Creutzfeldt-Jakob disease(CJD) is characterized clinically by rapidly progressive dementia with pyramidal, extrapyramidal, and cerebellar symptoms and signs, and histologically by spongiform change, neuronal loss and reactive gliosis. We have experienced 2 cases of CJD. Case 1 was a 36-year-old male who had suffered from myoclonus and cerebellar symptoms including sluggish speech, gait and balance disturbance. Case 2 was a 70-year-old female who had showed cognitive dysfunction, ataxic gait and disturbance of extraocular movement. Both patients, underwent brain biopsy. Case 1 revealed marked cortical atrophy, 2mm in thickness, with neuronal loss and astrocytic proliferation extending into white matter. The spongiform change, made up of many small, usually rounded or oval, vacuoles was noted mainly in the neuropil. Case 2 revealed remarkable spongiform change throughout the cortex and cytoplasmic vacuoles compressing the nuclei of neuronal cells were numerous. Neuronal loss and gliosis were also found without considerable change in the white matter. On double immunostaining against GFAP and PrP(Prion Protein), there was a weak positive reaction for PrP in the perinuclear cytoplasm in case 1, and a strongly positive reaction in case 2. The electron microscopic examination showed numerous membrane-bound vacuoles in neuropil and perikarya of neurons. The majority of the vacuoles were multiseptated by thin membranous structures. They demonstrated curled, or disrupted membrane, that had foldings and protrusions into the vacuolar clear spaces. There were neither identifiable virus-like particles nor amyloid deposition.
Female ; Male ; Humans

The use of osseointegrated implants is an accepted procedure for the treatment of Total, or partial edentulism and offers good predictability of long-term success. Osseointegration implies a firm and direct interlocking between vital bone and screw-shaped titanium implants. There should be not to interposed tissue between fixture and bone. This study was undertaken to assess the clinical condition, complication, and prosthodontic aftercare of different implant systems. One hundred fifty-nine patients treated with a total of 503 endosseous implants (364 Steri-oss threaded type, 69 Integral cylinder with HA coated type, 35 Steri-oss threaded with HA coated type, 21 Steri-oss cylinder with HA coated type and 14 3i implant type), Most of the implant were placed in type B and C bone quantity and type 2 and 3 bone quality according to Lekhorm and Zarb. The success rate of Steri-oss threaded type during healing and function was 92%, Steri-oss threaded type with hydroxyapatite coated was 91%, Steri-oss cylinder type with hydroxyapatite coated was 90%, Integral cylinder type with hydroxyapatite coated was 90% and 3i implant type was 93%. One hundred twenty-nine patients had been treated with implant prosthesis. 79 of these patients had received a fixed type prosthesis and 50 patients had received a removable type prosthesis. There were no differences between the implant systems with regard to age, gender. Failures were associated with poor bone quality, smaller implant sizes, a surgical installation technique and stress distribution when in function. Visual analgoue scales recorded as satisfied results functionally and esthetically, but 15% dissatified with chewing ability.
Aftercare ; Dental Implants* ; Durapatite ; Humans ; Mastication ; Mouth Rehabilitation* ; Mouth* ; Osseointegration ; Prostheses and Implants ; Prosthodontics ; Titanium ; Weights and Measures

The Kidd blood group is clinically significant since the Jk antibodies can cause acute and delayed transfusion reactions as well as hemolytic disease of newborn (HDN). In general, HDN due to anti-Jk(b) incompatibility is rare and it usually displays mild clinical symptoms with a favorable prognosis. Yet, we apparently experienced the second case of HDN due to anti-Jk(b) with severe clinical symptoms and a fatal outcome. A female patient having the AB, Rh(D)-positive boodtype was admitted for jaundice on the fourth day after birth. At the time of admission, the patient was lethargic and exhibited high pitched crying. The laboratory data indicated a hemoglobin value of 11.4 mg/dL, a reticulocyte count of 14.9% and a total bilirubin of 46.1 mg/dL, a direct bilirubin of 1.1 mg/dL and a strong positive result (+++) on the direct Coomb's test. As a result of the identification of irregular antibody from the maternal serum, anti-Jk(b) was detected, which was also found in the eluate made from infant's blood. Despite the aggressive treatment with exchange transfusion and intensive phototherapy, the patient died of intractable seizure and acute renal failure on the fourth day of admission. Therefore, pediatricians should be aware of the clinical courses of hemolytic jaundice due to anti-Jk(b), and they should be ready to treat this disease with active therapeutic interventions.
Bilirubin/blood ; Erythroblastosis, Fetal/*blood ; Fatal Outcome ; Female ; Humans ; Infant, Newborn ; Isoantibodies/blood ; Kidd Blood-Group System/*immunology

