Acute disseminated encephalomyelitis(ADEM) and acute relapsing disseminated encephalomyelitis(ARDEM) are representative demyelination diseases that occur among young children with a fulminant onset similar to encephalitis or meningitis. The diseases often occur after some viral infection of immunization and the etiology of these diseases is considered to be an autoimmune response because of the similarity in pathologic findings to experimental allergic encephalomyelitis. Cerebral computed tomography(CT) findings of demyelination in ADEM or ARDEM show normal to low density areas in the white matter. In cerebral MRI findings, a scattered distinct high intensity lesion considered to be demyelination is observed in 72-weighted imaging even in the early stages. ADEM is usually monophasic, but recurrent episodes may occure. When ADEM is reccurent, the distinction from multiple sclerosis becomes difficult. We report here a case of acute relapsing disseminated encephalomyelitis(ARDEM) in a 9 years old male child who experence ADEM, 3 times.
Autoimmunity ; Child ; Demyelinating Diseases ; Encephalitis ; Encephalomyelitis, Acute Disseminated* ; Encephalomyelitis, Autoimmune, Experimental ; Humans ; Immunization ; Magnetic Resonance Imaging ; Male ; Meningitis ; Multiple Sclerosis

BACKGROUND: Langerhans cells (LC), keratinocytes and Thy-1+ dendritic epidermal cells(DEC) are epidermal cells which are known to have important roles in inflammatory or immunologic skin disorders. Allergic contact dermatitis(ACD) is a prototype of a delayed hypersensitive reaction in which LC, keratinocytes and T lymphocytes play an important role. The role of LC in ACD is well known, but the role of Thy-1+ DEC is not yet fully revealed. Futhermore, the mechanism of irritant contact dermatitis(ICD) is not known and more study is required on the interaction between these epidermal cells in ICD. OBJECTIVE: The aim of this study is to observe the changes of these cells in ACD and ICD and to discuss their possible roles in the disease precess. MEHTODS: We evoked ACD with DNFB and ICD with croton oil in BALB/c mice and observed the morphologic changes of LC, Ia+ keratinocytes, and Thy-1+ DEC by immunoperoxidase staining when the inflammation was at its peak and at the resolution state. RESULTS: 1. In the control group, LC were evenly distributed and their average number was 1147+/-132/mm*. Thy-1+ DEC were slightly bigger than LC and showed uneven distribution. The average number of Thy-1+ DEC was 57+/-69/mm* Ia+ keratinocytes did not appeared. 2. On the 1st day of DNFB challenge, the number of LC was significantly decreased and their size and dendritic processes were increased when compared to those of the control group. Most of the keratinocytes showed Ia antigen expression on their surfaces. 3. On the 12th day of DNFB challenge, no significant changes in the number and morphologyof LC were noted when compared to the cotrol group, Ia+ keratinocytes were not observed. 4. there were no significant changes in the number and morphology of Thy-1+ DEC in ACD on the 1st and 12th day after DNFB challenge. 5. On the 2nd day after croton oil application, the number of LC was significantly decreased but the morphology not significantly changed. Ia+ keratinocytes were not observed. 6. On the 20th day after croton oil application, the number of LC was significantly increased but the morphology was not significantly changed. Ia+ keratinocytes were not observed. 7. There were no significant changes in th number and morphology of Thy-1+ DEC in ICD on the 2nd and 20th day after application of croton oil. Ia+ keratinocytes were not observed. CONCLUSION: In can be deduced that the LC have important roles in the mechanisms of both ACD and ICD reactions. Ia+ keratinocytes have an important role mainlyin the inflammatory precess of ACD. In addition, since the changes of the number of Langerhans cells in ACD and ICD showed different time courses and Ia+ keratinocytes appeared only in ACD, we hypothesized that different pathways of inflammation exist in ACD and ICD, and different cytokines may be responsible. It is probable that Thy-1+ DEC does not have any significant role in the inflammatory process of both ACD and ICD.
Animals ; Croton Oil ; Cytokines ; Dermatitis, Allergic Contact* ; Dermatitis, Contact* ; Dinitrofluorobenzene ; Histocompatibility Antigens Class II ; Inflammation ; Keratinocytes ; Langerhans Cells ; Mice ; Skin ; T-Lymphocytes

