BACKGROUND: To compare the diagnostic value between Phalen's test and reverse Phalen's test using a morphological change of the median nerve and the carpal tunnel in diabetics and normal controls seen by high-resolution ultrasonography and to research on an ultrasonography as an available tool for the screening and follow up aid-test of the carpal tunnel syndrome(CTS). METHODS: A cross-sectional area and a flattening ratio of the median nerve, and a cross-sectional area of the carpal tunnel were measured in neutral, maximally flexed(Phalen's test), and maximally extended (reverse Phalen's test) positions in 59 wrists of 30 normal controls and 60 wrists of 30 diabetics. RESULTS: 1) In controls and diabetics, the mean cross-sectional area of median nerve at the hamatum were 8.8/10.2 mm2, 8.0/9.5 mm2, 8.3/9.4 mm2, the mean flattening ratio were 3.0/3.0 mm2, 2.4/2.0 mm2, 3.2/3.0 mm2, the mean cross-sectional area of carpal tunnel were 176.5/197.7 mm2, 157.9/187.0 mm2, 170.6/192.5 mm2 in neutral, maximal flexion and maximal extension. 2) In controls, the cross-sectional area of median nerve and carpal tunnel were significantly decreased in maximal flexion(p<0.01), and in maximal extension(p<0.01). 3) In controls, the mean flattening ratio of median nerve was revealed significant change in maximal flexion(p<0.01), and in maximal extension(p<0.01). 4) In diabetics, the flattening ratio was significantly decreased in maximal flexion(p<0.01) with com- paring to neutral position. 5) In diabetics, the cross-sectional area of median nerve and carpal tunnel were significantly increased in all positions(p<0.05), and the mean flattening ratio of median nerve was similar to controls. CONCLUSION: In diabetics, increased cross-sectional area of median nerve can be explained by swelling of median nerve, also increased cross-sectional area of carpal tunnel is can be said to have taken place by the decreasing of the useful space in between the median nerve and carpal tunnel, this show that the diabetics have the high risk of the CTS. Phalen's test reveals higher degree of irritation to median nerve, The high-resolution ultrasonography is suggested as an available tool for the screening and follow up aid-test for the CTS
Carpal Tunnel Syndrome ; Follow-Up Studies ; Mass Screening ; Median Nerve* ; Ultrasonography ; Wrist*

No abstract available.
Tetanus*

An eccrine squamous syringometaplasia (ESS) is defined as a mature squamous metaplasia of the eccrine ducts. The clinical and pathological features of an ESS are presented. Syringometaplasia is a rare lesion, mostly occuring in the extremities, and as far as we know, no report on the ESS has been published in Korean literature. We experienced a case of an ESS occured in a 15 year-old male, who had a tender erythematous plaque in the right knee. The histologic examination revealed some scattered nests of metaplastic squamous epithelium in the deep dermis, associated with acute nonspecific panniculitis. The importance of the ESS is that it histologically simulates the well differentiated squamous cell carcinoma. The histopathologic findings were discussed and a brief review of the literature was made.
Adolescent ; Carcinoma, Squamous Cell ; Dermis ; Epithelium ; Extremities ; Humans ; Knee ; Male ; Metaplasia ; Panniculitis

To evaluate the expression of transforming growth factor-alpha(TGF-alpha) and proliferating cell nuclear antigen(PCNA) and its relation to the differentiation of the tumors, immunohistochemical studies were performed in 49 human gliomas. Tumors were graded by a 3-grade-system; grade I=low grade glioma, grade Il=anaplastic glioma, grade III=glioblastoma multiforme. TGF-A and PCNA were predominantly expressed in malignant gliomas compared with benign gliomas. Malignant gliomas revealed 87% TGF-A reactivity, while benign gliomas revealed 26% TGF-A reactivity. The proliferation index with PCNA was 26%+/-7%(mean+/-standard deviation) in malignant gliomas and 5%?% in benign gliomas. A strong positive correlation between tumor grade and extent of TGF-A and PCNA expression was found(P<0.0001, Chi square and P<0.002, T-test). Synchronous expression of TGF-A and PCNA was observed in 16 cases(33%). The results of this study support the suggestion that the expression of TGF-A might be a useful prognostic indicator in human gliomas.
Humans

