We observed three patients who showed widespread macular ashy-colored eruptions. They fit clinically and histopathologically with the typical erythema dyschromicum perstans (ashy dermatosis). Erythoma dyschromicum perstans is a peculiar pigmented condition of unknown etiology characterized by persistent ashy-gray colored macule, refractory to any modality. All of them have similar skin lesions which are multiple, variable sized oval-shaped, ash-colored macular eruption on the trunk and extremities. Histologic findings of 2 patients reveal the characteristic feature of focal hydropic degeneration of the basal cell layer of the epidermis, perivascular infiltrates of lymphocytes and histiocytes and melanin-laden macrophages in the corium, however, merely pigmentary incontinence into the corium in 1 patient. Literatures are briefly reviewed.
Dermis ; Epidermis ; Erythema* ; Extremities ; Histiocytes ; Humans ; Lymphocytes ; Macrophages ; Skin

Abducens nerve palsy associated with spinal surgery is extremely rare. We report an extremely rare case of abducens nerve palsy after lumbar spinal fusion surgery with inadvertent dural tearing, which resolved spontaneously and completely. A 61-year-old previous healthy man presented with chronic lower back pain of 6 weeks duration and 2 weeks history of bilateral leg pain. He was diagnosed as having isthmic spondylolisthesis at L4-5 and L5-S1, and posterior lumbar interbody fusion was conducted on L4-5 and L5-S1. During the operation, inadvertent dural tearing occurred, which was repaired with a watertight dural closure. The patient recovered uneventfully from general anesthesia and his visual analogue pain scores decreased from 9 pre-op to 3 immediately after his operation. However, on day 2 he developed headache and nausea, which were severe when he was upright, but alleviated when supine. This led us to consider the possibility of cerebrospinal fluid leakage, and thus, he was restricted to bed. After an interval of bed rest, the severe headache disappeared, but four days after surgery he experienced diplopia during right gaze, which was caused by right-side palsy of the abducens nerve. Under conservative treatment, the diplopia gradually disappeared and was completely resolved at 5 weeks post-op.
Abducens Nerve ; Abducens Nerve Diseases ; Anesthesia, General ; Bed Rest ; Diplopia ; Headache ; Humans ; Leg ; Low Back Pain ; Middle Aged ; Nausea ; Paralysis ; Spinal Fusion ; Spondylolisthesis

Recent studies have demonstrated that the patients with psoriasis have various immune alternation in both humoral and cellular immunities. However the results of these are still controversial. These facts promoted us to analyze the immune cells (T cell, T subsets and B cell) by rosette method for these cells in peripheral blood of 15 patients with psoriasis. And we also analyzed the effects of photo- chemotherapy(PUVA) on these cells. The results were summerized as follows; 1. The mean values of T cell, T, T, cell and B cell in peripheral blood of the- patients with psoriasis before PUVA therapy were 56. 2+-5.7%, 35.1+-6.9%, 5. 5+l.4%, 11.6+4. 0% respectively, These results of immune cells showed signi- ficantly lower mean values when these were compaired with the mean values. of nomnal control group(T cell; 65. 2+-2.9%, TM cell; 45.8+-3.2%, T cell; 7.3+ 1.3% B cell; 16.2+2.4%), respectively (T cell, Tm Tg, p<0.01, B cell; p<0.05). 2. The mean values of T cell, T, T, cell and B cell in peripheral blood (countinue..)
Humans ; Immunity, Cellular ; Photochemotherapy* ; Psoriasis* ; PUVA Therapy

Juvenile xanthogranuloma is a benign disseminated xanthomatous and granulomatous condition of the skin and other organs. The skin lesions usually disappear spontaneously within 1 to 5 years. Our case was 4 month-old boy who had have match head to pea sized scattered yellowish papules and nodules on scrotum since age of 1 month and then these skin lesions gradually spread to trunk, face and scalp without subjective symptoms. Histopathologically, biopsy specimen of the trunk revealed massive accumulation of histiocytes at dermis. With fat stain, fat substance is demonstrated within the foamy histiocytes. The skull x-ray revealed coin sized, well circumscribed osteolytic lesion on the left parietal bone. By the age of two and half, most of the skin lesions and bone defect on skull x-ray disappeared spontaneously.
Biopsy ; Dermis ; Head ; Histiocytes ; Humans ; Infant ; Male ; Numismatics ; Parietal Bone ; Peas ; Scalp ; Scrotum ; Skin ; Skull ; Xanthogranuloma, Juvenile*

Biliary atresia is a surgical disease of infancy with a very poor prognosis usually attributed to the rarity of surgically correctable case. This paper presents a case of incorrectable type of biliary atresia 50 days old Direan female infant who were subjected to the Modified Kasai Operation She had shown good bile excretion after surgery but developed recurrent fever, severe hypocalcemia and roentgenographically prover rickets during the follow up periods. She died 7 months after the operation.
Bile ; Biliary Atresia* ; Female ; Fever ; Follow-Up Studies ; Humans ; Hypocalcemia ; Infant ; Prognosis ; Rickets

