Intraosseous venographic features of the skull base have been studied by the injection of a water-soluble radiopaque medium in the occipital condyle. By this method, the whole intracranial epidural venous structures of the skull base were demonstrated without overlapping of the extracranial vein, except jugular veins and upper cervical vertebral venous plexi. Since 1966, a total of 82 venographies have been performed for the diagnosis of various lesion in the skull base. This series consisted of acoustic neurinoma(3), jugular glomus. Tumor(2), pituitary adenoma(6), sphenoid ridge meningioma(1), metastatic tumor(7), venous malformation(8), pachymeningitis externa(22), parasite infestation(3), trigeminal neuralgia(3), pseudotumor cerebri(16) and others(11). METHOD: Under premedication of Seconal 100 mg and Demerol 50 mg, the patient is placed in the Bowen-Hirtz position. However, until the plain roentgenogram is taken the patient may used a pillow for a comfortable interval. The skin of the mandibulomastoid region is prepared with iodine. A procaine wheal on superficial tissue is made 0.5cm below the lowest attachment of the pinna. Through the wheel an 18-guage spinal puncture needle is introduced in a slightly superior and posterior direction(superior 20 degrees Angle, posterior 10 degrees Angle) until the body surface is touched. The needle is further introduced through the body cortex by steady pressure and rotation. When the needle is firmly fixed the stylet is withdrawn and blood is aspirated from the needle as if in a vein. If free injection with 3-5cc of a saline is established easily by hand, the stylet should be replaced as before. The pillow is then removed and a plain X-ray film, submentovertical view, is taken. After confirmation of an adequate placement of the needle to the occipital condyle on the roentgenogram, an injection of 30cc of 60% angioconray is made as rapidly as possible by hand or a pressure injector. This is the only part of the examination that may cause discomfort to the patient. A film should be taken toward the end of the injection. One film is usually sufficient. Manual jugular compression and/or Vasalva maneuvers, to increase opacification, may be used but its efficacy is not always sufficiently constant. Satisfactory jugular compression can be obtained by use of a sphygmomanometer cuff, adjusted around the neck and inflated up to about 50 mmHg. With this technique the whole venous structure of the skull base, including the middle meningeal and orbital sinuses, can be visualized. This method, because of the close situation of the occipital condyle, has the advantage of demonstrating the whole marginal sinus of the foramen magnum and the upper cervical vertebral venous plexi. To date no complication have been encountered. Its diagnostic significance is gratifying in detecting the extent and localization of space-occupying lesion, inflammatory processes and venous thrombosis or malformation of the skull base.
Acoustics ; Diagnosis ; Foramen Magnum ; Hand ; Humans ; Iodine ; Iothalamic Acid ; Jugular Veins ; Meningitis ; Meperidine ; Neck ; Needles ; Orbit ; Parasites ; Phlebography* ; Premedication ; Procaine ; Secobarbital ; Skin ; Skull Base* ; Skull* ; Sphygmomanometers ; Spinal Puncture ; Veins ; Venous Thrombosis ; X-Ray Film

A 10-year-old boy had pin-head sized, discrete, yellowish waxy, translucent papules on the face and also, various sized round, circumscribed, erythematous patches with silvery white scales on the trunk. The clinical and histopathologic findgs were compatable with diagnosis of tuberous sclersis associate with psorlasis. There were strong familial history during 3 generation in psoriasis(Fig. 1) Both psoriasis and tuberous sclerosis are heritable skin diseases. Some heritable dermatologic conditions found in tuberous sclerosis including ichthyosis, hypertrichosis and palmar and plantar keratoses but there is no report of tuberous sclerosis associated with psoriasis in published literatures.
Child ; Diagnosis ; Humans ; Hypertrichosis ; Ichthyosis ; Keratosis ; Male ; Psoriasis* ; Skin Diseases ; Tuberous Sclerosis* ; Weights and Measures

