In 1861, Rokitansky first reported a unusual syndrome compatible with neurocutaneous melanosis, but it was coined by Van Bogaert in 1948. Neurocutaneous melanosis is a very much rare and less well-known member of phakomatoses. A review of the published material showed that only 40 cases of this syndrome had been reported until 1968 by Fox. It has been defined as a congenital disease which is manifested by parallel development of benign melanotic pigmentation of central nervous system and pigmented nevi of the skin. We have recently experienced a case of neurocutaneous melanosis. A 23 years old female was admitted to our hospital with complaints of generalized cafe au lait spots and giant nevi on the back and the left thigh accompanying severe headache, vomiting and right hearing disturbance. Diagnostic studies did not suggest any intracranial space-taking lesion except for evident hydrocephalus. Under the impression of Von Recklinghausen disease with right acoustic neurinoma the posterior fossa exploration was performed but no space talking lesion was noted. Numberous dark black-brownish pimentation was spread over the leptomeninges of the cisterna magna, brain stem, and right cerebellum. The increased intracranial pressure signs were completely relieved by ventriculo-atrial shunt. On biopsy it was identified as leptomeningeal melanin pigmentation. Detail consideration of neueurocutaneous melanosis was introduced with review of ever reported cases.
Biopsy ; Brain Stem ; Cafe-au-Lait Spots ; Central Nervous System ; Cerebellum ; Cisterna Magna ; Female ; Headache ; Hearing ; Humans ; Hydrocephalus ; Intracranial Pressure ; Melanins ; Melanosis* ; Neurocutaneous Syndromes ; Neurofibromatosis 1 ; Neuroma, Acoustic ; Nevus ; Nevus, Pigmented ; Numismatics ; Pigmentation ; Skin ; Thigh ; Vomiting ; Young Adult

The purpose of this study is to analyze the statistics of length and obliquity of the transverse processes, transitional vertebra, spina bifida and lumbar rib in the lumbar spine A-P films of 500 cases by random sample. The length of the transverse process was compared with the shortest distance of from the outmost point of it to the vertical line which was given at the spinous process of the corresponding vertebral body. The obliquity of the transverse process was represented by angle shaped by the central vertical line of the vertebral body and the central line of its transverse process. Transitional vertebra were identified by counting down from the C1 or T1 vertebral body. No difficulty was encountered in distinguishing spina bifida and lumbar rib. The results were as follows: 1. In the typical lumbar spine, the length of the L3 transverse process was the longest of all the transverse processes except for that of L5 and the direction of the transverse process was horizontal in the L1, L2 and L3 but a little oblique upward in the L4 and L5. 2. Lumbarization was slightly higher than sacralization in incidence. 3. The incidence of spina bifida was 11.8% and mainly observed in male. 4. The incidence of lumbar rib was 1.8% and all were attached to the L1.
Humans ; Incidence ; Male ; Ribs ; Spinal Dysraphism ; Spine*

Spontaneous intracerebral hemorrhage is generally very uncommon in young adult life. Moreover in infancy or childhood. The etiology of spontaneous intracerebral hemorrhage has been discussed in some detail, but the exact underlying causes, in many cases, remain in doubt. The clinical and radiological characteristics are same as ones of intracerebral hemorrhage in adulthood and the traditional methods in diagnostic approach of treatment are still available. We recently experienced a case of spontaneous intracerebral hematoma mainly located in the lateral portion of the basal ganglia in a 12 years old boy. He was admitted to our hospital through the emergency room with suddenly developed left side hemiplegia. There was no evidence of head trauma. Right side carotid angiogram revealed the hematoma. Upon surgery a large hematoma was noted in the lateral portion of the basal ganglia and its complete removal was quite possible. Recovery of the motor disturbance was discernibly rapid and he was discharged on foot on the postoperative 45th day.
Basal Ganglia ; Cerebral Hemorrhage ; Child ; Craniocerebral Trauma ; Emergency Service, Hospital ; Foot ; Hematoma* ; Hemiplegia ; Humans ; Male ; Young Adult

Intrasellar or pituitary abscess was first reported about a century ago, after then once relatively common but now is rare. Since 1925, about 50 cases have been reported in the literatures, of which characters were variable, but clinical very similar to one of pituitary tumor. So they were often diagnosed preoperatively as pituitary tumor. Several pathogenic factors were postulated in relation to clinical aspects. We had recently experienced a case of pituitary abscess combined with chromophobe adenoma. A 28 years old clerkman was admitted to our hospital with complaints of impared ejaculation and visual disturbance. Clinical aspects and diagnostic studies gave us a strong impression of pituitary tumor. Upon surgery we found a cystic mass in pituitary region, of which aspiration showed whitish-gray, tenacious and liquid material. Many polymorphous leukocytes were noted by direct smear, but no microorganisms were detected in culture. He had postoperatively suffered from transient polyuria and polydipsia, which soon disappeared under the medication of Esidrex. He was discharged from this hospital with recommendation of radiation therapy. Clinical features and treatment were also discussed with review of ever reported cases.
Abscess* ; Adenoma, Chromophobe ; Adult ; Ejaculation ; Humans ; Hydrochlorothiazide ; Leukocytes ; Male ; Pituitary Neoplasms ; Polydipsia ; Polyuria