Recently various kinds of anterior or posterior cervical instruments have been used for stabilization of unstable cervical spinal injury. Every device has different characteristics, so none can cover all of the various types of unstable injuries. Forty six patients of unstable cervical spine fracture and subluxation underwent stabilizing operation using the anterior Caspar plate(6 cases) and the Roy-Camille posterior plate system(40 cases) during recent 3-years. Each approach employed depends on the site of compression and mechanism of injury. Six patients who had complete neurological injury expired after the surgery. The follow-up period for the 40 patients was from 5 to 32 months(average-17.5 months). During follow-up period, 16 out of 22 patients(72.7%) who had a neurological deficit showed minimal to moderate improvement and only 4 patients(10%) complained of significant arm or neck pain. The only complication of instrumentation was 5 cases of screw breakout, but 3 of them did not have any problem. Radiologically 37 patients(92.5%) had firm fixation after surgery.
Arm ; Follow-Up Studies ; Humans ; Neck Pain ; Spinal Injuries ; Spine*

OBJECTIVE: The purpose of this study is to determine the time evolution and distribution of cerebral apoptosis using the middle cerebral artery occlusion model in rats. METHODS: A total of twenty four male rats - with 2, 3, 4, 6, 8, 12, 24 and 48 hours of middle cerebral artery occlusion respectively - were studied. The terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick-end labeling(TUNEL) method was used for the observation of the apoptotic cells. The apoptotic ratio was calculated and the distribution of apoptosis was inspected in the pyriform cortex, basal ganglia and middle cerebral artery territory cortex. The rats were divided into three groups(Group I: 2~4 hours of occlusion, Group II: 6~12 hours of occlusion, Group III: 24~48 hours of occlusion). RESULTS: In this study, the proportion of apoptosis increased with the duration of middle cerebral artery occlusion and reached a maximum after about 12 hours of middle cerebral artery occlusion. The mean values of the apoptotic ratio were 30.7+/-11.3% in group I, 60.8+/-2.6% in group II and 48.7+/-0.7% in group III. The distribution of apoptosis differed in the pyriform cortex, basal ganglia and middle cerebral artery territory cortex according to the duration of time of the middle cerebral artery occlusion. CONCLUSION: In the middle cerebral artery occlusion model of the rats, apoptosis is found to increase according to the occlusion time, reaching a peak after 6 hours, and the distribution of apoptosis changed from the pyriform cortex to the basal ganglia and middle cerebral artery territory cortex.
Animals ; Apoptosis* ; Basal Ganglia ; Deoxyuridine ; Humans ; Infarction, Middle Cerebral Artery* ; Ischemia ; Male ; Middle Cerebral Artery* ; Rats*

The authors report the problems of treatment in 37 consecutive cerebralarteriovenous malformations(AVM's) who underwent embolization, operation, combined treatment, or conservative care. The preoperative embolization is an integral part of the multidisciplinary treatment protocol for patients with cerebral AVM's. Life threatening intracerebral hematoma caused by bleeding from AVM's will be managed effectively with stereotactic Urokinase irrigation for urgently reducing the increased intracranial pressure and getting a time to change emergent to elective surgery. We also discussed the problems along the management of cerebral AMV's.
Clinical Protocols ; Hematoma ; Hemorrhage ; Humans ; Intracranial Arteriovenous Malformations* ; Intracranial Pressure ; Urokinase-Type Plasminogen Activator

Histopathology of pulmonary lymphangioleiomyomatosis(LAM) is studied using four new cases and six previously reported cases, which include two cases without definite evidence of LAM. The important diagnostic features of this lesion were nodular proliferation of immature smooth muscle and cleft or cyst formation within the nodules of smooth muscle cells. The nuclei of the smooth muscle cells were bigger than those of blood vessels or fibrotic lung, and the direction of nuclei was irregular. The lung parenchyma showed little inflammatory change but there were multiple air cysts with smooth muscle nodules at their margin. There were two cases with exuberant proliferation of smooth muscle nodules and two cases with papilliferous projections of the cells into lymphatic lumen. Whereas, three cases had only a few small slender nodules of smooth muscle cells at the margin of air cyst. The lymphatic lumen with smooth muscle nodules is dilated in four cases but other four cases show collapsed lumen. Pulmonary hemorrhage and hemosiderosis were prominent in three cases. There were variety of histology in terms of the cellularity of smooth muscle nodules, the size of the lymphatic lumen and the degree of pulmonary destruction, which may have significance on the clinical presentation and prognostication.
Cysts

Desmoplastic trichoepithelioma is a rare benign adnexal tumor that usually presents as an asymptomatic, firm, annular plaque. It most commonly occurs on sun-exposed areas in middle-aged women, especially on the face. Patients typically give a history of a single, slow-growing lesion that has been present for several years. The diagnosis of desmoplastic trichoepithelioma can be made when a triad of microscopic findings are observed in combination with a compatible clinical picture. We herein report a case of desmoplastic trichoepithelioma associated with syringomas on the face of a young woman.
Diagnosis ; Female ; Humans ; Syringoma*