BACKGROUND: The common causes of lower back pain with or without leg pain includes disk disease and spinal stenosis. A definitive diagnosis is usually made by means of magnetic resonance imaging (MRI), but treatment is often difficult because the MRI findings are not consistent with the symptoms of the patient in many cases. The objective of this study was to observe the correlation between the patterns of epidurography performed in patients having lower back pain with or without leg pain and the position or severity of the pain as subjectively described by the patients. METHODS: The subjects of this study were 69 outpatients with lower back pain with or without leg pain who visited our clinic and complained of predominant pain on one side. We performed caudal epidural block using an image intensifier. A mixture of the therapeutic drug and the contrast agent (10 ml) was injected to observe the contrast flow pattern. The patients who complained of predominant pain on one side were divided into the left side group and the right side group. A judgment of inconsistency was made if the contrast agent flowed to the side of the pain, while a judgment of consistency was made if the contrast agent flowed to the opposite side of the pain. The degree of the drug distribution was evaluated by counting the number of cells to which the contrast agent's flowed for evaluating the correlation between the contrasted cell and the severity of pain (one group < or = VAS 7, the other group > or = VAS 8) the degree of the contrast agent's contrast was evaluated by dividing and counting an image into 15 cells (the left, right, and middle sections at each level of L4, L5, S1, S2, and S3). RESULTS: Thirty out of the 69 patients who had laterality in pain, that is, those who complained of predominant pain on one side, showed that the laterality of the pain and the contrast agent flow was consistent, while 39 patients showed that the laterality was inconsistent (P: 0.137). The evaluation of the correlation between the pain and the contrast agent flow showed that the mean number of contrasted cells was 9.0 +/- 2.2 for the 46 patients in the group with a VAS of 7 or lower and 6.5 +/- 2.0 for the 23 patients in the group with a VAS of 8 or higher, indicating that the former group showed a significantly greater number of contrasted cells (P < 0.001). CONCLUSIONS: This study, conducted with patients having lower back pain with or without leg pain, showed that the contrast flow pattern of caudal epidurography had a significant correlation with the severity of the pain but not with the laterality of the pain.
Humans ; Judgment ; Leg ; Low Back Pain ; Magnetic Resonance Imaging ; Outpatients ; Spinal Stenosis

Between 1989 and 1993, 31 patients who had undergone ACL reconstruction using autogenous patellar bone-tendon-bone were studied to evaluate the effects on knee joint function. After having harvested the central one third of the patellar tendon, it was positioned isometrically through tunnels of tibia and femur and also central defect of the patellar ligament was sutured loosely. Clinically Hospital for special surgery(HSS) knee socre by Marshall 1997, manual knee test, knee extention and flexion angles, Cybex test, KT-2000 measurments and radiological study were performed for subjective and objective symptoms at the average follow-up 33 months (range 18-72 months). Quadriceps weakness of strength less than 80% of the normal side was present in 61% of patients, patellofemoral joint pain in 15%, AP translation more than 3mm in 23%, flexion contracture of 5 degree or more in 29%. Hospital for special surgery(HSS) knee score was improved from 35 to 46 in average during follow-up period. The height of the patella was increased in 2 cases and decreased in 6 cases within normal variation which was not significant statistically. The above results indicate that importance of postoperative rehabilitation program and extension position of knee joint after surgery place a major emphasis on the avoidance of flexion contracture and on the improvement of joint function.
Contracture ; Femur ; Follow-Up Studies ; Humans ; Joints ; Knee Joint ; Knee ; Patella ; Patellar Ligament ; Patellofemoral Joint ; Rehabilitation ; Tibia ; Transplants

Aortic stenosis is the most frequent type of valvular heart disease in adult. Approximately 2-7% of the population over the age of 65 suffer from aortic valve stenosis. Due to the increasing average life expectancy in Korea, degenerative aortic stenosis is increasing and becoming a troublesome health problem in older population. Because older patients with severe degenerative aortic stenosis have many other medical conditions so they are not suitable candidate for surgery. Recently, transcatheter aortic-valve implantation (TAVI) has been suggested as a less invasive treatment for patients with high perioperative risk. We report a successful TAVI case in severe aortic stenosis patient with high perioperative risk.
Adult ; Aortic Valve Stenosis ; Heart Valve Diseases ; Humans ; Korea ; Life Expectancy

It is very important for the anesthesiologists to manage this kind of patient during anesthesia because of severe hemodynamic change that is induced by aortic clamping and declamping, and its secondary effect on visce, heart and spinal cord, etc. To minimize the sudden severe hemodynamic change, we used the following agents and techniques in this clinical report. 1) Ethrane anesthesia with intermittent Innovar administration to minimize cardiac irritability. 2) To prevent secondary damage by distal hypotension during aortic clamping and declamping. 1. slight overhydration. 2. mannitol. 3. diuretics. 3) To prevent secondary damage by proximal hypertension during aortic clamping. 1. d-tubocurarine for muscle relaxation. 2. Morphine. 3. Chlorpromazine. 4. phentolamine. More over, we recommend this kind of anesthetic method in some other surgeries such as coarctation of aorta, aortic aneuryam and pheochromocytoma, etc. which may exhibit severe hemodynamic change during anesthesia.
Anesthesia ; Aortic Coarctation ; Chlorpromazine ; Constriction ; Diuretics ; Enflurane ; Heart ; Hemodynamics ; Humans ; Hypertension ; Hypertension, Renovascular* ; Hypotension ; Mannitol ; Morphine ; Muscle Relaxation ; Phentolamine ; Pheochromocytoma ; Spinal Cord ; Tubocurarine

