Spinal epidural abscesses were evaluated using Gadolinium-enhanced magnetic resonance imaging (MRI) in 19 surgically and clinically confirmed cases, including 13 with tuberculous spondylitis and 6 with pyogenic spondylitis. We observed rim enhancement patterns in 10 patients and diffuse enhancement patterns in 9 patients. The spread patterns were localized to ventral or dorsal epidural space and encircled entire epidural space. We conclude that rim enhancement indicates abscess and diffuse enhancement indicates granulation tissue and fibrosis. Tuberculous epidural abscess spreads to ventral epidural space and pyogenic epidural abscess encircles entire epidural space.
Abscess ; Epidural Abscess* ; Epidural Space ; Fibrosis ; Granulation Tissue ; Humans ; Magnetic Resonance Imaging* ; Spondylitis

Most of the malignant tumors of the pancreas are adenocarcinomas arising from the ductal epithelium. Primary leiomyosarcoma of the pancreas, even though it is the most common sarcoma of the pancreas, is very rare. We present a case of leiomyosarcoma of the pancreas, probably primary, with metastases to the stomach, lymph nodes, and abdominal wall. A 52-year-old woman visited the hospital with vague right upper abdominal pain and weigh loss of 6 kg for 2 months. The radiological and endoscopic examination revealed that she had a large heterogeneous mass, 11 cm in size, in the pancreatic body and tail, a 4 cm-sized mass in the paraaortic area, and a 3 cm-sized polypoid mass in the stomach. Histologically, they were all similar to one another and composed of markedly pleomorphic cells. Immunohistochemical and electron microscopic studies showed definite smooth muscle differentiation of the tumor cells. Two months later, the patient underwent an excision of a new 3 cm mass in the right lower abdominal wall, showing features of well differentiated leiomyosarcoma.
Abdominal Pain ; Abdominal Wall ; Adenocarcinoma ; Epithelium ; Female ; Humans ; Leiomyosarcoma* ; Lymph Nodes ; Middle Aged ; Muscle, Smooth ; Neoplasm Metastasis ; Pancreas* ; Sarcoma ; Stomach

PURPOSE: To examine the relationship between distance from hepatic capsule to tumor and recurrence among hepatocellular carcinoma patients in whom marginal recurrence was noted after radiofrequency ablation therapy. MATERIALS AND METHODS: Between January 2000 and December 2001, hepatocellular carcinoma patients with a tumor 5 cm or less in size and located 2 cm or less from the hepatic capsule underwent radiofrequency ablation therapy. We subsequently selected 37 patients (41 tumors) in whom immediate CT demonstrated complete tumor ablation and follow-up CT showed marginal recurrence. Tumors were grouped according to their distance from the hepatic capsule: Group I, adhered to the capsule; Group II, less than 1 cm from it; Group III, 1-2 cm distant. Of the 41 tumors, 22 were assigned to Group I, six to Group II, and 13 to Group III. Mean tumor size was 3.2 cm, and inter-group variation was small (Group I, 3.3 cm; Group II, 2.9 cm; Group III, 3.1 cm). Follow-up CT was used to determine marginal recurrence, and for inter-group comparison and the assessment of statistical significance, the t test was employed. RESULTS: Marginal recurrence was noted at mean 5.5 months (2.7 months in Group I, 3.0 months in Group II, and 10.5 months in Group III). The t test revealed significant difference between Group I and III (p<0.0001) but not between Groups I and II, or II and III. If '1 cm from hepatic capsule' was the criterion for classification, and Group I and II were combined and compared with Group III, there was significant difference between the two groups (<0.0001). CONCLUSION: Tumors which adhered to the hepatic capsule or were less than 1 cm from it recurred sooner than those situated 1-2 cm away.
Carcinoma, Hepatocellular* ; Catheter Ablation* ; Classification ; Follow-Up Studies ; Humans ; Recurrence*