Pigmented squamous cell carcinoma is a very rare malignant, pigmented, epidermal tumor. The rarity of pigmented squamous cell carcinomas may reflect in part their misdiagnosis as other pigmented neoplasms, particularly malignant melanoma. To our knowledge, only five cases have been reported in literature. We recently experienced a case of pigmented squamous cell carcinoma arising from pigmented actinic keratosis in a 77 years old female. Physical examination showed a 0.8 0.6 cm, smooth, dark brown pigmented patch with irregular but sharply defined borders located on the upper left chest. The biopsy specimen showed histologic findings of pigmented actinic keratosis with abundant melanin pigments, which became pigmented squamous cell carcinoma. Most of pigments in the squamous cell carcinoma were contained within the melanocytes along with the neoplastic squamous cells.
Actins* ; Aged ; Biopsy ; Carcinoma, Squamous Cell* ; Diagnostic Errors ; Female ; Humans ; Keratosis, Actinic* ; Melanins ; Melanocytes ; Melanoma ; Physical Examination ; Skin ; Thorax

BACKGROUND: All standard methods of hernia repair involve suturing together tissues which are not normally in apposition. This violates the basic surgical principle that tissue must never be approximated under tension and account for an unacceptable number of failures. Total reinforcement of the inguinal floor with a sheet of suitable biomaterial of a 'tension-free' technique is a more effective approach. METHODS: We have treated inguinal hernias by Bassini method in eighty-nine patients and by Lichtenstein tension free method in sixty-one patients from September, 1993 through December, 1995 and compared these two groups on age, sex, site, type anesthesia, operation time, admission date, postoperative complication, postoperative pain-killer injection period, recurrence. RESULTS: The result are as follows 1) There was no significantly difference compared Bassini method with Lichtenstein tension free method on age, sex, site, type, anesthesia, postoperative complications. 2) The average time of operation was 61.8 minutes on Bassini method and 53.6 minutes on Lichtenstein tension free method. 3) The postoperative complications were hematoma 2 cases, wound seroma 1 case on Bassini method, and wound seroma 1 case on Lichtenstein tension free method. 4) The average duration in the hospital stay after operation was 6.01 days on Bassini method and 4.75 days on Lichtenstein tension free method (p<0.01). 5) The average period for injection of pain-killer after operation was 3.61 days on Bassini method and 2.21 days on Lichtenstein tension free method (p<0.01). 6) The recurrence rate was 6 cases(6.7%) on Bassini method and no recurrence case on Lichtenstein tension free method (p<0.05). CONCLUSIONS: We conclude that Lichtenstein tension free method is less painful and shorter postoperative hospital stay than Bassini method.
Anesthesia ; Hematoma ; Hernia, Inguinal ; Herniorrhaphy* ; Humans ; Length of Stay ; Polypropylenes* ; Postoperative Complications ; Recurrence ; Seroma ; Wounds and Injuries

OBJECTIVE: To compare the diagnostic value between Phalen's test and reverse Phalen's test using a morphological change of the median nerve and the carpal tunnel seen by high-resolution ultrasonography and to research on an ultrasonography as an available tool for the screening and follow up aid-test of the carpal tunnel syndrome (CTS). METHOD: A cross-sectional area and a flattening ratio of the median nerve, and a cross-sectional area of the carpal tunnel were measured in neutral, maximally flexed (Phalen's test), and maximally extended (reverse Phalen's test) positions in 59 wrists of 30 normal subjects. RESULT: The cross-sectional area of median nerve was significantly decreased in maximal flexion (p<0.01), and in maximal extension (p<0.01). The mean flattening ratio of median nerve was revealed significant change in maximal flexion (p<0.01), and in maximal extension (p<0.01). The mean cross-sectional area of the carpal tunnel was significantly decreased in maximal flexion (p<0.01), and in maximal extension (p<0.01), with comparing to neutral position, respectively. CONCLUSION: Phalen's test reveals higher degree of irritation to median nerve. The high-resolution ultrasonography is suggested as an available tool for the screening and follow up aid-test for the CTS.
Carpal Tunnel Syndrome ; Follow-Up Studies ; Mass Screening ; Median Nerve* ; Ultrasonography ; Wrist*

