A case of lupus vulgaris who has the typical skin lesion on the patella region of the right knee was presented. The patient is 9 years old, the generally healthy male, and is no special finding of chest X-ray but tuberculin test was strong positive. The skin lesion started about 2 years ago as baby's palm sized erythematous patch with apple jelly nodule on the right knee joint region. Diagnosis was made by characteristic of clinical appearance and histulagial finding including other laboratory data. The treatment was done with INAH, PAS, streptomycin and pyridoxine for 3 months. Now,The skin lesion is almost healed and still continue treatment and observation go on.
Child ; Diagnosis ; Humans ; Knee Joint* ; Knee* ; Lupus Vulgaris* ; Male ; Patella* ; Pyridoxine ; Skin ; Streptomycin ; Thorax ; Tuberculin Test

BACKGROUND: Dyskinesia is a common side effect complicating long-term levodopa therapy for Parkinson's disease. However, the pathogenesis of dyskinesia has not been completely understood. In recent animal studies, it has been reported that a NMDA (N-methyl-D-aspartate) antagonist reduced levodopa-induced dyskinesia. These findings suggest that the hyperfunction of NMDA receptors on striatal efferent neurons contributed to the pathogenesis of dyskinesia. Amantadine has also been recently shown to antagonize central NMDA receptors. In the present study, we observed amantadine efficacy in levodopa-induced dyskinesia in parkinsonian patients. METHODS:Twenty-two parkinsonian patients with levodopa-induced dyskinesia participated in a placebo-controlled, cross-over study. We prescribed 100 mg amantadine daily as a starting dose, which was built up every four days and titrated up to 400 mg a day. After two weeks of a wash-out period, a placebo was given with the same schedule. The doses of levodopa and other antiparkinsonian drugs were unchanged during this period. We assessed the duration and disability of dyskinesia (UPDRS part IV, item 32 and 33) based on diary and interview. RESULTS: Amantadine was superior to placebo in reducing the duration of dyskinesia in 9 patients (42.9%) and the disability of dyskinesia in 11 patients (52.4%). The reduction of the duration and disability of dyskinesia was correlated with the dose of amantadine. CONCLUSIONS These findings suggest that amantadine can improve levodopa induced dyskinesia and supports the view that the hyperfunction of NMDA receptors contributes to the pathogenesis of levodopa induced dyskinesia.
Amantadine* ; Animals ; Appointments and Schedules ; Cross-Over Studies ; Dyskinesias* ; Humans ; Levodopa ; N-Methylaspartate ; Neurons, Efferent ; Parkinson Disease ; Receptors, N-Methyl-D-Aspartate

PURPOSE: Side firing laser prostatectomy(VLAP) is now considered as alternative promise of transurethral resection of the prostate(TURP). This study was designed to compare VLAP to conventional TURP in the efficacy and safety. MATERIALS AND METHODS: There was no significant differences in preoperative clinical characteristics between the TURP group and VLAP group. To evaluate the effectiveness and safety of VLAP, we compared the results of transurethral resection of prostate(TURP, n=115) to laser prostatectomy(VLAP, n=45) in international prostate symptom score(IPSS), maximal flow rate(Qmax), post-voiding residual urine at preoperative, after 1 month, 6 months and 12 months postoperatively. For the VLAP procedure, Nd: YAG was used. Patient was treated with 600micrometer internal reflector fiber covered by crystal glass cadding(SideTrackTM). RESULTS: There was no statistically significant difference in the results between TURP group and VLAP group. TURP group; IPSS of preoperative, after 1 month, 6 months, 12 months was 23.8, 9.0, 9.1, 9.0 and Qmax was 7.8ml/s, 17.0ml/s, 17.1ml/s, 17.6ml/s and residual urine was 159.3ml, 52.7ml, 40.0ml, 34.6ml. VLAP group; IPSS of preoperative, after 1 month, 6 months, 12 months was 22.8, 9.7, 9.8, 9.3 and Qmax was 8.1ml/s, 16.0ml/s, 16.7ml/s, 17.1ml/s and residual urine was 135.7ml, 46.8ml, 34.5ml, 28.1ml. Postoperative period of catheter indwelling and hospitalization was shorter in VLAP group than TURP group(3.7+/-2.0 days vs 5.3+/-1.9 days, 4.5+/-1.6 days vs 6.8+/-3.5 days). CONCLUSIONS: VLAP has no siginificant complications such as postoperative bleeding, TURP syndrome. VLAP would be recommended as following: 1) prostate weight is smaller, 2) physical status is poor, 3) anticoagulant treatment, 4) when patient wants more safe treatment. We had a good results by means of VLAP. The good results come from the use of internal reflecting type laser fiber. These results suggest that VLAP is considered the most promising alternative to TURP.
Catheters ; Fires* ; Glass ; Hemorrhage ; Hospitalization ; Humans ; Postoperative Period ; Prostate* ; Transurethral Resection of Prostate

