This case involves a 43-year-old man who had been diagnosed as having Charcot-Marie-Tooth disease (CMTD) 9 years ago and was scheduled to undergo posterior fusion of its spine due to a compression fracture. General anesthesia using propofol was selected as the anesthetic method, in order to avoid the occurrence of malignant hyperthermia due to inhalation anesthetics. The patient was given 100 mg of propofol for anesthetic induction, and then propofol was infused at a rate of 4-5 mg/kg/h with intermittent administration of fentanyl for anesthetic maintenance. Rocuronium 50 mg was injected for endotracheal intubation, and then rocuronium 10 mg was injected at 45 min intervals. There was no delay in awakening, and the patient experienced no problems postoperatively. Intravenous anesthesia using propofol is thought to be a safe and effective method of anesthesia for patients with CMTD.
Adult ; Anesthesia ; Anesthesia, General ; Anesthesia, Intravenous ; Anesthetics, Inhalation ; Charcot-Marie-Tooth Disease* ; Fentanyl ; Fractures, Compression ; Humans ; Intubation, Intratracheal ; Malignant Hyperthermia ; Propofol* ; Spine

A 24-year-old man was admitted due to an incidentally detected mass in his left testis, which showed radiopaque calcification on plain X-ray film. Left orchiectomy was performed, and the resected testis contained a well-demarcated, hard mass measuring 1.1 cm. Histological analysis revealed that the tumor was composed of neoplastic cells, fibrotic stroma, and laminated or irregularly shaped calcific bodies. The individual cells had abundant eosinophilic or clear cytoplasm with round nuclei, each of which contained one or two conspicuous nucleoli. They were arranged in cords, trabeculae, clusters, and diffuse sheets. There were several foci of intra-tubular growth patterns, with thickening of the basal lamina. Immunohistochemically, the neoplastic cells were positive for S-100 protein and vimentin, focally positive for inhibin alpha, and negative for cytokeratin, CD10, and Melan-A. In addition to reporting this rare case, we also review the relevant literature regarding large cell calcifying Sertoli cell tumors.
Basement Membrane ; Cytoplasm ; Eosinophils ; Humans ; Immunohistochemistry ; Inhibins ; Keratins ; MART-1 Antigen ; Orchiectomy ; S100 Proteins ; Sertoli Cell Tumor* ; Testis* ; Vimentin ; X-Ray Film ; Young Adult

A small beam or slit of light focused at the pupillary margin will induce regular, persistent oscillations of the pupil. The period of these cycles is the pupil cycle time that can be easily measured and expressed in milliseconds. When the efferent part of the light reflex of the pupil is normal, determination of the period of these cycles in milliseconds provides a number which may be correlated with conduction time in the anterior visual pathway. Cox and Drews reoorded pupillary response to alternating half-field visual stimuli and found that stimulation of the temporal visual field (nasal retina) caused more pupillary constriction than did equivalent stimulation of the nasal field(temporal retina). These findings imply an asymmertric decussation of pupillomotor pathways in the midbrain in humans as well as greater sensitivity of the nasal retina. We measured nasal and temporal pupil cycle time on 200 normal eyes of Koreans by half-field stimulation of the nasal and temporal retina. And we found that: 1. The mean temporal pupil cycle time was 1071 +/- 92m sec, in right eye and 1068 +/- 81m sec, in left eye. The mean nasal pupil cycle time was 894 +/- 63m sec, in right eye and 899 +/- 57m sec, in left eye. Difference between nasal and temporal pupil cycle time was 177 +/- 73m sec, in right eye and 169 +/- 64m sec, in left eye. 2. The difference of pupil cycle time between the right and left eyes was 3 +/- 84m sec, in temporal retina and 5 +/- 61m sec, in nasal retina. The difference of pupil cycle time between the two eyes was not significant statistically. 3. The mean temporal pupil cycle time of the two eyes was 1069 +/- 85m sec, and the mean nasal pupil cycle time was 897 +/- 62m sec. Difference between nasal and temporal pupil cycle time was 172 +/- 74m sec. In 95% of normal population, the discrepancy between temporal and nasal pupil cycle time was shorter than 253m sec. 4. The mean temporal pupil cycle time was 1066 +/- 86m sec, in male and 1072 +/- 83m sec, in female. The mean nasal pupil cycle time 901 +/- 63m sec, in male and 894 +/- 59m sec, in female. The difference of pupil cycle time between the male and female was not significant statistically.
Constriction ; Female ; Humans ; Male ; Mesencephalon ; Pupil* ; Reflex ; Retina ; Visual Fields ; Visual Pathways

Since patients with intracranial neoplasms usually represent their neurological symptoms rather early in the course of the disease, sudden unexpected death due to intracranial neoplasms is an uncommon event seen only exceptionally in medicolegal autopsy practice. Although meningiom is one of the most common primary intracranial neoplasms, sudden death due to the tumor is an uncommon event. We report a sudden, unexpected death of a 56-year-old female with an undiagnosed olfactory groove meningioma. It is assumed that peritumoral edema is related to the sudden death among the several mechanisms.
Female ; Humans