A 69 years old, otherwise healthy male pt. was admitted and soheduled for subtotal gastrectomy under the Dx. of stornach Ca. The induction of anesthesia and beginning of Operation were smooth and unevntful. After peritoneal opening, the surgeon complained of distended stomach which was synch- ronous with ventilation. With repeating tracheogram and endoscopic examination, the authors fecund unsuspected tracheo-esophageal fistula on the low-middle esophagus. Durins convalescenee the pt, had not suffered any pulmonary complication.
Aged ; Anesthesia ; Anesthesia, General* ; Esophagus ; Fistula* ; Gastrectomy ; Humans ; Male ; Stomach ; Ventilation

Kerion celsi is an inflammatory type of tinea capitis, which occurs chiefly in children between the ages of 4 and 14 years. We report a case of kerion celsi caused by Trichophyton(T.) mentagrophytes in 69 year-old man, who showed a 8x8 cm sized, erythematous boggy mass with pustules and crusts on the right occipital scalp. Cultures from scalp lesion and infected hair on Sabouraud dextrose agar media showed T. mentagrophytes. Histopathologic findings showed inflammatory cell infiltration in entire dermis and many spores around the hair shaft. The skin lesion was successfully treated with terbinafine (250 mg/ day) for 8 weeks. This case is reported with three interesting facts: Kerion celsi caused by T. mentagrophytes has been rarely reported in Korean literatures; Kerion celsi is occuring in an aged man with decreased cellular immunity after chemotherapy; Kerion celsi caused by T. mentagrophytes responded well to oral terbinafine.
Agar ; Aged ; Child ; Dermis ; Drug Therapy ; Glucose ; Hair ; Humans ; Immunity, Cellular ; Scalp ; Skin ; Spores ; Tinea Capitis* ; Trichophyton*

Porokeratotic eccrine ostial and dermal duct nevus (PEODDN) is a rare, benign congenital hamartoma involving the eccrine sweat duct. Histologically, the distinctive feature of PEODDN is the existence of keratinous plugs that represent cornoid lamellae overlying dilated infundibula of eccrine ducts. Lesions are typically asymptomatic papules or plaques that are located on the distal extremities, including palms, fingers and soles. We report a case of a 7-year old girl with PEODDN who exhibited lesions on the left knee and the perianal region.
Child ; Extremities ; Female ; Fingers ; Hamartoma ; Humans ; Knee* ; Nevus* ; Sweat

Subungual glomus tumors are benign neoplasms that arise from the neuromyoarterial apparatus. They present with various clinical symptoms such as localized pain, tenderness, and sensitivity to temperature change and can be palpated as a nodule or mass on physical examination. Pressure erosion can be seen at adjacent bones on radiography. However, in most cases, the tumors are too small to be inspected and located under the nail plate, which makes correct diagnosis and complete excision very difficult. Incomplete removal can cause recurrence or deformity to the residual nail, whereas extensive removal can cause trauma or deformity to the nail plate. Thus, correct differential diagnosis and preoperative evaluation of the location and extent of the tumor are very important. Here, we report 2 cases that were diagnosed and preoperatively evaluated using ultrasound.
Congenital Abnormalities ; Diagnosis* ; Diagnosis, Differential ; Glomus Tumor* ; Physical Examination ; Radiography ; Recurrence ; Ultrasonography*

Coccidioidomycosis is an endemic disease found in the southwestern part of North America. Travellers who visit the endemic area may carry the infection. We report a case of pulmonary coccidioidomycosis in a 74-year-old woman. She was healthy before visiting Arizona, U.S.A twice. After returning home, she began to complain of intermittent dry coughing. The symptom was mild, however, and she was treated symptomatically. Later a chest radiograph, which was taken 4 years after the onset of the symptom, showed a solitary pulmonary nodule in the right upper lobe. By percutaneous needle aspiration, a few clusters of atypical cells were noted in the necrotic background. A right upper and middle lobectomy was done. A 1.5 x 1.5 x 1.2 cm sized tan nodule was present in otherwise normal lung parenchyma. Microscopically, the nodule consisted of aggregates of multiple solid granulomas inside of which was mostly necrotic. Neutrophils and nuclear debris were scattered along the periphery of the necrotic foci. Numerous multinucleated giant cells were associated with the granulomas. In the necrotic area, mature spherules of Coccidioides immitis, which were 30-100 microm in diameter, were present. They contained numerous endospores which ranged from 5 to 15 microm and were also noted in multinucleated giant cells. The diagnosis of coccidioidomycosis was made. She is doing well after the resection.
Aged ; Case Report ; Coccidioides* ; Coccidioidomycosis/pathology ; Coccidioidomycosis/microbiology* ; Female ; Human ; Korea ; Lung Diseases, Fungal/pathology ; Lung Diseases, Fungal/microbiology*