PURPOSE: The purpose of this study was to understand the degree of pain belief in musculoskeletal patients, and to identify the correlation with chronic pain, pain coping and pain disability. METHODS: A total of 203 inpatients or outpatients with chronic pain in orthopedics agreed voluntarily to participate in this study and answer a questionnaire. Data were analyzed using SPSS/WIN 17.0 program with descriptive statistics, t-test, ANOVA, Scheffe test, Pearson's correlation coefficient, and simple linear regression. RESULTS: The degree of pain belief in this study showed statistically significant differences depending on their age, education, job, health status, and pain duration. Among the variables correlating with pain belief in this study, there were positive correlations between pain and pain disability, pain and passive coping, pain belief and passive coping, pain belief and pain, pain belief and pain disability. The strongest correlation was passive coping and pain disability. CONCLUSION: From the results of this study, we concluded that it is necessary to develop the nursing intervention which can help reducing negative pain belief in patients with chronic musculoskeletal pain. Also we need to enhance the ways of coping to active or chronic pains for controlling them effectively.
Adaptation, Psychological ; Chronic Pain ; Disability Evaluation ; Faith Healing ; Humans ; Inpatients ; Musculoskeletal Pain ; Orthopedics ; Outpatients ; Surveys and Questionnaires

Incontinentia pigmenti (IP), also known as Bloch-Sulzberger syndrome, is a rare X-linked dominant disorder that is generally lethal to males and almost always leads to death in utero. This disorder is a genodermatosis with characteristic cutaneous lesions and manifestations affecting the eyes, teeth, hair, and central nervous system. Genodermatosis is a hereditary disease caused by mutations in the nuclear factor-kappa B essential modulator gene mapped to chromosome Xq28. This gene encodes a variety of cytokines and chemokine regulators and is indispensable for protecting cells from tumor necrosis factor-induced apoptosis. Here we describe a case of male newborn with vesiculobullous cutaneous lesions over the left thigh and leg. We first considered the cutaneous lesions a skin infection, as they improved with intravenous antibiotics. However, recurrence and the need for repeated hospitali zations made us consider the differential diagnosis of IP, for which we performed a skin biopsy and chromosome analysis. The histology results were compatible with IP, that is, eosinophilic infiltration in the dermis and epidermis, and individual cell dyskeratinization. The chromosome analysis result was a normal 46, XY karyotype.Here we report the case of a male newborn with IP that manifested as multiple vesiculobullous skin lesions and was initially misdiagnosed as a recurrent skin infection.

PURPOSE: To evaluate the incidence of sacral insufficiency fracture in osteoporotic patients with compression fracture of the thoracolumbar (T-L) spine on magnetic resonance image (MRI), and to analyze the correlation of variable clinical factors and the incidence of sacral insufficiency fracture. MATERIALS AND METHODS: We retrospectively reviewed 160 patients (27 men, 133 women; age range of 50 to 89 years) who underwent spinal MRI and had compression fracture of the T-L spine. Compression fractures due to trauma or tumor were excluded. We evaluated the incidence of sacral insufficiency fracture according to the patients' age, sex, number of compression fractures, and the existence of bone marrow edema pattern of compression fracture. During the same period, we evaluated the incidence of spinal compression fracture in the patients of pelvic insufficiency fracture. RESULTS: Out of the 160 patients who had compression fracture in the T-L spine, 17 (10.6%) had insufficiency fracture of the sacrum. Compression fracture occurred almost 5 times more frequently in women (27:133), but the incidence of sacral insufficiency fracture was 2/27 for men (7.4%) and 15/133 for women (11.3%), with no statistically significant difference (p = 0.80). According to age, the ratio of insufficiency fracture to compression fracture was 0% (0/23) in the 50's, 10.6% (7/66) in the 60's, 12.5% (7/56) in the 70's, and 20.0% (3/15) in the 80's. In respect of single and multiple compression fracture, the incidence of sacral insufficiency fracture was 8/65 for men (12.3%) and 9/95 for women (9.5%), showing no significant difference (p=0.37). In the patients with and without compression fracture with bone marrow edema, insufficiency fracture occurred in 5/76 (6.6%) and 12/84 (14.3%), respectively. On the other hand, of the 67 patients who had pelvic insufficiency fracture, 27 (40.3%) also had spinal compression fracture. CONCLUSION: About 10% of the patients with osteoporotic compression fracture in the T/L spine also had pelvic sacral insufficiency fracture, which was not uncommon. These findings suggest the need to consider the possibility of pelvic sacral insufficiency fracture in cases of T/L spinal MRI for patients with osteoporotic compression fracture.
Bone Marrow ; Edema ; Female ; Fractures, Compression* ; Fractures, Stress* ; Hand ; Humans ; Incidence* ; Magnetic Resonance Imaging ; Male ; Osteoporosis ; Retrospective Studies ; Sacrum ; Spine*

