pressure is below 40 mmHg.
Carotid Arteries ; Carotid Artery, Internal ; Carotid Stenosis* ; Cause of Death ; Cerebral Infarction ; Constriction ; Endarterectomy ; Endarterectomy, Carotid* ; Female ; Follow-Up Studies ; Humans ; Infarction ; Male ; Recurrence ; Stroke

Nevoid basal cell carcinoma syndrome is a genetically determined disorder characterized by multiple basal cell carcinoma, palmoplantar pits and defects in other organs or tissues. Basal cell carcinoma may arise any sit of body. But infrequently typical basal cell carcinomas arise from the depressed epidermis which forms the base of the pits on the hands and feet. The patient was a 12 years old girl who developed multiple black-colored papules on the face and a dark reddish to black-colored pit over the palm and skin-colored depressed circumscribed pits on the plantar surface of feet. she also had an odontogenic cyst in the right maxilla, epidermal cyst on the trunk and mutiple intradermal nevi on the face. But the family history was not present. The histopathologic findings of the depressed pit of the palm showed a crater on the stratum corneum, and a well marginated tumor nest of basal cell carcinoma showing keratotic feature on the center of the lesion and reticulated feature on the periphery.
Basal Cell Nevus Syndrome* ; Carcinoma, Basal Cell* ; Child ; Epidermal Cyst ; Epidermis ; Female ; Foot ; Hand ; Humans ; Maxilla ; Nevus, Intradermal ; Odontogenic Cysts

PURPOSE: To investigate the clinical and radiological results after primary or revision total knee arthroplasty using fresh frozen femoral head strut allograft for severe bone defect. SUBJECTS AND METHODS: Seventeen patients (18 cases) with severe bone defect were taken primary or revision TKA from 1997 to 2001 using fresh frozen femoral head allograft. 12 cases of revision TKA and 6 of primary TKA were conducted. The average age was 66 years old(55~74) and the follow up period was 29 months(12~63 months). Bone defects were found at proximal tibia in 10 cases, distal femur in 2 and both sites in 6 cases. PCL substituting TKA with extension rod were 15, and PCL retaining TKA were 3. The clinical result was assessed with the knee score of Hospital for Special Surgery(HSS) and for assessment of allograft, simple X-ray film was employed. RESULTS: Average range of motion was increased from 71 degrees to 103 degrees and HSS score was increased from 46(18 ~68) to 83(68 ~91). With 17 of 18 femoral head strut allograft, union was seen and no clinical collapse was present. In one, partial allograft absorption was occured. The preoperative alignment was an average of 7 degrees varus(range 5 degrees~15 degrees) and postoperative alignment was averaged 6.1 degrees valgus(range 3 degrees ~7 degrees). No radiolucent lines were 2 mm or more in width, and there was no case of infection or fracture of allograft. CONCLUSIONS: Femoral head strut allograft was a satisfactory method of managing severe bone defect in primary or revision TKA.
Absorption ; Allografts* ; Arthroplasty* ; Femur ; Follow-Up Studies ; Head* ; Humans ; Knee* ; Range of Motion, Articular ; Tibia ; X-Ray Film

PURPOSE: Cyanate, known as one of the uremic toxins and derived spontaneously from urea, has several effects on the biologic substances including erythropoietin, antioxidant and ceruloplasmin. To find out the protective materials from the hazardous effect of cyanate in osteoblast, we added twenty amino acids, albumin globulin and hemoglobin in the culture media containing osteoblastic cells with cyanate. METHODS: Osteoblastic ROS 17/2.8 cells, exposed to various concentrations of sodium cyanate, were used to analyze for the cytotoxicity. The cyanate-induced cytotoxicity was assessed by the methylthiazolyldiphenyl-tetrazolium bromide (MTT) assay by measuring the absorbance of the reaction solution at 570 nm. Viability of the treated cells was expressed as A570 of sample/A570 of control. The degree of the carbamylation was measured using trinitrobenzenesulphonic acid. The degree of the carbamylation in amino acid was about 50% in average. RESULTS: The degree of the carbamylation in albumin was increased depending on the incubation time with cyanate and the concentration of the cyanate. The degree of the carbamylation in globulin and hemoglobin was nearly zero. Asp, Glu, Leu, Trp and Tyr among the twenty amino acids revealed the protective effect against the damage induced by cyanate. And only albumin among the three proteins revealed the protective effect. CONCLUSION: On the basis of these results, Asp, Glu, Leu, Trp, Tyr and albumin are useful tools for the protection against damages by cyanate carbamylation.
Albumins ; Amino Acids* ; Ceruloplasmin ; Culture Media ; Cyanates ; Erythropoietin ; Osteoblasts* ; Sodium ; Urea ; Viperidae