Common peroneal neuropathy during normal delivery is associated with instrumentation and prolonged time spent in a certain position. We report a case of unilateral common peroneal neuropathy in a vaginal delivery patient under labor analgesia with the combined spinal-epidural technique. A 29-year-old woman complained of weakness and numbness of the left foot two days after vaginal delivery. Neurologic examination and electrodiagnostic testing confirmed left common peroneal neuropathy. The patient was referred for rehabilitation, which substantially improved her mobility and function, and prevented secondary damage. The patient had not fully recovered at three months after the delivery. The possible etiology of the postpartum common peroneal neuropathy was most likely prolonged and excessive pressure around the knee by assistants. Excessive compression during delivery should be minimized or avoided. Patient education and awareness among the labor and delivery team will prevent this complication. Neurologic complications related to epidural analgesia should also be ruled out in these patients.
Adult ; Analgesia* ; Analgesia, Epidural ; Female ; Foot ; Humans ; Hypesthesia ; Knee ; Labor, Obstetric ; Neurologic Examination ; Patient Education as Topic ; Peroneal Neuropathies ; Postpartum Period ; Pregnancy ; Rehabilitation

Segmental neurofibromatosis is a rare disorder characterized by cafe-au-lait spots and neurofibrobmas, or only neurofibroma, limited to one region of the body. Disease-associated systemic involvement is uncommon. Most patients with segmental neurofibromatosis do not have a family history of neurofibromatosis. In Korea, there have been 3 reported cases of segmental neurofibromatosis. None of them had caf6-au-fait spots, systemic involvement, or family history. This report describes a case of segmental neurofibromatosis in a 25-year-old woman who had Becker's nevus-like cafe-au-lait spots and this was linked to the presence of Fanconi's syndrome in a second degree relative of the patient.
Adult ; Cafe-au-Lait Spots ; Female ; Humans ; Korea ; Neurofibroma ; Neurofibromatoses* ; Neurofibromatosis 1

BACKGROUND: Psoriasis is a chronic skin disease characterized histologically by prominent keratinocyte hyperplasia and an early inflammatory cell infiltrate. However, the pathogenesis is not fully understood yet. Recently, there has been growing interest in the probable role of a T cell mediated immune response in the pathogenesis. Especially, cytokine network involved in psoriasis has been studied. OBJECTIVE: This study was done to investigate the role of Interleukin-8(IL-8) and its inducer, Tumor necrosis factor-alpha(TNF-alpha) for pathogenesis of psoriasis. METHODS: We performed immunohistochemical staining using antibodies for IL-8 and TNF-alpha in frozen skin samples of 14 psoriatic patients who had not been treated for psoriatic lesion for 1 month and 3 normal skin samples as controls. RESULTS: There was no detectable discrete immunoreactivity for either TNF-alpha and IL-8 in epidermis and dermis of normal controls. In psoriatic lesions, the expression of TNF-alpha was found in dermal cells within the papillary dermis, particularly around blood vessels. The expression of IL-8 was presented on suprabasal keratinocytes above TNF-alpha-positive dermal tissue. CONCLUSION: Our results strongly suggest that histologic expression and functional interaction between IL-8 and its inducer, TNF-alpha have significant roles in the pathogenesis of psoriasis.
Antibodies ; Blood Vessels ; Dermis ; Epidermis ; Humans ; Hyperplasia ; Interleukin-8* ; Keratinocytes ; Necrosis ; Psoriasis ; Skin ; Skin Diseases ; Tumor Necrosis Factor-alpha*

We analyzed 13 cases of adult intussusceptions, which has been surgically treated, during the period from January 1987 to June 1997. There were 6 benign tumors, 2 malignant tumors and 5 others. The most common presenting symptom was abdominal pain. The types of intussusception were 3 jejuno- jejunal, 4 ileo-ileal, 1 ileocolic, 2 ileo-ileo-colic, and 1 colo-colic, intussusception of the vermiform appendix, and 1 combined type. In the pathlogic findings of the tumors, lipoma was the most common benign tumor and metastatic malignant melanoma was the most common malignant tumor. Other benign conditions were adhesion and granuloma due to tuberculosis. Surgical procedures were manual reduction, small bowel resection and anastomosis, a right hemicolectomy, a partial colectomy, and a polypectomy.
Abdominal Pain ; Adult* ; Appendix ; Colectomy ; Granuloma ; Humans ; Intussusception* ; Lipoma ; Melanoma ; Tuberculosis