Myasthenia Gravis is a neuromuscular disorder manifested by increasing weakness and fatigability of voluntary muscles with exercise, and partial or complete restoration of function following rest or the administration of anticholinesterase drugs. The anesthesiologists may be called upon to assist in the diagnosis of myasthenis, in treating the patient by artificial ventilation during acute exacerbations, to anesthetise the patient for thymectomy or other surgery. Therefore, the anesthesiologists must be familiar with the diagnosis and treatment of myasthnia gravis to carry on the appropriate therapy. Two cases of anesthesia for thymectomy in myasthenia gravis without using muscle relaxants was experienced, and no respiratory problems were encountered postoperatively.
Anesthesia* ; Cholinesterase Inhibitors ; Diagnosis ; Humans ; Muscle, Skeletal ; Myasthenia Gravis* ; Thymectomy* ; Ventilation

Prurigo pigmentosa(PP) is a rare dermatosis with an unknown cause characterized by intensely pruritic papules that resolve with reticulate pigmentation. It is a disease entitity commonly reported in Japan but seemingly rare in other parts of the world. We report 5 cases that clinically and histopathologically fulfilled the characterisitics of PP and were treated with dapsone resulting in significant clinical improvement.
Dapsone ; Japan ; Pigmentation ; Prurigo* ; Skin Diseases

It is well known that halogenated anesthetics have been mainly used for inhalation anesthesia these days. However many controversies still exist concerning hepatic cellular damage after halothane anesthesia. Although several articles have been issued concerning the effects of halogenated anesthetics for hepatitis B surface antigen positive patients, a study of frequent research and strict case collections is meaningful. The authors observed the effects of enflurane anesthesia on 15 HBsAg positive patients who had not recognized themselves whether they had hepatitis symptoms or were carriers. During the period of study, all groups(enflurane study group and enflurane and halothane control groups) did not experience any difficulty with the anesthesia, blood transfusion, and jaundice, etc. The comparative data of liver function tests did not show great differences during the convalescent period. According to this and other recent studies, we can positively conclude that halogenated anesthetics, especially enflurane, may favorably be used to administer HBsAg positive patients, unless any undesirable problems related to anesthesia exist.
Anesthesia* ; Anesthesia, Inhalation ; Anesthetics ; Anesthetics, Inhalation ; Blood Transfusion ; Enflurane* ; Halothane ; Hepatitis ; Hepatitis B Surface Antigens* ; Humans ; Jaundice ; Liver Function Tests

BACKGROUND: Skin cancer is divided into two categories, melanoma and nonmelanoma skin cancer, by its malignant potential. The former is prone to be metastatic and it often requires regional lymph node dissection and chemotherapy, while the latter is rarely metastatic with no need for such further treatment. We report here on the reconstruction methods after surgical removal of skin cancers, with excluding melanoma. OBJECTIVE: Our purpose was to analyze the reconstruction methods according to the location and size of the lesions after surgical removal of nonmelanoma skin cancers and we report on the clinical findings. METHODS: We analyzed 186 cases of nonmelanoma skin cancers that were treated Between January, 2000 and December, 2006 at the Department of Dermatology, Chonbuk University Hospital. The cases were analyzed according to the reconstruction methods for the defects after surgery, the gender ratio, the age range, the lesion site and the lesion size. RESULTS: The mean age of onset was 67.7 years old. The ratio of men to women was 1:1.02. The most common nonmelanoma skin cancer was basal cell carcinoma (66.7%), followed by squamous cell carcinoma (22.1%), and Bowen's disease (4.3%). The most common site of all the nonmelanoma skin cancers was the face (68.8%), followed by the trunk (7.5%) and scalp (6.5%). The most common reconstruction method was local flap (40.3%), followed by primary closure (38.7%), skin graft (18.8%) and secondary intention (2.2%). In terms of location, the most commonly used method was local flap for the face (50.0%) and primary closure for the trunk (53.3%), scalp (83.3%) and the upper (44.4%) and lower extremities (63.6%). According to the lesions' size, the most common method was flap for tumor between 10 mm and 30 mm in diameter (95.1%), primary closure for tumor less than 10 mm in diameter (66.7%) and graft for tumor greater than 30 mm in diameter (66.7%). CONCLUSION: We offer this data for the reconstruction methods of nonmelanoma skin cancers and their clinical findings in Korea.
Age of Onset ; Bowen's Disease ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Dermatology ; Female ; Humans ; Intention ; Korea ; Lower Extremity ; Lymph Node Excision ; Male ; Melanoma ; Scalp ; Skin ; Skin Neoplasms ; Transplants