This study was designed to investigate the therapeutic effect of dinitrochlorobenzene (DNCB) on alopecia areata. Forty patients with alopecia areata were sensitized by applying 0.1ml of 2% DNCB dissolved in aceton solution on the voiar aspect of left forearm. Patients were subsequently chaIlenged at weekly mtervals with 0. 1% DNCB solution appIied to one side of affected area for periods of 2 to 8 months. The other side of affected area was reserved as a contol site. The results were as follows. 1. In 29 out of 40 patients (72.5%), hair regrowth occurred either excIusiveIy on the treated site (18 cases) or considerably faster and denser on treated site(11 cases)(Table 1) 2. In the majority of cases, the regrowth of hair was observed, within eight weeks of the treatment. 3. The response to DNCB depended on the severity of the aIopecia. The response rate were 80.9% (17/21) in moderate degree (<25% bald area) cases, 68.7% (ll/16), in the extensive degree(>25% bald area) caes and 33% (1/3) in alopecia totalis(Tale 1) 4. The rate of response depended on the duration of the alopecia. Satisfaetory results were obtained in 19 out of 25 patients with a history of less than one year(76%), in 7 out of 10 patients with a history of one to three year(70%) and in 3 out of 5 patients with a history of more than three years (60%) (Table 2) 5. The main side reactions were burning sensation (3 cases), severe eczema (2 cases), folliculitis (2 cases) and cervical lymphadenopathy(7 cases). 6. Liver function test and complete blood cell count were in normal range during the course of treatment in 5 randomly selected patients. 7. Although the treatment of alopecia areata with DNCB still remains to be an experimental trial, this therapy could be substituted for corticosteroids in selected cases.
Adrenal Cortex Hormones ; Alopecia ; Alopecia Areata ; Blood Cell Count ; Burns ; Dinitrochlorobenzene* ; Eczema ; Folliculitis ; Forearm ; Hair ; Humans ; Liver Function Tests ; Reference Values ; Sensation

No abstract available.
Brain Edema* ; Brain*

Tibial Plateau fracture is relatively common injury which often produce major disability, and their treatment has been in controversy. Recent studies suggest that early knee motion and perhaps better surgical techniques have improved clinical end results. Protection from weight bearing and length of immobilization have varied among authors and variable treatment methods. Thirty-eight tibial plateau fractures treated at Kangnam Sacred Heart Hospital from March in 1984 to December in 1988 were analized and the followings were obtained. l. Of 38 patients, 29 patients were male and 9 female. 2. The most common associated injury was an ipsilateral fibular fracture. 3. Average duration of immobilization was 4 to 6 weeks in conservative treatment and 2 to 4 weeks in operative treatment. 4. We started partial weight bearing in 24 patients within 6 weeks and full weight bearing in 28 patients between 8 and 12 weeks, and good end results were obtained.
Clinical Study ; Female ; Heart ; Humans ; Immobilization ; Knee ; Male ; Weight-Bearing

The occurrence of fistulous tract between the thoracic subarachnoid space and the pleural cavity due to injury is uncommon. The one was developed after traffic accident and treated by surgical repair of the fistula : The other was post-operative complication of costotransversectomy for T2 sympathectomy. The complication was realized by the surgeon who was aware of the small leakage of cerebrospinal fluid from the dura propria of the T2 nerve root at the time of surgery. Intermittent pleural punctures for drainage and semisitting position were followed by spontaneous closure of the fistula. These cases were reported so that the uncommon condition might be added to the differential diagnosis of pleural effusion.
Accidents, Traffic ; Cerebrospinal Fluid ; Diagnosis, Differential ; Drainage ; Fistula* ; Pleural Cavity ; Pleural Effusion ; Punctures ; Subarachnoid Space ; Sympathectomy