This is a report revealing statical cause of death brought to the department of forensic medicine, Kyungpook National University School of Medicine based on the result of autopsy. The summary of result is as follows. 1. The number of autopsy made during 1998 were 356, of these 225 cases (63.2%) were male, and 131 (36.8%) were female. 2. 30's, 40's, 20's and 50's was the order according to the number of violent death, and in case of natural death, 30's, 50's, 40's was the oder. 3. August is the period during which autopsies are made most, with December placing second, and the other months are similar. 4. In distributing deaths by cases, violent deaths were 241 cases (67.7%), natural deaths were 105 (29.5%) and unknown cases were 10 (2.8%). 5. For the violent deaths, deaths due to injury were 128 cases (53.1%), asphyxia were 63 (26.1%), intoxications were 30 (12.4%) and abnormal temperature were 19 (7.9%). According to relationship with deaths, homicide is outstanding with 101 cases (41.9%), while suicide and accidental death was the same with 62 cases (25.7%). 6. For death due to injury, death due to blunt injury were 48 cases, sharp force injury which was used most in case of homicide were 43. 7. For the asphyxia, drowning is the most 20 cases, 13 cases of which is accidental death. 8. The deaths of intoxication is the largest part of suicide, and most of intoxication were involved in agrochemical. 9. Of 105 cases of natural death, deaths due to the disease of cardiovascular system were 51 cases (48.6%), of which deaths due to myocardial infraction were 35 cases. 10. Of all autopsy, alcohol intake were checked out in 90 cases and 21 cases of medical controversy took places. 11. Of all violent deaths, the cases involved in the discord between man and woman occupied percentage of 9.6. Of these, homicides were 18 cases, with all sacrificed being females, and of 16 cases of suicide, 13 cases were female.
Asphyxia ; Autopsy* ; Cardiovascular System ; Cause of Death ; Daegu* ; Drowning ; Female ; Forensic Medicine ; Gyeongsangbuk-do ; Homicide ; Humans ; Male ; Suicide ; Wounds, Nonpenetrating

Mycotic aneurysms are produced by an infected embolus from vegetations on the heart valves in bacterial endocarditis, which breaks off and lodges in the cerebral blood vessels. The wall of the embolized vessel becomes infected, invasion by inflammatory cells and necrosis of the wall are often followed by rupture and formation of a aneurysmal sac. These aneurysms are very are in incidence and are usually located more peripherally in the vascular tree than berry aneurysms, are more irregular in shape and are not necessarily located at bifurcations. Recently we experienced a case of mycotic aneurysm with intracerebral hematoma which had developed in a subacute bacteria endocarditis patient. The patient was 44 years old male patient with dilated right pupil and left hemiplegia. He was treated surgically by evacuation of intracerebral hematoma and excision of mycotic aneurysm. We also experienced another case of mycotic aneurysm with intracerebral hematoma in 17 years old male patient who had been suffered from fever of unknown origin. He was also treated surgically. We now reports 2 cases of mycotic aneurysm with intracerebral hematoma with a brief review of the literatures.
Adolescent ; Adult ; Aneurysm ; Aneurysm, Infected* ; Bacteria ; Blood Vessels ; Embolism ; Endocarditis ; Endocarditis, Bacterial ; Fever of Unknown Origin ; Heart Valves ; Hematoma* ; Hemiplegia ; Humans ; Incidence ; Intracranial Aneurysm ; Male ; Necrosis ; Pupil ; Rupture

Although transitional vertebrae are relatively frequent in limbosacral area, it is generally accepted that one cannot state whether the transition is due to lumbarization of S1 or sacralization of L5 from simple lumbar X-ray film alone. However, for the practical purpose, the author attempted to obtain a possible method to determine the level of the lumbosacral spine in simple X-ray films through the analysis of the 100 operated patients and 25 lumbago and/or sciatica patients. Furthermore to determine the level of the intervertebral disc space in post-operative films, a silver clip was attached near the operated region and reviewed the post-operative findings in simple lumbar X-ray films. The results were as follows : 1) To determine the level of the interverbral disc space in simple lumber X-ray films, origin of the psoas muscle shadow can be utilized as a landmark with about 80% accuracy. But if one leave the silver clip at the operated region, he can state the level in 100% accuracy with the information of pre-operative symptoms. 2) Sacralization was 10% in operated cases, 6% in non-operated cases and lumbarization was 6% in operated cases, 3.2% in non-operated cases. Spina bifida was 12% in operated cases, 11.2% in non-operated cases. Lumbar rib was 2% in all of operated and non-operated cases.
Humans ; Intervertebral Disc* ; Low Back Pain ; Psoas Muscles ; Ribs ; Sciatica ; Silver ; Spinal Dysraphism ; Spine ; X-Ray Film