Although an epiglottic cyst is often asymptomatic and harmless to the patient, discovery of a large epiglottic cyst after induction of anesthesia is a potentially life-threatening problem for the patient and provides a challenge for the anesthesiologist in airway management. We experienced a case of unanticipated difficult mask ventilation and intubation as a result of an asymptomatic epiglottic cyst. A 37-year-old woman presented for elective removal of a brain tumor. She had normal mouth opening and neck extension; no masses or distortions of the tongue or neck were observed. She was premedicated with 0.2 mg glycopyrrolate intramuscularly. Anesthesia and paralysis were induced with 250 mg thiopental, fentanyl 100ng and pipecuronium 6 mg. It was noted that ventilation of the lungs via mask was difficult. Despite insertion of an oropharyngeal airway, ventilation proved to be more difficult. Intubation was attempted. Direct laryngoscopy revealed a 2 cm cyst arising from the epiglottis. The cyst completely obscured the view of the epiglottis and larynx, preventing intubation despite multiple attempts by three anesthesiologists. We consulted an otolaryngologist and awakened the patient. During further questioning in the post anesthesia care unit she admitted to a several-years of dysphagia. Next day, she was admitted to the operation room for removal of an epiglottic cyst. She was intubated using fiberoptic bronchoscope guided awake intubation, and the remainder of anesthetia and the operation proceeded uneventfully. The pathology report confirmed the finding of a 2.5 X 1.5 X 1.5 cm epidermal cyst.
Adult ; Airway Management ; Anesthesia ; Brain Neoplasms ; Bronchoscopes ; Deglutition Disorders ; Epidermal Cyst ; Epiglottis ; Female ; Fentanyl ; Glycopyrrolate ; Humans ; Intubation* ; Laryngoscopy ; Larynx ; Lung ; Masks ; Mouth ; Neck ; Paralysis ; Pathology ; Pipecuronium ; Thiopental ; Tongue ; Ventilation

Our purpose was to compare the safety and efficacy of intravaginal misoprostol versus dinoprostone vaginal tablet for induction of labor at term pregnancies. Two hundred three patients with indications for induction of labor at term were randomly assigned to receive either intravaginal misoprostol or dinoprostone vaginal tablet. Fifty micrograms of misoprostol was placed in the posterior vaginal fornix every six hours, with a potential maximum of four doses. 3 milligrams of dinoprostone vaginal tablet was placed in the posterior vaginal fornix every eight hours, with a potential maximum of three doses. Further medication was withheld with the occurrence of spontaneous rupture of membrane, entry into adequate contraction pattern(twenty second sustained with two or more frequent uterine contraction in 10 minutes), nonreassuring FHR tracing, or delivery. Artificial membrane rupture with both study protocol was done at the discretion of the attending physician. After membrane rupture, in the cases of failure of active labor or arrest of dilation, oxytocin was administerated. Among those evaluated, 100 received misoprostol and 102 received dinoprostone. The average interval from start of induction to vaginal delivery was shorter in the misoprostol group(784.7 +/- 389.3 min) than in the dinoprostone group(988.3 +/- 369.5 min)(p<0.01). There was no significant difference in change of Bishop score between the two groups. No statistically significant differences were noted between two groups in case of need for oxytocin and oxytocin total dose, but significant difference was noted between two groups in case of indication for oxytocin augmentation. There were no significant differences in the routes of delivery. Intravaginal administration of misoprostol appears to be as effective as dinoprostone vaginal tablet for labor induction at full term pregnancies. Complications associated with prostaglndin administration were not statistically different between the two treatment groups.
Administration, Intravaginal ; Dinoprostone* ; Humans ; Membranes ; Membranes, Artificial ; Misoprostol* ; Oxytocin ; Pregnancy* ; Rupture ; Rupture, Spontaneous ; Uterine Contraction ; Vaginal Creams, Foams, and Jellies*

PURPOSE: We report a case of orbital B-cell lymphoblastic lymphoma in a 7-year-old boy. METHODS: A 7-year-old boy presented with proptosis and periorbital swelling of his left eye following a periorbital blunt trauma 1-month prior. During the course of routine ophthalmologic and radiologic examinatinos, the swelling spontaneously subsided without specific treatment. An outpatient follow-up was planned, but the swelling recurred 6 months later. An orbital CT and MRI showed an irregular mass with an indistinct margin in the left orbit, for which an incisional biopsy was performed. RESULTS: The orbital mass consisited of monotonous small to medium sized lymphoid cells with evenly dispersed open chromatin, thin nuclear membrane and inconspicuous nucleoli. Immunohistochemistry revealed that the cells were positive for CD79a and TdT, but negative for CD3 and CD5. These findings were compatible with a diagnosis of B cell lymphoblastic lymphoma. CONCLUSIONS: Lymphoblastic lymphoma of the orbit should be suspected and considered in the differential diagnosis for children with acutely progressing orbital mass.
B-Lymphocytes* ; Biopsy ; Child ; Chromatin ; Diagnosis ; Diagnosis, Differential ; Exophthalmos ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Lymphocytes ; Magnetic Resonance Imaging ; Male ; Nuclear Envelope ; Orbit* ; Outpatients ; Precursor Cell Lymphoblastic Leukemia-Lymphoma*