Pulsating exophthalmos, bruit, episcleral venous distention, conjunctival and (eye)lid edema, ophthalmoplegia, and ocular pain have long been regarded as the classic symptoms and signs of idiopathic dural carotid cavernous sinus fistula(CCF). We experienced a 39-year-old woman who presented with headache and cyclovertical diplopia. On neurologic examination, we found isolated left trochlear nerve palsy only. The past medical history was not remarkable. Intracranial magnetic resonance angiography revealed abnormal signals around the carotid siphon on both sides. Conventional angiography confirmed bilateral dural CCFs, leaking predominantly from the left side. Diplopia and headache had improved spontaneously over 3 weeks after the onset. Occasionally, isolated oculomotor or abducens nerve palsy has been reported as the sole clinical finding of symptomatic dural CCF. But isolated trochlear nerve palsy with dural CCF is extremely rare. Although the exact mechanisms of isolated trochlear nerve palsy by dural CCF is unclear, various mechanisms have been proposed, including compression of trochlear nerve by venous congestion or direct shunted flow in cavernous sinus, vascular steel phenomenon, and venous thrombosis.
Abducens Nerve Diseases ; Adult ; Angiography ; Carotid-Cavernous Sinus Fistula* ; Cavernous Sinus ; Diplopia ; Edema ; Exophthalmos ; Female ; Headache ; Humans ; Hyperemia ; Magnetic Resonance Angiography ; Neurologic Examination ; Ophthalmoplegia ; Steel ; Trochlear Nerve Diseases* ; Trochlear Nerve* ; Venous Thrombosis

No abstract available.
Toluene*

Leiomyosarcoma of the intestine is an uncommon malignant tumor of the small and large bowels. It may metastasize mostly to the peritoneum, omentum and liver. We describe a case of a liver metastasis from ileal leiomyosarcoma which was treated by right hepatic lobectomy. Ultrasonography revealed multiple cysts in both lobes of liver and pelvic mass. Computerized tomography of the abdomen revealed that lobulated, marginated, low density mass was noted in ileal loop, and multiple, well-defined, low density masses were identified in both lobes of the liver. The patient underwent exploratory laparotomy and removal of the ileal leiomyosarcoma. One month later, the patient underwent a right hepatic lobectomy and removal of a cystic mass on the liver dome of the left lobe. The patient recovered and was discharged by postoperative day 24.
Abdomen ; Humans ; Intestines ; Laparotomy ; Leiomyosarcoma* ; Liver* ; Neoplasm Metastasis* ; Omentum ; Peritoneum ; Ultrasonography

BACKGROUND: Contact dermatitis is frequently caused by cosmetics. Detection of causative allergens is important in prevention and treatment of cosmetic contact dermatitis. Patch test has been accepted as the only reliable diagnostic method to detect allergens. OBJECTIVE: The objectives of this study were to clarify evoluting trends of positive patch tests and to compare the positive frequencies of various allergens between different time sequences. MATERIALS AND METHODS: We reviewed patch test results of the 806 cosmetic contact dermatitis patients, who had visited our clinic from 1982 to 1997. We divided the patients into three groups as follows: I group:1982-1987, II group:1988-1992, III group:1993-1997 and compared the test results. The patch tests were performed with standard batteries, cosmetic-related allergens and the patients's own cosmetics. RESULTS: The results of the studies were summarized as follows; 1. Trends of increasing positivity in cosmetic-induced dermatitis was noted in a chronologic point of view. Among the patients, an increased proportion of males was notable. 2. In age distribution, a decreasing proportion of patients at the third & the fourth decades was observed. Contrary to this, the proportion of patients over the fifth decades was increased. 3. Among standard allergens, nickel sulphate showed the highest positive rate in all defined triple periods, whereas positive rates of neomycin sulphate & balsam of Peru were diminishing sequentially. Among fragrance allergens, cinnamic alcohol & cinnamic aldehyde revealed the highest positive rates. 4. In as is test, skin care products showed the highest positive rate, followed by toiletries and makeup products. Increasing positive rates of the toiletry products were observed in order of time. In fragrance products, positive rates reached their peak in the second period and declined in the third period. CONCLUSION: This study showed that perfume components were the most frequent allergens in cosmetics followed by preservative agents. Our study showed that comestic allergies in men seems to have increased.
Age Distribution ; Allergens ; Dermatitis ; Dermatitis, Allergic Contact ; Dermatitis, Contact* ; Humans ; Hypersensitivity ; Male ; Neomycin ; Nickel ; Patch Tests* ; Perfume ; Peru ; Skin Tests

PURPOSE: Recent data suggest that monotherapy with a broad-spectrum antibiotic may be as efficacious as, and potentially less costly than, standard multi-drug therapy. We compared mono-therapy with intravenous piperacillin-tazobactam (PT) with multi-drug therapy with cefotaxime and metronidazole (CM) in aspect of postoperative complications and hospital stay. METHODS: We reviewed the hospital records and medical costs of the pediatric patients who were managed for perforated appendicitis between April 2013 and May 2014 retrospectively. RESULTS: Forty-six patients with laparoscopic appendectomy for perforated appendicitis were included in our study. PT group was 20 and CM group was 26 patients. On admission, there were no significance in sex distribution, duration of symptoms, leukocyte count, and CRP levels. At postoperative third, fifth, and seventh day of each regimen, PT group have no statistical difference with CM group in leukocyte count, percentage of neutrophil, and CRP. There was no difference in abscess formation rate, wound infections, and hospital stay between two groups. There was only one patient who was readmitted with elevation of CRP and leukocyte count in CM group. CONCLUSION: Daily dosing with the mono-therapy of PT offers as efficient as multi-drug therapy of CM. To evaluate the efficacy of broad-spectrum antibiotics monotherapy in perforated appendicitis children, the cohort included more patients should be needed.
Abscess ; Anti-Bacterial Agents ; Appendectomy ; Appendicitis* ; Case-Control Studies* ; Cefotaxime* ; Child* ; Cohort Studies ; Hospital Records ; Humans ; Length of Stay ; Leukocyte Count ; Metronidazole* ; Neutrophils ; Postoperative Complications ; Retrospective Studies ; Sex Distribution ; Wound Infection