PURPOSE: The purposes of this study were to analyze the MR findings of medulloblastoma, and to evaluate the subarachnoid dissemination and the significance of contrast enhanced MR of brain and spine for tumor.. MATERIALS AND METHODS: The preoperative brain MR studies of 18 patients (9 males, 9 females;mean age, 9.4 years) with surgically proved medulloblastomas were retrospectively reviewed to characterize these neoplasms with regard to their location, size, MR signal intensity, appearance after contrast enhancement, presence of cyst and necrosis, subarachnoid dissemination, and other associated findings. In 14 patients postoperative spine MR studies were evaluated for staging and therapeutic planning. RESULTS: The most frequent location of medulloblastoma was the inferior vermis and the mean tumor size was 4.1 x 3.6 x 3.9 cm. On Tl-weighted image, medulloblastomas generally had low to intermediate signal, predominantly hypointense relative to white matter. On T2-weighted image, medulloblastomas showed modetately high signal, hyperintense relative to white matter. Inhomogeneous contrast enhancement was demonstrated in 13 patients(72.2%) after injection of gadopentetate dimeglumine(Gadolinium). Cyst and necrosis within the tumor were visualized in 15 patients(83.3%). Subarachnoid disseminations of medulloblastomas were noted in 11 patients(61.1%), of which 6 demonstrated intracranial and 2 intraspinal dissemination. Three had both intracranial and intraspinal dissemination. In nine cases with intracranial lesions, there were intraparenchymal mass formation(7), subarachnoid nodules(5), infundibular lesions(2) and diffuse gyral enhancement(I). In five cases with intraspinal lesions, there were extramedullary intradural small nodules(3), central canal nodules(2), intradural masses(I)and fine nodular and sheet-like leptomeningeal enhancement(1). Other associated findings included intratumoral hemorrhage(11.1%), per/tumoral edema(44.4%), tonsillar herniation(44.4%), hydrocephalus(88.9%) and calcification(44.4%). CONCLUSION: Medulloblastomas revealed low to intermediate signal intensity on Tl-weighted image and intermediate to moderately high signal intensity on T2-weighted image, relative to cerebellar white matter. Medulloblastomas were solid tumors with cystic necrosis, which showed inhomogeneous enhancement and subarachnoid disseminations to the intracranial and intraspinal spaces after Gd-DTPA enhancement. Gd-enhanced MR of brain and spine was an useful diagnostic modality in preoperative diagnosis and in staging of postoperative cases of medulloblastomas, which was superior to postcontrast CT or precontrast MR.
Brain* ; Diagnosis ; Gadolinium DTPA ; Humans ; Male ; Medulloblastoma ; Necrosis ; Retrospective Studies ; Spine*

No abstract available.
Hallux Valgus* ; Hallux*

The method of ankle arthrodesis is variable but compression arthrodesis has been widely used because of better results than non-compression arthrodesis. Twenty-one cases of ankle arthrodesis were carried out at department of orthopaedic surgery of Korea Veterans Hospital from January 1980 to June 1986, and were analysed clinically. The results obtained were as follows; l. Among 11 cases of compression arthrodesis, Charnleys method was done in 8 cases and Monofixateur in 3 cases. 2. Among 10 cases of non-compression arthrodesis, Chuinard-Peterson method was done in 7 cases and anterior 'sliding graft in 3 cases. 3. The average duration of immobilization after ankle arthrodesis was 11.7 weeks, and average 4.2 weeks were less needed in the compression arthrodesis than non-compression arthrodesis. 4. The postoperative complications were developed in 8 cases (38%): wound infection in 4 cases,skin necrosis in 3 cases and incisional neuroma in 1 case. 5. Bony union was obtained in 20 cases(95.2%) out of 21 cases at average 15.7 weeks, and in the non-compression arthrodesis and in the cnmpression arthrodesis, respectively, 90% at 17.7 weeks and 100% at 13.9 weeks.
Ankle Joint ; Ankle ; Arthrodesis ; Hospitals, Veterans ; Immobilization ; Korea ; Methods ; Necrosis ; Neuroma ; Postoperative Complications ; Transplants ; Wound Infection

The simultaneous occurrence of a renal cell carcinoma and a urothelial carcinoma in the same kidney is uncommon. Here we report the case of a 79-year-old woman with ipsilateral synchronous renal cell carcinoma and urothelial carcinoma. She was referred to our hospital for gross hematuria and right flank pain. A computed tomography scan showed a 15x20 mm enhanced lesion on the upper calyx and a 12x15 mm mass on the lateral aspect of the right kidney. We thus suspected a renal pelvis tumor and performed right hand assisted laparoscopic nephroureterectomy with bladder cuff excision (HALSNU). Gross findings were multiple, pale yellowish papillary masses on the upper and lower major calices, of which the largest one measured 16x20 mm. A separated solid mass measuring 12x16 mm was also noted on the anterior midportion of the kidney. The former was a urothelial carcinoma and the latter was a chromophobe renal cell carcinoma. We present a rare case of a chromophobe renal cell carcinoma and a urothelial carcinoma in the same kidney.
Aged ; Carcinoma, Renal Cell ; Female ; Flank Pain ; Hand ; Hematuria ; Humans ; Kidney ; Kidney Pelvis ; Urinary Bladder