Myoepitheliomas are well-established to occur in the salivary glands, but they have also been described in the breast, upper aerodigestive tract, skin, and soft tissues. We report here on a unique case of primary myoepithelioma that occurred in the right testis of a 28-year-old man. The tumor was entirely confined to the testis and it was clearly separated from the epididymis. Histopathology revealed mixed architectural patterns in which the reticular areas merged into the chondromyxoid stroma. The tumor cells, which were focally immunoreactive to pancytokeratin and S-100 protein, were round to ovoid and spindly arranged in cords, strands, and fascicles. They showed mild nuclear pleomorphism, sparse mitotic figures and a low Ki-67 proliferative index. There was no ductal differentiation in the tumor. To the best of our knowledge, there has been only one case report of a primary testicular myoepithelioma in the English medical literature.
Adult ; Breast ; Epididymis ; Humans ; Male ; Myoepithelioma ; S100 Proteins ; Salivary Glands ; Skin ; Testis

Sebaceous carcinoma is a malignant neoplasm frequently classified as periocular or extraocular. Extraocular sebaceous carcinoma is a relatively rare tumor commonly appearing in the head and neck region. Furthermore, extraocular sebaceous carcinoma limited to the epithelium, which is called ‘extraocular sebaceous carcinoma in situ’ is extremely rare with less than 10 cases reported in the literature. Herein, we present the case of a 93-year-old female who diagnosed as extraocular sebaceous carcinoma in situ occurring concurrently with actinic keratosis. In the present case, extraocular sebaceous carcinoma in situ as identified without any connection to an adnexal component but concurrent with actinic keratosis. This case is evidence that extraocular sebaceous carcinoma can arise from the epidermis and the tumor cells of intraepidermal squamous neoplasia can differentiate toward malignant sebocytes.

Sebaceous carcinoma is a malignant neoplasm frequently classified as periocular or extraocular. Extraocular sebaceous carcinoma is a relatively rare tumor commonly appearing in the head and neck region. Furthermore, extraocular sebaceous carcinoma limited to the epithelium, which is called ‘extraocular sebaceous carcinoma in situ’ is extremely rare with less than 10 cases reported in the literature. Herein, we present the case of a 93-year-old female who diagnosed as extraocular sebaceous carcinoma in situ occurring concurrently with actinic keratosis. In the present case, extraocular sebaceous carcinoma in situ as identified without any connection to an adnexal component but concurrent with actinic keratosis. This case is evidence that extraocular sebaceous carcinoma can arise from the epidermis and the tumor cells of intraepidermal squamous neoplasia can differentiate toward malignant sebocytes.

STUDY DESIGN: Prospective study. OBJECTIVES: This study compared the early postoperative analgesic effects and the postoperative nausea and vomiting (PONV) associated with 3 methods of pain control after posterior spinal decompression. SUMMARY OF LITERATURE REVIEW: Spinal surgery causes severe postoperative pain. Efficient and safe methods for postoperative analgesia after spinal surgery are necessary. MATERIALS AND METHODS: To determine the clinical symptoms and to assess improvements in postoperative pain, 52 patients in whom single-level posterior lumbar decompression was planned were randomly assigned to 3 groups. For postoperative pain control, 18 patients received a preoperative single-shot epidural injection (SEI), 16 patients received a postoperative continuous epidural injection (CEI), and 18 patients received only postoperative intravenous patient-controlled analgesia (IV-PCA). Patient ratings of pain intensity (visual analog scale score from 0 [no pain] to 10 [most severe pain]), nausea (from 0 [no nausea] to 5 [severe nausea]), and vomiting (from 0 [no vomiting] to 5 [severe vomiting]) were recorded immediately after the operation and at 4 hours, 12 hours, 1 day, and 2 days postoperatively. RESULTS: The CEI group showed significantly enhanced analgesic effects, followed by the SEI group and the IV PCA group (p < 0.05). PONV due to postoperative pain control was more severe in the IV PCA group than in the other 2 groups (p < 0.05). CONCLUSIONS: Continuous epidural injection (CEI) is effective for postoperative pain control and minimizes the occurrence of PONV after posterior spinal decompression.
Analgesia ; Analgesia, Patient-Controlled ; Decompression ; Humans ; Injections, Epidural ; Methods ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting ; Prospective Studies ; Spinal Stenosis ; Vomiting

A schwannoma is a benign tumor that originates from the peripheral nerve sheath. Schwannomas occur most commonly in the head and neck region involving the brachial plexus and the spinal nerves. The lower limbs are less commonly affected. This paper presents a case of a patient with a schwannoma showing atypical localization at the digital nerve of the foot causing neurological symptoms.
Brachial Plexus ; Foot ; Head ; Humans ; Lower Extremity ; Neck ; Neurilemmoma* ; Peripheral Nerves ; Spinal Nerves ; Toes*