No abstract available.
Humans ; Microcomputers*

Hypospadias can be repaired in the majority cases in 1-stage with a high success rate. We reviewed clinical experience of 50 patients who underwent primary hypospadias repair by 1 surgeon using 1-stage repairs except 3 cases in a 30-month period. The results were 1). The half of patients were younger than 5 years (48%). 2). A total of 34 cases (68.0%) had an associated ventral curvature. The dorsal tunica albuginea plication to correct intrinsic curvature was done in 21 cases (61.8%) and dividing the urethral plate in only 3 cases (8.8%). 3). Associated anomalies were cryptorchidism in 7, hydrocele in 3 and severe penoscrotal transposition in 8 cases. 4). 19 cases of anterior hypospadias were repaired by meatoplasty using Heineke-Mikulicz tissue rearrangement (9 cases), MAGPI (3 cases), pyramid procedure (4 cases), Mathieu urethroplasty (2 cases) and onlay island flap (1 case). Of the 31 cases of middle and posterior hypospadias onlay island flap repair was performed in 24 cases (77.4%). 5). The success rates in anterior, middle and posterior hypospadias were 94.7, 64.7 and 42.9%, respectively. The overall success rate was 70%. 6). The most commonly used procedure was onlay island flap urethroplasty. Only 14 of 25 cases (56.0%) were successful with this method but the last 8 cases were repaired with no complications. 7). The most common complications were urethrocutaneous fistula (11 cases) and meatal retraction (3 cases). The complications were managed by rotational advancement flap (11 cases), meatal based flap (2 cases) and urethral advancement (1 case) and the success rate was 73.3%. In conclusion, to achieve more satisfactory results the choice of operation depends on the configuration of either glans or meatus, presence or absence of chordee and status of ventral penile skin in anterior hypospadias. Although the 2-stage repair remains a safe and reliable alternatives for severe hypospadias 1-stage repair was more useful except severe hypospadias combined with penoscrotal transposition."
Cryptorchidism ; Female ; Fistula ; Humans ; Hypospadias* ; Inlays ; Male ; Skin

A case of multiple hamartomas of the unilateral chest wall in a four month old infant is presented. There have been a few reports on the CT findings of the chest wall hamartoma in infancy. We describe bone changes of the ribs and mineralization of this rare tumor on the CT scan, and the locations of two separate masses.
Hamartoma ; Humans ; Infant ; Miners ; Ribs ; Thoracic Wall* ; Thorax* ; Tomography, X-Ray Computed

OBJECTIVE: To assess the changes of ultrasonographic findings of median nerve according to wrist position change in normal and carpal tunnel syndrome hands. METHOD: We studied 31 carpal tunnel syndrome and 34 normal hands that were diagnosed by nerve conduction study and evaluated crossectional area, flattening ratio and distance to ulnar artery with diagnostic ultrasound. The parameters were tested according to the change of wrist position with neutral, extension and flexion in normal control and carpal tunnel syndrome. RESULTS: Crossectional area of carpal tunnel syndrome was larger than that of control. Flattening ratio of carpal tunnel syndrome was larger than that of control at extended position. Flattening ratio was greater in neutral and extended position than flexed position in carpal tunnel syndrome. Distance to ulnar artery were greater in flexed position than other positions in carpal tunnel syndrome. Frequency of least flattening ratio at flexion position in carpal tunnel syndrome was 64.52% and frequency of longest distance to ulnar artery at flexion position was 58.05%. CONCLUSION: Ultrasonography of median nerve showed no consistent findings according to change of wrist position between control and patients. Ultrasonographic diagnosis of carpal tunnel syndrome need further study for anatomical variations.
Carpal Tunnel Syndrome ; Diagnosis ; Hand ; Humans ; Median Nerve* ; Neural Conduction ; Ulnar Artery ; Ultrasonography ; Wrist*

The mesoblastic nephroma is a rare benign renal tumor that frequently appears as a neonatal abdominal mass. This benign tumor is composed primarily of connective tissue that growth between intact nephrons and often replaces most of the renal parenchyme. Contrast media within the calyceal systems are seen within the tumor representing function by nephrons trapped within the mass. Prognosis after complete excision is excellent.
Connective Tissue ; Contrast Media ; Nephroma, Mesoblastic* ; Nephrons ; Prognosis

The eosinophilia-myalgia syndrome associated with ingestion of L-tryptophan in man is defined by the CDC(1989) as follows: 1) eosinophil count more than 1,000 cells per microliter; 2) generalized myaligia(at some point during the course of illness) of severity sufficient to affect a patient's ability to pursue his or her usual daily activities; 3) no evidence of any infection(e.g., trichinosis) or neoplasm that would explain either the eosinophila or the myalgia. The pathologic findings of the eosinophilia-myalgia syndrome varies according to the degree of severity and types of inflammatory cells in the skeletal muscle. In order to simulate this syndrome in animals and further determine its histopathogenesis, L-tryptophan was administered to rats in the laboratory at various doses(25 mg/kg, 50 mg/kg, 150 mg/kg) over a set period of time. In this study, positive histopathologic findings were designated according to the inflammatory cell infiltration of the epimysium and epineurium. Most of the pathologic findings in the positive group were that of inflammatory cell infiltration composed mainly of eosinophils in the epimysial, epineurial connective and surrounding adipose tissues. Only a few necrotic muscle fibers were seen, and there was absence of any evidence of inflammatory cell inflitration in endoneurium or axonal degenerations. Of 59 rats which were given L-tryptophan, 27 rats(45.8%) met the criteria and were designated as belongintg to the positive group. Only 2 rats ingested with L-tryptophan(150 mg/kg) for 2 months and 4 months showed an eosinophil count more than 1,000 cells/microliter. The eosinophil count in the positive group showed significantly different levels when compared to the the negative group and control group. On the other hand, there were no significant differences in the electrodiagnostic study and serum CK, SGOT, SGPT level between the positive, negative and control groups. In summary, histopathologic findings similar to the eosinophilia-myalgia syndrome were inducible in rats followign the administration of L-tryptophan.
Male ; Humans ; Rats ; Animals