A 48-year-old male patient is presented in whom huge cystic cerebellar astrocytoma simulated cerebellopontine angle tumor. Surprisingly enough, the symptoms started only 20 days prior to admission and expired before opening the dura. The neurological manifestations were of throbbing suboccipital headache, right hemiparesis, slurred speech and ataxia associated with acute increased intracranial pressure. The vertebral angiogram revealed downwardly displaced inferior posterior cerebellar artery without tumor blush. There was no evidence of increased uptake of radioactive isotope in brain scan. Suboccipital craniectomy and total laminectomy of the first and second cervical spine was performed but intradural manipulation was postponed because of tensely bulged dura, excessive bleeding and unstable vital signs to tolerate general anesthesia. The patient died of respiratory arrest 5 hours after the operation. The huge size of cystic astrocytoma on the right cerebellar hemisphere and tremendous cerebellomedullary herniation were found at the time of postmortem examination. Various pathophysiological mechanism which caused this unusual regrettable clinical outcome are briefly considered.
Adult* ; Anesthesia, General ; Arteries ; Astrocytoma* ; Ataxia ; Autopsy ; Brain ; Headache ; Hemorrhage ; Humans ; Intracranial Pressure ; Laminectomy ; Male ; Middle Aged ; Neurologic Manifestations ; Neuroma, Acoustic ; Paresis ; Spine ; Transcutaneous Electric Nerve Stimulation ; Vital Signs

Occult meningocele is a cystic type of spinal dysraphism derived from developmental fusion defect during early fetal life. It is well known its common, but remarkably less than of myelomeningocele in incidence, combinations with other anormalies. A 11-year-old boy suffering from waddling gait and equinovarus foot deformity for 6 years, is presented. He has not any external protruded mass, hypertrichosis or abnormal pigmentation around his low back. He also has no evidence of neurofibromatosis or enlarged head. Pain spinal films show widening of intervertebral foramina and interpedicular distance, and spina bifida. With myelography using 90ml of Pantopaque, huge ectatic sac accompanying with multiple outpocketings of meninges like stocked tail is well demonstrated. Neurosurgical operation was not indicated. Operation for the correction of the foot deformity were performed by orthopedician.
Child ; Clubfoot ; Foot Deformities ; Gait ; Head ; Humans ; Hypertrichosis ; Incidence ; Iophendylate ; Male ; Meninges ; Meningocele* ; Meningomyelocele ; Myelography ; Neurofibromatoses ; Pigmentation ; Spinal Dysraphism ; Spine*

Occult meningocele is a cystic type of spinal dysraphism derived from developmental fusion defect during early fetal life. It is well known its common, but remarkably less than of myelomeningocele in incidence, combinations with other anormalies. A 11-year-old boy suffering from waddling gait and equinovarus foot deformity for 6 years, is presented. He has not any external protruded mass, hypertrichosis or abnormal pigmentation around his low back. He also has no evidence of neurofibromatosis or enlarged head. Pain spinal films show widening of intervertebral foramina and interpedicular distance, and spina bifida. With myelography using 90ml of Pantopaque, huge ectatic sac accompanying with multiple outpocketings of meninges like stocked tail is well demonstrated. Neurosurgical operation was not indicated. Operation for the correction of the foot deformity were performed by orthopedician.
Child ; Clubfoot ; Foot Deformities ; Gait ; Head ; Humans ; Hypertrichosis ; Incidence ; Iophendylate ; Male ; Meninges ; Meningocele* ; Meningomyelocele ; Myelography ; Neurofibromatoses ; Pigmentation ; Spinal Dysraphism ; Spine*

Interbody fusion was performed on eight cases of lumbar instability;five spondylolisthesis and three spondylolysis. Five cases were operated by anterolateral approach through the retroperitoneal space, and posterior approach on three cases after Cloward. Symptomatic improvement was obtained in almost all cases and complete fusion was observed on the roentgenogram three months later. Ambulation was possible from the immediate postoperative day without external support. While posterior approach has an advantage to observe the nerve root under direct vision, anterolateral approach has the following advantages;It is less destructive to the spinal structures, It can be performed without teasing the neural elements, anterior slipping of the vertebral body can be reduced easily, and its was applicable to the upper lumber level where neural elements qre compact. We believe interbody fusion has definite advantage to obtain strong weight bearing stability than fusion of any other parts of the spine because it has rapid recovery, low morbidity and high percentage of complete cure without disability.
Retroperitoneal Space ; Spine ; Spondylolisthesis ; Spondylolysis ; Walking ; Weight-Bearing