An intravenous pyogenic granuloma is a rare, benign, intravascular tumor, which arises from the vein wall and protrudes into the lumen. This is characterized by a lobular proliferation of capillaries similar to the more common cutaneous pyogenic granulomas. We report a case of intravenous pyogenic granuloma which showed lobular capillary proliferation in the perivenous connective tissue.
Capillaries ; Connective Tissue ; Granuloma, Pyogenic* ; Veins

BACKGROUND: Intrathecal labor analgesia using new local anesthetics such as ropivacaine or levobupivacaine becomes more popular by virtues of their safety and decreased motor weakness. However, the analgesic efficacy of the clinically effective intrathecal doses of these new local anesthetics combined with fentanyl has yet to be determined. METHODS: Sixty parturients who requested neuraxial analgesia in early active labor were randomly assigned to either ropivacaine (group R, n = 30) or levobupivacaine (group L, n = 30) group. Group R received 3 mg of intrathecal ropivacaine and the group L received 3 mg of intrathecal levobupivacaine mixed with 20 microg of fentanyl as part of a combined spinal-epidural (CSE) technique. The associated block parameters, such as pain scores, duration of analgesia, the highest levels of the sensory block and motor block scores 30 mins after the injection were compared between two groups. RESULTS: Intrathecal ropivacaine offered shorter analgesia (87 +/- 41 min vs. 122 +/- 56 min, P < 0.05) with lower sensory height (T8.5 vs. T6, P < 0.05) and led to lower incidence of complete analgesia (73 vs. 97%, P < 0.05) compared with intrathecal levobupivacaine. Although motor weakness was comparable in both groups, significantly weak perineal squeezing was noticed in Group L (7 of 30 parturients vs. 16 of 30, P < 0.05). CONCLUSIONS: Clinically relevant doses of intrathecal levobupivacaine in combination with fentanyl as part of a CSE technique provides more effective analgesia than equivalent doses of intrathecal ropivacaine in early labor, but is accompanied by slight motor weakness.
Analgesia* ; Anesthetics, Local ; Fentanyl* ; Incidence ; Injections, Spinal ; Virtues

A 57-year old woman presented with a complaint of pain on the left chest wall, incision scar area, axillae, upper forearm and limitation of motions at left shoulder for 4 years. She was treated under the diagnosis of postmastectomy pain syndrome. Pain was constrictive, myalgia in characters and the visual analog scale was 4. She said that the pain was worse when tired and fatigued, but relieved when in the bath. Associated symptoms were not found. A cervical epidural puncture (C6/7) was performed and 1% lidocaine with triamcinolone was injected. Gabapentin 300 mg daily was also given. Tender points injection with 0.5% bupivacaine and dexamethasone was performed several times. Stellate ganglion block with 1% lidocaine was also included once in the treatment regimen. On the second visit at the outpatient clinic, she showed fairly good signs of relief of pain and limitation of motions, but still remained anxious and complained of feeling of anger, frustration, and a feeling of loss and suffering. Hypnotic analgesia was indicated. Two sessions (1 hour for one session) were scheduled in a quiet room. Feelings of magnetic power on both palms were used as an induction technique and imagination on escalator was adopted for the deepening hypnosis, arm levitation for dissociation, a warm feeling of body for changing sensation, progressive relaxation, symbolic imagery for posthypnotic suggestion (turning the radio button) and glove analgesia technique were tried. Self-hypnosis and ego-strengthening were instructed for further pain relief. After the treatment, she was quite satisfied due to reduction of pain and stabilization of mind.
Ambulatory Care Facilities ; Analgesia* ; Anger ; Arm ; Axilla ; Baths ; Bupivacaine ; Cicatrix ; Dexamethasone ; Diagnosis ; Elevators and Escalators ; Female ; Forearm ; Frustration ; Humans ; Hypnosis ; Imagination ; Lidocaine ; Middle Aged ; Myalgia ; Punctures ; Relaxation ; Sensation ; Shoulder ; Stellate Ganglion ; Thoracic Wall ; Triamcinolone ; Visual Analog Scale