The etiologic factors causing low back pain are numerous and variable. Orthopaedic sugreons tend to focus attention to any defects of structural and functional origins such as pine, discs and facet joints. Clinically, however, the fact remains that not all abnormal findings produce back pain and vice vera. Among the many modalities of investigation to determine the etiology of back pain, plain X-ray of the lumbosacral spine is the single most important acreening method. In addition to antero-posterior, lateral and oblique views, stress view of the spine gives certain clue to predict the disc degeneration. The X-ray findings of a total of 503 patients with low back pain (the study group). admitted during the year of 1977 to the Department of Orthopaedic Surgery, National Medical Center, were reviewed and compared with the control group of 100 patients without relevance to back pain (the control group). Our intention was to explore the relationship between the abnormal findings of plain X-rays and occurence of back pain. and to further entrance the diagnostic value of the spine. The study group of 503 patients (86 cases of which were operated on) were diagnosed not only by routine plain X-rays but also by contrast myelography and tomography in addition to detailed physical examination. Following observations were made: 1. The sex was nearly equally distributed in the atudy group of 503 patients. The age ranged from the second to the eighth decade, dominant group being the third to fifth decades. 2. The causes of the low back pain were herniated disc, spondylosis, spondylolysis, and infection, in that order. 119 patients (23.7%) out of the 503 showed no roentgenologicaI abnormal findings. 3. 384 cases out of the 503 revealed abnormal findings, mainly congenital or developmental and degenerative changes in that order. 4. In a comparative study with the control group, congenital or developmental anomalies and degenerative changes were not related to low back pain. Disc. space narrowing, supposed to be valuable in establishing the diagnosis of low back pain was present in 26% of the cases in study group and in 11% in the control group. 5. The age incidence of the low back pain with congenital or developmental anomalies was mainly in th second and third decades, while that of disc space narrowing was in the third to fifth decade. The degenerative changes of the spine appeared after the fourth decade. 6. Transitional vertebra and tropism are supposed to plsy a role on the degenerative change of the spine. 7. The stress study of the spine had some benifit it the diagnosis of disc degeneration. The mobility of the L4-5 lesion with low back pain was increased to mean 15.1 and standard deviation 3.7, in comparison to the mean 12.3 and standard deviation 3.7 in the control group.
Back Pain ; Diagnosis ; Humans ; Incidence ; Intention ; Intervertebral Disc Degeneration ; Intervertebral Disc Displacement ; Low Back Pain ; Methods ; Myelography ; Physical Examination ; Spine ; Spondylolysis ; Spondylosis ; Tropism ; Zygapophyseal Joint

Under new mental health and welfare law, involuntary admission is allowed only for persons with mental illness based on the narrowed criteria of mental illness when they meet both need for treatment and danger to themselves and others. These stringent danger criteria along with narrowed definition of mental illness may prevent timely intervention for people with acute psychosis. It is claimed that the danger criteria is essential to keep up with international (UN, WHO) principles for legislation of mental health acts and laws of advanced countries. The international principles, however, do not necessarily call for stringent danger criteria for involuntary hospitalization. Danger criteria are not also prerequisites for involuntary hospitalization in many advanced countries. In countries with strict danger criteria, complementary measures seem to be taken for the drawback of danger criteria. As for the involuntary hospitalization by legal guardians, the complicated qualification for legal guardians may hinder prompt admission. The required number of legal guardians also needs to be changed from two to one person. Even in the situation where involuntary hospitalization is deemed urgent, there is no way to transport the patients to the hospital for assessment or temporary admission unless the police judges the patients to be dangerous to themselves or others. Outpatient treatment order can be an alternative to involuntary admission. However, it is rarely used since the order cannot be applied to those who do not have history of admission due to danger. For voluntary admission, status conversion to involuntary admission needs to be allowed in case of aggravation of symptoms to meet involuntary admission criteria. In addition, informal admission needs to be introduced to avoid unnecessary formal procedures for patients admitting voluntarily to open ward. In view of all these issues with new mental health and welfare law, entire revision of new mental health law is urgent to balance the rights to proper treatments and protection of human rights of persons with mental disorder.
Evaluation Studies as Topic* ; Hospitalization* ; Human Rights ; Humans ; Jurisprudence* ; Korea* ; Legal Guardians ; Mental Disorders ; Mental Health* ; Outpatients ; Patient Admission ; Police ; Psychotic Disorders