We report a case of acute septic arthritis of the hip in a child due to H. influenzae with review of the problems encountered. A one year and 9 months-old male child was admitted because of fever, limping and restlessness of 48-hour duration. Under the impression of septic arthritis of the right hip, blind broad-spectrum antibiotic regimen was initially instituted. Fever subsided immediately and two blood cultures yielded no growth, as did joint tapping. But fever recurred on the 8th day of admission. MRI demonstrated fluid collection in the right hip. Arthrotomy yielded thin pus. The antibiotic regimen was shifted to vancomycin, according to the culture report of S. aureus. However, spiking fever continued. On the 4th week of admission, recheck MRI demonstrated fluid collection in and out of the hip joint. A second arthrotomy yielded frank pus. H. influenzae was reported in pus culture for the first time, being susceptive only to chloramphenicol. Fever was down to normal temperature after injection of urfamycin. Radiograph on the 17th day after the 2nd arthrotomy revealed posterior dislocation of the right hip. MRI demonstrated granulation tissue within the acetabulum. Open reduction confirmed granulation tissue without pus. This case suggests: 1. Routine blind antibiotic regimen for gram-positive and negative organisms in the initial phase of treatment may fail in the rare case of H. influenzae. This may lead the surgeon to miss the optimum time of surgical intervention despite early diagnosis, 2. Arthrotomy may fail if not followed by antibiotics sensitive to the pathogen. 3. Delayed pathologic dislocation may ensue due to invasion of granulation tissue.
Acetabulum ; Anti-Bacterial Agents ; Arthritis, Infectious ; Child* ; Chloramphenicol ; Dislocations ; Early Diagnosis ; Fever ; Granulation Tissue ; Hip Joint ; Hip* ; Humans ; Infant ; Influenza, Human ; Joints ; Magnetic Resonance Imaging ; Male ; Psychomotor Agitation ; Suppuration ; Thiamphenicol ; Vancomycin

PURPOSE: To assess the value of computed tomography (CT) in the preoperative staging of transitional cellcarcinoma (TCC) of the renal pelvis. MATERIALS AND METHODS: We retrospectively evaluated the CT TNM staging of 38patients with TCC of the renal pelvis who had undergone preoperative abdominal CT examination between January 1990and January 1998. In CT staging for differentiation between early-stage (TO-2) and advanced-stage disease (T3-T4),three criteria were used, namely the presence or obliteration of the renal sinus fat layer, the smoothness orirregularity of margin between the tumor and renal parenchyma, and the presence or absence of hydronephrosisproximal to the tumor. CT staging was performed by two genitourinary radiologists blinded to the pathologicresults, and was compared with pathologic staging. RESULTS: Pathologic results revealed 19 cases of early stagedisease (TO=8, T1=9, T2=2) and 19 of advanced stage (T3=12, T4=7). Overall CT staging accuracy was 82%(31/38);fourcases were overstaged and three were understaged. In early-stage disease, sensitivity and specificity were 79%,and 84%, and in advanced stage disease were 83% and 80%. Three of four overstaged cases showed hydronephrosisproximal to the tumor. In the second CT staging, using proximal hydronephrosis of the tumor as a criterion forearly-stage disease, the sensitivity and specificity of early-stage disease were 95% and 75%, respectively, andthe specificity of advanced-stage disease was 95%. CONCLUSION: When hydronephrosis proximal to a tumor wasconsidered to be a sign of early stage disease, the CT staging of renal pelvic TCC was highly accurate.
Hydronephrosis ; Kidney Pelvis* ; Neoplasm Staging ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed

Mycoplasma pneumoniae is a common cause of respiratory tract infections and typically causes mild disease. Extrapulmonary manifestations of M. pneumoniae infection are also common, but rhabdomyolysis is a rare complication. Here, we describe the case of a previously healthy 23-year-old male who displayed the simultaneous onset of rhabdomyolysis and severe pneumonia requiring mechanical ventilation. Both conditions were resolved by a 10-day course of antimicrobial treatment and the patient was discharged without complication.
Humans ; Male ; Mycoplasma ; Mycoplasma pneumoniae ; Pneumonia ; Pneumonia, Mycoplasma ; Respiration, Artificial ; Respiratory Tract Infections ; Rhabdomyolysis ; Young Adult