BACKGROUND AND PURPOSE: Hemifacial spasm(HFS) is a chronic and often progressive disorder characterized by unilateral irregular clonic and tonic contractions of one or more muscles of facial expression. Many previous electrophysiologic studies showed characteristic features of HFS differentiating from other involuntary movements of the face. However, there has been no electrophysiologic study for estimating the clinical severity of HFS. This study was prospectively designed to evaluate the relationships between electrophysiologic findings and clinical severity of HFS. METHODS: The authors performed direct facial nerve stimulation, blink reflex, and lateral spread response in 62 patients with HFS, and compared the results of affected side with those of unaffected each other. Clinical severity was graded into seven groups (0-6) by questionnaire and confirmed by a neurologist. RESULTS: The results were as following. 1) The total number of subjects were 62, the number of patients in group 2 was 3 (4.8%), group 3 was 12 (19.3%), group 4 was 25 (40.3%), group 5 was 21 (33.9%), and group 6 was 1(1.6%). 2) The mean age was 54.5+/-9.1years old, the mean duration of the illness was 6.4+/-4.9years, male was 11(17.7%) and female was 51(82.3%), and involved sites were right in 26(41.9%) and left in 36(58.1%) patients. 3) Direct stimulation of facial nerve showed no differences between affected and unaffected sides in HFS. 4) The results of blink reflex showed more increased latencies and larger amplitudes of R1 & R2 responses in affected sides than in unaffected sides of HFS, but no differences among the groups. 5) The lateral spread responses were found in 45 of 62 (72.6%) patients by stimulation of zygomatic branch and recording in mentalis muscle, 26 of 62 (41.9%) patients by stimulation of mandibular branch and recording in orbicularis oculi muscle on affected side. 6) There was a linear correlation between the presence of lateral spread response with zygomatic or mandibular stimulation and the grade of clinical severity. CONCLUSION: We suspected that the lateral spread response was a significant electrophysiological test for estimating the clinical severity of HFS.
Blinking ; Dyskinesias ; Facial Expression ; Facial Nerve ; Female ; Hemifacial Spasm* ; Humans ; Male ; Muscles ; Prospective Studies ; Surveys and Questionnaires

Writer's cramp is one of the most frequent type of task-related dystonia. It is primarily defined by the appearance of involuntary muscle contractions soon after one begins to write and often co-exists with postural tremor. The cause of writer's cramp as well as other focal dystonia is still a matter of debate. Although the genetic background of some dys-tonia was well known, there have been few cases of writer's cramp that involve other family members. We experienced one family with writer's cramp and postural tremor. A 42-year-old man noted handwriting difficulty of gradual onset which began with postural tremor at the age of 25. When he wrote certain letters or numbers, he automatically had to press hard or hold the pen tightly, experiencing tremor as well as dystonia. His mother and four siblings also had simi-lar disabilities. All were right-handed, and had a postural tremor, prominent in their right hands. They noted the onset of symptoms between the age of 20 and 40. The symptoms had slowly progressed over a period of years and no patient described a remission of symptoms. Two of them eventually no longer attempted to write due to writer's cramp. Two members could write but barely readable and the other two had minimal distress. Alcohol somewhat relieved the cramp in only one of them. Levodopa was no beneficial to the cramp and baclofen relieved the cramp minimally. We report this rare case with familial writer's cramp and postural tremor that suggests autosomal dominant inheritance.
Adult ; Baclofen ; Dystonia ; Dystonic Disorders* ; Hand ; Handwriting ; Humans ; Levodopa ; Mothers ; Muscle Cramp ; Muscle, Smooth ; Siblings ; Tremor ; Wills

PURPOSE: No standard number of cores is obtained with a prostate needle biopsy. Routinely, we obtain 10 core biopsies but do not consider prostate volume or patient age. Consequently, we evaluated the clinical efficacy of prostate biopsy when taking into account prostate volume and patient age by use of the Vienna nomogram to suggest the proper number of cores. MATERIALS AND METHODS: Transrectal ultrasonography (TRUS)-guided prostate needle biopsies were performed in 326 patients between November 2006 and June 2009. Group A (10 cores biopsy) was 131 patients. Group B (biopsy using Vienna nomogram) was 134 patients. We compared the cancer detection rate between the two groups, especially according to age and prostate volume. The chi-squared test was used for statistical analysis. RESULTS: The overall cancer detection rates in groups A and B were 33.6% and 32.1%, respectively. In older patients (age> or =60 years), group B had a higher detection rate than did group A (37.0% vs. 35.6%). For patients with a small prostate (<30 g), group B had a significantly higher detection rate than did group A (62.1% vs. 30.4%, p=0.023). CONCLUSIONS: There was no significant difference in the overall cancer detection rate. However, in patients with a small prostate and in older patients, the Vienna nomogram was more effective than a 10-core biopsy. The Vienna nomogram could help to establish guidelines for prostate biopsy in Korea that take into account the prostate volume and the age of the patient. It could also help urologists to reduce unnecessary cores when diagnosing prostate cancer in the elderly population and in those with small prostates.
Aged ; Biopsy ; Biopsy, Needle ; Humans ; Korea ; Nomograms ; Prostate ; Prostatic Neoplasms